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BACKGROUND: Evidence suggests that prenatal air pollution exposure alters DNA methylation (DNAm), which could go on to affect long-term health. It remains unclear whether DNAm alterations present at birth persist through early life. Identifying persistent DNAm changes would provide greater insight into the molecular mechanisms contributing to the association of prenatal air pollution exposure with atopic diseases. OBJECTIVES: This study investigated DNAm differences associated with prenatal nitrogen dioxide (NO2) exposure (a surrogate measure of trafficrelated air pollution) at birth and 1 y of age and examined their role in atopic disease. We focused on regions showing persistent DNAm differences from birth to 1 y of age and regions uniquely associated with postnatal NO2 exposure. METHODS: Microarrays measured DNAm at birth and at 1 y of age for an atopy-enriched subset of Canadian Health Infant Longitudinal Development (CHILD) study participants. Individual and regional DNAm differences associated with prenatal NO2 (푛= 128) were identified, and their persistence at age 1 y were investigated using linear mixed effects models (푛= 124). Postnatal-specific DNAm differences (푛= 125) were isolated, and their association with NO2 in the first year of life was examined. Causal mediation investigated whether DNAm differences mediated associations between NO2 and age 1 y atopy or wheeze. Analyses were repeated using biological sex-stratified data. RESULTS: At birth (푛= 128), 18 regions of DNAm were associated with NO2, with several annotated to HOX genes. Some of these regions were specifically identified in males (푛= 73), but not females (푛= 55). The effect of prenatal NO2 across CpGs within altered regions persisted at 1 y of age. No significant mediation effects were identified. Sex-stratified analyses identified postnatal-specific DNAm alterations. DISCUSSION: Regional cord blood DNAm differences associated with prenatal NO2 persisted through at least the first year of life in CHILD participants. Some differences may represent sex-specific alterations, but replication in larger cohorts is needed. The early postnatal period remained a sensitive window to DNAm perturbations. [ABSTRACT FROM AUTHOR]

Background The Hospital Frailty Risk Score (HFRS) is scored using ICD-10 diagnostic codes in administrative hospital records. Home care clients in Canada are routinely assessed with Resident Assessment Instrument-Home Care (RAI-HC) which can calculate the Clinical Frailty Scale (CFS) and the Frailty Index (FI). Objective Measure the correlation between the HFRS, CFS and FI and compare prognostic utility for frailty-related outcomes. Design Retrospective cohort study. Setting Alberta, British Columbia and Ontario, Canada. Subjects Home care clients aged 65+ admitted to hospital within 180 days (median 65 days) of a RAI-HC assessment (n  = 167,316). Methods Correlation between the HFRS, CFS and FI was measured using the Spearman correlation coefficient. Prognostic utility of each measure was assessed by comparing measures of association, discrimination and calibration for mortality (30 days), prolonged hospital stay (10+ days), unplanned hospital readmission (30 days) and long-term care admission (1 year). Results The HFRS was weakly correlated with the FI (ρ 0.21) and CFS (ρ 0.28). Unlike the FI and CFS, the HFRS was unable to discriminate for 30-day mortality (area under the receiver operator characteristic curve (AUC) 0.506; confidence interval (CI) 0.502–0.511). It was the only measure that could discriminate for prolonged hospital stay (AUC 0.666; CI 0.661–0.673). The HFRS operated like the FI and CFI when predicting unplanned readmission (AUC 0.530 CI 0.526–0.536) and long-term care admission (AUC 0.600; CI 0.593–0.606). Conclusions The HFRS identifies a different subset of older adult home care clients as frail than the CFS and FI. It has prognostic utility for several frailty-related outcomes in this population, except short-term mortality. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the cues college students use to determine a sexual partner is refusing vaginal-penile sex (i.e., refusal interpretations). As a secondary aim, we explored the influence of item wording (not willing/non-consent vs refusal) on college students' self-reported refusal interpretations. A sample of 175 college students from Canada and the United States completed an open-ended online survey where they were randomly assigned to one of two wording conditions (not willing/non-consent vs refusal); students were then prompted to write about the cues they used to interpret their partner was refusing. An inductive coding procedure was used to analyze open-ended data. Themes included explicit and implicit verbal and nonverbal cues. The refusal condition elicited more explicit and implicit nonverbal cues than the not willing/non-consent condition. Frequency results suggested men reported interpreting more explicit and implicit verbal cues. Women reported interpreting more implicit nonverbal cues from their partner. Our findings reflect prior research and appear in line with traditional gender and sexual scripts. We recommend researchers consider using the word refusal when assessing the cues students interpret from their sexual partners as this wording choice may reflect college students' sexual experiences more accurately. [ABSTRACT FROM AUTHOR]

In this prospective study, we examined the association between three types of mental health symptom clusters (i.e., psychotic, internalizing, and externalizing) and the frequency and severity of violent-behavioral outcomes, and whether community disadvantage, residential instability, and criminogenic facility density moderated these associations. Study data were derived from 258 community-dwelling adults nested in 60 postal forward sortation areas (FSAs) in a large metropolitan area in Western Canada who were assessed twice over a 6-month period. In addition, census and administrative data were obtained on the same areas. Controlling for sociodemographic characteristics (i.e., age, gender, ethnicity, relationship status, and employment status), lifetime history of violent-behavioral outcomes, and community structural characteristics, internalizing and externalizing mental health symptoms were significantly positively associated with the frequency and severity of subsequent violence perpetration and with the severity of subsequent violent victimization. Several significant interactions were observed: internalizing symptoms increased the risk of frequent and severe violence perpetration in FSAs with high but not low disadvantage, and externalizing symptoms increased the risk of frequent violent victimization in FSAs with a high but not low criminogenic facility density. Only the interactive association of internalizing symptoms and community disadvantage with the severity of violence perpetration, however, remained significant after Bonferroni correction was applied. These findings provide tentative support that associations between mental health and violent-behavioral outcomes can vary with community context. The implication of these findings for assessing and managing violent-behavioral outcomes in the community is discussed. [ABSTRACT FROM AUTHOR]

Survival for hypoplastic left heart syndrome (HLHS) has improved dramatically. Little is known about early family function, quality of life (QOL), or well-being/adjustment for parents of infants with HLHS. Parent/family outcomes over time, predictors, and differences in 143 mothers and 72 fathers were examined. Parents reported better family function compared with published norms, but 26% experienced family dysfunction. QOL and well-being were significantly lower than adult norms. QOL scores generally declined over time, whereas self-reported well-being improved. Responses from mothers and fathers showed different trends, with mothers having worse scores on most measures and at most time points. Being a single parent was a risk factor for poorer family function, but not for lower individual QOL or well-being. Family characteristics, stress, and coping skills were predictive of outcomes. Parents' psychosocial responses to the challenges of life with infants with HLHS change over time. Individually tailored psychosocial support is needed. [ABSTRACT FROM AUTHOR]

This study outlines the development of attribution scales to assess the antecedent processes of proactive, reactive, and acquisitive offending. Empirical keying, internal consistency, and item performance were the three test development strategies. Six samples (total N = 1,527) from parole, university, probation, and prison were used. The Proactive scale (10 items) reflected coldness and distance between offender and victims, the Reactive scale (10 items) reflected recklessness and excuses for violent behavior, and the Acquisitive scale (15 items) reflected less negative views of crime and choices. Convergent and discriminant validities were demonstrated by the Proactive scale stronger correlations with planning items, the Reactive scale stronger correlations with affective and person-based items, and the Acquisitive scale stronger correlations with other-based motives. Linking Proactive, Reactive, and Acquisitive scales to an offense provides psychological meaning that can benefit assessment and interventions. [ABSTRACT FROM AUTHOR]

Background & Aims: Given that standardized language measures alone are inadequate for identifying functionally defined developmental language disorder (fDLD), this study investigated whether non‐linguistic cognitive abilities (procedural learning, motor functions, executive attention, processing speed) can increase the prediction accuracy of fDLD in children in linguistically diverse settings. Methods & Procedures: We examined non‐linguistic cognitive abilities in mono‐ and bilingual school‐aged children (ages 8–12) with and without fDLD. Typically developing (TD) children (14 monolinguals, 12 bilinguals) and children with fDLD (28 monolinguals, 12 bilinguals) completed tasks measuring motor functions, procedural learning, executive attention and processing speed. Children were assigned as fDLD based on parental or professional concerns regarding children's daily language functioning. If no concerns were present, children were assigned as TD. Standardized English scores, non‐verbal IQ scores and years of maternal education were also obtained. Likelihood ratios were used to examine how well each measure separated the fDLD versus TD groups. A binary logistic regression was used to test whether combined measures enhanced the prediction of identifying fDLD status. Outcomes & Results: A combination of linguistic and non‐linguistic measures provided the best distinction between fDLD and TD for both mono‐ and bilingual groups. For monolingual children, the combined measures include English language scores, functional motor abilities and processing speed, whereas for bilinguals, the combined measures include English language scores and procedural learning. Conclusions & Implications: A combination of non‐linguistic and linguistic measures significantly improved the distinction between fDLD and TD for both mono‐ and bilingual groups. This study supports the possibility of using non‐linguistic cognitive measures to identify fDLD in linguistically diverse settings. What this paper adds: What is already known on the subject: Given that standardized English language measures may fail to identify functional language disorder, we examined whether supplementing English language measures with non‐linguistic cognitive tasks could resolve the problem. Our study is based on the hypothesis that non‐linguistic cognitive abilities contribute to language processing and learning. This is further supported by previous findings that children with language disorder exhibit non‐linguistic cognitive deficits. What this paper adds to existing knowledge: The results indicated that a combination of linguistic and non‐linguistic cognitive abilities increased the prediction of functional language disorder in both mono‐ and bilingual children. What are the potential or actual clinical implications of this work?: This study supports the possibility of using non‐linguistic cognitive measures to identify the risk of language disorder in linguistically diverse settings. [ABSTRACT FROM AUTHOR]

Objectives: Complementary therapy (CT) use is prevalent among individuals living with cancer, who often consult family and friends (i.e., support persons) in making decisions about CT. This study examines the effect of an education seminar for adult cancer patients and support persons on the support persons' use, knowledge, and decision-making processes related to CT. Design: A patient education seminar that included support persons was developed and evaluated as part of a CT decision support research program. Survey data were collected before and after the education seminar to examine its impact on support persons' knowledge and use of CT, as well as their engagement in the CT decision-making process. Setting: The study was conducted in Western Canada. Subjects: 62 adult support persons. Interventions: Participants attended a 4-h CT education seminar at one in four provincial cancer centers. The seminar provided recommendations regarding how to make informed decisions about CT, where to find credible information, and key issues to consider to avoid potential risks of CT use. The evidence related to popular CT was also reviewed. Outcome Measures: The primary outcome was support persons' CT knowledge. Secondary outcomes included CT use, information-seeking behavior, decision self-efficacy, decision conflict, and distress. Results: A significant increase in support persons' CT knowledge was observed, as well as improved confidence in CT decision making. There was no significant difference in participants' CT use following the education seminar. Most indicated they would continue to locate information about CT using the Internet. A significant decrease in support persons' decisional conflict was reported; however, there were no significant change in distress related to CT decision making. Conclusions: This study demonstrates the importance of including support persons in patient education related to CT and the positive impact on their knowledge and treatment decision-making processes. No significant change in CT use, information seeking behavior and distress related to CT decisions, however, was observed in the study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To identify whether a Compassionate Mind Model‐based curriculum reduces students' perceived fears of compassion and improves their professional well‐being. Background: Enabling compassion is mandatory within nurse education but evidencing it is challenging. Research suggests that application of the Compassionate Mind Model might reduce students' fears of compassion and also decrease compassion fatigue. This study reports outcomes of a post‐registration curriculum based on that model for training Specialist Community Public Health Nurses (Health Visiting). Design: A quantitative, prospective evaluation of a 12‐month training course for Health Visiting students. Reporting was guided by the STROBE checklist for observational studies. Methods: Fears of compassion scales were applied at course start (time 1), mid‐point (time 2; +6 months) and end (time 3; +12 months) to evaluate fears of compassion of 26 post‐registration student Health Visitors (81% of course cohort) who provided data at all three points. The Professional Quality of Life tool was administered simultaneously to evaluate compassion satisfaction and burnout/secondary traumatic stress (compassion fatigue). Results: Between time 1 and time 3, mean fears of compassion scores decreased by 16.6‐48.5% (repeated measures analysis of variance); mid‐point scores were intermediary. At time 3, compassion satisfaction had increased slightly (+4.1%), negatively correlated with fears of compassion for self (r = −0.602; p =.001; n = 26) and fears of receiving compassion from others (r = −0.568; p =.002; n = 26). Burnout score decreased by 18.7%, correlated positively with fear of compassion for self (r = 0.493; p =.011; n = 26) and fear of receiving compassion from others (r = 0.615; p =.001; n = 26). Secondary traumatic stress score decreased by 16.5% but was not correlated with any fear of compassion. Conclusion: Findings suggest that application of the Compassionate Mind Model might reduce practitioners' fears of compassion linked to a decrease in risk of compassion fatigue. Relevance to clinical practice: The Compassionate Mind Model could provide an effective vehicle to promote compassion and nurse well‐being. [ABSTRACT FROM AUTHOR]

Objectives: Patients adapt to cancer through self‐management, which requires collaboration between patients and their healthcare providers. We aimed to describe patterns of patient–provider collaboration during radiotherapy and examine associations among patient–provider collaboration, self‐management and well‐being. Methods: An observational, cross‐sectional study was conducted at a cancer centre in the province of Ontario, Canada. Cancer patients (N = 130) completed a one‐time questionnaire during their radiotherapy. The questionnaire assessed three variables: collaboration with healthcare providers, self‐management and well‐being. Patterns of collaboration were analysed using descriptive statistics. Associations among study variables were assessed through structural equation modelling (SEM). Separate models were tested for patient–nurse and patient–oncologist collaboration. Results: Participants reported greater collaboration with oncologists than with nurses or radiation therapists. Most participants reported no collaboration with other providers within healthcare teams (e.g. social workers, dietitians). SEM revealed different patterns for the patient–nurse and patient–oncologist collaboration models, where collaboration predicted one self‐management aspect, and both physical and mental well‐being. Conclusion: During radiotherapy, patients collaborated mainly with doctors, nurses and radiation therapists. Collaborative relationships between patients and providers may enhance patient outcomes by fostering their self‐management skills. Initiatives to strengthen patient–provider relationships and support self‐management should be developed and applied to interprofessional‐cancer‐care teams. Impact: This is the first known study to empirically support the links among patient–provider collaboration, self‐management and patient outcomes. The study results can enhance practice, research and education. [ABSTRACT FROM AUTHOR]

Background: The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (MIDVAQ) is the Canadian–French adaptation of the Melbourne Low-Vision ADL Index. It measures performance, personal importance and handicap situation in 16 instrumental activities requiring near vision (standardized material, part A) and in 9 self-care and domestic activities (self-report questionnaire, part B). This study aimed at measuring the MIDVAQ reliability and its relationship with measures of visual functions and functional vision. Methods: The MIDVAQ was administered twice to 100 visually impaired participants, at home, with their personal visual and non-visual aid. A second rater was present at T1. Two different versions of part A were used alternately at T1 and T2. Results: The total Handicap scale demonstrates good internal reliability (Cronbach's alpha coefficient = 0.82) and very high inter-rater and test-retest reliability (ICCs = 1.00 and 0.86). Part A alternative versions are highly comparable. Vision function measures are significantly correlated with total Handicap score, for which 48% of the variance is explained by functional vision estimates, age, and education. Conclusions: The MIDVAQ is highly valid and reliable. It can be useful to measure the functional impact of the visual impairment, its progression, and the outcomes of low vision rehabilitation services. Even if administered at home in an ecological way, this measure of the impact of the visual impairment in daily activities is very reliable. Given its good metric properties, this tool can be confidently used to assess the functional impact of visual impairment, outcomes of the low vision rehabilitation services, etc. This measurement tool provides complementary information to those obtained from clinical measures of visual functions, by reflecting the interaction between the functional abilities with the requirements of the environment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article was to provide the reference data and evaluate psychometric properties for the percent grammatical utterances (PGU; Eisenberg & Guo, 2013) in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005). Method: Participants were 377 children who were between 4 and 9 years of age, including 300 children with typical language (TL) and 77 children with language impairment (LI). Narrative samples were collected using the ENNI protocol (i.e., a story generation task). PGU was computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for PGU were further evaluated. Results: PGU increased significantly in children between 4 and 9 years of age in both the TL and LI groups. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of PGU were all large (rs ≥ .557, ps < .001). The diagnostic accuracy of PGU was also good or acceptable from ages 4 to 9 years. Conclusions: With the attested psychometric properties, PGU computed from the ENNI could be used as an assessment tool for identifying children with LI between 4 and 9 years of age. The reference data of PGU could also be used for monitoring treatment progress. [ABSTRACT FROM AUTHOR]

Objectives: In this paper, we describe the degree of exercise and sedentary behavior among individuals with class III obesity, identify perceived benefits and barriers to exercise, and discuss the association of exercise barriers with activity and sedentary behavior. Methods: This was a cross-sectional study at a tertiary care center. Adults with class III obesity referred to the Bariatric Program completed the exercise benefits/barriers scale, the International Physical Activity Questionnaire Short-Form, and the Sedentary Behavior Questionnaire. Participants were asked to list additional exercise barriers. Results: The 80 participants engaged in a median of 699.0 MET-minutes/week of physical activity, and were sedentary 10.4 ± 4.5 hours/day. The mean exercise benefits/barriers score was 126.3 ± 12.8 (barrier score = 31.6 ± 5.3, benefit score = 87.8 ± 9.4). Less than 60% identified exercise as enjoyable, or a form of social interaction. More than 60% identified exercise barriers related to physical exertion. Additional barriers included pain and musculoskeletal comorbidities (39.4%), psychological factors (14.7%), and weight (12.6%). There was no statistically significant association between exercise barriers and sedentary behavior (p = .69) or physical activity (p = .08). Conclusions: Participants reported low physical activity, with high sedentary behavior and exercise barriers. Physical exertion, pain and musculoskeletal comorbidities were common barriers, which highlights importance of thoughtful exercise with attention to exercise barriers in this population. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how marginalised women perceive and rate equity‐oriented health care at a primary care clinic using items that evaluate patients' experiences of care. Background: Despite an increased recognition of the importance of health care that is equity‐oriented, and that understands the patient within the context of the broader social determinants of health, inequities in health remain prevalent around the world. Design: Items from the "EQUIP Primary Health Care" research programme were used to explore patients' experiences of equity‐oriented health care. Women were invited to complete the questionnaire with the explicit aim of gaining their input to improve quality of care at the clinic. The Strengthening the Reporting of Observational Studies in Epidemiology Statement was followed for the study. Methods: Sixty‐seven women who experienced significant health and social inequities, and were seeking care at a women's only nurse practitioner primary health care clinic in Canada, were invited to complete the questionnaire. For quality improvement purposes, correlational analyses were used to explore women's experiences of care. Results: Women's responses showed that Promote Emotional Safety and Trust and Overall Quality of Care were the most highly correlated domains, indicating the importance of the health care team in establishing trusting relationships, particularly for women who experience stigma and negative judgement when seeking care. Conclusion: Seeking feedback from patients on their experiences of care using items developed to explicitly tap into equity issues is useful in understanding how patients experience equity‐oriented health care. Responses from the women highlight the importance of understanding not only the what of equity‐oriented care but also the how. Relevance to clinical practice: The results of this study illustrate the importance of establishing trusting relationships, tailoring care, and using a nondiscriminatory approach when working with women who experience negative judgements when seeking care. [ABSTRACT FROM AUTHOR]

Background: A method that tracked tolerable noise level (TNL) over time while maintaining subjective speech intelligibility was reported previously. Although this method was reliable and efficacious as a research tool, its clinical efficacy and predictive ability of real-life hearing aid satisfaction were not measured. Purpose: The study evaluated an adaptive method to estimate TNL using slope and variance of tracked noise level as criteria in a clinical setting. The relationship between TNL and subjective hearing aid satisfaction in noisy environments was also investigated. Research Design: A single-blinded, repeated-measures design. Study Sample: Seventeen experienced hearing aid wearers with bilateral mild-to-moderately-severe sensorineural hearing loss. Data Collection and Analysis: Participants listened to 82-dB SPL continuous speech and tracked the background noise level that they could "put up with" while subjectively understanding .90% of the speech material. Two trials with each babble noise and continuous speech-shaped noise were measured in a single session. All four trials were completed aided using the participants' own hearing aids. The stimuli were presented in the sound field with speech from 0° and noise from the 180° azimuth. The instantaneous tolerable noise level was measured using a custom program and scored in two ways; the averaged TNL (aTNL) over the 2-min trial and the estimated TNL (eTNL) as soon as the listeners reached a stable noise estimate. Correlation between TNL and proportion of satisfied noisy environments was examined using the MarkeTrak questionnaire. Results: All listeners completed the tracking of noise tolerance procedure within 2 min with good reliability. Sixty-five percent of the listeners yielded a stable noise estimate after 59.9 sec of actual test time. The eTNL for all trials was 78.6 dB SPL (standard deviation [SD] = 4.4 dB). The aTNL for all trials was 78.0 dB SPL (SD = 3.3 dB) after 120 sec. The aTNL was 79.2 dB SPL (SD = 5.4 dB) for babble noise and 77.0 dB SPL (SD = 5.9 dB) for speech-shaped noise. High within-session test-retest reliability was evident. The 95% confidence interval was 1.5 dB for babble noise and 2.8 dB for continuous speech-shaped noise. No significant correlation was measured between overall hearing aid satisfaction and the aTNL (r = 0.20 for both noises); however, a significant relationship between aTNL and proportion of satisfied noisy situations was evident (ρ = 0.48 for babble noise and ρ = 0.55 for speech-shaped noise). Conclusion: The eTNL scoring method yielded similar results as the aTNL method although requiring only half the time for 65% of the listeners. This time efficiency, along with its reliability and the potential relationship between TNL and hearing aid satisfaction in noisy listening situations suggests that this procedure may be a good clinical tool to evaluate whether specific features on a hearing aid would improve noise tolerance and predict wearer satisfaction with the selected hearing aid in real-life loud noisy situations. A larger sample of hearing aid wearers is needed to further validate these potential uses. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease disproportionately affects North American Indigenous populations. Ethnic differences in cardiac responses to exercise are known, though Indigenous populations response is unknown. To evaluate cardiac responses to aerobic exercise among Canadian Indigenous and European adults. Methods: Indigenous (N = 12, 4 females, 1 male incomplete) and European (N = 12, all completed) Canadian age and sex-matched adults 19-40 years and free of cardiovascular disease or diabetes completed a cycle ergometer maximal aerobic power test and 30 min at 60% maximal aerobic capacity on two separate days. Echocardiographic assessments preceded and immediately followed exercise. Results: Responses to maximal exercise were similar among ethnicities including decreases in stroke volume index, cardiac output index and ejection fraction, and increases in arterial-ventricular coupling. However, following submaximal exercise, only Indigenous adults demonstrated reductions in end systolic volume, end diastolic volume (154.8 ± 40.6 mL to 136.5 ± 33.0 mL, p = 0.01, vs. 149.4 ± 22.4 mL to 147.1 ± 27.0 mL; p = 0.81), stroke volume index (44.9 ± 8.7 mL m−2 to 38.0 ± 6.5 mL m−2, p = 0.002, vs. 46.4 ± 7.1 mL m−2 to 44.0 ± 6.5 mL m−2; p = 0.28) and arterial compliance. Conclusion: Indigenous and European adults demonstrated similar cardiac responses to maximal exercise, though only Indigenous adults demonstrated cardiac responses to submaximal exercise. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals involved in pain management come from different disciplines, which may have different perspectives and training about evidence-based practice (EBP). A common concern for health professionals is pain management. Understanding how different professions involved in pain management view EBP forms the ideal context to study professional differences in EPP, and how this might influence pain management. Purpose: The purpose of this study was to compare different professions with respect to knowledge, attitudes and self-reported behavior toward EBP. Study design: Cross-sectional study. Methods: Physicians, nurses, occupational therapists, physical therapists and psychologists who were involved in pain management (n=675) completed an online survey on a single occasion. The survey included demographic questions and the EBP-knowledge, attitude, behavior questionnaire (EBP-KABQ). This is a 27-item questionnaire that has been validated for use with different health professionals, and measures four constructs related to EBP (knowledge, attitude, behavior and outcome/decision). Differences between professionals were identified using a one-way between groups analysis of variance, with post-hoc testing (statistical significance was set at P value less than 0.05; clinical significance set at a mean difference of 10%). Results: The score on three of the four subscales of the KABQ were statistically different across professions. In general, knowledge scores were high for all professions (83-87%). Nurses demonstrated statistically higher levels of EBP knowledge (87%) when compared with other groups (F=4.79, P=0.001), but the differences were not deemed clinically relevant. Behavior was the lowest subscale and the most variable across professions (37-56%). Physicians had statistically significant (F=25.69; P=0.001), and clinically relevant, higher behavior subscale scores (56%) when compared with other professional groups. Physicians (73%) also had higher outcome/decision subscale scores (F=6.50; P=0.001), but this was only marginally different from other professions (65-73%). The attitude subscale scores were low and were not different across professions (range 57-59%; F=1.65, P=0.16; NS). Conclusion: The current study indicates that physicians and allied health professionals have similar EBP attitudes and knowledge. All professional groups seem to have suboptimal implementation of EBP. The nature of medical decision-making, its evidentiary pool, or longer experience with EBP may contribute to greater implementation amongst physicians. [ABSTRACT FROM AUTHOR]

Vitamin B6 is important in fetal development, but little is known of the vitamin B6 status of pregnant women and newborns in North America and potential modifying factors. This prospective study determined maternal and cord plasma concentrations of pyridoxal 5′ phosphate (PLP; an indicator of vitamin B6 status) in a convenience sample of 368 Canadian pregnant women and their newborns. The association of maternal intake of vitamin B6 and fetal genetic variants with cord plasma PLP and homocysteine concentrations was also examined. Dietary and supplemental intakes of vitamin B6 were assessed in early and mid to late pregnancy. PLP concentrations were measured in maternal plasma in early pregnancy and at delivery, and in cord plasma. Six fetal variants of the MTHFR and CβS genes were assessed for their association with cord plasma PLP and homocysteine concentrations. Geometric mean (95% CI) PLP concentrations were 107 (98, 116) nmol/L in early pregnancy and 58 (53, 62) nmol/L at delivery, respectively, and 296 (275, 319) nmol/L in cord blood ( p < .0001). During early pregnancy and at delivery, 3.6% and 5.5% of women had plasma PLP concentrations <20 nmol/L, respectively. Ninety eight percent of the women with supplemental B6 intake of at least the recommended dietary allowance had PLP concentrations >20 nmol/L. Fetal genetic variants were not associated with cord PLP and homocysteine concentrations. Vitamin B6 deficiency is uncommon in a cohort of Canadian pregnant women due largely to prevalent vitamin B6 supplement use. [ABSTRACT FROM AUTHOR]

Aims To determine if there are brain activity differences between paediatric intensive care nurses and allied health professionals during pain intensity rating tasks and test whether these differences are related to the population observed (infant or adult) and professional experience. Background The underestimation of patients' pain by healthcare professionals has generally been associated with patterns of change in neural response to vicarious pain, notably reduced activation in regions associated with affective sharing and increased activation in regions associated with regulation, compared with controls. Paediatric nurses, however, have recently been found to provide higher estimates of infants' pain in comparison to allied health controls, suggesting that changes in neural response of this population might be different than other health professionals. Design Cross-sectional study. Methods Functional MRI data were acquired from September 2014-June 2015 and used to compare changes in brain activity in 27 female paediatric care nurses and 24 allied health professionals while rating the pain of infants and adults in a series of video clips. Results Paediatric nurses rated infant and adult pain higher than allied health professionals, but the two groups' neural response only differed during observation of infant pain; paediatric nurses mainly showed significantly less activation in the medial prefrontal cortex (linked to cognitive empathy) and in the left anterior insula and inferior frontal cortex (linked to affective sharing). Conclusions Patterns of neural activity to vicarious pain may vary across healthcare professions and patient populations and the amount of professional experience might explain part of these differences. [ABSTRACT FROM AUTHOR]

This study explored the impact of advertisements featuring individuals either with or without a physical disability on attitudes towards sexuality and disability. In addition, the authors sought to determine whether there is a relationship between these attitudes and endorsement of traditional versus egalitarian gender role beliefs. A total of 707 online participants completed the Gender Role Belief Scale, then rated a series of ads featuring individuals with or without a disability (or served as a no ad control), and completed the Attitudes toward Sexuality Questionnaire and Perceptions of Sexuality Scale. Results demonstrated a complex relationship between gender role beliefs and exposure to advertisements on attitudes towards the sexuality of women and men with physical disabilities. As hypothesized, the endorsement of traditional gender role beliefs was related to more negative attitudes towards the sexuality of women with physical disabilities. [ABSTRACT FROM AUTHOR]

People use the Internet for a wide range of online sexual activities (OSA): behaviours that involve sexual content, topics, and stimuli. Yet, current OSA summary statistics provide little perspective on patterns of OSA experience because researchers have not compared multiple indicators of experience within the same sample. We explored the prevalence, variety, and frequency of young men and women's experience with three OSA subtypes: non-arousal (e.g., accessing sexual health information), solitary-arousal (e.g., viewing pornography), and partnered-arousal (e.g., sending sexually explicit messages). We examined patterns in experience with specific OSAs, subtypes of OSAs, OSAs overall, and differences related to gender across the lifetime and recently. Young adults (N = 239) at a Canadian University completed a survey that included a new measure of 48 specific OSAs, representing the three subtypes. All participants reported at least one OSA experience in their lifetime (ranging 1-38). Although the prevalence and variety of experience was greater across the lifetime than recently, this difference was small and the pattern of results remained the same. Frequency of experience appeared greater for specific OSAs compared to OSA subtypes or overall. Frequency of specific OSAs were greater for the subgroup of participants who had engaged in the activity recently compared to the full sample. Significantly more men than women reported solitary-arousal OSA, and men reported greater variety and frequency of this subtype. This gender difference in prevalence and frequency only held for viewing sexually explicit pictures and videos online. We discuss implications for sexual scripts, researchers, clinicians, and educators. [ABSTRACT FROM AUTHOR]

University students who report a history of reading difficulties have been demonstrated to have poorer word reading and reading comprehension skills than their peers; yet, without a diagnosed learning disability, these students do not have access to the same support services, potentially placing them at academic risk. This study provides a comprehensive investigation of first-year academic achievement for students with a history of reading difficulties (n = 244) compared to students with no such history (n = 603). We also examine reported use of metacognitive reading and study strategies and their relations with GPA. Results indicate that students with a history of reading difficulties earn lower GPA and successfully complete fewer credits compared to students with no history of reading difficulty. These patterns varied somewhat by faculty of study. Students with a history of reading difficulties also reported lower scores across multiple metacognitive reading and study strategy scales, yet these scores were not associated with their academic performance. Together, these results demonstrate the importance of identifying students with a history of reading difficulties and that commonly used study strategy inventories have limited value in predicting their academic success. [ABSTRACT FROM AUTHOR]

Purpose:To test a model of child, family and service determinants of participation in family and recreational activities for young children with cerebral palsy (CP). Methods:Participants were a convenience sample of 429 children (242 males) with CP, aged 18 to 60 months, representing all levels of the Gross Motor Function Classification System (GMFCS). Children were divided into two groups by GMFCS levels, levels I to II and levels III to V. Data on impairments and gross motor function were collected by therapists; parents provided information about children’s health conditions and adaptive behaviour. Seven months later, parents reported on family life and services received. One year after the beginning of the study, parents reported their children’s participation. Data from the two groups of children were analysed separately using structural equation modelling. Results:The model explained 35% and 40% of the variance of frequency of participation in family and recreation and 28% and 38% of enjoyment in participation, for the two groups of children, respectively. Children’s adaptive behaviour, family ecology, and number of community recreational programs were associated with the frequency of participation for both groups. Gross motor function was only associated with the frequency of participation for children in levels III–V. Adaptive behaviour was associated with enjoyment for both groups. The extent services met children’s needs was associated with enjoyment for children in levels I to II and family ecology was a determinant of enjoyment for children in levels III to V. Conclusion:Supporting children’s adaptive behaviour, family ecology, and access to community recreational programmes may foster participation in family and recreational activities for young children with CP.Implications for RehabilitationParticipation in family and recreational activities for young children with CP is complex and influenced by child, family and environmental factors.Practitioners are encouraged to support children’s adaptive behaviour and access to community programs and family relationships, involvement in community activities and expectations of their children.Optimizing gross motor function for children who have limitations in self-mobility may enhance their participation in family and recreational activities.For children with a good prognosis for walking, providing services perceived by parents to meet their children’s needs may enhance children’s enjoyment of participation. [ABSTRACT FROM PUBLISHER]

This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS ( r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8-17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4-6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0-7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3-19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented. [ABSTRACT FROM AUTHOR]

Background Current guidelines disagree on the role for applying force to electrodes during electrical cardioversion (ECV) for atrial fibrillation, particularly when using self-adhesive pads. We evaluated the impact of this practice on transthoracic impedance (TTI) with varying force and in individuals with differing body mass indices (BMI). We additionally assessed whether specific prompts could improve physicians' ECV technique. Methods The study comprised three parts: (1) TTI was measured in 11 participants throughout the respiratory cycle and with variable force applied to self-adhesive electrodes in anteroposterior (AP) and anterolateral (AL) configurations. (2) Three participants in different BMI classes then had TTI measured with prespecified incremental force applied. (3) Ten blinded cardiology trainees simulated ECV on one participant with and without prompting (guideline reminders and force analogies) while force applied and TTI were measured. Results The AP approach was associated with 13% lower TTI than AL (P < 0.001). Strongly negative correlations were observed between force applied and TTI in the AL position, irrespective of BMI (P ≤ 0.003). In all cases, 80% of the total reduction in TTI observed was achieved with 8 kg-force (∼80 N). All prompts resulted in significantly greater force applied and modest reductions in TTI. Conclusions Applying force to self-adhesive electrodes reduces TTI and should be considered as a means of improving ECV success. Numerically greater mean force applied with a 'push-up' force analogy suggests that 'concrete' cues may be useful in improving ECV technique. [ABSTRACT FROM AUTHOR]

The article discusses a study which aimed to determine the role of religious involvement and related indicators such as religious coping, intrinsic religiosity and forgiveness in reducing the negative impact of early traumatic stress on the mental and physical health of adult survivors.

Objective: Most health professions recognize the value of evidence-based practice (EBP), yet the uptake of EBP across most health disciplines has been suboptimal. To improve EBP uptake, it is important to first understand the many dimensions that affect EBP use. The Evidence-Based practice Attitude and utilization SurvEy (EBASE) was designed to measure the attitudes, skills, and use of EBP among practitioners of complementary and alternative medicine (CAM); however, the dimensionality of the instrument is not well understood. The aim of the current research was to examine the psychometric properties of the attitudes, skills, and use subscales of EBASE. Design: This was a secondary analysis of data obtained from the administration of EBASE. Data were examined using principal components analyses and confirmatory methods. Internal consistency reliabilities of resultant subscales were also computed. Participants: 1314 U.S. chiropractors and 554 Canadian chiropractors. Results: A unidimensional structure best fit the attitudes and use subscales. Skills subscale items were best represented by subscales with a multidimensional structure. Specifically, the skills construct was best modeled with three dimensions (identification of the research question, locating research, and application of EBP). All subscales had acceptable internal consistency reliability estimates. Conclusions: The findings support the modification of the scoring guidelines for the original EBASE. These changes are likely to result in a more accurate measure of EBP attitudes, skills, and use among chiropractors, and possibly CAM providers more generally. [ABSTRACT FROM AUTHOR]

Background: Childhood acquired brain injuries can disrupt communication functions needed for success in school, work and social interaction. Cognitive-communication difficulties may not be apparent until adolescence, when academic, environmental and social-emotional demands increase. Objective: The Functional Assessment of Verbal Reasoning and Executive Strategies for Students (S-FAVRES) is a new activity-level measure of cognitive-communication skills in complex, contextual and integrative tasks that simulate real world communication challenges. It is hypothesized that S-FAVRES performance would differentiate adolescents with and without acquired brain injury (ABI) on scores for Accuracy, Rationale, Reasoning Subskills and Time. Methods: S-FAVRES was administered to 182 typically-developing (TD) and 57 adolescents with mild-to-severe ABI aged 12–19. Group differences, internal consistency, sensitivity, specificity, reliability and contributing factors to performance (age, gender, brain injury) were examined statistically. Results: Those with ABI attained statistically lower Accuracy, Rationale and Reasoning sub-skills scores than their TD peers. Time scores were not significantly different. Performance trends were consistent across tasks, administrations, gender and age groups. Inter-rater reliability for scoring was acceptable. Conclusion: The S-FAVRES provides a reliable, functional and quantifiable measure of subtle cognitive-communication difficulties in adolescents that can assist speech-language pathologists in planning treatment and integration to school and real world communication. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in designing cities that support not only walking, but also cycling. Bike Score® is a metric capturing environmental characteristics associated with cycling that is now available for over 160 US and Canadian cities. Our aim was to determine if Bike Score was associated with between and within-city variability in cycling behavior. Methods: We used linear regression to model associations between Bike Score and journey to work cycling mode share (US: American Community Survey, 2013 or 2012 5-year estimates; Canada: 2011 National Household Survey) for 5664 census tracts in 24 US and Canadian cities. Results: At the city level, the correlation between mean Bike Score and mean journey to work cycling mode share was moderate (r = 0.52). At the census tract level, the correlation was 0.35; a ten-unit increase in Bike Score was associated with a 0.5 % (95 % CI: 0.5 to 0.6) increase in the proportion of population cycling to work, a meaningful difference given the low modal shares (mean = 1.9 %) in many North American cities. Census tracts with the highest Bike Scores (>90 to 100) had mode shares 4.0 % higher (β =4.0, 95 % CI: 2.9 to 5.0) than the lowest Bike Score areas (0-25). City specific analyses indicated between-city variability in associations, with regression estimates between Bike Score and mode share ranging from 0.2 to 3.5 %. Conclusions: The Bike Score metric was associated bicycle mode share between and within cities, suggesting its utility for planning bicycle infrastructure. [ABSTRACT FROM AUTHOR]

Background. The attainment of walking is a focus of physical therapy intervention in children with cerebral palsy (CP) and may affect their independence in mobility and participation in daily activities. However, knowledge of determinants of independent walking to guide physical therapists' decision making is lacking. Objective. The aim of this study was to identify child factors (postural control, reciprocal lower limb movement, functional strength, and motivation) and family factors (family support to child and support to family) that predict independent walking 1 year later in young children with CP at Gross Motor Function Classification System (GMFCS) levels II and III. Design. A secondary data analysis of an observational cohort study was performed. Methods. Participants were 80 children with CP, 2 through 6 years of age. Child factors were measured 1 year prior to the walking outcome. Parent-reported items representing family factors were collected 7 months after study onset. The predictive model was analyzed using backward stepwise logistic regression. Results. A measure of functional strength and dynamic postural control in a sit-to-stand activity was the only significant predictor of taking ≥3 steps independently. The positive likelihood ratio for predicting a "walker " was 3.26, and the negative likelihood ratio was 0.74. The model correctly identified a walker or "nonwalker " 75% of the time. Limitations. Prediction of walking ability was limited by the lack of specificity of child and family characteristics not prospectively selected and measurement of postural control, reciprocal lower limb movement, and functional strength 1 year prior to the walking outcome. Conclusions. The ability to transfer from sitting to standing and from standing to sitting predicted independent walking in young children with CP. Prospective longitudinal studies are recommended to determine indicators of readiness for independent walking. [ABSTRACT FROM AUTHOR]

There are some children who encounter unexpected reading difficulties in the fourth grade. This phenomenon has been described as late emerging reading disabilities (LERD). Using Grade 4 as a starting point, this study examined the reading development of 964 children between kindergarten and Grade 7. The results showed that 72.0% of children had typical reading performance in Grade 4, whereas there was 0.7% with poor word reading, 12.6% with poor reading comprehension, 2.5% with poor word reading and comprehension, and 12.2% with borderline performance. We also showed that there were similar proportions of children who had early versus late emerging reading difficulties; however, most of the late emerging poor readers recovered by Grade 7. Furthermore, our study showed that poor comprehenders showed poorer performance than typical readers on word reading, pseudoword decoding, and spelling between Grade 1 and Grade 7 and poorer performance on a working memory task in kindergarten. Overall, this study showed that most children recover from late emerging reading problems and that working memory may be an early indicator for reading comprehension difficulties. [ABSTRACT FROM AUTHOR]

Purpose: Visual vertigo (VV) is a type of dizziness triggered by visual stimuli. Despite a high incidence, its relationship with anxiety is not well-defined or understood. This study evaluated anxiety levels in subjects with VV compared to vestibulopathic subjects without VV and healthy individuals.Methods: A cross-sectional study to evaluate anxiety among individuals with VV was conducted twice. The first study included 72 participants (66 to 83 years of age) from senior residential centers. The second included 31 participants from a vestibular rehabilitation program (age range 35–82 years). Study 1 also used the Activities-Specific Balance Confidence (ABC) scale and study 2 the Dizziness Handicap Inventory (DHI).Results: Subjects were classified as VV positive (27 in study 1, 10 in study 2) or vestibulopathic without VV (30 in study 1, 11 in study 2) based on Head Impulse or Dynamic Visual Acuity Tests and the Dizziness Questionnaire. The remaining were age-matched healthy controls. The outcome of each study demonstrated significantly higher anxiety levels (p = 0.0001) in the VV group compared to the other groups. The results of the ABC test demonstrated that subjects in the VV group had significantly lower self-confidence (p = 0.001) than those in the Vest and Cont groups and performed fewer balance-related activities of daily life. DHI results showed that VV group expressed higher (p < 0.001) mean scores for self-perceived feelings of dizziness and imbalance (54%), compared to the Vest (9%) and Cont groups (1%).Conclusions: Anxiety related to VV requires special attention when assessing and managing vestibulopathy, regardless of patient age.Implications for RehabilitationAnxiety is a characteristic of subjects with visual vertigo (VV) and vestibulopathy.Anxiety in subjects with VV is not related to age.VV should be considered when subjects with anxiety complain of imbalance.Anxiety and vestibulopathy are often interrelated and should be considered in diagnostic evaluations. [ABSTRACT FROM PUBLISHER]

Study design: A cross-sectional survey. Objective: The purpose of this study was to identify characteristics of Canadian doctors of chiropractic (DCs) associated with their number of workers' compensation patients. Summary of background data: It has been previously hypothesized that DCs that treat a relatively high volume of workers' compensation cases may have different characteristics than the general chiropractic community. Methods: Secondary data analyses were performed on data collected in the 2011 survey of the Canadian Chiropractic Resources Databank (CCRD). The CCRD survey included 81 questions concerning the practice and concerns of DCs. Of the 6,533 mailed questionnaires, 2,529 (38.7%) were returned. Of these, 652 respondents did not meet our inclusion criteria, and our final study sample included 1,877 respondents. Bivariate analyses were conducted between predetermined independent variables and the annual number of workers' compensation patients. A negative binomial multivariate regression was performed to identify significant factors associated with the number of workers' compensation patients. Results: On average, DCs received 10.3 (standard deviation (SD) = 17.6) workers' compensation cases and nearly one-third did not receive any such cases. The type of clinic (other than sole provider), practice area population (smaller than 500,000), practice province (other than Quebec), number of practice hours per week, number of treatments per week, main sector of activity (occupational/ industrial), care provided to patients (electrotherapy, soft-tissue therapy), percentage of patients with neuromusculoskeletal conditions, and percentage of patients referred by their employer or a physician were associated with a higher annual number of workers' compensation cases. Conclusion: Canadian DCs who reported a higher volume of workers' compensation patients had practices oriented towards the treatment of injured workers, collaborated with other health care providers, and facilitated workers' access to care. [ABSTRACT FROM AUTHOR]

Background Every year, injuries cost the Canadian healthcare system billions of dollars and result in thousands of emergency room visits, hospitalisations and deaths. The purpose of this study was to explore the relationship between neighbourhood socioeconomic status (NSES) and the rates of all-cause, unintentional and intentional severe injury in Greater Vancouver adults. A second objective was to determine whether the identified associations were spatially consistent or non-stationary. Methods Severe injury cases occurring between 2001 and 2006 were identified using the British Columbia's Coroner's Service records and the British Columbia Trauma Registry, and mapped by census dissemination areas using a geographical information system. Descriptive statistics and exploratory spatial data analysis methods were used to gain a better understanding of the data sets and to explore the relationship between the rates of severe injury and two measures of NSES (social and material deprivation). Ordinary least squares and geographically weighted regression were used to model these relationships at the global and local levels. Results Inverse relationships were identified between both measures of NSES and the rates of severe injury with the strongest associations located in Greater Vancouver's most socioeconomically deprived neighbourhoods. Social deprivation was found to have a slightly stronger relationship with the rates of severe injury than material deprivation. Conclusions Results of this study suggest that policies and programmes aimed at reducing the burden of severe injury in Greater Vancouver should take into account social and material deprivation, and should target the most socioeconomically deprived neighbourhoods in Greater Vancouver. [ABSTRACT FROM AUTHOR]

Aim To develop a generic self-management skills scale for use with adolescents diagnosed with a chronic health condition who are aged 12 to 18 years. Background There is a lack of methodologically sound scales for healthcare teams to use to measure self-management skills in adolescents with chronic conditions transitioning to adult care. Methods Adolescents aged 12 to 18 years with a broad range of chronic health conditions, including neurodevelopmental conditions, were recruited from May to August 2013 from nine outpatient clinics at Mc Master Children's Hospital ( Canada). Thirty-two participated in a cognitive interview, and 337 completed a questionnaire booklet. Interviews were used to develop the TRANSITION- Q. Rasch measurement theory ( RMT) analysis was used to identify items that represent the best indicators of self-management skills. Traditional psychometric tests of measurement performance were also conducted. Results The response rate was 92% (32/32 cognitive; 337/371 field test). RMT analysis resulted in a 14-item scale with three response options. The overall fit of the observed data to that expected by the Rasch model was non-significant, providing support that this new scale measured a unidimensional construct. Other tests supported the scale as scientifically sound, e.g. Person Separation Index = 0.82; good item fit statistics; no differential item function by age or gender; low residual correlations between items; Cronbach's alpha = 0.85; test-retest reliability = 0.90; and tests of construct validity that showed, as hypothesized, fewer skills in younger participants and in participants who required assistance to complete the scale. Finally, participants who agreed they are ready to transfer to adult healthcare reported higher TRANSITION- Q scores than did participants who disagreed. Conclusions The TRANSITION- Q is a short, clinically meaningful and psychometrically sound scale. This generic scale can be used in research and in paediatric and adolescent clinics to help evaluate readiness for transition. [ABSTRACT FROM AUTHOR]

Factors influencing the development of evidence-based nursing practice (EBNP) were examined in Prince Edward Island, Canada. An adapted electronic questionnaire was distributed to practicing registered nurses and nurse practitioners (n=68). An analysis of variance revealed a significant difference between nurses' clinical practice setting and the EBNP scale. Significant differences were also found between age and education level when compared with the EBNP subscales where novice nurses were less likely to rely on experience and intuition, and expert nurses with a higher level of education reported being more skilful at synthesising and applying information from research findings into their nursing practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: The function of specific abdominal muscles can be assessed using both electromyography (EMG) and ultrasound imaging (USI) thickness measures. However, the relationship between these two measurements is not conclusive during sitting isometric trunk efforts. OBJECTIVE: This study was conducted to assess the relationship between USI thickness and EMG amplitude measures of the right external oblique (EO) muscle during isometric efforts in the sitting position. METHOD: Eighteen subjects performed ramp isometric efforts progressing from 0 to 50% of their maximal voluntary contraction (MVC) in three trunk directions on a dynamometer: (1) forward flexion; (2) right lateral flexion; and (3) left axial rotation. USI and surface EMG amplitude measures of the EO muscle were recorded concomitantly and both normalized against rest values and maximal EMG, respectively. RESULTS: EO muscle was significantly more activated (p < 0.001) during forward flexion (42% on average) and axial rotation (35%) than during lateral flexion (24%). Non-significant (r=0.01; P=0.979) to highly significant (r=0.98; P < 0.0001) and negative and positive Pearson correlations were observed between EMG and EO thickness measures for both flexion and rotation directions. CONCLUSION: The negative correlations between EMG and USI measures as well as the great variability of these correlations across individuals suggest that USI is not a valid measures of EO muscle activity. USI thickness measures should be interpreted with great caution in research and clinical settings. [ABSTRACT FROM AUTHOR]

The Canadian Forces Firefighter Physical Fitness Maintenance Evaluation (FF PFME) requires firefighters in full fire-protective ensemble, including self-contained breathing apparatus, to correctly complete 10 work-related tasks on a measured and calibrated course. Fitness for duty is inferred from completion time of the course. We hypothesized that completion time may be dependent on pacing strategy and day-to-day fluctuations in biological function. To examine variability in performance, 20 females and 31 males (mean ± SD; age, 27.6 ± 10.5 years; height, 176.7 ± 8.3 cm; mass, 77.3 ± 13.4 kg) were familiarized with the FF PFME and then completed the test on 6 separate days. Pre-test behaviours (e.g., sleep, diet) and test conditions (e.g., calibration, time of day) were consistent. Repeated-measures ANOVA revealed a significant decrease in completion time between tests 1 and 6 (18.7%) and between all sequential pairs (e.g., tests 1 and 2). There was also a small but significant increase in the fraction of total test time for task completion and a corresponding decrease in the time to transition between tasks. The performance improvements cannot be explained by differences in effort (heart rate and perceived exertion). Coefficient of variation for tests 1, 2, and 3 was 7% and for tests 4, 5, and 6 was 2.6%. The results indicate the importance of practice on performance and the potential for false-positive or false-negative decision errors if biological variability is not taken into account. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. DESIGN: A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. STUDY SAMPLE: Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. METHODOLOGY: Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. RESULTS: Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. CONCLUSIONS: This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions. [ABSTRACT FROM AUTHOR]

Primary health care (PHC) can improve the health of women who have experienced intimate partner violence; yet, access to and fit of PHC services may be shaped by income and racialization. We examined whether income and racialization were associated with differences in PHC service use, unmet needs, fit with needs, and mental and physical health in a sample of 286 women who had separated from an abusive partner. Mothers, unemployed women, and those with lower incomes used more PHC services and reported a poorer fit of services. Poorer fit of services was related to poorer mental and physical health. [ABSTRACT FROM PUBLISHER]

Indigenous populations currently experience greater rates of cardiovascular disease. Although ethnic differences in cardiovascular responses to exercise have previously been identified, these responses among indigenous populations are unknown. Purpose: This investigation aimed to evaluate the vascular responses to aerobic exercise of Canadian indigenous and European adults. Methods: Twelve age- and sex-matched indigenous and European adults completed a cycle ergometer maximal aerobic power test and submaximal 30 min of 60% maximal aerobic capacity on two separate days. Blood pressure, pulse wave velocity, baroreceptor sensitivity, arterial compliance, vascular resistance, and intima-media thickness were directly measured before and after aerobic exercises. Results: Vascular responses to exercise were generally similar between indigenous and European adults including decreases in baroreceptor sensitivity and vascular resistance after maximal exercise. No changes in intima-media thickness, pulse wave velocity, and arterial compliance were observed after exercise in either group. However, after submaximal exercise, only European adults demonstrated reductions in baroreceptor sensitivity (spectral: 9.2 ± 4.3 to 11.5 ± 6.7 ms·mm Hg-1, P = 0.41, vs 15.8 ± 8.3 m·s-1 to 8.9 ±5.7 ms·mm Hg -1, P = 0.02; sequence: 14.6 ± 5.4 to 16.5 ± 11.0 ms·mm Hg-1, P = 0.48, vs 26.2 ± 10.5 m·s-1 to 15.4 ± 9.4 ms·mm Hg-1, P = 0.02). Similarly, decreases in blood pressure after exercise were observed only among European adults. Conclusions: Indigenous adults demonstrated vascular responses similar to those demonstrated by European adults, although blood pressure was only observed to decrease among European adults after maximal and submaximal exercise, and baroreceptor sensitivity, after submaximal exercise. [ABSTRACT FROM AUTHOR]

Objective: To survey hearing healthcare practitioners' (1) attitudes toward teleaudiology appointments, (2) willingness to conduct different clinical tasks via teleaudiology, and (3) willingness to conduct a teleaudiology appointment with different patient populations. Design: All participants were asked to complete the Attitudes toward Teleaudiology Scale for Practitioners (ATS-P), a 46-item online survey designed for this study. Study sample: The responses from 202 hearing healthcare practitioners working in Canada were collected. The sample consisted of 152 audiologists, 49 hearing instrument specialists, and one who did not specify a category. Results: The majority of respondents indicated that teleaudiology is likely to have a minimal effect on the quality of hearing healthcare in audiology and the quality of client-practitioner interactions, although many respondents indicated that teleaudiology would have a positive effect on accessibility to service. Nevertheless, a small minority of respondents indicated that teleaudiology would have a negative impact on quality of care in audiology. Conclusions: Willingness to use teleaudiology depended on a combination of the clinical tasks to be performed and the patient populations to be served. These findings can help guide the successful implementation of teleaudiology services. [ABSTRACT FROM AUTHOR]

Objective: To test a model of child, family and service determinants of self-care participation of children with cerebral palsy (CP), grouped by Gross Motor Function Classification System levels (I-II and III-V). Methods: Participants were a convenience sample of 429 children (242 males) with CP, aged 18-60 months. Data on impairments and gross motor function were collected by reliable therapists; parents provided information about children's health conditions and adaptive behaviour. Seven months later parents reported on family life and services received. One year after study onset, parents documented children's self-care participation. Data from two groups of children were analysed using structural equation modelling. Results: The model explained a significant proportion of the variance of self-care participation, with higher motor function, fewer health conditions and higher levels of adaptive behaviour being associated with greater self-care participation. Conclusion: Supporting children's gross motor function, health and adaptive behaviour may optimize self-care participation. [ABSTRACT FROM AUTHOR]

Objectives: Validity of the Early Clinical Assessment of Balance (ECAB), to monitor postural stability in children with cerebral palsy (CP), was evaluated. Methods: 410 children with CP, 1.5 to 5 years old, participated. Physical therapists scored children on the Movement Assessment of Infants Automatic Reactions section and Pediatric Balance Scale. Through consensus, researchers selected items from both measures to create the ECAB. Content and construct validity were examined through item correlations, comparison of ECAB scores among motor ability, age and gender groups and correlations with the Gross Motor Function Measure 66 basal and ceiling (GMFM-66-B&C). Results: Internal consistency was high (Cronbach's alpha = 0.92). ECAB differed significantly among motor ability, children <31 months old scored lower than older children, but there was no difference between boys and girls. ECAB and GMFM-66-B&C scores correlated strongly ( r = 0.97). Conclusion: Validity of the ECAB was supported. Reliability and responsiveness need study. [ABSTRACT FROM AUTHOR]

The article focuses on the development and assessment of the Multiligament Quality of Life questionnaire, which was designed to gather information related to treatment outcomes of patient with multiligament knee injuries. Topics discussed include the theoretical framework, design and procedure observed in creating the quality of life questionnaire and the findings and benefits presented by using the questionnaire to evaluate multiligament knee injuries.

This study aimed to assess the communicative skills of children and young adults with ring 14 syndrome and linear 14q deletions, investigating the relationships among their language development and their genetic, clinical, psychomotor and behavioural characteristics. Participants were 36 individuals with chromosome 14 aberrations whose parents completed a questionnaire, specifically developed in five languages, to assess their son's/daughter's development. Data analysis showed that chronological age does not account for the high individual variability found in the participants' skills. The comparison between participants with ring 14 syndrome and participants with 14q linear deletions showed that the former were characterised by a higher occurrence of epilepsy, abnormalities of the retina and autism. The participants with smaller amounts of deleted genetic material were those who had a higher level of language development. Because ring 14 syndrome is a rare genetic disease, the collection of data from a large group of individuals could be helpful to create expectations about the possible developmental outcomes of these children. [ABSTRACT FROM AUTHOR]

Context First-year residents begin clinical practice in settings in which attending staff and senior residents are available to supervise their work. There is an expectation that, while being supervised and as they become more experienced, residents will gradually take on more responsibilities and function independently. Objectives This study was conducted to define 'entrustable professional activities' ( EPAs) and determine the extent of agreement between the level of supervision expected by clinical supervisors ( CSs) and the level of supervision reported by first-year residents. Methods Using a nominal group technique, subject matter experts ( SMEs) from multiple specialties defined EPAs for incoming residents; these represented a set of activities to be performed independently by residents by the end of the first year of residency, regardless of specialty. We then surveyed CSs and first-year residents from one institution in order to compare the levels of supervision expected and received during the day and night for each EPA. Results The SMEs defined 10 EPAs (e.g. completing admission orders, obtaining informed consent) that were ratified by a national panel. A total of 113 CSs and 48 residents completed the survey. Clinical supervisors had the same expectations regardless of time of day. For three EPAs (managing i.v. fluids, obtaining informed consent, obtaining advanced directives) the level of supervision reported by first-year residents was lower than that expected by CSs (p < 0.001) regardless of time of day (i.e. day or night). For four more EPAs (initiating the management of a critically ill patient, handing over the care of a patient to colleagues, writing a discharge prescription, coordinating a patient discharge) differences applied only to night-time work (p ≤ 0.001). Conclusions First-year residents reported performing EPAs with less supervision than expected by CSs, especially during the night. Using EPAs to guide the content of the undergraduate curriculum and during examinations could help better align CSs' and residents' expectations about early residency supervision. [ABSTRACT FROM AUTHOR]

The “Why Have Sex?” questionnaire (YSEX?) is a comprehensive research tool developed to provide an organized taxonomy of reasons for engaging in sex for men and women. The measure has been empirically validated and has shown high internal reliability in general samples. The current study evaluated the psychometric properties of the YSEX? in a sample of 146 women with same-sex attraction. The questionnaire was completed by women considering motivations for casual sex and sex in a committed relationship with a female partner. Cronbach's alphas were calculated for each of the factors and subfactors of the YSEX? and overall reliability was excellent. Additionally, principal component analyses were conducted to determine if the previously established four-factor structure of the YSEX? could be replicated in this sample. While the four-facture structure accounted for much of the observed variance (79.0% for motivations for casual sex; 71.2% for motivations for sex in a committed relationship), results suggest that a three-factor structure may be more representative of the data, likely due to characteristics of the current sample. Based on the results of the analyses conducted, the YSEX? measure is reliable for women with same-sex attraction considering casual sex and sex in a committed relationship with a female partner. [ABSTRACT FROM AUTHOR]

This study investigated the relationship among working memory, processing speed, math performance, and reactivity to stress in 83 Grade 1 children. Specifically, 39 children with math disability (MD) were compared to 44 children who are typically achieving (TA) in mathematics. It is the first study to use a physiological index of stress (salivary cortisol levels) to measure children’s reactivity while completing tasks that assess the core components of MD: working memory for numbers, working memory for words, digits backward, letter number sequence, digit span forward, processing speed for numbers and words, block rotation, and math tasks. Grade 1 children with MD obtained significantly lower scores on the letter number sequence and quantitative concepts tasks. Higher levels of reactivity significantly predicted poorer performance on the working memory for numbers, working memory for words, and quantitative concepts tasks for Grade 1 children, regardless of math ability. Grade 1 children with MD and higher reactivity had significantly lower scores on the letter number sequence task than the children with MD and low reactivity. The findings suggest that high reactivity impairs performance in working memory and math tasks in Grade 1 children, and young children with high reactivity may benefit from interventions aimed at lowering anxiety in stressful situations, which may improve learning. [ABSTRACT FROM AUTHOR]

Background Self-reported and objectively-determined neighborhood built characteristics are associated with physical activity, yet little is known about their combined influence on walking. This study: 1) compared self-reported measures of the neighborhood built environment between objectively-determined low, medium, and high walkable neighborhoods; 2) estimated the relative associations between self-reported and objectively-determined neighborhood characteristics and walking and; 3) examined the extent to which the objectively-determined built environment moderates the association between self-reported measures of the neighborhood built environment and walking. Methods A random cross-section of 1875 Canadian adults completed a telephone-interview and postal questionnaire capturing neighborhood walkability, neighborhood-based walking, sociodemographic characteristics, walking attitudes, and residential self-selection. Walkability of each respondent's neighborhood was objectively-determined (low [LW], medium [MW], and high walkable [HW]). Covariate-adjusted regression models estimated the associations between weekly participation and duration in transportation and recreational walking and self-reported and objectively-determined walkability. Results Compared with objectively-determined LW neighborhoods, respondents in HW neighborhoods positively perceived access to services, street connectivity, pedestrian infrastructure, and utilitarian and recreation destination mix, but negatively perceived motor vehicle traffic and crime related safety. Compared with residents of objectively-determined LW neighborhoods, residents of HW neighborhoods were more likely (p < .05) to participate in (odds ratio[OR] = 3.06), and spend more time, per week (193 min/wk) transportation walking. Perceived access to services, street connectivity, motor vehicle safety, and mix of recreational destinations were also significantly associated with transportation walking. With regard to interactions, HW x utilitarian destination mix was positively associated with participation, HW x physical barriers and MW x pedestrian infrastructure were positively associated with minutes, and HW x safety from crime was negatively associated with minutes, of transportation walking. Neither neighborhood type nor its interactions with perceived measures of walkability were associated with recreational walking, although perceived aesthetics was associated with participation (OR = 1.18, p < .05). Conclusions Objectively-determined and self-reported built characteristics are associated with neighborhood-based transportation walking. The objectively-determined built environment might moderate associations between perceptions of walkability and neighborhood-based transportation walking. Interventions that target perceptions in addition to modifications to the neighborhood built environment could result in increases in physical activity among adults. [ABSTRACT FROM AUTHOR]