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PURPOSE: Cancer patient navigators (CPNs) can decrease the time from diagnosis to treatment, but workloads vary widely, which may lead to burnout and less optimal navigation. Current practice for patient distribution among CPNs at our institution approximates random distribution. A literature search did not uncover previous reports of an automated algorithm to distribute patients to CPNs. We sought to develop an automated algorithm to fairly distribute new patients among CPNs specializing in the same cancer type(s) and assess its performance through simulation on a retrospective data set. METHODS: Using a 3-year data set, a proxy for CPN work was identified and multiple models were developed to predict the upcoming week's workload for each patient. An XGBoost-based predictor was retained on the basis of its superior performance. A distribution model was developed to fairly distribute new patients among CPNs within a specialty on the basis of predicted work needed. The predicted work included the week's predicted workload from a CPN's existing patients plus that of newly distributed patients to the CPN. Resulting workload unfairness was compared between predictor-informed and random distribution. RESULTS: Predictor-informed distribution significantly outperformed random distribution for equalizing weekly workloads across CPNs within a specialty. CONCLUSION: This derivation work demonstrates the feasibility of an automated model to distribute new patients more fairly than random assignment (with unfairness assessed using a workload proxy). Improved workload management may help reduce CPN burnout and improve navigation assistance for patients with cancer. Cancer patient navigators suffer high burnout. A new AI system may help even out their workloads. [ABSTRACT FROM AUTHOR]

Screening for social determinants of health (SDOH) is recommended, but numerous barriers exist to implementing SDOH screening in clinical spaces. In this study, the authors identified how both active and passive information retrieval methods may be used in clinical spaces to screen for SDOH and meet patient needs. The authors conducted a retrospective sequential cohort analysis comparing the active identification of SDOH through a patient-led digital manual screening process completed in primary care offices from September 2019 to January 2020 and passive identification of SDOH through natural language processing (NLP) from September 2016 to August 2018, among 1735 patients at a large midwestern tertiary referral hospital system and its associated outlying primary care and outpatient facilities. The percent of patients identified by both the passive and active identification methods as experiencing SDOH varied from 0.3% to 4.7%. The active identification method identified social integration, domestic safety, financial resources, food insecurity, transportation, housing, and stress in proportions ranging from 5% to 36%. The passive method contributed to the identification of financial resource issues and stress, identifying 9.6% and 3% of patients to be experiencing these issues, respectively. SDOH documentation varied by provider type. The combination of passive and active SDOH screening methods can provide a more comprehensive picture by leveraging historic patient interactions, while also eliciting current patient needs. Using passive, NLP-based methods to screen for SDOH will also help providers overcome barriers that have historically prevented screening. [ABSTRACT FROM AUTHOR]

Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for pilot testing in an intervention study. Conclusion. Planning for an innovative, community-based pilot study takes considerable time and effort in a low-income setting like Pakistan. The primary outcome of the pre-testing phase of the study was the development of three important tools geared for low-income housing communities in Pakistan.

Mammography screening rates are typically lower in those with less economic advantage (EA). This study, conducted at an integrated health care system covering a mixed rurality population, assessed the ability of interventions (text messages linking to a Web microsite, digital health care workers, and a community health fair) to affect mammography screening rates and disparity in those rates among different EA populations. Payor type served as a proxy for greater (commercially insured) versus lower (Medicaid insured) EA. 4,342 subjects were included across the preintervention ("Pre") and postintervention ("Post") periods. Interventions were prospectively applied to all Medicaid subjects and randomly selected commercial subjects. Applying interventions only to lower EA subjects reversed the screening rate disparity (2.6% Pre vs. −3.7% Post, odds ratio [OR] 2.4 P < 0.01). When intervention arms ("Least," "More," "Most") were equally applied, screening rates in both EA groups significantly increased in the More arm (Medicaid OR = 2.04 P = 0.04, Commercial OR = 3.08 P < 0.01) and Most arm (Medicaid OR 2.57 P < 0.01, Commercial OR 2.33 P < 0.01), but not in the Least (text-only) arm (Medicaid OR 1.83 P = 0.11, Commercial OR 1.72 P = 0.09), although this text-only arm was inadequately powered to detect a difference. In summary, targeting interventions to those with lower EA reversed screening rate disparities, text messaging combined with other interventions improved screening rates in both groups, and future research is needed to determine whether interventions can simultaneously improve screening rates for all without worsening the disparity. [ABSTRACT FROM AUTHOR]

Background: Emergency department (ED) triage is performed to prioritize care for patients with critical and time-sensitive illness. Triage errors create opportunity for increased morbidity and mortality. Here, we sought to measure the frequency of under- and over-triage of patients by nurses using the Emergency Severity Index (ESI) in Brazil and to identify factors independently associated with each. Methods: This was a single-center retrospective cohort study. The accuracy of initial ESI score assignment was determined by comparison with a score entered at the close of each ED encounter by treating physicians with full knowledge of actual resource utilization, disposition, and acute outcomes. Chi-square analysis was used to validate this surrogate gold standard, via comparison of associations with disposition and clinical outcomes. Independent predictors of under- and over-triage were identified by multivariate logistic regression. Results: Initial ESI-determined triage score was classified as inaccurate for 16,426 of 96,071 patient encounters. Under-triage was associated with a significantly higher rate of admission and critical outcome, while over-triage was associated with a lower rate of both. A number of factors identifiable at time of presentation including advanced age, bradycardia, tachycardia, hypoxia, hyperthermia, and several specific chief complaints (i.e., neurologic complaints, chest pain, shortness of breath) were identified as independent predictors of under-triage, while other chief complaints (i.e., hypertension and allergic complaints) were independent predictors of over-triage. Conclusions: Despite rigorous and ongoing training of ESI users, a large number of patients in this cohort were under- or over-triaged. Advanced age, vital sign derangements, and specific chief complaints-all subject to limited guidance by the ESI algorithm-were particularly under-appreciated. [ABSTRACT FROM AUTHOR]

Introduction: Low and middle income countries bear a disproportionate burden of paediatric morbidity and mortality. South Africa, a middle income country, has unacceptably high mortality in children less than 5 years of age. Many factors that contribute to the child mortality rate are time sensitive and require efficient access to emergency care. Delays and barriers within the emergency medical services (EMS) system increase paediatric morbidity and mortality from time sensitive illnesses.Methods: This study is a qualitative evaluation of the prehospital care system for paediatric patients in Cape Town, South Africa. A purposive sample of healthcare personnel within and interacting with the EMS system were interviewed. A structured interview form was used to gather data. All interviews were audio recorded and transcribed; two independent reviewers performed blinded content analysis of the transcribed script.Results: 33 structured interviews were conducted over a 4 week period. Eight broad themes were identified during coding, including: access, communication, community education, equipment, infrastructure, staffing, training and triage. Subcategories were used to identify areas for targeted intervention. Overall agreement between the two independent coders was 93.36%, with a κ coefficient of 0.69.Conclusions: The prehospital system is central to delivering time sensitive care for paediatric patients. In a single centre middle income setting, communication barriers between dispatch personnel and medical facilities/EMS personnel were deemed to be a high priority intervention in order to improve care delivery. Other areas for targeted interventions should include broadening the advanced life support provider base and introducing basic medical language in dispatch staff training. [ABSTRACT FROM AUTHOR]

The transition to adulthood is a developmental phase which occurs as young people move from adolescence into adulthood. Young people with disabilities, including cerebral palsy (CP), and their families have reported challenges during the transition to adulthood because they are required to move to adult supports and services, which are often fragmented and bring about new questions and expectations to find necessary supports. Young people and their parents have been found to lack information about where to find services in adulthood, how to access the services and what to ask during the transitional process. The aim of this scoping review was to explore the information needs of young people with CP and their families during the transition to adulthood. The goal is to map the current published evidence within the transition to adulthood literature base to explore what is known about information needs during the transition to adulthood of young people with CP and their parents. This review seeks to synthesize what is known about information content, timing, methods of provision and delivery. Databases searched were OVID Medline, CINAL, ERIC, EMBASE, PsycINFO, Web of Science, Social Science Abstracts and Sociological Abstracts. Initially 675 articles were retrieved. Four hundred and forty-two articles were selected for title review. Two hundred and five articles remained for abstract review. Seventeen articles were included for full-text review. Eleven articles were included in this review. Data were organized into five themes: (1) identified information needs during the transition to adulthood (content), (2) identified recommended providers of information during the transition to adulthood (who), (3) identified delivery methods of information during the transition to adulthood (how), (4) identified timing of information delivery of information during the transition to adulthood (when) and (5) location of information provided during the transition to adulthood (where). This review found that young people with CP, their families and adult providers all possess information needs during the transition to adulthood. Young people with CP and their families seek information about what adult services will look like and how to access supports. Adult providers require information about CP. Youth with CP prefer individualized information be delivered to them when needed rather than presented in group sessions or via paper handout. Other recommendations included the development of parent support networks to assist parents in the transition to adulthood. The opportunity to learn from real-life experiences was also viewed as an important source of information as well as method to provide information.

Objective: People hospitalized for depression are often discharged before the acute phase of their illness has resolved and need timely care transitions to prevent relapse. We examined 30-day postdischarge service use for Ontarians, aged 15 years or older, who were hospitalized for depression. We focused on a pattern consistent with guideline and policy directions: higher rates of physician visits, postdischarge, combined with lower rates of emergency department (ED) admissions or rehospitalization.Methods: Administrative data for the fiscal year of 2005 were used to identify hospitalizations for depression and subsequent physician visits, ED admissions, or readmissions for depression within 30 days, postdischarge. Sex, age, income, and geographic location were examined along with the relation between health care resources (beds, EDs, and physicians) and postdischarge service use.Results: Sixty-three percent of patients discharged for depression were followed, within 30 days, by a physician visit for depression. Twenty-five percent were either rehospitalized or visited an ED. Women and people from urban or high income areas were more likely to have postdischarge physician visits. Readmissions and ED visits were correlated with number of EDs, but postdischarge physician visits were not related to the number of general practitioners, family physicians, and psychiatrists in the local area.Conclusion: One-third of Ontarians hospitalized for depression did not receive recommended follow-up outpatient care within 30 days of discharge and one-quarter received follow-up through ED visits or readmissions, highlighting the need to improve coordination and integration across care settings for these patients. There are tested transitional and outpatient models that improve quality and outcomes of depression care that merit serious consideration. [ABSTRACT FROM AUTHOR]

Objective: Gender disparities in mental health highlight the need to include gender equity measures when planning, implementing, and evaluating mental health programs at national, state or provincial, and municipal levels. This study aimed to identify, select, and assess the feasibility of comparing gender-sensitive mental health indicators in a low- (Peru), middle- (Colombia), and high- (Canada) income country.Methods: The indicators were selected by a multidisciplinary group of experts who used criteria and a framework proposed by the World Health Organization. Data from national, population-based databases from each country were used to measure the indicators.Results: Seven indicators (12-month prevalence of the following: depression, psychological distress, generalized anxiety disorder, suicide attempts, alcohol dependence, mental health service use, and psychological impairment) were feasible for measurement in at least two countries. Only five indicators were comparable between two countries, and only one was comparable among all countries (suicide attempts). The indicators that showed the greatest inequities between men and women were depression, anxiety, suicide attempts, use of mental health services, and alcohol dependence. Female-to-male ratios for prevalence of mental illness ranged from .1 to 2.3, and ratios for service use ranged from 1.3 to 1.9. Significant trends were found when the indicators were considered by age, education, marital status, and income.Conclusions: Some of these indicators can be used to identify populations most vulnerable to gender inequities in mental health. The results from this study may provide useful information to program planners who aim to implement, improve, and monitor national mental health strategies that reduce gender inequities under different national conditions. [ABSTRACT FROM AUTHOR]

Both depression and smoking are highly prevalent and related to poorer outcomes in cardiac patients. In this study, the authors examined the association between depressive symptoms and smoking status, described the frequency and type of antidepressant use, and prospectively tested the effects of antidepressant use in smokers on smoking status and psychosocial outcomes. Participants comprised 1,498 coronary artery disease (CAD) outpatients who completed a baseline survey which assessed depressive symptoms, current medications, and smoking status. A second survey was mailed 9 months later that assessed depressive symptoms, anxiety, insomnia and smoking status. Results showed that current and former-smokers had significantly greater depressive symptoms than non-smokers. Ten percent of patients were taking antidepressants, most frequently SSRIs, with significantly more smokers on antidepressants than former and non-smokers. At follow-up, smokers on antidepressants were less likely to have quit, had greater anxiety, depressive symptoms and insomnia than smokers not using antidepressants. This study demonstrated that smokers and quitters with CAD had greater depressive symptoms and use of antidepressants than non-smokers, but that the antidepressants utilized may not be optimizing outcomes. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women.Objective: To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting.Design: Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention.Setting: An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada.Participants: Adult women in a current or recent relationship.Intervention: Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (n = 144). Control participants received standard medical care (n = 149).Measurements: Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits.Results: The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (n = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions.Limitation: The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used.Conclusion: Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients.Primary Funding Source: Canadian Institutes of Health Research and Ontario Women's Health Council. [ABSTRACT FROM AUTHOR]

BACKGROUND: Over one-third of cardiac patients practice Mind-Body Therapy (MBT), particularly women. Considering women are less likely to engage in conventional physical activity, few studies have examined why MBT is well-accepted by women. OBJECTIVES: To qualitatively explore gender differences in the motivations for, and perceived effects of MBT, and the inter-relationships among alternative and conventional physical activities and secondary prevention programs. METHODS: A random subsample of 16 participants (8 female) who reported practicing MBT in a larger study of 661 cardiac patients was interviewed until theme saturation was achieved. Audiotapes were transcribed and coded based on interpretive-descriptive technique within Nvivo-7 software. An audit trail and second coder were utilized to ensure the transparency and validity of results. After main themes emerged, the data were split by gender to identify differences for each theme. RESULTS: Five themes emerged: (1) promotes positive well-being, (2) physical health benefits, (3) intrinsic and extrinsic motivations, (4) proactive health orientation, and (5) MBT as a preferred complementary and/or alternative physical activity. Men more often expressed preference for MBT for increased positive mood and cardiac-specific benefits, whereas women emphasized stress reduction, increasing self-efficacy, and physical activity, and were eager to see MBT offered in cardiac rehabilitation (CR). CONCLUSIONS: Both male and female users perceived substantial psychosocial and physical benefits of MBT practice. MBT addresses some of women's common barriers to CR. Copyright © 2008 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Objective: To determine whether men and women with type 2 diabetes have different psychosocial, behavioural, and clinical characteristics at the time of their first visit to a diabetes education centre.Design: A questionnaire on psychosocial and behavioural characteristics was administered at participants' first appointments. Clinical and disease-related data were collected from their medical records. Bivariate analyses (chi(2) test, t test, and Mann-Whitney test) were conducted to examine differences between men and women on the various characteristics.Setting: Two diabetes education centres in the greater Toronto area in Ontario.Participants: A total of 275 men and women with type 2 diabetes.Results: Women were more likely to have a family history of diabetes,previous diabetes education, and higher expectations of the benefits of self-management. Women reported higher levels of social support from their diabetes health care team than men did, and had more depressive symptoms, higher body mass, and higher levels of high-density lipoprotein cholesterol than men did.Conclusion: The results of this study provide evidence that diabetes prevention, care, and education need to be targeted to men and women differently. Primary care providers should encourage men to attend diabetes self-management education sessions and emphasize the benefits of self-care. Primary care providers should promote regular diabetes screening and primary prevention to women, particularly women with a family history of diabetes or a high body mass index; emphasize the importance of weight management for those with and without diabetes; and screen diabetic women for depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: The stress of medical practice has been recurrently studied, but work- and family-related determinants of health by gender remain under researched. Purpose: To test the hypothesis that cortisol excretion would be affected by the perceived severity of total workload imbalance. Method: By hierarchical regression analysis, the associations between work-family balance and diurnal salivary cortisol levels by sex in academic physicians (n = 40) were investigated. Results: Men physicians reported more paid work hours per week than women physicians and women more time in childcare, but their total working hours were similar. Controlling for sex and age, the mean of the diurnal cortisol release was associated with a combined effect of sex and responsibility at home. When morning cortisol, sex, and children at home were held constant, cortisol levels in the evening were associated with responsibility at home without significant gender interaction. Conclusion: With increasing responsibility at home, women and men reacted differently with regard to cortisol responses over the day. However, in the evening, controlling for the morning cortisol, these gender differences were not as obvious. These findings highlight traditional gender patterns among both women and men physicians in the challenge of finding a balance between work and family. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine utilization patterns of diabetes self-management training (DSME) and identify patient factors associated with attrition from these services at an ambulatory diabetes education centre (DEC). METHODS: A retrospective medical chart review of first time visits (536) to the centre between 1 August 2000 and 31 July 2001 was conducted for patients with type 2 diabetes. Descriptive analyses were conducted to examine utilization patterns over a 1-year period. Multivariable logistic regression was used to identify patient factors associated with attrition from DSME and non-use of group education among new patients. RESULTS: Almost 50% of new patients withdrew prematurely from recommended DSME services over the 1-year period, and only 24.8% attended group education. Patient variables such as being older than 65 years of age, primarily speaking English, or working full or part-time were associated with attrition from DSME and non-use of group education when compared with middle aged, non-English-speaking, and non-working patients. CONCLUSIONS: High DSME attrition rates indicate that retention needs to become a focus of programme policy, planning and evaluation to improve programme effectiveness. DSME tailored to the cultural and linguistic characteristics of the community, and convenient and accessible to working and older patients will potentially increase retention in and accessibility to these services. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We interviewed healthcare workers working in Toronto, Canada, regarding their experience of providing care to recent immigrant women suffering from postpartum depression. The objective was two-fold: 1) to identify potential barriers to care that recent immigrant women may encounter as perceived by healthcare workers; and 2) to identify challenges healthcare workers felt that they faced as providers of care to this population. METHODS: Qualitative semi-structured interviews were conducted with 16 key informants from various disciplines employed by healthcare agencies providing care to postpartum immigrant women in Toronto. Constant comparative analysis was used to analyze the data. RESULTS: Two main categories of barriers to care for recent immigrant women were identified: 'practical barriers' and 'culturally determined barriers'. Practical barriers included knowing where and how to access services, and language difficulties. Cultural barriers included fear of stigma and lack of validation of depressive symptoms by family and society. The challenges experienced by healthcare providers working with this population were organized into two other categories: 'professional limitations', and 'social/cultural barriers'. 'Professional limitations' included fear of incompetence, language barriers, and inadequate assessment tools. 'Social/cultural barriers' included the experience of cultural uncertainty. CONCLUSIONS: The results suggest that not only are there important barriers to accessing postpartum care for recent immigrant women, but it can also be challenging for healthcare workers to deliver such needed care. Understanding some of these barriers and challenges from the perspective of healthcare providers is an important step to remedying gaps and obstacles in the service system. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the prevalence of violence involving intimate partners among women visiting Canadian family practices and to assess participants' attitudes toward future use of computer-assisted screening for violence and other health risks.DESIGN: Self-report via written survey.SETTING: Group family practice clinic in inner-city Toronto, Ont.PARTICIPANTS: Women patients at least 18 years old who were fluent in English.MAIN OUTCOME MEASURES: Responses to questions about violence selected from the Abuse Assessment Screen and the Partner Violence Screen. Participants' attitudes toward computer-assisted screening as measured by the Computerized Lifestyle Assessment Scale (1 to 5) in the domains of benefits, privacy--barriers, interaction--barriers, and interest.RESULTS: Responses were received from 202 patients, 144 of whom were in current or recent relationships and completed the section on intimate-partner violence (IPV). The overall prevalence of IPV in current or recent relationships was 14.6%. Emotional abuse was reported by 10.4%, threat of violence by 8.3%, and physical or sexual violence by 7.6% of respondents. Emotional abuse was significantly associated with threat of violence and physical or sexual violence (P

The authors' objectives of this research were: (1) to assess levels of selfreported antidepressant adherence and reasons for nonadherence and (2) to investigate determinants of nonadherence. A group of general hospital and community psychiatry practice mood disorder outpatients (n=80) took a self-report questionnaire that assessed beliefs about antidepressants, self-efficacy, and reasons for nonadherence. High levels of adherence were reported: 58 patients (73%) indicated they took their medication as directed more than 80% of the time. Practical issues (e.g., simply forgetting or a change in routine) were the most frequently identified reasons for nonadherence. Patients were more likely to report nonadherence if they experienced a sexual side effect, had lower self-efficacy, were female, and had not completed post-secondary education. Clinicians should be cognizant of this complexity and address not only issues related to medication efficacy and tolerability, but also social mediators and health beliefs when prescribing antidepressants. [ABSTRACT FROM AUTHOR]

Background: Literature pertaining to the relationship between workplace factors and depression has been compartmentalized: work conditions, family conditions, and work-family balance have been studied separately as predictors of depressive symptoms but not concurrently.Objective: Work conditions and work-family spillover were considered concurrently as modifiable workplace factors associated with depressive symptomatology, while controlling for confounding socio-economic factors.Methods: This cross-sectional study involved 218 female health care workers who completed a survey assessing work conditions [Effort-Reward Imbalance (ERI) scale and Job Content Questionnaire (JCQ)], work-family balance (work-family spillover scale), sociodemographic information, and depressive symptoms [Center for Epidemiological Studies Depression (CES-D) scale].Results: Path analysis supported the presence of a direct relationship between depressive symptoms and high effort-reward imbalance, high negative work-family spillover, low positive family-to-work spillover, and low education. The indirect effect of low support from work was mediated by negative work-to-family spillover and high effort-reward imbalance. The indirect effect of high effort-reward imbalance was mediated by increased negative work-to-family spillover. The indirect effect of having children 18 years or younger was mediated by decreased positive family-to-work spillover. An indirect effect of low education was mediated by high effort-reward imbalance and high negative work-to-family spillover.Conclusions: The association between work conditions and depressive symptomatology is mediated by increased negative work-to-family spillover. The impact of having young children is mediated by decreased positive family-to-work spillover. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the impact of stroke survivors' behavioral and psychologic symptoms (BPS) on informal caregivers' experience of depression in the context of the caregiving situation. DESIGN: Cross-sectional survey using a structured quantitative interview. SETTING: Rehabilitation facility outpatient clinic, tertiary care facility outpatient clinic, and community care organizations. PARTICIPANTS: Ninety-four informal caregivers to stroke survivors completed standardized measurement instruments. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurement instruments included the Center for Epidemiological Studies Depression Scale, Brain Impairment Behavior Inventory-Revised, Caregiver Assistance Scale, Caregiving Impact Scale, and Mastery scale. RESULTS: A substantial percentage (44.7%) of caregivers were at risk of clinical depression. Caregivers experienced more depression symptoms when they cared for stroke survivors exhibiting more BPS of memory and comprehension difficulties, provided less assistance, experienced more lifestyle interference, and had lower mastery (F(5,85)=26.02, P<.001, adjusted R(2)=.58). CONCLUSIONS: BPS exhibited by stroke survivors contribute to informal caregivers' experience of depression. These results can assist rehabilitation professionals to identify informal care providers who are at greater risk of experiencing emotional distress and, therefore, may benefit from intervention. Copyright © 2006 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation [ABSTRACT FROM AUTHOR]

Women's health-promoting behavior changes and their correlates across the transition to motherhood and return to work are insufficiently understood. The purpose of this study was to describe and compare women's health-promoting behaviors, particularly physical activity (PA), across these transitions. A prospective, observational design was employed to assess 243 female healthcare workers from 3 sites with regard to health-promoting behaviors, and their demographic (e.g., age, parity) and psychosocial (i.e., work-family role spillover) correlates. Forty-two participants were recruited while pregnant and re-assessed during maternity leave and upon return to work, and compared to 201 non-pregnant participants. No significant changes in health-promoting behaviors were observed from pregnancy through the postpartum. Pregnant participants reported better nutrition than comparison participants (p=.001), and were more likely to check their pulse when exercising (p=.004). During pregnancy, health-promoting behaviors were related to parental status, with first-time mothers engaging in more positive behaviors. Correlates of PA during maternity leave and return to work included family income and exercise history. Positive family-to-work spillover was significantly greater among pregnant women than among comparison participants (p<.001), and positive work-to-family spillover was related to greater PA upon return to work (p<.01). This study reveals little variability in health-promoting behaviors from the prenatal to the postpartum period. Both demographic and psychosocial factors have effects on health-promoting behaviors, and we must look to these correlates to promote increased PA. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the rates of self-reported physical and emotional spousal abuse among recent Canadian-immigrant (CI) women compared to Canadian-born (CB) women. The study conducted secondary data analyses on the General Social Survey, 1999. A sample of CB (n = 3548) and CI (n = 313) women was drawn that included women 25 to 49 years of age who were currently married or in a common-law relationship. Person weights and bootstrapping estimates were used to estimate the 95% confidence intervals. The proportion of emotional spousal abuse was higher in CI (14.7%, 95% CI: 10.7-18.8%) compared to CB women (8.7%, 95% CI: 7.8-9.6%). However, the proportion of physical spousal abuse was not statistically different between two groups. Possible explanations are discussed setting direction for future research and services for immigrant women. [ABSTRACT FROM AUTHOR]

This descriptive study seeks to understand what first and second generation Portuguese women believe about wife abuse and what actions they believe are appropriate for an abused wife. Eighty first generation and 54 second generation women participated. The researcher read the questionnaire items aloud in one-on-one meetings. Overall, participants defined wife abuse broadly, did not approve of wife abuse, were most likely to believe that women should seek external help, and did not hold strong patriarchal beliefs. However, a number of generational differences were found. Second generation women were more likely to label an abusive behavior as abuse, and first generation women were more likely to approve of abuse, endorse indirect or traditional options to deal with wife abuse, and hold stronger patriarchal beliefs. The study's implications for research and practice within Portuguese communities are discussed. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative research aimed to elicit experiences and beliefs of recent South Asian immigrant women about their major health concerns after immigration. Methods: Four focus groups were conducted with 24 Hindi-speaking women who had lived less than five years in Canada. The audiotaped data were transcribed, translated, and analyzed by identification of themes and subcategories. Results: Mental health (MH) emerged as an overarching health concern with three major themes i.e. appraisal of the mental burden (extent and general susceptibility), stress-inducing factors, and coping strategies. Many participants agreed thatMHdid not become a concern to them until after immigration. Women discussed their compromised MH using verbal and symptomatic expressions. The stress-inducing factors identified by participants included loss of social support, economic uncertainties, downward social mobility, mechanistic lifestyle, barriers in accessing health services, and climatic and food changes. Women's major coping strategies included increased efforts to socialize, use of preventative health practices and self-awareness. Conclusion: Although participant women discussed a number of ways to deal with post-immigration stressors, the women's perceived compromised mental health reflects the inadequacy of their coping strategies and the available resources. Despite access to healthcare providers, women failed to identify healthcare encounters as opportunities to seek help and discuss their mental health concerns. Health and social care programs need to actively address the compromised mental health perceived by the studied group. [ABSTRACT FROM AUTHOR]

To determine predictors of clinical breast examination (CBE) among South Asian immigrant women residing in Toronto, Canada. A cross-sectional self-administered survey with women patients visiting family physician group practices. Fifty-four women participated in the study (response rate 77%). Twenty women (38.5%) ever had CBE. Compared to women who never had CBE, women who had CBE were statistically older, had lived more years in Canada, had better knowledge of breast cancer, had lower perceived barriers to CBE, and were more likely to have ever had a periodic health exam. No significant differences were found between the two groups for education, employment, English language abilities, perceived health, and perceived benefits of CBE. A direct logistic regression with five predictor variables, significant at a univariate level, was statistically reliable, chi2 (5, n=51) = 34.7, p < 0.001 and explained 67% of the variance in the CBE status. Age and perceived barriers to CBE remained significant over and above other predictor variables. The odds of ever had CBE increased with age and decreased with more perceived barriers. The study highlights the need for education interventions on breast cancer and screening among SA recent immigrant women. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac rehabilitation (CR) remains underused and inconsistently accessed, particularly for women and minorities. This study examined the factors associated with CR enrollment within the context of an automatic referral system through a retrospective chart review plus survey. Through the Behavioral Model of Health Services Utilization, it was postulated that enabling and perceived need factors, but not predisposing factors, would significantly predict patient enrollment.Subjects: A random sample of all atherosclerotic heart disease (AHD) patients treated at a tertiary care center (Trillium Health Centre, Ontario, Canada) from April 2001 to May 2002 (n = 501) were mailed a survey using a modified Dillman method (71% response rate).Measures: Predisposing measures consisted of sociodemographics such as age, sex, ethnocultural background, work status, level of education, and income. Enabling factors consisted of barriers and facilitators to CR attendance, exercise benefits and barriers (EBBS), and social support (MOS). Perceived need factors consisted of illness perceptions (IPQ) and body mass index.Results: Of the 272 participants, 199 (73.2%) attended a CR assessment. Lower denial/minimization, fewer logistical barriers to CR (eg, distance, cost), and lower perceptions of AHD as cyclical or episodic reliably predicted CR enrollment among cardiac patients who were automatically referred.Conclusion: Because none of the predisposing factors were significant in the final model, this suggests that factors associated with CR enrollment within the context of an automatic referral model relate to enabling factors and perceived need. A prospective controlled evaluation of automatic referral is warranted. [ABSTRACT FROM AUTHOR]

Purpose: To advance understanding about the popular health promotion strategies and factors associated with the successful transfer and uptake of health messages among Chinese and Indian immigrant women. Methods: Eight focus groups were conducted with 46 immigrant women, 24 from Mainland China and 22 from India, who had lived less than 5 years in Canada. Audiotaped data were transcribed, translated and analyzed by identification of themes and subcategories within and between groups. Results: In both ethnic groups, discussions on promoting health messages had five major themes, i.e., sources, barriers, facilitators, credibility and ways to improve access along with group specific sub-themes. Despite identification of several diverse sources of health information in the adopted country, Indian and Chinese immigrant women perceived most strategies as not very effective. The reasons of perceived ineffectiveness were barriers to accessing and comprehending the health messages; and limited prior exposure to institution based or formal health promotion initiatives. These women were more familiar with informal means of obtaining health information such as social networks, mass media and written materials in their mother tongue. Conclusion: Existing health communication and health promotion models need to be re-orientated from a one-way information flow to a two-way dialogue model to bridge the gap between program efficacy and effectiveness to reach underserved immigrant women. An 'outside the box' approach of non-institutional informal health promotion strategies needs to be tested for the studied groups. [ABSTRACT FROM AUTHOR]

ObjectivesTo compare male and female medical students by age, level of education before admission to medical school, race/ethnicity, parental education level, socioeconomic status, and attitudes toward public health care.MethodsIn 2001, we conducted an Internet-based survey of all students enrolled in the 16 medical schools across Canada. Based on the high response rate, first-year medical students at Canadian medical schools outside of Quebec were included in this analysis. The interactions between sex and age, years of premedical education, race/ethnicity, parental occupation, education and household income, impact of finances on choice of medical school, future specialty and practice location, attitudes toward private funding in the Canadian health care system were examined using descriptive statistics and x2 tests.ResultsThere were no significant differences between male and female medical students in age, level of education before admission, and race/ethnicity. Female students' fathers (p=.046) and mothers (p=.061) were more likely to hold positions of higher occupational status than were those of male students. There was no significant difference between the parental household incomes of male and female students. Male students were more likely than female students to state that financial considerations would affect their choice of specialty (p=.002) and practice location (p=.002). Male students were more likely to express a positive attitude toward private funding in the health care system, both with respect to increasing the amount of private funding (p=.007) and the addition of private paying patients (p=.002).ConclusionAlthough women have almost reached equity with men in undergraduate medical education, female students are more likely than male students to have highly educated parents, suggesting that some barriers to access may still exist. The differences in attitudes of female and male medical students to finances and the public health care system become increasingly important as more women practice medicine. These sex differences need to be investigated further, as they could have implications for health policy. [ABSTRACT FROM AUTHOR]