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Introduction: During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and compare admissions and length of stay (LOS) for psychiatric-related hospitalizations before and during the COVID-19 pandemic. Methods: We conducted a retrospective analysis using health administrative data comparing individuals with an acute psychiatric admission between two time periods: 1st March 2019 to 31st December 2019 (pre-COVID) and 1st March 2020 to 31st December 2020 (during-COVID). Multivariable negative binomial regression was used to model the association between most responsible diagnosis type and the two-time periods to hospital LOS, reporting the Rate Ratio (RR) as the measure of effect. Results: The cohort comprised 939 individuals who were predominately male (60.3%) with a severe mental illness (schizophrenia or mood-affective disorder) (72.7%) and a median age of 38 (IQR: 28.0, 52.0) years. In the multivariable analysis, anxiety disorders (RR: 0.63, CI: 0.4, 0.99) and personality disorders (RR: 0.52, CI: 0.32, 0.85) were significantly associated with a shorter LOS when compared to individuals without those disorders. Additionally, when compared to hospital admissions for non-substance related disorders the LOS for patients with substance-related disorders were significantly shorter during the COVID period (RR: 0.45, CI: 0.30, 0.67) and pre-COVID period (RR: 0.31, CI: 0.21, 0.46). Conclusions: We observed a significant difference in the type and length of admissions for various psychiatric disorders during the COVID-19 period. These findings can support systems of care in adapting to utilization changes during pandemics or other global health events. [ABSTRACT FROM AUTHOR]

We sought to characterize overdose and non-overdose mortality among PLWH amidst the illicit drug toxicity crisis in British Columbia, Canada. A population-based analysis of PLWH (age ≥19) in British Columbia accessing healthcare from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort linkage. Underlying causes of deaths were stratified into overdose and non-overdose causes. We compared (bivariate analysis) health-related characteristics and prescription history between PLWH died of overdose and non-overdose causes between April 2009 and March 2017. Among 9,180 PLWH, we observed 962 deaths (142 [14.7%] overdoses; 820 [85.2%] other causes). Compared to those who died from other causes, those who died of overdose were significantly younger (median age [Q, Q3]: 46 years [42, 52] vs. 54 years [48, 63]); had an indication of chronic pain (35.9% vs. 27.1%) and hepatitis C virus (64.8% vs. 50.4%), but fewer experienced hospitalization in the year before death. PLWH who died were most likely to be prescribed with opioids (>50%) and least likely with opioid agonist therapy (<10%) in a year before death. These findings highlight the syndemic of substance use, HCV, and chronic pain, and how the crisis is unqiuely impacting females and younger people. [ABSTRACT FROM AUTHOR]

Zhang and Savalei proposed an alternative scale format to the Likert format, called the Expanded format. In this format, response options are presented in complete sentences, which can reduce acquiescence bias and method effects. The goal of the current study was to compare the psychometric properties of the Rosenberg Self-Esteem Scale (RSES) in the Expanded format and in two other alternative formats, relative to several versions of the traditional Likert format. We conducted two studies to compare the psychometric properties of the RSES across the different formats. We found that compared with the Likert format, the alternative formats tend to have a unidimensional factor structure, less response inconsistency, and comparable validity. In addition, we found that the Expanded format resulted in the best factor structure among the three alternative formats. Researchers should consider the Expanded format, especially when creating short psychological scales such as the RSES. [ABSTRACT FROM AUTHOR]

Background: Factors that impact recurrence in stages IB to IV include larger tumor, high-risk histology, older age, and lymphovascular invasion (LVI); however, local studies on risk factors for recurrence in British Columbia and our local recurrence patterns have not been well studied. Furthermore, the efficacy of treatment modalities including surgery and chemoradiation in the different stages of cervical cancer have not been clarified in this population. Objectives: The purpose of this study is to determine the disease and treatment characteristics of stages IB to IV cervical cancer which are associated with survival differences within British Columbia. Methods/Design: We performed a retrospective population study. A chart review on cervical cancer patients in British Columbia between 1 January 2010 and 31 December 2017 was done. Demographic data and treatment details were collected. Data were analyzed using multivariate Cox regressions, pairwise comparison using the Log-Rank test, and chi-square tests. Results: We included 780 patients (stage I: 31.5%, II: 20.0%, III: 34.5%, and IV: 3.3%). LVI and p16 negativity were associated with decreased overall survival (OS), and multivariate analyses show them to be independent risk factors for poorer survival. Surgical resection in stage I was associated with improved survival, but not with stages II–IV. The use of radical radiation therapy (RT), brachytherapy, and concurrent chemotherapy were independently associated with improved survival in stages II–IV. Peri-RT chemotherapy was not associated with survival benefit in adeno/adenosquamous carcinoma. There were 180 recurrences (23.1%), mostly distant metastases (42.8%). There were fewer recurrences after resection of tumors <2 cm compared to tumors 2 cm or larger (6.49% vs 31.3%, p = 0.00011). Only 37.7% of recurrence/metastases were treated with first-line carboplatin/paclitaxel/bevacizumab, but it was associated with better OS compared to other regimens (median OS 40.1 vs 24.8 months, p = 0.03). Conclusion: A significant portion of patients with localized cervical cancer relapse despite radical therapy, with LVI and p16 negativity associated with poorer survival. Surgical resection may still play a role in stage IB disease, while RT, brachytherapy, and concurrent chemotherapy should be considered first-line therapy in stage II–IV diseases. First-line carboplatin, paclitaxel, and bevacizumab for recurrence shows improved survival. [ABSTRACT FROM AUTHOR]

PURPOSE Limited English-proficient (LEP) patients with non–small-cell lung cancer (NSCLC) may receive less palliative care services and more likely to receive aggressive end-of-life (EoL) care. Goals of this retrospective cohort study are to compare access to community palliative home care (CPHC), do not resuscitate (DNR) form completion, place of death, and health resource utilization at EoL between English-proficient (EP) and LEP patients with NSCLC in Vancouver, Canada. METHODS All patients with advanced NSCLC referred in 2016 and received medical care were included. Patients were classified as LEP if seen with a medical interpreter. Descriptive statistics and univariate and multivariate analyses were used to compare the outcomes between the two groups. RESULTS One hundred eighty-six patients were referred, 66% EP. Rates of CPHC referral and DNR form completion were the same for both groups (84% and 92%, P = 1.00). LEP patients received earlier access to CPHC (15 v 10 weeks before death, P = .039). Rates of ER visits within 6 months and 30 days of death were 0.89 for EP patients and 0.7 for LEP patients, P = .374, and 0.1 for EP patients and 0.13 for LEP patients, P = .244. Hospitalization rates within 6 months and 30 days of death were 1.4 for EP patients and 1.59 for LEP patients, P = .640, and 0.67 for EP patients and 0.81 for LEP patients, P = .091. EP patients were more likely to have a home death (26% v 14%), whereas LEP patients died in acute care (23% v 14%) or a tertiary palliative care unit (24% v 19%). This was not statistically significant (P = .335). LEP patients had better median overall survival (8.5 v 5.4 months, P < .001), but when controlled by age, mutation, and EP status, only receipt of palliative-intent systemic therapy was statistically significant. CONCLUSION EP and LEP patients with NSCLC have similar referral rates to CPHC, DNR form completion, and EoL health resource utilization. The measured EoL variables did not demonstrate significant disparities between EP and LEP patients. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is associated with intimate partner violence (IPV) perpetration and victimization. However, extant research has not distinguished between unidirectional and bidirectional IPV and has not examined relationships between IPV and functions of self-injury. This study of 1,018 university students revealed a significantly higher prevalence of NSSI among those who reported bidirectional IPV compared with nonviolent individuals. However, rates of NSSI in the unidirectional IPV groups are more similar to rates of NSSI in the bidirectional group than in nonviolent individuals. Individuals who engaged in bidirectional IPV were more likely to endorse interpersonal functions of self-injury than those who engaged in unidirectional IPV or no IPV. In contrast, intrapersonal functions of NSSI were not associated with IPV. Findings suggest that the association between IPV and NSSI may be best understood in the context of relationship conflict, rather than as a distinct correlate of either IPV victimization or IPV perpetration. [ABSTRACT FROM AUTHOR]

Background: Registered midwives in British Columbia (BC) are primary health care practitioners for healthy people throughout pregnancy and for approximately 6 weeks postpartum. BC registered midwives are authorized to prescribe and administer certain vaccines to adults under their care during the perinatal period and hepatitis B vaccine to high‐risk newborns. However, little has been documented about their recommendations for, and administration of, prenatal and infant vaccinations. This study surveyed midwives currently practicing in British Columbia to understand their vaccination practices. Methods: An online survey was administered to the members of the Midwives Association of BC in spring 2018. Outcome measures were the proportion of midwives who discussed, recommended, and administered the following vaccines: influenza, varicella, rubella, and infant hepatitis B. The proportion of midwives who discussed and recommended infant vaccines was measured. Barriers to discussion, recommendation, and administration of vaccines were captured. Results: Sixty‐three percent of 108 respondents administered vaccines to their clients. Hepatitis B and rubella were the most frequent vaccines administered. Logistical concerns were the greatest barrier to vaccine administration. This was followed by the perception that vaccine administration is not within the scope of practice of midwives, especially for influenza vaccine. Midwives who administered vaccines were significantly more likely to discuss and recommend vaccines to their clients and their infants. Conclusions: The majority of BC midwives discuss, recommend, and administer vaccines to their clients. Our survey highlighted key areas to address to strengthen midwifery capacity to discuss, recommend, and provide prenatal and infant vaccines. [ABSTRACT FROM AUTHOR]

Domestic violence is a widespread issue, with victims suffering emotional and physical harm and severe cases resulting in homicide. Media presentation of extreme instances of domestic homicide may affect public opinion and related public policies. This study examines the presentation of homicide in print news media in the context of victim–offender relationship (domestic vs. non-domestic) using measures of article prominence. The sample includes articles published in the Vancouver Sun over a 12-year period (2004-2015) that reported on a homicide in British Columbia, Canada, with nature of the victim–offender relationship specified (n = 3,877). Results show that domestic-related homicides are reported less prominently than are non-domestic homicides, including being shorter in length, less likely to be placed on the front page, and less likely to include an image. Results are discussed in light of media impact on public opinion and the influence on public efforts to address and prevent the consequences of domestic violence. [ABSTRACT FROM AUTHOR]

Physical dating violence (PDV) victimization among adolescents is a serious global problem. Although knowledge of trends in PDV victimization can help guide programming and health policies, little research has examined whether the prevalence of PDV victimization has increased, decreased, or remained stable over time among non-U.S.-based samples of youth. In addition, few studies have directly tested whether disparities in PDV victimization between boys and girls have narrowed, widened, or remained unchanged in recent years. To address these gaps, we used school-based data from the British Columbia Adolescent Health Survey (BC AHS) of 2003, 2008, and 2013 (n boys = 18,441 and n girls = 17,459) to examine 10-year trends in PDV victimization. We also tested whether trends differed across self-reported sex. Data from the 2003 to 2013 BC AHS revealed that recent PDV victimization rates had significantly decreased among youth overall (5.9%-5.0%) and boys (8.0%-5.8%), but not girls (5.3%-4.2%). Although boys had steeper declines than girls in PDV victimization rates, year-by-sex interactions indicate that the sex gap in PDV victimization had not significantly narrowed. Moreover, rates of PDV victimization over the 10-year period indicated significantly higher rates of PDV victimization among boys compared with girls. Despite positive declines in recent rates of PDV victimization among youth, important differences in rates of PDV victimization between boys and girls remain. These findings underscore the need for greater attention to sex differences in research and programming and health policies to reduce PDV victimization and the sex disparities therein. [ABSTRACT FROM AUTHOR]

Background: We assessed the prevalence and trends in racial discrimination among African Canadian adolescents in British Columbia. The association between racial discrimination and self-rated health, access to mental health services, substance use, suicidal thoughts and attempts, experience of extreme stress, among others were examined within the 2018 dataset. Methods: Secondary analysis used the data collected from African Canadian adolescents (n = 2448) as part of the British Columbia Adolescent Health Surveys (2003–2018). We examined whether racial discrimination increased, decreased, or remained stable over time. We evaluated experiences of racial discrimination for all adolescents, and then disaggregated analyses for boys, girls, immigrant, and Canadian-born African adolescents. We used Rao-Scott's adjusted chi-square to test differences in racial discrimination and adjusted logistic regressions to test trends across survey years, widening or narrowing gaps in racial discrimination, as well as the link to health outcomes. Results: Racial discrimination was significantly different across the survey years (Adjusted F = 4.60, p <.01), with the highest percentage of adolescents reporting past year racial discrimination in 2018 (29.9%) and the lowest percentage in 2013 (21.3%). Girls and immigrant African Canadian adolescents were more likely to have experienced racial discrimination. However, girls and Canadian-born adolescents had the highest odds of reporting racial discrimination in 2018 compared to 2003, AOR = 1.85, and 1.58, respectively. The findings reveal significant differences in the experiences of racial discrimination for boys and girls, as well as for immigrant and Canadian-born African adolescents. Significant differences were noted in the link between racial discrimination and self-rated health and engaging in behaviours that might expose them to health risks. The worst negative health outcomes were found for boys and immigrant African Canadian adolescents. Conclusion: The study suggests that more than 1 in 4 African Canadian adolescents in British Columbia report racial discrimination, which is an increasing trend in recent years. Those who reported racial discrimination also had the worst adverse health outcomes. There is a need for more public health action to reduce racism, create awareness about the negative health impacts, and provide better support for African Canadian adolescents. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Dental Hygiene is the property of Canadian Dental Hygienists Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

PURPOSE There is limited evidence to support the routine use of conformal radiotherapy (RT) techniques in the treatment of bone metastases. This study evaluated trends in advanced technique use within the province of British Columbia. MATERIALS AND METHODS Data on patients who received RT for bone metastases between 2009 and 2016 (with the exception of 2012) at 6 regional cancer centers were reviewed. Descriptive statistics summarized radiation technique patterns. Logistic regression assessed the influence of patient, treatment, and provider variables on receipt of RT technique. RESULTS A total of 24,215 RT courses were identified; 97% were planned by simple RT and 3% by advanced techniques (3-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and stereotactic body radiotherapy). The use of advanced techniques was significantly higher in recent years compared with in 2009 (odds ratios [ORs], 2.2, 4.2, 4.2, and 6.3, respectively, for the years 2013 to 2016; P, .001). Patients with thyroid, sarcoma, and neuroendocrine malignancies (ORs, 10.3, 5.5, and 5.2, respectively; P, .005) were more likely to be treated with advanced techniques, as were skull, sternum, rib, and pelvic metastases (ORs, 8.0, 5.2, 2.2, and 2.2, respectively; P, .001). Advanced techniques were most commonly used in the setting of reirradiation (38%). They were associated with slightly higher incompletion rates (3.0% v 1.5%, P, .005) and less use within 30 days of death (6% v 15%, P, .001). CONCLUSION Within our publicly funded, salary-based provincial health care system, we found that the majority of bone metastases are still being treated by simple RT; however, the use of advanced techniques is increasing, and we identified select patterns in which they are being prescribed. Additional study into clinical benefit is required. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to compare the factors related to heavy drinking among British Columbia (BC) Asian adolescents and South Korean adolescents. Design and Methods: A cross‐sectional descriptive design was used. Participants were 72,422 adolescents (12,382 BC Asian adolescents and 60,040 South Korean adolescents) from the 2018 BC Adolescent Health Survey and the 2018 Korean Youth Risk Behavior Web‐Based Survey. Complex samples descriptive statistics, Rao–Scott χ2 tests, and complex samples logistic regression analyses were performed. Results: Heavy drinking was reported by 8.6% of BC Asian adolescents and 7.7% of South Korean adolescents. Asian adolescents in BC and South Korea shared six risk factors and one protective factor linked to odds of heavy drinking. The strongest risk factor for heavy drinking in each region was current cigarette smoking. Other risk factors for heavy drinking included older age/higher grade (10/12th), early initiation of sexual intercourse (age 14 or younger), experiences of bullying, depression, and exercise. The only protective factor for heavy drinking, sufficient sleep, was similar in both regions. Practice Implications: This study suggests several nursing interventions and health promotion strategies to help us to prevent or reduce heavy drinking for BC Asian adolescents and South Korean adolescents. [ABSTRACT FROM AUTHOR]

Background: The use of diet and physical activity in alleviating the burden of migraine is unclear, therefore, more scientific study on the role of positive health behaviors in migraine management is needed. Objective: To explore the potential moderating influence of positive health behaviors on the early life stress‐migraine relationship in a sample of the Canadian adult population. Methods: This study used data from the 2011‐2012 Canadian Community Health Survey – Annual Component, a National cross‐sectional survey. Adults ≥18 years of age residing in British Columbia were surveyed about stressors experienced as children/teenagers (eg, parental divorce and substance abuse exposure). Migraine was self‐report of health‐professional diagnosis. Positive health behaviors were measured using an index of transportation and leisure time physical activity, and self‐reported frequency of vegetable and fruit consumption. Population survey weights were employed throughout and analytic models were adjusted for known confounders (nunweighted = 11,910). Results: The weighted prevalence of migraine was 9.7% (95% CI: 9.1%, 10.2%). Odds of migraine increased as number of stressors increased: 1 early life stressor (OR = 1.18, 95% CI: 1.01, 1.39), and ≥ 2 early life stressors (OR = 1.51, 95% CI: 1.29, 1.76), compared to no stress. There was evidence of effect modification by physical activity (χ2(4) = 16.02, P <.001). The association between 1 early life stressor and migraine was lower for those who were physically active (moderately active: OR = 1.20, 95% CI: 0.90, 1.61; active: OR = 0.82, 95% CI: 0.61, 1.11). This difference was not apparent for those who experienced 2 or more early life stressors (moderately active: OR = 1.67, 95% CI: 1.28, 2.17; active: OR = 1.55, 95% CI: 1.21, 1.99). Across all levels of early life stress, physically active respondents had lower odds of migraine than moderately active respondents. There was no effect modification by vegetable, fruit, and total fruit/vegetable consumption. Conclusions: Stressors experienced early in life are associated with migraine, and physical activity may ameliorate this relationship, particularly for those with exposure to a minimal level of early life stress. A higher dose of physical activity may yield greater benefit than a less intensive dose (ie, moderate activity level). However, the cross‐sectional nature of this study precludes us from inferring causality, and future investigation requires prospectively collected data. [ABSTRACT FROM AUTHOR]

Purpose: This study explores the relationship between rural residency, selected protective factors (family and school connectedness along with prosocial peer attitudes), and health‐compromising behaviors (alcohol and tobacco use and nonuse of seatbelt) among adolescents. Methods: A subsample of adolescents residing in remote areas was extracted from a province‐wide, school‐based survey in British Columbia (BC), Canada (weighted N = 2,999). We employed χ2 statistic to test rural‐urban differences separately by gender. Logistic regression analysis was used to examine the relationship between protective factors and behaviors compromising health. Findings: In boys, rural residency was associated with multiple problem behaviors (binge drinking, smokeless tobacco use, and nonuse of seatbelt), whereas for girls it was linked to riding without a seatbelt. The final logistic regression models confirmed that rural environment was a significant risk factor for not wearing a seatbelt among both boys and girls, and smokeless tobacco among boys (adjusted odds ratio between 1.44 and 3.05). Rurality, on the other hand, did not predict binge drinking. Logistic regression analyses also revealed that both school connectedness and prosocial peer attitude protected boys against binge drinking and smokeless tobacco, but the results were not as robust for girls. Conclusions: These findings could provide information for location‐based intervention efforts promoting adolescent health, highlighting the protective role of the school atmosphere and prosocial peer relationships, especially among boys. [ABSTRACT FROM AUTHOR]

Patient and visitor hand hygiene (HH) interventions have been demonstrated to reduce the rate of healthcare-associated infections. Observational audits on the oncology/ hematology/bone marrow transplant inpatient unit at British Columbia Children's Hospital indicated that patient, family, and visitor HH was sub-optimal with a compliance rate of 3.3%. Despite creating interventions aimed at improving this, the post-intervention rate only increased to 4.2% (not significant, p>0.05). Future work will include investigating barriers to accessing and utilizing these resources. [ABSTRACT FROM AUTHOR]

Introduction. Information on the psychosocial distress and needs of sarcoma patients at diagnosis is sparse. The Canadian Problem Checklist (CPC) and Psychosocial Screen for Cancer-Revised (PSSCAN-R) are validated tools to identify cancer patients' distress and are administered to all new patients referred to BC Cancer prior to their consultation. We used the CPC and PSSCAN-R to understand sarcoma patients' needs at the initial oncology consultation in British Columbia, Canada. Materials and Methods. All sarcoma patients who completed the CPC and PSSCAN-R within 6 months of diagnosis between 2011 and 2016 were included. The retrospective chart review identified baseline demographics: age, performance status, disease location, resectability, and histology. Analysis was conducted using descriptive statistics, chi-squared test, Fisher's exact test, and Kaplan–Meier method. Results. 413 sarcoma patients were identified. The majority of patients were over the age of 40 (83.3%) with ECOG performance status 0-1 (82.6%) and lower extremity tumors (55.4%). The most common diagnoses were liposarcoma 21.3%, undifferentiated pleomorphic sarcoma 12.1%, and myxofibrosarcoma 11.1%. At the initial consultation, 42.6% of patients were deemed resectable, 8.5% unresectable/metastatic, and 48.9% required further staging investigations. The top three patient-reported distress symptoms were feeling tense and unable to relax (50%), feeling nervous and shaky (48%), and experiencing repetitive and scary thoughts (42%). 38% of patients had subclinical/clinical anxiety symptoms, and 21% of patients had subclinical/clinical depression symptoms. 5% of patients expressed suicidal ideation. The top three concerns/needs were understanding of illness/treatment (45.5%), fear/worries (45.3%), and worry about family (23%). No differences in overall survival were identified for patients displaying symptoms of depression or anxiety versus no symptoms. Discussion. Up to 45% of sarcoma patients experience some form of psychological distress at disease presentation. Patients desire information about their diagnosis and treatment. Tailored interventions to individual psychological comorbidity and improved patient education resources would be beneficial. [ABSTRACT FROM AUTHOR]

Purpose: To assess the documentation of late-effects (LE) risks and screening recommendations in medical records of adolescent and young adult central nervous system (CNS), soft tissue, and bone tumor survivors. Methods: The medical records of all patients diagnosed with a CNS neoplasm, an arteriovenous malformation, a soft tissue, and bone tumor, at ages 15–39 years, treated between 1985 and 2010 with radiation therapy in the province of British Columbia, Canada, surviving >5 years, alive, and discharged to the community were assessed. The documentation of LE risks and screening recommendations were analyzed descriptively. Results: In the medical records of 132 CNS tumor survivors and 94 soft tissue or bone tumor survivors, 15% and 13% included no documentation of LE risks, 21% and 22% included only nonspecific documentation, and 64% and 65% minimal documentation, respectively. Documentation of at least one specific LE risk increased significantly among CNS tumor patient charts (from 29% in 1980–1989, to 67% in 1990–1999, to 88% in 2000–2010, χ2 [2, N = 132] = 32.257, p < 0.000) and soft tissue or bone tumor patient charts (from 47% [1980–1989] to 56% [1990–1999] to 78% [2000–2010], χ2 [2, N = 94] = 6.702, p = 0.035). There was no documentation of a screening recommendation in 75% of CNS tumor patient charts and 91% of soft tissue and bone tumor charts. Conclusion: The documentation of LE risks and screening recommendations has been limited, highlighting the need to improve written communication with primary care providers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate prospective surveillance and targeted physiotherapy (PSTP) compared to education (EDU) on the prevalence of arm morbidity and describe the associated program cost. Design: Pilot randomized single-blinded controlled trial. Setting: Urban with assessments and treatment delivered in hospitals. Participants: Women scheduled for breast cancer surgery. Interventions: Participants were randomly assigned (1:1) to PSTP (n = 21) or EDU (n = 20) and assessed presurgery and 12 months postsurgery. All participants received usual care, namely, preoperative education and provision of an education booklet with postsurgical exercises. The PSTP group was monitored for arm morbidity every three months and referred for physiotherapy if arm morbidity was identified. The EDU group received three education sessions on nutrition, stress and fatigue management. Main outcome measures: Arm morbidity was based on changes in the surgical arm(s) from presurgery in four domains: (1) shoulder range of motion, (2) strength, (3) volume, and (4) upper body function. Complex arm morbidity indicated ≥2 domains impaired. Second, the cost of the PSTP program was described. Results: At 12 months, 18 (49%) participants (10 PSTP and 8 EDU) had arm morbidity, with EDU participants presenting more complex arm morbidity compared to PSTP participants. PSTP participants attended 4.4 of 5 assessments with 90% retention. The PSTP program cost was $150 covered by the Health Care Provider and the Patient Out-of-Pocket Travel cost was CAN$40. Conclusion: Our results suggest that PSTP is feasible among women with breast cancer for early identification of arm morbidity. A larger study is needed to determine the cost and effectiveness benefits. [ABSTRACT FROM AUTHOR]

The article discusses a study that obtained sound levels and acoustic characteristic data in classroom serving children who are deaf and hard of hearing in grades K-2 in Canada and the U.S. Study highlights include signal-to-noise ratio recommended by the American Speech-Language-Hearing Association, sources of classroom noise, and the concept of the inverse square law.

Background: Studies assessing the prevalence of depression and anxiety in multiple sclerosis (MS) have used various ascertainment methods that capture different constructs. The relationships between these methods are incompletely understood. Psychiatric comorbidity is associated with lower health-related quality of life (HRQOL) in MS, but the effects of past diagnoses of depression and anxiety on HRQOL are largely unknown. We compared the prevalence of depression and anxiety in persons with MS using administrative data, self-reported physician diagnoses, and symptom-based measures and compared characteristics of persons classified as depressed or anxious by each method. We evaluated whether HRQOL was most affected by previous diagnoses of depression or anxiety or by current symptoms. Methods: We linked clinical and administrative data for 859 participants with MS. HRQOL was measured by the Health Utilities Index Mark 3. We classified participants as depressed or anxious using administrative data, self-reported physician diagnoses, and the Hospital Anxiety and Depression Scale. Multivariable linear regression examined whether diagnosed depression or anxiety affected HRQOL after accounting for current symptoms. Results: Lifetime prevalence estimates for depression were approximately 30% regardless of methods used, but 35.8% with current depressive symptoms were not captured by either administrative data or self-reported diagnoses. Prevalence estimates of anxiety ranged from 11% to 19%, but 65.6% with current anxiety were not captured by either administrative data or self-reported diagnoses. Previous diagnoses did not decrease HRQOL after accounting for current symptoms. Conclusions: Depression and, to a greater extent, anxiety remain underdiagnosed and undertreated in MS; both substantially contribute to reduced HRQOL in MS. [ABSTRACT FROM AUTHOR]

Reports of a primary care shortage are ubiquitous in Canada and the United States. We used a population-based, retrospective cohort study to examine the extent to which the feminization and aging of the primary care physician workforce and secular trends may contribute to changes in the availability of primary care services. We used billing data for all primary care physicians in British Columbia for the period 2005-12. We used multivariate linear mixed-effects models to study physician remuneration and activity levels. We found limited change in per physician remuneration over the study period. However, numbers of patient contacts and practice sizes (numbers of unique patients) declined by 14 percent and 10 percent, respectively. Although the feminization of the workforce--and, to a lesser extent, its aging--contributed to this decline, the primary driver appears to be a broad trend toward reduced clinical activity over time. To the extent that similar trends are occurring in the United States, the implications of our study for the availability of primary care services beyond Canada are potentially significant. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The prevailing theoretical model of the Schizotypal Personality Questionnaire (SPQ) is a three-factor model based on subscale-level analyses. However, recent item-level factor analyses of the SPQ suggest a four- or five-factor model. To examine the factor structure of the SPQ and how this structure may differ between undergraduate and community samples, the authors conducted exploratory and confirmatory item-level factor analyses of this measure on undergraduate ( N = 1,850) and community participants ( N = 1,464). A clear three-factor solution was found in the community sample, whereas a somewhat equivocal four-factor solution was found in the undergraduate sample. Both structures displayed gender invariance. This is the first study to address the issues of undergraduate sample generalizability and gender invariance in an item-level exploratory factor analysis of the SPQ. Given the disparate findings in the samples, this study indicates the importance of using both community and undergraduate samples when examining the factor structure of the SPQ. [ABSTRACT FROM AUTHOR]

Isocyanates such as toluene 2, 4-diisocyanate (TDI), methylene bisphenyl isocyanate (MDI), and hexamethylene diisocyanate (HDI) are known sensitizers and exposure to these chemicals can result in isocyanate-induced asthma—the leading cause of occupational asthma. A newly created exposure database was available containing occupational isocyanate measurements spanning 1981–1996 from Ontario and British Columbia (BC)—two of the largest provinces in Canada. The aim was to describe the historical measurements relative to exposure thresholds, ascertain differences in the data between provinces, and identify time trends. Descriptive statistics of the observations were summarized and stratified by isocyanate species and province. Chi-square tests and Student'st-testwere performed to determine differences between provinces. To investigate time trends in the odds of a measurement exceeding the limit of detection (LOD) and time-weighted average (TWA), mixed effects logistic regression models were constructed. In total, 6,984 isocyanate measurements were analyzed, the majority of which were below the LOD (79%). Overall, 8.3% of samples were in excess of the 2014 TLV-TWA of 0.005 ppm. Comparing the two provinces, the proportion of samples exceeding the LOD and TLV-TWA was greater in BC for all isocyanate species. Differences in time trends were also observed between provinces—the odds of a sample exceeding the TLV-TWA decreased over time in the case of MDI (Ontario only), TDI (both Ontario and BC), and other isocyanates (BC only). Our finding that a majority of the exposure measurements was below the LOD is similar to that reported by others. Differences between provinces may be due the fact that isocyanates are classified as a designated substance in Ontario and must adhere to specific exposure control regulations. Limitations of the database, such as finite number of variables and measurements available until 1996 only, presents challenges for more in-depth analysis and generalization of results. An argument is made that a Canadian occupational exposure database be maintained to facilitate risk assessments as well as for occupational epidemiology research. [ABSTRACT FROM PUBLISHER]

Objectives. Our objective is to contribute to the literature regarding the association between immigrant children's health, their ethnicity and their living in neighbourhoods with a high ethnic concentration of one's own ethnicity. Using data from families from five ethnic groups who all immigrated to Vancouver metropolitan region in Canada, our research question asks: How ethnicity, ethnic concentration and living in a neighbourhood with others of the same ethnic background contribute to the health of immigrant children? Design. Two data sets are integrated in our study. The first is the New Canadian Children and Youth Study, which collected original data from five ethnic groups who immigrated to metropolitan Vancouver. The second data set, from which we derived neighbourhood data, is the Canadian census. The dependent variable is health status as reported by the parent. Independent variables are at both the individual and neighbourhood levels, including ethnicity, sex and the percentage of people living in the neighbourhood of the same ethnic background. Analysis was completed using hierarchical linear modelling. Results. Children (n = 759) from 24 neighbourhoods were included in the analyses. Health status varied by ethnicity and ethnic concentration, indicating the heterogeneity of immigrant populations. Conclusion. With the lack of research on the health of immigrant children and youth living in ethnic concentrations, our findings make an important contribution to understanding the influences on the well-being of immigrant populations. [ABSTRACT FROM PUBLISHER]

Aim: The aim of the study was to evaluate and refine the eight‐factor structure of the 31 item McCloskey/Mueller Satisfaction Scale, which is one of the most widely used scales for measuring job satisfaction among nurses. However, this scale was developed in 1990 for the American nursing context and its psychometric validity and utility for use with non‐American nurse populations have been questioned by various researchers. Background: The eight‐factor, 31‐item McCloskey/Mueller Satisfaction Scale is one of the most widely used scales for measuring job satisfaction among nurses. However, this scale was developed in 1990 for the American nursing context, and its psychometric validity and utility for use with non‐American nurse populations have been questioned by various researchers. Methods: Data from a sample of 1007 Canadian nurses who were working in hospital and community settings were analyzed by using an exploratory factor analysis with varimax rotation. Results: The original factor structure of the McCloskey/Mueller Satisfaction Scale was unable to be replicated. The best‐fitting model that was obtained was a five‐factor model with 25 items. The Cronbach's alphas for the new McCloskey/Mueller Satisfaction Scale subscales ranged from 0.71 to 0.87, which indicated stronger internal consistency than the original subscales (α = 0.52–0.84). Conclusion: The reliability and structural validity of the revised 25 item instrument suggest that it is a potentially sound tool for measuring nurses’ job satisfaction. As a result of its sound dimensionality, it could be particularly useful when investigating individual and work factors that impact nurse job satisfaction or when evaluating the outcomes of organizational interventions that are aimed at increasing job satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: to measure sex differences in the risk of receiving potentially inappropriate prescription drugs and to examine what are the factors that contribute to these differences. Design: a retrospective cohort study. Setting: community setting of British Columbia, Canada. Participants: residents of British Columbia aged 65 and older (n = 660,679). Measurements: we measured 2013 period prevalence of prescription dispensations satisfying the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. We used logistic regressions to test for associations between this outcome and a number of clinical and socioeconomic factors. Results: a larger share of women (31%) than of men (26%) filled one or more potentially inappropriate prescription in the community. The odds of receiving potentially inappropriate prescriptions are associated with several clinical and socioeconomic factors. After controlling for those factors, community-dwelling women were at 16% higher odds of receiving a potentially inappropriate prescription than men (adjusted odds ratio = 1.16, 95% confidence interval = 1.12-1.21). Much of this sex difference stemmed from women's increased odds of receiving potentially inappropriate prescriptions for benzodiazepines and other hypnotics, for tertiary tricyclic antidepressants and for non-selective NSAIDs. Conclusion: there are significant sex differences in older adults' risk of receiving a potentially inappropriate prescription as a result of complex intersections between gender and other social constructs. Appropriate responses will therefore require changes in the information, norms and expectations of both prescribers and patients. [ABSTRACT FROM AUTHOR]

Background Coeliac disease is a chronic autoimmune disease that requires strict adherence to a gluten-free diet. However, strict adherence to a gluten-free diet is difficult, with findings from a recent review suggesting that up to 42% of individuals with coeliac disease do not eat a strict gluten-free diet. Methods The present study aimed to examine psychosocial predictors of adherence (purposeful and accidental) to a gluten-free diet among adults with coeliac disease over a 1-month period. In this longitudinal study, 212 North American adults with coeliac disease completed online questionnaires at two time points, baseline and 1 month later. Results The results revealed that intentions partially mediated the effects of symptom severity, self-regulatory efficacy, planning and knowledge on purposeful gluten consumption. Intentions did not mediate the effects of severity, response cost, self-regulatory efficacy, planning and knowledge for accidental gluten consumption but, interestingly, self-regulatory efficacy directly predicted fewer accidental incidents of gluten-consumption. Conclusions These findings delineate the differential psychological processes in understanding accidental and purposeful gluten consumption among adults with coeliac disease and emphasise the importance of bolstering self-regulatory efficacy beliefs to prevent accidental and purposeful consumption of gluten. [ABSTRACT FROM AUTHOR]

Many psychological scales written in the Likert format include reverse worded (RW) items in order to control acquiescence bias. However, studies have shown that RW items often contaminate the factor structure of the scale by creating one or more method factors. The present study examines an alternative scale format, called the Expanded format, which replaces each response option in the Likert scale with a full sentence. We hypothesized that this format would result in a cleaner factor structure as compared with the Likert format. We tested this hypothesis on three popular psychological scales: the Rosenberg Self-Esteem scale, the Conscientiousness subscale of the Big Five Inventory, and the Beck Depression Inventory II. Scales in both formats showed comparable reliabilities. However, scales in the Expanded format had better (i.e., lower and more theoretically defensible) dimensionalities than scales in the Likert format, as assessed by both exploratory factor analyses and confirmatory factor analyses. We encourage further study and wider use of the Expanded format, particularly when a scale’s dimensionality is of theoretical interest. [ABSTRACT FROM AUTHOR]

Background: Children diagnosed with cancer often require extensive care for medical, psychosocial and educational problems during and after therapy. Part of this care is provided by family physicians and non-cancer specialists, but their involvement in the first years after diagnosis has barely been studied. Studying non-oncology physician visits may provide insight into the roles of different health care providers. Methods: We included 757 children diagnosed with cancer under age 15 between 1991 and 2001 from a Canadian provincial registry, and matched each to 10 controls of the same birth year and sex. We determined the number of family physician and non-cancer specialist visits in the 5 years after diagnosis (for patients) or inclusion (for controls) using data from the provincial health insurance plan. Results: In the first year after diagnosis, almost all patients visited both a family physician and non-cancer specialist. Although after 5 years percentages decreased to 85 and 76 %, respectively, these were still significantly higher than in controls. In the first year after diagnosis, both family physicians and non-cancer specialists were often consulted for neoplasms (62 and 90 %, respectively) and to discuss results of lab tests. In addition, family physicians were often consulted for general symptoms and non-cancer specialists for nervous system problems and complications of medical care. Conclusions: Family physicians and non-cancer specialists are highly involved in the care for children with cancer in the first years after diagnosis, including for health problems related to cancer or its treatment. This necessitates good communication among all physicians. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) represent almost half of new HIV infections in Canada each year. However, the vast majority of research on HIV testing among MSM has been conducted in major urban centres. The present study addressed this gap by investigating HIV testing behaviour and predictors of HIV testing among MSM living outside major urban centres, in the Interior of British Columbia. An anonymous online survey of 153 MSM assessed HIV testing behaviour and psychosocial factors that may impact HIV testing (internalized homophobia, disclosure to healthcare providers (HCPs) of same sex attraction, and gay community involvement). Almost one-quarter (24%) had never been tested and over one-third (35%) had not disclosed same sex attraction to HCPs. Internalized homophobia was associated with a lower likelihood of HIV testing, and this relationship was partially explained by the fact that those high in internalized homophobia were less likely to disclose same sex attraction to their HCPs. Neither formal nor informal involvement in the gay community was related to HIV testing, and both types of involvement were relatively low in our sample. Further research is needed to better understand the distinctive health issues facing MSM living outside major urban centres. [ABSTRACT FROM PUBLISHER]

Comparing Measurements of CT Angiography, TEE, and Fluoroscopy Background Left atrial appendage (LAA) closure requires accurate preprocedural measurements, and trans-esophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) and fluoroscopy can be utilized. However, correlations between these measurements remain inadequately assessed. Methods Patients who underwent LAA closure at Vancouver General Hospital who had baseline LAA measurements by CCTA, TEE, and fluoroscopy were included in this analysis. CCTAs were performed with prospective-ECG-gating with Toshiba 320-detector or Siemens second generation 128-slice dual-source scanners, and images interpreted with VitreaWorkstation.™ LAA maximal dimensions were obtained for all patients at: (1) Amplatzer Cardiac Plug (ACP)/Amulet landing zone 10 mm within orifice, (2) WATCHMAN ostium, and (3) WATCHMAN depth measurements. Correlations and agreements were compared. Results We report 50 consecutive patients who underwent LAA closure (8 ACP, 10 Amulet, 32 WATCHMAN). Average age was 75.2 ± 8.7 years, mean CHADS2 score 3.0 ± 1.3, and CHA2DS2-VASc 4.7 ± 1.5. Procedural device implantation success was 100%. For ACP landing zone, mean maximal measurements were 24.1 ± 4.7 mm with CCTA, 22.3 ± 4.9 mm TEE, and 19.9 ± 5.6 mm fluoroscopy (P < 0.001); R value 0.81 fluoroscopy/CTA, 0.67 fluoroscopy/TEE, and 0.80 CTA/TEE. For WATCHMAN ostium, mean maximal measurements were 25.8 ± 4.7 mm CCTA (P < 0.001 vs. fluoroscopy, P = 0.16 vs. TEE), 25.1 ± 4.4 mm TEE (P = 0.016 vs. fluoroscopy), and 23.8 ± 4.9 mm fluoroscopy; R value 0.71 fluoroscopy/CTA, 0.65 fluoroscopy/TEE, and 0.74 CTA/TEE. Depth measurements were 34.3 ± 5.7 mm with CCTA, 31.1 ± 6.5 mm TEE, and 27.8 ± 7.1 mm fluoroscopy (all P < 0.01); and correlations with R value 0.28 fluoroscopy/CTA, 0.22 fluoroscopy/TEE, and 0.56 CTA/TEE. Conclusions All 3 imaging modalities correlated with ACP landing zone and WATCHMAN ostium measurements, with CCTA providing the largest measurements, followed by TEE and fluoroscopy. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Health care aides (HCAs) provide most direct care in long-term care (LTC) and home and community care (HCC) settings but are understudied. We validate three key work attitude measures to better understand HCAs' work experiences: work engagement (WEng), psychological empowerment (PE), and organizational citizenship behavior (OCB-O). Design and Methods: Data were collected from 306 HCAs working in LTC and HCC, using survey items for WEng, PE, and OCB-O adapted for HCAs. Psychometric evaluation involved confirmatory factor analysis (CFA). Predictive validity (correlations with measures of job satisfaction and turnover intention) and internal consistency reliability were examined. Results: CFA supported a one-factor model of WEng, a four-factor model of PE, and a one-factor model of OCB-O. HCC workers scored higher than LTC workers on Self-determination (PE) and lower on Impact, demonstrating concurrent validity. WEng and PE correlated with worker outcomes (job satisfaction, turnover intention, and OCB-O), demonstrating predictive validity. Reliability and validity analyses indicated sound psychometric properties overall. Implications: Study results support psychometric properties of measures of WEng, PE, and OCB-O for HCAs. Knowledge of HCAs' work attitudes and behaviors can inform recruitment programs, incentive systems, and retention/training strategies for this vital group of care providers. [ABSTRACT FROM AUTHOR]

Purpose A nurse navigator (NN) pilot project for patients with lung cancer was implemented in British Columbia, a publicly funded health-care system. The purpose was to improve referral practices, timelines, and availability of molecular testing for patients with advanced non-small-cell lung cancer (NSCLC). Methods Patients with stage IIIB/IV NSCLC referred to the BC Cancer Agency, Vancouver, in 2011 and 2014, pre- and post-implementation of an NN, were included. Referral patterns, systemic therapy, radiotherapy (XRT) timelines, and molecular testing practices were compared. Results The study included 408 patients: 212 in 2011 and 196 in 2014. Medical oncology (MO) end points comparing 2011 data with 2014 findings revealed that referral rates remained stable, and the proportion of patients who received systemic therapy increased from 57% to 69% (P = .05). Time from referral to MO consult was 18 days in 2011 versus 15.5 days in 2014 (P = .11); referral to systemic treatment was reduced from 48 to 38 days (P = .016). Comparison of molecular testing showed time between referral and the epidermal growth factor (EGFR) result was reduced from 34 days in 2011 to 20 days in 2014 (P < .001); rates of testing increased from 62% to 91%, respectively (P < .001); and EGFR mutation-positive rates were 19% versus 26%, respectively (P = .26). The radiation oncology (RO) end point results were as follows: 87% of patients were referred for RO consults in 2011 versus 80% in 2014 (P = .05), and the same proportion of patients received XRT (91% v87%, respectively). Time from referral to RO consult decreased from 10 days in 2011 to 8 days in 2014 (P = .005); and referral toXRT in 2011 and 2014 was 18 days versus 11.5 days, respectively (P < .001). Conclusion Implementation of an NN was associated with reduced wait times and increased molecular testing, improving appropriate delivery of first-line targeted therapy. NN involvement facilitates correct allocation of physician and clinical resources. [ABSTRACT FROM AUTHOR]

Objectives To compare the fall characteristics of individuals with and without Parkinson's disease ( PD) through the analysis of real-life falls captured on video. Design Observational cohort study. Setting Two long-term care facilities in British Columbia, Canada. Participants Individuals living in long-term care (N = 306; 16 with PD). Measurements Falls captured on video and analyzed (N = 906; 71 in participants with PD). Generalized estimating equation models were used to examine differences in fall characteristics between participants with and without PD. Results Individuals with PD were 1.3 times as likely as those without PD to fall because of incorrect weight shifting (95% confidence interval ( CI) = 1.03-1.65). Secondary steps during the fall event were 1.5 times as likely to be short in individuals with PD as in those without (95% CI = 1.23-1.78). Individuals with PD were also 1.6 times as likely to attempt to recover balance by reaching to grasp an external object (95% CI = 1.13-2.15) and 5.0 times as likely to secure grasp of the object (95% CI = 1.23-20.0). Conclusion Along with greater likelihood for individuals with PD to fall because of incorrect weight shifting, differences between groups were found in reactive stepping responses. This first detailed evidence of the characteristics of falls in PD should help to inform fall and injury prevention approaches for clinicians and rehabilitation professionals working with individuals with PD. [ABSTRACT FROM AUTHOR]

Suboptimal vitamin B12 (B12) status has been associated with an increased risk of congenital anomalies, preterm birth, and childhood insulin resistance. South Asians - Canada's largest minority group - and women of reproductive age are vulnerable to B12 deficiency. This study aimed to assess the prevalence of and factors associated with B12 deficiency and suboptimal B12 status in a convenience sample of young adult women of South Asian and European descent in Metro Vancouver. We measured serum B12, holotranscobalamin, plasma methylmalonic acid, red blood cell and plasma folate, and hematologic parameters in 206 nonpregnant, healthy women aged 19-35 years. Categorization for B12 status adhered to serum B12 cutoffs for deficiency (<148 pmol/L) and suboptimal B12 status (148-220 pmol/L). We collected demographic, lifestyle, and dietary intake data and conducted genotyping for common genetic variants linked to B-vitamin metabolism. The prevalence of deficiency and suboptimal B12 status were 14% and 20%, respectively. Serum vitamin B12 concentrations were negatively associated with oral contraceptive use and first-generation immigrant status, and positively with dietary B12 intake and B12 supplement use. The prevalence of B12 inadequacy in this sample of highly educated women is higher than in the general Canadian population. In light of maternal and fetal health risks associated with B12 inadequacy in early-pregnancy, practitioners should consider monitoring B12 status before and during early pregnancy, especially in immigrants and women with low dietary B12 intakes including non-users of vitamin supplements. [ABSTRACT FROM AUTHOR]

Background: Small kidneys due to renal hypodysplasia (RHD) result from a decrease in nephron number. The objectives of this study were to identify clinical variables that determine long-term renal outcome in children with RHD and to define the role of kidney size as a predictor of developing end-stage renal disease (ESRD). Methods: This was a single-center retrospective cohort analysis. The primary outcome was development of ESRD. We identified 202 RHD cases, with 25 (12 %) reaching ESRD at mean age of 8.9 (±6.6) years. Results: Children with RHD with a known genetic syndrome had the smallest kidneys while those with posterior urethral valves (PUV) had the largest kidneys at diagnosis. Cases with bilateral RHD were most likely to develop ESRD. Younger gestational age (OR 0.8, CI 0.69-0.99, p = 0.05), smaller kidney size at diagnosis (OR 0.13, CI 0.03-0.47, p = 0.002), lower best-estimated glomerular filtration rate (eGFR) (OR 0.74, CI 0.58-0.93, p = 0.01), proteinuria (OR 1.03, CI 1.01-1.05, p < 0.001) and high blood pressure (OR 1.02, CI 1.01-1.04, p = 0.01) were associated with development of ESRD, while kidney size at diagnosis was independently associated with ESRD (HR 0.03, CI 0.01-0.72, p = 0.043). Conclusions: In children with RHD, kidney size at diagnosis predicts the likelihood of developing ESRD. [ABSTRACT FROM AUTHOR]

HIV-positive people who use illicit drugs typically achieve lower levels of adherence to antiretroviral therapy and experience higher rates of sub-optimal HIV/AIDS treatment outcomes. Given the dearth of longitudinal research into ART adherence dynamics, we sought to identify factors associated with transitioning into and out of optimal adherence to ART in a longitudinal study of HIV-infected people who use illicit drugs (PWUD) in a setting of universal no-cost HIV/AIDS treatment. Using data from a prospective cohort of community-recruited HIV-positive illicit drug users confidentially linked to comprehensive HIV/AIDS treatment records, we estimated longitudinal factors associated with losing or gaining ≥95% adherence in the previous six months using two generalized linear mixed-effects models. Among 703 HIV-infected ART-exposed PWUD, becoming non-adherent was associated with periods of homelessness (adjusted odds ratio [AOR] = 2.52, 95% confidence interval [95% CI]: 1.56–4.07), active injection drug use (AOR = 1.25, 95% CI: 1.01–1.56) and incarceration (AOR = 1.54, 95% CI: 1.10–2.17). Periods of sex work (AOR = 0.51, 95% CI: 0.34–0.75) and injection drug use (AOR = 0.62, 95% CI: 0.50–0.77) were barriers to becoming optimally adherent. Methadone maintenance therapy was associated with becoming optimally adherent (AOR = 1.87, 95% CI: 1.50–2.33) and was protective against becoming non-adherent (AOR = 0.52, 95% CI: 0.41–0.65). In conclusion, we identified several behavioural, social and structural factors that shape adherence patterns among PWUD. Our findings highlight the need to consider these contextual factors in interventions that support the effective delivery of ART to this population. [ABSTRACT FROM AUTHOR]

Reasoned action approaches have primarily been applied to understand exercise behaviour for the past three decades, yet emerging findings in unconscious and Dual Process research show that behavior may also be predicted by automatic processes such as habit. The purpose of this study was to: (1) investigate the behavioral requirements for exercise habit formation, (2) how Dual Process approach predicts behaviour, and (3) what predicts habit by testing a model (Lally and Gardner in Health Psychol Rev 7:S137-S158, ). Participants (n = 111) were new gym members who completed surveys across 12 weeks. It was found that exercising for at least four bouts per week for 6 weeks was the minimum requirement to establish an exercise habit. Dual Process analysis using Linear Mixed Models (LMM) revealed habit and intention to be parallel predictors of exercise behavior in the trajectory analysis. Finally, the habit antecedent model in LLM showed that consistency (β = .21), low behavioral complexity (β = .19), environment (β = .17) and affective judgments (β = .13) all significantly ( p < .05) predicted changes in habit formation over time. Trainers should keep exercises fun and simple for new clients and focus on consistency which could lead to habit formation in nearly 6 weeks. [ABSTRACT FROM AUTHOR]

Background: Vitamin D supplementation is recommended for breastfed infants. Maternal supplementation beginning in gestation is a potential alternative, but its efficacy in maintaining infant 25-hydroxyvitamin D [25(OH)D] concentration after birth is unknown. Objectives: We determined the effect of 3 doses of maternal vitamin D supplementation beginning in gestation and continued in lactation on infant serum 25(OH)D and compared the prevalence of infant serum 25(OH)D cutoffs (>30, >40, >50, and >75 nmol/L) by dose at 8 wk of age. Design: Pregnant women (n = 226) were randomly allocated to receive 10, 25, or 50 µg vitamin D3/d from 13 to 24 wk of gestation until 8 wk postpartum, with no infant supplementation. Mother and infant blood was collected at 8 wk postpartum. Results: At 8 wk postpartum, mean [nmol/L (95% CI)] infant 25(OH)D at 8 wk was higher in the 50-µg/d [75 (67, 83)] than in the 25-µg/d [52 (45, 58)] or 10-µg/d [45 (38, 52)] vitamin D groups (P < 0.05). Fewer infants born to mothers in the 50-µg/d group had a 25(OH)D concentration,30 nmol/L (indicative of deficiency) than infants in the 25- and 10-µg/d groups, respectively (2% compared with 16% and 43%; P< 0.05). Fewer than 15% of infants in the 10-or 25-µg/d groups achieved a 25(OH)D concentration .75 nmol/L compared with 44% in the 50-µg/d group (P < 0.05). Almost all infants (w98%, n = 44) born to mothers in the 50-µg/d group achieved a 25(OH)D concentration .30 nmol/L. At 8 wk postpartum, mean maternal 25(OH)D concentration was higher in the 50-µg/d [88 (84, 91)] than in the 25-µg/d [78 (74, 81)] or 10-µg/d [69 (66, 73)] groups (P< 0.05). Conclusions: Maternal supplementation beginning in gestation with 50 µg vitamin D3/d protects 98% of unsupplemented breastfed infants against 25(OH)D deficiency (<30 nmol/L) to at least 8 wk, whereas 10 or 25 µg vitamin D/d protects only 57% and 84% of infants, respectively. This trial was registered at clinicaltrials.gov as NCT01112891. [ABSTRACT FROM AUTHOR]

Childhood sexual abuse is associated with adverse health outcomes. However, the impact of sexual abuse on HIV risk behaviors among people who inject drugs (IDU) has not been thoroughly characterized. We therefore sought to identify whether childhood sexual abuse was associated with syringe sharing among a sample of IDU in Vancouver, Canada. We assessed sexual abuse among two cohorts of IDUs via the Childhood Trauma Questionnaire. Multivariate logistic regression was used to estimate the relationship between childhood sexual abuse and syringe sharing. In total, 1380 IDU were included in the study, and 426 (30.9 %) IDU reported childhood sexual abuse. Syringe sharing (Adjusted Odds Ratio = 1.83, 95 % Confidence Interval 1.28-2.60) remained independently associated with childhood sexual abuse after adjustment for potential confounders. Given that a history of childhood sexual abuse appears to be elevated among IDU who engage in HIV risk behaviors (i.e., syringe sharing), HIV prevention efforts should include efforts to address historical trauma in this population. [ABSTRACT FROM AUTHOR]

Ninety-eight mothers of healthy firstborn infants 0 to 6 months old were randomly assigned to listen to 10-min of infant crying or infant cooing while continuously rating subjective feelings of frustration. Participants completed pre-test measures of depressed mood, empathy, and trait anger and post-test measures of infant-related harm thoughts, negative and positive emotions, and urge to comfort and to flee. Twenty-three (23.5 %) participants endorsed unwanted thoughts of active harm (e.g., throwing, yelling at, shaking the infant). Women in the cry condition were more likely than women in the coo condition to report thoughts of harm. Women in the cry condition who endorsed thoughts of harm reported higher frustration levels over the 10 min of crying, higher levels of post-test negative emotions, and stronger urges to flee the infant but not stronger urges to comfort the infant. Trait anger and personal distress empathy predicted the occurrence of unwanted thoughts of infant harm, whereas negative mood did not. Unwanted, intrusive, infant-related thoughts of harm may be triggered by prolonged infant crying, are predicted by personal distress empathy and a tendency to experience anger, and are associated with higher frustration, negative emotions, and the urge to escape the infant. [ABSTRACT FROM AUTHOR]

Introduction: Due to the challenging nature of tobacco addiction, individuals with cardiac conditions often continue to smoke at high rates (up to 62%), even after experiencing life-threatening events.Aims: This study examines pilot outcomes of a longitudinal Smoking Cessation Clinic (SCC) within cardiology services.Methods: This study is based on a retrospective review of the charts of 117 participants of the SCC (between September 2010 and May 2012). The main outcome of interest is self-reported 7-day point-prevalence of smoking abstinence verified by expired CO level. A secondary outcome was smoking reduction, defined as consuming 50% (or lower) than the baseline number cigarettes in the past week.Results: Thirty-five per cent of participants achieved smoking cessation, whereas 42.1% reduced their cigarette consumption. In multivariate regression analyses, salient predictors of smoking cessation included being male and a greater length of visiting the smoking cessation clinic.Conclusions: Providing evidence-based approaches to tobacco treatment within cardiology services is feasible and well received by patients with cardiac and other co-morbidity. The modest outcomes from this pilot study support the need for tobacco treatment in hospital cardiology settings. Such interventions may aid in reducing the disproportionate burden of tobacco-related disease among smokers with medical co-morbidity. [ABSTRACT FROM PUBLISHER]

Objective Incident reports guide fall prevention efforts in long-term care (LTC) facilities, often based on descriptions of how falls occurred. The validity of these reports is poorly understood. We examined agreement on fall characteristics between fall incident reports and analysis of video footage of real-life falls in LTC. Design/Setting/Participants Video capture of 863 falls (by 309 individuals) over 6 years in common areas of 2 LTC facilities in British Columbia. Measurements We reviewed each fall video with a previously validated questionnaire to determine the cause of imbalance leading to the fall, activity at the time of falling, and use of mobility aids. These data were compared with corresponding information recorded by staff on fall incident reports. Results There was agreement between video analysis and incident reports on the cause of imbalance in 45.5% of falls (kappa = 0.25), on activity at time of falling in 45.1% of falls (kappa = 0.22), and on use of mobility aids in 79.5% of falls (kappa = 0.59). When compared with video analysis, incident reports overreported falls due to slips, and falling while rising and while using a wheelchair or walker. Incident reports also underreported falls due to hit/bump and loss-of-support, and falling while standing and sitting down. Conclusion In more than 50% of falls, we found discrepancies between fall incident reports and analysis of video footage on the cause of imbalance and activity while falling. Emerging technologies incorporating video capture or wearable sensors should improve our ability to understand the mechanisms and improve the prevention of falls in LTC. [ABSTRACT FROM AUTHOR]

Background. We examined (1) patient characteristics and disease-modifying drug (DMD) exposure in late-onset (LOMS, ≥50 years at symptom onset) versus adult-onset (AOMS, 18–<50 years) MS and (2) the association between interferon-beta (IFNβ) and disability progression in older relapsing-onset MS adults (≥50 years). Methods. This retrospective study (1980–2004, British Columbia, Canada) included 358 LOMS and 5627 AOMS patients. IFNβ-treated relapsing-onset MS patients aged ≥50 (regardless of onset age, 90) were compared with 171 contemporary and 106 historical controls. Times to EDSS 6 from onset and from IFNβ eligibility were examined using survival analyses. Results. LOMS patients (6%) were more likely to be male, with motor onset and a primary-progressive course, and exhibit faster progression and were less likely to take DMDs. Nonetheless, 57% were relapsing-onset, of which 31% were prescribed DMDs, most commonly IFNβ. Among older relapsing-onset MS adults, no significant association between IFNβ exposure and disability progression was found when either the contemporary (hazard ratio [HR]: 0.46; 95% CI: 0.18–1.22) or historical controls (HR: 0.54; 95% CI: 0.20–1.42) were considered. Conclusion. LOMS differed clinically from AOMS. One-third of older relapsing-onset MS patients were prescribed a DMD. IFNβ exposure was not significantly associated with reduced disability in older MS patients. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to examine the main and interaction effects of perceived organisational support, span of control and leadership rank on novice nurse leaders' organisational commitment. Background As nurse leaders' organisational commitment is eroded at times of healthcare restructuring, it is important to study factors associated with organisational commitment. Methods Cross-sectional data from 69 novice nurse leaders, collected via mailed surveys at two time points, were analysed using hierarchical regression. Results The findings supported our hypotheses about the positive effect of perceived organisational support, the positive effect of leadership rank and the negative effect of span of control on novice nurse leaders' organisational commitment. In addition, perceived organisational support was shown to moderate the negative effect of span of control on novice nurse leaders' organisational commitment at time 2. Conclusion Organisational strategies aimed at supporting nurse leaders, and attention to span of control, are required to enhance the organisational commitment of novice nurse leaders. Implications for nursing management Nurse leaders with a wide span of control, in particular those with little leadership experience, need to adopt leadership strategies that maximise their effectiveness, such as organising smaller work groups or teams within their wide span of control. [ABSTRACT FROM AUTHOR]

There is little information on the private lives of women engaged in sex work, particularly how power dynamics within intimate relationships may affect intimate partner violence (IPV). Using baseline data of sex workers enrolled in a longitudinal cohort, “An Evaluation of Sex Workers' Health Access” (AESHA), the present study examined the association between sexual relationship power and IPV among sex workers in non-commercial partnerships in Vancouver, Canada. Pulweritz's Sexual Relationship Power Scale (SRPS) and The World Health Organization (WHO) Intimate Partner Violence against Women Scale (Version9.9) were used. Bivariable and multivariable logistic regression techniques were used to investigate the potential confounding effect of sexual relationship power on IPV among sex workers. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were reported. Of 510 sex workers, 257 (50.4%) reported having an non-commercial intimate partner and were included in this analysis. In the past 6 months, 84 (32.7%) sex workers reported IPV (physical, sexual or emotional). The median age was 32 years, 39.3% were of Aboriginal ancestry, and 27.6% were migrants. After controlling for known confounders (e.g., age, Aboriginal ancestry, migrant status, childhood trauma, non-injection drug use), low relationship power was independently associated with 4.19 increased odds (95% CI: 1.93–9.10) and medium relationship power was associated 1.95 increased odds (95% CI: 0.89–4.25) of IPV. This analysis highlights how reduced control over sexual-decision making is plays a critical role in IPV among sex workers, and calls for innovation and inclusive programming tailored to sex workers and their non-commercial intimate partnerships. [ABSTRACT FROM PUBLISHER]

Aim Mobility issues in the early postoperative period result in poor functional outcomes and diminished quality of life for patients of advanced age. We determined the incidence of and risk factors for mobility issues in the early postoperative period in patients receiving open heart cardiac surgery. Methods A retrospective chart review was carried out on 396 patients receiving open heart coronary artery bypass grafts ( CABG), valve replacements and combination CABG-valve replacements in a tertiary care hospital. Data on demographics, comorbidities, laboratory values, medications, anesthesia and postoperative care were abstracted. Mobility issues were considered present if they were documented in the medical chart. All pre- and intraoperative variables were entered into logistic regression. Results The mean age was 66.4 ± 11.9 years. In a subset of patients aged 75 years and older, the mean age was 79.8 ± 3.7 years. Mobility issues affected 36.9% of individuals from the total sample, and 47.6% of older patients. Increased age was a weak predictor in the total sample ( OR 1.03), but was the only predictor in older adults ( OR 1.1). The strongest predictors in the total sample were preoperative COPD ( OR 2.7), congestive heart failure ( CHF; OR 2.1), renal disease ( OR 1.9), and pre-existing physical impairment ( OR 1.8). Older patients with mobility issues were more likely to be discharged to acute care facilities, and had higher rates of mortality 3 years after surgery. Conclusions Over one-third of cardiac surgery patients experienced early postoperative mobility issues. Older patients and those with COPD, CHF, renal disease or pre-existing physical impairments might benefit from preoperative consultation with physical therapists. Geriatr Gerontol Int 2015; 15: 276-281. [ABSTRACT FROM AUTHOR]