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Community-engaged approaches to research can increase trust, enhance the relevance and use of research, address issues of equity and justice, and increase community knowledge and capacity. The HERCULES Exposome Research Center sought to engage local Atlanta communities to learn about and address their self-identified environmental health concerns. To do this, HERCULES and their stakeholder partners collaboratively developed a community grant program. The program was evaluated using mixed qualitative methods that included document review and semi-structured interviews. This paper presents the development, implementation, and evaluation of the grant program. HERCULES awarded one-year grants of $2,500 to 12 organizations within the Atlanta region, for a total 13 grants and $32,500 in funding. Grantees reported accomplishments related to community knowledge, awareness, and engagement in addition to material accomplishments. All grantees planned to sustain their programs, and some received additional funding to do so. Some grantees remained actively involved with HERCULES beyond the grant program. The HERCULES Community Grant Program was able to increase awareness of HERCULES among applicant communities, establish or enhance relationships with community-based organizations, and identify local environmental health concerns while providing tangible results for grantees and the communities they serve. Mini-grant programs are a feasible approach to address community environmental health and establish new relationships. This model may benefit others who aim to establish community-academic relationships while addressing community health concerns.

IntroductionThe exposome concept provides a framework to better incorporate the environment into the study of health and disease and has been defined by academics to encompass all lifetime exposures including toxicants, diet, and lifestyle choices. However, initial applications of the exposome concept have been less apt at measuring social determinants of health, focusing primarily on conventional environmental exposures and lifestyle choices that do not reflect the complex lived experience of many communities. To bring community voice into the exposome concept, the HERCULES Exposome Research Center and its Stakeholder Advisory Board co-developed the Exposome Roadshow. We present and discuss the resulting community-exposome definition to inform and improve exposome research.Materials and MethodsFour communities from distinct areas across metro-Atlanta participated in separate 2-day Exposome Roadshow workshops with concept mapping. Aligned with a popular education approach in which community knowledge is used to work collectively for change, concept mapping provided a systematic method to collect and visualize community members' knowledge and create a shared understanding to take action. Community members brainstormed, sorted, and rated their responses to the prompt: “What in your environment is affecting your and your community's health?” Responses were analyzed and visually depicted by concept maps consisting of separate but interrelated clusters of ideas. Community members discussed and validated the maps, selecting a final map illustrating their community's exposome.ResultsA total of 118 community members completed concept mapping. On average communities identified 7 clusters to define their exposome. The resulting concept maps offer a community definition of the exposome. Five major themes arose across all four communities: conventional environmental concerns, built environment, social relationships, crime and safety, and individual health and behaviors.DiscussionThe resulting community-exposome definition demonstrates the importance of expanding the scope of exposures beyond traditional environmental influences to include the lived experience of individuals and communities. While newer exposome definitions align more closely with this community definition, traditional exposome methods do not routinely include these factors. To truly capture the totality of lifetime exposures and improve human health, researchers should incorporate community perspectives into exposome research.

Purpose High-altitude ice crystals (HAICs) are causing one in-flight event or more per month for commercial aircraft. The effects include preventing air data probes (pitot pressure and total air temperature in particular) from functioning correctly and causing engines to roll back and shut down. The purpose of this study is to describe the process used by the National Research Council Canada (NRC) to develop and test a particle detection probe (PDP). The probe mounts on the fuselage of aircraft to sense and quantify the ice crystals in the environment. Design/methodology/approach The probe was demonstrated on the NRC Convair and Airbus A340 research aircraft as part of the European Union HAIC programme. The probe was ruggedised, adapted for easy installation in standard aircraft fittings and tested in a variety of conditions for longevity and endurance. Findings Efforts to achieve the safety requirements for flight on aircraft are discussed. The challenges, surprises and opportunities for testing on which the development group is capitalised are also presented. Practical implications It was demonstrated that the detectors gave signals proportional to the ice crystal content of clouds, and results demonstrating the functionality of the probe are presented. Originality/value This paper describes the multi-year process of developing the NRC PDP from a test cell sensor for detecting engine exhaust contaminants on an aircraft ice crystal detection probe. The work included over 20 flight tests on NRC aircraft and the Airbus HAIC test programme.

Introduction This study is part of a wider evaluation of a pilot to improve the experience of young adults with life-limiting conditions as they transition to adult services. The project was funded by Together for Short Lives. We developed a multidisciplinary outpatient clinic supporting young people aged 16–25 with life-limiting conditions, based in an adult hospice. Adult palliative care multidisciplinary teams (MDT) have many of the transferable skills and resources required to meet the needs of young adults with life-limiting conditions. By exploring the clinical needs encountered by the team in this project, we hope to improve palliative clinicians’ confidence in their ability to meet those needs, and to highlight areas where practice may need to be adapted or developed. Methods The Transition Team recorded in-depth team reflections around activity and learning over a period of 12 months between March 2019 and March 2020. The reflections concerning all clinical interactions with 7 patients were collated and analysed for themes. The themes were then developed alongside literature and expert opinion to form recommendations for other adult palliative care teams who wish to support young adults. Results Overall, three major themes were identified from the team reflections: Clinical learning, Carer support, and Relationships with other clinicians. The subthemes within clinical learning were: Role in identifying unmet needs and signposting to other services Identifying dying in patients with long term disability Safe management of complex symptoms when multiple teams are involved Anticipatory care planning. Recommendations were developed highlighting areas where additional training and research are needed as well as areas to prioritise in service development. Conclusions Reflecting on clinical interactions with young adults with life-limiting conditions enabled the project team to identify priorities for learning and further development of services for this patient group.

Background and Purpose: Clinician research competencies influence research use for evidence-based practice (EBP). We aimed to develop, refine, and psychometrically assess the Research Competencies Assessment Instrument for Nurses (RCAIN) to measure registered nurse research competencies (i.e., knowledge, skills, attitudes) focused on EBP-related domains: research process, knowledge synthesis, and knowledge translation activities. Methods: The preliminary psychometrics (face, content, construct/criterion validity) were evaluated based on 63 completed surveys. Results: The Cronbach’s α coefficients were .871, .813, and .946 for each domain, respectively; interitem correlations ranged from .472 to .833 (explained variance: 68.5%). Three components/factors revealed: comprehension of and skills required in research process and application of knowledge and skills. The revised RCAIN consists of 19 five-point Likert-type questions. Conclusions: The RCAIN assesses modifiable characteristics and explains variance in practice, health system, and patient outcomes. Further assessments are underway.

Introduction Access to cognitive assessments for children living remotely is limited. Telehealth represents a potential cost- and time-effective solution. A pilot study was conducted to determine the feasibility of telehealth to assess cognitive function in children with learning difficulties. Methods Thirty-three children (median age = 9 years 11 months), recruited from the New South Wales (NSW) Centre for Effective Reading, underwent assessment of intellectual ability. Comparisons were made between the intellectual ability index scores obtained by a psychologist sitting face-to-face with the children and another psychologist via telehealth using a web-based platform, Coviu. Results The telehealth administration method yielded comparable results to the face-to-face method. Correlation analyses showed high associations between the testing methodologies on the intellectual ability indices (correlation coefficient range = 0.981–0.997). Discussion Findings indicate that telehealth may be an alternative to face-to-face cognitive assessment. Future work in a broader range of cognitive tests and wider range of clinical populations is warranted.

© 2018 Elsevier Ltd Purpose: Transition to adult health and social-care services is a time of great uncertainty for young adults with life-limiting conditions; due to improved management, many who would have previously died before they were 18 years old are now surviving into early adulthood. Nevertheless, few services exist to meet their specific needs for specialist short breaks away from home. The purpose of this research was to determine the views and perspectives of young adults' parents/carers and staff engaged with a purpose-designed, pilot short-break service for 18–24 year olds with life-limiting conditions. Data were gathered through qualitative individual or focus group interviews involving two young adults, four mothers and fifteen health or social-care staff associated with the service. Data were analysed using Framework Analysis. Principal results: Emergent themes: (i) The need for a specialist short-break service; (ii) Decision making when using or delivering the service; (iii) Challenges of staffing and financing the service (iv) Meeting young adults' complex needs and preferences (v) Suggestions for how to improve the service. The young adults described how they benefitted from access to specialist, age-appropriate, on-site clinical skills facilities and opportunities to socialise with peers. Mothers said they benefitted from time alone or with other family members in the knowledge that the specialist short break service met the needs and preferences of their child as they made the transition to adult services. However, all participating mothers and staff expressed concern about the future well-being of young adults when they left the service at 24 years old. Major conclusions: This study provides new information to inform ongoing development of short-break services for the increasing number of young adults with life-limiting conditions who are surviving longer than they would previously have done. This will help to ensure that UK services are responsive to users' needs and preferences.

Background/Introduction: Literacy difficulties have significant long-term impacts on individuals, and therefore early identification and intervention are critical. Access to experienced professionals who conduct standardized literacy assessments with children is limited in rural and remote areas. The emerging literature supports the feasibility of using telepractice to overcome barriers to accessing specialist literacy assessment. The current study sought to determine the feasibility and reliability of telepractice assessments, using consumer-grade technology, in children with reading difficulties.Thirty-seven children, aged 8 to 12 years, with reading difficulties, attended a multidisciplinary reading clinic. Children completed literacy assessments delivered via a web-based application by a remotely located research assistant. A teacher was stationed with the child and coscored the assessments. Scores and qualitative observations of the two assessors were compared.Spearman's correlation analyses revealed strong agreement between telepractice- and face-to-face-rated scores (r = 0.79-0.99). Bland-Altman plots indicated excellent agreement between derived scores. Parents reported a high degree of comfort with the telepractice assessments. Clinicians reported the audio and video quality was sound in most cases.Web-based technology can enable remote delivery of literacy assessments. The technology has the potential to increase the availability of assessments to meet the needs of children who live remotely, in a timely manner and at their family's convenience.

Mortality rates of women suffering from an acute myocardial infarction (AMI) are high, and in young women are on the rise. The goal of this review is to investigate what is known about women's experience of AMI symptoms. By exploring the complexity and intersections evident in the literature though an integrative literature review process, it becomes apparent that the problem involves deeper contextual influences arisingfrom women's situation in society. Keyfindings in this review suggest that not recognizing the risk or symptoms of an AMI can lead to delayed health care seeking behaviours, and warrants the need for further education. Awareness of these findings has implications for women's health outcomes and mortality rates. This review adds value to clinical practice by reifying the potential gaps in knowledge currently available to women and health care providers, and suggests filling these gaps with new more inclusive ways of knowing surrounding this phenomenon.

Importance Convenient outpatient access for ophthalmology patients seeking urgent care could offer savings compared with an emergency department (ED) visit. Objective To evaluate the costs and visit durations of same-day access (SDA) in an ophthalmology department at an academic medical center vs ED care. Design, Setting, and Participants This single-center study was a retrospective quality improvement analysis of an institutional electronic medical record system at the Wilmer Eye Institute clinics and the Johns Hopkins Hospital ED. On June 1, 2015, the Wilmer Eye Institute and Johns Hopkins Hospital initiated an official policy of providing SDA to patients calling for appointments (ie, the same-day project). All ophthalmology clinic locations created same-day appointment slots for at least 1 practitioner. In recognition of seasonal variations in patient visit volumes, the 10 months before implementation (August 1, 2014, to May 31, 2015) were compared with complementary periods in 2015 to 2016 and 2016 to 2017. Main Outcomes and Measures The study tabulated encounters, charges, and visit length for outpatients seen on the same day or by previously scheduled appointments. For the ED patients, volume, diagnoses, charges, and length of stay data were collected. The numbers of SDA patients who indicated urgency were tabulated. Results The number of SDA patients increased from 22 781 to 26 579 for the first year after SDA implementation. The mean charge was $258 (95% CI, $250-$266; median, $184; interquartile range [IQR], $175-$320), and the mean clinic transit time was 1.55 hours (95% CI, 1.54-1.57 hours; median, 1.28 hours). For patients seeking eye care in the ED, the mean professional fee was $401 (95% CI, $390-$411; median, $360; IQR, $255-$500), the mean (SD) total hospital charge was $1040 ($999) (95% CI, $729-$1079; median, $1002; IQR, $334-$1429), and the mean length of stay was 7.30 hours (95% CI, 7.01-7.57 hours; median, 7.20 hours). The top 4 ophthalmic diagnoses for ED patients were conjunctivitis, cornea abrasion, iritis, and visual loss, which were unchanged after SDA implementation. In calendar year 2017, a total of 4062 SDA patients reported urgency; their estimated savings in charges compared with an ED visit were $580 866 in professional fees and $3 176 484 in hospital charges. Conclusions and Relevance Same-day access appears to be less expensive and to require less time in the health care system than a visit to the ED for an ophthalmic diagnosis. Substantial savings in time and money might be achieved if urgent eye care is delivered in the clinic rather than the ED.

Review question/objective The purpose of this review is to assess the effectiveness of physical activity interventions on the physical health outcomes of healthy older women living independently in the community. More specifically, the objectives are: 1. To systematically review randomized controlled studies of physical activity interventions designed to improve the physical health of healthy older women living independently in the community. 2. To appraise the effectiveness of physical activity interventions for older women on their physical health outcomes, including physical fitness. 3. To identify implications for policy and practice to promote physical activity in older women. Inclusion criteria Types of participants This review will consider studies in which the majority of women are 50 years and older who live independently in the community. To ensure that the data extracted is not confounded by numerous variables, studies that target women diagnosed with specific conditions such as arthritis, heart disease, stroke, cardiovascular disease, diabetes, hypertension, osteoporosis, bone density, obesity, depression, urinary incontinence and so on will not be included in this systematic review. However, interventions that target participants with risk factors for disease (e.g. cardiovascular, osteoporosis) but which are not diagnosed will be included in this review. Types of intervention(s)/phenomena of interest This review will consider randomized controlled studies of laboratory-, home- and community-based physical activity interventions with the specific goal of improving the physical health of older women living independently in the community. Types of outcomes This review will consider studies that include one of the following outcome measures: 1) cardiorespiratory (e.g. pulse, heart rate, blood pressure, aerobic capacity); 2) body composition (e.g. BMI, waist circumference, hip/waist ratio, % body fat); 3) flexibility (e.g. stretching, balance); and 4) muscular strength and endurance (e.g. grip strength, walking speed).

A historical examination of a nursing curriculum is a bridge between past and present from which insights to guide curriculum development can be gleaned. In this paper, we use the case study method to examine how the University of Victoria School of Nursing (UVic SON), which was heavily influenced by the ideology of second wave feminism, contributed to a change in the direction of nursing education from task-orientation to a content and process orientation. This case study, informed by a feminist lens, enabled us to critically examine the introduction of a “revolutionary” caring curriculum at the UVic SON. Our research demonstrates the fault lines and current debates within which a feminist informed curriculum continues to struggle for legitimacy and cohesion. More work is needed to illuminate the historical basis of these debates and to understand more fully the complex landscape that has constructed the social and historical position of women and nursing in Canadian society today.

REVIEW QUESTION/OBJECTIVE The purpose of this review is to systematically review literature to determine the period of prevalence of prodromal and acute symptoms experienced by adult women diagnosed with an acute myocardial infarction (AMI).More specifically, the objective of this descriptive review is to assess the prevalence and describe the distribution of prodromal and acute symptoms experienced by adult women during an AMI event, evident in documented literature between 1994 and the present date.The specific question for this review is: how common and how are prodromal and acute symptoms of an AMI distributed in adult women diagnosed with an AMI? CENTER CONDUCTING THE REVIEW University of Victoria and the Queen's Joanna Briggs Collaboration for Patient Safety: a Collaborating Centre of the Joanna Briggs Institute.

Implantable cardioverter defibrillator (ICD) implantation rates are increasing as advances in heart failure and arrhythmia management progress. Consequently, the number of ICD generator replacements is rising and ICD replacement is an opportune time for shared decision-making (SDM). Nurses should have distinct roles and responsibilities in SDM processes.To use a relational lens to localize the role of the nurse in SDM, and recommend ways in which nurses can be involved in SDM.An integrative review of 17 articles was conducted to determine the role of nurses in SDM.Our analysis revealedfour themes that helped us articulate nurse involvement in SDM; knowledge as a basis for SDM, sharing power in the nurse-patient relationship, utilization of decisional support strategies, and communication.Our findings support the participation of nurses in SDM. Nursing implications are offered, specifically for the management of patients facing ICD replacement.

YOUNG L, and WHARF HIGGINS J. Nursing Inquiry 2010; 17: 346–358 Using participatory research to challenge the status quo for women’s cardiovascular health Cardiovascular health research has been dominated by medical and patriarchal paradigms, minimizing a broader perspective of causes of disease. Socioeconomic status as a risk for cardiovascular disease is well established by research, yet these findings have had little influence. Participatory research (PR) that frames mixed method research has potential to bring contextualized clinically relevant findings into program planning and policy-making arenas toward developing meaningful health and social policies relevant to primary prevention. In this article we provide an overview of a PR program that included two quantitative and one qualitative studies and then we discuss lessons learned. The PR process we found was empowering for lone mothers, and transformative for lone mothers and researchers. Further, PR as an approach to research opened spaces in practice and policy-making arenas to raise upstream issues relevant to the health of low income lone mothers. We conclude that while PR is an effective approach to social determinants research, as a time-intensive endeavor, and one that does not easily align with research tradition, researchers must consider the strengths and drawbacks of PR when planning to implement such an approach.

Early discharge of children following surgery shifts the burden of care from professionals in hospital to family care-givers at home. We evaluated the relative effectiveness of telephone and videophone follow-up for children and families after a child's scoliosis surgery. Fourty-three patients and their families were enrolled in the study with 21 dyads receiving videophone and 22 dyads telephone support. At discharge, those in the intervention arm were provided with a videophone operating on the ordinary telephone network (PSTN). Data were gathered during telehealth contact on post-discharge day 3 and during extra calls with the clinic nurse, and during sessions with a research assistant comprising a follow-up call and an interview at the six-week post-surgical visit. Calls and interviews were recorded and transcribed. Data were analysed using constant comparative analysis. The results showed that videophone and telephone use provided care continuity for patients and their families following a child's back surgery. The relative effect of the videophone and telephone technology depended on the fit between the characteristics of the patients and families and the capacities of the technology. When implementing telehealth for follow-up care, a participatory process is recommended to ensure a fit between user characteristics and technology.

The objective of this review is to identify studies reporting on lay health worker- or volunteer-led community-based programs for blood pressure screening and cardiovascular awareness in order to determine if these programs contribute to changes in blood pressure among participants over time.The specific question for this review is: What are the changes in blood pressure among adult users of community-based blood pressure screening and awareness programs operated by lay health workers or volunteers as measured by the differences in systolic and diastolic blood pressure between the user's first visit to the program and their last visit to the program?Cardiovascular diseases, such as stroke and heart disease, are quickly becoming global diseases manifesting in countries and communities where they traditionally had not been widespread. The World Health Organization (WHO) has reported that "in the Asia/Pacific region, [cardiovascular disease] has become increasingly prevalent in recent decades, and now accounts for about one third of all deaths". One risk factor that can lead to cardiovascular disease is hypertension. Based on WHO data from 2008, hypertension is now a global problem affecting 27% of the population 25 years of age or older.The risk for cardiovascular disease also appears to be higher among people in urban areas. A recent United Nations population report indicates that in the next 40 years we could see an increase in the world's population by 2.3 billion people. The majority of these people will be residing in urban areas, particularly in developing nations. Between 2011 and 2050, "the population living in urban areas is projected to gain 2.6 billion, passing from 3.6 billion in 2011 to 6.3 billion in 2050". Population growth in urban areas is therefore not only projected to include the expected population growth but also expected to include a shift of rural population to urban centers and "most of the population growth expected in urban areas will be concentrated in the cities and towns of the less developed regions". This growth of urban areas has the potential to put enormous pressures on health care systems that are already struggling to cope with the rapid increase in diseases thought to be more prevalent in Western societies, such as cardiovascular diseases.Hypertension may be difficult to treat due to a number of factors. Globally, access to antihypertensive medications, hypertension screening, and access to medical care vary from one country to another. Lifestyle factors, such as salt and alcohol consumption, stress, smoking, body weight, and exercise, are risk factors for hypertension that may be influenced by culture, which can in turn support or hinder lifestyle decisions that could significantly affect blood pressure. Hypertension, however, is easy to detect. A trained person with access to a low-cost sphygmomanometer can detect abnormal blood pressures quickly; however, access to trained personnel is not universally guaranteed. Globally - according to one model of skilled health care worker density and total requirement offered for discussion by the Global Health Workforce Alliance and WHO - there could currently be an estimated shortage of over seven million skilled health care workers (midwifes, nurses and physicians), as measured against a theoretical density of skilled health care workers to population. The shortage of skilled health care workers in this model could grow to over 12 million by 2035 if the assumptions of the model and population growth estimates are valid. Through rapid urbanization the potential for inequities in access to healthcare is also increased.Over the last few years, a number of community-based blood pressure screening and education initiatives have been established. These initiatives have been created either as part of research, as part of community outreach programs by publicly funded agencies, or as part of an outreach by not-for-profit organizations with a particular interest in reducing cardiovascular disease in specific hard-to-reach populations. Several systematic reviews have been conducted to assess different models for delivering services to people living with high blood pressure to assess community-based programs with a focus on cardiovascular disease, and to assess effectiveness of community health workers (CHW) in a variety of settings. These systematic reviews point to the importance of distinguishing between different categories of health care providers, their training and their roles in program delivery when assessing studies for possible inclusion in a systematic review.In a systematic review of studies from the US by Brownstein et al. focusing on the effectiveness of community health workers (CHWs) in the care of people with hypertension, this category of health care providers went under many different names. Community health workers in this review were defined as "any health workers who carried out functions related to health care deliver, were trained as part of an intervention, had no formal paraprofessional or professional designation, and had a relationship with the community being served". One of the findings from this review was the wide variety of formal training of the CHWs. In other parts of the world, a CHW might be defined differently. In their review of CHW-based programs focusing on children's health, Bhattacharyya, Winch, LeBan and Tien found that "in general CHWs are not paid salaries because the MOH (Ministry of Health) or donors do not consider salaries to be sustainable. Yet CHWs are often held accountable and supervised as if they were employees. Community health worker programs must recognize that CHWs are volunteers (emphasis in original), even if they receive small monetary or nonmonetary incentives. They are volunteering their time to serve the community". One Canadian model for delivering a cardiovascular awareness program designed to reach older adults through their primary care provider is based on volunteers with basic training to perform blood pressure measurements and cardiovascular health information.In a global review of a wide range of public health and health promotion initiatives operated by lay health workers from 2005, Lewin et al. identified over 40 different names or terms for a lay health worker. However, the definition of a lay health worker used by Lewin et al. is very similar to the definition of CHWs offered by Brownstein et al. Lewin et al.'s systematic review was the only study with a global focus that was located that reviewed studies of programs with a cardiovascular component using lay health workers. In this study, the sample size of studies focusing on lay health workers and cardiovascular disease was small (N=3) and the results from two of the studies were inconclusive to the point where the authors felt they could not pool the results.While a lay health worker may or may not receive some compensation for their work, volunteers in higher income areas of the world such as in North America typically do not receive any compensation. Volunteers, as observed by Bhattacharyya et al., are common in many parts of the world, and in some areas they provide delivery of programs and services that reach hundreds of thousands of individuals. One challenge for this systematic review will therefore be to isolate those programs that are delivered by lay health workers or volunteers who receive little or no compensation and programs where staff is paid. The importance of this distinction is on one hand related to cost - as observed by Bhattacharyya et al., many organizations responsible for delivery of community-based programs do not have funding for salaried staff. On the other hand there might be other factors in the relationship between a community being served by a program and the staff delivering the program. One such factor could be linked to the role of the person delivering the program as either a paid health care professional or an unpaid lay health worker or volunteer.Through this proposed JBI systematic review, the reviewers will focus on community-based blood pressure screening and health information programs delivered by either lay health workers or volunteers. Previous systematic reviews have indicated that programs focusing on blood pressure reduction delivered in a variety of settings and delivered by a variety of health care professionals might lower blood pressure among program participants over time. This systematic review will be limited to community-based programs rather than hospital or research facility-based programs, and to programs delivered by lay health workers or volunteers rather than programs delivered by paid community health workers, nurses or teams of health care providers under direction of a primary care provider. Compared to other recent systematic reviews which focused on studies with comparison groups and included few studies where lay health workers were involved, this systematic review will attempt to fill this gap in knowledge about programs delivered by lay health workers or volunteers by focusing on non-randomized controlled studies which report blood pressure changes over time in programs targeting the general population. Community-based programs might have a variety of designs with a number of different interventions, and where possible these designs and interventions will be identified and subgroup analysis conducted as appropriate. It is hoped that this systematic review can extend the work by Lewin et al. by identifying additional studies globally, focusing on programs delivered by lay health workers or volunteers but limited to studies reporting changes in blood pressure over time. Where possible, a meta-analysis of the changes in blood pressure over time among participants in these programs will be conducted. (ABSTRACT TRUNCATED)

Lone mothers are a disadvantaged population, with research in several countries indicating that they experience low levels of physical and mental health. While research has demonstrated a socioeconomic gradient for cardiovascular disease (CVD), little research has explored lifestyle and clinical risk for CVD and prevalence of CVD events in lone mothers. The purpose of this study is (1) to compare select CVD lifestyle risks (smoking, obesity, physical activity), health, and relevant sociodemographic variables in partnered versus lone mothers; (2) to examine the relationship between partner status and having experienced a CVD event (myocardial infarction [MI], congestive heart failure [CHF], stroke). Data from the U.S. National Health and Nutrition Examination Survey III (NHANES III) included 1,446 women over 60 years with one or more children less than 17 years old. Lone mothers included women who were widowed, divorced, separated, never married, or married without the spouse living in the household (n = 623; weighted sample represents n = 3,904,450). Partnered mothers included women who reported living as married or married with the spouse in the household (n = 832; weighted sample represents n = 8,614,362). Weighted logistic regression was used to compare the prevalence of CVD risk factors in lone (43%) ver sus partnered (57%) mothers. Multivariate modeling was used to examine the relationship between partner status, CVD risks, and Coronary Heart Disease (CHD) events. Compared with partnered mothers, lone mothers were less educated and reported lower levels of income, health, and social support; and they were more likely to report non-White ethnicity. Lone mothers were more likely to be current smokers, overweight or obese, and physically active than partnered mothers. Those with clinical risks for CVD, including diabetes, elevated C-reactive protein, hypercholesterolemia, or hypertension, or all of these were more likely to be lone mothers. After adjusting for age, we found that mothers who had experienced a CVD event (MI, CHF, or stroke) were 3.3 times more likely to be a lone mother than a partnered mother (95% confidence interval (CI) 3.24, 3.31). Lone mothers are at increased risk for CVD. Health professionals and lone mothers should collaborate in the development of programs and policies not only to reduce lone mothers' risk for CVD, but also improve their conditions of living.

This article examines two discursive events during a major reorganization at Health Canada in 2000: a new leader’s informal speech to senior managers and his first formal memo to staff. Seen through the dual lens of systemic functional linguistics and critical discourse analysis, these events provide a perspective on the role of discourse in institutional settings. The events particularly illustrate the ways in which a leader’s discursive choices demonstrate conflicts between management styles: the command-and-control style of the old capitalism and that of the new capitalism, which defines the leader as a coach, mentor, facilitator, and motivator rather than as a commander. Unpacking leadership discourse can shed some light on how concealed messages contribute to the success or failure of discursive events, specifically at a time of organizational transformation when such discursive events are particularly important.

Telehealth is defined as the provision of health care via telecommunications wherever individuals are geographically separated. In this literature review, we explore the role of telehealth in family care. Telehealth has not been fully examined for its potential to support health and healing in families. Moreover, technological innovation, such as telehealth, presents an opportunity to question concepts and approaches to family care.

Background & Aims: Observational studies have suggested that Helicobacter pylori may protect against gastrointestinal reflux disease (GERD), but these results could be due to bias or confounding factors. We addressed this in a prospective, double blind, randomized, controlled trial. Methods: H. pylori –positive patients with at least a 1-year history of heartburn with a normal endoscopy or grade A esophagitis were recruited. Patients were randomized to 20 mg omeprazole, 250 mg clarithromycin, and 500 mg tinidazole twice a day for 1 week or 20 mg omeprazole twice a day and identical placebos. A second concurrently recruited control group of H. pylori –negative patients were given open label 20 mg omeprazole twice a day for 1 week. All patients received 20 mg omeprazole twice a day for the following 3 weeks and 20 mg omeprazole once daily for a further 4 weeks. Omeprazole was discontinued at 8 weeks and patients were followed up for a further 10 months. A relapse was defined as moderate or severe reflux symptoms. H. pylori eradication was determined by 13 C-urea breath test. Results: The H. pylori –positive cases were randomized to antibiotics (n = 93) or placebo (n = 97). Relapse of GERD occurred in 83% of each of the antibiotic, placebo, and H. pylori –negative groups during the 12-month study period. Life tables revealed no statistical difference between the 2 H. pylori –positive groups (log rank test, P = 0.84) or between the 3 groups (log rank test, P = 0.94) in the time to first relapse. Two patients in each group developed grade B esophagitis at 12 months. Conclusions: H. pylori eradication therapy does not seem to influence relapse rates in GERD patients. GASTROENTEROLOGY 2001;121:1120-1126

Health promotion is a set of strategies for positively influencing health through a range of individual, community-based, and population interventions. Despite international recognition that gender is a primary determinant of health and that gender roles can negatively affect health, the health promotion field has not yet articulated how to integrate gender theoretically or practically into its vision. For example, interventions often fail to critically consider women’s or men’s diverse social locations, gender-based power relations, or sex-based differences in health status. Yet without such analyses, interventions can result in the accommodation or exploitation of gender relations that disadvantage women and compromise their health. In this paper, we seek to ignite an agenda for health promotion for women. We discuss the need for a conceptual framework that includes a sex-gender-diversity analysis and critically considers ‘what counts’ as health promotion to guide the development and implementation of evidence-based practice. We also consider how innovative knowledge translation practices, technology developments and action research can advance this agenda in ways that foster the participation of a wide range of stakeholders.

The rapid uptake of simulation-based education has led to the development of simulation programs and centers all around the world. Unfortunately, many of these centers are functioning as localized silos and not taking advantage of the potential for collaboration with other regional centers to promote interprofessional education. In the province of British Columbia (BC), Canada, 38 institutions, including health care authorities, universities, colleges, and other health-related organizations, have participated in assessing the use of simulation in BC and in developing a provincial model that enables collaboration and interprofessional learning at the provincial level.This article describes methods and results of a needs assessment and discusses an interprofessional simulation in health care educational model that provides access for all health care professionals in BC regardless of their geographic location and/or institutional affiliation. We anticipate that this information will be useful to and supportive of others in developing simulation collaborations in their respective regions.

Educational preparation of health professionals for Palliative and End of Life Care (PEOLC) is inadequate, and nurses are no exception. In 2004, the Canadian Association of Schools of Nursing struck a Task Force to develop PEOLC competencies to address this issue. The development of national PEOLC nursing competencies involved a multi-step, emergent, interactive, and iterative process. An overarching principle guiding this process was building national consensus about the essential PEOLC specific competencies for nurses among experts in this field while simultaneously generating, revising, and refining them. There have been three stages in this iterative, multi-step process: 1) Generating a preliminary set of competencies, 2) Building a national consensus among educators and experts in the field on PEOLC specific competencies for nurses, and 3) Refining the consensus based competencies for curriculum development. Ongoing follow up work for this project is focusing on the integration of these competencies into nursing curricula.

In this paper, we begin by providing an overview of the Educator Pathway Project (EPP), an education infrastructure that was developed in response to emerging critical nursing workplace issues, and the related demand for enhanced workplace education. We then describe the EPP competency-based curriculum designed to prepare nurses as preceptors, mentors, and educators to lead learning with diverse learner groups. This competency-based curriculum was developed through a collaboration of nurse leaders across practice, academic, and union sectors and drew from a widely embraced curriculum development model (Iwasiw, Goldenberg, & Andrusyzyn, 2005). The goal of the curriculum was to prepare nurses through a four-level career pathway model that contextualized practice and education theory to various education-related roles and levels of experience within the practice setting. Over 1,100 nurses participated in this innovative intersectoral nursing initiative.

Grounded theory has served feminist research endeavors since the mid-1990s. Researchers from a variety of disciplines claim methodological compatibility and incorporate feminist principles into their grounded theory studies. This article seeks to demonstrate the epistemological affinity between feminist inquiry and grounded theory. Although this relationship is not necessarily unique, the authors contend that when combined, it loosens the androcentric moorings of the empirical processes underpinning grounded theory, enabling the researchers to design inquiry with greater potential to reveal issues particular to the lives and experiences of marginalized women. The article begins by retracing the roots of grounded theory and feminist inquiry to identify six key areas where the underpinnings of GT are enriched by a feminist perspective when working with women. In addition, the authors draw on the literature and their experience from a 2005 study of peer support and lone mothers’ health to demonstrate the advantages of combining these theoretical perspectives. Finally, the authors recommend that nurse researchers draw on feminist principles to guide their use of grounded theory to better serve the interests of women by surfacing issues of gender and power that influence the health experience.

Cardiovascular disease remains a health issue in North America, particularly for marginalized citizens. Although lifestyle issues and behavioral risk reduction continue to dominate prevention initiatives, an emerging literature suggests that contextual factors such as poverty and social exclusion also influence health. Using group and personal interviews (N = 38), this research explored the social and economic contexts shaping heart health-related experiences from the perspectives of low-income, lone mothers. The transcripts were analyzed using McKinlay and Marceau's upstream-midstream-downstream framework. The overriding pattern characterizing lone mothers’ discussions was that the women felt out of the mainstream of everyday life. They lacked the resources and power to effect change, particularly regarding heart health behaviors that were not perceived to be a priority compared to more pressing survival issues. Results are discussed in terms of concepts from the population health and social determinants literature, concluding with policy implications for enhancing health while living in poverty.

Purpose: To examine whether lone parenthood among Canadian women is associated with risk factors for cardiovascular disease (CVD). Methods: The sample was from the National Population Health Survey (NPHS) and it included 2,184 mothers (women with dependent children < 18 years of age) of whom 478 were lone (22%) and 1,706 (78%) were partnered mothers. Descriptive statistics and multiple logistic regression were undertaken with weighted data. Results: Compared to partnered mothers, lone mothers were significantly younger, and reported lower levels of education and income. Lone mothers reported significantly lower levels of health, less social support, and more distress and depression than partnered mothers. Further, lone mothers were significantly more likely to be smokers than partnered mothers. Odds ratios for being a lone mother and current smoker on social assistance in this analysis was 4.15 (95% CI 2.27-7.60), and for those reporting low or mid/high incomes respectively, were 2.99 (1.51-5.90) and 3.01 (1.93-4.70). There were no significant differences between the two groups for obesity or physical activity. Conclusions: Smoking is a significant CVD lifestyle risk for lone mothers. Smoking occurred in the context of considerable life stress, depression, and distress pointing to links between health behaviour, psychosocial factors, and CVD health. These results suggest that lone mothers are a key target group for primary prevention in the CVD field. Programs and policies that support lone mothers in their goals of attaining healthier lifestyles have the potential to contribute to the prevention of cardiovascular disease in Canadian women.

Heart transplantation (HT) is increasingly commonplace in countries with advanced health care systems. A review of the family and HT literature points to a gender inequity in the field: Men are more likely to be heart transplant recipients; women are more likely to contribute as their caregivers. In this critique, we argue that there are not only physiological but also social and economic issues that contribute to inequitable access to HT for women. Further, we point out that another invisible inequity in the heart transplant field is the lack of acknowledgment of, and support for, women whose contributions as family caregivers to the heart transplant process often ensure the success of heart transplant procedures. The authors call for recognition of these inequities and the development of policies that have the potential to ensure that women have equitable access to cardiovascular care in general and HT in particular, and that woman are recognized for, and supported in, their role as caregivers.

This chapter presents a different way of examining the macro-structure of university lectures which results in a reconfigured schema for this generic type. The discussion begins with a brief description of the corpus used in the analysis and then outlines the model of analysis. This is followed by a discussion of the different strands of which lectures are composed. After summarizing some of the main features of the strands that contribute to the macro-structure of lectures, the chapter identifies some of the pedagogical implications that result from a re-configuration of the schema of lectures . The focus in this section is on the reasons why students should be presented with an accurate representation of the formal schema of lectures. The purpose of the research and the new proposed macro-structure for monologic discourse at the tertiary level is to offer teachers of ESL and EFL (and their students) a more realistic representation of the schematic patterning of lectures to facilitate students' processing of information transmitted in this mode. Introduction The intention of this chapter is both to describe the macro-structure of university lectures and to identify some of the more prominent micro-features that contribute to this structure. My purpose is to propose a new schema for this generic type based on my analyses of many lectures. My research into this language variety has been motivated by my experience of teaching English as a Second Language to foreign students coming to study in Canadian universities.

H D Sesso Dr H D Sesso, Brigham and Women’s Hospital, Boston, MA, USA; hsesso@hsph.harvard.edu In men at lower risk of cardiovascular disease (CVD), do vitamin E and vitamin C supplements reduce major CVD events? ### Design: randomised placebo controlled trial (Physicians’ Health Study II). ClinicalTrials.gov NCT00270647. ### Allocation: unclear allocation concealment. ### Blinding: blinded (patients, clinicians, and outcome assessors) ### Follow-up period: ⩽10 years (mean 8 y). ### Setting: USA. ### Patients: 14 641 male physicians ⩾50 years of age (mean age 64 y). Men with a history of myocardial infarction (MI), stroke, or cancer were included. Exclusion criteria were history of cirrhosis, active liver disease, anticoagulant use, or serious illness. 5.1% of men had prevalent CVD. ### Intervention: after stratification for age, previous cancer or …

J Hippisley-Cox Prof J Hippisley-Cox, University Park, Nottingham, UK; Julia.hippisley-cox@nottingham.ac.uk Does QRISK score predict risk of cardiovascular disease (CVD) in a validation sample of general practice patients? How does it compare with Framingham score? ### Design: prospective cohort study. ### Setting: 2 validation cohorts from general practices in the UK that provided routinely collected clinical data to 1 of 2 research databases (QRESEARCH, n = 160; THIN, n = 274). ### Patients: patients who were included in the THIN (n = 1.07 million) or QRESEARCH (n = 0.61 million) databases, were 35–74 years of age (51% women), did not have diabetes or CVD, and were not taking statins at baseline. ### Description of prediction guide: QRISK score included traditional risk factors (age, sex, systolic blood pressure, smoking status, and total/high density lipoprotein serum cholesterol ratio) as well as social deprivation …

(2002) Health Psychol 21, 427. Mahler HI, Kulik JA. . Effects of a videotape information intervention for spouses on spouse distress and patient recovery from surgery. . ; . : . –37 . [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] QUESTION: Does a videotaped information intervention targeted at spouses of postoperative coronary artery bypass graft (CABG) patients reduce spousal distress and improve patient recovery? Randomised {allocation concealed}*, unblinded, controlled trial with 6 months of follow up. 3 hospitals in San Diego, California, USA. 296 patients (mean age 63 y, 76% men) who had first time CABG surgery without associated procedures (eg, heart valve repair) and their spouses (mean age 61 y). Couples were excluded if either the patient or spouse had previous CABG, serious medical conditions (eg, terminal cancer), were unable to speak English, or were taking antidepressants. Follow up was 83% at 6 months. 93 spouses were allocated to a mastery tape, 101 to a coping tape, and 102 to a control condition. The mastery and coping tapes provided procedural information (eg, lifting, exercise, diet, incision care) and sensory information (eg, emotions, sleep, appetite) regarding what to expect during the recovery period. … [1]: {openurl}?query=rft.jtitle%253DHealth%2Bpsychology%2B%253A%2B%2Bofficial%2Bjournal%2Bof%2Bthe%2BDivision%2Bof%2BHealth%2BPsychology%252C%2BAmerican%2BPsychological%2BAssociation%26rft.stitle%253DHealth%2BPsychol%26rft.aulast%253DMahler%26rft.auinit1%253DH.%2BI.%26rft.volume%253D21%26rft.issue%253D5%26rft.spage%253D427%26rft.epage%253D437%26rft.atitle%253DEffects%2Bof%2Ba%2Bvideotape%2Binformation%2Bintervention%2Bfor%2Bspouses%2Bon%2Bspouse%2Bdistress%2Band%2Bpatient%2Brecovery%2Bfrom%2Bsurgery.%26rft_id%253Dinfo%253Adoi%252F10.1037%252F0278-6133.21.5.427%26rft_id%253Dinfo%253Apmid%252F12211509%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1037/0278-6133.21.5.427&link_type=DOI [3]: /lookup/external-ref?access_num=12211509&link_type=MED&atom=%2Febnurs%2F6%2F2%2F48.atom [4]: /lookup/external-ref?access_num=000177618900002&link_type=ISI