The epidemiology of chronic pain in Canadian men and women between 1994 and 2007: longitudinal results of the National Population Health Survey.

BACKGROUND: The epidemiology of chronic pain is poorly understood due to a paucity of longitudinal studies limiting the ability to develop prevention strategies for a condition resistant to many current therapies. OBJECTIVES: To identify the incidence of and sociodemographic risk factors for chronic pain in Canadian women and men over a 12-year period. METHODS: Using data from the National Population Health Survey, individuals who developed chronic pain, defined as the presence of "usual pain" were identified. The cumulative incidence of chronic pain was calculated separately for men and women followed from 1994 to 2007. Biannual incidence and prevalence estimates of chronic pain were calculated during the same time period. Logistic regression analysis was used to examine predictors of chronic pain in men and women. RESULTS: The cumulative incidence over the 12-year period was 35.6% (women 39.0%; men 32.2%). Women had a higher biannual prevalence, but not incidence, of chronic pain compared with men. In women, being older, having lower education and being widowed, separated or divorced, increased the risk of chronic pain. There were no sociodemographic risk factors for chronic pain in men. CONCLUSION: Women had a higher prevalence - but not incidence - of chronic pain compared with men, indicative of longer duration of illness in women. Risk factors also differed according to sex, supporting current literature reporting potentially different mechanisms for men and women. A better understanding of risk factors is necessary to develop population-based preventive interventions. The former can only be achieved with population-based, longitudinal studies.

Providing delirium education for family caregivers of older adults.

Using the Knowledge to Action Process, an education session was developed to teach families of older adults about delirium. Seven sessions were held with 16 eligible participants. A significant increase in delirium knowledge was found following education, and many participants believed others should receive similar education. At follow up, most participants were able to recall information related to risk factors and signs of delirium. Families of older adults form a common communication link for their relatives between health care providers across settings; providing education to family caregivers may in part provide a solution to the problem of delirium.

Successful aging: considering non-biomedical constructs.

OBJECTIVES: Successful aging continues to be applied in a variety of contexts and is defined using a number of different constructs. Although previous reviews highlight the multidimensionality of successful aging, a few have focused exclusively on non-biomedical factors, as was done here. METHODS: This scoping review searched Ovid Medline database for peer-reviewed English-language articles published between 2006 and 2015, offering a model of successful aging and involving research with older adults. RESULTS: Seventy-two articles were reviewed. Thirty-five articles met the inclusion criteria. Common non-biomedical constructs associated with successful aging included engagement, optimism and/or positive attitude, resilience, spirituality and/or religiosity, self-efficacy and/or self-esteem, and gerotranscendence. DISCUSSION: Successful aging is a complex process best described using a multidimensional model. Given that the majority of elders will experience illness and/or disease during the life course, public health initiatives that promote successful aging need to employ non-biomedical constructs, facilitating the inclusion of elders living with disease and/or disability.

A critical review and synthesis of literature on reminiscing with older adults.

Reminiscing is an intervention that has been used independently in nursing with different populations for many years. A critical analysis of the literature on reminiscing was carried out in 3 stages: identification of the studies to be included, review of the studies to ensure that they were research-based, and critical appraisal of the studies. The analysis resulted in clarity regarding the operational definitions of reminiscing and life review. Of the many studies reviewed, only a handful were research-based. The others were valuable in other respects, such as providing guidance for the design of imaginative and age-related reminiscing and life-review programs.

Supportive care needs after an acute stroke: a descriptive enquiry of caregivers' perspective.

This mixed-methods study explored the use of the Supportive Care Needs Framework (M. Fitch, 1998; M. Fitch, H. B. Porter, & B. D. Page, 2008) as an overall guide to identify the wide spectrum of needs of the family caregivers of patients with stroke. Within this framework, a needs assessment survey developed for a different complex medical population was modified and administered to 10 caregivers of patients recently diagnosed with stroke to identify the specific needs of this population. The applicability of the tool was further evaluated through a focus group of nurses working in acute stroke care. The Supportive Care Needs Framework provides a useful and comprehensive framework for the assessment of caregiver need. Results suggest that although additional validation is needed, the modified survey may aid nurses in early identification of caregiver needs.

The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic review.

Objectives The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. Inclusion criteria This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. Search strategy The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Methodological quality Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data collection Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data synthesis Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. Results A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. Conclusion The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self.

The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic review.

OBJECTIVES: The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. INCLUSION CRITERIA: This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. SEARCH STRATEGY: The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. METHODOLOGICAL QUALITY: Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. DATA COLLECTION: Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. DATA SYNTHESIS: Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. RESULTS: A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. CONCLUSION: The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self.

Asthmatic bronchial epithelium is more susceptible to oxidant-induced apoptosis.

Abnormal apoptotic mechanisms are associated with disease pathogenesis. Because the asthmatic bronchial epithelium is characteristically damaged with loss of columnar epithelial cells, we postulated that this is due to unscheduled apoptosis. Using an antibody directed toward the caspase cleavage product of poly(ADP-ribose) polymerase, immunohistochemistry applied to endobronchial biopsies showed higher levels of staining in the bronchial epithelium of subjects with asthma as compared with normal control subjects (% epithelial staining [median (range) = 10.5 (1.4-24.5) versus 0.4 (0.0-9.7)]; P < 0.001). Because we were unable to determine whether this difference was due to ongoing inflammation in vivo, cultures of normal and asthmatic bronchial epithelial cells were used to study apoptosis in vitro. In complete growth medium, these cells showed no difference in their rate of proliferation or viability. However, cells from subjects with asthma were more susceptible to the apoptotic effects of H2O2 than cells from normal control subjects (% apoptotic cells = 32.2 [8.8-54.9] versus 14.3 [6.4-24.7]; P < 0.05), even though both were similarly affected by treatment with actinomycin D. These data indicate that the susceptibility of asthmatic bronchial epithelium to oxidants is greater than normal. This susceptibility may contribute to the rising trends in asthma associated with air pollution and diets low in antioxidants.