"Something is just not right with my hearing": early experiences of adults living with hearing loss.

OBJECTIVE: To understand the psychosocial process of how adults experience hearing loss; specifically, their readiness to accept that they may have hearing loss, and the challenges and coping strategies associated with it. DESIGN: A grounded theory methodology guided the research. A patient-orientated research approach informed the study. Thirty-nine individual interviews and six focus groups were completed. STUDY SAMPLE: Participants included 68 individuals aged 50 years and older with self-reported hearing loss living in Newfoundland and Labrador. RESULTS: The theoretical construct, 'Realising that something is just not quite right with my hearing' captured individuals' experiences as they gradually awakened to the fact that they had hearing loss. Three categories describe the process: (1) Rationalising suspicions, (2) Managing the invisible and (3) Reaching a turning point. CONCLUSIONS: Many individuals do not recognise hearing loss in its early stages, although they may be already experiencing its negative effects. It is important to identify motivators to engage individuals as early as possible in their hearing health. Taking a proactive approach to hearing health can help mitigate the potential negative outcomes of hearing loss.

A randomized controlled trial of the effect of an intensive 1-year care management program on measures of health status in independent, community-living old elderly: the Eldercare project.

BACKGROUND: Primary care practitioners are familiar with the frail elderly and commonly have to deal with their multi-morbidity and their functional decline, both physically and mentally. However, there are well elderly with high quality of life and very few co-morbidities who seldom seek medical care. OBJECTIVE: To determine if a nurse-based program of home-delivered care, linked directly with the primary care practitioner or primary care team, would improve quality of life, symptoms, satisfaction with care and utilization of community and medical services, in independent community living old elderly. DESIGN: Randomized controlled trial. SETTING: St. John's, Newfoundland, Canada. PARTICIPANTS: Two hundred and thirty-six independent, community-dwelling, cognitively functioning, people aged 80 years and older. INTERVENTION: A nurse-based program of care, carried out in the patients home, that involved a detailed assessment of needs, the development of a plan to meet the needs, and up to eight visits to the patients home during a 1-year period to facilitate the meeting of those needs. CONTROL GROUP: Usual care MAIN OUTCOME MEASUREMENTS: Quality of Life measured using the SF-36 and the CASP-19 scales; symptomology using the Comorbidity Symptom Scale; patient satisfaction using the PSQ-18; and assessment of health care services (community services, emergency room visits, hospitalizations, use of diagnostic services and family doctor visits) through patient recall, family physician chart review and assessment of hospitalization records. RESULTS: There were no statistical or meaningful differences between the intervention and control groups in any of the outcomes measured. CONCLUSION: The intensive, home-delivered, program of care for the well old elderly did not have an impact on the outcomes measured.

The healthy aged: Descriptive analysis by sex of cognitively functioning elderly patients 80 years and older living independently in the community.

OBJECTIVE: To describe a population of cognitively functioning seniors aged 80 years and older who are livingin dependently in the community. DESIGN: Descriptive cross-sectional study based on the enrolment cohort of a randomized controlled trial. SETTING: St John's, Nfld. PARTICIPANTS: A total of 236 cognitively functioning seniors aged 80 years and older living independently in the community. MAIN OUTCOME MEASURES: Demographic characteristics including age, sex, marital status, and education; health status and quality of life measured by the Short Form-36 and the CASP-19 (control, autonomy, self-realization,and pleasure); use of formal and informal community services;satisfaction with family physician care as measured by the Patient Satisfaction Questionnaire-18; and use of health care resources (family physician visits, emergency department visits,hospitalizations, and laboratory and diagnostic imaging tests). RESULTS: Overall, 66.5% of those in the group were women and the average age was 85.5 years. A quarter had postsecondary diplomas or degrees; 54.7% were widowed (69.4% of women and 25.3% of men). The cohort scored well in terms of health status and quality of life, with a range of scores on the Short Form­36 from 57.5 to 93.5 out of 100, and a score of 44 out of 57 on the CASP-19; they were satisfied with the care received from family physicians, with scores between 3.8 and 4.3 out of 5 on the Patient Satisfaction Questionnaire-18; and use of health services was low-70% had no emergency department visits in the previous year and 80% had not used any laboratory or diagnostic services. CONCLUSION: Seniors aged 80 years and older living in dependently are involved in the social fabric of society. They are generally well educated, slightly more than half are widowed,and two-thirds are female. They score well on scales that measure well-being and quality of life, and they use few health services. They are the healthy aged. TRIAL REGISTRATION NUMBER: NCT00452465 (ClinicalTrials.gov).

Evaluating the effectiveness of the cardiovascular assessment screening program with nurse practitioners and patients: results of a cluster randomised controlled trial.

BACKGROUND: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. To address this issue, the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. This manuscript reports on the second phase of an exploratory sequential mixed methods study that tested the effectiveness of the CASP with nurse practitioners (NPs) and patients in Canada. METHODS: A two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40-74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG). RESULTS: Eight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p < .0001, controlling for the effect of NP and BP category. CONCLUSION: NP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting. TRIAL REGISTRATION: ClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31.

Community-dwelling older adults with memory loss: needs assessment.

OBJECTIVE: To identify the health-related needs of community-dwelling older adults with mild memory loss. DESIGN: Qualitative study using semistructured, audiotaped, face-to-face interviews and focus groups. SETTING: A large community in Newfoundland. PARTICIPANTS: Twenty-two adults between the ages of 58 and 80 years. METHODS: This needs assessment used a qualitative methodology of collecting and analyzing narrative data to develop an understanding of the issues, resources, and constraints of community-dwelling older adults with mild memory loss. Data were collected through semistructured, audiotaped, face-to-face interviews and focus groups. Transcripts of the interviews were analyzed using interpretive phenomenologic analysis. MAIN FINDINGS: Three constitutive patterns with relational themes and subthemes were identified: forgetting and remembering, normalizing yet questioning, and having limited knowledge of resources. Participants described many examples of how their daily lives were affected by forgetfulness. They had very little knowledge of resources that provided information or support. Most of the participants believed they could not discuss their memory problems with their family doctors. CONCLUSION: It is important for older adults with mild memory loss to have access to resources that will assist them in understanding their condition and make them feel supported.

Development of the Cardiovascular Assessment Screening Program (CASP) using the qualitative findings of a mixed methods study and applying the TDF to address the barriers of and facilitators to comprehensive screening for cardiovascular disease.

BACKGROUND: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. This manuscript reports on the first phase of an exploratory sequential mixed methods study describing the integration of the qualitative study findings with the Theoretical Domains Framework (TDF) that led to the development of the Cardiovascular Assessment Screening Program (CASP). The main objective of the qualitative study was to inform the development of CASP. METHODS: Focus groups (5) and interviews (10) were conducted in rural and urban settings in one Canadian province with target health professionals, managers in health care organizations, and the public to obtain different perspectives to inform the CASP intervention. Three focus groups were held with nurse practitioners and two with members of the public; individual interviews were conducted with target groups as well. Application of the TDF provided a comprehensive approach to determine the main factors influencing clinician behaviour, to assess the implementation process, and to support intervention design. Behaviour change techniques, modes of delivery, and intervention components were selected for the development of the CASP. RESULTS: Themes identified such lack of knowledge about comprehensive screening, ambiguity around responsibility for screening, lack of time and commitment to screening were addressed in the components of the CASP intervention that were developed, including a website, education module, decision tools, and a toolkit. CONCLUSION: CASP is a theory-informed intervention developed through the integration of the findings from the focus groups and interviews with selected TDF domains, behaviour change techniques, and modes of delivery available in the local context that may be a useful approach for knowledge translation of evidence into practice.

Older Adults' Experiences with Remote Care for Specialized Health Service During the COVID-19 Pandemic: A Descriptive Qualitative Study.

The coronavirus disease (COVID-19) pandemic necessitated a rapid uptake of remote health care services. This qualitative descriptive study was designed to gain an understanding of older adults' experiences of remote care (telephone or online video conference appointments) for specialized health services during the COVID-19 pandemic. Twenty-one older adults (ages 65 years and older; 8 men and 13 women) living in eastern Canada participated in a semi-structured telephone interview. Data were analysed using qualitative content analysis. The vast majority of older adults were overall satisfied with their remote experiences of specialist care. Advantages to remote care for specialized services included convenience, safety during the pandemic, comfort, efficiency, and ease of visit. Disadvantages included communication not as effective, feeling depersonalized or disembodied, missing the human relationship, and wanting reassurance of physical assessment. It is important that health professionals understand the disadvantages for older adults of remote care visits in order to mitigate them.

Nurse leaders' experiences of upwards violence in the workplace: a qualitative systematic review.

OBJECTIVE: The objective of this review was to synthesize the qualitative literature on the experience of upwards violence in nursing workplaces directed towards nurse leaders who have authority over those who direct the violence towards them. INTRODUCTION: Workplace violence has impacted nursing work life for decades. It has been studied mostly from a downwards and lateral perspective and less often from an upwards direction towards individuals in leadership positions. Little is known about the experiences of nurse leaders or the potential consequences of workplace violence, including what impact upwards violence has on leadership ability and sustainability. INCLUSION CRITERIA: This review considered qualitative studies that included nurse leaders who experienced upwards violence in nursing workplaces from nurses they supervise. Nurse leaders were registered nurses or advanced practice nurses employed in a position where they supervised other nursing personnel (eg, registered nurses, licensed practical nurses, nurse practitioners, student nurses). The positions held by nurse leaders included all roles (eg, nurse manager, clinical nurse specialist, nurse practitioner, nursing professor) where the position included supervising other nursing personnel. METHODS: The search strategy aimed to find both published and unpublished studies in English from 2000. The search was first conducted in January 2019 and rerun in June 2020. The databases searched included CINAHL, MEDLINE, PsycINFO, and Embase. To ensure full coverage, databases not specific to the nursing profession, but with potential content on upwards violence, were also searched for examples of upwards violence against nurse leaders. These databases were ABI/INFORM, Sociological Abstracts, LexisNexis Academic, Scopus, and Web of Science. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, OpenGrey Repository, Health Business Elite, and Factiva. Papers meeting the inclusion criteria were appraised by two independent reviewers for methodological quality using the JBI critical appraisal checklist for qualitative research. Data extraction was conducted according to the standardized data extraction tool from JBI. The qualitative research findings were pooled using the JBI method of meta-aggregation. RESULTS: Six papers were included in the review yielding a total of 50 findings and nine categories. The categories were aggregated to form three synthesized findings: i) Physical, psychological, financial, and quality-of-work toll of upwards bullying: paying a high price; ii) Coping with violence alone; and iii) What happened to me? My take on the violence. The ConQual scores were low to moderate. CONCLUSION: The synthesized findings reveal that nurse leaders' experiences of upwards workplace violence is a troublesome problem that leads to a negative impact on physical and psychological health, and creates a cost in terms of time, money, and efficacy of the workplace.

The Lived Experience of Continuous Subcutaneous Insulin Infusion in Adults With Type 1 Diabetes Mellitus: A Phenomenological Inquiry.

Continuous subcutaneous insulin infusion (CSII) is a complex, medical device for the management of Type 1 Diabetes Mellitus (T1DM). There is limited research exploring the everyday experiences living with this device. The purpose of this study was to understand the lived experience of adults using CSII therapy to manage T1DM. Lived experiences from eight individuals were collected through semi-structured interviews and then analyzed using a hermeneutic approach to phenomenology. Four substantive themes with supporting subthemes were identified and represent the essence of participant experiences; that is, living with CSII eventually took ascendancy over managing T1DM.CSII therapy has gained popularity due to reported improvements in metabolic control and flexibility. However, the burden of the responsibility and psychological implications of CSII took ascendancy over T1DM. Living with CSII impacts the psychological well-being of individuals so psychological complications are as important to assess by healthcare professionals as physical and metabolic complications.

Experiences of older adults accessing specialized health care services in rural and remote areas: a qualitative systematic review.

OBJECTIVE: The objective of this review was to synthesize the literature on the experiences of older adults accessing specialized health care services while living in remote or rural areas. INTRODUCTION: Older persons with chronic illnesses often need specialized health care services. Those who live in remote or rural areas may have limited access to these specialized health care services, potentially leading to an increase in morbidity and mortality. Little is known about the experiences of older adults accessing specialized health care services while living in remote or rural areas. INCLUSION CRITERIA: This review considered studies of persons 65 years and older who have self-identified as living in remote or rural areas. They will have, on at least one occasion, sought access in person to specialized health care services for a chronic condition such as cardiovascular disease, renal disease, diabetes, cancer, mental illness, or a major health concern beyond the scope of a primary care clinician, such as palliative care. METHODS: The search strategy aimed to find both published and unpublished studies in English from 1980 onward. An initial limited search of MEDLINE and CINAHL was undertaken in February 2017, followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the articles. This informed the development of a search strategy, which was tailored for each information source. The search was first conducted in December 2018 and rerun in November 2019. The databases searched included CINAHL, PubMed, PsycINFO, and AgeLine. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, and MedNar. Papers meeting the inclusion criteria were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized data extraction tool from JBI. The qualitative research findings were pooled using the JBI method of meta-aggregation. RESULTS: Three papers were included in the review yielding a total of five findings and two categories. The categories were aggregated to form one synthesized finding: Distance often results in challenges accessing health care. For almost all older adults, the long distance to drive for specialized services was a barrier, especially for those living far out in the country, and led to delayed care. Lack of health education and peer support was also viewed as an issue. For one older adult, however, the distance was not seen as an issue; rather, it was viewed as an opportunity to enjoy time with family members. Participants noted that they had access to emergency care and, therefore, believed they were not putting their lives at risk by living in a rural area. The overall ConQual score was low. CONCLUSION: We believe that the distance to travel to obtain specialized services, as well as living in an area without specialized services, impacted this population's experience of obtaining specialized health care as well as their health. The spectrum of findings for our synthesized finding suggests that this was the case for some people, but not all. We speculate that people who have chosen to live outside an urban area or have lived in a rural area for a prolonged period come to accept their access to health care, including the distance to travel for health care and their potential for this to impact their health. The findings also suggest the older adults have a range of experiences; for some, distance was an issue and for others, it was not an issue. Some participants found living in a rural area impacted their care while others did not.

Recruitment of Healthcare Providers into Research Studies.

Recruitment of a sufficient number of healthcare providers (HCPs), such as nurses and nurse practitioners (NPs), as participants is essential to generate high quality research to address issues significant for clinical practice. Often the recruitment process reported in research studies is very brief and does not capture the reality of the challenges of obtaining an adequate sample. This manuscript describes the challenges that we experienced in trying to recruit a sufficient number of HCPs, specifically NPs, into a randomized controlled trial. Based on our experience, as well as a review of the literature on recruiting HCPs, we share recommendations for researchers trying to recruit busy professionals as participants. Key findings were not just about reaching the target participants, but actually using strategies to stimulate their interest and persuading them to be involved from the beginning. Important things to consider for successful recruitment are making an effort to meet with professionals face-to-face and building relationships with administrators and other staff within organizations. Other lessons learned were to ensure to allot extra time for recruitment to allow for unanticipated challenges and to utilize multimodal strategies simultaneously to ensure a more timely execution of the recruitment process.

Exploring how Heideggerian philosophy underpins phenomenolgical research.

This paper demonstrates the methodological implications of using Heideggerian philosophy to inform a phenomenological study of the experience of memory loss. In particular, it addresses the methodological implications in relation to forestructure and pre-understanding, gaining entry into the hermeneutic circle and the process of data analysis, by considering their influences on the research.

Implications for Paradigm Shift in Nursing: A Critical Analysis of Thomas Kuhn's Revolutionary Science and Its Relevance to Nursing.

By seeking answers to ontological and epistemological questions, nursing scholars explored the foundations of nursing and articulated the meaning of nursing science from various philosophical perspectives. This ongoing search for advancement and development of nursing aligns with the concept of "normal science" by Thomas Kuhn. Kuhn's science influenced nursing knowledge, resulting in the development of nursing metaparadigm and paradigms. Despite this influence, Kuhn's science's relevance for nursing science received a little scrutinization. This article presents a critical analysis of Kuhn's science and its influence on and relevance for nursing discipline and suggests implications for nursing knowledge development.

Experiences of older adults accessing specialized healthcare services in rural or remote areas: a systematic review protocol.

OBJECTIVE: The objective of this review is to synthesize the literature on the experiences of older adults accessing specialized healthcare services while living in remote or rural areas. INTRODUCTION: Older persons with chronic illnesses often need specialized healthcare services. Those who live in remote or rural areas may have limited access to these specialized healthcare services, potentially leading to an increase in morbidity and mortality. Little is known about the experience of older adults accessing specialized healthcare services while living in remote or rural areas. INCLUSION CRITERIA: This review will consider studies of persons 65 years and over who have self-identified as living in remote or rural areas. They will have on at least one occasion sought access in person to specialized healthcare services for a chronic condition(s) such as cardiovascular diseases, renal diseases, diabetes, cancers, mental illness or a major health concern beyond the scope of a primary care clinician, such as palliative care. METHODS: The search strategy will aim to find published and unpublished studies in English from 1980. Databases to be searched include: CINAHL, PubMed, PsycINFO, AgeLine, ProQuest Dissertations and Theses, Google Scholar and MedNar. Titles and abstracts will be screened against the inclusion criteria. Papers meeting the inclusion criteria will be appraised by two independent reviewers for methodological quality. Data will be extracted by two independent reviewers using a standardized data extraction tool. Findings will be pooled with the meta-aggregation approach, and a ConQual Summary of Findings will be presented.

Older nurses' experiences of providing direct care in hospital nursing units: a qualitative systematic review.

BACKGROUND: Most developed countries throughout the world are experiencing an aging nursing workforce as their population ages. Older nurses often experience different challenges then their younger nurse counterparts. With the increase in older nurses relative to younger nurses potentially available to work in hospitals, it is important to understand the experience of older nurses on high paced hospital nursing units. This understanding will lend knowledge to ways of lessening the loss of these highly skilled experienced workers and improve patient outcomes. OBJECTIVES: To identify, evaluate and synthesize the existing qualitative evidence on older nurses' experiences of providing direct care to patients in hospital nursing units. INCLUSION CRITERIA: The review considered studies which included registered nurses 45 years and over who work as direct caregivers in any type of in-patient hospital nursing unit. The phenomenon of interest was the experience of older nurses in providing direct nursing care in any type of in-patient hospital nursing unit (i.e. including but not limited to medical/surgical units, intensive care units, critical care units, perioperative units, palliative care units, obstetrical units, emergency departments and rehabilitative care units). The review excluded studies focussing entirely on enrolled nurses, licensed practical nurses and licensed vocational nurses. TYPES OF STUDIES: Qualitative data including, but not limited to the following methodologies: phenomenology, grounded theory, ethnography, action research and feminist research. METHODS: The databases CINAHL, PubMed, PsycINFO, Embase, AgeLine, Sociological Abstracts and SocINDEX were searched from inception; the search was conducted on October 13, 2017; no date limiters or language limiters were applied. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. RESULTS: Twelve papers were included in the review. Three synthesized findings were extracted from 12 categories and 75 findings. The three synthesized findings extracted from the papers were: (1) Love of nursing: It's who I am and I love it; (2) It's a rewarding but challenging and changing job; it's a different job and it can be challenging; (3) It's a challenging job; can I keep up? CONCLUSIONS: Older nurses love nursing and have created an identity around their profession. They view their profession positively and believe their job to be unlike any other, yet they identify many ongoing challenges and changes. Despite their desire to continue in their role they are often faced with hardships that threaten their ability to stay at the bedside. A key role of hospital administrators to keep older nurses in the workplace is to develop programs to prevent work related illness and to promote health. Given the low ConQual scores in the current systematic review, additional research is recommended to understand the older nurses' experience in providing direct care in hospital nursing units as well as predicting health age of retirement and length of bedside nursing.

Role of dispersal ability in the phenotypic differentiation and plasticity of two marine gastropods : I. Shape.

Species with contrasting abilities for dispersal may adopt different strategies in response to wide ranges of environmental conditions. These strategies were investigated here by comparisons of phenotypic differentiation and plasticity in the gastropods Austrocochlea constricta and Bembicium vittatum, which coexist in a range of intertidal habitats on the Abrolhos Islands and Albany in Western Australia. They differ in their potential for larval dispersal, A. constricta having a short mobile planktonic stage and B. vittatum developing directly from benthic eggs. Levels of among-population variation in shell shape and maximum size did not differ between the species, or between locations subject to contrasting levels of gene flow in the case of A. constricta. Results of a common garden translocation experiment, coupled with those of previous breeding experiments, suggest that variation in shape is predominantly genetically determined in B. vittatum, but plastic in A. constricta. Plasticity of shape in A. constricta was most pronounced at Albany, where previous data suggested the widest gene flow, and was greater than in B. vittatum at both locations. Change of shape in A. constricta subsequent to translocation was related to growth rate, a trait which was also more plastic in this species than in B. vittatum. The results agree with the notion that wide dispersal enhances physiological flexibility, while restricted dispersal promotes local genetic adaptation, but disagree with the hypothesis that wide dispersal promotes phenotypic homogeneity.

Assessing the need for hot meals: a descriptive Meals on Wheels study.

According to recent literature, delivering chilled Meals on Wheels to seniors increases food quality and safety. The purpose of this study was to determine the acceptability and/or feasibility of a cook-chill delivery system for participants in the Maimonides Geriatric Centre Meals on Wheels program in Montreal, Quebec. The authors also evaluated whether the meal was eaten upon delivery, documented where the meal was stored if consumption was delayed, determined what cooking/heating appliances were used and if the recipients were capable of heating up their meals, and assessed preferences for receiving chilled versus hot meals. Upon receiving the meal, 89% of the 60 seniors did not eat it immediately. Those who ate the meal later stored it in the refrigerator. All had some appliance available to heat the delivered meal; 55% used a microwave. Approximately 75% did not object to receiving meals chilled. The majority of recipients did not require delivery of hot meals, as most delayed consuming the meal until later in the day. Other meal-delivery program planners can use these findings when deciding if a cook-chill system is appropriate for their client populations.

HIV testing in pregnancy: using women's voices to inform policy.

BACKGROUND: In Canadian provinces with opt-out policies for maternal HIV screening, pregnant women are told HIV screening is routine and are provided with the opportunity to refuse. In Newfoundland and Labrador an opt-out screening policy has been in place since 1997. PURPOSE: This research study aimed to (1) obtain an increased understanding of the information women receive about HIV/AIDS during the opt-out screening process and (2) to advance the policy related dialogue around best practices in HIV screening within the province of Newfoundland and Labrador. METHODS: Twelve women who were between 14 and 35 weeks gestation participated. Interviews were transcribed verbatim and a thematic analysis was carried out. FINDINGS: The major themes are that women have difficulty obtaining clear information about maternal HIV screening, are often not told they have the right to refuse maternal screening, and experience paternalism from physicians. CONCLUSION: We recommend that physicians and other health care providers in be reminded that that current opt-out testing requires women's consent and that women must be given the option to refuse the test.

Workplace colorectal cancer-screening awareness programs: an adjunct to primary care practice?

Although regular screening can decrease morbidity and mortality from colorectal cancer, screening rates nationwide are suboptimal due to a lack of organized screening programs. Since workplace colorectal cancer-awareness programs can potentially mitigate both patient and physician barriers to screening, we assessed the workplace as a venue for implementing a colorectal cancer screening-awareness program. In this cross-sectional study, 3756 members of the Toronto Police Service attended an education session about colorectal cancer; 965 of these members gave their informed consent and completed a 5-item colorectal cancer risk-assessment questionnaire. Nearly one-third (30.9%, or 298/965) of this relatively young population (83.1%, or 802/965, < 50 years of age) were at average or above-average risk for colorectal cancer. In the Toronto Police Service population, the workplace was a useful adjunct to reliance on primary care physicians to raise awareness about this important public health issue. These findings should encourage the development of further Canadian workplace colorectal cancer-screening awareness programs.