A rat subchronic study transcriptional point of departure estimates a carcinogenicity study apical point of departure.

Considerations of human relevance and animal use are driving research to identify new approaches to inform risk assessment of chemicals and replace guideline-based rodent carcinogenicity tests. Here, the hypothesis was tested across four agrochemicals that 1) a rat 90-day transcriptome-based BEPOD is protective of a rat carcinogenicity study and 2) a subchronic liver or kidney BEPOD would approximate a cancer bioassay apical POD derived from other organs and a rat subchronic BEPOD would approximate a mouse cancer bioassay apical POD. Using RNA sequencing and BMDExpress software, liver and/or kidney BEPOD values were generated in male rats exposed for 90 days to either Triclopyr Acid, Pronamide, Sulfoxaflor, or Fenpicoxamid. BEPOD values were compared to benchmark dose-derived apical POD values generated from rat 90-day and rodent carcinogenicity studies. Across all four agrochemicals, findings showed that a rat 90-day study BEPOD approximated the most sensitive apical POD (within 10-fold) generated from the 90-day rat study and long-term rodent carcinogenicity studies. This study supports the conclusion that a subchronic transcriptome-based BEPOD could be utilized to estimate an apical POD within a risk-based approach of chronic toxicity and carcinogenicity agrochemical assessment, abrogating the need for time- and resource-intensive rodent carcinogenicity studies and minimizing animal testing.

Rural people who inject drugs: A cross-sectional survey addressing the dimensions of access to secondary needle and syringe program outlets.

OBJECTIVE: To better understand issues related to access to injecting equipment for people who inject drugs (PWID) in a rural area of New South Wales (NSW), Australia. DESIGN: Cross-sectional face-to-face survey using convenience and snowball sampling. SETTING: Six regional and rural population centres in Northern NSW, within the Hunter New England Local Health District. PARTICIPANTS: The sample included 190 PWID who had accessed a needle and syringe program outlet within 4 weeks of the survey. MAIN OUTCOME MEASURES: Data include demographic information, preferred location for accessing injecting equipment, reasons for that preference, whether they obtained enough equipment, travelling distance to an NSP and self-reported hepatitis C virus status. RESULTS: Sixty percent self-identified as Aboriginal people. The median age of respondents was 32 years and 60% were men. A significantly larger proportion (P < 0.05) of the Aboriginal respondents were women (27% versus 11.6%) and younger (37.6 versus 12.7%) compared to non-Aboriginal respondents. Most preferred to access injecting equipment at a community health facility (62.6%), as opposed to other secondary outlets, where they gained enough equipment (67.4%). Just over 80% said they were tested for HCV in the past year, with about 37% told they had tested positive. CONCLUSIONS: There are complex dimensions affecting how rural PWID access secondary NSP outlets. Although access is similarly limited as other rural health services because of the nature of injecting drug use and sensitivities existing in rural communities, there is potential for application of unique access models, such as, promoting secondary distribution networks.

Self-image differences as related to body image of students in a middle school.

OBJECTIVE: To examine whether gender and ethnic self-image differences exist among Asian and white adolescents within the context of body image. METHODS: One hundred seventy-seven students in a Midwestern US middle school were surveyed on self-image. Analyzed using 2-way ANOVA by gender and race. RESULTS: Asian students have lower self-image compared to white students, including the subcomponents of self-esteem, identity, and integrity. CONCLUSIONS: Asian students have more critical feelings about themselves, base their identities on a few sources rather than on diverse sources, and choose unrealistic standards. However, Asian girls scored better on the image-consciousness subscale.

Evaluating the economic loss of caregiving for palliative care patients.

OBJECTIVE: Our aim is to provide a unified measure of the economic burden faced by families during the palliative phase of care and to compare this measure to Statistics Canada's low-income cut-off. METHODS: Samples of palliative care patients living at home and their main informal caregivers were recruited in five Canadian urban regions. Interviews were performed every two weeks until the patient's passing, up to a maximum of six months. Participants were asked to provide details about their expenses and their absences from work that related specifically to the patient's condition. Income loss was evaluated for 192 family units. RESULTS: About 9 percent of families incurred economic losses in excess of 10 percent of their pre-study gross annual income; low-income status increased from 27 (before) to 40 (after). CONCLUSION: This is the first study to provide a unified measure of economic losses of caregiving that can be related to a publicly designated low-income threshold.

Measurement challenges of informal caregiving: a novel measurement method applied to a cohort of palliative care patients.

Informal caregiving is a complex concept, and inconsistencies are found in the literature regarding how to measure it. The differences in tasks included in the definition of caregiving, as well as the different methods used to measure caregiving time may explain the huge variations in results found in the literature. The current paper aimed to lay out the challenges of how to calculate the time spent by informal caregivers on providing care and assistance to an ill person at home. It also proposes a method for measuring informal caregiving time, which attempts to distinguish between "normal" activities and "caregiving" activities. The proposed measurement method is then applied to a cohort of informal caregivers of palliative care patients. The illustration study revealed that this method brought advantages comparatively to other methods, and that persisting challenges remain in measuring informal caregiving time. We conclude that, the estimate of time spent caregiving for palliative care patients may be useful in guiding support programs for the families taking care of a loved one at home during the palliative phase of care.

The trajectory of palliative care costs over the last 5 months of life: a Canadian longitudinal study.

OBJECTIVE: This study aimed to highlight the trajectory of palliative care costs over the last five months of life in five urban centres across Canada. SUBJECTS: The study sample was comprised of 160 terminally ill patients and their main informal caregivers. RESEARCH DESIGN: A first interview took place in the patient's home, and subsequent follow-up interviews were conducted by telephone at two week intervals until the patient's passing. MEASURES: Participants were asked to provide information on the goods and services they used related to the patients' health condition, and on informal caregiving time. RESULTS: The overall costs of care gradually increased from the fifth to the last month of the patients' life. A large part of this cost increase was attributable to inpatient care. Among outpatient care costs the largest increase was observed for home care. Informal care costs were particularly high over the last 3 months of life. CONCLUSIONS: The knowledge gained from this study would be useful to policy makers when developing policies that could help families caring for a terminally ill loved one at home.

Telehealth readiness assessment tools.

In planning a telehealth project, a readiness assessment can help to improve the chances of successful implementation by identifying the stakeholders and the factors that should be targeted. We conducted a literature search and identified six questionnaires on readiness that can be used when implementing telehealth projects. Only one of them was sufficiently generic to be used with all kinds of telehealth projects and with different groups of participants (patients and public, health-care practitioners and organization personnel like health-care managers and technical support managers), but it had rather limited psychometric evaluation. Two of them had had good psychometric evaluation but they were specific to particular telehealth projects and groups of stakeholders. All six published questionnaires were in English. We have developed and validated a French-Canadian version of the practitioner and organizational telehealth readiness assessment tool.

Developing and validating the French-Canadian version of the practitioner and organizational telehealth readiness assessment tools.

Only one telehealth readiness assessment tool, that of Jennett et al., covers all types of telehealth projects, regardless of health-care provision context. However, this instrument is only available in English and has not undergone psychometric evaluation. We developed a French-Canadian version of the Practitioner Telehealth Readiness Assessment Tool and the Organizational Telehealth Readiness Assessment Tool. Transcultural validity was assessed by nine practitioners and 12 clinical project co-ordinators or administrators. For practitioners and managers, there was no significant difference between the scores of the English and the French versions of the questionnaires. The results showed that the telehealth readiness of co-ordinators or administrators was greater than that of practitioners when the range in scores was taken into account. The French-Canadian versions of the two questionnaires make it possible to assess telehealth readiness among French speakers. However, other studies involving patients will be necessary to validate the Patient-Public Telehealth Readiness Assessment Tool.

The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: results of the international body project I.

This study reports results from the first International Body Project (IBP-I), which surveyed 7,434 individuals in 10 major world regions about body weight ideals and body dissatisfaction. Participants completed the female Contour Drawing Figure Rating Scale (CDFRS) and self-reported their exposure to Western and local media. Results indicated there were significant cross-regional differences in the ideal female figure and body dissatisfaction, but effect sizes were small across high-socioeconomic-status (SES) sites. Within cultures, heavier bodies were preferred in low-SES sites compared to high-SES sites in Malaysia and South Africa (ds = 1.94-2.49) but not in Austria. Participant age, body mass index (BMI), and Western media exposure predicted body weight ideals. BMI and Western media exposure predicted body dissatisfaction among women. Our results show that body dissatisfaction and desire for thinness is commonplace in high-SES settings across world regions, highlighting the need for international attention to this problem.

Costs associated with resource utilization during the palliative phase of care: a Canadian perspective.

OBJECTIVE: This study aimed to evaluate prospectively the resource utilization and related costs during the palliative phase of care in five regions across Canada. SUBJECTS: A cohort of 248 patients registered in a palliative care program and their main informal caregivers were consecutively recruited. RESEARCH DESIGN: A prospective research design with repeated measures was adopted. Interviews were conducted at two-week intervals until the patient s passing or up to a maximum of 6 months. MEASURES: The survey questions prompted participants to provide information on the types and number of goods and services they used, and who paid for these goods and services. RESULTS: The largest cost component for study participants was inpatient hospital care stays, followed by home care and informal caregiving time. In regard to cost sharing, the public health care system (PHCS), the family, and not-for-profit organizations (NFPO) sustained respectively 71.3%, 26.6%, and 1.6% of the mean total cost per patient. CONCLUSION: Such results provide a comprehensive picture of costs related to palliative care in Canada, by specifying the cost sharing between the PHCS, the family, and NFPO.

Introducing quality improvement methods into local public health departments: structured evaluation of a statewide pilot project.

OBJECTIVE: To test the feasibility and assess the preliminary impact of a unique statewide quality improvement (QI) training program designed for public health departments. DATA SOURCES/STUDY SETTING: One hundred and ninety-five public health employees/managers from 38 local health departments throughout Minnesota were selected to participate in a newly developed QI training program and 65 of those engaged in and completed eight expert-supported QI projects over a period of 10 months from June 2007 through March 2008. STUDY DESIGN: As part of the Minnesota Quality Improvement Initiative, a structured distance education QI training program was designed and deployed in a first large-scale pilot. To evaluate the preliminary impact of the program, a mixed-method evaluation design was used based on four dimensions: learner reaction, knowledge, intention to apply, and preliminary outcomes. DATA: Subjective ratings of three dimensions of training quality were collected from participants after each of the scheduled learning sessions. Pre- and post-QI project surveys were administered to collect participant reactions, knowledge, future intention to apply learning, and perceived outcomes. Monthly and final QI project reports were collected to further inform success and preliminary outcomes of the projects. PRINCIPAL FINDINGS: The participants reported (1) high levels of satisfaction with the training sessions, (2) increased perception of the relevance of the QI techniques, (3) increased perceived knowledge of all specific QI methods and techniques, (4) increased confidence in applying QI techniques on future projects, (5) increased intention to apply techniques on future QI projects, and (6) high perceived success of, and satisfaction with, the projects. Finally, preliminary outcomes data show moderate to large improvements in quality and/or efficiency for six out of eight projects. CONCLUSIONS: QI methods and techniques can be successfully implemented in local public health agencies on a statewide basis using the collaborative model through distance training and expert facilitation. This unique training can improve both core and support processes and lead to favorable staff reactions, increased knowledge, and improved health outcomes. The program can be further improved and deployed and holds great promise to facilitate the successful dissemination of proven QI methods throughout local public health departments.

Impact of a national campaign on hospital readmissions in home care patients.

OBJECTIVE: Assess impact of nationwide home health quality improvement campaign to reduce acute care hospitalization of home health recipients. DESIGN: Observational pre-post comparison of self-selected participating and non-participating agencies' quality performance; survey to determine uptake of program materials. SETTING: US home health care agencies. PARTICIPANTS: A total of 147 agencies with 147 non-participating agencies matched on patient length of service, pre-intervention hospitalization rate and pre-intervention rate of change in hospitalization rate. INTERVENTION(S): Public events; provision of educational packages and technical assistance; quality measure feedback. MAIN OUTCOME MEASURE(S): Post-intervention difference in risk-adjusted acute care hospitalization rate between participants and non-participants; difference in self-reported campaign material use between agencies whose hospitalization rate declined 2% or more and those whose rates increased by 2% or more. RESULTS: Hospitalization rate had a negative trend beginning before the campaign. In the matched pairs studied, it did not differ significantly between participants and non-participants, or from pre- to post-intervention period (28% in every case). Agencies that improved were more likely to report activities consistent with the campaign and using campaign interventions than those not improving (P < 0.001), regardless of participation status. CONCLUSIONS: Merely agreeing to participate in the campaign did not improve performance, but effective participation through adoption of campaign methods did.

Home Health Quality Improvement National Campaign: the journey and potential impact on clinical practice.

Home health agencies are in a position to respond to patient and healthcare system needs by implementing strategies targeted at reducing avoidable hospitalizations. Many different interventions exist that home care agencies can use in achieving the national goal to reduce avoidable acute care hospitalizations. This article provides an overview of the Home Health Quality Improvement (HHQI) National Campaign and the efforts directed toward this initiative. This overview explains the 4 best practices explored in depth by the campaign participants.

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada.

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational "will" to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational "will", while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action.

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta s regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior middle managers and service providers from 17 RHAs participating in a five year time series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational will to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational will, while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action. (AU)

The development of measures of community capacity for community-based funding programs in Canada.

Improving community capacity for influencing actions on the determinants of health is an immediate outcome of many Public Health Agency of Canada-funding community-based programs. Despite the importance of this outcome, it has been difficult to measure and describe the contribution of funding programs to improving community capacity. This paper reports on a study conducted to develop and establish the psychometric properties of scales that measure community capacity to address health issues in the context of federally funded community-based programs. A literature review and national think tank with 21 experts informed the development of the first draft of the scales that outlined nine key domains of community capacity. Two focus groups with community practitioners provided information on the face and content validity and general usability of this draft instrument. The revised instrument was sent for pilot testing to 114 community organizations. Qualitative and quantitative analyses were performed to assess the validity, reliability and usability of the instrument. Twenty-nine organizations returned a completed instrument (25% response rate). Principal Component Analysis confirmed scale unidimensionality for eight multi-item scales: all of the component loadings were considered good with all scales loading between 0.60 and 0.92. Scale internal consistency was also considered high with alphas between 0.72 and 0.86 for six of these eight scales. Spearman's correlations were significant for the remaining two multi-item scales (composed of two items each), indicating that the two items for each scale were significantly correlated to each other. One scale could not be analyzed quantitatively, as it contained only a single item. Triangulation of qualitative and quantitative results found consistency in interpretations of scale response sets. Feedback on the instrument indicated interest in using it for project planning and evaluation. Psychometric analyses and triangulation provided evidence of the construct validity and reliability of the instrument. The final instrument covers 9 domains and has a total of 26 items, each with a four-point rating scale and a section for qualitative contextual comments. The instrument provides quantitative and qualitative information on community capacity within the context and scope of community-based funding programs.

An examination of the stages of change construct for health promotion within organizations.

PURPOSE: The purpose of this research is to examine the organizational stages of change construct of the transtheoretical model of behavior change. DESIGN/METHODOLOGY/APPROACH: Data on organizational and individual stages of change for tobacco reduction, physical activity promotion, and heart healthy eating promotion were collected from service provider, senior management, and board level members of provincial health authorities across three data collection periods. FINDINGS: Results revealed significant correlations between individual and organizational stages of change for management level respondents, but inconsistent relationships for service providers and no significant correlations for board level respondents. There were no significant differences between respondent levels for organizational stage of change for any of the promotion behaviors. In general, changes in stage failed to predict whether there was a belief in an organization's capability of addressing any of the health promotion activities. There was also a large amount of variance between individual respondents for most health authorities in their reported organizational stages of change for physical activity and healthy eating. PRACTICAL IMPLICATIONS: Based on the results of the present study it is concluded that there is little evidence that the organizational stages of change construct is valid. The evidence indicates that assessing individual readiness within an organization may be as effective as asking individuals to report on organizational stages of readiness. ORIGINALITY/VALUE: This paper reports on the validity of the organizational stages of change construct in a health promotion context and provides information for those who are considering using it.

The personal costs of caring for a child with a disability: a review of the literature.

This article presents a review of the literature published from 1989 to 2005 for articles that examined the economic burden incurred by families as a result of caring for a child with disabilities. The review was performed according to a comprehensive economic conceptual model developed by the authors and to the guidelines set out by Canadian Coordinating Office for Health Technology Assessment. The analysis indicated that the burden incurred by these families can be substantial, especially among families who care for a child with a severe disability. However, the variability and the quality of methods is such that the return on investment in knowledge of costs in this area is not as high as it could have been had methodological procedures been more standardized. A comprehensive and systematic approach is suggested for future research.

Resources for health promotion: rhetoric, research and reality.

BACKGROUND: Canadian political discourse supports the importance of health promotion and advocates the allocation of health resources to health promotion. Furthermore, the current literature frequently identifies financial and human resources as important elements of organizational capacity for health promotion. In the Alberta Heart Health Project (AHHP), we sought to learn if the allocation of health resources in a regionalized health system was congruent with the espoused support for health promotion in Alberta, Canada. METHODS: The AHHP used a mixed method approach in a time series design. Participants were drawn from multiple organizational levels (i.e., service providers, managers, board members) across all Regional Health Authorities (RHAs). Data were triangulated through multiple collection methods, primarily an organizational capacity survey, analysis of organizational documents, focus groups, and personal interviews. Analysis techniques were drawn from quantitative (i.e., frequency distributions, ANOVAs) and qualitative (i.e., content and thematic analysis) approaches. RESULTS: In most cases, small amounts (<5%) of financial resources were allocated to health promotion in RHAs' core budgets. Respondents reported seeking multiple sources of public health financing to support their health promotion initiatives. Human resources for health promotion were characterized by fragmented responsibilities and short-term work. Furthermore, valuable human resources were consumed in ongoing searches for funding that typically covered short time periods. CONCLUSIONS: Resource allocations to health promotion in Alberta RHAs are inconsistent with the current emphasis on health promotion as an organizational priority. Inadequate and unstable funding erodes the RHAs' capacity for health promotion. Sustainable health promotion calls for the assured allocation of adequate, sustainable financial resources.

Identifying factors associated with regular physical activity in leisure time among Canadian adolescents.

PURPOSE: The purpose of this study was to identify the factors explaining regular physical activity among Canadian adolescents. DESIGN: A cohort study conducted over a period of 2 years. SETTING: A French-language high school located near Québec City. SUBJECTS: A cohort of 740 students (352 girls; 388 boys) aged 13.3 +/- 1.0 years at baseline. MEASURES: Psychosocial, life context, profile, and sociodemographic variables were assessed at baseline and 1 and 2 years after baseline. Exercising almost every day during leisure time at each measurement time was the dependent variable. RESULTS: The Generalized Estimating Equations (GEE) analysis indicated that exercising almost every day was significantly associated with a high intention to exercise (odds ratio [OR]: 8.33, confidence interval [CI] 95%: 5.26, 13.18), being satisfied with the activity practiced (OR: 2.07, CI 95%: 1.27, 3.38), perceived descriptive norm (OR: 1.82, CI 95%: 1.41, 2.35), being a boy (OR: 1.83, CI 95%: 1.37, 2.46), practicing "competitive" activities (OR: 1.80, CI 95%: 1.37, 2.36), eating a healthy breakfast (OR: 1.68, CI 95%: 1.09, 2.60), and normative beliefs (OR: 1.48, CI 95%: 1.14, 1.90). Specific GEE analysis for gender indicated slight but significant differences. CONCLUSIONS: This study provides evidence for the need to design interventions that are gender specific and that focus on increasing intention to exercise regularly.