A knowledge transfer study of the utility of the nova scotia seniors' mental health network in implementing seniors' mental health national guidelines.

BACKGROUND: The Canadian Coalition for Seniors' Mental Health (CCSMH) developed national best-practice guidelines in seniors' mental health. Promoting adoption of new guidelines is challenging, as paper dissemination alone has limited impact on practice change. PURPOSE: We hypothesized that the existing knowledge transfer (KT) mechanisms of the Nova Scotia Seniors' Mental Health Network would prove useful in transferring the CCSMH best-practice guidelines. METHODS: In this observational KT study, CCSMH best-practice guidelines were delivered through two interactive, case-based teaching modules on Depression & Suicide, and Delirium via a provincial tele-education program and local face-to-face sessions. Usefulness of KT was measured using self-report evaluations of material quality and learning. Evaluation results from the two session topics and from tele-education versus face-to-face sessions were compared. RESULTS: Sessions were well attended (N = 347), with a high evaluation return rate (287, 83%). Most participants reported enhanced knowledge in seniors' mental health and intended to apply knowledge to practice. Ratings did not differ significantly between KT session topics or modes of delivery. CONCLUSIONS: The KT mechanisms of a provincial seniors' mental health network facilitated knowledge acquisition and the intention of using national guidelines on seniors' mental health among Nova Scotian clinicians. Key elements of accelerating KT used in this initiative are discussed.

Dementia of acute onset in the Canadian Study of Health and Aging.

BACKGROUND: Although most people with dementia experience an insidious onset of symptoms, in some cases onset can be acute. The importance of acute onset is unclear. Some reports suggest that it portends a worse course. METHODS: We performed a secondary analysis of the clinical examination cohort (n=2914) of the Canadian Study of Health and Aging (CSHA). We defined "acute onset of dementia" from the Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) questionnaire, conducted with an informant. People with dementia of acute onset were compared to those with dementia of insidious onset for development of adverse outcomes of death and institutionalization over 5 years. RESULTS: Of the 1132 people who had dementia, 130 (11.5%) met criteria for acute onset. Compared with gradual-onset dementia patients, those with acute-onset dementia were more often men (42% vs. 30%, p < 0.05), resided in nursing homes (75% vs. 63%, p< 0.05), had vascular risk factors (72% vs. 47%, p < 0.05), and a Hachinski Ischemia Scale (HIS) score > or = 7 (64% vs. 19%, p < 0.05). More patients with dementia of acute onset than gradual onset were diagnosed with vascular dementia (55% vs. 13%; p < 0.05). Adjusted hazard ratios (HRs) for survival and institutionalization in the acute-onset group were 0.93 [95% confidence interval (CI) 0.7-1.2] and 0.76 (95% CI 0.4-1.3), respectively, compared with the gradual-onset group. CONCLUSIONS: People with acute-onset dementia had more vascular risk factors than those with gradual-onset dementia across all dementia diagnoses, and lower risks of institutionalization but worse survival. Routine inquiry about the onset of dementia might help to better clarify prognoses in patients with dementia.

Gender Differences in Smoking and Self Reported Indicators of Health.

HEALTH ISSUE: Smoking among Canadian women is a serious public health issue. Using the 1998-99 National Population Health Survey, this study examined underlying factors contributing to differences in prevalence of smoking among subgroups of women and men, and its effects on self-reported indicators of health. KEY FINDINGS: In Canada, 26.4% of women and 29.2% of men were classified as current smokers. Higher levels of education and income were associated with decreased odds of current smoking. Adjusting for all other factors, being an ethnic minority decreased the odds of current smoking for both men and women (OR:0.35, 99%CI:0.23-0.54; OR:0.13, 99%CI: 0.09-0.20 respectively). Single mothers had the highest odds of smoking (OR: 2.12, 99%CI: 1.28-3.51) when compared to married mothers with children under 25 years of age. Current women smokers and current and former men smokers were less likely to report very good or excellent health compared with never smokers (OR: 0.83, 99%CI: 0.70-0.98; OR: 0.49, 99%CI: 0.41-0.60; OR: 0.75, 99%CI: 0.63-0.90 respectively). Women who were current smokers had increased odds of needing health care and not receiving it (OR: 1.50, 99%CI: 1.10-2.05). DATA GAPS AND RECOMMENDATIONS: Key issues for Canadian women include an increased prevalence of smoking among young girls and the strong association between smoking and social and economic disadvantage. Tobacco control policies and programs must target high-risk groups more effectively. Of particular importance is the development of programs and policies that do not serve to reinforce existing inequities, but rather, contribute to their amelioration.