Associations between Sleep Duration and Indicators of Cardiometabolic Disease in Canadian Children and Adolescents: Analyses of the 2007-2009 Canadian Health Measures Survey.

BACKGROUND: Indicators of cardiometabolic disease-including obesity, hyperinsulinemia, and dyslipidemia-are associated with an increased risk of cardiovascular disease and type 2 diabetes. Rates of obesity and type 2 diabetes in Canadian children and adolescents have increased rapidly in recent years; research exploring modifiable risk factors is critical. Experimental and epidemiological research demonstrates that partial sleep loss is linked with deteriorations in indicators of cardiometabolic health. The objectives of this study are (1) to examine associations between short sleep duration and indicators of cardiometabolic disease in Canadian children and adolescents and (2) to identify determinants of short sleep duration in this population. METHODS: Logistic regression models were developed to examine associations between sleep duration and indicators of cardiometabolic disease and to identify predictors of short sleep duration. RESULTS: Compared with longer sleepers, children and adolescents with short sleep duration had greater odds of being overweight or obese. Sex- and age-stratified analyses indicated that short sleep duration was linked with greater odds of overweight/obesity in boys and adolescents only. Short sleepers did not have greater odds of having hyperinsulinemia, low HDL cholesterol, or high triglycerides. Age was a strong predictor of inadequate sleep duration. CONCLUSION: Future studies should include longitudinal designs that address whether short sleep duration in boys and in adolescents contributes directly to the development of overweight and obesity.

The impact of organisational factors on horizontal bullying and turnover intentions in the nursing workplace.

AIM: To examine the impact of organisational factors on bullying among peers (i.e. horizontal) and its effect on turnover intentions among Canadian registered nurses (RNs). BACKGROUND: Bullying among nurses is an international problem. Few studies have examined factors specific to nursing work environments that may increase exposure to bullying. METHODS: An Australian model of nurse bullying was tested among Canadian registered nurse coworkers using a web-based survey (n = 103). Three factors - misuse of organisational processes/procedures, organisational tolerance and reward of bullying, and informal organisational alliances - were examined as predictors of horizontal bullying, which in turn was examined as a predictor of turnover intentions. The construct validity of model measures was explored. RESULTS: Informal organisational alliances and misuse of organisational processes/procedures predicted increased horizontal bullying that, in turn, predicted increased turnover intentions. Construct validity of model measures was supported. CONCLUSION: Negative informal alliances and misuse of organisational processes are antecedents to bullying, which adversely affects employment relationship stability. IMPLICATIONS FOR NURSING MANAGEMENT: The results suggest that reforming flawed organisational processes that contribute to registered nurses' bullying experiences may help to reduce chronically high turnover. Nurse leaders and managers need to create workplace processes that foster positive networks, fairness and respect through more transparent and accountable practices.

Factors predicting depression across multiple domains in a national longitudinal sample of Canadian youth.

This prospective longitudinal study aimed to investigate the strength and relative importance of multiple predictors of depression in youth aged 16 to 20 years. Data were drawn from Statistics Canada's National Longitudinal Survey of Children and Youth (Statistics Canada 2007a, b). Hierarchical regressions were conducted separately by child gender (N = 796 boys; N = 919 girls) for two overlapping samples: mixed parent-child dyads (e.g., biological mothers, fathers and other caregivers; N = 1,715) and a subsample containing only biological mother-child dyads (N = 1,425). Parent-reported data were used from Cycle 1 when the children were aged 4 to 8 years. Parent and child-reported data were used from Cycle 4 when children were aged 10 to 14 years. The outcome measure of depressive symptoms was taken from Cycle 7 when the youth were aged 16 to 20 years. Adolescents reported more depression symptoms than young adults and girls reported more than boys. For boys, higher anxiety/depression scores at ages 4 to 8 years and 10 to 14 years, along with lower self-esteem at 10 to 14 years, predicted higher depression scores. Girls' depression was predicted by loss of a parent by ages 4 to 8 years and higher self-reported anxiety/depression and aggression at ages 10 to 14 years. Among biological mother-child dyads, maternal depression reported by mother when child was aged 4 to 8 years and 10 to 14 years significantly predicted depression for girls. At 10 to 14 years, child-reported lower parental monitoring (girls only) and greater parental rejection (boys and girls) predicted depression at ages 16 to 20 years.

Addressing FASD in British Columbia, Canada: analysis of funding proposals.

BACKGROUND: Fetal Alcohol Spectrum Disorder is a preventable health issue affecting about 10% of the population. This research examined proposals submitted to a call for funding for projects to improve outcomes for people with fetal alcohol spectrum disorder (FASD). OBJECTIVES: The aim was to use the proposals as proxy for perceptions of needs held by practitioners in British Columbia, Canada, where considerable FASD-related education and awareness exists. METHODS: Content analyses were conducted and Chi-square tests were used to test the relationship between proposal foci, community size and the submitting agency's experience with FASD. RESULTS: Nine foci were found: Skill Development, Care, Training, Resource Development, Education, Transition, Peer Support, Research and Other. No statistically significant difference was found in proposal foci according to size of community, and only one focus, Research, was associated with agency experience. Proposals varied in intensity, timing, participants, and focus of change (people or environments). CONCLUSIONS: Analysis of the proposals provides a unique view into perceptions regarding ways to improve outcomes for people with FASD.

Does rural residence limit access to mental health services?

INTRODUCTION: Rural residence may reduce access to specialized mental health services. The objective of this study was to examine the role of rural residence in relation to service utilization. Using Canadian data collected in 2002, service use was examined as a function of the presence of anxiety or mood disorders and rural/urban residence. Use of four different types of professional mental health services was examined in relation to rural residence and additional demographic, social, and health status factors known to predict use of services. METHODS: Data were obtained from Statistics Canada's Canadian Mental Health Survey Cycle 1.2. Rural residence was defined as living in a rural community with a population of 1000 or less. For all participants, associations between the presence of anxiety or mood disorders, rural/urban residence, and any service use or use of specialized mental health services (psychiatry and psychology) were examined. For participants who had used professional services, associations were examined between 17 predictor variables, including location of residence, and the use of four types of service providers (family doctor or GP; nurse, social worker, counsellor, or psychotherapist; psychiatrist; or psychologist). Predictors included demographic, social, and health status variables. Cross-tabulated counts and adjusted odds ratios with 99% confidence intervals based on bootstrapped variance estimates were used to evaluate predictors. RESULTS: Among the total sample (n = 35 140), 7.9% had used professional mental health services in the previous year. Among people who were likely to have had anxiety or mood disorders, rural or urban residence was not differentially related to past-year use of any professional services or specialized mental health services. Multivariate logistic regression was used to model factors predicting past year use of four different types of professional services. Location of residence was not a significant predictor of service utilization. Age, sex, race, level of education, degree of psychological distress, chronicity of distress, and the presence of anxiety or mood disorders predicted type of service used. CONCLUSIONS: The notion that rural residence limits access to mental health services was not supported. Other demographic and health status indicators such as age, sex, race, education, distress, and type of illness were more important predictors of service utilization. However, null findings related to geographic residence must be interpreted cautiously due to the small sample of rural residents who sought mental health services. The mental health system in Canada must provide a variety of professional services in order to meet the preferences of diverse groups, and mental health specialists must find ways to adequately support general practice physicians and counsellors who provide mental health services.

Personal characteristics and experiences of long-term allied health professionals in rural and northern British Columbia.

INTRODUCTION: Health sciences programs are being designed to attract students who are likely to stay and practice in rural and northern Canada. Consequently, student recruitment and screening are increasingly including assessment of suitability for rural practice. Although retention factors among rural physicians and nurses have been investigated, little is known about factors that contribute to the retention of other healthcare professionals who work in rural areas. The primary objective of this project was to identify the personal characteristics and experiences of allied health professionals who have worked long term in northern British Columbia (BC), Canada. METHODS: The study used a qualitative descriptive approach. Six speech language pathologists, four psychologists, four occupational therapists, eight social workers, and four physiotherapists practicing long term in northern BC were recruited, using a convenience sample and the snowball technique, to participate in semi-structured telephone interviews. The interviews were audiotaped and transcribed verbatim. A thematic content analysis identified the motivations for their decision to begin or stay working in northern communities, the reasons for choosing rural or northern education and key themes concerning personal characteristics and experiences. A process of member checking and an external audit validated the analysis and findings. RESULTS: There were two major themes for choosing rural and northern education. For some, selection of rural or northern training was based on accessibility to health education programs; all participants who chose rural and northern education had already decided that they were going to practice rurally. Generally, participants identified past positive experiences and rural background as influencing their practice location decision. Participants named the community's need for healthcare professionals, career advancement opportunities, welcoming employers, peer support, as well as promises of continuing education and interprofessional teamwork as key to their decision. Professional preferences for variety, challenges, and trying new aspects of the job such as teaching also impacted their decision. Also identified were individual factors and personal preferences such as the need for adventure, wilderness, and outdoor recreation, and community factors (eg people's friendliness and the slow pace). Such factors also influenced retention; however, retention was also affected by factors such as job satisfaction, and some community factors were only associated with retention. The analysis revealed a number of personal characteristics and experiences shared by long-term healthcare professionals, and that there is not one particular factor that determines duration of practice in rural and northern communities. CONCLUSION: The findings imply a combination of varying personal values impact the decision to come or stay in rural and northern communities. Personal characteristics and experiences help to shape these personal values. Over time and depending on stage of life, personal values change. Age and stage of life, rural background, and location of family members also have bearing on personal values, which in turn impact recruitment and retention. An explicit identification of values that have emerged out of personal characteristics and experiences may be useful in the selection of students for rural health education programs, as well as the recruitment and retention of healthcare professionals in rural and northern areas.

Alcohol consumption and health status in older adults: a longitudinal analysis.

Objective. This longitudinal study examines the relationship of alcohol consumption to mortality and changes in mental and functional health in older adults. Method.In a national population health survey, 4,187 participants aged 50 and older at baseline provided information on alcohol consumption, potential confounders, and follow-up vital status. Logistic regression estimated the odds ratio for mortality, increase in psychological distress, and decline in functional health 10 years later. Results. Compared with lifelong abstainers, light and moderate drinkers were at nonsignificantly lower risk of mortality. Among survivors, alcohol consumption showed no consistent relationship with increases in psychological distress. Occasional and light drinkers had significantly reduced risk of a substantial functional health decline, whereas moderate drinkers had nonsignificantly reduced risk. Discussion. Findings suggest that light-to-moderate alcohol consumption reduces the risk of substantial functional health decline in older middle-aged drinkers.

Pain reactivity and somatization in kindergarten-age children.

OBJECTIVE: To evaluate predictors of somatization and pain reactivity in childhood. METHODS: Facial expressions of children undergoing inoculation were scored for pain reactivity. Measures of temperament, pain experience, pain models, parental behavior, and parental ability to decode pain were examined for their ability to predict pain reactivity and somatization in a structural modeling analysis. RESULTS: Pain reactivity was associated positively with parental reports of their child's somatization. Child temperament, previous negative experiences with medical procedures, and maternal responses to their children's pain were positively associated with pain reactivity. CONCLUSIONS: Temperament and pain experience may play a role in children's pain reactivity, and reactivity may contribute to the development of somatization. Although the model that guided the analysis proved to be a reasonable description of the outcomes, several anticipated relationships were not significant. We discuss implications for a refined model of somatization and for early identification and prevention.