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1.
J Cardiothorac Vasc Anesth ; 36(3): 746-765, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-33589344

RESUMO

Enhanced Recovery Programs (ERPs) are protocols involving the whole patient surgical journey. These protocols are based on multimodal, multidisciplinary, evidence-based, and patient-centered approaches aimed at improving patient recovery after a surgical intervention. Such programs have shown striking positive results in different surgical specialties. However, only a few research groups have incorporated preoperative, intraoperative, and postoperative evidence-based interventions in bundles used to standardize care and build cardiac surgery ERPs. The Enhanced Recovery After Surgery Society recently published evidence-based recommendations for perioperative care in cardiac surgery. Their recommendations included 22 perioperative interventions that may be part of any cardiac ERP. However, various components integrated in already-published cardiac ERPs were neither graded nor reported in these recommendations. The goals of the current review are to present published cardiac ERPs and their effects on patient outcomes and reported components incorporated into these ERPs and to discuss the objectives and scope of cardiac ERPs.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Cirurgia Torácica , Humanos , Assistência Perioperatória/métodos , Cuidados Pós-Operatórios , Período Pós-Operatório
2.
PLoS One ; 16(7): e0254573, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34310640

RESUMO

OBJECTIVE: To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms. DESIGN AND SETTING: Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). PARTICIPANTS: 127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. INTERVENTION: This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. OUTCOME MEASURES: The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. RESULTS: Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. CONCLUSIONS: Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03157999.


Assuntos
Transtornos de Ansiedade/epidemiologia , Depressão/epidemiologia , Serviços de Assistência Domiciliar/normas , Enfermeiras e Enfermeiros/normas , Idoso , Idoso de 80 Anos ou mais , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/reabilitação , Análise Custo-Benefício , Depressão/fisiopatologia , Depressão/reabilitação , Feminino , Hospitais , Humanos , Masculino , Multimorbidade , Papel do Profissional de Enfermagem , Enfermeiros de Saúde Comunitária/normas , Qualidade de Vida , Apoio Social , Telefone , Cuidado Transicional/normas
3.
BMC Geriatr ; 20(1): 240, 2020 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-32650732

RESUMO

BACKGROUND: Older adults (> 65 years) with multiple chronic conditions (MCC) and depressive symptoms experience frequent transitions between hospital and home. Care transitions for this population are often poorly coordinated and fragmented, resulting in increased readmission rates, adverse medical events, decreased patient satisfaction and safety, and increased caregiver burden. There is a dearth of evidence on best practices in the provision of transitional care for older adults with MCC and depressive symptoms transitioning from hospital-to-home. This paper presents a protocol for a two-armed, multi-site pragmatic effectiveness-implementation trial of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led six-month intervention that supports older adults with MCC and depressive symptoms transitioning from hospital-to-home. The Collaborative Intervention Planning Framework is being used to engage patients and other key stakeholders in the implementation and evaluation of the intervention and planning for intervention scale-up to other communities. METHODS: Participants will be considered eligible if they are > 65 years, planned for discharged from hospital to the community in three Ontario locations, self-report at least two chronic conditions, and screen positive for depressive symptoms. A total of 216 eligible and consenting participants will be randomly assigned to the control (usual care) or intervention (CAST) arm. The intervention consists of tailored care delivery comprising in-home visits, telephone follow-up and system navigation support. The primary measure of effectiveness is mental health functioning of the older adult participant. Secondary outcomes include changes in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health and social service use and cost, from baseline to 6- and 12-months. Caregivers will be assessed for caregiver strain, depressive symptoms, anxiety, health-related quality of life, and health and social service use and costs. Descriptive and qualitative data from older adult and caregiver participants, and the nurse interventionists will be used to examine implementation of the intervention, how the intervention is adapted within each study region, and its potential for sustainability and scalability to other jurisdictions. DISCUSSION: A nurse-led transitional care strategy may provide a feasible and effective means for improving health outcomes and patient/caregiver experience and reduce service use and costs in this vulnerable population. TRIAL REGISTRATION: # NCT03157999 . Registration Date: April 4, 2017.


Assuntos
Múltiplas Afecções Crônicas , Cuidado Transicional , Idoso , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/terapia , Hospitais , Humanos , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/terapia , Ontário , Qualidade de Vida
4.
J Inorg Biochem ; 204: 110935, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31862582

RESUMO

From 1943 to 1980, some underground gold and uranium workers in Ontario, Canada were required to inhale aluminum dust for silicosis prevention. Workers were exposed to the dust for up to 30 min daily. This study explored the perceived organizational impact on workers exposed to the aluminum dust treatment in Northeastern Ontario. This qualitative descriptive study included 16 respondents who participated in individual semi-structured interviews. All respondents were Northeastern Ontario workers who were exposed to aluminum dust treatment for at least 1 year. Interviews were transcribed verbatim and analyzed thematically. Themes that emerged were: 1) confidence and trust in companies, 2) lack of participants' and heath care providers' knowledge, and 3) need for compensation and formal apology. Workers' perceived that their long term health was impacted by exposure. The results will be used to help workers, companies, and unions address workplace exposures. The latest information about McIntyre powder will enhance the knowledge about the impact of the exposure.


Assuntos
Alumínio/envenenamento , Poeira/análise , Exposição Ocupacional/efeitos adversos , Cultura Organizacional , Silicose/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Alumínio/análise , Tomada de Decisões , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/análise , Pesquisa Qualitativa , Silicose/etiologia , Confiança , Indenização aos Trabalhadores
5.
J Nutr Metab ; 2019: 9839320, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31032116

RESUMO

Objective: To validate an audio-video (AV) method of food journaling, in a free-living scenario, compared to direct, weighed food assessment. Design and Setting: Data were collected in a cafeteria. Meals, selected by participants (n=30), were documented using the AV method: participants video-recorded their tray while audio-recording a description of their selected meal, after which the research team digitally weighed each food item and created an itemized diary record of the food. Variables Measured: Data from the AV method and from the weighed food diaries were transcribed and entered into a nutrition software analysis program (Nutribase Pro 10.0). Nutrient outputs were compared between the two methods including kilocalories, macronutrients, and selected micronutrients. Analyses: Using mean scores for each variable, Wilcoxon signed-rank test and Spearman's correlation coefficients were conducted. Interclass correlation coefficient (ICC) was calculated for absolute agreement between the two methods to assess interrater reliability. Results: With the exception of Vitamin E and total weight, nutrient values were highly correlated between methods and were statistically significant given alpha = 0.05, power = 0.95, and effect size of 0.70. Conclusions: The AV method may be a meaningful alternative to diary recording in a free-living setting.

6.
JMIR Res Protoc ; 8(1): e11022, 2019 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-30679151

RESUMO

BACKGROUND: Community-based health and social resources can help individuals with complex health and social needs achieve their health goals. However, there is often inadequate access to these resources due to a lack of physician and patient awareness of available resources and the presence of social barriers that limit an individual's ability to reach these services. Navigation services, where a person is tasked with helping connect patients to community resources, embedded within primary care may facilitate access and strengthen the continuity of care for patients. OBJECTIVE: This study aims to describe the protocol to assess whether the implementation of the Access to Resources in the Community (ARC) navigation model (an innovative approach to navigation services) is feasible, including its potential to achieve its intended outcomes, and to assess the viability of the evaluation approach. METHODS: The study consists of a single-arm, prospective, explanatory, mixed-methods, pre-post design feasibility study focusing on primary care practice settings with vulnerable populations. Participants include primary care providers and patients. RESULTS: Enrollment is closed with 82 patients. Navigation services have ended for 69 patients. CONCLUSIONS: The study of an innovative complex intervention requires an adequate assessment of the feasibility of the intended approach during which the potential challenges of the planned intervention and need for its adaptation may be uncovered. Undertaking a feasibility study of the ARC navigation model from a conceptually clear and methodologically solid protocol will inform on the practicality and acceptability of the approach, demand for the services, ease of implementation, quality of integration of the new services within primary care, and practicality and potential for efficacy prior to initiating a randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT03105635; https://clinicaltrials.gov/ct2/show/NCT03105635 (Archived by WebCite at hhttp://www.webcitation.org/75FrwXORl). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/11022.

8.
Can J Rural Med ; 23(3): 76-84, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29905145

RESUMO

INTRODUCTION: Previous studies have shown that French-speaking family physicians (FSPs) in Ontario are less numerous in areas with high proportions of francophones. The purpose of the current study was to assess whether the degree of concordance between physicians' language of competence and the linguistic profile of the community in which they practise is associated with workload and to explore variations in this relation in rural and northern regions of the province. METHODS: This was a secondary analysis of the 2013 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey. We analyzed the primary practice location and language of competence of family physicians/general practitioners. We compared the practice characteristics of FSPs and non-French-speaking physicians (NFSPs) by the proportion of the francophone population, geographic location (north vs. south) and community size (urban vs. rural). RESULTS: Data for 10 548 family physician/general practitioners were analyzed. In areas densely populated by francophones, FSPs worked more hours per week on average and had a greater mean number of patient visits than NFSPs. Non-French-speaking physicians working in areas densely populated by francophones had fewer patient visits per hour on average than FSPs. In most cases, the results were particularly accentuated in rural and northern communities. CONCLUSION: Our findings suggest that, compared to NFSPs, the demands placed on FSPs are disproportionately greater in communities where the need for French-language health care services is greatest and the supply of FSPs is the smallest. Our results underline the importance of properly preparing family physicians to work in areas densely populated by francophones.


INTRODUCTION: Des études antérieures ont révélé que les médecins de famille francophones (MFF) en Ontario sont moins nombreux dans les régions à forte population francophone. L'objectif de cette étude était de déterminer si le degré de concordance entre la langue de compétence des médecins et le profil linguistique de la collectivité dans laquelle ils exercent est associé à la charge de travail, et d'examiner les variations de cette relation dans les régions rurales et nordiques de la province. METHODS: Il s'agit d'une analyse secondaire des données du sondage de 2013 sur le renouvellement annuel de l'inscription à l'Ordre des médecins et chirurgiens de l'Ontario. Nous avons déterminé le principal lieu de pratique et la langue de compétence de médecins de famille et d'omnipraticiens. Nous avons comparé les caractéristiques de la pratique des MFF et des médecins de famille non francophones (MFNF) par rapport à la proportion de la population francophone, l'emplacement géographique (nord par opposition à sud) et la taille de la collectivité (urbaine par opposition à rurale). RESULTS: Nous avons analysé les données provenant de 10 548 médecins de famille ou omnipraticiens. Dans les régions à forte population francophone, les MFF travaillaient en moyenne davantage d'heures par semaine et accueillaient en moyenne plus de patients que les MFNF. Les médecins non francophones qui travaillaient en régions à forte population francophone accueillaient en moyenne moins de patients par heure que les MFF. Dans la plupart des cas, les résultats étaient particulièrement marqués dans les collectivités rurales et nordiques de la province. CONCLUSION: Nos résultats suggèrent que les demandes imposées aux MFF sont disproportionnées par rapport à celles imposées aux MFNF dans les collectivités où le besoin de services de santé en français est le plus élevé et où la disponibilité de MFF est la plus faible. Nos résultats mettent en lumière l'importance de bien préparer les médecins de famille à travailler dans les régions à forte population francophone.


Assuntos
Barreiras de Comunicação , Clínicos Gerais/organização & administração , Relações Médico-Paciente , Médicos de Família/organização & administração , Serviços de Saúde Rural/organização & administração , Adulto , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Ontário , Médicos de Família/estatística & dados numéricos , População Rural/estatística & dados numéricos , Recursos Humanos , Carga de Trabalho
9.
J Interprof Care ; 30(6): 829-831, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27797632

RESUMO

Interprofessional collaboration (IPC) can be challenging, yet it has shown benefits for providers and patients. We examined the existing enablers and barriers to IPC at a local Community Health Center (CHC) and report on the existing types of IPC practice. We also report how implementing a men-sensitive healthy living programme united a team of health professionals/managers in attending to the needs of a population that to date had been largely underserved. A total of 16 employees were interviewed at the CHC. All respondents spoke positively of existing IPC and provided examples of existing collaborative practices. These CHC professionals (clinicians and managers) experienced greater intra- and extra-organisational collaborations as a result of experiencing a community-delivered programme. It also allowed the CHC professionals/managers to rethink the management and structure of collaborative practices and understand the needs and challenges of working with non-traditional partners (men and workplace-based managers). While our findings are context sensitive (case study design), they shed light on how uniting health professionals/managers around a challenging and non-traditional health issue (i.e., improving health in a hard-to-reach population subgroup) can strategically reduce resistance to collaborative practice development by strengthening team cohesion and fostering innovative interactions.


Assuntos
Relações Interprofissionais , Saúde do Homem , Equipe de Assistência ao Paciente , Comportamento Cooperativo , Humanos , Masculino , Comportamento Social
10.
Rural Remote Health ; 16(2): 3805, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27316568

RESUMO

INTRODUCTION: Rural and Northern Ontario francophones face many health-related challenges including poor health status, a poor supply of French-speaking physicians, and the potential for an inability or reduced ability to effectively communicate with anglophone healthcare providers. As such, it can reasonably be expected that rural and Northern Ontario francophones experience barriers when receiving care. However, the experience of physicians working in areas densely populated by francophones is largely unexplored. This paper identifies barriers experienced by French-speaking and Non-French-speaking rural and Northern Ontario physicians when serving francophone patients. METHODS: A series of key informant interviews were conducted with 18 family physicians practicing in rural and urban francophone communities of Northeastern Ontario. Interviews were analyzed using a thematic analysis process. RESULTS: Five categories of barrier were identified: (1) language discordance, (2) characteristics of francophone patients, (3) dominance of English in the medical profession, (4) lack of French-speaking medical personnel, and (5) physicians' linguistic (in)sensitivity. Some barriers identified were unique to Non-French-speaking physicians (eg language discordance, use of interpreters, feelings of inadequacy), some were unique to French-speaking physicians (eg limited French education and resources), and some were common to both groups (eg lack of French-speaking colleagues/staff, added time commitments, and the particularities of Franco-Ontarian preferences and culture). CONCLUSIONS: Healthcare providers and decision makers may take interest in these results. Although physicians were the focus of the present article, the barriers expressed are likely experienced by other healthcare providers, and thus the lessons learned from this article extend beyond the physician workforce. Efforts must be made to offer educational opportunities for physicians and other healthcare providers working in areas densely populated by francophones; these include linguistic and cultural sensitivity training, in addition to teaching strategies for the practice of 'active offer' of French-language services. In sum, the present study outlines the importance of linguistic concordant communication in healthcare delivery, and describes some of the challenges faced when providing French-language services in rural and Northern Ontario.


Assuntos
Barreiras de Comunicação , Cultura , Médicos de Família/organização & administração , Serviços de Saúde Rural/organização & administração , População Rural , Comunicação , Competência Cultural , Feminino , Humanos , Entrevistas como Assunto , Idioma , Masculino , Ontário , Relações Médico-Paciente , Características de Residência , Recursos Humanos
11.
Can Fam Physician ; 61(8): e382-90, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26505060

RESUMO

OBJECTIVE: To identify strategies to improve the quality of health services for Francophone patients. DESIGN: A series of semistructured key informant interviews. SETTING: Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. METHODS: Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection­data analysis process and were analyzed using a detailed thematic approach. MAIN FINDINGS: Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non­French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). CONCLUSION: Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist.


Assuntos
Comunicação , Medicina de Família e Comunidade/métodos , Idioma , Relações Médico-Paciente , Feminino , Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Ontário , Melhoria de Qualidade
12.
Disabil Health J ; 8(4): 611-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26141088

RESUMO

BACKGROUND: Cerebral Palsy (CP) is becoming more prevalent in the adult population, but there is limited information available regarding their Leisure-Time Physical Activity (LTPA). OBJECTIVE: To investigate the self-reported frequency and LTPA participation patterns in adults with CP, compared to the Canadian general population (CGP). METHODS: This was a cross-sectional, follow-up-survey of a cohort of 145 persons with CP. The primary outcome was the level of participation in LTPA. Questions were also posed about the motivations and self-reported barriers to LTPA participation. The survey results were compared to CGP estimates from the Canadian Community Health Survey (CCHS). RESULTS: Fifty-four participants completed the survey, and 90% reported participation in at least one LTPA per week. On average, they reported participating in LTPA 7.3 ± 5.7 times/week. They also reported participating in an average of 4.1 ± 2.4 different types of LTPA. Walking, home-exercise, and swimming were the most frequently reported as a primary LTPA in the CP sample. These finding were comparable to those from the CGP. However, adults with CP were more likely to participate in home-exercise than the CGP (p < 0.05). More than 40% reported that the purpose of their LTPA was fitness or body maintenance and 56% indicated an interest in starting new activities. Various barriers were also reported. CONCLUSIONS: Adults with CP frequently participated in LTPA. However, the majority of them are not achieving recommended daily physical activity levels. Also their LTPA habitually focuses on rehabilitative exercises and the diversity of LTPA is limited by several barriers.


Assuntos
Paralisia Cerebral , Pessoas com Deficiência , Exercício Físico , Comportamentos Relacionados com a Saúde , Atividades de Lazer , Adulto , Canadá , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Motivação , Natação , Caminhada , Adulto Jovem
13.
Anesth Analg ; 121(2): 430-6, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26076387

RESUMO

BACKGROUND: The I-gel (IG) supraglottic airway device is a reliable way to establish an airway. Its large ventilation lumen allows for easy passage of an endotracheal tube. With the use of a flexible bronchoscope, the IG offers a good visualization of the laryngeal inlet. This prospective randomized study aims to compare the success rate of flexible bronchoscope-guided tracheal intubation using either the IG or the LMA-Fastrach (FT) laryngeal masks. METHODS: One hundred twenty patients requiring general anesthesia were randomized to 1 of the 2 study groups: IG or FT. After anesthesia induction, the assigned laryngeal mask was inserted to obtain adequate ventilation. We then proceeded to a flexible bronchoscope-guided intubation through the supraglottic device. Tracheal intubation and laryngeal mask insertion success rates were noted, as well as the time required for these manipulations. The view of the laryngeal inlet was graded for each intubation attempt. RESULTS: Sixty patients were assigned to each study group. The intubation success rates were similar between the IG and the FT groups (100 % vs 95.0 % at first attempt; P = 0.12). The times required for tracheal intubation were significantly lower in the IG group (30 ± 11 seconds vs 50 ± 21 seconds; P < 0.0001). Glottic visualization was better in the IG group, with a significantly higher percentage of grade 1 visualization (63.3% vs 3.3%; P < 0.0001) and a lower percentage of grade 3 visualization (1.7% vs 60.0%; P < 0.0001), than that in the FT group. CONCLUSIONS: The use of the IG supraglottic airway device as a conduit for flexible bronchoscope-guided tracheal intubation results in a success rate equivalent to the use of the LMA-FT. However, the IG allows for shorter intubation times and a better visualization of the glottic opening compared with the LMA-FT.


Assuntos
Broncoscópios , Broncoscopia/instrumentação , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Adulto , Anestesia Geral , Broncoscopia/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Quebeque , Respiração Artificial , Fatores de Tempo , Resultado do Tratamento
14.
Arch Phys Med Rehabil ; 95(11): 2071-2077.e1, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24909589

RESUMO

OBJECTIVE: To describe changes in gross motor function and health-related quality of life (HRQOL) in adults with cerebral palsy (CP). DESIGN: An 8-year follow-up survey. SETTING: Participants who completed the baseline survey in 2003 were invited. PARTICIPANTS: The sample of adults with CP (N=54; response rate=37%) included a "younger group" (group 1; n=31; age, 23-27y; 15 women) and an "older group" (group 2; n=23; age, 33-42y; 10 women). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Gross Motor Function Classification System (GMFCS), Self-Rated Health (SRH), the Health Utility Index Mark III (HUI3), and the Assessment of Quality of Life (AQoL). RESULTS: Eight years after the initial survey, 27% of the participants in the combined group had deteriorations on the GMFCS, 52% on the SRH, 44% on the HUI3, and 25% on the AQoL. Members of group 1 reported stable scores as they made the transition to adulthood, while many of the group 2 members experienced declines, with relative risk of 1.47 (95% confidence interval [CI], 0.16-2.24) on the GMFCS, 1.36 (95% CI, 0.83-2.23) on the SRH, 1.19 (95% CI, 0.66-2.15) on the HUI3, and 3.17 (95% CI, 1.12-9.00) on the AQoL. CONCLUSIONS: Although much attention has focused on the transitions of persons with CP during their late teens and early 20s, this research found that deteriorations in the GMFCS levels and the HRQOL were most evident in adults in their late 20s and 30s. More detailed longitudinal studies are required to evaluate the longer-term health outcomes among persons with CP into their 30s and beyond.


Assuntos
Paralisia Cerebral/fisiopatologia , Nível de Saúde , Desempenho Psicomotor/fisiologia , Qualidade de Vida , Adolescente , Adulto , Fatores Etários , Feminino , Seguimentos , Humanos , Masculino , Transição para Assistência do Adulto , Adulto Jovem
15.
J Nutr Educ Behav ; 45(6): 708-12, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23830245

RESUMO

OBJECTIVE: To assess the reliability of manual data entry for home-packed food items by using digital photographs and dietary log sheets. METHODS: Data from 60 lunches were entered by researcher A and B independently. Researcher B re-entered researcher A's items within 1 week. Researcher B then re-entered her items 4 weeks from the initial entry point. RESULTS: The inter-rater reliability intraclass correlation coefficient (ICC) was 0.83 for total kilocalories and ranged from 0.75-0.87 for macronutrients. The intra-rater reliability ICC was 0.92 for total kcal and ranged from 0.90-0.92 for macronutrients. The inter-rater ICCs for the 5 selected micronutrients ranged from 0.33-0.83, whereas the intra-rater ICCs for these micronutrients ranged from 0.65-0.98. CONCLUSIONS AND IMPLICATIONS: This method of data entry is feasible and its reliability is promising for macronutrient investigations. Continued assessment of this method for investigations related to micronutrient content is recommended.


Assuntos
Coleta de Dados , Registros de Dieta , Almoço , Fotografação , Criança , Coleta de Dados/métodos , Coleta de Dados/normas , Feminino , Rotulagem de Alimentos , Humanos , Masculino , Reprodutibilidade dos Testes , Software , Estudantes
16.
Rural Remote Health ; 13(4): 2543, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24380635

RESUMO

INTRODUCTION: Previous studies have suggested that there may be a lack of French language healthcare services in the province of Ontario. The purpose of this study was to determine if physicians in Ontario who expressed a proficiency in providing services in the French language are located in 'Francophone communities'. METHOD: Responses from 10,968 Ontario-based family physicians (FPs) certified by the College of Family Physicians of Canada and uncertified general practitioners (GPs) who responded to the 2007 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey were analysed and compared to the 2006 census of the population of Ontario. Main outcome measures were the number of FP/GPs categorized by their language of competency to conduct medical practice and the number of people categorized by their first official language spoken. The physician-to-population ratio was then compared for different groups of communities in Ontario categorized by the degree of francophonie of the community: strong French communities, with a Francophone population ≥25%; moderate French communities, with a Francophone population of 10-24%; and weak/no French communities, with a Francophone population <10%. RESULTS: There are 5.6 French speaking FP/GPs for every 1000 Francophones in communities with a French population less than 10%. This ratio is considerably greater than what was found in moderate French communities (3.4 FP/GPs) and strong French (1.3 FP/GPs). Overall the lowest ratios were found in rural strong French communities both in southern and northern Ontario (0.8 FP/GPs and 0.9 FP/GPs respectively). The ratio for all of Ontario was 0.7-1.3. CONCLUSIONS: As the number of Francophones increases in a community, the availability of French-speaking FP/GPs actually decreases, particularly in rural northern Ontario. Furthermore, there is a paradoxical relationship between the potentially high number of FP/GPs in the province with French-language capabilities and the perceived deficiencies in the availability of French language medical services.


Assuntos
Competência Cultural , Área Carente de Assistência Médica , Multilinguismo , Médicos de Família/estatística & dados numéricos , Serviços de Saúde Rural , Canadá , França/etnologia , Clínicos Gerais/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Ontário , Características de Residência , Sociedades Médicas , Recursos Humanos
17.
Health Promot Perspect ; 3(2): 175-84, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24688967

RESUMO

BACKGROUND: Many Ontarians continue to report exposure to second-hand smoke in public spaces. Completely smoke-free environments are the preferred and socially responsible option for non-smoking policies; however, when considering the variety of landscapes in which post-secondary institutions are located, 'a one size fits all' smoking policy is unrealistic to implement and enforce. The purpose of the study was to: 1) gain a better sense of the prevalence of smoking and exposure to second-hand smoke in a post-secondary context that is geographically isolated; 2) assess the awareness of existing non-smoking initiatives; and 3) identify preferred approaches for tobacco control. METHODS: An online survey was distributed in 2012 to all members of the Laurentian University community. Descriptive statistics are presented, using frequency distributions, and group comparisons are reported, using Chi-Square analyses. RESULTS: A total of 1282 persons completed the survey. Nearly 80% of respondents reported that they had been exposed to second-hand smoke in the past month on campus and the majority of respondents felt that smoking should only be allowed in Designated Outdoor Smoking Areas (51.5%); including 37.3% of daily smokers and occasional smokers. CONCLUSION: Institutions with a geographically isolated campus, which limit options to divert smokers from public entrances, should consider the use of Designated Outdoor Smoking Areas. Implementation will create immediate reductions in the prevalence of smoking at building entrances and in high traffic locations and will therefore protect non-smokers from the dangers of environmental tobacco smoke.

18.
Can Fam Physician ; 58(12): e717-24, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23242903

RESUMO

OBJECTIVE: To determine how many physicians in Ontario express a proficiency in providing services in the French language, and to assess the geographic distribution of such physicians. DESIGN: Population-based analysis of the 2007 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey. SETTING: Ontario. PARTICIPANTS: A total of 22 688 GPs, FPs, and other specialists certified by the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada who responded to the survey. MAIN OUTCOME MEASURES: First official language spoken and languages of competency to conduct practice. RESULTS: The physician-to-patient ratio by first official language spoken is 1 physician per 138 Francophone patients in Ontario. There is 1 French-speaking GP or FP for every 297 Francophone patients, and most French-speaking physicians are located in southern Ontario (91.4%), at a ratio of 1 physician per 111 Francophone patients. The most promising French-speaking physician-to-Francophone patient ratios are found in southern Ontario (1:248 for GPs and FPs, and 1:202 for other specialists) and in urban Ontario (1:266 for GPs and FPs, and 1:209 for other specialists). CONCLUSION: Clearly, there is a promising number of physicians, relative to the amount of French-speaking residents in Ontario, who identified a competency in offering services in French. However, while the number of physicians who indicated a self-assessed competency to deliver health services in French is promising, it is the maldistribution of such services that is of concern. Thus, efforts must be made to attract French-speaking physicians to areas where there is the greatest demand, particularly in the northern part of the province.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Área Carente de Assistência Médica , Multilinguismo , Médicos/provisão & distribuição , Competência Cultural , Pesquisas sobre Serviços de Saúde , Humanos , Ontário , Médicos/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/provisão & distribuição , Serviços Urbanos de Saúde/estatística & dados numéricos , Serviços Urbanos de Saúde/provisão & distribuição
19.
J Sch Health ; 82(7): 311-7, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22671947

RESUMO

BACKGROUND: Advocates for the implementation of the Balanced School Day (BSD) schedule argue that this schedule will increase opportunities for physical activity. However, the relationship between this scheduling change and its impact on physical activity has not been examined. Thus, this study assessed levels of physical activity in students attending 2 different schools: 1 using the BSD and the other using the Traditional School Day (TSD) schedule. METHODS: Participation of students between grades 3 and 6 was sought. Data were collected over 4 school days using pedometers. Independent Sample t tests and 1-way analysis of variance (ANOVA) were performed. RESUTLS: A total of 117 students participated. Overall, average daily step counts for boys (6972 ± 1952) were significantly higher than girls (5742 ± 1495; p < .001). These average step counts represent 47% and 48% of the recommended amount of steps needed for health benefits for children between the ages of 6 and 12. The average daily step count for students using the BSD schedule was 6017 (±1666), while the average daily step count for students using the TSD schedule was 6788 (±1987). The difference in steps (771) was statistically significant (p = .03). CONCLUSIONS: These results do not support claims that the BSD offers increased physical activity. In fact, these results suggest that students enrolled in schools using the BSD schedule may have reduced daily physical activity. In addition, these results demonstrate that overall school-based physical activity is less than half of the recommended level; independent of school scheduling.


Assuntos
Atividade Motora/fisiologia , Serviços de Saúde Escolar/estatística & dados numéricos , Instituições Acadêmicas , Caminhada/fisiologia , Análise de Variância , Agendamento de Consultas , Criança , Proteção da Criança , Feminino , Promoção da Saúde , Humanos , Masculino , Ontário , Estatística como Assunto , Fatores de Tempo
20.
Health Promot Pract ; 13(3): 395-403, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22447669

RESUMO

INTRODUCTION: It is estimated that tobacco use kills more than 5 million people annually; it is the leading cause of preventable deaths. Recent public health interventions have likely contributed to a steady decline in rates of smoking over the past decade. Nevertheless, innovative and cost-effective approaches to smoking cessation remain a public health priority. The purpose of this study was to profile physically active smokers. METHOD: Data from the Canadian Community Health Survey 2007-2008-Ontario Sharing File were used. Responses from 41,800 persons aged 12 years and older were assessed to compare (a) the sociodemographic characteristics of physically active smokers to physically active nonsmokers in Ontario and (b) the types of leisure-time physical activities that are more commonly practiced among active Ontario smokers to active nonsmokers. RESULTS: Pearson χ(2) and independent samples t tests revealed that active smokers were more likely to be male, younger, single, and less educated and to have lower income than active nonsmokers. Active smokers were also more likely to report inexpensive, low-intensity, and solitary leisure-time physical activities. CONCLUSION: Our findings have important implications for physical activity promotion among smokers. Physical activity interventions for smokers need to be tailored differently than for nonsmokers.


Assuntos
Exercício Físico , Fumar/epidemiologia , Adulto , Feminino , Promoção da Saúde , Humanos , Atividades de Lazer , Masculino , Ontário/epidemiologia , Fatores Socioeconômicos
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