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1.
Lancet Psychiatry ; 6(11): 915-925, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601530

RESUMO

BACKGROUND: Housing First is increasingly implemented for homeless adults with mental illness in large urban centres, but little is known about its long-term effectiveness. The At Home/Chez Soi randomised controlled trial done in five cities in Canada showed that Housing First improved housing stability and other select health outcomes. We extended the At Home/Chez Soi trial at the Toronto site to evaluate the long-term effects of the Housing First intervention on housing and health outcomes of homeless adults with mental illness over 6 years. METHODS: The At Home/Chez Soi Toronto study was a randomised, controlled trial done in Toronto (ON, Canada). Here, we present the results of an extension study done at the same site. Participants were homeless adults (aged ≥18 years) with a serious mental disorder with or without co-occurring substance use disorder. In phase 1, participants were stratified by level of need for mental health support services (high vs moderate), and randomly assigned (1:1) using adaptive randomisation procedures to Housing First with assertive community treatment (HF-ACT), Housing First with intensive case management (HF-ICM), or to treatment as usual (TAU). Participants with moderate support needs were further stratified by ethnoracial status. Considering the nature of the Housing First intervention, study participants and study personnel were not masked to group assignment. Phase 1 participants could choose to enrol in the extension study (phase 2). The primary outcome was the rate of days stably housed per year analysed in the modified intention-to-treat population, which included all randomly assigned participants who had at least one assessment for the primary outcome. Participants contributed data to the study up to the point of their last interview. Multilevel multiple imputation was used to handle missing data. The trial was registered with ISRCTN, ISRCTN42520374. FINDINGS: Between Oct 1, 2009, and March 31, 2013, 575 individuals participated in phase 1 of the Toronto Site At Home/Chez Soi study (197 [34%] participants with high support needs and 378 [66%] with moderate support needs). Of the 378 participants with moderate support needs, 204 were randomly assigned to receive the HF intervention with ICM or with ethnoracial-specific ICM services (HF-ER-ICM; HF-ICM or HF-ER-ICM groups) and 174 were randomly assigned to TAU. Of the 197 participants with high support needs, 97 were randomly assigned to receive the HF intervention with ACT (HF-ACT treatment group) and 100 were randomly assigned to TAU group. Between Jan 1, 2014, and March 31, 2017, 414 (81%) of 575 phase 1 participants participated in the extended phase 2 study. The median duration of follow-up was 5·4 years (IQR 2·1-5·9). Among phase 2 participants, 141 had high support needs (79 participants in the HF-ACT group; 62 participants in the TAU group), and 273 had moderate support needs (160 participants in the HF-ICM or HF-ER-ICM group; 113 participants in the TAU group). 187 high support needs participants (93 participants in the HF-ACT group, 94 participants in the TAU group), and 361 moderate support needs participants (201 participants in the HF-ICM or HF-ER-ICM group, 160 participants in the TAU group) were included in the modified intention-to-treat analysis for the primary outcome. The number of days spent stably housed was significantly higher among participants in the HF-ACT and HR-ICM or HF-ER-ICM groups than participants in the TAU groups at all timepoints. For participants with moderate support needs, the rate ratio (RR) of days stably housed in the Housing First group, compared with TAU, was 2·40 (95% CI 2·03-2·83) in year 1, which decreased to 1·13 (1·01-1·26) in year 6. The RR of days stably housed for participants with high support needs, compared with TAU, was 3·02 (2·43-3·75) in year 1 and 1·42 (1·19-1·69) in year 6. In year 6, high support needs participants in the Housing First group spent 85·51% of days stably housed compared with 60·33% for the TAU group, and moderate needs participants in the Housing First group spent 88·16% of days stably housed compared with 78·22% for the TAU group. INTERPRETATION: Rent supplements and mental health support services had an enduring positive effect on housing stability for homeless adults with mental illness in a large, resource-rich urban centre, with a larger impact on individuals with high support needs than moderate support needs. FUNDING: Mental Health Commission of Canada, Ontario Ministry of Health and Long-Term Care, and the Canadian Institute of Health Research.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Pessoas em Situação de Rua/psicologia , Pessoas em Situação de Rua/estatística & dados numéricos , Transtornos Mentais/terapia , Avaliação de Programas e Projetos de Saúde/métodos , Habitação Popular/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/psicologia , Ontário , Tempo , População Urbana/estatística & dados numéricos
2.
J Nurs Adm ; 49(11): 549-555, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31651615

RESUMO

OBJECTIVE: This study aims to investigate the role of nurse managers in supporting point-of-care nurses' health information technology (IT) use and identify strategies employed by nurse managers to improve adoption, while also gathering point-of-care nurses' perceptions of these strategies. BACKGROUND: Nurse managers are essential in facilitating point-of-care nurses' use of health IT; however, the underlying phenomenon for this facilitation remains unreported. METHODS: A qualitative descriptive study was conducted with 10 nurse managers and 14 point-of-care nurses recruited from a mental health hospital environment in Ontario, Canada. Inductive and deductive content analyses were used to analyze the semistructured interviews. RESULTS: Nurse managers adopt the role of advocate, educator, and connector, using the following strategies: communicating system updates, demonstrating use of health IT, linking staff to resources, facilitating education, and providing IT oversight. CONCLUSIONS: Nurse managers use a variety of strategies to support nurses' use of health IT. Future research should focus on the effectiveness of these strategies.


Assuntos
Atitude do Pessoal de Saúde , Liderança , Informática Médica/organização & administração , Enfermeiras Administradoras/psicologia , Papel do Profissional de Enfermagem/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Papel Profissional , Feminino , Humanos , Ontário , Pesquisa Qualitativa
3.
J Environ Qual ; 48(4): 813-821, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31589700

RESUMO

Agricultural P losses are a global economic and water quality concern. Much of the current understanding of P dynamics in agricultural systems has been obtained from rainfall-driven runoff, and less is known about cold-season processes. An improved understanding of the magnitude, form, and transport flow paths of P losses from agricultural croplands year round, and the climatic drivers of these processes, is needed to prioritize and evaluate appropriate best management practices (BMPs) to protect soil-water quality in cold regions. This study examines multiyear, year-round, high-frequency edge-of-field P losses (soluble reactive P and total P [TP]) in overland flow and tile drainage from three croplands in southern Ontario, Canada. Annual and seasonal budgets for water, P, and estimates of field P budgets (including fertilizer inputs, crop uptake, and runoff) were calculated for each site. Annual edge-of-field TP loads ranged from 0.18 to 1.93 kg ha yr (mean = 0.59 kg ha yr) across the region, including years with fertilizer application. Tile drainage dominated runoff across sites, whereas the contribution of tiles and overland flow to P loss differed regionally, likely related to site-specific topography, soil type, and microclimate. The nongrowing season was the dominant period for runoff and P loss across sites, where TP loss during this period was often associated with overland flow during snowmelt. These results indicate that emphasis should be placed on BMPs that are effective during both the growing and nongrowing season in cold regions, but that the suitability of various BMPs may vary for different sites.


Assuntos
Fósforo , Movimentos da Água , Agricultura , Ontário , Estações do Ano
4.
J Water Health ; 17(5): 670-682, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31638019

RESUMO

In Ontario, Canada, information is lacking on chlorine and ultraviolet (UV) light disinfection performance against enteric viruses in wastewater. We enumerated enteroviruses and noroviruses, coliphages, and Escherichia coli per USEPA methods 1615, 1602, and membrane filtration, respectively, in pre- and post-disinfection effluent at five wastewater treatment plants (WWTPs), with full-year monthly sampling, and calculated log10 reductions (LRs) while WWTPs complied with their monthly geometric mean limit of 200 E. coli/100 mL. Modeling of densities by left-censored estimation and Bayesian inference gave very similar results. Polymerase chain reaction (PCR)-detected enteroviruses and noroviruses were abundant in post-disinfection effluent (mean concentrations of 2.1 × 10+4-7.2 × 10+5 and 2.7 × 10+4-3.6 × 10+5 gene copies (GC)/L, respectively). Chlorine or UV disinfection produced modest LRs for culture- (0.3-0.9) and PCR-detected enteroviruses (0.3-1.3), as well as noroviruses GI + GII (0.5-0.8). Coliphages and E. coli were more susceptible, with LRs of 0.8-3.0 and 2.5, respectively. Sand-filtered effluent produced significantly higher enteric virus LRs (except cultured enteroviruses). Coliphage and human enteric virus densities gave significantly positive correlations using Kendall's Tau test. Enteric viruses are abundant in wastewater effluent following routine chlorine or UV disinfection processes that target E. coli. Coliphages appear to be good indicators for evaluating wastewater disinfection of enteric viruses.


Assuntos
Desinfecção , Eliminação de Resíduos Líquidos/métodos , Águas Residuárias/virologia , Teorema de Bayes , Cloro , Escherichia coli , Humanos , Ontário , Raios Ultravioleta
5.
Clin Exp Rheumatol ; 37 Suppl 120(5): 100-111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621565

RESUMO

A patient history generally provides the most important information in diagnosis and management of patients with most rheumatic diseases, including osteoarthritis (OA). Patient history components can be expressed as quantitative, structured, "scientific" data, rather than "subjective" narrative descriptions, using patient self-report questionnaires. The Western Ontario McMaster (WOMAC) questionnaire is used in all OA clinical trials, and the health assessment questionnaire (HAQ) in all rheumatoid arthritis (RA) clinical trials, as "disease-specific" questionnaires. However, both questionnaires include scores for physical function function and pain; physical function scores are correlated highly significantly at r=0.78 in both RA and OA patients, while WOMAC pain scores are correlated with HAQ visual analogue scale (VAS) pain scores at r=0.73 in OA and r=0.71 in RA. Therefore, the WOMAC and HAQ may be regarded as largely "generic" questionnaires, at least for people with arthritis. Since it is not feasible to ask patients with different diagnoses to complete different care questionnaires in busy clinical settings, a single multidimensional HAQ (MDHAQ), derived from the HAQ and largely similar and informative in all rheumatic diseases, has been used in all rheumatology patients in several settings. The MDHAQ also has been incorporated into two OA clinical trials, with virtually identical results to the WOMAC. In routine clinical care, MDHAQ scores have documented that the disease burden of OA is comparable to RA in terms of scores for pain, physical function, and RAPID3 (routine assessment of patient index data) an index of pain, function and patient global assessment. Further observations indicate capacity of the MDHAQ to recognise fibromyalgia similarly to formal fibromyalgia criteria, as well as the ineffectiveness of opioids in OA, and similar prevalence of depression and other psychological issues in OA to RA. These findings also illustrate the value of a database of MDHAQ data for retrospective analysis of serendipitous observations from routine clinical care.


Assuntos
Osteoartrite , Inquéritos e Questionários , Humanos , Ontário , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
JAMA ; 322(9): 843-856, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31479136

RESUMO

Importance: Medical imaging increased rapidly from 2000 to 2006, but trends in recent years have not been analyzed. Objective: To evaluate recent trends in medical imaging. Design, Setting, and Participants: Retrospective cohort study of patterns of medical imaging between 2000 and 2016 among 16 million to 21 million patients enrolled annually in 7 US integrated and mixed-model insurance health care systems and for individuals receiving care in Ontario, Canada. Exposures: Calendar year and country (United States vs Canada). Main Outcomes and Measures: Use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine imaging. Annual and relative imaging rates by imaging modality, country, and age (children [<18 years], adults [18-64 years], and older adults [≥65 years]). Results: Overall, 135 774 532 imaging examinations were included; 5 439 874 (4%) in children, 89 635 312 (66%) in adults, and 40 699 346 (30%) in older adults. Among adults and older adults, imaging rates were significantly higher in 2016 vs 2000 for all imaging modalities other than nuclear medicine. For example, among older adults, CT imaging rates were 428 per 1000 person-years in 2016 vs 204 per 1000 in 2000 in US health care systems and 409 per 1000 vs 161 per 1000 in Ontario; for MRI, 139 per 1000 vs 62 per 1000 in the United States and 89 per 1000 vs 13 per 1000 in Ontario; and for ultrasound, 495 per 1000 vs 324 per 1000 in the United States and 580 per 1000 vs 332 per 1000 in Ontario. Annual growth in imaging rates among US adults and older adults slowed over time for CT (from an 11.6% annual percentage increase among adults and 9.5% among older adults in 2000-2006 to 3.7% among adults in 2013-2016 and 5.2% among older adults in 2014-2016) and for MRI (from 11.4% in 2000-2004 in adults and 11.3% in 2000-2005 in older adults to 1.3% in 2007-2016 in adults and 2.2% in 2005-2016 in older adults). Patterns in Ontario were similar. Among children, annual growth for CT stabilized or declined (United States: from 10.1% in 2000-2005 to 0.8% in 2013-2016; Ontario: from 3.3% in 2000-2006 to -5.3% in 2006-2016), but patterns for MRI were similar to adults. Changes in annual growth in ultrasound were smaller among adults and children in the United States and Ontario compared with CT and MRI. Nuclear medicine imaging declined in adults and children after 2006. Conclusions and Relevance: From 2000 to 2016 in 7 US integrated and mixed-model health care systems and in Ontario, rates of CT and MRI use continued to increase among adults, but at a slower pace in more recent years. In children, imaging rates continued to increase except for CT, which stabilized or declined in more recent periods. Whether the observed imaging utilization was appropriate or was associated with improved patient outcomes is unknown.


Assuntos
Diagnóstico por Imagem/tendências , Abdome/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Diagnóstico por Imagem/estatística & dados numéricos , Cabeça/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/estatística & dados numéricos , Imagem por Ressonância Magnética/tendências , Pessoa de Meia-Idade , Ontário , Cintilografia/estatística & dados numéricos , Cintilografia/tendências , Coluna Vertebral/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Tomografia Computadorizada por Raios X/tendências , Ultrassonografia/estatística & dados numéricos , Ultrassonografia/tendências , Estados Unidos , Adulto Jovem
8.
Sci Total Environ ; 690: 1342-1354, 2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31470496

RESUMO

Oil and gas development can result in natural gas migration into shallow groundwater. Methane (CH4), the primary component of natural gas, can subsequently react with solutes and minerals in the aquifer to create byproducts that affect groundwater chemistry. Hydro-biogeochemical processes induced by fugitive gas from leaky oil and gas wells are currently not well understood. We monitored the hydro-biogeochemical responses of a controlled natural gas release into a well-studied Pleistocene beach sand aquifer (Canadian Forces Base Borden, Ontario, Canada). Groundwater samples were collected before, during, and up to 700 days after gas injection and analyzed for pH, major and minor ions, alkalinity, dissolved gases, stable carbon isotope ratios of CO2 and CH4, and microbial community composition. Gas injection resulted in a dispersed plume of free and dissolved phase natural gas, affecting groundwater chemistry in two distinct temporal phases. Initially (i.e. during and immediately after gas injection), pH declined and major ions and trace elements fluctuated; at times increasing above baseline concentrations. Changes in the short-term were due to invasion of deep groundwater with elevated total dissolved solids entrained with the upward migration of free phase gas and, reactions that were instigated through the introduction of constituents other than CH4 present in the injected gas (e.g. CO2). At later times, more pronounced aerobic and anaerobic CH4 oxidation led to subtle increases in major ions (e.g. Ca2+, H4SiO4) and trace elements (e.g. As, Cr). Microbial community profiling indicated a persistent perturbation to community composition with a conspicuous ingrowth of taxa implicated in aerobic CH4 oxidation as well anaerobic S, N and Fe species metabolism.


Assuntos
Monitoramento Ambiental , Água Subterrânea/química , Metano/análise , Campos de Petróleo e Gás , Poluentes Químicos da Água/análise , Gás Natural , Ontário
11.
Can J Rural Med ; 24(4): 108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31552866
12.
Environ Monit Assess ; 191(9): 533, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375936

RESUMO

Long-term increased nutrient influx into normally nutrient-limited peatlands in combination with altered hydrological conditions may threaten a peatland's carbon storage function and affect its greenhouse gas (GHG) budget. However, in situ studies on the effects of long-term altered conditions on peatland functioning and GHG budgets are scarce. We thus quantified GHG fluxes in a peatland exposed to enhanced water level fluctuations and long-term nutrient infiltration in Ontario, Canada, via eddy-covariance and flux chamber measurements. The peatland was a prominent sink of - 680 ± 202 g carbon dioxide (CO2) and a source of 22 ± 8 g methane (CH4) m-2 year-1, resulting in a negative radiative forcing of - 80 g CO2 eq. m-2 y-1. During the growing season CH4 fluxes were constantly high (0.1 g m-2 s-1). Further, on three dates, we measured nitrous oxide (N2O) fluxes and observed a small flux of 2.2 mg m-2 day-1 occurring during the thawing period. Taking the studied ecosystem as a model system for other peatlands exposed to long-term increased nutrient infiltration and enhanced water level fluctuations, our data suggest that such peatlands can maintain their carbon storage function and CO2 sequestration may outweigh emissions of CH4.


Assuntos
Sequestro de Carbono , Monitoramento Ambiental/métodos , Gases de Efeito Estufa/análise , Metano/análise , Ciclo Hidrológico , Dióxido de Carbono/análise , Ecossistema , Óxido Nitroso/análise , Ontário , Estações do Ano
13.
Cancer Invest ; 37(8): 355-366, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31437020

RESUMO

Objectives: We examined the trends in survival based on treatment modality among non-small cell lung cancer (NSCLC) patients in the province of Ontario, Canada, from 2007 to 2015. Methods: We investigated the trends in survival based on treatment modality. Results: Among 56,417 identified patients, the mean age at diagnosis was 70.1 years (SD = 10.7). Treatment modalities varied significantly over time (p<.001). Overall, 23.0% of patients received surgical treatments. We observed more than 20% increase in five-year survival rates for all surgical groups over time. Conclusions: Patients undergoing sublobar/lobar resections had higher survival rate.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Sci Total Environ ; 693: 133567, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31374504

RESUMO

The aim of this study was to assess the variability of microbial risk associated with drinking water under various contaminant loading conditions in a drinking water source. For this purpose, a probabilistic-deterministic approach was applied to estimate the loadings of Cryptosporidium, Giardia, and Escherichia coli (E. coli) from fecal contamination sources during both dry and wet weather conditions. The relative importance of loads originating from various fecal contamination sources was also determined by a probabilistic approach. This study demonstrates that water resource recovery facilities were the dominant source of Giardia, yet rivers were more important with regards to Cryptosporidium. Estimated loadings were used as input to a three-dimensional hydrodynamic model of Lake Ontario; the fate and transport of microbial organisms were simulated at the influent of a drinking water intake. Discharge-based hydrodynamic modelling results were compared to observed concentrations. Simulated probability distributions of concentrations at the intake were used as an input to a quantitative microbial risk assessment (QMRA) model such that the variability of microbial risk in the context of drinking water could be examined. Depending on wind and currents, higher levels of fecal contamination reached the intake during wet weather loading scenarios. Probability distribution functions of Cryptosporidium, Giardia and E. coli concentrations at the intake were significantly higher during wet weather conditions when compared to dry conditions (p < 0.05). For all contaminants studied, the QMRA model showed a higher risk during wet weather (over 1 order of magnitude) compared to dry weather conditions. When considering sewage by-pass scenarios, risks remained below 2.7 × 10-7 person-1 day-1 for Giardia and E. coli O157:H7. Limited data were available for Cryptosporidium in by-pass effluents and the risk is unknown; hence it is critical to obtain reliable loading data for the riskiest scenarios, such as those associated with water resource recovery facility by-passes.


Assuntos
Monitoramento Ambiental , Microbiologia da Água , Poluição da Água/estatística & dados numéricos , Cryptosporidium , Água Potável , Escherichia coli , Fezes , Giardia , Hidrodinâmica , Lagos , Ontário , Medição de Risco , Rios , Esgotos , Recursos Hídricos , Tempo (Meteorologia)
15.
BMC Public Health ; 19(1): 1157, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438905

RESUMO

BACKGROUND: This study contributes to the limited number of studies that have explored the impact of not meeting the recommendations for moderate-to-vigorous physical activity, screen time, fruit and vegetable consumption and sleep on overweight and obesity among adolescents. METHODS: A cross-sectional study of data from the 2015 Ontario Student Drug Use and Health Survey (OSDUHS), a provincially representative survey of students in publically funded schools in Ontario, Canada, was conducted. This study included self-reported data from students aged 11-17 years (n = 9866). The main outcome variable was overweight or obesity, classified using WHO BMI cut-points. Four independent variables for healthy weight behaviours were examined: (1) moderate-to-vigorous physical activity (MVPA) (≥ 60 mins vs. < 60 mins everyday over the last seven days); (2) screen time (< 2 h daily vs. ≥ 2 h daily); (3) fruit and vegetable consumption (≥ 5 times/day vs. < 5 times/day); (4) sleep (adequate based on guidelines vs. inadequate). Covariates included sex, age, Subjective Social Status (SSS), parental education and ethnicity. Binomial and multinomial logistic regression models were fitted to determine whether not meeting the recommendations for healthy weight behaviours was associated with overweight or obesity status. RESULTS: Only 2% of students in Ontario met the recommendations for all four healthy weight behaviours and 33% of students did not meet any of the four recommendations. In both the binomial and multinomial models, not meeting the recommendations for MVPA was the only significant healthy weight behaviour associated with both overweight and obesity (AOR: 1.29, 95% CI: 1.03-1.62), and solely obesity (AOR: 1.45, 95% CI: 1.05-1.99). Males, students with lower SSS ratings, and students with parents with an education of 'High School' or less were also at significantly greater odds of being obese. CONCLUSION: Findings from this study show that inadequate levels of MVPA is a critical behavioural predictor of obesity status in adolescents between the ages of 11-17 years, after controlling for differences in screen time, fruit and vegetable consumption, sleep, and demographics. Findings from this study could have implications toward policies and programs targeted at reducing obesity, and increasing the physical activity rates of adolescents.


Assuntos
Comportamentos Relacionados com a Saúde , Obesidade Pediátrica/epidemiologia , Estudantes/psicologia , Adolescente , Criança , Estudos Transversais , Dieta/estatística & dados numéricos , Exercício/fisiologia , Feminino , Frutas , Guias como Assunto , Humanos , Masculino , Ontário/epidemiologia , Tempo de Tela , Autorrelato , Sono , Estudantes/estatística & dados numéricos , Fatores de Tempo , Verduras
16.
BMC Public Health ; 19(1): 1139, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426767

RESUMO

BACKGROUND: Previous research has linked excessive stress among post-secondary students to poor academic performance and poor mental health. Despite attempts to ameliorate mental health challenges at post-secondary institutions, there exists a gap in the evaluation of the specific sources of stress for students within the post-secondary setting. METHODS: The goal of this study was to develop a new instrument to better assess the sources of post-secondary student stress. Over the course of two years, the Post-Secondary Student Stressors Index (PSSI) was created in collaboration with post-secondary students as co-developers and subject matter experts. In this study, we used a combination of individual cognitive interviews (n = 11), an online consensus survey modeled after a traditional Delphi method (n = 65), and an online pre- (n = 535) and post-test (n = 350) survey to psychometrically evaluate the PSSI using samples of students from Ontario, Canada. We collected four types of evidence for validity, including: content evidence, response processes evidence, internal structure evidence, and relations to other variables. The test-retest reliability of the instrument was also evaluated. RESULTS: The PSSI demonstrated strong psychometric properties. Content validation and response processes evidence was derived from active student involvement throughout the development and refinement of the tool. Exploratory factor analysis suggested that the structure of the PSSI reflects the internal structure of an index, rather than a scale, as expected. Test-retest reliability of the instrument was comparable to existing, established instruments. Finally, the PSSI demonstrated good relationships with like measures of stress, distress, and resilience, in the hypothesized directions. CONCLUSIONS: The PSSI is a 46-item inventory that will allow post-secondary institutions to pinpoint the most severe and frequently occurring stressors on their campus. This knowledge will facilitate appropriate targeting of priority areas, and help institutions to better align their mental health promotion and mental illness prevention programming with the needs of their campus.


Assuntos
Estresse Psicológico/psicologia , Estudantes/psicologia , Inquéritos e Questionários , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Ontário , Psicometria , Reprodutibilidade dos Testes , Estudantes/estatística & dados numéricos , Adulto Jovem
17.
BMJ ; 366: l4151, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31292120

RESUMO

OBJECTIVE: To determine whether any association exists between exposure to 2009 pandemic H1N1 (pH1N1) influenza vaccination during pregnancy and negative health outcomes in early childhood. DESIGN: Retrospective cohort study. SETTING: Population based birth registry linked with health administrative databases in the province of Ontario, Canada. PARTICIPANTS: All live births from November 2009 through October 2010 (n=104 249) were included, and children were followed until 5 years of age to ascertain study outcomes. MAIN OUTCOME MEASURES: Rates of immune related (infectious diseases, asthma), non-immune related (neoplasms, sensory disorders), and non-specific morbidity outcomes (urgent or inpatient health services use, pediatric complex chronic conditions) were evaluated from birth to 5 years of age; under-5 childhood mortality was also assessed. Propensity score weighting was used to adjust hazard ratios, incidence rate ratios, and risk ratios for potential confounding. RESULTS: Of 104 249 live births, 31 295 (30%) were exposed to pH1N1 influenza vaccination in utero. No significant associations were found with upper or lower respiratory infections, otitis media, any infectious diseases, neoplasms, sensory disorders, urgent and inpatient health services use, pediatric complex chronic conditions, or mortality. A weak association was observed between prenatal pH1N1 vaccination and increased risk of asthma (adjusted hazard ratio 1.05, 95% confidence interval 1.02 to 1.09) and decreased rates of gastrointestinal infections (adjusted incidence rate ratio 0.94, 0.91 to 0.98). These results were unchanged in sensitivity analyses accounting for any potential differential healthcare seeking behavior or access between exposure groups. CONCLUSIONS: No associations were observed between exposure to pH1N1 influenza vaccine during pregnancy and most five year pediatric health outcomes. Residual confounding may explain the small associations observed with increased asthma and reduced gastrointestinal infections. These outcomes should be assessed in future studies.


Assuntos
Saúde da Criança , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza/efeitos adversos , Influenza Humana/prevenção & controle , Pandemias/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal , Adulto , Asma/epidemiologia , Pré-Escolar , Feminino , Gastroenteropatias/epidemiologia , Humanos , Lactente , Recém-Nascido , Infecção/epidemiologia , Ontário/epidemiologia , Gravidez , Pontuação de Propensão , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
18.
Ecotoxicol Environ Saf ; 182: 109354, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31272025

RESUMO

Selenium (Se) is a contaminant of concern in many aquatic ecosystems due to its narrow range between essentiality and toxicity in oviparous (yolk-bearing) vertebrates. The objective of the present study was to determine the effects of Se, experimentally added to in situ limnocorrals as selenite, on invertebrate communities and fathead minnow (Pimephales promelas) at environmentally realistic Se concentrations. Nine limnocorrals were deployed in a mesotrophic lake at the International Institute for Sustainable Development - Experimental Lakes Area in Ontario, Canada in May 2017. From June 1 to August 17, 2017, selenite was added to six enclosures to attain mean measured aqueous Se concentrations of 1.0 ±â€¯0.10 or 8.9 ±â€¯2.7 µg/L Se (in triplicate) and three limnocorrals were untreated controls (background mean aqueous Se = 0.12 ±â€¯0.03 µg/L). Benthic macroinvertebrates were collected throughout and at the end of the exposure period using artificial substrates to determine density, dry biomass, diversity, and taxa richness at the family level. Reproductively mature female fathead minnows (added on d 33 of the study) were collected throughout and at the end of the exposure period. After 77 d, Chironomidae and Gammaridae densities and biomass were significantly lower in the 8.9 µg/L Se treatment relative to the 1.0 µg/L Se treatment and the control. Invertebrate diversity (measured as Shannon's and Simpson's indices) significantly declined in the 1.0 µg/L and 8.9 µg/L Se treatments relative to the control (0.12 µg/L Se group). Fulton's condition factor for fathead minnow was significantly less in the 8.9 µg/L treatment compared to 0.12 and 1.0 µg/L Se experimental groups. The results of this study indicated that exposure to relatively low aqueous selenite concentrations can negatively affect invertebrate density and biomass, as well as fish condition. More research is necessary to characterize the risk of selenite exposure to aquatic invertebrates under realistic field conditions, and future risk assessments may need to consider reduced food availability as a factor that may impair the health of higher trophic level organisms in areas with elevated selenite.


Assuntos
Ecossistema , Selênio/toxicidade , Poluentes Químicos da Água/toxicidade , Animais , Organismos Aquáticos/fisiologia , Chironomidae , Cyprinidae/fisiologia , Feminino , Invertebrados/fisiologia , Lagos , Ontário , Reprodução/efeitos dos fármacos , Ácido Selenioso/toxicidade
19.
Plant Dis ; 103(9): 2263-2270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31322489

RESUMO

Alternaria leaf spot (ALS), caused by Alternaria spp., can occur wherever sugarbeet is grown. Infection by Alternaria spp. and disease management has historically been considered a minor issue in sugarbeet production in the United States. An increase of both incidence and severity in 2016 of ALS high enough to cause yield loss has been observed in Michigan. With a renewed need to consider potential management of this disease, the sensitivity was determined for populations of Alternaria spp. to three classes of fungicides currently labeled for management of leaf spot on sugarbeet, including demethylase inhibitor (DMI), quinone outside inhibitor (QoI), and organo-tin fungicides. Leaves with symptoms of ALS were sampled from sugarbeet fields in east-central Michigan and southwestern Ontario, Canada. Monoconidial isolates were obtained to determine sensitivity to each fungicide class above. A spiral gradient dilution method was used to estimate the fungicide effective concentration (in milligrams per liter) that caused a 50% inhibition of fungal growth in vitro for all isolates. Significant temporal shifts were detected in the frequencies of sensitivity phenotypes to DMI and QoI but not organo-tin fungicides from 2016 through 2017. Individual isolates of Alternaria spp. were recovered with cross-resistance to DMI and multiple resistance to DMI, QoI, and triphenyltin hydroxide fungicides. To our knowledge, this is the first report of a fungus other than Cercospora beticola with resistance to organo-tin fungicides. Fungicide sensitivity monitoring indicates that an effective integrated disease management approach combining fungicide efficacy trials and monitoring pathogen biology is essential for developing effective resistance management recommendations.


Assuntos
Alternaria , Beta vulgaris , Fungicidas Industriais , Alternaria/efeitos dos fármacos , Beta vulgaris/microbiologia , Farmacorresistência Fúngica , Fungicidas Industriais/farmacologia , Lagos , Michigan , Ontário , Estados Unidos
20.
Int J Equity Health ; 18(1): 101, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262310

RESUMO

BACKGROUND: People experiencing homelessness are often marginalized and are known to face barriers to accessing acceptable and respectful healthcare services. This study examines the experience of accessing hospital-based services of persons experiencing homelessness or vulnerable housing in southeastern Ontario and considers the potential of Equity-Oriented Health Care (EOHC) as an approach to improving care. METHODS: Focus groups and in-depth interviews with people with lived experience of homelessness (n=31), as well as in-depth interviews of health and social service provider key informants (n=10) were combined with qualitative data from a survey of health and social service providers (n=136). Interview transcripts and written survey responses were analyzed using directed content analysis to examine experiences of people with lived experience of homelessness within the healthcare system. RESULTS: Healthcare services were experienced as stigmatizing and shaming particularly for patients with concurrent substance use. These negative experiences could lead to avoidance or abandonment of care. Despite supposed universality, participants felt that the healthcare system was not accountable to them or to other equity-seeking populations. Participants identified a system that was inflexible, designed for a perceived middle-class population, and that failed to take into account the needs and realities of equity-seeking groups. Finally, participants did identify positive healthcare interactions, highlighting the importance of care delivered with dignity, trust, and compassion. CONCLUSIONS: The experiences of healthcare services among the homeless and vulnerably housed do not meet the standards of universally accessible patient-centered care. EOHC could provide a framework for changes to the healthcare system, creating a system that is more trauma-informed, equity-enhancing, and accessible to people experiencing homelessness, thus limiting identified barriers and negative experiences of care.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Problemas Sociais/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Grupos Focais , Humanos , Ontário , Inquéritos e Questionários
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