Search

Despite limited research, existing evidence suggests that there is an association between conduct disorder (CD) and various risky driver behaviours, such as driver aggression and driving after drinking. The current study sought to estimate the association between probable CD during childhood and past-year collision risk.

While some existing studies suggest that conduct disorder (CD) significantly increases risk of driving after drinking, outcomes have typically been assessed only up to age 21 years. Therefore, the current study sought to assess the relationship between symptoms of CD during childhood (before age 15 years) and the risk of engaging in driving after drinking during adulthood.

Objective: Assertive community treatment (ACT) studies that have used conventional, statistical growth modelling methods have not examined different trajectories of outcomes or covariates that could influence different trajectories, even though heterogeneity in outcomes has been established in other research on severe mental illness. The purpose of our study was to examine the general trend in mental health functioning of ACT clients over a 2-year follow-up time period, to discover groups of ACT clients with distinctive longitudinal trajectories of mental health functioning, and to examine if some of the key sociodemographic and illness-related factors influence group membership.Method: A 2-year, prospective, within-subjects study of 216 ACT clients within southern Ontario, collected functional outcome data at baseline and 12 and 24 months using the Colorado Client Assessment Record. Baseline covariates included sex, primary diagnosis, number of comorbidities, hospitalization history, and duration of illness. Growth mixture modelling (GMM) was used to examine trajectories.Results: Clinical staff assessments of ACT clients showed a statistically significant improvement in functioning and 84% achieved successful community tenure. GMM analysis identified 2 classes of ACT clients: class 1 (79.63% of clients) experienced lower and stable overall functioning, and class 2 (20.37%) showed a better baseline functioning score and improvement in the overall functioning over time. Class membership was predicted by the number of comorbidities and diagnosis.Conclusions: Our study suggests general stability in overall functioning for the sampled ACT clients over 2 years, but significant heterogeneity in trajectories of functioning.

AbstractCannabis use is common in youth and there is evidence that the co-occurrence of cannabis use (and other substance use) with mental illnesses predicts poorer outcomes, including suicide. The main purposes of this study were to: (i) identify rates of cannabis use and substance use disorder risk, and (ii) predictors for cannabis use among youth seeking help for mood and/or anxiety concerns in a sample population prescreened to exclude primary substance use disorders; and (iii) to determine if there was an association between cannabis use and functional impairment in this sample. We investigated substance use risk as well as hypothesized predictors of cannabis use and functional impairment including demographic characteristics, socioeconomic status, trait coping style, age of onset of several risk behaviors, current use of common addictive substances, level of functional impairment, and current psychiatric symptom severity. Results showed that approximately half of the participants were at moderate to high risk for a substance use disorder, and just over 4% appeared to have a primary substance use disorder. They also suggested an association between cannabis use and gender (male), age of first cannabis use, recent cigarette use, and functional impairment. Independently, functional impairment was predicted by inattentive coping style, depression severity, and total cannabis use score. These results confirm a high risk for addictive disorders and an association between cannabis use and functional impairment in this sample. These results support the need for substance use treatment programs to optimize care wherever youth with primary mood and/or anxiety concerns are seen.

IMPACT (Impaired Minds Produce Actions Causing Trauma) is an adolescent, hospital-based program aimed to prevent injuries and their consequences caused by alcohol or drug impairment and other high-risk behaviors. The overall objective of this evaluation was to determine the effect of the program on students’ knowledge and behavior regarding drinking and driving, over time.

Long-haul truck drivers are exposed to many workplace stressors that put them at greater health risk than the general population. Transport truck driving is currently the most common occupation for men in Canada and among the top most common occupations for men in the US, the United Kingdom and Australia. Literature to date suggests long-haul truck drivers have poor access to health care including primary care. Primary care reduces health inequity and has significant impact on the health of both individuals and populations. How primary care practitioners provide this important resource to their long-haul truck driver patients has not been well studied. In this study, we probed the responses of family physicians and nurse practitioners to the health experiences reported by long-haul truck drivers and explored their insights providing primary care to this occupational group.

Changes in health services and care needs have created high demand for case management of in-home services. To address this challenge, several models of case management have been used. Evaluations to date suggest that clients need different approaches for different circumstances at different times to optimize cost-effectiveness. Accordingly, one Canadian home care program adopted flexible client-driven case management, engaging clients as partners in flexibly selecting either an integrated team, consumer-managed or brokerage model of case management in keeping with their preferences and abilities. Using an exploratory, multimeasure quasi-experimental design, a generic model of program evaluation, and both quantitative and qualitative methods, researchers identified challenges in implementing this intervention, policy impediments the clients characteristically in each of the three case management models, and client, provider, and caregiver outcomes of flexible, client-driven care. While further longitudinal investigation is needed, findings suggest several important considerations for those interested in this option for care management. Alternative case management models do attract different client groups, and having a choice does not alter care costs or outcomes. Flexible client-driven case management may be experienced positively by case managers and other providers.

Knowledge diffusion and utilization (KDU) have become a key focus in the health research community because of the limited success to date of research findings to inform health policies, programs and services. Yet, evidence indicates that successful KDU is often predicated on the early involvement of potential knowledge users in the conceptualization and conduct of the research and on the development of a “partnership culture”. This study describes the integration of KDU theory with practice via a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health (CAREMH). This qualitative study, using a single-case design, included a number of data sources: proposals, meeting minutes, presentations, publications, reports and curricula vitae of CAREMH members. CAREMH has adopted the following operational strategies to increase KDU capacity: 1) viewing research as a means and not as an end; 2) bringing the university and researcher to the community; 3) using participatory research methods; 4) embracing trans-disciplinary research and interactions; and 5) using connectors. Examples of the iterative process between researchers and potential knowledge users in their contribution to knowledge generation, diffusion and utilization are provided. This case study supports the importance of early and ongoing involvement of relevant potential knowledge users in research to enhance its utilization potential. It also highlights the need for re-thinking research funding approaches. La diffusion et l’utilisation des connaissances sont devenues des orientations clés pour les chercheurs médicaux, car jusqu’à maintenant, les politiques, programmes et services de santé ne s’inspirent pas beaucoup des résultats de recherche. Certains indices portent cependant à croire qu’une diffusion et une utilisation efficaces des connaissances dépendent souvent de la participation précoce des utilisateurs éventuels des connaissances à la conceptualisation et à la conduite de la recherche, ainsi que de l’avènement d’une „ culture de partenariat ”. Notre étude décrit l’intégration, dans la pratique, de la théorie de la diffusion et de l’utilisation des connaissances, par le biais de l’analyse d’une étude de cas du CAREMH (un consortium pour la recherche appliquée et l’évaluation en santé mentale). Étude qualitative fondée sur un cas et faisant appel à plusieurs sources (les propositions, procès-verbaux, présentations, publications, rapports et curriculum vitæ des membres du CAREMH). Le CAREMH a adopté les stratégies opérationnelles suivantes pour accroître sa capacité de diffusion et d’utilisation des connaissances: 1) considérer la recherche comme un moyen plutôt qu’une fin; 2) amener l’université et le chercheur dans la collectivité; 3) utiliser des méthodes de recherche participatives; 4) profiter de la recherche et des interactions transdisciplinaires; et 5) utiliser des „ connecteurs ”. L’étude donne des exemples du processus itératif entre les chercheurs et les utilisateurs éventuels des connaissances pour que ces derniers contribuent à la création, à la diffusion et à l’utilisation de savoirs. L’étude de cas confirme l’importance, pour la recherche, de la participation précoce et continue des utilisateurs éventuels des connaissances, ceci pour améliorer l’utilisation des résultats. Elle souligne également le besoin de repenser les méthodes de financement de la recherche.

Objective: To examine what factors predict adolescents’ concepts of their health. Methods: The study, based on the longitudinal National Population Health Survey, included 1,493 adolescents who were 12–19 at the time of interview. Sex, age, grade, family structure, income, disability, chronic health problems, social supports, social involvement, school/work involvement, smoking, alcohol bingeing, physical activities, Body Mass Index (BMI) and psychological health status variables were examined. Using ordinal multivariate regression, self-rated health was regressed on all predictors, which were entered in blocks hierarchically. Results: The analyses revealed that adolescent perceptions of health are framed not only by their physical health status, but also by personal, socio-environmental, behavioural and psychological factors. Specifically, health problems, disability, age, female status, lower income, smoking, and higher BMI were associated with lower self-rated health. Conclusions: This study suggests that adolescent appraisals of their health are shaped by their overall sense of functioning, which includes both physical health and non-physical health dimensions. Á venir

Background: On November 29, 1996, Ontario introduced an Administrative Driver’s Licence Suspension (ADLS) law, which required that anyone charged with driving with a blood alcohol concentration (BAC) over the legal limit of 80 mg% or failing to provide a breath sample would have their licence suspended for a period of 90 days at the time the charge was laid. This study evaluates the early effects of Ontario’s ADLS law on alcohol-involved driver fatalities. Methods: Interrupted time series analysis with ARIMA modelling was applied to the monthly proportion of drivers killed in Ontario with a BAC over 80 mg% for the period Jan. 1, 1988 to Dec. 31, 1997. Results: A significant intervention effect was found, with ADLS being associated with an estimated reduction of 17.3% in the proportion of fatally injured drivers who were over the legal limit. Conclusion: These data provide an early indication that the law resulted in some success in reducing alcohol-related driver fatalities. Contexte: Le 29 novembre 1996, l’Ontario déposait une réglementation sur la suspension administrative des permis de conduire aux termes de laquelle toute personne conduisant un véhicule automobile alors que son alcoolémie dépasse la limite légale de 80 mg/100 ml ou refusant de fournir un échantillon d’haleine perdait son permis de conduire pour une durée de 90 jours, dès son inculpation. Cette étude évalue les premières répercussions de la réglementation ontarienne sur la proportion d’accidents mortels liés à l’alcool. Méthode: Une analyse interrompue des séries chronologiques à l’aide du modèle ARMMI a été appliquée à la proportion mensuelle de conducteurs ayant été tués en Ontario entre le 1er janvier 1988 et le 31 décembre 1997 et dont l’alcoolémie dépassait 80 mg/100 ml. Résultats: Les chercheurs ont constaté que la réglementation avait un |effet significatif, car elle était associée à une réduction approximative de 17,3% des décès parmi les conducteurs ayant une alcoolémie supérieure à la limite légale. Conclusion: Ces données préliminaires indiquent donc que la suspension administrative des permis de conduire peut réduire, dans une certaine mesure, le nombre d’accidents mortels reliés à l’alcool.

The purpose of this paper is to describe knowledge, attitudes and practices of cold and flu self-care and health care utilization, and to identify the predictors of health care utilization for the cold and flu among residents of London and Windsor. Using a random digit dialing survey method, 417 residents were interviewed between November–December, 1993 and February–March, 1994. This survey revealed good knowledge about colds and flu and understanding of appropriate physician visits. Only seven percent reported a doctor visit for their last cold. Socio-demographic, health status, attitude and knowledge level variables were subjected to a logistic regression analysis to identify which variables predicted self-reported physician visits. Only attitudes and health status showed statistically significant log odds (3.6 and 1.5, respectively). In summary, consistent with other studies, attitude and health status, not knowledge, appear to be significant predictors of physician visits for colds/flu. Le but de cet article est de décrire les connaissances, l’attitude et les pratiques en matière de soins personnels du rhume et de la grippe et le recours aux services de santé, ainsi qu’identifier les prédicteurs du recours aux services de santé pour les mêmes affections chez les résidents de London et de Windsor. En recourant à une méthode d’enquête par appel téléphonique composé de façon aléatoire, on a interviewé 417 résidents entre novembre et décembre 1993, et également entre février et mars 1994. Cette enquête a révêlé un bon niveau de connaissances et une bonne compréhension des consultations chez le médecin qui sont justifiées. Seulement sept pour cent des personnes ont déclaré avoir consulté un médecin lors de leur dernier rhume. On a fait une analyse de régression logistique sur les variables concernant le statut socio-démographique, l’état de santé, l’attitude et le niveau de connaissances pour identifier celles d’entre elles permettant de prédire des consultations du médecin auto-déclarées. Seules les variables correspondant à l’attitude et à l’état de santé ont montré des disparités statistiquement significatives (3,6 et 1,5 respectivement). En résumé, comme l’indiquent d’autres études, ce sont les variables relatives à l’attitude et à l’état de santé et non pas celle en rapport avec les connaissances qui semblent être des prédicteurs significatifs des consultations du médecin en cas de rhume et (ou) de grippe.

Self-rated health is a commonly used measure of physical health status. While the development of one’s perception of self-rated health likely occurs during childhood and adolescence, its development has been largely unexplored. This study addresses this issue by examining the relationship between adolescent self-rated health and personal (sex, age) and situation (family structure, family income) factors at five different time intervals to identify inter- and intra-cohort effects as well as concomitant changes in adolescent health compromising behaviour, specifically substance use. Five waves between 1989 and 1997 of the biennial Ontario Student Drug Use Survey (OSDUS) by the Addiction Research Foundation (ARF) consisting of 19,512 cases were examined. The results indicate the presence of both inter- and intra-cohort effects on self-rated health. In addition, health-compromising behaviours had a varied effect on self-rated health across grade. This analysis confirms some previous findings but also presents contradictory evidence by identifying the complexity of relationships among these factors and self-rated health.

Eight hundred fifty-four consecutive motor vehicle crash (MVC) victims admitted from August 1, 1986, through August 31, 1989, were prospectively assessed including measurement of blood alcohol concentration (BAC). One hundred six in-hospital interviews were conducted on competent consenting drivers ≥18 years old; 22.9 (n = 22) of those who were BAC tested (n = 96) were positive for alcohol on admission. The blood alcohol concentration positive [BAC(+)] and the BAC negative (-) drivers differed significantly on the following variables: driver education [BAC(-) > BAC(+): p < 0.01], license suspension ≤ 2 years before admission [BAC(+) > BAC(-): p< 0.01], frequency of self-reported intoxication in month before crash [BAC(+) > BAC(-): p< 0.05], driving within 2 hours of drinking ≤1 month before admission [BAC(+) > BAC(-): p= 0.01] and self-reported driving with BAC > 17 mmol/L ≤1 month before admission [BAC(+) > BAC(-): p< 0.01]. Follow-up interviews (n = 106) were conducted 1 year after discharge; drivers originally testing BAC(+) were more likely to drive within 2 hours of drinking (p< 0.05), and were more likely to admit to driving with a BAC > 17 mmol/L (p< 0.01). Original BAC(+) drivers were also more likely to report a subsequent MVC in the year following discharge (not statistically significant). There is a need to develop an assessment system to identify high crash-risk drivers and establish rehabilitation programs to reduce crash recidivism.

In the past 20 years, dramatic changes have occurred in the movement toward global economies and free/liberalized markets. Various trade agreements have been increasing international trade, challenging “unfair” trade practices and pushing to “harmonize” and coordinate regulations, taxation, policies and other public and private enterprises. Could these trade agreements affect alcohol and injury control policies? Furthermore, could trade agreements ultimately affect injury trends? Unfortunately research studies and data on this topic are scarce. This paper presents information on the principles underlying international trade agreements and indicates how these principles could potentially affect the sales, regulations and taxation of alcohol and impact on injuries. The call is for researchers to conduct the research needed to address these questions and potential impacts.

In recent years, many jurisdictions have legalized medicinal and/or recreational cannabis. Yet, limited information is available on the effects of cannabis commercialization (provision of legal supply of cannabis to adults through licensed retail outlets) on adverse outcomes, such as traffic fatalities. The purpose of this study was to systematically review the literature on the effects of cannabis retail outlets on traffic collisions, fatalities and other traffic-related outcomes.