Search

Selenium methionine (Se Met) is an essential micronutrient required for normal body function and is associated with additional health benefits. However, oral administration of Se Met can be challenging due to its purported narrow therapeutic index, low oral bioavailability, and high susceptibility to oxidation. To address these issues, Se Met was entrapped in z e i n-coated nanoparticles made from chitosan using an ionic gelation formulation. The high stability of both the Se Met and s e l e n o methionine nanoparticles (Se Met-NPs) was established using cultured human intestinal and liver epithelial cells, rat liver homogenates, and rat intestinal homogenates and lumen washes. Minimal cytotoxicity to Caco-2 and HepG2 cells was observed for Se Met and Se Met-NPs. Antioxidant properties of Se Met were revealed using a Reactive Oxygen Species (ROS) assay, based on the observation of a concentration-dependent reduction in the build-up of peroxides, hydroxides and hydroxyl radicals in Caco-2 cells exposed to Se Met (6.25–100 M). The basal apparent permeability coefficient (Papp) of Se Met across isolated rat jejunal mucosae mounted in U s s i n g chambers was low, but the Papp was increased when presented in NP. Se Met had minimal effects on the electrogenic ion secretion of rat jejunal and colonic mucosae in U s s i n g chambers. Intra-jejunal injections of Se Met-NPs to rats yielded increased plasma levels of Se Met after 3 h for the Se Met-NPs compared to free Se Met. Overall, there is potential to further develop Se Met-NPs for oral supplementation due to the increased intestinal permeability, versus free Se Met, and the low potential for toxicity.

Health economic evaluations are commonly conducted through a cost-utility analysis, where health benefits are measured using utility scores. A common utility measure is the European Quality of Life (EQ-5D). Osteoarthritis (OA) research studies commonly use disease-specific quality of life tools such as the Western Ontario and McMaster’s Universities Osteoarthritis Index (WOMAC) to derive utility scores, but the validity of this method is unknown. This research aims to determine the agreement between utility scores derived from WOMAC and the EQ-5D surveys among patients who have undergone Total Joint Replacement (TJR). To estimate the agreement, we calculated an intraclass correlation coefficient (ICC) and its 95% confidence interval (CI) and produced Bland Altman plots. Our results indicate good agreement between the two scores, as seen with the ICC value of 0.85, 95% CI (0.82 - 0.87).

The purpose of this study was to identify healthcare concerns of young people and adults with cerebral palsy (CP) in the Transitional and Lifelong Care (TLC) program, and determine whether there were patient factors associated with the number of healthcare concerns. A retrospective chart review of initial TLC consultations was completed (n = 241). Descriptive and inferential statistics were used to explore and explain patterns in the sample population. The participants reported a high number of concerns of varied nature that were not easily predicted by condition-specific or demographic variables. This study may better healthcare delivery for young people and adults with CP by raising awareness of the health needs of this population, and potentially leading to the creation of intervention and monitoring guidelines.Furthermore, this research has strong potential to influence priority setting in the development of adult-based clinical programs and contribute to best practices for effective transitional care.

Objective: To confirm the importance of sagittal spinal alignment on functional outcome with degenerative lumbar spondylolisthesis (DLS) surgery and to identify the radiographic parameters that predict functional outcomes after DLS surgery. Methods: Retrospective analysis of the prospectively collected functional and radiographic outcomes of the Canadian Spine Outcomes and Research Network DLS database. All patients underwent either decompression, posterolateral fusion or interbody fusion surgery with a minimum of one-year postoperative follow-up. Results: Most patients improve or remain unchanged in their sagittal spinal alignment regardless of surgery type with fusion procedures not experiencing statistically significantly improved alignment changes to decompression alone. By multiple linear regression adjusted for baseline patient age, body mass index, gender and preoperative presence of depression, worsening of a patient’s pelvic incidence-lumbar lordosis (LL) mismatch with any technique of DLS surgery was associated with a higher one-year postoperative ODI score R2 0.179 (95% CI 0.080, 0.415, p=0.004), back pain R2 0.152 (95% CI 0.021, 0.070, p 2 0.059 (95% CI 0.008, 0.066, p=0.014) score. Likewise, reduction of LL was associated with a higher ODI score R2 0.168 (-0.387, -0.024, p=0.027) and back pain R2 0.135 (95% CI -0.064, -0.010, p=0.007). Conclusions: This is the first work to examine DLS patients outside of extrapolated sagittal balance parameters from the adult scoliosis literature. Importantly, we show that any worsening in sagittal spinal alignment parameters with DLS surgery regardless of surgery type leads to poorer functional outcomes even among patients who remain within conventionally held appropriate sagittal balance.

Maternal consumption of a Western diet (WD) has been linked to alterations in fetoplacental metabolic programming and risk for the exposed fetus to develop obesity, cardiovascular disease, and type II diabetes mellitus. It may also cause oxidative damage to the placental mitochondria. This thesis investigated the metabolic effects of a WD on placentae using a guinea pig model of pregnancy and hyperpolarized 13C MRI for metabolic quantification. It was hypothesized that placental glycolytic metabolism would increase, and placental oxidative metabolism would decrease in WD-fed sows. Control diet- and WD-fed, pregnant sows underwent metabolic MRI at 33 days gestation and were investigated by quantifying the placental lactate-, alanine-, and bicarbonate-to-pyruvate ratios. A statistically significant relationship was detected between placental appearance and metabolism that could be useful as a biomarker of fetoplacental health. These results reinforce the importance of placental metabolic research to determine the relationship between WD consumption and placental metabolism.

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage. Interprofessional teams are effective at providing chronic disease management and care that meets the needs of patients. As part of an ongoing spread, an interprofessional primary care COPD management program was implemented at a family health team in Ontario. A qualitative case study was performed to determine the supporting or hindering factors to the implementation of the program. Data collected was deductively analyzed using the Consolidated Framework for Implementation Research. Eleven constructs were determined to meaningfully affect implementation. Cosmopolitanism, networks and communication, engaging, design quality and packaging, and reflecting and evaluating were identified as the most influential. This study provides a clearer understanding of the factors related to program implementation. These factors will be useful in informing the continued spread of the program as well as the implementation of future chronic care programs.

Glenoid reaming is one of the most challenging milestones of the total shoulder arthroplasty (TSA) procedure. For a successful TSA, adequate bone resurfacing is required to ensure a well-conformed positioning of the implant onto the native bone. In this study, a light-weight robot was employed to assert a prescribed thrust-force and reaming depth to mimic clinical practice. Reaming of bone-analogs indicated that specimen density had a linear relationship with reamer velocity and apparent machining stiffness. Human cadaveric bone studies confirmed a linear relationship between specimen density and reamer velocity in both subchondral and cancellous regions of the glenoid. A reaming operation mimicking version correction of glenoid was conducted in a position-controlled manner. A linear relationship was found between reamer-specimen contact surface and maximum reaming force. Findings of this study may be useful in simulator design and automation of this surgical procedure.

Wound prevention and management best practice guidelines and literature contain recommendations that treatment plans need to consider the client’s lifestyle but offer little guidance about the specific lifestyle factors to be considered, nor how to address these. A post positivist constructivist grounded theory study was used to explore this gap Participants were health care providers with at least 5 years of experience working with community dwelling adults with chronic wounds. Data were transcripts of two semi structured individual interviews, a reflective journal, relevant documents identified by participants and transcripts of focus groups. A common understanding of lifestyle factors was not found; however, a substantive theory was co-constructed. This work builds on a concept described by Schon (1987, pg 3)where best practices and research studies are described as occupying a high ground overlooking a swamp, where complex clients are managed with limited resources. In this study, three major themes emerged – the high ground, the swamp and co-occupation. The high ground included how the health care provider entered wound prevention and management, and that their initial task was local wound care. Health care providers expected wounds to heal with specific treatments within specific time frames. Practice, however, happens in the “swamp”. Participants described the context of the swamp to include ideas such as; the practicality of treatment, client characteristics, the client’s vocation, etc. Co-occupation occurs when the clinician and client are both engaged, working together on the common goal of identifying and addressing lifestyle factors within the context of the swamp.

Introduction: The most common method of spinal fusion includes pedicle screws instrumentation, either with or without interbody cage fusion. This thesis aimed to develop and test a novel stand-alone intervertebral device that eliminates the need for pedicle screws and rods. Method: The stand-alone cage was designed in collaboration with spinal surgeons and engineers using computer assisting drawings, and manufactured in titanium by 3D printing. Biomechanical testing comparing the stand-alone cage with standard posterior lumbar interbody fusion (PLIF) in sawbones (n=6) and cadavers (n=8). Result: Compared to PLIF, the stand-alone cage demonstrated no significant difference in range of flexion, lateral bend or axial rotation in sawbones; however, significant increase in range of extension was observed. Among cadavers, the stand-alone cage demonstrated a significant increase in range of motion (ROM) for flexion, extension, lateral bending to the right and total lateral bend ROM; but no significant increase to ROM in axial rotation. Conclusion: Due to the increased ROM associated with the stand-alone cage, this devise is not advisable to use as a fusion implant. Keywords Lumbar spine, anatomy, biomechanics, Posterior lumbar fusion, interbody fusion.

In this work I study two cases involving practices of science and technology in the backdrop of related and recent curricular reforms in both settings. The first case study is based on the 2005 South Asian earthquake in Muzaffarabad, Pakistan which led to massive losses including large scale injuries and disabilities. This led to reforms at many levels ranging from disaster management to action plans on disability, including educational reforms in rehabilitation sciences. Local efforts to deal with this disaster led to innovative approaches such as the formation of a Community Based Rehabilitation (CBR) model by a local NGO, which I study in detail. The second case study is based on the recent reform of science and technology curriculum in Ontario, which is related to the release of the 2007 Intergovernmental Panel for Climate Change (IPCC) reports. With climate change science driving this reform with curricular demands for students to learn ‘what scientists do’, my second case study details the formation of the Canadian CloudSat CALIPSO Validation Project (C3VP) and scientific practices which depict cutting edge science related to climate change. Towards contending with the complexity inherent in these cases, I have developed a hybrid framework which is based on Actor-Network Theory (ANT) and the mobilities paradigm while drawing on some aspects of the Annales school of historians. The resulting historical sociology or historiography depicts how these various networks were formed via mobilities of various actor-networks and vice versa. The practices involved in both cases evolved over time and required innovation in times of crises and challenges, and are far more than simple applications of method as required by biomedical and positivist representations of science inherent in both educational reforms. Non-human agency in the form of crisis and disaster also emerges as a key reason for the formation of these networks. Drawing from both cases, I introduce the concept of “transectionalities” as a metaphor which represent configurations of actor-networks in science and technology geared towards dealing with crisis and disaster scenarios. Based on these findings, I also extend the idea of “multiple ontologies” by Mol (2002) to “Epistemic-Ontologic-Techne-” configurations which is sensitive to considerations of time. Moreover, I also find that mathematics is a key mobilizing actor and material semiotic which mediates communication between humans and non-humans and term these dynamics as “mathematical mobilities.” Based on case study one, I also suggest the notion of “affective care” in clinical reasoning, which is based on enhancing the beneficial effect of human to human relationships in these engagements.

Problem: The number of maternity care providers varies across Canada. Women from rural communities or those marginalized due to physical, psychological or social issues including newcomers, often experience challenges accessing health care (Fraser Health, 2014; Rogers, 2003). Interprofessional collaborative maternity care [IPCMC] has been credited as a means of increasing access and promoting sustainability of services (Miller et al., 2012; Society of Obstetricians and Gynecologists of Canada, 2008). Midwifery could play a greater role in delivery of services through IPCMC. However, little is known about collaboration in these practices. The purposes of this study are to explore factors influencing enactment of IPCMC and understand whether and how midwives can provide relational care in these practices in ways that are positively evaluated by women and staff. Method: A qualitative multiple case study design was used to explore variations in 4 IPCMC practices in British Columbia, Canada. Sources of data included: observation and semi-structured interviews with staff (n=40) and women receiving care (n=33). Thematic analysis was applied to interview transcripts, observational field notes and analytic notes. Findings and Conclusions: Collaborative care was well received by patients when expectations were clear and continuity of information and philosophy were exercised. Contextual factors influenced development and implementation requiring adaptation over time. Communication, organization, mutual respect and commitment enabled collaboration and relational care. Policy changes to promote and sustain IPCMC include broader definitions of continuity of care; increased support and adoption of integrated funding models. Interprofessional education is needed to develop skills for effective collaboration.

Canadians on the transplant waiting list are dying every day because there are not enough available solid organs for transplantation. An important aspect of addressing this problem is to increase deceased organ donation consent rates. Consent rates are, in part, affected by the number of adults registering their commitment to deceased organ donation in the event of their death through a donor registry. In provinces such as Ontario, approximately 30% of the population is registered for deceased organ donation and approximately 60% of families consent to organ donation. These low figures have been attributed, without evidence, to the relatively high proportion of immigrants or ethnic minorities living in Ontario. This research uses Ontario’s large administrative databases to examine organ and tissue donor registration in the general population and familial consent among those referred for organ and tissue donation. Modified-Poisson regression was used to identify characteristics associated with donor registration and familial consent. The first manuscript examines deceased organ donor registration and familial consent among Chinese, South Asian and the remaining general public. Chinese and South Asian individuals registered and their families consented less for deceased organ donation than the general public. The second manuscript examines deceased organ donor registration among immigrants compared to long-term residents and identifies and quantifies characteristics associated with organ donor registration. Compared to long-term residents, immigrants as a group were much less likely to register for organ and tissue donation. Characteristics among the immigrant population associated with a higher likelihood of registration included economic immigrant status, living in a rural area (population < 10 000), living in an area with a lower ethnic concentration, less material deprivation, a higher education, ability to speak English and French, and more years residing in Canada. The third manuscript examines familial consent among immigrants and identifies and quantifies characteristics associated with familial consent. Compared to long-term residents, families of immigrants as a group were less likely to consent for deceased organ donation. However, there was no statistical difference in consent rates among immigrants and long-term residents who had registered for organ and tissue donation. The information gained from this study will guide organ procurement organization’s strategies and approaches to organ and tissue donation. These results can be used to implement and design donor awareness campaigns targeted at groups with lower donor registration and consent rates that are culturally sensitive and effective.

The valid and reliable Fitness-to-Drive Screening Measure© (FTDS) is a free online proxy measure that screens for at-risk older drivers using 54 driving-related items. This secondary data analysis aims to construct and validate a short form FTDS, using 200 caregiver FTDS response sets and 200 older driver on-road assessment pass/fail outcomes. To construct the short form, exploratory factor analysis and classical test theory techniques were employed to determine the most interpretable factor model and the minimum number of items that might be used to predict fitness to drive. Next, receiver operating characteristics curves were generated to evaluate the concurrent criterion validity of the constructed short form against driver on-road pass/fail outcomes. This study resulted in the construction of FTDS short form version 1 and 2. Both short forms were predictive of on-road pass/fail outcomes. This measure may provide proxy raters with efficient means to help identify at-risk older drivers.

Introduction: Measurement errors can seriously affect quality of clinical practice and medical research. It is therefore important to assess such errors by conduct- ing studies to estimate a coefficients reliability and assessing its precision. The intraclass correlation coefficient (ICC), defined on a model that an observation is a sum of information and random error, has been widely used to quantify reliability for continuous measurements. Sample formulas have been derived for explicitly incorporation of a prespecified probability of achieving the prespecified precision, i.e., the width or lower limit of a confidence interval for ICC. Although the concept of ICC is applicable to binary outcomes, existed sample size formulas for this case can only provide about 50% assurance probability to achieve the desired precision. Methods: A common correlation model was adopted to characterize binary data arising from reliability studies. A large sample variance estimator for ICC was derived, which was then used to obtain an asymmetric confidence interval for ICC by the modified Wald method. Two sample size formulas were derived, one for achieving a prespecified confidence interval width and the other for requiring a prespecified lower confidence limit, both with given assurance probabilities. The accuracy of the formulas was evaluated using numerical studies. The utility of the formulas was assessed using example studies. Results: Closed-form formulas were obtained. Numerical study results demon- strated that these formulas are fairly accurate in a wide range of scenarios. The examples showed that the formulas are simple to use in design reliability studies with binary outcomes. Discussion: The formulas should be useful in the planning stage of a reliability study with binary outcomes in which the investigator wishes to obtain an estimate of ICC with prespecified precision in terms of width or lower limit of a confidence interval. It is no longer justified to conduct reliability studies on the basis of sub-optimal formulas that provide only 50% assurance probability.

Cerebral palsy (CP) is a complex disorder. There is a gap in the literature in classifying children with CP broadly. The purpose of this thesis was to develop holistic classification systems for children with CP. As a first step, a search was conducted to explore the strategies used to classify children with developmental co-ordination disorder and autism-spectrum disorder. Two versions of holistic classification systems named the body function index in cerebral palsy (BFI-CP) versions I and II were developed using two methods. Then, the relationship and differences among the developed classification systems and the Gross Motor Function Classification System (GMFCS) were explored. Next, differences among subsets of the classifications that did not correspond to the ordinal levels of the GMFCS were explored. Next, the relationships between the developed classification systems (BFICP- I and II) and the GMFCS and the change in outcome of motor function were explored. Exploration of the existing classification systems of childhood disorders (Chapter 2) demonstrated that none of the classification systems in CP addressed the majority of the key features in the international consensus definition of CP. The BFI-CP I was developed using a summing technique and the BFI-CP II was developed using cluster analysis. The findings demonstrated a strong correlation between the BFI-CP I and the GMFCS (r=0.92), the BFI-CP II and the GMFCS (r=0.93), and the BFI-CP I and II (r=0.92), all (pχ² = 670.49, df=16, pχ² =685.57, df=16, p

Interactions between and among first-responders and emergency department (ED) healthcare providers impact the way in which patients are managed during emergency situations. The purpose of this study was to develop a grounded theory to explain the interactions between and among first-responders and ED healthcare providers during emergency situations. Interprofessional collaboration and teamwork has been extensively studied, however little is known about interactions that include first-responders. This study was guided by Strauss and Corbin’s (1990) approach to grounded theory. Data were collected through 256 hours of first-responder and ED observational opportunities and informal interviews with accompanying detailed field notes. As well, in-depth semi-structured interviews were conducted with 15 first-responders and ED healthcare providers. Data were organized using NVivo 10 software. A constant comparative approach consistent with grounded theory was used to analyze the field notes, interview transcripts, and policy documents until theoretical saturation was achieved. The proposed theoretical model, the Interactional Theory of Emergency Response and Care (ITERC), explains the interactions between and among first-responders and ED healthcare providers. Coming together for public safety is the core category that helps to describe the social processes of interactions of first-responders and ED healthcare providers during emergency situations. The four domains or subcategories provide further explanation of the micro, meso, and macro contexts that facilitate and/or impede interactions during emergency response and care. Factors that support first-responders and ED healthcare providers in their coming together for public safety include role clarity, clear communication, IPE, shared policies, and strategies to enhance systems issues such as managing offload delays. Given the importance of interactions between and among first-responders and ED healthcare providers and the effects on public safety, the ITERC may provide a beginning blueprint to guide educators, administrators, and policy makers in planning strategies to enhance the micro, meso, and macro factors influencing emergency response and care.

Purpose To determine in a population with lower extremity wounds associated with vasculopathy if: (1) previously proposed clinical signs of infection are valid indicators of wound infection; (2) low frequency (22.5 kHz) contact ultrasound debridement (LFCUD) is well tolerated and feasible to apply in a nurse-led vascular wound clinic; (3) healing outcomes are improved for patients receiving LFCUD in comparison to patients receiving usual care (UC). Methods A total of 80 patients were in the study. First, a pilot group of ten patients were followed to determine tolerability, feasibility and wound response of 4 weekly LFCUD treatments. Then 70 patients were randomly allocated into LFCUD plus UC (n= 33), or UC (n = 37). Clinical signs of wound infection were compared to tissue culture and physician evaluation. Outcomes included mean percentage decrease in wound surface area (%WSA), change in wound appearance (revised Photographic Wound Assessment Tool [revPWAT]), and change in pre- to post-treatment pain scores by Visual Analogue Scale (VAS). Results No individual clinical sign was both highly sensitive and specific to indicate infection. The presence of three combined signs yielded the highest positive likelihood ratio (7.2), but absence of signs was uninformative. LFCUD is well tolerated and feasible for nurse-application. After 4 treatments the between-group change in %WSA was not statistically significant. The LFCUD group showed a significant linear trend in WSA reduction with each treatment visit (p = < 0.01), and a significant improvement in wound appearance for the LFCUD group (4.36 revPWAT points, 2.07-6.66, 95% CI, p = 0.01) compared to UC. There was no significant decrease in wound infections between groups. There was a significant decline in VAS pain score of 16.56mm (± 32.5, t(31) = 2.89,p = 0.007, 95% CI) in the LFCUD group but this was not significant in the UC group. There were no treatment-related adverse effects. Conclusions Clinical signs of infection are specific, but inadequately present for screening the vascular population. LFCUD is well tolerated and resulted in superior wound appearance with consistent trending of WSA reduction. It was not determined that LFCUD reduces infection, improves healing times or supports wound closure.

BACKGROUNDManagement of urinary tract infections (UTIs) is compounded by the rising rates of resistance to antimicrobials. Public Health England highlighted areas of the North West of England as having suboptimal practices in the treatment of UTIs. This project aims to evaluate the resistance in Merseyside compared to the national rates, examine resistance in urological patients, review the rates of extended spectrum β-lactamase producing (ESBL) Escherichia coli over time, as well as consider increased fluid intake in the management of UTIs.METHODSUropathogen resistance rates in Merseyside from December 2012 to February 2013 were compared to those nationally reported, with sub analysis of resistance rates in urological patients. The rate of ESBL Escherichia coli in Cheshire was reviewed.MEDLINE, EMBASE, and unpublished literature using OpenGrey and OpenDOAR, were searched since inception to February 2015. Five studies recruiting 2182 patients were included in the analyses. Statistical analysis was performed using SPSS 22 and MedCalc 15.4.RESULTSResistance rates in Merseyside were not found to be higher than the national rates. Urological patients exhibited a statistically significant higher resistance (p

Health care for individuals living with myotonic dystrophy (DM1)—an uncommon, life-limiting neurological condition for which there are few treatments—may be challenged by patients’ symptoms including cognitive and behavioral impairments. Is patient-centered care—which incorporates the values, experiences and expertise of patients and their caregivers—feasible or achievable? Uncovering patients’ and their caregivers’ experiences of living with DM1, their health care expectations, and their health care providers’ (HCP) perspectives about care is essential for examining patient-centered care in this population. Therefore, the purpose of this research is to: (1) add patients’ and caregivers’ voices to the literature, (2) explore on-going care provision for individuals with DM1, and (3) probe whether patients’ and caregivers’ needs are being met. Forty-eight participants were purposively sampled from one academic centre in Ontario, Canada to participate in three studies. Phenomenology, photovoice and grounded theory—qualitative methodologies that prioritize participants’ experiences and recognize that researchers and participants co-construct the data—were used to explore patients’, caregivers’ and HCPs’ experiences about living with — or caring for individuals—with DM1. Semi-structured interviews were the primary data collection method; focus groups and photographs were also used in the photovoice study. Data analysis varied by methodology. Patient and caregiver participants’ described that DM1 symptoms—particularly fatigue and weakness— impacted their daily activities and sense of self; however, participants were resilient and problem-solved coping strategies. Patient and caregiver participants’ motivations for clinic attendance evolved along the disease trajectory, but most participants perceived that clinic attendance had tangible benefits. HCPs described that their main role was to provide hope for patients and their families. Most importantly, this research revealed that patient, caregiver and HCP participants described clinic as a ‘safe place’ for patients and caregivers to be understood, and to be empowered to take a proactive role in health care. DM1 participants derived a therapeutic benefit from attending clinic despite providers concerns that patient-centered care was challenged by complex biopsychosocial issues. This research raises questions about whether a physician-led model is the most efficient mode of care provision, or whether other models warrant investigation.

PURPOSE: To investigate the effect of American ginseng consumption on changes in average peak torque measures of dominant leg extensors following a downhill running bout. METHODS: Ten university aged male volunteers were divided equally into two groups in this double-blind study. Both groups performed baseline tests to determine average peak torque of leg extensors. Subjects then began a 4 week supplementation period of American ginseng or placebo. They then performed a downhill treadmill run at a speed between 9.7-11.3 km/h and -12% grade. The muscle strength protocol involving the dominant leg extensors was then repeated at one, two, and three days following the downhill run. RESULTS: There was no group by time interaction effect for the isometric (p=0.182), isokinetic at 60 d/s (p=0.542), nor the isokinetic at 180 d/s (p=0.893). CONCLUSION: 4 weeks of American ginseng consumption prior to downhill running was unable to attenuate post-exercise reductions in muscle strength.

Typically considered a disease of old-age, Parkinson’s disease can affect those younger in life, i.e., before the age of 55, when it is referred to as young-onset Parkinson’s disease (YOPD). Using constructionist grounded theory, this research sought to understand how, and why, individuals with YOPD became informed about their disease over time. A total of 39 individuals, who self-identified as living with YOPD, took part in this study which was organized according to four cycles of data collection. These cycles utilized focus groups, in-depth interviews and a private online discussion board, supplemented by 14 autobiographies written by individuals living with YOPD. As the research progressed, it became apparent the process of becoming informed about YOPD was entangled within larger processes of adjusting to, and building resilience to, uncertainty resulting from the disease; this uncertainty was rooted in one’s identity and in one’s ability to function. Resulting from this uncertainty was a perception of having lost control over one’s body and one’s life. The adjustment process described by individuals was categorized according to an initial level of logical adjustment followed by a second level of emotional adjustment that continued throughout one’s experience with the disease. Health information seeking was one of several resilience strategies used by individuals with YOPD to manage the uncertainty they experienced, in an attempt to restore the control they perceived they had lost. Health information was acquired through extant and elicited sources of information, differing primarily in the degree of interaction each afforded. Early after their diagnoses, individuals sought general information related to the disease, primarily from extant sources. Over time, as one adjusted to the disease, the information sought became more specific to the difficulties experienced by each person, and were acquired primarily through elicited sources. Knowledge accumulated from sources over time was filtered through one’s bodily experience with the disease to make the knowledge more personally relevant, while also influencing subsequent information seeking. The results of this research can help health care professionals provide care to those living with YOPD, and can also help in the design of patient education programs.

Restorative environments (RE) are increasingly being explored for their potential to foster psychophysiologic restoration and promote health and well-being. However, there is a paucity of research that focuses on oncology populations. The purpose of this study was to explore whether individuals treated for cancer with chemotherapy construed natural restorative environments (NREs) differently than age- and gender-matched individuals never treated for cancer. Fifteen individuals treated for cancer with chemotherapy (11 females and 4 males; treatment group) and 15 age- and gender-matched individuals (comparison group) participated in interviews and completed repertory grids based on construing NREs. Constructs were elicited directly from participants based on 10 standard a priori elements of natural settings, as well as an eleventh ideal NRE that was generated by each participant based on their preferences. Additionally, participants rated elements according to a standard construct defined as overall restorative—overall not restorative. Repertory grid data were analyzed both ideographically and nomothetically. Idiographic analyses indicated that while variation existed in the way NREs were construed, there were important similarities that indicated individual data could be aggregated. Subsequent nomothetic analyses revealed few differences in how individuals in either group construed NREs. Overwhelmingly, an ideal NRE was described as wild or remote natural environment that included a vista and water. The degree of naturalness was ultimately found to be the most important factor in predicting the restorative potential of a given natural environment, followed by interpretations of structure and the presence of water. Given that no differences were found between groups relative to how NREs were construed, it was determined that the experience of cancer and chemotherapy did not meaningfully impact the way participants in this study construed NREs. Therefore, it is anticipated that research and practice in the RE field that primarily targets healthy populations could be translated to oncology contexts with little difficulty. Given that individuals experiencing ill-health and disability secondary to cancer may stand to benefit meaningfully from restorative experiences with nature, fostering connections with nature and the environment in these contexts should be a future area of focus in the RE field.

Objectives: Certain Canadian subpopulations observe numerous modifiable and non-modifiable risk factors for diabetes. This study compares immigrants and Aboriginals (First Nations, Inuit, and Métis) with Canada-born individuals at higher risks for diabetes, and deciphers the determinant differences between them. Methods: Pooled Canadian Community Health Survey data (2001-2010) were used. Time trends for diabetes within each subsample were calculated using individual survey year prevalence rates; diabetes diagnoses were self-reported (N=33,565). Various risk factors were also examined using logistic regression. Results: Diabetes prevalence rates significantly increased from 2001 to 2010 for each subpopulation, as well as the total sample: Canada-Born individuals (3.9% to 5.7%), Immigrants (5.0% to 8.5%), Aboriginals (5.4% to 7.4%), and Canadians overall (4.1% to 6.4%). Conclusions: All Canadians, regardless of risk, experienced and will continue to experience a rise in diabetes. Future diabetes research involving the impact of race, culture, and ethnicity in Canadian immigrants should be holistically explored.

Introduction. This study examined movements of the center of pressure (CoP) during forward gait initiation, in Parkinson disease (PD) patients and healthy controls, in a dual task paradigm with manipulations of cue expectancy. Methods. The CoP trajectory was divided into three periods and, prior to testing, subjects were given instructions as to whether they would receive the cue to initiate gait. The secondary task was a numerical recitation. Results. PD patients demonstrated significantly reduced CoP movements and greater variability in the timing of the vocalizations compared to healthy controls. Both groups demonstrated significant increases in CoP movements when uncertain and significant increases in counting cadence when dual tasking. Conclusions. PD patients constrained their CoP movements more than healthy controls, reflecting a need to control stability, and uncertainty in task timing cues reflected increases in CoP movements during gait initiation in both PD patients and healthy controls.

This research aims to understand how parents use health information (such as those developed from the Move & PLAY study) with the aid of a knowledge broker when living with and caring for young children with cerebral palsy. This research was conducted under a qualitative case study methodology and used questionnaires and in-depth interviews to collect data. Findings include the complexity of both parental use of health information and the desire to use a knowledge broker. A provisional model has been created to help describe information use of parents with young children with cerebral palsy. This provisional model is an important addition to the field of knowledge translation and childhood rehabilitation, as it has implications for the facilitation of knowledge use in the everyday lives of families with children with chronic health conditions.

Healthy adult aging is associated with sarcopenia; a loss of skeletal muscle mass known as. Major contributors to this process include functional and morphological changes in the contractile tissue and within the neuromuscular system. Currently, the relationship between muscle mass, normalized strength, structural integrity, and neuromuscular properties [such as motor unit number estimates (MUNE)], in the tibialis anterior (TA) with aging is largely unknown. Therefore, to examine this relationship we recruited twelve young (25 ± 3 years old), six old (68 ± 5 years old) and six very old (79 ± 3 years old) men. Magnetic resonance (MR) images were obtained from the entire musculature of the leg from the tibial plateau to the malleoli. Muscle cross-sectional areas (CSA) were calculated using image processing software. Strength was measured as maximal isometric voluntary dorsiflexion contraction (MVC) torque; this was then normalized to CSA. Structural integrity of the muscle was evaluated by magnetization transfer ratio (MTR) using magnetic resonance imaging (MRI). Neuromuscular measures were also collected and decomposition-enhanced spike-triggered averaging was used to collect surface and intramuscular electromyography (EMG) signals. From these data, estimates of motor unit numbers were made. Muscle CSA was less only in the very old (11.2cm2), no differences existed between the young (13.4cm2) and old (11.7cm2). Strength was ~26% lower in the old and ~24% in the very old than the young. When strength was normalized to CSA there were no differences between the groups. Very old men had ~8% lower MTR values than the young and old men, with no differences between young and old. Neuromuscular measures, specifically the combination of a decreased compound muscle action potential (CMAP) and increased surface motor unit potential (SMUP), resulted in a decrease in MUNE between young [~147 motor units (MU)] and old (~109 MUs) and also between young and very old (~80 MUs). In conclusion, muscular structure and function appear to be maintained in the older adult due to compensatory motor unit remodeling; however in the very old adult the structural integrity of the muscle becomes compromised as motor unit losses are greater resulting in the acceleration of sarcopenia.

Hearing conservation programs (HCPs) often take an atheoretical, information-based approach to reducing noise-induced hearing loss. This research assesses HCPs through a Theory of Planned Behavior lens, with the goal of understanding subjective norms in children surrounding sound exposure and hearing conservation. Twelve participants engaged in one individual, structured interview. Data analysis consisted of three concurrent activities: data reduction, data display, and conclusion drawing/verification. This research ensured trustworthiness through the criterion of neutrality, which was achieved through the incorporation of both truth value and consistency. Four major themes emerged from the analysis of interview data: (1) knowledge regarding sound exposure and hearing conservation; (2) stigmatization surrounding the use of hearing protection devices in social settings; (3) emotional responses relating to sound; and (4) situational control influencing behaviour change. The perceived subjective norms surrounding sound exposure and hearing conservation reported by participants reflect an environment inimical to healthy hearing behaviours.

While JJ was a medical student, the authors worked on a two-part study of the stories of “good death” as they were told by palliative care patients, caregivers, physicians and nurses. In this personal reflection, de Jong (JJ), now a family practitioner and Clarke (LC), an artist and educator in medicine and health care, consider the value of such “story work” in the development of key skills for a physician. While this is the experience of two individuals, the conclusions have relevance for those engaging in story work within the context of medicine, medical education and the health care community.

Although the term “female sexual dysfunction” is fairly new, the medicalization of women's sexuality is not. As early as the sixteenth century, diagnosis of nymphomania was not uncommon, and the Victorian era saw a dramatic increase in the numbers of women with this “medical condition” (Groneman 1994). A canonical 1973 review of gynecology textbooks documented the profession's reliance on cultural views of women as “frigid,” and of sex and sexual pleasure as male‐centered; the authors suggest that gynecology may be “medicine practiced on women for the benefit of men” (Scully & Bart 2003: 14). While this is an oversimplification, this statement calls attention to the material and cultural biases that inform how biomedicine treats women's sexuality. Cultural and material influences on medical knowledge dominate current literature on the medicalization of female sexual dysfunction (FSD). In the twenty‐first century the pertinent influences include consumerism, privatization of medical research, and “Viagra culture.” This paper will review both feminist critiques and sociological studies of the medicalization of sex and especially female sexual dysfunction.

Purpose: The current study examines the associations between a range of risk factors and reports of suicide attempts, and attempts requiring medical care in a nationally representative study of high school students. The goal is to examine sex differences in the risk factors that are associated with suicide attempts and attempt-related injuries requiring treatment by a health-care provider. Methods: Data from the 2007 Youth Risk Behavior Survey for students in grades 9-12 were used to assess the prevalence and risk factors for suicidal behavior as well as differences in these for boys and girls. Cross-sectional multivariate logistic regression analyses were computed to determine the most important risk factors for suicide attempts and for suicide attempts requiring medical care for the sample overall and also stratified for boys and for girls. Results: Overall, 6.9% of adolescents attempted suicide (9.3% of girls versus 4.6% of boys). Girls were more likely than boys to report a suicide attempt in the past year (Adj.OR=2.89). Among girls, sadness (Adj.OR=5.74), weapon carrying (Adj.OR=1.48), dating violence (Adj.OR=1.60), forced sex (Adj.OR=1.72), and huffing glue (Adj.OR=2.04) were significantly associated with suicide attempts. Among boys, sadness (Adj.OR=10.96), weapon carrying (Adj.OR=1.66), forced sex (Adj.OR=2.60), huffing glue (OR=1.63), hard drug use (Adj.OR=2.18), and sports involvement (Adj.OR=1.52) were significantly associated with suicide attempts. Conclusions: These findings demonstrate similarities and differences in terms of the modifiable risk factors that increase risk for suicide attempts among boys and girls. In terms of the differences between boys and girls, hard drug use and sports involvement may be important factors for suicide prevention strategies that are directed specifically towards boys, while dating violence victimization may be an important risk factor to address for girls. Overall, these findings can help guide prevention, clinical practice, and intervention strategies to prevent suicidal behaviors among adolescents. [West J Emerg Med. 2010; 11(3): 258-264.]

This inquiry into matters of heart, conducted under the shadows of pending surgery, awakens themes of boyhood, education, and marriage and prompt questions about loyalty to a deceased father, connections with immigrant grandparents, loss and rediscovery of faith, and solitude versus community. A medical narrative, the book also chronicles a span of contemporary American life. Throughout Amato's account, the consistent reminder of his upcoming bypass invites readers to reflect on their own lives and selves. This is an intelligent and witty guide to an immensely common operation that nevertheless for each patient constitutes a unique experience-a veritable rite of passage., https://docs.lib.purdue.edu/purduepress_ebooks/1001/thumbnail.jpg

The discipline of politics examines the debates, ideas and institutions that surround community organisation and collective decision making about resources. In this chapter, the contribution of politics to health studies is examined. The first part of the chapter considers how politics is defined and how this underpins the various strands of political science. It also examines some of the key concepts of political study: power, ideology, democracy, government and the state. It also explores what contribution politics has and can make to health studies. The second part considers some of the theoretical and methodological approaches within politics. It looks at political ideologies, how they offer competing definitions of politics, varied views of the social and political world, and divergent views on health and health improvement. A case study explores how recent changes in many contemporary societies, associated in particular with neo-liberal economic policies, have led to a greater emphasis on freedom through choice. Individuals are called upon to take a greater role in self-care and risk management in relation to their bodies. At the same time the development of large multi-national companies has given rise to a system of production whereby their size and dominance have provided them with an ability to structure the food market.