Search

Adherence to COVID-19 social distancing restrictions may be challenging for adolescents, especially those concerned about social status. This study examined self-perceived popularity and reputation concerns as predictors of adherence to health guidelines and the effects of self-perceived popularity on adjustment. Adolescents (n = 1,068, 14-18 years at Time 1, M[subscript age] = 16.86 years) completed three self-report surveys across 10 months during the COVID-19 pandemic. Consistent with hypotheses, greater self-perceived popularity and concerns about peer reputation predicted less adherence, controlling for COVID-19 threat. Further, greater self-perceived popularity predicted less internalizing symptoms at Time 3. Adolescents' perceptions of their popularity may simultaneously act as a public health risk and provide social protection. Results emphasize the importance of acknowledging adolescents' social pressures and concerns regarding reputations and popularity during COVID-19.

We examined the impact of adolescents' popularity motivations on their involvement in relational aggression perpetration and victimization, heavy drinking, and antiauthority behavior, while also considering the role of teens' perception of their own popularity and psychosocial adjustment. High school students (N = 986; 50% female; M[subscript age] = 14.98 years) completed a battery of self-report questionnaires survey in the fall and again, 6 months later. Regression analysis controlling for Time 1 scores confirmed that stronger motivations to achieve or maintain popularity predicted increases in relational aggression perpetration and victimization, and antiauthority behavior. Furthermore, self-reported popularity predicted increases in heavy drinking, but only when popularity motivations were high. Finally, more frequent heavy drinking predicted increases in self-reported popularity over time. Findings emphasize the potential value of addressing adolescents' popularity motivations in attempts at reducing the aforementioned negative behaviors and associated risks.

This study examined aspects of peer clique participation that mitigated victimization by peers over a school year. Participants were 1,033 children age 8-14 years (M[subscript age] = 11.81; 444 boys and 589 girls), including 128 (66 boys) victimized children. Cliques (N = 162) and clique participation were assessed by using the Social Cognitive Map, friendship and behavioral nominations, and observed clique interactions. Almost all victimized children (93%) were clique members. On average, their cliques were more mixed-gender, loosely tied, and peripheral in the peer network, and they were more marginal clique members and treated more negatively during clique interactions than were nonvictims. Variation in clique experience revealed that victimization was mitigated over the school year by greater centrality and friendship within cliques and greater clique aggression, and exacerbated by greater clique victimization and age. These findings suggest that allegiance, affection, and power may deter attacks and motivate cliquemates' defense of victims.

The purpose of the present study was to examine how peer group processes of pressure and control and individual motivations for popularity would add to, and moderate the relationship between, childhood maltreatment and risky behavior in adolescence. A total of 1558 youth (804 girls) from three high schools in Ontario, Canada (M age = 15.02 years, SD = 0.86) reported on their alcohol use, delinquent behavior, childhood experiences of physical and emotional maltreatment and neglect, peer group processes involving control and individual popularity motivations. Regression analyses showed that, beyond the significant contributions of childhood maltreatment, peer group control predicted risky alcohol use and delinquent behavior. Peer group control and popularity motivations exacerbated the negative effect of physical maltreatment on delinquent behavior. Boys' experiences of peer group control were more strongly linked to alcohol use and delinquent behavior than girls'. These results suggest that there is a significant window of opportunity during adolescence where the peer group context can exacerbate or buffer childhood experiences.

The effectiveness of the Mathematical Skills Foundation Programme at Memorial University of Newfoundland (Canada), a program that evaluates the mathematical knowledge of each student to individualize instruction, was studied with data from 304 students. Results suggest that the remedial program did not have a positive measurable effect on students in later mathematics courses. (SLD)

Background: Moral distress, the phenomenon in which an agent is constrained in acting on their ethical choice, is a reoccurring theme in the literature on nurses' experiences of end-of-life care (EOLC). Understanding moral engagement solely through a lens of moral distress can be limiting—as such, we sought to explore the diverse experiences nurses consider ethically meaningful in their palliative and EOLC practice. Purpose and Methods: This article presents an exploration and analysis of stories told to us, within an interpretive description study, by five nurses practicing in EOLC in diverse settings across Canada. Although these stories were told to us in a research context, the purpose of this theory article is to explore what these stories demonstrate about the moral engagement of nurses caring for dying patients. Findings: Our analysis suggests that while moral distress is a feature of nursing stories, so too are many other dimensions of moral experience, including resilience, responsibility, and care. Implications for Practice: Expanding how we understand nurses' moral engagement in the care of dying patients has implications for how we account for the many responsibilities that nurses shoulder in striving to provide "good" care to people at the end of life. [ABSTRACT FROM AUTHOR]

Background: Childhood maltreatment (CM) is an established risk factor for various mental and substance use disorders. This study adds to existing evidence that CM may also be a risk factor for cancer.Methods: Based on data from a sample of 9783 men and 12,132 women from the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH), this analysis explores mediated associations between cancer in adulthood and different levels of exposure to three types of CM-childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV). "Cancer" was defined as an affirmative response to either of these questions: "Do you have cancer?" or "Have you ever been diagnosed with cancer?" The potential mediators were: smoking, depression, alcohol abuse/dependence, life stress, obesity, and physical activity.Results: For women, but not men, having experienced CM was significantly associated with a cancer diagnosis in adulthood, even when effects due to age and socio-demographic characteristics were controlled. Smoking, life stress, depression, and alcohol abuse/dependence reduced the strength of the association between CM and cancer in women. However, most associations remained statistically significant when controlling for effects due to these behavioural and other mediators. Evidence indicated a "dose-response" relationship, in that the likelihood of reporting cancer increased with the number of abuse types (CPA, CSA, CEIPV) reported, and with the severity of CPA.Conclusions: The analyses suggest an association between CM and cancer in women, even when the effects of known risk factors were taken into account. The association was graded, becoming stronger as CM exposure increased. Implications for the provision of cancer screening and other health care services to women with histories of CM to reduce health disparities are discussed. [ABSTRACT FROM AUTHOR]

Objective: To provide evidence of trends in child sexual abuse (CSA) in Canada.Methods: Using data from 15,801 males and 18,669 females who responded to the 2014 General Social Survey (GSS), we compared the prevalence of CSA by age cohorts. Age cohort patterns were examined for several sub-populations including males, females, Indigenous peoples, and people living in low-income households.Results: After an increase in the post-World War II period, there has been a decline in CSA in Canada since the early 1990s. Findings indicate a decline for both sexes; although, the evidence is more compelling for females. There is also evidence of a decline for Indigenous peoples, for those living in low-income households, and regardless of the relationship to the perpetrator (i.e., family member, a teacher/professor/tutor, a babysitter, a nanny, other non-family member but known to the respondent, or a stranger).Conclusions: In Canada, evidence from 3 retrospective population surveys suggests a decline in CSA since the early 1990s. However, given the associated harm, continued progress to the eradication of CSA is essential. [ABSTRACT FROM AUTHOR]

Background: It is well established that childhood maltreatment (CM) is a risk factor for various mental and substance use disorders. To date, however, little research has focused on the possible long-term physical consequences of CM. Diabetes is a chronic disease, for which an association with CM has been postulated.Methods: Based on data from a sample of 21,878 men and women from the 2012 Canadian Community Health Survey - Mental Health (CCHS - MH), this study examines associations between three types of CM (childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV)) and diabetes in adulthood. Multiple logistic regression models were used to examine associations between CM and diabetes controlling for the effects of socio-demographic characteristics and risk factors for type 2 diabetes.Results: When controlling socio-demographic characteristics, diabetes was significantly associated with reports of severe and frequent CPA (OR = 1.8) and severe and frequent CSA (OR = 2.2). A dose-response relationship was observed when co-occurrence of CSA and CPA was considered with the strongest association with diabetes being observed when both severe and frequent CSA and CPA were reported (OR = 2.6). Controlling for type 2 diabetes risk factors attenuated associations particularly for CPA. CEIPV was not significantly associated with having diabetes in adulthood.Conclusion: CPA and CSA are risk factors for diabetes. For the most part, associations between CPA and diabetes are mediated via risk factors for type 2 diabetes. Failure to consider severity and frequency of abuse may limit our understanding of the importance of CM as a risk factor for diabetes. [ABSTRACT FROM AUTHOR]

Background: The current breastfeeding initiation rate in Canada is approximately 87%. By one month, about 21% of women have stopped breastfeeding. Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. The aims of this pilot research study were to explore the relationship between intrapartum intravenous fluids given to mothers and postpartum breast swelling in the first 10 days postpartum and to determine if a larger study was warranted and feasible. Methods: A prospective, longitudinal, observational cohort pilot study with repeated measures and a within-subjects design was completed. Participants were first time mothers who have a single, healthy newborn and had a spontaneous vaginal birth. Daily data collection from admission into the study until postpartum day 10 took place. Descriptive statistics are reported and linear regression analysis was used to model the relationship between IV therapy and postpartum breast edema. Results: Women who received intravenous fluids during labour had higher levels of breast edema postpartum and rated their breasts as firmer and more tender than women who did not receive intravenous fluids. Participants who had intravenous fluids described patterns of fullness that appeared to be related to edema as opposed to fullness associated with engorgement and lactogenesis II. Conclusions: The findings demonstrate that mothers in this pilot study who received intravenous fluids in labour and postpartum had higher levels of breast edema. These results suggest a larger study is warranted to more fully examine the effects of intravenous fluids on postpartum breast swelling. [ABSTRACT FROM AUTHOR]

Previous studies have suggested that high-fat diets adversely affect bone development. However, these studies included other dietary manipulations, including low calcium, folic acid, and fibre, and (or) high sucrose or cholesterol, and did not directly compare several common sources of dietary fat. Thus, the overall objective of this study was to investigate the effect of high-fat diets that differ in fat quality, representing diets high in saturated fatty acids (SFA), n-3 polyunsaturated fatty acids (PUFA), or n-6 PUFA, on femur bone mineral density (BMD), strength, and fatty acid composition. Forty-day-old male Sprague-Dawley rats were maintained for 65 days on high-fat diets (20% by weight), containing coconut oil (SFA; n = 10), flaxseed oil (n-3 PUFA; n = 10), or safflower oil (n-6 PUFA; n = 11). Chow-fed rats (n = 10), at 105 days of age, were included to represent animals on a control diet. Rats fed high-fat diets had higher body weights than the chow-fed rats (p < 0.001). Among all high-fat groups, there were no differences in femur BMD (p > 0.05) or biomechanical strength properties (p > 0.05). Femurs of groups fed either the high n-3 or high n-6 PUFA diets were stronger (as measured by peak load) than those of the chow-fed group, after adjustment for significant differences in body weight (p = 0.001). As expected, the femur fatty acid profile reflected the fatty acid composition of the diet consumed. These results suggest that high-fat diets, containing high levels of PUFA in the form of flaxseed or safflower oil, have a positive effect on bone strength when fed to male rats 6 to 15 weeks of age. D'après des études, un régime riche en gras entraînent des effets néfastes sur la croissance osseuse. Cependant, ces études incluent d'autres manipulations diététiques comme un faible apport de calcium, d'acide folique, de fibres et des taux élevés de sucrose ou de cholestérol; de plus, ces études ne comparent pas les sources communes de gras alimentaires. Cette étude se propose donc d'analyser les effets de régimes riches en gras différant selon la qualité des gras, soit des régimes riches en acides gras saturés (SFA) soit en acides gras polyinsaturés n-3 ou n-6 (PUFA) sur la densité minérale osseuse du fémur (BMD), la force des os et sur la composition des acides gras. Sur une période de 65 jours, on donne à des rats Sprague-Dawley âgés de 40 jours un régime riche en gras (20 % par ration) contenant de l'huile de coco (SFA; n = 10), de l'huile de lin (n-3 PUFA; n = 10) ou de l'huile de carthame (n-6 PUFA; n = 11). Pour constituer le groupe de contrôle, on ajoute 10 rats âgés de 105 jours et dont le régime est normal. Les rats au régime riche en gras présentent une masse corporelle plus importante que les rats au régime normal (p < 0,001). D'un groupe à l'autre, on n'observe aucune différence de densité minérale osseuse du fémur (p > 0,05) et des propriétés mécaniques des os (p > 0,05). Les fémurs des groupes nourris au n-3 ou n-6 PUFA sont plus forts (mesurée par la charge maximale) que les groupes recevant un régime normal, et ce, après ajustement pour les différences significatives de masse corporelle (p = 0,001). Tel qu'anticipé, le contenu fémoral en acides gras reflète la composition du régime imposé. D'après ces observations, un régime riche en gras et contenant un fort taux de PUFA provenant de l'huile de lin ou de carthame a un effet favorable sur la force des os des rats profitant de cet apport entre la 6e et la 15e semaine de croissance. [ABSTRACT FROM AUTHOR]

Helps physicians and patients arrive at optimal strategies for breast radiotherapy after breast-conserving surgery (BCS) for early breast cancer. Outcomes; Evidence; Benefits; Harms; Recommendations.

Background: MOREOB (Managing Obstetrical Risk Efficiently) is a patient safety program for health care providers and administrators in hospital obstetric units. MOREOB has been implemented widely in Canada and gradually spread to the United States. The main goal of MOREOB is to build a patient safety culture and improve clinical outcomes. In 2013, 26 Ontario hospitals voluntarily accepted provincial funding to participate in MOREOB. The purpose of our study was to assess the effect of MOREOB on participant knowledge, organizational culture, and experiences implementing and participating in the program at these 26 Ontario hospitals.Methods: A convergent parallel mixed-methods study in Ontario, Canada, with MOREOB participants from 26 hospitals. The quantitative component used a descriptive pre-post repeated measures design to assess participant knowledge and perception of culture, administered pre-MOREOB and after each of the three MOREOB modules. Changes in mean scores were assessed using mixed-effects regression. The qualitative component used a qualitative descriptive design with individual semi-structured interviews. We used content analysis to code, categorize, and thematically describe data. A convergent parallel design was used to triangulate findings from data sources.Results: 308 participants completed the knowledge test, and 329 completed the culture assessment at all four time points. Between baseline and post-Module 3, statistically significant increases on both scores were observed, with an increase of 7.9% (95% CI: 7.1 to 8.8) on the knowledge test and an increase of 0.45 (on a scale of 1-5, 95% CI: 0.38 to 0.52) on the culture assessment. Interview participants (n = 15) described improvements in knowledge, interprofessional communication, ability to provide safe care, and confidence in skills. Facilitators and barriers to program implementation and sustainability were identified.Conclusions: Participants were satisfied with their participation in the MOREOB program and perceived that it increased health care provider knowledge and confidence, improved safety for patients, and improved communication between team members. Additionally, mean scores on knowledge tests for obstetric content and culture assessment improved. The MOREOB program can help organizations and individuals improve care by concentrating on the human and organizational aspects of patient safety. Further work to improve program implementation and sustainability is required. [ABSTRACT FROM AUTHOR]

The article presents author's views on an important Canadian and global health challenge, child maltreatment. He mentions that child maltreatment depends on collaboration with provinces, territories and other federal departments. He also talks about National Child Maltreatment Surveillance which acquiring, analyzing and interpreting data and information from multiple sources across different systems.

Glycerol phenylbutyrate (GPB) is currently approved for use in the US and Europe for patients of all ages with urea cycle disorders (UCD) who cannot be managed with protein restriction and/or amino acid supplementation alone. Currently available data on GPB is limited to 12 months exposure. Here, we present long-term experience with GPB. This was an open-label, long-term safety study of GPB conducted in the US (17 sites) and Canada (1 site) monitoring the use of GPB in UCD patients who had previously completed 12 months of treatment in the previous safety extension studies. Ninety patients completed the previous studies with 88 of these continuing into the long-term evaluation. The duration of therapy was open ended until GPB was commercially available. The primary endpoint was the rate of adverse events (AEs). Secondary endpoints were venous ammonia levels, number and causes of hyperammonemic crises (HACs) and neuropsychological testing. A total of 45 pediatric patients between the ages of 1 to 17 years (median 7 years) and 43 adult patients between the ages of 19 and 61 years (median 30 years) were enrolled. The treatment emergent adverse events (TEAE) reported in ≥10% of adult or pediatric patients were consistent with the TEAEs reported in the previous safety extension studies with no increase in the overall incidence of TEAEs and no new TEAEs that indicated a new safety signal. Mean ammonia levels remained stable and below the adult upper limit of normal (<35 µmol/L) through 24 months of treatment in both the pediatric and adult population. Over time, glutamine levels decreased in the overall population. The mean annualized rate of HACs (0.29) established in the previously reported 12-month follow-up study was maintained with continued GPB exposure. Following the completion of 12-month follow-up studies with GPB treatment, UCD patients were followed for an additional median of 1.85 (range 0 to 5.86) years in the present study with continued maintenance of ammonia control, similar rates of adverse events, and no new adverse events identified. [ABSTRACT FROM AUTHOR]

The outbreak of the COVID-19 virus dramatically changed daily life and created many obstacles for adolescents to engage in physical activity (PA). This study tracked rates of self-reported PA and examined its impact on adjustment among adolescents during the first 14 months of the pandemic. Canadian adolescents (N = 1068, 14-18 y, meanage = 16.95 y) reported on their frequency of PA, context of activity, and adjustment across 4 time points (April 2020 to June 2021). In line with our hypothesis, higher average levels of vigorous PA across the pandemic predicted less anxiety and depression and higher self-esteem at our study's end. Vigorous PA also buffered the relationships COVID-19 stress had with anxiety and self-esteem. The results further support recommendations for PA throughout the pandemic and while dealing with lockdown situations.

Objective: To establish whether there is a relationship between the frequency and severity of different types of childhood maltreatment and adulthood arthritis., Methods: Analysis of the 2012 Canadian Community Health Survey-Mental Health included 21,889 respondents ages ≥18 years. Severity and frequency of childhood physical abuse (CPA), and childhood sexual abuse (CSA), and the frequency of childhood exposure to intimate partner violence (CEIPV) were assessed by asking about "things that may have happened to you before you were 16 in your school, in your neighborhood, or in your family." Respondents were also asked about chronic conditions diagnosed by a health professional, including arthritis. Covariates were sociodemographic characteristics, health risk variables (e.g., obesity), mental disorders, and a count of other chronic conditions. Multivariate logistic regression analysis was used to examine associations between childhood maltreatment and arthritis., Results: A total of 17.5% of respondents reported arthritis. A higher prevalence of arthritis was observed for those who had experienced severe and/or frequent childhood maltreatment (32% for CPA and 27% for both CSA and CEIPV). These relationships persisted after controlling for sociodemographic variables. After controlling for all covariates, arthritis remained independently associated with severe and/or frequent CPA (dose-response relationship) and frequent CEIPV., Conclusion: We found that the greater the frequency and severity of childhood maltreatment, the greater the magnitude of association with arthritis. This might reflect the role of the enduring immune and metabolic abnormalities and chronic inflammation associated with childhood maltreatment in the etiopathogensis of osteoarthritis (OA) or be an indicator of the role of joint injury in causing OA., (© 2018, American College of Rheumatology.)

This Horizons is part of a series that identifies key, forward-thinking research questions and challenges that need to be addressed. Specifically, this Horizons paper discusses research in nutritional supplements and nutraceuticals for health, physical activity, and performance, and is the product of a discussion by an expert panel that took place in January 2018 prior to the Canadian Nutrition Society Thematic Conference "Advances in Sport Nutrition from Daily Living to High Performance Sport". The objective of this Horizons paper was to identify core considerations for future studies for this research area, and how scientists can be leaders in the field to ensure the best quality science is available for decision makers. It is strongly recommended that the various elements highlighted throughout this Horizons paper will increase the awareness of the significant before-, during-, and after-research due-diligence required to produce research of the highest quality. While it is recognized that many scientists will not be able to meet all of these aspects, it is nonetheless important to consider the points outlined and to recognize that those elements that are not met in studies may be significant limitations. Highlights Research questions that are hypothesis-driven are the strongest, and when combined with careful planning of the study, the result will often be of the best quality. Studies with a strong experimental design help discern between evidence-based findings and those that have not been substantiated.

Background and Purpose: The Edinburgh Postnatal Depression Scale (EPDS) was created specifically to screen for perinatal depression. The purpose of this study was to assess the psychometric properties of the EPDS for use in a population of pregnant and postpartum 14- to 24-year-olds in Canada., Methods: The Standards for Educational and Psychological Testing was used as the psychometric framework to assess the validity, reliability, and acceptability of responses obtained using the EPDS with pregnant and postpartum adolescents and young adults., Results: There were 102 young women who were surveyed. Principal component analysis supported the EPDS as a 2-dimensional instrument. Test scores also showed the EPDS to be reliable and acceptable., Conclusions: The EPDS was found to be a psychometrically sound tool for use in this population of young childbearing women.

Importance: African American men have the highest rates of prostate cancer incidence and mortality in the United States. Understanding underlying reasons for this disparity could identify preventive interventions important to African American men., Objective: To determine whether the association of obesity with prostate cancer risk differs between African American and non-Hispanic white men and whether obesity modifies the excess risk associated with African American race., Design, Setting, and Participants: Prospective study of 3398 African American and 22,673 non-Hispanic white men who participated in the Selenium and Vitamin E Cancer Prevention Trial (2001-2011) with present analyses completed in 2014., Main Outcomes and Measures: Total, low-grade (Gleason score <7), and high-grade (Gleason score ≥7) prostate cancer incidence., Results: With a median (interquartile range) follow-up of 5.6 (1.8) years, there were 270, 148, and 88 cases of total, low-, and high-grade prostate cancers among African American men and a corresponding 1453, 898, and 441 cases in non-Hispanic white men, respectively. Although not associated with risk among non-Hispanic white men, BMI was positively associated with an increase in risk among African American men (BMI, <25 vs ≥35: hazard ratio [HR], 1.49 [95% CI, 0.95, 2.34]; P for trend = .03). Consequently, the risk associated with African American race increased from 28% (HR, 1.28 [95% CI, 0.91-1.80]) among men with BMI less than 25 to 103% (HR, 2.03 [95% CI, 1.38-2.98]) among African American men with BMI at least 35 (P for trend = .03). Body mass index was inversely associated with low-grade prostate cancer risk within non-Hispanic white men (BMI, <25 vs ≥35: HR, 0.80 [95% CI, 0.58-1.09]; P for trend = .02) but positively associated with risk within African American men (BMI, <25 vs ≥35: HR, 2.22 [95% CI, 1.17-4.21]; P for trend = .05). Body mass index was positively associated with risk of high-grade prostate cancer in both non-Hispanic white men (BMI, <25 vs ≥35: HR, 1.33 [95% CI, 0.90-1.97]; P for trend = .01) and African American men, although the increase may be larger within African American men, albeit the racial interaction was not statistically significant (BMI, <25 vs ≥35: HR, 1.81 [95% CI, 0.79-4.11]; P for trend = .02)., Conclusions and Relevance: Obesity is more strongly associated with increased prostate cancer risk among African American than non-Hispanic white men and reducing obesity among African American men could reduce the racial disparity in cancer incidence. Additional research is needed to elucidate the mechanisms underlying the differential effects of obesity in African American and non-Hispanic white men.

Objective: To determine whether hospital-based perinatal nurses with expertise in adolescent mother-friendly care identify a need to improve inpatient nursing care of adolescent mothers and how well perinatal units support nurses' capacity to provide adolescent mother-friendly care., Design/setting/participants: A key informant survey of nurses from eight perinatal units at three hospitals (four separate sites) in a Canadian city., Methods: Perinatal nurses expert in the care of adolescent mothers were identified by their managers and colleagues. These nurses and all perinatal clinical educators were invited to participate. Twenty-seven of 34 potential key informants completed the survey., Results: Key informants rated their own skill in caring for adolescent mothers higher (median 8.0) than they rated the skill of other nurses (median 6.0) on their units. They attributed their expertise working with adolescent mothers to their clinical and life experiences and their ability to develop rapport with adolescents. A common reason for the assigned lower peer-group ratings was the judgmental manner in which some nurses care for adolescent mothers. Key informants also identified that hospital-based perinatal nurses lack adequate knowledge of community-based resources for adolescent mothers, educational programs related to adolescent mother-friendly care were insufficient, and policies to inform the nursing care of adolescent mothers were not available or known to them., Conclusion: A minority of perinatal nurses have expertise in adolescent mother-friendly care. There is a need for perinatal unit-level interventions to support the development of nurses' skills in caring for adolescent mothers and their knowledge of community-based resources. Peer mentoring and self-reflective practice are promising strategies., (© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Purpose: To examine five types of child maltreatment and other risk correlates to establish associations with anxiety and/or depression confirmed or suspected in children investigated by child welfare services., Methods: The present study used the data of a subsample of 10-15-year-olds (n = 4,381) investigated by child welfare services across Canada obtained from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003. The analysis took into account the nested structure of the data by considering the variability existing among families and the clustering of siblings within them. Several models were analyzed for the construction of the presented hierarchical model. Striving for parsimony, we included only statistically significant variables in the final model., Results: The strongest associations were found with child substance abuse, substantiated emotional maltreatment, primary caregiver's mental health problems, and substantiated sexual abuse. Among the child maltreatment variables, substantiated physical abuse and substantiated exposure to domestic violence did not show any statistically significant associations with anxiety and/or depression in the model., Conclusion: This analysis helped us in understanding child maltreatment and other adverse experiences in childhood that were related to anxiety and/or depression, which can further aid in the development of mental health and child welfare policies and programs., (Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the determinants of nurses' intentions to practice continuous labor support., Design: A descriptive survey based on the Theory of Planned Behavior., Setting: A large, urban Canadian hospital with 2 sites and 7,000 births per year., Participants: Ninety-seven registered nurses from 2 birthing units., Results: Scores measuring nurses' attitudes, subjective norms, and intentions regarding continuous labor support for women with epidural analgesia were significantly lower than those for women without epidural analgesia (p<.0001). Multiple regression analyses revealed that previous labor support courses, subjective norms, and perceived behavioral control explained 55% of the variance in nurses' intentions to provide continuous labor support to women without epidural analgesia while 88% of the variance in intentions to provide continuous labor support to women with epidural analgesia was explained by subjective norms and attitudes. Subjective norms made the most significant contribution to the variance in nurses' intentions to provide continuous labor support. Top perceived organizational barriers to continuous labor support included unit acuity and method of patient assignment., Conclusion: Nurses' intentions to provide continuous labor support are lower for women receiving epidural analgesia and are influenced by the perceived social pressures on their unit. Nurses view organizational barriers as important factors influencing their ability to provide continuous labor support.

Objective: To describe care provider attitudes towards multidisciplinary collaborative maternity care in Canada and the factors influencing such care from the perspective of members of national professional associations of care providers., Methods: A qualitative descriptive approach was used. Leaders of national associations nominated key members, who were invited to participate in semi-structured telephone interviews., Results: Twenty-five participants from six national care provider associations (family physicians, obstetricians, registered midwives, registered nurses, nurse practitioners, and rural physicians) were interviewed. Participants described at least one of two main benefits of collaborative maternity care: a partial solution to the human resources shortage in maternity care, and improved maternity care for women. Despite their belief that collaboration is needed, participants expressed concern about the effects of collaboration on their practice. In particular, some participants were concerned about how collaborative models could support woman-centred care or respond to local community needs and promote continuity of care. Significant barriers to collaboration include structural factors (fee structure, liability issues) and interdisciplinary rivalry between groups of providers (turf protection, lack of mutual respect). Strategies to promote collaboration that were supported by the participants include strong national leadership and interdisciplinary education., Conclusion: Representatives of professional associations of care providers believe that multidisciplinary collaborative maternity care is needed to sustain the availability of care providers and to improve access and women's choices for maternity care in Canada. However, they perceive that strong leadership and education are needed to address significant structural and relational barriers to collaborative practice.

Reliable national child maltreatment data are needed for developing and modifying policies aimed at preventing child maltreatment and helping child victims of maltreatment. Health Canada hosted a daylong forum in 2002 to solicit feedback from senior Government of Canada policy and program officials involved in child welfare programs and research in regard to the data collected in the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). This article reviews the discussions and debates regarding the utility of the CIS data for government policy makers and reflects on the implications for surveillance and knowledge in the area of child maltreatment. The key themes are definitions and measurement issues, the value of enhanced and additional data, and challenges to linking research and practice.