Carl D'Arcy

Letter and category fluency in community-dwelling Canadian seniors: a comparison of normal participants to those with dementia of the Alzheimer or vascular type.

Measures of letter (FAS) and category (Animal Naming) fluency were completed by community-dwelling, cognitively normal seniors (n = 635), and by individuals diagnosed with dementia of the Alzheimer type (DAT) (n = 155), or with vascular dementia (n = 39). Among normal seniors, category, but not letter fluency, declined with age, females performed better than males on letter but not on category fluency, and performance increased with education on both tasks. Among participants with DAT, letter fluency was influenced by level of education, whereas category fluency was education-, age-, and gender-invariant. Both measures differentiated normal seniors from those with dementia. Category fluency was more impaired than letter fluency at both mild and moderate stages of dementia, but neither task differentiated DAT from vascular dementia.

Rural families caring for a relative with dementia: barriers to use of formal services

Planning for the care of increasing numbers of elderly persons with dementia has become an urgent health services concern in Canada and elsewhere, yet little is known about the challenges of providing appropriate dementia care in rural areas. A community-based approach was used to obtain input from decision-makers and others to develop the objectives and design for a study of rural dementia care in the province of Saskatchewan, Canada. The resulting study design, which used both qualitative and quantitative methods, was then pilot tested in one rural health district (16,000 km2, population 20,000). This paper describes the study development process and reports selected findings from focus groups conducted with home care staff and family members, focussing on the theme of low use of formal supportive services such as home care and support groups by family caregivers. Participants identified eight barriers to the use of formal services, described consequences of low service use, and suggested strategies for addressing this concern.

Job strain among staff of rural nursing homes: A comparison of nurses, aides, and activity workers

Caring for growing numbers of residents with Alzheimer’s disease and related dementias increases the potential for stress among nursing home staff. To better understand occupational stress among caregivers in rural nursing homes, the authors studied differences in job strain among registered nurses, nursing aides, and activity workers. The authors discuss data from their survey questionnaires and focus group interviews with staff, providing insight into job strain and possible intervention strategies to improve the work environment.

A controlled trial of cognitive behavioral treatment of panic in alcoholic inpatients with comorbid panic disorder

Patients entering a 4-week inpatient alcoholism treatment program were screened for anxiety symptoms. Those with panic disorder with or without agoraphobia were randomly assigned to two groups. The treatment group received 12 hours of cognitive-behavioral treatment (CBT) for panic disorder in addition to the regular alcoholism treatment program: the control group received the regular program. Dropouts from the treatment group were also followed. Problem drinking and anxiety symptoms were measured at the start of the study, and at 3, 6, and 12 months posttreatment. Abstinence from drinking, and anxiety and mood symptoms improved after treatment in all of the groups; there were few differences in outcome between the groups. We concluded that this particular intervention had not been more effective than the regular alcohol treatment program in reducing problem drinking in those with panic disorder.

Assessing the validity of diagnostic information in administrative health care utilization data: experience in Saskatchewan.

Administrative health care utilization databases have been promoted as resources for pharmacoepidemiologic research for several years, but the validity of the diagnostic data in many systems has not been thoroughly investigated. This work outlines issues in assessing the validity of diagnostic information from a broad perspective, using results from the datafiles of the province of Saskatchewan to illustrate them and, where possible, contrasting them with findings from other databases. An evaluation of the validity of health care utilization data should be more than a simple check of coding and data entry errors. Comparisons of data records with information external to the computer system, an examination of the internal consistency of the data (especially in systems consisting of several data sources) and, where practicable, an assessment of the cohesiveness of the data within the context of current medical knowledge should be performed on a broad range of diagnoses and procedures. Careful consideration should also be given to the generalizability of results from the database. Summaries of such evaluations for all databases used for population‐health research purposes should be widely disseminated. We caution researchers to continue to seek ways to validate their results in each use of these databases. Copyright

Perceived Job Attributes, Job Satisfaction, and Psychological Distress: A Comparison of Working Men and Women

This paper evaluates the importance of perceived job attributes in accounting for previously observed sex differences in job satisfaction and psychological distress. This study sample consisted of 854 males and 272 females who were working full time. The results indicated that male ratings of job satisfaction were equivalent to those of females, while women scored higher than men on a measure of psychological distress. However, when job attribute perceptions were held constant, female job satisfaction was significantly higher than that of males and there were no sex differences in levels of psychololgical distress. Only marginally significant sex-by-job attribute interactions were found for job satisfaction and psychological distress, suggesting similar bases of satisfaction and mental health across sex. The results are discussed in terms of female expectations regarding employment and the importance of role-related stress in accounting for sex differences in psychological morbidity.

Social support and mental health: Direct, protective and compensatory effects☆

This study deals with the relationship between social support and mental health. This relationship was conceptualized as a multi-faceted one which may be understood in terms of direct (main), protective (buffering) and compensatory effects. Hypotheses relating to these effects were evaluated in terms of spousal/community support and job strains (pressure, autonomy, opportunities) among a sample of 455 married males who were employed on a full-time basis. Results indicated that spousal support generally had more important implications for psychological well-being than did community support. However, the relative impact of these different sources of support appeared to be related to the degree to which the mental health symptomology reported was affectively defined. With respect to protective effects, spousal support was found to moderate the relationship between certain job strains (pressure) and mental health. No protective effects were found for community support. Tests of the hypothesis that community support compensates for low levels of spousal support were made in terms of both direct and protective effects. No direct effect compensation was observed. However, protective effect compensation was observed for certain job strains (opportunities) and was relevant to a wide range of symptomology. The overall results suggest a primary/secondary hierarchy of supports and strains in which primary supports (e.g. spousal) assume a protective function with respect to secondary strains (e.g. job) while secondary supports (e.g. community) do not protect individuals from primary strains (e.g. spousal). Secondary supports have a protective function for secondary strains in the absence of primary supports. It is further suggested that sex roles may be important determinants of the availability and use of different support sources.

Registered nurses working alone in rural and remote Canada.

This paper describes the demographics of Registered Nurses (RNs) who work alone in rural and remote Canada, their workplaces, and the benefits and challenges of this unique nursing employment situation. Data presented are from a national survey, one of 4 principal approaches used in conducting the project The Nature of Nursing Practice in Rural and Remote Canada. Of the total survey sample, 412 nurses (11.5%) were employed as the only RN in their work setting. Variables of interest included level of education, employment setting, and regional distribution of workplaces. An exploration of predictors of work satisfaction confirmed previous research findings with respect to the importance of continuing education and face-to-face contact with colleagues. Findings from this analysis may inform policy decisions regarding the employment of RNs in rural and remote Canada.

Sex differences in the utilization of health services for psychiatric problems in Saskatchewan.

Comprehensive data on all pscyhiatric patients in Saskatchewan show that women are substantially higher users of health services for psychiatric problems than are men. Women: 1) use up to twice as many services as men in the private sector, but use almost the same number of public sector services; 2) tend to be treated for psychosomatic and neurotic disorders on an outpatient basis; 3) have only a slightly greater chance than men of being hospitalized; and 4) are less likely than men to have organic or addictive diagnoses. These differentials in utilization cannot be explained by age, diagnoses and/or marital status. Sex is the best predictor of utilization. These results are largely consistent with utilization and epidemiological literature. It seems more likely that these sex differences in utilization result from the interaction of biology, sex roles, and the functioning and labelling processes of the health system rather than from any single factor. Combining Andersens components of health behaviour with Freidsons lay-professional construction of illness continuum yields a possible framework for understanding sex differences in the utilization of psychiatric health services.

Common and unique risk factors and comorbidity for 12-month mood and anxiety disorders among Canadians.

Objective: To explore the common and unique risk factors for mood and anxiety disorders. What sociodemographic, psychological, and physical risk factors are associated with mood and anxiety disorders and their comorbidities? What is the impact of multiple risk factors? Method: Data from the Canadian Community Health Survey: Mental Health and Well-Being were analyzed. Appropriate sampling weights and bootstrap variance estimation were employed. Multiple logistic regression was used to estimate odds ratios and confidence intervals. Results: The annual prevalence of any mood disorder was 5.2%, and of any anxiety disorder 4.7%. Major depressive episode was the most prevalent mood and anxiety disorder (4.8%), followed by social phobia, panic disorder, mania, and agoraphobia. Among people with mood and anxiety disorders, 22.4% had 2 or more disorders. Risk factors common to mood and anxiety disorders were being young, having lower household income, being unmarried, experiencing greater stress, having poorer mental health, and having a medical condition. Unique risk factors were found: major depressive episode and social phobia were associated with being born in Canada; panic disorder was associated with being Caucasian; lower education was associated with panic and agoraphobia; and poor physical health was associated with mania and agoraphobia. People who were young, unmarried, not fully employed, and had a medical condition, greater stress, poorer self-rated mental health, and dissatisfaction with life, were more likely to have a comorbid mood and (or) anxiety disorder. As the number of common risk factors increases, the probability of having mood and anxiety disorders also increases. Conclusions: Common and unique risk factors exist for mood and anxiety disorders. Risk factors are additive in increasing the likelihood of disease.