Megan Steeves

Discursive meaning of hope for older persons with advanced cancer and their caregivers.

Cette étude a utilisé l’approche du discours critique de van Dijik afin d’explorer le discours sociétaux actuel sur l’espoir, et d’explorer l’espoir des patients agées avec cancer terminale, leurs soignants et leurs infirmières primaires. Quarante-trois articles de presse traitant de l’espoir et de cancer ont été recueillies et analysées pour explorer comment l’espoir est socialement construite par les médias de presse. Des entrevues individuelles de face à face, qualitatives et ouvertes ont été menées avec trois triades, constitués d’un patient de cancer palliatif âgé, un conjoint, et une infirmière primaire. Le discours prédominant de l’espoir et de cancer dans les articles de presse a été considérée comme discriminatoire à raison de l’âge; il a transmit le message que le seul espoir légitime qui existe pour les personnes atteintes d’un cancer est d’espérer un remède. Ce message a causé de la confusion et de la détresse pour les patients, leurs conjoints, et leur infirmières primaires, étant donné que leurs propre discours d’espoir ont été axés sur le confort, la paix et le maintien des relations à la fin de vie.

Developing and pilot-testing a Finding Balance Intervention for older adult bereaved family caregivers: A randomized feasibility trial.

PURPOSE This study aimed to test the feasibility of a psychosocially supportive writing intervention focused on finding balance for older adult bereaved family caregivers of advanced cancer patients. METHOD The Finding Balance Intervention (FBI) was tested for feasibility, acceptability and potential influence on increasing hope, coping and balance through a multi-method pilot study employing a randomized trial design with 19 older adults with an average age of 72 years. The intervention group received the FBI and a follow up visit from an RN-RA. The control group received the FBI at a second visit. The FBI, a theory-based intervention was developed from grounded theory qualitative data, applying Delphi methods to design a self-administered, psychosocially supportive, writing intervention for older adults who had lost a spouse after caregiving. RESULTS Feasibility was assessed and specific modifications identified. The FBI was easy to use, acceptable and of benefit. The FBI offered validation of emotions and ways to discover new ideas to find balance, which may enable bereaved caregivers to move forward on a unique journey through grief. The treatment group showed a statistically significant increase in restoration-oriented coping and higher oscillation activity. CONCLUSIONS The results suggest the FBI was easy to use, acceptable and of benefit. A full scale study, with specific modifications to the design, is needed to test the effectiveness of this innovative intervention.

Home care clients in the last year of life: is material deprivation associated with service characteristics?

Objectives: To compare demographic, social, medical, and health care characteristics of home care clients in the last year of life by quintile of deprivation and examine associations between material deprivation and service characteristics. Method: This retrospective study used administrative data for 700 clients who died while receiving home care services. Outcome measures were the receipt of supportive or palliative home care. Associations were assessed using multiple logistic regression. Result: Material deprivation was not associated with either the hours of home care received or the receipt of supportive home care services. Clients with dementia or stroke, those were older than 80 years and those who were single were less likely to receive palliative care services than other groups. Discussion: Inequalities in allocation of home care services based on age, diagnosis, and marital status, but not material deprivation, suggest the need to carefully match service with need at the end of life.

Epidemiology and Effects of Substance Use in Pregnancy

Substance use during pregnancy has important implications for health care providers and policymakers and can negatively affect a womans health and the health of her children. Understanding trends, patterns of use, and outcomes are critical to developing prevention campaigns, building awareness, and providing effective care. This review critically examines the current literature on substance use in pregnancy and during the postpartum period in terms of epidemiology, risk factors, and implications. The risk factors for substance use in pregnancy, the challenges associated with reporting these cases, and the adverse effects of common substances on maternal and fetal health are discussed.

Determinants of self-perceived health for Canadians aged 40 and older and policy implications

BackgroundPerceived health status indicates people’s overall perception of their health, including both physical and psychological dimensions. The aim of this study was to examine the determinants of self-perceived health for Canadians aged 40 and older using data from the Canadian Community Health Survey (2010).MethodsMultiple logistic regression models were employed to identify factors associated with self-perceived health in two age groups: Adults aged 65+ and Adults aged 40–64.ResultsWe found that higher income was significantly associated with better health status while chronic conditions and stress were associated with worse health status. In the 40–64 and 65+ age groups, individuals in the highest income bracket were 4.65 and 1.94 times, respectively, more likely to report better health than individuals in the lowest income bracket. The difference in the level of income associated health inequities between the two age groups point to the need for understanding the reasons behind lower inequities among seniors and how much the social protections provided by the Canadian government to seniors contribute to lowering inequities.ConclusionsThough Canada has a national public health insurance system providing coverage to all Canadians, health inequities associated with income persist providing further evidence of the importance of the social determinants of health. Examining the extent of these inequities and what factors influence them helps direct policy attention. In addition to documenting inequities, this paper discusses policy options for reducing the identified inequities.

The relationship between sociodemographic factors and reporting having terminated a pregnancy among Ghanaian women: a population-based study

Background Pregnancy termination is an illegal medical procedure in Ghana and 88% of induced abortions are performed in unsafe conditions, thus recipients face an elevated risk of abortion-related complications. This study aims to explore the associations between sociodemographic factors and reporting having terminated a pregnancy among Ghanaian women. Methods Logistic regression models were estimated using data from the 2014 Ghana Demographic and Health Survey (n=9396). ORs were computed for the associations between reporting pregnancy termination and select demographic and socio-economic factors. Results Education level, employment status, financial status and marital status of women are significantly associated with reporting having terminated a pregnancy. Conclusions Women who are employed, cohabit with a partner and are considered middle class or wealthy are more likely than their counterparts to report having terminated a pregnancy. Ghanaian women with intermediate levels of education are more likely than both their more- and less-educated counterparts to report having terminated a pregnancy. These findings highlight the need for the development of policies aimed at reducing unsafe abortions associated with unintended pregnancies. Specific recommendations include providing family planning education and outreach to high-risk groups to reduce unintended pregnancies and improving working conditions for expectant mothers, including provisions for paid maternity leave and job protection.

Prevalence of Diabetes-Related Complications and Their Association with Determinants Identified in Canada's Survey on Living with Chronic Diseases—Diabetes Component (SLCDC-DM-2011)

Abstract Objective This study aims to estimate the prevalence of diabetes-related complications, and the factors associated with them in the Canadian patients with diabetes. Methods Data from the 2011 Survey on Living with Chronic Diseases in Canada – Diabetes Component (SLCDC-DM-2011) were used to calculate the weighted prevalence of 16 diabetes-related complications. A multivariable sex-stratified logistic regression model was used to examine the association between each diabetes-related complication and select determinants. Results Among Canadian patients who self-reported having diabetes, 80.26 percent reported having at least one type of diabetes-related complications. The most frequently reported complications were high blood pressure (54.65%), cataracts (29.52%) and poor circulation (21.68%).Male patients were more associated to have at least one complication if they had an inappropriate BMI (OR=2.94 CI: 1.39-6.23),and had a high level of HbA1c (OR=2.32 CI: 1.05-5.13,) were older (OR=6.92 CI: 1.82-24.74), had diabetes for a longer period of time (OR=3.42 CI: 1.71-6.85) Among female patients more duration of having diabetes is significant variable associated with complication ( OR=2.00 CI: 1.05-3.81) Conclusion This study suggests that socio-economic factors including marital status, income and education had significant associations with most types of complications. Our findings also confirmed that low levels of physical activity and high levels of HbA1c were important determinant for many diabetes–related complications.

Screening and Management of Substance Use in Pregnancy: A Review

Substance use during pregnancy has important implications for health care providers, policy makers, and can negatively impact a womans health and the health of her children. Understanding trends, patterns of use and outcomes are critical to prevention campaigns, building awareness, and providing effective care. This review will discuss the current therapeutic approaches and recommendations for screening and patient management for substance use in pregnancy and during the postpartum period, and it is geared towards any care providers who care for patients or those who may care for patients who may be at risk for substance use during pregnancy.

Protective and Risk Factors Associated With Youth Attitudes Toward Violence in Canada

Adolescents and young adults are the main perpetrators and victims of violence in almost all parts of the world. Theories of human behavior predict that the intention to behave violently is formed in part by the individual’s attitude toward violent behavior. The purpose of this study was thus to investigate factors which both promote and protect against violent youth attitudes in Toronto, Canada’s largest urban center. Multinomial logit models were fit separately for males and females in Grades 7 to 9 using cross-sectional data from the 2006 International Youth Survey. Odds ratios were estimated for the associations between levels of attitude toward violence and select factors in each of the biological, familial, peer-related, school and community domains. A graded effect of school attachment on violent attitude was observed for both sexes; male and female students who do not like school at all are 9.89 (3.15-31.0) and 6.49 (2.19-19.2) times as likely as those who like school a lot to have the “most” versus “least” violent attitude, respectively. For every one-unit increase in (negative) perception of neighborhood score, male and female students are 1.15 (1.07-1.23) and 1.20 (1.12-1.28) times as likely to have the “most” versus “least” violent attitude. The number of victimization events was associated with attitude toward violence in males but not females, while the reverse was true for academic performance and exposure to prejudice. Our findings highlight the important relationships between connections to social environments and youth attitudes toward violence, and identify modifiable factors which may be amenable to intervention. Sex-specific differences in the predictors of violent youth attitudes warrant additional investigation and have implications for policy design.