Descriptive epidemiology of cleft lip and cleft palate in Western Australia

BACKGROUND: Most national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues to be problematic. The issue of enrollment with a family physician is worrying in Canada, where nearly 21% of the country's population reported not having a family physician in the last Commonwealth Fund survey.To respond to this important need, centralized waiting lists have been implemented in four Canadian provinces to help 'orphan,' or unaffiliated, patients find a family physician. These organizational mechanisms are intended to better coordinate the demand for and supply of family physicians. The objectives of this study are: to assess the effects of centralized waiting lists for orphan patients (GACOs) implemented in the province of Quebec and to explain the variation among their effects by analyzing factors influencing implementation process. METHODS: This study is based on two complementary and sequential research strategies. The first (objective 1) is a quantitative longitudinal design to assess the effects of all the GACOs (n = 93) in Quebec using clinical-administrative data. The second (objective 2) involves using four case studies to explain variations in effects through in-depth analysis of the various factors contributing to the observed effects. The primary source of data will be key actors involved in the GACOs. We expect to conduct around 40 semi-structured interviews. DISCUSSION: This will be the first study in Canada to evaluate the implementation of this innovation. It will provide an exhaustive picture of the effects of GACO implementation in Quebec and to assess their potential for generalization elsewhere in Canada. At the theoretical level, this study will produce new knowledge on the factors having the greatest influence on the implementation of primary care innovations in professional environments

Evaluation of psychometric properties of the Arabic version of the Internet Disorder Scale (IDS-15)

The internet in modern society has impacted individuals of all ages, especially youth. Over the past 25 years, internet has become increasingly accessible, affordable, and available to a large proportion of individuals worldwide. Despite the clear advantages the internet has brought, adverse effects including potential disordered internet use have been noted among a minority of users. This has led to an increase in the development of screening instruments and numerous validation studies in many countries. Although Arabic is spoken in 25 countries worldwide, little research has been carried out, probably because there is a lack of Arabic instruments assessing problematic internet use. The present study evaluated the psychometric properties of the Arabic version of the 15-item Internet Disorder Scale (IDS-15). A cross-sectional study was conducted among 327 active internet users (35.5 % male; mean age = 21.49 years [SD = 3.06]) using a pen-and-paper-based survey. All participants completed the IDS-15, Bergen Social Media Addiction Scale (BSMAS), and Satisfaction with Life Scale (SWLS). The concurrent validity of the Arabic IDS-15 was satisfactory as its total score was significantly correlated with scores on the BSMAS (standardized coefficient [β] = 0.382), time spent online (β = 0.310), time spent on social media (β = 0.368), time spent on sleep (β = 0.176), and SWLS score (β = 0.281). The internal consistency indicated good internal reliability. Confirmatory factor analysis supported the factor structure of the IDS-15. The Arabic version IDS-15 is a psychometrically sound and robust instrument for assessing internet disorder due to its excellent concurrent validity, good reliability, and satisfactory construct validity

Predictors of residential stability among homeless young adults : a cohort study.

Abstract : BACKGROUND: Homelessness episodes have been shown to be associated with serious health outcomes among youth. This study was undertaken to estimate the probability of reaching residential stability over time and to identify predictors of residential stability among homeless young adults aged 18 to 25 years. METHODS: A prospective cohort study was carried out in Montréal, Canada, between April 5(th) 2006 and January 21(th) 2009. Interviews conducted every three months included questions on life conditions and social and mental health factors that are known to influence residential trajectories. Residential status was determined, starting on the first day after recruitment; each follow-up day was classified as a homeless day or a housed day. A period of 90 days was used to define residential stability; therefore the main study outcome was the occurrence of the first consecutive 90 housed days during the follow-up period. Kaplan-Meier and Cox proportional-hazards regression analyses were conducted. RESULTS: Of the 359 participants, 284 reached 90 days of residential stability over the study period, representing an annual probability of 80.5 %. In multivariate analysis, youth who had a high school degree, had a formal sector activity, and those who had sought psychological help were more likely to reach residential stability. Being a man, injecting substances, and having an informal sector activity were associated with a decreased probability to reach residential stability. CONCLUSION: Exposure to factors related to opportunities that promote social integration increases the chance of reaching residential stability. On the other hand, factors related to high level of street entrenchment seem to interfere with stabilization. Maximum efforts should be made to prevent chronic homelessness among youth, targeting not only individual impairments but also hinging on services adapted to foster social connections among the youth

Gambling Problems among Community Cocaine Users

Cocaine use is highly prevalent and a major public health problem. While some studies have reported frequent comorbidity problems among cocaine users, few studies have included evaluation of gambling problems. This study aimed to estimate the prevalence of gambling problems and compare those who were at-risk gamblers with non-problem gamblers in terms of mental health problems, substance use problems, and some risk factors (i.e. family antecedents, erroneous perceptions and coping strategies) among individuals who smoke or inject cocaine. METHOD: A total of 424 smoked or injected cocaine users recruited through community-based programs in Montreal, Quebec completed the questionnaire, including the Canadian Pathological Gambling Index, the Composite International Diagnostic Interview (CIDI), the CAGE, and the Severity Dependence Scale (SDS). RESULTS: Of the sample, 18.4 % were considered at-risk gamblers, of whom 7.8 % had problems gambling and 10.6 % were moderate-risk gamblers. The at-risk group was more likely to have experienced a recent phobic disorder and alcohol problems than the non-problem group. A multivariate analysis showed that, compared to those who were non-problem gamblers, the at-risk ones were more likely to have lost a large sum of money when they first started gambling, believed that their luck would turn, and gambled in reaction to painful life events. These results indicate the need to include routines for screening to identify gambling problem among cocaine user

Out-of-pocket costs and adherence to antihypertensive agents among older adults covered by the public drug insurance plan in Quebec

Raymond Milan,1 Helen-Maria Vasiliadis,2,3 Samantha Gontijo Guerra,1 Djamal Berbiche3 1Health Sciences Program, Faculty of Medicine and Health Sciences, Universit&eacute; de Sherbrooke, 2Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universit&eacute; de Sherbrooke, Sherbrooke, 3Charles-Le Moyne Hospital Research Center, Longueuil, QC, Canada Objective: To evaluate the effect of patient out-of-pocket costs on adherence to antihypertensive agents (AHA) in community-dwelling older adults covered by the public drug insurance plan in Quebec. Methods: This is a secondary analysis of data from the &ldquo;&Eacute;tude sur la sant&eacute; des a&icirc;n&eacute;s&rdquo; study (2005&ndash;2008) on community-dwelling older adults in Quebec aged 65 years and older (N=2,811). The final sample included 881 participants diagnosed with arterial hypertension and treated with AHA. Medication adherence was measured with the proportion of days covered over a 2-year follow-up period (&lt;80% and &ge;80%). Out-of-pocket costs for AHA, in Canadian dollars (CAD), at cohort entry were categorized as follows: $0,$0.01&ndash;$5.00,$5.01&ndash;$10.00,$10.01&ndash;$15.00 and$15.01&ndash;36.00. Multivariable logistic regression models were constructed to study adherence to AHA as a function of out-of-pocket costs while controlling for several confounders. Models were also stratified by annual household income (<15,000 CAD and &ge;$15,000 CAD). Results: In this study, 80.8$15,000 CAD, those with an out-of-pocket cost&nbsp;of 10.01–15.00 CAD were significantly less adherent to their AHA than those with no contribution (OR&nbsp;=0.175, 95% CI: 0.042&ndash;0.740). Among participants reporting an income of &ge;$15,000 CAD, those with out-of-pocket costs of$0.01&ndash;$5.00 CAD (OR =0.194; 95$5.01&ndash;$10.00 CAD (OR =0.146; 95$10.01&ndash;$15.00 CAD (OR =0.192; 95$15.01&ndash;$36.00 CAD (OR =0.160, 95$15,000 CAD. A reduction in the amount of out-of-pocket costs and yearly maximum contribution for drugs may improve adherence to treatment. Keywords: medication adherence, seniors, hypertension, out-of-pocket costs, incom

sj-doc-2-cpa-10.1177_07067437231187459 - Supplemental material for Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon

Supplemental material, sj-doc-2-cpa-10.1177_07067437231187459 for Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon by Helen-Maria Vasiliadis, Catherine Lamoureux-Lamarche, Alexandra Chapdelaine, Martin D. Provencher, Peter J. Norton, Djamal Berbiche and Pasquale Roberge in The Canadian Journal of Psychiatry</p