Predictors of clinical breast examination among South Asian immigrant women

To determine predictors of clinical breast examination (CBE) among South Asian immigrant women residing in Toronto, Canada. A cross-sectional self-administered survey with women patients visiting family physician group practices. Fifty-four women participated in the study (response rate 77%). Twenty women (38.5%) “ever had” CBE. Compared to women who never had CBE, women who had CBE were statistically older, had lived more years in Canada, had better knowledge of breast cancer, had lower perceived barriers to CBE, and were more likely to have ever had a periodic health exam. No significant differences were found between the two groups for education, employment, English language abilities, perceived health, and perceived benefits of CBE. A direct logistic regression with five predictor variables, significant at a univariate level, was statistically reliable, X2 (5, n=51) = 34.7, p < 0.001 and explained 67% of the variance in the CBE status. Age and perceived barriers to CBE remained significant over and above other predictor variables. The odds of 'ever had' CBE increased with age and decreased with more perceived barriers. The study highlights the need for education interventions on breast cancer and screening among SA recent immigrant women.The study results are based on preliminary data collected for a health promotion project funded by the Canadian Breast Cancer Foundation. We acknowledge contributions by Jill Cameron and Ilene Hyman who were members of the research team. Also, we thank Ms. Reena Vanza and Amena Syed for their assistance in the data collection

Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties

Women physicians and stress

Most women physicians enjoy better than average physical health and lead satisfying and productive lives. However, higher than average rates of depression, anxiety, marital problems, and substance abuse have been reported by some, but not all, authors. This quantitative survey of 196 women physicians and qualitative focus groups with 48 other women physicians was conducted to determine perceptions of their health, stress, satisfaction, knowledge, and abuse rates in medical practice. Eight specialties plus family practice physicians participated. The average age was 44.1 years (SD 8.8, range 23–77). Seventy-four percent of women physicians were married, with children. Specialists and family physicians were similar in all demographic characteristics except that family physicians were more significantly likely to be divorced, separated, or widowed (p ≤ 0.01). Specialists perceived their personal physical health to be better than that of family doctors (p ≤ 0.05), and family physicians rated their medical knowledge better than that of specialists (p ≤ 0.0001). Women physicians over age 50 or with children over age 19 reported the best mental health (p ≤ 0.0001 and 0.003, respectively). Overall, 49% of women physicians reported usually having high levels of stress, 44% felt mentally tired, and 17% took antidepressant drugs. Seventy-three percent reported verbal abuse at work (71% in the last year), and 33% reported physical assault at work (11% in the last year). Focus groups identified three major sources of stress: high expectations, multiple roles, and work environment. These results are discussed and compared with the literature. Both personal and systemic strategies are required to solve the problems identified. Women physicians can facilitate the adoption of some of these strategies by sharing information about successes, challenges, and solutions

The Silver Lining of Heart Disease: What Type of Patients Will Be More Likely to Experience It?

After successfully coping with a life threatening event, people tend to look at the brighter side of life.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

Age Differences in Barriers to Cardiac Rehabilitation

Older patients with heart disease experience more CR barriers, and the nature of their barriers differs from those of younger patients. Health care professionals should identify and address these barriers in order to optimize the benefits of CR use for elderly patients.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

Expanding Workplace Inclusion of Employees Who Are Parents of Children with Disabilities through Diversity Training

Employed parents raising children with disabilities manage exceptional care responsibilities along with their work careers. This study examines the effects of targeted diversity training on human resource (HR) professionals’ knowledge of the work–family experiences of these parents, and on their self-efficacy in providing workplace supports. Using computer-based training in field settings, 64 U.S. human resource professionals in an international company participated in two diversity training sessions. Data related to knowledge and efficacy of dependent and disability care were collected before the first training and immediately after the second. HR participants demonstrated significant increases from pretest to posttest on the trained items: knowledge of dependent and disability care and self-efficacy regarding provision of workplace supports. There was no change in relevant but untrained variables over time. Training HR professionals on parents’ exceptional care responsibilities, specific community resources, and heightened self-efficacy promoted their likelihood to grant flexible work arrangements. Results suggest HR self-efficacy is developmental, building on prior knowledge of dependent care and tenure in HR positions. This is one of the first studies that address the effects of HR diversity training regarding employees providing exceptional care. Theoretical developments and implications for inclusive practices are discussed