Arab female and male perceptions of factors facilitating and inhibiting their physical activity: Findings from a qualitative study in the Middle East

Objectives: Physical inactivity is a leading global risk to health by contributing to obesity and other chronic diseases. Many chronic non-communicable diseases, such as cancer, diabetes, and cardiovascular diseases (CVDs), can be prevented and controlled by modifying lifestyle behaviors such as physical activity [PA]. However, prevalence of insufficient physical activity and obesity is high in the Middle East Region. In Qatar, the incidence rates of CVDs, diabetes, colon, and breast cancer have been rising rapidly. The purpose of this study was to explore facilitators and barriers influencing PA of adult Arab men and women living in Qatar and to understand what they think would be helpful to increase PA. The goal of the research is to identify culturally appropriate and effective interventions that improve the health of Arab population. Design: Using the socioecological model as the theoretical framework, we conducted an exploratory qualitative study with 128 Arab adult men and women living in Qatar. We utilized focus group interviews to collect the data and performed thematic analysis to generate themes. Results: At the individual level, perceived benefits of PA, presence of diseases, person’s will, motivation and goals, and time to exercise influenced the individual’s PA. At the sociocultural level, religious teachings of Islam, cultural, attitude, beliefs, and practices, and informal support influenced the participants’ PA. At the organizational and political level, physical environment to exercise, accessibility of facilities, organizational support, and health information about PA influenced their PA. Conclusion: Arab men and women are aware of the importance and benefits of PA. They have the motivation to be physically active, but in the absence of supportive environment, their knowledge might not translate into action. Creating supportive environments at multiple levels that are conducive to PA is warranted

Enhancing Employees’ Health and Well-being: Developing a Successful Holistic Wellness Challenge

Improving the overall health and wellness of employees is an important focus of many organizations. Healthy employees experience more job satisfaction and productivity. The University of Calgary offers programs and services that promote healthy living, a healthy work environment, and respect the employees’ lives outside of work as well as their work life. Collaborating with the university’s WellBeing and Work Life department, the purpose of our community health promotion project was to develop and provide recommendations for the implementation of a successful holistic wellness challenge for faculty and staff. Drawing on the Population Health Promotion Model, the Community as Partner model, and the nursing process, a windshield survey, key informant interviews, a focused review of literature, and an environmental scan of 15 Canadian universities (U15) and Vanderbilt University (well-known for its excellent occupational health program).  The information gained was used to create then pilot a holistic evidence-based challenge that aims to improve employees’ physical activity, exercise, mental health, social health, financial health, and nutrition. To increase community members’ awareness and participation in the wellness challenge, we developed brochures detail the health benefits to be gained and offer suggestions for implementing each component. Because our evidence-based recommendations are feasible and flexible with clear marketing strategies, they are more likely to be adopted by organizations and their employees

Implementing A Winter Wellness University Program: A Community Health Nursing Project

To improve the health and wellness of students, faculty and staff in a university setting, the authors developed and implemented a four-week health and wellness challenge project based on the application of the Population Health Promotion Model and the Community as Partner model to each of the steps of the community health nursing process. The purpose of this paper is to describe this community health improvement project, The Winter Wellness Challenge (WWC), which involved one university faculty in Western Canada. The entire project, which occurred over a 3-month period, included the following elements: a community health assessment of the community where the university was situated, which was initiated via a windshield survey, self-evaluated health status of program participants done via Survey Monkey prior to the start of the WWC program, the four-week intervention, and a post-intervention survey. In addition, key informant interviews were conducted with 21 participants after completion of the WWC to solicit participants’ feedback  about the utility of the project and to seek recommendations to improve future WWCs. The salient findings showed improvement in social support, duration of sleep, and stress level. From the participants’ perspective, the greatest improvement was in physical and nutritional wellness. The participants advocated for continuing implementation of the challenge in the future. Recommendations for improving the WWC were also provided

Enhancing Social Diversity and Communication in an Assisted Living Facility for Older Adults: A Community Health Nursing Project

Improving the health of specific populations requires community partnerships, collaboration, and an in-depth understanding of the diverse health status and health care needs of the population.  The purpose of this paper is to describe a community health project that the authors, in conjunction with the staff and residents, implemented at an assisted living facility for older adults who needed assistance with activities of daily living but who were otherwise fairly independent. The LODGE (pseudonym) community is located in a large urban centre in Western Canada.  The focus of this three and half month project was to gain information about this community in order to help optimize the function and independence of its members. The guiding frameworks included the nursing process, the Community as a Partner model and the Population Health model. The community assessment included a windshield survey, a general survey of 142 residents living in the facility (74% response rate), key informant interviews, literature review, and several brainstorming sessions with staff and residents.  The focus of data analysis was on the salient areas of strength and areas that needed improvement. The major finding regarding how to best optimize the function and independence of the residents included interventions related to (a) obtaining a more specific in-depth interview with residents who are inactive in both a physical and social sense in order to obtain more specific information about the activities and interests they valued in the past, and which ones they could still participate in if specific types of resources were provided , (b) enhancing relational communication and (c) increasing accessibility to information regarding the eligibility and benefits of the government funded Home Care services.  Interventions were viewed positively by members of the community. Recommendations are provided for expansion and sustainability of future community interventions. &nbsp

Arab Women's Breast Cancer Screening Practices: A Literature Review

Breast cancer incidence and mortality rates are increasing in the Arab world and the involved women are often diagnosed at advanced stages of breast cancer. This literature review explores factors influencing Arab women’s breast cancer screening behavior. Searched databases were: Medline, PubMed, Cochrane Database of Systematic Reviews, CINAHL Plus, Google Scholar, Index Medicus for WHO Eastern Mediterranean, and Asian Pacific Journal of Cancer Prevention. Breast cancer screening participation rates are low. Screening programs are opportunistic and relatively new to the region. Knowledge amongst women and health care providers, professional recommendation, socio-demographic factors, cultural traditions, beliefs, religious, social support, accessibility and perceived effectiveness of screening influence screening behavior

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Vietnamese women living in Canada : contextual factors affecting Vietnamese women’s breast cancer and cervical cancer screening practices

The aims of this qualitative research were to explore (a) how Vietnamese women participate in breast cancer and cervical screening, what leads Vietnamese women to seek health care, from whom they seek help, and the social support networks that they draw upon to foster their health care practices, (b) whether Vietnamese women find the current preventative cancer services suitable and accessible to them, (c) how Vietnamese women's breast cancer and cervical cancer screening practices are influenced by social, cultural, political, historical, and economic factors which are shaped by the conceptualisation of race, gender, and class, and (d) how differences between Vietnamese women's perspectives and those of health care providers influence women's health care experiences. By 2001, the estimated number of Vietnamese immigrants living in Canada was 151,410, approximately half of them women. Data from the U.S. and Australia show that breast cancer and cervical cancer are major contributors to cancer morbidity and mortality among Vietnamese women. Studies also suggest that Vietnamese women are at risk due to their low participation rate in these cancer preventative screening programs. Informed by Kleinman's explanatory model, postcolonialism, and feminism, in-depth interviews were conducted with 15 Vietnamese Canadian women and 6 health care providers. The study reveals the following major factors determining how Vietnamese women participate in breast cancer and cervical cancer screening programs: cultural conceptualisations of health and illness, social values and beliefs about the woman's body and social relationships; gendered roles and expectations; diminished social support networks; low socioeconomic status; and inaccessibility of health care services. At the theoretical level, I propose that health care professionals should (a) recognise that women of different ethno-cultural background are active participants in health care, (b) put less emphasis on western rationality and more on the recognisation that women's health care decision making is a dynamic process that varies under different circumstances, and (c) recognise that women's health care behaviour is influenced not only by their cultural knowledge and values, but also by their socially constructed position, race, gender, and class. At the practical level, I propose (a) that collaborative working relationships with physicians and improved physician-patient relationships are essential for successful promotional strategies for Vietnamese women, and (b) that a health education strategy must incorporate Vietnamese women's different ways of knowing. At the institutional level, increasing accessibility to these cancer preventive programs demands that health care policy makers increase institutional funding to support programs that provide services to immigrant women. Recommendations for future research include (a) a population-based survey to assess the current status of Vietnamese Canadian women's breast and cervical cancer screening practices, and to investigate the relationship between identified factors and Vietnamese women's cancer screening practices, (b) the development and implementation of a health promotion and disease prevention program that incorporates the findings of this study into its promotional strategies, and (c) an experimental study to evaluate the effectiveness of the newly developed promotional strategies on breast and cervical cancer screening among Vietnamese Canadian women.Graduate and Postdoctoral StudiesGraduat

What Influences Use of Nonpharmacological Treatments for Seniors with Mild or Moderate Dementia: An Integrative Review Protocol

An integrative review protocolAim: The aim of this integrative review is to explore the extent and nature of evidence concerning factors that influence use of nonpharmacological treatment interventions for community-dwelling seniors with mild-to-moderate dementia. Background: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it is unclear in the literature how seniors with mild or moderate dementia view, understand, and access nonpharmacological interventions. To our knowledge, no review has been conducted on factors influencing the use of nonpharmacological interventions for seniors with mild-to-moderate dementia. Design: An integrative review method will be used to meet the review objective. Review method: We will perform a systematic literature search from five electronic databases to locate relevant empirical and theoretical research evidence on the topic. Eligible studies include empirical research, both qualitative and quantitative methods, and theoretical studies published since 2000 in English, that explored factors influencing use of community-based nonpharmacological interventions for seniors with mild or moderate dementia. Eligibility criteria are studies that included community-dwelling seniors (≥ 65) with mild-to-moderate dementia, their care partners, or health care practitioners and that explored the use of community-based nonpharmacological dementia treatments. We will extract the data by creating matrices on quality appraisal, key methodological features, and key findings. Data analysis will include constant comparison of extracted data, examining relationships between concepts, overall strengths and weaknesses of the literature, and gaps in knowledge. Findings will be visually categorized and narratively summarized. Discussion: This integrative review will identify and synthesize enablers and barriers that influence use of nonpharmacological interventions by seniors with mild-to-moderate dementia, identify knowledge gaps, and inform future research studies and literature reviews

Study exploring depression and cardiovascular diseases amongst Arabic speaking patients living in the State of Qatar: Rationale and methodology

In Qatar, cardiovascular diseases are the leading cause of death. Studies show that depression is associated with an increased morbidity and mortality among cardiovascular patients. Thus, early detection of, and intervention for, depression among cardiovascular patients can reduce cardiovascular morbidity and mortality, and save health care costs. To date there is no study in the Gulf region exploring depression among cardiovascular patients. This paper describe phase I of the research program. Using both quantitative and qualitative research methodologies, we will investigate (1) the prevalence and severity of depression among patients who have confirmed diagnosis of cardiovascular diseases (2) how contextual factors such as social, cultural, and economic factors contribute to the risk of depression and its management among cardiovascular patients, and (3) formulate effective intervention strategies that are expected to increase awareness, prevention of and treatment for depression among cardiovascular patients, thus reducing cardiovascular diseases morbidity and mortality in Qatar