Conceptual and methodological issues in evaluations of road safety countermeasures

Researchers have a long history in the conduct of evaluations of road safety countermeasures. However, despite the strengths of some evaluative road safety evaluations that align with previous and current thinking on program evaluation, few published road safety evaluations have followed standard conceptualization and methodology outlined in numerous program evaluation textbooks, journal articles and Web-based handbooks. However, conceptual and methodological challenges inherent in many evaluations of road safety countermeasures can affect causal attribution. Valid determination of causal attribution is enhanced by use of relevant theory or hypotheses on the putative mechanisms or pathways of change and by the use of a process evaluation to assess the actual implementation process. This article provides a detailed description of the constructs of causal chain, program logic models and process evaluation. This article provides an example of how these standard methods of theory-driven evaluation can improve the interpretation of outcomes and enhance causal attribution of a road safety countermeasure

What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program

OBJECTIVE: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. DESIGN: Qualitative method of focus groups. SETTING/PARTICIPANTS: The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. METHOD: Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. MAIN FINDINGS: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. CONCLUSION: Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting

Systematic scoping review of factors and measures of rurality: toward the development of a rurality index for health care research in Japan

Background: Rural-urban health care disparities are an important topic in health services research. Hence, developing valid and reliable tools to measure rurality is needed to support high quality research. However, Japan, has no index to measure rurality for health care research. In this study, we conducted a systematic scoping review to identify the important factors and methodological approaches to consider in a rurality index to inform the development of a rurality index for Japan. Methods: For our review, we searched six bibliographic databases (MEDLINE, PubMed, CINAHIL, ERIC, Web of Science and the Grey Literature Report) and official websites of national governments such as Government and Legislative Libraries Online Publications Portal (GALLOP), from 1 January 1989 to 31 December 2018. We extracted relevant variables used in the development of rurality indices, the formulas used to calculate indices, and any measures for reliability and validity of these indices. Results: We identified 17 rurality indices from 7 countries. These indices were primarily developed to assess access to health care or to determine eligibility for incentives for health care providers. Frequently used factors in these indices included population size/density and travel distance/time to emergency care or referral centre. Many indices did not report reliability or validity measures. Conclusions: While the concept of rurality and concerns about barriers to access to care for rural residents is shared by many countries, the operationalization of rurality is highly context-specific, with few universal measures or approaches to constructing a rurality index. The results will be helpful in the development of a rurality index in Japan and in other countries

Process evaluation of a treatment program for mood and anxiety disorders among emerging adults: Preentry factors, engagement, and outcomes

Objective: Effective mental health services for emerging adults are needed. This work evaluated the logic model of one such program and assessed participation and medium-term outcomes. Methods: Baseline data were collected from 398 emerging adults attending an intake appointment at a mood and anxiety disorders treatment program in Canada for persons ages 16-25. Questionnaires about demographic characteristics, prior help seeking, symptoms, functional impairment, and health satisfaction were completed at baseline and at follow-up, approximately 2 to 10 months later (mean=6 months), depending on participants\u27 availability and willingness. Program satisfaction was also assessed. Preentry characteristics and disengagement were evaluated. Repeated-measures analyses were used to evaluate outcomes. Results: The program did not require physician referral; however, emerging adults who contacted the program had extensive prior help seeking: 73% had seen a family doctor and 32% had visited an emergency department. Among 370 individuals for whom full intake data were available, scores indicated moderate depression, moderate anxiety, and low satisfaction with quality of health. They reported either not functioning or underfunctioning for a mean of 4.3 days per week. Follow-up data indicated significant improvement on all measures, including clinically significant improvement in both depression and functioning. Patient satisfaction was high, and quality of health improved significantly. Conclusions: Results indicate that the model studied, which emphasizes early-stage intervention for mood and anxiety disorders among emerging adults, was associated with statistical and clinical improvement at intermediate follow-up. Outputs and medium-term outcomes of the model were satisfied

Monitoring the effects of COVID-19 in emerging adults with pre-existing mood and anxiety disorders

Aim: The COVID-19 quarantine closed many mental health services. Emerging adults with pre-existing mood or anxiety disorders were of concern for worsening symptoms. We sought to demonstrate a method for monitoring mental health status of a group of patients with reduced access to their usual mental health services during quarantine. Methods: A total of 326 patients enrolled in the First-Episode Mood and Anxiety Program in London, Ontario, Canada were invited to participate in online questionnaires regularly. Patients were flagged for high level of risk based on depression scores, suicidal ideation and worsening in anxiety, depression or quality of health. All patients were also asked if they wanted contact with a clinician. Results: One hundred and fourteen (35%) patients completed at least one questionnaire. Thirty were flagged based on scores; 37 (32.5%) participating patients requested help. Participants who were flagged for concerning scores were younger, more likely to be on the wait list for treatment, to have been laid off from work and have more functional impairment. Participants requesting support had higher symptom scores for depression and lower scores on quality of health. Conclusions: The process utilized here identified patients at risk and in need of clinical support in the context of pandemic quarantine. It provided an accessible avenue for invited patients to communicate both symptom status and need for contact. Such a process can provide valuable monitoring during times when the usual communications between patients and health care providers is compromised and clinician time is limited. It is easily implemented

Attention Deficit Hyperactivity Disorder, other mental health problems, substance use and driving: Examination of a population-based, representative Canadian sample

Purpose: The purpose of this study is to examine the relationships among self-reported screening measures of ADHD, other psychiatric problems, and driving-related outcomes in a provincially representative sample of adults 18 years and older living in the province of Ontario, Canada. Methods: The study examined the results of the Centre for Addictions and Mental Health (CAMH) Ontario Monitor, an ongoing repeated cross-sectional telephone survey of Ontario adults over a two year period. Measures: ADHD measures (Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1), previous ADHD diagnosis, ADHD medication use); psychiatric distress measures (General Health Questionnaire (GHQ12), pain, anxiety and depression medication use); antisocial behaviour measure (The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview (APD)); substance use and abuse measures (alcohol, cannabis and cocaine), Alcohol Use Disorders Identification Test (AUDIT), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)); driving-related outcomes (driving after drinking, driving after cannabis use, street racing, collisions in past year) and socio-demographics (gender, age, vehicle km travelled). Results: A total of 4014 Ontario residents were sampled, of which 3485 reported having a valid driver’s licence. Overall, 3.22% screened positively for ADHD symptoms on the ASRS-V1.1 screening tool. A greater percent of those who screened positively were younger, reported previous ADHD diagnosis and medication use, distress, antisocial behaviour, anti-anxiety and anti-depressant medication use, substance use and social problems compared to those who screened negatively. However, there were no statistically significant differences between those who screened positively or negatively for ADHD symptoms on self-reported driving after having two or more drinks in the previous hour, within an hour of using cannabis, marijuana or hash, in a street race or collision involvement as a driver in the past year. When a sequential regression was conducted to predict self-reported collisions, younger age, higher weekly kilometres driven showed higher odds of collision involvement, while the odds ratio for cannabis use ever, approached statistical significance. Discussion: This study is the first population-based study of a representative sample of adults 18 years and older living in Ontario, Canada. These results showed no relationship between the ADHD screen and collision when age, sex and kilometers driven are controlled for. However, these analyses are based on self-report screeners and not psychiatric diagnoses and a limited sample of ADHD respondents. Thus, these results should be interpreted with caution

Process evaluation of an early-intervention program for mood and anxiety disorders among older adolescents and young adults

Objective: Research to determine the best approach for providing early intervention for mood and anxiety disorders is imperative. The authors describe a process evaluation of an early-intervention program for transition-age youths with mood or anxiety disorders. Methods: Causal and logic models for pathways to care for the program, as well as descriptive data from 548 participating youths, are presented. Follow-up measures of functional improvement are reported. Results: Diagnostic characterization, symptom severity, and functional impairment of participants indicated that the model selected an appropriate catchment population without creating excessive overinclusion. Self-referred youths reported greater anxiety and substance use. Acceptance by the program was predictive of greater follow-through with treatment. Several variables, including frequent lifetimemarijuana use, predicted loss to follow-up. At follow-up, youths were significantly functionally improved. Conclusions: This process evaluation indicated that the model provided appropriate early intervention for youths with mood or anxiety disorders without causing excessive overinclusion

Personality, executive control, and neurobiological characteristics associated with different forms of risky driving

Background: Road crashes represent a huge burden on global health. Some drivers are prone to repeated episodes of risky driving (RD) and are over-represented in crashes and related morbidity. However, their characteristics are heterogeneous, hampering development of targeted intervention strategies. This study hypothesized that distinct personality, cognitive, and neurobiological processes are associated with the type of RD behaviours these drivers predominantly engage in. Methods: Four age-matched groups of adult (19-39 years) males were recruited: 1) driving while impaired recidivists (DWI, n = 36); 2) non-alcohol reckless drivers (SPEED, n = 28); 3) drivers with a mixed RD profile (MIXED, n = 27); and 4) low-risk control drivers (CTL, n = 47). Their sociodemographic, criminal history, driving behaviour (by questionnaire and simulation performance), personality (Big Five traits, impulsivity, reward sensitivity), cognitive (disinhibition, decision making, behavioural risk taking), and neurobiological (cortisol stress response) characteristics were gathered and contrasted. Results: Compared to controls, group SPEED showed greater sensation seeking, disinhibition, disadvantageous decision making, and risk taking. Group MIXED exhibited more substance misuse, and antisocial, sensation seeking and reward sensitive personality features. Group DWI showed greater disinhibition and more severe alcohol misuse, and compared to the other RD groups, the lowest level of risk taking when sober. All RD groups exhibited less cortisol increase in response to stress compared to controls. Discussion: Each RD group exhibited a distinct personality and cognitive profile, which was consistent with stimulation seeking in group SPEED, fearlessness in group MIXED, and poor behavioural regulation associated with alcohol in group DWI. As these group differences were uniformly accompanied by blunted cortisol stress responses, they may reflect the disparate behavioural consequences of dysregulation of the stress system. In sum, RD preference appears to be a useful marker for clarifying explanatory pathways to risky driving, and for research into developing more personalized prevention efforts

Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: Sex differences in a representative, population survey

Background: Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada. Methods: Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n = 5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use. Results: After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use. Conclusions: ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner

Attention deficit hyperactivity disorder symptoms, comorbidities, substance use, and social outcomes among men and women in a canadian sample

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%-3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific