Parental views on pediatric vaccination: the impact of competing advocacy coalitions

The debate on pediatric vaccination policy has been characterized by the presence of two distinct coalitions: those in favor of current vaccination policies and those expressing concern about these policies. The target of these coalitions is the vaccination decision of parents. To determine their influence, we conducted four focus groups in Toronto, Canada examining parental decision-making concerning pediatric vaccination. Our focus groups consisted of both fathers and mothers and parents who fully vaccinated and those who did not. Using the Advocacy Coalition Framework as an analytic guide, we identified several themes that provided insights into how effective the two coalitions have been in conveying their viewpoints. In general, we identified a variety of levels of belief systems existing amongst parents concerned about vaccination, some more amenable to change than others. We found that the choice to not vaccinate was largely a result of concerns about safety and, to a lesser extent, about lack of effectiveness. These parental views reflected the ability of the coalition concerned about vaccination to challenge parents' trust in traditional public health sources of information. In contrast, the parental decision to vaccinate was due to recognizing the importance of preventing disease and also a consequence of not questioning recommendations from public health and physicians and feeling pressured to because of school policies. Importantly, parents who fully vaccinate appear to have weaker belief systems that are potentially susceptible to change. While current policies appear to be effective in encouraging vaccination, if trust in public health falters, many who currently support vaccination may reevaluate their position. More research needs to be conducted to identify approaches to communicate the risks and benefits of vaccination to parents

Perfectionism, anxiety, and depressive distress: Evidence for the mediating role of negative automatic thoughts and anxiety sensitivity

This study assessed a mediational model in which negative automatic thoughts and anxiety sensitivity were hypothesized to mediate the relationship between perfectionism cognitions and depressive and anxiety symptoms.Participants: Participants were undergraduate students from an urban Canadian university. The data were collected from July 2009 to August 2010.Methods: In a cross-sectional evaluation, 992 undergraduate participants completed questionnaires that assessed perfectionism cognitions, negative automatic thinking, anxiety sensitivity, and anxiety and depressive symptoms. Mediational analysis confirmed the role of anxiety sensitivity and negative automatic thoughts in mediating the association between perfectionistic cognitions, anxiety symptoms, and depressive distress. Furthermore, in line with previous studies, nearly a third of students displayed an elevated prevalence of anxiety and depressive symptoms. This study further clarified the associations and mediating relationships among mood states associated with perfectionism.Social Science and Humanities Research Council (SSHRC

The mental health status of ethnocultural minorities in Ontario and their mental health care.

Background: Mental disorders are a leading cause of disability and early mortality. The objective of this study was to describe and compare psychosocial indicators and mental health service use among ethnoculturally diverse Ontarians. Methods: This is a cross-sectional analysis of the Ontario Health Study pilot investigation. Residents were mailed an invitation to one of 3 assessment centres (urban, rural and northern sites) from March 2009 to July 2010. Participants had an interview with a nurse and completed a questionnaire on a touchscreen kiosk. The questionnaire included sociodemographic items, and scales assessing symptoms of depressive symptoms (CES-D) and anxiety (GAD-7), social support (Lubben Social Network Scale), stressful life events, and mental health service use. Results: Eight thousand two hundred thirty-five residents participated, among whom 6652 (82.4 %) self-reported their ethnocultural background as White, 225 (2.8 %) as South Asian, 222 (2.8 %) East Asian, 214 (2.7 %) Southeast Asian, 197 (2.4 %) Black, and 28 (0.3 %) as Aboriginal. Based on their sociodemographic characteristics, participants from these ethnocultural minority groups were matched to White participants. Black participants reported significantly greater stressful life events than White participants (p = .04), particularly death (p < .05), divorce (p = .002) and financial difficulties (p < .001). East Asian participants reported significantly less social support than their White counterparts (p < .001), and this was not confounded by measurement variance. Mental health service use was significantly lower in all ethnocultural minorities except Aboriginals, when compared to White participants (p = .001). Conclusions: There is a high burden of psychosocial distress in several preponderant ethnocultural minorities in Ontario; many of whom are not accessing available mental health services

Interleukin-1 in the Response of Follicular Helper and Follicular Regulatory T Cells

The role of interleukin-1 in the regulation of humoral responses is poorly documented, in contrast to its role in inflammation. Recent findings suggest there is an interleukin-1 axis in the follicular T cell control of B cell responses, involving interleukin-1 receptors (IL-1R1 and IL-1R2) and receptor antagonists (IL-1Ra). Here, we revisit the literature on this topic and conclude that targeting the interleukin-1 pathway should be a valuable therapeutic approach in many diseases involving excessive production of (auto)antibodies, such as autoimmune diseases or allergy

Data mining of a remote behavioral tracking system for Type 2 Diabetes patients: A prospective, cohort study

Background: Complications from type 2 diabetes mellitus can be prevented when patients perform health behaviors such as vigorous exercise and glucose-regulated diet. The use of smartphones for tracking such behaviors has demonstrated success in type 2 diabetes management while generating repositories of analyzable digital data, which, when better understood, may help improve care. Data mining methods were used in this study to better understand self-monitoring patterns using smartphone tracking software. Objective: Associations were evaluated between the smartphone monitoring of health behaviors and HbA1c reductions in a patient subsample with type 2 diabetes who demonstrated clinically significant benefits after participation in a randomized controlled trial. Methods: A priori association-rule algorithms, implemented in the C language, were applied to app-discretized use data involving three primary health behavior trackers (exercise, diet, and glucose monitoring) from 29 participants who achieved clinically significant HbA1c reductions. Use was evaluated in relation to improved HbA1c outcomes. Results: Analyses indicated that nearly a third (9/29, 31%) of participants used a single tracker, half (14/29, 48%) used two primary trackers, and the remainder (6/29, 21%) of the participants used three primary trackers. Decreases in HbA1c were observed across all groups (0.97-1.95%), but clinically significant reductions were more likely with use of one or two trackers rather than use of three trackers (OR 0.18, P=.04). Conclusions: Data mining techniques can reveal relevant coherent behavior patterns useful in guiding future intervention structure. It appears that focusing on using one or two trackers, in a symbolic function, was more effective (in this sample) than regular use of all three trackers.The authors would like to thank NexJ Systems Inc. for their partnership in this trial and for the use of the Connected Wellness Platform as a clinical research tool. Funding was provided by the Public Health Agency of Canada and the Federal Development Agency of Southern Ontario. We offer special thanks to the staff of the Black Creek Community Health Centre and trial participants from the Jane-Finch community of Toronto, Ontario. Joel Katz is supported by a Canadian Institutes of Health Research Canada Research Chair in Health Psychology. The authors would like to acknowledge with sadness the untimely passing of study co-author, colleague, and friend, Dr. Nicholas Cercone. Dr. Cercone’s expertise and mentorship on data mining theory and technique was invaluable. His inspiring and supportive presence will be deeply missed

Worry Is Good for Breast Cancer Screening: A Study of Female Relatives from the Ontario Site of the Breast Cancer Family Registry

Background. Few prospective studies have examined associations between breast cancer worry and screening behaviours in women with elevated breast cancer risks based on family history. Methods. This study included 901 high familial risk women, aged 23–71 years, from the Ontario site of the Breast Cancer Family Registry. Self-reported breast screening behaviours at year-one followup were compared between women at low (N=305), medium (N=433), and high (N=163) levels of baseline breast cancer worry using logistic regression. Nonlinear relationships were assessed using likelihood ratio tests. Results. A significant non-linear inverted “U” relationship was observed between breast cancer worry and mammography screening (P=0.034) for all women, where women at either low or high worry levels were less likely than those at medium to have a screening mammogram. A similar significant non-linear inverted “U” relationship was also found among all women and women at low familial risk for worry and screening clinical breast examinations (CBEs). Conclusions. Medium levels of cancer worries predicted higher rates of screening mammography and CBE among high-risk women

Serial personal digital assistant data capture of health-related quality of life: A randomized controlled trial in a prostate cancer clinic

<p>Abstract</p> <p>Background</p> <p>In clinical and research practice linked to prostate cancer treatment, frequent monitoring of patient health-related quality of life (HRQOL) is essential. Practical and analytic limitations of paper questionnaire data capture may be overcome with the use of self-administered personal digital assistant (PDA) data collection. The objective of this study was to assess the reliability, validity, and feasibility of using PDA in place of paper versions of the International Prostate Symptom Score (IPSS), the Patient Oriented Prostate Cancer Utility Survey (PORPUS), and the International Index of Erectile Function-5 (IIEF-5) in a prostate cancer clinic setting.</p> <p>Methods</p> <p>152 participants were randomly assigned to one of three conditions: 1) paper followed by PDA survey; 2) PDA followed by paper survey; or 3) PDA followed by PDA survey. Evaluation included an assessment of data quality (internal consistency, test-retest reliability, response correlation, completeness of data), and feasibility (participation rates, time to completion, preference and difficultly/ease of using PDA).</p> <p>Results</p> <p>Internal consistency was similar for both PDA and paper applications. Test-retest reliability was confirmed for PDA repeated administration. Data from paper and PDA questionnaires were strongly correlated. Lower missed item rates were found in PDA administration. 82.8% of participants preferred using the PDA or had no preference. Mean difficulty/ease ratings indicated that participants found the PDA easy to use. Age did not significantly correlate with preference or difficulty.</p> <p>Conclusion</p> <p>The results confirm the adaptability of the IPSS, IIEF-5, and the PORPUS to PDA administration. Similarly, the findings of this study support the feasibility of using PDA technology for HRQOL serial data capture in the prostate cancer patient population.</p

Perfectionism and psychological distress: A modeling approach to understanding their therapeutic relationship

The present study assessed the effectiveness of a web-based psychoeducational intervention protocol for decreasing levels of perfectionism and psychological distress. Different levels of therapeutic intervention (no treatment, general stress management intervention, general stress management intervention plus cognitive behavioral intervention) were provided to perfectionistic participants over a 10-week period. It was found via a longitudinal structural equation model that higher levels of therapeutic intervention predicted greater improvements in perfectionism and psychological distress. Further, amount of improvement in trait perfectionism and perfectionistic automatic thoughts was highly related to amount of improvement in psychological distress. The findings attest to the potential usefulness of a web-based intervention that combines a general stress management intervention with a cognitive behavioral intervention.Social Sciences and Humanities Research Council (SSHRC

Reductions in negative automatic thoughts in students attending mindfulness tutorials predicts increased life satisfaction

University education confronts students with stressful developmental challenges that can lead to mental health problems. Innovative programs must address an increasing prevalence of these problems but are impeded by the high costs involved. In this study, thirty-nine undergraduate students attended weekly one hour mindfulness meditation tutorials during a single (14 week) semester. Tutorials involved 40 minutes of guided meditation, followed by open-ended discussions on mindfulness and related scientific research. Multiple regression analysis tested associations between self-reported changes in mindfulness, in negative automatic thoughts and in satisfaction with life.Reductions in automatic thoughts accounted for a significant proportion of variance in life satisfaction and decreases in automatic thoughts were associated with an increased life satisfaction. This finding suggests guided meditation tutorials merit consideration in promoting student mental health on university campuses.Social Sciences and Humanities Research Council (SSHRC

Reductions in Negative Automatic Thoughts in Students Attending Mindfulness Tutorials Predicts Increased Life Satisfaction

University education confronts students with stressful developmental challenges that can lead to mental health problems. Innovative programs must address an increasing prevalence of these problems but are impeded by the high costs involved. In this study, thirty-nine undergraduate students attended weekly one hour mindfulness meditation tutorials during a single (14 week) semester. Tutorials involved 40 minutes of guided meditation, followed by open-ended discussions on mindfulness and related scientific research. Multiple regression analysis tested associations between self-reported changes in mindfulness, in negative automatic thoughts and in satisfaction with life.Reductions in automatic thoughts accounted for a significant proportion of variance in life satisfaction and decreases in automatic thoughts were associated with an increased life satisfaction. This finding suggests guided meditation tutorials merit consideration in promoting student mental health on university campuses.