An integrated framework for the geographic surveillance of chronic disease

<p>Abstract</p> <p>Background</p> <p>Geographic public health surveillance is concerned with describing and disseminating geographic information about disease and other measures of health to policy makers and the public. While methodological developments in the geographical analysis of disease are numerous, few have been integrated into a framework that also considers the effects of case ascertainment bias on the effectiveness of chronic disease surveillance.</p> <p>Results</p> <p>We present a framework for the geographic surveillance of chronic disease that integrates methodological developments in the spatial statistical analysis and case ascertainment. The framework uses an hierarchical approach to organize and model health information derived from an administrative health data system, and importantly, supports the detection and analysis of case ascertainment bias in geographic data. We test the framework on asthmatic data from Alberta, Canada. We observe high prevalence in south-western Alberta, particularly among Aboriginal females. We also observe that persons likely mistaken for asthmatics tend to be distributed in a pattern similar to asthmatics, suggesting that there may be an underlying social vulnerability to a variety of respiratory illnesses, or the presence of a diagnostic practice style effect. Finally, we note that clustering of asthmatics tends to occur at small geographic scales, while clustering of persons mistaken for asthmatics tends to occur at larger geographic scales.</p> <p>Conclusion</p> <p>Routine and ongoing geographic surveillance of chronic diseases is critical to developing an understanding of underlying epidemiology, and is critical to informing policy makers and the public about the health of the population.</p

Prevalence and corrrelates of 12- month prescription drug misuse in Alberta

Objective: We examined the prevalence and correlates of prescription drug misuse (PDM) in a population-based sample of adults from Alberta. Methods: Data were collected from 3511 adults in Alberta aged 18 years and older in 2002 using a computer-aided telephone survey; the survey response rate was 57.4%. Results: The prevalence of 12-month PDM in Alberta was 8.2% in 2002. Opiates were the most frequently misused drug class, followed by sedatives, stimulants, and tranquilizers. Current disability was particularly associated with PDM. Odds of PDM were also elevated among adult students and adults with a high school diploma relative to adults with a post-secondary degree. Past-year problem gambling, illicit drug use, and alcohol use and dependence were each associated with PDM, while past-year binge drinking and daily smoking were not. Conclusions: Findings suggest PDM was an important public health concern in Alberta in 2002. Estimates suggest prescription use and misuse have increased substantially in Canada since that time. There is an urgent need for an ongoing assessment of this evolving problem so that effective prevention and therapeutic strategies can be developed.Ye

Enhancing Educators’ skills for promoting Critical Thinking in their classroom discourses: A randomized control trial

The literature reveals that educators find it challenging to foster critical thinking (CT) in their students if they have not learned how to use CT in their educational system or training. This paper reports findings from a national research project that was undertaken to enhance the educators’ ability to promote CT in their teaching practices. Using a randomized control trial design with a pre- and post-test, 91 educators from 14 of the 17 schools of nursing in Pakistan consented to enroll in the study and 72 completed the study. The intervention included 40 hours of learning experience during two workshops that focused on CT. Data were collected, pre- and post-intervention, via observations and audiotaping of the participants teaching sessions for 60-90 minutes. The data obtained was assessed for the educators’ level of questioning, teaching strategies, and facilitation skills. Data were analyzed using descriptive and inferential statistics. Compared with the pre- intervention data, findings from the post-intervention data in the experimental group revealed positive changes in their pedagogical skills, including a significant increase in the number of higher order questions that are considered important for developing students’ CT skills. This study affirms that educators must have structured training to use and foster CT in their teaching practices

The Alberta Ambassador Program: delivering Health Technology Assessment results to rural practitioners

BACKGROUND: The purpose of Health Technology Assessment (HTA) is to make the best possible summary of the evidence regarding specific health interventions in order to influence health care and policy decisions. The need for decision makers to find relevant HTA data when it is needed is a barrier to its usefulness. These barriers are highest in rural areas and amongst isolated practitioners. METHODS: A multidisciplinary team developed an interactive case-based instructional strategy on the topic of chronic non-cancer pain (CNCP) management using clinical evidence derived by HTA. The evidence for each of 18 CNCP interventions was distilled into single-sheet summaries. Clinicians and HTA specialists ('Ambassadors') conducted 11 two-hour interactive sessions on CNCP in eight of Alberta's nine health regions. Pre- and post-session evaluations were conducted. RESULTS: The sessions were attended by 130 individuals representing 14 health and administrative disciplines. The ambassador model was well received. The use of content experts as ambassadors was highly rated. The educational strategy was judged to be effective. Awareness of the best evidence in CNCP management was increased. Although some participants reported practice changes as a result of the workshops, the program was not designed to measure changes in patient outcome. CONCLUSION: The ambassador program was successful in increasing awareness of the best evidence in CNCP management, and positively influenced treatment decisions. Its teaching methods were felt to be unique and innovative by participants. Its methods could be applied to other clinical content areas in order to increase the uptake of the results of HTA

Enculturation and alcohol use problems among Aboriginal university students

Objective: To examine associations between Aboriginal enculturation, Canadian acculturation, and alcohol problems among Aboriginal university students living in an urban area in Canada. Methods: Data for this mixed methods study were collected through in-person surveys with a convenience sample of Aboriginal university students (n = 60) in 2008/2009. Results: Students evidenced high levels of Aboriginal enculturation and Canadian acculturation. Aboriginal enculturation was significantly associated with reduced alcohol problems for Aboriginal university students. There was no association between Canadian acculturation and alcohol problems. Qualitative findings suggest Aboriginal cultural practices helped students cope with problems in their daily lives and provided them with both personal and social rewards. Conclusions: This study found Aboriginal enculturation was significantly associated with reduced alcohol problems among Aboriginal university students. Results support the growth of programs and services that encourage Aboriginal students to maintain their cultural identity within the university setting. Can J Psychiatry. 2011;56(12):Ye

QLS front-line retention manual: methods for achieving a 94% cohort retention rate in longitudinal research

Permission to include the report granted by Gary O’Connor, Chief Executive Officer, ONTARIO PROBLEM GAMBLING RESEARCH CENTREThis Front-Line Manual, written mainly by and from the perspective of the QLS front-line staff describes how they developed, tested, and put into practice the methodology to achieve their extremely high retention rate. By discussing the underlying rationale for different approaches and tools, as well as providing numerous specific practical examples, this manual will hopefully assist other longitudinal studies in improving retention rates, and thus the strength of the results of those studies.Ye

Quinte longitudinal study of gambling and problem gambling

The Quinte Longitudinal Study (QLS) is a prospective study of gambling and problem gambling conducted in the Quinte region of Ontario, Canada from 2006 to 2011. A sample of 4,121 adults, 17 and older, was recruited via random digit telephone dialing with 26% of the sample overselected for higher levels of gambling involvement. The sample was roughly representative of the demographic profile of the Canadian adult population, and the geographic region had very similar gambling opportunities to the rest of Canada. The cohort was assessed annually over 5 years. Assessments were computerized and self-administered and were completed either online at the person’s home or at the QLS office in Belleville. The assessment collected comprehensive information on demographics, gambling behaviour, physical health, mental health, substance use and abuse, stressors, personal values, social functioning, personality, leisure activity, and intelligence. An exceptionally high retention rate of 93.9% after 5 years was achieved

Designing a Longitudinal Cohort Study of Gambling in Alberta: Rationale, Methods, and Challenges

Sherpa Romeo green journal. Permission to archive accepted author manuscript.Longitudinal research on the determinants of gambling behavior is sparse. This article briefly reviews the previous seventeen longitudinally designed studies, focusing on the methodology for each study. This is followed by a description of our ongoing longitudinal study entitled the Leisure, Lifestyle, & Lifecycle Project (LLLP). Participants for the LLLP were recruited from four locations in Alberta, Canada, including both rural and urban populations. In the LLLP most participants were recruited using random digit dialing (RDD), with 1808 participants from 5 age cohorts at baseline: 13-15, 18-20, 23-25, 43-45, and 63-65. Individuals completed telephone, computer, and face-to-face surveys at baseline, with the data collection occurring between February and October, 2006. At baseline, a wide variety of constructs were measured, including gambling behavior, substance use, psychopathology, intelligence, family environment, and internalizing and externalizing problems. Finally, the conclusions that can be drawn thus far are discussed as well as the plans for three future data collections.Ye