Project description:BackgroundScholars demand more focus on context-related factors of health literacy as the management of health information is seen as a social practice. One prominent factor is social support that is expected to be particularly relevant for persons vulnerable for low health literacy. It was shown that health literacy can differ across the life span and especially older people have been demonstrated to be vulnerable for low health literacy. Therefore, health literacy and the relation of social support on health literacy in different age groups should be investigated.MethodsIn a German nationwide survey 2,151 adults were interviewed face-to-face. General comprehensive health literacy was measured with the HLS19-Q47 which differentiates single steps of health information management - access, understand, appraise, and apply. Social support was measured with the Oslo 3 Social Support Scale. Bivariate and multivariate analyses were performed for all respondents and for five age groups.ResultsHealth literacy is relatively low in all age groups but particularly low among old-old people (76 + years). Also, the youngest adults (18-29 years) have slightly lower health literacy than middle-aged adults. On average, health literacy is higher among people with higher social support but this association varies between age groups. It tends to be quite strong among younger adults (18-45 years) and young-old persons (65-75 years) but is weak among older middle-aged (46-64 years) and old-old persons. The association also differs between steps of information management. It is stronger for accessing and applying information but there are differences in age groups as well.ConclusionsSocial support is a relevant aspect to improve individuals' health literacy and therefore should be addressed in interventions. However, it is necessary to differentiate between age groups. While both young adults and particularly old-old persons are challenged by health information management, young adults can strongly profit from social support whereas it can barely compensate the low health literacy of old-old persons. In addition, different challenges in information management steps in different age groups need to be considered when designing health literacy interventions. Thus, target group specific services and programs are needed.

Project description:Surgeons usually witness only the limb-threatening stages of infected, closed pedal puncture wounds in diabetics. Given that this catastrophic outcome often represents failure of conservative management of pre-infected wounds, some suggest consideration of invasive intervention (coring or laying-open) for pre-infected wounds in hope of preventing contamination from evolving into infection, there being no evidence based guidelines. However, an invasive pre-emptive approach is only justifiable if the probability of progression to catastrophic infection is very high. Literature search revealed no prior studies on the natural history of closed pedal puncture wounds in diabetics.A survey was conducted via an interviewer-administered questionnaire on 198 adult diabetics resident in the parish of St. James, Jamaica. The sample was selected using a purposive technique designed to mirror the social gradient and residential distribution of the target population and is twice the number needed to detect a prevalence of puncture wounds of 14% with a range of 7-21% in a random sample of the estimated adult diabetic population.The prevalence of a history of at least one closed pedal puncture wound since diagnosis of diabetes was 25.8% (CI; 19.6-31.9%). The only modifiable variable associated at the 5% level of significance with risk of pedal puncture wound, after adjustment by multivariable logistic regression, was site of interview/paying status, a variable substantially reflective of income more so than quality-of-care.Of 77 reported episodes of closed pedal puncture wound among 51 participants, 45.4% healed without medical intervention, 27.3% healed after non-surgical treatment by a doctor and 27.3% required surgical intervention ranging from debridement to below-knee amputation. Anesthetic foot (failure to feel the puncture) and sole of the forefoot as site of puncture were the variables significantly associated with risk of requiring surgical intervention.That 72.7% of wounds healed either spontaneously or after non-surgical treatment means that routine, non-selective surgical intervention for pre-infected closed pedal puncture wounds in diabetics is not justifiable. However the subset of patients with an anesthetic foot and a wound on the sole of the forefoot should be marked for intensive surveillance and early surgical intervention if infection occurs.

Project description:IntroductionCongenital hearing impairment is one of the principal issues that make distress to families especially those with a family history of hearing problems. Early detection of hearing impairment can make a difference regarding cognitive, attention, learning, speech, and social and emotional development of babies. Otoacoustic test emission is a very common screening test that can be used to pick up early cases and relieve family stress. We tried to evaluate the factors that may disrupt our results regarding the OAE test.MethodsA cross-sectional study included infants who were admitted to the nursery unit alone. Infants who were admitted to the NICU unit, infants with craniofacial anomalies, infants with vernix in the external auditory canal, and Infants with Stigmata associated with a syndrome known to include a sensorineural hearing loss were excluded from the study. Both transient evoked otoacoustic emissions (TEOAE) with distortion product otoacoustic emissions (DPOAE) Screening tests were performed by the same professional audiologist experienced in neonatal screening.ResultsA total of 1413 newborns (733 males and 680 females) were included in the study. Among them, 1368 babies (96.8%) passed the first OAE in both ears, while 45 babies (3.2%) didn't pass the first OAE in one or both ears.Significant correlations between the female gender and family history of congenital hearing loss with failure of the first OAE test results. Moreover, vaginal delivery (VD) infants had a 1.5-fold higher failure rates of first OAE test screening results in comparison to caesarian delivery (CD) infants.ConclusionOur study demonstrated higher failure rates of the first OAE in female infants, vaginal delivery infants, and infants with a family history of hearing impairment. It is recommended to postpone the first phase of hearing screening for those infants until the first scheduled vaccine appointment to achieve higher compliance attendance, and decrease family stress associated with false-negative results of the test.

Project description:BackgroundIn Canada, family physicians are permitted to charge patient fees for administrative services that are not covered by the public health insurance program, such as prescription renewals outside of an office visit, and completion of forms and sick notes. The objective of this study was to estimate the proportion of Ontario family physicians who offer various fee structures (i.e., à la carte, annual block fees for all uninsured services rendered or no charge) for uninsured administrative services.MethodsThis was a cross-sectional telephone survey conducted from April to July 2019 of a random sample of family physicians licensed to practise in Ontario. We excluded physicians with missing contact information or additional specialties, or whose primary practice was outside of Ontario, with a walk-in clinic, with an emergency department, or with an organization that cared for a specific population (e.g., nursing home) or did not provide care (e.g., insurance company). We categorized the geographic location of practices as large urban centre (population > 100 000), small to medium centre (population 1000-99 999) or rural area. We calculated survey weights to account for nonresponse and to ensure representativeness of the sample by geographic area and payment model.ResultsAmong the 221 physicians who met the inclusion criteria, the telephone was not answered at 42 practices, and the contact information was incorrect for 13, resulting in a sample of 166 physicians (response rate 75.1%). The majority of practices reported that they charged fees for uninsured services: 97 (58.3%, 95% confidence interval [CI] 50.6-65.8) charged à la carte, and 33 (20.3%, 95% CI 14.8-27.3) offered patients the option to pay an annual block fee; 19 (11.4%, 95% CI 7.4-17.3) charged no fees. Fee structures varied by geographic area but not physician payment model.InterpretationThe use of à la carte and annual block fees for uninsured administrative services was commonly reported by a sample of Ontario family physicians. Further research is needed to examine the prevalence of patient payment of fees for uninsured services, patient and physician perceptions of fees, and concordance with regulatory guidance.

Project description:BackgroundThe province of British Columbia is facing a family physician shortage despite consistent increases in the number of physicians per capita and ongoing reforms to address the shortage. We identify physicians' priorities for structural reform, describe the alignment of those priorities with BC's suite of reforms and compare responses between established physicians and those new to practice; we also assessed rates of burnout.MethodsAll family physicians credentialed within Vancouver Coastal Health in 2018 were invited to participate in a cross-sectional survey. Respondents were asked about their practice model and characteristics, demographics, level of burnout and reform priorities. We used χ2 tests and multivariable logistic regression to investigate associations between personal and practice characteristics, burnout and reform priorities.ResultsOf the 1017 family physicians invited to participate, 525 (51.6%) responded. Of these, 399 (76.0%) indicated a need for fundamental change to how primary care is delivered; 244 (46.4%) would prefer to be a clinic employee rather than a small business owner. Other reform priorities included options to practise in a team (stated as very important by 69.6% of respondents), direct funding for team roles (66.7%), direct clinic funding (59.8%), part-time work options (64.7%), and ability to take planned vacations and parental leave (81.1%). The importance of individual reform priorities varied based on the participants' model of practice, location and years in practice. Of respondents, 108 (21.1%) had experienced a high level of burnout.InterpretationAlmost half of family physicians would prefer to be employees rather than small business owners and over 20% reported a high level of burnout. Practice models offering direct employment model have very limited availability and are not included in the current suite of reforms in BC, potentially pulling physicians away from community-based family medicine and into other models or specialties.

Project description:BackgroundMany primary care patients receive both medical and chiropractic care; however, interprofessional relations between physicians and chiropractors are often suboptimal which may adversely affect care of shared patients. We surveyed Canadian family physicians in 2010 to explore their attitudes towards chiropractic and re-administered the same survey a decade later to explore for changes in attitudes.MethodsA 50-item survey administered to a random sample of Canadian family physicians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ); scores could range from 0 to 80 with higher scores indicating more positive attitudes toward chiropractic. We constructed a multivariable regression model to explore factors associated with CAQ scores.ResultsAmong eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, 27% were uncertain, and 25% held negative views. Most respondents (72%) referred at least some patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity among chiropractors presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the 80-point CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (- 1.55 points for each 10-year increment from age 28; 95%CI - 2.67 to - 0.44), belief that adverse events are common with chiropractic care (- 1.41 points; 95% CI - 2.59 to - 0.23) and reported use of the research literature (- 6.04 points; 95% CI - 8.47 to - 3.61) or medical school (- 5.03 points; 95% CI - 7.89 to - 2.18) as sources of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic.ConclusionsAlthough generally positive, Canadian family physicians' attitudes towards chiropractic are diverse, and most physicians felt that practice diversity among chiropractors was a barrier to interprofessional collaboration.

Project description:OBJECTIVES:Knowledge of how physical activity (PA) and sport participation are related to mental health throughout adolescence is scarce. Our objective was to describe PA levels and sport participation in a population-based sample of adolescents, and to explore how they relate to mental health in different age groups. DESIGN:A population-based cross-sectional study. SETTING AND PARTICIPANTS:The adolescent part of the Nord-Trøndelag Health Study, a Norwegian population-based health survey, conducted from 2006 to 2008. Of 10 464 invited participants (age 13-19 years), 7619 (73%) participated, of whom 3785 (50%) were boys. OUTCOME MEASURES:Mental health outcomes included psychological distress assessed using a short version of the Hopkins Symptom Check List Five items, self-esteem assessed using a short version of the Rosenberg Self-Esteem Scale and life satisfaction assessed with a single-item satisfaction with life measure. METHOD:Logistic regression models were used to estimate the likelihood of psychological distress, low self-esteem and low life satisfaction, according to self-reported PA level and type of sport participation, stratified by gender and school level (junior vs senior high school). RESULTS:Fewer senior high school students participated in team sports compared with junior high school students (p<0.001). Physically active adolescents and participants in team sports had higher self-esteem and life satisfaction. A high PA level, compared with a low PA level, was associated with reduced odds of psychological distress among senior high school students (OR 0.63, 95% CI 0.46 to 0.86 for girls and OR 0.46, 95% CI 0.27 to 0.79 for boys). Team sport participation was associated with reduced odds of psychological distress in senior high school girls. CONCLUSION:A high PA level was favourably associated with various dimensions of mental health, especially for adolescents in senior high school. Team sport participation may have a positive impact on mental health and should, therefore, be encouraged.

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