Patterns of use of natural health products by Ontario seniors

A random dialing telephone survey of 1,071 60+ year-olds in 4 Ontario communities identified 553 (52%) users of natural health products. Mean age was 72 yrs (min-max:60-95); 76% were female. The most frequently reported natural health products were: echinacea (27%), glucosamine (26%), garlic (20%), ginkgo biloba (10%), St. John's wort (5%), ginseng (5%), flax seed oil (3%), evening primrose oil (2%), devil's claw (2%), saw palmetto (2%). Natural source vitamin use was reported by 24% of users, and 6% reporting using herbal teas. 51% of users used 2 or more herbal products and 8% used 5 or more products. 19% of herbal users also used a conventional prescription drug to manage the same health problem as the herbal product. The reported range of monthly expenditures for these products varied from a few cents (grew their own) to $288 (CAN). Thirty-five percent of users did not know the price of at least one of their natural products. Of the 75% of respondents willing to disclose their annual household income ($CAN), 20 had an income of $46,000. The widespread use and potential for significant expenditure of limited resources would suggest that more study is required into the efficacy, safety and value of these products.

Compliance with recommendations in a geriatric outreach assessment service

Objectives: to measure the extent to which the recommendations of a geriatric outreach assessment service were being followed, and to determine what patient-related factors were associated with compliance with assessment recommendations. Methods: eighty-one eligible patients or caregivers who had an assessment in a geriatric outreach service participated in a telephone interview. The interview focused on the use of health services and compliance with assessment recomendations. Patient-related variables obtained from charts included demographics, caregiver support and stability, health status and assessment recommendations. Results: overall compliance with recommendations from the geriatric outreach assessment service was 65%. Patients were less likely comply fully with recommendations if they had a high number of recommendations [odds ratio (OR) = 0.23; 95% confidence interval (CI) = 0.12-0.46; P = 0.0001], inadequate caregiver support (OR) = 0.212; 95% CI = 0.04 to 1.02; P = 0.0523), or the ability to transfer themselves independently (OR = 0.12; 95% CI = 0.02-0.63; P = 0.0124). They were more likely to have full compliance if they had normal vision (OR = 6.67; 95% CI = 1.22- 36.46; P = 0.0284). Conclusion: it is important to focus on key issues when developing service recommendations and on the role of the informal caregiver in facilitating compliance with them. Good communication between the patient or caregiver and the family physician and geriatric services can help to identify strategies which might improve acceptance of recommendations.

Would older adults turn to community support services for help to maintain their independence?

The purpose of this article is to determine whether middle-aged and older adults would identify community support services (CSSs) as a source of assistance for difficulties with the instrumental activities of daily living (IADLs). Furthermore, we determine factors related to the identification of home health and CSSs. Telephone interviews were conducted with 768 adults aged 50 and older. Respondents were presented with a vignette describing a situation where loss of independence is threatened. They were asked what they would do in that situation. Although less than 20% mentioned CSSs, nearly 50% mentioned either a home health or CSS. Findings suggest those less likely to mention a home health or CSS include men, older adults, and the foreign born. In addition, those with less education, functional health limitations, no social support, and a lack of knowledge of where to find information about CSSs mentioned home health or CSSs less often. © The Author(s) 2010.

It's all about relationships:A qualitative study of health researchers' perspectives of conducting interdisciplinary health research

Background. Interdisciplinary research has been promoted as an optimal research paradigm in the health sciences, yet little is known about how researchers experience interdisciplinarity in practice. This study sought to determine how interdisciplinary research was conceptualized and operationalized from the researcher's perspective and to better understand how best to facilitate interdisciplinary research success. Methods. Key informant interviews were conducted with health researchers with expertise or experience in conducting interdisciplinary research. Interviews were completed either in person or over the telephone using a semi-structured interview guide. Data collection occurred simultaneously with data analysis so that emerging themes could be explored in subsequent interviews. A content analysis approach was used. Results. Nineteen researchers took part in this study. Interdisciplinary research was conceptualized disparately between participants, and there was modest attention towards operationalization of interdisciplinary research. There was one overriding theme, "It's all about relationships", that emerged from the data. Within this theme, there were four related subthemes: 1) Involvement in interdisciplinary research; 2) Why do I do interdisciplinary research?; 3) Managing and fostering interdisciplinary relationships; and 4) The prickly side to interdisciplinary research. Together, these themes suggest that the choice to conduct interdisciplinary research, though often driven by the research question, is highly influenced by interpersonal and relationship-related factors. In addition, researchers preferred to engage in interdisciplinary research with those that they had already established relationships and where their role in the research process was clearly articulated. A focus on relationship building was seen as a strong facilitator of interdisciplinary success. Conclusion. Many health researchers experienced mixed reactions towards their involvement in interdisciplinary research. A well thought-out rationale for interdisciplinary research, and strategies to utilize the contribution of each researcher involved were seen as facilitators towards maximizing the benefits that could be derived from interdisciplinary research. © 2008 Nair et al; licensee BioMed Central Ltd.

Older adults awareness of community health and support services for dementia care

The article examines where older adults seek help in caring for a parent with dementia and the factors associated with their identification of community health and support services as sources of assistance. The authors conducted telephone interviews, using random digit dialing, of 1,152 adults aged 50 and over in the city of Hamilton. Respondents received a vignette that raised issues related to parental dementia. In identifying support sources, over 37 per cent of respondents identified their physician, 33 per cent identified informal support such as family and neighbors, and 31 per cent identified home health services. Only 18 per cent identified community support services. Female participants having higher levels of education were more likely to identify their physician as a source of support. Knowing where to find information about community support services was associated with an increased likelihood of mentioning physicians and home health services as sources of assistance. © 2009 Copyright Canadian Association on Gerontology.

The use of natural health products (NHP) by Ontario seniors

A random dialing telephone survey in 4 Ontario communities obtained data on the use of natural health products (NHP) from 1,071 persons 60 years and older. 553 (52%) respondents were users of NHP. Prevalence of use was similar for females (53%) and males (48%). In this population modal users were of European descent, high school graduates and employed at least part-time. Half the users received recommendations about NHP from friends or relatives; another 22% learned about NHP through self-experimentation. Most users (81 %) decided by themselves whether they would buy an NHP rather than rely on input from another source (herbalist, physician, store owner/employee). 38% of NHP users had not informed their physician that they were using an NHP. When users had discussed NHP with their physician, less than 5% of physicians responded negatively. Some users felt natural health products were safer (15%) and less expensive (4%) than prescription drugs. 30% used NHP as a last resort for the treatment of a chronic disease. Nearly half (49%) of the users believed that if the government pays for prescription drugs, it should also pay for herbal remedies; 36% said the consumer should pay. In light of the extensive use of NHP by seniors, there is a need for clinical pharmacology studies of these products.

Health care needs of community-dwelling older adults

Objective. To identify, assess, and rank the importance of health care needs of community-dwelling older adults. Method. A structured telephone interview with 107 respondents (physicians, direct service providers and administrators) about the importance of a list of 31 health care needs of older adults. Respondents also identified the single most important health issue facing local older adults now and in the next 5 to 10 years. Results. The five most important health care needs, in descending order, are: care-giver support services, community long-term care services services for people with demential/Alzheimer's disease, palliative/end-of-life care, and services for cancer patients and their families. Community long-term care services were identified as the single most important health issue both now and in the next 5 to 10 years. Conclusion. The study findings should be of value to health and social service researchers, planners, providers and administrators regarding the needs of community-dwelling older adults.

Late-stage, primary open-angle glaucoma in Europe:Social and health care maintenance costs and quality of life of patients from 4 countries

Objective: The purpose of this study was to estimate costs and quality of life (QoL) of late-stage glaucoma patients in 4 European countries. Methods: Retrospective review of medical charts of patients with POAG who were followed in a low-vision or vision rehabilitation center in one of 4 countries for at least 1 year was used to determine patient characteristics, health status, and health care resource use. Visual impairment was measured by best-corrected visual acuity (Snellen score). Patients were also interviewed over the telephone in order to assess their health-related QoL (using EuroQol EQ-5D) and use of resources including: the number of visits to rehabilitation centers, visits to hospital and non-hospital specialists, the use of low-vision devices, medication, tests, and the use of hired home help. The costs associated with resource use were calculated from the perspective of a third-party payer of health and social care based on resource usage and unit costs in each country. Results: Patients undergoing visual rehabilitation in France (n=21), Denmark (n=59), Germany (n=60), and the United Kingdom (n=22) were identified, interviewed and had their medical charts reviewed. Annual maintenance costs of late-stage glaucoma amounted to €830 (±445) on average. Average home help costs were more than 3 times higher. QoL, on average, was 0.65 (±0.28). QoL was positively correlated with the level of visual acuity in the patients' best eye. On the other hand, visual acuity was also positively correlated to health care costs, but negatively correlated to costs of home help. Conclusions: The study was limited by its observational, uncontrolled design. The finding that late-stage glaucoma is associated with higher home help costs than health care maintenance costs suggests that potential savings from a better preventive treatment are to be found for social care payers rather than health care payers. © 2008 Informa UK Ltd All rights reserved.

Reducing the psychological distress of family caregivers of home based palliative care patients: Longer term effects from a randomised controlled trial.

Background: Palliative care incorporates comprehensive support of family caregivers because many of them experience burden and distress. However, evidence-based support initiatives are few.

Purpose: We evaluated a one-to-one psychoeducational intervention aimed at mitigating the distress of caregivers of patients with advanced cancer receiving home-based palliative care. We hypothesised that caregivers would report decreased distress as assessed by the General Health Questionnaire (GHQ).

Method: A randomised controlled trial comparing two versions of the delivery of the intervention (one face-to-face home visit plus telephone calls versus two visits) plus standard care to a control group (standard care only) across four sites in Australia.

Results: Recruitment to the one visit condition was 57, the two visit condition 93, and the control 148. We previously reported non-significant changes in distress between times 1 (baseline) and 2 (1-week post-intervention) but significant gains in competence and preparedness. We report here changes in distress between times 1 and 3 (8-week post-death). There was significantly less worsening in distress between times 1 and 3 in the one visit intervention group than in the control group; however, no significant difference was found between the two visit intervention and the control group.

Conclusions: These results are consistent with the aim of the intervention, and they support existing evidence demonstrating that relatively short psychoeducational interventions can help family caregivers who are supporting a dying relative. The sustained benefit during the bereavement period may also have positive resource implications, which should be the subject of future inquiry. © 2014 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

A randomized controlled trial of a self-management psychosocial intervention for men with prostate cancer and their partners: a study protocol.

Background
Little is known about interventions to help men and their partners cope with the after effects of prostate cancer treatment. The lack of in-depth descriptions of the intervention content is hindering the identification of which intervention (or component of an intervention) works.

Aim
To describe the development and evaluation of the content of a self-management psychosocial intervention for men with prostate cancer and their partners.

Design
A feasibility randomized controlled trial including structure, process, and outcome analysis.

Methods
This 9-week intervention commences on completion of treatment and consists of three group and two telephone sessions. The intervention focuses on symptom management, sexual dysfunction, uncertainty management, positive thinking and couple communication. Forty-eight couples will be assigned to either the intervention or a control group receiving usual care. Participants will be assessed at baseline, immediately postintervention and at 1 and 6 months postintervention. Outcome measures for patients and caregivers include self-efficacy, quality of life, symptom distress, uncertainty, benefits of illness, health behaviour, and measures of couple communication and support. An additional caregiver assessment will be completed by the partner.

Discussion
The main purpose of this feasibility study is to investigate the acceptability of the CONNECT programme to men with prostate cancer and their partners and to gain feedback from the participants and facilitators to make changes to and enhance the programme. Reasons why men do not want to participate will be collated to enhance recruitment in the future. We will also test recruitment strategies, randomization procedures, and the acceptability of the questionnaires. Ethical approval granted December 2010.

Healthful grocery shopping. Perceptions and barriers

While there is evidence of the factors influencing the healthfulness of consumers' food choice, little is known about how consumers perceive the healthfulness of their shopping. This study aimed to explore consumers' perceptions of, and identify barriers to, conducting a healthful shop. Using a qualitative approach, consisting of an accompanied shop and post-shop telephone interview, 50 grocery shoppers were recruited. Results showed that consumers used three criteria to identify a healthful shop: (1) inclusion of healthful foods; (2) avoidance or restriction of particular foods; and (3) achieving a balance between healthful and unhealthful foods. Those who take a balanced approach employ a more holistic approach to their diet while those who avoid or include specific foods may be setting criteria to purchase only certain types of food. The effectiveness of any of these strategies in improving healthfulness is still unclear and requires further investigation. Two barriers to healthful shopping were: (i) lack of self-efficacy in choosing, preparing and cooking healthful foods and (ii) conflicting needs when satisfying self and others. This highlights the need for interventions targeted at building key food skills and for manufacturers to make healthful choices more appealing. (C) 2013 Elsevier Ltd. All rights reserved.

Exploring public awareness and perceptions of palliative care: a qualitative study

Background: Research suggests that the public appear to be confused about the meaning of palliative care. Given the ageing population and associated increase in the number of patients requiring palliative care, it is vital to explore the public's understanding of this concept. Health-promoting palliative care seeks to translate hospice and palliative care ideals into broader public health practice.

Aim: To explore public perceptions of palliative care and identify strategies to raise awareness.

Design: An exploratory qualitative approach. Participants: Semi-structured telephone interviews were undertaken (N = 50) with members of the public who volunteered to participate in the study. The interviews focused on knowledge and perceptions of palliative care, expectations of palliative care services and the identification of strategies to raise public awareness of palliative care. The interviews were audio recorded and content analysed.

Results: Most participants had a general knowledge of palliative care, largely influenced by their own personal experience. They identified that palliative care was about caring for people who were dying and maintaining comfort in the last days of life. Participants expectations of services included the following: holistic support, symptom management, good communication and practical support to enable choice and carer support. Key aspects identified for promoting palliative care were the development of understanding and use of the term itself and targeted educational strategies.

Conclusion: Experience of palliative care generates understanding in the general public who also have ideas for increasing knowledge and awareness. The findings can inform policymakers about strategies to raise public awareness of palliative care.

The cemented custom femoral stem--a 10 year review

We report a series of 706 patients (759 hip implants) with an average follow up of 10.5 years (range, 10-11 years) following total hip replacement (THR) using a cemented custom-made femoral stem and a cemented HDP acetabular component. The fate of every implant is known. One hundred and seventy-four patients (23%) were deceased at the time of their 10-year review all died with a functioning THR in situ. Four hundred and sixty-two patients (61%) were subsequently reviewed. One hundred and twenty three patients (16%) were assessed by telephone review, as they were too ill or unwilling to attend. Kaplan-Meier survival analysis (all components) demonstrated a median survival at 10 years of 96.05% or 95% Confidence Intervals (CI) for median survival of (94.41% to 97.22%). Revision surgery occurred in 30 cases (3.9%). Seventeen had full revisions (2.2%) and 13 (1.7%) socket revisions only. Twenty-one out of 30 revisions were for infection or dislocation. There were 2 cases (0.3%) of revision for aseptic loosening of the stem. The 10-year results of the custom femoral titanium stem are encouraging and compare well with other cemented systems.

Student Teachers’ Perceptions of the Effectiveness of their Initial Preparation

What influences how well-prepared student teachers feel towards working in schools upon completion of their initial teacher preparation (ITP)? In order to investigate this question, we used a path analysis using data from a longitudinal study investigating the experiences of trainee and early career phase teachers in England. The data were generated via self-complete questionnaires and follow-up telephone interviews with 1,322 trainees. Those on undergraduate or school-based programmes felt better prepared to work as teachers than one-year postgraduate trainees, perhaps because the former give higher ratings of the quality of assessment of, and feedback received on, teaching practice, and because of the clarity of theory-practice links in programmes. Across different kinds of ITP programme, good relationships with school-based mentors significantly boosted trainees' confidence that their ITP had effectively prepared them for teaching. Trainees' motives for entering the profession and their initial concerns about and expectations of ITP also affected their perceptions of its effectiveness, by shaping the way they experienced aspects of their courses. Implications of these findings for policy and practice in teacher preparation are discussed. © 2011 Blackwell Publishing Ltd.

Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership):Do they contribute to differences in cancer survival?

Background:There are wide international differences in 1-year cancer survival. The UK and Denmark perform poorly compared with other high-income countries with similar health care systems: Australia, Canada and Sweden have good cancer survival rates, Norway intermediate survival rates. The objective of this study was to examine the pattern of differences in cancer awareness and beliefs across these countries to identify where these might contribute to the pattern of survival.Methods:We carried out a population-based telephone interview survey of 19 079 men and women aged =50 years in Australia, Canada, Denmark, Norway, Sweden and the UK using the Awareness and Beliefs about Cancer measure.Results:Awareness that the risk of cancer increased with age was lower in the UK (14%), Canada (13%) and Australia (16%) but was higher in Denmark (25%), Norway (29%) and Sweden (38%). Symptom awareness was no lower in the UK and Denmark than other countries. Perceived barriers to symptomatic presentation were highest in the UK, in particular being worried about wasting the doctor's time (UK 34%; Canada 21%; Australia 14%; Denmark 12%; Norway 11%; Sweden 9%).Conclusion:The UK had low awareness of age-related risk and the highest perceived barriers to symptomatic presentation, but symptom awareness in the UK did not differ from other countries. Denmark had higher awareness of age-related risk and few perceived barriers to symptomatic presentation. This suggests that other factors must be involved in explaining Denmark's poor survival rates. In the UK, interventions that address barriers to prompt presentation in primary care should be developed and evaluated. © 2013 Cancer Research UK. All rights reserved.