Introducing e-learning in a large multisite academic health sciences centre: a case study of e-curriculum planning and educator support /

This qualitative study investigated how a team of 7 hospital educators collaborated to develop e-curriculum units to pilot for a newly acquired learning -r management system at a large, multisite academic health sciences centre. A case study approach was used to examine how the e-Curriculum Team was structured, how the educators worked together to develop strategies to better utilize e-leaming in their ovwi practice, what e-curriculum they chose to develop, and how they determined their priorities for e-curriculum development. It also inquired into how they planned to involve other educators in using e-leaming. One set of semistructured interviews with the 6 hospital educators involved in the project, as well as minutes of team meetings and the researcher's journal, were analyzed (the researcher was also a hospital educator on the team). Project management structure, educator support, and organizational pressures on the implementation project feature prominently in the case study. This study suggests that implementation of e-leaming will be more successful if (a) educators involved in the development of e-leaming curriculum are supported in their role as change agents, (b) the pain of vmleaming current educational practice is considered, (c) the limitations of the software being implemented are recognized, (d) time is spent leaming about best practice, and (e) the project is protected as much as possible from organizational pressures and distractions.

Determining the Effectiveness of the Therapeutic Recreation Specialist - Certified Training at Baycrest Health Sciences

The purpose of this study was to determine the effectiveness of the “Champion” training of the Therapeutic Recreation Specialist – Certified (TRSC) at Baycrest Health Sciences (BHS). BHS recently implemented a new model for Therapeutic Recreation Services that employs the model of champion for implementation of both best and next practices within the organization. This mixed methods study used both case study and program evaluation in order to understand whether the training that comprised of five different topics allowed the six participants to develop the skills needed to be champions. The results supported that learning did occur during the training and that the experience was positive for the participants. The overall finding from this study is that while the training was useful, the participants did not feel confident about utilizing these skills without further training; hence, this training can only be considered an introduction to the concepts presented.

Ethics, tourists and the environmental practices of the North American cruise ship industry: a comparison study of the ethical standards of Alaskan and Caribbean cruise ship tourists

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 R43 S54 2005

The Influence of Burnout Symptoms on the Relationship between Work-Life Balance and Self-Rated Health

The effects of stress at work are estimated to cost Canadian employers more than 20 billion dollars annually through absenteeism, sick leave and decreased productivity. Over the past two decades, Canadians have reported higher stress levels, increased work hours and more work performed outside of normal business hours. This work-life imbalance has far-reaching repercussions–affecting an employee’s performance as well as their health. Chronic exposure to these high levels of stress can also lead to burnout. The primary purpose of this study was to determine the magnitude in which burnout symptoms influence the relationship between work-life balance and self-rated health. The secondary purpose of this study was to determine if gender and age interactions exist in the relationship between burnout, work-life balance, and self-rated health. This cross-sectional study involved secondary analysis of 220 managers, workers and human service professionals who completed an Occupational Health Clinics for Ontario Workers’ Mental Injury Toolkit (MIT) survey for the launch of the MIT. The MIT survey is a modified form of the short version of the Copenhagen Psychosocial Questionnaire and includes expanded questioning around burnout, stress, sleep troubles, cognitive, and somatic symptoms. There were no significant differences in self-rated health based on a respondent’s gender or age, indicating that no interaction of gender and age would be required. Respondents with low self-rated health reported significantly higher burnout and work-life imbalance compared to those with high self-rated health. The regression analysis demonstrated that the magnitude in which burnout mediates the relationship between work-life balance and self-rated health was 96%. These findings support previous studies that associate high levels of work-life imbalance or burnout with poor self-rated health or health outcomes. In this study, the shared variance between work-life balance and burnout also supports recent efforts to redefine the context and causes of burnout to include non-work factors. Based on our findings, the potential exists for the development of workplace health promotion strategies that address maintaining a balance between work and home as they may improve employee health and reduce burnout.

The effectiveness of a health versus appearance message on pregnant women's intentions to exercise postpartum : the moderating role of self-monitoring

Despite the confimied health benefits of exercise during the postpartum period, many new mothers are not sufficiently active. The present research aimed to examine the effectiveness of 2 types of messages on intention to exercise after giving birth on 2 groups of pregnant women (low and high self-monitors) using the Theory of Planned Behavior as a theoretical basis. Participants were 2 1 8 pregnant women 1 8 years of age and older (Mean age = 27.9 years, SD = 5.47), and in their second or third trimester. Women completed a demographics questionnaire, a self-monitoring (SM) scale and the Godin Leisure Time Exercise Questionnaire for current and pre-pregnancy exercise levels. They then read one of two brochures, describing either the health or appearance benefits of exercise for postpartum women. Women's attitudes, social norms, perceived behavioral control, and intentions to exercise postpartum were then assessed to determine whether one type of message (health or appearance) was more effective for each group. A MANOVA found no significant effect (p>0.05) for message type, SM, or their interaction. Possible reasons include the fact that the two messages may have been too similar, reading any message about exercise may result in intentions to exercise, or lack of attention given to the brochure. Given the lack of research in this area, more studies are necessary to confirm the present results. Two additional exploratory analyses were conducted. Pearson correlations found higher levels of pre-pregnancy exercise and current exercise to be associated with more positive attitudes, more positive subjective norms, higher perceived behavioral control, and higher intention to exercise postpartum. A hierarchical regression was conducted to determine the predictive utility of attitudes, subjective norms, and perceived behavioral control on intention for each self-monitoring group. Results of the analysis demonstrated the three independent variables significantly predicted intention (p < .001) in both groups, accounting for 58-62% of the variance in intention. For low self-monitors, attitude was the strongest predictor of intention, followed by perceived behavioral control and subjective norm. For high self-monitors, perceived behavioral control was the strongest predictors, followed by attitudes and subjective norm. The present study has practical and real world implications by contributing to our understanding of what types of messages, in a brochure format, are most effective in changing pregnant women's attitudes, subjective norm, perceived behavioral control and intention to exercise postpartum and provides ftirther support for the use of the Theory of Planned Behavior with this population.

The capillary supply of human skeletal muscle in health and disease

BACKGROUND: Capillaries function to provide a surface area for nutrient and waste exchange with cells. The capillary supply of skeletal muscle is highly organized, and therefore, represents an excellent choice to study factors regulating diffusion. Muscle is comprised of three specific fibre types, each with specific contractile and metabolic characteristics, which influence the capillary supply of a given muscle; in addition, both environmental and genetic factors influence the capillary supply, including aging, physical training, and various disease processes. OBJECTIVE: The present study was undertaken to develop and assess the functionality of a data base, from which virtual experiments can be conducted on the capillary supply of human muscle, and the adaptations of the capillary bed in muscle to various perturbations. METHODS: To create the database, an extensive search of the literature was conducted using various search engines, and the three key words - "capillary, muscle, and human". This search yielded 169 papers from which the data for the 46 variables on the capillary supply and fibre characteristics of muscle were extracted for inclusion in the database. A series of statistical analyses (ANOVA) were done on the capillary database to examine differences in skeletal muscle capillarization and fibre characteristics between young and old individuals, between healthy and diseased individuals, and between untrained, endurance trained, endurance welltrained, and resistance trained individuals, using SAS. RESULTS: There was a significantly higher capillarization in the young compared to the old individuals, in the healthy compared to the diseased individuals, and in the endurance-trained and endurance well-trained compared to the untrained individuals. CONCLUSIONS: The results of this study support the conclusion that the capillary supply of skeletal muscle is closely regulated by factors aimed at optimizing oxygen and nutrient supply and/or waste removal in response to changes in muscle mass and/or metabolic activity.

Migrations and gradations : reappraising the health profile of immigrants to Canada

New immigrants to Canada typically have a more favourable health profile than the non-immigrant population. This phenomenon, known as the 'healthy immigrant effect', has been attributed to both the socioeconomic advantage (ie. educational attainment, occupational opportunity) of non-refugee immigrants and existing screening protocols that admit only the healthiest of persons to Canada. It has been suggested that this health advantage diminishes as the time of residence in Canada increases, due in part to the adoption of health-risk behaviours such as alcohol and cigarette use, an increase in excess body weight, and declining rates of physical activity. However, the majority of health research concerning immigrants to Canada has been limited to cross-sectional studies (Dunn & Dyck, 2000; Newbold & Danforth, 2003), which may mask an immigrant-specific cohort effect. Furthermore, the practice of aggregating foreign-bom persons by geographical regions or treating all immigrants as a homogeneous group may also obfuscate intra-immigrant differences in health. Accordingly, this study uses the Canadian National Population Health Surveys (NPHS) and data from the United Nations Development Program (UNDP) to prospectively evaluate factors that predict health status among immigrants to Canada. Each immigrant in the NPHS was linked to the UNDP Human Development Index of their country of birth, which uses a combined measure of health, education, and per capita income of the populace. The six-year change in health function, psychological distress, and self-rated health were considered from a population health perspective (Evans, 1994), using generalized-estimating equations (GEE) to examine the compounding effect of past and recent predictors of health. Demographic

Comprehensive school health : an ethnographic case study

The purpose of this ethnographic case study was to describe the characteristics of one school's Comprehensive School Health (CSH) initiative and to explore the experiences of school community members in order to gain an understanding of how one school embraced a Comprehensive School Health approach. An elementary school (grades Junior Kindergarten to six) in Burlington, Ontario was the research site for this study. Multiple methods of data collection (observations, document analysis, interviews) were used in keeping with the ethnographic and case study approach. The data were coded using both a deductive and then inductive process (Merriam, 1998). From a deductive perspective, the coding system and the subsequent identification of categories were based on a priori categories identified by using the elements of CSH based on the Comprehensive School Health Consensus Statement prepared by the Canadian Association of School Health and the research questions. Findings included the role that various school community members as well as the implementation of different programs and policies played in applying a CSH approach. The impact ofthe physical environment was described as well as successes and challenges related to the school's experience in implementing CSH. Three main themes emerged that characterized this school's experience. The first theme relates to the fundamental question about CSH which is the school community's understanding o/the concept. The second theme focused on positive school culture and the third and most diverse theme was that of capacity. Engaging in CSH is a complex and long-term undertaking involving both the school and greater community. Based on the experiences of this school's community members, recommendations address the different levels of influence on the health of children.

Characterisation and optimisation of the flavour of health-promoting, plantderived bitterants in functional beverages.

Flavour is a combination of taste, odour, and chemesthetic sensations. Close associations exist between these sensory modalities, and thus, the overall flavour of a food or beverage product can change when the intensity of one or more of these sensations is altered. Strategies to modify flavour are often utilized by the food industry, and are central to the engineering of new and reformulated products. For functional food and beverages, flavour modification is particularly important, as fortifying agents can elicit high levels of less than desirable sensations, such as bitterness and astringency. The application of various flavour modifying strategies can decrease the perceived intensity of these sensations, and in tum, improve the sensory profile of the product. This collection of studies describes the sensory characteristics of experimental functional beverages fortified with trans-resveratrol, (+)-catechin, and/or caffeine, and examines the impact of novel flavour modifying strategies on the perceived flavour of these beverages. In the first study, results demonstrate that the flavour profile of Cabemet Sauvignon wines fortified with 20 mglL and 200 mg/L of trans-resveratrol is not perceived as different compared to control wine (0 mglL). However, Riesling wine fortified with 200 mg/L is perceived as significantly higher in bitterness compared to 20 mglL and control. For some functional food formulations, alternative strategies for flavour modification are needed. Traditional methods, such as the addition of sucrose and sodium chloride, may decrease the perceived 'healthiness' of a product, and thus, may be sub-optimal. In a second study, high and low concentrations of five different bitter inhibiting compounds - 'bitter blockers' - (B-cyclodextrin, homoeridictyol sodium salt, carboxymethylcellulose - low viscosity, zinc sulfate, magnesium sulfate) were tested for their efficacy towards decreasing the bitterness of high and low concentrations of caffeine and (+)catechin - two health-relevant, plant-derived bitterants. B-cyclodextrin and homoeridictyol sodium salt were the most effective blockers at decreasing (+ )-catechin and caffeine, respectively. In addition to bitter blockers, additional flavour modifying strategies, either alone or in combination - may also be successful in functional food formulations. Both sucrose and rebaudioside A - a plant-derived sweetener - were effective at decreasing the bitterness of (+)catechin. When added to (+)-catechin along with B-cyc1odextrin, both sweeteners provided the most effective decrease in bitterness compared to binary, ternary, or quaternary mixtures of (+)catechin together with bitter blockers, sweeteners, andlor odourants. The perceived intensity of sensations elicited by sweeteners and odourants was not affected by the addition of bitter blockers, and thus, their impact within these complex matrices is minimal. In addition, withinmodal (taste-taste) compared to cross-modal (taste-odour) sensory interactions were more effective at decreasing the bitterness of (+ )-catechin. Overall, results from these studies demonstrate that certain novel, alternative flavour modifying approaches may be successful towards lowering the bitterness and astringency elicited by (+ )-catechin and caffeine in aqueous solutions.

The Influence of Cerebral Blood Flow and Carbon Dioxide on Neuromuscular Responses During Environmental Stress

Although reductions in cerebral blood flow (CBF) may be implicated in the development of central fatigue during environmental stress, the contribution from hypocapnia-induced reductions in CBF versus reductions in CBF per se has yet to be isolated. The current research program examined the influence of CBF, with and without consequent hypocapnia, on neuromuscular responses during hypoxia and passive heat stress. To this end, neuromuscular responses, as indicated by motor evoked potentials (MEP), maximal M-wave (Mmax) and cortical voluntary activation (cVA) of the flexor carpi radialis muscle during isometric wrist flexion, was assessed in three separate projects: 1) hypocapnia, independent of concomitant reductions in CBF; 2) altered CBF during severe hypoxia and; 3) thermal hyperpnea-mediated reductions in CBF, independent of hypocapnia. All projects employed a custom-built dynamic end-tidal forcing system to control end-tidal PCO2 (PETCO2), independent of the prevailing environmental conditions, and cyclooxygenase inhibition using indomethacin (Indomethacin, 1.2 mg·Kg-1) to selectively reduce CBF (estimated using transcranial Doppler ultrasound) without changes in PETCO2. A primary finding of the present research program is that the excitability of the corticospinal tract is inherently sensitive to changes in PaCO2, as demonstrated by a 12% increase in MEP amplitude in response to moderate hypocapnia. Conversely, CBF mediated reductions in cerebral O2 delivery appear to decrease corticospinal excitability, as indicated by a 51-64% and 4% decrease in MEP amplitude in response to hypoxia and passive heat stress, respectively. The collective evidence from this research program suggests that impaired voluntary activation is associated with reductions in CBF; however, it must be noted that changes in cVA were not linearly correlated with changes in CBF. Therefore, other factors independent of CBF, such as increased perception of effort, distress or discomfort, may have contributed to the reductions in cVA. Despite the functional association between reductions in CBF and hypocapnia, both variables have distinct and independent influence on the neuromuscular system. Therefore, future studies should control or acknowledge the separate mechanistic influence of these two factors.

The role of self-presentation in adolescent health risk behaviours

Self-presentation has been identified as playing a key role in the perfonnance of various potentially hazardous health behaviours such as substance abuse, eating disorders and reckless behaviours (Leary, Tchividjian, & Kraxberger, 1994; Martin & Leary, 2001; Martin, Leary, & O'Brien, 2001). The present study investigated the role of selfpresentation on adolescent health-risk behaviours. Specifically, this study examined the prevalence of adolescent identified health-risk behaviours rooted in self-presentational motives in youths aged 13-18 years. The current study also identified the specific images associated with these behaviours desired by youth, and the targets of these behaviours. Also, the relationship between these behaviours, and several trait measures (social physique anxiety, public-self consciousness, fear of negative evaluations, selfpresentational efficacy) of self-presentation were examined. Finally, the gender differences in health risk behaviours and self-presentational concerns were examined. Participants in the present study were 96 adolescent students, 34 male and 62 female, recruited from various private schools across Southern Ontario. Students ranged in age from 13 to 18 years for both males (M age = 15.81 years, SD = 1.49) and females (M age = 14.89 years, SD = 1.17) and ranged from grades 8 through 13. Results of the current study suggested that Canadian adolescents between the ages of 13 and 18 years participated in health risk behaviours for self-presentational purposes. Drinking alcohol, skipping school, and performing stunts and dares were identified as the most common health risk behaviours performed for self-presentational purposes by both males and females. Appearing fun and cool were the most commonly reported desired images while appearing brave and mature were the least reported. The most desired target group cited was same sex friends, followed by other sex friends. Trait measures of self-presentational concerns identified females as being higher in public self-consciousness, and social physique anxiety than males. Males were found to be higher in self-presentational efficacy than females. The total number of health risk behaviours was predicted by selfpresentational efficacy and social physique anxiety for males, and social physique anxiety for females. Findings of the current study suggest that Canadian adolescents' health risk behaviours are rooted, in part, in self-presentational motives. Thus far, an educational approach to health interventions has been favoured and/or adopted by teachers, health promoters, and educators (Jessor, 1992). Implications of the current study suggest that although educational interventions are beneficial in presenting the associated risks with certain activities and/or behaviours, one reason this type of approach may be ineffective in changing adolescent behaviour over the long run is that it does not address the strong and prominent influences of interpersonal motives on health damaging behaviour. It is evident that social acceptance and public image are of importance to adolescents, and the desire to make the "right" impression and to achieve peer approval and acceptance often override health and safety concerns (Jessor, 1992). Thus, a self-presentational approach focusing on changing the images associated with the behaviours may be more successful at deterring adolescent health risk behaviours.

What children value : a scale to guide health promotion programs

Objective. Physical activity is important for the health of all human beings. Although it is important to develop good health promotion programs for children to increase participation in physical activity, to date there appear to be no programs based on what kids value beyond health and physical activity itself. This study proposed to create a scale with strong content and face validity that could uncover what any given population of children value in life regardless of their participation in physical activity and that experts feel could be related to physical activity. These findings will allow the development of targeted health promotion programs to increase children's participation in regular physical activity. Method In this study, a combination of qualitative and quantitative approaches was used. Data were gathered from seven experts in the field, sixty-seven children in grades three to five, five parents, and three teachers. From these data response groupings were created and sent to four experts to be given single word names. The resulting nine theme names were re-worked into "child-friendly" language. Four children were then asked to discuss theme names to see if they liked and understood them. The next step involved asking children and experts to rank order the nine themes, the children in general and the experts in terms of relevance to physical activity. From these results, possible versions of the scale were then created using the combined expert/children rankings. Each version was examined for content validity. Two versions of a scale resulted. These were sent to experts, parents, teachers and children in order to determine which one they liked better and to suggest any foreseeable problems. Once this information was collected, a beta (final prototype) version of the scale was created. Results. Nine common theme names were created from the response groupings. All four children agreed that they did understand and like each of the nine theme names. Experts and teachers agreed that full coverage of the content had been achieved. Children suggested a single wording change from "Being Accepted" to "Being Included". Five themes were selected for inclusion. The beta version of the scale included 12 forced choice statements, the first ten comparing all themes against one another followed by two anchor statements. Conclusion. At the outset it was recognized that it is essential to know what children think is important in their lives in order to serve as potential benefits in the development of effective physical activity promotion programs. This study developed a scale which could be used to determine what a population of children feel is important in order to focus health promotion programs for physical activity. The scale has strong face and content validity.

The implications of being an international medical graduate (IMG) in Canadian society : a qualitative study of foreign-trained physicians' resettlement, sense of identity and health status

This qualitative research study used grounded theory methodology to explore the settlement experiences and changes in professional identity, self esteem and health status of foreign-trained physicians (FTPs) who resettled in Canada and were not able to practice their profession. Seventeen foreign-trained physicians completed a pre-survey and rated their health status, quality of life, self esteem and stress before and after coming to Canada. They also rated changes in their experiences of violence and trauma, inclusion and belonging, and racism and discrimination. Eight FTPs from the survey sample were interviewed in semi-structured qualitative interviews to explore their experiences with the loss of their professional medical identities and attempts to regain them during resettlement. This study found that without their medical license and identity, this group of FTPs could not fully restore their professional, social, and economic status and this affected their self esteem and health status. The core theme of the loss of professional identity and attempts to regain it while being underemployed were connected with the multifaceted challenges of resettlement which created experiences of lowered selfesteem, and increased stress, anxiety and depression. They identified the re-licensing process (cost, time, energy, few residency positions, and low success rate) as the major barrier to a full and successful settlement and re-establishment of their identities. Grounded research was used to develop General Resettlement Process Model and a Physician Re-licensing Model outlining the tasks and steps for the successfiil general resettlement of all newcomers to Canada with additional process steps to be accomplished by foreign-trained physicians. Maslow's Theory of Needs was expanded to include the re-establishment of professional identity for this group to re-establish levels of safety, security, belonging, self-esteem and self-actualization. Foreign-trained physicians had established prior professional medical identities, self-esteem, recognition, social status, purpose and meaning and bring needed human capital and skills to Canada. However, without identifying and addressing the barriers to their full inclusion in Canadian society, the health of this population may deteriorate and the health system of the host country may miss out on their needed contributions.

Comprehensive school health, the social determinants of health, and the health status of children

As children are becoming increasingly inactive and obese, there is an urgent need for effective early prevention and intervention programs. One solution is a comprehensive school health (CSH) program, a health promotion initiative aimed at educating students about healthy behaviours and lifestyles, which also provides a link between the school, students, families, and the surrounding community. The purpose of this study was to explore the relationship between different components of CSH programs, as well as three determinants of health (gender, social support, socio-economic status), and physical activity, on the aerobic fitness and body mass index (BMI) of children. A newly developed and pilot-tested survey derived from Health Canada's fourpart CSH model (instruction, social support, support services, and a healthy physical environment) was sent to elementary school principals. Data on the gender, physical activity, parental education, and social support levels of students from these schools were gathered from a previous study. Multiple regression procedures were conducted to estimate the relationships between CSH components, the social determinants of health, physical activity, and BMI and aerobic fitness. Results showed that three CSH components were significantly associated with both BMI and aerobic fitness values in children, but accounted for less than 5% of the variance in both variables. Physical activity partially mediated the relationship between the significant CSH components, BMI, and particularly aerobic fitness. Furthermore, the social determinant and physical activity variables played independent roles in aerobic fitness values. No moderating effects of the social determinants were discovered.