Developing a theoretical framework using a nursing perspective to investigate perceived health in the "Sandwich Generation" group

Coexisting workloads from professional, household and family, and caregiving activities for frail parents expose middle-aged individuals, the so-called "Sandwich Generation", to potential health risks. Current trends suggest that this situation will continue or increase. Thus SG health promotion has become a nursing concern. Most existing research considers coexisting workloads a priori pathogenic. Most studies have examined the association of one, versus two, of these three activities with health. Few studies have used a nursing perspective. This article presents the development of a framework based on a nursing model. We integrated Siegrist's Effort-Reward Imbalance middle-range theory into "Neuman Systems Model". The latter was chosen for its salutogenic orientation, its attention to preventive nursing interventions and the opportunity it provides to simultaneously consider positive and negative perceptions of SG health and SG coexisting workloads. Finally, it facilitated a theoretical identification of health protective factors.

Health care workers' influenza vaccination: motivations and mandatory mask policy

BACKGROUND: Vaccination of health care workers (HCW) against seasonal influenza (SI) is recommended but vaccination rate rarely reach >30%. Vaccination coverage against 2009 pandemic influenza (PI) was 52% in our hospital, whilst a new policy requiring unvaccinated HCW to wear a mask during patient care duties was enforced. AIMS: To investigate the determinants of this higher vaccination acceptance for PI and to look for an association with the new mask-wearing policy. METHODS: A retrospective cohort study, involving HCW of three critical departments of a 1023-bed, tertiary-care university hospital in Switzerland. Self-reported 2009-10 SI and 2009 PI vaccination statuses, reasons and demographic data were collected through a literature-based questionnaire. Descriptive statistics, uni- and multivariate analyses were then performed. RESULTS: There were 472 respondents with a response rate of 54%. Self-reported vaccination acceptance was 64% for PI and 53% for SI. PI vaccination acceptance was associated with being vaccinated against SI (OR 9.5; 95% CI 5.5-16.4), being a physician (OR 7.7; 95% CI 3.1-19.1) and feeling uncomfortable wearing a mask (OR 1.7; 95% CI 1.0-2.8). Main motives for refusing vaccination were: preference for wearing a surgical mask (80% for PI, not applicable for SI) and concerns about vaccine safety (64%, 50%) and efficacy (44%, 35%). CONCLUSIONS: The new mask-wearing policy was a motivation for vaccination but also offered an alternative to non-compliant HCW. Concerns about vaccine safety and efficiency and self-interest of health care workers are still main determinants for influenza vaccination acceptance. Better incentives are needed to encourage vaccination amongst non-physician HCW.

The health of adolescents around a world in transition.

Since several years, the health of adolescents is on the agenda of ministers, decision makers and health professionals. Around the world, while there has been a steady decrease of the death rates among young children, this is not the case for young people. This is mainly linked with the fact that mortality and morbidity during this period of life is largely linked with non communicable diseases and conditions, including deaths from injuries, suicide, homicides and drug abuse. Unplanned pregnancies, illegal abortions, newly acquired HIV infections are also situations that have short and long term consequences. This paper reviews the epidemiological data pertaining to adolescent health and disease. It proposes evidence-informed avenues as how to address these issues in the field of health care (e.g. adolescent friendly services) and of prevention and health promotion. It also stresses the importance of creating safe environments for the development and well-being of young people and thus, of an interdisciplinary and inter sectorial approach to their complex health problems and challenges.

A systematic review of Twitter’s hashtags in public health: an example of a globally adopted standard

The objective is to find evidence and make recommendations on the use of Twitter in public health,particularly through the study of hashtags(#). This systematic review shows the use of Twitter in different areas of public health: epidemiological surveillance, health promotion, health protection and disease prevention. Articles on this subject published in indexed journals with impact factor show the importance of conversations to engage the attention of Twitter users by using citations (@ user) and retweets(RT); however, not much importance seems to be given to the use of hashtags(#), which are often assimilated to the concept of keywords. Although tracking recurring hashtagsshould be less expensive than computing Twitter content, the potential of hashtaggeddata has not been properly exploited or recognized over the past years, probably due to the lack of efficient tools.

Schools as Oral Health Promoters – Evaluation of National Sweet Selling Recommendation and Oral Health Education Material

The aims were to find out 1) if schools’ oral health practices were associated with pupils’ oral health behaviour and whether 2) the national sweet-selling recommendation and 3) distributing oral health material (OHEM) affected schools as oral health promoters. Three independently collected datasets from Finnish upper comprehensive schools (N=988) were used: longitudinal oral health practices data (n=258) with three-year follow up (2007 n=480, 2008 n=508, 2009 n=593) from principals’ online questionnaires, oral health behaviour data from pupils participating in the national School Health Promotion Study (n=970 schools) and oral health education data from health education teachers’ online questionnaires (2008 n=563, 2009 n=477 teachers). Oral health practices data and oral health behaviour data were combined (n=414) to answer aim 1. For aims 2 and 3, oral health practices data and oral health education data were used independently. School sweet selling and an open campus policy were associated with pupils’ use of sweet products and tobacco products during school time. The National Recommendation was quite an effective way to reduce the number of sweet-selling schools, but there were large regional differences and a lack of a clear oral health policy in the schools. OHEM did not increase the proportion of teachers teaching oral health, but teachers started to cover oral health topics more frequently. Women started to use OHEM more often than men did. Schools’ oral health policy should include prohibiting the selling of sweet products in school by legislative actions, enabling healthy alternatives instead, and setting a closed campus policy to protect pupils from school-time sweet consuming and smoking.

Development of prebiotic food products and health benefits

In the current context from the nutritional and epidemiological point of view, it can be seen an occurrence increase of Chronic Non-Communicable Diseases, as well as the inflammatory ones, ordinarily associated to a wrong feed, poor in fibers and rich in fats and simple and refined carbohydrates. This view has evidenced a progressive increase of diseases, highlighting the importance of colonic microbiota as an active mechanism of infectious processes control and modulation of immunologic answer. Therefore, constant the worries related to recovering and maintenance of healthy intestines, stocked with prebiotic nutrients that support the survival of beneficial health agents. This way, researchers and the segment of food industry has encouraged the development of products with prebiotic properties, looking for the health promotion, treatment and diseases prevention, besides the strengthening on the competitive market. This article will embrace the contents about physiologic effects of the main known prebiotic, their potential in relation to fermentatives bacterias, new developed products and used methodologies to the recognition of pre and probiotic functions.

Viable Health Games: Elements for Success

The main purpose of this study is to identify the elements of children's health games that have a positive impact on children’s health. The investigation is done by evaluating previous health game studies concentrating on children and five health affairs (such as asthma, cancer, diabetes, nutrition and obesity). In order to do so, firstly the topic of children’s health games is explained through its roots, as it is an interdisciplinary topic pertinent with many other fields. For this reason, the topics regarding the children’s health games as games, video games, children’s gameplay, and serious games along with health, relevant health affairs, and health promotion were covered. Secondly, the meta-study was conducted with the 56 articles on children’s health games. These 56 articles were analyzed with the coding technique defined by Charmaz’s Grounded Theory Method (Charmaz, 2006) for finding out which elements of children’s health games have a positive impact on children’s health promotion. The main result suggests that, although there are 24 different elements found and listed which all positive in their nature, their positive impact is a matter of how they are used or implemented through the consumption cycle of children’s health games and how all these elements interact with each other. In addition to this, a pragmatic proposal is formulated for possibly better or more successful health games. The study concludes with the declaration of the limitations encountered through the research and the recommendations for future research.

Viable Health Games: Elements for Success

The main purpose of this study is to identify the elements of children's health games that have a positive impact on children’s health. The investigation is done by evaluating previous health game studies concentrating on children and five health affairs (such as asthma, cancer, diabetes, nutrition and obesity). In order to do so, firstly the topic of children’s health games is explained through its roots, as it is an interdisciplinary topic pertinent with many other fields. For this reason, the topics regarding the children’s health games as games, video games, children’s gameplay, and serious games along with health, relevant health affairs, and health promotion were covered. Secondly, the meta-study was conducted with the 56 articles on children’s health games. These 56 articles were analyzed with the coding technique defined by Charmaz’s Grounded Theory Method (Charmaz, 2006) for finding out which elements of children’s health games have a positive impact on children’s health promotion. The main result suggests that, although there are 24 different elements found and listed which all positive in their nature, their positive impact is a matter of how they are used or implemented through the consumption cycle of children’s health games and how all these elements interact with each other. In addition to this, a pragmatic proposal is formulated for possibly better or more successful health games. The study concludes with the declaration of the limitations encountered through the research and the recommendations for future research.

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.

Health-related learning needs and interests of selected non-institutionalized elderly

The research question in this study was "How do the noninstitutionalized elderly in the Hamilton-Wentworth Region perceive their learning needs and interests related to health?" The theoretical foundations of instruction for adults were reviewed as well as learning needs and interests in adult education, the assessment of learning needs in general, and the assessment of the learning needs of the elderly. The methodology used was a descriptive design. A research-based questionnaire-interview was developed, refined, and pilot tested. From a random sampling procedure, a participant group of 23 was secured. The questionnaireinterview was administered in a home visit situation. Data, which were collected, were coded, analyzed, processed, and printed. The results indicated that each participant had many learning needs and interests of varying intensities. The participants had many preferences in the delivery of health promotion. The learning needs and interests had several significant correlations with other variables. The implications of the result~ were discussed.

Self-reported health status and lifestyle behaviours of the residents of the Town of Fort Erie, Ontario, as related to the Canadian Community Health Survey

The purpose of this cross sectional survey design was to examine self-reported health status and lifestyle behaviours of the residents of the Town of Fort Erie, Ontario, as related to the Canadian Community Health Survey. Using a mail-out survey, entitled the Fort Erie Survey of Health (FESH), a probability cluster sampling technique was used to measure self-reported health status (present health, health conditions, health challenges, functional health limitations) and lifestyle behaviour (smoking, alcohol use, drug use, physical activity, fruit and vegetable consumption, body weight, and gaming). Each variable was described and analyzed in relation to socio-economic variables, age and gender. The findings from this study were compared to the Canadian Community Health Survey 2000/2001. Overall, 640 surveys were completed. The majority of Fort Erie residents rated their present health as good and were satisfied with their overall health and quality of life. The main chronic conditions reported were arthritis, back pain and heart disease. Other main health problems reported were vision, sleeping and chronic pain. Overall, 14.6% smoke; 58.8% engaged in physical activity either occasionally or never as opposed to regularly engaging in physical activity; 52.1% did not eat the required daily fruits and vegetables; and 40.0% were in the overweight category. Persons who practiced one healthy lifestyle behaviour were more likely to practice other healthy promoting behaviours. Therefore, health promotion programs are best designed to address multiple risk factors simultaneously. The ffiSH was generally consistent with the Canadian Community Health Survey in the overall findings. A small number of inconsistencies were identified that require further exploration to determine if they are unique to this community.

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.

Exploring Chinese-Canadians' perspectives on health : a quantitative study

Chinese have unique perspectives on health and illness, which is mostly umecognized by western medicine. Immigration may contribute to problems with health consultations, inconvenience, and dissatisfaction. As the largest visible minority in Canada, Chinese- Canadians' perspectives on health should be studied in order to help Chinese immigrants adapt to a new health-care and health-promotion system, and keep them healthy. A quantitative questionnaire was designed based on the findings from a pilot study and previous literature. A hundred participants were recruited from Toronto, Vancouver, Halifax, and St. Catharines. Descriptive analysis and correlation analysis were used to investigate the structure of the variables. Findings indicated that most oftheir attitudes and corresponding practices to the different health aspects were positive. The relation between dietary practices and attitude was only found in small cities. Their attitudes were impacted by their length of stay in Canada. Their attitudes to regularly timed meals and psychological consultation were related to their acculturation level, as was the regularity of their practice of dental flossing. Their self-evaluated general health levels were also found to be affected by their medical history, education level, feeling to talk about • sexual health, and smoking, particularly in the male subjects of the study. In conclusion, they realized that each health aspect w~s important to their health. However, their practices did not bear a strong relation to their beliefs. Traditional thoughts about health reseeded with time. Acculturation level did not affect most of their attitudes or practices. Under pressure, the priority of the daily health practices decreased. Older persons, those with low incomes, lower education levels or families under stress need to pay more attention to their health level. In-depth future research was recommended.

A needs assessment of public health professionals: supporting the implementation of Ontario 2010 revised elementary health and physical education curriculum

Based on the Comprehensive School Health framework, Ontario's Foundations for a Healthy School (2009) outlines an integrated approach to school health promotion. In this approach the school, community and partners (including public health) are fully engaged With a common goal of youth health. With the recent introductions of the Ontario Public Health Standards (2009) and the revised elementary health and physical education curriculum (2010), the timing for a greater integration of public health with schools is ideal. A needs assessment was conducted to identify the perceived support required by public health professionals to implement the mandates of both policy documents in Ontario. Data was collected for the needs assessment through facilitated discussions at a provincial roundtable event, regional focus groups and individual interviews with public health professionals representing Ontario's 36 public health units. Findings suggest that public health professionals perceive that they require increased resources, greater communication, a clear vision of public health and a suitable understanding of the professional cultures in which they are surrounded in order to effectively support schools. This study expands upon these four categories and the corresponding seventeen themes that were uncovered during the research process.

Active2010 and the Ontario School System: A Top-Down Policy Implementation Analysis

In 2004, the Ontario Ministry of Health Promotion and Sport (MHPS) established Active2010: Ontario’s Sport and Physical Activity Strategy. Active2010 demonstrates a strong provincial government policy emphasis regarding sport participation and physical activity (PA), and identifies the school system as a primary vehicle for enhancing PA levels. This study examines the sport and PA initiatives MHPS is undertaking within the school system. Theoretical context regarding neo-liberalism in Canada and Canadian sport frames this study, while a revised version of Van Meter and Van Horn’s (1975) top-down model of policy implementation guides the research process. A case study of the school-based PA system is conducted which relies on the analysis of 11 semi-structured interviews and 47 official organizational documents. Four emergent categories of Jurisdictional Funding, Coercive Policy, Sector Silos, and Community Champions are identified. Additional insight is provided regarding neo-liberalism, provincial level government, interministerial collaboration, and government/non-profit sector partnership.