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

Études de cas sur l’impact de l’intégration du programme d’Agrément Canada sur le changement et l’apprentissage organisationnel : la Health Authority of Anguilla et la Ca’ Foncella Ospetale di Treviso

Cette recherche évalue si l’intégration du programme d’agrément MIRE (Mesures implantées pour le renouveau de l’évaluation) d’Agrément Canada, anciennement Conseil canadien d’agrément des services de santé, engendre du changement et de l’apprentissage organisationnel. Elle étudie le cas de deux organismes de santé, la Health Authority of Anguilla (HAA) et la Ca’ Foncella Opetale de Treviso (CFOT). La recherche comporte trois niveaux d’analyse pour lesquels des données qualitatives et quantitatives ont été recueillies : 1) les membres des équipes d’agrément; 2) les équipes d’agrément; 3) l’organisme dans son ensemble. Des questionnaires individuels administrés aux membres des équipes, des entretiens semi-structurés avec les chefs des équipes et les coordonnateurs de la qualité, une revue de documentation et plusieurs mesures périodiques du niveau de compliance aux normes MIRE ont été les techniques de collecte de données utilisées. Les résultats indiquent que les organismes ont opéré des transformations : 1) stratégiques; 2) de l’organisation; 3) des relations avec son environnement. Ils ont amélioré leurs systèmes et leurs pratiques de gestion de même que leurs communications internes et externes. Il y a eu aussi des apprentissages utiles par les individus, les équipes et les organismes. Les apprentissages individuels concernaient les programmes qualité, l’approche centrée sur la clientèle, la gestion des risques, l’éthique professionnelle, la gestion participative et l’évaluation des services. Les étapes « autoévaluation » et « apporter des améliorations et donner suite aux recommandations » du cycle d’agrément ont contribué le plus au changement et à l’apprentissage organisationnel. Les équipes interdisciplinaires d’agrément ont été le véhicule privilégié pour réaliser ces changements et ces apprentissages. La HAA et la CFOT ont amélioré progressivement leur niveau de compliance aux normes dans toutes les dimensions de la qualité, au niveau des équipes d’agrément et pour l’ensemble de l’organisation. Néanmoins, l’amélioration du niveau global de compliance était en deçà de la limite minimum des exigences du programme pour l’obtention d’un statut d’agrément sans restrictions importantes. L’envergure des changements et des apprentissages réalisés soulève la question de la capacité des organismes d’institutionnaliser ces nouvelles connaissances. La CFOT pourrait y arriver étant donné les ressources et les compétences à sa disposition.

Attitudes et habitudes de Canadiens relativement à la préparation des aliments à la maison et au repas en famille

Objectif. Décrire les attitudes et habitudes de Canadiens relativement à la préparation des aliments à la maison et au repas familial, afin de saisir les motivations à exploiter lors de la promotion de ces habitudes. Méthodes. Un sondage électronique de 39 questions à choix multiples a été placé sur le site des Diététistes du Canada du 16 novembre au 22 décembre 2006. Les énoncés analysés abordent la perception des bénéfices associés à la cuisine maison, à la planification des soupers et au repas familial, les obstacles à cuisiner, le temps de préparation et la planification des soupers, l’apprentissage de la cuisine, les sources d’idées recettes et la consommation des repas familiaux. Résultats. Au total, 4080 individus ont complété le questionnaire. Bien qu’ils croient que la cuisine maison puisse améliorer la qualité de l’alimentation et les comportements alimentaires, les répondants rencontrent plusieurs obstacles à la préparation des aliments au quotidien, parmi lesquels le manque de temps, d’énergie, d’idées et de planification. Bien qu’une majorité de Canadiens soupent en famille, il existe des écarts selon les groupes d’âge et les régions canadiennes. Conclusion. Cette étude souligne la pertinence d’élaborer des stratégies de communication pour informer les consommateurs sur les bénéfices de la cuisine maison et du repas en famille, afin de les aider à surmonter les défis associés à ces habitudes. Si les nutritionnistes sont des intervenants de choix, des collaborations interdisciplinaires sont proposées pour promouvoir une cuisine maison saine, bien planifiée, simplifiée et savourée en famille.

Variance in Bioethics Services: Challenges and Opportunities in Canada with a Focus on In-house vs. Outsourced Health Care Ethics Consultations

Étude de cas / Case study

Weight of evidence needed to substantiate a health effect for probiotics and prebiotics: regulatory considerations in Canada, EU, and US

Successful and responsible introduction of probiotic and prebiotic products into the worldwide marketplace requires labelling for health benefits that meets consumer needs, adheres to regulatory standards and does not overextend scientific evidence. Regulations differ among countries, but underlying all is an emphasis on scientific credibility of any statements of health benefits. This paper considers the value of different types of evidence offered in substantiation of efficacy and reviews different regulatory approaches to labelling for health claims. Limitations of in vitro, animal and different types of human studies used for efficacy substantiation for probiotics and prebiotics are discussed.

Dairy farmers’ attitudes and intentions towards improving dairy cow foot health

Dairy cow foot health is a subject of concern because it is considered to be the most important welfare problem in dairy farming and causes economic losses for the farmer. In order to improve dairy cow foot health it is important to take into account the attitude and intention of dairy farmers. In our study the objective was to gain insight into the attitude and intention of dairy farmers to take action to improve dairy cow foot health and determine drivers and barriers to take action, using the Theory of Planned Behavior. Five hundred Dutch dairy farmers were selected randomly and were invited by email to fill in an online questionnaire. The questionnaire included questions about respondents’ intentions, attitudes, subjective norms and perceived behavioral control and was extended with questions about personal normative beliefs. With information from such a framework, solution strategies for the improvement of dairy cow foot health can be proposed. The results showed that almost 70% of the dairy farmers had an intention to take action to improve dairy cow foot health. Most important drivers seem to be the achievement of better foot health with cost-effective measures. Possible barriers to taking action were labor efficiency and a long interval between taking action and seeing an improvement in dairy cow foot health. The feed advisor and foot trimmer seemed to have most influence on intentions to take action to improve dairy cow foot health. Most farmers seemed to be satisfied with the foot health status at their farm, which probably weakens the intention for foot health improvement, especially compared to other issues which farmers experience as more urgent. Subclinical foot disorders (where cows are not visibly lame) were not valued as important with respect to animal welfare. Furthermore, 25% of the respondents did not believe cows could suffer pain. Animal welfare, especially the provision of good care for the cows, was valued as important but was not related to intention to improve dairy cow foot health. The cost-effectiveness of measures seemed to be more important. Providing more information on the effects of taking intervention measures might stimulate farmers to take action to achieve improvement in dairy cow foot health.

Health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia : a systematic literature review of qualitative and quantitative data.

BACKGROUND: Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim of this study was to identify, summarise and synthesise available research addressing health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. METHODS: A systematic literature search of three databases was conducted in November 2014, as well as a manual search of reference lists. The selection criteria included quantitative and qualitative research studies written in English, regardless of the year of publication, exploring health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. The quality of all articles that met the inclusion criteria was assessed. The studies were critically appraised, and thematic analysis was used to synthesise the data. RESULTS: Thirty-six studies, published during 1977 and 2014, including data from 15 different countries, met the inclusion criteria. Nine key themes were identified as influencing the health care providers' attitudes towards induced abortions: 1) human rights, 2) gender, 3) religion, 4) access, 5) unpreparedness, 6) quality of life, 7) ambivalence 8) quality of care and 9) stigma and victimisation. CONCLUSIONS: Health care providers in sub-Saharan Africa and Southeast Asia have moral-, social- and gender-based reservations about induced abortion. These reservations influence attitudes towards induced abortions and subsequently affect the relationship between the health care provider and the pregnant woman who wishes to have an abortion. A values clarification exercise among abortion care providers is needed.

Influences of infrastructure and attitudes to health on value of travel time savings in bicycle journeys

In this paper we investigate how attitudes to health and exercise in connection with cycling influence the estimation of values of travel time savings in different kinds of bicycle environments (mixed traffic, bicycle lane in the road way, bicycle path next to the road, and bicycle path not in connection with the road). The results, based on two Swedish stated choice studies, suggest that the values of travel time savings are lower when cycling in better conditions. Surprisingly, the respondents do not consider cycling on a path next to the road worse than cycling on a path not in connection to the road, indicating that they do not take traffic noise and air pollution into account in their decision to cycle. No difference can be found between cycling on a road way (mixed traffic) and cycling in a bicycle lane in the road way. The results also indicate that respondents that include health aspects in their choice to cycle have lower value of travel time savings for cycling than respondents that state that health aspects are of less importance, at least when cycling on a bicycle path. The appraisals of travel time savings regarding cycling also differ a lot depending on the respondents’ alternative travel mode. The individuals who stated that they will take the car if they do not cycle have a much higher valuation of travel time savings than the persons stating public transport as the main alternative to cycling.

Knowledge and attitudes of health care workers from intensive care units regarding nosocomial transmission of influenza: a study on the immediate pre-pandemic period

The transmission of influenza in health care settings is a major threat to patients, especially those with severe diseases. The attitude of health care workers (HCWs) may influence the transmission of countless infections. The current study aimed to quantify knowledge and identify attitudes of HCWs involved in intensive care units (ICUs) regarding the risk of nosocomial influenza transmission. A questionnaire was applied through interviews to HCWs who worked in one of the five ICUs from a teaching hospital. Questions about influenza were deliberately dispersed among others that assessed several infectious agents. Forty-two HCWs were interviewed: nine physicians, ten nurses and 23 nursing technicians or auxiliaries. Among the 42 HCWs, 98% were aware of the potential transmission of influenza virus in the ICUs, but only 31% would indicate droplet precautions for patients with suspected infection. Moreover, only 31% of them had been vaccinated against influenza in the last campaign (2008). Nursing technicians or auxiliaries were more likely to have been vaccinated, both by univariate and multivariable analysis. When asked about absenteeism, only 10% of the study subjects stated that they would not go to work if they had an influenza-like illness. Those findings suggest that, in non-pandemic periods, influenza control in hospitals requires strategies that combine continuous education with changes in organizational culture.

A comparative study of health care policy in the United States and Canada: what policymakers in Latin America might and might not learn from their neighbors to the North

Includes bibliography