Teacher-Student Rapport: Investigating its Impact on the Dropout Rate in Physical and Health Education

This study was an investigation into whether strong teacher-student rapport relates to the drop-out rates of students in grade 9 and 10 health and physical education (HPE). In the study, One hundred and thirty-six grade 9 students from five high schools in Ontario participated in this study. Findings of whether or not rapport related to students’ decision to take an additional HPE credit beyond grade 9 did not prove conclusive. A significant multivariate interaction effect was not found; however, tests of between-subject effects on sex and grade 10 dropouts showed some interesting trends. More research is needed to further illuminate the link between teacher-student rapport and students’ enrollment in optional HPE classes.

Becoming Peer Health Leaders: A Mixed-Methods Evaluation of a Youth Leadership Camp Preparing Peer Leaders for Participation in a Health Promotion Initiative.

Youth are critical partners in health promotion, but the process of training young people to become meaningfully involved is challenging. This mixed-methods evaluation considered the impact of a leadership camp in preparing 42 grade seven students to become peer health leaders in a ‘heart health’ initiative. The experiences of participants and their sense of agency were explored. Data were collected from pre and post camp surveys, focus groups, student journals and researcher observations. Findings indicate that relationships with peers and adults were key to agency development, and participants appeared to broaden their perspectives on the meanings of ‘health’ and ‘leadership.’ Significant changes on two sub-scales of the Harter Perceived Competence Scale for Children were also found. Suggestions for practice and further research are provided.

Unpacking Pieces of a Puzzle: Understanding Obesity-Related Health Risk through Lifestyle Behaviours and Well-Being

The primary objective of this non-experimental study was to examine the differences based on obesity-related health risk in terms of physical activity, sedentary behaviour and well-being in adults. Participants (N = 50; Mage = 38.50, SDage = 14.21) were asked to wear a SenseWear Armband (SWA) across a seven day monitoring period followed by a questionnaire package. Using the National Institute of Health’s (1998) criteria, participants were classified as either least, increased, or high risk based on waist circumference and Body Mass Index scores. Differences between these classifications were found in the amount of time spent in active energy expenditure for bouts of ten minutes or more (p = .002); specifically between least and high risk (p < .05). No other differences (p > .05) emerged. Participants’ also perceived the SWA as a practical and worthwhile device. Overall, these findings provide practical applications and future directions for health promotional research.

Maternal High Fat Feeding: Impact of Female Offspring Body Composition and Bone Health

High fat diet (HFD) consumption in rodents alters body composition and weakens bones. Whether female offspring of mothers consuming a HFD are similarly affected at weaning and early adulthood is unclear. This research determined whether maternal HFD contributes to long-lasting alterations in body composition and bone health of female offspring. Rats were fed control or HFD for 10 weeks prior to and throughout pregnancy and lactation. Female offspring were studied at weaning or 3 months of age (consumed control diet). Main findings in female offspring: maternal HFD decreased lean mass, increased fat mass and femoral BMD at weaning, but not at 3 months; weanling femoral lipid composition reflected maternal diet, persisting to 3 months of age (decreased total and n6 polyunsaturates, increased saturates); and no differences in femoral strength at 3 months. In summary, 3 month old female offspring have similar body composition and bone health regardless of maternal diet.

Fit For Action: A Comparative Case Study of the Implementation of an Adaptive Fitness and Conditioning Program for Moderate Functioning Teens and Transition Age Youth with ASD

The purpose of my research was to develop and refine pedagogic approaches, and establish fitness baselines to adapt fitness and conditioning programs for Moderate-functioning ASD individuals. I conducted a seven-week study with two teens and two trainers. The trainers implemented individualized fitness and conditioning programs that I developed. I conducted pre and post fitness baselines for each teen, a pre and post study interview with the trainers, and recorded semi-structured observations during each session. I used multi-level, within-case and across case analyses, working inductively and deductively. My findings indicated that fundamental movement concepts can be used to establish fitness baselines and develop individualized fitness programs. I tracked and evaluated progressions and improvements using conventional measurements applied to unconventional movements. This process contributed to understanding and making relevant modifications to activities as effective pedagogic strategies for my trainers. Further research should investigate fitness and conditioning programs with lower functioning ASD individuals.

The Clinical Translation Gap in Child Health Exercise Research: A Call for Disruptive Innovation

In children, levels of play, physical activity, and fitness are key indicators of health and disease and closely tied to optimal growth and development. Cardiopulmonary exercise testing (CPET) provides clinicians with biomarkers of disease and effectiveness of therapy, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response that is hidden when the child is at rest. Yet the growth of clinical trials utilizing CPET in pediatrics remains stunted despite the current emphasis on preventative medicine and the growing recognition that therapies used in children should be clinically tested in children. There exists a translational gap between basic discovery and clinical application in this essential component of child health. To address this gap, the NIH provided funding through the Clinical and Translational Science Award (CTSA) program to convene a panel of experts. This report summarizes our major findings and outlines next steps necessary to enhance child health exercise medicine translational research. We present specific plans to bolster data interoperability, improve child health CPET reference values, stimulate formal training in exercise medicine for child health care professionals, and outline innovative approaches through which exercise medicine can become more accessible and advance therapeutics across the child health spectrum.

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.

How health organizations can apply scenario based planning and analytic technologies to make strategic consequential decisions in a time of uncertainty

The magnitude of the cervical cancer problem, coupled with the potential for prevention with recent technological advances, made it imperative to step back and reassess strategic options for dealing with cervical cancer screening in Kenya. The purpose of this qualitative study was: 1) to explore the extent to which the Participatory Action Research (PAR) methodology and the Scenario Based Planning (SBP) method, with the application of analytics, could enable strategic, consequential, informed decision making, and 2) to determine how influential Kenyan decision makers could apply SBP with analytic tools and techniques to make strategic, consequential decisions regarding the implementation of a Cervical Self Sampling Program (CSSP) in both urban and rural settings. The theoretical paradigm for this study was action research; it was experiential, practical, and action oriented, and resulted in co-created knowledge that influenced study participants’ decision making. Action Africa Help International (AAHI) and Brock University collaborated with Local Decision Influencing Participants (LDIP’s) to develop innovative strategies on how to implement the CSSP. SBP tools, along with traditional approaches to data collection and analysis, were applied to collect, visualize and analyze predominately qualitative data. Outputs from the study included: a) a generic implementation scenario for a CSSP (along with scenarios unique to urban and rural settings), and b) 10 strategic directions and 22 supporting implementation strategies that address the variables of: 1) technical viability, 2) political support, 3) affordability, 4) logistical feasibility, 5) social acceptability, and 6) transformation/sustainability. In addition, study participants’ capacity to effectively engage in predictive/prescriptive strategic decision making was strengthened.

Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.

The perceptions of commune health workers about an education strategy received for counselling fathers about infant and breastfeeding involvement

Objective To evaluate the perceptions of healthcare workers in Vietnam about the efficacy of a continuing education strategy about father involvement and breastfeeding counselling. Design One group, post-test only, quasi-experimental design Method A questionnaire based on Social Cognitive Theory (SCT; Bandura, 2004) was disseminated to participants (N=28). This questionnaire measured self-efficacy, outcome expectations, socio-structural factors, goal setting and behaviour. Multiple regressions were analyzed predicting participants’ practice of client focused father involvement consulting. Results Bivariate correlations demonstrated the anticipated patterns of association between SCT-based constructs. Multiple regression analysis indicated that outcome expectations and barriers were significant predictors of client focused father involvement consulting. Conclusions Participants reported that the education increased their self-efficacy, outcome expectations and client focused father involvement consulting behaviour. Future education should be accessible, increase counselling confidence and address beliefs about the outcomes and challenges of father involvement consulting.

Ideal timing to transfer from an acute care hospital to an interdisciplinary inpatient rehabilitation program following a stroke: an exploratory study

Affiliation: Dany Gagnon & Sylvie Nadeau: École de réadaptation, Faculté de médecine, Université de Montréal & Centre de recherche interdisciplinaire en réadaptation, Institut de réadaptation de Montréal

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.

Development of a Chinese version WHO Self-Assessment Tool for Evaluating Health Promotion in Hospital

[Support Institutions:] Department of Administration of Health, University of Montreal, Canada Public Health School of Fudan University, Shanghai, China

Reproductive Tourism in Argentina: Clinic Accreditation and its Implications for Consumers, Health Professionals and Policy Makers

A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much less consideration given to more recent ‘players’ in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context-specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices.

Barriers of evidence based policy making in iran's health system

La formation des sociétés fondées sur la connaissance, le progrès de la technologie de communications et un meilleur échange d'informations au niveau mondial permet une meilleure utilisation des connaissances produites lors des décisions prises dans le système de santé. Dans des pays en voie de développement, quelques études sont menées sur des obstacles qui empêchent la prise des décisions fondées sur des preuves (PDFDP) alors que des études similaires dans le monde développé sont vraiment rares. L'Iran est le pays qui a connu la plus forte croissance dans les publications scientifiques au cours de ces dernières années, mais la question qui se pose est la suivante : quels sont les obstacles qui empêchent l'utilisation de ces connaissances de même que celle des données mondiales? Cette étude embrasse trois articles consécutifs. Le but du premier article a été de trouver un modèle pour évaluer l'état de l'utilisation des connaissances dans ces circonstances en Iran à l’aide d'un examen vaste et systématique des sources suivie par une étude qualitative basée sur la méthode de la Grounded Theory. Ensuite au cours du deuxième et troisième article, les obstacles aux décisions fondées sur des preuves en Iran, sont étudiés en interrogeant les directeurs, les décideurs du secteur de la santé et les chercheurs qui travaillent à produire des preuves scientifiques pour la PDFDP en Iran. Après avoir examiné les modèles disponibles existants et la réalisation d'une étude qualitative, le premier article est sorti sous le titre de «Conception d'un modèle d'application des connaissances». Ce premier article sert de cadre pour les deux autres articles qui évaluent les obstacles à «pull» et «push» pour des PDFDP dans le pays. En Iran, en tant que pays en développement, les problèmes se situent dans toutes les étapes du processus de production, de partage et d’utilisation de la preuve dans la prise de décision du système de santé. Les obstacles qui existent à la prise de décision fondée sur des preuves sont divers et cela aux différents niveaux; les solutions multi-dimensionnelles sont nécessaires pour renforcer l'impact de preuves scientifiques sur les prises de décision. Ces solutions devraient entraîner des changements dans la culture et le milieu de la prise de décision afin de valoriser la prise de décisions fondées sur des preuves. Les critères de sélection des gestionnaires et leur nomination inappropriée ainsi que leurs remplaçants rapides et les différences de paiement dans les secteurs public et privé peuvent affaiblir la PDFDP de deux façons : d’une part en influant sur la motivation des décideurs et d'autre part en détruisant la continuité du programme. De même, tandis que la sélection et le remplacement des chercheurs n'est pas comme ceux des gestionnaires, il n'y a aucun critère pour encourager ces deux groupes à soutenir le processus décisionnel fondés sur des preuves dans le secteur de la santé et les changements ultérieurs. La sélection et la promotion des décideurs politiques devraient être basées sur leur performance en matière de la PDFDP et les efforts des universitaires doivent être comptés lors de leurs promotions personnelles et celles du rang de leur institution. Les attitudes et les capacités des décideurs et des chercheurs devraient être encouragés en leur donnant assez de pouvoir et d’habiliter dans les différentes étapes du cycle de décision. Cette étude a révélé que les gestionnaires n'ont pas suffisamment accès à la fois aux preuves nationales et internationales. Réduire l’écart qui sépare les chercheurs des décideurs est une étape cruciale qui doit être réalisée en favorisant la communication réciproque. Cette question est très importante étant donné que l'utilisation des connaissances ne peut être renforcée que par l'étroite collaboration entre les décideurs politiques et le secteur de la recherche. Dans ce but des programmes à long terme doivent être conçus ; la création des réseaux de chercheurs et de décideurs pour le choix du sujet de recherche, le classement des priorités, et le fait de renforcer la confiance réciproque entre les chercheurs et les décideurs politiques semblent être efficace.