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Nelder M.,Ministry of Health and Long Term Care | Kesavaraju B.,Salt Lake City Mosquito Abatement District | Farajollahi A.,Mercer County Mosquito Control | Healy S.,Monmouth County Mosquito Extermination Commission | And 5 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2010

The Asian tiger mosquito Aedes albopictus (Skuse) is rapidly increasing its global range and importance in transmission of Chikungunya and dengue viruses. We tested pellet formulations of a monomolecular film (Agnique) and (S)-methoprene (Altosid) under laboratory and field conditions. In the laboratory, Agnique provided 80% control for 20 days, whereas Altosid, in combination with Agnique, provided 80% control for > 60 days. During field trials, the 1:1 pellet ratio of combined products provided > 95% control for at least 32 days and 50% control for at least 50 days. Altosid remained effective after a 107-day laboratory-induced drought, suggesting that the product serves as a means of control during drought conditions and against spring broods in temperate regions. Agnique and Altosid, when used in tandem for cryptic, difficult-to-treat locations, can provide long-term control of Ae. albopictus larvae and pupae. The possible additive or synergistic effects of the combined products deserve further investigation. Copyright © 2010 by The American Society of Tropical Medicine and Hygiene.


Adam B.D.,University of Windsor | Murray J.,Ministry of Health and Long Term Care | Ross S.,Health Policy Strategies | Rynard V.,Health Policy Strategies
Health Education Research | Year: 2011

An intervention to address stigma directed toward HIV-positive men and to enhance the sexual health of gay and bisexual men was developed through a community-based process involving HIV prevention workers, public health, government and researchers. The intervention aimed to diminish stigma, create greater support for HIV-positive men, make disclosure safer and easier, discourage reliance on disclosure to prevent transmission and encourage testing. The question, 'If you were rejected every time you disclosed, would you?' was widely disseminated in the gay community and supported by the Web site, hivstigma.com, to encourage participation in blog-based discussions. Eight bloggers moderated lively discussions over 5 months. There were 20 844 unique visitors to the site averaging more than 5 min each; 4384 visitors returned more than 10 times. About 1,942 men answered a pre-test survey on a popular gay dating site and 1791, a post-test evaluation. Results show a statistically significant shift among those aware of the intervention toward reduced stigma-related attitudes and behaviors and toward recognition that HIV-positive gay men face stigma in the gay community and that stigma reduces the likelihood of HIV disclosure. © The Author 2011. Published by Oxford University Press. All rights reserved.


Stylianos S.,Psychiatric Patient Advocate Office | Kehyayan V.,Ministry of Health and Long Term Care
American Journal of Orthopsychiatry | Year: 2012

Although rights protection and best interest perspectives are frequently viewed as diametric opposites, mental health advocacy is an important strategy in pursuit of both civil rights and therapeutic goals for people with mental illness. Independent, client-centered advocacy supports the attainment of consumer-identified goals for recovery, equality, and social inclusion and mitigates the negative consequences of stigma and discrimination. Advocacy strives to return decision-making authority to consumers and thus to empower them to play a more central role in their own care, treatment, rehabilitation, and life choices. © 2012 American Orthopsychiatric Association.


Bottorff J.L.,University of British Columbia | Kelly M.T.,University of British Columbia | Oliffe J.L.,University of British Columbia | Johnson J.L.,University of British Columbia | And 2 more authors.
BMC Public Health | Year: 2010

Background. Although researchers have focused on women's smoking during pregnancy and the postpartum period and the influence of household interactions on their tobacco reduction efforts, little attention has been given to parents' efforts to regulate smoking during the child-rearing years. The objective of this study was to examine how parenting young children and gender relations reflected in couple dynamics influence household tobacco use patterns and, specifically, women's tobacco reduction efforts. Methods. As part of a longitudinal, grounded-theory study with 28 couples to examine the place of tobacco in the lives of new parents, each parent participated in one or two individual, semi-structured interviews during the first three years postpartum. Grounded theory methods and a gender relations framework were used to analyze transcribed data. Results. Two different parenting styles that couples adhered to were identified. These parenting styles reflected performances of femininities and masculinities, and were associated with particular smoking patterns. Traditional parenting reinforced by women's alignment with emphasized femininities and men's alignment with hegemonic masculinities placed women with smoking partners at risk for relapse. Women's actions to be supportive partners facilitated couples' continued smoking. In shared parenting dyads, egalitarian practices tended to support successful transitions to smoke-free homes. Women's ability to exert more influence around family decision making, and the acceptance of new masculine identities associated with fatherhood were influential. In non-smoking dyads where the mother, father, or both reduced or stopped smoking, we observed a subtext of potential conflict in the event either the mother or father relapsed. Conclusions. Decisions about tobacco use are made within relationships and social contexts that vary based on each individual's relationship to tobacco, divisions of domestic labour and childcare, and other activities that impact tobacco use. Sensitive approaches to tobacco reduction for women and men must be developed building on greater understanding of gender relations and how tobacco use is integrated in spousal and parental roles. © 2010 Bottorff et al; licensee BioMed aCentral Ltd.


Wilson E.D.,Ministry of Health and Long Term Care | Garcia A.C.,University of Western Ontario
Canadian Journal of Dietetic Practice and Research | Year: 2011

Purpose: There is increasing global interest in sustainability and the environment. A hospital/health care food service facility consumes large amounts of resources; therefore, efficiencies in operation can address sustainability. Beliefs, attitudes, and behaviours about environmentally friendly practices in hospital/health care food services were explored in this study. Methods: Questionnaires addressed environmentally friendly initiatives in building and equipment, waste management, food, and non-food procurement issues. The 68 participants included hospital food service managers, clinical dietitians, dietary aides, food technicians, and senior management. Data analysis included correlation analysis and descriptive statistics. Results: Average scores for beliefs were high in building and equipment (90%), waste management (94%), and non-food procurement (87%), and lower in food-related initiatives (61%) such as buying locally, buying organic foods, buying sustainable fish products, and reducing animal proteins. Average positive scores for behaviours were positively correlated with beliefs (waste management, p=0.001; food, p=0.000; non-food procurement, p=0.002). Average positive scores for attitude in terms of implementing the initiatives in health care were 74% for building and equipment, 81% for waste management, 70% for non-food procurement, and 36% for food. Conclusions: The difference in food-related beliefs, behaviours, and attitudes suggests the need for education on environmental impacts of food choices. Research is recommended to determine facilitators and barriers to the implementation of green strategies in health care. As food experts, dietitians can lead changes in education, practice, and policy development.


Chechulin Y.,Ministry of Health and Long Term Care | Nazerian A.,Ministry of Health and Long Term Care | Rais S.,Ministry of Health and Long Term Care | Malikov K.,Ontario Ministry of Health and Long Term Care
Healthcare Policy | Year: 2014

Literature and original analysis of healthcare costs have shown that a small proportion of patients consume the majority of healthcare resources. A proactive approach is to target interventions towards those patients who are at risk of becoming high-cost users (HCUs). This approach requires identifying high-risk patients accurately before substantial avoidable costs have been incurred and health status has deteriorated further. We developed a predictive model to identify patients at risk of becoming HCUs in Ontario. HCUs were defined as the top 5% of patients incurring the highest costs. Information was collected on various demographic and utilization characteristics. The modelling technique used was logistic regression. If the top 5% of patients at risk of becoming HCUs are followed, the sensitivity is 42.2% and specificity is 97%. Alternatives for implementation of the model include collaboration between different levels of healthcare services for personalized healthcare interventions and interventions addressing needs of patient cohorts with high-cost conditions.


Tiagi R.,Ministry of Health and Long Term Care | Chechulin Y.,Ministry of Health and Long Term Care
Healthcare Policy | Year: 2014

Objective: To assess the effect of rostering with a patient enrolment model (PEM) in Ontario on emergency department utilization for non-emergent care. Data sources/study setting: Administrative data for fiscal years 2006/07 through 2010/11 from the Ontario Ministry of Health and Long-Term Care were used for the analysis. Study design: Patient-level analysis with a difference-in- difference modelling approach was used to study the relationship. A control group was established using propensity score matching. Principal finding: Results suggest that rostering with a PEM is associated with a statistically significant reduction in emergency department (ED) (non-emergent) visits in Ontario. More specifically, enrolment with PEMs reduced ED visits by 3% during the study period, translating into cost savings of approximately $8 million for hospitals in Ontario. Conclusion: This study shows that PEMs have achieved some degree of success in enhancing health system efficiency in Ontario through the reduction in the use of EDs for non-emergent care.


Gilbert J.E.,Policy Research and Analysis | Gilbert J.E.,University of Toronto | Green E.,Nursing and Psychosocial Oncology | Green E.,McMaster University | And 5 more authors.
European Journal of Cancer Care | Year: 2011

The diagnostic phase of cancer care is an anxious time for patients. Patient navigation is a way of assisting and supporting individuals during this time. The aim of this review is to explore patient navigation and its role in the diagnostic phase of cancer care. We reviewed the literature for definitions and models of navigation, preparation for the role and impact on patient outcomes, specifically addressing the role of the nurse in patient navigation. Interviews and focus groups with healthcare providers and managers provided further insight from these stakeholder groups. Common to most definitions of navigation is the navigator's multifaceted role in facilitating processes of care, assisting patients to overcome barriers and providing information and support. Navigation may be provided by laypersons, clerical staff and/or healthcare professionals. In the diagnostic phase it has the potential to affect efficiency of diagnostic testing, patients' experience during this time and preparation for decision-making around treatment options. Patient care during the diagnostic phase requires various levels of navigation, according to individual informational, physical and psychosocial needs. Identifying those individuals who require more support - whether physical or psychosocial - during the diagnostic phase is of critical importance. © 2010 Cancer Care Ontario.


Chow W.,University of Toronto | Law S.,University of Toronto | Andermann L.,University of Toronto | Yang J.,Toronto Western Hospital | And 3 more authors.
Community Mental Health Journal | Year: 2010

This study evaluates the incorporation of Multi-Family Psycho-education Group (MFPG) to an Assertive Community Treatment Team developed to serve culturally diverse clients who suffers from severe mental illness. Participants included Chinese and Tamil clients and their family members. Family members' well-being, perceived burden, and acceptance of clients were assessed before and after the intervention. Focus group interviews with clinicians were conducted to qualitatively examine MFPG. Family members' acceptance increased after MFPG. Regular attendance was associated with reduction in perceived family burden. Culturally competent delivery of MFPG enhanced family members' understanding of mental illness and reduced stress levels and negative feelings towards clients. © The Author(s) 2010.


PubMed | University of Calgary, Li Ka Shing Knowledge Institute, Ministry of Health and Long Term Care and University of Alberta
Type: Comparative Study | Journal: BMJ open | Year: 2016

Alzheimers dementia (AD) is the most common cause of dementia, and several organisations, such as the National Institute for Health and Care Excellence, suggest that management of patients with AD should be tailored to their needs. To date, little research has been conducted on the treatment effect in different subgroups of patients with AD. The aim of this study is to examine the comparative effectiveness and safety of cognitive enhancers for different patient characteristics.We will update our previous literature search from January 2015 forward, using the same terms and electronic databases (eg, MEDLINE) from our previous review. We will additionally search grey literature and scan the reference lists of the included studies. Randomised clinical trials of any duration conducted at any time comparing cognitive enhancers alone or in any combination against other cognitive enhancers, or placebo in adults with AD will be eligible. The outcomes of interest are cognition according to the Mini-Mental State Examination, and overall serious adverse events. For each outcome and treatment comparison, we will perform a Bayesian hierarchical random-effects meta-analysis combining the individual patient data (IPD) from each eligible study. If the identified treatment comparisons form a connected network diagram, we will perform an IPD network meta-analysis (NMA) to estimate subgroup effects for patients with different characteristics, such as AD severity and sex. We will combine aggregated data from studies that we will not be able to obtain IPD, with the IPD provided by the original authors, in a single model. We will use the PRISMA-IPD and PRISMA-NMA statements to report our findings.The findings of this study will be of interest to stakeholders, including decision makers, guideline developers, clinicians, methodologists and patients, and they will help to improve guidelines for the management of patients with AD.CRD42015023507.

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