Social and Epidemiological Research

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Social and Epidemiological Research

Canada

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Patra J.,Social and Epidemiological Research | Patra J.,University of Toronto | Bakker R.,Erasmus Medical Center | Irving H.,Social and Epidemiological Research | And 5 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Background Descriptions of the effects of moderate alcohol consumption during pregnancy on adverse pregnancy outcomes have been inconsistent. Objective To review systematically and perform meta-analyses on the effect of maternal alcohol exposure on the risk of low birthweight, preterm birth and small for gestational age (SGA). Search strategy Using Medical Subject Headings, a literature search of MEDLINE, EMBASE, CINAHL, CABS, WHOlist, SIGLE, ETOH, and Web of Science between 1 January 1980 and 1 August 2009 was performed followed by manual searches. Selection criteria Case-control or cohort studies were assessed for quality (STROBE), 36 available studies were included. Data collection and analysis Two reviewers independently extracted the information on low birthweight, preterm birth and SGA using a standardised protocol. Meta-analyses on dose-response relationships were performed using linear as well as first-order and second-order fractional polynomial regressions to estimate best fitting curves to the data. Main results Compared with abstainers, the overall dose-response relationships for low birthweight and SGA showed no effect up to 10 g pure alcohol/day (an average of about 1 drink/day) and preterm birth showed no effect up to 18 g pure alcohol/day (an average of 1.5 drinks/day); thereafter, the relationship showed a monotonically increasing risk for increasing maternal alcohol consumption. Moderate consumption during pre-pregnancy was associated with reduced risks for all outcomes. Conclusions Dose-response relationship indicates that heavy alcohol consumption during pregnancy increases the risks of all three outcomes whereas light to moderate alcohol consumption shows no effect. Preventive measures during antenatal consultations should be initiated. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.


Urbanoski K.A.,Social and Epidemiological Research | Urbanoski K.A.,University of Toronto | Henderson C.,NHS Lothian | Castel S.,Sunnybrook Health science Center | Castel S.,University of Toronto
BMC Psychiatry | Year: 2014

Background: The Global Assessment of Functioning (GAF) is a widely used measure of psychiatric symptoms and functioning, yet numerous concerns persist about its reliability and validity. The objective of this study was to determine the extent to which GAF scores reflect physician-related differences in addition to information about patients.Methods: This is a secondary analysis of clinical data collected between 2005 and 2010 from inpatients at a psychiatric hospital (N = 1,852). Multilevel modeling was used to estimate the influence of physicians on GAF scores at admission and on the change between admission and discharge, controlling for patient clinical presentation.Results: Controlling for patient-level predictors, 7% of the residual variance in admission GAF scores and 8% of the residual variance in change scores was at the physician level. The physician-level variance was significantly larger than zero in both models.Conclusions: Although statistically significant, estimates of physician-level variance were not overwhelming, suggesting that the GAF was rated in a consistent manner across physicians in this hospital. While results lend support to the utility of the GAF for drawing comparisons between patients seen by different physicians across a large institution, further study is necessary to determine generalizability and to assess differences across multiple institutions. © 2014 Urbanoski et al.; licensee BioMed Central Ltd.


Santos Cruz M.,Federal University of Rio de Janeiro | Andrade T.,Federal University of Bahia | Bastos F.I.,Oswaldo Cruz Foundation | Leal E.,Federal University of Rio de Janeiro | And 4 more authors.
International Journal of Drug Policy | Year: 2013

Background: Crack use constitutes a major problem in cities across Brazil. While existing data suggest that crack use is generally concentrated among disenfranchised young people with extensive health problems and crime involvement, extensive data gaps exist. To address this issue, this study aimed to assess key characteristics of young crack users in two Brazilian cities. Methods: N=. 160 regular and young adult (ages 18-24) crack users were recruited by community-based methods in the cities of Rio de Janeiro (Southeast) and Salvador (Northeast). Assessments included an interviewer-administered questionnaire on key social, drug use, health and service use characteristics, as well as serological testing of HBV, HCV and HIV status, and were conducted anonymously between November 2010 and June 2011. Participants provided informed consent and received transportation vouchers following assessment completion. The study was approved by institutional ethics review boards. Results: The majority of participants were: male, with less than high school education, unstably housed (Rio only); gained income from legal or illegal work; arrested by police in past year (Salvador only); had numerous daily crack use episodes and shared paraphernalia (Salvador only); co-used alcohol, tobacco, cannabis and cocaine; had no injection history; rated physical and mental health as 'fair' or lower (Salvador only); had unprotected sex; were never HIV tested; were not HIV, HBV or HCV positive; and did not use existing social or health services, but desired access to crack user specific services. Conclusion: Crack users in the two Brazilian sites featured extensive socio-economic marginalization, crack and poly-drug use as well as sexual risk behaviours, and compromised health status. Social and health service utilization are low, yet needs are high. There is an urgent need for further research and for targeted interventions for crack use in Brazil. © 2013 Elsevier B.V.


Cunningham J.A.,Social and Epidemiological Research
Journal of Medical Internet Research | Year: 2012

Background: Alcohol problems are a serious public health concern, and few problem drinkers ever seek treatment. The Internet is one means of promoting access to care, but more research is needed to test the best types of interventions to employ. Evaluation of Internet-based interventions that contain a variety of research-validated cognitive-behavioral tools, which have been shown to be helpful to those with more severe alcohol concerns, should be a priority. Objective: To evaluate whether providing access to an extended Internet intervention for alcohol problems offers additional benefits in promoting reductions in alcohol consumption compared with a brief Internet intervention. The hypothesis for the current trial was that respondents who were provided with access to an extended Internet intervention (the Alcohol Help Center [AHC]) would display significantly improved drinking outcomes at 6-month follow-up, compared with respondents who were provided with access to a brief Internet intervention (the Check Your Drinking [CYD] screener). Methods: A single-blinded randomized controlled trial with a 6-month follow-up. A general population sample of problem drinkers was recruited through newspaper advertisements in a large metropolitan city. Baseline and follow-up data were collected by postal mail. Results: A volunteer sample of problem drinkers of legal drinking age with home access to the Internet were recruited for the trial. Of 239 potential respondents recruited in 2010, 170 met inclusion criteria (average age 45 years; 101/170, 59.4% male; average Alcohol Use Disorders Identification Test [AUDIT] score of 22). Follow-up rates were 90.0% (153/170) with no adverse effects of the interventions reported. A repeated-measures multivariate analysis of variance of the outcome measures using an intent-to-treat approach found a significantly greater reduction in amount of drinking among participants provided access to the AHC than among participants provided access to the CYD (P = .046). Conclusions: The provision of the AHC gave additional benefit in the short term to problem drinkers over that seen from the research-validated CYD, indicating the benefits of promoting access to these interventions as one means of helping people with problem drinking concerns.


Kim I.-H.,Social and Epidemiological Research | Carrasco C.,University of Toronto | Muntaner C.,University of Toronto | McKenzie K.,Social and Epidemiological Research | And 3 more authors.
American Journal of Public Health | Year: 2013

Objectives: In this prospective cohort study, we examined the trajectory of general health during the first 4 years after new immigrants' arrival in Canada. We focused on the change in self-rated health trajectories and their gender and ethnic disparities. Methods: Data were derived from the Longitudinal Survey of Immigrants to Canada and were collected between April 2001 and November 2005 by Statistics Canada. We used weighted samples of 3309 men and 3351 women aged between 20 and 59 years. Results: At arrival, only 3.5% of new immigrants rated their general health as poor. Significant and steady increases in poor health were revealed during the following 4 years, especially among ethnic minorities and women. Specifically, we found a higher risk of poor health among West Asian and Chinese men and among South Asian and Chinese women than among their European counterparts. Conclusions: Newly arrived immigrants are extremely healthy, but the health advantage dissipates rapidly during the initial years of settlement in Canada. Women and minority ethnic groups may be more vulnerable to social changes and postmigration settlement.


Goldner E.M.,Simon Fraser University | Jenkins E.K.,University of British Columbia | Fischer B.,Simon Fraser University | Fischer B.,Social and Epidemiological Research | Fischer B.,University of Toronto
Canadian Journal of Psychiatry | Year: 2014

Objective: Attention to knowledge translation (KT) has increased in the health care field in an effort to improve uptake and implementation of potentially beneficial knowledge. We provide an overview of the current state of KT literature and discuss the relevance of KT for health care professionals working in mental health. Method: A systematic search was conducted using MEDLINE, PsycINFO, and CINAHL databases to identify review articles published in journals from 2007 to 2012. We selected articles on the basis of eligibility criteria and then added further articles deemed pertinent to the focus of our paper. Results: After removing duplicates, we scanned 214 review articles for relevance and, subsequently, we added 46 articles identified through hand searches of reference lists or from other sources. A total of 61 papers were retained for full review. Qualitative synthesis identified 5 main themes: defining KT and development of KT science; effective KT strategies; factors influencing the effectiveness of KT; KT frameworks and guides; and relevance of KT to health care providers. Conclusions: Despite limitations in existing evidence, the concept and practice of KT holds potential value for mental health care providers. Understanding of, and familiarity with, effective approaches to KT holds the potential to enhance providers' treatment approaches and to promote the use of new knowledge in practice to enhance outcomes.


Kim I.-H.,Social and Epidemiological Research | Noh S.,Social and Epidemiological Research | Noh S.,University of Toronto | Muntaner C.,University of Toronto
International Archives of Occupational and Environmental Health | Year: 2013

Purpose: Homecare workers' diversity of emotional demands and their relation to mental health problems have not yet been fully explored. The purpose of this study is to investigate the types of emotional demands on homecare workers and the association of these demands with depression. Method: Data were collected from two surveys of a random sample of 1,599 homecare workers (June 2003-September 2003 and December 2003-February 2004). Depression was assessed using a 20-item RCES-D screening scale. Results: Homecare workers appeared to have a variety of emotional demands: unfair treatment, client's family abuse, unmet care needs, client health, and emotional suppression. In general, homecare workers were more likely to be exposed to their client health and emotional suppression (mean scores = 1.46-3.07) than to be exposed to unmet care needs, unfair treatment, and client's family abuse (mean scores = 1.02-1.38). After adjusting for potential confounders, four emotional-demand factors (excluding the client health factor) were significantly associated with a high risk of subthreshold depression at Wave 1. In particular, the factor "unmet care needs" was an essential predictor of 6-month subthreshold depression at Wave 2. Conclusion: This study illustrated the diversity of emotional demands among homecare workers and their association with depression. Our mixed findings regarding the cross-sectional and longitudinal analyses suggested that further research should refine the measurement of emotional demands and their relationship with mental health among homecare workers. © 2012 Springer-Verlag.


Tanaka M.,McMaster University | Wekerle C.,McMaster University | Schmuck M.L.,McMaster University | Paglia-Boak A.,Social and Epidemiological Research
Child Abuse and Neglect | Year: 2011

Objectives: Childhood maltreatment is a robust risk factor for poor physical and mental health. Child welfare youths represent a high-risk group, given the greater likelihood of severe or multiple types of maltreatment. This study examined the relationship between childhood maltreatment and self-compassion - a concept of positive acceptance of self. While not applied previously to a child welfare sample, self-compassion may be of value in understanding impairment among maltreatment victims. This may be most pertinent in adolescence and young adulthood, when self-identity is a focal developmental process. Methods: The present sample was drawn from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study, which followed randomly selected adolescents receiving child protection services across two years within an urban catchment area. Child maltreatment was assessed at baseline using the Childhood Trauma Questionnaire (Bernstein et al., 1994, 2003). Mental health, substance and alcohol use problems, suicide attempt, and self-compassion were assessed at the two-year follow-up point. There were 117 youths, aged 16-20 years (45.3% males) who completed the self-compassion scale (Neff, 2003). Bivariate correlations were computed between adolescent self-compassion and each form of self-reported maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect). Finally, hierarchical, stepwise regression was used to examine unique contributions of child maltreatment subtypes in predicting adolescent self-compassion, as well as maltreatment-related impairment. Results: Higher childhood emotional abuse, emotional neglect, and physical abuse were associated with lower self-compassion. Controlling for age and gender, emotional abuse was significantly associated with reduced self-compassion, even when the effects of emotional neglect and physical abuse were taken into account. Youths with low self-compassion were more likely to have psychological distress, problem alcohol use, and report a serious suicide attempt, as compared with those with high self-compassion. A number of maltreatment-related areas of impairment, identified by screening instruments, were significantly associated with lower self-compassion. Conclusion: Self-compassion may be a fruitful aspect of research to pursue in an effort to better understand the impact of childhood emotional abuse on adolescent functioning, particularly considering the under-researched group of those receiving child protective services. © 2011 Elsevier Ltd.


Kim I.-H.,Social and Epidemiological Research | Noh S.,Social and Epidemiological Research | Noh S.,University of Toronto
Journal of Immigrant and Minority Health | Year: 2014

This study examines ethnic and gender differences in exposure to discrimination and its association with depressive symptoms among five immigrant groups. Data were derived from a cross-sectional survey of 900 adult immigrants (50.8 % men, 49.2 % women) sampled from five ethnic immigrant communities in Toronto between April and September 2001. Men reported higher levels of discrimination than women. Ethiopians had the highest perception of discrimination followed by Korean, Iranian, Vietnamese, and Irish immigrants. With regard to discrimination-related depressive symptoms, Iranian and Korean men showed a greater risk than their Irish counterparts. Among women, Vietnamese and Irish seemed to be more vulnerable to discrimination than other ethnic groups. Despite experiencing the highest level of discrimination, Ethiopian men and women showed no association between discrimination and depressive symptoms. The exposure and psychological response to discrimination vary significantly across ethnicities and gender. © 2013, Springer Science+Business Media New York.


Fischer B.,Simon Fraser University | Fischer B.,Social and Epidemiological Research | Fischer B.,University of Toronto | Jones W.,Simon Fraser University | And 3 more authors.
BMC Health Services Research | Year: 2014

Background: Prescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere. Canada features the world's second-highest POA consumption rates. Following increases in POA-related harm, several POA control interventions have been implemented since 2010. Methods. We examined trends and patterns in POA dispensing in Canada by province for 2005-2012, including a focus on the potential effects of interventions. Data on annual dispensing of individual POA formulations - categorized into 'weak opioids' and 'strong opioids' - from a representative sub-sample of 5,700 retail pharmacies across Canada (from IMS Brogan's Compuscript) were converted into Defined Daily Doses (DDD), and examined intra- and inter-provincially as well as for Canada (total). Results: Total POA dispensing - driven by strong opioids - increased across Canada until 2011; four provinces indicated decreases in strong opioid dispensing; seven provinces indicated decreases specifically in oxycodone dispensing, 2011-2012. The dispensing ratio weak/strong opioids decreased substantively. Major inter-provincial differences in POA dispensing levels and qualitative patterns of POA formulations dispensed persisted. Previous increasing trends in POA dispensing were reversed in select provinces 2011-2012, coinciding with POA-related interventions. Conclusions: Further examinations regarding the sustained nature, drivers and consequences of the recent trend changes in POA dispensing - including possible 'substitution effects' for oxycodone reductions - are needed. © 2014 Fischer et al.; licensee BioMed Central Ltd.

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