One of the main determinants of public immunization success is health professionals' support and recommendations. Little is known about the physicians' level of support and intentions regarding A(H1N1) pandemic influenza vaccination. The aim of this survey was to document Canadian family physicians' and paediatricians' knowledge, attitudes and practices (KAP) as well as their intentions regarding A(H1N1) pandemic influenza vaccines right before the beginning of the largest immunization campaign in Canadian history.
A self-administered, anonymous, mail-based questionnaire was sent to a random sample of family physicians and to all paediatricians practicing in Canada. All 921 questionnaires received by October 29 2009 were included in the analysis. Between 72% and 92% of respondents agreed with the statements regarding vaccine safety, effectiveness and acceptability. More than 75% of respondents intended to recommend the A(H1N1) pandemic influenza vaccine to their patients and to get vaccinated themselves. The most significant factors associated with the intention to recommend A(H1N1) pandemic vaccines were physicians' intention to be vaccinated against influenza themselves and the perceived acceptability of the vaccine by the vaccinators.
Most Canadian family physicians and paediatricians surveyed were supportive of the A(H1N1) pandemic influenza vaccination before its implementation and large media coverage.
Knowledge & attitudes of healthcare providers (HCP) have significant impact on frequency with which vaccines are offered & accepted but many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can be integrated into formal education curricula.
(i) A questionnaire was sent to all Canadian nursing, medical & pharmacy schools to assess immunization-related curriculum content (ii) A 77-item web-based, validated questionnaire was emailed to final-year students in medicine, nursing, & pharmacy at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum.
The curriculum review yielded responses from 18%, 48%, & 56% of medical, nursing, & pharmacy schools, respectively. Time spent on immunization content varied substantially between & within disciplines from <1 to >50 hrs. Most schools reported some content regarding vaccine preventable diseases, immunization practice & clinical skills but there was considerable variability and fewer schools had learning objectives or formal evaluation in these areas. 74% of respondents didn't feel comfortable discussing vaccine side effects with parents/patients & only 21% felt they received adequate teaching regarding immunization during training.
Important gaps were identified in the knowledge of graduating nursing, medical, & pharmacy trainees regarding vaccine indications/contraindications, adverse events & safety. The national curriculum review revealed wide variability in immunization curriculum content & evaluation. There is clearly a need for educators to assess current curricula and adapt existing educational resources such as the Immunization Competencies for Health Professionals in Canada.
HIV-positive patients represent an immunosuppressed population at risk for severe influenza. In the event of a pandemic, such as 2009 H1N1, rapid implementation of vaccine clinical trials in target populations will be critical. In the present paper, knowledge and attitudes of HIV-positive adults regarding seasonal/pandemic influenza vaccination were evaluated, and facilitators and barriers to participation in vaccine clinical trials were explored.
A validated, 70-item, self-administered questionnaire was distributed to all HIV patients presenting for routine follow-up at eight Canadian Institutes of Health Research Canadian HIV Trials Network (CTN) sites from October 2008 to February 2009, as well as all participants in CTN trial 237. This study has representation from all Canadian provinces.
In total, 610 HIV-positive adults responded (298 CTN 237 participants; 312 non-CTN 237 participants). Most reported receiving influenza vaccine last season (83% of CTN 237 participants versus 83% non-CTN 237 participants; P not significant) and most would receive a pandemic influenza vaccine if offered (76% versus 73%; P not significant). A majority believed that it was important to include HIV patients in vaccine clinical trials (65% versus 53%; P<0.001) and would agree to participate in trials of a pandemic vaccine if invited (86% versus 51%; P≤0.0001). Predictors of willingness to participate in a pandemic vaccine trial were ‘desire to be protected from pandemic flu’, OR 4.5 (95% CI 2 to 8) and ‘desire to help others’, OR 2.3 (95% CI 1.3 to 4.5). ‘Fear of needles’, OR 0.49 (95% CI 0.1 to 1.5) and ‘need for extra blood tests’, OR 0.49 (95% CI 0.2 to 1.4) were key barriers to participation.
Most HIV-positive Canadian adults surveyed receive influenza vaccination. Protection from pandemic influenza is considered important and is a motivator for receiving influenza vaccine and future trial participation. Modifiable barriers to these objectives identified in the present study should be the focus of efforts to increase influenza immunization in this population.
HIV-positive adult attitudes; Pandemic influenza; Public health; Vaccine uptake
This study sought to determine public opinion on alternatives to project-specific consent for use of their personal information for health research.
The authors conducted a fixed-response random-digit dialed telephone survey of 1,230 adults across Canada.
We measured attitudes toward privacy and health research; trust in different institutions to keep information confidential; and consent choice for research use of one’s own health information involving medical record review, automated abstraction of information from the electronic medical record, and linking education or income with health data.
Support was strong for both health research and privacy protection. Studying communicable diseases and quality of health care had greatest support (85% to 89%). Trust was highest for data institutes, university researchers, hospitals, and disease foundations (78% to 80%). Four percent of respondents thought information from their paper medical record should not be used at all for research, 32% thought permission should be obtained for each use, 29% supported broad consent, 24% supported notification and opt out, and 11% felt no need for notification or consent. Opinions were more polarized for automated abstraction of data from the electronic medical record. Respondents were more willing to link education with health data than income.
Most of the public supported alternatives to study-specific consent, but few supported use without any notification or consent. Consent choices for research use of one’s health information should be documented in the medical record. The challenge remains how best to elicit those choices and ensure that they are up-to-date.
Regulatory decisions and scientific statements regarding the management of attention-deficit hyperactivity disorder (ADHD) raise questions about the safety of medications and the appropriate pretreatment evaluation to determine suitability for treatment with medication. This is particularly true in the setting of known structural or functional heart disease. The present paper reviews the available data, including peer-reviewed literature, data from the United States Food and Drug Administration Web site on reported adverse reactions in children using stimulant medication, and Health Canada data on the same problem. A consensus-based guideline on appropriate assessment is provided, based on input from members of the Canadian Paediatric Society, the Canadian Cardiovascular Society and the Canadian Academy of Child and Adolescent Psychiatry, with specific expertise and knowledge in the areas of both ADHD and pediatric cardiology. The present statement advocates a thorough history and physical examination before starting stimulant medications, with an emphasis on the identification of risk factors for sudden death, but does not routinely recommend electrocardiographic screening or cardiac subspecialist consultation unless indicated by history or physical examination findings. A checklist for identifying children who are potentially at risk of sudden death (independent of ADHD or medications used to treat it) is provided. Although recommendations are based on the best evidence currently available, the committee further agrees that more research on this subject is necessary to optimize the approach to this common clinical scenario.
Attention-deficit hyperactivity disorder; Consensus statement; Pediatric; Population health; Risk; Sudden death
OBJECTIVE: To survey adult medical and surgical patients about their concerns and satisfaction with their care in Canadian hospitals. DESIGN: Cross-sectional telephone survey undertaken from June 1991 to May 1992 with a standardized questionnaire. SETTING: Stratified random sample of public acute care hospitals in six provinces; 57 (79%) of the 72 hospitals approached agreed to participate. PATIENTS: Each participating hospital provided the study team with the names of 150 adult medical and surgical patients discharged home in consecutive order. A total of 4599 patients agreed to be interviewed (69% of eligible patients and 89% of patients contacted). MAIN OUTCOME MEASURES: Satisfaction with (a) provider-patient communication (including information given), (b) provider's respect for patient's preferences, (c) attentiveness to patient's physical care needs, (d) education of patient regarding medication and tests, (e) quality of relationship between patient and physician in charge, (f) education of and communication with patient's family regarding care, (g) pain management and (h) hospital discharge planning. RESULTS: Most (61%) of the patients surveyed reported problems with 5 or fewer of the 39 specific care processes asked about in the study. Forty-one percent of the patients reported that they had not been told about the daily hospital routines. About 20% of the patients receiving medications reported that they had not been told about important side effects in a way they could understand; 20% of the patients who underwent tests reported similar problems with communication of the test results. Thirty-six percent of those having tests had not been told how much pain to expect. In discharge planning, the patients complained that they had not been told what danger signals to watch for at home (reported by 39%), when they could resume normal activities (by 32%) and what activities they could or could not do at home (by 29%). Over 90% of the patients reported that they had had a relationship of confidence and trust with their physician and that they had been involved in decision making as much as they wanted to be. Fifteen percent of the patients whose admissions had been scheduled felt that they should have been admitted sooner. CONCLUSION: The self-reported patient data from this survey suggest that hospital routines, medications, tests, pain management and discharge planning are areas of communication to target in future quality-improvement efforts in Canadian hospitals.
A survey was conducted in a general pediatric practice to determine parents' attitudes to and compliance with the recommended Haemophilus influenzae type b vaccine program. Of 133 families surveyed 127 (95%) responded to the questionnaire. About one third of the parents did not have their children vaccinated. The decision against vaccination was made despite parent education, follow-up telephone contact and the pediatrician's expressed support of the vaccine program. Most of the respondents (86%) had no previous knowledge of the vaccine. The factor of greatest concern was the possibility of an adverse reaction. This concern was significantly more common among the parents who decided not to have their children vaccinated than among those who had their children vaccinated (chi 2 = 6.52, p less than 0.025). One third of the parents who indicated that they intended to have their children vaccinated required a telephone reminder. The findings suggest a need for public education about the vaccine, with particular emphasis directed at allaying fears about side effects.
Although dietary supplements (DS) are widely sold in pharmacies, the legal, ethical, and practice responsibilities of pharmacists with respect to these products have not been well defined. This systematic review of pharmacists' attitudes, knowledge, and professional practice behaviours toward DS is intended to inform pharmacy regulators' and educators' decision making around this topic.
Eligible studies were identified through a systematic database search for all available years through to March 2006. Articles were analyzed for this review if they included survey data on U.S. or Canadian pharmacists' attitudes, knowledge, or professional practice behaviors toward DS published in 1990 or later.
Due to the heterogeneity of the data, it was not possible to draw a conclusion with respect to pharmacists' general attitudes toward DS. Approximately equal numbers of pharmacists report positive as well as negative attitudes about the safety and efficacy of DS. There is strong agreement among pharmacists for the need to have additional training on DS, increased regulation of DS, and quality information on DS. In addition, survey data indicate that pharmacists do not perceive their knowledge of DS to be adequate and that pharmacists do not routinely document, monitor, or inquire about patients' use of DS. Despite this, a large proportion of pharmacists reported receiving questions about DS from patients and other health care practitioners.
Further research is needed to explore the factors that influence pharmacists' beliefs and attitudes about DS, to accurately evaluate pharmacists' knowledge of DS, and to uncover the reasons why pharmacists do not routinely document, monitor, or inquire about patients' use of DS.
OBJECTIVE: To determine the policies of Canadian medical schools concerning immunization of students and the methods used to promote these policies. DESIGN: Mail survey with the use of a 12-item, self-administered questionnaire; telephone follow-up to ensure response. SETTING: All 16 medical schools in Canada. PARTICIPANTS: Deans of Canada's 16 medical schools or their designates. All of them responded to the questionnaire. MAIN OUTCOME MEASURES: Policies on vaccination of students against diphtheria, hepatitis B, influenza, measles, mumps, poliomyelitis, rubella, tetanus and typhoid fever; recommended or required timing of such vaccination; methods for making students aware of immunization policies and for making vaccinations available to students; responsibility for payment for vaccination; compliance rates; methods used to monitor compliance; problems associated with noncompliance; policies for compensating students infected with hepatitis B or other vaccine-preventable diseases; and future plans for vaccination of medical students. RESULTS: Vaccination against rubella was required in 11 (69%) of the 16 medical schools, and vaccination against tetanus, diphtheria and hepatitis B was required in 10 (63%). Nine schools (56%) required vaccination against measles and poliomyelitis, and eight (50%) required mumps vaccination. Only three schools (19%) required or recommended influenza vaccination, and only one recommended vaccination against typhoid fever. The authors identified various methods used to promote student awareness of immunization policies, make vaccinations available, pay for vaccinations and monitor compliance. CONCLUSIONS: Each medical school has a unique set of requirements and recommendations for the vaccination of medical students. National guidelines on immunization for medical students and a comprehensive and nationally coordinated vaccination program would help to ensure that students receive proper protection from disease.
The collection of individual-level pandemic (H1N1) 2009 influenza immunization data was considered important to facilitate optimal vaccine delivery and accurate assessment of vaccine coverage. These data are also critical for research aimed at evaluating the new vaccine's safety and effectiveness. Systems used to collect immunization data include manual approaches in which data are collected and retained on paper, electronic systems in which data are captured on computer at the point of vaccination and hybrid systems which are comprised of both computerized and manual data collection components. This study's objective was to compare the efficiencies and perceptions of data collection methods employed during Canada's pandemic (H1N1) 2009 influenza vaccination campaign.
A pan-Canadian observational study was conducted in a convenience sample of public health clinics and healthcare institutions during the H1N1 vaccination campaign in the fall of 2009. The study design consisted of three stages: Stage 1 involved passive observation of the site's layout, processes and client flow; Stage 2 entailed timing site staff on 20 clients through five core immunization tasks: i) client registration, ii) medical history collection, iii) medical history review, iv) vaccine administration record keeping and v) preparation of proof of vaccine administration for the client; in Stage 3, site staff completed a questionnaire regarding perceived usability of the site's data collection approach. Before the national study began, a pilot study was conducted in three seasonal influenza vaccination sites in Ontario, to both test that the proposed methodology was logistically feasible and to determine inter-rater reliability in the measurements of the research staff. Comparative analyses will be conducted across the range of data collection methods with respect to time required to collect immunization data, number and type of individual-level data elements collected, and clinic staff perceptions of the usability of the method employed at their site, using analysis of variance (ANOVA).
Various data collection methods were employed at immunization sites across Canada during the pandemic (H1N1) 2009 influenza vaccination campaign. Our comparison of methods can facilitate planning an efficient, coordinated approach for collecting immunization data in future influenza seasons.
To assess awareness among persons at risk for lung cancer, chronic obstructive pulmonary disease (COPD) and sleep apnea regarding symptoms and risk factors of the disease, and their attitudes regarding the disease and toward those who are affected.
A quantitative hybrid telephone and Internet survey of a representative population of Canadian adults at risk for at least one of the three diseases was conducted. To measure the awareness and attitudes of First Nations, Inuit and Métis people to these diseases, a proportionate number were also surveyed.
A total of 3626 individuals were contacted. Of these, 3036 (84%) were eligible to participate. Of those at risk for lung cancer and COPD, 65% and 69%, respectively, were due to tobacco smoke exposure. Among those at risk, 72% believed that they were informed about lung cancer compared with 36% for COPD and 56% for sleep apnea. Most respondents were knowledgeable about the common symptoms of lung cancer, COPD and sleep apnea, but were less aware of the impact lifestyle choices could have on the development of these disorders and the availability of treatment. Most of the participants (77%) believed that smoking was an addiction rather than a habit (19%). There were no significant differences in the awareness of risk factors, symptoms and attitudes toward all three lung diseases between First Nations, Inuit and Métis people and the general population.
Canadians are reasonably aware of risk factors and symptoms for lung cancer and sleep apnea. However, there is poor awareness of COPD as a disease entity. There is a lack of appreciation for the impact lifestyle choices and changes can have on lung diseases.
Awareness; COPD; Lung cancer; Risk; Sleep apnea
Accurate information concerning alcohol consumption level and patterns is vital to formulating public health policy. The objective of this paper is to critically assess the extent to which survey design, response rate and alcohol consumption coverage obtained in random digit dialing, telephone-based surveys impact on conclusions about alcohol consumption and its patterns in the general population. Our analysis will be based on the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) 2008, a national survey intended to be representative of the general population. The conclusions of this paper are as follows: 1) ignoring people who are homeless, institutionalized and/or do not have a home phone may lead to an underestimation of the prevalence of alcohol consumption and related problems; 2) weighting of observations to population demographics may lead to a increase in the design effect, does not necessarily address the underlying selection bias, and may lead to overly influential observations; and 3) the accurate characterization of alcohol consumption patterns obtained by triangulating the data with the adult per capita consumption estimate is essential for comparative analyses and intervention planning especially when the alcohol coverage rate is low like in the CADUMS with 34%.
alcohol; average volume of consumption; patterns of drinking; adult per capita consumption; survey; random digit dialing; bias
A national needs assessment of Canadian gastroenterologists and gastroenterology nurses was undertaken to determine the perceived and unperceived educational and performance barriers to caring for patients with Crohn’s disease (CD).
A triangulated, mixed-method approach (qualitative and quantitative) was used to determine the nature and extent of knowledge gaps and barriers in the care of patients with CD.
Qualitative interviews were conducted with nine gastroenterologists, four gastroenterology nurses and nine patients with CD. Based on this exploratory research, a survey was designed and launched nationally (37 gastroenterologists, 36 gastroenterology nurses). Findings indicated that Canadian gastroenterologists and gastroenterology nurses lacked clarity regarding their roles and responsibilities across the continuum of CD care, and face communication gaps within the health care team, undermining their effectiveness. Gastroenterologists identified challenges in optimal diagnosis due to unclear testing and diagnostic criteria. They recognized knowledge gaps when treating patient subgroups and in prescribing biological therapies. Furthermore, gastroenterologists self-identified gaps in skill, knowledge, and confidence in monitoring disease progression and effectively assessing response to therapy. When managing patients with CD, gastroenterologists expressed challenges with patient issues outside their domain of medical expertise, particularly with the skills needed to facilitate effective patient communication and education that would enhance adherence to recommended treatments.
Educational initiatives should address diagnostic and treatment guidelines, as well as enhancement of clinical performance gaps in health care team processes and the patient-professional therapeutic relationship. To impact care and patient outcomes, these initiatives must be relevant to clinical practice settings and applicable to the practice context.
Crohn’s disease; Educational needs assessment; Gastroenterologists; Gastroenterology nurses; Mixed methods research, Patient-health care professional relationship
Recent reports of late stent thrombosis events following deployment of drug-eluting stents (DES) have raised concerns about their safety and role in the management of coronary artery disease. The Canadian Association of Interventional Cardiology and the Canadian Cardiovascular Society have carefully examined the available evidence, including the data presented at the recent Food and Drug Administration Circulatory System Devices Advisory Panel meeting. The purpose of the present statement is to summarize the available evidence relating to DES thrombosis and to provide practical recommendations regarding DES use and antiplatelet therapy.
Angioplasty; Stents; Thrombosis
Three hundred and twenty-two Canadian animal health technologists (AHTs) were surveyed to determine their attitudes toward postoperative pain management in dogs and cats following 6 surgical procedures, their concerns regarding the use of opioid analgesics, and their role within veterinary practices with respect to postoperative pain control. Two hundred and sixty-four (82%) returned the questionnaire. Pain perception was defined as the average of pain rankings for dogs and cats (on a scale of 1 to 10) following abdominal surgery, or the value for dogs or cats if the AHT worked with only 1 of the 2 species. Maximum concern about the risks associated with the postoperative use of morphine or oxymorphone was defined as the highest rating assigned to any of the 6 risks evaluated in either dogs or cats. Animal health technologists reported significantly higher pain perception scores than did veterinarians who completed a similar survey 2 years previously. Higher pain perception scores were associated with decreased satisfaction with the adequacy of analgesic therapy in their practice, higher pain control goals, and attendance at continuing education within the previous 12 months. The majority of AHTs (55%) agreed that one or more risks associated with the use of morphine or oxymorphone outweighed the benefits. The 3 issues that were perceived to pose the greatest risk were respiratory depression, bradycardia, and sedation and excitement, for dogs and cats, respectively. Most AHTs (68%) considered their knowledge related to the recognition and control of pain to be adequate, compared with 24% of veterinarians who responded to a similar previous survey. As for veterinarians, experience gained while in practice was ranked as the most important source of knowledge, while the technical program attended was ranked as least important. Over 88% of the AHTs provided nursing care during the postoperative period, monitored animals for side effects of postoperative analgesic therapy, informed veterinarians when animals were in pain, recommended analgesic therapy when they believed it was warranted, reported that animals received analgesics when they believed it was warranted, administered analgesics under the instruction of a veterinarian, and believed they were part of a team working to provide adequate postoperative pain control.
Pharmacist-led research has grown substantially over the past 10 to 15 years. The Research Grant Program of the Research and Education Foundation of the Canadian Society of Hospital Pharmacists (CSHP Foundation), initiated in 1992, is the only funding opportunity available specifically to members of the Society.
To evaluate the status of research projects funded by the Research Grant Program of the CSHP Foundation, to examine the outcomes of these projects, and to determine the opinions of grant recipients regarding this competition.
An e-mail survey was sent to each of the 34 hospital pharmacist researchers who received funding from the Research Grant Program of the CSHP Foundation during the period 1995 to 2008. Survey questions sought to evaluate scholarly outcomes (i.e., publications and presentations) from funded projects. The opinions of grant recipients about the value of the program were also solicited.
One of the potential respondents had returned the grant money and was ineligible for the survey. Of the 33 potential respondents, 30 (91%) responded to the survey. Overall, 24 of the projects had been completed at the time of the survey, and 19 of these had been published, resulting in a total of 26 manuscripts. Abstracts had been presented for 21 of the projects. In total, 49 abstracts had been presented at national (22), international (13), provincial (7) and local (7) conferences. The median award was $5000 (interquartile range $5000 to $7500). Eleven of the projects had received additional funding, primarily from the recipient’s hospital or health authority or from university sources. The survey respondents indicated that the grant from the CSHP Foundation had been critical to completion of their projects and had been of assistance in securing additional funding, when such funding was necessary. Respondents felt that dedicated research funding for hospital pharmacists in Canada should continue.
The Research Grant Program of the CSHP Foundation has been important to hospital pharmacists, enabling a variety of research projects to be initiated and completed. The high rate of project completion and the large number of publications and presentations resulting from this work speak to both the quality of the work and the dedication of the research teams. The CSHP Foundation should continue to fund this competition and should explore a more robust model, with larger awards and more funded projects each year.
hospital pharmacy; research; funding; grants; survey; pharmacie d’hôpital; recherche; financement; bourses; sondage
Although the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College (CMCC) endorse vaccination, the prevalence of anti-vaccination attitudes among Canadian chiropractors is unknown. This study describes the prevalence of anti-vaccination attitudes among Canadian chiropractic students.
An 11-item questionnaire about attitudes toward vaccination was distributed to students enrolled at CMCC during the 1999/2000 academic year. The responses for the 11 items were then summed to arrive at a total score ranging from 0 (most negative attitude toward vaccination) to 22 (most positive attitude toward vaccination). Respondents' perceptions of sources of vaccine information were also investigated.
Over 75% of the students (467 of 621) completed the questionnaire. Most students (53.3%) reported that in general they agreed with vaccination. This was especially true among first-year students (60.7%). However, among fourth year students, only 39.5% agreed with vaccination. The proportion of respondents who stated that they were against vaccination in general was 5 (4.5%) of 112 first-year students, 10 (8.3%) of 121 second-year students, 16 (13.9%) of 115 third-year students and 35 (29.4%) of 119 fourth-year students. The mean scores on the questionnaire were progressively lower with each higher year of study at the College. The mean survey scores for each year of study were first year, 15.9 (95% confidence interval [CI] 15.2–16.6); second year, 16.1 (95% CI 15.3–17.0); third year, 14.5 (95% CI 13.5–15.4); and fourth year, 12.8 (95% CI 11.7–13.9). The mean scores varied among year of study and were statistically significant using one-way ANOVA (p < 0.0001). Among students who relied primarily on informal sources of vaccine information, such as the chiropractic literature and informal talks at CMCC, anti-vaccination attitudes were more prevalent in later years.
Most CMCC students reported pro-vaccination attitudes, but there appeared to be an increase in anti-vaccination attitudes as students progressed through the CMCC program. This pattern was seen almost exclusively among students who relied primarily on informal sources of vaccine information rather than on core CMCC lectures or prior lectures at university.
Objective: To assess the impact of graphic Canadian cigarette warning labels on current adult smokers.
Design: A random-digit-dial telephone survey was conducted with 616 adult smokers in south western Ontario, Canada in October/November 2001, with three month follow up.
Main outcome measures: Smoking behaviour (quitting, quit attempts, and reduced smoking), intentions to quit, and salience of the warning labels.
Results: Virtually all smokers (91%) reported having read the warning labels and smokers demonstrated a thorough knowledge of their content. A strong positive relation was observed between a measure of cognitive processing—the extent to which smokers reported reading, thinking about, and discussing the new labels—and smokers' intentions to quit (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.16; p < 0.001). Most important, cognitive processing predicted cessation behaviour at follow up. Smokers who had read, thought about, and discussed the new labels at baseline were more likely to have quit, made a quit attempt, or reduced their smoking three months later, after adjusting for intentions to quit and smoking status at baseline (OR 1.07, 95% CI 1.03 to 1.12; p < 0.001).
Conclusions: Graphic cigarette warning labels serve as an effective population based smoking cessation intervention. The findings add to the growing literature on health warnings and provide strong support for the effectiveness of Canada's tobacco labelling policy.
The purpose of this study was to conduct an online survey of chiropractic students in the 2011/12 academic year at CMCC in order to determine their attitudes toward vaccination, their history of vaccination and their opinions towards their level of preparedness and confidence to discuss vaccination with patients.
All students enrolled in the program at CMCC were eligible to participate in this anonymous survey modeled after a similar survey administered in 1999/2000.
The response rate was 43%. Over 90% of all students reported they had been vaccinated. Roughly half of students felt they were well prepared to discuss vaccination with their patients and two-thirds felt they were confident to do so. Between 83.9% and 90% of students in various years of the program expressed a positive attitude toward vaccination.
Separate Welsh t-test for each year of study indicated statistically significant differences between our survey and the survey published in 1999/2000, with students in our study expressing a more positive attitude toward vaccination.
Students enrolled in the chiropractic program at CMCC in the 2011/12 expressed a positive attitude toward vaccination.
vaccination; chiropractic; survey; attitudes; vaccination; chiropratique; enquête; attitudes
The recent proliferation of studies describing factors associated with HPV vaccine acceptability could inform health care providers in improving vaccine coverage and support future research. This review examined measures of HPV and HPV-vaccine knowledge, attitudes, beliefs and acceptability, described psychometric characteristics, and provided recommendations about their use.
A systematic search of Medline, CINAHL, PsychoInfo, and ERIC through May 2008 for English language reports of quantitative data from parents, young adults or adolescents yielded 79 studies.
The majority of studies were cross-sectional surveys (87%), self-administered (67%), conducted before prophylactic vaccines were publicly available (67%) and utilized convenience samples (65%). Most measured knowledge (80%), general attitudes about HPV vaccination (40%), and willingness to vaccinate one's daughter (26%). Two thirds did not report reliability or validity of measures. The majority did not specify a theoretical framework.
Use of a theoretical framework, consistent labeling of constructs, more rigorous validation of measures, and testing of measures in more diverse samples are needed to yield measurement instruments that will produce findings to guide practitioners in developing successful community and clinical interventions.
human papillomavirus; vaccine; measures; methods; systematic review
In Germany, vaccination against hepatitis B is recommended for infants, children and adolescents since 1995 and for specific target groups since 1982. Little is known about knowledge about viral hepatitis and attitudes toward hepatitis B vaccination-factors likely to influence vaccine uptake.
In order to estimate vaccination coverage in adult target groups and in the overall adult population and to assess knowledge and attitudes, we conducted a nationwide cross-sectional telephone survey among 412 persons in November 2004. We defined participants as being vaccinated if they reported at least one previous vaccination against hepatitis B.
Vaccination coverage (vc) standardised for age, sex and residence was 29.6% in the general population and 58.2% in target groups for hepatitis B vaccination. Particular gaps in vaccine coverage were detected among health care workers (vc: 69.5%) and chronically ill persons (vc: 22.0%). Knowledge on risk factors and transmission was far below expectations, whereas the acceptance of vaccination in the majority of the population (79.0%) was good.
We conclude that educational measures could lead to a higher vaccination uptake in adult target groups.
Purpose: To describe Canadian Master of Physical Therapy (MPT) students' knowledge, attitudes, and practices regarding peer mentorship. Methods: A quantitative cross-sectional survey study was conducted. An online questionnaire was sent to 945 MPT students via e-mail, using a modified Dillman approach. Data were analyzed using descriptive statistics to describe the knowledge, attitudes, and practices of Canadian MPT students. Results: A total of 260 MPT students (27.5%) responded to the questionnaire. Most respondents (68.7%) did not have any experience in a peer mentorship relationship during their MPT programme. A few respondents (5.4%) reported having received formal training on peer mentorship as part of their PT curriculum. Respondents generally held positive attitudes toward peer mentorship: 65.9% agreed that including peer mentorship is important, 89.5% agreed that peer mentorship can assist with learning in clinical internships, and 84.1% agreed that peer mentorship can help the transition from student to professional. Most respondents (52.5%) did not participate in a peer mentorship relationship during a typical month. Conclusions: MPT students' attitudes toward peer mentorship are positive, yet their knowledge of and resources for peer mentorship are limited, and few students have been involved in peer mentorship practices. The findings highlight the importance of university programme support to provide a nurturing environment and structure to overcome barriers, promote commitment, and facilitate successful participation. The evidence from this study provides a rationale to support and guide peer mentorship programming for Canadian MPT students.
mentors; physical therapy; students; étudiants; mentors; physiothérapie; thérapie physique
Background. Swine outbreaks of pandemic influenza A (pH1N1) suggest human introduction of the virus into herds. This study investigates a pH1N1 outbreak occurring on a swine research farm with 37 humans and 1300 swine in Alberta, Canada, from 12 June through 4 July 2009.
Methods. The staff was surveyed about symptoms, vaccinations, and livestock exposures. Clinical findings were recorded, and viral testing and molecular characterization of isolates from humans and swine were performed. Human serological testing and performance of the human influenza-like illness (ILI) case definition were also studied.
Results. Humans were infected before swine. Seven of 37 humans developed ILI, and 2 (including the index case) were positive for pH1N1 by reverse-transcriptase polymerase chain reaction (RT-PCR). Swine were positive for pH1N1 by RT-PCR 6 days after contact with the human index case and developed symptoms within 24 h of their positive viral test results. Molecular characterization of the entire viral genomes from both species showed minor nucleotide heterogeneity, with 1 amino acid change each in the hemagglutinin and nucleoprotein genes. Sixty-seven percent of humans with positive serological test results and 94% of swine with positive swab specimens had few or no symptoms. Compared with serological testing, the human ILI case definition had a specificity of 100% and sensitivity of 33.3%. The only factor associated with seropositivity was working in the swine nursery.
Conclusions. Epidemiologic data support human-to-swine transmission, and molecular characterization confirms that virtually identical viruses infected humans and swine in this outbreak. Both species had mild illness and recovered without sequelae.
In the past 15 years, knowledge translation in healthcare has emerged as a multifaceted and complex agenda. Theoretical and polemical discussions, the development of a science to study and measure the effects of translating research evidence into healthcare, and the role of key stakeholders including academe, healthcare decision-makers, the public, and government funding bodies have brought scholarly, organizational, social, and political dimensions to the agenda.
This paper discusses the current knowledge translation agenda in Canadian healthcare and how elements in this agenda shape the discovery and translation of health knowledge.
The current knowledge translation agenda in Canadian healthcare involves the influence of values, priorities, and people; stakes which greatly shape the discovery of research knowledge and how it is or is not instituted in healthcare delivery. As this agenda continues to take shape and direction, ensuring that it is accountable for its influences is essential and should be at the forefront of concern to the Canadian public and healthcare community. This transparency will allow for scrutiny, debate, and improvements in health knowledge discovery and health services delivery.
To examine attitudes and knowledge about vaccinations in postpartum mothers.
This cross-sectional study collected data via written survey to postpartum mothers in a large teaching hospital in Connecticut. We used multivariable analysis to identify mothers who were less trusting with regard to vaccines.
Of 228 mothers who participated in the study, 29% of mothers worried about vaccinating their infants: 23% were worried the vaccines would not work, 11% were worried the doctor would give the wrong vaccine, and 8% worried that “they” are experimenting when they give vaccines. Mothers reported that the most important reasons to vaccinate were to prevent disease in the baby (74%) and in society (11%). Knowledge about vaccination was poor; e.g., 33% correctly matched chicken pox with varicella vaccine. Mothers who were planning to breastfeed (P = .01), were primiparous (P = .01), or had an income <$40,000 but did not receive support from the women, infants, and children (WIC) program were less trusting with regard to vaccines (P = .03). Although 70% wanted information about vaccines during pregnancy, only 18% reported receiving such information during prenatal care.
Although the majority of infants receive vaccines, their mothers have concerns and would like to receive immunization information earlier. Mothers who are primiparous, have low family incomes but do not qualify for the WIC program, or are breastfeeding may need special attention to develop a trusting relationship around vaccination. Mothers would benefit from additional knowledge regarding the risks and benefits of vaccines particularly during prenatal care.
Vaccinations; Mothers; Attitudes; Trust; Postpartum period