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1.  Labor force participation and health-related quality of life in HIV-positive men who have sex with men: The Multicenter AIDS Cohort Study 
AIDS and behavior  2012;16(8):2350-2360.
Too many people with HIV have left the job market permanently and those with reduced work capacity have been unable to keep their jobs. There is a need to examine the health effects of labor force participation in people with HIV. This study presents longitudinal data from 1,415 HIV-positive men who have sex with men taking part in the Multicenter AIDS Cohort Study. Generalized Estimating Equations show that employment is associated with better physical and mental health quality of life and suggests that there may be an adaptation process to the experience of unemployment. Post-hoc analyses also suggest that people who are more physically vulnerable may undergo steeper health declines due to job loss than those who are generally healthier. However, this may also be the result of a selection effect whereby poor physical health contributes to unemployment. Policies that promote labor force participation may not only increase employment rates but also improve the health of people living with HIV.
doi:10.1007/s10461-012-0257-3
PMCID: PMC3575137  PMID: 22814570
2.  Influence of employment and job security on physical and mental health in adults living with HIV: cross-sectional analysis 
Open Medicine  2012;6(4):e118-e126.
Background
In the general population, job insecurity may be as harmful to health as unemployment. Some evidence suggests that employment is associated with better health outcomes among people with HIV, but it is not known whether job security offers additional quality-of-life benefits beyond the benefits of employment alone.
Methods
We used baseline data for 1660 men and 270 women who participated in the Ontario HIV Treatment Network Cohort Study, an ongoing observational cohort study that collects clinical and socio-behavioural data from people with HIV in the province of Ontario, Canada. We performed multivariable regression analyses to determine the contribution of employment and job security to health-related quality of life after controlling for potential confounders.
Results
Employed men with secure jobs reported significantly higher mental health–related quality of life than those who were non-employed (β = 5.27, 95% confidence interval [CI] 4.07 to 6.48), but insecure employment was not associated with higher mental health scores relative to non-employment (β = 0.18, 95% CI –1.53 to 1.90). Thus, job security was associated with a 5.09-point increase on a 100-point mental health quality-of-life score (95% CI 3.32 to 6.86). Among women, being employed was significantly associated with both physical and mental health quality of life, but job security was not associated with additional health benefits.
Interpretation
Participation in employment was associated with better quality of life for both men and women with HIV. Among men, job security was associated with better mental health, which suggests that employment may offer a mental health benefit only if the job is perceived to be secure. Employment policies that promote job security may offer not only income stability but also mental health benefits, although this additional benefit was observed only for men.
PMCID: PMC3654507  PMID: 23687526
3.  Housing Characteristics and their Influence on Health-Related Quality of Life in Persons Living with HIV in Ontario, Canada: Results from the Positive Spaces, Healthy Places Study 
AIDS and Behavior  2012;16(8):2361-2373.
Although lack of housing is linked with adverse health outcomes, little is known about the impacts of the qualitative aspects of housing on health. This study examined the association between structural elements of housing, housing affordability, housing satisfaction and health-related quality of life over a 1-year period. Participants were 509 individuals living with HIV in Ontario, Canada. Regression analyses were conducted to examine relationships between housing variables and physical and mental health-related quality of life. We found significant cross-sectional associations between housing and neighborhood variables—including place of residence, housing affordability, housing stability, and satisfaction with material, meaningful and spatial dimensions of housing—and both physical and mental health-related quality of life. Our analyses also revealed longitudinal associations between housing and neighborhood variables and health-related quality of life. Interventions that enhance housing affordability and housing satisfaction may help improve health-related quality of life of people living with HIV.
doi:10.1007/s10461-012-0284-0
PMCID: PMC3481053  PMID: 22903401
Housing; Housing affordability; Housing satisfaction; Health-related quality of life; HIV
4.  Social determinants of health associated with hepatitis C co-infection among people living with HIV: results from the Positive Spaces, Healthy Places study 
Open Medicine  2011;5(3):e132-133.
Background
Social determinants of health (SDOH) may influence the probability of people living with HIV also being infected with hepatitis C virus (HCV). We compared the SDOH of adults co-infected with HCV/HIV with that of HIV mono-infected adults to identify factors independently associated with HCV infection.
Methods
In this cross-sectional study, face-to-face interviews were conducted with 509 HIV-infected adults affiliated with or receiving services from community-based AIDS service organizations (CBAOs). The primary outcome measure was self-reported HCV infection status. Chi-square, Student’s t tests, and Wilcoxon rank-sum tests were performed to compare SDOH of HCV/HIV co-infected participants with that of HIV mono-infected participants. Multivariable hierarchical logistic regression was used to identify factors independently associated with HCV co-infection.
Results
Data on 482 (95 HCV/HIV co-infected and 387 HIV mono-infected) adults were analyzed. Compared with participants infected with HIV only, those who were co-infected with HIV and HCV were more likely to be heterosexual, Aboriginal, less educated and unemployed. They were more likely to have a low income, to not be receiving antiretroviral treatment, to live outside the Greater Toronto Area (GTA), to use/abuse substances, experience significant depression, and utilize addiction counselling and needle-exchange services. They also were more likely to report a history of homelessness and perceived housing-related discrimination and to have moved twice or more in the previous 12 months. Factors independently associated with HCV/HIV co-infection were history of incarceration (odds ratio [OR] 8.81, 95% CI 4.43–17.54), history of homelessness (OR 3.15, 95% CI 1.59–6.26), living outside of the GTA (OR 3.13, 95% CI 1.59–6.15), and using/abusing substances in the past 12 months (OR 2.05, 95% CI 1.07–3.91).
Conclusion
Differences in SDOH exist between HIV/HCV co-infected and HIV mono-infected adults. History of incarceration, history of homelessness, substance use, and living outside the GTA were independently associated with HCV/HIV co-infection. Interventions that reduce homelessness and incarceration may help prevent HCV infection in people living with HIV.
PMCID: PMC3205830  PMID: 22046224
5.  Effects of an evidence service on community-based AIDS service organizations' use of research evidence: A protocol for a randomized controlled trial 
Background
To support the use of research evidence by community-based organizations (CBOs) we have developed 'Synthesized HIV/AIDS Research Evidence' (SHARE), which is an evidence service for those working in the HIV sector. SHARE consists of several components: an online searchable database of HIV-relevant systematic reviews (retrievable based on a taxonomy of topics related to HIV/AIDS and open text search); periodic email updates; access to user-friendly summaries; and peer relevance assessments. Our objective is to evaluate whether this 'full serve' evidence service increases the use of research evidence by CBOs as compared to a 'self-serve' evidence service.
Methods/design
We will conduct a two-arm randomized controlled trial (RCT), along with a follow-up qualitative process study to explore the findings in greater depth. All CBOs affiliated with Canadian AIDS Society (n = 120) will be invited to participate and will be randomized to receive either the 'full-serve' version of SHARE or the 'self-serve' version (a listing of relevant systematic reviews with links to records on PubMed and worksheets that help CBOs find and use research evidence) using a simple randomized design. All management and staff from each organization will be provided access to the version of SHARE that their organization is allocated to. The trial duration will be 10 months (two-month baseline period, six-month intervention period, and two month crossover period), the primary outcome measure will be the mean number of logins/month/organization (averaged across the number of users from each organization) between baseline and the end of the intervention period. The secondary outcome will be intention to use research evidence as measured by a survey administered to one key decision maker from each organization. For the qualitative study, one key organizational decision maker from 15 organizations in each trial arm (n = 30) will be purposively sampled. One-on-one semi-structured interviews will be conducted by telephone on their views about and their experiences with the evidence service they received, how helpful it was in their work, why it was helpful (or not helpful), what aspects were most and least helpful and why, and recommendations for next steps.
Discussion
To our knowledge, this will be the first RCT to evaluate the effects of an evidence service specifically designed to support CBOs in finding and using research evidence.
Trial registration
ClinicalTrials.gov: NCT01257724
doi:10.1186/1748-5908-6-52
PMCID: PMC3127774  PMID: 21619622
6.  Effect of bodychecking on rate of injuries among minor hockey players 
Open Medicine  2011;5(1):e57-e64.
Background
Bodychecking is a leading cause of injury among minor hockey players. Its value has been the subject of heated debate since Hockey Canada introduced bodychecking for competitive players as young as 9 years in the 1998/1999 season. Our goal was to determine whether lowering the legal age of bodychecking from 11 to 9 years affected the numbers of all hockey-related injuries and of those specifically related to bodychecking among minor hockey players in Ontario.
Methods
In this retrospective study, we evaluated data collected through the Canadian Hospitals Injury Reporting and Prevention Program. The study’s participants were male hockey league players aged 6–17 years who visited the emergency departments of 5 hospitals in Ontario for hockey-related injuries during 10 hockey seasons (September 1994 to May 2004). Injuries were classified as bodychecking-related or non-bodychecking-related. Injuries that occurred after the rule change took effect were compared with those that occurred before the rule’s introduction.
Results
During the study period, a total of 8552 hockey-related injuries were reported, 4460 (52.2%) of which were attributable to bodychecking. The odds ratio (OR) of a visit to the emergency department because of a bodychecking-related injury increased after the rule change (OR 1.26, 95% confidence interval [CI] 1.16–1.38), the head and neck (OR 1.52, 95% CI 1.26–1.84) and the shoulder and arm (OR 1.18, 95% CI 1.04–1.35) being the body parts with the most substantial increases in injury rate. The OR of an emergency visit because of concussion increased significantly in the Atom division after the rule change, which allowed bodychecking in the Atom division. After the rule change, the odds of a bodychecking-related injury was significantly higher in the Atom division (OR 2.20, 95% CI 1.70–2.84).
Interpretation
In this study, the odds of injury increased with decreasing age of exposure to bodychecking. These findings add to the growing evidence that bodychecking holds greater risk than benefit for youth and support widespread calls to ban this practice.
PMCID: PMC3205817  PMID: 22046222

Results 1-6 (6)