Previous research suggests an association between psychological dysfunction and Irritable Bowel Syndrome (IBS). We sought to confirm this relationship and examine the mechanisms by which psychosocial factors may amplify or maintain IBS complaints, and influence disability. One hundred and thirteen female participants, (45 IBS; 34 Crohn's; 34 healthy controls) were evaluated by psychological assessment which measured: symptom reporting, anxiety, depression, and impact of physical symptoms on daily activities. The assessment also evaluated the ways in which patients interpreted, understood and coped with unpleasant symptoms as well as the support and reactions from significant others to their symptoms. Subjects also participated in an experimental task designed to elicit physical sensations. Following the task, subjects were interviewed regarding cognitions and symptoms associated with the task. Results indicated that both patient groups had significantly greater physical and emotional symptomatology than healthy controls. The IBS patients were largely indistinguishable from the Crohn's patients, except that IBS patients were more likely to perceive their condition as more serious than Crohn's patients, and reported less personal control and responsibility in managing their symptoms. IBS patients also perceived far less social support from individuals close to them than did the Crohn's patients. Both IBS and Crohn's patients engaged in greater dysfunctional cognitive activity than did the controls during the experimental task. While anxiety, depression and coping attempts did not distinguish between patient groups, they were significantly associated with the amount of disability in daily activities regardless of diagnosis. These results suggest that the uncertain etiology of IBS may create additional sources of stress for the IBS patient. Consequently IBS patients may be more prone to misinterpret their IBS as a serious health threat and feel less able to control their symptoms. Furthermore, because of the uncertain etiology, the IBS patient may receive less support from significant others, thereby compounding stress and further taxing coping efforts. Our findings suggest that rather than a psychologic/psychiatric problem the IBS is better viewed as a medical problem within a biopsychosocial context. Psychosocial factors play a crucial role in the manifestation of disability regardless of the nature of the disease. However, the IBS is a unique medical problem in that the patient is placed at risk for stressors related to the uncertainty of the symptoms and the reactions of others.

Purpose. To evaluate the process of implementing decision support by call centre nurses for callers facing values-sensitive health decisions. Design. Exploratory case study guided by the Ottawa Model of Research Use with an embedded randomized controlled trial. Setting. A Canadian province-wide call centre. Intervention. Online autotutorial, skill-building workshop, decision support protocol, and performance feedback using simulated callers. Methods. (1) Barriers assessment using a survey, interviews, focus groups, and quality audit of baseline simulated calls. (2) Comparison of intervention and control groups using a knowledge test, quality audit of simulated calls, and acceptability surveys. (3) Assessment of the uptake and sustainability of decision support using a survey, interviews, and focus groups. Results. (1) Of 108 nurses, 57 responded to the barriers survey. Nurses had positive attitudes toward patient participation in decision making and their role in supporting callers. Main barriers included inadequate nurses' knowledge, skills, and confidence in providing decision support; lack of process to guide decision support calls; patient decision aids not formatted for telephone use; low public awareness; pressure to minimize call length, and unclear program direction. (2) Compared to controls (n=20), nurses (n=19) who participated in the intervention had improved knowledge (M= 74% vs. 60%, p=0.007) and provided a higher quality of decision support particularly in the domains of discussing values and support (M= 81.3% vs. 45.8%,p<0.0001) without significantly increasing call duration (M= 18.5 vs. 16.7 min, p=0.73). Nurses were satisfied with the multifaceted intervention. Twelve control group nurses opted to complete the training after the trial concluded. (3) Within 3 months post-intervention, 25 of the 31 nurses (n=19+12) completed the decision support uptake survey. Of these, 44% had used the protocol with real callers and 88% intended to use it. Nurses spoke positively about their experiences with real callers. Suggestions to improve sustainability included integrating the protocol in the call centre database, reformatting the patient decision aids, clarifying the program direction, establishing call length guidelines tailored to call type, implementing decision support training for all staff, and publicizing the new decision support services. Conclusions. The multifaceted intervention and process evaluation measures may provide a feasible approach to expanding call centre services to include values-sensitive decision support. However, to ensure sustainability, barriers within the practice environment need to be addressed and patient outcomes evaluated.

Abstract not available.

Febrile illnesses associated with malaria and pneumonia account for a large proportion of child mortality in sub-Saharan Africa. Three sub-studies were conducted to contribute to the development and evaluation of programs to improve home and community management of childhood fever. The first sub-study evaluated the ability of caregivers to identify fever in their child using palpation through a systematic review. Combination of results from 12 studies demonstrated that caregivers perform well in identifying fever. The second sub-study explored the nature and determinants of caregiver fever management practices using logistic regression and community-level data from Uganda. Caregiver education level, child age and household size were associated with home treatment while distance, region and initial home treatment practices were associated with care seeking. Clustering of fever management practices was significant at the village level. The third sub-study prepared a set of proposal guidelines and sample size framework for a multicentre, cluster-randomized trial of an integrated approach.

While medical geography has long contributed to epidemiological studies, applications of GIS in health research are now only beginning to be realized. Individual-level variables such as genetics or lifestyle do not fully explain the phenomena of health and disease---social and physical environments play a role in determining the health of populations as well. Using individual-level data from a cohort of close to 5000 elderly Canadians, GIS was used to create a spatial database of neighborhood socio-demographic and economic characteristics, based on proximity and containment analysis, to aid in understanding how environmental context influences successful aging in Canada. The work done for this thesis resulted in the creation of the first national combined spatial and aspatial database composed of demographic, socio-economic and GIS-derived local contextual spatial data linked to individual successful aging outcome data via postal code.

This thesis focuses on the ways in which Korean-Canadian youth construct their own understandings of health and fitness and introduce health and fitness practices into their daily lives. Grounded theory is used for an analysis of in-depth conversations with 9 Korean-Canadian adolescents. Results show how these young people appropriate elements of dominant Western health discourses to elaborate their own constructions of health and fitness. These constructions are racialized and gendered, and they speak of the importance of bodily shape and appearance. Furthermore, these constructions point to the high amount of school-related pressure and stress that seem to be part of the day-to-day lives of these adolescents. In that sense, health and fitness practices are very costly for Korean-Canadian adolescents in terms of money, time and self-discipline, but they are valuable to them as they are perceived as ways to successfully integrate Canadian culture, as ways to "belong."

The increasing prevalence of overweight status and obesity among the general population is a major public health concern. There is debate surrounding the role of recreational physical activity in the prevention of weight gain at the population level. This study examined the cross-sectional association between overweight status and obesity and recreational physical activity in a large representative sample of members of the Canadian Armed Forces (n = 4749) using polytomous logistic modelling. A systematic review of the literature looking at the longitudinal relationship between activity level and body mass was conducted and a health promotion intervention was developed. After adjustment for several significant covariates, recreational energy expenditure was significantly and inversely associated with the prevalence of class I obesity compared to normal weight classification (OR 0.94, 95% CI 0.90-0.97), but was not significantly associated with the odds of having a BMI classified as either overweight or obese class II/III (OR 1.01, 95% CI 0.98-1.03; OR 0.93, 95% CI 0.85-1.02) versus having a BMI classified as normal. This study suggests efforts to prevent overweight status and obesity at the population level could profitably address physical activity habits but need to consider the multi-factorial nature of the problem.

Asthma emergency department (ED) visits and hospitalization represent a great burden on the Canadian population in terms of morbidity and health expenditures. This thesis aims to understand the influence of socioeconomic status (SES) on these outcomes. This cross-sectional analysis of the NPHS 1996 Asthma Supplement was based on data from 1814 respondents with asthma. After controlling for various individual-level factors, measures of low SES (low education, low income and high unemployment) at the community level were strong predictors of increased risks of having at least one ED visit or having at least one hospitalization. At the household level, middle-income was associated with greater likelihood of hospitalization but not ED visits, whereas low education and unemployment were related to greater likelihood of ED visits. The relationship between ED visits or hospitalization and SES was not explained by more contacts with key primary health services. The greater use of ED visits among those with low household income was stronger in respondents reporting rare or no asthma symptoms as opposed to those with frequent or continuous symptoms. They may have altered symptom perception. The independent association of area-level SES with hospital use among individuals with asthma needs further research to identify the specific factors that could be the basis of community-based interventions to improve asthma control.

The prevalence of disabling musculoskeletal conditions in children underscores the importance of measuring function. The objectives for the current study were: (1) to develop an evaluative measure assessing function in adolescents with lower extremity orthopedic conditions and; (2) to provide a preliminary assessment of the validity, reliability and measurement properties of the newly developed scale. The Lower Extremity Activity Limitations Scale (LEALS) incorporates a 17-item self-report questionnaire and a 10-item functional performance test. Excessive internal consistency was established for both subscales of the LEALS. The construct validity of the LEALS was supported by its convergent validity with other measures of the same construct. Lastly, the LEALS self report scale was found to be more sensitive to change then the Activities Scale for Kids. Preliminary assessments suggest that the LEALS is a valid, reliable and responsive outcome measure assessing lower-extremity function in adolescents.

This multilevel study examined the influence of neighbourhood socioeconomic context on individual health as measured by self-rated health status and the Health Utilities Index (HUI) in urban neighbourhoods of the City of Ottawa and the combined cities of Ottawa and Gatineau. The samples were drawn from the respondents to the Canadian Community Health Survey 2000--2001 which included individuals 12 years of age and older. There were 1441 respondents within the 37 Ottawa neighbourhoods and 711 respondents within the 14 Gatineau neighbourhoods. The neighbourhood characteristics were derived from the 2001 Census. In Ottawa there was significant variation in health at the neighbourhood level. In age-adjusted models the neighbourhood low income rate and the neighbourhood low education rate were significantly associated with self-rated health (OR=1.35, 95% CI 1.01--1.81; OR=1.03, 95% CI 1.00--1.06, respectively) and a HUI score <0.973 (OR=1.31, 95% CI 1.10--1.56; OR=1.27, 95% CI 1.07--1.52, respectively). However, adjustment for individual level factors reduced the influence of the neighbourhood level variables such that they were no longer statistically significant. Similar results were found for the analysis of the combined cities. This study suggests that the differences in health between neighbourhoods of Ottawa and Ottawa-Gatineau can be attributed primarily to the compositional impact of the characteristics of individuals within the neighbourhoods.