The progressive aging of the population corresponds with a movement in gerontology focusing on factors that promote the positive aspects of aging. The concept of healthy aging corresponds with the multifaceted nature of health but few researchers have examined this concept using a multidimensional approach. The creation of a biopsychosocial definition of healthy aging draws on previous literature to determine important components and potential predictors. The major domains of this definition include physical, cognitive, social, and psychological health. Using cross-sectional and longitudinal data from the Manitoba Study of Health and Aging (MSHA), the purpose was to develop a multidimensional construct of healthy aging based on the four components outlined above. The association between each of the components and the overall construct of healthy aging was examined. A significant interaction was found between physical and cognitive health, indicating that each dimension of health must be assessed in the context of the other. The definition was validated against mortality and institutionalization. Overall healthy aging was significantly associated with future mortality and institutionalization. In addition, healthy aging was compared with the construct of self-rated health to investigate if they are separate constructs. Results indicated that they were overlapping constructs but each variable also had an independent effect on future mortality and institutionalization. Significant demographic predictors of healthy aging at time 2 included younger age and higher education. A greater number of chronic conditions; the presence of vascular factors such as high blood pressure, stroke, heart problems, and chest pain; the presence of neurological factors such as memory problems and nerve trouble; and the presence of other conditions such as chronic pain, eye and ear trouble, and foot problems were also associated with not meeting criteria for healthy aging at time 2. Overall the findings from this study provide support for the importance of a multidimensional definition of healthy aging that is distinct from the construct of self-rated health. The findings underscore the need to assess individual characteristics, such as age, sex, and education, when attempting to predict future health outcomes. A greater understanding of the factors that are associated with healthy aging may encourage opportunities to promote healthy aging. This research may have important implications for researchers, clinicians, and policymakers as they focus on improving quality of life for our aging population.

Objective: Significant investments to address childhood obesity require that we understand the factors that facilitate the use of research among public health practitioners in order to support evidence-informed strategies. Therefore the objective of this study is to understand the role of the interactive support of the SHAPES-Ontario Knowledge Exchange Extension (KE Extension) on evidence-informed knowledge use concerning youth physical activity in public health. The interactive support is defined according to three components: 1) Collaborative Partnership, 2) Community of Practice, and 3) Knowledge Broker. Methods: Two different groups of Public Health Organisations were selected. The Intervention group consisted of two Ontario Public Health Units from the SHAPES-Ontario KE Extension. The Comparison group consisted of one Ontario Public Health Unit and one Manitoba Regional Health Authority. The Comparison organisations did not have the intervention of the KE Extension. Semi-structured interviews were conducted with approximately four to five staff from each organisation. Qualitative analysis identified instances of evidence-informed knowledge use, interactive processes and other factors that influenced knowledge use related to youth physical activity in public health program planning and decision-making. This resulted in comprehensive case studies for each organisation. Cross case analysis identified the dominant similarities and difference in the factors that influence evidence-informed knowledge use across the organisations and how they inter-relate. Results: The cross case analysis indicated that having access to local youth physical activity surveillance data (e.g., SHAPES data) was the most important facilitator of evidence-informed practice. Interactive processes, specifically working groups, partnerships, and knowledge brokers, were found to be an important factor across the fours organisations. These interactive processes were found to have a reciprocal relationship with the information source and the context for sue, further facilitating evidence-informed knowledge use. The specific interactive mechanisms of the KE Extension did not emerge from the data, as the intervention was not intensive enough compared to the other activities within the Intervention organisations. Conclusions: Providing public health practitioners with access to local and relevant research evidence, coupled with intensive, sustained, and consistent interactive support for planning and decision-making may be effective at encouraging evidence-informed practice related to youth physical activity.

Tobacco remains the leading preventable cause of death in the world, and 5 million people worldwide continue to smoke. Further adding to the problem is the fact that smoking cessation rates are very low, and there are some smokers for whom quitting smoking is extremely difficult. Many smokers find nicotine replacement therapy (NRT) products unappealing, and even when used as directed NRTs only achieve modest cessation rates. Smokeless tobacco (ST) may be more appealing than NRT and deliver nicotine in a more palatable way to cigarette smokers. ST is also far less harmful than smoking. It is for these reasons that many scientists and health professionals have suggested the use of ST as a substitute for smoking to reduce tobacco-related harm. Although the health risk posed by ST appears to be much less than conventional cigarettes, the extent to which ST may serve as a harm reduction product is highly contentious. Furthermore, although ST products are legal and widely available, it remains unclear whether conventional cigarette smokers in Canada will use ST products as a substitute for cigarettes or as a cessation aid, if at all. And despite the strong evidence for the effectiveness of cigarette warning labels, there is little research on ST health warning labels. The current study investigated perceptions of ST products with and without HWLs and relative health risk messages among 611 young adult Canadian smokers aged 18-30. The study sought to examine the impact of ST health warning labels (HWLs) on appeal, willingness to use, and perceived health risk and addictiveness. Participants completed a survey during which they were asked to view and provide their opinions on a series of ST packages that were digitally altered according to each of six experimental conditions: (1) "standard" packages of leading ST brands, (2) "standard" packages + a relative risk message about the harm of cigarettes compared to ST added, (3) "Standard" packages + text HWL, (4) "Standard" packages + text HWL and relative risk message, (5) "Standard" packages + picture HWL, and (6) "Standard" packages + picture HWL and relative risk message. The findings indicate that many smokers are unaware that ST is less harmful to health compared to smoking. Despite this, approximately half of young adult Canadian smokers indicated that iv they were willing to try ST as a substitute for smoking and to help quit smoking. Picture warnings increased misperceptions about the health risk of ST and decreased smokers‘ willingness to try ST, whereas text warnings did not. Similarly, adding a relative health risk message to the warning label that communicates the lower risk of ST compared to cigarettes increased willingness to try ST when added to text warnings, and decreased willingness to try ST even further when added to picture warnings. This study is among the first to examine ST warning labels, and is the first to examine the impact of picture warning labels on ST. Overall, the findings suggest picture warnings may make it more difficult to communicate the differences in risk between ST and cigarettes.

The current study used a probabilistic Quantitative Microbial Risk Assessment (QMRA) framework to describe the change of E. coli O157:H7 concentration in lettuce through a foodborne pathway, to develop a predictive model for risk estimation for E. coli O157:H7 infection associated with lettuce. The model consisted of a series of pathogen-associated events including initial contamination, growth during cooling, cold storage and distribution, disinfection (chlorine, gaseous chlorine dioxide and gamma irradiation), and dose response after consumption. A modified Baranyi growth model was proposed which described the initial physiological state of E. coli O157:H7 as a function of the initial temperature. The modified Baranyi growth model was used to predict E. coli O157:H7 growth under realistic time-temperature profiles, accounting for the time dynamics of temperature fluctuation. The risk assessment model was constructed in an Excel spreadsheet and Monte Carlo uncertainty analysis was simulated using Crystal Ball. The results in the current study showed that temperature control was the key measure for minimizing the risk of E. coli O157:H7 infection associated with lettuce. Disinfecting contaminated lettuce using the hypothetical methods examined in the study had limited effectiveness in risk reduction. Temperature abuse occurring before or after the hypothetical disinfections significantly diminished the disinfection effect and contributed to increased risk. Of all simulated scenarios, the lowest risk was associated with adequate temperature control and irradiation (44 infections per 1000 consumptions [95%: 94 infection per 1,000 consumption; 5%: 5 infections per 1,000 consumption]). The model can be used to explore the public health impact of other potential strategies that can be adopted to minimize the risk of E. coli O157:H7, while taking into account the possible amplification of pathogen through the food chain.

Background: Dementia diagnosis and management is increasing in importance in the training of future family physicians. This research evaluated the effects of a dementia education program on family medicine residents’ knowledge, attitudes and confidence with respect to dementia assessment and management. A questionnaire was developed and validated for these purposes. Additionally, a focus group was conducted with family physicians to generate recommendations for improving dementia education in family medicine residency programs. Methods: The questionnaire consisted of a knowledge-based component, a component ascertaining preferences working with various age groups, and an attitudinal/comfort component. Test-retest reliability was assessed, in addition to validity by way of cognitive interviews. A content validity matrix was also completed. Family medicine residents participating in the dementia education program were asked to complete the questionnaire at baseline, interim and following program completion. Willing residents also participated in program feedback interviews. After approximately three months, residents completed the questionnaire for long-term follow-up. Differences in scores were examined between the participants and a comparison group of family medicine residents without program exposure. Qualitative data from the feedback interviews and the focus group were transcribed and analyzed for common themes. Results: Each questionnaire component demonstrated high internal consistency (Cronbach’s α: 0.83-0.91) and high intraclass correlation coefficients (0.74-0.91). Residents who had participated in the program scored significantly higher on the knowledge component compared to residents who did not, in addition to reporting greater comfort. Qualitative data indicated that residents found the program to be a valuable part of their residency education. Focus group results indicate that family physicians recommend the provision of early positive experiences facilitated by mentors, through a competency-based curriculum. Discussion: The developed questionnaire is a reliable measure for assessing dementia knowledge, attitudes and confidence. Results from the dementia education program show that it is effective in improving family medicine residents’ knowledge on dementia diagnosis and management, as well as in increasing comfort levels. Qualitative data from feedback interviews indicate strong endorsement of the program by its participants. Recommendations generated from the focus group were found to be relevant to dementia education and potentially more broadly to geriatric education.

Feeling connected to one’s community has been associated with increased self-rated health and well-being. Connectivity has also been linked to health behaviours such as smoking and obesity, which have been related to overall health status. Physical activity is related to overall health status as it protects against many chronic diseases. Unfortunately, less than 50% of Canadian adults are meeting the physical activity requirements set out by Canada’s Physical Activity Guide to Healthy Living. Thus, this study determines whether sense of connectedness is associated with current participation in leisure-time physical activity and intention to start or increase engagement in physical activity. Cross-sectional data from the Canadian Community Health Survey (CCHS) cycle 3.1 was used to analyze the association between sense of community belonging and physical activity among Canadians aged 25 to 64. A series of logistic regression models were used to analyze the data. People reporting a stronger sense of connectedness had greater odds of being physically active with income, education and sex often moderating the relationship. It appeared that the relative odds of being physically active were greatest among people who felt very strongly connected to their communities and in the highest socioeconomic groups. Further, feeling more that very weakly connected to the community increased the odds of intending to start or increase physical activity among inactive females and decreased the odds of intending to increase physical activity among moderately active males. This study provides preliminary results regarding how important social factors may alter population level physical activity. The results from this study inform our understanding of barriers and facilitators associated with physical activity and how policies and conditions which affect community connectedness may be used to enhance physical activity.

Background: Care transitions are a common and frequently adverse aspect of health care, resulting in a high-risk period for both care quality and patient safety (Coleman, 2003; Forster et al., 2003; Picker Institute 1999; van Walraven et al., 2004; Cook et al., 2000). Patients who have complex care needs and undergo treatment from multiple care settings may be at a greater risk for poor care transitions (Coleman et al., 2004). Using quantitative performance measurement scales is one method that can assess the quality of care transitions, and identify areas for improvement. The psychometric properties of the primary performance measurement scale, the Care Transitions Measure (CTM), have not been rigorously assessed, particularly within a higher risk, medically complex population such as older adults with musculoskeletal (MSK) disorders. Furthermore, despite the negative health implications that can result from poor transitions and the commonality of care transitions among persons with complex care needs, there is a significant dearth of research on this crucial aspect of health care. Methods: This research examines the ability of the CTM to adequately assess the quality of care transitions among a complex population of older MSK rehabilitation patients and explores care transitions from the perspective of the patient and the health care provider. Information was gathered through telephone administration of the CTM to MSK patients after they transitioned from inpatient rehabilitation units to home, and through a series of qualitative key informant interviews with a range of health care professionals in care settings relevant to the care continuum of older MSK patients. Inter-rater reliability, a type of reliability that has never been tested with the CTM, and construct validity were assessed and qualitative analyses were used to examine qualitative information obtained through the CTM administration to patients and through the interviews with health care providers. Results: The CTM demonstrated excellent inter-rater reliability for the overall score (intraclass correlation coefficient = 0.77; p=0.03) despite only fair agreement between each item. Internal consistency of the CTM was high (Cronbach’s alpha = 0.94). The construct validity of the CTM was supported; however qualitative data from the patient and health care provider perspectives suggest additional items should be considered for inclusion. Qualitative information from patients also suggests the need for revisions to the wording of some items and the response options. Health care provider interviews suggest that issues surrounding transitional care are similar regardless of the care setting involved. Conclusions: Although the CTM proved to be reliable, qualitative data suggests that the addition of items should be considered to improve the content validity of the CTM, which would in turn improve its construct validity as well. Recommendations for scale improvement are made, as are recommendations for an alternative scale to assess care transition quality from a health care provider perspective. The results of this study support efforts to improve the outcomes of care transitions, care planning, and the overall quality of life for older rehabilitation patients.

Abstract Objectives: This research project was undertaken to review two commonly used screening instruments for the elderly who attend at hospital emergency departments in Ontario. These instruments were then contrasted with a new potential screening instrument made up of items drawn from the Minimum Data Set-Acute Care instrument (MDS-AC Version 1_CAN). The hypothesized outcome was better specificity and sensitivity utilizing the newly prepared instrument in predicting at an earlier point if an elderly emergency department patient would become an alternate level of care (ALC) patient. The ability of the screener to predict negative outcomes (delirium, longer length of stay) was also analyzed. Methods: One dataset from a previous International Resident Assessment Instrument (interRAI) organization study in southern Ontario completed in 2000 was utilized to inform this research. Each of the commonly used screening instruments was crosswalked to the MDS-AC items, then both univariate and bivariate analyses were completed. Three research questions were then posed. By testing various logistic regression models, the research looked to establish whether the newly developed instrument would be able to perform comparably to the other two currently-used instruments, and whether it would be more effective in predicting ALC status and particular adverse patient outcomes. Results: The newly-developed instrument was found to perform more accurately. While several variables were tested, a core number were found to be more strongly predictive of future need for ALC status. Conclusions: Future research in this area is recommended.

Objective: To describe the effect of mindfulness on perceived health, perceptions of transit walking and transit walking behaviours by using qualitative and quantitative methods in hopes of assessing the feasibility of future mindfulness interventions in transit users. Method: Fifty-three residents of Kitchener-Waterloo were recruited at transit stops and public buildings. All participants took part in a cross-sectional mixed-methods telephone survey, including qualitative questions designed by the researcher, quantitative questions from validated surveys and the Mindful Attention Awareness Scale. Both a qualitative measure and a quantitative measure of transit mindfulness were used. Four participants who scored low on transit mindfulness but walked more than 30 minutes per day took part in a qualitative interview. Results: Walking to transit was perceived to be a good way to get exercise, but participants thought that the value of this exercise depends on the distance walked. Although the majority of study participants were mindful of the value of walking to transit they did not attain enough exercise doing so. Most observed associations between mindfulness, perceptions of transit walking, transit walking behaviours and perceived health were positive but did not reach significance, likely due to issues of statistical power and small sample size. Of the tested covariates age and gender appeared to influence the observed positive associations. Conclusions: There is potential for successful mindfulness interventions with transit users who are older or female, especially when increased levels of transit walking are encouraged. Younger males could be targeted in future interventions, targeting their lack of mindfulness and adequate transit walking. Future research on mindfulness should focus on creating measures that can be used to measure mindfulness in daily life and also retain the Buddhist definition of mindfulness in-the-moment. Reliance on self-report measures should be avoided. The results of this study could be useful at the local level to design research that examines perceptions of transit and transit-related exercise as light rail is implemented to replace bus transit.

Background: Alzheimer disease (AD) is a progressive, late-life neurodegenerative disorder. Given the aging population, AD is a significant health concern. According to the Alzheimer Society of Canada (Smetanin et al., 2009), in 25 years 2.8% of the Canadian population will have AD or a related dementia. Presently, there is no cure for AD; therefore, efforts to either delay AD onset or prevent AD altogether are a primary focus. The ability to proficiently speak many languages has been associated with certain cognitive advantages. Based on these findings, multilinguals are hypothesized to be more resistant to cognitive decline than monolinguals. More research is warranted in order to further this theory and to contribute to strategies to prevent or delay AD. Objectives: The first study objective was to evaluate whether multilingualism was associated with the development of AD. The second study objective was to assess whether multilingualism was associated with later dementia onset. Methods: Analyses were based on data from the Nun Study, a longitudinal study of aging in 678 participants 75+ years living in the United States. In order to address the first study objective, the association between multilingualism and AD was assessed in 157 participants using logistic regression models adjusted for age, education, apolipoprotein E-E4 (ApoE-E4) status, immigrant status, and occupation. Additional subgroup analyses also included covariates associated with career length and linguistic ability (grammatical complexity and idea density). AD was diagnosed based on criteria for both clinical dementia and AD neuropathology. Dementia was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criterion (American Psychiatric Association, 1994) (based on the Consortium to Establish a Registry for Alzheimer’s Disease battery of tests (Morris, Heyman, Mohs, & Hughes, 1989) and performance on activities of daily living), while AD neuropathology was based on the National Institute on Aging and Reagan Institute criterion (The National Institute on Aging - Reagan Institute (NIA-RI) Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease, 1997). In order to address the second study objective, dementia likelihood was assessed in 325 participants using discrete-time survival analyses adjusted for age, ApoE-E4 status, education, and linguistic ability. Results: When adjusted for age, education, ApoE-E4 status, occupation, and immigrant status, participants speaking two or more languages had similar AD risks compared to monolinguals (OR = 1.05; 95% CI = 0.45-2.50). However, when grammatical complexity was held constant across participants, speaking two or more languages was associated with a four-fold decrease in AD risk compared to speaking one language (OR = 0.25; 95% CI = 0.04-1.23), although this did not reach statistical significance. When the association between multilingualism and time of dementia onset was assessed, the dementia hazard function estimates for all participants were constant and persisted throughout the follow-up period of the study. When ApoE-E4 status and baseline age were held constant, participants speaking four or more languages were significantly less likely to develop dementia than monolingual participants (OR = 0.14; 95% CI = 0.01-0.66). An interaction between multilingualism and the other two covariates (ApoE-E4 status and baseline age) was observed: the oldest participants with an ApoE-E4 allele who spoke four or more languages had smaller dementia risks than younger participants without an ApoE-E4 allele who spoke one, two, or three languages. Participants speaking two or three languages were no less likely than monolinguals to develop dementia across the study duration. When idea density was held constant across participants, multilingualism was associated with a nonsignificant decreased risk of dementia for individuals speaking three (OR = 0.62; 95% CI = 0.16-2.41) or four or more languages (OR = 0.53; 95% CI = 0.06-4.91) while participants speaking two languages were no more at risk for dementia than monolinguals (OR = 1.08; 95% CI = 0.43-2.69). Discussion: Initially, multilingualism did not appear to confer protection against AD. After holding grammatical complexity constant across all participants, however, multilingualism was found to be associated with AD risk. Therefore, linguistic ability confounded the initial relationship measured by this study. When the association between multilingualism and time of dementia onset was evaluated, participants were no more likely to develop dementia in one time period than another, and monolingual participants were no more likely to develop dementia in earlier time periods than multilinguals. While a trend of decreasing dementia risk with ascending number of languages spoken was not observed, speaking four or more languages was consistently associated with decreased dementia risk compared to speaking one language. The presence of an ApoE-E4 allele and low linguistic ability had a strong and consistent significant association with increased AD and dementia risk. Therefore, the influence of these variables on the association of multilingualism with AD and dementia is worthy of further exploration. Overall, this study provided some support for a protective effect of multilingualism on AD and dementia. Some of the present investigation’s results differ, however, from those of previous studies. This is not surprising, considering the present study utilized different methodologies than other studies in this research area. For instance, our study employed a definition of multilingualism based on self-report data – participants were classified as multilingual based on the number of languages they reported proficiency with. Therefore, our definition of multilingualism was less strict than definitions used in previous studies. However, our study employed much stricter outcome criteria than those used in previous studies, as our study is the first in this area to confirm AD cases with AD neuropathology evaluations. Our study is also the first io utilize prospective data and to include participants who remained dementia-free in addition to participants developing AD and dementia. In addition, this is the only study in this research area to evaluate the relationship of multilingualism with AD and dementia in the context of important covariates such as ApoE-E4 status and linguistic ability. Therefore, while some of our results contrast with other findings in this area, this is understandable given our novel methodologies. A broad range of study methods must be used in the future if we are to generate the depth of evidence needed for a full understanding of the relationship of multilingualism with AD and dementia. A better understanding of this relationship may also provide insight into both cognitive and brain reserve mechanisms, which could help more individuals maintain cognitive function into late life.