In Canada, 3,300 children under the age of 20 are living with Crohn’s Disease (CD) (Crohn’s and Colitis Foundation of Canada, 2008). When an illness such as CD occurs in adolescence, the challenges associated with it are further compounded by the developmental tasks associated with this life stage. The purpose of this study was to understand how adolescents experience living with CD; to explore the impact of disease activity on their quality of life (QOL) and the strategies utilized to maintain and improve their QOL. Using a resiliency framework and narrative inquiry as a research methodology, seven adolescents were interviewed. The results include seven individual stories exemplifying their experiences, and from the stories shared, four patterns emerged: (1) Unconditional Support, (2) Embracing and Accepting Differences, (3) Attitudes and Personal Beliefs and (4) Daily Coping Strategies. These findings may have relevance for health professionals and families and adolescents with CD.

The use of prescription opioids for chronic non-cancer pain is complex. Opioids have the potential to alleviate discomfort and increase ones overall ability to function but, long term use also has potential physical and psychological impacts. The purpose of this study was to explore the lived experience of adults who use prescription opioids to manage chronic non-cancer pain. Nine participants were recruited and interviewed. Participants were asked to describe how using prescription opioids had affected their lives. Interviews were recorded, transcribed and analyzed thematically using Interpretative phenomenological analysis (IPA). Eight themes emerged from the data: the process of decision making, physical effects of using opioids, social consequences of using opioids, Guilt, fears, ambivalence, self-protection, and acceptance. Using opioids made pain more manageable and improved function for most of the participants. Nevertheless, using opioids was also associated with stigma, guilt, fears and ambivalence about their future as persons with chronic pain.

The Government of Canada’s National Aerial Surveillance Program (NASP) is responsible for the monitoring of ship based oil pollution in Canada’s three oceans. In many of these spills, the source of pollution is unknown as there are often no vessels found in the vicinity at the time of detection. In this work, the oil spills found in 2010 on the West Coast of Canada, alongside the collated vessel traffic data captured by the Canadian Coast Guard are investigated to determine the vessels most likely responsible for these spills. In terms of tools and techniques applied, oil spills are firstly hindcasted using the General NOAA Operational Modeling Environment (GNOME) to determine the location of their source. ArcGIS is used to geospatially reference and combine various data sets, and lastly the Analytical Hierarchy Process (AHP) is used to rank possible polluters found in the area of the spill.

Chronic low back pain (CLBP) is a challenging problem in Nova Scotia and is a leading cause of disability and a contributor to high health related costs to the system. The primary objective of this thesis is to develop and test a methodology for the creation of an electronic standardized assessment tool for chronic conditions such as CLBP using a triangulation method. The methodology involves evidence-based, expert and explicit clinical knowledge in the development of the tool. The outcome of this research is the development of a methodology model for the generation of electronic standardized assessment form for CLBP with 30 predictive factors. Experts evaluated the form for its use and usefulness, usability, and standardized terminologies. Intra-Class Correlation (ICC) and Cronbach’s alpha were used to measure inter-rater reliabilities among experts. The results were in the fair and moderate levels of agreement due to the limitation in sample size and the variation of disciplines among participants.

Captive animals are sometimes very inactive, which can elicit concern for their welfare. However, inactivity is difficult to interpret in terms of welfare, since while some forms reflect chronic fear (hiding), apathy, or depression-like states, others reflect positive states (e.g. relaxation). This thesis aimed to determine whether high levels or particular sub-types of inactivity indicate poor welfare in fur-farmed mink (Neovison vison), and to identify the specific psychological states involved. These questions were addressed by studying individual differences within populations on three commercial farms, and comparing mink in standard, non-enriched cages to those in enriched cages. Two hypotheses were tested on farms: that the most inactive mink experience chronic stress, and that this would impair reproduction. Inactive females did have smaller litters, a difference that was not attributable simply to their greater body fat. However, there was no evidence of endocrine stress nor increased fear in “glove tests”, and their kits also grew more quickly. This suggests that inactive females do not experience more chronic stress than active females do. Tests of responsiveness to stimuli (measured in terms of contact and orientation) showed that, compared to mink in enriched cages, non-enriched mink were more responsive to all types of stimuli, especially neutral ones. This finding is inconsistent with the hypothesis that inactive individuals in these conditions are apathetic or depressed; instead, it supports the alternative hypothesis that non-enriched cages induce boredom. However, this boredom-like hyper-responsiveness did not co-vary with inactivity levels. Finally, non-enriched cages did not consistently elevate total inactivity. However, they did induce specific types: inactivity in the nest box, lying alert (vs. sleeping), and lying belly down rather than curled up were all more common than in enriched cages. Inactivity in the nest box may reflect hiding; it seemed linked to fearfulness in glove tests and to endocrine stress responses. In sum, while non-enriched conditions induce poor welfare, they do not increase overall inactivity; furthermore, within populations, the welfare of highly inactive individuals is no more compromised than that of their more active counterparts. However, subtypes of inactivity provide more information about welfare than total inactivity. / NSERC (PGS)

Purpose: This thesis addresses feasibility issues of conducting a descriptive study of pain and health-related quality of life (HRQOL) in women after Cesarean section (c-section). Objectives: Feasibility issues surrounding population access, chart completeness for review, and preference for online data collection were investigated. Prevalence and prediction of postoperative pain and HRQOL at six-weeks was addressed to generate hypotheses for future study. Methods: A descriptive pilot design was used, collecting a convenience sample of 41 women recruited two hours prior to a planned c-section at Kingston General Hospital. Consenting women completed preoperative questionnaires via computerized tablet or paper and pen. Preoperative data included pain, HRQOL, anxiety, depression, somatization, HCU, and demographics. Six weeks postoperatively, women completed pain, HRQOL, and HCU questionnaires through the internet, postal mail, or telephone. A chart review was used to collect health and obstetrical history, and acute postoperative pain. Results: An average of two participants per week were recruited, with a participation rate of 83.7%. Online questionnaires were preferred by 34 women (83%) preoperatively, and 15 women (48.4%) postoperatively. Almost 40% of patient charts were incomplete, missing symptoms reported in the immediate postoperative period. Twenty-four percent of the sample was lost to follow-up. Mild postoperative pain was reported by seven women (23) within 24 hours of completing the questionnaire. Bodily pain and the physical component of HRQOL were worse both pre- and post-operatively than age- and sex-matched norms. Postoperative pain at six weeks was predicted by tubal ligation, pain expectancy, and severe postoperative acute pain. Postoperative HRQOL scores were correlated with preoperative HRQOL score, depression, somatization, and preoperative pain. HRQOL physical composite score, bodily pain scores, and trait anxiety were predictive of healthcare use. Conclusion: The planned c-section population is accessible for research purposes, however timing and mode of follow-up should be carefully considered due to the demands of newborn care. A larger study evaluating the prevalence of chronic pain after c-section is needed, in which the role of depression, anxiety, somatization, and pain expectancy in pain outcomes and the impact on healthcare use is investigated. / Thesis (Master, Nursing) -- Queen's University, 2007-10-01 13:12:33.096

Background: Coronary artery calcification (CAC) is common in chronic kidney disease (CKD) patients, and is demonstrable in fifty percent of incident dialysis patients. Therefore, the process of CAC initiation likely occurs in the pre-dialysis period. Pre-dialysis CKD patients have been shown to have a substantially higher burden of CAC than age and sex matched controls from the general population. Consequently, the hypothesis that CKD itself is a risk factor for CAC occurrence is biologically plausible. Objective: 1) To quantify the relationship between CKD and CAC in stage three to five CKD patients without known cardiovascular disease. 2) To estimate the strengths of associations between traditional cardiovascular disease risk factors, non- traditional cardiovascular disease risk factors and CAC in this patient population. Methods: This cross-sectional study investigated one hundred and nineteen CKD patients (excluding dialysis) receiving care at a single hospital in Kingston, Ontario, Canada. For the primary objective, correlational analyses were performed to evaluate associations between a priori selected variables of kidney function and CAC scores, as well as other a priori chosen variables of interest. Results: Mean and median CAC scores were 566.5 SD: 1108 and 111 (inter-quartile range 2 to 631.5) respectively. CAC correlated with age (r = 0.44, p<0.001), body mass index (r = 0.28, p = 0.002), high density lipoprotein cholesterol (r = -0.23, p = 0.01), diabetes mellitus (r = 0.23, p = 0.01), and the cardiovascular risk score (r = 0.35; p < 0.001). By multivariable linear regression controlling for eGFR and diabetes, age (ß = 0.05, 95% CI 0.03-0.06; p<0.001), body mass index (ß = 0.04, 0.02 - 0.07; p=0.001), and serum calcium (ß = 0.9, 0.15 - 1.6; p=0.02), were risk factors for CAC. Results from multivariable logistic regression modeling demonstrated consistent findings. Limitations: Inadequate sample size and uncontrolled confounding are possible limitations, but are unlikely to have changed the main study findings. Conclusions: In this study, traditional cardiovascular disease risk factors and serum calcium were associated with coronary artery calcification. No association was demonstrated between CKD and CAC. Studies exploring potential protective mechanisms against coronary artery calcification are needed.

No description available.

The possible involvement of spinal metabotropic glutamate receptors (mGluRs) were examined in animal models of persistent and chronic pain. In Study 1, it was shown that spinal administration of relatively selective group I mGluR antagonists, or a selective group III mGluR agonist, but not a non-selective mGluR antagonist, slightly, but significantly reduced nociceptive scores in the rat formalin test Also, spinal administration of a non-selective mGluR agonist, or a selective group I mGluR agonist, but not a relatively selective group II agonist, enhanced formalin-induced nociception. The pro-nociceptive effects of these agents were reversed by a non-selective mGluR antagonist or by an N-methyl-D-aspartate receptor (NMDAR) antagonist. In Study 2, it was shown that intrathecal administration of two non-selective mGluR agonists or a selective group I mGluR agonist, but not a selective group II or group III mGluR agonist, produced spontaneous nociceptive behaviours, (SNBs) in rats. Also, the SNBs induced by these agents were reduced by a non-selective mGluR antagonist or by an NMDAR antagonist. In Study 3, it was shown that intrathecal administration of a selective group I mGluR agonist produced persistent mechanical allodynia, mechanical hyperalgesia and heat hyperalgesia in rats. In Study 4, it was shown that early, but not late intrathecal administration of a relatively selective group I mGluR antagonist reduced nociceptive behaviours, in a model of neuropathic pain. In Study 5, it was shown that intrathecal administration of a selective group I mGluR antagonist reduced mechanical allodynia and cold hyperalgesia, while a selective group II mGluR agonist and a selective group III mGluR agonist only reduced mechanical allodynia and cold hyperalgesia, respectively, in the neuropathic pain model. Results from these studies first suggest that spinal group I mGluRs may be more critically involved in the development of chronic nociceptive behaviours, compared to persis

<p>This study determined the affordability of medicines for diabetic patients attending the diabetic clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu. The Study was a cross-sectional time-delimited, descriptive study of affordability of Medicines for diabetic patients aged &gt / 18 years and who pay for medicines out of pocket. A structured questionnaire was used to collect sociodemographic information about patients and the prescription was assessed in terms of conformity with essential medicines list (EML), cost and ability to be completely filled by the patient. Data was analysed using EPI Info software.the results show that medicines prescribed for diabetes are unaffordable to the majority of patients who attend the UNTH diabetic clinic.</p>