The hepatitis C virus (HCV) disproportionately affects the prison population. Studies demonstrate that healthcare provider knowledge of HCV risk factors is insufficient and many individuals are not aware that they are HCV positive. Early identification of HCV status can prompt early treatment and avoidance of complications that contribute to poor outcomes resulting in chronic disease progression. This doctor of nursing practice (DNP) project addresses provider identification of HCV risk factors at initial inmate intake to prison and whether providers obtained HCV testing based on guidelines from the Centers for Disease Control and Prevention (CDC). The principal investigator (PI) conducted a retrospective medical record review at Arizona State Prison Complex (ASPC) Lewis focusing on initial inmate intake forms identifying two of the CDC risk factors for HCV: drug abuse and tattoos; and ascertaining if a providers ordered a HCV test if inmates had one or both of these risk factors. The PI reviewed 51 randomly selected medical records; 40 records met inclusion criteria of 1) inmates who had an initial inmate intake evaluation occurring from 1 October 2013 to 1 October 2014 and 2) documentation of positive HCV risk factors. Analysis of the records showed a mean inmate age of 26.78 years with a variable racial distribution. The risk factor of tattooing was present in 37 (92.5%) of records reviewed and the risk factor of intravenous drug use (IVDU) was present in 7 (17.5%). Only 4 (10%) records of inmates with positive risk factors had a HCV test ordered by the provider: One physician (n=2) and one nurse practitioner (n=2). This project demonstrated a gap in HCV testing in the presence of risk factors in the inmate population at ASPC Lewis which is consistent with studies in the general population. This study does not identify any reasons for this consistency, but raises questions for future studies focused on provider knowledge, education and the institution of HCV testing protocols. This DNP project provides the foundation for a future full quality improvement Plan-Do-Study-Act based project aimed at educating providers about HCV testing according to CDC (2013a) guidelines and subsequently re-evaluating their HCV test ordering practices.

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This thesis explores distress and reactions after crime by a previously unknown perpetrator in a two-year perspective. Distress was investigated at eight months and two years, using quantitative and qualitative methods. The specific aims of the thesis were (I) to explore the level of distress and the role of risk factors for post-traumatic and general symptoms eight months post crime, (II) to examine the natural course of adjustment at a two-year follow-up in female and male victims of interpersonal violence, III) to investigate the relationship between shame, guilt, and distress among 35 victims of a single severe violent crime, and (IV) to use qualitative analysis to describe individual post-crime trajectories. The following questionnaires were used: Symptom Check List 90 (Derogatis & Cleary, 1977), Harvard Trauma Questionnaire (Mollica et al., 1992), the Test for Self-Conscious Affect (Tagney et al., 1989). Data were also obtained via semi-structured interviews, including the use of visual analog scales for subjective mental health measures. The participants in paper I were male and female Swedish adult victims of reported interpersonal violence eight months earlier. Participants were between 18 and 66 years of age (n=41). At follow-up (Paper II) the sample size had decreased (n=35). In paper III, adult victims (aged 18-64) of reported interpersonal violence were assessed within two weeks of reported crime (n=35). In paper IV a subsample of 11 adult crime victims were drawn from among the participants from papers I and II. Paper I showed that women reported more distress than men. Prior trauma, adverse childhood, female sex, previous psychiatric history, and unemployment were all associated with more distress. Peritraumatic reactions (especially secondary emotions following cognitive appraisals after the event) predicted the three core PTSD symptoms and comorbid conditions, together with female sex and psychiatric history. Paper II confirmed most of the risk factors at eight months and that, in general, no further recovery took place between eight months and two years. Paper III showed that shame-proneness and event-related shame were highly intercorrelated and related to higher symptoms levels, while the guilt measures were unrelated to each other as well as to symptoms. Paper IV explored narratives of victimization; the results suggest that individual differences within the same trajectories of recovery should be expected.

Aim: This study aims to investigate the experience of stress and the factors that impact on the intern psychologist in relation to first consultation with a non-fatal suicidal client. Intra and interpersonal factors, as well as institutional/environmental factors that influence/impact on intern clinical/counselling psychologist level of stress when assessing and managing a non-fatal suicidal client were identified. Methodology: The research methodology chosen for this study is based on the aim of the study, which is to investigate the experience of stress perceived by intern clinical/counselling psychologists in relation to consultation with a non-fatal suicidal client. A qualitative methodological approach will be used in this study as it allows for greater in-depth investigation and understanding of the experiences of intern clinical/counselling psychologists towards suicidal clients than would be generated by quantitative research methods. Five intern clinical/counseling psychologists were used in this qualitative study. They were interviewed using a semi-structured in- depth interview. The data was transcribed and analysed using thematic analysis. Findings: A variety of stressors were identified by the interns, but the majority described common variables. The main sources of stress for the interns was first contact with suicidal clients and lack of practical training and experience. The working environment, which included work load, administrative work and academic and competency based requirements, was also deemed stressful. In terms of personal stress, interns reported family and friends to be a source of stress at times. Personality also contributed to the interns levels of stress. Socio-cultural factors which impacted on the interns experience of stress in relation to consultation with non-fatal suicidal clients included, language difficulties and cultural differences. Recommendations: The internship was generally described as stressful. Recommendations included more practical experience and training prior to the commencement of the internship. This will equip interns with the skills and abilities necessary in successfully assessing and managing high risk clients. Organisational and professional factors can also be modified and include support as well as an understanding of the policies and procedures of the institution in which the internship is being done. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007.

Background: Vitamin D may be important in the causal pathway to breast cancer (BC) by influencing mammographic breast density (MD). However, previous study results in postmenopausal women are inconsistent. Study objectives were to prospectively examine the relationship between biomarkers of vitamin D (25-OH-D) and percent MD in postmenopausal women at northern latitudes. Potential effect modification by exemestane therapy, calcium or genetic polymorphisms in the vitamin D pathway was also examined. Methods: This study evaluated a sub-cohort of postmenopausal women at elevated BC risk who participated in the NCIC Clinical Trials Group placebo-controlled MAP.3 trial with exemestane. Levels of 25-OH-D were measured using LC-MS/MS from serum samples collected at baseline and year 1, averaged and adjusted for month of collection. Baseline and follow-up (≥ 3 year) percent MD was centrally assessed from film and digital mammograms with Cumulus software. Multivariable linear regression was used to estimate the effect of 25-OH-D on log transformed percent MD at follow-up and on the change in percent MD from baseline. Percent MD was also dichotomized and multivariable logistic regression was used to evaluate 25-OH-D levels between 1) women with lower (<25%) compared with higher (≥25%) percent MD and 2) women with a decrease compared with no change or an increase in percent MD over time. Results: Percent MD was measured for 568 participants with a follow-up mammogram and for 388 participants with a baseline mammogram in the same format as the follow-up. The geometric mean percent MD of the follow-up mammograms was 4.3% and few women (13.4%) had percent MD ≥ 25%. The unadjusted mean 25-OH-D concentration was 36.5 ng/mL (SD=10.6) based on pooled baseline and year one samples. After controlling for age, month of sampling and potential confounders, 25-OH-D was not predictive of log transformed percent MD at follow-up (p=0.36) or with annual mean changes from baseline (p=0.33). Similarly, results from the logistic regression analyses were not statistically significant and no interactions with exemestane, calcium or genetic polymorphisms were detected. Conclusion: No association was observed between vitamin D levels and percent MD at ≥3 year follow-up or change in percent MD from baseline. / Thesis (Ph.D, Community Health & Epidemiology) -- Queen's University, 2014-03-31 11:20:23.963

This thesis investigated the epidemiology and control of Cysticercus ovis infection on Canadian sheep farms. Canadian slaughter data indicated an increase in sheep carcass condemnations due to C. ovis in 2007 and 2008. Trace-back of 237 carcasses condemned in Ontario, between 2009 and 2011, revealed they originated from 133 farms across Canada. A case-control study was performed (n=40 cases, 56 controls) to identify farm-level risk factors for carcass condemnations. Farm dogs scavenging deadstock (OR=4.04; 95% CI: 1.16–14.04) and failing to dispose of deadstock properly (OR=11.78; 95% CI: 2.93–47.40) were significantly associated with condemnations in multivariable analyses. A transmission model for Taenia ovis was created and control options were assessed. Model simulations predicted cestocide treatment of guardian dogs every fifth week, and proper deadstock disposal would reduce the risk of C. ovis infection in lambs.

This research explored the risk and protective factors associated with criminality among adults with Fetal Alcohol Spectrum Disorder (FASD). While previous research has focused on identifying the factors that contribute to legal issues, there is a paucity of research on the protective factors that may lead to more positive outcomes for adults with FASD. The first paper examined the methodological issues encountered while conducting a mixed methods study on the experience of offenders and non-offenders with FASD. Difficulties with participant recruitment, the sample size, the terminology employed, and the appropriateness of psychometric measures were significant challenges that emerged during the research project. The second paper was a qualitative study that investigated the experience of adults with prenatal alcohol exposure and their families to determine the risk and protective factors for criminality. Families reported that neurobehavioural impairments such as difficulty with self-regulation and social skills deficits, combined with environmental demands that exceeded the capabilities of the individual with FASD, were important contributors to criminality. However, structure and supervision, education and employment, social and financial support, and positive peer influence were found to mitigate the risk of criminal behavior among adults with FASD. The findings from this thesis highlight the importance of including families in the research process as well as the need to have more family-centered services.

The objective of this thesis was to investigate the relationships between simple anthropometric measures and health risk towards a better characterization of the high-risk obesity phenotype. To this end, four studies were undertaken. The first study assessed the comparability of waist circumference (WC) data collected according to four commonly used measurement protocols in a sample of 520 community-dwelling men and women. This investigation quantified the influence of measurement site on the magnitude and reliability of WC and highlighted the impact of measurement site on prevalence estimates of abdominal obesity. To extend these findings, the second study examined the influence of WC measurement site on its association with cardiometabolic risk. Despite similar associations with risk factors including blood pressure, HDL-cholesterol, triglycerides, and blood glucose, prevalence estimates of metabolic syndrome differed depending on the anatomical site of WC measurement, particularly in women. In order to better understand the heterogeneity in human obesity and its sequelae, the third and fourth studies focused on the separate and combined influences of central and peripheral circumferences on health outcomes. Specifically, the third study used data from the Physical Activity Longitudinal Study (PALS) to demonstrate that after adjusting for BMI and WC, larger arm, calf, and thigh circumferences offer a protective effect against incident diabetes. The fourth study confirmed the opposing influences of central and peripheral circumferences on risk of all-cause mortality in a sample of 10,638 participants from the 1981 Canada Fitness Survey (CFS) with more than 12 y of follow-up. After adjustment for age, smoking status, alcohol consumption, leisure-time physical activity and BMI, WC was positively associated with mortality whereas arm, thigh, and calf circumferences were significantly protective in men and arm and thigh circumferences were protective in women. Collectively, the results from these studies contribute to a better understanding of the role of body dimensions in determining health risk and have implications for the use of anthropometric measures in clinical and research settings. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2009-04-17 14:23:44.372

A review of the literature strongly suggests that poor family dynamics play a critical role in an adolescent's choice of suicide. This thesis examines the literature and research findings on adolescent suicide and family functioning. It will bring together recent findings to help professionals access the information on adolescent suicide as it relates to the family. The psychosocial and cognitive theories of development are explored to provide a framework for understanding adolescents and the reasons for the choices and problem solving they make in their quest for identity. Since social workers are increasingly implicated in the prevention of youth suicide, the thesis applies the argument to prevention from a social work perspective.