BACKGROUND: The prevalence and burden of cardiovascular disease (CVD) is a concern. While CVD events will occur later in a woman’s life, modifiable risk factors for CVD occur earlier during adult years. While, there is strong evidence linking modifiable risk factors to CVD, the influence of the work environment on CVD risk is poorly understood. OBJECTIVES: The study objectives were to: 1) determine the prevalence of cardiovascular risk indicators; 2) determine the relationships between work patterns and lifestyle behaviours in female hospital workers; 3) determine the relationships between work patterns and cardiovascular risk indicators; and 4) determine the relationships between work patterns, lifestyle behaviours and cardiovascular risk while controlling for covariates. METHODS: Participants were female hospital workers (N= 466) from 2 hospital sites in Southeastern Ontario. Cardiovascular risk data were obtained through anthropometric measurements, blood sampling and self-report. Work pattern data were collected through self-report and linked with hospital administrative work data. Lifestyle behaviour data were obtained through self-report using validated questionnaires. Metabolic syndrome was classified in accordance with the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) (III) guidelines. RESULTS: Approximately 1 in 4 female participants had the metabolic syndrome, with elevated waist circumference being the most common CVD risk factor. After adjustments, the multivariate analysis found a few key significant associations between irregular work patterns, specifically extended shifts and CVD risk, specifically elevated systolic and diastolic blood pressure. However, consistent with the literature, the bivariate analyses revealed that after 6 or more years of shift work, female workers were more likely to develop the metabolic syndrome (OR 1.9, 95% CI 1.12, 3.17) and abdominally obesity (OR = 2.0, 95% CI, 1.31, 3.11). CONCLUSIONS: The findings from this study suggest that generally work patterns do not influence the development of unhealthy behaviours and cardiovascular risk factors, although a few key exceptions exist. Further research is needed to elucidate the mechanisms linking harmful and protective work pattern characteristics to CVD risk. Given the prevalence of abdominal obesity and overall CVD risk, hospital decision makers need to consider cardiovascular health within healthy workplace initiatives as the healthcare workforce is aging. / Thesis (Master, Nursing) -- Queen's University, 2009-09-24 18:39:03.718

Bakgrund: Ohälsosamma levnadsvanor är ett folkhälsoproblem och står för en femtedel av den totala sjukdomsbördan i Sverige. Var annan kvinna och var tredje man i åldrarna 16-84 år rapporterar att de inte har några ohälsosamma levnadsvanor. (Socialstyrelsen, 2011; Folkhälsomyndigheten, 2014). De flesta distriktssköterskor och sjuksköterskor i den svenska primärvården tycker att det är viktigt att arbeta med patienternas levnadsvanor, de tycker även att arbetet behöver utvecklas (Kardakis, Weinehall, Jerdén, Nyström & Johansson, 2013). Syfte: Att undersöka i vilken utsträckning distriktssköterskor och sjuksköterskor arbetar med rådgivning om levnadsvanor till patienter i primärvården. Syftet är också att undersöka hur de skulle vilja arbeta, vilken kunskap de tycker sig ha och om de anser att de behöver ytterligare kunskap om rådgivning kring levnadsvanor. Metod: En totalundersökning gjordes där samtliga distriktssköterskor och sjuksköterskor verksamma inom primärvårdens vårdcentraler i föreliggande landsting inkluderades i studien. Data samlades in med hjälp av en webbenkät. Resultat: Resultatet visade att de flesta respondenterna ansåg att arbetet med levnadsvanor var mycket eller ganska viktigt och att de flesta arbetade med rådgivning om levnadsvanor i ganska stor utsträckning. Det fanns inga signifikanta skillnader mellan specialistutbildade och grundutbildande sjuksköterskor. Slutsats: Distriktssköterskor och sjuksköterskor i primärvården i föreliggande landsting anser att arbetet med rådgivning om levnadsvanor är mycket viktigt. De arbetar också mycket med detta och anser sig ha kunskaper inom området, men de vill ändå arbeta mer med rådgivning om levnadsvanor och utveckla sin kompetens.  Det är tydligt att distriktssköterskor och sjuksköterskor i primärvården är en underutnyttjad resurs i arbetet med levnadsvanor. / Background: Unhealthy lifestyle behaviour is a public health problem, accounting for a fifth of the total burden of disease in Sweden. Every second woman and every third man aged 16-84 years report that they do not have any unhealthy lifestyle behaviours. (Socialstyrelsen, 2011; Folkhälsomyndigheten, 2014). Most district nurses and registered nurses in Swedish primary health care think it is important to work with lifestyle behaviours, they also think there is need for improvement (Kardakis, Weinehall, Jerdén, Nystrom & Johansson, 2013). Aim: To examine the extent to which district nurses and nurses are working with counseling patients on lifestyle behaviours in primary health care. The aim is also to examine how they would like to work, what knowledge they think they have and if they feel they need additional knowledge of counseling on lifestyle behaviours. Method: A comprehensive survey was made in which all district nurses and registered nurses working in primary health care centers in the present county were included in the study. Data were collected using an online survey. Results: The results showed that most respondents felt that the work with lifestyle behaviours was very or quite important. Most of the respondents were working quite widely with counseling on lifestyle behaviours. There were no significant differences between nurses with specialist education and registered nurses. Conclusion: District nurses and registered nurses in primary health care in this county believe that counseling on lifestyle behavior is very important. They also work a lot with this and claim to have knowledge about lifestyle behaviours. Still they want to work more with counseling on lifestyle behaviours and develop their skills. It is clear that district nurses and registered nurses in primary health care is an underutilized resource in the work with lifestyle behaviours.

Background: People from ethnic minority immigrant groups living in host countries are known to have higher risk factors for cardiovascular diseases. The role of acculturation, or assimilation into a different and dominant culture, is often studied from social and medical views when focusing on individuals diagnosed with cardiovascular diseases and their recovery after cardiac events. However, the effects of the complex roles of acculturation and religious coping on these individuals are rarely considered in the research. There is limited knowledge regarding the complex roles of acculturation and religious coping in adopting healthy lifestyle behaviours and managing stress among individuals with cardiovascular diseases from Arab communities in the Ottawa region. This research project’s general purpose was to explore and understand the complex roles of acculturation and religious coping through the experiences of individuals diagnosed with CVD from Arab communities in the Ottawa region. Objectives: The specific objectives were to 1) identify and understand the challenges among Arab immigrants related to acculturation and religiosity in adopting healthy lifestyle behaviours and managing stress; 2) measure and describe the levels of religious beliefs as well as religious coping strategies, acculturation, perceived stress, and healthy lifestyle behaviours among Arab individuals living in the region of Ottawa, Ontario, Canada who have been diagnosed with cardiac events or who are at high risk for cardiovascular diseases; and 3) explore the role of acculturation and religious coping in shaping male Arab individuals’ lived experiences after a cardiac event and to explore their ways of understanding lifestyle behaviours and cardiac rehabilitation during recovery. Methods: A mixed-method approach was adopted in this research, which included three separate studies: Study 1 was a qualitative study (views of key informants with first-hand knowledge) in which three face-to-face focus groups were conducted with 17 Arab health promoters; Study 2 was a cross-sectional survey study was conducted with 63 individuals from local Arab communities who had been diagnosed with cardiac events or who were at high risk for cardiovascular diseases; and Study 3 consisted of a phenomenographic qualitative study, semi-structured in-depth interviews with male Arab individuals (N=10), selected from Study 2, who identified themselves as having had cardiac events while living in Canada. Results: From the perspective of Arab health promoters, there was an overlapping between various aspects of acculturation and religious beliefs that may have impacted the healthy lifestyle of Arab immigrants. These challenges were coded in four themes: “Culture first!”: dominant influence of home country culture; “Religiosity alone does not make you healthy!”: limited religious influence; “It is not easy!”: difficulties adapting to the Canadian lifestyle; and “We are not young!”: generational differences in adopting a healthy lifestyle. Findings from the survey study indicated that most participants were oriented more toward their Arabic culture than Canadian culture. Participants tended to be religious, and their nutritional behaviours were healthier than physical activity behaviours. However, age, gender, and interestingly, length of time living in Canada did not affect the participants’ results in any of the questionnaires. Based on lived experiences of 10 participants in the interview study, five core themes were identified: “Stressful events or cardiac events!”: acculturative stress effects; “It was a dreamlike event!”: dismissing perceptions of cardiac events; “recognizing risk factors is not enough to avoid them”: perceived threat; religious coping outcomes: satisfaction and fatalism; Cardiac Rehabilitation programs: who refers and who participates. Conclusion: This dissertation showed that acculturation level plays an essential role in Arab immigrants’ beliefs and behaviours regarding their health status and their experiences in preventing cardiovascular diseases risk factors or in recovery after cardiac events. Religious coping seems to be a way for less acculturated Arab immigrants to manage stress and mental burdens and find internal peace and satisfaction. From the perspective of Arab health promoters, some religious or cultural beliefs may be barriers to engaging in physical activity, especially for women and older people, and these barriers may be exacerbated by acculturative stress. Religiosity may also play an essential indirect role in managing stress through socialization, family support, and the adoption of coping strategies. Arab individuals living in the region of Ottawa, Ontario, Canada, who have been diagnosed with cardiac events or who are at high risk for cardiovascular diseases may have been more religious and less acculturated in Canadian society. Their lifestyle health behaviours related to physical activity and nutrition may have been influenced by their health status, religious beliefs, and the practices or traditions of their culture of origin. Stress and mental burdens while living in Canada reflected negatively on Arab male individuals’ experiences with cardiac events. Stress was perceived as a potential cause of cardiac events and a factor leading to low self-efficacy in changing lifestyle behaviours. There is a need to promote healthy lifestyle messages and raise awareness about cardiovascular diseases risk factors among Arab communities. Future research is needed to design culturally adapted cardiac rehabilitation programs for Arab individuals and to evaluate the effectiveness of interventions with both physical and mental health components.

Contexte : Jusqu'à présent, les résultats de la recherche de contextes environnementaux et les comportements antécédents de l’obésité pédiatrique n'ont pas été cohérents. But : L’objectif global de cette thèse est d'étudier l'association entre les caractéristiques des parcs, des écoles et des quartiers résidentiels avec des indicateurs liés à l'adiposité : 1) De regroupés les parcs par leurs caractéristiques saillantes et déterminer si certains " types " de parcs sont associés à l'activité physique (AP) et à l'adiposité ; 2) Décrire les écoles en fonction de leurs caractéristiques d’environnement bâties (EB) et sociales prédominantes pour l'AP et d’explorer leurs associations avec l'AP; 3) Déterminer si les caractéristiques théoriquement marchable de l'EB résidentiel sont associées aux comportements de mouvement de 24 heures (sommeil, sédentarité, AP légère (APL), AP modérée à vigoureuse (APMV)) dans les analyses transversales et prospectives. Méthodes : Les données proviennent de la cohorte QUALITY, une étude québécoise portant sur 630 enfants, âgés de 8 à 10 ans lors du recrutement, et ayant une histoire d’obésité parentale. Les environnements des parcs, des résidences et des écoles de 512 participants habitant la Région métropolitaine de Montréal ont été caractérisés. Les données comprenaient des données administratives, de recensement et des observations directes y compris des questionnaires complétés par un membre du personnel de l’école. L'AP des jeunes a été auto rapporté et mesuré par accéléromètres au temps 0 et au suivi 2 ans plus tard. La sédentarité a été mesuré aux deux temps à l'aide d'accéléromètres et le sommeil a été calculé basé sur le temps pendant lequel l'accéléromètre n'était pas porté. L’adiposité a été mesuré avec un DXA au temps 0. L'indice de masse corporelle a été calculé aux deux temps. Les données ont été analysées avec l’analyse en composantes principales, l'analyse en grappes, la régression linéaire et logistique, les équations d'estimation généralisées et l'analyse des données compositionnelles. Résultats : Certaines caractéristiques particulières des parcs, des écoles et des aspects « marchables » des quartiers ont été associées aux résultats liés à l'adiposité chez les participants. Les types de parcs qui offraient des possibilités de jeux non structurés et une variété d'AP étaient associés à l'AP autodéclarée, et les parcs esthétiquement agréables étaient également associés à l’adiposité réduite. Les écoles qui offraient des possibilités de jeux non structurés et qui encourageaient l'AP étaient associées à l'AP. Les caractéristiques « marchables » des quartiers étaient associées à une augmentation de l'APMV et à une diminution du sommeil, de la sédentarité et de l'APL sur une période de 24 heures chez les filles. Conclusion : Cette thèse contribue à la littérature en examinant trois influences contextuelles importantes sur les résultats liés à l'adiposité chez les enfants. Ces environnements ont été caractérisés de façon objective, en opérationnalisant leurs principales caractéristiques et en utilisant des approches statistiques novatrices. Les résultats appuient le concept que la prévention de l'obésité et les efforts visants à accroître l'AP devraient inclure la prise en compte des EB et sociaux et devraient cibler les multiples facteurs qui favorisent des comportements sains chez les enfants. / Background: Paediatric obesity is a global public health concern. In order to identify potential population-based intervention and prevention strategies, environmental contexts are being investigated in relation to childhood obesity and antecedent behaviours, including physical activity (PA). However, to date, findings in the area have been inconsistent. Purpose: The overarching goal of this thesis is to investigate the association between features of parks, school and neighbourhood environments in relation to adiposity-related outcomes. Specifically: 1) To group and characterize parks by their salient features and to determine if certain park “types” are associated with PA and adiposity outcomes; 2) To characterise schools by their predominant built and social environmental features for PA and to explore associations between school features and PA in cross-sectional and prospective analyses; 3) To determine if theoretically walkable features of the neighbourhood built environment are associated with 24-hour movement behaviours (sleep, sedentary behaviour, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA)) in cross-sectional and prospective analyses. Methods: Data were drawn from the QUALITY Cohort, a Quebec-based study of 630 children age 8-10 years at baseline with a parental history of obesity. Baseline park, residential and school environments of 512 participants living in the Montreal Metropolitan Area were characterised. Data included geographically linked census and administrative data and in-person observations. Questionnaires were completed by school principals or physical education teachers. PA was measured at baseline and follow up using self-reported questionnaires and by accelerometer. Sedentary time was measured at baseline and follow up using accelerometers while sleep time was calculated as the time the accelerometer was not worn. Body fat was measured using a DXA at baseline. Overweight and obesity was identified using body mass index computed from measured weight and height at baseline and follow up. Analyses included principal component analysis, cluster analysis, linear and logistic regression, generalized estimating equations and compositional data analysis. Results: Findings point to specific features of parks, schools and theoretically walkable neighbourhood features that are associated with adiposity-related outcomes in the youth participants. Notably, certain types of parks that provide opportunities for unstructured play and a variety of physical activities are associated with self-reported PA while aesthetically pleasing parks are also associated with body fat. Schools that provide opportunities for unstructured play and that promote PA are associated with accelerometer measured PA, and the associations are different between boys and girls. Lastly, theoretically walkable neighbourhood features are associated with an increase in MVPA and a slight decrease in sleep, sedentary time and LPA over a 24-hour period among girls only. Conclusion: This thesis contributes to the literature by considering three important contextual influences on children’s adiposity-related outcomes: parks, school and the residential environment. This is done by objectively characterizing these environments, by operationalising key characteristics of them, and by using innovative statistical approaches. Findings support the notion that obesity prevention and efforts to increase PA should include the consideration and modification of built and social environments and should target the multiple population-level factors that support healthy behaviours among children.