BackgroundPhysical and sedentary activities have been identified as potentially modifiable risk factors for many diseases, including mental illness, and may be effective targets for public health ...policy and intervention. However, the relative contribution of physical activity versus sedentary behaviour to mental health is less clear. This study investigated the cross-sectional association between physical activity, sedentary activity and symptoms of depression and anxiety at age 14–15 in the National Longitudinal Survey of Children and Youth (NLSCY).MethodsRespondents aged 14–15 years between 1996 and 2009 who reported on symptoms of depression in the NLSCY were included (n=9702). Multinomial logistic regression was used to assess the relationship between physical and sedentary activity and symptoms of depression and anxiety. Joint models including both physical and sedentary activity were also explored. Models were adjusted for sex, ethnicity, immigration status, family income, parental education, recent major stressful life events and chronic health conditions.ResultsThe odds of having moderate and severe symptoms of depression and anxiety compared with no symptoms was 1.43 (1.11 to 1.84) and 1.88 (1.45 to 2.45) times higher, respectively, in physically inactive youth relative to physically active youth. The odds of having moderate and severe symptoms of depression and anxiety compared with no symptoms was 1.38 (1.13 to 1.69) and 1.31 (1.02 to 1.69) times higher, respectively, in sedentary youth relative to non-sedentary youth. In joint models including both physical and sedentary activity, sedentary activity was not consistently associated with symptoms of depression and anxiety.ConclusionsBoth physical inactivity and sedentary activity appear to be significantly related to symptoms of depression and anxiety. The importance of distinguishing these two behaviours has relevance for research as well as policies targeting physical activity and mental health in youth.
Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on ...anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population.
Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS). Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits.
Many individuals (57.8%) were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥ 4) were more likely to be diagnosed with fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29-1.88) and delirium (AOR: 1.61, 95% CI: 1.08-2.40) relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR): 1.32, 95% CI: 1.10-1.58) and be readmitted (AHR: 1.16, 95% CI: 1.01-1.33) within 30-days of discharge.
We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD.
Aim
The aim of the present study was to determine the barriers and motives influencing consumer reporting of adverse drug reactions (ADRs).
Methods
A systematic review, guided by the Cochrane ...Handbook, was conducted. Electronic searches included MEDLINE, EMBASE, PsycINFO, CINAHL, PubMed and the Cochrane Database of Systematic Reviews from 1964 to December 2014. Eligible studies addressed patients' perceptions and factors influencing ADR reporting. Studies about healthcare professional (HCP) reporting of ADRs were excluded. Studies were appraised for quality, and results were analysed descriptively.
Results
Of 1435 citations identified, 21 studies were eligible. Studies were primarily conducted in the UK, the Netherlands and Australia. The identified barriers to patient reporting of ADRs (n = 15 studies) included poor awareness, confusion about who should report the ADR, difficulties with reporting procedures, lack of feedback on submitted reports, mailing costs, ADRs resolved and prior negative reporting experiences. The identified motives for patients reporting ADRs (n = 10 studies) were: preventing others from having similar ADRs, wanting personal feedback, improving medication safety, informing regulatory agencies, improving HCP practices, responding to HCPs not reporting their ADRs and having been asked to report ADRs by HCPs.
Conclusions
Most patients were not aware of reporting systems and others were confused about reporting. Patients were mainly motivated to make their ADRs known to prevent similar suffering in other patients. By increasing patient familiarity and providing clear reporting processes, reporting systems could better achieve patient reporting of ADRs.
The present study used Canadian National Longitudinal data to examine a model of the mechanisms through which the effects of neighborhood socioeconomic conditions impact young children's verbal and ...behavioral outcomes (N = 3,528; M age = 5.05 years, SD = 0.86). Integrating elements of social disorganization theory and family stress models, and results from structural equation models suggest that both neighborhood and family mechanisms played an important role in the transmission of neighborhood socioeconomic effects. Neighborhood disadvantage manifested its effect via lower neighborhood cohesion, which was associated with maternal depression and family dysfunction. These processes were, in turn, related to less consistent, less stimulating, and more punitive parenting behaviors, and ultimately, poorer child outcomes.
Background
Spontaneous reporting of adverse drug reactions (ADRs) is an important source of information for post-marketing drug safety evaluation. Most countries have public access to reporting ...systems, but patients report only 3% of all ADRs. Little is known about factors affecting patient reporting. Our aim was to explore patients’ experiences reporting ADRs and their views on the usability of the Canadian Vigilance reporting forms on MedEffect.
Methods
An interpretive description qualitative study was used. Adults in Canada, who experienced an ADR, were invited to participate through social media (Kijiji, Facebook, Twitter) and by associations (e.g., Patients Canada or Canadian Arthritis Society). Participants were interviewed in English and French using structured interview guides. Inductive content analysis was used.
Results
Fifteen interviews were conducted from October 2014 to May 2015. Two participants reported ADRs to MedEffect, and others to physicians and/or pharmacists. Motives for reporting were intolerable side effect impacting daily activities and encouragement from others to report (e.g., family, colleagues). Factors that interfered with reporting were physicians normalized or minimized the side effect, confusion on what to report, no feedback after report submission to MedEffect, and previous experience with side effects. MedEffect forms were described as comprehensive and important, but its usability was affected by the number of questions and complexity of some questions.
Conclusions
Most participants were unaware of MedEffect and reported ADRs to physicians and pharmacists. Several barriers and motives affected patients’ reporting of ADRs. MedEffect form could be simplified for use by patients.
Aim
The aim of this study was to identify children with neurodevelopmental disorders and disabilities (NDD/D) and compare their healthcare service utilization to children without NDD/D using ...provincial linked administrative data.
Method
The sample included children aged 6 to 10 years (n=183 041), who were registered with the British Columbia Medical Services Plan. Diagnostic information was used for the identification and classification of NDD/D in six functional domains. Healthcare service utilization included outcomes based on physician claims, prescription medication use, and hospitalization.
Results
Overall, 8.3% of children were identified with NDD/D. Children with NDD/D had higher healthcare service utilization rates than those without NDD/D. Effect sizes were: very large for the number of days a prescription medication was dispensed; large for the number of prescriptions; medium for the number of physician visits, different specialists visited, number of different prescription medications, and ever hospitalized; and small for the number of laboratory visits, X‐ray visits, and number of days hospitalized.
Interpretation
The findings have policy implications for service and resource planning. Given the high use of psychostimulants, specialized services for both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D. Future studies may examine patterns of physician behaviours and costs attributable to healthcare service utilization for children with NDD/D.
What this paper adds
Children with neurodevelopmental disorders and disabilities (NDD/D) have higher healthcare service utilization than those without.
Based on provincial population‐based linked administrative health data, a sizeable number of children are living with NDD/D.
Given the high use of psychostimulants, specialized services for children with both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D.
Resumen
Niños con trastornos del neurodesarrollo y discapacidades: Estudio poblacional sobre uso de servicios de salud, utilizando datos administrativos
Objetivo
El objetivo de este estudio fue identificar niños con trastornos del neurodesarrollo y discapacidades (NDD/D) y comparar el uso de servicios de salud con niños sin NDD/D, utilizando datos administrativos vinculados a provincias.
Metodos
La muestra incluyo niños de 6 a 10 años de edad (n=183 041) que se encontraban registrados en el plan de Servicios Médicos de British Columbia (Canadá). Se utilizo información diagnostica para la identificación y clasificación de NDD/D en 6 dominios funcionales. La utilización de servicios de salud incluyo resultados basados en los pagos del médico, uso de prescripciones médicas, y hospitalizaciones.
Resultados
En total, 8.3% de los niños fueron identificados como NDD/D. Los niños con NDD/D mostraron índices más altos de utilización de servicios de salud que aquellos sin NDD/D. Los resultados estadísticos mostraron la siguiente frecuencia de utilización de servicios: Muy grandes para la cantidad de días que una prescripción medica fue dispensada; Grande para el numero de prescripciones; Mediana para el número de visitas medicas, para los diferentes especialistas visitados, numero de las diferentes prescripciones medicas y si fue hospitalizado; y Pequeña para el número de visitas al laboratorio, visitas a radiología y numero de días de hospitalización.
Interpretación
Los hallazgos tienen implicancia en cuanto a políticas de servicio y planificación de recursos. Dado el elevado uso de psicoestimulantes es posible que los servicios que más se necesiten para niños con NDD/D sean servicios especializados tanto para NDD/D como para condiciones psiquiátricas. Estudios futuros pueden examinar patrones de prestaciones del médico hacia estas poblaciones y costos atribuibles a la utilización de servicios de salud para niños con NDD/D.
Resumo
Crianças com desordens neurodesenvolvimentais e deficiências: um estudo populacional da utilização de serviços de saúde utilizando dados administrativos
Objetivo
O objetivo deste estudo foi identificar crianças com desordens neurodesenvolvimentais e incapacidades (DND/I) e comparar a utilização de serviços em relação a crianças sem DND/I usando dados administrativos de uma província.
Método
A amostra incluiu crianças de 6 a 10 anos (n=183.041), registradas no Plano de serviços medicos da British Columbia. Informação diagnóstica foi usada para identificação e classificação de DND/I em seis domínios funcionais. A utlização de serviços de saúde incluiu resultados baseados em consultas médicas, uso de medicamentos prescritos e hopitalização.
Resultados
Em geral, 8.3% das crianças foram identificadas como DND/I. As crianças com DND/I tiveram maior taxa de utilização de serviços do que as sem DND/I. O tamanho dos efeitos foi: muito alto para o número de dias de uso de um medicamento; alto para número de prescrições; médio para o número de visitas médicas, diferentes especialistas visitados, número de medicamentos diferentes prescritos, e ocorrência de hospitalização; e pequeno para número de visitas laboratoriais, raios‐x e número de dias hospitalizado.
Interpretação
Os achados têm implicações para políticas de serviços e planejamento de recursos. Dado o alto uso de psicoestimulantes, serviços especializados para DND/I e condições psiquiátricas podem ser os serviços mais utilizados por crianças com DND/I. Futuros estudos podem examinar os padrões de comportamentos dos médicos e custos atribuídos à utilização de serviços por crianças com DND/I.
What this paper adds
Children with neurodevelopmental disorders and disabilities (NDD/D) have higher healthcare service utilization than those without.
Based on provincial population‐based linked administrative health data, a sizeable number of children are living with NDD/D.
Given the high use of psychostimulants, specialized services for children with both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D.
This article is commented on by Cloet et al. on pages 1215–1216 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
The 10-item Kessler Psychological Distress Scale (K10) is a short measure of non-specific psychological distress, which has been shown to be a sensitive screen for the Diagnostic and Statistical ...Manual of Mental Disorders criteria for anxiety and mood disorders. The scale has yet to be validated as a measure of psychological distress for Aboriginal peoples in Canada.
Using the 2012 Aboriginal Peoples Survey (APS), this study examined the psychometric properties of the K10 for First Nations people living off reserve, Métis, and Inuit aged 15 or older. The factor structure and internal consistency of the K10 were examined via confirmatory factor analysis and Cronbach's alpha, respectively. Descriptive statistics by sex, education, household income, and age group were provided for the scale. K10 construct validity was further assessed by examining associations with mental health variables in the 2012 APS: self-rated mental health, self-reported diagnosed mood and anxiety disorders, and self-reported suicidal ideation in the past 12 months.
A unidimensional "Distress" model with correlated errors was a good fit to the data. Cronbach's alpha values were satisfactory. K10 mean scores were positively skewed, with most respondents reporting few or no distress symptoms. Females and respondents with lower education and household income levels had significantly higher distress. Respondents aged 55 or older had significantly lower distress than their younger counterparts. K10 mean scores were significantly higher for respondents who reported poor mental health, a diagnosed mood disorder, a diagnosed anxiety disorder, or suicidal ideation in the past 12 months. Results were consistent across all three Aboriginal groups.
Based on the 2012 APS, the total score of the K10 appears to be psychometrically sound for use as a broad measure of non-specific psychological distress for First Nations people living off reserve, Métis, and Inuit.
Although rates of daily smoking among Inuit have been decreasing since 1991, Inuit are still much more likely to smoke relative to the Canadian population as a whole. However, little population-based ...empirical research has identified characteristics associated with cigarette use among this population.
Based on data from the 2012 Aboriginal Peoples Survey, sex-specific logistic regression analyses, informed by an Inuit social determinants of health framework, described associations between current smoking and selected socio-demographic characteristics among Inuit men and women aged 18 or older who resided in Inuit Nunangat.
In 2012, 75% of Inuit men and 74% of Inuit women reported that they smoked cigarettes either daily or occasionally. Inuit men and women had lower odds of smoking if they were high school graduates. Among Inuit men, the odds of smoking were lower for those in higher-income households. Among Inuit women, the odds of smoking were lower for those who had postsecondary education or lived in food-secure households; odds were higher for women who had attended a residential school. Inuit of both sexes had significantly higher odds of smoking if they lived in crowded conditions or in homes where a regular smoker was present.
Some correlates of smoking among Inuit in Inuit Nunangat appear to be sex-specific. Findings from this study identify some of the protective and risk factors for smoking among this population and can help inform smoking prevention and cessation programs.
A variety of family processes have been hypothesized to mediate associations between income and young children's development. Maternal emotional distress, parental authoritative and authoritarian ...behavior (videotaped mother-child interactions), and provision of cognitively stimulating activities (Home Observation for Measurement of the Environment HOME scales) were examined as possible mediators in a sample of 493 White and African American low- birth-weight premature infants who were followed from birth through age 5. Cognitive ability was assessed by standardized test, and child behavior problems by maternal report, when the children were 3 and 5 years of age. As expected, family income was associated with child outcomes. The provision of stimulating experiences in the home mediated the relation between family income and both children's outcomes; maternal emotional distress and parenting practices mediated the relation between income and children's behavior problems.
To examine household income trajectories of children with and without neurodisability over a period of 6 years.
We used four cycles of the Canadian National Longitudinal Survey of Children and Youth, ...a longitudinal study of the development and well-being of Canadian children from birth into adulthood.
While household income increased over time for both groups, families of children with neurodisability had consistently lower household income compared to families of children without neurodisability even after controlling for child and family socio-demographic characteristics. The presence of an interaction effect between parent work status and child with neurodisability at baseline indicated that among children whose parent(s) were not working at baseline, household incomes did not differ between children with and without neurodisability.
The association between child with neurodisability and lower household income may not hold for all types of parents', working status is an important consideration.
Implications for Rehabilitation
Findings support the health selection hypothesis that health status shapes diverging economic conditions over time: children with a ND have lower household incomes than children without a ND child across all waves of the Canadian National Longitudinal Survey of Youth.
Income gaps did not increase or decrease over time; rehabilitation services and policies must consider the lower average incomes associated with raising a child with a ND.
Social assistance support likely plays a key role in closing the gap, especially for non-working families.
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