A new approach to improving healthcare personnel influenza immunization programs: a randomized controlled trial.

BACKGROUND: Healthcare personnel influenza immunization rates remain sub-optimal. Following multiple studies and expert consultations, the "Successful Influenza Immunization Programs for Healthcare Personnel: A Guide for Program Planners" was produced. This trial assessed the impact of the Guide with facilitation in improving healthcare personnel influenza immunization rates in Canadian healthcare organizations. METHODS: A sample of 26 healthcare organizations across six Canadian provinces (ON, MB, NS, BC, SK, NL) was randomized to Intervention (n=13) or Control groups (n=13). Baseline influenza immunization rates were obtained for 2008-2009; the study groups were followed over two subsequent influenza seasons. The Intervention group received the Guide, facilitation support through workshops for managers and ongoing support. The Control groups conducted programs as usual. The Groups were compared using their reported influenza healthcare personnel influenza immunization rates and scores from a program assessment questionnaire. FINDINGS: Twenty-six organizations agreed to participate. 35% (9/26) of sites were acute care hospitals, 19% (5/26) continuing care, long-term care organizations or nursing homes, and 46% (12/26) were mixed acute care hospitals and long-term care or regional health authorities. The median rate of influenza immunization among healthcare personnel for the Intervention group was 43%, 44%, and 51% at three points in time respectively, and in the CONTROL GROUP: 62%, 57%, and 55% respectively. No significant differences were observed between the groups at the three points in time. However, there was a 7% increase in the median rates between the Baseline Year and Year Two in the Intervention group, and a 6% decrease in the CONTROL GROUP over the same time period, which was statistically significant (0.071 versus -0.058, p < 0.001). INTERPRETATION: This pragmatic randomized trial of the Guide with facilitation of its implementation improved healthcare personnel immunization rates, but these rates continued to be sub-optimal and below rates achievable in programs requiring personnel to be immunized. TRIAL REGISTRATION: ClinicalTrials.gov NCT01207518.

Ethnic and socioeconomic comparisons of fitness, activity levels, and barriers to exercise in high school females.

The purpose of this study was to determine if high school females differed in individual measures of health-related physical fitness, barriers to exercise, or activity level based on ethnicity or socioeconomic status. A cross-sectional sample consisting of African American (28%), Hispanic (23%), and white (49%) female high school students, 46% from low socioeconomic groups and 54% from moderate or high socioeconomic groups (n = 1314, age = 16.2 +/- 0.9) participated in this study. A 15-question survey instrument assessed barriers to exercise and activity level. The FITNESSGRAM fitness test assessed aerobic capacity and body mass index (BMI), and skinfold calipers were used to assess percent body fat. Significant differences between African Americans, Hispanics, and whites were found on the following dependent variables: BMI, percent fat, mile run, perceived barriers to exercise, and activity level. Significant differences between socioeconomic groups were found on the following dependent variables: percent fat, mile run, activity level, and perceived barriers to exercise. These results suggest that students of minority and low socioeconomic groups should be given separate and different interventions regarding health-related fitness.

Long-term visual pathology in children with significant perinatal complications.

Eye research in infants who experience significant perinatal complications has been restricted to evaluation of structural ocular disease and spatial vision, and results show that these aspects of vision are at increased risk for abnormal or delayed development. To expand upon previous work, a battery of 17 vision tests was employed to assess, comprehensively, long-term outcome of functional vision. Seventy-six children (38 males, 38 females), between the corrected ages of 2 years 11 months and 10 years 2 months (mean 6y 6mo) with various significant complications (e.g. very preterm birth, bronchopulmonary dysplasia, intraventricular hemorrhage) were compared to normally developing, age-matched control children (n = 61; mean age 7y 1mo) on measures of visual acuity, contrast sensitivity, stereoacuity, peripheral vision, color vision, astigmatism, and binocular alignment. Results showed that at-risk children had more test results that fell within the suspect or abnormal range. At-risk children also had a slightly higher incidence of ocular disorders (e.g. strabismus) and refractive error. These data imply that children who experienced significant perinatal risk factors are at risk for long-term deficits of functional vision. However, most of these deficits appear to be relatively mild.

A community-based program for cardiovascular health awareness.

OBJECTIVE: The objective of the Cardiovascular Health Awareness Program (CHAP) is to improve the processes of care related to the cardiovascular health of older adults. PARTICIPANTS: Two Ontario communities including family physicians (FP), pharmacists, public health units and nurses, volunteer peer health educators, older adult patients and community organizations. SETTING: Community pharmacies and family physician offices. INTERVENTION: CHAP is designed to close a process of care loop around cardiovascular health awareness that originates from, and returns to, the FP. Older patients are invited by their FP to attend pharmacy CHAP sessions. At these sessions, trained volunteer peer health educators (PHEs) assist patients both in recording their blood pressure using a calibrated automated device and in completing a cardiovascular risk profile. This information is relayed to their respective FP via an automated computerized database. Pharmacists and patients receive copies of the results. Based on these cumulative risk profiles, patients are advised to follow-up with their FP. OUTCOMES: Of the FPs and pharmacists asked, 47% and 79%, respectively, agreed to participate in the project. 39% of older adult patients invited by their FPs attended the CHAP community pharmacy sessions. Of these, 100% agreed to having their risk profile, including their blood pressure readings, forwarded to their FP. Positive feedback about CHAP was expressed by the volunteer PHEs, the FPs and the pharmacists. CONCLUSION: The community-based pharmacy CHAP sessions are a feasible way of improving patient, physician, and pharmacist access to reliable blood pressure measurements and to cardiovascular health information. A randomized trial is in progress that will assess the impact of CHAP on monitoring of blood pressure.

Research on Alzheimer's caregiving in Canada: current status and future directions.

In December 2002, a national workshop was held in Ottawa to guide research directions for the caregiving of people with Alzheimer's disease in Canada. Prior to the workshop, a search was conducted to identify Canadian-based investigators who have conducted research related to caregiving of individuals with cognitive impairment, Alzheimer's disease and other dementia, identify relevant Canadian research studies, and provide an overview of results and themes emerging from this research. This paper summarizes findings from our search for Canadian studies, research themes identified at the national workshop in Ottawa, and recommendations from the workshop. The report first outlines patterns of caregiving and subsequently focusses on the impact of different ways of assisting Alzheimer's caregivers. It concludes by outlining the methodological challenges of observational and intervention studies related to Alzheimer's caregiving and recommendations on how to increase Canada's capacity to conduct research on Alzheimer's caregiving.

Testing young infants with the Welch Allyn suresight non-cycloplegic autorefractor.

Both eyes of 74 healthy 2-12-month-old human infants were refracted twice with the new Welch Allyn SureSight non-cycloplegic autorefractor. At least one reliable estimate of sphere and cylinder was obtained from both eyes of all babies attempted, and 88% of infants contributed two estimates from each eye. These measurements were collected in less than 2 min. Although spherical estimates changed little over the first year (mean = +1.78 D), cylindrical error appeared to decrease from a mean of about 1.4 D (at 6 months) to 0.9 D (at 12 months). Refractive estimates and variability agreed well with published infant data obtained with traditional cycloplegic retinoscopy. Repeatability was excellent for measurement of cylinder but for sphere, 17% of infants' estimates differed by at least 1.0 D between tests. However, given its simplicity and time-efficiency, the SureSight should be a good candidate for the relatively easy screening of significant refractive error in non-verbal paediatric patients.