Weight Change and Risk of Atherosclerosis Measured by Carotid Intima-Media Thickness (cIMT) from a Prospective Cohort-Analysis of the First-Wave Follow-Up Data of the Canadian Longitudinal Study on Aging (CLSA).

To explore impact of weight change (WC) on risk of atherosclerosis measured by cIMT, 20,700 participants from the CLSA follow-up were included in analysis. WC was defined as the difference of weight measured at follow-up and baseline, then quartered into four groups (Q1-Q4). cIMT > 1.0 mm was defined as high risk for atherosclerosis. Adjusted odds ratio (OR (95% CI)) from logistic regression models were used to evaluate the association between WC and risk of atherosclerosis. At follow-up, participants had gained 0.118 kg weight, on average, and 16.4% of them were at high risk for atherosclerosis. The mean levels of cIMT were comparable between participants from Q1 to Q4. Compared to Q2 (reference), the ORs (95% CI) were 1.00 (0.86, 1.15), 1.19 (1.03,1.38), and 1.25 (1.08,1.45) for Q1, Q3, and Q4, respectively. A similar pattern was observed when analyses were conducted for ages < 65 vs. 65+ separately, but it was weaker for those aged 65+. Results from the jointed distribution analyses indicated that moderate weight loss might increase risk for atherosclerosis among participants with obese BMI at baseline, but not for those with cardiovascular event status at baseline. Weight gain, however, would increase risk for atherosclerosis regardless of cardiovascular event status, or overweight/obese BMI at baseline.

Risky Business: Factors That Increase Risk of Falls Among Older Adult In-Patients.

In hospitals, older patients are at increased risk of falling multiple times. This study incorporated an epidemiologic cross-sectional design consisting of 4,348 older patients (≥65-year-old). Eight hundred eighty five (20.4%) in-patients experienced multiple falls while remaining participants had one fall incident. A patient fall event was recorded with age, sex, incident date, type of fall, and location. Logistic regression assessed risk factors found in patients with multiple falls compared to those with one fall. Significant differences were observed in the proportion of multiple falls: in a bed with no rails, standing, walking, and using a wheel/Geri chair (p < .05). Overall, sex, type of fall, and location were significant in predicting multiple falls (p < .05). Male patients were at 16.1% greater risk of multiple falls, when compared to females (p < .05). A fall in complex care, mental health, or respirology were more likely to experience multiple falls (OR = 2.659, 3.620, 1.593 respectively), while season had no impact.

Effectiveness of family-centred sexual health education and HPV self-sampling in promoting cervical cancer screening among hard-to-reach indian women in rural and tribal areas: a community-based pilot study.

BACKGROUND: While cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman-centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India. METHODS: Our community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30-69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants' uptake of cervical cancer screening was assessed after attendance in SHE. FINDINGS: Results revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS. CONCLUSIONS: The implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs.

Difficulty of falling asleep and non-high-density lipoprotein cholesterol level among Canadian older adults: a cross-sectional analysis of the Canadian Longitudinal Study for Aging baseline data.

OBJECTIVE: To examine whether difficulty of falling asleep (DoFA) is associated with non-high-density lipoprotein cholesterol (non-HDL-C) level among Canadian older adults. METHODS: 26,954 individuals aged 45-85 years from the baseline data of the Canadian Longitudinal Study for Aging were included in this study. DoFA was categorized into five groups by answer to the question "Over the last month, how often did it take you more than 30 min to fall asleep?" Response options are "Never, < 1 time/week, 1-2 times/week, 3-5 times/week, or 6-7 times/week". Non-HDL-C, the difference of total cholesterol and HDL-C, were categorized into five categories based on these cut-offs (< 2.6 mmol/L, 2.6-3.7 mmol/L, 3.7-4.8 mmol/L, 4.8-5.7 mmol/L, and ≥ 5.7 mmol/L). Ordinal logistic regression (logit link) continuation ratio models were used to estimate the odds of higher non-HDL-C levels for DoFA status. Adjusted means of non-HDL-C by DoFA status were estimated by general linear models. All analyses were sex separately using analytic weights to ensure generalizability. RESULTS: The proportions of DoFA in five categories were 41.6%, 25.7%, 13.6%, 9.4%, 9.7% for females and 52.9%, 24.9%, 10.5%, 6.1%, 5.6% for males, respectively. After adjustment of demographical and other covariates (such as depression, comorbidity, sleeping hour, etc.) compared to those who reported never having DoFA, the ORs (95% CIs) of higher levels of non-HDL-C for those whose DoFA status in < 1 time/week, 1-2 times/week, 3-5 times/week, and 6-7 times/week were 1.12 (1.05-1.21), 1.09 (0.99-1.18), 1.20 (1.09-1.33), 1.29 (1.17-1.43) in females and 1.05 (0.98-1.13), 0.95 (0.87-1.05), 1.21 (1.08-1.37), 0.97 (0.85-1.09) in males, respectively. The adjusted means of non-HDL-C among the five DoFA status were 3.68 mmol/L, 3.73 mmol/L, 3.74 mmol/L, 3.82 mmol/L, 3.84 mmol/L for females and 3.54 mmol/L, 3.58 mmol/L, 3.51 mmol/L, 3.69 mmol/L, 3.54 mmol/L for males, respectively. CONCLUSIONS: The results of this study have identified a risk association pattern between DoFA status and non-HDL-C levels in females but not in males. Further research is needed to confirm these findings.

Transnational contexts and local embeddedness of HIV/STI vulnerabilities among Thai and Filipino agricultural temporary foreign workers in Canada.

Each year Canada approves about 70,000 agricultural temporary foreign worker positions. However, few studies have examined temporary foreign workers' sexual health. In this mixed-methods study, we used surveys and focus groups to explore the knowledge of HIV and sexually transmitted infections (STI), sexual behaviours and the perspectives of sexual health of 100 Thai and Filipino temporary foreign workers in southwestern Ontario, Canada. The findings revealed that transnational migration had opened up social space that workers were not familiar with. Social isolation, stress and prolonged separation from spouses and partners resulted in the formation of new intimate relationships. Close to two-thirds of the 100 participants were sexually active in the twelve months prior to the study and over three-quarters did not use condoms. Many participants had misconceptions about HIV risks and safer sex practices. Few temporary workers accessed sexual health services due to language barriers, time constraints, stigma and lack of transport. As a result, many obtained medical advice and medicine through their families back home and relied on self-treatment in dealing with symptoms of genital infections. Effective sexual health promotion for temporary foreign workers must consider the complex interactive sociocultural and political processes that involve institutional practices in the local and transnational contexts.

"Fiercely independent": Experiences of aging in the right place of older women living alone with physical limitations.

This study explores the experience of aging among older Canadian women with physical limitations who live by themselves. While aging in place has been a policy priority in rapidly greying Canada, a lack of complementary public supports poses challenges for many older adults and their family members. Employing a qualitative methodology, and drawing from the notion of aging in the right place, we collected personal narratives of 12 women (aged 65 to 92) in two geographic areas in Ontario, including residents of regular houses, apartments, condominiums, assisted living and community housing for seniors. Through thematic analysis, we identified four overarching themes: 1) striving to continue on "at home", 2) living as a "strong independent woman", 3) the help needed to support their "independence", and 4) social activities to maintain self. Our findings illustrate how, despite their mobility limitations, older women can change their residential environment and their behavior by deploying the coping strategies and resources they have developed over time. However, we also found that older women are largely silent about their needs, and that experiences varied depending on life histories, health conditions, and the availability of supports in their wider environment (home care, alternative housing options, accessible transportation, opportunities for social and physical activities). We hope these findings will incite further studies and discussion to help make aging in the right place a real choice for anyone who wishes to do so.

Music Lessons: Exploring the Role and Meaning of Music for Older Adults with Dementia.

An aging population and increasing rates of dementia point to the need for alternative strategies that allow individuals to age in place. This multiple case study explored, from an insider's perspective, the role and meaning of music for individuals with dementia who are aging in place. Methods were semi-structured interviews, observations, and videos. The study's central theme is connection, with three types of "connectors" - self, partner, and music - as subthemes. Connection to self involves present moment awareness, accessing memories, and self-expression. Connection to partner builds on self-connection and spending time together with music. Lastly, the connection to music builds on the previous two subthemes as well as the desire to keep things "normal". This study provides insight into the growing body of interdisciplinary literature dedicated to dementia, music, aging in place, and contemplative practices, as well as implications for aging and caring for someone with dementia.

Depression and cardiovascular diseases among Canadian older adults: a cross-sectional analysis of baseline data from the CLSA Comprehensive Cohort.

OBJECTIVE: To examine whether cardiovascular disease (CVD) is associated with depression status. METHODS: 29,328 participants from baseline of Canadian Longitudinal Study for Aging were categorized into four groups of depression status. Group 1: no depression (reference); Group 2: currently with depression symptom (CES-D10 score ≥ 10, negative self-reported depression); Group 3: self-reported depression with no current symptom (CES-D10 score < 10, positive self-reported depression); and Group 4: self-reported depression with current symptom (CES-D10 score ≥ 10, self-reported depression). Six self-reported CVDs were grouped into two related disorders, i.e., heart related disorders (HRD) including heart disease, myocardial infarction, and angina; and peripheral/vascular related disorders (PRD) including hypertension, stroke, and peripheral vascular disease. Adjusted odds ratios (ORs) were used to evaluate the associations between depression and CVDs. RESULTS: 17.3% of participants had self-reported depression, 15.3% were with current depression symptom, 10.5% were with HRD and 34.4% were with PRD. After adjusting for variables of demographics, sex, lifestyles, and comorbidities, compared to reference, people in Group 2 had a slightly increased odds, but most of them were not statistically significant; the ORs (95% CI) were 1.36 (1.18-1.58, P < 0.0001) for HRD and 1.20 (1.09-1.32, P < 0.001) for PRD in Group 3; for people in Group 4, the ORs (95% CI) were 1.31 (1.08-1.61, P < 0.01) for HRD and 1.17 (1.02-1.34, P < 0.05) for PRD. Sex- and age-stratified analyses suggested that the increased ORs were more prevalent in men and people aged < 65 years. CONCLUSIONS: Seniors with self-reported depression are associated with an increased risk of CVDs, the association varies by depression status, sex and age.

Are Changes Needed for Therapeutic Recreation Undergraduate Curricula? Perceived Competencies of Therapeutic Recreationists and Recreation Staff Working with Seniors in Long Term Care Homes.

L'objectif de cette étude était d'identifier les lacunes dans les compétences gérontologiques autoperçues par le personnel en loisir dans les centres de soins de longue durée en Ontario. Deux séries de compétences gérontologiques ont été présentées dans un sondage en ligne qui a été distribué à du personnel en loisir œuvrant dans 500 centres de soins de longue durée. Parmi eux, 487 membres du personnel ont répondu au sondage. Ce sondage comportait des questions concernant les compétences actuelles du personnel et les compétences dont ils avaient eu connaissance avant d'entrer sur le marché du travail. Les facteurs perçus comme favorables à une plus grande confiance en ces compétences gérontologiques étaient l'expérience, la formation continue et les sessions de formation en cours d'emploi. Une meilleure compréhension des lacunes dans les compétences gérontologiques est nécessaire pour améliorer la formation en loisirs thérapeutiques, dont la formation continue dans ce domaine.The purpose of the study was to identify self-perceived gaps in gerontological competencies among recreation staff in long-term care homes in Ontario. Two sets of gerontological competencies, in an online survey, were distributed to recreation staff working in 500 long-term care homes. There were 487 recreation staff members who completed the questionnaire. The questionnaire contained questions regarding staff's current competencies and competencies that they recalled learning prior to entering the workforce. Factors that were perceived to contribute to confidence in gerontological competencies were experience, continuing education, in-service training sessions, and education. Understanding the gaps in gerontological competencies is required for enhancing therapeutic recreation education and continuing education.

Lifelong learning in active ageing discourse: its conserving effect on wellbeing, health and vulnerability.

The Active Ageing Framework has been adapted as a global strategy in ageing policies, practices and research over the last decade. Lifelong learning, however, has not been fully integrated into this discourse. Using survey data provided by 416 adults (aged 60 years and above) enrolled in non-formal general-interest courses in a public continuing education programme in Canada, this study examined the association between older adults' duration of participation in the courses and their level of psychological wellbeing, while taking their age, gender, self-rated health and vulnerability level into consideration. An analytical framework was developed based on the literature of old-age vulnerabilities and the benefits of lifelong learning. Two logistic regression and trend analyses were conducted. The results indicate that older adults' participation is independently and positively associated with their psychological wellbeing, even among those typically classified as 'vulnerable'. This result provides additional evidence that suggests the continuous participation in non-formal lifelong learning may help sustain older adults' psychological wellbeing. It provides older learners, even those who are most vulnerable, with a compensatory strategy to strengthen their reserve capacities, allowing them to be autonomous and fulfilled in their everyday life. The result of this study highlights the value of the strategic and unequivocal promotion of community-based non-formal lifelong learning opportunities for developing inclusive, equitable and caring active ageing societies.

I Learn, Therefore I am: A Phenomenological Analysis of Meanings of Lifelong Learning for Vulnerable Older Adults.

Background and Objectives: This study explores the lifelong learning experience of vulnerable older adults to find out (a) what is involved in their activities, (b) what meanings they take from their learning, and (c) how participation in a learning program helps to maintain their well-being and independent living despite their daily challenges. Research Design and Methods: This study employed a hermeneutic phenomenological approach. As part of a larger study, we conducted semi-structured interviews with older learners enrolled in general interest courses at a public continuing education program. In this study, we particularly focused on 10 vulnerable participants (8 women and 2 men, aged from 70 to 90), and analyzed their accounts following van Manen's (2014) guided existential inquiry method. After the inductive thematic analysis, we clustered the overarching themes into five existentials (lived-body, lived-relation, lived-space, lived-time, and lived-material) to explicate the meanings of their lived experience of learning. Results: The meanings of learning found in the five existential aspects included: (a) assurance for the dissonant body and mind; (b) a circle of camaraderie; (c) a balance between physical and mental spaces; (d) integration of past, present, and future; and (e) beyond knowledge and skills. Participants' continuous practice of learning works as a therapeutic self-help mechanism to counterbalance changes in their lifeworlds. Discussion and Implications: The findings contribute to the growing body of evidence of the wider benefits of lifelong learning and its crucial role in well-being and health among aging populations. Governments at all levels should take full advantage of these benefits.

Needs, Risks, and Context in Sexual Health Among Temporary Foreign Migrant Farmworkers in Canada: A Pilot Study with Mexican and Caribbean Workers.

Every year Canada hosts approximately 40,000 temporary foreign migrant farmworkers (MFWs). They are predominantly Mexican and Caribbean married men or single mothers who leave their families for months at a time over a span of many years. This pilot study investigated their knowledge about HIV/AIDS, attitudes towards condoms and their use, and perceived barriers to accessing sexual health services. A survey (n = 103) and four focus groups (n = 21) were conducted in Ontario's Niagara Region. The results suggest that MFWs commonly face vulnerabilities to HIV/AIDS, STIs and other sexual health issues due to personal, social-cultural, environmental and structural factors. The findings highlight the need for increasing culturally and gender sensitive sexual health education and harm reduction outreach and providing information about local health care systems and resources for MFWs. The study also calls for further community-based research and actions to reduce MFWs' perceived access barriers to health care services.

"Here for the residents": a case study of cultural competence of personal support workers in a long-term care home.

PURPOSE: This study explores the perception of cultural competence of personal support workers (PSWs) in a long-term care (LTC) home in Ontario. As Canada's demography becomes older and more diverse, LTC homes will increasingly accommodate residents from various cultural backgrounds. However, few studies have examined cultural competence among PSWs in the LTC home setting. DESIGN: The study employed a qualitative case study approach. Data collection and analysis were conducted in three phases: document analysis of organizational policies, a key informant interview with the Director of Care, and two focus groups with PSWs. RESULTS: Our findings illuminated the PSWs' broad definition of culture, the process of developing cultural competence and its strong connections to person-centered care, and the organizational factors that facilitate or hinder PSWs' cultural competence. IMPLICATIONS: The ambiguous perception of cultural competence reported by PSWs suggests the need for more education and further research on this topic.

Employers' paradoxical views about temporary foreign migrant workers' health: a qualitative study in rural farms in southern Ontario.

BACKGROUND: The province of Ontario hosts nearly a half of Canada's temporary foreign migrant farm workers (MFWs). Despite the essential role played by MFWs in the economic prosperity of the region, a growing body of research suggests that the workers' occupational safety and health are substandard, and often neglected by employers. This study thus explores farm owners' perceptions about MFWs occupational safety and general health, and their attitudes towards health promotion for their employees. METHODS: Using modified grounded theory approach, we collected data through in-depth individual interviews with farm owners employing MFWs in southern Ontario, Canada. Data were analyzed following three steps (open, axial, and selective coding) to identify thematic patterns and relationships. Nine employers or their representatives were interviewed. RESULTS: Four major overarching categories were identified: employers' dependence on MFWs; their fragmented view of occupational safety and health; their blurring of the boundaries between the work and personal lives of the MFWs on their farms; and their reluctance to implement health promotion programs. The interaction of these categories suggests the complex social processes through which employers come to hold these paradoxical attitudes towards workers' safety and health. There is a fundamental contradiction between what employers considered public versus personal. Despite employers' preference to separate MFWs' workplace safety from personal health issues, due to the fact that workers live within their employers' property, workers' private life becomes public making their personal health a business-related concern. Farmers' conflicting views, combined with a lack of support from governing bodies, hold back timely implementation of health promotion activities in the workplace. CONCLUSIONS: In order to address the needs of MFWs in a more integrated manner, an ecological view of health, which includes the social and psychological determinants of health, by employers is necessary. Employers and other stakeholders should work collaboratively to find a common ground, harnessing expertise and resources to develop more community-based approaches. Further research and continuous dialogue are needed.

Sustainable capacity building among immigrant communities: the raising sexually healthy children program in Canada.

The Raising Sexually Healthy Children (RSHC) program is a peer-to-peer leadership training program for immigrant parents in Toronto, Canada. It was established in 1998 with the goal of promoting family sex education and parent-child communication. This evaluative study examined the developmental processes and outcomes of the RSHC program to identify the strengths, challenges and insights that can be used to improve the program. It employed a multi-case study approach to compare the RSHC programs delivered in the Chinese, Portuguese and Tamil communities. Data collection methods included focus groups, individual interviews and document analysis. The cross-case analysis identified both common and unique capacity building processes and outcomes in the three communities. In this paper, we report factors that have enhanced and hindered sustainable capacity building at the individual, group/organizational and community levels, and the strategies used by these communities to address challenges common to immigrant families. We will discuss the ecological and synergetic, but time-consuming processes of capacity building, which contributed to the sustainability of RSHC as an empowering health promotion program for immigrant communities. We conclude the paper by noting the implications of using a capacity building approach to promote family health in ethno-racial-linguistic minority communities.

Patterns of computer and Internet usage among urology patients in two rural Northern Ontario communities.

INTRODUCTION: We wanted to determine if the Internet can be used as a potential health promotion tool among urology patients in Northern Ontario. We identified patients' computer and Internet access and use patterns in Kirkland Lake and Kapuskasing, Ontario. MATERIALS AND METHODS: This study was reviewed and approved by the ethics boards of the Kapuskasing and Kirkland Lake hospitals and Brock University. Data were collected by hand-written questionnaires in English and French. We performed a descriptive analysis of the data obtained. RESULTS: Out of the 137 questionnaires distributed and collected, we achieved a 95% response rate (7 questionnaires were incomplete). There were 67 men (52 %) and 63 women (48%) ranging in age from 24 to 84 (mean 56). Languages spoken were English (57%), French (38%) and other (5%). We divided the responses into 3 groups: non-Internet users, those with a computer but no Internet access and Internet users. Internet and non-Internet users were studied. Our results indicated that younger respondents, those with higher education and higher paying jobs, used the computer and Internet more often. The main reason behind their Internet was to seek health information for themselves, family and friends. CONCLUSION: About half of the respondents (55%) used the Internet to access health information. Patients' reactions toward online communication with their family physician were mixed. One limitation of this study is the small sample size, which inhibits making far-reaching conclusions. Our results demonstrate that individual empowerment, access to health information and access to services via emerging technologies are important issues for urology patients in rural Northern Ontario.