Understanding Newcomer Challenges and Opportunities to Accessing Nature and Greenspace in Riverdale, Hamilton, Ontario: A Neighborhood-Centered Photovoice Study.

BACKGROUND: Access to and engagement with greenspace is related to improved health benefits. We sought to collaborate with community members as partners in research and co-creators in knowledge to better understand which components within a newcomer-dense community help or hinder individual and community efforts to access greenspace and nature-based activities. METHODS: We used photovoice methodology to engage with local residents in focus groups, photowalks, and photo-elicitation interviews. Themes were developed using direct content analysis. RESULTS: A total of 39 participants (ages 11-70 years; median years in Canada of 3.25 years) were engaged in this program of research. From the analysis, we developed four themes: (a) peace and beauty; (b) memories of home; (c) safety and cleanliness; and (d) welcoming strengthened and new opportunities. Participants associated nature with peace, citing it as "under-rated" but "vital" to the neighborhood. Via photographs and stories, participants also shared a multitude of safety concerns that prevent their access to green/outdoor spaces for healthy active living programs or activities (e.g., woodchip-covered playgrounds, ample amounts of garbage littering the park and school grounds, lack of timely ice removal on sidewalks, limited safe biking paths, and unsafe motor vehicle practices at the crosswalks surrounding local parks). CONCLUSION: To translate the key ideas and themes into an informed discussion with policy and decision-makers, we held an in-person exhibition and guided tour where community members, the lead photovoice researcher, and SCORE! principal investigator shared information about each theme in the form of a pseudo-narrative peppered with prepared discussion questions.

Urinary incontinence in inpatient psychiatry: prevalence, change and relationship to length of stay.

AIMS AND OBJECTIVES: To identify the prevalence of urinary incontinence in inpatient psychiatric settings and its relationship to length of stay. BACKGROUND: Urinary incontinence is a common and disabling condition. Previous work has shown that urinary incontinence is not always considered to be important in inpatient psychiatry. DESIGN: Retrospective analysis of provincial database for inpatient psychiatry. METHOD: The study included all psychiatric inpatients in Ontario assessed with the Resident Assessment Instrument Mental Health at both admission and discharge since 1 October 2005. We used sex-based analyses to examine the prevalence of urinary incontinence at admission and change over the inpatient stay. Logistic regression was used to determine the relationship between urinary incontinence and experiencing an above average length of stay in hospital. RESULTS: The prevalence of urinary incontinence at admission was 5·6%; rates were higher among women and the profiles of afflicted men and women differed. Approximately 35% of psychiatric patients were no longer incontinent at the time of discharge, and new cases of incontinence were reported for 1·2% of patients. Both the presence of urinary incontinence at admission and development of urinary incontinence over the inpatient stay were related to increased likelihood of having a longer than average length of stay. These odds were significant for both sexes, but higher for women for the role of urinary incontinence at admission and higher for men for the role of developing urinary incontinence. CONCLUSION: Urinary incontinence was present among a non-trivial proportion of psychiatric inpatients and persisted for most throughout the inpatient stay. Presence of urinary incontinence was related to increased hospital stay. RELEVANCE TO CLINICAL PRACTICE: Mental health service providers should identify urinary incontinence quickly and pay attention to it; incorporating treatment into the care plan early on in the inpatient stay may help to ensure a more rapid return to the community.

Prevalence and correlates of urinary incontinence in a large cohort of psychiatric inpatients.

OBJECTIVE: Urinary incontinence is physically and psychologically disabling, and little information exists about this condition in psychiatric populations. This exploratory study examined the prevalence of urinary incontinence and factors associated with this condition among persons with mental illness in three age groups: under 45, 45-64, and 65 and older. METHODS: Data were from the Resident Assessment Instrument-Mental Health. Population-level data on adult inpatient psychiatric admissions (N=41,004) in Ontario, Canada, between October 2005 and June 2007 were analyzed. RESULTS: The prevalence of urinary incontinence was 6.2%, with higher rates among women and with increasing age. Across age groups, common treatable factors were found, including diarrhea, poorer cognitive and physical functioning, and use of chair restraint. CONCLUSIONS: Urinary incontinence was relatively common among psychiatric inpatients and associated with a number of treatable conditions. When it is assessed early during an admission and appropriate treatment measures are implemented, time in the hospital may decrease.

Relationship of metabolic syndrome and fibrinolytic dysfunction to cardiovascular disease.

BACKGROUND: The clustering of impaired glucose metabolism, elevated triglycerides, low HDL cholesterol, and abdominal obesity is known as the metabolic syndrome. Individuals with this syndrome suffer an excess of cardiovascular disease (CVD) for reasons that are unclear. METHODS AND RESULTS: We randomly sampled 1276 adults of South Asian, Chinese, European, and Native Indian ancestry from 4 communities in Canada. Participants provided fasting blood samples for glucose, lipids, and fibrinolytic measurements; had an oral glucose tolerance test; and underwent a B-mode carotid ultrasound examination. CVD was determined by history and ECG. The prevalence of the metabolic syndrome was 25.8% (95% CI, 23.5 to 28.2) and varied substantially by ethnic group: 41.6% among Native Indians, 25.9% among South Asians, and 22.0% among Europeans, compared with 11.0% among the Chinese (overall, P=0.0001). People with the metabolic syndrome had more atherosclerosis (maximum intimal medial thickness, 0.78+/-0.18 versus 0.74+/-0.18 mm; P=0.0005), CVD (17.2% versus 7.0%; P=0.0001), and elevated plasminogen activator inhibitor-1 (24.2 versus 14.6 U/mL; P=0.001) compared with levels among people without the metabolic syndrome. For the same amount of atherosclerosis, people with the metabolic syndrome had a greater prevalence of CVD, even among nondiabetic individuals. This difference in CVD prevalence among the groups was attenuated after adjustment for plasminogen activator inhibitor-1 levels, suggesting that fibrinolytic dysfunction mediates the increased risk of CVD in individuals with the metabolic syndrome. CONCLUSIONS: CVD among people with the metabolic syndrome is explained by their excess of atherosclerosis and impaired fibrinolysis. Interventions to prevent atherosclerosis progression and improve fibrinolytic function require evaluation in this high-risk group.