Health Care Providers' Perspectives on Promoting Physical Activity and Exercise in Health Care.

Health care providers (HCPs) are entrusted with providing credible health-related information to their patients/clients. Patients/clients who receive physical activity and exercise (PAE) advice from an HCP typically increase their PAE level. However, most HCPs infrequently discuss PAE or prescribe PAE, due to the many challenges (e.g., time, low confidence) they face during regular patient care. The purpose of this study was to ascertain HCPs' perspectives of what could be done to promote PAE in health care. HCPs (n = 341) across Nova Scotia completed an online self-reflection survey regarding their current PAE practices and ideas to promote PAE. The sample consisted of 114 physicians, 114 exercise professionals, 65 dietitians, and 48 nurses. Quantitative textual analysis (frequency of theme ÷ number of respondents) was performed to identify common themes to promote PAE in health care. In the pooled sample, the primary theme cited was to increase the availability of community programs (24.1% of respondents), followed by more educational opportunities for providers (22.5%), greater promotion of PAE from HCPs (17.1%), reducing financial barriers experienced by patients/clients (16.3%), and increasing availability of qualified exercise professionals (15.0%). Altogether, increased PAE education and greater availability of affordable community PAE programs incorporating qualified exercise professionals, would reduce barriers preventing routine PAE promotion and support the promotion of PAE in Nova Scotia.

Immunization completeness of children under two years of age in Nova Scotia, Canada.

OBJECTIVES: Canada's progress in establishing a national immunization registry and coordinated immunization schedule across provinces has been slow. The absence of a centralized registry means there are only limited data available on childhood immunization coverage in Canada. The aim of this study was to estimate the completeness and timeliness of immunization for two year-old children in Nova Scotia. METHODS: The study included 8,245 babies born in Nova Scotia during 2006. Immunization data were derived from three sources: Provincial Medical Insurance Physician Billing data, public health records, and self-report by parents. Immunization uptake rates for vaccines included in the Nova Scotia immunization schedule were calculated at ages 12, 18 and 24 months. Logistic regression was used to analyze vaccine uptake in relation to socio-economic factors. A telephone survey of a sample of parents of study children was completed. RESULTS: The overall immunization completeness rate was 49% at 12 months, 40% at 18 months and 58% at 24 months of age. Immunization completeness was significantly higher in more socially disadvantaged communities. CONCLUSIONS: Nova Scotia spends many millions of dollars on vaccine purchase and administration, but, as with numerous Canadian jurisdictions, there is no accurate system for monitoring or evaluating the program. The timeliness and completeness of immunization administration to pre-school children in Nova Scotia is inadequate. Further work should elucidate the barriers and enablers to immunization to ensure that public health education targets those most likely to be under-immunized. A provincial vaccination database should be established to monitor and evaluate the system.

Canadian initiatives to prevent hypertension by reducing dietary sodium.

Hypertension is the leading risk for premature death in the world. High dietary sodium is an important contributor to increased blood pressure and is strongly associated with other important diseases (e.g., gastric cancer, calcium containing kidney stones, osteoporosis, asthma and obesity). The average dietary sodium intake in Canada is approximately 3400 mg/day. It is estimated that 30% of hypertension, more than 10% of cardiovascular events and 1.4 billion dollars/year in health care expenses are caused by this high level of intake in Canada. Since 2006, Canada has had a focused and evolving effort to reduce dietary sodium based on actions from Non Governmental Organizations (NGO), and Federal and Provincial/Territorial Government actions. NGOs initiated Canadian sodium reduction programs by developing a policy statement outlining the health issue and calling for governmental, NGO and industry action, developing and disseminating an extensive health care professional education program including resources for patient education, developing a public awareness campaign through extensive media releases and publications in the lay press. The Federal Government responded by striking a Intersectoral Sodium Work Group to develop recommendations on how to implement Canada's dietary reference intake values for dietary sodium and by developing timelines and targets for foods to be reduced in sodium, assessing key research gaps with funding for targeted dietary sodium based research, developing plans for public education and for conducting evaluation of the program to reduce dietary sodium. While food regulation is a Federal Government responsibility Provincial and Territorial governments indicated reducing dietary sodium needed to be a priority. Federal and Provincial Ministers of Health have endorsed a target to reduce the average consumption of sodium to 2300 mg/day by 2016 and the Deputy Ministers of Health have tasked a joint committee to review the recommendations of the Sodium Work Group and report back to them.

THE VAXED PROJECT: an assessment of immunization education in Canadian health professional programs.

BACKGROUND: Knowledge & attitudes of healthcare providers (HCP) have significant impact on frequency with which vaccines are offered & accepted but many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can be integrated into formal education curricula. METHODS: (i) A questionnaire was sent to all Canadian nursing, medical & pharmacy schools to assess immunization-related curriculum content (ii) A 77-item web-based, validated questionnaire was emailed to final-year students in medicine, nursing, & pharmacy at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum. RESULTS: The curriculum review yielded responses from 18%, 48%, & 56% of medical, nursing, & pharmacy schools, respectively. Time spent on immunization content varied substantially between & within disciplines from <1 to >50 hrs. Most schools reported some content regarding vaccine preventable diseases, immunization practice & clinical skills but there was considerable variability and fewer schools had learning objectives or formal evaluation in these areas. 74% of respondents didn't feel comfortable discussing vaccine side effects with parents/patients & only 21% felt they received adequate teaching regarding immunization during training. CONCLUSIONS: Important gaps were identified in the knowledge of graduating nursing, medical, & pharmacy trainees regarding vaccine indications/contraindications, adverse events & safety. The national curriculum review revealed wide variability in immunization curriculum content & evaluation. There is clearly a need for educators to assess current curricula and adapt existing educational resources such as the Immunization Competencies for Health Professionals in Canada.

Increasing vaccination rates among health care workers using unit "champions" as a motivator.

Key members (a.k.a. "champions") within specific work units were provided with a brief training session designed to increase awareness of the benefits associated with influenza vaccination. The champions were responsible for encouraging members of their work units to accept an influenza vaccination and in some cases had the requisite training to administer the vaccination on site. Work units were randomly assigned to either champion present or champion absent conditions. Results show increased vaccination compliance for groups where a champion was present (N = 23). An independent sample t-test revealed a significant difference between the two groups t = 2.30, p < .03 which resulted in a percentage change from 41% in the unchampioned group to 52% in the championed group. Analyses which included only those units that had a fully trained champion (N = 13) produced a similar percentage increase in vaccine uptake from 41% to 54% (although this did not reach statistical significance; p = .08). Overall, the presence of a unit champion did produce a clinically relevant increase in vaccination rates in championed work units. This result has implications for future vaccination campaigns in hospital settings. Future research targeting the barriers and drivers of influenza vaccination among HCWs is recommended.

Gender differences in knowledge about chlamydia among rural high school students in Nova Scotia, Canada.

BACKGROUND: Chlamydia is the most prevalent sexually transmissible infection (STI) in Canadian adolescents. STI account for 20% of cases of infertility in Canada and 42% of ectopic pregnancies are attributable to previous chlamydia infection. Despite the importance of this infection, little is understood about young people's knowledge of it. METHODS: A survey was conducted at a rural high school in Nova Scotia, Canada, to assess students' knowledge of chlamydia and associations of knowledge with gender and protective behaviours. Knowledge was assessed using true-false responses to 15 statements about chlamydia. Each statement was examined for differences in the percentage of correct responses by sex. Correct responses were summed, creating a knowledge score. Socioeconomic status variables and age were included in multivariate regression models to determine if they modified associations between knowledge score and protective behaviours seen in simple regression. RESULTS: Eighty-six percent of registered students (n = 538) participated in the survey. Girls responded to 10 of the 15 knowledge statements significantly more often than boys. Respondents were least knowledgeable about their rights to confidential health services for chlamydia infection. Knowledge score was associated with use of both condoms and oral contraception at last intercourse in girls (odds ratio 1.15; 95% confidence interval 1.01-1.31). No association of knowledge score was seen with having had an STI test in the previous year. CONCLUSIONS: School sexual health programs should make special efforts to meet the needs of male students, and programs and health professionals should include information about the confidential nature of sexual health services for adolescents.

A pilot project for chlamydia screening in adolescent females using self-testing: characteristics of participants and non-participants.

OBJECTIVES: A self-test screening program for genital C. trachomatis infection in female students attending high school in rural Nova Scotia was introduced. The objectives of this pilot study were to determine the extent of uptake, reasons for being/not being screened, and whether students at risk would be more likely to be screened. METHODS: The screening program was carried out between September 2005 and May 2006. Test kits were accessed through the school's health centre without first seeing the school nurse for counselling. Tests were processed non-nominally at the laboratory. A cross-sectional survey was offered to all students in the school to assess factors related to participation or non-participation. Univariate analysis was carried out for young women's sexual activity and risk taking, reasons for being participants or non-participants, risk behaviours, and knowledge about chlamydia. RESULTS: One hundred and sixty-three women (58%) had had vaginal intercourse at least once. Twenty-four of these used the self-test kit. Though 83% of those not using the self-test knew that females with chlamydia are very often asymptomatic, 54% indicated lack of symptoms as a reason for not doing so. Many (49%) gave low probability of infection as a reason for not using the kit, but high-risk sexual activity was frequent in these young DISCUSSION: Uptake of self-testing for C. trachomatis was lower than anticipated. This may be due to lack of counselling meant to encourage testing to overcome a dissonance of knowledge and behaviour. Self-testing should be further explored to better understand its potential to increase chlamydia screening among Canadian adolescents.

Influenza vaccination and decisional conflict among regulated and unregulated direct nursing care providers in long-term-care homes.

The purpose of this study was to determine whether direct nursing care providers have decisional conflict about receiving influenza vaccinations and characteristics associated with decisional conflict. The researchers used a self-administered questionnaire mailed to direct nursing care providers in two long-term-care organizations. Most direct nursing care providers in both organizations (80% and 93%, respectively) intended to get the influenza vaccine. Unregulated direct nursing care providers had more decisional conflict than regulated providers, especially related to feeling uninformed about the pros and cons of influenza vaccination. Unclear valuing of the pros and cons of influenza vaccination was related to the age of the direct care providers in both organizations. Decisional conflict and influenza vaccination practices may be determined, in part, by age and by the culture of a health care organization. A decision aid to improve knowledge and clarify values may improve decision quality and increase influenza vaccination rates.

Tratado de ortodoncia

Los principios básicos de la ortodoncia. Oclusión normal de los dientes. Fisiología de la oclusión dentaria normal y del organo de la masticación. Factores que influencian el desarrollo y conservación de la oclusión normal dentaria. La mecánica natural de la dentición humana. Maloclusión dentaria. Análisis de los casos para su clasificación. Etiología de la maloclusión. Las líneas faciales en la maloclusión dentaria. Histología de los tejidos dentarios. Crecimiento y desarrollo de los dientes. Cambios tisulares que acompañan al movimiento dentario. Estudio de los casos. Aparatología ortodoncica. El arco de canto. Tratamiento de la maloclsuión dentaria. Tratamiento correctivo de la maloclusión. Tratamiento de la maloclusión dentaria. Técnica operatoria. Toma de impresiones y confección de modelos de yeso. Técnica operatoria. El consultorio. Equipo y trado del paciente