Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses' fetal surveillance practice using theoretical domains framework.

Background: Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour.

Risk Perception and Disaster Preparedness in Immigrants and Canadian-Born Adults: Analysis of a National Survey on Similarities and Differences.

Research has documented that immigrants tend to experience more negative consequences from natural disasters compared to native-born individuals, although research on how immigrants perceive and respond to natural disaster risks is sparse. We investigated how risk perception and disaster preparedness for natural disasters in immigrants compared to Canadian-born individuals as justifications for culturally-adapted risk communication and management. To this end, we analyzed the ratings on natural disaster risk perception beliefs and preparedness behaviors from a nationally representative survey (N = 1,089).

A theory-based process evaluation alongside a randomised controlled trial of printed educational messages to increase primary care physicians' prescription of thiazide diuretics for hypertension [ISRCTN72772651].

Background: Pragmatic trials of implementation interventions focus on evaluating whether an intervention changes professional behaviour under real-world conditions rather than investigating the mechanism through which change occurs. Theory-based process evaluations conducted alongside pragmatic randomised trials address this by assessing whether the intervention changes theoretical constructs proposed to mediate change. The Ontario Printed Educational Materials (PEM) cluster trial was designed to increase family physicians' guideline-recommended prescription of thiazide diuretics.

Attitudes to incorporating genomic risk assessments into population screening programs: the importance of purpose, context and deliberation.

Background: The use of an overall risk assessment based on genomic information is consistent with precision medicine. Despite the enthusiasm, there is a need for public engagement on the appropriate use of such emerging technologies in order to frame meaningful evaluations of utility, including the practical implementation and acceptability issues that might emerge. Doing so requires the involvement of the end users of these services, including patients, and sections of the public who are the target group for population based screening.

Managing children during a radiological or nuclear emergency--Canadian perspectives.

Children have a higher chance of being contaminated by radioactive materials during a radiological or nuclear (RN) emergency. They are more sensitive to radiation health effects and suffer more significant psychosocial impacts than adults during emergency response. This paper presents a summary of recommendations on effective management of children during an RN emergency.

The EnRiCH Community Resilience Framework for High-Risk Populations.

Introduction: Resilience has been described in many ways and is inherently complex. In essence, it refers to the capacity to face and do well when adversity is encountered. There is a need for empirical research on community level initiatives designed to enhance resilience for high-risk groups as part of an upstream approach to disaster management.

Looking inside the black box: results of a theory-based process evaluation exploring the results of a randomized controlled trial of printed educational messages to increase primary care physicians' diabetic retinopathy referrals [Trial registration number ISRCTN72772651].

Background: Theory-based process evaluations conducted alongside randomized controlled trials provide the opportunity to investigate hypothesized mechanisms of action of interventions, helping to build a cumulative knowledge base and to inform the interpretation of individual trial outcomes. Our objective was to identify the underlying causal mechanisms in a cluster randomized trial of the effectiveness of printed educational materials (PEMs) to increase referral for diabetic retinopathy screening. We hypothesized that the PEMs would increase physicians' intention to refer patients for retinal screening by strengthening their attitude and subjective norm, but not their perceived behavioral control.

Presenteeism and absenteeism: differentiated understanding of related phenomena.

In the past it was assumed that work attendance equated to performance. It now appears that health-related loss of productivity can be traced equally to workers showing up at work as well as to workers choosing not to. Presenteeism in the workplace, showing up for work while sick, seems now more prevalent than absenteeism.

Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework.

Background: The Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors' beliefs about managing uncomplicated back pain without x-rays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine x-rays.

"We don't have a back-up plan": an exploration of family contingency planning for emergencies following stroke.

Little research has explored emergency preparedness among families coping with stroke. In this longitudinal qualitative study, we explored contingency caregiving planning by interviewing (N = 18) family caregivers providing care for a stroke survivor at home during the first 6 months post-discharge from the hospital. Emergent themes showed most families did not have a concrete "back-up plan" for a crisis or disaster situation involving the primary caregiver being unable to provide care.

Uncertainty beyond probabilities of BSE: appraisals predicting worry and coping strategies in the Canadian public.

The impact of bovine spongiform encephalopathy (BSE) is not limited to the infection with the BSE agent but also affects psychosocial responses, such as worry and loss of confidence in public authorities. It was shown in past crises that these reactions depended upon the way the event was perceived by the public. Understanding the nature of the perceptions of BSE is therefore of great importance for risk management in all phases of the risk, including the period before the onset of a crisis, when BSE is still only a pending threat to human health.

Psychosocial considerations for mass decontamination.

Mass exposure to explosions, infectious agents, foodborne illnesses, chemicals or radiological materials may require mass decontamination that have critical psychosocial implications for the public and for both traditional and non-traditional responders in terms of impact and of response. Five main issues are common to mass decontamination events: (i) perception, (ii) somatisation, (iii) media role and communication, (iv) information sharing, (v) behavioural guidance and (vi) organisational issues. Empirical evidence is drawn from a number of cases, including Chernobyl; Goiania, Brazil; the sarin gas attack in Tokyo; the anthrax attacks in the USA; Three Mile Island; and by features of the 2003 severe acute respiratory syndrome pandemic.

Psychosocial considerations about children and radiological events.

Children are identified as a vulnerable population in the case of radiological events because of their increased physical sensitivity to radiation and its impact on critical development stages. Using a comprehensive integrated risk framework, psychosocial risk protective factors are discussed in a social ecology paradigm. Children have been shown to be both vulnerable and resilient; they are both easily impressionable and also quick to adapt and learn.

Psychological Stress Measure (PSM-9): integration of an evidence-based approach to assessment, monitoring, and evaluation of stress in physical therapy practice.

Stress can be a primary or secondary contributor to ill health via excessive and sustained sympathetic arousal leading to ischemic heart disease, hypertension, stroke, obesity, and mental ill health, or through related behaviors such as smoking, substance abuse, and over or inappropriate eating; or as a contextual variable in terms of risk factor and lifestyle outcome. In addition, psychosocial stress can impair recovery from any pathological insult or injury. Most assessments of stress relate to life events, and both past and current life stressors, acute and chronic, play a major role.

If schools are closed, who will watch our kids? Family caregiving and other sources of role conflict among nurses during large-scale outbreaks.

Objectives: The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of healthcare professionals as "first receivers" during infectious disease outbreaks, a collateral aspect to their role as responders. This article records and reports concerns expressed by Canadian emergency and critical care nurses in terms of organizational and social supports required during infectious disease outbreaks. The nature of work-family and family-work conflict perceived and experienced by nurses during infectious disease outbreaks, as well as the supports needed to enable them to balance their social roles during this type of heightened stress, are explored.

A social-cognitive perspective of terrorism risk perception and individual response in Canada.

The volume of research on terrorism has increased since the events of September 11, 2001. However, efforts to develop a contextualized model incorporating cognitive, social-contextual, and affective factors as predictors of individual responses to this threat have been limited. Therefore, the aim of this study was to evaluate a series of hypotheses drawn from such a model that was generated from a series of interviews with members of the Canadian public.

Emergency preparedness for higher risk populations: psychosocial considerations.

This paper was meant to be on 'vulnerable populations', as some population sub-groups do require special care, special planning and special integration of needs. However, the issue should be reframed in terms of groups at higher risks. The text explains how (1) there are contextual vulnerabilities, in (a) higher susceptibility, i.

Income and psychological distress: the role of the social environment.

Background: This article examines the relationship between lower income and the risk of experiencing high psychological distress over twelve years.

Data And Methods: Data from the first 12 years of the longitudinal National Population Health Survey (1994/1995 through 2006/2007) were analysed. Proportional hazards modelling was conducted to determine whether lower household income was associated with a greater risk of experiencing high distress, when adjusting for sociodemographic characteristics and baseline health status.

Health risk perceptions as mediators of socioeconomic differentials in health behaviour.

Differentials in health status and behaviour by socioeconomic status (SES) constitute a scientific and policy challenge. In this article, data from a national survey on Canadians' perceptions of population health risks were analysed to determine whether various types of health risk perceptions mediated SES differentials in health behaviour. As expected, health behaviours and risk perceptions both varied with SES.

Disaster and emergency management: Canadian nurses' perceptions of preparedness on hospital front lines.

Introduction: Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national, Web-based survey of Canadian nurses was conducted to assess perceptions of preparedness for disasters and access to support mechanisms, particularly for nurses in emergency and critical care units.

Hypotheses: The following hypotheses were tested: (1) nurses' sense of preparedness for infectious disease outbreaks and naturally occurring disasters will be higher than for chemical, biological, radiological, and nuclear (CBRN)-type disasters associated with terrorist attacks; (2) perceptions of preparedness will vary according to previous outbreak experience; and (3) perceptions of personal preparedness will be related to perceived institutional preparedness.

Methods: Nurses from emergency departments and intensive care units across Canada were recruited via flyer mailouts and e-mail notices to complete a 30-minute online survey.

Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.

Background: In response to the 2003 global outbreak of severe acute respiratory syndrome (SARS), and the threat of pandemic influenza, Canadian hospitals have been actively developing and revising their emergency plans. Healthcare workers are a particularly vulnerable group at risk of occupational exposure during infectious disease outbreaks, as seen during SARS and as documented/reported in the recent National Survey of the Work and Health of Nurses (Statistics Canada, 2006). Approximately one third of Canadian nurses identified job strain and poor health, related to their work environment.

Looking inside the black box: a theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM) to improve referral and prescribing practices in primary care in Ontario, Canada.

Background: Randomised controlled trials of implementation strategies tell us whether (or not) an intervention results in changes in professional behaviour but little about the causal mechanisms that produce any change. Theory-based process evaluations collect data on theoretical constructs alongside randomised trials to explore possible causal mechanisms and effect modifiers. This is similar to measuring intermediate endpoints in clinical trials to further understand the biological basis of any observed effects (for example, measuring lipid profiles alongside trials of lipid lowering drugs where the primary endpoint could be reduction in vascular related deaths).

Terrorism threats and preparedness in Canada: the perspective of the Canadian public.

Although Canada has not experienced a major terrorist attack, an increased global pending threat has put preparedness at the top of the Canadian government's agenda. Given its strong multicultural community and close proximity to the recently targeted United States, the Canadian experience is unique. However, minimal research exists on the public's reactions to terrorism threats and related preparedness strategies.

Do stressors explain the association between income and declines in self-rated health? A longitudinal analysis of the National Population Health Survey.

Although there is considerable evidence documenting the relationship between lower socioeconomic status (SES) and poorer health, longitudinal research is needed to study mechanisms that may explain this relationship. This study investigated whether income was associated with decline in self-rated health over a 2-year period and whether stressors mediated part of this social gradient. Participants in the National Population Health Survey (NPHS) who rated their health as excellent, very good, or good in 1994 and 1995 were followed over 2 years.