RESUMEN

OBJECTIVES: To determine the information needs and preferences of patients who had human papillomavirus-associated head and neck cancer (HNC) and who were aged 18-65 years in the post-treatment phase of recovery. SAMPLE & SETTING: 205 patients who completed treatment for HNC at two large cancer centers in Western Canada. METHODS & VARIABLES: A self-administered survey was completed in paper or online format. Participants were asked about information considered most important, sources of information used during recovery, and sources considered most helpful. RESULTS: Participants wanted information on signs and symptoms of recurrence, cure rates, post-treatment rehabilitation, treatment and recovery time frames, and financial assistance. They identified healthcare providers as the most frequently used and helpful source of information, but also reported that the Internet was useful and that an online information resource would be helpful during recovery. IMPLICATIONS FOR NURSING: Nurses can provide more personalized information for survivors of HNC by contributing to the development of reliable Internet-based resources. The developers of these resources could also consider creating ways to directly link healthcare providers and survivors of HNC who are experiencing problems stemming from diagnosis and treatment.

Asunto(s)

RESUMEN

This study explores the effect of age and chronic conditions on public perceptions of the health system, as measured by the Key Performance Indicators (KPIs) of healthcare, in the province of Alberta in Canada. Drawing from data collected by Government of Alberta's Department of Health and Wellness, this research examines two key questions: (1) Do people in the 65+ age group rate the KPIs of healthcare (i.e., availability, accessibility, quality, outcome, and satisfaction) more favorably compared to people in younger age groups in Alberta? (2) Does the rating of KPIs of healthcare in Alberta vary with different chronic conditions (i.e., no chronic problem, chronic illnesses without pain, and chronic pain)? The findings indicate that people in the older age group tend to rate the KPIs of healthcare more favorably compared to younger age groups in Alberta, net of socio-demographic factors, self-reported health status, and knowledge and utilization of health services. However, people experiencing chronic pain are less likely to rate the KPIs of healthcare favorably compared to people with no chronic health problem in Alberta. Discussion includes implications of the findings for the healthcare system in the province.

RESUMEN

OBJECTIVE: To examine the relationship between public perceptions of key performance indicators assessing various aspects of the health-care system. DESIGN: Cross-sequential survey research. Annual telephone surveys of random samples of adult Albertans selected by random digit dialing and stratified according to age, sex and region (n = 4000 for each survey year). The survey questionnaires included single-item measures of key performance indicators to assess public perceptions of availability, accessibility, quality, outcome and satisfaction with healthcare. Cronbach's α and factor analysis were used to assess the relationship between key performance indicators focusing on the health-care system overall and on a recent interaction with the health-care system. SETTING: The province of Alberta, Canada during the years 1996-2004. PARTICIPANTS: Four thousand adults randomly selected each survey year. MAIN OUTCOME MEASURE(S): Survey questions measuring public perceptions of healthcare availability, accessibility, quality, outcome and satisfaction with healthcare. RESULTS: Factor analysis identified two principal components with key performance indicators focusing on the health system overall loading most strongly on the first component and key performance indicators focusing on the most recent health-care encounter loading most strongly on the second component. Assessments of the quality of care most recently received, accessibility of that care and perceived outcome of care tended to be higher than the more general assessments of overall health system quality and accessibility. CONCLUSION: Assessments of specific health-care encounters and more general assessments of the overall health-care system, while related, nevertheless comprise separate dimensions for health-care evaluation.

Asunto(s)

RESUMEN

BACKGROUND: A basic tenet of palliative care is to maintain an individual's control over the dying process. However, when decline occurs quickly, as may be the case in advanced cancer, transition of responsibility for illness management to a family caregiver may become necessary when care takes place in the home. OBJECTIVE: The aim of this study was to understand the decision-making process that occurs between a dying individual and his or her family caregiver. METHODS: Participants in this grounded theory study were selected by purposive and theoretical sampling methods. Data were collected and analyzed using a constant comparison approach. RESULTS: The core category covering captured the inordinate efforts taken by informal caregivers to ensure that their family member would be able to die in the manner of his or her choosing. The basic social process, dancing on the stairs, chronicled the families' decision-making process as they navigated through this delicate and precarious end stage of life. CONCLUSIONS: Dancing on the stairs required a close relationship between 2 people who were willing to remain engaged with each other, despite the difficulties they faced. This decision-making process may be applicable to other health care transitions in people's lives that need to be managed with another person. IMPLICATIONS FOR PRACTICE: Palliative care education for nurses in all care health settings may ease transitions for end-stage patients. Health promotion initiatives designed to educate the lay public about advance directives and end-stage illness management in a home setting may help to prepare family caregivers for their future responsibilities.

Asunto(s)

RESUMEN

The monograph Changing Residence: The Geographic Mobility of Elderly Canadians (Northcott, 1988) reviewed the research that had been done up to the mid-1980s on the geographic mobility of older persons in Canada and elsewhere. The purpose of this article is to provide an update and overview of developments in the study of the geographic mobility of seniors since the mid-1980s with a particular emphasis on Canada. In this review, we first examine progress over the past 25 years in research about seniors' geographic mobility and focus on three topics: the relocation and geographic concentration of seniors, seasonal migration ("snowbirds"), and international migration. Second, we assess the current status of research on elder migration in Canada. Finally, we identify future challenges and unanswered questions, and make suggestions for future research.

Asunto(s)

RESUMEN

This article explores how elderly English-speaking Indian immigrant women living in Edmonton, Alberta, Canada perceive and manage mental distress. With elders' consent, in-depth interviews were recorded, transcribed and transcripts were thematically analyzed. The findings suggest that these women believed that to lower the risk of mental distress it is critical for individuals to ;maximize control over inner self' by ;being busy.' The elder's busy behavior is framed within the Indian cultural and spiritual/faith matrix in dialogue with acculturation experiences in Canada. ;Staying busy' allows these elders to use culture as a ;moral medicine' to facilitate coping and adaptation.

Asunto(s)

RESUMEN

The Canadian population is aging and becoming more ethnically diverse. This paper focuses on South Asian immigrant seniors and examines differences in housing and living arrangements among seniors who immigrated at different life stages. We interviewed a convenience sample of 161 immigrant seniors of South Asian descent in Edmonton, Alberta, to assess type of living arrangement, type of housing and dwelling density (measured in persons per room), activity in the neighbourhood, and means of transportation. Overall, those seniors who came to Canada before the end of mid-life were more likely than those who came at an older age to drive a car and, if married, to live in a one- or two-generation family. Women were more likely than men to be widowed, have poorer English-language skills, or live with a three-generation family if unmarried, and less likely to drive a car. Most respondents were satisfied with their living arrangements, housing, and perceived safety at home and in their neighbourhood. Theoretical implications are discussed.

Asunto(s)

RESUMEN

OBJECTIVES: To determine dentists" perceptions of the usefulness of digital technologies in improving dental practice and resolving practice issues; to determine dentists" willingness to use digital and electronic technologies; to determine perceived obstacles to the use of digital and electronic technologies in dental offices; and to determine dentists" attitudes toward Internet privacy issues. METHODS: An anonymous, self-administered survey of Canadian dentists was conducted by mail. A potential mailing list of 14,052 active Canadian dentists was compiled from the 2003 records of provincial regulatory bodies. For each province, 7.8% of the dentists were randomly selected with the help of computer software. The surveys were mailed to this stratified random sample of 1,096 dentists. RESULTS: The response rate was 28% (312/1,096). Of the 312 respondents, 4 (1%) were in full-time academic positions, 16 (5%) were not practising, and 9 (3%) provided incomplete data. Therefore, 283 survey responses were available for analysis. More than 60% of the dentists indicated that computer technology was quite capable or very capable of improving their current practice by increasing patient satisfaction, decreasing office expenses, increasing practice efficiency, increasing practice production, improving record quality and improving case diagnosis and treatment planning. More than 50% of respondents reported that digital photography and digital radiography were quite useful or very useful. About 70% of the dentists agreed or strongly agreed with using digital and electronic technologies to consult with dental specialists. Cost of equipment and lack of comfort with technology were regarded as significant or insurmountable obstacles by substantial proportions of respondents. CONCLUSIONS: Respondents generally viewed digital and electronic technologies as useful to the profession. Increased office efficiency and production were perceived as positive effects of digital and electronic technologies. These technologies are more often used for consulting with colleagues rather than for consulting with patients. The major obstacles to the general use of these technologies were related to cost, lack of comfort with technology and differences in legislation between provinces and countries. Privacy issues were not perceived as a significant barrier.

Asunto(s)

RESUMEN

OBJECTIVES: To determine the frequency of computers in Canadian dental offices and to assess their use; to evaluate Internet access and use in Canadian dental offices; and to compare use of computers and the Internet by Canadian dentists, by the general public and by other dental groups. METHODS: An anonymous, self-administered survey of Canadian dentists was conducted by mail. A potential mailing list of 14,052 active Canadian dentists was compiled from the 2003 records of provincial regulatory bodies. For each province, 7.8% of the general dentists were randomly selected with the help of computer software. The surveys were mailed to this stratified random sample of 1,096 dentists. RESULTS: The response rate was 28%. Of the 312 respondents, 4 (1%) were in full-time academic positions, 15 (5%) were not practising, and 9 (3%) provided incomplete data. Therefore, 284 survey responses were available for descriptive analysis. Two hundred and fifty-seven (90%) of the respondents had a computer in their primary practice. Computers were used mainly for administrative tasks (accounting, bookkeeping and scheduling) rather than clinical tasks. Internet access was common (185/250 or 74%), and high-speed Internet access (93/250 or 37%) was increasingly common, judging from the results of previous studies on computer use. The main reasons given for not having in-office Internet access were security or privacy concerns and no reported need for or interest in the service. CONCLUSIONS: Computer use was high in this sample of Canadian dentists, but a small proportion of dental offices remained without computers. Canadian dentists" use of the Internet was greater than that of American dentists, private enterprise and the North American public in general.

Asunto(s)

RESUMEN

An anonymous, self-administered, mail-out survey of Canadian Orthodontists was conducted to evaluate the characteristics of orthodontic Internet use. The response rate was 45.6% (304 of 667). A total of 76.6% of orthodontists reported having Internet access at work, and an additional 12.4% reported having Internet access from a different location. Statistically significant associations between Internet usage and office staff size (P < .001) and years of practice (P = .046) were observed. Offices with larger staffs had greater Internet access. Number of staffs and number of case starts were positively correlated (P < .001, r = 0.498). The odds ratio for having Internet access on the basis of increased case starts from the less than 100 to 300-399 categories was 5.67. Although not statistically significant, there was a trend for greater Internet access by younger practitioners.

Asunto(s)

RESUMEN

In this article, we examine how seniors are portrayed in the Globe and Mail. Thirty articles published in 2004 were selected and thematically analysed. Seniors were discussed in six different contexts, including family, work/retirement, community networks, scientific studies of population, social and health care policy, and social attitudes to aging. Issues pertaining to seniors were captured in three themes. The theme diversity of seniors made visible seniors of different genders, ages, health statuses, abilities, and needs. The successful aging theme provided positive examples of aging well but marginalized seniors who did not meet these expectations, thereby fostering intra-generational ageism. The apocalyptic demography / inter-generational conflict theme underscored the importance of society's support system for the elderly but raised the issue of inter-generational inequality, of presenting the elderly as a burden on younger persons in families and on society at large. Critical analyses suggested that both negative and positive newspaper portrayals of seniors might be ageist.

Asunto(s)

RESUMEN

The Health Quality Council of Alberta (HQCA) is charged with reporting to Albertans on the quality, safety and performance of the healthcare system. In 2004, the HQCA conducted a telephone survey (response rate: 55%) of 1,500 adult Albertans to assess their perceptions of and personal experiences with preventable medical errors (PMEs). A total of 559 (37.3%) respondents reported that they or a family member had ever experienced a PME. The most common PMEs were related to clinical performance (n=128), medication (n=123), diagnosis (n=121) and communication (n=73). Through this research, patients have provided an orientation to interventions to improve patient care and prevent medical errors.

Asunto(s)

RESUMEN

INTRODUCTION: To plan for future acceptance and implementation of computer-related technology, it is necessary to understand orthodontists' current perceptions and attitudes toward emerging technologies. METHODS: An anonymous, self-administered, mail-out survey of Canadian orthodontists was conducted. The response rate was 45.6% (304/667). RESULTS: Most orthodontists indicated that computer technology could improve current practice efficiency and quality of patient care. Only 15% reported that digital models are quite or very useful; 73.6%, 69.1%, 55%, and 37.4% agreed or strongly agreed with using digital and electronic technology to consult with other dental specialists, other orthodontists, general dentists, and the public, respectively. Cost of the technology was reported as a significant or insurmountable obstacle by 54% of the respondents. Interprovincial legislation, unclear consultation remuneration guidelines, and lack of comfort with the technology were not perceived as significant obstacles. Only 36% reported security or privacy issues as a significant or insurmountable obstacle. CONCLUSIONS: Canadian orthodontists seem to view digital and electronic technology as useful and capable of improving their offices' efficiency and production. Although they are sensitive to some potential obstacles, they are willing to overcome these and incorporate the technology into their practices.

Asunto(s)

RESUMEN

When parents try to assume responsibility for an ill adult-child with schizophrenia, the law, mental health practitioners, and often the ill person reject their right to do so. Consequently, these parents regard themselves as disenfranchised, i.e., lacking the rights required to care properly for their loved ones. Redefining Parental Identity, a grounded theory of caregiving and schizophrenia, traces changes in a parent's identity and caregiving during the erratic course of the child's mental illness. Participants were a purposive sample of 29 parent caregivers from 19 families in British Columbia, Canada, caring for 20 adult children. This understanding of their experience will be helpful to parents of people with schizophrenia, professional practitioners, and those involved in mental health care reform.

Asunto(s)

RESUMEN

Providing the right care, in the right place, to dying persons is hampered by a lack of understanding of where death and dying normally take place and ignorance about what influences location of death. This paper reports the findings of a multidisciplinary historical investigation of 20th-century influences on location of death in Canada. It builds on a study that found a hospitalization-of-death trend in Canada over much of the 20th century but a reduction in hospital deaths beginning in 1994. This study found 2 key influences on location of death: (1) health-care and health-system developments that consolidated care in hospitals while also raising and sustaining public expectations of beneficial if not curative hospital care--the rising hospital-death rate throughout the 20th century can thus be considered an outcome of the shift of illness care from the home to the hospital; and (2) reduced availability of home-based caregivers. A number of developments limited the availability of home care for chronically ill and terminally ill persons, including the increased participation of women in the workforce and the shift in nursing from private home duty to hospitals. Although some health and social support for home care has developed recently, this support clearly does not match that for hospital care. These findings indicate that location of death is an important focal point for studying and planning improvements in end-of-life care.

Asunto(s)