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Access to cardiac rehabilitation among South-Asian patients by referral method: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature143716
Source
Rehabil Nurs. 2010 May-Jun;35(3):106-12
Publication Type
Article
Author
Keerat Grewal
Yvonne W Leung
Parissa Safai
Donna E Stewart
Sonia Anand
Milan Gupta
Cynthia Parsons
Sherry L Grace
Author Affiliation
University of Toronto, ON. keerat.grewal@utoronto.ca
Source
Rehabil Nurs. 2010 May-Jun;35(3):106-12
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - ethnology - rehabilitation
Asia, Western - ethnology
Asian Continental Ancestry Group
Automation
Continuity of Patient Care
Emigrants and Immigrants
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
India - ethnology
Male
Middle Aged
Ontario
Referral and Consultation
Abstract
People of South-Asian origin have an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, South Asians are among the least likely people to participate in these programs. Automatic referral increases CR use and may reduce access inequalities. This study qualitatively explored whether CR referral knowledge and access varied among South-Asian patients. Participants were South-Asian cardiac patients receiving treatment at hospitals in Ontario, Canada. Each hospital refers to CR via one offour methods: automatically through paper or electronically, through discussion with allied health professionals (liaison referral), or through referral at the physician's discretion. Data were collected via interviews and analyzed using interpretive-descriptive analysis. Four themes emerged: the importance of predischarge CR discussions with healthcare providers, limited knowledge of CR, ease of the referral process for facilitators of CR attendance, and participants'needs for personal autonomy regarding their decision to attend CR. Liaison referral was perceived to be the most suitable referral method for participants. It facilitated communication between patients and providers, ensuring improved understanding of CR. Automatic referral may not be as well suited to this population because of reduced patient-provider communication.
PubMed ID
20450019 View in PubMed
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Automatic referral to cardiac rehabilitation.

https://arctichealth.org/en/permalink/ahliterature179514
Source
Med Care. 2004 Jul;42(7):661-9
Publication Type
Article
Date
Jul-2004
Author
Sherry L Grace
Alexandra Evindar
Tabitha N Kung
Patricia E Scholey
Donna E Stewart
Author Affiliation
University Health Network Women's Health Program, Toronto, Ontario, Canada. sherry.grace@uhn.on.ca
Source
Med Care. 2004 Jul;42(7):661-9
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Aged
Arteriosclerosis - rehabilitation
Causality
Cross-Sectional Studies
Factor Analysis, Statistical
Female
Humans
Logistic Models
Male
Middle Aged
Models, Psychological
Ontario
Patient Acceptance of Health Care - psychology
Referral and Consultation
Socioeconomic Factors
Abstract
Cardiac rehabilitation (CR) remains underused and inconsistently accessed, particularly for women and minorities. This study examined the factors associated with CR enrollment within the context of an automatic referral system through a retrospective chart review plus survey. Through the Behavioral Model of Health Services Utilization, it was postulated that enabling and perceived need factors, but not predisposing factors, would significantly predict patient enrollment.
A random sample of all atherosclerotic heart disease (AHD) patients treated at a tertiary care center (Trillium Health Centre, Ontario, Canada) from April 2001 to May 2002 (n = 501) were mailed a survey using a modified Dillman method (71% response rate).
Predisposing measures consisted of sociodemographics such as age, sex, ethnocultural background, work status, level of education, and income. Enabling factors consisted of barriers and facilitators to CR attendance, exercise benefits and barriers (EBBS), and social support (MOS). Perceived need factors consisted of illness perceptions (IPQ) and body mass index.
Of the 272 participants, 199 (73.2%) attended a CR assessment. Lower denial/minimization, fewer logistical barriers to CR (eg, distance, cost), and lower perceptions of AHD as cyclical or episodic reliably predicted CR enrollment among cardiac patients who were automatically referred.
Because none of the predisposing factors were significant in the final model, this suggests that factors associated with CR enrollment within the context of an automatic referral model relate to enabling factors and perceived need. A prospective controlled evaluation of automatic referral is warranted.
PubMed ID
15213491 View in PubMed
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Beyond adolescence exploring Canadian women and men's perception of overweight.

https://arctichealth.org/en/permalink/ahliterature160723
Source
Womens Health Issues. 2007 Nov-Dec;17(6):374-82
Publication Type
Article
Author
Enza Gucciardi
Shirley C Wang
Tina Badiani
Donna E Stewart
Author Affiliation
Ryerson University, School of Nutrition, Toronto, Ontario, Canada. egucciar@ryerson.ca
Source
Womens Health Issues. 2007 Nov-Dec;17(6):374-82
Language
English
Publication Type
Article
Keywords
Adult
Body Image
Body mass index
Canada - epidemiology
Cross-Sectional Studies
Female
Humans
Logistic Models
Male
Middle Aged
Obesity - epidemiology - psychology
Prevalence
Questionnaires
Self Concept
Sex Distribution
Abstract
The research literature strongly corroborates that desires and attempts to lose weight are more prevalent among women who are already within the healthy weight range than men. The development of a distorted weight perception, specifically an overestimation of one's body size, may manifest into caloric restriction and other disordered eating behaviors. However, there is no systematic process to monitor the prevalence of disordered eating behaviors in Canada. The objective of this study was to investigate the prevalence and the sociodemographic characteristics of Canadian adults who have a perception of being overweight when their body mass index indicates that they are normal or underweight based on self-reported heights and weights.
The responses to the 2000/2001 Canadian Community Health Survey by a representative sample of Canadians between the ages of 20 and 64 were analyzed. Bivariate and logistic regression analyses were performed.
The prevalence of perceiving oneself as overweight when at acceptable weight for height was 23.6% for women and 7.8% for men. The probability was significantly greater in women, some foreign-born residents, those with a higher income level, and with increasing age.
These results suggest that, in contrast to mainstream thinking, distorted weight perception is experienced by adult and aging women, and not only by adolescent girls. More research is needed to understand why distorted weight perception increases with age in women and what potential adverse effects it may have in this population.
PubMed ID
17951073 View in PubMed
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Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model.

https://arctichealth.org/en/permalink/ahliterature190169
Source
Womens Health Issues. 2002 May-Jun;12(3):122-8
Publication Type
Article
Author
LaToya T Austin
Farah Ahmad
Mary Jane McNally
Donna E Stewart
Author Affiliation
University Health Network Women's Health Program, Toronto, Ontario, Canada.
Source
Womens Health Issues. 2002 May-Jun;12(3):122-8
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - ethnology - prevention & control
Female
Health promotion
Hispanic Americans - psychology
Humans
Mammography - psychology
Mass Screening - psychology
Models, Theoretical
Ontario
Patient Acceptance of Health Care - ethnology
Uterine Cervical Neoplasms - ethnology - prevention & control
Vaginal Smears - psychology
Women's health
Abstract
The aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.
PubMed ID
12015184 View in PubMed
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A broader context for maternal mortality.

https://arctichealth.org/en/permalink/ahliterature170962
Source
CMAJ. 2006 Jan 31;174(3):302-3
Publication Type
Article
Date
Jan-31-2006
Author
Donna E Stewart
Author Affiliation
Women's Health University Health Network, University of Toronto, Toronto, Ont.
Source
CMAJ. 2006 Jan 31;174(3):302-3
Date
Jan-31-2006
Language
English
Publication Type
Article
Keywords
Adult
Canada
Cause of Death
Depression
Female
Humans
Maternal Health Services - standards
Maternal Mortality - trends
Pregnancy
Pregnancy Complications - mortality - prevention & control - psychology
Risk factors
Substance-Related Disorders
Violence
Notes
Cites: Can Fam Physician. 2005 Aug;51:1061-716121822
Cites: CMAJ. 2005 Aug 2;173(3):253-916076821
Comment In: CMAJ. 2006 May 9;174(10):144716682714
PubMed ID
16446467 View in PubMed
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Cardiologists' charting varied by risk factor, and was often discordant with patient report.

https://arctichealth.org/en/permalink/ahliterature157753
Source
J Clin Epidemiol. 2008 Oct;61(10):1073-9
Publication Type
Article
Date
Oct-2008
Author
Shannon Gravely-Witte
Donna E Stewart
Neville Suskin
Lyall Higginson
David A Alter
Sherry L Grace
Author Affiliation
University Health Network Women's Health Program, 200 Elizabeth St., Toronto, Ontario, Canada. sgravely@yorku.ca
Source
J Clin Epidemiol. 2008 Oct;61(10):1073-9
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - epidemiology - etiology
Clinical Competence
Diabetes Mellitus - epidemiology
Dyslipidemias - complications - epidemiology
Epidemiologic Methods
Female
Humans
Hypertension - complications - epidemiology
Male
Medical Records - standards
Middle Aged
Ontario - epidemiology
Outpatient Clinics, Hospital
Self Disclosure
Smoking - adverse effects - epidemiology
Socioeconomic Factors
Abstract
To assess the completeness of cardiac risk factor documentation by cardiologists, and agreement with patient report.
A total of 68 Ontario cardiologists and 789 of their ambulatory cardiology patients were randomly selected. Cardiac risk factor data were systematically extracted from medical charts, and a survey was mailed to participants to assess risk factor concordance.
With regard to completeness of risk factor documentation, 90.4% of charts contained a report of hypertension, 87.2% of diabetes, 80.5% of dyslipidemia, 78.6% of smoking behavior, 73.0% of other comorbidities, 48.7% of family history of heart disease, and 45.9% of body mass index or obesity. Using Cohen's k, there was a concordance of 87.7% between physician charts and patient self-report of diabetes, 69.5% for obesity, 56.8% for smoking status, 49% for hypertension, and 48.4% for family history.
Two of four major cardiac risk factors (hypertension and diabetes) were recorded in 90% of patient records; however, arguably the most important reversible risk factors for cardiac disease (dyslipidemia and smoking) were only reported 80% of the time. The results suggest that physician chart report may not be the criterion standard for quality assessment in cardiac risk factor reporting.
Notes
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Cites: Obes Surg. 2002 Feb;12(1):25-911868292
PubMed ID
18411042 View in PubMed
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Cesarean section rate differences by migration indicators.

https://arctichealth.org/en/permalink/ahliterature119161
Source
Arch Gynecol Obstet. 2013 Apr;287(4):633-9
Publication Type
Article
Date
Apr-2013
Author
Anita J Gagnon
Andrea Van Hulst
Lisa Merry
Anne George
Jean-François Saucier
Elizabeth Stanger
Olive Wahoush
Donna E Stewart
Author Affiliation
Ingram School of Nursing and Department of Obstetrics and Gynecology, McGill University, Montreal, Canada. anita.gagnon@mcgill.ca
Source
Arch Gynecol Obstet. 2013 Apr;287(4):633-9
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Canada
Cesarean Section - statistics & numerical data
Cities - statistics & numerical data
Emigrants and Immigrants - statistics & numerical data
Female
Humans
Pregnancy
Refugees - statistics & numerical data
Abstract
To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators?
Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed.
Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8-27.3). Cesarean section rates of African women were consistently high (31-33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (=2 years 29.8 %, >2 years 47.2 %).
Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.
PubMed ID
23132050 View in PubMed
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A comparison of physical activity environments between South Asians and white Caucasians with coronary heart disease.

https://arctichealth.org/en/permalink/ahliterature137210
Source
Ethn Dis. 2010;20(4):390-5
Publication Type
Article
Date
2010
Author
Shazareen N Khan
Sherry L Grace
Paul Oh
Sonia Anand
Donna E Stewart
Gilbert Wu
Milan Gupta
Author Affiliation
University of Toronto, Ontario, Canada.
Source
Ethn Dis. 2010;20(4):390-5
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
Asia, Southeastern - ethnology
Coronary disease - ethnology
Female
Humans
Male
Middle Aged
Motor Activity
Multivariate Analysis
Ontario - epidemiology
Abstract
South Asians (SA) are predisposed to developing premature coronary heart disease (CHD), partly due to the early onset of classic risk factors, including physical inactivity. The nature of physical activity (PA) environments in South Asians in Canada remains unknown. Our objective was to examine differences in PA environments for South Asian vs White Caucasian (WC) CHD patients. In a cross-sectional study, 2657 hospitalized CHD patients in Ontario completed The Perceived Environments Related to Physical Activity Questionnaire to assess their home and neighborhood environment, perceived neighborhood safety and availability of recreational facilities. Patients self-reporting their ethnocultural background as WC (N = 1301, 48.6%) or SA (N = 171, 6.4%) were included in this study. South Asians were significantly younger, had lower body mass index, higher levels of education, lower income, were less likely to smoke and reside rurally, and were more likely to be married, have diabetes mellitus and have experienced prior myocardial infarction (MI) than WC patients. South Asians also had lower availability of home exercise equipment and perceived convenience of local PA facilities, but better and safer neighborhood environments than WC patients. Multivariate analyses revealed that SA ethnocultural background remained significantly related to reduced availability of home exercise equipment and fewer convenient local PA facilities. Since physical inactivity is an important CHD risk factor, and SA ethnocultural background is associated with high CHD risk, this may represent a novel target for risk reduction. Thus, further research is required to optimize SA awareness of the need for PA, and access to equipment and facilities.
Notes
SummaryForPatientsIn: Ethn Dis. 2010 Autumn;20(4):48821305843
PubMed ID
21305827 View in PubMed
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Computer-assisted screening for intimate partner violence and control: a randomized trial.

https://arctichealth.org/en/permalink/ahliterature150630
Source
Ann Intern Med. 2009 Jul 21;151(2):93-102
Publication Type
Article
Date
Jul-21-2009
Author
Farah Ahmad
Sheilah Hogg-Johnson
Donna E Stewart
Harvey A Skinner
Richard H Glazier
Wendy Levinson
Author Affiliation
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. farah.ahmad@utoronto.ca
Source
Ann Intern Med. 2009 Jul 21;151(2):93-102
Date
Jul-21-2009
Language
English
Publication Type
Article
Keywords
Adult
Confidentiality
Diagnosis, Computer-Assisted
Domestic Violence
Family Practice - methods
Female
Humans
Male
Medical Records
Middle Aged
Ontario
Physician-Patient Relations
Risk Assessment - methods
Abstract
Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women.
To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting.
Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention.
An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada.
Adult women in a current or recent relationship.
Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (n = 144). Control participants received standard medical care (n = 149).
Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits.
The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (n = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions.
The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used.
Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients.
Canadian Institutes of Health Research and Ontario Women's Health Council.
PubMed ID
19487706 View in PubMed
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Continuity of cardiac care: cardiac rehabilitation participation and other correlates.

https://arctichealth.org/en/permalink/ahliterature165450
Source
Int J Cardiol. 2007 Jul 31;119(3):326-33
Publication Type
Article
Date
Jul-31-2007
Author
Dana L Riley
Donna E Stewart
Sherry L Grace
Author Affiliation
York University, Canada.
Source
Int J Cardiol. 2007 Jul 31;119(3):326-33
Date
Jul-31-2007
Language
English
Publication Type
Article
Keywords
Aged
Angina Pectoris - rehabilitation
Continuity of Patient Care - organization & administration
Female
Health Care Surveys
Humans
Interdisciplinary Communication
Male
Middle Aged
Myocardial Infarction - rehabilitation
Ontario
Patient satisfaction
Syndrome
Universal Coverage
Abstract
Continuity of care refers to the ongoing management of a patient's care over time and across practitioners, and the patient's experience of this care as coherent and consistent with their medical needs and context. Continuity of cardiac care is integral to secondary prevention and improved health outcomes.
This study examined patient perceptions of continuity, and how they relate to cardiac rehabilitation participation and other correlates.
Consecutive acute coronary syndrome patients at 3 hospitals were approached, and 661 consented to complete a survey (504 men, 157 women; 75% response rate). Nine months later, 506 participants completed a survey including the Heart Continuity of Care Questionnaire, open-ended continuity perceptions, and self-reported cardiac rehabilitation participation (yes/no).
The mean continuity perceptions were highly positive, and were equivalent to those found in another Canadian province, although open-ended responses revealed discontinuity with regard to outpatient visits and pharmacotherapy prescriptions. In a multivariate model (p=.003), the correlates of greater perceptions of continuity of cardiac care 9 months post-discharge were cardiac rehabilitation participation (p
Notes
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PubMed ID
17258332 View in PubMed
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83 records – page 1 of 9.