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The Importance of Informational, Clinical and Personal Support in Patient Experience with Total Knee Replacement: A Qualitative Investigation

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-03-24
Abstract: 

Background: Total knee arthroplasty (TKA) is the most frequently performed joint replacement surgery in North America. Patient perspectives on TKA have been investigated in various ways, including finding as many as 20% of TKA patients are dissatisfied with their surgical outcomes. Understanding the patient experience with TKA broadly and in relation to patient satisfaction is a key gap in existing literature.

 Methods: We report on the qualitative component of a mixed methods prospective cohort study examining patient experience and satisfaction post-TKA for adults in British Columbia, Canada. Data collection consisted of 45 in-depth interviews about individuals’ knee surgery experiences conducted eight months after surgery. Analysis consisted of thematic coding by multiple coders.

 Results: Participants’ descriptions of their TKA experiences were primarily concerned with support, or the provision of aid and assistance. Support was insufficient when their expectations of support were not met; unmet support expectations led to an overall negative TKA experience. Support operated in three key domains: (1) informational support, (2) clinical support, and (3) personal support. Key sources of informational and clinical support included pre-optimisation clinics, surgeons, and physiotherapists. Key topics for informational support included pain, pain management, and recovery trajectories. Personal support was provided by family, friends, other TKA patients, employers, and themselves.

 Conclusions: Patient needs and expectations for support are shaped both before and after TKA surgery. Patients with an overall positive TKA experience had improvement in their knee pain, stiffness or functioning post-TKA, had their major expectations and needs for support met during their TKA recovery, and believed that any significant future expectations or needs for ongoing support would be adequately met. In contrast, patients with an overall negative TKA experience had at least one major expectation or need for support not met during their TKA recovery, even in cases where they had good TKA outcomes. Suggested interventions to improve the experience of persons receiving TKA include an expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients’ TKA experience.

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Helmet Use Among Personal Bicycle Riders and Bike Share Users in Vancouver, BC

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-10-01
Abstract: 

Introduction: Public bike share users have low prevalence of helmet use, and few public bike share systems make helmets available. In summer 2016, a public bike share system launched in Vancouver, BC. Each bicycle is equipped with a free helmet, in response to BC's all-ages compulsory helmet law. This study assessed the prevalence of helmet use among adult cyclists on personal and public bicycles in Vancouver.

Methods: A survey of adult cyclists (age estimated at ≥16 years) at five screen line sites and at 15 public bike share docking stations was conducted. Observations were made on fair weather days in 2016. Observers recorded the gender of the rider, bicycle type, helmet use, and helmet type. In 2016, multivariable logistic regression was used to calculate the odds of helmet use by personal and trip characteristics.

Results: Observers conducted 87.5 hours of observation and recorded 11,101 cyclists. They observed 10,704 (96.4%) cyclists on personal bicycles and 397 (3.6%) public bicycle users. Overall, the prevalence of helmet use was 78.1% (n=8,670/11,101), higher for personal bicycle riders (78.6%, n=8,416/10,704) than bike share users (64.0%, n=254/397). Helmet use was associated with gender, bicycle facility type, and day and time of travel.

Conclusions: In a city with all-ages helmet legislation, helmet use is high but differs across infrastructure types and cyclist characteristics. Bike share systems could increase helmet use by providing complementary helmets coupled with supportive measures.

Document type: 
Article

Identifying the Leaders: Applying Diffusion of Innovation Theory to Use of a Public Bikeshare System in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015-03-01
Abstract: 

Public bike share programs are growing in popularity globally with increasing recognition of their potential and accrued benefits for mobility, health, and the environment. Any city planning to launch a program will be keenly interested in understanding who may use it, in order to enable strategic marketing that will facilitate quick uptake and adoption. We applied the Diffusion of Innovation Theory to data from a population-based telephone survey to characterize who is most likely to use a new public bike share program. The telephone survey of 901 Vancouver residents was conducted prior to the launch of Vancouver's public bike share program. Results showed that a majority (n=614/901, 69.1%, 95% CI: 66.3%/72.7%) of respondents thought that public bike share was a good idea, however, only a quarter (n=217/901, 24.2%, 95% CI: 21.1%, 27.3%) said they would be either likely or very likely to use the program. Logistic regression identified characteristics associated with greater and lower likelihood of use. These characteristics were used to create an adoption curve that defines population segments anticipated to be the leaders in adopting the program. The theory was used to develop implementation recommendations to maximize program uptake including ensuring that the program has tangible advantages over driving or transit; is affordable and easy to try out; integrates with transit and car share opportunities; and appeals to social trends such as environmental responsibility. These results can assist planning and promotion in cities set to launch public bike share programs.

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Xpey' Relational Environments: An Analytic Framework for Conceptualizing Indigenous Health Equity

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-09
Abstract: 

Introduction: Both health equity research and Indigenous health research are driven by the goal of promoting equitable health outcomes among marginalized and underserved populations. However, the two fields often operate independently, without collaboration. As a result, Indigenous populations are underrepresented in health equity research relative to the disproportionate burden of health inequities they experience. In this methodological article, we present Xpey’ Relational Environments, an analytic framework that maps some of the barriers and facilitators to health equity for Indigenous peoples.Methods: Health equity research needs to include a focus on Indigenous populations and Indigenized methodologies, a shift that could fill gaps in knowledge with the potential to contribute to ‘closing the gap’ in Indigenous health. With this in mind, the Equity Lens in Public Health (ELPH) research program adopted the Xpey’ Relational Environments framework to add a focus on Indigenous populations to our research on the prioritization and implementation of health equity. The analytic framework introduced an Indigenized health equity lens to our methodology, which facilitated the identification of social, structural and systemic determinants of Indigenous health. To test the framework, we conducted a pilot case study of one of British Columbia’s regional health authorities, which included a review of core policies and plans as well as interviews and focus groups with frontline staff, managers and senior executives.Conclusion: ELPH’s application of Xpey’ Relational Environments serves as an example of the analytic framework’s utility for exploring and conceptualizing Indigenous health equity in BC’s public health system. Future applications of the framework should be embedded in Indigenous research methodologies.

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Exposure to PM2.5 and Blood Lead Level in Two Populations in Ulaanbaatar, Mongolia

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2016-02-15
Abstract: 

Approximately 60% of the households in Ulaanbaatar live in gers (a traditional Mongolian dwelling) in districts outside the legal limits of the city, without access to basic infrastructure, such as water, sewage systems, central heating, and paved roads, in contrast to apartment residents. This stark difference in living conditions creates different public health challenges for Ulaanbaatar residents. Through this research study we aim to test our hypothesis that women living in gers burning coal in traditional stoves for cooking and heating during the winter are exposed to higher concentrations of airborne PM2.5 than women living in apartments in Ulaanbaatar, Mongolia, and this exposure may include exposures to lead in coal with effects on blood lead levels. This cross sectional study recruited a total of 50 women, 40–60 years of age, from these two settings. Air sampling was carried out during peak cooking and heating times, 5:00 p.m.–11:00 p.m., using a direct-reading instrument (TSI SidePak™) and integrated polytetrafluoroethylene (PTFE) filters using the SKC Personal Environmental Monitor. Blood lead level (BLL) was measured using a LeadCare II rapid field test method. In our study population, measured PM2.5 geometric mean (GM) concentrations using the SidePak™ in the apartment group was 31.5 (95% CI:17–99) μg/m3, and 100 (95% CI: 67–187) μg/m3 in ger households (p < 0.001). The GM integrated gravimetric PM2.5 concentrations in the apartment group were 52.8 (95% CI: 39–297) μg/m3 and 127.8 (95% CI: 86–190) μg/m3 in ger households (p = 0.004). The correlation coefficient for the SidePak™ PM2.5 concentrations and filter based PM2.5 concentrations was r = 0.72 (p < 0.001). Blood Lead Levels were not statistically significant different between apartment residents and ger residents (p = 0.15). The BLL is statistically significant different (p = 0.01) when stratified by length of exposures outside of the home. This statistically significant difference in increased BLL could be due to occupational or frequent exposure to other sources of indoor or outdoor air pollution that were not measured. Blood lead levels from our study population are the  study measurements published on women aged 40–60 years of age in Mongolia

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The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-09
Abstract: 

In the context of HIV, women’s sexual rights and sexual autonomy are important but frequently overlooked and violated. Guided by community voices, feminist theories, and qualitative empirical research, we reviewed two decades of global quantitative research on sexuality among women living with HIV. In the 32 studies we found, conducted in 25 countries and composed mostly of cis-gender heterosexual women, sexuality was narrowly constructed as sexual behaviours involving risk (namely, penetration) and physiological dysfunctions relating to HIV illness, with far less attention given to the fullness of sexual lives in context, including more positive and rewarding experiences such as satisfaction and pleasure. Findings suggest that women experience declines in sexual activity, function, satisfaction, and pleasure following HIV diagnosis, at least for some period. The extent of such declines, however, is varied, with numerous contextual forces shaping women’s sexual well-being. Clinical markers of HIV (e.g., viral load, CD4 cell count) poorly predicted sexual outcomes, interrupting widely held assumptions about sexuality for women with HIV. Instead, the effects of HIV-related stigma intersecting with inequities related to trauma, violence, intimate relations, substance use, poverty, aging, and other social and cultural conditions primarily influenced the ways in which women experienced and enacted their sexuality. However, studies framed through a medical lens tended to pathologize outcomes as individual “problems,” whereas others driven by a public health agenda remained primarily preoccupied with protecting the public from HIV. In light of these findings, we present a new feminist approach for research, policy, and practice toward understanding and enhancing women’s sexual lives—one that affirms sexual diversity; engages deeply with society, politics, and history; and is grounded in women’s sexual rights.

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Article

“I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2016-01
Abstract: 

We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients. Methods. We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis. Results. Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers' reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on "family planning" and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling. Discussion. Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention.

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Does Size Really Matter? A Sensitivity Analysis of Number of Seeds in a Respondent-Driven Sampling Study of Gay, Bisexual and Other Men Who Have Sex With Men in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2016-11-16
Abstract: 

Background Respondent-driven sampling (RDS) is an increasingly used peer chain-recruitment method to sample “hard-to-reach” populations for whom there are no reliable sampling frames. Implementation success of RDS varies; one potential negative factor being the number of seeds used. Methods We conducted a sensitivity analysis on estimates produced using data from an RDS study of gay, bisexual and other men who have sex with men (GBMSM) aged ≥16 years living in Vancouver, Canada. Participants completed a questionnaire on demographics, sexual behavior and substance use. For analysis, we used increasing seed exclusion criteria, starting with all participants and subsequently removing unproductive seeds, chains of ≤1 recruitment waves, and chains of ≤2 recruitment waves. We calculated estimates for three different outcomes (HIV serostatus, condomless anal intercourse with HIV discordant/unknown status partner, and injecting drugs) using three different RDS weighting procedures: RDS-I, RDS-II, and RDS-SS. We also assessed seed dependence with bottleneck analyses and convergence plots. Statistical differences between RDS estimators were assessed through simulation analysis. Results Overall, 719 participants were recruited, which included 119 seeds and a maximum of 16 recruitment waves (mean chain length = 1.7). The sample of   >0 recruitment waves removed unproductive seeds (n = 50/119, 42.0%), resulting in 69 chains (mean length = 3.0). The sample of >1 recruitment waves removed 125 seeds or recruits (17.4% of overall sample), resulting in 37 chains (mean length = 4.8). The final sample of >2 recruitment waves removed a further 182 seeds or recruits (25.3% of overall sample), resulting in 25 chains (mean length = 6.1). Convergence plots and bottleneck analyses of condomless anal intercourse with HIV discordant/unknown status partner and injecting drugs outcomes were satisfactory. For these two outcomes, regardless of seed exclusion criteria used, the crude proportions fell within 95% confidence intervals of all RDS-weighted estimates. Significant differences between the three RDS estimators were not observed. Conclusions Within a sample of GBMSM in Vancouver, Canada, this RDS study suggests that when equilibrium and homophily are met, although potentially costly and time consuming, analysis is not negatively affected by large numbers of unproductive or lowly productive seeds.

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An Integrated Approach to Care Attracts People Living with HIV who Use Illicit Drugs in an Urban Centre with a Concentrated HIV Epidemic

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2016-11-22
Abstract: 

Background People living with HIV (PLHIV) who are also marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care. The Dr. Peter Centre (DPC) is a non-profit integrated care facility with a supervised injection room that serves PLHIV experiencing multiple barriers to social and health services in Vancouver, Canada. This study examines whether the DPC is successful in drawing in PLHIV with complex health issues, including addiction. Methods Using data collected by the Longitudinal Investigations into Supportive and Ancillary health services (LISA) study from July 2007 to January 2010, linked with clinical variables available through the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program, we identified DPC and non-DPC clients with a history of injection drug use. Bivariable and multivariable logistic regression analyses compared socio-demographic and clinical characteristics of DPC clients (n = 76) and non-DPC clients (n = 482) with a history of injection drug use. Results Of the 917 LISA participants included within this analysis, 100 (10.9%) reported being a DPC client, of which 76 reported a history of injection drug use. Adjusted results found that compared to non-DPC clients with a history of injection drug use, DPC-clients were more likely to be male (AOR: 4.18, 95% CI = 2.09–8.37); use supportive services daily vs. less than daily (AOR: 3.16, 95% CI = 1.79–5.61); to have been diagnosed with a mental health disorder (AOR: 2.11; 95% CI: 1.12–3.99); to have a history of interpersonal violence (AOR: 2.76; 95% CI: 1.23–6.19); and to have ever experienced ART interruption longer than 1 year (AOR: 2.39; 95% CI: 1.38–4.15). Conclusions Our analyses suggest that the DPC operating care model engages PLHIV with complex care needs, highlighting that integrated care facilities are needed to support the multiple intersecting vulnerabilities faced by PLHIV with a history of injection drug use living within urban centres in North America and beyond.

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Prevalence, Type, and Correlates of Trauma Exposure Among Adolescent Men and Women in Soweto, South Africa: Implications for HIV Prevention

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2016-11-25
Abstract: 

BACKGROUND: Youth trauma exposure is associated with syndemic HIV risk. We measured lifetime prevalence, type, and correlates of trauma experience by gender among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa. METHODS: Using data from the Botsha Bophelo Adolescent Health Survey (BBAHS), prevalence of "ever" experiencing a traumatic event among adolescents (aged 14-19) was assessed using a modified Traumatic Event Screening Inventory-Child (TESI-C) scale (19 items, study alpha = 0.63). We assessed self-reported number of potentially traumatic events (PTEs) experienced overall and by gender. Gender-stratified multivariable logistic regression models assessed independent correlates of 'high PTE score' (≥7 PTEs). RESULTS: Overall, 767/830 (92%) participants were included (58% adolescent women). Nearly all (99.7%) reported experiencing at least one PTE. Median PTE was 7 [Q1,Q3: 5-9], with no gender differences (p = 0.19). Adolescent men reported more violent PTEs (e.g., "seen an act of violence in the community") whereas women reported more non-violent HIV/AIDS-related PTEs (e.g., "family member or someone close died of HIV/AIDS"). High PTE score was independently associated with high food insecurity among adolescent men and women (aOR = 2.63, 95%CI = 1.36-5.09; aOR = 2.57, 95%CI = 1.55-4.26, respectively). For men, high PTE score was also associated with older age (aOR = 1.40/year, 95%CI = 1.21-1.63); and recently moving to Soweto (aOR = 2.78, 95%CI = 1.14-6.76). Among women, high PTE score was associated with depression using the CES-D scale (aOR = 2.00, 95%CI = 1.31-3.03,) and inconsistent condom use vs. no sexual experience (aOR = 2.69, 95%CI = 1.66-4.37). CONCLUSION: Nearly all adolescents in this study experienced trauma, with gendered differences in PTE types and correlates, but not prevalence. Exposure to PTEs were distributed along social and gendered axes. Among adolescent women, associations with depression and inconsistent condom use suggest pathways for HIV risk. HIV prevention interventions targeting adolescents must address the syndemics of trauma and HIV through the scale-up of gender-transformative, youth-centred, trauma-informed integrated HIV and mental health services.

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