The association between individual counselling and health behaviour change: the See Kidney Disease (SeeKD) targeted screening programme for chronic kidney disease

Background: Health behaviour change is an important component of management for patients with chronic kidney disease (CKD); however, the optimal method to promote health behaviour change for self-management of CKD is unknown. The See Kidney Disease (SeeKD) targeted screening programme screened Canadians at risk for CKD and promoted health behaviour change through individual counselling and goal setting. Objectives: The objectives of this study are to determine the effectiveness of individual counselling sessions for eliciting behaviour change and to describe participant characteristics associated with behaviour change. Design: This is a cross-sectional, descriptive study. Setting: The study setting is the National SeeKD targeted screening programme. Patients: The participants are all ‘at risk’ patients who were screened for CKD and returned a follow-up health behaviour survey ( n = 1129). Measurements: Health behaviour change was defined as a self-reported change in lifestyle, including dietary changes or medication adherence. Methods: An individual counselling session was provided to participants by allied healthcare professionals to promote health behaviour change. A survey was mailed to all participants at risk of CKD within 2-4 weeks following the screening event to determine if behaviour changes had been initiated. Descriptive statistics were used to describe respondent characteristics and self-reported behaviour change following screening events. Results were stratified by estimated glomerular filtration rate (eGFR) (60 mL/min/1.73 m 2 ). Log binomial regression analysis was used to determine the predictors of behaviour change. Results: Of the 1129 respondents, the majority (89.8 %) reported making a health behaviour change after the screening event. Respondents who were overweight (body mass index [BMI] 25-29.9 kg/m 2 ) or obese (BMi ≥ 30.0 kg/m 2 ) were more likely to report a behaviour change (prevalence rate ratio (PRR) 0.66, 95 % confidence interval (CI) 0.44-0.99 and PRR 0.49, 95 % CI 0.30-0.80, respectively). Further, participants with a prior intent to change their behaviour were more likely to make a behaviour change (PRR 0.58, 95 % CI 0.35-0.96). Results did not vary by eGFR category. Limitations: We are unable to determine the effectiveness of the behaviour change intervention given the lack of a control group. Potential response bias and social desirability bias must also be considered when interpreting the study findings. Conclusions: Individual counselling and goal setting provided at screening events may stimulate behaviour change amongst individuals at risk for CKD. However, further research is required to determine if this behaviour change is sustained and the impact on CKD progression and outcomes

A national surveillance project on chronic kidney disease management in Canadian primary care: a study protocol.

INTRODUCTION: Effective chronic disease care is dependent on well-organised quality improvement (QI) strategies that monitor processes of care and outcomes for optimal care delivery. Although healthcare is provincially/territorially structured in Canada, there are national networks such as the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) as important facilitators for national QI-based studies to improve chronic disease care. The goal of our study is to improve the understanding of how patients with chronic kidney disease (CKD) are managed in primary care and the variation across practices and provinces and territories to drive improvements in care delivery. METHODS AND ANALYSIS: The CPCSSN database contains anonymised health information from the electronic medical records for patients of participating primary care practices (PCPs) across Canada (n=1200). The dataset includes information on patient sociodemographics, medications, laboratory results and comorbidities. Leveraging validated algorithms, case definitions and guidelines will help define CKD and the related processes of care, and these enable us to: (1) determine prevalent CKD burden; (2) ascertain the current practice pattern on risk identification and management of CKD and (3) study variation in care indicators (eg, achievement of blood pressure and proteinuria targets) and referral pattern for specialist kidney care. The process of care outcomes will be stratified across patients' demographics as well as provider and regional (provincial/territorial) characteristics. The prevalence of CKD stages 3-5 will be presented as age-sex standardised prevalence estimates stratified by province and as weighted averages for population rates with 95% CIs using census data. For each PCP, age-sex standardised prevalence will be calculated and compared with expected standardised prevalence estimates. The process-based outcomes will be defined using established methods. ETHICS AND DISSEMINATION: The CPCSSN is committed to high ethical standards when dealing with individual data collected, and this work is reviewed and approved by the Network Scientific Committee. The results will be published in peer-reviewed journals and presented at relevant national and international scientific meetings

Multimorbidity, dementia and health care in older people:a population-based cohort study

BACKGROUND: Little is known about how multimorbidity, dementia and increasing age combine to influence health outcomes or utilization. Our objective was to examine the joint associations between age, dementia and burden of morbidity with mortality and other clinical outcomes.METHODS: We did a retrospective population-based cohort study of all adults aged 65 years and older residing in Alberta, Canada, between 2002 and 2013. We used validated algorithms applied to administrative and laboratory data from the provincial health ministry to assess the presence/absence of dementia and 29 other morbidities, and their associations with mortality (our primary outcome), other clinical outcomes (emergency department visits, all-cause hospital admissions) and a proxy for loss of independent living (discharge to long-term care). Cox and Poisson models were adjusted for year-varying covariates. A 3-way interaction was modelled for dementia, the number of comorbidities, and age.RESULTS: There were 610 457 adults aged 65 years and older living in Alberta over the study period. Over median follow-up of 6.8 years, 153 125 (25.1%) participants died and 5569 (0.9%) were discharged to long-term care. The prevalence of people with at least 3 morbidities was 33.7% in 2003 and 50.2% in 2012. The prevalence of dementia rose from 6.2% in fiscal year 2003 to 8.3% in fiscal year 2012, representing a net increase of approximately 13 700 people. The likelihood of all 4 outcomes increased with age and with greater burden of morbidity; the presence of dementia further increased these risks. For example, the risk of mortality increased by 1.54 to 6.38 in the presence of dementia, depending on age and morbidity burden. The risk associated with dementia was attenuated by increasing comorbidity.INTERPRETATION: Older age, multimorbidity and dementia are all strongly correlated with adverse health outcomes as well as a proxy for loss of independent living. The increasing prevalences of dementia and multimorbidity over time suggest the need for coordinated national strategies aimed at mitigating the health challenges associated with the aging of the population.</p

A systematic quantitative literature review of pre-service teachers’ sense of belonging during school-based experience

Peer reviewedPublisher PD

Comorbidity as a driver of adverse outcomes in people with chronic kidney disease

Chronic kidney disease (CKD) is associated with poor outcomes, perhaps due to a high burden of comorbidity. Most studies of CKD populations focus on concordant comorbidities, which cause CKD (such as hypertension and diabetes) or often accompany CKD (such as heart failure or coronary disease). Less is known about the burden of mental health conditions and discordant conditions (those not concordant but still clinically relevant, like dementia or cancer). Here we did a retrospective population-based cohort study of 530,771 adults with CKD residing in Alberta, Canada between 2003 and 2011. Validated algorithms were applied to data from the provincial health ministry to assess the presence/absence of 29 chronic comorbidities. Linkage between comorbidity burden and adverse clinical outcomes (mortality, hospitalization or myocardial infarction) was examined over median follow-up of 48 months. Comorbidities were classified into three categories: concordant, mental health/chronic pain, and discordant. The median number of comorbidities was 1 (range 0-15) but a substantial proportion of participants had 3 and more, or 5 and more comorbidities (25 and 7%, respectively). Concordant comorbidities were associated with excess risk of hospitalization, but so were discordant comorbidities and mental health conditions. Thus, discordant comorbidities and mental health conditions as well as concordant comorbidities are important independent drivers of the adverse outcomes associated with CKD.</p

Multiage Education: An Exploration of Advantages and Disadvantages through a Systematic Review of the Literature

This systematic quantitative literature review explores existent empirical studies with an interest in multiage education in small school settings, with a specific focus on curriculum and pedagogy. Database searches were methodically conducted across six data bases. The inclusion criteria specified the need for empirical research, and publication dates ranged from 1997 to 2017. The article begins by setting the scene for the systematic review, exploring historical and international practices related to multiage complexities and terminology. Curriculum and pedagogical practices are explored to identify key advantages and disadvantages associated with a multiage approach in small school contexts

Optical Remote Sensing of Mesoscale Thermospheric Dynamics Above Svalbard and Kiruna

Vertical winds are key in thermospheric dynamics and only until recently have the detectors been sensitive enough for them to be measured accurately. Two narrow field Fabry-Perot Interferometers (FPIs) are used as well as one state-of-the-art all-sky FPI, SCANning Doppler Imager (SCANDI), which is capable of simultaneous measurements across the sky at high spatial and temporal resolution. They measure the atomic oxygen 630nm emission line which peaks in brightness at 240km altitude in the upper thermosphere region. Emission intensities, line-of-sight wind speeds and neutral temperatures are obtained. SCANDI’s existing infrastructure has been developed based upon the requirement to upgrade the sky map to higher spatial resolution, for the onset of solar maximum. The calibration methods and data analysis are presented. The wind-fitting algoithm is shown for the new map trigonometry. This fitting is verified by producing climatological horizontal wind-fields in a dial plot format and cross-comparing with SuperDARN climatologies. A statistical analysis of the vertical winds from 2002-2009 is presented leading to the possibility of ‘black swan events’ around midnight in the polar cap. These are events which are thought impossible but are, in reality, found to have a small finite chance of occurrence. An investigation into the mechanism of the generation of these events leads to the discovery of hydroxyl contamination in the Svalbard data set. A spectral simulation of the 630nm and the hydroxyl lines allows the determination of an emission intensity threshold of 40R (10R) below which the wind (temperature) values are significantly affected. The Svalbard data set is re-analysed excluding the contaminated data and a clean, more reasonable data set is presented with no black swan events. A statistical study of the relationship between the vertical and horizontal components of wind is presented showing the Burnside relationship is unsuitable for representing highlatitude winds. The CMAT2 atmosphere model data is used to assess which of Burnside et al’s (1982) assumptions are violated. The CUSPN campaign is presented showing the first results of the charged and neutral cusp region being simultaneously and independently measured using the EISCAT Svalbard Radar and the FPIs. Characteristic upwellings are observed concurrent with cusp precipitation and flux transfer events, which provides compelling evidence of high altitude ion-frictional heating

Multiage education: an exploration of advantages and disadvantages through a systematic review of the literature

This systematic quantitative literature review explores existent empirical studies with an interest in multiage education in small school settings, with a specific focus on curriculum and pedagogy. Database searches were methodically conducted across six data bases. The inclusion criteria specified the need for empirical research, and publication dates ranged from 1997 to 2017. The article begins by setting the scene for the systematic review, exploring historical and international practices related to multiage complexities and terminology. Curriculum and pedagogical practices are explored to identify key advantages and disadvantages associated with a multiage approach in small school contexts

The Associations Between Retirement and Cardiovascular Disease Risk Factors in China: A 20-Year Prospective Study

Despite China's being the largest and most rapidly aging country in the world, there have been no longitudinal studies investigating the relationship between retirement and cardiovascular disease risk factors in China. In this study, we assessed the associations between retirement and systolic blood pressure, diastolic blood pressure, waist circumference, body mass index, smoking status, and alcohol consumption over a 17-year period both before and after retirement among 1,084 people (41.3% women) who participated in the China Health and Nutrition Survey (1991-2011) at least once prior to the year in which they retired and at least once afterward. Piecewise models centered at the year of retirement were applied. Retirement was accompanied by a reduction in diastolic blood pressure, a slowdown in the increase of both systolic blood pressure and waist circumference, and a reduction in the probability of being a heavy alcohol drinker. The association between retirement and blood pressure was stronger for men and for urban dwellers. No significant associations with body mass index or smoking were found. This study suggests that retirement may be beneficial for blood pressure, waist circumference, and alcohol consumption in the Chinese context. Understanding the potential health influence of retirement is essential, given plans to raise the retirement age in China

Preservice Teachers’ Sense of Belonging During Practicum Placements

Original acceptance date 1/2/2021Peer reviewedPublisher PD