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This article is a summary of recent Open Access activity in Canada, focusing on policies and mandates, repositories, and initiatives in libraries.

Note du Comité. Groupe "Genre et Recherche en Santé"

Falls among older adults (age 65 years and older) residing in personal care homes (PCHs) are an important health concern. Atypical antipsychotic drugs (AADs) have been shown to be associated with fall risk among older adults. However, previous studies face some methodological limitations that affect the quality, consistency, and comparability of these studies. Therefore, a population-based study was undertaken to examine the effect of AAD use on the risk of falling among older PCH residents. A nested case-control study was conducted using the administrative healthcare records and Minimum Data Set for PCHs (MDS) housed at the Manitoba Centre for Health Policy in the Faculty of Medicine, University of Manitoba. The study period was from April 1, 2005 to March 31, 2007. Cases (n=626) were fallers as recorded in MDS. Using incidence density sampling, each case was matched to four controls on length of PCH stay, age, and sex (n=2,388). Exposure to AADs was obtained from the Drug Program Information Network database. Conditional logistic regression was used to model the effects of AAD use on the risk of falling while accounting for matching and for confounding of other covariates. While the adjusted odds of falling was statistically greater for AAD users versus nonusers (adjusted odds ratio = 1.60, 95% CI 1.10-2.32), this association was type and dose dependent. Compared to nonusers, the odds of falling was greater for quetiapine users, regardless of this drug's dose, and high dose risperidone users. On the other hand, low dose risperidone and olanzapine, irrespective of drug dose, use was not associated with the risk of falling. Furthermore, the effect of AAD use, in general, on the risk of falling was significantly greater for people with wandering problems (adjusted odds ratio = 1.84, 95% CI 1.09-3.09). Despite some methodological limitations, this research has provided some unique findings that enhance our understanding of AAD use as a fall risk factor. Study findings allow policymakers to further develop evidence-based interventions specific to AADs in order to better manage falls in the PCH setting. However, a great deal of research is still needed to address other important unanswered questions.

At a time when health literacy is emerging as a central concern in the health field, this thesis examines whether and how practitioners involved in the promotion of breastfeeding incorporate dimensions of health literacy as described in the current literature. Although there is little evidence that practitioners are familiar with specific definitions of health literacy, their description of practices reflected various facets of health literacy including functional health literacy, interactive and critical health literacy, and health literacy as composed of multiple literacies. This qualitative case study was set in a rural health district in the Canadian province of Nova Scotia where breastfeeding initiation and duration rates are lower than national averages and where health literacy was identified as a community health issue. In-depth face-to-face interviews were conducted with 30 professional and lay practitioners. Practices in one hospital-based and two community-based settings were observed. Data were analyzed for themes using an iterative process of constant comparison. Interview informants and mothers provided feedback on preliminary findings in focus group interviews. Findings reflect an emphasis on the transmission of information to persuade mothers to breastfeed, in contrast to strengthening their capacity to use information in making or acting on choices about how to feed their babies. Practitioners’ discomfort in identifying clients with low literacy skills raises fundamental concerns about the stigma associated with low literacy. A focus on the functional health literacy deficiencies of clients, not on their capacities, appears limiting in addressing the complexities of breastfeeding promotion. There is little evidence of practices which reflect critical health literacy or efforts to reduce structural barriers to breastfeeding. In conclusion, the study suggests that practitioners’ engagement in critical reflection of their breastfeeding promotion practices through the multidimensional frame of health literacy could help to further their practice and the conceptual development of health literacy.

Promoting uptake of research findings is an objective common to those who fund, produce and publish health services and policy research. Open access (OA) is one method being employed to maximize impact. OA articles are online, free to access and use. This paper contributes to growing body of research exploring the “OA advantage” by employing an article-level analysis comparing citation rates for articles drawn from the same, purposively selected journals. We used a two-stage analytic approach designed to test whether OA is associated with (1) likelihood that an article is cited at all and (2) total number citations that an article receives, conditional on being cited at least once. Adjusting for potential confounders: number of authors, time since publication, journal, and article subject, we found that OA archived articles were 60% more likely to be cited at least once, and, once cited, were cited 29% more than non-OA articles.

Canadian healthcare organizations are experiencing increasing challenges meeting the evolving health needs of aging and growing populations. The ability to manage conflict between multiple stakeholders with varying priorities, responsibilities and associations relative to the healthcare organization is critical to more effectively meet these challenges. The following qualitative research explores factors that contribute to conflict within a multidisciplinary healthcare teams setting and between regulated health professionals. Four registered nurses from an acute care hospital setting in a large metropolitan center were recruited to share their experiences of multidisciplinary team conflict through the use of facilitated focus group sessions. A thematic analysis revealed four main themes perceived as contributing to conflict: team discordance, professional expectations, relational conflict and communication barriers. These findings expand the current limited body of research while aiding the development of best practice tools and guidelines for healthcare organizations.

Abstract Introduction A phosphorylation score for estrogen receptor-alpha (ERα), called P7 score, was shown previously to be an independent prognostic factor in breast cancer patients treated with tamoxifen. Since mechanistic target of rapamycin (mTOR) activation is implicated in resistance to endocrine therapy in breast cancer we determined whether mechanistic target of rapamycin complex 1 (mTORC1) activation, measured by phosphorylation on S2448 (p-mTOR), was associated with the P7-score and/or clinical outcome in the same cohort. Methods mTOR phosphorylation status was determined at S2448 residue in vivo by immunohistochemistry in a cohort of more than 400 well-characterized ERα positive breast tumors. MCF7 cells were treated with estrogen and activation of mTOR pathway was determined by Western blotting. Results Contrary to earlier reports, p-mTOR expression, measured by immunohistochemistry, was negatively associated with size and nodal status. Additionally, p-S2448 mTOR expression was positively correlated with p-S118- ERα, p-S167-ERα and p-S282-ERα but negatively correlated with p-T311- ERα. Consistent with these, p-S2448 mTOR was negatively associated with P7-score and was significantly associated with overall survival (OS) (hazard ratio (HR) = 0.61, P = 0.028, 95% confidence interval (CI) 0.39 to 0.95, n = 337) and relapse-free survival (HR = 0.58, P = 0.0032, 95% CI 0.41 to 0.83, n = 337) following univariate but not multivariate analysis. Furthermore, we show that estrogen can regulate phosphorylation of mTOR and its down stream target p70S6 kinase. Additionally, recombinant mTOR can phosphorylate ERα in vitro. Conclusions These data suggest that in breast tumors where there is intact estrogen regulated signaling, mTOR is regulated by estrogen and therefore associated with an increased likelihood of responsiveness to endocrine therapy.

To meet the HIV prevention needs of sex workers in India, well-coordinated community-based organizations (CBOs) have integrated peer education and community mobilization into structural interventions. As the role of CBOs continues to expand into new service areas, it is important to understand how people who frequent these organizations receive these new interventions. This paper draws on an agency assessment conducted by Ashodaya Samithi in 2009, a CBO led by female, male and transgendered sex workers. In the past year, HIV+ sex workers of Ashodaya have registered their own organization, Ashraya. Based on qualitative findings, this paper describes how community-based empowerment programs can play important roles in improving access to care and antiretroviral (ART) treatment adherence. The rapid growth of Ashraya and its success at fostering social solidarity and large-scale structural interventions hold valuable lessons for community-based organizations and public health practitioners working in the field of HIV/AIDS.