Biomedical subjects

Heather Stuart

Publications and source records attributed to Heather Stuart.

14 recordsLinked to original sources

PubMed2006

Dealing with missing data in a multi-question depression scale: a comparison of imputation methods.

BACKGROUND: Missing data present a challenge to many research projects. The problem is often pronounced in studies utilizing self-report scales, and literature addressing different strategies for dealing with missing data in such circumstances is scarce. The objective of this study was to compare six different imputation techniques for dealing with missing data in the Zung Self-reported Depression scale (SDS). METHODS: 1580 participants from a surgical outcomes study completed the SDS. The SDS is a 20 question scale that respondents complete by circling a value of 1 to 4 for each question. The sum of the responses is calculated and respondents are classified as exhibiting depressive symptoms when their total score is over 40. Missing values were simulated by randomly selecting questions whose values were then deleted (a missing completely at random simulation). Additionally, a missing at random and missing not at random simulation were completed. Six imputation methods were then considered; 1) multiple imputation, 2) single regression, 3) individual mean, 4) overall mean, 5) participant's preceding response, and 6) random selection of a value from 1 to 4. For each method, the imputed mean SDS score and standard deviation were compared to the population statistics. The Spearman correlation coefficient, percent misclassified and the Kappa statistic were also calculated. RESULTS: When 10% of values are missing, all the imputation methods except random selection produce Kappa statistics greater than 0.80 indicating 'near perfect' agreement. MI produces the most valid imputed values with a high Kappa statistic (0.89), although both single regression and individual mean imputation also produced favorable results. As the percent of missing information increased to 30%, or when unbalanced missing data were introduced, MI maintained a high Kappa statistic. The individual mean and single regression method produced Kappas in the 'substantial agreement' range (0.76 and 0.74 respectively). CONCLUSION: Multiple imputation is the most accurate method for dealing with missing data in most of the missind data scenarios we assessed for the SDS. Imputing the individual's mean is also an appropriate and simple method for dealing with missing data that may be more interpretable to the majority of medical readers. Researchers should consider conducting methodological assessments such as this one when confronted with missing data. The optimal method should balance validity, ease of interpretability for readers, and analysis expertise of the research team.

Alberta↗

PubMed2006

Psychosocial risk clustering in high school students.

BACKGROUND: This secondary analysis describes the frequency of self-reported psychosocial risk factors in a geographically defined population of adolescents and quantifies the extent of multiple risks. Cluster analysis is used to develop three empirically distinct psychosocial risk clusters. METHODS: High school students in grades 9-13 from all seven public and two catholic high schools in the study area completed a class-administered survey. The analysis is based on 3540 surveys reflecting approximately a 71% response. Cumulative risk was calculated by summing the number of times students exceeded a pre-defined threshold on a series of global rating scales. Risk clusters were created using a non-hierarchical cluster analysis technique for binary data. Clusters were partially validated by examining differences in socio-demographic and health utilization patterns. Reliability was assessed by examining two, three, and four-group solutions across gender and grade strata. RESULTS: Multiple symptoms of emotional distress were reported by 37% of the sample, multiple stressors by 62% of the sample, and poly-drug use by 33%. In addition, three empirically distinct clusters were derived. Normals, 21% of the sample, did not report excessive stress or distress, and did not use substances. The Stressed (45%) reported excessive stress and distress predominantly related to schoolwork, parents, and facing problems. Virtually none used drugs. Substance Users (34%) reported excessive stress, distress, and high levels of substance use: smoking, drinking, and use of illicit drugs. Clusters were significantly different with respect to most socio-demographic factors, self-reported general health, and most aspects of health service utilization suggesting that they have some validity for targeting programs. CONCLUSIONS: This study highlights the importance of focusing on multi-morbidities and illustrates the use of cluster analysis to identify risk profiles that may be amenable to school-based health promotion and prevention programs.

Adolescent↗

PubMed2006

Mental illness and employment discrimination.

PURPOSE OF REVIEW: Work is a major determinant of mental health and a socially integrating force. To be excluded from the workforce creates material deprivation, erodes self-confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability. This review summarizes recent evidence pertaining to employment-related stigma and discrimination experienced by people with mental disabilities. A broad understanding of the stigmatization process is adopted, which includes cognitive, attitudinal, behavioural and structural disadvantages. RECENT FINDINGS: Stigma is both a proximate and a distal cause of employment inequity for people with a mental disability who experience direct discrimination because of prejudicial attitudes from employers and workmates and indirect discrimination owing to historical patterns of disadvantage, structural disincentives against competitive employment and generalized policy neglect. Against this background, modern mental health rehabilitation models and legislative philosophies, which focus on citizenship rights and full social participation, are to be welcomed. Yet, recent findings demonstrate that the legislation remains vulnerable to the very prejudicial attitudes they are intended to abate. SUMMARY: Research conducted during the past year continues to highlight multiple attitudinal and structural barriers that prevent people with mental disabilities from becoming active participants in the competitive labour market.

Employment↗

PubMed2006

Reaching out to high school youth: the effectiveness of a video-based antistigma program.

OBJECTIVE: To evaluate the impact on high school students of a video-based antistigma program portraying real life experiences of individuals with schizophrenia and lesson plans to guide classroom discussions and active learning. METHOD: We used a pre- and posttest design to measure the short-term impact of the program on student's knowledge of schizophrenia and its treatment as well as students' self-reported socially distancing behaviours. Participants (571 students) were from 8 high schools across Canada. RESULTS: Following the Reaching Out antistigma program, high school students were significantly more knowledgeable and less socially distancing. Impact also varied by age group and sex. CONCLUSIONS: Video-based antistigma programs are comparable to programs that deliver educational messages through direct contact with individuals with mental illnesses. Video-based programs are more easily disseminated on a broad scale.

Adolescent↗

PubMed2006

Media portrayal of mental illness and its treatments: what effect does it have on people with mental illness?

This article reviews dominant media portrayals of mental illness, the mentally ill and mental health interventions, and examines what social, emotional and treatment-related effects these may have. Studies consistently show that both entertainment and news media provide overwhelmingly dramatic and distorted images of mental illness that emphasise dangerousness, criminality and unpredictability. They also model negative reactions to the mentally ill, including fear, rejection, derision and ridicule. The consequences of negative media images for people who have a mental illness are profound. They impair self-esteem, help-seeking behaviours, medication adherence and overall recovery. Mental health advocates blame the media for promoting stigma and discrimination toward people with a mental illness. However, the media may also be an important ally in challenging public prejudices, initiating public debate, and projecting positive, human interest stories about people who live with mental illness. Media lobbying and press liaison should take on a central role for mental health professionals, not only as a way of speaking out for patients who may not be able to speak out for themselves, but as a means of improving public education and awareness. Also, given the consistency of research findings in this field, it may now be time to shift attention away from further cataloguing of media representations of mental illness to the more challenging prospect of how to use the media to improve the life chances and recovery possibilities for the one in four people living with mental disorders.

Communications Media↗

PubMed2005

Tumor cell pseudopodial protrusions. Localized signaling domains coordinating cytoskeleton remodeling, cell adhesion, glycolysis, RNA translocation, and protein translation.

The pseudopodial protrusions of Moloney sarcoma virus (MSV)-Madin-Darby canine kidney (MDCK)-invasive (INV) variant cells were purified on 1-microm pore polycarbonate filters that selectively allow passage of the pseudopodial domains but not the cell body. The purified pseudopodial fraction contains phosphotyrosinated proteins, including Met and FAK, and various signaling proteins, including Raf1, MEK1, ERK2, PKBalpha (Akt1), GSK3alpha, GSK3beta, Rb, and Stat3. Pseudopodial proteins identified by liquid chromatography tandem mass spectrometry included actin and actin-regulatory proteins (ERM, calpain, filamin, myosin, Sra-1, and IQGAP1), tubulin, vimentin, adhesion proteins (vinculin, talin, and beta1 integrin), glycolytic enzymes, proteins associated with protein translation, RNA translocation, and ubiquitin-mediated protein degradation, as well as protein chaperones (HSP90 and HSC70) and signaling proteins (RhoGDI and ROCK). Inhibitors of MEK1 (U0126) and HSP90 (geldanamycin) significantly reduced MSV-MDCK-INV cell motility and pseudopod expression, and geldanamycin treatment inhibited Met phosphorylation and induced the expression of actin stress fibers. ROCK inhibition did not inhibit cell motility but transformed the pseudopodial protrusions of MSV-MDCK-INV cells into extended lamellipodia. Dominant negative Rho disrupted pseudopod expression and, in serum-starved cells, L-alpha-lysophosphatidic acid (oleoyl) activation of Rho induced pseudopodial protrusions or, in the presence of the ROCK inhibitor, extended lamellipodia. RNA was localized to the actin-rich pseudopodial domains of MSV-MDCK-INV cells, but the extent of colocalization with dense actin ruffles was reduced in the extended lamellipodia formed upon ROCK inhibition. Rho/ROCK activation in epithelial tumor cells therefore regulates RNA translocation to a pseudopodial domain that contains proteins involved in signaling, cytoskeleton remodeling, cell adhesion, glycolysis, and protein translation and degradation.

Animals↗

PubMed2005

An ecologic study of parasuicide in Edmonton and Calgary.

OBJECTIVE: From 1986 to 1999, the suicide rate in the Edmonton Regional Health Authority (RHA) was greater than that in the Calgary RHA (mean rate ratio 1.4). We conducted a study to determine whether a similar relation holds for parasuicide, and if so, whether the pattern can be explained at the ecologic level by sociodemographic factors. METHODS: The Edmonton and Calgary RHAs provided data on emergency department visits for nonfatal intentional self-injury for 1997. We obtained sociodemographic data from the 1996 national census for the Edmonton and Calgary census metropolitan areas (CMAs) from Statistics Canada's public-use files. In each CMA, which is nearly coterminous with the corresponding RHA, we created 10 geographic areas based on average income. We analyzed the data at the ecologic level, using linear regression and multilevel Poisson regression. RESULTS: The parasuicide rate in the Edmonton CMA was greater than that in the Calgary CMA (rate ratio 1.3). In both CMAs, the parasuicide rate decreased as average income increased. In the final regression models, the only independent variables were average income, CMA, and their interaction term (linear regression model R2 = 0.82). CONCLUSIONS: The parasuicide rate in the Edmonton CMA is elevated, compared with that in the Calgary CMA. At the ecologic level, much of the variation in rates can be explained by average income and CMA. The high degree of correlation among the sociodemographic variables suggests that it may not be low income per se that is affecting the parasuicide rate but, rather, the consequences of belonging to a socially disadvantaged stratum of society.

Adolescent↗

PubMed2004

Stigma and work.

This paper addresses what is known about workplace stigma and employment inequity for people with mental and emotional problems. For people with serious mental disorders, studies show profound consequences of stigma, including diminished employability, lack of career advancement and poor quality of working life. People with serious mental illnesses are more likely to be unemployed or to be under-employed in inferior positions that are incommensurate with their skills or training. If they return to work following an illness, they often face hostility and reduced responsibilities. The result may be self-stigma and increased disability. Little is yet known about how workplace stigma affects those with less disabling psychological or emotional problems, even though these are likely to be more prevalent in workplace settings. Despite the heavy burden posed by poor mental health in the workplace, there is no regular source of population data relating to workplace stigma, and no evidence base to support the development of best-practice solutions for workplace anti-stigma programs. Suggestions for research are made in light of these gaps.

Employment↗

PubMed2004

Survey of colorectal cancer screening practices in a large Canadian urban centre.

INTRODUCTION: Colorectal carcinoma (CRC) is an ideal tumour for population-based screening policies. Screening guidelines are based on differing levels of evidence and opinion. The objective of this study was to determine current CRC screening practices in Alberta. METHODS: A questionnaire was mailed to all family physicians, gastroenterologists, general and colorectal surgeons, and general internal medicine specialists in a large Canadian urban centre. Results tabulated included response rate, specialty, presence/absence of a screening policy, and policy type. RESULTS: The 922 surveys mailed resulted in a 61% response rate. Among the responses, 58% (95% confidence interval [CI] 53.6%-62.6%) of physicians recommended screening to healthy individuals without a family history of CRC, and 96% (CI 94.7%-98%; p < 0.0001) to those with a family history. For patients without a family history of CRC, the majority of physicians chose the age of 50 to initiate screening (63%) by fecal occult blood testing (79%) or, less frequently, colonoscopy (26%). Screening frequency varied by the modality used. In individuals with a family history of CRC, most physicians initiated screening prior to the index case (45%) or by age 40 (31%), mostly with colonoscopy (84%); screening frequency varied mainly by modality. CONCLUSION: Despite the evidence supporting CRC screening in all persons at average risk, only 58% of physicians currently recommend screening to patients with no family history of CRC. Fecal occult blood testing was recommended most frequently in this subgroup, whereas most physicians screen people with a family history of CRC via colonoscopy, suggesting that they believe it to be a superior screening modality. As this looks to be the trend in practice, a randomized controlled trial comparing fecal occult testing with screening colonoscopy is needed.

Adult↗

PubMed2003

Stigma and the daily news: evaluation of a newspaper intervention.

OBJECTIVE: To evaluate a media intervention designed to improve one newspaper's portrayal of mental illnesses, specifically, schizophrenia. The project was part of an international antistigma program, Open the Doors, organized by the World Psychiatric Association. METHODS: The media intervention attempted to influence news content directly by providing reporters with more accurate background information and helping them develop more positive story lines. The evaluation compared story content and length over a 24-month period: 8 months prior to the antistigma intervention and 16 months postintervention. RESULTS: Positive stories outnumbered negative stories by a factor of 2 in both pre- and postperiods. Positive mental health stories increased by 33% in the postintervention period and their word count increased by an average of 25%. Stories about schizophrenia also increase by 33%, but their word count declined by 10%. At the same time, negative stories about mental illness increased by 25% and their word count by 100%. The greatest increase was in negative news about schizophrenia. Stigmatizing stories about schizophrenia increased by 46%, and their length increased from 300 to 1000 words per story per month. CONCLUSION: The immediate effects of the media intervention were positive, resulting in more and longer positive news stories about mental illness and more positive news stories about schizophrenia. However, when considered from a broader perspective, locally focused efforts yielded meager results in light of the larger increases in negative news, particularly in negative news concerning people with schizophrenia--the target group for the program.

Humans↗

PubMed2003

[Stigma and stigma reduction: lessons learned].

This paper reviews stigma and its consequences for mental health consumers, presents results from three large scale stigma-reduction programs that have been implemented at national and international levels, and focuses on the specific experiences of the Canadian Pilot Program of the World Health Organizations Global Program to Fight Stigma and Discrimination Because of Schizophrenia in order to draw lessons for better practices for anti-stigma programming. Experiences to date suggest that the most cost-effective interventions are likely to be carefully targeted to specific sub-populations. Broad-based public education campaigns have been disappointing and are unlikely to produce meaningful change in attitudes or behaviours. Approaches that employ contact with mental health consumers in the context of anti-stigma education appear most promising.

English Abstract↗

PubMed2003

Violence and mental illness: an overview.

THIS PAPER EVALUATES THE RELATIONSHIP OF MENTAL ILLNESS AND VIOLENCE BY ASKING THREE QUESTIONS: Are the mentally ill violent? Are the mentally ill at increased risk of violence? Are the public at risk? Mental disorders are neither necessary nor sufficient causes of violence. Major determinants of violence continue to be socio-demographic and economic factors. Substance abuse is a major determinant of violence and this is true whether it occurs in the context of a concurrent mental illness or not. Therefore, early identification and treatment of substance abuse problems, and greater attention to the diagnosis and management of concurrent substance abuse disorders among seriously mentally ill, may be potential violence prevention strategies. Members of the public exaggerate both the strength of the association between mental illness and violence and their own personal risk. Finally, too little is known about the social contextual determinants of violence, but research supports the view the mentally ill are more often victims than perpetrators of violence.

Journal Article↗

PubMed2002

Attitudes about schizophrenia from the pilot site of the WPA worldwide campaign against the stigma of schizophrenia.

BACKGROUND: A series of surveys were conducted to assess the attitudes of the public, and other groups, toward those with schizophrenia. The aim of these surveys was to aid in the planning and evaluation of the WPA anti-stigma initiative in Alberta, Canada. METHOD: A questionnaire was devised and administered via telephone to over 1,200 individuals in three Alberta cities, and in paper and pencil format to 40 members of the Schizophrenia Society of Alberta and 67 medical students. RESULTS: In contrast to some earlier findings, "loss of mind" was rated to be more disabling than any other handicapping condition. In general, respondents showed a relatively sophisticated understanding of schizophrenia and a higher level of acceptance than might have been predicted. Nonetheless, this acceptance was not as high for situations where closer personal contact was likely, and fears of dangerousness continue to be associated with schizophrenia. The majority of respondents, however, felt that treatment aided those with schizophrenia, expressed support for progressive programmes for the mentally ill, and stated that they would be willing to pay higher taxes so that programming could be improved. CONCLUSIONS: The results do not support the utility of a broad approach for an anti-stigma campaign, but rather suggest a more specific focus, such as perceived dangerousness.

Adolescent↗

PubMedDate not supplied

Length of stay for psychiatric inpatient services: a comparison of admissions of people with and without developmental disabilities.

This study investigated associations between the presence of developmental disabilities and length of inpatient stay for mental health care. All psychiatric admissions of people with developmental disabilities over a 5-year period were selected (n = 294), and were compared using survival analysis to a random sample of admissions from the general psychiatric population (n = 287). Overall, people with developmental disabilities stayed in hospital longer than those without developmental disabilities, and this extra stay was partially attributed to casemix differences between the cohorts. Subanalysis in both cohorts showed that those going back to their usual living arrangement stayed a shorter period than those who were discharged elsewhere, and that people with developmental disabilities were less likely to be discharged to their usual living arrangement than were people without the disability. This study highlighted the importance of specialized residential and personal supports for people with developmental disabilities and a coexisting mental disorder.

Adult↗