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Biomedical subjects

M J Ashley

Publications and source records attributed to M J Ashley.

At least 19 recordsLinked to original sources
PubMed2001

Validation of an independent living scale for post-acute rehabilitation applications.

The Independent Living Scale (ILS) was developed in a post-acute traumatic brain injury (TBI) rehabilitation facility over a 15-year period to assess three main areas: (1) activities of daily living, (2) behaviour, and (3) initiation. The purpose of this study was to examine the psychometric properties of the ILS, including test--retest stability, construct validity, and statistical fit. Statistical analysis was completed on all weekly scores between the years 1986-1995 (n = 5250). A previous study showed ILS inter-rater reliability to be 0.85 and convergent validity 0.82--0.87. This study demonstrated a test--retest stability of 0.72, the Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0.94 (marvelous), and a Bartlett Test of Sphericity result of 'scale items independent'. The ILS was shown to have good construct validity, inter-rater reliability, internal consistency, instrument stability, and convergent validity.

Activities of Daily Living↗
PubMed2000

Alcohol and breast cancer mortality in a cohort study.

Available epidemiological evidence indicates that alcohol intake is associated with a higher risk of developing breast cancer. Plausible biological pathways include its effect on levels of estrogens, cell membrane integrity and cell-to-cell communication, inhibition of DNA repair, and congener effect. The present study evaluated the impact of alcohol on mortality from breast cancer, an area with relatively few studies in the literature. The subjects were participants in a Canadian prospective cohort study, the National Breast Screening Study (NBSS). Women were enrolled in the cohort from 1980 to 1985 to evaluate the efficacy of mammographic screening. Information on usual diet and alcohol intake at enrolment and other epidemiological variables was collected by means of a mailed, self-administered questionnaire. Mortality from breast cancer during follow- up to 31 December, 1993 was ascertained by record linkage to the Canadian Mortality Data Base maintained by Statistics Canada. During the follow-up period of 1980-1993 (average 10.3 years), 223 deaths from breast cancer were identified for this analysis. The hazard ratios for the risk of death from breast cancer increased with intakes of total alcohol of 10-20 g/day (1.039, 1.009-1.071) and > 20 g/day ( 1.063, 1.029-1.098). This increase was contributed largely by the intake of wine, a 15% increase in risk at intakes higher than 10 g/day of alcohol from wine. Alcohol from spirits was associated with a small decrease in risk of death (hazard ratio at 10g/day, 0.945, 0.915-0.976). The effect of alcohol from beer was not significant in the two categories studied. Although our results were statistically significant, the magnitude of the change in risk was small.

Adult↗
PubMed2000

Heterogeneity among smokers and non-smokers in attitudes and behaviour regarding smoking and smoking restrictions.

OBJECTIVE: To determine if smokers and non-smokers cluster into meaningful, discrete subgroups with distinguishable attitudes and behaviours regarding smoking and smoking restrictions. DESIGN: Qualitative research with 45 smokers guided development of questionnaire items applied in a population based telephone survey of 432 current smokers and 1332 non-smokers in Ontario, Canada. METHODS: Cluster analysis of questionnaire items used to categorise adult smokers and non-smokers; comparison of clusters on sociodemographic characteristics and composite knowledge and attitude scores. RESULTS: Smokers clustered in three groups. "Reluctant" smokers (16%) show more concern about other people discovering that they smoke, but parallel "easygoing" smokers (42%) in supporting restrictions on smoking and not smoking around others. "Adamant" smokers (42%) feel restrictions have gone too far, and are less likely to accommodate non-smokers. Significant gradients across categories in the expected direction were observed with respect to smoking status, stage of change, knowledge, and attitude scores, and predicted compliance with restrictions, validating the proposed typology. Non-smokers also clustered into three groups, of which the "adamant" non-smokers (45%) are the least favourably disposed to smoking. "Unempowered" non-smokers (34%) also oppose smoking, but tend not to act on it. "Laissez-faire" non-smokers (21%) are less opposed to smoking in both attitude and behaviour. A significant gradient across categories in the expected direction was observed with respect to composite scores regarding knowledge of the health effects of active and passive smoking and a composite score on support for restrictions on smoking in public places. CONCLUSION: Recognition and consideration of the types of smokers and non-smokers in the population and their distinguishing characteristics could inform the development of tobacco control policies and programmes and suggest strategies to assist implementation.

Adult↗
PubMed1999

Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of alcohol consumption on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: There are 2 main options for those at risk for hypertension: avert the condition by limiting alcohol consumption or by using other nonpharmacologic methods, or maintain or increase the risk of hypertension by making no change in alcohol consumption. The options for those who already have hypertension include decreasing alcohol consumption or using another nonpharmacologic method to reduce hypertension; commencing, continuing or intensifying antihypertensive medication; or taking no action and remaining at increased risk of cardiovascular disease. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 with the terms ethyl alcohol and hypertension. Other relevant evidence was obtained from the reference lists of articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design, and graded according to the level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: A reduction in alcohol consumption from more than 2 standard drinks per day reduces the blood pressure of both hypertensive and normotensive people. The lowest overall mortality rates in observational studies were associated with drinking habits that were within these guidelines. Side effects and costs were not measured in any of the studies. RECOMMENDATIONS: (1) It is recommended that health care professionals determine how much alcohol their patients consume. (2) To reduce blood pressure in the population at large, it is recommended that alcohol consumption be in accordance with Canadian low-risk drinking guidelines (i.e., healthy adults who choose to drink should limit alcohol consumption to 2 or fewer standard drinks per day, with consumption not exceeding 14 standard drinks per week for men and 9 standard drinks per week for women). (3) Hypertensive patients should also be advised to limit alcohol consumption to the levels set out in the Canadian low-risk drinking guidelines. VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension and the previous recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control and the Canadian Hypertension Society. They have not been clinically tested. The low-risk drinking guidelines are those of the Addiction Research Foundation of Ontario and the Canadian Centre on Substance Abuse. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. The low-risk drinking guidelines have been endorsed by the College of Family Physicians of Canada and several provincial organizations.

Adult↗
PubMed1999

Factors influencing implementation of the legislated smoking ban on school property in Ontario.

BACKGROUND: Implementation of legislation in Ontario, Canada, that banned smoking on school property gave rise to perceptions of problems in some schools. A telephone survey was conducted to assess these problems. This analysis identifies risk or protective factors in the school environment associated with administrators' reports of problems. METHODS: Survey data were obtained from key informants in 213 high schools. Multiple logistic regression was used to identify school-related characteristics associated with: (1) major problems in implementing the ban and (2) recommendations that schools return to designated smoking areas. RESULTS: A protective factor against both outcomes was having a school no-smoking policy prior to the ban. Also protective against major problems was a perceived decrease in student smoking during the school day. The identification of safety risks to students who leave school property to smoke was a strong risk factor for both outcomes. Beliefs that the ban was not effective and opposition to it from teachers/staff were associated with desires for its repeal. CONCLUSIONS: In implementing legislated school smoking bans, attention should be given to informing teachers and gaining their support. Strategies for dealing with potential safety risks to students who leave school property to smoke should also be devised.

Attitude to Health↗
PubMed1998

Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies.

It is now well established that children's exposure to environmental tobacco smoke (ETS) results in substantial public health and economic impacts. Children are more likely than adults to suffer health effects from ETS exposure, and the home is the most important site of such exposure. Although the responsibility and authority of the community and health professionals to protect children from harm are entrenched in North American society, social, economic, legal, and political factors contribute to a lower level of support for ETS control measures in homes compared with workplaces and public places. It is now clear that ETS control in home environments must be a priority on the public health agenda. Programme and policy options and strategies for ETS control in home environments are outlined. We conclude that the current research base is inadequate to fully support programme and policy development in this area and priorities for research are identified.

Adult↗
PubMed1998

Smoking in the home: changing attitudes and current practices.

OBJECTIVES: Trends in attitudes and current practices concerning smoking in the home were examined. METHODS: Data from population-based surveys of adults in Ontario, Canada, were analyzed. RESULTS: Between 1992 and 1996, the percentage of respondents who agreed that parents spending time at home with small children should not smoke increased from 51% to 70%. In 1996, 34% of the homes surveyed were smoke-free. Smoke-free homes were associated with nonsmoking respondents and with the presence of children and no daily smokers in the home. Only 20% of homes with children and any daily smokers were smoke-free. CONCLUSIONS: Efforts are needed to assist parents in reducing children's exposure to environmental tobacco smoke in the home.

Adolescent↗
PubMed1998

Short report. How provincial and territorial legislators view tobacco and tobacco control: findings from a Canadian study.

We report on legislators' attitudes and experiences regarding tobacco and tobacco control using findings from a 1996/97 telephone survey of provincial and territorial legislators in Canada. Across all jurisdictions, legislators showed support for a number of tobacco control policies and for a major government role in implementing programs and policies to discourage youth from smoking. Further, substantial numbers of legislators indicated they did not have enough tobacco-related contact with medical and non-profit health organizations. These findings can guide the activities of health agencies, researchers and advocates in support of effective strategies to reduce the public health impact of tobacco use in Canada.

Attitude to Health↗
PubMed1997

The use of noncontingent reinforcement and contingent restraint to reduce physical aggression and self-injurious behaviour in a traumatically brain injured adult.

Many different intervention programmes for reducing undesirable behaviour with people with traumatic brain injury (TBI) have been investigated in recent years. The purpose of this study was to examine the potential of using noncontingent reinforcement (NCR) in combination with contingent restraint to reduce severe behaviour. The subject (E.L.) was a 40-year-old male with TBI admitted to a rehabilitation long-term care programme. E.L. had a history of physical aggression (PA) and self-injurious behaviour (SIB). Assessment conditions included a descriptive analysis, response scatterplot and Self-Injury Trauma (SIT) Scale. Attention was identified as the maintaining positive reinforcement for PA and SIB. Treatment conditions were compared using a reversal (ABAB) design. Attention (NCR) was delivered on a fixed-time schedule that was not dependent on the subject's behaviour. Contingent restraint was applied when E.L. exhibited PA or SIB that was dangerous to himself or others. During treatment, PA occurred over 4 times less often and SIB over 2.5 times less often. Results demonstrated that PA and SIB were sensitive to NCR. NCR can be an effective procedure for reducing severe behaviour maintained by socially-mediated positive reinforcement.

Adult↗
PubMed1997

Long-term follow-up of post-acute traumatic brain injury rehabilitation: a statistical analysis to test for stability and predictability of outcome.

A high percentage of the estimated 500,000 traumatic brain injuries (TBI) in the US every year occur with young people who will face many years of neurobehavioral and economic consequences. This study examined the long-term stability of outcome after post-acute TBI rehabilitation and possible predictors of long-term outcome based on a 127-item survey of 332 clients up to 14 years post-discharge. Correlational, factor, and multiple regression analysis indicated positive long-term outcome stability following rehabilitation with the exception of vocational status, which decreased over the same time period. A number of possible explanations for this occupational anomaly are suggested. Rating scale scores and latency-to-rehabilitation proved to be better predictors of long-term outcome than demographic data.

Activities of Daily Living↗
PubMed1997

Smoking control in the workplace: is workplace size related to restrictions and programs?

Regarding smoking control in the workplace, small independent operations may differ from large workplaces or from small worksites that are branch units of large companies/organizations. We examined the relationships of worksite and company size to workplace smoking restrictions and programs, using data from a population-based telephone survey. Three worker groups, differentiated by worksite and company size, were compared. Small workplace workers were least knowledgeable about smoking restrictions, reported fewer restrictions in place, and were least willing to intervene in coworkers' smoking. As well, smoking-related programs, although generally uncommon, were reported least often by these workers. Branch workers were not uniformly similar to either small or large workplace workers. In policy and program interventions, organizational influences and/or attributes of individuals drawn to different-size work settings should be considered.

Adult↗
PubMed1997

Moderate drinking and health. Implications of recent evidence.

OBJECTIVE: To address three questions (Is moderate drinking good for health? Should people drink to prevent heart disease? What is moderate drinking?) and to examine and compare two recent Canadian guidelines on low-risk drinking in the context of counseling patients. DATA SOURCES: English-language data sources were searched, particularly peer-reviewed health and social science literature and recent expert reports. STUDY SELECTION: Studies and reports were selected for their scientific merit and direct relevance to the three questions addressed and to the formulation of guidelines on low-risk drinking. SYNTHESIS: While moderate drinking might protect some older people against coronary heart disease, it is associated with increased risk of hemorrhagic stroke, certain cancers, accidents and injuries, and a range of social problems. For most health outcomes, risk increases as consumption of alcohol increases. CONCLUSIONS: While the data have limitations, they provide a basis for formulating guidelines on low-risk drinking. The two Canadian guidelines, one developed from the perspective of health recovery, the other from the perspective of health promotion, complement each other in the context of counseling patients.

Accidents↗
PubMed1997

Alcohol and health: individual and population perspectives.

This paper summarizes the relationships between alcohol consumption and health from both the individual and the population perspectives. On the individual level adverse consequences of alcohol consumption on mortality, morbidity and social harm are summarized. The potential health benefits of drinking are listed next, especially in the context of trying to balance positive and negative consequences. Even though the final decision rests with the individual it is suggested that from a health perspective light drinking on a regular basis is most advisable. In terms of advice to populations it should be noted that, due to the mutual interdependence of drinking behaviour in a society, the average individual consumption associated with the lowest individual risk is not necessarily the average per capita consumption associated with the lowest population risk. Thus, research at the population level has to be integrated with individual epidemiological research in order to come up with the best advice for the population in any given society.

Alcohol Drinking↗
PubMed1996

Feasibility of the neuropsychological spectrum in prediction of outcome following head injury.

This study provided further substantiation of the neuropsychological spectrum conceptualization (Templer, Campodonico, Trent, Spencer, & Hartlage, to appear; Templer, Spencer, & Hartlage, 1993; Templer, Campodonico, Trent, & Spencer, 1991). Two hundred and two traumatic brain injury patients were administered the Wechsler Adult Intelligence Scale-Revised, the Luria-Nebraska Neuropsychological Battery, the Wisconsin Card Sorting Test, the Booklet Category Test, and Trails A and B. The correlations between neuropsychological and intellectual tests were significantly lower than the correlations within intelligence tests and within neuropsychological tests. Neuropsychological tests predicted outcome better than intelligence tests. This was interpreted in terms of outcome for severely brain-damaged patients being more dependent upon basic neuropsychological functioning than on abstract thinking ability.

Adolescent↗
PubMed1996

Smoking in the workplace: do smoking patterns and attitudes reflect the legislative environment?

OBJECTIVE: With regard to the workplace, to examine restrictions on smoking, smoking at work, attitudes toward and reactions to restrictions, and workplace programmes in the context of the legislative environment. DESIGN: Population-based telephone interview survey of adult residents of the jurisdictions of Metropolitan Toronto, Ontario, Canada. SUBJECTS: Workers within the City of Toronto (n = 374) were compared with other workers (n = 536), because their legislative environments with regard to workplace smoking were markedly different, with workplaces in the City of Toronto being covered by a much more stringent bylaw. RESULTS: In comparison with other workers, City of Toronto workers reported workplace restrictions to be more common and widespread. These workers were also less likely to smoke at work, and more likely to smoke less at work and to have cut down on smoking at work. Quit-smoking rates, however, were similar. There was evidence of some compensatory smoking outside work, but additional compensation in association with more stringent restrictions was not found. City workers and other workers were similar in their support for smoke-free workplaces, in their attitudes to the role of governments in regulating workplace smoking, and in their perceptions of conflict between smokers and non-smokers. Reports of quit-smoking programmes and educational interventions in the workplace were similarly uncommon, although both groups of workers indicated strong support for the role of business and industry in helping people quit. CONCLUSIONS: Restrictions on smoking and smoking patterns reflected the legislative environment; a more stringent environment was associated with more restrictions and less smoking at work.

Canada↗