ABSTRACT: To investigate the risk of hospitalization for pneumonia in older adults in relation to biophysical environmental factors.
Population-based case control study with collection of personal interview data.
Hamilton, Ontario, and Edmonton, Alberta, Canada.
Seven hundred seventeen people aged 65 and older hospitalized for community-acquired pneumonia (CAP) from September 2002 to April 2005 and 867 controls aged 65 and older randomly selected from the same communities as the cases.
Odds ratios (ORs) for risk of pneumonia in relation to environmental and other variables.
Exposure to secondhand smoke in the previous month (OR=1.73, 95% confidence interval (CI)=1.04-2.90); poor nutritional score (OR=1.83, 95% CI=1.19-2.80); alcohol use per month (per gram; OR=1.69, 95% CI=1.08-2.61); history of regular exposure to gases, fumes, or chemicals at work (OR=3.69, 95% CI=2.37-5.75); history of regular exposure to fumes from solvents, paints, or gasoline at home (OR=3.31, 95% CI=1.59-6.87); and non-English language spoken at home (OR=5.31, 95% CI=2.60-10.87) were associated with a greater risk of pneumonia hospitalization in multivariable analysis. Age, congestive heart failure, chronic obstructive lung disease, dysphagia, renal disease, functional status, use of immunosuppressive disease medications, and lifetime history of smoking of more than 100 cigarettes were other variables associated with hospitalization for pneumonia.
In elderly people, present and past exposures in the physical environmental are associated with hospitalization for CAP.
Journal of the American Geriatrics Society 07/2009; 57(6):1036-40. · 3.74 Impact Factor
ABSTRACT: Organizational features can affect how staff view their quality of work life. Determining staff perceptions about quality of work life is an important consideration for employers interested in improving employee job satisfaction. The purpose of this study was to identify organization specific predictors of job satisfaction within a health care system that consisted of six independent health care organizations.
5,486 full, part and causal time (non-physician) staff on active payroll within six organizations (2 community hospitals, 1 community hospital/long-term care facility, 1 long-term care facility, 1 tertiary care/community health centre, and 1 visiting nursing agency) located in five communities in Central West Ontario, Canada were asked to complete a 65-item quality of work life survey. The self-administered questionnaires collected staff perceptions of: co-worker and supervisor support; teamwork and communication; job demands and decision authority; organization characteristics; patient/resident care; compensation and benefits; staff training and development; and impressions of the organization. Socio-demographic data were also collected.
Depending on the organization, between 15 and 30 (of the 40 potential predictor) variables were found to be statistically associated with job satisfaction (univariate analyses). Logistic regression analyses identified the best predictors of job satisfaction and these are presented for each of the six organizations and for all organizations combined.
The findings indicate that job satisfaction is a multidimensional construct and although there appear to be some commonalities across organizations, some predictors of job satisfaction appear to be organization and context specific.
BMC Health Services Research 04/2002; 2(1):6. · 1.66 Impact Factor
ABSTRACT: The objective of this study was to examine open-ended responses by healthcare staff to a quality-of-work-life survey. The results of the study indicated that staff in six healthcare organizations (n=1,819, response rate 30 percent) completed a 65-item QWL survey. Applying Q methodology to open-ended responses, we developed an overall rating of salient and critical issues. The most salient topics were those pertaining to what staff liked best and least about their workplace. The most critical issues included benefits, compensation, staff orientation and job demands.
Healthcare Management Forum. 01/2002; 15(4):73-81.
ABSTRACT: The objective of this research was to test whether extrinsic, intrinsic or “prior” traits best predict satisfaction with quality of work life (QWL) in health care. Extrinsic traits are salaries and other tangible benefits; intrinsic traits include skill levels, autonomy and challenge. Prior traits are those of the individuals involved, such as their gender or employment status. A survey of employees was conducted in seven different health-care settings located in the south central region of Ontario, Canada. A total of 65 questions were gathered into scales measuring such factors as co-worker support, supervisor support and teamwork and communication. These were factor-analyzed into intrinsic and extrinsic variables, and regressed against a satisfaction scale, with socio-demographic variables included. Based on the results, the following conclusions can be drawn: objectively identifiable traits of an organization – pay, benefits and supervisor style – play the major role in determining QWL satisfaction. Decision-makers with an interest in improving QWL in a health-care institution can focus on these traits and pay correspondingly less attention to enhancing staff autonomy or discretion.
Leadership in Health Services. 01/2001; 14(2):9-15.
Infections pose a substantial burden to the health of older adults. In this report, we describe the proceedings of a workshop to formulate and prioritize research questions about infections in older adults using an interdisciplinary approach.
Researchers from four sectors (basic science, clinical sciences, health services and epidemiology/determinants of health) and representatives from various Canadian local, provincial, and federal stakeholder groups were invited to a two-day workshop. Five multi-disciplinary groups and stakeholders from each of three healthcare settings (long term, acute care and community) discussed research priorities for each of the settings. Five to ten research questions were identified for each setting.
The research questions proposed ranged from risk factors and outcomes for different infections to the effect of nutrition on infection and the role of alternative and complementary medicine in treating infections. Health service issues included barriers to immunization, prolongation of hospital length of stay by infection, use of care paths for managing infections, and decision-making in determining the site of care for individuals with infections. Clinical questions included risk factor assessment for infection, the effectiveness of preventative strategies, and technology evaluation. Epidemiologic issues included the challenge of achieving a better understanding of respiratory infections in the community and determining the prevalence of colonization with multi-resistant bacteria.
The questions are of direct relevance to researchers in a wide variety of fields. Bringing together a multi-disciplinary group of researchers to frame and prioritize research questions about aging is feasible, participants valued the opinions of people working in other areas.
BMC Geriatrics. 01/2001;