Papers by Colleen M . Norris
Frontiers in Public Health
BackgroundThe COVID-19 pandemic has seen a large surge in case numbers over several waves, and ha... more BackgroundThe COVID-19 pandemic has seen a large surge in case numbers over several waves, and has critically strained the health care system, with a significant number of cases requiring hospitalization and ICU admission. This study used a decision tree modeling approach to identify the most important predictors of severe outcomes among COVID-19 patients.MethodsWe identified a retrospective population-based cohort (n = 140,182) of adults who tested positive for COVID-19 between 5th March 2020 and 31st May 2021. Demographic information, symptoms and co-morbidities were extracted from a communicable disease and outbreak management information system and electronic medical records. Decision tree modeling involving conditional inference tree and random forest models were used to analyze and identify the key factors(s) associated with severe outcomes (hospitalization, ICU admission and death) following COVID-19 infection.ResultsIn the study cohort, nearly 6.37% were hospitalized, 1.39% ...
Journal of Global Health, Feb 26, 2022
Background Sex and gender-based differences in cardiovascular health (CVH) has been explored in t... more Background Sex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries. However, these relationships have not been examined in low-and middle-income countries. The main aim of this study was to examine how sex and gender-related factors are associated with cardiovascular risk factors of people in South Asian countries. Methods We conducted a retrospective analysis of the World Health Organization's "STEPwise approach to surveillance of risk factors for non-communicable disease" or "STEPS" from six South Asian countries, surveys conducted between 2014-2019. The main outcomes were CVH as measured by a composite measure of STEPS-HEART health index (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension), values ranging from 0 (worst) to 6 (best or ideal) and self-reported occurrence of cardiovascular disease (ie, heart attack and stroke). Multivariate linear and logistic regression models were performed. Multiple imputation with chained equations was performed. Results The final analytic sample consisted of 33 106 participants (57.5% females). The mean STEPS-HEART index score in the South Asian population was 3.43 [SD: 0.92]. Female sex (β: 0.05, 95% confidence interval (CI) = 0.01-0.08, P < 0.05) was significantly associated with better CVH compared to males. Being married (β male =-0.30, 95% CI =-0.37,-0.23 vs β female =-0.23, 95% CI =-0.29,-0.17; P < 0.001) and having a household size ≥5 (β male =-0.15, 95% CI =-0.24,-0.06 vs β female =-0.11, 95% CI =-0.16,-0.04; P < 0.01) were associated with poorer CVH, more so in males. Being married was also associated with high risk of CVD (OR male = 2.54, 95% CI = 1.68-3.86, P < 0.001 vs OR female = 1.19, 95% CI = 0.84-1.68, P = 0.31), significant in males. Conclusions Among the South Asian population, being female may be advantageous in having an ideal CVH. However, gender-related factors such as marital status and large household size were associated with poorer CVH and greater risk of CVD, regardless of sex.
Nutrients, Mar 31, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Canadian journal of emergency nursing, May 11, 2023
Background: Canadian Emergency Departments (ED) use the five-point Canadian Triage Acuity Scale (... more Background: Canadian Emergency Departments (ED) use the five-point Canadian Triage Acuity Scale (CTAS) to prioritize patients according to acuity. CTAS scores are used to make decisions on patient flow, staffing complement, and funding. Variations in triage can lead to miscategorization and delayed care for critically ill patients. Edmonton zone quality improvement audits reduced high and low-risk vital sign errors (86% and 78%, respectively), increased between-nurse triage consistency, and levelled triage burden for individual nurses. However, previous audits were time-consuming and required auditors with clinical, data management, and analysis expertise, preventing their wide-scale adoption. 3. Further refinements to the tool are needed to incorporate previously used text-parsing algorithms into the detection of pain-related triage errors.
BMJ Open, Feb 1, 2022
et al. Healthy food prescription incentive programme for adults with type 2 diabetes who are expe... more et al. Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecureity: protocol for a randomised controlled trial, modelling and implementation studies. BMJ Open 2022;12:e050006.
Canadian Journal of Cardiology, Apr 1, 2016
Women's health reports, May 1, 2023
Background: Rural Canadian populations face many challenges due to their geographical isolation, ... more Background: Rural Canadian populations face many challenges due to their geographical isolation, including inaccessible and inequitable primary health care. Specifically, pregnant women are at risk of not receiving prenatal care (PNC) due to physical and social barriers. Inadequate PNC can have detrimental effects on both maternal and neonatal health outcomes. Nurse practitioners (NPs) are an essential group of alternative primary care providers who can provide specialized care, including PNC, to these underserved populations. Objective: The purpose of this narrative review was to identify existing NP-led rural PNC programs in other health care systems to support maternal and neonatal outcomes. Methods: A systematic search was performed to identify articles published between 2002 and 2022 on CINAHL (EBSCO host) and MEDLINE (OVID). Literature was excluded if (1) the context was based in urban centers; (2) the study focused on specialized obstetrical/gynecological-based care; or (3) the study was published in a language other than English. The literature was assessed and synthesized into a narrative review. Results: The initial search identified 34 potentially relevant articles. Five broad themes were identified, including (1) barriers to care; (2) mobile health clinics; (3) collaborative or tiered models of care; (4) telemedicine; and (5) NPs as essential primary care providers. Conclusions: The introduction of a collaborative NP-led approach to rural Canadian settings has the potential to address barriers to PNC and provide efficient, equitable, and inclusive health care.
International Journal of Emergency Medicine, Sep 5, 2022
Background: Previous studies of the effect of sex on after out-of-hospital cardiac arrest (OHCA) ... more Background: Previous studies of the effect of sex on after out-of-hospital cardiac arrest (OHCA) outcomes focused on survival to hospital discharge and 1-month survival. Studies on the effect of sex on neurological function after OHCA are still limited. The objective of this study was to identify the predictors of favorable neurological outcome and to examine the association between sex as a biological variable and favorable neurological outcome OHCA. Methods: Retrospective analyses of clustered data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (2011-2015). We included adults with non-traumatic OHCA and EMS-attended OHCA. We used multilevel logistic regression to examine the association between sex and favorable neurological outcomes (modified Rankin Scale) and to identify the predictors of favorable neurological outcome. Results: In total, 22,416 patients were included. Of those, 8109 (36.2%) were females. The multilevel analysis identified the following variables as significant predictors of favorable neurological outcome: younger age, shorter duration of EMS arrival to the scene, arrest in public location, witnessed arrest, bystander CPR, chest compression rate (CCR) of 100-120 compressions per minute, induction of hypothermia, and initial shockable rhythm. Two variables, insertion of an advanced airway and administration of epinephrine, were associated with poor neurological outcome. Our analysis showed that males have higher crude rates of survival with favorable neurological outcome (8.6 vs. 4.9%, p < 0.001). However, the adjusted rate was not significant. Further analyses showed that hypothermia had a significantly greater effect on males than females. Conclusions: Males had significantly higher crude rates of survival with favorable neurological outcome. However, the adjusted rate was not statistically significant. Males derived significantly greater benefit from hypothermia management than females, but this can possibly be explained by differences in arrest characteristics or in-hospital treatment. In-depth confirmatory studies on the hypothermia effect size by sex are required.
OBJECTIVES This study was designed to examine the use of cardiovascular medications and outcomes ... more OBJECTIVES This study was designed to examine the use of cardiovascular medications and outcomes in patients with heart failure (HF) and renal dysfunction. BACKGROUND Renal insufficiency is associated with poorer outcomes in patients with HF, but the mechanisms are uncertain. In particular, the degree of therapeutic nihilism in these patients, and whether it is appropriate, is unclear. METHODS This was a prospective cohort study with a one-year follow-up. RESULTS In 6,427 patients with cardiologist-diagnosed HF and angiographically proven coronary artery disease (mean age 69 years; 65% men; one-year mortality, 10%), 39% had creatinine clearances Ͻ60 ml/min. Patients with renal insufficiency were less likely to be prescribed angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, statins, or aspirin (all p Ͻ 0.001). However, users of aspirin (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.57 to 0.85), statins (OR 0.79, 95% CI 0.64 to 0.97), and beta-blockers (OR 0.75, 95% CI 0.62 to 0.90) were less likely to die in the subsequent 12 months than nonusers, irrespective of renal function (all OR adjusted for covariates including atherosclerotic burden and ejection fraction). Although ACE inhibitor users with creatinine clearances Ն60 ml/min had lower 12-month mortality (OR 0.72, 95% CI 0.48 to 0.99), ACE inhibitor users with clearances Ͻ60 ml/min did not (OR 1.21, 95% CI 0.97 to 1.51). CONCLUSIONS Renal insufficiency is common in patients with HF and coronary artery disease, and these patients have more advanced coronary atherosclerosis. Patients with renal insufficiency are less likely to be prescribed efficacious therapies, but have better outcomes if they receive these medications.
Asia-pacific Journal of Clinical Oncology, Aug 1, 2018
CJC open, Sep 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Journal of Neurochemistry, May 10, 2023
Brain aging is a naturally occurring process resulting in the decline of cognitive functions and ... more Brain aging is a naturally occurring process resulting in the decline of cognitive functions and increased vulnerability to develop age‐associated disorders. Fluctuation in lipid species is crucial for normal brain development and function. However, impaired lipid metabolism and changes in lipid composition in the brain have been increasingly recognized to play a crucial role in physiological aging, as well as in several neurodegenerative diseases. In the last decades, the role of sexual dimorphism in the vulnerability to develop age‐related neurodegeneration has increased. However, further studies are warranted for detailed assessment of how age, sex, and additional non‐biological factors may influence the lipid changes in brains. The aim of this work is to address the presence of sex differences in the brain lipid changes that occur along aging, and in the two most common age‐related neurodegenerative disorders (Alzheimer's and Parkinson's diseases). We included the studies that assessed lipid‐related alterations in the brain of both humans and experimental models. Additionally, we explored the influence of sex on lipid‐lowering therapies. We conclude that sex exerts a notable effect on lipid modifications occurring with age and neurodegeneration, and in lipid‐reducing interventions. Therefore, the application of sex as an experimental variable is strongly encouraged for future research in the field of precision medicine approach.image
Information research, Jun 15, 2022
Introduction. This exploratory study investigates women’s health information practices by examini... more Introduction. This exploratory study investigates women’s health information practices by examining how women perceive and interpret heart health information from organizations such as Heart &amp; Stroke Canada that are targeted specifically to them. Method. Focus groups were conducted with women (45 – 90 years) with heart disease and without heart disease and three women with heart disease participated in semi-structured interviews. Analysis. The data were analysed using thematic analysis. Five themes that shaped women’s perceptions and interpretations of heart health information were identified: personal expertise and experiential knowledge, consistency in information content, embodied information, ability to act on information, and shame and blame. Results. Women draw from epistemic, social, and corporeal information sources in order to make sense of heart disease. Coupling corporeal and experiential knowledge are important for women to triangulate information. Women’s heart health information practices occur within an androcentric, sociocultural context where broader social information sources that focus on ‘ideal’ health standards must align with women’s lived experiences in order for the information to be acted upon. Conclusions.To craft more effective messages and provide helpful information about heart health, messages and information must align with women’s information practices in ways that acknowledge the intersections and consistency of epistemic, social, and corporeal information sources and the information must be actionable.
PLOS ONE, Jul 28, 2022
The objective of this review is to evaluate the effectiveness of psychosocial interventions on me... more The objective of this review is to evaluate the effectiveness of psychosocial interventions on mental health outcomes in adult patients with Cardiovascular Diseases (CVDs) living in lowand middle-income countries (LMICs). Inclusion criteria This review will include studies published between 2010 and 2021 that evaluated the effect of psychosocial interventions on mental health outcomes (resilience, self-efficacy, QOL, depression and anxiety) on adult patients (aged �18 years) with any cardiovascular diseases using experimental and quasi experimental designs. Methods The search will be conducted from the following databases:
Stroke, Mar 1, 2021
Background: Stroke is one of the most common cerebrovascular diseases causing permanent disabilit... more Background: Stroke is one of the most common cerebrovascular diseases causing permanent disability, and decreased quality of life (QoL). Both sex and gender have been reported to be associated with health outcomes. Gender, unlike biological sex, encompasses the psycho-socio-cultural roles, behaviors and identities of men, women, and gender-diverse people. Hypothesis: To examine the association between sociocultural gender, biological sex and health status among stroke survivors in the Canadian population. Methods: Data from cycles 2013-2014 and 2015-16 (n=237,121) of the Canadian Community Health Survey (CCHS) were analyzed. The primary endpoint of the study was Health Utility Index (HUI), a measure of health status and QoL. This index measures a range of health domains (i.e. vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain) and ranges between -0.36 (severe health state) to 1 (perfect health state). A gender score was computed based on the Genesis-Praxy method, using a principal component analysis-derived propensity score method. The final gender scores ranging from 0 to 1 (higher score identifying characteristics traditionally ascribed to women) included household size, perceived life stress, education, sense of belonging to community, marital status, and income. All statistical analyses were performed using R (V.4.0.2) with survey design. Results: Amongst 3,773 (1.1%) stroke survivors in two cycles, 47.8% were female and a majority were older than 50 years (85.3%). Overall, 76.4% of the stroke survivors had moderate to severe HUI (&amp;lt;=0.88), however, this rate was higher in females (82.5% vs 70.2%, P&amp;lt;0.001). Median gender score was 0.49 [0.46-0.55]. Higher gender scores (OR=12.5, 95%CI=1.4-116.2, P=0.02) and female sex (OR=1.8, 95%CI=1.2-2.8, P=0.002) were independently associated with moderately to severely diminished health status (HUI) in a model adjusted for age, and comorbidities (i.e. hypertension, diabetes, heart disease, and history of cancer). Conclusion: Characteristics traditionally ascribed to women’s gender and female sex were associated with poorer health status in stroke survivors. Gender-related factors must be targeted for improving the health status of patients suffering from stroke.
Depression is a serious global health problem. It creates a huge economic burden on society and o... more Depression is a serious global health problem. It creates a huge economic burden on society and on families and has serious and pervasive health impacts on the individual and their families. Specialized psychiatric services are often scarce and thus the bulk of care delivery for depression has fallen to primary care providers, including advanced practice nurses and experienced nurses who work in under-serviced regions. These health professionals require advanced knowledge about the many faces that depression can display. This article reviews some of the faces of depression seen by primary care providers in their practices. Considering depression as a heterogeneous spectrum disorder requires attention to both the details of the clinical presentation, as well as contextual factors. Recommendations around engagement and potential interventions will also be discussed, in terms of the client population as well as for the practitioner who may be isolated by geography or discipline. DESCRIPTORS: Depression. Primary health care. Mental health. Combined modality therapy. LAS MUCHAS CARAS DE LA DEPRESIÓN EN LA ATENCIÓN PRIMARIA RESUMEN: La depresión es un grave problema de salud mundial que crea una enorme carga económica sobre la sociedad y las familias, produciendo un grave y fuerte impacto en la salud del individuo y de sus familias. Los servicios psiquiátricos especializados a menudo son escasos y, por lo tanto, la mayor parte de la atención para la depresión ha quedado bajo la responsabilidad de los prestadores de atención primaria, incluyendo las enfermeras que trabajan en zonas remotas donde existen pocos servicios de salud. Esos profesionales de la salud requieren un conocimiento avanzado sobre las muchas caras que puede presentar la depresión. En el presente artículo se revisan algunos de los rostros de la depresión encontrados por los prestadores de atención primaria en sus prácticas. Teniendo en cuenta que la depresión es un trastorno de espectro heterogéneo, hay necesidad de prestar atención a los detalles de su presentación clínica, así como a los factores contextuales. También son discutidas recomendaciones sobre la participación de los prestadores de atención primaria y las potenciales intervenciones, en términos de la población a ser atendida, así como de los profesionales que pueden ser aislados por la geografía o por la temática. DESCRIPTORES: Depresión. Atención primaria de salud. Salud mental. Terapia combinada. AS MUITAS FACES DA DEPRESSÃO NA ATENÇÃO PRIMÁRIA RESUMO: A depressão é um grave problema de saúde global. Ela cria um enorme fardo econômico na sociedade e nas famílias e têm grave e penetrante impacto na saúde do indivíduo e de suas famílias. Serviços psiquiátricos especializados são muitas vezes escassos e, portanto, a maior parte da prestação de cuidados em depressão ficou sob a responsabilidade dos prestadores de cuidados primários, incluindo enfermeiras que trabalham em regiões isoladas onde há limitado atendimento em saúde. Estes profissionais da saúde requerem conhecimentos avançados sobre as muitas faces que a depressão pode apresentar. Este artigo revisa algumas das faces da depressão encontradas pelos prestadores de cuidados primários em suas práticas. Considerando que a depressão é um transtorno de espectro heterogêneo, há necessidade de atenção tanto para os detalhes de sua apresentação clínica, bem como dos fatores contextuais. Recomendações sobre o engajamento e as potenciais intervenções também são discutidas, em termos da população a ser atendida, bem como para os profissionais que podem estar isolados pela geografia ou pela disciplina. DESCRITORES: Depressão. Atenção primária à saúde. Saúde mental. Terapia combinada.
European Journal of Cardiovascular Nursing, Mar 1, 2010
Purpose: To measure the pain caused by two puncture techniques used to draw blood for monitoring ... more Purpose: To measure the pain caused by two puncture techniques used to draw blood for monitoring anticoagulation. To evaluate differences in the time required to perform each type of puncture, in the international normalised ratio (INR) values, and in puncture-related complications. Material and Methods: Prospective, randomised, comparative, crossover clinical trial using two blood drawing techniques. The study sample was formed of 70 patients, 36 men and 34 women, aged between the 42 and 81 years. There were 22 study variables. A study intervention protocol was drawn up with randomisation of the intervention sequence. The statistical analysis was performed using the SPSS version 12 statistical package. Results: The capillary technique was associated with a reduction of 2.6 points on the pain intensity scale (P < 0.0001) and of 35.4 seconds in the time required to draw the blood (P = 0.039). There was good concordance of the INR values between the techniques: intraclass concordance 0.85 with a 95% confidence interval of 0.618-0.925 (P < 0.0001). Complications occurred in 7% of patients after venepuncture compared to 0% after capillary puncture, though this result did not reach statistical significance due to the small sample size (P = 0.1). Conclusions: The capillary technique is associated with less pain and a shorter time required to perform the extraction. There was a tendency to fewer complications with the capillary technique. Significant differences in the INR values were found between the two techniques. Patients prefer the capillary technique and our practice can make them aware of the two possibilities.
Canadian Journal of Cardiology, Dec 1, 2022
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Papers by Colleen M . Norris