Purpose: Homeless and Street-Involved Youth (SIY) often face substantial physical and emotional challenges and barriers accessing healthcare services. The objectives of the study are to: 1) obtain demographic information for Canadian SIY living in Toronto, Ontario; 2) evaluate self-perceptions of physical and mental health and 3) determine healthcare services used barriers to healthcare access and their association with self-reported health status.

Methods: Enhanced Street Youth Surveillance (E-SYS) is a repeated cross-sectional study of SIY, ages 15-24 years, across major urban centers in Canada. E-SYS conducts a nurse-administered survey and collects biological samples. We looked at descriptive statistics and chi-square tests to test for bivariate associations from E-SYS Cycle 6 (2010).

Results: A total of 195 SIY, with a mean age of 21.1 years (SD=2.4), were surveyed from Toronto and 60.8% were males. Commonly reported healthcare access points were youth drop-in centers, family doctors, street nurses, or hospital/emergency rooms. More than half (52.3%) reported barriers to accessing healthcare. SIY who reported fair or poor physical (p<0.01) and mental (p<0.03) health reported significantly more barriers than those reporting good to excellent physical and mental health, respectively. There were no differences in healthcare access barriers by gender, ethnicity, education or history of abuse.

Conclusion: Toronto SIY represent a vulnerable population, particularly given their low use of primary health care. Obtaining timely and appropriate health care services may be crucial to SIY well-being and outcomes. Further research is needed to identify the best approaches to improve access to healthcare for SIY in Canada.

Objective: To describe the numbers and activities of GPs with training in special competencies who have been registered in the Netherlands.

Design: Inventory of GPs who were documented in 16 registers in the year 2015, followed by an online survey.

Setting: General practice in the Netherlands

Subjects: GPs with special competencies.

Main outcome measures: Numbers per register, hours spent per month on activities related to special competencies.

Results: Overall 2833 registered GPs were identified. 1112 GPs responded to the online survey, including 219 GPs with special clinical competencies (51.8% response) and 55 GPs with special non-clinical competencies (59.8% response). The numbers per register varied, with less than 100 GPs in many registers but higher numbers for palliative care, echography, ophthalmology, travelers’ advice, obstetrics and quality consultants. High variation was seen in hours spent per month, highest for GPs with non-clinical competencies (mean: 19.6 hours) and lowest for GPs with registration as quality consultant (mean: 4.0 hours).

Discussion: GPs with special competencies (excluding quality consultants) comprise 9.7% of Dutch GPs. Their role and added value in the healthcare system should be a topic of research.

Over recent years, Europe has been facing up the spreading problem of Vaccine Hesitancy (VH). Since 2002-2005, a pilot question has been included in the annual World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) Joint Reporting Form (JRF), in order to monitor and understand the motivation behind the increasing number of reports on vaccine hesitancy

Objective: There is a paucity of research on the content of Primary Care Provider (PCP)-patient discussions regarding physical activity especially content on environmental factors related to physical activity. Variable coverage of environmental factors by PCPs could manifest as inconsistent patient behavioral responses which is what research has demonstrated. Knowing the extent to which PCPs discuss environmental factors would provide additional insight into designing more effective physical activity interventions for primary care settings. Therefore, we examined PCP’s coverage of environmental factors when counseling patients about physical activity.

Methods: For this cross-sectional study, 22.1% (n=104) of the PCPs practicing in the urban core of a large, metropolitan area self-reported whether they addressed any of the following six environmental factors when counseling patients about physical activity: places for physical activity, presence/absence of sidewalks/ trails/paths, traffic, home exercise equipment, safety from crime and aesthetics. In addition, they indicated the types of resources they used and needed to help convey information to patients about environmental factors. Multiple regression analysis was used to identify characteristics related to the number of environmental factors addressed.

Results: Twenty-five percent of the PCPs did not address any of the six environmental factors when counseling patients about physical activity. The regression analysis showed that being male, needing more resources (e.g., in-house staff) and a lighter patient load were significantly associated with addressing fewer environmental factors.

Conclusion: Providing PCPs with adequate resources could help them convey information to patients about environmental factors and potentially improve behavioral- and health-related patient outcomes.

Background: Item-Response Theory (IRT) is a modern psychometric technique able to develop a true score measure of Health-Related Quality Of Life (HRQOL) from survey data. The purpose of this study was to investigate both Physical Inactivity (PIA) and HRQOL as predictors of survival, with the aid of IRT.

Methods: Data for this research came from the 2001-02 NHANES and its corresponding linked mortality file. PIA status was determined from survey questions regarding moderate and vigorous leisure-time physical activity. HRQOL was assessed by entering five perceived health variables into a single parameter IRT model. Cox proportional hazards regression was used to model the effects of PIA and HRQOL on survival time while controlling for confounding variables (age, sex, race and income).

Results: A total of 5,985 adults were included in this analysis with a mean person-year follow-up of 9.24 years and 965 deaths. Adjusted model showed a significant (p = .006) three-way (HRQOL×PIA×SEX) interaction, requiring a stratified analysis. Among females, those with poor HRQOL had shorter survival time (Hazard Ratio (HR) = 3.08, 95% CI: 1.24, 7.65) than those with good HRQOL. Physically inactive females showed shorter survival time (HR = 1.88, 95% CI: 1.24, 2.85) as compared to those who were not physically inactive. Since the two-way (HRQOL×PIA) interaction was significant (p = .004), the analysis for males was further stratified by PIA status. Among males who were physically inactive, those with poor HRQOL showed shorter survival time (HR = 2.39, 95% CI: 1.46, 3.90) than their counterparts with good HRQOL. Among males with poor HRQOL, those who were physically inactive showed shorter survival time (HR = 4.25, 95% CI: 2.30, 7.83) than their counterparts who were not physically inactive.

Conclusion: Results from this study support both HRQOL and PIA as predictors of survival time. Health promotion programs should include physical activity in adults with poor HRQOL.