16 research outputs found
CaractĂ©risation de la vulnĂ©rabilitĂ© Ă la chaleur des aĂźnĂ©s du Sud du QuĂ©bec (Estrie, MontrĂ©al, Laval) : une analyse secondaire des donnĂ©es de lâĂ©tude NuAge.
Lâincidence dâĂ©vĂšnements liĂ©s Ă la chaleur (ĂLC) augmentera en raison des changements climatiques, du vieillissement et de lâurbanisation. Cette Ă©tude vise Ă dresser le portrait de la vulnĂ©rabilitĂ© des aĂźnĂ©s aux ĂLC, Ă dĂ©terminer leur incidence et leurs dĂ©terminants ainsi quâĂ construire un indice de vulnĂ©rabilitĂ© Ă la chaleur des personnes ĂągĂ©es (IVCPA). Une Ă©tude de cohorte prospective a Ă©tĂ© rĂ©alisĂ©e chez des aĂźnĂ©s vivant en communautĂ© dans les rĂ©gions de lâEstrie, de MontrĂ©al et de Laval enrĂŽlĂ©s dans lâ « Ătude longitudinale quĂ©bĂ©coise sur la nutrition comme dĂ©terminant dâun vieillissement rĂ©ussi ». La prĂ©valence des facteurs de risque ou de protection de nature mĂ©dicale, sociale et environnementale, prĂ©alablement identifiĂ©s dans les lignes directrices de SantĂ© Canada, a Ă©tĂ© examinĂ©e auprĂšs de 1679 personnes en 2005-2006. Les donnĂ©es sur les Ă©vĂ©nements mesurĂ©s sur une pĂ©riode de cinq annĂ©es (2006 Ă 2010) Ă©taient disponibles pour 1233 participants et provenaient de la RĂ©gie de lâAssurance Maladie du QuĂ©bec et de Med-Echo. Ils ont Ă©tĂ© considĂ©rĂ©s comme liĂ©s Ă la chaleur sâils survenaient un jour de tempĂ©rature Ă©levĂ©e (JTĂ; â„30oC) du 15 mai au 15 septembre (2006 Ă 2010). Des analyses de rĂ©gression logistique multivariĂ©es ont permis dâexaminer les associations entre les facteurs, lâIVCPA et deux Ă©vĂ©nements : 1) visite Ă lâurgence liĂ©e Ă la chaleur (VULC) et 2) tout ĂLC. Les rĂ©sultats montrent que la vulnĂ©rabilitĂ© des aĂźnĂ©s aux ĂLC est Ă©levĂ©e et diffĂšre selon les rĂ©gions. Les visites Ă lâurgence, les hospitalisations et les dĂ©cĂšs sont, respectivement, 2,6, 1,7 et 1,3 fois plus frĂ©quents les JTĂ que les jours de tempĂ©rature normale. Une autonomie et un revenu faibles sont associĂ©s Ă un risque accru de VULC (rapport de cotes ajustĂ© (RCA)=2,7; intervalle de confiance (IC) Ă 95%: 1,1-5,4 et RCA=3,2; IC Ă 95%: 1,1-8,5 respectivement) et dâĂLC (RCA=2,5; IC Ă 95%: 1,1-5,6 et RCA=2,8; IC Ă 95%: 1,1-7,6 respectivement). Ă lâinverse, une participation sociale Ă©levĂ©e est associĂ©e Ă une diminution marquĂ©e du risque de VULC (RCA=0,05; IC Ă 95%: 0,01-0,2) et dâĂLC (RCA=0,04; IC Ă 95%: 0,01-0,2). Les aĂźnĂ©s prĂ©sentant simultanĂ©ment six facteurs augmentant leur vulnĂ©rabilitĂ© Ă©taient sept fois plus Ă risque de VULC (rapport de cotes (RC)=7,4; IC Ă 95%: 1,5-36,2) ou dâĂLC (RC=7,8; IC Ă 95%: 1,6-37,2) comparativement Ă ceux avec aucun ou un seul facteur. Lâidentification des aĂźnĂ©s les plus vulnĂ©rables permettra de dĂ©velopper des stratĂ©gies dâintervention clinique et communautaire davantage ciblĂ©es
Anxiety, mood disorders and injection risk behaviors among cocaine users : results from the COSMO study
Abstract : BACKGROUND AND OBJECTIVES: Despite being common among cocaine users, mental health problems and their relationship with HIV and hepatitis C high risk injection behaviors are poorly documented. This study was undertaken to examine the relationships between mood and anxiety disorders and the sharing of drug injection equipment among cocaine users who inject drugs.
METHODS: The sample was drawn from a prospective cohort study and comprised of 387 participants. The outcome of interest was "sharing injection material" in the past 3 months. The presence of mood and anxiety disorders during the past year was assessed using the CIDI questionnaire. Statistical analyses were conducted on baseline data using logistic regression.
RESULTS: Most participants were male (84.5%) and were aged 25 or over (92.2%); 43.0% qualified for an anxiety disorder diagnosis and 29.3% for a mood disorder diagnosis. Participants with anxiety disorders were more likely to share needles (Adjusted Odds Ratio [AOR]: 2.13, 95%CI: 1.15-3.96) and other injection material (AOR: 1.81, 95%CI: 1.12-2.92). No significant association was found between mood disorders and sharing behaviors.
DISCUSSION AND CONCLUSIONS: Primary anxiety disorders but not mood disorders increases injection risk behaviors among cocaine users. These results bring to light another negative outcome of mental health comorbidity in this vulnerable population.
SCIENTIFIC SIGNIFICANCE: This study underlines the need to fine-tune therapeutic approaches targeting specific mental health problems in individuals with cocaine use disorders. Longitudinal studies that assess impulsivity and other correlates of psychiatric disorders are needed to examine underlying mechanisms of high risk injection behaviors in comorbid populations
Could we use parent report as a valid proxy of child report on anxiety, depression, and distress? : a systematic investigation of fatherâmotherâchild triads in children successfully treated for leukemia
Background
Systematic assessment of emotional distress is recommended in after care. Yet, it is unclear if parent report may be used as a proxy of child report. The aim of this study was to assess agreements and differences and explore possible moderators of disagreement between child and parent ratings.
Methods
Sixtyâtwo young survivors treated for acute lymphoblastic leukemia (9â18 years) and both parents responded to the Beck Youth Inventory (anxiety and depression) and the distress rating scale on the child's status. Parents completed the Brief Symptom Inventoryâ18 on their own psychological status. Systematic analyses of agreement and differences were performed.
Results
Motherâchild and fatherâchild agreements were fair on anxiety, depression, and distress (median intraclass correlation coefficient = 0.37). Differences between parents and children were medium sized (median d = 0.55) with parents giving higher scores than their children on anxiety, depression, and distress. Mothers reported distress more frequently than fathers (39 vs. 17%) when children reported none. The child being female and lower parental income were associated with lower agreement in fathers when rating child distress. Higher levels of parental psychological symptoms were consistently associated with lower agreement.
Conclusions
Parentâchild differences when rating adolescent survivorsâ difficulties may be more important than previously thought. Parent report probably cannot be considered as a valid proxy of older child report on such internalized domains as anxiety, depression, or distress in the afterâcare clinic. Parentsâ report is also likely to be influenced by their own mood, a factor that should be corrected for when using their report
Screening for distress in pediatric cancer survivors : a systematic comparison of one-step and two-step strategies to minimize detection errors
Background:Childhood cancer survivors should be routinelyscreened for psychological distress. However, existing screeningtools promoted by cancer care institutions, such as the DistressThermometer (DT) generate high rates of errors. The aim of thisstudy is to help refining strategies of screening psychologicaldistress in this population by exploring two-step methods com-bining the DT on step #1 with one question on step #2.Procedure:Data from 255 survivors of childhood acutelymphoblastic leukemia aged 13â40years were analyzed (38%13â18 years, 62% 19ĂŸyears, 53% females). We used the DTon step #1 and the individual emotion items from thePediatric Quality of Life Questionnaire (PedsQL) on step #2, todetect distress, depression and anxiety as measured by stand-ard instruments. We compared sensitivity, specificity, negativeand positive predictive values, Youden index, and clinical util-ity indices, in newly developed two-step strategies.Results:The best two-step strategies to screen anxious-depressive distress were DT 2 on step #1, with the item ofSadness on step #2, and DT 2 combined with the item ofConcerns. Two-step strategies outperformed the DT alone onthe correct identification of distressed survivors. However,two-step strategies did not outperform the DT used alone onthe correct detection of no distressed survivors. Results weresimilar when predicting depression or anxiety alone.Conclusion:Completing the DT with one single question onemotions from the PedsQL may minimize the number of par-ticipants falsely identified as distressed, which could be par-ticularly pertinent in resource-limited clinics
Contributing factors of unmet needs among young adult survivors of childhood acute lymphoblastic leukemia with comorbidities
Purpose: This study aimed to: (1) describe the domains and levels of unmet needs of young adult survivors of childhood acute lymphoblastic leukemia (cALL) with comorbidities, and (2) to explore the factors associated with higher levels of unmet needs. Unmet need was considered as supportive care needs not met.
Methods: The most vulnerable cALL survivors from the PETALE study cohort completed the Short-Form Survivor Unmet Needs Survey, the Brief Pain Inventory and the 15D instrument of health-related quality of life. Demographic and clinical information, including comorbidities, were obtained from medical records or self-reporting. The participants' needs and contributing factors to their needs were evaluated using nonparametric tests.
Results: Of the 72 participants, 9 (13%) reported moderate/high levels of overall unmet needs. âWorry about earning moneyâ (56%) and âDealing with feeling tiredâ (51%) were the most frequent unmet needs (all levels combined). The factors associated significantly with any domain of unmet needs were: having a comorbidity, reporting altered functional health status, high ALL risk status, pain, age (<26 years), and having previously received psychological support.
Conclusion: A minority of young adult survivors of cALL with comorbidities interviewed reported moderate/high levels of unmet needs. However, financial concerns and emotional health and relationship are the two domains of greatest need. Survivors with altered health condition are most at risk of experiencing moderate/high levels of unmet needs. If confirmed in larger samples, interventions should target modifiable contributors of unmet needs such as physical health and comfort, fatigue, and emotional health
Psychological risk in long-term survivors of childhood acute lymphoblastic leukemia and its association with functional health status : A PETALE cohort study
Background: Recent research has suggested that long-term pediatric cancer survivors were at risk of important physical and psychological morbidities. To date, we do not know to what extent functional health status contributes to psychological risk and which domains are most important. The aim of this study was to systematically explore which functional domain could explain anxiety, depression, and distress symptoms.
Procedure: We used data available for 105 adolescents and 182 adults successfully treated for childhood acute lymphoblastic leukemia at two Canadian sites part of the PETALE cohort. Participants were â„5 years postdiagnosis, aged 22 ± 6 years, 52% female, and 49% acute lymphoblastic leukemia high-risk status. The contribution of health functional status (15D/16D questionnaires) to self-reported anxiety, depression, and distress (Beck scales and distress thermometer) was evaluated using adjusted logistic regression models.
Results: Prevalence rates found for mild-severe anxiety, depression, and distress were 14%, 21%, and 30% among adolescents and 27%, 20%, and 19% among adults. Frequent health domains associated with psychological risk were sleeping and breathing in adolescents, and vitality/fatigue, discomfort/symptoms, mental function, and sleeping in adults. Mental function was systematically associated with psychological risk across age groups (median OR = 10.00, 95% CI 3.01-33.71). Exploratory mediation bootstrapping analyses suggested that the effect on psychological risk of overall health status and mental function problems was partly explained by social/work/school functioning.
Conclusion: The results identified important functional health domains that could be targeted for interventions preventing psychological risk: vitality/fatigue, discomfort/symptoms, sleeping, and mental function issues. Health domains probably affect mood partly by limiting social/work/school functioning
Inconsistencies between measures of cognitive dysfunction in childhood acute lymphoblastic leukemia survivors : description and understanding
Objectives
The frequency of cognitive difficulties in childhood cancer survivors varies according to the measurement strategy. The goal of this research is to (a) describe agreements and differences between measures of working memory and attention (b) identify contributors of these differences, such as emotional distress, affects, and fatigue.
Methods
We used data available for 138 adults successfully treated for childhood acute lymphoblastic leukemia (ALL) (PETALE cohort). Working memory and attention were assessed using subtests from the WAISâIV and selfâreported questionnaires (BRIEFâSR and CAARSâS:L). Potential contributors included emotional distress, anxiety, depression (BSIâ18), affects (PANAS), and fatigue (PedsQLâMFS). We explored measurement agreements and differences using diagnostic indices and multivariate regression models.
Results
The frequencies of working memory and attention deficits were higher when using cognitive tests (15%â21%) than with selfâreports (10%â11%). Selfâreported questionnaires showed high specificity (median 0.87) and low sensitivity (median 0.10), suggesting they did not reliably identify positive cases on cognitive tests. We identified negative affectivity as a possible contributor to inconsistencies between selfâreport and test results.
Conclusions
When measuring working memory and attention in childhood ALL survivors, cognitive test results and selfâreports should not be considered equivalent. At best, selfâreport may be used for screening (high specificity), but not to assess prevalence in large samples. Selfâreported difficulties are also probably influenced by the negative mood in this population
Predictors of residential stability among homeless young adults : a cohort study.
Abstract : BACKGROUND: Homelessness episodes have been shown to be associated with serious health outcomes among youth. This study was undertaken to estimate the probability of reaching residential stability over time and to identify predictors of residential stability among homeless young adults aged 18 to 25 years.
METHODS: A prospective cohort study was carried out in Montréal, Canada, between April 5(th) 2006 and January 21(th) 2009. Interviews conducted every three months included questions on life conditions and social and mental health factors that are known to influence residential trajectories. Residential status was determined, starting on the first day after recruitment; each follow-up day was classified as a homeless day or a housed day. A period of 90 days was used to define residential stability; therefore the main study outcome was the occurrence of the first consecutive 90 housed days during the follow-up period. Kaplan-Meier and Cox proportional-hazards regression analyses were conducted.
RESULTS: Of the 359 participants, 284 reached 90 days of residential stability over the study period, representing an annual probability of 80.5 %. In multivariate analysis, youth who had a high school degree, had a formal sector activity, and those who had sought psychological help were more likely to reach residential stability. Being a man, injecting substances, and having an informal sector activity were associated with a decreased probability to reach residential stability.
CONCLUSION: Exposure to factors related to opportunities that promote social integration increases the chance of reaching residential stability. On the other hand, factors related to high level of street entrenchment seem to interfere with stabilization. Maximum efforts should be made to prevent chronic homelessness among youth, targeting not only individual impairments but also hinging on services adapted to foster social connections among the youth
Prevalence and correlates of prescription opioid residue injection
Abstract: BACKGROUND: There is growing evidence of intravenous administration of prescription opioids (POs) in several countries. Preparation of POs for injection may leave residues in containers and filters used by people who inject drugs and may lead to adverse health outcomes if they are injected. METHODS: This exploratory study used cross-sectional data from the COSMO study, a prospective cohort of out-of-treatment cocaine users carried out in Montréal (Canada) between October 2010 and August 2015. For this analysis, only one visit per participant was selected, that is, the first time the participant reported PO injection during the study. The outcome of interest, "injection of PO residues", was defined as having injected PO residues from a filter and/or a container in the last month. Correlates of this outcome were identified using logistic regression analyses. RESULTS: Of the 122 participants who reported PO injection during the study period, 41.8% had injected PO residues. Reporting an unstable source of income (AOR=4.26; 95% CI: 1.03-17.69), a recent overdose (AOR=5.45; 95% CI: 1.50-19.88) and a preponderant use of opiates (mostly opiate use versus other drugs excluding alcohol and cannabis) (AOR=2.46; 95% CI: 1.08-5.63) increased the risk of PO residue injection. The odds of reporting PO residue injection rose by 7% per unit increase in the score of psychological distress (AOR=1.07 per unit increase; 95% CI: 1.01-1.12). CONCLUSIONS: The findings of this study suggest that PO residue injection is associated with markers of vulnerability. Further investigation is needed in order to better understand this understudied drug injection practice
CaractĂ©risation de la vulnĂ©rabilitĂ© Ă la chaleur des aĂźnĂ©s du Sud du QuĂ©bec (Estrie, MontrĂ©al, Laval) : une analyse secondaire des donnĂ©es de lâĂ©tude NuAge.
Lâincidence dâĂ©vĂšnements liĂ©s Ă la chaleur (ĂLC) augmentera en raison des changements climatiques, du vieillissement et de lâurbanisation. Cette Ă©tude vise Ă dresser le portrait de la vulnĂ©rabilitĂ© des aĂźnĂ©s aux ĂLC, Ă dĂ©terminer leur incidence et leurs dĂ©terminants ainsi quâĂ construire un indice de vulnĂ©rabilitĂ© Ă la chaleur des personnes ĂągĂ©es (IVCPA). Une Ă©tude de cohorte prospective a Ă©tĂ© rĂ©alisĂ©e chez des aĂźnĂ©s vivant en communautĂ© dans les rĂ©gions de lâEstrie, de MontrĂ©al et de Laval enrĂŽlĂ©s dans lâ « Ătude longitudinale quĂ©bĂ©coise sur la nutrition comme dĂ©terminant dâun vieillissement rĂ©ussi ». La prĂ©valence des facteurs de risque ou de protection de nature mĂ©dicale, sociale et environnementale, prĂ©alablement identifiĂ©s dans les lignes directrices de SantĂ© Canada, a Ă©tĂ© examinĂ©e auprĂšs de 1679 personnes en 2005-2006. Les donnĂ©es sur les Ă©vĂ©nements mesurĂ©s sur une pĂ©riode de cinq annĂ©es (2006 Ă 2010) Ă©taient disponibles pour 1233 participants et provenaient de la RĂ©gie de lâAssurance Maladie du QuĂ©bec et de Med-Echo. Ils ont Ă©tĂ© considĂ©rĂ©s comme liĂ©s Ă la chaleur sâils survenaient un jour de tempĂ©rature Ă©levĂ©e (JTĂ; â„30oC) du 15 mai au 15 septembre (2006 Ă 2010). Des analyses de rĂ©gression logistique multivariĂ©es ont permis dâexaminer les associations entre les facteurs, lâIVCPA et deux Ă©vĂ©nements : 1) visite Ă lâurgence liĂ©e Ă la chaleur (VULC) et 2) tout ĂLC. Les rĂ©sultats montrent que la vulnĂ©rabilitĂ© des aĂźnĂ©s aux ĂLC est Ă©levĂ©e et diffĂšre selon les rĂ©gions. Les visites Ă lâurgence, les hospitalisations et les dĂ©cĂšs sont, respectivement, 2,6, 1,7 et 1,3 fois plus frĂ©quents les JTĂ que les jours de tempĂ©rature normale. Une autonomie et un revenu faibles sont associĂ©s Ă un risque accru de VULC (rapport de cotes ajustĂ© (RCA)=2,7; intervalle de confiance (IC) Ă 95%: 1,1-5,4 et RCA=3,2; IC Ă 95%: 1,1-8,5 respectivement) et dâĂLC (RCA=2,5; IC Ă 95%: 1,1-5,6 et RCA=2,8; IC Ă 95%: 1,1-7,6 respectivement). Ă lâinverse, une participation sociale Ă©levĂ©e est associĂ©e Ă une diminution marquĂ©e du risque de VULC (RCA=0,05; IC Ă 95%: 0,01-0,2) et dâĂLC (RCA=0,04; IC Ă 95%: 0,01-0,2). Les aĂźnĂ©s prĂ©sentant simultanĂ©ment six facteurs augmentant leur vulnĂ©rabilitĂ© Ă©taient sept fois plus Ă risque de VULC (rapport de cotes (RC)=7,4; IC Ă 95%: 1,5-36,2) ou dâĂLC (RC=7,8; IC Ă 95%: 1,6-37,2) comparativement Ă ceux avec aucun ou un seul facteur. Lâidentification des aĂźnĂ©s les plus vulnĂ©rables permettra de dĂ©velopper des stratĂ©gies dâintervention clinique et communautaire davantage ciblĂ©es