Evaluating the influence of primary healthcare nurse practitioners' interventions in home care on hospitalizations and emergency department transfers.

RATIONALE: Home care allows patients with functional limitations to receive services at home and prevent health decline. Home care can reduce hospitalization and emergency department (ED) transfers. Integrating primary healthcare nurse practitioners (PHCNPs) in home care increases the supply of services, but little is known about their influence on patients' ability to remain at home. AIMS AND OBJECTIVES: Evaluate the influence of PHCNPs' interventions on hospitalizations and ED transfers in patients receiving care from interprofessional home care teams with PHCNPs. METHOD: The retrospective cohort study employed multiple logistic regression and Cox modelling techniques to assess the influence of PHCNP interventions on hospitalizations and ED transfers. Descriptive and bivariate analyses examined sample characteristics and variable associations. Four purposively selected sites in Québec, Canada, were included. Data were collected from electronic health records of all patients (n = 343) receiving home care from these teams. RESULTS: The characteristics of the sites, sample, and PHCNP interventions were described. Planned interventions led to a 5.8% decrease in hospitalizations and ED transfers (adjusted odds ratio [OR]: 0.058, p = 0.039), while unplanned interventions resulted in a 1.5-fold increase in this outcome (adjusted OR: 1.518, p < 0.001). The risk of hospitalization and ED transfers increased by 10.7 times with unplanned interventions (adjusted OR: 10.651, p = 0.002). Furthermore, imaging was associated with a 2-fold increased risk (adjusted OR: 1.954, p = 0.021), consultations with a 1.8-fold increased risk (adjusted OR: 1.849, p = 0.034), and laboratory test-related interventions after 30 or more days reduced the risk by 68.0% (adjusted OR: 0.320, p < 0.001). CONCLUSIONS: PHCNPs in interprofessional home care teams show promise in reducing hospitalizations and ED transfers through planned visits. These findings provide valuable insights that can contribute to enhancing home care services for a population with limited access to healthcare and high healthcare needs. Further research is needed in other jurisdictions.

Validation of the Burn Survivor Fear-Avoidance Questionnaire and Its Association With Pain Intensity, Catastrophizing, and Disability.

According to the Fear-avoidance (FA) model, FA beliefs can lead to disability due to avoidance of activities expected to result in pain or further injury. Extensive research on the relationship of FA, pain, catastrophizing, and disability has been generated with patients suffering from chronic neck and back pain, but little research has been conducted with burn survivors. To address this need, the Burn Survivor FA Questionnaire (BSFAQ) was developed (Langlois J, Vincent-Toskin, S, Duchesne, P et al. Fear-avoidance beliefs and behaviors of burn survivors: A mixed-methods approach. Burns 2021;47:175-89.) but has not been validated. Thus, the primary objective of this study was to investigate the construct validity of the BSFAQ among burn survivors. The secondary objective was to examine the relationship between FA and 1) pain intensity and 2) catastrophizing at baseline, 3 months and 6 months postburn, and 3) disability among burn survivors at 6 months postburn. A prospective mixed-methods approach was used to examine the construct validity by comparing the quantitative scores of the BSFAQ to independently performed qualitative interviews of burn survivors (n = 31) that explored their lived experiences, to determine if the BSFAQ discriminated those who had, from those who did not have FA beliefs. Data for the secondary objective, scores of burn survivors (n = 51) pain intensity (numeric rating scale), catastrophizing (pain catastrophizing scale), and disability (Burn Specific Health Scale-brief), were collected through a retrospective chart review. For the primary objective, Wilcoxon rank sum test results showed a statistically significant difference (P = .015) between the BSFAQ scores of participants who were identified from the qualitative interviews as fear avoidant compared to those who were identified as non fear avoidant, with a receiver operating characteristic curve indicating that the BSFAQ correctly predicted FA 82.4% of the time. For the secondary objective, Spearman correlation test results showed a moderate correlation between FA and 1) pain at baseline (r = .466, P = .002), 2) catastrophizing thoughts over time (r = .557, P = .000; r = .470, P = .00; r = .559, P = .002 respectively at each time point), and 3) disability at 6 months postburn (r = -.643, P = .000). These results support that the BSFAQ is able to discriminate which burn survivors are experiencing FA beliefs. It is also consistent with the FA model since burn survivors who express FA are more likely to report higher levels of pain early during their recovery that correlates with persistently elevated catastrophizing thoughts and ultimately results in higher self-reported disability. The BSFAQ demonstrates construct validity and is able to correctly predict fear-avoidant burn survivors; however, additional research is required to further examine the BSFAQ's clinimetric properties.

Attachment insecurities and under-commitment in distressed couples: The role of positive and negative partner behaviors.

Research has rarely considered intermediate variables in the association between attachment insecurities and relationship commitment. Based on attachment theory and Rusbult's Investment Model, we tested whether positive and negative partner behaviors explain this association in 91 distressed couples undergoing therapy. Path analyses based on the Actor-Partner Interdependence Model revealed that individuals with attachment avoidance reported perceiving fewer positive behaviors from their partner, which was associated with their own higher under-commitment. Partners of individuals with avoidance also reported perceiving fewer positive partner behaviors, which was in turn associated with their own higher under-commitment. Partners of individuals with attachment anxiety perceived more positive behaviors from their partner, which was associated to their own lower under-commitment. Perceived negative partner behaviors were only directly associated with higher under-commitment. These findings imply that perceived positive partner behaviors may be a key aspect to target in relationship therapy in couples who present with high attachment insecurities.

Risk-targeted behavioral activation for the management of work disability associated with comorbid pain and depression: a feasibility study.

PURPOSE: The purpose of the present study was to conduct a preliminary evaluation of the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with comorbid pain and depression. METHODS: The design of the study was a single-arm non-randomized trial. The sample consisted of 66 work-disabled individuals with comorbid pain and depression. The treatment program consisted of a 10-week standardized behavioral activation intervention supplemented by techniques to target two psychosocial risk factors for delayed recovery, namely, catastrophic thinking and perceptions of injustice. Measures of pain severity, depression, catastrophic thinking, perceived injustice, and self-reported disability were completed pre-, mid-, and post-treatment. Satisfaction with treatment was assessed at post-treatment. Return to work was assessed at 6-month follow-up. RESULTS: The drop-out rate was 18%. At treatment termination, 91% of participants indicated that they were "very" or "completely" satisfied with their involvement in the treatment program. Significant reductions in pain (Cohen's d = 0.71), depression (d = 0.86), catastrophic thinking (d = 1.1), and perceived injustice (d = 1.0) were observed through the course of treatment. In multivariate analyses, treatment-related reductions in depression, catastrophic thinking, and perceived injustice, but not pain, contributed significant unique variance to the prediction of return-to-work outcomes. CONCLUSIONS: Risk-targeted behavioral activation was found to be an acceptable and effective intervention for work-disabled individuals with comorbid pain and depression. The findings suggest that interventions targeting psychosocial risk factors for pain and depression might contribute to more positive recovery outcomes in work-disabled individuals with comorbid pain and depression. TRIAL REGISTRATION: ClinicalTrials.gov: NCT0517442 . Retrospectively registered.

Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes.

BACKGROUND: Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs. METHODS: A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes. RESULTS: Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes. CONCLUSIONS: This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.

Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams.

AIM: Describe brief (less than half a day) interventions aimed at improving healthcare team functioning. METHODS: A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL, Medline, EMBASE, PUBMED, Cochrane, RCT Registry-1990 to April 2020 and grey literature. Articles were screened independently by teams of two reviewers. Risk of bias was assessed. Data from the retained articles were extracted by one reviewer and checked by a second reviewer independently. A narrative synthesis was undertaken. RESULTS: Searches yielded 1928 unique records. Final sample contained twenty papers describing 19 studies, published between 2009 and 2020. Studies described brief training interventions conducted in acute care in-patient settings and included a total of 6338 participants. Participants' socio-demographic information was not routinely reported. Studies met between two to six of the eight risk of bias criteria. Interventions included simulations for technical skills, structured communications and speaking up for non-technical skills and debriefing. Debriefing sessions generally lasted between five to 10 minutes. Debriefing sessions reflected key content areas but it was not always possible to determine the influence of the debriefing session on participants' learning because of the limited information reported. DISCUSSION: Interest in short team interventions is recent. Single two-hour sessions appear to improve technical skills. Three to four 30- to 60-minute training sessions spread out over several weeks with structured facilitation and debriefing appear to improve non-technical skills. Monthly meetings appear to sustain change over time. CONCLUSION: Short team interventions show promise to improve team functioning. Effectiveness of interventions in primary care and the inclusion of patients and families needs to be examined. Primary care teams are structured differently than teams in acute care and they may have different priorities.

The Effect of Hypervigilance on the Relationship Between Sexual Victimization and Gait.

Two studies investigated the relationship between hypervigilance, vulnerable gait cues, and a history of sexual victimization. In Study 1 (N = 130), gait was coded for traits relating to vulnerability where half of the sample was unaware of being videotaped (Unaware condition) and the other half was aware (Aware condition) to induce hypervigilance (between-subjects design). Gait was associated with a history of victimization, but only in the Unaware condition. A mediation analysis found that perceived impact of victimization mediated the association between victimization and vulnerable gait. In Study 2, female university students (N = 62) were measured on their victimization history and hypervigilance. Walking styles of participants were coded for the presence of vulnerability cues in both an Unaware and Aware condition (within-subjects design). A regression analysis revealed an association between hypervigilance and a reduced change in walking style between the two conditions. More notably, hypervigilance was found to moderate the relationship between sexual victimization and vulnerable gait but not violent victimization and vulnerable gait. These results suggest that hypervigilance may be an adaptive response that reduces perceived vulnerability in sexually victimized women.

Randomized controlled trial of the immediate and long-term effect of massage on adult postburn scar.

BACKGROUND: One objective of massage therapy applied to hypertrophic scar (HSc), is to improve the structural properties so skin possesses the strength and elasticity required for normal mobility. However, research supporting this effect is lacking. The objective of this study was to characterize the changes in scar elasticity, erythema, melanin, and thickness immediately after a massage therapy session and after a 12-week course of treatment compared to intra-individual matched control scars. METHODS: We conducted a prospective, randomized, single-blinded, pragmatic, controlled, clinical trial evaluating the impact of a 12-week course of massage therapy. Seventy burn survivors consented to participate and 60 completed the study. Two homogeneous, intra-individual scars were randomized to usual care control or massage therapy plus usual care. Massage, occupational or physical therapists provided massage treatment 3x/week for 12 weeks. Scar site characteristics were evaluated weekly immediately before and after massage treatment including elasticity (Cutometer), erythema and melanin (Mexameter), and thickness (high-frequency ultrasound). Analysis of covariance (ANCOVAs) were performed to test for immediate and long-term treatment effects. A mixed-model approach was used to account for the intra-individual scars. RESULTS: Scar evaluation immediately before and after massage therapy at each time point revealed changes for all scar characteristics, but the group differences were predominantly present during the early weeks of treatment. The within group long-term analysis revealed a significant increase in elasticity, and a reduction in thickness, during the 12-week treatment period for both the control scar (CS) and massage scar (MS). The increase in elasticity reached significance at week 8 for the MS and week 10 for the CS and the reduction in thickness at week 5 for the CS and week 7 for the MS. There was no significant within group long-term differences for either erythema or melanin. There were group differences in erythema at week 8 and 11 where the CS was less erythematous than the MS. CONCLUSIONS: The immediate impact of forces applied during massage therapy may lead patients and therapists to believe that there are long-term changes in elasticity, erythema, and pigmentation, however, once baseline measures, the control scar, and time were incorporated in the analysis there was no evidence of long-term benefit. Massage therapy applied with the objective of increasing scar elasticity or reducing erythema or thickness over the long-term should be reconsidered.

Psychopathic Traits and the Cheater-Hawk Hypothesis.

The present study was a direct test of the cheater-hawk hypothesis which argues that psychopathy is related to two potentially adaptive interpersonal strategies: cheating and aggression. As expected, the measures of cheater and hawk behaviors comprised a single factor, according to a maximum-likelihood factor analysis. As hypothesized, psychopathic traits exhibited large positive correlations with measures of both cheater (entitlement, exploitiveness, and short-term mating orientation) and hawk (vengeance and aggression) behaviors. Furthermore, psychopathic traits were associated with the tendency of using individualistic and competitive tactics in an altruism game and being less likely to act in a prosocial manner. Finally, scores on the combined-cheater hawk variable were significantly correlated with psychopathic traits. As hypothesized, individuals scoring high on Factor 1 of psychopathy were more likely to utilize behaviors and strategies associated with the cheater-hawk designation, whether or not they scored high on Factor 2 of psychopathy. In general, the findings support the conceptualization that psychopathy represents a fast life-history strategy characterized by seeking personal gain over others, including exploitiveness (cheater), aggression (hawk), and risk taking. Results also indicate that cheater and hawk behaviors are part of a single strategy more often employed by those higher on psychopathic traits. Implications for treatment success are discussed.

Population genetic structure of the biological control agent Macrolophus pygmaeus in Mediterranean agroecosystems.

Biological control of agricultural pests relies on knowledge of agroecosystem functionality, particularly when affected by the use of mass-produced biological agents. Incorporating pre- and/or post-release information such as genetic diversity and structure on these agents using molecular-based approaches could advance our knowledge of how they perform in agroecosystems. We evaluated the population genetics of Macrolophus pygmaeus, the most widely used predatory mirid against many arthropod pests of greenhouse crops in the Mediterranean region, using the mitochondrial Cytb sequence and microsatellite data, and population genetics and phylogeny approaches. We investigated commercially mass-produced insects (i.e., commercial insects either mass-reared in the laboratory for many generations, or purchased by farmers and released in the greenhouses) and "wild" insects (i.e., that occur naturally outside or are collected in nature for release in the greenhouses). The mirids were mainly collected in agroecosystems in which solanaceous plants are grown in northern Spain, southern France and Greece. Both molecular markers and approaches distinguished 2 genetically differentiated populations. The less genetically diverse population, hereafter named the "commercial" strain included all individuals from laboratory mass-rearings and most releases of commercially bred individuals. The most genetically diverse population mainly comprised individuals originating from noncultivated environments, or from releases of "wild" individuals. Rare examples of hybridization between M. pygmaeus from the 2 populations were observed and asymmetric gene flow was revealed. These findings provide new insights into what happens to M. pygmaeus released in the agroecosystems we studied, and show that it is possible to monitor some commercial strains.

Agroecosystems shape population genetic structure of the greenhouse whitefly in Northern and Southern Europe.

BACKGROUND: To predict further invasions of pests it is important to understand what factors contribute to the genetic structure of their populations. Cosmopolitan pest species are ideal for studying how different agroecosystems affect population genetic structure within a species at different climatic extremes. We undertook the first population genetic study of the greenhouse whitefly (Trialeurodes vaporariorum), a cosmopolitan invasive herbivore, and examined the genetic structure of this species in Northern and Southern Europe. In Finland, cold temperatures limit whiteflies to greenhouses and prevent them from overwintering in nature, and in Greece, milder temperatures allow whiteflies to inhabit both fields and greenhouses year round, providing a greater potential for connectivity among populations. Using nine microsatellite markers, we genotyped 1274 T. vaporariorum females collected from 18 greenhouses in Finland and eight greenhouses as well as eight fields in Greece. RESULTS: Populations from Finland were less diverse than those from Greece, suggesting that Greek populations are larger and subjected to fewer bottlenecks. Moreover, there was significant population genetic structure in both countries that was explained by different factors. Habitat (field vs. greenhouse) together with longitude explained genetic structure in Greece, whereas in Finland, genetic structure was explained by host plant species. Furthermore, there was no temporal genetic structure among populations in Finland, suggesting that year-round populations are able to persist in greenhouses. CONCLUSIONS: Taken together our results show that greenhouse agroecosystems can limit gene flow among populations in both climate zones. Fragmented populations in greenhouses could allow for efficient pest management. However, pest persistence in both climate zones, coupled with increasing opportunities for naturalization in temperate latitudes due to climate change, highlight challenges for the management of cosmopolitan pests in Northern and Southern Europe.

Genetic structure of Bemisia tabaci Med populations from home-range countries, inferred by nuclear and cytoplasmic markers: impact on the distribution of the insecticide resistance genes.

BACKGROUND: Insecticide resistance management in Bemisia tabaci is one of the main issues facing agricultural production today. An extensive survey was undertaken in five Mediterranean countries to examine the resistance status of Med B. tabaci species in its range of geographic origin and the relationship between population genetic structure and the distribution of resistance genes. The investigation combined molecular diagnostic tests, sequence and microsatellite polymorphism studies and monitoring of endosymbionts. RESULTS: High frequencies of pyrethroid (L925I and T929V, VGSC gene) and organophosphate (F331W, ace1 gene) resistance mutations were found in France, Spain and Greece, but not in Morocco or Tunisia. Sequence analyses of the COI gene delineated two closely related mitochondrial groups (Q1 and Q2), which were found either sympatrically (Spain) or separately (France). Only Q1 was observed in Greece, Morocco and Tunisia. Bayesian analyses based on microsatellite loci revealed three geographically delineated genetic groups (France, Spain, Morocco/Greece/Tunisia) and high levels of genetic differentiation even between neighbouring samples. Evidence was also found for hybridisation and asymmetrical gene flow between Q1 and Q2. CONCLUSIONS: Med B. tabaci is more diverse and structured than reported so far. On a large geographic scale, resistance is affected by population genetic structure, whereas on a local scale, agricultural practices appear to play a major role.

Permanent genetic resources added to molecular ecology resources database 1 October 2012-30 November 2012.

This article documents the addition of 153 microsatellite marker loci to the Molecular Ecology Resources Database. Loci were developed for the following species: Brassica oleracea, Brycon amazonicus, Dimorphandra wilsonii, Eupallasella percnurus, Helleborus foetidus, Ipomoea purpurea, Phrynops geoffroanus, Prochilodus argenteus, Pyura sp., Sylvia atricapilla, Teratosphaeria suttonii, Trialeurodes vaporariorum and Trypanosoma brucei. These loci were cross-tested on the following species: Dimorphandra coccicinea, Dimorphandra cuprea, Dimorphandra gardneriana, Dimorphandra jorgei, Dimorphandra macrostachya, Dimorphandra mollis, Dimorphandra parviflora and Dimorphandra pennigera.

Permanent genetic resources added to molecular ecology resources database 1 April 2012 - 31 May 2012.

This article documents the addition of 123 microsatellite marker loci to the Molecular Ecology Resources Database. Loci were developed for the following species: Brenthis ino, Cichla orinocensis, Cichla temensis, Epinephelus striatus, Gobio gobio, Liocarcinus depurator, Macrolophus pygmaeus, Monilinia vaccinii-corymbosi, Pelochelys cantorii, Philotrypesis josephi, Romanogobio vladykovi, Takydromus luyeanus and Takydromus viridipunctatus. These loci were cross-tested on the following species: Cichla intermedia, Cichla ocellaris, Cichla pinima, Epinephelus acanthistius, Gobio carpathicus, Gobio obtusirostris, Gobio sp. 1, Gobio volgensis, Macrolophus costalis, Macrolophus melanotoma, Macrolophus pygmaeus, Romanogobio albipinnatus, Romanogobio banaticus, Romanogobio belingi, Romanogobio kesslerii, Romanogobio parvus, Romanogobio pentatrichus, Romanogobio uranoscopus, Takydromus formosanus, Takydromus hsuehshanesis and Takydromus stejnegeri.

Catastrophizers with chronic pain display more pain behaviour when in a relationship with a low catastrophizing spouse.

The present study examined the relationship between couple concordance of catastrophizing and adverse pain outcomes. Possible mechanisms underlying the relationship between couple concordance of catastrophizing and pain outcomes were also explored. Fifty-eight couples were recruited for the study. The chronic pain patients were filmed while lifting a series of weighted canisters. The spouse was later invited to view the video and answer questions about the pain experience of their partner. Median splits on Pain Catastrophizing Scale scores were used to create four 'catastrophizing concordance' groups: low catastrophizing patient-low catastrophizing spouse; low catastrophizing patient-high catastrophizing spouse; high catastrophizing patient-low catastrophizing spouse; and high catastrophizing patient-high catastrophizing spouse. Analyses revealed that high catastrophizing pain patients who were in a relationship with a low catastrophizing spouse displayed more pain behaviours than patients in all other groups. These findings suggest that high catastrophizing chronic pain patients may need to increase the 'volume' of pain communication to compensate for low catastrophizing spouses' tendency to underestimate the severity of their pain experience. Patients' perceived solicitousness and punitive response from the spouse could not explain the group differences in pain behaviour. Theoretical and clinical implications of the findings are discussed.

Individual and relational correlates of pain-related empathic accuracy in spouses of chronic pain patients.

OBJECTIVE: This study aims to investigate correlates of pain-related empathic accuracy in spouses of chronic pain patients. Specifically, analyses addressed: (1) the correlates of pain-related empathic accuracy, (2) the relation between pain-related empathic accuracy, and patient and spouse adaptational outcomes, and (3) the relation between pain-related empathic accuracy and relational outcomes. METHODS: Fifty-eight chronic pain patients (28 women and 30 men) were filmed while participating in a simulated occupational lifting task. Patients were asked to report their level of pain while lifting canisters partially filled with sand. Spouses were later asked to view the video record of their partner's performance and to estimate their partner's level of pain. Empathic accuracy was defined in terms of the overall discrepancy between patients' pain ratings and spouses' pain estimates, and by the degree of covariation between patients' pain ratings and spouses' pain estimates across trials. RESULTS: Analysis revealed that patients' pain severity, catastrophizing, fear of pain, and level of disability were significant correlates of empathic accuracy. Higher levels of pain-related empathic accuracy were associated to negative adaptational outcomes for chronic pain patients. With regard to the spouse, empathic accuracy was associated with the spouses' perceiving that they express less punitive responses when the patient is in pain. Empathic accuracy was not significantly related to relational outcomes. DISCUSSION: The results of this study suggest that empathic accuracy is associated with negative outcomes for the patient, and might not be an important correlate of marital satisfaction in couples in which one of the partners is suffering from chronic pain.

Validation of a French-Canadian version of the Pain Disability Index.

OBJECTIVE: To examine the psychometric properties of the Index de l'incapacité reliée à la douleur, a French-Canadian version of the Pain Disability Index (PDI). METHODS: A total of 176 chronic pain patients (94 women, 82 men) completed the French-Canadian version of the PDI (PDI-CF), as well as other pain-related measures. A subset of 52 patients (27 women, 25 men) also completed a lifting task designed to assess physical tolerance and pain behaviour. RESULTS: Confirmatory factor analysis of the PDI-CF supported the two-factor structure of the original PDI. Reliability analyses revealed that the PDI-CF total score had a high degree of internal consistency, comparable with the original PDI. The PDI-CF total score was significantly correlated with self-reported pain, pain catastrophizing, depressive symptoms, fear of movement or (re)injury, lift duration and pain behaviours. CONCLUSIONS: The results suggest that the PDI-CF is a reliable and valid measure of self-reported disability that is psychometrically similar to the original scale.

Level of distress among workers undergoing work rehabilitation for musculoskeletal disorders.

INTRODUCTION: Many studies have documented the high distress rates and their correlates among individuals experiencing persistent pain due to a musculoskeletal disorder (MSD). However, few have adopted a biopsychosocial perspective to understand this issue. OBJECTIVE: The first objective of this study was to examine workers' distress levels before they start work rehabilitation and to compare it to those in a healthy population. The second objective was to assess the correlations between distress and biopsychosocial factors. METHODS: The participants were 228 workers on sick leave due to persistent pain from an MSD and who were referred to an interdisciplinary work rehabilitation program. RESULTS: The workers had very high distress levels compared to normative data. Also, the results of a multiple regression showed that duration of absence, high occupational stress, perception of disability, and fear of movement and (re)injury were significantly associated with distress. CONCLUSIONS: These results highlight the importance of considering distress not only as a predictor of work disability, but as an independent outcome measure. This shift of paradigm could provide a more comprehensive approach in the understanding of workers' disability.

Microsatellite variability in the entomopathogenic fungus Paecilomyces fumosoroseus: genetic diversity and population structure.

The hyphomycete Paecilomyces fumosoroseus (Pfr) is a geographically widespread fungus capable of infecting various insect hosts. The fungus has been used for the biological control of several important insect pests of agriculture. However knowledge of the fungus' genetic diversity and population structure is required for its sustainable use as a biological control agent. We investigated length and sequence polymorphisms of nine microsatellite loci for 33 Pfr accessions sampled from various host species and geographical locations, and our results reveal complex mutational processes for these molecular markers. Only Pfr isolates from Bemisia tabaci were amplified successfully, indicating the existence of Pfr genotypes specifically associated with B. tabaci. Genetic relationships among the 25 Pfr isolates from B. tabaci were inferred from allelic variability data at eight microsatellite loci that were polymorphic and subsequently from sequence data from the flanking regions of three selected loci. Maximum parsimony and neighbor joining analyses partitioned Pfr genetic diversity in two major lineages. One lineage included genotypes from the B-biotype of B. tabaci distributed across the Americas and was strongly supported in both analyses. Another lineage was distributed across Asia and consisted of four distinct clusters. Allele size homoplasy was found at the three microsatellite loci. We obtained better discrimination and resolution of the relationships among isolates with sequence data, although not all isolates could be typed. Thus sequencing of microsatellite flanking regions and repeats is a promising approach for the identification of Pfr isolates that specifically infect certain B. tabaci biotypes and phylogeographic studies.