Double Trouble! Do Workplace Supports Mitigate Lost Productivity for Young Workers with Both Severe Rheumatic Diseases and Depressive Symptoms?

BACKGROUND: The objectives of this longitudinal study were to understand how comorbid rheumatic disease and depression symptoms were associated with at-work productivity among young adults, and to examine whether workplace support modified this association. METHODS: Seventy-six Canadian young adults who were employed and living with a rheumatic disease were surveyed three times over 27 months. Morbidity was defined by whether participants reported severe rheumatic disease symptoms and/or depressive symptoms. Participants were asked about presenteeism, absenteeism, and whether the workplace support needs (accommodation and benefit availability and use) were met. Generalized estimating equations were used to address study objectives. RESULTS: Seventeen participants experienced neither severe rheumatic disease nor depressive symptoms (no morbidity), 42 participants experienced either severe rheumatic disease or depressive symptoms (single morbidity), and 17 participants reported comorbidity at baseline. Participants with comorbidity reported greater presenteeism scores and were most likely to report absenteeism, compared to the other two morbidity levels. Having workplace support needs met was associated with decreased presenteeism over the 27-month period among participants with no and a single morbidity. Conversely, unmet support need was associated with greater presenteeism for participants with comorbidity. Having workplace support needs met did not modify the association between morbidity and absenteeism. CONCLUSION: Comorbid rheumatic disease and depression burden reduce productivity among young adults. A supportive work environment has the potential to address at-work productivity challenges. Additional research is needed to understand how workplace supports coupled with clinical interventions may tackle challenges at work for young adults living with rheumatic disease and depression.

Identifying the sociodemographic and work-related factors related to workers' daily physical activity using a decision tree approach.

BACKGROUND: The social and behavioural factors related to physical activity among adults are well known. Despite the overlapping nature of these factors, few studies have examined how multiple predictors of physical activity interact. This study aimed to identify the relative importance of multiple interacting sociodemographic and work-related factors associated with the daily physical activity patterns of a population-based sample of workers. METHODS: Sociodemographic, work, screen time, and health variables were obtained from five, repeated cross-sectional cohorts of workers from the Canadian Health Measures Survey (2007 to 2017). Classification and Regression Tree (CART) modelling was used to identify the discriminators associated with six daily physical activity patterns. The performance of the CART approach was compared to a stepwise multinomial logistic regression model. RESULTS: Among the 8,909 workers analysed, the most important CART discriminators of daily physical activity patterns were age, job skill, and physical strength requirements of the job. Other important factors included participants' sex, educational attainment, fruit/vegetable intake, industry, work hours, marital status, having a child living at home, computer time, and household income. The CART tree had moderate classification accuracy and performed marginally better than the stepwise multinomial logistic regression model. CONCLUSION: Age and work-related factors-particularly job skill, and physical strength requirements at work-appeared as the most important factors related to physical activity attainment, and differed based on sex, work hours, and industry. Delineating the hierarchy of factors associated with daily physical activity may assist in targeting preventive strategies aimed at promoting physical activity in workers.

Parallel latent trajectories of mental health and personal earnings among 16- to 20 year-old US labor force participants: a 20-year longitudinal study.

PURPOSE: Determine the number of latent parallel trajectories of mental health and employment earnings over two decades among American youth entering the workforce and estimate the association between baseline sociodemographic and health factors on latent trajectory class membership. METHODS: This study used data of 8173 participants from the National Longitudinal Survey of Youth 1997 who were 13-17 years old in 1997. Surveys occurred annually until 2011 then biennially until 2017, when participants were 33-37 years old. The Mental Health Inventory-5 measured mental health at eight survey cycles between 2000 and 2017. Employment earnings were measured annually between 1998 and 2017. Latent parallel trajectories were estimated using latent growth modeling. Multinomial logistic regression explored the association between baseline factors and trajectory membership. RESULTS: Four parallel latent classes were identified; all showed stable mental health and increasing earnings. Three percent of the sample showed a good mental health, steep increasing earnings trajectory (average 2017 earnings ~ $196,000); 23% followed a good mental health, medium increasing earnings trajectory (average 2017 earnings ~ $78,100); 50% followed a good mental health, low increasing earnings trajectory (average 2017 earnings ~ $39,500); and 24% followed a poor mental, lowest increasing earnings trajectory (average 2017 earnings ~ $32,000). Participants who were younger, women, Black or Hispanic, from lower socioeconomic households, and reported poorer health behaviors had higher odds of belonging to the poor mental health, low earnings class. CONCLUSION: Findings highlight the parallel courses of mental health and labor market earnings, and the influence of gender, race/ethnicity, and adolescent circumstances on these processes.

The working life expectancy of American adults experiencing depression.

OBJECTIVES: To estimate the working life expectancies (WLE) of men and women with depression, examining depression by symptom trajectories from the late 20s to early 50s, and to estimate WLE by race/ethnicity and educational attainment. METHODS: Data from 9206 participants collected from 1979 to 2018 in the US National Longitudinal Survey of Youth 1979 cohort were used. Depression was measured using the Center for Epidemiologic Studies Depression Scale Short Form at four time points (age 28-35, age 30-37, age 40, and age 50). Labor force status was measured monthly starting at age 30 until age 58-62. Depressive symptom trajectories were estimated using growth mixture modeling and multistate modeling estimated WLE from age 30-60 for each gender and depressive symptom trajectory. RESULTS: Five latent symptom trajectories were established: a persistent low symptom trajectory (n = 6838), an episodic trajectory with high symptoms occurring before age 40 (n = 995), an episodic trajectory with high symptoms occurring around age 40 (n = 526), a trajectory with high symptoms occurring around age 50 (n = 570), and a persistent high symptom trajectory (n = 277). The WLE for men at age 30 was 30.3 years for the persistent low symptom trajectory, 22.8 years for the episodic before 40 trajectory, 19.6 years for the episodic around age 40 trajectory, 18.6 years for the episodic around age 50 trajectory, and 13.2 years for the persistent high symptom trajectory. Results were similar for women. WLE disparities between depression trajectories grew when stratified by race/ethnicity and education level. CONCLUSIONS: Roughly a quarter of individuals experienced episodic depressive symptoms. However, despite periods of low depressive symptoms, individuals were expected to be employed ~5-17 years less at age 30 compared to those with low symptoms. Accessible employment and mental health disability support policies and programs across the working life course may be effective in maintaining work attachment and improving WLE among those who experience depression.

Impact of persistent pain symptoms on work absence, health status and employment 18 months following disabling work-related injury or illness.

OBJECTIVES: While most individuals physically injured at work will make a complete medical recovery, a portion of workers will experience persistent pain following their injury. This study estimated persistent pain prevalence and its association with health and return-to-work outcomes 18 months following the incidence of a disabling work-related injury. METHODS: We studied 1131 workers disabled by a work-related injury who were recruited from a sampling frame of disability benefit claimants in Ontario, Canada. Work injuries and claim benefits characteristics from administrative data were linked with measures of work status, pain symptoms, and physical and mental health obtained from telephone interviews completed 18 months postinjury. Associations of persistent pain symptoms with health and employment outcomes 18 months postinjury were estimated using multinomial and linear regression. RESULTS: Roughly 30% of participants reported no pain symptoms in the previous 4 weeks, 45% reported mild pain symptoms and 25% reported severe pain symptoms accompanied by substantial functional impairment. Workers with severe pain symptoms were more likely to not be currently working at 18 months (33%) vs those without pain symptoms (16%), and had poorer self-reported physical and mental health. Workers with severe pain symptoms had higher probabilities of benefit durations of 12-18 months (OR=9.35), higher lost-earnings costs (~47.7% higher) and higher healthcare expenditure costs at 18 months (~125.9% higher) compared with those with no pain symptoms. CONCLUSIONS: Persistent pain symptom prevalence 18 months postinjury is high among workers disabled by a work-related injury and associated with substantial functional impairment and longer wage replacement benefit duration.

Body mass index trajectories among the Canadian workforce and their association with work environment trajectories over 17 years.

OBJECTIVE: To determine the number of latent body mass index (BMI) trajectories from 1994 to 2010 among working Canadians and their association with concurrent trajectories in work environment exposures. METHODS: Data of employed individuals from the longitudinal Canadian National Population Health Survey were used. Group-based trajectory modelling was used to determine the number of latent BMI trajectories and concurrent psychosocial work environment trajectories. A multinomial logistic regression of BMI trajectory membership on trajectories in work environment dimensions (skill discretion, decision latitude, psychological demands, job insecurity, social support, physical exertion) was then explored. RESULTS: Four latent BMI trajectories corresponding to normal, overweight, obese and very obese BMI values were found. Each trajectory saw an increase in BMI (~2-4 kg/m2) over the 17-year period. A higher decision authority trajectory was associated with lower odds of belonging to the overweight and obese trajectories when compared with the normal weight trajectory. A decreasing physical exertion trajectory was associated with higher odds of belonging to the very obese trajectory when compared with the normal weight trajectory. CONCLUSIONS: Four BMI trajectories are present in the Canadian workforce; all trajectories saw increased body weight over time. Declining physical exertion and lower decision authority in the work environment over time is associated with increased likelihood of being in overweight and obese trajectories.

Changes in work factors and concurrent changes in leisure time physical activity: a 12-year longitudinal analysis.

OBJECTIVES: There is a paucity of longitudinal population-based studies examining whether changes in work factors are associated with concurrent changes in leisure time physical activity (LTPA). This study examines this issue using 12 years of longitudinal survey data. METHODS: Data were drawn from the Canadian National Population Health Survey. The initial analytical sample in 1994 of 6407 working individuals was followed every 2 years from 2000 to 2010. Seven work factors were measured as independent variables: skill discretion, decision authority, psychological demands, physical exertion, number of jobs, hours at work and shift schedule. LTPA was categorised as inactive, moderately active or active based on metabolic equivalent task values. Fixed-effects multinomial logistic models were used to examine associations between work factors and LTPA controlling for time-invariant effects and adjusted for covariates. RESULTS: Workers with lower skill discretion (OR=0.96; 95% CI 0.92 to 0.99), higher psychological demands (OR=0.95; 95% CI 0.92 to 0.99), higher physical exertion (OR=0.93; 95% CI 0.88 to 0.99) and longer work hours (OR=0.97; 95% CI 0.95 to 098) were associated with a lower odds of transitioning from inactive to active and moderately active. There was no evidence of effect modification by age or sex. CONCLUSION: Results suggest that as participants' skill discretion decreased, and their physical and psychological demands, and work hours increased, their likelihood of becoming more active and moderately active also decreased, supporting the value of targeting improvements in these work factors for physical activity interventions.

Trends in the prevalence of depression and anxiety disorders among Canadian working-age adults between 2000 and 2016.

BACKGROUND: Understanding the prevalence of major depressive episodes (MDEs) and anxiety disorders at the population level among different labour force segments is critical to assessing and planning equitable mental health policies for Canadians adults. This study quantified prevalence trends of annually reported MDEs, anxiety disorders, and comorbid MDEs and anxiety disorders among working-age Canadians by labour force status, between 2000 and 2016. DATA AND METHODS: This study used multiple cycles of the Canadian Community Health Survey. MDE prevalence was assessed using variants of the Composite International Diagnostic Interview and the Patient Health Questionnaire-9. Anxiety disorder prevalence captured the presence of an anxiety disorder diagnosed by a healthcare professional. Prevalence estimates were calculated in each survey cycle for three labour force groups: employed, unemployed and not participating in the labour force. A meta-analytic framework stratified by labour force status estimated prevalence trends. RESULTS: Between 2000 and 2016, MDE prevalence remained statistically stable over time at 5.4% (95% confidence interval [CI]: 4.7% to 6.0%), 11.7% (95% CI: 10.4% to 13.0%) and 9.8% (95% CI: 8.5% to 11.2%) among participants who were employed, unemployed, and not participating in the labour force, respectively. Anxiety prevalence ranged from 4.6% to 10.8%, and increased over time (employed: ß=0.26%/year, 95% CI: 0.08% to 0.45%; unemployed: ß=0.34%/year, 95% CI: -0.10% to 0.78%; not participating in the labour force: ß=0.55%/year, 95% CI: 0.15% to 0.95%). Stable comorbid MDE and anxiety prevalence ranged from 1.2% to 4.1% between 2003 and 2016. DISCUSSION: Trends suggest that MDE prevalence has remained stable among all labour force groups since 2000, while anxiety disorder prevalence has modestly increased since 2003. Disorder prevalence increased as labour force attachment decreased across all outcomes studied.

Association between dimensions of the psychosocial and physical work environment and latent smoking trajectories: a 16-year cohort study of the Canadian workforce.

BACKGROUND: This study aimed to determine the number of latent smoking trajectories among Canadians employed in the workforce over a 16-year period, and if latent trajectories in dimensions of the physical and psychosocial work environment were associated with specific smoking trajectories. METHODS: We studied 5461 employed adults from the longitudinal Canadian National Population Health Survey. Daily cigarette consumption was measured biannually from 1994 to 2010. Work environment factors (skill discretion, decision authority, psychological demands, job insecurity, physical exertion and workplace social support) were measured in 1994 and then from 2000 to 2010 using an abbreviated form of the Job Content Questionnaire. Smoking and work environment trajectories were derived using group-based trajectory modelling. Associations between work environment trajectory classes and smoking trajectory classes were estimated using multinomial logistic regression. RESULTS: Four latent smoking trajectories were seen: non-smokers; ceasing smokers (consuming ~14 cigarettes/day in 1994 and 0 in 2008-2010); smokers (consuming ~7 cigarettes/day between 1994 and 2010); and heavy smokers (consuming ~22 cigarettes/day in 1994 and ~14 in 2010). Lower skill discretion, high psychological demands, high physical exertion and low social support trajectories were associated with membership in the heavy smoking trajectory compared with the non-smoking trajectory. Low decision authority, high psychological demands and high physical exertion trajectories were associated with membership in the ceasing compared with the non-smoking trajectory. CONCLUSIONS: Certain physical and psychosocial work environment trajectories were associated with heavy and ceasing smoking behaviours over a 16-year period. The role of the work environment should be further considered in smoking cessation programmes.

How do childhood intelligence and early psychosocial adversity influence income attainment among adult extremely low birth weight survivors? A test of the cognitive reserve hypothesis.

Perinatal and later postnatal adversities have been shown to adversely affect socioeconomic trajectories, while enhanced early cognitive abilities improve them. However, little is known about the combined influence of these exposures on social mobility. In this study, we examined if childhood IQ moderated the association between four different types of postnatal adversity (childhood socioeconomic disadvantage, childhood sexual abuse, lifetime psychiatric disorder, and trait neuroticism) and annual earnings at 30-35 years of age in a sample of 88 extremely low birth weight survivors. Our results suggested that higher childhood IQ was associated with greater personal income at age 30-35. Extremely low birth weight survivors who did not face psychological adversities and who had higher childhood IQ reported higher income in adulthood. However, those who faced psychological adversity and had higher childhood IQ generally reported lower income in adulthood. Our findings suggest that cognitive reserve may not protect preterm survivors against the complex web of risk factors affecting their later socioeconomic attainment.

Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery.

OBJECTIVE: To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. METHODS: A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children's preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed. RESULTS: In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies. CONCLUSIONS: This systematic review suggests that AV interventions can be effective in reducing children's preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice.

An observational study of pain severity, cannabis use, and benefit expenditures in work disability.

OBJECTIVE: This study pools two cohorts of workers in Ontario interviewed 18 months following a disabling work-related injury to estimate the association between pain severity, cannabis use, and disability benefit expenditures. METHODS: Among 1650 workers, disability benefit expenditures obtained from administrative records were combined with self-reported measures of pain symptoms and cannabis use. Disability benefit expenditures comprised wage replacement benefits and expenditures on healthcare services. RESULTS: Past-year cannabis use was reported by 31% of participants, with approximately one third of cannabis use attributed to the treatment of conditions arising from the work-related injury. Condition-related cannabis use was elevated among the 34% of participants reporting severe pain symptoms. In regression models adjusted for age, sex, nature of injury, opioid prescription, and pre-injury chronic conditions, participants reporting condition-related cannabis use had equivalent wage replacement benefit expenditures (ß = 0.254, ns) and higher healthcare benefit expenditures (ß = 0.433, p = 0.012) compared to participants who did not use cannabis. Participants reporting cannabis use unrelated to conditions arising from their work-related injury had lower wage replacement benefit expenditures (ß = - 0.309, p = 0.002) and equivalent healthcare benefit expenditures (ß = - 0.251, ns) compared to participants not using cannabis. CONCLUSION: This novel study of workers' compensation claimants interviewed at 18 months post-injury did not observe a substantial relationship between cannabis use and disability benefit expenditures, suggesting that neither harm nor significant benefit is associated with cannabis use. These findings contribute to understanding the potential benefits and risks associated with cannabis use in settings that have legalized cannabis use.

RéSUMé: OBJECTIF: Cette étude regroupe deux cohortes de travailleurs et travailleuses de l'Ontario interviewés 18 mois après un accident de travail invalidant; elle vise à estimer l'association entre la gravité de la douleur, la consommation de cannabis et les dépenses en prestations d'invalidité. MéTHODE: Les dépenses en prestations d'invalidité de 1 650 travailleurs et travailleuses, obtenues en consultant les dossiers administratifs, ont été combinées aux indicateurs autodéclarés de symptômes de douleur et de consommation de cannabis. Les dépenses en prestations d'invalidité englobaient les prestations de remplacement du salaire et les dépenses en services de soins de santé. RéSULTATS: Une consommation de cannabis au cours de la dernière année a été déclarée par 31 % des participants; environ le tiers de cette consommation de cannabis était imputée au traitement d'affections causées par l'accident de travail. La consommation de cannabis liée à une affection était élevée chez les 34 % de participants ayant déclaré de graves symptômes de douleur. Selon nos modèles de régression ajustés selon l'âge, le sexe, la nature de la blessure, la prescription d'opioïdes et l'existence d'états chroniques avant l'accident, pour les participants ayant déclaré une consommation de cannabis liée à une affection, les dépenses en prestations de remplacement du salaire étaient équivalentes (ß = 0,254, ns) et les dépenses en prestations de soins de santé étaient supérieures (ß = 0,433, p = 0,012) à celles des participants n'ayant pas consommé de cannabis. Pour les participants ayant déclaré une consommation de cannabis sans rapport avec des affections causées par leur accident de travail, les dépenses en prestations de remplacement du salaire étaient inférieures (ß = -0,309, p = 0,002) et les dépenses en prestations de soins de santé étaient équivalentes (ß = -0,251, ns) à celles des participants n'ayant pas consommé de cannabis. CONCLUSION: Cette étude novatrice menée auprès de demandeurs d'indemnités interviewés 18 mois après leur accident n'a pas observé de relation importante entre la consommation de cannabis et les dépenses en prestations d'invalidité, ce qui semble indiquer que ni des préjudices, ni des avantages significatifs ne sont associés à la consommation de cannabis. Ces constats contribuent à la compréhension des avantages et des risques qui pourraient être associés à la consommation de cannabis dans les milieux où cette consommation est légale.

The adequacy of workplace accommodation and the incidence of permanent employment separations after a disabling work injury or illness.

OBJECTIVE: This study aimed to estimate the influence of the adequacy of employer accommodations of health impairments in predicting permanent separation from the employment relationship in a cohort of workers disabled by a work-related injury or illness. METHODS: The study used data from a retrospective, observational cohort of 1793 Ontario workers who participated in an interviewer-administered survey 18 months following a disabling injury or illness. The relative risks (RR) of a permanent employment separation associated with inadequate employer accommodations were estimated using inverse probability of treatment weights to reduce confounding. RESULTS: Over the 18-month follow-up, the incidence of permanent separation was 30.1/100, with 49.2% of separations related to health status. Approximately 51% of participants experiencing a separation were exposed to inadequate workplace accommodations, compared to 27% of participants in continuing employment. The propensity score adjusted RR of a health-related separation associated with inadequate accommodation was substantial [RR 2.72; 95% confidence interval (CI) 2.20-3.73], greater than the RR of separations not related to health (RR 1.68; 95% CI 1.38-2.21). CONCLUSIONS: Incidence of permanent separation in this cohort of Ontario labor force participants was approximately two times more frequent than would be expected. The adequacy of employer accommodation was a strong determinant of the risk of permanent separation. These findings emphasize the potential for strengthened workplace accommodation practices in this setting.

Association of persistent pain with the incidence of chronic conditions following a disabling work-related injury.

OBJECTIVES: In a cohort of workers disabled by a work-related injury or illness, this study aimed to: (i) compare pre-injury prevalence estimates for common chronic conditions to chronic condition prevalence in a representative sample of working adults; (ii) calculate the incidence of chronic conditions post-injury; and (iii) estimate the association between persistent pain symptoms and the incidence of common chronic conditions. METHODS: Eighteen months post-injury, 1832 workers disabled by a work-related injury or illness in Ontario, Canada, completed an interviewer-administered survey. Participants reported pre- and post-injury prevalence of seven physician-diagnosed chronic conditions, and demographic, employment, and health characteristics. Pre-injury prevalence estimates were compared to estimates from a representative sample of workers. Multivariable logistic regression was used to examine the association of persistent pain with post-injury chronic condition incidence. RESULTS: Age-standardized pre-injury prevalence rates for diabetes, hypertension, arthritis, and back problems were similar to prevalence rates observed among working adults in Ontario, while prevalence rates for mood disorder, asthma and migraine were moderately elevated. Post-injury prevalence rates of mood disorder, migraine, hypertension, arthritis, and back problems were elevated substantially in this cohort. High persistent pain symptoms were strongly associated with the 18-month incidence of these conditions. CONCLUSIONS: The incidence of five chronic conditions over an 18-month follow-up period post injury was substantial. Persistent pain at 18 months was associated with this elevated incidence, with population attributable fraction estimates suggesting that 37-39% of incident conditions may be attributed to exposure to high levels of persistent pain.

Major Depressive Episodes and Employment Earnings Trajectories over the Following Decade among Working-aged Canadian Men and Women.

OBJECTIVE: Quantify the association between experiencing a major depressive episode (MDE) and employment earnings over the following decade among working-aged Canadian men and women. METHODS: Ten national Canadian Community Health Survey (CCHS 2003-2014) cycles were linked to administrative tax records (1997-2016) for individuals 18-54 years old with information on past year MDE defined by the Composite International Diagnostic Interview Short Form (n=85,155) measured at baseline. Subsequent earnings were measured annually two to ten years post-MDE. MDE cases were matched with adult controls without MDE using 1:1 greedy nearest-neighbour without replacement propensity score matching for women and men. RESULTS: Using random-effects longitudinal modelling, among women (n=6,974) in the matched cohort (average initial earnings ~$52,119/annum, 2016 Canadian real dollars), experiencing an MDE was associated with average earnings of $4,473 less in the year the MDE was reported (95%CI=-$3,215,-$5,731) and an additional $363 less/year over the following decade (95%CI=-$132,-$594). Among men (n=3,620, average initial earnings ~$76,110/annum), an MDE was associated with an initial reduction in earnings of $5,023 (95%CI=-$2,453,-$7,593) followed by an earnings decline starting with $730/year, increasing to ~$1,810/year at ten years post-MDE. LIMITATIONS: Residual confounding by measures excluded from the propensity score. Only one MDE measurement limited exploring earnings trajectories of those with multiple episodes. CONCLUSIONS: Consistently lower earnings were seen for ten years after experiencing one MDE. The magnitude of earnings difference immediately after the MDE was similar for men and women. Findings reveal the critical period surrounding an MDE where effective clinical treatment and labor policy may help buffer longstanding earnings loss.

Evaluating the effect of delayed activation of rapid response teams on patient outcomes: a systematic review protocol.

BACKGROUND: Rapid response teams have been widely adopted across the world. Although evidence for their efficacy is not clear, they remain a popular means to detect and react to patient deterioration. This may in part be due to there being no standardized approach to their usage or implementation. A key component of their ability to be effective is the speed of response. OBJECTIVE: The objective of this review is to evaluate the effect of delayed response by rapid response teams on hospital mortality (primary), cardiac arrest, and intensive care transfer rates (secondary). METHODS: This review will include randomized and non-randomized studies which examined the effect of delayed response times by rapid response teams on patient mortality, cardiac arrest, and intensive care unit admission rates. This review will include studies of adult patients who have experienced a rapid response team consultation. The search strategy will utilize a combination of keywords and MeSH terms. MEDLINE and Embase will be searched, as well as examining gray literature. Two reviewers will independently screen retrieved citations to determine if they meet inclusion criteria. Studies will be selected that provide information about the impact of response time on patient outcomes. Comparisons will be made between consults that arrive in a timely manner and consults that are delayed. Quality assessment of randomized studies will be conducted in accordance with guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. Quality assessment of non-randomized studies will be based on the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool. Results of the review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DISCUSSION: This systematic review will identify and synthesize evidence around the impact of delayed response by rapid response teams on patient mortality, cardiac arrest, and intensive care transfer rates. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration: CRD42017071842 .

Association between psychosocial work conditions and latent alcohol consumption trajectories among men and women over a 16-year period in a national Canadian sample.

BACKGROUND: It is unclear how psychosocial working conditions influence future alcohol consumption. Using group-based trajectory modelling, this study aimed to determine: the number of latent alcohol consumption trajectories over 16 years in a representative sample of the Canadian workforce; the association between psychosocial working conditions and longitudinal alcohol consumption; and if the association between psychosocial work factors and longitudinal alcohol consumption differed among men and women. METHODS: We included 5458 employed adults from the longitudinal Canadian National Population Health Survey. Average daily alcohol consumption was measured every 2 years from 1994 to 2010. Psychosocial work factors were measured in 1994 using the Job Content Questionnaire. Group-based trajectory modelling was used to derive the appropriate number of alcohol behaviour trajectories. The association between psychosocial work factors and alcohol trajectory membership was estimated using multinomial logistic regression. Models were stratified by sex to determine if these associations differed among men and women. RESULTS: Three alcohol consumption trajectories were present: non-drinkers, light drinkers (0.5-1 drinks/day) and moderate drinkers (2-3 drinks/day). Higher workplace physical exertion and lower social support levels were associated with membership in the moderate drinking trajectory. Among men, lower psychological demands and higher physical exertion levels were associated with membership in the moderate drinking trajectory. Among women, lower levels of physical exertion were associated with membership in the light drinking trajectory, and higher psychological demand levels were associated with membership in the moderate drinking trajectory. CONCLUSIONS: Our study suggests that workplace physical exertion and psychological demands may be associated with different alcohol consumption trajectories among men and women.

Socioeconomic Attainment of Extremely Low Birth Weight Survivors: The Role of Early Cognition.

OBJECTIVES: To determine: (1) if childhood cognitive and academic abilities mediate the association between being born at extremely low birth weight (ELBW) and socioeconomic attainment at age 29 to 36 years; (2) which cognitive abilities (IQ, verbal abilities, fluid intelligence, mathematical abilities, or academic achievement) most strongly mediate this association; and (3) if the mediating role of cognition is different in ELBW survivors with significant neurosensory impairment (NSI). METHODS: A prospective, longitudinal cohort of 100 Canadian ELBW survivors born between 1977 and 1982 and 89 normal birth weight comparison participants were used to examine the mediating role of childhood cognition by using 5 cognitive mediators assessed at age 8 years (overall IQ, verbal IQ, performance IQ, quantitative ability, and academic achievement) on socioeconomic attainment at adulthood. Socioeconomic attainment was defined as personal annual earnings and full-time employment assessed via self-report at age 29 to 36 years. RESULTS: Mediation models revealed that childhood cognition mediated the association between ELBW status and income attainment, with mathematical abilities and overall IQ each accounting for 26% of the direct effect. Mediated effects were not statistically significant in full-time employment models. For both outcomes, the mediating effect of cognition was stronger for ELBW survivors with NSI. CONCLUSIONS: Childhood cognitive abilities partially mediate associations between ELBW status and adult income attainment. Early life cognition is a critical predictor of socioeconomic attainment in ELBW survivors, particularly in those born with NSI. Interventions aimed at enhancing early cognition in ELBW survivors may help optimize their later socioeconomic attainment.

Associations Between Childhood Cognition and Cardiovascular Events in Adulthood: A Systematic Review and Meta-analysis.

BACKGROUND: The success of behavioural interventions to optimize cardiovascular health is dependent on adequate cognitive functioning beginning in early life. In this study we aimed to systematically review studies that examined associations between childhood cognition and cardiovascular disease (CVD) events in adulthood. METHODS: This study followed the Meta-analysis Of Observational Studies in Epidemiology guidelines to systematically examine associations between childhood cognition and adult CVD, coronary heart disease, and stroke hospitalization or mortality events. Literature was retrieved from EMBASE, MEDLINE, PsycInfo, and CINAHL. RESULTS: Five longitudinal studies that examined links between childhood cognition and CVD in adulthood were included. Pooled estimates of unadjusted CVD events indicated a relative risk of 1.23 (95% confidence interval, 1.12-1.34) per standard deviation decrease in childhood IQ, whereas the pooled estimate adjusted for biopsychosocial confounding factors indicated an overall relative risk of 1.16 (95% confidence interval, 1.07-1.26). CONCLUSIONS: Lower childhood IQ is associated with an increased risk of cardiovascular events in adulthood, even after adjustment for confounding variables. Future research should examine the behavioural mechanisms by which these risks are mediated to optimize cardiovascular health.

Mental health of extremely low birth weight survivors: A systematic review and meta-analysis.

Although individuals born at extremely low birth weight (ELBW; < 1,000 g) are the most vulnerable of all preterm survivors, their risk for mental health problems across the life span has not been systematically reviewed. The primary objective of this systematic review and meta-analysis was to ascertain whether the risk for mental health problems is greater for ELBW survivors than their normal birth weight (NBW) peers in childhood, adolescence, and adulthood. Forty-one studies assessing 2,712 ELBW children, adolescents, and adults and 11,127 NBW controls were reviewed. Group differences in mental health outcomes were assessed using random effects meta-analyses. The impacts of birthplace, birth era, and neurosensory impairment on mental health outcomes were assessed in subgroup analyses. Children born at ELBW were reported by parents and teachers to be at significantly greater risk than NBW controls for inattention and hyperactivity, internalizing, and externalizing symptoms. ELBW children were also at greater risk for conduct and oppositional disorders, autistic symptoms, and social difficulties. Risks for parent-reported inattention and hyperactivity, internalizing, and social problems were greater in adolescents born at ELBW. In contrast, ELBW teens self-reported lower inattention, hyperactivity, and oppositional behavior levels than their NBW peers. Depression, anxiety, and social difficulties were elevated in ELBW survivors in adulthood. Group differences were robust to region of birth, era of birth, and the presence of neurosensory impairments. The complex needs faced by children born at ELBW continue throughout development, with long-term consequences for psychological and social well-being. (PsycINFO Database Record