Evidence for the use of cannabis-based medicines in osteoarthritis: a scoping review.

The purpose of this study was to conduct a scoping review to describe the evidence on the efficacy and safety of using cannabis-based medicines for osteoarthritis. The review was conducted following the framework proposed by Arksey and O'Malley and reported following PRISMA extension for scoping reviews guidelines. We conducted a comprehensive search across various databases including MEDLINE, Embase, Cochrane Library, CINAHL, Scopus, and Proquest, spanning from inception of each database to March 2023. We retrieved 2533 citations, and after deduplication, title and abstract screening, and full-text screening, 10 articles were included for analysis. These studies were composed of randomized-controlled trials (n = 4/10), cross-sectional surveys (n = 3/10), case studies (n = 2/10), and a cohort study (n = 1/10). Evidence for using cannabis-based medicines was mixed, with just 60% (n = 6/10) of included studies reporting statistically significant improvements in pain. Studies with larger samples sizes and longer durations of exposure did not find significant benefits for pain. The few adverse effects reported were generally mild and affected a minority of participants. Several studies also discovered that cannabis-based medicines were associated with a reduction in opioid use. Currently available data on the use of cannabis-based medicines in osteoarthritis is insufficient to make recommendations. Future research should address concerns regarding small sample sizes and short treatment durations to provide a more robust evidence base. Key Points • Current evidence remains mixed; studies that found a positive benefit with using cannabis-based medicines had limitations with small sample sizes and short durations of exposure • The use of cannabis-based medicines in osteoarthritis appears to be generally well tolerated, adverse effects are mild and experienced by a minority of participants • Cannabis-based medicines may decrease the use of opioids in patients with osteoarthritis • Future research should address the gaps in long-term efficacy and safety data.

Linking weather and health outcomes: Examining the potential influences of weather factors and particulate matter pollution on adverse pregnancy outcomes in the Kavre district, Nepal.

INTRODUCTION: Adverse pregnancy outcomes (APOs) include stillbirth, preterm birth, and low birthweight (LBW). Studies exploring the impact of weather factors and air pollution on APOs are scarce in Nepal. We examined the impacts of prenatal exposure to temperature, precipitation, and air pollution (PM2.5) on APOs among women living in Kavre, Nepal. METHODS: We conducted a hospital and rural health centers-based historical cohort study that included health facility birth records (n = 1716) from the Nepali fiscal year 2017/18 through 2019/20. We linked health records to temperature, precipitation, and PM2.5 data for Kavre for the six months preceding each birth. A random intercept model was used to analyze birthweight, while a composite APO variable, was analyzed using multivariable logistic regression in relation to environmental exposures. RESULTS: The proportion of LBW (<2500 gm), preterm birth (babies born alive before 37 weeks of gestation), and stillbirth was 13%, 4.3%, and 1.5%, respectively, in this study. Overall, around 16% of the study participants had one or more APOs. Total precipitation (ß: 0.17, 95% CI 0.01 to 0.33, p = 0.03) had a positive effect on birthweight in the wetter season. Negative effects for mean maximum (ß: 33.37, 95% CI -56.68 to -10.06, p = 0.005), mean (ß: 32.35, 95% CI -54.44 to -10.27, p = 0.004), and mean minimum temperature (ß: 29.28, 95% CI -49.58 to -8.98, p = 0.005) on birthweight was also observed in the wetter season. CONCLUSION: A positive effect of temperature (mean maximum, mean, and mean minimum) and total precipitation on birthweight was found in the wetter season. This study emphasizes the need for future research using larger cohorts to elucidate these complex relationships in Nepal.

Autistic Regression and Exposure to Industrial Chemicals: Preliminary Observations.

Exposure to industrial pollutants is a potential risk factor not fully explored in ASD with regression (ASD+R). We studied geographical collocation patterns of industrial air chemical emissions and the location of homes of children with ASD+R at different exposure times, compared with ASD cases without regression (ASD-R). Fifteen of 111 emitted chemicals collocated with ASD+R, and 65 with ASD-R. ASD+R collocated more strongly with different neurotoxicants/immunotoxicants a year before diagnosis, whereas ASD-R were moderately collocated with chemicals across all exposure periods. This preliminary exploratory analysis of differences in exposure patterns raises a question regarding potential pathophysiological differences between the conditions.

An investigation into the relationship between community engagement and maternal mental health in Calgary, Alberta using the All Our Families cohort.

INTRODUCTION: Existing literature shows that increased community engagement is associated with decreased depressive symptoms. To our knowledge, no existing studies have investigated the relationship between community engagement and adverse mental health among mothers in a Canadian context, nor has this relationship been studied over time. The current study aims to address these gaps by modelling the association between community engagement and anxiety and depression longitudinally using a cohort of prenatal and postnatal mothers living in Calgary, Alberta. METHODS: We used data from the All our Families (AOF) study, a prospective cohort study of expectant and new mothers in Calgary, Alberta from 2008 to 2017 across seven timepoints. We used three-level latent growth curves to model the relationship between individual-level community engagement and maternal depression and anxiety scores, while adjusting for both individual and neighborhood-level characteristics. RESULTS: The study sample consisted of 2129 mothers across 174 neighborhoods in Calgary. Adjusted latent growth curve models demonstrated that community engagement was associated with lower depression (b = - 0.28, 95% CI - 0.33, - 0.23) and anxiety (b = - 0.07, 95% CI - 0.12, - 0.02) scores among mothers over time. DISCUSSION: Adjusted results show that community engagement has a protective effect against depression and anxiety amongst mothers. The results of this study are in line with existing evidence suggesting that social cohesion, civic participation, and community engagement are protective against adverse mental health outcomes.

Investigating associations between maternal stress, smoking and adverse birth outcomes: evidence from the All Our Families cohort.

BACKGROUND: Independently, active maternal and environmental tobacco smoke exposure and maternal stress have been linked to an increased risk of preterm birth and low birth weight. An understudied relationship is the potential for interactive effects between these risk factors. METHODS: Data was obtained from the All Our Families cohort, a study of 3,388 pregnant women < 25 weeks gestation recruited from those receiving prenatal care in Calgary, Canada between May 2008 and December 2010. We investigated the joint effects of active maternal smoking, total smoke exposure (active maternal smoking plus environmental tobacco smoke) and prenatal stress (Perceived Stress Scale, Spielberger State-Trait Anxiety Inventory), measured at two time points (< 25 weeks and 34-36 weeks gestation), on preterm birth and low birth weight. RESULTS: A marginally significant association was observed with the interaction active maternal smoking and Spielberger State-Trait Anxiety Inventory scores in relation to low birth weight, after imputation (aOR = 1.02, 95%CI: 1.00-1.03, p = 0.06). No significant joint effects of maternal stress and either active maternal smoking or total smoke exposure with preterm birth were observed. Active maternal smoking, total smoke exposure, Perceived Stress Scores, and Spielberger State-Trait Anxiety Inventory scores were independently associated with preterm birth and/or low birth weight. CONCLUSIONS: Findings indicate the role of independent effects of smoking and stress in terms of preterm birth and low birthweight. However, the etiology of preterm birth and low birth weight is complex and multifactorial. Further investigations of potential interactive effects may be useful in helping to identify women experiencing vulnerability and inform the development of targeted interventions.

The implementation of target trial emulation for causal inference: a scoping review.

OBJECTIVES: We aim to investigate the implementation of Target Trial Emulation (TTE) for causal inference, involving research topics, frequently used strategies, and issues indicating the need for future improvements. STUDY DESIGN AND SETTING: We performed a scoping review by following the Joanna Briggs Institute (JBI) guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A health research-focused librarian searched multiple medical databases, and two independent reviewers completed screening and extraction within covidence review management software. RESULTS: Our search resulted in 1,240 papers, of which 96 papers were eligible for data extraction. Results show a significant increase in the use of TTE in 2018 and 2021. The study topics varied and focused primarily on cancer, cardiovascular and cerebrovascular diseases, and infectious diseases. However, not all papers specified well all three critical components for generating robust causal evidence: time-zero, random assignment simulation, and comparison strategy. Some common issues were observed from retrieved papers, and key limitations include residual confounding, limited generalizability, and a lack of reporting guidance that need to be improved. CONCLUSION: Uneven adherence to the TTE framework exists, and future improvements are needed to progress applications using causal inference with observational data.

Perceptions of Cannabis Use: A Qualitative Descriptive Study of Rheumatology Patients.

INTRODUCTION/OBJECTIVES: Some rheumatology patients use or contemplate using cannabis, however, may not be transparent about use with their providers. The objective of this qualitative descriptive study was to describe beliefs, perceptions, and learning needs of adults with rheumatic conditions regarding the use of cannabis products. METHODS: Purposive sampling was conducted through a rheumatology clinic and sought participants who were using or thinking about using cannabis. Two online focus groups based on cannabis use patterns (non-users and users) were conducted separately. Interviews were audio recorded and transcribed. Three research team members read the transcripts independently to identify initial codes and themes. Data saturation was reached with the interviews. RESULTS: We recruited 12 participants between 52 and 85 years old. The first theme was pain and desperation. Stigma was the second theme with a perception of physician opposition to cannabis, and the reluctance of many participants to discuss cannabis use with physicians. The final theme was a need for information and a general lack of trustworthy and credible sources. Users were willing to try cannabis even if they still had questions. CONCLUSION: Rheumatology patients are open to using cannabis due to the burden and suffering associated with pain. They remain silent on the topic, however, because of stigma and lack of engagement from health care professionals, particularly physicians. Patients voiced a strong need for information regarding cannabis and want healthcare providers to initiate discussion. These findings are clinically relevant to the management of rheumatic conditions and the promotion of therapeutic relationships.

Social participation of older people in urban and rural areas: Canadian Longitudinal Study on Aging.

BACKGROUND AND OBJECTIVES: Although the positive influence of social activity on health is now well-established, a complex relationship exists among social participation, personal, social and the environment. Social participation of older adults was examined in rural and urban settings to identify features of the built-environment and perception of neighborhood specific to the locale. RESEARCH DESIGN AND METHODS: Using cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA), we examined social participation and health of older people (65 + yrs) in relation to the built environment and sociocultural contexts for urban and rural areas. A social participation index was derived from responses on the frequency of participating in 8 social activities over the past 12 months. Personal, household and neighborhood indicators were examined to develop multivariable regression models for social participation in urban and rural cohorts. RESULTS: No meaningful differences were seen with the frequency of social participation between rural and urban settings; however, the type of community-related activities differed in that a greater proportion of urban participants reported sports and educational/cultural events than rural participants. Service club activities were greater for rural than urban participants. Different neighborhood features were statistically significant factors in explaining social participation in rural than in urban locales, although transportation was a significant factor regardless of locale. Trustworthiness, belonging and safety were perceived factors of the neighborhood associated with higher social participation for rural participants. DISCUSSION AND IMPLICATIONS: The relationship between home and health becomes stronger as one ages. Social and physical features of built environment specific to urban and rural settings need to be considered when implementing appropriate social activities for older people.

Developing a triage predictive model for access to a spinal surgeon using clinical variables and natural language processing of radiology reports.

PURPOSE: To utilize natural language processing (NLP) of MRI reports and various clinical variables to develop a preliminary model predictive of the need for surgery in patients with low back and neck pain. Such a model would be beneficial for informing clinical practice decisions and help reduce the number of unnecessary surgical referrals, streamlining the surgical process. METHODS: A historical cohort study was conducted using de-identified data from patients referred to a spine assessment clinic. Various demographic, clinical, and radiological variables were included as potential predictors. Full-text radiology reports of patients' MRI findings were vectorized using NLP before applying machine learning algorithms to develop models predicting who underwent surgery. Outputs from these models were then entered into a logistic regression model with clinical variables to develop a preliminary model predictive of surgical recommendations. RESULTS: Of the 398 patients assessed, 71 underwent spine surgery. NLP variables were significant predictors in univariate analysis but did not remain in the final logistic regression model. An outcome of receiving surgery was predicted by a primary symptom of low back and leg pain (adjusted odds ratio 2.81), distal pain indicated by a pain diagram (adjusted odds ratio 2.49) and self-reported difficulties walking (adjusted odds ratio 2.73). CONCLUSION: A logistic regression model was created to predict which patients may require spine surgery. Simple clinical variables appeared more predictive than variables created using NLP. However, additional research with more data samples is needed to validate this model and fully evaluate the usefulness of NLP for this task.

Climate change impacts on the health of South Asian children and women subpopulations - A scoping review.

Background and objectives: Climate change impacts are felt unequally worldwide; populations that experience geographical vulnerability, those living in small island states and densely populated coastal areas, and children and women are affected disproportionately. This scoping review aims to synthesize evidence from relevant studies centred on South Asia, identify research gaps specifically focused on children and women's health, and contribute to knowledge about South Asia's existing mitigation and adaptation strategies. Methods: A research librarian executed the search on six databases using controlled vocabulary (e.g., MeSH, Emtree, etc.) and keywords representing the concepts "vulnerable populations" and "climate change" and "health impacts" and "South Asia." Databases were searched from January 2010 to May 2020. Papers were screened independently by two researchers. Results: Forty-two studies were included, of which 23 were based in India, 14 in Bangladesh, and five in other South Asian countries. Nineteen studies focused on meteorological factors as the primary exposure. In contrast, thirteen focused on extreme weather events, nine on air pollution, and one on salinity in coastal areas. Thirty-four studies focused on the health impacts on children related to extreme weather events, meteorological factors, and air pollution, while only eight studies looked at health impacts on women. Undernutrition, ARI (acute respiratory infection), diarrheal diseases, low birth weight, and premature mortality were the major health impacts attributed to extreme weather events, meteorological factors, and air pollution exposure in children and women in the region. Conclusion: Extreme weather events, meteorological factors and air pollution have affected the health of children and women in South Asia. However, the gap in the literature across the South Asian countries concerning relationships between exposure to extreme weather events, meteorological factors, air pollution and health effects, including mental health problems in children and women, are opportunities for future work.

Neighbourhood Income Inequality and General Psychopathology at 3-Years of Age.

Background: Several studies have linked neighbourhood environment to preschool-aged children's behavioural problems. Income inequality is an identified risk factor for mental health among adolescents, however, little is known as to whether this relationship extends to younger children. Objective: To explore the association between neighbourhood-level income inequality and general psychopathology problems among preschool-aged children. Methods: We analyzed data from the All Our Families (AOF) longitudinal cohort located in Calgary, Canada at 3-years postpartum. The analytical sample consisted of 1615 mother-preschooler dyads nested within 184 neighbourhoods. Mothers completed the National Longitudinal Survey of Children and Youth Child Behaviour Checklist (NLSCY-CBCL), which assessed internalizing and externalizing symptoms. Income inequality was assessed via the Gini coefficient, which quantifies the unequal distribution of income in society. Mixed effects linear regression assessed the relationship between neighbourhood income inequality and preschooler's general psychopathology. Results: The mean Gini coefficient across the 184 neighbourhoods was 0.33 (SD = 0.05; min, max: 0.20-0.56). In the fully adjusted model income inequality was not associated with general psychopathology in children ß = 0.07 (95%CI: -0.29, 0.45). Neighbourhood environment accounted for 0.5% of the variance in psychopathology in children. Conclusion: The lack of significant findings may be due to a lack of statistical power in the study. Future studies should investigate this relationship with appropriately powered studies, and over time, to assess if income inequality is a determinant of preschooler psychopathology in Canada.

Contexte: Plusieurs études ont relié l'environnement du quartier aux problèmes de comportement des enfants d'âge préscolaire. L'inégalité du revenu est un facteur de risque identifié pour la santé mentale chez les adolescents, pourtant, on ne sait pas encore si cette relation s'étend aux enfants plus jeunes. Objectif: Explorer l'association entre l'inégalité du revenu au niveau du quartier et les problèmes de psychopathologie générale chez les enfants d'âge préscolaire. Méthodes: Nous avons analysé les données de la cohorte longitudinale All Our Families (AOF) située à Calgary, Canada, à 3 ans de postpartum. L'échantillon analytique consistait en 1615 dyades mère-enfant d'âge préscolaire logées dans 184 quartiers. Les mères ont rempli l'Enquête longitudinale nationale sur les enfants et les jeunes et la liste de contrôle du comportement de l'enfant (ELNEJ-LCCE), qui évaluaient les symptômes d'internalisation et d'externalisation. L'inégalité du revenu était évaluée par le coefficient Gini, qui quantifie la distribution inégale du revenu dans la société. La régression linéaire à effets mixtes a évalué la relation entre l'inégalité du revenu du quartier et la psychopathologie générale de enfants d'âge préscolaire. Résultats: Le coefficient Gini moyen dans les 184 quartiers était de 0,33 (ET = 0,05; min, max : 0,20­0,56). Dans le modèle complétement ajusté, l'inégalité du revenu n'était pas associée à la psychopathologie générale des enfants ß = 0,07 (IC à 95 % −0,29 à 0,45). L'environnement du quartier représentait 0,5 % de la variance de psychopathologie chez les enfants. Conclusion: L'absence de résultats significatifs peut être attribuable au manque de puissance statistique de l'étude. Les futures études devraient investiguer cette relation avec des études d'une puissance appropriée, et avec le temps, évaluer si l'inégalité du revenu est déterminante de la psychopathologie des enfants d'âge préscolaire au Canada.

The Impacts of Prenatal Mental Health Issues on Birth Outcomes during the COVID-19 Pandemic: A Scoping Review.

BACKGROUND: The severity of the COVID-19 pandemic is likely to exacerbate mental health problems during the prenatal period and increase the risk of adverse birth outcomes. This review assessed the published literature related to the impacts of prenatal mental health issues on birth outcomes during the COVID-19 pandemic. METHODS: This scoping review was conducted using PROSPERO, Cochrane Library, OVID Medline, Ovid EMBASE, OVID PsycInfo, EBSCO CINAHL, and SCOPUS. The search was conducted using controlled vocabulary and keywords representing the concepts "COVID19", "mental health" and "birth outcomes". The main inclusion criteria were peer-reviewed published articles from late 2019 to the end of July 2021. RESULTS AND DISCUSSION: After removing duplicates, 642 articles were identified, of which two full texts were included for analysis. Both articles highlighted that pregnant women have experienced increasing prenatal mental health issues during the COVID-19 pandemic and, further, increased the risk of developing adverse births. This scoping review highlighted that there is a lack of research on the impact of prenatal mental health issues on birth outcomes during the pandemic. CONCLUSION: Given the severity of the COVID-19 pandemic and the burdens of prenatal mental health issues and adverse birth outcomes, there is an urgent need to conduct further research.

Geographic inequalities in paediatric emergency department visits in Ontario and Alberta: a multilevel analysis of 2.5 million visits.

BACKGROUND: Research on intra- and inter-regional variations in emergency department (ED) visits among children can provide a better understanding of the patterns of ED utilization and further insight into how contextual features of the urban environment may be associated with these health events. Our objectives were to assess intra-urban and inter-urban variation in paediatric emergency department (PED) visits in census metropolitan areas (CMAs) in Ontario and Alberta, Canada and explore if contextual factors related to material and social deprivation, proximity to healthcare facilities, and supply of family physicians explain this variation. METHODS: A retrospective, population-based analysis of data on PED visits recorded between April 1, 2015 and March 31, 2017 was conducted. Random intercept multilevel regression models were constructed to quantify the intra- (between forward sortation areas [FSAs]) and inter- (between CMAs) variations in the rates of PED visits. RESULTS: In total, 2,537,442 PED visits were included in the study. The overall crude FSA-level rate of PED visits was 415.4 per 1,000 children population. Across CMAs, the crude rate of PED visits was highest in Thunder Bay, Ontario (771.6) and lowest in Windsor, Ontario (237.2). There was evidence of substantial intra- and inter-urban variation in the rates of PED visits. More socially deprived FSAs, FSAs with decreased proximity to healthcare facilities, and CMAs with a higher rate of family physicians per 1,000 children population had higher rates of PED visits. CONCLUSIONS: The variation in rates of PED visits across CMAs and FSAs cannot be fully accounted for by age and sex distributions, material and social deprivation, proximity to healthcare facilities, or supply of family physicians. There is a need to explore additional contextual factors to better understand why some metropolitan areas have higher rates of PED visits.

Risk Factors for Developing Concurrent Posttraumatic Stress Injury After Work-Related Musculoskeletal Injury: A Case-Control Study.

OBJECTIVE: This study aimed to study risk factors for developing concurrent posttraumatic stress injury (PTSI) among workers experiencing work-related musculoskeletal injury (MSI). METHODS: A case-control study was conducted using workers' compensation data on injured workers undergoing rehabilitation programs for concurrent MSI and PTSI (cases) and MSI only (controls). A variety of measures known at the time of the compensable injury were entered into logistic regression models. RESULTS: Of the 1948 workers included, 215 had concurrent MSI and PTSI. Concurrent MSI and PTSI were predicted by type of accident (adjusted odds ratio [OR], 25.8), experiencing fracture or dislocation fracture or dislocation (adjusted OR, 3.7), being public safety personnel (adjusted OR, 3.1), and lower level of education (adjusted OR, 1.9). CONCLUSIONS: Experiencing a concurrent PTSI diagnosis with MSI after work-related accident and injury appears related to occupation, type of accident, and educational background.

One Health, One Hive: A scoping review of honey bees, climate change, pollutants, and antimicrobial resistance.

Anthropogenic climate change and increasing antimicrobial resistance (AMR) together threaten the last 50 years of public health gains. Honey bees are a model One Health organism to investigate interactions between climate change and AMR. The objective of this scoping review was to examine the range, extent, and nature of published literature on the relationship between AMR and honey bees in the context of climate change and environmental pollutants. The review followed systematic search methods and reporting guidelines. A protocol was developed a priori in consultation with a research librarian. Resulting Boolean search strings were used to search Embase® via Ovid®, MEDLINE®, Scopus®, AGRICOLA™ and Web of Science™ databases. Two independent reviewers conducted two-stage screening on retrieved articles. To be included, the article had to examine honey bees, AMR, and either climate change or environmental pollution. Data, in accordance with Joanna Briggs Institute guidelines, were extracted from relevant articles and descriptively synthesized in tables, figures, and narrative form. A total of 22 articles met the inclusion criteria, with half of all articles being published in the last five years (n = 11/22). These articles predominantly investigated hive immunocompetence and multi-drug resistance transporter downregulation (n = 11/22), susceptibility to pests (n = 16/22), especially American foulbrood (n = 9/22), and hive product augmentation (n = 3/22). This review identified key themes and gaps in the literature, including the need for future interdisciplinary research to explore the link between AMR and environmental change evidence streams in honey bees. We identified three potential linkages between pollutive and climatic factors and risk of AMR. These interconnections reaffirm the necessity of a One Health framework to tackle global threats and investigate complex issues that extend beyond honey bee research into the public health sector. It is integral that we view these "wicked" problems through an interdisciplinary lens to explore long-term strategies for change.

Risk and Resilience: How Is the Health of Older Adults and Immigrant People Living in Canada Impacted by Climate- and Air Pollution-Related Exposures?

BACKGROUND: In the rapidly shifting Canadian climate, an ageing population, and increased migration, a greater understanding of how local climate and air pollution hazards impact older adults and immigrant populations will be necessary for mitigating and adapting to adverse health impacts. OBJECTIVES: To explore the reported health impacts of climate change and air pollution exposures in older adults and immigrant people living in Canada, identify known factors influencing risk and resilience in these populations and gaps in the literature. METHODS: We searched for research focused on older adults and immigrants living in Canada, published from 2010 onward, where the primary exposures were related to climate or air pollution. We extracted data on setting, exposures, health outcomes, and other relevant contextual factors. RESULTS AND DISCUSSION: We identified 52 eligible studies, most focused in Ontario and Quebec. Older people in Canada experience health risks due to climate and air pollution exposures. The extent of the risk depends on multiple factors. We found little information about the climate- and air pollution-related health impacts experienced by immigrant communities. CONCLUSIONS: Further research about climate- and air pollution-related exposures, health, and which factors promote or reduce resiliency in Canada's older adults and immigrant communities is necessary.

Characteristics and Prognostic Factors for Return to Work in Public Safety Personnel with Work-Related Posttraumatic Stress Injury Undergoing Rehabilitation.

PURPOSE: Public safety personnel (PSP) are at risk of developing posttraumatic stress injury (PTSI) due to exposure to traumatic experiences and accidents. Rehabilitation programs are available, but their success varies. We studied: (1) characteristics of PSP undergoing PTSI rehabilitation in comparison to non-PSP workers; and (2) predictive value of various factors for return to work. Methods A population-based cohort study was conducted using data on injured workers undergoing PTSI rehabilitation. Of the 488 workers included, 131 were PSP. Outcome measures were: (1) return to pre-accident work at rehabilitation discharge; (2) days receiving wage replacement benefits in the year following rehabilitation. Results PSP were mainly employed (90.8%), male (59.5%), paramedics/ambulance workers (58.0%); a minority (43.5%) returned to pre-accident work after rehabilitation. Compared to non-PSP workers, PSP were more likely to initially be diagnosed with psychological injuries (94.7% versus 59.4%, p < 0.001) rather than musculoskeletal injuries. Return to pre-accident work was predicted by shorter injury duration, having a primary mental health diagnosis, working at time of admission, and not having symptoms requiring treatment in a complex rehabilitation program. PSPs were slower to experience full recovery in the year after rehabilitation. Factors predicting fewer benefit days included not having a secondary psychological injury, being employed, and working at time of admission. Conclusions Most PSP did not return to work in full after PTSI rehabilitation. Outcomes are likely to improve by starting treatment earlier and maintaining connections with the workplace.

Household Air Pollution and Angina Pectoris in Low- and Middle-Income Countries: Cross-Sectional Evidence from the World Health Survey 2002-2003.

The evidence regarding the effects of household air pollution on angina pectoris is limited in low-and middle-income countries (LMICs). We sought to examine the association between household air pollution and angina pectoris across several countries. We analyzed data of individuals from 46 selected countries participating in the cross-sectional World Health Survey (WHS) 2002-2003. Pooled and stratified (sex, continent) logistic regression with sampling weights was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to quantify associations between the use of different household fuels with angina pectoris. In the pooled sample, we observed lower odds of angina pectoris with electricity use (OR: 0.68, 95% CI: 0.56-0.83) compared to those households reporting the use of gas as a household fuel. Increased odds of angina pectoris were observed with the use of agriculture/dung/shrub/other (OR: 1.65, 95% CI: 1.30-2.09), mixed (solid and non-solid fuels) (OR: 1.31, 95% CI: 1.09-1.56), and mixed solid fuel use (OR: 1.59, 95% CI: 1.12-2.25). Higher odds of angina pectoris were observed mainly with solid fuel use. The results highlight the importance of addressing these issues, especially in regions with a high proportion of solid fuel users and increasing levels of cardiovascular disease.

Household air pollution and arthritis in low-and middle-income countries: Cross-sectional evidence from the World Health Organization's study on Global Ageing and Adult Health.

BACKGROUND: Evidence points to a clear link between air pollution exposure and several chronic diseases though investigations regarding arthritis are still lacking. Emerging evidence suggests an association between ambient air pollution and rheumatoid arthritis. Household air pollution exposure, conversely, is largely unstudied but may be an important consideration for arthritis, particularly in low- and middle-income countries (LMICs), where cooking and heating activities can generate high indoor air pollutant levels. METHODS: We investigated the association of household air pollution (electricity vs. gas; kerosene/paraffin; coal/charcoal; wood; or agriculture/crop/animal dung/shrubs/grass as the main fuel used for cooking) and arthritis in six LMICs (China, Ghana, India, Mexico, the Russian Federation, South Africa) using data from Wave I of the World Health Organization Study on Global AGEing and Adult Health (SAGE) (2007-2010). Multivariable analyses were adjusted for sociodemographic, household and lifestyle characteristics and several comorbidities. RESULTS: The use of gas (aOR = 1.76, 95%CI: 1.40-2.21); coal (aOR = 1.74, 95%CI: 1.22-2.47); wood (aOR = 1.69, 95%CI: 1.30-2.19); or agriculture/crop/animal dung/shrubs/grass: aOR = 1.95 (1.46-2.61) fuels for cooking were strongly associated with an increased odds of arthritis, compared to electricity in cluster and stratified adjusted analyses. Gender (female), age (≥50 years), overweight (25.0 ≤BMI<30.0 kg/m2), obesity (BMI ≥30.0 kg/m2), former and current alcohol consumption, and the comorbidities angina pectoris, diabetes, chronic lung disease, depression and hypertension were also associated with a higher odds of arthritis. Underweight (BMI<18.5 kg/m2) and higher education levels (college/university completed/post-graduate studies) were associated with a lower odds of arthritis. CONCLUSIONS: These findings suggest that exposure to household air pollution from cook fuels is associated with an increased odds of arthritis in these regions, which warrants further investigation.