Risk of Mortality Associated with Potentially Inappropriate Medication Use Including Opioids in Older Adults.

INTRODUCTION AND OBJECTIVE: As the population ages, understanding the potential risks associated with inappropriate medication use becomes increasingly important. Given the lack of studies in this area, our objective was to study the risk of mortality associated with potentially inappropriate medication use involving opioids in community-dwelling older adults. METHODS: Data came from a longitudinal study on older adults aged ≥ 65 years recruited in primary care clinics between 2011 and 2013 with an average follow-up of 4.25 years. Older adults were excluded if they used an opioid or had a malignant tumor diagnosis in the year before the study survey. A nested case-control within a cohort of older adults with at least one opioid claim during follow-up was used to evaluate the risk of all-cause mortality. Four controls per case were matched on follow-up time using risk-set sampling, i.e., while still at risk of death when their matched case died. The risk of mortality was estimated using conditional logistic regression analyses. Exposure to potentially inappropriate medication use involving opioids, defined using the Beers 2019 criteria, was assessed from provincial drug claims data in the 0-90 days before death. RESULTS: In a cohort of 472 community-dwelling older adults with an incident episode of opioid use, there were 40 cases matched to 160 controls. Exposure to inappropriate medication use involving opioids in the 90 days before death was associated with an increased risk of mortality (odds ratio 6.81, 95% confidence interval 1.69-27.47), after adjusting for potential confounders. CONCLUSIONS: Exposure to inappropriate medication use involving opioids in the 90 days before death is associated with an increased risk of mortality in older adults. These findings can be used to encourage safer pain management strategies in older adults.

ESport programs in high school: what's at play?

Background: A growing number of high schools in Canada offer eSports (ES) in their facilities, which raises concerns regarding this activity's potential health risks for adolescents. Methods: The aim of this study is to describe the characteristics of 67 adolescent ES players (ESp) and to compare them to 109 recreational gamers in their high school (nESp). The two groups were compared on (1) sociodemographic and academic characteristics; (2) online and offline activities; (3) psychological characteristics. Results: Results show that ESp spend more time on online activities and report a higher proportion of problematic gaming compared to the nESp group. ESp report more often that gaming has positive consequences on their physical health and report more often negative consequences on their education compared to the nESp group. Conclusion: These results underscore the importance of screening gaming problems among adolescent ES players. Targeted prevention should be carried out with these teenagers and in order to be adapted, prevention efforts should consider both, the positive and negative consequences that ESp experience from gaming.

The Development of a New Patient-Reported Outcome Measure in Recessive Ataxias: The Person-Reported Ataxia Impact Scale.

Autosomal recessive cerebellar ataxias (ARCAs) are inherited neurological disorders that can affect both the central and peripheral nervous systems. To assess the effects of interventions according to the perception of people affected, patient-reported outcome measures (PROMs) must be available. This paper presents the development process of the Person-Reported Ataxia Impact Scale (PRAIS), a new PROM in recessive ataxias, and the documentation of its content validity, interpretability, and construct validity (structural and discriminant). The development followed the PROMIS framework and the Food and Drug Administration guidelines. A mixed-method study design was used to develop the PROM. A systematic review of the literature, semistructured interviews, and discussion groups was conducted to constitute an item pool. Experts' consultation helped formulate items, and the questionnaire was sent online to be completed by people affected. Statistical analyses were performed to assess the structural and discriminant validity. A total of 125 people affected by recessive ataxia completed the questionnaire. The factor analysis confirmed the three components: physical functions and activities, mental functions, and social functions. The statistical analysis showed that it can discriminate between stages of mobility and level of autonomy. It showed very good levels of internal consistency (0.79 to 0.89). The Person-Reported Ataxia Impact Scale (PRAIS) is a 38-item questionnaire that assesses the manifestations and impacts of the disease according to the perception of people affected by recessive ataxia. It can be used in clinical and research settings.

Predictors of job tenure for people with a severe mental illness, enrolled in supported employment programs.

OBJECTIVE: Different predictors of job tenure for people with a severe mental illness (SMI) have been documented. Conflicting results may be explained by the choice of indicators to measure job tenure. This study aimed to assess the contribution of employment specialist competencies working in supported employment programs, client variables, and work accommodations, in determining job tenure in the regular labor market. METHOD: A longitudinal study was conducted over 6 months, including people with SMI (n = 209) registered in 24 Canadian supported employment programs. Multivariable modeling analyses were performed. RESULTS: Overall, 67% (n = 140) of the sample were employed at the 6-month follow-up. Multilevel analyses showed that shorter duration of unemployment (i.e., the number of weeks worked), employment specialist knowledge, and working alliance were the strongest predictors of job tenure for people with SMI. With respect to the number of hours worked per week, diagnosis, executive functions, social functioning, work accommodations, and employment specialist skills were the strongest predictors of job tenure for people with SMI, with 57% of variance explained. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Understanding the various predictors of job tenure can assist employment specialists in providing better interventions for the work integration of people with SMI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon.

AIM: To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. METHODS: Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. RESULTS: The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. CONCLUSION: tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.

Single points of access to fill the "GAP" for unattached patients in primary care: what makes paediatric users more likely to require a medical appointment?

Unattachment to a regular primary care professional can affect children's and adolescents' well-being, considering their unique health needs. Having no alternative, many turn to emergency departments for non-urgent conditions. To help unattached patients access healthcare services while on waitlists, Quebec's government implemented single access points in each administrative region across the province. Our study aimed to describe the paediatric population using single access points and identify associations between their characteristics and need for a medical appointment. Clinical-administrative data of 1,323 paediatric access point users in the Montérégie region from November 2022 to March 2023 were utilized to conduct bivariate and multivariable regression analyses. Our study showed that young age, assessment trajectory, and specific reasons for calling were more likely to necessitate a medical appointment. While access points improve accessibility to doctors, questions remain regarding the relevance of medical consultations, inequities, and possible security issues resulting from the overall process.

Taxonomy of advanced access practice profiles among family physicians, nurse practitioners and nurses in university-affiliated team-based primary healthcare clinics in Quebec.

OBJECTIVES: The advanced access model is highly recommended to improve timely access to primary healthcare (PHC). However, its adoption varies among PHC providers. We aim to identify the advanced access profiles of PHC providers. DESIGN: A cross-sectional study was conducted between October 2019 and March 2020. Latent class analysis (LCA) measures were used to identify PHC provider profiles based on 14 variables, 2 organisational context characteristics (clinical size and geographical area) and 12 advanced access strategies. SETTING AND PARTICIPANTS: All family physicians, nurse practitioners and nurses working in the 49 university-affiliated team-based PHC clinics in Quebec, Canada, were invited, of which 35 participated. PRIMARY OUTCOME MEASURE: The LCA was based on 335 respondents. We determined the optimal number of profiles using statistical criteria (Akaike information criterion, Bayesian information criterion) and qualitatively named each of the six advanced access profiles. RESULTS: (1) Low supply and demand planification (25%) was characterised by the smallest proportion of strategies used to balance supply and demand. (2) Reactive interprofessional collaboration (25%) was characterised by high collaboration and long opening periods for appointment scheduling. (3) Structured interprofessional collaboration (19%) was characterised by high use of interprofessional team meetings. (4) Small urban delegating practices (13%) was exclusively composed of family physicians and characterised by task delegation to other PHC providers on the team. (5) Comprehensive practices in urban settings (13%) was characterised by including as many services as possible on each visit. (6) Rural agility (4%) was characterised by the highest uptake of advanced access strategies based on flexibility, including adjusting the schedule to demand and having a large number of open-slot appointments available in the next 48 hours. CONCLUSION: The different patterns of advanced access strategy adoption confirm the need for training to be tailored to individuals, categories of PHC providers and contexts.

Health care system costs related to potentially inappropriate medication use involving opioids in older adults in Canada.

BACKGROUND: Older adults are at risk of potentially inappropriate medication use given polypharmacy, multimorbidity, and age-related changes, which contribute to the growing burden associated with opioid use. The objective of this study was to estimate the costs of health service utilization attributable to opioid use and potentially inappropriate medication use involving opioids in older adults in a public health care system. METHODS: The sample included 1201 older adults consulting in primary care, covered by the public drug plan, without a cancer diagnosis and opioid use in the year before interview. Secondary analyses were conducted using two data sources: health survey and provincial administrative data. Health system costs included inpatient and outpatient visits, physician billing, and medication costs. Unit costs were calculated using annual financial and activity reports from 2013-2014, adjusted to 2022 Canadian dollars. Opioid use and potentially inappropriate medication use involving opioids were identified over 3 years. Generalized linear models with gamma distribution were employed to model 3-year costs associated with opioid use and potentially inappropriate medication use involving opioids. A phase-based approach was implemented to provide descriptive results on the costs associated with each phase: i) no use, ii) opioid use, and iii) potentially inappropriate medication use involving opioids. RESULTS: Opioid use and potentially inappropriate medication use involving opioids were associated with adjusted 3-year costs of $2,222 (95% CI: $1,179-$3,264) and $8,987 (95% CI: $7,370-$10,605), respectively, compared to no use. In phase-based analyses, costs were the highest during inappropriate use. CONCLUSIONS: Potentially inappropriate medication use involving opioids is associated with higher costs compared to those observed with opioid use and no use. There is a need for more effective use of health care resources to reduce costs for the health care system.

Workers' Worries, Pain, Psychosocial Factors, and Margin of Manoeuvre, in Relation to Outcomes in a Return-to-Work Program: An Exploratory Study.

PURPOSE: To explore the intensity and variation of workers' worries, pain, psychosocial factors, and margin of manoeuvre before and after a return-to-work program, and identified the psychosocial factors associated with non-return to work at the end of the rehabilitation program. METHODS: A pre-post study design was used. A convenience sample of 80 workers starting a return-to-work program and having a compensated musculoskeletal injury that caused an absence of more than three months from their regular work was recruited. Data were collected at baseline and at the end of the rehabilitation program on the nature of the worries and maintenance factors defined in Dugas' generalized anxiety and worry model, using validated questionnaires. The margin of manoeuvre was assessed by the treating occupational therapist. A series of descriptive analyses were performed, as well as Generalized Estimating Equations analyses. RESULTS: Workers' worries were work-related or disability-related 83% of the time at baseline. These worries were essentially based on the situation then occurring at work 90% of the time. For the Generalized Estimating Equations analyses on work status, the final model was significant, explaining 54% of the variance in non-return to work (Pseudo R2 = 0.54; p = 0.0001). Workers were 8.52 times less likely to return to work when the margin of manoeuvre was insufficient, and twice as likely not to return to work in the presence of intense worry. Worries were significantly associated with insufficient margin of manoeuvre. CONCLUSION: A strong association between workers' lack of margin of manoeuvre at work and their worries about their return to work, and poor work outcomes, supports the importance of the worker-environment interaction in rehabilitation programs.

Portrait of COVID-19 Outbreaks in the Workplaces of the Monteregie Region.

OBJECTIVES: The aims of the studies are to describe COVID-19 outbreaks in the workplaces of the Monteregie Region, Quebec, Canada, and to evaluate potential risk factors for identifying at least one COVID-19 outbreak in these workplaces. METHODS: An ecological retrospective cohort study was conducted using deidentified databases of COVID-19 outbreaks that occurred in workplaces from February 27, 2020, to June 30, 2021. RESULTS: Among 30,489 workplaces studied, 897 workplaces with at least one COVID-19 outbreak were identified. These outbreaks were associated with a sizeable number of workers in the workplace (adjusted odds ratio [aOR] = 6.78; 95% CI: 5.43-8.47), the presence of temporary foreign workers (aOR = 2.26; 95% CI: 1.53-3.33), contacts with clients (aOR = 1.93; 95% CI: 1.68-2.21), and being localized in the Montreal Metropolitan Area (aOR = 1.26; 95% CI: 1.09-1.45). CONCLUSIONS: These results enable the identification of potential risk factors for COVID-19 outbreaks in workplaces, with the aim of targeting workplaces where infection control and prevention measures might be enhanced or adapted to improve workers' health.

Correlates and trajectories of loneliness among community-dwelling older adults during the COVID-19 pandemic: A Canadian longitudinal study.

The COVID-19 pandemic provided a unique opportunity to examine the contributions of social interaction and other non-social factors to loneliness among older adults in the context of confinement measures constraining opportunities for in-person social interactions. This study aims to identify groups of individuals with heterogeneous trajectories of loneliness during the COVID-19 pandemic and to explore the sociodemographic, health, psychological and social interaction-related factors associated with these trajectories. In this 12-month longitudinal study, 614 community-dwelling individuals aged 60+ years completed telephone-based interviews on four occasions between May 2020 and May 2021. Loneliness was evaluated using the three-item version of the UCLA Loneliness Scale. Multilevel modelling assessed average changes in loneliness over time. Group-based trajectory modelling was performed to identify distinct trajectories of loneliness over time. Multinomial logistic regressions were conducted to explore the predictors of these trajectories. On average, there was a curvilinear change in loneliness that tracked the stringency of the COVID-19-related confinement measures. In this convenience sample, three heterogeneous trajectories were identified: a stable-low (17.2%), a fluctuating-moderate (48.8%) and a sustained-elevated (34.0%) trajectory. Participants in the sustained-elevated loneliness trajectory were more likely to live alone and experience elevated psychological distress and greater COVID-19 perceived health threat compared to those in the stable-low trajectory. Participants in the fluctuating-moderate loneliness group were more likely to have multimorbidity, experience greater psychological distress, and have less frequent in-person interactions than the stable-low loneliness group. Assessing the combination of sociodemographic, health, psychological and social factors may help identify individuals at higher risk for chronic loneliness.

Gender disparity in prestigious speaking roles: A study of 10 years of international conference programming in the field of gambling studies.

The objective of this study was to examine the distribution of prestigious speaking roles by gender at gambling studies conferences to better understand the state of gender representation within the field. Keyword searches were conducted in the fall of 2019. A total of 16 conferences that occurred between 2010-2019 and comprising 882 prestigious speaking opportunities were included. Quantitative analysis (i.e., t-tests, chi-squared posthoc tests) was undertaken to evaluate the representation of women speakers and if proportions were the same across genders for speakers. There were significantly less women than men within prestigious speaking roles at gambling studies conferences with only 30.2% of speakers being women (p < .001). This underrepresentation of women was consistent across conference location, speaker continent, speaker role, time, and across the majority of conferences. Women held prestigious speaking roles less frequently than men (M = 1.48 vs. 1.76; p < .001). A 9 to 1 (p < .001) ratio of men to women was found among top 10 most frequent prestigious speakers. While there was a higher proportion of women than men among student speakers and there was no significant gender disparity among early career researchers, there was a significantly lower proportion of women than men among speakers who hold more senior academic positions. There is an issue of gender disparity in prestigious speaking roles at conferences within the gambling studies field. This study highlights the need to counteract gender disparities and make room for diversity within the field.

Changes in self-rated physical and mental health and life satisfaction associated with opioid and potentially inappropriate opioid prescribing in primary care older adults.

OBJECTIVE: To examine changes in life satisfaction and physical and mental health associated with opioid and potentially inappropriate opioid prescribing (PIOP) among older adults. METHODS: Secondary data analysis from the Étude sur la Santé des Aînés (ESA)-Services study. The sample consisted of 945 older adults recruited in primary care with available health survey information linked to administrative medical record data. The exposure of interest was categorized as no prescription, opioid prescription, and PIOP, defined using the Beers criteria. Outcomes were self-rated physical health, mental health, and life satisfaction measured at baseline and at a 3-year follow-up. Generalized estimating equations were used to examine 3-year changes in outcomes as a function of opioid prescribing. Analyses were adjusted for covariates relating to health, psychosocial, and sociodemographic factors as well as duration/frequency of opioid prescribing. Analyses were conducted in the overall sample and in non-cancer patients. RESULTS: The sample had an average age of 73.1 years; the majority was Canadian-born (96.3%) while females made up over half (55.4%) the sample. Compared to not receiving an opioid prescription, PIOP was associated with a deterioration in physical health (ORadjusted = 0.65; 95%CI = 0.49, 0.86), but not mental health and life satisfaction. In non-cancer patients, PIOP was associated with poorer physical health (ORadjusted = 0.59; 95%CI = 0.40, 0.87) and opioid prescribing was marginally associated with improved life satisfaction (ORadjusted = 1.58; 95%CI = 0.96, 2.60). CONCLUSION: PIOP was associated with a deterioration in physical health. Patient-centred chronic pain management and the effect on health and well-being require further study in older adults.

The association between anemia and depression in older adults and the role of treating anemia.

OBJECTIVES: To investigate the association between anemia and depression and whether the treatment of anemia modifies the effect of the association between anemia and depression. METHODS: This secondary data analysis is based on data from the Enquête sur la santé des aînés (ESA)-Services study conducted in 2011-2013 on community-dwelling older adults recruited in primary care and have given access to their medico-administrative data (n = 1447). The presence of anemia was self-reported, as was depression (major and minor) aligned with symptoms of the DSM-5. Treated anemia was based on the presence of medications delivered to participants. Cross-sectional associations were analyzed using multivariable logistic regression, controlling for confounders. RESULTS: The prevalence of self-reported anemia in our sample was estimated at 6.7%. Self-reported anemia was associated with increased odds of depression. Individuals with untreated anemia had a 2.6-fold increased odds of depression compared to those with no anemia. In contrast, the odds of depression in individuals with treated anemia were not different from individuals with no anemia. CONCLUSION: The findings underline the importance of treating anemia in older adults. Future longitudinal studies are needed to replicate the findings and further explore the role of treating anemia on symptoms of depression.

An innovative model of psychological service delivery in primary healthcare: the Single-Session Intervention.

BACKGROUND: In Canada, the demand for mental health care exceeds the provision of services. This exploratory study aimed to assess the feasibility and impact of a new service delivery model for psychological consultations in primary care settings: the Single-Session Intervention (SSI), inspired by Advanced Access (AA) principles for appointment scheduling. The specific objectives were to examine whether the SSI increases accessibility to psychological consultations, to measure the effects of the intervention on different self-reported measures, and to assess users' consultation experiences. METHODS: Participants were recruited in a University Family Medicine Group in Quebec (Canada), and the SSI was delivered by the on-site psychologist. No referral or formal diagnosis was needed to attend, and participants could promptly obtain an appointment. Participants rated the intensity of their problem, their level of psychological distress and their well-being, before and after the SSI. They also rated their satisfaction with their consultation experience. There was a follow-up 4 to 6 weeks later. RESULTS: Of the N = 69 participants who received SSI, 91% were able to obtain an appointment in less than 7 working days. The number of patients who were able to benefit from a psychological consultation was about 7 times higher after the implementation of SSI compared to previous years, when a traditional model of service delivery was in place. After SSI, participants felt that the intensity of their problem and psychological distress were lower, and that their well-being was increased, as indicated by significant pre-post test clinical measures (p < 0.0001). The observed effects seemed to be sustained at follow-up. Moreover, 51% of participants said that one session was sufficient to help them with their problem. Participants rated SSI as a highly satisfying and helpful consultation experience (92,9% overall satisfaction). CONCLUSIONS: SSI, offered in a timely manner, could be an innovative and cost-effective intervention to provide mental health services on a large scale in primary healthcare. Further research is needed to replicate the results, but these preliminary data seem to indicate that psychological distress may be quickly addressed by SSI, thereby preventing further deteriorations in patients' mental health. TRIAL REGISTRATION: 2019-393, 26 March 2019.

Efficacy of a randomized controlled trial of integrative couple treatment for pathological gambling (ICT-PG): 10-month follow-up.

OBJECTIVE: Assess the efficacy of integrative couple treatment for pathological gambling (ICT-PG) in comparison to treatment provided in an individual approach. METHOD: Eighty couples were assigned randomly to ICT-PG (n = 44, Mage = 42.2, SD [13.4], n male gamblers = 29) or individual treatment (n = 36, Mage = 39.9 SD [13.0], n male gamblers = 31) with follow-ups at 4- and 10-months postadmission regarding the severity of gambling, the individual and couple's well-being. Linear mixed and generalized estimating equation models for repeated measures were applied to take into account the dependency of observations. Protocol was preregistered at www. CLINICALTRIALS: gov (ID: NCT02240485). RESULTS: Participants in both treatments generally improved over time with reductions on gambling expanses from an initial $4,000-$600 in a 90-day period following treatment, without difference across treatment conditions in money spent on gambling or frequency of gambling. However, on different indices of gambling severity, the participants in ICT-PG showed more improvement at follow-ups, with better control capacity (OR = 2.57, p < .0129) and greater reduction in gambling craving (OR = 5.83, p < .0001) and erroneous cognitions (OR = 2.63, p < .0063). The couple treatment was associated with a better individual well-being (e.g., less depression for partners, OR = 5.53; p < .0351, and gamblers, OR = 2.37; p < .0334) and couple well-being (e.g., better dyadic satisfaction for partners, OR = 2.02; p < .0057, and gamblers, OR = 3.07; p < .0212). CONCLUSIONS: The results underline the necessity to provide a greater diversity of treatment for gamblers and their partner. Further research should focus on identifying active components of ICT-PG and widen its provision to gamblers with concurrent addiction disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological Distress, Cognition, and Functional Disability Trajectory Profiles of Aging in Primary Care Older Adults.

OBJECTIVES: To identify profiles of aging by combining psychological distress, cognition and functional disability, and their associated factors. METHODS: Data were drawn from the Étude sur la Santé des Aînés-Services study and included 1585 older adults. Sociodemographic, psychosocial, lifestyle and health factors were informed from structured interviews. Group-based multi-trajectory modeling and multinomial logistic regression were used to identify aging profiles and correlates. Sampling weights were applied to account for the sampling plan. RESULTS: The weighted sample size was 1591. Three trajectories were identified: a favorable (79.0%), intermediate (14.5%), and severe scenario (6.5%). Factors associated with the severe scenario were older age, male gender, lower education, the presence of anxiety disorders, low physical activity, and smoking. Membership in the intermediate scenario was associated with daily hassles, physical disorders, anxiety and depression, antidepressant/psychotherapy use, low physical activity, and no alcohol use. High social support was protective against less favorable profiles. CONCLUSIONS: Symptoms of anxiety and depression and high burden of physical disorders were associated with less favorable trajectories. Modifiable lifestyle factors have a significant effect on healthy aging. CLINICAL IMPLICATIONS: Assessment and management of anxio-depressive symptoms are important in older adults. Clinical interventions including access to psychotherapy and promotion of healthier lifestyles should be considered.

Recovery expectations can be assessed with single-item measures: findings of a systematic review and meta-analysis on the role of recovery expectations on return-to-work outcomes after musculoskeletal pain conditions.

ABSTRACT: The objective of this systematic review is to quantify the association between recovery expectations and return-to-work outcomes in adults with musculoskeletal pain conditions. In addition, this review has the second objective to compare the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Relevant articles were selected from Embase, PsycINFO, PubMed, Cochrane, and manual searches. Studies that assessed recovery expectations as predictors of return-to-work outcomes in adults with musculoskeletal pain conditions were eligible. Data were extracted on study characteristics, recovery expectations, return-to-work outcomes, and the quantitative association between recovery expectations and return-to-work outcomes. Risk of bias was assessed using the Effective Public Health Practice Project. Odds ratios were pooled to examine the effects of recovery expectations on return-to-work outcomes. Chi-square analyses compared the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Thirty studies on a total of 28,741 individuals with musculoskeletal pain conditions were included in this review. The odds of being work disabled at follow-up were twice as high in individuals with low recovery expectations (OR = 2.06 [95% CI 1.20-2.92] P < 0.001). Analyses also revealed no significant differences in the predictive value of validated and nonvalidated single-item measures of recovery expectations on work disability (χ 2 = 1.68, P = 0.19). There is strong evidence that recovery expectations are associated with return-to-work outcomes. The results suggest that single-item measures of recovery expectations can validly be used to predict return-to-work outcomes in individuals with musculoskeletal pain conditions.

Morphologic clustering of earcanals using deep learning algorithm to design artificial ears dedicated to earplug attenuation measurement.

Designing earplugs adapted for the widest number of earcanals requires acoustical test fixtures (ATFs) geometrically representative of the population. Most existing ATFs are equipped with unique sized straight cylindrical earcanals, considered representative of average human morphology, and are therefore unable to assess how earplugs can fit different earcanal morphologies. In this study, a methodology to cluster earcanals as a function of their morphologies with the objective of designing artificial ears dedicated to sound attenuation measurement is developed and applied to a sample of Canadian workers' earcanals. The earcanal morphologic indicators that correlate with the attenuations of six models of commercial earplugs are first identified. Three clusters of earcanals are then produced using statistical analysis and an artificial intelligence-based algorithm. In the sample of earcanals considered in this study, the identified clusters differ by the earcanal length and by the surface and ovality of the first bend cross section. The cluster that comprises earcanals with small girth and round first bend cross section shows that earplugs induced attenuation significantly higher than the cluster that includes earcanals with a bigger and more oval first bend cross section.

Evaluation of the Psychometric Properties of the Arab Compulsive Internet Use Scale (CIUS) by Item Response Theory Modeling (IRT).

INTRODUCTION: The psychometric properties of the Arab translation of the Compulsive Internet Use Scale (CIUS) have been previously studied by confirmatory factor analysis (CFA) with AMOS software using the asymptotically distribution-free (ADF) estimator. Unidimensionality has been achieved at the cost of correlating several item variance errors. However, several reviews of SEM software packages and estimation methods indicate that the option of robust standard errors is not present in the AMOS package and that ADF estimation may yield biased parameter estimates. We therefore explored a second analysis through item response theory (IRT) using the parametric graded response model (GRM) and the marginal maximum likelihood (MML) estimation method embedded in the LTM package of R software. Differential item functioning (DIF) or item bias across subpopulations was also explored within IRT framework as different samples were investigated. The objective of the current study is to (1) analyze the Arab CIUS scale with IRT, (2) investigate DIF in three samples, and (3) contribute to the ongoing debate on Internet-use-related addictive behaviors using the CIUS items as a proxy. METHODS: We assessed three samples of people, one in Algeria and two in Lebanon, with a total of 1520 participants. RESULTS: Almost three out of every five items were highly related to the latent construct. However, the unidimensionality hypothesis was not supported. Furthermore, besides being locally dependent, the scale may be weakened by DIF across geographic regions. Some of the CIUS items related to increasing priority, impaired control, continued use despite harm, and functional impairment as well as withdrawal and coping showed good discriminative capabilities. Those items were endorsed more frequently than other CIUS items in people with higher levels of addictive Internet use. CONCLUSIONS: Contrary to earlier ADF estimation findings, unidimensionality of the CIUS scale was not supported by IRT parametric GRM in a large sample of Arab speaking participants. The results may be helpful for scale revision. By proxy, the study contributes to testing the validity of addiction criteria applied to Internet use related-addictive behaviors.