New opioid prescription claims and their clinical indications: results from health administrative data in Quebec, Canada, over 14 years.

OBJECTIVES: Describe new opioid prescription claims, their clinical indications and annual trends among opioid naïve adults covered by the Quebec's public drug insurance plan (QPDIP) for the fiscal years 2006/2007-2019/2020. DESIGN AND SETTING: A retrospective observational study was conducted using data collected between 2006/2007 and 2019/2020 within the Quebec Integrated Chronic Disease Surveillance System, a linkage administrative data. PARTICIPANTS: A cohort of opioid naïve adults and new opioid users was created for each study year (median number=2 263 380 and 168 183, respectively, over study period). INTERVENTION: No. MAIN OUTCOME MEASURE AND ANALYSES: A new opioid prescription was defined as the first opioid prescription claimed by an opioid naïve adult during a given fiscal year. The annual incidence proportion for each year was then calculated and standardised for age. A hierarchical algorithm was built to identify the most likely clinical indication for this prescription. Descriptive and trend analyses were performed. RESULTS: There was a 1.7% decrease of age-standardised annual incidence proportion during the study period, from 7.5% in 2006/2007 to 5.8% in 2019/2020. The decrease was highest after 2016/2017, reaching 5.5% annual percentage change. Median daily dose and days' supply decreased from 27 to 25 morphine milligram equivalent/day and from 5 to 4 days between 2006/2007 and 2019/2020, respectively. Between 2006/2007 and 2019/2020, these prescriptions' most likely clinical indications increased for cancer pain from 34% to 48%, for surgical pain from 31% to 36% and for dental pain from 9% to 11%. Inversely, the musculoskeletal pain decreased from 13% to 2%. There was good consistency between the clinical indications identified by the algorithm and prescriber's specialty or user's characteristics. CONCLUSIONS: New opioid prescription claims (incidence, dose and days' supply) decreased slightly over the last 14 years among QPDIP enrollees, especially after 2016/2017. Non-surgical and non-cancer pain became less common as their clinical indication.

Optimal delivery of aerosolized medication to mechanically ventilated pediatric and neonatal patients: A scoping review.

Objectives: Delivering aerosolized medication to patients during mechanical ventilation is a common practice in respiratory therapy for adult, pediatric, and neonatal populations. However, aerosol delivery in pediatric populations is inconsistent and challenging, impacting how the drug is delivered. Some factors that influence drug delivery efficiency are directly under the purview of the clinician or therapist administering the drugs. However, excessive variability exists amongst clinicians and therapists working at the same site and between different sites. This review aims to systematically summarize the literature to identify current practice variations, identify common practices, and provide suggestions to guide future research in this area. In addition, this scoping review aims to identify the available evidence and knowledge gaps in the literature regarding the delivery of aerosolized medication to pediatric populations during mechanical ventilation. More specifically, the question that guided our research was: What are the best strategies for optimizing aerosol delivery of medication to pediatric patients, including neonates, while on mechanical ventilation? Methods: A scoping review, using the Joanna Briggs Institute methodology, was conducted until September 2022 in the CINAHL, EMBASE (Ovid), and Medline (Ovid) databases. Our initial search yielded 248 articles. After screening the titles, abstracts, and full text of the articles according to inclusion and exclusion criteria, five articles were analyzed. Results: We identified three main topics for discussion: the type of device used for administering aerosolized medication, appropriate mechanical ventilation settings, and optimal placement of the nebulizer delivery system. Conclusion: Of the three topics we intended to discuss, we only found enough evidence to suggest using mesh nebulizers to increase aerosol deposition. We found conflicting or outdated results for the other two topics. This demonstrates a significant gap in the literature since aerosol medications are routinely administered to mechanically ventilated neonatal and other pediatric patients.

The relationship between adiposopathy and glucose-insulin homeostasis is not affected by moderate-intensity aerobic training in healthy women with obesity

The contribution of adiposopathy to glucose-insulin homeostasis remains unclear. This longitudinal study examined the potential relationship between the adiponectin/leptin ratio (A/L, a marker of adiposopathy) and insulin resistance (IR: homeostasis model assessment (HOMA)), insulin sensitivity (IS: Matsuda), and insulin response to an oral glucose tolerance test before and after a 16-week walking program, in 29 physically inactive pre- and postmenopausal women with obesity (BMI, 29-35 kg/m2; age, 47-54 years). Anthropometry, body composition, VO2max, and fasting lipid-lipoprotein and inflammatory profiles were assessed. A/L was unchanged after training (p = 0.15), despite decreased leptin levels (p < 0.05). While the Matsuda index tended to increase (p = 0.07), HOMA decreased (p < 0.05) and fasting insulin was reduced (p < 0.01) but insulin area under the curve (AUC) remained unchanged (p = 0.18) after training. Body fatness and VO2max were improved (p < 0.05) while triacylglycerols increased and HDL-CHOL levels decreased after training (p < 0.05). At baseline, A/L was positively associated with VO2max, HDL-CHOL levels, and Matsuda (0.37 < ρ < 0.56; p < 0.05) but negatively with body fatness, HOMA, insulin AUC, IL-6, and hs-CRP levels (− 0.41 < ρ < − 0.66; p < 0.05). After training, associations with fitness, HOMA, and inflammation were lost. Multiple regression analysis revealed A/L as an independent predictor of IR and IS, before training (partial R2 = 0.10 and 0.22), although A/L did not predict the insulin AUC pre- or post-intervention. A significant correlation was found between training-induced changes to A/L and IS (r = 0.38; p < 0.05) but not with IR or insulin AUC. Although changes in the A/L ratio could not explain improvements to glucose-insulin homeostasis indices following training, a relationship with insulin sensitivity was revealed in healthy women with obesity

The relationship between adiposopathy and glucose-insulin homeostasis is not affected by moderate-intensity aerobic training in healthy women with obesity.

The contribution of adiposopathy to glucose-insulin homeostasis remains unclear. This longitudinal study examined the potential relationship between the adiponectin/leptin ratio (A/L, a marker of adiposopathy) and insulin resistance (IR: homeostasis model assessment (HOMA)), insulin sensitivity (IS: Matsuda), and insulin response to an oral glucose tolerance test before and after a 16-week walking program, in 29 physically inactive pre- and postmenopausal women with obesity (BMI, 29-35 kg/m2; age, 47-54 years). Anthropometry, body composition, VO2max, and fasting lipid-lipoprotein and inflammatory profiles were assessed. A/L was unchanged after training (p = 0.15), despite decreased leptin levels (p < 0.05). While the Matsuda index tended to increase (p = 0.07), HOMA decreased (p < 0.05) and fasting insulin was reduced (p < 0.01) but insulin area under the curve (AUC) remained unchanged (p = 0.18) after training. Body fatness and VO2max were improved (p < 0.05) while triacylglycerols increased and HDL-CHOL levels decreased after training (p < 0.05). At baseline, A/L was positively associated with VO2max, HDL-CHOL levels, and Matsuda (0.37 < ρ < 0.56; p < 0.05) but negatively with body fatness, HOMA, insulin AUC, IL-6, and hs-CRP levels (- 0.41 < ρ < - 0.66; p < 0.05). After training, associations with fitness, HOMA, and inflammation were lost. Multiple regression analysis revealed A/L as an independent predictor of IR and IS, before training (partial R2 = 0.10 and 0.22), although A/L did not predict the insulin AUC pre- or post-intervention. A significant correlation was found between training-induced changes to A/L and IS (r = 0.38; p < 0.05) but not with IR or insulin AUC. Although changes in the A/L ratio could not explain improvements to glucose-insulin homeostasis indices following training, a relationship with insulin sensitivity was revealed in healthy women with obesity.

Efficacy of a Web-Based Tailored Intervention to Reduce Cannabis Use Among Young People Attending Adult Education Centers in Quebec.

BACKGROUND: Cannabis use is common among young adults. Web-based interventions are an increasingly popular way to reach this population. The aim of this study was to evaluate the efficacy of a Web-based tailored intervention, developed on theoretical and empirical grounds, to reduce cannabis use among young people by promoting a more positive intention to abstain. METHODS: An experimental design was employed to evaluate the efficacy of the intervention in reducing cannabis use (primary outcome) by bolstering intention (secondary outcome) to abstain from use. Participants were randomly assigned either to an experimental group that received the Web-based tailored intervention or to a control group that did not. RESULTS: Of 588 young adults (18-24 years of age) recruited, 295 were randomly assigned to the experimental group and 293 to the control group. At baseline, 343 reported using cannabis at least once in the past year. An intention-to-treat analysis showed that, at postintervention, a higher proportion of participants in the experimental group had reduced their cannabis use compared with the control group [10.8% vs. 5.1%, χ2(2) = 9.89, p = 0.007]. A mixed model for repeated measures revealed a statistically significant difference in terms of change in intention to abstain from cannabis use in the coming month [Group × Time interaction, F(1,474) = 8.03, p = 0.005]: intention increased for the experimental group (5.07 ± 2.07 to 5.45 ± 1.88; p < 0.001), but stayed stable for the control group (5.32 ± 2.03 to 5.36 ± 1.99; p = 0.779). CONCLUSION: This study shows that the intervention can be efficacious in reducing cannabis use among young people attending adult education centers.

Impact of a moderate-intensity walking program on cardiometabolic risk markers in overweight to obese women: is there any influence of menopause?

OBJECTIVE: The aim of this study was to examine the effect of brisk walking on cardiometabolic risk profile and on the gene expression (ie, messenger RNA [mRNA] levels) of inflammatory and thrombotic markers in abdominal and femoral subcutaneous adipose tissues (SATs) among sedentary overweight to obese women with different menopause statuses. METHODS: Sixteen late premenopausal (mean [SD] age, 49 [3] y; mean [SD] body mass index, 31.9 [3.0] kg/m) and 14 early postmenopausal (53 [2] y; 30.8 [1.9] kg/m) women were involved in a 16-week walking program (three sessions of 45 min/wk at 60% of heart rate reserve). Glucose-insulin homeostasis, lipid-lipoprotein profile, and inflammatory (tumor necrosis factor-α, interleukin-6 [IL-6], and adiponectin) and thrombotic (plasminogen activator inhibitor-1) SAT mRNA and plasma levels were measured before and after the intervention. RESULTS: Glucose area under the curve was reduced in all participants (P = 0.03) after the walking program. Increases in plasma tumor necrosis factor-α were observed in both groups (P = 0.001), whereas increases in plasminogen activator inhibitor-1 levels were found in postmenopausal women only (P = 0.014). However, plasma IL-6 and adiponectin levels remained unchanged after the intervention (0.07 < P < 0.98). Although femoral SAT adiponectin mRNA levels decreased in postmenopausal women only (P = 0.008), abdominal SAT IL-6 mRNA levels were reduced in both groups (P = 0.01). CONCLUSIONS: Taken together, our results show that, despite a reduced abdominal SAT IL-6 expression, brisk walking does not seem to exert a favorable impact on the cardiometabolic risk profile of overweight to obese women, irrespective of their menopause status.

Psychosocial factors and beliefs related to intention to not binge drink among young adults.

AIMS: The objective of the study was to identify psychosocial factors and salient beliefs associated with the intention of young people to not binge drink in the next month, applying an extended version of the theory of planned behavior. METHODS: Among 200 youths randomly recruited from adult education centers in the province of Quebec, Canada, 150 completed a questionnaire. Of these, 141 youths reported having used alcohol in the last year-analyses were performed on this sub-sample. RESULTS: The prediction model demonstrated that perceived behavioral control (odds ratio, OR = 2.60, 95% confidence interval, CI 1.59-4.23; P = 0.0001), attitude (OR = 2.49, 95% CI 1.14-5.43; P = 0.02) and moral norm (OR = 1.88, 95% CI 1.23-2.88; P = 0.004) are three determinant variables of intention to not binge drink in the next month. The intention is also related to cannabis use in the last month (OR = 0.17 95% CI 0.05-0.53; P = 0.002). Young people who believe that if they do not binge drink in the next month, they will have a lower risk of getting depressed (OR = 1.53, 95% CI 1.23-1.90; P = 0.0001), and those who believe they will be able to not binge drink even if they are at a party (OR = 1.58, 95% CI 1.29-1.94; P < 0.0001), are more likely to have a positive intention. CONCLUSION: Despite some methodological limitations, this study revealed several options for helping young people to not binge drink during their school career.

Impact of walking on adipose tissue lipoprotein lipase activity and expression in pre- and postmenopausal women.

OBJECTIVE: The aim of this study was to examine regional variation in adipose tissue lipoprotein lipase (AT-LPL) activity and expression in pre-and postmenopausal women, before and after training, once differences in chronological age or obesity degree are taken into account. METHODS: Sixteen late pre- and 14 early postmenopausal (49 +/- 2 vs. 52 +/- 2 years; p < 0.001) moderately obese women (body mass index 29-35 kg/m(2)) were subjected to a 16-week walking program (3 sessions/week of 45 min at 60% heart rate reserve). Abdominal and femoral AT-LPL activity and expression, fasting lipid-lipoprotein profile, body composition, and cardiorespiratory fitness (CRF) were measured before and after our intervention. Statistical analyses were performed using covariance analysis for age differences. RESULTS: AT-LPL activity and expression, lipid-lipoprotein metabolism, body fatness, and CRF were similar at baseline, irrespective of the group considered. Slight reductions in plasma cholesterol and high-density lipoprotein (HDL) cholesterol levels, fat mass and waist girth reductions, CRF increases as well as femoral AT-LPL activity and expression decreases after our intervention were comparable, regardless of menopausal status (0.0001 < p < 0.05). CONCLUSIONS: Lipid storage is decreased in the femoral depot after walking, regardless of menopausal status. Reduction in AT-LPL activity or expression does not lead to a more deleterious lipid-lipoprotein profile, despite the modest decrease noted in HDL cholesterol concentrations.

Impact of walking on eating behaviors and quality of life of premenopausal and early postmenopausal obese women.

OBJECTIVE: Aerobic exercise is known to improve health-related quality of life (QoL). The aim of this study was to compare the effects of a 16-week walking program on eating behaviors and QoL between late premenopausal and early postmenopausal obese and sedentary women, once chronological aging is taken into account. METHODS: Sixteen women 49 +/- 2 years old and 14 women 53 +/- 2 years old, whose body mass index ranged between 29 and 35 kg/m, were subjected to three sessions per week of 45-minute walking at 60% of their heart rate reserve. Fat mass and lean mass (bioelectrical impedance), cardiorespiratory fitness estimated by maximum oxygen consumption (2-km walking test), eating behaviors (Three-Factor Eating Questionnaire), and QoL, estimated by the Short Form-36 Health Survey, Pittsburgh Sleep Quality Index, and Perceived Stress Scale-10 questionnaires, were recorded before and after exercise. RESULTS: With the exception of a higher attitude of self-regulation in postmenopausal than in premenopausal women (P = 0.05), no between-group differences were observed in body composition, eating behaviors, and QoL at baseline. In all participants, body weight and fat mass decreased, whereas cardiorespiratory fitness increased after walking (0.001 < P < 0.0001). Situational susceptibility was the only eating behavior reduced after training in all women (P = 0.02). Neither the sleep quality index nor the perceived stress score changed in response to endurance exercise. Finally, in all women, Short Form-36 physical and mental scores increased after walking (0.001 < P < 0.05). CONCLUSIONS: Despite modest body weight and fat mass losses, a 16-week walking program seems to be sufficient to improve physical and mental well-being, irrespective of menopause status.