This study examined the associations of polysubstance use, mood disorders, and chronic conditions with the history of anxiety disorder among patients with opioid use disorder (OUD). We performed a secondary analysis of the baseline data from a clinical trial including 1,645 individuals with OUD, of which 513 had anxiety disorder. Substance use disorders (SUDs) included alcohol, amphetamines, cannabis, cocaine, and sedative use disorders. Mood disorders included major depressive disorder (MDD) and bipolar disorder (BD). Chronic conditions were allergies, gastrointestinal problem(s), skin problem(s), and hypertension. Sedative use disorder, MDD, BD, skin problems, and hypertension were significantly associated with anxiety disorder (p < 0.05). Additionally, more than two SUDs, two mood disorders, and more than two chronic conditions were significantly associated with anxiety disorder (p < 0.05). These findings highlight the comorbid mental health and physical health problems in individuals with OUD, as well as the need for integrated multidisciplinary treatment plans.

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Urinary incontinence (UI) is a common complication of type 2 diabetes mellitus (T2DM) for older adults (≥65 years) that is associated with reduced quality of life and risk of institutionalization. This convergent, mixed methods research study, informed by a model of clinical complexity, explored the complexities for older adults living with UI and T2DM, and home-care nurses providing care to this population in Ontario. In the quantitative strand, the most recently completed Resident Assessment Instruments for Home Care from 2011-2016 for older home-care clients with diabetes were analyzed to determine the prevalence and correlates of UI. The qualitative strand used interpretive description methodology to explore the experiences of 18 older adults living with T2DM and UI receiving home-care services and the experiences of 15 home-care nurses caring for this population. These data sources were converged to describe the factors that contributed to complexity for older adults with UI and T2DM: (a) challenges of living with multiple chronic conditions (MCC), medical instability, and high care needs; (b) financial barriers; (c) lack of understanding of older adults’ values and preferences by health-care providers; (d) caregiver burden; and (e) functional impairments. The health-care system contributed to this complexity through: (a) inadequate and minimal provision of nursing and interprofessional home-care services; (b) task-focused structure of home care; (c) minimal interprofessional collaboration; (d) lack of an integrated communication system; and (e) lack of navigation to community resources. Providing health-promoting care for older adults with UI and T2DM requires a system-wide enactment of integrated care that takes both a person- and family-centred care and social determinants of health approach. Interventions for older adults with MCC should involve standardized and comprehensive assessment, care coordination, enhanced nursing service provision, and interprofessional team collaboration to attend to the dimensions of complexity and ensure the needs of older adults and their caregivers are met. / Thesis / Doctor of Philosophy (PhD) / Many older adults with diabetes have urinary incontinence that is emotionally and physically bothersome. These older adults also receive home-care services. In this study, older adults were asked about how they care for their diabetes and incontinence and how their home-care workers help them with this care. Nurse participants were asked how they help older adults with diabetes and incontinence and the challenges they face. The results of home-care assessments done in Ontario were also analyzed to learn how common incontinence is in older adults with diabetes and factors associated with having incontinence. The study found many factors, such as living with many chronic conditions and lack of finances, as well limited home-care service provision and the task-focus of home care created challenges for these older adults. The findings can help in making changes to home-care service delivery to improve care for older adults and their caregivers.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-14T14:20:34Z No. of bitstreams: 1 arisegarciadesiqueiragalil.pdf: 3825957 bytes, checksum: 8e6346876438a33406d4180499457d56 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-17T14:50:06Z (GMT) No. of bitstreams: 1 arisegarciadesiqueiragalil.pdf: 3825957 bytes, checksum: 8e6346876438a33406d4180499457d56 (MD5) / Made available in DSpace on 2017-03-17T14:50:06Z (GMT). No. of bitstreams: 1 arisegarciadesiqueiragalil.pdf: 3825957 bytes, checksum: 8e6346876438a33406d4180499457d56 (MD5) Previous issue date: 2016-09-09 / O tabagismo representa um fator de risco para o desenvolvimento de complicações de doenças crônicas não transmissíveis, sendo classificado como uma delas e potencializador de outras condições semelhantes. Abordar tabagismo é intervenção custo-efetivo, em todos os níveis de atenção, prevenindo agravos, reduzindo tanto complicações quanto mortalidade cardiovascular e global. Para a população de alto risco cardiovascular (especialmente hipertensa, diabética e com doença renal crônica), com comorbidades presentes, parar de fumar pode ser a melhor intervenção a ser realizada. Em todas as intervenções que visem ampliar o alcance da cessação do tabaco, deve-se entender melhor o perfil dos fumantes de forma detalhada, e assim, traçar de forma efetiva, planos estratégicos para atenção individualizada e melhores resultados. Objetivos: Em usuários com múltiplas condições crônicas de alto e muito alto risco cardiovascular, identificar, conforme o uso do tabaco: 1. O perfil psicossocial, indicadores clínicos, metabólicos e comorbidades associadas; 2. As associações deste perfil de acordo com o uso do tabaco; 3. Avaliar temporalmente, num seguimento de 12 meses, indicadores clínicos (especialmente desfechos cardiovasculares e progressão da doença renal), segundo o uso do tabaco. Métodos: Estudo transversal, realizado no Centro HIPERDIA Minas Juiz de Fora, Brasil, que administra os pacientes com alto risco cardiovascular, hipertensão arterial, diabetes mellitus e doença renal crônica. Resultados: Dos 1558 participantes, 12% eram fumantes; 41% ex-fumantes e 47% nunca fumaram. Na análise univariada, tabagismo atual foi associado com sexo, idade, atividade física, consumo de álcool, sintomas depressivos, excesso de peso, e aterosclerose. Nas análises multinomiais, várias doenças crônicas foram associadas com o uso atual ou anterior do tabaco; doença pulmonar obstrutiva cônica e doença aterosclerótica foram mais prevalentes entre os pacientes que eram fumantes. Não houve diferenças estatísticas significativas na avaliação longitudinal de desfechos clínicos ou velocidade da filtração glomerular, segundo o uso do tabaco. Conclusão: O tabagismo foi tão prevalente na populacao estudada quanto na população geral. Fumantes apresentavam pior perfil clínico comparado aos exfumantes ou aos que nunca fumaram. O apoio à cessação do tabagismo pode render benefícios consideráveis, aliado à redução de custos de cuidados com a saúde, especialmente, em população com múltiplas condições crônicas de alto risco cardiovascular. / Smoking is a risk factor for the development of complications of chronic non communicable diseases and is classified as one potentiator and other similar conditions. Addressing tobacco use is cost-effective intervention at all levels of care, preventing diseases, reducing both complications as cardiovascular and overall mortality. For people at high cardiovascular risk (especially hypertension, diabetes and chronic kidney disease), with co-morbidities, smoking cessation may be the best intervention to be performed. In all interventions aimed at increasing the scope of tobacco cessation, should better understand the profile of smokers in detail, and thus draw effectively, strategic plans for individualized attention and better results. Aims: In users with multiple chronic conditions of high and very high cardiovascular risk, identify as tobacco use: 1. The psychosocial profile, clinical indicators, metabolic and associated comorbidities; 2. Associations of the profile according to the use of tobacco; 3. Evaluate temporally following a 12 month clinical indicators (especially cardiovascular outcomes and renal disease progression), according tobacco use. Methods: Cross-sectional study conducted in HIPERDIA Center Juiz de Fora Minas Gerais, Brazil, which manages patients with high cardiovascular risk, hypertension, diabetes mellitus and chronic kidney disease. Results: Of the 1558 participants, 12% were smokers; 41% former smokers and 47% had never smoked. In univariate analysis, current smoking was associated with sex, age, physical activity, alcohol consumption, depressive symptoms, overweight, and atherosclerosis. In multinomial analysis, several chronic diseases were associated with current or previous use of tobacco; chronic obstructive pulmonary disease and atherosclerosis were more prevalent among patients who were smokers. There were no statistically significant differences in the longitudinal evaluation of clinical outcomes or glomerular filtration rate, according to tobacco use. Conclusion: Smoking was so prevalent in the population studied as the general population. Smokers had poorer clinical profile compared to former smokers or those who never smoked. Support for smoking cessation can yield considerable benefits, combined with the reduction of care costs to health, especially in people with multiple chronic conditions and high cardiovascular risk.