Chronic kidney disease (CKD) is a multifaceted health problem with both physical and psychological manifestations. Increased symptom burden is associated with higher risk of mortality, decreased treatment adherence, and impaired quality of life. Despite the recognition of the importance of symptoms, the symptoms and mental health of individuals with CKD remain poorly understood in terms of their measurement, epidemiology and associated service use. The chapters in this dissertation aim to inform these knowledge gaps. Chapter 2 focusses on the symptom burden of patients receiving maintenance hemodialysis treatment and uses exploratory analyses to identify intra-dialytic symptom clusters associated with prolonged dialysis treatment recovery time. Chapters 3 and 4 are population-based studies examining mental health and addictions service utilization in patients with CKD using administrative data in Ontario, Canada. Chapter 3 is a cross-sectional study evaluating the prevalence of individuals with a history of mental health and addiction service use by levels of kidney function. Chapter 4 is a retrospective cohort study evaluating the rates of mental health and addiction service use over time in patients with CKD. Together, these chapters provide further understanding of how symptoms of dialysis and mental health and addiction service use may be measured in this patient population. They also inform considerations for the design of future symptom management and system-level mental health strategies in CKD. / Thesis / Doctor of Philosophy (PhD)

Background: Chronic non-cancer pain (CNCP) is a prevalent condition, imposing significant burden on healthcare systems. Ketamine is suggested as a potential intervention for CNCP management. We conducted a systematic review and network meta-analysis to assess ketamine's effects in adults with CNCP. Methods: We searched Medline, Embase, CINAHL, and Cochrane CENTRAL up to January-2024 for randomized trials involving adults with CNCP, comparing ketamine with placebo, usual care, or other interventions. Reviewers independently assessed trial eligibility, extracted data, and evaluated risk-of-bias using the Cochrane tool. A random-effects network meta-analysis was performed. We assessed evidence certainty using GRADE. Results: We included 38 trials, with the following comparisons made between ketamine and placebo, using 0-10 VAS: At <30 minutes, ketamine may slightly reduce pain intensity (-1.32, 95% CI: [-1.73 to -0.90], low-certainty). At 1-3 hours follow-up, ketamine may slightly reduce pain intensity (MD: -1.25, (95% CI: [-1.76 to -0.74], low-certainty). At 3-to-7 days follow-up, ketamine may have little to no effect on pain intensity (MD: -1.34, 95% CI: [-2.29 to -0.39], low-certainty). At 3-to-5 weeks follow-up, ketamine likely results in no pain reduction (MD: -0.99, 95% CI: [-2.00 to 0.03], moderate-certainty). At beyond 5 weeks the evidence about ketamine pain reduction is very uncertain (MD: -1.09, 95% CI: [-1.86 to -0.32], very-low-certainty). Ketamine had no effect on physical functioning. Compared to placebo, ketamine may result in a slight increase in the risk of gastrointestinal adverse events (RR: 3.97, 95% CI: [2.18 to 7.22], RD: 12%, 95% CI: [5% to 25%], very-low-certainty), an increase in risk of dizziness (RR: 3.66, 95% CI: [1.25 to 10.74], RD: 11%, 95% CI: [1% to 40%], low-certainty), may increase the risk of fatigue, somnolence, and sedation (RR: 2.89, 95% CI: [1.84 to 4.53], RD: 27%, 95% CI: [12% to 50%], low-certainty), may increase of the incidence of dissociative symptoms (RR: 4.22, 95% CI: [2.20 to 8.10], RD: 17%, 95% CI: [6% to 37%], low- M.Sc. Thesis – Sara Moradi; McMaster University – Health Research Methodology iv certainty), and it may result in a slight increase in the risk of visual impairment (RR: 10.21, 95% CI: [2.86 to 36.42], RD: not evaluable, very-low-certainty). We did not have enough data to pool effect estimates for other outcomes. Conclusion: Ketamine may provide small but important benefit in CNCP patients at immediate-to-short follow-up, but it probably has little to no benefit at beyond 3-weeks. Ketamine is likely to provide similar benefits compared to alternative active interventions; however, these benefits may be associated with important side-effects. / Thesis / Master of Science (MSc)

No / The increasing prevalence of chronic wounds has significant financial implications for nations with advanced healthcare provision. Although the diseases that predispose to hard-to-heal wounds are recognized, their etiology is less well understood, partly because practitioners in wound management lack specialized diagnostic support. Prognostic indicators for healing may be inherent to wound biochemistry but remain invisible under routine clinical investigation; lactate is an example of this. In this study, lactate concentration in exudate obtained from 20 patients undergoing wound management in hospital was variable but in some cases approached or exceeded 20 mM. In vitro viability studies indicated that fibroblasts and endothelial cells tolerated low levels of lactate (1-10 mM), but cell viability was severely compromised by high lactate concentrations (=20 mM). Scratched monolayer experiments revealed that cell migration was affected earlier than viability in response to increasing lactate dose, and this was shown by immunocytochemistry to be associated with cytoskeletal disruption. A prototype enzyme-based colorimetric assay for lactate generating a color change that was rapid in the context of clinical practise, and capable of functioning within a gel vehicle, was developed with point-of-care dipstick applications in mind. A randomized single-blinded trial involving 30 volunteers and using a color chart to calibrate the assay demonstrated that lactate concentration could be reliably estimated with 5 mM precision; this suggesting that "physiological" and "pathological" lactate concentration could be distinguished. The present data suggest that a dipstick-type colorimetric assay could comprise a viable diagnostic tool for identifying patients at-risk from high-wound lactate.

Psychology / (M.A.(Clinical Psycholoy)

National rates of chronic non-cancer pain (CNCP) are rising alongside increasing reports of prescription opioid abuse and mortality. Associations between the rise in CNCP and in opioid abuse seem logical, yet research on CNCP among individuals with opioid dependence is currently limited due to the complicated nature of comorbid conditions in research and treatment. This study aims to expand the CNCP knowledge base by responding to the question: Do individuals with CNCP participating in an opiate treatment program have better or worse treatment outcomes than individuals without CNCP? This study used a secondary dataset including 483 adults from Kentucky’s Opiate Recovery Treatment Outcome Study. Individuals in the sample met DSM-IV-TR criteria for opioid dependence and were in treatment at a licensed opiate treatment program (OTP). Analysis compared cases with and without CNCP on national treatment outcome measures including substance use, recovery support, education, employment, mental health symptoms, and criminal justice system involvement. Results indicated no differences at follow-up between the CNCP (n=163) and non-CNCP (n=320) individuals on substance abstinence, recovery supports, education level, or criminal justice system involvement. At baseline and follow-up there were more unemployed individuals and individuals receiving disability benefits in the CNCP group than the non-CNCP group. Reported anxiety and depression symptoms increased at follow-up, while use of prescription medicine for mental health symptoms declined for both groups (non-significant differences). The only predictors for CNCP cases in this sample were tobacco use and presence of a chronic medical condition. Recommendations include expansion of smoking cessation programs in substance abuse treatment settings. Future research might examine integrated treatment and medical home health models to better address biopsychosocial components of clients with comorbid conditions like opioid dependence and CNCP.

By 2015, 149 million Americans are expected to be living with chronic health conditions (Anderson 2010). This number is expected to continue rising. Many chronic health conditions require those living with them to perform health self-management tasks on a regular basis. Nearly two in every five adults with one chronic condition and three out of every five adults with at least two chronic conditions track their health information. This paper investigates the use of mobile applications and the need to develop applications specifically designed for individuals living with chronic health conditions. Pew data are used to determine who is tracking their health information and how they are tracking it. Results from this analysis show that individuals with chronic health conditions have 69% greater odds of tracking health information than individuals who do not live with chronic conditions. Additionally, those with chronic conditions are 254% more likely than those without chronic conditions to track health indicators that are not related to diet, weight or exercise. These individuals are not, however, using mobile applications to track their health information. People with chronic health conditions have higher probabilities of tracking health information on paper or in their heads than their probability of tracking via a mobile application. However, the probability that individuals track health information via mobile apps increases when analyzing a subset of the population who own smartphones. After learning more about individuals with chronic conditions and their health information tracking habits, several mobile health applications are reviewed. The reviews of these applications include the features offered by the applications and their price. The paper concludes with several recommendations for developing and disseminating mobile health tracking applications to individuals with chronic conditions, as well as suggestions for future research. / text

The study, using a quasi-experimental design, examined the relationship between participation in a comprehensive pulmonary rehabilitation program, locus of control, and the psychological and social concomitants of chronic obstructive pulmonary disease. The study investigated the following questions. To what degree participation in a comprehensive pulmonary rehabilitation program emphasizing a psychosocial component would: (1) generally produce a shift in persons from an external locus of control toward an internal locus of control, (2) specifically decrease the perception of chance, fate, or powerful others to influence and determine personal health; and (3) will result in the lessening of perceived negative effects of the psychological and social concomitants of chronic obstructive pulmonary disease. Two sample groups were evaluated in the study: (1) a group of 35 moderate to severe chronic obstructive pulmonary disease patients enrolled in a 96-hour comprehensive pulmonary rehabilitation program with a 32-hour psychosocial instructional component, and (2) a group of 35 moderate to severe chronic obstructive pulmonary disease patients receiving standard medical care at a Veterans Administration Hospital. Research instruments used for the study were the Multidimensional Health Locus of Control Scale and the Sickness Impact Profile. The research instruments were administered to each study group at approximately 16-week intervals. Results of the study indicated that participation in a comprehensive pulmonary rehabilitation program emphasizing a psychosocial component did not produce a significant shift in program participants from an external locus of control toward an internal locus of control, nor did it produce a significant decrease in the perception of chance, fate, or powerful others to influence and determine personal health. However, the study results indicated that participation in a comprehensive pulmonary rehabilitation program did produce a significant (P < .05) lessening of perceived negative physical and psychosocial effects of chronic obstructive pulmonary disease as measured by the physical scale, psychosocial scale, and total score of the Sickness Impact Profile.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a prevalent, refractory pelvic pain condition characterized by pain in the pelvic area and urinary frequency, largely unresponsive to medical interventions. This study used multiple mediations to test the associations of validated pain appraisal and behavioural coping strategies between pain and quality of life. Patients (N = 175) were recruited from tertiary care urology clinics and completed questionnaires. Exploratory factor analyses were conducted on four individual measures (Chronic Pain Coping Inventory, Survey of Pain Attitudes – Control subscale, Center for Epidemiologic Studies Depression Scale, and Pain Catastrophizing Scale), then on the empirically derived factors that produced four factors to be used in regression and multiple mediation models: illness-focused behavioural coping, catastrophizing, wellness-focused behavioural coping, and depression. In regressions, CP/CPPS patient symptoms (p < .01), illness-focused behavioural coping (p < .01) and wellness-focused behavioural coping (p < .05) predicted physical quality of life, while catastrophizing (p < .01) and illness-focused behavioural coping (p < .05) predicted mental quality of life. Mediation analyses showed that illness-focused behavioural coping strategies partially mediated the relationship between pain and physical quality of life, whereas catastrophizing and illness-focused behavioural coping strategies both fully mediated the relationship between pain and mental quality of life. These results identify catastrophizing and illness-focused coping as key psychosocial targets for interventions for patient quality of life in CP/CPPS. / Thesis (Master, Psychology) -- Queen's University, 2013-08-27 17:07:11.853

Pain has been described as the most complex human experience and most frequent reason patients seek medical treatment. Few people fail to experience the pain associated with disease, injury, or medical/surgical procedures. However, the impact of unemployment that results from chronic pain suffering has not been widely researched. To present a comprehensive view of the effect unemployment has upon the chronic pain experience, this study focused upon stress philosophy, chronic pain, employment, and coping effectiveness. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and a Personal Data Questionnaire (PDQ) were administered to 96 persons (four groups of 24 subjects) representing either unemployed or employed and either chronic or non-chronic (acute) pain populations.

This study investigated the relationship between preferred coping strategies, and major stressors for nondepressed, and depressed chronic pain patients. The subjects for this study were 67 chronic pain patients who are participating in a pain/spinal rehabilitation program. The information collected from the individuals or their records included: (1) basic demographic information, (2) level of activity, (3) level of perceived pain, (4) medication usage, (5) therapist rating of level of stabilization, (6) scores on three inventories including the Coping Strategies Questionnaire, the Ways of Coping Checklist, and the Beck Depression Inventory. Analyses included an examination of the relationship between level of depression and (1) type of stressors, (2) coping strategies, and (3) level of perceived pain. Further analyses included multiple regression with outcome as defined by therapist ratings at the end of treatment, and patients' ratings at follow up as the criterion variables.