Objetivo: Avaliar em pacientes submetidos à cirurgia de correção de ptose palpebral e dermatocálase: a) o nível de associação de medidas propedêuticas pré-operatórias (função do músculo levantador da pálpebra superior (FMLPS), distância margem palpebral superior ao centro da pupila (DMR1) e altura do sulco palpebral (AS), com a magnitude de desinserção do tendão do músculo levantador da pálpebra superior (MLPS). b) A influência da idade, sexo, presença de ectrópio/entrópio e cirurgia ocular prévia na magnitude de desinserção do tendão do MLPS. c) Avaliar as diferenças das medidas propedêuticas palpebrais pré e pós-operatórias . d) Avaliar a presença de desinserção do MLPS na pálpebra não-ptótica de pacientes com ptose unilateral. e) Avaliar a presença de desinserção do MLPS em pálpebras com DMR1 normal. Metodologia: Desenho do estudo: Série de casos, não comparativo, prospectivo. Casuística: Quarenta e quatro pacientes com ptose palpebral e dermatocálase foram incluídos. Intervenção: Exploração do tendão do MLPS durante a blefaroplastia em pacientes com ptose e dermatocálase. Nos casos de desinserção, o tendão foi refixado ao tarso. Desfechos analisados: Avaliação do nível de associação das medidas propedêuticas pré-operatórias (além de sexo, idade, diabetes, cirurgia ocular prévia, presença de ectrópio/entrópio e queixa de ptose) na magnitude de desinserção do MLPS. Foram utilizados modelos uni e multivariados. A interação entre as variáveis foi testada no modelo multivariado e também foi realizada a avaliação da diferença entre as medidas de FMLPS, DMR1 e AS antes e depois da intervenção. A dependência entre os olhos foi corrigida por meio de equações de estimações generalizadas. Correlação de Pearson foi utilizada para quantificar a dependência entre os olhos para FMLPS, DMR1 e AS. Resultados: A média de desinserção do tendão do MLPS foi de 5,47 mm ± 3,02 para o olho direito e 5,99 mm ± 2,60 para o esquerdo. Com exceção da queixa de ptose e da FMLPS, todas as variáveis testadas foram estatisticamente associadas à magnitude de desinserção do tendão do MLPS. Quando todas elas entraram em um modelo multivariado, somente a DMR1 e a AS foram estatisticamente preditoras da magnitude de desinserção do tendão do MLPS. Houve diferença estatisticamente significante entre a FMLPS antes e depois da cirurgia, sendo a excursão do MLPS mais limitada após a cirurgia, diminuindo, em média, 1,1 mm (p < 0,001). As medidas pré e pós-operatórias de DMR1 e AS foram estatisticamente diferentes, com melhora no pós-operatório, sendo que DMR1 aumentou, em média, 1,6 mm e a AS diminuiu, em média, 3,97mm (p < 0,001). Encontrou-se correlação significante entre os olhos para todas as variáveis propedêuticas analisadas antes e depois da cirurgia. O mesmo foi encontrado para a correlação quanto ao grau de desinserção nos dois olhos (p > 0,01). Conclusões: a) Das medidas pré-operatórias, DMR1 e AS foram as que mais se associaram à magnitude de desinserção do tendão do MLPS, sendo que houve interação entre as duas medidas para esta associação no modelo multivariado de análise. b) Idade, sexo, cirurgia ocular prévia e presença de ectrópio/entrópio estiveram associados ao grau de desinserção, mas somente no modelo univariado de análise. c) Houve aumento significativo das medidas de DMR1 no pós-operatório, diminuição da AS e da FMLPS. d) Houve quatro pacientes com ptose unilateral. Dois deles apresentaram desinserção do MLPS no olho sem ptose. e) Foram encontrados oito pacientes com medidas de DMR1 normais em um ou ambos os olhos. Destes, somente um não apresentou qualquer desinserção do MLPS / Purpose: To evaluate on patients who underwent to ptosis and dermatochalasis correction: a) the association of pre-operatory propedeutic measures (upper eyelid levator muscle function (UELMF), margin reflex distance (MRD1), and eyelid crease height (ECH)) on the amount of upper eyelid levator muscle (UELM) disinsertion. b) The association of gender, age, previous surgery, and ectropion/entropion were analyzed as predictive factors for the amount of upper eyelid levator muscle disinsertion. c) To evaluate the differences of eyelid propedeutic measures before and after surgery. d) To evaluate the amount of UELM disinsertion in the normal eyelids of patients with unilateral ptosis. e) To evaluate the amount of UELM disinsertion in patients with normal MRD1. Methods: Design of the study: prospective non comparative case series study. Population: Forty four patients with blepharoptosis and dermatochalasis were enrolled. Intervention: Exploration of the levator tendon (LT) during blepharoplasty and ptosis correction and in case of its disinsertion, the tendon was reattached to the tarsus. Outcome Measured: Margin reflex distance (MRD1), upper eyelid levator muscle function (UELMF), eyelid crease height (ECH), gender, age, diabetes, previous surgery, ectropion/entropion, and ptosis complaint were analyzed as predictive factors for the amount of upper eyelid levator muscle disinsertion. Both the uni and multivariate approaches were tested and for the latter, interaction from variables was also evaluated. The differences between UELMF, MRD1, ECH before and after surgery were evaluated bilaterally. Dependency between both eyes was corrected by generalized estimating equations. Pearson correlation was used to evaluate the dependency of the two eyes regarding UELMF, MRD1 and ECH. Results: The mean levator tendon disinsertion was 5.47 mm ± 3.02 for the right eye and 5.99 mm ± 2.60 for the left. For univariate models, with the exception of the complaint of ptosis and eyelid function, all variables were statistically related to the amount of disinsertion of the upper eyelid levator tendon. For the multivariate model, when all variables were considered, only MRD1 and ECH were significantly associated with the amount of disinsertion. There was a statistical significant difference between the measures of UELMF before and after surgery with excursion decreasing a mean value of 1.1 mm after the procedure (p < 0,001). Measures of MRD1 showed an increase in a mean of 1.6 mm and ECH decreased in a mean of 3.97 mm (p < 0,001). We had found a significant correlation between both eyes for all eyelid propedeutic variables analyzed, both before and after surgery. Correlation of the propedeutic measures before surgery, between the two eyes, was stronger for the group without previous surgery. The same results for correlation was found for the amount of disinsertion (p < 0.001). Conclusions: a) From the pre-operatory measures, MRD1 and ECH were the most important variables regarding association with the amount of UELM tendon disinsertion. A very important interaction was found between these two variables on the multivariable analysis model. b) Gender, age, diabetes, previous surgery, and presence of ectropion/entropion were associated with the amount of disinsertion but only on the univariable model of analysis. c) There was an increase on the measures of MRD1, ECH and UELMF decreased. d) Four patients had unilateral ptosis. Two of those patients presented UELM disinsertion on the eye without ptosis. (e) Eight patients had normal values for MRD1 in one or both eyes, from those, only one had no disinsertion

Background: Opioid use disorder (OUD) has been an increasing concern in Canada as mortality rates continue to rise. Though OUD treatments, such as methadone maintenance treatment (MMT), reduce its burden, they could potentially cause harm due to OUD’s variance in severity and presentation across individuals. It is hypothesized that genetic variants such as single nucleotide polymorphisms (SNPs) could predispose patients to respond differently to MMT. In addition, sex differences have been observed in opioid use patterns, treatment outcomes, and genetic make-up. As such, this thesis aims to identify significant SNPs associated with treatment outcomes in genome-wide association studies, and test biologically relevant SNPs with MMT outcomes of interest, while highlighting sex differences. This is achieved through a systematic review protocol, a systematic review, and a candidate gene study. Methods: A protocol was prepared for the planning of the first ever systematic review of genome-wide significant findings of medication-assisted treatment outcomes for OUD patients. The systematic review assessed the literature findings and study qualities, narratively summarizing significant associations. Next, a candidate gene study analyzed the association between SNPs in OPRM1 and CYP2B6 genes, and continued opioid use, relapse, and methadone dose within an ancestrally European sample (n=1226). Sex-stratified and sex-interaction analyses were also conducted. Results: The systematic review included 5 studies and qualitatively assessed 43 unique genetic variants. The candidate gene study showed no significant associations between the selected OPRM1 and CYP2B6 SNPs and outcomes of interest. While no significant differences between the sexes were observed, rs73568641 and rs3745274 showed near significance associations in only one sex, females, and males, respectively. Discussion: Through the study of genetic variants associated with treatment outcomes in the literature and our sample of ancestrally European individuals on MMT, we were able to highlight gaps in pharmacogenetics research and identify areas of focus for future studies. / Thesis / Master of Science (MSc) / Recently, opioid use disorder (OUD) has been declared a national crisis in Canada. OUD treatments are helpful in reducing opioid use and adverse events. However, their dosing and metabolism in patients can impact continued opioid use, relapse, or treatment dose changes. Due to the variability in response between individuals, there might be a genetic basis to treatment outcomes. This thesis explores which genetic variants reported in previous studies are involved in OUD treatment outcomes. Then, it tests select genetic variants in OPRM1 and CYP2B6 genes to see if they are linked to specific outcomes in an Ontario population and tries to identify if these associations differ by sex. No significant associations were found, though associations in males and females had near-significant results in one sex but not the other. Despite suggesting sex’s possible involvement in treatment outcomes, more research is necessary to confirm these findings.

Anxiety is one of the most common mental health disorders in the U.S. and is becoming increasingly common and problematic for college students across the country. Building on research conducted at single universities, we used a large national data set from the Center for Collegiate Mental Health (CCMH) and compared self-reported levels of anxiety amongst various groups of college students across the U.S., as well as the prevalence of comorbidity between anxiety reported on the generalized anxiety subscale of the Counseling Center Assessment of Psychological Symptoms (CCAPS) and other mental health concerns. We found that a number of self-reported variables (e.g., considered attempting suicide, experienced traumatic event, non- suicidal self-injury, etc.) on the CCAPS had a positive correlation with anxiety levels at intake. Interestingly, we found that those who participated in organized college athletics and those who are international students were found to have lower anxiety at intake than others. We further found that participants from certain demographic backgrounds had higher levels of anxiety than others. Notably, participants who reported they were born female had higher levels of anxiety than those born male. Similarly, women and transgender individuals had higher anxiety levels than men, and those who self-identified their gender identity had higher anxiety scores than women, men, and transgender individuals. Our results also indicate that, at intake, those who self-identified in their sexuality and identified as bisexual reported the highest levels of anxiety compared to those who identified as lesbian, questioning, gay, or heterosexual. Our model, which contained the variables sexual orientation, gender identity, marijuana use, experienced traumatic event, considered attempting suicide, non-suicidal self-injury, current financial situation, prescribed medication for mental health concerns, and emotional support from social network, was the best fit that most parsimoniously described which variables had the greatest impact on anxiety levels at intake. Finally, our results indicate that there is a relationship between generalized anxiety symptoms and other presenting concerns (distress, depression, social anxiety, hostility, eating concerns, substance use). Given our study's large sample size, we provide more generalizable data than single university studies and provide clinical and research recommendations.

Student Number : 0413807K - MSc research report - School of Public Health - Faculty of Health Sciences / Tuberculosis ranks among the top ten causes of global mortality. Globally it kills nearly 2 million people each year and is the second leading cause of death after Human Immune Deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS).Tuberculosis (TB) is primarily an illness of the respiratory system, and is spread by coughing and sneezing from an infectious person. Nearly a third of the world’s population is infected with the bacilli that causes TB and are at risk of developing tuberculosis (TB).1, 2 Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. In 2004, estimated per capita TB incidence was stable or falling in five out of six World Health Organization (WHO regions, but growing at 0.6% per year globally. The exception is the African region, where TB incidence was still rising.3, 4 HIV increases the risk of developing TB and accounts for much of the increase in countries where prevalence is high. 4 Co-infection is common and could be as high as 70% in high-burdened countries. Gains made in global TB control in the 1970 and 80s are being dramatically reversed by the effect of HIV/AIDS. HIV is the main reason for failure to meet Tuberculosis (TB) control targets in high HIV settings.3 Drug-resistant TB is a major problem. Resistance to single anti-tuberculosis drugs have been reported in almost every country surveyed. To make the situation worse, drugs resistant to all the major anti-TB drugs have emerged. 4 Drug-resistant TB is caused by inconsistent or partial treatment, when patients do not take all their medicines regularly for the required period because they start to feel better, because doctors and health workers prescribe the wrong treatment regimens, or because the drug supply is unreliable. A particularly dangerous form of drug-resistant TB is multidrug-resistant TB (MDR-TB), which is defined as the disease caused by TB bacilli resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.4, 5

Thesis (M.S.)--Boston University

Comorbidity between substance use disorders and post traumatic stress disorder (PTSD) is common. Despite evidence to suggest that people with heroin dependence are at particular risk of PTSD, there is a dearth of research focussing on the interrelationship between these disorders. The present thesis aims to identify the prevalence of PTSD among people with heroin dependence, the correlates of this comorbidity, and its impact on treatment outcomes, the utilisation of treatment services, and treatment costs. Study 1 examines the epidemiology of PTSD and heroin dependence among 10,641 Australian adults who participated in the National Survey of Mental Health and Wellbeing. The prevalence of PTSD was highest among people with heroin or other opioid use disorders compared with any other drug class (33.2%). Comorbid PTSD was associated with poorer occupational functioning, and poorer physical and mental health. While general population studies provide crucial population estimates they do not allow for a detailed examination of the relationship between highly disabling but low prevalence disorders. The remaining studies were undertaken using a sample of 615 treatment seeking and non-treatment seeking dependent heroin users. Study 2 examines the prevalence and correlates of this comorbidity. PTSD was common (lifetime 41%; current 31%) and was associated with a more severe clinical profile. Studies 3 and 4 were based on follow-up data on this large cohort. Study 3 is the first study to examine the impact of PTSD on 2 year treatment outcomes for heroin dependence. Across the 2 year period, those with current PTSD at baseline performed more poorly in terms of their occupational functioning, physical and mental health. Study 4 found that this did not equate to the greater use of treatment services or an increased cost to the health care system among those with PTSD. It is concluded that PTSD and heroin dependence are highly comorbid conditions, and that this comorbidity is associated with poorer functioning and poorer treatment outcomes. Individuals entering treatment for heroin dependence should be assessed for PTSD so that they may receive appropriate treatment and referral. Further research is also needed to determine how best to treat this comorbidity.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (p. 148-153).

The relationship that develops between a client and therapist is arguably one of the most important factors toward achieving positive outcomes from therapy. Although the therapeutic alliance has been well studied, there is a paucity of research related to the impact of this relationship when the client is an offender, of Aboriginal ancestry, or psychopathic. The present study employed an archival design in which a sample of 427 treated sexual offenders were examined with regard to their experience of therapeutic alliance with their primary therapists. Offenders who were admitted to the Clearwater Sex Offender Program at the Regional Psychiatric Centre Hospital in Saskatoon (RPC Prairies) between 1998 and 2005 completed a measure that rated the strength of their relationship with their primary therapists using the Working Alliance Inventory (WAI) roughly three months after program admission. Approximately 46% of the sample was of Aboriginal ancestry, while the majority of the balance (approximately 52%) was Caucasian. A sub-sample of 111 offenders was also scored on the PCL-R. Analysis of WAI scores among Aboriginal and non-Aboriginal offenders demonstrated a significant difference on the Bond scale of the WAI, suggesting that although the bonds between Aboriginal offenders and their primary therapists were not as strong as they were between non-Aboriginal offenders and therapists, Aboriginal offenders were still able to identify and agree on the goals and the tasks of the treatment (weaker bonds notwithstanding). Aboriginal offenders also spent slightly less time in treatment overall than their non-Aboriginal counterparts. The present research also found that as the scores on the WAI increased, rates of treatment noncompletion decreased, the implications of which would seem to highlight the need to foster and maintain strong therapeutic relationships. In terms of outcome, perhaps unexpectedly, results of the present research found that WAI was not a significant predictor of any recidivism criteria. Aboriginal Ancestry was related to non-sexual violent reconvictions and general reconvictions, but not sexual recidivism. Moreover, offenders who were both Aboriginal and reported low WAI scores were the most likely to recidivate in a non-sexual violent manner and in general, but not sexually. An examination of the relationship of working alliance to psychopathy found that WAI and PCL-R scores were not significantly correlated overall; however, a negative inverse relationship between the Lifestyle and Emotional facets with total WAI score was noted, suggesting that callous-unemotional traits and lifestyle were associated with weaker alliance. Interestingly, these correlations were not evident in the Aboriginal sample suggesting that other factors, aside from levels of psychopathy, were associated with working alliance in this ancestral group. In addition, results of the present analysis revealed WAI and PCL-R together, were better able to predict sexual recidivism for non-Aboriginal offenders than for Aboriginal offenders; however, the WAI and PCL-R jointly predicted nonsexual violent recidivism, but only for non-Aboriginal offenders, and jointly predicted general recidivism for both ancestral groups. Together, the results of this study attempt to further advance our understanding of the therapeutic alliance and its link to treatment outcome, Aboriginal ancestry, and psychopathy.

Little research has examined which individual factors may predict mental health court diversion outcome. Using data provided by a non-profit mental health services agency operating in the Durham Region in Ontario, this study examined 419 persons with mental illness participating in a post-charge diversion program. Socio-demographic and clinical characteristics were employed to investigate the relationship between clientspecific factors and level of program completion. Logistic regression results revealed that unemployment was a significant predictor of program completion. Employment and symptom severity were predictive of partial completion of court diversion. Additionally, participants who did not complete programming were more likely to have a concurrent disorder and were more likely to be residentially unstable than participants who did complete programming. These findings are discussed with respect to their implications for practice and future research. / UOIT

Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.