Background: Firefighters (FFs) are exposed to life-threatening conditions while carrying out their tasks. These strenuous conditions predispose them to a high rate of disability, morbidity and mortality. These hazardous conditions put them at risk for work limitations, but the literature is scarce in this matter. Objective: The overarching objective of this thesis is to determine the role of FFs health as predictors of work limitations in fire service. Specifically, the first objective is to determine whether work limitations differ among FFs based on the location or number of painful sites. The secondary objective is to determine whether non-musculoskeletal comorbid health condition predict work limitations among FFs. Participants: A convenience sample of FFs between the age of 18-60 years working in the province of Ontario, Canada. Methods: Participants completed either an online or paper-based survey including a work limitation questionnaire(WLQ-26) and a self-reported comorbidity questionnaire. For the first objective, a one-way ANOVA and post hoc test was used to determine the differences in work limitations among FFs based on the number or location of painful sites. For the secondary objective, a univariate linear regression was used to evaluate whether non-MSK comorbid health condition predict work limitations among FFs. Results: FFs with three or more painful sites had more physical limitations than FFs without pain, (Mean difference=1.03/10; 95% CI: 0.16-1.62; p=0.02). FFs with pain at the region of the spine experienced more physical limitations compared to FFs with no pain (Mean difference=0.89/10; 95% CI: 0.17-1.62; p=0.007). For the secondary objective, univariate analysis showed that having at least one comorbidity(p=0.04) had a small, but significant association with greater mental work limitations (F2,316=2.94; p=0.05; R2=0.02). Separate univariate analysis showed that women FFs having one comorbidity had a small but significant association with physical (R2=0.07; F2,97=3.92, p=0.02) and mental work limitations (R2=0.04; F2,101=1.89, p=0.15) than women without non-MSK comorbidity. Conclusion: Having multiple painful sites or pain at the spinal region influenced work limitations among FFs. Also, non-MSK comorbidity impacted mental limitations among FFs; especially among women FFs. Therefore, managing MSK and on-MSK comorbidities is a necessary health care goal to prevent work limitations. / Thesis / Master of Science (MSc)

The co-occurrence of anxiety disorders (ADs) and disruptive behavior disorders affects a substantial proportion of children and may cause significant impairment in functioning. Approximately 40% of clinic-referred youth with oppositional defiant disorder (ODD) meet criteria for an AD (Greene et al., 2002). In spite of the frequent co-occurrence of these disorders, there is little research examining the presence of AD in clinic-referred samples of youth with ODD. Thus, the purpose of the current study was to 1) examine the phenomenology of clinic-referred youth with ODD/AD as compared to youth with ODD alone, and 2) explore the role of cumulative family risk (CFR) in predicting level of impairment in youth with comorbid ODD/AD as compared to youth with ODD alone. There was mixed support for distinct clinical profiles among youth with ODD/AD as compared to youth with ODD alone: youth with ODD/AD had higher levels of anxiety, internalizing symptoms, and parent psychopathology whereas youth with ODD alone had higher levels of conduct problems, hyperactivity, and attention difficulties. However, there was little support for the role of CFR in predicting impairment in youth with ODD/AD. Future research should enlist a multi-informant, multi-contextual approach in examining the role of CFR in predicting impairment levels for youth with comorbid ODD/AD. / Ph. D.

Objective: Although findings have been mixed, accumulating evidence suggests that co-occurring attention-deficit/hyperactivity disorder (ADHD) diagnoses and symptoms negatively predict cognitive-behavioral therapy (CBT) outcomes for anxious youth. The current study extends past research by examining the association of not only ADHD but also other features of ADHD with treatment outcomes of youth who received an intensive CBT for a specific phobia. Method: 135 youth (ages 6-15; 52.2% female; 88.2% white) were randomized to either an individual or parent-augmented intensive CBT targeting a specific phobia. Latent growth curve models were used to explore the association of ADHD symptoms, effortful control, sluggish cognitive tempo, maternal depression and the two treatment conditions (i.e., individual versus parent-augmented) with pre-treatment severity of the specific phobia and the trajectory of change in the severity of the specific phobia from pre-treatment to the 6-month follow up after the intervention. Results: As expected, higher levels of ADHD symptoms were associated with lower levels of effortful control and increased maternal depression at pre-treatment. Contrary to expectations, ADHD symptoms and its associated difficulties were not significantly associated with treatment outcomes. Conclusion: Overall, the findings lend support to the generalizability of intensive CBT for a specific phobia to youth with comorbid ADHD and associated difficulties. Implications and limitations of the study are discussed. / Ph. D.

Although clinically significant symptoms of anxiety or depression are present in nearly one in two people with autism spectrum disorder (ASD), little is known about how these symptoms may relate to social motivation, a key construct in the etiology of ASD. The aim of the current study was to examine patterns of anxiety, depression, ASD symptomatology, and social motivation in youth with ASD. Using a large public dataset of well-characterized youth with ASD (N = 195), we examined varying patterns of these symptoms via latent profile analysis (LPA). Three distinct classes emerged: one with moderate ASD severity and low levels of comorbid psychopathology, a second with more severe ASD symptoms and similarly low anxiety and depression, and a third with significantly elevated anxiety and depression. Neither sex nor age differed significantly among these classes, and indices of social interest early in development did not predict class membership. Implications of these symptom patterns for assessment and treatment of comorbidity in ASD are discussed. / Doctor of Philosophy / A large proportion of individuals with autism spectrum disorder (ASD) experience symptoms of anxiety and depression. Anxiety and depression might be related to social motivation, which is a key concept associated with the development of ASD. The current study examined variation in anxiety, depression, social motivation, and ASD symptom severity in a large sample of youth with ASD. Individuals in the sample were classified in groups by a statistical model. Models produced three separate groups: one group with moderate symptoms of ASD and relatively low levels of anxiety and depression, a second with more severe ASD symptoms and similarly low anxiety and depression, and a final group with moderate ASD symptoms and high anxiety and depression. Social motivation was strongest in the first and second groups, and low social motivation was strongly associated with anxiety and depression symptoms. Age and sex did not predict group membership, nor did items measuring social motivation early in development. Implications of these symptom patterns for the assessment and treatment of anxiety and depression in ASD are discussed.

The current study evaluated a treatment designed specifically for children with attention-deficit/hyperactivity disorder (ADHD) and anxiety. The experimental treatment involved a combination of parent management training for ADHD and family-based treatment for anxiety. Sessions lasted approximately 90 minutes, and the treatment consisted of 10 weekly sessions. 8 children ages 8-12 with ADHD, Combined Type (ADHD-C) and at least one of three anxiety disorders (separation anxiety disorder, generalized anxiety disorder, social phobia) were selected for the study. Children were assessed with semi-structured diagnostic interviews and other standardized measures to determine study eligibility. The current study utilized a noncurrent multiple baseline design to evaluate treatment efficacy. Upon selection into the study, children were randomized to one of three baseline control conditions (i.e., 2, 3, or 4 weeks of waiting) in order to insure that change in behavior was associated with implementation of the treatment. Treatment commenced after the respective baseline periods. Families were assessed throughout treatment but more comprehensive assessments were conducted at pre-treatment, mid-treatment, and 1-week post-treatment. Results highlighted significant improvement in anxiety-related symptoms but more modest gains for ADHD-related symptoms. / Ph. D.

Yu, Kai Shing. / "November 2010." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 103-114). / Abstracts in English and Chinese. / Abstract --- p.2 / 中文摘要 --- p.6 / List of Contents --- p.9 / List of Table --- p.12 / Abbreviation --- p.13 / Acknowledgement --- p.14 / Chapter Chapter 1: --- Introduction --- p.15 / Chapter 1.1 --- Epidemiology of lung cancer --- p.15 / Chapter 1.2 --- Overview of significant prognostic factors for patients with NSCLC --- p.18 / Chapter 1.2.1 --- Tumor related factors --- p.19 / Chapter 1.2.2 --- Patient related factors --- p.21 / Chapter 1.3 --- Overview of significant prognostic factors for SCLC patients --- p.22 / Chapter Chapter 2: --- Literature Review --- p.25 / Chapter 2.1 --- Prevalence of co-morbidity among lung cancer patients --- p.25 / Chapter 2.2 --- Impact of co-morbidity on non small cell lung cancer patients --- p.28 / Chapter 2.3 --- Impact of co-morbidity on small cell lung cancer patients --- p.36 / Chapter 2.4 --- Summary of evidence from literature review --- p.40 / Chapter Chapter 3: --- Aim and Objectives --- p.42 / Chapter 3.1 --- General aim --- p.42 / Chapter 3.2 --- Specific objectives --- p.42 / Chapter 3.3 --- Main hypothesis --- p.42 / Chapter Chapter 4: --- Methodology --- p.43 / Chapter 4.1 --- Research design --- p.43 / Chapter 4.2 --- Study population --- p.43 / Chapter 4.3 --- Sample size estimation --- p.45 / Chapter 4.4 --- Data collection --- p.47 / Chapter 4.4.1 --- Demographic information --- p.47 / Chapter 4.4.2 --- Co-morbidity --- p.51 / Chapter 4.4.3 --- Adverse symptoms --- p.51 / Chapter 4.4.4 --- Disease characteristics --- p.52 / Chapter 4.4.5 --- Baseline laboratory findings --- p.53 / Chapter 4.4.6 --- Treatment data --- p.53 / Chapter 4.4.7 --- Follow up --- p.53 / Chapter 4.5 --- Statistical analyses --- p.54 / Chapter Chapter 5: --- Results --- p.56 / Chapter 5.1 --- Description of cohort --- p.56 / Chapter 5.2 --- Baseline characteristics --- p.58 / Chapter 5.3 --- Symptom presentation --- p.62 / Chapter 5.4 --- Histological characteristics --- p.64 / Chapter 5.5 --- Treatment characteristics --- p.67 / Chapter 5.6 --- Haematological characteristics of study population --- p.69 / Chapter 5.7 --- Prevalence of co-morbidity --- p.71 / Chapter 5.8 --- Overall survival --- p.74 / Chapter 5.8.1 --- Univariate and multivariate survival analysis for SCLC patients --- p.75 / Chapter 5.8.2 --- Univariate and multivariate survival analysis for NSCLC patients --- p.77 / Chapter 5.8.3 --- In-depth analyses for the Impact of co-morbidity on lung cancer survival --- p.79 / Chapter 5.8.4 --- Selected underlying causes of death --- p.84 / Chapter Chapter 6: --- Discussion --- p.85 / Chapter 6.1 --- Prognostic factors --- p.85 / Chapter 6.2 --- Prevalence of co-morbidity --- p.89 / Chapter 6.3 --- Impact of co-morbidity on lung cancer survival --- p.92 / Chapter 6.4 --- Strengths and limitations of this study --- p.97 / Chapter Chapter 7: --- Conclusions --- p.101 / Chapter Chapter 8: --- Implications and Recommendations for medial practice --- p.102 / References --- p.103

No description available.

The purpose of this work was to further understand nutritional status, especially body weight and composition, during colorectal cancer progression. Population-based studies of colorectal cancer patients were conducted using administrative health data (primary and co-morbid diseases, demographics), and computed tomography (CT) imaging (body composition). In cohort 1, administrative health data was used to study comorbidities and nutritional status in 574 colorectal cancer patients referred for chemotherapy. Multivariate Cox regression revealed several comorbidities, performance status and weight loss 20% predicted survival. In cohort 2, a serial CT image analysis assessed longitudinal body composition changes during the last 12 months preceding death from colorectal cancer (n=34). Body composition changes were typified by exponential increases in liver metastases with concurrent accelerations of muscle and fat loss. These results have the potential to make a difference in how colorectal cancer patients are treated and researched by dietitians, oncologists, and health services researchers. / Nutrition and Metabolism

Thesis (Ph.D.)--Pardee Rand Graduate School, 2006. / Title from PDF cover. Includes bibliographical references. Issued also in print.

Background/Objectives: West Nile neuroinvasive disease (WNND) is a severe neurological illness that develops in approximately 1% of individuals infected with West Nile virus (WNV). Manifesting most frequently as encephalitis (WNE), meningitis (WNM), or acute flaccid paralysis (WNP), there is no cure for WNND beyond supportive care and rehabilitation, and death or permanent disability are common outcomes. As the virus arrived in North America less than 20 years ago, determinants of severe disease progression following infection are still being explored. This project is the first to examine comorbid conditions as risk factors of WNND in Ontario using a population-based study design. As prevention is the only avenue of defence against WNND, identifying comorbid risk factors of WNND would allow for public health prevention campaigns targeted to high-risk groups. The main objectives of this thesis were to explore whether pre-existing chronic diseases were associated with the development of WNND, or any of its three manifestations (i.e., encephalitis, meningitis, acute flaccid paralysis). Methods: This was a retrospective, population-based study including all Ontario residents with a confirmed diagnosis of WNV infection between January 1, 2002 and December 31, 2012. A cohort of individuals with WNV was identified from a provincial laboratory database and individually-linked to health administrative databases. In the WNV cohort, individuals with WNND and 13 comorbid conditions were identified using algorithms based on ICD-10-CA diagnostic codes. Incidence of WNND following WNV infection was then compared among individuals with and without comorbid conditions using relative risks estimated by log binomial regression. Additionally, risk ratios were calculated for associations between specific comorbid conditions and WNND neuroinvasive manifestation (i.e., encephalitis, meningitis, acute flaccid paralysis). Finally, associations between Charlson Comorbidity Index (CCI) scoring and development of WNND was examined through calculation of relative risk using log binomial regression. Results/Potential Impact: Risk factors for WNND included male sex (aRR: 1.21; 95% CI: 1.00-1.46) in addition to the combined effect of hypertension and increasing age (5-year intervals) (aRR: 1.16; 95% CI: 1.08-1.24); WNND was also associated with increasing CCI scores; individuals in low, medium, and high categories had increased risk compared to individuals with a score of zero, but the greatest risk was in the high CCI category (aRR: 3.45; 95% CI: 2.25-4.83) Male sex (aRR: 1.32; 95% CI: 1.00-1.76), increasing age (aRR: 1.02; 95% CI: 1.02-1.03), and being immunocompromised (aRR: 2.61; 95% CI: 1.23-4.53) were associated with development of WNE. No risk factors were identified for WNM and WNP. Identification of comorbid risk factors of WNND will allow public health officials to identify high-risk groups and to develop prevention strategies targeted for vulnerable individuals.