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Background: Despite the many harms and limited efficacy of opioids in managing chronic noncancer pain (CNCP), they are commonly prescribed for these patients in North America. One of the harms associated with prolonged opioid use is opioid use disorder (OUD); however, the risk of addiction is uncertain. We systematically reviewed observational studies to establish the prevalence of (OUD), and to explore factors associated with OUD in patients with CNCP. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, and PsycINFO from inception to December 2018 to identify studies that explored the prevalence of OUD or risk factors for OUD in patients with CNCP. Two specialists in addiction medicine reviewed each potentially eligible study, blinded to results, to ensure their outcome met DSM-5 criteria for OUD. We pooled estimates of OUD across eligible studies using random-effects models. When possible, we pooled estimates of association with OUD for all independent variables reported by more than one study. Results: Twenty-two studies reported the prevalence of OUD, and six studies reported the association of 36 factors with OUD in patients with CNCP. The pooled prevalence of OUD was 20% (95% CI: 15% to 25%); however, we found evidence for small study effects (interaction p<0.001). When restricted to larger studies (≥900 patients), the pooled prevalence of OUD was 5.8% (95% CI: 2.8% to 9.5%; moderate certainty evidence). The prevalence of OUD was not associated with level of certainty of OUD criteria, under- or overestimation of instruments compared to DSM-5 criteria, severity of OUD, or risk of bias (interaction p values ranged from 0.34 to 0.92). Moderate certainty evidence demonstrated an association between OUD and male sex (OR 1.50 [95% CI: 1.05 to 2.14]; absolute risk increase (ARI) 2.7% [95% CI: 0.3% more to 5.8% more]), current smokers (OR 1.63; [95% CI: 1.25 to 2.12]; ARI 3.3% [1.3% more to 5.7% more]), and a history of mental health disorders (OR 1.49 [95% CI: 1.17 to 1.89]; ARI 2.6% [95% CI: 0.9% more to 4.6% more]). Low certainty evidence demonstrated an association between OUD and younger age (OR for every 10-year decrement, 1.60 [95% CI: 1.11 to 2.30]; ARI, 3.2% for every 10-year decrement [95% CI: 0.6% more to 6.6% more]). Moderate certainty evidence suggested no association between OUD and a history of alcohol abuse/dependence (OR 1.32 [95% CI: 0.84 to 2.07]; ARI 1.7% [95% CI: 0.9% less to 5.5% more]), and low certainty evidence suggested no association between OUD and a history of drug abuse (OR 1.51 [95% CI: 0.75 to 3.02]; ARI 2.7% [95% CI: 1.4% less to 9.9% more]). Conclusion: Moderate certainty evidence suggests that 6% of CNCP patients prescribed opioids will develop OUD. Younger men who smoke, with a history of mental health disorders, are at higher risk. Additional research is needed to establish the association between OUD and a history of drug or alcohol abuse. / Thesis / Master of Science (MSc) / Opioids are commonly prescribed for patients with chronic pain that is not due to cancer; however, long-term opioid use inevitably leads to physical dependence and may result in addiction. Prior studies have reported extremely variable rates of opioid use disorder (OUD) following prescription for chronic noncancer pain, ranging from less than 1% to more than 50%, which has led to considerable confusion. My systematic review found moderate certainty evidence that the prevalence of OUD following prescription for chronic pain is 5.8% (95% CI: 2.8% to 9.5%). Patients who were younger, current smokers, males, and had a history of mental health disorders, had a higher risk of developing OUD. These findings will help support shared care decision-making between patients with chronic pain considering opioid therapy and their healthcare providers.

Purpose of the study - Identify predictors of mortality and develop a related care plan for patients who are on antiretroviral therapy (ART) in Gondar, Ethiopia. Design - A quantitative, retrospective cohort study was conducted analysing medical records of HIV patients who presented to Gondar University Hospital (GUH), Gondar, and started ART between 1 January 2007 and 30 June 2010. Results - In defining the predictors of mortality, the findings in bivariate analysis revealed: female sex, CD4 cell count ≤ 50/μl, CD4 cell count 51-199/μl, a haemoglobin concentration ≤8g/dl, a history of oral candidiasis, tuberculosis and Cryptococcus meningitis were all statistically significant. A female sex, CD4 cell count ≤ 50/μl and CD4 cell count 51-199/μl maintain their significance level in the multivariate analysis. Conclusions - The study therefore recommends that clinicians and case managers be vigilant of these predictors of mortality while managing HIV patients who are on ART / Health Studies / M.A. (Public Health)

Background: Russia has undergone tremendous socioeconomic transformations. Particularly detrimental was the period of 1990-s that evidenced hazardous trends in public health. Alcohol consumption was suggested to be responsible for the negative health trends in the society. Male alcohol consumption attracted disproportional attention leaving female alcohol consumption, its predictors and influence on women’s health disregarded and uninvestigated. Aim: To describe the practices of female alcohol consumption and socio-demographic predictors of drinking, to explore the impact that drinking might have on the self-rated health of Russian women. Method: Cross-sectional analysis of data drawn from the Russia Longitudinal Monitoring Survey, round 20th. The association tests between the measures of alcohol consumption and covariates were run. Ordinal regression model tested the predictors of self-rated health.      Results: A Russian female drinker is middle-aged, high-educated, married/ cohabiting or divorced, resides from the urban area and is infrequent drinker. The frequency of drinking increases when she is young, high-educated, married/ cohabiting, resides from urban area. U-shaped relation between drinking and self-rated health was demonstrated: never drinkers and regular drinkers report poorer health than seldom-drinkers.  Conclusion: Predictors of female drinking in Russia are poorly investigated due to overrepresentation of research focused on men’s drinking. More studies are needed in order to explore the impact of drinking on self-rated health of  Russian women.

Introduction Prostate cancer (PCa) is the most common cancer among men in Sweden. The clinical course varies considerably, which makes it difficult to predict the prognosis in the individual case. In order to explore the early as well as the late course of the disease, large study groups and population-based cohorts are necessary. Aims To explore factors that influence the long-term outcome of men with low-risk tumours in a population-based register, to predict the long-term course, and to assess the mortality rate for men with prostate cancer (Paper I) To analyse long-term outcome and to investigate factors associated with long-term survival in patients with metastases to the skeleton (Paper II) To analyse early androgen deprivation treatment (ADT) failure and to define clinical predictors associated with short survival due to early ADT failure in prostate cancer patients with bone metastases (Paper III) To analyse the prognostic significance of the extent of bone metastases in relation to other pretreatment variables in prostate cancer patients, and to explore the impact of bone metastases on quality-of-life (Paper IV) Material and methods The study groups were assembled from The South East Region Prostate Cancer Register (SERPCR), and The Scandinavian Prostate Cancer Group (SPCG) Trial No. 5. In the first study, prognostic factors and long-term disease-specific mortality rates of low-risk prostate cancer patients from the early PSA era were analysed. In the second study, patient-related factors, quality-of-life (QoL) and long-term survival in 915 PCa patients with bone metastases (M1b) under ADT, were analysed. In Study III factors predicting primary failure to respond to ADT were identified. Study IV explored the impact of the extent of bone metastases on survival and QoL for these men. Result and conclusions The long-term disease-specific mortality of low-risk localised PCa is low, but the annual mortality rate gradually increases. This indicates that some tumours slowly develop into lethal cancer, particularly in men 70 years or older and with a PSA level ≥ 4 μg/L. From the SPCG Trial No. 5, a subgroup of patients with M1b disease and favourable set of predictive factors survived more than 10 years under ADT with an acceptable QoL. Independent predictors of long-term survival were identified as performance status (PS) &lt; 2, limited extent of bone metastases, and a PSA level &lt; 231 μg/L at the time of enrolment in the trial. However, four independent clinical predictors of early ADT failure could be defined. Men exhibiting these features should be considered for an alternative treatment. Patient grouping based on three categories of extent of bone metastases related to PS, haemoglobin, and QoL at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis.

Introduction : La prévalence de l’obésité chez les adultes canadiens a atteint un niveau record en 2015 (28.1 %). Les professionnels de santé de première ligne (PPL) ont un rôle crucial dans le contrôle de cette épidémie. Bien que la littérature internationale suggère que la prise en charge de l’obésité en première ligne est sous optimale, aucune étude canadienne fondée sur l’analyse de dossiers médicaux ne s’est encore penchée sur la question. Ce manque d’information est problématique, car il est impossible de juger de l’étendue du problème au pays. De plus, puisque les aspects de la prise en charge qui représentent les plus grands défis pour les PPL canadiens restent à définir, il est difficile d’adapter les programmes de formation qui leur sont destinés. Objectifs du projet de maîtrise : Établir le premier portrait de la prise en charge de l’obésité au Québec et évaluer quels sont les déterminants de la prise en charge de l’obésité. Méthodologie : Une étude de cohorte rétrospective a été menée auprès de 439 adultes traités dans l’un des 10 groupes de médecine familiale (GMFs) participants. Des mesures anthropométriques ont été réalisées auprès des patients dans le cadre d’une visite initiale. Les notes des médecins et des infirmières présentes au dossier médical ont été révisées sur une période de 18 mois afin d’y déceler la présence d’interventions documentées liées à la prise en charge de l’obésité. Les interventions ont été extraites des lignes directrices canadiennes en matière de gestion de l’obésité. Des modèles de régression logistique mixtes généralisés ont été complétés afin d’identifier les déterminants de la prise en charge de l’obésité. Résultats : Le taux de dépistage de l’obésité était bas (31 %). Parmi les patients ayant un indice de masse corporelle (IMC) mesuré ≥30 (n=175), 52 % avaient un diagnostic d’obésité et 38 % avaient obtenu du counseling lié aux habitudes de vie au cours de la période de suivi. L’IMC et le nombre de comorbidités identifiées du patient étaient des déterminants indépendants associés à la présence d’un diagnostic au dossier médical. La présence du diagnostic de même que le nombre de visites avec une infirmière au cours des 18 mois de suivi étaient quant à eux des déterminants associés au counseling sur les habituds de vie. Quatre-vingts pour cent des dépistages et des diagnostics de l’obésité ont été réalisés par des médecins seulement. Les infirmières ont considérablement participé à la réalisation du counseling (65 % MDs/35 % infirmières). Conclusions : Les taux de dépistage, de diagnostic et de counseling liés à l’obésité dans les GMFs sont sous-optimaux. Des interventions devront être développées afin d’améliorer la qualité des soins. Ces dernières devraient explorer la promotion d’un meilleur accès à des infirmières spécialisées et l’adaptation des programmes de formation initiale et continue. / Abstract : Background : The prevalence of obesity among Canadian adults reached a record high in 2015 (28.1%). Primary care providers (PCPs) play a crucial role regarding the management of this epidemic. Although international literature suggests that the management of obesity in the primary care setting is suboptimal, no Canadian study based on medical record review has yet assessed this issue. The current lack of information is problematic because it makes it impossible to judge the extent of the problem in the country. Moreover, since the aspects of obesity management which represent the greatest challenges for Canadian PCPs remain unidentified, it is difficult to adapt PCPs’ education programs. Objectives of the project: Identify the rates of obesity screening, diagnosis and management in Quebec and evaluate the predictors of obesity management. Methodology: A retrospective cohort study was conducted among 439 adults treated in one of 10 participating family medicine groups (FMG). Anthropometric measurements were performed from each patient as part of an initial visit. The clinical encounter notes of physicians and nurses from every patient medical record were reviewed over an 18 months period in order to detect the presence of documented obesity management interventions. The looked-for interventions were extracted from the Canadian guidelines for the management of obesity. Mixed-effects regression models were used to identify the predictors of obesity management. Results: The rate of obesity screening was low (31%). Among patients with a measured body mass index (BMI) ≥30 (n = 175), 52% had an obesity diagnosis and 38% received physical activity or nutritional counseling during the follow-up period. Patient’s BMI and number of identified comorbidities were independant predictors of obesity diagnosis. The presence of an obesity diagnosis in the medical record and the number of clinical encounters with a nurse during the 18-months period were independent predictors of lifestyle counseling. Eighty percent of screening and diagnoses were performed by physicians. Nurses were considerably more involved in the provision of lifestyle counselling (65 % GPs/35 % nurses). Conclusions : The rates of obesity screening, diagnosis and counselling in Quebec FMGs are suboptimal. Interventions have to be deployed in order to increase the quality of care. Future researches should explore the impact of an enhanced access to specialized nurses and the adaptation of the current initial and continuous education programs on the rates of obesity management.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

L’insécurité routière chez les conducteurs âgés est attribuable en partie, aux effets délétères du vieillissement normal sur le fonctionnement cognitif. Les méthodes d’évaluation neuropsychologique par les tests ayant montré une certaine efficacité dans le cas du dépistage des habiletés de conduite chez les conducteurs âgés atteints d’affections neurologiques pathologiques, la présente thèse vise à évaluer la pertinence de cette approche chez les conducteurs vieillissants de la population générale. Le principal objectif de cette thèse est ainsi d’obtenir une vue d’ensemble sur le rôle et la sensibilité des mesures neuropsychologiques dans la prédiction des habiletés et habitudes de conduite automobile sécuritaire chez les conducteurs âgés. Dans la même perspective, la thèse explore d’autre part le rôle de variables sociodémographiques et psychologiques. L’article 1 évalue la validité prédictive de sept tests des fonctions visuo-attentionnelles et de la mémoire de travail en regard des habiletés de détection périphérique chez 50 conducteurs âgés de 62 à 83 ans. L’étude sur simulateur de conduite comprend une condition de conduite simple et une condition plus soutenue incluant une distraction téléphonique de type « mains-libres ». Selon les résultats, certains tests cognitifs prédisent bien les temps de détection. En outre, la validité prédictive des tests est plus importante dans la situation de conduite plus exigeante. Cela dit, les résultats de l’article 2 révèlent que le recours aux stratégies d’évitement des situations exigeantes est plus prononcé chez les individus qui présentent des faiblesses à certains des tests neuropsychologiques proposés. Les résultats indiquent en outre que l’utilisation des stratégies d’évitement routier est plus fréquente chez les conducteurs ayant tendance à déprécier leurs habiletés de conduite générales, à exprimer une moindre perception de contrôle ainsi qu’une attitude défavorable à l’endroit des situations de conduite complexes ou risquées. Les stratégies d’évitement se révèlent donc comme des réponses autorégulatrices proportionnelles aux limitations cognitives et aux perceptions individuelles. Dans les deux études, l’âge ne permet pas d’expliquer les différences individuelles, ceci ni en termes d’habiletés de détection périphérique ni de tendances autorégulatrices. Le rôle du genre est cependant plus nuancé. Ainsi, le principal apport de la présente thèse réside dans la constatation que si d’une part, certaines limitations neuropsychologiques sont associées à une réduction des habiletés de détection périphérique, ces mêmes limitations s’accompagnent aussi de mesures autorégulatrices qui peuvent contribuer à réduire le risque routier. Il appert conséquemment que les méthodes de dépistage de l’insécurité routière chez les conducteurs âgés se basant sur l’évaluation des limitations cognitives et attentionnelles doivent également rechercher et évaluer la teneur de leurs comportements routiers autorégulateurs. Dans le contexte de vieillissement de la population, des interventions pourront également miser sur le renforcement de ces comportements. / The increase of crash rates in elderly population can be attributed in some part to the effects of normal aging on cognitive functioning. In the other hand, older drivers are likely to adopt self-regulated driving behaviours, such as driving habits to restrict their exposure to less complex situations. Neuropsychological assessments have shown some efficacy in the field of fitness-to-drive screening of older drivers suffering from neurological disorders. This thesis aims to assess the relevance of clinical neuropsychology in screening methods considering older drivers population. The main goal is thus to study the contribution and the sensitivity of neuropsychological testing in the prediction of skills and habits of safe driving among older drivers. In the same vein, the thesis investigates the role of other socio-demographic and psychological variables. To this end, article 1 evaluates the predictive validity of seven tests of visuo-attentional functions and working memory efficiency in relation to peripheral detection task performances in 50 drivers aged from 62 to 83 years in a simulated car driving environment. The driving simulation consisted of a simple driving condition and a condition including a "hands-free" cell phone distraction task. The results indicate that some neuropsychological tests, as opposed to age, are good predictors of detection performances. In addition, the predictive validity of the tests is more important in the most challenging driving condition. The Corsi Block Tapping test, assessing visuospatial working memory, is revealed as on of the best predictor of detection skills. Article 2 was carried from previous neuropsychological testing and self-administered questionnaires related to avoidance driving behaviours, drivers perceptions and attitudes. The results indicate that individuals who show higher difficulties in tests assessing visuospatial working memory, processing speed, and divided and selective attention capacities are significantly more likely to adopt avoidance driving strategies. The results also demonstrate that driving avoidance is higher among drivers who tend to depreciate their general driving skills, to express a lower perception of control and an unfavourable attitude towards risky driving. Avoidance strategies are thus proven to be self-regulatory responses which are proportionate to cognitive limitations and individual perceptions. In summary, this thesis demonstrates that peripheral detection performances of older drivers in a simulated car study, are well reflected in neuropsychological testing assessing working memory and other attentional abilities. Since detection skills are crucial for driving safety, an indirect link can be established between neuropsychological measures and road safety among older drivers. It also seems that those drivers, who have greater cognitive limitations, are more likely to avoid challenging driving situations, thereby balancing their crash risk. It is concluded that fitness-to-drive assessments based on neuropsychological screening need to be complemented with the assessment of self-regulatory behaviors. In the context of an aging population, new interventions should focus on strengthening self-regulatory behaviors of older drivers.

INTRODUCTION: Plusieurs études ont été menées sur le risque d’issus indésirables de grossesse associé à la prise de caféine durant la grossesse; cependant aucune étude n'a encore été réalisée sur les facteurs prédictifs de cette exposition. Pourtant, une prise en considération de ces facteurs augmenterait l’efficacité des recommandations nutritionnelles à ce sujet. En outre, peu d'études ont évalué le risque de nouveau-nés petits pour l'âge gestationnel (PAG) comparé aux autres issues indésirables de grossesse. OBJECTIFS: 1) Déterminer la fréquence de la consommation de caféine durant la grossesse et ses facteurs prédictifs ; 2) quantifier l’association de cette exposition au risque de (PAG). MÉTHODE: 3458 participantes ont été sélectionnées aléatoirement dans le Registre Québécois des Grossesses (RQG) créé par l’appariement de trois banques de données administratives : RAMQ, MED–ÉCHO et ISQ. Des analyses statistiques ont permis d’étudier les facteurs prédictifs de cette utilisation et une étude cas-témoins a permis de quantifier le risque de (PAG) qui lui est associé. RÉSULTATS: 87,3% des participantes consommaient de la caféine avant leur grossesse et 71,4% durant. L'âge maternel avancé, le tabagisme, l'hypertension et les hospitalisations avant la grossesse sont des facteurs prédictifs de la consommation de caféine durant la grossesse. Une augmentation de 20% de risque de PAG a été observée [OR = 1,19; 95% IC (1,01–1,40)]. CONCLUSION: La consommation de caféine pendant la grossesse est répandue et la sécurité de cette utilisation doit être questionnée. Nos résultats suggèrent que la consommation de caféine durant la grossesse augmenterait le risque de PAG. / BACKGROUND: Several studies have been conducted on the association between several adverse pregnancy outcomes and caffeine intake during pregnancy; but, no study has yet been conducted on the predictors of such exposure. However, a consideration of these factors would contribute in making nutritional recommendations in this regard more efficient. In addition, few studies had evaluated the risk of small for gestational age infants (SGA) compared to other adverse pregnancy outcomes. OBJECTIVES: 1) To determine the frequency of caffeine consumption during pregnancy and its predictors, 2) Quantify the association between SGA outcome and this exposure. METHODS: 3458 participants were randomly selected from the Quebec Pregnancy Registry (QPR) created by the linking of three administrative databases: RAMQ, MED-ECHO and ISQ. Statistical analyzes were used to examine predictors of the use and case-control study was conducted to quantify the risk of SGA associated with it. RESULTS: 87.3% of participants consumed caffeine prior to pregnancy and 71.4% during. Maternal age, smoking, hypertension and hospitalizations before pregnancy are predictors of caffeine consumption during pregnancy. A 20% increase in SGA risk was observed [OR = 1.19, 95% CI (1.01 - 1.40)]. CONCLUSION: Caffeine consumption during pregnancy is common and safety of this use must be questioned. Our results suggest that caffeine consumption during pregnancy increases the risk of SGA.

I chose the theme of obsessive-compulsive disorder as a topic of my thesis. The main reason was that it is a disorder I have worked as a therapist in individual or group therapy frequently. Also I have participated in several studies as evaluator in Psychiatric Centre, and I collected data from dozens of patients. In the first part the thesis deals with the symptoms, clinical picture, prevalence, aetiology and treatment of OCD. Thesis is focuses on behavioural and cognitive models of the disorder in detail, because the treatment used in the present group of patients was CBT. Various models of cognitive behavioural therapy I discuss in more detail, because they allow different views of what happens to the patient and how to change it. The practical part has two parts. The first deals with the effectiveness of group cognitive behavioral approach for OCD patients, who use antidepressants but were resistant to previous treatment and were attended a daycare center at the Prague Psychiatric Center. The second part of the thesis deals with finding a predictor of successful cognitive behavioral therapy in these patients. The aim was to determine whether certain demographic or clinical factors that we evaluated before treatment may predict success outcome. The result is the finding that severity of the...