PRISM :: Browsing by Author "Fiest, Kirsten"

Browsing by Author "Fiest, Kirsten"

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Open Access
Adverse health behaviours are associated with depression and anxiety in multiple sclerosis: A prospective multisite study
(SAGE PUBLICATIONS LTD, 2016) McKay, Kyla A.; Tremlett, Helen; Fisk, John D.; Patten, Scott B.; Fiest, Kirsten; Berrigan, Lindsay; Marrie, Ruth Ann
Background: Depression and anxiety are common among people with multiple sclerosis (MS), as are adverse health behaviours, but the associations between these factors are unclear. Objective: To evaluate the associations between cigarette smoking, alcohol use, and depression and anxiety in MS in a cross-Canada prospective study. Methods: From July 2010 to March 2011 we recruited consecutive MS patients from four MS clinics. At three visits over two years, clinical and demographic information was collected, and participants completed questionnaires regarding health behaviours and mental health. Results: Of 949 participants, 75.2% were women, with a mean age of 48.6 years; most had a relapsing-remitting course (72.4%). Alcohol dependence was associated with increased odds of anxiety (OR: 1.84; 95% CI: 1.32-2.58) and depression (OR: 1.53; 95% CI: 1.05-2.23) adjusting for age, sex, Expanded Disability Status Scale (EDSS), and smoking status. Smoking was associated with increased odds of anxiety (OR: 1.29; 95% CI: 1.02-1.63) and depression (OR: 1.37; 95% CI: 1.04-1.78) adjusting for age, sex, EDSS, and alcohol dependence. Alcohol dependence was associated with an increased incidence of depression but not anxiety. Depression was associated with an increased incidence of alcohol dependence. Conclusion: Alcohol dependence and smoking were associated with anxiety and depression. Awareness of the effects of adverse health behaviours on mental health in MS might help target counselling and support for those 'at risk'.
Open Access
Delirium in the Intensive Care Unit (ICU): a guide for patients and families
(2018-05-15) Fiest, Kirsten; Rosgen, Brianna; Friesen, Allison; Herold, Karolina
Open Access
Depression and Neurological Conditions in Canada
(2014-12-03) Fiest, Kirsten; Patten, Scott; Jette, Nathalie; Lavorato, Dina; Williams, Jeanne
Open Access
Depression in Epilepsy
(2014-05-02) Fiest, Kirsten; Patten, Scott; Jetté, Nathalie
A relationship between depression and epilepsy has been consistently reported in the literature. Most of this research has estimated the proportion of people with depression in epilepsy. More recently, research has focused on determining fast and accurate methods of diagnosing depression in clinical samples. In contrast, there is a relative dearth of research into the treatment of depression in epilepsy using both pharmacological and non-pharmacological methods. Despite this research, there are still gaps in the knowledge base of this association. The literature on depression in epilepsy has not been reviewed and summarized. Screening tools for identifying depression in epilepsy have either not been validated, or have not been validated with a gold standard tool. Finally, patterns of pharmacological and non-pharmacological treatment of depression in epilepsy have not been well characterized. The work reported in this dissertation addresses each of these three knowledge gaps. Based on a systematic review, the overall pooled prevalence of active depression in persons with epilepsy was found to be 23.1% (95% Confidence Interval (CI): 20.6%-28.3%), and the overall odds ratio of active depression in those with epilepsy, relative to those without, was 2.77 (95% CI: 2.09-3.67). Three depression screening tools, one of which was previously not validated, and new cut-points for scoring were explored in a group of 185 persons with epilepsy. Compared to a gold-standard diagnostic interview, the tools with the best overall balance of sensitivity and specificity were the Hospital Anxiety and Depression Scale at a cut-point of seven and the Patient Health Questionnaire with a cut-point of nine. Newly suggested cut-points for scoring performed better than those cut-points recommended for use in the general population. Considering both pharmacological and non- pharmacological treatments for depression in persons with epilepsy, the majority of persons (70.3%) with current depression were not receiving depression-related therapy. Of those treated, ii most were receiving non-pharmacological treatments for depression. More persons with a past history of depression (37.2%) were receiving treatment, of which the majority was by pharmacological management. The results of these studies characterize the identification and management of depression, addressing knowledge gaps and providing direction for future research.
Open Access
Determinants of non-adherence to disease-modifying therapies in multiple sclerosis: A cross-Canada prospective study
(SAGE PUBLICATIONS LTD, 2017) McKay, Kyla A.; Tremlett, Helen; Patten, Scott B.; Fisk, John D.; Evans, Charity; Fiest, Kirsten; Campbell, Trudy; Marrie, Ruth Ann
Background: Poor adherence to the disease-modifying therapies (DMTs) for multiple sclerosis (MS) may attenuate clinical benefit. A better understanding of characteristics associated with non-adherence could improve outcomes. Objective: To evaluate characteristics associated with non-adherence to injectable DMTs. Methods: Consecutive patients from four Canadian MS Clinics were assessed at three time points over two years. Clinical and demographic information included self-reported DMT use, missed doses in the previous 30 days, health behaviors, and comorbidities. Non-adherence was defined as <80% of expected doses taken. We employed generalized estimating equations to examine characteristics associated with non-adherence at all time points with findings reported as adjusted odds ratios (OR). Results: In all, 485 participants reported use of an injectable DMT, of whom 107 (22.1%) were non-adherent over the study period. Non-adherence was associated with a lower Expanded Disability Status Scale score (0-2.5 vs 3.0-5.5, OR: 1.80; 95% confidence interval (CI): 1.06-3.04), disease duration (>= 5 vs < 5 years, OR: 2.23; 95% CI: 1.10-4.52), alcohol dependence (OR: 2.14; 95% CI: 1.23-3.75), and self-reported cognitive difficulties, measured by the Health Utilities Index-3 (OR: 1.55; 95% CI: 1.08-2.22). Conclusions: Nearly one-quarter of participants were non-adherent during the study. Alcohol dependence, perceived cognitive difficulties, longer disease duration, and mild disability status were associated with non-adherence. These characteristics may help healthcare professionals identify patients at greatest risk of poor adherence.
Open Access
Evaluating the Association Between Delirium in the Intensive Care Unit and Subsequent Neuropsychiatric Disorders Post-Stay
(2018-08-03) Brown, Kyla Nicole; Stelfox, Henry Thomas; Fiest, Kirsten; Faris, Peter D.; Patten, Scott Burton
Individuals without pre-existing neuropsychiatric disorders are reported to be at increased risk of developing a neuropsychiatric disorder after admission to an Intensive Care Unit (ICU). This risk may be attributed to the severity of illness and the nature of therapies provided, including intubation, medically induced coma, and numerous medications. Furthermore, approximately half of ICU patients develop delirium during their stay, which may further add to the burden of neuropsychiatric disorders experienced by these patients. If delirium is not identified and treatment initiated early, patients may be at risk for adverse consequences, such as increased mortality, increased length of hospital stay and further cognitive impairment. Therefore, the objectives of this thesis were to (1) examine the overall prevalence and (2) incidence of neuropsychiatric disorders following a stay in a general systems ICU; and (3) determine the association between delirium in the ICU and an onset of a neuropsychiatric disorders subsequent to the ICU stay. The objectives for this study were addressed in two phases. In phase one, a systematic review and meta-analysis was conducted to address the overall pooled prevalence of depression, anxiety, trauma-and-stressor related, and neurocognitive disorders. Based on the analysis, the overall pooled prevalence of the disorders was: 32% (95% Confidence Interval [CI] 25%-39%), 32% (95% CI 24%-40%), 23% (95% CI 18%- 28%), and 42% (95% CI 25%-60%), respectively. The systematic review revealed a significant association between delirium and neuropsychiatric disorders (specifically trauma-and-stressor related and neurocognitive disorders). In phase two, a retrospective cohort study using administrative databases was conducted. The cumulative incidence for depressive, anxiety, trauma-and-stressor related, and neurocognitive disorders were: 10.6%, 8.9%, 2.5%, and 3.7%, respectively. The study results suggested that for patients who ever had delirium in the ICU, there was a 1.23 times the risk of developing any neuropsychiatric disorder compared to those who never had delirium in the ICU. Early treatment of delirium may be necessary to reduce the morbidity of delirium and possibly the subsequent development of neuropsychiatric disorders post-ICU stay.
Open Access
Facilitators and barriers to deprescribing antipsychotic medications in critically ill adult patients at transitions of care
(2022-07-09) Jaworska, Natalia; Fiest, Kirsten; Niven, Daniel; Ismail, Zahinoor
Antipsychotic medications are prescribed to critically ill adult patients in the intensive care unit (ICU) for clinical indications including delirium, agitation, and sleep disturbances. While there is some evidence for their use in managing agitation, antipsychotic medications have not convincingly shown efficacy for the management of delirium or sleep and are often continued at transitions of care in critically ill patients when they may no longer be necessary or appropriate. The current literature on antipsychotic minimization and deprescribing in critically ill patients is sparse lacking evaluation of underlying facilitators and barriers informing current antipsychotic prescribing practices that may be important in the development of effective minimization and deprescribing strategies. The studies presented in this thesis address knowledge gaps regarding antipsychotic prescribing and deprescribing practices among inpatient healthcare professionals who care for patients with and following critical illness. Based on a qualitative study with semi-structured interviews of 21 healthcare professionals, seven relevant domains from the Theoretical Domains Framework (TDF) contributing to antipsychotic prescribing and deprescribing were identified. A subsequent scoping review of the literature identified differences between healthcare professional perceived and actual prescribing practices, with few in-hospital deprescribing strategies available to guide practice. Thereafter, a nationwide modified Delphi consensus process informed by the qualitative study and scoping review identified consensus statements for antipsychotic minimization activities and antipsychotic deprescribing strategies for patients with and following critical illness. The results of these studies characterize and catalogue relevant priority facilitators and barriers to antipsychotic minimization and deprescribing in critically ill adult patients during their hospitalization to support best clinical prescribing practices.
Open Access
ICU Delirium Search Strategy
(2016) Fiest, Kirsten
Open Access
Impact of Family Presence on Delirium in Critically Ill Patients: A Retrospective Cohort Study
(2021-05-28) Mohsen, Samiha Tarek; Fiest, Kirsten; Sauro, Khara; Niven, Daniel
Delirium, an acutely disturbed state of consciousness, manifests as a collection of symptoms such as confusion. There is potential for family members of critically ill patients to assist in non-pharmacological delirium prevention and management (e.g., re-orientation). Despite this, there are few studies on the impact of Intensive Care Unit (ICU) family presence on delirium. To bridge these knowledge gaps, our study employed a population-based retrospective cohort design to explore the association between family presence and both the incidence and duration of delirium in critically ill patients. The electronic health records of consecutive adult patients admitted to any of 14 adult medical-surgical adult ICUs in Alberta, Canada between January 1, 2014 and December 30, 2018 were examined. Family presence in the ICU (exposure), was extracted using a validated algorithm (1. family physically present, 2. family phone call only, 3. no family presence or call [reference group]). Delirium was measured using the Intensive Care Delirium Screening Checklist (ICDSC). Incident delirium was quantified (primary outcome) using an ICDSC cut-off of ≥4 points, after family presence (yes/no). Duration of delirium (secondary outcome) was measured as the total number of ICU days (24-hour periods) with a positive ICDSC score (≥4 points). Multivariable mixed-effects logistic and linear regression models (accounting for clustering by patient re-admission and ICU site, where appropriate) were used to evaluate the association between family member presence and the incidence and duration of delirium in critically-ill patients in the ICU, respectively. All regression models were adjusted for relevant covariates (e.g., ICU admission type, Glasgow Coma Scale [GCS]). We included 25,537 patients. Family presence in the ICU was associated with lower incidence of delirium during elective-surgical admissions in patients with intact GCS (OR 0.60, 95%CI:0.39-0.97, p=0.02) as compared to patients in the reference group. Family presence in the ICU decreased duration of delirium (adjusted mean difference -1.87 days, 95%CI: -2.01 to -1.81, p<0.001) as compared to patients in the reference group. Family presence in the ICU may decrease the incidence of delirium in patients admitted for elective-surgical reasons with intact GCS and duration of delirium in all patients by up to 2 days.
Open Access
Late Life Search Strategy
(2016-11) Fiest, Kirsten; Job McIntosh, Christiane; Stelfox, H. Thomas; Parsons Leigh, Jeanna
Open Access
LIBERATE: a study protocol for midodrine for the early liberation from vasopressor support in the intensive care unit (LIBERATE): protocol for a randomized controlled trial
(2022-03-04) Opgenorth, Dawn; Baig, Nadia; Fiest, Kirsten; Karvellas, Constantine; Kutsogiannis, Jim; Lau, Vincent; Macintyre, Erika; Senaratne, Janek; Slemko, Jocelyn; Sligl, Wendy; Wang, Xiaoming; Bagshaw, Sean M.; Rewa, Oleksa G.
Abstract Background Intravenous (IV) vasopressors to support hemodynamics are a primary indication for intensive care unit (ICU) admission. Utilization of oral vasopressor therapy may offer an alternative to IV vasopressor therapy in the ICU, thus decreasing the need for ICU admission. Oral vasopressors, such as midodrine, have been used for hemodynamic support in non-critically ill patients, but their evaluation in critically ill patients to potentially spare IV vasopressor therapy has been limited. Methods The LIBERATE study will be a multicenter, parallel-group, blinded, randomized placebo-controlled trial. It will recruit adult (i.e., age ≥ 18 years) critically ill patients receiving stable or decreasing doses of IV vasopressors. Eligible patients will be randomized to receive either midodrine 10 mg administered enterally every 8 h or placebo until 24 h post-discontinuation of IV vasopressors. The primary outcome will be ICU length of stay. Secondary outcomes include all-cause mortality at 90 days, hospital length of stay, length of IV vasopressor support, re-initiation of IV vasopressors, rates of ICU readmission, and occurrence of AEs. Health economic outcomes including ICU, hospital and healthcare costs, and cost-effectiveness will be evaluated. Pre-planned subgroup analyses include age, sex, frailty, severity of illness, etiology of shock, and comorbid conditions. Discussion LIBERATE will rigorously evaluate the effect of oral midodrine on duration of ICU stay and IV vasopressor support in critically ill patients. Trial registration ClinicalTrials.gov NCT05058612 . Registered on September 28, 2021
Open Access
Long Term Neuropsychiatric Outcomes Search Strategy
(2017-06) Brown, Kyla; Fiest, Kirsten; Stelfox, Henry (Thomas)
Open Access
A Multicentre Implementation of a Quality Improvement Initiative to Reduce Delirium in Adult Intensive Care Units: An Interrupted Time Series Analysis
(2021-07-27) Owen, Victoria Susan; Niven, Daniel; Fiest, Kirsten; Faris, Peter; Stelfox, Thomas
In 2016, Alberta Health Services implemented the ICU Delirium Initiative in all intensive care units (ICUs) in Alberta. The ICU Delirium Initiative was based on the ABCDEF care bundle and recommended (A) appropriate pain management, (B) daily breaks in continuous sedation along with lowering mechanical ventilation support, (C) appropriate choices for sedation and pain control, (D) routine screening and management of delirium, (E) early mobilization and (F) engagement of family. The purpose of this thesis was to examine the effects of the ABCDEF delirium care bundle on patient-centred outcomes and processes of care among adults admitted to ICUs in Alberta. An interrupted time series analysis using retrospective linked clinical and administrative data from November 2014 to June 2019 was conducted in 14 adult general medical-surgical and one neurological ICU in Alberta. All patient admissions from each site were included after the site had transitioned to the current population-based electronic health documentation system. Provincial outcome trends were compared before and after the ICU Delirium Initiative was implemented in September 2016. The primary outcome was percent of delirium days per ICU. Secondary outcomes included: ever delirium, duration of mechanical ventilation, percent of coma days per ICU, percentage of sedation days using midazolam, adverse events and ICU length of stay and mortality. All outcomes were examined using mixed effects segmented linear regression with ICU site as the random effect. After the intervention, the overall percent of delirium days per ICU was 33.48% [95% Confidence Interval (CI) 29.64-37.31%] in January/February 2017 and decreased significantly by 0.34% every two months (95% CI 0.18-0.50%) following intervention implementation to a final estimate of 28.74% (95% CI 25.22-32.26%) in May/June 2019. The percentage of sedation days using midazolam decreased immediately following the intervention [decrease of 7.58% (95%CI 4.00-11.16%)]. Additionally, there were no significant changes in major adverse events (e.g., patient fall), minor adverse events (e.g., patient removal of peripheral intravenous), duration of mechanical ventilation, percentage of coma days per ICU or ICU mortality. These results suggest that population-based implementation of the ABCDEF bundle is feasible, effective, and safe.
Open Access
National Preclinical Sepsis Platform: developing a framework for accelerating innovation in Canadian sepsis research
(2021-03-19) Mendelson, Asher A; Lansdell, Casey; Fox-Robichaud, Alison E; Liaw, Patricia; Arora, Jaskirat; Cailhier, Jean-François; Cepinskas, Gediminas; Charbonney, Emmanuel; dos Santos, Claudia; Dwivedi, Dhruva; Ellis, Christopher G; Fergusson, Dean; Fiest, Kirsten; Gill, Sean E; Hendrick, Kathryn; Hunniford, Victoria T; Kowalewska, Paulina M; Krewulak, Karla; Lehmann, Christian; Macala, Kimberly; Marshall, John C; Mawdsley, Laura; McDonald, Braedon; McDonald, Ellen; Medeiros, Sarah K; Muniz, Valdirene S; Osuchowski, Marcin; Presseau, Justin; Sharma, Neha; Sohrabipour, Sahar; Sunohara-Neilson, Janet; Vázquez-Grande, Gloria; Veldhuizen, Ruud A W; Welsh, Donald; Winston, Brent W; Zarychanski, Ryan; Zhang, Haibo; Zhou, Juan; Lalu, Manoj M
Abstract Despite decades of preclinical research, no experimentally derived therapies for sepsis have been successfully adopted into routine clinical practice. Factors that contribute to this crisis of translation include poor representation by preclinical models of the complex human condition of sepsis, bias in preclinical studies, as well as limitations of single-laboratory methodology. To overcome some of these shortcomings, multicentre preclinical studies—defined as a research experiment conducted in two or more research laboratories with a common protocol and analysis—are expected to maximize transparency, improve reproducibility, and enhance generalizability. The ultimate objective is to increase the efficiency and efficacy of bench-to-bedside translation for preclinical sepsis research and improve outcomes for patients with life-threatening infection. To this end, we organized the first meeting of the National Preclinical Sepsis Platform (NPSP). This multicentre preclinical research collaboration of Canadian sepsis researchers and stakeholders was established to study the pathophysiology of sepsis and accelerate movement of promising therapeutics into early phase clinical trials. Integrated knowledge translation and shared decision-making were emphasized to ensure the goals of the platform align with clinical researchers and patient partners. 29 participants from 10 independent labs attended and discussed four main topics: (1) objectives of the platform; (2) animal models of sepsis; (3) multicentre methodology and (4) outcomes for evaluation. A PIRO model (predisposition, insult, response, organ dysfunction) for experimental design was proposed to strengthen linkages with interdisciplinary researchers and key stakeholders. This platform represents an important resource for maximizing translational impact of preclinical sepsis research.
Open Access
Novel Approaches to Breaking the Cycle of Intimate Partner Violence (IPV): Medical Trainee and Virtually-targeted Education to Increase Healthcare Provider Readiness to Manage IPV
(2022-04) Dillabough, Kaitlyn; Schneider, Prism; Fiest, Kirsten; Temple-Oberle, Claire
Intimate partner violence (IPV) is any violent or controlling behavior by a person in a dating, cohabitating or marital relationship to their partner in the form of psychological, physical, and/or sexual violence. Alas, global reports reveal one in three women experience IPV in their lifetime. To challenge the cycle of violence and mitigate associated morbidity and mortality, experts encourage an integrated, multi-faceted approach to IPV management in healthcare settings. The purpose of this thesis is to assess the mEDUCATE (Applying EDUCATE to Medical Student Intimate Partner Violence Training) program specifically, in the context of IPV education programs intended to prepare medical trainees for future practices that are conducive to meeting the societal need for healthcare provider IPV management. This manuscript-based thesis consists of two manuscripts in-progress. Both manuscripts focus on the mEDUCATE program, which was designed to educate medical trainees on IPV and current screening practices. Manuscript one is a qualitative evaluation of the mEDUCATE program using thematic analysis of semi-structured interviews. This study found value in the mEDUCATE program and established that medical trainees consider this training to be important and applicable to their future practice. Based on this research the mEDUCATE program is being modified for widespread, virtual implementation. The second manuscript presents the quantitative results of a pretest-posttest evaluation of the mEDUCATE program. The Physician Readiness to Manage IPV Survey (PREMIS) scores confirmed that medical trainees IPV knowledge and preparedness significantly increased post-training, The combined manuscripts demonstrate the value of implementing IPV training early in healthcare providers career to support consistent IPV screening practices and confidence in managing IPV; especially in critical circumstances like the COVID-19 pandemic that generate greater IPV frequency and severity.
Embargo
Overactive Bladder 5 years After the Mid-Urethral Sling Tensioning (MUST) Trial: Prospective Cohort Study Following a Multi-centre Randomized Controlled Trial in Alberta, Canada
(2024-06-21) Hughes, Taylor Ann Marie; Brennand, Erin; Metcalfe, Amy; Fidler-Benaoudia, Miranda; Fiest, Kirsten
Background: Mid-urethral slings (MUS) are the preferred surgical treatment for female stress urinary incontinence. However, a small subset of MUS patients experiences overactive bladder (OAB) requiring further treatment. The Mid-Urethral Sling Tensioning (MUST) Trial was a randomized controlled trial that compared MUS outcomes for intraoperative tensioning techniques: the Babcock clamp and Mayo Scissor. The trial provides an opportunity to gauge OAB after MUS through follow-up of a randomized controlled trial using patient reported outcomes and administrative health data. Objective: To assess the burden of overactive bladder (OAB) 5 years after MUS insertion using medication, surgical intervention and patient-reported OAB outcomes, and to compare OAB outcomes by MUS tensioning technique. Methods: MUST trial participants provided 5-year post-MUS data via patient-reported questionnaires linked to administrative health data. OAB burden was assessed by analyzing changes in pre- and 5-year post-op scores on validated OAB questionnaires, post-op OAB medication use and incidence of bladder onabotulinumtoxinA procedures. Results: Of the 318 MUST trial participants, 260 completed questionnaire data at 5 years; among them, 225 (86.9%) reported baseline OAB symptoms and 211 (81.5%) post-MUS. 127 (48.9%) experienced clinically significant worsening in at least one OAB symptom: 19.0% in daily urination, 22.5% in urgency, 18.1% in urine leakage, 23.9% in nightly urination; conversely, 38.7%, 40.3%, 47.6%, and 23.9% showed a significant improvement in these respective domains. Of total participants, 21.4% used OAB medication with a median start at 151 days post-op for a median duration of 319 days. Seven underwent an onabotulinumtoxinA procedure. In comparison of groups, the Babcock clamp tensioning technique provided less frequent nightly urination (19.5% versus 28.0%) and less leakage (11.3% versus 24.9%) than the Mayo Scissor. Conclusions: After MUS, 72.3% of patients experienced improvement of at least 1 OAB symptom, 79.2% were stable, and 48.9% reported worsening. 20% of patients trialed OAB medications, but by study end 75% had discontinued. This information advises surgeons and their patients of realistic expectations for OAB outcomes after MUS. Surgeons can freely choose tensioning techniques, expecting no significant difference in OAB outcomes.
Open Access
Predicting future harm from gambling over a five-year period in a general population sample: a survival analysis
(2021-01-07) Currie, Shawn R; Hodgins, David C; Williams, Robert J; Fiest, Kirsten
Abstract Background There is little longitudinal evidence on the cumulative risk of harm from gambling associated with excess spending and frequency of play. The present study sought to assess the risk of gambling problems over a five-year period in adults who exceed previously derived low-risk gambling limits compared to those who remain within the limits after controlling for other modifiable risk factors. Methods Participants were adults (N = 4212) drawn from two independent Canadian longitudinal cohort studies who reported gambling in the past year and were free of problem gambling at time 1. Multivariate Cox regression was employed to assess the impact over time of gambling above low-risk gambling thresholds (frequency ≥ 8 times per month; expenditure ≥75CAD per month; percent of household income spent on gambling ≥1.7%) on developing moderate harm and problem gambling. Covariates included presence of a DSM5 addiction or mental health disorder at time 1, irrational gambling beliefs, number of stressful life events in past 12 months, number of game types played each year, and playing electronic gaming machines or casino games. Results In both samples, exceeding the low-risk gambling limits at time 1 significantly increased the risk of moderate harm (defined as ≥2 consequences on the Problem Gambling Severity Index [PGSI]) within 5 years after controlling for other modifiable risk factors. Other significant predictors of harm were presence of a mental disorder at time 1, cognitive distortions about gambling, stressful life events, and playing electronic gaming machines or casino games. In one sample, the five-year cumulative survival rate for moderate harm among individuals who stayed below all the low-risk limits was 95% compared to 83% among gamblers who exceeded all limits. Each additional low-risk limit exceeded increased the cumulative probability of harm by 30%. Similar results were found in models when the outcome was problem gambling. Conclusions Level of gambling involvement represents a highly modifiable risk factor for later harm. Staying below empirically derived safe gambling thresholds reduces the risk of harm over time.
Open Access
Public perceptions during the first wave of the COVID-19 pandemic in Canada: a demographic analysis of self-reported beliefs, behaviors, and information acquisition
(2022-04-09) Leigh, Jeanna P.; Brundin-Mather, Rebecca; Soo, Andrea; FitzGerald, Emily; Mizen, Sara; Dodds, Alexandra; Ahmed, Sofia; Burns, Karen E. A.; Plotnikoff, Kara M.; Rochwerg, Bram; Perry, Jeffrey J.; Benham, Jamie L.; Honarmand, Kimia; Hu, Jia; Lang, Raynell; Stelfox, Henry T.; Fiest, Kirsten
Abstract Introduction We explored associations between sociodemographic factors and public beliefs, behaviors, and information acquisition related to the coronavirus disease 2019 (COVID-19) to identify how the experiences of subpopulations in Canada may vary. Methods We administered a national online survey through Ipsos Incorporated to adults residing in Canada. Sampling was stratified by population age, sex, and regional distributions. We used descriptive statistics to summarize responses and test for differences based on gender, age, educational attainment, and household income using chi-squared tests, followed by weighted logistic regression. Results We collected 1996 eligible questionnaires between April 26th and May 1st, 2020. Respondents mean age was 50 years, 51% were women, 56% had a post-secondary degree, and 72% had a household income <$100,000. Our analysis found differences within the four demographic groups, with age effects most acutely evidenced. Respondents 65 years and older were more likely to perceive the pandemic as very serious, less likely to report declines in overall health, and more likely to intend to get vaccinated, compared to 18–29 year olds. Women overall were more likely to report negative outcomes than men, including stress due to the pandemic, and worsening social, mental/emotional, and spiritual health. Respondents 45 and older were more likely to seek and trust information from traditional Canadian news sources, while 18-29 year olds were more likely to seek and trust information on social media; overall, women and respondents with a post-secondary degree were more likely to access and trust online information from public health sites. Conclusion This study found important demographic differences in how adults living in Canada perceived the COVID-19 pandemic, the impacts on their health, and their preferences for information acquisition. Our results highlight the need to consider demographic characteristics in tailoring the format and information medium to improve large scale acceptance and uptake of mitigation and containment measures.
Open Access
Recommendations for observational studies of comorbidity in multiple sclerosis
(LIPPINCOTT WILLIAMS & WILKINS, 2016) Marrie, Ruth Ann; Miller, Aaron; Sormani, Maria Pia; Thompson, Alan; Waubant, Emmanuelle; Trojano, Maria; O'Connor, Paul; Fiest, Kirsten; Reider, Nadia; Reingold, Stephen; Cohen, Jeffrey A.
Objective:To reach consensus about the most relevant comorbidities to study in multiple sclerosis (MS) with respect to incidence, prevalence, and effect on outcomes; review datasets that may support studies of comorbidity in MS; and identify MS outcomes that should be prioritized in such studies.Methods:We held an international workshop to meet these objectives, informed by a systematic review of the incidence and prevalence of comorbidity in MS, and an international survey regarding research priorities for comorbidity.Results:We recommend establishing age- and sex-specific incidence and prevalence estimates for 5 comorbidities (depression, anxiety, hypertension, hyperlipidemia, and diabetes); evaluating the effect of 7 comorbidities (depression, anxiety, hypertension, diabetes, hyperlipidemia, chronic lung disease, and autoimmune diseases) on disability, quality of life, brain atrophy and other imaging parameters, health care utilization, employment, and mortality, including age, sex, race/ethnicity, socioeconomic status, and disease duration as potential confounders; harmonizing study designs across jurisdictions; and conducting such studies worldwide. Ultimately, clinical trials of treating comorbidity in MS are needed.Conclusion:Our recommendations will help address knowledge gaps regarding the incidence, prevalence, and effect of comorbidity on outcomes in MS.
Open Access
Suicidal ideation in persons with neurological conditions
(2014-12-05) Altura, Kristianne Chelsea; Fiest, Kirsten; Jetté, Nathalie