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Background: Fried's Phenotype Model of Frailty (PMF) postulates that frailty is a syndrome. Features of a syndrome are a heterogeneous population that can be split into at least two classes, those presenting and those not presenting the syndrome. Syndromes are characterized by a specific mixture of signs and symptoms which increase in prevalence, from less to more severe classes. So far, the null hypothesis of homogeneity - signs and symptoms of frailty cannot identify at least two classes - has been tested using Latent Class Analysis (LCA) on the five dichotomized components of PMF (unintentional weight loss, exhaustion, weakness, slowness, and low physical activity). The aim of this study is to investigate further the construct validity of frailty as a syndrome using the extension offered by Factor Mixture Models (FMM).Methods: LCA on dichotomized scores and FMM on continuous scores were conducted to test homogeneity on the five PMF components in a sample of 1643 community-dwelling older adults living in Québec, Canada (FRéLE).Results: With dichotomized LCA, three frailty classes were found: robust, prefrail and frail, and the hypothesis of homogeneity was rejected. However, in FMM, frailty was better represented as a continuous variable than as latent heterogeneous classes. Thus, the PMF measurement model of frailty did not meet the features of a syndrome in this study.Conclusion: Using the FRéLE cohort, the PMF measurement model validity is questioned. Valid measurement of a syndrome depends on an understanding of its etiological factors and pathophysiological processes, and on a modelling of how the measured components are linked to these processes. Without these features, assessing frailty in a clinical setting may not improve patient health. Research on frailty should address these issues before promoting its use in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Cross-sectional and longitudinal studies show conflicting results regarding the association between cognition and life-space mobility, and little is known regarding the mediators and moderators of the association. The aim of this study was to investigate the association between cognition and life-space mobility in older adults, as well as the intervening variables modifying the relationship.Methods: Community-dwelling older adults aged 65 years and older (N = 1643) were assessed at three time points over a period of 2 years. Growth mixture models with mediation and moderation analysis were utilised to investigate association between cognitive function and life-space mobility. The potential mediators and moderators were depressive symptoms, locus of control, gait speed and grip strength. Analysis was controlled for age, sex, education, annual income, number of chronic illnesses, and living site.Results: The direct association between initial scores of cognitive function and life-space was mediated by initial scores of depressive symptoms and gait speed, and moderated by initial scores of grip strength. No direct association between change in cognitive function and change in life-space mobility was found; the scores were mediated by change in depressive symptoms.Conclusions: We conclude that the relationship between change in cognitive function and life-space mobility in older adults is not well-defined over an observation period of 2 years. [ABSTRACT FROM AUTHOR]

Background: Many systematic reviews have evaluated the effectiveness of interventions to prevent, delay, or decrease frailty symptoms, but no effort has been made to identify, map, and synthesize the findings from reviews across the full spectrum of interventions. Our objectives are to (1) synthesize findings from all existing systematic reviews evaluating interventions for preventing, delaying the onset, or decreasing the burden of frailty symptoms; (2) examine different conceptualizations of frailty that have been used in the development and implementation of interventions; and (3) inform policy by convening a stakeholder dialogue with Canadian health-system leaders. Methods/design: We will conduct an overview of systematic reviews to identify and synthesize all of the systematic reviews addressing interventions to preventing, delaying the onset, or decreasing the burden of frailty symptoms. To identify relevant systematic reviews, we will conduct database searches for published and grey literature as well as contact key experts and search reference lists of included reviews. Two reviewers will independently review all search results for inclusion and then conceptually map, extract key findings (including the conceptualization/definition of frailty used) and assess the methodological quality of all included reviews. We will then synthesize the findings by producing a 'gap map' (i.e. mapping reviews in a matrix according to the interventions and outcomes assessed), and narratively synthesize the key messages across reviews related to type of interventions. Discussion: Following the completion of the synthesis, we will use the findings to develop an evidence brief that mobilizes the best available evidence about the problem related to preventing, delaying the onset, or decreasing the burden of frailty symptoms in older adults, policy and programmatic options to address the problem and implementation considerations. The evidence brief will then be used as the input into a stakeholder dialogue, which will engage 18-22 Canadian health-system leaders (including policymakers, health providers, researchers, and other stakeholders) in 'off-the-record' deliberations to inform future actions and policymaking. Systematic review registration: PROSPERO CRD42015022082 [ABSTRACT FROM AUTHOR]

This study investigated the role of psychological variables and judicial problems in treatment retention for a low-threshold methadone program in Montreal, Canada. Logistic regression analyses were computed to examine associations between psychological variables (psychological distress, self-esteem, stages of change), criminal justice involvement, and treatment retention for 106 highly-disorganized opioid users. Higher methadone dosage was associated with increased odds of treatment retention, whereas criminal charges and lower self-esteem decreased these odds. Psychological variables could be identified early in treatment and targeted to increase potential treatment retention. Financial support for this study was provided by the Fonds de Recherche en Santé du Québec. [ABSTRACT FROM AUTHOR]

To examine the relationship between preference for group psychotherapy and adherence to group cognitive-behavioral therapy (CBT) for clients with panic disorder with agoraphobia (PDA), 109 participants experiencing PDA completed a questionnaire measuring preference for group treatment (PGTQ) before beginning CBT groups. A t test was used to compare preference scores for group treatment to investigate whether participants who completed treatment differed from those who abandoned treatment. Participants who completed group therapy expressed higher preference for group treatment than participants who dropped out of treatment ( t[107] = 1.99; p < 0.05). The PGTQ-4 presented adequate psychometric properties. Reliability analyses of the items retained after factorization demonstrated an acceptable level of internal consistency (Cronbach's alpha of 0.76). Preference for individual or group therapy appears to impact treatment retention for patients with PDA. Matching patients' preferences to the type of treatment modality used appears to be pertinent, especially for the treatment of anxiety disorders. In terms of practical implications, the rationale and benefits of group therapy should be explained to participants reluctant to engage in group therapy. Individual intervention or a combination of group and individual treatment could be considered for clients who are likely to drop out of group therapy. [ABSTRACT FROM AUTHOR]

Background Cross-sectional studies show that walking is associated with depression among older adults, but longitudinal associations have rarely been examined. The aim of this study was to investigate longitudinal associations between walking frequency and depressive symptoms in older adults to determine which variable is the stronger prospective predictor of the other. Design Longitudinal; four repeated measures over 5 years. Setting Population-based sample of urban-dwelling older adults living in the Montreal metropolitan area. Participants Participants from the VoisiNuAge study aged 68 to 84 (N = 498). Measurements Main exposures: depressive symptoms (Geriatric Depression Scale) and number of walking days in previous week (Physical Activity Scale for the Elderly). Covariates: age, education, and number of chronic illnesses. Cross-lagged panel analyses were performed in the entire sample and in sex-stratified subsamples. Results Depressive symptoms predicted walking frequency at subsequent time points (and more precisely, higher depressive symptoms were related to fewer walking days), but walking frequency did not predict depressive symptoms at subsequent time points. Stratified analyses revealed that prospective associations were statistically significant in women but not men. Conclusion The longitudinal association between walking frequency and depressive symptoms is one in which depressive symptoms predict reduced walking frequency later. Higher depressive symptoms are more likely a cause of reduced walking because of time precedence than vice versa. Future research on longitudinal relationships between meeting physical activity recommendations and depression are warranted. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that neighborhood environments are related to depressive mood in the general population. Older adults may be even more vulnerable to neighborhood factors than other adults. The aim of this paper is to review empirical findings on the relationships between neighborhood characteristics and depressive mood among older adults.Methods: A search of the literature was undertaken in PsycINFO and MEDLINE.Results: Nineteen studies were identified. Study designs were most often cross-sectional, included large sample sizes, and controlled for major individual characteristics. Mediational effects were not investigated. Statistical analysis strategies often included multilevel models. Spatial delimitations of neighborhood of residence were usually based on administrative and statistical spatial boundaries. Six neighborhood characteristics were assessed most often: neighborhood socioeconomic disadvantage, neighborhood poverty, affluence, racial/ethnic composition, residential stability, and elderly concentration. Selected neighborhood characteristics were associated with depressive mood after adjusting for individual variables. These associations were generally theoretically meaningful.Conclusions: Neighborhood variables seem to make a unique and significant contribution to the understanding of depressive mood among older adults. However, few studies investigated these associations and replication of results is needed. Several substantive neighborhood variables have been ignored or neglected in the literature. The implications of neighborhood effects for knowledge advancement and public health interventions remain unclear. Recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

The current study represents the further development and validation of an expanded version of the Inferential Confusion Questionnaire (ICQ-EV) in non-clinical and clinical samples. Inferential confusion seems to be particularly relevant to Obsessive-Compulsive Disorder (OCD) and is defined as a failure to recognize the unrealistic nature of obsessions due to a subjective form of reasoning. Factor analysis of the item-set of the ICQ-EV indicated a one-dimensional solution in non-clinical and clinical samples. It was hypothesized that inferential confusion as measured by the ICQ-EV would be particularly relevant to participants with OCD. Results confirmed convergent validity with strong relationships between the ICQ-EV and obsessive-compulsive symptoms in all samples independent of other cognitive domains and general distress. In addition, those with OCD scored higher on the ICQ-EV than non-clinical controls and a mixed anxiety disorder group so confirming group-criterion validity. Finally, the ICQ-EV also showed clinical validity with change in ICQ-EV scores during treatment significantly related to successful treatment outcome. [ABSTRACT FROM AUTHOR]

The aim of the current study was to investigate whether intrusions of individuals with obsessive-compulsive disorder (OCD) and nonclinical individuals differed in content and in context of occurrence. The results suggest that although the intrusions of OCD and nonclinical individuals are similar in content, they differ in their context of occurrence. Chi square analyses revealed that the intrusions of nonclinical participants were more likely to be directly linked than indirectly linked to observations in the here and now, whereas the intrusions of participants with OCD were more prone to be indirectly linked than directly linked to triggers in the environment at the time they occurred. The implications of the results for cognitive models of OCD are discussed. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–14, 2009. [ABSTRACT FROM AUTHOR]

Generally, research into the relationship between cognitive domains and obsessive–compulsive symptoms involves the use of scales that are highly intercorrelated with each other. The current study investigates the relationship between cognitive constructs and obsessive–compulsive symptoms using the item set of the Obsessive Beliefs Questionnaire and the Inferential Confusion Questionnaire. In order to create constructs that would not be excessively correlated with each other, factor scores were used to investigate the relationship between cognitive domains and obsessive–compulsive symptoms. Factor analysis followed by oblique rotation resulted in four moderately correlated cognitive constructs (importance/control of thoughts, inferential confusion/threat estimation, perfectionism/certainty and responsibility for preventing harm). With the exception of responsibility for preventing harm, the cognitive constructs under investigation were quite strongly related to obsessive–compulsive symptoms. In particular, hierarchical regression revealed the construct inferential confusion/threat estimation to be a global and strong predictor of obsessive–compulsive symptoms, followed by the constructs of perfectionism/certainty and the construct importance/control. Responsibility for preventing harm acted to be a negative predictor of obsessive–compulsive symptoms. It is concluded that the construct of inferential confusion acts as a more powerful predictor of obsessive–compulsive symptoms than any specific obsessive belief Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Although most cases are diagnosed at an early stage, endometrial carcinoma carries a poor prognosis when it recurs after previous definitive treatment or when diagnosed at an advanced stage.. There are typical and atypical metastatic sites of recurrent endometrial carcinoma. B DISCUSSION: b Endobronchial metastasis is by definition a bronchoscopically visible non-pulmonary tumor, involving the proximal central bronchus or sub segmental bronchi, with lesions histologically identical to the previously demonstrated primary tumor. Other rarely reported primary tumors include cancers from sarcoma, uterine cervix, skin tumors, thyroid gland, urinary bladder, and head and neck. [Extracted from the article]