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Ideally, the clinical goal for individuals with a history of anxiety disorder is not only to remit from the disorder, but also to reach optimal well-being. This broader concept of recovery aligns with Keyes' concept of complete mental health (CMH), including presence of happiness or life satisfaction, and social and psychological well-being, and absence of any past year mental illness including anxiety disorders, depressive disorders, substance dependence and suicidal ideation. This study's aim was to identify factors associated with CMH in a population-based sample of Canadians with a previous diagnosis of Generalized Anxiety Disorder (GAD) (n = =2128), of whom 40% are currently in CMH. Data were from the 2012 Canadian Community Health Survey-Mental Health (response rate=68.9%). The World Health Organization version of the Composite International Diagnostic Interview (WHO CIDI) scales were used to define lifetime and past-year GAD. Factors associated with complete mental health include female gender, older age, being married, reporting good to excellent physical health, being free of chronic insomnia, being able to manage household activities without difficulties, using religion or spirituality to cope, having a confidant, and never having had a major depressive disorder nor substance dependence. Results of this study suggest many with a history of anxiety disorders can achieve CMH and point to factors that appear to facilitate this process.

Objectives Approximately one-half of all children will sustain a fracture before adulthood. Understanding the factors that place a child at increased risk of fracture is necessary to inform effective injury prevention strategies. The purpose of this study was to examine the association between temperament and fracture risk in preschool-aged children. Methods Children aged 3 to 6 years who were diagnosed with a fracture were recruited from the Hospital for Sick Children Fracture Clinic. Using a retrospective case-control study design, the 148 cases were frequency-matched by age and sex to 426 controls from the TARGet Kids primary care paediatric cohort. The Childhood Behaviour Questionnaire, a 36-item caregiver response questionnaire was used to assess three of the following temperament factors: surgency (e.g., high activity level), negative affect (e.g., anger, fear, discomfort) and effortful control (e.g., attentional focusing). Results Unadjusted logistic models demonstrated no association between children with previous fracture and higher scores of surgency (unadjusted odds ratio [OR]=1.06, 95% confidence interval [CI]: 0.84, 1.34), negative affect (unadjusted OR=1.15, 95% CI: 0.93, 1.42) or effortful control (unadjusted OR=0.80, 95% CI: 0.63, 1.03). Further, models adjusted for covariates also demonstrated no significant association with surgency (1.00, 95% CI: 0.78, 1.29), negative affect (1.09, 95% CI: 0.86, 1.37) and effortful control (0.80, 95% CI: 0.61, 1.05). Conclusion None of the three main temperament types identified by the Childhood Behaviour Questionnaire were associated with an increase in fracture risk.

Individuals with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), have more rapid decline in lung function, more frequent exacerbations, and poorer quality of life than those with asthma or COPD alone. Air pollution exposure is a known risk factor for asthma and COPD; however, its role in ACOS is not as well understood.To determine if individuals with asthma exposed to higher levels of air pollution have an increased risk of ACOS.Individuals who resided in Ontario, Canada, aged 18 years or older in 1996 with incident asthma between 1996 and 2009 who participated in the Canadian Community Health Survey were identified and followed until 2014 to determine the development of ACOS. Data on exposures to fine particulate matter (PM2.5) and ozone (O3) were obtained from fixed monitoring sites. Associations between air pollutants and ACOS were evaluated using Cox regression models.Of the 6,040 adults with incident asthma who completed the Canadian Community Health Survey, 630 were identified as ACOS cases. Compared with those without ACOS, the ACOS population had later onset of asthma, higher proportion of mortality, and more frequent emergency department visits before COPD diagnosis. The adjusted hazard ratios of ACOS and cumulative exposures to PM2.5 (per 10 μg/m(3)) and O3 (per 10 ppb) were 2.78 (95% confidence interval, 1.62-4.78) and 1.31 (95% confidence interval, 0.71-2.39), respectively.Individuals exposed to higher levels of air pollution had nearly threefold greater odds of developing ACOS. Minimizing exposure to high levels of air pollution may decrease the risk of ACOS.

Material deprivation increases ACOS and death risk in people with asthma; air pollution may also increase death riskhttp://ow.ly/Eb8730dRPPc

Background Living with asthma is associated with a decrease in quality of life due to reductions in activities of daily living and increased psychological stress, both of which are associated with poor mental health outcomes. Objective The objective of this study was to quantify the burden of mental disorders on the adult asthma population and compare the risk of mental health services claims (MHSCs) in the 1 year before and 1 year after asthma diagnosis. Methods Ontario residents aged 25 to 65 years with incident physician-diagnosed asthma between April 1, 2005, and March 31, 2012, were included. MHSCs, which consisted of hospitalizations, emergency department (ED), and outpatient physician visits, were identified from universal health administrative data. Poisson regression models with repeated measures were used to estimate the relative risk (RR) of MHSCs for 2 time periods: 1 year after asthma diagnosis compared with the 1 year before and 2 years after compared with 2 years before. Results A total of 145,881 adults had incident asthma. In the 1 year after asthma diagnosis, 27% had an MHSC. The risk of ED visits for any mental disorders increased by 13% in the 1 year after asthma diagnosis compared with the 1 year before (adjusted RR [aRR], 1.13; 95% confidence interval [CI], 1.06-1.21). This increased risk of ED visits was not found when comparing 2 years after asthma diagnosis with 2 years before. The risk for outpatient physician visits for substance-related disorders increased by 21% at 1 year (aRR, 1.21; 95% CI, 1.14-1.28) and 37% at 2 years (aRR, 1.37; 95% CI, 1.28-1.46). Conclusions The significant comorbid burden of mental disorders in adults with newly diagnosed asthma highlights the need for primary care physicians to assess mental health needs and provide appropriate care.

Background A substantial proportion of patients with asthma return after being discharged from the emergency department (ED). Given the high economic burden of acute care claims, and the impact on productivity and quality of life, a better understanding of risk factors for ED return is of interest. Objective To quantify the rate and determine factors associated with return to the ED for asthma within 1 year of an initial ED visit for asthma. Methods Individuals aged 5 to 99 years living in Ontario, Canada, with an ED visit for asthma in the period 2008 to 2014 were included. Descriptive statistics were used to compare those with an ED return with those without an ED return. An adjusted modified Poisson regression model was used to estimate the relative risk of ED return for asthma within 1 year after the initial discharge. Results In total, 58,366 individuals met the inclusion criteria. At 1-year follow-up, 12.1% returned to the ED at least once. Younger age, being materially deprived, and having chronic obstructive pulmonary disease were significantly associated with increased risk of ED return within 1 year after the initial visit. Conclusions Nearly 1 in 8 individuals with a first ED visit for asthma returned to the ED within a year of the initial ED discharge. Targeting those at risk for ED return may help improve health care costs, productivity, and quality of life.

Background Approximately half of all children will sustain a fracture during childhood and adolescence. Understanding the factors that place a child at increased risk of fracture is necessary to inform effective injury prevention strategies. Methods A case-control study design with 128 cases and 426 frequency-matched controls (age and sex) was used to examine the risk of fracture (radiologist diagnosed fracture) in children ages 3–6 years. Cases were recruited from the Hospital for Sick Children Fracture Clinic and controls from the TARGet Kids primary care paediatric network. The Childhood Behaviour Questionnaire (CBQ), a 36-item caregiver response questionnaire was used to assess three temperament factors: surgency (i.e. impulsivity, high activity level); negative affect (i.e. anger, fear, discomfort); and effortful control (i.e. inhibitory control, attentional focusing) as the exposure. Results Unadjusted logistic models demonstrated no association between children with a fracture and higher scores of surgency (unadjusted OR = 1.06, 95% CI: 0.84, 1.34), negative affect (unadjusted OR = 1.15, 95% CI: 0.93, 1.42) or effortful control (unadjusted OR = 0.80, 95% CI: 0.63, 1.03). Models adjusted for covariates (waist circumference, maternal education, history of fracture, attendance in daycare, amount of time spent in unstructured playtime outdoors, having been breastfed, daily milk and soda consumption), also demonstrated no significant association with surgency (OR = 1.00, 95% CI: 0.78, 1.29), negative affect (OR = 1.09, 95% CI: 0.86, 1.37) and effortful control (OR = 0.80, 95% CI: 0.61, 1.05). Conclusions Children who are more extraverted, impulsive, aggressive or easily distracted as measured by the CBQ, are not at greater odds of experiencing a fracture, compared to their peers.