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Bastos ML, Oxlade O, Benedetti A, Fregonese F, Valiquette C, Lira SCC, Carvalho-Cordeiro D, Cavalcante JR, Faerstein E, Albuquerque MFM, Cordeiro-Santos M, Hill PC, Menzies D, Trajman A. A public health approach to increase treatment of latent TB among household contacts in Brazil. Int J Tuberc Lung Dis 2021; 24:1000-1008. [PMID: 33126931 DOI: 10.5588/ijtld.19.0728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities.METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician.RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI - 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial.DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.
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Affiliation(s)
- M L Bastos
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Respiratory Epidemiology & Clinical Research Unit
| | | | - A Benedetti
- Respiratory Epidemiology & Clinical Research Unit, Departments of Epidemiology, Biostatistics & Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - F Fregonese
- Respiratory Epidemiology & Clinical Research Unit
| | - C Valiquette
- Respiratory Epidemiology & Clinical Research Unit
| | - S C C Lira
- Recife Municipal Health Secretariat, Recife, PE, Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Pernambuco, Recife, PE
| | - D Carvalho-Cordeiro
- Manaus Municipal Health Secretariat, Manaus, AM, Programa de Pós-gradução em Enfermagem, Universidade Federal do Amazonas, Manaus, AM
| | - J R Cavalcante
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - E Faerstein
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - M Cordeiro-Santos
- Tropical Medicine Post-Graduation Program, Amazonas State University, Manaus, AM, Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, AM, Brazil
| | - P C Hill
- Centre for International Health, Otago Medical School, University of Otago, Otago, New Zealand
| | - D Menzies
- Respiratory Epidemiology & Clinical Research Unit, McGill International TB Centre, Departments of Epidemiology, Biostatistics & Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - A Trajman
- McGill International TB Centre, Internal Medicine Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Primary Health Care Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Carignan A, Valiquette L, Grenier C, Musonera JB, Nkengurutse D, Marcil-Héguy A, Vettese K, Marcoux D, Valiquette C, Xiong WT, Fortier PH, Généreux M, Pépin J. Anosmie et dysgueusie associées à l’infection au SRAS-CoV-2: étude cas–témoins appariée selon l’âge. CMAJ 2020; 192:E1487-E1492. [PMID: 33199460 DOI: 10.1503/cmaj.200869-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Alex Carignan
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué.
| | - Louis Valiquette
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Cynthia Grenier
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Jean Berchmans Musonera
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Delphin Nkengurutse
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Anaïs Marcil-Héguy
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Kim Vettese
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Dominique Marcoux
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Corinne Valiquette
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Wei Ting Xiong
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Pierre-Hughes Fortier
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Mélissa Généreux
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
| | - Jacques Pépin
- Départements de microbiologie et infectiologie (A. Carignan, L. Valiquette, C. Grenier, J. Musonera, D. Nkengurutse, A. Marcil-Héguy, K. Vettese, D. Marcoux, C. Valiquette, W. Xiong, J. Pépin), de chirurgie (P.-H. Fortier) et des sciences de la santé communautaire (M. Généreux), Université de Sherbrooke, Sherbrooke, Qué
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Carignan A, Valiquette L, Grenier C, Musonera JB, Nkengurutse D, Marcil-Héguy A, Vettese K, Marcoux D, Valiquette C, Xiong WT, Fortier PH, Généreux M, Pépin J. Anosmia and dysgeusia associated with SARS-CoV-2 infection: an age-matched case-control study. CMAJ 2020; 192:E702-E707. [PMID: 32461325 DOI: 10.1503/cmaj.200869] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anosmia and dysgeusia have been reported as potential symptoms of coronavirus disease 2019. This study aimed to confirm whether anosmia and dysgeusia are specific symptoms among those who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS We conducted an age-matched case-control study in the Eastern Townships region of Quebec between Mar. 10 and Mar. 23, 2020. We included adults (age ≥ 18 yr) who tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction. Cases were matched (1:1) according to 5-year age groups with control patents selected randomly from among all patients who tested negative for SARS-CoV-2 during the same period. Demographic and laboratory information was collected from medical records. Clinical symptoms and comorbidities associated with anosmia and dysgeusia were obtained by telephone interview with a standardized questionnaire. RESULTS Among 2883 people tested for SARS-CoV-2, we identified 134 positive cases (70 women [52.2%] and 64 men [47.8%]; median age 57.1 [interquartile range 41.2-64.5] yr). The symptoms independently associated with SARS-CoV-2 positivity in conditional logistic regression were anosmia or dysgeusia or both (adjusted odds ratio [OR] 62.9, 95% confidence interval [CI] 11.0-359.7), presence of myalgia (adjusted OR 7.6, 95% CI 1.9-29.9), blurred vision (adjusted OR 0.1, 95% CI 0.0-0.8) and chest pain (adjusted OR 0.1, 95% CI 0.0-0.6). INTERPRETATION We found a strong association between olfactory and gustatory symptoms and SARS-CoV-2 positivity. These symptoms should be considered as common and distinctive features of SARS-CoV-2 infection and should serve as an indication for testing and possible retesting of people whose first test result is negative.
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Affiliation(s)
- Alex Carignan
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que.
| | - Louis Valiquette
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Cynthia Grenier
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Jean Berchmans Musonera
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Delphin Nkengurutse
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Anaïs Marcil-Héguy
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Kim Vettese
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Dominique Marcoux
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Corinne Valiquette
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Wei Ting Xiong
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Pierre-Hughes Fortier
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Mélissa Généreux
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
| | - Jacques Pépin
- Departments of Microbiology and Infectious Diseases (Carignan, L. Valiquette, Grenier, Musonera, Nkengurutse, Marcil-Héguy, Vettese, Marcoux, C. Valiquette, Xiong, Pépin), Surgery (Fortier) and Community Health Sciences (Généreux), Université de Sherbrooke, Sherbrooke, Que
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Alsdurf H, Oxlade O, Adjobimey M, Ahmad Khan F, Bastos M, Bedingfield N, Benedetti A, Boafo D, Buu TN, Chiang L, Cook V, Fisher D, Fox GJ, Fregonese F, Hadisoemarto P, Johnston JC, Kassa F, Long R, Moayedi Nia S, Nguyen TA, Obeng J, Paulsen C, Romanowski K, Ruslami R, Schwartzman K, Sohn H, Strumpf E, Trajman A, Valiquette C, Yaha L, Menzies D. Resource implications of the latent tuberculosis cascade of care: a time and motion study in five countries. BMC Health Serv Res 2020; 20:341. [PMID: 32316963 PMCID: PMC7175545 DOI: 10.1186/s12913-020-05220-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The End TB Strategy calls for global scale-up of preventive treatment for latent tuberculosis infection (LTBI), but little information is available about the associated human resource requirements. Our study aimed to quantify the healthcare worker (HCW) time needed to perform the tasks associated with each step along the LTBI cascade of care for household contacts of TB patients. METHODS We conducted a time and motion (TAM) study between January 2018 and March 2019, in which consenting HCWs were observed throughout a typical workday. The precise time spent was recorded in pre-specified categories of work activities for each step along the cascade. A linear mixed model was fit to estimate the time at each step. RESULTS A total of 173 HCWs in Benin, Canada, Ghana, Indonesia, and Vietnam participated. The greatest amount of time was spent for the medical evaluation (median: 11 min; IQR: 6-16), while the least time was spent on reading a tuberculin skin test (TST) (median: 4 min; IQR: 2-9). The greatest variability was seen in the time spent for each medical evaluation, while TST placement and reading showed the least variability. The total time required to complete all steps along the LTBI cascade, from identification of household contacts (HHC) through to treatment initiation ranged from 1.8 h per index TB patient in Vietnam to 5.2 h in Ghana. CONCLUSIONS Our findings suggest that the time requirements are very modest to perform each step in the latent TB cascade of care, but to achieve full identification and management of all household contacts will require additional human resources in many settings.
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Affiliation(s)
- H Alsdurf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - O Oxlade
- McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada
| | - M Adjobimey
- Programme National contre la Tuberculose-Bénin, Centre National Hospitalier Universitaire de Pneumo-Phtisiologie-Cotonou, Cotonou, Benin
| | - F Ahmad Khan
- McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada
| | - M Bastos
- Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada.,Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - A Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada
| | - D Boafo
- Chest Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - T N Buu
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - L Chiang
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - V Cook
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - D Fisher
- Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada
| | - G J Fox
- The Faculty of Medicine and Health, The University of Sydney Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - F Fregonese
- McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada
| | - P Hadisoemarto
- Department of Public Health, Faculty of Medicine, TB-HIV Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - J C Johnston
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - F Kassa
- Programme National contre la Tuberculose-Bénin, Centre National Hospitalier Universitaire de Pneumo-Phtisiologie-Cotonou, Cotonou, Benin
| | - R Long
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - S Moayedi Nia
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - T A Nguyen
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - J Obeng
- Chest Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - C Paulsen
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - K Romanowski
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - R Ruslami
- Department of Biomedical Sciences, Division of Pharmacology & Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - K Schwartzman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada
| | - H Sohn
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - A Trajman
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Valiquette
- McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada
| | - L Yaha
- Programme National contre la Tuberculose-Bénin, Centre National Hospitalier Universitaire de Pneumo-Phtisiologie-Cotonou, Cotonou, Benin
| | - D Menzies
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. .,McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada. .,Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada.
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Abstract
Studies have shown that the use of a conventional sling backrest in a wheelchair may have a negative impact on the posture and health of users. To avoid such problems, this backrest is often replaced by a back cushion on a rigid surface. However, the use of the latter deprives many wheelchair users of the advantages provided by the sling backrest (easy folding, lightweight, low cost, unobtrusive, simplicity of design). In an effort to maintain these features while providing adequate posture, a new backrest was designed according to specific criteria. The "flexible contour backrest" has been developed so that it can be adapted to a person's back contour with stays, adjustable straps, and curved back posts. Preliminary comparisons done by some experts with commercially available backrests showed that design criteria were reached at 62.9% by the back cushion on a rigid surface, at 64% by the sling backrest, and at 67.7% by the adjustable-tension backrest. On the other hand, design criteria were reached at 80% by the new flexible contour backrest because its design brings together most of the positive features provided by these other backrests (easy to fold, light weight, unobtrusive, airy) as well as providing adequate posture and better fit to the user's morphology.
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Affiliation(s)
- F Parent
- Ecole Polytechnique de Montréal, Québec, Canada
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Lesage AD, Cyr M, Toupin J, Cormier H, Valiquette C. [Training of interviewers in the utilization of standardized questionnaires in psychiatry: studies realized with the Present State Examination (PSE)]. Acta Psychiatr Belg 1991; 91:129-44. [PMID: 1670414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Interview questionnaires offer more validity than self-administered format in exploring psychopathological or psychosocial phenomena of interest in psychiatric research. If used, special care needs to be paid to interviewers' training and ensuring that they maintain their reliability. No widespread training standards exist and each schedule may carry its own procedure. Our aims are to indicate how we trained interviewers with the French version of the Present State Examination (Wing, Cooper and Sartorius, 1974) and how we checked and kept acceptable interraters reliability during one study. We will provide data on the interraters reliability during the training and the study, as well as the test-retest reliability. These results will be used to support some guidelines when using this sort of psychiatric research questionnaires in order to ensure comparability both within the study and between studies.
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Affiliation(s)
- A D Lesage
- Centre de recherche, Hôpital Louis-H. Lafontaine, Montréal
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7
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Abstract
1. Mastication was studied in awake rabbits that had previously been prepared for chronic recording of jaw movement and jaw muscle electromyography (EMG) under general anesthesia. Data were stored on tape and replayed for computer-assisted analysis. Most data was taken from the mastication of rabbit chow, but the basic features described in the paper also apply to eating of other foods. The series of movements was divided into cycles, and the phases that compose them, using peaks in the vertical movement, velocity, and acceleration. 2. The whole series of movements from ingestion to swallowing was termed the masticatory sequence. We found, as have others, that the sequence can be divided into three consecutive periods, based on the form of the movements. These were named the preparatory, reduction, and preswallowing series of cycles. 3. The results of earlier studies suggest that the food is transported back to the molar teeth during the preparatory series, ground up during the reduction series, and that the bolus is formed for swallowing during the preswallowing series. 4. The typical cycle of the preparatory series was called type I; it had two phases: opening (O) and fast closing (FC). The jaw-opening muscles were very active during O, but EMG bursts from the closer muscles were small or undefinable during FC. There was not much movement away from the midline in either phase, and the cycles were the shortest in the sequence. 5. The reduction series was predominantly composed of type II cycles. These were of intermediate duration and had three phases [O, a short FC, and a slow closing phase (SC)], during which the pellets were crushed between the molar teeth. The jaw moved toward the working side during FC. At or soon after the start of SC, the closer muscles became very active and continued to contract as the teeth were drawn toward the midline and slightly backwards. 6. The preswallowing series was made up of five-phase cycles that we called type III. These were the longest of the sequence. Jaw opening now occurred in three stages: O1 was the fall from tooth contact to approximately the postural position, O2 was a pause, and O3 was defined as the final movement to maximum opening. The digastric burst occurred during O3. There were again two closing phases, FC and SC, but closer bursts were smaller than in type II, and SC was shorter.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- G Schwartz
- Faculté de Médecine Dentaire, Université de Montréal, Quebec, Canada
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Olsson KA, Lund JP, Valiquette C, Veilleux D. Activity during mastication of periodontal mechanosensitive neurons of the trigeminal subnucleus oralis of the rabbit. J Neurophysiol 1988; 59:341-57. [PMID: 3351567 DOI: 10.1152/jn.1988.59.2.341] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
1. The activity of mechanosensitive neurons was examined before and during mastication. One hundred and seventy-eight neurons were recorded in the rostral parts of the trigeminal sensory nuclei of 20 rabbits anesthetized with urethan. Twenty-eight neurons received inputs from the periodontal mechanoreceptors, all on the ipsilateral side. Nineteen had receptive fields that were restricted to one tooth; 2 could be activated from more than 1 tooth, and 6 included parts of the mucosa. Only the latter were spontaneously active. 2. All periodontal neurons with a mandibular input responded to graded electrical stimulation of the inferior alveolar nerve at minimum latencies of less than or equal to 3.4 ms, and approximately half had inputs from the sensorimotor cortex. 3. Almost all periodontal units recorded were found to lie in, or just outside, the dorsal part of the most rostral subdivision of the spinal trigeminal nucleus (subnucleus oralis, pars gamma). None projected to the ipsi- or contralateral thalamus. 4. All periodontal neurons fired during mastication. Those without mucosal receptive fields fired during jaw closure, with almost all activity confined to the slow-closing phase when pressure is applied to the teeth. Injections of local anesthetic showed that input from mucosal fields was responsible for activating neurons in other phases of the cycle. 5. Possible roles in the control of mastication for these periodontal interneurons were discussed.
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Affiliation(s)
- K A Olsson
- Faculté de médecine dentaire, Université de Montréal, Quebec, Canada
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9
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Hewitt LA, Valiquette C, Plaa GL. The role of biotransformation-detoxication in acetone-, 2-butanone-, and 2-hexanone-potentiated chloroform-induced hepatotoxicity. Can J Physiol Pharmacol 1987; 65:2313-8. [PMID: 3449191 DOI: 10.1139/y87-367] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The hepatotoxicity of chloroform (CHCl3) is thought to require biotransformation, by the polysubstrate monooxygenase system (P-450), to a reactive intermediate(s). Therefore, the potentiation of CHCl3-induced hepatotoxicity, which occurs following exposure to certain ketones, may hypothetically be explained by a reduced capacity of the cell to form glutathione conjugates (detoxicate the intermediate) and (or) by an increased rate of reactive intermediate(s) generation secondary to a modification of the P-450 system. To test these hypotheses, liver damage, as indicated by elevation in plasma alanine aminotransferase and ornithine carbamyl transferase activities, was modulated in male Sprague-Dawley rats by varying the time interval (10, 18, 24, 48, 72, 96 h) between acetone, 2-butanone, or 2-hexanone (15 mmol/kg, p.o.) pretreatment and CHCl3 (0.5 mL/kg, p.o.) administration. These data were compared with hepatic glutathione and with various parameters of the polysubstrate monooxygenase system: cytochrome P-450, cytochrome c reductase, cytochrome b5, and microsomal binding of 14CHCl3-derived radiolabel. Reduced detoxication capacity does not appear to be involved as hepatic glutathione levels were not reduced. Globally, a relationship between modifications to the polysubstrate monooxygenase system and potentiation of CHCl3-induced hepatotoxicity appears to exist. The rank order of each ketone's ability to modify P-450 parameters was the same in most instances as that based on peak ability to potentiate CHCl3-induced hepatotoxicity: 2-hexanone greater than 2-butanone greater than or equal to acetone. Therefore, these results suggest that a general relationship exists between the ketone-induced potentiation of CHCl3-induced hepatotoxicity and increased CHCl3 reactive metabolite generation. However, other factors may also contribute to the phenomenon.
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Affiliation(s)
- L A Hewitt
- Département de pharmacologie, Faculté de médecine, Université de Montréal, Québec, Canada
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10
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Lavigne G, Kim JS, Valiquette C, Lund JP. Evidence that periodontal pressoreceptors provide positive feedback to jaw closing muscles during mastication. J Neurophysiol 1987; 58:342-58. [PMID: 3655872 DOI: 10.1152/jn.1987.58.2.342] [Citation(s) in RCA: 193] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
1. Mastication was produced by stimulation of the right motor-sensory cortex of urethan-anesthetized rabbits with 15-s trains of shocks (1-ms duration) at 50 Hz. Movements of the lower jaw and jaw muscle electromyograms (EMGs) were recorded on magnetic tape for later computer analysis. 2. The stimulus site was chosen, and stimulus intensity adjusted, so that stereotyped movements were produced that included a wide swing of the mandible to the left side during jaw closure. 3. Control trials were alternated with trials in which a steel ball (2 mm diam) was thrust between the anterior molar teeth on the left side and left in place for several seconds. 4. When the obstruction was first introduced, a jaw opening reflex was sometimes evoked if the ball struck the buccal surface of the advancing mandibular molar teeth. Thereafter, when the ball was crushed between the occlusal surfaces of the teeth, no jaw opening reflex was seen. 5. Instead, the amplitude and duration of all the jaw closing EMGs increased, beginning at least 12 ms after contact with the ball. This caused a prolongation of the slow closing (SC) phase of the cycle that, coupled with a delay in the start of activity in the digastric muscle (jaw opener), prolonged the cycle by more than 60 ms. 6. During the SC phase of the obstructed trials, the medially directed grinding stroke was exaggerated because of an increase in the contraction of the contralateral zygomaticomandibular and anterior temporal muscles. 7. After collecting data, the sensory nerves to the maxillary and mandibular anterior molar teeth were cut to eliminate feedback from the periodontal pressoreceptors. Control and obstructed trials were repeated. 8. Following denervation, the obstructed cycles were of shorter duration. The mandible still moved to the right during SC in some animals, but the increase in closer muscle EMG activity was much reduced. 9. We conclude that periodontal receptors provide positive feedback to the jaw closing muscles during mastication. This is supplemented by input from other receptors, probably muscle spindles. In addition, an increase in periodontal feedback prolongs the SC phase and the early phases of the opening stroke.
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Affiliation(s)
- G Lavigne
- Centre de Recherche en Sciences Neurologiques et Faculté de Médecine Dentaire, Montréal, Canada
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