Transactive response DNA-binding protein 43 is enriched at the centrosome in human cells

The centrosome, as the main microtubule organizing centre, plays key roles in cell polarity, genome stability and ciliogenesis. The recent identification of ribosomes, RNA-binding proteins and transcripts at the centrosome suggests local protein synthesis. In this context, we hypothesized that TDP-43, a highly conserved RNA binding protein involved in the pathophysiology of amyotrophic lateral sclerosis and frontotemporal lobar degeneration, could be enriched at this organelle. Using dedicated high magnification sub-diffraction microscopy on human cells, we discovered a novel localization of TDP-43 at the centrosome during all phases of the cell cycle. These results were confirmed on purified centrosomes by western blot and immunofluorescence microscopy. In addition, the co-localization of TDP-43 and pericentrin suggested a pericentriolar enrichment of the protein, leading us to hypothesize that TDP-43 might interact with local mRNAs and proteins. Supporting this hypothesis, we found four conserved centrosomal mRNAs and 16 centrosomal proteins identified as direct TDP-43 interactors. More strikingly, all the 16 proteins are implicated in the pathophysiology of TDP-43 proteinopathies, suggesting that TDP-43 dysfunction in this organelle contributes to neurodegeneration. This first description of TDP-43 centrosomal enrichment paves the way for a more comprehensive understanding of TDP-43 physiology and pathology.

Targeting TDP-43 Pathology Alleviates Cognitive and Motor Deficits Caused by Chronic Cerebral Hypoperfusion

Vascular dementia is one of the most common forms of dementia in aging population. However, the molecular mechanisms involved in development of disease and the link between the cerebrovascular pathology and the cognitive impairments remain elusive. Currently, one common and/or converging neuropathological pathway leading to dementia is the mislocalization and altered functionality of the TDP-43. We recently demonstrated that brain ischemia triggers an age-dependent deregulation of TDP-43 that was associated with exacerbated neurodegeneration. Here, we report that chronic cerebral hypoperfusion in mice (CCH) produced by unilateral common carotid artery occlusion induces cytoplasmic mislocalization of TDP-43 and formation of insoluble phosho-TDP-43 aggregates reminiscent of pathological changes detected in cortical neurons of human brain samples from patients suffering from vascular dementia. Moreover, the CCH in mice caused chronic activation of microglia and innate immune response, development of cognitive deficits, and motor impairments. Oral administration of a novel analog (IMS-088) of withaferin A, an antagonist of nuclear factor-κB essential modulator (NEMO), led to mitigation of TDP-43 pathology, enhancement of autophagy, and amelioration of cognitive/motor deficits in CCH mice. Taken together, our results suggest that targeting TDP-43 pathogenic inclusions may have a disease-modifying effect in dementia caused by chronic brain hypoperfusion.

STochastic Optical Reconstruction Microscopy (STORM) reveals the nanoscale organization of pathological aggregates in human brain

AIMS

Histological analysis of brain tissue samples provides valuable information about the pathological processes leading to common neurodegenerative disorders. In this context, the development of novel high-resolution imaging approaches is a current challenge in neuroscience.

METHODS

To this end, we used a recent super-resolution imaging technique called STochastic Optical Reconstruction Microscopy (STORM) to analyse human brain sections. We combined STORM cell imaging protocols with neuropathological techniques to image cryopreserved brain samples from control subjects and patients with neurodegenerative diseases.

RESULTS

This approach allowed us to perform 2D-, 3D- and two-colour-STORM in neocortex, white matter and brainstem samples. STORM proved to be particularly effective at visualizing the organization of dense protein inclusions and we imaged with a <50 nm resolution pathological aggregates within the central nervous system of patients with Alzheimer's disease, Parkinson's disease, Lewy body dementia and fronto-temporal lobar degeneration. Aggregated Aβ branches appeared reticulated and cross-linked in the extracellular matrix, with widths from 60 to 240 nm. Intraneuronal Tau and TDP-43 inclusions were denser, with a honeycomb pattern in the soma and a filamentous organization in the axons. Finally, STORM imaging of α-synuclein pathology revealed the internal organization of Lewy bodies that could not be observed by conventional fluorescence microscopy.

CONCLUSIONS

STORM imaging of human brain samples opens further gates to a more comprehensive understanding of common neurological disorders. The convenience of this technique should open a straightforward extension of its application for super-resolution imaging of the human brain, with promising avenues to current challenges in neuroscience.

Monoclonal full-length antibody against TAR DNA binding protein 43 reduces related proteinopathy in neurons

Amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD), 2 incurable neurodegenerative disorders, share the same pathological hallmark named TDP43 (TAR DNA binding protein 43) proteinopathy. This event is characterized by a consistent cytoplasmic mislocalization and aggregation of the protein TDP43, which loses its physiological properties, leading neurons to death. Antibody-based approaches are now emerging interventions in the field of neurodegenerative disorders. Here, we tested the target specificity, in vivo distribution, and therapeutic efficacy of a monoclonal full-length antibody, named E6, in TDP43-related conditions. We observed that the antibody recognizes specifically the cytoplasmic fraction of TDP43. We demonstrated its ability in targeting large neurons in the spinal cord of mice and in reducing TDP43 mislocalization and NF-κB activation. We also recognized the proteasome as well as the lysosome machineries as possible mechanisms used by the antibody to reduce TDP43 proteinopathy. To our knowledge, this is the first report showing the therapeutic efficacy and feasibility of a full-length antibody against TDP43 in reducing TDP43 proteinopathy in spinal neurons of an ALS/FTLD mouse model.

A full-length antibody against TDP43 reduces TDP43 proteinopathy in spinal neurons of an amyotrophic lateral sclerosis/Frontotemporal lobar degeneration mouse model.

Key role of UBQLN2 in pathogenesis of amyotrophic lateral sclerosis and frontotemporal dementia

Ubiquilin-2 (UBQLN2) is a member of the ubiquilin family, actively implicated in the degradation of misfolded and redundant proteins through the ubiquitin-proteasome system and macroautophagy. UBQLN2 received much attention after the discovery of gene mutations in amyotrophic lateral sclerosis and frontotemporal dementia (ALS/FTD). The abnormal presence of positive UBQLN2 inclusion in the cytosol of degenerating motor neurons of familial and sporadic forms of ALS patients has been newly related to neurodegeneration. Only recently, data have emerged on its role in liquid-liquid phase separation, in stress granule development and in the formation of secondary amyloid structures. Furthermore, several animal models are available to investigate its involvement in TDP-43 pathology and neuroinflammation in ALS. This review addresses the molecular pathogenetic pathways involving UBQLN2 abnormalities which are converging toward defects in clearance mechanisms. UBQLN2.

De Novo Malignancies Screening After Liver Transplantation for Alcoholic Liver Disease: A Comparative Opportunistic Study

Patients having received a liver transplantation (LT) for alcoholic liver disease (ALD) have a high risk of de novo malignancies, especially in the upper aerodigestive tract and lungs due to their smoking and alcohol history. The aim of this retrospective study was to compare a group of patients transplanted for ALD who continue to smoke and who were included in an intensive screening program for tobacco-related cancers implemented at the Grenoble University Hospital and a group of similar patients followed according to usual practice (chest computed tomography [CT] scan every 5 years) at the Edouard Herriot Hospital in Lyon. The intensive screening program consisted of an annual checkup, including a clinical examination by an otorhinolaryngologist, a chest CT scan, and an upper digestive endoscopy. A total of 147 patients were included: 71 patients in Grenoble and 76 patients in Lyon. The cumulative incidence of a first tobacco-related cancer was 12.3% at 3 years, 20.6% at 5 years, 42.6% at 10 years, and 64.0% at 15 years. A curative treatment was possible in 80.0% of the patients in Grenoble versus 57.9% in Lyon (P = 0.068). The rates of curative treatment were 63.6% versus 26.3% (P = 0.062) for lung cancers, 100.0% versus 87.5% (P = 0.498) for lip-mouth-pharynx and larynx cancers, and 66.7% versus 100.0% (P = 1) for esophageal cancers, respectively. In addition, for lung cancers, regardless of study group, 68.7% received a curative treatment when the diagnosis was made by CT scan screening versus 14.3% when it was made because of symptoms (P = 0.008). In conclusion, our study strongly confirms the high rate of tobacco-related de novo malignancies in LT patients for ALD and suggests that the screening of lung cancer by annual chest CT scan could significantly increase the rate of curative treatment.

Neuronal Expression of UBQLN2P497H Exacerbates TDP-43 Pathology in TDP-43G348C Mice through Interaction with Ubiquitin

Mutations in the gene encoding ubiquilin-2 (UBQLN2) are linked to amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). UBQLN2 plays a central role in ubiquitin proteasome system (UPS) and UBQLN2 up-regulation exacerbates TDP-43 cytoplasmic aggregates. To analyze interaction between UBQLN2 and TDP-43 and to produce a relevant ALS animal model, we have generated a new transgenic mouse expressing UBQLN2^P497H under the neurofilament heavy (NFH) gene promoter. The UBQLN2^P497H mice were then bred with our previously described TDP-43^G348C mice to generate double-transgenic UBQLN2^P497H; TDP-43^G348C mice. With low-expression levels of UBQLN2, the double-transgenic mice developed TDP-43 cytosolic accumulations in motor neurons starting at 5 months of age. These double-transgenic mice exhibited motor neuron loss, muscle atrophy, as well as motor and cognitive deficits during aging. The microglia from double-transgenic mice were hyperresponsive to intraperitoneal injection of lipopolysaccharide (LPS). In vivo and in vitro analyses suggested that extra UBQLN2 proteins can exacerbate cytoplasmic TDP-43 accumulations by competing with the UPS for binding to ubiquitin. Thus, increasing the pool of ubiquitin promoted the UPS function with ensuing reduction of TDP-43 cytosolic accumulations. In conclusion, the double-transgenic UBQLN2^P497H; TDP-43^G348C mice provides a unique mouse model of ALS/FTD with enhanced TDP-43 pathology that can be exploited for drug testing.

Polarization mechanisms of dielectric materials at a binary liquid interface: impacts on electrowetting actuation

We explored polarization mechanisms at the interface between a dielectric material (an electrolyte) and an insulating liquid, during electrowetting actuation. Native surface charge density due to hydrophobic coating has been measured as an offset voltage for which the contact angle is at its minimum. Surface charge densities as low as 0.023 mC m^-2 have been measured using this method, demonstrating that electrowetting can be used as a probe to measure native surface charge density. This effect strongly differs depending on the kind of polarization and is at the origin of major discrepancies between alternative and direct polarization during electrowetting actuation. A new model describing electrowetting actuation is also proposed, leading to a more predictive description as well as useful recommendations on materials to obtain a stable actuation under DC polarization.

Synchrotron X-ray microtransections: a non invasive approach for epileptic seizures arising from eloquent cortical areas

Synchrotron-generated X-ray (SRX) microbeams deposit high radiation doses to submillimetric targets whilst minimizing irradiation of neighboring healthy tissue. We developed a new radiosurgical method which demonstrably transects cortical brain tissue without affecting adjacent regions. We made such image-guided SRX microtransections in the left somatosensory cortex in a rat model of generalized epilepsy using high radiation doses (820 Gy) in thin (200 μm) parallel slices of tissue. This procedure, targeting the brain volume from which seizures arose, altered the abnormal neuronal activities for at least 9 weeks, as evidenced by a decrease of seizure power and coherence between tissue slices in comparison to the contralateral cortex. The brain tissue located between transections stayed histologically normal, while the irradiated micro-slices remained devoid of myelin and neurons two months after irradiation. This pre-clinical proof of concept highlights the translational potential of non-invasive SRX transections for treating epilepsies that are not eligible for resective surgery.

[Pomalidomide for multiple myeloma]

Once characterized by a very poor outcome, multiple myeloma (MM) now has a significantly prolonged survival, with major improvements allowed by the use of "novel agents": proteasome inhibitors (first-in-class bortezomib) and immunomodulatory compounds (IMiDs; first-in-class thalidomide and lenalidomide). However, the vast majority - if not all - of patients with MM ultimately end up being refractory to all existing drugs, including these efficient novel agents. There is a clear unmet medical need in this situation, which warrants the development of the next generation of proteasome inhibitors and IMiDs, as well as new drug classes. This review focuses on pomalidomide, the next generation IMiD, recently approved by the US FDA and the EMA for patients with relapsed or refractory MM who have received at least two prior therapies, including lenalidomide and bortezomib, and have demonstrated disease progression on their last therapy.

An aptasensor for ochratoxin A based on grafting of polyethylene glycol on a boron-doped diamond microcell

A novel strategy for the fabrication of an electrochemical label-free aptasensor for small-size molecules is proposed and demonstrated as an aptasensor for ochratoxin A (OTA). A long spacer chain of polyethylene glycol (PEG) was immobilized on a boron-doped diamond (BDD) microcell via electrochemical oxidation of its terminal amino groups. The amino-aptamer was then covalently linked to the carboxyl end of the immobilized PEG as a two-piece macromolecule, autoassembled at the BDD surface, forming a dense layer. Due to a change in conformation of the aptamer on the target analyte binding, a decrease of the electron transfer rate of the redox [Fe(CN)6](4-/3-) probe was observed. To quantify the amount of OTA, the decrease of the square wave voltammetry (SWV) peak maximum of this probe was monitored. The plot of the peak maximum against the logarithm of OTA concentration was linear along the range from 0.01 to 13.2 ng/L, with a detection limit of 0.01 ng/L. This concept was validated on spiked real samples of rice.

Layer-specific activity of tissue non-specific alkaline phosphatase in the human neocortex

The ectoenzyme tissue non-specific alkaline phosphatase (TNAP) is mostly known for its role in bone mineralization. However, in the severe form of hypophosphatasia, TNAP deficiency also results in epileptic seizures, suggesting a role of this enzyme in brain functions. Accordingly, TNAP activity was shown in the neuropil of the cerebral cortex in diverse mammalian species. However in spite of its clinical significance, the neuronal localization of TNAP has not been investigated in the human brain. By using enzyme histochemistry, we found an unprecedented pattern of TNAP activity appearing as an uninterrupted layer across diverse occipital-, frontal- and temporal lobe areas of the human cerebral cortex. This marked TNAP-active band was localized infragranulary in layer 5 as defined by quantitative comparisons on parallel sections stained by various techniques to reveal the laminar pattern. On the contrary, TNAP activity was localized in layer 4 of the primary visual and somatosensory cortices, which is consistent with earlier observations on other species. This result suggests that the expression of TNAP in the thalamo-recipient granular layer is an evolutionary conserved feature of the sensory cortex. The observations of the present study also suggest that diverse neurocognitive functions share a common cerebral cortical mechanism depending on TNAP activity in layer 5. In summary, the present data point on the distinctive role of layer 5 in cortical computation and neurological disorders caused by TNAP dysfunctions in the human brain.

Lutter contre le tabac et promouvoir l'allaitement au Québec : un défi

Quebec's breastfeeding rates are in a deplorable state, and even more so for smoking mothers. Public health providers are trying to increase breastfeeding rates and decrease smoking in this specific target group. Should they prioritise tobacco cessation interventions, or breastfeeding promotion interventions, or give equal priority to both goals at the same time? The authors attempt to scientifically answer this question, through a comprehensive literature review over the last ten years. In general, women who smoke have the tendency be younger, be less educated and more underprivileged than mothers who do not smoke and to breastfeed less often. Smoking mothers who do breastfeed usually wean off breastfeeding earlier than those who do not smoke. Pregnancy is considered an ideal moment to stop smoking, but relapse after giving birth is very high. In light of the range of difficulties faced when trying to quit smoking, health professionals should encourage smoking mothers to breastfeed since the benefits of breastfeeding could actually serve to reduce some of the harmful effects related to tobacco. Nicotine patches can be prescribed to increase the chances for successful tobacco cessation amongst these mothers. To date, few studies have been carried out on nicotine replacement therapies and breastfeeding smokers. More research is needed to evaluate the risks and benefits of nicotine substitutes for this sub-group, in both the short and long term.

[Heart health promotion and preventive practices of Quebec nurses working in local community health centers]

The heart health promotion and prevention practices of nurses working in front-line services in 20 Québec CLSC's are analyzed through a qualitative (n = 47 nurses) and a quantitative approach (n = 177 nurses and n = 3802 patients). The results demonstrate that although nurses state they integrate prevention and promotion in their daily practice, patients report that nurses provide few prevention recommendations. The major challenge for prevention-promotion is to strengthen secondary prevention and, especially, integrate primary prevention and promotion in nurses' daily clinical practice.

The St-Louis du Parc Heart Health Project: a critical analysis of the reverse effects on smoking

OBJECTIVES

Although some school based smoking prevention programmes have shown positive impacts, others have had only short term effects, no effects, and in some cases reverse effects. The St-Louis du Parc Heart Health Project was a five year heart health promotion programme targeting children in eight elementary schools aged 9-12 years in disadvantaged multiethnic neighbourhoods in Montreal. In a controlled, longitudinal evaluation, the programme produced reverse effects on smoking--children exposed to the programme were more likely to initiate and to continue smoking than control children. This article explores hypotheses to explain the reverse effects.

DESIGN

Following work by an in-house committee, a consensus workshop with international experts was conducted to develop hypotheses to explain the reverse effects. This was complemented by an analysis of the programme's concordance with the standard guidelines on the school based prevention of tobacco use, and discussions with experts at the Centers for Disease Control and Prevention.

RESULTS

The programme respected most standard guidelines for smoking prevention programmes with respect to content and mode of delivery. Hypotheses to explain the reverse effects include: an unfavourable environment characterised by strong pro-smoking models and resistance to environmental interventions; heightened sensitivity to smoking among children most exposed to the programme; defence mechanisms among children stimulated by cognitive dissonance or anxiety; unanticipated effects associated with the health educator who delivered the programme; inadequate attention in programme development to the diverse cultural origins of the population targeted; and intervention content inappropriately targeted to children's stages of cognitive development.

CONCLUSION

Elementary school based interventions should aim to develop a clear and coherent social norm about the non-use of tobacco, as a precursor to or in close conjunction with having children as their primary target. Programme design should take key student characteristics into consideration and ensure that the modes of communication are adapted to the targeted group's characteristics. Neighbourhood level interventions should be orchestrated to complement regional, provincial, and national programmes.

A new step towards the lattice reconstruction in 3DAP

The spatial resolution of images produced by 3DAP is known not to be limited by the detector performance but by the physics of field ionisation and field evaporation. This resolution can be expressed by two parameters: the depth resolution and the lateral resolution, which have been shown to achieve, respectively, 0.06 and 0.2nm in an ideal case of a pure metal. By using this model and these values, the resolution along any crystallographic direction can be predicted. In addition, it is possible to predict the suitable sites of analysis where a given type of atomic planes can be resolved. Furthermore, it is shown that three types of planes with non-coplanar directions can be imaged in 3D reconstructed volumes. Thus, the reconstruction of the original tungsten lattice can be achieved with the use of Fourier Transform image analysis techniques. It is shown that the reliability of the method can be achieve the value of 90%.

Neuronal response to local electrical stimulation in rat thalamus: physiological implications for mechanisms of deep brain stimulation

High-frequency deep brain stimulation (DBS) of sensorimotor thalamus containing "tremor cells" leads to tremor arrest in humans with parkinsonian and essential tremor. To examine the possible underlying mechanism(s), we recorded in vitro intracellular responses of rat thalamic neurons to local intrathalamic stimulation. Such simulated DBS (sDBS) induced a sustained membrane depolarization accompanied by an increase in apparent membrane conductance in both motor and sensory neurons. With stimulation frequency above approximately 100 Hz, the sDBS-induced depolarization most typically led to repetitive neuronal firing or less frequently resulted in a complete blockade of action potential genesis. When regular intracellular current pulses were injected into cells to mimic "tremor" activity, such rhythmic discharges were invariably disrupted or abolished by the random spike firing induced during high-frequency sDBS. Low-frequency sDBS left rhythmicity unaffected.We conclude that clinical thalamic DBS may lead to a neuronal de-rhythmicity and tremor stoppage through masking and/or blocking rhythmic firing of tremor cells.

Au coeur de la vie: the Quebec Heart Health Dissemination Project

"Au coeur de la vie" is a research project which aims to evaluate the impact of a heart health dissemination program on primary and secondary prevention practices in local community clinics in the province of Quebec, Canada. Because the project starts in 2001 and no data has been collected to date this paper presents the theoretical model, the objectives of the program, the description of the dissemination procedures, and a brief overview of the evaluation.

Evidence against a major role of plasmalogens in the resistance of astrocytes in lactic acid-induced oxidative stress in vitro

Astrocytes are known to play a key role in buffering extracellular pH variations and, in addition, they are particularly resistant to oxidative stress and subsequent lipid peroxidation. This great resistance may be ascribed to the presence of high concentrations of certain antioxidants, but another explanation may be the presence of a high quantity of plasmalogens, which are a special group of glycerophospholipids characterized by a vinyl ether bond instead of an ester bond in the sn-1 position of the glycerol backbone. Plasmalogens are sensitive to free radical attack and acidity, and numerous works have supported the hypothesis that they may be antioxidant molecules that protect cells from oxidative stress. The aim of this work was to investigate, on astrocytes in lactic acid-induced oxidative stress (pH 5.5), the behavior of phospholipids and, in particular, plasmalogens. Two main techniques, based on the susceptibility of the vinyl ether bond to hydrolysis, were employed in this study to measure plasmalogen levels. In both cases, the sn-1 vinyl ether linkage was cleaved using mercuric chloride, producing a lysophospholipid that was assessed by phosphorus measurement or using HCl treatment, producing a long-chain fatty aldehyde assayed by gas chromatography/mass spectrometry. On astrocytes in culture, only plasmenylethanolamine (PlmEtn) was evidenced, representing 40% of glycerophosphoethanolamine lipids. When astrocytes were incubated with lactic acid, no modification in the amount of PlmEtn was seen. Furthermore, free aldehydes and aldehydes corresponding to the quantity of intact plasmalogens were similar to those observed on controls. In addition, the constancy of two lipid peroxidation markers, thiobarbituric acid reactive substances and polyunsaturated fatty acids, was clear evidence of the resistance of these cells in lactic acid conditions. In conclusion, our results fail to demonstrate a major role of plasmalogens in the resistance of astrocytes in lactic acid-induced oxidative stress.

Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation

BACKGROUND

A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay, Quebec. To address this problem, a diet and activity intervention during pregnancy, which was based on social learning theory, was initiated in 4 Cree communities.

METHODS

A prospective intervention compared dietary, weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy. A control period in 4 communities (July 1995-March 1996) was followed by an intervention period (April 1996-January 1997) when subjects were offered regular, individual diet counselling, physical activity sessions and other activities related to nutrition.

RESULTS

The intervention and control groups did not differ at baseline regarding their mean age (24.3 years [SD 6.29] v. 23.8 years [SD 5.86]), mean prepregnancy weight (81.0 kg [SD 19.46] v. 78.9 kg [SD 17.54]) and mean gestational age at recruitment (17.1 weeks [SD 7.06] v. 18.5 weeks [SD 6.92]). The intervention did not result in differences in diet measured at 24-30 weeks' gestation, rate of weight gain over the second half of pregnancy (0.53 kg per week [SD 0.32] v. 0.53 kg per week [SD 0.27]) or plasma glucose level (50 g oral glucose screen) between 24 and 30 weeks (7.21 mmol/L [SD 2.09] v. 7.43 mmol/L [SD 2.10]). Mean birth weights were similar (3741 g [SD 523] v. 3686 g [SD 686]), as was maternal weight at 6 weeks post partum (88.1 kg [SD 16.8] v. 86.4 kg [SD 19.0]). The only changes in dietary intake were a reduction in caffeine (pregnancy) and an increase in folate (post partum).

INTERPRETATION

This intervention had only a minor impact on diet; finding ways of encouraging appropriate body weight and activity levels remains a challenge.

The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood

OBJECTIVES

This study evaluated the impact of a 4-year, community-based cardiovascular disease prevention program among adults aged 18 to 65 years living in St-Henri, a low-income, innercity neighborhood in Montreal, Quebec.

METHODS

Awareness of and participation in the program were monitored in 3 independent sample telephone surveys. Self-reported behaviors were compared in St-Henri and a nearby comparison community before and after program implementation in both a 3-year repeat independent sample survey and a 5-year longitudinal cohort telephone survey.

RESULTS

Awareness of the program reached 37.4%, but participation was low (2%-3%). There were no secular declines in smoking or high-fat diet; physical inactivity increased in both communities. There were no statistically significant program effects detected in the independent sample surveys, although physical inactivity increased more in the comparison community than in St-Henri. In the longitudinal cohort sample, there was a small, statistically significant increase favoring St-Henri in frequency of cholesterol checkups.

CONCLUSIONS

Despite careful adaptation of the program to the local social context, there were few community-wide program effects. However, several component interventions showed promise in terms of community penetration and impact.

Prevalence and correlates of physical activity behaviors among elementary schoolchildren in multiethnic, low income, inner-city neighborhoods in Montreal, Canada

PURPOSE

To describe the prevalence and correlates of physical inactivity and of participation in organized sports at and outside school among elementary schoolchildren in multiethnic, low income, urban neighborhoods in Montreal, Canada.

METHODS

As part of the evaluation of a school-based heart health promotion program, baseline data on physical activity behaviors and potential correlates of these behaviors, were collected from 2285 students aged 9-13 in all 130 grade 4 to 6 classes in 24 inner-city elementary schools from May to June 1993.

RESULTS

One-fifth of boys (20.5%) and 24.4% of girls were inactive; 40.0% and 33.3% of boys and girls respectively, participated in school sports teams; 82.5% and 74.7% participated in organized sports outside school. Declines in activity levels with age were apparent in both genders. Children who participated in organized sports programs at and outside school, those with higher perceived self-efficacy for physical activity, and those with more parental support for engaging in physical activity were more active. Children of Asian family origin were less active. Socioeconomic status was related to participation in organized sports outside school.

CONCLUSIONS

To reach children in socio-economically disadvantaged areas and to prevent age-related declines in activity levels, interventions promoting physical activity should focus on increasing availability and access to community-based organized sports programs at and outside school. Also they should include components to increase parental support and to improve perceived self-efficacy for physical activity.

[Evaluative research on the distribution of health videocassettes destined for a disadvantaged Montreal population]

The present article describes the implementation and the evaluation of an intervention done in the context of a heart health community and multifactorial program. The intervention aimed to offer six videocassettes on cardiovascular health to a low-income and low-educated clientele through five video-clubs. All videoclubs (n = 5) from St. Henri/Petite Bourgogne agreed to distribute the videocassettes free of charge. Two components were examined: admissibility by videoclubs' owner and clientele's receptivity towards the intervention. Results showed that all videoclubs offered free display and service for the videocassettes. The article also presents a discussion of the feasibility and the possibilities to broaden this type of action.

[A cardiovascular health promotion program for 9-12 year old children and the community of Saint-Louis du Parc/Quebec]

This article presents a programme for cardiovascular health for 9 to 12 years old children, called "Healthy Heart" Saint-Louis du Parc and carried out in low socioeconomic and multiethnic part of Montreal, Quebec, Canada. These five years programme targets were more both spheres: school and community (leisure centre, ethnocultural centre, groceries and other places). We develop the objectives, the conceptual models underlying to the programme, the perspective of work, the infrastructure of the programme: its staff and financing, the partnerships and the structure organising. Then we present the various interventions carried out along the period and so a description of many evaluations. At last, we discuss about the programme continuation.

Prevalence and correlates of overweight among elementary schoolchildren in multiethnic, low income, inner-city neighbourhoods in Montreal, Canada

PURPOSE

Increased understanding of the early determinants of obesity is essential because of the increasing prevalence of obesity in many industrialized countries.

METHOD

As part of the evaluation of a school-based heart health promotion intervention, we measured height, weight, and triceps skinfold thickness at baseline in 2108 students aged 9-12 years (80.5% of eligible students) in 24 inner-city elementary schools located in multiethnic, low income neighbourhoods in Montreal, Canada. Data on student's socio-demographic and lifestyle characteristics were collected in classroom-administered questionnaires, and parents completed an at-home self-administered questionnaire.

RESULTS

Overall, 35.2% of boys and 33.0% of girls were overweight (> or = 85th age and gender-specific percentiles from NHANES 11, for body mass index and triceps skinfold thickness); 15.1% of boys and 13.3% of girls were obese (> or = 95th age and gender-specific percentiles for body mass index and triceps skinfold thickness). Younger age, having lived all one's life in Canada, and being of European or Central American/Caribbean family origin were independent correlates of obesity in boys. Younger age, ever smoked, mother obese and father obese were independent correlates of obesity in girls. Girls of Asian family origin were protected.

CONCLUSIONS

The very high prevalence of overweight students in this low income, multiethnic population suggests an important need for preventive intervention.

Correlates of the sustainability of community-based heart health promotion interventions

OBJECTIVES

This study investigated factors related to the perceived sustainability of 189 heart health promotion interventions initiated by a public health department or research initiative and implemented in a variety of organizations across Canada.

METHODS

Data were collected in a telephone survey of key informants from schools, restaurants, grocery stores, health care facilities, and sports facilities that had implemented a heart health promotion intervention (risk factor screening, courses for smoking cessation, healthy eating or physical activity, support groups to promote healthy lifestyles, environmental modification, dissemination of information) in the past 8 years.

RESULTS

Overall, 43.6% of 189 interventions were perceived to be very permanent, 34.8% were somewhat permanent, and 21.5% were not permanent. Independent correlates of perceived sustainability included intervention used no paid staff (odds ratio (OR) 95% confidence interval (95% Cl) = 3.7 (1.8, 7.5)), intervention was modified during implementation (OR (95% Cl) = 2.7 (1.4, 5.0)), there was a good fit between the local provider and the intervention (OR (95% Cl) = 2.4 (1.2, 5.0)), and there was the presence of a program champion (OR (95% Cl) = 2.3 (1.2, 4.4)).

CONCLUSION

Consideration of these factors by health promotion program planners could increase the potential for sustainability of health promotion interventions implemented in the community.

[Evaluative research on the distribution of health videocassettes destined for a disadvantaged Montreal population]

The present article describes the implementation and the evaluation of an intervention done in the context of a heart health community and multifactorial program. The intervention aimed to offer six videocassettes on cardiovascular health to a low-income and low-educated clientele through five video-clubs. All videoclubs (n = 5) from St. Henri/Petite Bourgogne agreed to distribute the videocassettes free of charge. Two components were examined: admissibility by videoclubs' owner and clientele's receptivity towards the intervention. Results showed that all videoclubs offered free display and service for the videocassettes. The article also presents a discussion of the feasibility and the possibilities to broaden this type of action.

Sputum eosinophilia is more closely associated with airway responsiveness to bradykinin than methacholine in asthma

Hyperresponsiveness of the airways to various spasmogenic stimuli is a characteristic feature of bronchial asthma. However, the association between the different stimuli to which asthmatic airways are hyperresponsive and airways inflammation is not completely understood. We have investigated the relationship between airway inflammation and airway hyperresponsiveness in asthma, as assessed by bronchoprovocation tests to methacholine and bradykinin, two well defined bronchoconstrictor agonists. Sputum induction by hypertonic saline and methacholine and bradykinin challenges were performed in 14 nonsmoking subjects with mild-to-moderate asthma. Airway responsiveness to either agonist did not correlate with sputum neutrophils, lymphocytes, and macrophages. Whilst the absolute number of eosinophilia failed to be significantly related to methacholine responsiveness (r=-0.47; p=0.09), it correlated markedly and significantly with provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (r=0.72; p<0.01). When expressed as % of total cell counts, sputum eosinophils correlated with both types of responsiveness (r=-056; p=0.04 and r=-0.76, p<0.001, respectively). Although the concentration of eosinophil cationic protein (ECP) in the sputum correlated with the absolute numbers of eosinophils (r=0.62; p<0.02), no correlation was found between ECP levels and the airway responsiveness to any of the agonists tested. In subjects with mild-to-moderate asthma, airway responsiveness to bradykinin is more strongly associated with the magnitude of eosinophilic inflammation in the airways than methacholine. This finding underlines the selectivity of diverse agonists in assessing airway hyperresponsiveness and cellular inflammation in asthma.

One-year predictors of smoking initiation and of continued smoking among elementary schoolchildren in multiethnic, low-income, inner-city neighbourhoods

OBJECTIVE

To identify one-year predictors of smoking initiation among never-smokers, and of continued smoking among ever-smokers.

DESIGN

Two sequential cohorts of grade 4 and 5 children. Data were collected as part of Coeur en sante St Louis du Parc, a non-randomised controlled trial to evaluate the impact of a school-based heart health promotion programme.

SETTING

24 inner-city elementary schools located in multiethnic, low-income neighbourhoods in Montreal.

SUBJECT

1824 schoolchildren aged 9-12 years with baseline and one-year follow-up data.

MAIN OUTCOME MEASURES

Changes in smoking behaviour over a year; the ability of baseline data to predict smoking initiation and continued smoking a year later was investigated in logistic regression analyses.

RESULTS

The prevalence of ever-smoking was 21.1% at baseline and 30.2% at one-year follow up. One in six never-smokers initiated smoking; one in three ever-smokers continued smoking. Predictors of initiation included age (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.3 to 2.0), male gender (OR = 1.5 (95% CI = 1.1 to 2.0)), friends who smoke (OR = 2.3 (95% CI = 1.7 to 3.3)), sibling(s) who smoke (OR = 1.9 (95% CI = 1.2 to 3.1)), father/mother who smokes (OR = 2.2 (95% CI = 1.6 to 3.0)), and frequent high fat/"junk food" consumption (OR = 1.6 (95% CI = 1.1 to 2.1)). Age and friends who smoke were also independent predictors of continued smoking in both genders. In addition, in boys, current smokers at baseline were 2.6 times (95% CI = 1.4 to 5.0) more likely to continue smoking than past smokers. In girls, being overweight was associated with continued smoking (OR = 3.5 (95% CI = 1.6 to 7.6)).

CONCLUSIONS

Smoking prevention programmes should address parental and sibling influences on smoking, in addition to refusal skills training. Among girls, weight-related issues may also be important.

Prevalence and correlates of early smoking among elementary schoolchildren in multiethnic, low-income inner-city neighborhoods

PURPOSE

The prevalence and correlates of early smoking were investigated among schoolchildren in grades 4-6 living in multiethnic, low-income neighborhoods in Montreal.

METHODS

As part of the evaluation of a school-based heart health promotion program, baseline data on the prevalence of early smoking were collected from 2285 students aged 9-13 years in 24 inner-city elementary schools during May-June 1993.

RESULTS

Overall, 28.7% of boys and 20.3% of girls had smoked. Girls began trying later than boys, but by age 13 the prevalence of experimental or regular smoking by girls overtook that of boys. Univariately, ever smoking varied considerably by family origin, from 2.1% among Vietnamese girls, to 35.8% among Portuguese boys. In multivariate analysis, age, perceived smoking habits of friends, and smoking by family members, were strong correlates of smoking. Being of Asian family origin was negatively associated with smoking. None of the indicators of social class were significantly associated with ever smoking.

CONCLUSIONS

Smoking prevention should begin with children even younger than age 9 in multiethnic, low-income, inner-city neighborhoods. With the exception of a lower prevalence of smoking among Asian children, ethnicity and social class were not strong influences on early smoking behavior in this population.

[Evaluation of the implementation of an educational curriculum: optimal interventions for the adoption of an educational program of health in elementary schools]

A multiple case study design is used to explain the level of implementation of a "Heart Health" curriculum by grade four teachers of eight schools in a Montreal multiethnic and underprivileged district. An interview and logbook examine the following variables: 1) personal characteristics of the teachers; 2) organizational characteristics of the schools; 3) characteristics of the program; 4) collaboration between the health and educational sectors; and 5) curriculum level of use and fidelity of implementation. The results show in particular that the personal characteristics of the teachers and the characteristics of the program explain the level of implementation of the Heart Health curriculum.

The "Yes, I Quit" smoking cessation course: does it help women in a low income community quit?

The objectives were to evaluate the impact of "Yes, I Quit" (a smoking cessation course tailored for women in a low income, low education community), and to identify baseline predictors of short and longer-term self-reported cessation. The impact was evaluated in a before-after study design with no comparison group. Baseline data were collected in self-administered questionnaires at the beginning of the first session of the course. Follow-up data were collected in telephone interviews at one, three and six months after the designated Quit Day. Self-reported quit rates among 122 participants were 31.1%, 24.7% and 22.3% at one, three and six months. Non-quitters reduced their consumption by 10.3, 8.3, and 7.1 cigarettes per day at one, three and six months. Multivariate logistic regression analyses showed that being in excellent/good health was significantly associated with cessation at one month (odds ratio (OR) = 2.4). Being married (OR = 13.0) and no other smokers in the household (OR = 3.6) were associated with three-month cessation. Only being married was associated with six-month cessation (OR = 6.8). "Yes, I Quit" produced quit rates among low income, low education participants comparable to those reported for cessation programs directed at the general population of smokers. Good health is associated with early cessation, while support from a spouse is important to maintaining a non-smoking status among quitters.

[Study of parental participation in curricular and extracurricular activities]

This preliminary study of parental participation in curricular and extra-curricular activities was conducted in the general framework of the healthy heart project in St. Louis du Parc, an underprivileged and multiethnic neighbourhood in Montreal. A general understanding of this type of participation is essential in order to adapt the role parents play in health programs developed in conjunction with the school. A conceptual framework was developed to help understand how and why parents of primary school children participate in school activities. Qualitative analysis of 15 semi-directed interviews conducted with various schools and other organizations revealed those obstacles to parental involvement, and the factors that encourage parents to participate. It was clear that there were wide social and cultural gaps between parents and schools. An important factor is how people perceive those barriers. Teachers stressed organizational and language communications difficulties. Others pointed to the lack of knowledge of the community, to poor communications skills and the parents' lack of those skills that would allow them to participate actively. A more open-minded attitude by school authorities and a more proactive and positive attitude of teachers toward parents are essential requirements, but not the only ones. Further interviews with parents should help provide more details and information.

[Evaluation of the implementation of an educational curriculum: optimal interventions for the adoption of an educational program of health in elementary schools]

A multiple case study design is used to explain the level of implementation of a "Heart Health" curriculum by grade four teachers of eight schools in a Montreal multiethnic and underprivileged district. An interview and logbook examine the following variables: 1) personal characteristics of the teachers; 2) organizational characteristics of the schools; 3) characteristics of the program; 4) collaboration between the health and educational sectors; and 5) curriculum level of use and fidelity of implementation. The results show in particular that the personal characteristics of the teachers and the characteristics of the program explain the level of implementation of the Heart Health curriculum.

[Institutionalization of community programs: review of theoretical models and proposal of a model-]

Community-based health promotion programs to change lifestyle habits must remain in their host organizations for extended periods of time in order to have impact. Their effectiveness can be closely linked to their long term viability or institutionalization. To remain viable, these programs must survive beyond initial investment and support by external organizations. However, some programs disappear when external investment is withdrawn. This can be costly and in addition can generate resistance to the implementation of other health promotion programs in the future. Recently, interest in the processes involved in the institutionalization of these programs has increased. Based on 28 publications, this article reviews selected conceptual models that highlight environmental, organizational, community and marketing-related, variables possibly related to the institutionalization process. A new model is proposed to link these diverse models according to: characteristics of the program, characteristics of the host organization, characteristics related to the adoption, implementation and incorporation of the program, and finally characteristics related to the fit (mutual adjustment) between the host and the program.

Reliability of proxy reports of parental smoking by elementary schoolchildren

PURPOSE

To investigate the reliability of reports of parental smoking by elementary schoolchildren aged 9-13 years, and to identify the correlates of disagreement between student proxy and parent self-reports.

METHODS

As part of the evaluation of a school-based heart health promotion program, data on parental smoking status were collected from 1240 student-mother pairs and 898 student-father pairs.

RESULTS

Agreement for parental smoking status was 93.1% among student-mother pairs and 86.4% among student-father pairs. Among student-mother pairs, reports by students aged 9 years were more likely to disagree with mothers' self-reports than those of older children (odds ratio (OR) = 3.1). Among student-father pairs, the only significant correlate of disagreement was living in a single-parent family headed by the mother (OR = 2.6).

CONCLUSIONS

Children 10-years or older can provide reliable reports of the smoking status of cohabiting parents.

[Study of parental participation in curricular and extracurricular activities]

This preliminary study of parental participation in curricular and extra-curricular activities was conducted in the general framework of the healthy heart project in St. Louis du Parc, an underprivileged and multiethnic neighbourhood in Montreal. A general understanding of this type of participation is essential in order to adapt the role parents play in health programs developed in conjunction with the school. A conceptual framework was developed to help understand how and why parents of primary school children participate in school activities. Qualitative analysis of 15 semi-directed interviews conducted with various schools and other organizations revealed those obstacles to parental involvement, and the factors that encourage parents to participate. It was clear that there were wide social and cultural gaps between parents and schools. An important factor is how people perceive those barriers. Teachers stressed organizational and language communications difficulties. Others pointed to the lack of knowledge of the community, to poor communications skills and the parents' lack of those skills that would allow them to participate actively. A more open-minded attitude by school authorities and a more proactive and positive attitude of teachers toward parents are essential requirements, but not the only ones. Further interviews with parents should help provide more details and information.

[Transition of the roles and mandates of public health professionals]

There is a call for a new intervention paradigm that integrates all dimensions of physical, political and economic environments that might impact on health. The Ottawa Charter, the Global Plan for Health Promotion and the Health and Welfare Policy to mention a few, suggest that public health agents broaden their roles and their mandates. From health educators, they are now being asked to not only continue to favour the development of personal skills, to help create supporting environments, to reorient health services, to reinforce community action, as well as elaborate health public policies but to also become consensus builders towards this new paradigm. This article discusses the transition of the role and mandate of the individual health professional. In order to do so, the article traces the practice of the health professional beginning at the end of the 1970's and compares it to that of 1996 looking at the following dimensions: roots, objectives, place of activity, favoured strategies and approaches. Furthermore, it will try to identify new obstacles in health promotion. Finally, it will underline the new challenges for public health near the year 2000.