The Signature Biobank: A longitudinal biopsychosocial repository of psychiatric emergency patients

The Signature Biobank is a longitudinal repository of biospecimen, psychological, sociodemographic, and diagnostic data that was created in 2012. The Signature Consortium represents a group of approximately one hundred Quebec-based transdisciplinary clinicians and research scientists with various expertise in the field of psychiatry. The objective of the Signature Biobank is to investigate the multi-faceted underpinnings of psychiatric disorders among patients in crisis. The Signature Consortium is expanding and includes new active members that seek to highlight the contributions made by Signature Biobank since its inception. This article details our research protocol, directions, and summarizes contributions. To date, we have collected biological samples (n = 1,986), and questionnaire data (n = 2,085) from psychiatric emergency patients of the Institut universitaire en santé mentale de Montréal (Quebec, Canada), with a large proportion from whom both data types were collected (n = 1,926). In addition to this, a subsample of patients was followed-up at hospital discharge, and two additional outpatient clinic appointments (n = 958 with at least one follow-up). In addition, a socio-demographically matched comparison group of individuals who were not hospitalized for psychiatric disorders (n = 149) was recruited from the surrounding catchment area. To summarize, a systematic review of the literature shows that the Signature Biobank has contributed to better characterizing psychiatric comorbidities, biological profiles, and psychosocial functioning across some of the most common psychiatric disorders, including psychosis, mood, anxiety, and substance use disorders. The Signature Biobank is now one of the world's largest repositories of data collected from patients receiving care at a psychiatric emergency unit.

La economía poskeynesiana, ¿un pensamiento heterodoxo desconocido?

<p>La teoría poskeynesiana es una de las numerosas escuelas de pensamiento heterodoxas en economía. En sus estudios sobre crecimiento y productividad, tiene varias similitudes con la teoría francesa de la regulación, que en Quebec y fuera de Francia es sobre todo conocida en los departamentos de ciencias políticas. En lo que toca a la teoría de precios y empresa, así como en la investigación del mercado laboral, se inspira en gran medida en el trabajo de economistas institucionalistas, tanto de Estados Unidos (EU), como del Reino Unido. Se hace una breve historia del surgimiento de la teoría poskeynesiana. Después, se evocará las principales características de la economía poskeynesiana.</p><div> </div>

Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study

OBJECTIVES

To evaluate the relationship between individual bacterial and viral pathogens and disease severity.

METHODS

Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up).

RESULTS

Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease.

CONCLUSIONS

In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.

Cognitive psychophysiological treatment of bodily-focused repetitive behaviors in adults: An open trial

BACKGROUND

Body-focused repetitive behaviors (BFRBs), such as hair pulling, skin picking, and nail biting, are repetitive, destructive, and nonfunctional habits that cause significant distress. Separate BFRBs form a cohesive group and could be assessed as part of the Tourette/tic spectrum or obsessive-compulsive spectrum of disorders. The treatment of choice is either antidepressant or behavioral treatment, both of which have shown effectiveness. The cognitive psychophysiological (CoPs) model focuses on the tension and emotional build up that triggers habits by addressing cognitive-behavioral, emotional and psychophysiological processes preceding onset rather than the habit itself. The CoPs approach has already shown efficacy in treatment of tic and Tourette disorder.

OBJECTIVE

The aim of the current open trial was to view whether BFRBs can be validly assessed on a standard tic scale (Tourette Symptom Global Scale; TSGS) and evaluate the efficacy of the CoPs intervention on 64 participants (54 completers) with 1 of 3 subtypes of BFRBs (hair pulling, nail biting, and skin picking) compared to a waitlist control.

METHOD

Participants were assessed at baseline on an adapted TSGS and after receving 14 weeks of CoPs therapy with six months follow up.

RESULTS

The TSGS was reliably and validly adapted to measure BFRBs. The CoPs intervention was effective for all BRFB subtypes with a large effect size (intention-to-treat g = 1.54; completers g = 2.04), with 74% of patients showing clinically significant improvement. Mood and self-esteem also improved posttreatment. The decrease in symptoms was maintained at the 6-month follow-up, with a further decrease in perfectionism.

CONCLUSION

BFRBs can be reliably assessed as a tic spectrum disorder rather than as part of the obsessive-compulsive spectrum. The CoPs model may offer a complementary treatment for BFRBs.

Evaluation of a cognitive psychophysiological model for management of tic disorders: an open trial

BACKGROUND

Tic disorders, in particular chronic tic disorder and Tourette syndrome, affect about 1% of the population. The current treatment of choice is pharmacological or behavioural, addressing tics or the premonitory urges preceding tic onset.

AIMS

The current study reports an open trial evaluating the effectiveness of a cognitive psychophysiological treatment addressing Tourette-specific sensorimotor activation processes rather than the tic.

METHOD

Forty-nine people with Tourette syndrome and 36 people with chronic tics completed 10 weeks of individual cognitive psychophysiological therapy. Outcome measures included two tic severity scales and psychosocial measures.

RESULTS

Post-treatment both groups had significantly improved on the tic scales with strong effect sizes across tic locations and complex and simple tics, maintained at 6-month follow-up with further change in perfectionism and self-esteem.

CONCLUSIONS

The cognitive psychophysiological approach targeting underlying sensorimotor processes rather than tics in Tourette's and chronic tic disorder reduced symptoms with a large effect size.

Evidence that oxidative stress is higher in replacement gilts than in multiparous sows

The recent success obtained in term of increasing the litter size of sows has not correlated with a reduction of replacement rate. There is thus an increased economic demand for gilts with optimal reproductive potential and longevity. Unfortunately, replacement gilts are known to be more susceptible to diseases and less productive than multiparous sows. Interestingly, reproductive performance, resistance to diseases and longevity could all be largely affected by oxidative stress. To investigate whether oxidative stress conditions could account for the poor longevity of gilts, three distinct groups of conventional Yorkshire × Landrace sows were formed based on their similar age and parity (gilts, second parity sows as well as fourth to fifth parity sows). All animals were slaughtered during the post-ovulatory period, and blood as well as tissue samples were collected. Biomarkers of oxidative damage to proteins (carbonyls) and DNA (8-OHdG) were analysed in samples. Specific mRNA expression of major antioxidants such as glutathione peroxidases 1, 3 and 4 (GPx1, GPx3, GPx4) as well as superoxide dismutases 1 and 2 (Sod1, Sod2) were monitored in liver and kidney samples by quantitative RT-PCR. Specific enzymatic activities of both GPx and SOD were measured by spectrophotometric assays. The plasma concentration of protein carbonyls was significantly different between the three groups with the highest concentration being observed in gilts (p ≤ 0.001). The mRNA expression levels of GPx1 and GPx4 were also significantly increased in the liver of gilts when compared to multiparous sows (p ≤ 0.05). SOD2 enzymatic activity was found to be higher in the liver of gilts than multiparous sows (p ≤ 0.05). Taken together, these results indicate that replacement gilts sustain significantly higher oxidative conditions than multiparous sows. Current findings may contribute to the design of nutritional regimens that will increase the productivity of gilts by counteracting oxidative stress.

Active and safe transportation of elementary-school students: comparative analysis of the risks of injury associated with children travelling by car, walking and cycling between home and school

INTRODUCTION

Elementary school active transportation programs aim to address physical inactivity in children by prompting a modal shift from travel by car to walking or cycling among children living a distance from school conducive to walking or cycling. The objectives of this study are to evaluate the risk of injury related to walking, cycling and travelling by car between home and school among elementary-school students in the Montréal area and to evaluate the impact on number of injuries of a modal shift from travel by car to walking or cycling.

METHODS

The risk of injury was estimated for the 2003-2007 period by calculating the average annual rate of injury in children aged 5 to 12 years walking, cycling or being driven in a car, per 100 million kms travelled during the normal hours of travel between home and school. The impact of a modal shift from travel by car was evaluated for children living a distance from school conducive to walking and cycling (under 1.6 km), that is, the targets of active transportation programs. This evaluation was done using the regional rate of injury calculated for each travel mode.

RESULTS

Between 2003 and 2007, an average of 168 children aged 5 to 12 years were injured each year while walking (n = 64), cycling (n = 28) and being driven in a car (n = 76) during the normal hours of travel between home and school in the Montréal area. The rate of injury was 69 children injured per 100 million kms for travel by car (reference group), 314 pedestrians (relative risk [RR] = 4.6; 95% confidence interval [CI]: 4.3-5.1) and 1519 cyclists (RR = 22.2; 95% CI: 14.3-30.0). A shift of 20% in the distance travelled by car to walking by children living less than 1.6 km from their school is estimated to result in an increase of 2.2% (n = 3.7) in the number of children injured each year in the area. In the case of a shift to cycling, the number of resulting injuries is estimated to be 24.4, an increase of 14.5%.

CONCLUSION

The risk of injury among elementary-school students during the normal hours of travel between home and school is higher for walking and cycling than for travel by car, and cyclists are at greater risk of injury than pedestrians. A modal shift from travel by car would increase the number of children injured in the area (minor injuries, for the most part) if no action were taken to reduce the risk of injury to pedestrians and cyclists.

Meta-cognitions in tourette syndrome, tic disorders, and body-focused repetitive disorder

OBJECTIVE

To explore if self-reported presence of thinking about tics or body-focused repetitive behaviours (BFRBs; gests) are direct triggers of tic or gest onset in 3 groups: Tourette syndrome (TS; n =18), persistent chronic tic disorders (TDs; n = 42), and a comparison group with BFRB (n = 36).

METHOD

The 3 groups completed a thinking about tics inventory, listing 22 items derived from clinician consensus that asked whether thoughts always, sometimes, or never exclusively triggered tic onset. Other questionnaires measured mood, perfectionism, impulsivity, premonitory urge, and self-rated tension. Sixty-three participants completed the inventory twice, and the inventory was completed pre- and post-behavioural intervention by a further 54.

RESULTS

The ranking of the thoughts reported as likely to trigger tics or gests was positively correlated across TD and BFRB groups. Exploratory principal components analysis of a reduced 12-item set (the thinking about tics inventory) in TS and TD groups revealed that such thoughts could be grouped into 3 separate subscales: thoughts about the interference of tics or gests, thoughts anticipating tics or gests, and thoughts about whether the person has permission to perform the tic or the gest. The 3 sets of subscales showed good and acceptable internal consistency and overall score showed good test-retest reliability, suggesting thoughts about tics or gests are robust and measurable. The subscales correlated with impulsivity, tic or behaviour severity, and ratings of frequency decreased post-behavioural treatment.

CONCLUSIONS

Thinking about tics or gests is reported as triggering tics or gests in both TD and BFRB, and meta-cognition seems independent of premonitory sensations and relates to distinct clinical characteristics in each clinical group.

Inference-based therapy for body dysmorphic disorder

Body dysmorphic disorder (BDD) is a debilitating disorder characterized by an excessive pre-occupation with an imagined or very slight defect in one's physical appearance. Despite the overall success of cognitive behavioural therapy (CBT) in treating BDD, some people do not seem to benefit as much from this approach. Those with high overvalued ideation (OVI), for instance, have been shown to not respond well with CBT. The purpose of this study was to evaluate the efficacy of an inference-based therapy (IBT) in treating BDD. IBT is a cognitive intervention that was first developed for obsessive-compulsive disorder with high OVI, but whose focus on beliefs can also apply to a BDD population. IBT conceptualizes BDD obsessions (e.g., 'I feel like my head is deformed') as idiosyncratic inferences arrived at through inductive reasoning processes. Such primary inferences represent the starting point of obsessional doubt and the treatment focuses on addressing the faulty inferences that maintain the doubt. Thirteen BDD participants, of whom 10 completed, underwent a 20-week IBT for BDD. The participants improved significantly over the course of therapy, with large diminutions in BDD and depressive symptoms. OVI also decreased throughout therapy and was not found to be related to reduction in BDD symptoms. Although a controlled-trial comparing CBT with IBT is needed, it is proposed that IBT constitutes a promising treatment alternative for BDD especially in cases where OVI is high.

Cognitive behavioral management of Tourette's syndrome and chronic tic disorder in medicated and unmedicated samples

OBJECTIVE

Cognitive behavior therapy (CBT) and medication can be administered in combination in treating tic disorders but there are no studies evaluating the effectiveness of CBT with and without medication. The current study compares the efficacy of CBT in combination with medication and without medication.

METHOD

CBT was administered in a consecutively referred sample of 76 people diagnosed either with Gilles de la Tourette Syndrome or chronic tic disorder. The sample was divided into a medicated and a non-medicated group. Twenty three were stabilized on medication and 53 were not receiving medication. Measures administered pre- and post-CBT in both groups included: main outcome measure of Tourette Syndrome Global Scale and measures of mood.

RESULTS

Repeated measures analysis of variance on the initial sample revealed no difference between medicated and non-medicated groups in outcome. A further analysis comparing the 23 receiving medication with 23 not receiving medication matched on baseline clinical variables also yielded no significant group differences, either in treatment outcome on main tic outcome measures or on other clinically relevant questionnaires.

DISCUSSION

CBT for tic disorders is an effective treatment administered either in combination with medication or alone.

The effect of fire frequency on local cembra pine populations

It has been predicted that global climate change will lead to increasing drought in the Alps during the 21st century, as well as an increased fire risk, fires being currently rare in these mountains. Herein we describe fire frequency reconstruction using high-resolution analyses of macroscopic sedimentary charcoal, pollen, and plant macrofossils. Sediments were sampled from a subalpine pond within the dry western French Alps. Results show that the early-Holocene expansion of Pinus cembra (7200 calibrated years BP) occurred in Acer/Alnus incana/Betula woodlands, which were affected by fires with moderate mean fire-free intervals (MFFI = 173 +/- 61 yr [mean +/- SE]). Superposed Epoch Analyses show that the abundance of P. cembra macroremains decreased significantly after burning, although they never disappeared entirely. Statistics suggest that fires spread through cembra pine communities; they were not stand-replacing fires but mainly surface fires, probably killing nonreproductive pines. An increase in fire frequency occurred 6740 years ago, when four fires appear to have occurred within 140 years. These fires may have been associated with a regional drought and could have affected the composition of the subalpine forest by depleting the local P. cembra population in the short-term. The predicted increase in drought in the future could, therefore, affect the cembra pine ecosystem in the Alps if fire frequency is reduced to intervals of less than 80 years.

Record of metal workshops in peat deposits: history and environmental impact on the Mont Lozère Massif, France

This study aims to document the history of the metallurgical activities on the Mont Lozère massif in the Cévennes Mountains in Southern France. Many medieval sites of metallurgical wastes (slags) have been reported on the massif. These sites are thought to represent ancient lead workshops. The impact of past metallurgical activity on the environment was studied using geochemical and palynological techniques on a core collected in the Narses Mortes peatland near medieval smelting area. Two main periods of smelting activities during the last 2200 years were revealed bythe lead concentration and isotopic composition along the core profile: the first period corresponds to the Gallic period (approximately ca. 300 B.C. to ca. 20 A.D.) and the second one to the Medieval period (approximately ca. 1000-1300 A.D.). Forest disturbances are associated with lead anomalies for the two metallurgical activities described. The impact of the first metallurgy was moderate during the Gallic period, during which beech and birch were the tree species most affected. The second period corresponds to the observed slag present in the field. Along with agropastoral activities, the medieval smelting activities led to the definitive disappearance of all tree species on the summit zones of Mont Lozère. The abundance of ore resources and the earlier presence of wood on the massif justify the presence of workshops at this place. The relationship between mines and ores has been documented for the Medieval period. There is no archaeological proof concerning the Gallic activity. Nevertheless, 2500-2100 years ago, the borders of the Gallic Tribe territory, named the Gabales, were the same as the present-day borders of the Lozère department. Julius Caesar reported the existence of this tribe in 58 B.C. in "De Bello Gallico", and in Strabon (Book IV, 2.2) the "Gabales silver" and a "treasure of Gabales" are mentioned, but to this day, they have not been found.

Conformational changes of pediocin in an aqueous medium monitored by fourier transform infrared spectroscopy: a biological implication

Fourier transform infrared (FTIR) spectroscopy was used to investigate the secondary structure of pediocin PA-1 in different aqueous media in relation to its antimicrobial activity. The experiments were performed at pD (pH meter corrected for deuterium isotope effect) 6, 7, and 8 and during a heating-cooling cycle of 20-80 degrees C. At pD 6, (i.e. pediocin's most active form), the FTIR results show that pediocin adopts an unordered structure with a small contribution of beta-turn. After a heating-cooling cycle, thermally-induced changes in pediocin are reversed and its activity is maintained. Increasing the pD to 7 and 8 leads to a more ordered secondary structure. For these two pD values, an increase in temperature induces an irreversible aggregation of protein as revealed by the amide I' band. The analysis of the Tyr region provides more insight into the aggregation process. In fact, it appears to be a two-step process, involving first the C (carboxy)-terminus of pediocin and then the N (amino)-terminus. This study reveals two major points: (1) the preservation of pediocin flexibility is essential for maintaining its activity; and (2) the aggregation of its C-terminus is sufficient to induce a loss of activity, suggesting that this region plays an important role in the activity of pediocin.

Inferred effects of cloud deposition on forest floor nutrient cycling and microbial properties along a short elevation gradient

Cloud water deposition often increases with elevation, and it is widely accepted that this cloud water increases acid loading to upland forest ecosystems. A study was undertaken in south-eastern Quebec to determine if a 250 m elevation gradient (i.e. 420-665 m), along a uniform sugar-maple stand on the slope of Mount Orford, corresponded to a pH gradient in the forest floor and to predictable changes in soil nutrient availability and microbial properties. Precipitation data from a nearby study, and a photographic survey, provided presumptive evidence that this elevation gradient corresponded to a strong gradient in cloud water deposition. Forest floor temperature did not differ significantly across elevations. Forest floor moisture content was significantly higher, whereas pH and exchangeable Ca and Mg were significantly lower, at the higher elevations. Average seasonal net nitrification rates, determined by long-term laboratory incubations, did not differ significantly across elevations, whereas average seasonal net ammonification rates were significantly higher at higher elevations. Basal respiration rates and microbial biomass did not differ significantly across elevations, but metabolic quotient was significantly higher at higher elevations indicating possible environmental stress on forest floor microbial communities due to cloud water deposition. Anaerobic N mineralisation rates were significantly higher at higher elevations suggesting that N-limited microbial communities frequently exposed to cloud cover can be important short-term sinks for atmospheric N, thereby contributing to increase the active-N fraction of forest floors. We conclude that, where no significant changes in vegetation or temperature occur, elevation gradients can still be used to understand the spatial variability of nutrient cycles and microbial properties.

The storage of household long guns: the situation in Quebec

This survey on the storage of household firearms in Quebec was conducted in 1994. At that time, 35% (175/504) of survey participants who kept long guns in their homes had failed to comply with Canadian firearm storage regulations. In most cases (85%; n=149), this was because at least one stored long gun was found to be both operable and accessible. Thirty-seven per cent of participants stated that no one, including themselves, had used their firearm(s) in the 12 months preceding the survey. These findings point to two possible ways of dealing with long guns kept in the home: render these weapons inoperable or inaccessible, which would increase the level of compliance with the regulations, and dispose of those no longer in use. The results of this survey have never been published before, and constitute the only information of this kind with respect to Quebec.

Concussions in athletes produce brain dysfunction as revealed by event-related potentials

We have used event-related potentials (ERP) to assess cerebral activity following mild traumatic brain injuries in 20 college athletes practising contact sports. Concussion victims showed a striking decrease in P300 amplitude, an effect presumed to reflect alterations in attentional-cognitive processes. Moreover, the degree of impairment was strongly related to the severity of post-concussion symptoms. Our data suggest that concussions cause objectively measurable changes in the electrophysiological markers of brain activity and hence in the functions of the structures from which they originate. ERPs may thus constitute a reliable method to accurately monitor the clinical course and recovery of head injuries in athletes.

The attitude of Canadian nurses towards advance directives

This article seeks to shed light on the beliefs that influence nurses' intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses' beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients' wishes, nurses should be aware that they do not systematically guarantee respect of a patient's autonomy, nor do they replace a relationship based on trust between patients and health care professionals.

Understanding the use of a community-based drive-home service after alcohol consumption among young adults

To know and understand the intention of young adults to use, during the Christmas and New Year's period, the community drive-home service after drinking alcohol, that is, to phone for oneself when they are the driver or when they are the passenger to suggest to a friend who is the driver to phone for the service. This study was conducted in the Province of Quebec, Canada, among a representative sample of 544 young adults aged 18 to 24 years. Self-administered questionnaires were completed by mail. Young adults showed a very good knowledge of the drive home service and had a very positive attitude toward its use. Among those who reported having experienced drinking too much alcohol during the Christmas and New Year's period, 17 percent had phoned when they were the driver and 36 percent had, when they were a passenger, suggested to a friend who was the driver to phone the community drive-home service. Nonetheless, more than half of them intended to use or to recommend its use to a friend in the future. Several factors identified in this study might be useful for increasing this drive-home service and therefore, contribute to lowering the risk of injury related to alcohol-impaired driving among young adults.

Respiratory nematodiases in raptors in Quebec

This is a retrospective study on wild raptors submitted to the Université de Montréal (Quebec, Canada) from 1989 to 1996. Cyathostoma spp. (Nematoda: Syngamidae) adults and/or eggs were found in air sacs, lungs, bronchi, and trachea of 12 raptors (Falconiformes and Strigiformes) from Quebec, Canada, belonging to eight different species, five of which are first host records for this parasite: barred owl (Strix varia), snowy owl (Nyctea scandiaca), northern harrier (Circus cyaneus), northern goshawk (Accipiter gentilis), and broad-winged hawk (Buteo platypterus). The infection was considered fatal in four birds, while no significant clinical signs were observed in the other cases. Major pathologic changes included diffuse pyogranulomatous air sacculitis, pneumonia, and bronchitis. A few unidentified larval nematodes embedded in a granuloma were found in the lungs of an additional Coopers' hawk (Accipiter cooperii); they were not considered clinically significant. A dead nematode, surrounded by necrotic inflammatory cells, was found in the air sac of a northern goshawk. The presence of nematodes in air sacs or lungs should be considered in wild raptors demonstrating respiratory problems.

Comparison of patients' and health care professionals' attitudes towards advance directives

OBJECTIVES

This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent.

DESIGN

Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension.

SETTING

Health care institutions in the province of Québec, Canada.

SURVEY SAMPLE

The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions.

RESULTS

Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes.

CONCLUSION

More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy.

Delayed recall in dementia: sensitivity and specificity in patients with higher than average general intellectual abilities

OBJECTIVE

Distinguishing early dementia from normal aging is especially difficult in patients with higher than average intellectual abilities. To find signs useful in determining that the elderly "worried and well" are not in an early phase of dementia, we compared the neuropsychological test performance of demented patients, patients who were not found to be demented, and control subjects.

METHOD

A retrospective study of neuropsychological test results from persons over 50 years of age who had an age-adjusted verbal intelligence quotient (VIQ) greater than or equal to 110. Analysis of covariance (using age and education as covariates) was used to compare the normal, no dementia, and dementia groups. Significant differences were further analyzed using Tukey's post hoc procedure. Tests on which the three groups differed at ap < 0.01 level were included in multivariate analyses.

RESULTS

The no dementia patient group performed at functional levels comparable to those of the control group. By contrast, patients with dementia showed significant impairment on tests of memory, naming, and visuospatial function compared with both the control and no dementia groups. Immediate and delayed paragraph recall classified groups with a 96% specificity and 80% sensitivity in the multivariate discriminant analysis.

CONCLUSIONS

These results suggest that in patients with higher than average intelligence, the absence of a significant dementing process (as well as its presence) can be determined with reasonable probability.

Low-grade papillary adenomatous tumors of the temporal bone: report of two cases and review of the literature

Two cases of tumors of the posterior portion of the petrous bone are presented. Both resulted in significant loss of hearing and caused extensive bone destruction. Microscopically, they corresponded to papillary adenomatous tumors with few histologically aggressive features. Immunohistochemical studies were done, and a positive reaction was obtained with the antibodies against the cytokeratins, Leu-7 and neuronal-specific enolase. A diagnosis of adenocarcinoma of the endolymphatic sac was made. These are rare tumors known for their long clinical prodrome and their local aggressiveness. Increased awareness will allow for earlier diagnosis and treatment.

Blood lead levels in children and pregnant women living near a lead-reclamation plant

OBJECTIVE

To determine the effect of lead contamination around a lead-reclamation plant on the blood lead levels of children and pregnant women living in the area.

DESIGN

Prevalence study.

SETTING

Residents living 150 m or less (high-exposure area), 151 to 400 m (intermediate-exposure area) or 401 to 800 m (low-exposure area) southeast from the plant.

PARTICIPANTS

All children aged 10 years or less and all pregnant women living in the designated area.

OUTCOME MEASURES

Correlation of venous blood lead levels with soil lead concentrations in the areas in which the subjects lived and with sociodemographic and behavioural factors.

MAIN RESULTS

Of the estimated 57 pregnant women 38 (67%) participated: 20 were in the high-exposure area and 18 in the other two areas; their geometric mean blood lead levels were low (0.15 and 0.13 mumol/L respectively). Of the 625 eligible children 510 (82%) participated: 169 were in the high-exposure area, 179 in the intermediate-exposure area and 162 in the low-exposure area; their geometric mean lead levels were 0.43, 0.30 and 0.26 mumol/L respectively. Within each age group children in the high-exposure area had the highest levels. The mean levels for children aged 6 months to 5 years were 0.49, 0.35 and 0.28 mumol/L in the three areas respectively. Within each exposure group children aged 1 to 2 years had the highest levels. No potential confounding variables could explain the relation between blood lead level and soil lead concentration.

CONCLUSIONS

The pregnant women's blood lead levels did not seem to be affected by exposure level, but the children's levels were primarily related to the soil lead concentration.

The measurement of death depression

A 17-item true-false Death Depression Scale with good internal consistency and face validity was constructed and found to have six factors--death despair, death loneliness, death dread, death sadness, death depression, and death finality. It correlated positively with death anxiety, general depression, and general anxiety. Feasibility of a Likert format was explored.

[Selection of target behaviors before planning health education objectives: application to prevention of STD in teenagers]

This article describes a semi-quantitative technique enabling the person responsible for the planning of a health education program to select the behaviour that should be targeted. The technique is adapted from Morley and used within Green's health education planning model. The relevant behaviours are ranked according to their importance and their changeability. A global weight is calculated for both by multiplying the weights attributed for each criterion of importance and changeability. This method is illustrated by an application for sexually transmitted diseases in teenagers. Calculations are made both for younger and older teenagers.

A study of LH-RH receptors in the pituitary gland of the winter flounder (Pseudopleuronectes americanus Walbaum)

A study using an iodinated [D-Ser(tBu)6,Pro9-NHEt]LH-RH (Buserelin), demonstrated the presence of a single class of high-affinity (KD = 2.90 nM), high-capacity LH-RH binding sites in pituitaries obtained from sexually mature male and female winter flounder. Displacement curves for unlabeled Buserelin and other preparations of mammalian and fish LH-RH, but a lack of competition for structurally unrelated peptide hormones, indicated the hormone specific nature of the fish pituitary LH-RH receptor preparation. Compared with native mammalian LH-RH and salmon LH-RH, Buserelin and an analog of salmon LH-RH, [D-Arg6,Trp7,Leu8,Pro9-NHEt]LH-RH, had significantly higher binding affinities for the flounder pituitary receptor correlating with results of previous studies demonstrating the superagonist biological activity of LH-RH analogs in trout and goldfish.

Keller arthroplasty: a prospective review

A prospective study of the Keller procedure for hallux valgus was carried out on 44 female patients (75 feet) with an average age of 66 years. The average follow-up was 31 months (range, 12-64 months). The operation was effective in improving symptoms (joint pain and bunion tenderness), cosmesis, function (footwear and level of activity) and in decreasing the deformity. The operation did not have an influence on metatarsal calluses. Cock-up deformity was common postoperatively but did not affect the results. The overall patient satisfaction rate was 77%.

Characteristics of the beta-adrenergic receptor in the rat ventral prostate using [125I]cyanopindolol

The binding characteristics of the beta-adrenergic receptor in the rat ventral prostate homogenate have been studied using the highly potent beta-adrenergic antagonist [125I]cyanopindolol (CYP) as ligand. The bound ligand was separated from the free moiety by precipitation with polyethylene glycol (PEG-6000). This technique is simple, accurate, fast and more advantageous than filtration of the hormone-receptor complex on glass fiber filters or direct centrifugation. [125I]CYP binds to a single class of high affinity sites at an apparent KD value of 23 pM. Using 0.1 microM (-)propranolol to determine non-specific binding, a number of sites of 600 fmol/mg protein were measured. The observed order of potency of adrenergic agonists (KD values) in competing for [125I]CYP binding was: (-)isoproterenol (25 nM) greater than (-)epinephrine (74 nM) much greater than (-)norepinephrine (1900 nM). Detailed study of the binding potency of a large series of beta 1- and beta 2-adrenergic agonists and antagonists showed the presence of a typical beta 2-subtype adrenergic receptor in the rat ventral prostate. The best estimate indicates that the proportion of beta 2-adrenergic receptors in rat ventral prostate is more than 95% of the total population of beta-adrenergic receptors in this tissue. The high selectivity and density of beta 2-adrenergic receptors in rat ventral prostate suggest a physiological role of circulating and/or locally secreted catecholamines in the control of prostatic growth and function.

The production of high affinity monoclonal antibodies to human chorionic gonadotropin and their application to immunoradiometric assay

Production of monoclonal antibodies against hCG has been studied using hCG as the antigen. This study reports the successful isolation of hybrid clones secreting monoclonal antibodies specific for hCG with an affinity constant higher than 10(10) M-1. Of 23 fusions, only 17 fusions have produced positive clones which secrete antibodies giving high levels of binding with 125I-labelled hCG in the supernatant. Finally, 6 different monoclonal antibodies have been isolated; 4 of them, specific for the beta-subunit, with a Ka approximately 1.1-4.0 X 10(11) M-1 and 2 others, specific for the alpha-subunit, presenting an affinity of 2.5 X 10(10) M-1. When the antibodies specific for the beta-subunit are used, specific and highly sensitive radioimmunoassays are obtained after only 3 hrs of incubation. Using iodinated monoclonal antibodies specific for the alpha-subunit and tubes coated with antibodies against the beta-subunit, we have developed sensitive immunoradiometric assays.

Third-trimester induced abortion in Georgia, 1979 and 1980

We reviewed 86 third-trimester induced abortions reported to the Georgia Department of Human Resources in 1979 and 1980. Only three of the 78 with adequate data were classified correctly. Fetal deaths in utero accounted for 67.4 per cent of reported cases and first- or second-trimester abortions 18.6 per cent. The true rate of induced abortions performed in the third trimester was 4.3 per 100,000 legal abortions. Diagnosed anencephaly accounted for two out of the three valid third-trimester induced abortions performed.

Solid-phase synthesis and some biological properties of ovine corticotropin-releasing factor

Ovine corticotropin-releasing factor (CRF) was synthesized by solid-phase method and isolated using two purification steps: gel filtration and high performance liquid chromatography. The synthetic peptide is a potent stimulator of ACTH release, as well as cyclic AMP accumulation and release in rat adenohypophyseal cells in culture and shows highly specific binding to bovine anterior pituitary plasma membranes.

[Control of the quality of water in the framework of a national rural water program on the Ivory Coast. Preliminary results]

In the framework of a National Hydraulic Village Program (NHVP) which aim is to equip each village of the Ivory Coast with wells or drillings, a water quality control service was designed, directly on the field, at the Health Rural Sector Bases. The standards of drinkability were revised according to the NHVP constraints. The technics used were adapted to local conditions. Sanitary education was part of the technics used by the field agents. 1,553 wells were analysed by the end of 1978, 17.7% of which were "polluted". Pollution was transient without treatment in 68% of the above cases. The most polluted cases had a rate of fecal coliforms a 1,000 time inferior to the average traditional wells. The drillings were less polluted (10%) than the large diameter wells (24%): in the latter there was a direct correlation between rain fall and pollution. The technical visits by the agents in the villages represented privileged moments of sensibilisation and education of the villagers.