Évaluation d’un programme d’implication parentale lors du placement du jeune en centre de réadaptation

Le présent article rend compte de l’évaluation d’un programme de réadaptation pour les jeunes placés au Centre jeunesse de Québec. Le programme « Transfert des acquis », instauré en 1996, propose de mobiliser, dès le début du placement, le jeune et ses parents dans une démarche d’apprentissage axée sur la résolution des problèmes vécus par la famille et sur le retour éventuel du jeune au sein de cette dernière. Les résultats de l’évaluation montrent que le principe d’impliquer les parents dans la démarche de réadaptation entraîne des changements positifs dans la perception du placement chez le jeune et chez les parents et concourt à augmenter les séjours du jeune dans sa famille au cours du placement. Le programme démontre qu’il est possible, avec le soutien approprié, de mobiliser les parents et le jeune et d’accélérer ainsi le retour de ce dernier dans la famille.In 1996, le Centre jeunesse de Québec initiated a rehabilitation program for adolescents in residential care. The initiative proposes to involve, at the onset of the program, both parents and their adolescent in dealing with their problems and planning for a home return. The evaluation results suggest that parental involvement can change both the parents’ and the adolescent’s perception about the residential care stay. Moreover, home visits during the residential care period are increased and chances for returning home at the end of the program are better. The program demonstrates that for these families, working intensively towards a return of their youngster is possible and feasible with the appropriate support

Assessment of mechanical properties of isolated bovine intervertebral discs from multi-parametric magnetic resonance imaging

BACKGROUND: The treatment planning of spine pathologies requires information on the rigidity and permeability of the intervertebral discs (IVDs). Magnetic resonance imaging (MRI) offers great potential as a sensitive and non-invasive technique for describing the mechanical properties of IVDs. However, the literature reported small correlation coefficients between mechanical properties and MRI parameters. Our hypothesis is that the compressive modulus and the permeability of the IVD can be predicted by a linear combination of MRI parameters. METHODS: Sixty IVDs were harvested from bovine tails, and randomly separated in four groups (in-situ, digested-6h, digested-18h, digested-24h). Multi-parametric MRI acquisitions were used to quantify the relaxation times T1 and T2, the magnetization transfer ratio MTR, the apparent diffusion coefficient ADC and the fractional anisotropy FA. Unconfined compression, confined compression and direct permeability measurements were performed to quantify the compressive moduli and the hydraulic permeabilities. Differences between groups were evaluated from a one way ANOVA. Multi linear regressions were performed between dependent mechanical properties and independent MRI parameters to verify our hypothesis. A principal component analysis was used to convert the set of possibly correlated variables into a set of linearly uncorrelated variables. Agglomerative Hierarchical Clustering was performed on the 3 principal components. RESULTS: Multilinear regressions showed that 45 to 80% of the Young’s modulus E, the aggregate modulus in absence of deformation H(A0), the radial permeability k(r) and the axial permeability in absence of deformation k(0) can be explained by the MRI parameters within both the nucleus pulposus and the annulus pulposus. The principal component analysis reduced our variables to two principal components with a cumulative variability of 52-65%, which increased to 70-82% when considering the third principal component. The dendograms showed a natural division into four clusters for the nucleus pulposus and into three or four clusters for the annulus fibrosus. CONCLUSIONS: The compressive moduli and the permeabilities of isolated IVDs can be assessed mostly by MT and diffusion sequences. However, the relationships have to be improved with the inclusion of MRI parameters more sensitive to IVD degeneration. Before the use of this technique to quantify the mechanical properties of IVDs in vivo on patients suffering from various diseases, the relationships have to be defined for each degeneration state of the tissue that mimics the pathology. Our MRI protocol associated to principal component analysis and agglomerative hierarchical clustering are promising tools to classify the degenerated intervertebral discs and further find biomarkers and predictive factors of the evolution of the pathologies

Assessment of mechanical properties of muscles from multi-parametric magnetic resonance imaging

ABSTRACT: We hypothesized that a relationship existed between the mechanical properties and the magnetic resonance imaging (MRI) parameters of muscles, as already demonstrated in cartilaginous tissues. The aim was to develop an indirect evaluation tool of the mechanical properties of degenerated muscles. Leg and arm muscles of adult rabbits were dissected, and tested 12 hours post mortem, in a state of rigor mortis, or 72 hours post mortem, in a state of post-rigor mortis. The tests consisted of a multi-parametric MRI acquisition followed by a uniaxial tensile test until failure. The statistical analysis consisted of multiple linear regressions and principal component analysis. Significant differences existed between the rigor mortis and post-rigor mortis groups for E but not for the MRI parameters. 78%, 60% or 33% of the Young’s modulus could be explained by the MRI parameters in the post-rigor mortis group, rigor mortis group or both groups respectively. These relationships were confirmed by the principal component analysis. The proposed multi-parametric MRI protocol associated to principal component analysis is a promising tool for the indirect evaluation of muscle mechanical properties and should be useful to find biomarkers and predictive factors of the evolution of the pathologies

Long term evaluation of disease progression through the quantitative magnetic resonance imaging of symptomatic knee osteoarthritis patients: correlation with clinical symptoms and radiographic changes

The objective of this study was to further explore the cartilage volume changes in knee osteoarthritis (OA) over time using quantitative magnetic resonance imaging (qMRI). These were correlated with demographic, clinical, and radiological data to better identify the disease risk features. We selected 107 patients from a large trial (n = 1,232) evaluating the effect of a bisphosphonate on OA knees. The MRI acquisitions of the knee were done at baseline, 12, and 24 months. Cartilage volume from the global, medial, and lateral compartments was quantified. The changes were contrasted with clinical data and other MRI anatomical features. Knee OA cartilage volume losses were statistically significant compared to baseline values: -3.7 ± 3.0% for global cartilage and -5.5 ± 4.3% for the medial compartment at 12 months, and -5.7 ± 4.4% and -8.3 ± 6.5%, respectively, at 24 months. Three different populations were identified according to cartilage volume loss: fast (n = 11; -13.2%), intermediate (n = 48; -7.2%), and slow (n = 48; -2.3%) progressors. The predictors of fast progressors were the presence of severe meniscal extrusion (p = 0.001), severe medial tear (p = 0.005), medial and/or lateral bone edema (p = 0.03), high body mass index (p < 0.05, fast versus slow), weight (p < 0.05, fast versus slow) and age (p < 0.05 fast versus slow). The loss of cartilage volume was also slightly associated with less knee pain. No association was found with other Western Ontario McMaster Osteoarthritis Index (WOMAC) scores, joint space width, or urine biomarker levels. Meniscal damage and bone edema are closely associated with more cartilage volume loss. These data confirm the significant advantage of qMRI for reliably measuring knee structural changes at as early as 12 months, and for identifying risk factors associated with OA progression

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Modélisation individu-centrée pour aider à la détection et à l'interprétation des effets des polluants chimiques sur la dynamique de population d'un poisson, la gambusie, en écosystème expérimental

L évaluation expérimentale des effets des polluants chimiques chez le poisson au niveau de la population constitue la problématique de cette étude. L utilisation d écosystèmes expérimentaux (cosmes) a été proposée pour étudier les effets des polluants au niveau de la population. La gambusie (Gambusia holbrooki) est une espèce de poisson qui permet de telles études. Cependant, lors des expériences en cosme, le nombre de réplicats étant limité et la variabilité inter-réplicat étant importante, la puissance statistique des comparaisons entre populations témoins et exposées aux polluants est très faible. Pour améliorer la situation, nous proposons de compléter les données témoins réelles en simulant, à l'aide d'un modèle individu-centré probabiliste, l ensemble des populations attendues en conditions témoins. Les traits d histoire de vie de la gambusie nécessaires pour paramétrer le modèle ont été caractérisés. Ensuite, le modèle a été programmé, calé et validé. Enfin, deux études de cas ont permis de montrer que l utilisation du modèle permet d augmenter la puissance statistique des comparaisons entre les populations témoins et celles exposées.The experimental assessment of the chemicals effects on fish at the population level is the context of this study. The use of outdoor experimental ecosystems (cosm) has been proposed as a tool to study the effects of chemicals at the population level. The mosquitofish (Gambusia holbrooki) is a convenient fish species for such studies. Nevertheless, studies conducted in cosm are limited to a few numbers of replicates. This, together with the high variability characterizing the population level, are limiting factors for detecting significant responses other than strong effects. An alternative could be the modelling of the probabilistic distributions of the variables of the control populations, in order to virtually increase the number of replicates. Experiments were conducted to determine the life history traits of the mosquitofish required to establish the parameters of the model. Then, an individual-based model of the population dynamics of the mosquitofish was build, calibrate and validate. Finally, from two case studies, the model was shown to improve the statistical power of the comparisons between the control and the chemical-exposed populations.RENNES1-BU Sciences Philo (352382102) / SudocSudocFranceF