Utilisation des services par les personnes fréquentant les ressources pour personnes itinérantes de Montréal et de Québec, et atteintes de troubles concomitants de santé mentale et de toxicomanie

Contexte : Depuis les années 1990, le Québec vit une vague de désinstitutionnalisation et crée des ressources plus intégrées pour les personnes ayant des troubles concomitants de santé mentale et de toxicomanie. Or, aucune étude au Québec n’a précisé l’utilisation des services par les personnes itinérantes atteintes de troubles concomitants, qui éprouvent plusieurs difficultés à recevoir des services. Objectif : Décrire l’utilisation de services en santé mentale et en toxicomanie de personnes fréquentant les ressources pour personnes itinérantes. Méthode : Les troubles de santé mentale, ceux liés aux substances et les troubles concomitants, et l’utilisation des services relativement à ces problèmes sont décrits à partir des données d’une enquête effectuée auprès de la clientèle utilisant des ressources pour personnes itinérantes de Montréal et de Québec (n=757). Résultats : Vingt-deux pour cent de la population qui utilise des ressources a éprouvé des troubles concomitants au cours d’une année. Ces personnes n’utilisent pas plus les services de santé mentale ou ceux liés à la toxicomanie que les personnes n’ayant que le type de problème en question, et ces taux d’utilisation de services sont très bas. Conclusion : Des pistes de solutions (logements supervisés, programmes PACT) sont suggérées et les efforts d’intégration doivent se continuer afin d’améliorer l’accessibilité aux soins de cette clientèle.Context: Since the 90’s, the province of Quebec pass through a deinstitutionalization process and integrated resources for people having concurrent mental health and drug related disorders were created. In Quebec, no study specified the utilization of services by homeless people with concurrent disorders, a population who face difficulties in receiving services. Objective: To describe utilization of mental health and substance related disorders services of clientele using resources intended for homeless people. Methods: This study uses data from a survey conducted on the clientele of resources for homeless persons in Montreal and Quebec city (n=757). Mental health problems, substance use disorders and concurrent disorders, as well as utilization of services related to these problems by clientele from resources for homeless people are presented. Results: Twenty-two percent of this population had concurrent disorders during a one-year period. They don’t use more mental health and substance related disorders services than those with a single problem and their utilization of these services is very low. Conclusion: Some suggestions are brought (supportive housing, PACT programs) and it is proposed to continue working on integration of services in order to improve accessibility for this clientele.Contexto: desde la década del 90 se produce en Quebec una ola de desinstitucionalización, acompañada por la creación de recursos más integrados para quienes padecen problemas concomitantes de salud mental y toxicomanía. Sin embargo, ningún estudio llevado a cabo en Quebec a precisado la utilización de los servicios por parte de los itinerantes que padecen problemas concomitantes y que experimentan diversas dificultades para recibir dichos servicios. Objetivo: describir el uso de los servicios de salud mental y toxicomanía por parte de quienes frecuentan los recursos para itinerantes. Método: los problemas de salud mental, aquéllos ligados al consumo de sustancias psicotrópicas y problemas concomitantes y la utilización de los servicios relacionados con estos problemas se describen a partir de datos de una investigación realizada con la clientela que utiliza los recursos para itinerantes en Montreal y en Quebec (n=757). Resultados: el veintidós por ciento de la población que utiliza estos recursos ha experimentado problemas concomitantes durante el curso de un año. Estas personas no utilizan los servicios de salud mental o relacionados con la toxicomanía más que las personas que tienen sólo el tipo de problema en cuestión, y el porcentaje de utilización de estos servicios es muy bajo. Conclusión: se sugieren soluciones posibles (departamentos en alquiler supervisados, programas PACT) y se señala que los esfuerzos de integración deben continuar con el objetivo de mejorar el acceso a los servicios por parte de esta clientela

Évaluation de la qualité de vie et des besoins des personnes itinérantes atteintes de troubles mentaux graves : perceptions d’une équipe itinérance-outreach

Ce projet, mis sur pied par l'équipe itinérance-outreach du CLSC des Faubourgs à l'automne 1998, étudie comment les membres de cette équipe perçoivent l'impact de leur intervention clinique auprès des personnes itinérantes atteintes de troubles mentaux. Un échantillon de convenance (n=52) a été sélectionné à partir de la clientèle de l'équipe. Les besoins de la clientèle ont été évalués à l'aide du Camberwell Assessment of Needs (CAN-F, Phelan et al., 1995). La qualité de vie a été mesurée à deux reprises, à l'aide du Questionnaire de la qualité de vie du Wisconsin (Version intervenant ; Becker et al., 1993). L'étude démontre que l'intervention clinique est associée à une amélioration de la qualité de vie des itinérants souffrant de pathologies mentales graves et ce, malgré l'existence de multiples autres besoins non comblés. L'étude suggère que la démarche de l'équipe itinérance-outreach touche les aspects cliniques et s'associe à l'amélioration des problèmes sociaux des personnes itinérantes atteintes de troubles mentaux graves.Assessment of quality of life and needs of homeless mentally ill people: perceptions of an outreach teamThis project established by an outreach team from the CLSC des Faubourgs in autumn 1998, studies how the members of this team perceive the impact of their clinical intervention with homeless people suffering of severe mental illness. A convenience sample (n=52) was selected within the team's clientele. The clientele's needs were evaluated with the Camberwell Assessment of Needs (CAN-F, Phelan et al., 1995). Quality of life was measured twice with the Wisconsin Quality of Life Questionnaire (Becker et al., 1993). The project shows that clinical intervention is associated with an improvement in quality of life of severely mentally ill homeless people and this despite the existence of numerous other needs that are not met. The study suggests the work done by the outreach team touches the clinical aspects and is associated with the improvement of social problems of severely mentally ill homeless people.Evaluación de la calidad de vida y de las necesidades de las personas itinerantes afectadas por desórdenes mentales graves: percepciones de un equipo itinerancia-outreachEste proyecto, puesto en marcha por el equipo itinerancia-outreach del CLSC des Faubourgs en el otoño 1998, estudia cómo los miembors de este equipo perciben el impacto de sus intervenciones clínicas con las personas itinerantes afectadas por desórdenes mentales. Un muestreo de conveniencia (n=52) fue seleccionado entre la clientela del equipo. Las necesidades de la clientela fueron evaluadas con la ayuda del Camberwell Assessment of Needs (CAN-F, Phelan Y al.,1995) En dos ocasiones, la calidad de vida fue medida con ayuda del Cuestionario de la calidad de vida de Wisconsin (Versión trabajador que interviene; Becker Y al., 1993) El estudio demuestra que la intervención clínica está asociada a un mejoramiento de la calidad de vida de los itinerantes que sufren de patologías mentales graves, y eso a pesar de la existencia de otra serie de necesidades no satisfechas. El estudio sugiere que el trabajo del equipo itinerancia-outreach aborda los aspectos clínicos y se asocia al mejoramiento de los problemas sociales de las personas itinerantes que sufren de desórdenes mentales graves

Meilleures pratiques et formation dans le contexte du continuum des services en santé mentale et en toxicomanie : le programme de formation croisée du sud-ouest de Montréal

Cet article présente le programme de formation croisée du sud-ouest de Montréal. Les auteurs estiment que le contexte post-désinstitutionalisation et d’intégration des services en santé mentale impose de nouveaux rôles aux intervenants oeuvrant dans les différents réseaux de services. La formation croisée apparaît donc comme un modèle particulièrement adapté à leurs besoins afin d’optimiser leurs interventions. Le modèle est présenté à partir des études les plus récentes et est illustré par le programme de formation croisée, développé pour les réseaux de la santé mentale et de la toxicomanie dans le sud-ouest de Montréal. Ses applications sont explorées pour d’autres réseaux.This article presents the cross training program in Montreal’s south-west. The authors underline that the context of post-deinstitutionalization and mental health service integration impose new roles to professionals who work within these different networks of services. Cross training thus appears as a model that is particularly adapted to their needs in order to optimize their interventions. The model is presented with a review of the most recent studies and is illustrated with the cross training program, a model developed by the networks of mental health care and addiction treatment in Montreal’s south-west. The program’s applications are examined for other networks of care and services.Este artículo presenta el programa de formación cruzada del suroeste de Montreal. Los autores estiman que el contexto de posdesinstitucionalización e integración de los servicios de salud mental impone roles nuevos a los interventores que laboran en las diversas redes de servicios. La formación cruzada parece por consiguiente un modelo particularmente adaptado a sus necesidades para optimizar sus intervenciones. El modelo es presentado a partir de los estudios más recientes y es ilustrado por medio del programa de formación cruzada, un modelo desarrollado para las redes de salud mental y toxicomanía en el suroeste de Montreal. Se exploran sus aplicaciones para otras redes.Este artigo apresenta o programa de formação cruzada do sudoeste de Montreal. Os autores acreditam que o contexto de pós-desinstitucionalização e de integração dos serviços em saúde mental impõe novos papéis aos intervenientes que trabalham nas diferentes redes de serviços. A formação cruzada demonstra ser, então, um modelo especialmente adaptado a suas necessidades a fim de otimizar suas intervenções. O modelo é apresentado a partir dos estudos mais recentes e é ilustrado pelo programa de formação cruzada, um modelo desenvolvido para as redes da saúde mental e da toxicomania no sudoeste de Montreal. Suas aplicações são exploradas para outras redes

Cartographie des savoirs locaux et gouvernance territoriale multi-niveaux : regards croisés Nord / Sud

Large information systems used by international organizations and central governments are inadequate to meet local development issues. We show through a series of case studies in Northern and Southern situations diverse interest of using local knowledge through mapping. Technological innovations in the field of geomatics and ICT represent a promising approach to enhance the position of this kind of knowledge alongside conventional expertise. (Résumé d'auteur

Processing thermal barrier coatings via sol-gel route: crack network control and durability

Thermal barrier coatings (TBC) processed by sol–gel route are deposited onto NiPtAl bond coated superalloy substrates. A crack microstructure, if well controlled, is adequate to get satisfactory thermo-mechanical behaviour when the TBC is cyclically oxidized. This paper deals with the adjustment of the properties of the microcracked network which is inherent to the process by changing the formulation of the sol and by adding a reinforcement step. The objective is to reduce the size and depth of the surface cracks network. This network controls the release of thermo-mechanical stress in the layers and reduces detrimental propagation of cracks that could result in the spallation of the coatings during engine operation. Several physico-chemical characterizations were performed, associated to image analyses to (i) evaluate the cracks distribution (depth, length and width), in the case of two dispersants, and (ii) to estimate their influence on the performances of TBC systems. Characterizations by cyclic oxidation were carried out using a cyclic oxidation instrumented rig to monitor on a real time basis the crack propagation and spallation. Correlations between the cracked network parameters and the lifetime of the TBC are proposed in this paper

As primeiras cultivares brasileiras de goiabeira serrana: SCS 411 Alcântara e SCS 412 Helena

Feijoa is one of the more promising native fruit-trees of Southern Brazil to be commerciallyexploited in its native habitat. Its commercial exploration depends on the availability of cultivars which attendthe market by offering fruits with quality and fair prices. The two new cultivars, SCS 411 Alcântara e SCS 412Helena, are the first ones to be available for feijoa production in Brazil and are the result of the geneticimprovement and selection program initiated by Epagri twenty years ago. Beyond good quality and highproductivity, these two cultivars offer a harvesting period of two months, from early March with ‘Alcântara’ tolate April with ‘Helena’.A goiabeira serrana consta entre as espécies frutíferas nativas do Sul do Brasil, ainda não exploradas comercialmente, como sendo uma das mais promissoras. Sua exploração comercial depende, entre outrascondições, da disponibilidade de cultivares que possam atender ao mercado em termos de oferta de frutos de qualidade a preços condizentes. As cultivares ora lançadas, SCS 411 Alcântara e SCS 412 Helena, são as primeiras a ser disponibilizadas para o cultivo da goiabeira serrana no Brasil e resultam de um trabalho de melhoramentogenético e seleção iniciado há 20 anos pela Epagri. Além de qualidade e produtividade, estas duas cultivares autocompatíveis se completam, proporcionando um escalonamento da colheita, desde o início de março com ‘Alcântara’ até o final de abril com ‘Helena’

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362