Prevalence of radiologically defined osteoarthritis in the finger and wrist joints of adult residents of Tecumseh, Michigan, 1962-65

Radiographs of the fingers and wrists of adult participants in the Tecumseh Community Health Study in 1962-1965 were examined for signs of osteoarthritis (OA). The severity of OA for each of 32 joints of the fingers and wrists was recorded for each individual. Attention was restricted to the 3035 participants who were 32 years of age or older and for whom a diagnosis of OA was available for each of 32 joints. Joint-specific prevalence rates of OA increased sharply with age for both sexes, and at the older ages, the prevalence rates for most joints were higher for females. Older individuals with OA also had a greater number of affected joints, with females having a greater number of affected joints than males. Of those individuals aged 44 years or younger, only 6.2% had one or more joints affected with OA. The percentages were 21.6 and 42.0% for those aged 45-59 years and 60 or more years, respectively. The distal interphalangeal (DIP) joints were the most frequently affected joints in all age categories for both sexes and OA in the proximal interphalangeal (PIP) joints was positively associated with OA in the DIP joints. However, controlling for the number of affected DIP joints, the PIP joints of older subjects were more likely to exhibit OA than the PIP joints of younger subjects. Though there is an association between OA in the DIP and PIP joints, there was only a small, nonsignificant association (OR= 1.24, 95% CI=0.83, 1.84) between disease in the DIP and PIP joints of the same finger.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27568/1/0000612.pd

French Translation of the Multidimensional Pain Inventory: L’inventaire multidimensionnel de la douleur

BACKGROUND: The Multidimensional Pain Inventory (MPI) is a widely used tool in the evaluation of pain conditions. This questionnaire has been translated and validated in multiple languages. However, there is no validated French-language version available for clinicians and researchers interested in evaluating people living with pain

La thérapie cognitivo-comportementale dans les cliniques spécialisées du Pavillon Albert-Prévost dans les 50 dernières années : innovations et évolution

Le Pavillon Albert-Prévost (PAP) a joué un rôle de premier plan dans le développement d’une psychiatrie moderne. Cette institution de soins et d’enseignement en santé mentale a été profondément marquée par la pensée freudienne et a longtemps été considérée comme un lieu phare de l’enseignement de la psychanalyse en milieu hospitalier au Québec. Mais le PAP a aussi su intégrer au fil des ans d’autres approches thérapeutiques, basées sur les données probantes. Si l’arrivée de cliniciens novateurs dans les années 1980, a permis la sensibilisation du milieu à d’autres approches thérapeutiques, la transformation du dispositif de soins en cliniques spécialisées, en 1994, marque un point décisif dans le développement de la thérapie cognitivo-comportementale, mais surtout dans son intégration dans le traitement quotidien de patients souffrant de problématiques diverses et dans son enseignement à des générations de cliniciens.The Pavillon Albert-Prévost (PAP) has played a leading role in the development of modern psychiatry in the province of Québec. It has also been, in the francophone milieu, the teaching hospital that was the most deeply influenced by psychoanalytic theories. The arrival of somatic approaches, particularly biofeedback and relaxation, in the Psychosomatic medicine and consultation-liaison service, as introduced by Dr. Jacques Monday in the 1970s, was initially greeted with great scepticism by the majority of his colleagues at PAP. In the 1980s and 1990s, Dr. Camille Laurin, then head of the department, invited Dr. Louis Chaloult to offer a clinical supervision seminar to mental health professionals. Drs. Chaloult and Monday trained generations of clinicians in cognitive behavior therapy and relaxation therapy as, over time, these approaches both practical, efficient and effective became more widely practiced and recommended by practice guidelines in psychiatry. Dr. Chaloult with the help of Dr. Jean Goulet developed a CBT teaching curriculum for residents in psychiatry and other health care professionals, wrote an influential textbook on CBT, co-developped a widely consulted website www.tccmontreal.com providing CBT practice guides for clinicians and patients alike, became one of the first psychiatrists acting as a psychiatre répondant in CLSCs (teaching CBT to other members of the team in order to provide CBT in primary care), co-developed the Centre de Psychothérapie at the PAP to promote cross theoretical training in psychotherapy for residents in psychiatry and interns of other mental healthcare disciplines. In this spirit, Dre. Thanh-Lan Ngô contributed to these endeavors and co-created with Dr. Jean Leblanc and Dre. Magalie Lussier-Valade another website www.psychopap.com dedicated to the transfer of knowledge in CBT as well as other forms of psychotherapy in order to celebrate 100 years of teaching in psychiatry at the PAP. Following the creation of specialised outpatient clinics in 1994, CBT was more widely offered and developed as a standard of care. These influential programs include those of three psychologists Dr Michel Dugas’ Generalised anxiety disorder model, Pascale Brillon’s teaching of trauma focussed CBT (with three books on the subject, Dr Richard Fleet’s research on emergency room presentation of panic disorder. This collaborative teaching and research program included Dre. Julie Turcotte and Dr. Pierre Savard, both specialised in CBT and instrumental in training generations of psychiatrists in evidence-based treatments for severe refractory disorders. At the Early psychosis clinic, an innovative program of CBT modules adapted to the functional and symptomatic impairment level of the heterogeneous clientele was developed by Pierre Fortier and Dr. Jean-Pierre Mottard. At the Readaptation for Psychosis program, France Bérubé and Jocelyne St-Onge, offered auditory hallucinations group, metacognitive therapy, the integrated psychotherapy programme. At the Personality disorder clinic, dialectical behavior therapy groups were offered by Julie Jomphe who trained many cohorts of residents, offered adaptations to families (Family connections), adolescents, and children (in schools). At the Psychosomatic service Donald Bouthillier treated somatisation disorders with affective-cognitive behavioral therapy for somatization disorder. And finally, at the Mood disorder clinic, Drs. Ngô, Bernard Gauthier, Léon Maurice Larouche, Anne-Sophie Boulanger along with Manon Quesnel, Renée Leblanc and colleagues offered a sequential program of CBT approaches to treat severe and refractory mood disorders

French translation of the Multidimensional Pain Inventory: L'inventaire multidimensionnel de la douleur

T he Multidimensional Pain Inventory (MPI) scale (1) was developed based on cognitive-behavioural concepts applied to chronic pain (2), which allows researchers to evaluate the cognitive, behavioural and emotional aspects of pain (3). The tool is an integral part of the Multiaxial Assessment of Pain and enables individuals with pain to be classified according to psychosocial and behavioural factors rather than factors related to their physical injury alone. The MPI stands out for being easy to administer, corresponding closely with a cognitive-behavioural perspective in terms of theory and being psychometrically robust (1). It has good psychometric properties (reliability and validity The MPI has been validated in English (1) and validated translations of the scale have been completed in the following languages -German (10), Dutch (2), Italia

Évaluation d’un programme d’aide au succès de sevrage des benzodiazépines

L’efficacité d’un nouveau programme de sevrage des BZD basé sur l’approche cognitivo-comportementale (PASSE) a été évaluée en le comparant à une autre condition où les participants ne reçoivent que du soutien social. Le programme d’une durée de 20 semaines débute par une préparation de quatre semaines suivie d’un sevrage standard pendant les 16 semaines suivantes. Quarante-huit participants (24 dans chaque condition) ayant un diagnostic de trouble anxieux ont participé à cette étude. Les deux conditions de traitement actif ont été comparées avec une condition contrôle de sevrage standard comprenant 41 participants. Les résultats au post-traitement permettent d’affirmer que les participants dans les deux conditions de traitement actif ont un taux de succès supérieur au sevrage. Parmi ceux qui ont complété le programme, il n’y avait aucune différence en terme de succès au sevrage entre les résultats de la condition soutien social et de l’intervention PASSE, mais lorsque les abandons étaient pris en considération, l’intervention PASSE démontrait des résultats supérieurs comparativement à la condition soutien social. Les résultats suggèrent que l’approche béhaviorale-cognitive peut aider l’individu qui désire débuter un sevrage des BZD à mieux en tolérer les effets immédiats.The efficacy of a new cognitive-behavioral group program to help discontinuation of benzodiazepines (PASSE) was evaluated by comparison to a group receiving only social support. Both programs lasted 20 weeks commencing with a preparatory period of one month and then tapering continually during 16 subsequent weeks until discontinuation. Forty-eight participants (24 in each condition) with a diagnosis of anxiety disorder took part in the study. These two active conditions were compared with a separate group of 41 people receiving standard tapering with physician counselling only. The results post-treatment supported the hypothesis that those receiving either of the two active treatments succeeded better in discontinuing benzodiazepines than those receiving the standard treatment. Among those completing the two active programs there was no difference in outcome between the social support and the cognitive behavioral (PASSE) group. However, when the rate of dropout was considered, the cognitive-behavioral group proved significantly superior than the social support group. The results suggest that a cognitive-behavioral program can help people wishing to discontinue benzodiazepines to psychologically tolerate the immediate effects of discontinuation.La eficacia de un nuevo programa de abstinencia de las BZD, basado en el enfoque cognitivo-comportamental (PASSE), fue evaluado al compararlo con otra condición en la que los participantes no reciben más que apoyo social. El programa de una duración de 20 semanas inicia con una preparación de cuatro semanas, seguidas de una abstinencia estándar durante las 16 semanas siguientes. Cuarenta y ocho participantes (24 de cada condición) con un diagnóstico de trastorno de ansiedad participaron en este estudio. Las dos condiciones de tratamiento activo fueron comparadas con una condición de control de abstinencia estándar que comprendía 41 participantes. Los resultados posteriores al tratamiento permiten afirmar que los participantes de las dos condiciones de tratamiento activo tienen una tasa de éxito superior a la abstinencia. Entre aquellos que completaron el programa no hubo ninguna diferencia en términos de éxito en la abstinencia, entre los resultados de la condición de apoyo social y de la intervención PASSE. Pero en el momento de tomar en consideración el abandono del medicamento, la intervención PASSE demostró resultados comparativamente superiores a la condición de apoyo social. Los resultados sugieren que el enfoque cognitivo-comportamental puede ayudar al individuo que desea iniciar la abstinencia de las BZD para tolerar mejor los efectos inmediatos.A eficácia de um novo programa de desabituação no uso das BZD, baseado na abordagem cognitivo-comportamental (PASSE) foi avaliada em comparação a uma outra condição na qual os participantes recebem apenas um apoio social. O programa de 20 semanas de duração inicia-se com uma preparação de quatro semanas, seguida de um programa de desabituação comum durante as próximas 16 semanas. Participaram deste estudo 48 pessoas (24 em cada condição) tendo um diagnóstico de transtorno de ansiedade. As duas condições de tratamento ativo foram comparadas a uma condição de controle do processo de desabituação comum, que contou com 41 participantes. Os resultados no pós-tratamento permitem-nos afirmar que os participantes nas duas condições de tratamento ativo têm uma taxa de sucesso superior à desabituação. Entre os que concluíram o programa, não havia nenhuma diferença em relação ao sucesso na desabituação entre os resultados da condição de apoio social e da intervenção PASSE, mas quando os abandonos eram levados em consideração, a intervenção PASSE demonstrava resultados superiores em relação à condição de apoio social. Os resultados sugerem que a abordagem cognitivo-comportamental pode ajudar o indivíduo, que deseja iniciar um processo de desabituação do uso das BZD, a melhor tolerar os efeitos imediatos