Psychosocial assessment tools for use before transplantation are predictive of post-operative psychosocial and health behavior outcomes: a narrative review of the literature

IntroductionIn end-stage diseases, transplantation may be necessary. The limited number of donors led to the development of several pre-transplant psychosocial assessment tools. We summarized the predictive value of these tools before solid-organ transplantation.MethodsThe PRISMA search strategy and the MEDLINE database were used to review the literature. From 1,050 records, we found thirteen studies using four different scales (Millon Behavioral Health Inventory [MBHI], Psychosocial Assessment of Transplant Candidates [PACT], Stanford Integrated Psychosocial Assessment for Transplantation [SIPAT], and Transplant Evaluation Rating Scale [TERS]).ResultsTERS and MBHI were associated with the highest number of positive studies concerning pre-transplant scores and primary outcomes. Psychosocial scales predict in a systematic way psychosocial and health behavioural outcomes, but generated mixed results for mortality and rejection.DiscussionThis narrative review underlines the need for multidisciplinary evaluation and well-conducted clinical trials to assist transplant teams in utilizing psychosocial evaluation effectively during evaluation of candidates

Responsiveness and clinical utility of the geriatric self-efficacy index for urinary incontinence

OBJECTIVES: To report on the responsiveness testing and clinical utility of the 12-item Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI). DESIGN: Prospective cohort study. SETTING: Six urinary incontinence (UI) outpatient clinics in Quebec, Canada. PARTICIPANTS: Community-dwelling incontinent adults aged 65 and older. MEASUREMENTS: The abridged 12-item GSE-UI, measuring older adults' level of confidence for preventing urine loss, was administered to all new consecutive incontinent patients 1 week before their initial clinic visit, at baseline, and 3 months posttreatment. At follow-up, a positive rating of improvement in UI was ascertained from patients and their physicians using the Patient's and Clinician's Global Impression of Improvement scales, respectively. Responsiveness of the GSE-UI was calculated using Guyatt's change index. Its clinical utility was determined using receiver operating curves. RESULTS: Eighty-nine of 228 eligible patients (39.0%) participated (mean age 72.6+5.8, range 65–90). At 3-month follow-up, 22.5% of patients were very much better, and 41.6% were a little or much better. Guyatt's change index was 2.6 for patients who changed by a clinically meaningful amount and 1.5 for patients having experienced any level of improvement. An improvement of 14 points on the 12-item GSE-UI had a sensitivity of 75.1% and a specificity of 78.2% for detecting clinically meaningful changes in UI status. Mean GSE-UI scores varied according to improvement status (P<.001) and correlated with changes in quality-of-life scores (r=0.7, P<.001) and reductions in UI episodes (r=0.4, P=.004). CONCLUSION: The GSE-UI is responsive and clinically useful

Étude des différences mâle/femelle au niveau de la repolarisation cardiaque

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal

Association between cardiovascular diseases and dementia among various age groups: a population-based cohort study in older adults

Abstract The link between cardiovascular (CV) risk factors or diseases and dementia is documented. There is conflicting evidence whether age moderates the association. We need to study this gap so that research and clinical initiatives target appropriate age groups. A cohort of 320,630 adult patients without dementia was built using Quebec healthcare databases (1998–2010). The CV risk factors were hypertension, diabetes and dyslipidemia, while diseases included stroke, myocardial infarction (MI), chronic heart failure (HF), and atrial fibrillation (AF). Dementia risk and CV risk factors or diseases were assessed using incidence rate ratios and Cox regression across age groups. The cohort presented by mainly female sex (67.7%) and mean age of 74.1 years. Incident rate of dementia increased with age, ranging from 4.1 to 93.5 per 1000 person-years. Diabetes, stroke, HF and AF were significantly associated with dementia risk, hazard ratios ranged from 1.08 to 3.54. The strength of association decreased in advanced age for diabetes, stroke and HF. The results suggest that prevention of diabetes, stroke, HF and AF are crucial to mitigate dementia risk. The pathophysiology of dementia in younger and older populations seems to differ, with less impact of CV risk factors in advanced age

Antipsychotics and Risks of Cardiovascular and Cerebrovascular Diseases and Mortality in Dwelling Community Older Adults

This study aims to investigate the effect of antipsychotic agents on cardiovascular and cerebrovascular diseases (CVD/CEV) and mortality risks in the older population living in a community. A cohort of 42,650 new users of antipsychotic agents was built using Quebec healthcare databases (1998–2011). The outcomes were CVD/CEV and mortality incidence in 5 years of follow-up in the total cohort, sub-cohort of patients with no schizophrenia/dementia, sub-cohort with schizophrenia, and sub-cohort with dementia. Comparisons were made between the new users who continued the treatment (adherent level ≥ 60%) vs. those ceasing treatment (adherence level < 60%) using inverse probability of treatment weighting and Cox models. Comparing high adherence vs. low levels, CVD/CEV risk was increased by 36% in the sub-cohort with schizophrenia for atypical antipsychotic users and by 25% in the sub-cohort with dementia for typical antipsychotic users. An increasing mortality risk of 2- to 3-fold was linked with the typical antipsychotic use in all cohorts except the sub-cohort with schizophrenia; in addition, mortality risk is linked with the use of high vs. low doses. Antipsychotics were not linked with CVD/CEV risk, except for atypical antipsychotics in patients with schizophrenia and typical antipsychotics in patients with dementia. The mortality risk was linked with the use of typical antipsychotics and the dose used

DISPOSITIFS DÉCLARÉS D’ENSEIGNEMENT DE LA LECTURE AU MOYEN DE LA LITTÉRATURE DE JEUNESSE EN CONTEXTE D’INCLUSION PÉDAGOGIQUE D’ÉLÈVES HDAA DU PREMIER CYCLE DU PRIMAIRE

Les recherches en lien avec l’enseignement avec la littérature de jeunesse auprès des élèves HDAA ont été réalisées en contexte de classes spéciales. Aucune d’entre elles ne s’intéressaient au contexte d’inclusion d’élèves HDAA dans des classes régulières, ni à décrire les liens entre, d’une part, le type et l’ampleur des dispositifs didactiques d’enseignement avec la littérature de jeunesse et, d’autre part, le nombre d’élèves HDAA inclus dans la classe. Il s’agit de l’objet de ce texte. Le devis est descriptif. Les résultats montrent des différences en fonction de la quantité d’élèves HDAA inclus.USE OF READING INSTRUCTION METHODS INCORPORATING CHILDREN’S LITERATURE IN INCLUSIVE EDUCATION CONTEXTS WITH ELEMENTARY CYCLE ONE HSMLD STUDENTSStudies on the use of children’s literature to teach students with handicaps, social maladjustments, or learning disabilities (HSMLD) have been conducted in the context of special education classes. Yet, none have explored the context of regular classrooms integrating students with HSMLD, nor described the links between the type and extent of pedagogical methods that incorporate children’s literature used to teach and the number of students with HSMLD included in the classroom. This article contributes to remedying this gap. Our methodological approach is descriptive. Results indicate differences in relation to the number of students with HSMLD included in the classroom.Studies on the use of children’s literature to teach students with handicaps, social maladjustments, or learning disabilities (HSMLD) have been conducted in the context of special education classes. Yet, none have explored the context of regular classrooms integrating students with HSMLD, nor described the links between the type and extent of pedagogical methods that incorporate children’s literature used to teach and the number of students with HSMLD included in the classroom. This article contributes to remedying this gap. Our methodological approach is descriptive. Results indicate differences in relation to the number of students with HSMLD included in the classroom

Effect of androgen deficiency on mouse ventricular repolarization

We previously demonstrated that female mouse ventricles have longer action potential durations (APDs) than males. This delayed repolarization results from a lower current density of the ultrarapid delayed rectifier K+ current (IK,ur) and a lower expression level of its underlying K+ channel (Kv1.5). To evaluate whether this sex difference could be attributable to the action of male sex hormones, we studied the effect of androgen deficiency on ventricular repolarization. We compared cardiac electrophysiological properties in castrated (orchiectomized; ORC) and control (CTL) male mice. Q-Tc intervals as well as APDs measured at 20 %, 50 % and 90 % of repolarization were all significantly longer in ORC than in CTL. The current density of IK,ur was significantly lower in ORC than in CTL (at +50 mV, ORC: 29 ± 4 pA pF−1, n = 25; CTL: 48 ± 5 pA pF−1, n = 17; P = 0.006). In contrast, all the other K+ currents present in mouse ventricular myocytes were comparable between ORC and CTL. Moreover, results of Western blot analysis showed a lower expression level of Kv1.5 protein in ORC but no difference between the two groups for the other K+ channels studied. This study demonstrates that androgen deficiency leads to a reduction in the density of IK,ur and Kv1.5 in mouse ventricle, and consequently, to prolongation of APD and Q-Tc interval. In conclusion, these findings strongly suggest that male sex hormones contribute to the sex difference that we previously reported in cardiac repolarization in adult mouse heart