Le rôle de l'endothéline-1 dans l'invasion tumorale des ostéosarcomes due aux métalloprotéases

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Soutiens et contraintes de la relation d'aide reliés aux occupations : perceptions de résidants et du responsable d'une résidence d'accueil en santé mentale

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Ressources résidentielles pour adultes avec un trouble mental : développement d'un modèle et d'un instrument de mesure

Ce projet de recherche revisite la conceptualisation du logement et des ressources résidentielles pour les adultes avec un trouble mental. Les objectifs visent : (1) à identifier les attributs, dimensions et domaines ; (2) à développer un nouveau modèle ; (3) à concevoir un instrument de mesure pour décrire l’éventail des ressources résidentielles en santé mentale. Méthodologie : Phase 1: Le devis de recherche s’articule autour de la cartographie de concepts, caractérisée par une méthodologie mixte. L’échantillonnage, par choix raisonné, a permis de recueillir une pluralité de perceptions et d’expériences (p.ex. personnes utilisatrices de services, proches, responsables de ressources résidentielles, gestionnaires). Les participants proviennent de cinq régions du Québec (nombre total de participations = 722). Au cours des six étapes de la cartographie de concepts, les participants ont généré des attributs décrivant le logement (n = 221), leur ont accordé une cote numérique (n = 416) et les ont regroupés en catégories (n = 73). Douze participants ont interprété des cartes conceptuelles produites par des analyses multivariées, soit l’échelonnage multidimensionnel (MDS) et la typologie hiérarchique. Des analyses par composantes principales (PCAs) ont été utilisées pour raffiner la conceptualisation (n = 228). Phase II: L’instrument a été développé, utilisé et ajusté à la suite de deux groupes de discussions (n = 23) et d’une étude transversale auprès de ressources résidentielles (n = 258). La passation se fait via une entrevue téléphonique semi-structurée enregistrée, d’une durée moyenne de 130 minutes. Résultats : Les participants ont généré 1382 idées (99.5% de saturation). Les cartes conceptuelles issues de la cartographie de concepts comprennent 140 idées (attributs du logement), 12 dimensions et cinq domaines (indice de stress MDS = 0.2302, 10 itérations). Les analyses PCAs ont permis de retenir quatre domaines, 11 composantes (α = 0.600 à 0.933) et 81 attributs. Les domaines sont : (1) environnement géophysique; (2) atmosphère et fonctionnement du milieu; (3) soutien et interventions offerts; (4) pratiques organisationnelles et managériales. L’instrument développé comprend quatre domaines, 10 dimensions et 83 attributs. À cela s’ajoutent des variables descriptives. L’instrument résulte des Phases I et II de ce projet. Conclusion : L’instrument a été développé en collaboration avec diverses parties prenantes, à partir de considérations ontologiques, réalistes, causales et statistiques. Il dresse le profil détaillé d’une ressource résidentielle sous ses différentes facettes et s’appuie sur la prémisse qu’il n’existe pas de milieu résidentiel idéal pour tous.It is still a challenge to systematically describe housing for adults with severe mental illness and identify attributes that differentiate between facilities. While revisiting housing conceptualization, this research project objective is threefold: (1) identify common and commensurate housing attributes, dimensions and domains; (2) generate a new housing model; (3) develop an environmental instrument to describe housing ranging from 24-hour staffed congregate settings to apartment with no onsite support. Methods: Phase 1: A mixed-methods participatory approach as well as a purposeful sampling strategy designed to gather a mixture of relevant viewpoints were used. Participants were from five regions of Quebec and included multiple stakeholders (e.g. consumers, family members, operators of facilities, managers). As part of a six-step group concept mapping process, participants brainstormed (n = 221), rated (n = 416) and sorted (n = 73) into categories housing attributes. Participants (n = 12) were also involved in the interpretation of the conceptual maps produced using two-dimensional multidimensional scaling (MDS) and hierarchical cluster analysis (total incidents of participation = 722). These maps and the rating data obtained from a subgroup of participants (n = 228) were used to conduct principal components analyses (PCAs) to refine the conceptualization. Phase II: An instrument was designed, used and adjusted. The study design included two focus groups with experts (n = 23) as well as a cross sectional survey with 258 residential facilities. The instrument was administered using audio-taped semi-structured telephone interviews (130 minutes in average). Results: Participants brainstormed 1382 statements (99.5% saturation). The conceptual maps (MDS stress value = 0.2302, 10 iterations) comprised 140 selected statements (housing attributes), 12 dimensions and five preliminary domains. Corroboration and refinement using PCAs retained four domains, 11 components (α = 0.600 to 0.933) and 81 attributes. The domains are: (1) geo-physical environment; (2) milieu atmosphere and functioning; (3) provision of services and support; (4) organizational and managerial practices. Based on Phase I and II results, the environmental instrument comprises 4 domains, 10 dimensions and 83 attributes. It also includes descriptive variables. Conclusion: The instrument was designed with stakeholders’ inputs and based on conceptual, statistical and empirical considerations. It provides a multifaceted facility profile based on multiple levels attributes. It covers several elements of healthcare quality assessment starting from the assumption that there is no ideal setting for all

Facteurs déterminants de l’attitude des professionnels en santé mentale envers le rétablissement - une revue de littérature

Objective: The attitudes of mental health professionals towards consumers’ recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals. Methods: A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included. Results: From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals’ pessimistic attitudes towards recovery. Conclusions: This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers

Elevation of circulating big endothelin-1: an independent prognostic factor for tumor recurrence and survival in patients with esophageal squamous cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Endothelin(ET) axis plays a key role in many tumor progression and metastasis via various mechanisms such as angiogenesis, mediating extracellular matrix degradation and inhibition of apoptosis. However, there is limited information regarding the clinical significance of plasma big ET-1 levels in esophageal cancer patients. Circulating plasma big ET-1 levels were measured in patients with esophageal squamous cell carcinoma(ESCC) to evaluate the value of ET-1 as a biomarker for predicting tumor recurrence and patients survival.</p> <p>Methods</p> <p>Preoperative plasma big ET-1 concentrations were measured by an enzyme linked immunosorbent assay(ELISA) in 108 ESCC patients before surgery, and then again at 1,2,3,10 and 30 days after curative radical resection for ESCC. The association between preoperative plasma big ET-1 levels and clinicopathological features, tumor recurrence and patient survival, and their changes following surgery were evaluated.</p> <p>Results</p> <p>The preoperative plasma big ET-1 levels in ESCC patients were significantly higher than those in controls. And there was a significant association between plasma big ET-1 levels and disease stage, as well as invasion depth of the tumor and lymph node status. Furthermore, plasma big ET-1 levels decreased significantly after radical resection of the primary tumor and patients with postoperative recurrence had significantly higher plasma big ET-1 levels than that of patients without recurrence. Finally, the survival rate of patients with higher plasma big ET-1 concentrations (>4.3 pg/ml) was significantly lower than that of patients with lower level (≤ 4.3 pg/ml). Multivariate regression analysis showed that plasma big ET-1 level is an independent prognostic factor for survival in patients with ESCC.</p> <p>Conclusion</p> <p>Plasma big ET-1 level in ESCC patients may reflect malignancy and predict tumor recurrence and patient survival. Therefore, the preoperative plasma big ET-1 levels may be a clinically useful biomarker for choice of multimodality therapy in ESCC patients.</p