Étude comparative du fonctionnement dans la communauté des jeunes adultes schizophrènes et de leurs pairs sans psychopathologie

La schizophrénie est un trouble mental qui touche environ un pour cent de la population et dont les symptômes et troubles associés affectent la capacité des individus à fonctionner dans la communauté. Dans la dernière décennie, des services spécialisés dans la détection et l’intervention précoce dès le premier épisode psychotique ont été implantés dans plusieurs pays. Or, ces services ont surtout ciblé, jusqu’ici, la réduction des symptômes et de la demande de soins. Les difficultés fonctionnelles des jeunes adultes schizophrènes justifient que les services qui leur sont destinés misent également sur la réadaptation et l’amélioration du fonctionnement dans la communauté. Les besoins, priorités et préférences de cette population, ainsi que l’impact des particularités développementales du jeune âge adulte sur leur fonctionnement, sont méconnus. Cette étude propose de documenter le fonctionnement dans la communauté des jeunes adultes schizophrènes au stade du premier épisode psychotique et de le comparer à celui de leurs pairs sans psychopathologie. L’utilisation d’un modèle théorique de réadaptation, le modèle de Compétence, permet de conceptualiser le fonctionnement sous l’angle de la relation personne-environnement. Ce projet s’inscrit dans une approche de recherche synthétique ; le devis préconisé est une étude de cas multiples avec l’utilisation de méthodes mixtes (qualitatives et quantitatives), selon un modèle concurrent de triangulation (Creswell & Plano Clark, 2007). Les résultats mettent en lumière des différences entre les deux groupes dans les domaines des relations sociales et conjugales, du cheminement académique et de l’indépendance résidentielle et financière. Les données qualitatives, analysées selon le modèle de la théorisation ancrée (Glaser & Strauss, 1967), permettent de comprendre les processus sociaux impliqués dans l’accomplissement des tâches développementales au jeune âge adulte, ainsi que les conditions personnelles et systémiques sous-jacentes. Les résultats soulignent l’importance d’adapter les services résidentiels aux particularités développementales, de favoriser le soutien aux études et d’inclure les amis et les pairs dans la réadaptation des personnes touchées. Cette thèse permet à la fois d’identifier les besoins et priorités de cette population, de donner une voix aux jeunes adultes schizophrènes dans l’élaboration des services qui leur sont destinés et d’examiner les enjeux méthodologiques reliés à l’utilisation d’un devis mixte en recherche clinique.Schizophrenia is a mental health disease that affects approximately one percent of the population and whose symptoms and associated deficits hinder community functioning in affected individuals. Over the last decade, specialized services in early detection and intervention of first-episode psychosis have been implemented in many countries. So far, these services have primarily targeted symptoms and use of psychiatric care as outcomes. The significant functional difficulties experienced by young adults with schizophrenia call for a shift in emphasis towards rehabilitative strategies. No study has documented the needs, preferences and priorities of this population in terms of rehabilitation services and of the influence of developmental characteristics of young adulthood on functional outcome. This study aims to examine community functioning of young adults with schizophrenia after the first episode of psychosis and to compare it with community functioning of their unaffected peers. Community functioning is conceptualized from the perspective of person-environment interaction through the lens of the Model of Competence. A multiple case study is used within the canvas of a synthetic research approach. A concurrent, mixed methods design (qualitative and quantitative) is implemented for triangulation purposes (Creswell & Plano Clark, 2007). Results indicate salient differences between the clinical and comparison groups in the areas of social and conjugal relationships, academic achievement as well as financial and residential independence. Qualitative data analyzed through a grounded theory approach (Glaser & Strauss, 1967) highlight the social processes through which young adults achieve developmental tasks. Personal and systemic conditions that constraint and facilitate processes are recognized. The results have implications for psychiatric practices. First, residential services should be adapted to the developmental characteristics of this age group. Second, supported education should be valued and implemented as a key service for young adults with schizophrenia. Third, friends and members of the social network should be included as early and intensively as possible in the rehabilitation process. Overall, this study leads to methodological innovations in the use of mixed methods in clinical research, to identification of needs and priorities in the design of rehabilitation strategies and to the recognition of the voices and input of young adults with schizophrenia

The Use of Psychotropic Medication in Iranian Children with Developmental Disabilities

The use of psychotropic medication in children is increasing worldwide. Children with developmental disabilities seem to be prescribed these medications at a higher rate compared to their non-disabled peers. Little is known about prescribing in non-Western, middle-income studies. In Iran, the file records of 1133 children, aged 2 to 17 years, assessed as having autism spectrum disorder (ASD) or an intellectual disability (ID) in Tehran City and Province from 2005 to 2019 were collated, and information from parental reports of medications was extracted. Upwards of 80% of children with ASD and 56% of those with ID were prescribed a psychotropic medication with around one quarter in each group taking two or more medications. The rates were higher among male children showing difficult-to-manage behaviors such as hyperactivity, but less so for children of fathers with higher levels of education. The lack of alternative management strategies may be a significant driver for the use of psychotropic medications in Iran and other Low and Middle Income countries, despite their known side effects, and their failure to address the developmental needs of the children. Rather, multi-disciplinary, behavioral, therapeutic, and educational interventions are required, but these are not available widely in Iran, although a start has been made

Carbon Disclosure Project: les investisseurs au secours de l'environnement?

La réduction des émissions de gaz à effet de serre (GES) est un défi de taille auquel fait face l’humanité. Taxes sur le carbone, réglementations, accords internationaux, systèmes de plafonnement et d'échange de droits d'émissions, marchés volontaires et réglementés de crédits carbone sont les moyens les plus utilisés pour promouvoir la transition d’une économie à forte empreinte carbone vers un système économique « décarbonisé ». C’est dans ce contexte que le Carbon Disclosure Project (CDP), un système de déclaration volontaire des émissions de GES, fait son apparition au début des années 2000. Depuis, le nombre d’entreprises ayant déclaré leurs émissions est passé de 235 en 2003 à 3050 en 2010. L’objectif principal de cet essai est d’évaluer si la récente popularité du CDP auprès des entreprises est susceptible de mener à une réelle diminution des émissions de GES. Le contexte dans lequel apparaît le CDP, les informations qu’il collige et le rôle que peut jouer les approches volontaires dans la protection de l’environnement indiquent que le CDP a le potentiel de mener à une réduction des GES chez ses participants. Toutefois, une étude attentive de sept déclarations soumises en 2011 jette une lumière différente sur le succès apparent du CDP et sur sa capacité à fournir une information qui soit utile aux investisseurs pour inciter ces derniers à investir dans des entreprises plus performantes au niveau de la gestion du carbone. Ce travail montre également que le CDP apporte des avantages, des risques et des défis pour les investisseurs, les entreprises et l’environnement. Cet essai conclut que la participation d’une entreprise au CDP ne signifie pas nécessairement qu’elle intègre l’enjeu des changements climatiques à sa stratégie d’affaire, qu’elle ait mis en place des actions concrètes de réduction d’émission, qu’elle prévoit participer à un système d’échange de droits d’émissions ou qu’elle se soit fixée des cibles de réduction. Malgré cela, le CDP contribue très probablement à aborder la variable de la consommation d’énergie et le problème du réchauffement du climat dans les prises de décisions des entreprises, et ce, en attendant la création d’un cadre politique international clair sur le carbone et l’apparition de mesures réglementaires. En ce sens, le CDP est un pas de plus dans la lutte aux changements climatiques

«Je dois mettre dans ma tête que c’est pour rendre service» : engagements et contraintes de l’emploi des préposées au soutien à domicile embauchées par le Chèque emploi-service

Le système chèque emploi-service (CES) est un dispositif qui permet l’allocation aux usagers et usagères de services de soutien à domicile une enveloppe d’heures de services qu’ils et elles peuvent utiliser afin d’embaucher les préposées aux services de soutien à domicile (PSD) de leur choix. En prenant pour point de départ la diversité des expériences d’emploi de quatorze travailleuses interviewées individuellement, ce mémoire de maitrise s’articule autour de deux pôles principaux : 1) une revue historique des enjeux qui ont contribué au façonnement du système d’allocation directe CES et aux conditions d’emploi qui lui sont liées, et 2) une analyse des dynamiques qui contribuent à l’informalisation du secteur des services de soutien à domicile au Québec. Ce projet permet d’alimenter notre compréhension de la néolibéralisation de l’État social, à la fois dans son rôle de prestataire de soins de santé et de services sociaux, que de régulateur des marchés du travail.The « Cheque-Emploi-Service » (CES) system is a cash-for-care program that allows home care service users to be allocated hours of service that they can use to choose and hire home care support workers (PSD). Taking as a point of departure the diversity of experiences of fourteen women workers interviewed individually, this Master’s thesis is articulated around two main poles: 1) a historical review of the issues that have shape the direct fundings in Quebec and its related employment conditions, and 2) an analysis of the dynamics that contribute to the informalization of the home support service sector. This project feeds our understanding of the neoliberalization of the welfare state both as a provider of health care and social services, as an employer, and as a regulator of labour markets

Ice vs. steel: Ballistic impact of woven carbon/epoxy composites. Part II – Numerical modelling

© 2019 Elsevier Ltd Part I of this study covered ballistic tests, in which both solid (steel) and fragmenting (ice) spherical projectiles were fired at specimens of carbon-fibre-reinforced polymer (CFRP) composite. The velocity of impacts varied from 70 to 90 m/s for the solid projectiles and from 300 to 500 m/s for the fragmenting projectiles, resulting in three consistent and comparable levels of structural damage for both types of projectiles. The observed dynamic deformation behaviour and resultant damage were examined using a combination of non-invasive analysis techniques. The focus of this Part II is on the development of a mesoscale modelling strategy for CFRP employing a phenomenological continuum-damage approach. The developed model was validated against the data from original ballistic-impact experiments, demonstrating accurate predictions of both deformation behaviour and observed resultant damage of tested specimens for the various experimental loading conditions without modification of the modelling parameters

Micro CT analysis of dynamic damage in laminates: impact vs. blast loading

Dynamic loading is often an unavoidable condition in various applications of carbon-fibre-reinforced polymers and can cause various modes of damage. Realisation of dynamic damage in composites can differ significantly from that under quasi-static loading conditions. A comprehensive study of damage in composites caused by a wide variety of impact and blast loading is currently lacking. The work presents a detailed analysis of damage in specimens of a 2×2 twill weave T300 carbon-fibre/epoxy composite subjected to ballistic loading with both steel and ice projectiles (with energies from 95 J to 865 J at 70-90 m/s and 300-500 m/s, respectively) and air blast (with incident pressures of 0.4 MPa, 0.6 MPa and 0.8 MPa and wave speeds between 650 m/s and 950 m/s). The resultant damage was analysed in-depth based on detailed volumetric data obtained with high-resolution X-ray micro computed tomography

Evaluation of novel dual-hit models of 'schizophrenia-like' symptoms in the rat

Schizophrenia is a debilitating disorder comprising positive, negative and cognitive deficits with a poorly-defined neurobiological basis. Animal models with greater translational reliability and validity are essential to develop improved therapies and aid understanding of disease aetiology. This thesis utilised the well-established isolation rearing developmental disruption model of schizophrenia in the rat as the base for producing novel ‘dual-hit’ combination models of the disease, with the aim of improving disease validity and model robustness. Pharmacological insults were added to the isolation rearing model, first in the form of prenatal administration of the antimitotic agent methylazoxymethanol (MAM), and subsequently perinatal treatment with the N-methyl-D-aspartate receptor antagonist phencyclidine (PCP). The resulting ‘dual-hit’ models were assessed for behavioural and neurobiological validity to schizophrenia, and the incurred deficits challenged with the atypical antipsychotic risperidone and the putative adjunct therapy lamotrigine. Combination of isolation rearing and prenatal MAM on gestational day 17 did not produce more robust behavioural deficits than isolation rearing alone, but did cause marked reductions in hippocampal volume, akin to those observed in the clinic. Addition of perinatal PCP treatment on post-natal days seven, nine and eleven to the isolation rearing protocol produced more robust behavioural deficits, with limitations. Baseline hyperlocomotion in a novel arena in three cohorts was accompanied by an elevated locomotor response to acute PCP treatment, highlighting sensitization. Visual and spatial learning deficits were observed in the novel object discrimination task, whilst fear-motivated conditioning was impaired in a conditioned emotional response paradigm. Preattentional processing was also somewhat deficient in combination-treated animals in the prepulse inhibition of acoustic startle paradigm. Inconsistent deficits in visuo-spatial learning and cognitive flexibility were observed in a Morris water maze task. Acute treatment with the atypical antipsychotic compound risperidone at 0.5mg/kg caused marked sedation. At lower doses, pretreatment 30 mins prior to behavioural testing elevated prepulse inhibition and reversed emotional conditioning deficits, and returned baseline locomotor activity to levels similar to control. There was no effect on visual reference memory deficits. Conversely, pretreatment with the sodium-channel blocker lamotrigine reversed a deficit in visual reference memory, but had no effect on sensorimotor gating or fear-motivated conditioning. These data suggest that the combination of isolation rearing and perinatal PCP treatment to rats produces a model of schizophrenia-like symptoms that possesses some validity to the human condition, but lacks the desired robustness of a preclinical model. Further validation and improvement may allow this model to become a useful tool in on-going preclinical research

Performance assessment of novel side firing safe tips for endodontic applications

During root canal or periodontal treatment, directing laser energy onto the walls of the root canal is essential for effective disinfection. This study assessed the performance of four different fiber modifications that have increased lateral emission, including three designs with safe tips to reduce irradiation directed toward the root apex. Free-running pulsed infrared lasers (Nd:YAG, Er:YAG, and Er, Cr:YSGG) and a diode laser (980 nm) were used in combination with plain ended (forward emitting) laser fibers; conical laser fibers, side firing honeycomb pattern fibers without a safe end; honeycomb fibers with silver coated ends, conical fibers with selectively abraded tips, and selectively abraded honeycomb fibers with silver coated tips (20 fibers for each laser type). Laser emissions forward and laterally were measured, and digital photographs and thermally sensitive paper used to record the emission profiles. Thermochromic dyes painted onto the root surface of an extracted tooth were used to explore the distribution of laser energy with different tips designs. All three safe tipped ends gave reduced emissions in the forward direction (range 17-59%), but had similar lateral emission characteristics. Fiber designs with reduced forward emission may be useful for various dental laser procedures. (C) 2011 Society of Photo-Optical Instrumentation Engineers (SPIE). [DOI: 10.1117/1.3563637

Towards an integrated understanding of aggression in the general population : findings from an epidemiological catchment area study

The goal of this study is to identify patterns of various forms of aggression in the general population and their psychosocial and environmental correlates. Data from the Montreal Epidemiological Catchment Area study (N = 1855) were analyzed using latent class analysis and multinomial logistic regression. Four classes were identified: a ‘Low Aggression’ profile (91.4%) – individuals were older, more likely to be women, and had greater quality of life – and three profiles with individuals displaying aggression. The ‘Acting out’ profile (4.3%) reported property and mild verbal aggression, and profile membership was associated with impulsivity. The ‘Violent’ profile (2.0%) reported severe verbal aggression and physical aggression, and membership was associated with posttraumatic stress disorder and substance use disorders. Finally, the ‘Self-injuring’ profile (2.2%) reported self-harming behaviors along with mild verbal aggression and property destruction and were psychologically distressed. Findings are consistent with the risk factors in violence risk assessment instruments. They also shed light on how different types of aggression are interrelated and may help in the development of a psychological formulation of individuals for whom different types of aggression co-occur so that integrated prevention strategies may be put in place