Analyse de la marche chez les adolescents sains et atteints de scoliose idiopathique : une étude cinétique et cinématique intégrée

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

Identification des déterminants de l'intention des infirmières à exercer la surveillance clinique d’adultes hospitalisés lors du pic d'action des opioïdes sous-cutanés

Introduction : L’administration d’opioïdes par voie sous-cutanée peut occasionner des épisodes de dépression respiratoire menant à des décès évitables. Grâce à leur efficacité, les opioïdes demeurent la thérapie de premier choix pour le soulagement de la douleur modérée à sévère. Cependant, de plus en plus d’usagers présentent un ou plusieurs facteurs de risque de dépression respiratoire qui justifient une surveillance clinique adaptée à leur condition. Pour assurer une surveillance sécuritaire des usagers, des lignes directrices professionnelles doublées de mesures organisationnelles sous forme de directives et protocoles de surveillance infirmière ont été instaurées. La surveillance clinique demeure toutefois inadéquate, nous permettant de supposer qu’il existe, au-delà des éléments organisationnels, des déterminants individuels influençant la surveillance infirmière. Objectif : Identifier les déterminants de l’intention des infirmières d’exercer la surveillance clinique lors du pic d’action des opioïdes sous-cutanés auprès d’adultes hospitalisés. Méthodes : Étude corrélationnelle prédictive auprès d’infirmières d’unités de chirurgie et médecine (n = 104) d’un établissement de santé québécois par le biais d’un questionnaire auto-rapporté. Des régressions multiples ont été réalisées pour identifier les déterminants associés à l’intention d’adopter le comportement souhaité. Résultats : La perception de contrôle et la norme professionnelle ont été identifiés comme étant les principaux déterminants de l’intention des infirmières à exercer une surveillance lors du pic d’action des opioïdes. Discussion et conclusion : Par l’identification des déterminants individuels les plus susceptibles d’expliquer l’intention d’exercer une surveillance adaptée lors du pic d’action des opioïdes, cette étude permet de cibler des pistes d’intervention en matière de sécurité clinique.Introduction: Subcutaneous administration of opioids may cause episodes of respiratory depression leading to preventable deaths. Due to their efficacy, opioids remain the first-choice therapy for the relief of moderate to acute pain. However, more and more inpatients have one or more risk factors for respiratory depression that justifies clinical surveillance adapted to their condition. To ensure safe monitoring of inpatients, professional guidelines, coupled with organizational measures in the form of guidelines and nurse monitoring protocols, have been introduced. Despite the action taken, clinical surveillance remains inadequate, allowing us to assume that there are, beyond the organizational elements, individual determinants influencing nurse supervision. Objective: Identify the determinants of the intention of nurses to conduct clinical surveillance of adults in hospital during the peak action of subcutaneous opioids. Methods: Predictive correlational study among nurses of surgical and medicine units of a Quebec health facility (n = 104) through a self-reported questionnaire. Multiple regressions were carried out to identify the determinants associated with the intention to perform the desired behaviour. Results: Perceived control and professional standards have been identified as the key determinants of nurses' intention to perform clinical surveillance associated with opioid at the time of peak effect. Discussion and conclusion: By identifying the individual determinants most likely to explain the intention to exercise appropriate surveillance at the peak of opioid action, this study helps to target clinical safety interventions

Vitamin D in the prevention of exacerbations of asthma in preschoolers (DIVA): Protocol for a multicentre randomised placebo-controlled triple-blind trial

Introduction Preschoolers have the highest rate of emergency visits and hospitalisations for asthma exacerbations of all age groups, with most triggered by upper respiratory tract infections (URTIs) and occurring in the fall or winter. Vitamin D insufficiency is highly prevalent in Canadian preschoolers with recurrent asthma exacerbations, particularly in winter. It is associated with more URTIs and, in patients with asthma, more oral corticosteroid (OCS) use. Although evidence suggests that vitamin D supplements significantly decrease URTIs and asthma exacerbations requiring OCS, there is insufficient data in preschoolers. This study aims to determine the impact of vitamin D 3 supplementation on exacerbations requiring OCS, in preschoolers with recurrent URTI-induced asthma exacerbations. Methods and analysis This is a phase III, randomised, triple-blind, placebo-controlled, parallel-group multicentre trial of vitamin D 3 supplementation in children aged 1-5 years, with asthma triggered by URTIs and a recent history of frequent URTIs and OCS use. Children (n=865) will be recruited in the fall and early winter and followed for 7 months. They will be randomised to either the (1) intervention: two oral boluses of 100 000 international unit (IU) vitamin D 3 (3.5 months apart) with 400 IU vitamin D 3 daily; or (2) control: identical placebo boluses with daily placebo. The primary outcome is the number of exacerbations requiring OCS per child, documented by medical and pharmacy records. Secondary outcomes include number of laboratory-confirmed viral URTIs, exacerbation duration and severity, parent functional status, healthcare use, treatment deintensification, cost and safety. Ethics and dissemination This study has received ethical approval from all sites. Results will be disseminated via international conferences and manuscripts targeting paediatricians and respirologists, and to families of asthmatic children via our Quebec parents-partners outreach programme. If proven effective, findings may markedly influence the management of URTI-induced asthma in high-morbidity preschoolers and could be directly implemented into practice with an update to clinical guidelines. Trial registration number NCT03365687

Complete genome sequence of Escherichia coli Siphophage BRET

The lytic Escherichia coli siphophage BRET was isolated from a chicken obtained at a local market in Abidjan, Côte d’Ivoire. Its linear genome sequence consists of 59,550 bp (43.4% GC content) and contains 88 predicted genes, including 4 involved in archaeosine biosynthesis. Phage BRET is related (95% nucleotide identity) to Enterobacteria phage JenK

Genetic Variation in the Familial Mediterranean Fever Gene (MEFV) and Risk for Crohn's Disease and Ulcerative Colitis

BACKGROUND AND AIMS: The familial Mediterranean fever (FMF) gene (MEFV) encodes pyrin, a major regulator of the inflammasome platform controlling caspase-1 activation and IL-1beta processing. Pyrin has been shown to interact with the gene product of NLRP3, NALP3/cryopyrin, also an important active member of the inflammasome. The NLRP3 region was recently reported to be associated with Crohn's disease (CD) susceptibility. We therefore sought to evaluate MEFV as an inflammatory bowel disease (IBD) susceptibility gene. METHODOLOGY AND RESULTS: MEFV colonic mucosal gene expression was significantly increased in experimental colitis mice models (TNBS p<0.0003; DSS p<0.006), in biopsies from CD (p<0.02) and severe ulcerative colitis (UC) patients (p<0.008). Comprehensive genetic screening of the MEFV region in the Belgian exploratory sample set (440 CD trios, 137 UC trios, 239 CD cases, 96 UC cases, and 107 healthy controls) identified SNPs located in the MEFV 5' haplotype block that were significantly associated with UC (rs224217; p = 0.003; A allele frequency: 56% cases, 45% controls), while no CD associations were observed. Sequencing and subsequent genotyping of variants located in this associated haplotype block identified three synonymous variants (D102D/rs224225, G138G/rs224224, A165A/rs224223) and one non-synonymous variant (R202Q/rs224222) located in MEFV exon 2 that were significantly associated with UC (rs224222: p = 0.0005; A allele frequency: 32% in cases, 23% in controls). No consistent associations were observed in additional Canadian (256 CD trios, 91 UC trios) and Scottish (495 UC, 370 controls) sample sets. We note that rs224222 showed marginal association (p = 0.012; G allele frequency: 82% in cases, 70% in controls) in the Canadian sample, but with a different risk allele. None of the NLRP3 common variants were associated with UC in the Belgian-Canadian UC samples and no significant interactions were observed between NLRP3 and MEFV that could explain the observed flip-flop of the rs224222 risk allele. CONCLUSION: The differences in association levels observed between the sample sets may be a consequence of distinct founder effects or of the relative small sample size of the cohorts evaluated in this study. However, the results suggest that common variants in the MEFV region do not contribute to CD and UC susceptibility.Journal ArticleResearch Support, N.I.H. ExtramuralResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Identification des déterminants de l’intention des infirmières d’exercer la surveillance clinique lors du pic d’action des opioïdes sous-cutanés auprès d’adultes hospitalisés

Introduction : L’administration d’opioïdes par voie sous-cutanée peut occasionner des épisodes de dépression respiratoire menant à des décès évitables. Grâce à leur efficacité, les opioïdes demeurent la thérapie de premier choix pour le soulagement de la douleur modérée à sévère. Cependant, de plus en plus d’usagers présentent un ou plusieurs facteurs de risque de dépression respiratoire qui justifient une surveillance clinique adaptée à leur condition. Pour assurer une surveillance sécuritaire des usagers, des lignes directrices professionnelles doublées de mesures organisationnelles sous forme de directives et protocoles de surveillance infirmière ont été instaurées. La surveillance clinique demeure toutefois inadéquate, nous permettant de supposer qu’il existe, au-delà des éléments organisationnels, des déterminants individuels influençant la surveillance infirmière. Objectif : Identifier les déterminants de l’intention des infirmières d’exercer la surveillance clinique lors du pic d’action des opioïdes sous-cutanés auprès d’adultes hospitalisés. Méthodes : Étude corrélationnelle prédictive auprès d’infirmières d’unités de chirurgie et médecine (n = 104) d’un établissement de santé québécois par le biais d’un questionnaire auto-rapporté. Des régressions multiples ont été réalisées pour identifier les déterminants associés à l’intention d’adopter le comportement souhaité. Résultats : La perception de contrôle et la norme professionnelle ont été identifiés comme étant les principaux déterminants de l’intention des infirmières à exercer une surveillance lors du pic d’action des opioïdes. Discussion et conclusion : Par l’identification des déterminants individuels les plus susceptibles d’expliquer l’intention d’exercer une surveillance adaptée lors du pic d’action des opioïdes, cette étude permet de cibler des pistes d’intervention en matière de sécurité clinique.Introduction: Subcutaneous administration of opioids may cause episodes of respiratory depression leading to preventable deaths. Due to their efficacy, opioids remain the first-choice therapy for the relief of moderate to acute pain. However, more and more inpatients have one or more risk factors for respiratory depression that justifies clinical surveillance adapted to their condition. To ensure safe monitoring of inpatients, professional guidelines, coupled with organizational measures in the form of guidelines and nurse monitoring protocols, have been introduced. Despite the action taken, clinical surveillance remains inadequate, allowing us to assume that there are, beyond the organizational elements, individual determinants influencing nurse supervision. Objective: Identify the determinants of the intention of nurses to conduct clinical surveillance of adults in hospital during the peak action of subcutaneous opioids. Methods: Predictive correlational study among nurses of surgical and medicine units of a Quebec health facility (n = 104) through a self-reported questionnaire. Multiple regressions were carried out to identify the determinants associated with the intention to perform the desired behaviour. Results: Perceived control and professional standards have been identified as the key determinants of nurses’ intention to perform clinical surveillance associated with opioid at the time of peak effect. Discussion and conclusion: By identifying the individual determinants most likely to explain the intention to exercise appropriate surveillance at the peak of opioid action, this study helps to target clinical safety interventions

Trauma symptoms as factors associated with early motherhood among young women who had contact with child protective services

Abstract: Young women who had contact with child protective services (CPS) are two to three times more likely to become young mothers than their peers in the general population. Adverse life events, such as maltreatment and placement instability, are associated with an increased risk of early motherhood. Adverse events may lead to trauma symptoms, which could contribute to the circumstances that lead young women to become mothers. In this study, we explored the association between trauma symptoms and early motherhood, after controlling for the effects of maltreatment, placement instability, and risky sexual behaviors, among 112 young women who had contact with CPS. The results of a multivariate binary logistic regression analysis showed that symptoms of trauma related to sexual disturbance were associated with an increased risk of early motherhood while anger and suicidality as trauma symptoms were associated with a decrease in this risk. These results suggest that the long-term consequences of adverse events, such as trauma symptoms, should be considered in the study of early motherhood. Furthermore, a trauma-sensitive approach focused on the links between traumatic events and behavioral dysfunction could be helpful in supporting young women who had contact with CPS and are preparing for early motherhood

Genetic Risk Factors for Post-Infectious Irritable Bowel Syndrome Following a Waterborne Outbreak of Gastroenteritis.

BACKGROUND & AIMS: Acute gastroenteritis is the strongest risk factor for irritable bowel syndrome (IBS). In May 2000, >2300 residents of Walkerton, Ontario, developed gastroenteritis from microbial contamination of the municipal water supply; a longitudinal study found that >36.2% of these developed IBS. We used this cohort to study genetic susceptibility to post-infectious (PI)-IBS. METHODS: We screened 79 functional variants of genes with products involved in serotoninergic pathways, intestinal epithelial barrier function, and innate immunity and performed fine mapping in regions of interest. We compared data from Walkerton residents who developed gastroenteritis and reported PI-IBS 2 to 3 years after the outbreak (n = 228, cases) with data from residents who developed gastroenteritis but did not develop PI-IBS (n = 581, controls). RESULTS: Four variants were associated with PI-IBS, although the association was not significant after correction for the total number of single nucleotide polymorphisms. Two were located in TLR9, which encodes a pattern recognition receptor (rs352139, P545P; P = .0059 and rs5743836, -T1237C; P = .0250; r(2) < 0.14); 1 was in CDH1, which encodes a tight junction protein (rs16260, -C160A; P = .0352); and 1 was in IL6, which encodes a cytokine (rs1800795, -G174C; P = .0420). Denser mapping of these 3 regions revealed 1 novel association in IL6 (rs2069861; P = .0069) and 14 associations that could be accounted for by linkage disequilibrium with the 4 original variants. The TLR9, IL6, and CDH1 variants all persisted as independent risk factors for PI-IBS when controlling for previously identified clinical risk factors. CONCLUSION: This is the first descriptive study to assess potential genetic determinants of PI-IBS. Genes that encode proteins involved in epithelial cell barrier function and the innate immune response to enteric bacteria are associated with development of IBS following acute gastroenteritis.JOURNAL ARTICLESCOPUS: ar.jinfo:eu-repo/semantics/publishe