L’intégration des services de santé mentale de première ligne. Étude du modèle développé à la Clinique communautaire de Pointe-St-Charles

L'examen d'une expérience de collaboration établie depuis 25 ans entre la Clinique communautaire de Pointe-St-Charles, qui a un mandat de Centre local de services communautaires, et l'hôpital Douglas, un centre spécialisé en psychiatrie, a permis de documenter un mode de partenariat particulier pour des services de santé mentale destinés à des adultes. Avec le soutien d'une équipe de consultants en psychiatrie disponible sur place, les professionnels 1 des équipes multidisciplinaires de première ligne sont responsables du plan de traitement établi et assurent un suivi de longue durée, si nécessaire. L'approche d'intervention mise également sur l'enracinement de cette Clinique dans le quartier et sur une tradition de collaboration avec plusieurs organismes communautaires qui accueillent les personnes suivies à cette clinique. Ce modèle d'organisation est soumis à des pressions, vu les transformations dans le réseau de la santé et des services sociaux. Cette étude, réalisée durant la période de reconfiguration des services de santé au Québec, a permis d'apporter un éclairage sur les conditions de réalisation du modèle d'intervention à la Clinique communautaire de Pointe-St-Charles et d'identifier des pistes d'amélioration, en considérant le point de vue des usagers et celui des professionnels impliqués.A close examination of the experience of collaboration established over the past 25 years between the Clinique communautaire de Pointe-St-Charles - which has the primary care mandate of a CLSC (local community services), and the Douglas Hospital, a centre specialized in psychiatry, - has allowed to document a particular type of partnership for adult mental health services. With the support of a team of psychiatric consultants, first line multidisciplinary teams of professionals are responsible for the treatment plan established as well as ensuring, if necessary, continuity of long-term care. This approach also counts on the fact this clinic is deeply-rooted in the neighborhood as well as on the tradition of collaboration with many community organizations servicing people treated at this clinic. This model of organization is submitted to pressures caused by the transformation of the health and social services system. This study realized during the transformation period, has allowed to shed new light on the conditions of realization of the intervention model at the Pointe-St-Charles community clinic and identify points of improvement by considering the perspective of consumers and professionals involved.El examen de una experiencia de colaboración establecido hace 25 anos entre la Clínica comunitaria de Pointe-St-Charles que tiene un mandato de Centro local de servicios comunitarios y el Hospital Douglas, un centro especializado en psiquiatría, ha permitido documentar un modo de trabajo conjunto, particular para los servicios de salud mental destinados a adultos. Con el apoyo de un equipo de consultantes en psiquiatría disponibles en el lugar, los profesionales de los equipos multidiciplinarios de primera línea son responsables del plan de tratamiento establecido y aseguran un seguimiento prolongado cuando es necesario. El modelo de intervención se basa igualmente en el enraizamiento de esta Clínica en el barrio y en la colaboración de varios organismos comunitarios que reciben a las personas que son seguidas en esta clínica. Dadas las transformaciones de la red de la salud y de los servicios sociales, este modelo organizacional está sometido a presiones. Este estudio, realizado durante le periodo de reconfiguración de los servicios de salud en el Quebec, ha permitido clarificar a cerca de las condiciones de realización del modelo de intervención en la Clínica comunitaria de Pointe-St-Charles e identificar las pistas para mejorarlo, considerando el punto de vista de los usuarios y de los profesionales implicados

Le point de vue des aidants familiaux sur les services en santé mentale offerts à leurs proches

La présente étude a été menée auprès de 40 aidants familiaux membres d'associations de soutien aux familles et amis de personnes souffrant de maladie mentale. Ces aidants ont été rencontrés individuellement afin de documenter leur opinion sur les services en santé mentale offerts à leur proche. L'analyse de leurs commentaires témoigne à la fois de l'expression de satisfaction et d'insatisfaction au sujet de l'organisation des services par la quasi-totalité des participants. Toutefois, la question de l'organisation des services, plus spécifiquement en rapport avec leur accessibilité, entraîne le plus grand nombre de commentaires d'insatisfaction.Caregivers: their perspective on mental health services offered to relatives The current study has been conducted with 40 caregivers who are part of family support groups of people suffering of mental disorders. These caregivers have been interviewed individually in order to document their opinion on mental health services offered to their relatives. Analysis of their comments indicate both the expression of satisfaction and lack of it regarding organisation of services by most participants. However, the issue of service organisation, and more specifically in relation with access, entail the greatest number of comments of dissatisfaction.El punto de vista de ayudantes familiares sobre los servicios de salud mental ofertos a sus próximos La investigación presente ha sido realizada con 40 ayudantes familiares miembros de asociaciones de apoyo a las familias y amigos de personas que padecen de enfermedad mental. Los ayudantes han sido encontrados individualmente para documentar su opinoón de los servicios en salud mental ofertos a sus próximos. La análisis de sus comentarios demuestra a la vez una expresión de satisfacción y de insatisfacción de la organisación de los servicios para la quasi totalidad de los participantes. Sin embargo, la cuestión de la organisación de los servicios, más especificamente en relación a su accesibilidad, demuestra un nombre más importante de comentarios de insatisfacción.O ponto de vista dos assistentes familiares sobre os serviços em saúde mental oferecidos a seus parentes O presente estudo foi realizado junto a 40 assistentes familiares, membros de associações de apoio a famílias e amigos de pessoas que sofrem de doenças mentais. Estes assistentes foram consultados individualmente para documentar sua opinião sobre os serviços em saúde mental oferecidos a seus parentes. A análise de seus comentários demonstra a satisfação e, ao mesmo tempo, a insatisfação, com respeito à organização dos serviços, na quase totalidade dos participantes. Entretanto, a questão da organização dos serviços, mais especificamente em relação à sua acessibilidade, recebe o maior número de comentários de insatisfação

L’accentuation québécoise : une approche tonale

Cet article basé sur une analyse de trois locuteurs cherche à apporter des éléments d’éclaircissement sur les notions d’accent tonal et d’accent dynamique et sur les modalités de réalisation des accents tonals complexes dans le français québécois spontané.This article based on an analysis of three speakers aims at clarifying the distinction between stress accent and pitch accent in French and contributes evidence on the modalities of phonetic implementation of a complex pitch accent in spontaneous Quebec French

On the Use of DHB/Aniline and DHB/N,N-Dimethylaniline Matrices for Improved Detection of Carbohydrates: Automated Identification of Oligosaccharides and Quantitative Analysis of Sialylated Glycans by MALDI-TOF Mass Spectrometry

This study demonstrates the application of 2,5-dihydrohybenzoic acid/aniline (DHB/An) and 2,5-dihydroxybenzoic acid/N,N-dimethylaniline (DHB/DMA) matrices for automated identification and quantitative analysis of native oligosaccharides by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS). Both matrices are shown to be superior to pure DHB for native glycans in terms of signal intensities of analytes and homogeneity of sample distribution throughout the crystal layer. On-target formation of stable aniline Schiff base derivatives of glycans in DHB/An and the complete absence of such products in the mass spectra acquired in DHB/DMA matrix provide a platform for automated identification of reducing oligosaccharides in the MALDI mass spectra of complex samples. The study also shows how enhanced sensitivity is achieved with the use of these matrices and how the homogeneity of deposited sample material may be exploited for quick and accurate quantitative analysis of native glycan mixtures containing neutral and sialylated oligosaccharides in the low-nanogram to mid-picogram range

Le syntagme intonatif en langage spontané : étude préliminaire

Une étude portant sur le syntagme intonatif (SI) en langage spontané menée à partir d’un corpus de français du Québec révèle des valeurs relativement stables quant à la longueur de ces SI exprimée en termes d’unités prosodiques minimales. La variabilité rencontrée ne peut être exprimée à l’aide de paramètres sociaux.A study of intonational phrasing (IP) in a corpus of spontaneous speech of Quebec French reveals relatively stable values of length of IPs when expressed in terms of minimal prosodic units. Variability in IP length is not statistically related to the social characteristics of the speakers

Perspective d’usagers suivis en clinique externe d’établissements de première, deuxième et troisième lignes

L'étude regroupe les résultats de quatre enquêtes majeures sur la satisfaction de la clientèle de services de consultation externe en santé mentale de Montréal. Elle implique des milieux offrant des services de base, des services spécialisés et des services ultra-spécialisés. Effectuée à l'aide d'entrevues individuelles auprès d'un total de 856 patients, elle a permis de documenter la perspective de ces usagers. Les principales tendances observées indiquent que les patients sont généralement très satisfaits de la façon d'être des intervenants et de l'alliance thérapeutique établie avec eux. L'organisation et le fonctionnement des services génèrent toutefois des taux de satisfaction nettement inférieurs. Ces résultats semblent refléter l'impact des transformations récentes dans le système de services en santé mentale.This study is based on results of four major surveys on the satisfaction of the clientele regarding external consultation of mental health services in Montréal. It covers milieux offering primary care, specialized and ultra-specialized services. Conducted with 856 patients through personal interviews, this study has allowed to document consumers' perspectives. The major tendencies observed indicate that patient are generally highly satisfied with the work of mental health professionals and the therapeutic alliance they establish with them. Organization as well as functioning of services however, generate less satisfaction. These results appear to reflect the impact of recent transformation of the mental health system.El estudio reagrupa los resultados de cuatro grandes encuestas sobre la satisfacción de la clientela de los servicios de consulta externa en salud mental de Montreal. Esta implica los medios que ofrecen servicios de base, servicios especializados y servicios ultra especializados. Efectuada por medio de entrevistas individuales a 856 pacientes, la misma ha permitido documentar la perspectiva de estos usuarios. Las principales tendencias observadas indican que en general los pacientes se encuentran satisfechos de la manera de ser de los trabajadores y de la alianza terapéutica que se ha establecido con ellos. La organización y el funcionamiento de los servicios generan sin embargo algunos porcentajes de satisfacción, netamente inferiores. Estos resultados parecen reflejar el impacto de las recientes transformaciones en el sistema de servicios en salud mental

Characterization of Whole and Fragmented Wild-Type Porcine IgG

Glycoproteomic analyses of tryptic (glyco)peptides from wild-type (WT) porcine IgG were performed. In a first protocol, intact antibody was digested with trypsin, followed by glycopeptide enrichment and liquid chromatography-tandem MS (HPLC–MS/MS). This procedure allowed to detect N-glycopeptides observed previously (Lopez, P. G. et al., Glycoconj. J. 2016, 33 (1), 79), plus other non-reported N-glycopeptides. The method provided useful information but did not allow to discern between Fab (antigen-binding region) and Fc (constant region, fragment crystallizable) peptides/glycopeptides. In a second scheme, glycoproteomic analysis was attempted for Fab and Fc fragments obtained by papain and Fabulous™ hydrolysis. Usually employed for milligram amounts of antibodies, the papain and Fabulous™ protocols were adapted to 200 μg of WT IgG. Fab and Fc fragments were separated by size-exclusion (SEC) HPLC. Fractions collected were reanalyzed by gel electrophoresis (SDS-PAGE). Bands were excised, and fragments digested in-gel, followed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) MS and HPLC/MS–MS. In the protocol no glycopeptide enrichment was involved, that is, whole tryptic digests were analyzed. Fc N-glycopeptides were identified, and greater numbers of non-glycosylated peptides were tabulated. Very few peptides overlapped between Fc and Fab, as most peptides were clearly from Fc or Fab. HPLC-MS/MS detected more sialylated glycoforms than MALDI-TOF-MS. Sections of Fab and Fc were assigned de novo, through a database search or manually

The MHC class I peptide repertoire is molded by the transcriptome

Under steady-state conditions, major histocompatibility complex (MHC) I molecules are associated with self-peptides that are collectively referred to as the MHC class I peptide (MIP) repertoire. Very little is known about the genesis and molecular composition of the MIP repertoire. We developed a novel high-throughput mass spectrometry approach that yields an accurate definition of the nature and relative abundance of unlabeled peptides presented by MHC I molecules. We identified 189 and 196 MHC I–associated peptides from normal and neoplastic mouse thymocytes, respectively. By integrating our peptidomic data with global profiling of the transcriptome, we reached two conclusions. The MIP repertoire of primary mouse thymocytes is biased toward peptides derived from highly abundant transcripts and is enriched in peptides derived from cyclins/cyclin-dependent kinases and helicases. Furthermore, we found that ∼25% of MHC I–associated peptides were differentially expressed on normal versus neoplastic thymocytes. Approximately half of those peptides are derived from molecules directly implicated in neoplastic transformation (e.g., components of the PI3K–AKT–mTOR pathway). In most cases, overexpression of MHC I peptides on cancer cells entailed posttranscriptional mechanisms. Our results show that high-throughput analysis and sequencing of MHC I–associated peptides yields unique insights into the genesis of the MIP repertoire in normal and neoplastic cells

Prioritization of Referrals in Outpatient Physiotherapy Departments in Québec and Implications for Equity in Access

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation was 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector