Le point de vue des responsables des ressources de type familial sur les transformations des services de santé mentale au Québec

Cet article décrit les principaux résultats d’une étude qui a examiné le point de vue des responsables  de résidences d’accueil sur les récentes transformations des services en santé mentale, et sur l’impact de ces dernières sur leur travail auprès des personnes souffrant de troubles mentaux graves. Les résidences d’accueil (plus communément nommées « familles d’accueil ») représentent, au Québec, l’un des plus anciens modèles d’hébergement pouvant accueillir dans la communauté les personnes avec troubles mentaux graves. De fait, l’apparition des premières résidences d’accueil remonte au milieu des années 1950. Ainsi, bon nombre des individus qui ont dû quitter les unités de soins psychiatriques lorsque s’est amorcé au Québec le processus de désinstitutionnalisation, ont été placés dans des résidences d’accueil. Rappelons que les résidences d’accueil sont des habitations privées situées dans la communauté appartenant à des particuliers et dans lesquelles sont hébergées au plus, neuf personnes. Ces résidences d’accueil doivent offrir un environnement normal aux résidants, leurs responsables doivent veiller à la sécurité de ces derniers, en plus de leur procurer certains services matériels et d’encourager leur intégration sociale. Aujourd’hui les résidences d’accueil sont régies par la Loi 120 (Gouvernement du Québec, 1995) et sont désignées par l’appellation « ressources de type familial » (RTF).This article presents the major findings from a study that examined foster home caregivers’ views on the impact of the transformation of mental health services on caregivers and their work with persons with serious mental illness. In Québec foster homes, (or more commonly known as foster families), represent one of the oldest models of community based housing for persons with serious mental illness. In fact, the emergence of the first foster home dates back to the 1950ies. Over time, a large number of persons discharged from psychiatric hospitals during the process of deinstitutionalization were placed into these homes. Foster homes are private homes located in the community and operated by non professionals who can accommodate up to nine individuals. These residences provide a normal environment for its residents. Foster home caregivers must ensure a secure and safe environment as well as obtain certain services and encourage the social integration of the residents. Today foster homes are regulated by Bill 120 (Québec Government, 1995) and are designated as “family type resources” (RTF).Este artículo describe los principales resultados de un estudio que ha examinado el punto de vista de los responsables de las residencias de alojamiento acerca de las transformaciones recientes en los servicios de salud mental y el impacto de estos últimos en su trabajo con las personas que sufren de trastornos mentales graves. Las residencias de alojamiento (más comúnmente llamadas “familias de alojamiento”) representan en Quebec uno de los modelos de alojamiento más antiguos que pueden alojar en la comunidad a personas con trastornos mentales graves. De hecho, la aparición de las primeras residencias de alojamiento remontan a mediados de los años 1950. De este modo, un buen número de individuos que tuvieron que dejar las unidades de atención psiquiátrica cuando el proceso de desintitucionalización inició en Québec, fueron colocadas en las residencias de alojamiento. Recordemos que las residencias de alojamiento son habitaciones privadas situadas en la comunidad, que pertenecen a particulares y en las que se alojan como máximo nueve personas. Estas residencias deben ofrecer un ambiente normal a los residentes, sus responsables deben cuidar de la seguridad de los residentes, además de procurarles ciertos servicios materiales y alentar su integración social. Actualmente las residencias de alojamiento se rigen por la Ley 120 (Gobierno de Quebec, 1995) y son denominadas “recursos de tipo familiar” (RTF).Este artigo descreve os principais resultados de um estudo que examinou o ponto de vista dos responsáveis pelas residências sobre as recentes transformações dos serviços em saúde mental e sobre o impacto destas sobre seu trabalho junto às pessoas que sofrem de transtornos mentais graves. As residências (normalmente chamadas de “famílias de acolhimento”) representam, no Quebec, um dos mais antigos modelos de alojamento, podendo acolher na comunidade as pessoas com transtornos mentais graves. De fato, o aparecimento das primeiras residências data de meados dos anos 1950. Assim, várias pessoas, que tiveram que deixar as unidades de atendimento psiquiátricos, quando foi iniciado no Quebec o processo de desinstitucionalização, foram transferidas para as residências. Lembremos que as residências são domicílios privados, situados na comunidade, que pertencem a particulares, e nos quais são alojados no máximo nove pessoas. Estas residências devem oferecer um ambiente normal aos residentes, seus responsáveis devem garantir a segurança dos residentes, além de lhes fornecer alguns serviços materiais e encorajar sua integração social. Hoje, as residências são regidas pela Lei 120 (Governo do Quebec, 1995) e são designadas pelo nome de “recursos de tipo familiar” (RTF)

Le développement d'un modèle d'enseignement des habiletés professionnelles d'ordre socioaffectif en techniques humaines

"Programme d'aide à la recherche sur l'enseignement et l'apprentissage"Également disponible en version papierTitre de l'écran-titre (visionné le 5 déc. 2009)Bibliogr.: p. 245-27

External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol.

INTRODUCTION: Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department. METHODS AND ANALYSIS: This study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority. ETHICS AND DISSEMINATION: This study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT02616419

Assessment of the longitudinal humoral response in non-hospitalized SARS-CoV-2-positive individuals at decentralized sites: Outcomes and concordance

IntroductionEarly in the COVID-19 pandemic, reagent availability was not uniform, and infrastructure had to be urgently adapted to undertake COVID-19 surveillance.MethodsBefore the validation of centralized testing, two enzyme-linked immunosorbent assays (ELISA) were established independently at two decentralized sites using different reagents and instrumentation. We compared the results of these assays to assess the longitudinal humoral response of SARS-CoV-2-positive (i.e., PCR-confirmed), non-hospitalized individuals with mild to moderate symptoms, who had contracted SARSCoV-2 prior to the appearance of variants of concern in Québec, Canada.ResultsThe two assays exhibited a high degree of concordance to identify seropositive individuals, thus validating the robustness of the methods. The results also confirmed that serum immunoglobulins persist ≥ 6 months post-infection among non-hospitalized adults and that the antibodies elicited by infection cross-reacted with the antigens from P.1 (Gamma) and B.1.617.2 (Delta) variants of concern.DiscussionTogether, these results demonstrate that immune surveillance assays can be rapidly and reliably established when centralized testing is not available or not yet validated, allowing for robust immune surveillance

Upregulated IL-32 expression and reduced gut short chain fatty acid caproic acid in people living with HIV with subclinical atherosclerosis

Despite the success of antiretroviral therapy (ART), people living with HIV (PLWH) are still at higher risk for cardiovascular diseases (CVDs) that are mediated by chronic inflammation. Identification of novel inflammatory mediators with the inherent potential to be used as CVD biomarkers and also as therapeutic targets is critically needed for better risk stratification and disease management in PLWH. Here, we investigated the expression and potential role of the multi-isoform proinflammatory cytokine IL-32 in subclinical atherosclerosis in PLWH (n=49 with subclinical atherosclerosis and n=30 without) and HIV- controls (n=25 with subclinical atherosclerosis and n=24 without). While expression of all tested IL-32 isoforms (α, β, γ, D, ϵ, and θ) was significantly higher in peripheral blood from PLWH compared to HIV- controls, IL-32D and IL-32θ isoforms were further upregulated in HIV+ individuals with coronary artery atherosclerosis compared to their counterparts without. Upregulation of these two isoforms was associated with increased plasma levels of IL-18 and IL-1β and downregulation of the atheroprotective protein TRAIL, which together composed a unique atherosclerotic inflammatory signature specific for PLWH compared to HIV- controls. Logistic regression analysis demonstrated that modulation of these inflammatory variables was independent of age, smoking, and statin treatment. Furthermore, our in vitro functional data linked IL-32 to macrophage activation and production of IL-18 and downregulation of TRAIL, a mechanism previously shown to be associated with impaired cholesterol metabolism and atherosclerosis. Finally, increased expression of IL-32 isoforms in PLWH with subclinical atherosclerosis was associated with altered gut microbiome (increased pathogenic bacteria; Rothia and Eggerthella species) and lower abundance of the gut metabolite short-chain fatty acid (SCFA) caproic acid, measured in fecal samples from the study participants. Importantly, caproic acid diminished the production of IL-32, IL-18, and IL-1β in human PBMCs in response to bacterial LPS stimulation. In conclusion, our studies identified an HIV-specific atherosclerotic inflammatory signature including specific IL-32 isoforms, which is regulated by the SCFA caproic acid and that may lead to new potential therapies to prevent CVD in ART-treated PLWH

Cross-validation of ELISA and a portable surface plasmon resonance instrument for IgG antibody serology with SARS-CoV-2 positive individuals.

We report on the development of surface plasmon resonance (SPR) sensors and matching ELISAs for the detection of nucleocapsid and spike antibodies specific to the novel coronavirus 2019 (SARS-CoV-2) in human serum, plasma and dried blood spots (DBS)

Time series analysis of dengue incidence in Guadeloupe, French West Indies: Forecasting models using climate variables as predictors

BACKGROUND: During the last decades, dengue viruses have spread throughout the Americas region, with an increase in the number of severe forms of dengue. The surveillance system in Guadeloupe (French West Indies) is currently operational for the detection of early outbreaks of dengue. The goal of the study was to improve this surveillance system by assessing a modelling tool to predict the occurrence of dengue epidemics few months ahead and thus to help an efficient dengue control. METHODS: The Box-Jenkins approach allowed us to fit a Seasonal Autoregressive Integrated Moving Average (SARIMA) model of dengue incidence from 2000 to 2006 using clinical suspected cases. Then, this model was used for calculating dengue incidence for the year 2007 compared with observed data, using three different approaches: 1 year-ahead, 3 months-ahead and 1 month-ahead. Finally, we assessed the impact of meteorological variables (rainfall, temperature and relative humidity) on the prediction of dengue incidence and outbreaks, incorporating them in the model fitting the best. RESULTS: The 3 months-ahead approach was the most appropriate for an effective and operational public health response, and the most accurate (Root Mean Square Error, RMSE = 0.85). Relative humidity at lag-7 weeks, minimum temperature at lag-5 weeks and average temperature at lag-11 weeks were variables the most positively correlated to dengue incidence in Guadeloupe, meanwhile rainfall was not. The predictive power of SARIMA models was enhanced by the inclusion of climatic variables as external regressors to forecast the year 2007. Temperature significantly affected the model for better dengue incidence forecasting (p-value = 0.03 for minimum temperature lag-5, p-value = 0.02 for average temperature lag-11) but not humidity. Minimum temperature at lag-5 weeks was the best climatic variable for predicting dengue outbreaks (RMSE = 0.72). CONCLUSION: Temperature improves dengue outbreaks forecasts better than humidity and rainfall. SARIMA models using climatic data as independent variables could be easily incorporated into an early (3 months-ahead) and reliably monitoring system of dengue outbreaks. This approach which is practicable for a surveillance system has public health implications in helping the prediction of dengue epidemic and therefore the timely appropriate and efficient implementation of prevention activities