Soins intégrés. Handicaps sociaux et ordre moral dans un centre japonais pour le traitement de l'épilepsie

Soins intégrésHandicaps sociaux et ordre moral dans un centre japonais pour le traitement de l'épilepsieCet article traite du programme de soins appliqué dans un centre japonais de traitement de l'épilepsie (JEC) dont l'objectif est de permettre la réintégration sociale des patients. Bien que ce programme ait été mis sur pied parce que des groupes de pression évoquaient les nombreux problèmes sociaux qui affectent les personnes épileptiques, il détourne l'attention de ces problèmes dans sa forme actuelle. Le programme du JEC est centré sur la réforme du comportement; il vise à remodeler les habitudes et la personnalité des gens souffrant d'épilepsie. Dans cet institut, les pratiques et les connaissances relatives à l'épilepsie et aux incapacités qui y sont liées reproduisent, selon moi, l'idéologie japonaise dominante en ce qui concerne la définition d'une personne « convenable » (Lock 1988). Il en résulte au moins deux conséquences : d'abord, cette reproduction justifie et « naturalise » une certaine répartition des services qui est fondamentalement inégalitaire ; ensuite, elle légitime les différences entre patients et médecins dans la capacité à définir les connaissances autorisées relatives à l'épilepsie et aux incapacités correspondantes.Comprehensive CareSocial Disability and thé Moral Order in a Japanese Institutefor thé Treatment ofEpilepsyThis paper is about thé comprehensive care treatment program at a Japanese institute for thé treatment of epilepsy (JEC), a program whose stated objectives are to produce social réintégration in people with epilepsy. Though thé treatment program was initially founded because lobbying groups pointed out numerous social problems which people with epilepsy hâve, it diverts attention from thèse issues in ils présent form. The treatment program is geared toward behavioral reform, i.e. toward molding thé habits and personalities of indi-viduals with epilepsy. The practices and knowledge about epilepsy and disability related to epilepsy at thé JEC, I contend, reproduce dominant Japanese ideas about thé « correct » person (Lock 1988). At least two ideological conséquences resuit in this context : a par-ticular (and decidedly non-egalitarian) distribution of services is justified and naturalized ; and différences between patients and physicians in thé power to defïne authoritative knowledge about epilepsy and disability is justified

Longitudinal Mediation Models of Coping, Spiritual Connection, Spiritual Meaning, Positive Affect and Distress in Cancer Survivors

Religiosity/spirituality is linked to better well-being. Spiritual Framework of Coping (SFC) model proposes paths to achieving emotional well-being, through spiritual connections/coping and meaning-making. To test SFC, four models were examined in 103 cancer patients, assessed at diagnosis, and again 12-/18-/24-/36- months post-diagnosis. Measures include religious and active-cognitive coping, religious attendance/importance, positive affect, spiritual meaning, and psychological distress (mood and depressive symptoms). Mediation was established by hierarchical multiple regressions and a Sobel test statistic. Positive affect served as a mediator between positive coping and spiritual meaning, and between spiritual connections and spiritual meaning. Spiritual meaning served as a mediator between positive affect and distress. Results support the SFC model, highlighting the importance of meaning and positive affect in adjusting to cancer.The Ohio State University College of the Arts and SciencesNational Cancer InstituteAmerican Cancer SocietyNational Institutes of HealthThe Ohio State UniversityNational Institute of Mental HealthUS Army Medical Research and Development CommandLongaberger Compan

Non-invasive evaluation of pulmonary glutathione in the exhaled breath condensate of otherwise healthy alcoholics

SummaryBackgroundChronic alcoholism is associated with an elevated risk for pulmonary infection and a 3-fold chance for incidence and mortality of acute respiratory distress syndrome with critical injury. Limited sampling of the alveolar lining fluid has restricted clinical studies of the role of glutathione (GSH) redox balance in pulmonary function and diseased states. Non-invasive sampling in the exhaled breath condensate (EBC) to monitor alveolar GSH would facilitate research in pulmonary oxidative stress.MethodsEBC was collected from otherwise healthy subjects with and without a history of alcohol abuse. Reduced and oxidized EBC glutathione (GSH and GSSG, respectively), pH, and hydrogen peroxide were measured.ResultsGSH was statistically decreased in alcohol abusers only when normalized to protein (4.7nmol/mg protein [0.75, 11.4] vs. 13.4 [7.8, 26.4], p=0.03). In contrast, GSSG was significantly elevated in the EBC from alcohol abusers when compared to controls, 5.62 [0.45, 8.94] vs. 0.50nM [0.38, 0.80], p=0.03. Thus, a greater percentage was in the oxidized GSSG form when subjects abused alcohol (35.3% [11.8, 58.1] vs. 5.2 [3.6, 6.1], p<0.001). These concentrations represented a 40mV shift in GSH redox state towards a more oxidized state.ConclusionsProper sample preparation was essential to prevent GSH loss and artificial oxidation. The shift in redox potential or %GSSG, which were not affected by dilution, may serve as better markers of pulmonary oxidative stress. Furthermore, these data suggested that the oxidant stress observed in the lavage fluid of otherwise healthy alcoholics could be measured non-invasively in the EBC

Natalizumab in pediatric multiple sclerosis patients

Abstract: Pediatric multiple sclerosis (MS) comprises 25% of all cases of MS. Although first-line disease-modifying therapy (DMT) including interferons and glatiramer acetate appear to be well tolerated in this population, recent work has suggested that a growing number of children suffer from disease which is resistant to treatment with these therapies. Natalizumab is a therapy which, although associated with a 1 : 1000 risk for progressive multifocal leukoencephalopathy (PML), has been shown to be well tolerated in the adult population and may lead to disease remission in adults with highly active disease. Reports of use of this therapy in the pediatric population with highly active disease have been published. This paper reviews current experience with the use of natalizumab in the pediatric MS population, with attention to potential risks and possible long-term outcomes in this population

Striatal and thalamic GABA level concentrations play differential roles for the modulation of response selection processes by proprioceptive information.

The selection of appropriate responses is a complex endeavor requiring the integration of many different sources of information in fronto-striatal-thalamic circuits. An often neglected but relevant piece of information is provided by proprioceptive inputs about the current position of our limbs. This study examines the importance of striatal and thalamic GABA levels in these processes using GABA-edited magnetic resonance spectroscopy (GABAMRS) and a Simon task featuring proprioception-induced interference in healthy subjects. As a possible model of deficits in the processing of proprioceptive information, we also included Parkinson's disease (PD) patients in this study.The results show that proprioceptive information about unusual postures complicates response selection processes in controls, but not in PD patients. The well-known deficits of PD patients in processing proprioceptive information can turn into a benefit when altered proprioceptive information would normally complicate response selection processes. Striatal and thalamic GABA levels play dissociable roles in the modulation of response selection processes by proprioceptive information: Striatal GABA levels seem to be important for the general speed of responding, most likely because striatal GABA promotes response selection. In contrast, the modulation of response conflict by proprioceptive information is closely related to thalamic GABA concentrations with higher concentration being related to a smaller response conflict effect. The most likely explanation for this finding is that the thalamus is involved in the integration of sensorimotor, attentional, and cognitive information for the purpose of response formation. Yet, this effect in the thalamus vanishes when controls and PD patients were analyzed separately

Ventricular divergence correlates with epicardial wavebreaks and predicts ventricular arrhythmia in isolated rabbit hearts during therapeutic hypothermia

INTRODUCTION: High beat-to-beat morphological variation (divergence) on the ventricular electrogram during programmed ventricular stimulation (PVS) is associated with increased risk of ventricular fibrillation (VF), with unclear mechanisms. We hypothesized that ventricular divergence is associated with epicardial wavebreaks during PVS, and that it predicts VF occurrence. METHOD AND RESULTS: Langendorff-perfused rabbit hearts (n = 10) underwent 30-min therapeutic hypothermia (TH, 30°C), followed by a 20-min treatment with rotigaptide (300 nM), a gap junction modifier. VF inducibility was tested using burst ventricular pacing at the shortest pacing cycle length achieving 1:1 ventricular capture. Pseudo-ECG (p-ECG) and epicardial activation maps were simultaneously recorded for divergence and wavebreaks analysis, respectively. A total of 112 optical and p-ECG recordings (62 at TH, 50 at TH treated with rotigaptide) were analyzed. Adding rotigaptide reduced ventricular divergence, from 0.13±0.10 at TH to 0.09±0.07 (p = 0.018). Similarly, rotigaptide reduced the number of epicardial wavebreaks, from 0.59±0.73 at TH to 0.30±0.49 (p = 0.036). VF inducibility decreased, from 48±31% at TH to 22±32% after rotigaptide infusion (p = 0.032). Linear regression models showed that ventricular divergence correlated with epicardial wavebreaks during TH (p<0.001). CONCLUSION: Ventricular divergence correlated with, and might be predictive of epicardial wavebreaks during PVS at TH. Rotigaptide decreased both the ventricular divergence and epicardial wavebreaks, and reduced the probability of pacing-induced VF during TH