Qualité de vie, participation et moment de l'intervention en réadaptation chez les personnes âgées ayant une déficience visuelle

La qualité de vie (QV) et la participation sont deux cibles importantes des interventions en réadaptation. Pourtant, peu d’études ont documenté la QV globale et la participation des personnes âgées ayant une déficience visuelle (DV). Par ailleurs, les cliniciens et les chercheurs en réadaptation visuelle s'entendent pour reconnaître qu’une intervention dès l’apparition de la DV serait un élément important contribuant au succès des interventions et pourrait donc influencer positivement la QV et la participation. Or, la sévérité de la DV au moment de l’intervention initiale en réadaptation (MIR) et ses impacts à long terme sur la QV ainsi que la participation ont été peu explorés. Objectif : Cette étude vise à approfondir les connaissances liées à la QV, à la participation et au MIR des aînés ayant une DV acquise à l’âge adulte. Méthodologie : Cette étude descriptive corrélationnelle transversale a sollicité la participation de personnes âgées présentant une DV causée par la dégénérescence maculaire liée à l’âge et ayant participé à un programme de réadaptation. Les 140 participants, recrutés à l’Institut Nazareth et Louis-Braille, ont répondu à divers questionnaires validés dont l’Indice de la qualité de vie et la Mesure des habitudes de vie pour évaluer, dans l’ordre, leur QV et leur participation dans les activités courantes et les rôles sociaux (réalisation et satisfaction). L’acuité visuelle a permis de qualifier la sévérité de la DV au MIR. Résultats : La QV des participants s’est révélée bonne et équivalente à celle de la population générale. Les symptômes dépressifs et le soutien social expliquaient 54% (p < 0,001) de la variance de la QV. Comparativement aux personnes âgées sans déficience, les participants présentaient plus de restrictions de participation, mais ils se disaient en général satisfait de leur niveau de participation. Enfin, ils présentaient au mieux une DV modérée au MIR. Il n’y avait pas d'association significative entre le MIR et les deux variables dépendantes, la QV et la participation, mise à part une faible corrélation significative avec le niveau de réalisation dans les activités courantes (r = -0,18 p = 0,03). Conclusion : Bien que les personnes âgées avec une DV semblent satisfaites de leur vie en général et de leur niveau de participation, elles demeurent plus vulnérables comparativement à leurs paires sans déficience. En effet, elles présentent plus de symptômes dépressifs et plus de restrictions de participation, même après avoir suivi un programme de réadaptation. Une DV modérée plutôt que sévère au MIR ne prédit pas une meilleure QV, ni participation à long terme pour cette population. Cependant, le contexte de l’étude n’a pas permis de vérifier l’impact d’une prise en charge au stade léger de la DV. Des études longitudinales s’avèrent nécessaires afin de mieux comprendre l'impact de la DV sur la QV et la participation des personnes âgées. Les recherches futures devraient également examiner les prédicteurs de la QV et de la participation afin de développer des programmes de réadaptation plus étroitement liés aux besoins de cette population.Abstract: Quality of life (QOL) and participation are important outcomes of rehabilitation interventions. However, few studies have documented global QOL and participation of older people with visual impairment (VI). In addition, clinicians and researchers in vision rehabilitation accept that intervention at the onset of VI is an important element contributing to its success and, therefore, could positively influence QOL and participation. However, VI severity at the time of the initial rehabilitation intervention and its long-term impacts on QOL and participation have not been extensively explored. Purpose: This study aimed to deepen the knowledge related to QOL, participation and time of the initial rehabilitation intervention for older adults with VI acquired in later life. Methods: This descriptive correlational cross-sectional study involved elderly people with VI caused by age-related macular degeneration who had participated in a rehabilitation program. The 140 participants, recruited at the Institut Nazareth et Louis-Braille, responded to various validated questionnaires including the Quality of Life Index and Assessment of Life Habits to assess QOL and participation in daily activities and social roles (accomplishment and satisfaction), respectively. Visual acuity determined VI severity at the time of the initial rehabilitation intervention. Results: The participants' QOL was good and equivalent to that of the general population. Depressive symptoms and social support explained 54% (p<0.001) of the QOL variance. Compared to older adults without disabilities, participants had greater participation restrictions, but they were generally satisfied with their level of participation. Finally, they had at best a moderate VI at the time of the initial rehabilitation intervention. There was no significant association between time of the initial rehabilitation intervention and both dependant variables, QOL and participation, except a weak significant correlation with the level of accomplishment in daily activities (r = -0.18, p = 0.03). Conclusions: Although older adults with VI seem satisfied with their life in general and their level of participation, they remain more vulnerable compared to their peers without disabilities. In fact, they have more depressive symptoms and participation restrictions, even after completing a rehabilitation program. A moderate rather than severe VI at the time of the initial rehabilitation intervention does not predict a better long-term QOL or participation in this population. However, the context of the study did not allow testing the impact of an intervention when the VI was mild. Longitudinal studies are needed to better understand the impact of VI on QOL and participation of older adults. Future research should also examine predictors of QOL and participation to develop rehabilitation programs linked more closely to the needs of this population

Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Context: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice. Case Presentation: A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time. Discussion: The patient’s presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work. Relevance to Clinical or Professional Practice: The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work

Adipocyte CREB Promotes Insulin Resistance in Obesity

SummaryIncreases in adiposity trigger metabolic and inflammatory changes that interfere with insulin action in peripheral tissues, culminating in beta cell failure and overt diabetes. We found that the cAMP Response Element Binding protein (CREB) is activated in adipose cells under obese conditions, where it promotes insulin resistance by triggering expression of the transcriptional repressor ATF3 and thereby downregulating expression of the adipokine hormone adiponectin as well as the insulin-sensitive glucose transporter 4 (GLUT4). Transgenic mice expressing a dominant-negative CREB transgene in adipocytes displayed increased whole-body insulin sensitivity in the contexts of diet-induced and genetic obesity, and they were protected from the development of hepatic steatosis and adipose tissue inflammation. These results indicate that adipocyte CREB provides an early signal in the progression to type 2 diabetes

Auditory Hallucinations and the Brain’s Resting-State Networks: Findings and Methodological Observations

In recent years, there has been increasing interest in the potential for alterations to the brain’s resting-state networks (RSNs) to explain various kinds of psychopathology. RSNs provide an intriguing new explanatory framework for hallucinations, which can occur in different modalities and population groups, but which remain poorly understood. This collaboration from the International Consortium on Hallucination Research (ICHR) reports on the evidence linking resting-state alterations to auditory hallucinations (AH) and provides a critical appraisal of the methodological approaches used in this area. In the report, we describe findings from resting connectivity fMRI in AH (in schizophrenia and nonclinical individuals) and compare them with findings from neurophysiological research, structural MRI, and research on visual hallucinations (VH). In AH, various studies show resting connectivity differences in left-hemisphere auditory and language regions, as well as atypical interaction of the default mode network and RSNs linked to cognitive control and salience. As the latter are also evident in studies of VH, this points to a domain-general mechanism for hallucinations alongside modality-specific changes to RSNs in different sensory regions. However, we also observed high methodological heterogeneity in the current literature, affecting the ability to make clear comparisons between studies. To address this, we provide some methodological recommendations and options for future research on the resting state and hallucinations

On the motivations for Merleau-Ponty’s ontological research

This paper attempts to clarify Merleau-Ponty’s later work by tracing a hitherto overlooked set of concerns that were of key consequence for the formulation of his ontological research. I argue that his ontology can be understood as a response to a set of problems originating in reflections on the intersubjective use of language in dialogue, undertaken in the early 1950s. His study of dialogue disclosed a structure of meaning-formation and pointed towards a theory of truth (both recurring ontological topics) that post-Phenomenology premises could not account for. A study of dialogue shows that speakers’ positions are interchangeable, that speaking subjects are active and passive in varying degrees, and that the intentional roles of subjects and objects are liable to shift or ‘transgress’ themselves. These observations anticipate the concepts of ‘reversibility’ and ‘narcissism’, his later view of activity and passivity, and his later view of intentionality, and sharpened the need to adopt an intersubjective focus in ontological research

BREATHOMICS APPROACH TO INVESTIGATE SYSTEMIC SCLEROSIS USING THERMAL DESORPTION AND COMPREHENSIVE TWO-DIMENSIONAL GAS CHROMATOGRAPHY HIGH-RESOLUTION TIME-OF-FLIGHT MASS SPECTROMETRY

Systemic sclerosis (SSc) is a chronic and heterogenous auto-immune disease of unknown origin characterized by fibrosis, inflammation, vascular damages, and involvement of internal organs. Organ involvement appears at the early stage of the disease[1,2]. Interstitial lung disease (ILD) is one of the most common types of pulmonary involvement, responsible for the disease severity, and leading to high morbidity and mortality. One of the challenges in SSc remains the early diagnosis of patients with a high risk of disease progression driving mortality[3]. There is an unmet need for biological markers enabling SSc early diagnosis, prognosis, disease progression monitoring, and improving patients’ classification for more targeted therapies. Ideally, new diagnostic methods for SSc should be simple, fast, accurate, and cost-effective. Comprehensive two-dimensional gas chromatography (GC×GC) has a great potential for exhaled breath analysis. The increased peak capacity and sensitivity of GC×GC, provided by the combination of two capillary columns of different stationary phases by means of a modulator, enable the chromatographic separation and detection of thousands of compounds from a complex matrix[4]. For this reason, we carried out an exploratory study on SSc[5]. Basically, breath samples were collected in 5L Tedlar® bags. Volatiles contained in the sampling bag were then transferred onto Tenax®GR/Carbopack™B thermal desorption tubes (Markes International Ltd., Llantrisant, UK) and finally released and separated into a Pegasus GC-HRT 4D (LECO Corporation, St Joseph, MI, USA) through a mid-polar Rxi-624SilMS (30 m × 0.25 mm × 1.4 μm) as first column (dimension) and a polar Stabilwax (2 m × 0.25 mm ×0.5μm) as second dimension. The exhaled breath of 32 patients and 30 healthy subjects was therefore analyzed. The high resolving power of this approach and the use of statistical models enabled the identification of 16 compounds discriminating SSC patients from healthy ones[5]. However, further investigations had to be held to reach a better disease classification. In fact, the biomarkers highlighted here could be related to the scarring (fibrosis) of the lungs making these non-specific to SSCs. The second phase of the study aims to go deeper in patient stratification. Three groups were investigated: 50 SSC patients, 50 SSC-fibrosis patients and 50 ILD ones. The samples were collected at Maastricht medical center and CHU of Liège. All samples were then analyzed in the OBiACHem lab. Currently, a classification model is under construction to stratify patients based on their fibrosis status. [1] E. Zanatta, V. Codullo, J. Avouac, Y.A.-J. bone spine, undefined 2020, Elsevier (2019). [2] O. Bonhomme, B. André, F. Gester, … D. de S.-, undefined 2019, Academic.Oup.Com (n.d.). [3] J. Guiot, M. Henket, B. Andre, M. Herzog, N. Hardat, M.S. Njock, C. Moermans, M. Malaise, R. Louis, Clin. Epigenetics 12 (2020). [4] D. Zanella, J. Focant, F.A. Franchina, Anal. Sci. Adv. 2 (2021) 213–224. [5] D. Zanella, J. Guiot, P.-H. Stefanuto, L. Giltay, M. Henket, F. Guissard, B. André, M. Malaise, J. Potjewijd, F. Schleich, R. Louis, J.-F. Focant, Anal. Bioanal. Chem. 2021 41314 413 (2021) 3813–3822

La TD-GC×GC-HRTOFMS pour investiguer la fibrose pulmonaire chez des patients

Comprehensive two-dimensional gas chromatography has a great potential for exhaled breath analysis. The increased peak capacity and sensitivity, provided by the combination of two capillary columns of different stationary phases by means of a modulator, enable the chromatographic separation and detection of thousands of compounds from a complex matrix. For this reason, we carried out an exploratory study on SSc. Basically, breath samples were collected in 5L Tedlar® bags. Volatiles contained in the sampling bag were then transferred onto Tenax®GR/Carbopack™B thermal desorption tubes and finally released and separated into a Pegasus GC-HRT 4D through a mid-polar Rxi-624SilMS as first column (dimension) and a polar Stabilwax as second dimension. The exhaled breath of 32 patients and 30 healthy subjects was therefore analyzed. The high resolving power of this approach and the use of statistical models enabled the identification of 16 compounds discriminating SSC patients from healthy ones. However, further investigations had to be held to reach a better disease classification. In fact, the biomarkers highlighted here could be related to the scarring of the lungs making these non-specific to SSCs. The second phase of the study aims to go deeper in patient stratification. Three groups were investigated: 50 SSC patients, 50 SSC-fibrosis patients and 50 ILD ones. The samples were collected at Maastricht medical center and CHU of Liège. All samples were then analyzed in the OBiACHem lab. Currently, a classification model is under construction to stratify patients based on their fibrosis status

Awareness Tool for Safe and Responsible Driving (OSCAR) : A Potential Educational Intervention for Increasing Interest, Openness and Knowledge About the Abilities Required and Compensatory Strategies Among Older Drivers

Abstract : Objective: This pilot study aimed to verify the impact of the awareness tool for safe and responsible driving (OSCAR) on older adults’ (1) interest, openness, and knowledge about the abilities and compensatory strategies required for safe driving; (2) awareness of changes that have occurred in their own driving abilities; and (3) actual utilization of compensatory strategies. Methods: A preexperimental design, including a pretest (T0) and posttest (T1) 8 to 10 weeks after exposure to the intervention, was used with 48 drivers aged between 67 and 84. The participants had a valid driving license and drove at least once a week. Results: Overall, the results demonstrate that OSCAR increased interest, openness, and knowledge about the abilities and compensatory strategies of older drivers (P < .01). After exposure to OSCAR, the majority of the participants confirmed that changes had occurred in at least one of their abilities. Moreover, half of the older drivers reported having started using 6 or more compensatory strategies. Conclusion: In summary, in addition to increasing older adults’ interest, openness, and knowledge to discussion about driving, OSCAR also improved awareness of the changes that could negatively impact safe driving and enhanced utilization of compensatory strategies. While promoting safe driving and the prevention of crashes and injuries, this intervention could ultimately help older adults maintain or increase their transportation mobility. More studies are needed to further evaluate OSCAR and identify ways to improve its effectiveness