75 results on '"Lajoie C"'
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2. A Longitudinal Survey on Canadian Emergency Physician Burnout.
- Author
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de Wit K, Tran A, Clayton N, Seeburruth D, Lim RK, Archambault PM, Chan TM, Rang LCF, Gray S, Ritchie K, Gérin-Lajoie C, and Mercuri M
- Subjects
- Humans, Canada epidemiology, Male, Longitudinal Studies, Female, Adult, Middle Aged, Emergency Medicine, Surveys and Questionnaires, Burnout, Professional epidemiology, Burnout, Professional psychology, Physicians psychology, Physicians statistics & numerical data, Emergency Service, Hospital statistics & numerical data
- Abstract
Study Objective: Since Canada eased pandemic restrictions, emergency departments have experienced record levels of patient attendance, wait times, bed blocking, and crowding. The aim of this study was to report Canadian emergency physician burnout rates compared with the same physicians in 2020 and to describe how emergency medicine work has affected emergency physician well-being., Methods: This longitudinal study on Canadian emergency physician wellness enrolled participants in April 2020. In September 2022, participants were invited to a follow-up survey consisting of the Maslach Burnout Inventory and an optional free-text explanation of their experience. The primary outcomes were emotional exhaustion and depersonalization levels, which were compared with the Maslach Burnout Inventory survey conducted at the end of 2020. A thematic analysis identified common stressors, challenges, emotions, and responses among participants., Results: The response rate to the 2022 survey was 381 (62%) of 615 between September 28 and October 28, 2022, representing all provinces or territories in Canada (except Yukon). The median participant age was 42 years. In total, 49% were men, and 93% were staff physicians with a median of 12 years of work experience. 59% of respondents reported high emotional exhaustion, and 64% reported high depersonalization. Burnout levels in 2022 were significantly higher compared with 2020. Prevalent themes included a broken health care system, a lack of societal support, and systemic workplace challenges leading to physician distress and loss of physicians from the emergency workforce., Conclusion: We found very high burnout levels in emergency physician respondents that have increased since 2020., (Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2024
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3. Change in heart rate variability during two firefighting work cycles.
- Author
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Gendron P, Laurencelle L, Lajoie C, Trudeau F, Houle J, and Goulet ÉDB
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- Humans, Male, Heart Rate physiology, Body Temperature, Firefighters
- Abstract
This study aimed to determine whether the change in heart rate variability from pre to post firefighting is modulated by different work cycles. Thirteen male firefighters underwent two firefighting simulations that comprised two identical 25-min work bouts intercalated by a passive recovery period of either 20 min (T20) or 5 min (T5). The square root of the mean squared differences of successive R-R intervals (RMSSD) and aural temperature were measured at rest before (PRE) and after (POST) firefighting simulations. The decrease in RMSSD was different between firefighting simulations (T20: -10 ± 21.2 ms, T5: -19.9 ± 20.9 ms, interaction, p = 0.02). Post-firefighting aural temperature was greater ( p = 0.05) in T5 (37.18 ± 0.53 °C) than in T20 (36.88 ± 0.49 °C). In conclusion, a shorter recovery period of 5 min between firefighting work bouts decreases post-firefighting heart rate variability, possibly attributed to a lower parasympathetic reactivation and a higher absolute value of body temperature. more...
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- 2023
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4. Mental health and addiction health service use by physicians compared to non-physicians before and during the COVID-19 pandemic: A population-based cohort study in Ontario, Canada.
- Author
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Myran DT, Roberts R, McArthur E, Jeyakumar N, Hensel JM, Kendall C, Gerin-Lajoie C, McFadden T, Simon C, Garg AX, Sood MM, and Tanuseputro P
- Subjects
- Humans, Ontario epidemiology, Pandemics, Cohort Studies, Patient Acceptance of Health Care, Mental Health, COVID-19 epidemiology
- Abstract
Background: The Coronavirus Disease 2019 (COVID-19) pandemic has exacerbated mental health challenges among physicians and non-physicians. However, it is unclear if the worsening mental health among physicians is due to specific occupational stressors, reflective of general societal stressors during the pandemic, or a combination. We evaluated the difference in mental health and addictions health service use between physicians and non-physicians, before and during the COVID-19 pandemic., Methods and Findings: We conducted a population-based cohort study in Ontario, Canada between March 11, 2017 and August 11, 2021 using data collected from Ontario's universal health system. Physicians were identified using registrations with the College of Physicians and Surgeons of Ontario between 1990 and 2020. Participants included 41,814 physicians and 12,054,070 non-physicians. We compared the first 18 months of the COVID-19 pandemic (March 11, 2020 to August 11, 2021) to the period before COVID-19 pandemic (March 11, 2017 to February 11, 2020). The primary outcome was mental health and addiction outpatient visits overall and subdivided into virtual versus in-person, psychiatrists versus family medicine and general practice clinicians. We used generalized estimating equations for the analyses. Pre-pandemic, after adjustment for age and sex, physicians had higher rates of psychiatry visits (aIRR 3.91 95% CI 3.55 to 4.30) and lower rates of family medicine visits (aIRR 0.62 95% CI 0.58 to 0.66) compared to non-physicians. During the first 18 months of the COVID-19 pandemic, the rate of outpatient mental health and addiction (MHA) visits increased by 23.2% in physicians (888.4 pre versus 1,094.7 during per 1,000 person-years, aIRR 1.39 95% CI 1.28 to 1.51) and 9.8% in non-physicians (615.5 pre versus 675.9 during per 1,000 person-years, aIRR 1.12 95% CI 1.09 to 1.14). Outpatient MHA and virtual care visits increased more among physicians than non-physicians during the first 18 months of the pandemic. Limitations include residual confounding between physician and non-physicians and challenges differentiating whether observed increases in MHA visits during the pandemic are due to stressors or changes in health care access., Conclusions: The first 18 months of the COVID-19 pandemic was associated with a larger increase in outpatient MHA visits in physicians than non-physicians. These findings suggest physicians may have had larger negative mental health during COVID-19 than the general population and highlight the need for increased access to mental health services and system level changes to promote physician wellness., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: MS received speaker fees from AstraZeneca and PT is supported by a Physicians’ Services Incorporated Graham Farquharson Knowledge Translation fellowship. CGL is a CO-PI on a physician wellness grant from the Mach-Gaennslen Foundation matched by the Ottawa Hospital. TM, CGL, CS – The opinions and conclusions expressed are the writers’ own and are not those of the Canadian Medical Association. DTM, RLR, EM, NJ, JH, AXG – These authors have declared that no competing interests exist., (Copyright: © 2023 Myran et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.) more...
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- 2023
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5. Humans not heroes: Canadian emergency physician experiences during the early COVID-19 pandemic.
- Author
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Tran A, Wallner C, de Wit K, Gérin-Lajoie C, Ritchie K, Mercuri M, Clayton N, Boulos M, Archambault P, Schwartz L, Gray S, and Chan TM
- Subjects
- Humans, Male, Female, Pandemics, SARS-CoV-2, Canada epidemiology, COVID-19 epidemiology, Physicians psychology
- Abstract
Background: The pandemic has upended much clinical care, irrevocably changing our health systems and thrusting emergency physicians into a time of great uncertainty and change. This study is a follow-up to a survey that examined the early pandemic experience among Canadian emergency physicians and aimed to qualitatively describe the experiences of these physicians during the global pandemic. The study was conducted at a time when Canadian COVID-19 case numbers were low., Methods: The investigators engaged in an interview-based study that used an interpretive description analytic technique, sensitised by the principles of phenomenology. One-to-one interviews were conducted, transcribed and then analysed to establish a codebook, which was subsequently grouped into key themes. Results underwent source triangulation (with survey data from a similar period) and investigator-driven audit trail analysis., Results: A total of 16 interviews (11 female, 5 male) were conducted between May and September 2020. The isolated themes on emergency physicians' experiences during the early pandemic included: (1) disruption and loss of emergency department shift work; (2) stress of COVID-19 uncertainty and information bombardment; (3) increased team bonding; (4) greater personal life stress; (5) concern for patients' isolation, miscommunication and disconnection from care; (6) emotional distress., Conclusions: Canadian emergency physicians experienced emotional and psychological distress during the early COVID-19 pandemic, at a time when COVID-19 prevalence was low. This study's findings could guide future interventions to protect emergency physicians against pandemic-related distress., Competing Interests: Competing interests: CG-L reports employment with the Canadian Medical Association and notes that the opinions and conclusions expressed are the writers’ own and are not those of the Canadian Medical Association., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2023
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6. Multimodality approach to treat calciphylaxis in end-stage kidney disease patients.
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Lajoie C, Ghanemi A, Bourbeau K, Sidibé A, Wang YP, Desmeules S, and Mac-Way F
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- Humans, Female, Retrospective Studies, Calcium, Calciphylaxis etiology, Calciphylaxis therapy, Kidney Failure, Chronic complications, Kidney Failure, Chronic therapy
- Abstract
A multimodality approach has been proposed as an effective treatment for calciphylaxis in patients with end-stage kidney disease. In this retrospective study, we report the cases of 12 end-stage kidney disease patients from l'Hôtel-Dieu de Québec hospital (Canada) who were diagnosed with calciphylaxis between 2004 and 2012 and treated with a multimodality clinical approach including sodium thiosulfate (STS). Statistical analyses were performed to evaluate the impacts of patients characteristics, the different interventions as well as therapy regimen on the therapeutic response. The majority of patients ( n = 9) were hemodialyzed. The patients-associated comorbidities were consistent with previously reported risk factors for calciphylaxis: Diabetes ( n = 11), calcium-based phosphate binders use ( n = 10), warfarin use ( n = 9), obesity ( n = 7), female gender ( n = 8) and intravenous iron use ( n = 8). STS was given for a median duration of 81 days. 75% of the patients had a response (total or partial) including a complete response in 42% of patients. One-year mortality rate was low (25%). STS was used during a mean duration of 83.33 ± 41.52 days and with a total cumulating dose of 1129.00 ± 490.58 g. The recorded mean time before a complete response was 102.20 days (51-143). Pain improvement occurred after a mean time of 8.67 ± 10.06 days. None of the studied factors was statistically associated with a complete or a partial response to the multimodality approach. Although our data have a limited statistical power, they support treating calciphylaxis with a multimodality approach including STS as its effects are independent from important clinical variables. more...
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- 2023
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7. Cardiorespiratory Fitness of Police Recruits: Normative Reference Values and Temporal Trend.
- Author
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Poirier S, Houle J, Lajoie C, and Trudeau F
- Subjects
- Male, Humans, Female, Adult, Police, Physical Fitness, Reference Values, Exercise Test methods, Retrospective Studies, Canada, Cardiorespiratory Fitness, Cardiovascular Diseases
- Abstract
Abstract: Poirier, S, Houle, J, Lajoie, C, and Trudeau, F. Cardiorespiratory fitness of police recruits: normative reference values and temporal trend. J Strength Cond Res 37(1): 207-212, 2023-Several studies have highlighted the increased risk of cardiovascular diseases (CVDs) among police officers. Given the longitudinal association between cardiorespiratory fitness (CRF) in early adulthood and later appearance of CVD, the identification of police recruits exhibiting lower CRF could allow the implementation of targeted CVD prevention strategies. Unfortunately, norm-referenced values for the CRF of Canadian police recruits are not yet available. Thus, this research aimed to provide norm-referenced values for the CRF of police recruits in the province of Quebec (Canada) and to evaluate the temporal trend in the CRF of police recruits over a 14-year period. First, a model was developed to estimate maximal oxygen consumption (V̇O2max) based on the results of the physical ability test (PAT) used for the recruitment of police officers in Quebec. Based on the previously developed model, the CRF of police recruits who completed the PAT from 2004 to 2017 was retrospectively assessed using administrative records. The analysis of 7,234 PAT results including 2,150 females (29.7%) and 5,084 males (70.3%) suggests that police recruits generally present high levels of CRF with an average estimated V̇O2max of 53.3 ml·min-1·kg-1 for males and 43.8 ml·min-1·kg-1 for females. Furthermore, our analyses showed significant but small positive correlations between estimated V̇O2max and time periods of PAT performance for male (rs = 0.105, p < 0.001) and female recruits (rs = 0.125, p < 0.001). Overall, our results suggest that the CRF of police recruits in Quebec is considerably higher than that of their North American peers., (Copyright © 2022 National Strength and Conditioning Association.) more...
- Published
- 2023
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8. Impact of emulsifiers for the nanoencapsulation with maltodextrin of cannabis oil by spray drying on the physicochemical properties and bioaccessibility of cannabinoids.
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Lajoie C, Doyen A, Feutry P, Gagnon D, and Brisson G
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- Dronabinol, Emulsifying Agents chemistry, Emulsions chemistry, Peroxides, Polysaccharides, Polysorbates chemistry, Powders chemistry, Soybean Proteins, Spray Drying, Water chemistry, Whey Proteins chemistry, Cannabinoids, Cannabis
- Abstract
Our study aimed to investigate the impact of various emulsifiers, namely whey protein isolate (WPI), soy protein isolate (SPI), and Tween 80 (Tw), on their ability to encapsulate cannabis oil with maltodextrin as the wall material. The physicochemical properties of the powder, the stability of the cannabinoids, and their bioaccessibility during static in vitro digestion were examined. The average diameter of fat globules in liquid nanoemulsions was 170, 259, and 95 nm for WPI, SPI, and Tw, respectively. The encapsulation efficiency was high for protein emulsifiers (>95%) compared to Tw (∼16%). Upon powder reconstitution in water, the emulsified fat droplets remained stable for WPI (176 nm); however, higher fat globule size (diameters of 346 nm and 210 nm) was observed for SPI and Tw powders, respectively. All oil powders had high solubility (>97%). The peroxide value (PV) showed nearly a fourfold increase for the oil extracted from the powder than the initial PV of bulk oil (5.2 mEq). However, UPLC-TUV analysis of the main cannabinoids (CBD, THC, and CBN) indicated that there is no significant difference between the various formulations and the bulk oil, except for lower Tw. The in vitro digestion model results showed higher bioaccessibility of the cannabinoids for Tw (∼53%) than for proteins (WPI ∼ 7% and SPI ∼ 10%). These findings suggest that the emulsifiers used for spray drying nanoencapsulation of cannabis oil have an impact on the encapsulation efficiency and cannabinoid bioaccessibility, highlighting the importance of choosing adequate emulsifiying agents for their optimal oral delivery. more...
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- 2022
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9. The benefit of scratch patch testing to demonstrate ocular contact allergy to brimonidine tartrate.
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Ringuet J, Lajoie C, Bourgault S, Simonyan D, and Houle MC
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- Adrenergic alpha-Agonists adverse effects, Brimonidine Tartrate adverse effects, Humans, Patch Tests, Quinoxalines adverse effects, Dermatitis, Allergic Contact diagnosis, Dermatitis, Allergic Contact drug therapy, Dermatitis, Allergic Contact etiology
- Abstract
Introduction: Ocular allergies to brimonidine are frequent in patients treated for glaucoma. There is variability in reporting due to the lack of diagnostic criteria and the absence of cutaneous testing. Many false-negative patch tests (PT) have been described. Alternative methods, such as strip and scratch PT, have been used without a standardized method., Objectives: The primary objective is to identify the best method of cutaneous testing and brimonidine concentration for patch testing. The secondary objective is to identify clinical signs and symptoms suggestive of ocular allergy., Patients and Methods: A retrospective review of patient files suspected of brimonidine ocular allergy was performed. Patch testing method, brimonidine concentration and clinical symptoms were reviewed., Results: Of the 36 patients identified, half tested positive for brimonidine for at least one of the testing methods. The scratch PT demonstrated 17 positive reactions (94% detection rate). Three patients reacted with strip PT. No positive results were found with standard PT. The 5% brimonidine concentration demonstrated the highest sensitivity. The absence of eyelid pruritus was associated with negative testing., Conclusion: In the investigation of ocular allergy to brimonidine, scratch PT proved to be an essential tool. Brimonidine 5% pet. appeared as the most sensitive concentration for scratch PT., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.) more...
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- 2022
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10. Suicide and Self-Harm Among Physicians in Ontario, Canada.
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Sood MM, Rhodes E, Talarico R, Gérin-Lajoie C, Simon C, Spilg E, McFadden T, Kyeeremanteng K, T Myran D, Grubic N, and Tanuseputro P
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- Humans, Ontario epidemiology, Retrospective Studies, Risk Factors, Physicians, Self-Injurious Behavior epidemiology, Suicide psychology
- Abstract
Background: Studies of occupation-associated suicide suggest physicians may be at a higher risk of suicide compared to nonphysicians. We set out to assess the risk of suicide and self-harm among physicians and compare it to nonphysicians., Methods: We conducted a population-based, retrospective cohort study using registration data from the College of Physicians and Surgeons of Ontario from 1990 to 2016 with a follow-up to 2017, linked to Ontario health administrative databases. Using age- and sex-standardized rates and inverse probability-weighted, cause-specific hazards regression models, we compared rates of suicide, self-harm, and a composite of either event among all newly registered physicians to nonphysician controls., Results: Among 35,989 physicians and 6,585,197 nonphysicians, unadjusted suicide events (0.07% vs. 0.11%) and rates (9.44 vs. 11.55 per 100,000 person-years) were similar. Weighted analyses found a hazard ratio of 1.05 (95% confidence interval: 0.69 to 1.60). Self-harm requiring health care was lower among physicians (0.22% vs. 0.46%; hazard ratio: 0.65, 95% confidence interval: 0.52 to 0.82), as was the composite of suicide or self-harm (hazard ratio: 0.70, 95% confidence interval: 0.57 to 0.86). The composite of suicide or self-harm was associated with a history of a mood or anxiety disorder (odds ratio: 2.84, 95% confidence interval: 1.17 to 6.87), an outpatient mental health visit in the past year (odds ratio: 3.08, 95% confidence interval: 1.34 to 7.10) and psychiatry visit in the preceding year (odds ratio: 3.87, 95% confidence interval: 1.67 to 8.95)., Interpretation: Physicians in Ontario are at a similar risk of suicide deaths and a lower risk of self-harm requiring health care relative to nonphysicians. Risk factors associated with suicide or self-harm may help inform prevention programs. more...
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- 2022
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11. Primary Care Physician Use and Frequency of Visits Among Physicians in Ontario, Canada.
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Rhodes E, Kendall C, Talarico R, Muggah E, Gerin-Lajoie C, Simon C, McFadden T, Myran D, Sood MM, and Tanuseputro P
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- Adult, Cohort Studies, Female, Humans, Income, Male, Ontario epidemiology, Retrospective Studies, Physicians, Primary Care
- Abstract
Importance: Maintaining a healthy physician workforce includes the routine use of primary care physician (PCP) services; however, physicians may face barriers to attaining formal care., Objective: To analyze access to and frequency of visits to PCPs among physicians compared with nonphysicians., Design, Setting, and Participants: This population-based, retrospective cohort study used registration data from the College of Physicians and Surgeons of Ontario, Canada, from January 1, 1990, to March 31, 2018. Data for all newly practicing physicians as of March 31, 2018, were linked to Ontario health administrative databases. Data were analyzed from August 25, 2020, to August 6, 2021., Main Outcomes and Measures: The main outcomes were enrollment in a PCP practice and visits with a PCP. Generalized estimating equations compared primary care visits between physicians and nonphysicians, matched 1:5 based on age, sex, neighborhood income quintile, and health region., Results: Among 19 581 physicians (mean [SD] age, 43.99 [8.94] years; 53.27% male) matched to 97 905 nonphysicians, physicians were less likely to be enrolled with a PCP than were nonphysicians (81.8% vs 86.4%; absolute difference, 4.6%; adjusted odds ratio [OR], 0.75; 95% CI, 0.72-0.79) and had fewer primary care visits during the preceding 2 years (median [IQR], 2 [0-4] vs 4 [1-7]; adjusted relative rate ratio [RRR], 0.59; 95% CI, 0.58-0.60). Physicians aged 40 years or older and male physicians were less likely to be rostered (ages 40-44 years: OR, 0.70 [95% CI, 0.64-0.77]; male: OR, 0.60 [95% CI, 0.57-0.63]) and more likely to have a lower frequency of PCP visits (ages 40-44 years: RRR, 0.53 [95% CI, 0.51-0.56]; male: RRR, 0.50 [95% CI, 0.50-0.51]) compared with nonphysicians., Conclusions and Relevance: In this retrospective cohort study, enrollment with a PCP practice and frequency of visits were lower among physicians compared with a matched general population of nonphysicians. Individual, system, and medical cultural factors associated with these results need to be better understood so that physicians can take better care of themselves and their patients. more...
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- 2022
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12. Fitness components associated with performance of a law enforcement physical employment standard in police cadets.
- Author
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Poirier S, Gendron A, Gendron P, and Lajoie C
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- Cross-Sectional Studies, Employment, Exercise Test methods, Humans, Muscle Strength, Physical Fitness, Law Enforcement, Police
- Abstract
Background: The physical preparation of cadets for both physical employment standards (PES) and police job performance is a major concern for police organizations. Identifying fitness components associated with both PES performance and work performance can provide essential information for the physical training of police cadets. Therefore, the objective of this study was to assess the association of fitness components with performance of the Standardized Physical Abilities Test (SPAT), a new law enforcement PES., Methods: A sample of 41 police cadets was recruited to take part in this cross-sectional study. First, the participants were assessed using six fitness assessments (standing broad jump, medicine ball put, grip strength test, visuomotor reaction time (VMRT) test, modified agility T-test, and 600-meter run). In a second experiment, participants performed the SPAT., Results: Bivariate correlation analysis showed moderate to strong associations between each fitness assessment and SPAT performance. Based on stepwise multiple regression analysis, results at the VMRT Test, the medicine ball put, and the agility T-test accounted for 66.0% of the variability in SPAT performance (R
2 =0.660; P<0.001)., Conclusions: Overall, our results suggest that exercise prescriptions for police cadets should focus on power, agility, and VMRT. Furthermore, our results show that performance in a PES can be estimated rather precisely based on low-cost fitness assessments. Therefore, such methodology could be used to develop fitness assessments specific to PES requirements. more...- Published
- 2022
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13. Correction to: Canadian emergency medicine physician burnout: a survey of Canadian emergency physicians during the second wave of the COVID-19 pandemic.
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Mercuri M, Clayton N, Archambault P, Wallner C, Boulos ME, Chan TM, Gérin-Lajoie C, Gray S, Schwartz L, Ritchie K, and de Wit K
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- 2022
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14. Severe Paraneoplastic Dermatomyositis in a Patient With High-Grade Serous Ovarian Cancer.
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Lajoie C, Brault C, Fortin S, de Guerke L, and Auclair MH
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- Female, Humans, Immunoglobulins, Intravenous therapeutic use, Middle Aged, Dermatomyositis complications, Dermatomyositis diagnosis, Dermatomyositis drug therapy, Ovarian Neoplasms complications, Ovarian Neoplasms diagnosis, Ovarian Neoplasms therapy, Paraneoplastic Syndromes diagnosis, Paraneoplastic Syndromes drug therapy, Paraneoplastic Syndromes etiology
- Abstract
Background: Paraneoplastic dermatomyositis following a diagnosis of ovarian cancer is rare. There are very few cases reported on the management of severe forms., Case: We report the case of a 50-year-old woman diagnosed with stage IIIC high-grade serous ovarian cancer and a severe form of paraneoplastic dermatomyositis requiring mechanical ventilation. She had significant comorbidities further adding to the complexity of the chemotherapy regimen. Intravenous immunoglobulin and corticosteroids were also administered. The dermatomyositis remained poorly controlled, and the patient was ultimately referred to palliative care., Conclusion: The necessity to treat the underlying neoplasia creates a fine balance between the aggressive treatments required and the clinical state of the patient. Multidisciplinary collaboration is warranted to offer best management., (Copyright © 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.) more...
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- 2022
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15. Canadian emergency medicine physician burnout: a survey of Canadian emergency physicians during the second wave of the COVID-19 pandemic.
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Mercuri M, Clayton N, Archambault P, Wallner C, Boulos ME, Chan TM, Gérin-Lajoie C, Gray S, Schwartz L, Ritchie K, and de Wit K
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- Burnout, Psychological, Canada epidemiology, Child, Female, Humans, Male, Pandemics, Surveys and Questionnaires, Burnout, Professional epidemiology, Burnout, Professional psychology, COVID-19 epidemiology, Emergency Medicine, Physicians psychology
- Abstract
Objectives: A previous survey of Canadian emergency medicine (EM) physicians during the first wave of the COVID-19 pandemic documented less than 20% experienced high levels of burnout. This study examined the experience of a similar group of physicians during the second pandemic wave. We reported the associations between burnout and physician age, gender, having children at home and training route., Methods: This study utilized a national survey of Canadian emergency physicians. We collected data on demographics and measured burnout using the Maslach Burnout Inventory (MBI). Multiple logistic regression models identified associations between the emotional exhaustion and depersonalization domains of the MBI and EM physician demographics (age, gender, children living at home, and training route)., Results: Between November 25, 2020, and February 4, 2021, 416 emergency physicians completed the survey, representing all Provinces or Territories in Canada (except Nunavut). The mean participant age was 44, 53% were male, 64% had children living at home and 41% were FRCPC and 41% CCFP-EM trained. Sixty percent reported high burnout (either high emotional exhaustion and/or high depersonalization). Increasing age was associated with lower emotional exhaustion and depersonalization; female or nonbinary gender was associated with an increase in emotional exhaustion; and having children living at home was associated with lower depersonalization., Conclusions: Most Canadian emergency physicians participating in our study during the COVID-19 pandemic reported high burnout levels. Younger physicians and female physicians were more likely than their coworkers to report high burnout levels. Hospitals should address emergency physician burnout during the pandemic because it is a threat to quality of patient care and retention of the workforce for the future., (© 2021. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).) more...
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- 2022
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16. Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada.
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Myran DT, Cantor N, Rhodes E, Pugliese M, Hensel J, Taljaard M, Talarico R, Garg AX, McArthur E, Liu CW, Jeyakumar N, Simon C, McFadden T, Gerin-Lajoie C, Sood MM, and Tanuseputro P
- Subjects
- Adult, Ambulatory Care, Anxiety, Cohort Studies, Depression, Family Practice, Female, Humans, Male, Mental Disorders, Middle Aged, Ontario, Psychiatry, Psychological Distress, SARS-CoV-2, Telemedicine, COVID-19, Mental Health, Pandemics, Patient Acceptance of Health Care, Physicians psychology, Stress, Psychological, Substance-Related Disorders
- Abstract
Importance: Physicians self-report high levels of symptoms of anxiety and depression, and surveys suggest these symptoms have been exacerbated by the COVID-19 pandemic. However, it is not known whether pandemic-related stressors have led to increases in health care visits related to mental health or substance use among physicians., Objective: To evaluate the association between the COVID-19 pandemic and changes in outpatient health care visits by physicians related to mental health and substance use and explore differences across physician subgroups of interest., Design, Setting, and Participants: A population-based cohort study was conducted using health administrative data collected from the universal health system (Ontario Health Insurance Plan) of Ontario, Canada, from March 1, 2017, to March 10, 2021. Participants included 34 055 physicians, residents, and fellows who registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018 and were eligible for the Ontario Health Insurance Plan during the study period. Autoregressive integrated moving average models and generalized estimating equations were used in analyses., Exposures: The period during the COVID-19 pandemic (March 11, 2020, to March 10, 2021) compared with the period before the pandemic., Main Outcomes and Measures: The primary outcome was in-person, telemedicine, and virtual care outpatient visits to a psychiatrist or family medicine and general practice clinicians related to mental health and substance use., Results: In the 34 055 practicing physicians (mean [SD] age, 41.7 [10.0] years, 17 918 [52.6%] male), the annual crude number of visits per 1000 physicians increased by 27%, from 816.8 before the COVID-19 pandemic to 1037.5 during the pandemic (adjusted incident rate ratio per physician, 1.13; 95% CI, 1.07-1.19). The absolute proportion of physicians with 1 or more mental health and substance use visits within a year increased from 12.3% before to 13.4% during the pandemic (adjusted odds ratio, 1.08; 95% CI, 1.03-1.14). The relative increase was significantly greater in physicians without a prior mental health and substance use history (adjusted incident rate ratio, 1.72; 95% CI, 1.60-1.85) than in physicians with a prior mental health and substance use history., Conclusions and Relevance: In this study, the COVID-19 pandemic was associated with a substantial increase in mental health and substance use visits among physicians. Physician mental health may have worsened during the pandemic, highlighting a potential greater requirement for access to mental health services and system level change. more...
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- 2022
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17. Cardiorespiratory fitness in police recruits: Assessing the validity of the 20-meter shuttle run test for recruitment purposes.
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Poirier S, Gendron A, Trudeau F, and Lajoie C
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- Exercise Test methods, Humans, Oxygen Consumption, Physical Fitness, Police, Cardiorespiratory Fitness
- Abstract
Background: Although the 20-meter shuttle run test (20MSR) is frequently used by police organisations for recruitment purposes, to our knowledge no study has yet assessed the accuracy of this test to estimate maximal oxygen consumption (VO2max) in police recruits., Objective: The primary objective of this study was to assess the validity of the 20MSR as a predictor of VO2max in police cadets., Methods: 49 police cadets completed both an indirect calorimetry VO2max assessment and a 20MSR. Based on their results, estimated VO2max was calculated using an established equation. Furthermore, two models estimating the VO2max was also developed using the final stage completed and sex as independent variables in the first model (model A) as well as the final half-stage completed and sex in the second model (model B)., Results: A strong and significant bivariate correlation was found between measured VO2max and the final stage completed at the 20MSR (r = 0.874, p < 0.001). Nevertheless, limits of agreement analysis showed relatively large agreement errors between measured VO2max and estimated VO2max based on the established equation (0.46±6.29 ml·min-1·kg-1), model A (0.00±5.58 ml min-1 kg-1), and model B (0.00±5.48 ml min-1·kg-1)., Conclusions: Although the 20MSR can be a useful tool to estimate cardiorespiratory fitness for research and conditioning purposes, the large agreement errors found in this study suggest that results at the 20MSR should be interpreted with caution when making "pass or fail" decisions. more...
- Published
- 2022
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18. Programmed vs. Thirst-Driven Drinking during Prolonged Cycling in a Warm Environment.
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Jeker D, Claveau P, Abed MEF, Deshayes TA, Lajoie C, Gendron P, Hoffman MD, and Goulet EDB
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- Adult, Body Fluids metabolism, Humans, Isometric Contraction, Male, Muscle Cramp epidemiology, Muscle Cramp etiology, Muscle, Skeletal physiology, Time Factors, Young Adult, Athletes, Athletic Performance physiology, Bicycling physiology, Drinking physiology, Environmental Exposure, Physical Endurance physiology, Temperature, Thirst physiology
- Abstract
We compared the effect of programmed (PFI) and thirst-driven (TDFI) fluid intake on prolonged cycling performance and exercise associated muscle cramps (EAMC). Eight male endurance athletes (26 ± 6 years) completed two trials consisting of 5 h of cycling at 61% V˙O2peak followed by a 20 km time-trial (TT) in a randomized crossover sequence at 30 °C, 35% relative humidity. EAMC was assessed after the TT with maximal voluntary isometric contractions of the shortened right plantar flexors. Water intake was either programmed to limit body mass loss to 1% (PFI) or consumed based on perceived thirst (TDFI). Body mass loss reached 1.5 ± 1.0% for PFI and 2.5 ± 0.9% for TDFI ( p = 0.10). Power output during the 20 km TT was higher ( p < 0.05) for PFI (278 ± 41 W) than TDFI (263 ± 39 W), but the total performance time, including the breaks to urinate, was similar ( p = 0.48) between conditions. The prevalence of EAMC of the plantar flexors was similar between the drinking conditions. Cyclists competing in the heat for over 5 h may benefit from PFI aiming to limit body mass loss to <2% when a high intensity effort is required in the later phase of the race and when time lost for urination is not a consideration. more...
- Published
- 2021
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19. Cystoid macular edema secondary to latanoprostene bunod.
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Hébert M, Gravel JF, You E, Qi SR, and Lajoie C
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- Humans, Macular Edema chemically induced, Macular Edema diagnosis, Macular Edema drug therapy, Ocular Hypertension, Prostaglandins F, Synthetic adverse effects
- Published
- 2021
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20. Canadian emergency physician psychological distress and burnout during the first 10 weeks of COVID-19: A mixed-methods study.
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de Wit K, Mercuri M, Wallner C, Clayton N, Archambault P, Ritchie K, Gérin-Lajoie C, Gray S, Schwartz L, and Chan T
- Abstract
Objectives: The aim of this study was to report burnout time trends and describe the psychological effects of working as a Canadian emergency physician during the first weeks of the coronavirus disease 2019 (COVID-19) pandemic., Methods: This was a mixed-methods study. Emergency physicians completed a weekly online survey. The primary outcome was physician burnout as measured by the emotional exhaustion and depersonalization items, from the Maslach Burnout Inventory. We captured data on work patterns, aerosolizing procedures, testing and diagnosis of COVID-19. Each week participants entered free text explaining their experiences and well-being., Results: There were 468 participants who worked in 143 Canadian hospitals. Burnout levels did not significantly change over time (emotional exhaustion P = 0.632, depersonalization P = 0.155). Three participants were diagnosed with COVID-19. Being tested for COVID-19 (odds ratio [OR] 11.5, 95% confidence interval [CI] 3.1-42.5) and the number of shifts worked (OR 1.3, 95% CI 1.1-1.5 per additional shift) were associated with high emotional exhaustion. Having been tested for COVID-19 (OR 4.3, 95% CI 1.1-17.8) was also associated with high depersonalization. Personal safety, academic and educational work, personal protective equipment, the workforce, patient volumes, work patterns, and work environment had an impact on physician well-being. A new financial reality and contrasting negative and positive experiences affected participants' psychological health., Conclusion: Emergency physician burnout levels remained stable during the initial 10 weeks of this pandemic. The impact of COVID-19 on the work environment and personal perceptions and fears about the impact on lifestyle have affected physician well-being., Competing Interests: Dr. Gérin‐Lajoie reports employment with the Canadian Medical Association and notes that the opinions and conclusions expressed are the writers’ own and are not those of the Canadian Medical Association., (© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.) more...
- Published
- 2020
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21. The Concept of Vulnerability in Mental Health Research: A Mixed Methods Study on Researcher Perspectives.
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Lajoie C, Poleksic J, Bracken-Roche D, MacDonald ME, and Racine E
- Subjects
- Humans, Research Personnel, Ethics, Research, Mental Health
- Abstract
The concept of vulnerability plays a central role in research ethics in signaling that certain research participants warrant more careful consideration because their risk of harm is heightened due to their participation in research. Despite scholarly debates, the descriptive and normative meanings ascribed to the concept have remained disengaged from the perspective of users of the concept and those concerned by its use. In this study, we report a survey- and interview-based investigation of mental health researcher perspectives on vulnerability. We found that autonomy-based understandings of vulnerability were predominant but that other understandings coexisted, reflecting considerable pluralism. A wide range of challenges were associated with this concept, and further training was recommended by researchers. more...
- Published
- 2020
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22. Physical training in the fire station and firefighters' cardiovascular health.
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Gendron P, Lajoie C, Laurencelle L, Lemoyne J, and Trudeau F
- Subjects
- Adult, Humans, Male, Occupational Health, Preventive Health Services, Program Evaluation, Quebec, Cardiovascular Diseases prevention & control, Firefighters statistics & numerical data, Health Status Indicators, Occupational Diseases prevention & control, Physical Conditioning, Human methods
- Abstract
Background: Few fire departments in Québec have a diversified health promotion programme. Yet, many allow firefighters to physically train during working hours., Aims: To compare the weekly physical activity (PA) level and cardiovascular health indicators of firefighters who physically train on duty to those who do not., Methods: Participants underwent a cardiovascular health assessment and completed an online questionnaire., Results: One hundred and five full-time male firefighters participated in the study. Two groups were formed: firefighters who physically train while on duty (E, n = 64) and firefighters who do not (NoE, n = 41). Following statistical adjustments, off-duty weekly PA was not different between the two groups (E: 239 ± 224 versus NoE: 269 ± 249 min, P = 0.496); however, total weekly PA was higher (P = 0.035) in E (381 ± 288 min) than in NoE (274 ± 200 min). A difference was also observed in obesity prevalence measured with waist circumference (E: 9% versus NoE: 27%, P = 0.026) and in physical inactivity prevalence (E: 0% versus NoE: 27%, P < 0.001). After statistical adjustments, E firefighters have a significantly lower waist-to-height ratio than NoE firefighters (E: 0.51 ± 0.05 versus NoE: 0.54 ± 0.05, P = 0.017)., Conclusions: Results show that firefighters who physically train while on duty have a higher total PA level on a weekly basis and have better cardiovascular health indicators. Our findings suggest that fire services should promote physical training while on duty to improve firefighters' cardiovascular health., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.) more...
- Published
- 2020
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23. Physicians' access to primary care: results from the Canadian Medical Association National Physician Health Survey.
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McFadden T, Simon C, Kobeissi B, and Gerin-Lajoie C
- Subjects
- Attitude of Health Personnel, Canada epidemiology, Female, Health Surveys statistics & numerical data, Humans, Male, Practice Patterns, Physicians', Health Services Accessibility statistics & numerical data, Physicians statistics & numerical data, Primary Health Care statistics & numerical data, Societies, Medical statistics & numerical data
- Published
- 2020
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24. Enriching our understanding of vulnerability through the experiences and perspectives of individuals living with mental illness.
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Lajoie C, Fortin J, and Racine E
- Subjects
- Ethics, Research, Female, Humans, Interviews as Topic, Male, Qualitative Research, Mental Disorders psychology, Vulnerable Populations psychology
- Abstract
Vulnerability is a central concept in research ethics and typically serves to identify individuals or groups whose participation in research prompts specific concerns or warrants special consideration. While theoretical discussions on vulnerability have contributed valuable insights to discussions of mental health research and care, they have not been enriched thus far by stakeholder perspectives. This oversight has important consequences for the ways in which we frame vulnerability. It misses the far-reaching insights and experiential knowledge of mental health research participants whose experiences this ethics concept ultimately seeks to capture. In view of this gap, our study combines a pragmatist ethics framework and interpretive phenomenological analysis of qualitative interviews to explore user perspectives on the notion of vulnerability through the lived experiences of mental health research participants and patient-advocates. Importantly, these perspectives offer essential clues to address the difficulties of operationalizing concerns for vulnerability in concrete and practical ways. They help refine our understanding of this key ethics concept. more...
- Published
- 2019
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25. Shortened Recovery Period Between Firefighting Work Bouts Increases Cardiac Response Disproportionately With Metabolic Rate.
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Gendron P, Trudeau F, Laurencelle L, Goulet ÉDB, Houle J, and Lajoie C
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- Adult, Anthropometry, Body Temperature, Humans, Male, Oxygen Consumption physiology, Surveys and Questionnaires, Young Adult, Basal Metabolism physiology, Firefighters, Heart Rate physiology, Physical Exertion physiology, Workload
- Abstract
Objective: To compare physiological responses between two firefighting simulations with different recovery periods, one having work bouts intercalated by a shortened recovery period., Methods: Thirteen male firefighters participated in two different simulations, which comprised two identical 25-minute effort bouts (E1 and E2) intercalated by a recovery period of either 20 (T20) or 5 (T5) minutes., Results: From E1 to E2, the increase of mean heart rate (HR) (26 ± 5 vs 14 ± 5 bpm, P < 0.001) and mean VO2 (1.8 ± 0.4 vs 1.3 ± 0.4 mL kg min, P < 0.001) was higher in T5 than in T20., Conclusion: Results indicate that a shortened recovery time between firefighting work bouts intensifies cardiac strain disproportionately with metabolic rate, since mean HR increased by 19.3% and 10.8% while mean VO2 increased by only 7.2% and 5.0% in T5 and T20, respectively. more...
- Published
- 2019
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26. Addressing the Practical Implications of Intersectionality in Clinical Medicine: Ethical, Embodied and Institutional Dimensions.
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Barned C, Lajoie C, and Racine E
- Subjects
- Humans, Morals
- Published
- 2019
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27. Cardiovascular health profile among Québec male and female police officers.
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Gendron P, Lajoie C, Laurencelle L, and Trudeau F
- Subjects
- Adult, Body Mass Index, Cardiovascular Diseases physiopathology, Exercise, Female, Health Surveys, Humans, Male, Middle Aged, Prevalence, Quebec, Risk Factors, Cardiovascular Diseases epidemiology, Obesity epidemiology, Police
- Abstract
To document the cardiovascular health profile of Québec police officers (PO). Participants answered an online questionnaire evaluating the presence of cardiovascular disease (CVD) risk factors and symptoms. Two thousand, ninety-nine (2,099) male (age: 40.8 ± 9.2 years) and 756 female (age: 37.9 ± 7.9 years) PO participated in this study. The prevalence of obesity (body mass index ≥30 kg/m
2 ) and diagnosed hypertension was respectively 21.1, and 14.3% in male and 7.3 and 4.1% in female PO. According to 2013 American College of Sports Medicine guidelines, 27.0 and 48.0% of male and 12.1 and 56.7% of female PO were categorized as being at moderate and high CVD risk, respectively. These findings suggest that Québec police departments should help PO to adopt and maintain a healthy lifestyle to decrease CVD risk. more...- Published
- 2019
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28. Significant differences in maternal carotenoid provisioning and effects on offspring fitness in Chinook salmon colour morphs.
- Author
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Lehnert SJ, Garver KA, Richard J, Devlin RH, Lajoie C, Pitcher TE, and Heath DD
- Subjects
- Animal Feed, Animal Nutritional Physiological Phenomena, Animals, Female, Fish Diseases immunology, Fish Diseases virology, Humans, Infectious hematopoietic necrosis virus, Maternal Nutritional Physiological Phenomena, Ovum, Real-Time Polymerase Chain Reaction veterinary, Rhabdoviridae Infections immunology, Rhabdoviridae Infections veterinary, Rhabdoviridae Infections virology, Salmon growth & development, Carotenoids administration & dosage, Genetic Fitness, Pigmentation genetics, Pigmentation physiology, Salmon physiology
- Abstract
In oviparous species, maternal carotenoid provisioning can deliver diverse fitness benefits to offspring via increased survival, growth and immune function. Despite demonstrated advantages of carotenoids, large intra- and interspecific variation in carotenoid utilization exists, suggesting trade-offs associated with carotenoids. In Chinook salmon (Oncorhynchus tshawytscha), extreme variation in carotenoid utilization delineates two colour morphs (red and white) that differ genetically in their ability to deposit carotenoids into tissues. Here, we take advantage of this natural variation to examine how large differences in maternal carotenoid provisioning influence offspring fitness. Using a full factorial breeding design crossing morphs and common-garden rearing, we measured differences in a suite of fitness-related traits, including survival, growth, viral susceptibility and host response, in offspring of red (carotenoid-rich eggs) and white (carotenoid-poor eggs) females. Eggs of red females had significantly higher carotenoid content than those of white females (6× more); however, this did not translate into measurable differences in offspring fitness. Given that white Chinook salmon may have evolved to counteract their maternal carotenoid deficiency, we also examined the relationship between egg carotenoid content and offspring fitness within each morph separately. Egg carotenoids only had a positive effect within the red morph on survival to eyed-egg (earliest measured trait), but not within the white morph. Although previous work shows that white females benefit from reduced egg predation, our study also supports a hypothesis that white Chinook salmon have evolved additional mechanisms to improve egg survival despite low carotenoids, providing novel insight into evolutionary mechanisms that maintain this stable polymorphism., (© 2018 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2018 European Society For Evolutionary Biology.) more...
- Published
- 2018
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29. Physiological and Psychological Adaptations of Trained Cyclists to Spring Cycling Camps.
- Author
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Dionne JF, Lajoie C, Gendron P, Freiberger E, and Trudeau F
- Abstract
The purpose of our study was to assess physiological adaptations and measure mood outcomes following a cycling training camp in competitive athletes. Fourteen competitive athletes (8 males, 6 females) performed 2 incremental tests to exhaustion before and after a training camp. Volume and intensity (load) of the training regimen were recorded. Submaximal and maximal metabolic data were analysed, as well as economy variables (gross mechanical efficiency and cycling economy). Skeletal muscle adaptations were assessed using near infrared spectroscopy (NIRS). For both genders (n = 14), peak power output, peak power output-W/kg ratio and peak power output-B[La] were significantly increased (p < 0.05) after the cycling training camp (p < 0.05). Significant increases occurred for gross mechanical efficiency measured at the lactate threshold (+4.9%) and at the same precamp lactate threshold power output (+2.9%). At the lactate threshold and Post Camp Lactate Threshold Power, cycling economy increased by 5.2 and 2.9%, respectively (p < 0.05). These power measurements were significantly correlated with individual fluctuations in deoxyhaemoglobin in the vastus lateralis for male cyclists only. Profile of Mood State questionnaire results showed that subcategories "Tension-Anxiety", "Confusion", "Fatigue" and "Total Global Score" significantly decreased after the training camp. Cycling training camps were associated with positive adaptations (increased cycling economy, gross mechanical efficiency and power output) as well as some mental benefits. This indicates that despite some significant physiological adaptations participants probably did not overreach during their CTC. more...
- Published
- 2018
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30. Ice cream rounds: The adaptation, implementation, and evaluation of a peer-support wellness rounds in an emergency medicine resident training program.
- Author
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Calder-Sprackman S, Kumar T, Gerin-Lajoie C, Kilvert M, and Sampsel K
- Subjects
- Canada, Curriculum, Humans, Needs Assessment, Ontario, Program Development, Program Evaluation, Emergency Medicine education, Health Promotion, Internship and Residency, Peer Group, Physicians psychology, Teaching Rounds organization & administration
- Abstract
Introduction/Innovation ConceptEmergency medicine (EM) requires physicians to deal with acutely ill patients in a fast-paced and dynamic environment, which creates a barrier to debriefing after critical events. These unique challenges can negatively impact wellness. We sought to adapt and implement a peer-support wellness program called 'Ice Cream Rounds' in an EM residency setting., Methods: A needs assessment survey was conducted among EM residents at The University of Ottawa to gauge interest and obtain resident input regarding program design. The structure of the sessions was adapted from similar initiatives in Canadian Pediatric Residency programs.Curriculum, Tool or MaterialConfidential peer-support sessions were created and piloted. Residents preferred peer facilitators, rather than staff, so two residents obtained training the Faculty of Medicine's Wellness Program to lead sessions. Attendance at rounds was voluntary; however, overall attendance was recorded along with feedback from pilot sessions. Discussion topics included difficult patient encounters, poor patient outcomes, challenges in residency, and ethical issues. Post implementation feedback demonstrated that Ice Cream Rounds was a helpful forum for residents to discuss important issues with colleagues., Conclusions: This is the first Canadian EM training program to adapt, implement, and evaluate peer-support wellness rounds for debriefing, and this initiative can be easily adopted by any EM training program. more...
- Published
- 2018
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31. Cardiovascular disease risk in female firefighters.
- Author
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Gendron P, Lajoie C, Laurencelle L, and Trudeau F
- Subjects
- Adult, Body Mass Index, Cardiovascular Diseases epidemiology, Cross-Sectional Studies, Diabetes Mellitus, Type 2 epidemiology, Dyslipidemias epidemiology, Female, Humans, Hypertension epidemiology, Middle Aged, Obesity epidemiology, Occupational Health, Quebec, Risk Assessment statistics & numerical data, Risk Factors, Surveys and Questionnaires, Cardiovascular Diseases diagnosis, Firefighters statistics & numerical data, Risk Assessment methods
- Abstract
Background: Female firefighters are in the minority in the Québec firefighter population and worldwide. To our knowledge, no study has focused on cardiovascular risk factors in female firefighters, and further research in this area is needed to evaluate and reduce the risk of on-duty sudden cardiac death., Aims: To evaluate the prevalence of cardiovascular disease (CVD) risk factors in female firefighters in Québec., Methods: A cross-sectional study using an online questionnaire to evaluate lifestyle and CVD risk factors and symptoms., Results: Forty-one female firefighters (age: 38.2 ± 9.9 years) participated in this study, representing ~7% of all female Québec firefighters. The prevalence of obesity (body mass index ≥ 30 kg/m2), hypertension, dyslipidaemia, type 2 diabetes mellitus, smoking and physical inactivity was 12% (95% confidence interval [CI] 4-26%), 5% (95% CI 0.6-19%), 5% (95% CI 0.6-19%), 3% (95% CI 0.1-14%), 14% (95% CI 5-29%) and 62% (95% CI 5-7%), respectively. Among survey participants, 76% (59-88%) had moderate to high CVD risk according to the 2013 American College of Sports Medicine guidelines. Eighty-two per cent of participants did not meet the National Fire Protection Association's required cardiorespiratory fitness standard of 12 metabolic equivalents., Conclusions: A high proportion of female firefighters in this study were at moderate to high risk of CVD. These findings suggest that they would benefit from healthy lifestyle initiatives. more...
- Published
- 2018
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32. Cardiovascular Disease Risk Factors in Québec Male Firefighters.
- Author
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Gendron P, Lajoie C, Laurencelle L, and Trudeau F
- Subjects
- Adult, Body Mass Index, Humans, Life Style, Male, Middle Aged, Prevalence, Quebec, Risk Factors, Surveys and Questionnaires, Symptom Assessment, Diabetes Mellitus, Type 2 epidemiology, Dyslipidemias epidemiology, Firefighters statistics & numerical data, Hypertension epidemiology, Obesity epidemiology
- Abstract
Objective: We aimed to document the prevalence of cardiovascular disease (CVD) risk factors and symptoms in Québec firefighters., Methods: Seven hundred and seventy-nine (779) male firefighters (age: 41.6 ± 10.4 years; body mass index [BMI]: 28.0 ± 3.6 kg/m) answered an online questionnaire evaluating lifestyle and the presence of CVD risk factors and symptoms., Results: The prevalence of obesity (BMI is more than or equal to 30 kg/m), diagnosed hypertension, diagnosed dyslipidemia, and diagnosed type 2 diabetes mellitus was respectively 23.6%, 12.2%, 17.4%, and 1.7%. Among survey participants, 34.5% were categorized as moderate and 43.6% as high CVD risk, according to American College of Sports Medicine guidelines., Conclusions: A high proportion of Québec firefighters are at moderate to high risk of CVD. These findings suggest that Québec fire departments should help all firefighters to adopt and maintain a healthy lifestyle. more...
- Published
- 2018
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33. Physician performance feedback in a Canadian academic center.
- Author
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Garvin D, Worthington J, McGuire S, Burgetz S, Forster AJ, Patey A, Gerin-Lajoie C, Turnbull J, and Roth V
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Ontario, Patient Satisfaction, Quality Indicators, Health Care, Clinical Competence, Formative Feedback, Practice Patterns, Physicians', Quality of Health Care
- Abstract
Purpose This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization. Design/methodology/approach A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions. Findings This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met. Originality/value This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement. more...
- Published
- 2017
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34. Medical Assistance in Dying.
- Author
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Ritchie K, Gérin-Lajoie C, and Naik V
- Subjects
- Humans, Medical Assistance, Terminal Care, Euthanasia, Suicide, Assisted
- Published
- 2017
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35. Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer.
- Author
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Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, and Green E
- Subjects
- Cooperative Behavior, Humans, Psychotherapy methods, Depression therapy, Depressive Disorder, Major therapy, Neoplasms psychology, Patient Care Team
- Abstract
Background: Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta-analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow-up. Meta-analyses of pharmacological and psychological interventions are included as a comparison., Methods: A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancer patients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta-analyses were conducted using summary data., Results: Key findings included eight reports of four collaborative care interventions, eight pharmacological, and nine psychological trials. A meta-analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short-term (up to 12 weeks), but not longer-term effectiveness was demonstrated for both pharmacological and psychological interventions., Conclusions: Collaborative care interventions have newly emerged as multidisciplinary care delivery models, which may result in more long-term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancer patients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence-base for the management of depression in cancer., (Copyright © 2016 John Wiley & Sons, Ltd.) more...
- Published
- 2017
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36. Management of Depression in Patients With Cancer: A Clinical Practice Guideline.
- Author
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Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, and Green E
- Subjects
- Antidepressive Agents therapeutic use, Combined Modality Therapy, Depression diagnosis, Depression drug therapy, Humans, Neoplasms drug therapy, Ontario, Practice Guidelines as Topic, Psychotherapy, Randomized Controlled Trials as Topic, Depression therapy, Neoplasms therapy
- Abstract
Purpose: This report updates the Cancer Care Ontario Program in Evidence-Based Care guideline for the management of depression in adult patients with cancer. This guideline covers pharmacologic, psychological, and collaborative care interventions, with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer., Methods: Recommendations were developed by synthesizing information from extant guidelines and reviews and searching for randomized controlled trials from the date of database inception (1964 for MEDLINE and 1974 for EMBASE) to January 2015. Quality assessment of guidelines and systematic reviews were conducted by using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), Assessment of Multiple Systematic Reviews (AMSTAR), and Cochrane Risk of Bias tools. Final recommendations were developed through a standardized Program in Evidence-Based Care multidisciplinary expert and knowledge user review process., Results: Two high-quality relevant clinical practice guidelines, eight pharmacologic trials, nine psychological trials, and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed. Eight specific recommendations were made to establish a standard of care for the management of depression in patients with cancer. The recommendations and practical management tools were reviewed as being well organized and helpful, although systemic barriers to implementation were identified., Conclusion: This updated guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and/or pharmacologic interventions, without evidence for the superiority of any specific treatment over another. New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression., (Copyright © 2016 by American Society of Clinical Oncology.) more...
- Published
- 2016
- Full Text
- View/download PDF
37. Influence on intraocular pressure of anti-inflammatory treatments after selective laser trabeculoplasty.
- Author
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Champagne S, Anctil JL, Goyette A, Lajoie C, and Des Marchais B
- Subjects
- Aged, Anti-Inflammatory Agents adverse effects, Anti-Inflammatory Agents therapeutic use, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Anti-Inflammatory Agents, Non-Steroidal pharmacology, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Clonidine analogs & derivatives, Clonidine therapeutic use, Combined Modality Therapy, Diclofenac adverse effects, Diclofenac therapeutic use, Double-Blind Method, Eye Pain drug therapy, Eye Pain prevention & control, Female, Follow-Up Studies, Glaucoma, Open-Angle drug therapy, Humans, Male, Middle Aged, Models, Immunological, Pain, Postoperative drug therapy, Pain, Postoperative prevention & control, Placebos, Postoperative Complications drug therapy, Prednisolone adverse effects, Prednisolone pharmacology, Prednisolone therapeutic use, Prospective Studies, Surveys and Questionnaires, Treatment Outcome, Uveitis, Anterior drug therapy, Anti-Inflammatory Agents pharmacology, Diclofenac pharmacology, Glaucoma, Open-Angle surgery, Intraocular Pressure drug effects, Laser Therapy, Postoperative Complications prevention & control, Prednisolone analogs & derivatives, Trabeculectomy, Uveitis, Anterior prevention & control
- Abstract
Introduction: Selective laser trabeculoplasty (SLT) is an effective and safe procedure to lower intraocular pressure (IOP) in the management of open-angle glaucoma. The post-laser inflammatory reaction could be positively implicated in SLT efficacy and the relevance of postoperative use of topical anti-inflammatory remains controversial. The goal of this study is to determine the effect of various anti-inflammatory treatments on intraocular pressure and on side effects following SLT., Material and Methods: A prospective, randomized, double-blind study with a control group was conducted. Ninety-six eyes of 67 patients with primary open-angle glaucoma who underwent SLT were enrolled in this study between March 2009 and March 2012. Eyes recruited in the study were randomized to receive either prednisolone acetate 1%, diclofenac 0.1% or a placebo. The 3 treatments were administered 4 times a day for 5 days following SLT. The intraocular pressures were measured at regular intervals during the 6-months follow-up period. Side effects were also evaluated with a questionnaire as well as with the ocular exam., Results: The analysis of the relative IOP decrease over the 6-months period revealed a significant difference between the time points of follow-up (P<0.0001), but no group effect (P=0.2980). No significant difference regarding anterior chamber inflammation and discomfort was observed between the 3 groups., Conclusion: There was no difference in intraocular pressure reduction, intraocular inflammation or ocular discomfort post-SLT when comparing the 3 treatment modalities., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.) more...
- Published
- 2015
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38. Greater physical fitness is associated with better air ventilation efficiency in firefighters.
- Author
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Gendron P, Freiberger E, Laurencelle L, Trudeau F, and Lajoie C
- Subjects
- Adult, Exercise Test, Humans, Male, Metabolic Equivalent, Oxygen metabolism, Respiratory Protective Devices, Task Performance and Analysis, Time Factors, Walking physiology, Young Adult, Firefighters, Muscle, Skeletal metabolism, Physical Exertion physiology, Physical Fitness physiology, Pulmonary Ventilation physiology
- Abstract
Firefighting is a hazardous task associated with a heavy workload where task duration may be limited by air cylinder capacity. Increased fitness may lead to better air ventilation efficiency and task duration at a given heavy work intensity. This study compared performance, air ventilation and skeletal muscle oxygen extraction during a maximal graded walking test (GWT), a 10 METS (metabolic equivalent) treadmill test (T10) and a simulated work circuit (SWC). Participants (n = 13) who performed the SWC in a shorter time had significantly lower air cylinder ventilation values on the T10 (r = -0.495), better peak oxygen consumption (r = -0.924) during the GWT and significantly greater skeletal muscle oxygen extraction during the SWC (HbDiff, r = 0.768). These results demonstrate that the fastest participants on the SWC had better air ventilation efficiency that could prolong interventions in difficult situations requiring air cylinder use., (Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.) more...
- Published
- 2015
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39. Energy expenditure at work in physical education teachers.
- Author
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Trudeau F, Laurencelle L, and Lajoie C
- Subjects
- Adult, Female, Heart Rate physiology, Humans, Male, Oxygen Consumption physiology, Physical Fitness physiology, Quebec, Energy Metabolism, Motor Activity physiology, Occupational Health, Physical Education and Training
- Abstract
The objective of this study was to quantify work energy expenditure (EE) in physical education (PE) teachers. Sixty-four (64) physical educators (49 men, 15 women) had their individualized linear function between heart rate (HR) and oxygen consumption measured by laboratory testing. HR was then recorded on 2 different days at work to estimate EE, correlated with a diary of daily tasks. Average absolute EE was low-to-moderate (2.7 ± 1.4 to 4.6 ± 2.5 kcal·min(-1)) and low when expressed in relative values (15.3 ± 6.1% to 24.8 ± 7.6% of VO2max). However, these physical educators often reached very high intensities (from 7.5 ± 7.9% to 23.8 ± 22.3% of work time at 100 bpm and more). PE teaching requires a light-to-moderate EE with more intense periods of physical activity. The variety of tasks performed (office work, supervision and monitoring, mixed participation and active participation) significantly influenced EE., (Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.) more...
- Published
- 2015
- Full Text
- View/download PDF
40. Complete normalization of severe brain 18F-FDG hypometabolism following electroconvulsive therapy in a major depressive episode.
- Author
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Lajoie C, Levasseur MA, and Paquet N
- Subjects
- Aged, Depressive Disorder, Major diagnostic imaging, Female, Humans, Positron-Emission Tomography, Brain diagnostic imaging, Brain metabolism, Depressive Disorder, Major metabolism, Depressive Disorder, Major therapy, Electroconvulsive Therapy, Fluorodeoxyglucose F18
- Abstract
We describe a patient with a complex neuropsychiatric disorder who presented a severe and diffuse cerebral glucose hypometabolism on (18)F-FDG PET initially which, in the clinical setting, was suspicious of an advanced neurodegenerative disease. Further evaluation suggested a major depressive episode with agitation and poor response to medication. Electroconvulsive therapy (ECT) brought excellent results. A follow-up cerebral (18)F-FDG PET was completely normal, thus illustrating the potential for complete recovery and normalization of brain metabolism in major depressive episode following ECT. It also shows the risk of false interpretation of brain PET in patients with depression. more...
- Published
- 2013
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- View/download PDF
41. Clinical Focus on Prosodic, Discursive and Pragmatic Treatment for Right Hemisphere Damaged Adults: What's Right?
- Author
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Ferré P, Ska B, Lajoie C, Bleau A, and Joanette Y
- Abstract
Researchers and clinicians acknowledge today that the contribution of both cerebral hemispheres is necessary to a full and adequate verbal communication. Indeed, it is estimated that at least 50% of right brain damaged individuals display impairments of prosodic, discourse, pragmatics and/or lexical semantics dimensions of communication. Since the 1990's, researchers have focused on the description and the assessment of these impairments and it is only recently that authors have shown interest in planning specific intervention approaches. However, therapists in rehabilitation settings still have very few available tools. This review of recent literature demonstrates that, even though theoretical knowledge needs further methodological investigation, intervention guidelines can be identified to target right hemisphere damage communication impairments in clinical practice. These principles can be incorporated by speech and language pathologists, in a structured intervention framework, aiming at fully addressing prosodic, discursive and pragmatic components of communication. more...
- Published
- 2011
- Full Text
- View/download PDF
42. Immunization with a poly (lactide co-glycolide) encapsulated plasmid DNA expressing antigenic regions of HPV 16 and 18 results in an increase in the precursor frequency of T cells that respond to epitopes from HPV 16, 18, 6 and 11.
- Author
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Matijevic M, Hedley ML, Urban RG, Chicz RM, Lajoie C, and Luby TM
- Subjects
- Adult, Antigens, Viral genetics, Cancer Vaccines administration & dosage, Double-Blind Method, Female, Human papillomavirus 11 immunology, Human papillomavirus 6 immunology, Humans, Immunization, Immunodominant Epitopes, Plasmids, Polyglactin 910, Precursor Cells, T-Lymphoid immunology, Uterine Cervical Neoplasms virology, Vaccines, DNA administration & dosage, Young Adult, Uterine Cervical Dysplasia virology, Antigen Presentation, Antigens, Viral immunology, Cancer Vaccines immunology, Human papillomavirus 16 immunology, Human papillomavirus 18 immunology, T-Lymphocytes immunology, Uterine Cervical Neoplasms immunology, Uterine Cervical Neoplasms therapy, Vaccines, DNA immunology, Uterine Cervical Dysplasia immunology, Uterine Cervical Dysplasia therapy
- Abstract
A phase II trial was conducted in subjects with human papillomavirus (HPV) associated high-grade cervical dysplasia testing the safety and efficacy of a microparticle encapsulated pDNA vaccine. Amolimogene expresses T cell epitopes from E6 and E7 proteins of HPV types 16 and 18. An analysis was performed on a subset of HLA-A2+ subjects to test whether CD8+ T cells specific to HPV 16, 18, 6 and 11 were increased in response to amolimogene immunization. Of the 21 subjects receiving amolimogene, 11 had elevated CD8+ T cell responses to HPV 16 and/or 18 peptides and seven of these also had increases to corresponding HPV 6 and/or 11 peptides. In addition, T cells primed and expanded in vitro with an HPV 18 peptide demonstrated cross-reactivity to the corresponding HPV 11 peptide. These data demonstrate that treatment with amolimogene elicits T cell responses to HPV 16, 18, 6 and 11., (Copyright © 2011 Elsevier Inc. All rights reserved.) more...
- Published
- 2011
- Full Text
- View/download PDF
43. In vivo electroporation enhances the potency of poly-lactide co-glycolide (PLG) plasmid DNA immunization.
- Author
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Barbon CM, Baker L, Lajoie C, Ramstedt U, Hedley ML, and Luby TM
- Subjects
- Adjuvants, Immunologic pharmacology, Animals, Antigen-Presenting Cells immunology, Aryl Hydrocarbon Hydroxylases immunology, Cell Line, Tumor, Cytochrome P-450 CYP1B1, Cytokines immunology, Female, Immunity, Innate, Injections, Intramuscular, Mice, Mice, Inbred BALB C, Mice, Inbred C3H, Mice, Transgenic, Microspheres, Phagocytes immunology, Plasmids immunology, Polylactic Acid-Polyglycolic Acid Copolymer, T-Lymphocytes immunology, Electroporation, Lactic Acid pharmacology, Polyglycolic Acid pharmacology, Vaccines, DNA immunology
- Abstract
Immunization with plasmid DNA that has been encapsulated in poly lactide-co-glycolide (PLG) microparticles targets the plasmid DNA to antigen presenting cells and elicits immune responses to the encoded antigen(s). Application of a series of electrical pulses (EPT) immediately following unformulated DNA injection enhances expression of the encoded antigen and increases immune responses. The combination of using EPT before or after PLG-encapsulated plasmid DNA immunization was tested to determine if enhanced immune responses would be generated. The results show that the combination lead to both enhanced expression of antigen and more robust T cell responses, even if EPT was applied prior to immunization. The data also demonstrate that recruitment of phagocytes to the injection site was markedly enhanced by EPT, and this resulted in an increase of the antigen expression levels in these cells. Co-administration of microparticles and EPT also effected localized necrosis of muscle fibers, caused persistent Th-1-modulated cytokine production, and lead to the release of two endogenous adjuvants, uric acid and HMGB1. In all, we describe that increased immunogenicity observed with the combination of PLG-encapsulated plasmid DNA microparticle with EPT was caused by an increase in the recruitment of antigen presenting cells which mediated a more robust T cell response than observed with immunization alone., (Copyright © 2010 Elsevier Ltd. All rights reserved.) more...
- Published
- 2010
- Full Text
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44. Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy.
- Author
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Letartre L, Basheikh A, Anctil JL, Des Marchais B, Goyette A, Kasner OP, and Lajoie C
- Subjects
- Adult, Aged, Aged, 80 and over, Aqueous Humor metabolism, Conjunctiva surgery, Female, Glaucoma surgery, Humans, Male, Middle Aged, Ocular Hypotension etiology, Ocular Hypotension metabolism, Retrospective Studies, Visual Acuity, Intraocular Pressure, Ocular Hypotension surgery, Sclera surgery, Surgical Flaps, Suture Techniques, Trabeculectomy adverse effects
- Abstract
Objective: To assess the efficacy of transconjunctival suturing of the scleral flap in improving hypotony maculopathy resulting from overfiltration after trabeculectomy., Design: Retrospective review., Participants: 35 eyes of 33 patients., Methods: Patients underwent transconjunctival scleral flap suturing for hypotony maculopathy following trabeculectomy using mitomycin C. The scleral flap was sutured through the conjunctiva as an outpatient clinic procedure using a spatulated needle with a 10-0 nylon suture., Results: The average age of the patients was 67.5 (SD 4.80, range 39-83) years, and 52% patients were male. The average duration of hypotony prior to transconjunctival suturing of the flap was 108.0 (SD 68.3) days. The median intraocular pressure (IOP) before suturing was 3 mm Hg, and the median IOP 6 months after the procedure was 9 mm Hg (p < 0.0001). The median best-corrected visual acuity (BCVA) before transconjunctival suturing of the scleral flap was 20/100, and the median BCVA 6 months after the procedure was 20/30 (p < 0.0001). Compared with visual acuity before suturing the average gain in BCVA was 4.9 (SD 0.8) lines., Conclusions: Transconjunctival suturing of the trabeculectomy scleral flap is an effective treatment to raise IOP and improve visual loss from hypotony maculopathy after trabeculectomy with overfiltering blebs. more...
- Published
- 2009
- Full Text
- View/download PDF
45. The cardiac neural stem cell phenotype is compromised in streptozotocin-induced diabetic cardiomyopathy.
- Author
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El-Helou V, Proulx C, Béguin P, Assimakopoulos J, Gosselin H, Clement R, Villeneuve L, Huot-Marchand JE, Deblois D, Lajoie C, and Calderone A
- Subjects
- Animals, Apoptosis physiology, Blood Glucose drug effects, Blood Glucose metabolism, Body Weight, Dexamethasone pharmacology, Glucocorticoids pharmacology, Humans, Insulin metabolism, Intermediate Filament Proteins genetics, Intermediate Filament Proteins metabolism, Male, Nerve Tissue Proteins genetics, Nerve Tissue Proteins metabolism, Nestin, Neurons physiology, Organ Size, Rats, Rats, Sprague-Dawley, Rats, Zucker, Stem Cells cytology, Ventricular Function, Left physiology, Ventricular Remodeling, Cardiomyopathies etiology, Cardiomyopathies pathology, Diabetes Mellitus, Experimental complications, Diabetes Mellitus, Experimental pathology, Myocardium cytology, Neurons cytology, Phenotype, Stem Cells physiology
- Abstract
Neural stem cells were identified in the rat heart and during scar formation and healing participated in sympathetic fiber sprouting and angiogenesis. In the setting of diabetes, impaired wound healing represents a typical pathological feature. These findings provided the impetus to test the hypothesis that experimental diabetes adversely influenced the phenotype of cardiac neural stem cells. Streptozotocin (STZ)-induced diabetic rats were associated with elevated plasma glucose levels, significant loss of body weight and left ventricular contractile dysfunction. In the heart of STZ-diabetic rats, the density of nestin immunoreactive processes emanating from cardiac neural stem cells were reduced. The latter finding was reaffirmed as nestin protein expression was significantly decreased in the heart of STZ-diabetic rats and associated with a concomitant reduction of nestin mRNA. Employing the TUNEL assay, the loss of nestin expression in STZ-diabetic rats was not attributed to widespread cardiac neural stem cell apoptosis. Insulin administration to STZ-diabetic rats with established hyperglycaemia led to a modest recovery of nestin protein expression in cardiac neural stem cells. By contrast, the administration of insulin immediately after STZ injection improved plasma glucose levels and significantly attenuated the loss of nestin protein expression. These data highlight the novel observation that nestin protein expression in cardiac neural stem cells was significantly reduced in STZ-induced type I diabetic rats. The aberrant cardiac neural stem cell phenotype may compromise their biological role and predispose the diabetic heart to maladaptive healing following ischemic injury. more...
- Published
- 2009
- Full Text
- View/download PDF
46. Infarct size is increased in female post-MI rats treated with rapamycin.
- Author
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Lajoie C, El-Helou V, Proulx C, Clément R, Gosselin H, and Calderone A
- Subjects
- Animals, Blotting, Western, Cicatrix prevention & control, Collagen biosynthesis, Disease Models, Animal, Female, Fibrosis, Heart Ventricles drug effects, Heart Ventricles enzymology, Heart Ventricles metabolism, Heart Ventricles pathology, Myocardial Infarction enzymology, Myocardial Infarction prevention & control, Myocardium enzymology, Myocardium metabolism, Nitric Oxide Synthase Type III antagonists & inhibitors, Phosphorylation, Rats, Rats, Sprague-Dawley, Ribosomal Protein S6 Kinases, 70-kDa metabolism, Sirolimus administration & dosage, Sirolimus adverse effects, Sirolimus therapeutic use, Transforming Growth Factor beta3 biosynthesis, Cicatrix pathology, Myocardial Infarction pathology, Myocardium pathology, Sirolimus pharmacology, Ventricular Remodeling drug effects
- Abstract
Rapamycin represents a recognized drug-based therapeutic approach to treat cardiovascular disease. However, at least in the female heart, rapamycin may suppress the recruitment of putative signalling events conferring cardioprotection. The present study tested the hypothesis that rapamycin-sensitive signalling events contributed to the cardioprotective phenotype of the female rat heart after an ischemic insult. Rapamycin (1.5 mg/kg) was administered to adult female Sprague-Dawley rats 24 h after complete coronary artery ligation and continued for 6 days. Rapamycin abrogated p70S6K phosphorylation in the left ventricle of sham rats and the noninfarcted left ventricle (NILV) of 1-week postmyocardial-infarcted (MI) rats. Scar weight (MI 0.028 +/- 0.006, MI+rapamycin 0.064 +/- 0.004 g) and surface area (MI 0.37 +/- 0.08, MI+rapamycin 0.74 +/- 0.03 cm2) were significantly larger in rapamycin-treated post-MI rats. In the NILV of post-MI female rats, rapamycin inhibited the upregulation of eNOS. Furthermore, the increased expression of collagen and TGF-beta3 mRNAs in the NILV were attenuated in rapamycin-treated post-MI rats, whereas scar healing was unaffected. The present study has demonstrated that rapamycin-sensitive signalling events were implicated in scar formation and reactive fibrosis. Rapamycin-mediated suppression of eNOS and TGF-beta3 mRNA in post-MI female rats may have directly contributed to the larger infarct and attenuation of the reactive fibrotic response, respectively. more...
- Published
- 2009
- Full Text
- View/download PDF
47. Female rats fed a high-fat diet were associated with vascular dysfunction and cardiac fibrosis in the absence of overt obesity and hyperlipidemia: therapeutic potential of resveratrol.
- Author
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Aubin MC, Lajoie C, Clément R, Gosselin H, Calderone A, and Perrault LP
- Subjects
- Acetylcholine pharmacology, Animals, Aorta drug effects, Aorta physiology, Blood Pressure, Female, Fibrosis pathology, Hyperlipidemias, Myocardium pathology, Nitroprusside pharmacology, Obesity, Rats, Rats, Sprague-Dawley, Resveratrol, Vasodilation drug effects, Vasodilator Agents pharmacology, Ventricular Dysfunction, Left pathology, Ventricular Dysfunction, Left physiopathology, Antioxidants therapeutic use, Dietary Fats administration & dosage, Fibrosis physiopathology, Stilbenes therapeutic use, Ventricular Dysfunction, Left drug therapy
- Abstract
It remains presently unknown whether vascular reactivity is impaired and whether maladaptive cardiac remodeling occurs before the onset of overt obesity and in the absence of hyperlipidemia. Normal female rats were fed a high-fat diet for 8 weeks and were associated with a modest nonsignificant increase of body weight (standard diet, 300 +/- 10, versus high-fat diet, 329 +/- 14 g) and a normal plasma lipid profile. In rats fed a high-fat diet, systolic (171 +/- 7 mm Hg) and diastolic blood pressures (109 +/- 3) were increased compared to a standard diet (systolic blood pressure, 134 +/- 8; diastolic blood pressure, 96 +/- 5 mm Hg), and acetylcholine-dependent relaxation of isolated aortic rings (high-fat diet, 22 +/- 5%, versus standard diet, 53 +/- 8%) was significantly reduced. Furthermore, perivascular fibrosis was detected in the heart of rats fed a high-fat diet. The exogenous addition of resveratrol (trans-3,5,4'-trihydroxystilbene) (0.1 microM) to aortic rings isolated from rats fed a high-fat diet restored acetylcholine-mediated relaxation (47 +/- 9%). The administration of resveratrol (20 mg/kg/day for 8 weeks) to rats fed a high-fat diet prevented the increase in blood pressure and preserved acetylcholine-dependent relaxation of isolated aortic rings. However, resveratrol therapy failed to attenuate the perivascular fibrotic response. These data have demonstrated that a high-fat diet fed to normal female rats can elicit a hypertensive response and induce perivascular fibrosis before the development of overt obesity and in the absence of hyperlipidemia. Resveratrol therapy can prevent the hypertensive response in female rats fed a high-fat diet but is without effect on the progression of perivascular fibrosis. more...
- Published
- 2008
- Full Text
- View/download PDF
48. Effects of pH and temperature on recombinant manganese peroxidase production and stability.
- Author
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Jiang F, Kongsaeree P, Schilke K, Lajoie C, and Kelly C
- Subjects
- Enzyme Activation, Enzyme Stability, Hydrogen-Ion Concentration, Recombinant Proteins chemistry, Recombinant Proteins metabolism, Temperature, Peroxidases chemistry, Peroxidases metabolism, Pichia enzymology, Pichia genetics
- Abstract
The enzyme manganese peroxidase (MnP) is produced by numerous white-rot fungi to overcome biomass recalcitrance caused by lignin. MnP acts directly on lignin and increases access of the woody structure to synergistic wood-degrading enzymes such as cellulases and xylanases. Recombinant MnP (rMnP) can be produced in the yeast Pichia pastoris alphaMnP1-1 in fed-batch fermentations. The effects of pH and temperature on recombinant manganese peroxidase (rMnP) production by P. pastoris alphaMnP1-1 were investigated in shake flask and fed-batch fermentations. The optimum pH and temperature for a standardized fed-batch fermentation process for rMnP production in P. pastoris alphaMnP1-1 were determined to be pH 6 and 30 degrees C, respectively. P. pastoris alphaMnP1-1 constitutively expresses the manganese peroxidase (mnp1) complementary DNA from Phanerochaete chrysosporium, and the rMnP has similar kinetic characteristics and pH activity and stability ranges as the wild-type MnP (wtMnP). Cultivation of P. chrysosporium mycelia in stationary flasks for production of heme peroxidases is commonly conducted at low pH (pH 4.2). However, shake flask and fed-batch fermentation experiments with P. pastoris alphaMnP1-1 demonstrated that rMnP production is highest at pH 6, with rMnP concentrations in the medium declining rapidly at pH less than 5.5, although cell growth rates were similar from pH 4-7. Investigations of the cause of low rMnP production at low pH were consistent with the hypothesis that intracellular proteases are released from dead and lysed yeast cells during the fermentation that are active against rMnP at pH less than 5.5. more...
- Published
- 2008
- Full Text
- View/download PDF
49. Effect of furfural, vanillin and syringaldehyde on Candida guilliermondii growth and xylitol biosynthesis.
- Author
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Kelly C, Jones O, Barnhart C, and Lajoie C
- Subjects
- Candida drug effects, Cell Proliferation drug effects, Dose-Response Relationship, Drug, Benzaldehydes administration & dosage, Bioreactors microbiology, Candida cytology, Candida physiology, Cell Culture Techniques methods, Furaldehyde administration & dosage, Xylitol metabolism
- Abstract
Xylitol is a five-carbon sugar alcohol with established commercial use as an alternative sweetener and can be produced from hemicellulose hydrolysate. However, there are difficulties with microbiological growth and xylitol biosynthesis on hydrolysate because of the inhibitors formed from hydrolysis of hemicellulose. This research focused on the effect of furfural, vanillin, and syringaldehyde on growth of Candida guilliermondii and xylitol accumulation from xylose in a semi-synthetic medium in microwell plate and bioreactor cultivations. All three compounds reduced specific growth rate, increased lag time, and reduced xylitol production rate. In general, increasing concentration of inhibitor increased the severity of inhibition, except in the case of 0.5 g vanillin per liter, which resulted in a faster late batch phase growth rate and increased biomass yield. At concentrations of 1 g/l or higher, furfural was the least inhibitory to growth, followed by syringaldehyde. Vanillin most severely reduced specific growth rate. All three inhibitors reduced xylitol production rate approximately to the same degree. more...
- Published
- 2008
- Full Text
- View/download PDF
50. Production and separation of manganese peroxidase from heme amended yeast cultures.
- Author
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Jiang F, Kongsaeree P, Charron R, Lajoie C, Xu H, Scott G, and Kelly C
- Subjects
- Cell Proliferation, Enzyme Activation, Enzyme Stability, Peroxidases genetics, Phanerochaete genetics, Recombinant Proteins metabolism, Cell Culture Techniques methods, Heme metabolism, Peroxidases isolation & purification, Peroxidases metabolism, Phanerochaete metabolism, Pichia physiology, Protein Engineering methods
- Abstract
A method for the production and concentration of the lignin-degrading enzyme, manganese peroxidase (rMnP), was developed using the yeast Pichia pastoris in high cell density, fed-batch cultivations. A gene encoding manganese peroxidase (mnp1) from the white-rot fungus Phanerochaete chrysosporium was cloned into a protease deficient (pep4-) strain of the methylotrophic yeast P. pastoris. Heme is an important cofactor for active rMnP production, and amendment of yeast cultures with heme increased active rMnP concentrations. In both shake-flasks and fed-batch bioreactors, the relationship between heme concentration and rMnP activity was logarithmic, with increasing heme concentrations resulting in progressively lesser increases in enzyme activity. Scale-up from shake-flasks to 2 L fed-batch cultivations increased rMnP activities from 200 U/L to 2,500 U/L, with addition of 0.1 g/L heme (added heme per liquid volume) at the beginning of the fed-batch phase resulting in higher enzyme activities than addition at the beginning of the batch phase. A combination of centrifugation, acetone precipitation, dialysis, and freeze drying was found to be effective for concentrating the rMnP from 2,500 U/L in the P. pastoris bioreactor culture to 30,000 U/L in 0.1 M potassium phosphate buffer pH 6. The rMnP recovery yield was 60% and the purity was 1-4%. By using 0.1 g/L heme during the fed-batch cultivation, the heme content of the final enzyme preparation could be reduced by 97%, and had sufficiently high rMnP activity and low enough color to be suitable for pulp bleaching experiments., ((c) 2007 Wiley Periodicals, Inc.) more...
- Published
- 2008
- Full Text
- View/download PDF
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