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Question(s): How cost-effective is group-based pelvic floor muscle training (PFMT) for treating urinary incontinence in older women?, Design: Economic evaluation conducted alongside an assessor-blinded, multicentre randomised non-inferiority trial with 1-year follow-up., Participants: A total of 362 women aged ≥ 60 years with stress or mixed urinary incontinence., Intervention: Twelve weekly 1-hour PFMT sessions delivered individually (one physiotherapist per woman) or in groups (one physiotherapist per eight women)., Outcome Measures: Urinary incontinence-related costs per woman were estimated from a participant and provider perspective over 1 year in Canadian dollars, 2019. Effectiveness was based on reduction in leakage episodes and quality-adjusted life years. Incremental cost-effectiveness ratios and net monetary benefit were calculated for each of the effectiveness outcomes and perspectives., Results: Both group-based and individual PFMT were effective in reducing leakage and promoting gains in quality-adjusted life years. Furthermore, group-based PFMT was ≥ 60% less costly than individual treatment, regardless of the perspective studied: -$914 (95% CI -970 to -863) from the participant's perspective and -$509 (95% CI -523 to -496) from the provider's perspective. Differences in effects between study arms were minor and negligible. Adherence to treatment was high, with low loss to follow-up and no between-group differences., Conclusion: Compared with standard individual PFMT, group-based PFMT was less costly and as clinically effective and widely accepted. These results indicate that patients and healthcare decision-makers should consider group-based PFMT to be a cost-effective first-line treatment option for urinary incontinence., Trial Registration: ClinicalTrials.govNCT02039830., (Copyright © 2022 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Objectives: To evaluate the scale-up of the OPUS-AP program to improve the care of residents at long-term care (LTC) centers through the systematic implementation of resident-centered approaches to care, the application of nonpharmacologic interventions for the management of behavioral and psychological symptoms of dementia (BPSD), and the deprescribing of antipsychotics where these are not clinically indicated., Design: Prospective, closed cohort., Setting and Participants: Residents with major neurocognitive disorder (MNCD) from 24 (phase 1) and 129 (phase 2) publicly funded LTC centers in Quebec, Canada., Methods: The primary outcome was antipsychotic deprescribing (cessation or dose reduction). Secondary outcomes included changes in benzodiazepine and antidepressant prescriptions, BPSD, and falls. Comparisons were made between assessments at baseline and after 9 months., Results: OPUS-AP phase 2 was conducted from March to December 2019 in 329 clinical wards at 129 LTC centers. At baseline, the 10,601 included residents had a mean age of 82.9: 64.6% were of female sex, 73.7% had a diagnosis of MNCD, and 47.0% had an antipsychotic prescription. These characteristics were similar to those of the 1054 residents at the 24 LTC centers in phase 1. In phase 2, successful antipsychotic deprescribing was achieved for 77.1% of residents in whom this approach was attempted, compared to 85.5% in phase 1. Phase 1 and 2 showed statistically significant improvements in the Cohen-Mansfield Agitation Inventory score and reduced use of benzodiazepines in residents with successful antipsychotic deprescribing. These improvements were of a smaller magnitude in phase 2. Statistically significant reductions in falls were observed in phase 2., Conclusions and Implications: The scale-up of the OPUS-AP program from 24 to 129 LTC centers was successful and resulted in a significant reduction in antipsychotic use, as well as improvement in BPSD, and reductions in benzodiazepine use and falls in residents with successful antipsychotic deprescribing., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

The high rate of youth suicide in some First Nations villages of Northern Quebec is an important public health problem. Based on a six-year field study in three villages belonging to the Atikamekw and Anishinabe groups, this paper proposes changes in three areas of social policy that could contribute to prevention of youth suicide. These three areas are: youth protection, administration of justice, and housing. An argument is made first to adapt the youth protection law of Quebec and to give greater responsibility to communities in individual cases in order to prevent child placement outside the villages. Regarding the administration of justice, we suggest initiatives to encourage rapid prosecution of crimes on reserves and the adoption of an approach based on reconciliation between perpetrator and victim. Finally, we indicate how housing measures could help safeguard children's wellbeing given that overcrowding can contribute to suicide. The discussion also proposes that these three key changes in social policy could be relevant in other Aboriginal communities both within and outside of Quebec., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objectives: To arrive at a better estimation of informant-specific correlates of suicidal behavior in young adolescents and to see how agreements and discrepancies between child and parent informants can contribute to the development of research and interventions., Method: The weighted sample from the Quebec Child Mental Health Survey conducted in 1992 included 825 adolescents, aged 12 to 14 years, and their parents. The adolescent and one parent were questioned by two different interviewers. The response rate was 80.3%. Three categories of independent variables were assessed: adolescent, family, and socioeconomic characteristics. Logistic regression models were based on the adolescent and parent informant reports., Results: Parents identified 6 of the 59 adolescents having reported suicidal ideation and 2 of the 36 adolescents having reported suicide attempts. Two informant-specific models of correlates of suicidal behavior were found. The adolescent model included internalizing and externalizing mental disorders, family stressful events, and parent-adolescent relationship difficulties, while the parent model included perceiving a need for help for the adolescent, parent's depressive disorders, and parent-adolescent relationship difficulties., Conclusion: The study shows the relevance of considering informant-specific correlates of suicidal behavior in the development of research and interventions targeting youths suicidal behavior.

This study examined the intratester and intertester reliability of the electronic digital goniometer EDI-320 for the measurement of active neck flexion and extension in healthy subjects. In the context of evidence-based practice, the EDI-320 instrument has the potential to improve patient assessment, provide a clearer picture of patient progress, and confirm the effectiveness of physiotherapy interventions. However, the psychometric properties of the EDI-320 have not yet been documented for cervical spine range of motion. Forty-four individuals with no known history of cervical disorder within the three months prior to the testing, voluntarily consented to participate in this study. Repeated measurements with the EDI-320 were taken by two trained testers (TH1 and TH2) and data were recorded by two separate observers. Subjects performed a standardized warm-up. Testers were required to repeat palpation of bony landmarks prior to each trial. Measurements were taken at the end-range of active cervical flexion and extension for each subject. Both testers measured each subject twice. The intraclass correlation coefficients (ICC) were derived from one-way ANOVA for intratester reliability and a two-way ANOVA for intertester reliability. Paired t -tests were then applied to verify for systematic error. Moderate intratester reliability was found for both testers for flexion (TH1: ICC=0.77; 95% CI: 0.62-0.87; TH2: ICC=0.77; 95% CI: 0.58-0.87). As for extension, high intratester reliability was found for TH1 (ICC=0.79; 95% CI: 0.65-0.88) and moderate for TH2: (ICC=0.83; 95% CI: 0.63-0.92). Intertester reliability results showed a moderate reliability for both flexion and extension (ICC=0.66; 95% CI: 0.24-0.84) on the first trial. On the second trial, reliability was moderate for flexion (ICC=0.73; 95% CI: 0.53-0.85) and high for extension (ICC=0.80; 95% CI: 0.64-0.89). The t -test analysis revealed the inclusion of systematic error by Tester 2 for intratester reliability. This error was also found for all but one of the intertester reliability calculations. This study has shown that the EDI-320 is a moderately reliable instrument for quantifying cervical flexion and extension range of motion. The presence of systematic error in the study highlights the importance of following standardized procedures and suggests that the EDI-320 could be more reliable than reported in this study. Further psychometric studies investigating the validity of the EDI and reliability with subjects affected by cervical pathology is warranted., (Copyright 2001 Harcourt Publishers Ltd.)

Objective: This study presents the results of a psychiatric epidemiological survey using a sample of adolescents from refugee families., Method: The sample included 203 adolescents, aged 13 to 19 years, coming from 35 countries. Psychopathology was assessed with the Diagnostic Interview Schedule for Children Version 2.25 and general functioning with the Children's Global Assessment Scale (CGAS)., Results: The total rate of psychopathology excluding simple phobia was 21% compared with 11% in a province-wide survey of young adolescents. Overanxious disorder had a high prevalence of 13%. The rates of major depression and conduct disorders were also high, at 5% and 6%. The rate of 3% of attempted suicide was similar to the rate found in Montreal high schools. Girls had a higher rate of psychopathology than boys, with a gender ratio similar to the one found in the provincial survey. Father's long-term unemployment in the first year of settlement was associated with psychopathology for the whole sample, and family structure was associated with psychopathology for boys only., Conclusions: The high rate of psychopathology in this group confirmed results from other surveys with similar samples. On the other hand, the CGAS scores indicated that many of the adolescents with a diagnosis had good social adaptation.

A cucumber mosaic virus isolate from an Ixora plant originating in the Philippines and first described 20 years ago (CMV-Ix) by Waterworth and Povish differs from other characterized CMV strains in its anomalous satellite support and in several biological and molecular properties. We describe the preparation of infectious transcripts from cloned complementary DNA and the characterization of progeny virus. The results confirm that CMV-Ix has a more limited host range than most CMV isolates. Virions of CMV-Ix are smaller than those of the control CMV-S, independent of the type of negative stain used. Furthermore, CMV-Ix from transcripts supports the replication of the satellite T-CARNA 5 but not of D-CARNA 5.

Two satellite RNA of cucumber mosaic virus (CMV) designated J876-CARNA-5 (for cucumber mosaic virus-associated RNA-5) and D27-CARNA-5 have been molecularly and biologically characterized. J876-CARNA-5 (387 nucleotides (nt)) and D27-CARNA-5 (391 nt) have nearly identical 5' half insertion/deletion regions where 120 nt replace approximately 70 nt of D-CARNA-5 (335 nt), the first variant described and sequenced. J876-CARNA-5 possesses the 15-nt conserved sequence element in its 3' half which is present in all tomato necrogenic variants and induces the same level of necrosis in tomatoes as the prototype necrogenic D-CARNA-5. D27-CARNA-5 lacks the 3' half necrosis-determining element and attenuates the CMV symptoms in tomato. Transcripts of cloned cDNA of J876-CARNA-5 were stably propagated in tomato in the presence of CMV-1. Purified J876-CARNA-5 progeny, inoculated with CMV-1 in a quantitative bioassay, induced tomato necrosis at the same dilution level as the natural satellite. Several computer-generated secondary structures of CMV satellites were examined and the possible correlation of a defined secondary structural element with necrosis induction is discussed.

Total RNA extracted from cucumber mosaic virus (CMV) strains WT, with its associated satellite CARNA 5 (CMV-associated RNA 5), was successfully electroporated into isolated tomato protoplasts. At various time intervals samples were extracted for total nucleic acids and analyzed by semidenaturing polyacrylamide gel electrophoresis (PAGE). Sequence-specific hybridization probes were used for the detection of viral and satellite RNAs following Northern transfer. The resulting PAGE patterns and/or autoradiographs depict the proportional presence of viral and satellite RNAs in the extracts over time and have been referred to as "replication footprint profiles" (RFPs) of specific CMV/CARNA 5 combinations. The effective isolation and infection of tomato protoplasts, combined with the ability to follow virus/satellite titers during the infection by RFP analysis, yield results similar to those of infected plants and reduces experiments of 21 or more days in whole plants to less than 72 h in protoplasts.

In tomato, the disease-modulating effects of a cucumber mosaic virus (CMV) satellite isolate from Belgium, here designated T-CARNA-5 (CARNA-5 = CMV-associated RNA-5), were found to be different depending on the supporting helper virus strain. With two CMV strains, T-CARNA-5 induced lethal necrosis, but with a third strain from Ixora spp. (CMV-Ix), aggravated stunting was observed. However, the primary structure of the T-CARNA-5 contained within virus isolated from tobacco or tomato infected with each of these three CMV strains, conformed to the conserved sequence profile of CARNA-5 isolates which are necrogenic in tomato. Dilution endpoint bioassay of T-CARNA-5 established a direct cause-effect relationship between it and tomato necrosis or stunting, depending on the helper virus. Total nucleic acid extracts taken at different times from tomato plants infected with the above CMV strains and T- or S-CARNA-5 (used as non-necrogenic control) showed viral RNA, ssCARNA-5 and dsCARNA-5 to be present in significant amounts, but in sometimes dissimilar proportions depending on the combination; except in CMV-Ix/S-CARNA-5 infection where neither ss-nor dsCARNA-5 was found. The experiments established that CARNA-5 biological expression studies in CMV-infected tomato have to take into account the helper virus satellite replication support function, which may be a primary codeterminant of quantitative or qualitative differences in the symptom modulation observed.

Cucumber mosaic virus (CMV), a widespread and economically important virus of vegetable crops, often contains a satellite RNA, here designated CARNA-5 (for CMV-associated RNA 5). Viral satellites are small nucleic acids that are sequence-unrelated to, but replicatively dependent upon, the viral genome. They essentially are molecular parasites of their helper viruses, and thereby frequently modulate viral symptom expression. Some isolates of CARNA-5 change normally moderate CMV symptoms in tomato into a lethal disease named tomato necrosis; others ameliorate CMV symptoms in tomato and other important crop plants. Here we report on the identification and molecular characterization of a 334-nucleotide necrogenic CARNA-5 isolated from tomato fields in southern Italy, where a massive outbreak of lethal necrosis occurred in the summer of 1988. This is the first time that direct evidence is given for the involvement of a viral satellite in a crop disease of epidemic scale. The possible molecular interrelationships between plant, virus, satellite and other factors that influence the satellite-induced symptom modulation underlying such a catastrophe are discussed.

The nucleotide sequence of the satellite of arabis mosaic virus was determined using the satellite RNA encapsidated in virions. The 300-nucleotide long sequence showed extensive homology (50%) with that of the 359-nucleotide satellite RNA of tobacco ringspot virus, which occurs both in a linear and a circular form. This homology also revealed the presence of conceived sequences believed to mediate self-cleavage of the latter as well as other viral satellite RNAs. A circular form of the arabis mosaic virus satellite can be isolated from infected tissues and partially converts to the linear form upon elution from denaturing gels.

The double-stranded forms of CARNA 5 and PARNA 5, viral satellites of the cucumovirus group, after denaturation and polyacrylamide gel electrophoresis under appropriate conditions allow their complementary strands to be separated and fractionated. These fractionated (+) and (-) strands are free of contaminating viral RNA fragments. They serve as templates for the preparation of cDNAs of opposite polarity, which are used to probe the viral RNA-dependent replication of CARNA 5 and PARNA 5.