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Background: People with intellectual/developmental disabilities (IDD) are known to have high rates of prescription drug use, particularly for psychotropic medications. This is of concern due to the many side effects associated with these medications and because of the risks of polypharmacy. In this paper we compare the most commonly dispensed drugs and all psychotropic medications for youth with IDD compared with youth without IDD. Methods: Using population‐level administrative health data over a 10‐year period, this study examined medications dispensed to youth with an IDD aged 15–24 years compared with youth without an IDD. The most common medications dispensed and the number of youth they were dispensed to were determined. As well a wide variety of psychotropic medications were examined. Results: There were a total of 20 591 youth with IDD and 1 293 791 youth without IDD identified. Youth with IDD had higher odds of being dispensed pain medications, amoxicillin, salbutamol, levothyroxine and all the psychotropic medications (antidepressants, antipsychotics, anxiolytics, anti‐adrenergic agents, mood stabilisers and stimulants). For youth with IDD, 6558 (31.85%) were dispensed two or more different psychotropic medications within a year, compared with 75 963 (5.87%) of youth without IDD. Discussion: Compared to youth without IDD, youth with IDD had significantly higher odds of being dispensed most of the prescription medications studied, including all of the psychotropic medications. They were also twice as likely to be dispensed two or more medications from different classes of psychotropic drugs within the same year. These findings have important implications for the health of people with IDD and for their health care providers. [ABSTRACT FROM AUTHOR]

This article offers a social science analysis of the resilience concept’s success and common sense uses. Based on a sample of letters from the readers of the French author Boris Cyrulnik’s self-help best-sellers, the article first depicts the characteristics of the attitude of the letters’ authors towards Cyrulnik and what they expect from him. Second, it proposes to understand resilience as a language game used to communicate about suffering and then analyses why certain readers feel resilient while others don’t. It concludes that this way of reacting to adversity (i. e., tapping one’s inner resources, never giving up) is particularly desirable in a context where autonomy has become more prestigious.

Purpose: A significant number of people will experience prolonged symptoms after COVID-19 infection that will greatly impact functional capacity and quality of life. The aim of this study was to identify trajectories of health-related quality of life (HRQOL) and their predictors among adults diagnosed with COVID-19., Methods: This is a retrospective analysis of an ongoing prospective cohort study (BQC-19) including adults (≥18y) recruited from April 2020 to March 2022. Our primary outcome is HRQOL using the EQ-5D-5L scale. Sociodemographic, acute disease severity, vaccination status, fatigue, and functional status at onset of the disease were considered as potential predictors. The latent class mixed model was used to identify the trajectories over an 18-month period in the cohort as a whole, as well as in the inpatient and outpatient subgroups. Multivariable and univariable regressions models were undertaken to detect predictors of decline., Results: 2163 participants were included. Thirteen percent of the outpatient subgroup (2 classes) and 28% in the inpatient subgroup (3 classes) experienced a more significant decline in HRQOL over time than the rest of the participants. Among all patients, age, sex, disease severity and fatigue, measured on the first assessment visit or on the first day after hospital admission (multivariable models), were identified as the most important predictors of HRQOL decline. Each unit increase in the SARC-F and CFS scores increase the likelihood of belonging to the declining trajectory (univariable models)., Conclusion: Although to different degrees, similar factors explain the decline in HRQOL over time among the overall population, people who have been hospitalized or not. Clinical functional capacity scales could help to determine the risk of HRQOL decline., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

This article aims at describing the tensions arising from working on and with someone in psychiatry, in order to make this person more "autonomous". First, through the example of the recovery, it acknowledges, the normative horizon of what is considered today as "good care": a negotiation between partners, aiming at increasing the possibilities for everyone to follow their own lifestyle. It then seeks to describe how this definition of good care is endorsed and applied in two institutions (in Belgium and in France) hosting people with severe mental health issues where the care teams are using three words ("contract", "project" and "autonomy"). The article analyses the difficulties encountered while putting into practice these demanding ideals and shows how and to what end the care teams take action in defining the "good" projects and, in a more general way, what patients can or should expect from themselves and from their future., (© 2019. Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Telerehabilitation could prevent sequelae from COVID-19. We aimed to assess the feasibility of telerehabilitation; describe pulmonary and functional profiles of COVID-19 patients; and explore the effect of telerehabilitation on improving pulmonary symptoms and quality of life., Methods: We conducted a pre-experimental, pre-post pilot study. We recruited COVID-19 patients who had returned home following hospitalization. The intervention included eight weeks of supervised physiotherapy sessions. We documented technological issues, success of recruitment strategies, and participants' attendance to supervised sessions. We measured the impact of pulmonary symptoms on quality of life and functional health., Results: We scheduled 64 supervised sessions with seven participants with few technological issues. Initial scores showed that pulmonary symptoms moderately to highly impacted quality of life. At eight weeks, all patients had improved from 10 to 45 points on the EuroQol-Visual Analog Scale (EQ-VAS) instrument, indicating clinical significance., Conclusion: We developed and administered a telerehabilitation intervention during a global pandemic that targets key symptoms of the relevant disease., (Copyright © 2021 Pamela Tanguay, Nicole Marquis, Isabelle Gaboury, Dahlia Kairy, Matthieu Touchette, Michel Tousignant, Simon Décary.)

Acute leukemias are the most common pediatric cancer. With a cure rate of about 80%, their treatment is based on a combination of cytotoxic chemotherapies whose intensity is adapted to prognostic factors. Sometimes, allogeneic hematopoietic stem cell transplantation is indicated. New therapeutic options are being developed, such as CAR T-cells., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: The purpose of this article is to describe the development of a new Web platform to optimize self-management after pulmonary rehabilitation (PR) for persons living with a chronic respiratory disease (CRD) and to present data on its usability. Method: The Web platform is informed by a theoretical framework of behaviour changes and concepts of self-management and self-efficacy. It uses breathing exercises and a logbook and is meant to be a self-management tool. Usability was tested for 8 months after PR with a group consisting of five patients with chronic obstructive pulmonary disease and one with pulmonary fibrosis. We evaluated adherence (e.g., number of exercise/weeks), quality of life, dyspnoea, and functional capacity. We measured frequency count for adherence and pre-post differences per patient for clinical outcomes. Results: Four participants' adherence was higher than 50% of completed exercises (72 exercise/weeks). Five of six participants showed maintenance of functional capacity (6-minute walk test) 8 months after PR. Four participants showed maintenance of their quality of life. Four participants showed a deterioration in dyspnoea on the Borg Scale of Perceived Exertion. Conclusions: We developed a new theory-informed Web platform to optimize self-management after PR for persons living with a CRD. The pilot Web platform appears to optimize adherence to self-management techniques and possibly stabilize people's health outcomes., (© Canadian Physiotherapy Association.)

Background: Pulmonary rehabilitation (PR) has proven effective in improving exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD). In Canada, however, there are insufficient rehabilitation services. New strategies such as telerehabilitation must be deployed to increase accessibility. This study aims to investigate the effect of telerehabilitation on exercise tolerance and quality of life and to document patient satisfaction and adherence., Materials and Methods: Twenty-six patients with moderate to very severe COPD participated in this pre-/postintervention study. They received 15 in-home teletreatment sessions over 8 weeks via videoconference from a service center to their home. Education was provided via self-learning health capsules. Assessments were carried out twice before (T0 and T1; 8 weeks apart) and immediately after the intervention (T2). Primary outcome measures were changes in exercise tolerance (6-min walk test [6MWT] and cycle endurance test [CET]) and quality of life (Chronic Respiratory Questionnaire [CRQ])., Results: There were significant improvements between pre- and postintervention (T2-T1) on the 6MWT (32 m; p<0.001), CET (41 s; p=0.005), and three of four CRQ domains (dyspnea [p<0.001], fatigue [p=0.002], and emotion [p=0.002]). Improvements in the CET and fatigue during the 8-week intervention period were greater than changes over 8 weeks of maturation (T1-T0) (p=0.004 and 0.02, respectively). Participants' satisfaction and adherence rate with telerehabilitation were very high., Conclusions: Using telehealth technology to deliver in-home PR is a feasible and practical solution for patients with moderate to very severe COPD. The telerehabilitation program was associated with beneficial effects on exercise tolerance and quality of life and was well received by users.

This study investigated if improvements can be maintained over 24 weeks when in-home pulmonary telerehabilitation is combined with asynchronous self-management education for Chronic Obstructive Pulmonary Disease (COPD). Twenty-three community-living elders with moderate to very severe COPD participated in a pre/post-intervention study. Over 8 weeks, they had access to self-learning capsules on self-management, received 15 in-home teletreatment sessions and were encouraged to gradually engage in unsupervised sessions. Participants were assessed before the intervention (T1), immediately after the intervention (T2), and 6 months later (T3). Outcome measures were (1) exercise tolerance (6-minute walk test [6MWT]), Cycle Endurance Test [CET]), and (2) quality of life (Chronic Respiratory Questionnaire [CRQ]). Although there were significant improvements after 8 weeks of pulmonary telerehabilitation on the 6MWT, CET and three of four CRQ domains, none of these improvements were maintained after 6 months and scores returned to their baseline values (all p values > 0.05 when comparing T3 with T1). While pulmonary telerehabilitation is possible and has a positive impact on patients with moderate to very severe COPD, improvements were not maintained in the long-term even when physical therapy was accompanied by self-management education.

Background: Spatially resolved exposure models are increasingly used in epidemiology. We previously reported that, although exhibiting a moderate correlation, pregnancy nitrogen dioxide (NO2) levels estimated by the nearest air quality monitoring station (AQMS) model and a geostatistical model, showed similar associations with infant birth weight., Objectives: We extended this study by comparing a total of four exposure models, including two highly spatially resolved models: a land-use regression (LUR) model and a dispersion model. Comparisons were made in terms of predicted NO2 and particle (aerodynamic diameter<10 μm, PM10) exposure and adjusted association with birth weight., Methods: The four exposure models were implemented in two French metropolitan areas where 1026 pregnant women were followed as part of the EDEN mother-child cohort., Results: Correlations between model predictions were high (≥ 0.70), except for NO2 between the AQMS and both the LUR (r = 0.54) and dispersion models (r = 0.63). Spatial variations as estimated by the AQMS model were greater for NO2 (95%) than for PM10 (22%). The direction of effect estimates of NO2 on birth weight varied according to the exposure model, while PM10 effect estimates were more consistent across exposure models., Conclusions: For PM10, highly spatially resolved exposure model agreed with the poor spatial resolution AQMS model in terms of estimated pollutant levels and health effects. For more spatially heterogeneous pollutants like NO2, although predicted levels from spatially resolved models (all but AQMS) agreed with each other, our results suggest that some may disagree with each other as well as with the AQMS regarding the direction of the estimated health effects., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The purpose of this pilot study was to investigate the efficacy of in-home telerehabilitation for people with Chronic Obstructive Pulmonary Disease (COPD). Three community-living elders with COPD were recruited in a rehabilitation outpatient group and by direct referrals from pneumologists with outpatients who have COPD. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (15 sessions) were conducted by two trained physiotherapists from a service center to the patient's home. Locomotor function (walking performance) and quality of life were measured in person prior to and at the end of the treatment by an independent assessor. Clinical outcomes improved for all subjects except for locomotor function in the first participant. In-home telerehabilitation for people with COPD is a realistic alternative to dispense rehabilitation services for patients requiring physical therapy follow-up.

Background: Studies of the effects of air pollutants on birth weight often assess exposure with networks of permanent air quality monitoring stations (AQMSs), which have a poor spatial resolution., Objective: We aimed to compare the exposure model based on the nearest AQMS and a temporally adjusted geostatistical (TAG) model with a finer spatial resolution, for use in pregnancy studies., Methods: The AQMS and TAG exposure models were implemented in two areas surrounding medium-size cities in which 776 pregnant women were followed as part of the EDEN mother-child cohort. The exposure models were compared in terms of estimated nitrogen dioxide (NO2) levels and of their association with birth weight., Results: The correlations between the two estimates of exposure during the first trimester of pregnancy were r = 0.67, 0.70, and 0.83 for women living within 5, 2, and 1 km of an AQMS, respectively. Exposure patterns displayed greater spatial than temporal variations. Exposure during the first trimester of pregnancy was most strongly associated with birth weight for women living < 2 km away from an AQMS: a 10-µg/m3 increase in NO2 exposure was associated with an adjusted difference in birth weight of -37 g [95% confidence interval (CI), -75 to 1 g] for the nearest-AQMS model and of -51 g (95% CI, -128 to 26 g) for the TAG model. The association was less strong (higher p-value) for women living within 5 or 1 km of an AQMS., Conclusions: The two exposure models tended to give consistent results in terms of association with birth weight, despite the moderate concordance between exposure estimates.

The School Census is the only regularly updated dataset covering almost all of the population of a specific age, which records changes of address along with ethnicity and some family economic circumstances. It can be used to measure internal and international family migration as shown in this report. The School Census is suited to identify and quantify new local migration streams between censuses, successfully identifying the local distribution of Eastern European immigration in the decade since 2000. The measures do not provide a complete measure of migration, either internally or internationally. The exclusion of those outside the state school system means that internal migration is under-estimated, and international migration is approximately measured. The advantages of the School Census are its frequent updates, its fine geographical information, and its indicators of ethnicity and low family income, which powerfully complement other sources.

Purpose: Little is known about the physiology of walking in chronic obstructive pulmonary disease (COPD). Our objective was to evaluate the cardiac and respiratory responses as well as the electrical activity of lower limb muscles during walking in patients with COPD compared with healthy controls., Methods: Cardiorespiratory parameters were monitored during a 6-min walking test (6 MWT) in 10 patients with COPD and 11 healthy controls. Surface EMG (sEMG) data were recorded in five muscle groups (soleus, medial gastrocnemius, tibialis anterior, vastus lateralis, and rectus femoris) of the right leg during walking. The integrated signal (iEMG) and the median frequency were obtained from the sEMG signal of each muscle group., Results: Although the walking distance and speed were significantly reduced in patients with COPD compared with those in controls, patients walked at a higher percentage of peak VO2. The overall sEMG patterns were similar between patients with COPD and controls. A fall in the sEMG median frequency during the 6 MWT was observed for the vastus lateralis and the rectus femoris in patients with COPD and in controls suggesting a muscle fatiguing contracting profile., Conclusion: The 6 MWT was performed at a relatively higher intensity in patients with COPD compared with healthy controls. The progressive fall in the sEMG median frequency of the vastus lateralis and rectus femoris in both groups suggested the occurrence of a muscle fatiguing profile during walking. The performance of a daily activity such as walking imposes a high physiological demand in patients with COPD.

Blackcurrant (Ribes nigrum L.) is a widely grown commercial crop valued for its high vitamin C (l-ascorbic acid, AsA) content. In the present study, a systematic analysis of the mechanism of fruit AsA accumulation was undertaken. AsA accumulation occurred during fruit expansion and was associated with high in situ biosynthetic capacity via the l-galactose pathway and low rates of turnover. Cessation of AsA accumulation was associated with reduced biosynthesis and increased turnover. Translocation of AsA from photosynthetic or vegetative tissues contributed little to fruit AsA accumulation. Manipulation of substrate availability by defoliation had no effect on fruit AsA concentration but significantly reduced fruit yields. Supply of the AsA precursor l-galactono-1,4-lactone to intact, attached fruit transiently increased fruit AsA concentration which rapidly returned to control levels after removal of the compound. These data suggest strong developmental, metabolic and genetic control of AsA accumulation in blackcurrant fruit and indicate the potential for breeding high AsA cultivars.

To gain greater insight into the mechanism of dormancy release in the potato tuber, an investigation into physiological and biochemical changes in tuber and bud tissues during the transition from bud dormancy (immediately after harvest) to active bud growth was undertaken. Within the tuber, a rapid shift from storage metabolism (starch synthesis) to reserve mobilization within days of detachment from the mother plant suggested transition from sink to source. Over the same period, a shift in the pattern of [U-(14)C]sucrose uptake by tuber discs from diffuse to punctate accumulation was consistent with a transition from phloem unloading to phloem loading within the tuber parenchyma. There were no gross differences in metabolic capacity between resting and actively growing tuber buds as determined by [U-(14)C]glucose labelling. However, marked differences in metabolite pools were observed with large increases in starch and sucrose, and the accumulation of several organic acids in growing buds. Carboxyfluorescein labelling of tubers clearly demonstrated strong symplastic connection in actively growing buds and symplastic isolation in resting buds. It is proposed that potato tubers rapidly undergo metabolic transitions consistent with bud outgrowth; however, growth is initially prevented by substrate limitation mediated via symplastic isolation.

Antimonial-containing drugs are the first line of treatment against the parasite Leishmania. Resistance to antimonials has been correlated to its reduced accumulation. We used a dominant negative functional cloning strategy where a Leishmania mexicana expression cosmid bank was transfected in cells resistant to trivalent antimony (SbIII). Cells were selected for increased sensitivity to SbIII. One cosmid was isolated that could bestow SbIII sensitivity to resistant cells. The gene part of this cosmid that is responsible for increased SbIII sensitivity corresponds to AQP1, an aquaglyceroporin. AQP1 was recently shown to be a route by which SbIII can accumulate in Leishmania cells. Transport studies have shown that the L. mexicana AQP1 can restore SbIII transport in resistant cells. Southern blot analysis indicated that the copy number of neither the AQP1 gene nor the other AQP homologues was changed in antimony-resistant mutants of several Leishmania species. The AQP1 gene sequence was also unchanged in mutants. However, the AQP1 RNA levels were downregulated in several Leishmania promastigote species resistant to antimonials. In general, but not always, the level of AQP1 transcript levels correlated well with the accumulation of SbIII and resistance levels in Leishmania cells. AQP1 thus appears to be a key determinant of antimonials accumulation and susceptibility in Leishmania.

In the protozoan parasite Leishmania, drug resistance can be a complex phenomenon. Several metabolic pathways and membrane transporters are implicated in the resistance phenotype. To monitor the expression of these genes, we generated custom DNA microarrays with PCR fragments corresponding to 44 genes involved with drug resistance. Transcript profiling of arsenite and antimony resistant mutants with these arrays pinpointed a number of genes overexpressed in mutants, including the ABC transporter PGPA, the glutathione biosynthesis genes gamma-glutamylcysteine synthetase (GSH1) and the glutathione synthetase (GSH2). Competitive hybridisations with total RNA derived from sensitive and methotrexate resistant cells revealed the overexpression of genes coding for dihydrofolate reductase (DHFR-TS), pteridine reductase (PTR1) and S-adenosylmethionine synthase (MAT2) and a down regulation of one gene of the folate transporter (FT) family. By labelling the DNA of sensitive and resistant parasites we could also detect several gene amplification events using DNA microarrays including the amplification of the S-adenosyl homocysteine hydrolase gene (SAHH). Alteration in gene expression detected by microarrays was validated by northern blot analysis, while Southern blots indicated that most genes overexpressed were also amplified, although other mechanisms were also present. The microarrays were useful in the study of resistant parasites to pinpoint several genes linked to drug resistance.

Sixty-one men with known hypercholesterolemia (plasma cholesterol greater than 265 mg/dl), most of whom were previous participants in the Coronary Primary Prevention Trial of the U.S. Lipid Research Clinic Program, were chosen to take part in this study to test the effectiveness of a new low-calorie (Questran Light) cholestyramine formulation against the proven effectiveness of the currently marketed formulation Questran in maintaining lowered plasma cholesterol levels. The study recorded changes in fasting plasma lipids, total cholesterol, high-density lipoprotein cholesterol, triglycerides, and calculated low-density lipoprotein cholesterol. After establishing baseline lipid/lipoprotein levels in a 3-week period during which all participants received the currently marketed formulation, the men were randomized into 2 groups, 1 group (n = 31) taking the new Questran Light formulation of 4 g of cholestyramine in 5 g of powder per pack, while the other group (n = 30) continued to take the marketed Questran formulation of 4 g of cholestyramine in 9 g of powder per pack. Each group consumed a total of 24 g/day of cholestyramine in 2 divided doses. At the end of the maintenance phase of the study there were no statistically significant mean changes in percentage from baseline to end-point lipid/lipoprotein levels within either group, nor were there any significant differences between the Questran Light group or the currently marketed Questran formulation group. The new low-calorie cholestyramine formulation appears to be equally as effective in maintaining lowered plasma cholesterol levels as the currently marketed formulation.

This double-blind, crossover trial compared the sensory and product preparation characteristics of two cholestyramine powder preparations. The study involved 100 healthy volunteers, aged 22-65 (mean 42 years). Questran, a currently marketed product containing sucrose as a sweetener, was compared with Questran Light, a new formulation substituting aspartame for 90 percent of the sucrose. Comparisons were conducted with the two products mixed in water and orange juice. The subjects expressed a significant overall preference for the new formulation mixed in either water (77 percent) or orange juice (80 percent) (p less than 0.01 in both comparisons). Subjects expressed an overwhelming preference for the old product (99 percent) with respect to ease of preparation, although the ratings of the new product were generally neutral rather than negative. The new product is somewhat more difficult to prepare compared with the old cholestyramine preparation, but offers significantly increased patient acceptance based on sensory evaluations.