This mixed method pilot study examined whether the treatment of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) would have an impact on marital relationships and family functioning. Eight patients receiving treatment from an adult ADHD Research Program and their spouses completed two questionnaires measuring marital adjustment and family functioning prior to and following 12 weeks of treatment. Follow-up semi-structured qualitative interviews were conducted with five of the couples. Quantitative results indicated that adults with ADHD observed an improvement in marital relationships following treatment. However, spouses did not observe a significant change. Neither adults with ADHD, nor their spouses reported family functioning changing as a result of treatment. The qualitative interviews suggested that adults with ADHD were more likely to describe their relationships as improving, whereas spouses were more cautious in their interpretation of their relationships following treatment. Neither adults with ADHD, nor their spouses reported changes in family functioning following treatment. In general, both adults with ADHD and their spouses supported the use of multimodal treatment for the treatment of ADHD. / Cette étude pilote utilise une méthode mixte pour examiner si le traitement d'un partenaire ayant le trouble de déficit de l'attention avec ou sans hyperactivité (TDAH) avait un effet sur les relations conjugales et fonctionnement de la famille. Huit patients qui ont reçu le traitement du programme de recherche du TDAH et leurs conjoints ont terminé deux questionnaires, qui mesurent l'état de leur relation conjugale et le fonctionnement de la famille, avant et après 12 semaines du traitement. Des entretiens semi-structurés ont été complétés avec cinq couples. Le résultat quantitatif suggère que les adultes avec le TDAH montrent des améliorations à leurs relations conjugales. Mais, leurs conjoints n'avaient pas observé cette amélioration. Ni les adultes avec le TDAH et ni leurs conjoints ont observé un changement dans le fonctionnement de la famille. Les entretiens qualitatifs suggèrent que les adultes avec le TDAH étaient plus susceptibles de décrire que leurs relations améliorent, mais les conjoints étaient plus prudents avec leurs interprétations de leurs relations après le traitement. Ni les adultes avec le TDAH et ni leurs conjoints ont observé un changement dans le fonctionnement de la famille après le traitement. En général, les adultes avec le TDAH et leurs conjoints soutenues utilisé un traitement multimodale pour le traitement du TDAH.

The objectives of this thesis were: (i) assess the role of indoor air pollutants and allergens with respect to their individual contribution to EIB and reported asthma in elementary schoolchildren in Montreal and Port Alberni; and (ii) to determine how the effect of these indoor environmental pollutants and allergens are modified by host factors, such as gender. The hypothesis was that increased levels of indoor allergens and pollutants are associated with a higher prevalence of asthma and/or EIB; this association being modified by gender. / Initially a cross-sectional study was carried out of 989 Montreal elementary schoolchildren, and 1,785 Port Alberni elementary schoolchildren. A questionnaire was completed by the parents and exercise test was carried out in which the children performed spirometry before and after a free running exercise test. / For the purpose of this thesis a sub-sample of 332 children from Montreal and 305 children from Port Alberni were combined and a more detailed case-control study pertaining to home environment carried out. (Abstract shortened by UMI.)

Rh hemolytic disease of the newborn, once a major cause of perinatal mortality and long-term disability, is rarely seen in developed countries today. This drastic reduction in the frequency of disease occurrence has followed the widespread postpartum use of Rh immunoglobulin. However, more than half the world's population does not have access to this health care technology. / The objective of this thesis was to study the epidemiology of Rh disease in developed country settings and specifically to quantify the magnitude of Rh disease reduction that occurred secondary to Rh prophylaxis, and to changes in birth order, the quality of medical care and other Rh disease determinants. Another objective was to identify feasible and cost-effective options for Rh disease control in developing countries. / Study methods include Poisson regression modeling of surveillance data from Manitoba, Nova Scotia, Canada and the United States and a model based on conditional probabilities obtained from the medical literature and vital statistics publications. Outcomes considered in these analyses include maternal Rh sensitization, Rh hemolytic disease of the newborn, perinatal deaths from Rh disease and infant deaths from hemolytic disease of the newborn. / The results show that besides Rh prophylaxis, changes in other determinants of Rh disease were responsible for significant reductions in the disease over the last four decades. Changes in the birth order resulted in a 35% reduction in Rh sensitizations, while changes in the quality of medical care were responsible for about 80% of the reduction in perinatal deaths from Rh disease. Rh prophylaxis was found to be responsible for reducing the rate of maternal Rh sensitization (both Rh D and Rh non-D) by 60-69% and the rate of perinatal and infant deaths by 80-90% (estimated effects are independent but not mutually exclusive). Effects of other Rh disease determinants, such as abortion rates, racial composition, race and Rh type-specific blood transfusions, were also quantified. Finally, a decision analysis of various Rh prophylaxis options was modeled with a view to optimizing cost-effectiveness and minimizing cost. The option of administering Rh prophylaxis to first births was found to be the most cost-effective and feasible option. It is recommended as a first step for Rh disease control in countries like India.

Research on suicidal behaviors from non-Western countries is limited, and knowledge from Western studies may not be suitable for developing appropriate intervention strategies in other cultures. An understanding of the sociocultural context within which suicidal behaviors take place can provide valuable insight into the processes that contribute to risk of suicide. The aim of the present study was to estimate the prevalence and identify correlates of suicide ideation and suicide attempt in a population of college age youth in India. The cross-sectional study took place in Ahmedabad, the largest city in the western state of Gujarat. A total of 1,817 undergraduate college students aged 18-24 years completed a questionnaire with self-report measures assessing suicidal thoughts and suicide attempts in the past 12 months and over their lifetime, as well as potential risk factors. Independent risk factors were identified through logistic regression models. Overall, 11.7% of youth reported suicidal thoughts in their lifetime, and 4.0% reported lifetime suicide attempts. Results indicate that suicidal behaviors were significantly associated with economic stress, illness or mental health problems of a family member, experiences of caste discrimination or caste conflict, religious or political conflict, and depressive symptoms. The findings underscore the importance of sociocultural factors in determining vulnerability to suicidal behaviors in the Indian context and point to the need for culturally appropriate and locally informed approaches in mental health service delivery. / Force est de constater que la recherche sur les comportements suicidaires dans les pays non occidentaux ne revêt qu’une valeur limitée. Ainsi, les conclusions d’études occidentales ne peuvent pas toujours être transposées à d’autres cultures et servir à l’élaboration de stratégies d’intervention au sein de ces différentes cultures. Or, la compréhension du contexte socioculturel dans lequel les comportements suicidaires interviennent peut fournir de précieux renseignements sur les processus qui contribuent au risque de les comportements suicidaires. Le but de la présente étude était d’estimer la prévalence et identifier les corrélats de l’idéation suicidaire et des tentatives de suicide au sein d’une population de jeunes collégiens indiens. L’étude transversale a été menée à Ahmedabad, la plus grande ville de l’Ouest de l’État du Gujarat. Un total de 1817 étudiants de premier cycle âgés entre 18 à 24 ans ont rempli un questionnaire comportant des mesures auto déclarées évaluant les pensées suicidaires et les tentatives de suicide au cours des 12 derniers mois et tout au long de leur vie, ainsi que des facteurs de risque potentiels. En outre, des facteurs de risque indépendants ont été identifiés à l’aide de modèles de régression logistique. Globalement, 11,7% des jeunes ont rapportés avoir entretenu des pensées suicidaires au cours de leur vie, et 4,0% ont déclaré avoir fait une tentative de suicide durant leur vie. Les résultats indiquent que les comportements suicidaires sont associés de façon significative au stress économique, à la maladie ou aux problèmes de santé mentale d’un membre de la famille, aux expériences de discrimination de castes ou aux conflits parmi les castes, aux conflits religieux ou politiques, et aux symptômes dépressifs. Les résultats soulignent l’importance des facteurs socioculturels dans la détermination de la vulnérabilité au les comportements suicida

No description available.

ABSTRACT Alzheimer's disease (AD) is characterized by neurodegeneration, memory loss and premature cerebral circulatory deficits marked by a vascular structural pathology thought to involve elevated levels of amyloid-beta (Aβ) and transforming growth factor-beta 1 (TGF-β1). We sought to investigate the role of Aβ and TGF-β1 in promoting cerebrovascular dysfunction as well as disturbances in glial, neuronal and cognitive function using transgenic mice overexpressing either (APP, TGF mice) or both (APP/TGF mice) peptides. We attempted to remedy arterial and hemodynamic deficits using a pharmacological approach with free radical scavengers and the peroxisome proliferator-activated receptor γ (PPARγ) agonist pioglitazone, compounds known to correct peripheral vascular dysfunction. In addition, we evaluated treatment outcome on glial, neuronal and cognitive AD markers. We found that cerebrovascular dysfunction in APP mice was mediated by a pro-oxidant pathway activated by soluble Aβ, and that it was completely remedied with antioxidant treatment and pioglitazone, even at an advanced age. In contrast, cerebrovascular impairments of TGF mice were insensitive to antioxidants, related to alterations in signaling molecules within the vessel wall, accompanied by vascular fibrosis and responsive only to pioglitazone. APP mice also featured AD-like glial, neuronal and memory deficits, and contrary to an antioxidant, pioglitazone completely reversed most of these in aged animals, although earlier treatment may be warranted to restore memory. In contrast, TGF mice experiencing chronic cerebrovascular insufficiency lacked neuronal and cognitive impairments. This suggested that, alone or at insufficient levels, hemodynamic deregulation does not necessarily lead to memory loss, but constitutes an aggravating factor in the presence of underlying pathology. In APP/TGF mice, the vascular phenotype was predominantly TGF-like, featuring / La maladie d'Alzheimer (MA) est caractérisée par la mort neuronale, la perte de la mémoire, une dysfonction cérébrovasculaire et pathologie structurelle des vaisseaux cérébraux, que l'on croit associées aux niveaux élevés d'amyloïde-bêta (Aβ) et du «transforming growth factor-beta 1» (TGF-β1). Nous avons évalué le rôle de ces deux protéines dans la pathologie cérébrovasculaire associée à la MA, ainsi qu'aux changements gliaux, neuronaux et cognitifs, en se servant de souris transgéniques qui sur-expriment l'une ou les deux (modèles APP, TGF et APP/TGF) de ces protéines. Nous avons tenté d'améliorer les déficits artériels et hémodynamiques, ainsi que marqueurs gliaux, neuronaux et cognitifs, avec des antioxydants et un agoniste des récepteurs PPARγ, la pioglitazone, composés efficaces contre les troubles vasculaires périphériques. Chez les souris APP, les problèmes cérébrovasculaires ont été attribués au stress oxydatif engendré par l'Aβ soluble, et étaient complètement normalisés par les antioxydants et la pioglitazone, en dépit de l'âge avancé des souris. Seule la pioglitazone a été efficace chez les souris TGF, dont les dysfonctions cérébrovasculaires étaient accompagnées par une fibrose, et plutôt reliées à des changements dans les molécules vasomotrices de la paroi vasculaire. Les souris APP exhibaient des déficits gliaux, neuronaux et cognitifs, dont la plupart ont été complètement normalisés par la pioglitazone, quoiqu'un traitement précoce soit peut-être requis pour restaurer la mémoire. En revanche, malgré une insuffisance cérébrovasculaire chronique, les indices neuronaux et mnémoniques des souris TGF étaient intacts. Ceci suggère qu'un trouble hémodynamique seul ou au seuil observé dans le modèle TGF, en l'absence d'une pathologie sous-jacente, ne suffit pas à perturber la mémoire, et constitue donc un facteur aggravant dans la MA. Le$

A cohort of 2037 first year elementary school children was established in 1978 and examined annually on two other occasions to study the epidemiology of dental caries. Data on risk factors were collected from the parents through a questionnaire at the same time as the last two dental examinations. Some information on risk factors was also collected from the child at the time of dental examination. Prevalence of caries initially was high and the evolution of prevalence indices over the 24 month period is described. The incidence of caries for deciduous and permanent dentition is given by the relative increment of decay among teeth at risk at the beginning of the interval and those becoming at risk during the interval. Treatment level initially was low but increased between the second and third year of observation. Oral hygiene and nutritional habits did not conform to generally acceptable good preventive practices. Moreover, these behaviors are not stable. Whether by univariate (analyses of variance) or multivariate (multiple linear regression) analyses, certain factors consistently show an influence on dental caries. They are: father's schooling, presence of prostheses in parents, number of visits to the dentist, voluntary consumption of fluoride, number of years of this fluoride consumption, brushing, consumption of soft drinks, candies and vegetables, and eating before bed. These findings lend credence to the belief that despite continuing controversies about risk factors for dental caries, programs aimed at modifying behavior pertaining to the aforementioned factors are justified.

Acute respiratory changes have previously been observed in aluminium potroom workers. The main purposes of this study were to determine the prevalences of such changes amongst potroom workers assigned respectively to either one of the plant electrolytic processes, namely the Soderberg and the Prebake, and to compare the prevalence in each exposure group to that in unexposed workers of the same plant. Pulmonary function tests were administered four times on the first working shift of the week to 385 of the 412 subjects who had also answered a respiratory symptoms questionnaire. An index of acute changes was devised. Among the 279 smokers, those exposed to the Prebake process and with high exposure to the Soderberg had a higher index on average than those with low exposure to the Soderberg process and unexposed workers. Among the 106 workers who had never smoked, no significant differences appeared.

In North America, ethnic minority patients are at high risk for misdiagnosis of psychosis. A number of care models are in use for delivery of mental health services in multicultural settings, cultural consultation being one. Research on how these models address bias in diagnosis however remains sparse. We analyzed data from a cultural consultation service to determin e the frequency of re-diagnoses and associated factors, and describe the reasoning process used in resolving uncertainty of a psychosis diagnosis. Re-diagnoses occurred in 49% of cases and was more likely in recent immigrants and persons of non-Black ethnicity. A 3-step reasoning process was identified: (1) problematizing the original diagnosis; (2) explaining symptoms in terms of biomedical, psychological or social processes; (3) confirming or re-interpreting the diagnosis of a psychotic disorder. This process sheds light on psychiatric reasoning in complex cases and can be used in refining cultural competence training and service delivery. / En Amérique du Nord, les patients issus de minorités ethniques sont à haut risque de diagnostic erroné de la psychose. Un certain nombre de modèles de soins sont en cours d'utilisation pour la fourniture de services de santé mentale dans un environnement multiculturel, de consultation culturelle en être un. La recherche sur la façon dont l'adresse biais de ces modèles dans le diagnostic reste cependant rare. Nous avons analysé les données d'un service de consultation culturelle de déterminer la fréquence de ré-diagnostics et les facteurs associés, et de décrire le processus de raisonnement utilisé dans la résolution de l'incertitude d'un diagnostic de psychose. Re-diagnostics eu lieu dans 49% des cas et était plus élevée chez les immigrants récents et les personnes d'origine ethnique non-Noire. Un processus de raisonnement en 3 étapes a été identifié: (1) problématiser le diagnostic initial, (2) expliquer les symptômes en termes de recherche biomédicale, les processus psychologiques ou sociaux, (3) de confirmer ou de ré-interpréter le diagnostic d'un trouble psychotique. Ce processus met en lumière le raisonnement psychiatriques dans les cas complexes et peuvent être utilisés dans le raffinage de formation des compétences culturelles et la prestation des services. fr

Closely related strains of Escherichia coli have been shown to cause extraintestinal infections in unrelated persons. This study tests whether a food reservoir may exist for these E. coli. Isolates from three sources collected over the same time period and geographic area were compared. The sources comprised E. coli isolates from women with urinary tract infection (UTI) (n = 353); retail meat (n = 417); and restaurant/ready-to-eat foods (n = 74). E. coli were evaluated for antimicrobial susceptibility and O:H serotype and compared by using six different genotyping methods. We identified 17 clonal groups that contained E. coli isolates (n = 72) from more than one source. E. coli from retail chicken (O25:H4-ST131 and O114:H4-ST117) and honeydew melon (O2:H7-ST95) were indistinguishable from or closely related to E. coli from human UTIs. This study provides strong support for the role of food reservoirs in the dissemination of E. coli causing community-acquired UTIs. / Il a été démontré que des souches de Escherichia coli étroitement reliées causaient des infections extraintestinales chez des personnes non-reliées. Cette étude teste l'hypothèse selon laquelle il existerait un réservoir alimentaire pour ces souches d'E. coli. Des isolats provenant de trois sources différentes et récoltés durant les mêmes périodes et régions géographiques ont été comparés. Les sources incluaient des isolats d'E. coli provenant de femmes soufrant d'infection urinaire (IU) (n=353); de viande vendue au détail (n = 417); et d'aliments de restauration/prêts-à-manger (n =74). Les E. coli ont été évalués pour leur susceptibilité aux agents antimicrobiens et leur sérotype O:H, et ont été comparés par l'intermédiaire de six différentes méthodes de génotypage. Nous avons identifié 17 groupes clonaux contenant des isolats d'E. coli (n = 72) provenant de plus d'une source. Des E. coli provenant de viande de poulet (O25:H4-ST131 et O114:H4-ST117) et de melon au miel (O2:H7-ST95) étaient indistinguables ou étroitement reliés à des E. coli provenant d'IUs. Cette étude supporte fortement le rôle des réservoirs alimentaires dans la dissémination du E. coli causant des IUs acquises dans la communauté.