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Biomedical subjects

A Lesage

Publications and source records attributed to A Lesage.

At least 37 records · Page 2Linked to original sources
PubMed2000

Unmet needs in the community: can existing services meet them?

OBJECTIVE: This prospective study of community cases examined: (a) needs for care; (b) whether services meet the needs; and (c) personal factors associated with unmet needs. METHOD: Two separate 'Needs for Care Assessment Schedule Community version' evaluations identified 38 subjects with No Need (NN), 19 with Met Needs (MN) and 25 with Unmet Needs (UNM). Other instruments included the Diagnostic Interview Schedule-Abridged Version (DISSA) and repeated measures of symptoms and social functioning. RESULTS: (a) Cases did not equate needs. (b) Services utilization did not equate having met needs. (c) Respondents with UNM were more likely to present high rates of lifetime DSM-II-R disorders, no marital relationship ever, no employment, high rates of life events, and physical or sexual abuse in childhood. They have worse outcome in terms of distress and social functioning. CONCLUSION: Personal factors may prevent respondents from seeking, engaging and benefiting from treatment.

Acute Disease↗
PubMed1998

Purification of toxic compounds from larvae of the gray fleshfly: the identification of paralysins.

Larval haemolymph of Neobellieria bullata (Insecta, Diptera) is highly toxic to adults of the same species: injection causes instant paralysis to death. Referring to their dramatic effect in adult insects the responsible compounds were designated paralysins. Two paralysins, soluble in organic solvents and heat stable, were chromatographically purified to homogeneity. They were identified by use of mass spectrometry and nuclear magnetic resonance respectively as beta-alanine-tyrosine (beta-Ala-Tyr) and as 3-hydroxy-kynurenine (3-HK). The quantities of beta-Ala-Tyr and 3-HK in the insect appear to increase steadily during larval development, with peak values prior to the pupal stage. These findings may contribute to a better understanding of some aspects of the process of insect metamorphosis. Orienting experiments in mammals suggest that both compounds, when injected intraspinally, are also neurotoxic to rats. In addition, cytotoxicity tests revealed that 3-HK, but not beta-Ala-Tyr is toxic to human neuroblastoma cells, rat primary cortex neurons as well as to rat glial cells.

Animals↗
PubMed1998

Factors related to utilization of services for mental health reasons in Montreal, Canada.

This study examines factors related to the utilization of services for mental health reasons by Montreal residents. Data were drawn from telephone interviews. A random sample of 893 respondents completed a questionnaire on service utilization and the Diagnostic Interview Schedule Self Administered to assess DSM-III-R psychiatric disorders. Results indicate that 12.8% of the population had used such services in the past year. Medical doctors and psychiatrists, whose services are free of charge under universal health coverage, were consulted, respectively, by 4.1% and 2.0% of respondents. Psychologists, whose services are not free, were seen by 3.4% of respondents. In all, 42.0% of respondents who presented a current diagnosis used services in the past year. The highest proportion of users (48.0%) was found among respondents who presented both current and lifetime diagnoses and among respondents with comorbidity. The choice of caregiver was related also to pattern of disorders: respondents with current and comorbid disorders tended to consult general practitioners, while respondents with lifetime disorders or with lifetime and current disorders favoured specialized care. In line with other studies, self-perception of mental health, gender and marital status were related to utilization; unlike other studies, attitudes and age were not. It is argued that particularities found in this study stem not only from methodological considerations, but also from the configuration of the mental health system in Quebec, where the greater availability of psychologists may facilitate service utilization.

Adolescent↗
PubMed1998

Patients versus rehabilitation practitioners: a comparison of assessments of needs for care.

OBJECTIVE: A group of 47 young adults suffering from schizophrenia was interviewed to garner their views on their needs for care. METHOD: Three members of a specialized multidisciplinary rehabilitation team, who had been caring for these patients, on average, for the past 4 years, completed a questionnaire to assess the needs for care of these individuals. Patient and staff assessments were then compared. RESULTS: Patients and staff do not share similar views on the presence of clinical and social problems. Further analyses of the perceived importance of living-skills deficits, the perceived difficulties in dealing with these, and the recent developments in rehabilitation practices challenge whether patient-staff consensus is indeed essential for rehabilitation. CONCLUSION: We propose that staff should listen to patients' points of view more carefully, especially in the areas of work, studies, and independent living.

Activities of Daily Living↗
PubMed1997

Three-dimensional structure of the DNA-binding domain of the fructose repressor from Escherichia coli by 1H and 15N NMR.

FruR is an Escherichia coli transcriptional regulator that belongs to the LacI DNA-binding protein family. By using 1H and 15N NMR spectroscopy, we have determined the three-dimensional solution structure of the FruR N-terminal DNA-binding domain consisting of 57 amino acid residues. A total of 809 NMR-derived distances and 54 dihedral angle constraints have been used for molecular modelling with the X-PLOR program. The resulting set of calculated structures presents an average root-mean-square deviation of 0.37 A at the main-chain level for the first 47 residues. This highly defined N-terminal part of the structure reveals a similar topology for the three alpha-helices when compared to the 3D structures of LacI and PurR counterparts. The most striking difference lies in the connection between helix II and helix III, in which three additional residues are present in FruR. This connecting segment is well structured and contains a type III turn. Apart from hydrophobic interactions of non-polar residues with the core of the domain, this connecting segment is stabilised by several hydrogen bonds and by the aromatic ring stacking between Tyr19 of helix II and Tyr28 of the turn. The region containing the putative "hinge helix" (helix IV), that has been described in PurR-DNA complex to make specific base contacts in the minor groove of DNA, is unfolded. Examination of hydrogen bonds highlights the importance of homologous residues that seem to be conserved for their ability to fulfill helix N and C-capping roles in the LacI repressor family.

Amino Acid Sequence↗
PubMed1997

Priming of cultured neurons with sabeluzole results in long-lasting inhibition of neurotoxin-induced tau expression and cell death.

Sabeluzole was described to have antiischemic, antiepileptic, and cognitive-enhancing properties, and is currently under development for Alzheimer's disease. Recently, it was reported that repeated treatments with sabeluzole protect cultured rat hippocampal neurons against NMDA- and glutamate-induced neurotoxicity. We evaluated the possibility that sabeluzole elicits neuroprotection by acting, either directly or indirectly, on tau proteins. We found that repeated treatments during development of primary cultures of cerebellar granule cells with nanomolar concentrations of sabeluzole resulted in mature cells that were resistant to the excitotoxicity induced by glutamate. Also, sabeluzole treatment specifically prevented the glutamate-induced increase of tau expression without modifying the basal pattern of expression of tau proteins, as shown by measurement of mRNA and protein levels. In human neuroblastoma cell line SH-SY5Y, differentiated by treatment with retinoic acid, doxorubicin increased tau immunoreactivity, and later induced cell death. Both effects were prevented by sabeluzole. Our data indicate that increased tau expression is a common response to different types of cells to neurotoxic agents, and that sabeluzole-induced neuroprotection is functionally associated with the prevention of the injury-mediated increase of tau expression.

Animals↗
PubMed1997

Epidemiologic assessment of overmet need in mental health care.

The traditional purpose of psychiatric epidemiologic surveys has been the assessment of mental illness and, by implication, the need for care. Previous research has focused on unmet need, defined as those who meet "caseness" but do not receive care, but has rarely examined the converse. Since survey respondents receiving care but not meeting caseness have been found to represent up to one-half of mental health service users, this is a significant service delivery issue. The data are drawn from the Mental Health Supplement to the Ontario Health Survey (the Supplement), a household survey of 9,953 respondents, which used the University of Michigan's version of the Composite International Diagnostic Interview (UM-CIDI) as its diagnostic instrument. Community residents who used formal mental health services in the past year but who did not have a concurrent UM-CIDI/DSM-III-R (Diagnostic and Statistical Manual 3, revised) diagnosis were defined as "treated without CIDI disorder". Their need for care was evaluated by comparing them to "treated depressed" and "healthy" respondents, using indicators of functional impairment, vulnerability to developing disorder, and risk of relapse. The match between need and care levels was examined by comparing their type and intensity of use with those of the treated depressed. Results present strong evidence for conceptualizing need as continuous, rather than discrete. The results for the group defined as "treated without CIDI disorder" were consistently between those for the other two groups (with the "treated depressed" always showing the highest need) on all indicators as well as on a summary need index. However, their type and intensity of service use appeared to be unrelated to their level of need. Although some of the "treated without CIDI disorder" group may require preventive or follow-up treatment, the need for service for others is not as convincingly demonstrated. Outcome studies are needed to provide comparative data to describe more fully the problems experienced by this group and indicate whether treatment is helpful. In an age of fiscal restraint, when resource reallocation (rather than generation of new resources) is the likely scenario, such close examination of the fit between need and care is critical if services are to be targeted appropriately.

Adolescent↗
PubMed1997

Reversed neurovegetative symptoms of depression: a community study of Ontario.

OBJECTIVE: Most research on depression with reversed neurovegetative features (hypersomnia, hyperphagia, and weight gain) has been based on site-specific clinic-based samples. The goal of this study was to delineate the epidemiology of reversed symptoms in a large community sample and to use other symptom patterns for comparison. METHOD: Interviewers assessed 8,116 subjects across Ontario, aged 15-64 years, by using the World Health Organization Composite International Diagnostic Interview. Individuals who met the DSM-III-R criteria for major depression, current or lifetime, were classified into four groups on the basis of lifetime neurovegetative symptoms: episodes of typical symptoms only, episodes of reversed symptoms only, neither type, or both types (fluctuating-symptom group). The groups were compared on demographic characteristics, comorbidity, disability, and health care utilization. RESULTS: Of the 653 individuals with lifetime major depression, 11.3% had episodes of reversed symptoms only, and another 5.8% were classified as fluctuating. Most of the differences among the four groups were due to the unique characteristics of the groups with neither type of episode or a fluctuating pattern; individuals who had experienced only reversed symptoms were remarkably similar to those who had had only typical symptoms. The fluctuating-symptom group had high rates of comorbidity, substance abuse, and health care utilization. CONCLUSIONS: Several popular beliefs about depression with reversed features did not hold true for this community sample. Identifying individuals who fluctuate between reversed and typical episodes may be important in studies of major depression, in particular when reversed neurovegetative symptoms are a consideration.

Adolescent↗
PubMed1997

The treatment of sexually dysfunctional men without partners: a controlled study of three behavioural group approaches.

BACKGROUND: Models of sex therapy for sexual dysfunction in single men are available, but their value is not well established. This controlled study compared three approaches to the treatment of sexually dysfunctional single men. METHOD: Sixty-nine single men diagnosed as sexually dysfunctional were randomly assigned to treatments focusing on either their sexual dysfunction, their interpersonal problems, a combination of both or a waiting list; 51 completed treatment and 50 the one-year follow-up. Treatment was administered in small groups in 15 weekly sessions and four six-weekly sessions during the first six months of a year-long follow-up. RESULTS: No clinically meaningful change was observed during the waiting period. In contrast, a significant and equivalent improvement was observed in all treatment groups by the end of treatment. However, differences between them were in evidence at 6 and 12 months' follow-up. CONCLUSIONS: Both treatments paying attention to the patients' interpersonal difficulties resulted in significantly better outcomes overall than the approach that concentrated on problems in sexual functioning alone.

Adult↗
PubMed1997

Clinical specificity of prison inmates with severe mental disorders. A case-control study.

BACKGROUND: We wished to determine whether prison inmates with severe mental disorders possess specific clinical characteristics compared with psychiatric in-patients suffering from similar problems. METHOD: Under a case-control design, 69 male prison inmates suffering from a schizophrenic or major affective disorder were matched for age and diagnostic spectrum to 60 male psychiatric in-patients. Standardised interviews were used to diagnose psychiatric disorders according to DSM-III-R and social functioning criteria. Case-notes were reviewed to cull data regarding social life, criminal record and service use. RESULTS: Inmates were more likely to suffer from delusional/NOS psychotic disorders (72%) or major depression (70%), and psychiatric in-patients from schizophrenic or bipolar disorder (62% and 71%, respectively). Comorbidity was more prevalent among inmates than among in-patients, while in-patients presented less social autonomy than did inmates. CONCLUSIONS: The clinical specificity of prison inmates with severe mental disorders clearly differentiates them from psychiatric in-patients, and warrants recognition of their special needs for assessment and integrated treatment approaches.

Adaptation, Psychological↗
PubMed1997

[Lessons in transferring resources: the system of fees per patient].

Dowries can be defined as lump sum payments or continuing grants which health authorities make between themselves and to local authorities or voluntary organisations in respect of people with severe mental disorders to be cared for in the community instead of in hospital. This paper has three aims. First to describe how dowries and other processes were set up to encourage the closure of two psychiatric hospitals in England. The broader financing context for mental health care (prior to the reforms in England engendered by the NHS and Community Care Act, 1990) is also described and shows some similarities to the current arrangements in Québec. Second, we abstract some information from a long-running evaluation of the reprovision programme to look at the type of services used in the community by former long-stay patients of these two hospitals and the comparative costs of hospital and community-based care. After leaving hospital, former patients require considerable inputs from other health and social care services; any development of community care for these patients should at the least mirror the facilities provided on the hospital campus. The final aim of this paper is to examine the extent to which this English system of budget reallocation ("dowries") can be employed in Québec to further reduce long-stay hospital provision. There are many similarities between the health and social care systems of the two countries but there are also organisational and political differences. It is not sensible, therefore, to transfer the English budget reallocation to Québec wholesale, but we suggest that there are important process and implementation issues which can guide the development of financing mechanisms in Québec.

Fee-for-Service Plans↗
PubMed1997

[Relevance of the stress-coping paradigm in the elaboration of a stress management model for schizophrenics].

Studies having used the stress-vulnerability model of schizophrenia as a conceptual framework demonstrate from different perspectives the contribution of stress when symptoms and deteriorations associated with this illness appear. The stress-coping paradigm provides an explanation of the effects of stress on health according to a contextual approach underlining how the coping process allows to diminish the negative effects of stress and favour adaptation in difficult or conflicting situations. This article proposes the integration of these two dominant currents and presents the Stress management model for schizophrenics. This new model provides the opportunity to favour the comprehension of the process of rehabilitation for schizophrenics and the development of new methods of intervention in rehabilitation.

Adaptation, Psychological↗
PubMed1996

Trimeric assembly and three-dimensional structure model of the FACIT collagen COL1-NC1 junction from CD and NMR analysis.

The 3D structure of the COL1-NC1 junction of FACIT type XIV collagen was investigated using GYCDPSSCAG and (GPP*)3GYCDPSSCAG synthetic peptides, circular dichroism, and NMR. At -20 degrees C and under air oxidation catalyzed by Cu2+, the peptide (GPP*)3GYCDPSSCAG is able to self-associated with high yield into a stable triple disulfide bonded trimer. The presence of a triple helical conformation was confirmed by circular dichroism. The analysis of the trimer by 2D NMR provided a set of distance constraints for the noncollagenous part. Molecular models for the 3D structure of COL1-NC1 junction were calculated, using the NMR distance constraints in combination with the 3D structural data recently established by X-ray crystallography [Bella, J., Eaton, M., Brodsky, B., & Berman, H. M. (1994) Science 266, 75-81] for a collagenous triple helix. From the eight theoretically possible arrangements for the three interchain disulfide bonds, only two close disulfide conformers are compatible with the experimental data. The main feature of the trimer structure is the asymmetry of the molecule due to the disulfide bond pattern that induces a particular folding of one chain. This chain forms a turn-like structure locked by two disulfide bonds with the two other chains. The turn-like folding is close to that observed for the cyclized oxidized monomeric peptide. This is the first report of the 3D structure model for a junction between a collagenous triple helical domain and a noncollagenous domain.

Amino Acid Sequence↗
PubMed1996

Measuring the need for psychiatric treatment in the general population: the community version of the MRC Needs for Care Assessment.

The community version of the MRC Needs for Care Assessment Schedule (NFCAS-C) is a new instrument designed for the psychiatric conditions seen in general populations. Its principles are based on the original Needs for Care Assessment, although that was developed for the very different population of those with long-standing mental illness (Brewin et al. 1987). The NFCAS-C is designed to reproduce, in an itemized and systematic manner, the functioning of well-organized primary care and psychiatric services. It is primarily intended for research purposes, in particular, the comparison of treatment needs and services in different populations. In this paper we describe the problems of assessing the need for psychiatric care in general populations and the rationale and development of the instrument, while in its companion we present the results of a reliability study (Lesage et al. 1995).

Adult↗
PubMed1996

Bronchogenic cancer in the elderly: operative risk and long-term prognosis.

Surgery for bronchogenic cancer raises the question of benefit to elderly patients. The present study reviews a cohort of 223 patients aged 70 years and more (range: 70-84), who underwent thoracotomy for pulmonary malignancy over a 10-year period. The aim of the study was to evaluate both operative risk and 5-year survival. Medical history was negative in 29% of the patients; 26% had a history of cardio-vascular disease, and 19% had a history of malignancy in complete remission. Tumor histology was squamous-cell carcinoma for 70.4%, adenocarcinoma for 24.2%, large-cell carcinoma for 3.6%, and small-cell carcinoma for 1.3% of the patients. 48.4% of patients were in stage I, 17.2% in stage II, and 30.3% in stage III. Exploratory thoracotomy was carried out in 5.8% of patients. A resection was achieved in 210 patients (pneumonectomy in 28.5%, lobectomy in 71.5%). Operative mortality was 7.2% for the whole series, 10% after pneumonectomy and 6.6% after lobectomy. Mortality was similar below and above 75 years. Overall 5-year survival was 32.9% (45.7% for stage I, 36.3% for stage II, and 13.8% for stage III). Survival was not influenced by age, symptomatic or asymptomatic presentation, medical history, and in particular not by history of malignant disease. Although operative mortality is slightly increased when compared to younger patients, long-term results legitimize surgery for bronchogenic cancer in the elderly.

Aged↗