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Biomedical subjects

C Mercier

Publications and source records attributed to C Mercier.

At least 127 records · Page 7Linked to original sources
PubMed1991

Coordinating community and public-institutional mental health services: some unintended consequences.

Where a target group such as the mentally ill tend to use multiple and varied services over a long period of time, service coordination is often seen as the key to continuity of care. This article argues that coordination also has its perverse effects. To demonstrate, two types of community organizations (COs) working in mental health in the Canadian province of Québec are examined: alternative COs, which have their roots in community action and maintain few formal links with each other or with institutional resources; and transitional structures, COs which are developed with the cooperation of psychiatric professionals, are closely linked to hospitals and are often part of a tightly coordinated system of community services. With respect to access, continuity, programs, internal structure and flexibility, each type of community resource has particular strengths and weaknesses. In the first part of the article, these are described and compared. In the second part of the article, we examine the possible effects of Québec's new mental health policy on COs working in mental health. The policy seeks to create comprehensive systems coordinating all services at the regional level-including alternative organizations, transitional structures and public institutions. The imperatives of the complex planning process risk diluting or even eradicating the differences between the two types of mental health COs described earlier. The process may thus rob certain service users of the particular advantages they found in alternative COs. For those mentally ill who, by choice or by chance, remain marginal to the coordinated system, there may ultimately be no resources available at all.

Community Mental Health Services↗
PubMed1991

Modeling alcohol metabolism with the DARC/CALPHI system.

We present our general system for QSAR search, CALPHI (Computer-Aided Law by Hyperstructure Investigation) set up in the context of the DARC structural language. We use it to construct global, fragmentary, and topological models of the capacity of alcohols to undergo glucuronidation. The DARC/PELCO model, more precisely and more significantly, explains 98% of the total variance with only three parameters, while treating the whole set of primary, secondary, and tertiary alcohols, whereas the best previously reported treatment restricted to primary alcohols, explains only 90% of the variance with two parameters. It provides an explicit and more precise interpretation of alcohol metabolism. The PELCO methodology is extended to evaluate the prediction reliability of both global and fragmentary models. PELCO leads to more predictions when comparison is made at the same level of reliability.

Alcohols↗
PubMed1991

{Staff perceptions of the community approach in psychiatry}.

Since the 1960s, psychiatric practice in North America and in many Western countries has been increasingly oriented toward implementing community services for the care of the chronically mentally ill. This study is part of a larger research project whose main goal was to assess the impact of a community-based program on the quality of life and social reintegration of psychiatric patients living in a remote area. The project took place in the northwestern region of Quebec where the community approach is clearly recognized as a basic principle in the delivery of mental-health services. The first part of this research, reported here, measured to what extent staff attitudes correspond with the community orientation.

Attitude of Health Personnel↗
PubMed1991

[Crisis centers and mental health services: the experiences in south west Montreal].

Based on data collected during the assessment phase of setting up the crisis centre L'Autre Maison, this article aims to present the services offered by the centre and to examine its integration with other resources within the community. Secondly, the article proceeds with a detailed analysis of the nature of crises that motivated clients to resort to the centre, which allows the authors to confirm the essentially social nature of these crises. Following a presentation of the results, the authors enter a broader discussion on: 1) the training received by personnel that works in the area of crisis intervention; 2) the organization of mental health services; and 3) the prevention programs focused on avoiding the oncoming of a crisis.

Adolescent↗
PubMed1990

Occlusive disease of the renal arteries and chronic renal failure: the limits of reconstructive surgery.

In order to investigate the value of renal revascularization in patients with chronic renal failure and associated occlusive lesions of the renal arteries, the long-term results of 48 revascularizations in 43 patients operated upon between January 1980 and May 1988 were analyzed. There were 36 men and 7 women whose mean age was 61.8 years (range 36 to 79 years). The diagnosis of kidney failure was based on serum creatinine levels greater than 120 micromoles/L on two consecutive determinations. Patients were divided into four groups: Group I (23 patients) had a creatininemia between 120 and 200 mumoles/L, Group II (16 patients) between 200 and 350 mumoles/L, Group III (2 patients) between 350 and 800 mumoles/L and Group IV (2 patients) who had chronic renal failure requiring hemodialysis. Hypertension was found in 37 patients. Renal artery restoration was unilateral in 38 patients, 12 of whom had a solitary kidney. Restoration was bilateral in five patients. In 24 patients, renal artery surgery was associated with reconstruction of the infrarenal aorta. Three patients undergoing associated aortic procedures (7%) died after surgery. Thirty-nine patients were followed for a mean of 35.1 months; one patient was lost to follow-up. Improvement or stabilization of renal function was noted in 24 patients (62%). Deterioration was found in 15 patients (38%), six of whom presently required chronic hemodialysis. In Groups I and II, 69.5% of patients stabilized or improved their kidney function. Renal function worsened in all patients in Groups III and IV. We conclude that restorative renal surgery can improve renal function in patients whose preoperative serum creatinine levels are less than 350 mumoles/L. In this population of patients, associated aortic restoration should be performed only when absolutely necessary.

Adult↗
PubMed1990

Effects of electrical stimulation on the activity of hexokinase in the medial gastrocnemius muscle of aged rats after hindlimb suspension.

1. The activity of the enzyme Hexokinase (E.C. 2.7.1.1.) has been measured after a 21 day period of hindlimb suspension and a 14 day period of recovery with or without electrical stimulation in the old rat Medial Gastrocnemius muscle divided in its white and red parts. 2. After suspension, the activity of the enzyme increased in both parts of the muscle and returned near its control value more rapidly in the red part of the muscle when electrical stimulation was applied.

Adaptation, Physiological↗
PubMed1990

[Organ procurement in pediatrics. General and ethic aspects].

The progress in organ transplantation is leading an increase in the demand for organs. Any non-harvested organs from a dead child mean at least a delay or even the loss of hope for life. All brain dead children do not undergo organ harvesting because there are still obstacles. The definition of brain death must be clear and include the destruction of all the brain system. Intensive care units must be motivated by improved contacts with transplantation teams. The number of parents who refuse could decrease with better public information, good contacts with medical teams and the quality of discussion with parents when a child dies. Energy should be concentrated on improving the collective consciousness about this new aspect of medicine.

Attitude↗
PubMed1990

[Application of ultrasono-micrometric technic to study vasomotility].

An experimental model of simultaneous recording of pressure and flow (instantaneous and mean values) and of the vascular diameter (by ultrasonomicrometry) at the entry of a clearly limited territory of the systemic circulation has been developed in the animal together with a programme of data aquisition and analysis. This programme allows quantification of the different viscoelastic properties of the vessel wall which characterise arterial flow in the arteries of distribution (capacitance vessels) and irrigation (resistance vessels). The model was applied to the study of the pharmacological effects of two antianginal agents, a nitrate derivative (ND) administered acutely by slow intravenous infusion at a dose of 25 micrograms/Kg/mn over 20 minutes (total dose: 500 micrograms/Kg) and a substitute sydronimous substance (SYD) administered in the same manner at a dose of 15 g/Kg/mn over 20 minutes (total dose: 300 micrograms/Kg). The hypotensive effects obtained were comparable and significant (p less than 0.001) in both cases. The ND led to a fall in mean blood pressure of 9.7 +/- 1.3% and SYD of 10.0 +/- 2.1%. However, SYD led to an increase in aortic blood flow (11.7 +/- 3.6%, p less than 0.01) whilst the ND had no significant effect on this parameter (+ 6.07 +/- 5.7%). As a result, there was a much greater decrease of peripheral resistances after administration of SYD (-22.8 +/- 3.1%) than with the ND (-12.7 +/- 4.2%). This difference was also observed when the input impedence of the vascular bed was studied (-31.2 +/- 6.9% after SYD and -12.0 +/- 2.5% after the ND).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[Diagnostic approach in coronary disease in vascular surgery. Role of myocardial scintigraphy].

Dipyridamole thallium scintigraphy (tomo SMTD) (fig. 2) and a bicycle stress-testing ECG were performed in a prospective study of 102 patients (Tabl. VIII) referred for aortic reconstruction surgery with aortic cross-clamping (fig. 1), carried out without knowledge of tomo SMTD results. A clinical coronary artery disease (CAD) was suspected in 45 patients (44%). The exercise test (tabl. IV) was inadequate in 78%, normal in 11% and abnormal in 11% of patients. Tomo SMTD (tabl. VI et X) was normal in 60 patients (59%), abnormal with persistent defect in 21 (20.5%) and abnormal with transient defect in 21 (20.5%). Post-operative cardiac events (tabl. I) occurred in 4 patients (3.9%): 2 deaths, 1 non-fatal myocardial infarction and 1 rest angina; but only 2 of these had documented CAD. All 4 had abnormal tomo SMTD (3 with transient, 1 with persistent defect). It is concludes that abnormal tomo SMTD had a significant pronostic value (p less than 0.03) in predicting post-perative cardiac events (tabl. XI, fig. 3) after abdominal aortic surgery with cross-clamping. This test facilitates selection of patients for coronary angiography.

Aged↗
PubMed1990

Vascular reconstruction after extended resection of a retroperitoneal fibromatosis.

We report the case of a 25-year-old man who underwent successful en-bloc resection of a retroperitoneal fibromatosis, extended to the right kidney and testis, with excision of the right iliac arteries and veins. Arterial replacement was done by means of a right iliofemoral prosthetic graft. A right femorocaval prosthetic graft with a temporary arteriovenous fistula was used for venous replacement. The patient is still alive and after 3 years shows no sign of recurrence on successive computed tomographic scans. He has preserved patency of the right arterial and venous iliac grafts. To our knowledge, this is the first documented case of simultaneous arterial and venous iliac replacement successfully performed after excision of a retroperitoneal tumor.

Adult↗
PubMed1990

[Evaluation of coronary risk in arterial surgery].

To evaluate the incidence of coronary artery disease in peripheral vascular surgery, three groups of patients (table. I) were studied retrospectively: 286 patients who had vascular surgery with no concern for the location of arterial lesions (group I); 130 patients electively operated for infra-renal abdominal aortic aneurysm (group II); and 120 patients who had 139 carotid endarterectomies (group III). The frequency of cardiac history (table II) evaluated in the three groups of patients, was respectively 42.6%, 41.4.% and 27.5%. Operative mortality in the three groups was respectively 6%, 3.8% and 1%. In group I, mortality of cardiac origin was 2.2% and cardiac morbidity 7%. In this group, analysis of results showed that the existence of cardiac history is a significant risk factor (table III) for the mortality and incidence of cardiac complications (p less than 0.005). In groups II et III, operative mortality of cardiac origin was respectively 1.5% and 0%; cardiac morbidity was respectively 4.6 and 2.2%. On the basis of this analysis, we can conclude that cardiac complications are the main cause of mortality and morbidity in peripheral vascular surgery and that the existence of cardiac history is a significant predictive factor in evaluation of operative risk in vascular surgery.

Aged↗
PubMed1989

Aortoiliac reconstruction and renal transplantation: staged or simultaneous.

Aortoiliac atherosclerosis can jeopardize the outcome of renal transplantation. During a five-year period, 176 renal transplants were performed. Of these, four patients underwent prior or simultaneous arterial reconstruction. In two, transplantation was successfully performed three and ten months after abdominal aortic aneurysm repair. In the two others with aortoiliac occlusive lesions, simultaneous arterial reconstruction and transplantation were successfully performed. We conclude that the discovery of aortoiliac lesions in a candidate for renal transplantation warrants consideration for staged or simultaneous arterial reconstruction to widen the indications for transplantation in such individuals and provide satisfactory long-term transplant durability.

Adult↗
PubMed1989

Insulin and glycemic responses in healthy humans to native starches processed in different ways: correlation with in vitro alpha-amylase hydrolysis.

The aim of the study was to elucidate how extracted starches submitted to food processing (or not) can influence plasma insulin and glucose responses in healthy subjects. Native starches from wheat, manihot, smooth peas, or mung beans were tested either raw, as starch gels (boiled and cooled), or cooked and cooled after a preliminary industrial processing: extrusion cooking for wheat, tapioca for manihot, and noodles for mung beans. Eighteen healthy subjects randomly assigned received three different starches under one form of conditioning. All products were submitted to in vitro alpha-amylolysis. Raw manihot starch produced the lowest (p less than 0.05) metabolic responses. Cooking significantly (p less than 0.01) increased plasma responses. However, cooked mung bean noodles gave metabolic responses similar to those of raw products. Close correlations were found between percentages of in vitro starch hydrolysis at 30 min and mean areas under the glycemic curves and the insulinemic curves (r = 0.95, p less than 0.001).

Adult↗
PubMed1989

[The role of subjective factors in medication compliance].

In 1974, Van Putten was wondering "Why schizophrenic patients refuse to take their medication?" Twenty years later, the entire October 1986 issue of Psychiatric Annals deals with the subject of compliance in the case of maintenance psychotropic drugs. This paper aims to relate the empirical observations made during 152 interviews with chronic psychiatric patients to the broader considerations reported in specialized literature on compliance in the case of psychotropic drugs and of lithium. These two types of data make it possible to explain how the "perceived" advantages and disadvantages of medication go beyond the positive and negative factors objectively recognized and how they intervene in the decision to continue, modify freely or give up the treatment. In conclusion, the author reports studies on the effectiveness of various strategies proposed for increasing compliance.

Adult↗
PubMed1989

[Alternative resources and intermediate structures in the context of Québec.].

In Québec, a consensus appears to have developed over the last few years around the need to develop community-based resources in mental health. However, the concept of community resources is fragmented: there is a conceptual distinction between Alternative and Intermediary Resources, both of which are located outside the walls of the institution, but which have different objectives, and suggest different means for supporting the mentally disturbed in the community. Attempts to operationalize these concepts have tended to have the effect of masking their conceptual particularity. In this article, the conceptual distinctions - as they have developed in the Québec context - are clarified, and the implications of erasing them are discussed.

English Abstract↗
PubMed1989

[Stress and health at work for day care workers : the alleviating role of social support.].

This study, which focuses on the child care work environment, asks four questions : Is the state of stress among child care workers greater than that observed in a normal population? Are there aspects of the work itself that are more associated with the worker's personal state of stress? What link can we establish between the state of stress and the state of health of this group? Finally, can supportive relationships lessen the negative impact of certain work environments? 165 female workers, of which 85% are teachers, took part in the study on a volunteer basis after their child care centre had been selected arbitrarily. Subjects answered five questionnaires to measure the state of their stress, mental health, physical health, the emotional support of their spouse and the importance given to stress-related factors in the workplace. Results show that the state of stress of these workers is, on the average, no higher than that found in a normal population. However, work situations involving child supervision, interpersonal relations among staff, as well as feelings of being overworked are considered the most stressful. These work situations, even the most stress-producing, are not associated to a worker's state of physical or mental stress. It's the stress state itself, in its role as an intermediate variable, that makes the connection between sources of stress and the person's state of health. Finally, emotional support is linked to the state of stress, but has no direct link to the state of physical or mental health. A spouse's support is nonetheless considered as regular and effective protection against increases in the state of stress. A number of methodological implications are also discussed.

English Abstract↗
PubMed1989

[Living conditions and place of residence.].

When looking at how people with severe mental disorders reintegrate the community, housing stands out as a key factor. Until now, the specialized press has mostly focused on the description and assessment of various residential programs that deal with readaptation. Rarely have we attempted to find out from psychiatric outpatients themselves what their living conditions are like or what opinion they have on their environment. Based on research conducted on a group of 151 individuals who had received care in a psychiatric ward, this article reports on the person's living conditions relating to their type of accomodations. Survey data shows the possibility for: 1) comparing various types of housing arrangements with the individuals' clinical and socio-demographic characteristics ; and 2) considering the impact of the type of residence on other areas of life. These informations are also put into perspective with the individual's own assessment of his or her living conditions.

English Abstract↗