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Biomedical subjects

J Blacher

Publications and source records attributed to J Blacher.

At least 19 recordsLinked to original sources
PubMed2006

[Disseminated tuberculosis and profound thrombopenia].

Thrombocytopenia within the context of disseminated tuberculosis can lead to complications requiring rapid treatment. Although the origin is generally central, thrombocytopenia can arise from an immune disorder. We hereby report a case of disseminated tuberculosis associated with thrombocytopenia, which required, in addition to antituberculosis therapy initiated before bacteriological proof, corticosteroid treatment and multiple platelet transfusions. The discovery of anti-platelet antibodies along with the success of immunomodulator therapy confirmed the auto-immune origin of this thrombocytopenia.

Adrenal Cortex Hormones↗
PubMed2006

Syndrome specificity and behavioural disorders in young adults with intellectual disability: cultural differences in family impact.

BACKGROUND: This study examined whether behaviour problems and adaptive behaviour of low functioning young adults, and well-being of their families, varied by diagnostic syndrome [intellectual disability (ID) only, cerebral palsy, Down syndrome, autism], as well as by cultural group. METHODS: Behaviour disorders in young adults with moderate to severe ID were assessed from information provided by 282 caregivers during in-home interviews. The sample consisted of 150 Anglo participants, and 132 Latino, primarily Spanish-speaking, participants drawn from Southern California. RESULTS: Behaviour disorders and maternal well-being showed the same pattern across disability syndromes. Autism was associated with the highest scores in multiple behaviour problem areas as well as maternal reports of lower well-being. Down syndrome was associated with the lowest behaviour problem scores and the highest maternal well-being. When behaviour problems were controlled for, diagnostic groups accounted for no additional variance in maternal stress or depression. The pattern of behaviour problems and well-being did not differ by sample (Anglo vs. Latino), although level on well-being measures did. Latina mothers reported significantly higher depression symptoms and lower morale, but also higher positive impact from their child than did Anglo mothers. CONCLUSIONS: Caregivers of young adults with autism report more maladaptive behaviour problems and lower personal well-being, or stress, relative to other diagnostic groups, regardless of cultural group. However, cultural differences exist in caregiver reports of depression, morale, and positive perceptions. Implications for service provision aimed at families of children with challenging behaviour problems are discussed in the context of culture.

Activities of Daily Living↗
PubMed2006

The transition to school: adaptation in young children with and without intellectual disability.

BACKGROUND: Previous research has highlighted the importance of the transition to school for young children and their families. A child's successful adaptation to school is likely influenced by a number of factors, including academic, social, emotional, behavioural and cognitive competencies. Children with intellectual disability (ID) may be at heightened risk for early school difficulties, in part due to their deficits in cognitive and adaptive behaviours. METHODS: Factors associated with the adaptive transition to school in young children with (n = 24) and without (n = 43) ID were examined. Adaptive transitions were defined as having few teacher-reported problem behaviours and positive student-teacher relationships. Child self-regulatory skills and both parent- and teacher-reported social skills were evaluated to determine if they predicted positive adaptation in school for 5- to 6-year-old children. Data were gathered from child assessments, parent reports on standardized measures, direct observations of delay of gratification tasks and teacher reports on standardized measures. RESULTS: Children with ID had significantly more teacher-reported problem behaviour, poorer overall student-teacher relationships, fewer parent- and teacher-reported social skills and fewer self-regulation skills than typically developing children. Self-regulation at child age 36 months (latency to touch a desired toy) was significantly related to adaptation to school, as were parent and teacher reports of social skills. Social skills significantly predicted adaptation to school, even after accounting for the effects of child IQ and adaptive behaviour. CONCLUSIONS: Children with ID had less positive early school experiences, as indicated by multiple indices of adaptation to school. Fostering early social skills may be an important target for increasing the positive adaptation to school for young children, especially those with ID.

Adaptation, Psychological↗
PubMed2006

Socio-economic position, household composition, health status and indicators of the well-being of mothers of children with and without intellectual disabilities.

BACKGROUND: Many previous studies have reported that mothers of children with intellectual disabilities (IDs) are more likely to show signs of psychological distress and have lower well-being than mothers of 'typically developing' children. Our aim was to estimate the extent to which these differences may be accounted for by between-group differences in socio-economic position. METHODS: This study involved secondary analysis of happiness, self-esteem and self-efficacy variables in a nationally representative sample of 6954 British mothers with dependent children under the age of 17 years, 514 of whom were supporting a child with an ID. RESULTS: Mothers of children with IDs reported lower levels of happiness, self-esteem and self-efficacy than mothers of children without IDs. Statistically controlling for differences in socio-economic position, household composition and maternal characteristics fully accounted for the between-group differences in maternal happiness, and accounted for over 50% of the elevated risk for poorer self-esteem and self-efficacy. CONCLUSIONS: A socially and statistically significant proportion of the increased risk of poorer well-being among mothers of children with IDs may be attributed to their increased risk of socio-economic disadvantage.

Adolescent↗
PubMed2006

Mothers of young adults with intellectual disability: multiple roles, ethnicity and well-being.

BACKGROUND: Two opposing perspectives--role strain and role enhancement--were considered as predictive of women's psychological and physical health. The authors examined the relation between multiple role occupancy (parenting, employment, marriage) and well-being (depression and health) among mothers of young adults with intellectual disability (ID). METHODS: Participants were 226 mothers aged 35-70 years old caring for a young adult aged 16-26 years old with moderate to severe/profound ID. Mothers were of either Latino ethnicity (n=117) or Anglo (n=109). Mothers' ethnicity and degree of acculturation and young adults' adaptive behaviour and behaviour problems were examined as potential moderators. RESULTS: Mothers who were employed, married, or both reported better well-being than mothers who were both unemployed and unmarried, especially when their offspring had relatively higher adaptive functioning. This relationship between role occupancy and well-being was fully mediated by socio-economic status (SES) factors. Results did not suggest a role enhancement effect, but instead indicated a role shortage effect; unemployed, unmarried mothers experienced markedly poor well-being, while all other mothers experienced comparable well-being. Well-being scores were higher for Anglo than for Latino mothers; this relationship was entirely accounted for by SES. In Latina mothers, the relation between role occupancy and well-being was moderated by degree of acculturation. CONCLUSIONS: Findings suggest that multiple roles benefit mothers of young adults with ID primarily through their impact on socio-economic resources. For more acculturated Latina mothers, occupying more roles predicted better well-being even after controlling for SES. Latina mothers who were unemployed and unmarried had lower SES, and this group emerged as at particular risk. The latter group may benefit most from respite assistance and other interventions aimed at addressing their physical and mental health.

Acculturation↗
PubMed2005

[New treatment strategies for hypertension. Which guidelines and how to apply them].

The diagnosis of hypertension by blood pressure measurements taken in the physician's office has been called into question by several studies. The onset of cardiovascular events appears to correlate better with ambulatory blood pressure measurements than with those taken during consultation (either "white coat" or masked hypertension). While the US, WHO, French and European guidelines diverge as to the specific antihypertensive drug among the seven classes available should be chosen for first-line treatment, there is a consensus for specific choices as a function of the type of hypertension. In any case, most treatment trials show that more than two antihypertensive drugs are often necessary. Treatment can thus begin with two drugs. The optimal target blood pressure is defined by the US JNC7 according to whether the patient also has diabetes or a nephropathy. When hypertension is uncomplicated, the target level is 140/90 mmHg. In the case of diabetes or nephropathy, it is 130/80 mmHg. In all cases, diet and exercise changes are also necessary and it is essential that patients understand them if they are to comply with them. Diastolic blood pressure remains the most important figure for those younger than 50 years, but afterwards, systolic pressure is more relevant. Aortic pressure may be more closely associated with cardiovascular risk than the blood pressure measured at the brachial artery. The concept of comprehensive management is radically modifying our behavior : the hypertensive patient is now above all a patient at high cardiovascular risk and the treatments to consider must not be limited to antihypertensive drugs but must also include treatment of other cardiovascular risk factors (aspirin, statins, smoking cessation, etc.).

Aged↗
PubMed2005

Body composition and fat repartition in relation to structure and function of large arteries in middle-aged adults (the SU.VI.MAX study).

OBJECTIVE: To investigate associations of body composition assessed by bioimpedance analysis and anthropometric indicators of fat repartition with carotid structure and function. DESIGN: Cross-sectional epidemiological study. SUBJECTS: A total of 1014 middle-aged apparently healthy adults participating in the SU.VI.MAX study. MEASUREMENTS: Body composition (fat mass, fat-free mass) was assessed by bioimpedance analysis and anthropometric indicators of fat repartition (waist circumference (WC); waist-hip-ratio (WHR)) were simultaneously collected. Carotid ultrasound examination included measurements of intima-media thickness (IMT) at the common carotid arteries (CCA) and assessment of atherosclerotic plaques in extracranial carotid arteries. Carotid-femoral pulse-wave velocity (PWV) was used as a marker of aortic stiffness. RESULTS: In multivariate analyses adjusted for major known cardiovascular risk factors in addition to age, gender and height, fat-free mass, fat mass (FM), and WC were positively associated with CCA-IMT and lumen diameter. No significant association was found with occurrence of carotid plaques. PWV was only associated with WC. Associations of CCA-IMT and PWV with WC were not significant anymore after further adjustment on body mass index (BMI) or FM. CONCLUSION: WC was the only measurement positively associated with both early atherosclerosis markers such as CCA-IMT and arterial stiffness. Although this association depends on overall adiposity, as assessed by the BMI, it emphasizes the importance of WC in clinical practice and prevention programs as a screening tool for individuals at risk for cardiovascular disease.

Abdomen↗
PubMed2005

Preschool children with and without developmental delay: behaviour problems, parents' optimism and well-being.

BACKGROUND: Children with intellectual disability are at heightened risk for behaviour problems, and these are known to increase parenting stress. This study explored the relation of behaviour problems to less child-related domains of parent well-being (depression and marital adjustment), as well as the moderating effect of a personality trait, dispositional optimism. METHOD: Participating children (N = 214) were classified as developmentally delayed, borderline, or nondelayed. Mothers' and fathers' well-being and child behaviour problems were assessed at child ages 3 and 4 years. RESULTS: Parents of delayed and nondelayed preschoolers generally did not differ on depression or marital adjustment, but child behaviour problems were strongly related to scores on both measures. Optimism moderated this relationship, primarily for mothers. When child behaviour problems were high, mothers who were less optimistic reported lower scores on measures of well-being than did mothers who were more optimistic. CONCLUSIONS: Interventions for parents that aim to enhance both parenting skills and psychological well-being should be available in preschool. It may be beneficial for such programmes to focus not only on behaviour management strategies aimed at child behaviour change, but also on parents' belief systems, with the aim of increasing dispositional optimism.

Affect↗
PubMed2005

Preschool children with intellectual disability: syndrome specificity, behaviour problems, and maternal well-being.

BACKGROUND: Children with intellectual disability (ID) are at heightened risk for behaviour problems and diagnosed mental disorder. Likewise, mothers of children with ID are more stressed than mothers of typically developing children. Research on behavioural phenotypes suggests that different syndromes of ID may be associated with distinct child behavioural risks and maternal well-being risks. In the present study, maternal reports of child behaviour problems and maternal well-being were examined for syndrome-specific differences. METHODS: The present authors studied the early manifestation and continuity of syndrome-specific behaviour problems in 215 preschool children belonging to 5 groups (typically developing, undifferentiated developmental delays, Down syndrome, autism, cerebral palsy) as well as the relation of syndrome group to maternal well-being. RESULTS: At age 3, children with autism and cerebral palsy showed the highest levels of behaviour problems, and children with Down syndrome and typically developing children showed the lowest levels. Mothers of children with autism reported more parenting stress than all other groups. These syndrome-specific patterns of behaviour and maternal stress were stable across ages 3, 4 and 5 years, except for relative increases in behaviour problems and maternal stress in the Down syndrome and cerebral palsy groups. Child syndrome contributed to maternal stress even after accounting for differences in behaviour problems and cognitive level. CONCLUSIONS: These results, although based on small syndrome groups, suggest that phenotypic expressions of behaviour problems are manifested as early as age 3. These behavioural differences were paralleled by differences in maternal stress, such that mothers of children with autism are at elevated risk for high stress. In addition, there appear to be other unexamined characteristics of these syndromes, beyond behaviour problems, which also contribute to maternal stress.

Adult↗
PubMed2005

[Homocysteine, folic acid, group B vitamins and cardiovascular risk].

Although there is a high degree of proof relating plasma homocysteine levels to cardiovascular risk, the role of homocysteine as a causal cardiovascular risk factor remains controversial. Prospective long-term clinical trials in high cardiovascular risk populations usually show a positive relationship between plasma homocysteine and the degree of cardiovascular risk. However, shorter term studies and/or those carried out in populations with lower cardiovascular risk show either a weaker correlation or no relationship at all. To date no study has shown proof of the reversibility of cardiovascular risk due to hyperhomocysteinaemia; nevertheless, a number of studies using intermediate criteria support the hypothesis of a benefit due to reduction of plasma homocysteine levels. A number of therapeutic trials published with clinical criteria have not shown convincing results in either direction. A number of interventional trials are underway: notably the SUFOLOM 3 trial in France, and the question of a benefit on cardiovascular risk by reducing homocysteine levels should be answered in the next few years. In the meantime, with the exception of homocysteinuria in which therapeutic strategies have shown their efficacy in the reduction of atherothrombotic risk with high levels of proof, the authors do not recommend the treatment of mild hyperhomocysteinaemia in any clinical setting other than "clinical trials" and certain "compassionate" indications such as early and/or recurrent vascular events associated with hyperhomocysteinaemia in the absence of conventional risk factors.

Cardiovascular Diseases↗
PubMed2004

[Peripheral arterial disease: what management practices for general practitioners?].

OBJECTIVE: The purpose of this study was to analyze the results of the ATTEST study in order to evaluate general medicine management practices for peripheral arterial disease (PAD). Our analysis was based on the guidelines for good practice which recommend measurement of the systolic pressure index (SPI), search for other localizations of atherothrombosis, treatment of risk factors including smoking, walking exercises, and long-term prescription of anti-platelets. METHODS: ATTEST is a cross-sectional multicentric observational epidemiologic study conducted in metropolitan France. The study has recruited 8.475 analyzable patients with symptomatic PAD alone (3811 patients) or associated with other atherothrombotic localizations (2416 patients) or other cardiovascular diseases (2248 patients). These patients were followed by 3020 physicians. The current analysis thus included 6227 patients (81.2% men, 18.8% women, mean age 67.2 years), including 78.8% who had reached the stage of intermittent claudication. Risk factors included current or past smoking (61%), hypercholesterolemia (66.3%), hypertension (63.1%) and diabetes mellitus (26%). RESULTS: Arterial duplex Doppler exams of the lower limbs were performed in 91.2% of the patients but measurement of the SPI for diagnostic purposes had been performed in only 17%. The majority (85.8%) of the patients with proven coronary artery disease or cervico-encephalic involvement had had an ECG and 69.3% had had a duplex Doppler of the supra-aortic trunks. Smoking continued in 39% of the patients and an aid to cease smoking had been prescribed for only 7% of the patients who were non-smokers for less than one year. Nearly two-thirds of the patients analyzed had received advice concerning physical activities. Finally, anti-platelets had been prescribed for 92.2% of the patients. CONCLUSIONS: The general practitioner plays a crucial role in the diagnosis and treatment of PAD. Although measurement of the SPI is recommended as an early diagnostic tool and for evaluation of severity, it had been performed in less than one-third of the patients. Search for another localization of atherothrombosis had been performed in more than half of the patients. The physicians generally delivered advice on physical exercise and prescribed anti-platelets. The fight against smoking was however largely insufficient. The results of this study warrant further optimization of the collaboration between general practitioners and vascular disease specialists.

Adult↗
PubMed2004

Association between pulse pressure, carotid intima-media thickness and carotid and/or iliofemoral plaque in hypertensive patients.

Increased common carotid artery intima-media thickness (CCA-IMT) and carotid and/or iliofemoral (C/IF) plaque are frequent in subjects treated for hypertension, but their association with pulse pressure (PP) has rarely been studied. Using ultrasound techniques, CCA-IMT and C/IF plaques were studied in 323 hypertensive subjects, who were classified into four groups according to the adequacy of blood pressure (BP) control (systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg) and PP (high or low). After adjustment for confounding variables, an increase in CCA-IMT was the only factor significantly and independently associated with high PP, irrespective of the effectiveness of blood pressure control and of antihypertensive drug treatment. CCA-IMT correlated with age, PP, waist-to-hip ratio, tobacco consumption, and heart rate. C/IF plaques correlated with age, tobacco consumption, diabetes mellitus, and dyslipidaemia. To conclude, even with SBP<140 mmHg and DBP<90 mmHg on treatment, hypertensive subjects may have increased CCA-IMT values and C/IF plaque. Four cardiovascular risk factors seem to be involved in these alterations, namely tobacco consumption, dyslipidaemia, diabetes and increased PP. Only the latter factor does not have a standardized effective treatment.

Aged↗
PubMed2003

Influence of L-nitro-arginine methyl ester, acetylcholine, and adenosine on mean blood pressure, pulse pressure, and pulse pressure amplification in rats.

The blood pressure pattern in spontaneously hypertensive rats (SHRs) involves three main characteristics: increase in mean blood pressure (MBP); increase in thoracic aorta (proximal) and iliac (distal) pulse pressure (PP); disappearance of the normal PP amplification between the proximal and the distal arteries. Whether pharmacologic agents may reduce MBP with different or even opposite effects regarding PP and PP amplification has been poorly investigated. In SHRs and Wistar-Kyoto (WKY) anesthetized rats, the NO inhibitor l-nitro-arginine methyl ester (l-NAME) was infused at the dosage of 1 mg/kg for 30 min. Before and after infusion, 7 microg/kg/min acetylcholine (Ach) and 200 mg/kg adenosine (Ado) were perfused for 4 min. Proximal and distal intra-arterial BP was monitored throughout the procedure. In both WKYs and SHRs, l-NAME increased proximal and distal systolic (SBP), diastolic (DBP), and MBP but not PP. Before l-NAME, SBP, DBP, and MBP were significantly reduced by Ado and Ach. After l-NAME, such blood pressure reductions were abolished with Ach but not Ado. In both strains, the proximal and distal PP, when expressed in percent reduction of MBP, were significantly higher under Ado than under Ach. The Ado but not Ach changed PP amplification, causing a reduction in WKYs and an increase in SHRs independent of l-NAME. Vasodilating agents may reduce MBP with significantly different effects on PP. The Ado alters PP amplification, an effect not obtained with the nitric oxide endothelium-dependent vasorelaxing agent Ach. Tail SBP measurements cannot predict such dissociated changes.

Acetylcholine↗
PubMed2003

[Retinal vein occlusion and hyperhomocysteinemia].

INTRODUCTION: Previous studies have reported that an elevated plasma homocysteine level is a risk factor for vascular disease. The aim of this study is to determine whether hyperhomocysteinemia is a risk factor for retinal vein occlusion (RVO) and whether it is a prognostic factor. PATIENTS AND METHODS: The plasma homocysteine level was measured in 101 patients and compared to the plasma homocysteine level of controls. The relation between plasma homocysteine level and the other known risk factors of retinal vein occlusion was studied, as well as the correlation between the clinical outcome of the RVO and the plasma homocysteine level. RESULTS: The mean plasma homocysteine level was significantly higher in the 101 RVO patients than in the 29 controls (11.9 mmol/l vs 8.6, p<0.001). We found no relation between plasma homocysteine and other risk factors of vascular disease except for the hematocrit level. Hyperhomocysteinemia was more frequent in the ischemic forms and in bilateral RVO, but the difference was not statistically significant. CONCLUSIONS: Hyperhomocysteinemia seems to be an independent risk factor for RVO and was more frequent in severe RVO, but our study did not evidence an association with a severe prognosis. Vitamin therapy can decrease homocysteinemia but its efficacy in the prevention and in the treatment of RVO remains to be demonstrated.

Adult↗