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Biomedical subjects

R Boyer

Publications and source records attributed to R Boyer.

At least 19 recordsLinked to original sources
PubMed2004

Detection of depression and anxiety disorders by home care nurses.

Several studies have reported that psychiatric disorders, mainly depression and anxiety disorders, were masked and undiagnosed among older adults, particularly frail elderly. This phenomenon could have a significant impact on elderly quality of life. In this study, we assessed the utility of three measures for detecting mental health disorders among frail elderly receiving home care services: (1) the PRIME-MD; (2) a standard psychological distress measure (PDI-29), and (3) the health care case manager'sa priori judgment on the subject's mental health status. Results obtained by home care nurses were compared to those obtained by clinical psychologists using a structured diagnostic interview (SCID for DSM-IV). The study was conducted in two community health service centres. During the study's period, all patients in the health care workers' caseload without cognitive impairment and not reporting significant stressful life events during the six-week period preceding the interview (n = 315) were asked to participate in the study. Results showed that 42.9% of the volunteers that agreed to meet a psychologist at home (n = 177) had a current SCID-IV diagnosis. The specificity of the PRIME-MD test performed by nurses was 83.8% and its sensitivity was 41.7%. The correct classification rate was 66.7%. Results indicated that the PDI-29 items showed better performance characteristics than the PRIME-MD in identifying current cases. The specificity of the PDI-29 was 59.0% and its sensitivity was 73.6%. These results lead us to the conclusion that the PRIME-MD, previously proposed by Spitzer, R.L., Williams, J.B., Kroenke, K., Linzer, M., DeGruy, F.V. 3rd, Hahn, S.R., et al. (1994, Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. Journal of the American Medical Association, 272 (22), 1749-1756.) to help physicians in primary care clinics, could be less appropriate than the PDI-29 when used by home care nurses in identifying undiagnosed mental health disorders in frail older adults living at home. Moreover, this study showed that the health care case manager'sa priori judgment on the care receiver's mental health status is not sufficient in identifying frail elderly mental health services needs. A two-stage screening procedure is proposed to help home care nurses.

Adult↗
PubMed2001

Synthesis and evaluation of oxodioxolenylmethyl carbamate prodrugs of pseudomycins.

With the aim of increasing therapeutic indexes of novel cyclic depsinonapeptide pseudomycins, we synthesized and evaluated a series of mono-, di-, and trioxodioxolenylmethyl carbamate prodrugs (2 and 4) of pseudomycin B 1 and pseudomycin C' 3. It is rather encouraging to note that several members of the newly synthesized prodrugs described herein (e.g., 2a, 2e, and 4e) exhibited comparable in vivo efficacy to that achieved by the parent compounds, yet free of tail vein irritation and histamine induced toxicity in vivo.

Animals↗
PubMed2001

N-acyloxymethyl carbamate linked prodrugs of pseudomycins are novel antifungal agents.

We describe herein the synthesis, bioconversion, antifungal activity, and preliminary toxicology evaluation of a series of N-acyloxymethyl carbamate linked triprodrugs of pseudomycins. The syntheses of these prodrugs (3-6) were achieved via simple N-acylation of PSB (1) or PSC' (2) with various prodrug linkers (7-9). As expected, upon incubation with mouse and/or human plasma, many of these prodrugs (3, 5, and 6) were converted to the parent compound within a few hours. Of particular significance, two pseudomycin triprodrugs (5 and 6) showed excellent in vivo efficacy against systemic Candidiasis without tail vein irritation being observed.

Animals↗
PubMed2001

Relationship between soil lead and airborne lead concentrations at Springfield, Missouri, USA.

This study tests whether lead deposited to soil from automobiles during past years in a medium-sized US city (population 150,000) may present a current health risk. It examines the relationship between current soil lead concentrations at nine locations within the city of Springfield, Missouri, and airborne lead levels measured at the same locations during years (1975-1981) when lead emissions from automobiles were much greater than at present. A strong, significant correlation is found between soil and airborne lead levels at eight of the sites (r = 0.91, P < 0.005 for soil lead vs. 1979 airborne lead), in low-traffic areas as well as in areas adjacent to heavy traffic flow. Residual lead concentrations in these soils are relatively low, even for the high-traffic sites, as expected for a medium sized city.

Air Pollutants↗
PubMed2001

Correlates of psychotropic drug use in the elderly compared to adults aged 18-64: results from the Quebec Health Survey.

This study documents correlates of psychotropic drug use among older adults and compares the results observed in this group to those observed in individuals aged 18-64. A multivariate logistic regression analysis using data from the Quebec Health Survey (1992-1993) was employed to study predisposing and facilitating factors of this behavior. Results showed that 22% of the elderly reported having used anxiolytics, sedatives or hypnotics during the two days preceding the survey, compared to 4.9% of the respondents aged 18-64. Combining both samples, perceived health status, physical functional status, and health services utilization for psychological distress symptoms were the main health factors associated with psychotropic drug use. A significant difference was observed between the two age groups with regard to the association between the respondents' health status and the use of anxiolytics, sedatives or hypnotics. When the effect of other explanatory factors was controlled, older adults in poor health used anxiolytics, sedatives or hypnotics 2.21 times more than individuals aged 18-64 with a similar health condition, whereas older adults in good health used these drugs 7.49 times more than healthy individuals aged 18-64. Furthermore, after controlling for the effect of the respondents' physical and psychological health status, our results showed that more women than men used psychotropic drugs (OR = 1.57; 99% CI = 1.26-1.94). Low-income respondents were also more likely to report using these medications (OR = 1.53; 99% CI = 1.22-1.90). These results were interpreted as supporting the socio-cultural hypothesis of psychotropic drug use, which suggests that the prescribing and utilization of psychotropic drugs is influenced not only by symptoms but also by the social characteristics of individuals. It is suggested that future research may contribute to a better understanding of psychotropic drug utilization in the older adult community-dwelling population by examining consumers' attitudes and health care providers' social values concerning the appropriateness of this behavior.

Adolescent↗
PubMed2001

Posttraumatic stress disorder, trauma exposure, and the current health of Canadian bus drivers.

OBJECTIVE: Previous studies of veterans have linked posttraumatic stress disorder (PTSD) after combat-related trauma to increased reports of health problems. It is unclear whether this association between PTSD and increased health problems generalizes to civilians who are exposed to a broader array of traumatic events. We also do not know whether trauma exposure is associated with increased health problems in individuals who do not develop PTSD. Using a non-treatment-seeking civilian sample, we examined whether lifetime PTSD or trauma exposure by itself was associated with current health problems. METHODS: Using a cross-sectional design and self-report measures, we evaluated urban Canadian bus drivers (n = 342) on trauma exposure, lifetime PTSD, and current health problems. Based on their responses, we divided our sample into individuals who had never experienced trauma (n = 91), trauma-exposed individuals who had never developed PTSD (n = 218), and persons who developed PTSD at some point after trauma (n = 33). We compared these groups on health problems, treatment service use, and health assessment measures. RESULTS: The PTSD group reported increased health complaints, more frequent use of health treatments, and poorer health self-ratings compared with the exposed non-PTSD and nonexposed groups. Trauma-exposed drivers without PTSD did not differ from unexposed drivers on any health measure. Controlling for sex and trauma frequency did not alter our findings. CONCLUSIONS: Trauma exposure that leads to PTSD is associated with increased health problems, while trauma exposure alone is not. Our results extend previous findings to a broader civilian context and clarify associations between trauma exposure and health.

Adult↗
PubMed2001

Loneliness in relation to suicide ideation and parasuicide: a population-wide study.

Some links between loneliness and different manifestations of suicidal conduct have been reported in variety of subgroups (e.g., college students, the elderly, psychiatric patients). We tested this hypothesis by using the results of a population-wide survey. Strong associations among suicide ideation, parasuicide and different ways of being lonely and alone, defined either subjectively (i.e., the feeling), or objectively (i.e., living alone or being without friends), were observed. Moreover, prevalence of suicide ideation and parasuicide increased with the degree of loneliness. Only minimal differences between men and women were found.

Adolescent↗
PubMed2000

Outcomes in a referral cohort of patients with anxiety disorders.

This study describes 6- and 12-month outcomes in a referral cohort with anxiety disorders and identifies treatment and prognostic factors related to these outcomes. Patients were recruited at three general hospital clinics, two psychologist-run clinics, and one psychiatric hospital clinic. Outcomes included severity of symptoms, physical and mental health status, and subjective global change in problem severity. Of 254 patients eligible for follow-up, 165 (65.0%) completed a follow-up questionnaire. Methods of treatment included consultation with return to the primary care physician (38.2%); or continued treatment at the clinic, with medications (16.4%), psychotherapy (22.4%), or both (23.0%). Both severity of symptoms and mental health status improved but remained abnormal at follow-up. In multiple logistic regression, subjective global improvement was related to a diagnosis of panic disorder only, treatment with psychotherapy, and type of referral. Change over time in symptom severity was related to clinic type, and change over time in mental health was related to clinic type and duration of previous treatment.

Adult↗
PubMed2000

Anxiety, significant losses, depression, and irrational beliefs in first-offence shoplifters.

OBJECTIVE: To evaluate the relationship among demographic data, anxiety, significant losses, depression, and irrational beliefs reported by first-offence shoplifters. METHOD: One hundred and six adult shoplifters who were first-time offenders completed a self-administered questionnaire. RESULTS: Men and women were equally likely to be arrested for this offence. The majority of offenders were poor and unemployed. Depression, but not anxiety, was the most common psychiatric disorder associated with shoplifting. Subjects with depression presented the greatest number of irrational beliefs related to shoplifting. CONCLUSIONS: The authors suggest 2 categories of shoplifters: those who shoplift through rational choice; and those for whom shoplifting is a response to depression or leads to the fulfillment of some psychological needs. In conclusion, shoplifting does not have a unitary motive, and the clinical implications are that the affective and cognitive aspects of shoplifters' behaviours must be taken into account.

Adolescent↗
PubMed2000

Decompressive craniotomy in medically uncontrollable malignant infarction.

Patients with progressive neurological deficit following large cerebral infarctions are viewed to have a uniformly poor prognosis. We present two patients with large middle cerebral artery infarctions in which a decompressive craniotomy was life saving and resulted in functional outcome. The clinical course of patients with malignant infarction and the treatment issues involved including patient selection and the timing and extent of cranial decompression are discussed.

Adult↗
PubMed2000

Emotional distress among couples involved in first-trimester induced abortions.

OBJECTIVE: To establish the prevalence of clinically significant psychological distress in women and men involved in first-trimester abortions and to identify related risk factors. DESIGN: Prospective cohort study. SETTING: A downtown Montreal public abortion clinic and the Montreal metropolitan area. PARTICIPANTS: We recruited 197 women and 113 men involved in first-trimester abortions and compared them with control groups composed of 728 women and 630 men 15 to 35 years old who had taken part in a previous public health survey (Enquête Santé Québec 1987). One hundred twenty-seven women and 69 men completed the follow-up questionnaire. MAIN OUTCOME MEASURES: Level of distress as measured by the Ilfeld Psychological Symptom Index. RESULTS: Before the abortion, 56.9% of women and 39.6% of men were much more distressed than their respective controls. Three weeks after the abortion, 41.7% of women and 30.9% of men were still highly distressed. Predictors of distress for women were fear of negative effects on the relationship, unsatisfactory relationships, relationships of less than 1 year, ambivalence about the decision to abort, not having a previous child, and suicidal ideation (this association was weaker than in controls). Predictors for men were fear of negative effects on the relationship, relationships of less than 1 year, preoccupation with the abortion and anxiety about its accompanying pain, negative perceptions of their own health, suicidal gestures in the past, and suicidal ideation in the past year (only the association with suicidal gestures was marginally stronger than in controls). CONCLUSION: Being involved in a first-trimester abortion can be highly distressing for both women and men.

Abortion, Legal↗
PubMed1999

[How to prevent post-traumatic stress disorder before traumatization occurs?].

OBJECTIVE: To provide an update on methods of preventing the onset of posttraumatic stress disorder (PTSD) before trauma occurs. METHOD: Survey and analysis of the literature (mainly articles) found in the Medline, Psychinfo, and Pilot databases. RESULTS: Most research focuses on identifying risk factors and reinforcing individual resistance as the prime means of preventing PTSD. The severity of the trauma is by far the most serious risk factor. To reinforce resistance and prevent the onset of PTSD, the army has favoured psychoeducational approaches. However, the literature survey has found no pretrauma prevention program for other high-risk occupations. CONCLUSION: The usefulness of identified risk factors for the primary prevention of PTSD is limited, since with the exception of the trauma itself, they play a minor role on the onset of severe-trauma PTSD. Psychoeducational approaches aimed at reinforcing the resistance of individuals at risk are promising, but their potential has to be further explored in individuals in high-risk trades. Finally, it has been suggested that other avenues of research in the primary prevention (pretrauma) of PTSD be explored. These include the identification of possible protection factors, the influence of genetic make-up and of biological variables, the cumulative effects of exposure to stressors, and the presence of chronic stressors.

Adaptation, Psychological↗
PubMed1998

Pathogenesis of adenocarcinoma in Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant condition characterized by intestinal hamartomatous polyps, mucocutaneous melanin deposition, and increased risk of cancer. Families with PJS from the Johns Hopkins Polyposis Registry were studied to identify the molecular basis of this syndrome and to characterize the pathogenesis of gastrointestinal hamartomas and adenocarcinomas in PJS patients. Linkage analysis in the family originally described by Jeghers in 1949 and five other families confirmed linkage to 19p13.3 near a recently identified gene responsible for PJS. Germ-line mutations in this gene, STK11, were identified in all six families by sequencing genomic DNA. Analysis of hamartomas and adenocarcinomas from patients with PJS identified loss of heterozygosity (LOH) of 19p markers near STK11 in 70% of tumors. Haplotype analysis indicated that the retained allele carried a germ-line mutation, confirming that STK11 is a tumor suppressor gene. LOH of 17p and 18q was identified in an adenocarcinoma but not in hamartomas, implying that allelic loss of these two regions corresponds to late molecular events in the pathogenesis of cancer in PJS. The adenocarcinomas showing 17p LOH also demonstrated altered p53 by immunohistochemistry. None of the 18 PJS tumors showed microsatellite instability, LOH on 5q near APC, or mutations in codons 12 or 13 of the K-ras proto-oncogene. These data provide evidence that STK11 is a tumor suppressor gene that acts as an early gatekeeper regulating the development of hamartomas in PJS and suggest that hamartomas may be pathogenetic precursors of adenocarcinoma. Additional somatic mutational events underlie the progression of hamartomas to adenocarcinomas, and some of these somatic mutations are common to the later stages of tumor progression seen in the majority of colorectal carcinomas.

Adenocarcinoma↗