Biomedical subjects

Claude Vincent

Publications and source records attributed to Claude Vincent.

14 recordsLinked to original sources

PubMed2006

Public telesurveillance service for frail elderly living at home, outcomes and cost evolution: a quasi experimental design with two follow-ups.

BACKGROUND: Telesurveillance is a technologically based modality that allows the surveillance of patients in the natural setting, mainly home. It is based on communication technologies to relay information between a patient and a central call center where services are coordinated. Different types of telesurveillance systems have been implemented, some being staffed with non-health professionals and others with health professional, mainly nurses. Up to now, only telesurveillance services staffed with non-health professionals have been shown to be effective and efficient. The objective of this study was to document outcomes and cost evolution of a nurse-staffed telesurveillance system for frail elderly living at home. METHODS: A quasi experimental design over a nine-month period was done. Patients (n = 38) and caregivers (n = 38) were selected by health professionals from two local community health centers. To be eligible, elders had to be over 65, live at home with a permanent physical, slight cognitive or motor disability or both and have a close relative (the caregiver) willing to participate to the study. These disabilities had to hinder the accomplishment of daily life activities deemed essential to continue living at home safely. Three data sources were used: patient files, telesurveillance center's quarterly reports and personal questionnaires (Modified Mini-Mental State, Functional Autonomy Measurement System, Life Event Checklist, SF-12, Life-H, Quebec User Evaluation of Satisfaction with Assistive Technology, Caregiver Burden). The telesurveillance technology permitted, among various functionalities, bi-directional communication (speaker-receiver) between the patient and the response center. RESULTS: A total of 957 calls for 38 registered clients over a 6-month period was recorded. Only 48 (5.0%) of the calls were health-related. No change was reported in the elders' quality of life and daily activity abilities. Satisfaction was very high. Caregivers' psychological burden decreased substantially. On a 3 months period, length of hospital stays dropped from 13 to 4 days, and home care services decreased from 18 to 10 visits/client. Total cost of health and social public services used per client dropped by 17% after the first 3 months and by 39% in the second 3 months. CONCLUSION: The ratio of 0.50 calls per client to the call center for health events is three times higher than that reported in the literature. This difference is probably attributable to the fact that nurses rather than non-health professional personnel were available to answer the clients' questions about their health and medications. Cost evolution showed that registering older adults at a telesurveillance center staffed by nurses, upon a health professional recommendation, costs the health care system less and does not have any negative effects on the well-being of the individuals and their families. Telesurveillance for the elderly is effective and efficient.

Aged↗

PubMed2006

Lipoteichoic acid increases TLR and functional chemokine expression while reducing dentin formation in in vitro differentiated human odontoblasts.

Gram-positive bacteria entering the dentinal tissue during the carious process are suspected to influence the immune response in human dental pulp. Odontoblasts situated at the pulp/dentin interface are the first cells encountered by these bacteria and therefore could play a crucial role in this response. In the present study, we found that in vitro-differentiated odontoblasts constitutively expressed the pattern recognition receptor TLR1-6 and 9 genes but not TLR7, 8, and 10. Furthermore, lipoteichoic acid (LTA), a wall component of Gram-positive bacteria, triggered the activation of the odontoblasts. LTA up-regulated the expression of its own receptor TLR2, as well as the production of several chemokines. In particular, an increased amount of CCL2 and CXCL10 was detected in supernatants from LTA-stimulated odontoblasts, and those supernatants augmented the migration of immature dendritic cells in vitro compared with controls. Clinical relevance of these observations came from immunohistochemical analysis showing that CCL2 was expressed in vivo by odontoblasts and blood vessels present under active carious lesions but not in healthy dental pulps. In contrast with this inflammatory response, gene expression of major dentin matrix components (type I collagen, dentin sialophosphoprotein) and TGF-beta1 was sharply down-regulated in odontoblasts by LTA. Taken together, these data suggest that odontoblasts activated through TLR2 by Gram-positive bacteria LTA are able to initiate an innate immune response by secreting chemokines that recruit immature dendritic cells while down-regulating their specialized functions of dentin matrix synthesis and mineralization.

Cell Differentiation↗

PubMed2005

Reliability of the seated postural control measure for adult wheelchair users.

PURPOSE: To evaluate the test-retest and interrater reliability of the Seated Postural Control Measure for Adults 1.0 (SPCMA 1.0). METHOD: The participants were evaluated first by two raters and then, 3 weeks later, by one rater. Section 1 (one item, seven-point scale) evaluates the adult's overall ability to control its posture in a sitting position. Sections 2 and 3 (22 items each, scored on a seven-point scale), evaluate the adult's postural alignment in a static position and the changes in postural alignment induced by a dynamic activity. RESULTS: For the test-retest reliability, the intraclass correlation coefficient (ICC) of section 1 was excellent (0.95) and moderate to good for sections 2 and 3 (0.60 - 0.62) and their subsections (0.47 - 0.78). For interrater reliability, the three sections had good to excellent ICCs (0.68 - 0.93) and their subsections had moderate to good ICCs (0.41 - 0.69). A large range was observed in Kappa coefficients (test-retest and interrater reliability) for the item analysis of the sections 2 and 3, due to a lack of variability in some items. CONCLUSIONS: The results confirm that the SPCMA is reliable as a whole. Suitable information has been obtained for the development of the SPCMA 2.0 and, although further psychometric testing is needed, the latter should improve clinical evaluation of seated postural control in adult wheelchair users.

Activities of Daily Living↗

PubMed2005

Adaptation of a seated postural control measure for adult wheelchair users.

PURPOSE: Clinical measures of seated postural control in adults are not standardized and most are derived from in-house tools. The purpose of this study is to adapt a pediatric instrument to evaluate seated postural control in adult wheelchair users. METHOD: The new instrument is called the Seated Postural Control Measure for Adults (SPCMA) 1.0. Five preliminary versions were pretested with some 20 adults by two raters and a group of experts. RESULTS: This instrument comprises three sections: Section 1, level of sitting scale for adults (1 item, 7-point ordinal scale); Section 2, static postural alignment (22 items, 7-point ordinal scale); and Section 3, postural alignment after a dynamic activity, propulsion of the wheelchair on flat terrain and an incline (22 items, 7-point ordinal scale). CONCLUSIONS: The SPCMA for Adults 1.0 improves the quality and uniformity of evaluations done by different raters, which facilitates more rigorous follow-up of clients over time, communication between professionals, and objective verification of the attainment of intervention objectives.

Activities of Daily Living↗

PubMed2005

Reliability and construct validity studies of an obstacle course assessment of wheelchair user performance.

The objective of this study is to evaluate the reliability and construct validity of an obstacle course assessment of wheelchair user performance (OCAWUP). Seventeen experienced wheelchair users using three different propulsion methods (two hands, one hand and one foot or motorized wheelchair) were assessed twice on the 10 obstacles of the OCAWUP. To evaluate reliability, time (in seconds) and degree of ease (DE) in overcoming obstacles (four-level scale) were assessed by three occupational therapists. Construct validity was assessed by verifying whether the OCAWUP's global score of ease (GSE) varied with wheelchair propulsion methods and the functional independence measure (FIM). Intraclass correlation coefficients calculated for reliability of time and GSE were up to 0.74 for test-retest reliability and up to 0.97 for interrater reliability. Cohen's kappa coefficients calculated for DE reliabilities varied from 0.09 to 1.0 with degrees of association up to 65%. A significant difference (P<or =0.01) in GSE scores is shown between propulsion methods. A high significant correlation (rs=0.84, P< or =0.05) was found between GSE and scores of FIM items associated with mobility. Reliability of time and GSE is substantial or better. Reliability of DE is not as good, with a few items indicating poor reliability. OCAWUP's construct validity is good.

Acceleration↗

PubMed2004

Migration and maturation of human dendritic cells infected with Toxoplasma gondii depend on parasite strain type.

Migration and maturation of human dendritic cells derived from CD34+ progenitor cells (DC) infected by Toxoplasma gondii were studied in an in vitro model. We demonstrated that infection with virulent type I strains RH and ENT or type II low virulent strains PRU and CAL induced DC migration towards MIP-3beta. However, type II strains induced a higher percentage of migrating cells than that induced by type I strains or positive controls (chemical allergen or lipopolysaccharides). Type II strains produced soluble factors responsible of the high migration whereas heat killed tachyzoites did not induced a migration higher than positive controls. We also demonstrated that infection by virulent strains and not by type II stains or heat killed tachyzoites triggers DC maturation. A soluble factor released by type II strains was responsible of the absence of DC maturation. Taken together, these results demonstrated that the interference of T. gondii in the behaviour of DC functions is related to the strain types and can be supported by secretion of soluble factors by the parasite.

Animals↗

PubMed2004

Identification of rehabilitation needs after a stroke: an exploratory study.

BACKGROUND: Services to meet adequate rehabilitation needs of elderly stroke survivors are not always provided. Indeed, since 1995, in the wake of the Quebec shift to ambulatory care, home care services, mainly those related to rehabilitation of the elderly, are either unavailable or incomplete. The aim of this study was to examine the rehabilitation needs of this clientele from their hospitalization to their reintegration into the community. METHODS: The "Handicap Production Process" conceptual approach was chosen to help identify the rehabilitation needs of persons affected by physical or cognitive disabilities due to the interactions between personal and environmental factors, and (activities of daily living, social roles). This qualitative exploratory study was performed in 2003. Data were collected among four groups of experts: patients, caregivers, health care providers and administrators. Data triangulation was used to ensure a rigorous analysis and validity of the results. RESULTS: Unfulfilled needs could be found in the categories of pertaining to residence, community living, psychological and emotional needs. Indeed, it appears that a psychological follow-up to discuss acceptance and consequences of non-acceptance would facilitate mid-to long-term rehabilitation. CONCLUSION: Improving accessibility to healthcare services, respecting priority parking spaces for the disabled as well as promoting public awareness would enable a better social reintegration and recovery of social roles, thus limiting the onset of handicap situations.

Activities of Daily Living↗

PubMed2003

The inhibition of MAPK pathway is correlated with down-regulation of MMP-9 secretion induced by TNF-alpha in human keratinocytes.

MMP-9 (92 kDa) is the major gelatinase able to degrade collagen IV, secreted by keratinocytes that are actively involved in wound-healing or tumorigenesis. Since the invasive phenotype of cancers is dependent on MMP-9 expression, it appeared of interest to precisely characterize which signal transduction pathways activated by TNF-alpha are involved in MMP-9 up-regulation induced by TNF-alpha. In HaCaT cells, activation of MMP-9 occurs at the transcriptional level. Inhibition of the MAPK pathway using specific inhibitors of the Ras, Raf, MEK1/2, and Erk1/2 cascade was correlated with a marked inhibition of MMP-9 activity, as determined by gene and protein expression. MAPK pathway activation via TNF-alpha was confirmed by marked AP-1 activation detected in EMSA. Under our experimental conditions, p38 MAPK and SAPK/JNK pathways were not activated. Gene and protein expression of other MMPs that regulate MMP-9, such as MMP-1 and MMP-13, were also up-regulated by TNF-alpha and inhibited by UO126, providing evidence that the MAPK pathway plays a fundamental role in the regulation of MMP-9 secretion by keratinocytes. As TNF-alpha is known to be a main activator of NF-kappaB pathway, the effects of campthothecin and caffeic acid were investigated, such as, TNF-alpha campthothecin up-regulated MMP-9 activity but caffeic acid only weakly inhibited MMP-9 activation induced by TNF-alpha. However, NF-kappaB is activated as shown from immunostaining data, a nuclear staining and higher Western blotting expression of p50 and p65 NF-kappaB subunits were detected after TNF-alpha treatment. A higher specific signal was also detected in EMSA for TNF-alpha-treated cells.

Caffeic Acids↗

PubMed2003

Mobility of wheelchair users: a proposed performance assessment framework.

PURPOSE: Few standardized outcome measures used in the clinical assessment of wheelchair user performance assess or document all the factors that influence mobility. This article presents a conceptual framework that suggests a more all-encompassing view of wheelchair mobility performance assessment. METHOD: After determining, through a survey of the literature, which factors influence wheelchair mobility, a conceptual framework was proposed. Outcome measures of wheelchair mobility were then surveyed. An analysis of these assessment tools allowed factors to be determined that were considered in the clinical assessment of wheelchair mobility performance. A comparison of these led to observations being drawn, which could allow the development of a valid and reliable standardized outcome measure to be used in clinics. RESULTS AND CONCLUSION: Future improvements to the clinical assessment of wheelchair mobility performance should focus on developing an assessment tool considering all categories of factors influencing wheelchair mobility. These categories are the user's profile, the wheelchair, the environment, the daily activities and social roles and the assessment and training received. A controlled-environment outcome measure using a standardized obstacle course with fundamental situations would allow rehabilitation therapists to evaluate clients for the selection of a wheelchair and to document their progress during training. This tool should make it possible to extrapolate the results and thereby apply them to daily activities and social roles.

Activities of Daily Living↗

PubMed2003

Malignant Langerhans cell tumor: a case with a favorable outcome associated with the absence of blood dendritic cell proliferation.

Malignant Langerhans cell tumor is a rare malignant proliferation of Langerhans cells, with a negative prognosis due to its dissemination throughout the body, leading to death within 1 year. This disease has to be distinguished from Langerhans cell histiocytosis. The favorable evolution of a case of Langerhans cell tumor, characterized by the absence of metastasis 18 months after its occurrence, may be due to the initial treatment, which consisted of complete and large resection of the tumor. The authors searched for abnormal dendritic cells or progenitors in the blood but found no large amounts or proliferation of CD34(+) or CD1a(+) cells at the diagnosis and 1 year later. This case report shows that malignant Langerhans cell tumor is not always a lethal disease. The condition may be related to surgical treatment and the absence of malignant cells in the blood when the diagnosis was performed.

Adult↗

PubMed2003

[Evaluation of a wheelchair recycling program].

BACKGROUND: In 1998, 11.8% of the Quebec population over 15 years showed mobility problems and 2.3% of that group revealed that their needs were not met. The same year, the Régie de l'assurance-maladie du Québec distributed more than 4,500 wheelchairs and repaired some 30,000 others, at a cost of over $20 million. The recycling of wheelchairs is seen as a solution for improving this situation. This paper presents an evaluation of a wheelchair recycling program. METHODS: Three groups of participants involved in the recycling of wheelchairs contributed to the gathering of information. These were: personnel (n = 9), occupational therapists in the community (n = 5) and users of refurbished wheelchairs (n = 20). RESULTS: A participative and qualitative research approach was conducted with the 1st group. The results outline the inefficacy of the process on the structural level (e.g. not enough resources to collect unused wheelchairs), operational level (e.g. absence of norms to recycle), strategic level (e.g. absence of policy to encourage people to give back their unused wheelchair) and systemic level (e.g. the state is not imputable). A quantitative approach with the 2nd and 3rd groups revealed high satisfaction with regard to the efficacy, appearance, safety, durability and comfort as well as the delivery and follow-up services rendered. PRACTICE IMPLICATIONS: The evaluation procedure herein proposed can be customized to fit other contexts and provides policy-makers with quick access to field data to help them choose the appropriate course of action.

Canada↗

PubMed2002

Relationship between expression of matrix metalloproteinases and migration of epidermal and in vitro generated Langerhans cells.

Langerhans cells (LC) are dendritic cells that capture foreign antigens and migrate with them to the regional lymph nodes where they are presented to naive T cells. The possible role of matrix metalloproteinase-9 (MMP-9) in migration was suggested following experiments in a mouse model and in human skin explants. Using in vitro generated LC (iLC) derived from CD34+ cord blood cells and epidermal LC (eLC), we investigated the correlation between MMP-9 and other MMPs production and cell migration. Cells were activated by Bandrowski's base (BB), a chemical allergen, or by recombinant birch pollen allergen 1 (rBetv 1). Contact with allergens triggered migration of these cells, with a maximum rate being reached after 24 h. Migration was preceded by production of MMP-2 and MMP-9; part of the molecules were recovered as pro-MMPs in cell culture supernatant and part were associated with cell membrane proteins. At the cellular level, membrane-type 1 (MT1) and MT3-MMP were also identified. Addition of tumor necrosis factor-alpha (TNF-alpha) initiated pro-MMP-2 and pro-MMP-9 production followed by cell migration in a dose-dependent manner. These data imply that TNF-alpha is a key molecule for MMP production and cell migration. Furthermore, activation of iLC with BB or rBet v 1 induced synthesis of TNF-a and expression of TNF RII on the cell membrane, suggesting an autocrine loop. In conclusion, membrane-associated MMP-2 and-9 rather than soluble MMPs appear to be involved in cell migration.

Allergens↗

PubMed2002

Examination of new environmental control applications.

The aim of this study was to examine the application of new Environmental Control Systems (ECSs) in the homes of users and caregivers. The research questions were: (1) Can new ECS applications improve the activities of daily living (ADL) of people with significant functional limitations who require personal assistance? (2) Can new ECS applications replace home services and lessen caregiver burden? To answer these questions, user satisfaction regarding ECS applications, impact on ADL, technical performance, and caregiver burden were examined. This collaborative investigation involving a local community health care center, a telephone monitoring service, an industrial partner, and a university research team used a case study approach. Five users with moderate cognitive problems or significant functional limitations who required personal assistance were chosen, along with their caregivers, for a 3-month in-home trial to test new ECS alternatives. The ECS in the study featured remote control functions (e.g., door lock release, outside intercom), specific verbal reminders (e.g., reminders to turn off stove elements), and automatic functions (e.g., night-lights in the bathroom and hallway). Information was collected in the users' homes with three standardized questionnaires and a company-designed questionnaire. The overall technical performance of the ECS was found to be in most cases moderately efficient. Participant satisfaction revealed that ECS alternatives needed improvement with respect to the service aspects such as follow-up services and repair/servicing. Caregiver burden was lessened for psychological aspects but not for physical tasks. Users seemed to have a positive perception of the impact of the ECS on many of their ADL. We learned six lessons from this 15-month case study, namely: (1) the use of remote control by people with moderate cognitive impairments was difficult; (2) verbal reminders were greatly appreciated; (3) the automatic ECS applications needed more adjustment; (4) reactions varied depending on the participant's perspective; (5) other assessment tools might have been better suited to mild cognitive problems; and (6) removal of a beneficial product at the conclusion of the evaluation phase raised ethical considerations.

Activities of Daily Living↗

PubMedDate not supplied

Development of a standardized instrument to assess computer task performance.

OBJECTIVE: The purpose of this study was to determine the psychometric properties of the Assessment of Computer Task Performance, specifically, the test-retest reliability, internal consistency, construct validity, and ability to discriminate between known groups. METHOD: This assessment comprises 14 standardized and timed tasks. It was administered to 24 persons with upper-extremity impairments and 30 with no impairments by a trained occupational therapist. To assess the test-retest reliability, participants in the impaired group were retested within 2 to 7 days. Intraclass correlation coefficients were calculated to determine test-retest reliability. Internal consistency was assessed with Cronbach's alpha, and factor analysis was conducted to examine construct validity. The Mann Whitney U Test was used to assess the test's ability to discriminate between the groups. RESULTS: Results indicated that the tool has excellent reliability and internal consistency, can discriminate between groups, and has appropriate construct validity. CONCLUSION: The Assessment of Computer Task Performance provides occupational therapists with an accurate test to measure computer performance and can assist them in providing computer access services.

Adolescent↗