Anticonvulsant hypersensitivity syndrome.
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Adult↗
Biomedical subjects
G Bravo
Publications and source records attributed to G Bravo.
Knowledge of the legislation governing proxy consent to treatment and research.
OBJECTIVE: To assess the knowledge of four groups of individuals regarding who is legally authorised to consent to health care or research involving older patients. DESIGN: A provincewide postal survey. SETTING: Province of Quebec, Canada. PARTICIPANTS: Three hundred older adults, 434 informal caregivers of cognitively impaired individuals, 98 researchers in aging and 136 members of research ethics boards (REBs). MEASUREMENTS: Knowledge was assessed through a pretested postal questionnaire comprising five vignettes that describe hypothetical situations involving an older adult who requires medical care or is solicited for research. The respondent had to identify the person who is legally authorised to provide consent. RESULTS: Nearly 80% of all respondents provided the correct answer when the hypothetical scenario depicted a person who was competent to consent or incompetent but legally represented. Knowledge was worse (from 2% among older adults to 44% among REB members) for the scenario describing a research situation that involved an incompetent adult without a legal guardian. CONCLUSION: The observed lack of knowledge raises doubts about the ability of current legislation to truly protect the rights of older adults with diminished decision making capacity. It points to the need for educational programmes aimed at increasing public awareness of the legislation put in place for those requiring special protection.
Aged↗
Predictors of handicap situations following post-stroke rehabilitation.
PURPOSE: Many stroke survivors have to cope with impairments and disabilities that may result in the occurrence of handicap situations. The purpose of the study was to explore bio-psycho-social predictors of handicap situations six months after discharge from an intensive rehabilitation programme. METHODS: At discharge from a rehabilitation programme, participants were evaluated with instruments measuring motor, sensory, cognitive, perceptual, affective and psychosocial impairments and disabilities that may play a role in the development of handicap. Some other demographic and clinical variables, and those related to rehabilitation, were also collected. Six months later, they were re-assessed in their own environment in order to document their handicap level with the Assessment of Life Habits (LIFE-H). RESULTS: One hundred and thirty-two stroke patients participated in the discharge evaluation and 102 of them also participated in the handicap measurement. Relationships between handicap level and impairments and disabilities were all statistically significant. Multiple regression analyses indicated that affect, lower extremity co-ordination, length of stay in rehabilitation, balance, age and comorbidity at the end of an intensive rehabilitation programme are the best predictors of handicap situations six months later (adjusted R(2): 68.1%). CONCLUSIONS: In spite of its exploratory nature, this study revealed that, among a substantial number of personal characteristics, some were more related to a handicap measure and have greater predictive value. Other studies should be carried out to validate these findings and to consider more environmental factors in order to better understand factors related to the development of handicap situations.
Aged↗
Sympathetic blockade significantly improves cardiovascular alterations immediately after spinal cord injury in rats.
Immediately after an experimental spinal cord injury (SCI) in rats, there is a large fall in mean arterial pressure (MAP) and heart rate (HR), followed by an abrupt increase in MAP. To better understand the mechanism involved in these early cardiovascular alterations, we tested the effect of treatment with ganglionic and sympathetic blockers in anesthetized rats subjected to T-5 SCI. Fall in MAP was partially diminished by propranolol and pentolinium, while increase in MAP was abolished by propranolol and pentolinium. Adrenalectomy did not diminish the fall in MAP and HR, however, the increase in MAP was significantly reduced. Likewise, propranolol and pentolinium completely abolished the effects in HR. These data suggest that the early cardiovascular alterations secondary to SCI results from an increased parasympathetic activity and a sympathetic withdrawal.
Adrenergic beta-Antagonists↗
Mechanisms involved in the cardiovascular alterations immediately after spinal cord injury.
The early cardiovascular effects resulting from an acute spinal cord injury (SCI) produced by a contusion procedure at T5-T6 were evaluated in anaesthetized rats. The mean arterial pressure (MAP) and heart rate (HR) were measured during one hour after the injury. A marked decrease in MAP and HR was observed immediately after injury, followed by an abrupt increase in MAP. These changes were observed between 3 and 9 min and the basal values were recovered after 20 min. Fall in the MAP and HR and increase in MAP induced by SCI were abolished by atropine. The interruption of the parasympathetic outflow by vagotomy also significantly diminished the fall and increase in MAP and the fall in HR. Likewise, pre-treatment with nitric oxide synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) completely abolished the effects produced by SCI. These data suggest that after SCI the decrement in MAP and HR was probably due to acetylcholine release from parasympathetic fibers and NO from endothelial source probably by a cholinergic stimulation. Additionally, the MAP increase observed was probably due to a reflex compensatory vasoconstriction.
Acetylcholine↗
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↗
Efficacy of a nurse-led multidimensional preventive programme for older people at risk of functional decline. A randomized controlled trial.
OBJECTIVE: To verify the efficacy of a multidimensional preventive programme on functional decline of older people. DESIGN: Randomized controlled trial. SETTING: Community of Sherbrooke City, Quebec, Canada. SUBJECTS: A representative sample of individuals aged over 75 living at home and identified to be at risk of functional decline by postal questionnaire (n = 503). INTERVENTION: Subjects randomized to the study group (n = 250) were assessed at home by a nurse on 12 dimensions (including medication, depressive mood, risk of falls, hearing). A report of the assessment was sent to the general practitioner with recommendations for interventions. A monthly telephone contact was carried out by the nurse for surveillance and to verify if the recommendations had been applied. METHODS: The primary outcome--functional decline--was defined as either death, admission to an institution or increase of > or = 5 points on the disability score of the Functional Autonomy Measurement System (SMAF) scale during the reference year. Secondary outcomes were functional autonomy (on the SMAF), well-being (General Well-being Schedule), perceived social support (Social Provisions Scale) and use of health care services. RESULTS: Of the 494 subjects who completed the study, 48 (19.6%) of 245 in the study group and 49 (19.7%) of 249 in the control group had functional decline (relative risk 1.00; 95% confidence interval 0.82-1.23). There were no differences between the groups in all secondary outcomes. CONCLUSIONS: This study confirms the inefficacy of multidimensional programmes for preventing functional decline in the older population. More effort should be devoted to improving the efficacy of specific interventions for conditions causing functional decline.
Aged↗
Features of the engraftment of allogeneic hematopoietic stem cells using reduced-intensity conditioning regimens.
The features of the engraftment in 26 patients allografted using reduced-intensity conditioning regimen (8 with chronic myelogenous leukemia, 6 with acute myelogenous leukemia, 9 with acute lymphoblastic leukemia, 1 with hybrid acute leukemia, 1 with myelodysplasia and 1 with thalassemia major) were analyzed. Patients received a median of 10 x 10(8)/Kg mononuclear cells (range 1.6 to 22.9), and a median of 4.2 x 10(6)/Kg CD34 cells (range 0.3 to 14). There was a linear correlation between the number of infused mononuclear cells (MNC) and that of CD34 cells (r = 0.78, p = 0.002). Three patients (11%) failed to engraft; in those who engrafted, the median time to achieve > 500 granulocytes was 11 days (range 10 to 22), and the median time to achieve > 10,000 platelets was 12 days (range 10 to 41). The three patients who failed to engraft received less than 5 x 10(8)/Kg MNC (1.6, 4.6 and 4.9) and less than 0.5 x 10(6)/Kg CD34; however, five of eight patients who received less than 5 x 10(8)/Kg MNC still engrafted successfully. On the other hand, all the patients who received less than 0.5 x 10(6)/Kg CD34 cells failed to engraft. Within the group of patients who engrafted, it was found that those who received more than 7 x 10(6)/Kg CD34+ cells tended to earlier recover > 20 x 10(9)/L platelets (p = 0.02), and > 0.5 x 10(9)/L neutrophils (p = 0.06) before day 15, than those who received less than 7 x 10(6)/Kg CD34+ cells. No such association could be established between the number of MNC and the time for recovery. In these patients allografted using reduced-intensity conditioning regimens, the target doses of hematopoietic cell used were similar to those described for conventional allografts: The number of CD34 infused cells was significantly related to the possibility of failure to engraft and to the recovery rate of the hemopoiesis.
Adolescent↗
Further pharmacological analysis of the orphan 5-HT receptors mediating feline vasodepressor responses: close resemblance to the 5-HT7, receptor.
It has been suggested that the late hypotensive response to serotonin (5-hydroxytryptamine; 5-HT) in vagosympathectomised cats, being potently mimicked by 5-carboxamidotryptamine (5-CT), not modified by ketanserin and blocked by methiothepin or methysergide, is mediated by '5-HT1-like' receptors. Nevertheless, current guidelines for 5-HT receptor classification refer to this receptor as an orphan receptor. Thus, the present study set out to reanalyse the above suggestion in terms of the classification schemes proposed in 1994 and 1998 by the NC-IUPHAR subcommittee on the classification of 5-HT receptors. Intravenous (i.v.) bolus injections of 5-CT (0.003-0.3 microg/kg), 5-HT (1-100 microg/kg) and 5-methoxytryptamine (5-MeO-T; 1-100 microg/kg) produced dose-dependent vasodepressor responses with a rank order of agonist potency of 5-CT >> 5-HT = 5-MeO-T with sumatriptan (10-300 microg/kg) virtually inactive. The vasodepressor responses to 5-HT, 5-CT and 5-MeO-T were not attenuated following i.v. administration of the antagonists GR127935 (5-HT(IB/ID); 30 microg/kg), tropisetron (5-HT3/4; 3000 microg/kg), (+/-)-pindolol (beta-adrenergic and 5-HT1A; 4000 microg/kg) or equivalent volumes of physiological saline. In contrast, the above vasodepressor responses were markedly and specifically antagonised by i.v. methiothepin (100 microg/kg), lisuride (30 microg/kg and 100 microg/kg), mesulergine (300 microg/kg and 1000 microg/kg) or LY215840 (300 microg/kg and 1000 microg/kg). The above lines of evidence, therefore, indicate that the orphan receptors mediating the vasodepressor responses to 5-HT in vagosympathectomised cats are pharmacologically similar to other 5-HT7 receptors mediating vascular and non-vascular responses (e.g. relaxation of the canine external carotid artery and guinea-pig ileum as well as feline tachycardia).
5-Methoxytryptamine↗
Recurrence in a different location of a cerebral arteriovenous malformation in a child after radiosurgery.
The case of a 9-year-old girl with a right parietal arteriovenous malformation (AVM) of the brain obliterated after gamma knife (GK) radiosurgery with subsequent regrowth in a different site is reported. As far as we know, this is the first reported case of regrowth of an AVM in a different location after radiosurgery in a child. This situation has to be considered within the context of causes of unsuccessful treatment of AVMs with radiosurgery and justifies angiographic monitoring of pediatric patients until they reach adulthood.
Child↗
Early changes in nitric oxide synthase activity in atrial intramural arteries following experimental spinal cord injury in rats.
Previously, we have shown that immediately after an experimental spinal cord injury (SCI) in anaesthetized rats, there is a large fall in mean arterial pressure (MAP) and heart rate (HR), followed by an abrupt increase in MAP. To evaluate the participation of nitric oxide (NO), we evaluated the activity of nitric oxide synthase (NOS) using Nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemistry in sections of atria at several post-injury time-intervals. Staining increased at 3 min, reached a maximum at 9 min and diminished 30 min after injury. Pretreatment with atropine prevented changes in MAP, HR and NADPH-d staining suggesting that such modifications result from an increased vagal stimulation. In conclusion, the NOS activity is transiently elevated in the atrial intramural arteries of rats subjected to an SCI.
Animals↗
Quality of care in unlicensed homes for the aged in the eastern townships of Quebec.
BACKGROUND: The recent proliferation of unlicensed homes for the aged in Quebec, coupled with the increased needs of the population they serve, has raised concerns about the quality of case these homes provide. The authors compared the quality of care in unlicensed homes with that in licensed long-term care facilities in a region of Quebec. METHODS: The study involved 301 impaired people aged 65 and over in 88 residential care facilities (52 unlicensed, 36 licensed) in the Eastern Townships of Quebec. Study participants were chosen according to a 2-stage sampling scheme: stratified sampling of the primary units (facilities) and random sampling of the secondary units (residents). Quality of care was measured using the QUALCARE scale, a multidimensional instrument that uses a 5-point scale to assess 6 dimensions of care: environmental, physical, medical management, psychosocial, human rights and financial. A mean score of more than 2 was considered indicative of inadequate care. RESULTS: Overall, the quality of care was similar in the unlicensed and licensed facilities (mean global score 1.61 [standard error of the mean (SEM) 0.06] and 1.47 [SEM 0.09] respectively). Examination of dimension-specific quality-of-care scores revealed that the unlicensed homes performed worse than the licensed facilities in 2 areas of care: physical care (mean score 1.80 [SEM 0.08] v. 1.51 [SEM 0.09] respectively, p = 0.017) and medical management (1.37 [SEM 0.06] v. 1.14 [SEM 0.05], p = 0.004). The dimension-specific scores also revealed that both types of homes lacked appropriate attention to the psychosocial aspect of care. Overall, 25% of the facilities provided inadequate care to at least one resident. This situation was especially prevalent among homes with fewer than 40 residents, where up to 20% of the residents received inadequate care. INTERPRETATION: Most of the unlicensed homes for the aged that were studied delivered care of relatively good quality. However, some clearly provided inadequate care.
Aged↗
Age-related changes in upper extremity performance of elderly people: a longitudinal study.
The objective of this research was to study age-related changes in the upper extremity performance of healthy community-dwelling elderly people, by using a longitudinal design. In 1995-1996. gross and fine manual dexterity, global performance, motor coordination, grip strength, tactile recognition, two-point discrimination, touch/pressure threshold, and tactile localization of 264 of the 360 subjects initially evaluated in 1992-1993 were reevaluated by using the same upper extremity measuring instruments. Those who did not participate (n = 96) were found to be significantly different from those who participated in the longitudinal study. Although the survivors were younger, more active, and perceived themselves in better health than the nonparticipants, their upper extremity performance significantly decreased in the 3-year period, with a few exceptions. In general, the decline was related to the initial score but not to age.
Aged↗
Correlates of care quality in long-term care facilities: a multilevel analysis.
Hierarchical modeling was employed to explore correlates of the quality of care provided in long-term care facilities. For this purpose, a multilevel analysis offers two advantages over traditional analytical approaches. First, it accounts for the correlated nature of data recorded on multiple residents from the same facility. Second, it enables the investigators to study the influence of both resident and facility characteristics on care quality. The analysis was performed on data from 301 residents randomly sampled from 88 facilities located in the Province of Quebec, Canada. Results revealed that the presence of cognitive deficits was the strongest correlate of the quality of care provided to a resident. However, this relationship was found to vary significantly across facilities. Four facility-level variables were found to influence the relationship between cognitive functioning and care quality: the number of external collaborators the facility has, the type of training the facility manager has, the size of the facility, and the age distribution of its clientele. From these results, we suggest means to improve the quality of care provided to cognitively impaired older adults living in long-term care facilities.
Administrative Personnel↗
Spontaneous cerebrospinal fluid fistulae associated with empty sellae: surgical treatment and long-term results.
OBJECTIVE: To evaluate the accuracy of different diagnostic tools for cerebrospinal fluid fistulae (CFFs) associated with empty sellae and to assess the long-term results after surgical treatment. METHODS: Records were retrospectively reviewed for 38 of 44 patients who were treated for CFFs associated with empty sellae between 1972 and 1996. Glucose and radioisotope analyses of nasal fluids were used to establish the CFF diagnosis. Computed tomography, magnetic resonance imaging, and cisternography were used to localize the sites of the CFFs. Treatment was performed using three different approaches, i.e., subfrontal approach, transsphenoidal approach, and lumboperitoneal shunt placement. RESULTS: Glucose and radioisotope analyses of nasal fluids confirmed CFFs in 97 and 100% of the cases, respectively. For localization of the sites, a leak in the sella was suggested in 32% of the cases using gammagraphy, in 50% using computed tomography or magnetic resonance imaging, and in 75% using computed tomographic contrast cisternography. After surgery, rhinorrhea ceased for 34 patients (89%), but 14 (41%) patients experienced recurrences of the rhinorrhea 6 months to 20 years after surgery (mean, 4.2 yr). Cure rates for the subfrontal approach, transsphenoidal approach, and shunt placement were 94, 85, and 86%, and the recurrence rates were 43, 33, and 50%, with mean times of 7.8, 4.2, and 0.8 years, respectively. CONCLUSION: In this series, confirmation of CFFs was easy, although localization of the sites remained difficult. Recurrences were more numerous and occurred sooner after treatment with shunts; packing of the sella through a craniotomy achieved better and more stable results, although differences were not statistically significant.
Adolescent↗
Clinical outcome of cotransplantation of peripheral nerve and adrenal medulla in patients with Parkinson's disease. Clínica Puerta de Hierro Neural Transplantation Group.
OBJECT: Transplants of adrenal medulla (AM) and fetal ventral mesencephalon (FVM) are currently being tested as therapeutic alternatives in patients with Parkinson's disease (PD). At the Clínica Puerta de Hierro in Madrid, a controlled clinical trial is underway to establish which donor tissue, if any, is the best for open surgical implantation in patients with PD. METHODS: Since 1987, varying degrees of clinical improvement have been achieved in Grade IV and V parkinsonian patients by implanting perfused AM and FVM into the right caudate nucleus. To investigate further whether implantation of different types of donor tissues results in qualitatively and quantitatively different degrees of recovery, four patients with Grade IV or V PD received implants of pre-coincubated autologous AM and intercostal nerve in the caudate nucleus. Four nonsurgically treated patients served as a control group. Three years posttransplantation, longer on phases (46.2%+/-10.4% of the day presurgery to 87.5%+/-10.4% of the day 36 months postsurgery) and improved symptoms in on and off phases persist in all four cases, with reduced dyskinesias (67.1%+/-9.2% of the day in on phases presurgery to 17%+/-13.8% of the day in on phases 36 months postsurgery). Progress appears to be stepwise, starting within weeks of tranplantation and becoming clinically significant in the 2nd and 3rd months (similar to our AM- and sooner than in our FVM-implanted patients), followed by a period of stability and, after a second wave of improvement 12 to 18 months posttransplantation (similar to FVM implants), has continued (87.5+/-7 points presurgery to 46+/-5.6 points 36 months postsurgery). In the experimental group, doses of levodopa have been reduced by more than 60% and dopamine agonist use has not resumed. In contrast, there have been no significant clinical changes in the control group. CONCLUSIONS: Implantation of tissue other than fetal tissue can promote a long-term improvement in the clinical symptomatology of seriously disabled parkinsonian patients. This finding is supported by the autopsy report of a patient with PD who had undergone grafting of AM plus peripheral nerve in which it was demonstrated that a large number of tyrosine hydroxylase-positive cells survive 1 year after implantation. In addition, there was a dense network of host dopaminergic fibers around the graft.
Adrenal Medulla↗
Profile of residents in unlicensed homes for the aged in the eastern townships of Quebec.
BACKGROUND: The number of unlicensed homes for the aged in Quebec has increased rapidly over the last decade. Because these homes are not linked in any formal way to the Quebec Ministry of Health and Social Services, little is known about their residents. The objective of this study was to describe the sociodemographic characteristics and disability profile of elderly residents in unlicensed homes for the aged. Comparisons were made to a sample of residents drawn from licensed long-term facilities. METHODS: The target population was restricted to residents aged 65 years and over in facilities in the Eastern Townships of Quebec who had some difficulties with at least 2 activities of daily living. This population included 94% of elderly people in licensed facilities and 64% of those in unlicensed homes. The study population comprised 301 impaired people in 88 residential care facilities (36 licensed, 52 unlicensed). They were selected using a 2-stage sampling scheme: stratified sampling of the primary units (homes) and simple random sampling of the secondary units (residents). Facility managers were interviewed to collect descriptive information about themselves and their facilities. Residents were assessed with regard to their cognitive abilities (using the Modified Mini-Mental State [3MS] Examination) and their functional autonomy (using the Functional Autonomy Measurement System [Système de mesure de láutonomie fonctionnelle (SMAF)]. RESULTS: Although residents without impairment were excluded from the study, the unlicensed facilities were found to house people who were, on average, less cognitively and physically impaired than their counterparts in the licensed facilities (p < 0.001). Nonetheless, a substantial proportion of the residents in the unlicensed homes had severe cognitive disabilities (38.5% had 3MS score of less than 60) and functional disabilities (17.0% had an SMAF score of more than 40). The corresponding figures for residents in the licensed facilities with these scores were 65.3% and 66.7%. Of the managers of the unlicensed facilities 31.9% had no training and 58.8% had no previous experience in caring for the elderly people. The staff-resident ratio was lower among the unlicensed homes than among the licensed facilities (mean 0.05 [standard error of the mean (SEM) 0.01] v. 0.39 [SEM 0.03], p < 0.001). In addition, only 26.0% of the unlicensed homes employed qualified staff, as compared with 63.0% of the licensed facilities (p < 0.001). INTERPRETATION: This study provides evidence that many residents of unlicensed homes have considerable care needs. These homes appear ill-equipped to address their needs, which raises doubts about their ability to deliver high-quality care.
Activities of Daily Living↗
Prolactin and interleukin-6 in neuropsychiatric lupus erythematosus.
We investigated the levels of prolactin (PRL) and interleukin-6 (IL-6) in the cerebrospinal fluid (CSF) and serum of systemic lupus erythematosus patients with central nervous system involvement (CNS-SLE), and examined whether PRL and IL-6 have a relationship. Serum and CSF PRL and IL-6 were measured in the following groups of patients and controls: group I: seven patients with CNS-SLE; group II: three SLE patients without CNS involvement (non CNS-SLE); group III: 10 patients with neurocysticercosis; and group IV: six healthy women. The patients were clinically assessed. CSF PRL and IL-6 were elevated in group I (CNS-SLE) in comparison with all other groups (p<0.001). In addition, four of seven patients had higher levels of IL-6 and PRL in CSF than in serum. A positive correlation between PRL and IL-6 in CSF of SLE was observed (r=0.88, p<0.001). The mean serum PRL concentrations were not significantly different in all groups, but high levels of IL-6 were found in the serum of group I in comparison with groups II and IV (p<0.001). The serum levels of group III were not different from those of group I. These results demonstrate the presence of intrathecal synthesis and elevations of CSF PRL and IL-6 in active CNS-SLE involvement and indicate that measurements of CSF PRL and IL-6 may be useful in the evaluation of neuropsychiatric lupus erythematosus.
Central Nervous System Diseases↗