Biomedical subjects

Gina Bravo

Publications and source records attributed to Gina Bravo.

At least 19 recordsLinked to original sources

PubMed2006

Outcome value of Clara cell protein in serum of patients with acute respiratory distress syndrome.

OBJECTIVE: Injury to the alveolocapillary barrier characterizes ALI/ARDS; therefore determining levels of lung epithelium-specific small proteins in serum may help predict clinical outcomes. We examined whether serum Clara cell protein (CC-16) concentration is correlated with the outcome, mechanical ventilation duration, and incidence of nonpulmonary organ failure. DESIGN: Prospective multicenter observational study conducted by the Quebec Critical Care Network. MEASUREMENTS: Seventy-eight adult ARDS patients requiring mechanical ventilation were enrolled and 28-day mortality was the primary outcome. Ventilatory parameters were computed and blood was sampled daily. Clinical information collected included cause of death, duration of mechanical ventilation, number of ventilator-free days, and organ failures. RESULTS: Median serum levels of CC-16 were significantly higher in nonsurvivors than survivors on days 0-2 (19.93 microg/l, IQR 11.8-44.32, vs. 8.9, 5.66-26.38) and sustained up to day 14. CC-16 levels were correlated positively with the number of failing organs (rho 0.3623) and requirement for prolonged mechanical ventilation. Predictors of patient mortality included age, arterial carbon dioxide partial pressure, CC-16, and APACHE II score (odds ratios 1.35, 1.52, 1.37, 1.159, respectively). CONCLUSIONS: Higher initial CC-16 serum level is associated with increased risk of death, fewer ventilator-free days, and increased frequency of nonpulmonary multiple organ failure. CC-16 is a valuable biomarker of ARDS that may help predict outcome among ARDS patients with high-risk mortality.

Adult↗

PubMed2006

Predictors of long-term participation after stroke.

PURPOSE: (1) To explore factors that predict long-term participation after stroke (2-4 years after discharge from rehabilitation), and (2) to determine factors that predict both short- and long-term participation. METHODS: Biopsychosocial data of people who had had a stroke were measured at discharge from an intensive rehabilitation unit using valid instruments. Six months later (n=102) as well as 2-4 years later (n=66), social participation of the survivors was measured in their living environments. Participation was estimated with the Assessment of Life Habits (LIFE-H), which includes 12 categories of daily activities and social roles. RESULTS: From multivariate regression analyses, the best predictors of long-term participation after stroke appear to be age, comorbidity, motor coordination, upper extremity ability and affect. Age, comorbidity, affect and lower extremity coordination are the best predictors of participation after stroke at both measurement times. CONCLUSIONS: With the exception of age, these factors may be positively modified and thus warrant special attention in rehabilitation interventions.

Activities of Daily Living↗

PubMed2006

Relationship between multimorbidity and health-related quality of life of patients in primary care.

Previous studies about the association of multimorbidity and the health-related quality of life (HRQOL) in primary-care patients are limited because of their reliance on simple counts of diseases from a limited list of diseases and their failure to assess the severity of disease. We evaluated the association while taking into account the severity of the medical conditions based on the Cumulative Illness Rating Scale (CIRS) score, and controlling for potential confounders (age, sex, household income, education, self-perception of economic status, number of people living in the same dwelling, and perceived social support). We randomly selected 238 patients to construct quintiles of increasing multimorbidity (CIRS). Patients completed the 36-item Medical Outcomes study questionnaire (SF-36) to evaluate their HRQOL. Applying bivariate and multivariate linear regression analyses, we used the CIRS as either a continuous or a categorical (quintiles) variable. Use of the CIRS revealed a stronger association of HRQOL with multimorbidity than using a simple count of chronic conditions. Physical more than mental health deteriorated with increasing multimorbidity. Perceived social support and self-perception of economic status were significantly related to all scales of the SF-36 (p < 0.05). Increased multimorbidity adversely affected HRQOL in primary-care adult patients, even when confounding variables were controlled for.

Adult↗

PubMed2006

Improving the quality of residential care using goal attainment scaling.

OBJECTIVE: To illustrate the potential of goal attainment scaling (GAS) as a means to improve the quality of care provided by residential care facilities to frail older adults. DESIGN: A pre-test/post-test single-group design. SETTINGS/PARTICIPANTS: Twenty facilities providing inadequate care to at least one resident. These facilities were identified with a case-finding questionnaire followed by a thorough investigation of the quality of care delivered to a sample of frail older adults. INTERVENTION: The 6-month intervention was conducted by three interdisciplinary teams of health professionals experienced in caring for frail older adults. The intervention was tailored to the main quality problems identified at baseline in the facility. The first task of the intervention team was to set weighted priority goals in conjunction with the facility manager. Subsequent monthly on-site visits, interspersed with frequent telephone calls, were devoted to assisting the manager and staff implement permanent changes in the areas of care targeted for improvement. MEASUREMENTS: Pre- and post-intervention GAS scores. RESULTS: Two facilities were lost to follow-up. A total of 81 facility goals were established at the onset of the study. Goals per facility ranged from 2 to 9 (mean = 4.5, SD = 2.04). GAS scores increased significantly between pre- and post-intervention (P < .001). Goal achievement varied with the manager's own rating of the quality of care provided in the facility (P = .008), his/her education level (P = .037), and the intervention team (P = .049). CONCLUSIONS: This study shows that quality improvement objectives established with the manager following a thorough evaluation of the quality of care provided in the facility can, on average, be attained with the help of experienced health professionals. It also provides some insight into the types of facilities where preset objectives are more likely to be achieved.

Journal Article↗

PubMed2006

Adaptation and coping following a first stroke: a qualitative analysis of a phenomenological orientation.

Stroke can have consequences in all areas of a person's life. If not coped with optimally, this life event will have a deleterious effect on the quality of life. The aim of this study was to improve understanding of appraisal and coping, post-stroke. Ten individuals were purposely recruited upon admission for a first stroke to participate in this qualitative study. Participants were asked to share their personal experiences with regard to their efforts to deal with the consequences of the stroke. In-depth interviews were transcribed verbatim and the content was analyzed using a rigorous method, inspired by a phenomenological orientation. Seven themes related to appraisal (unpredictability, overwhelming, feeling out of control, threat, turning point, acceptance/resignation and future prospects) and five themes related to coping (active and passive compensation, escape, change how the situation is perceived and utilization of resources) emerged from the content analysis of the in-depth interviews. In conclusion, since returning to the previous life style and activities is rather improbable, changing how the situation is perceived appears to be the most effective way of coping, in order to reach a state of acceptance/resignation favourable to an optimal quality of life.

Adaptation, Psychological↗

PubMed2006

Long-term changes in participation after stroke.

BACKGROUND AND PURPOSE: People who have had a stroke may have difficulty resuming some of their previous activities, which leads to a decline in their participation in daily activities and social roles. The purposes of this study were to compare participation 6 months (T1) and between 2 and 4 years (T2) after discharge from a rehabilitation unit and to verify if any changes were associated with changes in personal and environmental factors. METHOD: Participation of people who had had a stroke was measured at T1 and T2 with the Assessment of Life Habits. RESULTS: A significant reduction (p < .001) in participation in daily activities was observed, specifically in the following categories: nutrition, p < .001; fitness, p = .004; personal care, p < .001; and housing, p = .001. However, participation in social roles was maintained during this period (p = .10). The increased perception of technology as a facilitator (environmental factor) over time explained a part of the decline in participation (R2 = 0.13). CONCLUSION: Factors associated with the reduction in participation in daily activities should be further studied in order to prevent this decline.

Activities of Daily Living↗

PubMed2005

Using goal attainment scaling to improve the quality of long-term care: a group-randomized trial.

OBJECTIVE: To assess the effect of a 6-month interdisciplinary customized intervention based on goal attainment scaling and aimed at improving the quality of care provided by long-term care facilities to frail older adults. DESIGN: A pair-matched group-randomized trial with quality of care measurements taken before and after the intervention and 6 months later. SETTING: Forty unregulated small-to-medium sized long-term care facilities delivering inadequate care to at least one resident. Facilities were matched on baseline quality of care, health district, and size. One member of each pair was then randomly allocated to the intervention, the other acting as a control. STUDY PARTICIPANTS: The trial involved 201 frail older adults randomly selected from the 40 participating facilities. INTERVENTION: The intervention was tailored to the main quality problems identified at baseline in the facility. The first task of the intervention team was to set weighted quality improvement goals with the facility manager, which were then recorded on a goal attainment follow-up guide. Subsequent monthly on-site visits, interspersed with frequent telephone calls, were meant to assist the manager and staff to implement permanent changes in the areas of care targeted for improvement. Main outcome measure. Quality of care measured with the Quality of Care (QUALCARE) Scale, a multidimensional instrument that uses a 5-point scale to assess six subdimensions of care: environmental, physical, medical management, psychosocial, human rights, and financial. A score greater than 2 is considered indicative of inadequate care. RESULTS: The intervention effect on the overall quality of care was neither clinically nor statistically significant. Change from baseline to the end of the intervention averaged .21 and .22 in the experimental and control conditions, respectively (P = 0.86). CONCLUSION: Attainment of preset quality improvement objectives did not translate into detectable improvements in the care provided to residents.

Activities of Daily Living↗

PubMed2005

Physical health and mental disorder in elderly suicide: a case-control study.

The psychological autopsy method was used to study 95 cases of suicide. Ninety-five comparison subjects matched for gender, age, region, and date of death were selected from the death register. This study showed that suicide cases did not differ from controls with regard to the number of chronic health problems and, compared to the suicide cases, the controls had less functional autonomy six months prior to death. If minor and sub-threshold depression cases were included, 74.7% of the suicide cases would have been considered as having a mental health disorder compared to 12.6% in the control group. When the effect of other co-variables were controlled for, multivariate analysis showed that suicide cases and controls did not differ according to marital status, education, income, and living arrangement. Furthermore, suicide cases were no more likely than controls to seldom meet with family members or friends or to have been isolated during the six-month period preceding their death. Our findings suggest that detection of psychiatric disorders, mainly depression, must be included in late life suicide prevention strategies.

Aged↗

PubMed2005

Participation after stroke compared to normal aging.

OBJECTIVE: To examine the reduction in participation of people who have had a stroke compared with healthy people with normal aging. DESIGN: Participation of people who had a stroke was compared with participation of healthy subjects. SUBJECTS/PATIENTS: Forty-six people who had a stroke for 2-4 years and 46 healthy participants matched on age, sex and living environment. MEASUREMENTS: Participation was estimated with the Assessment of Life Habits (LIFE-H). The LIFE-H (short version 2.1) is composed of 58 daily activities and social roles associated to the 12 categories of the Disability Creation Process model. The LIFE-H gives separate scores for each category, for 2 main subsections "Daily activities" and "Social roles" and a total score. RESULTS: Scores of healthy subjects did not reach the maximum value (9/9) of the LIFE-H, their mean scores varying from 6.3 to 8.6, according to the categories. These scores are higher than of the participants with stroke for all categories (scores varying from 3.9 to 6.5; p-values from 0.002 to <0.001), except the interpersonal relationships category (score of 7.8 vs 8.0) where no difference was found (p=0.49). The disruption in participation after stroke varies according to the categories of the LIFE-H, but is more important in the daily activities categories. CONCLUSION: The comparison of the scores obtained by the 2 groups suggests that a part of the reduction in participation in daily activities and social roles after stroke is attributable to normal aging and not entirely to the stroke itself. It helps to focus interventions on activities and roles disruption domains that are really attributable to stroke.

Activities of Daily Living↗

PubMed2005

Effectiveness of unilateral and symmetrical bilateral task training for arm during the subacute phase after stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of an arm training programme combining repetition of unilateral and symmetrical bilateral tasks for people in the subacute phase after stroke. DESIGN: Randomized controlled trial. SETTING: Inpatient functional rehabilitation unit. SUBJECTS: Forty-one people who had had a stroke, in the subacute phase, receiving conventional arm occupational and physical therapy, were randomized to an experimental group (n=20) and a control group (n=21). INTERVENTIONS: In addition to the usual arm therapy in the rehabilitation unit, the experimental group received an arm therapy programme (15-20 45-min sessions) based on repetition of unilateral and symmetrical bilateral tasks. The control group received additional usual arm therapy of a similar duration and frequency to the experimental treatment. MAIN MEASURES: The effect of the programme was judged on the basis of: (1) arm impairments (motor function, grip strength, gross and fine manual dexterity and motor co-ordination), (2) arm disabilities in tasks related to daily activities, and (3) functional independence in activities of daily living (ADL) and instrumental ADL (IADL). RESULTS: Although both experimental and control groups of participants improved similarly during the study period, the statistical analyses did not show any difference between the groups at the end of the treatment for the different dependent variables evaluated: (1) arm impairments: p = 0.43-0.79; (2) arm disabilities: p = 0.16-0.90; and (3) functional independence: p = 0.63 and 0.90. CONCLUSIONS: An arm training programme based on repetition of unilateral and symmetrical bilateral practice did not reduce impairment and disabilities nor improve functional outcomes in the subacute phase after stroke more than the usual therapy.

Activities of Daily Living↗

PubMed2005

Comparison of provincial and territorial legislation governing substitute consent for research.

In Canada, provincial and territorial laws address circumstances in which a substitute decision-maker may be appointed for an adult deemed legally incapable of making decisions in one or more areas of life. We searched for provincial and territorial laws that explicitly address substitute decision-making about research participation, and found significant differences among Canadian jurisdictions. In some provinces and territories there is no direct statutory guidance on the issue. Differences among jurisdictions that address substitute decision-making about research in legislation include whether judicial intervention is required to authorize the substitute decision-maker, whether any advance directive in place must explicitly authorize the decision about research in order for a proxy to consent, and how risk and benefit thresholds beyond which substitute consent to research is prohibited are articulated. It is imperative that government, researchers, and the Canadian public revisit the principles underpinning substitute decision-making about research in light of national and international norms, in order to lend clarity and consistency to this area of law and research practice.

Canada↗

PubMed2005

Correlates of suicide in the older adult population in Quebec.

This study was undertaken to describe the characteristics of adults aged 60 years and over who committed suicide in Quebec in 1998-1999. In this study, 42.6% of the suicide cases presented mental disorders at the time of their death, mainly depression. Sixty-five (65.3%) percent of the suicide cases would have been considered as having a mental health disorder if sub-threshold depression cases were included. Only 27.7% of the cases did not express any idea of death during the 6-month period preceding their suicide. One interesting finding was that 53.5% of the suicide cases consulted a general practitioner or specialist during the 2-week period preceding their death. Our results showed that only 8.1% had a severe level of functional limitations at the time of their death. This result leads us to interpret with caution the conclusion of some studies suggesting that physical frailty is a major causal factor associated with suicide among the elderly.

Aged↗

PubMed2004

Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of multimodal supervised physiotherapy programs with the absence of treatment among women with persistent postnatal stress urinary incontinence. METHODS: This was a single-blind randomized controlled trial. Sixty-four women with stress urinary incontinence were randomly assigned to 8 weeks of either multimodal pelvic floor rehabilitation (n = 21), multimodal pelvic floor rehabilitation with abdominal muscle training (n = 23), or control non-pelvic floor rehabilitation (n = 20). The primary outcome measure consisted of a modified 20-minute pad test. The secondary outcome measures included a Visual Analog Scale describing the perceived burden of incontinence, the Urogenital Distress Inventory, the Incontinence Impact Questionnaire, and pelvic floor muscle function measurements. RESULTS: Two patients dropped out, leaving 62 for analysis. At follow-up, more than 70% of the women in the treatment groups (14/20 in the pelvic floor and 17/23 in the pelvic floor plus abdominal group) were continent on pad testing compared with 0% of women in the control group. Scores on the pad test, Visual Analog Scale, Urogenital Distress Inventory, and Incontinence Impact Questionnaire improved significantly in both treatment groups (all P <.002), whereas no changes were observed in the control group. Pelvic floor muscle function, however, did not improve significantly in either active group. CONCLUSION: Multimodal supervised pelvic floor physiotherapy is an effective treatment for persistent postnatal stress urinary incontinence.

Abdominal Muscles↗

PubMed2004

The role of technology in task-oriented training in persons with subacute stroke: a randomized controlled trial.

This trial compares the effects of task-oriented physical therapy (PT) provided with and without the use of rehabilitation technology on locomotor recovery in 63 persons with subacute stroke. Participants in the experimental (EXP) group used a treadmill, a Kinetron isokinetic exerciser, and a limb-load monitor, whereas those in the control (CTL) group did not while engaging in PT 1 h per day, 5 days per week for 2 months. Locomotor recovery was assessed by clinical (gait speed, Fugl Meyer motor leg and arm subscores, the Balance Scale, the Timed Up and Go, and the Barthel ambulation subscore) and laboratory outcomes (gait kinematics and kinetics) pre- and posttherapy and 3 months later. Within groups, gait speed (P < 0.01) and all secondary measures improved posttherapy (P < 0.01-0.05), and improvements in clinical measures were maintained at follow-up, but there was no difference between groups (P > 0.05). When the groups were pooled, the increase in gait speed was associated (r = 0.52, P = 0.003) with an increase in ankle power generation of the affected leg. The results demonstrate that the efficacy of the task-oriented approach is not dependent on rehabilitation technology.

Aged↗

PubMed2003

Comparison of changes in upper and lower extremity impairments and disabilities after stroke.

The aims of this study were to determine if the changes in impairment and disability measures for the upper and lower extremities were equivalent during the post-stroke rehabilitation period and whether the rates of change were maintained 6 months after discharge from rehabilitation. A prospective cohort study design was used. One-hundred-and-thirty-two people who had sustained a stroke and who were enrolled in an intensive functional rehabilitation programme were recruited. Upper and lower extremity impairments and disabilities were evaluated at admission, at discharge from rehabilitation and 6 months later. During active rehabilitation, the changes in both extremities were smaller for the impairment measures (standardized response mean (SRM), 0.37-0.63) than the disability measures (SRM, 0.76-1.05). While the changes in upper and lower extremities were equivalent for impairment measures, they were larger in the lower extremity for disability measures, indicating that the rate of functional improvement was faster in the lower extremity during active rehabilitation. After discharge, however, while the rate of motor recovery in the lower extremity dropped (SRM, 0.54-0.18), it was maintained in the upper extremity (SRM, 0.45 and 0.42). Present findings indicate that functional (disability) measures improve faster than impairment measures in both extremities during the active rehabilitation period and suggest that motor recovery occurs at a different rate in the upper and lower extremities, with that of the upper extremity occurring later and extending into the period after discharge from active rehabilitation.

Aged↗

PubMed2003

Arm and leg impairments and disabilities after stroke rehabilitation: relation to handicap.

OBJECTIVES: (1) To examine the relationships between measures of impairment and disability for the arm and leg with a measure of handicap and (2) to identify the impairment or disability most strongly related to handicap situations. DESIGN: Prospective cohort study. SETTING: Intensive functional rehabilitation unit and community. PATIENTS: One hundred and two persons who had a stroke. MAIN OUTCOME MEASURES: Arm and leg impairments and disabilities were evaluated with reliable and valid tests at discharge from rehabilitation. Six months later, handicap situations were evaluated with the Assessments of Life Habits (LIFE-H). RESULTS: Arm and leg impairments and disabilities are correlated with handicap situations. Disability of the leg is more strongly associated with handicap than arm disability. Arm and leg disabilities are not statistically more strongly related to handicap than arm and leg impairments. CONCLUSIONS: The high correlations found between handicap situations and the impairment and disability measures of the leg provide new information that support the importance of mobility to promote integration after stroke.

Aged↗

PubMed2002

A prospective evaluation of the Charlson Comorbidity Index for use in long-term care patients.

OBJECTIVES: Because of the high prevalence of coexisting medical conditions in frail older adults, clinical investigators often need to adjust for comorbidity when assessing the effect of long-term care (LTC) on patient outcomes. This study examined the prognostic value of the Charlson Comorbidity Index (CCI) in predicting 3-year mortality and functional decline in the LTC setting and compared its prognostic value to that of two data-derived comorbidity indices. DESIGN: Longitudinal cohort study. SETTING: Eighty-eight residential care facilities from Quebec, Canada. PARTICIPANTS: Two hundred ninety-one dependent older adults aged 65 and older. MEASUREMENTS: Subjects' functional abilities were assessed at baseline and 3 years later with the revised version of the Functional Autonomy Measurement System(SMAF). Comorbidity data and the exact date of death for those who had died were collected retrospectively from the subjects' medical files. Subjects were classified as functional decliners if they died or gained 5 points or more on the SMAF between the two assessments. RESULTS: Multivariate Cox and logistic regressions were used to derive two new comorbidity indices, one for predicting mortality and the other for identifying functional decliners. Although the CCI performed well in predicting these two outcomes, its performance was generally inferior to that of the two newly proposed indices. CONCLUSIONS: Findings suggest that the CCI can be improved upon when used to measure comorbidity in LTC patients.

Aged↗

PubMed2002

Relationship between regulatory status, quality of care, and three-year mortality in Canadian residential care facilities: a longitudinal study.

OBJECTIVES: To compare the mortality rate in regulated and unregulated facilities, controlling for confounding variables, and investigate the effect of care quality on residents' length of survival. DATA SOURCES/STUDY SETTING: At baseline, subjects were assessed in their living environment with respect to their functional autonomy, cognitive abilities, and quality of care. Vital status, disease-related information, and hospitalization data were retrieved three years later from the subjects' medical files. STUDY DESIGN: A three-year follow-up study of 299 residents from 88 long-term care facilities located in the province of Quebec, Canada. The effect of regulatory status and quality of care on length of survival was investigated by means of multivariable Cox proportional hazards regression models, from both traditional and competing risks perspectives. PRINCIPAL FINDINGS: Controlling for age, comorbidity, and baseline functional abilities, a resident's length of survival is not significantly influenced by the regulatory status of the facility in which he or she lived at baseline. However, residents with poor quality ratings at baseline had shorter survival times than those provided with good care. Median survival was 28 months among residents classified as receiving inadequate care compared to 41 months for those adequately cared for (p = 0.0217). CONCLUSIONS: The study suggests that quality of care has a much stronger influence on resident outcomes than regulation per se. This finding underscores the relevance of testing innovative interventions aimed at improving the quality of care provided in long-term care facilities, regardless of their regulatory status.

Activities of Daily Living↗