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Biomedical subjects

L Dubé

Publications and source records attributed to L Dubé.

At least 19 recordsLinked to original sources
PubMed2006

Nutritional implications of patient-provider interactions in hospital settings: evidence from a within-subject assessment of mealtime exchanges and food intake in elderly patients.

OBJECTIVE: To examine the nutritional implications of the interactions taking place between patients and care providers during mealtimes in hospital settings. Specifically, we tested research propositions that the amount and nature of interpersonal behaviours exchanged between patients and providers impact patients' food intake. These propositions were derived from prior evidence of social influences on eating behaviour and a well-established framework that identifies two fundamental modalities of human interaction: striving for mastery and power (agency) and efforts to promote union with others (communion). DESIGN: In a within-subject naturalistic study, participants were observed on multiple meals (n=1477, 46.2 meals/participant on average), during which participants' and providers' agency- and communion-related behaviours and patients' protein and energy intake were recorded. Meal-level frequency and complementarity of patients' and providers' behaviours were computed to test research propositions. SETTING: Dining room of a geriatric rehabilitation unit. SUBJECTS: Thirty-two elderly patients (21 females, mean age:78.8, 95% CI: 76.4, 81.1). RESULTS: Meal-level frequency of patient-provider exchanges (P=0.016) and patients' agency-related behaviours (P=0.029), as well as mutual reciprocation of patients' and providers' communion-related behaviours (P=0.015) on a given meal were positively linked to protein intake. Higher energy intake was found during meals where patients expressed more agency-related behaviours (P=0.029). CONCLUSION: Results present evidence that the amount and nature of patient-provider interpersonal exchanges on a given meal influence the nutritional quality of food intake in hospitalized elderly. They provide insights into how to improve the design and delivery of routine care to this malnutrition-prone population. SPONSORSHIP: This study was supported by the Canadian Institutes of Health Research (Operating grant to Laurette Dubé, Doctoral Fellowship to Catherine Paquet) the Fonds de la Recherche en santé du Québec and by the Danone Institute (Doctoral fellowship to Danielle St-Arnaud McKenzie).

Aged↗
PubMed2005

[Anthracycline-induced heart failure aggravated by pregnancy. Survival after cardiac assistance with artificial heart device and heart transplantation].

We report a case of a young woman suffering from a steady anthracycline-induced myocardiopathy with a decreased left ventricular function on echocardiography. A pregnancy was initiated, without worsening of the cardiopathy until 34 weeks. Nine days after delivery, an acute heart failure was observed leading to heart transplantation after cardiac assistance with heart cardiac device. As pregnancy is an extended stress test for a chronic failing heart, a multidisciplinary decision of pregnancy initiation and follow up should be preferred in pre and postpartum period, when such a cardiopathy exists.

Adult↗
PubMed2002

[Multimodal monitoring of head injuries in children].

As in the case of adults, there are three main goals in the monitoring of severe head trauma in children: to prevent or minimize the apparition of secondary lesions, to optimize treatment, to help make precise prognosis. The basic monitoring is composed of repeated clinical examinations, brain radiological imaging and control of vital parameters (blood pressure, temperature, PaO2 (SpO2), PaCO2 (FETCO2), haemoglobin, haematocrit. On the other hand, during specific brain monitoring, the brain perfusion (TCD, intracranial pressure), the electrical activity of the brain and sometimes the brain oxygenation (SvjO2) are controlled. The data obtained from the brain monitoring must always be interpreted carefully. A child with a severe head trauma, in ICU, always requires constant and competent medical attention.

Child↗
PubMed2002

[Potential advantages a new syringe pump system].

OBJECTIVES: To evaluate what could be the benefit in terms of alarm suppression, of a new syringe pumps system, which allows automatic relay without alarms. PATIENTS AND METHODS: We have prospectively recorded the nature and the mode of relay of all syringe pumps for administration of drugs to patients in two ICU. The perfusion regimen was studied in 61 patients over the complete duration of their stay in two ICU. Alarms were also recorded in one ICU room, over 13 days consecutive. The records were processed off-line with an automatic detection-recognition system in order to assess the origin of each alarm. Accordingly, the amount of alarm corresponding to monitor, ventilator and syringe pumps was computed. RESULTS: We found that syringe pumps, which would provide automatic relays without alarm, would suppress 17% of alarms in ICU and automatize 65% of the relay procedures, which are usually performed often in emergency, on response to the end of perfusion alarm. CONCLUSION: New syringe pumps allow both reduction of alarms in ICU and a better management of nurse workload. Indeed syringe relay can be planned in advance.

Equipment Failure↗
PubMed2001

[Severe metabolic alkalosis following hypokalemia from a paraneoplastic Cushing syndrome].

Metabolic alkalosis is frequently observed in critically ill patients. Etiologies are numerous but endocrinal causes are rare. We report a case of a patient with severe respiratory insufficiency, metabolic alkalosis and hypokalemia. The evolution was fatal. Further explorations revealed an ectopic Adrenocorticotropine Hormone syndrome. The initial tumor was probably a small cell lung carcinoma.

ACTH Syndrome, Ectopic↗
PubMed2001

Clinical predictors of health-related quality of life depend on asthma severity.

The National Asthma Education and Prevention Program guidelines define asthma severity before treatment by lung function and symptoms. It has been assumed, but not demonstrated, that improvement in these measures would translate into improvement in health-related quality of life (HRQL). Because HRQL is an important outcome in asthma management, we asked what are the determinants of HRQL? To address this question, we retrospectively analyzed HRQL data, as measured by the Juniper Asthma Quality of Life Questionnaire, in subjects with mild versus moderate-severe asthma from two clinical trials. We examined whether these traditional clinical outcomes have different relationships to HRQL depending on asthma severity. We also assessed whether the relationship between clinical outcomes and HRQL in subjects with moderate-severe asthma would change when subjects improved to mild-moderate disease with controller medication treatment. Lung function was not an independent predictor or determinant of HRQL at any level of asthma severity, whereas intensity of shortness of breath predicted HRQL at all levels of asthma severity. Rescue beta-agonist use independently predicted HRQL in subjects with mild asthma, but not in those with moderate-severe asthma. In subjects with moderate-severe asthma who improved to mild-moderate disease with controller treatment, rescue beta-agonist use predicted HRQL. We conclude that the independent determinants of HRQL vary according to asthma severity and change with asthma treatment.

Adult↗
PubMed2000

Promoting health or promoting pleasure? A contingency approach to the effect of informational and emotional appeals on food liking and consumption.

Here, we suggest that the relative effectiveness of informational and emotional appeals in persuasive communications may depend on the dominant basis of attitude towards the focal item (affective or cognitive), and on the precise response being targeted (i.e. influencing affect-based food liking or cognitive-based consumption). Ninety-five participants (milk drinking adults) participated in an experiment in which they were presented with a persuasive communication promoting milk consumption. A mixed design combined as between-participants factors attitude bases (two: affective/cognitive) and persuasive appeals (two: informational/emotional) with, as a within-participants measure, types of effect (two: liking and consumption change intent). We also measured immediate feelings and thoughts responses to the communication. As expected, cognition-based attitudes were not sensitive to a match between persuasive appeals and types of effect. For affect-based attitudes, results confirmed the predicted superiority of a match between the affective and cognitive bases of the targeted responses and that of the persuasive appeal. Food liking was particularly sensitive to an emotional appeal while an informational appeal tended to be more influential on food consumption. The underlying mechanism of these effects and their implication for the practice of health promotion and food marketing are discussed.

Adult↗
PubMed2000

Abstinence and well-being among members of Alcoholics Anonymous: personal experience and social perceptions.

The authors examined the subjective experience of well-being (WB) among abstinent Alcoholics Anonymous (AA) members and social perceptions of an abstinent alcoholic's WB among 3 nonalcoholic French-Canadian samples: male police officers, Catholic nuns, and university women. The short-term abstinent AA members, along with the university women, reported the lowest self-ratings of WB, whereas the Catholic nuns reported the highest. However, among the abstinent AA members, the level of WB was positively related to the length of abstention. The 3 nonalcoholic groups evaluated an abstinent AA member more positively than a nonabstinent alcoholic. These evaluations of an abstinent AA member converged with the AA members' self-evaluations on the measure of WB.

Adaptation, Psychological↗
PubMed1999

Attitudinal moderation of correlation between food liking and consumption.

This paper focuses on the degree of correlation between food liking and consumption and proposes the degree of correspondence between affective and cognitive aspects of liking and consumption as moderators of this correlation. In a close-response questionnaire, 103 young females (average age of 20) indicated their liking for and consumption of 12 non-alcoholic cold beverages. They also indicated their level of agreement with affective and cognitive statements associated with each beverage as well as the affective or cognitive statement that was representative of their attitude toward each beverage. Even though there are affective and cognitive bases of both liking and consumption, the affective basis dominates liking whereas the cognitive basis dominates consumption for most beverage categories. Separate analyses conducted at the level of individual subjects and of individual beverage categories both revealed that those cases in which the attitude basis for liking and consumption showed the highest correspondence, also manifested the highest liking-consumption correlation. Results are discussed with regard to health promotion and food marketing strategies.

Adult↗
PubMed1999

Pharmacogenetic association between ALOX5 promoter genotype and the response to anti-asthma treatment.

Clinically similar asthma patients may develop airway obstruction by different mechanisms. Asthma treatments that specifically interfere with the 5-lipoxygenase (ALOX5) pathway provide a method to identify those patients in whom the products of the ALOX5 pathway (that is, the leukotrienes) contribute to the expression of the asthma phenotype. Failure of an asthma patient to respond to treatment with ALOX5-pathway modifiers indicates that leukotrienes are not critical to the expression of the asthmatic phenotype in that patient. We previously defined a family of DNA sequence variants in the core promoter of the gene ALOX5 (on chromosome 10q11.2) associated with diminished promoter-reporter activity in tissue culture. Because expression of ALOX5 is in part transcriptionally regulated, we reasoned that patients with these sequence variants may have diminished gene transcription, and therefore decreased ALOX5 product production and a diminished clinical response to treatment with a drug targeting this pathway. Such an effect indicates an interaction between gene promoter sequence variants and drug-treatment responses, that is, a pharmacogenetic effect of a promoter sequence on treatment responses.

Alleles↗
PubMed1998

Managing emotions. Accenting the positive might not produce the highest satisfaction payoff.

The relationship between patient emotions during hospitalization and their retrospective satisfaction varies across service elements, across emotions, and is influenced by the temporal positioning of both emotions and the service element. Marketers should concentrate on reducing negative emotions attributed to the provider (e.g., hostility and frustration) and to the hospitalization situation (e.g., distress and depression), according to the results of the authors' study. Providers also should attempt to alleviate negative emotional states connected with arousal (e.g., jittery and excited). Positive emotions were found to be only weakly related to satisfaction. The authors suggest segmenting patients on the basis of their emotional states at particular junctures of the service delivery and then "socializing" both providers and patients to ensure successful emotion management.

Emotions↗
PubMed1997

Similarities and differences in affective and cognitive origins of food likings and dislikes.

In a field study, 355 French-Canadian adults (Caucasians; 119 men, 236 women; average age of 40) freely stated the food item they liked and disliked the most, the reasons for their attitude and the context of their last consumption of these two food items. Content analysis revealed that the origins of food likes and dislikes are at the same time very similar and very different. They are similar in terms of the overwhelming influence of affective factors, in particular sensory experience, in the formation of both positive and negative attitudes toward food. Similarity between origins of food likes and dislikes in the same subjects is higher when they are from affective sources than when they are from cognitive sources. Food likes and dislikes are also similar in terms of the high salience of the social dimension in subjects' memories of consumption contexts. Results also show that food likes and dislikes also differ in many ways. Subjects can more easily elicit attitude bases and consumption contexts for food likes than they do for food dislikes. Beside taste as their common and most frequent base, results show that dislikes originate from more specific (e.g. texture, smell, appearance) and more intense sensory experiences than likes. Further, physiological consequences that contribute to food likes and dislikes are not the same: likes originate from positive nutritional value whereas dislikes follow from negative physiological responses, in particular nausea. Also, specific factors contribute uniquely to likes and dislikes. Functional aspects (e.g. flexibility, preparation) were the second most important reasons for food likes while having almost no influence on dislikes. In contrast, food symbolism was the third most important reason for food dislikes with almost no effect on food likes.

Adult↗
PubMed1997

Individual differences in circadian variations of consumers' emotional state.

A laboratory study investigated the effect of circadian orientation on consumers' emotional state at different times of day. Subjects' emotional state was measured using the Pleasure-Arousal-Dominance scale in the morning and in the evening. Individual circadian orientation (morningness-eveningness) was also assessed. Analyses showed that changes in consumers' emotional state as a function of the time of the day is moderated by individual differences in circadian orientation. Morning-types were in a more pleasurable emotional state in the morning than in the evening. The predicted reversed pattern for the evening-types did not reach significance. Null effects were reported for the arousal and submissive/dominance dimensions of emotional state. Morning-types rated themselves as more awake than evening-types. Morning-types were more awake in the morning than in the evening and vice-versa for evening-types. The magnitude of the differences between evening-type and morning-type individuals was significant in the morning. Findings are discussed from methodological, theoretical, and marketing perspectives.

Adolescent↗
PubMed1996

Effect of treatment with zileuton, a 5-lipoxygenase inhibitor, in patients with asthma. A randomized controlled trial. Zileuton Clinical Trial Group.

OBJECTIVE: To study the effect of 3 months of treatment with zileuton, an inhibitor of the enzymatic pathway (5-lipoxygenase) leading to leukotriene formation, on disease control in patients with mild to moderate asthma. DESIGN: Randomized, double-blind, parallel-group study in 401 patients. A 10-day placebo lead-in was followed by a double-blind treatment period of 13 weeks. SETTING: Asthma study clinics in university hospitals and private practices. PATIENTS OR OTHER PARTICIPANTS: Patients with mild to moderate asthma (forced expiratory volume in the first second [FEV1], 40% to 80% of predicted) whose only treatment was inhaled beta-agonists. INTERVENTIONS: Treatment with 600 mg or 400 mg of zileuton or placebo (each taken four times daily.) MAIN OUTCOME MEASURES: Frequency of asthma exacerbation requiring treatment with corticosteroids, use of inhaled beta-agonists, pulmonary function tests, asthma symptom assessment, and quality-of-life evaluation. Safety was evaluated by monitoring adverse events. RESULTS: Only eight (6.1%) of 132 patients receiving 600 mg of zileuton four times a day required corticosteroid treatment for asthma vs 21 (15.6%) of 135 patients receiving placebo (P=.02), giving a relative risk of 2.6. At the time of expected peak drug concentration, the average FEV1 improved 15.7% in the 600-mg zileuton group vs 7.7% in the placebo group (P=.006). Quality-of-life assessments significantly improved in the 600-mg zileuton group and not in the placebo group (P=.007 for the overall score). Elevations in liver function tests (more than three times normal), all of which reversed with drug withdrawal, occurred in five patients (P=.03 vs placebo), three patients (P=.12 vs placebo), and no patients treated with 600 mg of zileuton, 400 mg of zileuton, or placebo, respectively. CONCLUSIONS: Three months of 5-lipoxygenase inhibition produced a significant improvement in asthma control. These data indicate that 5-lipoxygenase products of arachidonic acid metabolism are mediators of inflammation with an important role in the biology of asthma.

Adrenergic beta-Agonists↗
PubMed1996

The emotional experience of hospitalization: its moderators and its role in patient satisfaction with foodservices.

OBJECTIVES: To investigate the basic dimensions of patient emotional experience of hospitalization; to identify the moderators of emotional experience in terms of individual characteristics and contextual factors; and to investigate the contribution of the dimensions of the patient emotional experience to satisfaction with foodservices. DESIGN: Survey questionnaire. SUBJECTS/SETTING: One hundred two hospitalized patients of a specialized, acute-care, urban hospital in Canada who required one or more overnight stays. Patients with notable physical, cognitive, or emotional limitations were excluded from the study. Patients admitted to the obstetrics department were also excluded because of the unique nature of their emotional experience of hospitalization. STATISTICAL ANALYSES PERFORMED: Factor analysis followed by orthogonal rotation (varimax), analyses of variance, and multiple regression analyses. RESULTS: Five dimensions represented the emotional experience of hospitalization: positive emotions, arousal emotions, and three negative dimensions structured on the basis of their possible causes (situation-, other-, or self-attributed negative emotions). Individual characteristics (gender, age, marital status, perceived health status) and contextual factors (perceived control over the situation, complexity of medical diagnosis, and admission procedures) significantly influenced patient emotions. Satisfaction with foodservices was structured in technical and interpersonal dimensions; the largest part of the common variance was accounted for by interpersonal aspects. The relationship between emotions and satisfaction was direct for positive emotions and, surprisingly, for situation-attributed negative emotions and self-attributed negative emotions. Other-attributed negative emotions and arousal emotions were negatively associated with satisfaction with foodservices. APPLICATIONS: Results suggest that dietitians' interventions should be adapted for subgroups of patients who experience different emotions. Results also provide insights on individual and contextual factors that can be used to identify or better understand the specific characteristics of these subgroups. The pattern of relationships between emotions and satisfaction demonstrates that the fine-tuning of dietitians' interventions as a function of patients' emotional states may be conducive to increased patient satisfaction with foodservices.

Adult↗
PubMed1996

Evidence from incorporation and patch-clamp experiments for a nonselective channel of large conductance at the luminal membrane of rabbit proximal tubule.

The presence of nonselective ionic channels at the apical membrane of rabbit proximal tubule cells was investigated by fusion of proximal tubule brush border membrane vesicles onto a planar bilayer and by means of patch clamp measurements on primary cultured proximal tubule cells. The fusion of brush border membrane vesicles onto a phosphatidylethanolamine-phosphatidylcholine (1:1) planar bilayer led to the identification of a nonselective channel of 115 pS in 200 mM NaCl conditions with an ionic permeability sequence for Na+, K+, and Cl- corresponding to PNa/PK = 0.3 and PNa/PCl = 3, respectively. This channel showed an increased open probability at depolarizing potentials, but its activity was independent of the Ca2+ concentration in both the cis and trans compartments. These findings were subsequently confirmed in inside-out patch clamp experiments carried out on primary cultured proximal tubule cells. This channel was seldom seen in cell-attached recordings on resting cells, but its presence was observed with a higher probability in patch excised experiments performed following superfusion of the cells with a hypotonic solution. It is suggested on the basis of these observations that the apical membrane of rabbit proximal tubule cells contains a voltage-dependent nonselective channel, the activity of which may contribute to the regulation of the membrane potential.

Animals↗