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Biomedical subjects

Michel Bédard

Publications and source records attributed to Michel Bédard.

16 recordsLinked to original sources

Incidents in a psychiatric forensic setting: association with patient and staff characteristics.

Patient-related incidents are of particular concern for those working with forensic psychiatric populations. Evidence suggests that personality, stress, and burnout of nursing staff are predictive of incidents. However, the exact relationship of these factors with staff-patient interactions and the incidents that occur within these interactions have not been thoroughly explored. The authors collected data on the nature of incidents on a forensic unit within a psychiatric hospital over a 1-year period, as well as data on the characteristics of 13 staff members. They found that 10% of patients were responsible for 58% of the incidents. Patients with a diagnosis of schizophrenia were disproportionately involved in incidents. The frequency of non-violent incidents varied among nursing teams to an extent greater than that expected by chance. A relationship between incidents and some staff characteristics was also found. These results highlight the need for further research into the incidents that occur in situations where patient attributes, nurse attributes, and environmental factors produce complex interactions.

Adult↗

Understanding burden differences between men and women caregivers: the contribution of care-recipient problem behaviors.

BACKGROUND: This study was carried out to determine why women caring for men report more burden than other caregivers, and to further examine the role of care-recipient problem behaviors as determinants of burden. METHOD: A sample of 557 primary caregivers of community-dwelling individuals referred to a memory clinic was used. All care-recipients had a diagnosis of Alzheimer's disease (NINCDS-ADRDA). Data on care-recipient function, caregiver attributes, external supports and caregiver burden were obtained on the first visit. Hierarchical regression models were used to determine the contribution of gender, after controlling for care-recipient status, caregiver attributes, and external supports. RESULTS: This model explained 46% of the variability in caregiver "role burden", with care-recipient problem behaviors and dependence in instrumental activities of daily living. The caregiver/care-recipient gender interaction explained an additional 4% of the variance (p = 0.001); women caring for men scored 5.61 higher on the burden scale than other caregivers. Specific problem behaviors (e.g., anger) were more problematic for women caregivers than men. CONCLUSION: These results indicate that the experience of men and women caregivers may be different despite seemingly identical circumstances, and highlight the need for interventions geared to the specific needs of women caregivers.

Aged↗

Health impact on caregivers of providing informal care to a cognitively impaired older adult: rural versus urban settings.

INTRODUCTION: Rural caregivers, compared to urban caregivers, may experience a heavier burden, which could result in poorer health status for these caregivers. Furthermore, caregiving demands may prevent rural caregivers from engaging in healthy behaviours. We investigated potential differences between rural and urban caregivers in the health impact on these caregivers of caring for cognitively impaired individuals. METHODS: Two convenience samples of caregivers of older adults with cognitive impairment were obtained from Northern Ontario. The rural sample (n = 20) was taken from a community of < 15,000 inhabitants, the urban sample (n = 17) from a community of 125,000. We obtained demographical information for caregivers and care recipients, and information regarding the level of independence in activities of daily living and frequency of behaviour problems of care recipients, the type and quantity of supports available and used by caregivers, global health indices and a measure of healthy behaviours from caregivers. RESULTS: A greater proportion of rural caregivers was non-spousal and employed. Care recipients' characteristics from the 2 groups were similar, except for higher frequencies of behaviour problems among the rural sample. Rural caregivers had access to fewer formal supports but did not report greater burden, poorer health status, or fewer healthy behaviours than urban caregivers. However, for rural caregivers, higher reports of burden were associated with fewer healthy behaviours (r = 0.79, p = 0.001); we found no such association for urban caregivers (r = 0.04, p = 0.861). CONCLUSION: Rural caregivers may have special needs regarding the management of behaviour problems in care recipients and in the promotion of healthy behaviours for themselves. Primary health care providers have an important role in ensuring that these needs are met.

Activities of Daily Living↗

Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries.

PRIMARY OBJECTIVE: To examine the potential efficacy of a mindfulness-based stress reduction approach to improve quality of life in individuals who have suffered traumatic brain injuries. RESEARCH DESIGN: Pre-post design with drop-outs as controls. METHODS AND PROCEDURES: We recruited individuals with mild to moderate brain injuries, at least 1 year post-injury. We measured their quality of life, psychological status, and function. Results of 10 participants who completed the programme were compared to three drop-outs with complete data. EXPERIMENTAL INTERVENTION: The intervention was delivered in 12-weekly group sessions. The intervention relied on insight meditation, breathing exercises, guided visualization, and group discussion. We aimed to encourage a new way of thinking about disability and life to bring a sense of acceptance, allowing participants to move beyond limiting beliefs. MAIN OUTCOMES AND RESULTS: The treatment group mean quality of life (SF-36) improved by 15.40 (SD = 9.08) compared to - 1.67 (SD = 16.65; p = 0.036) for controls. Improvements on the cognitive-affective domain of the Beck Depression Inventory II (BDI-II) were reported (p = 0.029), while changes in the overall BDI-II (p = 0.059) and the Positive Symptom Distress Inventory of the SCL-90R (p = 0.054) approached statistical significance. CONCLUSIONS: The intervention was simple, and improved quality of life after other treatment avenues for these participants were exhausted.

Adaptation, Psychological↗

Associations between psychotic symptoms and dependence in activities of daily living among older adults with Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is associated with dependence in activities of daily living (ADL). In addition to the cognitive impairment resulting from AD, the presence of psychotic symptoms may further increase this dependence. The objective of this study was to quantify the additional contribution of psychotic symptoms to dependence in ADL. METHOD: We analyzed data from 558 individuals with AD referred to a memory clinic. Information on ADL, psychotic symptoms, depression symptoms, and cognition was collected with standardized instruments. RESULTS: The frequency of psychotic symptoms was correlated with dependence in ADL (r = -.44, p < .001). The independent contribution of psychotic symptoms to ADL (basic and instrumental) after consideration for cognitive impairment and depression symptoms was assessed with hierarchical regression models. Twenty-five percent of basic ADL variance was explained by cognition; psychotic symptoms accounted for an additional 7% of the variance (b = -0.12, p < .001). Cognitive impairment explained 31% of instrumental ADL variance; psychotic symptoms accounted for an additional 6% (b = -0.21, p < .001). DISCUSSION: Psychotic symptoms are associated with dependence in ADL after controlling for cognitive impairment and depression symptoms. Future research should investigate possible causal linkages between psychotic symptoms and dependence in ADL. This may have implications regarding interventions to maintain independent living in people with AD.

Activities of Daily Living↗

Renal impairment and medication use among psychogeriatric inpatients.

OBJECTIVES: To determine the prevalence of renal impairment and the dosage appropriateness of several medications for which dosing guidelines in the advent of renal impairment are available. METHOD: The authors assessed the renal function and medication use of 37 psychogeriatric patients (mean age of 75 years) living in a psychiatric hospital. Renal function was determined by serum creatinine (SCr) levels and creatinine clearance (CCr) data using the Cockcroft and Gault equation. RESULTS: Thirteen of 37 patients (35%) were found to have renal impairment according to CCr data but only two patients (6%) were considered impaired according to SCr levels (k=0.19). Of 44 medications for which dosing guidelines were available, only two (5%) were prescribed inappropriately. CONCLUSION: These data suggest that CCr data should be used over SCr levels to determine renal impairment and to support the monitoring of psychogeriatric patients for declines in renal function and required medication adjustments.

Aged↗

Current evaluation and future needs of a mental health data linkage system in a remote region: a Canadian experience.

Linking client data across care sectors and agencies is becoming essential to ensure continuity of care, evaluation, and planning of mental health services delivery. The Data Linkage System (DLS), a record-linked, client-based, mental health database in northwestern Ontario, was established in response to this need. It is a voluntary system currently used by 30 of 40 mental health programs. The study surveyed program administrators to determine the system's utilization, perceived value, and future needs regarding data collection. The survey results delineated the perceived usefulness of the DLS in a remote region. The findings will provide direction for continued development of the DLS.

Community Mental Health Services↗

The independent contribution of driver, crash, and vehicle characteristics to driver fatalities.

Several driver, crash, and vehicle characteristics may affect the fatality risk of drivers involved in crashes. To determine the independent contribution of these variables to drivers' fatality risk, we used data from single-vehicle crashes with fixed objects contained in the US Fatal Accident Reporting System. A multivariate logistic regression revealed that the odds ratio (OR) of a fatal injury increased with age, reaching 4.98 (99% confidence interval (CI) = 2.01-12.37) for drivers aged 80 + compared with drivers aged 40-49 years. Female gender (OR = 1.54, 99% CI = 1.35-1.76) and blood alcohol concentration greater than 0.30 (OR = 3.16. 99% CI = 1.96-5.09) were also associated with higher fatality odds. In comparison with front impacts, driver-side impacts doubled the odds of a fatality (OR = 2.26, 99% CI = 1.92-2.65), and speeds in excess of 111 kilometers per hour (kph: 69 mph) prior to or at impact were related to higher fatality odds (OR = 2.64, 99% CI = 1.82-3.83) compared with speeds of less than 56 kph (35 mph). Three-point seatbelts were protective against fatal injuries (OR = 0.46, 99% CI = 0.39-0.53 compared with no belt). These data suggest that increasing seatbelt use, reducing speed, and reducing the number and severity of driver-side impacts may prevent fatalities. The importance of age and gender suggests that the specific safety needs of older drivers and female drivers may need to be addressed separately from those of men and younger drivers.

Accidents, Traffic↗

Assessing the quality of drug detailing.

This study measured the validity of a new instrument, the Assessment Instrument for Drug Detailing (AIDD), used by doctors to score the quality of drug detailing provided by pharmaceutical representatives in their offices. Five pharmaceutical representatives provided "good, medium, and poor" details to 135 family doctors in their offices, who were blinded to the quality of the details. A "reference standard group" constructed the details and trained the representatives. An "assessment group" trained family physicians to use the AIDD to score the details. Physicians discriminated between different quality details in all but one domain, nomenclature (P </=.001). Physicians scored good quality presentations 2.3 points higher than poor quality details, and reported that they learned more from good than poor quality details. Approximately 71% of the variability in physicians' global ratings (R(2) = 0.71) was explained by assigned detail quality, F(2, 118) = 54.64, P <.0001, presentation time, F(2, 118) = 9.98, P <.0001, pharmaceutical representative, F(4, 118) = 9.58, P <.0001, and physician rating the detail, F(109, 118) = 1.94, P <.0001.

Analysis of Variance↗

Correlates of health status for family caregivers in bereavement.

The purpose of this retrospective cohort study was to identify aspects of caregiving associated with health status among family caregivers in bereavement. Study participants included 151 family caregivers of terminally ill patients who had died, on average, 294 days prior to the study telephone interview. The interview covered two main areas: patient characteristics and caregiver characteristics. Multivariate linear regressions revealed that as the age of the care recipient (regression coefficient [b] = -0.32; 95% confidence interval [CI] -0.48,-0.15) and caregiver (b = -0.14; 95% CI = -0.25, -0.02) increased, caregivers experienced a decline in their physical health during bereavement. Furthermore, caregivers who reported that caregiving interrupted their usual activities (b = -5.97; 95% CI = -9.79, -2.15) had a decline in physical health during bereavement. A poorer mental health status during bereavement was seen in caregivers who reported poor physical health during caregiving (b = -4.31; 95% CI = -8.17, -0.45); and that they received insufficient family support in caregiving (b = -6.01; 95% CI = -9.75, -2.27). It was also revealed that a home death was associated with higher mental health of the caregiver (b = 3.55; 95% CI = 0.26, 6.84). The practice implications of these findings are discussed in this paper.

Aged↗

Long-term efficacy of combined relaxation: biofeedback treatments for chronic headache.

Thirty-four patients having chronic idiopathic headaches participated in a long-term study comparing autogenic relaxation training alone (REL) with combinations of relaxation and electromyographic biofeedback (REL + EMG) or relaxation and temperature biofeedback (REL + TEMP). Assignment to treatment conditions was balanced on demographics and clinical characteristics, as well as headache classification according to muscle contraction or vascular headache symptomatology. The results indicate that REL + TEMP produced no additional improvements over REL following the 8-week treatment program, or at 6-month, or 12-month follow-up. However, REL + EMG produced significantly greater reductions in headache activity measures than the REL and REL + TEMP conditions at all post-treatment time points. Headache activity continued to improve over the follow-up period independent of treatment condition. These data indicate that EMG biofeedback augments long-term clinical improvements in headache patients who undergo autogenic relaxation training.

Adolescent↗

A comparison of client and mental health worker assessment of needs and unmet needs.

This study was set up to examine agreement on needs identified by mental health clients and their primary mental health workers. Mental health workers assessed a convenience sample of clients who completed an interview about the services they receive. Data were collected from 78 client and staff dyads regarding 11 need domains. Mental health workers and clients did not agree on the number of needs (ICC = 0.42). Kappa coefficients indicated significant agreement between staff and clients for only 1 of the 11 need domains (vocational need kappa = 0.67; others ranged from 0 to 0.58). The data further revealed that mental health workers and clients disagreed about unmet needs (kappa ranged from -0.07 to 0.46). These findings show that clients and staff have divergent opinions regarding needs. Integrating clients' perspectives into treatment plans may help address this issue.

Adult↗

The influence of passengers on older drivers involved in fatal crashes.

The authors examined if the presence of passengers affects the risk of making unsafe actions among older drivers, and determined what specific types of unsafe actions may be affected (positively or adversely) by the presence of passengers. They used 1975 to 1998 data from the U.S. Fatality Analysis Reporting System (FARS); unsafe actions were based on driver-related factors. The authors calculated the odds ratio (OR) of making unsafe driving actions in the presence of passengers compared to situations where drivers were alone. In general, the presence of passengers was beneficial to older drivers (e.g., for drivers aged 65 to 79 with four or more passengers, OR = 0.73 [99% Confidence interval[CI] = 0.61, 0.86. For drivers aged 65 to 79, the presence of passengers was associated with a reduced risk of some unsafe actions (e.g., driving the wrong way, OR = 0.37 [95% CI = 0.30, 0.46]) but a higher risk of other actions (e.g., ignoring signs/warnings/right of way, OR = 1.18 [95% CI = 1.15, 1.22]). These findings are discussed in the context of strategies to maximize safe driving in older adults.

Accidents, Traffic↗

Visual attention and older drivers: the contribution of inhibition of return to safe driving.

Increasing data suggest that visual attention may be impaired in some older drivers, and that such impairment may be related to poorer driving abilities and a higher crash risk. Because effective scanning of the environment is important for safe driving, the authors sought to examine the relationship between a reflexive visual attention mechanism and driving. To examine this issue the authors conducted a preliminary study using the inhibition of return (IOR) paradigm, which has been labeled as a fundamental search mechanism. Forty-one drivers aged 55 and over completed two on-road driving evaluations and IOR testing. After accounting for the contribution of age, IOR statistically predicted overall driving evaluation scores (p = .045), and the number of errors in scanning the environment (p = .031). To the authors' knowledge these findings represent the first documentation of a relationship between IOR and driving. The results are informative regarding the importance of reflexive visual attention mechanisms towards safe driving.

Aged↗

Evaluation of a re-training program for older drivers.

BACKGROUND: Some older drivers may have a higher crash risk than others. Because many of these drivers have not received formal driving training, we evaluated the effectiveness of a re-training program for older drivers as it is currently being offered. Specifically, we examined if older drivers who received the training would have better scores on a driving evaluation than drivers who did not receive the training. METHODS: We used a randomized controlled trial. Participants first took part in on-road driving evaluations (possible scores ranged from 0 to 100), after which they were block randomized into training (treatment) or waiting (control) groups based on the driving evaluation results, age, and sex. Individuals in the treatment group attended driver re-training sessions, and were tested once more with the on-road test. Those in the control group completed their second driving evaluation and were then offered the re-training sessions. The second evaluations took place approximately two months after the first evaluations. RESULTS: Sixty-five participants completed two driving evaluations. Despite the overall improvement in driving scores (3.73, SD = 6.87, p = 0.001), we found no statistically significant difference between the control and treatment groups. The mean improvement for the control group was 3.46 (SD=6.72) compared to 4.02 (SD=7.11) for the treatment group (p = 0.747). Drivers' age was related to overall driving scores (r = -0.55, p = 0.001) but not changes between the first and second evaluations (r = 0.01, p = 0.955). INTERPRETATION: Although we have not demonstrated a statistically significant impact of the intervention, the overall increase suggests that an initial driving evaluation may underestimate the actual driving ability of many older drivers. Furthermore, although older drivers may have lower driving scores initially, they have the ability to improve on these scores. These findings should encourage us to explore diverse approaches to improve driving safety.

Accident Prevention↗