Pain, functional disability and mental disorders as potential mediators of the association between chronic physical conditions and suicidal ideation in community living older adults.

OBJECTIVES: To examine the associations between chronic physical conditions and suicidal ideation and to assess whether associations are mediated by pain, anxiety, depression, post-traumatic stress syndrome (PTSS), and functional disability. METHODS: The study sample includes 1533 older adults aged 65+ recruited in primary care clinics between 2011-2013 and participating in Quebec's Health Survey on Services "Étude sur la Santé des Aînés-Services" (ESA-S) study. Path analysis was used to assess the associations. The presence of suicidal behaviour was ascertained using 4 questions. PTSS was based on a validated scale for primary care older adults. Anxiety and depression were assessed according to DSM-IV criteria. Pain was self-reported on an ordinal scale and functional disability was based on the presence of disability in 8 dimensions of activities of daily living. The main predictors included a list of 13 physical disorders identified by diagnostic codes. Suicidal ideation was also controlled by a number of socio-demographic and psychosocial factors. RESULTS: PTSS, depression, and functional disability mediate the association between various chronic conditions and suicidal ideation. Although pain and anxiety are associated with many physical disorders, they did not mediate the association with suicidal ideation. CONCLUSIONS: Chronic physical disorders are associated with suicidal ideation, either directly or indirectly through PTSS, depression, and functional disability. The findings underscore the importance of early identification and management of older patients with specific chronic disorders in primary care as they may be most at risk for suicidal ideation.

Rebound of a coal tar creosote plume following partial source zone treatment with permanganate.

The long-term management of dissolved plumes originating from a coal tar creosote source is a technical challenge. For some sites stabilization of the source may be the best practical solution to decrease the contaminant mass loading to the plume and associated off-site migration. At the bench-scale, the deposition of manganese oxides, a permanganate reaction byproduct, has been shown to cause pore plugging and the formation of a manganese oxide layer adjacent to the non-aqueous phase liquid creosote which reduces post-treatment mass transfer and hence mass loading from the source. The objective of this study was to investigate the potential of partial permanganate treatment to reduce the ability of a coal tar creosote source zone to generate a multi-component plume at the pilot-scale over both the short-term (weeks to months) and the long-term (years) at a site where there is >10 years of comprehensive synoptic plume baseline data available. A series of preliminary bench-scale experiments were conducted to support this pilot-scale investigation. The results from the bench-scale experiments indicated that if sufficient mass removal of the reactive compounds is achieved then the effective solubility, aqueous concentration and rate of mass removal of the more abundant non-reactive coal tar creosote compounds such as biphenyl and dibenzofuran can be increased. Manganese oxide formation and deposition caused an order-of-magnitude decrease in hydraulic conductivity. Approximately 125 kg of permanganate were delivered into the pilot-scale source zone over 35 days, and based on mass balance estimates <10% of the initial reactive coal tar creosote mass in the source zone was oxidized. Mass discharge estimated at a down-gradient fence line indicated >35% reduction for all monitored compounds except for biphenyl, dibenzofuran and fluoranthene 150 days after treatment, which is consistent with the bench-scale experimental results. Pre- and post-treatment soil core data indicated a highly variable and random spatial distribution of mass within the source zone and provided no insight into the mass removed of any of the monitored species. The down-gradient plume was monitored approximately 1, 2 and 4 years following treatment. The data collected at 1 and 2 years post-treatment showed a decrease in mass discharge (10 to 60%) and/or total plume mass (0 to 55%); however, by 4 years post-treatment there was a rebound in both mass discharge and total plume mass for all monitored compounds to pre-treatment values or higher. The variability of the data collected was too large to resolve subtle changes in plume morphology, particularly near the source zone, that would provide insight into the impact of the formation and deposition of manganese oxides that occurred during treatment on mass transfer and/or flow by-passing. Overall, the results from this pilot-scale investigation indicate that there was a significant but short-term (months) reduction of mass emanating from the source zone as a result of permanganate treatment but there was no long-term (years) impact on the ability of this coal tar creosote source zone to generate a multi-component plume.

[Assisted reproductive techniques in women aged 38 years or more]. / Prise en charge en Assistance médicale à la procréation des femmes de 38 ans et plus: résultats d'une enquête à propos de 84 couples.

OBJECTIVE: More and more young women are delaying childbearing until the fourth decade of life: thus, Assisted Reproductive Techniques centres receive more and more requests from ageing women. The aim of the study is to analyse the purpose of these requests, the biological and clinical features of these patients and the results in our infertility centre. PATIENTS AND METHODS: A retrospective study was carried out at the CHU of Saint-Etienne from 01.01.01 to 31.12.04. We analysed the social, clinical and biological features of 84 couples when the woman's age was equal or superior to 38 years, representing 218 cycles. A questionnaire was used to collect social data. RESULTS: Several factors can explain the increasing number of ageing women consulting for infertility: extend university time and professional career, professional stability, contraception and late meeting of the partner, false reassuring information concerning progress in ART, second child desire after a late first pregnancy, but also second marital unions and child desire in the redefined couple. In our study, above 40 years old, the pregnancy (19.4 versus 10.5%) and delivery rates (16.7 versus 5.8%) clearly decreased in IUI. Thus, most of the clinicians propose, in first choice, an IVF cycle to a 40 year-old woman. The ultrasound measurement of antral follicle count can accurately evaluate the prognosis in terms of pregnancy (P<0.01) and delivery rate (P=0.03). For patients with unfavourable prognosis, oocyte donation, embryo donation, or adoption can be considered. DISCUSSION AND CONCLUSION: ART cannot compensate for the natural decrease in pregnancy rates and the increase in early miscarriages in ageing women. Therefore, it is essential to inform young women of the negative effects of age on their potential fertility.

Electrophysiological changes during the sleep onset period of psychophysiological insomniacs, psychiatric insomniacs, and normal sleepers.

The electroencephalograms (EEGs) of the sleep onset period (SOP) of psychophysiogical insomniacs. psychiatric insomniacs, and controls were compared using power spectral analysis. We predicted that psychophysiological insomniacs would show elevated cortical arousal throughout their entry into sleep. Electroencephalograms, electrooculograms (EOGs), and electromyograms (EMGs) were recorded for two consecutive nights. Power spectral analysis of EEG from the sleep onset period was performed on all standard frequency bands. Psychophysiological insomniacs had less alpha during the first part of the SOP and did not show the dramatic drop in alpha across the SOP that characterizes normal sleep. They showed less delta in the last quartile of the chronological analysis of the SOP. Psychiatric insomniacs showed lower relative beta power values overall, while psychophysiological insomniacs showed higher relative beta power values during wakefulness. This microanalysis indicates that the SOP is generally similar for psychiatric insomniacs and normal sleepers but that clear differences in the SOP of psychophysiological insomniacs exist. They have higher cortical arousal during the SOP than do psychiatric insomniacs and controls. The dramatic changes in power values in the latter two groups as sleep begins are not seen in the psychophysiological insomniacs, which may help explain the difficulty that psychophysiological insomniacs have discriminating between wakefulness and sleep.

Body temperature and the return of slow wave activity in extended sleep.

The time courses of slow wave sleep (SWS) and EEG slow wave activity (SWA) were examined in relation to core body temperature (CBT) during extended sleep periods of 15 h. Ten subjects (4 male, 6 female; aged 18-29 years) slept in the laboratory for 3 consecutive nights (2 of 8 h, and the last of 15 h). Bedtime was as close as possible to subjects' habitual bedtimes, but was always between 23.00 h and 1.00 h, and was the same on all nights. Standard polysomnographic measures as well as rectal temperature were collected continuously each night. Using 3 h blocks, SWS and SWA declined with time asleep, then showed a significant increase in the final 3 h. Using a more specific measure with 15 min means, 8 of the 10 subjects showed SWA returns late in sleep, that were not related to preceding amounts of waking after sleep onset (WASO), rapid eye movement sleep (REMS), or WASO+REMS. The timing and magnitude of the SWA return was significantly associated with the phase of CBT as indexed by delay from sleep onset to CBT minimum. The findings are consistent with a 12 h rhythm of SWS and SWA that is related to the phase of the CBT rhythm, with the minor pole of SWS/SWA occurring independently of WASO and/or REMS.

Within-subject comparisons of implant-supported mandibular prostheses: choice of prosthesis.

Although previous studies have demonstrated that implant-supported prostheses are more satisfactory and efficient for edentulous patients than are conventional prostheses, until now no investigation has directly compared different types of implant-supported prostheses. We carried out a within-subject cross-over clinical trial with fixed and long-bar removable implant-supported mandibular prostheses. Fifteen subjects were randomly divided into two groups. One group received the fixed prosthesis first, while the other first received the removable. After a two-month adaptation period, psychometric measurements of various aspects of the prostheses and physiological tests of masticatory efficiency were carried out. The prostheses were then changed, and the procedures repeated. At the end of the study, subjects chose the prosthesis they wished to keep. In this paper, we report on the data gathered at this last appointment. Eight subjects chose the fixed (F group), and seven chose the removable (R group). Both groups rated stability and ability to chew with the fixed as significantly better than with the removable. However, the R group rated ease of cleaning as the most important factor governing their decision, followed by esthetics and stability. The F group considered stability to be the most important factor in their decision, followed by chewing ability and ability to clean. There was a tendency for the removable to be chosen by older subjects (+50 years). These results suggest that patients choose fixed or removable implant-supported prostheses for specific reasons, and that patient attitudes should be considered when the design of a prosthesis is being planned for an individual patient.

Genetic tagging of tumor cells with retrovirus vectors: clonal analysis of tumor growth and metastasis in vivo.

Retrovirus vector infection was used to introduce large numbers of unique genetic markers into tumor cell populations for the purpose of analyzing comparative changes in the clonal composition of metastatic versus that of nonmetastatic tumors during their progressive growth in vivo. The cell lines used were SP1, a nonmetastatic, aneuploid mouse mammary adenocarcinoma, and SP1HU9L, a metastatic variant of SP1. Cells were infected with delta e delta pMoTN, a replication-defective retrovirus vector which possesses the dominant selectable neo gene and crippled long terminal repeats. G418r colonies were obtained at a frequency of 4 x 10(-3). Southern blot analysis of a number of clones provided evidence of random and heritable integration of one or two copies of the proviral DNA. Clonal evolution of primary tumor growth and the nature of lineage relationships among spontaneous metastases and primary tumors were analyzed by subcutaneously injecting 10(5) cells from a pooled mixture of 3.6 x 10(2) G418r SP1HU9L or 10(4) G418r SP1 colonies into syngeneic CBA/J mice. The most striking finding was the relative clonal homogeneity of advanced primary tumors; they invariably consisted of a small number (less than 10) of distinct clones despite the fact that hundreds or thousands of uniquely marked clones had been injected. In the case of the metastatic SP1HU9L cells, the nature of these "dominant" clones varied from one tumor to another. Analysis of a number of lung metastases revealed that a proportion of them were derived from dominant primary tumor clones and were composed of one, and sometimes two, distinct progenitors. In some animals, all the lung metastases were derived from a common progenitor clone, whereas in others, each metastatic nodule had a different progenitor. The results show the following. (i) Retrovirus vector infection can be used to introduce large numbers of unique and stable clonal markers into tumor cell populations. (ii) The progeny of a very limited number of clones dominate in advanced primary tumors. (iii) Mammary carcinoma metastases are of mono- or biclonal origin. The significance of the results is discussed.

An efficient strategy for gene mapping using multipoint linkage analysis: exclusion of the multiple endocrine neoplasia 2A (MEN2A) locus from chromosome 13.

Members of four families in which multiple endocrine neoplasia type 2A (MEN-2A) is segregating were typed for seven DNA markers and one red cell enzyme marker on chromosome 13. Close linkage was excluded between the MEN2A locus and each marker locus tested. By means of multipoint analysis and the genetic map of chromosome 13 developed by Leppert et al., MEN2A was excluded from any position between the most proximal marker locus (D13S6) and the most distal marker locus (D13S3) and from within 12 cMorgans outside these two loci, respectively. However, the support of exclusion within an interval was diminished under the assumption of a substantially larger genetic map in females. The strategy of multipoint analysis, which excluded between 1.5 and 2.0 times more chromosome 13 than did two-point analysis, demonstrates the utility of linkage maps in mapping disease genes.

[Parents of a handicapped child (review of American literature).]. / Les parents d'un enfant handicapé (Revue de la littérature américaine).

The presence of an handicapped child is a cause of major stress in a family and the source of serious upheavals. For the parents, this occurence can promote personal growth or lead to dissatisfaction or an inadaptive process that will influence their life on many levels: personal, conjugal, familial and social. The handicapped child's birth itself affects the parents and triggers many emotions, feelings behaviors and attitudes. The parents find themselves in a complex and irreversible situation to which they have to adapt. They have to organize their life in order to provide favorable conditions for the development of the child while preserving their own and their family's integrity. This article presents the different stages the parents have to go through to achieve a certain peace of mind. It also describes the reactions of the handicapped children's siblings in terms of their feelings and needs and underlines the determining role of the parents towards them. The professionals involved in those situations have to understand the underlying family dynamics. Their objective is to help the parents provide a stimulating environment to the handicapped child while preserving harmony in their family.