Cost effectiveness of newborn screening for cystic fibrosis: a simulation study.

BACKGROUND: Early detection of cystic fibrosis (CF) by newborn screening (NBS) reduces the rate of avoidable complications. NBS protocols vary by jurisdiction and the cost effectiveness of these different protocols is debated. OBJECTIVE: To compare the cost effectiveness of various CF NBS options. METHODS: A Markov model was built to simulate the cost effectiveness of various CF-NBS options for a hypothetical CF-NBS program over a 5-year time horizon assuming its integration into an existing universal NBS program. NBS simulated options were based on a combination of tests between the two commonly used immunoreactive trypsinogen (IRT) cutoffs (96th percentile and 99.5th percentile) as first tier tests, and, as a second tier test, either a second IRT, pancreatic-associated protein (PAP) or CFTR mutation panels. CFTR mutation panels were also considered as an eventual third tier test. Data input parameters used were retrieved from a thorough literature search. Outcomes considered were the direct costs borne by the Quebec public health care system and the number of cases of CF detected through each strategy, including the absence of screening option. RESULTS: IRT-PAP with an IRT cutoff at the 96th percentile is the most favorable option with a ratio of CAD$28,432 per CF case detected. The next most favorable alternative is the IRT1-IRT2 option with an IRT1 cutoff at the 96th percentile. The no-screening option is dominated by all NBS screening protocols considered. Results were robust in sensitivity analyses. CONCLUSION: This study suggests that NBS for cystic fibrosis is a cost-effective strategy compared to the absence of NBS. The IRT-PAP newborn screening algorithm with an IRT cutoff at the 96th percentile is the most cost effective NBS approach for Quebec.

[Determinants of the intention of post-secondary students to eat at least five servings of vegetables and fruit daily]. / Déterminants de l'intention de consommer au moins cinq portions de légumes et de fruits chaque jour chez des jeunes adultes aux études postsecondaires.

BACKGROUND: Vegetable and fruit consumption helps reduce the occurrence of overweight, obesity, and other chronic diseases. However, only 50% of young adults eat at least five servings of these foods daily. Based on the construct of the Theory of planned behaviour of Ajzen (1991) to which other constructs were added (descriptive norm, perceived regularity of the behaviour and past behaviour), this study aims at identifying the determinants in the intention of young adults in postsecondary education institutions to eat at least five servings of vegetables and fruit daily during the next three months. METHODS: A sample of 385 students in two CEGEP (junior college institutions) in the Quebec City area participated in this correlation study on a volunteer basis. While attending class, they completed a self-administered questionnaire. RESULTS: Hierarchical regression analyses showed that perceived behavioural controls and the perceived weight of facilitating factors and barriers to the behaviour, explained 75% of the intention variance. Another 4% was explained when the perceived regularity of the behaviour, the descriptive norm, and past-behaviour, were added to the analysis. Logistic regression analyses show that individuals presenting weak/strong intention can be differentiated among themselves as to the perception of benefits derived from a daily consumption of vegetables and fruit (such as maintaining good health, eating foods that taste good), and as to facilitating factors/barriers that assist or inhibit such consumption (possessing more information on the nutritional value and taste of vegetables and fruit, or disposing of sufficient time to prepare them). CONCLUSION: To our knowledge, this is the first study done in Quebec using a recognized theoretical model to identify the determinants of the intention to eat at least five servings of vegetables and fruit daily in a sample of young adults in postsecondary education institutions. The results may be helpful in designing the contents of interventions aimed at maintaining and increasing daily consumption of vegetables and fruit by young adults.

[Psychosocial determinants of drug users to use a new syringe]. / Déterminants psychosociaux d'utilisateurs de drogues d'utiliser une seringue neuve.

BACKGROUND: A limited number of injection drug users are hard to reach through needle-exchange programs. They obtain their injection material from drug-using peers. This dependence on others can make them more at risk of contracting HIV through sharing non-sterile syringes. The aim of this study is to identify determinants of the intention to systematically resort to use of a new syringe by injection drug users rarely or never involved in needle-exchange programs in Quebec. METHODS: A cross-sectional survey was conducted in Québec city by means of a questionnaire measuring variables from the theory of planned behavior and past behavior. Participants (n=97) were recruited by acquaintances who kept regular contacts with the local needle-exchange programs. Multiple linear regression was used to identify the psychosocial determinants of the intention, and beliefs underlying those determinants were identified using multiple logistic regression. RESULTS: Half of participants reported using a new syringe for each injection in the last month. In multivariate analyses, this past behavior together with theory of planned behavior constructs explained 70% of the variation in participants intent to use a new syringe for each injection (control beliefs: beta=0.39; past behavior: beta=0.27; attitude: beta=0.21; perceived behavioral control: beta=0.20; subjective norm: beta=0.12). In logistic regression, six important beliefs were identified. CONCLUSION: This study resulted in the development of a predictive model of intention to use always a new syringe for each injection among a population of injection drug users in Quebec. Study results could serve as the foundation for the development of interventions to promote this behavior.

Vascular calcifications in homozygote familial hypercholesterolemia.

BACKGROUND: Patients with homozygous familial hypercholesterolemia (hmzFH) attributable to LDL receptor gene mutations have shown a remarkable increase in survival over the last 20 years. Early onset coronary heart disease (CHD) and calcific aortic valve stenosis are the major complications of this disorder. We now report extensive premature calcification of the aorta in patients with hmzFH. METHODS AND RESULTS: We examined 25 hmzFH patients from Canada; mean age was 32 years (range 5 to 54), and mean baseline cholesterol before treatment was 19+/-5 mmol/L (737+/-206 mg/dL). Aortic calcification was quantified using computed tomography (CT). An elevated mean calcium score was found in patients by age 20 and correlated with age (r(2)=0.53, P=0.001). One quarter (24%) of patients underwent aortic valve surgery. CONCLUSIONS: We document premature severe aortic calcifications in all adult hmzFH patients studied. These presented considerable surgical management challenges. Strategies to identify and monitor aortic calcification in hmzFH by noninvasive techniques are required, as are clinical trials to determine whether additional or more intensive therapies will prevent the progression of such calcifications. Whether vascular calcifications in hmzFH subjects are related to sustained increases in LDL-C levels or to other mechanisms, such as abnormal osteoblast activity, remains to be determined.

Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: report of the thirty-person/ten-country panel.

There is abundant evidence that the risk of atherosclerotic vascular disease is directly related to plasma cholesterol levels. Accordingly, all of the national and transnational screening and therapeutic guidelines are based on total or LDL cholesterol. This presumes that cholesterol is the most important lipoprotein-related proatherogenic risk variable. On the contrary, risk appears to be more directly related to the number of circulating atherogenic particles that contact and enter the arterial wall than to the measured concentration of cholesterol in these lipoprotein fractions. Each of the atherogenic lipoprotein particles contains a single molecule of apolipoprotein (apo) B and therefore the concentration of apo B provides a direct measure of the number of circulating atherogenic lipoproteins. Evidence from fundamental, epidemiological and clinical trial studies indicates that apo B is superior to any of the cholesterol indices to recognize those at increased risk of vascular disease and to judge the adequacy of lipid-lowering therapy. On the basis of this evidence, we believe that apo B should be included in all guidelines as an indicator of cardiovascular risk. In addition, the present target adopted by the Canadian guideline groups of an apo B <90 mg dL(-1) in high-risk patients should be reassessed in the light of the new clinical trial results and a new ultra-low target of <80 mg dL(-1) be considered. The evidence also indicates that the apo B/apo A-I ratio is superior to any of the conventional cholesterol ratios in patients without symptomatic vascular disease or diabetes to evaluate the lipoprotein-related risk of vascular disease.

Simulations of spinodal nucleation in systems with elastic interactions.

Systems with long-range interactions quenched into a metastable state near the pseudospinodal exhibit nucleation that is qualitatively different from classical nucleation near the coexistence curve. We observe nucleation droplets in Langevin simulations of a two-dimensional model of martensitic transformations and determine that the structure of the nucleating droplet differs from the stable martensite structure. Our results, together with experimental measurements of the phonon dispersion curve, allow us to predict the nature of the droplet. The results have implications for nucleation in many solid-solid transitions and the structure of the final state.

Factors explaining the intention to give blood among the general population.

BACKGROUND AND OBJECTIVES: The aim of this study was to identify factors explaining the intention to donate blood. MATERIALS AND METHODS: A random sample of 4000 respondents drawn from the general population received a questionnaire by mail. This questionnaire assessed variables as defined by the most prominent social cognitive theories. RESULTS: Overall, the respondents expressed a neutral mean level of intention to give blood in the next 6 months (2.84 on a five-point scale); 56.2% had never given blood in the past. The variables explaining 74% of the variance of intention were: perceived behavioural control (beta = 0.39; P < 0.001); factors facilitating taking action (beta = 0.25; P < 0.001); anticipated regret (beta = 0.16; P < 0.001); moral norm (beta = 0.11; P < 0.001); attitude (beta = 0.08; P < 0.01); level of education (beta = -0.03; P < 0.05); and past experience in giving blood (beta = 0.09; P < 0.001). Nonetheless, the predictive power of perceived behavioural control and moral norm was higher among the ever donors (both at P < 0.01) compared to the never donors, whereas the reverse was observed for attitude (P < 0.05). CONCLUSIONS: People's intentions are mainly determined by perceived barriers and obstacles regarding blood donations. This suggests that promotional strategies should focus on the elimination of barriers to action as well as the development of a higher perception of control. Also, messages should be adapted to the targeted population, based on their previous blood donation behaviour (i.e. never donors vs. ever donors).

Concussions among university football and soccer players: a pilot study.

OBJECTIVE: A pilot study to examine the incidence and characteristics of concussions for one season of university football and soccer. DESIGN: Retrospective survey. PARTICIPANTS: 60 football and 70 soccer players reporting to 1998 fall training camp. Of these, 44 football and 52 soccer players returned a completed questionnaire. MAIN OUTCOME MEASURES: Based on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous season, the duration of symptoms, the time for return to play and any associated risk factors for concussions. RESULTS: Of all the athletes who returned completed questionnaires, 34.1% of the football players and 46.2% of the soccer players had experienced symptoms of a concussion during the previous season. Only 16.7% of the concussed football players and 29.2% of the concussed soccer players realized they had suffered a concussion. All of the concussed football players and 75.0% of the concussed soccer players experienced more than one concussion during the season. The symptoms from the concussion lasted for at least 1 day in 28.6% of the football players and 18.1% of the soccer players. Variables that increased the odds of suffering a concussion during the previous season for football and soccer players included a past history of a recognized concussion. CONCLUSION: More university soccer players than football players may be experiencing sport related concussions. Variables that seem to increase the odds of suffering a concussion during the previous season for football and soccer players include a history of a recognized concussion. Despite being relatively common, many players may not recognize the symptoms of a concussion.

Relation and lexical priming during the interpretation of noun-noun combinations.

This research indicates that recent exposure to a similar combination (e.g., oil moisturizer or surgery treatment) influences the processing of a subsequent combination (e.g., oil treatment) by increasing the availability of the lexical entries for the modifier and head noun, and by altering the availability of the relation used to link the two nouns. The amount of lexical and relational priming obtained depends on whether the modifier or head noun is in common between the prime and target. The head noun prime yields more lexical priming than does the modifier prime and this finding suggests that the head noun is more strongly activated than the modifier. In contrast, relation priming is obtained only from the modifier prime and this finding is consistent with the CARIN theory (C. L. Gagné & E. J. Shoben, 1997) but inconsistent with schema-based theories of conceptual combination (e.g., G. L. Murphy, 1988; E. J. Wisniewski, 1996).

[Concomitant treatment of psychosis and drug addiction.]. / Traitement concomitant de la psychose et de la toxicomanie.

The high prevalence of addiction problems of people with psychosis and the lack of resources to respond to their complex reality has lead a multidisciplinary team at the Centre de santé mentale communautaire (CSMC) to establish a group allowing interventions on drug addiction and psychosis in a concomitant way. Following a brief presentation of problems and intervention models proposed in the literature, this article aims at summarizing the experience of the CSMC and their strategy in order to respond to the needs of these patients. Thus, this article presents the reasons for modifications made over the years, the relevance of the motivational approach with these patients who are often unmotivated in changing their behaviour regarding substance abuse and the strengths and limits of this approach. The objectives of the therapeutic group, the framework, content and clientele are then discussed. Finally the authors examine various perspectives.