Met and unmet needs of homeless individuals at different stages of housing reintegration: A mixed-method investigation.

This study aimed to identify and compare major areas of met and unmet needs reported by 455 homeless or recently housed individuals recruited from emergency shelters, temporary housing, and permanent housing in Quebec (Canada). Mixed methods, guided by the Maslow framework, were used. Basic needs were the strongest needs category identified, followed by health and social services (an emergent category), and safety; very few participants expressed needs in the higher-order categories of love and belonging, self-esteem, and self-actualization. The only significant differences between the three housing groups occurred in basic needs met, which favored permanent housing residents. Safety was the only category where individuals reported more unmet than met needs. The study results suggested that increased overall access to and continuity of care with family physicians, MD or SUD clinicians and community organizations for social integration should be provided to help better these individuals. Case management, stigma prevention, supported employment programs, peer support and day centers should particularly be more widely implemented as interventions that may promote a higher incidence of met needs in specific needs categories.

Speaking Out and Being Heard Residents' Committees in Quebec's Residential Long-Term Care Centre.

Residents' councils in Quebec's residential and long-term care centres have the mandate to promote the improvement of living conditions for residents, to assess their level of satisfaction, and to defend their rights. Based on two studies on the autonomy of councils, we examined how committees can express themselves on topics other than those the management is already aware of, to reveal various previously unknown aspects of the services, and to voice unexpressed concerns. We are especially interested in what makes management receptive, or not, to what the committee members say. The councils' ability to express them selves is, in fact, inseparable from its capacity to listen to the management teams, and we seek to determine the conditions required to perform this dual capacity.

[Public Participation and Mental Health: the contrasted and unfinished response of mental health users]. / Participation publique et santé mentale : la réponse contrastée et inachevée des utilisateurs de services.

OBJECTIVES: The objective of this article is show the way that mental health users in Quebec responded to the last Mental Health Action Plan Directive (2005-2010): the strength of the links which were labelled as follows: 'The MSSS, The Health and Social Service Agencies, as well as the Centers of Health and Service Agencies must be sure to obtain the participation of mental health users (and those close to them), in all mental health and planning organizational services.' (MSSS, 2005: p.16) METHOD: The results presented in this article are based on the qualitative exploratory study conducted in the 11 regions of Quebec. In total 35 persons participated in the study, 13 service users, 11 persons coming from institutional environments (interveners and administrators) and 11 key players. RESULTS: The PASM's directive gave rise to a major mobilization of service users who drew up social groupings to engage in the participation activities. As well, it has permitted a generalization and regionalization of participation activities. However, the imprecision regarding the organization of the participants relative to the means required to implement the long-awaited results, has given rise to multiple interpretations, and therefore, to uneven results according to the regions, including the interior of the main region. CONCLUSIONS: The participation of service users will remain a principle whose effects will be contingent, as long as the ministerial willingness will not be accompanied by precise targets to reach, a planned process of rendering of accounts and adequate financing.

La participation des personnes utilisatrices aux exercices de planification et d'organisation des services de santé mentale au Québec / Participação dos usuários no planejamento e organização dos serviços de saúde mental no Quebec

Cet article documente la manière dont s'est renouvelé et s'est transformé au fil du temps le projet de faire participer les usagers aux exercices de planification et d'organisation des services de santé mentale au Québec (Canada). Pour ce faire, les auteurs reviennent sur l'ensemble des documents ministériels qui ont traité de cette question et dégage, pour les principaux moment-clés, les principales modalités de participation des usagers.

Este artigo documenta a forma como se renovou e se transformou, ao longo do tempo, o projeto de participação dos usuários no planejamento e organização dos serviços de Saúde Mental no Quebec (Canadá). Para isso, os autores reavaliaram todo o conjunto de documentos ministeriais que trataram desta questão e retiraram, para os momentos-chaves, as principais modalidades de participação dos usuários.

Gender relations and risks of HIV transmission in South India: the discourse of female sex workers' clients.

In South India, where the majority of the country's cases of HIV are concentrated, transmission of infection occurs mainly within networks composed of female sex workers, their clients and the other sexual partners of the latter. This study aims to determine how gender relations affect the risks of HIV transmission in this region. Semi-structured interviews were carried out with 30 clients and analysed qualitatively. Results show that clients perceive sexual relations with female sex workers as a vice involving loss of control and contact with women at the bottom of the social ladder. Paradoxically, this sometimes allows them to conform to the masculine ideal, in giving sexual satisfaction to a woman, in a context of incompatibility between the idealised and actual masculine and feminine archetypes. Attitudes to condoms, affected by various facets of the client-female sex worker relationship, are indicators of the link between this relationship and the risks of contracting HIV. The results suggest that there is a need for expanding targeted HIV prevention towards clients and female sex workers alongside more general interventions on gender issues, particularly among young people, focusing on the structural elements moulding current relations between men and women, with particular consideration of local cultural characteristics.

[Progress and living situations among the elderly with severe mental illness: perspectives of psychosocial services]. / Cheminements et situations de vie des personnes âgées présentant des troubles mentaux graves : perspectives d'intervenants psychosociaux.

Services for elders with severe mental illness (SMI) have major deficiencies, among them a lack of adequate psychosocial services. Some analysts have attributed this situation to "double stigmatization" targeting both ageing and mental illness in our societies. Using qualitative methods (23 semi-directed interviews, theme-based content analysis), our exploratory research aims to understand better the perceptions of psychosocial practitioners working in community and institutional settings about the elderly with SMI and their living situations. Our informants evoke living situations marked by a lack of support (isolation), of resources (financial precariousness/poverty) and of power (learned passivity), traits that are related not only to mental illness per se, but also to long term psychiatric institutionalization. For them, the current situation of elders with SMI is the end product of biographies in which life-course, illness-course and life in services and/or institutions join and, sometimes, become indistinguishable. Implications for psychosocial practices are discussed.

[A reflection on services to families in which the mother suffers from a mental disorder]. / Réflexion sur les services aux familles dont la mère souffre d'un trouble de santé mentale (TSM).

This article presents results of a research conducted in Québec City between 2004 and 2006. The objective of this study was to examine services to families in which the mother suffers from a mental disorder. The authors examine the experiences and perspectives of parents with a mental disorder, spouses and children on the services offered to families ; the study also examines the organisation, the basis and the context of actions and interactions between stakeholders of various sectors of services to families with a parent with severe mental illness. The authors conclude that despite Quebec's good intentions, members of families in which the mother suffers from a mental disorder do not benefit from a truly comprehensive family-focused approach.

Transient asynchronous testicular growth in adolescent males with a varicocele.

PURPOSE: We assessed the testicular growth of adolescent males followed nonsurgically for the presence of left varicocele. MATERIALS AND METHODS: We retrospectively reviewed the charts of adolescent males with a diagnosis of unilateral left varicocele and ultrasound testis volume measurements seen during a 10-year period. A total of 161 boys underwent at least 2 testicular ultrasounds as part of the evaluation for left varicocele. Patients were excluded from study for a history of inguinal/scrotal pathology or endocrinopathy that could affect testicular size. Sonographic testicular volume was calculated using the Lambert volume (length x width x height x 0.71). The resulting volumes were compared to previously published criteria for surgical repair (15%, 20% and 2 cc size differentials). RESULTS: Of the 71 boys with 3 followup ultrasounds 38 (54%) initially had a 15% or greater volume differential. After nonsurgical followup with ultrasounds for 2 years 60 boys (85%) had testicular volume differentials in the normal range (less than 15%). Of the patients 71% were spared potential surgery by size criteria and 50% were spared surgery by the same 15% volume differential criteria. CONCLUSIONS: Adolescent males with unilateral left varicocele often demonstrate asynchronous testicular growth that usually equalizes in time. Therefore, sonographic testicular size measurement at a single point during adolescence is insufficient to determine the need for varicocelectomy. When contemplating varicocelectomy we recommend at least 2, and preferably 3, testicular volume measurements 1 year apart to establish accurately decreased left testicular volume compared to a normal right testis.

Effect of the luteinizing hormone on embryo production in superovulated rabbit does.

For most domestic animals, the responses to superovulation treatments are not controlled as a consequence of the lack of knowledge on exogenous gonadotrophins effects on the ovarian function. The role of luteinizing hormone (LH) on the number and quality of embryos produced was evaluated on rabbit does superovulated with porcine FSH (pFSH). Parameters of embryos recovery, in vitro and in vivo embryo development rates after freezing/thawing were compared. We used three experimental groups: (1) control group without superovulation treatment, (2) "pFSH+pLH" and (3) "pFSH" groups where females were treated with pFSH, respectively, with (20%) or without (0%) porcine LH supplementation. The number of corpora lutea and the number of embryos produced were significantly higher (p<0.001) in superovulated does than in control group (27.1, 26.7 versus 11.9 corpora lutea and 20.3, 21.2 versus 9.6 embryos produced for pFSH+pLH, pFSH and control group, respectively). However, both gonadotrophins administrations (groups 2 and 3) led to defaults of ovulation when compared with untreated does. No significant difference was observed between the number and quality of the embryos produced by does treated with pFSH+pLH or with pFSH alone. Moreover, we observed no significant difference between results of in vivo and in vitro viability assays after thawing. We concluded that pFSH alone seems to be sufficient to stimulate the follicles growth and that exogenous pLH administrated has no effect on the quantity and quality of embryos. Further studies are needed to evaluate the hormonal patterns before and after the gonadotrophins injections in the rabbit species.

The Quebec complaint examination system: stakeholder perspectives on the purpose and intake of complaints.

Québec's complaint examination system has devoted considerable effort to supporting dissatisfied users who may wish to register complaints. It is open to question, however, whether this level of effort has, in fact, aided users in filing their complaints, and whether, once filed, the intake and processing of complaints has been rigorous and fair. Has the intake and handling of complaints at least improved? This is the question we shall attempt to answer here by presenting the results of our study concerning the impact of the Complaint Assistance and Support Centers (CAAPs) on the intake of complaints. The results show that the Québec complaint examination system and its Complaint Assistance and Support Centers help make complaints more admissible and ensure that each complaint is examined. However, the system is also hindered by differences and conflicting interpretations among the various stakeholders regarding the legitimacy of complaints, respect for users' rights, and the mission of the system. Although complaint examination systems seek to encourage users to express their points of view, users' voices are still only partly audible.

Semen production in two rabbit lines divergently selected for 63-d body weight.

Thirty-one bucks from two lines divergently selected for 63-d body weight (low, L and high, H) were solicited every week (twice at a 15min interval) during 18 weeks resulting in 482 ejaculates. While differing markedly on adult body weight (L: 4650g versus H: 5925g), both lines had the same testis weight. Libido did not differ between the lines. The proportion of ejaculates suitable for insemination was markedly higher in the L line (66.5% versus 44.2%). Mass motility and the volume of the ejaculates were higher in the L line while the sperm concentration was higher in the H line. Overall, the total number of spermatozoa per ejaculate was similar in both lines but the efficient number of spermatozoa per ejaculate, a synthetic criterion taking into account the ability of the ejaculate for insemination was higher in the L line (229 versus 170x10(6)). The L line had higher values of average path velocity, linearity and curvilinear velocity but a lower value of beat cross frequency. In the L line, both ejaculates had the same concentration, while in the H line, the first ejaculate was more concentrated than the second one. Some male reproductive traits are therefore genetically related to body weight.

Activation of the calcineurin pathway is associated with detrusor decompensation: a potential therapeutic target.

PURPOSE: We hypothesized that the calcineurin pathway mediated some of the complex remodeling process that allows a bladder subjected to partial outlet obstruction to adapt to its new workload. Atrial natriuretic factor mRNA expression served as a marker of calcineurin activation. MATERIALS AND METHODS: A total of 16 New Zealand White rabbits underwent surgical creation of partial outlet obstruction, followed by randomization to receive cyclosporin A (20 mg/kg intramuscularly twice daily) or no additional treatment for 14 days. Three animals underwent 2 weeks of partial bladder outlet obstruction followed by bladder biopsy and the reversal of obstruction. RESULTS: Atrial natriuretic factor expression was seen only in bladders with severe hypertrophy and it disappeared with the reversal of outlet obstruction. Cyclosporin A treatment resulted in a decrease in atrial natriuretic factor mRNA expression (p <0.05) and a marked shift in myosin heavy chain A-to-B ratios toward normal (p <0.01) and an increase in smooth muscle cross sectional area (p <0.05). Bladder mass decreased 40% but did not attain statistical significance (p = 0.08). CONCLUSIONS: The calcineurin pathway has a significant role in bladder wall hypertrophy following partial outlet obstruction. Bladder hypertrophy could not be fully prevented by cyclosporin A, suggesting that multiple signaling pathways are involved in this pathophysiology. The expression of myosin heavy chain AB isoforms is regulated in part by the calcineurin pathway.

Effect of different number of frozen spermatozoa inseminated on the reproductive performance of rabbit does.

The relationship between the number of frozen spermatozoa inseminated and fertility rate and litter size at birth in rabbit does was investigated. Six hundred artificial inseminations (AI) were performed on multiparous lactating does with three spermatozoa concentrations: 10, 25, 50x10(6)spermatozoa/AI. All the does were synchronized with 20 UI of eCG 2 days before AI. The estimated sexual receptivity was 87%. The freezing-thawing procedure strongly reduced kinetic and functional traits (acrosome integrity, capacitation) of the spermatozoa. The number of spermatozoa inseminated did not affect the reproductive performance: the mean fertility rate and litter size values were 51.5% and 7.6%, respectively. Sexually receptive does (n=522) inseminated with frozen spermatozoa showed a 58.0% fertility rate whereas, non-receptive does (n=78), had a very poor fertility rate (7.8%).

Partial bladder outlet obstruction alters Ca2+ sensitivity of force, but not of MLC phosphorylation, in bladder smooth muscle.

Partial bladder outlet obstruction in the rabbit produces changes in bladder function similar to those seen clinically in patients with obstructive uropathies. Whole organ function is significantly altered, as are the smooth muscle cells inside the bladder wall. This study was designed to determine whether outlet obstruction alters smooth muscle function at the level of contractile filaments. Rabbit bladders were partially obstructed for 2 wk. Triton X-100 was used to provide a detergent-skinned bladder smooth muscle preparation that would allow control of the intracellular environment while the ability to shorten and develop force is maintained. Ca2+-force and Ca2+-myosin light chain (MLC) phosphorylation relations and maximal velocity of shortening were determined. The Ca2+ sensitivity of force was significantly lower in tissues from animals subjected to outlet obstruction compared with tissues from control animals. In contrast, no difference was noted in the Ca2+ sensitivity of MLC phosphorylation. Maximal levels of stress and MLC phosphorylation were similar in both animal groups. Maximal velocity of shortening was significantly slower in tissues from outlet-obstructed animals at all Ca2+ concentrations compared with tissues from control animals. Ultrastructurally, detergent skinning had little effect on structural integrity. Moreover, tissues from obstructed animals showed an increase in the number of sarcolemmal attachment plaque structures. We suggest that partial bladder outlet obstruction produces deleterious (e.g., decrease in Ca2+ sensitivity of force) and compensatory (e.g., increase in membrane attachment plaques) changes in bladder smooth muscle cells.

The relationship between rabbit semen characteristics and reproductive performance after artificial insemination.

The relationships between several rabbit buck semen traits, concerning either the ejaculate or the dose inseminated (volume, mass motility, pH, percentage of motile sperm (PMS), concentration, number of total and motile sperm per ejaculate and per insemination dose) and the reproductive performance of does was investigated in 839 inseminations involving 54 bucks and 111 does. Four genetic types were involved: INRA1601 strain (A), INRA2066 strain (B) and the two reciprocal crossbreds (AB and BA). The mating design was A x A, B x B, (AB or BA) x (AB or BA). Semen was diluted (1:9) and a constant volume of 0.5 ml was inseminated 2-4h after collection. Therefore, the total number of spermatozoa per dose was variable and proportional to the initial concentration. Mass motility significantly influenced the kindling rate. Taken separately, volume, PMS and concentration did not influence the kindling rate but their product, the number of motile sperm per ejaculate, did. Litter size (total born) was significantly influenced by concentration and all variables depending on it, particularly the number of total and motile sperm per dose. However, reproductive performances were predominantly influenced by the physiological status of the does at insemination (lactation stage and receptivity).

[Continuity of care: a solution? Perspective of people with dual disorders.]. / La continuité des soins : une solution? Perspective des personnes avec comorbidité

The authors discuss the current limits of the concept of continuity of care and the difficulties set by its determination from the perspective of the consumer. Obvious facts around this concept are also questionned. This reflection is anchored in preliminary results of an ongoing study on continuity of care with people with a dual diagnosis of mental disorder and substance abuse.