Stress in Parents of Children With Genetically Determined Leukoencephalopathies: A Pilot Study.

Genetically determined leukoencephalopathies comprise a group of rare inherited white matter disorders. The majority are progressive diseases resulting in early death. We performed a cross-sectional pilot study including 55 parents from 36 families to assess the level of stress experienced by parents of patients with genetically determined leukoencephalopathies, aged 1 month to 12 years. Thirty-four mothers and 21 fathers completed the Parenting Stress Index-4th Edition. One demographic questionnaire was completed per family. Detailed clinical data was gathered on all patients. Statistical analysis was performed with total stress percentile score as the primary outcome. Mothers and fathers had significantly higher stress levels compared with the normative sample; 20% of parents had high levels of stress whereas 11% had clinically significant levels of stress. Mothers and fathers had comparable total stress percentile scores. We identified pediatric behavioral difficulties and gross motor function to be factors influencing stress in mothers. Our study is the first to examine parental stress in this population and highlights the need for parental support early in the disease course. In this pilot study, we demonstrated that using the Parenting Stress Index-4th Edition to assess stress levels in parents of patients with genetically determined leukoencephalopathies is feasible, leads to valuable and actionable results, and should be used in larger, prospective studies.

A genetic algorithm for designing distributed computer network topologies.

The topological design of distributed packet switched networks consists of finding a topology that minimizes the communication costs by taking into account a certain number of constraints such as the delay and the reliability. This paper proposes a genetic algorithm (GA) for generating low-cost feasible computer network topologies subject to these constraints. The implementation of this algorithm has been subjected to extensive tests in order to measure the quality of solutions. Computational results confirm the efficiency of the GA to provide good solutions for medium-sized computer networks, in comparison with well-tried conventional methods.

[Adequacy of health care services for young immigrant families]. / Adéquation des services de santé aux jeunes familles immigrantes.

This article relates the results of descriptive exploratory research conducted through interviews with 297 young immigrant families and 40 health and social workers on the primary health problems encountered by the families and on how they resolved these problems. Families and workers rank problems in different orders of priority. While families give priority to the health problems of their children, workers give priority to the problems encountered by the mothers, and in particular, mental health problems. Families and workers alike express a desire for help from the health and social service system for these problems. For families, this help would come from family doctors and nurses. These health providers are subsequently consulted; when they are not, language is determined to be the main obstacle to accessibility. Difficulties related to cultural compatibility of services are seen as more numerous by workers than by families.

Consent: radiologists' dilemma about contrast media.

In February 1990 the Conseil d'évaluation des technologies de la santé du Québec released a report advocating the use of high-osmolar contrast media for "low-risk" patients. The authors of the report justified not mentioning to these patients, in the course of obtaining informed consent for examinations requiring intravascular contrast media, that there are two classes of contrast agent. Furthermore, they advocated concealing this policy from the public. In contrast, the authors of this article suggest that informed consent is the product of a dialogue between the consenting person (the patient) and the one requesting consent (the radiologist). Such a dialogue can exist only if the doctor gives the patient sufficient information so that the two are at the same level of understanding; the patient can then make an informed decision. These discussions are held in the name of equity. Three criteria that can be used to test for ethical equity--impartiality, reciprocity and "examplarity"--are discussed. The authors of this paper argue that a policy limiting access to low-osmolar contrast media is justifiable. However, concealing from the patient and the public the existence of a choice of contrast media is considered ethically indefensible.

[Problematic situations of intercultural misunderstanding in social services]. / Situations d'incompréhensions interculturelles dans les services sociaux: problématique.

This article discusses research on the difficulties of practising social work in a multicultural and multiethnic context. The research is based on critical incidents that were experienced by 40 social workers in "the most ethnic" public social service centres of the Montréal region in 1990-1992. The most significant culture shocks that occurred between workers of a developed Western-type society and clients from developing, non-Western societies relate to a different notion of the role of social services, to different methods et educating children, to unequal relationship between men and women, to a different notion of family and to a different notion of physical and mental health. The authors emphasize that a better understanding of these shocks and an effort to identify and analyze these sensitive zones of intercultural encounter can have a definite impact on the practice and training of social workers.

The LPN-ADN articulation project.

Faced with a staffing situation where RN positions were needed but there were more LPN positions than were needed. Tucson Medical Center began an LPN-ADN articulation project to rectify the situation without resorting to layoffs. With the cooperation of a local junior college, LPNs are enrolled in ADN programs that provide a more flexible work/study situation. This article describes the program and the results thus far.

[The radical psychiatry trend and intervention with women (a Californian experience).]. / Le courant de psychiatrie radicale et l'intervention auprès des femmes (une expérience californienne).

It was in the wake of the movement for a critical psychiatry, originated by Eric Berne, that the Radical psychiatry collective developed in Berkely California at the beginning of the 70's. Starting with an analysis of the dominant therapeutic intervention, which was seen alienating, and its resultant, an oppression of which the individual is unaware, the Collective teaches a new practice represented by the following equation : consciousness of one's oppression + contact with other in the same situation + action = liberation. This equation is intended to reply to the preceeding formula : oppression + unawareness of one's oppression + isolation = alienation. Utilizing the personality composant concepts elaborated in transactional analysis, that is the ego state : the Parent, the Adult, and the Child, the Collective shows that certain aspects of social Males, learned through socialization, are unequally and differently developed in men and women. Consequently, a harmonious meeting of man and woman is impossible. To resolve these difficulties, the Collective runs mixed therapeutic help, and women's groups. The latter, developed primarily by Hogie Wyckoff, take into consideration the specific oppression of women and help them to work on those qualities wich are insufficiently developed or undervalued by an inequitable capitalist society. The thrust of radical psychiatry associates the fundamental characteristics of capitalist society, principally human relation, and the problems of everyday individual experience. It also demonstrates the logical ordeming of social males - limiting and unsatisfactory by functional -in such a society. The approach is highly interesting in relation to therapeutic practice with women in general, and more specifically, with social and health service clients. Nevertheless, the approach should not be limited to the sole consideration of the concrete and interactional factors involved in the relation between an intervener from the educated middle class and a client from a popular milieu, often deprived at many levels. The repercussions of class differences on a supposedly equal relationship are still unknown, since radical psychiatry interveners works principally with a middle class clientele. This gap constitutes the principal limit of the observed approach, a limit which should be more thoroughly investigated and analysed.