[Benzodiazepine dependence and the risk of depression and anxiety disorders: seniors' health study]. / La dépendance aux benzodiazépines et le risque de troubles anxieux et de dépression : étude sur la santé des aînés.

AIM OF THE STUDY: The objective of this study is to examine the relationship between benzodiazepine dependence and anxiety disorders and depression in people aged 65 years and over. We referred to the data from the study on the health of seniors, a survey of a representative sample of 707 benzodiazepine users living in the community in Quebec, Canada. Benzodiazepine dependence, anxiety disorders and depression were measured using self-reported questionnaires based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth revised edition. RESULTS: Seniors have consumed an average daily dose of 6.1±7.6mg diazepam equivalent to an average of 205±130 days. The prevalence of benzodiazepine dependence has been estimated at 9.5%. This dependence increases the risk of minor depression for females (relative risk [RR]=4.36, confidence interval 95% [95% CI]=1.19 to 15.99). CONCLUSION: The results of this study suggest that the use of benzodiazepines is far from being optimal among seniors in Quebec. The proportion of seniors who develop an addiction is important. The results illustrate the need to develop and implement programs to improve the quality of benzodiazepine use among this population.

Effectively detect dependence on benzodiazepines among community-dwelling seniors by asking only two questions.

Consumption of benzodiazepines (BZDs) is common among seniors. When used over a long period of time, BZDs can induce dependence. The present study aimed to equip nurses with valid screening questions for detecting BZD dependence among seniors, applicable to clinical practice and based on the DSM-IV-TR version. A random sample of 707 BZD users aged 65 years and over was screened for BZD dependence using the DSM-IV-TR criteria for substance dependence. To predict a diagnosis of BZDs dependence, sensitivity and specificity were computed for each pair of items. Results showed that an affirmative answer to 'Have you try to stop taking this medication?' and 'Over the past 12 months, have you noticed any decrease in the effect of this medication?' led to a sensitivity of 97.1% and a specificity of 94.9% to detect BZD dependence. Asking these two simple questions can be easily integrated into clinical practice and have considerable potential for identifying cases of BZD dependence.

Symptoms of psychological distress among older adults in Canadian long-term care centres.

Psychological distress can lead to negative consequences affecting the quality of life of older adults living in long-term care centres. The goal of this study was to determine the prevalence of symptoms of psychological distress and their associated factors among these residents. A cross-sectional descriptive study was conducted among 1999 long-term care residents aged 65 and over. Nine hundred and eleven persons (45.6%) displayed at least one symptom of psychological distress either at one time or more in the week preceding data collection, and 22.4% were identified as psychologically distressed. Multivariate analysis indicated that psychological distress was associated with disruptive behaviours and benzodiazepine use among women residents, and with insomnia in men residents. In conclusion, when clinicians screen for mental health disorders, they should take into consideration that symptoms of insomnia or disruptive behaviours may mask psychological distress.

[Psychological well-being and related concepts: a conceptual comparative analysis.]. / Le bien-être psychologique et ses concepts cousins, une analyse conceptuelle comparative.

The concept of psychological well-being acquired more importance in the field of health over the last decade. Ever since research paid more attention to "quality of life", psychological well-being became popular. The increasing interest in this concept entailed the development of many scales of measure. However, less importance has been given to the conceptual development of its construct, thus creating confusion between terms which at first appear similar: psychological well-being, subjective well-being, quality of life, spirit, satisfaction in life, happiness and mental health. The objective of this literature review (n:57) was to conduct a conceptual and comparative analysis (Morse et al., 1996) of psychological well-being with competitive concepts according to a comtemporary approach of analysis. Results show that these concepts are distinct and should not be used in an interchangeable way. They are distinct on various levels: type of measure (objective/subjective), type of evaluation (cognitive and affective), attributes, antecedents, consequences and influence of time (temporary/stable). Results of this review brings new light at the conceptual level for several terms. Graphic 1 illustrates its various positions thus favoring a better use of these terms in research.

[The challenge of interdisciplinarity]. / L'interdisciplinarité, un défi à relever.

The restructuring of health services and the shift to ambulatory care has resulted in several institutions considering the adoption of program management. This approach intensifies interdisciplinary team work, the latest care delivery method for various services. But what exactly is an interdisciplinary team? And what is the nurse's role within that team? These two questions are often asked in the literature, as well as in practice. The answers to these questions are still confusing. The inability of the nursing profession to define itself clearly in comparison with other health care professionals has negative consequences. This article presents a vision of interdisciplinarity as a means for nurses to define themselves within an interdisciplinary team.

[Pills are my responsibility]. / Les pilules sont ma responsabilité.

As major users of medications, senior citizens are often in the position of having to manage a large number of these products. Health professionals recognize the extent of this problem and are taking steps to promote the safe use of drugs. In spite of this, seniors are still playing a passive role that disregards the predictive factors for drug use. With seniors' co-operation, an innovative community project was developed to increase their knowledge and influence the predictive factors for drug use. A group of eight elderly women took part in four meetings to produce a preventive pamphlet for seniors. First, these women gained an awareness of the problem. Then, they decided what information should be included in the pamphlet. Finally, they served as agents for change by handing out pamphlets in their area. Qualitative results show that the project objectives were met; that seniors were actively involved in the entire process. The project raised awareness, forged social relationships, improved participants' sense of self-worth, and fostered a positive view of health. There is every indication that, in future, more seniors should be actively included in any community effort aimed at solving problems that directly concern them.

[Medical treatment of osteoradionecrosis]. / Traitement médical des ostéoradionécroses.

The medical treatment of radiation-induced osteitis is advocated by all, with highly variable practical modalities. In our historical series, we have noted 12 good results out of 48 patients treated. In the light of R. Dambrain's work, we have used a procedure associating two antibiotics to Calcitonin during more than two months, with encouraging results.