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Purpose: Cross-language studies suggest more similarities than differences in how dysarthria affects the speech of people with Parkinson's disease (PwPD) who speak different languages. In this study, we aimed to identify the relative contribution of acoustic variables to distinguish PwPD from controls who spoke varieties of two Romance languages, French and Portuguese., Method: This bi-national, cross-sectional, and case-controlled study included 129 PwPD and 124 healthy controls who spoke French or Portuguese. All participants underwent the same clinical examinations, voice/speech recordings, and self-assessment questionnaires. PwPD were evaluated off and on optimal medication. Inferential analyses included Disease (controls vs. PwPD) and Language (French vs. Portuguese) as factors, and random decision forest algorithms identified relevant acoustic variables able to distinguish participants: (a) by language (French vs. Portuguese) and (b) by clinical status (PwPD on and off medication vs. controls)., Results: French-speaking and Portuguese-speaking individuals were distinguished from each other with over 90% accuracy by five acoustic variables (the mean fundamental frequency and the shimmer of the sustained vowel /a/ production, the oral diadochokinesis performance index, the relative sound level pressure and the relative sound pressure level standard deviation of the text reading). A distinct set of parameters discriminated between controls and PwPD: for men, maximum phonation time and the oral diadochokinesis speech proportion were the most significant variables; for women, variables calculated from the oral diadochokinesis were the most discriminative., Conclusions: Acoustic variables related to phonation and voice quality distinguished between speakers of the two languages. Variables related to pneumophonic coordination and articulation rate were the more effective in distinguishing PwPD from controls. Thus, our research findings support that respiration and diadochokinesis tasks appear to be the most appropriate to pinpoint signs of dysarthria, which are largely homogeneous and language-universal. In contrast, identifying language-specific variables with the speech tasks and acoustic variables studied was less conclusive.

Background: ETAP-1 was created to evaluate the quality of services trajectory from families' perspective. The items of ETAP-1 were developed from previous studies on integrated care, existing quality assessments, and consultations with families and experts in evaluation and in autism spectrum disorder (ASD)., Method: The questionnaire was completed by 200 parents of children aged 5 and under who were recently diagnosed with ASD or intellectual disability. Of these, 183 received diagnostic evaluation through a clinic specialized in ASD; the other 17 underwent diagnostic evaluation in hospital settings., Results: Factor analysis supported the a priori dimensions of quality and distinctions between experiences before and during diagnostic evaluation. The instrument had high internal consistency, convergent and discriminant validity with other measures and was sensitive to differences in service delivery models., Discussion: ETAP-1 is useful in organizing information on families' experiences throughout their services trajectories and according to a dynamic perspective., (© 2020 John Wiley & Sons Ltd.)

Knowledge of how animal species use food resources available in the environment can increase our understanding of many ecological processes. However, obtaining this information using traditional methods is difficult for species feeding on a large variety of food items in highly diverse environments. We amplified the DNA of plants for 306 scat and 40 soil samples, and applied an environmental DNA metabarcoding approach to investigate food preferences, degree of diet specialization and diet overlap of seven herbivore rodent species of the genus Ctenomys distributed in southern and midwestern Brazil. The metabarcoding approach revealed that these species consume more than 60% of the plant families recovered in soil samples, indicating generalist feeding habits of ctenomyids. The family Poaceae was the most common food resource retrieved in scats of all species as well in soil samples. Niche overlap analysis indicated high overlap in the plant families and molecular operational taxonomic units consumed, mainly among the southern species. Interspecific differences in diet composition were influenced, among other factors, by the availability of resources in the environment. In addition, our results provide support for the hypothesis that the allopatric distributions of ctenomyids allow them to exploit the same range of resources when available, possibly because of the absence of interspecific competition., (© 2020 John Wiley & Sons Ltd.)

The present study investigated family quality of life (FQOL) as experienced by 493 mothers and fathers (295 families) of young children with autism spectrum disorder (ASD) prior to receiving early intervention services in the province of Québec. These families were most satisfied with their physical and material well-being and least satisfied with their family interactions. Children's level of functioning across various standardized and subjective measures were positively associated with parents' FQOL. In both parents, family characteristics associated with financial and personal resources were also linked to FQOL. The child's age and the number of children were associated with mothers' FQOL. Overall, these findings provide a portrait of ASD-related stressors and resources relevant to both parents during the early childhood period.

The effectiveness of early intensive behavioral intervention (EIBI) for children with autism spectrum disorders (ASDs) has been demonstrated by many studies and meta-analyses. Although it is considered an exemplary practice in several countries, few studies have investigated the maintenance of gains made in EIBI over time. Thirty-two children were assessed at posttreatment and 1-year follow-up after they attended a low-to-moderate-intensity (10 to 20 hr per week) EIBI program delivered by a public rehabilitation center. Between baseline and posttreatment, children showed significant gains in most areas of intellectual functioning and a significant decrease of autism symptom severity, but no change in adaptive behavior. Gains in intellectual functioning were maintained over a 1-year period after treatment termination, but autism symptom severity had increased to approximately pretreatment levels during that interval. Considerable individual variability was noted in the evolution of outcomes.

Background: Avoidance of antigenic stimuli was found to significantly reverse airway obstruction of horses with severe equine asthma (sEA). To date, no published study investigated the influence of steaming hay on lower airway condition of sEA-affected horses. The objectives were to determine the clinical, cytological and cytokine respiratory responses of both sEA and control (CTL) horses experimentally exposed to steamed or dry hay., Results: A cohort of 6 sEA horses and 6 CTL horses was involved in this field study. On day 0, both groups were fed with steamed hay for 5 consecutive days, followed by a wash-out period of 26 days prior to be fed with dry hay for 5 consecutive days. Investigations performed 2 days prior to and 5 days after each challenge included clinical score, tracheal mucus accumulation, and bronchoalveolar lavage fluid (BALF) cytology and cytokine mRNA expression. Feeding steamed hay significantly decreased its mould content (P < 0.001). Mucus score significantly increased when feeding dry hay (P = 0.01). No significant influence of challenge type was found on clinical score. Percentages of neutrophils (P < 0.001) as well as mRNA expression of IL-1β (P = 0.024), IL-6R (P = 0.021), IL-18 (P = 0.009) and IL-23 (P = 0.036) in BALF of sEA affected horses were significantly increased after both (steamed and dry hay) challenges. Relative mRNA expression of IL-1β, IL-6R and IL-23 in BALF were also significantly correlated to neutrophil percentages and both clinical and tracheal mucus score., Conclusions: Steaming significantly decreased mould content but inconsistently influenced the respiratory response of sEA affected horses when fed hay. Based on BALF cytology and cytokine profiles, its relevance might be controversial as a non-medicinal therapy for sEA-affected horses.

This report describes a rare case of gastric impaction caused by a trichophytobezoar in a foal. This case highlights the difficulty in diagnosing this condition and reports surgical removal via a gastrotomy after failure of medical treatment.

The Beach Center Family Quality of Life Scale (Beach Center FQOL) is used to evaluate and develop family-centered intervention services. However, its use with families of children with autism spectrum disorder (ASD) and in non-English speaking populations requires further investigation. The present study sought to assess the psychometric properties of a French translation of this scale on 452 parents of children aged 5 and under who were recently diagnosed with ASD. The resulting Satisfaction and Importance scales presented excellent internal consistency at the scale level and acceptable internal consistency at the subscale level. Theoretical model positing 5 dimensions of FQOL generally fit the data acceptably. Satisfaction ratings were found to be sensitive to changes and were negatively correlated with parenting stress.

Background: Genome-wide association studies (GWAS) have to date identified 94 genetic variants (single nucleotide polymorphisms (SNPs)) associated with risk of developing breast cancer. A score based on the combined effect of the 94 risk alleles can be calculated to measure the global risk of breast cancer. We aimed to test the hypothesis that the 94-SNP-based risk score is associated with clinico-pathological characteristics, breast cancer subtypes and outcomes in early breast cancer., Methods: A 94-SNP risk score was calculated in 8703 patients in the PHARE and SIGNAL prospective case cohorts. This score is the total number of inherited risk alleles based on 94 selected SNPs. Clinical data and outcomes were prospectively registered. Genotyping was obtained from a GWAS., Results: The median 94-SNP risk score in 8703 patients with early breast cancer was 77.5 (range: 58.1-97.6). The risk score was not associated with usual prognostic and predictive factors (age; tumor, node, metastasis (TNM) status; Scarff-Bloom-Richardson grade; inflammatory features; estrogen receptor status; progesterone receptor status; human epidermal growth factor receptor 2 (HER2) status) and did not correlate with breast cancer subtypes. The 94-SNP risk score did not predict outcomes represented by overall survival or disease-free survival., Conclusions: In a prospective case cohort of 8703 patients, a risk score based on 94 SNPs was not associated with breast cancer characteristics, cancer subtypes, or patients' outcomes. If we hypothesize that prognosis and subtypes of breast cancer are determined by constitutional genetic factors, our results suggest that a score based on breast cancer risk-associated SNPs is not associated with prognosis., Trial Registration: PHARE cohort: NCT00381901 , Sept. 26, 2006 - SIGNAL cohort: INCa RECF1098, Jan. 28, 2009.

Aim: Adjuvant clinical trials in early human epidermal growth factor receptor 2 (HER2)-positive breast cancer have assessed either sequential or concomitant incorporation of trastuzumab with chemotherapy; only the North Central Cancer Treatment Group (NCCTG)-N9831 trial prospectively compared both modalities. In routine trastuzumab has been incorporated into a concurrent regimen with taxane chemotherapy instead of sequential modality on the basis of a positive risk-benefit ratio. This present study assessed sequential versus concomitant administration of adjuvant trastuzumab., Methods: A population combining patients from Protocol for Herceptin ® as Adjuvant therapy with Reduced Exposure (PHARE) a randomised phase III clinical trial (NCT00381901) and SIGNAL (RECF1098) a prospective study specifically designed for Genome-wide Association Studies (GWAS) analyses was studied. In this cohort with 58 months of median follow-up, the comparison in the HER2-positive group of adjuvant trastuzumab and chemotherapy modalities was based on a propensity score methodology. Treatment modalities were based on physician's choice and comparisons adjustment were made by a propensity score methodology. Overall Survival (OS) and Disease-Free Survival (DFS) were estimated using the Kaplan-Meier method, and comparisons between groups were based on the log rank test., Results: The SIGNAL/PHARE cohort included 11,728 breast cancer cases treated in adjuvant setting; some 5502 of them with HER2-positive tumour: 34.5% (1897/5502) were treated by sequential and 65.5% (3605/5502) by concomitant modality of administration for taxane-chemotherapy and trastuzumab. The adjusted comparison found similar OS (HR = 1.01; 95% CI: 0.86-1.19) and similar DFS (HR = 1.08; 95% CI: 0.96-1.21)., Conclusion: These results suggest that the sequential administration of trastuzumab given after the completion of adjuvant chemotherapy might be as valid as the concomitant administration of trastuzumab and taxane chemotherapy in the adjuvant setting., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Human epidermal growth factor receptor 2-positive breast cancer is a subtype of interest regarding its outcome and the impressive impact of human epidermal growth factor receptor 2 targeted therapy. Constitutional variants may be involved in the aetiology of human epidermal growth factor receptor 2-positive breast cancer, and we propose a case-case study to test the hypothesis that single nucleotide polymorphisms may be associated with human epidermal growth factor receptor 2 status. A Genome-Wide Association Study was used in a cohort of 9836 patients from the SIGNAL/PHARE study (NCT00381901-RECF1098). The main goal was to identify variants specifically related to human epidermal growth factor receptor 2-positive breast cancer. A two-staged genotyping strategy was carried out to cover as large a proportion of the genome as possible. All subjects were genotyped using the Illumina HumanCore Exome chip set. Principal Components Analysis and k -means were then used to characterize the ancestry of the participants. A random sample of subjects from the main "European" cluster was genotyped with the Omni5 chip set. These data were then used to impute missing genotypes from the remaining subjects genotyped only using the HumanCore Exome array. From the 9836 patients, a total of 8703 cases including 3230 patients with human epidermal growth factor receptor 2-positive breast cancer were analyzed. Despite having 80% power to detect an odds ratio of 1.23 in this population, no variant achieved genome-wide significance for association with the occurrence of human epidermal growth factor receptor 2-positive breast cancer vs. any other subtype of breast tumour. Our study was unable to identify constitutional polymorphisms that are strongly associated with human epidermal growth factor receptor 2-positive status among breast cancer patients.

Genetic polymorphisms are associated with breast cancer risk. Clinical and epidemiological observations suggest that clinical characteristics of breast cancer, such as estrogen receptor or HER2 status, are also influenced by hereditary factors. To identify genetic variants associated with pathological characteristics of breast cancer patients, a Genome Wide Association Study was performed in a cohort of 9365 women from the French nationwide SIGNAL/PHARE studies (NCT00381901/RECF1098). Strong association between the FGFR2 locus and ER status of breast cancer patients was observed (ER-positive n=6211, ER-negative n=2516; rs3135718 OR=1.34 p=5.46×10-12). This association was limited to patients with HER2-negative tumors (ER-positive n=4267, ER-negative n=1185; rs3135724 OR=1.85 p=1.16×10-11). The FGFR2 locus is known to be associated with breast cancer risk. This study provides sound evidence for an association between variants in the FGFR2 locus and ER status among breast cancer patients, particularly among patients with HER2-negative disease. This refinement of the association between FGFR2 variants and ER-status to HER2-negative disease provides novel insight to potential biological and clinical influence of genetic polymorphisms on breast tumors.

Introduction: Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese)., Methods and Analysis: Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life., Ethics and Dissemination: The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided., Trial Registration Number: NCT02753192, Pre-results., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Sequence clustering is a common early step in amplicon-based microbial community analysis, when raw sequencing reads are clustered into operational taxonomic units (OTUs) to reduce the run time of subsequent analysis steps. Here, we evaluated the performance of recently released state-of-the-art open-source clustering software products, namely, OTUCLUST, Swarm, SUMACLUST, and SortMeRNA, against current principal options (UCLUST and USEARCH) in QIIME, hierarchical clustering methods in mothur, and USEARCH's most recent clustering algorithm, UPARSE. All the latest open-source tools showed promising results, reporting up to 60% fewer spurious OTUs than UCLUST, indicating that the underlying clustering algorithm can vastly reduce the number of these derived OTUs. Furthermore, we observed that stringent quality filtering, such as is done in UPARSE, can cause a significant underestimation of species abundance and diversity, leading to incorrect biological results. Swarm, SUMACLUST, and SortMeRNA have been included in the QIIME 1.9.0 release. IMPORTANCE Massive collections of next-generation sequencing data call for fast, accurate, and easily accessible bioinformatics algorithms to perform sequence clustering. A comprehensive benchmark is presented, including open-source tools and the popular USEARCH suite. Simulated, mock, and environmental communities were used to analyze sensitivity, selectivity, species diversity (alpha and beta), and taxonomic composition. The results demonstrate that recent clustering algorithms can significantly improve accuracy and preserve estimated diversity without the application of aggressive filtering. Moreover, these tools are all open source, apply multiple levels of multithreading, and scale to the demands of modern next-generation sequencing data, which is essential for the analysis of massive multidisciplinary studies such as the Earth Microbiome Project (EMP) (J. A. Gilbert, J. K. Jansson, and R. Knight, BMC Biol 12:69, 2014, http://dx.doi.org/10.1186/s12915-014-0069-1).

DNA metabarcoding offers new perspectives in biodiversity research. This recently developed approach to ecosystem study relies heavily on the use of next-generation sequencing (NGS) and thus calls upon the ability to deal with huge sequence data sets. The obitools package satisfies this requirement thanks to a set of programs specifically designed for analysing NGS data in a DNA metabarcoding context. Their capacity to filter and edit sequences while taking into account taxonomic annotation helps to set up tailor-made analysis pipelines for a broad range of DNA metabarcoding applications, including biodiversity surveys or diet analyses. The obitools package is distributed as an open source software available on the following website: http://metabarcoding.org/obitools. A Galaxy wrapper is available on the GenOuest core facility toolshed: http://toolshed.genouest.org., (© 2015 John Wiley & Sons Ltd.)

No agreement has been reached yet on the co-occurrence of Intellectual Disability (ID) and Autism Spectrum Disorders (ASD) in young children. This study describes the clinical profiles of 253 children with ASD between 30 and 65 months old, on IQ and adaptive behaviors, prior to their entry in an early behavioral intervention program. Results showed that 36.8% of the children met the criteria for ID, with 60.2% of these in the mild range (IQ 50-69) and 39.8% in the moderate range (IQ 35-49). ID profiles were similar for boys and girls. Intellectual and adaptive behavior profiles are described as well as their links to various socioeconomic factors.

Parents of children with autism spectrum disorder are known to experience more stress than parents of children with any other conditions. The current study describes the parental stress of 118 fathers and 118 mothers at the onset of their children's Early Intensive Behavioral Intervention program. The objectives of the study were to compare and analyze each parent's stress and to identify factors that might predict their stress. Results indicated that fathers reported higher levels of stress than mothers. Correlations indicated that the stress levels of both parents were associated with their child's age, intellectual quotient, severity of autistic symptoms, and adaptive behaviors. Paternal stress, but not maternal stress, was predicted by severity of autistic symptoms and child's gender. Results are discussed in terms of their implications for services and early interventions.

Objective: To compare the changes in splenic length and thickness and in packed cell volume (PCV) following detomidine or xylazine administration and subsequent epinephrine infusion., Hypothesis: Spleen relaxation occurs following xylazine or detomidine administration and interferes with subsequent splenic contractile response to epinephrine., Study Design: Randomized non-blinded crossover experimental study., Animals: 6 healthy adult mares., Methods: The mares received an intravenous (IV) epinephrine infusion (1 μg kg(-1 ) minute(-1) over 5 minutes) one hour after IV administration of detomidine (0.01 mg kg(-1) ), xylazine (0.5 mg kg(-1) ) or no drug (control), with a withdrawal period of at least 7 days between experiments. The splenic length measured in two different axes, the splenic thickness, and the PCV were measured prior to sedation (T0), 30 minutes later, and at 5-minute intervals from the start of the epinephrine infusion (T1) until T1 + 40 minutes. Changes from base-line and between treatments were compared using a two-way anova for repeated measures. Significance was set at p < 0.05., Results: Splenic length was significantly increased and PCV was significantly decreased after detomidine administration compared to baseline. Epinephrine infusion resulted in a significant decrease in splenic length and thickness, and a significant increase in PCV, irrespective of prior treatment with detomidine or xylazine., Conclusions: Detomidine administration was followed by a sonographically detectable increase of splenic length. Neither detomidine nor xylazine interfered with the ability of the spleen to contract following subsequent administration of an epinephrine infusion given one hour later., Clinical Relevance: Previous sedation with alpha-2 agonists does not preclude the efficiency of epinephrine as a medical treatment of left dorsal displacement of the large colon, but further investigations are required with other drug doses and different time intervals between administrations., (© 2013 The Authors. Veterinary Anaesthesia and Analgesia © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.)

Background: The goal of this study was to identify measures to facilitate access to the Quebec Breast Cancer Screening Program for women with activity limitations, considering the barriers to screening uptake in that population., Methods: The study was carried out in three stages. First, 124 semi-structured interviews were conducted in five regions of Quebec with five groups of key informants. The content analysis lead to the identification of 64 proposals, which were submitted to 31 experts through a two-round Delphi survey process. Finally, consultations were held with 11 resource people to determine which decision-making levels (local, regional, provincial) could play a key role in implementing the proposals., Results: A strong consensus (≥80%) was achieved for 25 proposals seen as highly relevant and feasible., Discussion: The implementation of such proposals could substantially improve access to screening, given the prevalence of activity limitations in the age group targeted by the program.

The aim of this special issue of the Canadian Journal of Program Evaluation was to present an overview of current practices in the field of evaluation of complex interventions. Seasoned evaluators described their approaches to these types of evaluation in the healthcare context. Building upon their contributions, this synthesis offers a cross-sectional reading of their experiences, highlighting the common and divergent features of their approaches as well as their most pressing concerns and interests.

This paper reports results from a case study on household food insecurity needs and the interventions that address them. It aimed at comparing households' perceptions on food insecurity experience and vulnerability to those of other stakeholders: community workers, programme managers and representatives from donor agencies. Semi-structured interviews with 55 households and 59 other stakeholders were conducted. Content analysis was performed, using a framework encompassing food sufficiency, characterization of household food insecurity and vulnerability of households to food insecurity. Overall, the results draw attention to a gap between households and the other stakeholders, where the later do not seem always able to assess the realities of food-insecure households. Other areas of divergences include: characteristics of food insecurity, relative importance of various risk factors related to food insecurity and the effectiveness of the community assistance to enhance the households' ability to face food insecurity. These divergent perceptions may jeopardize the implementation of sustainable solutions to food insecurity. Training of stakeholders for a better assessment of households' experience and needs, and systematic evaluation of interventions, appear urgent and highly relevant for an adequate response to households' needs. Collaboration between all stakeholders should lead to knowledge sharing and advocacy for policies dedicated to poverty reduction.

Objectives: The aim of the study was (i) to describe the needs of food-insecure households and their assessment of community programmes, as expressed by households and perceived by stakeholders; and (ii) to examine the similarities and differences between households' and stakeholders' perceptions in Quebec City area., Design/setting/subjects: A semi-structured interview and sociodemographic questionnaire with fifty-five households and fifty-nine stakeholders (community workers, managers, donor agencies). The transcriptions were subjected to content analysis and inter-coder reliability measurement., Results: The respondents' perceptions converge towards three main categories of needs: needs specific to food security, conditions necessary for achieving food security and related needs. There was agreement on the necessity of better financial resources, although the impact of financial resources alone may be uncertain in the opinion of some stakeholders. Different perceptions of needs and of their fulfilment by community programmes emerge between both groups. Despite households found positive aspects, they complained that quality of food and access were major needs neglected. Their account suggests overall a partial fit between the programmes and food security needs; even a combination of programmes (e.g. collective kitchens, purchasing groups, community gardens) was insufficient to adequately meet these needs. In contrast, most stakeholders perceived that the household's primary need was a basic amount of food and that the households were satisfied with programmes., Conclusions: It is urgent to evaluate the overall effect of community programmes on specific aspects of household food insecurity. The results emphasise that community programmes alone cannot bring about social change needed to prevent food insecurity.

This paper focuses on the links between the WHO atlas on global resources for persons with intellectual disabilities (Atlas-ID) project and the right to health in international human rights law. The WHO Atlas-ID project initiated by the Department of Mental Health and Substance Abuse of the WHO was designed to collect, compile and disseminate data on intellectual disabilities services and resources throughout the world. The right to health, as linked to all other human rights, brings a set of globally agreed upon norms and standards, and out of these norms arise governmental obligations. Even in countries which have a relatively high standard of living, persons with intellectual disabilities are very often denied the opportunity to enjoy the full range of economic, social and cultural rights. This paper aims at establishing the WHO Atlas-ID and the international human rights instruments as two parts of a holistic approach in regards to State provided services to persons with intellectual disabilities and their families.

The co-occurrence of mental health and substance use disorders is becoming increasingly recognized as a single problem, and professionals recognize that both should be addressed at the same time. Medical best practices recommend integrated treatment. However, criticisms have arisen, particularly concerning the difficulty of implementing integrated teams in specific health-care contexts and the appropriateness of the proposed model for certain populations. Using logic analysis, we identify the key clinical and organizational factors that contribute to successful implementation. Building on both the professional and organizational literatures on integrated services, we propose a conceptual model that makes it possible to analyze integration processes and places integrated treatment within an interpretative framework. Using this model, it becomes possible to identify key factors necessary to support service integration, and suggest new models of practice adapted to particular contexts.

Objectives: To evaluate client treatment retention and evolution in terms of living conditions, at-risk behaviours, and the use of psychoactive substances (PAS) over a one-year period, following admission into a low-threshold methadone program in Montreal., Method: Individual interviews were administered to 114 clients from Relais-Méthadone (RM) at admission and one year after treatment initiation. Participants reported on PAS consumption and unsafe practices of drug use and sexual behaviours at high risk for transmission of HIV, sexually transmitted infections (STI) and other blood-borne viruses (BBV). Services utilized by clients were documented from Relais-Méthadone files. Bivariate analyses were used to compare data recorded at admission and one-year follow-up., Results: The treatment retention rate after one year at RM was 64%. However, by taking into account those clients who were transferred to a regular program during the study period, as well as those who voluntarily tapered their methadone treatment (16.7%), the status of 80.7% of clients demonstrated improvement one year after admission into treatment. Furthermore, the clients who remained in treatment for a year for whom information was available (n = 60) showed a tendency towards more stable living conditions. They also demonstrated a significant decrease in both the number of PAS injections and in risky behaviours related to drug consumption. A statistically significant decrease in the frequency of heroine and cocaine use was also observed. By contrast, however, two thirds of the individuals in treatment after a year (n = 42) maintained or increased their daily consumption of other PAS., Discussion: The treatment retention rate is comparable to other low or regular threshold substitution programs. The results support previous studies showing that the methadone substitution treatment reduces heroine and cocaine consumption, and decreases the number of unsafe behaviours that could potentially transmit HIV, STI and BBV for the majority of clients who remained in treatment. Future research could focus attention on people who abandon treatment and those who present at-risk behaviours during treatment.

Work integration for people with mental illness is complex and difficult. For those who obtain employment, job tenure is typically brief. The purpose of this article is to identify the personal determinants of job tenure of people with severe mental illness registered in prevocational programs. Out of 105 people with mental illness who are employed during the nine month follow-up after their registration in a prevocational program, close to 50 % kept their first job. According to the job tenure indicators (first or last job obtained), the results from survival analyses show that the significant variables are related to background characteristics (financial aid), work-related characteristics (length of absence from the workplace, type of job), cognitive (executive functions), and clinical aspects (paranoid symptoms). In conclusion, the authors propose not only to assess personal variables to better understand the work integration process for people with mental illness, but also to conduct a systematic evaluation of the job site.

This article discusses the relationships between socio-demographic, clinical characteristics and Quality of Life (QOL) of individuals with schizophrenia. The client version of the Canadian version of the Wisconsin Quality of Life Index (CaW-QLI) was used with a population of 182 individuals with either schizophrenia or schizo-affective disorder. Multivariate analyses of variance with Tukey post hoc tests were used to assess differences between groups defined according to socio-demographic and clinical characteristics on all sub-scale scores in addition to the global score on the CaW-QLI. Relationships between socio-demographic characteristics and QOL were found for gender, age, education, employment status and living arrangement. Differences in QOL were found between groups with different clinical characteristics, such as diagnosis, hospitalization during the last 12 months and age at first hospitalization. Using socio-demographic and clinical variables in addition to psychosocial variables appears to be promising for understanding QOL in psychotic patients. Methodological considerations for future research are discussed.

A prospective study of individuals with a mental illness aimed to identify significant determinants of their integration in the work force. Regression and mean comparison analysis allowed exploring an individual's most typical characteristics that could explain his or her socio-professional integration, while considering several professional integration indicators. First, results suggest that linked to work (e.g. commitment to work) and socio-demographic variables (e.g. financial support received) can predict performing a work activity and obtaining competitive employment. Second, 2 additional variables can predict autonomy in employment, which are a feeling of efficiency in looking for work and a capacity to overcome obstacles to work integration. Third, cognitive and clinical variables are associated with a delay to start work. Fourth, the number of hours worked per week is explained by the feeling of efficiency in overcoming health problems and others motivational and psychosocial variables. Finally, it is important to clearly identify the professional integration indicators in order to determine the significant predictors.

This study conducted with a sample of 71 families of individuals suffering from schizophrenia, examines by means of regression analysis, the link between support that families receive from their social network, satisfaction with mental health services, family burden and their psychological distress and quality of life. These analyses reveal that three variables predict 31 % of the variance associated with psychological distress. These variables are : obtaining counselling and advisory guidance from their network, the burden associated with daily-living and the satisfaction of services. Five variables account for 63 % of the quality of life. More specifically, counselling and advisory guidance as well as reassurance of their worth by members of their network, the burden felt during daily-living, the burden associated with difficult behavior and finally, satisfaction with services. The components of social support are the strongest predictors associated with mental health of families of individuals suffering from schizophrenia.

Background: Adaptation of people suffering from schizophrenia still raises numerous questions left unanswered by correlational studies and predictive models. A theoretical framework likely to bring new answers is the stress process perspective. Using the transactional model of coping, to which psychological and social variables have been added, this exploratory research studies the adaptation of 101 people with schizophrenia., Method: The research design is correlational with only one crosswise measure., Results: The model predicts 60.7% of variance of adaptation and gives support that the transactional model of coping contributes to this variance. Five variables show a significant effect and account for 48% of the variance, and three interaction effects (two two-way and one three-way) add another 12.7% to the explained variance., Conclusion: Results give support to the significant impact of the variables education, age and negative symptoms on adaptation. They highlight the importance of accommodation, a cognitive strategy used by people with schizophrenia to increase their adaptation. They also challenge the broadly accepted assumption of a negative influence of life events on adaptation. Finally, the interaction effects allow us to better understand the mutual effects of variables on adaptation and confirm their relevance.

This paper describes an experience in the exchange of information between researchers and practitioners, where conditions favorable to knowledge exchange were systematically documented. Conditions related to the organization proved to be the most determining, as did the quality and intensity of communication between the actors. This communication process is enhanced by characteristics related to practitioners and researchers. However, the well-established boundaries between the practitioners and the researchers, fueled by distinctive rules of practice, remain a major issue. Knowledge brokerage, effective reporting skills, and adapted, well-focused feedback could help to bring together the researchers and their partners.

Article 8 of the Act Respecting the Protection of Persons Whose Mental State Presents a Danger to Themselves or to Others (Québec, 1997) introduced a new legal framework requiring a linkage between police departments and crisis intervention services to prevent involuntary hospitalizations. Through telephone interviews, observation sessions, and documentary analysis, the authors studied the implementation of article 8 in 16 Québec administrative regions. Results pertain to organizational consequences for the health and police sectors and methods of collaboration between the two sectors. They cast light on the difficulties of implementing article 8 and suggest conditions for the success of initiatives aimed at reducing unjustified recourse to the legal system and hospitalization in cases of persons with mental health problems.

The psychometric properties of the Injection Drug User Quality of Life Scale (IDUQOL) were assessed in 61 Montreal IDUs in 2001, 85% of whom were reinterviewed within four weeks. The reliability of the IDUQOL was acceptable (ICC = 0.71) and concordance between the IDUQOL and the Flanagan Quality of Life Scale was moderate (Pearson coefficient = 0.57). Quality of life was negatively associated with injection cocaine and emergency department use with both instruments; these results were more striking for the IDUQOL. The IDUQOL is a culturally relevant quality of life instrument with good psychometric properties. The IDUQOL may be useful in the development and evaluation of interventions for IDUs.

Objective: To evaluate the accessibility to a Montreal low-threshold methadone program (Relais-Méthadone). This program is aimed at a marginalized population of heroin addicts who are injection drug users (IDU)., Method: The data (n = 141 clients) were collected during the first year of the program implementation with questionnaires administered by the programme workers., Results: Analysis of the characteristics of the clients revealed that the program does reach the target population. The program's clientele is characterized by long-time and frequent heroin use, unstable lifestyles, and the presence of numerous behaviours that put them at high risk for HIV transmission. The retention of clients in the program is very high (88%) within the first 30 days., Interpretation: These results demonstrate the importance and value of flexible intervention programs in reaching a marginalized clientele exposed to the HIV virus, who would not have access to regular programs characterized by restrictive selection criteria and limited availability.

Professional rehabilitation of people with severe mental illness is a field of research often left aside. Despite the aspiration of people with severe mental illness to employment, their presence in the job market remains low. Lack of supports appears to be one explanation. Thus, the aim of this study was to identify the types of necessary supports to maintain these people in employment. Six (6) participants have been recruited following a qualitative methodology. Ten types of supports have been identified and classified according to their direct association to work or to the residential or community environment. To conclude, the authors suggest a greater involvement from mental health workers in the identification and development of supports that favour maintaining these people in employment.

The Wisconsin Quality of Life Index (W-QLI, Becker, Diamond and Sainfort, 1993) consists of eight scales: satisfaction with life domains, occupational activities, symptoms, physical health, social relations/support, finances, psychological wellbeing, and activities of daily living. The W-QLI has been modified to fit the characteristics of the Canadian population, the universal Canadian health system, and community and social services in Canada and the modified form was named CaW-QLI (Diaz, Mercier, Hachey, Caron, and Boyer, 1999). This study will verify the empirical basis of these theoretical dimensions by applying a cross-validation procedure on two samples, most of whose subjects have a serious mental illness. Confirmatory factor analyses and exploratory factor analyses using the principal component extraction technique with varimax rotation were applied. With the exception of the occupational activities domain, the remaining scales were correctly identified by the factor analyses on each sample. The occupational activities scale should be developed by additional items for representing this scale, which is too brief, and two other items should be revised in order to improve the quality of the instrument.

This article questions the effectiveness of a managerial tool in changing a health-care system. The process of implementing regional planning and its impact on creating integrated service networks is examined, using a case study and a multi-dimensional analytic model. This model highlights the influence of contextual, structural, cultural and dynamic factors on forming networks. The regional planning developed in the province of Québec (Canada), aimed at a major transformation of the mental health-care system. In each district, organizations working with people who have serious mental disorders were mobilized to plan and implement a more coordinated, continuous and diversified supply of services, under the direction of a regional health body. This study outlines the limitations of regional planning as a tactic for transforming the system. It recommends instead developing more diversified integration strategies to further the process of forming integrated service networks within a complex system. In conclusion, a brief discussion deals with the difficulties related to the study of systemic change implementation.

Severe mental disorders affect the daily activities and lifestyles of people suffering from these problems. A descriptive study was conducted in order to determine the meaning that people with severe mental disorders give to their daily activities. In this study, the meaning of the activities was defined based on Kielhofner's Human Occupation Model, using three indicators: sense of competence, importance and pleasure. These indicators were measured for each daily activity through a semi-structured interview of 45 people suffering from severe mental disorders, using the Occupational Questionnaire. In general, the activities included in the categories of hygiene and self-care, meals and sleep, scored the highest average for each indicator, i.e. sense of competence, importance and pleasure. Work, however, stands out in terms of the importance it is given as an activity, while social activities are valued through their association with pleasure. An analysis of the results underlines the importance that occupational therapists have an improved understanding of the meaning that people suffering from mental disorders give to their daily activities in order to support their efforts in developing a more positive perception of the way they occupy their time.

Organizing services in an integrated network as a model for transforming healthcare systems is often presented as a potential remedy for service fragmentation that should enhance system efficiency. In the mental health sector, integration is also part of a diversified response to the multiple needs of the clients, particularly people with serious mental health disorders. The authors describe how the notion of integrated service networks came to serve as a model for transforming the mental health system in Quebec, and they propose a frame of reference for this notion. They also address the challenges and issues raised by this mode of service organization in the mental health sector and more generally in a context of transforming healthcare systems.

Objectives: Alcohol dependence is a prevalent psychiatric disorder affecting approximately 12% of the adult population at some point in their lifetime. Psychosocial treatments are associated with only modest success rates. The first Canadian clinical trial with naltrexone, an opiate antagonist, was conducted to evaluate its safety and usefulness as an adjunctive treatment in the management of alcohol dependence., Methods: One hundred twenty alcohol-dependent individuals were assessed to receive treatment with 50 mg of naltrexone orally for 12 weeks in an open-label trial. Patients were seen biweekly and received a concurrent psychosocial intervention. Treatment was conducted at multiple sites in Canada., Results: Fifty-four per cent of subjects completed the entire 12 weeks of treatment. During the study, 39% of patients abstained, while of the individuals reporting drinking at baseline, 86% were consuming less alcohol by their final visit. These reductions were accompanied by a significant decrease in craving for alcohol at week 12, as measured by the Obsessive Compulsive Drinking Scale (P<0.01). Naltrexone was well tolerated and no serious adverse events were experienced., Conclusions: The data lend support to the hypothesis that endogenous opioid activity is involved in the regulation of alcohol intake, and that antagonists of endogenous opioids decrease craving and drinking. Opiate antagonists such as naltrexone are a new strategy in the treatment of alcohol dependence. Naltrexone can be safely given to female and male alcoholics, is acceptable to patients, and plays a role in reducing alcohol consumption and preventing relapse to heavy drinking.

This study examined an intersectoral work insertion program that involves the collaboration of six stakeholders from different sectors in the community, including health and vocation. An innovative program logic model has been developed that explains the theoretical rationale behind intersectoral collaboration and work insertion. The principles and ideology of local development have led to the development of this program and have several implications for the social integration of individuals with mental illness. The paper first discusses how such an approach is developed and implemented and follows with a presentation of a model of an intersectoral work insertion program.

The authors describe the barriers related to socio-professional integration of people with severe mental disorders according to different perspectives of various people involved. Focus groups (22) have been conducted in almost every region in Quebec involving 87 participants in vocational rehabilitation programs, 47 non participants and 51 employers. Eighty (80) vocational program administrator completed a questionaire. The barriers identified by these groups are compared with those described in other studies. It seems that the results are similar: the main obstacle is prejudice towards mental illness and people with mental disorders, no matter who is questionned. Barriers to socio-professional integration are reviewed according to the theories of feeling of self-efficiency (Bandura, 1977,1997), causal attribution (Weiner, 1986) and planned behavior (Ajzen, 1991, 1996). Analysis of barriers to socio-professional integration carried out in the light of these three theories, allows to suggest points of reference for new tools and integration strategies.