Psychological distress in frequent users of primary health care and emergency departments: a scoping review.

INTRODUCTION: Frequent users of healthcare services are a small proportion of patients with disproportionately high healthcare usage. A wide array of factors, including psychological distress, leads to frequent use of healthcare services. There is no existing synthesis of research on frequent use and psychological distress in the general population. This scoping review aimed to compare psychological distress between frequent and non-frequent users and to examine the association between psychological distress and frequent use of healthcare services in primary care and emergency department (ED) services. METHODS: A scoping review was performed following the five steps defined by Arksey and O'Malley. A search strategy was developed with an information specialist in five databases (Medline, PsycINFO, CINAHL, SCOPUS, and PubMed) for articles in English published between 1963 and October 2018. To be included, studies had to be quantitative, have taken place in a primary care or ED setting, have documented frequent use, and have measured psychological distress in patients. Two team members independently gathered the data for each of the included studies. Results were collated, summarized, and reported using narrative synthesis. RESULTS: Seven studies met the inclusion criteria. Psychological distress in primary care is generally higher in frequent users, and increased psychological distress scores are associated with frequent use. Both studies set in EDs reported noteworthy findings, stating that frequent users reported higher levels of psychological distress and that psychological distress was associated with frequent use. CONCLUSION: Psychological distress is prevalent in frequent users and has a significant association with frequent use. As such, psychological distress should be evaluated by physicians to prevent or reduce frequent use and to identify candidates for interventions.

Validation of and Normative Data of the DVAQ-30, a New Video-Naming Test for Assessing Verb Anomia.

OBJECTIVE: Anomia is usually assessed using picture-naming tests. While many tests evaluate anomia for nouns, very few tests have been specifically designed for verb anomia. This article presents the DVAQ-30, a new naming test for detecting verb anomia in adults and elderly people. METHOD: The article describes three studies. Study 1 focused on the DVAQ-30 development phase. In Study 2, healthy participants and individuals with post-stroke aphasia, mild cognitive impairment, Alzheimer's disease, or primary progressive aphasia were assessed using the DVAQ-30 to establish its convergent and discriminant validity, test-retest reliability, and internal consistency. In Study 3, a group of adults and elderly Quebec French-speaking adults were assessed to obtain normative data. RESULTS: The DVAQ-30 had good convergent validity and distinguished the performance of healthy participants from that of participants with pathological conditions. The test also had good internal consistency, and the test-retest analysis showed that the scores had good temporal stability. Furthermore, normative data were collected on the performance of 244 participants aged 50 years old and over. CONCLUSIONS: The DVAQ-30 fills an important gap and has the potential to help clinicians and researchers better detect verb anomia associated with pathological aging and post-stroke aphasia.

The role of semantic memory in the recognition of emotional valence conveyed by written words.

The main goal of this study was to examine the role of semantic memory in the recognition of emotional valence conveyed by words. Eight participants presenting with the semantic variant of primary progressive aphasia (svPPA) and 33 healthy control participants were administered three tasks designed to investigate the formal association between the recognition of emotional valence conveyed by words and the lexical and semantic processing of these words. Results revealed that individuals with svPPA showed deficits in the recognition of negative emotional valence conveyed by words. Moreover, results evidenced that their performance in the recognition of emotional valence was better for correctly than for incorrectly retrieved lexical entries of words, while their performance was comparable for words that were correctly or incorrectly associated with semantic concepts. These results suggest that the recognition of emotional valence conveyed by words relies on the retrieval of lexical, but not semantic, representations of words.

Mindfulness mechanisms and psychological effects for aMCI patients: A comparison with psychoeducation.

Amnestic mild cognitive impairment (aMCI), an Alzheimer's disease prodrome, is characterized by cognitive and psychological symptoms, the latter aggravating prognosis. A mindfulness-based intervention (MBI) represents a promising non-pharmacological framework for Alzheimer's disease prevention. The Monitoring + Acceptance Theory (MAT) postulates that MBI improves cognition through monitoring, and psychological well-being, through acceptance. This single-blind preliminary randomized-controlled study investigated the effects of a MBI on anxio-depressive symptoms, quality of life, and memory, compared to a psychoeducation-based intervention in older adults with aMCI. The contribution of MAT components and of ruminations' reduction to intervention efficacy were examined. Participants assigned to both conditions experienced similar benefits regarding anxio-depressive symptoms and aging-related quality of life. General quality of life and memory remained unchanged. A partial support of the MAT and of ruminations reduction to the MBI's efficacy was found. The findings provide new insights on the effects and mechanisms of a MBI on aMCI symptoms.

Towards an assessment for organizational participatory research health partnerships: A systematic mixed studies review with framework synthesis.

Within the health sciences, organizational participatory research (OPR) is defined as a blend of research and action, in which academic researchers partner with health organization members. OPR is based on a sound partnership between all stakeholders to improve organizational practices. However, little research on the evaluation of OPR health partnership exists. This systematic mixed studies review sought to produce a new theoretical model that structures the evaluation of the OPR processes and related outcomes of OPR health partnerships. Six bibliographic databases were searched together with grey literature sources for OPR health partnership evaluation questionnaires. Six questionnaires were included, from which a pool of 95 OPR health partnership evaluation items were derived. The included questionnaires were appraised for the quality of their origin, development and measurement properties. A framework synthesis was performed using an existing OPR framework by organizing questionnaire items in a matrix using a hybrid thematic analysis. This led to our proposed Organizational Participatory Research Evaluation Model (OPREM) that includes three axes, Trust, Collective Learning and Sustainability (with specific dimensions) and 95 items. This model provides information to help stakeholders comprehensively structure the evaluation of their partnerships and subsequent improvement; thus, potentially helping to improve health organization practices.

Temporal (1970-2016) changes in human pressures and wetland response in the St. Lawrence River (Québec, Canada).

Temporal changes (1970-2016) in St. Lawrence River wetlands were assessed between Cornwall and Québec (≈400 km) to assess wetland response to cumulative anthropogenic pressures in the watershed. Emergent wetlands area and biomass of submerged aquatic vegetation (SAV) were contrasted among five regions subjected to sharply different water level/discharge regime (stabilized, semi-natural, tidal), nutrient concentrations and shoreline use (rural to urbanized). Between 1970 and 2016, over the growing season (April-Sept.), St. Lawrence River mean water level at Sorel dropped by ≈1 m and mean water temperature increased by ≈3 °C. Reductions in phosphorus concentrations (by ≈2-fold) were observed over time both in water and in SAV tissues, in phase with improvements of urban wastewater treatment and P-reduction in upstream Lake Ontario. Nitrate concentrations in water increased and SAV biomass decreased between the 1970s and 2008 in the downstream regions of Lake Saint-Pierre and fluvial corridor subjected to the cumulative impacts from urban centers and intensively farmed watersheds. Over the 1970-2010 period, dropping water levels yielded slightly increasing wetland areas, owing to the downslope colonization of emergent and submerged plants. In urbanized regions, emergent wetlands shifted towards drier assemblages dominated by invasive reed species. Encroachment of wetlands by agriculture accounted for most wetland losses in rural Lake Saint-Pierre, which holds the single largest area (197 km2) of continuous wetland habitat of the entire watershed. Our results highlight the strong response of riverine wetlands to a wide range of human pressures, including dropping water levels, changing nutrient concentrations, rising population and intensifying agriculture.

In the eye of the beholder: Assessing the water quality of shoreline parks around the Island of Montreal through citizen science.

As a part of the FreshWater Watch project aiming to promote volunteers' water monitoring in 25 cities around the world, St. Lawrence River water quality was characterized at 28 public shoreline parks around Montreal Island, Quebec, Canada. This involved training of 69 citizen scientists by researchers of the Université de Montréal in five one-day sessions. Shoreline sampling yielded 174 data points over three summers (May 2013 to November 2015). Water turbidity, nitrate and phosphate concentrations were measured in situ, together with the thickness and type of beach-cast vegetation, and the relative abundance of different types of beach litter. Data generated by citizen scientists provided 1) an overview of the water quality of the St. Lawrence and Des Prairies rivers around the Island of Montreal, 2) an estimation of the quantity and types of beach-cast aquatic plants and filamentous algae, and 3) novel insights into the distribution of the nuisance cyanobacterium Lyngbya wollei. Overall, half of the sites were classified as "good" being characterized by low turbidity, nitrate and phosphate concentrations, and little deposition of beach-cast vegetation. Lyngbya wollei was found at 57% of the sites, revealing a more frequent occurrence than initially anticipated. The amount of litter recorded along the shoreline was generally small, comprising items related to picnicking (cans/bottles), smoking, and fishing activities in most parks. Wind exposure and rain events explained a significant fraction of the variability in nutrient concentration and turbidity among sites and dates. Shoreline condition assessed from water quality and vegetation data from this study was not correlated, however, with the most serious problem of faecal coliform counts gathered by the City of Montreal. This assessment of the quality and utilization of shoreline parks provides additional information to support planning and management activities of municipalities.

Spatial and temporal variations of a saxitoxin analogue (LWTX-1) in Lyngbya wollei (Cyanobacteria) mats in the St. Lawrence River (Québec, Canada).

The concentration of the saxitoxin analogue LWTX-1 was quantified in samples of the benthic filamentous cyanobacterium Lyngbya wollei (Farlow ex Gomont) Speziale and Dyck collected in two fluvial lakes of the St. Lawrence River (Canada) over the 2006-2013 period. The study was aimed at documenting the spatial (between fluvial lakes, between sites within each lake) and temporal (inter-annual, monthly) variations of toxin concentration in relation with hydrological (water level), physical (water temperature, conductivity, transparency), chemical (nutrients in overlying water) and biological (L. wollei biomass and mat condition) characteristics. Toxin concentration was hypothesized to vary seasonally with biomass accumulation and environmental conditions. Toxin concentrations measured in Lake Saint-Louis (51±40µg LWTX-1g-1 DM, N=29 days in 2007, 2009-2011) were double those in Lake Saint-Pierre (25±31µg LWTX-1g-1 DM, N=26 days in 2006-2008, 2012-2013); however, August 2007 measurements taken from both lakes did not differ significantly. Ten of the twelve highest values (>100µg LWTX-1g-1 DM) were obtained from Lake Saint-Louis, between April and October in 2007, 2010 or 2011. Under ice samples showed intermediate concentrations of LWTX-1 (42±9µg LWTX-1g-1 DM, N=2). Concentrations of LWTX-1 were positively correlated with Secchi depth (r=0.59, p<0.001), L. wollei biomass (Spearman r=0.31, p<0.01) and %N in filaments (r=0.48, p<0.001), suggesting toxin production was linked to mat growth and metabolism rather than water quality. Although LWTX-1 has been reported to have a low toxicity, monitoring of L. wollei abundance is required to assess the environmental and human health risks posed by this taxon in the St. Lawrence - Great Lakes system.

Cumulative Illness Rating Scale was a reliable and valid index in a family practice context.

BACKGROUND AND OBJECTIVE: The goal of this study was to validate an instrument measuring the clinical burden of several medical problems in the same patient (multimorbidity), in a family practice context and, more specifically, to verify if trained nurses can score the Cumulative Illness Rating Scale (CIRS) from chart review. STUDY DESIGN AND SETTING: A convenience sample of 40 patients was selected. The attending physicians scored the CIRS during clinical interview (CIRS-MD/I), then three nurses scored the CIRS during clinical interview (CIRS-NUR/I) and three other nurses scored the CIRS from chart review (CIRS-NUR/C) (interrater reliability). Two of these nurses scored the CIRS-NUR/C again 2 months later (intrarater reliability). RESULTS: For interrater reliability, the intraclass correlation coefficients were 0.81 (0.70-0.89) for the CIRS-NUR/I and 0.78 (0.66-0.87) for the CIRS-NUR/C. The intrarater reliability of the CIRS-NUR/C was 0.89 (0.80-0.94) for one of the nurses and 0.80 (0.65-0.89) for the other. Concomitant validity of these two forms of CIRS with the CIRS-MD/I ranged from 0.73 to 0.84. CONCLUSION: The CIRS appears to be a reliable and valid instrument in a primary care context and trained nurses can score the CIRS from chart review.

Mental State Inferences Abilities Contribution to Verbal Irony Comprehension in Older Adults with Mild Cognitive Impairment.

OBJECTIVE: The present study examined mentalizing capacities as well as the relative implication of mentalizing in the comprehension of ironic and sincere assertions among 30 older adults with mild cognitive impairment (MCI) and 30 healthy control (HC) subjects. METHOD: Subjects were administered a task evaluating mentalizing by means of short stories. A verbal irony comprehension task, in which participants had to identify ironic or sincere statements within short stories, was also administered; the design of the task allowed uniform implication of mentalizing across the conditions. RESULTS: Findings indicated that participants with MCI have second-order mentalizing difficulties compared to HC subjects. Moreover, MCI participants were impaired compared to the HC group in identifying ironic or sincere stories, both requiring mental inference capacities. CONCLUSION: This study suggests that, in individuals with MCI, difficulties in the comprehension of ironic and sincere assertions are closely related to second-order mentalizing deficits. These findings support previous data suggesting a strong relationship between irony comprehension and mentalizing.

Clinical, physiological and radiological features of asthma with incomplete reversibility of airflow obstruction compared with those of COPD.

OBJECTIVES: To compare clinical features, pulmonary function and high-resolution computed chest tomography (HRCT) findings of asthmatic patients with a component of incomplete reversibility of airflow obstruction (AIRAO) with those of patients with smoking-induced chronic obstructive pulmonary disease (COPD). METHODS: Thirteen patients with COPD (six males and seven females, mean age 59 years, mean smoking 50.5 pack-years) and 14 patients with AIRAO (six males and eight females, mean age 52 years) despite optimal treatment, with no significant smoking history (mean 1.5 pack-years) and no significant environmental exposure or any other respiratory disease, were studied. Patients had respiratory questionnaires, pulmonary function tests, allergy skin-prick tests and an HRCT to evaluate possible parenchymal or bronchial abnormalities. Eight patients in each group also had exercise tests. All patients were stable at the time of the study. RESULTS: As expected, atopy was more prevalent in AIRAO (n=13) than in COPD (n=1) patients. Mean forced expiratory volume in 1 s (FEV1) and forced vital capacity (percentage of predicted value) were 39% and 61%, respectively, in COPD patients and 49% and 71%, respectively, in AIRAO patients; FEV1 improved by 18% in COPD patients and and by 22% in AIRAO patients after use of inhaled salbutamol. Mean functional residual capacity was greater in COPD patients than in AIRAO patients (178% versus 144% of the predicted value), while the mean carbon monoxide diffusing capacity of the lungs (DLCO) was lower in COPD patients than in AIRAO patients (62% versus 89% of the predicted value). Exercise tolerance was similar in both groups, as were postexercise changes in arterial oxygen pressure (PaO2). Emphysematous changes were observed in COPD patients and AIRAO patients who had evaluable HRCTs (10 versus two patients, although very mild in asthma), bronchial dilations (zero versus six patients), bronchial wall thickening (two versus eight patients) and an acinar pattern (one versus five patients). Mean thickness of the large airway wall to outer diameter (intermediary bronchus) ratio was 0.176 in COPD and 0.183 in AIRAO (P>0.05). CONCLUSIONS: Asthma may lead to physiological features similar to COPD but may be distinguished by demonstrating a preserved DLCO and a higher ratio of airway to parenchymal abnormalities on HRCT scan.

Periphyton as an indicator of water quality in the St Lawrence River (Québec, Canada).

The performance of various algal indices to document improvements in water quality across a low nutrient concentration gradient was assessed during 2 years in the St Lawrence River (Quebec, Canada). Water-quality variables and periphyton samples were collected on navigational buoys near Montreal during the spring, summer and fall of 1994 and 1995. Exposure to urban wastewater varied widely within the sector surrounding the island of Montreal, with some areas upstream receiving no direct effluents and areas further downstream receiving treated and untreated wastewater. Faecal coliform concentrations provided a good tracer of effluents and were significantly correlated to nutrient concentrations (r = 0.33-0.72, p < 0.001) and water transparency (r = 0.70, p < 0.001). Despite a strong gradient in faecal coliform concentration (< 2 to > 20 000 UFC/100 ml), algal biomass and diversity did not reflect differences between sites with varying levels of urban wastewater. Taxonomic composition of periphyton communities, particularly the presence of the cyanophyte Plectonema notatum Schmidle, was related (r = 0.48, p = 0.004) to exposure to urban effluents. Variables describing seasonal changes (temperature, Julian day, river discharge, conductivity, NO2-NO3) explained a large fraction of total variance (38-52% of total variance) and thus exerted the predominant influence on algal biomass and species composition in the St Lawrence River. Variables describing the presence of effluents explained 1-22% of the variance in compositional data. Subtle changes in periphyton species composition were the only response to different levels of exposure to urban wastewater in the Montreal area, which represented relatively small differences in comparison to natural seasonal variability.

Selective impairment of fornix-transected rats on a new nonspatial, odor-guided task.

In the present experiment, sham-operated (SH) and fornix-transected (FX) rats were trained on a new nonspatial, odor-guided task. On each session, eight odor pairs were presented twice. On the first occurrence of a pair, rats were reinforced for pushing the container (go response) in which the olfactory stimuli were placed. On the second occurrence, they were not reinforced and had to refrain from responding (no-go response) to be scored as success. Rats were first trained to criterion on odor pairs made of replicates of the same odor (S pairs). Then they were trained to criterion on pairs made of different odors, each member of the pair overlapping with that of another pair (O pairs) and finally, on pairs of different odors with no overlap (NO pairs). The results showed that the number of sessions to reach criterion was significantly higher in FX than in SH rats during training on O pairs, but not during training on S or on NO pairs. These findings are consistent with the configural (Rudy and Sutherland, 1995: Hippocampus 5:375-389) or relational (Eichenbaum et al., 1994: Behav Brain Sci 17:449-518) account of the hippocampal memory function.

Characteristics of bronchial asthma with incomplete reversibility of airflow obstruction.

BACKGROUND: Incomplete reversibility of airflow obstruction (IRAO) can be observed in some asthmatic patients without significant smoking history nor evidence of other respiratory condition. The characteristics of this group remain however to be defined. METHODS: We compared 18 asthmatic patients with persistent airflow obstruction, defined as an FEV1 < or = 75% predicted despite optimal corticosteroid treatment, to others with complete reversibility of airflow obstruction, paired for age and gender (CRAO, FEV1 > 80% of predicted). RESULTS: Mean duration of asthma was 31.6 years for IRAO patients and 17.7 for the CRAO group and mean baseline FEV1 was 48.6 +/- 2.6% and 89.3 +/- 3.4%, respectively. Patients with IRAO had more severe airflow obstruction and hyperinflation than those with CRAO, while lung compliance and CO diffusion were similar. Overall healthcare use was similar in the two groups, but those with IRAO had a greater global asthma-related discomfort, increased diurnal variation of airflow obstruction and used higher doses of inhaled corticosteroids than those with CRAO. Patients with IRAO had slightly increased airway wall thickness on high resolution chest tomography compared with CRAO. Baseline FEV1 however, was not correlated with the measured airway wall thickness. CONCLUSION: We found that asthmatic patients with IRAO have a more severe asthma and asthma of longer duration than asthmatic subjects with CRAO. Our data suggest that in asthma, IRAO may result from long-standing airway inflammation and associated structural changes, although this remains to be further documented.

Effects of hippocampal cholinergic deafferentation on learning strategy selection in a visible platform version of the water maze.

Recent evidence has suggested that the relative levels of acetylcholine (ACh) between brain structures may be an important factor in the choice of behavioral strategy in settings in which either hippocampal or dorsal striatal brain systems can be employed both effectively and independently (McIntyre and Gold. 1999. Soc Neurosci Abs 25:1388). The current investigation used the neurotoxin 192 IgG-saporin to deplete the hippocampus of ACh selectively, while leaving ACh in other brain regions, including dorsal striatum, intact. Rats were then trained on a version of the Morris water maze, in which behavioral strategies attributed to the hippocampus and dorsal striatum are placed in direct competition. It was predicted that rats with hippocampal ACh depletion would display a cue bias. Contrary to this prediction, depleting hippocampal ACh did not bias against and, in fact, promoted use of a hippocampal place strategy in this task, as indicated by choice in competition tests and performance on hidden platform training trials. These data add to a growing literature demonstrating that the septohippocampal cholinergic system is not required for accurate spatial learning and suggest a complex role for basal forebrain projections in processing information about the spatial environment.