Citalopram and viloxazine in the treatment of depression by means of slow drop infusion. A double-blind comparative trial.

Antidepressant efficacy and tolerability of citalopram and viloxazine were compared under double-blind conditions during the first two weeks of treatment with slow drop infusion, followed by oral administration for the rest of the six week trial period. The 62 severely depressed and hospitalised patients included in the intention-to-treat analysis had a mean age of 45 years (range 23 to 70 years). About two thirds of the patients were female. Thirty patients were allocated to the citalopram and 32 patients to the viloxazine group. The mean MADRS total score at baseline was 34 in both groups and decreased to 12.3 in the citalopram and to 16.9 in the viloxazine group after 14 days of infusion. On day 42 (end point) the scores dropped to 6.7 in the citalopram and to 13.1 in the viloxazine group respectively. The group differences reached the level of significance at both time points (p < 0.05) in favour of citalopram. The analysis of treatment emergent adverse events based on the UKU scale showed a higher frequency of nausea on day 14 and constipation at study end in the viloxazine group (p < 0.05) whereas reported weight gain (day 21) and concentration difficulty (day 21) were more frequently seen in the citalopram group (p < 0.05). Standard laboratory investigations and ECG analyses did not show clinically relevant abnormalities. It is concluded that antidepressant treatment with citalopram infusion followed by oral citalopram may be more efficacious than a corresponding treatment schedule with viloxazine.

Citalopram versus fluoxetine: a double-blind, controlled, multicentre, phase III trial in patients with unipolar major depression treated in general practice.

Two selective serotonin reuptake inhibitors (SSRIs), citalopram and fluoxetine, both at a daily dose of 20 mg, were compared in patients with unipolar major depression treated in general practice. This was a multicentre, double-blind, randomized trial carried out in France. The duration of treatment was 8 weeks. Patients were assessed by means of the Montgomery-Asberg Depression Rating Scale (MADRS), the 17 items Hamilton Depression Rating Scale (HAMD) and the investigator's Clinical Global Impressions (CGI), Observed and spontaneously reported adverse events were also recorded. A total of 357 patients of both sexes, aged between 21 and 73 years, entered the double-blind phase of the trial. A clear reduction of both the MADRS and the HAMD mean total scores was observed in both treatment groups with no statistically significant differences between treatments. Apart from back pain recorded more frequently in the citalopram group, no significant difference was found between the two treatment groups with regard to adverse events, and both citalopram and fluoxetine were considered to be well tolerated. It was concluded that citalopram was as effective as fluoxetine in the treatment of unipolar major depression. Citalopram showed an earlier onset of recovery than fluoxetine.

Epidemiological study of reptured intracranial aneurysms in the Saguenay-Lac-Saint-Jean region (Quebec, Canada).

BACKGROUND: Using a population-based register of the Saguenay-Lac-Saint-Jean region (Quebec, Canada), the genealogical reconstruction of 533 individuals with intracranial aneurysm (IA) showed a familial aggregation (the presence of aneurysm in two or more first- to third-degree relatives) for 159 (29.8%) of them; this proportion is much higher than reported elsewhere. OBJECTIVE: As part of an ongoing project to assess a genetic predisposition to intracranial aneurysms in the Saguenay-Lac-Saint-Jean population, the objective of the present study was to determine whether age-specific rates of reputed cerebral aneurysms were higher than in other populations. DESIGN: A retrospective study of cases of proven ruptured IAs which were hospitalized during the 1973 to 1992 period was conducted. Age-adjusted rates were computed and compared to those reported in the Helsinki population. RESULTS: We identified 412 cases of ruptured aneurysms. The age-adjusted incidence rate was 7.2/100,000/year (6.2 for men, 8.1 for women), which is similar to the incidence rates reported in other studies. Although the mean age at time of rupture was younger (46.6 years +/- 13.8) than usually reported, no increase in age-specific incidence rates was detected. CONCLUSIONS: The results of this epidemiological study neither support nor reject the hypothesis of a genetic predisposition to intracranial aneurysms in the Saguenay-Lac-Saint-Jean population.

Familial intracranial aneurysms: recurrence risk and accidental aggregation study.

BACKGROUND: The Saguenay-Lac-Saint-Jean (SLSJ) region is a geographically isolated area (population 285,955) located in the Northeastern part of the Province of Quebec, Canada. Using a population-based register, the genealogical reconstruction of 502 individuals with ruptured intracranial aneurysm (RIA) showed a familial aggregation (the presence of aneurysm in two or more first- to third-degree relatives) for 144 (28.7%) of them; this proportion is much higher than reported elsewhere. OBJECTIVE: In order to assess the genetic predisposition to RIA in the SLSJ population, the objective of the present study is to compare familial and non-familial cases and to provide an estimate of the recurrence risk ratio for siblings. RESULTS: The age at the time of rupture, the number of intracranial aneurysms for each patient and the location of RIAs were not statistically different in the familial versus the non-familial group. Of the 3449 siblings, 20 (0.58%) had suffered a RIA. The recurrence risk ratio calculated for siblings (defined as the risk of disease among siblings divided by the estimated population prevalence) is 1.6 (CI 95% 1.0-2.4). In other respects, we observed very large kinships in the SLSJ population, with an average number of siblings of 7.2 (SD +/- 3.4), ranging from 0 to 17 individuals. With such large families and on the basis of chance alone, we expected 31.3% of the patients to have at least one first- to third-degree relative with RIA. CONCLUSION: These data show that siblings of patients with RIA in the SLSJ population have a greater risk of RIA than the general population. Nevertheless, the largest part of the familial occurrence observed in the SLSJ region can be explained by accidental aggregation, due to large kinships. We propose that, in this population, an underlying genetic predisposition must be suspected only when three or more cases of RIA are identified among first- to third-degree relatives.

Dental sealants. Who needs them?

Most childhood tooth decay is preventable with a combination of fluoride--which protects the smooth surfaces of a tooth--and dental sealants--which protect tooth surfaces with irregularities called pits and fissures. Sealants are plastic coatings that protect these vulnerable areas, often narrower than a single toothbrush bristle, from decay-causing bacteria and food in the mouth. Yet, 1988-1991 data from the National Health and Nutrition Examination Survey showed that while many children still had cavities, over 80% of which were related to pits and fissures, relatively few children had sealants applied to permanent teeth. As caries has gone from a ubiquitous disease to one affecting only half of children in early elementary school and two-thirds of those who are 15 years of age, dentists must consider how to best target sealants to individual children who are at greatest risk for new disease. Most sealants are placed in private dental offices, but children at greatest risk for problems resulting from tooth decay are least likely to get private care. State and local health departments, therefore, have gone after hard-to-reach children and adolescents through school-based and school-linked sealant programs, often using portable dental equipment. This article focuses on public health strategies for community-based prevention.

Preoperative diagnosis of conjoined roots anomaly with herniated lumbar disks.

Twelve cases of nerve root anomalies encountered during investigation for low back pain and sciatica are presented. Most of these patients had a herniated lumbar intervertebral disk and were operated upon with the preoperative knowledge of an associate nerve root malformation. Three patients were found to have a symptomatic nerve root malformation without disk herniation. These patients were conservatively treated. In all cases we found a constant myelographic sign that is described.

[Systematic family nursing intervention applied to the birth of a disabled child: effects on the parents' adaptation]. / Une intervention infirmière familiale systémique appliquée dès la naissance d'un enfant ayant une déficience: les effets sur l'adaptation des parents.

This quasi-experimental study evaluated the effectiveness of a new systemic family nursing intervention to facilitate the adaptation of parents with a handicapped child, as well as variations in effectiveness according to the gender of the parent, family income, and type of handicap. Conducted over a 6-month period, the intervention began immediately after birth and included the participation of 198 mothers and fathers of 6-month-old babies with Down syndrome or a cleft lip and/or palate. Half of the group received the intervention, while the other half, constituting the control group, received regular services. Emotional distress was measured, as were various aspects of parental stress. The results confirm the program's effectiveness. Almost all parental stress indicators showed less stress among parents who received the intervention. For some indicators, the effect of the intervention varied with the parent's gender. No significant correlation was found to exist between the program's effectiveness and family income or type of handicap. These results are discussed in light of the goals of the intervention, various aspects of parental adaptation, and a number of factors that may be linked to the effectiveness of the intervention.

Longitudinal effects of an early family intervention programme on the adaptation of parents of children with a disability.

This study assesses the longitudinal effects of an original early intervention programme on the adaptation of parents of children with a disability (Down syndrome and cleft lip/palate, i.e. DS and CLP). Variations in the effects of the programme according to the time of measurement, the type of disability and parent's gender are also examined. Globally, the results show a better adaptation among parents who participated in the intervention programme compared to those who did not participated in the programme. These parents had lower levels of parental stress, they had more positive perceptions and attitudes concerning their child's disability and their parental situation, they were more confident in their own resources and the help they could receive from others, they had lower levels of emotional distress, anxiety and depression and they perceived more emotional support from their spouse. In general, these gains were maintained throughout the year when the children were between six and 18 months of age, they were relatively similar for parents of children with DS and parents of children with CLP, as well as for mothers and fathers.

[Early surgery of intracranial aneurysms]. / Chirurgie précoce des anévrysmes intracraniens.

In spite of scientific progress during the last two decades, microsurgery, neuroanesthesiology, and a better knowledge of the pathophysiology of cerebral vasospasm, the outcome of subarachnoid hemorrhage (S.A.H.) patients remains very poor. Each year, 28,000 North Americans are afflicted. Eighteen thousand of these patients will either die or become severely debilitated, a mortality morbidity of 64%. Only one patient out of five may return to the premorbid state. International cooperative studies report that the highest rate of rebleeding occurs during the first 24 hours post S.A.H. There is no rebound phenomenon during the 7th-8th day post S.A.H. Cerebral vasospasm begins during the 2d-4th day post S.A.H. and reaches its peak around the 8th day post bleed. Antifibrinolytics like AMICAR (aminocaproic acid) do not reduce significantly the rebleeding rate. In most of the cases the therapeutic level of these drugs is reached only on the third or fourth day of treatment. Hence antifibrinolytics are inactive during the first crucial seventy two hours. Antifibrinolytics increase the incidence of vasospasm, hydrocephalus, and thromboembolic phenomenon. At Infant Jesus Hospital, Quebec City, S.A.H. patients are operated on early since more than two years. Patients included in this study were admitted between January 1983 and December 1984. One hundred and thirty six patients were operated upon, 22 patients operated on acutely, less than 72 hours post S.A.H. Evaluation of these patients included the Glasgow Coma Scale (G.C.S.), the grade according to Botterell classification, a CT Scan, and angiography. A preoperative evaluation included Botterell classification and G.C.S., a post operative evaluation was performed during the first and seventh post operative days.(ABSTRACT TRUNCATED AT 250 WORDS)

[Deinstitutionalization : community-orientated services and training of workersts.]. / Désinstitutionnalisation, «communautarisation¼ des services et formation des intervenants.

The "deinstitutionalization" of services and their community uses imply important modifications in our professional practices. The citizen, the parent and the community resources become necessary partners in the care of the person maladjusted to his family and community environment. This change means that our social values have to undergo important modifications so that parents and citizens are recognized the abilities and resources to assist the actions of the professional services'networks. We have to study what professional abilities need to be developed in the different community environment to respect and give value to these new resources of the human and social ecology. A pedagogy of services has to be thought of in order to prepare both parent and citizen to be responsible for certain needs in the family and community. The training and the specialization of the personnel is in need of pedagogical strategies that will trancend the theoretical knowledge and will take account the environment's know how. In other words, strategies that will blend the theoretical knowledge with the Empirical one. Two training experiences are presented: one implies the initial training (Research project and in the house intervention) and the other is involved with the training of network's helpers (Community integrated services). Those experiences are two among others which illustrate the need to define the relationship between power and knowledge in order to help the growth of true institutional alternatives in education, psychiatry, social work. Finally, we should ask what type of society facilitates the collaboration between alternative professional resources and mutual aid?

[Not Available]. / L'annonce d'une déficience motrice cérébrale : Une relation de confiance à construire entre les parents, le personnel paramédical et les médecins.

The disclosure of a diagnosis of cerebral palsy and its related disabilities is a difficult situation for parents, caregivers and physicians. A literature review shows that for the past 20 years, the number of dissatisfied parents has not changed. The goal of this qualitative and exploratory study - made at the request of the rehabilitation community - is to describe the process by which a diagnosis of cerebral palsy is disclosed, from the perspective of the people involved, and to determine what factors foster or inhibit a trusting relationship. Results show that parents, caregivers and physicians have two different perspectives at the time of disclosure, and it is difficult for them to agree. Parents are overwhelmed by the tragedy, while physicians are focused on the information they are providing. The disclosure creates great uncertainty that can block communication among parents, caregivers and physicians, but it could also be used to stimulate new coping strategies.

A study of inbreeding and kinship in intracranial aneurysms in the Saguenay Lac-Saint-Jean region (Quebec, Canada).

The genealogies of 533 individuals with an intracranial aneurysm (IA) born in the Saguenay-Lac-Saint-Jean region, a geographically isolated area located in northeastern Quebec, were reconstructed using a population-based register. A control group consisting of three individuals of the same sex and born on the same day and in the same municipality than the IA patients was created; the genealogies of the 1599 controls were also reconstructed. The coefficients of inbreeding and kinship were calculated. Familial aggregation, i.e. the presence of IA in two or more first- to third-degree relatives, was also sought. The mean inbreeding coefficient was lower in the IA group than in the control group (7.92 x 10(-4) versus 10.04 x 10(-4)). The mean kinship coefficient was higher in the IA group than in the control group (2.17 x 10(-4) versus 1.55 x 10(-4)). Forty-eight IA patients (9.0%) were first-degree relatives compared to only 1.9% of the control individuals. The proportion of individuals showing familial aggregation was higher in the IA group than in the control group (29.8% and 18.6% respectively). These results strongly suggest that some IA are genetically determined in this population.

Adaptation of parents in relation to their 6-month-old infant's type of disability.

The adaptation of parents to a disabled infant was studied in relation to the type of disability presented by the baby. Participants were divided according to three types of disability and one control group: patents of infants with (1) Down's syndrome (DS), (2) congenital heart disease (CHD), (3) a cleft lip and/or palate (CLP), and (4) no disability (ND). The data were collected using a self-administered questionnaire given to each parent 6 months after the birth of their baby. The measures included parenting stress, stress appraisal, and psychological distress. Overall, the results indicate that parents of infants with DS and parents of infants with CHD report greater levels of parenting stress and psychological distress than parents of babies with CLP or non-disabled infants. Mothers were found to report greater levels of stress and distress overall, but differences across diagnostic groups were similar for mothers and fathers. The implications of the findings for theory and clinical intervention are discussed.

Citalopram versus maprotiline: a controlled, clinical multicentre trial in depressed patients.

In a double-blind trial, comprising 96 depressed patients, citalopram was compared with maprotiline. The trial period was 6 weeks with ratings (MADRS, CGI) and side effects recordings taking place at Weeks 0, 1, 2, 4, and 6. Both drugs were administered as a single evening dose, 40 or 60 mg for citalopram, and 75 or 150 mg for maprotiline. MADRS total scores and CGI scores showed a highly significant reduction in both groups with no significant difference between them, whether the groups were considered as a whole or whether they were subdivided into endogenously/non-endogenously depressed or melancholic/non-melancholic patients. Side effects were not significantly different, but the maprotiline group showed more anticholinergic side effects, whereas the citalopram group showed more nausea, increased sweating and headache. Two patients on maprotiline were withdrawn because of side effects (hypotension and somnolence in the one case; tremor and insomnia in the other). One patient in each group was withdrawn because of increased transaminases, the citalopram-treated patient having increased values, however, already at baseline. Apart from this, no cardiovascular side effects and no pathological laboratory values related to treatment were observed. The authors conclude that citalopram is a safe antidepressant drug and as effective as maprotiline.