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1.
Environ Entomol ; 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38748595

RESUMO

During the eradication program undertaken against Anoplophora glabripennis (Motschulsky) in the Greater Toronto Area, information was collected on the numerous signs of injury found on wounded trees. Herein, we used a portion of this information to assess the characteristics of logs with signs of oviposition (i.e., pits). Specifically, we related the basal diameter, type (log bole vs. log branch), height above ground, and branch hierarchy level of logs with pits to tree size (i.e., height and diameter at breast height) and level of infestation intensity. In general, pits were concentrated on logs from the bole and branches that were 8-14 cm in diameter in the lower 8 m of the bole and in the first 2 levels of the branching hierarchy. Oviposition pit location was strongly influenced by tree size-both height and diameter at breast height, with more pits on the lower bole in small trees and then higher on the bole and into the branches as tree size increased. As tree-level infestation intensity increased, pits were found on both larger and smaller diameter portions of the trees, presumably as preferred oviposition sites became saturated. These findings can improve the efficacy of surveillance activities for A. glabripennis.

2.
J Econ Entomol ; 114(4): 1622-1630, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-33959749

RESUMO

The wool of the invasive, non-native hemlock woolly adelgid, Adelges tsugae Annand (Hemiptera: Adelgidae), occurs mostly on hemlock (Tsuga sp.) twigs, but can be dislodged from the canopy and end up on the forest floor and tree stem underneath the canopy. Herein, we developed and tested the efficacy of two novel sampling techniques, which are based on a visual examination of the forest floor and the hemlock stem for A. tsugae wool. Subsequently, we compared these two techniques to a visual examination of foliage and ball sampling which are two methods currently used operationally. We sampled 11 hemlock stands, with low to moderate incidence A. tsugae populations, near Ithaca, New York in 2016 and assessed the probability of detecting wool on a tree and in a stand, as well as the relative variation and relative net precision for each of the four techniques. We found that sampling the tree stem outperformed foliage and ground sampling, likely because of its higher detection rate and lower relative variation, but not ball sampling. Our findings suggest that combining stem, ball and ground sampling was the most effective combination of techniques and gave a high probability of detecting an infested tree or an infested stand. All techniques were an improvement over foliage sampling, even after increasing the foliage sampling effort fivefold.


Assuntos
Hemípteros , Animais , Florestas , New York , Tsuga ,
3.
J Econ Entomol ; 113(1): 496-503, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-31588491

RESUMO

We developed an approach using sticky trap arrays as an early detection tool for populations of first-instar nymphs of the hemlock woolly adelgid (Adelges tsugae Annand), a pest of hemlocks (Tsuga spp. [Pinaceae]) in North America. We considered the detection rate of at least one nymph from trapping arrays consisting of one to six sticky panels, where we varied both the surface area of each trap that we assessed and the length of the trapping duration. We also estimated the time needed to set up, service, and assess groups of traps and attempted to relate capture of nymphs on traps to incidence and abundance of A. tsugae in the canopy above the traps. Arrays consisting of two traps provided a detection rate of 75% when 87.5% of the surface area of each trap was assessed, a process that required 38 min per array. The probability of detecting nymphs on traps left in the field for 5-6 d was similar to that for traps left for 12 d. The number of nymphs trapped in an array predicted the probability of finding A. tsugae in the canopy but only when all six traps were fully assessed. To reliably detect incipient A. tsugae infestations, we recommend placing arrays of traps at 1 km intervals along the perimeter of a stand during peak activity of first-instar sistentes nymphs and servicing these arrays every 5-7 d.


Assuntos
Hemípteros , Animais , América do Norte , Ninfa , Tsuga
4.
PLoS One ; 13(10): e0206001, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30332473

RESUMO

INTRODUCTION: Kawasaki disease (KD) can be associated with concomitant viral or bacterial infections. Children with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications. Although concomitant infection does not affect coronary outcome, it is unknown how it influences the response to IVIG treatment. METHODOLOGY: Retrospective cohort study between 2008 and 2016 in a tertiary pediatric university hospital, including 154 children, of which 59 (38%) had concomitant infection. RESULTS: Children with concomitant infection were more likely to have fever 48 hours after initial IVIG treatment (36% vs 20%, p = 0.05) and to be treated with a second dose (33% vs 18%, p = 0.04). Children with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p = 0.04), and 48 hours after IVIG administration (111 vs 59 mg/L, p = 0.003). Nevertheless, there was no statistically significant difference in the prevalence of coronary complications (Z-score > 2.5) between children with and without concomitant infection (36% vs 39%, p = 0.68). CONCLUSION: Children with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment. This association increases the likelihood of receiving a second dose of IVIG but not the risk of coronary complication. Accordingly, prospective studies to distinguish true IVIG resistance from infection induced persistent fever is warranted.


Assuntos
Doenças Transmissíveis/complicações , Resistência a Medicamentos , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Proteína C-Reativa/metabolismo , Pré-Escolar , Doença da Artéria Coronariana/etiologia , Feminino , Febre/etiologia , Humanos , Imunoglobulinas Intravenosas/efeitos adversos , Masculino , Síndrome de Linfonodos Mucocutâneos/microbiologia , Síndrome de Linfonodos Mucocutâneos/virologia , Resultado do Tratamento
5.
PLoS One ; 12(7): e0181482, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28759584

RESUMO

Uncertainty about future spread of invasive organisms hinders planning of effective response measures. We present a two-stage scenario optimization model that accounts for uncertainty about the spread of an invader, and determines survey and eradication strategies that minimize the expected program cost subject to a safety rule for eradication success. The safety rule includes a risk standard for the desired probability of eradication in each invasion scenario. Because the risk standard may not be attainable in every scenario, the safety rule defines a minimum proportion of scenarios with successful eradication. We apply the model to the problem of allocating resources to survey and eradicate the Asian longhorned beetle (ALB, Anoplophora glabripennis) after its discovery in the Greater Toronto Area, Ontario, Canada. We use historical data on ALB spread to generate a set of plausible invasion scenarios that characterizes the uncertainty of the beetle's extent. We use these scenarios in the model to find survey and tree removal strategies that minimize the expected program cost while satisfying the safety rule. We also identify strategies that reduce the risk of very high program costs. Our results reveal two alternative strategies: (i) delimiting surveys and subsequent tree removal based on the surveys' outcomes, or (ii) preventive host tree removal without referring to delimiting surveys. The second strategy is more likely to meet the stated objectives when the capacity to detect an invader is low or the aspirations to eradicate it are high. Our results provide practical guidelines to identify the best management strategy given aspirational targets for eradication and spending.


Assuntos
Besouros/fisiologia , Espécies Introduzidas , Segurança , Animais , Conservação dos Recursos Naturais/métodos , Tomada de Decisões , Geografia , Modelos Biológicos , Ontário , Probabilidade , Risco , Árvores , Incerteza
6.
BMC Pediatr ; 17(1): 72, 2017 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-28292285

RESUMO

BACKGROUND: Orofacial clefts are usually isolated cases but can be associated with other congenital malformations that are either recognised or unrecognised syndromes. The reported prevalence and pattern of such associated malformations, however, vary among studies. OBJECTIVES: To assess the frequencies and aetiologies of congenital malformations and associated medical conditions in children with orofacial clefts in Burkina Faso (Western Africa). METHODS: A retrospective descriptive study was carried out at the El Fateh-Suka Clinic in Ouagadougou, Burkina Faso. All children who attended surgery for the repair of a cleft lip and/or palate were included in this study. RESULTS: The frequency of congenital malformations associated with cleft lip and/or palate was 39/185 (21.1%). In the group with multiple congenital malformations of unknown origin (34 patients; 18.4%), 66.7% had cleft lip and palate, followed by isolated cleft lip (27.4%) and isolated cleft palate (5.9%). The digestive system (35.3%), the musculoskeletal system (19.6%), and eye, ear, face, and neck (15.7%) were the most affected systems. In the group of syndromic malformations (five patients; 2.7%), amniotic band syndrome (one patient), Van der Woode syndrome (one patient), Goltz syndrome (one patient), and holoprosencephaly (two patients) were identified. Medical conditions included anaemia (39.4%), infections (9.2%), malnutrition (7.5%), and haemoglobinopathies (4.3%). CONCLUSIONS: Congenital malformations and medical co-morbidities were frequent in children with OFCs. Further studies and a National Malformations Registry are needed to improve the comprehension of OFCs in Burkina Faso.


Assuntos
Anormalidades Múltiplas/epidemiologia , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Adolescente , Burkina Faso/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Síndrome
7.
J Environ Manage ; 193: 188-200, 2017 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-28226258

RESUMO

Assessing risks of uncertain but potentially damaging events, such as environmental disturbances, disease outbreaks and pest invasions, is a key analytical step that informs subsequent decisions about how to respond to these events. We present a continuous risk measure that can be used to assess and prioritize environmental risks from uncertain data in a geographical domain. The metric is influenced by both the expected magnitude of risk and its uncertainty. We demonstrate the approach by assessing risks of human-mediated spread of Asian longhorned beetle (ALB, Anoplophora glabripennis) in Greater Toronto (Ontario, Canada). Information about the human-mediated spread of ALB through this urban environment to individual geographical locations is uncertain, so each location was characterized by a set of probabilistic rates of spread, derived in this case using a network model. We represented the sets of spread rates for the locations by their cumulative distribution functions (CDFs) and then, using the first-order stochastic dominance rule, found ordered non-dominant subsets of these CDFs, which we then used to define different classes of risk across the geographical domain, from high to low. Because each non-dominant subset was estimated with respect to all elements of the distribution, the uncertainty in the underlying data was factored into the delineation of the risk classes; essentially, fewer non-dominant subsets can be defined in portions of the full set where information is sparse. We then depicted each non-dominant subset as a point cloud, where points represented the CDF values of each subset element at specific sampling intervals. For each subset, we then defined a hypervolume bounded by the outermost convex frontier of that point cloud. This resulted in a collection of hypervolumes for every non-dominant subset that together serve as a continuous measure of risk, which may be more practically useful than averaging metrics or ordinal rank measures. Overall, the approach offers a rigorous depiction of risk in a geographical domain when the underlying estimates of risk for individual locations are represented by sets or distributions of uncertain estimates. Our hypervolume-based approach can be used to compare assessments made with different datasets and assumptions.


Assuntos
Modelos Teóricos , Medição de Risco , Animais , Meio Ambiente , Geografia , Humanos , Incerteza
8.
Pediatr Int ; 59(3): 265-270, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27589358

RESUMO

BACKGROUND: Diagnosis of Kawasaki disease (KD) can be challenging in the absence of a confirmatory test or pathognomonic finding, especially when clinical criteria are incomplete. We recently proposed serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an adjunctive diagnostic test. METHODS: We retrospectively tested a new algorithm to help KD diagnosis based on NT-proBNP, coronary artery dilation (CAD) at onset, and abnormal serum albumin or C-reactive protein (CRP). The goal was to assess the performance of the algorithm and compare its performance with that of the 2004 American Heart Association (AHA)/American Academy of Pediatrics (AAP) algorithm. RESULTS: The algorithm was tested on 124 KD patients with NT-proBNP measured on admission at the present institutions between 2007 and 2013. Age at diagnosis was 3.4 ± 3.0 years, with a median of five diagnostic criteria; and 55 of the 124 patients (44%) had incomplete KD. CA complications occurred in 64 (52%), with aneurysm in 14 (11%). Using this algorithm, 120/124 (97%) were to be treated, based on high NT-proBNP alone for 79 (64%); on onset CAD for 14 (11%); and on high CRP or low albumin for 27 (22%). Using the AHA/AAP algorithm, 22/47 (47%) of the eligible patients with incomplete KD would not have been referred for treatment, compared with 3/55 (5%) with the NT-proBNP algorithm (P < 0.001). CONCLUSION: This NT-proBNP-based algorithm is efficient to identify and treat patients with KD, including those with incomplete KD. This study paves the way for a prospective validation trial of the algorithm.


Assuntos
Algoritmos , Tomada de Decisão Clínica/métodos , Técnicas de Apoio para a Decisão , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Adolescente , American Heart Association , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Linfonodos Mucocutâneos/sangue , Estudos Retrospectivos , Estados Unidos
9.
Environ Entomol ; 45(2): 320-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26748671

RESUMO

A nonnative woodwasp, Sirex noctilio F., has established in pine forests in eastern North America. To facilitate prediction of the full range of impacts S. noctilio could have as it continues to spread in North American forest ecosystems, we studied the effects of infection by a nonsterilizing parasitic nematode on S. noctilio size, fecundity, and flight capacity and on the native woodwasp, S. nigricornis, size and fecundity. We also developed predictive models relating size to fecundity for both species. On average, S. noctilio (3.18 ± 0.05 mm) were larger than S. nigricornis (2.19 ± 0.04 mm). For wasps of similar size, S. nigricornis was more fecund. Nematode infection negatively affected potential fecundity by a mean difference of 36 and 49 eggs in S. noctilio and S. nigricornis, respectively. Nematode-infected males of S. noctilio, however, were larger than uninfected individuals. Nematode infection showed inconsistent results on mean speed and total distance flown by S. noctilio males and females. Nematode infection did not affect total distance flown by females, and so is unlikley to have a direct, or strong influence on S. noctilio flight capacity. Models developed to predict fecundity of Sirex spp. from body size, based on the close relationship between pronotum width and potential fecundity for both species (R(2) ≥ 0.69), had low measures of error when compared with true values of fecundity (± 25-26 eggs).


Assuntos
Tylenchoidea/fisiologia , Vespas/fisiologia , Vespas/parasitologia , Animais , Tamanho Corporal , Feminino , Fertilidade , Voo Animal , Espécies Introduzidas , Masculino , Ontário , Controle Biológico de Vetores , Especificidade da Espécie
10.
J Neurosurg Pediatr ; 17(1): 34-40, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26431247

RESUMO

OBJECT A major challenge in sagittal craniosynostosis surgery is the high transfusion rate (50%-100%) related to blood loss in small pediatric patients. Several approaches have been proposed to prevent packed red blood cell (PRBC) transfusion, including endoscopic surgery, erythropoietin ortranexamic acid administration, and preoperative hemodilution. The authors hypothesized that a significant proportion of postoperative anemia observed in pediatric patients is actually dilutional. Consequently, since 2005, at CHU Sainte-Justine, furosemide has been administered to correct the volemic status and prevent PRBC transfusion. The purpose of this study was to evaluate the impact of postoperative furosemide administration on PRBC transfusion rates. METHODS This was a retrospective study of 96 consecutive patients with sagittal synostosis who underwent surgery at CHU Sainte-Justine between January 2000 and May 2012. The mean age at surgery was 4.9 ± 1.5 months (range 2.8-8.7 months). Patients who had surgery before 2005 constituted the control group. Those who had surgery in 2005 or 2006 were considered part of an implementation phase because furosemide administration was not routine. Patients who had surgery after 2006 were part of the experimental (or furosemide) group. Transfusion rates among the 3 groups were compared. The impact of furosemide administration on transfusion requirement was also measured while accounting for other variables of interest in a multiple logistic regression model. RESULTS The total transfusion rate was significantly reduced in the furosemide group compared with the control group (31.3% vs 62.5%, respectively; p = 0.009), mirroring the decrease in the postoperative transfusion rate between the groups (18.3% vs 50.0%, respectively; p = 0.003). The postoperative transfusion threshold remained similar throughout the study (mean hemoglobin 56.0 g/dl vs 60.9 g/dl for control and furosemide groups, respectively; p = 0.085). The proportion of nontransfused patients with recorded hemoglobin below 70 g/dl did not differ between the control and furosemide groups (41.7% vs 28.6%, respectively; p = 0.489). Surgical procedure, preoperative hemoglobin level, estimated blood loss, and furosemide administration significantly affected the risk of receiving a postoperative PRBC transfusion. When these variables were analyzed in a multiple logistic regression model, furosemide administration remained strongly associated with a reduced risk of being exposed to a blood transfusion (OR 0.196, p = 0.005). There were no complications related to furosemide administration. CONCLUSIONS A significant part of the postoperative anemia observed in patients who underwent sagittal craniosynostosis surgery was due to hypervolemic hemodilution. Correction of the volemic status with furosemide administration significantly reduces postoperative PRBC transfusion requirements in these patients.


Assuntos
Craniossinostoses/cirurgia , Craniotomia/estatística & dados numéricos , Diuréticos/farmacologia , Transfusão de Eritrócitos/estatística & dados numéricos , Furosemida/farmacologia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/terapia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Craniotomia/efeitos adversos , Diuréticos/administração & dosagem , Feminino , Furosemida/administração & dosagem , Humanos , Lactente , Masculino
11.
Eval Program Plann ; 34(3): 196-205, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21555043

RESUMO

For more than a decade now, evaluation has developed considerably in France, thanks in particular to the Société Française de l'Évaluation, whose charter sets out a number of principles designed to guide the work of evaluators. This article examines how the evaluation process surrounding a regional public health plan (referred to as PRSP)--itself being a new instrument for regional planning in France--accords with one of these principles, which specifies that evaluation must be framed according to "a three-fold logic involving public management, democracy and scientific debate." Our analysis shows that while this evaluation was driven primarily by managerial concerns (i.e., assessing the capacity of the plan to structure health policy in a region), it also provided an Opportunity for restoring dialogue with a range of actors by opening up a space of cooperation and consultation. In addition, in order to ensure the legitimacy of the evaluation's conclusions, the knowledge produced by the evaluators had to rest on an irreproachable methodology. This example illustrates how evaluation, in the French tradition, is a process that strives to reconcile the viewpoints and expectations of managers, scientists and the general public; it is also a process that brings out lines of tension and areas of complementariness between these three logics.


Assuntos
Democracia , Políticas , Saúde Pública/métodos , Diversidade Cultural , Coleta de Dados , Tomada de Decisões , França , Humanos , Prática de Saúde Pública
12.
Environ Entomol ; 40(3): 679-88, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22251647

RESUMO

The emerald ash borer, Agrilus planipennis Fairmaire, is an exotic invasive insect causing extensive mortality to ash trees, Fraxinus spp., in Canada and the United States. Detection of incipient populations of this pest is difficult because of its cryptic life stages and a multiyear time lag between initial attack and the appearance of signs or symptoms of infestation. We sampled branches from open-grown urban ash trees to develop a sample unit suitable for detecting low density A. planipennis infestation before any signs or symptoms are evident. The sample unit that maximized detection rates consisted of one 50-cm-long piece from the base of a branch ≥6 cm diameter in the midcrown. The optimal sample size was two such branches per tree. This sampling method detected ≈75% of asymptomatic trees known to be infested by using more intensive sampling and ≈3 times more trees than sampling one-fourth of the circumference of the trunk at breast height. The method is less conspicuous and esthetically damaging to a tree than the removal of bark from the main stem or the use of trap trees, and could be incorporated into routine sanitation or maintenance of city-owned trees to identify and delineate infested areas. This research indicates that branch sampling greatly reduces false negatives associated with visual surveys and window sampling at breast height. Detection of A. planipennis-infested asymptomatic trees through branch sampling in urban centers would provide landowners and urban foresters with more time to develop and implement management tactics.


Assuntos
Besouros , Agricultura Florestal/métodos , Fraxinus/parasitologia , Animais , Cidades , Agricultura Florestal/economia , Árvores/parasitologia
14.
Annu Rev Entomol ; 55: 521-46, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19743916

RESUMO

The Asian longhorned beetle (ALB), Anoplophora glabripennis (Motschulsky), and citrus longhorned beetle (CLB), Anoplophora chinensis (Forster) (Coleoptera: Cerambycidae), are polyphagous xylophages native to Asia and are capable of killing healthy trees. ALB outbreaks began in China in the 1980s, following major reforestation programs that used ALB-susceptible tree species. No regional CLB outbreaks have been reported in Asia. ALB was first intercepted in international trade in 1992, mostly in wood packaging material; CLB was first intercepted in 1980, mostly in live plants. ALB is now established in North America, and both species are established in Europe. After each infestation was discovered, quarantines and eradication programs were initiated to protect high-risk tree genera such as Acer, Aesculus, Betula, Populus, Salix, and Ulmus. We discuss taxonomy, diagnostics, native range, bionomics, damage, host plants, pest status in their native range, invasion history and management, recent research, and international efforts to prevent new introductions.


Assuntos
Besouros , Interações Hospedeiro-Parasita , Controle de Insetos , Árvores/parasitologia , Animais , China , Besouros/classificação , Besouros/fisiologia
15.
Health Policy ; 81(1): 42-55, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16793169

RESUMO

More than three decades ago, the report A New Perspective on the Health of Canadians (1974) highlighted the significance of other determinants than the healthcare system. The adoption of healthy public policy was identified in the Ottawa Charter (1986) as one of five strategies aiming to promote health. It must now be acknowledged that even if we have a better understanding of health determinants, the latter are not necessarily taken into consideration when developing public policies. The purpose of this paper is to help foster a better understanding of the healthy public policies by presenting a conceptual framework that is inspired by the Advocacy Coalition Framework developed by Sabatier and Jenkins-Smith (1999). On the one hand, this paper intends to show the relevance of the notion of subsystem of public policies in healthy public policy process. On the other, it aims to convince that it is necessary to channel the analysis around the decision-making process, the prospective evaluation of public policies and the knowledge transfer and appropriation process. Finally, the purpose of this paper is to contribute to the ongoing debate about the role of knowledge, values or beliefs in the formulation and adoption of public policies. After briefly summarizing the theoretical developments in studies on public policies, the logic and components of the ACF are introduced. The main criticisms regarding the ACF are then examined, followed by an introduction of the conceptual framework that is adapted to the reality of healthy public policies. The notions of the subsystem of public policy(ies), of process and of learning process are central to this framework.


Assuntos
Defesa do Consumidor , Política de Saúde , Formulação de Políticas , Atenção à Saúde , Programas Nacionais de Saúde/legislação & jurisprudência , Quebeque
16.
J Palliat Med ; 9(4): 912-21, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16910806

RESUMO

BACKGROUND: Family caregivers caring for a patient with terminal cancer may experience significant psychological distress. OBJECTIVE: The purpose of this study was to determine the extent to which the family caregivers' psychological distress is influenced by the patients' performance status while taking into account individual characteristics of caregivers and their unmet needs. METHODS: Two hundred twelve family caregivers were assigned to three cohorts according to the patient's performance status, as measured by the Eastern Collaborative Oncology Group Functional Scale (ECOGS). Interview information was collected on the services and care provided, as well as on the caregivers' characteristics and level of psychological distress. RESULTS: Family caregivers' psychosocial distress is strongly associated with the patients' terminal disease progress and declined functioning. The level of psychological distress varies from 25.2 to 33.5 (p = 0.0008) between the groups. Moreover, the percentage of caregivers with a high level of psychological distress varies from 41% to 62%, while this percentage is estimated at 19.2% in general population. A high distress index was significantly associated with the caregiver's burden, the patient's young age, the patient's symptoms, the caregiver's young age and gender, a poor perception of his/her health and dissatisfaction with emotional and tangible support. CONCLUSIONS: Family caregivers of patients in the advanced stages of cancer experience a high level of psychological distress, which increases significantly as the patient loses autonomy. Health care policies and programs need to be revisited in order to take the reality of these patients and their families into account.


Assuntos
Cuidadores/psicologia , Família/psicologia , Neoplasias/classificação , Estresse Psicológico/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Neoplasias/fisiopatologia , Índice de Gravidade de Doença , Apoio Social , Estresse Psicológico/classificação
17.
Can Fam Physician ; 52(12): 1572-3, 2006 Dec.
Artigo em Francês | MEDLINE | ID: mdl-17327895

RESUMO

OBJECTIVE: Serious problems in the continuity of medical care provided to cancer patients are a frequent occurrence; the source of these problems is not well understood. The purpose of this research is to determine how these problems arise and how they are perpetuated. DESIGN: Qualitative descriptive study based on Anthony Giddens's theory of structuration. SETTING: Four teaching hospitals in the Quebec City region. PARTICIPANTS: Cancer patients (n = 62), family physicians (n = 14), and oncology specialists (n = 13). METHOD: Individual interviews were conducted with breast cancer and lung cancer patients. Their medical files were examined so that they could be ranked according to the stage of their disease. We also conducted individual interviews with a sampling of the patients' family physicians and oncology specialists at the hospitals participating in the study. An analysis of the content of the interviews was performed following the principles of grounded theory. MAIN FINDINGS: When conditions arise that are likely to lead to problems in the continuity of medical care, patients and physicians often try to compensate. Health care providers employ regulation strategies and patients and their families employ substitution strategies. Although these strategies generally get results, they constitute one-time actions by the physician or patient to circumvent a problem. And because they do not address the problem across the system, the source of the problem does not change. CONCLUSION: One of the unintentional consequences of the strategies used by clinicians and patients is the masking of the real issues involved in continuity of care; these strategies actually get in the way of in-depth changes based on the needs of the health care system as a whole.


Assuntos
Neoplasias da Mama/terapia , Continuidade da Assistência ao Paciente/normas , Hospitais de Ensino , Neoplasias Pulmonares/terapia , Neoplasias da Mama/epidemiologia , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Padrões de Prática Médica , Prevalência , Quebeque/epidemiologia , Inquéritos e Questionários
18.
Med Teach ; 27(1): 71-5, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16147774

RESUMO

Although qualitative research is gaining recognition in medicine and in medical education, most clinical teachers do not know how to perform a critical appraisal of articles in these fields. This article describes a grid for the critical appraisal of qualitative research articles so that clinical teachers are in a better position to evaluate this type of research and to teach the critical appraisal of it. The grid is comprised of 12 items with an explanation and suggestions for additional reading for each item.


Assuntos
Educação Médica , Publicações Periódicas como Assunto/normas , Pesquisa/normas , Coleta de Dados/normas , Interpretação Estatística de Dados , Humanos , Competência Profissional , Projetos de Pesquisa/normas
20.
Naturwissenschaften ; 91(10): 472-80, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15729760

RESUMO

Insects are considered the most important predators of seed cones, the female reproductive structures of conifers, prior to seed dispersal. Slightly more than 100 genera of insects are known to parasitize conifer seed cones. The most diverse (i.e., number of species) of these genera is Megastigmus (Hymenoptera: Torymidae), which comprises many important seed pests of native and exotic conifers. Seed chalcids, Megastigmus spp., lay eggs inside the developing ovules of host conifers and, until recently, oviposition was believed to occur only in fertilized ovules. Ovule development begins just after pollination, but stops if cells are not fertilized. The morphological stage of cone development at the time of oviposition by seed chalcids has been established for many species; however, knowledge of ovule development at that time has been documented for only one species, M. spermotrophus. Megastigmus spermotrophus oviposits in Douglas-fir ovules after pollination but before fertilization. Unlike the unfertilized ovules, those containing a M. spermotrophus larva continue to develop, whether fertilized or not, stressing the need to broaden our understanding of the insect-plant interactions for this entire genus. To achieve this task, we reviewed the scientific literature and assembled information pertaining to the timing of oviposition and to the pollination and fertilization periods of their respective host(s). More specifically, we were searching for circumstantial evidence that other species of Megastigmus associated with conifers could behave (i.e., oviposit before ovule fertilization) and impact on female gametophyte (i.e., prevent abortion) like M. spermotrophus. The evidence from our compilation suggests that seed chalcids infesting Pinaceae may also oviposit before ovule fertilization, just like M. spermotrophus, whereas those infesting Cupressaceae seemingly oviposit after ovule fertilization. Based on this evidence, we hypothesize that all species of Megastigmus associated with Pinaceae can oviposit in unfertilized ovules, whereas those exploiting Cupressaceae cannot, and thus oviposit only in already fully developed fertilized seeds. Furthermore, we predict that the presence of a larva in unfertilized ovules of all Pinaceae will influence the development of the female gametophyte by preventing its abortion. This influence on the Pinaceae can be interpreted as an ability to parasitize any of the potential seeds present in a seed cone, and as such represents a much more efficient oviposition strategy than searching and locating only fertilized seeds. Concomitantly, this ability has likely led to an overestimation of the impact of the species of seed chalcid infesting Pinaceae on seed production.


Assuntos
Insetos/fisiologia , Oviposição/fisiologia , Sementes/parasitologia , Traqueófitas/parasitologia , Animais , Feminino , Interações Hospedeiro-Parasita
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