["Responding to vulnerability": Ethics and CHSLD in the Age of COVID-19]. / « Répondre à la vulnérabilité ¼ : l'éthique et les CHSLD au temps de la COVID-19.

The intrusion of the COVID-19 in Quebec witnesses the failure of seniors' residences to adequately protect their residents. The long-standing carelessness of an entire society towards frail elderly people has become clear. The text is divided into two parts. The first part shows that as much as the Quebec hospital, under the direction of the Ministry of Health, was ready to deal with the pandemic, as long-term centres for people with loss of autonomy were not. The second part discusses the type of ethics that guided officials in their decisions. This type of ethics does not seem to me to be consistent with the ethical vision that would be appropriate in long-term care. Ethics should be one that corresponds to the nature of these centres, it should be a response to vulnerability. The conclusion calls for citizen dialogue to arrive at an appropriate response to the situation of these people.

Iron status and intake of older infants fed formula vs cow milk with cereal.

One hundred four infants were randomly assigned to receive whole cow milk plus iron-fortified cereal (WCM + C) in accord with the previous recommendations of the Committee of Nutrition/American Academy of Pediatrics (CON/AAP); one of two iron-fortified, follow-up formulas; or an iron-fortified infant formula. Mean iron intakes and vitamin C exceeded the recommended dietary allowance in all groups. By 12 mo of age, mean ferritin and mean corpuscular volume were lower in the WCM + C group and significantly more infants had serum ferritin concentrations < 12 micrograms/L. We conclude that infants 6-12 mo of age fed whole cow milk and iron-containing table food are at risk of developing depleted iron stores but not anemia. The iron insufficiency in these infants is not due to inadequate intake of iron or vitamin C, but probably to relatively poor bioavailability of iron in infant cereal.

Low birth weight and household structure.

Data collected during postnatal visits were used to study the risk of low birth weight (LBW) among unmarried women living alone and among unmarried women living with a partner or another adult, using married women living with their husbands as the reference group. Information on 1,627 singleton live births was included in a binomial regression, controlling for seven potential confounding variables: mother's age, education, gestational weight gain, parity, smoking status, and presence of medical problems preceding or during pregnancy. Unmarried women living alone were at greater risk of bearing a LBW infant than married women living with their husbands (RR = 2.0, 95% Cl = 1.2-3.4). Unmarried women living with a partner had a slightly lower risk of LBW than married women (RR = 0.6, 95% Cl = 0.3-1.3) and unmarried women living with another adult had a slightly increased risk (RR = 1.3, 95% Cl = 0.6-3.0), although neither of these results was statistically significant. On the basis of these findings, we suggest that public health interventions should target women according to their household structure rather than their marital status.

Parent report as a means of administering the prescreening developmental questionnaire: an evaluation study.

The increasing emphasis on screening the pediatric population for developmental delays requires that rapid and efficient screening tests be developed and evaluated. This study assessed the ability of three rapid screening procedures to predict full Denver Developmental Screening Test (DDST) results. Ninety children were randomly assigned to one of three prescreening groups. The first group was prescreened with the Prescreening Developmental Questionnaire (PDQ), administered in the "standard" fashion, i.e., mother reads and answers 10 questions about her child's development. The second group was prescreened using a modified means of administering the PDQ (PDQ-M); a health care professional read each PDQ question to the mother. The third group was prescreened with the Alpern-Boll Developmental Profile II, a relatively lengthy procedure utilizing parent report information. All of the children were then tested with the DDST. Each of the prescreening procedures was highly predictive of performance on the DDST. The Alpern-Boll profile, as anticipated, demonstrated greater validity than the PDQ and PDQ-M on six of seven indices of prescreening test validity, generated from a four-group referral matrix. The PDQ-M was more similar to the Alpern-Boll on four indices, while the PDQ was more similar on three. It was judged that the two PDQ procedures were equivalent in their validity characteristics. The PDQ-M appears to be an acceptable means of rapidly screening preschool children for developmental delays.

Measurement of H- density in plasma by photodetachment.

Techniques have been developed for measurement of the density of H- in a plasma by photodetachment. Photodetachment is detected by the increase in electron density with no change in positive ion density after a light pulse from a ruby laser. The authenticity of photodetachment signals can be assured by their comparison with known cross sections for photodetachment of H-. Interpretations of photodetachment data are less ambiguous than probe interpretations because photodetachment is not affected by the mass of positive ions and is not limited in usefulness by the Debye distance. Photodetachment measurements with time resolution and spatial resolution are straightforward.

Risk of low birthweight and prematurity among foreign-born mothers.

Data collected during postnatal visits were used to study the risk of low birthweight (LBW) and prematurity among foreign-born mothers and mothers born in Canada. 2,913 singleton live births were included in the analysis. Odds ratios (OR) and 95% confidence intervals (CI) for LBW and prematurity were estimated using a logistic regression model. Foreign-born mothers did not have a higher risk of LBW or prematurity as compared to native-born mothers (OR = 1.1, 95% CI = 0.8-1.5; OR = 1.0, 95% CI = 0.7-1.4, respectively). For both LBW and prematurity, women in the intermediate category of length of stay (1-3 years) had a somewhat lower risk and women with the shortest length of stay (less than one year) had a slightly higher risk than women with the longest length of stay (more than 3 years). However, none of these results was statistically significant. Results of this study suggest that foreign-born mothers do not have a higher risk than Canadian-born mothers of bearing a LBW or premature infant. This finding differs from the widespread perception that immigrant mothers are at high risk for adverse birth outcomes.

Framing genomics, public health research and policy: points to consider.

Genetic information can be used to target interventions that improve health and prevent disease. Indeed, the results of population genomics research could be useful for public health and national pandemic plans. Yet, firm scientific evidence originating from such research and the indicators of the role of health determinants, gene-gene and gene-environment interaction remain to be assessed and validated before being integrated into pandemic plans or public health programmes. It is not clear what is the role of the State in research on the elucidation of the determinants of gene-gene and gene-environment interactions and how, when, and if such data can be accessed and used for such planning. Over a period of 3 years, we sought to address these questions by gathering data and literature relevant to research in public health genomics, preparing issues papers and, finally, consulting with stakeholders on a provisional 'points to consider' document at various times. Examining in turn the issues of privacy, State powers, stakeholder perceptions, and public participation, we propose in this article, for each of these themes, a series of recommendations aiming to provide guidance on the role of the State in the use of genomic information for public health research, prevention and planning.

[Ethics and contraception in adolescence]. / Ethique et contraception à l'adolescence.

PIP: In the 1st part of his article, the author describes adolescent sexuality as it exists today. The cultural codes which, in the past, had been established to prevent pregnancy are no longer appropriate. To propose moral statements about adolescent contraception remains full of hazards for several reasons. The 2nd section presents some landmarks which would contain ethical reflections concerning adolescent contraception. The author says that adolescent contraception must no longer be couched in secrecy as it has been in the past. Adolescent responsibiltiy while sexually active is another item which is addressed in this section. However, this responsibility is almost impossible in a society without an ethical model. It is also shown that real responsibility requires early sexual education. Finally, the author challenges some current medical practices in the field. He points out that the doctor functions as an educator. (author's modified)^ieng

[Contributions of ethics to the practice of intensive care]. / La contribution de l'éthique à la pratique de la médecine intensive.

Intensive care, one of the greatest achievements of modern medicine, is not without its problems. In what sense could ethics contribute towards an intensive care medicine which would be humane and respectful of what it means to be sick? After having presented a phenomenology of what it means to be sick and in intensive care, the author proposes an ethical framework which could guide the decision-making of physicians specialized in the field. This framework has three levels. Level one deals with the basic values of benevolence and autonomy which are those of medicine itself. Level two deals with the implementation of these values, which bioethics sees as conflicting. Implementation is achieved by "conversation" between the physician and the patient. Finally, the physician is invited to question his or her own attitude towards the unavoidable dilemmas created by the paradoxes and contradictions of modern medicine.

Gastric rupture and death caused by ipecac syrup.

We have reported a fatal complication of a therapeutic dose of ipecac syrup administered in a hospital emergency room. This child received 15 ml of ipecac syrup shortly after ingesting one to five tablets of chlorpheniramine maleate (4 mg). A prolonged course of vomiting (more than 24 hours) eventually resulted in gastric rupture and death. While the use of ipecac is both efficacious and safe in the overwhelming majority of cases, there have been documented fatalities after appropriate doses. For this reason, ongoing education for physicians is important; education of parents is also warranted since wide-scale distribution to families is the accepted standard. Because most patients stop vomiting within two to three hours after ipecac administration, we recommend that children with persistent vomiting should be observed in a medical facility, where electrolyte levels can be measured and fluids can be replaced if necessary.

A curriculum for teaching clinical ethics in neonatal-perinatal medicine.

Ethical thought plays a role in clinical decision-making, especially in fields such as neonatal-perinatal medicine. There is limited information, however, on the best way to teach ethics to postgraduate medical trainees in this subspeciality. This article describes the development, implementation, and evolution of a structured curriculum in ethics for a program in neonatal-perinatal medicine. The curriculum is facilitated by a specialist in ethics and based on hypothetical case scenarios, which are discussed using a framework that highlights the ethical values promoted or neglected in each decision option. Formal evaluation of the program has been impossible, but informal reviews indicate that there is a high degree of satisfaction.

A new tetratertiary phosphine ligand and its use in Pd-catalyzed allylic substitution.

A new tetraphosphine, the cis-cis-cis-1,2,3,4-tetrakis(diphenylphosphinomethyl)cyclopentane (Tedicyp) 1 has been synthesized, characterized, and used in Pd-catalyzed allylic substitutions. The Tedicyp was easily prepared in seven steps from the commercially available himic anhydride. The structure of the complex Tedicyp-borane was determined by X-ray analysis. The tetraphosphine in combination with [Pd(eta(3)-C(3)H(5))Cl](2) affords a very efficient catalyst for allylic substitution of several allylic acetates. Under mild conditions, very high turnover numbers and turnover frequencies have been obtained.

Developmental expression of alcohol dehydrogenase (ADH3) in zebrafish (Danio rerio).

Alcohol dehydrogenase (ADH) is the primary enzyme responsible for metabolism of ethanol to acetaldehyde. One class of ADH has been described in fish, and has been found to be structurally similar to mammalian class III ADH (glutathione-dependent formaldehyde dehydrogenase) but functionally similar to class I ADH (primarily responsible for ethanol metabolism). We have cloned a cDNA by RT-PCR from zebrafish (Danio rerio) liver representing the zebrafish ADH3 gene product, with a coding region of 1131 nucleotides. The deduced amino acid sequences share 90% identity to ADH3 from the marine fish Sparus aurata, and 82 and 81% identity to the mouse and human sequences, respectively. Using a quantitative competitive RT-PCR assay, ADH3 mRNA was detected at all timepoints analyzed and was lowest between 8 and 24 h postfertilization. Thus, differential ADH3 expression may be at least partly responsible for temporal variations in the sensitivity of zebrafish embryos to developmental alcohol exposure.

Comparison of internal medicine, pediatric, and medicine/pediatrics applicants and factors influencing career choices.

BACKGROUND: A reemergence of medical students choosing primary care is occurring, with medicine/pediatrics as an increasingly popular option. We compared applicants to pediatrics, medicine, and medicine/pediatrics and the factors that influence career choice. METHODS: We designed a survey to gather objective data and information shown to influence career choices. Applicants interviewing in our three primary care programs completed the survey. RESULTS: Pediatric applicants were more likely to be women and to choose their career in the 2nd year of medical school. Medicine/Pediatrics applicants had the highest interest in practicing primary care and in pursuing an academic career. However, they had the smallest number of role models. The average education debt was the same. CONCLUSION: Differences in applicants applying to primary care programs may be used to target particular applicants and to counsel medical students on career choice.

Association of bone mineral density and pediatric fractures.

Bone mineral density in the lumbar spine and the left femoral neck was measured for a group of 17 children, 3-14 years of age, who had sustained traumatic fractures. Children with any signs of metabolic bone disease were excluded from the study. Identical measurements were made on an age- and sex-matched control population using dual photon absorptiometry. Analysis of bone mineral measurements revealed that there were no statistically significant differences between the lumbar and femoral neck densities of the two groups. The results indicate that reduced bone density is unlikely to play a significant role in acute traumatic pediatric fractures.

Reflexiones éticas sobre la medicina personalizada: ¿la alianza entre la ciencia y la medicina, realizada por fin / Réfl exions éthiques sur la médecine personnalisée: l’alliance de la science et de la médecine enfi n réalisée?

La medicina personalizada es la última corriente médica del momento y podría imponerse en la práctica médica a partir del 2010. La medicina personalizada se caracteriza por la utilización de datos derivados principalmente de la genómica, con el fin de escoger terapias hechas a la medida para cada paciente. Si bien las grandes corrientes de pensamiento representan, con frecuencia, una revolución con respecto al modo de pensamiento precedente, se insertan, sin embargo, en un continuum que busca establecer la unión entre ciencia y medicina. Los promotores de la medicina personalizada consideran que se logrará la alianza y, al mismo tiempo, garantizará el devenir de una medicina eficaz y segura. A pesar de las grandes promesas de la medicina personalizada y sus próximas aplicaciones en diferentes especialidades médicas como la cardiología y la oncología, es necesario superar numerosos retos y obstáculos para su aplicación real en clínica. También es importante evaluar de manera ética y crítica esta nueva forma de medicina que pretende ser a la vez más científica y más individualizada. De una parte, la refl exiónética obliga a afrontar los retos generalmente asociados a la genómica y a cuestionar realmente el aporte de nuevos datos científicos a la medicina. De otra parte, esta reflexión también obliga a evaluar la paradoja de la medicina personalizada que intenta fundamentarse sobre datos científi cos sólidos, ciertos y generalizables, con el fin de adaptarse a la situación única e incierta de un paciente.