RESUMO
Equinus and toe walking are common locomotor disorders in children with cerebral palsy (CP) walking barefoot or with normal shoes. We hypothesized that, regardless of the type of footwear, the plantar flexors do not cause early equinus upon initial foot contact but decelerate ankle dorsiflexion during weight acceptance (WA). This latter action promoted by early flat-foot contact is hypothesized to be functional. Hence, we performed an instrumented gait analysis of 12 children with CP (Gross Motor Function Classification System class: I or II; mean age: 7.2 yr) and 11 age-matched typically developing children. The participants walked either barefoot, with unmodified footwear (4° positive-heel shoes), or with 10° negative-heel shoes (NHSs). In both groups, wearing NHSs was associated with greater ankle dorsiflexion upon initial foot contact, and greater tibialis anterior activity (but no difference in soleus activity) during the swing phase. However, the footwear condition did not influence the direction and amplitude of the first ankle movement during WA and the associated peak negative ankle power. Regardless of the footwear condition, the CP group displayed 1) early flattening of the foot and ample dorsiflexion (decelerated by the plantar flexors) during WA and 2) low tibialis anterior and soleus activities during the second half of the swing phase (contributing to passive equinus upon foot strike). In children with CP, the early action of plantar flexors (which typically decelerate the forward progression of the center of mass) may be a compensatory mechanism that contributes to the WA's role in controlling balance during gait.NEW & NOTEWORTHY Adaptation to walking in negative-heel shoes was similar in typically developing children and children with cerebral palsy: it featured ankle dorsiflexion upon initial contact, even though (in the latter group) the soleus was always spastic in a clinical examination. Hence, in children with cerebral palsy, the early deceleration of ankle dorsiflexion by the plantar flexors (promoted by early flattening of the foot, and regardless of the type of footwear) may have a functional role.
Assuntos
Adaptação Fisiológica , Paralisia Cerebral/fisiopatologia , Pé Chato/fisiopatologia , Músculo Esquelético/fisiopatologia , Dedos do Pé/fisiopatologia , Caminhada , Tornozelo/fisiopatologia , Paralisia Cerebral/complicações , Criança , Feminino , Pé Chato/etiologia , Humanos , MasculinoRESUMO
Research on persons infected with HIV is critically assessed by using the notions developed in the sociology of illness. Has this research stimulated new questions or led to reformulations in research paradigms? Methodological problems related to data collection are pointed out, namely: the recruitment of HIV-positive participants for such studies and the stance they adopt during interviews. The contributions made by studies that have focused on adjustment strategies or resorted to the notions of stigmatization, identity and illness trajectory are also discussed. In conclusion, questions are raised about what implications the new HIV/AIDS treatments will have on this field of social science research.
Assuntos
Síndrome da Imunodeficiência Adquirida/psicologia , Infecções por HIV/psicologia , Ciências Sociais/tendências , Adaptação Psicológica , Humanos , Relações Interpessoais , EstereotipagemRESUMO
The analysis of articles about AIDS published from 1982 to 1986 in 6 national French dailies sheds light on how the 'AIDS social phenomenon' was constructed during this period. The press passed information about this new disease from the medical domain into the public sphere. As the press circulated AIDS news (information) among various groups and emphasized the rapid extension and catastrophic proportions of this unforeseen 'epidemic', AIDS became an issue around which social relations polarized. The processes at work during the four phases of the construction of this social phenomenon are described: naming, comparisons with past epidemics, popularization of medical knowledge and symbolic values attributed to it, competition over claims to discoveries and patents, discourses about the other (in particular, homosexuals). During each phase, a concept or fact related to progress in the medical sciences served as the basis for attempts to make a meaning out of this new disease.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Jornais como Assunto , Percepção Social , Síndrome da Imunodeficiência Adquirida/etiologia , Síndrome da Imunodeficiência Adquirida/transmissão , Atitude Frente a Saúde , França , Humanos , Opinião Pública , Mudança SocialRESUMO
The way individual conceptions and experiences of illnesses are socially constructed is shown through the historical analysis of diseases, particularly epidemics. For centuries, sickness did not clearly correspond to what we now call the patient status. Several factors were necessary for this social status to develop. Sickness had to cease being a mass phenomenon. Medicine had to become capable of providing efficacious treatment and of taking the sick out of the custody of religious institutions. Through social legislation, the notions of illness and of health had to be related to the world of work. Owing to the first two factors, sickness was transformed from a collective into an individual affair, from a way of dying into a way of living. Once related to production processes and medical custody, it became the individual's social condition.
Assuntos
Surtos de Doenças/história , Papel do Doente , Sociologia Médica/história , França , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , HumanosRESUMO
BACKGROUND: Almost 10% of breast and ovarian cancer are inherited, and the majority are linked to BRCA1 and BRCA2 germline mutations. Despite the uncertainty, consensus guidelines were defined to assist practitioners', and patients' decisions about the health care decisions to be made. METHODOLOGY: The ad hoc committee consisted of 14 experts designated by the French National Institute for Health and Medical Research. They all attended eleven workshops at which a systematic analytical review of more than 3,500 articles was carried out. Five additional experts critically analyzed the first version of the report. PROCESS: Two thresholds were defined on a probability scale giving the risk of developing breast or ovarian cancer, to serve as a means of deciding as whether an intervention is worthwhile. The first threshold is that above which an intervention can be envisaged or recommended; the second is that under which an intervention can be ruled out; between the two, the decision has to be made on a each by case basis. SCREENING AND PREVENTIVE STRATEGIES ANALYZED: About breast cancer: 1) hormonal interventions; 2) primary prevention (diet, family planning and chemoprevention); 3) screening (breast self-examination, clinician breast examination, tumor markers, imaging); 4) prophylactic mastectomy. About ovarian cancer: 1) hormonal stimulation; 2) screening (clinical screening, ultrasound and tumor markers); 3) prophylactic oophorectomy. MAIN CONCLUSIONS: With each strategy the following points were dealt with: the information to be delivered to the consult and, the procedure and the indications. The committee's opinion about BRCA mutation screening is that population-based or even large scale implementation are not justified. The committee feels that specific management is indispensable and advocates the use of defined and evaluated procedures, and involvement in clinical trials.
Assuntos
Neoplasias da Mama/genética , Neoplasias da Mama/prevenção & controle , Mama/cirurgia , Predisposição Genética para Doença , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/prevenção & controle , Ovário/cirurgia , Fatores Etários , Neoplasias da Mama/diagnóstico , Feminino , França , Humanos , Neoplasias Ovarianas/diagnóstico , Comitê de ProfissionaisRESUMO
BACKGROUND: Almost 10% of breast and ovarian cancer are inherited, and the majority are linked to BRCA1 and BRCA2 germline mutations. Despite the uncertainty, consensus guidelines were defined to assist practitioners', and patients' decisions about the health care decisions to be made. METHODOLOGY: The Ad Hoc Committee consisted of 14 experts designated by the French National Institute for Health and Medical Research. They all attended eleven workshops at which a systematic analytical review of more than 3500 articles was carried out. Five additional experts critically analyzed the first version of the report. PROCESS: Two thresholds were defined on a probability scale giving the risk of developing breast or ovarian cancer, to serve as a means of deciding as whether an intervention is worthwhile. The first threshold is that above which an intervention can be envisaged or recommended; the second is that under which an intervention can be ruled out; between the two, the decision has to be made on a each by case basis. SCREENING AND PREVENTIVE STRATEGIES ANALYZED: About breast cancer: 1) hormonal interventions; 2) primary prevention (diet, family planning and chemoprevention); 3) screening (breast self-examination, clinician breast examination, tumor markers, imaging); 4) prophylactic mastectomy. About ovarian cancer: 1) hormonal stimulation; 2) screening (clinical screening, ultrasound and tumor markers); 3) prophylactic oophorectomy. MAIN CONCLUSIONS: With each strategy the following points were dealt with: the information to be delivered to the consultant, the procedure and the indications. The Committee's opinion about BRCA mutation screening is that population-based or even large scale implementation are not justified. The Committee feels that specific management is indispensable and advocates the use of defined and evaluated procedures, and involvement in clinical trials.
Assuntos
Neoplasias da Mama/genética , Neoplasias da Mama/prevenção & controle , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/prevenção & controle , Anticarcinógenos , Proteína BRCA2 , Biomarcadores Tumorais/análise , Neoplasias da Mama/diagnóstico , Autoexame de Mama , Dieta , Feminino , Genes BRCA1 , Humanos , Mastectomia , Mutação , Proteínas de Neoplasias/genética , Neoplasias Ovarianas/diagnóstico , Ovariectomia , Fatores de Risco , Fatores de Transcrição/genéticaRESUMO
This study investigated patterns of HIV disclosure to significant others (parents, siblings, children, other relatives, friends and colleagues) and describe them in terms of socio-demographic background and other characteristics, including experiences of AIDS-related discrimination. It also assessed the relationship between disclosure patterns and adherence to HAART. We used a cross-sectional survey conducted among a national representative sample of 2,932 HIV-infected people recruited in French hospitals. HIV disclosure patterns were both selective and cumulative: disclosure was more frequent for friends and siblings, while concealment prevailed concerning children, other relatives, and colleagues; but patients who disclosed their seropositivity to one significant other were also more likely to disclose it to other significant others. Patients reporting experiences of discrimination from sexual partners were less likely to be highly adherent, and we also found a significant relationship between uncontrolled disclosure and non-adherence. Patients who have opted for concealment probably consider non-adherence and uncontrolled disclosure as competing risks, but among them a significant minority loses on both counts. Counselling provided to HIV-infected people should not separate the adherence and disclosure issues, and adherence interventions should seek to help patients to manage concurrently disclosure/concealment of their seropositivity and its consequences.
Assuntos
Terapia Antirretroviral de Alta Atividade/psicologia , Infecções por HIV/psicologia , Cooperação do Paciente/estatística & dados numéricos , Autorrevelação , Adulto , Estudos Transversais , Relações Familiares , Feminino , França , Infecções por HIV/tratamento farmacológico , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Preconceito , EstereotipagemRESUMO
BACKGROUND: Since the last recommendations, up to 2500 new references had been published on that topic. METHODOLOGY: On the behalf of the health Minister, the Ad Hoc Committee consisted of 13 experts carried out a first version revisited by five additional experts who critically analyzed the first version of the report. MAIN UPDATING: Breast and ovarian cancer seem to be associated with fewer deleterious mutations of BRCA1 and BRCA2 than previously thought. The screening of ovarian cancer is still not an attractive option while in contrast MRI may be soon for these young women with dense breast, the recommended option for breast cancer screening. The effectiveness of prophylactic surgeries is now well established. French position is to favor such surgeries with regard to a quality of life in line with the expected benefit, and providing precise and standardized process described in the recommendation. CONCLUSIONS: Due to methodological flaws, the low power and a short follow-up of the surveys, this statement cannot however aspire to a high stability.
Assuntos
Neoplasias da Mama/genética , Neoplasias Ovarianas/genética , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/terapia , Confidencialidade , Feminino , França/epidemiologia , Genes BRCA1 , Genes BRCA2 , Genótipo , Humanos , Mastectomia , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/terapia , Fenótipo , Relações Médico-PacienteRESUMO
BACKGROUND AND PURPOSE: Almost 10% of breast and ovarian cancers are familial, and the majority are linked to BRCA1 and BRCA2 germline mutations. Despite uncertainty about the management of female gene carriers, consensus guidelines have been established to assist practitioners and consultees in making health care decisions. METHODOLOGY: The Ad Hoc Committee was composed of 14 experts appointed by the French National Institute for Health and Medical Research, all of whom attended eleven workshops at which more than 3500 articles were systematically analyzed. Five additional experts critically analysed the first version of the report. CRITERIA AND DECISION PROCESS: On a probability scale of the risk of developing breast or ovarian cancers, two thresholds were defined for use in determining whether an intervention would be worthwhile. The first is the threshold above which an intervention can be envisaged or recommended, and the second is the one below which an intervention can be ruled out; between the two, the decision has to be made on a case-by-case basis. SCREENING AND PREVENTIVE STRATEGIES ANALYZED: With respect to breast cancer: 1) hormonal interventions; 2) primary prevention (diet, family planning and chemoprevention); 3) screening (breast self-examination, clinician breast examination, tumor markers, imaging); 4) prophylactic mastectomy. With respect to ovarian cancer: 1) hormonal stimulation; 2) screening (clinical screening, ultrasound and tumor markers); 3) prophylactic oophorectomy. MAIN CONCLUSIONS: For each strategy the following points were addressed: the information to be given to the consultee, the procedure and the indications. In addition, the committee's opinion about BRCA1 and BRCA2 mutation screening is that population-based, or even large-scale, implementation are not justified. Although no scientific evidence is available, the committee feels that specific management is indispensable and advocates the use of defined and evaluated procedures, and participation in clinical trials.
Assuntos
Neoplasias da Mama/prevenção & controle , Neoplasias Ovarianas/prevenção & controle , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Neoplasias da Mama/terapia , Atenção à Saúde/normas , Feminino , França , Aconselhamento Genético/legislação & jurisprudência , Humanos , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/terapia , Prevenção Primária/normasRESUMO
BACKGROUND: Almost 10% of breast and ovarian cancer are inherited, and the majority are linked to BRCA1 and BRCA2 germline mutations. Despite the uncertainty in the management of women gene carriers, consensus guidelines were defined to assist practitioners', and patients' decisions about the health care decisions to be made. METHODOLOGY: The Ad Hoc Committee consisted of 14 experts designated by the French National Institute for Health and Medical Research. They all attended eleven workshops at which a systematic analytical review of more than 3500 articles was carried out. Five additional experts critically analysed the first version of the report. CRITERIA AND DECISION PROCESS: Two thresholds were defined on a probability scale giving the risk of developing breast or ovarian cancer, to serve as a means of deciding as whether an intervention is worthwhile. The first threshold is that above which an intervention can be envisaged or recommended; the second is that under which an intervention can be ruled out; between the two, the decision has to be made on a each by case basis. STRATEGIES ANALYZED: About breast cancer: 1) hormonal interventions; 2) primary prevention (diet, family planning and chemoprevention); 3) screening (breast self-examination, clinician breast examination, tumor markers, imaging); 4) prophylactic mastectomy. About ovarian cancer: 1) hormonal stimulation; 2) screening (clinical screening, ultrasound and tumor markers); 3) prophylactic oophorectomy. MAIN CONCLUSIONS: With each strategy the following points were dealt with; the information to be delivered to the Consultant, the procedure and the indications. In addition, the Committee's opinion about BRCA1 and BRCA2 mutation screening is that population-based or even large scale implementation are not justified. Although no scientific evidence is available, the Committee feels that specific management is indispensable and advocates the use of defined and evaluated procedures, and involvement in clinical trials.