The Psychiatric Assessment Schedule for Adult with Developmental Disability (PAS-ADD) Checklist: reliability and validity of French version

BACKGROUND

The lack of psychometric measures of psychopathology especially in intellectual disabilities (ID) population was addressed by creation of the Psychiatric Assessment Schedule for Adult with Developmental Disability (PAS-ADD-10) in Moss et al. This schedule is a structured interview designed for professionals in psychopathology. The PAS-ADD Checklist was created as a screening tool designed for non-specialists in mental illness, such as families and care staff. The Checklist includes 29 symptoms items graded on a four-point scale. When the score passes the threshold, this indicates the need for further psychiatric assessment. In a study by Moss et al. and a replication by Sturmey et al., the PAS-ADD Checklist was validated and proved reliable as a screening tool for psychiatric disorders in a population of adults with ID. In this study, the French translation of the Checklist is compared with the English version and the psychometric properties are presented for outpatients.

METHOD

The French version was created by translation and back translation. Acceptability, internal consistency, inter-rater reliability, factorial analysis and sensitivity/specificity were calculated.

RESULTS

Reliability analyses for sub-scales and threshold scales showed good (Cronbach's alpha coefficient greater than 0.7) to acceptable (alpha over 0.6) internal consistency. Cronbach's alpha was over 0.8 when the total scale was considered. Spearman Rank correlations, calculated for 45 pairs of raters on threshold scores, are above 0.66, which is a good sign of accordance between non-specialist raters. Sensitivity and specificity were computed for the number of participants who did and did not cross threshold and for whom a psychiatric disorder was or was not present. The sensitivity was 55% and specificity was 70%. The confirmatory factor analysis with a three-factor solution explained only 46.1%, which suggests a mediocre fit of the data to the model. Even if items have good saturation on each factor, it does not fit with the theoretical model.

CONCLUSIONS

The validity of the French version in this sample seems to be acceptable. Specificity was higher than those reported in the English version and sensitivity was lower. The French version was less successful in screening than English version, probably because of the low number of false negatives in this sample, which constitutes recruitment bias in a psychiatric sample. Nevertheless, the French version of the PAS-ADD Checklist is reliable as a general screening tool for psychiatric disorders.

Comparing residential programmes for adults with autism spectrum disorders and intellectual disability: outcomes of challenging behaviour and quality of life

BACKGROUND

Owing to methodological issues, little research has been conducted to examine quality of life (QoL) as a treatment outcome in autism spectrum disorders (ASD) and intellectual disabilities (ID). This study was conducted to combine QoL measures and objective observations of challenging behaviours (CB) in order to evaluate changes over time in adults with ASD and ID who were treated in two different residential programmes; we hypothesised that a decrease in CB would be related to an improved QoL.

METHOD

In a longitudinal study (45 months), we followed 31 adults with ASD and ID who had been integrated into two residential programmes [Autism Programme with a Structured Method (PAMS) vs. traditional programme for ID (No-PAMS)] for 2-19 years. QoL [Quality of Life Inventory in a Residential Environment (IQVMR)] and severity of autistic features (Childhood Autism Rating Scales) were evaluated annually. CB, as measured by the Aberrant Behaviour Checklist (ABC), including stereotypic behaviour and inappropriate speech, were repeatedly assessed every 3 months.

RESULTS

Observed separately, the groups' results were different. In the PAMS programme, stereotypic behaviour and inappropriate speech (ABC scores) significantly decreased, and the IQVMR total score increased; in contrast, in the comparison group, ABC scores did not change and the IQVMR total score decreased. In all, three mixed-effect ANCOVAs partially confirmed that the PAMS programme had an effect on CB and that QoL improvement did not directly depend on the type of programme but on reducing CB as measured by the ABC.

CONCLUSION

The PAMS programme has a positive and indirect influence on QoL by reducing CB.

Quality of life of adults with pervasive developmental disorders and intellectual disabilities

The purpose of this study was to observe quality of life (QoL) and global evolution of persons with Pervasive Developmental Disorders (PDD) in three different groups. Individualized programs for PDD were compared to traditional programs for intellectual disabilities. Behavioural disorders were repeatedly evaluated using the Aberrant Behaviour Checklist (ABC) and QoL once a year. Little research has investigated this domain due to methodological problems with a non-verbal population. Two preliminary studies of individualized programs showed a significant reduction in behaviour disorders over the course of the study. The recent inclusion of a control group indicates that a traditional program reduces lethargy/social withdrawal (ABC factor 2). A good QoL was measured for the three groups.

Tuberculosis in European cities: establishment of a patient monitoring system over 10 years in Paris, France

BACKGROUND

Tuberculosis (TB) is a persistent public health problem in European cities. France has been unable to report on treatment outcomes until now, and it is not known whether the World Health Organization (WHO) target cure rate of 85% has been met.

METHODS

All patients placed under treatment in four hospitals and five out-patient Social Medical Centres in Paris were followed up between 1996 and 2005. Patient monitoring and evaluation were performed using a new software programme, TB-INFO.

RESULTS

In a cohort of 1127 patients, 76% had pulmonary TB, of whom 39% were smear-positive, 81% were foreign-born and 9.3% were human immunodeficiency virus positive. At the end of the follow-up, 16% were cured and 54% had completed treatment. Among the 1118 non-multidrug-resistant patients, these percentages were 17% and 46%, respectively, for smear-positive pulmonary patients. Some patients died (1.9%) or failed treatment (0.1%), but many more defaulted (20.5%) as they interrupted treatment (1.5%), were lost to follow-up (19.5%) or were transferred out (7.9%).

CONCLUSIONS

This 10-year follow-up of TB patients, managed with TB-INFO software, shows that a patient monitoring system can be implemented in France, providing essential information. Treatment success in this cohort of patients was far below the WHO target.

Kinetics of circulating antibodies, immune complex and specific antibody-secreting cells in tuberculosis patients during 6 months of antimicrobial therapy

OBJECTIVE

During the follow-up of a group of patients with active tuberculosis, the predictive potential of several antibody-based assays was evaluated in monitoring treatment efficacy.

DESIGN

Eleven patients with bacteriologically documented pulmonary tuberculosis and two patients with tuberculosis pleurisy were studied over a period of 6 months, from the day before treatment to its completion. The kinetics of the humoral response to Mycobacterium tuberculosis was determined by the number of specific circulating antibody secreting cells (ASC) (ELISPOT assay), as well as the titres of specific circulating antibody and specific antibody present in circulating immune complexes (quantitative ELISA).

RESULTS

Follow-up ELISPOT assays, performed after initiation of tuberculosis therapy showed a rapid increase of ASC, during the first week, followed by rapid 3-10 fold decline of ASC in 12 of 13 patients tested. This decline occurred more rapidly than the mycobacterial culture conversion. In contrast, follow-up of ELISA assays did not give relevant information in assessing the outcome of treatment.

CONCLUSION

In comparison with direct detection of tubercle bacilli in sputum samples, the rapid clearance of specific circulating ASC occurring early on after the onset of therapy could suggest a potential usefulness of ELISPOT in monitoring therapeutic response.

[Intrabronchial curietherapy. Experiences at Hôpital Saint-Louis after the treatment of 149 patients]

Endobronchial tumour obstruction threatens to occur in cases of carcinoma of the bronchus throughout the course of the disease. Such patients can benefit from relief of the bronchial obstruction by several techniques which are currently available. We have treated 149 patients with endobronchial radiotherapy. Seventy three patients were treated with a view to cure, 47 with a palliative dose and 29 received endobronchial radiation in complement with external irradiation. The treatment was carried out in series repeated every 15 days until a maximum of three treatments, consisting of two sessions at 24 hour intervals delivering at each session and irradiating of 7 Gy with a 1 cm catheter. All the clinical signs were relieved and in 79% of patients there was a symptomatic benefit. One hundred and thirty two patients were evaluated by control endoscopy two months after the treatment and 64 had a complete histological remission. The median survival was 14.4 months for patients treated with intent to cure. Obtaining a histological remission was a gauge for prolonged survival (median survival 26.5 months), 11 (7.4%) had massive hemoptysis and 13 (8%) irradiation pneumonitis, all of which occurred some time after the therapeutic procedure. The results confirm the feasibility and the good results of endobronchial irradiation in this field and encourage the idea of controlled multi-centre trials in order to assess a placed of endobronchial radiotherapy in the therapeutic strategy of bronchial cancer.

An experimental comparison of three types of case management for homeless mentally ill persons

OBJECTIVE

Three types of case management were compared to determine their relative effectiveness in helping people with severe mental illness who were homeless or at risk of homelessness.

METHODS

Subjects recruited from a psychiatric emergency room and inpatient units were randomly assigned to one of the three treatment conditions: broker case management, in which the client's needs were assessed, services were purchased from multiple providers, and the client was monitored; assertive community treatment only, in which comprehensive services were provided for an unlimited period; and assertive community treatment augmented by support from community workers, who assisted with activities of daily living and were available for leisure activities. Of 165 subjects recruited, 135 were followed for 18 months.

RESULTS

Compared with clients assigned to broker case management, clients assigned to assertive community treatment only and assertive community treatment with community workers had superior outcomes on several variables. They were number of contacts with the assigned treatment program, resource utilization (for example, use of entitlements), severity of thought disorder, activity level, and client satisfaction. Clients in the assertive community treatment only condition achieved more days in stable housing than those in the other two treatment conditions. No significant treatment group effects were found on income, self-esteem, or substance abuse.

CONCLUSIONS

Assertive community treatment is superior to broker case management in assisting individuals with serious mental illness who are at risk of homelessness.

Treatment of brittle fingernails and onychoschizia with biotin: scanning electron microscopy

Pathologic hoof changes in horses and swine can be normalized by administration of biotin. This vitamin has been given orally to women with brittle fingernails or onychoschizia. The aim of the study was to test whether the favorable clinical results could be corroborated by scanning electron microscopy. We investigated the distal ends of the fingernails from 32 persons. They were placed into three groups: group A consisted of 10 control subjects with normal nails, group B comprised eight patients with brittle nails studied before and after biotin treatment, and group C was 14 patients with brittle nails in whom the administration of biotin did not coincide exactly with the initial and terminal clipping of the nails. The thickness of the nails in group B increased significantly by 25%. In group C, the increase was 7%. Splitting of the nails were reduced in groups B and C and the irregular cellular arrangement of the dorsal surface of brittle nails became more regular in all nails of group B and in 8 of 11 nails of group C.

Morphological abnormalities in vitamin B6 deficient tarsometatarsal chick cartilage

The aim of this study was to test the hypothesis that deficiency of vitamin B6 would produce morphological characteristics of osteochondral lathyrism. To accomplish this goal, morphological characteristics of chick cartilage in which lathyrism was produced by two separate dietary regimens was compared to morphological changes encountered in vitamin B6 deficiency. Vitamin B6 deficiency should reduce activity of lysyloxidase needed for producing intermolecular cross-links. The question to be addressed was: would this latter deficiency impair collagen morphological features and secondarily other structures indirectly by reducing collagen molecular assembly? Failure of cross-linking of collagen in the positive controls was related to a lack of functional aldehyde cross-link intermediates which are blocked by homocysteine and aminoacetonitrile. Day-old-male Lohmann chicks were fed adequate (6 mg/kg) or vitamin B6-deficient diets. Cross-link defects were induced by homocysteine-rich diets (0.6% w/w) or a diet containing aminoacetonitrile (0.1% w/w). Animals were sacrificed at 6 weeks of age and Ossa tarsalia articular cartilage specimens, as well as the proximal end of tarsometatarsus were dissected from the tibial metatarsal joint, a major weight-bearing site. Light microscopic observations revealed reduction of subarticular trabecular bone formation, concurrent with overexpansion of the hypertrophic cell zone. Ultrastructural electron microscopy observation of articular fibro-cartilage indicated significant thickening of collagen fibers in vitamin B6 deficient birds, as well as the positive controls in comparison to that of cage-matched control birds. It was concluded that vitamin B6 deficient cross-linking may be responsible for the observed delay in bone development and aforementioned cartilage histological alterations.

Opportunistic agents in bronchoalveolar lavage in 99 HIV seropositive patients

During a ten month period, 117 fibreoptic bronchoscopies and bronchoalveolar lavages (BAL) were performed in human immunodeficiency virus (HIV) infected patients suspected of having opportunistic pulmonary infections. The BAL were classified into 3 groups, according to clinical manifestations related to HIV infection at the time of fibreoptic bronchoscopy: pre-acquired immunodeficiency syndrome (AIDS) (n = 54), AIDS with Kaposi's sarcoma (n = 37), AIDS without Kaposi's sarcoma (n = 26). On chest X-ray, diffuse infiltrates were most common (54%), followed by normal X-rays (24%) and localized infiltrates (18%). Amongst the 117 BAL, 68 (58%) yielded at least one opportunistic agent. In 28 BAL performed for pulmonary signs or unexplained fever with normal chest X-rays, one or several opportunistic agents were isolated in 17 samples of BAL fluid. The most frequently identified opportunistic agents were Pneumocystis carinii (in 38% of BAL) and cytomegalovirus (35%); these were associated in 17% of BAL. There was no statistically significant difference in opportunistic agents among the 3 groups of BAL (pre-AIDS, AIDS with Kaposi's sarcoma, AIDS without Kaposi's sarcoma). In particular, cytomegalovirus was found in BAL with the same frequency in these 3 groups.

Opportunistic agents in bronchoalveolar lavage in 99 HIV seropositive patients

During a ten month period, 117 fibreoptic bronchoscopies and bronchoalveolar lavages (BAL) were performed in human immunodeficiency virus (HIV) infected patients suspected of having opportunistic pulmonary infections. The BAL were classified into 3 groups, according to clinical manifestations related to HIV infection at the time of fibreoptic bronchoscopy: pre-acquired immunodeficiency syndrome (AIDS) (n = 54), AIDS with Kaposi's sarcoma (n = 37), AIDS without Kaposi's sarcoma (n = 26). On chest X-ray, diffuse infiltrates were most common (54%), followed by normal X-rays (24%) and localized infiltrates (18%). Amongst the 117 BAL, 68 (58%) yielded at least one opportunistic agent. In 28 BAL performed for pulmonary signs or unexplained fever with normal chest X-rays, one or several opportunistic agents were isolated in 17 samples of BAL fluid. The most frequently identified opportunistic agents were Pneumocystis carinii (in 38% of BAL) and cytomegalovirus (35%); these were associated in 17% of BAL. There was no statistically significant difference in opportunistic agents among the 3 groups of BAL (pre-AIDS, AIDS with Kaposi's sarcoma, AIDS without Kaposi's sarcoma). In particular, cytomegalovirus was found in BAL with the same frequency in these 3 groups.

Measurement of bacterial and fungal air counts in two bone marrow transplant units

We evaluated air contamination with bacteria and fungi in a transplantation unit, successively housed in two buildings. Bacterial air contamination was least in laminar air flow rooms, and reduced in ultraclean air rooms in comparison with conventional rooms. Similar results were obtained with culture of air for fungi.

SO2-induced bronchopathy decreases airway sensitization with intratracheal ovalbumin in the rat

We investigated in this study the effect of SO2-induced bronchopathy on airway sensitization to ovalbumin in the rat. Sprague-Dawley rats were immunized with a single intratracheal injection of ovalbumin (OA) 100 micrograms in 0.1 ml PBS or 0.1 ml Bordetella pertussis (BP) heat-killed vaccine (6.5 X 10(9) cells X ml-1). The rats were primed immediately after SO2 exposure (60 h, 200 ppm; group I, n = 16) and three months after exposure was achieved (group II, n = 24), then compared to a control group exposed to air (group III, n = 30). Airway sensitization was evaluated by the in vitro contractile response to antigen challenge using paired tracheal rings. Specific IgE level was determined with PCA reactions. No significant difference was found in the maximal contractile responses to carbamyl choline within and between each group. Excepted in animals of group III, OA alone was not found able to sensitize the airways. When OA was used in association with BP, sensitization of the airways occurred, but this occurrence was found to depend upon a previous SO2 exposure: 73.3% in group III, 41.7% in group II and 25% in group I were sensitized. In addition, only five animals (BP + OA injected rats of group III) displayed a PCA positive reaction. It is concluded that: 1) the concomitant intratracheal injection of BP with OA increased the occurrence of specific airway sensitization, 2) a previous chronic exposure to SO2 decreased the specific tracheal smooth muscle sensitization to intratracheal ovalbumin. This decrease persisted, although slighter, when immunization was done three months after the exposure to SO2 was stopped.

Application of the avidin-biotin-peroxidase complex method to the light microscopic localization of the IgA in the tracheal mucosa and the thoracic lymph nodes of the rat

Visualization of rat IgA within the tracheal mucosa and the thoracic lymph nodes was achieved using the avidin-biotin-peroxidase complex (ABC) method. This technique was compared to the indirect immunoperoxidase technique and both techniques were applied at the light microscopic level, with various fixing and embedding procedures. The ABC method was found superior to the indirect method with respect to sensitivity, to background staining and to the overall reaction time.

Suppression of bronchoalveolar lymphocyte antibody secretion by alveolar macrophage: an in vitro study in the rabbit

The effect of rabbit alveolar macrophage (AM) on the antibody secretion of bronchoalveolar lymphocytes was investigated in vitro, using a plaque-forming cell assay. Animals were intratracheally primed and reimmunized with 10(10) sheep red blood cells (SRBC). Free alveolar cells were obtained by lung lavage and broncho-alveolar lymphocyte-enrichment was achieved through Sephadex G-10 columns. Cell suspensions with various macrophage-to-lymphocyte ratios (AM:L from 1:25 to 3:1) were prepared using appropriate numbers of plastic adherent alveolar cells. After a 4 day in vitro co-culture of 5 X 10(6) alveolar cells (AM plus lymphocytes) with 3 X 10(6) SRBC, IgM and IgG antibody-forming cells (AFC) were counted. A significant suppressive effect (p less than 0.05) of AM on both IgM and IgG-AFC was observed when AM:L ratio was increased from 1:25 to 1:10. This effect was slightly accentuated with higher AM:L values, required viable AM, and was not affected by adding indomethacin in the culture medium. Moreover, a preliminary co-culture of AM with bronchoalveolar lymphocytes and the antigen was necessary for the expression of this suppressive effect. These data suggest that the suppressive activity of primed AM on alveolar lymphocytes may be of physiologic significance in vivo in the regulation of one of the pulmonary immune responses to airborne antigens, namely local antibody production.

Immunologic competence of the bronchi in the rabbit: the IgA-mediated plaque-forming response to intratracheally injected sheep erythrocytes

Immune responses to intratracheally injected sheep erythrocytes in rabbits were investigated in bronchi, thoracic lymph nodes (TLN), mesenteric lymph nodes (MLN) and spleen using an IgA-mediated haemolytic plaque-assay. The time-course appearance of specific IgA antibody forming cells (IgA-AFC) was studied in each tissue after primary and secondary immunizations. Overall low splenic and MLN responses suggest weak systemic and intestinal immunizations, respectively. Peak IgA-AFC concentrations occurred in TLN five days after priming and, in a lesser extent, three days after the booster. Conversely, the bronchial response was delayed, progressive and enhanced by the re-immunization. These results strongly suggest that bronchial-derived, IgA-precommitted cells are the major source of these specific IgA-AFC which concentrate in bronchi and that, before homing in the submucosa, they accumulate transiently in the TLN.

Renal devitalization using 95 per cent ethyl alcohol

Preoperative embolization of renal arteries with solid material before nephrectomy is a standard procedure for the treatment of renal cell carcinoma. However, it often is difficult to use these materials and sometimes special equipment is required. We have used 95 per cent ethyl alcohol in 3 patients to devitalize kidneys with tumors. Our results show 95 per cent ethyl alcohol to be safe, effective and easy to use. When combined with epidural anesthesia alcohol embolization is well tolerated by the patient, and its destructive effect is complete and limited to the selected organ.

[Bacteriology of bronchial secretions. Proposals for a practical attitude in bacterial respiratory tract infections]

The inadequacy of the standard bacteriological method in the study of expectorations is unanimously accepted. Oropharyngeal contamination of specimens largely explains why this examination is a poor index of the causative organisms in bacterial respiratory infections. In a mixed clinical situation with few or non-specific signs of bacterial infection and of variable severity, the physician should answer two questions: 1) Is it a bacterial infection? 2) What is the causative organism? and their corollary: 1) Should one prescribe an antibiotic? 2) Which one? Only culture of blood or pleural fluid allow an accurate reply to these questions in about 50% of cases and they are the indispensable investigations of reference. Initial efforts undertaken to improve the standard examination of expectorations never overcome the stumbling block of oro-pharyngeal contaminations. The bacterial count of expectorated bacteria, a non traumatic method, represents some real progress. In 50% of cases it enables a predominant pathogen to be identified before any antibiotics are given. Bronchoscopy diminishes contamination, allows direct sampling and the inspection and biopsying of bronchial mucosal lesions and aids drainage in very suppurative disorders. Trans-tracheal puncture avoids oropharyngeal contamination in the majority of cases and appears to provide reliable results much more often. A pragmatic approach is recommended according to the clinical picture. Bronchial and limited alveolar infections which are well tolerated, heal without exception on blind antibiotic therapy. In suppurating infections (bronchiectasis, cavitating pneumonias), the yield and the reliability of the examinations are increased. Serious bacterial infections, by their extent or by their site, justify a more aggressive diagnostic and therapeutic attitude. It should be stressed, however, that death caused by inadequate antibiotic therapy remains the exception when one or two successive courses of antibiotics have been prescribed for the pathogens presumed responsible according to the clinical picture or found after one or more bacterial examinations.