The challenges of decolonising participatory research in indigenous contexts: the Atautsikut community of practice experience in Nunavik

Historically, research involving Indigenous peoples has been the scene of power imbalances between Indigenous communities and researchers. Indigenous peoples have often been put in the position of passive subjects of research rather than participants or collaborators with agency, a situation that the current movement of decolonisation of research and practices in the field of Indigenous health aims to counteract. Participatory research seeks a better balance of input, decision-making and power between research participants and research teams and values participants’ knowledges. As such, it is a particularly relevant approach for researchers to involve community members and support self-determination of Indigenous people. Yet, if its explicit intentions are aiming at a decolonising approach, the socio-structural context of participatory research initiatives in Indigenous communities brings obstacles to the approach’s success. The development and implementation of the participatory project Atautsikut: A Community of Practice in Youth Mental Health and Wellness in Nunavik, has been an occasion to document certain barriers that take place in participatory research. This article describes Atautsikut as a starting point for a reflection on the challenges of decolonising participatory research. It discusses how, despite intentions, structural barriers, blind spots and unexpected contextual elements may challenge the journey towards decolonising research.

Intercultural Training in Tense Times: Cultural Identities and Lived Experiences Within a Community of Practice of Youth Mental Health Care in Montréal

This article presents an analysis of the lived experiences of youth mental health practitioners taking part in Transcultural Interinstitutional and Interdisciplinary Case Discussion Seminars (TIICDS), an intercultural training initiative developed in Montréal (Québec, Canada), while considering the current context of increasing social polarizations. Using insights from the community of practice (CoP) framework and drawing on the analysis of 21 seminar sessions and 26 semi-structured individual interviews, this article examines the relation between the local sociopolitical context, the participants' verbalization about their identities, and the affect and cognition evoked by the training. Results indicate that TIICDSs present several features of a CoP and that intercultural training needs to build on both theoretical and experiential knowledge, while considering local contextual elements. These include historical and contemporary social representations and power differentials between groups, the cultural identities of trainees, and the institutions and sociopolitical structures in which clinical practices take place. These elements, we argue, are sensitive and potentially conflictual but can be addressed through supportive and reflexive group-based initiatives such as CoPs that bring together practitioners on a regular basis and provide them with a 'culturally safe enough' space in which they can learn to complexify their understanding of clinical situations.

Climate change and Indigenous mental health in the Circumpolar North: A systematic review to inform clinical practice

Climate change is disproportionally impacting the Circumpolar North, with particular impacts among Indigenous populations. Environmental changes are felt in many aspects of daily life of Northern communities, including both physical and mental health. Thus, health institutions from around the Arctic must meet emerging needs, while the phenomenon remains marginal to their southern counterparts. In this systematic review, we aimed to review current scientific knowledge on the mental health impacts of climate change in Indigenous Peoples across the Circumpolar North. Seven databases were searched. Original peer-reviewed research articles were included if they addressed links between climate change and mental health in Arctic or Subarctic Indigenous Populations. After extraction, data were synthesized using thematic analysis. Of the 26 articles that met inclusion criteria, 16 focused on Canadian Inuit communities and 21 were exclusively qualitative. Being on the land was identified as a central determinant of wellbeing. Immediate impacts of climate change on mental health were felt through restricted mobility and disrupted livelihoods. Effects on mental health were further felt through changes in culture and identity, food insecurity, interpersonal stress and conflicts, and housing problems. Various ways in how communities and individuals are coping with these effects were reported. Understanding climate-related pathways of mental health risks in the Arctic is crucial to better identify vulnerable groups and to foster resilience. Clinicians can play a role in recognizing and providing support for patients affected by these disruptions. Policies sensitive to the climate-mental health relationship must be advocated for.

L’engagement dans les soins en collaboration en santé mentale jeunesse pour les familles migrantes : des lieux cliniques ancrés dans leurs contextes institutionnel et sociopolitique

Objectifs Cet article vise à combler certaines lacunes dans la littérature concernant les conditions propices à des soins en collaboration de qualité en santé mentale jeunesse (SMJ) pour les jeunes migrants et leurs familles, dans les services de première ligne. Il examine les facteurs susceptibles de favoriser l’engagement des familles migrantes dans les services, en tenant compte des dimensions liées à la rencontre clinique, aux enjeux systémiques et aux questions institutionnelles/sociopolitiques.

Méthode Utilisant un devis multiphase en méthodes mixtes, l’article présente séquentiellement les résultats qualitatifs et quantitatifs spécifiques aux familles migrantes, d’un vaste programme de recherche sur les soins en collaboration en SMJ dans des quartiers culturellement et socioéconomiquement diversifiés. Ces résultats proviennent de données collectées à Montréal au cours de la dernière décennie par le biais de questionnaires, d’entrevues semi-structurées, de groupes de discussion, d’observation participante et de documentation. Les participants à la recherche étaient des enfants, des adolescents et des parents de familles migrantes, des cliniciens et des gestionnaires.

Résultats Les résultats suggèrent que le macrosystème sociopolitique et institutionnel structure l’espace de la clinique et influence le processus de soins. En particulier, les réformes successives du système de santé posent des défis de taille aux institutions et aux équipes en SMJ quant à leur capacité à créer un environnement favorable à la continuité des soins et au partenariat interinstitutionnel et à la collaboration interprofessionnelle, des facteurs associés à l’engagement des familles dans les soins. Cet engagement est également tributaire des représentations que les familles migrantes se font de la santé mentale et des services. Ces représentations sont façonnées par leur expérience des soins, mais aussi par ce que leur environnement socioculturel et les discours publics leur permettent d’imaginer de ces services. Cela invite à considérer une intégration de dimensions culturelles et sociopolitiques dans le concept d’engagement. Enfin, les résultats suggèrent également que les écoles jouent un rôle important pour favoriser l’engagement dans les soins de santé mentale.

Conclusion La qualité des soins de santé mentale pour les enfants et adolescents migrants dépend de l’engagement des familles dans les services, et aussi de l’engagement réciproque des cliniciens et des institutions. Les contextes politiques où des tensions entre les groupes majoritaires et minoritaires sont présentes peuvent également faire obstacle aux soins. Étant donné que les familles migrantes s’engagent moins dans les services par rapport aux familles non migrantes, ces considérations appellent à un examen important des moyens pour faciliter l’engagement des familles migrantes dans les soins en collaboration en SMJ. L’article propose certaines avenues pour favoriser cet engagement.

[Migrant Families' Engagement in Youth Mental Health Collaborative Care: Clinical Spaces Anchored within their Institutional and Sociopolitical Context]

Objective This article aims at filling some gaps in the literature regarding conditions conducive to high-quality collaborative care in youth mental health (YMH) for migrant families. It focuses on the factors that are susceptible to foster the engagement of migrant families in the services, by examining the clinical encounter, as well as sociopolitical and institutional dimensions. Methods Using a multiphase mixed methods design, it sequentially follows qualitative and quantitative results regarding migrant families within the different projects of a research program on collaborative care in YMH in culturally and socioeconomically diverse neighborhoods, done in Montreal during the last decade. These results come from data collected through questionnaires, semi-structured interviews, focus groups, participatory observation and documentation, with research participants being children, adolescents and parents from migrant families, clinicians and managers. Results The results suggest that the sociopolitical and macro institutional system finds its way into the clinical space by influencing the process of care. In particular, successive reforms of the health system challenge institutions and YMH teams in their capacity to create a favourable environment for continuity of care and interinstitutional partnership and interprofessional collaboration, factors associated with families' engagement into care. This engagement is also dependent on the representations of mental health and services that migrant families hold. These representations are shaped by their experience of the services, but also by what their sociocultural environment and the public discourses allow them to imagine of these services. This calls for the integration of cultural and sociopolitical dimensions within the concept of engagement. Finally, results also suggest that schools are playing an important role to foster engagement in mental health care. Conclusion The quality of mental health care for migrant children and adolescent relies on the engagement of families, as well as on the mutual engagement of clinicians and of their institutions. Political contexts where tensions between majority and minority groups are present can also act as barriers to the care. Given that migrant families are engaging less in the services compared to non-migrant families, these considerations call for an important review of avenues to facilitate engagement of migrant families into collaborative care YMH services. This article suggests certain avenues to promote this engagement.

IL-15 improves skeletal muscle oxidative metabolism and glucose uptake in association with increased respiratory chain supercomplex formation and AMPK pathway activation

BACKGROUND

IL-15 is believed to play a role in the beneficial impact of exercise on muscle energy metabolism. However, previous studies have generally used supraphysiological levels of IL-15 that do not represent contraction-induced IL-15 secretion.

METHODS

L6 myotubes were treated acutely (3 h) and chronically (48 h) with concentrations of IL-15 mimicking circulating (1-10 pg/ml) and muscle interstitial (100 pg/ml -20 ng/ml) IL-15 levels with the aim to better understand its autocrine/paracrine role on muscle glucose uptake and mitochondrial function.

RESULTS

Acute exposure to IL-15 levels representing muscle interstitial IL-15 increased basal glucose uptake without affecting insulin sensitivity. This was accompanied by increased mitochondrial oxidative functions in association with increased AMPK pathway and formation of complex III-containing supercomplexes. Conversely, chronic IL-15 exposure resulted in a biphasic effect on mitochondrial oxidative functions and ETC supercomplex formation was increased with low IL-15 levels but decreased with higher IL-15 concentrations. The AMPK pathway was activated only by high levels of chronic IL-15 treatment. Similar results were obtained in skeletal muscle from muscle-specific IL-15 overexpressing mice that show very high circulating IL-15 levels.

CONCLUSIONS

Acute IL-15 treatment that mimics local IL-15 concentrations enhances muscle glucose uptake and mitochondrial oxidative functions. That mitochondria respond differently to different levels of IL-15 during chronic treatments indicates that IL-15 might activate two different pathways in muscle depending on IL-15 concentrations.

GENERAL SIGNIFICANCE

Our results suggest that IL-15 may act in an autocrine/paracrine fashion and be, at least in part, involved in the positive effect of exercise on muscle energy metabolism.

Collaborative youth mental health service users, immigration, poverty, and family environment

BACKGROUND

This article examines the association between immigration, poverty and family environment, and the emotional and behavioral problems reported by youth and their family receiving mental health (MH) services within a collaborative care model in a multiethnic neighborhood.

METHOD

Participants in this study were 140 parent-child dyads that are part of an ongoing longitudinal project looking at the association between individual, familial, social and organizational factors, and outcomes of youth receiving MH services in local health and social service organizations in the Montreal area. Measures included in this study were collected at the initial phase of the longitudinal project (Time 0). Parents completed a sociodemographic questionnaire and the Family Environment Scale (FES), and both parents and children completed the Strength and Difficulties questionnaire (SDQ).

RESULTS

Results suggest that the family environment, especially family conflicts, has a significant role in the MH problems of children seeking help in collaborative MH services. In this specific population, results also show a trend, but not a statistically significant association, between poverty or immigration and emotional and behavioral problems. They suggest as well that boys show more MH problems, although this could be a contamination effect (parents' perspective).

CONCLUSIONS

The results support the importance of interventions that not only target the child symptomatology but also address family dynamics, especially conflicts. Collaborative care models may be particularly well suited to allow for a coherent consideration of family environmental factors in youth mental health and to support primary care settings in addressing these issues.

Perception of Interprofessional Collaboration and Co-Location of Specialists and Primary Care Teams in Youth Mental Health

OBJECTIVES

Interprofessional collaboration is a cornerstone of youth mental health collaborative care models. This article presents quantitative results from a mixed-methods study. It analyses the organizational predictors of the perception of interprofessional collaboration of professionals comparing two models of services within recently constituted youth mental health collaborative care teams.

METHODS

Professionals (n=104) belonging to six health and social services institutions completed an online survey measuring their perceptions of interprofessional collaboration through a validated questionnaire, the PINCOM-Q.

RESULTS

Results suggest that the integrated model of collaborative care in which specialized resources are co-located with the primary care teams is the main significant predictor of positive perception of interprofessional collaborations in the youth mental health team.

CONCLUSION

More research on the relation between service delivery models and interprofessional relations could help support the successful implementation of collaborative care in youth mental health.

Collaborating to improve child and youth mental health in Nunavik

Following various reports highlighting the lack of mental health services for children and youth in Nunavik (Quebec, Canada), high rates of child placements under youth protection, and gaps in the coordination of services, the Regional Partnership Committee of Nunavik decided to prioritize collaborative, community-based approaches to the health and wellbeing of children, youth, and their families. It is in this context that the regional project Ilagiinut (‘For families’) was initiated and is being piloted in Kuujjuaraapik. In mental health care, collaborative practices are highly valued, and various models are flourishing. However, collaborative care models are not necessarily easy to implement and involve a variety of ingredients, including trust, strong partnerships, clarity of roles, and power dynamics, all of which are influenced by culture and context. In this study, we conducted a total of 54 interviews with administrators, clinicians, and Inuit family members to explore their everyday expectations for and experiences with child and youth mental health services and collaboration between people involved in care. In our analysis we explore how context influences expectations, beliefs, and experiences, and ultimately how these factors impact the nature of services offered to children, youth, and families. The aim is to shed light on obstacles to and facilitators of collaboration in child and youth mental health in order to inform individuals, communities, and organizations that are trying to change policy and practice.

Perspectives of Migrant Youth, Parents and Clinicians on Community-Based Mental Health Services: Negotiating Safe Pathways

Youth mental health (YMH) services are greatly underutilized, particularly for migrant youth. Collaborative models of care offer promising avenues, but research on these treatment modalities is still scarce, particularly for migrants. The goal of this exploratory study is to better understand quality of care including factors improving access to care and collaborative YMH services use, efficacy and satisfaction, for this vulnerable population. This qualitative study relies on a multi-informants (youth, parents, clinicians) and multiple case study design to explore YMH collaborative services for migrant youth living in an urban setting (Montreal, Canada). Participants are five young patients (12-15 years old), one of their parents and their primary care therapist (N = 15). They come from migrant families, have a psychiatric diagnosis and have been receiving mental health services in a collaborative care setting for at least 6 months. Transcripts of semi-structured interviews for the five triads were thematically analyzed to draw similarities and contrasts between actors, across and within case-studies. Based on these findings, four themes emerged concerning the optimal care setting for collaborative YMH services for migrant families: (1) providing an equilibrium between communication, collaboration and privacy/confidentiality, (2) special attention to ensuring the continuity of care and the creation of a welcoming environment where trusting relationships can develop, (3) the inclusion of family intervention, and (4) the provision of collaborative decision-making pathways to care, addressing interprofessional and interinstitutional collaboration as well as cultural differences in explanatory models and values.

Experience and representations of health and social services in a community of Nunavik

OBJECTIVES

The study aims to explore representations and experiences with health and social services in an Inuit community of Nunavik.

METHODS

A total of 15 semi-structured interviews were conducted with Inuit adults from a community of Northern Quebec. Informal interviews and participatory observation was conducted on six visits over two years. A thematic inductive analysis of data was conducted.

RESULTS

Participants' experiences with care were largely related to the nature of interactions with service providers, and feelings about whether perceived needs were being met. Often these needs were socio-economic. Perceptions of services were based on concepts of trust, privacy and fear of consequences of divulging information, three intrinsically related themes.

CONCLUSIONS

Reflections must be made on how to address the socio-economic needs of patients and how to go beyond the immediate requests to hear the psychosocial needs that patients might not feel safe to talk about.

Canadian Rural/Remote Primary Care Physicians Perspectives on Child/Adolescent Mental Health Care Service Delivery

INTRODUCTION

Primary Care Physicians (PCP) play a key role in the recognition and management of child/adolescent mental health struggles. In rural and under-serviced areas of Canada, there is a gap between child/adolescent mental health needs and service provision.

METHODS

From a Canadian national needs assessment survey, PCPs' narrative comments were examined using quantitative and qualitative approaches. Using the phenomenological method, individual comments were drawn upon to illustrate the themes that emerged. These themes were further analyzed using chi-square to identify significant differences in the frequency in which they were reported.

RESULTS

Out of 909 PCPs completing the survey, 39.38% (n = 358) wrote comments. Major themes that emerged were: 1) psychiatrist access, including issues such as long waiting lists, no child/adolescent psychiatrists available, no direct access to child/adolescent psychiatrists; 2) poor communication/continuity, need for more systemized/transparent referral processes, and need to rely on adult psychiatrists; and, 3) referral of patients to other mental health professionals such as paediatricians, psychologists, and social workers.

CONCLUSIONS

Concerns that emerged across sites primarily revolved around lack of access to care and systems issues that interfere with effective service delivery. These concerns suggest potential opportunities for future improvement of service delivery.

IMPLICATIONS

Although the survey only had one comment box located at the end, PCPs wrote their comments throughout the survey. Further research focusing on PCPs' expressed written concerns may give further insight into child/adolescent mental health care service delivery systems. A comparative study targeting urban versus rural regions in Canada may provide further valuable insights.

La santé mentale jeunesse : un domaine à la croisée des chemins

Si l’importance grandissante de la santé mentale des jeunes fait consensus, de multiples questionnements émergent cependant quant aux spécificités de ce domaine, qui ne peut être conçu comme une extension des services adultes pour des groupes plus jeunes. Cet article aborde ces questionnements en croisant les savoirs provenant de la documentation et ceux qui émergent à la suite de l’implantation du Plan d’action en santé mentale au Québec.

Le Plan d’action en santé mentale a mis de l’avant la collaboration et le partenariat entre institutions et disciplines. Malgré des avancées significatives, des discontinuités peu favorables à une prise en charge écosystémique persistent. Un ensemble de recherches récentes suggère que les contextes organisationnels qui encadrent les services influencent à la fois la façon dont les interventions sont mises en place et leurs résultats cliniques. Une structure de gestion flexible qui engage les intervenants en favorisant une appropriation du pouvoir, tout en minimisant les sources de stress au travail et en facilitant la création de partenariats, semble nécessaire pour favoriser la concertation interdisciplinaire et intersectorielle. Celle-ci est essentielle à la mise en place de services en santé mentale jeunesse.

[Youth mental health at the cross roads of service organization]

The importance of children and youth mental health is increasingly recognized. This rapidly developing field cannot be conceptualized as an extension of adult services to a younger age group and its developmental and organizational specificities are the object of debate. Reviewing recent literature in this domain and some preliminary information about the Quebec Mental Health Plan implementation, this paper addresses some of the questions which structure this debate in Quebec.Quebec mental health plan has put at the forefront collaboration among disciplines and partnership among institutions. In spite of having produced significant improvement in the field, discontinuities in services, which interfere with an ecosystemic model of care, persist. Recent studies suggest that the organisational climate which surrounds youth mental health services has a direct impact on the quality of services and on youth health outcomes. A flexible management structure, which engages clinicians and health workers, favors empowerment, minimizes work stress and facilitates partnership, is needed to foster successful interdisciplinary and intersectorial collaboration. This collaboration is the cornerstone of youth mental health services.

Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada

SUMMARY

This study provides evidence that a number of frailty-related characteristics (older age, de novo admission to long-term care (LTC), comorbidities [Charlson Index, osteoporosis, osteoporosis risk factors, sarcopenia risk factors, and dementia]) have increased in the hip fracture population from 2001-2008. This will have significant impact on community resources, as the number of people discharged to the community is also increasing.

INTRODUCTION

The aim of this study is to estimate secular changes in the prevalence of selected frailty-related characteristics among the hip fracture population in the Canadian province of Quebec (2001-2008) and the potential impact of these changes on healthcare services.

METHODS

The Quebec hospitalization database was used to identify nontraumatic hip fractures for the purposes of calculating age- and sex-specific rates. Also estimated were time trends for selected frailty-related characteristics and discharge destinations.

RESULTS

A significant decline in fracture rates was evident for all age groups except for those <65; sex differences were also observed. Almost all frailty-related characteristics increased over time, ranging from 2 to 14 % per year, which translates to an estimated increase from 16 to 112 %, over the study period. For those whose prior living arrangement was LTC, rates of hip fractures declined significantly (women OR = 0.93, 0.91-0.95; men OR = 0.97, 0.94-0.99). In-hospital mortality and discharge to inpatient rehabilitation decreased, while discharges back to community and to LTC increased.

CONCLUSIONS

Although hip fracture rates decreased for older hip fracture patients, the absolute number and prevalence of specific frailty-related characteristics increased. Policy makers should review care models to ensure that adequate resources are provided to the community to offset the expected increase in demand arising from ongoing changes in patients' characteristics.

Addressing trauma in collaborative mental health care for refugee children

Primary care institutions, including clinics, schools and community organizations, because of their closeness to the family living environment, are often in a privileged position to detect problems in traumatized refugee children and to provide help. In a collaborative care model, the child psychiatrist consultant can assist the primary care consultee and family in holding the trauma narrative and organizing a safe network around the child and family. The consultant can support the establishment of a therapeutic alliance, provide a cultural understanding of presenting problems and negotiate with the consultee and the family a treatment plan. In many settings, trauma focused psychotherapy may not be widely available, but committed community workers and primary care professionals may provide excellent psychosocial support and a forum for empathic listening that may provide relief to the family and the child.

Spirituality and Religion in Youth Suicide Attempters' Trajectories of Mental Health Service Utilization: The Year before a Suicide Attempt

OBJECTIVE

Youth suicide attempters are high-risk for suicide. Many have untreated mental disorders and are not receiving services. It is crucial to understand potential influences associated with service use. Spirituality/religion are one influence in youths' mental health service trajectories. This study explored youths' experiences of spirituality/religion as it relates to their help-seeking the year before their suicide attempt.

METHOD

Fifteen youth (aged 14-18) who made a suicide attempt(s) one to two years prior were consecutively recruited through the Depressive Disorders Program of a psychiatric hospital and interviewed using a mixed-methods design, including an adapted psychological autopsy method.

RESULTS

THREE THEMES EMERGED: religious community members acted as a bridge, step, or provider to mental health services; religious/spiritual discourses were encountered within services; and many youths reported changes in spirituality/religious beliefs the year before their suicide attempt.

CONCLUSIONS

Spirituality/religion can have a role in these youths' service trajectories. How this confers protection or challenges needs to be clarified. Our findings can inform policies supporting training religious leaders about suicide intervention to foster coordination with mental health services, and service-providers in judiciously approaching spiritual/religious themes in suicide prevention.

Referral Patterns and Training Needs in Psychiatry among Primary Care Physicians in Canadian Rural/Remote Areas

OBJECTIVES

This study examined the referral patterns of rural/remote primary care physicians (PCPs) as well as their needs and interests for further training in child/adolescent mental health.

METHODS

Surveys were mailed to Canadian rural/remote PCPs requesting participants' demographic information, training and qualifications, referral patterns, and identification of needs and interests for continuing medical education (CME).

RESULTS

PCPs were most likely to refer to mental health programs, and excessive wait times are the most common deterrent. Major reasons for referral were to obtain recommendations regarding medications and assessing non-responsive patients. While PCPs expressed higher levels of confidence in making appropriate referrals, they were much less confident in their knowledge and skills in managing mental health problems. Professional development in child/adolescent psychiatry is a moderate or highly perceived CME need. Overall, attention deficit/hyperactivity disorder (ADHD) was the most commonly chosen topic of interest and CME in the community was preferred, but some regional differences emerged.

CONCLUSIONS

PCPs viewed limited community resources and self-identified gaps in skills as barriers to service provision. Professional development in child and adolescent mental health for PCPs by preferred modes appears desired.

Partnership at the forefront of change: documenting the transformation of child and youth mental health services in quebec

OBJECTIVE

The Quebec Plan d'action en santé mentale (PASM) (Mental Health Action Plan) reform, a major transformation of the province's mental health care system, has put primary care rather than hospital-based care at the forefront of mental health service delivery. This study documents perceptions of changes in child and youth mental health (CYMH) services following the reform, as well as facilitators and obstacles to collaboration and partnership in CYMH services, and the specific challenges related to collaboration and partnership when servicing multi-ethnic populations.

METHODS

This qualitative participatory research study collected data using semi-structured individual interviews, focus groups and participant observation in community-based health and social service institutions. Thematic analysis was performed.

RESULTS

The reform process encountered challenges in building a common culture of care within and between institutions, while collaboration and partnership evolved in a positive direction throughout the study. Study results highlighted the importance of fostering communication at all levels. Collaboration and partnership was facilitated by opportunities for clinical discussions, dialogue on models of care, harmonizing administrative and clinical priorities, and involving key actors and structures. The results revealed difficulties in implementing multidisciplinary work and in negotiating partners' responsibilities. Quality of partnership and collaboration appeared particularly crucial in providing optimal care to vulnerable families, including migrants.

CONCLUSION

The PASM reform involved a major and challenging transformation in CYMH services. Continuous dialogue through time and leadership sharing appeared promising to foster this transformation.

Measuring the quality of interprofessional collaboration in child mental health collaborative care

Objective

This pilot study examines the potential utility of the Perception of Interprofessional Collaboration Model and the shared decision-making scales in evaluating the quality of partnership in child mental health collaborative care.

Methods

Ninety-six primary care professionals working with children and youth responded to an internet survey which included the Perception of Interprofessional Collaboration Model scale (PINCOM-Q) and an adapted version of a shared decision-making scale (Échelle de confort décisionnel, partenaire—ECD-P). The perceptions of child mental health professionals were compared with those of other professionals working with children.

Results

The PINCOM-Q and the ECD-P scales had an excellent internal consistency and they were moderately correlated. Child mental health professionals’ Individual Interprofessional Collaboration scores from the PINCOM-Q individual aspects subscale were better than that of other child professionals.

Conclusion

These scales may be interesting instruments to measure the quality of partnership in child mental health collaborative care settings. Research needs to replicate these findings and to determine whether the quality of collaboration is a predictor of mental health outcome.

Measuring the quality of interprofessional collaboration in child mental health collaborative care

OBJECTIVE

This pilot study examines the potential utility of the Perception of Interprofessional Collaboration Model and the shared decision-making scales in evaluating the quality of partnership in child mental health collaborative care.

METHODS

Ninety-six primary care professionals working with children and youth responded to an internet survey which included the Perception of Interprofessional Collaboration Model scale (PINCOM-Q) and an adapted version of a shared decision-making scale (Échelle de confort décisionnel, partenaire-ECD-P). The perceptions of child mental health professionals were compared with those of other professionals working with children.

RESULTS

The PINCOM-Q and the ECD-P scales had an excellent internal consistency and they were moderately correlated. Child mental health professionals' Individual Interprofessional Collaboration scores from the PINCOM-Q individual aspects subscale were better than that of other child professionals.

CONCLUSION

These scales may be interesting instruments to measure the quality of partnership in child mental health collaborative care settings. Research needs to replicate these findings and to determine whether the quality of collaboration is a predictor of mental health outcome.

P3-13-09: Impact of Estrogen Receptor Negativity on Clinical Outcomes Following Accelerated Partial Breast Irradiation

Purpose: To determine the impact of estrogen receptor (ER) negativity on clinical outcomes for patients treated with Accelerated Partial Breast Irradiation (APBI).

Materials/Methods(s): We evaluated 506 consecutive patients treated with interstitial brachytherapy (n= 199), balloon-based brachytherapy (n=203), and 3D-CRT (n=104). ER negative (ERN) status was assigned using the traditional definition of an ER nuclear IHC stain &lt; 10%, which corresponds to an Allred/NSABP staining score of &lt; 2. 63 patients (12.5%) were ER negative and 443 (87.5%) were ER positive (ERP). Patient demographics and clinical outcomes (IBTR, RNF, DM, DFS, CSS, OS) were analyzed for each group.

Results: The two groups had similar patient characteristics. Tumor sizes were slightly larger for the ERN group at 11.9mm vs. 10.7mm, although this was not statistically significant (p=0.14). No differences were seen in median age (63 vs. 64 years, p=0.36), rate of HER-2/neu overexpression (83% vs. 91%, p=0.11), or lymph node positivity (6% vs. 9%, p=0.55) between the ERN vs. ERP groups, respectively. There were an equal distribution of invasive ductal carcinoma (ERN n=55, 87%; ERP n=387, 87%) and DCIS (ERN n=8, 13%; ERP n=56, 13%) patients within each group. The use of chemotherapy (55% vs. 15%, p&lt;0.001) and nuclear grade (71% vs. 12%, p&lt;0.001) were higher in the ERN vs. ERP cohort. With a mean follow up of 6.1 years, the 5-year actuarial rates of ipsilateral breast tumor recurrence (IBTR), regional nodal failure (RNF), and distant metastasis (DM) for the entire cohort were 1.8%, 0.6%, and 3.2%. Although this was not statistically significant, ERN patients appear to have an increased rate of local failure than patients with ERP histology (4.0% vs. 1.5%, p=0.13). Rates of RNF and DM were, however, significantly higher for the ERN group (RNF: 4.9% ERN vs. 0% ERP, p&lt;0.001; DM: 12.1% ERN vs. 2.0% ERP, p&lt;0.001). Although there was no difference in overall survival at six years (86% vs. 90%, p=0.67), we observed a shorter disease-free survival (86.4% vs. 96.5%, p= 0.01) and cause-specific survival (90% vs. 98%, p=0.01) for the ERN vs. ERP groups.

Conclusion: The ER negative phenotype of early-stage breast cancer may have a decreased rate of locoregional control. We observed a higher rate of DM with reduced disease-free and cause-specific survival in ER negative cases, emphasizing the importance of systemic therapy and careful, long-term follow up for these patients. Prospective study of this histologic subtype with a larger cohort of patients is needed to substantiate these findings.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-09.

Outcomes by breast cancer subtype in patients treated with accelerated partial breast irradiation

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Background: To determine clinical outcomes for patients treated with accelerated partial breast irradiation (APBI) based on breast cancer subtype.

Methods: We evaluated 516 consecutive patients who received APBI with a minimum follow-up of 6 months. Methods of APBI delivery included interstitial brachytherapy (n=221), balloon-based brachytherapy (n=201), and 3D-CRT (n=106). Women were assigned a breast cancer subtype (BCST) based on results of testing for estrogen (ER), progesterone (PR), and human epidermal growth factor (HER2/neu) receptors. Those without test results for all three receptors were excluded. 278 patients were eligible and submitted for analysis. Receptor subtypes were approximated as follows: ER+, PR+/–, and HER-2 negative [luminal A (LA), 164 pts.]; ER+, PR+/–, and HER-2 positive [luminal B (LB), 81 pts.]; ER/PR–, HER-2+ [HER-2 (H2), 5 pts.], and ER/PR/HER-2 negative [basal (B), 28 pts.]. An analysis was then performed to estimate IBTR, RNF, DM, DFS, CSS, and OS.

Results: Mean age was 66 years, median follow-up was 4.9 yrs. Basal and H2 subtype patients had higher histologic grades (Gr. 3 = 75% vs. 10% LA/LB, p<0.001), larger tumors (13.0mm vs. 10.7mm LA/LB, p=0.05), and were more likely to receive chemotherapy (68% vs. 15% LA/LB, p<0.001). Basal subtype patients were also more likely to be African American (18% vs. 4% LA/LB, p=0.002). Margin and nodal status were similar between all BCSTs. At five years, IBTR rates were 2.9%, 3.2%, 0%, and 4.8% for LA, LB, H2, and B subtypes, respectively (p=0.75). The IBTR within the B subtype group was due to a single elsewhere failure, the rate of which was not statistically different than that for the LA subtype (2.9%, p=0.30). DM was only seen in LA (2.5%) and LB (1.4%) (p=0.87). Disease-free survival (95-100%), CSS (97%-100%), and OS (80-100%) (Table) were also not statistically different (p=0.98, 0.85, 0.24, respectively) between BCST categories.

Conclusions: Five-year local control rates after treatment with APBI are excellent for luminal, HER2, and triple-negative phenotypes of early-stage breast cancer. Further study of BCST is important and may be useful when counseling patients on adjuvant treatment options following breast-conserving surgery.

Long-term results of full-dose gemcitabine with radiation therapy compared to 5-fluorouracil with radiation therapy for locally advanced pancreatic cancer

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Background: To retrospectively compare the efficacy and toxicity of full-dose gemcitabine-based chemoradiotherapy (GemRT) vs. 5-fluorouracil (5-FU)-based chemoradiotherapy (5FURT) for locally advanced pancreas cancer (LAPC).

Methods: From January 1998 to December 2008, 93 patients with LAPC were treated either with 5FURT (n=38) or GemRT (n=55). 5FURT consisted of standard-field radiotherapy given concurrently with infusional 5-FU or capecitabine. GemRT consisted of involved-field radiotherapy given concurrently with full-dose gemcitabine (1000 mg/m2 weekly) with or without erlotinib. The follow-up time was calculated from the time of diagnosis to the date of death or last contact.

Results: Eighty-eight of 93 patients have died, and only one was lost to follow-up after developing DM. The median OS was 11.2 months (range 1.5-96). Patient characteristics (including Zubrod score, age, tumor stage, nodal stage, tumor location, and grade) were not significantly different between treatment groups. The OS was significantly better for GemRT compared to 5FURT (median 12.5 months vs. 10.2 months; 51% vs. 34% at 1 year; 12% vs. 0% at 3 years; 7% vs. 0% at 5 years; respectively; p=0.04), although the two groups had same DM (34% at 1 year). GemRT cohort was more likely to receive gemcitabine before or after chemoradiotherapy than 5FURT cohort (85% vs. 37%, p<0.001). Of the subset who received gemcitabine either before or after chemoradiotherapy, OS was still significantly better for GemRT without concurrent erlotinib compared to 5FURT (median 15.1 months vs. 10.7 months; 70% vs. 36% at 1 year; 21% vs. 0% at 3 years; 11% vs. 0% at 5 years; respectively; p=0.005), as was the rate of DM (23% vs. 45%; respectively; p=0.04). The subsequent hospitalization, percent of survival time spend in the hospital, acute and late grade 3-5 gastrointestinal toxicities were not significantly different between the GemRT and 5FURT groups.

Conclusions: Full-dose GemRT was associated with improved OS compared to standard 5FURT. This approach yielded a moderate number of long-term survivors and was not associated with increased hospitalization or severe gastrointestinal toxicity.

No significant financial relationships to disclose.

Potential role of chemoradiotherapy for metastatic pancreatic cancer

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Background: Patients with metastatic pancreatic cancer have a poor outcome and the radiotherapy is typically only given to patients requiring palliation. We analyzed our institutional pancreas database to compare the outcome between chemotherapy alone vs. chemoradiotherapy.

Methods: From January 2000 to December 2008, 199 metastatic pancreatic cancer patients were retrospectively analyzed. 13 (6.5%) patients received chemoradiotherapy and 186 (93.5%) patients received chemotherapy alone. Chemotherapy regimens consisted of 5-fluorouracil, gemcitabine, erlotinib, or cisplatin. The follow-up time was calculated from the time of diagnosis to the date of death or the last contact. Kaplan-Meier analysis was used to calculate the overall survival (OS).

Results: Median OS was 5.3 months for all patients. Median OS was 4.9 months (0.4–27.0) for patients treated with chemotherapy alone and 7.8 months (0.6–44.1) for those treated with chemoradiotherapy (p = 0.013). Univariate survival analysis of categorical variables for patients treated with chemoradiotherapy revealed that age, race, gender, location of metastatic site, T stage (T3 v. T4) or nodal stage were not significant. However, ECOG performance status (1 v. 2/3) and the dose of radiation (<35 v. >35 Gy) received were associated with improved survival (p = 0.013, p=0.049). Median OS was 12.9 months for ECOG 1 vs. 5.6 months for ECOG 2/3. Median OS was 11.1 months for patients treated with radiotherapy dose > 35 Gy vs. 5.9 months for those who received less than 35 Gy. 3/13 (23%) patients who received chemoradiotherapy lived nearly two years or more.

Conclusions: Metastatic pancreatic cancer patients with good performance score may benefit from chemoradiotherapy. Long-term survival was observed in this selected group.

No significant financial relationships to disclose.

EVALUATION OF THE UNITED KINGDOM NATIONAL EXTERNAL QUALITY ASSESSMENT SERVICE 2008 (UK NEQAS 2008) GUIDELINES FOR THE DIAGNOSIS OF SUBARACHNOID HEMORRHAGE USING SPECTROPHOTOMETRIC XANTHOCHROMIA: A RETROSPECTIVE STUDY

Objective: Evaluation of the UK NEQAS 2008 guidelines for the interpretation of spectrophotometric xanthochromia. Method: A search of the laboratory database for all the xanthochromia test results between May 1st 2008 and May 1st 2009 was performed. Medical charts were reviewed for patients of Hôpital de l’Enfant-Jésus (HEJ) that had at least one detectable pigment (bilirubin, oxyhemoglobin, or methemoglobin). Xanthochromia results obtained with 4 different criteria (Chalmers original, Modified Chalmers, Duiser and UK NEQAS 2008) were compared. Results: We reviewed 41 medical charts (2 patients with duplicate lumbar punctures (LP) for a total of 43 LP). For these 41 patients there were 11 positive xanthochromia results, 5 of which were in concordance with a final diagnosis of subarachnoid hemorrhage (SAH). The diagnosis of the 6 other positive xanthochromia results were as follow: meningeal spread of a lymphoma, cerebral amyloid angiopathy, exertional headache, viral encephalitis with a possibility of petechiaes on the cerebral CT and second LP. Interpretation (negative/positive) of 40/43 LP was identical for the 4 methods. 2 LP were positive with Duiser and UK NEQAS 2008 but negative with Chalmers approaches (final diagnosis: SAH and cerebral amyloid angiopathy). 1 LP was positive only by the Duiser method (viral encephalitis). Conclusions: UK NEQAS 2008 guidelines identified all SAH but are sensitive to traumatic and pathologic meningeal lesions. Except for a case of viral encephalitis with a suspicion of cerebral petechiaes on CT, UK NEQAS 2008 gave xanthochromia results similar to the one in use at HEJ (Duiser). Chalmers original and Modified Chalmers methods missed one of the five SAH.

[Preliminary qualitative evaluation of a shared-care mental health programme with youths in Montréal: facing institutional and cultural uncertainty]

This article describes a collaborative mental health care project for youths, implemented in Montreal in a multiethnic setting. The authors examine the adjustments needed in the shared-care model to address the complexity of cultural and cooperation issues raised in the provision of services to a multiethnic population. A preliminary qualitative evaluation of the project shows how first-line workers face many uncertainties, stemming from both the institutional context and the multicultural reality of the population served. Results from this study advance the hypothesis that although uncertainties may generate discomfort and confusion, they may also open a space for innovation and acceptance of otherness.

Patterns in the care of oligodendrogliomas and oligoastrocytomas: A single center experience

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Background: Although rare, oligodendrogliomas (ODs) and oligoastrocytomas (OAs) have established a unique identity due to their sensitivity to chemotherapy, especially if they exhibit combined loss of heterozygosity (LOH) of 1p and 19q. However, optimal management is still controversial and data is lacking on actual practice patterns. This study describes the epidemiology of ODs/OAs at a community based hospital in Michigan and evaluates the management of these tumors, especially with respect to 1p/19q LOH. Methods: A retrospective review was conducted of all cases of OD and OA that were managed at our institution from 1975 to 2007. 135 patients were isolated. Of these, 48 patients had already been evaluated for 1p/19q LOH. This latter subset underwent data collection and analysis. Results: 31 patients had low-grade tumors (either ODs or OAs) while 17 had high grade tumors (anaplastic ODs or anaplastic OAs). Of the low grade tumors, 35% had combined 1p/19q LOH. 71% underwent surgical resection, 35% received chemotherapy, and 26% received radiation therapy. As for the high grade tumors, 47% had combined 1p/19q LOH. 88% underwent surgical resection, 76% received chemotherapy, and 59% received radiation therapy. At a mean of 29 months of follow up, eight patients had tumor progression while 12 died. Median progression free survival (MPFS) for patients receiving chemotherapy was increased in patients with combined 1p/19q LOH, for both low-grade tumors (34 vs. 20 months) and high-grade tumors (14 vs. 8 months). Also, significantly more patients with low-grade tumors and combined 1p/19q LOH were offered chemotherapy when compared to those without 1p/19q LOH (64% vs 20%, p = 0.04, Fisher exact). However, in patients with high-grade tumors, knowledge of 1p/19q LOH did not significantly impact the choice to administer chemotherapy (88% vs. 67%, p = 0.67). Conclusions: Patients with ODs/OAs and combined 1p/19q LOH who have been treated with chemotherapy demonstrate increased MPFS when compared with those without this genotype. Despite this, determination of 1p/19q LOH significantly affects physician choice to offer chemotherapy only in patients with low-grade tumors, but not in those with high-grade tumors. A future study is in development to determine 1p/19q LOH status for the remaining 87 patients.

No significant financial relationships to disclose.

Health care access for refugees and immigrants with precarious status: public health and human right challenges

Migration flux is being transformed by globalization, and the number of people with either undocumented or with a precarious status is growing in Canada. There are no epidemiological data on the health and social consequences of this situation, but clinicians working in primary care with migrants and refugees are increasingly worried about the associated morbidity. This commentary summarizes findings from a pilot study with health professionals in the Montreal area and suggests that the uninsured population predicament is a national problem. Although ethical and legal issues associated with data collection by clinicians, institutions and governments need to be examined, estimating the public health consequences and long-term cost associated with problems in access to health care due to migratory status should be a priority. Current regulations and administrative policies appear to be at odds with the principles of equal rights set out by the Canadian Charter of Rights and Freedoms and the UN Convention on the Rights of the Child. Beyond the commitment of individual clinicians, Canadian medical associations should take an advocacy role and scrutinize the ethical and medical implications of the present system.

Comparison of metabolic activity in mantle cell lymphoma at biospy site and other tumor sites using 18F-FDG PET

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Background: Mantle cell lymphoma (MCL) is a mature B-cell non-Hodgkin’s lymphoma (NHL) with a variable clinical course ranging from indolent to aggressive. Treatment for MCL is complicated by this variability, as systemic chemotherapy for NHL is directed by the aggressiveness of the lymphoma. Previous attempts have been made to correlate clinical outcome in MCL with histologic features. More recently, measurement of metabolic activity using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) was found to be highly correlative with the aggressiveness of NHL. Given the clinical heterogeneity of MCL, the search for the true metabolic status in MCL is important in prognostication and management. We propose to study the metabolic activity in MCL by comparing the maximum SUV at the site of biopsy with the highest SUV in other MCL areas of the body. Methods: 12 patients with newly diagnosed MCL and having staging by FDG-PET were identified. PET(CT) body scans were obtained in the usual fashion. The SUVs, defined as tumor activity divided by dose injected per lean body mass, from the PET and PET-CT cameras were cross validated to produce the same value in a given phantom and patient. Maximum biopsy SUV was measured by searching the maximum value within a volume of interest over the known biopsy site, and highest body SUV was similarly searched in known tumor sites in other body areas. Results: One patient was excluded because the tumor at the biopsy site had been completely resected. The remaining 11 patients (M:F=8:3, age=63±8 yrs) were analyzed. The SUV at biopsy sites ranged from 2.1 to 9.8 (mean=5.2±2.3). The SUV in other tumor sites ranged from 4.8 to 18.6 (mean=8.9±4.1), which was significantly higher when compared to the respective biopsy site (p=0.0036). Conclusions: As the SUV of MCL at the biopsy site may not represent the highest SUV, it is important to search other tumor sites in the body for the highest SUV to help in grading, managing, and subsequent monitoring of MCL. Perhaps FDG-PET can direct biopsies to tumor sites with the highest SUV and subsequently provide useful histologic detail for predicting clinical course. Future study is needed to correlate the maximal SUV of MCL with histology and clinical course.

No significant financial relationships to disclose.

Caring for migrant and refugee children: challenges associated with mental health care in pediatrics

This article reviews aspects of the mental health care of migrant and refugee children. It highlights the challenges of access to care for these children and of considering the role of pediatricians in their mental health care. It also looks at the sources of differences in presentation of mental health issues of migrant youth when compared with dominant culture youth, examining the contributions of culture, context, and the families' own views. Models of care will be described that have tried to elicit a better understanding of the difficulties migrant and refugee children may encounter. Some avenues through which we may expand our current psychiatric models of care will also be addressed. These avenues include the use of interpreters and cultural brokers, addressing the debate around ethnic matching between therapists and patients, promoting a sensitivity to otherness and mediation, and looking at the importance of time issues.

Immigrants and mental health services: increasing collaboration with other service providers

INTRODUCTION

This article examines the potential modifications of care indicated to engage migrant and refugee families in making use of needed mental health services for their children in Canada and the role psychiatrists can play in this process.

METHOD

The clinical and consultative role of the members of the Transcultural Child Psychiatry Service at the Montreal Children's Hospital is used as a model. This model has been useful in engaging both migrant families and local front line service providers to work with each other in a collaborative manner.

RESULTS

Important aspects to be considered in these cases are: Modifications in obtaining access to care; Issues of communication (i.e., the use of interpreters); Addressing cultural differences in understanding and responding to a child's difficulties; recognizing the plasticity of culture; Collaboration with colleagues in hospitals and with professionals in the community.

CONCLUSIONS

New models of care, involving increased collaboration between professionals, need to be devised to facilitate the mental health care of immigrant and refugee children and their families.

The development and therapeutic modalities of a transcultural child psychiatry service

INTRODUCTION

To look at the specificities of the work of a Transcultural Child Psychiatry Team developed to meet the need for specialized services for Montreal and Quebec's culturally diverse immigrant and refugee pediatric population.

METHOD

A Transcultural Child Psychiatry Team was started at McGill University in 1995. The clinic's development and method of service provision for its patient population will be described.

RESULTS

Modalities of assessment and treatment are modified to meet the needs of the team's clientele and also reflect the philosophical underpinnings of the team's practitioners.

CONCLUSION

In this model of service delivery, current mental health care practice is modified in order to address the social specificities and cultural diversity of transcultural child psychiatric populations.

Sexual abuse: a comparison between resilient victims and drug-addicted victims

The goal of this study was to determine which variables distinguish resilient victims from drug-addicted victims, who were sexually abused during their childhood--in addition, to measure the contribution of these variables to the level of distress experienced by the victims. There were two groups of 20 women interviewed. The resilient group showed no clinically significant symptoms of mental distress, and the addicted group were undergoing treatment for drug dependency. They all completed a semi-structured interview and a questionnaire regarding the type and severity of their sexual abuse, mental health status, self-esteem, locus of control, support and cognitive factors from Finkelhor's model. Both of these groups were equally and severely abused. Resilient and addicted women both received a moderate level of support. These women also reported the same sense of betrayal and powerlessness. Furthermore, both groups believe, to a large degree, that they now control what happens to them (internal locus of control). There were three distinguishing variables among the two groups, they were stigmatization, self-blame, and hazard for the locus of control. In comparison, resilient women had less self-blame for having been abused and they also felt less stigmatized than addicted women. In fact, stigmatization and self-blame account for 65% of the TSC-40 variance. These results suggest that cognitive strategies, particularly those that are linked to the interpretation of the event, may have some importance in the recovery.

Mediators of behavioral problems in 7-year-old children born after 24 to 28 weeks of gestation

We tested the hypothesis that prematurity acts through its association with neuromotor and intellectual functioning to explain behavior problems at school age. Sixty-one extremely preterm (EP) very low birth weight (VLBW) children (< 29 wk and < 1,500 g) born in 1987-1990 and 44 normal birth weight children (NBW) (> 37 wk and > 2,500 g) were matched for age, sex, and socioeconomic status (SES). Mediator variables were evaluated at a hospital at 5 years and 9 months. Behaviors were evaluated at school at 7 years by peers, teachers, and parents. When compared with NBW children, EP/VLBW children had poorer IQ and neuromotor development. At school, EP/VLBW children were evaluated by peers as more sensitive/ isolated, and by teachers and parents as more inattentive and hyperactive than NBW. When mediators were introduced, the previously significant relation between prematurity and behavior problems disappeared. Hyperactive and inattentive behaviors were explained by a specific working memory factor for the latter, and by a general intellectual delay for the former, whereas sensitive/isolated behaviors were best explained by neuromotor delays. Inattentive behaviors were also related to family adversity. At school age, extreme prematurity had thus an indirect effect on behaviors via specific and nonspecific intellectual and neuromotor delays.

High-risk sexual behaviors in a context of substance abuse: a focus group approach

Clinical studies show that heavy and dependant substance users engage with high frequency in high-risk sexual behaviors. To better understand the dynamics of unsafe sexual practices among alcoholics or non-intravenous drug users (IDUs), a series of focus group discussions was conducted with 26 single, sexually active men and women in treatment for substance abuse. Results show that unsafe sexual practices in this subgroup may be explained by three factors: (1) intoxication, (2) negative perceptions of condoms, and (3) cognitive distortions. Furthermore, men's negative perceptions of condoms and women's concerns about not opposing men by fear of being rejected seem to be synergetic to bringing about the negative outcome. Implications for clinical practices are discussed.

Isolation and purification of serum and interfacial peptides of a trypsinolyzed beta-lactoglobulin oil-in-water emulsion

Information on the conformation of proteins adsorbed to an oil-water interface is usually determined by following the time course of enzymatic hydrolysis of the protein in an oil-in-water emulsion. Unlike previous works reported in the literature, the research presented in this paper provides information on which peptides are actually in contact with the lipid bilayer (interfacial peptides) and those segments that project into the aqueous phase (serum peptides). In order to achieve this classification of peptides, we present a method to separate serum peptides from interfacial peptides by initial centrifugation steps followed by reversed-phase high-performance liquid chromatography. The effectiveness of the method was ascertained by performing proteolysis on beta-lactoglobulin adsorbed to an oil-water interface in a soybean oil-water emulsion. It was found that more peptides are qualitatively and quantitatively found adsorbed to the oil-water interface as compared to peptides released into the serum.

[Resilience factors in the victims of sexual abuse: state of affairs]

OBJECTIVE

The aim of this literature review is to examine factors leading to the recovery of child sexual abuse survivors.

METHOD

This paper provides a definition of resilience and presents the individual and environmental protective factors. A methodological examination of the studies is carried through.

RESULTS

Researchers have documented that 20% to 44% of adult who were sexually abused during their childhood show no apparent signs of negative outcome. However, very few studies as been interested in resilient women and their protective mechanisms. Recent research on protective factors reveal that searching for support, disclosing the abuse and giving a meaning to the abuse are all adaptative cognitive strategies. Furthermore, the perception of benefits and having an external attributional style are both related to less psychological distress. Social support, in general and after the revelation, also appears as a determinant of resilience. However, avoidance, even if victims find it very useful, proves to be a non-adaptative strategy, which may lead to be a catalyst to victims' symptomatology. Definitional problems and the lack of longitudinal studies limit the conclusions that can be drawn.

CONCLUSION

The rare studies involving resilient victims show that social support as well as certain cognitive coping strategies may lead to recovery. However the extent of their contribution remains unknown.

Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns

AIMS

To examine the consistency and/or variability of gender differences in drinking behavior cross-culturally.

DESIGN, SETTING, PARTICIPANTS

Women's and men's responses in 16 general population surveys from 10 countries, analyzed by members of the International Research Group on Gender and Alcohol.

MEASUREMENTS

Comparable measures of drinking, versus abstention, typical drinking frequencies and quantities, heavy episodic drinking, intoxication, morning drinking, and alcohol-related family and occupational problems.

FINDINGS

Women and men differed little in the probability of currently drinking versus abstaining, but men consistently exceeded women in typical drinking frequencies and quantities and in rates of heavy drinking episodes and adverse drinking consequences, while women were consistently more likely than men to be life-time abstainers. In older age groups, both men and women drank smaller quantities of alcohol and were more likely to stop drinking altogether, but drinking frequencies did not change consistently with age.

CONCLUSIONS

A theoretical synthesis proposes that gender roles may amplify biological differences in reactions to alcohol, and that gender differences in drinking behavior may be modified by macrosocial factors that modify gender role contrasts.

Prevalence of personality disorders among clients in treatment for addiction

This study determined the prevalence of personality disorders among clients in treatment for addiction; this prevalence was compared with those found in similar studies and in clinical samples of individuals suffering from other Axis I disorders. Our sample comprised 255 subjects. The first edition of the Millon Clinical Multiaxial Inventory (MCMI) was used. Only 11.8% of the subjects did not score over 84 on any of the 11 Axis II scales. Over one-half had a score of 84 or higher on the passive-aggressive and dependent-personality scales. The mean number of scales in the 84+ category was 2.68. Comparisons show that this sample was more severe in most cases.