Faculté de médecine – Travaux et publications

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Accès libre
Participation at home of adults with multiple disabilities and influencing factors from their parents' perspective
Cutnam, Gabrielle; Iavorova Kroumova, Elisa; Rochette, Annie; Université de Montréal. Faculté de médecine. École de réadaptation (Taylor and Francis, 2025-02-03)
To understand participation at home of adults with multiple disabilities and the indicatorsof their engagement from the parents’ perspective as well as to explore the influencing environmentalfactors.Methods: A qualitative, descriptive design was used. Participants had to be the parent of an adultpresenting multiple disabilities aged between 21 and 65 with no degenerative diagnosis. Semi-structuredinterviews were conducted using an interview guide, anchored in the Human Development Model –Disability Creation Process and developed through an iterative process. Data were analyzed using a6-step qualitative analysis process.Results: The majority (5/8) of participating parents were aged between 56 and 61 years and were theparents of an adult with multiple disabilities aged between 21 and 41. Two themes for participationwere generated: communication to build relationships, and they are disabled, but not so much whereasfour themes relating to environmental factors were generated: context as a determinant of meaningfulactivity, the effects of the caregiver’s attitude on social participation, the importance of the relationship oftrust, and facilitating participation through adaptations.Conclusion: Non-verbal communication and context of realization of activities of adults with multipledisabilities should be considered as they contribute to making participation meaningful.
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Perceived training needs of municipal stakeholders in Quebec (Canada) relating to universal design action plans
Rochette, Annie; Vermeulen, Perrine; Boucher, Normand; Roussel, Nathalie; Simard, Nathalie; Grondin-Gravel, Gabrielle; Morissette, A.; Lamontagne, Michel; Fougeyrollas, Patrick; Université de Montréal. Faculté de médecine. École de réadaptation (Taylor and Francis, 2025-02-21)
Quebec (Canada) municipalities with ≥15 000 inhabitants are legally required to produce an annual action plan to reduce barriers encountered by person with disabilities. Actual tools for universal design are diverse and not harmonised between cities, leading to important training needs. We thus aimed to identify priority training needs among municipalities of all sizes. We use a two-phase sequential descriptive design starting with an online survey (Phase 1) anchored into dimensions of inclusive access followed by focus group discussions (Phase 2). Descriptive statistics and a semi-inductive content analysis for qualitative data were used. A total of n = 114 municipalities responded to Phase 1 including nearly half (37/78) of municipalities with a population ≥15 000 inhabitants. The top five priority needs were 1) Needs assessment, 2) General knowledge, 3) Practical and organisational knowledge, 4) Design/planning phase and 5) Know-how, attitudes, mentalities, culture of the municipalities. Participants (n = 10) to Phase 2 insisted on their needs for practical knowledge, including authentic, contextualised examples coming from other cities. No major differences in needs to prioritise emerged when contrasting larger and smaller size’s municipalities. Results highlighted a variety of training needs, including the importance of prioritising practical contextualised knowledge anchored in authentic experience.
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Attenuating hyperammonemia preserves protein synthesis and muscle mass via restoration of perturbed metabolic pathways in bile duct-ligated rats
Bosoi, Cristina R.; Kumar, Avinash; Oliveira, Mariana M.; Welch, Nicole; Clément, Marc-André; Tremblay, Mélanie; Ten-Have, Gabriella A. M.; Engelen, Marielle P. K. J.; Bémeur, Chantal; Deutz, Nicolaas E. P.; Dasarathy, Srinivasan; Rose, Christopher; Université de Montréal. Faculté de médecine. Département de médecine (Springer, 2025-01-23)
Sarcopenia and hepatic encephalopathy (HE) are complications of chronic liver disease (CLD), which negatively impact clinical outcomes. Hyperammonemia is considered to be the central component in the pathogenesis of HE, however ammonia's toxic effects have also been shown to impinge on extracerebral organs including the muscle. Our aim was to investigate the effect of attenuating hyperammonemia with ornithine phenylacetate (OP) on muscle mass loss and associated molecular mechanisms in rats with CLD. Six-week bile duct-ligated (BDL) rats and Sham-operated controls were treated with OP (1 g/kg, oral) for 5 weeks. Body composition, assessed by EchoMRI, and muscle protein fractional synthesis rate were evaluated. Signalling mechanisms regulating protein homeostasis, ATP content and metabolic intermediates in the tricarboxylic acid cycle (TCA) in skeletal muscle were quantified. OP treatment attenuated hyperammonemia, prevented brain edema and improved locomotor activity in BDL rats. Increased muscle ammonia, reduction in lean body mass, decreased muscle protein synthesis rate and ATP content were restored in OP-treated versus saline-treated BDL rats. TCA cycle intermediary metabolite, α-ketoglutarate, alterations of molecular markers regulating protein homeostasis including mTOR signalling and autophagy, were also preserved in muscle of OP-treated BDL rats. OP attenuated hyperammonemia, preserved muscle protein synthesis and prevented muscle mass loss in a preclinical model of CLD through restoration of perturbed signalling responses and altered TCA intermediary metabolites. Ammonia-lowering strategies have the potential for rapid clinical translation for simultaneous neuroprotection and sarcopenia prevention in patients with CLD.
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How have neck muscle vibration effects on visuospatial behavior and spatial neglect been explored? A scoping review
Duclos, Noémie C.; Sorita, Eric; Poncet, Frédérique; Duclos, Cyril; Jamal, Karim; Université de Montréal. Faculté de médecine. École de réadaptation (Taylor and Francis, 2024-11-28)
Introduction: Neck muscle vibration (NMV) has been proposed as a bottom-up intervention toenhance visuospatial exploration in post-stroke patients with unilateral spatial neglect (USN). Whilesome studies report enlarged visual exploration during NMV application, others find no significantimpact, highlighting inconsistencies in the literature. The diversity in NMV application methodsand the variation in visuospatial outcome measures may contribute to these conflicting findings.This study aimed to overview the methodological approaches used to investigate NMV’s effects onvisuospatial behavior in USN patients, focusing on aspects beyond sample size and study design.Methods: Among the seven databases, studies that applied NMV and assessed visual or perceptualoutcomes were included in the analysis. Two independent reviewers screened titles and abstractsto select the studies to analyze. Data about the publication, population, modalities of application,and outcomes were extracted and synthesized.Results: Twenty-five publications from 1988 to 2023 were included, involving a total of 512participants, of whom 114 (22.3%) had USN. The presence of USN was assessed based on paper-and-pencil tests. The frequency of NMV was set between 80 and 125 hz. In 22 studies, NMV wereapplied on the left side of the neck muscles. Six studies proposed multiple NMV sessions, lastingbetween 5 and 50 minutes/day, 3–5 times/week, for 2–4 weeks. One study included a follow-upperiod of up to 1.4 years. The tasks during NMV often involved indicating the subjective straightahead (SSA, n = 8), pointing out targets, or no specific activity (n = 7, each). The SSA and cancella-tion tests were the most frequent outcomes.Conclusions: NMV application modalities varied widely across studies, with only vibration fre-quency showing consistency. The tasks performed during NMV and the outcome measures werediverse and generally unrelated to activities of daily living. Therefore, NMV effects during moreecologically valid tasks should be explored.
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Effect of a whole-group intervention on children’s participation in interactive book reading
McMahon-Morin, Paméla; Nasri, Bouchra; Verduyckt, Ingrid; Rezzonico, Stefano; Gingras, Marie-Pier; Université de Montréal. Faculté de médecine. École d'orthophonie et d'audiologie (Taylor and Francis, 2024-09-12)
This study examined the effects of an SLP-delivered whole-class interactive book reading intervention and a professional development program on children’s self-initiated participation. Eleven kindergarten teachers and the children in their classes participated in this quasi-experimental study. They were filmed during book reading at pre- and post-intervention, and follow-up. Children’s types of spontaneous comments appeared to be more diverse after the intervention, and the types that increased or emerged were consistent with the language targets of the interactive book reading. Nonparametric statistical tests were conducted. Significant changes were found in the number of hands raised by children to make a spontaneous comment and in the number of spontaneous comments after the intervention and at follow-up. Results for child-initiated interaction sequences were mitigated. This study invites school-based SLPs to foster children’s self-initiated participation in their tier-1 intervention and to support teachers in using children’s spontaneous comments to further scaffold children’s learning.
Accès libre
Improving pelvic floor muscle training with AI : a novel quality assessment system for pelvic floor dysfunction
El-Sayegh, Batoul; Dumoulin, Chantal; Leduc-Primeau, François; Sawan, Mohamad; Université de Montréal. Faculté de médecine. École de réadaptation (MDPI, 2024-10-29)
The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a ±1 scale point with 97% accuracy. These results demonstrate the system’s potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously.
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Management of physical impairments, activity limitations and participation restrictions in survivors of childhood acute lymphoblastic leukemia: perspectives from physiotherapists
Brochu, Annie; Hébert, Luc J.; Fiscaletti, Melissa; Kairy, Dahlia; Université de Montréal. Faculté de médecine. École de réadaptation (Lippincott, 2024-10-04)
Background: Survivors of childhood acute lymphoblastic leukemia (cALL) present a high risk of long-term neuromusculoskeletal (NMSK) sequelae. Clinical guidelines for specific management of these complications are still lacking. The aim of this study is to (1) describe current physiotherapy practice with cALL survivors at one of Canada’s specialized pediatric oncology centers, (2) explore perceived optimal management of long-term NMSK sequelae by physiotherapists, and (3) identify the barriers and facilitators for its in-clinic implementation. Methods: This qualitative descriptive study with a focus group using a semi-structured interview guide was conducted with physiotherapists (n = 6) from one of Canada’s specialized pediatric oncology centers. We performed a hybrid analysis including both a deductive and an inductive approach using the International Classification of Functioning, Disability, and Health and Consolidated Framework for Implementation Research. Results: Even though the participants were experts in managing NMSK sequelae in survivors of cALL, standardized management of these patients is lacking. Physiotherapists described their perceived optimal management of NMSK sequelae as systematic and interdisciplinary. Barriers (eg, relative priority and availability of resources) and facilitators (eg, relative benefit and commitment) for implementing this perceived optimal management were identified. Conclusion: Physiotherapy management could improve care and services offered to survivors of cALL. The identification of barriers and facilitators to best practice offers relevant potential solutions to explore in order to improve and optimize management of this patient group.
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Physical impairments, activity limitations, and participation restrictions of childhood acute lymphoblastic leukemia survivors with and without hip osteonecrosis : a PETALE cohort study
Brochu, Annie; Kairy, Dahlia; Alos, Nathalie; Laverdière, Caroline; Sinnett, Daniel; Sultan, Serge; Curnier, Daniel; Miron, Marie-Claude; Ramy, El-Jalbout; Fiscalett, Melissa; Hébert, Luc J.; Université de Montréal. Faculté de médecine. École de réadaptation (Springer, 2024-04-02)
Purpose Long-term musculoskeletal complications represent a growing burden for survivors of childhood acute lymphoblastic leukemia (cALL). This study aimed to describe physical impairments, activity limitations, and participation restrictions in a high-risk subgroup of cALL survivors of the PETALE cohort. Methods This cross-sectional study, using observational data from the PETALE cohort, included a subgroup of survivors who presented high-risk criteria for late effects. Outcomes measures consisted of hip magnetic resonance imaging, maximal isometric muscle strength (MIMS) or torque (MIMT), range of motion (ROM), Near Tandem Balance (NTB), 6-Minute Walk Test (6MWT), Five Time Sit-to-Stand Test (FTSST), and health-related quality of life. Descriptive statistics and regression analyses were performed. Results Survivors (n = 97, 24.2 ± 6.7 years old) showed limited grip strength, FTSST, and NTB performance compared to reference values (p < 0.001). Thirteen participants (14.6%, 18 hips) had hip osteonecrosis (ON) (53.8% male). Higher severity hip ON was found in female survivors (66.7% vs. 22.2%). Survivors with hip ON had reduced hip external rotation ROM compared to those without (p < 0.05). Relationships were found between MIMS and ROM outcomes (r = 0.32, p < 0.01) and with 6MWT (r = 0.39–0.41, p < 0.001). Our multiple linear regression model explained 27.6% of the variance of the 6MWT. Conclusions Survivors in our subgroup had clinically significant physical impairments and activity limitations, and those with hip ON showed worst hip impairment outcomes. Implications for Cancer Survivors These findings emphasize the importance of long-term follow-up including physical therapy assessment to help early identification and management of physical impairments and activity limitations in survivors of cALL.
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Trajectories of opioid consumption as predictors of patient-reported outcomes among individuals attending multidisciplinary pain treatment clinics
Angarita-Fonseca, Adriana; Lacasse, Anaïs; Choinière, Manon; Kaboré, Jean-Luc; Sylvestre, Marie-Pierre; Tchouangue Dinkou, Gillis Delmas; Bruneau, Julie; Martel, Marc Olivier; Hovey, Richard; Motulsky, Aude; Rahme, Elham; Pagé, Gabrielle; Université de Montréal. Faculté de médecine. Département d'anesthésiologie et de médecine de la douleur (Wiley, 2023-10-06)
Purpose This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment. Methods This study used data from the Quebec Pain Registry (2008–2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life). Results We identified three trajectories of opioid consumption: “no or very low and stable” opioid consumption (n = 2067, 96.3%), “increasing” opioid consumption (n = 40, 1.9%), and “decreasing” opioid consumption (n = 39, 1.8%). Patients in the “no or very low and stable” trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the “increasing” opioid consumption group had significantly greater depression scores at 6-month compared to patients in the “no or very low and stable” trajectory group. Conclusion Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.
Accès libre
A prospective cohort study of acute pain and in-hospital opioid consumption after cardiac surgery : associations with psychological and medical factors and chronic postsurgical pain
Pagé, Gabrielle; Ganty, Praveen; Wong, Dorothy; Rao, Vivek; Khan, James; Ladha, Karim S.; Hanlon, John; Miles, Sarah; Katznelson, Rita; Wijeysundera, Duminda; Katz, Joel; Clarke, Hance; Université de Montréal. Faculté de médecine. Département d'anesthésiologie et de médecine de la douleur (Lippincott, Williams & Wilkins, 2024-01-31)
BACKGROUND: Understanding the association of acute pain intensity and opioid consumption after cardiac surgery with chronic postsurgical pain (CPSP) can facilitate implementation of personalized prevention measures to improve outcomes. The objectives were to (1) examine acute pain intensity and daily mg morphine equivalent dose (MME/day) trajectories after cardiac surgery, (2) identify factors associated with pain intensity and opioid consumption trajectories, and (3) assess whether pain intensity and opioid consumption trajectories are risk factors for CPSP. METHODS: Prospective observational cohort study design conducted between August 2012 and June 2020 with 1-year follow-up. A total of 1115 adults undergoing cardiac surgery were recruited from the preoperative clinic. Of the 959 participants included in the analyses, 573 completed the 1-year follow-up. Main outcomes were pain intensity scores and MME/day consumption over the first 6 postoperative days (PODs) analyzed using latent growth mixture modeling (GMM). Secondary outcome was 12-month CPSP status. RESULTS: Participants were mostly male (76%), with a mean age of 61 ± 13 years. Three distinct linear acute postoperative pain intensity trajectories were identified: “initially moderate pain intensity remaining moderate” (n = 62), “initially mild pain intensity remaining mild” (n = 221), and “initially moderate pain intensity decreasing to mild” (n = 251). Age, sex, emotional distress in response to bodily sensations, and sensitivity to pain traumatization were significantly associated with pain intensity trajectories. Three distinct opioid consumption trajectories were identified on the log MME/day: “initially high level of MME/day gradually decreasing” (n = 89), “initially low level of MME/day remaining low” (n = 108), and “initially moderate level of MME/day decreasing to low” (n = 329). Age and emotional distress in response to bodily sensations were associated with trajectory membership. Individuals in the “initially mild pain intensity remaining mild” trajectory were less likely than those in the “initially moderate pain intensity remaining moderate” trajectory to report CPSP (odds ratio [95% confidence interval, CI], 0.23 [0.06–0.88]). No significant associations were observed between opioid consumption trajectory membership and CPSP status (odds ratio [95% CI], 0.84 [0.28–2.54] and 0.95 [0.22–4.13]). CONCLUSIONS: Those with moderate pain intensity right after surgery are more likely to develop CPSP suggesting that those patients should be flagged early on in their postoperative recovery to attempt to alter their trajectory and prevent CPSP. Emotional distress in response to bodily sensations is the only consistent modifiable factor associated with both pain and opioid trajectories.
Accès libre
Virtual group psychotherapy for chronic pain : exploring the impact of the virtual medium on participants’ experiences
Moore, Emily; Paré, Catherine; Carde, Estelle; Pagé, Gabrielle; Université de Montréal. Faculté de médecine. Département d'anesthésiologie et de médecine de la douleur (Oxford University Press, 2023-09-21)
Background Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants’ experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management. Methods This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit. Results Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants. Conclusions Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts.
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One-year opioid consumption trajectories among individuals receiving multidisciplinary postsurgical care : a single-center observational study from the Toronto General Hospital Transitional Pain Service
Pagé, Gabrielle; Katz, Joel; Darville, Rasheeda; Gabriel, Gretchen; Ladha, Karim S.; Huang, Alexander; Ganty, Praveen; Katznelson, Rita; Tamir, Diana; Fiorellino, Joseph; Kahn, Michael; Tao, Leeping; Slepian, Maxwell; Wieskopf, Jeffrey; Clarke, Hance; Université de Montréal. Faculté de médecine. Département d'anesthésiologie et de médecine de la douleur (BMJ Publishing Group, 2024-07-30)
Introduction The Transitional Pain Service (TPS) is an innovative, personalized approach to postsurgical opioid consumption and pain management. The objectives of this study were to identify trajectories of opioid consumption and pain intensity within 12 months after initiating treatment through the TPS, identify biopsychosocial factors associated with trajectory membership, and examine the relationship between trajectory membership and other outcomes of interest over the same 12-month period. Methods Consecutive patients referred to the TPS were included in the present study (n=466). After providing informed consent, they completed self-report questionnaires at the initial visit at the TPS (either pre surgery or post surgery) and at every TPS visit until 12 months. Growth mixture modeling was used to derive trajectories and identify associated factors. Results Results showed three distinct opioid consumption trajectories for both presurgical opioid consumers and opioid-naïve patients. These trajectories all decreased over time and among those who were consuming opioids before surgery that returned to presurgical levels. Being man, having a substance use disorder, or reporting higher levels of pain interference were associated with higher daily opioid consumption for presurgical opioid consumers. For presurgical opioid-naïve individuals, higher opioid consumption trajectories were associated with higher levels of psychological distress. Five pain intensity trajectories were identified, and there were no significant association between opioid consumption and pain intensity trajectories. Conclusions Results suggest that opioid consumption and pain intensity trajectories mostly decrease after surgery in a high-risk population enrolled in a TPS. Results also show heterogeneity in postsurgical recovery and highlight the importance of using personalized interventions to optimize individual trajectories. Data availability statement No data are available. Data are available on reasonable request. No data are available for sharing as consent was not obtained from participants for this purpose.
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Associations between weight loss attempts, weight-related stress and body image during childhood and adolescence in children with parental obesity
Harnois-Leblanc, Soren; Van Hulst, Andraea; Lucibello, Kristen M.; Harbec, Marie-Josée; Sabiston, Catherine M.; Maximova, Katerina; Sylvestre, Marie-Pierre; Henderson, Mélanie; Université de Montréal. Faculté des arts et des sciences. École de psychoéducation; Université de Montréal. Faculté de médecine. Département de pédiatrie; Université de Montréal. École de santé publique. Département de médecine sociale et préventive (Mary Ann Liebert, 2024-09-06)
Background: Few longitudinal studies have investigated the role of weight-loss attempts or weight-related stress on body image during childhood. We examined whether weight-loss attempts and weight-related stress are associated with weight misperception and body dissatisfaction across childhood and adolescence. Methods: Data were drawn from the Quebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort of Canadian children with parental obesity (8–10 years: n = 630; 10–12 years: n = 564; 15–17 years: n = 377). We assessed weight-loss attempts and weight-related stress at baseline and first follow-up, and perceived and desired silhouettes at first and second follow-up with questionnaires. Weight misperception consisted of the difference in BMI z-score (zBMI) from the perceived silhouette and the measured zBMI. Body dissatisfaction consisted of the discordance between perceived and desired silhouettes. We estimated multivariable mixed-effects regression models adjusting for age, sex, pubertal stage, parental BMI and education, and sport-based teasing. Results: Weight loss attempts were associated with a higher weight misperception score (ever tried, beta [95% confidence intervals; CI]: 0.13 [0.01–0.24]) and with 2.13 times higher desire to be thinner (95% CI: 1.39–3.26) at the subsequent follow-up. Similarly, children stressed by their weight had a higher misperception score (beta [95% CI]: 0.15 [0.02–0.27]) and greater desire to be thinner at the next follow-up (odds ratio [95% CI]: 1.73 [0.999–3.00]). Conclusions: Weight-loss attempts and weight-related stress in children and adolescents are associated with weight misperception and body dissatisfaction, supporting empowerment and counseling focusing on healthy eating behaviors and a positive body image.
Embargo
The association between depressive symptoms and overweight or obesity in prepubertal children: findings from the QUALITY cohort
Bonin, Sarah; Harnois-Leblanc, Soren; Béland, Mélanie; Simoneau, Gabrielle; Mathieu, Marie-Ève; Barnett, Tracie A.; Sabiston, Catherine M.; Henderson, Mélanie; Université de Montréal. Faculté de médecine. Département de pédiatrie; Université de Montréal. Faculté de médecine. École de kinésiologie et des sciences de l'activité physique; Université de Montréal. École de santé publique. Département de médecine sociale et préventive (Elsevier, 2024-08-24)
Background: Youth obesity and depression are public health concerns. Although metaanalyses suggest a positive association between those conditions in adults and adolescents, evidence remains unclear in prepubertal children. We examined the bidirectional associations between levels of depressive symptoms and weight status in 8-10-year-old children with a parental history of obesity, over two years, and whether they differ by sex. Methods: Data were drawn from QUebec Adipose and Lifestyle InvesTigation in Youth Cohort Study’s baseline and first follow-up evaluations (n=558). Depressive symptoms were assessed using the 12-item Center for Epidemiological Studies Depression scale and weight status using body mass index z-scores based on World Health Organization standards. Linear and logistic regression models were used to test the directionality and magnitude of the associations, adjusting for age, sex, physical activity, screen time, parental education, alcohol and cigarette use, and baseline outcome measure. Results: Children with higher levels of depressive symptoms at baseline were not more likely to have overweight/obesity at follow-up (odds ratio [95% Coefficient Interval] = 0.95[0.88;1.02]). Baseline overweight/obesity was not associated with subsequent higher levels of depressive symptoms (beta coefficient [95% Coefficient Interval] = 0.20 [-0.47;0.87]). No sex differences emerged. Limitations: Selection bias may have occurred due to loss at followup (10% attrition) and exclusion of 6 participants taking mood disorder medication. Conclusions: Unlike in adults and adolescents, no association between weight status and depressive symptoms was observed in childhood over two years. Underlying mechanisms linking both conditions later in life may not apply as early as prepubertal childhood.
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Adiposity and cardiac autonomic function in children with a family history of obesity
Saade, Marie-Béatrice; Holden, Samuel; Lisa, Kakinami; McGrath, Jennifer J.; Mathieu, Marie-Ève; Poirier, Paul; Barnett, Tracie A.; Beaucage, Pierre; Henderson, Mélanie; Université de Montréal. Faculté de médecine. Département de pédiatrie; Université de Montréal. Faculté de médecine. École de kinésiologie et des sciences de l'activité physique; Université de Montréal. École de santé publique. Département de médecine sociale et préventive (Springer, 2024-09-21)
Purpose Data on associations between adiposity and heart rate variability (HRV) in pre-pubertal children are limited. We examined the associations between adiposity indices and HRV, independent of lifestyle behaviors, comparing multiple indicators of adiposity, and explored differences between boys and girls. Methods Data stem from 469 participants of the QUALITY cohort (630 children aged 8-10 yrs with a parental history of obesity). Adiposity indices included waist-to-height ratio, body mass index (BMI) percentiles and categories (overweight, obesity), dual-energy x-ray absorptiometry (DEXA) defined fat mass percentage and android/gynoid ratio. HRV indices in the frequency and the spectral domain were derived from a daytime 3-hr Holter recording. Multivariable linear regression models were adjusted for age, sex, Tanner stage, physical activity, screen time, and fitness. Interactions between sex and adiposity were tested. Results Greater adiposity was associated with decreased parasympathetic modulation and increased sympathetic dominance. Waist-to-height ratio was associated with lower parasympathetic activity: RMSSD (B=-23.32 [-42.42, -4.22]), pNN50 (B=-16.93 [-28.58, -5.27]), LF/HF ratio (B=1.83 [0.97, 2.70]). Patterns of association were similar for android/gynoid ratio. Overweight was not associated with altered HRV. Obesity was negatively associated with RMSSD and pNN50 and positively with LF/HF ratio. Greater fat mass percentage was associated with lower RMSSD, pNN50 and HF, and increased LF/HF ratio. There were no differences between boys and girls. Conclusion Specific markers of adiposity relate to altered HRV in childhood, with waist-to-height ratio being potentially a more relevant marker of HRV than BMI and more pragmatic than percent body fat. NCT03356262, November 11, 2017.
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Work disability and musculoskeletal disorders among teleworkers : a scoping review
Hong, Quan Nha; Li, Jingjing; Kersalé, Marietta; Dieterlen, Eloi; Mares, Adrian; Ahmadian Sangkar, Zeinab; Paquet, Virginie; Lederer, Valérie; Laberge, Marie; Coutu, Marie-France; Université de Montréal. Faculté de médecine. École de réadaptation (Springer, 2024-03-28)
Purpose This project aimed to examine the existing evidence on work disability or musculoskeletal disorders (MSDs) among teleworkers. Method A scoping review was conducted in eight bibliographic databases (MEDLINE, CINAHL, Embase, PsycINFO, ABI/Inform Global, EBM Reviews, Web of Science, Dissertations & Theses Global) from inception to June 2022. Results Out of 9192 records identified, a total of 79 selected articles representing 77 studies were retained. Most studies were published after 2019, aligning with the COVID-19 pandemic’s telework surge. Among the included papers, 51 addressed MSDs among teleworkers, 17 were on work disability, and 11 addressed both concepts. The studies were predominantly cross-sectional. Some trends are emerging, although study results are contradictory. Several papers reported increased musculoskeletal discomfort among teleworkers. Factors associated with MSDs among teleworkers include poor workstation setup, extended workdays, sedentary lifestyle, excessive devices use, and psychological factors. Regarding work disability, studies found that telework is associated with reduced absenteeism but increased presenteeism, with employees more likely to work while unwell from home than when on-site. Mixed results were found regarding teleworkers’ work ability and functioning. Conclusion This paper provides an overview of the literature on work disability and MSDs among teleworkers. It identifies literature gaps, underlining the need for ergonomic improvements, long-term impact studies, a better conceptualization of presenteeism in the context of telework, and tailored interventions to enhance the telework experience.
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Vascular injury derived apoptotic exosome-like vesicles trigger autoimmunity
Juillard, Sandrine; Karakeussian-Rimbaud, Annie; Normand, Marie-Hélène; Turgeon, Julie; Veilleux-Trinh, Charlotte; Robitaille, Alexa; Rauch, Joyce; Chruscinski, Andrzej; Grandvaux, Nathalie; Boilard, Éric; Hébert, Marie-Josée; Dieudé, Mélanie; Université de Montréal. Faculté de médecine. Département de microbiologie, infectiologie et immunologie (Elsevier, 2024-08-11)
According to a central tenet of classical immune theory, a healthy immune system must avoid self-reactive lymphocyte clones but we now know that B cells repertoire exhibit some level of autoreactivity. These autoreactive B cells are thought to rely on self-ligands for their clonal selection and survival. Here, we confirm that healthy mice exhibit self-reactive B cell clones that can be stimulated in vitro by agonists of toll-like receptor (TLR) 1/2, TLR4, TLR7 and TLR9 to secrete anti-LG3/perlecan. LG3/perlecan is an antigen packaged in exosome-like structures released by apoptotic endothelial cells (ApoExos) upon vascular injury. We demonstrate that the injection of ApoExos in healthy animals activates the IL-23/IL-17 pro-inflammatory and autoimmune axis, and produces several autoantibodies, including anti-LG3 autoantibodies and hallmark autoantibodies found in systemic lupus erythematosus. We also identify γδT cells as key mediators of the maturation of ApoExos-induced autoantibodies in healthy mice. Altogether we show that ApoExos released by apoptotic endothelial cells display immune-mediating functions that can stimulate the B cells in the normal repertoire to produce autoantibodies. Our work also identifies TLR activation and γδT cells as important modulators of the humoral autoimmune response induced by ApoExos.
Accès libre
In silico human cardiomyocyte action potential modeling : exploring ion channel input combinations
Boulay, Emmanuel; Troncy, Éric; Jacquemet, Vincent; Huang, Hai; Pugsley, Michael; Downey, Anne-Marie; Venegas Baca, Rafael; Authier, Simon; Université de Montréal. Faculté de médecine. Département de pharmacologie et physiologie (SAGE, 2024-03-13)
In silico modeling offers an opportunity to supplement and accelerate cardiac safety testing. With in silico modeling, computational simulation methods are used to predict electrophysiological interactions and pharmacological effects of novel drugs on critical physiological processes. The O’Hara-Rudy’s model was developed to predict the response to different ion channel inhibition levels on cardiac action potential duration (APD) which is known to directly correlate with the QT interval. APD data at 30% 60% and 90% inhibition were derived from the model to delineate possible ventricular arrhythmia scenarios and the marginal contribution of each ion channel to the model. Action potential values were calculated for epicardial, myocardial, and endocardial cells, with action potential curve modeling. This study assessed cardiac ion channel inhibition data combinations to consider when undertaking in silico modeling of proarrhythmic effects as stipulated in the Comprehensive in Vitro Proarrhythmia Assay (CiPA). As expected, our data highlight the importance of the delayed rectifier potassium channel (IKr) as the most impactful channel for APD prolongation. The impact of the transient outward potassium channel (Ito) inhibition on APD was minimal while the inward rectifier (IK1) and slow component of the delayed rectifier potassium channel (IKs) also had limited APD effects. In contrast, the contribution of fast sodium channel (INa) and/or L-type calcium channel (ICa) inhibition resulted in substantial APD alterations supporting the pharmacological relevance of in silico modeling using input from a limited number of cardiac ion channels including IKr, INa, and ICa, at least at an early stage of drug development.
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Fast computation of multivariate synchrony index in sliding windows: application to cardiac neurons
Longpré, Jean-Philippe; Salavatian, Siamak; Beaumont, Éric; Armour, J. Andrew; Ardell, Jeffrey L.; Jacquemet, Vincent; Université de Montréal. Faculté de médecine. Département de pharmacologie et physiologie (2014-09)
Multielectrode array neuronal recordings in atrial ganglionated plexi are characterized by low firing rates, marked non-stationarity, interplay with the cardiovascular and pulmonary systems and artifacts generated by myocardial activity, which creates challenges very different from brain recordings. To explore population dynamics of intrinsic cardiac neurons, a jitter-based synchrony index has been defined to quantify pairwise synchrony between neurons. In this paper, we extend this synchrony index to multiple time series in order to monitor global (multivariate) synchrony. Numerical techniques are developed to efficiently compute synchrony indices and their statistical significance in a large number of time windows. A scaletime graphical representation is proposed to visualize synchrony in sliding windows of varying lengths. This approach is validated in synthetic time series and in experimental data sets recorded in 11 dogs. Results show the ability of the method to monitor synchrony over time in neuron populations, between neurons and the cardiopulmonary system and between neuron firing and electrical stimulation. These tools will facilitate the exploration and robust quantitative analysis of multiple-hour recordings in cardiac ganglionated plexi to efficiently identify relevant periods of activity in relation to physiological or external stimuli and cardiac arrhythmia.
Accès libre
Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women
Dumoulin, Chantal; Cacciari, Licia P.; Hay‐Smith, E. Jean C.; Université de Montréal. Faculté de médecine. École de réadaptation (Wiley, 2018-10-04)
Background Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI). This is an update of a Cochrane Review first published in 2001 and last updated in 2014. Objectives To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations. Search methods We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In‐Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles. Selection criteria Randomised or quasi‐randomised controlled trials in women with SUI, UUI or MUI (based on symptoms, signs or urodynamics). One arm of the trial included PFMT. Another arm was a no treatment, placebo, sham or other inactive control treatment arm. Data collection and analysis At least two review authors independently assessed trials for eligibility and risk of bias. We extracted and cross‐checked data. A third review author resolved disagreements. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We subgrouped trials by diagnosis of UI. We undertook formal meta‐analysis when appropriate. Main results The review included 31 trials (10 of which were new for this update) involving 1817 women from 14 countries. Overall, trials were of small‐to‐moderate size, with follow‐ups generally less than 12 months and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration, study populations and outcome measures. There was only one study of women with MUI and only one study with UUI alone, with no data on cure, cure or improvement, or number of episodes of UI for these subgroups. Symptomatic cure of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were eight times more likely to report cure (56% versus 6%; risk ratio (RR) 8.38, 95% confidence interval (CI) 3.68 to 19.07; 4 trials, 165 women; high‐quality evidence). For women with any type of UI, PFMT groups were five times more likely to report cure (35% versus 6%; RR 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women; moderate‐quality evidence). Symptomatic cure or improvement of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were six times more likely to report cure or improvement (74% versus 11%; RR 6.33, 95% CI 3.88 to 10.33; 3 trials, 242 women; moderate‐quality evidence). For women with any type of UI, PFMT groups were two times more likely to report cure or improvement than women in the control groups (67% versus 29%; RR 2.39, 95% CI 1.64 to 3.47; 2 trials, 166 women; moderate‐quality evidence). UI‐specific symptoms and quality of life (QoL) at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT group were more likely to report significant improvement in UI symptoms (7 trials, 376 women; moderate‐quality evidence), and to report significant improvement in UI QoL (6 trials, 348 women; low‐quality evidence). For any type of UI, women in the PFMT group were more likely to report significant improvement in UI symptoms (1 trial, 121 women; moderate‐quality evidence) and to report significant improvement in UI QoL (4 trials, 258 women; moderate‐quality evidence). Finally, for women with mixed UI treated with PFMT, there was one small trial (12 women) reporting better QoL. Leakage episodes in 24 hours at the end of treatment: PFMT reduced leakage episodes by one in women with SUI (mean difference (MD) 1.23 lower, 95% CI 1.78 lower to 0.68 lower; 7 trials, 432 women; moderate‐quality evidence) and in women with all types of UI (MD 1.00 lower, 95% CI 1.37 lower to 0.64 lower; 4 trials, 349 women; moderate‐quality evidence). Leakage on short clinic‐based pad tests at the end of treatment: women with SUI in the PFMT groups lost significantly less urine in short (up to one hour) pad tests. The comparison showed considerable heterogeneity but the findings still favoured PFMT when using a random‐effects model (MD 9.71 g lower, 95% CI 18.92 lower to 0.50 lower; 4 trials, 185 women; moderate‐quality evidence). For women with all types of UI, PFMT groups also reported less urine loss on short pad tests than controls (MD 3.72 g lower, 95% CI 5.46 lower to 1.98 lower; 2 trials, 146 women; moderate‐quality evidence). Women in the PFMT group were also more satisfied with treatment and their sexual outcomes were better. Adverse events were rare and, in the two trials that did report any, they were minor. The findings of the review were largely supported by the 'Summary of findings' tables, but most of the evidence was downgraded to moderate on methodological grounds. The exception was 'participant‐perceived cure' in women with SUI, which was rated as high quality. Authors' conclusions Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic and symptoms on UI‐specific symptom questionnaires. The authors of the one economic evaluation identified for the Brief Economic Commentary reported that the cost‐effectiveness of PFMT looks promising. The findings of the review suggest that PFMT could be included in first‐line conservative management programmes for women with UI. The long‐term effectiveness and cost‐effectiveness of PFMT needs to be further researched.

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