Comparaison des comités d’éthique de France et du Québec en regard de l’incapacité à consentir à la recherche

BackgroundFrench and Quebec legislation allow the inclusion of decisionally-incompetent subjects in research, provided certain conditions are met. In both jurisdictions, ethics committees are charged with ensuring that research protocols meet these conditions. We investigated committee members’ knowledge and opinions regarding substitute consent for research purposes.MethodsTwo consecutive postal surveys were conducted among all members of ethics committees from France and Quebec. Knowledge and opinions about proxy consent were measured with clinical vignettes describing hypothetical situations involving incapable adults. For each vignette, respondents were asked to either identify the person legally authorized to consent or choose the substitute decision-maker whom they considered best suited to do so.ResultsKnowledge of the legislation governing substitute consent was poor in both samples, especially in situations involving an incompetent person who did not have a legal representative. Knowledge was worse among French ethics committee members (p < 0.001). In hypothetical clinical studies that involved no risk to the subject's health, 59% of respondents favored consent from a close relative. As the risk increased, the proportion gradually decreased to 14.2%, while the proportion against soliciting the cognitively impaired older adult tended to increase (from 5.8 to 31.2%). These trends were observed in both samples.ConclusionThese findings underscore the need to better educate ethics committee members about legislation regarding prospective subjects who lack decisional capacity. Such efforts could improve both knowledge of and compliance with legal provisions that enable or restrict the participation of cognitively-impaired patients in research projects. Moreover, study findings provide some support for enlarging the category of persons who are authorized to consent to low-risk research on behalf of incapacitated adults who lack legal representation.     

Comparaison de l’excrétion urinaire de biomarqueurs d’exposition aux pyréthrinoïdes et aux pyréthrines chez les résidents de régions urbaine et rurale de la Province de Québec,Canada

BackgroundResidents of rural (agricultural) areas are often suspected of being exposed to higher levels of pesticides than residents of urban areas. However, only a limited number of studies have specifically evaluated the impact of the geographical area of residence on pyrethroid and pyrethrin exposure in the general population. This study aimed at comparing the levels of biomarkers of exposure between an urban and rural, adult and children, population of the Province of Quebec, Canada.MethodsA total of 154 urban (Montreal) and 154 rural (Monteregie) participants provided a complete overnight timed-urine collection and filled a self-administered questionnaire. Urine samples were analyzed for pyrethroid and pyrethrin metabolites: cis- and trans-dichloro- and cis-dibromo- vinyldimethylcyclopropane carboxylic acids, phenoxy- and fluorophenoxy-benzoic acids and chrysanthemum dicarboxylic acid. Amounts of metabolites (pmol/12 h par kilogram body weight) and their frequency of detection in the two populations were compared and interpreted with the help of the answers gathered by questionnaire.ResultsAdults and children from the rural area tended to excrete higher levels of the main urinary metabolites, the cis- and trans-dichlorovinyldimethylcyclopropane carboxylic acids and the phenoxybenzoic acid, than those living in the urban area. When the adults and children were combined, this difference was statistically significant for the phenoxybenzoic acid (p = 0.020), marginally significant for the trans-dichlorovinyldimethylcyclopropane carboxylic acid (p = 0.053) and nonsignificant for the cis-dichlorovinyldimethylcyclopropane carboxylic acid (p = 0.158). The chrysanthemum dicarboxylic acid, the fluorophenoxybenzoic acid and the dibromovinyldimethylcyclopropane carboxylic acid were detected in much lower proportion but, in the case of the fluorophenoxybenzoic acid, the relative frequency of detection was statistically significantly higher (p < 0.001) in the rural population.ConclusionThe presence of a baseline level of biomarkers in the urban and rural population confirms the ubiquity of pyrethroids and pyrethrins in the environment. However, in the rural adult and infantile population under study, other factors possibly contributed to slightly increase exposure compared to the urban population, namely the use of mosquito repellents and household insecticides as reported by questionnaire.     

Étude de germathiazolidines et de dithioacétals germaniés dérivés de la cystéamine et méthylcystéamine N-substituées: synthèse et activité radioprotectrice

Synthesis and pharmacological studies (toxicity, radioprotective activity) of new N-substituted germathiazolidines and germylated dithioacetals prepared from N-substituted cysteamine and methylcysteamine by an acetyl group, —(CH₂)₃NH₂, or a partial amino acid

are described.A notable decrease in the toxicity and a rather important increase in the radioprotective activity of these new organometallic molecules compared to N-substituted cysteamine and methylcysteamine have been observed.     

Dépister la dénutrition de l’enfant

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. PEM increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Paediatric Society recommends weighing and measuring any child when hospitalized or seen as outpatients. Body mass index (BMI) must be calculated and analyzed according to references anytime growth kinetics cannot be analyzed. Any child with a BMI below the third centile or –2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an aetiology, and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing a nutritional strategy along with the global care plan. A target weight needs to be determined as well as the quantitative, qualitative and modality of nutritional care. This plan must be evaluated afterwards in order to adapt nutritional therapy.     

Disparités géographiques d’évolution d’incidence des cancers de la thyroïde par taille entre 1983 et 2000 en France

BackgroundThe aim of this investigation was to study geographic time trends of thyroid cancer incidence according to tumor size in France, 1983 to 2000.MethodsIncidence data were provided from six French registries over the period 1983–2000 covering seven administrative districts. Five tumor size groups were distinguished: < 10 mm, 10–20 mm, 20–40 mm, > 40 mm and unknown size. Papillary cancers diagnosed in women were analyzed according to tumor size in each geographic area. World age standardized rates were calculated and annual percent change rates were estimated for each tumor size group in each geographic area. Loglinear Poisson regression models were used to study geographic discrepancies in time trends incidences.ResultsThe six French registries included 2222 papillary thyroid cancers in women between 1983 et 2000. Thyroid cancer incidence was increasing in the six geographic areas. Geographical variations in time trends incidence between registries reflected geographical variations in time trends incidence of small sized tumors (less than 10 mm).ConclusionWide geographic variations in thyroid cancer incidence were noticed for small size tumors, which may be correlated with geographic variations in medical practices.     

Caractéristiques associées à la dépression et aux symptômes de stress post-traumatique chez les femmes victimes d’agression sexuelle durant l’enfance

BackgroundA significant proportion of childhood sexual abuse victims suffer from psychological sequelae in adulthood. Factors that provide a better understanding for the reasons why some victims develop these sequelae remain under-explored. In this context, the main objective is to examine the specific contribution of the contextual characteristics of childhood sexual abuse, multitype childhood maltreatment and adolescent suicide attempts on the development of depression and post-traumatic stress disorder in adulthood among sexually abused women as children. A secondary objective aimed to establish the prevalence of various forms of childhood maltreatment, adult onset post-traumatic stress disorder and depression among those women.MethodsThe sample included 479 women victims of childhood sexual abuse who participated in two separate surveys taken by women in the province of Quebec.ResultsMore than half of these women reported at least one other form of childhood maltreatment, 30% of them presented post-traumatic disorder and 40% suffered from depression in adulthood. Regression analysis indicates that post-traumatic stress disorder was associated with early onset childhood sexual abuse and intergenerational continuity of sexual victimization, as well as childhood physical maltreatment and negligence. Depression was associated with childhood psychological maltreatment and negligence, a non-supportive response following child sexual abuse related disclosure and suicide attempt in adolescence.ConclusionThese results confirm the need to consider the cumulative effects of various childhood adversity factors in the psychosocial assessment of sexually abused women in early life, thus helping to better understand and treat their psychological sequelae.     

Etude de la cytotoxicitéin vitro de dérivés du carbazole I. Nitro et amino-9H-carbazoles

The cytotoxicity of 33 carbazole derivatives was studied in vitro, in a clonogenic assay using murine leukemia 1210. Results are compared to those obtained with reference drugs, particularly N-2-methyl-9-hydroxyellipticinium acetate (NMHE). 3-Amino-2-nitro-9H-carbazole (free base and hydrochloride) and NMHE exhibit similar cytotoxic activities against L1210 cells.