Publications by authors named "David Renaud"

66 Publications

Support care needs of people with hearing and vision impairment in dementia: a European cross-national perspective.

Disabil Rehabil 2021 May 23:1-13. Epub 2021 May 23.

Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA.

Purpose: Aging-related sensory impairments are among the most common and disabling comorbidities in people with dementia (PwD). This study explored the unmet support care needs (SCNs) from the perspectives of people with hearing and/or vision impairment in dementia (PwD), and their care partners in Europe.

Methods: This was a two-phase mixed methods study. We administered standardized questionnaires of SCNs and quality of life (QoL) to PwD with hearing and/or vision impairment ( = 97), and their care partners ( = 97) in the UK, France, and Cyprus. Next, a purposive sub-sample of 34 participants (PwD and care partners) participated as focus groups (FGs) or semi-structured interviews to explore their SCNs in depth.

Results: Over 94% of the participants reported unmet SCNs (median, 13 (range 5-23)). Nearly three-quarters reported SCNs in the moderate to high range, with the most prevalent unmet SCNs for PwD being in the psychological (>60%) and physical domains (>56%), followed by the need for health information (>46%). Emergent qualitative themes were: (1) the need for tailored support care interventions; (2) care burden, social isolation, and loneliness arising from the combined problems; (3) the need for adequate support from professionals from the different fields, including education around the use of sensory aids. Both study phases revealed that SCNs were highly individualized.

Conclusions: This cross-national study revealed that PwD with sensory impairment and their care partners experience a wide range of unmet SCNs, the interactions between sensory impairments, SCNs and QoL are also complex. A tailored intervention could address these unmet SCNs, including additional support with sensory aids, psychological support, more information about concurrent impairments, and joined up health systems providing care.Implications for rehabilitationA majority of participants with combined age-related hearing, vision, and cognitive impairment had unmet SCNs.The needs of care partners including the risk of loneliness and social isolation, need to be considered.Individually tailored, specific interventions for hearing, vision, and cognitive impairment should incorporate physical and psychological support, as well as education.
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http://dx.doi.org/10.1080/09638288.2021.1923071DOI Listing
May 2021

Perspectives on the Management of Surplus Dairy Calves in the United States and Canada.

Front Vet Sci 2021 13;8:661453. Epub 2021 Apr 13.

Department of Population Medicine, University of Guelph, Guelph, ON, Canada.

The care of surplus dairy calves is a significant issue for the United States and Canadian dairy industries. Surplus dairy calves commonly experience poor welfare as evidenced by high levels of mortality and morbidity, and negative affective states resulting from limited opportunities to express natural behaviors. Many of these challenges are a result of a disaggregated production system, beginning with calf management at the dairy farm of origin and ending at a calf-raising facility, with some calves experiencing long-distance transportation and commingling at auction markets or assembly yards in the interim. Thus, the objectives of this narrative review are to highlight specific challenges associated with raising surplus dairy calves in the U.S. and Canada, how these challenges originate and could be addressed, and discuss future directions that may start with refinements of the current system, but ultimately require a system change. The first critical area to address is the management of surplus dairy calves on the dairy farm of origin. Good neonatal calf care reduces the risk of disease and mortality, however, many dairy farms in Canada and the U.S. do not provide sufficient colostrum or nutrition to surplus calves. Transportation and marketing are also major issues. Calves can be transported more than 24 consecutive hours, and most calves are sold through auction markets or assembly yards which increases disease exposure. Management of calves at calf-raisers is another area of concern. Calves are generally housed individually and fed at low planes of nutrition, resulting in poor affective states and high rates of morbidity and mortality. Strategies to manage high-risk calves identified at arrival could be implemented to reduce disease burden, however, increasing the plane of nutrition and improving housing systems will likely have a more significant impact on health and welfare. However, we argue the current system is not sustainable and new solutions for surplus calves should be considered. A coordinated and holistic approach including substantial change on source dairy farms and multiple areas within the system used to market and raise surplus dairy calves, can lead to more sustainable veal and beef production with improved calf outcomes.
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http://dx.doi.org/10.3389/fvets.2021.661453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076512PMC
April 2021

Predicting morbidity and mortality using automated milk feeders: A scoping review.

J Dairy Sci 2021 Jun 23;104(6):7177-7194. Epub 2021 Mar 23.

Department of Population Medicine, University of Guelph, Guelph, ON, Canada N1G 2W1. Electronic address:

Automated milk feeders (AMF) are computerized systems that provide producers with a tool that can be used to more efficiently raise dairy calves and allow for easier implementation of a high plane of nutrition during the milk feeding phase. Automated milk feeders also have the ability to track individualized behavioral data, such as milk consumption, drinking speed, and the number of rewarded and unrewarded visits to the feeder, that could potentially be used to predict disease development. The objective of this scoping review was to characterize the body of literature investigating the use of AMF data to predict morbidity and mortality in dairy calves during the preweaning stage. This review lists the parameters that have been examined for associations with disease in calves and identify discrepancies found in the literature. Five databases and relevant conference proceedings were searched. Eligible studies focused on the use of behavioral parameters measured by AMF to predict morbidity or mortality in preweaned dairy calves. Two reviewers independently screened titles and abstracts from 6,675 records identified during the literature search. After title and abstract screening, 382 studies were included and then assessed at the full-text level. Of these, 56 studies fed calves using an AMF and provided some measure of morbidity or mortality. Thirteen examined AMF parameters for associations with morbidity or mortality. The studies were completed in North America (n = 6), Europe (n = 6), and New Zealand (n = 1). The studies varied in sample size, ranging from 30 to 1,052 calves with a median of 100 calves. All 13 studies included enteric disease as an outcome and 11 studies evaluated respiratory disease. Of the studies measuring enteric disease, 8 provided disease definitions (n = 8/13, 61.2%); however, for respiratory disease, only 5 provided a disease definition (n = 5/11, 45.5%). Disease definitions and thresholds varied greatly between studies, with 10 using some form of health scoring. When evaluating feeding metrics as indicators of disease, all 13 studies investigated milk consumption and 6 and 7 studies investigated drinking speed and number of rewarded and unrewarded visits, respectively. Overall, this scoping review identified that daily milk consumption, drinking speed, and rewarded and unrewarded visits may provide insight into early disease detection in preweaned dairy calves. However, the disparity in reporting of study designs and results between included studies made comparisons challenging. In addition, to aid with the interpretation of studies, standardized disease outcomes should be used to improve the utility of this primary research.
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http://dx.doi.org/10.3168/jds.2020-19645DOI Listing
June 2021

A focus group study of Ontario dairy producer perspectives on neonatal care of male and female calves.

J Dairy Sci 2021 May 2;104(5):6080-6095. Epub 2021 Mar 2.

Department of Population Medicine, University of Guelph, Guelph, ON, Canada, N1G 2W1. Electronic address:

Providing optimal calf care remains a challenge on many dairy farms and has important implications for the future health, welfare, and productivity of male and female calves. Recent research suggests that male dairy calves receive a lower quality of care early in life than female calves, but further investigation is required to determine the factors that influence this disparity. The objectives of this study were to understand dairy producer perspectives on neonatal calf care practices and explore differences between male and female calf care. Overall, 23 dairy producers in Ontario, Canada, participated in 4 focus groups about calf care practices that were recorded and evaluated qualitatively using thematic analysis. Major barriers for good calf care included lack of knowledge about the best management practices for calf care and the prioritization of farm resources toward the milking herd. Some producers also noted that farm infrastructure (particularly during challenging weather) and employee training were important limitations. The economic cost of providing good neonatal calf care was important primarily for male calves and acted as a motivation or a barrier depending on the producer's beliefs about calf care and how they chose to market their calves. The primary source of knowledge producers used to develop calf care practices was their own experience, although many also relied on dairy-industry advisors, most often veterinarians. Producers were motivated by social norms, along with intrinsic pride and obligation to provide good calf care, and these motives were influenced by their emotional state. Producers expressed beliefs about which aspects of calf care are most important-notably colostrum management-and appreciated simple and economical solutions to calf-rearing challenges. Calf care practices were varied, and we identified a diversity of knowledge, motivations, and barriers to adopting best management practices, which sometimes differed between male and female calves. Some producers said that they did not know what happened to their male calves after they left the farm and tended to prioritize the care of female over male calves in subtle ways, such as less timely provision of colostrum. The infrastructure investment and other costs associated with caring for male calves often limited their care, but producers were still motivated to provide adequate care for male calves. These findings represent potential targets for additional research and intervention strategies to improve calf care practices on dairy farms.
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http://dx.doi.org/10.3168/jds.2020-19507DOI Listing
May 2021

Characterization of fecal branched-chain fatty acid profiles and their associations with fecal microbiota in diarrheic and healthy dairy calves.

J Dairy Sci 2021 Feb 23;104(2):2290-2301. Epub 2020 Dec 23.

Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5, Canada. Electronic address:

Branched-chain fatty acids (BCFA) have recently been reported to play a role in human gut health during early life. However, little information is available on the fecal BCFA profiles in young ruminants and whether they are associated with the development of neonatal calf diarrhea. The objectives of this study were to (1) characterize BCFA profiles in feces collected from young calves, (2) compare the fecal BCFA composition between diarrheic and nondiarrheic dairy calves, and (3) explore the potential relationships between BCFA and microbiota in the feces. A total of 32 male Holstein dairy calves (13 ± 3 d old) with the same diet management were grouped as diarrheic (n = 16) or healthy (n = 16) based on fecal score (determined by liquid fecal consistency with some solid particles); diarrhea cases were defined as fecal score ≥2 for at least 2 d. Fecal samples were collected on the seventh day after calf arrival, and the fecal BCFA and microbial profiles were assessed using gas chromatograph and amplicon sequencing, respectively. In total, 7 BCFA were detected in the feces of all dairy calves; however, the concentrations of fecal BCFA differed between diarrheic and nondiarrheic calves. Specifically, the concentrations of iso-C16:0, iso-C17:0, anteiso-C17:0, and total even-chain BCFA were significantly higher in the feces of diarrheic calves. When the associations between BCFA and bacteria were studied, the relative abundance of Eggerthella was positively correlated with the concentrations of iso-C16:0 (ρ = 0.67), iso-17:0 (ρ = 0.77), anteiso-C17:0 (ρ = 0.73), and iso-C18:0 (ρ = 0.65), whereas the relative abundance of Subdoligranulum was positively correlated with the concentrations of iso-C14:0 (ρ = 0.62), iso-C15:0 (ρ = 0.78), and anteiso-C15:0 (ρ = 0.63). Use of random forest algorithm showed that BCFA such as anteiso-C15:0, iso-C16:0, iso-C17:0, iso-C18:0, and total even-chain BCFA could be used as biomarkers to differentiate diarrheic calves from healthy ones. Our findings generated fundamental knowledge on the potential roles of BCFA in neonatal calf gut health. Follow-up studies with larger animal populations are warranted to validate the feasibility of using BCFA as indicators of health status in neonatal calves.
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http://dx.doi.org/10.3168/jds.2020-18825DOI Listing
February 2021

Risk factors for poor health outcomes for male dairy calves undergoing transportation in western Canada.

Can Vet J 2020 12;61(12):1265-1272

Animal Welfare Program (Wilson, Stojkov, Fraser), University of British Columbia, Vancouver V6T 1ZA; Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1 (Renaud).

The condition of 640 male dairy calves was recorded and their health deterioration, morbidity, and mortality evaluated after long-distance transport. Assessments included a health examination, weight estimation, and measure of failed transfer of passive immunity (FTPI). A McNemar Test and logistic regression analysis were used to evaluate the effects of pre-transport condition on subsequent health. Before transport, calf health and age at shipping varied between farms; overall, 17%, 8%, and 12% of calves had diarrhea, navel disease, and FTPI, respectively, and calves were transported at a median age of 5 days. In their first 2 weeks after transportation, 23% and 44% of calves were treated for diarrhea and bovine respiratory disease (BRD), respectively, and 4% died. Calves with navel disease, low body weight, and a depressed attitude at the farm of origin were more likely to experience negative health outcomes. Better health before transportation is needed to protect the subsequent health and welfare of young calves.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659877PMC
December 2020

Selected hematological, biochemical, and acid-base variables of Paso Fino horses living at different altitudes.

Trop Anim Health Prod 2020 Nov 17;53(1). Epub 2020 Nov 17.

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.

This study aimed at describing selected hematological, biochemical, and acid-base variables of adult horses living at sea level and comparing them to those living at 5 different altitudes. One hundred and thirty-eight healthy Paso Fino horses > 2 years old were enrolled. Altitudes included the following: altitude A (0 to 50 m above sea level, masl; n = 23), B (1000 to 1050 masl; n = 25), C (1450 masl; n = 30), D (1950 to 2050 masl; n = 30), and E (2950 to 3100 masl; n = 30). A portable blood gas analyzer was used to determine selected biochemical and acid-base variables. Hematocrit (Htc) was measured by blood centrifugation and total plasma protein as total solids using a refractometer. A one-way ANOVA with Tukey's HSD post hoc test or a Wilcoxon signed-rank test, depending of the normality of the data, was conducted to compare groups. Horses at sea level had lower Htc (25% ± 2) and Hb (8 ± 0.8 mg/dL) concentration than those horses living ≥ 1000 masl (P < 0.05, for all comparisons). No differences in Htc and Hb were identified in horses living between 1000 and 3000 masl (P > 0.05, for all comparisons). The venous PCO was significantly lower in horses living at altitudes ≥ 1000 masl than those living at 0 masl (42 ± 4.8 mmHg) (P = 0.001, for all comparisons). No differences in PCO were identified in horses living between 1000 and 3000 masl. This study showed that the Htc, Hb, and PCO of horses living at sea level were different compared to those in healthy horses living at altitudes ≥ 1000 masl. However, differences in TPP and electrolyte concentrations were not identified.
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http://dx.doi.org/10.1007/s11250-020-02449-6DOI Listing
November 2020

Acid-base disorders in sick goats and their association with mortality: A simplified strong ion difference approach.

J Vet Intern Med 2020 Nov 3;34(6):2776-2786. Epub 2020 Nov 3.

Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.

Objectives: To investigate the acid-base status of sick goats using the simplified strong ion difference (sSID) approach, to establish the quantitative contribution of sSID variables to changes in blood pH and HCO and to determine whether clinical, acid-base, and biochemical variables on admission are associated with the mortality of sick goats.

Animals: One hundred forty-three sick goats.

Methods: Retrospective study. Calculated sSID variables included SID using 6 electrolytes unmeasured strong ions (USI) and the total nonvolatile buffer ion concentration in plasma (A ). The relationship between measured blood pH and HCO , and the sSID variables was examined using forward stepwise linear regression. Cox proportional hazard models were constructed to assess associations between potential predictor variables and mortality of goats during hospitalization.

Results: Hypocapnia, hypokalemia, hyperchloremia, hyperlactatemia, and hyperproteinemia were common abnormalities identified in sick goats. Respiratory alkalosis, strong ion acidosis, and A acidosis were acid-base disorders frequently encountered in sick goats. In sick goats, the sSID variables explained 97% and 100% of the changes in blood pH and HCO , respectively. The results indicated that changes in the respiratory rate (<16 respirations per minute), USI, and pH at admission were associated with increased hazard of hospital mortality in sick goats.

Conclusions And Clinical Importance: The sSID approach is a useful methodology to quantify acid-base disorders in goats and to determine the mechanisms of their development. Clinicians should consider calculation of USI in sick goats as part of the battery of information required to establish prognosis.
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http://dx.doi.org/10.1111/jvim.15956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694813PMC
November 2020

Hot topic: Health and welfare challenges in the marketing of male dairy calves-Findings and consensus of an expert consultation.

J Dairy Sci 2020 Dec 15;103(12):11628-11635. Epub 2020 Oct 15.

Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, 2357 Main Mall, Vancouver, BC, Canada V6T 1Z6.

A diverse group of Canadian experts was convened for a focused 2-d discussion on potential health and welfare problems associated with the marketing (i.e., transportation and sale) of male dairy calves. Written notes and audio recording were used to summarize the information provided on transport times and marketing practices. Content analysis was used to develop a consensus statement on concerns, possible solutions, and recommendations to improve male dairy calf marketing. The group noted that calves across all Canadian regions are commonly transported at 3 to 7 d of age and undergo transport for 12 to 24 h or longer depending on the location of their dairy farm of origin. Calves in some regions are marketed almost exclusively through auction markets, whereas others have more direct sales. A need was identified for better criteria for calf fitness for transport, maintaining farm biosecurity, reducing the use of antimicrobial therapy in calf production, and improving education for farmers and veterinarians on the importance of neonatal care for male dairy calves before transportation. Experts noted that major changes in male dairy calf marketing will be required to comply with amendments to the federal Health of Animals Regulations (Part XII) on animal transportation; collaborative effort will be needed to safeguard animal health and welfare as this transition is made.
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http://dx.doi.org/10.3168/jds.2020-18438DOI Listing
December 2020

Smell and taste changes are early indicators of the COVID-19 pandemic and political decision effectiveness.

Nat Commun 2020 10 14;11(1):5152. Epub 2020 Oct 14.

Lyon Neuroscience Research Center, CNRS UMR5292, INSERM U1028, University Claude Bernard Lyon 1, Bron, France.

In response to the COVID-19 pandemic, many governments have taken drastic measures to avoid an overflow of intensive care units. Accurate metrics of disease spread are critical for the reopening strategies. Here, we show that self-reports of smell/taste changes are more closely associated with hospital overload and are earlier markers of the spread of infection of SARS-CoV-2 than current governmental indicators. We also report a decrease in self-reports of new onset smell/taste changes as early as 5 days after lockdown enforcement. Cross-country comparisons demonstrate that countries that adopted the most stringent lockdown measures had faster declines in new reports of smell/taste changes following lockdown than a country that adopted less stringent lockdown measures. We propose that an increase in the incidence of sudden smell and taste change in the general population may be used as an indicator of COVID-19 spread in the population.
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http://dx.doi.org/10.1038/s41467-020-18963-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560893PMC
October 2020

[Mindfulness meditation for family caregivers].

Soins Gerontol 2020 Sep - Oct;25(145):40-45. Epub 2020 Jul 18.

Centre de mémoire de ressources et recherches, Institut Claude-Pompidou, centre hospitalier universitaire de Nice, 10 rue Molière, 06100 Nice, France.

A significant proportion of elderly people suffering from neurodegenerative pathologies are cared for by an informal caregiver. From the earliest stages of the disease, the psychological and behavioural disorders of patients constitute stress and anxiety factors for their caregivers. Mindfulness meditation has proven its usefulness in the management of anxiety. A study proposes caregiver management based on a mindfulness meditation program.
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http://dx.doi.org/10.1016/j.sger.2020.07.010DOI Listing
October 2020

Short communication: Condition of male dairy calves at auction markets.

J Dairy Sci 2020 Sep 16;103(9):8530-8534. Epub 2020 Jul 16.

Animal Welfare Program, University of British Columbia, Vancouver, British Columbia V6T 1ZA, Canada.

Male dairy calves in North America are frequently marketed through live auctions. Calves have been observed in suboptimal condition both at auctions and upon arrival at calf-rearing facilities that supply the veal or dairy-beef industries. The objectives of this study were to describe the health of male dairy calves at a commercial auction in British Columbia, Canada, examine the relationships between calf price and condition, and use price data from other auctions to reflect more broadly on the variability in calf condition at auction markets. Price and breed were recorded for 1,624 male calves, and a sample of 355 calves was assessed using a standardized health exam and body weight estimation. Linear regression was used to assess which calf characteristics were associated with price. Prices for young dairy calves at auctions in 2 other provinces (Nova Scotia and Quebec) were compiled for comparison. Twenty percent of calves had at least one health abnormality; the most common was navel disease (12%), followed by ocular or nasal discharge (4%), a depressed (dull, unable, or unwilling to rise) attitude (2%), coughing (2%), and joint inflammation (1%). The mean (±SD) estimated body weight was 47 ± 8 kg with a range of 27 to 82 kg. Calves were sold for up to Can$370 (median Can$140), but 10.5% sold for Can$10 or less, and 2.8% were not sold at all. [The mean exchange rate over the course of this study (Oct. 2017 to Mar. 2018) was Can$1 = US$0.79.] Calves with a depressed attitude sold for lower prices than bright, alert calves. In addition, those with Brown Swiss or Jersey genetics sold for lower prices than those with Holstein genetics, and cross-bred calves with beef genetics sold for higher prices. During 2018, 62% of young dairy calves sold at the Nova Scotia auction and 18% of young Holstein calves sold in Quebec were classed as lower quality and sold for 23% and 40%, respectively, of the value of higher-quality calves. The results underline the need to develop solutions to reduce the risk of marketing calves in poor condition at auction markets.
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http://dx.doi.org/10.3168/jds.2019-17860DOI Listing
September 2020

Subjective cognitive and non-cognitive complaints and brain MRI biomarkers in the MEMENTO cohort.

Alzheimers Dement (Amst) 2020 5;12(1):e12051. Epub 2020 Jul 5.

Clinical and Research Memory Centre of Lyon Lyon Institute for Elderly Charpennes Hospital University Hospital of Lyon Lyon France.

Introduction: Subjective cognitive complaints may be a signature of preclinical stage Alzheimer's disease. However, the link between subjective cognitive and non-cognitive complaints and brain alterations remains unclear.

Methods: The relationship between cognitive and non-cognitive complaints and brain biomarkers, measured by structural magnetic resonance imaging, was investigated in 2056 participants of the MEMENTO cohort of outpatients, who were dementia-free at baseline. We assessed whether the cognitive status at inclusion or the presence of the apolipoprotein E gene variant () ε4 could modulate the association between the intensity of complaints and brain lesions.

Results: Smaller hippocampal volume was associated with higher memory complaints and discomfort in daily life. In ε4 carriers, smaller whole-brain white matter and gray matter volumes and gyrification indices in several regions of interest of the parietal and temporal lobes, in the entorhinal and the para-hippocampal gyrus, were associated with higher memory complaint score.

Conclusions: The intensity of subjective complaints in not only memory but discomfort in daily life was associated with brain degeneration markers. The presence of ε4 modulated the relationships between subjective memory complaints and brain alterations.
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http://dx.doi.org/10.1002/dad2.12051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335902PMC
July 2020

Linking perturbations to temporal changes in diversity, stability, and compositions of neonatal calf gut microbiota: prediction of diarrhea.

ISME J 2020 09 22;14(9):2223-2235. Epub 2020 May 22.

Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2P5, Canada.

Perturbations in early life gut microbiota can have long-term impacts on host health. In this study, we investigated antimicrobial-induced temporal changes in diversity, stability, and compositions of gut microbiota in neonatal veal calves, with the objective of identifying microbial markers that predict diarrhea. A total of 220 samples from 63 calves in first 8 weeks of life were used in this study. The results suggest that increase in diversity and stability of gut microbiota over time was a feature of "healthy" (non-diarrheic) calves during early life. Therapeutic antimicrobials delayed the temporal development of diversity and taxa-function robustness (a measure of microbial stability). In addition, predicted genes associated with beta lactam and cationic antimicrobial peptide resistance were more abundant in gut microbiota of calves treated with therapeutic antimicrobials. Random forest machine learning algorithm revealed that Trueperella, Streptococcus, Dorea, uncultured Lachnospiraceae, Ruminococcus 2, and Erysipelatoclostridium may be key microbial markers that can differentiate "healthy" and "unhealthy" (diarrheic) gut microbiota, as they predicted early life diarrhea with an accuracy of 84.3%. Our findings suggest that diarrhea in veal calves may be predicted by the shift in early life gut microbiota, which may provide an opportunity for early intervention (e.g., prebiotics or probiotics) to improve calf health with reduced usage of antimicrobials.
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http://dx.doi.org/10.1038/s41396-020-0678-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609338PMC
September 2020

The economic impact that registered veterinary technicians have on Ontario veterinary practices.

Can Vet J 2020 05;61(5):505-511

Agricultural Communications and Epidemiological Research (ACER) Consulting, Guelph, Ontario.

In Canada, registered veterinary technicians (RVTs) are highly trained, regulated professionals working as an integral part of the veterinary team, but there has been little work to quantify their impact on veterinary practices. The objectives of the study were to explore the utilization rates of RVTs and quantify the economic value that RVTs bring to veterinary practices in Ontario, Canada. An online survey was deployed to explore the function of RVTs and their non-credentialed counterparts in practices. There were 169 responses, with 112 respondents providing economic indicators. For each additional RVT/veterinarian, gross annual revenue per veterinarian (RPV) increased by $79 118 (SE = $21 146, < 0.0001). For 1- and 2-veterinarian practices, if the veterinarian frequently performed RVT duties, the practices were less profitable than clinics that relied on RVTs to perform such duties ( = 0.0001). Finally, clinics which paid their RVTs over $21 per hour earned $122 342 (SE = $58 874, = 0.04) more RPV relative to clinics which paid their RVTs $15 or less per hour.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7155880PMC
May 2020

Pharmacologic Approaches for the Management of Apathy in Neurodegenerative Disorders.

Front Pharmacol 2019 23;10:1581. Epub 2020 Jan 23.

Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressources et de Recherche, Nice, France.

Apathy is one of the most frequent behavioral disturbances in many neurodegenerative disorders and is known to have a negative impact on the disease progression, particularly in Alzheimer's disease. Therapeutic options are currently limited and non-pharmacological approaches should constitute first line treatments. Pharmacological agents likely to reduce apathy levels are lacking. The objective of the present article is to review recent pharmacological treatments for apathy in neurodegenerative disorders. The Pubmed database was searched with a particular focus on articles published as of January 2017. Current main levels of evidence have been reported so far with cholinergic, glutamatergic and dopaminergic agents to reduce levels of apathy, despite several conflicting results. Treatment duration and samples sizes may have however decreased the validity of previous results. Ongoing studies involving more participants/treatment duration or distinct neural pathways may provide new insights in the treatment of apathy in neurodegenerative disorders.
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http://dx.doi.org/10.3389/fphar.2019.01581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989486PMC
January 2020

Pathways to care for people with dementia: An international multicentre study.

Int J Geriatr Psychiatry 2020 02 1;35(2):163-173. Epub 2019 Dec 1.

Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia.

Objective: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care.

Methods: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant.

Results: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care.

Conclusions: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.
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http://dx.doi.org/10.1002/gps.5223DOI Listing
February 2020

Absence of Relationship Between Self-Reported Sleep Measures and Amyloid Load in Elderly Subjects.

Front Neurol 2019 13;10:989. Epub 2019 Sep 13.

INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Epidémiologique, Montpellier, France.

To determine the relationships between self-reported sleep profile and cortical amyloid load in elderly subjects without dementia. This cross-sectional study included 143 community-dwelling participants aged ≥70 years (median: 73 years [70-85]; 87 females) with spontaneous memory complaints but dementia-free. Sociodemographic characteristics, health status, neuropsychological tests, sleep, and F-florbetapir (amyloid) PET data were collected. The clinical sleep interview evaluated nighttime sleep duration, but also daytime sleep duration, presence of naps, and restless leg syndrome (RLS) at time of study. Validated questionnaires assessed daytime sleepiness, insomnia, and risk of sleep apnea. The cortical standardized uptake value ratio (SUVr) was computed across six cortical regions. The relationship between sleep parameters and SUVr (cut-off ratio>1.17 and tertiles) was analyzed using logistic regression models. Amyloid-PET was positive in 40.6% of participants. Almost 40% were at risk for apnea, 13.5% had RLS, 35.5% insomnia symptoms, 22.1% daytime sleepiness, and 18.8% took sleep drugs. No significant relationship was found between positive amyloid PET and nighttime sleep duration (as a continuous variable, or categorized into <6; 6-7; ≥7 h per night). Logistic regression models did not show any association between SUVr and daytime sleep duration, 24-h sleep duration, naps, RLS, daytime sleepiness, insomnia symptoms, and sleep apnea risk (before and after adjustment for APOEε4 and depressive symptoms). Our study did not confirm the association between amyloid-PET burden, poor sleep quantity/quality in elderly population, suggesting that the interplay between sleep, and amyloid is more complex than described.
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http://dx.doi.org/10.3389/fneur.2019.00989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753692PMC
September 2019

Benzodiazepine use and brain amyloid load in nondemented older individuals: a florbetapir PET study in the Multidomain Alzheimer Preventive Trial cohort.

Neurobiol Aging 2019 12 14;84:61-69. Epub 2019 Aug 14.

UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHU de Tours, Tours, France.

It remains unclear whether benzodiazepines (BZDs) constitute a risk factor for Alzheimer's disease (AD). In this study, we investigated associations between chronic use of BZDs and brain amyloid load, a hallmark of AD, in 268 nondemented older individuals. F-florbetapir positron emission tomography scans were performed to assess amyloid load as measured by standardized uptake value ratios, which were compared between chronic BZD users and nonusers using adjusted multiple linear regressions. Short- versus long-acting BZDs were also considered in the analyses. Standardized uptake value ratios were significantly lower in BZD users (n = 47) than in nonusers (n = 221), independent of multiple adjustments. The effect was stronger for short-acting BZDs than for long-acting BZDs. This is the first large clinical study showing a reduced brain amyloid load in chronic BZD users, especially with short-acting BZDs. Our results do not support the view of BZD use as a risk factor for AD and instead support the involvement of pharmacological mechanisms related to neuronal hyperactivity, neuroinflammation, and sleep quality as potential targets for blocking amyloid accumulation.
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http://dx.doi.org/10.1016/j.neurobiolaging.2019.08.008DOI Listing
December 2019

Recommendations for the Nonpharmacological Treatment of Apathy in Brain Disorders.

Am J Geriatr Psychiatry 2020 04 9;28(4):410-420. Epub 2019 Aug 9.

Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; Association Innovation Alzheimer (VM, PR), Nice, France; Centre Hospitalier Universitaire (CHU) de Nice (RD, PR), CMRR, Nice, France.

Apathy is a common neuropsychiatric syndrome observed across many neurocognitive and psychiatric disorders. Although there are currently no definitive standard therapies for the treatment of apathy, nonpharmacological treatment (NPT) is often considered to be at the forefront of clinical management. However, guidelines on how to select, prescribe, and administer NPT in clinical practice are lacking. Furthermore, although new Information and Communication Technologies (ICT) are beginning to be employed in NPT, their role is still unclear. The objective of the present work is to provide recommendations for the use of NPT for apathy, and to discuss the role of ICT in this domain, based on opinions gathered from experts in the field. The expert panel included 20 researchers and healthcare professionals working on brain disorders and apathy. Following a standard Delphi methodology, experts answered questions via several rounds of web-surveys, and then discussed the results in a plenary meeting. The experts suggested that NPT are useful to consider as therapy for people presenting with different neurocognitive and psychiatric diseases at all stages, with evidence of apathy across domains. The presence of a therapist and/or a caregiver is important in delivering NPT effectively, but parts of the treatment may be performed by the patient alone. NPT can be delivered both in clinical settings and at home. However, while remote treatment delivery may be cost and time-effective, it should be considered with caution, and tailored based on the patient's cognitive and physical profile and living conditions.
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http://dx.doi.org/10.1016/j.jagp.2019.07.014DOI Listing
April 2020

Relationships between objectives sleep parameters and brain amyloid load in subjects at risk for Alzheimer's disease: the INSIGHT-preAD Study.

Sleep 2019 09;42(9)

Université Côte d'Azur, CoBTeK lab, Centre Mémoire de Ressources et de Recherche, Nice University Hospital France.

Study Objectives: Sleep changes have been associated with increased risks of developing cognitive disturbances and Alzheimer's disease (AD). A bidirectional relation is underlined between amyloid-beta (Aß) and sleep disruptions. The sleep profile in participants at risk to develop AD is not fully deciphered. We aim to investigate sleep-wake changes with objective sleep measurements in elderly participants without cognitive impairment depending on their brain amyloid status, positive (Aß+) or negative (Aß-) based on standard absorption ratios (SUVr) positron emission tomography-florbetapir imaging.

Methods: Sixty-eight participants without cognitive impairment who have accepted to be involved in the sleep ancillary study from the InveStIGation of Alzheimer's Predictors in Subjective Memory Complainers (INSIGHT-pre AD) cohort, aiming to record sleep profile based on the analyses of an ambulatory accelerometer-based assessment (seven consecutive 24-hour periods). Neuropsychological tests were performed and sleep parameters have been individualized by actigraph. Participants also underwent a magnetic resonance imaging scan to assess their hippocampal volume. Based on SUVr PET-florbetapir imaging, two groups Aß+ and Aß- were compared.

Results: Participants were divided into two groups: Aß+ (n = 24) and Aß- (n = 44). Except for the SUVr, the two subgroups were comparable. When looking to sleep parameters, increased sleep latency, sleep fragmentation (wake after sleep onset [WASO] score and awakenings) and worst sleep efficiency were associated with cortical brain amyloid load.

Conclusion: Actigraphic sleep parameters were associated with cortical brain amyloid load in participants at risk to develop AD. The detection of sleep abnormalities in those participants may be of interest to propose some preventive strategies.
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http://dx.doi.org/10.1093/sleep/zsz137DOI Listing
September 2019

How many patients are eligible for disease-modifying treatment in Alzheimer's disease? A French national observational study over 5 years.

BMJ Open 2019 06 24;9(6):e029663. Epub 2019 Jun 24.

Neurology, CHU de la Pitiè Salpêtrière-AP-HP, Paris, France.

Objective: We aimed to study the epidemiology of the prodromal and mild stages of Alzheimer's disease (AD) patients who are eligible for clinical trials with disease-modifying therapies.

Settings: We analysed two large complementary databases to study the incidence and characteristics of this population on a nationwide scope in France from 2014 to 2018. The National Alzheimer Database contains data from 357 memory centres and 90 private neurologists. Data from 2014 to 2018 have been analysed.

Participants: Patients, 50-85 years old, diagnosed with AD who had an Mini-Mental State Exam (MMSE) score of ≥20 were included. We excluded patients with mixed and non-AD neurocognitive disorders.

Primary Outcome Measure: Descriptive statistics of the population of interest was the primary measure.

Results: In the National Alzheimer Database, 550 198 patients were assessed. Among them, 72 174 (13.1%) were diagnosed with AD and had an MMSE ≥20. Using corrections for specificity of clinical diagnosis of AD, we estimated that about 50 000 (9.1%) had a prodromal or mild AD. In the combined electronic clinical records database of 11 French expert memory centres, a diagnosis of prodromal or mild AD, certified by the use of cerebrospinal fluid AD biomarkers, could be established in 195 (1.3%) out of 14 596 patients.

Conclusions: AD was not frequently diagnosed at a prodromal or mild dementia stage in France in 2014 to 2018. Diagnosis rarely relied on a pathophysiological marker even in expert memory centres. National databases will be valuable to monitor early stage AD diagnosis efficacy in memory centres when a disease-modifying treatment becomes available.
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http://dx.doi.org/10.1136/bmjopen-2019-029663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597622PMC
June 2019

Alzheimer's disease: Estimating its prevalence rate in a French geographical unit using the National Alzheimer Data Bank and national health insurance information systems.

PLoS One 2019 6;14(5):e0216221. Epub 2019 May 6.

Université Côte d'Azur, CHU de Nice, Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Nice, France.

Background: Reliable epidemiological data on Alzheimer's disease are scarce. However, these are necessary to adapt healthcare policy in terms of prevention, care and social needs related to this condition. To estimate the prevalence rate in the Alpes-Maritimes on the French Riviera, with a population of one million, we present a capture-recapture procedure applied to cases of Alzheimer's disease, based on two epidemiological surveillance systems.

Methods: To estimate the total number of patients affected by Alzheimer's disease, a capture-recapture study included a cohort of patients with Alzheimer's disease or receiving medications only eligible for use for this condition, recorded by a specific health insurance information system (Health Insurance Cohort, HIC), and those registered in the French National Alzheimer's Data Bank ("Banque Nationale Alzheimer", BNA) in 2010 and 2011. We applied Bayesian estimation of the Mt ecological model, taking into account age and gender as covariates, i.e. factors of inhomogeneous catchability.

Results: Overall, 5,562 patients with Alzheimer's disease were recorded, of whom only 856 were common to both information systems. Mean age and F/M sex ratio differed between BNA and HIC surveillance systems, 81 vs 84 years and 2.7 vs 3.2, respectively. A Bayesian estimation, with age and gender as covariates, yields an estimate of 15,060 cases of Alzheimer's disease [95%HPDI: 14,490-15,630] in the Alpes-Maritimes. The completeness of the HIC and BNA databases were respectively of 25.4% and 17.2%. The estimated prevalence rate among the population over 65 years old was 6.3% in 2010-2011.

Conclusions: This study demonstrates that it is possible to determine the number of subjects affected by Alzheimer's disease in a geographical unit, using available data from two existing surveillance systems in France, i.e. 15,060 cases in the Alpes-Maritimes. This is the first stage of a population-based approach in view of adapting available resources to the population's needs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216221PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502320PMC
January 2020

Invited review: Completeness of reporting of experiments: REFLECTing on a year of animal trials in the Journal of Dairy Science.

J Dairy Sci 2019 Jun 17;102(6):4759-4771. Epub 2019 Apr 17.

Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.

Reproducibility is an essential element of the scientific process, and it requires clear and complete reporting of study design, conduct, and analysis. In the human and animal health literature, incomplete reporting is associated with biased effect estimates. Moreover, incomplete reporting precludes knowledge synthesis and undervalues the resources allocated to the primary research. The Reporting Guidelines for Randomized Controlled Trials for Livestock and Food Safety (REFLECT) statement, published in 2010, is a checklist developed by expert consensus to provide guidance on what study elements should be reported in any intervention trial (designed experiment) involving livestock. The Journal of Dairy Science (JDS) has recently endorsed the use of reporting guidelines. To assess the status of reporting of controlled experiments in JDS and to provide a baseline for future comparison, we evaluated the reporting of 18 items from the REFLECT statement checklist in a sample of 137 controlled trials published in JDS in 2017. Two reviewers independently screened titles and abstracts for relevance and then evaluated a sample of 120 papers reporting controlled trials (experimental studies involving at least one intervention and one comparison or control group), using yes or no questions. Although some items, such as treatment details and statistical analysis, were well reported, other areas, including sample size justification, allocation concealment, blinding, study flow, baseline data, and ancillary analyses, were often not reported or were incompletely described. This work highlights the need for authors and reviewers to take advantage of guidelines and checklists for reporting. Adherence to reporting guidelines can help improve the completeness of reporting of research, expedite and better inform the peer-review process, increase clarity for the reader, and allow for knowledge synthesis, such as meta-analysis, all of which serve to increase the value of the work conducted.
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http://dx.doi.org/10.3168/jds.2018-15797DOI Listing
June 2019

Reproductive management practices on dairy farms: The Canadian National Dairy Study 2015.

J Dairy Sci 2019 Feb 26;102(2):1822-1831. Epub 2018 Dec 26.

Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada, N1G 2W1.

The objectives of this cross-sectional study were to characterize reproductive management practices on Canadian dairy farms and describe differences based on regional and demographic factors. A questionnaire was offered to all licensed Canadian dairy producers and included 189 questions regarding producer and farm background information, herd dynamics, biosecurity, disease prevalence, calf health, animal welfare, milking practices, reproduction, and internet use. Twenty-four questions were related to estrus detection, hormonal protocols for reproduction, insemination, and pregnancy diagnosis. A total of 1,373 producers responded to the survey, representing a response rate of 12.5%. Estrus detection practices in lactating cows were associated with herd size, barn type, region, organic production, breeding method, and age of respondent. The most commonly used estrus-detection method in cows was visual (51.0% of farms for first insemination; 45.5% for subsequent inseminations). Estrus detection for nulliparous heifers was associated with herd size, barn type, region, and breeding method, with visual detection also the most common method for heifers (71.3% of farms). Eighty percent of farms used strictly artificial insemination, 2.8% used natural service only, and 16.8% used a combination of artificial insemination and natural service. Breeding method was associated with herd size, barn type, region, and education level of the respondent. Pregnancy diagnosis method was associated with herd size, barn type, region, and organic production. Ultrasound was the most commonly used method of pregnancy diagnosis (used by 52.2% of farms). Sixty-nine percent of farms rechecked cows for pregnancy, and rectal palpation was the most commonly used method (employed by 48.7%). Reproductive management practices vary considerably among Canadian dairy farms and decisions are associated with farm-level factors, including region, herd size, and barn type, as well as producer-level factors, such as age, managerial role, and education level.
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http://dx.doi.org/10.3168/jds.2018-14683DOI Listing
February 2019

Evaluating the impact of meloxicam oral suspension administered at parturition on subsequent production, health, and culling in dairy cows: A randomized clinical field trial.

PLoS One 2018 12;13(12):e0209236. Epub 2018 Dec 12.

Solvet Animal Health, Calgary, Alberta, Canada.

Parturition is a painful event experienced by cows at the onset of lactation. This pain could lead to a reduced feed intake, altered metabolic and immunological status, and a host of other diseases that could seriously limit her productive herd lifespan. The objective of the current study was to assess the effect of administration of a single dose of oral meloxicam, a non-steroidal anti-inflammatory drug (NSAID), on the production and health status of cows during their lactation. A total of 2,653 (1,009 meloxicam-treated and 1,644 untreated control) cows were enrolled across 20 herds in the provinces of Ontario and Quebec, Canada. Relative to untreated controls, meloxicam-treated cows produced 0.64 kg/day (SE = 0.29. P = 0.03) more milk over the first 3 test days (90-120 days in lactation), had 0.75 times the odds of subclinical mastitis at first test (SE = 0.08, P = 0.01), and were culled or died at 0.46 times the rate (SE = 0.16, P = 0.03) before 60 days in milk. These results are consistent with previous research and lend support to the hypothesis that parturition is a painful event in cattle. Attempts to ameliorate such pain with analgesics is associated with a variety of positive health and production outcomes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209236PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291144PMC
May 2019

Neural correlates of episodic memory in the Memento cohort.

Alzheimers Dement (N Y) 2018 22;4:224-233. Epub 2018 May 22.

Inserm, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, ISPED, CIC 1401-EC, Univ Bordeaux, Bordeaux, France.

Introduction: The free and cued selective reminding test is used to identify memory deficits in mild cognitive impairment and demented patients. It allows assessing three processes: encoding, storage, and recollection of verbal episodic memory.

Methods: We investigated the neural correlates of these three memory processes in a large cohort study. The Memento cohort enrolled 2323 outpatients presenting either with subjective cognitive decline or mild cognitive impairment who underwent cognitive, structural MRI and, for a subset, fluorodeoxyglucose-positron emission tomography evaluations.

Results: Encoding was associated with a network including parietal and temporal cortices; storage was mainly associated with entorhinal and parahippocampal regions, bilaterally; retrieval was associated with a widespread network encompassing frontal regions.

Discussion: The neural correlates of episodic memory processes can be assessed in large and standardized cohorts of patients at risk for Alzheimer's disease. Their relation to pathophysiological markers of Alzheimer's disease remains to be studied.
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http://dx.doi.org/10.1016/j.trci.2018.03.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021546PMC
May 2018

Pharmacoresistant Severe Mental Health Disorders in Children and Adolescents: Functional Abnormalities of Cytochrome P450 2D6.

Front Psychiatry 2018 24;9. Epub 2018 Jan 24.

Service de génétique moléculaire, pharmacogénétique et hormonologie, Centre de Ressource Biologie Paris-Sud, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, Nice, France.

Background: Severe mental health disorders in children and adolescents represent a major public health problem. Despite adequate drug treatment, some patients develop pharmacoresistant disease. As a consequence, physicians are confronted with prescribing challenges, prolonged hospitalization and increased risk of adverse events, thus aggravating short-, medium-, and long-term prognosis. The majority of psychotropic treatments, particularly antipsychotics and antidepressants, are metabolized at hepatic level by cytochrome P450 (CYP), particularly by CYP3A4 and CYP2D6. Several genetic polymorphisms are described to be associated with ultrarapid (UM) or poor drug metabolism (PM), inducing clinical resistance and/or adverse events, and might therefore be related to pharmacoresistant severe mental health disease.

Case Presentation: A total of nine pharmacoresistant patients (four females, five males) aged 11-16 (mean 14.1) years have been genotyped for between January, 2015 and April, 2016. Patients were diagnosed with schizophrenia ( = 5), autism spectrum disorders ( = 2), intellectual disability with challenging behavior ( = 2), oppositional defiant disorder ( = 1), and post-traumatic stress and borderline personality disorders ( = 1). They had a treatment history with on average 6.1 (3-9) psychotropic, 5 (3-7) antipsychotic, and 3.4 (2-5) CYP2D6-metabolized antipsychotic and antidepressant molecules. Five patients (56%) presented functional anomalies of the gene: three patients were UM metabolizers with gene duplication and two patients were PM with *4/*41 and *3/*4 polymorphisms.

Conclusion: Functional anomalies of concerned more than half of our pediatric inpatient sample with pharmacoresistant disease. However, our case reports are limited by the low sample size. Nevertheless, knowledge of individual metabolism and in particular genotyping should be considered for clinical workup and therapy adjustment in resistant patients in child and adolescent psychiatry and might permit better treatment outcome, increased treatment adherence and diminished adverse events.
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http://dx.doi.org/10.3389/fpsyt.2018.00002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810290PMC
January 2018

Excessive Sleepiness and Longer Nighttime in Bed Increase the Risk of Cognitive Decline in Frail Elderly Subjects: The MAPT-Sleep Study.

Front Aging Neurosci 2017 28;9:312. Epub 2017 Sep 28.

University of Montpellier, Montpellier, France.

To identify self-reported sleep-wake disturbances that increase the risk of cognitive decline over 1-year follow-up in frail participants. Risk factors for cognitive impairment need to be better identified especially at earliest stages of the pathogenesis. Sleep-wake disturbances may be critical factors to consider and were thus being assessed in this at-risk population for cognitive decline. Frail elderly participants aged ≥70 years were selected from a subsample of the Multi-domain Alzheimer Preventive Trial (MAPT) for a sleep assessment (MAPT-sleep study) at 18-month follow-up (M18). Sleep-wake disturbances were evaluated using a clinical interview (duration of daytime and nighttime sleep, time in bed, number of naps, and presence of clinically-defined sleep disorders) and numerous validated questionnaires [Epworth Sleepiness Scale for excessive daytime sleepiness (EDS), Insomnia Severity Scale and Berlin Questionnaire]. Cognitive decline was defined as a difference between the MMSE and cognitive composite scores at M24 and M36 that was ranked in the lowest decile. Multivariate logistic regression models adjusted for several potential confounding factors were performed. Among the 479 frail participants, 63 developed MMSE-cognitive decline and 50 cognitive composite score decrease between M24 and M36. Subjects with EDS had an increased risk of MMSE decline (OR = 2.46; 95% CI [1.28; 4.71], = 0.007). A longer time spent in bed during night was associated with cognitive composite score decline (OR = 1.32 [1.03; 1.71], = 0.03). These associations persisted when controlling for potential confounders. Patients with MMSE score decline and EDS had more naps, clinically-defined REM-sleep Behavior Disorder, fatigue and insomnia symptoms, while patients with cognitive composite score decline with longer time in bed had increased 24-h total sleep time duration but with higher wake time after onset. The risk of cognitive decline is higher in frailty subjects with EDS and longer nighttime in bed. Early detection of sleep-wake disturbances might help identifying frail subjects at risk of cognitive decline to further propose sleep health strategies to prevent cognitive impairment. http://www.clinicaltrials.gov NCT00672685; Date of registration May, 2nd 2008.
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http://dx.doi.org/10.3389/fnagi.2017.00312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625324PMC
September 2017
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