L’intégration, dans la communauté, des personnes présentant une déficience intellectuelle : étude des manifestations d'opposition ou d'appui du voisinage

La volonté d'intégrer, dans la communauté, les personnes présentant une déficience intellectuelle et de changer le mode de vie institutionnel par un mode de vie similaire à celui des autres citoyens, oriente depuis plusieurs années les services de réadaptation. Comme le souligne Kebbon (1987), ce désir d'intégrer les personnes présentant une déficience intellectuelle est largement issu du principe de la normalisation. D'abord formulé en Scandinavie par Nirje (1969) puis repris aux États-Unis par Wolfensberger (1972), ce principe statue qu'un effort constant doit être fait pour rendre normales les conditions de vie des personnes présentant une déficience intellectuelle. L'intégration est "une condition nécessaire à la normalisation et est habituellement le moyen d'y aboutir" (Kebbon, 1987; 69). Toutefois, selon plusieurs auteurs, le succès ou l'échec de l'intégration repose largement sur l'acceptation et l'appui du public (Eisenring et Pasche, 1981; lonescu, 1987; Kastner, Repucci et Pezzoli, 1979; Roth et Smith, 1983; Sandler et Robinson, 1981; Seltzer, 1984; Sternlicht, 1976). La connaissance des réactions des personnes qui vivent dans le voisinage d'une ressource d'hébergement pour personnes ayant une déficience intellectuelle s'avère donc essentielle afin de bien évaluer le processus d'intégration et d'offrir aux personnes déficientes une meilleure qualité de vie. Le mouvement de désinstitutionnalisation et d'intégration des personnes déficientes a été amorcé au Québec depuis une dizaine d'années. Or, on ne sait encore que peu de choses quant aux réactions de la population à cette intégration communautaire. Deux études québécoises (Coté, Ouellet et Lachance, 1990; lonescu et Despins, 1990) portant sur les attitudes envers l'intégration communautaire des personnes ayant une déficience intellectuelle apportent quelques renseignements. L'étude de lonescu et Despins réalisée auprès d'étudiants et d'étudiantes de niveau collégial et universitaire, montre que 85,5% des répondants sont favorables à l'intégration communautaire des personnes présentant une déficience intellectuelle. Celle de Côté et al. menée auprès du grand public, indique que les deux tiers des répondants ne seraient pas défavorables à la présence de ces personnes dans leur quartier. Toutefois, aucune étude québécoise réalisée auprès de personnes qui vivent directement en contact avec le phénomène de l'intégration des personnes présentant une déficience intellectuelle n'a été recensée. Comment réagissent les gens lorsqu'ils sont confrontés au phénomène de l'intégration? Acceptent-ils la présence des personnes ayant une déficience intellectuelle ou, au contraire, s'y opposent-ils? Comment manifestent-ils leur acceptation ou leur opposition? Voilà autant de questions auxquelles ce mémoire tentera de répondre.

La télévision et le changement d'attitudes chez les personnes de 55 ans et plus

Vieillir, réalité existentielle reliée à la condition humaine. Le fait de vieillir bouscule, répugne, effraie. On en parle beaucoup, comme pour conjurer le mauvais sort, l'éloigner de soi; rarement pour se l'approprier, pour en sonder la richesse. Les médias et les spécialistes de tout acabit nous bombardent quotidiennement d'information sur le sujet. Mais la vraie nature du vieillissement humain n'est jamais apparue aussi mystérieuse. La vieillesse est perçue avant tout comme un problème et non comme une phase normale du développement humain, avec toute sa richesse et ses mille et une possibilités. Les informations véhiculées sur son sujet, particulièrement par les médias, agissent souvent comme un prisme grossissant ce qui vieillit plutôt mal en nous, mais camouflant ce qui vieillit plutôt bien. C'est bien connu, les gens heureux n'ont pas d'histoire. Or être vieux, pour une société axée sur le rendement et l'efficacité, c'est être perçu comme un problème et, par conséquent, c'est être malheureux. Ce sont ces stéréotypes et les attitudes auxquels ils donnent naissance qui nous ont incités à entreprendre cette étude. Quel médium de masse, sinon celui de la télévision, se prêtait le mieux à une intervention visant à changer ces stéréotypes et les attitudes négatives vis-à-vis le vieillissement et les personnes âgées? Comme une nouvelle série d'émissions s'adressant à des personnes de 55 ans et plus venait d'être mise sur pied à Radio-Québec, nous y avons vu une occasion unique d'évaluer l'impact de ce médium par le message véhiculé sur les perceptions et les attitudes de la population ciblée concernant son propre vieillissement. Bref, cette recherche tente de vérifier s'il est possible de modifier les perceptions, les attitudes et les stéréotypes de la société actuelle face au vieillissement et particulièrement auprès des premiers concernés. Elle s'adresse à ceux et celles pour qui la vieillesse pourrait aussi devenir un symbole d'épanouissement et de richesse collective autant qu'individuelle.

Influence of climate variability and stocking strategies on greenhouse gas emissions (GHGE), production and profit of a northern Queensland beef cattle herd

Previous studies of greenhouse gas emissions (GHGE) from beef production systems in northern Australia have been based on models of ‘steady-state’ herd structures that do not take into account the considerable inter-annual variation in liveweight gain, reproduction and mortality rates that occurs due to seasonal conditions. Nor do they consider the implications of flexible stocking strategies designed to adapt these production systems to the highly variable climate. The aim of the present study was to quantify the variation in total GHGE (t CO2e) and GHGE intensity (t CO2e/t liveweight sold) for the beef industry in northern Australia when variability in these factors was considered. A combined GRASP–Enterprise modelling platform was used to simulate a breeding–finishing beef cattle property in the Burdekin River region of northern Queensland, using historical climate data from 1982–2011. GHGE was calculated using the method of Australian National Greenhouse Gas Inventory. Five different stocking-rate strategies were simulated with fixed stocking strategies at moderate and high rates, and three flexible stocking strategies where the stocking rate was adjusted annually by up to 5%, 10% or 20%, according to pasture available at the end of the growing season. Variation in total annual GHGE was lowest in the ‘fixed moderate’ (~9.5 ha/adult equivalent (AE)) stocking strategy, ranging from 3799 to 4471 t CO2e, and highest in the ‘fixed high’ strategy (~5.9 ha/AE), which ranged from 3771 to 7636 t CO2e. The ‘fixed moderate’ strategy had the least variation in GHGE intensity (15.7–19.4 t CO2e/t liveweight sold), while the ‘flexible 20’ strategy (up to 20% annual change in AE) had the largest range (10.5–40.8 t CO2e/t liveweight sold). Across the five stocking strategies, the ‘fixed moderate’ stocking-rate strategy had the highest simulated perennial grass percentage and pasture growth, highest average rate of liveweight gain (121 kg/steer), highest average branding percentage (74%) and lowest average breeding-cow mortality rate (3.9%), resulting in the lowest average GHGE intensity (16.9 t CO2e/t liveweight sold). The ‘fixed high’ stocking rate strategy (~5.9 ha/AE) performed the poorest in each of these measures, while the three flexible stocking strategies were intermediate. The ‘fixed moderate’ stocking strategy also yielded the highest average gross margin per AE carried and per hectare. These results highlight the importance of considering the influence of climate variability on stocking-rate management strategies and herd performance when estimating GHGE. The results also support a body of previous work that has recommended the adoption of moderate stocking strategies to enhance the profitability and ecological stability of beef production systems in northern Australia.

Téléopération d'un robot collaboratif par outil haptique

Ce projet de recherche, intitulé Téléopération d'un robot collaboratif par outil haptique traite un des problèmes contemporains de la robotique, à savoir la coopération entre l'humain et la machine. La robotique est en pleine expansion depuis maintenant deux décennies: les robots investissent de plus en plus l'industrie, les services ou encore l'assistance à la personne et se diversifient considérablement. Ces nouvelles tendances font sortir les robots des cages dans lesquelles ils étaient placés et ouvrent grand la porte vers de nouvelles applications. Parmi elles, la coopération et les interactions avec l'humain représentent une réelle opportunité pour soulager l'homme dans des tâches complexes, fastidieuses et répétitives. En parallèle de cela, la robotique moderne s'oriente vers un développement massif du domaine humanoïde. Effectivement, plusieurs expériences sociales ont montré que l'être humain, constamment en interaction avec les systèmes qui l'entourent, a plus de facilités à contribuer à la réalisation d'une tâche avec un robot d'apparence humaine plutôt qu'avec une machine. Le travail présenté dans ce projet de recherche s'intègre dans un contexte d'interaction homme-robot (IHR) qui repose sur la robotique humanoïde. Le système qui en découle doit permettre à un utilisateur d'interagir efficacement et de façon intuitive avec la machine, tout en respectant certains critères, notamment de sécurité. Par une mise en commun des compétences respectives de l'homme et du robot humanoïde, les interactions sont améliorées. En effet, le robot peut réaliser une grande quantité d'actions avec précision et sans se fatiguer, mais n'est pas nécessairement doté d'une prise de décision adaptée à la situation, contrairement à l'homme qui est capable d'ajuster son comportement naturellement ou en fonction de son expérience. En d'autres termes, ce système cherche à intégrer le savoir-faire et la capacité de réflexion humaine avec la robustesse, l'efficacité et la précision du robot. Dans le domaine de la robotique, le terme d'interaction intègre également la notion de contrôle. La grande majorité des robots reçoit des commandes machines qui sont généralement des consignes de trajectoire, qu'ils sont capables d'interpréter. Or, plusieurs interfaces de contrôle sont envisageables, notamment celles utilisant des outils haptiques, qui permettent à un utilisateur d'avoir un ressenti et une perception tactile. Ces outils comme tous ceux qui augmentent le degré de contrôle auprès de l'utilisateur, en ajoutant un volet sensoriel, sont parfaitement adaptés pour ce genre d'applications. Dans ce projet, deux outils haptiques sont assemblés puis intégrés à une interface de contrôle haptique dans le but de commander le bras d'un robot humanoïde. Ainsi, l'homme est capable de diriger le robot tout en ajustant ses commandes en fonction des informations en provenance des différents capteurs du robot, qui lui sont retranscrites visuellement ou sensoriellement.

La participation en amont de grands projets d'aménagement : les effets sur le projet et ses acteurs.

Depuis plus de trente ans, nos pratiques démocratiques évoluent au rythme de liens grandissants entre les instances décisionnelles et la société civile. Les exemples de démarches participatives s’accumulent et leurs formes sont de plus en plus diverses. Au cours des dernières années, les démarches en amont sont de plus en plus présentes dans le paysage participatif et les organisations sont plus nombreuses que jamais à faire le pari de l’amont. C’est le cas d’Hydro-Québec avec ses les tables d’information et d’échange (TIE). Ces tables, existantes depuis la fin des années 1990 et dirigées par le maître d’ouvrage, regroupent plusieurs acteurs du milieu. Elles se tiennent dès le début du processus de planification. L’Office de consultation publique de Montréal (OCPM) a elle aussi faut le saut en amont en adaptant ses méthodes pour intervenir plus tôt dans le processus pour certains mandats. À travers deux études de cas, une portant sur les TIE du complexe hydroélectrique de la Romaine, et l’autre sur la consultation de l’OCPM sur la planification détaillée du secteur de Griffintown, ce mémoire explore les effets de la participation en amont sur les projets et sur ces acteurs.

La participation en amont de grands projets d'aménagement : les effets sur le projet et ses acteurs

Depuis plus de trente ans, nos pratiques démocratiques évoluent au rythme de liens grandissants entre les instances décisionnelles et la société civile. Les exemples de démarches participatives s’accumulent et leurs formes sont de plus en plus diverses. Au cours des dernières années, les démarches en amont sont de plus en plus présentes dans le paysage participatif et les organisations sont plus nombreuses que jamais à faire le pari de l’amont. C’est le cas d’Hydro-Québec avec ses les tables d’information et d’échange (TIE). Ces tables, existantes depuis la fin des années 1990 et dirigées par le maître d’ouvrage, regroupent plusieurs acteurs du milieu. Elles se tiennent dès le début du processus de planification. L’Office de consultation publique de Montréal (OCPM) a elle aussi faut le saut en amont en adaptant ses méthodes pour intervenir plus tôt dans le processus pour certains mandats. À travers deux études de cas, une portant sur les TIE du complexe hydroélectrique de la Romaine, et l’autre sur la consultation de l’OCPM sur la planification détaillée du secteur de Griffintown, ce mémoire explore les effets de la participation en amont sur les projets et sur ces acteurs.

Etiologic diagnosis of bovine infectious abortion by PCR

Infectious abortion is a significant cause of reproductive failure and economic losses in cattle. The goal of this study was to detect nucleic acids of several infectious agents known to cause abortion including Arcanobacterium pyogenes, Bovine Herpesvirus 1, Brucella abortus, Campylobacter fetus subsp. venerealis, Chlamydophila abortus, Leptospira sp., Listeria monocytogenes, Salmonella sp., Mycoplasma bovis, Mycoplasma bovigenitalium, Neospora caninum, and Tritrichomonas foetus. Tissue homogenates from 42 fetuses and paraffin-embedded tissues from 28 fetuses and 14 placentas/endometrium were included in this study. Brucella abortus was detected in 14.2% (12/84) of the samples. Salmonella sp. DNA was amplified from 2 fetuses, and there was one positive for Neospora caninum, and another for Listeria monocytogenes. This PCR-based approach resulted in identification of the etiology in 19% of samples, or 20% if considered fetal tissues only.

Evaluation of gastrointestinal motility in awake rats: a learning exercise for undergraduate biomedical students

Souza MA, Souza MH, Palheta RC Jr, Cruz PR, Medeiros BA, Rola FH, Magalhaes PJ, Troncon LE, Santos AA. Evaluation of gastrointestinal motility in awake rats: a learning exercise for undergraduate biomedical students. Adv Physiol Educ 33: 343-348, 2009; doi: 10.1152/advan.90176.2008.-Current medical curricula devote scarce time for practical activities on digestive physiology, despite frequent misconceptions about dyspepsia and dysmotility phenomena. Thus, we designed a hands-on activity followed by a small-group discussion on gut motility. Male awake rats were randomly submitted to insulin, control, or hypertonic protocols. Insulin and control rats were gavage fed with 5% glucose solution, whereas hypertonic-fed rats were gavage fed with 50% glucose solution. Insulin treatment was performed 30 min before a meal. All meals (1.5 ml) contained an equal mass of phenol red dye. After 10, 15, or 20 min of meal gavage, rats were euthanized. Each subset consisted of six to eight rats. Dye recovery in the stomach and proximal, middle, and distal small intestine was measured by spectrophotometry, a safe and reliable method that can be performed by minimally trained students. In a separate group of rats, we used the same protocols except that the test meal contained (99m)Tc as a marker. Compared with control, the hypertonic meal delayed gastric emptying and gastrointestinal transit, whereas insulinic hypoglycemia accelerated them. The session helped engage our undergraduate students in observing and analyzing gut motor behavior. In conclusion, the fractional dye retention test can be used as a teaching tool to strengthen the understanding of basic physiopathological features of gastrointestinal motility.

Rheological, mechanical and mucoadhesive properties of thermoresponsive, bioadhesive binary mixtures composed of poloxamer 407 and carbopol 974P designed as platforms for implantable drug delivery systems for use in the oral cavity

This study described the formulation and characterisation of the viscoelastic, mechanical and mucoadhesive properties of thermoresponsive, binary polymeric systems composed of poloxamer (P407) and poly(acrylic acid, C974P) that were designed for use as a drug delivery platform within the oral cavity. Monopolymeric and binary polymeric formulations were prepared containing 10, 15 and 20% (w/w) poloxamer (407) and 0.10-0.25% (w/w) poly(acrylic acid, 934P). The flow theological and viscoelastic properties of the formulations were determined using controlled stress and oscillatory rheometry, respectively, the latter as a function of temperature. The mechanical and mucoadhesive properties (namely the force required to break the bond between the formulation and a pre-hydrated mucin disc) were determined using compression and tensile analysis, respectively. Binary systems composed of 10% (w/w) P407 and C934P were elastoviscous, were easily deformed under stress and did not exhibit mucoadhesion. Formulations containing 15 or 20% (w/w) Pluronic P407 and C934P exhibited a sol-gel temperature T(sol/gel), were viscoelastic and offered high elasticity and resistance to deformation at 37 degrees C. Conversely these formulations were elastoviscous and easily deformed at temperatures below the sol-gel transition temperature. The sol-gel transition temperatures of systems containing 15% (w/w) P407 were unaffected by the presence of C934P; however, increasing the concentration of C934P decreased the T(sol/gel) in formulations containing 20%(w/w) P407. Rheological synergy between P407 and C934P at 37 degrees C was observed and was accredited to secondary interactions between these polymers, in addition to hydrophobic interactions between P407 micelles. Importantly, formulations composed of 20% (w/w) P407 and C934P exhibited pronounced mucoadhesive properties. The ease of administration (below the T(sol/gel)) in conjunction with the viscoelastic (notably high elasticity) and mucoadhesive properties (at body temperature) render the formulations composed of 20% (w/w) P407 and C934P as potentially useful platforms for mucoadhesive, controlled topical drug delivery within the oral cavity. (c) 2009 Published by Elsevier B.V.

The azo dye Disperse Orange 1 induces DNA damage and cytotoxic effects but does not cause ecotoxic effects in Daphnia similis and Vibrio fischeri

Azo dyes constitute the largest group of colorants used in industry and can pass through municipal waste water plants nearly unchanged due to their resistance to aerobic treatment, which potentially exposes humans and local biota to adverse effects. Unfortunately, little is known about their environmental fate. Under anaerobic conditions, some azo dyes are cleaved by microorganisms forming potentially carcinogenic aromatic amines. In the present study, the azo dye Disperse Orange 1, widely used in textile dyeing, was tested using the comet, Salmonella/microsome mutagenicity, cell viability, Daphnia similis and Microtox (R) assays. The human hepatoma cell line (HepG2) was used in the comet assay and for cell viability. In the mutagenicity assay. Salmonella typhimurium strains with different levels of nitroreductase and o-acetyltransferase were used. The dye showed genotoxic effects with respect to HepG2 cells at concentrations of 0.2, 0.4, 1.0, 2.0 and 4.0 mu g/mL. In the mutagenicity assay, greater responses were obtained with the strains TA98 and YG1041, suggesting that this compound mainly induces frameshift mutations. Moreover, the mutagenicity was greatly enhanced with the strains overproducing nitroreductase and o-acetyltransferase, showing the importance of these enzymes in the mutagenicity of this dye. In addition, the compound induced apoptosis after 72 h in contact with the HepG2 cells. No toxic effects were observed for either D. similis or Vibrio fischeri. (C) 2011 Elsevier B.V. All rights reserved.

Alleviation of dormancy in annual ryegrass (Lolium rigidum) seeds by hydration and after-ripening

The effect of hydration (priming) treatment on dormancy release in annual ryegrass seeds from two populations was investigated. Hydration duration, number, and timing with respect to after-ripening were compared in an experiment involving 15 treatment regimens for 12 wk. Seeds were hydrated at 100% relative humidity for 0, 2, or 10 d at Weeks 1, 6, or 12 of after-ripening. Dormancy status was assessed after each hydration treatment by measuring seed germination at 12-hourly alternating 25/15 C (light/dark) periods using seeds directly from the hydration treatment and seeds subjected to 4 d postpriming desiccation. Seeds exposed to one or more hydration events during the 12 wk were less dormant than seeds that remained dry throughout after-ripening. The longer hydration of 10 d promoted greater dormancy loss than either a 2-d hydration or no hydration. For the seed lot that was most dormant at the start of the experiment, two or three rather than one hydration event or a hydration event earlier rather than later during after-ripening promoted greater dormancy release. These effects were not significant for the less-dormant seed lot. For both seed lots, the effect of a single hydration for 2 d at Week 1 or 6 of after-ripening was not manifested until the test at Week 12 of the experiment, suggesting that the hydration events alter the rate of dormancy release during subsequent after-ripening. A hydrothermal priming time model, usually used for modeling the effect of priming on germination rate of nondormant seeds, was successfully applied to dormancy release resulting from the hydration treatments.

Creatine in Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial

GUALANO, B., V. DE. SALLES PAINNELI, H. ROSCHEL, G. G. ARTIOLI, M. NEVES JR, A. L. DE SA PINTO, M. E. DA SILVA, M. R. CUNHA, M. C. G. OTADUY, C. DA COSTA LEITE, J. C. FERREIRA, R. M. PEREIRA, P. C. BRUM, E. BONFA, and A. H. LANCHA JR. Creatine in Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial. Med. Sci. Sports Exerc., Vol. 43, No. 5, pp. 770-778, 2011. Creatine supplementation improves glucose tolerance in healthy subjects. Purposes: The aim was to investigate whether creatine supplementation has a beneficial effect on glycemic control of type 2 diabetic patients undergoing exercise training. Methods: A 12-wk randomized, double-blind, placebo-controlled trial was performed. The patients were allocated to receive either creatine (CR) (5 g.d(-1)) or placebo (PL) and were enrolled in an exercise training program. The primary outcome was glycosylated hemoglobin (Hb(A1c)). Secondary outcomes included the area under the curve of glucose, insulin, and C-peptide and insulin sensitivity indexes. Physical capacity, lipid profile, and GLUT-4 protein expression and translocation were also assessed. Results: Twenty-five subjects were analyzed (CR: n = 13; PL: n = 12). Hb(A1c) was significantly reduced in the creatine group when compared with the placebo group (CR: PRE = 7.4 +/- 0.7, POST = 6.4 +/- 0.4; PL: PRE = 7.5 +/- 0.6, POST = 7.6 +/- 0.7; P = 0.004; difference = -1.1%, 95% confidence interval = -1.9% to -0.4%). The delta area under the curve of glucose concentration was significantly lower in the CR group than in the PL group (CR = -7790 +/- 4600, PL = 2008 +/- 7614; P = 0.05). The CR group also presented decreased glycemia at times 0, 30, and 60 min during a meal tolerance test and increased GLUT-4 translocation. Insulin and C-peptide concentrations, surrogates of insulin sensitivity, physical capacity, lipid profile, and adverse effects were comparable between the groups. Conclusions: Creatine supplementation combined with an exercise program improves glycemic control in type 2 diabetic patients. The underlying mechanism seems to be related to an increase in GLUT-4 recruitment to the sarcolemma.

High sucrose intake in rats is associated with increased ACE2 and angiotensin-(1-7) levels in the adipose tissue

Sucrose-fed rats, a model of metabolic syndrome, are characterized by insulin resistance, obesity, hypertension, and high plasma levels of triacylglycerols and angiotensin II (Ang II). However, whether tissue renin-angiotensin system (RAS) is altered in metabolic syndrome is unclear. To study this issue, food ad libitum and water (C) or 20% sucrose solution (SC) were given to adult male Wistar rats, for 30 days. Body weight (BW), blood pressure (BP), epididymal adipose tissue (EPI) mass, rate of in vivo fatty acid (FA) synthesis in EPI, circulating glucose, insulin, leptin, angiotensins I and II, triacylglycerols, and plasma renin (PRA) and angiotensin-converting enzyme (ACE) activities were evaluated. In kidneys and EPI, gene and protein expression of type 1 (AT(1)) and 2 (AT(2)) Ang II receptors, ACE, angiotensinogen (ACT) as well as protein expression of angiotensin-converting enzyme 2 (ACE2) were determined. In both tissues, Ang I, Ang II and Ang-(1-7) contents were also measured by HPLC. In SC rats higher BP, EPI mass, circulating triacylglycerols, insulin, leptin, PRA and, Ang II were found. In EPI, the rate of in vivo FA synthesis was associated with increased Ang-(1-7), protein expression of AT(1) and AT(2) receptors, ACE2, ACT, and gene expression of ACT although a reduction in ACE activity and in adipose Ang I and Ang II contents was observed. In kidneys, AT(1) and AT(2), ACE and ACT gene and protein expression as well as protein expression of ACE2 were unaltered while Ang II, Ang-(1-7) and ACE activity increased. These RAS component changes seem to be tissue specific and possibly are related to enhancement of FA synthesis, EPI mass and hypertension. (C) 2010 Elsevier B.V. All rights reserved.

Mandibular Function is Severely Impaired in Systemic Sclerosis Patients

Aims: To evaluate the presence of temporomandibular disorders (TMD) in systemic sclerosis (SSc) patients and its possible association with the severity of skin involvement. Methods: The presence of TMD was evaluated in 35 SSc women and 30 age- and sex-matched healthy controls by means of the anamnestic (A(i)) and clinical (D(i)) Helkimo indices; the jaw mobility was further analyzed (M(I)). Skin involvement was scored by the Modified Rodnan Skin Score (MRSS). Results: Signs and symptoms of TMD were more frequent in SSc patients than in controls, the frequency distribution of the different clinical dysfunction indices differing significantly (P < .001) between patients (D(i)0 8.6%, D(i)I 48.6%, D(i)II 22.8%, and D(i)III 20%) and controls (D(i)0 50%, D(i)I 33.3%, and D(i)II 16.7%). Cyclophosphamide for severe and rapidly progressive cutaneous fibrosis was prescribed in six out of seven patients with severe signs (D(i)III), in contrast this treatment was indicated for only two out of 25 patients with mild to moderate signs (D(i)I and D(i)II, P <. 001). Impaired jaw mobility was more frequent in SSc patients than controls (P < .001). It was severe in 77.1% (M(I)II) and mild in 22.9% (M(1)I) of the cases, in contrast to controls (M(I)0 33.4%, M(I)I 53.3%, and M(I)II 13.3%; P < .001). Approximately half of SSc patients with severe (M(I)II) but none of those with mild impairment were on cyclophosphamide treatment for severe cutaneous fibrosis (P = .02). Conclusion: Severe signs of TMD according to the anamnestic and clinical Helkimo indices were very frequent in SSc patients. J OROFAC PAIN 2010;24:197-202

Follow-up of Pregnant Women With Autoimmune Hepatitis The Disease Behavior Along With Maternal and Fetal Outcomes

Goals: To assess maternal and fetal outcomes and clinical management of pregnancy in patients with autoimmune hepatitis (AIH). Background: There is a paucity of information about maternal and fetal outcomes, and AIH activity during pregnancy and in the postpartum period. There is no consensus about the administration of azathioprine during pregnancy and breastfeeding. Study: Retrospective analysis of 54 pregnancies (3 still in progress) in 39 AIH patients. Results: The median age at conception was 24 years, and 68.4% of women had liver cirrhosis. Before conception and in early pregnancy, azathioprine and prednisone were administered in 48.1%, but treatment regimen vas usually changed further to 20 mg/d prednisone and 20.4%, were off treatment. There were 36 livebirths, and fetal loss rates were 29.4% (13 miscarriages, 1 stillbirth, and 1 ectopic pregnancy). Preterm birth rate was 11.8%. In 2 cases, there was acute fetal distress; and in 2 others congenital malformations (3.9%). The rate of serious maternal complication was 7.8%, with no deaths. There were no flares in 41.2% pregnancies, but aminotransferase elevations occurred in 54.9%, 31.4% of which were true AIH relapses, only registered in the postpartum period. Conclusions: Despite the high fetal miscarriage rate, pregnancy in AIH was safe. Patients needed careful monitoring, especially in the postpartum period because of relapses. There was no evidence of a cause and effect relationship among azathioprine administration and premature births and congenital abnormalities, but more studies are necessary. Higher doses of prednisone may be an alternative option for those who prefer azathioprine withdrawal during pregnancy.