Traumatisme craniocérébral, services de santé mentale et suicide de l'enfance à l'âge adulte : une étude épidémiologique et qualitative de la situation québécoise (1987 à 2013)

Introduction et recension des écrits : Récemment, les suicides de vétérans et d’athlètes professionnels ont attiré l’attention sur l’association entre le TCC et le suicide. Les lignes directrices concernant la prise en charge en santé mentale dans cette population demeurent fragmentaires. Les objectifs de cette thèse sont de 1) déterminer si une association existe entre le TCC subi dans l’enfance et le suicide futur, 2) explorer si les personnes qui se sont suicidées ont consulté un psychiatre dans l’année précédant le suicide et évaluer si cela diffère selon que la personne ait eu un TCC ou non, 3) décrire et qualifier l’offre québécoise de santé mentale offerte en réadaptation aux enfants et aux adultes ayant subi un TCC. Méthodologie : Le volet épidémiologique consiste en une étude de cohorte rétrospective sur un échantillon de 135 703 enfants ayant reçu des services médicaux au Québec en 1987 et suivis jusqu’en 2008. Le volet qualitatif comprend un sondage auprès des gestionnaires des programmes de réadaptation TCC du Québec, des groupes de discussion avec des cliniciens et des entrevues avec des survivants de TCC et leurs proches. Résultats : Notre étude épidémiologique confirme une association significative entre le TCC subi dans l’enfance (HR 1,49 IC95% 1,04- 2,14), dans l’adolescence (HR 1,57, IC 95% 1,09-2,26) et à l’âge adulte (HR 2,53, IC95% 1,79-3,59) et le suicide. Malgré un risque de suicide plus élevé, les personnes avec un TCC et qui se sont suicidées n’ont pas consulté de psychiatre plus fréquemment que les personnes sans TCC (OR 1,29, IC 95% 0,75- 2,24). Par ailleurs, notre étude qualitative révèle que les forces du système actuel incluent une bonne qualité des services, mais qu’il existe des faiblesses au niveau de l’accès aux médecins spécialisés, du dépistage systématique et de l’accès aux services à long terme. Nos recommandations incluent le développement d’une approche coordonnée en santé mentale, l’implication automatique d’un gestionnaire de cas et l’amélioration des mécanismes d’accès après le congé.

Les transferts de fonds virtuels – une technologie innovatrice et un moyen potentiel de blanchiment d’argent

Travail dirigé présenté à la Faculté des études supérieures et postdoctorales en vue de l’obtention du grade de Maître ès sciences (M.Sc) en Criminologie – Option sécurité intérieure

Les transferts de fonds virtuels – une technologie innovatrice et un moyen potentiel de blanchiment d’argent

Travail dirigé présenté à la Faculté des études supérieures et postdoctorales en vue de l’obtention du grade de Maître ès sciences (M.Sc) en Criminologie – Option sécurité intérieure

The IRS research bulletin.

Vols. for 1993 and 1994 and 1995/1996 issued in combined form.

El peruano.

Includes separately paged, detachable sections: Normas legales, (año 1, 1980-) and: Boletín oficial, (1990?-).

Refugee resettlement program.

Description based on: Oct. 1, 1980-Sept. 30, 1981.

Healthy people 2000 review.

Issue for 2000 called 7th and final review.

5-ton, 6x6, M39 series trucks (multifuel) : model, chassis, M40A2C ... NSN without winch, 2320-00-969-4114 ... NSN with winch, 2320-00-965-0321 ....

Includes index.

5-ton, 6x6, M39 series trucks (multifuel) : model, chassis, M40A2C ... NSN without winch, 2320-00-969-4114 ... NSN with winch, 2320-00-965-0321 ....

Includes index.

Organizational maintenance manual : truck, dump, 20-ton, 6 X 4, on-off highway, 71,000 GVW, IHC model F-5070 (CCE), (NSN 3805-00-192-7249).

Includes indexes.

Operator's manual : fire direction center, artillery, OA-8389/GSG-10(V) (batallion) (NSN 7010-01-017-7039).

"15 January 1986."

Operator's manual : fire direction center, artillery, OA-8389/GSG-10(V) (battalion) (NSN 7010-01-017-7039).

"15 January 1986."

Genetic Epidemiology of Alcohol-Induced Blackouts

Background: Alcohol-induced blackouts (ie, periods of anterograde amnesia) have received limited recent research attention. Objective: To examine the genetic epidemiology of lifetime blackouts and having had 3 or more blackouts in a year, including analyses controlling for the frequency of intoxication. Design, Setting, and Participants: Members of the young adult Australian Twin Register, a volunteer twin panel born between January 1, 1964, and December 3 1, 1971, were initially registered with the panel as children by their parents between 1980 and 1982. They underwent structured psychiatric telephone inter-views from February 1996 through September 2000. The current sample contains 2324 monozygotic and dizygotic twin pairs (mean [SDI age 29.9 [2.5] years) for whom both twins' responses were coded for blackout questions and for frequency of intoxication. Main Outcome Measure: Data on lifetime blackouts and having had 3 or more blackouts in a year were collected within an examination of the genetic epidemiology of alcoholism. Results: A lifetime history of blackouts was reported by 39.3% of women and 52.4% of men; 11.4% of women and 20.9% of men reported having had 3 or more blackouts in a year. The heritability of lifetime blackouts was 52.5% and that of having had 3 or more blackouts in a year was 57.8%. Models that controlled for frequency of intoxication found evidence of substantial genetic contribution unique to risk for the blackouts and a significant component of genetic risk shared with frequency of intoxication. Conclusions: The finding of a substantial genetic contribution to liability for alcohol-induced blackouts including a component of genetic loading shared with frequency of intoxication may offer important additional avenues to investigate susceptibility to alcohol-related problems.

Imaging features of ocular adnexal lymphoproliferative disease

Purpose To evaluate the imaging characteristics of a cohort of patients with ocular adnexal lymphoproliferative disease (OALD). Methods A noncomparative retrospective review between 1992 and 1995 and prospective study from 1995 to 2005 of the clinical, imaging and treatment of 105 patients presenting to tertiary orbital referral centre presenting with OALD. Results One hundred and five patients (mean age 61 years, range 11-90 years) with equal gender distribution were included. Fifty-three were primary and 52 were secondary. Computed tomography (CT) usually showed a well-circumscribed lesion of greater than brain density, moulding to adjacent tissues with moderate enhancement. Aggressive histology was associated with bone destruction, while moulding was associated with indolent histology (P < 0.005). MRI in OALD showed intermediate signal intensity on T1- and T2-weighted images and moderate enhancement with gadolinium. Gallium scanning sensitivity to detect ocular adnexal disease was 25 and 57% for systemic involvement. Positron emission tomography (PET) upstaged (71%) of patients with systemic lymphoproliferative involvement, having a higher sensitivity than CT in detecting distant disease (86 vs 72%). Conclusions CT and/ or MRI are essential in the evaluation of OALD and can be used to establish that an orbital lesion may be lymphoprolifetaive in nature. Further, these imaging modalities may predict the behaviour of the lymphoma in certain cases. Gallium scanning provides no additional information to CT and does not influence patient treatment. PET represents an important addition to the assessment of OALD with real impact on patient management.

A GERAÇÃO Y E A PUBLICIDADE NA MÍDIA IMPRESSA REVISTA: UMA CONEXÃO POSSÍVEL

A conexão que se estabelece entre a publicidade veiculada na mídia impressa revista e os jovens da chamada Geração Y é o principal foco deste trabalho. Estes jovens, nascidos entre 1980 e meados da década de 90, no século XX, se desenvolveram juntamente com as novas tecnologias da comunicação, cresceram com um computador ligado ao mundo pela internet, com o telefone celular e jogos interativos, mas continuam sendo assediados pelas revistas. Com o objetivo de conhecer melhor esta conexão, saber como a Geração Y se comporta diante das mensagens publicitárias e verificar se existe um padrão de consumo entre estes jovens foram realizadas investigações exploratórias em fontes primárias e secundárias complementada por um estudo conclusivo descritivo. Depois de uma revisão da literatura que trata dos conceitos de geração até o perfil da Geração Y, e de uma análise histórica da mídia revista, a realização de pesquisas aplicadas em forma de grupos focais e de um estudo descritivo, nos permitiu concluir que existe uma sobrevida para a mídia impressa revista, e ainda por muito tempo. Aspectos como a tangibilidade, portabilidade e a tradição são os pilares que garantem às revistas uma sólida confiabilidade por parte dos jovens da Geração Y, sobrepondo-se à mídia eletrônica, volátil e pouco confiável para eles.