Biomedical subjects

M Falardeau

Publications and source records attributed to M Falardeau.

At least 19 recordsLinked to original sources

PubMed1996

Factors determining compliance with screening mammography.

OBJECTIVE: To determine factors affecting compliance with screening mammography prescribed by family physicians. DESIGN: Secondary analysis of a nonrandomized trial. SETTING: University-affiliated family medicine clinic in Montreal. PATIENTS: Women aged 50 to 69 years who were given a written prescription for a screening mammography during their visit at the clinic between Oct. 12, 1991, and May 31, 1992, and who had not undergone mammography in the preceding 2 years and had never been treated for breast cancer. Information on the potential factors was obtained through a telephone questionnaire 2 months after the visit. OUTCOME MEASURES: Indicator of compliance presence of result of screening mammography in patient chart, potential factors influencing compliance: age, level of education, marital status, socioeconomic level, smoking status, perceived health status, perceived psychological well-being, risk factors for breast cancer, use of health services including frequency of Papanicolaou test, Health Belief Model variables. RESULTS: Of the 171 eligible women, 113 (66.1%) underwent the prescribed mammography within 2 months after the visit to the clinic, and 149 (87.1%) responded to the questionnaire. The patients' socioeconomic characteristics, perceived health status, health utilization indices and risk factors for breast cancer were not found to be predictors of compliance. The strongest predictor of compliance was the number of previous mammograms. Women who had undergone mammography previously were less likely to be noncompliant than those who had not (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02 to 0.51; p = 0.005). Women who did not comply were less likely than those who did to believe that a prescription from their physician would convince them to undergo mammography (OR 0.21, 95% CI 0.007 to 0.60; p = 0.004). Other factors associated with noncompliance were the expression of fear of mammography (OR 2.09, 95% CI 1.08 to 4.02; p = 0.03) and the lack of time to take the test (OR 3.07, 95% CI 1.21 to 7.80 p = 0.02). Being a smoker was negatively associated with compliance (OR 0.43; 95% CI 0.22 to 0.86; p = 0.02). The stepwise logistic regression model accounted for 87.5% of the outcome (chi2 for goodness of fit = 164.4; p = 0.0001). CONCLUSION: Family physicians who prescribe screening mammography, even to women who consult for other reasons, are likely to overcome some of the barriers observed in association with population screening rates. However, physician-oriented approaches are not likely to reach the 30% to 40% of reluctant women who appear to hold negative views toward physicians' recommendations. Further study is necessary to determine how better to reach these women.

Aged↗

PubMed1995

Continuous ambulatory peritoneal dialysis for patients with severe left ventricular systolic dysfunction and end-stage renal disease.

To better define the survival and quality of life of patients with major left ventricular systolic dysfunction and end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD), we reviewed all cases who started CAPD between May 1984 and March 1993 who had an isotopic left ventricular ejection fraction (LVEF) < or = 35%. Seventeen patients (12 men and five women with a mean age of 51.6 +/- 14.9 years) met the inclusion criteria. Mean isotopic LVEF before initiation of CAPD was 24.8% +/- 8.2%. All patients were symptomatic from congestive heart failure. Thirteen patients were classified as New York Heart Association grade III or IV. Continuous ambulatory peritoneal dialysis was associated with a significant improvement of isotopic LVEF, of functional status, and of blood pressure control. In 10 patients with a second measurement on CAPD, LVEF increased from a mean value of 23.2% +/- 9.1% to a mean value of 30.3% +/- 8.1% (P < 0.01). This represents a 30% increase of LVEF. After 6 months on CAPD, 94% of patients were classified as New York Heart Association grade I or II. Actuarial survival rates were 94%, 80%, and 64% at 12, 18, and 24 months, respectively. The mean duration of CAPD was 24 +/- 17 months. These results suggest that current CAPD treatment is an elective modality of treatment in patients with concomitant heart and renal failure.

Adult↗

PubMed1994

[Effect of ranitidine on blood alcohol and glucose levels after ingestion of alcohol].

Are alcohol and glucose blood levels modified in fasting subjects taking ranitidine? This experience tries to simulate normal life conditions. Nine men, volunteer, aged from 24 to 29 years old, without any digestive symptoms, ate a standard lunch after five hours of fasting, took 0.35 g of alcohol per kg. Ethanol blood levels, glycemia and blood levels of insulin and glucagon were taken at regular intervals every 10 to 15 minutes during all the experiment (120 minutes). After the initial experiment, all subjects took 150 mg of ranitidine p.o. b.i.d. during seven days. Afterward they were submitted to the same protocol. Between both experiments no differences were found on blood levels of ethanol. Peak concentration, decreasing rate, and biodisponibility (estimated by area under the curve) did not change. There was a tendency to have a faster decrease in glucose blood level (p < 0.05). This study does not show any significant modification of ethanol metabolism after taking ranitidine p.o.; those results are differing from data already found with studies using cimetidine.

Adult↗

PubMed1994

[Breast cancer screening: is family medicine intervention effective?].

A non-randomized controlled trial was conducted in two family medicine centers. The objectives were to evaluate whether or not a systematic prescription by family physicians of a screening mammography to women aged 50 to 69 belonging in majority to a disadvantaged socio-economic group, would permit to reach at least 60% of them and to explore which factors were associated with compliance to the prescription. The experimental intervention consisted in the prescription by the family physician of a mammogram to those patients found eligible for the screening procedure irrespective of the reason for encounter. A total of 468 of the 870 women who consulted a physician during the study period were eligible for a screening mammography. In the experimental group, the mammography prescription rate was 89% for eligible women. At the end of the study, 58.8% (95% Conf. Int.:51.9%-65.7%) of the women in the experimental group and 13.4% (95% Conf. Int.:9.4%-17.4%) of those in the control group had passed a mammography (p < 0.0001). The adjusted odds ratio for the family physician's intervention was 14.98 (95% Conf. Int.:7.86-28.58). Women over 60 years of age and those who perceived themself more vulnerable to breast cancer were more likely to respond positively to their physician's recommendation. This study confirms that family physicians can effectively reach, in the area of clinical prevention, individuals who might not be reached otherwise.

Aged↗

PubMed1993

Nutritional profile of women with fibrocystic breast disease.

The relationship between nutritional factors including eating habits and the presence or absence of fibrocystic breast disease (FBD) with regard to other known risk factors has been investigated in women participating in the National Breast Screening Study (NBSS) in Montreal, Canada. Included in this case-control study were 334 patients with FBD aged 40-59 years at entry to NBSS and 340 controls. Personal and family history was collected from medical records and by interview conducted by a research nurse. Nutritional assessment was done by 24-hour dietary recall, by a food frequency questionnaire and by identification of changes in eating habits 5 years prior to diagnosis. Women > or = 50 years with FBD had higher intake of energy, carbohydrate, fibre, vitamin D, free folacin, calcium, sodium, potassium and magnesium but lower intake of cholesterol than controls. In women < 50 years body mass index and lower protein, niacin and zinc intake, were associated with FBD. In logistic regression analysis, breast pain and education > 12 years were among the most important predictive variables for FBD. The use of oral contraceptives, cholesterol intake > or = 300 mg/day, the proportion of energy provided by fat and saturated fatty acid intake above 10% of energy had a protective effect. The comparison of FBD patients diagnosed by biopsy and those by clinical examination indicated that increasing age had a significant association with the risk of biopsy and a rather weak association with the percentage of energy supplied by fat.

Adult↗

PubMed1993

Case-control study of fibrocystic breast disease.

An epidemiological case-control study of FBD has been conducted to evaluate the differences observed between cases and controls in relation to the presence or absence of clinical findings and risk factors for fibrocystic breast disease (FBD). A total of 334 patients with FBD were identified among 6,232 women aged 40-59 who had participated in the National Breast Screening Study in Montréal while 340 age-matched controls were selected at random from the same cohort. All women were interviewed by a well trained nurse. Controls were significantly heavier and had a higher body mass index (BMI) than cases; however, cases had longer school attendance than controls. The menstrual cycle was shorter in cases and the number of pregnancies was greater in controls. Significant odds ratios were observed for BMI (O.R. = 0.72, 95% CI = 0.51 - 1.02) suggesting that a higher value of BMI had a rather protective effect; a similar pattern was observed in women using oral contraceptives. Since nodularity was strongly associated with FBD, it was excluded from a model of logistic regression; in this instance, longer school attendance (> 12 years), older age at menopause (> 45 years) and breast pain were significantly associated with an increased risk of FBD.

Adult↗

PubMed1992

Peritonitis in continuous ambulatory peritoneal dialysis: impact of a compulsory switch from a standard to a Y-connector system in a single North American Center.

One hundred one continuous ambulatory peritoneal dialysis (CAPD) patients from a single North American center were analyzed in a retrospective and cross-over study for peritonitis rates using a standard system (Travenol System II) or a Y-shaped disconnect-disinfectant system (Travenol O-set). Twenty-one of 34 patients using the standard set (group I) had 53 episodes of peritonitis in 508 patient-months or one episode per 9.6 patient-months. Nine of 17 patients switching from the standard to the disconnect-disinfectant system (group II) experienced 22 episodes of peritonitis in 275 patient-months or one episode per 12.5 patient-months on the standard set, while six patients had 10 episodes of peritonitis in 275 patient-months or one episode per 27.5 patient-months on the disconnect-disinfectant system (P less than 0.04). Twenty-eight of 67 new CAPD patients starting on the disconnect-disinfectant system (group III) had 37 episodes of peritonitis in 1,086 patient-months or one episode per 29.4 patient-months (P less than 0.01 v group I). Exit-site infections (ESI) occurred in 35.3% of patients using the standard set versus 34.3% of those using the O-set. The presence of an ESI was not associated with a higher risk of peritonitis, but modified the bacteriological profile of subsequent peritonitis episodes in patients using the O-set, favoring the organisms isolated from the exit site. Decreases in peritonitis rates with the O-set were due to a reduction of peritonitis episodes secondary to most bacterial agents and not only to skin organisms. Diabetics using intraperitoneal insulin had similar peritonitis and ESI rates as nondiabetics.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

[Quality of life of patients after restorative surgery for cancer of the rectum].

During the last decades surgeons have put a tremendous effort to perform low anterior resection (LAR) as a curative procedure for rectal cancer treated classically by abdomino-perineal resection (APR) and permanent colostomy. A psychological evaluation testing the multi-dimensional concept of quality of life was done in 32 patients (M = 21; F = 11) treated by APR and compared to 28 patients (M = 16; F = 12) treated by LAR. Patients were assessed for quality of life on the following dimensions: physical well-being, psychological well-being, dietary habits, surgical response, social concerns, body image, stress and marital adjustment. Using as covariables social support and time elapsed since surgery, a covariate analysis was used to determine the presence of group ans sex interaction. Patients with LAR had a better body image (p.001), dietary habits (p.003) and tolerance to stress (p.004). Better global quality of life (p.001), physical well being (p.001) and less surgical sequela (p.001) were found with LAR in women only. No significant difference was found on psychological well being, social concerns and marital adjustment in both surgical groups.

Adult↗

PubMed1992

Survival of breast-cancer patients with previous or subsequent neoplasms.

The authors reviewed retrospectively 1510 patients with breast cancer operated on between 1960 and 1980. They compared 1353 patients who had an isolated breast cancer (group 1) with 157 patients who also had breast cancer but had other cancers either previously or subsequently (group 2). The mean age of patients in group 2 was 2 years more than that of patients in group 1. Group 2 patients had fewer T3 tumours, more T1 tumours (TNM classification), a lower incidence of lymph-node involvement and clinically less advanced tumours than group 1 patients. Hormonal status, histologic type of tumour and surgical and adjuvant treatment were identical in both groups. The 10-year survival rate (considering death from breast cancer) was 54.6% in group 1 versus 78.1% in group 2. The overall survival rate (considering death from breast cancer or from the other cancer) was 54.1% in group 1 versus 64.5% in group 2. Survival was also better in group 2 for each clinical stage. The authors conclude that patients who have another cancer before or after the development of their breast cancer have a better survival rate than those who have isolated breast cancer with no previous or subsequent neoplasms.

Breast Neoplasms↗

PubMed1991

[Selective galactophorectomy for mono-orificial nipple discharge without associated mass: technique and results. Apropos of seventy-three cases].

A single duct mammary discharge is a sign of an underlying disease: inflammatory, benign proliferative disease or even cancer. Selective resection of a ductolobular tree insures appropriate diagnosis and causative and definitive treatment of the discharge. Mammogram is essential. Galactography is quite usefull and reliable but may be unindicated or contraindicated. Surgery includes catheterization of the hole, methylene blue dye staining of the duct, circumareolar or radial incision, dissection, pyramidal resection of the whole galactophoric tree and closure with a retracting suture of the nipple. Woman's age, color of the discharge, pre-operative galactography suggest the diagnosis which has been in our series of 73 cases an inflammatory process in 53.4% of cases, a benign proliferative in 42.5% of cases and an epithelioma in situ in 4.1% of cases. The 46 cases of serous, serosanguinous or sanguinous discharge were due to an inflammatory process in 15 cases (32.6%), a benign proliferative in 28 cases (60.9%) and an in situ carcinoma in 3 cases (6.5%).

Adult↗

PubMed1991

Cancer of the breast: a study of 1520 consecutive patients operated on between 1960 and 1980.

A retrospective study was carried out of 1520 consecutive patients with breast cancer operated on at the Hôpital Notre-Dame in Montreal between 1960 and 1980. Age and hormonal status of the patient, and duration, size, location, histologic type and stage of the tumour were studied. The authors grouped the patients according to four types of surgical treatment: radical (487 patients), modified radical (497 patients) and simple (220 patients) mastectomies and conservative procedures (316 patients). Adjuvant treatments included radiotherapy in 60%, hormone therapy in 4.7% and chemotherapy in 6.7% of patients. Overall survival at 5, 10 and 15 years was 71.3%, 58.7% and 51.1%; in patients with stage I disease, survival rates were, respectively, 86%, 78% and 72%; rates for patients with stage II disease were 74%, 62% and 53%. The population characteristics and survival rates were similar to those reported by others. The four types of treatment did not produce significantly different survival rates in patients with stage I lesions. However, this was not the case in patients with stage II and III lesions in whom simple mastectomy (McWhirter procedure) was associated with significantly worse results. Finally, this study confirmed the prognostic importance of stage, size of the tumour and degree of axillary lymph-node involvement.

Adult↗

PubMed1986

[Complications of the treatment of cervix neoplasms by radiotherapy].

Of 939 patients treated by radiotherapy for carcinoma of the cervix at the hôpital Notre-Dame in Montreal, between 1979 and 1981, 275 (29.3%) had digestive, urologic, gynecologic, vascular, osseous and cutaneous complications. Surgery was necessary to treat 73 complications in 55 patients (5.9%): 42 digestive (25 occlusions, 13 fistulas and 4 perforations); 22 urologic (16 occlusions, 5 fistulas, 1 hemorrhage); 6 gynecologic (3 hemorrhage and 3 uterine necrosis); 1 cutaneous, 1 vascular and 1 osseous necrosis. No direct correlation was found between the incidence of the complications and certain predisposing factors such as the type of radiotherapy, patients' age, stage of the disease and gynecologic surgery before radiotherapy. However, there was a strong correlation between the incidence of complications and the dose of radiotherapy and the need for gynecologic surgery after radiotherapy. High morbidity was observed in the 55 patients treated surgically: they had to undergo a mean of 2.36 operations each, 2.98 general anesthetics, 1.81 hospitalizations (mean duration 75.7 days); 21 had one or more definitive stomas. The death rate was 5.45%. Surgical treatment was individualized. Limited resections were performed for occlusions, fistulas and perforations whenever it was technically feasible to treat digestive and urologic complications. A bypass procedure was used when resection would have been too extensive or dangerous. The majority of rectal lesions were treated by colostomy and a Hartmann procedure.

Adolescent↗

PubMed1984

Treatment of benign breast disease with vitamin A.

Twelve patients with benign breast disease (BBD) were treated with 150,000 IU of vitamin A daily taken orally. All patients were symptomatic and had measurable or evaluable breast masses. At 3 months of treatment, complete or partial responses were observed in five patients, and marked pain reduction in nine was observed. Side effects were generally mild in nature, consisting mostly of skin and mucosal changes, and were rapidly reversible upon discontinuation of the drug. Treatment was interrupted or discontinued in only two patients, and the dosage of vitamin A was reduced in one on account of toxicity. No hepatotoxicity was observed. Investigation of the chemopreventive role of either vitamin A or retinoids in patients with BBD who are at high risk of developing breast cancer is suggested.

Adult↗

PubMed1984