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PubMed2000

[Off-site and alternative services in community mental health care in Quebec].

The objective of this article is to understand the evolution of the practice of "elsewhere" and "otherwise" that alternative community resources in Québec have consistently advocated. Towards this end, we begin by identifying the meaning and significance of the ideas of "elsewhere" and "otherwise" in the context of the transformation of Quebec's mental health system since 1989. Then we present the results of an exploratory study carried out between 1997 and 1999 in which the coordinators as well as members of 6 community mental health organisations in a semi-urban region of Quebec were interviewed. The results of the study suggest the validity of certain fears that community resources are becoming "deradicalized." The analysis presented here suggests the unfolding of a complex process involving the integration of alternative resources into the broader public mental health system, internal dynamics, and the emerging limitations of the vision of "elsewhere" and "otherwise" that has guided them until now. Twenty years after alternative community resources appeared on the Quebec mental health scene, is it time to reform the philosophy of "elsewhere" and "otherwise"?

Community Mental Health Services↗
PubMedDate not supplied

[Beyond the statistics: why are Quebec physicians emigrating?].

During the period 1986-1999, about 16% of the annual average number of active physicians in Quebec have left for the US or an other Canadian province. The absolute number was 2367. During the same period, 661 would have returned to Quebec. The majority of the outmigrating doctors were graduated from the anglophone university of the Province (although 44 percent are francophone) whereas the majority of the returning doctors were graduated from the 3 francophone universities of the Province. As a matter of fact, 78 percent of the returning doctors are francophone. The migration decision is equally linked to post-graduate training and occupational opportunities and job satisfaction. This feature should be related to an other: those who have returned to Quebec have had a geographic and occupational mobility level far lower than those who have not returned. Finally, it is noteworthy that there are significant differences between the doctors emigrating to the US and their colleagues going to an other Canadian province.

Adult↗
PubMed2001

[Palliative care: profile of medical practice in the Quebec city region].

OBJECTIVE: To describe the palliative care provided by physicians in the Quebec city region and to identify factors that affect its delivery. DESIGN: Mailed survey. SETTING: Quebec city region. PARTICIPANTS: General practitioners in active clinical practice. MAIN OUTCOME MEASURES: Physicians' personal and professional characteristics and their palliative care practice (volume of work, source of requests for follow-up care, place of delivery of care, resources used, difficulties, encountered). RESULTS: Of the 476 physicians (67%) who responded to our survey, 295 (62%) provided palliative care. Of these, 70% saw no more than two patients requiring palliative care per month, and 55% devoted no more than 2 hours per week to this aspect of patient care. Most (76%) provided palliative care in a variety of settings (private office, home, institution). Home care teams working out of local community health centres are the resource physicians drew upon most frequently (69%). The main difficulties encountered were a lack of clinical expertise, scheduling home care, and providing patients and families with emotional support. CONCLUSION: Most physicians in the Quebec city region provided palliative care occasionally. This care could be improved by removing various logistical and professional barriers.

Adult↗
PubMed2001

Vaccination practices of Quebec family physicians. Influenza vaccination status and professional practices for influenza vaccination.

OBJECTIVE: To assess influenza vaccination status and influenza vaccination practices of family physicians in Quebec. DESIGN: Mail survey of a random sample of 1000 family physicians. SETTING: Family practices in the province of Quebec. PARTICIPANTS: Of 1000 Quebec family physicians sent questionnaires, 550 responded. After excluding physicians who worked only in institutions, had no patients older than 65 years, or did clinical work less than 20% of the time, 379 respondents were eligible for the study. MAIN OUTCOME MEASURES: Vaccination status of family physicians in 1996 and professional practices based on six clinical and administrative activities pertaining to influenza vaccination. RESULTS: Prevalence of vaccination was 35.5% (95% confidence interval 30.8% to 40.4%) among responding physicians and was higher among those 60 years and older, those with a chronic condition, and those perceiving high peer pressure to get vaccinated. Most respondents frequently assessed the current influenza vaccination status of their patients, risk factors for influenza-related complications, and contraindications to the vaccine. They also frequently provided education about influenza and its vaccine, recommended vaccination, and administered the vaccine. Only a few reported assessing prior influenza vaccinations or recording vaccination status regularly. Finally, vaccinated physicians recommended the vaccine more frequently to their patients than unvaccinated physicians did. CONCLUSION: Promotion programs focusing on peer influence could increase vaccination of family physicians. This could in turn improve vaccination coverage of elderly patients.

Aged↗
PubMed2002

Regional variation in the management of acute myocardial infarction in the province of Quebec.

BACKGROUND: Previous studies have shown that there are differences in acute myocardial infarction (AMI) management in Canada and in the United States. However, there has been little research to evaluate regional variations in AMI treatment and outcomes for Canadian patients. OBJECTIVE: To determine whether regional variation in the management of AMI in Quebec has an impact on patient mortality and morbidity. PATIENTS AND METHODS: Discharge summary and physician claims databases for 76,012 patients with AMI were used between January 1, 1988 and December 31, 1995 to build 16 cohorts for the administrative regions of the province of Quebec. The clinical characteristics, prescription medications, cardiac procedure use, readmissions for cardiac complications and mortality across the different regions were compared. RESULTS: After adjusting for age and sex, discharge prescriptions resulted in the following ranges: angiotensin-converting enzyme inhibitors 34% to 46% of patients, acetylsalicylic acid 49% to 77%, beta-blockers 32% to 54%, calcium channel blockers 25% to 48%, lipid-lowering drugs 4% to 16% and nitrates 76% to 86%. Procedure use varied considerably across the province during the initial 10 days post-AMI (catheterization 3% to 28%; percutaneous coronary intervention 1% to 8%, and coronary artery bypass surgery 0 to 2%), as well as one year after discharge (27% to 47%, 8% to 17%, and 6% to 12%, respectively). Some variation was observed for cardiac complications after one year (unstable angina 9% to 21%; congestive heart failure and recurrent myocardial infarction, no major variation). However, there was no significant regional variation observed for one-year and three-year mortality rates (19% to 22% and 27% to 31%, respectively). CONCLUSIONS: There was marked regional variation in the rates of discharge prescriptions for cardiac medications and cardiac procedures in patients who have had an AMI in Quebec. These results suggest that the type of treatment received for an AMI depends on the region in which the patient lives. This variation appeared to affect readmission rates for unstable angina, but had no impact on mortality or other cardiac complications post-AMI.

Adult↗
PubMedDate not supplied

[Impact of lack of resources in dialysis practice in Quebec].

The purpose of this descriptive study was to assess the impact of limited resources on the practice of dialysis in Quebec and to highlight certain ethical issues. Twelve semi-structured interviews were done with nurses in charge of 14 dialysis centres in Quebec. A survey using self-administered questionnaires was also carried out between January 2000 and July 2001, with a convenience sample of 412 patients and 156 other persons involved, including 116 dialysis nurses. Two discussion groups brought together sixteen stakeholders from four dialysis centres. The results presented here were obtained by triangulating methods and data. They show that access to dialysis is not limited by Quebec nephrologists, that patients are increasingly old and sick, that teams are working to the utmost of their ability and that it is difficult for nursing staff to provide optimal care under these conditions.

Adult↗
PubMed2005

Utilization of non-steroidal anti-inflammatory drugs in Quebec: adherence to the Canadian consensus on prescription guidelines.

BACKGROUND: Adverse events associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) have led to the publication of Canadian prescription guidelines. Prescription practices following the publication of these guidelines and the introduction of COX-2 inhibitors in the Quebec formulary of reimbursed medications remain largely unexplored. OBJECTIVES: To compare the prevalence of contra-indications and selected risk factors for NSAID-toxicity among COX-2 inhibitor users and non-selective NSAID users. METHODS: A case-control analysis was conducted in a random sample of Quebec adult drug plan members who were treated with celecoxib (n=42,422 cases), rofecoxib (n=25,674 cases), full-dose (anti-inflammatory doses) of non-selective NSAIDs (n=9,673 cases), or low-dose NSAIDs (n=2,745 controls) in the year 2000. Data were obtained from the Quebec prescription and medical services databases (RAMQ). RESULTS: Patients with a history of gastropathy were more likely to be prescribed COX-2 inhibitors than low-dose NSAIDs; the odds ratios were 1.73 (95%CI: 1.56-1.91) and 1.49 (1.33-1.66), respectively for celecoxib and rofecoxib. Corresponding results for concomitant use of anticoagulants were 1.95 (1.34-2.83) for celecoxib and 1.87 (1.26-2.77) for rofecoxib, and for use of corticosteroids they were 1.29 (1.08-1.54) and 1.23 (1.01-1.49). Conversely, patients with the following characteristics were less likely to receive COX-2 inhibitors than low-dose non-selective NSAIDs: age 75+ (OR=0.64; 0.56-0.72 for celecoxib, OR=0.48; 0.76-0.99 for rofecoxib), hypertension (OR=0.83; 0.75-0.92 for celecoxib, OR=0.87; 0.77-0.97 for rofecoxib), and concomitant use of diuretics (OR=0.72; 0.63-0.82 for celecoxib; OR=0.77; 0.66-0.89 for rofecoxib). CONCLUSION: Patients with risk factors for NSAID gastropathy were more likely prescribed COX-2 inhibitors, while the presence of other contra-indications led to the prescription of low-dose non-selective NSAIDs. However, 12.7% of users of full-dose non-selective NSAIDs were age 75+ and 12.0% had a history of gastropathy, which are considered important risk factors for adverse events.

Adult↗
PubMed2005

Prevalence of musculoskeletal activity limitation and associated factors among adults in the general population in the 1998 Quebec Health Survey.

OBJECTIVE: To estimate the prevalence of short term and longterm musculoskeletal activity limitation among the general adult population of the province of Quebec, and to identify which factors are associated with these limitations. METHODS: We analyzed cross-sectional data from the 1998 Quebec Health Survey. Logarithmic binomial regression models were used to estimate prevalence ratios of (1) short term activity limitation related to musculoskeletal disorders (MSD); and (2) longterm activity limitation related to MSD in relation to demographic and behavioral variables and comorbidity factors. RESULTS: About one-fifth of participants reporting short term activity limitation and one-third of participants reporting longterm activity limitation mentioned MSD as a cause. Multivariate analyses showed that higher age, lower income, being overweight, ill defined nervousness, and the number of traumatic events that occurred before age 18 years were significantly associated with short term and longterm activity limitation related to MSD, whereas being in the minority ethnic group was protective for both outcomes. Female sex, physical inactivity, being a former alcohol drinker, and mental disorders were also associated with longterm activity limitation. CONCLUSION: MSD are a major cause of activity limitation among adults from Quebec. With the aging population and the increasing prevalence of obesity, increasing prevalence of activity limitation related to MSD is to be expected.

Activities of Daily Living↗
PubMed2005

Penetrating thoracoabdominal injuries in Quebec: implications for surgical training and maintenance of competence.

BACKGROUND: The frequency of penetrating trauma is low in Canada. Current recommendations for the care of patients with penetrating injuries originate from inner city trauma centres with a high volume of such injuries and may not apply to Canada. The purpose of this study was to review the incidence and treatment of penetrating thoracoabdominal injuries in the 4 tertiary trauma centres in Quebec. METHODS: We identified all patients with penetrating thoracic or abdominal injuries who were taken to any of the 4 tertiary trauma centres in the province of Quebec between Apr. 1, 1998, and Mar. 31, 2001. Patients who were dead on arrival were excluded. Only patients with an Abbreviated Injury Scale of 2 or greater for the thoracic or abdominal regions were included. RESULTS: In total, 245 patients meeting our inclusion criteria were identified. Of these 223 (91%) were male. The mean (and standard deviation) age was 33.8 (13.2) years; range 15-90 years. The median Injury Severity Score was 10 (range 4-75). Overall in-hospital mortality was 6.9%. There were 203 patients (82.8%) with thoracic injuries and 192 patients (78.4%) with abdominal injuries. Fifty (20.4%) of these patients had injuries to both regions. A thoracotomy was carried out in 48 (31.4%) of 153 patients who had injuries to the thorax, and the abdomen was explored in 133 (93.7%) of the 142 patients with abdominal injuries. The incidence of these injuries in the study period varied from 3 to 49 cases per centre. CONCLUSIONS: The annual incidence of penetrating thoracoabdominal injuries is extremely low in all 4 of Quebec's tertiary trauma centres, and the number of thoracoabdominal procedures is even lower. Such a low exposure may jeopardize education and clinical competence. We need to rethink our educational strategies both for residents and for continuing medical education. New approaches to training and maintenance of competence must be developed.

Abdominal Injuries↗
PubMed1991

Quantitation of beta-thalassemia genes in Quebec immigrants of Mediterranean, southeast Asian, and Asian Indian origins.

Beta-thalassemia minor occurs at 5% frequency (on average) in populations migrant (since 1945) from Mediterranean countries to the province of Quebec. Individuals of Southeast Asian/Chinese and Asian Indian origin now living in the province also carry beta-thalassemia genes at similar frequencies. We characterized beta-thalassemia genes on 68 chromosomes (19 patients and 30 carriers identified by screening) to describe heterogeneity of beta-thalassemia alleles and to evaluate desirability of DNA tests in carrier screening. Thirteen different mutations account for 74% of the 68 beta-thalassemia chromosomes: seven occur on Mediterranean chromosomes (IVS I,nt110, Non 39, IVS I,nt6, IVS I,nt1G----A, IVS II,nt1, Fr8, IVS II,nt745) another three on SE Asian chromosomes (Fr 41-42, IVS II,nt654, HbE) and yet another three on Asian Indian chromosomes (IVS I,nt5, 619 bp del, IVS I,nt1G----T). Twenty-six percent (18/68) of the chromosomes carried none of 17 alleles accounting for 92-96% of beta-thalassemia molecular pathology in reference populations. The Italian beta-thalassemia chromosomes in the Quebec sample least resembled those in the corresponding source population. Until the spectrum of mutations in Quebec populations is fully defined, phenotype assay remains the most reliable and efficient method for beta-thalassemia carrier screening.

Asia, Southeastern↗
PubMedDate not supplied

[Major measles epidemic in the region of Quebec despite a 99% vaccine coverage].

The 1989 measles outbreak in the province of Quebec has been largely attributed to an incomplete vaccination coverage. In the Quebec City area (pop. 600,000) 1,363 confirmed cases of measles did occur. A case-control study conducted to evaluate risk factors for measles allowed us to estimate vaccination coverage. It was measured in classes where cases did occur during the outbreak. This population included 8,931 students aged 5 to 19 years old. The 563 cases and a random sample of two controls per case selected in the case's class were kept for analysis. The vaccination coverage among cases was at least 84.5%. Vaccination coverage for the total population was 99.0%. Incomplete vaccination coverage is not a valid explanation for the Quebec City measles outbreak.

Adolescent↗
PubMed1990

Screening for neuroblastoma at 3 weeks of age: methods and preliminary results from the Quebec Neuroblastoma Screening Project.

A large neuroblastoma screening study was recently started in the province of Quebec, Canada. This project, a collaboration between the Quebec Network for Genetic Medicine and the University of Minnesota, is studying the impact of screening infants for the preclinical detection of neuroblastoma on the population-based mortality caused by this tumor. All infants born in Quebec during a 5-year period will be screened twice, at 3 weeks and at 6 months. Urinary homovanillic acid and vanillylmandelic acid determination from dried filter paper samples is used for screening. Initial qualitative screening is done by means of thin-layer chromatography with confirmatory quantitative screening by gas chromatography-mass spectrometry (GC-MS). During the initial 6 months of 3-week screening, 41,673 neonates (92% compliance rate) were screened and 10.6% of them were tested also by GC-MS. Nine of these neonates had positive results on two GC-MS tests and were referred for evaluation to rule out the presence of neuroblastoma. Four had the tumor, 1 had a calcified adrenal gland, and 4 had no tumor detected. Three additional neonates had clinical diagnosis of neuroblastoma before they reached the screening age of 3 weeks. A neuroblastoma that did not secrete homovanillic acid or vanillylmandelic acid was diagnosed clinically in 1 additional patient who tested negative by screening.

Chromatography, Gas↗
PubMed1983

Seroepidemiological survey of maedi-visna virus infection in sheep and goat flocks in Quebec.

Maedi-visna, a chronic viral disease of adult sheep characterized by progressive dyspnoea or neurological manifestations, was first recognized and described clinically in Canada in 1970. Seroepidemiological study was conducted in sheep and goats in various areas of Quebec. Sera of 10% of the animals of selected flocks were collected and specific antibodies against maedi-visna virus were tested by a modified direct complement fixation test. Results show seropositive rate of 67.6% for Sherbrooke sheep; of 40.5, 41.1 and 47.1% for Quebec, Saint-Hyacinthe and Nicolet sheep respectively and only 29.2 and 20.0% positive sera in l'Assomption and Rimouski animals. Prevalence rate of positive goats varied according to geographic areas (0 to 36.8%). Statistical analysis of various factors, e.g. age, breed, mode of raising, origin and size of flock showed no relation between these factors and the geographic areas. But, some clinical problems in the sheep flocks such as cough, rapid breathing, mortality and abortion were associated with high infection rate (greater than or equal to 50%) to maedi-visna virus. In goats, no correlation was demonstrated between these clinical signs and serological results. Our results suggest that it is important to consider this disease in an adequate program of preventive medicine in Quebec.

Animals↗
PubMed1984

Presence of antibodies to bovine viral diarrhea-mucosal disease virus (border disease) in sheep and goat flocks in Quebec.

A seroepidemiological study of border disease was conducted in sheep and goats in various areas of Quebec. Sera of 10% of animals of selected flocks were collected and specific antibodies against bovine viral diarrhea- mucosal disease were tested by seroneutralization. Results show that 10.9% and 16% of sheep and goats respectively gave a positive reaction. The lower serological prevalence was found in sheep flocks of the Sherbrooke area (5.4%) while the highest percentage of positive sera was observed in the Quebec area (24.7%). The prevalence in goats varied according to areas (2.6 to 45.5%). No relation was observed in seropositive animals between age, sex, breed and the presence of abortions in the flocks. Our serological results indicate that border disease is probably present in Quebec sheep and goat flocks but that the clinical diagnosis of this disease is not well established.

Animals↗
PubMed1995

Frequent users of ambulatory health care in Quebec: the case of doctor-shoppers.

OBJECTIVE: To examine the patterns of use of ambulatory care in Quebec in 1991, with special emphasis on patients who received care from more than 20 physicians. DESIGN: Retrospective study of population-based data. SETTING: Province of Quebec. PARTICIPANTS: All 7,154,591 people eligible for coverage under the Régie de l'assurance-maladie du Québec (RAMQ) (Quebec Health Insurance Plan) in 1991, including 3639 people who received ambulatory care from more than 20 physicians. DATA EXTRACTION: The databanks of the RAMQ. OUTCOME MEASURES: Mean number (and standard deviation) of physician visits and services received, place of visit (clinic or private office), mean cost of services, patient's age, diagnosis, type of specialist visited and social assistance status of frequent users. RESULTS: The patients who obtained ambulatory care from more than 20 physicians received 10 times more medical services than the overall patient population (59.6 v. 5.8), and the mean cost per patient for ambulatory care was also 10 times higher ($1379 v. $136). Almost all of the frequent users visited at least one outpatient clinic, as compared with 37.3% of the overall population. A higher proportion of the frequent users than of the overall population obtained care from specialists (98.9% v. 54.7%), mainly general surgeons and psychiatrists. The most frequent diagnoses among the frequent users were anxiety (36.0%), abdominal pain (24.3%), drug or alcohol dependence (22.2%) and depression (16.4%). CONCLUSIONS: A small proportion of the population obtained ambulatory care from a high number of physicians during the year, leading to high expenses. Identifying and understanding this type of frequent user may be useful in developing strategies to promote more effective health-care-seeking behaviours and reduce overuse.

Adolescent↗
PubMed1993

[Risky sex and contraception in students in France, Quebec and Spain].

In the context of a transational study, 404 sexual active 17-21 years-old students living in Lyon (France), Montreal (Quebec) and Salamanque and Madrid (Spain) have answered a questionnaire dealing with their contraceptive patterns, their perceptions of AIDS and their risky sexual behaviors. Results show that each group uses a different contraceptive strategy. In France and in Quebec those who had their first intercourse before 17 years of age used oral contraceptive rather than the condom. As for AIDS girls from Quebec had a higher index of risky sexual behaviors (CASH) than French, but the opposite was true among boys, while both girls and boys from Spain adopted safer sexual behaviors. Multiple regression analysis shows that the CASH rests on different predictors according to each national context.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Quebec after a decade of epidemic HIV infection: what is the status of interventions in health promotion?].

Quebec has the highest rate in Canada of AIDS among injection drug users (IDU), women and individuals originating from Model II countries. Long-term prevention of HIV transmission in Quebec calls for intervention measures (individual risk reduction) as well as the implementation of health promotion strategies. A rigorous conceptual framework like the Ottawa Charter for Health Promotion allows us to better identify relevant measures to be developed in order to curb the HIV epidemic in the province of Quebec.

Disease Outbreaks↗
PubMed1993

[Primary lipoprotein lipase deficiency. Study in Quebec].

Primary lipoprotein lipase deficiency is a rare autosomal recessive disease that causes hyperchylomicronaemia complicated by pancreatitis. Recent advances in molecular biology have facilitated its diagnosis and enabled heterozygous subjects to be identified. Numerous mutations are responsible for lipoprotein lipase deficiency. In some eastern regions of Quebec province homozygotes have been found in very high concentrations: up to 200 times the frequency observed in all other parts of the world. Heterozygocity may represent 1 in 40 subjects. Two mutations account for 95 percent of the Quebec cases, and each of them has its own characteristic geographical distribution. These peculiarities have been ascribed to a founder effect suggested by the analysis of the first colons' migrations and by the study of homozygotes' genealogy. Most of the ancestors of the Quebec carriers came from northwestern France in the 17th century, and heterozygotes alleged to be healthy carriers of the trait may have a predisposition to premature development of a cardiovascular disease. Their blood lipid levels and the composition of their lipoproteins (particularly those with low density) are suggestive of an atherogenic potential similar to that of hyperapobetalipoproteinaemia or familial combined hyperlipidaemia. Molecular biology would be a useful tool to confirm or infirm this hypothesis and to identify subjects at risk of developing a cardiovascular disease.

Cardiovascular Diseases↗