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PubMed1995

How has extracorporeal shock-wave lithotripsy changed the treatment of urinary stones in Quebec?

OBJECTIVES: To determine the number of people who underwent treatment of urinary stones in Quebec before and after the introduction of extracorporeal shock-wave lithotripsy (ESWL) and to determine how the introduction of ESWL influenced resource utilization. DESIGN: Before-after study; data were obtained from administrative databases and hospital-based cost estimates. SETTING: The 68 acute care hospitals in Quebec in which treatment of urinary stones is undertaken. PATIENTS: Quebec residents admitted to hospital for treatment of urinary stones between the fiscal years 1984 and 1992. OUTCOME MEASURES: Number of people treated for urinary stones per year, total number of procedures per year (including open surgery, percutaneous procedures, retrograde procedures and ESWL), and annual resources (including number of hospital bed-days and direct costs) for treatment of urinary stones used overall and in hospitals with and without ESWL services. RESULTS: Over the study period the number of people treated for urinary stones increased by 59%. As well, the combined frequency of ESWL and surgery (the two main treatment methods) increased by 107%. These increases were largely due to rates of treatment that grew by 52% among women and by 34% among men. The total number of hospital bed-days decreased by 28%, which reflected shorter hospital stays for ESWL. However, despite this decrease, the total direct annual costs were 7% higher in 1992 than in 1984 because of the increased numbers of people treated and procedures performed. In the three hospitals that offered ESWL the number of hospital bed-days and the direct costs of treating urinary stones increased by 49% and $2.5 million respectively. In the 65 other hospitals these figures decreased by 41% and about $2.9 million respectively. CONCLUSIONS: Because of increased intervention rates the total cost of treating urinary stones has risen since the introduction of ESWL. The introduction of ESWL has also been associated with a shift in the use of resources for treating urinary stones to hospitals with a lithotriptor. The reasons for the increased intervention rates are unknown. However, given the possibility of negative health effects and the increased costs, studies to determine whether the increased rates improve health outcomes are warranted.

Adult↗
PubMed1977

[Health services priorities in Quebec].

The reform of health services in Quebec, of which the most important stage was the creation of the Department of Social Affairs and the Quebec Health Insurance Board, has solved certain problems such as the inaccessibility to care because of the cost, the paucity of medical personnel and the excessive increase in the cost of the services offered to hospital patients. A critical analysis of both the reform and its practical consequences points to certain conclusions which, far from rejecting the principle of the reform, indicate none the less various possibilities for reorienting its priorities. Observing the rate of recourse to health services as well as the attitudes and conduct of health professionals have helped us to identify the causes of certain tendencies inspired by the incentives inherent in the reform. The organization of health services in Quebec must be oriented toward new priorities: the prevention and treatment both of environmental diseases and diseases associated with ageing plus the definition of a global approach to public health.

Attitude of Health Personnel↗
PubMed1996

[The competence of family physicians in caring for dementia patients. A survey of general practitioners in Quebec].

OBJECTIVE: To assess the knowledge and skills of general practitioners in Quebec with respect to persons with dementia. DESIGN: A questionnaire containing 47 multiple-choice questions on aptitude and nine questions on practice profiles and demographics. SETTING: Province of Quebec. PARTICIPANTS: Twelve hundred general practitioners selected randomly. MAIN OUTCOME MEASURES: Performance with respect to the questionnaire's four objectives: to rate background knowledge, to evaluate physicians' knowledge of the assessment and treatment of dementia, to assess follow-up, and to assess interpersonal skills. RESULTS: Average performance on the questionnaire was 64.7%, with a standard deviation of 11.79%. Performance did not differ markedly from one objective to the next. Most respondents were male (61.6%), working in urban settings (61.7%). Most (72.5%) were between 25 and 44 years, and 44.7% had between 6 and 15 years' experience. About half (44.7%) belonged to group practices, 43.8% worked in acute care hospitals, and 20.6% worked in extended care hospitals. CONCLUSIONS: Quebec general practitioners have average ability to care for patients with dementia. Continuing education should focus on increasing physicians' knowledge of dementia, especially for those with the lowest scores; physicians 55 years and older, those practising alone, and those who spend less than 60% of their practice time with elderly patients.

Adult↗
PubMed1996

Factors explaining the increase in cost for physician care in Quebec's elderly population.

OBJECTIVE: To examine what role demographic factors and increases in physician fees and utilization played in the rise in costs of physician services provided for elderly people in Quebec between 1982 and 1992, and to investigate changes in patterns of care (type and amount of services) related to utilization. DESIGN: Retrospective study of population-based data. SETTING: Province of Quebec. SUBJECTS: Elderly people (65 years of age and over) in Quebec in 1982 (n = 589,800) and in 1992 (n = 803,600). OUTCOME MEASURES: Proportion of the increase in physician care costs attributable to (a) aging (defined as a shift in the age distribution) of the elderly population, (b) the increase in the size of the elderly population, (c) the increase in physician fees and (d) the increase in utilization of physician services; proportion of care provided by general practitioners (GPs) and by specialists; proportion of minor and complete examinations provided by GPs; and rates of hospital admissions and surgery. RESULTS: Aging was responsible for 0.5% of the increase in physician care costs between 1982 and 1992, population growth for 27.0% and the increase in physician fees for 25.5%. The increased utilization accounted for 47.0% of the total cost increase. Analyses of the utilization data revealed a shift toward more costly services, more visits to specialists and higher rates of hospital admissions and surgery in 1992 than in 1982. CONCLUSIONS: Aging and population growth had minor effects on the increase in physician care costs between 1982 and 1992. Increased utilization was the most important factor. The appropriateness of this trend needs to be verified.

Age Distribution↗
PubMed1998

Profile of residents in unlicensed homes for the aged in the eastern townships of Quebec.

BACKGROUND: The number of unlicensed homes for the aged in Quebec has increased rapidly over the last decade. Because these homes are not linked in any formal way to the Quebec Ministry of Health and Social Services, little is known about their residents. The objective of this study was to describe the sociodemographic characteristics and disability profile of elderly residents in unlicensed homes for the aged. Comparisons were made to a sample of residents drawn from licensed long-term facilities. METHODS: The target population was restricted to residents aged 65 years and over in facilities in the Eastern Townships of Quebec who had some difficulties with at least 2 activities of daily living. This population included 94% of elderly people in licensed facilities and 64% of those in unlicensed homes. The study population comprised 301 impaired people in 88 residential care facilities (36 licensed, 52 unlicensed). They were selected using a 2-stage sampling scheme: stratified sampling of the primary units (homes) and simple random sampling of the secondary units (residents). Facility managers were interviewed to collect descriptive information about themselves and their facilities. Residents were assessed with regard to their cognitive abilities (using the Modified Mini-Mental State [3MS] Examination) and their functional autonomy (using the Functional Autonomy Measurement System [Système de mesure de láutonomie fonctionnelle (SMAF)]. RESULTS: Although residents without impairment were excluded from the study, the unlicensed facilities were found to house people who were, on average, less cognitively and physically impaired than their counterparts in the licensed facilities (p < 0.001). Nonetheless, a substantial proportion of the residents in the unlicensed homes had severe cognitive disabilities (38.5% had 3MS score of less than 60) and functional disabilities (17.0% had an SMAF score of more than 40). The corresponding figures for residents in the licensed facilities with these scores were 65.3% and 66.7%. Of the managers of the unlicensed facilities 31.9% had no training and 58.8% had no previous experience in caring for the elderly people. The staff-resident ratio was lower among the unlicensed homes than among the licensed facilities (mean 0.05 [standard error of the mean (SEM) 0.01] v. 0.39 [SEM 0.03], p < 0.001). In addition, only 26.0% of the unlicensed homes employed qualified staff, as compared with 63.0% of the licensed facilities (p < 0.001). INTERPRETATION: This study provides evidence that many residents of unlicensed homes have considerable care needs. These homes appear ill-equipped to address their needs, which raises doubts about their ability to deliver high-quality care.

Activities of Daily Living↗
PubMed2001

Platelet factor V New York: a defect in factor V distinct from that in factor V Quebec resulting in impaired prothrombinase generation.

Studies were performed on a patient with a longstanding bleeding disorder whose major defects were impaired platelet prothrombinase activity in the absence of added factor Va, and a platelet factor V value that was either decreased or at the lower limit of normal when assayed on multiple occasions. In contrast, plasma factor V values were consistently normal. Unlike Scott Syndrome, in which platelet prothrombinase activity is decreased in both the presence and absence of added factor V, her platelets appeared to utilize added factor Va normally in supporting the generation of prothrombinase activity. These findings suggest an intrinsic defect in platelet factor V as the basis of her platelet prothrombinase defect. This defect appears to be different than that described in the Quebec platelet disorder (factor V Quebec). Immunoblot analyses of washed platelet lysates demonstrated a pattern of variably sized factor V molecules that was entirely similar to that observed in normal platelets, and both the heavy and light chains of her factor V after thrombin cleavage were of the same size as that observed in normal platelets. In addition, her platelet multimerin was normal and immunoblot analysis excluded the type of generalized granular protein defect and pathological proteolysis that has been suggested to explain the factor V defect in the Quebec platelet disorder. The findings in this patient thus suggest a new type of platelet factor V defect as the basis for the impaired capacity of her activated platelets to support prothrombinase generation. The findings further support an important role for platelet factor V in hemostasis.

Blood Coagulation Factors↗
PubMed2005

Genetic analysis of pbp2x in clinical Streptococcus pneumoniae isolates in Quebec, Canada.

OBJECTIVES: To investigate the nature of the amino acid motifs found in penicillin-binding protein (PBP) 2x of penicillin-resistant Streptococcus pneumoniae isolates across the province of Quebec (Canada), and to obtain preliminary information regarding the prevalence of these alterations. METHODS: The pbp2x genomic region encompassing codons 178-703, which includes the entire region of the transpeptidase domain, was sequenced and compared for 52 clinical isolates comprising 20 penicillin-susceptible (PSSP), 20 penicillin-intermediate (PISP) and 12 penicillin-resistant (PRSP) pneumococci. RESULTS: The degree of diversity within PBP2x correlated with increased resistance to beta-lactam antibiotics. There were an average of 5.0 +/- 1.8 mutations in PSSP, 37.9 +/- 4.4 in PISP, and 63.0 +/- 2.0 in PRSP isolates when compared with the control penicillin-susceptible strain R6. At least six distinct amino acid profiles were identified among PISP strains isolated in Quebec. In contrast, all PRSP isolates shared a similar pattern of altered amino acids compared with the sequence from susceptible strains. CONCLUSIONS: These data will be useful in future studies to monitor the genetic changes associated with the emergence and spread of beta-lactam resistance in Quebec.

Amino Acid Sequence↗
PubMed2001

Geographic distribution of Desulfitobacterium frappieri PCP-1 and Desulfitobacterium spp. in soils from the province of Quebec, Canada.

The presence of indigenous Desulfitobacterium species in 44 soil samples taken from various sites in the southern part of the province of Quebec (Canada) and four from locations outside Quebec was investigated. Twenty-four of these soils were sampled from contaminated industrial sites. Indigenous Desulfitobacterium bacteria from soil samples were enriched by cultivation in anaerobic soil slurry culture. Total DNA was then extracted from these slurries and polymerase chain reaction (PCR) amplifications were performed with primers targeting 16S ribosomal RNA gene sequences of Desulfitobacterium spp. and of Desulfitobacterium frappieri PCP-1. A positive PCR signal was obtained in 31 soil slurry cultures. Resolution of single-strand DNAs of some of the PCR products by a single-strand conformational polymorphism protocol suggests that more than one species of Desulfitobacterium were present in the corresponding slurry cultures. These results suggest that Desulfitobacterium are ubiquitous in soils in the province of Quebec, especially in soils from the St. Lawrence valley and the southern part of the province.

Journal Article↗
PubMed1998

The ethics of farming-out: ideology, the state, and the asylum in nineteenth-century Quebec.

This article traces the development of the farming-out system of asylum provision which emerged in Quebec for the treatment and care of those who were considered to be insane. The kind of asylum provision that developed in Quebec was met with strong criticism by alienists elsewhere in Ontario, Britain and the United States who considered farming-out to be highly unethical. These criticisms were not lost on the state which tried to exercise increased control over the daily affairs of the asylum. But for much of the nineteenth century the state largely failed in these efforts. The community response to the rise of the farming-out system further complicated the role of the state in the management and control of insanity. I argue that the farming-out system is best considered as the product of complex relations between the state officials, alienists, and community members. This understanding of asylum development in Quebec has important implications for the study of the nineteenth-century state formation.

Canada↗
PubMed1988

[Demographic change and French Quebec].

"The socio-political climate and the dissemination of demographic results interact very closely over language matters in Quebec. An examination of the decline of the French-speaking population in North America casts some doubt on the thesis of the linguistic polarization of Canada. An overview of the factors which determine the future size and linguistic composition of Quebec's population shows that French Quebec has arrived at an extremely critical turning point. The most recent results on interprovincial migration and language shift will likely encourage a firm and careful language policy, in order to avoid the prospect of losing ground to English." (SUMMARY IN ENG AND SPA)

Americas↗
PubMed1990

[The urban population of Quebec, 1795-1971: origin and other census characteristics].

"This paper presents the first results of a comprehensive study devoted to the history of the population of the city and the region of Quebec, between 1795 and 1971. Data on origin, place of birth, religion and language have been used in order to analyse the degree of homogeneity of the population. In 1971, the Quebec region [contained] almost exclusively persons from French-Canadian origin, born in the province of Quebec, baptized in the catholic church, and speaking French. This image of [a] highly homogeneous population should however be retouched, particularly with regard to the genetical contribution of British and especially Irish immigrants." (SUMMARY IN ENG AND SPA)

Americas↗
PubMed1992

[The future of linguistic groups in Quebec: balances and options].

"During the 1981-1986 period, the balance between demographic phenomena was such that the proportion of francophones in the population tended to increase in Quebec. In this article, we project the 1981-1986 situation and other scenarios to see the impact of increasing immigration on the proportion of francophones in Quebec. The results suggest that there is an antinomy between an increase of the total population and an increase of the proportion of francophones. Thus, the policy of the provincial government to accept 55,000 immigrants per year would probably lead to a decrease in the proportion of francophones in Quebec." (SUMMARY IN ENG AND SPA)

Acculturation↗
PubMed1989

[The current reproductive life of women. The Quebec case].

The author reviews the current reproductive patterns of women in the province of Quebec, Canada. "Through birth control and family planning, Quebec women experience an average of two pregnancies and give birth to 1.7 children. Sexual life is not reserved any more to married women, and starts at an increasingly early age. The percentage of teenagers experiencing a pregnancy is increasing. The rate of induced abortion is the highest at age 18-24. From the age of 18, more than half of the young women use oral contraceptives. The most educated women have the smallest number of pregnancies; they start their marital and reproductive life later than other women, and declare a larger percentage of induced abortion. Less educated women resort however to sterilization at an earlier age." Data are from the Quebec Health Survey of 1987 and other official sources. (SUMMARY IN ENG AND SPA)

Abortion, Induced↗
PubMed1991

[The formation of Quebec's urban populations: the Saguenay region in the nineteenth and twentieth centuries].

The author explores trends in urbanization during the nineteenth and twentieth centuries for the Saguenay region of Quebec province, Canada. He finds that "the Saguenay region experienced rapid urbanization at the end of the 19th century....Towns...attracted large numbers of immigrants from various geographic origins, with a marked male dominance. Flows from the East of Quebec...increased significantly (rural exodus) while new recruitment areas appeared in the more distant and more urbanized regions of western Quebec (selective outmigration)." (SUMMARY IN ENG AND SPA)

Americas↗
PubMed1992

[The demo-political debate in Quebec: inclusion or exclusion?].

"The purpose of this paper is to present some aspects of a current research project on the evolution of demographic thought on immigration and integration [in Quebec, Canada], especially since the beginning of the 1960s. The paper is divided into two parts: the first is a brief consideration of the concept of integration in demography; the second presents four propositions which we believe characterize demo-political discourse at the present time. In brief, these four propositions are: 1) immigration today is unique in the history of Quebec; 2) immigration is not a solution to apprehended demographic decline; 3) immigration is linked to Quebec's capacity to receive new immigrants; and 4) the state is the leader in policy matters. In conclusion, regarding the 'inclusion/exclusion' duality, we suggest that demo-political discourse leans more heavily toward exclusion than toward inclusion." (SUMMARY IN ENG AND SPA)

Acculturation↗
PubMed1983

[The migratory movements of young people who left English-language high schools in Quebec in 1971].

"The present article is an abridged version of the last of four reports on a longitudinal study of migratory movements, in and out of Quebec, of one cohort of young anglophones, those who left high school in Quebec in 1971." The data concern 975 individuals, who are a representative sample of those leaving English-language high schools in Quebec in 1971. The subjects were followed up in 1979 and again in 1982-1983. The results indicate that by 1982-1983, about 50 percent of those surveyed had left the province. (summary in ENG, SPA)

Americas↗
PubMed1993

[The territorial dimension of Quebec's international immigration].

"This paper is devoted to the spatial distribution of Quebec's international immigrants, and to the main territorial stakes related to this type of migration. After analysing international immigration as a flow (distribution of the cohorts of immigrants who entered Quebec during a given period) as well as a stock (distribution of all immigrants surviving in Quebec and their redistribution through internal migration), a critical analysis of the territorial stakes as defined by various agents (active at different levels) is proposed." (SUMMARY IN ENG)

Agriculture↗
PubMed1996

Tyrosinemia: the Quebec experience.

Tyrosinemia, a genetic disorder of the liver and kidneys, is caused by reduced activity of fumarylacetoacetate hydrolase (FAH), the final enzyme in the degradation of tyrosine. The consequent presence of succinylacetone in urine or blood is pathognomonic of tyrosinemia and is used as a confirmatory test in the Quebec neonaral screening program. Due to a complex founder effect, the province of Quebec has an unusually high prevalence of tyrosinemia, particularly in the Saguenay-Lac Saint-Jean region (where the prevalence is 1 in 1850). Tyrosinemia has several different clinical presentations, ranging from acute liver failure with severe coagulopathy early in life, to slowly progressing cirrhosis with multiple nodules and variable renal dysfunction, to normal liver function with renal failure. Hepatocarcinoma has been found in approximately one third of cases. FAH complementary DNA has been cloned and mapped to chromosome 15q23-q25. The mutation observed in Quebec is a splice mutation at intron 12. This mutation is common and has been observed in other areas of the world as well, although more than 20 mutations causing tyrosinemia have now been described. Liver transplantation remains the definitive treatment. The author's team has carried out 28 liver transplantations (including 2 combined liver-kidney transplantations) in 25 children. The overall survival rate has been 92%; two children died as a result of primary nonfunction. The primary indications for transplantation were hepatic nodules (in 14 cases), neurological crises (6) and hepatic (3) or renal failure (2). An abnormal glomerular filtration rate (GFR) of less than 80 mL/min per 1.73 m2 was documented before transplantation in 54% of the cases. The rate normalized after liver transplantation in most patients, with rapid improvement in tubular function. However, patients with a severely low rate (less than 55 mL/min per 1.73 m2) before transplantation still had borderline renal function and poor growth after the transplantion, despite normal liver function. Therefore, for children with a consistently low GFR, careful consideration should be given to performing a combined liver-kidney transplantation, and a renal biopsy should form part of the pretransplantation evaluation.

Amino Acid Metabolism, Inborn Errors↗