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PubMed1987

Drug information services in Quebec: determination of community and hospital pharmacists' needs.

A survey of Quebec pharmacists was conducted to determine drug information resources currently available, obtain information on pharmacists' involvement as drug information providers, and determine their perceived drug information needs. Responses were obtained from 665 of 3283 registered pharmacists for a response rate of 20.3 percent. Hospital and community pharmacists represented more than 90 percent of the respondents. The two reference texts most frequently found in community pharmacists' libraries were Compendium of Pharmaceutical Specialties and Goodman and Gilman's The Pharmacological Basis of Therapeutics, the latter being available to only 49 percent of the pharmacists. More than 60 percent of the hospital pharmacists had at least 10 of the reference texts listed on our survey instrument. The majority of pharmacists were actively involved in a variety of clinical pharmacy services. Providing drug information to consumers or health professionals was one of the most common activities. Several pharmacists expressed their needs for drug information center (DIC) support in different drug information categories. Information on drug interactions and adverse drug reactions was rated as an important need by 68 and 59.9 percent of the community pharmacists, respectively. The institution of a regional DIC may provide the support system needed by the pharmacists of Quebec.

Drug Information Services↗
PubMed2005

Bone mineral density measurement and osteoporosis treatment after a fragility fracture in older adults: regional variation and determinants of use in Quebec.

BACKGROUND: Osteoporosis (OP) is a skeletal disorder characterized by reduced bone strength and predisposition to increased risk of fracture, with consequent increased risk of morbidity and mortality. It is therefore an important public health problem. International and Canadian associations have issued clinical guidelines for the diagnosis and treatment of OP. In this study, we identified potential predictors of bone mineral density (BMD) testing and OP treatment, which include place of residence. METHODS: Our study was a retrospective population-based cohort study using data from the Quebec Health Insurance Board. The studied population consisted of all individuals 65 years and older for whom a physician claimed a consultation for a low velocity vertebral, hip, wrist, or humerus fracture in 1999 and 2000. Individuals were considered to have undergone BMD testing if there was a claim for such a procedure within two years following a fracture. They were considered to have received an OP treatment if there was at least one claim to Quebec's health insurance plan (RAMQ) for OP treatment within one year following a fracture. We performed descriptive analyses and logistic regressions by gender. Predictors included age, site of fracture, social status, comorbidity index, prior BMD testing, prior OP treatment, long-term glucocorticoid use, and physical distance to BMD device. RESULTS: The cohort, 77% of which was female, consisted of 25,852 individuals with fragility fractures. BMD testing and OP treatment rates were low and gender dependent (BMD: men 4.6%; women 13.1%; OP treatment: men 9.9%; women 29.7%). There was an obvious regional variation, particularly in BMD testing, ranging from 0 to 16%. Logistic regressions demonstrate that individuals living in long term care facilities received less BMD testing. Patients who had suffered from vertebral fractures, or who had received prior OP treatment or BMD testing, regardless of gender, subsequently received more BMD testing and OP treatments. Furthermore, increasing the distance between a patient's residence and BMD facility precluded likelihood of BMD testing. CONCLUSION: BMD testing rate was extremely low but not completely explained by reduced physical access; gender, age, social status, prior BMD testing and OP treatment were all important predictors for future BMD testing and OP treatment.

Aged↗
PubMed1990

Genealogical reconstruction of myotonic dystrophy in the Saguenay-Lac-Saint-Jean area (Quebec, Canada).

The prevalence of myotonic dystrophy (MyD) in the Saguenay-Lac-Saint-Jean (SLSJ) region (Quebec, Canada) is 30 to 60 times the world's prevalence. We identified 746 patients (673 still alive) distributed in 88 families. Using a population-based register of the SLSJ area and several marriage repositories from northeastern Quebec, we could trace back all patients to a couple who settled in "Nouvelle-France" in 1657. The MyD gene was then passed on over 10 to 14 generations. This genealogical reconstruction is a strong argument in favor of the genetic homogeneity of MyD in the SLSJ region.

Female↗
PubMed2003

Implementation of an innovative grant programme to build partnerships between researchers, decision-makers and practitioners: the experience of the Quebec Social Research Council.

OBJECTIVES: This paper examines a grant programme developed by the Quebec Social Research Council in the 1990s to encourage the building of research partnerships between researchers, decision-makers and practitioners. In particular, it studies the perceptions of key participants concerning the reasons behind the programme's successful implementation and growth. METHODS: In addition to secondary data about institutional involvement in the programme, 10 researchers and administrators were consulted as key informants. The method of concept mapping was used in order to draw out a consensus on the different factors associated with the successful implementation of the programme. RESULTS: The participants identified 10 main factors that help explain the programme's successful implementation. These factors were then grouped into a model containing four dimensions: the leadership and coherence shown in the programme's implementation; the presence of a favourable political and social conjuncture; the programme's responsiveness to the needs of health and social services institutions; and the programme's responsiveness to the needs of the university milieu. CONCLUSIONS: Although this model remains specific to the prevailing situation in Quebec at the time of its application, it may help stimulate reflection and contribute to an understanding of how research policies can encourage partnerships between researchers, practitioners and decision-makers.

Cooperative Behavior↗
PubMed1997

Asbestos, asbestosis, and lung cancer: observations in Quebec chrysotile workers.

One prospective epidemiologic study of asbestos cement workers with radiological small opacities has been cited as a rationale for attributing excess lung cancer to asbestosis. This approach could have considerable practical value for disease attribution in an era of decreasing exposure. However, a recent International Agency for Research on Cancer review concludes that the mechanism of production of asbestos-related lung cancer are unknown. Asbestosis, therefore, cannot be a biologically effective dose marker of lung cancer susceptibility. Asbestosis nonetheless would be useful in identifying asbestos-attributable lung cancer cases if it could be proven an infallible exposure indicator. In this study, we tested this hypothesis in the chrysotile miners and millers of Quebec, Canada. We examined exposure histories, autopsy records, and lung fiber content for 111 Quebec chrysotile miners and millers. If the hypothesis of an asbestosis requirement for lung cancer attribution were accurate, we would expect as asbestosis diagnosis to separate those with lung cancer and high levels of exposure from those with lower levels of exposure in a specific and sensitive manner. This is the first such study in which historical job-based individual estimates based on environmental measurements, lung fiber content, exposure timing, and complete pathology records including autopsies were available for review. We found significant excesses of lung tremolite and chrysotile and estimated cumulative exposure in those with lung cancer and asbestosis compared to those with lung cancer without asbestosis. However, when the latter were directly compared on a case-by-case basis, there was a marked overlap between lung cancer cases with and without asbestosis regardless of the measure of exposure. Smoking habits did not differ between lung cancer cases with and without asbestosis. In regression models, smoking pack-years discriminated between those with the without lung cancer, regardless of asbestosis status. Most seriously, the pathologic diagnosis of asbestosis itself seemed arbitrary in many cases. We conclude that although the presence of pathologically diagnosed asbestosis is a useful marker of exposure, the absence of this disease must be regarded as one of many factors in determining individual exposure status and disease causation.

Aged↗
PubMed1998

Neoplastic and nonneoplastic hepatic changes in lake whitefish (Coregonus clupeaformis) from the St. Lawrence River, Quebec, Canada.

As part of a survey of fish diseases, lake whitefish (Coregonus clupeaformis) were collected in fall 1995 from the St. Lawrence River 15 km upstream of Quebec City, Quebec, Canada, to assess the prevalence of liver lesions. A total of 141 fish were captured and necropsied, and three standard sections of liver were taken for histological examination. Prevalences of altered hepatocyte foci, hepatocellular carcinoma, cholangioma, and cholangiocarcinoma were 0.7%, 2.1%, 0.7%, and 2.1%, respectively. Thus, the overall prevalence of liver neoplasia was 4.9% (7/141). Hepatic tumors were only observed in fish 7 years old or older. Fish age was significantly and positively correlated with the index assessing the number and size of macrophage aggregates (p<0.001; rs = 0.16). Hepatocyte vacuolation, anisokaryosis, lymphocytic infiltration, and bile duct hyperplasia were also observed but were not related to the age, length, sex, or condition factor of the fish. These results represent the first report on a series of hepatic tumors in a wild salmonid species.

Adenoma, Bile Duct↗
PubMed2005

[Factors associated with short- and long-term use of benzodiazepines in the elderly from Quebec].

In Quebec, benzodiazepines are some of the most extensively used drugs by the elderly. The goal of this study was to identify factors associated with short- and long-term benzodiazepine use among 2,039 elderly persons having participated in the Quebec Health Survey conducted in 1998. Results of the multivariate, multinomial logistic regression showed that a higher number of chronic health problems, a higher number of physicians visited and general practitioners consulted were associated with short- and long-term use of benzodiazepines. Factors specifically associated with long-term use were female gender (OR = 1.84) and the presence of benzodiazepine users in the household (OR = 1.90). In this study, we were unable to show a difference between the two groups of users with regards to the risk factors studied. This result leads us to conclude that prevention of long-term use must be aimed at all new benzodiazepine users.

Aged↗
PubMed2001

Ambulatory use of inhaled beta(2)-agonists for the treatment of asthma in Quebec : a population-based utilization review.

STUDY OBJECTIVES: To assess whether the utilization of inhaled short-acting beta(2)-agonists (ISAB) and inhaled long-acting beta(2)-agonists (ILAB) for the treatment of asthma was appropriate according to the 1996 Canadian Asthma Consensus Conference recommendations. DESIGN: Population-based retrospective drug utilization review using pharmacists' billing data of the Prescription Drug Insurance Plan administered by the Quebec health insurance board. However, the database used did not contain complete patient clinical information to accurately assess severity of asthma. SETTING: Province of Quebec, Canada. PATIENTS: Persons who received at least one outpatient prescription of ISAB (age range, 5 to 45 years) or ILAB (age range, 12 to 45 years) for the treatment of asthma between August 1997 and April 1998. MEASUREMENTS: Percentages of patients whose use was appropriate according to three criteria regarding the average daily dose of ISAB (criterion 1), the renewal interval of ILAB (criterion 2), and the concomitant daily use of corticosteroids for the expected length of utilization of ILAB (criterion 3). RESULTS: Overall proportions of appropriate use according to criterion 1 were as follows: 75% (without inhaled corticosteroids [ICS]) and 84% and 43% (with one or more than one prescription of ICS, respectively). Appropriateness was slightly higher for female patients, younger patients (5 to 18 years old), and those treated by pediatricians. However, appropriateness was only 9% among patients who received at least two prescriptions of ISAB during the study period. The proportion of appropriate use was 19% according to criterion 2 and 15% according to criterion 3; there were few differences by gender or by age, but the appropriateness according to criterion 2 was somewhat higher for patients of respirologists. CONCLUSION: Compared to the 1996 Canadian asthma consensus conference recommendations, ISAB are overused, ICS are underused, and ILAB are often used improperly. Close collaboration between health professionals and patients is essential to improve the pharmacotherapy of asthma.

Administration, Inhalation↗
PubMed1988

Environmental pleural plaques in residents of a Quebec chrysotile mining town.

We report four cases of pleural plaques found at autopsy in individuals who resided in or near the chrysotile mining town of Thetford Mines, Quebec, and who had never been employed in the chrysotile mining and milling industry. Three of these patients were farmers, and one was a road construction worker. Lung asbestos content of these cases was compared with that of a group of nine persons living in the same vicinity who did not have pleural plaques. The plaque group was found to have an equal chrysotile content but about a fourfold elevation in median tremolite content, a statistically significant increase. Fiber sizes were the same in both groups. Also, one plaque case had an elevated level of relatively long titanium oxide fibers. These observations suggest that environmental pleural plaques in this region of Quebec are probably caused by exposure to tremolite derived from local soil and rock and that other types of mineral fibers such as titanium oxide may occasionally also be the cause of such lesions.

Aged↗
PubMed2005

Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec.

BACKGROUND: Since 2002 an epidemic of Clostridium difficile-associated disease (CDAD) caused by a hypervirulent toxinotype III ribotype 027 strain has spread to many hospitals in Quebec. The strain has also been found in the United States, the United Kingdom and the Netherlands. The effects of this epidemic on mortality and duration of hospital stay remain unknown. We measured these effects among patients admitted to a hospital in Quebec during 2003 and 2004. METHODS: We compared mortality and total length of hospital stay among inpatients in whom nosocomial CDAD developed and among control subjects without CDAD matched for sex, age, Charlson Comorbidity Index score and length of hospital stay up to the diagnosis of CDAD in the corresponding case. RESULTS: Thirty days after diagnosis 23.0% (37/161) of the patients with CDAD had died, compared with 7.0% (46/656) of the matched control subjects (p < 0.001). Twelve months after diagnosis, mortality was 37.3% (60/161) among patients with CDAD and 20.6% (135/656) among the control subjects (p < 0.001), for a cumulative attributable mortality of 16.7% (95% confidence interval 8.6%-25.2%). Each case of nosocomial CDAD led, on average, to 10.7 additional days in hospital. INTERPRETATION: This study documented a high attributable mortality among elderly patients with CDAD mostly caused by a hypervirulent strain, which represents a dramatic change in the severity of this infection.

Adolescent↗
PubMed2005

Malaria "epidemic" in Quebec: diagnosis and response to imported malaria.

BACKGROUND: Imported malaria is an increasing problem. The arrival of 224 African refugees presented the opportunity to investigate the diagnosis and management of imported malaria within the Quebec health care system. METHODS: The refugees were visited at home 3-4 months after arrival in Quebec. For 221, a questionnaire was completed and permission obtained for access to health records; a blood sample for malaria testing was obtained from 210. RESULTS: Most of the 221 refugees (161 [73%]) had had at least 1 episode of malaria while in the refugee camps. Since arrival in Canada, 87 (39%) had had symptoms compatible with malaria for which medical care was sought. Complete or partial records were obtained for 66 of these refugees and for 2 asymptomatic adults whose children were found to have malaria: malaria had been appropriately investigated in 55 (81%); no malaria smear was requested for the other 13. Smears were reported as positive for 20 but confirmed for only 15 of the 55; appropriate therapy was verified for 10 of the 15. Of the 5 patients with a false-positive diagnosis of malaria, at least 3 received unnecessary therapy. Polymerase chain reaction testing of the blood sample obtained at the home visit revealed malaria parasites in 48 of the 210 refugees (23%; 95% confidence interval [CI] 17%- 29%). The rate of parasite detection was more than twice as high among the 19 refugees whose smears were reported as negative but not sent for confirmation (47%; 95% CI 25%- 71%). INTERPRETATION: This study has demonstrated errors of both omission and commission in the response to refugees presenting with possible malaria. Smears were not consistently requested for patients whose presenting complaints were not "typical" of malaria, and a large proportion of smears read locally as "negative" were not sent for confirmation. Further effort is required to ensure optimal malaria diagnosis and care in such high-risk populations.

Adult↗
PubMed1993

Fatal occupational injury rates: Quebec, 1981 through 1988.

OBJECTIVES: The purpose of the study was to estimate the death rates from occupational injuries in the province of Quebec for the period 1981 through 1988. METHODS: Worker's compensation files were used to ascertain numbers of deaths, which were used as the numerators in figuring the rates (it was estimated that these files reported 83% of the true number of deaths among men). Annual average estimates of the labor force were used as denominators. RESULTS: From 1981 through 1988, compensation was awarded for 1227 fatal work injuries. Among men (96% of the victims), rates declined from 1981 to 1988 (from 12.7 to 8.1 per 100,000); women's rates were stable (< or = 1.0 per 100,000). Compared with men, women had excess mortality from violent acts. Motor vehicle crashes accounted for 36% of all fatal injuries in 1984 and 1985 and declined thereafter. Fatal injury rates in forestry and mining rose to a 1987 maximum of 67.6 per 100,000. The construction sector had the largest number of deaths, despite a decline in rates from 1981 to 1988 (from 27.8 to 15.9 per 100,000). CONCLUSIONS: Except for construction and agriculture, reported fatal occupational injury rates in Quebec were similar to those in the United States. Motor vehicle crashes, falls, violent acts, and farming-related injuries were the most frequent causes of death.

Accidents, Occupational↗
PubMed1994

Sex bias in the management of coronary artery disease in Quebec.

This study tests the hypothesis that, given the absence of financial barriers to major coronary procedures in Quebec, women are as likely as men to undergo such procedures. The use of coronary procedures in 33,940 patients with ischemic heart disease, admitted during 1 year to 78 Quebec hospitals, was analyzed. The male-to-female age- and severity-adjusted odds ratios for the use of these procedures were 1.47 for diagnostic procedures, 1.38 for therapeutic procedures, and 1.26 for diagnostic and therapeutic procedures. These results suggest that differences in the use of coronary procedures by sex are influenced by factors other than financial accessibility.

Aged↗
PubMed1996

Polychlorinated biphenyl (PCB) and dichlorodiphenyl dichloroethylene (DDE) concentrations in the breast milk of women in Quebec.

OBJECTIVES: This study documented the concentration of polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethylene (DDE) in the breast milk of women from Quebec, Canada, and assessed the impact of various sociodemographic and lifestyle factors on these levels. METHODS: From 1988 to 1990, milk samples were obtained from 536 Quebec women and analyzed for seven PCB congeners and p,p'-DDE. Information was obtained on subjects' physical, sociodemographic, and lifestyle characteristics. RESULTS: Mean concentrations were 0.52 mg/kg lipids (95% confidence interval [CI] = 0.50, 0.54) and 0.34 mg/kg lipids (95% CI = 0.32, 0.35) for PCBs (Aroclor 1260) and DDE, respectively. Age and history of breast-feeding showed statistically significant correlations with PCB and DDE concentrations. CONCLUSIONS: Concentrations of PCBs and DDE measured in this study are at the lower end of the concentration range recently reported for women living in industrialized countries. The modulating factors identified here should be considered when conducting studies on organochlorine exposure and disease.

Adolescent↗
PubMed2000

Managing medical technology: lessons for the United States from Quebec and France.

Important modifications to technology assessment, diffusion, adoption, and utilization must take place if the United States is to better employ medical technology and save resources so as to assure access for the uninsured and underinsured. The United States can learn from other health systems that are more successful in achieving these goals. The author selects for comparison the health systems of France and Quebec. The discussion focuses on the differences between the three systems in the management of medical technology on a range of policy-relevant dimensions, including health system structure, attitudes about planning versus market competition, government regulation, the balance between decentralization and centralization, the needs of the individual and those of the society, linkages between technology assessment and policy-making, and the importance of medical technology assessment for medical practice. Seven specific recommendations are made for better managing medical technology in the United States, drawing on what can be observed from the experiences of Quebec and France.

Diffusion of Innovation↗
PubMed1981

Is consumer control possible in health care services? The Quebec case.

In the late 1960s, the Canadian province of Quebec carried out a major reform of its health and social service institutions. As a consequence of the ideology dominating that period, the reform placed great emphasis on citizen participation, establishing local community service centers (centres locaux de services communautaires-CLSC) with boards of directors composed principally of residents of the districts served. This article examines the possible changes brought about by the granting of formal power to health institution consumers. Does this formal power permit citizens to exercise any real control over the institutions? And if so, what does this consumer control modify in terms of the nature, quality, and adaptability of the services offered? Afer a brief description of the Quebec health and social service reform and the resulting CLSCs, this article evaluates consumers' power in these institutions and analyzes the conditions under which such power is exercised. The next section outlines changes that have taken place in the CLSCs, singling out three types of changes for further examination: innovations, adaptations, and transformations. The following section examines the consumers' role in bringing about these changes. On the basis of this analysis, it is possible to conclude that consumer participation is necessary to effect certain types of changes which, otherwise, can deteriorate into bureaucratic processes. The analysis also indicates the existence of diverging and even antagonistic interests between providers (professional employee) and consumers. These contradictions may eventually call into question the classical models of producer self-management.

Community Health Centers↗
PubMed2001

Testing relationships among determinants of health, health policy, and self-assessed health status in Quebec.

By removing financial barriers, the Canada Health Act (1984) equalized access to health care services in Canada. Yet class, educational, and geographical disparities in individual and population health status persist. Recent health reform policies in Quebec assert that health and well-being are a function of income, educational level, housing conditions, employment, and other socioeconomic factors. They suggest that health policy should encompass social policies that influence individual and community socioeconomic factors which in turn affect health. Against the backdrop of these reforms, this study tests the importance of socioeconomic factors as a determinant of health--while controlling for other known determinants through a logistic regression model--with data from the Santé Quebec health surveys 1987 and 1992-93. The results confirm the importance of economic security as a determinant of individual health. This effect appears to operate through an individual income variable and through the community-level variable of regional unemployment. The importance of the income effect declined between 1987 and 1992-93. This may indicate that an increased focus on the socioeconomic determinants of health has reduced inequalities in health. It may also mean that health inequalities appear inevitable until health care policy merges completely with broader health and social policies. But such integration may well conflict with economic (and political) imperatives of the post-Fordist capitalist system.

Adolescent↗
PubMed1991

Characteristics of physicians practicing in alternative primary care settings: a Quebec study of local community service center physicians.

Since the early 1970s, there have been two primary care networks in Quebec: the traditional one characterized by private practice remunerated on a fee-for-service basis, and the public one comprising 15 percent of physicians and characterized by salaried practice within publicly funded local community health service centers (CLSCs). Using data collected on 616 Quebec generalists, 333 in private practice and 283 in CLSCs, we compared physicians' profiles in both networks. In contrast to their colleagues in private practice, CLSC physicians are younger, more often women, and more often graduates of innovative primary care training programs. They are more sensitive to the biopsychosocial nature of health problems and to giving patients an active role in their care. Significant differences were also observed in physicians' self-reported clinical practices, more so for women than for men. The study suggests that alternative primary care settings attract physicians that are more preventive and socially oriented. As a result, they may contribute to the emergence of a more comprehensive type of medical practice in health care delivery systems.

Adult↗