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[Suicide prevention by preventing mental disorders: how far did we get in Quebec?].

The relationship between mental illness and suicide no longer has to be demonstrated. In Quebec however, those intervening in the prevention of suicide, without denying this link, appear not to have integrated this information in their practice. As in North America and Europe, very few prevention centres have evaluated the efficiency and impact of their intervention. Finally, the few programs promoting mental health or preventing mental illness elaborated in Quebec seldom aim at preventing suicide. In these conditions how can we expect reducing the suicide rate?

Humans↗

Do women physicians do more STD prevention than men? Quebec study of recently trained family physicians.

OBJECTIVES: To examine differences attributable to sex of family physicians in their practices and in their perceptions of sexual history taking and safer sex counseling, and to ascertain whether sex of physicians influences counseling about condoms. DESIGN: Cross-sectional survey. SETTING: Quebec family practices. PARTICIPANTS: Recently graduated (1991) Quebec family physicians: 54 men and 92 women. MAIN OUTCOME MEASURES: Frequency and content of sexual history, frequency of safer sex counseling, perceived level of comfort in taking a sexual history, perceived adequacy of medical training to take sexual histories, perceived difficulty with sexual history taking according to patients' characteristics, and perceived effectiveness of safer sex counseling. RESULTS: Response rate was 80% of 183 physicians contacted. There were few differences attributable to sex of physician in family physicians' practices and perceptions regarding sexual history taking. Men's perceptions regarding the difficulty of sexual history taking did not vary according to patient's sex, but most women reported more difficulty with male patients. Male physicians reported more difficulty with teenagers; female physicians experienced more difficulty questioning adults. More than 85% of male and female physicians reported recommending condom use to a patient in their practice at least weekly. Women physicians seemed to do more condom-related counseling than their male colleagues, even after controlling for other variables. Salaried practice in a local community health centre did not influence condom-related counseling. CONCLUSIONS: Women family physicians are more inclined than men to counsel patients about condom use. Increasing numbers of women in family practice could have a beneficial effect on prevention of STDs and undesired pregnancies.

Adolescent↗

[Role models of residents graduating in family medicine and in different specialties in Quebec].

OBJECTIVE: To describe and compare the role models of Quebec residents graduating from French-language faculties of family medicine and from medical specialities. DESIGN: Survey by mail. PARTICIPANTS: Quebec residents graduating in family medicine (189), medical specialities (147), and surgical specialities (64) in 1990. MAIN OUTCOME MEASURES: Number of models chosen, social, demographic, professional, and personal characteristics of primary role models, role models' influence on students. RESULTS: Role models chosen by family medicine graduates more closely resemble those of their medical speciality colleagues than those of their surgical speciality colleagues. Family medicine graduates, particularly female graduates, have more difficulty choosing models. Their choices are based mainly on qualities that reflect a biopsychosocial approach to care and concern with the community aspects of medical practice. CONCLUSION: Choosing role models is a complex process. Medical faculty in residency programs play an important role in the professional identity of future physicians.

Adult↗

Psychological distress and use of ambulatory medical services in the Quebec Medicare system.

OBJECTIVE: To document the impact of psychological distress symptoms on the use of ambulatory medical services in a universal insurance coverage context. DATA SOURCES: Data from the Quebec Health Survey (1987) linked with billing data from the Quebec Medicare system. The time frame for the utilization variables is one year before and one year after the QHS survey. STUDY DESIGN: LISREL was used to test a model introducing perceived health need as an explanatory factor of the relationship between psychological distress and the number of visits to a physician. Two samples were formed from the matched file. Sample A (n = 2,000) was used in an exploratory phase to adequately specify the model. Sample B (n = 2,000) was used to confirm the results obtained with Sample A. PRINCIPAL FINDINGS: The proposed model explained 35 percent of the number of visits to a physician in Sample A and 24 percent in Sample B. The effect of psychological distress symptoms on the respondent's perceived health need was as important as the effect of physical health status. The effect of the respondent's previous health services utilization on the number of visits to a physician was also significant. CONCLUSIONS: These results may be interpreted to indicate that in a universal insurance coverage context, psychological distress is a significant predictor of perceived health need.

Adolescent↗

Maternal education and fetal and infant mortality in Quebec. Fetal and Infant Mortality Study Group of the Canadian Perinatal Surveillance System.

OBJECTIVES: This article examines differences in fetal and infant mortality by maternal education in the province of Quebec, where the rates are among the lowest in Canada. DATA SOURCE: The data are from linked birth and infant death records (including stillbirths) for the 1990-1991 birth cohorts in Quebec. MAIN RESULTS: Fetal and infant mortality rates were greater for the offspring of mothers with less than 12 years of education, compared with mothers with at least 14 years, even after adjusting for maternal age, parity, marital status and infant's sex. When intermediate factors such as birthweight or both gestational age and fetal growth were taken into account, the differentials in mortality by education diminished. If all education groups had experienced the low rates attained by the higher education group, the number of fetal and infant deaths would have been reduced by approximately 20%.

Adolescent↗

Falling hospital mortality for acute myocardial infarction in Quebec hospitals.

OBJECTIVE: To present in-hospital mortality trends for acute myocardial infarction (AMI). DESIGN: Observational study using the Quebec administrative hospital database, which records all hospitalizations for AMI, for the period 1986 to 1996. RESULTS: From 1986 to 1996, the case fatality rate for AMI decreased from 18.4% to 12.7% despite an increase in the total number of admissions, due to an ageing population. Men and women have had similar yearly mortality reductions--7.6% versus 7.4%, respectively--although the absolute case fatality rate remains significantly higher for women. The mortality reduction for men was constant over the decade, while the decline for women was more pronounced over the last five years. Improving case fatality rates were also observed in the elderly and again were most evident from 1991 to 1996. CONCLUSIONS: These data show a sharp decline in case fatality rates for AMI patients treated in Quebec hospitals from 1986 to 1996, suggesting that treatment advances observed in clinical trials are being applied at a population level. While improved survival has been observed in all patient groups, the data suggest that the part of the decline in mortality may be due to increased penetration of proven treatment strategies in women and the elderly.

Age Distribution↗

Pathology review of screening negative neuroblastomas: a report from the Quebec Neuroblastoma Screening Project.

BACKGROUND: The Quebec Neuroblastoma Screening (QNS) Project completed a 5-year program for measuring urinary vanillylmandelic acid (VMA)/homovanillic acid (HVA) levels at age 3 weeks and/or 6 months in 89% of 476,603 Quebec-born infants from 1989-1994; 45 screening positive preclinical cases (S-positive cases) and 20 congenital/neonatal (C/N) cases were identified. As of April 1997, an additional 59 cases in the same birth cohort were diagnosed clinically; these neuroblastomas developed after screening verified normal VMA/HVA levels (S-negative cases). METHODS: Pathology specimens from 45 of 59 S-negative cases were reviewed centrally and classified according to the Shimada system. Results were compared with clinical data and also with S-positive and C/N cases. RESULTS: Of 45 S-negative cases, 27 tumors had favorable histology (FH) and 18 had unfavorable histology (UH). Approximately 52% of FH tumors were diagnosed before age 1 year, whereas UH tumors were nearly exclusively (94%) diagnosed after age 1 year (P < 0.01). Approximately 89% of FH tumors were Stage I, II, or IV-S, whereas 72% UH tumors were Stage III or IV (P < 0.001). All children with FH tumors were alive at last follow-up (range of follow-up period: 9-79 months; median, 35 months), whereas 8 children with UH tumors died of disease even after limited follow-up (range of follow-up period: 0-60 months; median, 20 months). By contrast, S-positive and C/N cases were predominantly (97%) FH tumors, often (76%) Stage I, II, or IV-S, with excellent clinical outcome (survival rate of 98%). CONCLUSIONS: The majority of the UH neuroblastomas that developed in the birth cohort of the QNS Project were included in the group of S-negative cases and could not be detected by the screening at age 3 weeks and/or 6 months.

Child↗

PCBs, dioxins and furans in Hooded Merganser (Lophodytes cucullatus), Common Merganser (Mergus merganser) and mink (Mustela vison) collected along the St. Maurice River near La Tuque, Quebec.

A pulp and paper mill located in La Tuque on the St. Maurice River, Quebec, and using the kraft bleaching process was historically the largest pulp and paper industry point source of chlorinated dibenzo-p-dioxins and dibenzofurans in Quebec. A study was undertaken to document the bioaccumulation of PCBs, dioxins and furans in piscivorous birds and mammals in this area. Hooded and Common Merganser eggs were collected in nest boxes along the St. Maurice River and Common Merganser fledglings were collected at two sites on the river. Wild minks were trapped along the St. Maurice River and in a control area upstream. Analysis of pooled merganser eggs showed contamination with dioxins, furans and PCBs. Liver samples of fledglings were contaminated with 2,3,7,8-tetrachlorodibenzofuran at the downstream site. Analysis of mink livers showed a significant higher contamination with dioxins and furans in some downstream samples compared with the upstream samples.

Journal Article↗

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada.

OBJECTIVES: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and human immunodeficiency virus (HIV) infection among injection and noninjection drug users in Quebec City and to identify associated risk factors. STUDY DESIGN: Cross-sectional study of 738 drug users attending a sexually transmitted disease/HIV prevention and needle-exchange program in Quebec City, Canada. RESULTS: The prevalences of N. gonorrhoeae and C. trachomatis were, respectively, 0.4% (95% CI: 0.08%-1.2%) and 3.4% (95% Cl: 2.2%-5.0%). Through multivariate analysis, risk factors associated with sexually transmitted diseases were: among women, being aged between 20 and 24 years and having unprotected sex with commercial partners; in noninjection drug users; cocaine use and first intercourse before 13 years of age; in male noninjection drug users, having regular sexual partners in the previous 6 months. No case of HIV was found in participants who have never injected drugs, but the prevalence was 5.5% (6/110) among the exinjectors and 10.1% (35/347) in current injectors. CONCLUSION: Moderate sexually transmitted disease and HIV prevalences were found, although a high proportion of drug users reported risky behaviors. Needle-exchange program sites may offer a good opportunity to provide sexually transmitted disease/HIV prevention and medical services to drug users.

Adult↗

Subtyping of Neisseria meningitidis strains isolated in Quebec, Canada: correlation between deduced amino acid sequences and serosubtyping techniques.

Routine serosubtyping of Neisseria meningitidis relies upon reactivity of whole cells to monoclonal antibodies (mAbs). This procedure is limited in providing maximum serosubtype information because some epitopes in whole cells are masked and because mAbs are currently unavailable for some epitopes. To address masking of epitopes in whole cells, we isolated outer membrane vesicles (OMVs) from nine representative meningococcal strains that were isolated (1991-1993) in the province of Quebec, Canada; the OMVs were used in enzyme-linked immunosorbent assay for reactivity to mAbs, and improved serosubtyping information was obtained. A recent proposal assigns subtypes based on deduced amino acid sequences in the variable regions of the class 1 outer membrane protein. This scheme maintains the subtyping nomenclature that is based on reactivity to mAbs by defining the sequences in the epitopes recognized by the mAbs. We used this technique to assign subtypes to the meningococcal strains isolated in Quebec. For the strains tested, serosubtyping using mAbs and subtyping based on deduced amino acid sequences were in complete agreement. Subtyping using deduced amino acid sequences is superior because it does not depend on the availability of mAbs.

Amino Acid Sequence↗

[Fighting cholera in shanty-town. Successful experience of a Quebec project adapted to Peru].

Originally designed in Quebec, the MOI project was a collaboration between two professors of social work from Quebec and two members of the Peruvian NGO called SUR in Villa de Salvador, one of poorest slum areas on the outskirts of Lima. The approach is founded on the notion that the body is the primary instrument through which a person can interact with the world around him or her, and that the physical and mental health of an individual exists within the context of healthy conditions of life that must include at least a basic social and health infrastructure as well as healthy hygiene practices on the part of individuals, families and the local community. Preschool children (ages 4-6), study a different part of the body and its proper care each week through classroom observation games. Parents' help is requested to modify unhealthy conditions, at the same time to enrich the children's experience and to mobilize the community to improve health conditions. During the 1991 cholera epidemic, not a single case was counted in the experimental district, despite its clearly socio-economically impoverished status, and despite the fact that the Ministry of Health recorded 86,650 cases in the Lima-Callao district, accounting for about 40% of the total number of cases in the Peru. The prior work made it easier to explain how cholera is spread and what special new measures needed to be taken in addition to the hygiene habits already taught.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

High daily doses of benzodiazepines among Quebec seniors: prevalence and correlates.

BACKGROUND: Use of high daily doses of benzodiazepines is generally contraindicated for seniors. While both patient and physician factors may influence the use of high daily doses, previous research on the effect of patient factors has been extremely limited. The objectives of this study were to determine the one year prevalence of use of high daily doses of benzodiazepines, and examine physician and patient correlates of such use among Quebec community-dwelling seniors. METHODS: Patient information for 1423 community-dwelling Quebec seniors who participated in the Canadian Study of Health and Aging was linked to provincial health insurance administrative data bases containing detailed information on prescriptions received and prescribers. RESULTS: The standardized one year period prevalence of use of high daily doses of benzodiazepines was 7.9%. Use of high daily doses was more frequent among younger seniors and those who had reported anxiety during the previous year. Patients without cognitive impairment were more likely to receive high dose prescriptions from general practitioners, while those with cognitive impairment were more likely to receive high dose prescriptions from specialists. CONCLUSION: High dose prescribing appears to be related to both patient and physician factors.

Journal Article↗

[Genesis of a profession: pharmacists in Quebec in the 19th century].

Before pharmacy was legally recognized as an autonomous profession and before pharmacists were sufficiently numerous and organized to represent their own interests, some "underground" developments marked the appearance of this group in the field of health care. The purpose of this article is to identify and analyze some of the events which led to the emergence in Quebec of pharmacy as a distinct medical profession and the restructuring of the medical community with advances in commercial and industrial activity in the pharmaceutical field. These developments are important to understand the particular orientation of pharmacy in Quebec and also to demonstrate the importance of pharmaceuticals in the health profession.

Canada↗

[A conjoined birth: the emergence of kinesiotherapy in France and the establishment of physiotherapy in Quebec: trajectories in mirrors].

In France, the development of manual care was considerably conditioned by its popular origin, whereas in Quebec such treatments were put into practice in a country where nothing of the kind had ever existed. Although France had left its mark there, it was from England that the first qualified practitioners--already called physiotherapists--came. In those two countries, World War I had been a period of organization and recognition which had brought out the practice as a complement of military surgery. In Quebec, the medical issues at stake, which were important at first, were progressively reduced because of private activity exploiting physiotherapists. The profession's protection system showed its efficiency by having doctors' lack of competence in physiotherapy acknowledged. Such a situation led on the free access to physiotherapy for patients. But the sharing of medical acts with other professions remained a serious handicap. In France, the medical issues at stake remain significant. Physicians have always kept physiotherapists and physiotherapy under control through medical prescription, physiotherapists being perceived as considerably less threatening towards the autonomy of the profession. On the other hand, the organization of officially recognized health professions prevents them from encroaching upon one another's professional acts.

Canada↗

[The history of health in Quebec: relationships and specificities].

The remarkable development of the history of health in Quebec during the last two decades occurred at the junction of two main historiographical movements: the international resurgence of the history of health, and the metamorphosis of the historian's gaze toward Quebec. The author examines specific features issued from this junction. He shows that many historians challenged the "retard du Québec" thesis. Studying, as they did, the relations between health service providers, they unveiled their respective interests and conflicts, which led to the invalidation of the idea of a monolithic backwards society.

Canada↗

[Quebec's physicians, infant mortality and nationalist politics, 1910-1940].

This article analyzes the discourse of a Québécois medical elite, comprising primarily public health physicians and pediatricians, concerning infant mortality between 1910 and 1940. It emphasizes its similarities with nationalist discourse, and the fact that nationalist ideology provided doctors with arguments to justify the staggeringly high infant mortality rate experienced by their compatriots and encouraged them to glorify the high birthrate of French Canadians. According to the medico-nationalist discourse, the high birthrate (or "Revanche des berceaux") would even have been an obstacle to their struggle against infant mortality (or their "Veillée"). The legendary fecundity of French-Canadian women, a myth that is historically questionable, could thus explain, at least partially, the fact that public health measures adopted in Quebec during this period were less stringent than in Ontario, the "sister province" that Quebec's hygienists took nonetheless as their point of reference.

Canada↗

Quebec mental health services networks: models and implementation.

PURPOSE: In the transformation of health care systems, the introduction of integrated service networks is considered to be one of the main solutions for enhancing efficiency. In the last few years, a wealth of literature has emerged on the topic of services integration. However, the question of how integrated service networks should be modelled to suit different implementation contexts has barely been touched. To fill that gap, this article presents four models for the organization of mental health integrated networks. DATA SOURCES: The proposed models are drawn from three recently published studies on mental health integrated services in the province of Quebec (Canada) with the author as principal investigator. DESCRIPTION: Following an explanation of the concept of integrated service network and a description of the Quebec context for mental health networks, the models, applicable in all settings: rural, urban or semi-urban, and metropolitan, and summarized in four figures, are presented. DISCUSSION AND CONCLUSION: To apply the models successfully, the necessity of rallying all the actors of a system, from the strategic, tactical and operational levels, according to the type of integration involved: functional/administrative, clinical and physician-system is highlighted. The importance of formalizing activities among organizations and actors in a network and reinforcing the governing mechanisms at the local level is also underlined. Finally, a number of integration strategies and key conditions of success to operationalize integrated service networks are suggested.

Journal Article↗

A cross-sectional survey of the clinical and psychological features of low back pain and consequent work handicap: use of the Quebec Task Force classification.

A hospital-based cross-sectional study examined 657 consecutive referrals with low back pain over two years to a district rheumatology service serving a population of about 250,000 people. Five hundred and thirty-eight had mechanical/degenerative low back pain. The mean age was 48.6 (range 18-80 SD 15.3) years; 64% were women. Patients with radiating pain or neurological deficit (Quebec Task Force classification) were significantly more disabled (Roland disability score p < 0.001) and depressed (Modified Zung score p < 0.05) than those without radiating pain. Women were more impaired (p = 0.02) than men but had similar disabilities (mean Roland score 11.7, range 0-24 SD 6.5). Fifty-three per cent of patients were receiving benefits and were significantly more likely to have musculoskeletal comorbidities than those in work (p < 0.025). It is concluded that the Quebec Task Force classification of low back pain impairment is a helpful descriptor and related to both physical and psychological disability and handicap in employment.

Adolescent↗