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PubMed2003

Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec.

OBJECTIVE: 1). To determine the likelihood of sterilization reversal and of subsequent sterilization after sterilization reversal among men and women and 2). to examine the likelihood of pregnancy after sterilization (contraceptive failure) and of pregnancy after sterilization reversal. METHODS: Payment data from the Quebec provincial health insurance system were obtained for each person undergoing vasectomy or female sterilization from January 1, 1980 to December 31, 1999 and linked through a unique identifying number for each person. Using standard techniques of survival analysis, we computed the cumulative probability of experiencing each of six events. RESULTS: Among women, 0.9% (of 311960) experienced a pregnancy after sterilization, 1.8% (of 321929) obtained a reversal after sterilization, 61% (of 4369) achieved a pregnancy after sterilization reversal and 48% achieved a delivery; 23% (of 4677) obtained a subsequent sterilization after reversal. Among men, 2.4% (of 310827) obtained a reversal after vasectomy and 18% (of 6694) obtained a subsequent vasectomy after reversal. All of these risks were much higher among those in the youngest age groups. CONCLUSION: Sterilization reversal and pregnancy after sterilization are not rare. Relatively high rates of reversal among the youngest age groups suggest a need for better counseling about alternative contraceptive strategies.

Adolescent↗
PubMed2000

Mass balance model of source apportionment, transport and fate of PAHs in Lac Saint Louis, Quebec.

A mass balance model has been developed and calibrated to describe the sources, transport and fate of seven polycyclic aromatic hydrocarbons (PAHs; anthracene, benzo(a)pyrene, benzo(b)fluoranthene, chrysene, fluoranthene, phenanthrene, and pyrene) in the water and sediments of, and atmosphere over Lac Saint Louis, Quebec. The model uses specified input rates from background advective flows and emissions from the Alcan aluminum smelting facility at Beauharnois to deduce atmospheric concentrations and rates of wet and dry deposition to the three segment lake. Concentrations in water and sediment as well as relevant mass fluxes and residence times are computed and compared satisfactorily with monitoring data for five of the seven PAHs. Underestimation of concentrations for anthracene and phenanthrene is attributed to unquantified additional sources. The sources of the PAH burden in the lake are apportioned, and the implications of these results are discussed including likely response times to changes in loadings. It is suggested that this mass balance approach is more widely applicable to situations in which water bodies are impacted by a variety of contaminant sources.

Air Pollutants↗
PubMed2001

Organotins in zebra mussels (Dreissena polymorpha) and sediments of the Quebec City Harbour area of the St. Lawrence River.

Toxic antifouling agents such as tributyltin (TBT) and triphenyltin (TPT) have been released in aquatic ecosystems through the use of antifouling paint applied to ship hulls, pleasure crafts and fish nets and these compounds can bioaccumulate in aquatic organisms. The purpose of this study was 1) to assess the extent of the distribution of organotins from a contaminated marina to the St. Lawrence River system by measuring organotin concentrations in zebra mussels (Dreissena polymorpha) and in sediments collected from 9 sites along the St. Lawrence River near Quebec City in July 1998, and 2) to examine the histopathological condition of zebra mussel tissues from these sites. TBT concentrations in zebra mussels were between 37 and 1078 ng Sn g(-1) wet weight, with the highest value found in the Bassin Louise marina. Elevated concentrations were also found in two other marinas. The concentrations decreased sharply to background levels just outside the marinas. All butyltins were detected in all sediments analysed, with highest values found in the Bassin Louise marina. Phenyltins were detected in three of the nine sites in low concentrations (<55 ng Sn g(-1)) in zebra mussels. There was a significant correlation between TBT in sediments and mussels. Gonadal development of zebra mussels varied largely between sites, and was negatively associated to TBT levels in mussel tissue. This study shows that TBT contamination remains a problem in localised freshwater sectors of the St. Lawrence River.

Animals↗
PubMed2003

Prevalence of and carcass condemnation from maedi-visna, paratuberculosis and caseous lymphadenitis in culled sheep from Quebec, Canada.

We determined the prevalence of lung and mammary gland lesions associated with maedi-visna (MV) infection, the prevalence of paratuberculosis (PTB), and the prevalence and lesions distribution of caseous lymphadenitis (CL) in culled sheep. Total of 451 ewes and 34 rams were selected randomly from two slaughterhouses in Quebec, Canada. MV serostatus was determined by recombinant ELISA test. PTB diagnosis was based on characteristic histological lesions in the terminal ileum, ileocecal lymph node and/or ileocecal valve and CL by gross detection of abscesses and isolation of Corynebacterium pseudotuberculosis. Seroprevalence of MV was 44% (95% CI: 40, 48). Seropositivity increased with age and was higher in ewes than in rams. The percentages of lung and mammary gland lesions in seropositive sheep were 14 and 40%, respectively, but mammary gland lesions lack specificity. The prevalence of PTB was 3% (95% CI: 2, 5). PTB increased with age and was lower among sheep with abscesses. The prevalence of CL was >/=21% (95% CI: 17, 24). The most-prevalent site of caseous lymphadenitis lesions was the thoracic cavity. The risk of carcass condemnation was significantly associated with region, body score and abscesses. Only the presence of abscesses was associated with an increase in trimming of carcasses.

Abattoirs↗
PubMed2003

Maedi-visna impact on productivity in Quebec sheep flocks (Canada).

An epidemiological study was conducted to determine the impact of maedi-visna (MV) seropositivity on productivity in commercial sheep flocks of the province of Quebec, Canada. A total of 1734 ewes and 220 rams were selected randomly from 29 flocks distributed in the Bas-St-Laurent and Estrie regions. Serostatus was determined with an enzyme-linked immunosorbent assay (ELISA) using recombinant proteins.Flock-specific, animal-level seroprevalence varied from 3 to 70% (median=29%). Seroprevalence increased with age and size of the flock, and was higher in ewes relative to rams (but was not associated with body score). A decrease of 0.94 kg per lamb in weaning weight was seen only for lambs raised by seropositive ewes >/=4 years old, and seropositivity in ewes of any age was associated with an increase in 0-30 days lamb-mortality (OR: 1.65). The impact of MV infection on weaning weight and lamb mortality did not vary between flocks, and seropositivity in ewes was not associated with litter size or lamb's birth weight.

Aging↗
PubMed2002

Economic analysis of the 1992-1993 mass immunization campaign against serogroup C meningococcal disease in Quebec.

The objective of the study was to evaluate the cost-effectiveness and utility of the mass immunization campaign performed in the province of Quebec in 1992-1993, following an outbreak of serogroup C meningococcal disease (CMD). Effectiveness data were extracted from a population-based cohort study, and cost estimates were obtained from surveys. Costs of the campaign to the health system were $ 26 million (1993 Canadian dollars). Between 48 and 74 CMD cases, and between 7 and 11 deaths were prevented in the following 5 years. Net societal costs were between $ 18 and 21 million (using a 3% discount rate), net costs per death averted were between $ 1.7 and 3.0 million, between $ 58,000 and 105,000 per life-year gained, and between $ 49,000 and 87,000 per quality-adjusted life-year gained. These economic indices are less favorable than those for current routine immunization programs in Canada, but within the range of those for other common health interventions.

Cohort Studies↗
PubMed2003

The dental care pathway of welfare recipients in Quebec.

IN Quebec (Canada), the utilization of dental care services varies greatly from one social class to another: whereas the well-to-do visit the dentist often for check-ups, those most in need demonstrate a "wait-and-see" attitude. The objective of our research was to describe the dental care pathway of the underprivileged when confronted with symptoms, and to understand how this pathway might be interrupted and possibly lead to tooth extractions. We arranged 16 one-on-one interviews with adult Montrealers who had experienced a dental problem during the 12 months preceding the interview. These participants, 9 women and 7 men aged between 30 and 48, lived in great poverty: all were welfare recipients, and as such, enjoyed the benefits of a government programme that entitled them to free basic dental care. During the interviews, the interviewers asked the participants to describe their latest dental problem and their subsequent behaviour. The dental care pathway of our participants was characterized by a strategy of adapting to the symptoms. This process of adapting, which can last several months, is essentially an individual process in which the individuals often resort to self-medication to soothe their pain. They decide to visit a dentist when the pain is too great and self-medication is no longer effective. Once this decision is made, their dental care pathway may nevertheless be interrupted in two ways: first, in the failure to find a dentist, and second, later, in the failure to complete treatments that are not covered by the welfare program, such as endodontic treatment. The fragmented character of these dental care pathways refers us to two features of accessibility: financial accessibility and acceptability. With regard to financial accessibility, our study shows that the public coverage intended for welfare recipients presents major gaps. As for acceptability, our participants are strongly critical of the dental profession, and develop a culture of rejection of it.

Adult↗
PubMed2002

Support for the presence of bipolar disorder susceptibility loci on chromosome 5: heterogeneity in a homogeneous population in Quebec.

A very large pedigree derived from the Saguenay-Lac-St-Jean region of Quebec contains a branch where a distal chromosome 5q haplotype seems to cosegregate with bipolar affective disorder. The authors used a diagnosis model where Bipolar Types I and II and schizoaffective disorder bipolar type were considered as affected, while single or recurrent episode major depression was classified as unknown and all the others diagnoses as unaffected. Model-free two-point LOD score values of 3.41 and 2.21 were observed at D5S432 in the 5p region with sib_ibd and sib_phase from the ASPEX package, but simulation studies did not permit the conclusion of a significant linkage because associated empirical P values were equal to .0026 and .0037. A parametric LOD score value of 2.15 was obtained at locus D5S412 in the distal chromosome 5q area. In order to investigate heterogeneity in the single multigenerational family, the pedigree was divided into five branches. Our simulation study suggested that the five branches of the Saguenay-Lac-St-Jean bipolar pedigree had low power to detect linkage under intrapedigree heterogeneity in this region.

Bipolar Disorder↗
PubMed2005

[Migration, ethics and public health in Quebec].

This article analyses the ethical issues of migration in relation to public health in Quebec. There are two objectives: to describe the progression of analysis of the migration phenomenon in public health over the last thirty years and to state the ethical debate it raises. The progression of analysis of the migration phenomenon has been characterised by various approaches: intercultural, acculturation, transcultural, and migratory journey. Although these approaches have contributed to the development of knowledge about the reality of immigration, they have also, in spite of themselves, generated stigmatisation, discrimination and the proliferation of prejudices. Generally, findings that have emerged when migration is taken into account indicate an imbalance of power. For some, to focus on the phenomenon of migration promotes the power imbalance while for others, to disregard it masks the issue.

Acculturation↗
PubMed1996

The Drug Utilization Review Network of Quebec.

Drug utilization review programs have been recognized as an effective way to control health care spending while maintaining quality services. This article describes the structure, mandate and activities of Quebec's Drug Utilization Review Network. This 112-member network, which represents 45% of health care facilities in the province, was established to promote the optimal utilization of drugs through the provision of support to pharmacology committees, therapeutic committees and pharmacy departments. The network's main role is to coordinate multi-centre drug utilization studies. Future challenges include maintaining member interest and evaluating the clinical and economic impact of the network's efforts.

Cost Control↗
PubMed2002

Validity of the French-language version of the Quebec back pain disability scale in low back pain patients in France.

OBJECTIVES: The primary objectives were to evaluate the acceptability in France of the Quebec Back Pain Disability Scale (QBPDS) in its original French-language version and to study its correlational validity against indicators of impairment, pain, disability, psychological status, and perceived health status. MATERIAL AND METHODS: Thirty-two patients with chronic low back pain were recruited at the rheumatology outpatient clinic of a French hospital. A physical examination was performed for determination of an impairment score, and scales were completed for pain (visual analog scale and Saint-Antoine Questionnaire), disability (QBPDS and Dallas Scale [DS]), perceived health status (Nottingham Health Profile, NHP), and psychological status (Hospital Anxiety and Depression Scale, HADS). RESULTS: Acceptability, internal consistency, and content validity of the QBPDS were satisfactory. Investigation of correlational validity showed good agreement with the DPQ (r = 0.755) and NHP (r = 0.739) and fair agreement with the impairment score (r = 0.449), the VAS pain score (r = 0.448), and the HADS score (r = 0.473). The QBPDS showed good discriminating power. Validity of the QBPDS was confirmed. DISCUSSION: Our results confirm the good measurement properties of the original French-language version of the QBPDS in French hospital-clinic patients with chronic low back pain. Comparison of the QBPDS and DPQ in this study shows that the QBPDS is better for evaluating disability, whereas the DPQ evaluates the overall, functional, psychological, and social impact of low back pain.

Adult↗
PubMed2002

[Influence of vegetation on the accumulation of peat in southern Quebec].

Mirabel bog (southern Quebec) was studied with the aim of specifying the past influence of local vegetation on peat accumulation. This influence was essentially translated by the reduction of minerotrophic inputs and peat accumulation induced by the highering of the peatland surface. Extremely rich initial conditions allow to explain the very high accumulations of the beginning of the Holocene, observed in various plant communities, among which Larix forests with ferns and Carex without modern analogues. Moreover, the structure (forest density) and the composition (dominance of Cyperaceae or Ericaceae) of these communities have locally controlled the dynamic of peat accumulation. These results point out the interest of the confrontation between palynological and macrofossil data and the spatialisation of palaeoecological studies.

Cyperaceae↗
PubMed2003

Influenza-like illness during pregnancy: results from a study in the eastern townships, Province of Quebec.

OBJECTIVES: (1) To assess the frequency of influenza and influenza-like illness (ILI) during pregnancy; (2) to explore the associated risk of adverse maternal and fetal outcomes. METHODS: All women who delivered at the Sherbrooke University Hospital in the province of Quebec during the period of February 15 to April 30, 2002, were invited to complete a questionnaire. Medical records of participating women and of their infants were reviewed. Complement-fixing antibody titres against influenza A were measured in paired sera drawn during antenatal screening and at delivery. RESULTS: The study participation rate was 96.3%. Nine of 517 women stated that they had received the influenza vaccine during pregnancy, and only 3 of 47 women with a chronic pulmonary disease had been immunized. Overall, 464 ILI episodes were reported by 331 women, and a significant maternal complication occurred in 8 cases. ILI episodes resulted in medical consultations in 55.4% of cases, and in antibiotic prescriptions in 13.8% of cases. There was no indication of an increased frequency of adverse perinatal outcomes associated with ILI during pregnancy. Paired sera were available for 156 participants and seroconversion was observed in 6.6%. CONCLUSIONS: ILI during pregnancy was associated with health services utilization but complications were infrequent. More studies are needed to demonstrate the usefulness of routine vaccination of healthy pregnant women against influenza.

Adolescent↗
PubMed2005

Postpartum urinary and anal incontinence: a population-based study of quality of life of primiparous women in Quebec.

OBJECTIVE: To describe the quality of life of primiparous women with urinary or anal incontinence. METHODS: A questionnaire was mailed at six months postpartum to 2492 primiparous women living in Quebec. The prevalence of urinary incontinence was assessed at six months postpartum through the FPSUND severity score index; the prevalence of anal incontinence was assessed by the grading system of Vaizey et al.; the quality of life of women who developed incontinence was assessed using the Shumaker's I-QOL for urinary incontinence and Lowry's quality of life instrument for anal incontinence. Descriptive analysis, t-test, analysis of variance, and linear regression were used. RESULTS: The prevalence of urinary incontinence was 29.6% and of anal incontinence was 20.6%. Quality of life was affected significantly by the presence of urinary incontinence or both forms of incontinence (P 0.001) and by the type of urinary incontinence (P < 0.001). Women with all types of anal incontinence had significantly lower quality of life scores for access to toilet (P < 0.001), lifestyle (P < 0.01), self-esteem (P = 0.037), and total score (P < 0.001). Quality of life correlated with the severity of both urinary incontinence and anal incontinence: the more severe the urinary or anal incontinence, the lower the quality of life score. CONCLUSION: Women who have urinary or anal incontinence, or both, have significant reductions in indicators of quality of life. Research is needed to evaluate strategies for preventing and treating these problems.

Adult↗
PubMed2005

Mother's death and child survival: the case of early Quebec.

The aim of this paper is to account for the effect of mother's death on child survival in a historical population. Using comprehensive data on the early French Canadian population of Quebec, evidence is provided for a higher risk of dying for motherless children that remains significant over all childhood and long after the death of the mother. The specific effect of the loss of maternal care was estimated by comparing mortality before and after mother's death, furnishing a means to control for family heterogeneity. No differential in investment between genders was detected before age 3, but older girls suffered a three-fold higher susceptibility to mother's death than their male counterparts. This suggests that grown-up girls assuming the responsibilities of the missing mother had a lower chance of survival.

Age Factors↗
PubMed1989

Origin and diffusion of the myotonic dystrophy gene in the Saguenay region (Quebec).

A very high prevalence (approximately 1/475 in 1985) of myotonic dystrophy (Steinert disease) is observed in the Saguenay region, which is located in the north-east part of the Province of Quebec. For various reasons, however, the literature on the subject generally associates a high degree of selective disadvantage with this gene, which seems to contradict the Saguenay data. Using a computerized regional population register, we have reconstituted patients' genealogies and family biographies. We have thus been able to study the origin of the gene and to compare the demographic behavior of patients and controls. On the whole, patients seem to be very little disadvantaged compared to controls, in terms of reproduction as well as of geographical and occupational mobility.

Female↗
PubMed1989

Myotonic dystrophy in Quebec: geographical distribution and concept of genetic homogeneity.

The geographical distribution relative to place of residence of patients with myotonic dystrophy (MD) and admitted to a Quebec hospital during a five year period (1980-1984) is presented and discussed. The sample consists of 72 males and 68 females of varying ages over 10 years. Analysis of the data shows a North Shore distribution of patients in a cline from Saguenay-Lac-St-Jean, through Québec City and to Montréal. However, a low prevalence is apparent on the South Shore, east of Québec City, for which an historical and genealogical explanation are discussed. This geographic distribution favours the hypothesis of genetic homogeneity for the MD gene in the Québec population. A stronger second argument comes from genealogical studies of 10 families sampled from the Chicoutimi Muscular Dystrophy Clinic. Genealogical paths traced to ancestors who founded Charlevoix for these 10 families go back to a cluster of 25 founders, one of whom must have been the carrier of the MD gene. The probative third argument for genetic homogeneity comes from the allelic distribution of the apolipoprotein E (ApoE) gene in the Québec City, Saguenay and in families with MD. The ApoE locus is on chromosome 19 and closely linked to MD. In MD-affected individuals there is a linkage disequilibrium for the epsilon 4 allele while non-MD members of these families show allelic frequencies not differing significantly from the control population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Nuclear inclusions in oculopharyngeal muscular dystrophy in Quebec.

Seven French-Canadian cases of clearcut oculopharyngeal muscular dystrophy (OPMD) had their muscle studied for the presence of intranuclear inclusions, and they were all positive. Inclusions of both "mature" and "immature" types were seen in our material. The presence of such intranuclear structures should be added to the criteria of the clinical picture and the family history for diagnosis of a case and inclusion of a family in further genetic studies. Reverse genetic studies of large families and biochemical studies of these intranuclear structures may help to understand the pathogenesis of this common disease in Quebec.

Aged↗