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PubMed2005

Prevalence of pathological gambling in Quebec in 2002.

OBJECTIVE: To assess gambling behaviours and the problems associated with pathological gambling among the adult population of Quebec in 2002. METHOD: In Phase 1 of this 2-phase study, a total sample of 8842 adults was assessed. We used the South Oaks Gambling Screen (SOGS), adapted for telephone interview, to assess one-half of the sample; the other one-half was evaluated with the Canadian Problem Gambling Index (CPGI). In the study's second phase, we compared the classifications obtained from these screening instruments with classifications obtained by a psychologist using a semistructured clinical telephone interview. RESULTS: The results indicate that the prevalence of pathological gambling in 2002 (at which time 0.8% of the adult population were classified as probable pathological gamblers) did not differ from the proportion obtained in 1996 (1.0%), despite the significant decrease in gambling participation in 2002 (81% vs 90% in 1996). The most popular gambling activities were buying lottery tickets (68%), participating in fundraising draws (40%), gambling in casinos (18%), playing cards with family or with friends (10%), playing bingo (9%), and playing video lotteries (8%). The findings obtained from the SOGS and the CPGI revealed that the 2 instruments perform similarly when identifying pathological gambling prevalence. However, the results of the semistructured clinical telephone interviews differed from the results obtained with the screening instruments: 82% of the gamblers initially identified as probable pathological gamblers by the SOGS or the CPGI were not confirmed by a clinical interview. CONCLUSION: The discrepancy between the results of the screening questionnaires and the clinical evaluation is significant, and this difference needs to be addressed before further cross-sectional or longitudinal studies are conducted.

Adult↗
PubMed2006

Agreement between staff and service users concerning the clientele's mental health needs: a Quebec study.

OBJECTIVES: This article examines the differences found between clientele with severe mental health problems and their key health workers in terms of assessing service users' needs in 6 Quebec service areas. METHOD: We questioned 165 pairs of users and staff, using the Camberwell Assessment of Needs questionnaire. The profile of serious and overall problems encountered by clientele from each of the sites was compared. RESULTS: The sites with the greatest degree of user-staff agreement in identifying problems were also the ones where users considered that local services best met their needs. CONCLUSIONS: The study demonstrated that, in needs assessment, major differences exist between the perceptions of users and their key workers in the various sites. These differences can be explained in part by users' individual characteristics, by types of needs, by local particularities, and by service use.

Cooperative Behavior↗
PubMed2006

Pharmacologic response to a diagnosis of late-life depression: A population study in Quebec.

OBJECTIVE: To identify predictors of receiving psychoactive medication and receiving recommended first-line pharmacotherapy in individuals with newly diagnosed late-life depression. METHODS: We undertook a retrospective database cohort study of 5258 beneficiaries of the Quebec provincial health insurance plan between 1999 and 2002. Subjects were aged 65 to 84 years and diagnosed with depression by primary care physicians or psychiatrists between October 2000 and March 2001; they had no depression diagnosis in the previous year. We defined receipt of psychoactive medication as having a pharmacy claim in the year following the depression diagnosis. We determined receipt of recommended first-line pharmacotherapy from the first psychoactive medication dispensed following diagnosis and defined it accordingly; we defined first-line pharmacotherapy according to the 2001 Canadian Psychiatric Association guidelines. We used multivariate generalized estimating equations models to identify the determinants of the 2 outcomes. RESULTS: A total of 4421 (84.1%) patients received psychoactive medication following diagnosis; 2623 (59.3%) patients had not received antidepressants in the previous year. Of these, 1310 (49.9%) received recommended first-line pharmacotherapy. Independent predictors of receiving psychoactive medication were female sex, depression not otherwise specified (NOS), increasing comorbidity, and living in rural areas. Independent predictors of receiving recommended first-line pharmacotherapy were male sex, depression NOS, receiving medication in the month following diagnosis, and having the same physician diagnosing and treating the patient. CONCLUSION: Male sex and continuity of care predicted that patients had the recommended medication dispensed.

Age Factors↗
PubMed1983

[Suicides and attempted suicides in relation to the delivery of medical care: study of legal prosecutions in Quebec between 1968 and 1977].

This study analyzes 39 malpractice suits based on suicide attempts of hospital patients in Quebec between the years 1968 and 1977. Both the age and sex of the victims, as well as the pathology involved, the site of occurrence, the technique used and the foreseeability of the event are examined. The study discusses the two main criteria that are used by the courts to determine liability for such occurrences, that is the foreseeability of the attempt and the possibility of its prevention. This is followed by an outline of the different factors that are considered by the courts in determining liability, such as the nature of the illness, the behavior of the patient, the site of hospitalization and the type of surveillance prescribed and exercised. This analysis illustrates the difficulty in predicting the behavior of suicidal patients. In addition, as demonstrated, it is often impossible to prevent these patients from committing suicide. In conclusion, it is important to recognize the difficulties facing those who do decide to sue, difficulties stemming from the requirement of proving fault on the part of the doctor or the hospital staff in either not foreseeing the event or in not prescribing appropriate measures so as to prevent its occurrence.

Delivery of Health Care↗
PubMed1984

[Toward a redefinition of community psychiatry in Quebec].

Community Psychiatry is in troubled waters in Quebec. Overwhelmed by their caseloads, community clinics do not see the end of the tunnel with their new long-term mentally-ill patients. The painful reality of the new asylum in the community raises questions about Community Psychiatry despite its remarkable progress. The authors analyze the state of the art about schizophrenia, which is mainly related to chronic mental patients and point out the discrepancy between the original ideals of Community Psychiatry and the clinical reality. They develop the four following propositions to redefine Community Psychiatry in the actual context: recognize the need for the asylum as a process; tolerate the paradox of the multidisciplinary work; narrow the target population and the type of therapy offered; and secure continuity with the community.

Chronic Disease↗
PubMed1991

Prevalence estimates of pathological gambling in Quebec.

Pathological gambling was officially defined and recognized as a psychiatric illness by the American Psychiatric Association in 1980. This survey reports the results of a province-wide study in Quebec based on telephone interviews using standardized assessment instruments with 1,002 subjects. The current prevalence of pathological gambling is 1.2%. The results also show that 88% of the respondents have gambled at least once in their life. The implications of these results for the prevention and treatment of this debilitating disorder are discussed.

Adult↗
PubMed1993

Homicide followed by suicide: a Quebec case series, 1988-1990.

Homicide followed by suicide is a rare but tragic event. Psychiatrists and mental health professionals are often called upon to comment publicly on the event or to help the "hidden victims," the survivors of the tragedy. There were 39 such cases in Quebec between 1988 and 1990, and they have been reviewed through the examination of the coroner's files. The epidemiological rates of homicide, suicide, homicide-suicide and the sociodemographic and clinical characteristics of the perpetrators and victims are presented and compared with the international literature. Sociological and psychopathological hypotheses are presented with a special reference to the possibility of various subgroups of perpetrators. Research needs to be pursued along the lines of more detailed case studies of psychopathological characteristics using the psychological autopsy approach. The reconstruction of the couple's relationship and of the final circumstances leading up to the tragedy may provide warning indices that could be helpful in preventing such tragedies.

Adolescent↗
PubMed1994

Prevalence of pathological gambling and related problems among college students in the Quebec metropolitan area.

The prevalence of pathological gambling and problems associated with it were measured among 1,471 students of three colleges in the Quebec city metropolitan area. Almost 90% of the students had gambled and 21.7% of the students engage in this behaviour once a week or more. The prevalence of pathological gamblers was found to be 2.8% for the entire sample. The percentage of pathological gamblers was much higher among males (5.7%) than females (0.6%). The results indicate that pathological gambling is associated with economic, professional and interpersonal problems. The discussion addresses the implications of the present findings and suggests avenues for future research.

Adolescent↗
PubMed1997

Use of health services for anxiety disorders: a multisite study in Quebec.

OBJECTIVE: We investigated patient characteristics and use of services for anxiety disorders among patients seeking care from participating clinicians at 7 anxiety clinics in Quebec: 3 general hospital clinics, 3 psychologist-run clinics, and one psychiatric hospital clinic. METHODS: Persons eligible for the study were those who were visiting the clinics for the first time, had a current diagnosis of an anxiety disorder, and could communicate in French or English. Subjects recruited through advertisements were excluded. Data, collected by a self-administered questionnaire, included demographics, treatment history, use of services for anxiety, and the Beck Anxiety Inventory (BAI). RESULTS: The sample comprised 235 subjects: 146 seen at 3 general hospital clinics, 54 at 3 psychologist-run clinics, and 35 at a psychiatric hospital clinic. There were statistically significant differences by clinic type in the prevalence of specific anxiety diagnoses, BAI score, referral source, antidepressant use, and use of services. High-intensity use (10 or more consultations during the previous year) was reported by 23.4% of the sample for medical services and 19.6% for mental health services. Multiple logistic regression identified variables associated with high-intensity use of medical services (higher BAI score, 1 to 4 years since first sought treatment, and less than 12 years of education) and high-intensity use of mental health services (clinic type, obsessive-compulsive disorder [OCD], and 5 or more years since first sought treatment). CONCLUSIONS: The patient populations seen at different types of anxiety clinics differ in several respects, including referral source, previous treatment, and severity of symptoms. Regardless of type of clinic, patients with a longer time since they first sought treatment use more services, particularly mental health services. Those with less education use more medical services than those with greater education.

Adult↗
PubMed1998

[Child psychiatric day treatment centers in Quebec for children 0-12 years of age].

OBJECTIVES: The review lists the child psychiatry day-care centres in Quebec, evaluates their capacity, and describes them according to the age range for admission, the psychopathologies treated, and the parent involvement required. METHOD: The 26 programs selected, which are all associated with a hospital centre, assess and treat children aged 0 to 12 years on a day-care basis. Organization, clinical operation, and research are addressed during a semisupervised interview. RESULTS: The average capacity is 18 children (4 to 40), with a total capacity of 454 children. The number of preschool patients can be compared with the number of school patients. Few programs are dedicated to invasive development disorders, and one-third treat behavioural or emotional disorders. The larger capacity programs treat patients of both genders. Most programs are eclectic and encourage but do not require parental involvement. CONCLUSIONS: Results take into account different theoretical influences, the controversy about integration criteria and parent involvement, and the specificity of the child psychiatry mission.

Child↗
PubMed1992

Characteristics of pharmaceutical opinions written in a Quebec community pharmacy.

OBJECTIVE: To describe the characteristics of pharmaceutical opinions written in a community pharmacy and to estimate the possible effects of these opinions on patient drug profiles. DESIGN: Retrospective survey. SETTING: The community pharmacy where these opinions were written is located in a rural area of the province of Quebec. Only health-related items are sold and no merchandise is displayed in this pharmacy. PARTICIPANTS: Ten pharmacists worked at this pharmacy during the period of the study. INTERVENTION: Pharmacists were paid when they sent advice to a patient or a physician about the patient's drug profile or about the therapeutic value of a prescribed treatment. This survey included recommendations made from 1978 to 1983. A sample of 600 opinions was drawn at random from a total of 1992 opinions that had been written at the site of the study. MAIN OUTCOME MEASURE: The impact of each opinion was assessed by analyzing patient drug profiles for three months after the opinion was written to determine if the recipient had followed the pharmacist's recommendation. RESULTS: Pharmacists, on their own initiative, sent 97.9 percent of the opinions. Only 1.7 percent of the opinions were requested by patients and 0.4 percent by physicians. Most opinions were addressed to patients (86.7 percent) rather than to physicians (13.3 percent). Almost four of five recommendations sent to patients were about compliance (45.1 percent) or were suggestions for improving the therapeutic effect of a medication or replacing a drug with nondrug treatment (33.4 percent). The three most common recommendations sent to prescribers were to replace one drug with another (25 percent), to change the dose or dosing schedule of a drug (16.3 percent), and to discontinue drug treatment (16.3 percent). Chemical stability, underuse or overuse of a medication, and adverse effects were the most frequent causes of recommendations sent to patients. Adverse effects, interactions, and the underuse of a medication were the most frequent reasons for recommendations sent to physicians. The proportion of recommendations that were implemented was 77.7 percent for patients and 58.1 percent for physicians. CONCLUSIONS: The pharmaceutical opinion seemed to be a good means of communicating with patients and prescribers on a wide variety of problems encountered in a community pharmacy. It allowed pharmacists to be paid for their expertise even if a drug was not dispensed. Also, the pharmaceutical opinion could compensate for the loss of income when the pharmacist recommended replacing a prescribed medicine with nondrug treatment.

Community Pharmacy Services↗
PubMed2001

Platelets from patients with the Quebec platelet disorder contain and secrete abnormal amounts of urokinase-type plasminogen activator.

The Quebec platelet disorder (QPD) is an autosomal dominant platelet disorder associated with delayed bleeding and alpha-granule protein degradation. The degradation of alpha-granule, but not plasma, fibrinogen in patients with the QPD led to the investigation of their platelets for a protease defect. Unlike normal platelets, QPD platelets contained large amounts of fibrinolytic serine proteases that had properties of plasminogen activators. Western blot analysis, zymography, and immunodepletion experiments indicated this was because QPD platelets contained large amounts of urokinase-type plasminogen activator (u-PA) within a secretory compartment. u-PA antigen was not increased in all QPD plasmas, whereas it was increased more than 100-fold in QPD platelets (P <.00009), which contained increased u-PA messenger RNA. Although QPD platelets contained 2-fold more plasminogen activator inhibitor 1 (PAI-1) (P <.0008) and 100-fold greater u-PA-PAI-1 complexes (P <.0002) than normal platelets, they contained excess u-PA activity, predominantly in the form of two chain (tcu-PA), which required additional PAI-1 for full inhibition. There was associated proteolysis of plasminogen in QPD platelets, to forms that comigrated with plasmin. When similar amounts of tcu-PA were incubated with normal platelet secretory proteins, many alpha-granule proteins were proteolyzed to forms that resembled degraded QPD platelet proteins. These data implicate u-PA in the pathogenesis of alpha-granule protein degradation in the QPD. Although patients with the QPD have normal to increased u-PA levels in their plasma, without evidence of systemic fibrinogenolysis, their increased platelet u-PA could contribute to bleeding by accelerating fibrinolysis within the hemostatic plug. QPD is the only inherited bleeding disorder in humans known to be associated with increased u-PA.

Blood Platelet Disorders↗
PubMed2006

Perceived conflict in the couple and chronic illness management: preliminary analyses from the Quebec Health Survey.

BACKGROUND: The quality of the relationship with the spouse/partner appears crucial among patients with multiple chronic conditions where illness management is complex and multifaceted. This study draws on data from the Quebec Health Survey (QHS) to examine, among patients with one or more chronic conditions, the relation between marital status, the perceived conflict with the spouse/partner, and what the patients do to manage their illness as well as how they perceive their health. METHODS: Data from the QHS 1998 were used. The sample included 7547 coupled adults who had one or more chronic health problems lasting more than 6 months. Independent variables included marital status, perceived conflict with the spouse/partner, and the number of chronic conditions. Illness management was defined broadly as a measure of the patient's efforts at self-care and an illness status indicator, including visits to the generalist and the specialist, the use of telephone health line in the last 12 months, self-rated general health, mental health, and a measure of psychological distress. Linkages between the independent variables and illness management were assessed for males and females separately with logistic regressions, while accounting for the survey sampling design and household clustering. RESULTS: Female patients who did not live with their partner and had never been married were more likely to report a negative perception of their general health and a higher psychological distress than those who were married. Perceived conflict with the partner was linked to a negative perception of mental health and a higher psychological distress among both men and women. Compared to patients with only one chronic condition, males who reported more than one chronic condition were more likely to have consulted a generalist prior to the survey and used the telephone health line, whereas females were more likely to have consulted a specialist. Both males and females with more than one chronic condition were more likely to have a negative perception of their general health and mental health. CONCLUSION: The study provides a useful preliminary measure of the importance of living arrangements and the quality of the couple relationship in chronic illness management broadly conceived as a measure of the patient's efforts at self-care and an illness status indicator. Results of this study prod us to examine more closely, within longitudinal designs, the influence of living arrangements and the presence of conflict in the couple on chronic illness management as well as the modifying effect of gender on these associations.

Adult↗
PubMed2005

Quality of life after acute myocardial infarction: a comparison of diabetic versus non-diabetic acute myocardial infarction patients in Quebec acute care hospitals.

BACKGROUND: Previous studies have evaluated the individual effects of acute myocardial infarction (AMI) and diabetes mellitus on health-related quality of life outcomes (QOL). Due to the rising incidence of these comorbid conditions, it is important to examine the synergistic impact of diabetes mellitus and AMI on QOL. METHODS: In this study, we assessed using several previously validated questionnaires the QOL and functional status of 96 diabetic patients and 491 non-diabetic patients admitted to Quebec hospital sites with AMI between 1997 and 1998. We also conducted multivariate analyses to ascertain whether diabetes mellitus was an independent determinant of SF-36 physical functioning (PCS) and mental health (MCS) component score QOL outcomes after AMI. RESULTS: Both patient groups had similar baseline clinical characteristics, but diabetic patients had slightly higher rates of cardiac risk factors compared to non-diabetics. Overall, QOL measures were similar between both patient groups at baseline, but diabetic patients reported poorer functional status than non-diabetic patients. Over the study period, there were significant differences between the QOL and functional status of diabetic and non-diabetic populations. By one year, diabetic patients reported poorer QOL outcomes than non-diabetic patients. However, diabetic patients showed greater improvements in their functional status, but were less likely to return to work compared to non-diabetic patients. In contrast with these findings, our multivariate analyses showed that diabetes mellitus was not an independent determinant of QOL and functional status. CONCLUSION: Our study findings suggest that diabetes mellitus is not an independent determinant of QOL after AMI.

Acute Disease↗
PubMed1989

Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients.

Three-hundred thirty-two cases of pleural diffuse malignant mesothelioma (DMM) seen at large centers in Ontario and Quebec from 1965 to 1984 were reviewed retrospectively. Previous asbestos exposure was found in 44% of patients. Diagnosis was most often made by exploratory thoracotomy; pleural biopsy or cytology were rarely contributory. The delay in diagnosis was often long (median time, 3.5 months) and thrombocytosis (platelets greater than or equal to 400,000/microL) was common (41% of cases). The median survival (MS) was only 9 months. Eleven clinical variables were analyzed for prognostic significance. The three most important prognostic factors using a univariate analysis were stage, weight loss, and histologic type. For 118 patients with complete data, multivariate analysis showed that the stage of disease, high platelet count, and asbestos exposure were the most important prognostic factors. There was no cure of DMM, and we did not find any drastic differences in survival among groups of patients subjected to the different therapeutic measures. Radical surgery and radiotherapy were ineffective and we confirmed the low response rate to chemotherapeutic agents. This large retrospective trial can serve as a baseline for future studies in this field. In particular, it provides the basis for appropriate stratification variables to be used in future therapeutic trials.

Adult↗
PubMed1978

The distributional effects of national health insurance in Quebec.

In November of 1970 a major change in public health policy occurred in Quebec: the movement from a mixed private-public system to a completely public system of financing health care (known as Medicare). This policy change had important economic effects on the distribution of income, taxation, and health care costs. This paper analyzes these economic effects by focusing on the changes in financial burden of medical care costs between 1969-70 and 1971-72 for eight income classes. The key results that emerge are: the total cost of medical care increases sharply for all of the income groups, and the burden of the cost of medical care becomes more equitable across the income groups. Based on these results, policy considerations for the present debate on national health insurance in the United States are offered.

Financing, Government↗
PubMed2006

Integrated service networks: the Quebec case.

In the current context of health-care reform, integrated service networks are presented as main solutions to enhance efficiency. During the past few years, there has been an abundance of literature focusing on integration and the underlying implementation issues. However, the concept of integrated service networks remains fluid, and there are few typologies on health-care inter-organizational relations. The Quebec health-care system offers fertile ground for furthering our understanding of this concept because of its public system of funding, its integration of health and social missions, and the present reform's state of development. On the basis of a review of the literature and empirical studies, this article intends to clarify the concept of integrated service networks. A typology of inter-organizational relations and the main parameters for organizing integrated service networks are presented. The article also discusses the effectiveness of integration models.

Community Mental Health Services↗
PubMed2001

Sexual behaviour, condom use and HIV risk situations in the general population of Quebec.

We conducted 3501 telephone interviews to determine the sexual and protective behaviours of the general population in Quebec. Among the 858 respondents who had had at least one occasional partner during the last 5 years, 25.4% had had at least one occasional partner who refused to use a condom. More women had had an occasional partner who had refused than men (29.8% vs 21.1%, P<0.001) and fewer women than men succeeded in negotiating condom use, but more of these women decided not to have sexual relations. The frequency of condom use during the last sexual relation changes if the partner is a regular cohabiting partner (12.5%), a regular non-co-habiting partner (42.2%) or an occasional partner (70.8%). Our study provides important information for the development of prevention programmes for the heterosexual population and demonstrates the importance of the type of relationship maintained by the partners on the sexual behaviours.

Adolescent↗