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PubMed2006

Delivery of high-tech home care by hospital-based nursing units in Quebec: clinical and technical challenges.

BACKGROUND: The role that hospital-based nurses should play in the delivery of high-tech home care, and how they should be supported in that role, are topics that remain understudied. Our research objective was to document how hospital-based nursing teams perceive and deal with the clinical and technical challenges associated with the provision of high-tech home care. METHODS: Four home care interventions were selected: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. A self-administered survey was sent to all hospital-based units providing these interventions in the province of Quebec, Canada (n = 154; response rate: 70.8%). We used descriptive statistical analyses to derive mean values for scores on either a five- or a six-level Likert scale. RESULTS: Despite variation across the four interventions, our results indicate that while nursing teams believe these interventions increase patients' autonomy, they also recognize that they generate anxiety and impose constraints on patients' lives. Nurses must increase efforts to deal with both clinical and technical challenges and help patients overcome the barriers to appropriate use of home care technologies. CONCLUSIONS: While nursing teams generally perceive high-tech home care as beneficial, they still experience significant technical and clinical challenges. Some of these challenges could be addressed by strengthening professional training initiatives, while others require broader home care policy interventions.

Adaptation, Psychological↗
PubMed2005

A healthcare revolution: Quebec's new model of healthcare.

Over the past two years as CEO of the Montreal Health Authority I have participated in the preparation and now the implementation of what I consider the first real reform in healthcare since the beginning of Medicare in 1970. In my opinion Quebec is undergoing a second "quiet revolution" in healthcare as important as the first one, a revolution not in structure but in the philosophy of how healthcare is provided to its population.

Delivery of Health Care↗
PubMed2001

Human rights enforcement agencies and the protection of older workers against discrimination: the case of the Quebec Human Rights Commission.

The article provides insight into the way a human rights enforcement agency, the Quebec Human Rights Commission, implements legal dispositions prohibiting age discrimination in employment. Drawing on data from claims filed before the Commission, the article establishes a quantitative profile of cases and examines the factors that are involved in the decisions made by the Commission. It is argued that (1) the Commission's approach in investigating age discrimination cases and (2) the burden of proof put on respondents are main contributing factors to a very limited number of cases being validated. However, despite apparent shortcomings, the Commission still fulfills an important role in defending and promoting older workers' rights. Its overall impact can be assessed only in connection with other social and employment policies geared at older workers. In conclusion, some recommendations to improve the functioning of the Commission are made.

Aged↗
PubMed2003

Distribution of fasting plasma insulin, free fatty acids, and glucose concentrations and of homeostasis model assessment of insulin resistance in a representative sample of Quebec children and adolescents.

BACKGROUND: Plasma fasting insulin and the homeostasis model assessment of insulin resistance (HOMA-IR) are markers of IR, which, at least in part, mediates the relation of obesity to increased cardiovascular risk. Increased free fatty acids (FFAs) may be involved in the pathogenesis of IR. Our objectives were to describe the distributions of fasting plasma insulin, glucose, and FFAs and HOMA-IR in youth and to assess the relationship between FFAs and markers of IR. METHODS: Fasting plasma insulin, glucose, and FFAs were measured in a representative sample of Quebec youth comprising 2244 individuals 9, 13, and 16 years of age. RESULTS: In all age and sex groups, glucose exhibited remarkably tight distributions (median CV, 7.1%) in contrast to insulin, HOMA-IR, and FFAs (median CVs, 52%, 54% and 45%, respectively). For every percentile examined, 9-year-olds had lower insulin concentrations and HOMA-IR values than 13- and 16-year-olds. We observed strong correlations between insulin concentrations and HOMA-IR values, as well as close similarity in their rankings of individuals. The mean concentrations of glucose were higher in our population than in other Caucasian pediatric populations. No positive correlations were detected between FFAs and markers of IR. CONCLUSIONS: We report some of the first data on the distributions of fasting plasma insulin, HOMA-IR, and FFAs from a representative sample of youth. HOMA-IR does not appear more informative than fasting insulin as a marker of IR. Our findings on higher mean glucose concentrations in this population require confirmation in other representative samples of youth to assess whether the North American distribution of glucose concentrations is shifting positively.

Adolescent↗
PubMed2005

Volume of screening mammography and performance in the Quebec population-based Breast Cancer Screening Program.

BACKGROUND: In the Quebec Breast Cancer Screening Program (Programme quebecois de depistage du cancer du sein [PQDCS]), radiologists' and facilities' volumes of screening mammography vary considerably. We examined the relation of screening-mammography volume to rates of breast cancer detection and false-positive readings in the PQDCS. METHODS: The study population included 307,314 asymptomatic women aged 50-69 years screened during 1998-2000. Breast cancer detection rates were analyzed by comparing all women with screening-detected breast cancer (n = 1709) and a 10% random sample of those without (n = 30,560). False-positive rates were analyzed by comparing the 3159 women with false-positive readings and the 27,401 others in the 10% random sample. Characteristics of participants, radiologists and facilities were obtained from the PQDCS information system. Data were analyzed by means of logistic regression. RESULTS: The rate of breast cancer detection appeared to be unrelated to the radiologist's screening-mammography volume but increased with the facility's screening-mammography volume. The breast cancer detection rate ratio for facilities performing 4000 or more screenings per year, compared with those performing fewer than 2000, was 1.28 (95% confidence interval [CI] 1.07-1.52). In contrast, the frequency of false-positive readings was unrelated to the facility's screening volume but was inversely related to the radiologist's screening volume: the rate ratio for readers of 1500 or more screenings per year compared with those reading fewer than 250 was 0.53 (95% CI 0.35-0.79). INTERPRETATION: Radiologists' and facilities' caseloads showed independent and complementary associations with performance of screening mammography in the PQDCS. Radiologists who worked in larger facilities and read more screening mammograms had higher breast cancer detection rates while maintaining lower false-positive rates.

Aged↗
PubMed2004

Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity.

BACKGROUND: Recent reports suggest that Clostridium difficile colitis may be evolving into a more severe disease. During the second half of 2002 we noted an increase in the number of patients with severe C. difficile-associated diarrhea (CDAD) in our institution. We describe cases of CDAD at our institution over a 13-year period and investigate changes in illness severity. METHODS: We undertook a retrospective chart review of all cases of CDAD diagnosed at the Centre hospitalier universitaire de Sherbrooke from Jan. 1, 1991, to Dec. 31, 2003. Because the hospital serves a well-defined population of Quebec, we were also able to calculate population-based incidence during this period. We abstracted data on individual patients from patient charts and from hospital and pharmacy computer databases. We defined cases of CDAD as having a positive C. difficile cytotoxicity assay result, or endoscopic or histopathological evidence of pseudomembranous colitis. A case was considered complicated if one or more of the following was observed: megacolon, perforation, colectomy, shock requiring vasopressor therapy, or death within 30 days after diagnosis. RESULTS: A total of 1721 cases of CDAD were diagnosed during the study period. The incidence increased from 35.6 per 100,000 population in 1991 to 156.3 per 100,000 in 2003; among patients aged 65 years or more, it increased from 102.0 to 866.5 per 100,000. The proportion of cases that were complicated increased from 7.1% (12/169) in 1991-1992 to 18.2% (71/390) in 2003 (p < 0.001), and the proportion of patients who died within 30 days after diagnosis increased from 4.7% (8/169) in 1991-1992 to 13.8% (54/390) in 2003 (p < 0.001). A high leukocyte count (20.0 small ha, Cyrillic 10(9)/L or greater) and an elevated creatinine level (200 micromol/L or greater) were strongly associated with adverse outcomes: in 2003, 45 (40.9%) of 110 patients with a high leukocyte count or creatinine level, or both, had complicated CDAD and 28 (25.5%) died within 30 days after diagnosis. After adjustment for age and other confounding factors, patients initially given oral vancomycin therapy had a risk of progression to complicated CDAD that was 79% lower than the risk among patients initially treated with metronidazole (adjusted odds ratio 0.2, 95% confidence interval 0.06-0.8, p = 0.02). INTERPRETATION: An epidemic of CDAD with an increased case-fatality rate has had important consequences on the elderly population of our region. Our observational data suggest that the equivalence of vancomycin and metronidazole in the treatment of CDAD needs to be questioned.

Adolescent↗
PubMed2004

Completed suicides among Quebec adolescents involved with juvenile justice and child welfare services.

In the Province of Quebec (Canada), adolescents involved with the child welfare and juvenile justice systems committed at least one third of all completed suicides in their age group in 1995 and 1996. Their risk of suicide, standardized for age and sex, was five times that of the general adolescent population, and female juvenile delinquents had the highest relative risk of suicide (36.1). Cumulated risk factors may explain those results. Since 40% of those suicides did occur when subjects were still actively involved with the child welfare and juvenile justice systems, those agencies should revise their suicide prevention strategies.

Adolescent↗
PubMed2005

Correlates of suicide in the older adult population in Quebec.

This study was undertaken to describe the characteristics of adults aged 60 years and over who committed suicide in Quebec in 1998-1999. In this study, 42.6% of the suicide cases presented mental disorders at the time of their death, mainly depression. Sixty-five (65.3%) percent of the suicide cases would have been considered as having a mental health disorder if sub-threshold depression cases were included. Only 27.7% of the cases did not express any idea of death during the 6-month period preceding their suicide. One interesting finding was that 53.5% of the suicide cases consulted a general practitioner or specialist during the 2-week period preceding their death. Our results showed that only 8.1% had a severe level of functional limitations at the time of their death. This result leads us to interpret with caution the conclusion of some studies suggesting that physical frailty is a major causal factor associated with suicide among the elderly.

Aged↗
PubMed1996

Does allowing the sale of wine in Quebec grocery stores increase consumption?

OBJECTIVE: To determine if allowing wine sales in corner grocery stores, beginning in 1978 for domestic Quebec wines and then in 1983 for imported wines, in addition to sales in government monopoly stores, led to an increase in alcohol consumption. METHOD: Aggregate retail sales data for the period 1953 to 1990 were analyzed using econometric regression techniques. Time series (unit root) analysis and structural modeling were used to take into account the effect of price, income and other social, economic and demographic factors in order to determine the effect of factors underlying consumption behavior in both the long and short term. RESULTS: In the post-intervention period, wine consumption continued along the rising trend established in the pre-intervention period, with an apparent shift in favor of domestic wine consumption. The increase in wine consumption was highest in the period immediately following privatization, but the increase eventually dampened down within a few years. There was no fundamental change in the responsiveness of wine consumption to price. CONCLUSION: Our findings suggest that the level of wine consumption can be controlled through price changes when alcohol availability increases through increased sales outlets.

Adolescent↗
PubMedDate not supplied

[Recent health services reform in Quebec Province, Canada: on the frontier of preserving a public system].

This paper analyzes recent changes in the Canadian health system through a case study of Quebec. As the last Province to adopt federal principles of universal coverage, comprehensiveness, and public management, its reform, conducted in 1971, met these objectives by means of key innovations. In the 1980s and early 90s, a process of health services evaluation in this Province and in Canada as a whole launched a period of extensive changes. The relevant measures are described herein: decentralization and regional management, "clinical shift", selective reduction in the supply of services, and new mechanisms for resource allocation and social control. There is a tendency towards an environment of public competition, but the approach that was adopted for regulation does not correspond to the main models from central countries. Within a scenario of budget constraints, technocratically-defined measures allowed for the settlement of benefits, preserving the system's main guidelines. This evidence is one of the main contributions of comparative analysis to health system reform in peripheral countries. The study identifies the relationships between these measures and a worldwide trend towards cost control and macroeconomic adjustment policies, discussing the relevant implications for health services.

Canada↗
PubMed2005

Genetic characterization of Cryptosporidium isolates from ringed seals (Phoca hispida) in Northern Quebec, Canada.

This study reports the molecular characterization of Cryptosporidium spp. isolates identified from intestinal contents of ringed seals (Phoca hispida) from Nunavik (Quebec, Canada). Cryptosporidium spp. fragments of 18S rRNA, HSP-70, and actin loci were amplified by PCR from seal intestinal contents. PCR-positive specimens were sequenced and compared with other Cryptosporidium species and genotypes reported previously. Sequence analysis showed the presence of C. muris and 2 novel genotypes in ringed seals.

Actins↗
PubMed1988

Mandatory driver training and road safety: the Quebec experience.

In January 1983, the Quebec Government made driver training courses mandatory for any person seeking a first driver's license. Using accident and licensure data over a five-year period, we conducted an evaluation of the impact of the enactment of mandatory driver training on: the risk of accident for newly licensed drivers; the mortality and morbidity of these accidents; the number of new drivers; and the mean age of licensure. Results of our time series analyses show that this legislation had no appreciable effect on the risk of accident or on the mortality/morbidity rate per accident for newly licensed drivers aged 18 and over. However, since 1983, the number of women under 18 years of age getting their first driver's license has increased by 20 per cent, and their mean age has decreased from over 18 to under 18. Mandatory driver training may have increased the numbers and risks of accidents for young, primarily female, drivers.

Accidents, Traffic↗
PubMed1996

The effects of a 4-year program promoting bicycle helmet use among children in Quebec.

OBJECTIVES: This study assessed the effectiveness of a 4-year program of bicycle helmet promotion that targeted elementary school children in one region of Quebec. The program revolved primarily around persuasive communication and community organization, combining standard educational activities and activities to facilitate helmet acquisition and use. METHODS: Helmet use was compared between more than 8000 young cyclists in municipalities exposed or not exposed to the program. Factors influencing helmet use were controlled through the use of multivariate analyses. RESULTS: Helmet use increased from 1.3% before program implementation to 33% in 1993. The program was clearly effective in most cycling circumstances and for various groups of children. However, the benefits of the program were unequally distributed; the program was one third as effective in poorer municipalities as in "average-rich" ones. CONCLUSIONS: This community-based program that combined various types of activities appeared to be effective. New intervention models are needed to ensure an equitable distribution of benefits.

Accidents, Traffic↗
PubMed2006

Integrated watershed management in Quebec (Canada): a participatory approach centred on local solidarity.

The Quebec Water Policy was launched in November 2002 in support of reform of the water governance. One of the government commitments is to gradually implement watershed-based management for 33 major watercourses located primarily in the St. Lawrence plain. At the local and regional levels, watershed organizations are responsible for implementing integrated management, from a sustainable-development perspective, by preparing a master plan for water (MPW), which will include watercourses, lakes, wetlands and aquifers. These watershed organizations rely on public consultation, as well as local and regional expertise, on the responsibilities for water of the municipalities and regional county municipalities of the territory, as well as those of the ministries and other government agencies. They are also required to observe national priorities regarding protection, restoration, and development of water resources and to comply with relevant guidelines, directives, standards, regulations, and legislation. The role of watershed organizations is to act as planning and consultation tables. Government representatives are present, on the initial process, as the facilitator and for scientific and technical support. They do not have, at this moment, any voting or decisional rights. After two years, integrated water management mobilized water stakeholders on watersheds and they are on their way to initiating their first MPW.

Community Participation↗
PubMed1985

Physicians' acceptance of an alternative to fee-for-service payment: a possible source of change in Quebec medicine.

This article reports on a survey conducted on a sample of Quebec physicians at the end of 1981. The objective of the study was to assess the acceptance by physicians of a possible change in their current mode of remuneration and to identify the consequences of such a change on the physicians' practice and on the attainment of broader health care objectives. The results presented in this article seem to indicate that neither the present fee-for-service mode of payment nor a change to time-based remuneration can reconcile both professional and broader health care objectives. Implications of these findings for health policies are discussed.

Attitude of Health Personnel↗
PubMed1983

Are women in female jobs for their health? A study of working conditions and health effects in the fish-processing industry in Quebec.

A questionnaire concerning environmental conditions, work organization, and health-related symptoms was administered to 209 male and female workers in fish-processing plants in Quebec. Jobs in these factories were "ghettoized," with 88.9 percent of job titles held primarily (more than 75 percent) by members of one sex. In general, significantly more women than men reported that their work sites exposed them to environmental aggressors such as noise and cold. Women also reported significantly more often that their jobs were uninteresting, that they could not move around, and that their work speed was fast. Women reported fatigue, stress, insomnia, digestive problems, and aches and pains significantly more often than did men (analysis controlled for age). When the effects of work speed were examined specifically, it was found that a fast work speed was associated with fatigue, stress, insomnia, and digestive problems in both sexes, and with aches and pains in women. It is suggested that women are required to work at a faster speed than men, and that this is a factor in the greater prevalence of health-related symptoms among women. Our interpretation of these data calls into question the commonly held belief that men and women are assigned to sex-specific jobs in order to protect the health of "the weaker sex."

Environment↗
PubMed2003

Compensation for musculoskeletal disorders in Quebec: systemic discrimination against women workers?

Criteria for evaluating workers' compensation claims for occupational disease are strongly linked to medical expertise as supported by scientific study, yet decision-makers are not necessarily familiar with the meaning of these studies. While this is a problem for all claimants, who bear the burden of proving that work caused their injury, the adverse impact of misunderstanding of scientific data can have particular consequences for women, whose work more often appears to be benign. This article reports on a study of empirical data drawn from analysis of 314 workers' compensation appeal tribunal decisions on compensation claims, in Quebec, for musculoskeletal disorders alleged to be related to repetitive work. The study considers randomly selected decisions rendered between 1994 and 1996 on diagnoses of tendonitis, epicondylitis, and carpal tunnel syndrome and, in a follow-up, looks at significant legal decisions by the same tribunals, rendered over a longer period (1987-96). Results indicate that women workers are significantly less likely than their male counterparts to have their occupational disease claims accepted by the appeal tribunal. Evidence suggests that inappropriate overreliance on scientific studies for adjudication purposes contributes to a greater rate of refusal of claims by women workers.

Adult↗
PubMed1984

Survival of the fittest? The democratization of hospital administration in Quebec.

In 1973 the Canadian Province of Quebec "democratized" its hospital boards of directors by replacing their traditional lay community or religious members with individuals more representative of the hospitals' major interest groups. In the province's English-speaking hospitals, patients, community organizations, physicians and nonprofessional hospital employees elected representatives to boards that were formerly comprised mostly of business executives. After a brief description of the social organization of the former "elite" boards and their role in the distribution of power within hospitals, the paper demonstrates how the "elite" board members and hospital administrators retained control despite "democratization." Several theoretical explanations for this outcome are critically examined in the light of these empirical findings. One suggestion is that the "elite" administration survived democratization because it was "fitter" in terms of ability to influence the hospitals' major economic and political constraints.

Democracy↗