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PubMed1996

Impact of a mass immunization campaign against serogroup C meningococcus in the Province of Quebec, Canada.

A mass immunization campaign was conducted in the Province of Quebec, Canada, during the winter of 1993, following an increase in the incidence of meningococcal disease, which was mainly caused by a virulent clone of Neisseria meningitidis, serogroup C, serotype 2a. About 1.6 million doses of the polysaccharide vaccine were administered, covering 84% of the target population aged between 6 months and 20 years; the overall cost was about 25.5 million Canadian dollars. Cases notified to the regional health authorities by clinicians, hospital laboratories, and the provincial reference laboratory from January 1990 up to March 1994 have been included in the analysis. In the first year following the campaign, the incidence of the disease dropped markedly among vaccinees as well as the unvaccinated fraction of the target population, while it remained unchanged among persons aged more than 20 years. This suggests the existence of herd immunity. The overall field efficacy of the vaccine was 79%, more in teenagers and less in under-5-year-olds. A minimum of 37 cases were prevented during the first year.

Adolescent↗
PubMed1996

Psychodemographic profile of stockpeople working on independent and integrated swine breeding farms in Quebec.

As a part of a larger study, the psychodemographic profile of Quebec pig stockpeople was described based on a sample of 48 persons working on independent farms randomly selected in the Richelieu-Saint-Hyacinthe region, and on a convenience sample of 38 others employed by 5 organizations of integrated swine production chosen among the largest ones in Québec. The 2 groups of stockpeople were described separately because of the differences between the 2 types of production. Demographic data (age, sex, level of education, training and experience in swine production, seniority on the farm) were obtained through a face-to-face interview. The personality profile was assessed using a standard personality test (French translation of the Sixteen Personality Factor Questionnaire). Both the stockpersons on independent farms and those employed by the organizations were more reserved, emotionally stable, serious, conscientious, unsentimental, controlled, introverted, and less anxious than the average person in the general population. However, multivariate analyses revealed some differences between these two groups of stock-persons (P = 0.021) as well as between the employees of the different organizations (P = 0.0038). These differences in personality profiles may reflect differences in working conditions, particularly regarding the human relationships, and in corporate cultures of the organizations.

Animal Husbandry↗
PubMed1996

Autosomal recessive disorders in Saguenay-Lac-St-Jean, Quebec: study of kinship.

Saguenay-Lac-St-Jean is a geographically isolated region of northeastern Quebec in which several autosomal recessive disorders have a high incidence. The kinship coefficients of all possible pairs of 567 probands were calculated and compared with those of 1701 matched control individuals. The mean kinship coefficient of the group containing all 567 probands was 5.57 times higher than that of the control group (0.000981 versus 0.000176). Overall, 45.5% of the probands were third-degree cousins, compared with 32.9% of the control group. However, in each disorder only a few probands were traced back to the most represented founder couple in Saguenay-Lac-St-Jean. Molecular data added a new dimension to the concept of kinship by showing that at least in the study area, closely related individuals do not necessarily carry identical mutations, which, in turn, may have a great impact on carrier screening. Our results strongly suggest that the high incidence of autosomal recessive disorders in Saguenay-Lac-St-Jean is the result of a founder effect.

Case-Control Studies↗
PubMedDate not supplied

[Hockey injuries: consultations in a hospital center in Quebec].

OBJECTIVES: Assess the context and characteristics of hockey injuries, and evaluate the probable effects of regulations concerning mandatory use of head and neck protective equipment. DESIGN: Descriptive study of 247 patients suffering from hockey injuries. Cases were recorded at the emergency room of the Hôpital de l'Enfant-Jésus, in Quebec City, from October 1 1991 to April 30 1992. Injury characteristics are presented by categories, and "Organized hockey on skates" (HPO) is the only category where protective equipment is mandatory. RESULTS: Nearly 42% of consultations were related to non-HPO. In the HPO injuries 15.4% were head injuries whereas in other categories, head injuries represented 31.4%, 33.3% and 44.0% of total injuries. DISCUSSION: Data suggest that regulation imposing mandatory head and neck protection should be maintained in the HPO category because of its apparent preventive effect. Accordingly, implementation could also be considered in other categories.

Adolescent↗
PubMedDate not supplied

[An indicator of needs for the regional allocation of public health resources in Quebec].

This paper proposes an indicator of needs for regional resource allocation in public health in Quebec. In the literature, the only reported measure of needs for regional resource allocation in public health has two parameters: size of population and Potential Years of Life Lost for preventable causes of death (APVP-EV). We verified whether APVP-EV were associated with various indices of socioeconomic conditions and lifestyle, preventive behaviours, satisfaction with social life, healthy life expectancy and some clienteles specific to public health. Our analysis indicates that the rate of Potential Years of Life Lost by avoidable causes is significantly related to all variables except satisfaction with social life. We therefore propose using size of population and its rate of APVP-EV to determine regional allocation of resources in public health.

Adolescent↗
PubMedDate not supplied

[Study of immunization promotion against influenza in nursing homes and long term care facilities in Quebec].

This study measured the rate of influenza immunization in nursing homes and long-term care facilities, and evaluated the effectiveness of a promotion program in reaching the national objective of 95% coverage. At the end of 1993, data were provided by 55 of the 79 nursing homes in the region of Montérégie, Quebec. The mean reported immunization rate was 78%, minimum 19% and maximum 100%. In 70% of cases, non-vaccination was due to patient refusal. In 1994, an intervention was carried out in a random sample of 28 nursing homes. Directors, chiefs of nursing and consulting physicians were informed of the coverage achieved in their institution in relation to the national objective. In addition, presentations were given to the nursing personnel and residents. These presentations were made by post-graduate medical students in 22 of the 28 nursing homes in the experimental group. No increase in the mean immunization rate was observed, indicating that it will be more difficult than expected to reach the desired level of coverage.

Aged↗
PubMed1996

[The scale of social provisions: their validation in Quebec].

This article presents the results of the Quebec validation of the Social Provisions Scale (Cutrona et Russell, 1989). L'échelle de provision sociales was administered to 790 people on the course of two studies. The first one included 387 university students of first level and the second was realized with 266 people from the general population, 79 welfare recipients and 58 persons with a diagnosis related to psychosis. The results show that the scale presents a good internal coherence and a satisfying temporal stability, thus assuring the fidelity of the instrument. The factorial analyses have not reproduced exactly the same profile as the original instrument, however the moderate correlations between the different social provisions sustain the validity of the multidimensional construct of social support. Moreover, analyses of the variance and the discriminating analysis allow to acknowledge that the sub-scales have a high discriminating power; they allow to distinguish the general population from welfare recipients and people suffering from psychosis. Finally, norms are presented for the general population.

Humans↗
PubMed1997

Seventeenth-century European origins of hereditary diseases in the Saguenay population (Quebec, Canada).

For over three decades much research has been devoted to the identification of founders who could have been the first carriers of different deleterious genes in the French Canadian population. In some cases this research led to an investigation of the European origins of these founders. Using up-to-date data on genealogical records of 673 probands (6 hereditary diseases) and 99 control group individuals born in the Saguenay region (Quebec, Canada), we show that it is difficult to identify a precise region where a deleterious gene could have originated. By taking several key factors into consideration (founders' genetic contribution, level of commonness, sex, birth year), we found many possible candidates for each disease, leading to various regions of origin in France (Aunis, Maine, Normandie, Orléanais, Perche, and other provinces) or outside France (British Isles, other European countries). Our results also showed notable differences between the origins of male and female founders. Furthermore, all founders common to at least 95% of the probands of a given disease were also common to 95% of the probands of at least one other disease; among these founders 29 were common to 95% or more of the probands of each group (including the control group).

Emigration and Immigration↗
PubMedDate not supplied

Knowledge and attitude assessment of Quebec daycare workers and parents regarding HIV/AIDS and hepatitis B.

ISSUES: Cases of discrimination occur in Quebec daycares towards HIV-positive children as well as HIV-negative children born to seropositive parents. OBJECTIVES: Offer three-hour information sessions on bloodborne diseases, specifically HIV and hepatitis B, universal precautions, as well as legal, ethical and psychosocial aspects of HIV/AIDS to: 1) ensure that daycare workers have basic medical information on transmission of HIV and other bloodborne infections, 2) review basic hygiene including universal precautions, 3) link daycares to HIV/AIDS resources in their communities, and 4) facilitate the development of pro-active daycare policies for the integration of HIV-positive children. RESULTS: In total, 108 information sessions were given, in which 349 daycares participated. Results show an important difference in terms of knowledge and attitudes of the participants. Of the daycares which participated in the information sessions, 37% have developed their own pro-active policy.

Adult↗
PubMedDate not supplied

[Joint program of pharmacovigilance in Quebec: comparison with France, Aquitaine and the Basque region].

The Joint Pharmacovigilance Program in the province of Quebec was initiated by academic and professional bodies to serve since 1986 as a Regional Center for drug adverse reaction spontaneous reports. The contents of its database are compared with those of France, the Aquitaine Region around Bordeaux and the Basque country in Spain, recently presented in Thérapie. The similarity of some data is striking: two thirds of reported adverse effects are already labeled; fatal reactions account for 2%; the female/male ratio is > 1 and reaches 2 in patients aged > 74 years. The nature of reporters does however show some differences; 57% of Québec reports originate from pharmacists (90% in hospitals), against 0.8% in Aquitaine and 3.3% in the Basque. Specialists provide 21% of reports in Québec but are responsible for 63% in France. These discrepancies may be explained by organisational differences in professional practice. A comparison of the signal generating values of reports in the French system would be both interesting and feasible.

Adverse Drug Reaction Reporting Systems↗
PubMed1997

Utilization of anti-asthma medications in two Quebec populations of anti-asthma medication users: a prescription database analysis.

This study describes the utilization of anti-asthma medications in two groups of users of such medications in the province of Quebec, Canada, during the year from June 1, 1990, to May 31, 1991. It is based on a secondary analysis of existing data banks recording the medications reimbursed by two government-funded ambulatory drug reimbursement programs that cover individuals aged 65 and over (seniors) and income security (welfare) recipients (ISRs). The study analyzed the use of the anti-asthma medications included in the list of medications eligible for reimbursement for program beneficiaries. Use was studied in two random samples of individuals who had at least one prescription filled for an anti-asthma medication (2566 seniors and 3695 ISRs). The most commonly used medication in both groups was inhaled salbutamol 100 mcg. Various forms of theophylline tablets were also used by a high proportion of the sample studied. Over 75% of the seniors and 68% of the ISR group used at least one form of theophylline during the course of the year. Inhaled corticosteroids were used by 43% of the seniors and by 36% of the ISR group, and sympathomimetics (beta 2-agonists), by 63% of seniors and 68% of ISRs.

Adolescent↗
PubMed1996

Importance of outside hospital mortality as a first acute ischemic heart event: the Quebec Cardiovascular Study.

Among 4371 men aged 35 to 64 in 1973 who were randomly selected, living in Quebec City suburbs, without clinical evidence of ischemic heart disease (IHD) at entry and followed for 16 years, 426 had a first acute IHD event; of these, 296 had a nonfatal myocardial infarction (MI), 50 a fatal MI (death within four weeks of the acute event) and 80 an early death, ie, they died before the diagnosis of MI was made. Among these 80 early deaths attributed to IHD in the absence of any other apparent cause, 55 men died within 1 h from the onset of symptoms or were found dead in their bed (group A) while 25 died more than 1 h after the onset of symptoms (group B). In this population, a first acute IHD event carried a 31% (130 of 426) case fatality within the first four weeks. Groups A and B accounted for 42% (55 of 130) and 19% (25 of 130) of the total acute ischemic mortality, respectively. As expected, fatal events increased with age, but the proportion of early deaths over the total IHD mortality was as frequent in younger men as in older men. Smoking, increased systolic and diastolic blood pressure and serum cholesterol were associated with increased nonfatal events. A similar association, except for serum cholesterol, was observed for all fatal events. No significant risk factor profile differentiated early from late fatal events. In conclusion, in this population, nearly a third of men with a first IHD event died, most of them outside the hospital. None of the main established risk factors differentiated men with a fatal MI from those with an early death.

Adult↗
PubMed1996

Content validity of the Quebec licensing examination (OSCE). Assessed by practising physicians.

OBJECTIVE: To assess content validity of the objective structured clinical examination (OSCE), which uses multiple encounters with standardized patients and which is included in the Quebec licensing examination (QLEx). DESIGN: Descriptive study using written questionnaires based on Likert-type scales. SETTING: Examination centres of the QLEx. PARTICIPANTS: Thirteen practising family physicians with 3 to 6 years' practice experience who passed the QLEx OSCE in May 1993. MAIN OUTCOME MEASURES: Opinion whether the QLEx OSCE globally measured the competence of family physicians; opinion whether OSCE cases and stations made it possible to assess the main clinical abilities required of a family physician; opinion on specific statements about each case, such as how frequently the case was seen in the participants' practice, if the participants knew how to deal with the problem, if the simulated patient was believable, if the clinical situation was realistic, and if the duration of the station was adequate; and participants' self-assessment of their performance on the case. RESULTS: Eleven participants (84.6%) agreed that the OSCE globally measured the competence of a family physician. All agreed that the OSCE cases and stations made it possible to assess the main clinical skills required of a family physician. For most of the cases, participants believed that they knew how to deal with the problem, that the clinical situation was realistic, that the simulated patient was believable, and that the case duration was adequate. CONCLUSIONS: The results of this study support the content validity of the QLEx OSCE and confirm that it assesses the main skills needed for practising family medicine and adequately samples possible encounters or cases seen in family practice.

Adult↗
PubMedDate not supplied

Prevalence of chlamydial infection and frequency of risk behaviours for STDs and HIV infection among adolescents in public juvenile facilities in the province of Quebec.

This study aimed to determine the prevalence of chlamydial infection in adolescents entering public juvenile facilities in the province of Quebec and the frequency of their risk behaviours for STDs and HIV infection. Adolescents were asked to complete an anonymous self-administered questionnaire and to be screened for Chlamydia trachomatis. Of 731 sexually active adolescents, 62% agreed to be tested. The overall prevalence rate was 7.7% (95% confidence interval: 5.1%-10.3%). The prevalence was significantly higher in female than in male teenagers: 12% vs 3% (p < 0.001, Fisher's exact test). These results suggest that screening for chlamydial infection should be offered to all sexually active female teenagers admitted into juvenile facilities. For males, selective screening taking into account sexual history would be a more realistic approach. The frequency of high risk activities for STDs and HIV infection points to the importance of specific prevention programs for this population.

Adolescent↗
PubMedDate not supplied

Evaluation of the Quebec Public Information Campaign and Human Immunodeficiency Virus (HIV) Antibody Screening Program directed to persons transfused between 1978 and 1985.

This study aimed to determine the number and characteristics of the blood recipients tested for HIV infection as a result of the provincial HIV antibody screening program (directed to persons transfused between 1978 and 1985 and their contacts) and to estimate the rate of HIV seroprevalence among them. All physicians in the province of Quebec were provided with a special prescription form for HIV testing of eligible patients. Over a six-month period, a total of 6,348 special prescription forms were used. The HIV seroprevalence was 0.13% (95% confidence interval: 0.04% to 0.2%). We estimated an increase of 16.5% (12,061 tests) in the number of HIV tests related to the program. These results were consistent with those found by similar programs elsewhere in Canada but less than expected. Multiple strategies, including direct notification of transfusion recipients, particularly pediatric patients, are probably necessary to reach infected blood recipients still unaware of their infection.

Adolescent↗
PubMedDate not supplied

[Mortality attributable to tobacco smoking in Quebec].

In industrialized countries, tobacco smoking is the main cause of preventable morbidity and premature deaths. Although mortality attributable to smoking has already been estimated for the population of the province of Québec, it has never been studied on a regional basis. We calculated the mortality attributable to smoking by socio-sanitary regions of the province of Québec for 10 fatal diseases positively associated with smoking. The calculations were made for the years 1984 through 1993 taking into account Canadian Census data (demographic variables), the Santé-Québec survey (prevalence of smoking), the death registry of the "Bureau de la statistique du Québec" (mortalitry data), and the American cohort of the "Cancer Prevention Study II" (relative risks). For the diseases investigated, 24,637 and 62,711 deaths were attributable to smoking for women and men respectively during the period studied, thus representing 29.4% and 51.2% of attributable percentages. There is no statistical difference between the regions, which indicates a general problem for all the province. These data again confirm the incredible impact of smoking on public health. The struggle against smoking should be a primary area for action for the benefit of all Quebecers.

Adult↗
PubMed1997

[Validation of Satisfaction with Life Domains Scale in Quebec].

This article presents the results of the Quebec validation of the Satisfaction With Life Domains Scale: This scale was developed in the United States for the general population and adapted for severely mentally ill individuals. Two hundred and sixty six individuals from the general population and 245 severely mentally ill persons participated in this study. Factor analysis allowed the identification of four sub-scales for the clinical population and five for the general population. The scale (alpha = 0.90) and the sub-scales (alpha between 0.60 et 0.84) show excellent internal consistencies and the test-retest reliability was good (r = 0.73). Moreover, analysis of the variance and the discriminant analysis allow to acknowledge that the sub-scales have a high discriminating power; they allow to distinguish the general population from welfare recipient and people suffering from psychosis. The overall results suggest that l'Echelle de satisfaction des domaines de vie have good psychometric properties and can be considered as a valid instrument for assessing subjective quality of life in descriptive or evaluative studies.

Analysis of Variance↗