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PubMed1999

[Utilizing assistive devices: comparison of the American model with the reality of the needs of Quebec].

In order to understand better the nature of the success or failure of a recommendation of a technical aid, a group of occupational therapists from Québec became interested in an American assessment called "Assistive technology device predisposition assessment". This assessment is based on the "Matching Person and Technology" model proposed by Scherer in 1994. The model describes 40 factors that can influence the use (or the non use) of technical aids. A participative and qualitative study was conducted with the collaboration of 10 francophone occupational therapists, in order to verify if the tool can be adapted to Québec's context. Each had to reconstruct two case studies following the recommendation of a technical aid: the first showing a satisfactory use of a technical aid and the second, a non use of a technical aid. According to the participants' experience, the results show that the American assessment focuses well on the pertinent factors of technical aids, providing that seven other specific factors are added. This article describes four of the case studies that show the importance of considering different influential factors that could render other significant results. Finally, the study generated two proposals for further research in the area of technical aids.

Decision Making↗
PubMedDate not supplied

Medical decision making in the choice of a thrombolytic agent for acute myocardial infarction. Quebec Acute Coronary Care Working Group.

Little is known about how physicians make decisions when the evidence is incomplete or controversial. While thrombolysis improves survival following acute myocardial infarction (AMI), conflicting evidence exists as to any specific agent's superiority, particularly if cost-effectiveness is considered. Using a Bayesian hierarchical model, the authors examined the patient, physician, and hospital characteristics that are related to the decision-making process concerning the choice of thrombolytic agent in a prospective registry of 1,165 AMI patients receiving thrombolysis. Tissue plasminogen activator (t-PA) was administered to 432 patients (31.8%) and streptokinase (SK) to the remainder. The presence of an anterior infarction, a previous myocardial infarction, low blood pressure, a cardiologist decision maker, younger age, and receiving treatment within six hours after the start of symptoms were independent predictors of receiving t-PA. The levels of importance that physicians accorded to these patient characteristics differed according to their practicing institutions. Generally, they followed evidence-based medicine and reasonably targeted high-risk patients to receive the more expensive t-PA. However, they also preferentially treated younger patients, where only a small absolute advantage appears to exist.

Aged↗
PubMed1989

[Opinion: informed consent and mental capacity in clinical psychiatric practice (a Quebec perspective)].

This paper on informed consent and psychiatry, asks the fundamental question if informed consent doctrine applies or not to psychiatric practice. In a dialectic between systems of thought in psychiatry and law, the author stresses the importance of particular clinical situations which can be addressed or not in terms of application of informed consent doctrine. The purpose of the paper is not to give a final answer but to bring questions and stimulate thought.

Humans↗
PubMed1995

[Markers of depression regarding DSM and popular diagnosis: an analysis of concordance in Quebec patients].

OBJECTIVE: To query the universality of affective disorder markers, particularly the level of consistency between DSM diagnostic criteria and the criteria implicit in popular diagnoses. METHOD: Utilization of data from the Santé Québec (1987) survey to compare depression markers reported by respondents who identified themselves or were identified by a member of their household as "suffering from depression" and markers underlying DSM-III diagnostic criteria. RESULTS: A popular diagnosis of depression is implicitly different from a psychiatric diagnosis considering an interdiagnosis similarity of 9.5%. CONCLUSION: It is therefore important to become more knowledgeable about the markers underlying diagnosis of affective disorders.

Adolescent↗
PubMed2005

Factors influencing the initiation and duration of breastfeeding among low-income women followed by the Canada prenatal nutrition program in 4 regions of quebec.

The factors that influence the actual initiation and duration of breastfeeding were studied among low-income women followed by the Canada Prenatal Nutrition Program (CPNP). A group of 196 pregnant women were selected at random from a sample of 6223 pregnant women who registered with the CPNP. Two 24-hour recalls and information regarding lifestyle habits, peer support, and infant-feeding practices were obtained between 26 and 34 weeks of gestation and 21 days and 6 months after birth. Women who received a university education (completed or not completed) versus women with < or = high school education (odds ratio [OR], 8.40; 95% confidence interval [CI], 1.02-69.50), women born outside Canada (OR,8.81; 95% CI, 3.34-23.19), and women of low birth weight infants (OR, 0.39; 95% CI, 0.16-0.96) were more likely to initiate breastfeeding. Late introduction of solid foods (P = .004), nonsmoking (P = .005), multiparity (P = .012), and a higher level of education (P = .049) were positively associated with the duration of breastfeeding among initiators. Understanding factors associated with initiation and duration of breastfeeding among low-income women is critical to better target breastfeeding promotion.

Adult↗
PubMed2005

Post-Quebec.

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Congresses as Topic↗
PubMedDate not supplied

Psychotropic drug usage in Quebec urban women: pharmacological aspects.

Data on patterns of psychotropic drug use from a two-part study of Québec urban women are reported. Part I involved telephone interviews with 1187 women on their use of pain, sleep, and psychotropic medications. In Part II, 179 women participated in a further person-to-person interview. Areas covered included frequency and duration of use, efficacy of the product, dosage, presence of undesirable side effects, source of drug information, and the concomitant use of other medications. Diazepam and flurazepam (Valium and Dalmane) were the most frequently consumed psychotropes, with diazepam second only to aspirin as the most commonly used of all the medications. The majority of psychotropic users obtained the drug initially through a general practitioner for nonspecific health reasons, were satisfied with the efficacy of the drug, took the medication as directed, felt informed of the effects, and found no undesirable side effects. Multiple psychotrope use was not prevalent, and users of mood-modifiers were generally alcohol abstainers. The differences between the high and moderate users, including satisfaction with the psychotropes as well as initial dosages, are discussed along with comparative data from other similar drug studies. Findings lend credence to the hypothesis that the vague and ill-defined health problems precipitating a psychotropic prescription may in fact be economic, social, or psychological in origin.

Adolescent↗
PubMed2003

Genome-wide linkage scan reveals multiple susceptibility loci influencing lipid and lipoprotein levels in the Quebec Family Study.

A genome-wide linkage study was performed to identify chromosomal regions harboring genes influencing lipid and lipoprotein levels. Linkage analyses were conducted for four quantitative lipoprotein/lipid traits, i.e., total cholesterol, triglyceride, HDL-cholesterol (HDL-C), and LDL-C concentrations, in 930 subjects enrolled in the Québec Family Study. A maximum of 534 pairs of siblings from 292 nuclear families were available. Linkage was tested using both allele-sharing and variance-component linkage methods. The strongest evidence of linkage was found on chromosome 12q14.1 at marker D12S334 for HDL-C, with a logarithm of the odds (LOD) score of 4.06. Chromosomal regions harboring quantitative trait loci (QTLs) for LDL-C included 1q43 (LOD = 2.50), 11q23.2 (LOD = 3.22), 15q26.1 (LOD = 3.11), and 19q13.32 (LOD = 3.59). In the case of triglycerides, three markers located on 2p14, 11p13, and 11q24.1 provided suggestive evidence of linkage (LOD > 1.75). Tests for total cholesterol levels yielded significant evidence of linkage at 15q26.1 and 18q22.3 with the allele-sharing linkage method, but the results were nonsignificant with the variance-component method. In conclusion, this genome scan provides evidence for several QTLs influencing lipid and lipoprotein levels. Promising candidate genes were located in the vicinity of the genomic regions showing evidence of linkage.

Adult↗
PubMed2001

Age at onset of narcolepsy in two large populations of patients in France and Quebec.

BACKGROUND: Narcolepsy usually starts around adolescence; however, there is great variability in the clinical presentation of narcolepsy. OBJECTIVE: To determine the age at onset in conjunction with severity of narcoleptic symptoms in two large populations of narcoleptic patients with a similar genetic background. METHODS: Information on age at onset and severity of the condition was obtained in 317 patients with well-defined narcolepsy-cataplexy from Montpellier (France) and in 202 from Montreal (Canada). RESULTS: The mean age at onset was 23.4 years in Montpellier and 24.4 in Montreal. The age at onset was bimodal in two independent patient populations: a first peak occurring at 14.7 years, and a second peak occurring at 35. Age at onset clearly differentiates patients with a positive family history of narcolepsy (early onset) from those without a family history. Other clinical and polygraphic findings may indicate that young age at onset is associated with increased severity of the condition (higher frequency of cataplexy and decreased mean sleep latency on the Multiple Sleep Latency Test). CONCLUSION: Bimodal distribution of age at onset of narcolepsy was found in two independent patient populations. Our data suggest that age at onset is genetically determined.

Adolescent↗
PubMed2003

Adenomatous hyperplasia of the thyroid gland in beluga whales (Delphinapterus leucas) from the St. Lawrence Estuary and Hudson Bay, Quebec, Canada.

We evaluated thyroid gland lesions in beluga whales (Delphinapterus leucas) from the St. Lawrence Estuary (n = 16) and Hudson Bay (n = 14). Follicular cysts and nodules of adenomatous hyperplasia of the thyroid gland were found in eight and nine adults from the St. Lawrence Estuary (n = 10), respectively, and in four and six adults from Hudson Bay (n = 14), respectively. The total volume of the lesions of thyroid adenomatous hyperplasia was positively correlated with age in both populations. Comparison between populations could not be performed because of differences in age structures of sample groups. Beluga whales from both populations have unique thyroid lesions among marine mammals.

Age Factors↗