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PubMedDate not supplied

[Relation between global health and care consumption in Quebec immigrants].

This article examines the relationship between global health and care consumption in immigrants and native Quebecers. Care consumption is defined as the percentage of the population who consulted a health professional, while global health is represented by the ridit index. Mean values for ridit and care consumption do not differ significantly between immigrants and native Quebecers. The ridit increases significantly with age in native Quebecers and immigrants, indicating a progressive deterioration of global health for both groups. However, the relation between ridit values grouped for age and health professional consultation do not differ significantly between immigrants and native Quebecers. These results suggest a close link between global health and care consumption. The recently established immigrants represent an exception however. Those persons who arrived between 1980 and 1987 enjoy a better global health than native Quebecers, but consult health professionals in an identical manner.

Emigration and Immigration↗

PubMedDate not supplied

[Pneumonology in Quebec 1991. A specialty with big challenges].

A brief review of the history of pneumology in Quebec is presented. The present situation is however such that while the incidence of respiratory diseases is steadily increasing, it seems that there will soon be a shortage of manpower in respiratory diseases specialists during the 90's. The Quebec Pneumologist Association faces quite a challenge for the coming years. It will have to solve this problem as soon as possible, with the collaboration of our universities, of the Federation of Quebec Medical Specialists, and with the Quebec Government. This is a must if the Quebec population is to receive the respiratory cares which it expects.

Forecasting↗

PubMed1991

Sequencing of the variant thyroxine-binding globulin (TBG)-Quebec reveals two nucleotide substitutions.

Thyroxine-binding globulin (TBG) is a liver glycoprotein that transports thyroid hormone in serum. In 1987 a variant TBG was discovered in an infant born in Quebec, following an investigation prompted by the finding of low blood thyroxine (T4) level on screening for neonatal hypothyroidism. This variant, TBG-Quebec, has cathodal shift on isoelectric focusing, reduced affinity for thyroxine, and markedly reduced stability. The latter property of the variant molecule is probably responsible for the partial TBG deficiency. We now report the results of sequencing of the entire coding region and exon-intron junctions of TBG-Quebec, which revealed two nucleotide substitutions; one, located in exon 3, changes the normal codon 283 of TTG (leucine) to that of TTT (phenylalanine), and the other, in exon 4, results in the replacement of the normal histidine-331 (CAT) by tyrosine (TAT). Allele-specific amplification (ASA) confirmed the cosegregation of the two nucleotide substitutions with the TBG-Quebec phenotype in individual members of this family. The substitution in codon 283, but not that in codon 331, has been previously described and, when occurring alone, does not alter the properties of the gene product. Thus, it appears that the replacement of histidine-331 by tyrosine is responsible for the observed altered properties of TBG-Quebec. However, the question of whether substitution of both amino acids is necessary for expression of the variant phenotype has yet to be answered.

Alleles↗

PubMed1990

Cystic fibrosis mutations in North American populations of French ancestry: analysis of Quebec French-Canadian and Louisiana Acadian families.

A 3-bp deletion (delta F508) in the cystic fibrosis (CF) gene is the mutation on the majority of CF chromosomes. We studied 112 CF families from North American populations of French ancestry: French-Canadian families referred from hospitals in three cities in Quebec and from the Saguenay-Lac St. Jean region of northeastern Quebec and Acadian families living in Louisiana. delta F508 was present on 71%, 55%, and 70% of the CF chromosomes from the major-urban Quebec, Saguenay-Lac St. Jean, and Louisiana Acadian families, respectively. A weighted estimate of the proportion of delta F508 in the French-Canadian patient population of Quebec was 70%. We found that 95% of the CF chromosomes with delta F508 had D7S23 haplotype B, the most frequent haplotype on CF chromosomes. In the Saguenay-Lac St. Jean families, 86% of the CF chromosomes without delta F508 had the B haplotype, compared with 31% for the major-urban Quebec and Louisiana Acadian families. The incidence of CF in the Saguenay-Lac St. Jean population was 1/895 live-born infants.

Blotting, Southern↗

PubMed1998

[Quebec spirometry reference values].

Lung volumes forced expiratory flow rates and carbon monoxide diffusing capacity (apnea) were measured in 397 non-smoking, nonatopic, asymptomatic subjects (219 women, 178 men). The equipments and methods for measurements met the ATS criteria. The linear regression of the different variables according to age and height allowed the elaboration of a new set of predictive equations (Quebec). When comparing the different reference values used in North America and Europe, it is found that those of Miller and associates as well as those recommended by the CECA provide the best description of the Quebec situation. However, we would eventually prefer the reference values of Miller and associates over those of the CECA, because they better fit the current ATS criteria and also provide references for smokers. Lung volumes and forced expiratory flow rates of 97 non-smoking, nonatopic, asymptomatic manual workers were measured in the same conditions and submitted to the same comparisons. Quebec predictive values as well as those of Miller and associates isolated the same individuals in the so called abnormal zone. We therefore conclude that Quebec's standards should be preferred in the Province of Quebec pulmonary function laboratories.

Adult↗

PubMed1982

The decline of official language minorities in Quebec and English Canada.

"This paper considers the evolution of French outside of Quebec and the English in Quebec.... The total historical set of national data on ethnicity, mother tongue, knowledge of official languages and home language [is first presented]. The 120 year stability showing French at around 30 percent of the national total is a function of compensating factors including high French fertility and high English immigration. During the 1960s both of these demographic supports disappeared and thus mobility across linguistic lines has become a particularly sensitive issue. "The picture with regard to French outside of Quebec has changed rather radically in the last thirty-five years. For instance, there was one French child to every nine in 1941 and one to every twenty-one children in 1976. While the English of Quebec were once represented in various parts of the province, their strength is now largely limited to the Montreal metropolitan area which includes 76 percent of the English mother tongue group. Outside of Montreal, the English amounted to 7.9 percent of Quebec's population in 1941 and 5.6 percent in 1976. The paper concludes with a discussion of the social factors that underlie these trends and their relevance to the models of institutional and territorial bilingualism." (summary in FRE)

Africa↗

PubMed2005

A report on the health of asbestos, Quebec miners 1940.

BACKGROUND: Twenty years after the start-up of the Canadian asbestos industry, reports began to appear of respiratory disease and deaths in asbestos workers in England and in France. An inquiry from the UK in 1912 as to the health of Quebec miners was met by a denial of ill-health, but the loading of the premiums of asbestos workers in the 1930s indicated that, despite further reassuring health studies on Quebec miners, actuaries had data that gave cause for serious concern. METHODS: A report made to the Canadian asbestos industry by a company doctor in 1940, reviewing the literature and presenting his health findings on some 500 employees, was studied in the context of the published information available at the time, and of unpublished contemporaneous material subsequently obtained by legal discovery. RESULTS: The physician denied that the health and longevity of Quebec's miners and millers were adversely affected, and was dismissive of earlier reports of there being serious health risks associated with working with asbestos. CONCLUSIONS: The methodology employed in his health study was defective and his denial of the literature uninformed. The study was widely circulated, and while it may have boosted Canadian industry morale, it met with a sceptical response from British industry. In denying that conditions in Quebec's asbestos mines and mills disabled and killed workers, the author allied himself to fellow professionals loyal to Government and to industry.

Asbestos↗

PubMed1993

Is selective abortion for a genetic disease an issue for the medical profession? A comparative study of Quebec and France.

This article discusses the results of a study of the stand and attitudes of physicians from the Picardie, Nord-Pas-de-Calais region in France and the province of Quebec (Canada) regarding abortion following the diagnosis of a fetal anomaly by ultrasound, amniocentesis, or chorionic villus sampling. The study examined the degree of acceptability of abortion for several specific conditions as well as the physicians' perceptions of their role in the women's decision to abort. The study shows a consensus (over 75 per cent of the physicians surveyed) for aborting a fetus with trisomy 21. There is a similar consensus, except among Francophones in Quebec, for muscular dystrophy, cystic fibrosis, and Huntington disease. Conversely, there is no consensus (below 60 per cent) for several anomalies. In these cases, Quebec Anglophone physicians find abortion more acceptable than Quebec Francophone or French physicians. Concerning the role of the practitioners in the decision to abort, physicians in France tend to be much more directive than their overseas colleagues. Several hypotheses are suggested to explain the difference between the three groups surveyed.

Abortion, Therapeutic↗

PubMed1991

Hospital ethics committees in Quebec: an overview.

In June 1989, La Direction de la Sante physique (ministere de la Sante et des Services sociaux) (MSSS) undertook a major research project focusing on ethics committees in Quebec, in cooperation with Laval University's Groupe de recherche en Ethique Medicale (GREM). Initially, three major objectives were set out: to prepare a faithful overview of ethics committees in Quebec; to inform all those involved of the available resources, and to collect the data required to eventually carry out in-depth research on ethics committees. A number of government documents refer to the existence of ethics committees, whether to request their cooperation or to entrust mandates to them; moreover, the Law Reform Commission of Canada recently published a document that proposed establishing a Canadian Advisory Council on Biomedical Ethics. The MSSS, therefore, had to study the situation in Quebec with regard to ethics committees in order to be in a position to clarify its position in future discussions. This overview is the outcome of the first stage of this research project. Essentially, it represents the first of three main sections of a single document. It [1] presents general data on ethics committees, [2] contains a description of each committee by socio-sanitary region and type of committee, and in section three it deals with the principal resources available in bioethics in Quebec, Canada, and throughout the world.

Clinical Protocols↗

PubMed1975

Anaesthetic technicians in the province of Quebec.

I have described the recent history of the development of anaesthetic technicians in the Province of Quebec. Anaesthetic technicians will have the same training program as inhalation therapists. This program is organized through the CEGEP (College D' Enseignement General et Professionnel) system in Quebec. The Association of Anesthetists of the Province of Quebec (AAPQ) has sponsored inhalation therapy and now sponsors fully the program for training anaesthetic and technicians. The Government has approved the program. It is now in operation and the first anaesthetic technicians in Quebec have in fact graduated in 1973.

Allied Health Personnel↗

PubMed1999

Do ethnic groups use health services like the majority of the population? A study from Quebec, Canada.

The purpose of this study was to compare the use of medical services over a period of one year by members of ethnic groups and native Quebecers in Canada, while controlling for a number of confounding factors. The objective was to determine whether the two groups made the same number of medical visits to the same sites (private offices, outpatient clinic and emergency room and hospital inpatient care) and the same types of physicians (general practitioners, specialists). Two sources of data were used. The first was the Quebec Health Survey conducted in 1987 on a representative sample of 31,995 noninstitutionalized persons. Through personal interviews and self-administered questionnaires, data were collected on the demographic characteristics and health status of the respondents. The second source of data was the Quebec physician claims database, which contains a complete registry of services paid to physicians on a fee for service basis in the 12 months prior to the survey. The two databases were linked at the individual level (success rate is 88%). Members of ethnic groups aged 15 years and older were then individually matched to native Quebecers having the same six characteristics (age, gender, household income, access to health care facilities, perceived health and overall health). Final sample size was 1182 (divided equally into the two study groups). Results showed that neither the average number of medical services used over a year by the two groups nor the number of users differed. However, ethnic groups made more visits to specialists in private offices. Although not definite, possible explanations of these results are discussed. It is concluded that health care professionals should be sensitive to the particular needs of ethnic groups in order to provide them with accessible and appropriate services.

Adolescent↗

PubMed2004

Implanting telehealth network for paediatric cardiology: learning from the Quebec experience.

The implementation committee of the Quebec Child Telehealth Network was formed in 1997, with a mandate to build a network dedicated to the diagnosis of congenital cardiac disease via telemedicine. We devised criterions for selection to determine which peripheral centres would be linked by telemedicine to the university-based services for paediatric cardiology provided in the Canadian Province of Quebec. The criterions included: distance from a university centre, number of births per year, and presence of an already-established outreach clinic for paediatric cardiology. The Quebec Network became operational in 2000, and was composed of 32 peripheral centres and 4 university centres. A total of 363 transmissions of echocardiograms occurred over a 3-year period from January 2000 to December 2002. Peripheral centres located at a distance greater than 100 kilometres from a university centre were 8.5 times more likely to use the network. Criterions other than distance did not influence whether or not a peripheral centre used the network. Cardiac abnormalities were identified in almost two-thirds of the transmissions. The use of the Quebec Network resulted in the avoidance of transfers or clinic visits to university hospitals in seven-tenths of cases. We conclude that distance greater than 100 kilometres from a centre offering subspecialty services in paediatric cardiology is the most important criterion for choosing the peripheral centres that are most likely to use a telehealth network. In its first three years of operation, the telehealth network had a major impact on the delivery of paediatric cardiac care, improving access to subspecialty services across the province.

Computer Communication Networks↗

PubMed1999

Targeted hepatitis C lookback: Quebec, Canada.

BACKGROUND: Since March 1990, all blood donations in Canada are screened for antibodies to hepatitis C virus (HCV). Because HCV may cause chronic asymptomatic hepatitis, in February 1995, the Canadian Red Cross began targeted HCV lookback studies. STUDY DESIGN AND METHODS: From March 1990 to March 1997, the Quebec Center of the Canadian Red Cross collected 1,750,846 donations, and there were 561 anti-HCV-positive repeat donors, from whom 3,196 blood components had been issued to the hospitals. Hospital blood bank directors were asked to test recipients and return results to the Quebec Center. One hundred nine hospitals were surveyed to determine methods and resources involved in lookback. The transfusion medicine service at the Royal Victoria Hospital (RVH) developed a standard operating procedure for performing lookbacks and analyzed the costs and outcomes of lookbacks. RESULTS: As of April 1998, information has been received on 2329 (73%) of components; 1020 patients had died of unrelated causes, 590 were untraceable, and 353 were tested. Of those tested, 215 (61%) were anti-HCV positive; their average age was 47, and at least 53 percent were already aware of their HCV status. Few hospitals had received any additional resources to perform lookbacks. At the RVH, lookback on 182 components resulted in the identification of nine seropositive recipients, average age 70, who did not previously know their HCV status; four of these patients had abnormal alanine aminotransferase levels. The cost of lookback per newly diagnosed case of HCV was estimated at $2727 (US) for the Quebec Center and $6014 (US) for the RVH. CONCLUSION: Targeted lookback in the province of Quebec on 3196 components has resulted in the identification of 101 seropositive recipients who did not previously know their HCV status.

Blood Banks↗

PubMed2006

Quebec's approach to population health: an overview of policy content and organization.

While Canada's international leadership in the area of health promotion has been widely acknowledged in the past, Quebec's approach could be better known. Canada's second largest province has indeed developed a comprehensive public health infrastructure and adopted a population health approach which features an integrated set of legislative, organizational and programmatic policy instruments. These instruments not only ensure the core functions of public health, but also foster public intervention on the social determinants of health. In addition, Quebec's policy is supported by a solid research infrastructure, networked expertise and a mobilized workforce among health professionals. In spite of the interest it represents for the larger public health community in Canada and elsewhere, this largely French-speaking province's approach remains little known because of language and cultural barriers between Quebec and Anglo-Saxon countries, and it has yet to be systematically discussed in the English-language literature. This article provides an overview of policies and administrative structures in Quebec to support public health and address socially determined inequalities in health. It analyzes the development of these policies over the past decade and offers insight to their core content.

Health Policy↗

PubMed1995

The Quebec Back Pain Disability Scale. Measurement properties.

STUDY DESIGN: The Quebec Back Pain Disability Scale is a 20-item self-administered instrument designed to assess the level of functional disability in individuals with back pain. The scale was administered as part of a larger questionnaire to a group of 242 back pain patients. Follow-up data were obtained after several days and after 2 to 6 months. OBJECTIVES: The goal of this study was to determine whether the Quebec scale is a reliable, valid, and responsive measure of disability in back pain, and to compare it with other disability scales. SUMMARY OF BACKGROUND DATA: A number of functional disability scales for back pain are being used, but their conceptual validity is uncertain. Unlike most published instruments, the Quebec scale was constructed using a conceptual approach to disability assessment and empirical methods of item development, analysis, and selection. METHODS: The authors calculated test-retest and internal consistency coefficients, evaluated construct validity of the scale, and tested its responsiveness against a global index of change. Direct comparisons with the Roland, Oswestry, and SF-36 scales were carried out. RESULTS: Test-retest reliability was 0.92, and Cronbach's alpha coefficient was 0.96. The scale correlated as expected with other measures of disability, pain, medical history, and utilization variables, work-related variables, and socio-demographic characteristics. Significant changes in disability over time, and differences in change scores between patients that were expected to differ in the direction of change, were found. CONCLUSIONS: The Quebec scale can be recommended as an outcome measure in clinical trials, and for monitoring the progress of individual patients participating in treatment or rehabilitation programs.

Adolescent↗

PubMed1996

Should the gap be filled between guidelines and actual practice for management of low back pain in primary care? The Quebec experience.

STUDY DESIGN: A prospective cohort study. OBJECTIVES: To describe health services utilization for low back pain in the province of Quebec, Canada, and to compare it with North American guidelines. SUMMARY OF BACKGROUND DATA: The Quebec Task Force and the Agency for Health Care Planning and Research (United States) published guidelines for the management of low back pain in 1987 and 1994, respectively. METHODS: A cohort of 2147 adults with low back pain identified at the Quebec Worker's Compensation Board were selected randomly and observed over 2 years' time for their health care utilization profile. RESULTS: During the study period, 57.8% of the workers still under active care 7 weeks after their back injury had not yet been referred to a specialist. Specialized imaging techniques were obtained by 4.5% of the patients, with a delay of 7 weeks or more in 66% of them. Surgery was performed on 1.6% of the patients. The presence of an initial specific diagnosis and proximity to a university hospital significantly increased utilization rate and reduced the delays. CONCLUSION: Health services utilization for back pain in Quebec was equal or lower to what currently is practiced elsewhere, but access to specialists was not meeting the current recommendations. This would represent a 12% net increase in new specialist contacts and a quicker access in 39% who saw a specialist. Before such an effort can be considered, health care planners will need a better definition of the role of the specialist consultation in the guidelines and scientific evidence specifically addressing their benefit in primary care, especially in the absence of a specific diagnosis.

Adolescent↗

PubMedDate not supplied

Hormone therapy prescription among physicians in France and Quebec.

OBJECTIVE: Our objective was to compare physician characteristics associated with high-frequency hormone therapy (HT) prescription between gynecologists and general practitioners (GPs) within and between France and Quebec, Canada. DESIGN: A self-administered mail survey was sent to a representative sample of 2,000 physicians in France and 1,000 physicians in Quebec. High-frequency prescribers were those who reported prescribing HT to more than 70% of their postmenopausal patients. The following characteristics were included in the analysis: country, specialty, age, gender, characteristics of the practice (solo or group, private or public, rural or urban, number of patients seen daily, duration of practice, percentage of women 45 years or older), teaching or research activities, participation in education course on HT, and practice patterns relating to menopausal women (having patient education materials available, providing materials to patients, and discussing the possibility of HT). RESULTS: The analysis covered 974 physicians in France (389 GPs and 585 gynecologists) and 452 physicians in Quebec, Canada (318 GPs and 134 gynecologists). Despite differences in health care, in both countries gynecologists were more likely to be high-frequency prescribers than were GPs, although this difference was smaller in Quebec. Canadian physicians were more likely to prescribe HT. The difference between countries was greatest among GPs. Except for nationality and practice patterns designed to provide women with information, none of the physician characteristics was associated with high-frequency prescription among GPs. Among gynecologists, only the number of patients per day and the provision of information were associated with high-frequency prescription. CONCLUSIONS: Notwithstanding a common language, differences in the prescription pattern of HT between countries were greatest at the level of primary care than secondary care. In both countries, specialists were more likely to prescribe HT than were GPs. Implementation of clinical practice guidelines to set baseline standards in the field of menopausal health remains a challenge but will need to take into account cultural characteristics as well as level of medical care.

Age Distribution↗

PubMed1997

Geographic distribution of French-Canadian low-density lipoprotein receptor gene mutations in the Province of Quebec.

A total of 35 homozygous and 1320 heterozygous patients with familial hypercholesterolemia (FH) was screened for the presence of six low-density lipoprotein receptor (LDLR) gene mutations previously reported among French-Canadians. The geographic distribution of patients' birthplaces and the relative prevalence of these six mutations in the LDLR gene in the province of Quebec were compared. For this purpose, the 16 administrative regions of the province of Quebec were grouped into seven geographic regions. The relative frequency of the six mutations differed in the seven regions: the > 15 kb deletion (delta > 15 kb) had the highest relative frequency in the Bas St-Laurent/Gaspésie region, and the point mutation in exon 3 had the highest relative frequency in the Saguenay-Lac-St-Jean/Côte-Nord region. In the Montreal area, the delta > 15 kb and the mutation in exon 3 had prevalence rates of 71.2% and 13.0%, respectively, whereas the relative frequencies of the delta > 15 kb and the point mutation in exon 3 in the Quebec city region were 57.5 and 21.8%, respectively. Finally, in Saguenay-Lac-St-Jean/Côte-Nord, the relative frequency of the delta > 15 kb only reached 31.5% and the point mutation in exon 3, 59.2%. Thus, on the north shore of the St. Lawrence River, the prevalence of the delta > 15 kb decreases from west to north-east, whereas the relative frequency of the mutation in exon 3 appears to increase. These observations provide a better characterization of FH among French-Canadians of Quebec, a Canadian province with a high prevalence of this inherited disease.

Exons↗