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PubMed1987

[The capitalist development of regions and labor force mobility in Quebec, from 1966 to 1976].

"In this paper the author presents a study of the spatial mobility of the Quebec population between 1966 and 1976, in the light of regional capitalist development. Based on an empirical operationalization of the concepts of mobility and development, the author demonstrates that Quebec presents a very irregular distribution of its poles of development over its territory, and that the mobility of the work force is in the image of this distribution. A few regions within the Montreal metropolitan area have attained a relatively evolved state of capitalist development and consequently are able to attract within their limits a large majority of migrants moving inside of or toward Quebec. In contrast, it can be observed that the majority of the regions in Quebec may be qualified as 'underdeveloped', and that their net mobility figures are negative." (SUMMARY IN ENG AND SPA)

Americas↗

PubMed1981

[Presence of the bacterial kidney disease in salmonid fish in Quebec (author's transl)].

Presence of the bacterial kidney disease in salmonid fish in Quebec During the summers of 1979 and 1980, wild and hatchery fish were analysed for the presence of the bacterial kidney disease (BKD) agent in salmonid fish in Quebec by the indirect immunofluorescence technique. The causative agent of BKD was detected in all hatcheries tested. Ten to 25% of the fish were positive. The presence of this agent was independent of age and species. We were unable to detect the BKD in fish from the rivers in the northern part of Quebec (over the 50th parallel). The first detection of BKD in Quebec was made in the spring of 1979 in a hatchery. A high mortality occurred in fish over a year old. The majority of the fish were positive by immunofluorescence and the bacteriun was isolated from some fish. Three weeks before the disease appeared, six ponds received fish from this hatchery. No mortality was observed in those ponds and in the middle of the summer the percentage of carrier fish by immunofluorescence was approximately 20%.

Animals↗

PubMed2004

Correlates of diet quality in the Quebec population.

OBJECTIVE: To determine the correlates of a high-fat diet in urban, suburban and rural areas of Quebec, Canada. DESIGN: A secondary analysis of data collected as part of a 5-year multi-factorial, multi-setting, community-intervention project. SETTING: Urban, suburban and rural settings of the province of Quebec, 1997. SUBJECTS: Data were analysed from a sample of 5214 participants (2227 males, 2987 females). A food-frequency questionnaire was completed and a global index of food quality was calculated. Logistic regression was used to identify correlates of a diet high in total fats, saturated fat and cholesterol. RESULTS: In both genders, lower level of education, smoking status, French and English languages compared with other languages spoken at home, and a rural environment were associated with poor diet quality. Having no intention to eat low-fat dairy products more often was associated with a high-fat diet. In men, obesity (body mass index >/=30 kg m(-2)) and absence of reported health problems were correlates of a high-fat diet, while, in women, lower physical activity was a correlate. CONCLUSIONS: Future health interventions in Quebec should target people with low education, smokers and those living in a rural environment. Obese men and sedentary women should have access to specific dietetic resources.

Adolescent↗

PubMed2004

The Quebec Association of Gastroenterology position paper on colorectal cancer screening - 2003.

Colorectal cancer is a leading cause of death and the third most common cancer in Canada. Evidence suggests that screening can reduce mortality rates and the cost effectiveness of a program compares favourably with initiatives for breast and cervical cancer. The objectives of the Association des gastro-entérologues du Québec Task Force were to determine the need for a policy on screening for colorectal cancer in Quebec, to evaluate the testing methods available and to propose one or more of these alternatives as part of a formal screening program, if indicated. Fecal occult blood testing (FOBT), endoscopy (including sigmoidoscopy and colonoscopy), barium enema and virtual colonoscopy were considered. Although most clinical efficacy data are available for FOBT and sigmoidoscopy, there are limitations to programs based on these strategies. FOBT has a high false positive rate and a low detection yield, and even a combination of these strategies will miss 24% of cancers. Colonoscopy is the best strategy to both detect and remove polyps and to diagnose colorectal cancer, with double contrast barium enema also being a sensitive detection method. The Task Force recommended the establishment, in Quebec, of a screening program with five- to 10-yearly double contrast barium enema or 10-yearly colonoscopy for individuals aged 50 years or older at low risk. The program should include outcome monitoring, public and professional education to increase awareness and promote compliance, and central coordination with other provincial programs. The program should be evaluated; specific billing codes for screening for colorectal cancer would help facilitate this. Formal feasibility, effectiveness and cost-effectiveness studies in Quebec are now warranted.

Barium Sulfate↗

PubMed1997

Prediction of multiple hypermutable codons in the human PAH gene: codon 280 contains recurrent mutations in Quebec and other populations.

The predicted mutability profile (MUTPRED) of the phenylalanine hydroxylase (PAH) gene shows that the 48 CpG sites (template and atemplate strands) are either empty of known mutations (7 sites), harbour "PKU" alleles involving CpG doublets (16 sites), or contain mutations that do not involve a C-->T or G-->A substitution in the doublet. These hypermutable sites harbour 32 different mutations in association with at least 66 different haplotypes and hyperphenylalaninemia. The E280K mutation in exon 7 of the PAH gene is a cause of phenylketonuria. It occurs on four different haplotypes in Europeans and on haplotypes 1 and 2 in Quebec. Whereas a single recombination event could explain the two haplotype associations in Quebec, the mutation does involve a CpG dinucleotide. By analyzing multiallelic markers 5' (STR) and 3' (VNTR) to the E280K allele on 12 mutant and 30 normal chromosomes, we conclude that recurrent mutation is the likely origin of E280K in Quebec. The PAH mutation database shows that the allele accounts for 1.5% of PKU chromosomes worldwide.

Codon↗

PubMed1995

Screening for neuroblastoma in North America. Preliminary results of a pathology review from the Quebec Project.

BACKGROUND: The Quebec Neuroblastoma Screening Project was initiated to assess clinical and biologic aspects of neuroblastomas detected by screening infants born in the province of Quebec from May 1, 1989, to April 30, 1994. METHODS: Infants were screened for preclinical detection of neuroblastoma by determination of catecholamine metabolites, vanillylmandelic acid (VMA), and homovanillic acid (HVA). Patients with tumors discovered through this screening as well as patients in the same birth cohort with clinically detected tumors were referred to Quebec Oncology Centers for further investigation, diagnosis, and treatment. Pathology specimens were submitted to Childrens Hospital Los Angeles for central review. Tumors were histopathologically classified according to the Shimada system. RESULTS: As of August, 1993, 340,000 infants were screened at 3 weeks and 245,000 of them were retested at 6 months of age. Thirty-one tumors were detected through this screening and removed. Histologic material was available for 27 cases: 14 were detected at 3 weeks of age and 13 at 6 months of age. Twenty-six patients had tumors with favorable histology (FH), and one patient had a Stage I tumor with unfavorable histology (UH). At the time of this writing, all mass screening patients are alive, including one child with relapsed disease. During this period, 48 tumors were detected clinically in the same birth cohort, 40 of which were evaluated histologically. Of these 40 cases, 28 of 29 tumors diagnosed in patients up to age 12 months indicated an FH, whereas 9 of 11 tumors diagnosed in patients older than age 12 months indicated a UH. All patients with FH tumors are alive including a child with relapsed disease. The single patient with UH diagnosed before age 12 months died of disease. Of the nine patients with UH diagnosed after age 12 months, four died of disease, one relapsed, and four are alive (including one treated with bone marrow transplantation) after variable follow-up periods. CONCLUSIONS: The tumors detected by mass screening, similar to those tumors detected through clinical examination before age 12 months, were predominantly FH with good prognosis. However, those tumors that were missed by screening and were detected clinically after the patient was 12 months of age were predominantly UH, with serious clinical problems. This subgroup of patients not detectable by the current screening system presents an immediate and important clinical challenge that should be addressed in future studies.

Age Factors↗

PubMed2003

Trend in prevalence of neural tube defects in Quebec.

BACKGROUND: In Canada, the first recommendations on the use of folic acid (FA) supplements by women planning a pregnancy or capable of becoming pregnant were issued in 1993. In 1998, fortification of flour with FA became mandatory. The objective of this study was to assess the impact of these measures on the prevalence of neural tube defects (NTDs) in the province of Quebec. METHODS: The study population included stillbirths, live births, and elective terminations for fetal malformations that were reported in 1992-2000 for women residing in the province of Quebec. NTD cases were identified from stillbirth certificates and hospital discharge summaries. RESULTS: There was a marked decrease in the total NTD rate after 1997. The average NTD rate was 1.89 per 1000 total births during the period of 1992-1997, and 1.28 per 1000 in 1998-2000, a 32% reduction (p < 0.001). CONCLUSIONS: Fortification of flour, which began in early 1997 and gradually became widespread, is a very plausible explanation for the timing, shape, and magnitude of the decrease in NTD prevalence observed in Quebec and other Canadian provinces. An increase in FA supplement use may have played only a minor role. Birth Defects Research (Part A) 67:000-000, 2003.

Dietary Supplements↗

PubMed2006

Brain death diagnoses and evaluation of the number of potential organ donors in Quebec hospitals.

PURPOSE: Faced with our inability to respond to the growing number of Quebec patients waiting for organ transplants, we sought to determine the number of potential organ donors (OD) in acute care hospitals. METHODS: A retrospective chart review of all acute care, in-hospital deaths in Quebec in the year 2000 was undertaken. Hospital record librarians provided statistics and completed questionnaires on each chart after applying exclusion and inclusion criteria. RESULTS: There were 24,702 acute care in-hospital deaths reported by 83 hospitals participating in the study on a voluntary basis. Analyzing 2,067 files meeting inclusion criteria, we identified 348 potential OD (1.4% of deaths). In hospitals not providing tertiary adult trauma care, the potential donor rate was 0.99% of all deaths. There were 4.5 times more potential donors in tertiary care adult trauma centers. Brain death was formally diagnosed in 268/348 patients, and organ donation discussed as an option with 230/268 families. Consent for donation was given in 70% of cases, although not all these patients proved to be suitable after evaluation. There were 125 actual donors in Quebec in the year 2000 (18 per million population). CONCLUSIONS: The gap between used and potential donors can be explained by several factors including failure to approach families for organ donation, family refusal, incomplete neurological assessment of patients, and medical unsuitability of some consented donors. There is room for improvement in the identification of potential donors and in the presentation of organ donation as an end of life option to families.

Brain Death↗

PubMed2002

The system of care and services for frail older persons in Canada and Quebec.

Since the early 70s, Canada has had a public health care system that guarantees all Canadians universal access to hospital and medical services free of charge. The same values and principles have governed the organization of health and social services in Quebec, including long-term care and services. Over time, changes have occurred within the Quebec system in order to adapt services to new realities more effectively; such changes involve a diversification of services oriented towards helping individuals remain in the community, and services provided close to clients' own environments. Mechanisms have also been established to improve clinical assessment of clients' needs, in order to make service orientation and admission to residential facilities more systematic. Nonetheless, reform is required in order to respond to certain trends related to client needs, i.e., greater needs due to the significant increase in the number of older persons, but also needs that differ from those of a younger population, for whom the system was designed. The new Quebec policy on services for frail older persons advocates a different concept of organization of services for this population group and presupposes major changes in the ways in which services are delivered.

Aged↗

PubMed1991

Geographical variations of motor-vehicle injuries in Quebec, 1983-1988.

Data furnished by the Régie de l'Assurance Automobile du Québec (RAAQ) were used to describe the geography of motor vehicle accidents in the province of Quebec for the period 1983-1988. These were also used to evaluate the risk factors associated with zones of high risk with regards to accidents for the 97 Municipalités Régionales de Comté (MRC). The results demonstrate that non-severe accidents are more frequent in the urban context. On the other hand, severe accidents are more frequent in the rural context. The Standard Morbidity Ratio (SMR) highlights those MRC's with the risk of severe or non-severe accidents, where risks are twice that of Quebec as a whole. The demographic characteristics (age, sex) of the driver and passengers and the place of the accident (region, density) were used in the model LOGIT to evaluate risk factors associated with high risk zones. Results of the model for those severely injured are different from those for non-severely injured people. This holds true for the location of accidents as well as for demographic characteristics. In both models, women and people over 65 years of age are low-risk groups for accidents. The authors indicate certain action to be undertaken in Quebec by the Government to improve this situation.

Accidents, Traffic↗

PubMed2005

The emergence of manganese-related health problems in Quebec: an integrated approach to evaluation, diagnosis, management and control.

This paper describes the strategy developed in Quebec to deal with an emerging problem: manganism in welders. Only two cases of manganism had been reported to the Commission de la santé et de la sécurité du travail (CSST, Workers Compensation Board in Quebec) before 2000. In the fall of 2001, the CSST was informed of a possible cluster of manganism and received 20 compensation claims from one plant. Action was rapidly taken to understand and tackle this emerging problem. Under the leadership of the CSST, a coordinating working group implemented medical and environmental subcommittees involving representatives of the different partners of the prevention network. After a literature review to document the health risks associated with manganese and the lack of some important information, a panel of international experts was formed to try to reach agreement on the parameters to consider in the diagnosis and management of manganism. The CSST compensation management policies would be adjusted accordingly. Simultaneously, all the available industrial hygiene data were analyzed to estimate where and at what levels workers were exposed to manganese. To complete these data, the exposure of workers in more than 50 industrial plants was evaluated and existing control measures were documented. All these data have been presented for a revision of the Quebec permissible exposure limit (PEL). In this integrated approach, the next step targets the formation of neurologists and neuropsychologists for a standardized medical evaluation, to complete workplace evaluation in the high risk sectors, inform workers and employers and recommend control measures where required, based on a revised PEL. Many strategies will be used to inform the prevention network (about 1000 people), employers and employees of the risks of overexposure to manganese and of the measures to control exposure in all the plants where workers are susceptible to be exposed to manganese.

Environmental Health↗

PubMed2002

Interdisciplinary collaboration within Quebec Community Health Care Centres.

Central to the success of many recent health system reforms is the implementation of new primary health care delivery models. The central characteristic common to these new models usually emphasises interdisciplinary collaboration. Using empirical research, this paper studies interdisciplinary collaboration among various groups of professionals within an original Canadian primary health care delivery model, the Quebec Community Health Care Centres (CCHCs). The entire population of more than 150 CHCCs have been surveyed. The goals of this study are (1) to measure the achieved intensity of inter-professional collaboration among Quebec CHCCs, and (2) to identify the organisational and professional factors fostering or limiting interdisciplinary collaboration. The results show that Quebec CHCCs have reached modest results in achieving interdisciplinary collaboration especially since interdisciplinary collaboration is a central objective that has been pursued for more than 25 years. This study demonstrates that the main factors associated with interdisciplinary collaboration are closely linked to work group internal dynamics. Interdisciplinary collaboration is linked to the simultaneous and antagonistic effect of some central intragroup process factors. Conflicting values and beliefs are present that both enhance and limit interdisciplinary collaboration. The presence of conflicting stimuli seriously undermines the strength of the CHCC work group's shared beliefs and strongly limits interdisciplinary collaboration. The results also stress the importance of administrative formalisation initiatives to enhance collaboration among different professions. The efficacy of formalisation in this context is based on its capacity to offer an articulated and operative interdisciplinary framework that can generate a counteractive effect to the traditional professional framework. It offers concrete rules that help align the work group beliefs with interdisciplinary values. The formalisation of functions and processes appears thus to be an interesting means to further interdisciplinary collaboration.

Community Health Centers↗

PubMed2002

A Quebec survey of issues in cancer pain management.

We report the results of a cancer pain survey mailed to Quebec hematologist-oncologists and palliative care physicians in 1999. The survey was designed to sample views on the current status of pain management and on obstacles to the provision of adequate pain relief for patients. The survey, formulated by an ethics network centered at the Clinical Research Institute of Montreal, was distributed to all members of the Association of Hematologist-Oncologists of Quebec and to all physician members of the Quebec Palliative Care Association. Responses were obtained from 138 Palliative Care Association members (response rate 61%) and 76 hematologist-oncologists (response rate 45%). Major obstacles reported included inadequate assessment of both contributory psychosocial issues and severity of pain, patient reluctance to take opioids, and inadequate access to non-drug techniques for pain relief. Access to opioids was not regarded as a problem. Both groups felt generally competent in their ability to manage various aspects of cancer pain therapy. They gave little credit to their formal medical school or residency training. Fifty-six percent of the palliative care group and 57% of the hemato-oncologists rated their medical school experience as only "poor" or "fair" on a 4-point scale. Residency ratings were modestly better. We conclude that medical faculties should assign a high priority to teaching health professionals patient assessment techniques. Simple symptom assessment scales should be routinely used in oncology/palliative care practice. Medical school training in pain management is not highly regarded and should be enhanced. We also note that, based on response to the scenario of a patient presenting with severe pain, many physicians, while feeling competent in the use of opioids, may be overly conservative in their initial use.

Attitude of Health Personnel↗

PubMed2002

Molecular characterization of three new avian infectious bronchitis virus (IBV) strains isolated in Quebec.

Three unrecognized field isolates of Infectious Bronchitis Virus (IBV) were recovered from commercial broiler chickens vaccinated with live Mass viral strain (H120). These isolates were identified by immunofluorescence using monoclonal antibodies produced against reference serotypes: Mass, Conn, and Ark. RT-PCRs were performed on viral RNAs to amplify S1 gene using a specific set of primers S1OLIGO3' and S1OLIGO5'. Restriction polymorphism (RFLP) of PCR products was determined by the use of HaeIII restriction enzyme. As expected, patterns of PCR products were different from common pattern of strains assigned to Mass serotype M41, Beaudette, H120, and Florida. Molecular analysis showed a nucleotide insertion in hypervariable region one (HVR-1) of S1 gene of only Quebec isolates (Qu16, Qu_mv and Q_37zm). However, New Brunswick IBV isolate (NB_cp) did not display these insertions. Major amino acid changes involved insertion of two stretches (aa118-119: Arg-Ser and aa141-145: Sys-Ser-Asn-Ala-Ser-Cys) located at N-terrminal and C-terminal regions of HVR-2. It is speculated that cysteine residue located upstream and downstream of Cys-Ser-Asn-Ala-Ser-Cys segment might be involved in the formation of loop structure and disulfide bond that could trigger important epitope changes. Insertion of new NXT and NXS (X not equal to P) glycosylation motifs scattered along S1 region and insertion of cysteine residues in HVR are contributing to the antigenic shifting of Quebec isolates. Fragment insertions were thought to be induced by inter-serotype recombination between vaccine strain (H120) that belongs to Mass serotype and another strain belonging to Ark serotype. Phylogenetic tree based on amino acid sequences showed that Quebec isolates formed a new phylogenetic cluster.

Amino Acid Sequence↗

PubMed2002

The Quebec classification and a new Swedish classification for whiplash-associated disorders in relation to life satisfaction in patients at high risk of chronic functional impairment and disability.

Unlike the Quebec classification system, which is based primarily on pathoanatomy, a new Swedish classification system is based on the site of functional impairment and disability. A prospective study was performed on 85 patients with whiplash-associated disorders grade II according to the Quebec classification. The patients were examined 3-36 months following trauma. A team of professionals with different training performed the diagnostic procedure. An independent assessor classified these patients according to a Swedish classification system. All patients answered questionnaire regarding life satisfaction. Logistic regression demonstrated significant differences in 6 of 10 specific dimensions of life satisfaction between the classification categories C and D (presence of arm symptoms) in a Swedish classification. Patients with whiplash-associated disorders grade II and neuropsychological symptoms seem to have a worse prognosis for spontaneous recovery than those without. A new Swedish classification system seems to be an important complement to the Quebec classification.

Absenteeism↗

PubMed2004

Quebec population and telehealth: a survey on knowledge and perceptions.

Telehealth is widely considered to be a promising tool that addresses many of the challenges currently facing the health care system in Canada. However, diffusion of telehealth will ultimately depend on its acceptance among health care professionals and the general population. This study explores public understanding and perceptions of telehealth in the Province of Quebec (Canada). A telephone survey involving interviews with a random sample of 1242 individuals was conducted in various Quebec regions. Only 8.9% of respondents were familiar with the term "telehealth," whereas telehealth applications, especially teletriage, appeared to be more commonly known. A large majority of respondents believed telehealth could facilitate access to health care services, improve quality of care, and reduce health care expenditures. Legal responsibility in cases of medical error was reported as the leading public concern related to telehealth. Furthermore, nearly 50% of Quebec's population would use telehealth services when offered to them. The principal factors weighing in favor of willingness to use telehealth services were: knowledge of telehealth applications perception of telehealth benefits, reduced barriers to telehealth, and the fact of being female. Promoting the use of telehealth in the general population and dissipating concerns related to its applications will require global educational strategy that will inform the public about the benefits of telehealth as well as addressing ethical and legal issues.

Health Care Surveys↗

PubMed2001

Relations between n-3 fatty acid status and cardiovascular disease risk factors among Quebecers.

BACKGROUND: Epidemiologic evidence shows an inverse relation between fish consumption and death from ischemic heart disease. This beneficial effect is attributed to n-3 fatty acids. OBJECTIVES: The purpose of this study was to examine the association between plasma phospholipid concentrations of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and various cardiovascular disease risk factors among Quebecers. DESIGN: The study population consisted of 1460 subjects aged 18-74 y who participated in the 1990 Quebec Heart Health and Nutrition Survey. Data were obtained through home interviews and clinic visits. RESULTS: Expressed as the percentage of total fatty acids in plasma phospholipids, the geometric means of EPA, DHA, and their combination were 0.47%, 1.19%, and 1.70%, respectively. Concentrations of n-3 fatty acids were positively associated with fish intake. We found positive associations between EPA and total cholesterol, LDL cholesterol, HDL cholesterol, plasma glucose, and systolic and diastolic blood pressure. We found positive associations between DHA and total cholesterol, the ratio of total to HDL cholesterol, triacylglycerols, systolic blood pressure, and plasma glucose and insulin. We also found positive associations between the ratio of EPA to arachidonic acid and total cholesterol, HDL cholesterol, and systolic blood pressure and a negative association with the ratio of total to HDL cholesterol. CONCLUSIONS: Our results indicate that concentrations of EPA and DHA in plasma phospholipids reflected Quebecer fish consumption. Results also show that EPA and the ratio of EPA to arachidonic acid can positively influence HDL-cholesterol concentrations.

Adult↗

PubMed1994

Association between exposure to pulsed electromagnetic fields and cancer in electric utility workers in Quebec, Canada, and France.

The authors report the association between exposure to pulsed electromagnetic fields (PEMFs) and cancer in a nested case-control study of electric utility workers in Quebec, Canada (follow-up, 1970-1988), and France (follow-up, 1978-1989), among whom 2,679 cases of cancer were identified. Exposures were assessed through a job-exposure matrix based on about 1,000 person-weeks of measurements from exposure meters worn by workers. Exposures were considerably higher in Quebec than in France. No association was found between PEMFs and cancers previously suspected of association with magnetic fields (leukemia, other hematopoietic cancers, brain cancer, or melanoma). However, there was a clear association between cumulative exposure to PEMFs and lung cancer, with odds ratios rising to 3.11 (95% confidence interval (CI) 1.60-6.04) in the highest exposure group (84 cases). This association with largely confined to Quebec, where there was a monotonic exposure-response relation with an odds ratio of 6.67 (95% CI 2.68-16.57) in the highest exposure group (32 cases). The association is substantial and was not explained by smoking or other occupational exposures. However, several factors limit the strength of the evidence for a causal relation: lack of precision in what the meters measured; little previous evidence for this association; and no elevated risk for lung cancer in the utility workers overall in comparison with the general population.

Case-Control Studies↗