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PubMed1998

Salmonella prevalence in crops of Ontario and Quebec broiler chickens at slaughter.

Swabs of crop contents of 635 broiler chickens were obtained from 9 Ontario and 12 Quebec processing plants and cultured for Salmonella to determine prevalence in broiler crops. Serotypes of positive cultures were determined to evaluate the serotype profile. The overall prevalence of contamination was low (4.3%). Prevalence was higher in broilers sampled in Quebec (5.8%) than in those sampled in Ontario (2.2%). In Quebec, there were differences in prevalence among the groups of broilers sampled at the various plants. These differences were believed to be attributable to differences in Salmonella prevalence among groups of flocks delivered to the plants due to the limited exposure of the chickens to the plant. The serotype profile of Salmonella isolated from the crops of broilers in this study was similar in several respects to profiles obtained from other surveys of Canadian broiler flocks using either environmental samples or cloacal swabs. Similarities included: predominance of Salmonella hadar and Salmonella heidelberg; several other common serotypes at a low prevalence; little Salmonella enteritidis isolated in other studies, and no S. enteritidis isolated in this study. Results of this field survey of Salmonella in crops of broilers are similar to those of Canadian studies of other internal and environmental sites of broilers. The similarity indicates that monitoring of Salmonella environments of flocks of live broiler chickens should define profiles of Salmonella contamination of the carcasses and would also aid in determination of Salmonella contamination status of broiler flocks. Such information would assist efforts to reduce Salmonella contamination in broiler chickens.

Abattoirs↗
PubMed2003

Residents' duty hours in the province of Quebec, Canada.

The author describes the five decades of efforts by residents in the medical schools of the province of Quebec, Canada, to negotiate scientific, cultural, social, and economic issues that affect them as trainees. At present, the residents' association, the Fédération des Médecine résidents du Quebec negotiates collective agreements on working conditions and other issues with the Quebec Ministry of Health, not the hospital association. The federation has become recognized as an important body throughout Canada, and its representatives regularly participate in meetings concerning the country's health care system. The author describes the duty hours provisions of the current collective agreement (1996-2002), and remarks that in general, the agreement's regulations are helpful to residents, prevent the possibility of abusive work schedules, and, among other benefits, provide generous time off for conferences, examinations, and study time. However, some residents, particularly those in surgical disciplines, believe that the work-hours provisions are too restrictive, as they wish to maximize their acute-care surgical experiences in the operating room via frequent on-call hours. At present, residents in all disciplines are allowed to remain in the hospital to attend to patient care duties as much as they wish, but they may not be on official call more than is stipulated by the collective agreement. These agreements have also created some difficulties in providing coverage for patients; the author discusses various solutions to this problem.

Attitude of Health Personnel↗
PubMed1991

Population genetics of vitamin D-dependent rickets in northeastern Quebec.

Vitamin D-dependent rickets (VDD1) is an autosomal recessive disorder that was recognized in Saguenay-Lac-St-Jean (SLSJ) in 1970. The great majority of the VDD1 cases reported in the French Canadian population of Quebec originated from SLSJ, Charlevoix, and the Haute Côte Nord, all regions located in northeastern Quebec. The prevalence at birth in SLSJ was estimated at 1/2916 live borns, and the carrier rate was estimated at 1/27 inhabitants in the SLSJ region. The mean coefficient of inbreeding was not elevated in the VDD1 group of SLSJ compared with three matched control groups. The mean coefficient of kinship was 2.5 times higher in the VDD1 group than in the control groups. In the SLSJ region, the places of origin of the VDD1 children and their children did not show a clustered non-uniform distribution. Endogamy was not found to be higher in the VDD1 group than in control groups. The genealogical reconstruction showed all the obligate carriers of the VDD1 gene, but one, to be related to a small set of founders who settled in New France in the 17th century. All these results, as well as a strong linkage disequilibrium between RFLPs located on the long arm of chromosome 12 and the VDD1 locus, support the hypothesis of a founder effect for VDD1. They also suggest that a unique mutation accounts for most, if not all, of the cases known in northeastern Quebec.

Consanguinity↗
PubMedDate not supplied

Cost-effectiveness of positron emission tomography for the management of potentially operable non-small cell lung cancer in Quebec.

BACKGROUND: The potential benefits of positron emission tomography (PET) scanning stem from the fact that it can reduce the number of diagnostic examinations; particularly, the number of unnecessary thoracic surgeries. OBJECTIVE: To evaluate the economic impact and cost-effectiveness of PET scanning in the management of potentially operable non-small cell lung cancer in Quebec. METHODS: A decision tree was developed. Two strategies were compared: chest computed tomography (CT) alone or CT and whole-body PET. The various paths of each strategy were dependent on the numerous variables that were determined from a literature review. The costs and life expectancy were determined for each strategy under consideration. Life expectancy was calculated using the declining exponential approximation of life expectancy. Costs were obtained from the Quebec diagnosis-related group database and Quebec physician fee schedules. RESULTS: The mean cost of the CT strategy was US dollars 8,455 per patient compared with US dollars 9,723 for the PET strategy, for a cost differential of US dollars 1,268. The PET strategy extended life expectancy by slightly more than three months (0.27 years) compared with the survival of the CT strategy. The incremental cost-effectiveness ratio was US dollars 4,689. Considering the number of new cases and the prevalence of mediastinal metastases, the budget impact would be US dollars 8,613,693. CONCLUSION: The use of PET to detect local and distant metastases in non-small cell lung cancer is an intervention that would require an acceptable investment for each life-year gained.

Analysis of Variance↗
PubMed2006

Seasonal variance in serum levels of vitamin d determines a compensatory response by parathyroid hormone: study in an ambulatory elderly population in Quebec.

BACKGROUND: Although the seasonal variance in serum levels of vitamin D in the elderly is well known, its significance on parathyroid hormone (PTH) remains controversial. OBJECTIVE: To identify the variability and correlation between serum levels of vitamin D and PTH in a sample of community-dwelling elderly patients in the Province of Quebec, Canada, where vitamin D and calcium are supplemented in the food. METHODS: Cross-sectional study in an ambulatory elderly population in the Province of Quebec. Samples were analyzed at the Metabolic and Calcium Research Centre, Royal Victoria Hospital, Montreal, Quebec. 256 healthy men and women aged 65-94 (mean age +/- SD: 72.8 +/- 5.6) were analyzed. Serum levels of 25-hydroxyvitamin D (25(OH)D3) and PTH were determined between 1994 and 1999 using commercial radioimmunoassay kits to measure calciotropic hormones. We examined data in different seasons of the year and observed the behavior of the data through time. A cut-off level of 25 nmol/l for 25(OH)D3 was established to define vitamin D deficiency. A correlation between vitamin D levels vs. PTH levels was also obtained. RESULTS: There is a predominance of females with a 75% of the population. Among them, 32% showed levels of vitamin D <20 nmol/l as compared to 51% of the male population (p < 0.02). A seasonal variance in the levels of vitamin D was observed with the lower levels happening in early spring with a recovery at the end of the summer (p < 0.004). These low levels of vitamin D corresponded with an inverse pattern in the levels of PTH more importantly in early spring. CONCLUSION: This study not only confirms previous reports that despite vitamin D food supplementation a vitamin D deficiency is still a finding in elderly population in the Northern hemisphere, but also that a compensatory change in PTH levels concurrently occurs with a potential significance on bone strength and risk of fractures.

Aged↗
PubMed1993

A survey of Quebec pediatricians' attitudes toward donor insemination.

Inspired by a study done in France, Quebec pediatricians were surveyed regarding their knowledge of children conceived by donor insemination (DI) and their families, as well as their attitudes and opinions about DI. A two-part questionnaire was mailed to all 487 members of the Quebec Association of Pediatricians. One hundred and ninety-seven (40%) responded. Findings indicate that Quebec pediatricians have treated few children conceived by DI and know little about how their families are handling the issue of DI. Most pediatricians favored telling DI offspring about their mode of conception, and almost half stated that such children, at maturity, should have the right to know their biological fathers. Their opinions reflect the growing trend toward openness in adoption and DI.

Adolescent↗
PubMed2005

Challenges facing child psychiatry in Quebec at the dawn of the 21st Century.

OBJECTIVES: This study aimed to identify hospital resources by region, determine human resources by type of service and region, and describe how services generally operate in child psychiatry within the province of Quebec. METHODS: Data collection took place from May to October 2001. We sent a semistructured questionnaire to all child psychiatry service heads. We collected human resource data and produced organizational charts based on the responses obtained. These charts were forwarded to each of the participating services for validation. We grouped Quebec's 18 social health regions into 3 categories: central (4 regions with 606 370 youths), adjoining (4 regions with 589 750 youths), and peripheral (10 regions with 368 635 youths). RESULTS: The response rate was 100%. We identified 35 child psychiatry services: 13 in the central regions, 9 in the adjoining regions, and 13 in the peripheral regions. Overall, we identified 177 short-stay beds, 476 places in day or evening hospitals, and 113 places in day or evening centres. Most of these resources were located in the central regions. Quebec had 138.2 full-time equivalent (FTE) child psychiatrists (69.8% in the central regions) and 706 FTE professionals. At March 31, 2001, 4285 youths were waiting for services. CONCLUSIONS: We observed a shortage of child psychiatrists and professionals, regardless of the norm used. Adjoining and peripheral regions should have access to a minimal range of human and hospital resources in child psychiatry.

Adolescent↗
PubMed1991

Outbreaks in Quebec pig farms of respiratory and reproductive problems associated with encephalomyocarditis virus.

Encephalomyocarditis virus (EMCV) was isolated from tissues of aborted fetuses and weaned and suckling piglets from 4 different pig farms in Quebec. The farms were experiencing reproductive failure in sows of different parities concomitant to respiratory problems in suckling and postweaning piglets. At necropsy, gross lesions were confined to the lung and consisted of pulmonary congestion and edema of various degrees. Lesions of multifocal interstitial to proliferative pneumonia were found in the lungs of these piglets. Bacteriologic examination of various tissues from necropsied pigs yielded no pathogens in most cases. No significant antibody titers against 3 swine viruses (transmissible gastroenteritis virus, porcine parvovirus, and swine influenza virus) and two bovine viruses (bovine viral diarrhea and infectious bovine rhinotracheitis viruses) were detected in the sera of convalescent pigs. The Quebec EMCV isolates were antigenically related to the reference ATCC-VR129 strain of EMCV, as demonstrated by indirect immunofluorescence, serum neutralization (SN), and Western immunoblotting. However, one of the Quebec isolates could be distinguish by SN. EMCV-specific SN antibody titers up to 1:12,800 were detected in thoracic and ascitis fluids of aborted fetuses and in sera of convalescent pigs. A possible pneumotropic EMCV variant in swine may exist.

Abortion, Veterinary↗
PubMed1998

Determinants of ambulatory physician utilization among adults with chronic diseases in Quebec.

OBJECTIVES: To test the explanatory power of a model of ambulatory service use and to determine the relative roles of the main determinants of physician utilization for two chronic medical conditions in adults in Quebec. METHODS: A behavioral model based on Andersen's model was developed and tested by linking two databases: the Quebec health survey as regards patient characteristics, and the Quebec health insurance board data on physician characteristics and service use. Path analysis was used for data analysis. RESULTS: The model explained a little less than 20% of the variation in service use. The number of hospitalizations, physician's specialty and perceived health were the most important predictors of the volume of visits. CONCLUSION: Further specification of utilization, relating it to a particular medical condition, does not necessarily lead to an increase in the explanatory power of the model. We recommend that future research should put more emphasis on provider-related determinants rather than focusing on the type and purpose of utilization.

Age Factors↗
PubMed2006

Delays to reperfusion therapy in acute ST-segment elevation myocardial infarction: results from the AMI-QUEBEC Study.

BACKGROUND: Through the AMI-QUEBEC Study we sought to describe delays to reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) and to identify factors associated with prolonged delays. METHODS: We reviewed the charts of all consecutive patients with STEMI admitted to 17 hospitals in the province of Quebec in 2003 to obtain data on the time from presentation to reperfusion therapy. Data were available for 1189 (83.0%) of 1432 patients. RESULTS: The median delay to reperfusion therapy was 32 minutes (first and third quartile [Q1, Q3] 20, 49) for 535 patients who received fibrinolytic therapy, 109 minutes (Q1, Q3 79, 150) for 455 patients who underwent primary percutaneous coronary intervention (PCI) at the initial hospital of presentation and 142 minutes (Q1, Q3 115, 194) for 199 patients who underwent primary PCI after an interhospital transfer. Patients who presented outside daytime working hours, those who received primary PCI and those who required interhospital transfer for primary PCI were less likely to receive reperfusion therapy within current recommended times (odds ratios [ORs] 0.49, 0.56 and 0.15, respectively). Increased age was associated with prolonged delays only among patients who received fibrinolytic therapy (OR for each 10-year increase in age 0.95, 95% credible interval [CrI] 0.93-0.99 for fibrinolytic therapy and 0.99, 95% CrI 0.95-1.05, for primary PCI). INTERPRETATION: In 2003, many patients with STEMI in Quebec were not treated within the recommended times. Delays may be reduced by reorganizing pre-and in-hospital care for patients with STEMI to expedite delivery of reperfusion therapy.

Age Factors↗
PubMed1992

Community participation in Quebec's health system: a strategy to curtail community empowerment?

Since the beginning of the 1970s, the province of Quebec has undergone a major reform of its health and social services system. Following this reform, the state has become a major protagonist, and the participation of the population is a built-in element in the system, guaranteed by law. Now, about 20 years later, there is a major effort to reorganize health services, in the wake of a "dewelfarization" mood that has reached Canada and Quebec. This article reviews the successes and pitfalls of public participation in Quebec's health system, presents the way in which participation is dealt with in current reform proposals, and draws lessons for people in many countries who have recently been encouraged to jump onto the bandwagon of participation as a strategy to promote the health of populations.

Community Health Centers↗
PubMedDate not supplied

Predictors of pretravel consultation in tourists from Quebec (Canada).

BACKGROUND: Although many tourists from Quebec (Canada) each year visit destinations at risk for infectious diseases, only a few of them seek travel health advice. To identify the determinants of travel health consultation, we conducted a study among Quebec's tourists visiting two popular sun destinations. METHODS: A conceptual model based on psychosocial determinants of human behavior was constructed. A cross-sectional survey was carried out, from January to April 1999, on two samples of travelers planning to visit Mexico and the Dominican Republic. One sample was composed of people who did not consult a travel clinic (cluster sampling in seven flights), and the other sample was one of clients of travel clinics (purposive selection of 13 specialized clinics located in Quebec). A 34-item self-administered bilingual questionnaire was distributed to travelers. Statistical analysis included a multivariate approach (logistic regression). RESULTS: A total of 2,242 travelers were surveyed (response rate in flight 75% and in clinics 99%). We present only results reported by French-speaking tourists: 1,152 who did not consult a travel clinic and were reached in flight, and 449 who were reached in clinics. Multivariate analyses indicated that travel agent recommendation was the most important predictor of consultation among travelers (OR 8.0, 95% CI 5.1-13), especially among those under 45 years of age and those who never sought pretravel consultation before (OR 21, 95% CI 11-41). Other important predictors were: traveling for the first time, traveling with children, previous consultation, perception about efficacy of immunization, risk perception, and information from travel agent, family doctor, and pharmacist. CONCLUSIONS: Despite its limitations, this study provides data that should help improve public health interventions aimed at encouraging travelers to get a pretravel consultation.

Adolescent↗
PubMed1999

Prevalence of gestational diabetes mellitus among James Bay Cree women in northern Quebec.

BACKGROUND: The prevalence of gestational diabetes mellitus has been reported to vary widely in aboriginal populations. Most of the data have come from the United States. To help determine the extent of gestational diabetes in Canada's aboriginal population, the authors assessed the prevalence in a population of Cree women in northern Quebec. METHODS: A cross-sectional study was conducted using the National Diabetes Data Group (NDDG) criteria. Information was obtained from patient charts on pregnancies between January 1995 and December 1996 among women residing in 9 Cree communities in the eastern James Bay region of northern Quebec. Women who were not Cree, had pre-existing diabetes, had spontaneous abortion or were receiving glucocorticoid treatment were excluded. RESULTS: Data on 654 pregnancies that met the inclusion criteria were available. Results of the screening oral glucose challenge test were available for 579 of the pregnancies; the remaining 75 were excluded. The mean gestational age at screening was 28.3 (standard deviation 2.6) weeks. The prevalence of gestational diabetes was 12.8% (74/579) (95% confidence interval [CI] 10.1%-15.5%). The prevalence in the inland communities was twice as high as that in the coastal communities (18.0% v. 9.3%, p = 0.002). Women with gestational diabetes or impaired glucose tolerance tended to be older, have had more pregnancies, weigh more before pregnancy and have heavier babies than those with a normal glycemic status. INTERPRETATION: The prevalence of gestational diabetes among James Bay Cree women in northern Quebec is twice as high as that among women in the general North American population and the second highest reported in an aboriginal group worldwide.

Adolescent↗
PubMed1999

Quality of care in unlicensed homes for the aged in the eastern townships of Quebec.

BACKGROUND: The recent proliferation of unlicensed homes for the aged in Quebec, coupled with the increased needs of the population they serve, has raised concerns about the quality of case these homes provide. The authors compared the quality of care in unlicensed homes with that in licensed long-term care facilities in a region of Quebec. METHODS: The study involved 301 impaired people aged 65 and over in 88 residential care facilities (52 unlicensed, 36 licensed) in the Eastern Townships of Quebec. Study participants were chosen according to a 2-stage sampling scheme: stratified sampling of the primary units (facilities) and random sampling of the secondary units (residents). Quality of care was measured using the QUALCARE scale, a multidimensional instrument that uses a 5-point scale to assess 6 dimensions of care: environmental, physical, medical management, psychosocial, human rights and financial. A mean score of more than 2 was considered indicative of inadequate care. RESULTS: Overall, the quality of care was similar in the unlicensed and licensed facilities (mean global score 1.61 [standard error of the mean (SEM) 0.06] and 1.47 [SEM 0.09] respectively). Examination of dimension-specific quality-of-care scores revealed that the unlicensed homes performed worse than the licensed facilities in 2 areas of care: physical care (mean score 1.80 [SEM 0.08] v. 1.51 [SEM 0.09] respectively, p = 0.017) and medical management (1.37 [SEM 0.06] v. 1.14 [SEM 0.05], p = 0.004). The dimension-specific scores also revealed that both types of homes lacked appropriate attention to the psychosocial aspect of care. Overall, 25% of the facilities provided inadequate care to at least one resident. This situation was especially prevalent among homes with fewer than 40 residents, where up to 20% of the residents received inadequate care. INTERPRETATION: Most of the unlicensed homes for the aged that were studied delivered care of relatively good quality. However, some clearly provided inadequate care.

Aged↗
PubMed1999

Rate and cost of hospitalizations for asthma in Quebec: An analysis of 1988/89, 1989/90 and 1994/95 data.

The objectives of this study were to evaluate recent trends in the frequency and length of stay of hospitalization for asthma in the province of Quebec and to estimate the costs of asthma hospitalizations. Data were extracted for persons hospitalized for 30 days or less with a primary diagnosis of asthma in all Quebec short-stay hospitals during the years 1988/89, 1989/90 and 1994/95. There were 1.76 asthma hospitalizations per 1000 persons in Quebec in 1988/89, down to 1.44 in 1989/90 and up again to 1.75 in 1994/95. There was a small decrease in mean length of stay when the three data years were compared. In all three years, the rate of hospitalization was particularly high among young boys. In 1994/95, more hospitalizations occurred during the fall months. We estimated the total cost for asthma hospitalization that year to be $18 to $21 million.

Adolescent↗
PubMed1999

Variations in the treatment of early-stage breast cancer in Quebec between 1988 and 1994.

BACKGROUND: The influence of organizational factors on the process and outcomes of the treatment of breast cancer has been extensively investigated. Although the quality of care is presumed to be better in larger centres, evidence is inconsistent. This study was conducted to determine whether therapies for patients with breast cancer varied according to hospital caseload. METHODS: Women newly diagnosed between 1988 and 1994 with early-stage node-negative primary breast cancer were randomly selected from the Quebec tumour registry and the Quebec hospital discharge database. Data were collected from medical charts, and only women having undergone dissection of the axilla were included in the analyses. Logistic regression analysis was used to adjust for case mix and organizational variables. RESULTS: The final sample included 1259 patients with node-negative stage I or II primary breast cancer. The proportion of women who underwent breast-conserving surgery increased significantly with hospital caseload (from 78.0% in hospitals admitting fewer than 25 new cases each year to 88.0% in those admitting 100 patients or more; p for trend < 0.001). This trend remained significant even after statistical adjustment for case mix and organizational factors (p for trend = 0.001). Of the 1039 women who underwent breast-conserving surgery 965 (92.9%) received radiotherapy. Use of systemic adjuvant therapy (tamoxifen or chemotherapy, or both) increased with the number of patients treated in a given centre (from 60.1% to 68.5%), but this trend disappeared after adjustment for case mix and other factors. The proportion of patients receiving systemic adjuvant therapy consistent with published consensus guidelines tended to increase with caseload for those treated in hospitals participating in multicentre clinical trials but decrease with caseload for patients in hospitals not involved in clinical research. INTERPRETATION: The care of patients in Quebec with early-stage breast cancer is characterized by a high prevalence of both breast-conserving surgery and systemic adjuvant therapy. Large centres, especially those actively involved in clinical research, rapidly adopt innovative therapeutic modalities.

Breast Neoplasms↗
PubMedDate not supplied

The health of Cree, Inuit and southern Quebec women: similarities and differences.

Using the data from a number of the surveys conducted over the last 10 years by Santé Québec, this study examines the health characteristics of two populations of Aboriginal women of northern Quebec compared to those of women in the rest of the province. The northern populations had a larger proportion of young women. Aboriginal women have heavier family responsibilities than other Quebec women. Inuit women had a much higher prevalence of smoking and drug use. Alcohol consumption was less frequent in northern women, but the quantity consumed was higher compared to other Quebec women. Cree women tended to be more obese, had higher levels of blood glucose and lower levels of cholesterol. Inuit women tended to have lower rates of hypertension and higher rates of declared hearing problems and mental disorders. The similarities and differences observed among these three populations of women can assist decision-makers in setting priorities with regards to maintaining and improving their health.

Adolescent↗
PubMed2001

Waiting time for breast cancer surgery in Quebec.

BACKGROUND: Currently there is no agreement on the optimal time to treatment of breast cancer; however, given the considerable emphasis on early detection, one would expect a similar emphasis on early treatment. The purpose of our study was to assess the time interval to surgery from initiation of diagnosis among Quebec women with breast cancer and to examine the influence on waiting time of age, pattern of care and cancer stage. METHODS: Records of physician fee-for-service claims and of hospital admissions were obtained for all Quebec women who underwent an invasive procedure for the diagnosis or treatment of breast cancer between 1992 and 1998. Waiting time was calculated as the number of days between the first diagnostic procedure and surgical treatment. RESULTS: There were 29,606 episodes of breast cancer surgery among 28,100 women: 5922 mastectomies and 23,684 lumpectomies. The absolute number of episodes of breast cancer treated with surgery rose from 3626 in 1992 to 5162 in 1998. The overall median waiting time was 34 days (interquartile range [IQR] 19-62); 13.5% of the women waited longer than 90 days. The median waiting time rose from 29 days (IQR 15-54) in 1992 to 42 days (IQR 24-72) in 1998, representing a relative increase of 37% (95% confidence interval [CI] 32%-43%) after adjusting for age and cancer stage. The median waiting time increased with the number of diagnostic procedures, from 24 days (IQR 14-42) with 1 procedure to 48 days (IQR 27-84) with 3 procedures to 72 days (IQR 43-121) with 4 procedures, representing adjusted relative increases of 97% (95% CI 91%-103%) and 194% (95% CI 181%-208%), respectively. The proportion of women receiving 3 or more diagnostic procedures before surgery increased steadily over the study period, from 19.2% in 1992 to 33.0% in 1998. The median waiting time was shorter with more advanced stages of cancer: 53 days (IQR 30-86) for carcinoma in situ, 35 (IQR 20-62) for localized disease, 28 (IQR 16-49) for regional disease and 24 (IQR 11-52) for disseminated disease. INTERPRETATION: Waiting time between initial diagnosis and first surgery for breast cancer has increased substantially in Quebec between 1992 and 1998. Possible explanations include increased demand, decreased resources and changes in patterns of care.

Adult↗