Injury mortality among the Cree of northern Quebec, 1982-91

This study describes the mortality from injuries in the Cree communities of northern Quebec for the period 1982-91. Comparison of different data sources for the completeness of ascertainment of injury mortality showed that no single source of information provided a complete count of deaths. Coroners' reports provided some details on the circumstances of fatal events but would gain usefulness if police and coroners employed a more structured approach to the collection of information on the circumstances of injury deaths. Circumstances of deaths were obtained from mortality interviews with relatives of victims. Drownings were the most common cause of injury death. Groups at high risk of drowning were adult males during boating and snowmobile transport for hunting and toddlers not supervised during their play near the water. None of the victims had worn a personal flotation device. Motor vehicle fatalities affected adult males and were often associated with acute alcohol ingestion. Few victims wore safety belts. Suicides affected mostly males. Half of the suicides resulted from gunshot wounds and 70 percent of victims had ingested alcohol prior to the event. Detailed information on the determinants of injury mortality should help in establishing injury prevention strategies

La construction d'une rationalité : les médecins et la prescription de psychotropes aux personnes âgées

The perception of physicians about psychotropic drug prescribing to the elderly Recently, inappropriate use of medications has become a public health concern for the elderly population because of its widespread use and potential consequences on autonomy. Psychotropic medications are in and of themselves a category for which there are proven associations with negative health consequences in the elderly population (falls, confusion and associated morbidity and mortality). However, if the decision-making process leading to prescription or re-prescription depends on many other variables than the available pharmacological information, few studies exist on the social determinants, and especially on the « non- scientific » aspects, of psychotropic drug prescribing. This article presents the results of a study on the perception of physicians about psychotropic drug prescribing to the elderly and analyses the decision-making process surrounding the prescription.Résumé. Une proportion importante de personnes âgées consomme des médicaments psychotropes et beaucoup d'entre elles le font pendant plusieurs années. Nombre d'études épidémiologiques démontrent pourtant que des risques accrus de troubles cognitifs, de chutes et d'hospitalisation sont associés à cette consommation. Aussi, il n'est pas étonnant de constater l'intérêt croissant pour ce phénomène et la multiplication des études axées sur « l'utilisation rationnelle des médicaments », c'est-à-dire l'utilisation définie par les autorités de santé publique selon les indications pour lesquelles les médicaments sont mis sur le marché. Cette démarche se fonde cependant sur l'a priori d'un comportement scientifique et standardisé de la part des médecins, les déviations aux normes cliniques étant d'emblée considérées comme irrationnelles. Or, c'est compter sans les facteurs dits « subjectifs » qui sous-tendent la relation thérapeutique, tels que le poids de la demande exprimée par le patient, la forte symbolique du médicament et de l'acte de prescrire. À partir d'une enquête portant sur les représentations des médecins concernant la prescription de psychotropes aux personnes âgées, cet article vise à cerner les étapes de la construction d'une rationalité face à la décision de prescrire.La construcción de una racionalidad : los médicos y la prescripción de psicotrópicos Una importante proporción de personas de edad consume psicotrópicos y son numerosas las que lo hacen desde hace bastante tiempo. No obstante, un cierto número de estudios epidemiologicos ha demostrado que este consumo está asociado al aumento de riesgos en cuanto a trastornos cognitivos, caídas y hospitalizaciones. No es por lo tanto extraño el creciente interés por este fenómeno y la multiplicación de los estudios centrados en « la utilización racional de los medicamentos », es decir, la utilización definida por las autoridades de salud pública según las primeras indicaciones para las cuales los medicamentos fueron puestos en venta. No obstante, este procedimiento parte del a priori de un comportamiento cientifico y estandartizado de parte de los médicos, las desviaciones de las normas clínicas están consideradas desde un principio como irracionales. Pero esto no toma en cuenta los factores llamados « subjetivos » subyacentes en la relación terapeútica tales como el peso de la demanda expresada por el paciente, la carga simbólica del medicamento y del acto de recetar. Este artículo intenta delimitar las etapas de la construcción de una racionalidad frente a la decisión de recetar, a partir de un estudio sobre las representaciones que tienen los médicos en cuanto a la prescripción de psicotrópicos a las personas de edad.Collin Johanne, Damestoy Nicole, Lalande Raymond. La construction d'une rationalité : les médecins et la prescription de psychotropes aux personnes âgées. In: Sciences sociales et santé. Volume 17, n°2, 1999. pp. 31-52

Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings

Objectives. We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. Methods. The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. Results. Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. Conclusion. Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls