Relation entre le modèle de croyances relatives à la santé, le sentiment d'efficacité personnelle, l'attribution causale de la maladie et l'observance aux auto-soins diabétiques

Dans le but de ressortir les facteurs les plus significatifs de l'observance aux auto-soins diabétiques, cette étude descriptive a associé le Modèle de croyances relatives à la santé de Rosenstock (1974; voir Rosenstock, 1990), le Sentiment d'efficacité personnelle de Bandura (1977) et l'Attribution causale de la maladie de Weiner (1971; voir Weiner et al., 1972). Pour atteindre les objectifs fixés, 13 associations diabétiques réparties dans six régions administratives québécoises ont été visitées sur une période de quatre mois. L'échantillon final se composait de 231 sujets adultes. Diagnostiqués atteints de diabète depuis plus d'un an, 20,3% des participants étaient catégorisés de type 1 et 77,1% de type 2. Cent dix neuf (119) femmes et cent douze (112) hommes ont répondu à cinq questionnaires soit l'Échelle de croyances relatives à la santé concernant le diabète (1987), l'Échelle d'efcacité [efficacité] personnelle pour le diabète (Provost-Beinier, 1994), le Questionnaire d'attribution causale du diabète (Plante, 1996), le Questionnaire d'observance aux auto-soins diabétiques (Plante, 1996) ainsi que le Questionnaire sur la situation sociodémographique et diabétique (Plante, 1996). Ce dernier questionnaire impliquait aussi la vérification du taux d'hémoglobine glyquée des participants ainsi que de leur indice de masse corporelle."--Résumé abrégé par UMI

Risk of asthmatic episodes in children exposed to sulfur dioxide stack emissions from a refinery point source in Montreal, Canada.

BACKGROUND: Little is known about the respiratory effects of short-term exposures to petroleum refinery emissions in young children. This study is an extension of an ecologic study that found an increased rate of hospitalizations for respiratory conditions among children living near petroleum refineries in Montreal (Canada). METHODS: We used a time-stratified case-crossover design to assess the risk of asthma episodes in relation to short-term variations in sulfur dioxide levels among children 2-4 years of age living within 0.5-7.5 km of the refinery stacks. Health data used to measure asthma episodes included emergency department (ED) visits and hospital admissions from 1996 to 2004. We estimated daily levels of SO2 at the residence of children using a) two fixed-site SO2 monitors located near the refineries and b) the AERMOD (American Meteorological Society/Environmental Protection Agency Regulatory Model) atmospheric dispersion model. We used conditional logistic regression to estimate odds ratios associated with an increase in the interquartile range of daily SO2 mean and peak exposures (31.2 ppb for AERMOD peaks). We adjusted for temperature, relative humidity, and regional/urban background air pollutant levels. RESULTS: The risks of asthma ED visits and hospitalizations were more pronounced for same-day (lag 0) SO2 peak levels than for mean levels on the same day, or for other lags: the adjusted odds ratios estimated for same-day SO2 peak levels from AERMOD were 1.10 [95% confidence interval (CI), 1.00-1.22] and 1.42 (95% CI, 1.10-1.82), over the interquartile range, for ED visits and hospital admissions, respectively. CONCLUSIONS: Short-term episodes of increased SO2 exposures from refinery stack emissions were associated with a higher number of asthma episodes in nearby children

Effect of Family Medicine Groups on Visits to the Emergency Department among Diabetics in Quebec between 2000 and 2011: A Population-Based Segmented Regression Analysis of an Interrupted Time Series

Poster Presentation Background: Family Medicine Groups (FMG) were introduced in Quebec in 2002 to reorganize primary care practices and encourage team-based and inter-professional approaches to service delivery. We measured the effect of this reform on the rate of emergency department (ED) visits among patients diagnosed with diabetes. Methods: Administrative databases were used to derive the weekly rate of ED visits between April 1, 2000 and March 31, 2012. We performed an interrupted segmented regression analysis to derive the estimated and extrapolated rates of visits in the years following the initial reform implementation. We employed an outcome control series of diabetics visiting the ED to treat appendicitis to strengthen the study’s internal validity. Results: A gradual decline in the rate of visits was observed for short term diabetes related complications and total ED visits. After 9 years of reform implementation, we observed a reduction of 1.42 and 1.70 ED visits per 10,000 diabetics to treat short term complications in urban and rural areas, respectively. A steady decrease was also observed in the total rate of ED visits in urban areas where we observed a reduction of 6.72 visits per 10,000 diabetics 9 years following the reform. Visits coded for appendicitis showed no clinically relevant changes over the study period. Interpretation: Our results suggest that the decreases in the rate of ED visits are attributed to the implementation of the FMG model across the province. The steady decline in the rate of total ED visits in urban areas is of particular relevance where overutilization of the ED is a problem. Evidence of these decreases despite the low-intensity nature of the FMG reform suggests the potential for this model to act as a future platform for implementing comprehensive care models for chronic disease management

Nutritional content of sliced bread available in Quebec, Canada : focus on sodium and fibre content

Bread is a highly consumed food and an important source of nutrients in the diet of Canadians, underlining the need to improve its nutritional quality. The Food Quality Observatory (Observatory) aimed to evaluate the nutritional value of the sliced bread products available in Quebec (Canada), according to their grain type and main flour. Analyses included comparing the bread’s sodium content to Health Canada’s daily values (DV) and sodium voluntary targets, comparing the bread’s fibre content thresholds with the source of fibre mentioned, and assessing whether the main flour was associated with the nutrient content. The nutritional values of 294 sliced breads available in Quebec were merged with sales data (from October 2016 to October 2017), with 262 products successfully cross-referenced. The results showed that 64% of the breads purchased were ‘low’ in fibre (i.e., below 2 g per two slices), while 47% were ‘high’ in sodium (i.e., above 15% DV per two slices). Attention should be paid to 100% refined grain bread and to bread with refined flour as the main flour, since they are great sellers, while showing a less favourable nutrient content. This study shows that there is room for improvement in the nutritional content of Quebec’s bread offer, particularly regarding sodium and fibre content

Assessing nutritional value of ready-to-eat breakfast cereals in the province of Quebec (Canada) : a study from the Food Quality Observatory

Objective: The Food Quality Observatory was created in the province of Quebec (Canada) in 2016. In this study, the Observatory aimed to generate a methodology to (1) test the use of sales data combined with nutrient values to characterise the nutritional composition of ready-to-eat (RTE) breakfast cereals offered and purchased in the province of Quebec (Canada) and (2) verify the extent to which a front-of-pack label based on the percentage of daily value (DV) for total sugar, as a strategy to improve the food supply, would be distributed in this food category. Design: Nutritional information were obtained by purchasing each RTE breakfast cereal available in the Greater Montreal area. Cereals were then classified according to their processing type. Setting: The nutritional values of 331 RTE breakfast cereals available in Quebec were merged with sales data covering the period between May 2016 and May 2017. A total of 306 products were successfully cross-referenced. Results: Granola and sweetened cereals were the most available (36·6 % and 19·6 %, respectively) and purchased (19·8 % and 40·9 % of sales, respectively). When compared with other types of cereals, granola cereals had a higher energy, fat, saturated fat, protein content and a lower Na content. A larger proportion of chocolate (65 %) and sweetened cereals (49 %) were above 15 % of the DV for sugar. Conclusions: This study showed that the methodology developed generates important data to monitor nutritional quality of the food supply and ultimately contribute to improve the nutritional quality of processed foods

Risk of Asthmatic Episodes in Children Exposed to Sulfur Dioxide Stack Emissions from a Refinery Point Source in Montreal, Canada

BACKGROUND: Little is known about the respiratory effects of short-term exposures to petroleum refinery emissions in young children. This study is an extension of an ecologic study that found an increased rate of hospitalizations for respiratory conditions among children living near petroleum refineries in Montreal (Canada). METHODS: We used a time-stratified case-crossover design to assess the risk of asthma episodes in relation to short-term variations in sulfur dioxide levels among children 2-4 years of age living within 0.5-7.5 km of the refinery stacks. Health data used to measure asthma episodes included emergency department (ED) visits and hospital admissions from 1996 to 2004. We estimated daily levels of SO2 at the residence of children using a) two fixed-site SO2 monitors located near the refineries and b) the AERMOD (American Meteorological Society/Environmental Protection Agency Regulatory Model) atmospheric dispersion model. We used conditional logistic regression to estimate odds ratios associated with an increase in the interquartile range of daily SO2 mean and peak exposures (31.2 ppb for AERMOD peaks). We adjusted for temperature, relative humidity, and regional/urban background air pollutant levels. RESULTS: The risks of asthma ED visits and hospitalizations were more pronounced for same-day (lag 0) SO2 peak levels than for mean levels on the same day, or for other lags: the adjusted odds ratios estimated for same-day SO2 peak levels from AERMOD were 1.10 [95% confidence interval (CI), 1.00-1.22] and 1.42 (95% CI, 1.10-1.82), over the interquartile range, for ED visits and hospital admissions, respectively. CONCLUSIONS: Short-term episodes of increased SO2 exposures from refinery stack emissions were associated with a higher number of asthma episodes in nearby children

Statut et apports en fer chez les femmes non enceintes du Nunavik

La prévalence d'anémie, de déficience en fer et d'anémie ferriprive ainsi que les apports en fer total et absorbable ont été évalués chez un groupe représentatif de femmes inuites non enceintes âgées de 18 à 74 ans résidant au Nunavik. L'anémie, la déficience en fer et l'anémie ferriprive étaient présentes chez 43%, 36% et 21% de ces femmes respectivement (n=466). Une proportion plus importante de femmes âgées entre 18 et 49 ans souffraient d'anémie ferriprive (61 % des cas d'anémie), alors que les femmes de plus de 50 ans souffraient davantage d'anémie de type inflammatoire (42% des anémies). Les apports en fer total ont été estimés à 14 mg/jour et ceux en fer absorbable à 1,5 mg/jour (n=346). En tout, 23 % des femmes avaient des apports insuffisants en fer total et 45 % avaient des apports insuffisants en fer absorbable le jour précédant l'entrevue. La prévalence d'apports inadéquats en fer absorbable a été associée avec la déficience en fer et la déplétion des réserves, alors qu'aucune relation significative n'a été trouvée avec le fer total. Les déficiences en vitamines A, B₉ et B₁₂ sont peu fréquentes et ne semblent pas être des facteurs étiologiques importants de l'anémie chez les femmes du Nunavik. Cependant, une consommation plus faible de céréales et de boissons sucrés, des apports plus élevés de mollusques, l'obésité abdominale, la sécurité alimentaire et l'emploi ont été associés avec un meilleur statut en fer selon les analyses multivariées. L'anémie et la carence en fer sont des problèmes majeurs de santé au Nunavik. Bien que l'OMS recommande une supplémentation en fer universelle lorsque la prévalence d'anémie ferriprive excède 20%, des programmes d'intervention en nutrition sont requis de façon urgente pour améliorer le statut en fer des femmes inuites du Nunavik