Statut socio-économique et utilisation des services de santé à Montréal

National health insurance was implemented in Quebec in late 1970. Previously reported surveys carried out in Montreal in 1969-70 and 1971-72 showed that while there was no change in overall volume of services, there was a redistribution, with increases among the poor and decreases among the wealthy. We conducted a survey in late 1974 to determine the "steady-state" impact of l’assurance-maladie on social class differences in health care utilization. In a socially heterogeneous area of Montreal 1,559 households were surveyed. When reported morbidity status was taken into account, physician visit rates in the past two weeks were 21.6 per cent, 20.2 per cent, and 20.4 per cent in low, middle and high economic classes respectively, confirming the disparity of access has been reduced. However, relative to the non-poor, the poor still made considerable use of hospital clinics and emergency rooms for primary care and more of their visits entailed prescriptions and physician-initiated requests to return. The latter may indicate that the poor still consult the doctor for more advanced conditions than the non-poor. There is no evidence of abuse of "free" medical care by the poor. In contrast to the equalization in use of physician services, dental services are still unequally distributed, although compared with the 1969-70 and 1971-72 surveys, utilization rates were higher in 1974 in all social classes. The overall increase in per capita physician visits was confirmed by statistics of the Régie de l’assurance-maladie du Québec. A parallel increase in the supply of physicians kept the workload of the average physician at a constant level

Statut socio-économique et utilisation des services de santé à Montréal

National health insurance was implemented in Quebec in late 1970. Previously reported surveys carried out in Montreal in 1969-70 and 1971-72 showed that while there was no change in overall volume of services, there was a redistribution, with increases among the poor and decreases among the wealthy. We conducted a survey in late 1974 to determine the "steady-state" impact of l’assurance-maladie on social class differences in health care utilization. In a socially heterogeneous area of Montreal 1,559 households were surveyed. When reported morbidity status was taken into account, physician visit rates in the past two weeks were 21.6 per cent, 20.2 per cent, and 20.4 per cent in low, middle and high economic classes respectively, confirming the disparity of access has been reduced. However, relative to the non-poor, the poor still made considerable use of hospital clinics and emergency rooms for primary care and more of their visits entailed prescriptions and physician-initiated requests to return. The latter may indicate that the poor still consult the doctor for more advanced conditions than the non-poor. There is no evidence of abuse of "free" medical care by the poor. In contrast to the equalization in use of physician services, dental services are still unequally distributed, although compared with the 1969-70 and 1971-72 surveys, utilization rates were higher in 1974 in all social classes. The overall increase in per capita physician visits was confirmed by statistics of the Régie de l’assurance-maladie du Québec. A parallel increase in the supply of physicians kept the workload of the average physician at a constant level.

The consumption of coffee and black tea and the risk of lung cancer

Purpose Coffee and black tea are among the most consumed beverages worldwide. While their potential role in lung cancer occurrence has been investigated in several studies, results have been inconclusive. We investigated the associations between intake of coffee and black tea with lung cancer in a population-based case-control study in Montreal, Canada. Methods These analyses included 1,130 cases and 1,483 controls. Adjusted odds ratios (OR) were estimated between four metrics of coffee and black tea consumption (frequency, average daily amount, duration, and cumulative amount) and lung cancer, using unconditional logistic regression. Results The adjusted ORs (95% confidence intervals) for lung cancer comparing daily to never consumers were 0.73 (0.49-1.10) for coffee and 1.05 (0.85-1.31) for black tea. Analyses of other metrics did not reveal any clear patterns of increasing or decreasing risk with increasing amounts or duration of consumption. There was no strong evidence of OR modification by sex or smoking level. The OR estimates did not materially differ by histological subtype for either of the beverages. Conclusion Our results do not provide strong support for associations between consumption of coffee and black tea and lung cancer

Inverse Association between Dietary Intake of Selected Carotenoids and Vitamin C and Risk of Lung Cancer.

While diets rich in fruit and vegetables appear to reduce lung cancer risk, the evidence for individual carotenoid and vitamin intakes has been judged too limited to reach firm conclusions. Data from a case-control study of lung cancer (Montreal, QC, Canada, 1996-2002) were used to investigate the role of dietary intakes of β-carotene, α-carotene, β-cryptoxanthin, lutein/zeaxanthin, lycopene, and vitamin C in lung cancer risk. In-person interviews elicited dietary information from 1,105 incident cases and 1,449 population controls. Usual frequency of consumption of 49 fruits and vegetables 2 years prior to diagnosis/interview was collected. Odds ratios (ORs) and 95% confidence intervals (CIs) between intake variables and lung cancer were estimated using logistic or polytomous regression, adjusting for potential confounding factors including a detailed smoking history. ORs associated with upper versus lower tertiles of intake were 0.66 (95% CI = 0.51-0.84) for β-carotene, 0.70 (95% CI = 0.55-0.90) for α-carotene, 0.65 (95% CI = 0.51-0.84) for β-cryptoxanthin, 0.75 (95% CI = 0.59-0.95) for lycopene, and 0.74 (95% CI = 0.58-0.96) for vitamin C. ORs suggestive of a protective effect were found for elevated intakes of β-carotene, α-carotene, β-cryptoxanthin, and lycopene in male heavy smokers and of vitamin C in female heavy smokers. Selected antioxidants were also associated with a lower risk of lung cancer in female moderate smokers, and of squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. These results suggest that several dietary antioxidants found in common food sources may protect against lung cancer, even among heavy smokers

Listing Occupational Carcinogens

The occupational environment has been a most fruitful one for investigating the etiology of human cancer. Many recognized human carcinogens are occupational carcinogens. There is a large volume of epidemiologic and experimental data concerning cancer risks in different work environments. It is important to synthesize this information for both scientific and public health purposes. Various organizations and individuals have published lists of occupational carcinogens. However, such lists have been limited by unclear criteria for which recognized carcinogens should be considered occupational carcinogens, and by inconsistent and incomplete information on the occupations and industries in which the carcinogenic substances may be found and on their target sites of cancer. Based largely on the evaluations published by the International Agency for Research on Cancer, and augmented with additional information, the present article represents an attempt to summarize, in tabular form, current knowledge on occupational carcinogens, the occupations and industries in which they are found, and their target organs. We have considered 28 agents as definite occupational carcinogens, 27 agents as probable occupational carcinogens, and 113 agents as possible occupational carcinogens. These tables should be useful for regulatory or preventive purposes and for scientific purposes in research priority setting and in understanding carcinogenesis

Maternal Exposure to Occupational Solvents and Childhood Leukemia

Many organic solvents are considered probable carcinogens. We carried out a population-based case–control study including 790 incident cases of childhood acute lymphoblastic leukemia and as many healthy controls, matched on age and sex. Maternal occupational exposure to solvents before and during pregnancy was estimated using the expert method, which involves chemists coding each individual’s job for specific contaminants. Home exposure to solvents was also evaluated. The frequency of exposure to specific agents or mixtures was generally low. Results were generally similar for the period ranging from 2 years before pregnancy up to birth and for the pregnancy period alone. For the former period, the odds ratio (OR), adjusted for maternal age and sex, for any exposure to all solvents together was 1.11 [95% confidence interval (CI), 0.88–1.40]. Increased risks were observed for specific exposures, such as to 1,1,1-trichloroethane (OR = 7.55; 95% CI, 0.92–61.97), toluene (OR = 1.88; 95% CI, 1.01–3.47), and mineral spirits (OR = 1.82; 95% CI, 1.05–3.14). There were stronger indications of moderately increased risks associated with exposure to alkanes (C5–C17; OR = 1.78; 95% CI, 1.11–2.86) and mononuclear aromatic hydrocarbons (OR = 1.64; 95% CI, 1.12–2.41). Risk did not increase with increasing exposure, except for alkanes, where a significant trend (p = 0.04) was observed. Home exposure was not associated with increased risk. Using an elaborate exposure coding method, this study shows that maternal exposure to solvents in the workplace does not seem to play a major role in childhood leukemia