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1.
Syst Rev ; 11(1): 275, 2022 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-36529833

RESUMO

BACKGROUND AND AIMS: Young people with stroke (YPwS) persistently experience challenges with disability, social reintegration, employment, and financial stability to provide for themselves and their families. The aims of this scoping review are to (1) identify and collate information resources for YPwS and evidence-based self-managements programs and (2) identify gaps in age-specific resources available for YPwS after traditional rehabilitation services have ended and/or who are returning to live in the community. METHODS: We will include both qualitative and quantitative studies, including all study designs. Participants will be community-dwelling adults aged between 18 and 65 years with a clinical diagnosis of stroke. We will include information resources and evidence-based self-managements programs for YPwS. Search terms will include stroke, young people, and community dwelling. We will search electronic databases such as MEDLINE. The reference lists of included studies, systematic reviews, and stroke guidelines and stroke-specific websites will also be searched. We will also contact Stroke Support Organizations and international/national allied health professional organisations to gather information resources about YPwS. We will also conduct a comprehensive environmental scan of additional resources using the search engine Google. The titles, abstracts, full-text articles, and contents of the resources identified by the search will be assessed against the inclusion and exclusion criteria to identify potentially relevant resources. RESULTS AND CONCLUSIONS: Existing resources and self-management programs will be collated and categorized according to the type of needs addressed such as physical, emotions, activities of daily living, information, relationships, and social needs as well as the key gaps identified.


Assuntos
Atividades Cotidianas , Acidente Vascular Cerebral , Adulto , Humanos , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Acidente Vascular Cerebral/terapia , Vida Independente , Projetos de Pesquisa , Fatores Etários , Literatura de Revisão como Assunto
2.
Acta Psychiatr Scand ; 134(5): 374-384, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27404582

RESUMO

OBJECTIVE: The objective was to compare, in a real-world setting, the risk of mental and physical health events associated with different antipsychotic drugs (clozapine, olanzapine, risperidone, quetiapine and first-generation antipsychotics) in patients with SZ. METHODS: This is a retrospective cohort study using administrative data. Outcome measures included any mental health event (suicide, hospitalization or emergency visit for mental disorders) and physical health event (death other than suicide, hospitalization or emergency visit for physical disorders). Cox proportional hazard models were used to estimate the hazard ratios of the events associated with the use of the different antipsychotic drugs. RESULTS: The cohort included 18 869 adult patients living in the province of Quebec (Canada) with SZ and starting antipsychotic drugs between January 1998 and December 2005. Results show that quetiapine and not using any antipsychotics were associated with an increased risk of mental and physical health events as compared to other drugs. The second finding is the confirmation of better performance of clozapine. The results were robust across sensitivity analyses. CONCLUSION: Both findings call for an international public health and drug agencies surveillance of 'real-world' antipsychotic medication to ensure the optimal choices in treatment guidelines for SZ.


Assuntos
Antipsicóticos/administração & dosagem , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/efeitos adversos , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Clozapina/administração & dosagem , Clozapina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina , Modelos de Riscos Proporcionais , Quebeque , Fumarato de Quetiapina/administração & dosagem , Fumarato de Quetiapina/efeitos adversos , Estudos Retrospectivos , Risperidona/administração & dosagem , Risperidona/efeitos adversos , Resultado do Tratamento
3.
Can J Neurol Sci ; 38(5): 728-33, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21856576

RESUMO

OBJECTIVE: Despite the evidence of cognitive deficits in Multiple Sclerosis (MS) patients, evaluation of their cognitive integrity is often limited to the use of clinical interviews and questionnaires. However, the consensus in the literature is that these patients under- or overestimate their deficits and repercussions. The objective of this study was to clarify why some patients overestimate while others underestimate their memory deficits. METHOD: Fifty-four participants (30 MS, 24 controls) completed the Prospective and Retrospective Memory Questionnaire (PRMQ) and were tested on a battery of neuropsychological tests. Based on the test results, MS patients were categorized as having either mild or moderate/severe cognitive deficits. RESULTS: The moderate/severe MS group differed from the two other groups on the Rey Auditory Verbal Learning Test (RAVLT) but did not differ from the control group on the PRMQ. Conversely, the mild MS group did not differ from the control group on the RAVLT but did report significantly more problems than this group on the PRMQ. There was no difference between the two clinical groups on the Depression Index (Beck) but there was a significant correlation (r=.409) between the depression scores and the overestimation of prospective memory problems (PRMQ). CONCLUSION: The results explain the contradiction in the literature. It is the mild group who overestimates, maybe because they are overly concerned by their deficits, whereas the cognitive impairments of the moderate/severe group lead them to underestimate and may make their self-assessment unreliable. Formal testing or information from a significant other would be advisable.


Assuntos
Transtornos Cognitivos/etiologia , Transtornos da Memória/complicações , Transtornos da Memória/etiologia , Esclerose Múltipla/complicações , Adulto , Análise de Variância , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Humanos , Masculino , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Inquéritos e Questionários , Aprendizagem Verbal/fisiologia
4.
J Thromb Haemost ; 9 Suppl 1: 56-65, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21781242

RESUMO

The haemostatic role of platelets was established in the 1880s by Bizzozero who observed their ability to adhere and aggregate at sites of vascular injury. It was only some 80 years later that the function of platelets in maintaining the structural integrity of intact blood vessels was reported by Danielli. Danielli noted that platelets help preserve the barrier function of endothelium during organ perfusion. Subsequent studies have demonstrated further that platelets are continuously needed to support intact mature blood vessels. More recently, platelets were shown to safeguard developing vessels, lymphatics, as well as the microvasculature at sites of leukocyte infiltration, including inflamed organs and tumours. Interestingly, from a mechanistic point of view, the supporting role of platelets in these various vessels does not necessarily involve the well-understood process of platelet plug formation but, rather, may rely on secretion of the various platelet granules and their many active components. The present review focuses on these nonconventional aspects of platelet biology and function by presenting situations in which platelets intervene to maintain vascular integrity and discusses possible mechanisms of their actions. We propose that modulating these newly described platelet functions may help treat haemorrhage as well as treat cancer by increasing the efficacy of drug delivery to tumours.


Assuntos
Plaquetas/fisiologia , Animais , Hemostasia , Humanos
5.
Child Care Health Dev ; 36(3): 421-7, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-19961503

RESUMO

BACKGROUND: This study examines how active transportation could help increase the daily physical activity volume of school-aged children. METHODS: Using data from the 2003 Origin-Destination Survey carried out among 5% of the 3.5 million residents of the Greater Montreal Area, we determined the proportion of short motorized trips made daily by children 5-14 years old (16 837 children sampled) and estimated the number of steps these trips would account for if they were travelled by foot, taking into account variables such as age, sex and height of children. Modal choice and trip purpose were also examined. RESULTS: In 2003, 31.2% of the daily trips made by children aged 5-14 years in the Greater Montreal Area were 1 km or less (0.6 mile). Of these, 33.0% were motorized trips. Overall, 13.1% of the children in the area had 'steps in reserve', an average of 2238 steps per child per day. If they were performed, these steps would account for 16.6% of the daily recommended volume of physical activity for children. CONCLUSION: Replacing short motorized trips with walking could increase the physical activity level of children and contribute to meet the recommended guidelines, as long as these walking trips add to their daily physical activity volume. It could also reduce their dependence towards adults for moving around.


Assuntos
Ciclismo/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Meios de Transporte/estatística & dados numéricos , Caminhada/estatística & dados numéricos , Adolescente , Canadá , Criança , Pré-Escolar , Exercício Físico/fisiologia , Feminino , Promoção da Saúde , Humanos , Masculino , Atividade Motora/fisiologia , Meios de Transporte/métodos
6.
Leukemia ; 21(12): 2506-11, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17805326

RESUMO

Previous studies have shown that high levels of MMP-9 can be detected in the serum of patients with various lymphoid malignancies and in leukemia/lymphoma culture supernatants. Indeed, aggressive forms of lymphoma constitutively produce MMP-9 and its elevated levels in the serum or in tissues correlate with advanced stage and poor patient survival. In vitro, MMP-9, which is also produced by the host peritumoral cells in response to the presence of tumors, plays an important role in migration of tumor cells through artificial basement membranes or endothelial cells. In this study, using MMP-9-deficient mice, we show that absence of MMP-9 does not prevent the development of primary T-cell leukemia. Furthermore, MMP-9-deficient cell lines retained their tumorigenic potential, as shown by their ability to induce thymic lymphoma in young syngeneic wild-type animals. In addition, these MMP-9-deficient tumor cells disseminate in normal mice, or mice that are deficient for MMP-9, indicating that tumor growth and dissemination can occur in total absence of MMP-9. These results show for the first time than lymphoma growth can occur in total absence of MMP-9 and have consequences for therapy of invasive cancers with inhibitors of MMPs.


Assuntos
Leucemia Induzida por Radiação/enzimologia , Leucemia de Células T/enzimologia , Linfoma de Células T/enzimologia , Metaloproteinase 9 da Matriz/deficiência , Proteínas de Neoplasias/deficiência , Neoplasias Induzidas por Radiação/enzimologia , Neoplasias do Timo/enzimologia , Animais , Linhagem Celular Tumoral/transplante , Cruzamentos Genéticos , Feminino , Leucemia Induzida por Radiação/patologia , Leucemia de Células T/etiologia , Linfoma de Células T/etiologia , Linfoma de Células T/patologia , Masculino , Metaloproteinase 9 da Matriz/genética , Metaloproteinase 9 da Matriz/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Invasividade Neoplásica/patologia , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/fisiologia , Neoplasias Induzidas por Radiação/patologia , Organismos Livres de Patógenos Específicos , Neoplasias do Timo/etiologia , Neoplasias do Timo/patologia
7.
Int J Obes (Lond) ; 30(4): 677-83, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16276358

RESUMO

CONTEXT: Obesity rates are rising sharply among all industrialized countries; the situation seems to be worse in English speaking countries. Taking into account genetic predisposition, excess of caloric intake combined with low energy expenditure will usually result in obesity. OBJECTIVES: To describe and compare regional obesity rates across Canada and assess the ecological relationship between regional rates of obesity, low level of leisure-time physical activity, and low fruit and vegetable consumption. DESIGN: Cross-sectional population-based analysis from the 2003 Canadian Community Health Survey. MEASURES AND DATA ANALYSES: Canadian population distributions of body mass index (BMI), leisure-time physical activity and daily fruit and vegetable consumption were obtained from Statistics Canada. All these measures were based on the respondent's self-reported answers to a computer-assisted personal or telephone interview. Obesity rates (BMI> or =30), rates of low level of leisure-time physical activity (less than 1.5 kcal of energy expenditure per day), and rates of low fruit and vegetable consumption (less than five times a day) for the 106 Canadian Health regions were mapped to illustrate their geographical distribution. Cartograms were used in addition to traditional mapping to take into account the differences in population density between these small areas. RESULTS: In 2003, 15.2% of Canadian individuals aged 20 years and older were considered obese. The rates of obesity varied substantially between the 106 Canadian health regions: from 6.2% in Vancouver to 47.5% in aboriginal population area. At the health region level, low leisure-time physical activity and low fruit and vegetable consumption are both good predictors of obesity (odds ratio of 9.2 and positive predictive value of 93% when considered simultaneously). CONCLUSION: There is a strong gradient in obesity prevalence between Canadian health regions. At the regional level, high rates of low level of physical activity, and high rates of low fruit and vegetable consumption were both found good predictors of high rates of obesity.


Assuntos
Dieta , Exercício Físico , Frutas , Obesidade/epidemiologia , Verduras , Adulto , Idoso , Índice de Massa Corporal , Canadá/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Inquéritos e Questionários
9.
Leukemia ; 17(4): 751-9, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12682633

RESUMO

We have previously shown that ICAM-1-deficient mice were resistant to lymphoma dissemination of intravenously injected 164T2 lymphoma cells. Highly aggressive variants of this cell line, however, could overcome this resistance. To discern the complex pattern of gene expression involved in the evolution of aggressiveness in lymphoma cells, we compared the transcriptome of 164T2 cells with that of their aggressive variants using cDNA arrays. We identified several genes that were differentially expressed in nonmetastatic lymphoma cells and their metastatic variants. Galectin-7, associated with the development of chemically induced mammary carcinoma, was one such gene whose expression was significantly upregulated. We showed that it was constitutively expressed in aggressive variants, at both mRNA and protein levels. Galectin-7 expression in aggressive lymphoma cells was induced upon in vivo selection in several organs, including the thymus, the spleen and kidneys. We also showed that treatment of nonaggressive lymphoma cells with 5-aza-2'-deoxycytidine was sufficient to induce galectin-7 gene expression. This report is the first to show that galectin-7 is expressed in aggressive lymphoma.


Assuntos
Azacitidina/análogos & derivados , Galectinas/biossíntese , Regulação Neoplásica da Expressão Gênica , Linfoma de Células T/metabolismo , Proteínas de Neoplasias/biossíntese , Neoplasias Induzidas por Radiação/metabolismo , Neoplasias do Timo/metabolismo , Animais , Antimetabólitos Antineoplásicos/farmacologia , Azacitidina/farmacologia , Decitabina , Progressão da Doença , Feminino , Galectinas/genética , Galectinas/fisiologia , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Linfoma de Células T/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Metástase Neoplásica , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/fisiologia , Transplante de Neoplasias , Neoplasias Induzidas por Radiação/patologia , Análise de Sequência com Séries de Oligonucleotídeos , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , RNA Neoplásico/biossíntese , RNA Neoplásico/genética , Organismos Livres de Patógenos Específicos , Neoplasias do Timo/patologia , Células Tumorais Cultivadas/efeitos dos fármacos , Células Tumorais Cultivadas/metabolismo , Células Tumorais Cultivadas/patologia
10.
J Dairy Sci ; 85(11): 3013-25, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12487467

RESUMO

The effect of dietary fiber on endogenous N secretion was studied using a 15N isotope dilution technique in four fistulated Holstein cows. Two isonitrogenous diets differing only in fiber (NDF and ADF) content were used in a crossover design. One diet (HF) contained 37.4% NDF, while the other (LF) contained 23.3%. A new model was developed to estimate endogenous N secretions and losses for the preintestinal, intestinal, and the total sections of the gastrointestinal tract. Three precursor pools: TCA-soluble fraction of plasma, intestinal mucosa, and milk were compared. Although endogenous losses estimated with the model were numerically different for each precursor pool selected (TCA-soluble fraction > mucosa > milk), treatment effects were similar. As intestinal mucosa is probably closest to the precursor pool, these data are discussed. Non-urea N endogenous secretions contributed 13% of the duodenal N flow but were not affected by the fiber content of the diet. The nonurea N endogenous flow at the duodenum was comprised of approximately equal inputs from endogenous N direct, and that incorporated into the microbial biomass. Total endogenous N flows at the duodenum exceeded, by nearly twofold, estimated inputs of urea-N to microbial biomass. Metabolic fecal output averaged 17% of fecal N and was not affected by level of dietary fiber, but net losses from secretions occurring in the small intestine were higher with the low fiber diet. Overall, endogenous N secretions represented 30% of total digestive tract protein synthesis.


Assuntos
Bovinos/fisiologia , Fibras na Dieta/farmacologia , Intestino Delgado/metabolismo , Nitrogênio/metabolismo , Rúmen/metabolismo , Animais , Bovinos/metabolismo , Estudos Cross-Over , Fibras na Dieta/administração & dosagem , Digestão , Duodeno/metabolismo , Duodeno/microbiologia , Feminino , Conteúdo Gastrointestinal/química , Trânsito Gastrointestinal , Íleo/metabolismo , Lactação/metabolismo , Leite/química , Modelos Biológicos , Isótopos de Nitrogênio
11.
Am Surg ; 67(2): 115-7; discussion 117-8, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11243531

RESUMO

Controversy persists regarding the most effective inguinal hernia repair. The purpose of this study is to compare the complications, charges, patient satisfaction, and recovery time between laparoscopic (LH) and open mesh herniorrhaphy (OH). A nonrandomized prospective analysis of 233 consecutive inguinal hernia repairs was performed over a 12-month period by 27 surgeons. The type of repair was determined by surgeon preference. Cost analysis was performed using anesthesia records and hospital cost. Patient satisfaction and recovery time were evaluated by third-party interview. A total of 113 OHs and 120 LHs were performed; 11 OHs and 42 LHs were bilateral. Patient demographics were equivalent for the two groups. No statistical difference was noted when comparing anesthesia/operating room time between the two groups. The LHs accrued an additional charge of $2254 per case. Complication rates were 4.4 per cent for the OHs and 8.3 per cent for the LHs. All complications were considered minor. No infectious complications or recurrences were noted in either group. Satisfaction rates and pain indices were nearly identical for both OHs and LHs. The LHs had a shorter recovery time by 5.5 days. We conclude that LH is associated with a higher complication rate and cost than OH. Pain indices are similar, but LH has a shorter recovery time.


Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia , Estudos de Coortes , Custos e Análise de Custo , Humanos , Laparoscopia/economia , Laparoscopia/estatística & dados numéricos , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Tempo
13.
Sante Ment Que ; 26(2): 62-91, 2001.
Artigo em Francês | MEDLINE | ID: mdl-18253606

RESUMO

This article's objective is to share the clinical experience acquired through the activities of the Substance abuse Group established within the framework of the program destined to people suffering from a first psychosis at the Polyclinique Sainte-Anne, an external clinic of the Centre Hospitalier Robert-Giffard. Inspired by an american program specifically designed for people with schizophrenia and a problem of addiction, this psychoeducation and skills training program's goal is to help participants develop the motivation to reduce or cease their use, to recognize high risk situations and develop the skills to avoid relapse and reduce the ill effects of substance abuse.

15.
J Clin Psychopharmacol ; 20(3): 295-304, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10831015

RESUMO

This study compared the long-term (12 months) effectiveness of risperidone (RP) with that of conventional neuroleptics (CNs) in a population with chronic schizophrenia who had shown suboptimal response to CNs. A randomized, open, parallel, multicenter design was used. One hundred eighty-four subjects meeting DSM-IV criteria for schizophrenia were randomly assigned to receive either RP or a CN, and 165 of them completed the follow-up. Outcome measures were taken at 3, 6, and 12 months and included the Positive and Negative Syndrome Scale (PANSS) and the Extrapyramidal Symptom Rating Scale. Within this 12-month follow-up, RP was found to be superior to CNs in terms of both the average change in score from baseline on the PANSS (p = 0.006) and the proportion of good responders (as defined by a 20% decrease in total PANSS scores;p = 0.03). For positive symptoms, the effectiveness of the RP treatment tended to increase over time. At 12 months, the percentage of good responders in the RP group was twice as large as that in the CN group (30% vs. 15%;p = 0.03). The superiority of RP over CNs was constant over the three dose categories. In both the RP and the CN groups, the maximum decrease in psychopathology was achieved with the lowest dose range. A worsening of akathisia was less frequent in subjects receiving RP than in those receiving CNs (p = 0.02). In conclusion, this study showed that, compared with CNs, RP is beneficial in the treatment of patients with chronic schizophrenia and that some of these benefits may appear only after longer-term treatment.


Assuntos
Antipsicóticos/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/efeitos adversos , Doença Crônica , Relação Dose-Resposta a Droga , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento , Escalas de Graduação Psiquiátrica , Risperidona/efeitos adversos , Psicologia do Esquizofrênico
17.
JSLS ; 3(2): 137-40, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10444014

RESUMO

Gallbladder duplication is an unusual congenital biliary anomaly, and its laparoscopic management has rarely been described. This is a report of a gallbladder duplication successfully treated with laparoscopic cholecystectomies. Previous cases are summarized, and recommendations for optimal laparoscopic management are presented.


Assuntos
Vesícula Biliar/anormalidades , Laparoscopia , Feminino , Humanos , Pessoa de Meia-Idade
19.
Can Fam Physician ; 44: 73-9, 1998 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9481465

RESUMO

OBJECTIVES: To evaluate the efficacy and applicability of a behavioural treatment for insomnia that can be administered by family physicians in various clinical settings. DESIGN: Efficacy of the treatment was evaluated by single-case experimental designs (multiple baseline across subjects). Applicability was assessed through semistructured interviews with physicians. SETTING: Two private offices, two offices in community health centres, and one office in a family medicine unit. PARTICIPANTS: Six general practitioners and 24 chronic insomniac patients recruited through media advertisements and from physicians' practices. Of an initial 38 subjects screened, six were excluded for sleep-onset latency less than 30 minutes, five for psychological conditions, one for physical handicaps, and two for other reasons. INTERVENTIONS: Physicians used stimulus-control treatment during individual therapeutic sessions. Patients using hypnotics were encouraged to taper off their medications after treatment was initiated. MAIN OUTCOME MEASURES: Time it took patients to get to sleep (sleep-onset latency), amount of hypnotic use, and practitioners' evaluation of the treatment. RESULTS: Fifteen patients completed the treatment; 80% of them reduced their sleep-onset latency. Six of the seven patients using hypnotics at the beginning of the study reduced or stopped their medications. All therapeutic gains were maintained at 3 and 6 months. Physicians thought stimulus-control treatment could be used in medical practice, but specified that it was most useful for highly motivated patients. CONCLUSION: Family physicians can use stimulus-control treatment effectively for patients with chronic insomnia. This nonpharmacologic approach could help motivated patients reduce their use of hypnotics.


Assuntos
Terapia Comportamental , Distúrbios do Início e da Manutenção do Sono/terapia , Adulto , Doença Crônica , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Sono , Resultado do Tratamento
20.
CMAJ ; 155(11): 1555-60, 1996 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-8956832

RESUMO

OBJECTIVE: To examine what role demographic factors and increases in physician fees and utilization played in the rise in costs of physician services provided for elderly people in Quebec between 1982 and 1992, and to investigate changes in patterns of care (type and amount of services) related to utilization. DESIGN: Retrospective study of population-based data. SETTING: Province of Quebec. SUBJECTS: Elderly people (65 years of age and over) in Quebec in 1982 (n = 589,800) and in 1992 (n = 803,600). OUTCOME MEASURES: Proportion of the increase in physician care costs attributable to (a) aging (defined as a shift in the age distribution) of the elderly population, (b) the increase in the size of the elderly population, (c) the increase in physician fees and (d) the increase in utilization of physician services; proportion of care provided by general practitioners (GPs) and by specialists; proportion of minor and complete examinations provided by GPs; and rates of hospital admissions and surgery. RESULTS: Aging was responsible for 0.5% of the increase in physician care costs between 1982 and 1992, population growth for 27.0% and the increase in physician fees for 25.5%. The increased utilization accounted for 47.0% of the total cost increase. Analyses of the utilization data revealed a shift toward more costly services, more visits to specialists and higher rates of hospital admissions and surgery in 1992 than in 1982. CONCLUSIONS: Aging and population growth had minor effects on the increase in physician care costs between 1982 and 1992. Increased utilization was the most important factor. The appropriateness of this trend needs to be verified.


Assuntos
Honorários Médicos/tendências , Serviços de Saúde para Idosos/economia , Serviços de Saúde para Idosos/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Honorários Médicos/estatística & dados numéricos , Serviços de Saúde para Idosos/tendências , Hospitalização/tendências , Humanos , Quebeque
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