Material and social deprivation and health and social services utilisation in Québec: a local-scale evaluation system.

Very few studies have employed local-scale analyses to evaluate how well primary health care and social services reach the most socially and economically deprived individuals. This paper describes a project, conducted in close partnership with decision-makers and practitioners at selected local community service centres (in French, CLSCs) in Quebec, Canada, that developed a system for assessing primary care and social services utilisation by applying deprivation levels defined at the local scale (i.e., according to the distribution of deprivation in individual CLSC service areas). More than 25 years ago, Québec started setting up a province-wide network of publicly financed CLSCs whose mission was to offer first-line health and social services at the local level. Now approximately one Quebecer in four receives at least one service a year from a CLSC. The evaluation system presented in this article is built on deprivation profiles for each CLSC service area and comprises maps, relative indices of service utilisation, and an interpretation framework that facilitates the integration of new data into the decision-making and services planning processes. Study results show that deprivation levels, when defined using local perspectives, correspond more closely to decision-makers' perceptions, that relative indices are sensitive to key determinants of services provision and utilisation, and that the interpretation framework is useful for reassessing intervention strategies.

Vasectomy and prostate cancer in Québec, Canada.

The present investigation measured the association between vasectomy and prostate cancer (PC) in the male population of Québec, Canada. The Québec Health Insurance Board and the Québec Cancer Registry were our principal sources of information. Lung cancer cases and the male population of Québec served as controls for comparative purposes. Within a retrospective design, our preliminary results indicate an association between vasectomy and PC. Among the 1925-39 birth cohort of individuals diagnosed with PC in 1990--93, the global odds ratio was 2.6 (95% CI=1.7--4.3) while it was compared with lung cancer as the control group. This risk increased with the length of time between vasectomy and the diagnosis of cancer. An historical design indicated strong cohesion of the results. Besides, the risk does not vary when we control for the place of residence of the individuals. Vasectomy seems to increase the risk of PC at least 10 years after the operation, but we cannot exclude the impact of a possible detection bias among vasectomized individuals.

[Malaria at the dawn of the millennium: lessons taken from the literature]. / Le paludisme a l'aube du millenaire: leçons tirees de la litterature.

The entomological approach has dominated in the past the geographical--epidemiological study of malaria. Nowadays, new approaches are considering aspects such as representations, attitudes to adopt, change in the transmission process according to the ecosystems. The geographical approach here highlighted implies firstly the knowledge of the geo-epidemiology at the small areas love. This approach should also consider the entomological parameters, the environmental factors and the therapeutic behaviors in order to evaluate the efficiency of the action programmes.

[Spatial/temporal analysis of the incidence of certain cancers by sites in Quebec: 1984-1986 and 1989-1991]. / Analyse espace/temps de l'incidence de certains sièges de cancer au Québec: 1984-1986 et 1989-1991.

Basing our views on recent works of an Ontarian research group, we analyze the profiles of incidence of the main types of cancers observed in the province of Québec for the periods 1984-1986 and 1989-1991. Using the Québec Tumors Registry, we have calculated standardized incidence rates according to sex for each of the 32 departments of community health in the province. A geographical analysis of cancers was conducted via two methods of spatial autocorrelation (SA). Many cancer sites (i.e., breast, lung, stomach) show a positive SA (p < 0.05), indicating an aggregation of cases. Several aggregation schemes observed in Québec resemble those observed in Ontario. In women, the highest incidence rate increases are in leukemia and lung cancer; in men, prostate cancer and leukemia show the highest increase of rates (p < 0.01). The consistency of our observations with those of the Ontario group is discussed.

[Aging and disability in Quebec: regional projections 1991-2006]. / Vieillissement et incapacites au Quebec: perspectives regionales 1991-2006.

PIP: "The rapid aging of Quebec's population in the next few decades will entail significant regional disparities. Based on regional demographic projections by the Bureau de la Statistique du Quebec (BSQ) for the years 1991-2006 and data from Statistics Canada's Health and Activity Limitation Survey (HALS), we analyze changes in clienteles with mobility impairments. This analysis shows not only the extent of regional disparities but also their impact on the evolution of disabilities that restrict mobility." (EXCERPT)^ieng

[Geo-pathologic considerations on the most frequent tumors in Quebec presented in 1984-1986 and 1989-1991]. / Considérations géo-pathologiques sur les tumeurs les plus fréquentes au Québec relevées en 1984-1986 et 1989-1991.

This study describes the geographical variations in the incidence of, and mortality due to, the most frequent cancers in Quebec. They are breast, colon and tracheal, bronchial, and lung cancers in women and prostate, colon and trachea, bronchial and lung cancers in men. Data for the periods 1984 to 1986 and 1989 to 1991 for the whole of the Quebec Community Health Department are reviewed. A direct method of standardization, with the world population as the reference population, was used to allow comparison of geographical units. The ranking correlation method was used to test correlations for the various cancer sites. There were significant coefficients between the two periods only for lung cancer for both sexes, for both incidence and mortality. The spatial autocorrelation method was used to determine the presence or absence of a geographical configuration from the estimated rates. Moran I values were positive and significant for the two periods for lung cancer associated mortality and for the incidence of breast cancer. This implicates local factors (probably associated with lifestyle). The results for the incidence of lung cancer among men and women were similar for the period 1989 to 1991. The advantages and limitations of the methods used and also the data available are considered.

Alzheimer's disease: preliminary study of spatial distribution at birth place.

Alzheimer's disease (AD) is a neurodegenerative disorder which is characterized by a progressive loss of memory and the alteration of cognitive functions. At least three chromosomal segments have been associated with early-onset AD in genetic linkage studies. These results argue for a certain degree of heterogeneity in the genetic origin of some forms of AD, although environmental risk factors cannot be ruled out in late-onset AD. In this preliminary study, we analyzed the geographical distribution of the birth places of a sample of 235 AD cases born in a defined region of Quebec (Canada), between 1895 and 1935. We wished to test the hypothesis that risk factors acting at, or around birth place and time play a role in the etiology of AD. The field of study was divided into rural and urban areas. A reference population of live births was used to compute a measure of odds ratio (OR). The OR results showed a statistically significant excess of AD cases in the rural area as compared to the reference population. When stratified for sex, the OR results showed a global excess of female AD cases in both the rural and the urban areas. For men, only the urban area presented a statistically significant deficit. We also analyzed the structures of the genealogical kinships of the rural and urban sub-groups. Although AD cases from the rural sub-group were more closely related to each other than those from the urban one, removal of the kin pairs from the OR analysis seemed to have little effect on the rural/urban distribution of cases. Therefore, the OR results would not appear to be due primarily to a difference in the kinship structures of the two sub-groups. This could mean that some risk factors for AD afflict women more strongly than men, the effect being different depending on the urban or rural origin. However, potential biases such as a higher rate of report for women, differential migration between birth places or a differential mortality ratio between sexes could produce spurious results in the direction of what we have observed in this preliminary study.

[Homogeneity of the spatial distribution of cancers of the female reproductive tract in Quebec]. / Homogénéité de la distribution spatiale des cancers du système reproducteur féminin au Québec.

Risk factors associated with women's reproductive life and sexual growth do not adequately predict cancer incidence of the breast, uterus and ovary. The heterogeneous worldwide distribution of these cancers could imply that some environmental and cultural risk factors are involved in their cancerogenesis. The few attempts made so far to unravel their spatial structures at a geographic scale facilitating the search for exogenous risk factors have proved inconclusive. This study reports the results of a spatial analysis of the cancer incidence rates for breast, cervix, endometrium and ovary among Community Health Departments (CHD) in Quebec using a spatial autocorrelation method. Correlograms built according to four definitions of the inter-CHDs distance indicate that breast and ovary incidence rates follow quite similar spatial gradients attesting to their etiologic affinity. They also suggest that the spatial distribution of endometrial cancer follows a gradient divergent from that of breast and ovary cancers, and that the CHDs' spatial scale does not suitably describe the distribution of cervical cancer. The demonstration of a structured spatial distribution for breast, endometrium and ovary cancers in Québec strengthen the hypothesis that cultural or environmental risk factors are involved in their etiology. But, the observed disparities in the spatial structure of these cancers imply that their etiologic specificity may be greater than their biologic bond would suggest.

Neurodegenerative diseases and risk factors: a literature review.

Degenerative diseases of the central nervous system are significant causes of mortality among elderly people in industrialized countries. For the most part, the causes of these diseases are unknown. It is also very difficult to diagnose this type of disease quickly and accurately. This article reviews the epidemiological research on the principal neurodegenerative disorders, focusing on geographical, hereditary and viral and toxicological exposure correlates. We look in particular at the effect of exposure to toxins as well as the effect that deficiencies of elements such as calcium and selenium could have on the development of these neurological diseases. We also consider the possible protectionist effect of some variables on the development of certain neurological diseases.

Food habits of French Canadians in Montreal, Quebec.

OBJECTIVES: Since the 1960's, marked sociocultural and economic changes have affected lifestyle, religious practices, and family structure among French Canadians in Quebec. Recent nutritional assessment was unavailable, despite indications of change. METHODS: A survey was carried out in 1988 in a representative sample living in Greater Montreal, to obtain current data on food habits, nutrient intakes and sociodemographic factors, using interviewer-administered questionnaires and seven-day food records. RESULTS: Some 845 families (1450 individuals from different age groups) were studied in two phases: summer/fall and winter/spring. Mean household size in the study population was 2.7. Among adults, extremes of educational level were observed, with 33% having elementary school only and 28% having completed university. On average, each household spent $CAN 89.90 a week for food, $26.00 for tobacco, and $13.50 for alcohol. Breakfast was eaten regularly by 90% of subjects while 96% ate lunch and 99% ate dinner. Morning snacks were consumed by 36% and afternoon snacks were taken by 50%. Milk was consumed with breakfast by 24% of respondents, with lunch by 19%, and with dinner by 24%. On weekdays, 81% of subjects ate their main meals at home, while on weekends this figure was 95%. Time spent for meals varied by meal, and was slightly longer on weekends. Specialty diets, including vegetarianism, were followed by 7% of the study subjects, while 22% adhered to health-related diets. CONCLUSIONS: The food record analyses revealed adequate nutrient intakes overall in relation to the 1990 Canadian Recommended Nutrient Intakes, although further investigation is needed before addressing dietary quality in specific age-sex groups. Protein comprised 16% of energy, fat 38%, and carbohydrates composed 45% or 46% for males and females, respectively. Subsequent analyses will evaluate nutrient intakes in relation to health and sociodemographic indicators in this population.

[Preliminary results on the residence distribution at birth of patients with Alzheimer's disease in the Saguenay-Lac-Saint-Jean/Quebec (the IMAGE project)]. / Résultats préliminaires sur la répartition lors de la naissance de sujets atteints de la maladie d'Alzheimer au Saguenay-Lac-St-Jean/Québec (projet IMAGE).

The IMAGE Project is pursuing the establishment of a population-based registry of Alzheimer's disease (AD) cases in the Saguenay-Lac-Saint-Jean (SLSJ) (Quebec). The authors report on the spatial distribution at birth of 221 possible, probable and definite cases. A large network of key-informants for screening AD cases has been established over SLSJ. The spatial distribution of cases at birth and at the onset of disease has been computed by calculating the Alzheimer birth rate (ABR) on the basis of three scales: six specific geographical spheres of screening, all municipalities, and the public health departments. The statistical significance of results was determined using the theoretical Poisson and the Chi square distributions. ABR for each of the geographical spheres of screening showed no statistically significant differences considering either residence at the onset of the disease or residence at birth. Furthermore, differences were observed between rural and urban areas with an interesting trend for a higher number of cases than expected in one area of SLSJ. The spatial distribution of cases considered on the basis of residence at birth appears to show a different pattern, but no significant, from that measured on the basis of residence at the onset of disease. Screening of cases is actively being pursued all across SLSJ by the IMAGE network. There is a clear trend towards rural residence at birth of cases. It remains to see whether or not this observation is due to a geographical concentration of familial cases.

Food habits and esophageal cancer: an overview.

Cancer of the esophagus has a more varied geographical distribution and incidence than any other commonly occurring cancer. Its incidence rate is increasing in many countries, especially among males. Esophageal cancer has been found to be associated with the consumption of alcohol and tobacco, particularly when combined, and in the last decade the role of nutrition and diet in the etiology of this disease has attracted worldwide attention. Regions with a large incidence of this disease are generally located in poor parts of the world, and their inhabitants share several dietary characteristics. They subsist on a diet high in starch and almost without fresh fruit or vegetables, eat rapidly without sufficient mastication, and consume many foods (rice gruel) and drinks (tea) at very high temperatures. Hard and scratchy foods also are consumed frequently. In the high-risk region of northern Iran, where the frequency of esophageal cancer is higher among women than men, the main food during pregnancy contains strong black pepper and sharp crushed pomegranate seeds, which irritate the esophagus.

[Mortality due to cancers of the brain and lymphatic tissues and leukemia as a function of agriculture pesticide use in Quebec (1976-1985)]. / Mortalité par cancers du cerveau, des tissus lymphatiques et la leucémie selon l'utilisation des pesticides, en agriculture, au Québec (1976-1985).

Potential hazards associated with the use of agricultural pesticides are a growing concern for society. We describe the relationships between the mortality data for cancers of the brain, the lymphatic tissues and leukemia, and the spatial distribution of agricultural pesticide use for 34 drainage basins in Quebec, from 1976-1985. The basins were grouped into three categories (low, intermediate, and high exposure) according to the level of sales of pesticides. For cancers of the lymphatic tissues among women 35 to 64 years of age, a high relative risk (RR) was observed (RR = 1.91, 95% Confidence Interval = 1.14, 3.18) in basins highly exposed to pesticides compared to those with low exposure. Analysis of correlation for this cancer at 34 basins showed significant associations between geographical distributions of the Standardized Mortality Ratio (SMR) and those of numerous variables indicative of pesticide use in agriculture. Agreement between the results for mortality data in this exploratory study and the results from another study on cancer incidence data for 1982-1983, supports the hypothesis of a potential relationship between the use of pesticides in agriculture and cancer of the lymphatic tissues.

Geographical variations of motor-vehicle injuries in Quebec, 1983-1988.

Data furnished by the Régie de l'Assurance Automobile du Québec (RAAQ) were used to describe the geography of motor vehicle accidents in the province of Quebec for the period 1983-1988. These were also used to evaluate the risk factors associated with zones of high risk with regards to accidents for the 97 Municipalités Régionales de Comté (MRC). The results demonstrate that non-severe accidents are more frequent in the urban context. On the other hand, severe accidents are more frequent in the rural context. The Standard Morbidity Ratio (SMR) highlights those MRC's with the risk of severe or non-severe accidents, where risks are twice that of Quebec as a whole. The demographic characteristics (age, sex) of the driver and passengers and the place of the accident (region, density) were used in the model LOGIT to evaluate risk factors associated with high risk zones. Results of the model for those severely injured are different from those for non-severely injured people. This holds true for the location of accidents as well as for demographic characteristics. In both models, women and people over 65 years of age are low-risk groups for accidents. The authors indicate certain action to be undertaken in Quebec by the Government to improve this situation.

International comparisons of nutrition and mortality from pancreatic cancer.

Average per capita consumption of eggs, milk, and meat; total caloric intake; and protein and fat consumption in 29 countries from 1964 through 1966 was related to the average age-adjusted mortality rates from cancer of the pancreas in these same countries for the period 1978 through 1979. A direct and significant correlation between mortality rates from cancer of the pancreas and per capita consumption of eggs, milk (p less than 0.001), and meat (p less than 0.01 for males and p less than 0.05 for females) was found. The total caloric intake was directly correlated with mortality rates from pancreatic cancer (p less than 0.01). This correlation was stronger for calories derived from animal sources of food (p less than 0.001) for both sexes, while consumption of vegetable calories correlated with decreased rates of mortality from pancreatic cancer. The average per capita intake of both total and animal fat was also directly correlated with mortality from cancer of the pancreas (p less than 0.001). This suggests that animal sources of calories, protein, and fat may play an important role in the etiology of pancreatic cancer.

Obesity, hypertension, hyperuricemia and diabetes mellitus among the Cree and Inuit of northern Québec.

In the last thirty years, sociocultural and political changes have profoundly affected the way of life of the Cree and Inuit of Northern Québec. Their health status profile has also changed. This study presents the main results of a health survey performed among the Cree and Inuit in 1982-1984 by a multidisciplinary team. Obesity, arterial hypertension, hyperuricemia and diabetes mellitus while almost unknown in the past, have now been added to the list of Cree and Inuit health problems. Crees have the highest risk for obesity, hypertension and diabetes mellitus. Hyperuricemia for unknown reasons seems more prevalent among the Inuit. Our findings suggest that further in-depth studies of chronic conditions in these communities are needed.

[The impact of the hospitalization site on length of stay in short-stay hospitals in Quebec]. / L'influence du lieu d'hospitalisation sur la longueur du séjour en centre hospitalier de courte durée au Québec.

If the influence of age or disease on the length of stay is evident, this is not the case for the impact of the distance between the site of hospitalization and the residence of the patient. In addressing this issue, the study analyzes the length of stay of four groups of patients: patients aged 45-64 with cardiovascular problems; patients aged 45-64 with rheumatismal problems; patients aged 65 and over with cardiovascular problems; and patients aged 65 and over with rheumatismal problems. Hospitalization sites are grouped under four categories: (i) within the "Departement de Santé Communitaire" (DSC) of patients' residence; (ii) outside the DSC of patients' residence but within their "région socio-sanitaire"; (iii) outside the DSC of patients' residence and outside their "région socio-sanitaire"; and (iv) outside the DSC of patients' residence but within Greater Montreal or Greater Quebec. The Student test is used.

Correlates of health-care use: Inuit and Cree of northern Quebec.

This case study of the use of health-care services in northern Quebec is the first of a series of reports dealing with the health status, risk factors and access to care of the two major aboriginal populations in this region, the Cree and the Inuit. The focus of the broader study is on the health status and risk factors in these native populations. This research, based on a survey conducted in 1983-84, describes the present health status and health-care system of the Cree and Inuit, then presents a path analysis model of their use of health services. The purpose of this approach is to provide health planners and care providers with useful information and to encourage the development of well-organized and reasonable health-care service delivery to these populations.

Socio-spatial perspectives on the utilization of emergency hospital services in two urban territories in Quebec.

Hospital emergency services located in urban areas have been severely congested for several years in the province of Quebec. This problem is not caused by ambulatory patients who are using emergency services as a regular source of care, but by patients in need of emergency services. To study the factors affecting the utilization rates of emergency services in two urban areas, the city of Laval and the Quebec metropolitan area, two samples of more than 30,000 patients each were drawn from the 1981 file of the Régie de l'assurance-maladie du Quebec. The utilization rates of emergency services for emergent and urgent causes in these two samples were computed on the basis of the census tract location of these patients. The socio-economic characteristics of these census tracts were taken from the 1981 Canadian census, the distance travelled from each census tract to the location of hospital emergency services was computed and included as a predictor of the utilization rates. Also, the prevalence of chronic and psychiatric diagnoses were obtained for each census tract. The result of the analysis showed that distance affected the utilization rates only in the Quebec metropolitan area where the hospitals are mostly located in the downtown area near deprived and working class neighbourhoods, while the socio-economic characteristics affected the utilization rates in both Quebec and Laval.