Effects of students' peer teaching in a new pharmacokinetics teaching format.

INTRODUCTION: The aim of this work was to evaluate the impact of a teaching method in pharmacokinetics (PK) in terms of satisfaction and performance in the final test of students. MATERIAL AND METHODS: This method consisted of the development of a practical problem and a peer-tutored solution by small groups of three or four students. Students enrolled in the second year of pharmaceutical studies had to generate a PK practical problem, to propose a solution and to conduct a peer-tutored solution of the practical problem completed by another student group in a learning-connected classroom. Student's performance was assessed by individual semi-structured interviews and by comparing the scores obtained in the final test with those obtained in previous years. RESULTS: More than 70% of the students were highly satisfied with the new format of the PK course, especially concerning the development and the design of a practical problem. More than 94% of the students considered that the content of the lecture-based teaching was at least adapted and in accordance with the objectives of the PK course. Students reported very constructive discussions and interactions with peers and the teacher. In addition, students significantly increased their score at the final PK test compared to previous years (53.27±19.10% in 2015-2017 vs. 71.30±13.47% in 2018-2019, P<.0001). CONCLUSION: This new method including peer teaching was applied in PK and allowed to significantly increase the performance and the satisfaction of the students in PK.

[Public health surveillance and role of administrative data]. / Importance de la surveillance en santé publique et utilité des données administratives.

BACKGROUND: Public health surveillance constitutes an important activity since it helps in identifying health needs through data collection, and contributes to decision making and actions by analyzing and interpreting data and communicating key results. METHODS: This paper presents a discussion on the concept of public health surveillance, its objectives and its historical evolution. It deals with the importance of surveillance systems while describing their components and challenges. In addition, the authors point out the importance of administrative data as a relevant source for the surveillance of public health problems, particularly chronic diseases and risk factors. RESULTS: This theoretical discussion leads to the proposal of a conceptual model for surveillance systems, which integrates implementation and evaluation. CONCLUSION: This article provides a summary of the concept of public health surveillance and underlines the general aspects to be considered by the managers of surveillance systems. It also discusses the use of administrative data for surveillance.

[Mother-daughter relationship inventory]. / L'inventaire des relations mère-fille.

The present paper centers on the validation of the French-version of the mother-daughter relationship inventory (MDREL), a self-reported questionnaire developed by Inazu and Fox (1980) and translated by Achim. This nine-item self-reported questionnaire assesses young women's perceptions pertaining to the social-emotional support conveyed by their mother, as well as the overall quality of their mother-daughter relationship. The MDREL is the product of factor analyses conducted on 23 statements concerning young women's perception regarding the following dimensions: presence of an open-communication between the mother and the daughter; presence of uncertainties and ambiguities in the description made by the daughter concerning her relationship with her mother; ambivalence expressed by the daughter in regards to mother-daughter rapprochement and intimacy. This instrument is of great interest as it specifically assesses the perceived quality of the mother-daughter relationship during adolescence, a period in which the mother remains an authority-figure and the daughter's sexuality is activated. A total of 126 young women completed the French-version of this self-reported questionnaire. Results indicate good psychometric properties in both validity and reliability. Factor analyses of the French-version of the MDREL yielded two distinct factors, namely an allo-centered and a self-centered assessment. This French-version of the MDREL named l'Inventaire des relations mère-fille (IRMF) can thus be used in studies that focus on mother-daughter relationships. The problematic overtone present in many items suggests that this instrument can be administered to clinical populations.

Promotion by orotic acid of liver carcinogenesis in rats initiated by 1,2-dimethylhydrazine.

Our earlier experiments revealed that orotic acid, a precursor for pyrimidine nucleotides, selectively stimulated the growth of carcinogen-modified liver cells to grow into enzyme-altered hepatocytes (Cancer Lett., 16: 191-196, 1982). The present study was designed to determine whether prolonged feeding of orotic acid will result in hepatocellular carcinoma in initiated rats. Accordingly, groups of rats were given i.p. either 1,2-dimethylhydrazine dihydrochloride (100 mg/kg) or an equivalent volume of 0.9% sodium chloride solution 18 hr after two-thirds partial hepatectomy. After 1 week of recovery, they were continued on either the basal diet or the basal diet containing 1% orotic acid for 10 to 13 months. Some groups of rats, in addition, received a single necrogenic dose of CCl4 8 weeks following exposure to orotic acid diet. The results obtained indicated that 87.5% of initiated rats exposed to orotic acid developed hepatocellular carcinomas in 10 months and 100% in 13 months. Initiated rats exposed to orotic acid diet coupled with a single administration of CCl4 developed 100% hepatocellular carcinoma by 10 months. In contrast, the incidence of hepatocellular carcinoma in initiated rats fed basal diet alone for 13 months was 37.5%, while, in those that received CCl4 in addition, the incidence was 25% in 10 months. Interestingly, a significant number of liver cancers (29 to 36%) in the orotic acid-fed group metastasized to lungs, whereas none of the liver cancers in rats exposed to basal diet metastasized.(ABSTRACT TRUNCATED AT 250 WORDS)

Occurrence and risk factors of oral candidiasis treated with oral antifungals in seniors using inhaled steroids.

Oral candidiasis (OC) is a frequent side effect of inhaled corticosteroids (iCSTs). This study estimated occurrence and significance of risk factors of OC treated with antifungals in users of iCSTs under conditions of normal use. This retrospective analysis used data drawn from drug insurance plan records in Quebec, Canada. The sample contained 27,000 seniors using anti-asthma medications during 1990. Three years of data (1989-1991) were searched for use of oral antifungals concurrent with exposure to iCSTs. A case-control study examined factors leading to increased probability of first incidence of OC in new users of iCSTs. Three-year occurrence for OC was 7%. Increased risk for a first occurrence of OC was significantly associated with higher doses of iCST, increased length of iCST exposure, use of antibiotics, use of oral steroids, having three or more prescribers, a history of use of both high and low strengths of iCST, and concurrent use of oral steroids and diabetes medications. The occurrence of OC is relatively high. Knowledge of factors leading to increased risk could facilitate the targetting of patients who need timely intervention, under conditions of normal use.

Economic evaluation of zuclopenthixol acetate compared with injectable haloperidol in schizophrenic patients with acute psychosis.

Zuclopenthixol acetate is a rapid-acting, injectable neuroleptic drug with a duration of action that allows for administration once every 2 to 3 days, in contrast to injectable haloperidol, which may require administration more than once daily. To assess the place of zuclopenthixol acetate in the treatment of acute episodes of schizophrenia, a cost-consequence analysis was performed comparing this new medication with short-acting, injectable haloperidol. The perspective of the Quebec health care system was adopted. The study population comprised patients diagnosed with schizophrenia who experienced an acute episode of psychosis and who were treated with intramuscular (i.m.) haloperidol. The study assessed patients for 9 days after the start of treatment. The literature was the principal source of comparative data about the clinical outcomes of the two treatments. The total cost associated with zuclopenthixol acetate i.m. or haloperidol i.m. was modeled using a decision tree built around the number of i.m. injections required to achieve stabilization. To establish costs, expert panels were consulted and patients' files were reviewed for a sample of schizophrenic patients who had been hospitalized in a large psychiatric or general hospital subsequent to a visit to the emergency department and had received a short-acting i.m. neuroleptic drug. Only a direct medical records costs were considered. Because zuclopenthixol acetate was not on the market at the time of the study, the file review did not allow for a direct estimate of its related costs but did provide an account of haloperidol use. The literature shows that zuclopenthixol acetate is similar to haloperidol with respect to the control of psychotic episodes; however, zuclopenthixol acetate is associated with increased sedation and a lower incidence of extrapyramidal symptoms. Using the base-case estimate for the number of injections required for stabilization, the incremental cost of zuclopenthixol acetate 50 mg over haloperidol was $25.00 (1995 Canadian dollars) per patient at the psychiatric hospital and $21.00 per patient at the general hospital. The results were sensitive to the estimate of the number of injections and the number of minutes of nursing care required by agitated patients. Zuclopenthixol acetate resulted in cost savings over haloperidol if it permits a reduction of 25% in minutes of nursing care or if 85% of patients require 2 injections or less (45% requiring 1 injection and 40% requiring 2). However, whichever drug is used, the cost of the injectable neuroleptic represents a small fraction of the cost of care for acutely psychotic patients.

Economic evaluation of antibacterials in the treatment of acute sinusitis.

OBJECTIVE: The objective of this study was to compare costs, efficacy and cost efficacy of alternate oral antibacterial regimens for the ambulatory treatment of acute sinusitis. A public third-party perspective was adopted. DESIGN: The analysis was based on a decision tree and considered the episode of care from the decision to initiate an antibacterial until the end of the first course of treatment or the end of a subsequent course of treatment when needed. Efficacy data were retrieved from published clinical trials. Direct medical costs included the costs of physician visits, diagnostic tests and medications. SETTING: The study pertained to adults treated in a primary-care setting in the Canadian province of Québec. INTERVENTIONS: The antibacterials studied were amoxicillin, amoxicillin/clavulanate, azithromycin, cefaclor, cefuroxime axetil and clarithromycin. MAIN OUTCOME MEASURES AND RESULTS: The main outcome measured was the proportion of patients showing resolution or improvement of their symptoms. Initiating a treatment with amoxicillin was associated with similar efficacy and lower overall costs when compared with the other antibacterials. Low dosages of clarithromycin and azithromycin followed amoxicillin in terms of cost-efficacy ratio. CONCLUSIONS: This study confirms the place of amoxicillin as a first choice agent for acute sinusitis, with low dose clarithromycin and azithromycin as second choices.

Alzheimer's disease: a review of the disease, its epidemiology and economic impact.

This article consists of a critical review of Canadian, American and European studies published between 1976 and 1997 on the subject of Alzheimer's disease (AD), and its epidemiology, patterns of care, prognostic factors, and economic impact. As the population ages in North America and Europe, significant increases in the prevalence of AD over the next decades have been projected. The elderly population represents the largest consumer group of health care resources and the management of common diseases occurring in this population will have major medical, social, and economic implications. As a result, researchers will need to integrate the ever-increasing knowledge on AD when addressing governmental and societal concerns regarding its impact. Described herein is the study findings, limitations, and differences observed following the review of the diagnostic criteria, prevalence rates, incidence rates and risk factors. Highlighted are the areas where data is lacking. To refine current models of disease progression, and better address where health care resources and new therapies would be most beneficial, the review of predictors of institutionalization and predictive models of disease progression and survival, was performed. New research questions are indicated.

[Determinants of geographic variations in asthma medication in Quebec]. / Analyse des variations géographiques de l'usage des médicaments de l'asthme au Québec.

BACKGROUND: The study of geographic variations in the use of medication can constitute an interesting and useful option in public health surveillance for the identification of population needs and for the fair partition of resources. Many studies report variations in the use of medication that are not always understood. Considering the importance of medication, particularly for chronic diseases like asthma, it is important to identify factors that can explain geographic differences in the utilization of medications in order to determine optimal prescription practices. METHODS: We used a multilevel analysis to explore determinants of variation among welfare recipients and subscribers covered by the Quebec public drug plan, aged five to 44, who claimed at least one prescription for an asthmatic medication in 2003. The analysis was based on 73 small areas in Quebec's 15 health regions. RESULTS: Prevalence of usage and hospitalization rates are the main predictors of variation in medication intensity. On the other hand, prevalence of usage is related to the area of residence, proportion of welfare recipients and prevalence of smokers. The quality of medication is related to practitioners' specialty. CONCLUSION: Different factors contribute to the understanding of geographic variations in asthma medication but it remains important to control for severity. Small area analysis makes it possible to identify specific areas facing more important problems in the prevalence and use of medication for asthma and thus leads to better understanding of local needs for more targeted interventions.

Persistence and determinants of statin therapy among middle-aged patients for primary and secondary prevention.

AIMS: Statins have been shown to significantly reduce morbidity and mortality in patients with coronary artery disease (CAD), and also in patients with dyslipidaemia when statins are taken regularly. Middle-aged patients have the highest level of forecasting benefit and little is known about persistence rate of these therapies in a real-life setting. The objective was to evaluate the persistence rate of middle-aged patients initiating a statin therapy and its relation with several determinants for primary and secondary prevention. METHODS: A cohort was reconstructed using the RAMQ databases. All patients aged 50-64 years-old who received at least one statin prescription between 1 January, 1998 and 31 December, 2000 for a new intention of treatment for dyslipidaemia were included in the cohort and followed up until 30 June, 2001. The date of the first prescription of statin was defined as the index date. There were 4316 patients in the secondary prevention (CAD diagnosis) and 13,642 patients in primary prevention cohort. The cumulative persistence rate was estimated using Kaplan-Meier, and Cox regression models were used to estimate the hazard ratio of ceasing statins. RESULTS: We found that persistence with statins had fallen to 71% after 6 months of treatment, and had declined to 45% after 3 years in the secondary prevention cohort; the corresponding figures were 65% and 35% in the primary prevention cohort. Our results suggest that patients with dyslipidaemia in primary prevention compared with those in secondary prevention (HR: 1.18; 1.11-1.25) are less likely to be persistent. Patients with other cardiovascular risk factors such as age (HR: 0.99; 0.98-0.99), diabetes (HR: 0.84; 0.79-0.90), hypertension (HR: 0.76; 0.72-0.80) were most likely to be persistent with statins. We observed lower persistence in patients who have used the greatest number of pharmacies and prescribing physicians. CONCLUSION: This analysis indicates that barriers to persistence occur early in the therapeutic course. Overall persistence with statins is low, and particularly among patients with few other cardiovascular risk factors.

Communication of verbal information by community pharmacists.

Communication of verbal information on prescribed drugs is recognized as an important function of the pharmacist. This article describes and analyzes the communication behavior adopted by community pharmacists in the province of Quebec. Data were collected by means of two questionnaires mailed to a random sample of 634 community pharmacists. Percentage of prescriptions for new medications on which the pharmacists indicated they provide verbal information averaged 68.9 (SD 24.2). A majority of respondents indicated that they include information on the indication and mode of administration in more than 75 percent of their counseling episodes. However, on average, rare but serious adverse effects were less frequently discussed. The frequency of verbal communication was analyzed according to the pharmacist's gender, number of years since licensure, employment status, work setting, and perceptions of both professional and commercial dimensions of the pharmacist's role. Regression showed that perception of the professional dimension of the role, gender, workload, and floor surface of the pharmacy were related to provision of verbal information on new prescribed medications.

Utilization of anti-asthma medications in two Quebec populations of anti-asthma medication users: a prescription database analysis.

This study describes the utilization of anti-asthma medications in two groups of users of such medications in the province of Quebec, Canada, during the year from June 1, 1990, to May 31, 1991. It is based on a secondary analysis of existing data banks recording the medications reimbursed by two government-funded ambulatory drug reimbursement programs that cover individuals aged 65 and over (seniors) and income security (welfare) recipients (ISRs). The study analyzed the use of the anti-asthma medications included in the list of medications eligible for reimbursement for program beneficiaries. Use was studied in two random samples of individuals who had at least one prescription filled for an anti-asthma medication (2566 seniors and 3695 ISRs). The most commonly used medication in both groups was inhaled salbutamol 100 mcg. Various forms of theophylline tablets were also used by a high proportion of the sample studied. Over 75% of the seniors and 68% of the ISR group used at least one form of theophylline during the course of the year. Inhaled corticosteroids were used by 43% of the seniors and by 36% of the ISR group, and sympathomimetics (beta 2-agonists), by 63% of seniors and 68% of ISRs.

Effect of age on the conformity rate to short-acting beta-agonist use criteria in asthma.

STUDY OBJECTIVES: Assess compliance to asthma guidelines and influence of age concerning inhaled short-acting beta2-agonist (SABA) utilization in 5 to 45-year-old asthmatic subjects in the province of Quebec. DESIGN: Population-based retrospective drug utilization review using a computerized database of claims submitted to a private prescription drug insurance plan. PATIENTS: Subjects who received at least one outpatient prescription of SABA (age range, 5 to 45 years) for the treatment of asthma between January 1996 and December 1997. MEASUREMENTS: Percentages of patients whose use was appropriate according to the criteria regarding the average daily dose of SABA. Use was considered appropriate if the consumption rate corresponded to a maximum of two puffs per day (Salbutamol equivalent) in subjects who did or did not use inhaled corticosteroids (ICS) at an estimated maximum dose of 800 mcg/day of Beclomethasone (BDP) equivalent for the 5 to 11-year-olds and 1000 mcg/day for the 12 to 45-year-olds. RESULTS: In 1996, use was found to be appropriate for 74.4% of the 394 patients who received an SABA without ICS as compared with 70.7% for 593 patients in 1997. If we consider those who received an ICS at low to moderate doses, appropriate use was found for 51% of the 375 patients in 1996 and 57.6% for 254 patients in 1997. If we exclude patients who did not renew their SABA, appropriate use drops to 46.3% for 1996 and 34.3% for 1997 for the group who receive SABA without ICS (29.4% and 37.6%, respectively, for those with ICS). There is a relationship between age and appropriateness; the percentage of appropriateness was higher for the younger ones (5 to 14-year-old group; 83% in 1996 and 86% in 1997 for the patients who received a SABA without IS and 58.5% in 1996 and 73% in 1997 for the patients who received a SABA using ICS (p < 0.05). CONCLUSION: Our results indicate that adherence to asthma guidelines concerning SABA is poor. SABA are still overused, particularly among ICS users, which might be explained by undertreatment or poor compliance. Appropriate SABA use was significantly more common among younger groups (p < 0.05). This can be explained by better treatment in that age group, better compliance or less severe asthma.

Rate and cost of hospitalizations for asthma in Quebec: An analysis of 1988/89, 1989/90 and 1994/95 data.

The objectives of this study were to evaluate recent trends in the frequency and length of stay of hospitalization for asthma in the province of Quebec and to estimate the costs of asthma hospitalizations. Data were extracted for persons hospitalized for 30 days or less with a primary diagnosis of asthma in all Quebec short-stay hospitals during the years 1988/89, 1989/90 and 1994/95. There were 1.76 asthma hospitalizations per 1000 persons in Quebec in 1988/89, down to 1.44 in 1989/90 and up again to 1.75 in 1994/95. There was a small decrease in mean length of stay when the three data years were compared. In all three years, the rate of hospitalization was particularly high among young boys. In 1994/95, more hospitalizations occurred during the fall months. We estimated the total cost for asthma hospitalization that year to be $18 to $21 million.

Dietary orotic acid enhances the incidence of gamma-glutamyltransferase positive foci in rat liver induced by chemical carcinogens.

Feeding male Fischer F-344 rats for 5 weeks a diet containing 1% orotic acid, a precursor for pyrimidine nucleotide biosynthesis, resulted in an increased incidence of gamma-glutamyltransferase (EC 2.3.2.2) positive foci induced by chemical carcinogens including 1,2-dimethylhydrazine, diethylnitrosamine, benzo[a]pyrene, and aflatoxin B1. This unique effect of orotic acid can be accentuated by supplying a liver cell proliferative stimulus. The enzyme altered hepatocytes have a higher labelling index (4.4%) compared with that of the hepatocytes in the surrounding liver (0.26%). The effect of orotic acid on the increased incidence of foci cannot be attributed to either the induction of liver cell proliferation or the imposition of a preferential inhibitory effect on the proliferation of normal hepatocytes while permitting the carcinogen-modified hepatocytes to respond to an endogenous or exogenous liver cell proliferative stimulus and grow to form foci. Orotic acid also did not behave like some of the promoters of liver carcinogenesis such as phenobarbital and polychlorinated biphenyls in that it did not induce either the phase I or phase II components of hepatic drug metabolizing enzyme systems. Some of the possible mechanisms by which orotic acid enhances the incidence of gamma-glutamyltransferase positive foci by carcinogens are discussed.