Breast cancer screening practices for women aged 35 to 49 and 70 and older.

OBJECTIVE: To describe physician practices with regard to opportunistic screening for breast cancer in women aged 35 to 49 years and 70 years of age and older, and to identify the determinants associated with the practice of prescribing screening mammography. DESIGN: Postal survey. SETTING: Quebec. PARTICIPANTS: Simple random sample of 1400 general practitioners practising in Quebec in 2009. MAIN OUTCOME MEASURES: Five cancer screening practices among 4 types of female clientele and the factors influencing physicians in their practice of prescribing screening mammography. RESULTS: The response rate was 36%. For women aged 35 to 49 years, more than 80% of physicians reported using practices judged adequate, except for the teaching of breast self-examination and referrals to genetic counseling (60% and 54%). For women 70 years of age and older with good life expectancy, only 50% of general practitioners prescribed screening mammography. For the 70 years of age and older age group without good life expectancy, for whom screening is not indicated, nearly half of physicians continued to do the clinical breast examination and more than one-third reviewed family history. The main determinants for the practice of prescribing mammography are a favourable attitude to screening, screening skills, peer support, belief in the efficacy of mammography, and sufficient knowledge of the issue and of recommendations. CONCLUSION: Improvements are needed in the practice of teaching breast self-examination to women aged 35 to 49 years and referring them to genetic counseling, as well as in prescribing mammography for women 70 years of age and older who are in good health. Public health actions to improve these practices should focus on physician attitudes and skills and on communicating clearer recommendations.

Cost effectiveness of an air-inflated static overlay for pressure ulcer prevention: a randomized, controlled trial.

UNLABELLED:  Numerous pressure-relieving surfaces of varying costs are available for the prevention of pressure ulcers. There is insufficient evidence to draw conclusions regarding the efficacy or merits of using more expensive technologies. The purpose of this unblinded, randomized, prospective study was to compare the clinical and the cost effectiveness of an inflated overlay with rented, pressure-relieving surfaces for the prevention of pressure ulcers. METHODS: Patients in a 257-bed acute care facility were included if they had a Braden score of ≤ 14, had no skin lesion(s), were ≥ 18 years, weighed < 300 lb, and submitted signed consent. One hundred, ten patients (110) were randomized into a control group using either a microfluid static overlay (MSO) or a low-air-loss dynamic mattress (LALDM) with pulsation (n = 55) or into an experimental group using an inflated static overlay (ISO) (n = 55). Both groups had identical positioning protocols. No statistically significant differences were noted between the 2 groups with regard to age, gender, weight, or Braden scale score. Head-to-toe assessments were performed 3 times a week for a maximum of 14 days to deter- mine presence of pressure ulcers and comfort; Fisher's exact and chi- squared tests were used to assess categorical data, and unpaired t-test and Mann-Whitney statistic tests were used to compare continuous variables. Comparative cost of support surface use was determined at the end of the study. RESULTS: In the control group, 50 patients used an MSO and 5 patients used an LALDM; in the experimental group, 55 patients used an ISO. No significant difference in pressure ulcer incidence was found between the control (n = 6) and experimental groups (n = 2) (11% versus 4%, respectively; P = 0.2706), and there was no significant difference in comfort (90% versus 85%; P = 0.7129). However, a significant difference was noted in total cost ($13,606 CAD versus $3,364 CAD, P ≤ 0.001); the ISO was less expensive. CONCLUSION: The use of an ISO offers a cost-effective option for the prevention of pressure ulcers in a moderate to very high-risk population. .

Evaluation of the impact of interdisciplinarity in cancer care.

BACKGROUND: Teamwork is a key component of the health care renewal strategy emphasized in Quebec, elsewhere in Canada and in other countries to enhance the quality of oncology services. While this innovation would appear beneficial in theory, empirical evidences of its impact are limited. Current efforts in Quebec to encourage the development of local interdisciplinary teams in all hospitals offer a unique opportunity to assess the anticipated benefits. These teams working in hospital outpatient clinics are responsible for treatment, follow-up and patient support. The study objective is to assess the impact of interdisciplinarity on cancer patients and health professionals. METHODS/DESIGN: This is a quasi-experimental study with three comparison groups distinguished by intensity of interdisciplinarity: strong, moderate and weak. The study will use a random sample of 12 local teams in Quebec, stratified by intensity of interdisciplinarity. The instrument to measure the intensity of the interdisciplinarity, developed in collaboration with experts, encompasses five dimensions referring to aspects of team structure and process. Self-administered questionnaires will be used to measure the impact of interdisciplinarity on patients (health care utilization, continuity of care and cancer services responsiveness) and on professionals (professional well-being, assessment of teamwork and perception of teamwork climate). Approximately 100 health professionals working on the selected teams and 2000 patients will be recruited. Statistical analyses will include descriptive statistics and comparative analysis of the impact observed according to the strata of interdisciplinarity. Fixed and random multivariate statistical models (multilevel analyses) will also be used. DISCUSSION: This study will pinpoint to what extent interdisciplinarity is linked to quality of care and meets the complex and varied needs of cancer patients. It will ascertain to what extent interdisciplinary teamwork facilitated the work of professionals. Such findings are important given the growing prevalence of cancer and the importance of attracting and retaining health professionals to work with cancer patients.

[The impact of multiple vaccinations on vaccine schedule adherence and parental attitudes in Monteregie]. / Impact des injections multiples sur l'observance du calendrier de vaccination et opinions des parents en Montérégie.

OBJECTIVE: This study aimed to explore the impact of adding new vaccines on schedule adherence and parental opinion of multiple injections. METHOD: A descriptive cross-sectional study by self-administered questionnaire mailed to a stratified random sample of each of two cohorts of children drawn from the Montérégie Birth Register: the 2002-2003 cohort (old vaccination schedule) and the 2004-2005 cohort (new schedule). Two surveys were done: Survey 1 (fall 2005-winter 2006) questioned parents whose address could be validated by Canada411.ca; Survey 2 (fall 2006) surveyed parents whose address was validated by the Quebec health insurance board (RAMQ). Incomplete or missing vaccine data were completed by verifying the vaccinators' files. RESULTS: Analysis of schedule adherence by the Kaplan-Meier survival approach showed that the 2nd and 3rd doses of the DTaP-P-Hib vaccine were received late by the youngest children compared to the oldest (median number of days late: 2 days for the 2nd vaccine (p = 0.013) and 4 days for the 3rd vaccine (p < 0.001)). Many parents (76%) prefer 2 to 3 injections during a single visit, and 61% fear an increase in the risk of side effects. CONCLUSION: Even if the evaluated lateness has only a small public health impact, parents must be reassured about the safety of multiple vaccines.

Supermarket workers: their work and their health, particularly their self-reported musculoskeletal problems and compensable injuries.

A literature review revealed that cashiers are the most studied of all supermarket workers, while little is known about other types of employees. However, cashiers are far from being the only supermarket workers affected by musculoskeletal disorders. The musculoskeletal health of supermarket employees other than cashiers was therefore examined for one company. Two sources of data were used: compensation statistics (from the company's 57 corporate supermarkets) and self-reported questionnaires (administered in 4 selected stores). These sources provided very different descriptive statistics, both in terms of the size of problems (depending on which aspects were compared, compensation statistics depicted 2 to 18 times fewer disorders than self-reports), and in terms of which body regions were most affected. There were also discrepancies with regard to identifying those departments which were most at risk (wrappers according to self-reports, delicatessen according to compensation reports). According to self-reports, 83% of workers (excluding cashiers) reported at least one musculoskeletal disorder over a 12-month period, and 32% had problems severe enough to impede regular activities. Different approaches to calculating rates were also used within each data source. Calculations using the number of hours worked annually by all workers were deemed to be the best. The significance of these results for supermarket employees and in terms of intervention and prevention in other sectors is examined.

Responsiveness of the physical work performance evaluation, a functional capacity evaluation, in patients with low back pain.

BACKGROUND AND PURPOSE: The Physical Work Performance Evaluation (PWPE) is a functional capacity evaluation. This study investigated the responsiveness of the PWPE. METHODS: The internal and external responsiveness was tested. For the internal responsiveness, the change in the pre-/post-test PWPE scores of a group participating in a work rehabilitation program (n = 27) was compared to that of a comparison group of healthy subjects (n = 30). The external responsiveness was tested with the rehabilitation group, and the change in their PWPE scores was compared to concurrent and empirical criteria. RESULTS: The comparison of the change in pre-/post-test PWPE scores showed that the change for the rehabilitation group was significantly different from that for the comparison group, but only for one section of the PWPE. Changes in six criteria were seen after completion of the program, but there was no significant correlation between these changes and the change in the overall PWPE score. DISCUSSION AND CONCLUSION: The overall PWPE level of work score does not appear to have the ability to measure clinically significant changes achieved through a work rehabilitation program.

[Test-retest reliability of the Work-related Physical Capacity Evaluation]. / Etude de fidélité test-retest de l'Evaluation des Capacités Physiques reliées au Travail.

BACKGROUND: Functional capacity evaluations are used to quantify and qualify the physical abilities of an individual in relation to the physical requirements of an occupation. One major observation associated with functional capacity evaluations is a lack of evidence on their psychometric properties. PURPOSE: This article presents the results of a study on the test-retest reliability of a functional capacity evaluation tool: the Physical Work Performance Evaluation (PWPE). The PWPE is an instrument for evaluating the physical work capacities of individuals with physical limitations resulting from a health problem. METHODS: The PWPE was administered twice to a convenience sample of 30 workers in good health. RESULTS: In the section on 'Dynamic Strength', the tasks demonstrate a good test-retest reliability (0.79 < ICC < 0.91). The three sections and the global score of the PWPE demonstrate a moderate stability (0.43 < kappa > 0.52). PRACTICE IMPLICATIONS: The PWPE score should be interpreted with caution and further studies on its psychometric properties will be necessary to clarify its clinical utility.

Biodegradation of polyethylene films with prooxidant additives.

Prooxidant additives represent a promising solution to the problem of the environment contamination with polyethylene film litter. Prooxidants accelerate photo- and thermo-oxidation and consequent polymer chain cleavage rendering the product apparently more susceptible to biodegradation. The question not fully resolved remains the biodegradation itself, its mechanism and especially the factors influencing the time-frame in which it can occur. The presented review is aimed to provide comprehensible information for both microbiologists and polymer scientists, who need participate in the research leading to an understanding of the microorganism action on the oxidized polyethylene and to design of new materials.

Are vaccination information leaflets useful for vaccinators and parents?

Three vaccination information leaflets (VIL) were evaluated in the province of Québec in 2002-2003 to examine their use by vaccinators (nurses and physicians), and their success in reaching parents of infants and toddlers. Data were collected from vaccinators and parents by postal survey. Reception of all of the VIL was higher among nurses (98%) than among physicians (39%). Only 14% of parents were familiar with all the VIL. Vaccinators who used the VIL, and the parents who were familiar with them, were satisfied with their presentation, clarity, quantity of information, pertinence and credibility. While the information leaflets were useful for vaccinators, few parents were reached, limiting the impact of this method of promotion.

Investigating the correlation between hospital of primary treatment and the survival of women with breast cancer.

BACKGROUND: To understand the relation between hospital of initial treatment and the survival of women with breast cancer, the authors investigated the characteristics of the treatment center that were related most to outcome. METHODS: The authors selected women from 5 regions of Quebec, Canada, who were diagnosed with lymph node-negative breast cancer between 1988 and 1994. Data were collected by chart review, queries to physicians, and linkage with administrative data bases. Overall survival to the end of 1999 was analyzed using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: The study population included 1727 women with a median follow-up of 6.8 years. The 7-year survival rate was 82% (95% confidence interval [95%CI], 80-84%). Compared with women who were treated in centers with > or = 100 new cases per year, the hazard ratio (HR) of death from any cause was 1.80 (95%CI, 1.23-2.63), 1.44 (95%CI, 1.03-2.03), and 1.30 (95%CI, 0.96-1.76) among women who were treated in hospitals with < 25 new cases, 25-49 new cases, and 50-99 new cases per year after adjusting for case mix and characteristics of the attending physician. However, the significance of caseload disappeared after adjusting for the type of hospital. By contrast, women who were treated in centers with either on-site radiotherapy, research activity, or teaching status had significantly better outcomes, even after adjusting for caseload (HR, 0.68; 95%CI, 0.50-0.92). These associations were independent of primary treatment received, which was a strong determinant of outcome. CONCLUSIONS: Primary treatment of early-stage breast cancer in larger hospitals was associated with improved survival. This relation was mediated by factors related to proficiency of care, which tended to cluster within institutions.

The interrater reliability of a functional capacity evaluation: the physical work performance evaluation.

The purpose was to evaluate the interrater reliability of the Dynamic Strength, Position Tolerance, and Mobility tasks of the Physical Work Performance Evaluation (PWPE), a Functional Capacity Evaluation often used with workers disabled due to back pain. For each worker's evaluation, two raters were preselected among five trained raters. One of the raters administered the PWPE while the other functioned as a silent rater. A convenience sample of 40 workers disabled due to back pain and referred to an occupational rehabilitation center was used. In general, the reliability was "substantial" (0.61 < or = kappa < or = 0.80) to "almost perfect" (0.81 < or = kappa < or = 1.00) for most of the 21 tasks and three sections of the PWPE evaluated with the exception of three tasks in the Mobility section (ladder climbing (kappa = 0.47), repetitive trunk rotation--standing (kappa = 0.54), and repetitive trunk rotation--sitting (kappa = 0.37)) task and the Mobility section itself (kappa = 0.54). Several reasons could explain the lower agreement on the observation of the physical signs associated with these tasks. Since these tasks involve rotation movements or complex neuromuscular integration, it seemed difficult for the raters to define what are the normal physical signs and when physical signs of maximal functional capacity are present. The criteria for establishing the presence of the physical signs in the PWPE should be improved.

Elderly trauma patients with rib fractures are at greater risk of death and pneumonia.

BACKGROUND: The purpose of this study was to show that elderly patients admitted with rib fractures after blunt trauma have increased mortality. METHODS: Demographic, injury severity, and outcome data on a cohort of consecutive adult trauma admissions with rib fractures to a tertiary care trauma center from April 1, 1993, to March 31, 2000, were extracted from our trauma registry. RESULTS: Among 4,325 blunt trauma admissions, there were 405 (9.4%) patients with rib fractures; 113 were aged > or = 65. Injuries were severe, with Injury Severity Score (ISS) > or = 16 in 54.8% of cases, a mean hospital stay of 26.8 +/- 43.7 days, and 28.6% of patients requiring mechanical ventilation. Mortality (19.5% vs. 9.3%; p < 0.05), presence of comorbidity (61.1% vs. 8.6%; p < 0.0001), and falls (14.6% vs. 0.7%; p < 0.0001) were significantly higher in patients aged > or = 65 despite significantly lower ISS (p = 0.031), higher Glasgow Coma Scale score (p = 0.0003), and higher Revised Trauma Score (p < 0.0001). After adjusting for severity (i.e., ISS and Revised Trauma Score), comorbidity, and multiple rib fractures, patients aged > or = 65 had five times the odds of dying when compared with those < 65 years old. CONCLUSION: Despite lower indices of injury severity, even after taking account of comorbidities, mortality was significantly increased in elderly patients admitted to a trauma center with rib fractures.

Discriminative and predictive validity assessment of the quebec task force classification.

STUDY DESIGN: A prospective cohort study of workers with low back pain who had been absent from work for more than 4 weeks was conducted. OBJECTIVE: To assess the discriminative and predictive validity of the Quebec Task Force Classification for workers during the subacute phase of disability from back pain. SUMMARY OF BACKGROUND DATA: The Quebec Task Force Classification was designed for clinical decision making, prognosis establishment, quality of care evaluation, and scientific research in low back pain. METHODS: For this study, 104 workers absent from work because of back pain were classified according to the first four categories of the Quebec Task Force Classification 4 weeks after their first day of work absence. They then were randomized into four treatment groups: standard care (control), clinical-rehabilitation intervention, occupational intervention, and the Sherbrooke model (a combination of the clinical-rehabilitation and occupational interventions). Functional status, pain level, and work status were assessed at baseline and after 1 year. Duration of full compensation and back-related costs were calculated over a mean follow-up period of 6.5 years. The discriminative validity of the Quebec Task Force Classification was evaluated using Kendall tau correlation coefficients. Predictive validity was evaluated using logistic regression analyses. Age, gender, comorbidities, body mass index, and treatment group were considered as potential confounders. RESULTS: Significant but low correlation coefficients were found between Quebec Task Force Classification categories and functional status scores at baseline. Subjects classified as having distal radiating pain (categories 3 and 4) at baseline were more likely to have a lower functional status, higher pain level, and no return to regular work at the 1-year follow-up evaluation. They also were more likely to accumulate more days of full compensation and to cost more after a mean follow-up period of 6.5 years. CONCLUSION: The Quebec Task Force Classification demonstrated good predictive ability by discriminating between subjects with and those without distal radiating pain.