Measuring Health Literacy in Primary Healthcare: Adaptation and Validation of a French-Language Version of the Brief Health Literacy Screening among Patients with Chronic Conditions Seen in Primary Care.

BACKGROUND: The Brief Health Literacy Screening (BHLS) is a short self-report instrument developed to identify patients with inadequate health literacy. This study aimed to translate the BHLS into French Canadian (BHLS-FCv) and to evaluate its psychometric properties among patients with chronic conditions in primary care. METHODS: The BHLS was translated into French using the Hawkins and Osborne's method. Content validity was evaluated through cognitive interviews. A validation study of the BHLS-FCv was conducted in two primary care clinics in the province of Quebec (Canada) among adult patients with chronic conditions. Psychometric properties evaluated included: internal consistency (Cronbach's alpha); test-retest reliability (intraclass correlation coefficient); and concurrent validity (Spearman's correlations with the Health Literacy Questionnaire (HLQ)). RESULTS: 178 participants completed the questionnaire at baseline and 47 completed the questionnaire two weeks later over the telephone. The average score was 13.3. Cronbach's alpha for internal consistency was 0.77. The intraclass correlation coefficient for test-retest reliability was 0.69 (95% confidence interval: 0.45-0.83). Concurrent validity with Spearman's correlation coefficient with three subscales of HLQ ranged from 0.28 to 0.58. CONCLUSIONS: The BHLS-FCv demonstrated acceptable psychometric properties and could be used in a population with chronic conditions in primary care.

Family planning decisional needs assessment for recessive hereditary disorders: Insights from carrier couples and professionals.

OBJECTIVE: Carrier couples of recessive diseases face an important decision-making process regarding their familial planning that can become a significant source of discomfort and potential regrets. To date, no study has described the decisional needs of carrier couples of Leigh syndrome French-Canadian type, hereditary tyrosinemia type 1, hereditary motor and sensory neuropathy with or without agenesis of the corpus callosum and autosomal recessive spastic ataxia of Charlevoix-Saguenay undergoing family planning decision-making process. Our study aimed to describe the decisional needs of carrier couples according to the Ottawa Decision Support Framework. METHODS: A qualitative descriptive study was conducted. Qualitative individual and joint couple interviews were performed among 39 carrier individuals and 11 health and social care professionals. RESULTS: Carrier couples' decision-making process is complex, and their decisional needs include, among others, sufficient knowledge about the disease and the reproductive options, personal values and available support. Increased decisional conflict was observed among carriers of diseases associated with low morbidity and mortality. CONCLUSION: Family planning decision-making is an evolutive deliberative process that requires appropriate shared decision-making to insure decisional comfort. PRACTICE IMPLICATIONS: Carrier couples family planning decision-making process needs to be better supported.

How Should Compassion Be Expressed as a Primary Clinical and Ethical Value in Anorexia Nervosa Intervention?

Use of force in the care of patients with severe anorexia nervosa is controversial but can be justified when the disorder becomes life-threatening. This commentary examines the role of force in compassionate care of an adolescent patient hospitalized with extreme anorexia nervosa and suggests strategies for reaching consensus, minimizing harm, and maximizing the chance of a therapeutic outcome when forced intervention is a compassionate thing to do.

Effects and Acceptability of an Individualized Home-Based 10-Week Training Program in Adults with Myotonic Dystrophy Type 1.

BACKGROUND: Muscle weakness is a cardinal sign of myotonic dystrophy type 1, causing important functional mobility limitations and increasing the risk of falling. As a non-pharmacological, accessible and safe treatment for this population, strength training is an intervention of choice. OBJECTIVE: To document the effects and acceptability of an individualized semi-supervised home-based exercise program on functional mobility, balance and lower limb strength, and to determine if an assistive training device has a significant impact on outcomes. METHODS: This study used a pre-post test design and men with the adult form of DM1 were randomly assigned to the control or device group. The training program was performed three times a week for 10 weeks and included three exercises (sit-to-stand, squat, and alternated lunges). Outcome measures included maximal isometric muscle strength, 10-Meter Walk Test, Mini-BESTest, 30-Second Chair Stand Test and 6-minute walk test. RESULTS: No outcome measures showed a significant difference, except for the strength of the knee flexors muscle group between the two assessments. All participants improved beyond the standard error of measurement in at least two outcome measures. The program and the device were well accepted and all participants reported many perceived improvements at the end of the program. CONCLUSIONS: Our results provide encouraging data on the effects and acceptability of a home-based training program for men with the adult form of DM1. These programs would reduce the financial burden on the health system while improving the clinical services offered to this population.

Trajectoire et vécu des personnes traitées pour un infarctus du myocarde en région éloignée : étude exploratoire descriptive.

Introduction : Cardiovascular disease is on the rise and is the second leading cause of death among Canadians. Background : The care pathway followed by myocardial infarction patients in remote areas has an impact on their continuity of care.Objective : To describe the care pathway of myocardial infarction patients living in a remote area.Methods : A qualitative formative research design was used. Two samples were created, the first comprising sixteen people who had undergone a percutaneous transluminal coronary angioplasty, and the second made up of four health professionals working in Family Medicine Groups (FMGs).Results : Eight steps were identified and three priority needs were raised, namely : 1) understanding the pathway of care and services ; 2) effectively communicating health information to the various establishments ; and 3) setting up follow-up by FMG health professionals when the patient returns home.Discussion : Nurses play a key role in all steps of the pathway and in meeting patients’ needs.Conclusion : The care and service pathway are suboptimal but the same for participants from this remote area.

[Health Literacy in Patients Presenting Severe Mental Disorders]. / La littératie en santé chez les personnes présentant des troubles mentaux graves.

Objectives The Quebec government's 2015-2020 Ministerial Mental-Health Action Plan aims at developing an optimal autonomy level in society and achieving an adequate use of healthcare services among individuals with severe mental disorders. Individuals presenting with such disorders frequently have other long-term conditions. In order to manage their conditions, these individuals must have access to, understand, and use health-related information. This corresponds to the concept of health literacy (HL). Although some research has been conducted on the HL of individuals with severe mental-health disorders, none has been done in the province of Quebec (Canada) and the measurement questionnaire previously used did not adequately take into account the multiple dimensions of HL. Using a multidimensional questionnaire would thereby be beneficial. Specifically, the objective herein was to describe the HL among individuals with a severe mental disorder residing in the community in the Saguenay-Lac-Saint-Jean region (Québec, Canada). Methods This quantitative research used a descriptive design. The participants were recruited from the community mental-health program at the Dolbeau-Mistassini CLSC, which is part of the Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Saguenay-Lac-Saint-Jean. The participants were selected using a convenience sampling. Three questionnaires were used for data collection: 1) the French version of the Health Literacy Questionnaire (HLQ), a self-report questionnaire with 9 scales; 2) the French version of the Disease Burden Morbidity Assessment to get a portrait of the chronic diseases of participants; and 3) a standard sociodemographic questionnaire. The scores for the dimensions of the HLQ have been described with descriptive statistics. The average values of the nine QLS scales for the different participant subgroups were compared with Student's t-tests or ANOVA. Results Based on the overall HLQ results, the dimension Ability to understand health information reflected a lower level of HL. Overall, the averages for the various dimensions for the study population were all slightly lower than those previously described using the same questionnaire but with populations of the elderly or people with chronic conditions. Conclusion The results highlight the need to continue investigating the HL concept for the population segment with severe mental disorders. This study also brings out the need to adapt the health education delivered to this population so as to help such individuals better understand health-related information.

Participation restriction in childhood phenotype of myotonic dystrophy type 1: a systematic retrospective chart review.

AIM: Myotonic dystrophy type 1 (DM1), a neuromuscular disorder, is divided into four clinical phenotypes: congenital; childhood; adult-onset, and late-onset. Publications about the childhood phenotype, especially the long-term outcome, are scarce. The aims of this study were to assess and describe participation outcomes in adults with the childhood phenotype. METHOD: A retrospective chart methodology. Data were extracted from health records for 63 adults with childhood DM1 (32 males, 31 females; mean age 34y, standard deviation [SD] 11y 6mo; range 18-54y) who had attended the Saguenay Neuromuscular Clinic, Canada. RESULTS: Thirty-four adults (54%) lived with their parents or in foster homes, and most patients needed services or help to live independently. A significant proportion (22%) were isolated in regard to friendship. Very few adults had children, although 33% lived with a spouse. The majority of patients (86%) relied on social security and only one person was currently working. Financial responsibilities were often an issue and 13 (21%) were under legal guardianship. INTERPRETATION: This study showed that patients with the childhood phenotype present a guarded prognosis regarding long-term social participation. These participation restrictions could be related to behavioural, cognitive, and social stigma problems in childhood. This study illustrates the absolute necessity to pursue an interdisciplinary follow-up of these patients when they are reaching adulthood.

Plasma concentrations of buprenorphine following a single subcutaneous administration of a sustained release formulation of buprenorphine in sheep.

The goal of the present study was to evaluate the potential use of slow release buprenorphine in sheep. Twelve adult female sheep (6 Dorset and 6 Suffolk, 12 months of age) were used for this project and were divided into 2 experimental groups (n = 6/group comprising 3 Dorset and 3 Suffolk sheep). Sustained release (SR) buprenorphine was administered subcutaneously in the scapular region at a concentration of 0.1 mg/kg body weight (BW) for group 1 and of 0.05 mg/kg BW for group 2. Following blood collections at selected time points, plasma concentrations of buprenorphine was performed by tandem liquid chromatograph-mass spectrometry. Mean buprenorphine concentration was above 0.1 ng/mL at 48 h up to 192 h post-injection for group 1 and it was above 0.1 ng/mL at 48 h up to 72 h post-injection for group 2. In conclusion, a long lasting potential analgesic plasma level of buprenorphine is attained following a single subcutaneous injection of 0.1 mg/kg BW of SR buprenorphine in sheep. However the effective analgesic plasma threshold still needs to be determined in sheep.

L'objectif de la présente étude était d'évaluer l'utilisation potentielle de buprénorphine à relâchement lent (RL) chez le mouton. Douze brebis adultes (6 Dorset et 6 Suffolk, 12 mois d'âge) ont été utilisées pour ce projet et ont été réparties en deux groupes expérimentaux (n = 6/groupe, 3 Dorset et 3 Suffolk). De la buprénorphine à relâchement continu a été administrée par voie sous-cutanée dans la région scapulaire à une concentration de 0,1 mg/kg de poids corporel (PC) pour le groupe 1 et à 0,05 mg/kg de PC pour le groupe 2. Suite à des prélèvements sanguins à des moments sélectionnés, les concentrations plasmatiques de buprénorphine ont été déterminées par spectrométrie de masse en tandem avec la chromatographie en phase liquide. La concentration moyenne de buprénorphine était supérieure à 0,1 ng/mL après 48 h et jusqu'à 192 h post-injection pour le groupe 1, et était supérieure à 0,1 ng/mL après 48 et jusqu'à 72 h post-injection pour le groupe 2. En conclusion, un niveau plasmatique prolongé de buprénorphine avec un potentiel analgésique est atteint suite à une injection sous-cutanée unique de 0,1 mg/kg de PC de buprénorphine RL chez le mouton. Toutefois, le seuil plasmatique analgésique réel demeure encore à être déterminé chez le mouton.(Traduit par Docteur Serge Messier).

[The journal club as a teaching strategy to develop evidence-based practice for undergraduate students in nursing]. / Utilisation d'un club de lecture comme méthode pédagogique pour favoriser l'appropriation des données probantes par des étudiantes au baccalauréat en sciences infirmières.

INTRODUCTION: Contemporary nursing practice requires constant updating of knowledge, especially in regards to research results found in academic or scientific papers. CONTEXT: As part of the university curriculum in nursing, students must develop their skills in relation to the understanding and evaluation of research evidence. OBJECTIVES: The objective of this study was to explore the appreciation and effects of a new teaching approach, the use of a journal club within a nursing research course, with undergraduate students in nursing sciences. METHOD: As part of a qualitative exploratory descriptive design, a questionnaire with open-ended questions about their appreciation and perception of the effects of the journal club was administered to the participating students (n = 41) at the end of the course. RESULTS: Participation in the journal club appears to have provided an introduction to the scientific area of nursing, to have improved several skills related to the evaluation of scientific articles and has increased motivation to adopt evidence-based practice. CONCLUSION: The use of a journal club within an undergraduate research course in nursing was a relevant teaching method that aroused great interest in the undergraduate students in nursing.

Prevalence of lifestyle risk factors in myotonic dystrophy type 1.

BACKGROUND: The prevalence of unhealthy lifestyle habits such as smoking has seldom been described in neuromuscular disorders, including myotonic dystrophy type 1 (DM1). However, it is essential to document the unhealthy lifestyle habits as they can exacerbate existing impairments and disabilities. The objectives are: 1) To determine the prevalence of risk factors among individuals with DM1; 2) To compare the prevalence among classic and mild phenotypes. METHOD: A survey was done on a sample of two-hundred (200) patients with DM1 as part of a larger study. Lifestyle risk factors included being overweight or obese, tobacco smoking, illicit drug use, excessive alcohol consumption and physical inactivity. A registered nurse administered the validated public health survey. Categorization of risk factors were based on national standards and compared with provincial and regional prevalences. RESULTS: 50% of DM1 patients were overweight or obese, 23.6% were regular smokers, and 76% were physically inactive. Except for overweight and obesity, significant differences were observed between patients with classic and mild phenotypes for all the other lifestyle risk factors: those with the classic phenotype being more often regular smokers, consuming more often illicit drugs and being less physically active. CONCLUSIONS: The results of this study will provide guidance for the development of better adapted and focussed health promotion interventions in the future.

[Analysis of the nursing role in the care of patients with neuromuscular disorders]. / Analyse du rô1e de l'infirmière dans le suivi des personnes atteintes de maladies neuromusculaires.

The nursing role in neuromuscular disorders has been shown as a promising solution in service organization. However, the role of neuromuscular nurses has scarcely been addressed in the literature. The present evaluation process was geared toward defining nursing role in relation to systematic follow-up of neuromuscular disorders and to assess its theoretical background.