Assessment of surveillance of human West Nile virus infection in Quebec, 2003.
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Adult↗
Biomedical subjects
C Poulin
Publications and source records attributed to C Poulin.
Medical and nonmedical stimulant use among adolescents: from sanctioned to unsanctioned use.
BACKGROUND: The past decade has seen a generalized upward trend in the prevalence of adolescent use of substances, including stimulants. The purpose of this article was to determine the prevalence of and risk factors for the medical and nonmedical use of stimulants, and the diversion of prescribed stimulants among adolescent students, and to demonstrate links between medical use, nonmedical use and the diversion of stimulants. METHODS: A self-reported anonymous questionnaire was administered in 1998 to a random sample of students in grades 7, 9, 10 and 12 in New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador about their medical and nonmedical use of stimulants (Benzedrine, Dexedrine, Ritalin, Cylert, diet pills, "speed," "uppers," "bennies" and "pep pills"). A total of 13,549 students completed the questionnaire, representing a 99% participation rate among the students present at school on the day of the survey. RESULTS: Of the 5.3% of students who reported medical use of stimulants in the 12 months before the survey, 14.7% reported having given some of their medication, 7.3% having sold some of their medication, 4.3% having experienced theft and 3.0% having been forced to give up some of their medication. Nonmedical stimulant use by students who did not have a prescription for stimulants was significantly related to increased numbers of students who gave or sold some of their prescribed stimulants, at both the school class and individual student levels (p < 0.001). INTERPRETATION: Although the vast majority of adolescent students taking prescribed stimulants appeared to be using their medication as sanctioned, a link was found between medical and nonmedical stimulant use and the diversion of medication from sanctioned to unsanctioned use.
Adolescent↗
The association between substance use, unplanned sexual intercourse and other sexual behaviours among adolescent students.
AIMS: To determine the prevalence of high-risk sexual behaviours and the influence of substance use and unplanned sexual intercourse on multiple sexual partners, inconsistent condom use and reasons for not always using condoms among adolescent students. DESIGN: A standardized self-reported anonymous questionnaire administered to a representative sample of students. SETTING: The Canadian provinces of Nova Scotia, New Brunswick, Newfoundland and Labrador, and Prince Edward Island in 1998. PARTICIPANTS: 9997 students in grades 9, 10 and 12 in the public school system. MEASUREMENTS: Items on sexual intercourse, unplanned sexual intercourse, number of sexual partners, condom use, alcohol use, episodes of binge drinking and drunkenness, cigarette smoking and cannabis use. FINDINGS: About 37.5% of males and 39.7% of females reported having engaged in sexual intercourse in the 12 months prior to the survey. Of those, 68.0% of males and 61.5% of females reported having engaged in unplanned sexual intercourse, 40.9% of males and 32.1% of females reported having more than one sexual partner, and 49.9% of males and 64.1% of females reported inconsistent condom use. Unplanned sexual intercourse under the influence of alcohol or other drug was found to be an independent risk factor for multiple sexual partners and inconsistent condom use. CONCLUSION: The demonstration of an association between substance use, unplanned sexual intercourse and other sexual behaviours lends support to a harm minimization approach, including the provision of non-judgemental information and interventions addressing unplanned sexual intercourse under the influence of a substance.
Adolescent↗
Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among at-risk women, young sex workers, and street youth attending community organizations in Quebec City, Canada.
BACKGROUND: Despite a relatively recent decline in the global incidence of Chlamydia trachomatis and Neisseria gonorrhoeae it seems that some segments of the population such as street youth, sex workers, and individuals with social problems or delinquent behavior could be part of a core group for STDs. These persons may be reluctant to undergo STD diagnosis in traditional medical settings. GOALS: To determine the prevalence of C trachomatis and N gonorrhoeae infection using polymerase chain reaction on urine samples among subjects attending an anonymous HIV testing clinic and four community organizations in Quebec City, and to identify associated risk factors. STUDY DESIGN: A cross-sectional study of 626 street youth, sex workers, and women with social problems or delinquent behavior was conducted. RESULTS: The prevalences of N gonorrhoeae and C trachomatis were, respectively, 1.1% (95% CI, 0.5%--2.3%) and 5.8% (95% CI, 4.1%--7.9%). No significant difference was found between men and women, but the sexually transmitted disease (STD) prevalence was much higher in subjects younger than 20 years: 11.4% versus 3.6% (P < 0.01). In a logistic regression model, factors independently associated with STD infection were age younger than 20 years (OR, 2.6; P = 0.007), occasional sex partners (OR, 2.9; P = 0.007), and injection of drugs (OR, 2.8; P = 0.002) in the preceding 6 months. CONCLUSIONS: A moderate STD prevalence was found in the study population. The prevalence, however, can be considered high (>10%) among street youth and young sex workers. Providing community-based STD screening and treatment services appear to be an efficient method for reaching these high-risk groups.
Adolescent↗
Evaluation of a modified sanitary napkin as a sample self-collection device for the detection of genital chlamydial infection in women.
A modified sanitary napkin was compared with endocervical swab and urine specimens for the detection of urogenital Chlamydia trachomatis infection. Endocervical swabs and/or first-catch urine were collected from 510 women at medical or community settings in Quebec City. Participants were also asked to wear a modified sanitary napkin (Ezy-Detek) during 4 consecutive hours and to bring it back to the clinic or mail it to the laboratory. Endocervical and urine specimens were tested using the Cobas Amplicor CT/NG assay (Roche Diagnostic Systems) according to the manufacturer's instructions, as were specimens collected with the napkin after adequate preparation. If the PCR test result was positive on the endocervical sample or on any two samples, a woman was considered to be infected. PCR testing results on paired samples were identical for 493 (96.6%) of 510 women. According to the definition given above, 58 (11.3%; 95% confidence interval [CI], 8.7 to 14.5%) women were infected with C. trachomatis. The sensitivity and specificity of PCR testing on modified sanitary napkin specimens were, respectively, 93.1% (54 of 58; 95% CI, 83.3 to 98.1%) and 98.9% (447 of 452; 95% CI, 97.4 to 99.6%) compared to 81.0% (47 of 58; 95% CI, 68.6 to 90.1%) and 100% (451 of 451; 95% CI, 99.2 to 100%) for urine specimens. The positive and negative predictive values were, respectively, 91.5% (54 of 59) and 99.1% (447 of 451) for the sanitary napkin specimens compared to 100% (47 of 47) and 97.6% (451 of 462) for urine samples. These results suggest that a modified sanitary napkin represents an effective noninvasive device for self-collection of specimens to detect urogenital C. trachomatis infection.
Adolescent↗
Reliability of intraoperative electrophysiological monitoring in selective posterior rhizotomy.
OBJECT: Selective posterior rhizotomy is a well-established treatment for spasticity associated with cerebral palsy. At most medical centers, responses of dorsal rootlets to electrical stimulation are used to determine ablation sites; however, there has been some controversy regarding the reliability of intraoperative stimulation. The authors analyzed data obtained from the McGill Rhizotomy Database to determine whether motor responses to dorsal root stimulation were reproducible. METHODS: A series of 77 patients underwent selective dorsal rhizotomy at a single medical center. The dorsal roots from L-2 to S-2 were stimulated to determine the threshold amplitude. The roots were then stimulated at 2 to 4 times the highest threshold with a 1-second 50-Hz train. A second stimulation run of the entire dorsal root was performed before it was divided into rootlets. Rootlets were individually stimulated and sectioned according to the extent of abnormal electrophysiological propagation. Motor responses were recorded by electromyography and were also assessed by a physiotherapist, and grades of 0 to 4+ were assigned. The difference in grades between the first and second stimulation trains was determined for 752 roots. Statistical analysis demonstrated a clear consistency in motor responses between the two stimulation runs, both in the electromyographic readings and the physiotherapist's assessment. More than 93% of dorsal roots had either no change or a difference of only one grade between the two trials. Furthermore, the vast majority of dorsal roots assigned a grade of 4+ at the first trial maintained the same maximally abnormal electrophysiological response during the second stimulation run. CONCLUSIONS: This study indicates that currently used techniques are reproducible and reliable for selection of abnormal rootlets. Intraoperative electrophysiological stimulation can be valuable in achieving a balance between elimination of spasticity and preservation of underlying strength.
Cerebral Palsy↗
Inhibition of human dermal fibroblast proliferation by removal of dermatan sulfate.
In the current study, a glycosaminoglycan lyase, chondroitinase B, was used to study the role of dermatan sulfate proteoglycans on human dermal fibroblast proliferation. Pretreatment with chondroitinase B significantly decreased fibroblast proliferative responses to serum (20% to 55%). In contrast, heparinase III and chondroitinase AC were less effective in inhibiting fibroblast proliferation to serum. Analysis of glycosaminoglycans on chondroitinase B-treated fibroblasts confirmed that dermatan sulfate was removed from fibroblasts by this enzyme. Chondroitinase B treatment also decreased proliferation to basic fibroblast growth factor (bFGF) by 20% and reduced receptor binding by 25%. Heparinase III inhibited bFGF binding by 73%, but decreased proliferation to bFGF by only 21%. Chondroitinase AC had no effect on bFGF proliferation or binding. These data suggest that dermatan sulfate proteoglycans play a significant role in the control of human dermal fibroblast proliferation.
Cell Adhesion↗
Prevention of paracetamol poisoning.
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Acetaminophen↗
Septo-optic dysplasia plus: a spectrum of malformations of cortical development.
The authors describe three children with septo-optic dysplasia (SOD)-plus: SOD and an associated malformation of cortical development. All three children had developmental delay, and two of the children had significant associated motor deficits. The associated cortical malformations with SOD include a spectrum of disorders of neuronal organization, not limited, as previously described, to schizencephaly. SOD-plus should be suspected in children with SOD and developmental delay.
Abnormalities, Multiple↗
Problem gambling among adolescent students in the atlantic provinces of Canada.
The objectives of the present study were to determine the prevalence of problem gambling among adolescent students in the Atlantic provinces of Canada, and to determine the role of age and deception about legal age status as potential risk factors for problem gambling. In 1998, a total of 13,549 students in grades 7, 9, 10 and 12 in the public school systems of the four Atlantic provinces completed a self-reported anonymous questionnaire that included the South Oaks Gambling Screen-Revised for Adolescents. About 8.2% and 6.4% of adolescent students met the broad definition of at-risk and problem gambling, respectively. About 3.8% and 2.2% of adolescent students met the narrow definition of at-risk and problem gambling, respectively. The prevalence of problem gambling did not vary according to age. Using a fake identification or lying about one's age was found to be an independent risk factor for problem gambling. Playing video gambling machines was the gambling activity associated with the single greatest independent risk of using a fake identification or lying about one's age. It was concluded that deception about legal age status may be a facilitating factor permitting adolescents to gamble to the point of experiencing problems.
Journal Article↗
Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada.
OBJECTIVES: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and human immunodeficiency virus (HIV) infection among injection and noninjection drug users in Quebec City and to identify associated risk factors. STUDY DESIGN: Cross-sectional study of 738 drug users attending a sexually transmitted disease/HIV prevention and needle-exchange program in Quebec City, Canada. RESULTS: The prevalences of N. gonorrhoeae and C. trachomatis were, respectively, 0.4% (95% CI: 0.08%-1.2%) and 3.4% (95% Cl: 2.2%-5.0%). Through multivariate analysis, risk factors associated with sexually transmitted diseases were: among women, being aged between 20 and 24 years and having unprotected sex with commercial partners; in noninjection drug users; cocaine use and first intercourse before 13 years of age; in male noninjection drug users, having regular sexual partners in the previous 6 months. No case of HIV was found in participants who have never injected drugs, but the prevalence was 5.5% (6/110) among the exinjectors and 10.1% (35/347) in current injectors. CONCLUSION: Moderate sexually transmitted disease and HIV prevalences were found, although a high proportion of drug users reported risky behaviors. Needle-exchange program sites may offer a good opportunity to provide sexually transmitted disease/HIV prevention and medical services to drug users.
Adult↗
Harm reduction: concepts and practice. A policy discussion paper.
This paper provides an overview of the context, definition, and key features of the harm reduction approach, and provides several examples of current programs in various countries. Both licit and illicit drugs are included in these illustrations. Some of the critical issues, and the strategies needed to advance harm reduction, are discussed. [Translations are provided in the International Abstracts Section of this issue.]
Canada↗
Surveillance of drug overdose deaths using medical examiner data.
This paper describes the epidemiology of drug overdose deaths investigated by the medical examiner in one of the cities participating in the Canadian Community Epidemiology Network on Drug Use and assesses the quality of the information obtained from medical examiner charts with respect to drug overdose deaths, for surveillance purposes. Information was abstracted from medical examiner charts of all deaths involving drugs from 1993 to 1995 in Halifax, Nova Scotia. During these three years, 636 deaths from all causes were investigated by the medical examiner. Of the 42 overdose deaths, 47.6% were suicides. Ethanol was detected in 47.8% of overdose deaths, and 61.9% of all overdose deaths involved psychotropic medications. Two deaths were attributed to an illicit drug (cocaine). An independent review performed by a toxicologist and a medical examiner revealed poor overall agreement concerning overdose as a cause of death (Kappa coefficient: 0.27). In conclusion, the average crude mortality rate due to drug overdose in Halifax from 1993 to 1995 was 4.1 deaths per 100,000 population. Potential threats to the quality of data were the lack of standardization concerning toxicological testing and the definition of drug overdose.
Adult↗
[Vas deferens occlusion: preference or science?].
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Cautery↗
Alcohol disorders in Canada as indicated by the CAGE questionnaire.
OBJECTIVE: To describe alcohol disorders in the general Canadian population, using as a standard indicator the CAGE questionnaire (Have you felt you needed to cut down on your drinking? Have you felt annoyed by criticism of your drinking? Have you felt guilty about drinking? Have you felt you needed a drink first thing in the morning [eye-opener]?). DESIGN: Secondary analysis of data from Canada's Alcohol and Other Drugs Survey (CADS), a national telephone survey conducted in 1994 of a representative sample of 12,155 people aged 15 years or more. PARTICIPANTS: The CAGE questionnaire was administered to 5894 drinkers who had consumed alcohol in the 12 months before the CADS survey. MAIN OUTCOME MEASURES: Respondents with positive (2 or more affirmative responses) and negative results on the CAGE questionnaire were compared as to demographic characteristics, alcohol consumption and harmful consequences of their drinking. Independent predictors of a positive result were identified by means of logistic regression analysis. RESULTS: A total of 5.8% of CAGE-tested current drinkers had a positive result on the past-year CAGE in 1994. The proportion of respondents reporting alcohol-related problems in one or more areas of their life was 7 times greater among drinkers with a positive result on the CAGE questionnaire than among those with a negative result (66.8% v. 9.5%) (p < 0.0001). When all demographic characteristics were controlled for simultaneously, male sex, residence in the Atlantic provinces, Quebec or the Prairies, single/never married or divorced/separated marital status, and low education level were found to be independent risk factors for a positive result on the CAGE questionnaire. About 85% of the respondents with a positive result had not sought help for their drinking. Applying the estimated sensitivity and specificity of the CAGE questionnaire in detecting alcohol dependence, as per criteria of the Diagnostic and Statistical Manual, in a general US population, the authors estimated that 4.1% of Canadians had an alcohol dependence in 1994. CONCLUSION: The large proportion of current drinkers with a positive result on the CAGE questionnaire who did not seek help for their drinking underscores the need for identification and brief interventions by physicians. Further research is needed to elucidate the underlying reasons for regional differences in CAGE status.
Adolescent↗
Alcohol, tobacco and cannabis use among Nova Scotia adolescents: implications for prevention and harm reduction.
OBJECTIVE: To characterize adolescent drug use in terms of a risk continuum and to explore the rationale for harm reduction as a potential approach for school-based drug prevention. DESIGN: Self-reported surveys, in 1991 and 1996, of adolescent students concerning their use of drugs, especially alcohol, tobacco and cannabis, and the harmful consequences of such use. SETTING: Nova Scotia. PARTICIPANTS: A total of 3452 (in 1991) and 3790 (in 1996) junior and high school students in randomly selected classes in the public school system. OUTCOME MEASURES: Prevalence of drug use and patterns of multiple drug use and of alcohol- and drug-related problems; independent risk factors for multiple drug use. The risk continuum for the response to alcohol problems was used as a policy framework. RESULTS: The prevalence of cigarette smoking and the use of hallucinogens and stimulants was markedly higher in 1996 than in 1991. Over one-fifth (21.9%) of the students reported multiple drug use of alcohol and tobacco and cannabis in the 12 months before the 1996 survey. The 3 main subgroups--nonusers, users of alcohol only and users of multiple drugs--had distinct patterns of use, numbers of problems and risk factors. In all, 27.1% of the students had experienced at least 1 alcohol-related problem and 6% had experienced at least 1 drug-related problem in the 12 months before the 1996 survey. CONCLUSION: There is a need for integrated school- and community-based drug prevention programs, with goals, strategies and outcome measures capturing the full spectrum of patterns of use and levels of risk among subgroups of the adolescent student population.
Adolescent↗
Prevalence and risk behaviours for HIV infection among inmates of a provincial prison in Quebec City.
OBJECTIVE: To assess HIV prevalence and related risk factors among inmates at the Quebec Detention Centre (QDC). DESIGN: Cross-sectional prevalence study. METHODS: Inmates incarcerated at the QDC in September 1994 were asked to participate in an anonymous survey concerning HIV infection. Volunteers answered a questionnaire and provided a saliva sample during a meeting with an interviewer. RESULTS: The overall participation rate was 95% (618 out of 651). HIV prevalence was 2% (11 out of 499) in men. All HIV-infected men were injecting drug users (IDU) with an HIV prevalence of 9% (11 out of 129) in this group. HIV prevalence was 14% (9/63) among male IDU admitting previous needle-sharing and 3% (two out of 66) among the other IDU (odds ratio, 5.3; P = 0.028). Twelve male inmates admitted injecting drugs during imprisonment, of whom 11 shared needles and three were HIV-positive. HIV prevalence in men reporting sexual intercourse with men prior to incarceration was 10% (five out of 52). Nine of the 119 women were HIV-infected (8%), seven of whom were IDU (prevalence of 16% in female IDU). One of the two non-IDU had sexual contacts with male IDU, and the other with men who had sex with men. Tattooing was not associated with HIV infection in either men or women. CONCLUSIONS: Prisoners constitute a group at high risk of HIV infection mainly because of the high proportion of them who are IDU. Imprisonment offers a good opportunity to provide education and preventive programs to this specific group that might otherwise be difficult to reach.
Female↗
[Social representation of labels associated to mental illness].
The social context linked to deinstitutionalization brought the authors to study the impact of labels placed on people having undergone psychiatry. The objective of this research is to better understand the subtleties made by the public concerning the following terms: the mentally ill person (malade mental), the ex-psychiatric patient (ex-patient psychiatrique) and the person suffering from a mental health problem (personne souffrant d'un problème de santé mentale). Data collected from 255 francophone residents from the Montréal area show that the expression "ex-psychiatric patient" is less stigmatizing than the expressions "mentally ill person" or "person suffering from a mental health problem" (PSMHP), as it refers to a past event that is over and done with. The expression "mentally ill person" emphasizes the chronic nature of the health problem suffered by the individual, where as the PSMHP focuses on the person's potential for recovery. The expression "ex-psychiatric patient" points to the capacity to function normally in society.
Adolescent↗