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Biomedical subjects

F Lavoie

Publications and source records attributed to F Lavoie.

At least 19 recordsLinked to original sources
PubMed2003

Drug utilization review of celecoxib in Ontario.

Cyclooxygenase (COX)-2-specific inhibitors were developed to circumvent the gastrointestinal toxicity of non-specific non-steroidal anti-inflammatory drugs while maintaining efficacy. However, the higher acquisition cost of COX-2-specific inhibitors has resulted in the implementation of a programme for cost containment in the Ontario public drug program. This programme consists of limited use (LU) criteria that need to be met for drug reimbursement of patients with osteoarthritis (OA) or rheumatoid arthritis (RA). Determining the proportion of patients eligible for reimbursement for celecoxib according to the LU criteria (based on prior treatment failure and the presence or history of serious ulcer-related gastrointestinal complications) can provide an indication of the extent of adherence to suggested guidelines. Using a patient-based survey and an analysis of the Ontario Drug Benefit Program database, the proportion of patients prescribed celecoxib who met rigorous or pragmatic definitions of the LU criteria was determined. The extent of coprescription of gastroprotective agents among patients taking celecoxib was also determined. Using the pragmatic definition, the majority of patients in the patient-based survey (53% for OA and 81% for RA) met the LU criteria. Similarly, in the database analysis, the majority of patients (76% for OA and 78% for RA) met the LU criteria. These data suggest that physician prescribing of celecoxib is consistent with the LU criteria. Concomitant prescription of gastroprotective agents in patients taking celecoxib was approximately 40%. It is recommended that further investigations be performed to determine the long-term impact of LU criteria on clinical and economic outcomes, since these criteria may also serve to restrict use in patients who may benefit from taking COX-2-specific inhibitors.

Aged↗
PubMed2003

Persistency of use of COX-2-specific inhibitors and non-specific non-steroidal anti-inflammatory drugs (NSAIDs) in Quebec.

The effectiveness of pharmacological therapies is dependent in part on patient persistency with the prescribed therapeutic regimen. In the case of non-specific non-steroidal anti-inflammatory drugs (NSAIDs), effectiveness is often compromised by undesirable side-effects, poor compliance or discontinuation of therapy. While patterns of utilization of non-specific NSAIDs have been investigated, few data are available on the patterns of persistency for cyclooxygenase (COX)-2-specific inhibitors. This study used a provincial health-care system database in Quebec, Canada, to determine the duration of treatment in new users of COX-2-specific inhibitors and non-specific NSAIDs over the first 3 months of treatment, and to characterize the factors associated with treatment persistency. Results demonstrate that the median duration of treatment was longer among patients initially prescribed COX-2-specific inhibitors (30 days and 23 days for celecoxib and rofecoxib respectively) than in those prescribed non-selective NSAIDs (10 days). Although the percentage of patients remaining on COX-2-specific drugs declined over the course of treatment, few patients on either celecoxib or rofecoxib switched drugs, either to the other COX-2-specific inhibitor or to non-specific NSAIDs. Factors associated with persistent drug use were: COX-2-specific inhibitors, age, and the use of gastroprotective agents either at treatment initiation or during follow-up. Dosage, chronic disease score and prescriber's specialty were only marginally associated with persistency. Prior use of gastroprotective agents was associated with lower persistency. Although the limitations of this study, which included lack of information on the indication for the prescription and the reason for switch or discontinuation, preclude definite conclusions regarding patterns of use of these drugs, the data suggest that the use of COX-2-specific inhibitors may result in increased persistency with treatment.

Adolescent↗
PubMed2001

Proximate effects of a child sexual abuse prevention program in elementary school children.

OBJECTIVE: The effects of the sexual child abuse prevention program ESPACE were evaluated by means of a Solomon-type design with first and third grade children. ESPACE is an adaptation of the American Child Assault Prevention Program (CAP). Possible side effects of the program were also examined. METHOD: A total of 133 children (64 first-graders and 69 third-graders) participated in the study. Children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills towards abusive and potentially abusive situations. A follow-up measure (2 months) was administered to verify whether knowledge and skills were maintained. RESULTS: Results indicated that children participating in the prevention program showed greater preventive knowledge and skills relative to children not participating. Follow-up data showed that knowledge gains were maintained while the preventive skill gains may attenuate. However, while global skill scores decreased between post-test and follow-up, children still showed greater preventive skills at follow-up than before the program. In terms of unanticipated side effects, results revealed that almost half of the parents noted positive reactions following children's participation in the ESPACE program. Furthermore, the majority of parents did not identify negative reactions in their children following their participation in the workshop. CONCLUSION: The findings suggest that the Quebec adaptation of the CAP program was effective in training children in abuse prevention concepts and skills.

Analysis of Variance↗
PubMed2001

Reactive and proactive aggression: predictions to physical violence in different contexts and moderating effects of parental monitoring and caregiving behavior.

This study aimed at (a) comparing the links of proactive and reactive aggression at 13 years of age to delinquency-related violence and dating violence at ages 16 and 17, and (b) examining the moderating effects of parental supervision, and mother's and father's warmth and caregiving behaviors on these links. Based on a sample of 525 Caucasian boys, the results showed that proactive aggression uniquely predicted delinquency-related violence, whereas reactive aggression uniquely predicted later dating violence. The relation between proactive aggression and delinquency-related violence, however, was moderated by parental supervision. The relation between reactive aggression and dating violence was moderated by mother's warmth and caregiving behavior. The implications of the findings for the theoretical and practical distinction between proactive and reactive aggression are discussed.

Adolescent↗
PubMed2001

An economic model for determining the costs and consequences of using various treatment alternatives for the management of arthritis in Canada.

OBJECTIVE: To construct a decision analytical model to compare the costs and clinical consequences of treating patients with celecoxib or various nonsteroidal anti-inflammatory drug (NSAID)/gastrointestinal (GI) co-therapy regimens for the management of osteoarthritis and rheumatoid arthritis. The model quantified the number of patients expected to experience any GI complication commonly associated with NSAID therapy. DESIGN: Resource use for the treatment of each GI complication in the model was estimated after consulting Canadian experts. Standard unit costs from Ontario were applied to resources to calculate the cost of each complication. MAIN OUTCOME MEASURES AND RESULTS: The model revealed that the NSAID-alone regimen was associated with the lowest cost [$262 Canadian dollars ($Can) per patient per 6 months] followed by the celecoxib regimen ($Can273), diclofenac/misoprostol ($Can365), NSAID + histamine H2 receptor antagonist ($Can413), NSAID + misoprostol ($Can421), and NSAID + proton pump inhibitor ($Can731). A break-even analysis showed that up to 80% of the study cohort could be treated with celecoxib instead of the NSAID-alone regimen without increasing the health system's overall budget. Celecoxib was associated with the fewest GI-related deaths, hospitalised events; symptomatic ulcers, and cases of anaemia. The celecoxib regimen was also associated with the fewest cases of upper GI distress. Sensitivity analyses revealed that the model was most sensitive to the distribution of GI risk in the population and to the ingredient costs of the treatment alternatives. CONCLUSIONS: This model indicates that the use of celecoxib could lead to the avoidance of a significant number of NSAID-attributable GI adverse events, and the incremental cost of using celecoxib for arthritis patients > or = 65 years of age in place of current treatment alternatives would not impose an excessive incremental impact on a Canadian provincial healthcare budget.

Aged↗
PubMed2001

[Female victimization in the context of dating violence in adolescence: development of an instrument (VIFFA)].

The aim is to report on the development and preliminary validation of an instrument, VIFFA (Violence faite aux Filles dans les Fréquentations à l'Adolescence), on female victimization in the context of dating violence in adolescence. Objectives are twofold: to document the psychometric qualities of this self-report and to propose an instrument adapted to the context of young teens. The instrument refers to concepts of physical, emotional, and sexual abuse. Questioning in two phases is used to achieve proper understanding of the concept studied and to help select the partner to whom they refer in the second detailed phase. Girls were questioned on violence sustained and boys on violence inflicted. The total sample included 331 boys and 377 girls; their mean age was 14.6 years. A social desirability questionnaire was used to evaluate discriminant validity and the results indicate that the adolescents' answers were not distorted by social desirability. The factorial analyses resulted in 4 slightly different factors for girls and boys. With regard to the girls (violence sustained), the factors included Verbal and Emotional Abuse, Physical Abuse, Control through Jealousy and Sexual Abuse. With the boys (violence inflicted), the factors were Psychological Abuse, Jealousy and Sexual Abuse, Severe Physical Abuse and Minor Physical Abuse. Validation studies indicate that the instrument has adequate psychometric qualities and is adapted to the context of adolescence. An innovative aspect is the place given to items concerning jealousy.

Adolescent↗
PubMed2000

Changes in the treatment and outcomes of acute myocardial infarction in Quebec, 1988-1995.

BACKGROUND: Few studies have reported population-based information on the treatment trends and outcomes of patients who have had an acute myocardial infarction (AMI). We therefore examined patterns of care and outcomes for AMI patients in Quebec, Canada, between 1988 and 1995. METHODS: Longitudinal data files of hospital admissions in Quebec (Med-Echo database) and inpatient and outpatient services (Régie de l'Assurance Maladie du Québec database) were used to construct cohorts of all AMI patients in the province between 1988 and 1995. Temporal trends in the use of cardiac procedures after an AMI, discharge prescriptions and mortality rates were examined. RESULTS: Between 1988 and 1995 the age- and sex-adjusted rates of AMI in the Quebec population declined (148 per 100,000 in 1988 to 137 per 100,000 in 1995). The use of intensive cardiac procedures increased in the same period; the 1-year cumulative incidence rate of catheterization increased from 28% in 1988 to 31% in 1994, that of angioplasty rose from 8% to 15% and that of coronary artery bypass surgery from 6% to 8%. Prescriptions for ASA, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors increased, and prescriptions for nitrates and calcium antagonists decreased. These temporal changes were paralleled by a decrease in mortality rates post-AMI. All-cause 1-year cumulative incidence mortality rates decreased from 23% in 1988 to 19% in 1994. INTERPRETATION: The decrease in AMI-related mortality in Quebec between 1988 and 1995 may be linked to changes in treatment strategies (i.e., increased use of cardiac surgical procedures and medications shown to increase survival).

Age Factors↗
PubMed1999

[Contribution of individual characteristics to learning by children with first exposure to a prevention of abuse program].

This study explores the contribution of personal characteristics in the knowledge and skills gains of children taking part in the child abuse prevention program ESPACE. The program is an adaptation of the widely implemented American Child Assault Prevention Program (CAP). A group of 107 fourth-grade children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills in abusive and potentially abusive situations. Children were also invited to complete questionnaires evaluating individual characteristics such as self-esteem, locus of control and self-efficacy. The results highlight the importance of certain individual variables such as the child's gender, self-efficacy and perception of athletic competence in the acquisition of sexual abuse preventive skills.

Child↗
PubMed1998

Treating hyperlipidemia for the primary prevention of coronary disease. Are higher dosages of lovastatin cost-effective?

OBJECTIVE: To compare the average and marginal life-time cost-effectiveness of increasing dosages of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, such as lovastatin, for the primary prevention of coronary heart disease (CHD). METHODS: We estimated the lifelong costs and benefits of the modification of lipid levels achieved with lovastatin based on published studies and a validated CHD prevention computer model. Patients were middle-aged men and women without CHD, with mean total serum cholesterol levels of 6.67, 7.84, and 9.90 mmol/L (258, 303, and 383 mg/dL), and high-density lipoprotein cholesterol levels of 1.19 mmol/L (46 mg/dL), as described in clinical trials. We estimated the cost per year of life saved for dosages of lovastatin ranging from 20 to 80 mg/d that reduced the total cholesterol level between 17% and 34%, and increased high-density lipoprotein cholesterol level between 4% and 13%. RESULTS: After discounting benefits and costs by 5% annually, the average cost-effectiveness of lovastatin, 20 mg/d, ranged from $11,040 to $52,463 for men and women. The marginal cost-effectiveness of 40 mg/d vs 20 mg/d remained in this range ($25,711 to $60,778) only for persons with baseline total cholesterol levels of 7.84 mmol/L (303 mg/dL) or higher. However, the marginal cost-effectiveness of lovastatin, 80 mg/d vs 40 mg/d, was prohibitively expensive ($99,233 to $716,433 per year of life saved) for men and women, irrespective of the baseline total cholesterol level. CONCLUSIONS: Assuming that $50,000 per year of life saved is an acceptable cost-effectiveness ratio, treatment with lovastatin at a dosage of 20 mg/d is cost-effective for middle-aged men and women with baseline total cholesterol levels of 6.67 mmol/L (258 mg/dL) or higher. At current drug prices, treatment with 40 mg/d is also cost-effective for total cholesterol levels of 7.84 mmol/L (303 mg/dL) or higher. However, treatment with 80 mg/d is not cost-effective for primary prevention of CHD.

Anticholesteremic Agents↗
PubMed1997

A head-to-head comparison of the cost effectiveness of HMG-CoA reductase inhibitors and fibrates in different types of primary hyperlipidemia.

The objective of this study was to compare the lifetime cost-effectiveness of HMG-CoA reductase inhibitors and fibrates for the treatment of hyperlipidemia. Estimates of lipid modification achieved due to drug therapy were based on published head-to-head comparisons of specific HMG-CoA reductase inhibitors and fibrates in randomized, double-blind studies. We used a validated coronary heart disease (CHD) prevention computer model to estimate the costs and benefits of lifelong lipid modification. The patients were middle-aged men and women who were free of CHD, with either primary type IIa or IIb hyperlipidemia. The intervention used were specific HMG-CoA reductase inhibitors and fibrates at several dosages, which reduced total cholesterol 11-34% and increased high-density lipoprotein cholesterol 1-29%. The main outcome measure was the cost per year of life saved after discounting benefits and costs by 5% annually. The lifetime cost effectiveness of HMG-CoA reductase inhibitors (fluvastatin, lovastatin, pravastatin, simvastatin) and fibrates (bezafibrate, fenofibrate, gemfibrozil) for the treatment of primary hyperlipidemia varied according to patient population, the effectiveness of each drug in modifying lipid levels, and the price of each drug. The estimates of cost per year of life saved for HMG-CoA reductase inhibitors range from $19,886 to $73,632, and $16,955 to $59,488 for fibrates according to gender and type of primary hyperlipidemia. Fluvastatin 20 mg/day was significantly more cost effective than gemfibrozil 1200 mg/day for male patients with type IIa hyperlipidemia. Simvastatin 17.3 mg/day or 20 mg/day yielded similar cost-effectiveness ratios compared with fibrates among type II hyperlipidemic patients. However, micronized fenofibrate was more cost effective than simvastatin 20 mg/day among type IIb patients. The cost effectiveness of lipid therapy varies widely and can be maximized by selecting specific drugs for specific lipid abnormalities.

Bezafibrate↗
PubMed1997

The experience of caregiving among mothers of adults suffering from psychotic disorders: factors associated with their psychological distress.

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.

Adult↗
PubMed1995

[Mothers of psychotic patients and their difficulties with the health care system].

This article describes the difficulties perceived by mothers of people suffering from psychotic problems when coping with the healthcare system. The 99 interviewees were recruited through mutual help groups and hospitals. In addition to feeling left to themselves to care for their child, their main grievances relate to the fact that their child does not have access to workforce integration resources, that therapeutic follow-up (non-drug related) is inadequate and that they do not receive updates on the state of health of their child. Mothers belonging to mutual help groups are significantly more upset about the difficulties they encounter when coping with the healthcare system, in comparison to mothers who do not belong to such groups. In light of comments by experts and the interviewees, the authors make suggestions designed to improve existing services, as well as collaboration between healthcare teams and the families concerned.

Adaptation, Psychological↗
PubMed1995

A study of the prevalence of sexual coercion in adolescent heterosexual dating relationships in a Quebec sample.

Very few studies which have addressed the issue of sexual violence in dating relationships have provided prevalence rates for coercion that is perpetrated and sustained for both sexes during adolescence, while adequately accounting for the totality of unwanted sexual experiences. The present study addresses these issues by examining the rates of perpetrated and sustained sexual coercion among 644 French-speaking adolescents between 15 and 19 years of age with heterosexual dating experience from Quebec (Canada). Chi-square analyses reveal that girls are more often the victims of coercion, while boys more frequently perpetrate it. However, some boys are victims of sexual coercion. The most frequently occurring unwanted sexual experiences are kissing, and petting or fondling. Verbal coercion, consisting of continual arguments and pressure, is the strategy most often used by those who perpetrate unwanted sexual experiences, and is the strategy most frequently reported by those who suffer it. More extreme forms of sexual violence are also reported, but at a lower rate. Such high rates of sexual coercion during adolescence, as observed in the present study within a culture which is increasingly open to issues regarding sexuality, argue strongly for the implementation of prevention and intervention programs within this age group.

Adolescent↗
PubMed1994

{Social support and the help offered by mothers to their psychologically troubled sons or daughters}.

We describe in this paper the everyday support mothers give to their adult sons or daughters suffering from psychotic disorders. We also describe the support these women receive from their social network regarding specific needs related to their children's disorders. Ninety-nine women, representing all socioeconomic groups, were interviewed. They were recruited through hospitals and self-help groups. The results of this study highlight the fact that participants give a substantial amount of support to their children, that they have considerable concern for their children's well-being, and that members of their family are their main source of emotional and practical support, and of advice. Mental health professionals give primarily informational support to respondents, in part through community-based agencies. The respondents who belong to self-help groups have significantly more needs related to their children's disorders and have more concern for their children's well-being than do the other respondents.

Adolescent↗
PubMed1993

Homicide, schizophrenia and substance abuse or dependency.

Few studies have extensively studied the aggressive behaviours of mentally disordered offenders. This investigation compared 14 schizophrenics found not guilty of homicide by reason of insanity (NGRI) with 12 schizophrenics convicted of homicide. A comparison group of 15 homicide offenders with no major mental disorder was used. Drug and alcohol consumption, previous history of aggression against others as well as mental health were assessed using standardized, reliable, valid instruments. Significantly more of the inmates with no major mental disorder were diagnosed as having a history of drug or alcohol abuse or dependency (60%) than the NGRI schizophrenics (35.7%). In addition, both groups of convicted homicide offenders were more likely to have committed homicide under the influence of drugs or alcohol than the NGRI group. No significant difference distinguished the groups for the mean number of aggressive incidents. The subjects found NGRI assaulted more often during an acute phase of mental illness than the convicted schizophrenics. Although both groups appeared to have a similar number of hospitalizations, most of the hospitalizations of the convicted schizophrenics occurred after the crime.

Adolescent↗
PubMed1982

[Widowhood : problem and factors of adaptation.].

The death of a spouse is a crisis situation which the majority of the population will experience. Some are affected over a long period by the effects of mourning, while others adapt more easily. Starting with a review of writing on the subject, this article describes first the principal stages of the mourning reaction, then it identifies the associated financial, health, and interpersonal problems experienced by widows and widowers. Age, income, previous mourning, the existence of a confidant, frequenting friends and other widows or widowers, satisfaction in relation to help received, participation in diverse associations, are the principal factors favouring adaptation to widowhood. Depressive behaviour, one month after onset of widowhood, and the delayed reaction to mourning indicate a possible negative reaction.

English Abstract↗