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Biomedical subjects

M Gaudet

Publications and source records attributed to M Gaudet.

At least 19 recordsLinked to original sources
PubMed2006

Effectiveness of a participative intervention on psychosocial work factors to prevent mental health problems in a hospital setting.

OBJECTIVES: To assess the effectiveness of a workplace intervention aimed at reducing adverse psychosocial work factors (psychological demands, decision latitude, social support, and effort-reward imbalance) and mental health problems among care providers. METHODS: A quasi-experimental design with a control group was used. Pre-intervention (71% response rate), and one-year post-intervention measures (69% response rate) were collected by telephone interviews. RESULTS: One year after the intervention, there was a reduction of several adverse psychosocial factors in the experimental group, whereas no such reduction was found in the control group. However, there was a significant deterioration of decision latitude and social support from supervisors in both experimental and control groups. There was also a significant reduction in sleeping problems and work related burnout in the experimental hospital, whereas only sleeping problems decreased in the control group while both client related and personal burnout increased in this hospital. The comparison between the experimental and control groups, after adjusting for pre-intervention measures, showed a significant difference in the means of all psychosocial factors except decision latitude. All other factors were better in the experimental group. CONCLUSION: Results suggest positive effects of the intervention, even though only 12 months have passed since the beginning of the intervention. Follow up at 36 months is necessary to evaluate whether observed effects are maintained over time. In light of these results, we believe that continuing the participative process in the experimental hospital will foster the achievement of a more important reduction of adverse psychosocial factors at work. It is expected that the intensity of the intervention will be directly related to its beneficial effects. Long term effects will however depend on the willingness of management and of staff to appropriate the process of identifying what contributes to adverse psychosocial factors at work and to adopt means to reduce them.

Adolescent↗
PubMed2001

Tolerability of antihypertensive drugs in a community-based setting.

BACKGROUND: Outside the experimental environment of clinical trials, the tolerability of angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), and the angiotensin II antagonist losartan has not been compared. OBJECTIVES: The purpose of this study was to estimate, in current clinical practice, the 3-month cumulative incidence of side effects among first-time users of losartan, ACEIs, and CCBs for hypertension. METHODS: We conducted a prospective cohort study through a network of 173 pharmacies across Canada to identify patients with hypertension who were newly prescribed monotherapy with losartan, an ACEI, or a CCB. Individuals were interviewed by telephone 3 times over a 3-month period to determine perceived side effects of the antihypertensive medication prescribed. Data were analyzed using a multivariate logistic regression model. RESULTS: Among the 663 eligible individuals, the 3-month cumulative incidence of perceived side effects was 52.5% (42/80), 60.2% (222/369), and 69.6% (149/214) for those treated with losartan, an ACEI, and a CCB, respectively. After adjustment for sex, age, level of education, number of symptoms perceived the week before entering the study, prior use of antihypertensive drugs, current use of any other drug, drug insurance coverage, and duration of hypertension, the odds of reporting a side effect were significantly higher among patients treated with an ACEI (odds ratio [OR] = 1.78: 95% CI, 1.02-3.12) or a CCB (OR = 2.65; 95% CI, 1.47-4.78) compared with patients treated with losartan. CONCLUSIONS: In a community-based setting, we observed that losartan is better tolerated than ACEIs and CCBs. Given that the occurrence of side effects may contribute to lower adherence to drug treatment, the low incidence of side effects associated with losartan makes it an attractive antihypertensive drug choice.

Adolescent↗
PubMed2000

Appropriateness of omeprazole prescribing in Quebec's senior population.

BACKGROUND: Prescribing omeprazole for the treatment of digestive disorders accounts for an important part of the costs in Quebec's drug benefit plan. In July 1993, the Quebec drug program listed omeprazole, with restriction, in its formulary. On January 1, 1994, this restriction was lifted; since then, omeprazole has been listed in the regular provincial formulary. OBJECTIVE: To describe the appropriateness of initial omeprazole prescribing in the ambulatory senior population of Quebec in the 27 months after being listed without restriction. SUBJECTS AND METHODS: A retrospective population-based cohort study was performed using prescription and medical services claims databases of the Quebec drug program. Data were extracted for elderly patients who received their first omeprazole prescription between July 1, 1994 and March 31, 1996. RESULTS: Among the 47,140 first-time users of omeprazole identified, 7516 (15.9%) had had an endoscopy in the previous six months, 2308 (4.9%) were given an antimicrobial agent and omeprazole simultaneously, and 22,730 (48.2%) received omeprazole after prior use of an H2 receptor antagonist (H2RA) or a prokinetic drug. A total of 26,525 (56.3%) first-time users were prescribed omeprazole based on at least one of the three criteria listed above. Among these users, 729 (2.8%) received an H2RA concurrently with omeprazole. Altogether, 25,796 (54.7%) first-time users received omeprazole appropriately. CONCLUSIONS: Although reimbursement for omeprazole prescriptions has not been restricted in Quebec since January 1, 1994, it was prescribed appropriately for elderly patients in the majority of cases studied.

Aged↗
PubMed1997

A cross-sectional study of private psychiatric practices under a single-payer health care system.

OBJECTIVES: To examine current concerns that in the Canadian single-payer mental health care system, the "rich worried well" (that is, wealthy individuals who are worried yet mentally well) may overuse psychiatric services, while low-income, uninsured mentally ill individuals may remain undertreated. The current study focuses on the mental health care in the Canadian region of Ottawa-Carleton, where a single-payer system provides universal access to mental health services, to assess how psychiatric services are provided by psychiatrists in private practice. METHOD: One hundred and seven private psychiatrists working in the region of Ottawa-Carleton completed a questionnaire which contained questions about the sociodemographic characteristics and background of the psychiatrists themselves and which asked the psychiatrists specific questions about the sociodemographic status, diagnosis, and treatment of each patient seen on November 10, 1994. RESULTS: Approximately 93% of the patients seen met criteria for one or more Axis I disorders, of which mood and anxiety disorders were the most common. Wealthier patients were relatively underrepresented among the patients treated by the private psychiatrists. In addition, we found no significant differences in the distribution of Axis I, Axis II, and Axis III disorders between patients earning below $30,000 per year compared with patients earning above $60,000 per year. CONCLUSIONS: Our results suggest that outpatient psychiatric care delivered by private psychiatrists in a Canadian single-payer system targets primarily individuals with major psychiatric disorders and does not seem to favour "the worried well." Larger epidemiological studies with independent assessments of psychiatric populations are necessary to confirm our findings.

Adolescent↗
PubMed1995

[Evaluation of the ventilatory function in elderly subjects].

OBJECTIVES: Many elderly subjects are at risk of respiratory failure due to effect of age on ventilatory system and the deleterious effects of toxins and respiratory diseases. As spirometry is the main technique currently used to detect altered ventilatory function we first used this method in very elderly subjects then compared the results with clinical measurements of chest and abdominal ampliation. METHODS: Among 65 subjects over 75 years of age, with no cardiorespiratory or neuropsychologic impairment and who had undergone spirometry and chest and abdominal ampliation measurements in 1991, 24 were re-examined in 1994 using exactly the same techniques. Forced vital capacity and maximum expiratory volume/second were measured at the patient's home with a previously calibrated spirometer. All tests were run according to the recommendations of the European Respiratory Society. Variations in upper chest, lower chest and abdominal circumferences were also recorded. RESULTS: Mean age of the subjects was 84.1 +/- 3.7 years and all spirometric tests were reproductible within a given measurement session. There was no significant difference for forced vital capacity or for maximum expiratory volume/second between the 1991 and the 1994 values with variations of 2.1 +/- 0.4 and 9.4 +/- 3.4% respectively. Four of the 24 initially asymptomatic subjects had signs of obstruction which resolved in 2 with the salbutamol and/or ipratropium bromide. The correlations between spirometric data and chest and abdominal ampliations were significative. CONCLUSIONS: Spirometry can be an effective tool in elderly patients. In addition to frequent discovery of reversible bronchial obstruction (7 to 41% according to the series), it can be used to screen for reduced ventilatory "reserve". Chest ampliations measures also appear to be simple means of determining which subjects could benefit from physical therapy aimed at improving chest and abdominal musculature.

Aged↗
PubMed1995

[Secondary hyperparathyroidism in the elderly. Apropos of 200 assays of intact parathormone].

OBJECTIVES: To evaluate the frequency of high levels of intact parathormone in an elderly population of hospitalized patients and to determine whether there are any correlations with different factors involved in phosphocalcium metabolism, nutritional status and renal function. METHODS: Intact parathormone was assayed in all patients admitted to a geriatric ward (n = 200). Other laboratory tests included serum phosphorus, calcium, total albumin, prealbumin, ionized calcium, creatinine with calculation of the clearance and in 50 patients radioimmunoassay for 25 hydroxyvitamin D. RESULTS: Intact parathormone was abnormally high (> 65 pg/ml) in 40 patients. Mean levels increased significantly with age and reached 70.5 pg/ml in patients 90 years of age and over. No correlation was found between intact parathormone and total serum calcium, corrected serum calcium, albumin or prealbumin. Inversely there was a significant correlation with serum phosphorus and creatinine and creatinine clearance. Serum levels of 25 hydroxyvitamin D were abnormally low in 82% of the patients. There was a constant and significant decrease in intact parathormone level 15 days after calcium and calcifediol substitution therapy in 13 patients. CONCLUSION: The frequency of hyperparathyroidism increases with age to affect nearly 1 out of 2 subjects over 90. It would be useful to determine a threshold level for elderly subjects with a major risk of bone fracture.

Aged↗
PubMed1994

[Psycho-behavioral disorders in geriatric institution].

Residents in geriatric institutions are progressively older, and they increasingly present psycho-behavioural disorders that affect the function of these institutions. Only after failure of classical medical investigation based on the observed symptoms and seeking a well-defined syndrome and treatment are these disorders attributed to progressive intellectual deterioration which escapes all classical "technical" medical efforts. Drug treatment thus becomes accessory and the disorders must be viewed as complex interactions between the subject and his institutional and familial circles. These interactions are highly pathogenic and feed the symptomatology, aggravating the disorders and producing new symptoms. For this reason, management must be adaptative, aiming at the best possible equilibrium of the subject in the institution. It should also be fully encompassing, engaging the whole of the actors within the institution. The objective can only be attained by a team equipped with gereologic knowledge, used to interdisciplinary work and constantly seeking an explicit institutional aim, taking into account all the required medical, psychological, social, familial, judicial and ethic factors.

Aged↗
PubMed1994

Clinical impact of rapid in vitro susceptibility testing and bacterial identification.

During the past decade, a variety of instrument-assisted bacterial identification and antimicrobial susceptibility test systems have been developed which permit provision of test results in a matter of hours rather than days, as has been the case with traditional overnight procedures. These newer rapid techniques are much more expensive than older methods. It has been presumed but not proven that the clinical benefits of rapid testing to patients with infection offset the added cost. The intent of this study was to objectively define the clinical impact of rapid bacterial identification and antimicrobial susceptibility testing. A 1-year study was performed in which infected, hospitalized patients in a tertiary-care, teaching, medical center were randomly assigned to one of two groups: patients for whom identification and susceptibility testing was performed by using a semi-automated, rapid, same-day procedure and those for whom testing was accomplished by using traditional overnight techniques. The two groups were compared with respect to numerous demographic descriptors, and then patients were monitored prospectively through the end of their hospitalization with the aim of determining whether there existed objectively defineable differences in management and outcome between the two groups. The mean lengths of time to provision of susceptibility and identification test results in the rapid test group were 11.3 and 9.6 h, respectively. In the overnight test group, these values were 19.6 and 25.9 h, respectively (P < 0.0005). There were 273 evaluable patients in the first group and 300 in the second group. Other than the length of time required to provide susceptibility and identification test results, no significant differences were noted between the two groups with respect to > 100 demographic descriptors. With regard to measures of outcome, the mean lengths of hospitalization were also the same in both groups. Mortality rates were however, lower in the rapid test group (i.e., 8.8% versus 15.3%). Similarly, statistically significantly fewer laboratory studies, imaging procedures, days of intubation, and days in an intensive or intermediate-care area were observed with patients in the rapid test group. Rapid testing was also associated with significantly shortened lengths of elapsed time prior to alterations in antimicrobial therapy. Lastly, patient costs for hospitalization were significantly lower in the rapid test group. The results of this study indicate the rapid same-day bacterial identification and susceptibility testing in the microbiology laboratory can have a major impact on the care and outcome of hospitalized patients with infection.

Adolescent↗
PubMed1994

Thiamine status of elderly patients with cardiac failure including the effects of supplementation.

This study compared the thiamine status of 35 elderly hospital inpatients with cardiac failure (CF) with that of 35 elderly inpatients with other diagnoses (Non-CF). The CF group was then randomly allocated to CF1 group (thiamine treatment, 200 mg per day for 7 days), and CF2 group (non supplemented). The effect of the thiamine treatment on the cardiac failure course was examined. Although there was no significant difference in thiamine status between CF and Non-CF groups, 11.5% of the first group against only 6.0% of the second was deficient with the thiamine pyrophosphate stimulation effect (TPPE) test. The same trend was observed, if NYHA functional assessment was taken into account, thiamine deficiency was more frequent in class 4 than in class 3. No significant difference for thiamin status was observed in patients receiving furosemide treatment and those without furosemide treatment. Although vitamin treatment permitted a significant improvement in thiamine status, the course of the cardiopathy was not significantly different in CF1 (supplemented) and CF2 (non supplemented) groups. Whether systematic thiamine supplementation is indicated in CF patients requires further investigation.

Aged↗
PubMed1993

[Secondary hyperparathyroidism in hospitalized aged patients: apropos of 200 assays of intact parathyroid hormone].

Plasma intact parathyroid hormone (PTH) determinations were performed in 200 elderly patients admitted in a geriatric care unit. Abnormally high levels of PTH were observed in 40 subjects. There was a significant correlation between plasma ionized calcium determinations or creatinine clearance and PTH levels. Subjects with high PTH levels exhibited constantly reduced levels of 25 OH-D3. A calcium and vitamin D supplement, performed in 13 patients, was constantly followed by a decrease of the PTH level.

Aged↗
PubMed1993

Lung function in advanced age: study of ambulatory subjects aged over 75 years.

Spirometric parameters including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and various parietal parameters (superior and inferior rib cage and abdominal maximal expansion amplitudes) were measured in 65 ambulatory subjects aged over 75 years. The population was divided into three age groups: group 1: 75-79; group 2; 80-84, group 3: 85 and older. A marked decrease in clinical and spirometric results was observed between groups 1 and 2, and 1 and 3, but there was no difference between groups 2 and 3. Such findings might be attributed to a survival effect. There was a high correlation between the parietal parameters and FVC and FEV1. In clinical practice, this simple parietal assessment may be of value in the identification of elderly subjects at risk of acute respiratory distress.

Aged↗
PubMed1989

Epidemiology of affective and anxiety disorders in children and adolescents.

Epidemiologic studies in psychiatry in general, and child psychiatry in particular, represent a new focus. Certain disease entities in children and adolescents are better studied than others. Depression and anxiety of childhood seem to exemplify this statement. Depressive illness in childhood, although recently accepted in its full clinical implications, is a relatively well researched area with regard to epidemiology and prevalence. A number of factors have been identified as being influential such as age, race, socioeconomic status, sex, IQ, and source of information. Anxiety, however, still remains an area that is unexplored and not well researched. Very few studies have epidemiologically looked at the various types of anxiety and their prevalence in childhood and adolescence. Factors that further complicate this have been the relationships between anxiety and the normal developmental stages as well as the association between anxiety and depression. The various symptoms or subtypes of anxiety seem to be normal phenomena at different developmental stages. As a result, the identification of anxiety disorders, as they specifically influence children and adolescents, has been very much undervalued. Further research is needed to differentiate anxiety from depressive disorders and more specifically to distinguish among the different subtypes of anxiety disorders and to study their prevalence. It is only then that greater attention can be given to the course, prognosis, and treatment outcome of the anxiety disorders.

Adolescent↗