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Biomedical subjects

R Verreault

Publications and source records attributed to R Verreault.

At least 19 recordsLinked to original sources
PubMed2005

Symptoms of psychological distress among older adults in Canadian long-term care centres.

Psychological distress can lead to negative consequences affecting the quality of life of older adults living in long-term care centres. The goal of this study was to determine the prevalence of symptoms of psychological distress and their associated factors among these residents. A cross-sectional descriptive study was conducted among 1999 long-term care residents aged 65 and over. Nine hundred and eleven persons (45.6%) displayed at least one symptom of psychological distress either at one time or more in the week preceding data collection, and 22.4% were identified as psychologically distressed. Multivariate analysis indicated that psychological distress was associated with disruptive behaviours and benzodiazepine use among women residents, and with insomnia in men residents. In conclusion, when clinicians screen for mental health disorders, they should take into consideration that symptoms of insomnia or disruptive behaviours may mask psychological distress.

Aged↗
PubMed2004

[Environmental hazards for falls in elders in low income housing].

BACKGROUND: About 35% of elders living at home fall each year. The objectives of this study were to evaluate the environmental hazards associated with falls in 58 low income housings for elders and to determine the contribution of environmental factors to these falls. METHODS: Participants were interviewed to document their health problems, their knowledge concerning the Issue of falls, and their history of falls during the last year. Environmental hazards were identified and evaluated with a standardised checklist. The levels of hazards (percentage of factors identified which represent a hazard) were measured for the different sectors and for the entire dwelling and communal spaces. The hazards were also evaluated according to four main variables (structure of the building, characteristics of the floor surface, environmental obstacles, risk-taking behaviour). RESULTS: A total of 172 participants were recruited for the study. For dwellings and communal spaces, the hazards were respectively higher in bathrooms (mean=27.0%; p<0.05) and interior stairs (mean=22.5%; p<0.05). For the communal spaces of buildings of less than 20 Years, the global hazard was higher in the smaller buildings ( three stories, mean=12.6%; p<0.001). For dwellings of the larger buildings, the global hazard was higher for younger buildings (<20 years, mean=16.6%; >or=20 years, mean=13.5%; p<0.001). Among the variables documented, risk-taking behaviour was the more frequent factor for the dwellings (mean=32.0%; p<0.05) as for the communal spaces (mean=42.5%; p<0.05). Finally, only 34% of the participants mentioned receiving information concerning the falls among elders. Among the 27 falls documented, an environmental factor was identified in 55% of the cases. CONCLUSION: The study helped to document the presence of environmental factors which could be a hazard for falls in elders' housing and to suggest preventive and remedial actions.

Accidental Falls↗
PubMed2001

Past exposure to vaccines and subsequent risk of Alzheimer's disease.

BACKGROUND: It has been suggested that changes to the immune system could be a factor in age-related conditions such as Alzheimer's disease. Our objective was to examine the association between past exposure to conventional vaccines and risk of Alzheimer's disease. METHODS: We analyzed data from a representative community sample of subjects 65 years of age or older participating in the Canadian Study of Health and Aging, a prospective cohort study of dementia. Screening and clinical evaluations were done at both baseline and follow-up. Past exposure to vaccines was assessed at baseline by means of a self-administered questionnaire. RESULTS: Of the 4392 eligible subjects who were cognitively unimpaired and for whom vaccine information was available at baseline (in 1991-1992) and who completed follow-up 5 years later (in 1996-1997), 527 were diagnosed as having cognitive impairment or dementia other than Alzheimer's disease and were excluded from these analyses. Of the remaining subjects, 3682 were cognitively unimpaired at follow-up and 183 were newly diagnosed as having Alzheimer's disease. After adjustment for age, sex and education, past exposure to vaccines against diphtheria or tetanus, poliomyelitis and influenza was associated with lower risk for Alzheimer's disease (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.27-0.62; OR 0.60, 95% CI 0.37-0.99; and OR 0.75, 95% CI 0.54-1.04 respectively) than no exposure to these vaccines. INTERPRETATION: Past exposure to vaccines against diphtheria or tetanus, poliomyelitis and influenza may protect against subsequent development of Alzheimer's disease.

Age Distribution↗
PubMed2001

Progression of impairment in patients with vascular cognitive impairment without dementia.

Little is known about progression, short of dementia, in vascular cognitive impairment. In the Canadian Study of Health and Aging, 149 participants (79.3 +/- 6.7 years; 61% women) were found to have vascular cognitive impairment, no dementia (CIND). After 5 years, 77 participants (52%) had died and 58 (46%) had developed dementia. Women were at greater risk of dementia (OR 2.1, 1.0 to 4.5). Of 32 participants alive without dementia, cognition had deteriorated in seven and improved in four. Half of those with vascular CIND developed dementia within 5 years, suggesting a target for preventive interventions.

Aged↗
PubMed2001

Physical activity and risk of cognitive impairment and dementia in elderly persons.

CONTEXT: Dementia is common, costly, and highly age related. Little attention has been paid to the identification of modifiable lifestyle habits for its prevention. OBJECTIVE: To explore the association between physical activity and the risk of cognitive impairment and dementia. DESIGN, SETTING, AND SUBJECTS: Data come from a community sample of 9008 randomly selected men and women 65 years or older, who were evaluated in the 1991-1992 Canadian Study of Health and Aging, a prospective cohort study of dementia. Of the 6434 eligible subjects who were cognitively normal at baseline, 4615 completed a 5-year follow-up. Screening and clinical evaluations were done at both waves of the study. In 1996-1997, 3894 remained without cognitive impairment, 436 were diagnosed as having cognitive impairment-no dementia, and 285 were diagnosed as having dementia. MAIN OUTCOME MEASURE: Incident cognitive impairment and dementia by levels of physical activity at baseline. RESULTS: Compared with no exercise, physical activity was associated with lower risks of cognitive impairment, Alzheimer disease, and dementia of any type. Significant trends for increased protection with greater physical activity were observed. High levels of physical activity were associated with reduced risks of cognitive impairment (age-, sex-, and education-adjusted odds ratio, 0.58; 95% confidence interval, 0.41-0.83), Alzheimer disease (odds ratio, 0.50; 95% confidence interval, 0.28-0.90), and dementia of any type (odds ratio, 0.63; 95% confidence interval, 0.40-0.98). CONCLUSION: Regular physical activity could represent an important and potent protective factor for cognitive decline and dementia in elderly persons.

Aged↗
PubMed2001

Efficacy of eye patching for traumatic corneal abrasions: a controlled clinical trial.

STUDY OBJECTIVE: We sought to evaluate the efficacy of eye patching in the treatment of traumatic corneal abrasions in terms of time to healing and reduction in pain and discomfort. METHODS: One hundred sixty-three patients presenting at the emergency department of a large university-affiliated hospital with traumatic corneal abrasions were included in this single-blind prospective controlled trial. Eligible patients were assigned to 1 of 2 treatment regimens: topical antibiotic ointment and occlusive patch over the affected eye (n=82) or topical antibiotic ointment 4 times a day without an occlusive patch (n=81). Patients were reexamined every 24 hours until corneal healing occurred. Healing evaluation was performed by the emergency physician, using a slit lamp with fluorescein staining, without knowledge of the patient's assignment to a treatment group. The degree of discomfort was assessed at each visit by using a visual analog scale. RESULTS: Both treatment groups were similar regarding size of the corneal lesions, delay from trauma to first ED visit, presence of foreign body or siderosis, initial degree of discomfort, and presence of specific symptoms (irritation, foreign body sensation, photophobia, redness, and pain). In the patched group, cumulative incidences of healing were 51%, 78%, and 92% after 1, 2, and 3 days, respectively, compared with 60%, 83%, and 88% in the nonpatched group. In the patched group, symptoms of initial discomfort decreased by 4.8, 4.1, and 5.5 cm after 1, 2, and 3 days, respectively, compared with 3.3, 5.1, and 6.5 cm in the nonpatched group. CONCLUSION: Eye patching does not appear to be beneficial in the treatment of traumatic corneal abrasions compared with topical antibiotic ointment.

Administration, Topical↗
PubMed2000

Vascular dementia : incidence and risk factors in the Canadian study of health and aging.

BACKGROUND AND PURPOSE: Very few population-based studies have systematically examined incident vascular dementia (VaD). From the Canadian Study of Health and Aging cohort, incidence rates of VaD were determined and risk factors analyzed. METHODS: This was a cohort incidence study that followed 8623 subjects presumed to be free of dementia over a 5-year period. The risk factors were examined with a nested prospective case-control study. Exposure was determined by means of a risk factor questionnaire administered to the subject or a proxy at the beginning of the study. RESULTS: On the basis of 38 476 person-years at risk, the annual incidence rate was estimated to be 2.52 per thousand undemented Canadians (95% CI 2. 02 to 3.02). Including an estimation of the probability of VaD among the decedents, this figure rose to 3.79. For the risk factors study, 105 incident cases of VaD according to the NINCDS-AIREN criteria were compared with 802 control subjects. Significant risk factors were: age (OR=1.05), residing in a rural area (2.03), living in an institution (2.33), diabetes (2.15), depression (2.41), apolipoprotein E epsilon4 (2.34), hypertension for women (2.05), heart problems for men (2.52), taking aspirin (2.33), and occupational exposure to pesticides or fertilizers (2.05). Protective factors were eating shellfish (0.46) and regular exercise for women (0.46). There was no relation with sex, education, or alcohol. CONCLUSIONS: The study confirmed some previously reported risk factors but also suggested new ones. It raised concerns about the prescription of aspirin and perhaps other factors related to rural life.

Age Distribution↗
PubMed1998

Behavioral approaches for reducing agitation in residents of long-term-care facilities: critical review and suggestions for future research.

Many residents in long-term-care facilities demonstrate agitated behaviors. Research on behavioral approaches for reducing agitation in nursing home residents has been conducted during the past 25 years. This research is critically reviewed in this article and suggestions for future research are offered. Empirical evidence suggests that behavioral approaches are effective. Antecedent control strategies have been shown to reduce physically nonaggressive behaviors. Both aggressive and verbally agitated behaviors have been successfully treated by manipulating reinforcing consequences of these behaviors. Future research in this area needs to test behavioral treatments using randomized group designs, compare behavioral interventions to other treatments used alone or in combination, specify criteria for clinically significant improvement, diversify and ascertain the validity of assessment methods, and verify the maintenance of treatment effects over relatively long follow-up periods.

Aged↗
PubMed1996

[Dietary treatment of mild to moderate hypercholesterolemia. Effectiveness of different interventions].

OBJECTIVE: To compare the efficacy of brief dietary intervention by family physicians in their daily practice and in group sessions to standard dietetic treatment in mild to moderate hypercholesterolemia. DESIGN: Randomised clinical trial. SETTING: Family practice clinic in a remote community. PARTICIPANTS: Between September 1, 1991 and September 30, 1992, 135 men and women between 20 and 60 years old with mild to moderate hypercholesterolemia were recruited and randomly assigned to three treatment groups to be taught the American Heart Association low fat diet. Each participant had an LDL-C reading higher than the desirable level set by the Canadian Consensus Conference on Cholesterol. INTERVENTIONS: The three treatment groups received different interventions: individual consultations with a family physician in his office (phase I); group sessions with a physician and a dietician (phase II); and individual consultations with a dietician (phase II). Participants were followed for 6 months with visits and blood tests every 2 months. MAIN OUTCOME MEASURES: Reduction in serum levels of total cholesterol, LDL-C, HDL-C, and triglycerides was measured after 2, 4, and 6 months of dietary treatment. Changes in risk factors (smoking, weight, level of physical activity) and patients' cholesterol/saturated fat index were also measured. RESULTS: Ninety-nine subjects completed the 6-month regimen. The mean reduction in serum LDL-C was 0.08 mmol/L (1.8%) in Group I, 0.07 mmol/L (1.6%) in Group II, and 0.28 mmol/L (6.3%) in Group III (P = 0.94). An LDL-C reduction of 10% or more relative to initial level was observed in 27% of participants in Group I and approximately 40% of subjects in the other two groups (P = 0.41). Counseling resulted in a decrease in body weight, smoking, and dietary fat consumption and an increase in physical activity. CONCLUSIONS: Treatment by a dietician achieved better results and should remain the standard. Physicians should focus on the detection and control of other heart disease risk factors.

Adult↗
PubMed1995

Marital adjustment and depression.

Twenty patients diagnosed major depression and 20 matched normal control subjects were compared in terms of marital adjustment and other related features. Marital adjustment reported by the depressed group was significantly worse than that of the normal group. Both groups, however, had adjustment scores above the cut-off point for maladjustment. These results question the causal role ascribed to marital maladjustment in the genesis of depression.

Adjustment Disorders↗
PubMed1994

The treatment of depression with group behavioural-cognitive therapy and imipramine.

Twenty-four outpatients meeting DSM-III-R criteria for major depression were assigned to group behavioral-cognitive therapy either with or without antidepressant medication (imipramine). Eighteen patients completed 15 weekly sessions of treatment. Equivalent improvement was observed in both regimens after treatment. The results essentially maintained at six months follow-up. This suggests that a group format of behavioural-cognitive therapy is a viable therapeutic intervention for outpatients diagnosed as suffering from major depression. However, the addition of imipramine to group behavioural-cognitive therapy did not enhance the outcome.

Ambulatory Care↗
PubMed1994

[The use of diagnostic and surgical procedures in elderly persons in Quebec].

The rapid aging of the population constitutes a new challenge for the health care delivery system. This paper presents the progression of use of several diagnostic and surgical procedures in the elderly in Quebec from 1981 to 1989. Data were obtained from claims to the Régie de l'assurance maladie du Québec for the years 1981, 1985 and 1989. The rate of coronary artery bypass surgery increased by more than 700% in people 65 years and over between 1981 and 1989. This increase was especially high in the oldest age group (q 75 years). There was also a significant increase in surgery for abdominal aortic aneurysm, while the rate of carotid endarterectomy remained stable for people 65 years and over during this period. The rates of all abdominal surgical procedures examined (appendicectomy, repair of hiatal and inguinal hernia, cholecystectomy and colectomy) were relatively stable in elderly during the study period. Total hip replacement more than doubled in people 65 years and over, while other types of hip arthroplasty significantly decreased over this period. All types of diagnostic procedures examined (coronary angiography, bronchoscopy, gastroduodenoscopy and retrograd cholangio-pancreatography) increased significantly, especially in very old people. This study suggests that surgical care is increasing in the elderly in Quebec. This progression is expected to continue in the coming years so that surgical care of the elderly will become a significant part of our health care delivery system.

Aged↗
PubMed1990

Use of electric blankets and risk of testicular cancer.

Electric blankets are an important domestic source of electromagnetic fields (EMF) because of the relatively high intensity of emission, prolonged exposure, and intimate contact with the source. In a case-control study of testicular cancer in western Washington during 1981 to 1984, the relation between EMF exposure from electric blankets and the occurrence of testicular cancer was examined. The respective proportions of cases and controls who reported the use of an electric blanket were almost identical (age-adjusted rate ratio (RR) = 1.0, 95% confidence interval (CI) 0.7-1.4). Distributions of the duration of use were also very similar in cases and controls. Compared with controls, the frequency of use of an electric blanket was slightly lower in men with seminoma (RR = 0.7, 95% CI 0.5-1.2) and slightly higher among men with nonseminoma germ cell tumors (RR = 1.4, 95% CI 0.9-2.3). Overall, the results of this study suggest that increased exposure to EMF from electric blankets contributes little, if at all, to the risk of testicular cancer in adult white men.

Bedding and Linens↗
PubMed1989

A case-control study of diet and invasive cervical cancer.

A population-based case-control study was conducted to assess the relation of diet, especially intake of vitamins A, C and E and of folic acid, to the risk of invasive cervical cancer. Cases were 189 women diagnosed with cervical carcinoma between 1979 and 1983 in 3 counties of the Seattle area. Controls (N = 227) were selected through random digit dialling. Diet during the year preceding diagnosis was assessed by interview, using a food frequency questionnaire covering the intake of 66 food items. After adjustment for known risk factors, frequent consumption of dark green or yellow vegetables and of fruit juices was related to a reduced risk of cervical cancer. Similarly, high dietary intake of carotene was associated with a lower risk of the disease, especially of the squamous-cell type. There was an inverse relationship between vitamin C intake and the risk of cervical carcinoma. The adjusted relative risk (RR) was 0.5 (95% confidence interval: 0.2-1.0) for the highest quartile of intake compared to a RR of 1.0 for the first quartile. High vitamin E intake was also related to a reduced risk, the risk for women in the highest quartile being only one-third of the risk for those in the first quartile. Intake of pre-formed vitamin A and of folic acid was not related to the risk of cervix cancer. Thus, our study suggests that the risk of invasive cervical carcinoma might be influenced by some aspects of diet.

Adult↗
PubMed1989

Body weight and prognostic indicators in breast cancer. Modifying effect of estrogen receptors.

The relations of body weight, height, and Quetelet index to axillary node involvement at diagnosis, estrogen receptor status, and histologic features of the primary tumor were examined in 656 patients with a newly diagnosed infiltrating breast carcinoma first treated in Québec City from July 1982 to December 1984. Node involvement increased with body weight and Quetelet index. This association was more regular and much stronger among patients with estrogen receptor-positive tumors than among those with estrogen receptor-negative breast cancers. Among patients with estrogen receptor-positive tumors, the percentage with involved nodes at diagnosis increased regularly from 32.9% among lean patients (Quetelet index less than 21 kg/m2) to 65.6% among obese women (Quetelet index greater than 27 kg/m2). This trend was seen even after adjustment for age and tumor size. In contrast, among patients with estrogen receptor-negative breast cancers, the association of weight and Quetelet index with node involvement were weak and irregular. The modifying effect of estrogen receptor status on the relation of obesity to node involvement was apparent in pre- and post-menopausal women. Body weight and Quetelet index were not related to estrogen receptor status or to any of the measured histologic features of breast tumors including nuclear grade, histologic grade, tubule formation, mitotic activity, and size of nucleus of cancer cells. These findings suggest that the observed deleterious effect of obesity on breast cancer prognosis is unlikely to be an artifact of delayed diagnosis in overweight patients. It may be due to hormonal changes associated with increases in body weight.

Axilla↗
PubMed1989

Diet, mammographic features of breast tissue, and breast cancer risk.

This case-control study was designed to reevaluate the association of the morphology of breast tissue seen on mammograms with breast cancer risk and to assess the relation of diet, especially intake of fat and vitamin A, to the high-risk mammographic images. The cases included 290 patients with newly diagnosed breast cancer who were first treated in Quebec in 1982-1984. The controls included 645 women who participated in the Canadian National Breast Screening Study. Risk of breast cancer was higher among women with the P2 or DY parenchymal pattern (relative risk (RR) = 3.7, 95% confidence interval (Cl) 2.0-7.0) than it was among those with the N1 pattern. Moreover, risk increased regularly with the extent of nodular and homogeneous densities on the mammogram. Relative risk was 5.5 (95% Cl 2.3-13.2) for women in whom 60% or more of the volume of the breast showed either nodular or homogeneous densities compared with women without such densities. Among controls, increase in energy-adjusted saturated fat intake was associated with an increase in extent of high-risk mammographic features. Energy-adjusted polyunsaturated fat or cholesterol intake did not, however, appear to influence the morphology of breast tissue seen on the mammogram. Increasing carotenoid and fiber intakes were associated with a reduction of the extent of densities on the mammogram, but retinol intake seemed to have little or no effect on mammographic features. These data suggest that elevation in saturated fat intake and reduction in carotenoid and fiber intakes may be related to an increase in breast cancer risk through effects of these nutrients on breast tissue morphology.

Adult↗
PubMed1989

A case-control study of pedestrian and bicyclist injuries in childhood.

We identified children ages 0 to 14 years injured in traffic as pedestrians or bicyclists in Montreal, Canada. Two hundred children with injuries who received a score of 2 or more on the Maximum Abbreviated Injury Severity scale were considered as cases and compared with 400 uninjured children seen in the same hospitals for non-traumatic reasons. Systematic, blinded interviews and tests were conducted with parents to determine the role of a series of social, familial, personal, and behavioral characteristics. After adjustment for age, gender and socioeconomic area of residence, logistic regression analyses showed higher risks of injury to be related to fewer years of parents' education, a history of accident to a family member, an environment judged as unsafe, and poor parental supervision. Absence of physical health problems, fewer family preventive behaviors and reported lack of cautiousness were also related to a higher risk, whereas neither aggressivity nor behavioral disturbance, whether internalizing or externalizing, showed any such relation. These data suggest that the child's personality and behavior are weaker risk factors for pedestrian and bicyclist injuries than are family and neighborhood characteristics.

Accidents, Traffic↗