[Accuracy of a self-administered questionnaire on the use of antibiotics]

BACKGROUND

To document the ambulatory use of drugs and the indications for that use, investigators often rely on self-administered questionnaires of questionable accuracy. The present study assessed the accuracy of a French Canadian self-administered questionnaire with regard to documenting current antibiotic drug use.

METHODS

The information independently obtained from physicians and pharmacists was compared with the information reported by 340 patients. Patients were asked to participate in the study by their pharmacist at the time that their prescribed antibiotic was dispensed. The proportion of agreement between the data sources was calculated with regard to antibiotic regimen characteristics and indications for use and the nature of the treated infection.

RESULTS

Self-reported information demonstrated a high level of agreement with data provided by physicians (k = 0.87) and pharmacists (k = 0.94), with regard to antibiotic names. Regarding the nature of the treated infection, the agreement between self-reported information and data obtained from physicians was substantial (k = 0.63). A total of 242 patients completed the questionnaire twice at two-week intervals. Test-retest reliability was high regarding both the antibiotic name (k = 0.72) and the nature of the treated infection (k = 0.86).

CONCLUSIONS

The self-administered questionnaire assessed in this study can reliably and accurately document the name of antibiotics used and the nature of the treated infections. Further work is needed to improve the accuracy of the questionnaire with regard to other components of antibiotics use.

Billing for cognitive services: understanding Québec pharmacists' behavior

BACKGROUND

There is growing evidence that pharmacists' interventions to solve drug-related problems are effective and cost-saving. Since 1978, under the Quebec provincial drug plan, payment for two cognitive services, the pharmaceutical opinion and the refusal to dispense a prescription, has been disbursed to community pharmacists. However, the number of claims for these services lags far behind expectations.

OBJECTIVE

To identify factors influencing Quebec community pharmacists in the billing for a pharmaceutical opinion or for a refusal to dispense.

METHODS

Questions on predisposing, enabling, and reinforcing factors potentially related to pharmacists' behavior were included in a self-administered questionnaire sent to all 3517 community pharmacists practicing in the province of Quebec during 1996. Using multivariate logistic regression, models were built to explain billing for an opinion and billing for a refusal.

RESULTS

According to our models, the typical pharmacist who billed for opinions or refusals in Quebec is <45 years of age, has attended a continuing education program on this topic, and believes that billing for interventions is important. This typical pharmacist handles a mean daily volume of 100-250 prescriptions, uses a decision-support computer program, and has sufficient technical staff assistance. This pharmacist believes that interventions can be billed rapidly and are consistently paid by the province's drug plan.

CONCLUSIONS

In order to increase the billing of pharmaceutical care in community pharmacies, tailored educational programs should be offered to pharmacists. There is also a need to improve working conditions in pharmacies.

Psychosocial factors at work, smoking, sedentary behavior, and body mass index: a prevalence study among 6995 white collar workers

This cross-sectional study examined whether psychosocial factors at work were associated with smoking, sedentary behavior, and body mass index. The study population was composed of 3531 men and 3464 women employed as white collar workers in 21 organizations. Data were collected at worksites. Psychological demands and decision latitude at work were measured with the Karasek 18-item questionnaire. Smoking, sedentary behavior, and mean body mass index were compared by quartiles of decision latitude and psychological demands and by job strain categories. Prevalence of smoking, mean number of cigarettes smoked per day, prevalence of sedentary behavior, and mean body mass index were not consistently associated with decision latitude, psychological demands, or high job strain. However, prevalence of smoking was elevated in women belonging to the highest quartile of psychological demands (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0 to 1.6) and in the active job strain groups in both men (OR, 1.6; 95% CI, 1.2 to 2.1) and women (OR, 1.4; 95% CI, 1.0 to 2.0). Prevalence of sedentary behavior was elevated in men in the lowest quartile of decision latitude (OR, 1.3; 95% CI, 1.0 to 1.7), in the passive group (OR, 1.3; 95% CI, 1.0 to 1.5), and in the high strain group (OR, 1.2; 95% CI, 1.0 to 1.6). In women, this prevalence was elevated in the third quartile of psychological demand (OR, 1.3; 95% CI, 1.1 to 1.6). These results provide only partial support for an association between some psychosocial factors at work and the prevalence of smoking and sedentary behavior.

Effect of family responsibilities and job strain on ambulatory blood pressure among white-collar women

OBJECTIVE

This study was conducted to determine whether large family responsibilities and their combination with high job strain were associated with an increase in ambulatory blood pressure (BP) among white-collar women.

METHODS

A cross-sectional study was conducted in a stratified random sample of 199 white-collar women with or without children who were employed full time in jobs involving high or low strain. These women were selected from a population of 3183 women of all ages, employed in eight organizations in Quebec City, Canada. Subjects wore an ambulatory BP monitor for 24 hours during a working day. Mean BPs were calculated. Different measures of family responsibilities were used, based on the number of children and their ages, and domestic work. Job strain was measured using the Job Content Questionnaire recommended by Karasek.

RESULTS

Family responsibility measures were significantly related to diurnal BP among women holding a university degree (N=69). Indeed, women having large family responsibilities had increases in systolic and diastolic BPs of 2.7 to 5.7/1.8 to 4.0 mm Hg (p< or =.05). Among women holding a university degree, increases in diurnal systolic and diastolic BPs reached 8.1 to 10.9/5.5 to 7.1 mm Hg (p< or =.01) among women having both large family responsibilities and high job strain. These results were independent of confounders. There was no significant association among women without a university degree (N=130).

CONCLUSIONS

Large family responsibilities were associated with significant increases in diurnal systolic and diastolic BPs among white-collar women holding a university degree. In these women, the combined exposure of large family responsibilities and high job strain tended to have a greater effect on BP than the exposure to only one of these factors.

Job strain and ambulatory blood pressure among female white-collar workers

OBJECTIVES

The association between job strain and ambulatory blood pressure was studied among female white-collar workers.

METHODS

This cross-sectional investigation studied 210 women in high- or low-strain jobs randomly selected from 3183 women of all ages, employed as white-collar workers. The women wore an ambulatory blood pressure monitor for 24 hours during a workday. Mean blood pressures were calculated. Psychological demands and decisional latitude were measured twice (14 months before and 7 days before the blood pressure measurement) with 2 scales recommended by Karasek.

RESULTS

Significant differences in blood pressure were found according to current job strain among the women holding a university degree. Their mean blood pressures during work were significantly higher [8.0 mm Hg (1.1 kPa) systolic and 6.4 mm Hg (0.8 kPa) diastolic blood pressure] in the high-strain group than in the low-strain group. Statistically significant elevations in blood pressure over the 24-hour period were also found for women with a university degree. Cumulative exposure to high strain over 14 months was also significantly associated with high systolic blood pressure at work, in the evening, and over a 24-hour period irrespective of other factors related to blood pressure. Among the women without a university degree, the blood pressure differences observed between the job strain groups were less than 1 mm Hg (0.1 kPa) and not statistically significant.

CONCLUSIONS

These results provide support for the effect of job strain on ambulatory blood pressure only among female white-collar workers holding a university degree.

A Comparison of Retrospective and Concurrent Drug Utilization Review of Omeprazole

Objective:

To compare the appropriateness of omeprazole prescriptions in a concurrent drug utilization review (DUR) with the assessed appropriateness of a retrospective DUR.

Methods:

A retrospective DUR of omeprazole was conducted on prescriptions written from August 23, 1993, to October 8, 1993, in a 340-bed university hospital. This DUR served as a baseline for a concurrent DUR that began on January 27, 1995, and ended on March 16, 1995. The concurrent DUR integrated three steps aimed at improving the quality of omeprazole use: Approval of the criteria by the pharmacology and therapeutics committee of the hospital, distribution of a drug bulletin to all physicians, and a pharmacist's verbal recommendations to physicians whose prescriptions did not meet explicit criteria.

Results:

Twenty-nine and 64 prescriptions were reviewed in the retrospective and concurrent DURs, respectively. During the concurrent DUR, the pharmacist made 34 verbal recommendations. Of these, 25 (74%) were agreed to by the prescribers. In comparison with the retrospective DUR, the percentage of prescriptions meeting the criteria of indication, combination therapy, and dosage went from 38% to 75% (p < 0.05), from 76% to 95% (p < 0.05), and from 83% to 100% (p > 0.05), respectively, during the concurrent DUR.

Conclusions:

The concurrent DUR appeared to successfully improve the quality of omeprazole utilization in the hospital.

[Evaluation of a project for nutritional rehabilitation at home in Benin]

Childhood malnutrition is a public health problem in most developing countries and the rehabilitation of malnourished children is a real challenge for health services. The main aim of this study was to evaluate the implementation of a community-based strategy for nutritional rehabilitation at home (NRH). This strategy was assessed in two districts of Benin. We also evaluated its effects on the nutrition status of the children involved in the study. Screening and rehabilitation protocols were developed for the project and were defined before the study began. The implementation process was evaluated by checking whether the children registered for NRH had received adequate treatment from the health agencies. Intervention was judged to be adequate if it was consistent with that previously set out in the rehabilitation protocol. The variables studied concerned whether the health workers had adequately implemented NRH and had applied UNICEF's three. "A" (Assessment, Analysis and Action). The results of the rehabilitation process were recorded. The weight and age of the children were determined to evaluate changes in their nutrition status. The study population was a group of 452 children aged 0 to 35 months old. The frequency of NRH sessions was adequate in 259 cases (57.9%), the quality of observations and advice was adequate in 284 cases (63.1%) and the protocol was followed properly in 151 cases (34.1%). At inclusion, 191 children (42.3%) were suffering from mild malnutrition and 146 (32.3%) were suffering from severe malnutrition. Seventy children (15.5%) were rehabilitated as defined in the protocol standards. One hundred and fifty nine children (35.2%) were lost to follow-up, 83 (18.4%) stopped the treatment and 83 (18.4%) were declared rehabilitated when they were not. The nutrition status of 69 of the 70 children who completed NRH had improved. Thus, there are flaws in the implementation process, with the three "A" not being reliably applied by health workers, particularly in terms of analysis and action. However, NRH does seem to be effective for the rehabilitation of children suffering from malnutrition, improving their nutrition status at least.

Electrophysiological evidence that a subset of midbrain dopamine neurons integrate the reward signal induced by electrical stimulation of the posterior mesencephalon

This study was aimed at determining whether midbrain dopamine (DA) neurons are trans-synaptically activated by rewarding electrical stimulation applied near the midline in the posterior mesencephalon (PM), and in the affirmative, whether the increase in firing was proportional to the rewarding effectiveness of the stimulation. Experiments were performed on male Long-Evans rats trained to lever press to obtain 400 ms trains of cathodal rectangular pulses. Following the training period, curves relating the rates of responding to the stimulation frequencies were determined at two current intensities and reward thresholds were calculated for each animal. Each animal was then anesthetized with urethane (1.2 g/kg, i.p.) and firing rate of DA neurons were recorded before, during, and after each of 50 trains (1 train/3 s) of stimulation to the PM using stimulation parameters that either sustained near threshold responding (rewarding), or failed to sustain responding (non-rewarding), in the behavioral tests. A total of 24 DA cells were recorded from 13 behaviorally trained animals, and of these, 17 (71%) responded to rewarding stimulation by an increase in firing, five (21%) were unresponsive and two (8%) were inhibited. In 12 of the 17 cells that were activated, the increase in firing was proportional to the rewarding effectiveness of the stimulation rather than the total strength of the stimulation. These results provide evidence that a subset of midbrain DA neurons are trans-synaptically activated by rewarding PM stimulation and constitute a second, or subsequent, stage of the reward-relevant pathway that integrates the PM reward signal.

Activation of neurotensin receptors in the prefrontal cortex stimulates midbrain dopamine cell firing

The effects of medial prefrontal cortex microinjections of 3 nmol/0.5 microl of neurotensin-(1-13), the inactive fragment neurotensin-(1-8), or vehicle on the firing rate of midbrain dopamine neurons were studied in anesthetized rats. Twelve of 19 cells tested with neurotensin-(1-13) showed an average 20-25% increase in firing rate between 10 and 20 min after the injection. This effect was not mimicked by neurotensin-(1-8) (9 cells), nor by a control injection (10 cells) suggesting that it is mediated by high-affinity neurotensin receptors. These results suggest that activation of neurotensin receptors in the medial prefrontal cortex can modulate neural activity of a subpopulation of midbrain dopamine neurons.

[Evaluation of the prescription quality: hospital databases]

Hospital databases can be used to evaluate drug prescription quality with the help of drug utilization review (DUR). A DUR appraises the appropriateness of prescribing by means of explicit criteria established in accordance with evidence-based data, and then suggests interventions designed to modify prescriber's practice. On the one hand, the capacity of the review to show the variations, and, on the other hand, the assessment of the impact of interventions implemented to correct those variations, depend on the quality of hospital databases. This article has two objectives: to identify the required data, both to carry out a DUR and to evaluate its outcomes, and to define the essential qualities of hospital databases.

Job strain and psychological distress in white-collar workers

OBJECTIVES

In line with Karasek's job strain model, the objective of the study was to determine whether workers submitted to high job strain, a combination of high psychological demand and low decision latitude, develop more psychological distress than workers not submitted to high job strain. A second objective was to determine whether social support at work modifies the association between job strain and psychological distress.

METHODS

The design was cross-sectional and included white-collar workers in the Québec city area. A self-administered 26-item questionnaire (the Job Content Questionnaire) measured psychological demand, decision latitude, and social support at work. Psychological distress was measured by the Psychiatric Symptom Index, a 14-item self-administered instrument.

RESULTS

Among the 2889 participants, the prevalence of psychological distress was 27.8%. High job strain was present in 20.5% of the subjects. The crude odds ratio (OR) of high job strain with psychological distress was 3.52 [95% confidence interval (95% CI) 2.54-4.88]. The OR adjusted for age, gender, employment status, occupation, social support at work, nonwork social support, cynicism, hostility, domestic load, and stressful life events during the last 12 months was still significant (OR 2.45, 95% CI 1.66-3.62).

CONCLUSIONS

Our results support the association between job strain and psychological distress. Social support at work, although significantly associated with psychological distress, did not modify the association between job strain and psychological distress.

[Validation of a French adaptation of the international prostatic symptom score]

OBJECTIVE

To evaluate the reliability and the validity of a French Canadian version of the International Prostatic Symptom Score.

DESIGN

Between November 23, 1993 and April 8, 1994, a self-administered questionnaire was submitted to a group of men on two occasions at an interval of at least one week. This questionnaire was composed of seven questions designed to score the severity of prostatic symptoms and two questions designed to score quality of life.

CONTEXT

Family medicine unit and prostatic cancer screening programme of the hormonal treatment clinic of the Laval University hospital centre.

PARTICIPANTS

Men between the ages of 50 and 80 years presenting for prostatic cancer screening or for a family medicine visit were invited to participate. A total of 207 men answered the questionnaire on the first occasion and all but two answered the questionnaire on the second occasion. MAIN ASSESSMENT CRITERIA: The internal consistency of the scale, its test-retest stability, the correlation between the prostatic symptom index of the scale and the quality of life index and the urine output were estimated.

RESULTS

The internal consistency of the scale has found to be good, with Cronbach's coefficient alpha equal to 0.82. Each question of the scale displayed a good test-retest stability, with coefficient Kappa varying between 0.41 and 0.66 according to the question. The correlation coefficient between the prostatic symptom index of the scale and the quality of life index was 0.75 (P < 0.001). An inverse linear relationship was observed between urine output and the prostatic symptom index, with a correlation coefficient of -0.289 (p < 0.001).

CONCLUSION

The psychometric qualities of the adapted scale, evaluated during the present study, are similar to the qualities of the original English language I-PSS scale. The present French version of the scale constitutes a reliable and valid tool to assess the severity of prostatic symptoms in the Quebec male population.

Leisure physical activity and age at menarche

Early menarche has been associated with higher risk of breast cancer. A prospective study of 2487 girls, has been conducted in Quebec City, Canada, to evaluate the relationship of exercise to menarche, taking personal and family characteristics into account. Weight, height, body mass index, and abdominal and supra-iliac skinfolds were inversely associated with age of menstruation. Mother's age at menarche was positively associated with age of menstruation. Age, mother's age at menarche, and weight-adjusted incidence density ratios (IDR) showed no association between energy expenditure and onset of menstruation. Girls who participated in dance, gymnastic figure skating, synchronized swimming, or diving competitions had a lower risk of reaching menarche at an early age (IDR = 0.71 (0.51-0.97)).

A nested case-control study of the correlates of early menarche

Age at menarche, an early determinant of breast cancer risk, shows both a downward secular trend and marked differences by socioeconomic status, both presumably the reflection of dietary variations. A cohort study is being conducted in the Quebec City, Canada, area to assess the relation between diet, physical activities, and menarche. In the fall of 1986, 3,022 fifth-grade girls (mean age, 10.7 years) agreed to participate in the study. All of the girls' parents provided information on health, familial, and socioeconomic variables. A 3-day dietary record and a 7-day physical activity recall were provided by 95.8% of the girls. All dietary information was verified with each girl by a dietician. Body weight and height and two skinfold thickness measurements were also recorded for 98% of the subjects. At the beginning of the study, 107 girls had already experienced menarche. In the fall of 1987, letters were sent to the mothers of the remaining 2,915 girls; 2,854 (97.9%) responded. In the preceding year, 352 girls had reached menarche. Of these, 333 (94.6%) had provided baseline dietary data. A case-control analysis was conducted in which these 333 girls were compared with 333 age-matched premenarcheal girls. There was a weak association between energy intake, energy expenditure, and early menarche. Weight, height, skinfold thickness, mother's age at menarche, and participation in a dance, ballet, gymnastics, or figure skating club were also associated with the early onset of menstruation.

Dietary and physical determinants of menarche

Age at menarche shows a downward secular trend and differs according to socioeconomic conditions, presumably the result of dietary variations. We report two studies conducted in Quebec City in which the relation between diet and menarche was evaluated. In 1978-1980, baseline information for these studies was obtained on girls aged 9 through 15 and included body weight, height, fatfold thickness at six sites, percent of body fat (derived from underwater weighing), and a 3-day dietary record. In a cross-sectional study of 207 girls aged 11 through 15, we compared dietary patterns between premenarcheal and menarcheal girls using logistic regression. In a 6-year follow-up study of 109 girls who had not experienced menarche at the baseline data collection, the relation between time of occurrence of menarche and dietary patterns was assessed using proportional hazards models. The results confirm the association between body weight and age at menarche. Body fat, however, was not strongly related to the onset of menstruation. In both studies, a higher dietary energy intake was associated with an earlier age at menarche. Dietary composition, and dietary fat in particular, was not related to menarche.

Diet and age at menarche

Early menarche has been associated with higher risk of breast cancer. A prospective study has been conducted in Quebec City, Canada, to evaluate the relationship of dietary intake to age at menarche. On three occasions during the schoolyear 1986-87, 2,299 pre-menarche. Incidence density ratios (IDRs) adjusted for age at entry and mothers' age at menarche were computed using proportional hazards models. IDRs for quartiles of energy, nutrient and food-group intakes were not different from the null value. In this population of well-nourished girls, diet did not influence the age at onset of menarche.