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Vasiliadis HM, Lunghi C, Rahme E, Rochette L, Gignac M, Massamba V, Diallo FB, Fansi A, Cortese S, Lesage A. ADHD medications use and risk of mortality and unintentional injuries: a population-based cohort study. Transl Psychiatry 2024; 14:128. [PMID: 38418443 PMCID: PMC10901868 DOI: 10.1038/s41398-024-02825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/01/2024] Open
Abstract
We assessed the association between the use of medications for attention-deficit/hyperactivity disorder (ADHD) and the risk of all-cause mortality and unintentional injuries leading to emergency department (ED) or hospital admission in individuals aged ≤24 years with ADHD. We conducted a population-based retrospective cohort study between 2000 and 2021 using Quebec health administrative data. Individuals were followed from the first ADHD diagnosis or ADHD medication claim until turning 25, death, or study end. Exposure was defined as mutually exclusive episodes of ADHD medication use and/or coverage under the public provincial drug plan (PDP): 1) covered and not treated with ADHD medication; 2) covered and treated with ADHD medication; and 3) not covered under the PDP. The risk of all-cause mortality and unintentional injuries associated with exposure episodes was estimated using multivariable survival analyses. The cohort included n = 217 192 individuals aged 1-24 years with a male to female ratio of close to 2:1. Compared to non-medication use, episodes of ADHD medication use, overall, were associated with reduced all-cause mortality (adjusted hazard ratio, aHR 0.61, 95% CI 0.48-0.76) and unintentional injury leading to ED (0.75, 0.74-0.77) or hospitalisation (0.71, 0.68-0.75). Episodes of stimulants were associated with a lower risk of all-cause mortality and reduced risk of unintentional injuries, while episodes with non-stimulants and with both stimulants and non-stimulants concomitantly were associated with reduced risk of unintentional injuries, but not of all-cause mortality. Although residual confounding cannot be excluded, stimulants may have a protective effect in terms of risk of all-cause mortality and both stimulants and non-stimulants for ADHD may reduce the risk of unintentional injuries. The findings of the current study should inform clinical decision making on the choice of starting a pharmacological treatment for ADHD, when a balance needs to be struck between expected benefits and possible risks.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Department of Community Health Science, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueil, QC, J4K 0A8, Canada.
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueil, QC, J4K 0A8, Canada.
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, 1595 Boulevard Alphonse-Desjardins, Lévis, QC, G6V 0A5, Canada
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio, 48 - 40126, Bologna, Italy
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Martin Gignac
- Montreal Children's Hospital, McGill University Montreal, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Victoria Massamba
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Fatoumata Binta Diallo
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Alvine Fansi
- Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal /Montreal West Island Integrated University Health and Social Services Centre, Montreal, QC, Canada
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus, Building 44, Room 4059, University Rd, Southampton, SO171PS, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, HighPoint Venue, Bursledon Rd, Southampton, SO19 8BR, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, One Park, New York City, NY, 10016, USA
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari "Aldo Moro", Bari, Italy
| | - Alain Lesage
- Department of Psychiatry and Addictology, University of Montreal, Research Centre of the Institut universitaire en santé mentale de Montréal, 7401, rue Hochelaga, Montreal, QC, H1N 3M5, Canada
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Schwartz L, Nouvet E, de Laat S, Yantzi R, Wahoush O, Khater WA, Rwililiza EM, Abu-Siam I, Krishnaraj G, Amir T, Bezanson K, Wallace CS, Sow OB, Diallo AA, Diallo FB, Elit L, Bernard C, Hunt M. Aid when 'there is nothing left to offer': Experiences of palliative care and palliative care needs in humanitarian crises. PLOS Glob Public Health 2023; 3:e0001306. [PMID: 36962993 PMCID: PMC10021221 DOI: 10.1371/journal.pgph.0001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/11/2022] [Indexed: 04/18/2023]
Abstract
Access to palliative care, and more specifically the alleviation of avoidable physical and psychosocial suffering is increasingly recognized as a necessary component of humanitarian response. Palliative approaches to care can meet the needs of patients for whom curative treatment may not be the aim, not just at the very end of life but alleviation of suffering more broadly. In the past several years many organizations and sectoral initiatives have taken steps to develop guidance and policies to support integration of palliative care. However, it is still regarded by many as unfeasible or aspirational in crisis contexts; particularly where care for persons with life threatening conditions or injuries is logistically, legally, and ethically challenging. This article presents a synthesis of findings from five qualitative sub-studies within a research program on palliative care provision in humanitarian crises that sought to better understand the ethical and practical dimensions of humanitarian organizations integrating palliative care into emergency responses. Our multi-disciplinary, multi-national team held 98 in-depth semi-structured interviews with people with experiences in natural disasters, refugee camps in Rwanda and Jordan, and in Ebola Treatment Centers in Guinea. Participants included patients, family members, health care workers, and other staff of humanitarian agencies. We identified four themes from descriptions of the struggles and successes of applying palliative care in humanitarian settings: justification and integration of palliative care into humanitarian response, contextualizing palliative care approaches to crisis settings, the importance of being attentive to the 'situatedness of dying', and the need for retaining a holistic approach to care. We discuss these findings in relation to the ideals embraced in palliative care and corresponding humanitarian values, concluding that palliative care in humanitarian response is essential for responding to avoidable pain and suffering in humanitarian settings.
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Affiliation(s)
- Lisa Schwartz
- Health Research, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Elysée Nouvet
- School of Health Studies, Western University, London, Ontario, Canada
| | - Sonya de Laat
- Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Yantzi
- Health Research, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Wejdan A. Khater
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Ar Ramtha, Jordan
| | | | | | | | - Takhliq Amir
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kevin Bezanson
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | | | - Oumou Bah Sow
- Ministère de la santé, Conakry, Guinée
- Université de Conakry, Conakry, Guinée
| | | | | | - Laurie Elit
- Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Carrie Bernard
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Diallo FB, Pelletier É, Vasiliadis HM, Rochette L, Vincent A, Palardy S, Lunghi C, Gignac M, Lesage A. Morbidities and mortality of diagnosed attention deficit hyperactivity disorder (ADHD) over the youth lifespan: A population-based retrospective cohort study. Int J Methods Psychiatr Res 2022; 31:e1903. [PMID: 34952999 PMCID: PMC8886284 DOI: 10.1002/mpr.1903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/07/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of ADHD, and related comorbidities, mortality, and type of health service use among children and young adults, using different case definitions. METHODS We conducted a population-based retrospective cohort study between 2000 and 2018, using the Quebec Integrated Chronic Disease Surveillance System (QICDSS) database. All residents aged less than 25 years eligible for health insurance coverage were included. We compared outcomes of three indicators (morbidity, services use and mortality) according two different algorithms of ADHD definitions, to the general population. RESULTS The cumulative prevalence of ADHD has risen steadily over the past decade, reaching 12.6% in 2017-2018. People with ADHD have a higher prevalence of psychiatric comorbidities, make greater use of medical, mental health services, and are hospitalized more often. The comparison of prevalence between the two algorithms and the general population for the three indicators showed that the cohort having one claim was very close to that with two or more, and statistically significant higher to that of people without ADHD. CONCLUSION This finding support that a single claim algorithm for ADHD can be used for case definition. More research is needed on the impact of potentially effective treatments in improving consequences of ADHD.
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Affiliation(s)
- Fatoumata Binta Diallo
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Éric Pelletier
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Science, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Louis Rochette
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Annick Vincent
- Clinique FOCUS, Saint-Augustin-de-Desmaures, Quebec, Canada
| | - Sylvain Palardy
- Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Carlotta Lunghi
- Department of Health sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Martin Gignac
- Montreal Children's Hospital, McGill University Montreal, Montreal, Quebec, Canada
| | - Alain Lesage
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada.,Department of Psychiatry, University of Montreal, Research Centre of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
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Nouvet E, Bezanson K, Hunt M, Kouyaté S, Schwartz L, Diallo FB, de Laat S, Bah-Sow OY, Diallo AA, Diallo P. Dying in honour: experiences of end-of-life palliative care during the 2013-2016 Ebola outbreak in Guinea. J Int Humanit Action 2021; 6:10. [PMID: 38624820 PMCID: PMC8105689 DOI: 10.1186/s41018-021-00099-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/15/2021] [Indexed: 04/17/2024]
Abstract
With no cure and a high mortality rate, Ebola virus disease (EVD) outbreaks require preparedness for the provision of end-of-life palliative care. This qualitative study is part of a larger project on palliative care in humanitarian contexts. Its goal was to document and deepen understanding of experiences and expectations related to end-of-life palliative care for patients infected with Ebola virus disease (EVD) in West African Ebola treatment centres (ETCs) during the 2013-2016 epidemic. It consisted of 15 in-depth semi-structured interviews with individuals impacted by EVD in a Guinean ETC: either as patients in an ETC, healthcare providers, healthcare providers who were also EVD patients at one point, family relations who visited patients who died in an ETC, or providers of spiritual support to patients and family. Analysis was team based and applied an interpretive descriptive approach. Healthcare delivery in humanitarian emergencies must remain respectful of patient preferences but also local and contextual values and norms. Of key importance in the Guinean context is the culturally valued experience of "dying in honour". This involves accompaniment to facilitate a peaceful death, the possibility of passing on final messages to family members, prayer, and particular practices to enact respect for the bodies of the deceased. Participants emphasized several challenges to such death in Ebola treatment centres (ETCs), as well as practices they deemed helpful to alleviating dying patients' suffering. An overarching message in participants' accounts was that ideally more would have been done for the dying in ETCs. Building on participants' accounts, we outline a number of considerations for optimizing end-of-life palliative care during current and future public health emergencies, including for COVID-19.
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Affiliation(s)
- Elysée Nouvet
- School of Health Studies, Western University, London, Canada
| | - Kevin Bezanson
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Sekou Kouyaté
- Laboratoire Socio-Anthropologique de la Guinée, Conakry, Guinea
| | - Lisa Schwartz
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Fatoumata Binta Diallo
- Faculté des Sciences et Techniques en Santé, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - Sonya de Laat
- Global Health Program, McMaster University, Hamilton, Canada
| | | | - Alpha Ahmadou Diallo
- Ministry of Health, Republic of Guinea and Université de Conakry, Conakry, Guinea
| | - Pathé Diallo
- Centre Médical & Conseil en Santé (CEMECO), Conakry, Guinea
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Camara E, Barry IK, Diallo FB, Diallo ML, Diop MM, Cherif MS, Diallo IS, Kouyaté M, Bangoura MA, Barry A, Barry MC, Ngadande IH, Kaba O, Kolié OO, Camara DD, Diallo SB, Dia H. [Epidemiological and clinical profile of children with Coronavirus disease (COVID-19) at the Center for the Treatment of Epidemics and Infection Prevention (CTEIP) of the University Hospital of Donka in Conakry]. Pan Afr Med J 2020; 37:363. [PMID: 33796176 PMCID: PMC7992426 DOI: 10.11604/pamj.2020.37.363.26211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022] Open
Abstract
COVID-19 is caused by SARS-CoV-2 virus, which is genetically similar to severe acute respiratory syndrome (SARS) virus. In pediatrics, it has a benign clinical course. Since the outbreak of COVID-19 pandemic in Guinea, whose epicenter was Conakry, pediatric cases have been reported at the CTEIP in Donka. The purpose of this study was to determine their epidemiological profile. We conducted a descriptive cross-sectional study of children aged 0-16 years admitted to the CTEIP, Donka, over a period of four months. Out of 7308 patients, coming predominantly from 5 communes of Conakry and hospitalized in the CTEPI, 189 were aged between 0 and 16 years (2 .59%). The majority of patients were within the age-group 0-4-years (38.62%) with a sex-ratio (F/M) of 1.52; 62.96% were students, 70% of children lived in Conakry, 28.57% of mothers were traders and contact persons (39.68%); 37.57% of fathers were civil servants, 2.65% of children had a history of sickle cell disease and 1.59% had allergic rhinitis. Asymptomatic patients accounted for 52.38% of cases and diagnosed patients were 74.6%. Symptoms included fever, rhinorrhea, headache, cough, abdominal pain, sneezing, diarrhea, physical asthenia. The incidence of COVID-19 among children hospitalized in the CTEIP of Donka is low. Children aged 5 years and older are more affected and nearly 50% are asymptomatic. Common symptoms are fever, headache, rhinorrhea, cough, abdominal pain, sneezing, diarrhea, physical asthenia.
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Affiliation(s)
- Emmanuel Camara
- Service de Pédiatrie, Hôpital National Donka, Conakry, Guinée
| | | | | | | | | | | | | | | | | | - Aissata Barry
- Service de Pédiatrie, Hôpital National Donka, Conakry, Guinée
| | | | | | - Oumar Kaba
- Service de Pédiatrie, Hôpital National Donka, Conakry, Guinée
| | - Ouo Ouo Kolié
- Service de Pédiatrie, Hôpital National Donka, Conakry, Guinée
| | | | | | - Hasmiou Dia
- Service de Pédiatrie, Hôpital National Ignace Deen, Conakry, Guinée
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Lussier MT, Richard C, Binta Diallo F, Boivin N, Hudon C, Boustani É, Witteman H, Jbilou J. I am ready to see you now, Doctor! A mixed-method study of the Let's Discuss Health website implementation in Primary Care. Health Expect 2020; 24:243-256. [PMID: 33285012 PMCID: PMC8077096 DOI: 10.1111/hex.13158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Let's Discuss Health (LDH) is a website that encourages patients to prepare their health‐care encounters by providing communication training, review of topics and questions that are important to them. Objective To describe LDH implementation during primary care (PC) visits for chronic illnesses. Methods Design: Descriptive mixed‐method study. Setting: 6 PC clinics. Participants: 156 patients and 51 health‐care providers (HCP). Intervention: LDH website implementation. Outcome Measures: Perceived quality and usefulness of LDH; perceived quality of HCP‐patient communication; patient activation; LDH integration in routine PC practices and barriers to its use. Results Patients reported a positive perception of the website in that it helped them to adopt an active role in the encounters; recall their visit agenda and reduce encounter‐related stress; feel more confident to ask questions, feel more motivated to prepare their future medical visits and improve their chronic illness management. However, a certain disconnect emerged between HCP and patient perceptions as to the value of LDH in promoting a sense of partnership and collaboration. The main barriers to the use of LDH are HCP lack of interest, limited access to technology, lack of time and language barriers. Conclusion Our findings indicate that it is advantageous for patients to prepare their medical encounters. However, the study needs to be replicated in other medical environments using larger and more diverse samples. Patient and Public Contribution Patient partners were involved in the conduct of this study.
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Affiliation(s)
- Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada.,Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Claude Richard
- Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Fatoumata Binta Diallo
- Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Nathalie Boivin
- École réseau de Science infirmière (ÉRSI), University of Moncton, Moncton, NB, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Élie Boustani
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Holly Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Laval, QC, Canada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau Brunswick, Université de Sherbrooke, École de psychologie, University of Moncton, Moncton, NB, Canada
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Codsi MP, Rodrigue R, Authier M, Diallo FB. [Not Available]. Can Fam Physician 2019; 65:e311-e315. [PMID: 31300445 PMCID: PMC6738470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectif Identifier les facteurs propres au stage d’externat en médecine familiale (MF) pouvant être associés à un changement d’intention de s’inscrire en MF. Type d’étude Étude descriptive transversale. Un questionnaire autoadministré sur SurveyMonkey, distribué de septembre 2015 à avril 2016. Contexte Les milieux de stages en MF affiliés à l’Université de Montréal (Québec). Participants Les externes qui effectuaient leur stage dans les milieux ayant accepté de participer et n’avaient pas encore fait leur choix de résidence. Principaux paramètres à l’étude Des facteurs spécifiques au stage ayant une influence sur le changement d’intention de s’inscrire en MF. Résultats Dans l’échantillon, le stage en MF est généralement très apprécié, améliore l’image de cette spécialité et influence l’intention des étudiants de s’inscrire en MF. Plusieurs facteurs spécifiques au stage ont pu être associés à un changement positif de l’intention des étudiants de s’inscrire en MF. Le degré d’exposition à différents champs de pratique, la perception de l’ambiance générale, la rencontre d’un modèle de rôle et l’intérêt à revenir travailler dans le milieu de stage ont tous été associés, de façon modérée, au changement d’intention de s’inscrire en MF. Une association faible a été observée pour la perception de l’intérêt des médecins envers leur travail, le stage en milieu rural, l’appréciation du contact avec les médecins, la perception du niveau de difficulté du stage et le degré de satisfaction face à l’évaluation finale. Les résultats pour les autres facteurs sont non statistiquement significatifs. En ce qui concerne le changement négatif du rang de la MF, 2 facteurs ont été identifiés, soit l’absence de modèle de rôle et le manque d’intérêt à revenir travailler dans le milieu. De nouveaux facteurs positifs sont identifiés, soit la perception face à l’ambiance générale et l’intérêt à revenir travailler dans le milieu de stage. Conclusion Plusieurs facteurs propres au stage en MF semblent agir comme moteurs de changement potentiel en faveur de la MF. Cela pourrait servir à la production d’un outil d’évaluation et d’amélioration du stage en MF.
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Affiliation(s)
- Marie-Pierre Codsi
- Médecin de famille clinicienne et enseignante à la Clinique universitaire de médecine de famille (CUMF) de Notre-Dame au Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Québec).
| | - Rachel Rodrigue
- Résidente en médecine de famille à la CUMF de Saint-Eustache au Centre intégré de santé et de services sociaux des Laurentides (Québec)
| | - Marie Authier
- Professeure adjointe de clinique au Département de médecine de famille et médecine d'urgence à la Faculté de médecine de l'Université de Montréal, facilitatrice de recherche et chercheure au Réseau de recherche en soins primaires de l'Université de Montréal, et conseillère en amélioration continue de la qualité et enseignante aux résidents en médecine de famille à la CUMF Maisonneuve-Rosemont
| | - Fatoumata Binta Diallo
- Coordonnatrice de projets de l'Équipe de recherche en soins de première ligne au Centre intégré de santé et de services sociaux de Laval et de l'Hôpital de la Cité-de-la-Santé
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Codsi MP, Rodrigue R, Authier M, Diallo FB. Family medicine rotations and medical students' intention to pursue family medicine: Descriptive study. Can Fam Physician 2019; 65:e316-e320. [PMID: 31300446 PMCID: PMC6738467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify specific factors occurring during family medicine (FM) rotations that were associated with a change in intention to pursue FM. DESIGN Transversal descriptive study. A self-administered questionnaire was distributed on SurveyMonkey between September 2015 and April 2016. SETTING Family medicine rotation sites affiliated with the University of Montreal in Quebec. PARTICIPANTS Medical students who were conducting their rotations at participating sites and who had not yet chosen their residency specialty. MAIN OUTCOME MEASURES Specific factors occurring during a rotation that influenced medical students' intention to pursue FM in residency. RESULTS In the sample population, it was found that the FM rotation was generally highly appreciated by study participants, and that it improved the FM specialty's image while positively influencing the participants' intention to pursue FM. The degree of exposure to different areas of practice, overall atmosphere, the presence of role models, and the desire to return to the rotation site to practise were all moderately associated with a positive change in intention to pursue FM. There was a weak association between pursuing FM and participants' perception of physicians' interest in their work, rural rotation sites, positive interactions with physicians, perceptions of the rotation's level of difficulty, and degree of satisfaction with the final assessment. The results for other factors were not statistically significant. Concerning a negative change in the intention to pursue FM in residency, 2 factors were identified: the absence of a role model and lack of interest in returning to the rotation site. New positive factors were identified: overall atmosphere and the desire to return to the rotation site to practise. CONCLUSION Several factors related to the FM rotations appeared to act as prime motivators for change toward pursuing FM. This could support the development of an assessment tool and the improvement of FM rotations.
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Affiliation(s)
- Marie-Pierre Codsi
- Clinical family physician and teacher at the Clinique universitaire de médecine de famille (CUMF) de Notre-Dame (Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal) in Quebec.
| | - Rachel Rodrigue
- Family medicine resident at the CUMF de Saint-Eustache (Centre intégré de santé et de services sociaux des Laurentides) in Quebec
| | - Marie Authier
- Assistant Clinical Professor in the Department of Family Medicine and Emergency Medicine at the University of Montreal, a research facilitator and researcher for the Primary Healthcare Research Network at the University of Montreal, and a quality improvement advisor and a teacher to family medicine residents at the CUMF de Maisonneuve-Rosemont
| | - Fatoumata Binta Diallo
- Project Coordinator for the Équipe de recherche en soins de première ligne at the Centre intégré de santé et de services sociaux de Laval and at the Hôpital de la Cité-de-la-Santé
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Lessard A, Lussier MT, Diallo FB, Labrecque M, Rhéaume C, Pluye P, Grad R. Drug samples in family medicine teaching units: a cross-sectional descriptive study: Part 2: portrait of drug sample management in Quebec. Can Fam Physician 2018; 64:e540-e545. [PMID: 30541820 PMCID: PMC6371884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To draw a portrait of drug sample management in academic primary health care settings and assess conformity to existing Canadian guidelines. DESIGN Descriptive cross-sectional survey. SETTING All 33 family medicine teaching units (FMTUs) in Quebec that kept drug samples. PARTICIPANTS Health care professionals or FMTU staff who managed drug samples (ie, managers). MAIN OUTCOME MEASURES Drug sample managers completed a self-administered questionnaire between February and December 2013. Questionnaires inquired about sample selection, procurement, reception, storage, inventory, and disposal. Results were compared with the Canada's Research-Based Pharmaceutical Companies Code of Ethical Practices (2012) and the Canadian Medical Association Guidelines for Physicians in Interactions with Industry (2007). RESULTS All 33 FMTUs responded to the questionnaire. According to managers, no FMTUs had written selection criteria to guide sample choice. Almost one-third (30%) of FMTUs had uncontrolled access to drug sample cabinets. Even though pharmaceutical companies must distribute drug samples to authorized professionals only, these professionals were involved in the procurement and the reception of samples in 79% and 56% of FMTUs, respectively. Only 15% of FMTUs kept track of samples distributed, 82% checked expiration dates, and 85% ensured proper disposal as recommended. CONCLUSION The management of drug samples in the FMTUs in Quebec is heterogeneous, with many FMTUs and pharmaceutical companies not following Canadian guidelines.
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Affiliation(s)
- Andréa Lessard
- Clinician scientist in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke in Quebec and at the Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean in Quebec
| | - Marie-Thérèse Lussier
- Full Professor in the Department of Family Medicine and Emergency Medicine at the University of Montreal in Quebec, a member of the Équipe de recherche en soins de première ligne of the Centre intégré de santé et de services sociaux de Laval in Quebec, Director of the University of Montreal Primary Care Research Network, Regional Network Director for the Canadian Primary Care Sentinel Surveillance Network in Quebec, and a teacher and practising physician at the Cité de la Santé Family Medicine Teaching Unit in Laval
| | - Fatoumata Binta Diallo
- Research coordinator in the Équipe de recherche en soins de première ligne of the Centre intégré de santé et de services sociaux de Laval and at the Cité de la Santé Family Medicine Teaching Unit.
| | - Michel Labrecque
- Professor Emeritus in the Department of Family Medicine and Emergency Medicine at Laval University
| | - Caroline Rhéaume
- Clinical researcher in the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec and in the Department of Family Medicine and Emergency Medicine at Laval University
| | - Pierre Pluye
- Professor in the Department of Family Medicine at McGill University in Montreal
| | - Roland Grad
- Family physician in the Herzl Family Practice Centre in Montreal and Associate Professor in the Department of Family Medicine at McGill University
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Rhéaume C, Labrecque M, Moisan N, Rioux J, Tardieux É, Diallo FB, Lussier MT, Lessard A, Grad R, Pluye P. Drug samples in family medicine teaching units: a cross-sectional descriptive study: Part 1: drug sample management policies and the relationship between the pharmaceutical industry and residents in Quebec. Can Fam Physician 2018; 64:e531-e539. [PMID: 30541819 PMCID: PMC6371883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the existence and the level of health care professional (HCP) knowledge of local policies regarding drug sample use and the relationship between residents and the pharmaceutical industry in academic primary health care settings. DESIGN Descriptive cross-sectional survey. Health care providers were invited to complete a self-administered questionnaire on drug sample use between February and December 2013. Managers of drug samples were also asked to complete a specific questionnaire on drug sample management and policies and an inventory log sheet. Data about the existence of written policies were validated with health and social services centre (HSCC) directors or pharmacy departments and family medicine teaching unit (FMTU) directors between February and June 2014. SETTING All 42 FMTUs in Quebec. PARTICIPANTS All HCPs in the FMTUs authorized to hand out drug samples (practising physicians, residents, pharmacists, and nurses). Dispensers were defined as those who reported using drug samples. Managers were defined as HCPs or staff members who managed drug samples. MAIN OUTCOME MEASURES Existence of written policies on drug sample use in HSCCs and FMTUs; whether FMTUs applied the HSCC policies if they existed; whether dispensers were aware of the existence of the policies; and whether policies on the relationships between residents and pharmaceutical companies existed. RESULTS Among the 42 FMTUs, 33 (79%) kept drug samples. Of these, 30% (10 of 33) did not have policies about drug samples in the FMTU or in the HSCC. A total of 67% (579 of 859) of HCPs from these FMTUs reported using drug samples. Most dispensers did not know if a policy existed in their FMTU (n = 297; 51%) or their HSCC (n = 420; 73%). Eleven (26%) of the 42 FMTU directors reported having a policy regarding relationships between residents and the pharmaceutical industry. Most drug sample dispensers were not aware whether such a policy existed (n = 310; 54%). CONCLUSION Many FMTUs did not have policies regarding drug samples or relationships between residents and the pharmaceutical industry. Variation in use and management of drug samples and the lack of knowledge of HCPs about the existence of policies point to the need to implement uniform policies in all FMTUs in Quebec.
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Affiliation(s)
- Caroline Rhéaume
- Clinical researcher in the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec and in the Department of Family Medicine and Emergency Medicine at Laval University in Quebec
| | - Michel Labrecque
- Professor Emeritus in the Department of Family Medicine and Emergency Medicine at Laval University
| | - Nadine Moisan
- Pharmacist, a clinical teacher, and Professor in the Department of Family Medicine and Emergency Medicine at Laval University
| | - Jacky Rioux
- Research assistant in the Department of Family Medicine Emergency Medicine at Laval University at the time of the study
| | - Émilie Tardieux
- Research assistant in the Department of Family Medicine Emergency Medicine at Laval University at the time of the study
| | - Fatoumata Binta Diallo
- Research coordinator in the Équipe de recherche en soins de première ligne of the Centre intégré de santé et de services sociaux de Laval and at the Cité de la Santé Family Medicine Teaching Unit.
| | - Marie-Thérèse Lussier
- Full Professor in the Department of Family Medicine and Emergency Medicine at the University of Montreal in Quebec, a member of the Équipe de recherche en soins de première ligne du Centre intégré de santé et de services sociaux de Laval, Director of the University of Montreal Primary Care Research Network, Regional Network Director for the Canadian Primary Care Sentinel Surveillance Network in Quebec, and a teacher and practising physician at the Cité de la Santé Family Medicine Teaching Unit
| | - Andréa Lessard
- Clinical scientist in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke in Quebec and at the Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean in Quebec
| | - Roland Grad
- Family physician in the Herzl Family Practice Centre in Montreal and Associate Professor in the Department of Family Medicine at McGill University
| | - Pierre Pluye
- Associate Professor in the Department of Family Medicine at McGill University
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Lussier MT, Diallo FB, Pluye P, Grad R, Lessard A, Rhéaume C, Labrecque M. Drug samples in family medicine teaching units: a cross-sectional descriptive study: Part 3: availability and use of drug samples in Quebec. Can Fam Physician 2018; 64:e546-e552. [PMID: 30541821 PMCID: PMC6371885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To draw a portrait of drug sample distribution and to assess the concordance between drug samples distributed and the medical problems encountered in the ambulatory primary health care setting. DESIGN Descriptive cross-sectional survey. A self-administered questionnaire was distributed to all health care professionals (HCPs) in family medicine teaching units (FMTUs) that kept drug samples between February and December 2013. Dispensers were defined as HCPs reporting the use of drug samples. Concurrently, an inventory log sheet was completed by managers of drug samples to document the contents of sample cabinets. Data from the Canadian Disease and Therapeutic Index were used as the criterion standard to assess the consistency between the drug samples found in the cabinets and the profile of the most frequent health problems encountered in primary care. SETTING All 33 FMTUs that kept drug samples in Quebec. PARTICIPANTS Health care professionals authorized to hand out drug samples (practising physicians, residents, pharmacists, and nurses), and managers of drug sample cabinets. MAIN OUTCOME MEASURES Dispensing practices of HCPs; number of doses of each drug contained in the sample cabinets; total market value of the samples; concordance between the drug sample categories made available and the most common medical problems encountered in primary care; and data on safe handling, ethical issues, effect of the pharmaceutical industry on prescribing behaviour, and inventory of samples. RESULTS Among 859 HCPs, 579 (67%) reported dispensing drug samples. A large proportion of dispensers (88%) were unable to find the specific drug they sought and half of them (51%) provided the patients with a drug sample even if it was not their first choice for treatment. The drug sample cabinet inventory revealed products from 292 different companies and identified a total of 382 363 medication doses for a total value of $201 872. We found gaps among types of drugs provided to patients, those the HCPs would consider useful, and those available in the cabinets. CONCLUSION Drug samples available in FMTUs do not meet the needs of many patients and HCPs, suggesting that the main driving force for drug sample distribution is not patient care. Policies on drug samples in FMTUs should be uniform across the province, and management should be as strict as in community pharmacies. Otherwise, prohibiting their use should be considered.
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Affiliation(s)
- Marie-Thérèse Lussier
- Full Professor in the Department of Family Medicine and Emergency Medicine at the University of Montreal in Quebec, a member of the Équipe de recherche en soins de première ligne of the Centre intégré de santé et de services sociaux de Laval, Director of the University of Montreal Primary Care Research Network, Regional Network Director for the Canadian Primary Care Sentinel Surveillance Network in Quebec, and a teacher and practising physician at the Cité de la Santé Family Medicine Teaching Unit
| | - Fatoumata Binta Diallo
- Research coordinator in the Équipe de recherche en soins de première ligne of the Centre intégré de santé et de services sociaux de Laval and at the Cité de la Santé Family Medicine Teaching Unit.
| | - Pierre Pluye
- Professor in the Department of Family Medicine at McGill University in Montreal
| | - Roland Grad
- Family physician in the Herzl Family Practice Centre in Montreal and Associate Professor in the Department of Family Medicine at McGill University
| | - Andréa Lessard
- Clinical scientist in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke in Quebec and at the Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean in Quebec
| | - Caroline Rhéaume
- Clinical researcher in the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec and in the Department of Family Medicine and Emergency Medicine at Laval University
| | - Michel Labrecque
- Professor Emeritus in the Department of Family Medicine and Emergency Medicine at Laval University
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Diallo FB, Fombonne É, Kisely S, Rochette L, Vasiliadis HM, Vanasse A, Noiseux M, Pelletier É, Renaud J, St-Laurent D, Lesage A. Prevalence and Correlates of Autism Spectrum Disorders in Quebec: Prévalence et corrélats des troubles du spectre de l'autisme au Québec. Can J Psychiatry 2018; 63:231-239. [PMID: 29056086 PMCID: PMC5894913 DOI: 10.1177/0706743717737031] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To estimate the prevalence, comorbidities, and service use of people with autism spectrum disorders (ASDs) based on data from Quebec Integrated Chronic Diseases Surveillance System (QICDSS). METHODS We included all residents up to age 24 eligible for health plan coverage who were in Quebec for at least 1 day from January 1, 1996, to March 31, 2015. To be considered as having an ASD, an individual had to have had at least 1 physician claim or hospital discharge abstract from 2000 to 2015 indicating one of the following ASD diagnosis codes: ICD-9 codes 299.0 to 299.9 or their ICD-10 equivalents. RESULTS The QICDSS shows that the prevalence of ASD has risen steadily over the past decade to approximately 1.2% ( n = 16,940) of children and youths aged 1 to 17 years in 2014 to 2015. The same prevalence was obtained using Ministry of Education data. Common medical comorbidities included congenital abnormalities of the nervous system, particularly in the first year of life. Psychiatric comorbidity was much more highly prevalent, especially common mental disorders like anxiety and attention-deficit/hyperactivity disorder. Children and youths with ASDs made on average 2.3 medical visits per year compared with 0.2 in the general population. Between 18 and 24 years old, the mental health needs of individuals with ASDs were met less by medical specialists and more by general practitioners. CONCLUSION Information derived from this database could support and monitor development of better medical services coordination and shared care to meet the continuous and changing needs of patients and families over time.
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Affiliation(s)
- Fatoumata Binta Diallo
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec
| | - Éric Fombonne
- 2 Department of Psychiatry, Oregon Health Sciences University, Portland, Oregon, USA
| | - Steve Kisely
- 3 Departments of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.,4 School of Medicine, University of Queensland, Queensland, Australia
| | - Louis Rochette
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec
| | | | - Alain Vanasse
- 6 Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec
| | - Manon Noiseux
- 7 Department of Public Health, Health and Social Services Centre of Montérégie-Centre, Montérégie, Quebec
| | - Éric Pelletier
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec
| | - Johanne Renaud
- 8 Department of Psychiatry, McGill University, Montreal, Quebec
| | - Danielle St-Laurent
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec
| | - Alain Lesage
- 1 Quebec's Public Health Institute (Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec), Quebec, Quebec.,9 Department of Psychiatry, Research Centre of the Montreal Mental Health University Institute, University of Montreal, Montreal, Quebec
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Diallo FB, Pelletier É, Vasiliadis HM, Rochette L, Lin E, Smith M, Langille D, Thompspon A, Noiseux M, Vanasse A, St-Laurent D, Kisely S, Fombonne É, Lesage A. [Estimating the Prevalence and Incidence Rate of Autism Spectrum Disorder (ASD): Interprovincial Comparisons]. Sante Ment Que 2018; 43:65-81. [PMID: 32338686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective The prevalence of diagnosed autism spectrum disorders (ASD) has risen steadily over time. There is therefore a need for the monitoring of treated ASD for timely policy making. The objective of this study is to report and compare over a 10-year period the prevalence and incidence rate of diagnosed ASD in four Canadian provinces. Methods This study utilized data from the provinces of Manitoba, Ontario, Quebec and Nova Scotia with access to linked administrative database sources used in the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence rate of a physician diagnosis of ASD. Estimates were produced using health datasets for outpatient and inpatient care (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the three other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were extracted. The target population consisted of all residents aged 24 and under eligible for healthcare coverage under provincial law between 1999 and 2012. To be considered as having ASD, an individual had to have at least one physician claim or hospital discharge abstract indicating one of the following: ICD-9 codes 299.0 to 299.9 or their ICD-10 equivalents, F84.0 to F84.9. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by sex and age groups. The main analyses focused on those aged 17 years or less, with the 18 to 24 years group added to show the subsequent progression of the disorder. Results Our findings show that the annual prevalence of ASD rose steadily between 1999 and 2012 in all provinces and for all age groups although this increase varied across Canadian provinces. There were higher annual prevalence estimates in Ontario (4.8 per 1,000) and Nova Scotia (4.2 per 1,000) compared to Quebec (3.0 per 1,000) and Manitoba (2.5 per 1,000), among persons aged 17 years and younger in 2011. As compared to 1999, Quebec and Ontario reported a fivefold and fourfold increase in 2010-2012, the highest among provinces. The prevalence was four times higher in boys than in girls. By age group, the highest prevalence was observed in those aged between 1 to 4 and 5 to 9 years depending on the province. ASD was generally diagnosed before age 10. Incident cases were more frequently diagnosed by pediatricians followed by either psychiatrists or general practitioners depending on the province. Conclusion Our research confirms that ASD has risen steadily in terms of prevalence and incidence rate and that it varies considerably across provinces. It also demonstrates that health administrative databases can be used as registers for ASD. Information derived from these databases could support and monitor development of improved coordination and shared care to meet the continuous and changing needs of patients and families over time. Implication for future research include exploring the etiology of ASD in more recent cohorts as well as investigating the association between variations in health service availability and the prevalence of ASD.
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Affiliation(s)
- Fatoumata Binta Diallo
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec
| | - Éric Pelletier
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec
| | - Helen-Maria Vasiliadis
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke ; Centre de recherche Charles-Le Moyne - Saguenay - Lac-Saint-Jean sur les innovations en santé (CR-CSIS)
| | - Louis Rochette
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec
| | - Elizabeth Lin
- Centre for Addiction and Mental Health, Research Scientist
| | | | | | | | - Manon Noiseux
- Centre intégré de santé et de services sociaux de la Montérégie
| | - Alain Vanasse
- Université de Sherbrooke, Département de médecine de famille et de médecine d'urgence
| | - Danielle St-Laurent
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec
| | | | - Éric Fombonne
- Oregon Health & Science University, Departments of Psychiatry, Pediatrics & Behavioral Neuroscience Sciences
| | - Alain Lesage
- Bureau d'information et d'études en santé des populations. Institut national de santé publique du Québec ; Centre de recherche de l'Institut universitaire en santé mentale de Montréal
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Vasiliadis HM, Diallo FB, Rochette L, Smith M, Langille D, Lin E, Kisely S, Fombonne E, Thompson AH, Renaud J, Lesage A. Temporal Trends in the Prevalence and Incidence of Diagnosed ADHD in Children and Young Adults between 1999 and 2012 in Canada: A Data Linkage Study. Can J Psychiatry 2017; 62:818-826. [PMID: 28616934 PMCID: PMC5714116 DOI: 10.1177/0706743717714468] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There is a need for the routine monitoring of treated attention-deficit hyperactivity disorder (ADHD) for timely policy making. The objective is to report and assess over a decade the prevalence and incidence of diagnosed ADHD in Canada. METHODS Administrative linked patient data from the provinces of Manitoba, Ontario, Quebec, and Nova Scotia were obtained from the same sources as the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence of a primary physician diagnosis of ADHD ( ICD-9 and ICD-10 codes: 314, F90.x) for consultations in outpatient and inpatient settings (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the 3 other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were retained. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by age and sex groups. RESULTS The prevalence of ADHD between 1999 and 2012 increased in all provinces and for all groups. The prevalence was approximately 3 times higher in boys than in girls, and the highest prevalence was observed in the 10- to 14-year age group. The incidence increased between 1999 and 2012 in Manitoba, Quebec, and Nova Scotia but remained stable in Ontario. Incident cases were more frequently diagnosed by general practitioners followed by either psychiatrists or paediatricians depending on the province. CONCLUSION The prevalence and incidence of diagnosed ADHD did not increase similarly across all provinces in Canada between 1999 and 2012. Over half of cases were diagnosed by a general practitioner.
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Affiliation(s)
- Helen-Maria Vasiliadis
- University of Sherbrooke, Faculty of Medicine and Health Sciences, Research Center–Hôpital Charles LeMoyne, Longueuil, Québec
| | - Fatoumata Binta Diallo
- Bureau d’information et d’études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec
| | | | - Mark Smith
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba
| | - Donald Langille
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Elizabeth Lin
- Department of Psychiatry, Centre for Addiction and Mental Health, Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario
| | - Steve Kisely
- School of Medicine, The University of Queensland, Queensland, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Eric Fombonne
- Oregon Health and Sciences University, Portland, Oregon
| | | | - Johanne Renaud
- Department of Psychiatry, CIUSSS Douglas Mental Health University Institute, McGill University, Montreal, Québec
| | - Alain Lesage
- Université de Montréal, Institut Universitaire de Santé Mentale Montréal, Montréal, Québec
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Lesage A, Diallo FB. Prenatal Antidepressant Use and Risk of Autism Spectrum Disorders in Children. JAMA Pediatr 2016; 170:714. [PMID: 27243219 DOI: 10.1001/jamapediatrics.2016.0733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alain Lesage
- Department of Psychiatry, University of Montreal, Montreal, Québec, Canada2Institut Universitaire en Santé Mentale de Montréal, Montreal, Québec, Canada
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Lesage A, Rochette L, Émond V, Pelletier É, St-Laurent D, Diallo FB, Kisely S. A Surveillance System to Monitor Excess Mortality of People With Mental Illness in Canada. Can J Psychiatry 2015; 60:571-9. [PMID: 26720826 PMCID: PMC4679166 DOI: 10.1177/070674371506001208] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada. METHODS We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290-319 or ICD-10 F00-F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval. RESULTS We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods. CONCLUSIONS Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces.
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Affiliation(s)
- Alain Lesage
- Professor, Department of Psychiatry, University of Montreal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec; Invited Psychiatric Expert, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Louis Rochette
- Statistician, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Valérie Émond
- Head, Chronic Disease Surveillance Unit, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Éric Pelletier
- Epidemiologist, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Danielle St-Laurent
- Scientific Director, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Fatoumata Binta Diallo
- Research Coordinator, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec
| | - Stephen Kisely
- Professor, Queensland Centre for Health Data Services, University of Queensland, Brisbane, Australia
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Baldé IS, Diallo FB, Diallo Y, Diallo A, Diallo MH, Camara MK, Sy T, Diallo MS. [Intrapartum obstetrical transfers: sociodemographic, clinical and prognosistic aspects in Conakry, Guinea]. Med Trop (Mars) 2011; 71:628-629. [PMID: 22393638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The objectives of this descriptive prospective study were to determine the frequency of intrapartum obstetrical transfers, assess the sociodemographic profile of parturients requiring transfer, describe transfer modalities, and assess maternal and newborn outcomes. Study included all patients requiring intrepartum obstetrical transfer to the Ignace Deen University Hospital Gynecology Obstetrics Clinic in Conakry, Guinea from August 1st, 2009 to July 31st, 2010. Out of 3122 deliveries during the study period, intrapartum transfer was required in 220 cases, i.e. 7.05%. Mean patient age was 23.2 years (range, 14 to 44). The risk for intrapartum transfer was higher among multiparous or nulliparous women (incidence, 8.79%) and adolescents (incidence, 10%). Patients requiring transfer were mainly housewives (60%) and uneducated women (57.27%). Most had had an insufficient number (<4) of antenatal examinations (76.36%) and had been examined at peripheral maternity units (62.73%). In 175 cases (79.54%), patients were transferred by taxi. In 191 patients, treatment required surgery including 130 caesarian sections. There were 12 maternal deaths (5.45%) and 45 neonatal deaths out of 242 newborns including 22 twin deliveries (18.59%). Further work is necessary to improve referral and transfer at all levels of the health pyramid.
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Drapeau A, Boyer R, Diallo FB. Discrepancies between survey and administrative data on the use of mental health services in the general population: findings from a study conducted in Québec. BMC Public Health 2011; 11:837. [PMID: 22040030 PMCID: PMC3233633 DOI: 10.1186/1471-2458-11-837] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 10/31/2011] [Indexed: 11/17/2022] Open
Abstract
Background Population surveys and health services registers are the main source of data for the management of public health. Yet, the validity of survey data on the use of mental health services has been questioned repeatedly due to the sensitive nature of mental illness and to the risk of recall bias. The main objectives of this study were to compare data on the use of mental health services from a large scale population survey and a national health services register and to identify the factors associated with the discrepancies observed between these two sources of data. Methods This study was based on the individual linkage of data from the cycle 1.2 of the Canadian Community Health Survey (CCHS-1.2) and from the health services register of the Régie de l'assurance maladie du Québec (RAMQ). The RAMQ is the governmental agency managing the Quebec national health insurance program. The analyses mostly focused on the 637 Quebecer respondents who were recorded as users of mental health services in the RAMQ and who were self-reported users or non users of these services in the CCHS-1.2. Results Roughly 75%, of those recorded as users of mental health services users in the RAMQ's register did not report using mental health services in the CCHS-1.2. The odds of disagreement between survey and administrative data were higher in seniors, individuals with a lower level of education, legal or de facto spouses and mothers of young children. They were lower in individuals with a psychiatric disorder and in frequent and more recent users of mental health services according to the RAMQ's register. Conclusions These findings support the hypotheses that social desirability and recall bias are likely to affect the self-reported use of mental health services in a population survey. They stress the need to refine the investigation of mental health services in population surveys and to combine survey and administrative data, whenever possible, to obtain an optimal estimation of the population need for mental health care.
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Affiliation(s)
- Aline Drapeau
- Département de psychiatrie de l'université de Montréal, C,P, 6138 Succ, Centre-Ville, Montréal, H3C 3J7, Canada.
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Sy T, Diallo Y, Diallo A, Soumah A, Diallo FB, Hyjazi Y, Diallo MS. [Breech presentation: mode of delivery and maternal and fetal outcomes at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital]. Mali Med 2011; 26:41-44. [PMID: 22766520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The authors in a prospective, analytical study of 8 months from January 1st to August 31st performed at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital; assessed the impact of the mode of delivery in breech presentation on maternal and fetal outcome in the African context of Guinea. Breech presentation in mono fetal pregnancy of at least 28 weeks of amenorrhea was the inclusion criterion in this study. Among 1490 deliveries, 144 breech presentations were reviewed, representing a frequency of 9.66%. Half of breech deliveries (49.99%) were premature against only 11.85% in cephalic presentations. The breech was incomplete in 57.64% cases and complete in 42.35%. Caesarean section was performed in 40.97% of cases against 39.54% in cephalic presentation. The indications were often primiparity (30.50%), acute fetal distress (28.81%) and macrosomia (23.72%). Deliveries through the lower route frequently used the maneuver of Bracht (52.50%). 54.16% of the new-born babies had a fetal weight lower than 2500 g at born. Morbid Apgar score at the 1st minute after delivery through the lower route was found in 69.40% of the breech presentation born babies; however, this rate was 32.70% in cephalic presentation (p=0.000). The maternal morbidity concerned essentially perineal lesions (26.53%). The outcome is largely better in case of delivery through the upper route. The caesarean section is an alternative for the improvement of fetal outcome in countries with low resources.
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Affiliation(s)
- T Sy
- Service de Gynecologie Obstetrique Ignace Deen CHU de Conakry, Conakry, Republique de Guinee.
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Sow PG, Ndiaye IP, Soumare M, Dieye AM, Traore I, Diallo FB. [Study of two cases of virological failure antiretrovirals in the Institute of Social Hygiene (ISH) of Dakar]. Mali Med 2011; 26:48-52. [PMID: 22766411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT The long term treatment of VIH/SIDA puts down majors risks among which the happening of virological failure or resistance to the anti-retroviral treatment at the patient. OBJECTIVE To study the cases of resistance to antiretroviral to a cohort of 70 patients of the social hygiene of Dakar. METHOD This is a retrospective study of the medical records of 70 patients followed in the social hygiene of Dakar during 24 mouths. Data were gathered with the help of form having following variables: The period of meadow inclusion; The period of inclusion; The period of rebound virological; The rate of CD4 count; The viral load and weight of patients. RESULTS Average of age in inclusion is of 47.5 years with a sex ratio of the women HIV 1 was dominant. Two cases of virological failure were found or (2.8%). The patient 1 was the stade II of the classification of the with as therapeutic class 2INTI + 2 INNTI. It was in stage asymptomatic with as therapeutic protocol DDI + 3TC + NVP. The patient 2 was at the stade III of the whom that is to say at the stade in AIDS with as therapeutic class: 2INTI + 1IP with the protocol of treatment DDI + 3TC +IND. CONCLUSION The virological failure to the newly infected persons noticed more and more in the world poses a problem of public health because it constitutes a threat for the success of the programs of treatment of the HIV/AIDS.
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Affiliation(s)
- P G Sow
- Institut d’Hygiene Sociale de Dakar, Dakar/Fann, Senegal.
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Sy T, Diallo FB, Diallo Y, Camara MK, Diallo A, Cissoko M, Lontsi GR, Diallo MS. [Management of pre-term labor: use of nifedipine in Conakry, Guinea]. Med Trop (Mars) 2010; 70:141-144. [PMID: 20486348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This purpose of this prospective and descriptive study was to evaluate the utility of a calcium-channel inhibitor, i.e. nifedipine, for management of preterm labor in our work setting in terms of safety and cost-effectiveness in comparison with betamimetics classically used for this indication. Study was carried out over a six-month period in the department of Gynecology-Obstetrics Department of Ignace Deen National Hospital in Conakry, Guinea. Pregnant women meeting the following criteria were included: 28 to 33 weeks of amenorrhea, six days of hospitalization either for preterm labor or for another diagnosis that was associated with the occurrence of preterm labor during hospitalization, and absence of contraindications for tocolysis using nifedipine. A total of 42 women were included. Pregnancy was extended for more than 48 hours after the first dose of nifedipine in 86.8% of cases. Administration of nifedipine failed in 5 cases including one case in which it was necessary to change the tocolytic and 4 cases in which delivery occurred less than 48 hours after the first dose of nifedipine. In 68% of cases, 90 mg of nifedipine were sufficient to stop uterine contractions within 48 hours. In 39.5% of cases, no side effects were observed. Adverse effects in the other cases were dizziness (39.5%) and headache (18.4%). The mean term of delivery was 36 weeks +/- 5 days of amenorrhea with a mean extension of 6.2 weeks. Apgar score was low in 30.5% of the newborns and normal in 69.5%. One newborn (2.8%) died. The results of this study indicate that nifedipine is an effective, economical and safe drug for tocolysis and that it can be used as an alternative to betamimetis in countries with limited resources. An information campaign is needed to promote use of nifedipine as a tocolytic in obstetrical facilities of our country.
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Affiliation(s)
- T Sy
- Service de gynécologie-obstétrique, CHU Ignace Deen, Conakry, Guinée.
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Diallo FB, Bell L, Moutquin JM, Garant MP. The effects of exclusive versus non-exclusive breastfeeding on specific infant morbidities in Conakry. Pan Afr Med J 2010. [DOI: 10.4314/pamj.v2i1.51704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sy T, Diallo Y, Toure A, Diallo FB, Balde AA, Hyjazi Y, Diallo MS. [Management of ectopic pregnancy in Conakry, Guinea]. Med Trop (Mars) 2009; 69:565-568. [PMID: 20099670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ectopic pregnancy is one of the most frequent hemorrhagic emergencies encountered in gynecology and obstetrics. The purpose of this 16-month descriptive prospective study at the Ignace Deen Gynecology-Obstetric clinic at Conakry University Hospital in Guinea was to assess diagnostic techniques and therapeutic attitudes regarding ectopic pregnancy in a low-resource setting. The frequency of ectopic pregnancy was 1.4%. Mean patient age was 28.9 years. Ectopic pregnancy was often observed at the second or third pregnancy (47.1%) in women who were giving birth for the second or third time (36.0%) and had a history of sexually transmitted infections (88.2%) or abortions (43.1%). Most women had no schooling (60.8 %), were poor and lived in a marital home (86.3%). Presenting symptoms included the classic triad of amenorrhea (98.0%), abdominopelvic pain (92.2%), and vaginal bleeding (62.7%). Definitive diagnosis was achieved by ultrasound examination in 76.6% of cases and by puncture of the Douglas pouch in 84%. The most frequent site of ectopic pregnancy was the ampulla of the uterine tube (66.9%). Abdominal and ovarian pregnancy was observed in 3 and 4 of the 51 cases respectively. Surgical management was performed in all cases. The most frequent procedure was salpingectomy (80.3%). Proper treatment of sexually transmitted infections (STI), start-up of post-abortion care facilities, and provision of information during early consultation at the first signs of pregnancy would help reduce the frequency and improve the prognosis of ectopic pregnancy.
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Affiliation(s)
- T Sy
- Service de gynécologie obstétrrique, CHU Ignace Deen, Conakry, Guinée.
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Diallo FB, Bell L, Moutquin JM, Garant MP. The effects of exclusive versus non-exclusive breastfeeding on specific infant morbidities in Conakry. Pan Afr Med J 2009; 2:2. [PMID: 21532898 PMCID: PMC2984275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 03/26/2009] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study examines the effect of exclusive versus non-exclusive breastfeeding on specific infant morbidities from birth to nine months, in Conakry (Guinea). METHOD A cross-sectional study was conducted on 1,167 mother-infant pairs who visited one of 20 immunization centres in Conakry for vaccination between the 45(th) and 270(th) days of the child's life. Two data sources were used: the infant health book and an orally administered questionnaire completed with the mother. Data analyses included univariate cross-tabulations and multivariate logistic regression models to estimate the effect of breastfeeding on infant morbidity. RESULTS Exclusive breastfeeding decreased with the infant's age. At six months of age, the proportion of infants who were exclusively breastfed was only 15.5%. After adjusting for the infant's age, and the interaction between the type of breastfeeding and the infant's age, exclusive breastfeeding significantly protected the infants against many of the studied morbidities (OR: 0.28, CI: 0.15-0.51) and specifically against diarrhoea (OR: 0.38; 95% CI: 0.17 - 0.86), respiratory infections (OR: 0.27; 95% CI: 0.14 - 0.50), and low growth rate (OR: 0.11; 95% CI: 0.02 - 0.46), but not for otitis, urinary infection, or meningitis. CONCLUSION This investigation confirmed the protective effects of exclusive breastfeeding on some specific infant's morbidities during the first nine months of life. The results of this study are of great importance for the development of an information program designed to encourage the exclusive breastfeeding among the mothers of Conakry, Guinea.
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Diallo FB, Diallo MS, Sylla M, Diaw ST, Diallo TS, Diallo Y, Diakite S. [Premature delivery: epidemiology, etiologic factors, prevention strategies]. Dakar Med 1998; 43:70-3. [PMID: 9827160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Early delivery is not rare, it is an important cause of perinatal mortality. In this study its rate, was 4.95%. The early and late ages of procreation were particularly interested (7.95%) and 3.90%. The first and last parities were more exposed (7.75%-5.31%). The woman occupation was as an important risk-factor. The incidences increased in the poor and rich women groups (7.34%-3.84%) the early labor risk was reduced when the women had efficient prenatal care; when the women had delivered early, the early labor risk increased. So when the women had delivered a stillborn. The early labor risk factor was more important. Finally the authors founded 83.33% of maternal causes could be controlled by efficient prenatal care. Even this rate was so important in the foetal group causes.
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Affiliation(s)
- F B Diallo
- Clinique Gynécologique-Obstétricale, Hôpital Ignace Deen CHU de Conakry
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Diallo FB, Diallo MS, Diallo B, Diallo TS, Dient A, Diallo Y, Camara ND. [Maternal morbidity associated with delivery apropos of 124 cases]. Dakar Med 1998; 43:95-100. [PMID: 9827165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
In a prospective survey, the authors related 124 cases of maternal traumatic lesions during a child birth. They were apper lesions in 13% of uterine rupture, and lower lesions in 87% cervical vaginal and vulvoperineal ruptures). Adolescent primiparas were the most concerned with an incidence of 9.12% followed by the greater number of multiparas 8.24%. Age, parity, badly or unassisted deliveries were the main factors of risk. For the uterine rupture surgical intervention was preservative in 62% of cases. Suture has been essential in lower lesions. One maternal decease is registered, the foetal forecast is bad (14 foetal decease out of 16) in the uterine rupture. Morbidity was important: 64% in cicatricial perineum, 62% in cicatricial uterine, 37% in hysterectomy. In results, that all the cases of maternal traumatic lesions observed were avoidable. The authors recommended a better pregnancy and delivery care.
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Affiliation(s)
- F B Diallo
- Faculté de Médecine, Université de Conakry, République de Guinée Conakry
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Diallo FB, Idi N, Baraka D, Hadiza I, Garba M, Dare M, Labo I, Sahabi I. [Uterine rupture at the Niamey Central Maternity Reference Center, Nigeria. Epidemiologic features and prevention strategies]. Dakar Med 1998; 43:74-8. [PMID: 9827161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The authors have documented 50 cases of U.R., out 2,151 normal deliveries. During the same period, 614 surgeries for caesarean sections were performed. The U.R. frequency has been estimated at 1.80%. 98% of the U.R. were referred to us from outside in the vicinity maternities of Niamey. The maximum number of frequencies occurs between the ages of 15-42 years, and in decreasing order, among multiparas (with a parity of 5 and above). Uterine scars are among the principal causing factors. Sub total hysterectomy was the most widely used surgical method (60%). Among the 50 cases, 8 maternal deaths (16%) and 48 fatal deaths were reported (96%). The average length of stay in hospital was between 4 and 7 days. The shortest was 5 day and the longest 17 days. In order to alleviate this dramatic situation, the authors suggest the following measures: the implementation of a family planning programme (to discourage multiparity) a wide information campaign of the population, the insurance of a better treatment of uterus scars, the building of surgical units closer to rural areas, the provision of a better equipment to medical centres, the retraining of medical personnel.
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Affiliation(s)
- F B Diallo
- Faculté de Médecine, Universitéde Conakry, République de Guinée Conakry
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Diallo MS, Diallo TS, Diallo FB, Diallo Y, Camara AY, Onivogui G, Keita N, Diawo SA. [Anemia and pregnancy. Epidemiologic, clinical and prognostic study at the university clinic of the Ignace Deen Hospital, Conakry (Guinee)]. Rev Fr Gynecol Obstet 1995; 90:138-41. [PMID: 7784781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Our intentions were to determine the incidence of the association of anemia and pregnancy, to evaluate maternal and fetal prognosis and to offer some recommendations regarding national health care policies. This prospective study lasting 30 months included all cases of anemia and pregnancy detected by clinical and laboratory examinations. Thus 13,191 women were enrolled in the study but only 1408 cases of anemia and pregnancy (10.67%). Primipara and grand multipara were particularly at risk. Severe forms of anemia and pregnancy were encountered often (51.71%). Maternal and fetal prognoses were very poor. Maternal mortality was 852/100,000, accounting for 65% of the maternal mortality of the department. The stillborn rate was 50 per thousand. This is a serious health problem which needs to be dealt with by a national health education programme.
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Affiliation(s)
- M S Diallo
- Clinique universitaire de Gynécologie-Obstétrique, Hôpital Ignace Deen, Conakry Guinée
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Diallo FB, Camara ND, Diallo Y, Camara Y, Onivogui G, Coulibaly I, Diallo MS. [Epidemiology and prognosis of cervix cancer. Experience of the University Gynecology and Obstetric Clinic Ignace Deen of Conakry in 10 years: 1982-1991]. Dakar Med 1992; 37:199-204. [PMID: 1345096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
The cancer of the cervix is a tumor that can be detected at an early stage. Unfortunately, it is still detected lately in our service. Thus, it is the underlying cause of death by gynecological affection. After a preliminary work in 1982 about 35 case histories, the authors undertake a 10 years retrospective study where they showed that: the cancer of the cervix is the primary gynecological cancer (78.7%), it obtains between 25 and 65 years, the most often associated factors are early sex, (28%), poor living conditions (22%), cercivitise (17%), metrorrhagias (24%) and leucorrhoea are the most frequent signs. buding lesions are the dominant macroscopic form (68%) epidermoid carcinoma is the most important histological type, 98.7% cancer cases are detected at advanced stages (T3 and T4), the prognosis is dramatic: most patients die at home. This is a great public health issue the solution of which implies the collective action of decision-markers, health personnel and the communities themselves in order to promote early detection.
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