Os organismos comunitários em saúde mental no Quebec, Canadá / The mental health community organizations from Quebec (Canada)

Resumo Este estudo apresenta os organismos comunitários em saúde mental (OCSM) do Quebec, Canadá. Especificamente, traça reflexões considerando sua origem, inserção no sistema público de saúde, princípios, características e formatos. Os OCSM são serviços autônomos, originados na comunidade, que oferecem atividades sem fins lucrativos no setor da saúde e assistência social. Realizou-se estudo descritivo, de abordagem qualitativa, com revisão não sistemática da literatura. Os resultados apontaram o surgimento dos OCSM no contexto de desospitalização de pacientes, mas com déficit de recursos substitutivos ao hospital psiquiátrico. Apontaram também sua consolidação como alternativa à psiquiatria tradicional, reconhecimento e financiamento parcial, pelo governo, como parte da assistência à saúde mental. Constatou-se que os OCSM compartilham certos princípios, mas concretizam-se em vários formatos, destacando-se por estimular a defesa dos direitos e a convivência em comunidade de pessoas em sofrimento psíquico. Contudo, observaram-se limitações quanto ao alcance e à interação entre OCSM e estabelecimentos públicos, e questiona-se o papel do Estado frente a tais organismos. Conclui-se apontando aproximações e distanciamentos entre características da assistência em saúde mental promovida pelos OCSM no Quebec e pelo Brasil; e indica-se a continuidade das discussões, visando à sedimentação de políticas e práticas em saúde mental, que garantam o cuidado na comunidade.

Abstract This study presents the Mental Health Community Organizations (MHCO) from Quebec (Canada). The authors draw up reflections considering its origin, insertion into the public health system, principles, characteristics and formats. The MHCO are autonomous, community-based services that provide nonprofit activities in health and social service fields. A descriptive, qualitative study based on a non-systematic review of the literature was done. The results point to the emergence of the MHCO in a context of dehospitalization of patients, but without enough resources replacing the psychiatric hospital. They were consolidated as an alternative to traditional psychiatry, recognized by the government as part of mental health care, and partially financed by the State. The MHCO share some principles, but they materialize in several formats. They stand out for encouraging the defense of rights, and socially reintegrating people in psychological distress. However, there are limitations considering their reach and interaction with public establishments, and the role of the State over these institutions is questioned. We conclude by pointing out similarities and differences between mental health assistance promoted by the MHCO from Quebec and by Brazil. It is necessary to continue dialoguing, aiming to establish policies and practices in mental health that guarantee community-based care.

Anticoagulants in Older Patients with Nonvalvular Atrial Fibrillation after Intracranial Hemorrhage / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Patients with nonvalvular atrial fibrillation (NVAF) who survive an intracranial hemorrhage (ICH) have an increased risk of ischemic stroke and systemic embolism (IS/SE). We investigated whether starting oral anticoagulants (OACs) among older NVAF patients after an ICH was associated with a lower risk of IS/SE and mortality but offset by an increase in major bleeding. METHODS: We assembled a patient cohort from the Quebec Régie de l'Assurance Maladie du Québec (RAMQ) and Med-Echo administrative databases. We identified older adults with NVAF from 1995 to 2015. All patients with incident ICH and discharged in community were included. Patients were categorized according to OAC exposure. Outcomes included IS/SE, all-cause mortality, recurrent ICH and major bleeding after a quarantine period of 6 weeks. Crude event rates were calculated at 1-year of follow-up, and Cox proportional hazard models with a time-dependent binary exposure were used to assess adjusted hazard ratios (AHRs). RESULTS: The cohort of 683 NVAF patients with ICH aged 83 years on average. The rates (per 100 person-years) for IS/SE, death, ICH and major bleeding were 3.3, 40.6, 11.4, and 2.7 for the no OAC group; and 2.6, 16.3, 5.2, and 5.2 for OAC group, respectively. The AHR for IS/SE and death was 0.10 (95% confidence interval [CI], 0.05 to 0.21), 0.43 (95% CI, 0.19 to 0.97) for recurrent ICH and 1.73 (95% CI, 0.71 to 4.20) for major extracranial bleeding comparing OAC exposure to non-exposed. CONCLUSIONS: Initiating OAC after ICH in older individuals with NVAF is associated with a reduction of IS/SE and mortality and a trend in recurrent ICH supporting its use after ICH.

Quebec Serve and Protect Low Back Pain Study: What About Mental Quality of Life?

BACKGROUND: As of now, the impact of low back pain (LBP) and its chronic state, chronic low back pain (CLBP), on mental health-related quality of life (HRQOL) has never been investigated among police officers. The present investigation aims at studying this relationship using a biopsychosocial model. METHODS: Between May and October 2014, a Web-based cross-sectional study was conducted among Quebec police officers (Quebec, Canada). Mental HRQOL was measured using the role emotional (RE) and the mental health (MH) domains of the SF-12v2 Health Survey. The impact of CLBP on mental HRQOL (as opposed to acute/subacute LBP or no LBP) was studied with a multivariate linear regression model. RESULTS: Of the 3,589 police officers who participated in the study, 1,013 (28.4%) reported CLBP. The mean age of respondents was 38.5 ± 8.7 years, and 32.0% were females. The RE (44.1/100) and MH (49.0/100) mean scores of the CLBP group were comparable with the scores found in populations suffering from cancer or heart diseases. Compared to officers without LBP, the presence of CLBP was significantly associated with lower RE (β: −0.068; p = 0.003) and MH (β: −0.062; p = 0.002) scores. These relationships were not found in the acute/subacute LBP group. CONCLUSION: Our results underscore how frequent CLBP is among police officers and how burdensome it is. Considering the importance of good physical and mental health for this occupational population, police organizations should be aware of this issue and contribute to the efforts toward CLBP prevention and management in the workplace.

Lógicas de mobilidade, projetos profissionais e experiências interculturais dos estudantes internacionais no Quebec / Logics of mobility, professional projects and intercultural experiences of international students in Quebec / Lógicas de movilidad, proyectos profesionales y experiencias interculturales de los estudiantes internacionales en Quebec

This article aims to analyze the logics of international student mobility in Quebec, as well as their professional projects after graduation and the cultural effects of this experience. This article demonstrates that strategic and "experiential" motives join those linked to an emigration project to Canada to support students' mobility logics. With regard to career projects after studies, it is observed that such projects are marked by uncertainty. If some students consider staying and working in Canada or returning to their home country, a large majority have difficulty in finding a satisfactory job and aiming for an international career. In terms of cultural effects of studies outside the country of origin, there is a more pronounced reflexivity, a highlight of individualization and acculturation as a personality dimension.

El presente artículo tiene como objetivo analizar las lógicas de movilidad de los estudiantes internacionales en Quebec, así como sus proyectos profesionales después de la diplomación y los efectos culturales de esa experiencia. Este artículo demuestra que los motivos de naturaleza estratégica y "experiencial" se unen a aquellos vinculados a un proyecto de emigración a Canadá para sostener las lógicas de movilidad de los estudiantes. En lo que se refiere a los proyectos de carrera después de los estudios, se observa que tales proyectos están marcados por la incertidumbre. Si algunos estudiantes consideran permanecer y trabajar en Canadá o volver a su país de origen, una gran mayoría tiene dificultades para encontrar un empleo satisfactorio y objetiva una carrera internacional. En términos de efectos culturales de los estudios fuera del país de origen, se destaca una reflexividad más acentuadas, un destaque de la individualización y una aculturación como dimensión de la personalidad.

Consent to care of persons with intellectual disability in Quebec: from vulnerability to capability / Consentimiento para el cuidado de las personas con discapacidad intelectual en Quebec: desde la vulnerabilidad hasta la capacidad

Abstract: Persons with an intellectual disability (ID) who interact with the Quebec health and social services system are faced with major decisions regarding the care they are offered. As consent to care derives from the fundamental right of all persons to personal inviolability and to autonomous decision making, they therefore have the right to accept or refuse any and all health and psychosocial care proposed. However, as free and informed consent to care must be given by an able person, the situation becomes somewhat more complicated whereas persons with ID are concerned. This article presents reflections on the challenges and issues relative to these persons' consent to health and psychosocial care.

Resumen: Las personas con discapacidad intelectual (ID) que interactúan con el sistema de salud y los servicios sociales de Quebec se enfrentan a decisiones importantes sobre la atención que se les brinda. Dado que el consentimiento a la atención se deriva del derecho fundamental de todas las personas a la integridad personal y a la toma de decisiones autónomas, éstas tienen el derecho de aceptar o rechazar cualquier atención de salud y psicosocial que se les proponga. Sin embargo, como el consentimiento libre e informado a la atención debe ser dado por una persona apta, la situación se vuelve más complicada en las personas con ID. Este artículo presenta reflexiones sobre los desafíos y temas relativos al consentimiento de estas personas hacia la salud y la atención psicosocial.

Association between Satisfaction with Assistive Technology Devices and Psychosocial Impact among Some Mentally or Physically Disabled Children / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to identify the association between satisfaction with assistive technology devices and psychosocial impact among some mentally or physically disabled children. METHODS: The study subjects were 120 disabled children and their primary caregivers who were using rental assistive technology devices in Gwangju and Jeollanam-Do. Data were collected by structured questionnaire composed of general characteristics of subjects, characteristics related with using assistive devices. Quebec User Evaluation of Satisfaction with assistive Technology 2.0 (QUEST 2.0) and Psychosocial Impact of Assistive Device Scale (PIADS). The statistical analysis were performed by descriptive statistics, t-test, ANOVA and Pearson's correlational analysis. RESULTS: The total mean score for QUEST 2.0 was 4.08±0.66 (satisfaction with devices, 4.01±0.70; satisfaction with the assistive devices service, 4.14±0.90) and the mean of PIADS was 1.00±0.75 (ability, 0.99±0.78; adaptability, 1.04±0.86; self-respect, 0.99±0.74). The scores of PIADS was statistically significant difference according to usage time of assistive devices. The PIADS was significantly positive correlated with QUEST 2.0 CONCLUSIONS: The mentally or physically disabled children reported that the higher level of satisfaction and the more positive impact of psychosocial aspect with assistive technology devices. It would be necessary to perform further studies for addressing the effects of assistive technology devices.

Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum

OBJECTIVE: To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. METHODS: In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. RESULTS: Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. CONCLUSION: Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum.

A Multidisciplinary Workplace Intervention for Chronic Low Back Pain among Nursing Assistants in Iran

STUDY DESIGN: Interventional research with a 6-month follow-up period. PURPOSE: We aimed to establish the effectiveness of a multidisciplinary workplace intervention on reduction of work-related low back pain (WRLBP), using ergonomic posture training coupled with an educational program based on social cognitive theory. OVERVIEW OF LITERATURE: WRLBP is a major occupational problem among healthcare workers, who are often required to lift heavy loads. Patient handling is a particular requirement of nurse aides, and has been reported as the main cause of chronic WRLBP. METHODS: We included 125 nursing assistants from two hospitals affiliated to Qom University of Medical Sciences from May to December 2015. There was an intervention hospital with a number of 63 nursing assistants who received four multidisciplinary educational sessions for 2 hours each plus ergonomic posture training over two days and a control hospital with a number of 62 nursing assistants who didn't receive educational intervention about low back pain. The outcomes of interest were reductions in WRLBP intensity and disability from baseline to the follow up at 6 months, which were measured using a visual analog scale and the Quebec Disability Scale. Descriptive and analytical statistics were used to analyze the data. RESULTS: The comparison tests showed significant change from baseline in reduction of WRLBP intensity following the multidisciplinary program, with scores of 5.01±1.97 to 3.42±2.53 after 6 months on the visual analog scale in the intervention group (p<0.001) and no significant change in control groups. There was no significant difference in the disability scores between the two groups (p=0.07). CONCLUSIONS: We showed that our multidisciplinary intervention could reduce the intensity of WRLBP among nurse aides, making them suitable for implementation in programs to improve WRLBP among nursing assistants working in hospitals.

A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel Obstruction

OBJECTIVES: To investigate the surgical outcomes of different uvulopalatopharyngoplasty (UPPP). METHODS: All subjects underwent overnight polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Quebec sleep questionnaire and the snoring scale at the baseline and 3 and 12 months following operation. The primary endpoint was the overall effective rate representing the sum of the surgical success rate and effective rate. RESULTS: The overall effective rate at 12 months post surgery was 55.6% for simple UPPP, 95.8% for UPPP+GA, and 92.3% for UPPP+TBA. The surgical success rate at 3 and 12 months postoperation for UPPP+GA or UPPP+TBA was significantly higher than simple UPPP (P<0.05). Marked improvement was observed in all patients in the snoring scale score and the ESS score 3 and 12 months following surgery compared to the baseline (P<0.05 in all). CONCLUSION: UPPP, UPPP+GA, and UPPP+TBA are all effective in improving the surgical outcome of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with multilevel obstruction. UPPP+TBA appears to be the most effective in treating OSAHS patients.

Internalized homophobia as a partial mediator between homophobic bullying and self-esteem among youths of sexual minorities in Quebec (Canada) / Homofobia internalizada como mediador parcial do bullying homofóbico e autoestima entre jovens de minorias sexuais em Quebec (Canadá)

Verbal/psychological homophobic bullying is widespread among youths of sexual minorities. Homophobic bullying has been associated with both high internalized homophobia and low self-esteem. The objectives were to document verbal/psychological homophobic bullying among youths of sexual minorities and model the relationships between homophobic bullying, internalized homophobia and self-esteem. A community sample of 300 youths of sexual minorities aged 14 to 22 years old was used. A structural equation model was tested using a nonlinear, robust estimator implemented in Mplus. The model postulated that homophobic bullying impacts self-esteem both directly and indirectly, via internalized homophobia. 60.7% of the sample reported at least one form of verbal/psychological homophobic bullying. The model explained 29% of the variance of self-esteem, 19.6% of the variance of internalized homophobia and 5.3% of the verbal/psychological homophobic bullying. The model suggests that the relationship between verbal/psychological homophobic bullying and self-esteem is partially mediated by internalized homophobia. The results underscore the importance of initiatives to prevent homophobic bullying in order to prevent its negative effects on the well-being of youths of sexual minorities.

A homofobia verbal/psicológica (bullying homofóbico) é comum entre jovens de minorias sexuais. Está associada com homofobia internalizada e baixa autoestima. Os objetivos foram documentar o bullying homofóbico verbal/psicológico entre jovens de minorias sexuais e modelar a relação entre o bullying homofóbico, homofobia internalizada e autoestima. Foi utilizada uma amostra da comunidade com 300 jovens de minorias sexuais, na faixa etária entre 14 a 22 anos. Foi testado um modelo de equação estrutural usando um estimador não linear, robusto, implementado no Mplus. O modelo postula que o bullying homofóbico tem impacto na autoestima, direta e indiretamente, via homofobia internalizada. Os resultados apontaram que 60,7 % da amostra relataram pelo menos uma forma de bullying homofóbico verbal/psicológico. O modelo explicou 29% da variância da autoestima, 19,6% da variância da homofobia internalizada e 5,3 % do bullying homofóbico verbal/psicológico. O modelo sugere que a relação entre bullying homofóbico verbal/psicológico, assédio moral e autoestima é parcialmente mediada por homofobia internalizada. Os resultados sublinham a importância de iniciativas para prevenir o bullying homofóbico, evitando os efeitos negativos sobre o bem-estar dos jovens de minorias sexuais.

MyRisk_Stroke Calculator: A Personalized Stroke Risk Assessment Tool for the General Population

BACKGROUND AND PURPOSE: There is a variety of stroke risk factors, and engaging individuals in reducing their own personal risk is hugely relevant and could be an optimal dissemination strategy. The aim of the present study was to estimate the stroke risk for specific combinations of health- and lifestyle-related factors, and to develop a personalized stroke-risk assessment tool for health professionals and the general population (called the MyRisk_Stroke Calculator). METHODS: This population-based, longitudinal study followed a historical cohort formed from the 1992 or 1998 Sante Quebec Health Surveys with information for linkage to health administrative databases. Stroke risk factors were ascertained at the time of survey, and stroke was determined from hospitalizations and death records. Cox proportional hazards models were used, modeling time to stroke in relationship to all variables. RESULTS: A total of 358 strokes occurred among a cohort of 17805 persons (men=8181) who were followed for approximately 11 years (i.e., -200000 person-years). The following regression parameters were used to produce 10-year stroke-risk estimates and assign risk points: for age (1 point/year after age 20 years), male sex (3 points), low education (4 points), renal disease (8 points), diabetes (7 points), congestive heart failure (5 points), peripheral arterial disease (2 points), high blood pressure (2 points), ischemic heart disease (1 point), smoking (8 points), >7 alcoholic drinks per week (3 points), low physical activity (2 points), and indicators of anger (4 points), depression (4 points), and anxiety (3 points). According to MyRisk_Stroke Calculator, a person with 75%, respectively. CONCLUSIONS: The MyRisk_Stroke Calculator is a simple method of disseminating information to the general population about their stroke risk.

La participation des personnes utilisatrices aux exercices de planification et d'organisation des services de santé mentale au Québec / Participação dos usuários no planejamento e organização dos serviços de saúde mental no Quebec

Cet article documente la manière dont s'est renouvelé et s'est transformé au fil du temps le projet de faire participer les usagers aux exercices de planification et d'organisation des services de santé mentale au Québec (Canada). Pour ce faire, les auteurs reviennent sur l'ensemble des documents ministériels qui ont traité de cette question et dégage, pour les principaux moment-clés, les principales modalités de participation des usagers.

Este artigo documenta a forma como se renovou e se transformou, ao longo do tempo, o projeto de participação dos usuários no planejamento e organização dos serviços de Saúde Mental no Quebec (Canadá). Para isso, os autores reavaliaram todo o conjunto de documentos ministeriais que trataram desta questão e retiraram, para os momentos-chaves, as principais modalidades de participação dos usuários.

O Comitê Cidadão como estratégia cogestiva em uma pesquisa participativa no campo da saúde mental / The Citizen Committee as a co-management strategy in participatory research in the field of mental health in Quebec

O tema dos direitos dos usuários ganha centralidade na discussão contemporânea no campo da saúde mental. A partir da criação de um Comitê Cidadão, composto por usuários e familiares em uma aliança de pesquisa internacional entre Brasil e Canadá, propomos discutir os efeitos, nestes sujeitos, da experiência de cogestão promovida pela pesquisa participativa "Gestão Autônoma da Medicação (GAM)". Através de descrição detalhada do histórico do Comitê e de entrevista e análise de transcrição da voz de seus membros, problematizamos a relação dialogada entre o saber científico e o saber advindo da experiência singular destes sujeitos, em uma perspectiva metodológica de pesquisa participativa. Como resultado da pesquisa, observamos que a experiência do Comitê Cidadão na cogestão da pesquisa em saúde pode ser propiciadora do aumento nos graus de autonomia, maior empoderamento e exercício de protagonismo e cidadania, com a consequente emergência de sujeitos de direitos.

The theme of users' rights has become a central issue in contemporary debate on mental health. Drawing from the experiences of "Comitê Cidadão" (Citizen Committee), consisting of users and family members in an international research alliance between Brazil and Canada, an attempt is made to discuss the effects of the experience of co-management of the so-called Autonomous Medication Administration (GAM - Gestão Autônoma da Medicação) participatory research project on these individuals. By means of a detailed description of the background of the Committee and interviews and analysis of the voice transcriptions of its members, the problems raised by the relation of dialogue between scientific knowledge and users' knowledge are examined in a methodological approach of participatory research. As a result of the research, it was established that the experience of the Citizens Committee in co-management of health research can be propitious to the increase in the degree of autonomy, greater empowerment and the exercise of leadership and citizenship, with the consequent emergence of subjects with rights.

Contribution des hôpitaux de jour en psychiatrie dans le champ contemporain de la santé mentale au Québec / Contribuição dos hospitais-dia de psiquiatria no campo da saúde mental em Quebec

Actuellement au Québec, les hôpitaux de jour en psychiatrie sont des milieux de jour offrant un programme thérapeutique intensif de courte durée, principalement dans un contexte d'activités de groupe. Alors que les hôpitaux de jour sont des acteurs qui font partie intégrante du système de soins en santé mentale depuis plusieurs décennies, la question de leur rôle et de leur contribution spécifique dans le champ des approches et des pratiques de traitement et pour les personnes qu'ils rejoignent est rarement posée. Cet article s'articule autour de l'hypothèse selon laquelle les repères et les cadres actuellement dominants dans le champ de la psychiatrie et de la santé mentale permettent mal de dégager et de prendre en compte certains des paramètres dont il faut tenir compte pour parvenir à préciser et à situer le rôle et la contribution des hôpitaux de jour, dans le système de soin comme pour les personnes auxquelles ces milieux de pratique s'adressent. À partir des résultats préliminaires d'une étude exploratoire poursuivie dans quatre hôpitaux de jour où différents acteurs ont été rencontrés lors d'entrevues (personnes utilisatrices, intervenants, gestionnaires), cet article propose de dégager quelques pistes d'analyse et de réflexion.

Em Quebec, atualmente, os hospitais-dia em psiquiatria oferecem um programa terapêutico intensivo de curta duração, focado em atividades de grupo. Esses hospitais-dia são parte integrante do sistema de saúde em psiquiatria e saúde mental depois de várias décadas, entretanto o seu papel em relação às suas práticas com a inclusão daqueles que seguiram esse tratamento é raramente colocado. Nessa perspectiva, este artigo se articula em torno da hipótese de que os valores de referencia, hoje dominantes no campo da psiquiatria e saúde mental, não permitem identificar e levar em conta certos parâmetros necessários para se precisar e situar o papel e a contribuição específica dos hospitais-dia no sistema de saúde mental e para as pessoas às quais se destinam. À partir de resultados preliminares de um estudo exploratório realizado em quatro hospitais-dia em psiquiatria, com entrevistas individuais (pessoas usuárias, trabalhadores e gestores), se propõe identificar algumas pistas de análise e reflexão.

Représentation sociale de la santé d'immigrants allophones de Montréal, Canada / Social representation of health by allophones immigrants of Montreal, Canada

La province de Québec accueille 50 000 immigrants par an dont 35% sont allophones. Les immigrants ont une meilleure santé que les natifs à leur arrivée. Cet état de santé diminue avec le temps. Des liens ont été établis entre acculturation et prise de poids. L'analyse des représentations sociales de la santé révèle les obstacles et les opportunités de ces personnes à adopter de « saines habitudes de vie ¼. Une étude qualitative exploratoire a été menée à Montréal. L'analyse révèle des conceptions spécifiques de la santé, une évaluation positive de leur état de santé et les causes reliées à cet état. Un grand nombre de croyances, de normes et d'opinions sont exprimées en lien avec l'alimentation et l'activité physique. La représentation de la santé en contexte migratoire présente un conflit entre les valeurs du pays d'origine et du pays hôte. Des mécanismes d'enchantement et de désenchantement sont opérés pour combler l'écart entre idéal espéré et réalité vécue.

The province of Quebec allowed 50,000 immigrants per year of which 35% are allophones. Immigrants have better health than natives and the health status decrease with the time. Links are done between acculturation and increase of bodyweight. The analysis of social representation (SR) of health shows obstacles and opportunities to adopt a "healthy lifestyles". A qualitative exploratory study was done in Montreal. The analysis reveals specific conceptions of health, a positive health status assessment and origins of this status. Lots of beliefs, norms and opinions are connected with food and physical activity. The social representation of health in migration context shows a struggle between country of birth values and host country values. The Mechanisms of "enchanting" and "disenchanting" are working to fill the gap between the hoped ideal and the lived reality.

A luta contra os maus-tratos no Québec. Alguns paralelos na implementação de "Cidades Amigas dos Idosos" / The fight against child abuse in Quebec. Some parallels in the implementation of "Cities Friends of the Elderly" / La lutte à la maltraitance au Québec. Quelques mises en parallèle avec la démarche « Villes Amies des Aînés ¼

Embora a luta contra os maus-tratos conte com 30 anos de história e de ações no Québec (Canadá), somente em 2010 foi adotado o primeiro Plano de ação governamental para combater os maus-tratos a idosos 2010-2015. O presente artigo faz um levantamento das políticas públicas e das ações de luta contra os maus-tratos às pessoas idosas no Québec e expõe, paralelamente, os laços entre essas políticas públicas e ações de luta contra os maus-tratos e a iniciativa de implantação e de avaliação do programa Cidades Amigas dos Idosos da Organização Mundial da Saúde (OMS, 2007), que foi introduzido como programa governamental no Québec desde 2009. Oferece, assim, uma análise detalhada do conteúdo de 4 documentos públicos recentes. Num segundo momento, o projeto Arrimage, uma pesquisa - ação intersetorial de luta contra os maus tratos em curso em Montreal, é descrito, demonstrando a importância de ações concertadas.

Bien que la lutte à la maltraitance compte 30 ans d'histoire et d'actions au Québec (Canada), ce n'est qu'en 2010 que fut adopté le premier Plan d'action gouvernemental pour contre la maltraitance envers les personnes aînées 2010-2015. Le présent article fait le point sur les politiques publiques et lês actions de lutte à la maltraitance envers lês personnes aînées au Québec puis expose, em parallèle, lês liens entre ces politiques publiques et actions de lutte à la maltraitance et la démarche d'implantation et d'évaluation du programme Villes Amies des Aînés de l'Organisation Mondiale de la Santé (OMS, 2007), qui a été introduit comme programme gouvernemental au Québec depuis 2009. Il offre ainsi une analyse détaillée Du contenu de 4 documents publics récents. Dans um deuxième temps, Le projet Arrimage, une recherche-action intersectorielle de lutte à la maltraitance em cours à Montréal, est décrit démonstrant l'importance des actions concertées.

A implementação de "Cidades Amigas dos Idosos no Québec": a importância da participação do conjunto dos atores / The implementation of "Cities Friends of the Elderly in Québec": the importance of the participation of all actors

Resumo não identificada

Incidence of epithelial lesions of the conjunctiva in a review of 12,102 specimens in Canada (Quebec) / Incidência de lesões epiteliais da conjuntiva em revisão de 12.102 casos no Canadá (Quebec)

PURPOSE: The purpose of this study was to assess the relative frequency of epithelial lesions of the conjunctiva in Canada. METHODS: A retrospective study of 12,102 consecutive cases received during 16 years (1993-2009) at the Henry C. Witelson Ocular Pathology Laboratory in Montreal, Canada, was performed. Demographic data was retrieved from histopathological request forms and specimens were categorized and analyzed by mean percentage. The relative frequency of epithelial lesions of the conjunctiva from a single center in Canada, representing the province of Quebec was reviewed. RESULTS: Of the 12,102 specimens reviewed, 273 were conjunctival lesions (2.25 percent), including 86 epithelial tumors (0.71 percent) of the conjunctiva that comprised the studied sample. The average age of these patients was 59.9 ± 17.6 years, and gender distribution was 66 (69 percent) males and 30 (31 percent) females. Fifteen lesions (17.4 percent) were classified as squamous cell papillomas (mean age, 57.3 ± 16.7 years). Within the ocular surface squamous neoplasia (OSSN) spectrum, there were 10 (11.6 percent) actinic keratosis (63.8 ± 17.6 years), 27 (31.3 percent) cases of conjunctival intraepithelial neoplasia (CIN) with variable degrees of atypia (mild to moderate) (63.9 ± 15.3 years), 15 (17.4 percent) carcinomas in situ (66.7 ± 18.0 years), and 17 (19.7 percent) squamous cell carcinomas (SCC) (56.2 ± 19.4 years). Two other rare cases of malignant tumors included one basal cell carcinoma and one mucoepidermoid carcinoma. CONCLUSIONS: The distribution of our sample is similar to the one reported by the American Forces Institute of Pathology (AFIP) in 1994. When we compare our sample to others coming from countries with high levels of sunlight exposure, we found a lower incidence of ocular surface squamous neoplasia, including squamous cell carcinomas in Canada.

OBJETIVO: O estudo realizado teve como objetivo fornecer a relativa frequência de cada lesão epitelial de conjuntiva no Canadá. MÉTODOS: Trata-se de estudo retrospectivo de todos os casos recebidos durante 16 anos (1993-2009) no Henry C. Witelson Ocular Pathology Laboratory, em Montreal. Dados epidemiológicos foram obtidos por meio de requerimento e laudos histopatológicos, sendo classificados e analisados pelo porcentual na amostra. A relativa frequência de lesões epiteliais da conjuntiva foram obtidas em um único centro de análises no Canadá. RESULTADOS: Entre 12.102 espécimes revisadas, 273 foram lesões conjuntivais (2,25 por cento), sendo 86 tumores epiteliais (0,71 por cento) entre a amostra estudada. A idade média das lesões neoplásicas da conjuntiva foi de 59,9 ± 17,6 anos, e a distribuição por sexo foi de 66 (69 por cento) homens e 30 (31 por cento) mulheres. Quinze lesões (17,4 por cento) foram classificadas como papilomas de células escamosas (idade média 57,3 ± 16,7 anos). No grupo das neoplasias escamosas da superfície ocular (NESO) foram encontrados 10 (11,6 por cento) casos de queratose actínica, (63,8 ± 17,6 anos), 27 (31,3 por cento) casos de neoplasia intraepitelial (NIC), com moderada atipia (63,9 ± 15,3 anos), 15 (17,4 por cento) carcinomas in situ (66,7 ± 18,0 anos), e 17 (19,7 por cento) carcinomas de células escamosas (CCE) (56,2 ± 19,4 anos). Dois outros casos menos frequentes de tumores malignos foram incluídos; um carcinoma de célula basal e outro carcinoma mucoepidermoide. CONCLUSÃO: A distribuição de nossa amostra é semelhante a encontrada no Armed Forces Institute of Pathology (AFIP) em 1994, porém quando comparamos nossa amostra com estudos realizados em países com altos níveis de exposição solar observamos menor incidência de neoplasias escamosas da superfície ocular, incluindo-se carcinomas de células escamosas.

A simplified Chinese version of the Quebec sleep questionnaire was evaluated for reliability and validity / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To develop a simplified Chinese version of the 32-item Quebec sleep questionnaire (QSQ) and to examine the reliability and validity.</p><p><b>METHODS</b>A cross-sectional sample of 141 patients [22 simple snorers and 119 obstructive sleep apnea hypopnea syndrome (OSAHS)] and a longitudinal sample of 55 patients [35 in uvulopalatopharyngoplasty (UPPP) group and 20 in control group] completed the simplified Chinese version of QSQ for assessment of its feasibility, reliability, validity and responsiveness.</p><p><b>RESULTS</b>QSQ had good feasibility. All internal consistency coefficients exceeded 0.65. Intraclass correlation coefficients of five domains for test-retest reliability ranged from 0.82 - 0.91. There were significant differences in four domains (daytime sleepiness, diurnal symptoms, nocturnal symptoms and social interactions) among patients with different severity of apnea hypopnea index (AHI) and lowest saturation of arterial oxygen (LSaO2, P < 0.01 or < 0.05). Correlations between QSQ scores and five domains and Epworth sleepiness scale (ESS) were statistically significant (P < 0.01). Correlations between QSQ scores and three domains (daytime sleepiness, nocturnal symptoms and social interactions) and polysomnography (PSG) indices (AHI and LSaO2) were statistically significant (P < 0.05). There were significant differences in scores of five domains of patients between at baseline and after UPPP. There were significant differences in change scores of five domains between patients who were treated and those who were not.</p><p><b>CONCLUSION</b>The simplified Chinese version of QSQ offers good reliability, validity and responsiveness and can be used as a OSAHS-specific instrument to assess impact of illness and treatment effectiveness in OSAHS patients.</p>