[The social sciences at the Faculty of Pharmacy: and innovative course of community health at the University of Montreal]. / Les sciences sociales à la faculté de pharmacie In cours innovant de santé communautaire à l'Université de Monteréal.

Social sciences are important for training in pharmacy faculties. The course set up at the Faculty of Pharmacy of the University of Montreal in 2011 is a very innovative way to meet this challenge. The purpose of this report is to share this experience by providing a synthetic description. Many students were able to develop new skills and strengthen their skills, including leadership and critical thinking. The Faculty of Pharmacy was also able to achieve greater visibility in the Montreal community, that is to say from the associations, but also with what is out there called the "local health network" linking various health care professionals and institutions. Beyond the quantifiable results, this course is an evolving learning process in which the group interactions, individual and collective values and the task sharing allow students to build a working knowledge of social factors, which d.etermine health problems.

Impact of oxaliplatin-induced neuropathy in patients with colorectal cancer: a prospective evaluation at a single institution.

Oxaliplatin plays a major role in the treatment of colorectal cancer (crc), but is associated with the development of neuropathies. The main objective of the present prospective study was to estimate the proportion of participants with grade 1, 2, 3, or 4 peripheral sensory neuropathies according to the U.S. National Cancer Institute's Common Terminology Criteria for Adverse Events (version 4) among crc patients treated with oxaliplatin (adjuvant or metastatic, folfox or xelox regimens) at the Centre hospitalier universitaire de Sherbrooke. Among the 57 patients so treated between May 2012 and April 2013, about 60% reported grade 2 neuropathy, at maximum, during treatment. About 25% of patients had to stop treatment because of neuropathies. In a subset of patients contacted approximately 22 months after treatment cessation, neuropathies persisted in 70%. Oxaliplatin-induced neuropathy affects a significant number of crc patients and can influence the course of treatment and outcomes.

Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case-control study.

The extent to which childhood asthma incidence is influenced by asthma control and severity during pregnancy is unknown. We have studied this association during the child's first 10 yrs of life. A two-stage, case-control study, nested in a cohort of 8,226 children of asthmatic mothers, was conducted using three interlinked databases of Quebec, Canada, and mailed questionnaires. A total of 2,681 asthmatic children and 30,318 age-matched controls were selected (< or =20 controls.case(-1); stage 1), and 3,254 selected mothers were mailed questionnaires to obtain additional information (stage 2). Asthma control and severity was defined using validated indexes and childhood asthma incidence based on at least one asthma-related diagnosis and prescription received within 2 yrs. A total of 44 confounders were considered. Compared with children of mild controlled asthmatic mothers, children whose mothers had moderate-to-severe uncontrolled asthma during pregnancy had an increased risk of asthma (adjusted OR 1.27, 95% CI 1.06-1.52). No increased risk was observed for children of mild uncontrolled and moderate-to-severe controlled mothers. Based on one of the largest studies of children of asthmatic mothers, a significant increase in asthma risk was demonstrated among children whose mothers had poor control and increased severity of asthma during pregnancy, indicating that this element should be added to the expanding list of determinants of childhood asthma. As it constitutes a risk factor where pregnant asthmatic females can intervene, it is of great importance for physicians to optimally treat asthmatic females during pregnancy and to encourage females to be adherent to the prescribed asthma medications.

Risk of perinatal mortality associated with asthma during pregnancy.

BACKGROUND: Thirteen studies investigating the association between asthma during pregnancy and perinatal mortality reported generally no increased risk. Most of these studies should be interpreted with caution because they were limited in terms of statistical power. A study was therefore undertaken to evaluate whether maternal asthma during pregnancy increases the risk of perinatal mortality. METHODS: Through three administrative databases from Québec (Canada), a cohort of women with and without asthma who had at least one pregnancy between 1990 and 2002 was formed. Perinatal mortality was identified by diagnostic codes. The adjusted odds ratio (OR) of perinatal mortality in women with and without asthma was compared using Generalised Estimation Equation (GEE) models. The first model included all potential confounders (except small for gestational age, SGA), the second model excluded birth weight, gestational age at birth and SGA and the third model excluded birth weight, gestational age at birth but included only SGA. This analysis was also stratified for birth weight and gestational age at birth. RESULTS: The cohort was formed of 13 100 and 28 042 single pregnancies in women with and without asthma. The crude OR of perinatal mortality was 1.35 (95% CI 1.08 to 1.67), which decreased to 0.93 (95% CI 0.75 to 1.17) after adjustment for birth weight and gestational age at birth. Women with asthma had a higher rate of low birthweight babies and preterm delivery than those without asthma. CONCLUSION: The increased risk of low birthweight babies and premature delivery in women with asthma may partly explain the association between maternal asthma and the increased risk of perinatal mortality.

Can access to spirometry in asthma education centres influence the referral rate by primary physicians for education?

BACKGROUND AND OBJECTIVES: Asthma remains uncontrolled in a large number of asthmatic patients. Recent surveys have shown that a minority of asthmatic patients are referred to asthma educators. The objective of the present study was to assess the influence of increased access to spirometry in asthma education centres (AECs) on the rate of patient referrals to these centres by general practitioners. METHODS: A one-year, prospective, randomized, multicentric, parallel group study was conducted over two consecutive periods of six months each, with added spirometry being offered in the second six-month period to the experimental group. Ten AECs were enrolled in the project. An advertisement describing the AECs' services was sent by mail to a total of 303 general practitioners at the start of each period, inviting them to refer their patients. Measures of the frequency of medical referrals to the AECs were assessed for each period. RESULTS: The group of AECs randomly selected for spirometry in the second six-month period received 48 medical referrals during the first period and 32 during the second one, following proposed spirometry. AECs that had not offered spirometry received five referrals during the first period and seven during the second period. One AEC withdrew a few weeks after the study began and others encountered administrative problems, reducing their ability to provide interventions. CONCLUSIONS: Referral to AECs is not yet integrated into the primary care of asthma and offering more rapid access to spirometry in the AECs does not seem to be a significant incentive for such referrals.

Use of inhaled corticosteroids following discharge from an emergency department for an acute exacerbation of asthma.

BACKGROUND: Most patients who have an asthma exacerbation leading to a visit to an emergency department (ED) will benefit from treatment with inhaled corticosteroids (ICS) at discharge. We investigated whether asthmatic children and adolescents were receiving ICS after discharge from the ED and identified the characteristics of patients and physicians associated with their use. METHODS: A cohort of 4042 asthmatic patients aged 5-17 years was selected from the administrative database of the Regie de l'assurance maladie du Quebec between 1997 and 1999. The proportion of patients using ICS 1, 3, and 6 months after ED discharge was estimated. Using GEE models the independent contribution of sociodemographic variables, markers of asthma severity, prior use of healthcare services and ICS, and physician characteristics was investigated on the likelihood of using ICS after ED discharge. RESULTS: 68% of children and 51% of adolescents had a valid prescription for ICS in the month following discharge. At 6 months after discharge the corresponding figures were 77% and 60%. The strongest predictors of ICS use were age, with adolescents being less likely to use ICS than children (OR 0.49; 95% CI 0.43 to 0.56), prior use of ICS (OR 2.28; 95% CI 2.00 to 2.61), and filling a prescription for oral corticosteroids in the month following discharge (OR 2.29; 95% CI 2.03 to 2.58). However, patients who had an ED visit or a hospital admission for asthma during the 6 months before discharge were not more likely to use ICS after discharge. CONCLUSION: A large proportion of patients with clear markers of uncontrolled or severe asthma did not have a valid prescription for an ICS after discharge from the ED.

Assessment of the readability and comprehensibility of a CFC-transition brochure.

BACKGROUND: In anticipation of public confusion about the availability of medications during the metered-dose inhaler CFC phaseout period, a multidisciplinary effort has resulted in the development of a brochure designed to educate patients and health care providers about the health consequences of ozone depletion and the transition to CFC-free inhaled products. This brochure is the subject of this assessment. OBJECTIVES: The primary purpose of this study was to estimate the grade of reading difficulty of a brochure designed to educate patients about the change to CFC-free inhalation products. A secondary objective was to assess baseline knowledge of patients concerning CFC transition and their comprehension of this issue after reading the brochure. METHODS: Standard readability formulae were used to assess the grade level of the CFC transition brochure. In addition, baseline knowledge of the CFC transition process and comprehensibility of the brochure were measured via a 2-page questionnaire. RESULTS: The SMOG, Rix, and Flesch-Kincaid tests yielded readability at grade levels of 14, 10, and 10.4, respectively. The survey indicated that even after reading the brochure, many patients had concerns about the transition process. CONCLUSIONS: These results suggest that the readability of the brochure entitled Your Metered-Dose Inhaler Will Be Changing... Here Are the Facts...may not be appropriate for a large segment of the population for whom it is intended. Further, the comprehensibility assessment suggests that many patients are either unaware of or unable to understand the impending changes to their inhaled therapies.

Etidronate and alendronate in the treatment of postmenopausal osteoporosis.

OBJECTIVE: To review the clinical trials evaluating the efficacy of etidronate and alendronate in the treatment of established postmenopausal osteoporosis. DATA SOURCE: A MEDLINE search was performed (from 1966 through September 1998) using the search terms bisphosphonates, etidronate, alendronate, and postmenopausal osteoporosis. English-language articles were considered for review. STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, double-blind, placebo-controlled clinical trials using fracture as an end point were selected to review the efficacy of etidronate and alendronate in the treatment of postmenopausal osteoporosis. Results for the outcomes of bone mineral density (BMD) and fracture are summarized. DATA SYNTHESIS: Etidronate and alendronate increase spinal BMD in postmenopausal women with osteoporosis. In one study, etidronate decreased the number of women sustaining new radiographic vertebral fractures over two years, but this effect was lost after three years of treatment. Alendronate reduces the number of radiographic vertebral fractures in postmenopausal women with a low bone mass. In women with preexisting fractures, alendronate decreases the number of patients with radiographic vertebral fractures, clinical (i.e., symptomatic vertebral and nonvertebral) fractures, and hip fractures. A significant reduction in the overall number of nonvertebral fractures has not been demonstrated in clinical trials evaluating either alendronate or etidronate. CONCLUSIONS: No studies have directly compared the efficacy of alendronate and etidronate and the results of long-term clinical trials (i.e., >5 y) have not been published. Based on the results obtained in clinical trials using fracture as an end point, alendronate appears to be the bisphosphonate of choice. Safety profiles and cost should also be considered in the choice of etidronate or alendronate for the treatment of postmenopausal osteoporosis.

Nonchemotherapy drug-induced agranulocytosis: a review of 118 patients treated with colony-stimulating factors.

To determine the role of growth factors in nonchemotherapy drug-induced agranulocytosis, we reviewed 118 published reports of administration of colony-stimulating factors for the disorder. Main outcomes were total duration of neutropenia and mortality. The mean time to neutrophil recovery was 4.6 +/- 3.2 days and 7.7 +/- 5.1 days in patients with a granulocyte count at diagnosis of 0.1-0.5 x 10(3)/mm3 and less than 0.1 x 103/mm3, respectively. The mortality rate was 4.2%. Without therapy with growth factors, the mean time to neutrophil recovery after discontinuation of the offending agent was reported to be 10 +/- 8 days. The mortality rate was 16% in one study. We conclude that hematopoietic growth factors may shorten the duration of neutropenia and reduce mortality in patients with severe drug-induced agranulocytosis.

An interdisciplinary community-based educational model.

The purpose of this article is to describe an innovative partnership among academic, community, and service to better meet the health care needs of underserved populations. The Center for Community Health Education, Research, and Service--a coalition of Boston education institutions, health services providers, and community agencies--was formed with a grant from the W. K. Kellogg Foundation. The initial goal was to establish academic community health centers comparable to the large teaching hospitals that combine service, education, and research as the corner-stone of their mission. With faculty based in the neighborhood health centers, students have learning opportunities to assess, plan care, and treat individuals and families using a community-based primary care model. The nature of the partnership, including the structure and process of implementation, is described. The developmental socialization of advanced practice nursing students in a community based-setting is discussed. Educational and service outcomes are identified.

The President Clinton crisis and the Starr report: children's perceptions and parents' awareness.

INTRODUCTION: The media have suggested that the President Clinton crisis, as publicized by the Starr Report, has had detrimental effects on school-age children. Parents, too, have been concerned that their children are confused about the presidential controversies involving dishonesty, mistrust, betrayal, infidelity, and misuse of authority. The purpose of this study was to explore the perceptions and reactions of school-age children to information surrounding the President Clinton situation, as well as parents' perceptions of their children's knowledge and reactions. METHOD: A descriptive, qualitative design was used in this study. Data collection took place during the 2-week period following publication of the 1998 Starr Report. Fifty-one parents and 67 school-age children were interviewed using semi-structured interview guides with 5 open-ended questions addressing the President Clinton situation. RESULTS: Major themes that emerged from children's interviews were lying, getting caught, infidelity, and role modeling. Parents' awareness of their children's knowledge regarding the President Clinton situation varied; few were aware of the depth of knowledge their children had, nor had they discussed this situation with their children. DISCUSSION: Findings have relevance for nurse practitioners as they support parents in listening to and talking with their children about tough issues such as morality and sexuality in the context of real life events.

Violence prevention: a community approach.

Violence among children and adolescents has been elevated to the status of a public health problem in the United States today. Pediatric nurse practitioners are in a unique position to play a major role in violence prevention. This article describes the impact of violence on the preschool child including developmental and behavioral issues. Violence prevention must be all-inclusive as a routine component of anticipatory guidance for preschool children and their families. Ways to integrate violence prevention into a primary care approach are addressed. Community-based outreach programs that further buffer the impact of violence on these children are discussed.