L'utilisation de services de santé et de médicaments par des personnes âgées de Montréal qui reçoivent des soins maintien à domicile.

A survey was conducted among 160 persons aged 64 year or more in Montreal who were receiving home care. They answered at home a questionnaire on their use of health care services and drugs, and showed the interviewer all the drugs they were taking. In comparison with similar data from elsewhere, the use of health care services (an average of 8.0 encounters with a physician per person per year) and of drugs (an average of 5.3 per person) by this group seems high. Perhaps this group of people was obviously sicker than others of the same age, but this remains to be shown. Moreover, despite the reported frequency of health problems, it is uncertain whether such use of services and drugs was necessary. The question is raised whether the home care system is doing for the patient what it was intended to do.     

Ecole d'été de l'A.C.E.M.I.—Haïti

Six Canadian medical students record their experience at a summer school of tropical medicine in Haiti, sponsored by the Canadian Association of Medical Students and Internes. The social, economic and medical background is described, including “Voodoo” practices, language and Haitian art. Attention is directed to the occurrence of umbilical tetanus, diarrhea and malnutrition. From even a brief stay in a country such as Haiti one comes to appreciate that a public health program in an underdeveloped nation is not strictly a medical undertaking but must be seen in its social and economic contexts.     

Etude comparée expérimentale de l'électrophorèse des protéines et des électrolytes chez des chiens

A higher survival rate and faster wound healing in dogs on a controlled and well-balanced diet have been demonstrated when compared with those not under dietetic control.

Electrophoretic comparison of serum proteins was carried out in two groups of dogs. The first was on a well-controlled and well-balanced diet; the second group received an uncontrolled diet. The dogs in Group 2 had a lower concentration of total proteins, and globulins, especially gamma-globulins, were diminished; however, the serum albumin was higher. The albumin/globulin ratio was 0.93 in Group 1 and 2.07 in Group 2.

Serum electrolyte levels also showed some slight differences. Sodium and potassium levels were higher in well-nourished dogs, while chloride and bicarbonates were slightly lower.

     

Priorités dans le domaine de la santé au Québec

The reform of health services in Quebec, of which the most important stage was the creation of the Department of Social Affairs and the Quebec Health Insurance Board, has solved certain problems such as the inaccessibility to care because of the cost, the paucity of medical personnel and the excessive increase in the cost of the services offered to hospital patients. A critical analysis of both the reform and its practical consequences points to certain conclusions which, far from rejecting the principle of the reform, indicate none the less various possibilities for reorienting its priorities. Observing the rate of recourse to health services as well as the attitudes and conduct of health professionals have helped us to identify the causes of certain tendencies inspired by the incentives inherent in the reform. The organization of health services in Quebec must be oriented toward new priorities: the prevention and treatment both of environmental diseases and diseases associated with ageing plus the definition of a global approach to public health.     

Etude clinique préliminaire sur l'emploi de la dihexyvérine en obstétrique

This study attempted to evaluate the effect of dihexyverine HCl (Metaspas), an anticholinergic and direct smooth muscle relaxant (spasmolytic), in shortening the first stage of labour. One hundred and five patients constituted the series: 31 were primiparae, 27 secundiparae and 47 multiparae. The majority of these (95) received one intramuscular injection (10 mg.) of dihexyverine. Alphaprodine (Nisentil), 40 mg., was administered in all but 10 cases, since dihexyverine has no analgesic action. Seventy-five control patients were used: 25 were primiparae, 25 secundiparae and 25 multiparae. Alphaprodine alone was administered to these control patients. The length of time for dilatation from 4 cm. to 10 cm. was the selected criterion. In the control group, the average time for complete cervical dilatation was 4 hours, 10 minutes. In the group treated by dihexyverine, complete dilatation was achieved in 1 hour, 16 minutes. On the average, the first stage of labour was 2 hours and 54 minutes shorter with dihexyverine; the clinical effect begins 10-30 minutes after administration. The only side effect encountered was a skin rash in one patient.     

Correction de l'hypertension intracrânienne créée par compression mécanique directe du cerveau

An attempt has been made to correct cerebral hypertension induced by direct compression of the brain in a group of six dogs. The animals, which had been previously fitted with an inflatable subdural rubber balloon, were either kept eupneic (isolated mechanical hypertension) or deliberately hypoventilated (mixed mechanical and acidotic hypertension). In the first instance, administration of urea brought the intracranial pressure back to control values while, in the second case, injection of an amine buffer controlled only the acidotic component of intracranial hypertension.     

Oral hygiene awareness among female Saudi school children

OBJECTIVE: To evaluate the oral hygiene habits and utilization of professional dental health services by all the children in the primary schools, and to compare the differences in oral hygiene awareness (OHA) and dental health status of schoolchildren who are exposed to dental health education and those who are not. METHODS: Participants included 400 Saudi children, randomly selected from the primary female schools in Al-Kharj, Kingdom of Saudi Arabia on April 2007. Two hundreds children (age 9-11) from the 25 schools, who were exposed to the dental health education program on April 2006, were randomly selected as the study group. Two hundred children (age 9-11) from the schools, which were not exposed to such program were also randomly selected as the control group. The required information about oral hygiene awareness was collected through an especially designed questionnaire. RESULTS: Tooth brushing for 2 times a day or after meals were more common among schoolchildren of study group, than schoolchildren of control group. A significant difference (p=0.00) was observed between study group and control group, with regard to never brush their teeth. There was no significant difference between study group and control group with respect to using dental floss, using mouthwash, and in relation to never visiting a dentist for check up. The main reason cited by study group, and by control group for visiting the dentist was that they had severe toothache. Both groups presently consume more sweetened soft drinks. A significant (p=0.00) higher frequency of good dental status was observed in the study group, as compared with that of the control group. CONCLUSION: The school which applied this program, showed improved OHA of children as compared with the control group. Systematic school-based oral health promotion programs are urgently needed in the Kingdom to target lifestyles and health needs of children.     

Les médecins québécois étudieront les économies dans les pratiques médicales

The Quebec government has signed agreements with two of the province's medical federations which aim to lower health care costs over the next 20 months without reducing insured services. The government hopes to save more than $60 million by measures such as reducing specialists' billings by 1%, instituting more efficient medical practices, and limiting complete medical examinations to one per patient per year.     

Hypoglycémie spontanée et insuffisance rénale chronique.

Although glucose intolerance occurs as a consequence of chronic renal failure, improvement of a diabetic state by deterioration of renal function is a well known phenomenon. Recently occasional cases of spontaneous hypoglycemia in patients with chronic renal failure have been reported; two such cases and the results of metabolic studies are described in this paper. Pituitary, thyroid and adrenal function appeared to be normal. The results of an oral glucose tolerance test were normal; an appropriate insulin response was demonstrated in one patient, and a slightly elevated basal insulin value with a delayed insulin response to oral administration of glucose was demonstrated in the other. An insulin tolerance test did not support the hypothesis of increased insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concentration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concnetration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase in insulin values. The plasma alanine concentration was low and the proinsulin/insulin ratio was increased. The origin of this hypoglycemia is not clear but is probably multifactorial. However, low hepatic glycogen stores and inadequate gluconeogenesis due to substrate deficiency seem to be involved.     

Expérience clinique avec une épreuve de réserve hypophysaire

A test of pituitary reserve was used in the investigation of 14 children with retarded growth and 15 adults with endocrine disorders. Mepyrapone (Metopiron), 500 mg. every four hours, was administered orally for 48 hours. The pituitary response was determined by the amount of 17-hydroxycorticosteroid in a 24-hour urine sample (by a modification by Peterson of the Porter-Silber method). Pituitary reserve was decreased in four patients who were pituitary dwarfs, one who had retarded growth, two patients with Sheehan's syndrome, three with pituitary tumours, one who had panhypopituitarism without a tumour, and one case of limited adrenal reserve (confirmed by a negative response to ACTH stimulation). The pituitary reserve was normal in three patients with gonadal dysgenesis, three who exhibited retarded growth, one case of diabetes insipidus, one cretin, one patient treated by steroids, three with psychogenic amenorrhea, and five normal controls. It is concluded that this test of pituitary reserve is useful in the assessment of children with growth retardation and in establishing the diagnosis of pituitary insufficiency in adults.     

Invalidité temporaire et troubles émotifs.

The author deals with temporary incapacity, as currently expressed by "sick leave." Minor psychiatric problems are involved more and more as a cause of temporary incapacity, and sometimes the duration of such leaves of absence is much longer than might be warranted by the nature of the problem. Challenges by paying agents and employers are more and more frequent. On the basis of literature of a very general nature the author distinguishes between a difficult personal situation, a symptom, an illness, functional limitations and invalidity, the last one being at the crossroads between medical, personal and social reasons. The author emphasizes the particular difficulties experienced by physicians faced with that kind of problem and describes the rapid intervention needed to deal with the underlying reasons for an obvious request for a leave of absence.     

Fécondation extracorporelle d'oocytes humains et transfert d'embryons: quelques considérations techniques et éthiques.

In vitro fertilization of human oocytes is successful only when several techniques are perfectly mastered. Accurate prediction of imminent ovulation by rapid radioimmunoassay of luteinizing hormone in the plasma, suitable hormonal treatment or ultrasonography, or a combination of these, leads to the recovery of mature oocytes. Factors such as suction strength and bore size of the aspiration needle may interfere with the recovery of follicular oocytes during endoscopy. Capacitation of the spermatozoa, the most critical part of the whole process, requires the presence of serum or serum albumin. Fertilization and embryonic development in vitro occur in well defined experimental conditions. However, in spite of all the precautions currently taken, the rate of success, in terms of pregnancies continued to term, is still much lower than that observed under natural conditions. Much better results will likely be obtained in the near future. The literature suggests that in vitro fertilization and embryo transfer do not have any harmful physical effects on the offspring. Moreover, the laws of biology suggest that in vitro fertilization of human oocytes does not raise any ethical problem with regard to the potential offspring. However, it is extremely difficult to identify ethical problems related to the influence of the technique of in vitro fertilization on the evolution of man and human society.     

L'entraînement physique après un remplacement valvulaire mitral.

To determine whether women with mitral valve prostheses can improve their physical fitness without suffering cardiac dysfunction or hemolysis, 10 women (mean age 47 years) who had undergone mitral valve replacement (an average of 3.7 years earlier) were enrolled in an 8-week program of exercise on a bicycle ergometer. They exercised three times a week, starting at 60% and increasing to 80% of their maximal heart rate achieved during stress testing. Nine other women with similar clinical characteristics (mean age 48 years) constituted a control group. Exercise produced significant cardiovascular improvement, as evidenced by a mean decrease of 12 beats/min in the heart rate at steady-state work load (p less than or equal to 0.01), a mean increase of 121 kpm in the maximal tolerated work load (p less than or equal to 0.01), and a mean increase of 4 ml/kg X min-1 in the peak oxygen consumption (p less than or equal to 0.01). There was a small increase in the mean plasma hemoglobin level (15 to 29 mg/dl) and the mean reticulocyte count (1.8% to 2.4%) after the program (p less than or equal to 0.05). There were no significant changes in any of the variables studied in the control group. There were no changes in the clinical, electrocardiographic or echocardiographic findings in the experimental group. Although slightly increased hemolysis may occur, women with mitral valve replacement can improve their cardiovascular condition by exercising.     

Les sténoses pulmonaires périphériques congénitales: Présentation de 16 observations et revue de la littérature

Sixteen cases of peripheral pulmonary stenosis have been studied clinically and by cardiac catheterization. Diagnosis has been proved in all cases by manometric measurements and/or cineangiocardiography. All patients except two were below 2 years of age. Ten cases were of type I, i.e. the stenosis was localized to the pulmonary trunk or its main branches. Six patients were of type III, i.e. they had diffuse stenosis of the pulmonary arterial tree. The physical findings, which in many cases are typical and include the presence of a systolic murmur over both lung fields, should alert the physician to the diagnosis at the bedside. At cardiac catheterization the configuration of the pressure tracing in the main pulmonary artery is typical, showing an abrupt rise and fall of the systolic wave followed by a low situated dicrotic notch. There is no doubt that in the past many cases of peripheral pulmonary stenosis have been wrongly diagnosed as “essential pulmonary hypertension”.     

L''évaluation de l''incapacité dermatologique en santé au travail.

This paper presents a simple method for evaluating the extent of impairment in occupational dermatosis based on the portion (P) of the anatomic area involved (A) and the coefficient of physiologic disturbance (C). A percentage value is assigned to each anatomic area on the basis of its functional importance. The coefficient of physiologic disturbance is the average of four factors (stiffness, dehydration, thickening, and pruritus or pain). The formula (P X A). C gives the final percentage of impairment.     

Utilité de l'épreuve d'effort sur tapis roulant peu après un infarctus du myocarde.

A program of reconditioning through walking was prescribed for 130 patients following an exercise test on a treadmill 3 weeks after a myocardial infarction. At 8 and at 12 weeks the patients again underwent an exercise test. The protocol is safe and permits the detection of angina, arrhythmias and dyspnea during the exercise, thus avoiding delays in treatment. The heart rate and the systolic blood pressure were measured at the end of each stage of the test and after 3 minutes of recuperation. About 75% of the patients attained the target energy output of the two submaximal tests (4 and 7 mets at 3 and 8 weeks respectively); an output of 7 mets permits a patient to resume his or her usual daily activities. The results of the tests at 3 and 12 weeks (the latter a maximal test) showed that the probability of an aerobic capacity of 7 mets or greater at 12 weeks is 86% if the 3-week test is completed. Clinical observations alone did not have the same prognostic value 3 weeks after the infarction.     

Comparaison de la réponse métabolique du petit prématuré alimenté parentéralement, puis au lait maternel de prématurité.

The nitrogen retention and plasma amino acid concentration were determined in eight preterm infants (mean birth weight 970 +/- 130 g; mean gestational age 28 +/- 1 weeks) receiving successively total parenteral nutrition and their own mother's milk. The nitrogen retention during both regimens was comparable to the fetal accretion rate. Plasma amino acid concentrations were lower during the enteral phase of the study than during parenteral nutrition. The metabolic response of small preterm infants is related to the quality of amino acids as well as to the route of intake.     

Abcès rénal et périrénal chez l''enfant.

One child with a pure perinephric abscess and three with renal abscesses, one of which had perinephric extension, are described. All presented with a long course of subacute infection leading to localizing symptoms or signs in the flank. The diagnosis was confirmed by radiologic examination. All the abscesses were surgically drained at various intervals after diagnosis, while the patients were receiving antibiotic therapy. Salvage of renal function was possible in all cases. A rational approach to the diagnosis and management of such abscesses is emphasized.     

Evaluation d''un nouveau cholécystocinétique

Boyden's test meal (egg yolk beaten with cream), used during cholecystography, remains in the stomach for a long time and could interfere with the radiological findings on barium meal examination performed after cholecystography.

A new preparation based on corn oil emulsion (G.P. Prep) was evaluated in 33 patients with and without symptoms of gallbladder disease. The criteria used in the evaluation of results were three: reduction in the gallbladder dimensions, variations in the cholecystovertebral angle, and visualization of the extrahepatic bile ducts.

The gallbladder dimensions were determined before and after contraction with the aid of a metallic perforated ruler (Colcher's) placed at the estimated level of the gallbladder at the time of exposure.

     

Etudiants inscrits aux facultés de médecine du Canada, 1976-77.

The 1976-77 statistical study of medical school enrollment by the Association of Canadian Medical Colleges shows that total enrollment in Canadian medical schools had increased 103.8% since 1960-61, although the rate of increase had decreased to almost zero by 1976-77. Women accounted for 30.3% of the total enrollment in 1976-77 (for all years of the course), which represents an increase of more than 550% in the 17-year period; for the 16 schools the proportion ranged between 23.9% and 43.8%. Enrollment of foreign students had decreased from 340 in 1966-67 to 90 (1.2%) in 1976-77; 71 of the 90 students were American. For the entire nation the mean number of medical students per 10 000 population was 3.1, but in British Columbia the figure was only 1.5. Of the Canadian and landed immigrant students 94.5% were attending medical school in their home province.