Soutien au réseau des services de garde montréalais dans la prévention et la gestion de la COVID-19 : un service à 3 pôles

SettingFrom April 2020, in sight of child care reopening, the Direction régionale de santé publique de Montréal (DRSPM) conducted a situational analysis with its child care (CC) partners in order to learn about the challenges they envisioned in their role in preventing and managing COVID-19. The CC partners requested access to preferred public health support.InterventionThe DRSPM established a service consisting of three components: (1) telephone support available 6 to 7 days/week for CC managers facing a COVID-19 situation; (2) a regional committee combining four Montreal representatives of CC associations and one from the Ministère de la Famille; (3) prevention brigades formed by front-line health workers from the Centres intégrés universitaires de santé et de services sociaux (CIUSSS).OutcomesThis health promotion intervention (1) enabled CC services to handle the pandemic with better capability and confidence through facilitating access to accurate and positive information; (2) supported the commitment and collaboration of CC services by acting as a mediator between them and decision-makers; and (3) responded to the psychosocial needs of community members.ImplicationsThis service helped to adjust public policy and promote community resilience by raising awareness of the importance of balancing COVID-19 prevention and the collateral impacts of the pandemic.     

Convivialité des municipalités canadiennes à l’égard des aînés : portrait et facteurs associés

ObjectivesThis study aimed to (1) document, globally and by domain, Canadian municipalities’ level of age-friendliness, and (2) identify municipality characteristics most associated with age-friendliness.MethodsA cross-sectional survey was sent to all Canadian municipalities (N=3406) with an online survey of 56 items from 9 domains providing age-friendliness scores. These scores were then crossed with the following municipality characteristics: percentage of adults aged 65 and older, population density, material deprivation, social deprivation, degree of metropolitan influence, implementation step of an age-friendly municipality initiative and geographic area.ResultsNine hundred twenty-one municipalities completed the survey. Overall, municipalities’ age-friendliness total score is good (58.4%). Four domains have high scores: Security (80.0%), Respect and social inclusion (65.0%), Outdoor spaces and building (62.2%), and Social participation (62.2%). Higher age-friendliness is associated with metropolitan municipalities, regions other than Prairies and Atlantic, higher residential density, greater proportion of older adults, greater social deprivation, lower material deprivation, and the last step of an age-friendly initiative.ConclusionThis portrait of Canadian municipalities’ age-friendliness can be used to strengthen actions promoting active aging.     

Rôle du Pédodontiste dans le diagnosticde l’infection par le virus d’immunodéficience humaine (VIH) chez l’enfant

Human immunodeficiency virus (HIV) infection is a disease described as having significant and frequent oral manifestations with an early onset character. Which could be a very interesting diagnostic clue. The odonto-stomatologist is therefore in the front line to detect the immunodeficiency caused by this pathology, even though the patient may be unaware of his condition or the aggravation of it, as was the case with our patient.     

Amélioration des habiletés communicationnelles en médecine à l'aide du jeu de rôle : étude auprès de 28 étudiants de deuxième cycle d'études médicales

Background:

Medical teaching is usually centred on an objective-based approach and influenced by a flexnerian approach inducing an emphasis on abilities and skills more than the know-how. The know-how is usually under taught and assessed.

Aim:

To assess the competencies in announcing bad news of students in medicine in addition to their satisfaction about the methods used which were serious games.

Methods:

Students in the third-pregraduate year of medicine who performed their externship in a Department of Pathology of a university Hopsital were included during the year 2018-2019. Seven groups including 4 externs performing a 3-week-period were included. The training started with a pre-test, which consisted in an Objective-Structured-Clinical situation with a simulated patient and a evaluator with a checklist. The students were asked to perform a serious game, then they assisted to a lecture-based learning about the rules of announce of bad news. The serious game was screened then watched by all the students. After a debriefing session, the students were asked to fulfill a post test and a questionnaire-test

Results:

Twenty-eight students were included. The mean score accounted for 6,76 +/- 2,78 over 20 for the pre-test and 13,17 +/- 1,99 over 20 for the post-test. A significant difference was observed between the pre and post test (p<0.0001). All the students expressed their satisfaction. 27 students wished to repeat the experience. All the students put emphasis on the importance of the peer and auto-evaluation phase using videos. 14 students suggested to integrate this teaching method to the curriculum of the Faculty before their internship.

Conclusion:

Inspite of some limits, this study highlighted the improvement of the students’ relational competences in addition to their satisfaction related to the use of role play in the acquisition of relational competences related to particular situation such as the announce of bad news.     

L’influence de l’identité professionnelle sur la détresse psychologique dans les métiers spécialisés des secteurs de la construction et manufacturier au Québec

ObjectiveThis study explores how the structure of professional identity and its undermining are associated with symptoms of psychological distress in the skilled trades, focusing on the construction and manufacturing sectors in Quebec. One limitation of the current research is its neglect of professional identity, even though this concept is important to explaining psychological distress symptoms.MethodsThe sample includes 282 workers from four manufacturing and seven construction sites in Quebec. Data were collected for the years 2016 and 2017. Multilevel regression analysis was carried out with the statistical software Stata 13. Five variables were controlled in this study: sex, gender, age, type of team and occupational sector.ResultsThe results of multilevel regression models, addressing variations across 54 participating teams, suggested that a low skilled trades self-esteem, a higher professional identification, a low integration of differences, heavy demands at work, and job insecurity are associated with psychological distress, as are the factors of being a woman or being a younger worker.ConclusionStudy results corroborate the importance of taking preventive actions on identity dimensions to reduce psychological distress symptoms. In particular, at the level of skilled trades culture, it would be beneficial to incorporate values based on a better inclusion of all workers and an open mind with regard to differences.     

Débats autour des races canines et de la santé publique à Montréal et au Québec (2016–2019)

ObjectivesWe examine the public policies that have been formulated to reduce the incidence of dog bites. We do so to encourage the adoption of policies aligned with One Health promotion.MethodsThis case-study research involved an ethnographic approach. Our qualitative analysis derived from participant observation, policy documents, media coverage, and interviews with stakeholders in Montreal (Quebec).ResultsFollowing on from a human fatality due to dog bite injuries, the City of Montreal decided to ban certain types of dogs based on their ‘breed.’ In the ensuing discussions, the ‘Calgary model’ emerged as an alternative to breed-specific legislation. These discussions led to a change in policy direction for Montreal, and for Quebec as a whole. Furthermore, we discerned marked improvements with respect to intersectoral coordination in the wake of this controversy.Conclusion‘Policy mobilities’ offer a useful conceptual apparatus for understanding how public policies for dog bite prevention are polarized around controversial proposals, to the detriment of discussions that focus on policy implementation.     

Évaluation de la voie radiale distale dans les interventions coronaires percutanées. Essai contrôlé, randomisé de non infériorité

Research Problem: The conventional radial approach is the recommended vascular access for percutaneous coronary interventions. It is effective and feasible but associated with a risk of occlusion of the radial artery.The distal radial approach is proposed as a new approach to reduce complications and preserve the radial artery. However, few clinical trials in real life were conducted in North African patients.This trial aims to evaluate the efficacy and safety of the distal radial approach versus the conventional radial approach. Investigative process: This trial is a non-inferiority, randomized controlled trial with two parallel arms: distal radial approach and conventional radial approach. Two hundred fifty patients scheduled for percutaneous coronary intervention will be included.The two main endpoints are the puncture success rate with a non-inferiority margin of 10% and the occlusion rate of the punctured radial artery attributed to the end of hemostasis and to 30 days. Secondary endpoints: catheterization success, crossover rate, procedure time, radial artery spasm, bleeding complications, QuickDASH pain score, Operator satisfaction.A single blind analysis will be led according to the per-protocol and intention-to-treat methods. Research Plan: Ethical considerations will be undertaken and respected. This trial will run for four months from February 2022. The results will provide parameters related to the efficacy and safety of the distal radial approach, improving clinical practice.Trial registration : {"type":"clinical-trial","attrs":{"text":"NCT05311111","term_id":"NCT05311111"}}NCT05311111     

Rôle des acides gras alimentaires dans la physiopathologie des hépatopathies alcooliques

Many experimental studies in animals suggest that dietary fat plays an important role in the pathogenesis of alcoholic liver disease. Polyunsaturated fatty acids potentiate alcohol-induced liver injury at least in part by inducing cytochrome P450 2E1, cyclooxygenase-2 and lipid peroxydation. On the other hand, dietary saturated fatty acids reduce steatosis, necrosis, inflammation and fibrosis in conjunction with decreased expression of TNF-α and cyclooxygenase-2, and reduce lipid peroxidation. Dilinoleoyl-phosphatidylcholine prevents alcohol-induced fibrosis and cirrhosis in baboons and stimulates collagenase activity in cultured lipocytes. There are few human studies which confirm these experimental results. Epidemiological studies suggest a relationship between daily fat intake, particularly dietary polyunsaturated fatty acids, and the risk of liver cirrhosis in alcoholics. The studies having demonstrated that being overweight is a risk factor of alcoholic cirrhosis and that the apolipoprotein E polymorphism influences the severity of liver injury in alcoholic cirrhotics strongly favor the role of fatty acids in the pathogenesis of human alcoholic liver disease.     

Fermeture percutanée des communications interventriculaires congénitales par la prothèse Amplatzer Duct OccluderII: données préliminaire d’une étude Tunisienne monocentrique

Introduction . Percutaneous closure of congenital ventricular septal defects (VSDs) represents a promising alternative to surgery with lower rate of complications and shorter hospital stay. Its main limitation is the choice of the appropriate device for each type of defect. Aim. To report the experience of the service of cardiology (Sahloul hospital, Sousse, Tunisia) in percutaneous closure of congenital VSDs with Amplatzer Duct Occluder II (ADOII). Methods. This was a retrospective, monocentric study, conducted from January 2013 to December 2017. The study included patients treated by percutaneous closure of congenital VSDs with the ADOII device. Results. Twelve patients (6 boys; 6 girls) were included. The mean±SD of patients’ age and weight were 65±41 months and 23±10 kg, respectively. VSDs were peri-membranous (n=9) and muscular (n=3), and defects were restrictive (n=11) and non-restrictive (n=1). The mean (minimum-maximum) size of VSDs was 4.72 (3-6) mm. Eleven ADOII prostheses were successfully implanted. One failure procedure was noted with migration of the device into the pulmonary artery. A second child with perimembranous defect developed transient atrioventricular block. No deaths occurred. Conclusion. The present early experience shows that percutaneous closure with ADOII device of perimembranous and trabecular VSDs is safe and effective.     

L’expérimentation médicale sur les prisonniers (partie 4): le dilemme du ‘Pour’ et du ‘Contre’.

Given the long history of abuse of prisoners in medical experimentation, it is understandable that additional safeguards have been established to protect this social category. However, the debate between the detractors and the supporters of the medical experimentation in the prison environment is still going on. The present history note, the fourth in a series on medical experimentation on prisoners, intended to relate the main arguments of both sides: ie; the detractors and supporters of medical experimentation on prisoners.