The American Academy of Pediatrics recommends that children and adolescents with a family history of premature cardiovascular disease (CVD) and/or parental total cholesterol (TC) ≥6.2 mmol/L be screened for hypercholesterolemia. Questionnaires (from children and parents), clinical and blood sample data were collected in a provincially representative sample of 9-, 13-, and 16-year-olds (n = 2217) in Quebec to evaluate the usefulness of parental history (PH) of CVD and/or parental hypercholesterolemia to screen youth for raised low density lipoprotein cholesterol (LDL-C). Mean bias assessed by an external laboratory gold standard ranged from 1.0% to 2.1%, -0.4% to 5.1%, and -1.4% to 0.1% according to TC, triglyceride, and high density lipoprotein cholesterol tertiles. LDL-C was calculated using the Friedewald equation. Positive PH was defined as one/both biological parents diagnosed with a high cholesterol level, and/or taking cholesterol-lowering medication, and/or ever having had a heart attack, angina, stroke, cerebral vascular disease, peripheral vascular disease, and/or taking medication 'for the heart'. Performance statistics were calculated to determine the usefulness of PH in predicting borderline/high LDL-C (LDL-C ≥2.8 mmol/L) and high LDL-C (LDL-C ≥3.4 mmo1/L). 18.3% and 4.8% of subjects had borderline/high LDL-C and high LDL-C; positive predictive value (PPV) was 23.7% and 7.7%, respectively. Therefore PPVs were only marginally higher than the corresponding population prevalences and likelihood ratios were respectively 1.38 and 1.63: close to 1.00. In conclusion, PH offers little improvement over random screening.

There is growing consensus that health-related quality of life (HRQL) outcomes are important for the allocation of scarce medical resources and for facilitating clinical decision-making. However, because most instruments of HRQL are self-report measures inappropriate conclusions may be drawn from studies that assess changes in HRQL over time or between groups. If the individuals evaluating themselves experience a response shift (defined as changes in their internalized standard of evaluating their level of functioning, in their values, or in their conceptualization of the target construct), then measures taken over time or between groups are no longer comparable. To date, response shift has not been formally assessed in the stroke population, and only to a limited extent in the HRQL field. The global objective of this thesis was to examine how the experience of recovering from a stroke modifies people's perception of their health-related quality of life (HRQL), and the extent to which response shift occurs during the first six months post-stroke. / The first study used structural equation modeling for data from a prospective cohort to evaluate response shift by examining changes in a theoretical model of HRQL based on the measurement model of the Medical Outcome Study 36-Item Short Form Health Survey (SF-36). This study found no evidence of reconceptualization and changes in internal standards over time, but suggested that if response shift does occur with stroke it is likely to be mediated by the event itself and not the recovery process. Two subsequent studies evaluated response shift using the then test (a retrospective assessment of HRQL) and an individualized measure of HRQL. The data collection for these studies was incorporated into a randomized controlled trial. The results from the then test provided support for the occurrence of response shift among persons with stroke with no such effect in a control group. Changes on the individualized measure of HRQL showed that individuals with stroke experienced a reconceptualization and a change in values between 6 and 24-weeks post-stroke. A final comparison of the three techniques evaluated in this thesis provided the basis for proposed guidelines for future assessments of change in HRQL based on the comparative feasibility and validity of the methods. To date, there is evidence to show that individuals undergoing changes in physical health experience changes in internal standards of health and values. If response shift is not measured and accounted for, inappropriate conclusions regarding the impact of a disease such as stroke or the efficacy of a treatment intervention may go unnoticed.

Introduction. Research into medications for Alzheimer's disease (AD) is primarily conducted in drug trials, were efficacy is assessed by changes in score on established outcome measurement scales. However, physicians' and caregivers' perspectives on efficacy, along with their perspectives on other factors that may influence prescribing (e.g., adverse effects), remain largely unexplored. The objective of this thesis is to examine these perspectives to gain a broader understanding of the factors that can influence the use of medications in AD. / Methods. Two studies were conducted. The first involved all of the Province of Quebec's geriatricians, neurologists, and psychogeriatricians, as well as a random sample of Quebec's 8,115 general practitioners. The second study involved 375 caregivers who attended AD-related support groups. Questionnaires were used to collect data on the proportion of patients prescribed cholinesterase inhibitors (ChEIs), efficacy requirements for prescribing new medications, acceptance of adverse effects, physician-caregivers discussions about medications, and caregiver pressure on physicians to prescribe medications. / Results. Response rates were 35.4% (physicians) and 64.4% (caregivers). More stringent efficacy requirements on the part of physicians were negatively associated with prescribing ChEIs, although effect sizes were small and associations were not always statistically significant. More stringent efficacy requirements on the part of caregivers were negatively associated with prescribing in some instances (e.g., required improvements to patients' ability to eat, OR=0.74, 95% CI=0.61 to 0.89), but not in others (e.g., required improvements to patients' speech, OR=1.02, 95% CI=0.81 to 1.19). Caregivers' willingness to accept adverse effects was positively associated with prescribing ChEIs (odds ratios for 11 adverse effects ranged from 1.83 to 8.30); however, prescribing was not associated with physicians being the first to discuss the use of medications to treat AD (OR=2.37; 95% CI=0.90 to 6.24), nor was it associated with caregiver pressure on physicians to prescribe (OR=1.33; 95% CI=0.49 to 3.58). / Conclusion. This research is the first to show how physician and caregiver perspectives on issues such as efficacy and safety can affect the use of medications in AD.

A biological assay based on human cancer cells was developed as an index of metabolic state. This assay is used here to describe the metabolic actions of a variety of agents: oxygen, melatonin, vitamin C, the drugs oligomycin and imatinib, as well as extra-low frequency (ELF) magnetic fields (MFs). Based on chromosome counts in cancer cells, it led us to uncover a basic mechanism of interaction between ELF MFs and biological materials. The action of MFs is through an alteration of the structure of water originally described by Russian physicists at Lomonosov University in Moscow, in the early 1980s. As is the case in many projects, our work started as a fundamental investigation, specifically of the effects of oxygen on cancer cells in culture.Chromosome counts above 46 are observed in the majority of human tumours. But while real tumours grow in oxygen and nutrient restricted environments, cultured cancer cells are provided with 21% oxygen and generous nutrition, stimulating their metabolism. We studied the connection between metabolic activity of cancer cells and their chromosome counts, observing that five metabolic restrictors induced catabolism and chromosome losses in five hyperploid cancer cell lines. These karyotype contractions allow cancer cells to support fewer chromosomes, increase their proliferation rate and acquire the phenotype of a stable, growing tissue. Hyperploid cancer cells expand or contract their karyotypes through rapid mechanisms of endo-reduplication or chromosome loss. These fast meta-genetic mechanisms explain the surprising adaptability of tumours to changing micro-environments and therapeutic interventions. Furthermore, karyotype contraction may provide a basis for the previously observed carcinogenic action of some anti-oxidants, positioning metabolic restriction as a meta-genetic mechanism of tumour promotion.Biological effects of ELF MFs have lacked a credible mechanism of interaction between fields and living material. The effect of ELF MFs was evaluated in our human cancer cell cultures. Ultimately, five cancer cell lines were exposed to ELF MFs within the range of 0.025 to 5 µT, and were examined for karyotype changes after 6 days. Similar to the chemical metabolic restrictors, all cancer cells lines lose chromosomes from MF exposure. MFs from 25 nT to 5 µT reduce the chromosome counts, with a mostly flat dose-response. Constant MF exposures for three weeks allow a rising return to the baseline, unperturbed karyotypes. From this point, small MF increases or decreases are again capable of inducing KCs. Our data suggests that the KCs are caused by MF interference with mitochondria's ATP synthase (ATPS), compensated by the action of AMP-activated protein kinase (AMPK). The effects of MFs are similar to those of the ATPS inhibitor oligomycin. They are amplified by metformin, an AMPK stimulator, and attenuated by resistin, an AMPK inhibitor. Over environmental MFs, KCs of various cancer cell lines show exceptionally wide and flat dose-responses, except for those of erythro-leukemia cells, which display a progressive rise from 0.025 to 0.4 µT. These observations lead us to uncover a subtle mechanism of interaction between MFs and human metabolism. MFs cause an alteration in the structure of water that impairs the flux of protons in ATPS hydrophilic channels, with many downstream biological effects. Although the connection between MFs and ATPS inhibition through increased proton impedance is fairly clear, the consequences of typical human MF exposures on AMPK and metabolism should be more complex to unravel. This mechanism may be environmentally important, in view of the central role played in human physiology by ATPS and AMPK, particularly in their links to diabetes, cancer and longevity. Our work provides a defensible mechanism to explain the action of MFs on biological materials. / Un test d'état métabolique utilisant des cellules humaines cancéreuses est utilisé pour décrire les effets d'une variété d'agents: oxygène, mélatonine, vitamine C, les drogues oligomycine et imatinib, ainsi que les champs magnétiques (CM) de basse fréquence (BF).Basé sur le comptage de chromosomes (CC) de cellules cancéreuses, il nous amené à découvrir un mécanisme d'interaction entre CM BF et le matériel biologique qui passe par une altération de la structure de l'eau décrite par des physiciens russes au début des années 1980. Nos recherches ont débuté par une investigation des effets de l'oxygène sur les cellules en culture.Des CC supérieurs à 46 sont observés dans la majorité des tumeurs humaines. Alors que les tumeurs réelles se développent dans un milieu pauvre en oxygène et nutriments, les cellules cancéreuses sont entourées par un taux d'oxygène de 21% et une nutrition généreuse, ce qui stimule leur métabolisme. Nous rapportons des réductions de CC suite à une activité métabolique réduite chez cinq types de cellules cancéreuses hyperploïdes. Ces contractions permettent aux cellules de supporter moins de chromosomes, d'augmenter leur prolifération et d'acquérir le phénotype d'un tissu stable en progression. Les cellules hyperploïdes augmentent ou réduisent leur karyotype par des mécanismes rapides d'endo-reduplication ou de pertes chromosomiques. Ces mécanismes méta-génétiques rapides expliquent l'adaptation surprenante des tumeurs aux environnements variables et aux interventions thérapeutiques. La contraction des karyotypes pourrait fournir une base à l'action carcinogénique préalablement observée de certains antioxydants, présentant la restriction métabolique comme un mécanisme méta-génétique de promotion cancéreuse.Les effets biologiques des CM BF n'avaient pas de mécanisme crédible d'interaction entre champ et matériel vivant. Cinq lignées de cellules cancéreuses exposées aux CM BF dans la plage de 0.025 à 5 µT ont montré des changements de karyotype après 6 jours, tout comme les restricteurs métaboliques, avec une dose-réponse essentiellement plate. Une continuation de l'exposition sur trois semaines permet un retour progressif au karyotype original de base. De ce point, de petites augmentations ou décroissances de CM sont à nouveau capables d'induire des contractions de karyotypes. Nos croyons que les contractions sont causées par une interférence des CM avec l'ATP synthase (ATPS) des mitochondries, compensée par l'action de la protéine kinase activée par l'AMP (AMPK). Les effets des CM sont similaires à ceux de l'olygomycine, un inhibiteur de l'ATPS. Ils sont amplifiés par la metformine, un stimulateur de l'AMPK, et atténués par la résistine, un inhibiteur de l'AMPK. Sur la plage des CM environnementaux, les contractions de karyotypes de diverses lignées cancéreuses montrent des doses-réponses plates, sauf pour celles des cellules erythro-leucémiques, qui montrent une augmentation progressive de 0.025 à 0.4 µT.Ces observations nous ont mené à découvrir un mécanisme subtil d'interaction entre CM et le métabolisme humain. Les CM causent une altération de la structure de l'eau qui réduit le flux de protons dans les canaux hydrophiles de l'ATPS. Bien que la connexion entre CM et l'inhibition de l'ATPS par l'augmentation de l'impédance aux protons soit raisonnablement claire, les conséquences des expositions magnétiques humaines typiques sur l'AMPK et le métabolisme sont plus complexes à dégager. Ce mécanisme d'interaction pourrait être important pour l'environnement, en vue du rôle central joué dans la physiologie humaine par l'ATPS et l'AMPK, particulièrement dans leurs liens avec le diabète, le cancer et la longévité. Nos travaux fournissent un mécanisme crédible pour expliquer l'action des CM sur le matériel biologique.

This study evaluated the Aga Khan University Urban Primary Health Care Program's effectiveness, six years after implementation in lower-middle class Karachi. The study supplemented surveillance data which showed two-fold improvements in health indicators. / One Program and one Comparison area were successfully matched post hoc on ethnicity and socioeconomic status. Study participants included women in both areas who had been pregnant in the last 5 years and resident for over 1 year. / The Program achieved 88% community coverage: 85% with outreach visits and 65% with clinic-based services. Factors which potentially confounded the surveillance estimates included secular improvements in water, sanitation, and socioeconomic status, along with the utilization of other health-care providers and health education resources. The Program's unique services were community health worker outreach (home visits and educational meetings) and growth monitoring. / The Program was found to be effective in improving most knowledge scores, some healthy behaviours, and no impacts. Positive results included: increased immunization and family planning knowledge scores by 5-10%, higher maternal-child immunization rates by 10-20%, and greater colostrum feeding practice by 10%. Negative results included: no additional diarrhea knowledge; no change in healthy behaviours towards diarrhea treatment, breast feeding, family planning or maternity care; and no health impact on fertility or childhood nutritional status. (Abstract shortened by UMI.)

North American adolescents are not meeting physical activity guidelines for health, thus, understanding how to increase this population's physical activity is crucial. Building on organizations' capacities to develop and sustain popular health promoting programs is a viable approach, but one that has rarely been used in physical activity intervention research.To build on the capacity of a YMCA to promote physical activity to the teenagers they serve, the YMCA and I formed a participatory research partnership, developing and implementing means to evaluate and inform the YMCA teen program. Our partnership and our work served as the object of my case study with which I sought to understand the processes contributing to sustainable organizational capacity changes. The specific case understudy pertains to two and a half years of qualitative data. I collected all email between me and YMCA partners, conducted semi-structured interviews with partners at specific time points over and conversational interviews throughout the case study period. Internal YMCA documents as well as those produced through our partnership, and field notes also informed the case. I used inductive and deductive thematic analysis to analyse the data. Findings illustrate that workforce and organizational development capacities at the YMCA were increased through our partnership, resource allocation, and leadership. Specifically, through a shared leadership process, whereby, I would respond to YMCA partners' perceived needs, yet also guide them beyond those needs, partners and I combined our complementary objectives, knowledge, and skills to generate an integrated program vision, rationale, and evaluation results. This integrated program perspective provided YMCA partners with validation, reminders, and awareness regarding their work processes and the teen program. In turn, these intermediary outcomes contributed to practice changes YMCA partners have maintained and built upon, regarding programming, health promotion, and evaluation. Notably, contextual aspects of the partnership, namely, partners' reciprocity and patience contributed to its success.This case study illustrates how a university researcher and a YMCA can partner to develop and implement a program evaluation, results of which can help YMCA partners make research-informed decisions, which may in turn positively impact physical activity and other organizational programs. Moreover, the findings indicate the participatory process contributed to YMCA partners' use of program evaluation results and to their developing program evaluation competence. Lessons learned from this study may be applicable to other partnerships striving to increase adolescent PA participation as well as general organizational health promotion capacities. / Comme la majorité des adolescents nord-américains ne suivent pas les directives en matière d'activité physique pour une vie active saine, il est crucial que nous trouvions un moyen d'accroître leur activité physique. Aider les organisations à améliorer leurs capacités à mettre en place et à maintenir des programmes de promotion de la santé est une approche viable, mais elle a rarement été utilisée dans le domaine de la recherche interventionnelle sur l'activité physique.Afin d'améliorer la capacité d'un YMCA à promouvoir l'activité physique auprès des adolescents, le YMCA et moi avons développé un partenariat de recherche participative. En partenariat, nous avons développé et mis en place des mesures d'évaluation du programme adolescent du YMCA. Notre partenariat et nos processus fut l'objet de mon étude de cas à travers lequel j'ai voulu comprendre les processus qui contribuent à des changements organisationnels. Le cas consiste en deux ans et demi de données qualitatives. J'ai recueilli les courriels entre les partenaires du YMCA et moi-même et j'ai fait des entretiens semi-structurés et non-structurés avec les partenaires. Des notes de terrain ainsi que des documents internes du YMCA et de notre partenariat ont également servis de données. J'ai effectué une analyse thématique de façon inductive et déductive.Les résultats illustrent que des capacités de la main d'œuvre du YMCA et de l'organisation elle-même se sont améliorées grâce à notre partenariat, l'allocation des ressources, et le pouvoir d'influence. Spécifiquement, un processus de pouvoir d'influence partagé (où d'une part je répondais aux besoins de mes partenaires du YMCA et d'autre part je guidais mes partenaires plus loin que leurs besoins perçus), le YMCA et moi avions réussi à mettre ensemble nos objectifs, connaissances, et expertises complémentaires pour générer une vision, raison d'être, et résultats d'évaluation du programme intégrées. Cette perspective intégrée à procurer aux partenaires de la valorisation, des rappels, et une prise de conscience que par rapport à leur travail et le programme adolescent lui-même. Ces résultats intermédiaires ont contribué aux changements de pratiques que les partenaires du YMCA ont maintenues et développées davantage, en ce qui a trait à la programmation, la promotion de la santé, et l'évaluation de programme. Enfin, des aspects contextuels du partenariat qui ont contribué à sa réussite.Cette étude de cas illustre comment un chercheur universitaire et un YMCA peuvent collaborer pour développer et mettre en place une évaluation de programme, dont les résultats peuvent aider le YMCA à prendre des décisions éclairées, ceux qui peuvent à leur tour, avoir un impact positif sur des programmes organisationnels d'activité physique ainsi que d'autres programmes organisationnels. De surcroît, les résultats indiquent que le processus participatif a contribué à l'usage que font les partenaires YMCA des résultats d'évaluation et aussi au développement de leurs compétences en évaluation de programme. Les leçons tirées de cette étude de cas pourraient s'appliquer à d'autres partenariats voulant accroître le niveau d'activité physique des adolescents, ainsi que des capacités générales de promotion de la santé.

In 2011, an estimated 3 million children died in their first four weeks of life. The majority of these neonatal deaths are avoidable if effective low-cost interventions, such as clean delivery practices, exclusive breastfeeding, and newborn resuscitation are available. However, these interventions are clearly not reaching many of the women and newborns who need them most. A major challenge is how best to expand access to essential obstetric and newborn interventions, particularly among disadvantaged populations and in areas with poor access to health services. This requires an understanding of the social and geographical patterning of neonatal mortality rates (NMR) as well as evidence about which policies can reduce inequalities in access to essential maternal and newborn care. The three objectives of my thesis addressed these issues directly.First, we described socioeconomic inequalities in NMR across low- and middle-income countries (LMIC) and assessed changes in inequalities over the past decade. Using Demographic and Health Survey (DHS) data from 24 countries, we estimated absolute and relative socioeconomic inequalities using the Slope Index of Inequality and the Relative Index of Inequality, respectively. In most countries, absolute and relative inequality in NMR declined over the approximate 10-year period. There was, however, considerable heterogeneity both in the magnitude of NMR inequalities between countries and in how inequalities changed over time. Furthermore, there remained a substantial survival advantage for newborns born into wealthier and more educated households, which should be considered in global efforts to further reduce NMR. Next, we evaluated the impact of a policy that removes user fees for facility-based deliveries on health service utilization, neonatal mortality, and socioeconomic inequalities. Using DHS data from ten countries in sub-Saharan Africa, we employed a difference-in-differences regression approach to control for underlying secular trends in the outcomes that are common across countries and for time invariant differences between countries. Reducing fees for delivery services was associated with an increase in facility-based deliveries and a possible reduction in NMR. Furthermore, increases in facility-based deliveries occurred across all socioeconomic groups, with no indication that richer or more educated women benefited more from the policy change.Finally, we assessed the effect of distance to emergency obstetric and newborn care (EmONC) services on early neonatal mortality and examined whether proximity to services contributed to socioeconomic inequalities in early neonatal mortality. Using geographical coordinates collected in both surveys, we linked data from the 2011 Ethiopian DHS with comprehensive facility census data from the 2008 Ethiopian EmONC Needs Assessment. Closer proximity to delivery services and higher level of care were associated with lower early NMR. Distance to EmONC services was a main determinant of total inequality in NMR, although it did not make a significant contribution to socioeconomic inequality. In this thesis, we have identified several barriers that contribute to large and persistent inequalities in neonatal mortality and in the utilization of essential obstetric and newborn care in LMIC. The findings highlight the importance of a multipronged policy approach that addresses geographic accessibility and quality of obstetric and newborn services, affordability barriers, and socioeconomic inequalities to significantly reduce neonatal mortality. Further research examining the relative importance of various access barriers in different settings will help policy makers and planners adopt locally relevant approaches to improve newborn survival. / En 2011, environ 3 millions d'enfants sont morts au cours des quatre premières semaines de leurs vies. La majorité de ces morts néonatales peuvent être évitées si des interventions abordables, telles que des accouchements sanitaires, l'allaitement exclusif et la réanimation des nourrissons sont disponibles. Cependant, ces interventions ne sont pas accessibles aux femmes et aux nouveaux nés qui en ont le plus besoin. Un des défis majeurs à relever est de formuler la meilleure stratégie pour étendre l'accès des interventions obstétriques et des interventions aux nouveaux nés aux populations désavantagées et dans les zones qui manquent des services de santé. Cela nécessite une connaissance des dynamiques sociales et géographiques des taux de mortalité néonatale (TMN) et des données concernant les politiques pouvant réduire les inégalités d'accès aux soins essentiels aux mères et aux nouveaux nés. Les trois objectifs de ma thèse explorent directement ces sujets. D'abord, nous décrivons les inégalités socioéconomiques du TMN à travers les pays à bas et moyens revenus (PBMR). Basée sur les données du Demographic and Health Surveys (DHS) sur 24 pays, nous calculons les inégalités absolues et relatives. Dans la plupart des pays, les inégalités absolues et relatives du TMN ont diminué sur une période approximative de 10 ans. Il y a toutefois une hétérogénéité considérable quant à la magnitude des inégalités du TMN entre les pays et quant à leur fluctuation dans le temps. De plus, un avantage de survie substantiel pour les nouveaux nés des ménages riches et éduqués subsiste encore. Ensuite, nous évaluons l'impact des politiques supprimant les coûts des accouchements qui ont lieu dans des établissements de santé sur l'utilisation des services de santé, la mortalité néonatale et sur les inégalités socioéconomiques. Avec les données du DHS de dix pays sub-sahariens, nous utilisons l'approche de différence-en-différences dans des modèles de régression pour réguler les tendances séculaires des indicateurs communs à tous les pays ainsi que pour contrôler toute différence fixe dans le temps qui pourrait exister entre les pays. La réduction des coûts liés aux services d'accouchement est associée à une augmentation du nombre d'accouchements dans les établissements de santé et à une réduction potentielle du TMN. De plus, l'augmentation des accouchements en établissements de santé a eu lieu dans tous les groupes socioéconomiques.Enfin, nous évaluons l'effet de la distance entre le domicile et les centres des services obstétricaux et néonataux d'urgence (SONU) sur la mortalité néonatale. Dans ce projet, nous lions les données géographiques du DHS 2011 sur l'Éthiopie avec celles du recensement exhaustif des établissements de santé de 2008 sur l'Éthiopie. La proximité des services d'accouchement et un niveau élevé de soins sont associés à un plus faible taux de mortalité néonatale. La distance des services SONU est un déterminant principal des inégalités totales dans le taux de mortalité néonatale, malgré le fait qu'elle ne contribue pas significativement aux inégalités socioéconomiques. Dans cette thèse, nous identifions plusieurs obstacles qui contribuent aux inégalités larges et persistantes dans le taux de mortalité néonatale et de l'utilisation des soins obstétrique et néonataux essentiels dans les PBMR. Les résultats démontrent l'importance d'une approche politique multidimensionnelle qui prend en considération l'accessibilité géographique, la qualité des services obstétriques et néonataux, et l'accessibilité des coûts et des inégalités socioéconomiques afin de réduire sensiblement la moralité néonatale. D'autres recherches portant sur l'importance relative des obstacles à l'accessibilité dans différents contextes aideront les décideurs politiques et les administrateurs à adopter des approches locales appropriées pour améliorer la survie des nouveaux nés.

<p> This study explored an increase in the number of sexual assaults in students who were under the influence of alcohol. Seventy percent of students were raped when alcohol was a contributing factor at the time of assault. Location was also a major factor in the number of campus sexual assaults. Sixty-five percent of assaults were on campus; among these assaults, 90% of these sexual assaults were committed on college grounds. Acquaintance and date rapes are also very common on college campuses. Ninety percent of the victims reported by the Assault Survivors Advocacy Program (ASAP) were acquainted with the perpetrator. Chi square tests were conducted on alcoholic versus non-alcoholic assaults (<i>X</i> ² = 13.762, <i>p</i> &lt; .0001), on-campus compared to off-campus assaults (location; <i> X</i> ² = 38.81, <i>p</i> &lt; .0001), and on stranger in contrast to non-stranger assaults ( <i>X</i> ²= 55.048, <i>p</i> &lt; .0001). Although the sample size was small for alcohol, location, and acquaintance assaults, all three tests were statistically significant, indicating that alcohol, location, and acquaintance played a role in sexual victimization of students at the University of Northern Colorado.</p>

Introduction. At the request of a working group formed to recommend policy with respect to partner notification (PN) for HIV infection in Quebec, we examined practice and attitudes of seropositive patients and physicians. / Methods. We reviewed published studies on PN for HIV and conducted interviews with seropositive patients as well as focus groups and a telephone survey with a sample of clinicians treating HIV infection. / Results. Among previously undiagnosed partners notified through PN programs, seroprevalence ranged from 11% to 32%, with costs varying from 800$ to 3200 $ per new HIV diagnosis. In our study, most current partners had been contacted (interviews: 14/15 (93%); survey: 29/30 (97%)), but not previous partners (interviews: 6/39 (15%); survey: 29/200 (14%)). Many patients wanted more of their partners to be informed, but preferred to remain anonymous to these partners. Most clinicians were favorable to PN but felt they needed a clearer mandate and additional resources to do active notification beyond encouraging index patients to notify their partners. / Discussion. In Quebec, PN is carried out unsystematically and is usually limited to the index patient notifying his or her current partner. Most patients and physicians would be willing to collaborate with a more systematic PN program if it were voluntary and confidential.

A cost-effectiveness analysis is used to compare two alternative strategies for the control of tuberculosis in facilities providing long-term care to the elderly: (1) systematic screening of all new residents with the Mantoux test to identify persons infected with the tubercule bacillus, and preventive treatment of those who are most at risk of tuberculosis as recommended by the U.S. Department of Health and Human Services and (2) clinical follow-up of the index-case contacts as recommended by the Quebec Ministry of Health and Social Services. Incremental effectiveness and cost associated with the American strategy are estimated with a Markov model applied to the Quebec long-term care facilities population. Costs are estimated in the perspective of the health care system. Even though complications due to isoniazid chemoprophylaxis cluster in the year following admission, the American approach is advantageous. At the end of the implementation phase throughout the province of Quebec, this approach prevents 32 cases of tuberculosis annually. The incremental cost is 121 626$ per year for the entire province, 3 822 $ per case avoided, 9 555$ per death avoided, 3 437 $ per life-year saved and 2 756$ per quality-adjusted life-years saved. Those costs compare favourably to other health prevention measures recommended for the elderly population.