Cette étude descriptive-corrélative vérifie la relation entre le déni de la maladie et l'observance thérapeutique auprès de 44 hommes et femmes atteints de trouble bipolaire vivant dans la communauté et tous membres du groupe de soutien Les Bipos Inc. Les instruments de mesure comprennent: Perception de l'Impact de la Maladie Mentale (PIMM), des échelles analogues pour l'observance et un questionnaire sur l'histoire de la maladie (hospitalisation et rechute). Les résultats démontrent des corrélations fortes entre la dimension espoir du PIMM et la cessation partielle des médicaments; entre la cessation partielle des médicaments et le nombre de rechutes; entre l'observance des rendez-vous thérapeutiques et la cessation totale du traitement pharmacothérapeutique. Plusieurs coefficients de corrélation d'ordre moyen sont démontrés entre les autres dimensions du PIMM et l'observance. L'influence significative (p < 0.05) du groupe de soutien sur quelques dimensions du PIMM est aussi démontrée.

The purpose of this study was to introduce positive life skills to a family with special needs. A qualitative single case study was used to discover whether positive life skills would be advantageous as tools or resources for one family with special needs. Mental skills activities, such as Orlick's Feeling Great program for children, were adapted and presented through audio tape and activities to the family, at their home on a weekly basis. Information was gained through observations, conversations, interviews and interactions. Weekly notes were gathered and reported. Two interviews were taped mid-way through the program and at the end of the program. The interviews were transcribed; the objective was to see if the positive life skills were useful as tools or resources for the family. A detailed description of the responses of the child, the parents and the researcher are given. Through the span of this study the family was equipped with a common language and action for dealing effectively with stressful situations. Of immeasurable value was the family's discovery that despite their many demands, there was time to spend together which could re-energize each of them. The coping of this family was improved and they viewed themselves as functioning at a much greater level than before this program began. This project presents one family's journey of interacting with each other while discovering that mental skills can help them all to face the special demands and stress of their unique family. Future research could examine the collaborative efforts of education or health professions in supporting children with disability and their families, with respect to the usefulness of mental skills as a means of coping with unique demands.

Introduction. Statins may be under-prescribed in clinical settings. This study was undertaken to determine if the same is true in the military. The cost-effectiveness of statin therapy in patients identified by current Canadian cholesterol guidelines was also explored. Methods. Charts of 1424 Canadian military personnel (age &ge; 45) were reviewed at eleven Canadian bases. Risk factors and cholesterol values were used to identify drug therapy candidates and patients not being treated to target values. Cost-effectiveness ratios were estimated based on a systematic review of the literature. Results. 53/111 patients on therapy were not being treated to target cholesterol levels, while 172/1313 not on therapy were drug therapy candidates. An average of 2.89 years of life saved (YOLS) in drug therapy candidates was forecasted, costing less than $10,000/YOLS. Conclusion. The health benefits of statin therapy in this population are substantial and the cost-effectiveness is acceptable. Statin therapy warrants greater attention as a preventive strategy.

The combination of ethnicity and birthplace was used to identify first and second generation Chinese immigrants and US born white Americans. Cancer incident cases for three comparison groups were obtained. Population counts for each study group were extracted from The Integrated Public Use Microdata Series (IPUMS-98). Direct Age-standardized incidence rates (ASIRs) were calculated using the "world population" as a standard. ASIRs were compared among first, second generation Chinese immigrants and US born white Americans for nasopharyngeal, esophageal, stomach, liver, colon, rectum, lung, female breast and prostate cancers. Observed, relative and cause-specific survival rates were calculated for the three study groups. The advantages and disadvantages of the three survival rates were compared. Cause-specific survival rates for female breast, prostate, colorectal, and lung cancer were compared among first and second generation Chinese immigrants and US born white Americans. Multivariate survival analysis was conducted using Cox proportional hazard model. Other prognostic factors, such as stage at diagnosis, age, gender, and had or did not have directed surgery during first therapy, SEER registry, and marital status, were examined. (Abstract shortened by UMI.)

This thesis study employed epidemiologic methods to investigate snowboarding injuries and, where appropriate, included alpine skiing injuries. There were two components: a descriptive component and an etiologic component. The injuries were described as proportions of the total number of respective sports injuries. Crude, specific and standardized injury rates were calculated. A variant of the case-control design was then used to identify potential risk factors for the more severe snowboarding injuries. This project built upon previous studies and contributes to the growing body of knowledge regarding snowboarding injuries. The large sample size provided statistical power often lacking in other studies. This project investigated 2,501 snowboarding injuries experienced at 71 ski centres across the province of Quebec during the 1996/97 ski season. The descriptions of snowboarding injuries in this project reinforce what has been published. However, the additional information provided by the participation data permits assessment of age and sex distributions in the injured sports enthusiasts. (Abstract shortened by UMI.)

Cette étude examine l'effet de la désinstitutionnalisation sur les perceptions de parents d'enfants-adultes vivant avec une déficience intellectuelle. L'échantillon est constitué de' 66 participants divisés en deux groupes. Le groupe expérimental comptait 33 personnes responsables d'un enfant-adulte qui allait vivre la transition d'un milieu institutionnel à un milieu communautaire. Le groupe témoin comptait aussi 33 personnes responsables d'un enfant-adulte qui vivait dans la communauté depuis au moins deux ans. Les membres du groupe expérimental ont été évalués avant la désinstitutionnalisation de l'enfant-adulte et de nouveau de quatre à six mois après la transition en milieu communautaire. Les sujets du groupe témoin ont été évalués deux fois en respectant un intervalle similaire à celui du groupe expérimental. Les instruments de mesure utilisés sont l'Inventaire des rôles liés à l'intégration sociale (version revisée), l'Échelle des comportements négatifs, l'Échelle québécoise de comportements adaptatifs (ÉQCA), l'Échelle de stress familial et l'Échelle de fréquence des contacts. Les résultats indiquent, pour les deux groupes, qu'il n'existe aucune différence entre les perceptions parentales aux deux temps d'évaluation, sauf pour la fréquence de contacts des parents du groupe expérimental avec l'enfant-adulte. Le nombre de visites des parents à l'enfant-adulte dans sa nouvelle résidence a augmenté significativement. Il ressort aussi des analyses effectuées que l'augmentation de la fréquence des contacts est associée à une réduction de la distance entre le domicile familial et le milieu de vie de l'enfant-adulte vivant avec une déficience intellectuelle. Enfin, les analyses révèlent une réduction du nombre de comportements négatifs, tels qu'évalués par les intervenants, approchant du niveau de signification.

This thesis evaluated the surveillance of communicable diseases on the island of Montserrat, and the island's preparedness to monitor emerging communicable diseases. The evaluation consisted of a review and assessment of the activities that make up the communicable disease surveillance system, and a survey of staff within the Ministry of Health designed to determine their level of satisfaction with surveillance and their suggestions for improvement. A survey of clinical staff was also conducted to determine their awareness of the presentations and management of two emerging diseases. The system was found to be simple, acceptable, flexible and useful. Staff reported being satisfied with most surveillance tasks. The local laboratory was found to be inadequate and the Ministry unprepared for monitoring emerging diseases. Recommendations include continuation of the existing system, development of guidelines for contact tracing and re-assessment of the role of the laboratory. Continuing education is needed for staff and patients.

Background. Despite its prevalence and clinical relevance, cognitive impairment typically remains undetected in 50% of cases. Objective. To develop clinically sensible (quick, simple, acceptable), accurate and readily recalled screens for cognitive impairment based on easily reproducible analytic strategies. Methods. The Canadian Study of Health and Aging (CSHA-1) served as the derivation data set. 3MS cognitive screening questions which were judged as most likely to be employed by busy clinicians and which were significantly associated (via chi2 analysis) with cognitive impairment were selected as independent variables for multivariate analysis. The screening tests derived from logistic regression and recursive partitioning analyses which most closely approximated the sensitivity and specificity of the entire 3MS were externally validated. Results. Two logistic regression based scales and two recursive partitioning algorithms demonstrated sensitivities and specificities approaching those of the complete 3MS (approximately 80% and 60% respectively). The sensitivity was superior to that of the MMSE. Conclusion. Readily reproducible multivariate analysis based strategies can be developed which generate practical screening tests with psychometric properties approaching those of the 3MS. Given the existence of verification bias, these screens as well as screens with higher sensitivity and lower specificity must be validated prospectively before they can be clinically employed.

A ce stade de notre travail, sans revenir en profondeur sur ce qui a deja ete dit, un bref rappel de notre cheminement merite d'etre fait. A l'aide de notre cadre conceptuel nous avons interroge le processus de creation et de modification des arretes municipaux de la ville d'Ottawa portant restriction sur l'usage du tabac dans le lieu de travail et les lieux publics. La question fondamentale qui traverse l'ensemble de ce travail etait de comprendre comment les acteurs sociaux particuliers s'y sont pris pour elaborer les deux By-laws. Nous avons ainsi pu mettre en lumiere la maniere dont le probleme du tabagisme avait ete defini en terme de sante publique, de morale et de facon plus globale en terme d'externalite negative. Dans la solution au probleme, nous nous sommes enquis de savoir comment l'autorite, a partir de la question du non-fumeur, en est venue a legitimer l'appropriation de la gestion du tabagisme par l'Etat. L'analyse du processus decisionnel des appelants a la cause a permis de montrer que la rationalite politique n'avait pas ete absolue mais qu'elle s'etait dotee d'emblee de solutions privilegiees empruntees dans son entourage institutionnel. (Abstract shortened by UMI.)

Indirect standardization was used to produce estimates of the prevalence of selected risk factors and health status indicators for all health units in Ontario, based on their socio-demographic characteristics and on the relationships between these socio-demographic variables and the health variables of interest, as measured by the Ontario Health Survey (OHS). Socio-demographic variables were drawn from both the OHS and the 1986 Census of Canada. In addition, the validity of the estimates was assessed. A total of 13 combinations of predictor variables were used to estimate 18 selected health status indicators and risk factors. Results showed that the choice of predictor variables used for estimation can have a substantial impact on the error associated with a set of estimates. As well, it was found that the dispersion of the estimates was reduced in comparison to the true values. The ranking of the estimates was found to vary from poor to good. In addition, estimates were shown to be better than using the provincial value as the estimate for each health unit value. Comparison by region showed that estimates for northern regions had somewhat more error than estimates for other regions and that addition of a geographic identifier reduced the amount of error among the estimates. Given all these results, it was concluded that this type of methodology does not appear to be adequate to meet the information needs for health units but that other methods such as regression might produce better results.