Clinic In Montreal Research Articles

First Lifetime Back Pain and Physiatry Treatment

The role of psychological factors in recovery from first lifetime low back pain (LBP) was explored in this study. Consecutive clients from one physiatry clinic in Montreal who had LBP of less than 3 months' duration, were on sick leave and receiving workers' compensation benefits, and reported the current event as first lifetime LBP were enrolled. Psychological factors that fluctuate with current events (Psychiatric Symptom Index) and remain stable over time (General Well Being Scale) were assessed. Outcomes were late return to work (> 31 days) and 1 year incidence of compensated recurrence. Results from two multivariate models indicated lower psychological distress predicted late return to work, and higher well being, higher aggressiveness, and lower anxiety predicted compensated recurrence. Researchers concluded psychological factors do not impact clients with all types of LBP in the same way. For individuals lacking prior LBP experience, better psychological functioning increased lengthy work absence. Thus, awareness of the clients' psychological profiles and previous LBP experiences may benefit recovery.

Determinants of low-risk and high-risk cervical human papillomavirus infections in Montreal University students.

Previous studies have been inconsistent about the degree of sexual transmissibility of cervical human papillomavirus (HPV) infection. The authors hypothesize that risk factors for HPV infection vary according to HPV type. To estimate the prevalence of HPV infection in asymptomatic women and to identify risk factors for overall HPV infection and HPV infection by oncogenic and nononcogenic type. A cross-sectional survey was conducted at the McGill University clinic in Montreal. Cervical specimens were collected from 489 female students presenting at the clinic for a routine Papanicolaou test. Data on potential risk factors was obtained by questionnaire. Human papillomavirus DNA was detected by the polymerase chain reaction using consensus primers (MY09/11) followed by hybridization with generic and type-specific probes using Southern blot and dot blot techniques. The overall HPV prevalence was 21.8%. A low-risk HPV infection was found in 6.2% of the women, 11.8% had a high-risk HPV infection (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58), 7.1% had an unknown HPV type, and 2.7% had a multiple type infection. Two profiles emerged for sexual activity and risk of HPV infection according to oncogenic risk after multivariate analysis. Lifetime frequency of sexual intercourse and lifetime number of oral sex partners was associated with high-oncogenic-risk HPV infections; however, HPV infection with low-oncogenic-risk types was invariant with respect to markers of sexual activity. These results suggest that there are differences in epidemiologic correlates of transmission between low-risk and high-oncogenic-risk HPV types based on oncogenicity. This finding has important implications for primary prevention of HPV infection and cervical cancer precursors.

Migration and HIV: an epidemiological study of Montrealers of Haitian origin.

We aimed to determine the prevalence of HIV infection and associated risk factors among Montrealers of Haitian origin. We carried out a voluntary, anonymous survey in 7 primary care medical clinics in Montreal among 5039 persons aged 15 to 49 years born in Haiti or with at least one parent born in Haiti. The participation rate was 94.3%. Overall, HIV prevalence was 1.3% (1.6% in men and 1.1% in women). The HIV prevalence was lower among those born in Canada or who had resided in Canada longer. The prevalence among subjects who had travelled to Haiti in the previous 5 years was 2.0%, twice the rate of those who had not. The adjusted population attributable fraction of HIV infections associated with having had unprotected sex in Haiti was 10.2%. This study identified risk factors which will help in the design of more effective prevention programmes among Montrealers of Haitian origin.

Evaluation of skills training at Montreal's Clinic for Young Adults

Therapeutic approaches and studies conducted at Montreal's Clinique Jeunes Adultes focus on evaluating the operations of the clinic and on validating French-language versions of psychoeducational modules for training social skills, and assessment scales. Research also aims at finding ways of improving rehabilitation programs based on a better understanding of the patients' subjective perceptions of their illness, goals and recovery.

Long-term psychiatric patients' knowledge about their medication.

Fifty-three long-term psychiatric outpatients at two clinics in Montreal were surveyed about their knowledge of the psychotropic medications they took and about their opinions of the quality of information they had received about medications. Most respondents were male and had a diagnosis of schizophrenia or schizoaffective disorder. Most respondents could identify one medication they took; nearly three-quarters could name a second one. Two-thirds reported having received information on medication, but many respondents wanted the information repeated, and more than half wanted more information. Chronicity and higher levels of education were associated with being better informed.

Cutaneous malignant melanoma in women is uncommonly associated with a family history of melanoma in first-degree relatives: a case-control study.

Sun exposure is the principal cause of malignant melanoma, but other risk factors may be important. During their reproductive years women are at a greater risk for melanoma than men. We performed an age-matched case-control study of cutaneous malignant melanoma in 159 women attending a single oncology clinic in Montreal. A reported family history of cutaneous malignant melanoma in first-degree relatives was associated with a significantly increased risk of melanoma (adjusted relative risk: 4.28, P = 0.046). No subject was a member of a hereditary melanoma family (three or more cases of melanoma in first-degree relatives). As expected, variables related to sun exposure were also strong determinants of risk. Height was a significant risk factor, but the difference between the mean heights of cases and controls was only 2 cm (P = 0.009). The age of menarche of cases was lower than in controls (mean 12.70 and 13.08 years respectively, P = 0.036) but there was no significant elevation in risk associated with other reproductive variables. This study suggests that a family history of malignant melanoma is a significant risk factor, but that hereditary melanoma may be less common than is currently believed.

A Passion for Nutrition and Communication

This article includes a brief discussion of the early development of the dietetic profession in Canada and the various roles of dietitians. Then it focuses on and describes in some detail the practice and activities of three dietitians in a private nutrition clinic in Montreal.

Increased incidence of malignant melanoma of the skin in workers in a telecommunications industry.

In 1982 physicians at a hospital melanoma clinic in Montreal noticed that among their patients there had been seven men working in a single telecommunications company. This raised suspicions that working in that industry might be associated with development of malignant melanoma of the skin (MMS). A preliminary gross comparison with general population rates indicated that there was an increased risk in this working group. To estimate the risk of MMS more accurately, a standardised incidence ratio (SIR) was calculated based on the rates of MMS in the local population of the Greater Metropolitan Montreal Area for the years 1976-83. During that period, among workers in all plants for the company, 10 male cases of MMS were observed for an expected number of 3.7 (SIR = 2.7; 95% CI = 1.31-5.02). No cases were observed among female workers (expected = 1.3). The excess was significant among cases with a short latency (less than 20 years since beginning of employment). There was no apparent pattern of exposure based on job titles or departments.

Alexithymia. The development of a valid and reliable projective measure (the objectively scored Archetypal9 Test).

The aim of this study was to examine whether the Archetypal9 Test (AT9) could meet the need for a valid and reliable test with which to measure the alexithymic trait cluster. Participants in this study included 61 patients drawn from pain clinics in Montreal (Royal Victoria Hospital) and Detroit (Henry Ford Hospital) and 30 patients undergoing minor surgery at the Royal Victoria Hospital in Montreal. All 91 subjects took both the AT9 Test and the Clarke Vocabulary Scale. The results of the attempts at validation reveal that the objectively scored AT9 Test (SAT9) is a highly internally consistent instrument, that it has demonstrated construct validity, and that it can significantly discriminate between patient groups (pain patients and medical patients). The SAT9 is positively related to age, inversely related to occupational level, and uncorrelated with IQ (as measured by the Clarke Vocabulary Scale). The authors concluded that thus far, the SAT9 has proven to be a valid instrument which can be used to measure a central feature of alexithymia.

Who Should Provide Primary Health Care to Children: Pediatricians or Family Medicine Physicians?

INTRODUCTION —Robert A. Hoekelman, MD This debate is one of a series entitled "Controversies in Child Health and Pediatric Practice." In 1978 and 1979, the Department of Pediatrics at the University of Rochester conducted 12 such debates, which were published in book form in 1981.1 It is interesting that of these 12 controversies, not one has been resolved. That may prove to be the case for the controversy presented in this debate, "Who should provide primary health care to children: pediatricians or family medicine physicians?" Our guest speakers are Dr Michael Klein and Dr James E. Strain. Dr Klein is Professor of Family Medicine and Assistant Professor of Pediatrics at McGill University School of Medicine. He is also Director of the Department of Family Medicine and of the Herzl Family Practice Center at the Sir Mortimer B. Davis Jewish General Hospital in Montreal. Dr Klein received his medical degree at Stanford University in 1966, and he was his class's recipient of the pediatric Harold K. Kaiser Award. Dr Klein served his internship at Bronx Municipal Hospital Center at Albert Einstein University and his pediatric residency at Montreal Children's Hospital. During his last year, he served as Senior Resident in Neonatology under Robert Usher at the Royal Victoria Hospital. He then became a fellow in biochemical genetics under Charles Scriver and the Chief Medical Resident at Montreal Children's Hospital under Mary Ellen Avery. In 1970, he came to Rochester as a Fellow in Ambulatory Pediatrics. Dr Klein's practice experience is extensive. He was the pediatric coordinator of the St Jacques Clinic in Montreal during the late 1960s and the medical director of the Westside Health Services in Rochester from 1971 to 1975, after which he assumed his current position.

The Well-Being Clinic: a study of the effectiveness of an attempt to provide routine mental health check-ups for community groups.

The existence of a Well-Being Clinic should in itself be an encouragement to people to seek help in emotional problems. The positive health orientation of the clinic lessens the likelihood of those exploring the state of their mental health being labelled "neurotic." It should help relieve chronic and often unnecessary concern about mental health derived from the public's misinterpretation of well-intentioned mental health propaganda. It should help in the early detection of mental illnesses and social maladjustment thus making early treatment possible. And it should make useful contributions to the field of psychiatric research by assisting in the assessment of the effectiveness of existing treatment resources and perhaps by identifying as yet unrecognized disturbed human relationships. On the negative side it can be said that the clinic may bring to light many cases for whom there is at present no therapeutic resource, and that it may miss many cases of early illness. The degree of effectiveness of the initial screening interview may roughly parallel that obtained in mass radiography of the chest in the field of preventive public health. Yet compared with a community in which a Well-Being Clinic does not exist, it can be argued that Montreal has set in motion a promising venture. The idea of the Well-Being Clinic has been favorably received in Montreal. Professional and industrial organizations have shown an interest in setting up further clinics adapted to their particular needs. Outlying communities have expressed similar interest. The clinics in Montreal have remained financially self-supporting. And the 2 group programs to which they were attached had over the past year a paying enrolment of 200 persons. The clinics, therefore, have not been a costly experiment. Remembering that in the final analyses it is the well people of the community who must carry the burden of the ill, and this is by no means only a financial burden, it is of paramount importance that experimentation should go forward in the direction of keeping the healthy as healthy as possible.

Lead poisoning in childhood treated by the subcutaneous administration of a chelating agent.

In 1982 physicians at a hospital melanoma clinic in Montreal noticed that among their patients there had been seven men working in a single telecommunications company. This raised suspicions that working in that industry might be associated with development of malignant melanoma of the skin (MMS). A preliminary gross comparison with general population rates indicated that there was an increased risk in this working group. To estimate the risk of MMS more accurately, a standardised incidence ratio (SIR) was calculated based on the rates of MMS in the local population of the Greater Metropolitan Montreal Area for the years 1976-83. During that period, among workers in all plants for the company, 10 male cases of MMS were observed for an expected number of 3.7 (SIR = 2.7; 95% CI = 1.31-5.02). No cases were observed among female workers (expected = 1.3). The excess was significant among cases with a short latency (less than 20 years since beginning of employment). There was no apparent pattern of exposure based on job titles or departments.

ESTROGENS AND THEIR EFFECT ON CILIATED MUCOSA

The nature of a relationship between the nasopharyngeal mucosa and the gonads is a question which has attracted the attention of investigators now and then from the time of Hippocrates to the present. 1a Apart from some observations on the connection between epistaxis and cyclic activity of the uterine mucosa, the problem had little practical interest for members of the medical profession until Mortimer, Wright and Collip lb reported observations which linked atrophic rhinitis and ozena to a pituitary dystrophy and encouraging results from the treatment of patients with such conditions by nasal insufflation of estrogenic material. Later, further encouraging results were reported from the Montreal clinic 1c on the use of this type of therapy in the treatment of patients for constitutional deafness. Confirmation of the beneficial effects of estrogenic topical therapy in cases of atrophic rhinitis was obtained by Blaisdell 2 and, less enthusiastically, by Soskin and Bernheimer. 3 The latter investigators expressed