Pierre Fréchette's research while affiliated with Université du Québec and other places

Inuit populations meet a large portion of their food needs by eating country food in which pollutants are concentrated. Despite the fact that they contain pollutants, the consumption of country food has many health, social, economic, and cultural benefits. A risk determination process was set up in order to help regional health authorities of Nunavik to deal with this particular issue. Based on Nunavik health authorities' objectives to encourage the region's inhabitants to change their dietary habits, and on both the risks and the benefits of eating country food, several management options were developed. The options aimed at reducing exposure to contaminants by either substituting certain foods with others that have a lower contaminant content or by store-bought foods. This article aims at assessing the potential economic impact of these risk management options before being implemented. Relevant economic data (aggregate income and monetary outlays for the purchase of food and equipment required for food production by households) were collected and identified to serve as a backdrop for the various replacement scenarios. Results show that household budgets, and the regional economy, are not significantly affected by the replacement of contaminated foods with the purchase of store-bought meat, and even less so if the solution involves replacing contaminated foods with other types of game hunted in the region. When financial support is provided by the state, the households can even gain some monetary benefits. Results show that public health authorities' recommended changes to dietary habits among the Inuit of Nunavik would not necessarily involve economic constraints for Inuit households.

Social cohesion has emerged as a powerfulhybrid concept used by academics and policyanalysts. Academics use the concept tounderline the social and economic failings ofmodernity, linking it to the decline ofcommunal values and civic participation. Policy analysts use it to highlight the socialand economic inequities caused byglobalization. The desired effect of usingthis concept is often to influence governmentsto implement policies that will enhance socialcohesion by reducing social and economicdisparities. Despite its widespread use,however, statistical measures of socialcohesion tend to overlook local, non-Westernstrategies of social inclusion as well as thesocial impact of non-Western economic systems,such as the mixed economy typical of manyAboriginal communities in North America. Inthis paper, we develop a model of socialcohesion that addresses these omissions throughthe use of social indicators that measure boththe behavior and perceptions of Inuit living inthe Canadian Arctic with respect to the social,cultural and economic conditions of Arcticcommunities. We explain how and why measuringsocial cohesion is optimized by combining bothculturally-specific and non-specific socialindicators.

Background: The use of medical staff from various medical specialties as trauma team leaders (TTL) is a subject of debate and varies from one region to another. This survey reports the current situation among Canadian trauma centers. Methods: Trauma centers were identified on the Internet through the provincial health ministry and regional health authority websites and the Trauma Association of Canada (TAC). Provincially designated or TAC-accredited trauma centers were surveyed by telephone and mail to obtain and confirm information regarding hospital designation and the medical specialties assuming the role of TTL. Results: 30 trauma centers in nine of the ten Canadian provinces were identified. Surgeons were assigned the role of TTL in 25 of 30 hospitals (83%), and assumed this role an average of 59.4% (- 39%) of the time. The use of emergency medicine physicians as TTL was reported in 18 hospitals (60%), and 34.4% (- 38%) of the time. Other specialties were reported as TTL in seven hospitals (23%) for 6.2% (- 19%) of the time. Conclusion: Surgeon involvement as TTL remains the most frequent approach used at major Canadian trauma centers, however nonsurgeon specialists, particularly emergency medicine physicians, lead a nonnegligible proportion of trauma team resuscitations.

The purpose of this study was to show that blunt diaphragmatic rupture does not require immediate emergency operation in the absence of other indications. We reviewed all patients with blunt diaphragmatic rupture admitted within 24 hours of injury to one of six university trauma centers providing trauma care for the province of Quebec from April 1, 1984, to March 31, 1999. Multivariate analysis of demographic profiles, severity indices, indications for operation, and preoperative delays was performed. There were 160 patients (91 men and 69 women) with blunt diaphragmatic rupture. Mean age was 40.1 +/- 16.2 years. Mean Injury Severity Score was 26.9 +/- 11.5 and mortality was 14.4%. Patients undergoing emergency surgery for indications other than diaphragmatic rupture had a significantly higher Injury Severity Score than those undergoing surgery for repair of diaphragmatic rupture alone (34.7 +/- 10.7 vs. 22.0 +/- 9.0, p < 0.001). In patients undergoing surgery for diaphragmatic rupture alone, delay before repair of the diaphragmatic hernia did not lead to an increased mortality compared with patients undergoing immediate surgery (3.4% vs. 5.0%, p = NS). Blunt diaphragmatic rupture in the absence of other surgical injuries carries low mortality. Operative repair of diaphragmatic rupture can be deferred without appreciable increased mortality if no other indication mandates immediate surgery.

Regionalization of trauma care services in our region was initiated in 1993 with the designation of four tertiary trauma centers. The process continued in 1995 with the implementation of patient triage and transfer protocols. Since 1995, the network of trauma care has been expanded with the designation of 33 secondary, 30 primary, and 32 stabilization trauma centers. In addition, during this period emergency medical personnel have been trained to assess and triage trauma victims within minimal prehospital time. The objective of the present study was to evaluate the impact of trauma care regionalization on the mortality of major trauma patients. This was a prospective study in which patients were entered at the time of injury and were followed to discharge from the acute-care hospital. The patients were identified from the Quebec Trauma Registry, a review of the records of acute-care hospitals that treat trauma, and records of the emergency medical services in the region. The study sample consisted of all patients fulfilling the criteria of a major trauma, defined as death, or Injury Severity Score (ISS) > 12, or Pre-Hospital Index > 3, or two or more injuries with Abbreviated Injury Scale scores > 2, or hospital stay of more than 3 days. Data collection took place between April 1, 1993, and March 31, 1998. During this period, four distinct phases of trauma care regionalization were defined: pre-regionalization (phase 0), initiation (phase I), intermediate (phase II), and advanced (phase III). A total of 12,208 patients were entered into the study cohort, and they were approximately evenly distributed over the 6 years of the study. During the study period, there was a decline in the mean age of patients from 54 to 46 years, whereas the male/female ratio remained constant at 2:1. There was also an increase in the mean ISS, from 25.5 to 27.5. The proportion of patients injured in motor vehicle collisions increased from less than 45% to more than 50% (p < 0.001). The mortality rate during the phases of regionalization were: phase 0, 52%; phase I, 32%; phase II, 19%; and phase III, 18%. These differences were clinically important and statistically significant (p < 0.0001). Stratified analysis showed a significant decline in mortality among patients with ISS between 12 and 49. The change in mortality for patients with fatal injuries (ISS > or = 50) was not significant. During the study period, the mean prehospital time decreased significantly, from 62 to 44 minutes. The mean time to admission after arrival at the hospital decreased from 151 to 128 minutes (p < 0.001). The latter decrease was primarily attributable to changes at the tertiary centers. The proportion of patients with ISS between 12 and 24 and between 25 and 49 who were treated at tertiary centers increased from 56 to 82% and from 36 to 84%, respectively (p < 0.001). Compared with the secondary and primary centers, throughout the course of the study the mortality rate in the secondary and tertiary centers showed a consistent decline (p < 0.001). In addition, the mortality rate in the tertiary centers remained consistently lower (p < 0.001). The results of multivariate analyses showed that after adjusting for injury severity and patient age, the primary factors contributing to the reduced mortality were treatment at a tertiary center, reduced prehospital time, and direct transport from the scene to tertiary centers. This study produced empirical evidence that the integration of trauma care services into a regionalized system reduces mortality. The results showed that tertiary trauma centers and reduced prehospital times are the essential components of an efficient trauma care system.

Background: Regionalization of trauma care services in our region was initiated in 1993 with the designation of four tertiary trauma centers. The process continued in 1995 with the implementation of patient triage and transfer protocols. Since 1995, the network of trauma care has been expanded with the designation of 33 secondary, 30 primary, and 32 stabilization trauma centers. In addition, during this period emergency medical personnel have been trained to assess and triage trauma victims within minimal prehospital time. The objective of the present study was to evaluate the impact of trauma care regionalization on the mortality of major trauma patients. Methods: This was a prospective study in which patients were entered at the time of injury and were followed to discharge from the acute-care hospital. The patients were identified from the Quebec Trauma Registry, a review of the records of acute-care hospitals that treat trauma, and records of the emergency medical services in the region. The study sample consisted of all patients fulfilling the criteria of a major trauma, defined as death, or Injury Severity Score (ISS) >12, or Pre-Hospital Index > 3, or two or more injuries with Abbreviated Injury Scale scores > 2, or hospital stay of more than 3 days. Data collection took place between April 1, 1993, and March 31, 1998. During this period, four distinct phases of trauma care regionalization were defined: pre-regionalization (phase 0), initiation (phase I), intermediate (phase II), and advanced (phase III). Results: A total of 12,208 patients were entered into the study cohort, and they were approximately evenly distributed over the 6 years of the study. During the study period, there was a decline in the mean age of patients from 54 to 46 years, whereas the male/female ratio remained constant at 2:1. There was also an increase in the mean ISS, from 25.5 to 27.5. The proportion of patients injured in motor vehicle collisions increased from less than 45% to more than 50% (p < 0.001). The mortality rate during the phases of regionalization were: phase 0, 52%; phase I, 32%; phase II, 19%; and phase III, 18%. These differences were clinically important and statistically significant (p < 0.0001). Stratified analysis showed a significant decline in mortality among patients with ISS between 12 and 49. The change in mortality for patients with fatal injuries (ISS ≥ 50) was not significant. During the study period, the mean prehospital time decreased significantly, from 62 to 44 minutes. The mean time to admission after arrival at the hospital decreased from 151 to 128 minutes (p < 0.001). The latter decrease was primarily attributable to changes at the tertiary centers. The proportion of patients with ISS between 12 and 24 and between 25 and 49 who were treated at tertiary centers increased from 56 to 82% and from 36 to 84%, respectively (p < 0.001). Compared with the secondary and primary centers, throughout the course of the study the mortality rate in the secondary and tertiary centers showed a consistent decline (p < 0.001). In addition, the mortality rate in the tertiary centers remained consistently lower (p < 0.001). The results of multivariate analyses showed that after adjusting for injury severity and patient age, the primary factors contributing to the reduced mortality were treatment at a tertiary center, reduced prehospital time, and direct transport from the scene to tertiary centers.