The Quebec Population Health Research Network

Older adults living with neurocognitive disorders (NCD) face a higher risk of polypharmacy, exposure to potentially inappropriate medications and related adverse events. Pharmacists can help manage these issues and improve the appropriateness of pharmacotherapy. To evaluate the impact of pharmacists' interventions, as members of primary care interprofessional teams, on medication use and patient-reported outcome measures among older adults living with or under investigation for a neurocognitive disorder. The effect of a six-month follow-up by a primary care interprofessional team pharmacist on the number of medications, potentially inappropriate medications (PIMs) and anticholinergic burden for older adults living at home under evaluation for or living with a NCD was assessed through a controlled quasi-experimental study. Eligible older adults were 65 years or older and were enrolled between September 2021 and February 2025. The patient-reported outcomes were the evolution of participants' quality of life, treatment burden and satisfaction with care. The outcomes were evaluated using difference in differences (D-I-D) and their 95% confidence interval (95% CI). Pharmacist interventions significantly reduced the mean anticholinergic burden in the intervention arm (n=177) compared to the control arm (n=128) (D-I-D: -0.29; 95% CI: -0.56 - -0.11). A non-statistically significant trend toward a reduction was also observed for the mean number of PIMs (D-I-D: -0.11; [-0.22; 0.00]). The interventions also improved participants' satisfaction with care (6.97; [0.23; 13.72]). The mean number of medications used, as well as the burden of treatment and quality of life were stable after follow-up. Pharmacist-led interventions in interprofessional primary care settings contributed to the appropriateness of pharmacotherapy and satisfaction of older adults under evaluation for or living with a NCD after a six-month follow-up.

Introduction: Patients with traumatic injuries often experience substantial acute pain, which can lead to chronic pain and persistent opioid use after hospital discharge. However, little is known about interventions to support trauma patients to prevent such health issues and their costs. Objectives: To describe the nature and extent of the evidence on follow-up interventions for pain management or optimal opioid use and their economic evaluation in patients with traumatic injuries after hospital discharge. Methods: The 6-stage framework for scoping reviews proposed by Arksey and O’Malley and Levac et al., enhanced by the recommendations from the Joanna Briggs Institute guidelines, will be used. CINAHL, Embase, MEDLINE, ProQuest databases, PsycINFO, the Cochrane Central Register of Controlled Trials and Web of Science will be searched. Two reviewers will independently screen, select and extract the data. An interdisciplinary advisory committee and 2 patient partners will be consulted throughout the review process to ensure its relevance. Discussion and Research Spin-offs: This scoping review will provide a comprehensive overview of the current state of knowledge on follow-up interventions for adult patients with traumatic injuries to reduce their pain and opioid use after hospital discharge, while taking economic measures into account. The results will inform research and, ultimately, contribute to the sustainable implementation of interventions to prevent chronic pain and opioid use disorder in these patients.

Medication adherence is essential for achieving favorable health outcomes, particularly in older adults with multiple chronic conditions. This systematic review critically appraised current evidence on interventions aimed at enhancing medication adherence in older adults. Literature searches were performed in PubMed/MedLine, EMBASE, and Web of Science for articles published up to December 31, 2024. We identified peer-reviewed studies assessing interventions to improve medication adherence in older adults (≥ 60 years). The primary outcome was intervention effectiveness; secondary outcomes were clinical parameters, disease control, health-related quality of life, rehospitalization rates, event rates, mortality rates, feasibility, acceptability or satisfaction levels, and overall costs or cost-effectiveness. A total of 128 studies was included: 96 randomized controlled trials (RCTs), 16 pre-post studies, 9 non-RCTs, and 7 longitudinal evaluations. The majority (51.2%) was implemented in primary care. An educational component was present in 56.3% of interventions, a technical component in 47.6%, and an attitudinal component in 32.0%. Only 3.2% of interventions included rewards. Various healthcare professionals, such as pharmacists, nurses, and physicians, were involved in delivering interventions. Most studies reported improved adherence, though some factors, such as high baseline adherence, insufficient intervention intensity, and brief follow-up limited the effectiveness. Secondary outcomes often included improvements in disease knowledge, patient satisfaction, quality of life, and clinical indicators like blood pressure and HbA1c levels. Despite most studies showed a positive impact on adherence, a high heterogeneity was highlighted, and effectiveness was mainly observed in the short term.

BackgroundIndividuals of lower socioeconomic position (SEP) are at increased risk of developing cardiovascular disease (CVD). Variability in movement behaviours, including physical activity, sedentary behaviour, and sleep, contributes to CVD risk and socioeconomic gradients in cardiovascular health. Movement behaviour habits often begin early in life, with adolescence representing a sensitive period for establishing behaviour patterns that persist into adulthood. This study aims to evaluate the extent to which socioeconomic inequalities in adult CVD risk can be mitigated by using causal decomposition to model interventional scenarios on unhealthy movement behaviours during adolescence.MethodsWe will conduct a population-based cohort study of adolescents from the Add Health study, recruited in 1994-1995 from the United States and followed into adulthood. Unhealthy movement behaviours - low moderate-to-vigorous physical activity, high recreational screen time, and short sleep duration - will be operationalized based on the 24-hour Movement Guidelines and measured twice during adolescence (12-24 years). Parental education and family financial hardship will be used to measure SEP. The outcome will be the 10-year risk of CVD, as measured in adulthood (33-41 years) using a validated risk score. G-formula-based causal decomposition with time-varying covariates will be used to quantify the change of socioeconomic inequalities in adult CVD risk under two interventional scenarios: (1) elimination (unhealthy movement behaviours are eliminated in the population during adolescence) and, (2) equalization (the distributions of unhealthy movement behaviours in the low SEP group during adolescence are equalized to those in the high SEP group).ConclusionsThis study will use causal decomposition methods to estimate policy-relevant effects, providing evidence to guide interventions targeting adolescent movement behaviours and reduce socioeconomic inequalities in CVD risk.

This study revisits the polygyny‒fertility relationship in sub-Saharan Africa amid significant sociodemographic transformations, including declines in both fertility rates and the prevalence of polygyny. Using data from multiple rounds of the Demographic and Health Surveys across 23 African countries, we examine the contribution of polygyny to reductions in the total fertility rate (TFR), explore how the polygyny‒fertility relationship has evolved over time, and assess changes in the total number of children ever born, number of recent births, ideal fertility, and the desire for another child by polygyny status. Our findings show that the decline in polygyny has substantially contributed to reductions in TFR. While realized fertility—measured by children ever born and recent births—has declined for all married women, reductions have been greater among women in monogamous unions. Fertility preferences, including ideal fertility and the desire for another child, have decreased only among women in monogamous unions, while remaining stable for those in polygynous unions. Additionally, except for children ever born, we find minimal variation in fertility outcomes by wife's rank within polygynous unions. Taken together, these results underscore the complex influence of marriage systems on fertility and highlight the distinct fertility patterns of women in monogamous versus polygynous unions.

Higher mortality has been reported in older patients with moderate traumatic brain Injuries (TBI) compared to younger patients. To identify the risk factors associated with in-hospital mortality, complications and extended length of stay in moderate TBI patients. DESIGN: a multicentre observational cohort study using the Quebec Trauma Registry. Hospitalized patients aged ≥ 16 with a moderate TBI (a head injury with an Abbreviated Injury Scale (AIS) ≥ 3, and a GCS score of 9-12). In-hospital mortality, complications and prolonged length of stay. Multivariable logistic regression. We included 1005 patients, 38.1% of whom were aged ≥ 65. The in-hospital mortality rate was 20.1%. Male sex (OR = 1.6 [95% CI:1.02-2.6], age (≥ 85years old VS < 65years) (OR = 18.7 [95% CI: 9.2-38.1]), ≥ 2 comorbidities (OR = 2.3 [95% CI: 1.3-4.0]), Injury Severity Score (OR = 1.04 [95% CI: 1.01-1.1]), presence of intraparenchymal hematoma (OR = 3.5 [95% CI: 2.2-5.5]) or other CT scan findings (cerebral edema, pneumocephalus, subpial hemorrhage, and pituitary injury) (OR = 1.9 [95% CI: 1.2-3.1]) were associated with increased odds of mortality. Male sex (OR = 1.8 [95% CI: 1.2-2.6]), age (65-74: OR = 1.7 [95% CI: 1.1-2.8] & 75-84: OR = 1.6 [95% CI: 1.03-2.6]), ≥ 2 comorbidities (OR = 2.9 [95% CI: 1.8-4.7]), thoraco-abdominal concomitant injury (OR = 2.0 [95% CI: 1.01-3.8]), and subarachnoid hemorrhage (OR = 7.6 [95% CI:1.5-38.5]) were associated with increased odds of complications. The number of comorbidities (≥ 2 OR = 1.7 [95% CI: 1.1-2.7]), spine injury (OR = 2.4 [95% CI: 1.4-4.1]), and delirium (OR = 3.1 [95% CI:1.8-5.2]) were associated with an increased odd of extended length of stay. This study identified risk factors of in-hospital mortality, complications and extended length of stay, most of which are quickly available in the Emergency Department (ED). These factors could help clinicians identify moderate TBI patients at high risk of in-hospital mortality and guide shared decision-making regarding goals of care.

BackgroundHealthcare workers (HCWs) can face situations that conflict with their moral beliefs, leading to moral injury, an adverse psychological consequence that was more frequent during the COVID-19 pandemic. Self-compassion is a potential coping mechanism for moral injury by encouraging acceptance of human limitations and suffering.ObjectivesThis study aimed to examine the associations between self-compassion components and moral injury prevalence among HCWs in Quebec, Canada, during the COVID-19 pandemic.Research designA cross-sectional study design was employed. Participants: and research context: The sample of this study consisted of HCWs and leaders from the Quebec province. Participants completed validated self-administered questionnaires assessing both positive and negative self-compassion components (self-kindness vs self-judgment; common humanity vs isolation; and mindfulness vs overidentification) and moral injury dimensions (self-oriented and other-oriented). Prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations between self-compassion components and moral injury dimensions were modeled using Poison robust regressions. The models were adjusted for various covariates, including sex, age, gender, and socio-demographic and lifestyle factors.Ethical considerationsEthical approval for this study was obtained from the ethics committee of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale in Quebec, Canada. All participants provided written informed consent prior to participating in the study. Additionally, permission was sought and obtained from the original authors of the tools used in this study, including the self-compassion and moral injury scales.ResultsThe study involved 572 HCWs (60.5% nurses) and leaders. Around half of the participants (50.70%) exhibited moderate levels of self-compassion, while the prevalence of low levels of self-compassion ranged from 21.68% to 48.08% for the positive subscales and from 23.78% to 44.41% for the negative subscales. Regarding moral injury, 10.14% of participants reported moderate to high self-oriented moral injury, 29.19% reported moderate to high other-oriented moral injury, and 13.81% demonstrated moderate to high total moral injury. Higher self-compassion levels were associated with lower moral injury prevalence. HCWs with high self-compassion had a 93% lower likelihood of experiencing moral injury (PR: 0.07, 95% CI: 0.03-0.19). Self-kindness demonstrated the strongest association with reduced moral injury (PR: 0.24, 95% CI: 0.11-0.52), followed by mindfulness (PR: 0.37, 95% CI: 0.18-0.75). However, common humanity did not show a statistically significant association with moral injury prevalence.ConclusionThese findings suggest a potential association between self-compassion and reduced prevalence of moral injury among HCWs, highlighting promising interventions to manage moral injury during crises. Such initiatives could promote the mental wellbeing of HCWs and preventing the negative consequences of moral injury, including anxiety, depression, and burnout.