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Background The literature is inconsistent regarding the effect of the presence of chronic physical and mental diseases on cognitive decline in older adults. The objectives of this study were to explore the effect of chronic diseases on subsequent cognitive decline assessed via the Mini Mental State Examination (MMSE) in community living older adults. Methods We used data from individuals (n = 2010) participating in the ESA (Étude sur la Santé des Aînés) study. Cognitive status was measured with the MMSE at baseline and after 1 year. Chronic diseases were identified via administrative databases in accordance with International Classification of Diseases 9/10. Multivariate linear regression was used to assess the change in MMSE as a function of chronic physical and mental disorders, while adjusting for socio-demographic and clinical factors Results Significant decreases in MMSE scores were found in patients who had a stroke (β value: -2.83) or diabetes (β value: -1.06) and in older adults aged older than 75 years (β value: -0.91). Conclusions When adjusting for other chronic diseases, stroke, diabetes and advanced age were associated with subsequent cognitive decline in older adults during a one-year follow-up. Longer follow-up is recommended to assess long-term effect. [ABSTRACT FROM AUTHOR]

Background: North American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians' enrolment of orphan patients through centralized waiting lists, the Guichet d'accès aux clientèles orphelines, with higher payments for vulnerable patients. This study analyzed whether any significant changes were observed in the numbers of patient enrolments with family physicians' after the introduction of the new financial incentives. Prior to then, financial incentives had been offered for enrolment of vulnerable patients only and there were no incentives for enrolling non-vulnerable patients. After 2011, financial incentives were also offered for enrolment of non-vulnerable patients, while those for enrolment of vulnerable patients were doubled. Methods: A longitudinal quantitative analysis spanning a five-year period (2008-2013) was performed using administrative databases covering all patients enrolled with family physicians through centralized waiting lists in the province of Quebec (n = 494,697 patients). Mixed regression models for repeated-measures were used. Results: The number of patients enrolled with a family physician through centralized waiting lists more than quadrupled after the changes in financial incentives. Most of this increase involved non-vulnerable patients. After the changes, 70% of patients enrolled with a family physician through centralized waiting lists were non-vulnerable patients, most of whom had been referred to the centralized waiting lists by the physician who enrolled them, without first being registered in those lists or having to wait because of their priority level. Conclusion: Centralized waiting lists linked to financial incentives increased the number of family physicians' patient enrolments. However, although vulnerable patients were supposed to be given precedence, physicians favoured enrolment of healthier patients over those with greater health needs and higher assessed priority. These results suggest that introducing financial incentives without appropriate [ABSTRACT FROM AUTHOR]

Objectives To identify the determinants of antihypertensive medication adherence in community-living elderly adults. Design Longitudinal observational study. Setting Population-based health survey in the province of Quebec, Canada. Participants Data from a representative sample (N = 2,811) of community-dwelling adults in Quebec aged 65 and older participating in the Étude sur la Santé des Aînés study. The final study sample analyzed consisted of 926 participants taking antihypertensive drugs during the 2 years of the study. Measurements Adherence to antihypertensive medication was measured using days of supply obtained during a specified time period. Depression and anxiety disorders were assessed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, and physical health status was measured using the Charlson Comorbidity Index. Other factors considered were age, education, marital status, annual family income, and number of antihypertensive drugs that participants used. Results Mean antihypertensive proportion (percentage) of days supplied in was 92.5% in Year 1 and 59.4% in Year 2. The presence of depression and anxiety disorders and the number of antihypertensive medications significantly predicted medication adherence. The sex by depression and anxiety disorders interaction term was significant. Conclusion Adherence to antihypertensive medication was significantly associated with depression and anxiety disorders in men but not women. The treatment of depression and anxiety disorders in individuals with hypertension may be helpful in improving medication adherence rates and healthcare outcomes. [ABSTRACT FROM AUTHOR]

Our findings help identify workplaces that have higher risks of COVID-19 outbreaks, such as workplaces with high on-site worker counts, that employ temporary foreign workers, that employ staff who have contact with clients or that are localized in an urban setting. This information is instrumental in better addressing occupational hazards and risks. Objectives: The aims of the studies are to describe COVID-19 outbreaks in the workplaces of the Monteregie Region, Quebec, Canada, and to evaluate potential risk factors for identifying at least one COVID-19 outbreak in these workplaces. Methods: An ecological retrospective cohort study was conducted using deidentified databases of COVID-19 outbreaks that occurred in workplaces from February 27, 2020, to June 30, 2021. Results: Among 30,489 workplaces studied, 897 workplaces with at least one COVID-19 outbreak were identified. These outbreaks were associated with a sizeable number of workers in the workplace (adjusted odds ratio [aOR] = 6.78; 95% CI: 5.43–8.47), the presence of temporary foreign workers (aOR = 2.26; 95% CI: 1.53–3.33), contacts with clients (aOR = 1.93; 95% CI: 1.68–2.21), and being localized in the Montreal Metropolitan Area (aOR = 1.26; 95% CI: 1.09–1.45). Conclusions: These results enable the identification of potential risk factors for COVID-19 outbreaks in workplaces, with the aim of targeting workplaces where infection control and prevention measures might be enhanced or adapted to improve workers' health. [ABSTRACT FROM AUTHOR]