Jean-Yves Frappier

Canadian Consensus Guidelines on Human Papillomavirus

OBJECTIVE To serve as a guideline for health care providers on the use of continuous and extended combined hormonal contraception regimens, to prevent pregnancy, and to delay menses that affect health-related quality of life. OPTIONS All combined hormonal contraceptive methods available in Canada that may be used in a continuous or extended regimen are reviewed, and the implications are discussed. OUTCOMES Efficacy of cited regimens and assessment of their side effects, patient safety, medical usage and non-contraceptive benefits, cost-effectiveness, and availability in Canada. Indications for patient counselling are also provided. EVIDENCE Medline, PubMed, and Cochrane Database were searched for articles published in English between 1977 and May 2007. Relevant publications and position papers from appropriate reproductive health and family planning organizations were also reviewed. VALUES The quality of evidence is rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS The guideline is intended to help reduce unintended pregnancies and improve health-related quality of life in women who find their menses problematic. Increased awareness and empowerment of women, their partners, and health care professionals will improve their ability to make appropriate choices between continuous or extended and cyclic usage of these regimens. SPONSORS The development of this guideline has been supported by unrestricted grants from Bayer HealthCare Pharmaceuticals, Janssen Ortho, Organon Canada Ltd., Paladin Labs Inc., Pfizer Canada Inc., and Wyeth Pharmaceuticals.Objective: To promote guidelines for health care providers on the key aspects of HPV infection and the management of HPV-related disease in the new era of vaccine availability.

Evaluation of a Sexual Abuse Prevention Workshop in a Multicultural, Impoverished Urban Area

Participants in the ESPACE sexual abuse prevention workshop were in grades 1 through 4 and attended three Montreal, Canada, public schools in low socioeconomic areas. The sample was culturally diverse, with half born outside of Canada. An evaluation was conducted to explore the effects associated with participating in the workshop and the effects of booster sessions conducted two years later. Outcomes included knowledge gained, the ability to offer behavioral responses to abusive situations, peer victimization, sense of safety, empathy, self-efficacy, and support. Results revealed that participants in this sample obtained low scores on measures of sexual abuse knowledge and that short booster sessions that elicit childrens recall of the learned material might produce greater improvements.

Parental Support Provided by Nonoffending Caregivers to Sexually Abused Children: A Comparison Between Mothers and Fathers

Parental support provided to child sexual abuse (CSA) victims is a key element in their recovery process. Yet, little is known about the extent and nature of support provided by fathers when they are not identified as the perpetrators. This study compares abuse-specific and nonspecific support provided by 92 mothers and 32 fathers after disclosure and six months later. The assessment of both types of support revealed that only the provision of nonspecific support was predicted by gender. With the exception of social support, all other dimensions increased in the months following disclosure. Implications for child protective agencies include early detection of a small group of parents who may have difficulty offering support to their child, in order to foster the development of optimal support strategies.

Psychological and Physical Health of Nonoffending Parents After Disclosure of Sexual Abuse of Their Child

ABSTRACT Disclosure of child sexual abuse can be traumatic for nonoffending parents. Research has shown its impact on mothers’ mental health, which includes heightened psychological distress, depression, and post-traumatic stress disorder. Very little is known, however, about its impact on their physical health or on fathers’ health. The self-perceived mental and physical health of nonoffending parents after child sexual abuse disclosure was compared to determine gender-related differences in this regard. Interviews were conducted with 109 mothers and 43 fathers of 6- to 13-year-old sexually abused children. Bivariate analyses revealed that a fair proportion of parents reported psychological and physical problems after disclosure. However, proportionally more mothers than fathers reported psychological distress, depression, and use of professional services. Fathers were more likely to resort to health services instead of social services and to use medication for depression. Study findings provide leads for health and social service providers for the development of intervention protocols and referral procedures sensitive to gender issues, and they shed new light on specific needs of nonoffending parents.

Sexual Health of Adolescents in Quebec Residential Youth Protection Centres

ObjectivesTo document risk behaviours and prevalence of chlamydia and gonorrhoea infections among adolescents aged 14 to17 years entering care in Quebec Youth Protection Centres (YPC).MethodsFrom July 2008 to May 2009, adolescents residing in six YPCs completed a questionnaire during a face-to-face interview. Questions covered sexual and substance use behaviours prior to admission, as well as other health issues affecting respondents’ mental and physical health. Urine samples were tested for Chlamydia trachomatis genital infection (CTGI) and Neisseria gonorrhoea genital infection (NGGI).ResultsAmong 578 participants aged 14 to 17 years, 89% had had consensual sexual relations. Sexual risk behaviours included early sexual initiation (66% at <14 years); multiple partners (median lifetime number: girls 5, boys 8); 50% or more of sexual relations under the influence of drugs or alcohol (girls 43%, boys 48%); group sex (girls 38%, boys 43%); and sex in exchange for money or other goods (girls 27%, boys 8%). Only a quarter of boys and girls used double protection (condom and a contraceptive method) during the most recent vaginal relation. A history of pregnancy was reported by 28% of girls. Prevalence of CTGI was 9.3% (CI: 5.5–14.5) among girls and 1.9% (CI: 0.6–4.4) among boys. Prevalence of NGGI gonorrhoea was 1.7% (CI: 0.3–4.8) among girls and 0% (CI: 0.0–1.4) among boys.In multivariate analyses, factors significantly associated with chlamydia infection among sexually active girls were: hospitalization for alcohol intoxication; and a history of suicidal ideation with plan.ConclusionSexual risk behaviours are common among adolescents entering YPCs, resulting in high levels of chlamydia infection. Mental health issues such as substance misuse and serious depressive symptoms are associated with these high rates. A youth’s stay in these facilities is an opportune time to screen not only for sexual risk behaviours but also for mental health problems; appropriate risk reduction education and referrals can then be provided as needed.RésuméObjectifsDécrire les comportements à risque et la prévalence des infections à chlamydia et de la gonorrhée chez les adolescents de 14 à 17 ans placés dans les centres québécois de protection de la jeunesse (CPJ).MéthodeEntre juillet 2008 et mai 2009, des adolescents placés dans six CPJ ont rempli un questionnaire au cours d’une entrevue en personne. Les questions portaient sur les comportements sexuels des répondants, leur consommation de substances avant le placement et d’autres enjeux ayant une incidence sur leur santé physique et mentale. Des échantillons d’urine ont été prélevés pour détecter les infections génitales à Chlamydiae trachomatis (IGCT) et les infections génitales à Neisseria gonorrhoeae (IGNG).RésultatsSur les 578 participants de 14 à 17 ans, 89 % avaient eu des relations sexuelles consensuelles. Les comportements sexuels à risque étaient l’initiation sexuelle précoce (66 % à <14 ans); les partenaires multiples (nombre médian à vie: filles 5, garçons 8); 50 % ou plus de relations sexuelles avec facultés affaiblies par la drogue ou l’alcool (filles 43 %, garçons 48 %); les activités sexuelles en groupe (filles 38 %, garçons 43 %); et les relations sexuelles en échange d’argent ou de cadeaux (filles 27 %, garçons 8 %). Seulement le quart des garçons et des filles avaient utilisé une double protection (condom et méthode anticonceptionnelle) au cours de leur dernière relation vaginale. Des antécédents de grossesse ont été déclarés par 28 % des filles. La prévalence des IGCT était de 9,3 % (IC: 5,5-14,5) chez les filles et de 1,9 % (IC: 0,6-4,4) chez les garçons. La prévalence des IGNG était de 1,7 % (IC: 0,3-4,8) chez les filles et de 0 % (IC: 0,0-1,4) chez les garçons.Dans nos analyses multivariées, les facteurs présentant une corrélation significative avec les infections à chlamydia chez les filles sexuellement actives étaient: l’hospitalisation pour intoxication alcoolique; et des antécédents d’idées suicidaires avec des plans.ConclusionLes comportements sexuels à risque sont courants chez les adolescents placés dans les CPJ, ce qui entraîne des niveaux élevés d’infections à chlamydia. Des troubles de santé mentale, comme l’abus de substances et les symptômes de dépression grave, sont associés à ces taux élevés. Le séjour d’une ou d’un jeune dans ces centres est un moment opportun de dépister non seulement ses comportements sexuels à risque, mais aussi ses troubles de santé mentale; on peut alors sensibiliser la personne à la réduction des risques et la diriger vers les ressources appropriées.

Impact of child sexual abuse disclosure on the health of nonoffending parents: A longitudinal perspective

ABSTRACT The impact of child sexual abuse (CSA) disclosure on parents’ psychological health has been documented among samples of nonoffending parents. Much less is known about the parents’ physical health. This study assesses the longitudinal impact of CSA disclosure on both the mental and physical health of parents and explores potential gender differences. Interviews with 92 mothers and 32 fathers were completed approximately 12 months and 18 months following disclosure. Generalized as well as mixed model analyses revealed that mothers reported more psychological distress, Posttraumatic Stress Disorder (PTSD) symptoms and activity limitation than fathers. With the exception of PTSD symptoms which showed a significant reduction over time, all other psychological and physical symptoms persisted. The findings highlight the importance of ensuring services for an extended period for the small proportion of parents who display especially high vulnerability.

Adolescents’ perceptions of the quality of interpersonal relationships and eating disorder symptom severity: The mediating role of low self-esteem and negative mood

ABSTRACT Few studies have examined how the perceived quality of multiple interpersonal relationships is related to eating disorder (ED) symptom severity in adolescents and how psychological variables might influence these associations. The aim of this study is to determine whether the perceived level of trust, communication, and alienation in the relationship with one’s mother, father, and peers are predictive of ED severity in adolescent females and to test the mediating effects of low self-esteem and negative mood on these associations. Adolescent females aged 12 to 18 (N = 186) with a diagnosis of Anorexia Nervosa (Restrictive; AN-R or Binge/Purge; AN-B/P) completed self-report measures evaluating the perceived quality of interpersonal relationships, ED symptom severity, low self-esteem, and negative mood. Multiple regressions revealed that the level of perceived alienation in the relationship with one’s mother and peers was positively associated with ED symptom severity. Low self-esteem and negative mood acted as mediators of these associations. Considering that a high level of perceived alienation in the relationship with one’s mother and peers appears to be associated with more severe ED symptoms through its impact on self-esteem and mood, improvements in the quality of these interactions are likely to be an effective target of intervention among adolescents.