How to mobilise users' experiential knowledge in the evaluation of advanced technologies and practices in Quebec? The example of the permanent users' and relatives' panel.

INTRODUCTION: With the purpose of supporting scientific professionals and helping them to better integrate the expertise of users in their work, a users' and relatives' panel (URP) was set up at the National Institute for Excellence in Health and Social Services in Quebec (INESSS), Canada for the social services and mental health directorate. URPs are advisory structures that mobilise the experiential knowledge of people affected by various issues. OBJECTIVES: The objective of this study is to assess from a diverse stakeholders' perceptions: (1) the experience of developing and implementing the URP within the context of an Agencies for Health Technology Assessment and Assessment of Social Services (AHTAASS), (2) the contribution of such a URP, (3) the challenges encountered and (4) the perspectives of improvement for the following years. METHODOLOGY: We conducted a qualitative descriptive evaluation study. Nineteen interviews were conducted: six with URP members and 13 with staff representatives. The documents related to the creation of the panel, the URP minutes summarising the discussions and the reports published during that period were collected and analysed. Following a preliminary round of data analysis, a debriefing meeting was conducted with a few participants to validate the results. RESULTS: The panel was set up as part of the INESSS' desire to better integrate experiential knowledge into its recommendations. Twelve projects were presented to the panel on various themes. The URP enabled health professionals to consider dimensions they had not identified, to better integrate the experiential data collected from users into their work and to develop recommendations that made more sense to users. Panel members and INESSS professionals learned to work together, moving the working methods from consultation to collaboration and even coconstruction. Based on the panel's significant contribution, the INESSS decided to maintain it and to strengthen its place in its system to better integrate the experiential knowledge of users into its work. CONCLUSION: This research illustrates how AHTAASS can set up a URP composed exclusively of users, and how it can contribute and be evaluated. It shows that URPs are structures that value the sharing of experiential knowledge of its members, humanise decision-making and give meaning to the work done by scientific professionals. PATIENT OR PUBLIC CONTRIBUTION: One patient-researcher has contributed to the preparation and writing of this manuscript.

Which factors drive the choice of the French-speaking Quebec population towards a COVID-19 vaccination programme: A discrete-choice experiment.

OBJECTIVES: The aims of this study were to elicit preferences about the coronavirus disease 2019 (COVID-19) vaccine campaign in the general French-speaking adult Quebec population and to highlight the characteristics of the vaccine campaign that were of major importance. METHODS: A discrete-choice experiment (DCE) was conducted between April and June 2021, in Quebec, Canada. A quota sampling method by age, gender and educational level was used to achieve a representative sample of the French-speaking adult population. The choice-based exercise was described by seven attributes within a vaccine campaign scenario. A mixed logit (MXL) model and a latent class logit (LCL) model were used to derive utility values. Age, gender, educational level, income and fear of COVID-19 were included as independent variables in the LCL. RESULTS: A total of 1883 respondents were included for analysis, yielding 22,586 choices. From these choices, 3425 (15.16%) were refusals. In addition, 1159 (61.55%) individuals always accepted any of the vaccination campaigns, while 92 individuals (4.89%) always refused vaccine alternatives. According to the MXL, relative weight importance of attributes was effectiveness (32.50%), risk of side effects (24.76%), level of scientific evidence (22.51%), number of shots (15.73%), priority population (3.60%), type of vaccine (0.61%), and vaccination location (0.28%). Four classes were derived from the LCL model and attributes were more or less important according to them. Class 1 (19.8%) was more concerned about the effectiveness (27.99%), safety (24.22%) and the number of shots (21.82%), class 2 (55.3%) wanted a highly effective vaccine (40.16%) and class 3 (17.6%) gave high value to the scientific evidence (42.00%). Class 4 preferences (7.4%) were more balanced, with each attribute having a relative weight ranging from 1.84% (type of vaccine) to 21.32% (risk of side effects). Membership posterior probabilities to latent classes were found to be predicted by individual factors such as gender, annual income or fear of COVID-19. CONCLUSIONS: Vaccination acceptance relies on multiple factors. This study allowed assessment of vaccination-specific issues through a choice-based exercise and description of factors influencing this choice by segmenting the sample and drawing profiles of individuals. Moreover, besides effectiveness and safety, a major point of this study was to show the importance given by the general population to the level of scientific evidence surrounding vaccines. PATIENT OR PUBLIC CONTRIBUTION: A small group of citizens was involved in the conception, design and interpretation of data. Participants of the DCE were all from the general population.

Growth trends clustering: A novel method for detecting forest disturbances and extracting climate signals in tree rings.

Tree-ring widths contain valuable historical information related to both forest disturbances and climate variability and changes within forests. However, current methods are still unable to accurately distinguish between disturbances and climate signals in tree rings, especially in the case of climate anomalies. To address this issue, we developed a novel method, called Growth Trends Clustering (GTC) that uses the distribution characteristics of tree-ring widths within a stand to distinguish the effects of climate and other forest disturbances. GTC employed a Gaussian mixture model to fit the probability density distribution of annual ring-width index (RWI) in a stand. Discriminative criteria were established to cluster diverse sub-distributions from the Gaussian mixture model into categories of growth release, suppression, or normal trends. This approach allowed us to identify the occurrence, duration, and severity of forest disturbances based on percentage changes in the growth release or suppression categories of trees. And the effect of climate on tree growth was assessed according to the mean statistics of the growth normal categories. Using common forest disturbances such as defoliating insects and thinning as examples, we validated our method using tree-ring collections from six sites in British Columbia and Quebec, Canada. We found that the GTC method was superior to traditional time-series analysis methods (e.g., Radial Growth Averaging, Boundary Line, Absolute Increase, and Curve Intervention Detection) for detecting past forest disturbances and was able to significantly enhance climate signals. In summary, the GTC method presented in this study introduces a novel statistical approach for accurately distinguishing between forest disturbances and climate signals in tree rings. This is particularly important for understanding forest disturbance regimes under climate change and for developing future disturbance mitigation strategies.

SARS-CoV-2 seroprevalence and mental health of school staff: a cross-sectional study of schools from four areas of Montreal, Quebec in 2021.

OBJECTIVES: To assess the seroprevalence of infection-acquired SARS-CoV-2 and the mental health of school/daycare staff in the months after reopening of schools in Montreal, Quebec (Canada) in the Fall of 2020 and whether these varied by school and participant characteristics. DESIGN: A cross-sectional design based on a convenience sample of schools/daycares and staff was used as the originally planned longitudinal design was no longer feasible due to obstacles in recruitment, for example, teacher's strike. SETTING: Forty-nine schools/daycares in four Montreal neighbourhoods from March to October 2021. PARTICIPANTS: Three-hundred and sixty-two participants completed both questionnaires and serology tests. PRIMARY AND SECONDARY OUTCOME MEASURES: SARS-CoV-2 seroprevalence and prevalence of anxiety, depression, resilience and burnout/emotional exhaustion. RESULTS: The seroprevalence estimate made representative to the Quebec population of educators was 8.6% (95% CI 5.2 to 13.0). The adjusted seroprevalence in high school was 20% that of elementary school (aRR=0.20, 95% CI 0.07 to 0.58). Thirty per cent of seropositive staff were exposed to a household member with confirmed COVID-19. Prevalence of high emotional exhaustion/burnout was 35%, 44% and 53% in daycare, elementary school and high school staff, respectively. However, moderate/severe anxiety and depression and low resilience did not exceed 18%. After adjusting for confounders, being very afraid of catching COVID-19 at school was associated with moderate-severe anxiety, moderate-severe depression and high emotional exhaustion (aRR=4.4, 95% CI 2.2 to 8.9; aRR=2.8, 95% CI 1.5 to 5.4; aRR=2.2, 95% CI 1.6 to 3.0, respectively). CONCLUSION: The seroprevalence, anxiety and depression among school/daycare staff were comparable to the reported levels in the adult population of Quebec. The prevalence of emotional exhaustion/burnout was high across all school levels and exceeding the average across all occupations in the USA and in teachers in Germany.

Can you be a peer if you don't share the same health or social conditions? A qualitative study on peer integration in a primary care setting.

BACKGROUND: Peer support has been extensively studied in specific areas of community-based primary care such as mental health, substance use, HIV, homelessness, and Indigenous health. These programs are often built on the assumption that peers must share similar social identities or lived experiences of disease to be effective. However, it remains unclear how peers can be integrated in general primary care setting that serves people with a diversity of health conditions and social backgrounds. METHODS: A participatory qualitative study was conducted between 2020 and 2022 to explore the feasibility, acceptability, and perceived effects of the integration of a peer support worker in a primary care setting in Montreal, Canada. A thematic analysis was performed based on semi-structured interviews (n = 18) with patients, relatives, clinicians, and a peer support worker. FINDINGS: Findings show that peers connect with patients through sharing their own hardships and how they overcame them, rather than sharing similar health or social conditions. Peers provide social support and coaching beyond the care trajectory and link identified needs with available resources in the community, bridging the gap between health and social care. Primary care clinicians benefit from peer support work, as it helps overcome therapeutic impasses and facilitates communication of patient needs. However, integrating a peer into a primary care team can be challenging due to clinicians' understanding of the nature and limits of peer support work, financial compensation, and the absence of a formal status within healthcare system. CONCLUSION: Our results show that to establish a relationship of trust, a peer does not need to share similar health or social conditions. Instead, they leverage their experiential knowledge, strengths, and abilities to create meaningful relationships and reliable connections that bridge the gap between health and social care. This, in turn, instills patients with hope for a better life, empowers them to take an active role in their own care, and helps them achieve life goals beyond healthcare. Finally, integrating peers in primary care contributes in overcoming obstacles to prevention and care, reduce distrust of institutions, prioritize needs, and help patients navigate the complexities of healthcare services.

Aiming for transformations in power: lessons from intersectoral CBPR with public housing tenants (Québec, Canada).

Intersectoral collaborations are recommended as effective strategies to reduce health inequalities. People most affected by health inequalities, as are people living in poverty, remain generally absent from such intersectoral collaborations. Community-based participatory research (CBPR) projects can be leveraged to better understand how to involve people with lived experience to support both individual and community empowerment. In this paper, we offer a critical reflection on a CBPR project conducted in public housing in Québec, Canada, that aimed to develop intersectoral collaboration between tenants and senior executives from four sectors (housing, health, city and community organizations). This single qualitative case study design consisted of fieldwork documents, observations and semi-structured interviews. Using the Emancipatory Power Framework (EPF) and the Limiting Power Framework (LPF), we describe examples of types of power and resistance shown by the tenants, the intersectoral partners and the research team. The discussion presents lessons learned through the study, including the importance for research teams to reflect on their own power, especially when aiming to reduce health inequalities. The paper concludes by describing the limitations of the analyses conducted through the EPF-LPF frameworks and suggestions to increase the transformative power of future studies.

Punishing "Privilege": Antisemitic Hate Crime in Canada.

Both federal government and civil society organization data point to consistently rising incidents of antisemitic narratives and acts across Canada. In spite of this, antisemitic hate crime has not been the focus of any academic research here, some would argue because Jews are not typically thought to be an at-risk community. Rather, the Jewish community is thought to occupy a relatively privileged place in society which shields them from bias motivated attacks. Countering this narrative, our study, based in Ontario and Quebec, reveals that Jewish individuals and institutions are highly vulnerable to discursive, physical, and property violations. Many of those we spoke with felt embattled by the narrative attacks that rendered the community vulnerable to corollary physical attacks. Of particular significance are the enabling images of Jews that equate "Jewish privilege" with excessive power and control. We explore these themes, concluding with calls for strategies intended to counter hateful narratives.

Cohort profile: the CARTaGENE Cohort Nutrition Study (Quebec, Canada).

PURPOSE: To address emerging nutritional epidemiological research questions, data from contemporary cohorts are needed. CARTaGENE is the largest ongoing prospective cohort study of men and women in Québec, Canada. Dietary information was collected making it a rich resource for the exploration of diet in the aetiology of many health outcomes. PARTICIPANTS: CARTaGENE recruited over 43 000 men and women aged 40-69 in two phases (A and B). In phase A, a total of 19 784 men and women were enrolled between 2009 and 2010. In 2011-2012, phase A participants of CARTaGENE were recontacted and invited to complete the self-administered Canadian Diet History Questionnaire II, which assessed usual intake over the past 12 months of a comprehensive array of foods, beverages and supplements; 9379 participants with non-missing age and sex data and with plausible total energy intake comprise the CARTaGENE Cohort Nutrition Study (4212 men; 5167 women). FINDINGS TO DATE: Available dietary data include intake of total energy, macronutrients and micronutrients, food group equivalents and a measure of diet quality based on the Canadian Healthy Eating Index 2005 (C-HEI 2005). Intake and diet quality varied among participants though they generally met the recommended dietary reference intakes for most nutrients. The mean C-HEI 2005 score was 61.5 (SD=14.0; max score=100), comparable to the general Canadian population. The mean (SD) scores for men and women separately were 57.0 (14.1) and 65.2 (12.8), respectively. C-HEI scores were higher for never smokers (61.6), those who had attained more than a high school education (61.4) and those with high physical activity (60.4) compared with current smokers (55.8), less than high school education level (56.2) and low physical activity (57.6), respectively (p values<0.01). FUTURE PLANS: The CARTaGENE Cohort Nutrition Study is an additional resource of the CARTaGENE platform and is available internationally to examine research questions related to diet and health among contemporary populations. Starting in 2024, annual diet assessments using two 24-hour dietary recalls over a 30-day period will take place, further expanding the cohort as a resource for dietary research.

Childhood and Adolescent Depression Symptoms and Young Adult Mental Health and Psychosocial Outcomes.

Importance: Depression is a leading cause of disability. The timing and persistence of depression may be differentially associated with long-term mental health and psychosocial outcomes. Objective: To examine if depression symptoms during early and middle childhood and adolescence and persistent depression symptoms are associated with impaired young adult outcomes independent of early risk factors. Design, Setting, and Participants: Data for this prospective, longitudinal cohort study were from the Québec Longitudinal Study of Child Development, a representative population-based Canadian birth cohort. The cohort consists of infants born from October 1, 1997, to July 31, 1998. This is an ongoing study; data are collected annually or every 2 years and include those ages 5 months to 21 years. The end date for the data in this study was June 30, 2019, and data analyses were performed from October 4, 2022, to January 3, 2024. Exposures: Depression symptoms were assessed using maternal reports in early childhood (ages 1.5 to 6 years) from 1999 to 2004, teacher reports in middle childhood (ages 7 to 12 years) from 2005 to 2010, and self-reports in adolescence (ages 13 to 17 years) from 2011 to 2015. Main Outcomes and Measures: The primary outcome was depression symptoms at age 20 years, and secondary outcomes were indicators of psychosocial functioning (binge drinking; perceived stress; not being in education, employment, or training; social support; and experiencing online harrasment) at age 21 years. All outcomes were self-reported. Adult outcomes were reported by participants at ages 20 and 21 years from 2017 to 2019. Risk factors assessed when children were aged 5 months old were considered as covariates to assess the independent associations of childhood and adolescent depression symptoms with adult outcomes. Results: The cohort consisted of 2120 infants. The analytic sample size varied from 1118 to 1254 participants across outcomes (56.85% to 57.96% female). Concerning the primary outcome, adjusting for early risk factors and multiple testing, depression symptoms during adolescence were associated with higher levels of depression symptoms (ß, 1.08 [95% CI, 0.84-1.32]; P < .001 unadjusted and Bonferroni adjusted) in young adulthood. Concerning the secondary outcomes, depression symptoms in adolescence were only associated with perceived stress (ß, 3.63 [95% CI, 2.66-4.60]; P < .001 unadjusted and Bonferroni adjusted), while both middle-childhood (ß, -1.58 [95% CI, -2.65 to -0.51]; P = .003 unadjusted and P < .001 Bonferroni adjusted) and adolescent (ß, -1.97 [95% CI, -2.53 to -1.41]; P < .001 unadjusted and Bonferroni adjusted) depression symptoms were associated with lower levels of social support. There were no associations for binge drinking; not being in education, employment, or training; or experiencing online harrasment. Conclusions and Relevance: In this cohort study of Canadian children and adolescents, childhood and adolescent depression symptoms were associated with impaired adult psychosocial functioning. Interventions should aim to screen and monitor children and adolescents for depression to inform policymaking regarding young adult mental health and psychosocial outcomes.

MSPB: a longitudinal multi-sensor dataset with phenotypic trait measurements from honey bees.

We present a one-year-long multi-sensor dataset collected from honey bee colonies (Apis mellifera) with rich phenotypic measurements. Data were collected non-stop from April 2020 to April 2021 from 53 hives located at two apiaries in Québec, Canada. The sensor data included audio features, temperature, and relative humidity. The phenotypic measurements contained beehive population, number of brood cells (eggs, larva and pupa), Varroa destructor infestation levels, defensive and hygienic behaviors, honey yield, and winter mortality. Our study is amongst the first to combine a wide variety of phenotypic trait measurements annotated by apicultural science experts with multi-sensor data, which facilitate a broader scope of analysis. We first summarize the data collection procedure, sensor data pre-processing steps, and data composition. We then provide an overview of the phenotypic data distribution as well as a visualization of the sensor data patterns. Lastly, we showcase several hive monitoring applications based on sensor data analysis and machine learning, such as winter mortality prediction, hive population estimation, and the presence of an active and laying queen.

Impact of the COVID-19 pandemic on hepatitis C virus screening in provincial prisons in Montreal, Quebec, Canada.

Background: Little is known about the impact of the COVID-19 pandemic on hepatitis C (HCV) screening efforts in carceral settings. We explored the impact of the pandemic on HCV screening in two of Quebec's largest provincial prisons. Methods: Retrospective data of HCV-related laboratory tests between July 2018 and February 2022 at l'Établissement de détention de Montréal (EDM) and l'Établissement de détention de Rivière-des-Prairies (EDRDP) were obtained. To examine the association between the pandemic and the number of HCV-antibody (HCV-Ab) tests, a three-level time period variable was created: pre-outbreak, outbreak, and post-outbreak. Negative binomial regression (with monthly admissions as an offset) was used to assess the change in HCV-Ab tests across time periods and by prisons. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were calculated. Results: A total of 1,790 HCV-Ab tests were performed; 56 (3%) were positive. Among these, 44 (79%) HCV RNA tests were performed; 23 (52%) were positive. There was a significant decrease in HCV-Ab screening at EDM during the outbreak (aOR 0.29; 95% CI 0.17-0.48) and post-outbreak (aOR 0.49; 95% CI 0.35-0.69) periods, compared to the pre-outbreak period. There was no significant change in HCV-Ab screening at EDRDP during the outbreak (aOR 0.98; 95% CI 0.49-2.11) but a significant increase in HCV-Ab screening post-outbreak (aOR 1.66; 95% CI 1.04-2.72). Conclusion: The COVID-19 pandemic negatively affected HCV screening at EDM but had minimal impact at EDRDP. To eliminate HCV from carceral settings, minimizing screening interruptions during future outbreaks and combined HCV/SARS-CoV-2 screening should be prioritized.

Insights from coronial recommendations for preventing natural deaths in sport and recreation in Québec, Canada.

Introduction: This descriptive retrospective study analyzed coronial recommendations for natural deaths in sport and recreation from January 2006 to December 2019 using data from the Bureau du coroner du Québec. Methods: Reports with recommendations were analyzed by sex, age group, cause of death, context, and activity. The nature of recommendations was assessed using a public health-based model. Thematic analysis was conducted following a four-phase approach in which themes developed were emphasized and further connected with existing literature. Results: Reports involving individuals aged 18-24 and reports related to ice hockey were significantly more likely to contain recommendations. Reports related to individuals ≥45 years old, or related to cycling or hunting had higher death frequencies, but relatively low recommendation rates. Most recommendations aligned with the public health-based model but specifying implementation time frames was rare (11.7%). Nearly 60% of coroner's recommendations focused on automated external defibrillator implementation, delivery and training. Discussion: Mitigation of sudden cardiac arrest risk for individuals ≥45 years old, timely treatment of life-threatening arrhythmias especially for activity practiced in remote regions and specifying implementation time frames were identified as improvement areas. The multi-faceted approach to enhancing public access defibrillation developed by the International Liaison Committee on Resuscitation in 2022 addresses recurrent themes covered by coroners and holds the potential to inform evidence-based decision making.

Varroa destructor and deformed wing virus interaction increases incidence of winter mortality in honey bee colonies.

Winter mortality of honey bee colonies represents a major source of economic loss for the beekeeping industry. The objectives of this prospective study were to estimate the incidence risk of winter colony mortality in southwestern Quebec, Canada and to evaluate and quantify the impact of the associated risk factors. A total of 242 colonies from 31 apiaries was selected for sampling in August 2017. The presence of Varroa destructor, Vairimorpha (Nosema) spp., Melissococcus plutonius, deformed wing virus (DWV), and viruses of the acute-Kashmir-Israeli complex (AKI complex) was investigated in each colony. Management practices of the various colonies were obtained from a questionnaire. The incidence risk of colony mortality during the winter of 2017-2018 was estimated to be 26.5% [95% confidence interval (CI): 15.4 to 40.3]. In logistic regression modeling of winter mortality in colonies, an interaction was discovered between V. destructor and DWV; the detection of ≥ 1 V. destructor mites per 100 bees was associated with higher odds of mortality (3.46, 95% CI: 1.35 to 8.90) compared to colonies with < 1 mite per 100 bees, but only in DWV-positive colonies. There were more colony losses in apiaries from beekeepers owning 1 to 5 colonies than in apiaries from beekeepers owning over 100 colonies, which suggests that beekeeper experience and/or type of management are important contributors to winter colony mortality. Assuming a causal relationship, the results of this study suggest that up to 9% of all colony mortalities in the population could have been prevented by reducing the level of V. destructor to < 1 mite per 100 bees in all colonies.

La mortalité hivernale des colonies d'abeilles est une cause importante de pertes économiques en apiculture. Cette étude prospective visait à estimer le risque d'incidence de mortalité hivernale des colonies d'abeilles et les facteurs de risque associés dans le sud-ouest du Québec (Canada). Au total, 242 colonies provenant de 31 ruches ont été sélectionnées en août 2017. La présence de Varroa destructor, de Vairimorpha (Nosema) spp., de Melissococcus plutonius, du virus des ailes déformées (DWV) et des virus du complexe AKI ont été évalués. Les pratiques de régie ont été obtenues selon un questionnaire. Le risque de mortalité des colonies à l'hiver 2017­2018 a été estimé à 26,5 % (95 % CI : 15,4 à 40,3). Dans un modèle de régression logistique, la détection de ≥ 1 mite de V. destructor par 100 abeilles était associée à des cotes plus élevées de mortalité (3,46, 95 % CI : 1,35 à 8,90) comparativement aux colonies avec < 1 mite par 100 abeilles, mais seulement pour les colonies positives au DWV. Les ruchers d'apiculteurs possédant entre 1 et 5 colonies présentaient une mortalité plus élevée comparativement à ceux d'apiculteurs possédant plus de 100 colonies, suggérant une influence de l'expérience ou du type de régie. En assumant une relation causale, les résultats de cette étude suggèrent que jusqu'à 9 % de toutes les mortalités hivernales observées dans la population auraient pu être prévenues en réduisant le niveau d'infestation par V. destructor à moins d'une mite per 100 abeilles dans toutes les colonies.(Traduit par les auteurs).

Uncovering wastewater treatment plants as possible sources of legionellosis clusters through spatial statistics approach and environmental analysis.

Wastewater treatment plants (WWTPs) are suspected reservoirs of Legionella pneumophila (Lp). The required aeration and mixing steps lead to the emission and dispersion of bioaerosols potentially harboring Lp. The aim of the project is to evaluate municipal WWTPs as a possible source of legionellosis through the statistical analysis of case clusters. A space-time scanning statistical method was implemented in SaTScan software to identify and analyze WWTPs located within and close to spatiotemporal clusters of legionellosis detected in Quebec between 2016 and 2020. In parallel, WWTPs were ranked according to their pollutant load, flow rate and treatment type. These parameters were used to evaluate the WWTP susceptibility to generate and disperse bioaerosols. Results show that 37 of the 874 WWTPs are located inside a legionellosis cluster study zone, including six of the 40 WWTPs ranked most susceptible. In addition, two susceptible WWTPs located within an extended area of 2.5 km from the study zone (2.5-km buffer) were included, for a total of 39 WWTPs. The selected 39 WWTPs were further studied to document proximity of population, dominant wind direction, and surrounding water quality. Samples collected from the influent and the effluent of six selected WWTPs revealed the presence of Legionella spp. in 92.3% of the samples. Lp and Lp serogroupg 1 (Lp sg1) were detected below the limit of quantification in 69% and 46% of the samples, respectively. The presence of Legionella in wastewater and the novel statistical approach presented here provides information to the public health authorities regarding the investigation of WWTPs as a possible source of Legionella exposure, sporadic cases, and clusters of legionellosis.

Implementing the patient partnership approach to quality improvement of care and services: A multiple case study protocol.

CONTEXT: Patient and family partners are being increasingly engaged worldwide in processes aimed at the quality improvement (QI) of healthcare services. There is also growing interest in documenting these engagement processes within organizations to share and improve them. To support the provincial implementation of this approach, the Quebec's ministry of health and social services published, in 2018, the "Framework for the partnership approach between patients, their families and health and social service stakeholders". However, while this framework provides guidelines by describing each partner's role and the ways in which patient and family partners should be engaged in QI processes, it remains unclear how these recommendations were actually used and implemented by different healthcare organizations. The aim of this paper is to present the protocol of a multiple case study that is being conducted to document how this approach was implemented in different large healthcare organizations in Quebec. This study is being conducted in partnership with a patient partner/co-researcher. METHODS: This qualitative multiple case study will be conducted in four large healthcare organizations in Quebec. Twelve to 15 key respondents will be recruited for each case. Data will be collected from multiple sources: 1) semi-structured individual interviews with the key respondents, 2) non-participant observations of the meetings of the QI committee engaging PFPs and 3) analysis of documents describing the implementation context, vision, structures and/or processes. The framework method will be used to conduct intracase and intercase qualitative data analysis. DISCUSSION: The multiple cases included will allow for comparisons between different ways of engaging PFPs in QI processes within an organization, the factors influencing these practices, their advantages and disadvantages, and their implementation outcomes. The conclusions drawn from this study will allow us to make recommendations regarding PFP engagement in the QI of care and services and to propose implementation examples for other organizations wishing to design and implement PFP engagement initiatives in their context in Quebec or elsewhere.

[Domestic violence among Quebec women during the health crisis: Trends and risk factors]. / La violence conjugale chez les femmes québécoises durant la crise sanitaire : évolution et facteurs de risque.

This article examines the evolution of domestic violence (DV) among Quebec women during the Covid-19 pandemic and the factors associated with this phenomenon. Based on the literature, we observed that DV increased significantly in Quebec during the health crisis. Furthermore, it appears that job loss, which affected more women than men, increased social isolation, deterioration of the mental health of spouses, increased alcohol and cannabis consumption, and difficulties in reconciling work and family life are the factors that contribute most to the increase in DV in Quebec during this period.

Emergency Department Use among Patients with Mental Health Problems: Profiles, Correlates, and Outcomes.

Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012-2017), using Quebec (Canada) administrative databases. ED user profiles were identified through latent class analysis, and multinomial logistic regression used to associate patients' characteristics and their outpatient service use. Cox regressions were conducted to assess adverse outcomes 12 months after the last ED use. Four ED user profiles were identified: "Patients mostly using EDs for accessing MH services" (Profile 1, incident MDs); "Repeat ED users" (Profile 2); "High ED users" (Profile 3); "Very high and recurrent high ED users" (Profile 4). Profile 4 and 3 patients exhibited the highest ED use along with severe conditions yet received the most outpatient care. The risk of hospitalization and death was higher in these profiles. Their frequent ED use and adverse outcomes might stem from unmet needs and suboptimal care. Assertive community treatments and intensive case management could be recommended for Profiles 4 and 3, and more extensive team-based GP care for Profiles 2 and 1.

A comparison of self-reported chronic disease, health awareness and behaviours in social housing residents: cross-sectional study of communities in Ontario and Quebec.

OBJECTIVE: Social housing programs are integral to making housing more affordable to Canadian seniors living in poverty. Although the programs are similar across Canada, there may be inter-provincial differences among the health of residents that could guide the development of interventions. This study explores the health of low-income seniors living in social housing in Quebec and compares it with previously reported data from Ontario. RESULTS: 80 responses were obtained in Quebec to compare with the previously reported Ontario data (n = 599) for a total of 679 responses. More Ontario residents had access to a family doctor (p < 0.001). Quebec residents experienced less problems with self-care (p = 0.017) and less mobility issues (p = 0.052). The visual analog scale for overall health state was similar in both provinces (mean = 67.36 in Ontario and 69.23 in Quebec). Residents in Quebec smoked more cigarettes per day (p = 0.009). More residents in Ontario participated in moderate physical activity (p = 0.09), however, they also spent more time per day on the computer (p = 0.006).

Comparing standardised precipitation and barley yield across Quebec.

Climate change and variability continue to affect crop production across the world in general and in Quebec in particular. Therefore, it is important to better understand this climate-yield nexus. Unfortunately, in Quebec, there are currently no studies that analyse both precipitation and barley yield. This study aims at filling this research gap by comparing standardised precipitation (SPI) against barley yield gaps across Quebec for three peripheral and three southern/central regions of Quebec. The study uses growing season precipitation data from Ouranos and barley yield data from Institut de la Statistique du Québec. This work deploys the use of standardised index (SPI) index and a machine learning yield gap algorithm (actual barley yield minus projected barley yield) to provide a provincial portrait of the relationships between SPI and barley yield. The results show that the peripheral regions record below zero SPIs (Abitibi-Temiscamingue - 0.48, Saguenay-Lac-Saint-Jean - 0.14 and Outaouais - 0.10) and more yield gap years, while the southern/central regions record positive SPIs (Estrie 1.17, Centre du Quebec 0.86 and Monteregie: 0.33) and fewer years with yield gaps. This shows that there is a south-north gradient in the variations of SPI and yield gaps. The SPI and yield patterns can be explained by prolonged winters further north of Quebec and recently winters with insufficient snow cover which triggers rapid snow melt and thus shortening the growing season for barley. Policy actions around drought-resistant varieties within a co-creation context and more research that explores daily and monthly liquid precipitation totals during the growing season of the crop need to be explored. There is also a need to better understand the economic costs and benefits of the associated yield gaps as well as the impacts of temperature.

Physiological response during exercise is preserved in children exposed to a suboptimal gestational environment.

OBJECTIVE: This study investigated whether exposure to suboptimal gestational factors (SGFs) alters mechanical efficiency (ME) and substrate oxidation during rest and exercise in children as a mechanism contributing to obesity. METHODS: Data from the Quebec Adiposity and Lifestyle Investigation in Youth cohort were used. Children aged 8 to 10 years performed an incremental maximal cycling test with indirect calorimetry. Their ME was measured during submaximal and maximal effort. The substrate oxidation during rest and submaximal effort was also computed. ME and substrate oxidation results between children exposed to each SGF during pregnancy (gestational diabetes mellitus: n = 68; hypertensive disorders: n = 49; maternal smoking: n = 77) and nonexposed children (n = 370) were compared. RESULTS: No difference was observed for ME during submaximal (F[3,540] = 0.46, p = 0.713) and maximal effort (F[3,545] = 0.86, p = 0.463) between exposed and nonexposed children. The percentage contributions of lipids and carbohydrates did not differ during rest (F[3,545] =1.68, p = 0.169) or submaximal exercise (F[3,544] = 0.31, p = 0.534) between exposed and nonexposed children. CONCLUSIONS: Children exposed to investigated SGFs display a similar physiological response regarding ME and substrate oxidation during rest and exercise compared to nonexposed children. Future studies should confirm these novel results and continue investigating other research avenues to explain the higher risk of obesity in this population.