Relationship between nutritional condition and causes of death in beluga whales Delphinapterus leucas from the St. Lawrence estuary, Quebec, Canada.

Carcasses of endangered beluga whales Delphinapterus leucas from the St. Lawrence Estuary, Canada, have been examined consistently since 1983 to determine causes of death. The objective of this study is to compare the nutritional condition of belugas that died of different causes. Previously published categories of death were refined to discriminate acute from chronic pathological processes. Bayesian linear models were used to predict cause of death from the scaled mass index (SMI). Causes of death were as follows: 'bacterial diseases', 'verminous pneumonia', 'toxoplasmosis', 'other parasitic diseases', 'other infectious diseases', 'trauma-entrapment', 'other noninfectious diseases', 'dystocia-postpartum complications', 'neonatal mortality', 'cancer', 'primary starvation' and 'undetermined'. The models predicted a lower nutritional condition for the 'neonatal mortality' in belugas <290 cm in length and for 'primary starvation' and 'verminous pneumonia' categories for belugas ≥290 cm. Belugas that died from 'dystocia-postpartum complications' or from 'undetermined causes' had a higher-than-average SMI. Animals in the 'trauma-entrapment' category did not exhibit the highest nutritional condition, which was unexpected since individuals that died from trauma or entrapment are often used as references for optimal nutritional condition in other cetacean populations. Females that died from dystocia and postpartum complications were in similar nutritional condition as females dead from other causes during, or shortly after, pregnancy. This suggests that these females are not obese, ruling out a possible cause of dystocia. Although studying dead animals biases results toward low nutritional condition, our findings support the link between chronic pathological processes and poorer nutritional condition in belugas.

Trends in COPD severe exacerbations, and all-cause and respiratory mortality, before and after implementation of newer long-acting bronchodilators in a large population-based cohort.

BACKGROUND: Little is known about the trends in morbidity and mortality at the population level that followed the introduction of newer once-daily long-acting bronchodilators for COPD. The purpose of the study was to evaluate whether the availability of new bronchodilators was associated with changes in the temporal trends in severe COPD exacerbations and mortality between 2007 and 2018 in the older population with COPD; and whether this association was homogeneous across sex and socioeconomic status classes. METHODS: We used an interrupted time-series and three segments multivariate autoregressive models to evaluate the adjusted changes in slopes (i.e., trend effect) in monthly severe exacerbation and mortality rates after 03/2013 and 02/2015 compared to the tiotropium period (04/2007 to 02/2013). Cohorts of individuals > 65 years with COPD were created from the nationally representative database of the Quebec Integrated Chronic Disease Surveillance System in the province of Quebec, Canada. Whether these trends were similar for men and women and across different socioeconomic status classes was also assessed. RESULTS: There were 130,750 hospitalizations for severe exacerbation and 104,460 deaths, including 24,457 (23.4%) respiratory-related deaths, over the study period (928,934 person-years). Significant changes in trends were seen after 03/2013 for all-cause mortality (-1.14%/month;95%CI -1.90% to -0.38%), which further decreased after 02/2015 (-1.78%/month;95%CI -2.70% to -0.38%). Decreases in respiratory-related mortality (-2.45%/month;95%CI -4.38% to -0.47%) and severe exacerbation (-1,90%/month;95%CI -3.04% to -0.75%) rates were only observed after 02/2015. These observations tended to be more pronounced in women than in men and in higher socioeconomic status groups (less deprived) than in lower socioeconomic status groups (more deprived). CONCLUSIONS: The arrival of newer bronchodilators was chronologically associated with reduced trends in severe exacerbation, all-cause and respiratory-related mortality rates among people with COPD > 65 years. Our findings document population benefits on key patient-relevant outcomes in the years following the introduction of newer once-daily long-acting bronchodilators and their combinations, which were likely multifactorial. Public health efforts should focus on closing the gap between lower and higher socioeconomic status groups.

Increasing our knowledge about the epidemiology of Helicobacter pylori in Nunavik's Inuit population (Québec, Canada) using Qanuilirpitaa? 2017 cross-sectional survey.

Helicobacter pylori is a bacterium that may colonise and proliferate in human stomachs, leading invariably to chronic inflammation and, to a lesser extent, to peptic ulcers and cancer. The main objective of this study is to describe the epidemiology surrounding H. pylori in Nunavik's Inuit population using the 2004 and 2017 Health Surveys. Estimated prevalences were 70.9% for bacterial colonisation using a stool antigens test (SAT), 72.5% for anti-H. pylori antibodies, 12.7% for faecal occult blood in participants aged ≥ 50 and respectively of 28.4%, 11.2% and 2.4% for a prior diagnosis of colonisation, gastritis and peptic ulcer in the medical charts, with under five cases of gastric cancer reported. Variables associated with higher SAT+ prevalence were the number of household members (prevalence ratio [PR] = 1.03) and age (quadratic relationship), whereas mainly drinking municipal (PR = 0.84) and natural water (PR = 0.72) compared to bottled water, and increasing alcohol consumption (PR = 0.96) were associated with reduced prevalence. Despite current regional guidelines targeting high risk individuals in the context of high prevalence, Nunavik's health authorities must remain vigilant by following gastric cancer incidence and the rapid evolution of guidelines, while considering local realities.

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.

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.

[Burnout, Secondary Traumatic Stress and Psychological Distress of Intervention Workers and Managers in the Community Sector in Quebec. Portrait of the Situation During the COVID-19 Pandemic]. / Burnout, stress traumatique secondaire et détresse psychologique chez les intervenant(e)s et les gestionnaires dans le milieu communautaire au Québec. Portrait de la situation pendant la pandémie de la COVID-19.

Objectives This article looks at emotional difficulties experienced by intervention workers and managers from three associations of community organizations (mental health, homelessness and for people with disabilities) in Quebec during the COVID-19 pandemic. More specifically, we document manifestations, sometimes concurrent, of burnout, secondary traumatic stress and psychological distress reported by participants, comparing participants who reported having a management role with those who did not. Method Analyses were conducted based on responses of almost 300 participants to an online questionnaire comprised of 140 items, including scales pertaining to psychosocial risks, professional life quality and psychological distress. Results Our results show that many participants experience emotional difficulties, often experiencing mid levels of burnout, secondary traumatic stress and mid or high levels of psychological distress, or sometimes a combination of two or three difficulties concomitantly. The odds were higher for participants with management roles to obtain a higher score for burnout and psychological distress than for those who did not have a management role. Conclusion Contrary to an observed tendency of focusing on the bettering of individual adaptation skills to stressful situations, emotional difficulties experienced by intervention workers are a collective issue that therefore requires collective solutions. Two limits of this study are the question of the sample's representativity, as well as the way our results could reflect or not the situation of intervention workers in the public sector in Quebec or elsewhere in Canada.

The effect of Montreal's supervised consumption sites on injection-related infections among people who inject drugs: An interrupted time series.

BACKGROUND: Between June and November 2017, four supervised consumption sites (SCS) began operating in Montreal, Quebec. Earlier studies on SCS focused on examining their effects on blood-borne viral infections and overdose mortality. Our objective was to examine the effect of Montreal's SCS on the incidence, health service use and outcomes of injection-related infections (IRI) in people who inject drugs. METHODS: We used Quebec's provincial administrative health data to identify people who inject drugs in Montreal and calculated the incidence of IRI in this population between December 2014 and December 2019. We conducted a retrospective, population-based interrupted time series to estimate the effect of Montreal's four SCS on the monthly incidence rates of IRI-related hospitalizations, emergency department (ED) visits, physician visits, and mortality. We also examined the effects of SCS on average length of IRI-related hospitalizations and incidence of hospitalizations involving surgery. RESULTS: The average age of Montreal's people who inject drugs was 41.84 years, and 66.41% were male. After the implementation of SCS, there was a positive level change in the incidence of hospitalizations (0.97; 95% confidence interval [CI]: 0.26, 1.68) for IRI. There was also a significant post-intervention decline in hospitalization trends (-0.05; 95% CI: -0.08, -0.02), with modest trend changes in ED visits (-0.02; 95% CI: -0.05, 0.02). However, post-intervention changes in level (0.72; 95% CI: -3.85, 5.29) and trend (0.06; 95% CI: -0.23, 0.34) for physician visits remained limited. SCS had no effect on the average length of hospitalizations, but there was a decreasing post-intervention trend in hospitalizations involving surgery (-0.03; 95% CI: -0.06, 0.00). CONCLUSION: Following the opening of the SCS, there was a moderate decline in the rate of hospitalizations to treat IRI, but the impact of the sites on the rate of physician visits remained limited. These findings suggest that SCS may mitigate the incidence of more serious and complicated IRI over time.

Phylogenetic Network Analyses Reveal the Influence of Transmission Clustering on the Spread of HIV Drug Resistance in Quebec from 2002 to 2022.

BACKGROUND: HIV drug resistance (HIV-DR) may jeopardize the benefit of antiretroviral therapy (ART) in treatment and prevention. This study utilized viral phylogenetics to resolve the influence of transmission networks on sustaining the spread of HIV-DR in Quebec spanning 2002 to 2022. METHODS: Time trends in acquired (ADR) and transmitted drug resistance (TDR) were delineated in treatment-experienced (n = 3500) and ART-naïve persons (n = 6011) with subtype B infections. Similarly, non-B-subtype HIV-DR networks were assessed pre- (n = 1577) and post-ART experience (n = 488). Risks of acquisition of resistance-associated mutations (RAMs) were related to clustering using 1, 2-5, vs. 6+ members per cluster as categorical variables. RESULTS: Despite steady declines in treatment failure and ADR since 2007, rates of TDR among newly infected, ART-naive persons remained at 14% spanning the 2007-2011, 2012-2016, and 2017-2022 periods. Notably, half of new infections among men having sex with men and heterosexual groups were linked in large, clustered networks having a median of 35 (14-73 IQR) and 16 (9-26 IQR) members per cluster, respectively. Cluster membership and size were implicated in forward transmission of non-nucleoside reverse transcriptase inhibitor NNRTI RAMs (9%) and thymidine analogue mutations (TAMs) (5%). In contrast, transmission of M184V, K65R, and integrase inhibitors (1-2%) remained rare. Levels of TDR reflected viral replicative fitness. The median baseline viremia in ART-naïve groups having no RAMs, NNRTI RAMs, TAMs, and M184VI were 46.088, 38,447, 20,330, and 6811 copies/mL, respectively (p < 0.0001). CONCLUSION: Phylogenetics emphasize the need to prioritize ART and pre-exposure prophylaxis strategies to avert the expansion of transmission cascades of HIV-DR.

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.

Trends in toxicological findings in unintentional opioid or stimulant toxicity deaths in Québec, Canada, 2012-2021: Has Québec entered a new era of drug-related deaths?

INTRODUCTION: We aimed to describe rates and toxicological findings of unintentional opioid and stimulant toxicity deaths, 2012-2021. METHODS: The dataset included accidental deaths determined by the Coroner to be due to opioids or stimulants. We calculated annual crude mortality rates and described combinations of drugs identified in toxicological examinations of these deaths. We described temporal trends in the detection of specific opioids, stimulants, benzodiazepines (including novel benzodiazepines), gabapentinoids and z-drugs in deaths due to opioids and stimulants. RESULTS: Mortality rates increased over time, reaching their peak in 2020 and remaining high in 2021. In deaths due to opioids, there was a decline in the proportion of deaths involving pharmaceutical opioids after 2019, and a corresponding increase in the proportion of deaths with fentanyl detected. Benzodiazepines were often present in deaths due to opioids, with novel benzodiazepines increasing rapidly from 2019 onwards. Cocaine was the most frequently detected drug in deaths due to stimulants, but amphetamine/methamphetamine was detected in around half of all stimulant deaths from 2016 onwards. DISCUSSION AND CONCLUSIONS: Despite availability of a multitude of overdose prevention interventions, mortality rates due to drug toxicity have increased in Québec. Toxicological findings of these deaths suggest concerning shifts in the illicit drug market, with Québec potentially having entered a new era of elevated overdose mortality. Intervention scale-up is essential, but unlikely to be sufficient, to reduce drug-related mortality. Policy reform to address the root causes of drug toxicity deaths, including an unpredictable drug supply, strained health systems and socio-economic precarity, is essential.

[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.

Socioeconomic risk and the longitudinal child lifetime prevalence of child protection involvement.

BACKGROUND: North American studies find that geographic indicators of disadvantage, such as concentrated poverty, significantly increase the risk of child protection involvement. Despite having one of the most extensive family support systems and progressive income redistribution policies in North America, the Canadian province of Québec still faces geographic variations in socioeconomic conditions that remain a major risk factor for child protection involvement. OBJECTIVE: This study asks how child protection involvement is distributed across socioeconomically distinct geographic areas of the province. Drawing from prior literature, we hypothesize that the highest level of child protection involvement across childhood (age 0-17) is found in the lowest socioeconomic areas. PARTICIPANTS & SETTING: This is a population-based prevalence study using administrative child protection data spanning the years 2000 to 2017 across Québec. METHODS: We constructed cumulative risk life tables of first instances of child protection events (report confirmation, compromised security or development, and out-of-home placement). Prevalence rates were mapped onto 10,650 Census dissemination areas divided into three tiers according to a validated socioeconomic status (SES) index. RESULTS: The highest childhood prevalence of confirmed child protection reports, finding of compromised security or development, and out-of-home placement was found in the lowest SES areas. Rates in low SES areas can be over twice the rates in high SES areas. CONCLUSIONS: Area-level socioeconomic vulnerability remains a robust predictor of child protection involvement even in a socially progressive context. Our findings underscore that without targeted pediatric and family services, as well as poverty-alleviation programs for high-need families in high-need areas, even well-intentioned systems may fall short of reaching the families most in need.

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.

Prevalence and geographic distribution of Echinococcus genus in wild canids in southern Québec, Canada.

Echinococcus spp. is an emerging zoonotic parasite of high concern. In Canada, an increase in the number of human and animal cases diagnosed has been reported, but information regarding the parasite's distribution in wildlife reservoir remains limited. A cross-sectional study was conducted to estimate the prevalence of wild canids infected with Echinococcus spp. and Echinococcus multilocularis in areas surrounding populated zones in Québec (Canada); to investigate the presence of areas at higher risk of infection; to evaluate potential risk factors of the infection; and as a secondary objective, to compare coproscopy and RT-PCR diagnostic tests for Taenia spp. and Echinococcus identification. From October 2020 to March 2021, fecal samples were collected from 423 coyotes (Canis latrans) and 284 red foxes (Vulpes vulpes) trapped in 12 administrative regions. Real-time PCR for molecular detection of genus Echinococcus spp. and species-specific Echinococcus multilocularis were performed. A total of 38 positive cases of Echinococcus spp., of which 25 were identified as E. multilocularis, were detected. Two high-risk areas of infection were identified. The prevalence of Echinococcus spp. was 22.7% (95% CI 11.5-37.8%) in the Montérégie centered high-risk area, 26.5% (95% CI 12.9-44.4%) in the Bas-St-Laurent high-risk area, and 3.0% (95%CI 1.8-4.7%) outside those areas. For E. multilocularis, a prevalence of 20.5% (95% CI 9.8-35.3%) was estimated in the high-risk area centered in Montérégie compared to 2.4% (95% CI 1.4-3.9%) outside. Logistic regression did not show any association of infection status with species, sex, or geolocation of capture (p > 0.05). This study shows the circulation of Echinococcus in a wildlife cycle in 9/12 administrative regions of Québec.

Aggressive behaviors in first-episode psychosis: Distinction between the premorbid phase and the onset of psychosis.

BACKGROUND: There is a well-established, although complex, association between aggression and psychosis, particularly in the early stages of illness. Some persons display aggressive behaviors even prior to psychosis onset. However, factors associated with aggressive behaviors prior to and at first-episode psychosis (FEP) onset remain underdocumented. AIMS: The objective is two-fold: 1) to describe the prevalence of verbal and physical aggression occurring during the premorbid phase and at FEP onset; 2) distinguish the factors associated with aggressive behaviors during these two periods. METHOD: Data on aggressive behaviors and factors potentially associated therewith were collected through research interviews and chart reviews among 567 persons with FEP admitted to two early intervention services in Montreal, Canada. Logistic regression analyses were conducted to identify factors associated with aggressive behaviors in both periods. RESULTS: In the premorbid phase, 46.1 % (n = 257/558) of patients presented aggression (verbal: 35.9 %; towards objects: 24.2 %; against others: 27.9 %). At FEP, 18.1 % (n = 101/558) presented aggressive behaviors (verbal: 12.9 %; towards objects: 6.1 %; against others: 8.8 %). In the premorbid phase, lower education, prior justice involvement, cluster B personality traits/disorder and poorer functioning were associated with aggressive behaviors, while, at FEP, only prior homelessness was associated with aggression. CONCLUSIONS: Aggressive behaviors are frequent in patients with FEP, prior onset and at FEP. Premorbid aggressive behaviors seem to be associated with premorbid difficulties. Early detection of youth with psychosis and those at high risk of psychosis, particularly homeless youth, is necessary to provide access to early specialized interventions and possibly prevent aggressive behaviors and their consequences.

Validation of Database Autopsy for Review of Pregnancy-Associated Deaths in Canada.

The database autopsy method was developed to determine probable causes of maternal deaths in the Canadian Institute for Health Information's hospital discharge abstract database; however, the method has yet to be validated. Using immediate cause of death information from Québec's hospitalization database as the gold standard, this study assessed the validity and reliability of the database autopsy method for pregnancy-associated deaths. The method had high sensitivity and specificity for identifying the most common causes of these deaths, as well as high interobserver agreement. We conclude that the database autopsy method is valid and reliable overall.

Profiles of healthcare use of persons living with dementia: A population-based cohort study.

AIM: Persons living with dementia are a heterogeneous population with complex needs whose healthcare use varies widely. This study aimed to identify the healthcare use profiles in a cohort of persons with incident dementia, and to describe their characteristics. METHODS: This is a retrospective cohort study of health administrative data in Quebec (Canada). The study population included persons who: (i) had an incident dementia diagnosis between 1 April 2015 and 31 March 2016; (ii) were aged ≥65 years and living in the community at the time of diagnosis. We carried out a latent class analysis to identify subgroups of healthcare users. The final number of groups was chosen based on clinical interpretation and statistical indicators. RESULTS: The study cohort consisted of 15 584 individuals with incident dementia. Four profiles of healthcare users were identified: (i) Low Users (36.4%), composed of individuals with minimal healthcare use and fewer comorbidities; (ii) Ambulatory Care-Centric Users (27.5%), mainly composed of men with the highest probability of visiting cognition specialists; (iii) High Acute Hospital Users (23.6%), comprised of individuals mainly diagnosed during hospitalization, with higher comorbidities and mortality rate; and (iv) Long-Term Care Destined Users (12.5%), who showed the highest proportion of antipsychotics prescriptions and delayed hospitalization discharge. CONCLUSIONS: We identified four distinct subgroups of healthcare users within a population of persons living with dementia, providing a valuable context for the development of interventions tailored to specific needs within this diverse population. Geriatr Gerontol Int 2024; 24: 789-796.

Predicting the Population Risk of Suicide Using Routinely Collected Health Administrative Data in Quebec, Canada: Model-Based Synthetic Estimation Study.

BACKGROUND: Suicide is a significant public health issue. Many risk prediction tools have been developed to estimate an individual's risk of suicide. Risk prediction models can go beyond individual risk assessment; one important application of risk prediction models is population health planning. Suicide is a result of the interaction among the risk and protective factors at the individual, health care system, and community levels. Thus, policy and decision makers can play an important role in suicide prevention. However, few prediction models for the population risk of suicide have been developed. OBJECTIVE: This study aims to develop and validate prediction models for the population risk of suicide using health administrative data, considering individual-, health system-, and community-level predictors. METHODS: We used a case-control study design to develop sex-specific risk prediction models for suicide, using the health administrative data in Quebec, Canada. The training data included all suicide cases (n=8899) that occurred from January 1, 2002, to December 31, 2010. The control group was a 1% random sample of living individuals in each year between January 1, 2002, and December 31, 2010 (n=645,590). Logistic regression was used to develop the prediction models based on individual-, health care system-, and community-level predictors. The developed model was converted into synthetic estimation models, which concerted the individual-level predictors into community-level predictors. The synthetic estimation models were directly applied to the validation data from January 1, 2011, to December 31, 2019. We assessed the performance of the synthetic estimation models with four indicators: the agreement between predicted and observed proportions of suicide, mean average error, root mean square error, and the proportion of correctly identified high-risk regions. RESULTS: The sex-specific models based on individual data had good discrimination (male model: C=0.79; female model: C=0.85) and calibration (Brier score for male model 0.01; Brier score for female model 0.005). With the regression-based synthetic models applied in the validation data, the absolute differences between the synthetic risk estimates and observed suicide risk ranged from 0% to 0.001%. The root mean square errors were under 0.2. The synthetic estimation model for males correctly predicted 4 of 5 high-risk regions in 8 years, and the model for females correctly predicted 4 of 5 high-risk regions in 5 years. CONCLUSIONS: Using linked health administrative databases, this study demonstrated the feasibility and the validity of developing prediction models for the population risk of suicide, incorporating individual-, health system-, and community-level variables. Synthetic estimation models built on routinely collected health administrative data can accurately predict the population risk of suicide. This effort can be enhanced by timely access to other critical information at the population level.