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.

What do you fantasize about? An exploratory factor analysis of minor attracted person's sexual fantasies.

Current knowledge on the sexual fantasies of minor attracted persons (MAPs) is primarily focused on these individuals' attraction to minors. Furthermore, MAPs' sexual fantasies are often perceived as revolving systematically around scenarios involving a minor. However, this raises the question of whether their sexual fantasies extend beyond minors. To explore this, we analyzed data from 403 MAPs (364 men and 39 women), using a modified Joyal Sexual Fantasy Questionnaire (JSFQ). Our exploratory factor analysis (EFA) revealed 5 factors: Male Partner Focused Fantasies (α = 0.905), Female Partner Focused Fantasies (α = 0.882), Coercing Focused Fantasies (α = 0.867), Promiscuous/Unattached Focused Fantasies (α = 0.848), and Romantic/Relational Sexual Fantasies (α = 0.650). These results not only highlight the diversity of MAPs' sexual interests of beyond their attraction to minors, paving the way for further research, but also suggest new perspectives for practitioners.

Developmental Trajectories Leading to Hostility Toward Women: A Structural Equation Modeling Study.

Hostility toward women is frequently examined as a risk factor for violence against women, but research on its antecedents is sparse. The aim of this study was to explore the developmental and psychological antecedents associated with hostility toward women in a Canadian sample of sexual aggressors of women. Drawing on Malamuth's confluence model of sexual aggression, we developed a multifactorial model of hostility toward women, using structural equation modeling. The results indicate the presence of three trajectories, all starting from childhood victimization and leading to hostility toward women, involving antisocial characteristics, emotional negativity, anxiety, and depression.

Respiratory health and its determinants among Nunavimmiut: results from the Qanuilirpitaa? 2017 Nunavik Health Survey.

OBJECTIVES: Respiratory diseases are the leading cause of hospitalization in Nunavik (northern Québec, Canada) and contribute to disparities in life expectancy with the rest of Canada. As part of Qanuilirpitaa? 2017, a cross-sectional population-based health survey, we sought to describe the prevalence of respiratory health indicators, including the first estimate of airway obstruction based on spirometry in an Inuit population, and explore their associated characteristics. METHODS: We analyzed data from 1296 participants aged 16 years and older, using multivariate logistic regression to assess characteristics associated with spirometry-determined airway obstruction and self-reported respiratory symptoms, i.e., wheezing in the last year and chronic cough during at least 3 months. RESULTS: In this relatively young population (83% aged 16 to 54), the prevalences of wheezing, chronic cough, and airway obstruction were, respectively, 27% (95% CI 24-30), 21% (18-23), and 17% (14-20). These estimates are prone to biases due to the relatively low participation rate (about 37%). The most consistent associations were with smoking (≥ 15 pack-years; odds ratio [OR] 3.13, 3.39, and 2.86 for the three indicators, respectively) and food security (OR 0.55 with wheezing and OR 0.26 with chronic cough), as defined in the Household Food Security Survey Module. Wheezing was also associated with allergic sensitization to dogs (2.60) and obesity (2.18). Chronic cough was associated with respiratory infections during childhood (2.12), housing in need of major repairs (1.72), and housing crowding (1.50), and was negatively associated with participation to traditional activities (0.62) and going on the land (0.64). Airway obstruction was associated with being underweight (3.84) and post-secondary education (0.40). Among young adults and women, wheezing was also associated with any inhalation of solvents for recreational purposes during their lifetime (2.62 and 1.56, respectively), while airway obstruction was associated with regular marijuana use (2.22 and 1.84, respectively). CONCLUSION: Smoking and food insecurity are both highly prevalent and strongly associated with respiratory symptoms in Nunavik. Together with essential smoking prevention and cessation programs, our findings suggest that solving food security and housing crises, improving socioeconomic conditions, and promoting traditional lifestyle may improve respiratory health in Nunavik.

RéSUMé: OBJECTIFS: Les maladies respiratoires sont la première cause d'hospitalisation au Nunavik (Nord-du-Québec, Canada) et contribuent aux écarts d'espérance de vie avec le reste du Canada. Dans le cadre de l'enquête transversale et populationnelle Qanuilirpitaa? 2017, cette étude décrit la prévalence d'indicateurs de santé respiratoire et explore les caractéristiques qui leur sont associées. Elle fournit le premier estimé de la prévalence d'obstruction respiratoire par spirométrie dans la population inuite. MéTHODES: Les données de 1 296 participants âgés de 16 ans et plus ont été analysées par régression logistique multivariée pour évaluer les caractéristiques associées avec le wheezing (dans la dernière année), la toux chronique (durant au moins 3 mois) et l'obstruction bronchique (mesurée par spirométrie). RéSULTATS: Dans cette population relativement jeune (83 % entre 16 et 54 ans), les prévalences de wheezing, de toux chronique et d'obstruction bronchique étaient de 27 % (IC95% 24-30), 21 % (18-23) et 17 % (14-20). Ces estimés pourraient être biaisés puisque le taux de participation à l'enquête était relativement faible (environ 37 %). Les associations les plus fortes et consistantes sont observées avec le tabagisme (≥ 15 paquets-années; RC 3,13, 3,39 et 2,86 pour les trois indicateurs, respectivement) et avec la sécurité alimentaire (RC 0,55 avec le wheezing et 0,26 avec la toux chronique), définie à partir du Module d'enquête sur la sécurité alimentaire des ménages. Le wheezing était notamment associé avec la sensibilisation allergique aux chiens (2,60) et l'obésité (2,18). La toux chronique était associée avec les infections respiratoires sévères dans l'enfance (2,12), un logement ayant besoin de réparations majeures (1,72) et un logement surpeuplé (1,50); tandis que participer aux activités traditionnelles (0,62) et aller souvent dans la nature (0,64) semblaient protecteurs. L'obstruction bronchique était associée avec un faible indice de masse corporelle (3,84) et un niveau de scolarité postsecondaire (0,40). Le wheezing était aussi associé avec le fait d'avoir déjà inhalé des solvants chez les jeunes adultes (2,62) et chez les femmes (1,56), tandis que l'obstruction bronchique était associée avec la consommation régulière de cannabis chez les jeunes adultes (2,22) et chez les femmes (1,84). CONCLUSION: Le tabagisme et l'insécurité alimentaire sont fort prévalents et fortement associés avec des symptômes respiratoires au Nunavik. En plus de rappeler l'importance de la prévention du tabagisme, ces résultats supportent la pertinence des efforts communautaires et gouvernementaux pour résoudre les crises de l'insécurité alimentaire et du logement, améliorer les conditions socioéconomiques et promouvoir la culture inuite afin d'améliorer la santé respiratoire au Nunavik.

Inadequate Coping Strategies of Men who Have Committed Sexual Aggression Against Women: A Study of Their Developmental Antecedents.

Several researchers have found that men who have committed sexual aggression have inadequate coping strategies (e.g., paraphilic sexual fantasies, substance abuse). However, very few researchers have empirically examined the factors potentially associated with the development of these strategies. In 2011, Maniglio hypothesized that the inadequate coping strategies of men who have committed sexual aggression are the result of childhood victimization, mediated by internalized psychological problems. The present study therefore empirically tested this hypothesis in a Canadian sample of 205 men who had committed sexual aggression against women, of whom 37 committed sexual murder. Structural equation modeling (SEM) resulted in the identification of several direct and indirect trajectories leading from childhood victimization (psychological, physical, sexual) to the development of inadequate coping strategies (paraphilic sexual fantasies, alcohol and drug use) mediated by internalized psychological problems (e.g., anxiety, depression, social isolation). The theoretical and clinical implications of these developmental trajectories are discussed.

Sexual Recidivism During Treatment: Impact on Therapists.

There are few studies of therapists' reactions to working with individuals who have committed sexual offenses, and almost none on reactions following sexual recidivism by a patient who is currently in treatment. Consequently, the aim of the current study was to analyze the cognitive and emotional reactions, as well as the intervention strategies, of therapists who have learned of the sexual recidivism of a patient. A total of 59 participants from the province of Quebec (Canada) completed a questionnaire on their reactions to this event. Participants' responses to their patient's recidivism varied as a function of gender, experience, and the way they learned of the recidivism. The most common cognitions reported were thinking of the victim and thinking about the consequences of further judicialization for the patient and those close to them. The most common emotions reported were sadness for the victim and fear that the patient would reoffend again. The most common intervention strategies were being sensitive to the experience of the patient and asking the patient what drove them to offend. Support measures for therapists working with individuals who have committed sexual offenses during treatment are discussed.

Recidivism Rates of Treated, Non-Treated and Dropout Adolescent Who Have Sexually Offended: a Non-Randomized Study.

The primary objective of this study was to evaluate the effectiveness of a cognitive-behavioral treatment in reducing recidivism by adolescents who have sexually offended (ASO). A secondary objective was to determine whether typologies based on victim age (child, adult/peer, mixed) and relationship (intrafamilial, extra familial, intra/extra familial) discriminate ASO in terms of response to treatment and recidivism. The sample comprised 327 adolescents 12-18 years old (M = 15.8 years, SD = 1.9) who were evaluated in an outpatient clinic after committing a contact sexual assault. Official data on recidivism (criminal charges) was collected after a follow-up period of 21-162 months (M = 7.8 years, SD = 32.2). Survival analysis indicated that adolescents who completed treatment (n = 62) had a recidivism rate for violence (including sexual violence) almost half that of adolescents who had either not completed the treatment or not received treatment (n = 261), (16.1 vs. 30.7%). Neither of the two typologies studied had any effect on the completion of treatment. However, sexual aggression against adults/peers was associated with an increased probability of violent re-offending. These results confirm the effectiveness of this cognitive-behavioral treatment -which targets risk factors associated with sexual aggression as well as those associated with violence in general-in ASO.

Epidemiology associated with the exposure to Toxoplasma gondii in Nunavik's Inuit population using the 2017 Qanuilirpitaa cross-sectional health survey.

Foci of high seroprevalence against Toxoplasma gondii are observed in Nunavik, the Inuit land of Northern Quebec (Canada). Considering the rare occurrence of felids in the region, exposure is suspected to be driven by water- and food-borne transmission routes. Hypotheses were that drinking untreated water from natural sources and eating country food mostly raw increased the risk of exposure to the parasite. Data from 1,300 Inuit participants of the 2017 Nunavik Health Survey were included in three weighted robust Poisson regression models. The effect of three types of exposure variables: (1) water treatment (yes/no) and if country food was mostly eaten raw (yes/no); (2) main source of drinking water (bottled/municipal/natural) and frequency of country food consumption (continuous) and (3) drinking water risk (low/intermediate/high) and frequency of a raw country food consumption (continuous), on the presence of Toxoplasma antibodies were estimated. Models were adjusted for age, sex and ecological region, with multiple sensitivity analyses being performed. Toxoplasma gondii seroprevalences were consistently correlated with age quadratically, sex (prevalence ratio = PRwoman/man ranged from 1.18 to 1.22), ecological region (PRHudsonBay/HudsonStrait ranged from 2.18 to 2.41; PRHudsonBay/UngavaBay ranged from 1.52 to 1.59) and consuming bivalve mollusc/urchin (PR varied from 1.02 to 1.21) across all three models. Each increase of two consumptions per month of beluga (PR ranged from 1.01 to 1.03), seal liver (PR ranged from 1.01 to 1.02) and goose (PR ranged from 1.01 to 1.02) were also associated with seropositivity, albeit more clearly in models 2 and 3, while drinking water mainly from natural (PR of 1.47) or municipal (PR = 1.42) sources compared to bottled water, was correlated with seroprevalence, although results were compatible with the null. Our results suggest that both the oocyst- (mollusc/urchin, drinking water) and cyst-borne (walrus, seal liver and goose) transmission pathways could be present in Nunavik.

Previously undetected super-spreading of Mycobacterium tuberculosis revealed by deep sequencing.

Tuberculosis disproportionately affects the Canadian Inuit. To address this, it is imperative we understand transmission dynamics in this population. We investigate whether 'deep' sequencing can provide additional resolution compared to standard sequencing, using a well-characterized outbreak from the Arctic (2011-2012, 50 cases). Samples were sequenced to ~500-1000x and reads were aligned to a novel local reference genome generated with PacBio SMRT sequencing. Consensus and heterogeneous variants were identified and compared across genomes. In contrast with previous genomic analyses using ~50x depth, deep sequencing allowed us to identify a novel super-spreader who likely transmitted to up to 17 other cases during the outbreak (35% of the remaining cases that year). It is increasingly evident that within-host diversity should be incorporated into transmission analyses; deep sequencing may facilitate more accurate detection of super-spreaders and transmission clusters. This has implications not only for TB, but all genomic studies of transmission - regardless of pathogen.

In Canada, tuberculosis disproportionately affects the Inuit, a group of indigenous people inhabiting the Arctic regions. Canada is aiming to eliminate tuberculosis among the Inuit by 2030. One way to help stop transmission and prevent future outbreaks is to trace how and where the disease spreads using DNA sequencing. This information can then be used by public health organizations to identify possible interventions. Typically, the DNA of the bacterium that causes tuberculosis ­ Mycobacterium tuberculosis, or Mtb for short ­ is sequenced 50­100 times and a consensus DNA sequence is then generated for each patient from this data. These consensus DNA sequences are then compared to help piece together who infected whom. Recently, scientists have realized that the bacteria a person is infected with may have different DNA sequences due to people being infected with more than one bacterium or the bacterium developing variations in its genome after the infection. However, current DNA sequencing practices may miss these differences, making it harder to trace how the disease spreads. Now, Lee et al. show that sequencing the DNA of Mtb from an infected person 500­1000 times (i.e. ∼10-20 times more than usual) makes it easier to detect genetic differences and determine how tuberculosis spreads. This approach, also known as 'deep sequencing', was used to analyze DNA samples of Mtb collected from about 50 people during an outbreak of tuberculosis in 2011-2012, which had previously undergone standard DNA sequencing. This deep sequencing approach identified a 'super-spreading event' where one person had likely transmitted tuberculosis to up to 17 others during the outbreak. Lee et al. found that most of these people had visited the same 'gathering houses' which are social venues in the community. Implementing targeted public health interventions at these sites may help stop future outbreaks. To fully understand how useful this method will be for tracking the spread of tuberculosis, deep and routine sequencing will need to be compared against each other in different settings and outbreaks. Furthermore, the approach used in this study may be useful for tracking the transmission of other infectious diseases.

The unique contribution of a local response group in the field investigation and management of a trichinellosis outbreak in Nunavik (Québec, Canada).

SETTING: Consumption of raw game meats is important for Inuit health and well-being but may sometimes increase risk of exposure to parasites. In Nunavik, following trichinellosis outbreaks in the 1980s caused by raw walrus consumption, a diagnostic test was developed for the region and offered to all Inuit communities by 1997. Despite this prevention program, an important trichinellosis outbreak occurred in 2013, affecting 18 inhabitants of Inukjuak. INTERVENTION: Because the classical outbreak investigation did not rapidly converge toward a common food source or specific event, a local response group, composed of four community members appointed by the Municipal Council as well as the regional public health physician, nurse and wildlife parasitologist, was created. Their objective was to investigate potential sources of infection related to the outbreak, hence the investigation of the types of meats consumed, the movement of meats between and within the community, and the local practices of processing game meat. OUTCOMES: Though the source of infection was not fully confirmed, this local investigation identified the distribution of transformed polar bear meat as the most probable source of infection. The creation of this unique, intersectoral and intercultural local response group fostered the use of local knowledge to better understand aspects of the modern food system, and is one of the most innovative outcomes of this investigation. IMPLICATIONS: Integrating multiple ways of knowing was critical for the management of this important public health issue and contributed to community members' mobilization and empowerment with respect to local food safety issues.

Canadian economic impact of improved workplace productivity in patients with major depressive disorder treated with vortioxetine.

OBJECTIVE: The AtWoRC study is an interventional, open-label Canadian study that demonstrated significant improvements in cognitive function and workplace productivity in patients with major depressive disorder (MDD) treated with vortioxetine for a current major depressive episode. The objective of the present analysis was to assess the Canadian economic impact of improved workplace productivity based on the AtWoRC study results. METHODS: The economic impact of improved productivity in patients with MDD treated with vortioxetine was assessed over a 52-week period considering productivity loss due to absenteeism and presenteeism using the standard human capital approach and an employer's perspective. Absenteeism was measured with the Work Productivity and Activity Impairment questionnaire; and presenteeism with the Work Limitation Questionnaire. Productivity gains following treatment initiation with vortioxetine were estimated using the difference from baseline. RESULTS: In the AtWoRC study, patients at baseline reportedly missed, in the past 7 days, an average of 8.1 h due to absenteeism and 3.0 h due to presenteeism. Following 52 weeks of treatment with vortioxetine, patients reportedly missed an average of 4.9 h due to absenteeism and 2.0 h due to presenteeism. This improved workplace productivity translated into savings of C$110.64 for 1 week of work following 52 weeks of treatment. The cumulative 52-week economic impact showed potential savings of C$4,550 when factoring in the cost of therapy. CONCLUSION: This study suggested that workplace productivity gain due to an improvement in symptoms of MDD following treatment with vortioxetine will lead to substantial cost savings for the Canadian economy.

Real-life assessment of aripiprazole monthly (Abilify Maintena) in schizophrenia: a Canadian naturalistic non-interventional prospective cohort study.

BACKGROUND: With previously established efficacy of aripiprazole once-monthly injectable formulation (AOM) in pre-registration randomized controlled trials, the current study was designed to evaluate its effectiveness in patients treated for schizophrenia in regular clinical settings in Canada. METHODS: Following their clinicians' decision to prescribe AOM, 193 patients with a diagnosis of schizophrenia, were recruited from 17 Canadian community or hospital-based settings. The primary outcome of global functioning was assessed with the Global Assessment of Functioning Scale (GAF) at 3-month intervals for 1 year. Secondary outcomes (social and occupational functioning and illness severity) and adverse drug reactions (ADR) were also assessed. RESULTS: A majority of the 169 evaluable patients were within the first 5 years of diagnosis (early phase). A linear mixed model analysis showed a significant main effect of time (Type III test p < 0.001) after adjusting for baseline GAF score, with a change in mean GAF scores from 49 at baseline to 61 at 12 months. No differences between early vs late phase were observed. Results on secondary outcome measures of function (Social and Occupational Functioning Scale) and illness severity (Clinical Global Impression-Severity Scale and Brief Psychiatric Rating Scale) were similar. Serious ADRs were observed in 29 (14.6%) patients and akathisia in 18 (9.1%) patients. At month-12, significant (≥7%) weight gain was observed in 25.7% (n = 27/105) of patients. CONCLUSIONS: Treatment with AOM is effective in improving symptoms and functioning in schizophrenia patients treated in regular clinical settings. Akathisia was infrequent while one quarter of patients gained clinically significant weight. TRIAL REGISTRATION: Unique identifier: NCT02131415 . First posted: 06 May 2014.

Sexual Homicide in France.

The primary objective of this study was to describe and compare the modus operandi, and associated contextual and situational factors, of French serial sexual murderers (SSMs) and nonserial sexual murderers (NSMs). A further objective was to verify the generalizability of the conclusions of James and Proulx's 2016 systematic review of the modus operandi of sexual murderers, the majority of whom were American or English. Detailed data on the precrime, modus operandi, postcrime, and victimology factors of 120 French sexual murderers (SSMs: n = 33; NSMs: n = 87) were compared. The results suggest that choice-structuring properties that shape the modus operandi of French sexual murderers are similar to those reported by James and Proulx: The modus operandi of French SSMs was shaped by homicidal, sadistic, and rape fantasies, while that of NSMs was shaped by the need to satisfy immediate, especially sexual, needs. However, it should be noted that while the modus operandi of American and English NSMs is primarily shaped by general deviance, that of French NSMs appear be primarily shaped by sexual deviance.

The Unusual Suspects: Multiple-Perpetrator and Multiple Concurrent Victim Sexual Homicide.

Sexual homicide typically implies a crime involving two people: perpetrator and victim. Thus, multiple-perpetrator and multiple concurrent victim sexual murderers are unusual, empirically invisible due to their exclusion from (or burying within) research samples. The present study examines 21 such cases of male sexual murderers having perpetrated at least one sexual homicide either together with a co-offender or alone but killing two victims at once. The aim was to investigate just how unusual, or not, these cases may be in relation to current scientific understanding of sexual murderers and their crimes. A descriptive analysis of offenses (co-offender and offender-victim dynamics, modus operandi) and offender characteristics is presented. Main findings, that multiple-perpetrator and multiple concurrent victim sexual murderers are not so unusual in that they are well conceptualized through application of the established sexualized, grievance, and rape murderer typology, are discussed in relation to clinical and empirical implications.

Long-term functioning outcomes are predicted by cognitive symptoms in working patients with major depressive disorder treated with vortioxetine: results from the AtWoRC study.

OBJECTIVE: AtWoRC (Assessment in Work productivity and the Relationship with Cognitive symptoms) was an interventional, open-label, Canadian study (NCT02332954) designed to assess the association between cognitive symptoms and workplace productivity in working patients with major depressive disorder (MDD) receiving vortioxetine. METHODS: Eligible patients with MDD received vortioxetine (10-20 mg/day) and were assessed over 52 weeks at visits emulating a real-life setting (n = 199). Partial correlation between changes in patient-reported cognitive symptoms (20-item Perceived Deficits Questionnaire-Depression; PDQ-D-20) and workplace productivity (Work Limitations Questionnaire; WLQ) was assessed at 12 and 52 weeks. Additional assessments included depression severity, cognitive performance, and patient-reported functioning. Structural equations model (SEM) analyses assessed causal relationships between changes in measures of cognition and functioning over time, adjusted for improvements in depressive symptoms. RESULTS: Statistically significant improvements in all outcomes from baseline to week 52 were seen in the overall population and both subgroups (first treatment and switch). Response and remission rates were 77% and 56%, respectively. Improvements in PDQ-D-20 and WLQ productivity loss scores at weeks 12 and 52 were significantly correlated. SEM analyses found patient-rated cognitive symptoms (PDQ-D-20) at weeks 12 and 26 were significantly predictive (p < 0.05) of patient-reported functioning (Sheehan Disability Scale) at the subsequent visit. Depression severity and objectively measured cognitive performance did not significantly predict functional outcomes at any timepoint. CONCLUSION: These results demonstrate the long-term benefits of vortioxetine treatment in working patients with MDD and emphasize the strong association between cognitive symptoms and functioning in a real-world setting.

Assessment of naturally acquired neutralizing antibodies against rabies Lyssavirus in a subset of Nunavik's Inuit population considered most at risk of being exposed to rabid animals.

Contact with infected saliva through the bite of a rabid animal is the main route of infection with the rabies Lyssavirus in humans. Although a few individuals have survived the infection, rabies remains the most lethal zoonotic infection worldwide. Over the last century, the dogma that rabies is invariably fatal has been challenged by the survival and recovery of infected animals. In humans, 11 studies have found rabies virus-specific antibodies in unvaccinated individuals exposed to rabies virus reservoir species, suggesting the possibility of asymptomatic rabies virus infection, contact with non-infectious virus or exposure to the virus without viral replication. Two of these studies were conducted in Arctic hunters. Considering the extensive exposure of Nunavik's Inuit to potentially infected animals through hunting, trapping, skinning and the preparation of Arctic carnivores, we analysed archived serum samples from the 2004 Nunavik Inuit Health Survey for the presence of rabies virus-neutralizing antibodies (rVNA) in this sub-population. A total of 196 participants who were considered at highest risk for exposure to rabies virus were targeted. Serum samples were tested for the presence of rVNA using a variation of the fluorescent antibody virus neutralization test, an assay recommended for the quantification of neutralizing antibody titres following vaccination. Our study identified two seropositive individuals among the 196 participants but a review of their medical record and a phone interview revealed previous vaccination. Our results do not provide evidence for naturally acquired rVNA in Nunavik's Inuit population.

Sexual Interests of Child Sexual Exploitation Material (CSEM) Consumers: Four Patterns of Severity Over Time.

This study analyzed the evolution over time of the activity of consumers of child sexual exploitation material (CSEM). To this end, images and metadata were extracted from the hard drives of 40 individuals convicted of possession of child pornography and analyzed. A sample of these images ( N = 61,244) was categorized by the age of the subjects depicted and-using the Combating Paedophile Information Networks in Europe (COPINE) scale-by severity of the acts depicted. Collecting activity was observed to follow four patterns. The most prevalent pattern was a progressive decrease in the age of the person depicted and a progressive increase in the severity of the sexual acts. In light of the results, we propose four explanations of the nature of, and variations in, child-pornography collections.

Assessment in Work Productivity and the Relationship with Cognitive Symptoms (AtWoRC): primary analysis from a Canadian open-label study of vortioxetine in patients with major depressive disorder (MDD).

OBJECTIVE: The Assessment in Work Productivity and the Relationship with Cognitive Symptoms (AtWoRC) study aimed to assess the association between cognitive symptoms and work productivity in gainfully employed patients receiving vortioxetine for a major depressive episode (MDE). METHODS: Patients diagnosed with major depressive disorder (MDD) and treated with vortioxetine independently of study enrollment were assessed over 52 weeks at visits that emulated a real-life setting. Patients were classified as those receiving vortioxetine as the first treatment for their current MDE (first treatment) or having shown inadequate response to a previous antidepressant (switch). The primary endpoint was the correlation between changes in patient-reported cognitive symptoms (20-item Perceived Deficits Questionnaire [PDQ-D-20]) and changes in work productivity loss (Work Limitations Questionnaire [WLQ]) at week 12. Additional assessments included changes in symptom and disease severity, cognitive performance, functioning, work loss, and safety. RESULTS: In the week 12 primary analysis, 196 eligible patients at 26 Canadian sites were enrolled, received at least one treatment dose, and attended at least one postbaseline study visit. This analysis demonstrated a significant, strong correlation between PDQ-D-20 and WLQ productivity loss scores (r=0.634; p<0.001), and this correlation was significant in both first treatment and switch patients (p<0.001). A weaker correlation between Digit Symbol Substitution Test and WLQ scores was found (r=-0.244; p=0.003). CONCLUSION: At 12 weeks, improvements in cognitive dysfunction were significantly associated with improvements in workplace productivity in patients with MDD, suggesting a role for vortioxetine in functional recovery in MDD.

The Etiology of Risk in Sexual Offenders: A Preliminary Model.

Sexual offender risk assessment practice is considered by many to be atheoretical. The identification of the most predictive risk factors and tools has typically overshadowed questions about etiology. To gain insight into the origins of criminal behavior among sexual offenders, we developed and validated an etiological model of risk based on the theoretical framework of Beech and Ward. Our model focused on persistence rather than onset, and encompassed both the sexual and nonsexual criminal activity of these offenders. It comprised two pathways. The first was characterized by sexual victimization, social isolation, and early deviant sexual fantasies. It led to a prolific involvement in sexual criminality (especially toward children) and predicted sexual recidivism. The second pathway was characterized by externalization problems, sexual promiscuity, and physical/psychological victimization, and was associated with nonsexual offending and serious sexual offenses directed (mostly) toward women. It predicted all types of recidivism.

Limited impact of pneumococcal vaccines on invasive pneumococcal disease in Nunavik (Quebec).

OBJECTIVE: In 2002, a mass immunization campaign using the 23-valent pneumococcal polysaccharide vaccine (PPV23) was carried out in Nunavik to control an outbreak caused by a virulent clone of serotype 1 Streptococcus pneumoniae. At the same time, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced for routine immunization of infants, replaced by the 10-valent vaccine (PCV10) in 2009, and the 13-valent vaccine (PCV13) in 2011. The objective of this study was to describe the epidemiology of invasive pneumococcal disease (IPD) in relation to pneumococcal vaccine use. METHOD: Retrospective analysis of IPD cases identified by the Quebec Public Health Laboratory during the period 1997-2016. RESULTS: One hundred thirty-two IPD cases were identified during the study period. In adults, serotype 1 incidence decreased following the 2002 PPV23 mass campaign, but breakthrough cases occurred. Following PCV use, the incidence of vaccine-type IPD decreased markedly in children and also in adults but serotypes not covered by conjugate vaccines increased. The overall IPD rate was 43/100,000 person-years in the 1997-1999 pre-vaccine era and 58/100,000 person-years in 2010-2016. CONCLUSIONS: The 2002 PPV23 mass immunization campaign may have contributed to control the serotype 1 outbreaks in Nunavik, but its effect was short-lived as IPDs caused by serotypes included in this vaccine continued to occur after 2005. PCV use in children induced important modifications in the epidemiology of IPD, but most of the benefits were eroded by serotype replacement.