Portrait of Montréal healthcare workers infected with SARS-CoV-2 during the first wave of the pandemic: a cross-sectional study.

OBJECTIVES: During the first wave of COVID-19 in Québec, healthcare workers (HCWs) represented 25% of the cases in Montréal. A study was conducted to describe SARS-CoV-2-infected HCWs in Montréal, and certain workplace and household characteristics. Secondary objectives included estimating the associations between having had access to personal protective equipment (PPE) and training, and following self-isolation recommendations, and certain sociodemographic and workplace characteristics. METHODS: A cross-sectional study was conducted, based on a stratified random sample, among Montréal HCWs who tested positive for SARS-CoV-2 between March and July 2020. A total of 370 participants answered a telephone-administered questionnaire. Descriptive statistics were conducted, followed by log binomial regressions to estimate the associations. RESULTS: Study participants were mostly female (74%), born outside of Canada (65%), and identified as Black, Indigenous, and People of Colour (BIPOC; 63%). In terms of healthcare positions, most were orderlies (40%) or registered nurses (20%). Half (52%) of the participants reported having had insufficient access to PPE and 30% reported having received no training related to SARS-CoV-2 infection prevention, with large proportions being BIPOC women. Working evening or night shifts decreased chances of having had sufficient access to PPE (OR 0.50; 0.30-0.83). CONCLUSION: This study describes the profile of the HCWs who were infected during the first wave of the pandemic in Montréal. Recommendations include collecting comprehensive sociodemographic data on SARS-CoV-2 infections and ensuring equitable access to infection prevention and control training and PPE during health crises, particularly those at highest risk of exposure.

RéSUMé: OBJECTIFS: Lors de la première vague de la COVID-19 au Québec, les travailleurs de la santé (TS) représentaient 25 % des cas à Montréal. Une étude a été menée pour décrire les TS infectés par le SRAS-CoV-2 à Montréal, ainsi que certaines caractéristiques liées au travail et au ménage. Les objectifs secondaires visaient à estimer les associations entre le fait d'avoir eu accès à un équipement de protection individuelle (EPI) et à une formation, ainsi que la capacité de suivre les recommandations d'auto-isolement et différentes caractéristiques sociodémographiques et du lieu de travail. MéTHODOLOGIE: Une étude transversale a été menée, sur la base d'un échantillon aléatoire stratifié, parmi les TS de Montréal qui ont été testés positifs pour le SRAS-CoV-2 entre mars et juillet 2020. Un total de 370 participants a répondu à un questionnaire administré par téléphone. Des statistiques descriptives ont été réalisées, suivies de régressions log binomiales pour estimer les associations. RéSULTATS: Les participants étaient en majorité des femmes (74 %), nés à l'extérieur du Canada (65 %) et s'identifiaient comme des personnes Noires, des Autochtones et des personnes de couleur (BIPOC; 63 %). En termes d'emploi dans le système de santé, 40 % étaient des préposés aux bénéficiaires et 20 % des infirmières cliniciennes. La moitié (52 %) des participants ont déclaré ne pas avoir eu un accès suffisant à l'EPI et 30 % ont déclaré n'avoir reçu aucune formation liée à la prévention des infections SRAS-CoV-2, une grande partie d'entre eux étant des femmes BIPOC. Le fait de travailler le soir ou la nuit diminuait les chances d'avoir un accès suffisant aux EPI (OR 0,50; 0,30­0,83). CONCLUSION: Cette étude décrit le profil des travailleurs de santé qui ont été infectés lors de la première vague de la pandémie à Montréal. Les recommandations comprennent la collecte de données sociodémographiques complètes et de s'assurer de fournir de l'EPI et des formations en prévention et contrôle des infections pendant les crises sanitaires, en particulier pour les personnes les plus à risque d'exposition.

Spatio-temporal clusters and patterns of spread of dengue, chikungunya, and Zika in Colombia.

BACKGROUND: Colombia has one of the highest burdens of arboviruses in South America. The country was in a state of hyperendemicity between 2014 and 2016, with co-circulation of several Aedes-borne viruses, including a syndemic of dengue, chikungunya, and Zika in 2015. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed the cases of dengue, chikungunya, and Zika notified in Colombia from January 2014 to December 2018 by municipality and week. The trajectory and velocity of spread was studied using trend surface analysis, and spatio-temporal high-risk clusters for each disease in separate and for the three diseases simultaneously (multivariate) were identified using Kulldorff's scan statistics. During the study period, there were 366,628, 77,345 and 74,793 cases of dengue, chikungunya, and Zika, respectively, in Colombia. The spread patterns for chikungunya and Zika were similar, although Zika's spread was accelerated. Both chikungunya and Zika mainly spread from the regions on the Atlantic coast and the south-west to the rest of the country. We identified 21, 16, and 13 spatio-temporal clusters of dengue, chikungunya and Zika, respectively, and, from the multivariate analysis, 20 spatio-temporal clusters, among which 7 were simultaneous for the three diseases. For all disease-specific analyses and the multivariate analysis, the most-likely cluster was identified in the south-western region of Colombia, including the Valle del Cauca department. CONCLUSIONS/SIGNIFICANCE: The results further our understanding of emerging Aedes-borne diseases in Colombia by providing useful evidence on their potential site of entry and spread trajectory within the country, and identifying spatio-temporal disease-specific and multivariate high-risk clusters of dengue, chikungunya, and Zika, information that can be used to target interventions.

Roles of AGD2a in Plant Development and Microbial Interactions of Lotus japonicus.

Arabidopsis AGD2 (Aberrant Growth and Death2) and its close homolog ALD1 (AGD2-like defense response protein 1) have divergent roles in plant defense. We previously reported that modulation of salicylic acid (SA) contents by ALD1 affects numbers of nodules produced by Lotus japonicus, but AGD2's role in leguminous plants remains unclear. A combination of enzymatic analysis and biological characterization of genetic materials was used to study the function of AGD2 (LjAGD2a and LjAGD2b) in L. japonicus. Both LjAGD2a and LjAGD2b could complement dapD and dapE mutants of Escherichia coli and had aminotransferase activity in vitro. ljagd2 plants, with insertional mutations of LjAGD2, had delayed flowering times and reduced seed weights. In contrast, overexpression of LjAGD2a in L. japonicus induced early flowering, with increases in seed and flower sizes, but reductions in pollen fertility and seed setting rates. Additionally, ljagd2a mutation resulted in increased expression of nodulin genes and corresponding increases in infection threads and nodule numbers following inoculation with Rhizobium. Changes in expression of LjAGD2a in L. japonicus also affected endogenous SA contents and hence resistance to pathogens. Our results indicate that LjAGD2a functions as an LL-DAP aminotransferase and plays important roles in plant development. Moreover, LjAGD2a activates defense signaling via the Lys synthesis pathway, thereby participating in legume-microbe interaction.

Disability and sexual and reproductive health service utilisation in Uganda: an intersectional analysis of demographic and health surveys between 2006 and 2016.

BACKGROUND: The United Nations through universal health coverage, including sexual and reproductive health (SRH), pledges to include all people, leaving no one behind. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social identities and health determinants reveal a complex pattern in SRH service use. Framed within a larger mixed methods study conducted in Uganda, we examined how disability, among other key social determinants of health (SDH), was associated with the use of SRH services. METHODS: We analysed data from repeated cross-sectional national surveys, the Uganda Demographic and Health Surveys (DHS) of 2006, 2011, and 2016. The three outcomes of interest were antenatal care visits, HIV testing, and modern contraception use. Our main exposure of interest was the type of disability, classified according to six functional dimensions: seeing, hearing, walking/climbing steps, remembering/concentrating, communicating, and self-care. We performed descriptive and multivariable logistic regression analyses, which controlled for covariates such as survey year, sex, age, place of residence, education, and wealth index. Interaction terms between disability and other factors such as sex, education, and wealth index were explored. Regression analyses were informed by an intersectionality framework to highlight social and health disparities within groups. RESULTS: From 2006 to 2016, 15.5-18.5% of study participants lived with some form of disability. Over the same period, the overall prevalence of at least four antenatal care visits increased from 48.3 to 61.0%, while overall HIV testing prevalence rose from 30.8 to 92.4% and the overall prevalence of modern contraception use increased from 18.6 to 34.2%. The DHS year, highest education level attained, and wealth index were the most consistent determinants of SRH service utilisation. People with different types of disabilities did not have the same SRH use patterns. Interactions between disability type and wealth index were associated with neither HIV testing nor the use of modern contraception. Women who were wealthy with hearing difficulty (Odds Ratio (OR) = 0.15, 95%CI 0.03 - 0.87) or with communication difficulty (OR = 0.17, 95%CI 0.03 - 0.82) had lower odds of having had optimal antenatal care visits compared to women without disabilities who were poorer. CONCLUSION: This study provided evidence that SRH service use prevalence increased over time in Uganda and highlights the importance of studying SRH and the different disability types when examining SDH. The SDH are pivotal to the attainment of universal health coverage, including SRH services, for all people irrespective of their social identities.

Modelling Spatiotemporal Patterns of Lyme Disease Emergence in Québec.

Lyme disease is a growing public health problem in Québec. Its emergence over the last decade is caused by environmental and anthropological factors that favour the survival of Ixodes scapularis, the vector of Lyme disease transmission. The objective of this study was to estimate the speed and direction of human Lyme disease emergence in Québec and to identify spatiotemporal risk patterns. A surface trend analysis was conducted to estimate the speed and direction of its emergence based upon the first detected case of Lyme disease in each municipality in Québec since 2004. A cluster analysis was also conducted to identify at-risk regions across space and time. These analyses were reproduced for the date of disease onset and date of notification for each case of Lyme disease. It was estimated that Lyme disease is spreading northward in Québec at a speed varying between 18 and 32 km/year according to the date of notification and the date of disease onset, respectively. A significantly high risk of disease was found in seven clusters identified in the south-west of Québec in the sociosanitary regions of Montérégie and Estrie. The results obtained in this study improve our understanding of the spatiotemporal patterns of Lyme disease in Québec, which can be used for proactive, targeted interventions by public and clinical health authorities.

Machine learning and dengue forecasting: Comparing random forests and artificial neural networks for predicting dengue burden at national and sub-national scales in Colombia.

The robust estimate and forecast capability of random forests (RF) has been widely recognized, however this ensemble machine learning method has not been widely used in mosquito-borne disease forecasting. In this study, two sets of RF models were developed at the national (pooled department-level data) and department level in Colombia to predict weekly dengue cases for 12-weeks ahead. A pooled national model based on artificial neural networks (ANN) was also developed and used as a comparator to the RF models. The various predictors included historic dengue cases, satellite-derived estimates for vegetation, precipitation, and air temperature, as well as population counts, income inequality, and education. Our RF model trained on the pooled national data was more accurate for department-specific weekly dengue cases estimation compared to a local model trained only on the department's data. Additionally, the forecast errors of the national RF model were smaller to those of the national pooled ANN model and were increased with the forecast horizon increasing from one-week-ahead (mean absolute error, MAE: 9.32) to 12-weeks ahead (MAE: 24.56). There was considerable variation in the relative importance of predictors dependent on forecast horizon. The environmental and meteorological predictors were relatively important for short-term dengue forecast horizons while socio-demographic predictors were relevant for longer-term forecast horizons. This study demonstrates the potential of RF in dengue forecasting with a feasible approach of using a national pooled model to forecast at finer spatial scales. Furthermore, including sociodemographic predictors is likely to be helpful in capturing longer-term dengue trends.

How Servant Leadership Leads to Employees' Customer-Oriented Behavior in the Service Industry? A Dual-Mechanism Model.

Although servant leadership has been acknowledged as an important predictor of employees' behavioral outcomes in the service industry, there is still no cohesive understanding of the positive association between servant leadership and employees' customer-oriented behavior (COB). This research, drawing on cognitive affective processing system theory (CAPS), empirically investigates the influence of servant leadership on employees' COB by exploring two mediators (i.e., organizational identification and vitality). We conducted two studies in China, using a cross-sectional design to survey employees in service-oriented technical organizations (Study 1) and a time-lagged design to survey hospitality employees with frontline service jobs in star-level hotels (Study 2). Across both samples, we found that servant leadership enhanced employees' COB by simultaneously increasing their organizational identification and vitality. We discuss the implications of these results for future research and practice.

A systematic review of aberration detection algorithms used in public health surveillance.

The algorithms used for detecting anomalies have evolved substantially over the last decade to take advantage of advances in informatics and to accommodate changes in surveillance data. We identified 145 studies since 2007 that evaluated statistical methods used to detect aberrations in public health surveillance data. For each study, we classified the analytic methods and reviewed the evaluation metrics. We also summarized the practical usage of the detection algorithms in public health surveillance systems worldwide. Traditional methods (e.g., control charts, linear regressions) were the focus of most evaluation studies and continue to be used commonly in practice. There was, however, an increase in the number of studies using forecasting methods and studies applying machine learning methods, hidden Markov models, and Bayesian framework to multivariate datasets. Evaluation studies demonstrated improved accuracy with more sophisticated methods, but these methods do not appear to be used widely in public health practice.

Initial Usability Evaluation of a Knowledge-Based Population Health Information System: The Population Health Record (PopHR).

We report the baseline usability of a novel web-based application, the Population Health Record (PopHR), designed to facilitate the effective use of population health information by public health professionals and to support evidence-based decision-making. The usability test was conducted with ten potential users who each completed eight tasks using the PopHR system. Participant responses were recorded, including timestamps for each data entry. Overall, the task completion rate was 96% while the success rate was 88%. The average time-on-task was 3.11 minutes, with more time spent on tasks requiring a user to stratify data along multiple dimensions, such as age, sex, or geographical region. Usability scores indicated that the current version of PopHR has good usability. Potential improvements identified included adding supporting information, offering different visualizations, and enhancing system stability. These findings are examples of addressable usability problems encountered in developing a population health record system.