Changes in industrial air pollution and the onset of childhood asthma in Quebec, Canada.

Ambient air pollution has been associated with asthma onset and exacerbation in children. Whether improvement in air quality due to reduced industrial emissions has resulted in improved health outcomes such as asthma in some localities has usually been assessed indirectly with studies on between-subject comparisons of air pollution from all sources and health outcomes. In this study we directly assessed, within small areas in the province of Quebec (Canada), the influence of changes in local industrial fine particulate matter (PM2.5), nitrogen dioxide (NO2), and sulfur dioxide (SO2) concentrations, on changes in annual asthma onset rates in children (≤12 years old) with a longitudinal ecological design. We identified the yearly number of new cases of childhood asthma in 1282 small areas (census tracts or local community service centers) for the years 2002, 2004, 2005, 2006, and 2015. Annual average concentrations of industrial air pollutants for each of the geographic areas, and three sectors (i.e., pulp and paper mills, petroleum refineries, and metal smelters) were estimated by the Polair3D chemical transport model. Fixed-effects negative binomial models adjusted for household income were used to assess associations; additional adjustments for environmental tobacco smoke, background pollutant concentrations, vegetation coverage, and sociodemographic characteristics were conducted in sensitivity analyses. The incidence rate ratios (IRR) for childhood asthma onset for the interquartile increase in total industrial PM2.5, NO2, and SO2 were 1.016 (95% confidence interval, CI: 1.006-1.026), 1.063 (1.045-1.090), and 1.048 (1.031-1.080), respectively. Positive associations were also found with pollutant concentrations from most individual sectors. Results suggest that changes in industrial pollutant concentrations influence childhood asthma onset rates in small localities.

Associations between environmental noise and myocardial infarction and stroke: Investigating the potential mediating effects of hypertension.

BACKGROUND: We investigated whether hypertension may be a mediator in the pathway linking environmental noise exposure to incident MI and stroke. METHODS: Separately for MI and stroke, we built two population-based cohorts from linked health administrative data. Participants were residents of Montreal (Canada) between 2000 and 2014, aged 45 years and older who were free of hypertension and MI or stroke at time of entry. MI, stroke and hypertension were ascertained from validated case definitions. Residential long-term environmental noise exposure, expressed as the annual mean level acoustic equivalent 24 h (LAeq24h), was estimated from a land use regression model. We performed mediation analysis based on the potential outcomes framework. We used a Cox proportional hazards model for the exposure-outcome model and a logistic regression for the exposure-mediator model. In sensitivity analysis we applied a marginal structural approach to estimate the natural direct and indirect effects. RESULTS: Each cohort included approximately 900 000 individuals, with 26 647 incident cases of MI and 16 656 incident cases of stroke. 36% of incident MI and 40% of incident stokes had previously developed hypertension. The estimated total effect per interquartile range increase (from 55.0 to 60.5 dB A) in the annual mean LAeq24h was 1.073 (95% confidence interval (CI): 1.070-1.077) for both MI for stroke. We found no evidence of exposure-mediator interaction for both outcomes. The relationships between environmental noise and MI and stroke was not mediated by hypertension. CONCLUSIONS: This population-based cohort study suggests that the main route by which environmental noise exposure may cause MI or stroke is not through hypertension.

Exposure to ambient air pollutants and the onset of dementia in Québec, Canada.

BACKGROUND: Effects of air pollutants are related to oxidative stress which is also linked to the pathogenesis of dementia including Alzheimer's and related diseases. OBJECTIVE: We assessed associations between exposure to air pollutants and the onset of dementia; the association with the distance between residence and major roads was also assessed for the island of Montreal. METHODS: We created an open cohort of adults aged 65 years and older starting in 2000 and ending in 2012 in the province of Québec, Canada using linked medico-administrative databases. New cases of dementia were defined based on a validated algorithm. Annual residential levels of nitrogen dioxide (NO2) and fine particles (PM2.5) at residential levels were estimated for each year of follow up using estimates based on satellite images and ground air monitoring data. Hazard ratios (HRs) were assessed with Extended (time dependent exposure) Cox models with age as the time axis and stratified for sex, for the annual exposure level at each residential address. Models were adjusted for the calendar year, area-wide social and material deprivation indexes and for NO2 or PM2.5; they were also indirectly adjusted for smoking. RESULTS: 1,807,133 persons (13,242,270 person-years) were followed and 199,826 developed dementia. From models (adjusted for calendar year, social and material deprivation indexes), HRs for an interquartile range (IQR) increase in time-varying exposure to NO2 (IQR 13.26 ppb), PM2.5 (IQR 3.90 µg/m³), and distance to major roads (IQR 150 m, in Montreal only), were 1.005 (CI 95% 0.994-1.017), 1.016 (CI 95% 1.003-1.028) and 0.969 (CI 95% 0.958-0.980), respectively. CONCLUSIONS: Results suggest that the onset of dementia may be related to residential exposure to PM2.5, NO2, and distance to major roads.

Bioavailability and chronic toxicity of bismuth citrate to earthworm Eisenia andrei exposed to natural sandy soil.

The present study describes bioavailability and chronic effects of bismuth to earthworms Eisenia andrei using OECD reproduction test. Adult earthworms were exposed to natural sandy soil contaminated artificially by bismuth citrate. Average total concentrations of bismuth in soil recovered by HNO3 digestion ranged from 75 to 289mg/kg. Results indicate that bismuth decreased significantly all reproduction parameters of Eisenia andrei at concentrations ≥ 116mg/kg. However, number of hatched cocoons and number of juveniles seem to be more sensitive than total number of cocoons, as determined by IC50; i.e., 182, 123 and > 289mg/kg, respectively. Bismuth did not affect Eisenia andrei growth and survival, and had little effect on phagocytic efficiency of coelomocytes. The low immunotoxicity effect might be explained by the involvement of other mechanisms i.e. bismuth sequestered by metal-binding compounds. After 28 days of exposure bismuth concentrations in earthworms tissue increased with increasing bismuth concentrations in soil reaching a stationary state of 21.37mg/kg dry tissue for 243mg Bi/kg dry soil total content. Data indicate also that after 56 days of incubation the average fractions of bismuth available extracted by KNO3 aqueous solution in soil without earthworms varied from 0.0051 to 0.0229mg/kg, while in soil with earthworms bismuth concentration ranged between 0.310-1.347mg/kg dry soil. We presume that mucus and chelating agents produced by earthworms and by soil or/and earthworm gut microorganisms could explain this enhancement, as well as the role of dermal and ingestion routes of earthworms uptake to soil contaminant.

Functional and molecular responses of the blue mussel Mytilus edulis' hemocytes exposed to cadmium - An in vitro model and transcriptomic approach.

The bivalve mollusk, Mytilus edulis, is used as a sentinel species in several monitoring programs due to its ability to bio-accumulate contaminants. Its immune system consists of hemocytes and humoral components, which constitute the main part of the hemolymph. The present study is aimed at understanding the effects of Cd on the differentially expressed genes involved in the phagocytosis of M. edulis' hemocytes. Our approach focuses on an in vitro model by exposing hemocytes to different concentrations of Cd ranging from 10-9 M to 10-3 M. Phagocytosis and cell viability as functional markers were measured using flow cytometry. The molecular mechanisms regulated by Cd were investigated using RNA-seq and DGE analysis. Results showed that viability and phagocytosis of hemocytes exposed to 10-3 M of Cd were significantly decreased after 21 h of exposure. RNA sequencing data showed that 1112 transcripts (out of 352,976 contigs) were differentially regulated by the highest concentration of Cd. Among these identified transcripts, 1028 and 84 were up and down-regulated respectively. The induction of super oxide dismutase (SOD), glutathion-s-transferase (GST), cytochrome P450 2C8 (CYP2C8), multidrug resistance protein (MRP1) and heat shock protein 70 (HSP70) suggests that Cd can regulate key molecular mechanisms. In addition, several toll-like receptors (TLR) as well as genes involved in phagocytosis (actin and CDC42) and apoptosis (caspase 8 and XIAP/IAP) were induced by Cd. Thus, our model highlights the effect of Cd on the phagocytic function of M. edulis' hemocytes along with the regulation of gene expression involved in innate immunity, detoxification and apoptosis. Further investigations need to be pursued to unravel the effects of Cd on the molecular mechanisms identified in this study.

Attitudes and lifestyle changes following Jog your Mind: results from a multi-factorial community-based program promoting cognitive vitality among seniors.

This study examined the effects on attitudes and lifestyle behavior of Jog your Mind, a multi-factorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. A quasi-experimental study was conducted. Twenty-three community organizations were assigned either to the experimental group (offering the program) or to the control group (creating a waiting list). They recruited 294 community-dwelling seniors. The aims of the study were to verify the effects of the program on attitudes and behaviors related to cognitive vitality and to explore its effects on cognitive vitality. Data was collected at baseline and after the program. Regression analyses revealed that, following their participation in the program, experimental group participants reported: (i) in terms of attitudes, having a greater feeling of control concerning their cognitive capacities, (ii) in terms of behaviors, using significantly more memory strategies and practicing more physical activity and stimulating activities than control group participants. However, the program had no significant effects on measures of cognitive vitality. This study supports the fact that a multi-factorial community-based program can have significant effects on seniors' attitudes and lifestyle behaviors related to cognitive vitality but at short term, no effects on cognitive vitality it-self were found.

Differential sensitivity to cadmium of immunomarkers measured in hemocyte subpopulations of zebra mussel Dreissena polymorpha.

Increasing discharge of industrial wastes into the environment results in pollution transfer towards hydrosystems. These activities release heavy metals such as cadmium, known as persistent pollutant that is accumulated by molluscs and exercise immunotoxicological effects. Among molluscs, the zebra mussel, Dreissena polymorpha constitutes a suitable support for freshwater ecotoxicological studies. In molluscs, homeostasis maintain is ensured in part by hemocytes that are composed of several cell populations involved in multiple physiological processes such as cell-mediated immune response or metal metabolism. Thus, hemocytes constitute a target of concern to study adverse effects of heavy metals. The objectives of this work were to determine whether immune-related endpoints assessed were of different sensitivity to cadmium and whether hemocyte functionalities were differentially affected depending on hemocyte subpopulation considered. Hemocytes were exposed ex vivo to concentrations of cadmium ranging from 10-6 M to 10-3 M for 21h prior flow cytometric analysis of cellular markers. Measured parameters (viability, phagocytosis, oxidative activity, lysosomal content) decreased in a dose-dependent manner with sensitivity differences depending on endpoint and cell type considered. Our results indicated that phagocytosis related endpoints were the most sensitive studied mechanisms to cadmium compared to other markers with EC50 of 3.71±0.53×10-4M for phagocytic activity and 2.79±0.19×10-4M considering mean number of beads per phagocytic cell. Lysosomal content of granulocytes was less affected compared to other cell types, indicating lower sensitivity to cadmium. This suggests that granulocyte population is greatly involved in metal metabolism. Mitochondrial activity was reduced only in blast-like hemocytes that are considered to be cell precursors. Impairment of these cell functionalities may potentially compromise functions ensured by differentiated cells. We concluded that analysis of hemocyte activities should be performed at sub-population scale for more accurate results in ecotoxicological studies.

Functional features of hemocyte subpopulations of the invasive mollusk species Dreissena polymorpha.

Dreissena polymorpha is a mussel species that invaded many lotic and lentic inland waters in Western Europe and North America. Its positive or negative interactions with biotic and abiotic components of ecosystems are numerous, making this bivalve the subject of numerous studies in ecology, ecophysiology and ecotoxicology. In these contexts, the functional characterization of the zebra mussel hemocytes is of particular interest, as hemocytes are central cells involved in vital functions (immunity, growth, reproduction) of molluscan physiology. Dreissena polymorpha circulating hemocytes populations were characterized by a combination of structural and functional analysis. Assessments were performed during two contrasted physiological periods for mussels (gametogenesis and spawning). Three hemocyte types were identified as hyalinocytes and blast-like cells for agranular hemocytes and one granulocyte population. Flow cytometry analysis of hemocytes functionalities indicated that blast-like cells had low oxidative and mitochondrial activities and low lysosomal content. Hyalinocytes and granulocytes are fully equipped to perform innate immune response. Hyalinocytes exhibit higher oxidative activity than granulocytes. Such observation is not common since numerous studies show that granulocytes are usually cells that have the highest cellular activities. This result demonstrates the significant functional variability of hemocyte subpopulations. Moreover, our findings reveal that spawning period of Dreissena polymorpha was associated with an increase of hyalinocyte percentage in relation to low levels of biological activities in hemocytes. This reduction in hemocyte activity would reflect the important physiological changes associated with the spawning period of this invasive species known for its high reproductive potential.

The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003-2010 follow-up.

INTRODUCTION: In 2003, the Quebec government made important changes in its primary healthcare (PHC) system. This reform included the creation of new models of PHC, Family Medicine Groups (e.g. multidisciplinary health teams with extended opening hours and enrolment of patients) and Network Clinics (clinics providing access to investigation and specialist services). Considering that equity is one of the guiding principles of the Quebec health system, our objectives are to assess the impact of the PHC reform on equity by examining the association between socio-economic status (SES) and utilization of healthcare services between 2003 and 2010; and to determine how the organizational model of PHC facilities impacts utilization of services according to SES. METHODS: We held population surveys in 2005 (n = 9206) and 2010 (n = 9180) in the two most populated regions of Quebec province, relating to utilization and experience of care during the preceding two years, as well as organizational surveys of all PHC facilities. We performed multiple logistical regression analyses comparing levels of SES for different utilization variables, controlling for morbidity and perceived health; we repeated the analyses, this time including type of PHC facility (older vs newer models). RESULTS: Compared with the lowest SES, highest SES is associated with less emergency room visits (OR 0.80) and higher likelihood of at least one visit to a PHC facility (OR 2.17), but lower likelihood of frequent visits to PHC (OR 0.69), and higher affiliation to a family doctor (OR 2.04). Differences remained stable between the 2005 and 2010 samples except for likelihood of visit to PHC source which deteriorated for the lowest SES. Greater improvement in affiliation to family doctor was seen for the lowest SES in older models of PHC organizations, but a deterioration was seen for that same group in newer models. CONCLUSIONS: Differences favoring the rich in affiliation to family doctor and likelihood of visit to PHC facility likely represent inequities in access to PHC which remained stable or deteriorated after the reform. New models of PHC organizations do not appear to have improved equity. We believe that an equity-focused approach is needed in order to address persisting inequities.

Effect of summer outdoor temperatures on work-related injuries in Quebec (Canada).

OBJECTIVE: To quantify the associations between occupational injury compensations and exposure to summer outdoor temperatures in Quebec (Canada). METHODS: The relationship between 374,078 injuries compensated by the Workers' Compensation Board (WCB) (between May and September, 2003-2010) and maximum daily outdoor temperatures was modelled using generalised linear models with negative binomial distributions. Pooled effect sizes for all 16 health regions of Quebec were estimated with random-effect models for meta-analyses for all compensations and by sex, age group, mechanism of injury, industrial sector and occupations (manual vs other) within each sector. Time lags and cumulative effect of temperatures were also explored. RESULTS: The relationship between daily counts of compensations and maximum daily temperatures reached statistical significance for three health regions. The incidence rate ratio (IRR) of daily compensations per 1°C increase was 1.002 (95% CI 1.002 to 1.003) for all health regions combined. Statistically significant positive associations were observed for men, workers aged less than 45 years, various industrial sectors with both indoor and outdoor activities, and for slips/trips/falls, contact with object/equipment and exposure to harmful substances/environment. Manual occupations were not systematically at higher risk than non-manual and mixed ones. CONCLUSIONS: This study is the first to quantify the association between work-related injury compensations and exposure to summer temperatures according to physical demands of the occupation and this warrants further investigations. In the context of global warming, results can be used to estimate future impacts of summer outdoor temperatures on workers, as well as to plan preventive interventions.

In vitro immunotoxicology of quantum dots and comparison with dissolved cadmium and tellurium.

The increasing use of products derived from nanotechnology has raised concerns about their potential toxicity, especially at the immunocompetence level in organisms. This study compared the immunotoxicity of cadmium sulfate/cadmium telluride (CdS/Cd-Te) mixture quantum dots (QDs) and their dissolved components, cadmium chloride (CdCl2 )/sodium telluride (NaTeO3 ) salts, and a CdCl2 /NaTeO3 mixture on four animal models commonly used in risk assessment studies: one bivalve (Mytilus edulis), one fish (Oncorhynchus mykiss), and two mammals (mice and humans). Our results of viability and phagocytosis biomarkers revealed that QDs were more toxic than dissolved metals for blue mussels. For other species, dissolved metals (Cd, Te, and Cd-Te mixture) were more toxic than the nanoparticles (NPs). The most sensitive species toward QDs, according to innate immune cells, was humans (inhibitory concentration [IC50 ] = 217 µg/mL). However, for adaptative immunity, lymphoblastic transformation in mice was decreased for small QD concentrations (EC50 = 4 µg/mL), and was more sensitive than other model species tested. Discriminant function analysis revealed that blue mussel hemocytes were able to discriminate the toxicity of QDs, Cd, Te, and Cd-Te mixture (Partial Wilk's λ = 0.021 and p < 0.0001). For rainbow trout and human cells, the immunotoxic effects of QDs were similar to those obtained with the dissolved fraction of Cd and Te mixture. For mice, the toxicity of QDs markedly differed from those observed with Cd, Te, and dissolved Cd-Te mixture. The results also suggest that aquatic species responded more differently than vertebrates to these compounds. The results lead to the recommendation that mussels and mice were most able to discriminate the effects of Cd-based NPs from the effects of dissolved Cd and Te at the immunocompetence level.

Effects of a major municipal effluent on the St. Lawrence River: A case study.

The St. Lawrence River (SLR) is the second largest waterway in North America. The discharge of the City of Montreal wastewater treatment plant (WWTP) represents the largest volume of treated wastewaters being released into the river. It also ranks as the largest sewage treatment plant of its kind in North America. Over the last decade, intensive multidisciplinary research has focused on assessing the impacts of Montreal wastewater effluents on the SLR. We describe the major findings of these investigations, including the determination of the fate of contaminants, bioaccumulation in fish and invertebrates, ecotoxicological measurements of aquatic animal health, evaluation of endocrine disruption, parasitism in fish, and combined effects of multiple stressors on the SLR. Impacts of the effluents from the WWTP on aquatic organisms from the SLR are both toxicological and ecological, demonstrating the need for an integrated view of the impacts of municipal effluents on aquatic ecosystems.

Health-related quality of life in patients with alpha-1 antitrypsin deficiency: the French experience.

The French registry of patients with alpha-1 antitrypsin deficiency (AATD)-associated emphysema was launched in 2006. Here, we aimed to report on the baseline characteristics of these patients, their health-related quality of life (HRQoL) and factors associated with HRQoL. Another goal was to survey the practices of French physicians regarding augmentation therapy. We included 273 patients with AATD, emphysema, obstructive-pattern [forced expiratory volume in 1 sec/forced volume capacity (FEV1/FVC) < 0.7], FEV1 ≤ 80% predicted. Mean (SD) age was 51.8 (11.1) years, 240 (87.9%) of patients were smokers or ex-smokers, mean (SD) FEV1 was 40.5% (15.7) predicted. Mean (SD) SGRQ score was 49.0 (20.0) and was higher for females than males (52.7 [20.7] vs 46.8 [18.2]; p = 0.01). Dyspnea showed the strongest association with SGRQ score (r = 0.65; p < 0.0001), followed by chronic bronchitis (r = 0.33; p < 0.0001) and wheezing (r = 0.32; p < 0.0001). Number of exacerbations in the year before inclusion was also significantly associated with SGRQ score (r = 0.36; p < 0.0001). The SGRQ score was associated with the 6-min walking distance (r = -0.53, p < 0.0001), FEV1 (% predicted, r = -0.53, p < 0.0001) and DLCO (% predicted, r = -0.52, p < 0.0001). It was also associated with the GOLD 2006 (r = 0.53; p < 0.0001) and GOLD 2011 (r = 0.63; p< 0.0001) classifications and with the BODE index (r = 0.37; p < 0.0001). Age, history of tobacco smoking or current smoking did not show any association with SGRQ total scores. On multivariate analysis, a model including age, chronic bronchitis, dyspnea (MRC scale), diffusing lung capacity and 6-min walking distance explained 57% of the variation in the score. The French registry provides important insights into the clinical characteristics of French patients with AATD-related emphysema.

[Are new forms of primary health care organization (PHLU) associated with a better health care experience for patients with chronic diseases in Quebec?]. / Les nouvelles formes d'organisations de soins de santé primaires (OSSP) sont-elles associées à une meilleure expérience de soins chez les patients atteints de maladies chroniques au Québec ?

AIM: To assess the extent to which new forms of PHC organization - Family medicine groups (FMG) and Network clinics (NC) - established in Quebec since 2003, are associated with a better experience of care than other forms of PHC organization, for patients with chronic diseases. METHODS: Two surveys were conducted in 2010 in two regions of Quebec: the first among 9,180 residents and the second among 606 PHC organizations. Indices of experience of care were constructed concerning accessibility, continuity, comprehensiveness and perceived outcomes. Five categories of chronic diseases were selected. Descriptive analyses and multilevel regression analyses were conducted to compare the different forms of PHC organization. RESULTS: Individuals with chronic diseases tend to report a better experience of care than those without chronic diseases for all dimensions except for accessibility. FMGs compare to group practices on all dimensions and NCs are associated with a poorer experience of care on most dimensions. CONCLUSION: Experience of care associated with FMGs and NCs is not superior to that associated with group practices.

Performance of the BODE index in patients with α1-antitrypsin deficiency-related COPD.

The BODE (body mass index, airflow obstruction, dyspnoea and exercise capacity) index is used to decide on referral and transplantation of patients with chronic obstructive pulmonary disease (COPD). The BODE index has not been validated in patients with α1-antitrypsin deficiency, who account for 15% of COPD patients undergoing lung transplantation. We sought to validate the BODE index in α1-antitrypsin deficiency-related COPD. We assessed the prognostic value of the BODE index in 191 patients followed from 2006 to 2012 in a French prospective cohort of patients with α1-antitrypsin deficiency. 20 patients died during follow-up and 22 underwent lung transplantation. Survival (95% CI) was 93.0% (91.7-94.3%) at 3 years and 76.0% (72.9-79.1%) at 5 years. The 3-year survival was 97.4% (96.6-98.2%), 98.0% (96.7-99.3%), 87.7% (84.5-90.9%) and 75.3% (66.0-84.6%) for patients with BODE index 0-2, 3-4, 5-6 and 7-10, respectively. Survival discrimination of the BODE index was better than with both forced expiratory volume in 1 s and Global Initiative for Chronic Obstructive Lung Disease classification. Regarding calibration, expected survival by BODE index was noticeably lower than observed survival. The BODE index showed very good survival discrimination in patients with α1-antitrypsin deficiency-related COPD. Larger studies are needed to support its use to drive patient referral for lung transplantation.

Validation of 2 new measures of continuity of care based on year-to-year follow-up with known providers of health care.

PURPOSE: In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (personal provider continuity, KPC-PP). METHODS: Patients with diabetes or cardiovascular disease (N = 765) were approached in the waiting rooms of 28 primary care clinics in 3 regions of the province of Quebec, Canada; answered a survey questionnaire measuring relational continuity, interpersonal communication, coordination within the clinic, coordination with specialists, and overall coordination; and gave permission for their medical records to be reviewed and their medical services utilization data for the previous 2 years to be accessed to measure KPC. Using generalized linear mixed models, we assessed the association between KPC and the patients' responses. RESULTS: Among the 5 different patient-reported measures or their combination, KPC-MP was significantly related with overall coordination of care: for high continuity, the odds ratio (OR) = 2.02 (95% CI, 1.33-3.07), and for moderate continuity, OR = 1.61 (95% CI, 1.06-2.46). KPC-MP was also related with the combined continuity score: for high continuity, OR = 1.52 (95% CI, 1.11-2.09), and for moderate continuity, OR = 1.48 (95% CI, 1.10-2.00). KPC-PP was not significantly associated with any of the survey measures. CONCLUSIONS: The KPC-MP measure, based on readily available administrative data, is associated with patient-perceived overall coordination of care among multiple physicians. KPC measures are potentially a valuable and low-cost way to follow the effects of changes favoring group practice on continuity of care for entire populations. They are easy to replicate over time and across jurisdictions.

Summer outdoor temperature and occupational heat-related illnesses in Quebec (Canada).

BACKGROUND: Predicted rise in global mean temperature and intensification of heat waves associated with climate change present an increasing challenge for occupational health and safety. Although important scientific knowledge has been gathered on the health effects of heat, very few studies have focused on quantifying the association between outdoor heat and mortality or morbidity among workers. OBJECTIVE: To quantify the association between occupational heat-related illnesses and exposure to summer outdoor temperatures. METHODS: We modeled 259 heat-related illnesses compensated by the Workers׳ Compensation Board of Quebec between May and September, from 1998 to 2010, with maximum daily summer outdoor temperatures in 16 health regions of Quebec (Canada) using generalized linear models with negative binomial distributions, and estimated the pooled effect sizes for all regions combined, by sex and age groups, and for different time lags with random-effect models for meta-analyses. RESULTS: The mean daily compensation count was 0.13 for all regions of Quebec combined. The relationship between daily counts of compensations and maximum daily temperatures was log-linear; the pooled incidence rate ratio (IRR) of daily heat-related compensations per 1 °C increase in daily maximum temperatures was 1.419 (95% CI 1.326 to 1.520). Associations were similar for men and women and by age groups. Increases in daily maximum temperatures at lags 1 and 2 and for two and three-day lag averages were also associated with increases in daily counts of compensations (IRRs of 1.206 to 1.471 for every 1 °C increase in temperature). CONCLUSION: This study is the first to quantify the association between occupational heat-related illnesses and exposure to summer temperatures in Canada. The model (risk function) developed in this study could be useful to improve the assessment of future impacts of predicted summer outdoor temperatures on workers and vulnerable groups, particularly in colder temperate zones.

Survival benefit of lung transplant for cystic fibrosis since lung allocation score implementation.

RATIONALE: The survival benefit of lung transplantation (LT) in adult patients with cystic fibrosis (CF) is debated. OBJECTIVES: We sought to assess the survival benefit of LT in adult patients with CF. METHODS: We used data from the United Network for Organ Sharing Registry to identify adult patients with CF on a wait list for LT in the United States between 2005 and 2009. Survival times while on the wait list and after LT were modeled by use of a Cox model that incorporated transplantation status as a time-dependent covariate. Evolution in lung allocation score (LAS) while on the wait list was used as a surrogate for disease severity. We fitted a model for the joint distribution of survival and longitudinal disease process (LAS over time). MEASUREMENTS AND MAIN RESULTS: A total of 704 adult patients with CF were registered on a wait list during the study period. The cumulative incidence of LT was 39.3% (95% confidence interval, 35.6-42.9%) at 3 months and 64.7% (61.0-68.4%) at 12 months, whereas the incidence of death while on the wait list at the same times was 8.5% (6.4-10.6%) and 12.9% (10.3-15.5%), respectively. Survival after LT was 96.5% (94.7-98.2%) at 3 months; 88.4% (85.1-91.8%) at 12 months; and 67.8% (59.9-76.8%) at 3 years. LT conferred a 69% reduction in the instantaneous risk of death (51-80%). The interaction between LAS and LT was significant: the higher the LAS, the greater the survival benefit of LT (P < 0.001). CONCLUSIONS: LT confers a survival benefit for adult patients with CF.

Impact of Québec's healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up.

BACKGROUND: Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change achieved following these reforms. METHODS: We conducted two surveys of PHC organizations, in 2005 and 2010, in two regions of the province of Québec, Canada. From the responses to these surveys, we derived a measure of organizational change based on an index of conformity to an ideal type (ICIT). One set of explanatory variables was contextual, related to coercive, normative and mimetic influences; the other consisted of organizational variables that measured receptivity towards new PHC models. Multilevel analyses were performed to examine the relationships between ICIT change in the post-reform period and the explanatory variables. RESULTS: Positive results were attained, as expressed by increase in the ICIT score in the post-reform period, mainly due to implementation of new types of PHC organizations (Family Medicine Groups and Network Clinics). Organizational receptivity was the main explanatory variable mediating the effect of coercive and mimetic influences. Normative influence was not a significant factor in explaining changes. CONCLUSION: Changes were modest at the system level but important with regard to new forms of PHC organizations. The top-down decreed reform was a determining factor in initiating change whereas local coercive and normative influences did not play a major role. The exemplar role played by certain PHC organizations through mimetic influence was more important. Receptivity of individual organizations was both a necessary condition and a mediating factor in influencing change. This supports the view that a combination of top-down and bottom-up strategy is best suited for achieving substantial changes in PHC local organization.

Responses of freshwater mussel (Elliptio complanata) hemocytes exposed in vitro to crude extracts of Microcystis aeruginosa and Lyngbya wollei.

Lyngbya wollei is a benthic filamentous cyanobacterium that produces a toxin analogous to the neurotoxic saxitoxin known as lyngbyatoxin (LYNGTX). Microcystis aeruginosa form blooms in the pelagic area of eutrophic lakes and produce a series of potent hepatotoxins-microcystins (MCYST). The aim of this study in vitro study was to examine the difference between the crude extracts of either M. aeruginosa or L. wollei toward the immune system of Elliptio complanata mussels. Freshly isolated hemolymph was plated and exposed to the crude extract of each species at LYNGTX or MCYST equivalent concentrations of 5, 10 and 25 µg/L for 18 h. Immunocompetence was characterized by following changes in hemocyte numbers, metabolic activity (viability), and phagocytosis. Hemocyte counts were not affected, indicating no turnover of hemocytes. Hemocyte metabolic activity was higher in cells exposed to crude extracts of L. wollei. Exposure to L. wollei extracts led to decreased pro-inflammatory precursors such as reactive oxygen species (ROS) and cyclooxygenase (COX) activities. Phagocytosis increased at 25 µg/L for both types of crude extracts. However, hemocytes exposed to crude extracts of M. aeruginosa produced more ROS and COX compared to hemocytes exposed to crude extracts of L. wollei. In conclusion, the data suggest that the crude extract of M. aeruginosa was more toxic than crude extract of L. wollei to mussel hemocytes.