Patient and professional perspectives on physical activity promotion in routine cancer care: a qualitative study.

BACKGROUNDS: Physical activity is associated with many benefits in reducing cancer symptoms and treatments side effects. Yet, studies consistently show that knowledge about physical activity is under-promoted among people diagnosed with cancer. Therefore, we aimed to contribute to filling this gap by ascertaining patient and professional perspectives regarding physical activity promotion. METHODS: This study took place in Montreal, Canada. We conducted individual, semi-structured interviews with cancer patients who participated in a physical activity program and professionals working in the healthcare system. Participants had to be aged over 18 years, be able to communicate verbally in either English or French, and consent to an audio-recorded interview. A hybrid deductive-inductive approach to content analysis was applied to analyze interview transcripts using Dedoose and Microsoft Excel software. RESULTS: Our sample comprised 21 patients (76.2% women) and 20 professionals (80% women). We identified 24 factors (barriers, facilitators, and improvement suggestions) influencing physical activity promotion across organizational, community, and social levels. Results suggest that to improve physical activity promotion in cancer care, it is necessary to showcase exercise specialists as a healthcare resource, to champion for this change within health organizations, to develop partnerships between public and private sectors of the health and fitness industries, and to reassess social norms concerning cancer survivorship and treatment. CONCLUSION: These findings shed light on the gaps and the bright lights in physical activity promotion for people diagnosed with cancer across numerous levels.

Online yoga programme for resident physicians in Québec: an evaluation of feasibility and impact on mental health.

OBJECTIVES: To evaluate the feasibility of the Bali Yoga Programme for Residents (PYB-R), an 8-week virtual yoga-based intervention and determine its impact on the mental health of resident physicians. DESIGN: Single-group repeated measures study. SETTING: Associations from the four postgraduate medical education programmes in Québec, Canada. PARTICIPANTS: Overall, 55 resident physicians were recruited to participate of which 53 (96.4%) completed the assessment pre-PYB-R. The postintervention assessment was completed by 43 residents (78.2%) and 39 (70.9%) completed all phases (including 3-month follow-up). Most were in their first year (43.4%) or second year (32.1%) of residency. The majority were female (81.1%) with a mean age of 28±3.6 years. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was feasibility as measured by participation in the PYB-R. Secondary outcome measures were psychological variables (anxiety, depression, burn-out, emotional exhaustion, compassion fatigue and compassion satisfaction) and satisfaction with the PYB-R. Residents were further subgrouped based on the quality of work life and a number of PYB-R sessions attended. RESULTS: The attrition rate for programme completion was 19%. Of the 43 residents who completed the PYB-R, 90.6% attended between 6 and 8 sessions. Repeated-measures analysis of variances (ANOVAs) at three time points (baseline, PYB-R completion and 3-month follow-up) confirmed a decrease in scores for depression and anxiety, and an increase in scores for compassion satisfaction. No changes were observed in the other psychological variables evaluated. ANOVAs also confirmed that a better quality of life at work helps develop compassion satisfaction, a protective factor to compassion fatigue. Most participants (92.9%) indicated they were satisfied or very satisfied with the quality of the programme. CONCLUSIONS: A virtual yoga-based programme is feasible and has lasting positive effects for up to 3 months on the mental health of resident physicians. Further research is warranted to validate these findings using a larger sample of residents with a control group.

Perceptions of COVID-19 vaccination and factors influencing COVID-19 vaccine acceptance among indigenous peoples in Quebec, Canada: Insights from a facebook posts and comments analysis.

Vaccination rates in Canada tend to be lower among Indigenous peoples than the rest of the population. The COVID-19 pandemic provided an unprecedented opportunity to better understand Indigenous perceptions about vaccination. The aim of this study was to explore perceptions of COVID-19 vaccine and other factors influencing COVID-19 vaccine acceptance as evidenced by public posts and comments on Facebook by Indigenous peoples in Quebec, Canada. We collected data on 95 Facebook pages or groups used by Indigenous peoples in Quebec between November 1, 2020, to June 15, 2021. To identify posts relating to COVID-19 vaccination, a keyword search ("vaccination," "vaccine," "shot," "does," "Moderna," "Pfizer") was carried out in English and French in the search bar of each Facebook page/group. Results show that First Nations peoples and Inuit in Quebec had important concerns about the usefulness, safety and effectiveness of COVID-19 vaccine. They also expressed fear of being used as test subjects for the rest of the population. Motivations mentioned by First Nations peoples and Inuit to get vaccinated against COVID-19 included to travel again and return to normal life with their loved ones, and the desire to protect the most vulnerable in their communities, especially Elders. Results show that Indigenous health care professionals were considered as reliable and trustful source of information regarding COVID-19, and that seeing role models being vaccinated build confidence and foster acceptance of the vaccine. Culturally adapted messages and vaccination campaigns by and for Indigenous peoples appear to be key to building trust toward COVID-19 vaccination.

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.

Experiences of racism of Black medical students and residents in Montréal: "I wear my stethoscope around my neck at all times".

Background: Black students and residents experience racism in medical school. This qualitative study documents Black students' and residents' experiences of racism using Critical Race Theory (CRT) and explores their coping mechanisms using the theatrical metaphor. Methods: We conducted semi-structured interviews with four Black medical students and residents (two medical students and two residents) studying in Montréal and analyzed their experiences through counter-stories. We identified themes related to their experiences of racism during medical training and their coping mechanisms. Results: Our analysis reveals these experiences of racism occur in academic and clinical settings (classes, internships, social interactions with peers, faculty, and patients, and through the curriculum), in the form of microaggressions. The analysis also indicates that Black students and residents try to cope with racism using a hyper-ritualization strategy to better fit in (e.g., clothing, behaviours). Conclusion: Considering that Black students and residents experience various forms of racism (subtle or explicit) during their medical training, these findings urge us to increase awareness about racism of students, residents, teachers and health care workers in universities and teaching hospitals. Pathways to increase the representation of Black students and residents seem to be part of the solution, but improving the learning environment must be a priority to achieve racial justice in medical training in Québec.

Contexte: Les étudiants et les résidents noirs sont victimes de racisme dans les facultés de médecine. Cette étude qualitative documente les expériences de racisme des étudiants et des résidents noirs à l'aide de la théorie critique de la race (TCR) et explore leurs mécanismes d'adaptation à l'aide de la métaphore théâtrale. Méthodes: Nous avons mené des entrevues semi-structurées avec quatre étudiants et résidents noirs en médecine (deux étudiants en médecine et deux résidents) étudiant à Montréal et analysé leurs expériences par le biais de contre-récits. Nous avons identifié des thèmes liés à leurs expériences du racisme pendant la formation médicale et à leurs mécanismes d'adaptation. Résultats: Notre analyse révèle que ces expériences de racisme se produisent dans les milieux universitaires et cliniques (cours, stages, interactions sociales avec des pairs, des membres du corps professoral et des patients, et dans le cadre du curriculum), sous la forme de microagressions. L'analyse indique également que les étudiants et les résidents noirs tentent de faire face au racisme en utilisant une stratégie d'hyper-ritualisation pour mieux s'intégrer (par exemple, vêtements, comportements). Conclusion: Étant donné que les étudiants et les résidents noirs sont confrontés à diverses formes de racisme (subtil ou explicite) au cours de leur formation médicale, ces résultats nous incitent à sensibiliser davantage les étudiants, les résidents, les enseignants et les travailleurs de la santé au racisme dans les universités et les hôpitaux universitaires. Les parcours visant à accroître la représentation des étudiants et des résidents noirs semblent faire partie de la solution, mais l'amélioration de l'environnement d'apprentissage doit être une priorité pour atteindre la justice raciale dans la formation médicale au Québec.

Preliminary Reliability and Validity of the Self-Determination Inventory: Student Report French Translation.

There is a strong and growing focus on self-determination in French-speaking countries, and this pilot study reports the technical adequacy of the Self-Determination Inventory: Student Report (SDI:SR) French Translation. Data were collected with 471 French-speaking youth with and without disabilities in Canada (Quebec), Switzerland, France, and Belgium. Key findings showed it was feasible to use 20 (of 21) items to represent the self-determination construct in the French-speaking sample. The same set of items function in the same way across students with and without disabilities, and students with disabilities descriptively scored lower. Overall, this study provides promising evidence for reliability and validity of the SDI:SR French Translation and suggests ongoing development and larger-scale testing of the SDI:SR French Translation is warranted.

Social Determinants Influencing the Non-Adoption of Norms Favorable to the Prevention and Control of Type 2 Diabetes: Qualitative Research.

Diet, physical activity, and body shape play an essential role in the development of type 2 diabetes (T2D) and are the social dimensions most targeted by health professionals in their practices or intervention aimed at preventing and controlling T2D. However, several interventions focus more on individual factors and less on social determinants likely to influence the adoption of dietary, body, and physical activity standards favorable to the prevention and control of T2D. This study aims to explore the social determinants influencing the rejection or adoption of dietary, bodily, and physical activity norms favorable to the prevention and control of T2D among migrants from sub-Saharan Africa. A qualitative exploratory design guided data collection and analysis. Semi-structured qualitative interviews and focus groups were conducted between October 2022 and March 2023 in Montreal and Quebec Cities. The cost of food, the difficulty of accessing certain foods, a reliable level of income, work schedules, the gazes of relatives or communities, migration policies, disappointment and stressful situations linked to migratory status, racial microaggressions, and the lack of food guides adapted to the realities of MASS were the main determinants identified by the participants. These determinants can influence the adoption of public health recommendations on diet for the prevention and control of T2D. People living with T2D obviously have an important role to play, but much of the work lies outside their control. Therefore, Preventive, clinical, or awareness-raising interventions should more consider the life and structural contexts in which these people navigate without ignoring their pre-migratory rules of dietary, body, and physical activity norms.

Assessing cost and cost savings of teleconsultation in long-term care facilities: a time-driven activity-based costing analysis within a value-based healthcare framework.

BACKGROUND: Quebec's healthcare system faces significant challenges due to labour shortage, particularly in long-term care facilities (CHSLDs). The aging population and increasing demand for services compound this issue. Teleconsultation presents a promising solution to mitigate labour shortage, especially in small CHSLDs outside urban centers. This study aims to evaluate the cost and cost savings associated with teleconsultation in CHSLDs, utilizing the Time-Driven Activity-Based Costing (TDABC) model within the framework of Value-Based Healthcare (VBHC). METHODS: This study focuses on CHSLDs with fewer than 50 beds in remote regions of Quebec, where teleconsultation for nighttime nursing care was implemented. Time and cost data were collected from three CHSLDs over varying periods. The TDABC model, aligned with VBHC principles, was applied through five steps, including process mapping, estimating activity times, calculating resource costs, and determining total costs. RESULTS: Teleconsultation increased the cost per minute for nursing care compared to traditional care, attributed to additional tasks during remote consultations and potential technical challenges. However, cost savings were realized due to reduced need for onsite nursing staff during non-eventful nights. Overall, substantial savings were observed over the project duration, aligning with VBHC's focus on delivering high-value healthcare. CONCLUSIONS: This study contributes both theoretically and practically by demonstrating the application of TDABC within the VBHC framework in CHSLDs. The findings support the cost savings from the use of teleconsultation in small CHSLDs. Further research should explore the long-term sustainability and scalability of teleconsultation across different CHSLD sizes and settings within the VBHC context to ensure high-value healthcare delivery.

Managing Virtual Presenteeism during the COVID-19 Pandemic: A Multilevel Study on Managers' Stress Management Competencies to Foster Functional Presenteeism.

Teleworking remains an attractive option for many workers since the COVID-19 pandemic, but it presents significant management challenges, particularly when employees face health issues. The management of virtual presenteeism, where employees continue teleworking despite being ill, has received limited attention. This study explores the relationship between managers' stress management competencies (SMCs), mental health, and job performance of virtual presentees, aiming to fostering more functional presenteeism. We examine whether managers' SMCs promote functional presenteeism by comparing managers' self-assessments with employee assessments, and analyzing how agreement levels between the two affect mental health and job performance. Data were collected from 365 teleworkers supervised by 157 managers in a large public organization in Québec. The results indicate that virtual presentees' mental health and job performance are closely linked to employees' assessment of their managers' SMCs. Employees who agreed with their manager or overestimated their managers' SMCs exhibited better mental health and job performance than those who agreed with their manager on low SMCs or underestimated their managers. This study expands on the health-performance framework of presenteeism and self-other agreements, highlighting management practices that should be enhanced in the context of virtual presenteeism.

Omicron incidence and seroprevalence among children in Montreal, Canada, in early 2023: final results from the longitudinal EnCORE serology study.

Since early 2022, routine testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on symptoms and exposure history has largely ceased in Canada. Consequently, seroprevalence studies, particularly longitudinal studies, have become critical for monitoring the rate of incident SARS-CoV-2 infections and the proportion of the population with evidence of immunity. EnCORE is a longitudinal SARS-CoV-2 seroprevalence study comprising five rounds of serology testing from October 2020 to June 2023, in a sample of 2- to 17-year-olds (at baseline), recruited from daycares and schools in four neighbourhoods of Montreal, Canada. We report on SARS-CoV-2 incidence and seroprevalence among the 509 participants in the fifth and final round of the study. Seroprevalence of antibodies from either infection or vaccination was 98% (95 per cent confidence interval [CI]: 97, 99). The infection-acquired seroprevalence was 78% (95% CI: 73-82), and the incidence rate was 113 per 100 person-years (95% CI: 94-132), compared to the seroprevalence of 58% and the incidence rate of 133 per 100 person-years, respectively, in the fourth round of testing (mid-late 2022). Of the 131 participants newly seropositive for infection in Round 4, only 18 were seronegative for infection in Round 5 (median follow-up: 326 days).

Root and biomass allocation traits predict changes in plant species and communities over four decades of global change.

Global change is affecting the distribution and population dynamics of plant species across the planet, leading to trends such as shifts in distribution toward the poles and to higher elevations. Yet, we poorly understand why individual species respond differently to warming and other environmental changes, or how the trait composition of communities responds. Here we ask two questions regarding plant species and community changes over 42 years of global change in a temperate montane forest in Québec, Canada: (1) How did the trait composition, alpha diversity, and beta diversity of understory vascular plant communities change between 1970 and 2010, a period over which the region experienced 1.5°C of warming and changes in nitrogen deposition? (2) Can traits predict shifts in species elevation and abundance over this time period? For 46 understory vascular species, we locally measured six aboveground traits, and for 36 of those (not including shrubs), we also measured five belowground traits. Collectively, they capture leading dimensions of phenotypic variation that are associated with climatic and resource niches. At the community level, the trait composition of high-elevation plots shifted, primarily for two root traits: specific root length decreased and rooting depth increased. The mean trait values of high-elevation plots shifted over time toward values initially associated with low-elevation plots. These changes led to trait homogenization across elevations. The community-level shifts in traits mirrored the taxonomic shifts reported elsewhere for this site. At the species level, two of the three traits predicting changes in species elevation and abundance were belowground traits (low mycorrhizal fraction and shallow rooting). These findings highlight the importance of root traits, which, along with leaf mass fraction, were associated with shifts in distribution and abundance over four decades. Community-level trait changes were largely similar across the elevational and temporal gradients. In contrast, traits typically associated with lower elevations at the community level did not predict differences among species in their shift in abundance or distribution, indicating a decoupling between species- and community-level responses. Overall, changes were consistent with some influence of both climate warming and increased nitrogen availability.

Photoinduced Evolutions of Permafrost-Derived Carbon in Subarctic Thermokarst Pond Surface Waters.

In subarctic regions, rising temperature and permafrost thaw lead to the formation of thermokarst ponds, where organics from eroding permafrost accumulate. Despite its environmental significance, limited knowledge exists regarding the photosensitivity of permafrost-derived carbon in these ponds. In this study, laboratory experiments were conducted to explore the photochemical transformations of organic matter in surface water samples from thermokarst ponds from different environments in northern Quebec, Canada. One pond near Kuujjuarapik is characterized by the presence of a collapsing palsa and is therefore organically rich, while the other pond near Umiujaq is adjacent to a collapsing lithalsa and thus contains fewer organic matters. Photobleaching occurred in the Umiujaq sample upon irradiation, whereas the Kuujjuarapik sample exhibited an increase in light absorbance at wavelength related to aromatic functionalities, indicating different photochemical aging processes. Ultrahigh-resolution mass spectrometry analysis reveals that the Kuujjuarapik sample preferentially photoproduced highly unsaturated CHO compounds with great aromaticity, while the irradiated Umiujaq sample produced a higher proportion of CHON aromatics with reduced nitrogen functionalities. Overall, this study illustrates that the photochemical reactivity of thermokarst pond water varies with the source of organic matter. The observed differences in reactivity contribute to an improved understanding of the photochemical emission of volatile organic compounds discovered earlier. Further insights into the photoinduced evolutions in thermokarst ponds may require the classification of permafrost-derived carbon therein.

Boreal moss-microbe interactions are revealed through metagenome assembly of novel bacterial species.

Moss-microbe interactions contribute to ecosystem processes in boreal forests. Yet, how host-specific characteristics and the environment drive the composition and metabolic potential of moss microbiomes is still poorly understood. In this study, we use shotgun metagenomics to identify the taxonomy and metabolic potential of the bacteria of four moss species of the boreal forests of Northern Québec, Canada. To characterize moss bacterial community composition and diversity, we assembled the genomes of 110 potentially novel bacterial species. Our results highlight that moss genus, species, gametophyte section, and to a lesser extent soil pH and soil temperature, drive moss-associated bacterial community composition and diversity. In the brown gametophyte section, two Stigonema spp. showed partial pathway completeness for photosynthesis and nitrogen fixation, while all brown-associated Hyphomicrobiales had complete assimilatory nitrate reduction pathways and many nearly complete carbon fixation pathways. Several brown-associated species showed partial to complete pathways for coenzyme M and F420 biosynthesis, important for methane metabolism. In addition, green-associated Hyphomicrobiales (Methylobacteria spp.) displayed potential for the anoxygenic photosystem II pathway. Overall, our findings demonstrate how host-specific characteristics and environmental factors shape the composition and metabolic potential of moss bacteria, highlighting their roles in carbon fixation, nitrogen cycling, and methane metabolism in boreal forests.

Sons Shorten Mother's Lifespan in Preindustrial Families with a High Level of Infant Mortality.

AbstractIn dimorphic vertebrates where males are larger than females, the energetic costs of producing and rearing sons can exceed those of daughters. In humans, differences in maternal energy intake suggest that sons require 10% and 7% more energy than daughters during pregnancy and lactation, respectively. Due to a trade-off between reproduction and somatic maintenance, having sons is expected to have a more pronounced detrimental impact on a mother's lifespan than having daughters. A limitation of previous studies investigating this hypothesis is that the increased mortality cost of having sons was assumed to affect all mothers equally. Using a dataset from a preindustrial Quebec population monitored over two centuries, we found that the number of sons decreased postmenopausal lifespan only in mothers experiencing high infant mortality. Our study highlights the importance of interindividual variation in environmental conditions and maternal health when studying effects of offspring sex on reproductive costs.

Reasons for High Emergency Department Use Among Patients With Common Mental Disorders or Substance-Related Disorders.

Aims: This study examined the reasons for high emergency department (ED) use among patients with common mental disorders (MDs), substance-related disorders (SRDs) or co-occurring MDs-SRDs. Method: Following content analysis, 42 high ED users (three-plus visits/year) recruited in two Quebec EDs were interviewed. Results: The reasons included barriers to outpatient care, patient disabilities and professional practices. Patients with SRDs trust outpatient services less, those with MDs had important unmet needs and those with MDs-SRDs faced care coordination issues. Conclusion: Improvements such as ED use monitoring, consolidating MD-SRD practices and continuous training are needed in EDs and outpatient services to enhance access and continuity of care.

Combining Short- and Long-Read Sequencing Technologies to Identify SARS-CoV-2 Variants in Wastewater.

During the COVID-19 pandemic, the monitoring of SARS-CoV-2 RNA in wastewater was used to track the evolution and emergence of variant lineages and gauge infection levels in the community, informing appropriate public health responses without relying solely on clinical testing. As more sublineages were discovered, it increased the difficulty in identifying distinct variants in a mixed population sample, particularly those without a known lineage. Here, we compare the sequencing technology from Illumina and from Oxford Nanopore Technologies, in order to determine their efficacy at detecting variants of differing abundance, using 248 wastewater samples from various Quebec and Ontario cities. Our study used two analytical approaches to identify the main variants in the samples: the presence of signature and marker mutations and the co-occurrence of signature mutations within the same amplicon. We observed that each sequencing method detected certain variants at different frequencies as each method preferentially detects mutations of distinct variants. Illumina sequencing detected more mutations with a predominant lineage that is in low abundance across the population or unknown for that time period, while Nanopore sequencing had a higher detection rate of mutations that are predominantly found in the high abundance B.1.1.7 (Alpha) lineage as well as a higher sequencing rate of co-occurring mutations in the same amplicon. We present a workflow that integrates short-read and long-read sequencing to improve the detection of SARS-CoV-2 variant lineages in mixed population samples, such as wastewater.

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.

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.

Medical Assistance in Dying in Quebec: A Continuum Between Teams' Accountability and Interdisciplinary Support Groups' Assumption of Responsibility.

Objectives: In the province of Quebec, Canada, interdisciplinary support groups (ISGs) are mandated to support those who are involved in the clinical, administrative, legal and ethical aspects of medical assistance in dying (MAiD). This article presents the results of a mixed-method, multi-phase study carried out in 2021 on ISGs with the aim to describe current ISG practices, critically analyze them and make recommendations on promising practices for provincial implementation. Method: Semi-structured interviews (42) and focus groups (7) with coordinators of 24 ISGs were used to identify promising practices and confirm their utility with participants. Results: We have distributed the ISGs along what we coined an "ISG continuum." Between teams' accountability (decentralization) and ISGs' assumption of responsibility for MAiD requests (centralization), a middle ground approach, focused on the value of support, should be favored. Conclusion: The structuring of ISGs and their practices is intimately linked to their values. Harmonization of ISGs and their practices, while considering their specific values and contexts, can contribute to the equity and quality of services intended for those who request MAiD and those who support them.