Predicting malaria risk considering vector control interventions under climate change scenarios.

Many studies have projected malaria risks with climate change scenarios by modelling one or two environmental variables and without the consideration of malaria control interventions. We aimed to predict the risk of malaria with climate change considering the influence of rainfall, humidity, temperatures, vegetation, and vector control interventions (indoor residual spraying (IRS) and long-lasting insecticidal nets (LLIN)). We used negative binomial models based on weekly malaria data from six facility-based surveillance sites in Uganda from 2010-2018, to estimate associations between malaria, environmental variables and interventions, accounting for the non-linearity of environmental variables. Associations were applied to future climate scenarios to predict malaria distribution using an ensemble of Regional Climate Models under two Representative Concentration Pathways (RCP4.5 and RCP8.5). Predictions including interaction effects between environmental variables and interventions were also explored. The results showed upward trends in the annual malaria cases by 25% to 30% by 2050s in the absence of intervention but there was great variability in the predictions (historical vs RCP 4.5 medians [Min-Max]: 16,785 [9,902-74,382] vs 21,289 [11,796-70,606]). The combination of IRS and LLIN, IRS alone, and LLIN alone would contribute to reducing the malaria burden by 76%, 63% and 35% respectively. Similar conclusions were drawn from the predictions of the models with and without interactions between environmental factors and interventions, suggesting that the interactions have no added value for the predictions. The results highlight the need for maintaining vector control interventions for malaria prevention and control in the context of climate change given the potential public health and economic implications of increasing malaria in Uganda.

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.

Differential Influence of Environmental Factors on Malaria Due to Vector Control Interventions in Uganda.

BACKGROUND: Few studies have explored how vector control interventions may modify associations between environmental factors and malaria. METHODS: We used weekly malaria cases reported from six public health facilities in Uganda. Environmental variables (temperature, rainfall, humidity, and vegetation) were extracted from remote sensing sources. The non-linearity of environmental variables was investigated, and negative binomial regression models were used to explore the influence of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) on associations between environmental factors and malaria incident cases for each site as well as pooled across the facilities, with or without considering the interaction between environmental variables and vector control interventions. RESULTS: An average of 73.3 weekly malaria cases per site (range: 0-597) occurred between 2010 and 2018. From the pooled model, malaria risk related to environmental variables was reduced by about 35% with LLINs and 63% with IRS. Significant interactions were observed between some environmental variables and vector control interventions. There was site-specific variability in the shape of the environment-malaria risk relationship and in the influence of interventions (6 to 72% reduction in cases with LLINs and 43 to 74% with IRS). CONCLUSION: The influence of vector control interventions on the malaria-environment relationship need to be considered at a local scale in order to efficiently guide control programs.

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.

In vitro assessment of the genotoxicity and immunotoxicity of treated and untreated municipal effluents and receiving waters in freshwater organisms.

Municipal wastewater effluent is one of the largest sources of pollution entering surface waters in the Laurentian Great Lakes. Exposure to wastewater effluent has been associated with impaired immune systems and induction of genotoxicity to aquatic animals. Due to habitat degradation and environmental pollution linked to industrial development and population growth, several regions of the Great Lakes have been designated Areas of Concern (AOCs). In this study, we assessed the effect of extracts of sewage influent, (treated) effluent and receiving surface waters from the Hamilton Harbour AOC and the Toronto and Region AOC (Ontario, Canada) on the phagocytic immune response of rainbow trout (Oncorhynchus mykiss) kidney leukocytes and the genotoxicity (DNA strand breaks) of these extracts on freshwater mussel (Eurynia dilatata) hemocytes. We identified and quantified numerous chemicals present in the various samples extracted for exposure. In freshwater mussels, extracts from Hamilton Harbour AOC induced DNA damage with the most frequency (12 out of 28 samples) regardless of sample type, reflecting past and present industrial activities. In contrast, extracts from Toronto and Region AOC induced DNA damage infrequently (2 out of 32 (summer) and 5 out of 32 (fall) samples, respectively) and from different WWTPs at different times. None of the extracts induced any significant effect on phagocytosis of rainbow trout kidney leukocytes. The present study indicates that despite overall improvements to effluent quality, treatment of influent by WWTPs may not result in a corresponding improvement of the genotoxicity of effluents. In vitro bioassays are useful and cost-effective rapid-screening tools for preliminary assessments of contamination of aquatic ecosystems.

Relationships between long-term residential exposure to total environmental noise and stroke incidence.

Background: Noise has been related to several cardiovascular diseases (CVDs) such as coronary heart disease and to their risk factors such as hypertension, but associations with stroke remain under-researched, even if CVD likely share similar pathophysiologic mechanisms. Aim: The objective of the study was to examine the association between long-term residential exposure to total environmental noise and stroke incidence in Montreal, Canada. Materials and Methods: We created an open cohort of adults aged ≥45years, free of stroke before entering the cohort for the years 2000 to 2014 with health administrative data. Residential total environmental noise levels were estimated with land use regression (LUR) models. Incident stroke was based on hospital admissions. Cox hazard models with age as the time axis and time-varying exposures were used to estimate associations, which were adjusted for material deprivation, year, nitrogen dioxide, stratified for sex, and indirectly adjusted for smoking. Results: There were 9,072,492 person-years of follow-up with 47% men; 26,741 developed stroke (21,402 ischemic; 4947 hemorrhagic; 392 had both). LUR total noise level acoustic equivalent for 24 hours (LAeq24h) ranged 44 to 79 dBA. The adjusted hazard ratio (HR) for stroke (all types), for a 10-dBA increase in LAeq24h, was 1.06 [95% confidence interval (CI): 1.03-1.09]. The LAeq24h was associated with ischemic (HR per 10 dBA: 1.08; 95% CI: 1.04-1.12) but not hemorrhagic stroke (HR per 10 dBA: 0.97; 95% CI: 0.90-1.04). Conclusion: The results suggest that total environmental noise is associated with incident stroke, which is consistent with studies on transportation noise and other CVD.

The influence of the environment and indoor residual spraying on malaria risk in a cohort of children in Uganda.

Studies have estimated the impact of the environment on malaria incidence although few have explored the differential impact due to malaria control interventions. Therefore, the objective of the study was to evaluate the effect of indoor residual spraying (IRS) on the relationship between malaria and environment (i.e. rainfall, temperatures, humidity, and vegetation) using data from a dynamic cohort of children from three sub-counties in Uganda. Environmental variables were extracted from remote sensing sources and averaged over different time periods. General linear mixed models were constructed for each sub-counties based on a log-binomial distribution. The influence of IRS was analysed by comparing marginal effects of environment in models adjusted and unadjusted for IRS. Great regional variability in the shape (linear and non-linear), direction, and magnitude of environmental associations with malaria risk were observed between sub-counties. IRS was significantly associated with malaria risk reduction (risk ratios vary from RR = 0.03, CI 95% [0.03-0.08] to RR = 0.35, CI95% [0.28-0.42]). Model adjustment for this intervention changed the magnitude and/or direction of environment-malaria associations, suggesting an interaction effect. This study evaluated the potential influence of IRS in the malaria-environment association and highlighted the necessity to control for interventions when they are performed to properly estimate the environmental influence on malaria. Local models are more informative to guide intervention program compared to national models.

Manuscript title: Long─term residential exposure to environmental/transportation noise and the incidence of myocardial infarction.

BACKGROUND: Cardiovascular effects of environmental noise are a growing concern. However, the evidence remains largely limited to the association between road traffic noise and hypertension and coronary heart diseases. OBJECTIVES: To investigate the association between long-term residential exposure to environmental/transportation noise and the incidence of myocardial infarction (MI) in the adult population living in Montreal. METHODS: An open cohort of adults aged 45 years old and over, living on the island of Montreal and free of MI before entering the cohort was created for the years 2000-2014 with the Quebec Integrated Chronic Disease Surveillance System; a systematic surveillance system from the Canadian province of Quebec starting in 1996. Residential noise exposure was calculated in three ways: 1) total ambient noise levels estimated by Land use regression (LUR) models; 2) road traffic noise estimated by a noise propagation model CadnaA and 3) distances to transportation sources (roads, airport, railways). Incident MI was based on diagnostic codes in hospital admission records. Cox models with time-varying exposures (age as the time axis) were used to estimate the associations with various adjustments (material deprivation indicator, calendar year, nitrogen dioxide, stratification for sex). Indirect adjustment based on ancillary data for smoking was performed. RESULTS: 1,065,414 individuals were followed (total of 9,000,443 person-years) and 40,718 (3.8%) developed MI. We found positive associations between total environmental noise, estimated by LUR models and the incidence of MI. Total noise LUR levels ranged from ~44 to ~79 dBA and varied slightly with the metric used. The adjusted hazard ratios (HRs) (also adjusted for smoking) were 1.12 (95% Confidence Intervals [CI]: 1.08-1.15), 1.11 (95%CI: 1.07-1.14) and 1.10 (95%CI: 1.06-1.14) per 10 dBA noise levels increase respectively in Level Accoustic equivalent 24 h (LAeq24 h), Level day-evening-night (Lden) and night level (Lnight). We found a borderline negative association between road noise levels estimated with CadnaA and MI (HR: 0.99 per 10 dBA; 95%CI: 0.98-1.00). Distances to major roads and highways were not associated with MI while the proximity to railways was positively associated with MI (HR for ≤100 vs > 1000 m: 1.07; 95%CI: 1.01-1.14). A negative association was found with the proximity to the airport noise exposure forecast (NEF25); HR (<1 vs >1000 m) = 0.88 (95%CI: 0.81-0.96). CONCLUSIONS: These associations suggest that exposure to total environmental noise at current urban levels may be related to the incidence of MI. Additional studies with more accurate road noise estimates are needed to explain the counterintuitive associations with road noise and specific transportation sources.

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.

Does Place Matter? An International Comparison of Early Childhood Development Outcomes between the Metropolitan Areas of Melbourne, Australia and Montreal, Canada.

There is strong consensus about the importance of early childhood development (ECD) for improving population health and closing the health inequity gap. Environmental features and public policies across sectors and jurisdictions are known to influence ECD. International comparisons provide valuable opportunities to better understand the impact of these ecological determinants on ECD. This study compared ECD outcomes between metropolitan Melbourne (Australia) and Montreal (Canada), and contrasted disparities across demographic and socioeconomic characteristics. Methods: Population wide surveys using the Early Development Instrument (EDI) were conducted among 4-6 years-old children in both Montreal and Melbourne in 2012, measuring five domains of ECD: 1-Physical Health/Well-Being (PHYS); 2-Social Competence (SOC); 3-Emotional Maturity (EMOT); 4-Language/Cognitive Development (COGN); and 5-Communication Skills/General Knowledge (COMM). Descriptive analyses of summary EDI indicators and domain indicators (including median scores and interquartile ranges) were compared between metropolitan areas, using their respective 95% confident intervals (CIs). Analyses were performed using Stata software (v14). Results: The proportion of children developmentally vulnerable in at least one domain of ECD was 26.8% (95% CIs: 26.2, 27.3) in Montreal vs. 19.2% (95% CIs: 18.8, 19.5) in Melbourne. The Melbourne advantage was greatest for EMOT and COGN (11.5% vs. 6.9%; 13.0% vs. 5.8%). In both Montreal and Melbourne, boys, immigrants, children not speaking the language of the majority at home, and those living in the most deprived areas were at greater risk of being developmentally vulnerable. Relative risks as a function of home language and area-level deprivation subgroups were smaller in Montreal than in Melbourne. Conclusion: This study shows that Melbourne's children globally experience better ECD outcomes than Montreal's children, but that inequity gaps are greater in Melbourne for language and area-level deprivation subgroups. Further research is warranted to identify the environmental factors, policies, and programs that account for these observed differences.

Gender-specific correlates of perceived life stress: a population-based study, Montreal, Canada, 2012.

OBJECTIVES: To identify the gender-specific correlates of perceived life stress in a representative sample of the Montreal population. METHOD: Data were extracted from the Local Health Survey Program (called "TOPO") collected in 2012. TOPO-2012 provided information on chronic diseases, their determinants and risk factors, as well as lifestyle and health services utilization. Poisson regression was used to identify significant correlates of perceived life stress. RESULTS: Single-parent females were 21% more likely (RR = 1.21; 95% CI = 1.04-1.42) to report stressful life compared to females living alone. Females born in Canada or established female immigrants were significantly more likely to report stressful life (respectively RR = 1.34; 95% CI = 1.12-1.60 and RR = 1.31; 95% CI = 1.08-1.58) than recent female immigrants. Furthermore, females living in a privileged material neighbourhood reported significantly higher perceived life stress (14% higher) than females living in a deprived neighbourhood. On the other hand, males with higher annual household income were 9% more likely (OR = 1.09; 95% CI = 1.05-1.14) to perceive life stress than males reporting a lower income. Also, overweight males reported higher stress (RR = 1.13; 95% CI = 1.01-1.26) than their normal weighted counterparts. Additionally, males who were diagnosed with a physical health problem were more likely to report stressful life (RR = 1.44; 95% CI = 1.28-1.61) than males who did not report any physical health problem. CONCLUSION: Identifying correlates of stress at the population level may help researchers characterize people vulnerable to daily stress, provide health agencies the advantage to forecast and prevent its occurrence and diseases associated with it, as well as offer policy advocates a pivotal edge to reduce disparities in population health.

A population-based birth cohort study of the association between childhood-onset asthma and exposure to industrial air pollutant emissions.

BACKGROUND: Studies of the association between air pollution and asthma onset have mostly focused on urban and traffic-related air pollution. We investigated the associations between exposure to industrial emissions and childhood-onset asthma in a population-based birth cohort in Quebec, Canada, 2002-2011. METHODS: The cohort was built from administrative health databases. We developed separately for PM2.5 and SO2 different metrics representing children's time-varying residential exposure to industrial emissions: 1) yearly number of tons of air pollutant emitted by industries located within 2.5 km of the residence; 2) distance to the nearest "major emitter" (≥100 tons) of either PM2.5 and SO2 within 7.5 km of the residence, and; 3) tons of air pollutant emitted by the nearest "major emitter" within 7.5 km, weighted by the inverse of the distance and the percentage of time that the residence was downwind. To handle the large number of zeros (i.e., children unexposed) we decomposed the exposure variable into two covariates simultaneously included in the regression model: a binary indicator of exposure and a continuous exposure variable centered at the mean value among exposed children. We performed Cox models using age as the time axis, adjusted for gender, material and social deprivation and calendar year. We indirectly adjusted for unmeasured secondhand smoke. RESULTS: The cohort included 722,667 children and 66,559 incident cases of asthma. Across the different exposure metrics, mean percentage changes in the risk of asthma onset in children exposed to the mean relative to those unexposed ranged from 4.5% (95% CI: 2.8, 6.3%) to 10.6% (95% CI: 6.2, 15.2%) for PM2.5 and, from 1.1% (95% CI: -0.1, 3.3%) to 8.9% (95% CI: 7.1, 11.1%) for SO2. Indirect adjustment for secondhand smoke did not substantially affect the associations. In children exposed, the risk of asthma onset increased with the magnitude of the exposure for all metrics, except the distance to the nearest major emitter of SO2. CONCLUSIONS: In this population-based birth cohort, residential exposure to industrial air pollutant emissions was associated with childhood-onset asthma. Additional studies with improved models for estimating exposure to industrial point-sources are needed to further support the observed associations.

Immunotoxicity and genotoxicity of single-walled carbon nanotubes co-exposed with cadmium in the freshwater mussel, Elliptio complanata.

Potential immunotoxicity and genotoxicity of as-produced and purified single walled carbon nanotubes (SWCNT, 500 µg L-¹) with or without cadmium (20 µg L-¹) was investigated in hemocytes of the freshwater mussel, Elliptio complanata. Our results showed a decrease in hemocyte viability after 3, and 8 days of exposure and an increase of hemocyte phagocytic efficiency for organisms exposed to Cd. No modification of the cyclo-oxygenase (COX) activity was measured. An increase in DNA damage was measured after 1 day of exposure to Cd and a potentiating effect of combined exposures was observed.

Quelle est l'association entre les caractéristiques résidentielles et du quartier et le développement de l'enfant à la maternelle?

OBJECTIVES: Evaluate the association between residential and neighbourhood characteristics of families and children and the latter's development, using data from the Montréal Survey on the Preschool Experiences of Children in Kindergarten (MSPECK). METHOD: A sample of 1101 children was extracted from a survey frame that included Montréal children assessed in the 2012 Québec Survey of Child Development in Kindergarten (2012 QSCDK). Data collected from the children's parents were used to document the following residential and neighbourhood characteristics (independent variables): material deprivation in the neighbourhood, housing health, residential crowding, housing instability, neighbourhood safety, and access to resources. Linking QSCDK data provided a measure of development for children in kindergarten (dependent variable). Logistic regression was used to predict the probability of kindergarten children being vulnerable in at least one domain of development, or in two or more domains. RESULTS: Children living in neighbourhoods perceived to be dangerous are 1.5 times more likely to be vulnerable in at least one domain of development, compared with their peers living in neighbourhoods perceived to be safe (95% CI: 1.02-2.14). A similar result is observed for vulnerability in two or more domains of development (OR 1.67; 95% CI: 1.07-2.61). Children living in families who lack access to resources are also more likely to be vulnerable in two or more domains of development than their peers in families who have easy access to resources (OR 1.56; 95% CI: 1.003-2.44). CONCLUSION: Parents' feelings of insecurity and lack of access to local resources can limit children's opportunities for socialization and their exposure to enriching experiences.

Field biomonitoring using the zebra mussel Dreissena polymorpha and the quagga mussel Dreissena bugensis following immunotoxic reponses. Is there a need to separate the two species?

The zebra mussel, Dreissena polymorpha constitutes an extensively used sentinel species for biomonitoring in European and North American freshwater systems. However, this invasive species is gradually replaced in freshwater ecosystem by Dreissena bugensis, a closely related dreissenid species that shares common morphological characteristics but possess some physiological differences. However, few are known about differences on more integrated physiological processes that are generally used as biomarkers in biological monitoring studies. Declining of zebra mussel populations raises the question of the sustainability of using one or both species indifferently to maintain the quality of environmental pollution monitoring data. In our study, we performed a field comparative study measuring immune-related markers and bioaccumulation of PCBs, PAHs and PBDEs in sympatrically occurring mussel populations from three sites of the St. Lawrence River. For tested organisms, species were identified using RFLP analysis. Measurement of bioaccumulated organic compounds indicated a higher accumulation of PCBs and PBDEs in D. bugensis soft tissues compared to D. polymorpha while no differences were noticed for PAHs. Results of hemocytic parameters highlighted that differences of hemocyte distributions were associated to modulations of phagocytic activities. Moreover, marked differences occurred in measurement of hemocytic oxidative activity, indicating divergences between the two species for ROS regulation strategies. This physiological characteristic may deeply influence species responses facing environmental or pollution related stress and induce bias if the two species are not differentiated in further biomarker or bioaccumulation measurement-based studies.

Effects on patients of variations in the implementation of a cardiometabolic risk intervention program in Montréal. / Effets sur les patients des variations dans l'implantation d'un programme d'intervention sur le risque cardiométabolique à Montréal.

INTRODUCTION: In 2011, the Agence de la santé et des services sociaux de Montréal (ASSSM), in partnership with the region's Centres de santé et de services sociaux (CSSS), coordinated the implementation of a program on cardiometabolic risk based on the Chronic Care Model. The program, intended for patients suffering from diabetes or hypertension, involved a series of individual follow-up appointments, group classes and exercise sessions. Our study assesses the impact on patient health outcomes of variations in the implementation of some aspects of the program among the six CSSSs taking part in the study. METHODS: The evaluation was carried out using a quasi-experimental "before and after" design. Implementation variables were constructed based on data collected during the implementation analysis regarding resources, compliance with the clinical process set out in the regional program, the program experience and internal coordination within the care team. Differences in differences using propensity scores were calculated for HbA1c results, achieving the blood pressure (BP) target, and two lifestyle targets (exercise level and carbohydrate distribution) at the 6- and 12-month follow-ups, based on greater or lesser patient exposure to the implementation of various aspects of the program under study. RESULTS: The results focus on 1185 patients for whom we had data at the 6-month follow- up and the 992 patients from the 12-month follow-up. The difference in differences analysis shows no clear association between the extent of implementation of the various aspects of the program under study and patient health outcomes. CONCLUSION: The program produces effects on selected health indicators independent of variations in program implementation among the CSSSs taking part in the study. The results suggest that the effects of this type of program are more highly dependent on the delivery of interventions to patients than on the organizational aspects of its implementation.

INTRODUCTION: En 2011, l'Agence de la santé et des services sociaux de Montréal (ASSSM), en partenariat avec les Centres de santé et de services sociaux (CSSS) de la région, a coordonné la mise en oeuvre d'un programme sur le risque cardiométabolique s'inspirant du Chronic Care Model. Ce programme destiné aux patients diabétiques ou hypertendus comporte une séquence de suivis individuels, des cours de groupe et des séances d'activité physique. Notre étude évalue l'impact de la variation dans l'implantation de certains aspects du programme entre les six CSSS participant à l'étude sur les résultats de santé des patients. MÉTHODOLOGIE: L'évaluation a été réalisée à l'aide d'un devis quasi-expérimental « avantaprès ¼. Des variables d'implantation ont été construites à partir de données colligées lors de l'analyse d'implantation concernant les ressources, la conformité au processus clinique prévu dans le programme régional, l'expérience du programme et la coordination interne au sein de l'équipe de soins. Des différences de différences utilisant des scores de propension ont été calculées pour les résultats d'HbA1c, l'atteinte de la cible de tension artérielle (TA) et de deux cibles d'habitudes de vie (niveau d'activité physique et répartition des glucides alimentaires) à 6 mois et à 12 mois de suivi, en fonction de l'exposition des patients à un degré plus ou moins important d'implantation de divers aspects du programme à l'étude. RÉSULTATS: Les résultats portent sur les 1 185 patients pour lesquels on disposait de données de suivi à 6 mois et les 992 patients pour le suivi à 12 mois. Les analyses de différences de différences ne révèlent aucune association claire entre le degré d'implantation des divers aspects du programme à l'étude et les résultats de santé chez les patients. CONCLUSION: Le programme produit des effets sur les indicateurs de santé sélectionnés indépendamment des variations dans l'implantation du programme entre les CSSS participant à l'étude. Les résultats suggèrent que les effets d'un tel programme sont davantage tributaires de la prestation des interventions auprès des patients que des aspects organisationnels liés à son implantation.

T lymphocyte-proliferative responses of harbor seal (Phoca vitulina) peripheral blood mononuclear cells (PBMCs) exposed to pharmaceuticals in vitro.

The ubiquity of pharmaceuticals in the aquatic environment and the accumulation in organisms of lower trophic levels have been documented. The immunotoxicity of these xenobiotics has however been little investigated. This study assessed the effects of pharmaceuticals on the immune responses of harbor seal lymphocytes. Peripheral blood mononuclear cells isolated from harbor seal pups were exposed to varying concentrations of 17α-ethinyl estradiol (250-50,000µg/L), naproxen (500-100,000µg/L), carbamazepine (500-100,000µg/L), erythromycin (750-150,000µg/L) and binary mixtures thereof in vitro. All individual compounds and mixtures inhibited lymphocyte proliferation. Mixture effects were non-additive and predictive values overestimated the inhibition of proliferation. Male pups were more sensitive to erythromycin exposure. Comparison with the sensitivity of the 11B7501 cell line showed a higher sensitivity of pups to individual compounds and the inverse trend for mixtures. Based on our results, we hypothesize that pharmaceuticals may have the potential to interrupt immune functions in harbor seals.

Exposure to low environmental concentrations of manganese, lead, and cadmium alters the serotonin system of blue mussels.

Serotonin plays a crucial role in mussel survival and reproduction. Although the serotonin system can be affected by metals, the effects of environmental concentrations of metals such as manganese (Mn), lead (Pd), and cadmium (Cd) have never been studied in blue mussels. The present study aimed to determine the effects of exposure to Mn, Pb, or Cd on serotonin levels, monoamine oxidase (MAO) activity, and serotonin transporter (SERT) levels in the blue mussel Mytilus edulis. Mussels were exposed in vivo to increasing and environmentally relevant doses of Mn (10-1000 nM; 0.5-50 µg/L), Pb (0.01-10 nM; 0.002-2 µg/L), or Cd (0.01-10 nM; 0.001-1 µg/L) for 28 d. Serotonin levels, MAO activity, and SERT expression were analyzed in the mussel mantle. Expression of SERT protein was significantly decreased, by up to 81%, following Mn, Pb, or Cd exposure. The activity of MAO in females was almost 2-fold higher, versus males, in nonexposed control mussels. In mussels exposed to 0.1 nM of Pb (0.02 µg/L), MAO activity was increased in males and decreased in females. In Cd-exposed mussels, a sex-dependent, inverted nonmonotonic pattern of MAO activity was observed. These results clearly indicate that low environmental concentrations of Mn, Pb, and Cd affect the serotonin system in blue mussels. Environ Toxicol Chem 2018;37:192-200. © 2017 SETAC.