Implementation of Artificial Intelligence-Based Diabetic Retinopathy Screening in a Tertiary Care Hospital in Quebec: Prospective Validation Study.

BACKGROUND: Diabetic retinopathy (DR) affects about 25% of people with diabetes in Canada. Early detection of DR is essential for preventing vision loss. OBJECTIVE: We evaluated the real-world performance of an artificial intelligence (AI) system that analyzes fundus images for DR screening in a Quebec tertiary care center. METHODS: We prospectively recruited adult patients with diabetes at the Centre hospitalier de l'Université de Montréal (CHUM) in Montreal, Quebec, Canada. Patients underwent dual-pathway screening: first by the Computer Assisted Retinal Analysis (CARA) AI system (index test), then by standard ophthalmological examination (reference standard). We measured the AI system's sensitivity and specificity for detecting referable disease at the patient level, along with its performance for detecting any retinopathy and diabetic macular edema (DME) at the eye level, and potential cost savings. RESULTS: This study included 115 patients. CARA demonstrated a sensitivity of 87.5% (95% CI 71.9-95.0) and specificity of 66.2% (95% CI 54.3-76.3) for detecting referable disease at the patient level. For any retinopathy detection at the eye level, CARA showed 88.2% sensitivity (95% CI 76.6-94.5) and 71.4% specificity (95% CI 63.7-78.1). For DME detection, CARA had 100% sensitivity (95% CI 64.6-100) and 81.9% specificity (95% CI 75.6-86.8). Potential yearly savings from implementing CARA at the CHUM were estimated at CAD $245,635 (US $177,643.23, as of July 26, 2024) considering 5000 patients with diabetes. CONCLUSIONS: Our study indicates that integrating a semiautomated AI system for DR screening demonstrates high sensitivity for detecting referable disease in a real-world setting. This system has the potential to improve screening efficiency and reduce costs at the CHUM, but more work is needed to validate it.

Which factors drive the choice of the French-speaking Quebec population towards a COVID-19 vaccination programme: A discrete-choice experiment.

OBJECTIVES: The aims of this study were to elicit preferences about the coronavirus disease 2019 (COVID-19) vaccine campaign in the general French-speaking adult Quebec population and to highlight the characteristics of the vaccine campaign that were of major importance. METHODS: A discrete-choice experiment (DCE) was conducted between April and June 2021, in Quebec, Canada. A quota sampling method by age, gender and educational level was used to achieve a representative sample of the French-speaking adult population. The choice-based exercise was described by seven attributes within a vaccine campaign scenario. A mixed logit (MXL) model and a latent class logit (LCL) model were used to derive utility values. Age, gender, educational level, income and fear of COVID-19 were included as independent variables in the LCL. RESULTS: A total of 1883 respondents were included for analysis, yielding 22,586 choices. From these choices, 3425 (15.16%) were refusals. In addition, 1159 (61.55%) individuals always accepted any of the vaccination campaigns, while 92 individuals (4.89%) always refused vaccine alternatives. According to the MXL, relative weight importance of attributes was effectiveness (32.50%), risk of side effects (24.76%), level of scientific evidence (22.51%), number of shots (15.73%), priority population (3.60%), type of vaccine (0.61%), and vaccination location (0.28%). Four classes were derived from the LCL model and attributes were more or less important according to them. Class 1 (19.8%) was more concerned about the effectiveness (27.99%), safety (24.22%) and the number of shots (21.82%), class 2 (55.3%) wanted a highly effective vaccine (40.16%) and class 3 (17.6%) gave high value to the scientific evidence (42.00%). Class 4 preferences (7.4%) were more balanced, with each attribute having a relative weight ranging from 1.84% (type of vaccine) to 21.32% (risk of side effects). Membership posterior probabilities to latent classes were found to be predicted by individual factors such as gender, annual income or fear of COVID-19. CONCLUSIONS: Vaccination acceptance relies on multiple factors. This study allowed assessment of vaccination-specific issues through a choice-based exercise and description of factors influencing this choice by segmenting the sample and drawing profiles of individuals. Moreover, besides effectiveness and safety, a major point of this study was to show the importance given by the general population to the level of scientific evidence surrounding vaccines. PATIENT OR PUBLIC CONTRIBUTION: A small group of citizens was involved in the conception, design and interpretation of data. Participants of the DCE were all from the general population.

Vulnerability of barley yields in Québec.

Climate projections across Québec indicate increased water stress and recurrent vulnerability of cropping systems. In recent years, reports of droughts and water stress have been recorded across the province. Many parts of Québec have experienced droughts in the past few years, which have had uninvestigated impacts on crops. These droughts have been described as some of the most significant in the last 80 years. On the positive side, climate change is likely to trigger shorter winters and therefore longer growing seasons for several crops. However, for crops like maple syrup, the regions suitable for their cultivation will shift northwards. Despite these projections, studies monitoring the susceptibility of barley to environmental changes, climate variability, and adaptive capacity across Québec are still limited. This study aims to provide a provincial-scale portrait of vulnerability of barley in Québec based on historical growing season precipitation, barley yield, and socioeconomic data (literacy and poverty rates) using a composite statistical model. Growing season precipitation data were downloaded from Ouranos. Barley yield data were collected from the Institut de la Statistique du Québec, and the socio-demographic data were collected from the Advisory Council of Poverty and the Institut de la Statistique du Québec. A vulnerability index with sub-indices (sensitivity, exposure, and adaptive capacity) is deployed. It is hypothesised that (1) vulnerability is inversely associated with adaptive capacity, and (2) the peripheral regions of Québec are more vulnerable and less adaptive to climate stressors. Initial results show that when the vulnerability index for barley is more prominent, the associated index of adaptive capacity is relatively lower. A significant gradient between the peripheral and southern regions of Québec is observed, with vulnerability lowest around Montreal/Laval and gradually increasing towards the peripheral regions. A better understanding of vulnerability warrants a change in approach from focusing solely on climate-related variables to integrating socioeconomic proxies. The challenge, however, has been how to introduce these socioeconomic proxies into empirical and process-based crop models.

Revealing the Most Vulnerable Groups: Courtesy Stigma in Caregivers of Autistic Persons in Quebec.

Introduction: Caregivers of autistic persons often face "courtesy stigma," a phenomenon by which caregivers experience stigma because of their association with a person whose disability may be stigmatized. Understanding the repercussions of this stigma is crucial not only for caregivers' mental health but also for the quality of care provided to their dependent. This study aimed to explore courtesy stigma among caregivers of autistic persons in Quebec, examining its prevalence and impact in order to identify groups that are particularly susceptible to negative outcomes. Methods: This study used a cross-sectional online survey methodology employing quota sampling to collect responses from 194 participants. Data were collected using a computer-assisted web interview (CAWI) platform. The impact of courtesy stigma was measured in terms of care burden, mental health, and overall well-being of caregivers. Results: The findings revealed that caregivers frequently experience rejection, isolation, and work-related challenges. Notably, caregivers' health was below average with the lowest reported health outcomes in Quebec. The caregivers who are the most vulnerable to negative outcomes included female caregivers, those aged 45 or older, financially strained households, caregivers of children requiring elevated levels of support, caregivers who isolated due to their autistic dependents, and those who experienced stigmatization directed at themselves or their children in the form of rejection.Interestingly, 60% of respondents reported that the caregiving burden was "not at all" to "somewhat" difficult, raising questions about factors that may mitigate caregiving challenges over time. Conclusion: Negative outcomes from courtesy stigma vary depending on certain risk factors and individual characteristic. This study underscores the need for targeted public policies and interventions, particularly for those at a higher risk of experiencing the negative effects of courtesy stigma on the burden of care, overall health, and mental health. By tailoring resources and support for these priority groups, we can better address the challenges faced by families of autistic persons.

Trends in toxicological findings in unintentional opioid or stimulant toxicity deaths in Québec, Canada, 2012-2021: Has Québec entered a new era of drug-related deaths?

INTRODUCTION: We aimed to describe rates and toxicological findings of unintentional opioid and stimulant toxicity deaths, 2012-2021. METHODS: The dataset included accidental deaths determined by the Coroner to be due to opioids or stimulants. We calculated annual crude mortality rates and described combinations of drugs identified in toxicological examinations of these deaths. We described temporal trends in the detection of specific opioids, stimulants, benzodiazepines (including novel benzodiazepines), gabapentinoids and z-drugs in deaths due to opioids and stimulants. RESULTS: Mortality rates increased over time, reaching their peak in 2020 and remaining high in 2021. In deaths due to opioids, there was a decline in the proportion of deaths involving pharmaceutical opioids after 2019, and a corresponding increase in the proportion of deaths with fentanyl detected. Benzodiazepines were often present in deaths due to opioids, with novel benzodiazepines increasing rapidly from 2019 onwards. Cocaine was the most frequently detected drug in deaths due to stimulants, but amphetamine/methamphetamine was detected in around half of all stimulant deaths from 2016 onwards. DISCUSSION AND CONCLUSIONS: Despite availability of a multitude of overdose prevention interventions, mortality rates due to drug toxicity have increased in Québec. Toxicological findings of these deaths suggest concerning shifts in the illicit drug market, with Québec potentially having entered a new era of elevated overdose mortality. Intervention scale-up is essential, but unlikely to be sufficient, to reduce drug-related mortality. Policy reform to address the root causes of drug toxicity deaths, including an unpredictable drug supply, strained health systems and socio-economic precarity, is essential.

Beyond struggle: A strengths-based qualitative study of cannabis use among queer and trans youth in Québec.

BACKGROUND: Queer and trans (QT) youth report higher rates of cannabis use than their cisgender and heterosexual peers. Explanations for this have overwhelmingly focused on the difficulties QT youth face, while little research has examined how cannabis use can relate to QT youth's strengths. We sought to explore how cannabis use could be involved in the experiences of QT youth from a strengths-based perspective. METHODS: We conducted a QT youth-led, community-based study composed of 27 semi-structured interviews with QT young adults aged 21-25 years and living in Québec who use(d) cannabis regularly. Through reflexive thematic analysis (Braun & Clarke, 2019), we used a strengths-based lens informed by the Minority Strengths Model (Perrin et al., 2020) to explore how cannabis use featured in participants' efforts to survive and thrive. RESULTS: We generated three themes representing how cannabis featured in participants' efforts to survive and thrive. First, cannabis was used to facilitate the production of an authentic QT self, a process that involved self-discovery, introspection, exploration, awareness, and expression. Cannabis supported, accompanied, and/or complicated this process. Second, cannabis use (and non-use) was involved in building QT community and connection, which constituted a crux of participants' wellbeing. Third, cannabis was used to face adversity, such as marginalization, QT oppression, mental health challenges, and structural under-resourcing. This adversity contrasted experiences of QT identities themselves, which were described as a source of joy and pride. CONCLUSION: Our analysis illustrates many ways in which cannabis use (and non-use) features in QT youth's efforts to survive and thrive. As a result, we encourage loved ones, clinicians, researchers and policy makers to adopt a view of QT cannabis use that is expansive and inclusive of QT youth's strengths.

Development of Promising Interventions to Improve Human Papillomavirus Vaccination in a School-Based Program in Quebec, Canada: Results From a Formative Evaluation Using a Mixed Methods Design.

BACKGROUND: Despite the availability of school-based human papillomavirus (HPV) vaccination programs, disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. A total of 3 interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with a web-based information and decision aid tool, and a telephone reminder using motivational interviewing (MI) techniques. OBJECTIVE: Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students' parents in Quebec, Canada. METHODS: In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions' relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses' knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool's relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Québec Research Ethics Committee (MP-20-2019-4655, May 16, 2019). RESULTS: The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired. CONCLUSIONS: We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents' knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale.

[Domestic violence among Quebec women during the health crisis: Trends and risk factors]. / La violence conjugale chez les femmes québécoises durant la crise sanitaire : évolution et facteurs de risque.

This article examines the evolution of domestic violence (DV) among Quebec women during the Covid-19 pandemic and the factors associated with this phenomenon. Based on the literature, we observed that DV increased significantly in Quebec during the health crisis. Furthermore, it appears that job loss, which affected more women than men, increased social isolation, deterioration of the mental health of spouses, increased alcohol and cannabis consumption, and difficulties in reconciling work and family life are the factors that contribute most to the increase in DV in Quebec during this period.

Comparing standardised precipitation and barley yield across Quebec.

Climate change and variability continue to affect crop production across the world in general and in Quebec in particular. Therefore, it is important to better understand this climate-yield nexus. Unfortunately, in Quebec, there are currently no studies that analyse both precipitation and barley yield. This study aims at filling this research gap by comparing standardised precipitation (SPI) against barley yield gaps across Quebec for three peripheral and three southern/central regions of Quebec. The study uses growing season precipitation data from Ouranos and barley yield data from Institut de la Statistique du Québec. This work deploys the use of standardised index (SPI) index and a machine learning yield gap algorithm (actual barley yield minus projected barley yield) to provide a provincial portrait of the relationships between SPI and barley yield. The results show that the peripheral regions record below zero SPIs (Abitibi-Temiscamingue - 0.48, Saguenay-Lac-Saint-Jean - 0.14 and Outaouais - 0.10) and more yield gap years, while the southern/central regions record positive SPIs (Estrie 1.17, Centre du Quebec 0.86 and Monteregie: 0.33) and fewer years with yield gaps. This shows that there is a south-north gradient in the variations of SPI and yield gaps. The SPI and yield patterns can be explained by prolonged winters further north of Quebec and recently winters with insufficient snow cover which triggers rapid snow melt and thus shortening the growing season for barley. Policy actions around drought-resistant varieties within a co-creation context and more research that explores daily and monthly liquid precipitation totals during the growing season of the crop need to be explored. There is also a need to better understand the economic costs and benefits of the associated yield gaps as well as the impacts of temperature.

Changes in prenatal cannabis-related diagnosed disorders after the Cannabis Act and the COVID-19 pandemic in Quebec, Canada.

BACKGROUND AND AIMS: Public health concerns regarding pregnant women's health after the enactment of the Cannabis Act in Canada (CAC) (a law that allowed non-medical cannabis use), and the potential impact of the COVID-19 pandemic, call for a contemporary assessment of these two events. Our study measured associations between the CAC, the COVID-19 pandemic and the monthly prevalence rates of cannabis-, all drug- and alcohol-related diagnosed disorders among pregnant women in the province of Quebec. DESIGN, SETTING AND PARTICIPANTS: This was a quasi-experimental design applying an interrupted time-series methodology in the province of Quebec, Canada. The participants were pregnant women aged 15-49 years, between January 2010 and July 2022. MEASUREMENTS: Administrative health data from the Québec Integrated Chronic Disease Surveillance System were used to classify pregnant women according to cannabis-, all drug (excluding cannabis)- and alcohol-related disorders. The CAC (October 2018) and the COVID-19 pandemic (April 2020) were evaluated as (1) slope changes and (2) level changes. Cannabis-, all drug (excluding cannabis)- and alcohol-related disorders were measured by total monthly age-standardized monthly prevalence rate of each disorder for pregnant women aged 15-49 years. FINDINGS: Before the CAC, the prevalence rate of cannabis-related diagnosed disorders significantly increased each month by 0.5% [95% confidence interval (CI) = 0.3-0.6] in the pregnant population. After the CAC, there were significant increases of 24% (95% CI = 1-53) of cannabis-related diagnosed disorders. No significant changes were observed for all drug (excluding cannabis)- and alcohol-related diagnosed disorders associated with the CAC. A non-significant decrease of 20% (95% CI = -38 to 3) was observed during the COVID-19 pandemic in alcohol-related disorders. CONCLUSIONS: The monthly incidence rates of diagnosed cannabis-related disorders in pregnant women in Quebec increased significantly following the enactment of the Cannabis Act in Canada. Diagnoses of all drug (excluding cannabis)- and alcohol-related disorders remained relatively stable.

Predicting the Population Risk of Suicide Using Routinely Collected Health Administrative Data in Quebec, Canada: Model-Based Synthetic Estimation Study.

BACKGROUND: Suicide is a significant public health issue. Many risk prediction tools have been developed to estimate an individual's risk of suicide. Risk prediction models can go beyond individual risk assessment; one important application of risk prediction models is population health planning. Suicide is a result of the interaction among the risk and protective factors at the individual, health care system, and community levels. Thus, policy and decision makers can play an important role in suicide prevention. However, few prediction models for the population risk of suicide have been developed. OBJECTIVE: This study aims to develop and validate prediction models for the population risk of suicide using health administrative data, considering individual-, health system-, and community-level predictors. METHODS: We used a case-control study design to develop sex-specific risk prediction models for suicide, using the health administrative data in Quebec, Canada. The training data included all suicide cases (n=8899) that occurred from January 1, 2002, to December 31, 2010. The control group was a 1% random sample of living individuals in each year between January 1, 2002, and December 31, 2010 (n=645,590). Logistic regression was used to develop the prediction models based on individual-, health care system-, and community-level predictors. The developed model was converted into synthetic estimation models, which concerted the individual-level predictors into community-level predictors. The synthetic estimation models were directly applied to the validation data from January 1, 2011, to December 31, 2019. We assessed the performance of the synthetic estimation models with four indicators: the agreement between predicted and observed proportions of suicide, mean average error, root mean square error, and the proportion of correctly identified high-risk regions. RESULTS: The sex-specific models based on individual data had good discrimination (male model: C=0.79; female model: C=0.85) and calibration (Brier score for male model 0.01; Brier score for female model 0.005). With the regression-based synthetic models applied in the validation data, the absolute differences between the synthetic risk estimates and observed suicide risk ranged from 0% to 0.001%. The root mean square errors were under 0.2. The synthetic estimation model for males correctly predicted 4 of 5 high-risk regions in 8 years, and the model for females correctly predicted 4 of 5 high-risk regions in 5 years. CONCLUSIONS: Using linked health administrative databases, this study demonstrated the feasibility and the validity of developing prediction models for the population risk of suicide, incorporating individual-, health system-, and community-level variables. Synthetic estimation models built on routinely collected health administrative data can accurately predict the population risk of suicide. This effort can be enhanced by timely access to other critical information at the population level.

Changes in the incidence of cannabis-related disorders after the Cannabis Act and the COVID-19 pandemic in Québec, Canada.

BACKGROUND: The Canadian Cannabis Act (CCA, implemented in October 2018) and the COVID-19 pandemic (April 2020) might have contributed to cannabis-related harms in Québec, known for its stringent cannabis legal framework. We explored changes in incidence rates of cannabis-related disorders (CRD) diagnoses associated with these events in Québec. METHODS: We utilized linked administrative health data to identify individuals aged 15 year+ newly diagnosed with CRD during hospitalizations, emergency, and outpatients clinics across Québec, from January 2010 and March 2022 (147 months). Interrupted time-series analyses (ITSA) assessed differences (as percentage changes) in sex- and age-standardized, and sex-stratified, monthly incidence rates (per 100,000 population) attributed to the CCA and the COVID-19 pandemic, compared to counterfactual scenarios where pre-events trends would continue unchanged. RESULTS: The overall monthly mean rates of incident diagnoses nearly doubled from the pre-CCA period (1.56 per 100,000 population) to the COVID-19 pandemic period (3.02 per 100,000 population). ITSA revealed no statistically significant level or slope changes between adjacent study periods, except for a decrease in the slope of incidence rates among males by 1.84 % (95 % CI -3.41 to -0.24) during the COVID-19 pandemic compared to the post-CCA period. During the post-CCA period, the trends of incidence rates in the general and male populations grew significantly by 1.22 % (95 % CI 0.08 to 2.35) and 1.44 % (0.04 to 2.84) per month, respectively. Similarly significant increases were observed for the general and female populations during the COVID-19 pandemic, with monthly rates rising by 1.43 % (95 % CI 0.75 to 2.12) and 1.75 % (95 % CI 0.13 to 3.37), respectively. These increases more than doubled pre-CCA rates. CONCLUSIONS: The incidence rates of CRD diagnoses across Québec appears to have increased following the implementation of the CCA and during the COVID-19 pandemic. Our findings echo public health concerns regarding potential cannabis-related harms and are consistent with previous Canadian studies.

Alouette-R normative data for French-speaking school-aged children living in Quebec.

BACKGROUND: The Alouette-R (2005) by Lefavrais is one of the most widely used tools to assess reading skills in French. However, this instrument does not have normative data specific to the French-speaking population of Quebec, Canada. AIMS: The validity of an assessment being strongly compromised when using inappropriate norms, the first objective of this study was to establish local norms for the Alouette-R. The second objective was to provide sensitivity and specificity data for each Alouette-R measure in the French-speaking Quebec population. The third objective was to compare Quebec and French normative data and their sensitivity to better understand the applicability and effectiveness of the Alouette-R test at the regional level. METHODS & PROCEDURES: A total of 347 fluent readers and 48 children with dyslexia from 3rd to 6th grades were recruited from different regions in Quebec. Participants had to read aloud the 265-word text of the Alouette-R in a maximum of 3 min. OUTCOMES & RESULTS: Norms (means, standard deviations and percentiles) by school grades were created for each test measure: reading time, number of words read, number of errors, number of words correctly read, reading accuracy index and reading fluency index. The sensitivity (i.e., the ability to correctly identify children with dyslexia) and specificity (i.e., the ability to correctly identify children without dyslexia) of these measurements were also documented. The norms and their sensitivity were then compared with those of the original French study by Lefavrais in 2005. CONCLUSIONS & IMPLICATIONS: The presence of differences between European and Quebec norms supports the importance of using local norms when assessing language skills. The reading accuracy and fluency indexes are the measurements that best discriminated children with dyslexia from those without a reading disorder in our study. This study will allow clinicians working in Quebec to have a better interpretation of the Alouette-R measurements and ultimately avoid erroneous conclusions resulting from the use of foreign normative data. WHAT THIS PAPER ADDS: What is already known on this subject The Alouette-R is a reading test validated and standardized in France to screen for dyslexia in children. The validity of existing norms with the Quebec population in Canada is questionable due to socio-linguistic differences with the population of France. What this study adds to existing knowledge This study provides for the first time normative and sensitivity/specificity data of the Alouette-R for French-speaking school-aged children living in Quebec. Differences were noted with the normative data from France, which supports the importance of using local normative data when administering reading tests in Quebec. What are the potential or actual clinical implications of this work? When administering the Alouette-R, clinicians in Quebec will now be able to use normative data adapted to the local population, which will limit erroneous conclusions resulting from the use of foreign normative data. In addition, the sensitivity and specificity values reported in the article will allow these clinicians to better interpret their results when screening for a developmental reading disorder.

Year-round monitoring of three water sources in Québec, Canada, reveals site-specific differences in conditions for Cryptosporidium and Giardia contamination.

Cryptosporidium and Giardia are protozoan parasites responsible for gastrointestinal illnesses in humans and in animal species. The main way these parasites are transmitted is by ingestion of their (oo)cysts in drinking water. Monitoring (oo)cysts in water sources is beneficial to evaluate the quality of raw water supplying treatment plants. Currently, the only standardized protocol to enumerate these parasites from water samples is United States Environmental Protection Agency (USEPA) Method 1623.1. With this method, we monitored three major water sources in Quebec over a year to assess temporal and geographical variations of these parasite (oo)cysts. These three water sources have independent watersheds despite being in the same region. We found a general pattern for Giardia, with high concentrations of cysts during cold and transition periods, and significantly lower concentrations during the warm period. Cryptosporidium's concentration was more variable throughout the year. Statistical correlations (Pearson's correlation coefficients) were established between the concentration of each parasite and various environmental parameters. The three study sites each showed unique factors correlating with the presence of both protozoa, supporting the idea that each water source must be seen as a unique entity with its own particular characteristics and therefore, must be monitored independently. Although some environmental parameters could be interesting proxies to the parasitic load, no parameter was strongly correlated throughout the whole sampling year and none of the parameters could be used as a single proxy for all three studies sources.

Epidemiology of Pediatric Tumors in Quebec: A 17-Year Report of Cancer in Young People in the Canada Registry.

BACKGROUND: Cancer is the leading cause of disease-related death among children of more than 1 year of age. However, childhood cancer risk factors and etiology are yet to be fully understood. The goal of this study is to identify geographic variation among children and adolescents diagnosed with pediatric tumors between 2001 and 2018 in the province of Quebec. METHODS: We analyzed pediatric patients less than 15 years of age from the Cancer in Young People in Canada (CYP-C) surveillance system who were diagnosed between 2001 and 2018 with cancer in the province of Quebec. The age-standardized age-adjusted incidence rates (AAIR) per 100,000 person years were calculated for all childhood cancers by cancer subgroups, Quebec Health regions, and age groups. RESULTS: Overall, 3904 pediatric patients less than 15 years old were diagnosed with cancer in the province of Quebec in 2001-2018. The overall incidence rate (IR) in the province of Quebec was 16.14 (95%CL [15.56-16.73]) per 100,000 person years. For childhood cancers, regions that presented a higher AAIR were Chaudière-Appalaches and Capitale-Nationale with 18.2 and 17.5 per 100,000 person years, respectively. The incidence rates (IRs) in Chaudière-Appalaches (95% CI 1.0439-1.3532) and in Capitale-Nationale (95% CI 1.0124-1.2942) were statistically higher than the incidence in the province of Quebec (p = 0.0090 and p = 0.0310, respectively). When comparing the AAIR of the CNS tumor subgroup in Chaudière-Appalaches and in Capitale-Nationale, with the provincial average, we noticed a statistically higher incidence in Chaudière-Appalaches and a trend for Capitale-Nationale (p < 0.0001 and p = 0.0602, respectively). CONCLUSION: There is evidence of spatial clusters in Chaudière-Appalaches and Capitale-Nationale as areas for all childhood cancers. Further studies should be performed to investigate potential risk factors in these regions.

Differences between the healthcare systems of Quebec and France for the treatment of pain due to spinal disorders.

In Quebec, Canada, the public healthcare system offers free medical services. However, patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage. In contrast, private clinics provide expedited care but are relatively scarce and entail out-of-pocket expenses. Once a patient with pain caused by a spinal disorder meets a pain medicine specialist, spinal intervention is quickly performed when indicated, and patients are provided lifestyle advice. Transforaminal epidural steroid injections are frequently administered to patients with radicular pain, and steroid injections are administered on a facet joint to control low back or neck pain. Additionally, medial branch blocks are performed prior to thermocoagulation. France's universal healthcare system ensures accessibility at controlled costs. It emphasizes physical activity and provides free physical therapy services. However, certain interventions, such as transforaminal and interlaminar epidural injections, are not routinely used in France owing to limited therapeutic efficacy and safety concerns. This underutilization may be a potential cause of chronic pain for many patients. By examining the differences, strengths, and weaknesses of these two systems, valuable insights can be gained for the enhancement of global spinal pain management strategies, ultimately leading to improved patient outcomes and satisfaction.

Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Virus in Seals, St. Lawrence Estuary, Quebec, Canada1.

We describe an unusual mortality event caused by a highly pathogenic avian influenza (HPAI) A(H5N1) virus clade 2.3.4.4b involving harbor (Phoca vitulina) and gray (Halichoerus grypus) seals in the St. Lawrence Estuary, Quebec, Canada, in 2022. Fifteen (56%) of the seals submitted for necropsy were considered to be fatally infected by HPAI H5N1 containing fully Eurasian or Eurasian/North American genome constellations. Concurrently, presence of large numbers of bird carcasses infected with HPAI H5N1 at seal haul-out sites most likely contributed to the spillover of infection to the seals. Histologic changes included meningoencephalitis (100%), fibrinosuppurative alveolitis, and multiorgan acute necrotizing inflammation. This report of fatal HPAI H5N1 infection in pinnipeds in Canada raises concerns about the expanding host of this virus, the potential for the establishment of a marine mammal reservoir, and the public health risks associated with spillover to mammals.Nous décrivons un événement de mortalité inhabituelle causé par un virus de l'influenza aviaire hautement pathogène A(H5N1) clade 2.3.4.4b chez des phoques communs (Phoca vitulina) et gris (Halichoerus grypus) dans l'estuaire du Saint-Laurent au Québec, Canada, en 2022. Quinze (56%) des phoques soumis pour nécropsie ont été considérés comme étant fatalement infectés par le virus H5N1 de lignées eurasiennes ou de réassortiment eurasiennes/nord-américaines. Un grand nombre simultané de carcasses d'oiseaux infectés par le H5N1 sur les sites d'échouement a probablement contribué à la contamination de ces phoques. Les changements histologiques associés à cette infection incluaient : méningo-encéphalite (100%), alvéolite fibrinosuppurée et inflammation nécrosante aiguë multi-organique. Cette documentation soulève des préoccupations quant à l'émergence de virus mortels, à la possibilité d'établissement de réservoirs chez les mammifères marins, et aux risques pour la santé publique associés aux propagations du virus chez les mammifères.

S'attaquer aux défis de l'adhésion aux principes de la saine alimentation.

The purpose of this article is to describe the impact of the research program entitled "Adherence to healthy eating recommendations: identification of measures, determinants and interventions". Beyond the main results described in this article, this program had a major impact on the training of graduate students. It was also a unique opportunity to develop and validate measurement tools relevant to nutrition research, and to make them available to the scientific community. Lastly, this program was a catalyst for establishing new collaborations and setting up larger-scale studies.

The Quebec Semantic Memory Battery: Development, Standardization, and Psychometric Assessment of a Semantic Memory Battery in French.

OBJECTIVE: People with aphasia often experience semantic memory (SM) impairment. To improve diagnostic outcomes, SM tasks should recruit various sensory input channels (oral, written, and pictographic), permitting accessible, complete evaluation. There is a need for SM batteries for French-speaking Quebecers that use multiple input channels. The present study, therefore, describes the development of a novel French-language semantic battery: la Batterie québécoise de la mémoire sémantique (BQMS), the assessment of the BQMS's psychometric properties, and the establishment of normative data for the BQMS. METHOD: We first developed eight SM tasks. Following a pilot validation study, we determined the BQMS's reliability and validity, to ensure consistent, accurate detection of SM impairment. Among French-speaking Quebecers with cerebrovascular aphasia (n = 10), people with the semantic variant of Primary Progressive Aphasia (n = 4), and healthy controls (n = 14), we examined its convergent validity, concurrent validity, test-retest reliability, and internal consistency. Finally, we established normative data for the BQMS by calculating cut-off scores per task that indicate SM impairment (in 93 cognitively healthy French-speaking Quebecers), stratified by sociodemographic variables associated with performance. RESULTS: The BQMS shows high concurrent, discriminant, and convergent validity, as well as good test-retest reliability and internal consistency. The cut-off score indicating SM impairment ranged from the 2nd to 25th percentiles (stratified by task, age, and sex). CONCLUSIONS: The BQMS's psychometric properties indicate that it could be a valuable clinical tool for detecting SM impairment. Our normative data will help clinicians detect such impairments.

Quebec French Translation, Cultural Adaptation, and Validation of the Singing Voice Handicap Index-10 Questionnaire for Singers with Dysphonia.

OBJECTIVES/HYPOTHESIS: Dysphonia is a common voice disorder that can significantly impact a person's life; it requires a collaborative evaluation by both speech-language pathologists and otolaryngologists that takes the patient's perspective into account. The aim of this study was to translate and culturally adapt the Singing Voice Handicap Index questionnaire (SVHI-10), a reliable patient-reported outcome evaluation tool for dysphonia, for the Quebec French population. The result is the Singing Voice Handicap Index-10-QC (SVHI-10-QC). STUDY DESIGN: This study was a prospective translation and validation process. METHODS: The translation process complied with international recommendations and followed a standard forward-backward translation procedure and cognitive debriefing with 10 singers. The Quebec French version was administered to two study samples: 30 vocal professionals with no dysphonia and 53 vocal professionals with dysphonia as one of their primary complaints. The SVHI-10-QC was assessed for construct validity, internal consistency, discriminatory capacity, and test-retest reliability. RESULTS: The SVHI-10-QC is valid, reliable, and ready for use with singer-patients suffering from dysphonia. CONCLUSIONS: The SVHI-10-QC is a reliable and valid tool for assessing the impact of dysphonia on French Quebec singers' quality of life.