Incident Diabetes in Women With Patterns of Gestational Diabetes Occurrences Across 2 Pregnancies.

Importance: Gestational diabetes is a type 2 diabetes risk indicator, and recurrence further augments risk. In women with a single occurrence across 2 pregnancies, it is unclear whether first- vs second-pregnancy gestational diabetes differ in terms of risk. Objective: To compare the hazards of incident diabetes among those with gestational diabetes in the first, in the second, and in both pregnancies with women without gestational diabetes in either. Design, Setting, and Participants: This was a retrospective cohort study with cohort inception from April 1, 1990, to December 31, 2012. Follow-up was April 1, 1990, to April 1, 2019. Participants were mothers with 2 singleton deliveries between April 1, 1990, and December 31, 2012, without diabetes before or between pregnancies, who were listed in public health care insurance administrative databases and birth, stillbirth, and death registries in Quebec, Canada. Data were analyzed from July to December 2023. Exposure: Gestational diabetes occurrence(s) across 2 pregnancies. Main outcomes and measures: Incident diabetes from the second delivery until a third pregnancy, death, or the end of the follow-up period, whichever occurred first. Results: The 431 980 women with 2 singleton deliveries studied had a mean (SD) age of 30.1 (4.5) years at second delivery, with a mean (SD) of 2.8 (1.5) years elapsed between deliveries; 373 415 (86.4%) were of European background, and 78 770 (18.2%) were at the highest quintile of material deprivation. Overall, 10 920 women (2.5%) had gestational diabetes in their first pregnancy, 16 145 (3.7%) in their second, and 8255 (1.9%) in both (12 205 incident diabetes events; median [IQR] follow-up 11.5 [5.3-19.4] years). First pregnancy-only gestational diabetes increased hazards 4.35-fold (95% CI, 4.06-4.67), second pregnancy-only increased hazards 7.68-fold (95% CI, 7.31-8.07), and gestational diabetes in both pregnancies increased hazards 15.8-fold (95% CI, 15.0-16.6). Compared with first pregnancy-only gestational diabetes, second pregnancy-only gestational diabetes increased hazards by 76% (95% CI, 1.63-1.91), while gestational diabetes in both pregnancies increased it 3.63-fold (95% CI, 3.36-3.93). Conclusions and relevance: In this retrospective cohort study of nearly half a million women with 2 singleton pregnancies, both the number and ordinal pregnancy of any gestational diabetes occurrence increased diabetes risk. These considerations offer greater nuance than an ever or never gestational diabetes dichotomy.

Rural-Urban Differences in Healthcare Use in Persons With Dementia Between 2000 and 2019: A Quebec Population-Based Study.

Background: Rural persons with dementia face medical services gaps. This study compares the health service utilization of rural and urban community-dwelling individuals with incident dementia. Methods: This study used a repeated annual cross-sectional cohort design spanning a period from 2000 to 2019 analyzing age-adjusted rates for 20 indicators of service use and mortality one year after diagnosis in Quebec administrative databases. Results: Of 237,259 persons, 20.1% were rural. Most rural persons had more emergency department visits and hospitalizations, shorter stays, less alternate level of care and fewer family physicians' and cognition specialists' visits. All groups had similar long-term care and mortality rates. Conclusion: Policy implications of these disparities are discussed.

The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study.

BACKGROUND: A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. OBJECTIVE: This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. METHODS: We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. RESULTS: During prepandemic influenza seasons, overall RV detection was 92.7% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3%; coinfections: 456/1493, 30.5%) in children (<18 years) and 62.8% (2723/4339) (influenza: 1742/4339, 40.1%; coinfections: 264/4339, 6.1%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1%) to 90.3% (308/341) in 2021-22 (ORVs: 278/341, 82%; SARS-CoV-2: 30/341, 8.8%; coinfections: 110/341, 32.3%) and 88.9% (361/406) in 2022-23 (ORVs: 339/406, 84%; SARS-CoV-2: 22/406, 5.4%; coinfections: 128/406, 31.5%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7% (333/762) in 2020-21 (ORVs: 26/762, 3.4%; SARS-CoV-2: 307/762, 40.3%; coinfections: 7/762, 0.9%) to 57.8% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2%; SARS-CoV-2: 552/1265, 43.6%; coinfections: 42/1265, 3.3%) and 50.1% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5%; SARS-CoV-2: 337/1488, 22.6%; coinfections: 36/1488, 2.4%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. CONCLUSIONS: Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations.

New opioid prescription claims and their clinical indications: results from health administrative data in Quebec, Canada, over 14 years.

OBJECTIVES: Describe new opioid prescription claims, their clinical indications and annual trends among opioid naïve adults covered by the Quebec's public drug insurance plan (QPDIP) for the fiscal years 2006/2007-2019/2020. DESIGN AND SETTING: A retrospective observational study was conducted using data collected between 2006/2007 and 2019/2020 within the Quebec Integrated Chronic Disease Surveillance System, a linkage administrative data. PARTICIPANTS: A cohort of opioid naïve adults and new opioid users was created for each study year (median number=2 263 380 and 168 183, respectively, over study period). INTERVENTION: No. MAIN OUTCOME MEASURE AND ANALYSES: A new opioid prescription was defined as the first opioid prescription claimed by an opioid naïve adult during a given fiscal year. The annual incidence proportion for each year was then calculated and standardised for age. A hierarchical algorithm was built to identify the most likely clinical indication for this prescription. Descriptive and trend analyses were performed. RESULTS: There was a 1.7% decrease of age-standardised annual incidence proportion during the study period, from 7.5% in 2006/2007 to 5.8% in 2019/2020. The decrease was highest after 2016/2017, reaching 5.5% annual percentage change. Median daily dose and days' supply decreased from 27 to 25 morphine milligram equivalent/day and from 5 to 4 days between 2006/2007 and 2019/2020, respectively. Between 2006/2007 and 2019/2020, these prescriptions' most likely clinical indications increased for cancer pain from 34% to 48%, for surgical pain from 31% to 36% and for dental pain from 9% to 11%. Inversely, the musculoskeletal pain decreased from 13% to 2%. There was good consistency between the clinical indications identified by the algorithm and prescriber's specialty or user's characteristics. CONCLUSIONS: New opioid prescription claims (incidence, dose and days' supply) decreased slightly over the last 14 years among QPDIP enrollees, especially after 2016/2017. Non-surgical and non-cancer pain became less common as their clinical indication.

Explainable artificial intelligence models for predicting risk of suicide using health administrative data in Quebec.

Suicide is a complex, multidimensional event, and a significant challenge for prevention globally. Artificial intelligence (AI) and machine learning (ML) have emerged to harness large-scale datasets to enhance risk detection. In order to trust and act upon the predictions made with ML, more intuitive user interfaces must be validated. Thus, Interpretable AI is one of the crucial directions which could allow policy and decision makers to make reasonable and data-driven decisions that can ultimately lead to better mental health services planning and suicide prevention. This research aimed to develop sex-specific ML models for predicting the population risk of suicide and to interpret the models. Data were from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), covering up to 98% of the population in the province of Quebec and containing data for over 20,000 suicides between 2002 and 2019. We employed a case-control study design. Individuals were considered cases if they were aged 15+ and had died from suicide between January 1st, 2002, and December 31st, 2019 (n = 18339). Controls were a random sample of 1% of the Quebec population aged 15+ of each year, who were alive on December 31st of each year, from 2002 to 2019 (n = 1,307,370). We included 103 features, including individual, programmatic, systemic, and community factors, measured up to five years prior to the suicide events. We trained and then validated the sex-specific predictive risk model using supervised ML algorithms, including Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGBoost) and Multilayer perceptron (MLP). We computed operating characteristics, including sensitivity, specificity, and Positive Predictive Value (PPV). We then generated receiver operating characteristic (ROC) curves to predict suicides and calibration measures. For interpretability, Shapley Additive Explanations (SHAP) was used with the global explanation to determine how much the input features contribute to the models' output and the largest absolute coefficients. The best sensitivity was 0.38 with logistic regression for males and 0.47 with MLP for females; the XGBoost Classifier with 0.25 for males and 0.19 for females had the best precision (PPV). This study demonstrated the useful potential of explainable AI models as tools for decision-making and population-level suicide prevention actions. The ML models included individual, programmatic, systemic, and community levels variables available routinely to decision makers and planners in a public managed care system. Caution shall be exercised in the interpretation of variables associated in a predictive model since they are not causal, and other designs are required to establish the value of individual treatments. The next steps are to produce an intuitive user interface for decision makers, planners and other stakeholders like clinicians or representatives of families and people with live experience of suicidal behaviors or death by suicide. For example, how variations in the quality of local area primary care programs for depression or substance use disorders or increased in regional mental health and addiction budgets would lower suicide rates.

The risk of contact between visitors and Borrelia burgdorferi-infected ticks is associated with fine-scale landscape features in a southeastern Canadian nature park.

BACKGROUND: Infectious diseases are emerging across temperate regions of the world, and, for some, links have been made between landscapes and emergence dynamics. For tick-borne diseases, public parks may be important exposure sites for people living in urbanized areas of North America and Europe. In most cases, we know more about the ecological processes that determine the hazard posed by ticks as disease vectors than we do about how human population exposure varies in urban natural parks. METHODS: In this study, infrared counters were used to monitor visitor use of a public natural park in southern Quebec, Canada. A risk index representing the probability of encounters between humans and infected vectors was constructed. This was done by combining the intensity of visitor trail use and the density of infected nymphs obtained from field surveillance. Patterns of risk were examined using spatial cluster analysis. Digital forest data and park infrastructure data were then integrated using spatially explicit models to test whether encounter risk levels and its components vary with forest fragmentation indicators and proximity to park infrastructure. RESULTS: Results suggest that, even at a very fine scales, certain landscape features and infrastructure can be predictors of risk levels. Both visitors and Borrelia burgdorferi-infected ticks concentrated in areas where forest cover was dominant, so there was a positive association between forest cover and the risk index. However, there were no associations between indicators of forest fragmentation and risk levels. Some high-risk clusters contributed disproportionately to the risk distribution in the park relative to their size. There were also two high-risk periods, one in early summer coinciding with peak nymphal activity, and one in early fall when park visitation was highest. CONCLUSIONS: Here, we demonstrate the importance of integrating indicators of human behaviour visitation with tick distribution data to characterize risk patterns for tick-borne diseases in public natural areas. Indeed, understanding the environmental determinants of human-tick interactions will allow organisations to deploy more effective risk reduction interventions targeted at key locations and times, and improve the management of public health risks associated with tick-borne diseases in public spaces.

Characteristics for Low, High and Very High Emergency Department Use for Mental Health Diagnoses from Health Records and Structured Interviews.

Introduction: Patients with mental health diagnoses (MHD) are among the most frequent emergency department (ED) users, suggesting the importance of identifying additional factors associated with their ED use frequency. In this study we assessed various patient sociodemographic and clinical characteristics, and service use associated with low ED users (1-3 visits/year), compared to high (4-7) and very high (8+) ED users with MHD. Methods: Our study was conducted in four large Quebec (Canada) ED networks. A total of 299 patients with MHD were randomly recruited from these ED in 2021-2022. Structured interviews complemented data from network health records, providing extensive data on participant profiles and their quality of care. We used multivariable multinomial logistic regression to compare low ED use to high and very high ED use. Results: Over a 12-month period, 39% of patients were low ED users, 37% high, and 24% very high ED users. Compared with low ED users, those at greater probability for high or very high ED use exhibited more violent/disturbed behaviors or social problems, chronic physical illnesses, and barriers to unmet needs. Patients previously hospitalized 1-2 times had lower risk of high or very high ED use than those not previously hospitalized. Compared with low ED users, high and very high ED users showed higher prevalence of personality disorders and suicidal behaviors, respectively. Women had greater probability of high ED use than men. Patients living in rental housing had greater probability of being very high ED users than those living in private housing. Using at least 5+ primary care services and being recurrent ED users two years prior to the last year of ED use had increased probability of very high ED use. Conclusion: Frequency of ED use was associated with complex issues and higher perceived barriers to unmet needs among patients. Very high ED users had more severe recurrent conditions, such as isolation and suicidal behaviors, despite using more primary care services. Results suggested substantial reduction of barriers to care and improvement on both access and continuity of care for these vulnerable patients, integrating crisis resolution and supported housing services. Limited hospitalizations may sometimes be indicated, protecting against ED use.

Prevalence of pathogens in honey bee colonies and association with clinical signs in southwestern Quebec, Canada.

Honey bees can be affected by a variety of pathogens, which impacts their vital role as pollinators in agriculture. A cross-sectional study was conducted in southwestern Quebec to: i) estimate the prevalence of 11 bee pathogens; ii) assess the agreement between beekeeper suspicion of a disease and laboratory detection of the causative pathogen; and iii) explore the association between observed clinical signs and pathogen detection in a colony. A total of 242 colonies in 31 apiaries owned by 15 beekeepers was sampled in August 2017. The prevalence of Varroa destructor detection was estimated as 48% for colonies and 93% for apiaries. The apparent prevalence of colonies infected by Nosema spp. and Melissococcus plutonius was estimated as 40% and 21%, respectively. At least 180 colonies were tested by polymerase chain reaction (PCR) for deformed wing virus (DWV), acute-Kashmir-Israeli complex (AKI complex), and black queen cell virus (BQCV), which were detected in 33%, 9%, and 95% of colonies, respectively. Acarapis woodi, Paenibacillus larvae, and Aethina tumida were not detected. Varroasis was suspected by beekeepers in 14 of the 15 beekeeping operations in which the mite was detected. However, no correlation was found between suspected European foulbrood and detection of M. plutonius or between suspected nosemosis and detection of Nosema spp. Colony weakness was associated with Nosema spore counts of at least 0.5 × 106 per bee. Melissococcus plutonius was more frequently detected in colonies showing scattered brood.

Les abeilles mellifères peuvent être affectées par plusieurs agents pathogènes, impactant leur rôle vital de pollinisateur en agriculture. Une étude transversale a été réalisée dans le sud-ouest du Québec afin 1) d'estimer la prévalence de onze agents pathogènes de l'abeille, 2) d'évaluer l'accord entre la suspicion d'une maladie par l'apiculteur et la détection de l'agent causal, 3) d'explorer les associations entre les signes cliniques et la détection d'un agent pathogène dans une colonie. Au total, 242 colonies de 31 ruchers appartenant à 15 apiculteurs ont été échantillonnées en août 2017. La prévalence de Varroa destructor a été estimée à 48 % pour les colonies et à 93 % pour les ruchers. La prévalence apparente de colonies infectées par Nosema spp. ou Melissococcus plutonius a été estimée à respectivement 40 % et 21 %. Le virus des ailes déformées, le complexe viral AKI et le virus de la reine noire ont été détectés dans respectivement 33 %, 9 % et 95 % dans des 180 colonies testées par PCR. Acarapis woodi, Paenibacillus larvae et Aethina tumida n'ont pas été détectés. La varroase était suspectée par les apiculteurs de 14 des 15 entreprises où la mite a été détectée. Aucune corrélation n'a été trouvée entre la suspicion de loque européenne et la détection de M. plutonius ou entre la suspicion de nosémose et la détection de Nosema spp. La faiblesse des colonies a été associée à des comptes de Nosema d'au moins 0,5 × 106 spores par abeille. Melissococcus plutonius était plus fréquemment détecté parmi les colonies présentant du couvain en mosaïque.(Traduit pas les auteurs).

Tree-Based Machine Learning to Identify Predictors of Psoriasis Incidence at the Neighborhood Level: A Populational Study from Quebec, Canada.

BACKGROUND: Psoriasis is a major global health burden affecting ~ 60 million people worldwide. Existing studies on psoriasis focused on individual-level health behaviors (e.g. diet, alcohol consumption, smoking, exercise) and characteristics as drivers of psoriasis risk. However, it is increasingly recognized that health behavior arises in the context of larger social, cultural, economic and environmental determinants of health. We aimed to identify the top risk factors that significantly impact the incidence of psoriasis at the neighborhood level using populational data from the province of Quebec (Canada) and advanced tree-based machine learning (ML) techniques. METHODS: Adult psoriasis patients were identified using International Classification of Disease (ICD)-9/10 codes from Quebec (Canada) populational databases for years 1997-2015. Data on environmental and socioeconomic factors 1 year prior to psoriasis onset were obtained from the Canadian Urban Environment Health Consortium (CANUE) and Statistics Canada (StatCan) and were input as predictors into the gradient boosting ML. Model performance was evaluated using the area under the curve (AUC). Parsimonious models and partial dependence plots were determined to assess directionality of the relationship. RESULTS: The incidence of psoriasis varied geographically from 1.6 to 325.6/100,000 person-years in Quebec. The parsimonious model (top 9 predictors) had an AUC of 0.77 to predict high psoriasis incidence. Amongst top predictors, ultraviolet (UV) radiation, maximum daily temperature, proportion of females, soil moisture, urbanization, and distance to expressways had a negative association with psoriasis incidence. Nighttime light brightness had a positive association, whereas social and material deprivation indices suggested a higher psoriasis incidence in the middle socioeconomic class neighborhoods. CONCLUSION: This is the first study to highlight highly variable psoriasis incidence rates on a jurisdictional level and suggests that living environment, notably climate, vegetation, urbanization and neighborhood socioeconomic characteristics may have an association with psoriasis incidence.

Partners with a Highly Favorable Attitude Toward Breastfeeding Contribute to Promoting Initiation and Length of Breastfeeding for More than 5 Months in a Population-Based Canadian Study.

Introduction: Promoting maternal breastfeeding for at least 6 months is important to improve children physical health during infancy and neurodevelopmental outcomes in childhood. For this guideline to be followed, it is paramount to identify what factors best support the initiation and length of breastfeeding. This study estimates the contribution of various child- and parent-level factors, as well as the sociodemographic context in predicting maternal breastfeeding initiation and duration. Methods: This study draws on data from the Quebec Longitudinal Study of Child Development. Mothers who never breastfed when the infant was 5 months old (n = 630, 28.3%) were compared to mothers who breastfed for less than 5 months (n = 844, 38.0%) and mothers breastfeeding for more than 5 months (n = 749, 33.7%), using multivariable multinomial regression models. Results: Mothers with a partner showing a positive attitude toward breastfeeding were up to 13 times more likely to breastfeed their infant for more than 5 months. The positive attitude of partners toward breastfeeding was the strongest predictor of breastfeeding duration, followed by the maternal educational attainment and timing she returns to work. Most prenatal and perinatal child-level factors and the sociodemographic context predicted breastfeeding duration, but to a lesser extent. Discussion: This finding underscores the role of the partner's attitude in promoting initiation and length of breastfeeding. As such, educational campaigns and health practitioners could target both the mother and their partner in promoting breastfeeding.

The Disease Burden of Hereditary Angioedema: Insights from a Survey in French-Canadians from Quebec.

Background: Limited data are available on the clinical profile and disease burden of hereditary angioedema (HAE) in Canadians. Objective: This study aimed to assess HAE disease characteristics and the burden of disease in Canadians with HAE types I, II, and normal levels of C1 inhibitor (nC1-INH). Materials and Methods: A 46-item patient survey evaluating clinical characteristics and burden of disease was developed and disseminated by the HAE patient organization Angio-oédeme héréditaire du Québec in Quebec, Canada, from May 2019 to February 2020. The survey received Research Review Board ethics approval. Results: In the 35 respondents, HAE type I was the most common (46%), followed by nC1-INH (43%). Female participants were significantly younger at first symptom presentation than males (p=0.04). Prior to diagnosis, 69% of participants underwent unnecessary treatments and procedures, with a 10-year delay between first symptoms and diagnosis. Before starting the current treatment, 42% of participants experienced weekly HAE attacks. Most participants identified experiencing attacks in the abdomen (89%), followed by the larynx (66%), feet (66%), hands (63%), and face (63%). Most attacks were severe or moderate, yet almost half of patients waited >1 hr before getting medical attention at their last emergency department (ED) visit. HAE was associated with decreased health-related quality of life, leading to significant functional impairment in personal and professional life. As compared to HAE type I/II, patients with HAE nC1-INH were treated more often with tranexamic acid for long-term prophylaxis, and their condition was less controlled, resulting in more attacks and ED visits. Conclusion: HAE manifests in this patient population as frequent moderate-to-severe attacks and a high disease burden; the HAE subtype may differentially affect care requirements. There is an urgent need for increased awareness and education on HAE among treating physicians.

Wild fish consumption and latitude as drivers of vitamin D status among Inuit living in Nunavik, northern Québec.

OBJECTIVE: To measure vitamin D status and estimate factors associated with serum 25-hydroxyvitamin D (25(OH)D) in Nunavimmiut (Inuit living in Nunavik) adults in 2017. DESIGN: Data were from Qanuilirpitaa? 2017 Nunavik Inuit Health Survey, a cross-sectional study conducted in August-October 2017. Participants underwent a questionnaire, including an FFQ, and blood samples were analysed for total serum 25(OH)D. SETTING: Nunavik, northern Québec, Canada. PARTICIPANTS: A stratified proportional model was used to select respondents, including 1,155 who identified as Inuit and had complete data. RESULTS: Geometric mean serum vitamin D levels were 65·2 nmol/l (95 % CI 62·9-67·6 nmol/l) among women and 65·4 nmol/l (95 % CI 62·3-68·7 nmol/l) among men. The weighted prevalence of serum 25(OH)D < 75 nmol/l, <50 nmol/l <30 nmol/l was 61·2 %, 30·3 % and 7·0 %, respectively. Individuals who were older, female, lived in smaller and/or more southerly communities and/or consumed more country (traditional) foods were at a reduced risk of low vitamin D status. Higher consumption of wild fish was specifically associated with increased serum 25(OH)D concentration. CONCLUSION: It is important that national, regional and local policies and programs are in place to secure harvest, sharing and consumption of nutritious and culturally important country foods like Arctic char and other wild fish species, particularly considering ongoing climate change in the Arctic which impacts the availability, access and quality of fish as food.

Change in intention and hesitancy regarding COVID-19 vaccines in a cohort of adults in Quebec during the pandemic.

Although COVID-19 vaccine uptake was high in Quebec for the primary series, vaccine acceptance decreased for the subsequent booster doses. This article presents the evolution of vaccine intention, self-reported vaccination behaviors, and vaccine hesitancy over 2 years. A series of cross-sectional surveys were conducted in Quebec between March 2020 and March 2023, with a representative sample of 3,330 adults recruited biweekly via a Web panel. Panelists could have answered multiple times over the course of the project. A cohort of respondents was created to assess how attitudes and behaviors about COVID-19 vaccines evolved. Descriptive statistics and multivariate logistic regressions were performed. Among the 1,914 individuals with no or low intention of getting vaccinated in Fall 2021 (Period 1), 1,476 (77%) reported having received at least two doses in the Winter 2023 (Period 2). Not believing in conspiracy theory (OR = 2.08, 95% CI: 1.65-2.64), being worried about catching COVID-19 (OR = 2.12, 95% CI: 1.65-2.73) and not living in a rural area (ORs of other areas are 2.27, 95% CI: 1.58-3.28; 1.66, 95% CI: 1.23-2.26; 1.82 95% CI: 1.23-2.73) were the three main factors associated with being vaccinated at Period 2. Among the 11,117 individuals not hesitant at Period 1, 1,335 (12%) became hesitant at Period 2. The three main factors significantly associated with becoming vaccine hesitant were the adherence to conspiracy theories (OR = 2.28, 95% CI: 1.95-2.66), being a female (OR = 1.67, 95% CI: 1.48-1.90) and being younger than 65 years old (the ORs for 18-34, 35-49, and 50-64 compared with 65 and over are 2.82, 95% CI: 2.32-3.44; 2.39, 95% CI: 2.00-2.86 and 1.82, 95% CI: 1.55-2.15 respectively). As the pandemic is over, monitoring the evolution of vaccine attitudes and uptake will be important.

Nunavimmi puvakkut kaggutimik aanniaqarniq: Qanuilirqitaa? Lung cancer in Nunavik: How are we doing? A retrospective matched cohort study.

BACKGROUND: Whether Inuit in Canada experience disparities in lung cancer survival remains unknown. When requiring investigation and treatment for lung cancer, all residents of Nunavik, the Inuit homeland in Quebec, are sent to the McGill University Health Centre (MUHC), in Montréal. We sought to compare survival among patients with lung cancer at the MUHC, who were residents of Nunavik and Montréal, Quebec, respectively. METHODS: We conducted a retrospective cohort study. Using lung cancer registry data, we identified Nunavik residents with histologically confirmed lung cancer diagnosed between 2005 and 2017. We aimed to match 2 Montréal residents to each Nunavik resident on sex, age, calendar year of diagnosis, and histology (non-small cell lung cancer v. small cell lung cancer). We reviewed medical records for data on additional patient characteristics and treatment, and obtained vital status from a provincial registry. We compared survival using Kaplan-Meier analysis and Cox proportional hazards regression. RESULTS: We included 95 residents of Nunavik and 185 residents of Montréal. For non-small cell lung cancer, median survival times were 321 (95% confidence interval [CI] 184-626) days for Nunavik (n = 71) and 720 (95% CI 536-1208) days for Montréal residents (n = 141). For small cell lung cancer, median survival times were 190 (95% CI 159-308) days for Nunavik (n = 24) and 270 (95% CI 194-766) days for Montréal residents (n = 44). Adjusting for matching variables, stage, performance status, and comorbidity, Nunavik residents had a higher hazard of death (hazard ratio 1.68, 95% CI 1.17-2.41). INTERPRETATION: Nunavik residents experience disparities in survival after lung cancer diagnosis. Although studies in other Inuit Nunangat regions are needed, our findings point to an urgent need to ensure that interventions aimed at improving lung cancer survival, including lung cancer screening, are accessible to Inuit Nunangat residents.

Predictors of clinical deterioration and intensive care unit admission in trauma patients transferred from northern Quebec to a level 1 trauma centre: a retrospective cohort study.

BACKGROUND: Trauma care in Nunavik, Quebec, is highly challenging. Geographic distances and delays in transport can translate into precarious patient transfers to tertiary trauma care centres. The objective of this study was to identify predictors of clinical deterioration during transport and eventual intensive care unit (ICU) admission for trauma patients transferred from Nunavik to a tertiary trauma care centre. METHODS: This is a retrospective cohort study using the Montreal General Hospital (MGH) trauma registry. All adult trauma patients transferred from Nunavik and admitted to the MGH from 2010 to 2019 were included. Main outcomes of interest were hemodynamic and neurologic deterioration during transport and ICU admission. RESULTS: In total, 704 patients were transferred from Nunavik and admitted to the MGH during the study period. The median age was 33 (interquartile range [IQR] 23-47) years and the median Injury Severity Score was 10 (IQR 5-17). On multiple regression analysis, transport time from site of injury to the MGH (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.06), thoracic injuries (OR 1.75, 95% CI 1.03-2.99), and head and neck injuries (OR 3.76, 95% CI 2.10-6.76) predicted clinical deterioration during transfer. Injury Severity Score (OR 1.04, 95% CI 1.01-1.08), abnormal local Glasgow Coma Scale score (OR 2.57, 95% CI 1.34-4.95), clinical deterioration during transfer (OR 4.22, 95% CI 1.99-8.93), traumatic brain injury (OR 2.44, 95% CI 1.05-5.68), and transfusion requirement at the MGH (OR 4.63, 95% CI 2.35-9.09) were independent predictors of ICU admission. CONCLUSION: Our study identified several predictors of clinical deterioration during transfer and eventual ICU admission for trauma patients transferred from Nunavik. These factors could be used to refine triage criteria in Nunavik for more timely evacuation and higher level care during transport.

The relationship between hot temperatures and hospital admissions for psychosis in adults diagnosed with schizophrenia: A case-crossover study in Quebec, Canada.

INTRODUCTION: Some studies have found hot temperatures to be associated with exacerbations of schizophrenia, namely psychoses. As climate changes faster in Northern countries, our understanding of the association between temperature and hospital admissions (HA) for psychosis needs to be deepened. OBJECTIVES: 1) Among adults diagnosed with schizophrenia, measure the relationship between mean temperatures and HAs for psychosis during summer. 2) Determine the influence of individual and ecological characteristics on this relationship. METHODS: A cohort of adults diagnosed with schizophrenia (n = 30,649) was assembled using Quebec's Integrated Chronic Disease Surveillance System (QICDSS). The follow-up spanned summers from 2001 to 2019, using hospital data from the QICDSS and meteorological data from the National Aeronautics and Space Administration's (NASA) Daymet database. In four geographic regions of the province of Quebec, a conditional logistic regression was used for the case-crossover analysis of the relationship between mean temperatures (at lags up to 6 days) and HAs for psychosis using a distributed lag non-linear model (DLNM). The analyses were adjusted for relative humidity, stratified according to individual (age, sex, and comorbidities) and ecological (material and social deprivation index and exposure to green space) factors, and then pooled through a meta-regression. RESULTS: The statistical analyses revealed a statistically significant increase in HAs three days (lag 3) after elevated mean temperatures corresponding to the 90th percentile relative to a minimum morbidity temperature (MMT) (OR 1.040; 95% CI 1.008-1.074), while the cumulative effect over six days was not statistically significant (OR 1.052; 95% IC 0.993-1.114). Stratified analyses revealed non statistically significant gradients of increasing HAs relative to increasing material deprivation and decreasing green space levels. CONCLUSIONS: The statistical analyses conducted in this project showed the pattern of admissions for psychosis after hot days. This finding could be useful to better plan health services in a rapidly changing climate.

The Qanuilirpitaa? 2017 Nunavik Health Survey: design, methods, and lessons learned.

OBJECTIVE: To depict the design, methods, sociodemographic characteristics of the population, and lessons learned during the Qanuilirpitaa? 2017 Nunavik Inuit Health Survey, the third major health survey to be conducted among youth and adults residing in Nunavik (Northern Quebec, Canada). METHODS: Qanuilirpitaa? 2017 is a cross-sectional survey that served to update information regarding various aspects of physical health, mental health, and general well-being of Nunavimmiut. The survey was guided by the ethics principles of Ownership, Control, Access, and Possession (OCAP®) ( https://fnigc.ca/ocap ). Questionnaires and clinical tests were administered to residents from the 14 coastal communities onboard the Canadian Coast Guard Ship Amundsen during late summer and early fall 2017. As part of the community component of the survey, qualitative interviews were performed with key respondents, and services and resources supporting health and well-being in the 14 communities were inventoried and characterized. RESULTS: A total of 1326 Nunavimmiut aged 16 and over participated in the survey. Despite difficulties encountered with the recruitment of participants, co-interpretation sessions with Inuit partners revealed that the survey had succeeded in capturing cultural, socio-economic, and lifestyle characteristics of Nunavimmiut. In all, 20 thematic reports have been published covering various aspects of health and well-being of Nunavimmiut. Regional and local reports pertaining to the community component were produced. More in-depth analyses have ensued, and results are presented in articles published in this CJPH supplement issue. CONCLUSION: Information from this survey is being used to update health services and programs in the region and for the development of health policies and public health interventions to tackle key health-related issues faced by Nunavimmiut. Drawing lessons from challenges and successes encountered in Qanuilirpitaa? 2017, this survey paved the way to the upcoming Inuit-led Qanuippitaa? National Inuit Health Survey to be conducted every 5 years throughout Inuit Nunangat.

RéSUMé: OBJECTIF: Décrire la conception, les méthodes, les caractéristiques sociodémographiques de la population et les leçons tirées de l'Enquête sur la santé des Inuits du Nunavik Qanuilirpitaa? 2017, la troisième grande enquête de santé menée auprès de jeunes et d'adultes résidant au Nunavik (Nord du Québec, Canada). MéTHODES: Qanuilirpitaa? 2017 est une enquête transversale qui a permis la mise à jour des informations concernant divers aspects de la santé physique, de la santé mentale et du bien-être général des Nunavimmiut. L'enquête a été guidée par les principes de propriété, de contrôle, d'accès et de possession (OCAP®) ( https://fnigc.ca/ocap ). Des questionnaires et des tests cliniques ont été administrés à des résidents des 14 communautés côtières, à bord du navire Amundsen de la Garde côtière canadienne, à la fin de l'été et au début de l'automne 2017. Des entrevues qualitatives ont également été réalisées avec des répondants clé dans le cadre de la composante communautaire. RéSULTATS: Au total, 1 326 Nunavimmiut âgés de 16 ans et plus ont été recrutés. Malgré les difficultés rencontrées lors du recrutement des participants, les rencontres de co-interprétation ont permis de vérifier que l'enquête avait réussi à capturer les caractéristiques culturelles, socioéconomiques et les habitudes de vie de la population. Au total, 20 rapports thématiques ont été publiés, lesquels couvrent différents aspects de la santé et du bien-être des Nunavimmiut. Un rapport régional et des rapports locaux liés à la composante communautaire ont également été produits. Des analyses plus approfondies ont également été réalisées, dont les résultats sont présentés dans les articles publiés dans ce numéro supplémentaire de la Revue canadienne de santé publique. CONCLUSION: Les informations issues de cette enquête sont utilisées pour la mise à jour des services de santé dans la région et pour le développement de politiques de santé et d'interventions de santé publique, ayant pour cibles les principaux défis auxquels les Nunavimmiut sont confrontés. Grâce aux leçons apprises lors de sa réalisation, cette enquête a pavé la voie aux prochaines enquêtes Qanuippitaa ? qui seront menées tous les 5 ans dans tout l'Inuit Nunangat.

Similar and different? A cross-cultural comparison of the prevalence, course of and factors associated with suicidal thoughts and behaviors in first-episode psychosis in Chennai, India and Montreal, Canada.

BACKGROUND: Data from high-income countries (HICs) show a high risk of suicidal thoughts and behaviors (STBs) in first-episode psychosis (FEP). It is unknown, however, whether rates and associated factors differ in low- and middle-income countries (LMICs). AIMS: We therefore aimed to compare the 2-year course of STBs and associated factors in persons with FEP treated in two similarly structured early intervention services in Chennai, India and Montreal, Canada. METHOD: To ensure fit to the data that included persons without STBs and with varying STBs' severity, a hurdle model was conducted by site, including known predictors of STBs. The 2-year evolution of STBs was compared by site with mixed-effects ordered logistic regression. RESULTS: The study included 333 FEP patients (168 in Chennai, 165 in Montreal). A significant decrease in STBs was observed at both sites (OR = 0.87; 95% CI [0.84, 0.90]), with the greatest decline in the first 2 months of follow-up. Although three Chennai women died by suicide in the first 4 months (none in Montreal), Chennai patients had a lower risk of STBs over follow-up (OR = 0.44; 95% CI [0.23, 0.81]). Some factors (depression, history of suicide attempts) were consistently associated with STBs across contexts, while others (gender, history of suicidal ideation, relationship status) were associated at only one of the two sites. CONCLUSIONS: This is the first study to compare STBs in FEP between two distinct geo-sociocultural contexts (an HIC and an LMIC). At both sites, STBs reduced after treatment initiation, suggesting that early intervention reduces STBs across contexts. At both sites, for some patients, STBs persisted or first appeared during follow-up, indicating need for suicide prevention throughout follow-up. Our study demonstrates contextual variations in rates and factors associated with STBs. This has implications for tailoring suicide prevention and makes the case for more research on STBs in FEP in diverse contexts.

Veal calves management in Québec, Canada: Part I. Association between passive immunity transfer at arrival and health disorders.

Morbidity and mortality remain important concerns for veal production which traditionally involves very young calves being transported directly from dairy farms to calf-raising facilities or sold through auction markets from dairy farms. There are few studies that examine the relationship between transfer of passive immunity and health outcomes in veal production in Québec. The objective of this study was to investigate the risk factors associated with morbidity and mortality in milk and grain-fed veal facilities in Québec. Between October 2017 and December 2018, a prospective cohort study was conducted on 59 batches of milk- and grain-fed veal calves from Montérégie and Centre du Québec regions in Québec, Canada. A total of 30 calves per batch were randomly sampled for the transfer of passive immunity (TPI) status using the Brix refractometer (serum threshold ≥ 8.4%). Throughout the production cycle, arrival, treatment, mortality, and slaughter records of each batch of calves were extracted and used to quantify individual- and group-level risk factors. Morbidity and mortality were modelled through generalized linear mixed models (GLMMs) using a logit link, as function of categorical variables (individual inadequate TPI, arrival season, purchasing sites, and arrival weights) and a continuous variable (proportion of inadequate TPI in the batch). Given that the health and performance data are usually collected retrospectively under commercial settings, incomplete data was recognized as a potential issue. Thus, multiple imputation models were used. From 59 batches where 1729 calves were sampled for measuring TPI, 1084 calves had a serum Brix% < 8.4% giving a prevalence of 62.7% of inadequate TPI. The prevalence of morbidity and mortality in those 59 batches were not associated with the batch-level inadequate TPI prevalence. On the other hand, individual calves with inadequate TPI had higher odds of morbidity (OR: 1.56; 95% CI: 1.2-2.05, P = 0.001) compared to those calves with adequate TPI. Odds of mortality, on the other hand, were not significantly affected by inadequate TPI (OR:1.27; 95% CI: 0.74-2.18, P = 0.3). Calves arriving to the facility during the winter season had lower odds of mortality than those arriving in fall (OR:0.16; 95% CI: 0.03-0.78, P = 0.02). In conclusion, this study suggests that inadequate TPI, as assessed upon arrival in veal farms, remains an important concern for negative health outcomes in veal calves.