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2.
Can Bull Med Hist ; 39(1): 1-36, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35506606

RESUMO

In 1979, the Canadian Society for the History of Medicine, founded in Quebec City, Canada, in 1950, inaugurated its first official organizational organ, Newsletter/Nouvelles, which ran for 10 issues in five annual volumes. In 1984, this modest means of institutional communication expanded to become the Canadian Bulletin of the History of Medicine / Bulletin canadien d'histoire de la médecine, a peer-reviewed journal that continues to the present. Central to the founding and operation of both publications was Kenneth B. Roberts of the Faculty of Medicine, Memorial University of Newfoundland. This discussion outlines the foundation, evolution, and activities of both these periodicals from 1979 to 1994. Their relationship to the growth of both the Canadian Society for the History of Medicine and the field of medical history in Canada are also delineated.


Assuntos
Medicina , Sociedades , Canadá , Quebeque
3.
PLoS One ; 17(5): e0266079, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35507549

RESUMO

Population history reconstruction, using extant genetic diversity data, routinely relies on simple demographic models to project the past through ascending genealogical-tree branches. Because genealogy and genetics are intimately related, we traced descending genealogies of the Québec founders to pursue their fate and to assess their contribution to the present-day population. Focusing on the female and male founder lines, we observed important sex-biased immigration in the early colony years and documented a remarkable impact of these early immigrants on the genetic make-up of 20th-century Québec. We estimated the immigrants' survival ratio as a proportion of lineages found in the 1931-60 Québec to their number introduced within the immigration period. We assessed the effective family size, EFS, of all immigrant parents and their Québec-born descendants. The survival ratio of the earliest immigrants was the highest and declined over centuries in association with the immigrants' EFS. Parents with high EFS left plentiful married descendants, putting EFS as the most important variable determining the parental demographic success throughout time for generations ahead. EFS of immigrant founders appears to predict their long-term demographic and, consequently, their genetic outcome. Genealogically inferred immigrants' "autosomal" genetic contribution to 1931-60 Québec from consecutive immigration periods follow the same yearly pattern as the corresponding maternal and paternal lines. Québec genealogical data offer much broader information on the ancestral diversity distribution than genetic scrutiny of a limited population sample. Genealogically inferred population history could assist studies of evolutionary factors shaping population structure and provide tools to target specific health interventions.


Assuntos
Emigrantes e Imigrantes , Emigração e Imigração , Características da Família , Feminino , Humanos , Masculino , Linhagem , Quebeque/epidemiologia
4.
Sci Rep ; 12(1): 7220, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508611

RESUMO

Climate change affects timings, frequency, and intensity of frost events in northern ecosystems. However, our understanding of the impacts that frost will have on growth and survival of plants is still limited. When projecting the occurrence of frost, the internal variability and the different underlying physical formulations are two major sources of uncertainty of climate models. We use 50 climate simulations produced by a single-initial large climate ensemble and five climate simulations produced by different pairs of global and regional climate models based on the concentration pathway (RCP 8.5) over a latitudinal transect covering the temperate and boreal ecosystems of western Quebec, Canada, during 1955-2099 to provide a first-order estimate of the relative importance of these two sources of uncertainty on the occurrence of frost, i.e. when air temperature is < 0 °C, and their potential damage to trees. The variation in the date of the last spring frost was larger by 21 days (from 46 to 25 days) for the 50 climate simulations compared to the 5 different pairs of climate models. When considering these two sources of uncertainty in an eco-physiological model simulating the timings of budbreak for trees of northern environment, results show that 20% of climate simulations expect that trees will be exposed to frost even in 2090. Thus, frost damage to trees remains likely under global warming.


Assuntos
Mudança Climática , Árvores , Ecossistema , Quebeque , Estações do Ano , Árvores/fisiologia
5.
BMC Prim Care ; 23(1): 84, 2022 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-35436845

RESUMO

BACKGROUND: The implementation of evidence-based innovations is incentivized as part of primary care reform in Canada. In the Province of Québec, it generated the creation of interprofessional care models involving registered nurses and social workers as members of primary care clinics. However, the scope of practice for these professionals remains variable and suboptimal. In 2019, expert committees co-designed and published two evidence-based practice guides, but no clear strategy has been identified to support their assimilation. This project's goal is to support the implementation and deployment of practice guides for both social workers and registered nurses using a train-the-trainer educational intervention. METHODS/DESIGN: This three-phase project is a developmental evaluation using a multiple case study design across 17 primary care clinics. It will involve trainers in healthcare centers, patients, registered nurses and social workers. The development and implementation of an expanded train-the-trainer strategy will be informed by a patient-oriented research approach, the Kirkpatrick learning model, and evidence-based practice guides. For each case and phase, the qualitative and quantitative data will be analyzed using a convergent design method and will be integrated through assimilation. DISCUSSION: This educational intervention model will allow us to better understand the complex context of primary care clinics, involving different settings and services offered. This study protocol, based on reflective practice, patient-centered research and focused on the needs of the community in collaboration with partners and patients, may serve as an evidence based educational intervention model for further study in primary care.


Assuntos
Enfermeiras e Enfermeiros , Assistentes Sociais , Prática Clínica Baseada em Evidências , Humanos , Atenção Primária à Saúde , Quebeque
6.
Sante Publique ; Vol. 33(6): 853-862, 2022 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-35485017

RESUMO

INTRODUCTION: Retention of healthcare workers (HCWs) in the healthcare system during the COVID-19 pandemic could become a challenge. It is therefore important to better understand what are the motivational elements that could explain a greater or lesser motivation to care for infected patients. OBJECTIVES: To evaluate factors modulating HCWs' willingness to treat COVID-19 infected patients. METHODS: HCWs from Québec, Canada, were invited to complete an online survey during the first wave of the COVID-19 pandemic between the months of April and July 2020. The survey focused on the intention to avoid treating infected patients, prior experiences in treating COVID-19 patients and anxiety levels. Descriptive statistics and multiple regression analysis were used to assess which factors explained differences in HCWs intention to avoid treating patients. RESULTS: A total of 430 HCW completed the survey. A majority were women (87%) and nurses (50%). Of those, 12% indicated having considered measures to avoid working with COVID-19 infected patients and 5% indicated having taken actions to avoid working with infected patients. A further 18% indicated that they would use a hypothetical opportunity to avoid working with infected patients. Having previously treated infected patients was associated with a significant reduction in the intention to avoid work (OR: 0.56 CI 0.36-0.86). Amongst HCWs, physicians had a significantly reduced intention to avoid treating infected patients (OR: 0.47 CI 0.23-0.94). We also found that an increase in anxiety score was associated with a greater intention to avoid treating COVID-19 infected patients (OR: 1.06 CI 1.04-1.08). CONCLUSION: Study results suggest that previous experience in treating COVID-19 infected patients is protective in terms of work-avoidance intentions. We also found that amongst HCWs, physicians had a significantly lower intention to avoid working with COVID-19 infected patients. Finally, our results show that increase in anxiety is associated with a higher intention to avoid treating infected patients. Characterization of factors associated with low anxiety levels and low reluctance to work during the COVID-19 pandemic could be useful in staffing facilities during the present and future healthcare crisis.


Assuntos
COVID-19 , Influenza Humana , Atitude do Pessoal de Saúde , COVID-19/terapia , Feminino , Pessoal de Saúde , Humanos , Masculino , Motivação , Pandemias , Quebeque/epidemiologia
7.
Sante Publique ; Vol. 33(6): 897-904, 2022 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-35485021

RESUMO

INTRODUCTION: Psychosocial impacts of the coronavirus (COVID-19) pandemic, including those on mental health, are now recognized. However, the experience of the COVID-19 pandemic differs from one individual, group or context to another and solutions to cope with it must be adapted and contextualized. AIM OF THE STUDY: This study aims to identify factors of psychosocial vulnerability in rural populations in Quebec (Canada). METHOD: The approach is adapted from previous work on the prevention and reduction of the psychosocial impacts of climate change in non-metropolitan areas. A descriptive qualitative design based on several data sources was used. The data come from a press review, a review of the scientific literature, semi-structured interviews with key actors in the community and municipal domains. RESULTS: Data triangulation and validation by community organization teams (public health department) identified forty-one (N = 41) factors (e.g., social cohesion, digital literacy) likely to increase or decrease the psychosocial vulnerability of rural populations in the context of a pandemic. These factors are grouped under six categories of determinants: 1) population's knowledge and attitudes towards the pandemic, 2) previous experience of difficult events, 3) community dynamism, social cohesion and solidarity, 4) citizens, municipalities and government authorities' involvement, 5) health and social services and those from their intersectoral partners, and 6) land use planning. CONCLUSION: These results are useful for local and regional public health teams in developing local portraits of psychosocial vulnerabilities to support plans to strengthen community resilience and reduce social and health inequalities accentuated by the pandemic.


Assuntos
COVID-19 , Pandemias , Adaptação Psicológica , COVID-19/epidemiologia , Humanos , Pandemias/prevenção & controle , Quebeque/epidemiologia , População Rural
8.
Sante Publique ; Vol. 33(6): 991-995, 2022 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-35485030

RESUMO

INTRODUCTION: Facing COVID-19, most of health care system first responded with the confinement of the population and an increase of intensive care resources. Primary care was then mobilized variably and more or less coordinated. PURPOSE OF RESEARCH: Comparing the involvement of primary care in four francophone regions with similar primary care to draw lessons for reforms directions in light of the COVID experience. RESULTS: Mobilization of primary care actors was important, heterogeneous and linked to local context and previous dynamics at the territorial level or the practice level except in Quebec where primary care is governed by health authorities. The creation of COVID centers was systematic as "warm practices" in Quebec or left to the initiative of local stakeholders more or less supported by health authorities. Teleconsultation, largely dominated by the use of the telephone, was implemented everywhere, generally supported by flexible and adapted pricing. The performance of diagnostic tests such as vaccination by new professionals within a legal, financial and simple training framework is a major area for improvement. Information systems to assess local needs were insufficient everywhere. CONCLUSION: The definition of primary care governance methods and, in particular, the link between professionals and public health operators in the four areas studied is a priority area for improvement at both local and national levels.


Assuntos
COVID-19 , Bélgica , COVID-19/epidemiologia , França/epidemiologia , Humanos , Atenção Primária à Saúde , Quebeque/epidemiologia , Suíça
9.
Can Vet J ; 63(4): 379-385, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35368389

RESUMO

Because antimicrobial usage (AMU) data are crucial in understanding and dealing with the threat that antimicrobial resistance (AMR) poses to global health, data of the sale of antimicrobials from 2016 to 2019 of CDMV Inc. - a major distributor of veterinary products in Canada - were collected and analyzed for the province of Quebec. The primary objective was to describe the evolution of AMU sales data for dairy cattle, small animals, and horses; a secondary objective was to determine effects of a new provincial regulation on antimicrobials of very high importance (in Quebec) on sales for dairy cattle. Results are described in milligrams of antimicrobials per kilogram of animal biomass (mg/PCU) for dairy cattle, small animals, and horses; intramammary products were analyzed for number of treatments per 100 cow-years; and results for dairy cattle were compared in Canadian-defined course doses for cattle (DCDbovCA) per 100 cow-years to a recent study for this species in Quebec. Between 2016 and 2019, there were decreased sales of Category 1 antimicrobials for all species included in the study (Category 1-VI for small animals). This reduction was even more apparent for dairy cattle, for which a 76% decrease occurred from 2018 to 2019 (1.7 to 0.4 mg/PCU). This marked reduction was attributed to the new regulation implemented in February 2019. Since a farm- and clinic-level AMU monitoring system has not yet been implemented in Quebec, analysis of CDMV Inc. sales enabled observations of temporal trends in AMU for dairy cattle, horses, and small animals. These temporal trends based on CDMV Inc. sales will be useful for making comparisons and validating trends derived from farm- and clinic-level data generated by a monitoring system.


Analyse des données de ventes d'antibiotiques du principal distributeur de médicaments au Québec de 2016 à 2019 : une estimation de l'utilisation des antibiotiques chez les bovins laitiers, les chevaux et les animaux de compagnie. Étant donné que les données sur l'utilisation des antimicrobiens (UAM) sont cruciales pour comprendre et faire face à la menace que la résistance aux antimicrobiens (RAM) fait peser sur la santé mondiale, les données sur les ventes d'antibiotiques de 2016 à 2019 de CDMV Inc. ­ un important distributeur de produits vétérinaires au Canada ­ ont été recueillies et analysées pour la province de Québec. L'objectif principal du projet était de décrire l'évolution des données de ventes d'antibiotiques pour les bovins laitiers, les animaux de compagnie et les chevaux; un objectif secondaire était de déterminer les effets d'une nouvelle réglementation provinciale relative à l'usage des antimicrobiens de catégorie 1 ­ très haute importance ­ (au Québec) sur les ventes d'antibiotiques pour les bovins laitiers. Les résultats sont décrits en milligrammes d'antibiotiques par kilogramme de biomasse animale (mg/PCU) pour les bovins laitiers, les animaux de compagnie et les chevaux. Les produits intramammaires sont analysés selon le nombre de traitements par 100 vaches-années. Les résultats pour les bovins laitiers ont aussi été comparés à une étude récente réalisée au Québec pour cette espèce en « traitement type pour les bovins au Canada ¼ (DCDbovCA) par 100 vaches-années. Entre 2016 et 2019, les ventes d'antimicrobiens de catégorie 1 ont diminué pour toutes les espèces de l'étude (catégorie 1-VI pour les animaux de compagnie). Cette réduction a été encore plus apparente pour les bovins laitiers, pour lesquels une diminution de 76 % s'est produite de 2018 à 2019 (1,7 à 0,4 mg/PCU). Cette baisse marquée a été attribuée à la nouvelle réglementation mise en place en février 2019. Puisqu'un système de surveillance sur l'utilisation des antibiotiques à l'échelle des fermes et des cliniques vétérinaires n'a pas encore été mis en place au Québec, l'analyse des ventes de CDMV Inc. a permis d'observer les tendances temporelles de l'UAM pour les bovins laitiers, les chevaux et les animaux de compagnie. Ces tendances temporelles, basées sur les ventes de CDMV Inc., seront utiles pour effectuer des comparaisons et valider les tendances dérivées des données au niveau des fermes et des cliniques vétérinaires générées par un futur système de surveillance sur l'utilisation des antibiotiques.(Traduit par les auteurs).


Assuntos
Anti-Infecciosos , Animais , Antibacterianos , Anti-Infecciosos/uso terapêutico , Canadá , Bovinos , Fazendas , Feminino , Cavalos , Quebeque
10.
Front Public Health ; 10: 756037, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35372193

RESUMO

Introduction: The objective of this study was to characterize the combinations of demographic and socioeconomic characteristics associated to the unwillingness to receive the COVID-19 vaccines during the 2021 Quebec's vaccination campaign. Materials and Methods: In March-June 2021, we conducted an online survey of the participants of the CARTaGENE population-based cohort, composed of middle-aged and older adults. After comparing the vaccinated and unvaccinated participants, we investigated vaccine hesitancy among participants who were unvaccinated. For identifying homogeneous groups of individuals with respect to vaccine hesitancy, we used a machine learning approach based on a hybrid tree-based model. Results: Among the 6,105 participants of the vaccine cohort, 3,553 (58.2%) had at least one dose of COVID-19 vaccine. Among the 2,552 participants, 221 (8.7%) did not want to be vaccinated (91) or were uncertain (130). The median age for the unvaccinated participants was 59.3 years [IQR 54.7-63.9]. The optimal hybrid tree-based model identified seven groups. Individuals having a household income lower than $100,000 and being born outside of Canada had the highest rate of vaccine hesitancy (28% [95% CI 19.8-36.3]). For those born in Canada, the vaccine hesitancy rate among the individuals who have a household income below $50,000 before the pandemic or are Non-retired was of 12.1% [95% CI 8.7-15.5] and 10.6% [95% CI 7.6-13.7], respectively. For the participants with a high household income before the pandemic (more than $100,000) and a low level of education, those who experienced a loss of income during the pandemic had a high level of hesitancy (19.2% [8.5-29.9]) whereas others who did not experience a loss of income had a lower level of hesitancy (6.0% [2.8-9.2]). For the other groups, the level of hesitancy was low of around 3% (3.2% [95% CI 1.9-4.4] and 3.4% [95% CI 1.5-5.2]). Discussion: Public health initiatives to tackle vaccine hesitancy should take into account these socio-economic determinants and deliver personalized messages toward people having socio-economic difficulties and/or being part of socio-cultural minorities.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Demografia , Humanos , Programas de Imunização , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Quebeque/epidemiologia , Vacinação
11.
JAMA Netw Open ; 5(4): e226739, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35404459

RESUMO

Importance: Causes of death in children with birth defects are poorly understood. Objective: To determine mortality rates by cause of death in children with and without birth defects. Design, Setting, and Participants: This longitudinal cohort study included a population-based sample of 1 037 688 children and was conducted in all hospitals in Quebec, Canada, with 7 700 596 person-years of follow-up between birth and age 14 years (April 1, 2006, to March 31, 2020). Exposures: Presence or absence of a birth defect. Main Outcomes and Measures: Outcomes were all-cause and cause-specific mortality. Hazard ratios (HRs) and 95% CIs were computed for the association between birth defects and mortality with Cox proportional hazards models adjusted for patient characteristics. Results: Among the 1 037 688 children in the cohort, 95 566 had birth defects (56.5% boys). There were 532 542 boys in the cohort (51.3%), and mean (SD) age at the end of follow-up was 7.42 (3.72) years. There were 918 deaths among children with defects, and the mean (SD) age was 0.93 (2.07) years at death; there were 1082 deaths among the 942 122 children without defects, and the mean (SD) age at death was 0.50 (1.51) years. Mortality rates were higher for children with birth defects compared with no defect (1.3 vs 0.2 deaths per 1000 person-years, respectively). Girls (HR, 5.66; 95% CI, 4.96-6.47) and boys (HR, 4.69; 95% CI, 4.15-5.29) with birth defects had an elevated risk of death before 14 years compared with unaffected children. Birth defects were associated with mortality from circulatory (HR, 26.59; 95% CI, 17.73-39.87), respiratory (HR, 23.03; 95% CI, 15.09-35.14), and digestive causes (HR, 31.77; 95% CI, 11.87-85.04), but anomalies were rarely listed as the cause of death. Compared with children with no defect, those with birth defects were at greatest risk of death between 28 and 364 days of life. Conclusions and Relevance: This cohort study of 1 037 688 children suggests that birth defects were strongly associated with mortality owing to circulatory, respiratory, and digestive causes. This finding suggests that the contribution of birth defects may be underestimated in mortality statistics.


Assuntos
Mortalidade da Criança , Adolescente , Criança , Estudos de Coortes , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Modelos de Riscos Proporcionais , Quebeque/epidemiologia
12.
Environ Sci Technol ; 56(8): 5009-5019, 2022 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-35395156

RESUMO

Ultraviolet absorbents (UVAs) and industrial antioxidants (IAs) are contaminants of emerging concern. In this study, we investigated the distribution and partitioning of these contaminants in surface water, suspended particulate matter (SPM), sediment, and various tissues of lake sturgeon (Acipenser fulvescens) and northern pike (Esox lucius) from the St. Lawrence River (SLR), Quebec, Canada. Results indicated that 2,6-di-tert-butyl-1,4-benzoquinone (BHTQ) was the dominant contaminant in the dissolved phase of the surface water, with median concentrations of 43, 15, and 123 ng/L for three sampling sites, respectively. Surface water collected downstream of a major city showed higher levels of various UVAs, BHTQ, and diphenylamine compared to the upstream, suggesting the influence of the urban activities on the contamination of these emerging contaminants in the SLR. SPM showed greater sorption capacities of most target contaminants compared to those of the sediment. Different contamination profiles were found in lake sturgeon and northern pike, implying that the accumulation of UVAs and IAs in fish depends on their feeding behavior. The field-based tissue-specific bioaccumulation factors (BAFs) for frequently detected contaminants (log BAF 1.5-4.2) were generally comparable to or lower than the Estimation Program Interface modeling results (1.4-5.0), indicating that some of these contaminants may be less bioaccumulative than previously expected.


Assuntos
Antioxidantes , Poluentes Químicos da Água , Animais , Monitoramento Ambiental/métodos , Peixes , Material Particulado , Quebeque , Água , Poluentes Químicos da Água/análise
13.
PLoS One ; 17(4): e0265764, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35377902

RESUMO

Olfactory identification disorder is regarded as an early marker of Alzheimer's disease (AD) and of similar diagnostic significance of biological or cognitive markers. Premature damage of the entorhinal olfactory cortex, the hippocampus and the orbitofrontal cortex characterize AD and suggest a specific impairment of olfactory identification. The use of psychophysical olfactory identification tests in clinical diagnostic practice is therefore strongly recommended, but not required. As these widespread tests are rarely used, an innovative test, adapted to this target group has been developed. It has been used and validated in a routine care protocol at different Memory Centers in France and in Quebec, Canada. A total of 157 participants were recruited: including 63 Alzheimer's patients and 94 healthy controls. The test was composed of 14 odorants diluted into 4 different concentrations. A computer interface generated randomization of 6 odors per participant and the automatic calculation of identification scores, of perceptual thresholds and of composite scores. All participants underwent a Mini Mental Scale Examination within the previous three months or on the same day of the olfactory test. The Alzheimer's patients had a score between 20 and 30 and healthy controls participants had a score above 28 without any loss of points on recalled items. The results show that our olfactory identification test is able to significantly differentiate Alzheimer's patients from healthy controls (p < 0.001), and to distinguish the French population tested from the Quebec population (p < 0.001). This study highlights an olfactory identification disorder as a target for early diagnosis of AD. Its cultural qualities make it a potential candidate for differentiated calibration between France and Quebec.


Assuntos
Doença de Alzheimer , Transtornos do Olfato , Doença de Alzheimer/epidemiologia , França , Humanos , Testes Neuropsicológicos , Transtornos do Olfato/diagnóstico , Quebeque , Olfato
14.
PLoS One ; 17(4): e0265580, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35385548

RESUMO

BACKGROUND: Despite greater acceptance of sexual and gender diversity and the scientific consensus that same-gender attraction, creative gender expression, and transness are not mental illnesses, LGBTQI2+ persons are still commonly told that they can or should change their sexual orientation, gender identity, or gender expression (SOGIE). The aim of this study was to describe the prevalence of SOGIE conversion efforts, including their sociodemographic correlates, among LGBTQI2+ persons. METHODS: Using community-based sampling, we assessed SOGIE conversion attempts and involvement in conversion services of 3,261 LGBTQI2+ persons aged 18 years and older in Quebec, Canada. RESULTS: A quarter of respondents experienced SOGIE conversion attempts, and fewer than 5% were involved in conversion services. Over half of those who were involved in SOGIE conversion services consented to them, but the services' goals were made clear and explicit to only 55% and 30% of those who engaged in SO and GIE conversion, respectively. The results also suggest that family plays a key role in SOGIE conversion attempts and services utilization, and that indigenous, intersex, transgender, non-binary, and asexual persons, people of colour, as well as individuals whose sexual orientation is not monosexual (i.e., bisexual, pansexual) were more likely to have been exposed to conversion attempts and involved in conversion services. CONCLUSIONS: This study found that the prevalence of conversion efforts is substantial. Interventions to protect LGBTQI2+ people from such attempts should focus not only on legal bans, but also on supporting families who need to be counseled in accepting sexual and gender diversity. Health professionals need to be adequately trained in LGBTQI2+ affirmative approaches. Religious therapists should consult with colleagues and undergo supervision to ensure that their religious beliefs do not interfere with their practice.


Assuntos
Minorias Sexuais e de Gênero , Pessoas Transgênero , Feminino , Identidade de Gênero , Humanos , Masculino , Quebeque , Comportamento Sexual
15.
Circ Cardiovasc Imaging ; 15(4): e013796, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35369710

RESUMO

BACKGROUND: The benefit of fetal echocardiograms (FE) to detect severe congenital heart diseases (SCHD) in the setting of a normal second-trimester ultrasound is unclear. We aimed to assess whether the increase in SCHD detection rates when FE are performed for risk factors in the setting of a normal ultrasound was clinically significant to justify the resources needed. METHODS: This is a multicenter, population-based, retrospective cohort study, including all singleton pregnancies and offspring in Quebec (Canada) between 2007 and 2015. Administrative health care data were linked with FE clinical data to gather information on prenatal diagnosis of CHD, indications for FE, outcomes of pregnancy and offspring, postnatal diagnosis of CHD, cardiac interventions, and causes of death. The difference between the sensitivity to detect SCHD with and without FE for risk factors was calculated using generalized estimating equations with a noninferiority margin of 5 percentage points. RESULTS: A total of 688 247 singleton pregnancies were included, of which 30 263 had at least one FE. There were 1564 SCHD, including 1071 that were detected prenatally (68.5%). There were 12 210 FE performed for risk factors in the setting of a normal second-trimester ultrasound, which led to the detection of 49 additional cases of SCHD over 8 years. FE referrals for risk factors increased sensitivity by 3.1 percentage points (95% CI, 2.3-4.0; P<0.0001 for noninferiority). CONCLUSIONS: In the setting of a normal second-trimester ultrasound, adding a FE for risk factors offered low incremental value to the detection rate of SCHD in singleton pregnancies. The current ratio of clinical gains versus the FE resources needed to screen for SCHD in singleton pregnancies with isolated risk factors does not seem favorable. Further studies should evaluate whether these resources could be better allocated to increase SCHD sensitivity at the ultrasound level, and to help decrease heterogeneity between regions, institutions and operators.


Assuntos
Cardiopatias Congênitas , Ultrassonografia Pré-Natal , Canadá , Ecocardiografia , Feminino , Coração Fetal/anormalidades , Coração Fetal/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/epidemiologia , Humanos , Gravidez , Segundo Trimestre da Gravidez , Quebeque/epidemiologia , Estudos Retrospectivos
16.
Artigo em Inglês | MEDLINE | ID: mdl-35409493

RESUMO

Several research contributions have depicted the impact of the pandemic environment on healthcare and social care personnel. Even though the high prevalence of burnout depression and anxiety in healthcare settings before COVID-19 has been well documented in the research, the recent increase in psychological distress and mental health issues in healthcare and mental health workers should be attributed to the effect of the COVID-19 pandemic. The aim of the present study is to develop, evaluate, and compare a model of COVID-19 workplace stressors between two different territories, the Italian region of Lombardy and the Canadian province of Quebec. Within this model, burnout is depicted as the strongest determinant of mental health symptoms for mental health workers. In turn, the main workplace determinants of burnout are the perception of a lack of support from the organization and the fear of contracting COVID-19 at work. Findings also provide insights for designing interventions to promote and protect mental health workers in the context of the pandemic. In conclusion, it is necessary to monitor burnout and carefully analyze elements of organizational culture, in addition to offering clinical and psychological care for those in need.


Assuntos
Esgotamento Profissional , COVID-19 , Ansiedade/epidemiologia , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Esgotamento Psicológico , COVID-19/epidemiologia , Canadá , Depressão/epidemiologia , Depressão/psicologia , Pessoal de Saúde/psicologia , Humanos , Saúde Mental , Pandemias , Quebeque/epidemiologia , SARS-CoV-2 , Local de Trabalho/psicologia
17.
CMAJ Open ; 10(2): E379-E389, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35440485

RESUMO

BACKGROUND: There have been multiple waves in the COVID-19 pandemic in many countries. We sought to compare mortality and respiratory, cardiovascular and renal dysfunction between waves in 3 Canadian provinces. METHODS: We conducted a substudy of the ARBs CORONA I study, a multicentre Canadian pragmatic observational cohort study that examined the association of pre-existing use of angiotensin receptor blockers with outcomes in adults admitted to hospital with acute COVID-19 up to April 2021 from 9 community and teaching hospitals in 3 Canadian provinces (British Columbia, Ontario and Quebec). We excluded emergency department admissions without hospital admission, readmissions and admissions for another reason. We used logistic and 0-1-inflated ß regression models to compare 28-day and in-hospital mortality, and the use of invasive mechanical ventilation, vasopressors and renal replacement therapy (RRT) between the first 3 waves of the COVID-19 pandemic in these provinces. RESULTS: A total of 520, 572 and 245 patients in waves 1, 2 and 3, respectively, were included. Patients in wave 3 were on average younger and had fewer comorbidities than those in waves 1 and 2. The unadjusted 28-day mortality rate was significantly lower in wave 3 (7.8%) than in wave 1 (18.3%) (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.24-0.78) and wave 2 (16.3%) (OR 0.46, 95% CI 0.27-0.79). After adjustment for differences in baseline characteristics, the difference in 28-day mortality remained significant (adjusted OR wave 3 v. wave 1: 0.46, 95% CI 0.26-0.81; wave 3 v. wave 2: 0.52, 95% CI 0.29-0.91). In-hospital mortality findings were similar. Use of invasive mechanical ventilation or vasopressors was less common in waves 2 and 3 than in wave 1, and use of RRT was less common in wave 3 than in wave 1. INTERPRETATION: Severity of illness decreased (lower mortality and less use of organ support) across waves among patients admitted to hospital with acute COVID-19, possibly owing to changes in patient demographic characteristics and management, such as increased use of dexamethasone. Continued application of proven therapies may further improve outcomes. STUDY REGISTRATION: ClinicalTrials.gov, no. NCT04510623.


Assuntos
COVID-19 , Pandemias , Adulto , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Colúmbia Britânica , COVID-19/epidemiologia , COVID-19/terapia , Estudos de Coortes , Hospitais , Humanos , Insuficiência de Múltiplos Órgãos , Ontário , Quebeque/epidemiologia , SARS-CoV-2
18.
Can J Public Health ; 113(3): 385-393, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35380364

RESUMO

OBJECTIVES: We previously estimated the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies following the first pandemic wave at 2.23% in Québec, Canada. Following the much bigger second wave in fall 2020 and early 2021, we estimated the seroprevalence of anti-SARS-CoV-2 in Québec during the first months of 2021. METHODS: Blood samples from regular, asymptomatic (for ≥ 14 days) donors were collected between January 25, 2021 and March 11, 2021. Anti-SARS-CoV-2 seropositivity was assessed using an enzyme-linked immunosorbent assay that captures antibodies directed against the receptor binding domain of the SARS-CoV-2 spike (and hence cannot discriminate between infection- and vaccine-induced seropositivity). Seroprevalence estimates were adjusted for regional distribution, age, and sex. RESULTS: Samples from 7924 eligible donors were analyzed, including 620 (7.8%) vaccinated donors and 7046 (88.9%) unvaccinated donors (vaccination status unknown for 258 (3.3%) donors). Overall, median age was 51 years; 46.4% of donors were female. The adjusted seroprevalence was 10.5% (95% CI = 9.7-11.3) in the unvaccinated population and 14.7% (95% CI = 13.8-15.6) in the overall population. Seroprevalence gradually decreased with age and was higher among donors who self-identified as having a racial/ethnic background other than white, both in the overall and in the unvaccinated populations. CONCLUSION: The seroprevalence of SARS-CoV-2 antibodies significantly increased in Québec since spring 2020, with younger persons and ethnic minorities being disproportionately affected. When compared with the cumulative incidence rate reported by public health authorities (i.e., 3.3% as of March 11, 2021), these results suggest that a substantial proportion of infections remain undetected despite improvements in access to COVID-19 testing.


RéSUMé: OBJECTIFS: Lors d'une première étude, nous avons estimé la séroprévalence des anticorps contre le syndrome respiratoire aigu sévère coronavirus 2 (SRAS-CoV-2) après la première vague pandémique à 2,23 % au Québec, Canada. Cette seconde étude estime la séroprévalence de l'anti-SRAS-CoV-2 au Québec lors de la deuxième vague pandémique. MéTHODES: Des échantillons de donneurs de sang asymptomatiques (≥ 14 jours) ont été prélevés entre le 25 janvier et le 11 mars 2021. La séropositivité a été évaluée à l'aide d'un dosage immuno-enzymatique qui capture les anticorps dirigés contre la protéine Spike du récepteur de domaine de liaison du SARS-CoV-2 (et ne peut donc distinguer l'immunité induite par l'infection et la vaccination). La séroprévalence a été ajustée en fonction de l'âge et du sexe par région. RéSULTATS: Des échantillons de 7 924 donneurs ont été analysés, dont 620 (7,8 %) étaient vaccinés et 7 046 (88,9 %) étaient non vaccinés (statut vaccinal inconnu pour 258 (3,3 %) donneurs). Dans l'ensemble, l'âge médian était de 51 ans et 46,4 % des donneurs étaient des femmes. La séroprévalence ajustée était de 10,5 % (IC 95 % = 9,7 à 11,3) dans la population non vaccinée et de 14,7 % (IC 95 % = 13,8 à 15,6) dans la population globale. La séroprévalence diminuait progressivement avec l'âge et était plus élevée chez les donneurs d'origine ethnique autre que blanche. CONCLUSION: La séroprévalence anti-SRAS-CoV-2 a considérablement augmenté au Québec depuis le printemps 2020, les personnes plus jeunes et les minorités ethniques étant plus touchées. Comparés au taux d'incidence cumulatif signalé par la santé publique (c.-à-d. 3,3 % au 11 mars 2021), ces résultats suggèrent qu'une proportion importante d'infections reste non détectée.


Assuntos
COVID-19 , SARS-CoV-2 , Anticorpos Antivirais , Doadores de Sangue , COVID-19/epidemiologia , Teste para COVID-19 , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia , Estudos Soroepidemiológicos
19.
Can J Public Health ; 113(3): 394-404, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35437697

RESUMO

OBJECTIVES: Psychological consequences of COVID-19 contact, symptoms, or diagnosis are being increasingly reported. Few studies have examined the psychological effects tied to these events, using an unaffected comparison group. Most did not consider confounding factors like fear and stigma. This study aims to (1) identify individual characteristics associated with COVID-19 contact/symptoms or diagnosis and (2) examine the independent association between COVID-19 contact/symptoms or diagnosis and psychological symptoms. METHODS: From September 2020 to February 2021, 20,327 adults participated in community-based surveys in Quebec. Using repeated cross-sectional online questionnaire, data were collected on probable generalized anxiety disorder (GAD) and major depression episode (MDE), using the GAD-7 and the PHQ-9 scales, respectively. Self-reported events of (1) contact with a case or symptoms of COVID-19, and (2) diagnosis of COVID-19 were examined, along with several sociodemographic and pandemic-related factors. RESULTS: COVID-19 contact, symptoms, or diagnosis was more frequent in young adults, healthcare or social services workers, adults living with children, and those reporting a greater sense of threat, stigma, financial losses, or daily stress. COVID-19 contact or symptoms and diagnosis were associated with probable MDE relative to the unaffected group (adjusted odds ratio [aOR]: 1.25, 95% CI: 1.12-1.39 and aOR:1.82, 95% CI: 1.48-2.2, respectively). Suicidal thoughts and psychomotor retardation were the symptoms most closely associated with a COVID-19 diagnosis. CONCLUSION: Results from this study stress the need for better understanding, recognition, and support for people suffering from psychological symptoms following a COVID-19 diagnosis.


RéSUMé: OBJECTIFS: Les conséquences psychologiques d'un contact, de symptômes ou d'un diagnostic de COVID-19 sont de plus en plus signalées. Peu d'études ont examiné les effets psychologiques liés à ces évènements en utilisant des groupes non affectés et n'ont pas tenu compte des facteurs de confusion tels que la peur et la stigmatisation. Cette étude vise à 1) identifier les caractéristiques associées au contact/symptômes ou diagnostic de COVID-19 et 2) examiner l'association entre un contact/symptômes ou diagnostic de COVID-19 et les symptômes psychologiques. MéTHODES: Un total de 20 327 adultes ont participé à une enquête transversale populationnelle au Québec entre septembre 2020 et février 2021. À l'aide d'un questionnaire en ligne, des données ont été recueillies sur l'anxiété généralisée probable (GAD-7) et la dépression majeure probable (PHQ-9). Les évènements autodéclarés de 1) contact avec un cas ou de symptômes de COVID-19 et 2) diagnostics de COVID-19 furent examinés, ainsi que plusieurs facteurs sociodémographiques et liés à la pandémie. RéSULTATS: Les contacts, symptômes ou diagnostics de COVID-19 étaient plus fréquents chez les jeunes adultes, les travailleurs de la santé, les adultes vivant avec des enfants, et ceux rapportant plus de stigmatisation, pertes financières, stress quotidien ou un plus haut niveau de menace perçue. Des contacts ou symptômes de COVID-19 et un diagnostic de COVID-19 étaient associés à de la dépression majeure probable comparativement au groupe non affecté (RCa : 1,25, IC à 95% : 1,12-1,39 et RCa : 1,82, IC à 95% : 1,48-2,2, respectivement). Les pensées suicidaires et le retard psychomoteur étaient aussi plus étroitement associés à un diagnostic de COVID-19. CONCLUSION: Les résultats de cette étude soulignent le besoin d'améliorer nos connaissances et notre soutien pour les personnes souffrant de symptômes psychologiques suite à un diagnostic de COVID-19.


Assuntos
COVID-19 , Ansiedade/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Teste para COVID-19 , Criança , Estudos Transversais , Depressão , Humanos , Quebeque/epidemiologia , SARS-CoV-2 , Autorrelato , Inquéritos e Questionários , Adulto Jovem
20.
Rech Soins Infirm ; (147): 67-81, 2022 Feb 10.
Artigo em Francês | MEDLINE | ID: mdl-35485037

RESUMO

Context : Quebec's "medical aid in dying" (MAID) is a medical intervention mostly practiced in palliative care units. MAID results from a deep revolution within Quebec's ethics regarding end-of-life care. However, there is a lack of empirical studies regarding nursing practice within the context of MAID.Aim : To conduct a literature review of legal and scientific data, as well as data from the media, related to the patient experience of nursing practices in palliative care for patients in Quebec who have requested MAID.Methodology : Burn, Grove, and Sutherland's methodology allowed us to extract and analyze six empirical studies from the CINAHL database. We also analyzed 17 media articles and one legal paper that documents the legalization of MAID in Quebec.Results : There has been a strict law governing MAID since 2015, but some major social events and issues have recently allowed for the expansion of the practice. The literature review allowed us to identify two themes : 1). the nature of nursing practice within MAID, and 2). the need for nursing education that addresses the complex aspects of MAID.Discussion and conclusion : We discuss the effects of the domination of the biomedical narrative on MAID and the collapse of Quebec's health system, which both negatively impact nursing practice in the context of MAID.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Suicídio Assistido , Assistência Terminal , Humanos , Cuidados Paliativos , Quebeque
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