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1.
CJEM ; 23(1): 80-84, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33683615

RESUMO

OBJECTIVES: To understand the feasibility, utilization rate, and satisfaction of the first Virtual Pediatric ED (V-PED) in Canada. METHODS: We conducted a prospective cohort study examining the feasibility and impact of virtual care as an adjunct to in-person emergency care at a tertiary pediatric hospital from May to July 2020. Children (< 18 years) from Ontario and Quebec seeking V-PED care were included. A secure, encrypted, video platform within the hospital's electronic medical record was used. Caregivers self-determined appropriateness of V-PED using a standardized online triage questionnaire to request their appointment. The V-PED is directly launched from the patient's chart and the family joins the portal via hyperlink. Outcome measures included the number of V-PED visits, hospital admission rates, and caregiver satisfaction using a 10-item voluntary post-visit online survey. RESULTS: A total of 1036 V-PED visits were seen of which 176 (17.0%) were referred for further in-person ED assessment, and 8 (0.8%) required hospital admission. Of the 107 completing patient experience surveys (10% response), most respondents (69%) endorsed they "very likely" or "definitely" would have presented in-person to the ED if V-PED were unavailable. Overall satisfaction was rated as excellent (9 or 10 out of 10) in 87% of respondents. CONCLUSION: Our novel V-PED is feasible, has high caregiver satisfaction, and can reduce the burden of in-person ED visits. Future work must ensure the safety of emergency virtual care and examine how to increase capacity and integrate V-PED within traditional emergency medicine.


Assuntos
Emergências/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Encaminhamento e Consulta , Telemedicina/métodos , Triagem/métodos , Realidade Virtual , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Ontário/epidemiologia , Estudos Prospectivos , Quebeque/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-33672804

RESUMO

A total of 475,214 COVID-19 cases, including 13,659 deaths, had been recorded in Canada as of 15 December 2020. The daily reports of confirmed cases and deaths in Canada prior to 15 December 2020 were obtained from publicly available sources and used to examine regional variations in case fatality rate (CFR). Based on a factor of underestimation and the duration of time from symptom onset to death, the time-delay adjusted CFR for COVID-19 was estimated in the four most affected provinces (Quebec, Ontario, Alberta, and British Columbia) and nationwide. The model-based adjusted CFR was higher than the crude CFR throughout the pandemic, primarily owing to the incorporation in our estimation of the delay between case reports and deaths. The adjusted CFR in Canada was estimated to be 3.36% nationwide. At the provincial level, the adjusted CFR was the highest in Quebec (5.13%)-where the proportion of deaths among older individuals was also the highest among the four provinces-followed by Ontario (3.17%), British Columbia (1.97%), and Alberta (1.13%). Provincial-level variations in CFR were considerable, suggesting that public health interventions focused on densely populated areas and elderly individuals can ameliorate the mortality burden of the COVID-19 pandemic.


Assuntos
/mortalidade , Pandemias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Ontário/epidemiologia , Quebeque/epidemiologia , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-33673155

RESUMO

In adults, higher anxiety level related to COVID-19 has been associated with having a pre-existing medical or mental health condition and poor sleep quality. However, no study yet has looked at these links in children. The present study's main aim was to assess family changes associated with child and parent fears and concerns about COVID-19. We conducted a cross-sectional study among 144 families with children aged 9-12 years during the COVID-19 lockdown period. Families came from Quebec, Canada, and the survey was done in the early stages of the lockdown (April-May 2020). A phone-based survey assessed parent and child COVID-19-related fears and concerns, family-related changes and health issues. Results showed the more fears parents have about COVID-19, the more fears their child also has. Moreover, changes in family sleep habits were associated with parental and child fears and concerns about COVID-19. Reduced access to health services was associated with parental concerns about COVID-19. If another lockdown was to be put in place in the future, it would be important to inform families on the importance of sleep schedules and to maintain or increase health appointments when possible.


Assuntos
/psicologia , Medo , Relações Pais-Filho , Adulto , Ansiedade , Criança , Controle de Doenças Transmissíveis , Estudos Transversais , Humanos , Quebeque , Sono
4.
CMAJ Open ; 9(1): E149-E156, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33653770

RESUMO

BACKGROUND: Information on the epidemiology of patients in hospital with laboratory-confirmed coronavirus disease 2019 (COVID-19) in Canadian acute care hospitals is needed to inform infection prevention and control strategies and public health measures. The aim of this surveillance was to describe the epidemiology of patients in hospital with laboratory-confirmed COVID-19 in a network of Canadian acute care hospitals between Mar. 1 and Aug. 31, 2020. METHODS: Through prospective surveillance, we identified adult and pediatric patients in hospital with laboratory-confirmed COVID-19 using a standard definition between Mar. 1 and Aug. 31, 2020, through the Canadian Nosocomial Infection Surveillance Program (CNISP), a network of 78 hospitals. Patient demographic and clinical characteristics and data on treatment, interventions and outcomes were reviewed and described. RESULTS: As of Aug. 31, 2020, the CNISP had received data for 1906 patients in hospital with COVID-19 in 49 sentinel hospitals in 9 provinces. The majority of patients in hospital with COVID-19 were older (median age 71 yr) and had underlying medical conditions (85.8%). Few children with COVID-19 were admitted to a participating hospital (n = 37, 1.9%). Acquisition of COVID-19 in hospitals was infrequent (6.4% of all cases). A total of 32.8% of patients were admitted from a long-term care facility or retirement home. Health care workers constituted 10.6% of adult patients aged 18-65 years in hospital with COVID-19. Thirty-day attributable mortality was 16.2%. Hospital admission rates peaked in mid-April and were highest in Ontario and Quebec. INTERPRETATION: Surveillance findings indicate that a high proportion of Canadian patients in hospital with COVID-19 during the first 6 months of the pandemic were older adults with underlying medical conditions. Active surveillance of patients in hospital with COVID-19 is critical to enhancing our knowledge of the epidemiology of COVID-19 and to identifying populations at risk for severe outcomes, which will help guide Canada's response in the coming months.


Assuntos
/diagnóstico , Ambulatório Hospitalar/estatística & dados numéricos , /genética , Adulto , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Monitoramento Epidemiológico , Feminino , Pessoal de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Ontário/epidemiologia , Estudos Prospectivos , Quebeque/epidemiologia
5.
J Parasitol ; 107(1): 39-47, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33535231

RESUMO

Few studies have examined community structure among myxozoan species in fish. Herein myxozoan communities are described from 2 cyprinid species, the spottail shiner (Notropis hudsonius) and the common shiner (Luxilus cornutus), from mesotrophic and eutrophic localities in rivers in southwestern Quebec, Canada. Four myxozoan species were found, and total prevalence ranged from 60 to 86.7% in spottail shiners at 4 localities along the Richelieu River. Component species richness ranged from 2 to 4 and mean infracommunity richness from 0.87 to 1.47. Prevalence, component species richness, and infracommunity species richness in the spottail shiner were comparable to those from other localities in the Great Lakes and St. Lawrence River that were exposed to municipal effluents. Nine myxozoan species were found in common shiners from the Bras d'Henri micro-watershed. Component species richness varied from 6 to 8 at 4 localities, with total prevalence being 100% at all localities except 1, where it was 80%. Mean infracommunity richness ranged from 1.73 to 2.27. Prevalence, component species richness, and infracommunity species richness in the common shiner from the Bras d'Henri micro-watershed were among the highest observed for myxozoan communities from any host species to date. It is concluded that moderate levels of eutrophication are sufficient to generate species-rich communities of myxozoan parasites in fishes.


Assuntos
Cyprinidae/parasitologia , Doenças dos Peixes/parasitologia , Myxozoa/classificação , Doenças Parasitárias em Animais/parasitologia , Animais , Myxozoa/anatomia & histologia , Myxozoa/isolamento & purificação , Prevalência , Quebeque , Rios
6.
Nutr Metab Cardiovasc Dis ; 31(4): 1238-1246, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33632598

RESUMO

BACKGROUND AND AIMS: During aerobic physical activity (PA), hypoglycemia is common in people with type 1 diabetes (T1D). Few studies have compared the effectiveness of different carbohydrate (CHO) intake strategies to prevent PA-induced hypoglycemia. Our objective was to compare the efficacy of two CHO intake strategies, same total amount but different CHO intake timing, to maintain glucose levels in the target range (4.0-10.0 mmol/L) during PA in people with T1D. METHODS AND RESULTS: An open-label, randomized, crossover study in 33 participants (21 adults; 12 adolescents). Participants practiced 60 min PA sessions (ergocyle) at 60% VO2peak 3.5 h after lunch comparing an intake of 0.5 g of CHO per kg of body weight applied in a pre-PA single CHO intake (SCI) or in a distributed CHO intake (DCI) before and during PA. The percentage of time spent in glucose level target range during PA was not different between the two strategies (SCI: 75 ± 35%; DCI: 87 ± 26%; P = 0.12). Hypoglycemia (<4.0 mmol/L) occurred in 4 participants (12%) with SCI compared to 6 participants (18%) with DCI (P = 0.42). The SCI strategy led to a higher increase (P = 0.01) and variability of glucose levels (P = 0.04) compared with DCI. CONCLUSIONS: In people living with T1D, for a 60 min moderate aerobic PA in the post-absorptive condition, a 0.5 g/kg CHO intake helped most participants maintain acceptable glycemic control with both strategies. No clinically significant difference was observed between the SCI and DCI strategies. ClinicalTrials.gov Identifier: NCT03214107 (July 11, 2017).


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/dietoterapia , Carboidratos da Dieta/administração & dosagem , Exercício Físico , Hipoglicemia/prevenção & controle , Adolescente , Adulto , Fatores Etários , Biomarcadores/sangue , Estudos Cross-Over , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Carboidratos da Dieta/metabolismo , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemia/sangue , Hipoglicemia/etiologia , Masculino , Pessoa de Meia-Idade , Quebeque , Fatores de Tempo , Resultado do Tratamento
7.
Nutr Metab Cardiovasc Dis ; 31(3): 921-929, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33549453

RESUMO

BACKGROUND AND AIMS: There is debate over the independent and combined effects of caloric restriction (CR) and physical activity (PA) on reduction in fat mass and in epicardial fat thickness. We compared the impact of a similar energy deficit prescription by CR or by CR combined with PA on total fat mass, epicardial fat thickness, and cardiometabolic profile in individuals with type 2 diabetes. METHODS AND RESULTS: In this 16-week randomized controlled study, 73 individuals were randomly enrolled to receive: 1) a monthly motivational phone call (Control), 2) a caloric deficit of -700 kilocalories/day (CR), or 3) a caloric deficit of -500 kilocalories/day combined with a PA program of -200 kilocalories/day (CR&PA). Total fat mass, epicardial fat, and cardiometabolic profile were measured at baseline and after 16 weeks. While comparable weight loss occurred in both intervention groups (-3.9 ± 3.5 kg [CR], -5.1 ± 4.7 kg [CR&PA], -0.2 ± 2.9 kg [Control]), changes in total fat mass were significantly different between all groups (-2.4 ± 2.9 kg [CR], -4.5 ± 3.4 kg [CR&PA], +0.1 ± 2.1 kg [Control]; p < 0.05) as well as epicardial fat thickness (-0.4 ± 1.6 mm [CR], -1.4 ± 1.4 mm [CR&PA], +1.1 ± 1.3 mm [Control]; p < 0.05). There were no significant differences in trends for cardiometabolic parameters improvement between groups. CONCLUSIONS: For a similar energy deficit prescription and comparable weight loss, the combination of CR&PA provides a greater reduction in fat mass and epicardial fat thickness than CR alone in individuals with comparable weight loss and with a similar energy deficit prescription. These results, however, do not translate into significant improvements in cardiometabolic profiles. CLINICALTRIALS. GOV IDENTIFIER: NCT01186952.


Assuntos
Composição Corporal , Restrição Calórica , Diabetes Mellitus Tipo 2/dietoterapia , Terapia por Exercício , Adiposidade , Adulto , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio , Projetos Piloto , Quebeque , Fatores de Tempo , Resultado do Tratamento
9.
J Environ Manage ; 284: 112073, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33556830

RESUMO

This study compares the delivered cost of forest biomass and its associated GHG emissions for three sizes of biorefinery including 50,000 m3 (small scale), 250,000 m3 (medium scale), and 700,000 m3 (large scale). The proposed methodology in this study includes harvest intensity which is often overlooked. The Pontiac region located in the Province of Quebec (Southeastern Canada) is used as a case study due to the availability of data in this forestry biomass rich region. Furthermore, there are significant similarities with other forestry regions to enable generalisation of the proposed case study. Harvest intensities of 423 harvest zones (cutblocks) are considered in cost and GHG emissions analysis of delivered biomass from each cutblock to the biorefinery. The results show that harvest intensities of cutblocks must be prioritized over conventional parameters such as transportation distance. The selection and prioritisation of cutblocks according to transportation distance without considering harvest intensities would result in an increase of about 12.5% in delivered costs of biomass for small and medium scale biorefineries. Results also reveal that the transportation distance would be a more significant parameter when using the same harvest intensity for all the selected cutblocks. Required logistics and harvesting equipment for three biorefinery sizes were also quantified. Sensitivity analysis shows that reduced productivity of harvest equipment by 20% could increase the delivered costs of biomass and GHG emissions by 10% for medium and large scale biorefineries and by 13% for a small scale biorefinery.


Assuntos
Agricultura Florestal , Florestas , Biomassa , Canadá , Quebeque
11.
BMC Health Serv Res ; 21(1): 85, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485327

RESUMO

BACKGROUND: Due to regional, professional, and resource limitations, access to mental health care for Canada's Indigenous peoples can be difficult. Telemental health (TMH) offers the opportunity to provide care across vast distances and has been proven to be as effective as face-to-face services. To our knowledge, there has been no qualitative study exploring the experiences of TMH staff serving the Indigenous peoples in Northern Quebec, Canada; which is the purpose of this study. METHODS: Using a qualitative descriptive design, the entire staff of a TMH clinic was recruited, comprising of four psychiatrists and four support staff. Individual semi-structured interviews were conducted through videoconferencing, and results were thematically analyzed. RESULTS: To address the mental health gap in Northern communities, all psychiatrists believe in the necessity of in-person care and note the synergistic effect of combining in-person care and TMH services. This approach to care allows psychiatrists to maintain both an insider and outsider identity. However, if a patient's condition requires hospitalization, then the TMH staff face a new set of information sharing and communication challenges with the inpatient staff. TMH staff believe that the provision of culturally sensitive care to Northern patients at the inpatient unit is progressing; however, more work needs to be done. Despite the strong collegial atmosphere within the clinic and collective efforts to provide quality TMH services, all participants express a sense of frustration with the paper-based and scattered documentation system. CONCLUSION: The TMH team works in cohesion to offer TMH services to Indigenous peoples; yet, automatization is needed to improve the workflow efficiency within the clinic and collaboration with the Northern clinics. More research is needed on the functioning of TMH teams and the separate but important roles of each team member.


Assuntos
Povos Indígenas , Canadá , Comunicação , Serviços de Saúde do Indígena , Humanos , Serviços de Saúde Mental , Grupos Populacionais , Psiquiatria , Quebeque , Comunicação por Videoconferência
12.
Can J Public Health ; 112(1): 17-28, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33464556

RESUMO

OBJECTIVES: In order for physical distancing directives to be effective at lowering and flattening the epidemic peak during a pandemic, individuals must adhere to confinement guidelines. Recent reviews highlight the paucity of research on empirical correlates of adherence to physical distancing and quarantine directives. METHODS: In this cross-sectional study, 1003 individuals were recruited using quota sampling to form a sample approximately representative of the population of Quebec (Canada) in terms of age, gender, and urbanicity. Participants completed an online survey on adherence to physical distancing during the COVID-19 pandemic. This survey evaluated socio-demographic, health, cognitive, emotional, and social factors related to physical distancing. RESULTS: Individuals aged 70 and older (OR = 1.67, 95% CI = 1.04-2.67), women (OR = 1.35, 95% CI = 1.02-1.79), and those who were not essential workers (OR = 3.28, 95% CI = 2.24-4.81) reported more physical distancing. Injunctive personal norms (OR = 1.67, 95% CI = 1.23-2.31), perceived benefits of physical distancing to others (OR = 1.47, 95% CI = 1.12-1.93), and descriptive social norms (OR = 1.26, 95% CI = 1.04-1.52) were independent predictors of adherence status. Individuals adhered more to physical distancing if they believed that it was their civic duty to do so and that physical distancing helped protect others, and if they perceived that most other people were following these directives. In contrast, perceived personal risk and emotional factors were not independently related to physical distancing. CONCLUSION: These results highlight the importance of health beliefs and perceived social norms in shaping responses to physical distancing directives. These findings offer insights into ways to frame public health communications to promote physical distancing during a pandemic.


Assuntos
/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Guias como Assunto , Quarentena/psicologia , Adolescente , Adulto , Idoso , Estudos Transversais , Emoções , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia , Normas Sociais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
13.
Rech Soins Infirm ; (143): 7-18, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33485286

RESUMO

Introduction : A discussion paper based on a teaching experience, and presenting a reflective viewpoint developed as part of the university nursing course Theory in Nursing.Context : A critical look at the historiography and reference works used in nursing courses.Objectives : To shed new light on the foundations of the nursing discipline by seeking to better integrate the participation of religious communities in the development of nursing knowledge.Method : Analysis of articles from Recherche en soins infirmiers and a reflective approach influenced by an interdisciplinary perspective linking nursing science, history, and the contribution of Pierre Bourdieu’s work.Results : Observation of the complete absence of contributions to nursing knowledge before Florence Nightingale (1820-1910) and of a century-long silence after her.Discussion : Analysis of the observed reflex to disavow the legacy of nursing sisters in Quebec through the analysis of three aspects : the Nightingalian episteme, the historiographical positioning of nurses and historians, and the construction of knowledge based on the experience of the Sisters of Providence at the Hôpital Saint-Jean-de-Dieu.Conclusion : By ignoring the Franco-Catholic origin of the scientific field of nursing, this disciplinary knowledge deprives itself of a powerful nursing model.


Assuntos
Educação em Enfermagem , Currículo , Educação em Enfermagem/história , Educação em Enfermagem/organização & administração , História do Século XIX , História do Século XX , Humanos , Quebeque
14.
BMC Anesthesiol ; 21(1): 15, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435887

RESUMO

BACKGROUND: Data on postoperative outcomes of the COVID-19 patient population is limited. We described COVID-19 patients who underwent a surgery and the pandemic impact on surgical activities. METHODS: We conducted a multicenter cohort study between March 13 and June 192,020. We included all COVID-19 patients who underwent surgery in nine centres of the Province of Québec, the Canadian province most afflicted by the pandemic. We also included concomitant suspected COVID-19 (subsequently confirmed not to have COVID-19) patients and patients who had recovered from it. We collected data on baseline characteristics, postoperative complications and postoperative mortality. Our primary outcome was 30-day mortality. We also collected data on overall surgical activities during this first wave and during the same period in 2019. RESULTS: We included 44 COVID-19 patients, 18 suspected patients, and 18 patients who had recovered from COVID-19 at time of surgery. Among the 44 COVID-19 patients, 31 surgeries (71%) were urgent and 16 (36%) were major. In these patients, pulmonary complications were frequent (25%) and 30-day mortality was high (15.9%). This mortality was higher in patients with symptoms (23.1%) compared to those without symptoms (5.6%), although not statistically significant (p = 0.118). Of the total 22,616 cases performed among participating centres during the study period, only 0.19% had COVID-19 at the time of surgery. Fewer procedures were performed during the study period compared to the same period in 2019 (44,486 cases). CONCLUSION: In this Canadian cohort study, postoperative 30-day mortality in COVID-19 patients undergoing surgery was high (15.9%). Although few surgeries were performed on COVID-19 patients, the pandemic impact on surgical activity volume was important. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04458337 .


Assuntos
/epidemiologia , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia , Análise de Sobrevida
15.
Artigo em Inglês | MEDLINE | ID: mdl-33419196

RESUMO

The use of slip-resistant winter footwear is crucial for the prevention of slips and falls on ice and snow. The main objective of this paper is to evaluate a mechanical testing method to determine footwear slip resistance on wet and dry ice surfaces and to compare it with the human-centred test method introduced by researchers at KITE (Knowledge, Innovation, Talent, Everywhere)-Toronto Rehabilitation Institute-University Health Network. Phase 1 of this study assessed the repeatability and reproducibility of the mechanical method by evaluating ten different occupational winter boots using two SATRA Slip resistance testers (STM 603, SATRA Technology Centre, Kettering, UK). One tester is located in Toronto and one in Montreal. These boots were chosen based on the needs of the IRSST (Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, Montréal, Quebec, Canada), who were primarily interested in providing safe winter footwear for police, firefighters and municipal workers. In Phase 2, the results of the human-centred test approach were compared with the mechanical results. In Phase 3, two of these boots with conflicting results from the previous phases were tested using a second human-centred method. In Phase 1, the mechanical testing results obtained in the two labs showed a high linear correlation (>0.94) and good agreement on both ice surfaces; however, they revealed a bias (~0.06) between the two labs on the dry ice condition. The mechanical and human-centred tests (phase 2) were found to be better correlated in the wet ice condition (R = 0.95) compared to the dry ice condition (R = 0.34). Finally, the rating of the footwear slip resistance based on the number of slips counted in phase 3 was consistent with the rating by the human-centred test method (phase 2), but not the mechanical method (phase 1). The findings of this study provide a better understanding of the limitations of the SATRA ice tray for measuring footwear slip resistance and demonstrate that the mechanical method must be further refined to make it more comparable to the human-centred methods to achieve better agreement with real-world performance.


Assuntos
Gelo , Sapatos , Acidentes por Quedas , Canadá , Humanos , Quebeque , Reprodutibilidade dos Testes
16.
Bull Cancer ; 108(3): 284-294, 2021 Mar.
Artigo em Francês | MEDLINE | ID: mdl-33461728

RESUMO

INTRODUCTION: Many clinical practice guidelines on palliative sedation have been developed. To date, studies on French-language guidelines are lacking, despite the specific and potentially influential end-of-life positions taken by some French-speaking countries. This study aimed to perform a systematic review of the guidelines related to palliative sedation for adults in French-speaking countries, taking a synchronic and diachronic approach (current and former guidelines). METHODS: Guidelines published in French since 2000 were searched for multiple databases. In addition, prominent palliative care experts in French-speaking countries were contacted individually. A content analysis of all guidelines was conducted. RESULTS: A total of 21 guidelines from 18 countries were identified. Among them, at the time of the data collection, 14 guidelines were effectively compiled in four countries or provinces: Belgium, France, Canada (Quebec) and Switzerland. No guidelines were found for African countries. The recommendations analyzed were very heterogeneous in form (simple proposals or formal guidelines) and in substance (i.e. different types of sedation). DISCUSSION AND CONCLUSION: The quantity and volume of the guidelines found and the heterogeneity of the terminology prevented a detailed analysis of the content of the texts. An analysis must be performed using a synchronic approach only and focusing on a specific element of one type of sedation.


Assuntos
Hipnóticos e Sedativos/administração & dosagem , Idioma , Cuidados Paliativos/normas , Guias de Prática Clínica como Assunto/normas , África , Bélgica , França , Humanos , Quebeque , Suíça , Terminologia como Assunto
17.
Am J Bot ; 108(1): 159-171, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512730

RESUMO

PREMISE: Lichens are one of the main structural components of plant communities in the North American boreal biome. They play a pivotal role in lichen woodlands, a large ecosystem situated north of the closed-crown forest zone, and south of the forest-tundra zone. In Eastern Canada (Quebec), there is a remnant LW found 500 km south of its usual distribution range, in the Parc National des Grands-Jardins, originated mainly because of wildfires. We inferred the origin of the lichen Cladonia stellaris from this LW and assessed its genetic diversity in a postfire succession. METHODS: We genotyped 122 individuals collected across a latitudinal gradient in Quebec. Using the software Stacks, we compared four different approaches of locus selection and single-nucleotide polymorphism calling. We identified the best fitting approach to investigate population structure and estimate genetic diversity of C. stellaris. RESULTS: Populations in southern Quebec are not genetically different from those of northern LWs. The species consists of at least four phylogenetic lineages with elevated levels of genetic diversity and low co-ancestry. In Parc National des Grands-Jardins, we reported high values of genetic diversity not related with time since fire disturbance and low genetic differentiation among populations with different fire histories. CONCLUSIONS: This first population genomic study of C. stellaris is an important step forward to understand the origin and biogeographic patterns of lichen woodlands in North America. Our findings also contribute to the understanding of the effect of postfire succession on the genetic structure of the species.


Assuntos
Líquens , Rena , Animais , Ascomicetos , Canadá , Ecossistema , Florestas , Líquens/genética , Metagenômica , América do Norte , Filogenia , Quebeque , Estados Unidos
18.
BMJ Open ; 11(1): e043166, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504558

RESUMO

OBJECTIVE: High blood pressure (BP) is a risk factor for cardiovascular disease. Examining the role of inflammatory mediators on BP is important since vitamin D (VD) is a modifiable risk factor, which possibly modulates inflammatory cytokines. This study simulated what are known as average 'controlled direct effects (CDE)' of inflammatory markers, C reactive protein (CRP), tumour necrosis factor-α (TNF-α), and interlukin-6 (IL-6) on continuous BP measures, while fixing VD, an intermediate variable to specific level. DESIGN: Cross-sectional study. SETTING: We analysed data from the Multi-Community Environment-and-Health Study, 2005-2009, conducted in Eeyou Istchee, Quebec, Canada. PARTICIPANTS: This study recruited 1425 study Indigenous Cree participants from seven Cree communities. Only adults with serum VD levels, inflammatory markers and BP measures were included in this data analysis. PRIMARY AND SECONDARY OUTCOMES MEASURES: Inflammatory markers examined the top 25th exposure percentiles. VD 'insufficiency' (ie, 25-hydroxyvitamin-D levels<50 nmol/L) defined by the Institute of Medicine. CDE for each inflammatory marker in the presence and absence of population VD insufficiency simulated the average direct effect change for systolic and diastolic BP (SBP and DBP) measures. All models were adjusted for exposure-and-mediator outcome relationship. RESULTS: Among 161 participants, 97 (60 %) were female. The prevalence of VD insufficiency was 32%. CDE estimates show in the presence and absence of population vitamin D insufficiency, inflammatory markers have a slightly different association on BP. TNF-α significantly and inversely associated with SBP in the presence of vitamin D insufficiency, fully adjusted model ß = -13.61 (95% CI -24.42 to -2.80); however, TNF-α was not associated with SBP in the absence of vitamin D insufficiency. CRP, IL-6 were also not significantly associated with BP measures, although the magnitude of association was greater for those with elevated inflammation and VD insufficiency. CONCLUSION: This novel analysis shows in the presence of VD insufficiency, inflammation (particularly TNF-α) may affect SBP. Additional research is needed to elucidate these findings, and the temporal relationship between these variables.


Assuntos
Hipertensão/sangue , Hipertensão/fisiopatologia , Inflamação/sangue , Interleucina-6/sangue , Deficiência de Vitamina D/etnologia , Adolescente , Adulto , Idoso , Pressão Sanguínea , Canadá , Criança , Pré-Escolar , Estudos Transversais , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Lactente , Recém-Nascido , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia , Fator de Necrose Tumoral alfa/sangue , Vitamina D , Adulto Jovem
19.
Nutr Metab Cardiovasc Dis ; 31(2): 658-665, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33358714

RESUMO

BACKGROUND AND AIMS: The first hybrid artificial pancreas (AP) systems with insulin only (mono-hormonal) have recently reached the market while next generations systems are under development including those with glucagon addition (bi-hormonal). Understanding the expectations and impressions of future potential users about AP systems is important for optimal use of this clinically effective emerging technology. METHODS AND RESULTS: An online survey about AP systems which consisted of 50 questions was addressed to people with type 1 diabetes in the province of Quebec, Canada. Surveys were completed by 123 respondents with type 1 diabetes (54% women, mean (SD) age 40.2 (14.4) y.o., diabetes duration 23.7 (14.1) years, 58% insulin pump users and 43% glucose sensor users). Of the respondents, 91% understood how AP systems work, 79% trusted them with correct insulin dosing, 73% were willing to replace their current treatment with AP and 80% expected improvement in quality of life. Anxiety about letting an algorithm control their glucose levels was expressed by 18% while the option of ignoring or modifying AP instructions was favoured by 88%. As for bi-hormonal AP systems, 83% of respondents thought they would be useful to further reduce hypoglycemic risks. CONCLUSIONS: Overall, respondents expressed positive views about AP systems use and high expectations for a better quality of life, glycemic control and hypoglycemia reduction. Data from this survey could be useful to health care professionals and developers of AP systems.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Glucagon/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Hipoglicemiantes/uso terapêutico , Sistemas de Infusão de Insulina , Insulina/uso terapêutico , Pâncreas Artificial , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/psicologia , Feminino , Glucagon/efeitos adversos , Pesquisas sobre Serviços de Saúde , Humanos , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Sistemas de Infusão de Insulina/efeitos adversos , Internet , Masculino , Pessoa de Meia-Idade , Pâncreas Artificial/efeitos adversos , Preferência do Paciente , Qualidade de Vida , Quebeque
20.
Sci Total Environ ; 750: 141484, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32829260

RESUMO

The SARS-CoV-2 is a novel coronavirus identified as the cause of COVID-19 and, as the pandemic evolves, many have made parallels to previous epidemics such as SARS-CoV (the cause of an outbreak of severe acute respiratory syndrome [SARS]) in 2003. Many have speculated that, like SARS, the activity of SARS-CoV-2 will subside when the climate becomes warmer. We sought to determine the relationship between ambient temperature and COVID-19 incidence in Canada. We analyzed over 77,700 COVID-19 cases from four Canadian provinces (Alberta, British Columbia, Ontario, and Quebec) from January to May 2020. After adjusting for precipitation, wind gust speed, and province in multiple linear regression models, we found a positive, but not statistically significant, association between cumulative incidence and ambient temperature (14.2 per 100,000 people; 95%CI: -0.60-29.0). We also did not find a statistically significant association between total cases or effective reproductive number of COVID-19 and ambient temperature. Our findings do not support the hypothesis that higher temperatures will reduce transmission of COVID-19 and warns the public not to lose vigilance and to continue practicing safety measures such as hand washing, social distancing, and use of facial masks despite the warming climates.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Alberta , Betacoronavirus , Colúmbia Britânica/epidemiologia , Humanos , Incidência , Ontário , Quebeque , Temperatura
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