Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 13.602
Filtrar
1.
Waste Manag ; 104: 74-81, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31962219

RESUMO

Instrument bundles placed within the Ste. Sophie landfill (Quebec, Canada) have been collecting temperature and settlement data since January 2010. Previous modelling efforts simulated settlement based on a three-component model to account for primary or instantaneous compression, secondary compression or mechanical creep and time-dependent biodegradation-induced settlement. In northern climates where waste may be placed under frozen conditions, a time-dependent biodegradation-induced settlement term is unable to simulate settlement due to biodegradation as waste temperatures transition from below zero to optimal values for anaerobic degradation. This paper presents a temperature-dependent biodegration-induced settlement model. The model simulates heat generation as a function of temperature and tracks the expended energy as the waste degrades. The ratio of the expended energy to the total potential expended energy is used in the proposed temperature-dependent biodegradation-induced settlement term. The new term better accounts for the delayed biodegradation process observed in wastes placed under frozen conditions. The model was able to simulate the settlement trends observed at the Ste. Sophie landfill. The goal of developing and including a temperature-dependent biodegradation-induced settlement term in the model was to study the effects of operating conditions on waste settlement and stabilization. An optimized waste lift placement strategy could enhance waste stabilization and improve the airspace utilization within a landfill, simultaneously bringing increased revenues to landfill operators while decreasing the post closure environmental burden of landfills.


Assuntos
Eliminação de Resíduos , Biodegradação Ambiental , Canadá , Modelos Teóricos , Quebeque , Temperatura Ambiente , Instalações de Eliminação de Resíduos
2.
Chemosphere ; 239: 124796, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520972

RESUMO

In July 2013, a fatal train derailment led to an explosion and fire in the town of Lac-Mégantic (LM), Quebec, and the crude oil contamination of regional surface water, soil, and sediment in the adjacent Lake Mégantic. This study investigated the degradation potential of the spilled crude oil by using the sediments from the incident site as the source of microorganisms. Two light crude oils (LM source oil and Alberta Sweet Mixed Blend (ASMB)) were tested at 22 °C for 4 weeks and 4 °C for 8 weeks, respectively. The post-incubation biological and chemical information of the samples were analysed. There was no marked difference in degradation efficacy and biological activities for both the LM and ASMB oils, although the biodegradation potential differed between the two incubations. Higher temperature favoured the growth of microorganisms, thus for the degradation of all petroleum hydrocarbons, except for some conservative biomarkers. The degradation of both oils followed the order of resolved components > total saturated hydrocarbons (TSH) > unresolved complex mixture (UCM) >total aromatic hydrocarbons (TAH). Normal alkanes were generally degraded more significantly than branched ones, and polycyclic aromatic hydrocarbons (PAHs). Degradation of polycyclic aromatic hydrocarbons (PAHs) and their alkylated congeners (APAHs) for both incubations generally decreased as the number of aromatic rings, and the degree of alkylation increased. This study showed that the LM sediments can biodegrade the petroleum hydrocarbons efficaciously if appropriate ambient temperatures are generated to favour the growth of autochthonous microorganisms.


Assuntos
Sedimentos Geológicos/microbiologia , Hidrocarbonetos/química , Hidrocarbonetos/metabolismo , Petróleo/metabolismo , Poluentes Químicos da Água/metabolismo , Alcanos/química , Alcanos/metabolismo , Biodegradação Ambiental , Lagos/microbiologia , Poluição por Petróleo , Hidrocarbonetos Policíclicos Aromáticos/química , Hidrocarbonetos Policíclicos Aromáticos/metabolismo , Quebeque , Temperatura Ambiente , Poluentes Químicos da Água/química
3.
Accid Anal Prev ; 134: 105265, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704639

RESUMO

Intersections represent the most dangerous sites in the road network for pedestrians: not only is modal separation often impossible, but elements of geometry, traffic control, and built environment further exacerbate crash risk. Evaluating the safety impact of intersection features requires methods to quantify relationships between different factors and pedestrian injuries. The purpose of this paper is to model the effects of exposure, geometry, and signalization on pedestrian injuries at urban signalized intersections using a Full Bayes spatial Poisson Log-Normal model that accounts for unobserved heterogeneity and spatial correlation. Using the Integrated Nested Laplace Approximation (INLA) technique, this work leverages a rich database of geometric and signalization variables for 1864 intersections in Montreal, Quebec. To collect exposure data, short-term pedestrian and vehicle counts were extrapolated to AADT using developed expansion factors. Results of the model confirmed the positive relationship between pedestrian and vehicle volumes and pedestrian injuries. Curb extensions, raised medians, and exclusive left turn lanes were all found to reduce pedestrian injuries, while the total number of lanes and the number of commercial entrances were found to increase them. Pedestrian priority phases reduced injuries while the green straight arrow increased injuries. Lastly, the posterior expected number of crashes was used to identify hotspots. The proposed ranking criteria identified many intersections close to the city centre where the expected number of crashes is highest and intersections along arterials with lower pedestrian volumes where individual pedestrian risk is elevated. Understanding the effects of intersection geometry and pedestrian signalization will aid in ensuring the safety of pedestrians at signalized intersections.


Assuntos
Acidentes de Trânsito/prevenção & controle , Ambiente Construído , Pedestres/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Teorema de Bayes , Humanos , Quebeque , Fatores de Risco , Análise Espaço-Temporal
4.
BMC Public Health ; 19(1): 1683, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842822

RESUMO

BACKGROUND: Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada. METHODS: We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral. RESULTS: Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/µl), 22% presented with advanced HIV (CD4 < 200 cells/µl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation. CONCLUSIONS: While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.


Assuntos
Infecções por HIV/terapia , Refugiados/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Fármacos Anti-HIV/uso terapêutico , Resistência a Medicamentos/genética , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Quebeque , Estudos Retrospectivos
5.
Environ Sci Technol ; 53(23): 14054-14062, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31693360

RESUMO

Global warming mitigation strategies are likely to affect human health and biodiversity through diverse cause-effect mechanisms. To analyze these effects, we implement a methodology to link TIMES energy models with life cycle assessment using open-source software. The proposed method uses a cutoff to identify the most relevant processes. These processes have their efficiencies, fuel mixes, and emission factors updated to be consistent with the TIMES model. The use of a cutoff criterion reduces exponentially the number of connection points between models, facilitating the analysis of scenarios with a large number of technologies involved. The method is used to assess the potential effects of deploying low-carbon technologies to reduce combustion emissions in the province of Quebec (Canada). In the case of Quebec, the reduction of combustion emissions is largely achieved through electrification of energy services. Global warming mitigation efforts reduce the impact on human health and ecosystem quality, mainly because of lower global warming, water scarcity, and metal contamination impacts. The TIMES model alone underestimated the reduction of CO2eq by 21% with respect to a full account of emissions.


Assuntos
Ecossistema , Aquecimento Global , Biodiversidade , Canadá , Humanos , Quebeque
6.
BMC Health Serv Res ; 19(1): 815, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703678

RESUMO

BACKGROUND: Around the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices. METHODS: In-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers. RESULTS: Our findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement. CONCLUSION: This research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.


Assuntos
Administração de Serviços de Saúde/normas , Relações Profissional-Paciente , Melhoria de Qualidade/organização & administração , Serviços de Saúde Comunitária/normas , Hospitais/normas , Humanos , Estudos Longitudinais , Quebeque
7.
BMC Infect Dis ; 19(1): 982, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752729

RESUMO

BACKGROUND: Hepatitis B (HBV) and Human Immunodeficiency Virus (HIV) share common risk factors for exposure. Co-infected patients have an increased liver-related mortality risk and may have accelerated HIV progression. The epidemiology and demographic characteristics of HIV-HBV co-infection in Canada remain poorly defined. We compared the demographic and clinical characteristics and factors associated with advanced hepatic fibrosis between HIV and HIV-HBV co-infected patients. METHODS: A retrospective cohort analysis was conducted using data from the Canadian Observational Cohort (CANOC) Collaboration, including eight sites from British Columbia, Quebec, and Ontario. Eligible participants were HIV-infected patients who initiated combination ARV between January 1, 2000 and December 14, 2014. Demographic and clinical characteristics were compared between HIV-HBV co-infected and HIV-infected groups using chi-square or Fisher exact tests for categorical variables, and Wilcoxon's Rank Sum test for continuous variables. Liver fibrosis was estimated by the AST to Platelet Ratio Index (APRI). RESULTS: HBV status and APRI values were available for 2419 cohort participants. 199 (8%) were HBV co-infected. Compared to HIV-infected participants, HIV-HBV co-infected participants were more likely to use injection drugs (28% vs. 21%, p = 0.03) and be HCV-positive (31%, vs. 23%, p = 0.02). HIV-HBV co-infected participants had lower baseline CD4 T cell counts (188 cells/mm3, IQR: 120-360) compared to 235 cells/mm3 in HIV-infected participants (IQR: 85-294) (p = 0.0002) and higher baseline median APRI scores (0.50 vs. 0.37, p < 0.0001). This difference in APRI was no longer clinically significant at follow-up (0.32 vs. 0.30, p = 0.03). HIV-HBV co-infected participants had a higher mortality rate compared to HIV-infected participants (11% vs. 7%, p = 0.02). CONCLUSION: The prevalence, demographic and clinical characteristics of the HIV-HBV co-infected population in Canada is described. HIV-HBV co-infected patients have higher mortality, more advanced CD4 T cell depletion, and liver fibrosis that improves in conjunction with ARV therapy. The high prevalence of unknown HBV status demonstrates a need for increased screening among HIV-infected patients in Canada.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Antivirais/administração & dosagem , Coinfecção/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Hepatite B/tratamento farmacológico , Adulto , Colúmbia Britânica/epidemiologia , Coinfecção/epidemiologia , Coinfecção/virologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Hepatite B/epidemiologia , Hepatite B/virologia , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/genética , Vírus da Hepatite B/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Quebeque/epidemiologia , Estudos Retrospectivos , Fatores de Risco
8.
BMC Health Serv Res ; 19(1): 882, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752860

RESUMO

BACKGROUND: Optimising health professionals' contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada). METHODS: We used Giddens' structuration theory to guide our study given its' facilitation of the understanding of the dynamic between structural constraints and actors' actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016-2017. RESULTS: Forty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others' inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs' sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity). CONCLUSION: Several new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.


Assuntos
Profissionais de Enfermagem , Papel do Profissional de Enfermagem , Atenção Primária à Saúde , Grupos Focais , Reforma dos Serviços de Saúde , Humanos , Relações Interprofissionais , Entrevistas como Assunto , Pesquisa Qualitativa , Quebeque
10.
Mar Pollut Bull ; 145: 174-184, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31590774

RESUMO

Elevated concentrations of persistent organic pollutants (POPs) and emerging halogenated flame retardants (HFRs) have been reported in tissues of the endangered St. Lawrence Estuary (Canada) beluga population as well as in minke whales visiting that same feeding area. This study examined the linkages between blubber concentrations of POPs and emerging HFRs, and transcription in skin of genes involved in the regulation of thyroid and steroid axes in belugas and minke whales from the St. Lawrence Estuary. In belugas, concentrations of PCBs, OCs and hexabromobenzene (HBB) were positively correlated with the transcription of thyroid- and/or steroid-related genes, while Dec-604 CB concentrations were negatively associated with the transcription of glucocorticoid and thyroid genes. In minke whales, PBDE concentrations changed positively with Esrß transcript levels and HBB concentrations negatively with Nr3c1 transcripts. Present results suggest that several biological functions including reproduction and energetic metabolism may represent potential targets for organohalogens in these whales.


Assuntos
Beluga/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Baleia Anã/genética , Poluentes Químicos da Água/toxicidade , Tecido Adiposo/química , Animais , Beluga/metabolismo , Ecotoxicologia , Estuários , Feminino , Retardadores de Chama/análise , Retardadores de Chama/toxicidade , Masculino , Baleia Anã/metabolismo , Bifenilos Policlorados/análise , Bifenilos Policlorados/toxicidade , Quebeque , Esteroides/metabolismo , Glândula Tireoide/efeitos dos fármacos , Poluentes Químicos da Água/análise
11.
Sante Publique ; Vol. 31(3): 357-365, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640323

RESUMO

OBJECTIVE: This article focuses on health promotion laboratories, a Quebec professional development program offered by the Public Health Department of the Montréal Region to teams of professionals and managers working in health promotion within local public health organizations. The objective is to examine the process of translating the knowledge gained by participants as a result of the program over the longer term within the organization. METHOD: This was a qualitative descriptive study. The work was guided by Nonaka's Organizational Knowledge Creation Model. Data were collected from participants at several types of discussion and development events held in the three months following the end of the pilot project. A thematic content analysis was performed using a grid derived from Nonaka's model. RESULTS: The analysis revealed the presence of both externalization and internalization in two of the sites, as well as a considerable volume of combinations in the four sites studied. In the latter case, the learnings reused over the longer term were similar to those that had been transferred in the short term (e.g. ideas and methods relating to partnership, planning, etc.). CONCLUSION: These results are important, in that they confirm the laboratories' potential to propagate the learnings throughout the organization, beyond the short-term gains made by participants during the laboratories. These learnings could potentially pave the way for new practices.


Assuntos
Promoção da Saúde/organização & administração , Aprendizagem , Administração em Saúde Pública , Humanos , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Quebeque
12.
Gynecol Oncol ; 155(2): 245-253, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604665

RESUMO

OBJECTIVE: We assessed whether human papillomavirus (HPV) viral load is an independent predictor of underlying cervical disease and its diagnostic accuracy by age. METHODS: The Biomarkers of Cervical Cancer Risk study was a case-control study from 2001 to 2010 in Montréal, Canada. Cases were histologically-confirmed cervical intraepithelial neoplasia (CIN), adenocarcinoma in situ (AIS), or cervical cancer cases. Controls were women presenting for routine screening with normal cytology results. We quantified HPV16/18/31/33/45 viral load from exfoliated cervical cells using a real-time PCR assay. Diagnostic accuracy of viral load was assessed using the area under the receiver operating characteristic curve (AUC). We restricted the analysis to the 632 cases and controls who were HPV16/18/31/33/45 positive. RESULTS: Geometric mean HPV16/18/31/33/45 viral load increased with severity of lesion grade, ranging from 0.7, 3.1, 4.8, 7.2, and 12.4 copies/cell in normal, CIN1, CIN2, CIN3&AIS, and cervical cancer respectively. The adjusted odds ratio of CIN1+ and CIN2+ increased respectively by 1.3 (95%CI 1.1-1.4) and 1.2 (95%CI 1.1-1.3) per log-transformed viral copy/cell increase of HPV16/18/31/33/45. This association was mainly driven by HPV16, 18, and 31 viral loads. The AUC of HPV16/18/31/33/45 viral load for discriminating between normal and CIN1+ women was 0.70 (95%CI 0.64-0.76) in HPV-positive women, and was 0.76 (95%CI 0.66-0.86) for women ≥30 years and 0.66 (95%CI 0.58-0.74) for women under 30 years. CONCLUSIONS: HPV viral load has lower diagnostic accuracy than has been reported for other HPV screening triage tests. However, it may be useful for triaging HPV tests in settings without cytology results such as HPV self-sampling.


Assuntos
Adenocarcinoma in Situ/virologia , Alphapapillomavirus/isolamento & purificação , Neoplasia Intraepitelial Cervical/virologia , Infecções por Papillomavirus/virologia , Neoplasias do Colo do Útero/virologia , Adulto , Idoso , Área Sob a Curva , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Quebeque , Carga Viral/fisiologia , Adulto Jovem
13.
BMC Health Serv Res ; 19(1): 752, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653231

RESUMO

BACKGROUND: People living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes, and human and financial costs for PLCs and healthcare systems. National cancer control programs advocate organizing in a network to coordinate actions, solve fragmentation problems, and thus improve clinical outcomes and care experiences for every dollar invested. The variable outcomes of such networks and factors explaining them have been documented. Governance is the "missing link" for understanding outcomes. Governance refers to the coordination of collective action by a body in a position of authority in pursuit of a common goal. The Quebec Cancer Network (QCN) offers the opportunity to study in a natural environment how, why, by whom, for whom, and under what conditions collaborative governance contributes to practices that produce value-added outcomes for PLCs, healthcare providers, and the healthcare system. METHODS/DESIGN: The study design consists of a longitudinal case study, with multiple nested cases (4 local networks nested in the QCN), mobilizing qualitative and quantitative data and mixed data from various sources and collected using different methods, using the realist evaluation approach. Qualitative data will be used for a thematic analysis of collaborative governance. Quantitative data from validated questionnaires will be analyzed to measure relational coordination and teamwork, care experience, clinical outcomes, and health-related health-related quality of life, as well as a cost analysis of service utilization. Associations between context, governance mechanisms, and outcomes will be sought. Robust data will be produced to support decision-makers to guide network governance towards optimized clinical outcomes and the reduction of the economic toxicity of cancer for PLCs and health systems.


Assuntos
Redes Comunitárias/organização & administração , Neoplasias/terapia , Redes Comunitárias/economia , Custos de Cuidados de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Institucionalização , Estudos Longitudinais , Estudos de Casos Organizacionais , Quebeque , Projetos de Pesquisa
14.
J Health Organ Manag ; 33(5): 563-587, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31483206

RESUMO

PURPOSE: Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation. DESIGN/METHODOLOGY/APPROACH: A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases. FINDINGS: Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases. ORIGINALITY/VALUE: This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.


Assuntos
Atenção Primária à Saúde , Listas de Espera , Canadá , Medicina de Família e Comunidade , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Estudos de Casos Organizacionais , Desenvolvimento de Programas , Pesquisa Qualitativa , Quebeque , Participação dos Interessados
15.
Ecotoxicology ; 28(7): 843-851, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392632

RESUMO

In 2015, five billion liters of untreated urban wastewater (UWW) were released into the St. Lawrence River (Quebec, Canada) over the course of four days in order to repair the Montreal's sewer interceptor network related to the city's primary wastewater treatment plant. The UWW discharge originated mainly from household, industrial, and hospital sources. The objective of this study was to investigate the toxicological effects of this unprecedented punctual UWW release on aquatic invertebrates to gather information that could help understand the potential impacts to the receiving environment of overflow episodes occurring during heavy rain events. Water samples were collected at four impacted and non-impacted sites during and four weeks after the release. The freshwater crustacean Daphnia magna were experimentally exposed to surface water collected from UWW-impacted sites for 13 days and analyzed for life-history endpoints and suitable biomarkers related to oxidative stress (i.e., catalase, superoxide dismutase, lipid peroxidation, and glutathione-s-transferase) and reproduction (chitinase). Results indicated that D. magna growth and reproduction were significantly increased by exposure to UWWs. These effects were correlated with an increase in chitinase activity, which is primarily controlled by reproductive hormones and involved in growth, suggesting potential impacts on these processes. Results also indicated that some UWW samples might have caused oxidative stress during the release but that it was overcome by antioxidant defenses and did not lead to cellular damage. Overall, current results contribute to a better understanding of the biological impacts of UWW to aquatic invertebrates for a better stormwater management.


Assuntos
Daphnia/efeitos dos fármacos , Rios/química , Águas Residuárias/toxicidade , Animais , Daphnia/crescimento & desenvolvimento , Daphnia/fisiologia , Oxirredução/efeitos dos fármacos , Quebeque , Reprodução/efeitos dos fármacos
16.
Vox Sang ; 114(7): 675-686, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31396980

RESUMO

BACKGROUND AND OBJECTIVES: In Canada, Héma-Québec is considering the possibility of allowing men who have sex with men (MSM) to donate plasma for fractionation combined with a mandatory quarantine period. This study aims to assess the acceptability and operational feasibility of the programme in the targeted population. MATERIALS AND METHODS: Seven focus groups with MSM (N = 47) were conducted in Montréal, regarding their beliefs underlying attitudes, subjective norms and perceived behavioural control relating to intention to participate in a programme of plasma donation for fractionation. A theoretical thematic content analysis was realized. RESULTS: Participants brought up benefits of the programme. Some are altruistic (help others, save lives, contribute as citizens), while others are linked to what it could bring to their community (progress, opportunity to include MSM in blood donation programmes, acknowledgement of MSM's contributions to the well-being of others). However, even if the programme is in accordance with their altruistic values, it clashes with their values of equality and social justice. Many disadvantages were raised (discrimination and stigmatization of MSM, the fact that their blood is presented as being not as good as the blood of others). Facilitating factors and barriers to participation were put forward in terms of programme characteristics and sites where donations would be made. CONCLUSION: The findings suggest some interest in the programme of plasma donation for fractionation, but this is significantly tempered by the fact that differential treatment for MSM would continue and that their demands regarding access to whole blood donation are still unmet.


Assuntos
Doadores de Sangue , Segurança do Sangue/métodos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Adolescente , Adulto , Segurança do Sangue/normas , Humanos , Masculino , Quebeque , Minorias Sexuais e de Gênero
17.
Int J Behav Nutr Phys Act ; 16(1): 61, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387609

RESUMO

BACKGROUND: The objective of this study was to develop and validate a short, self-administered questionnaire to assess diet quality in clinical settings, using the Alternative Healthy Eating Index (AHEI) as reference. METHODS: A total of 1040 men and women (aged 44.6 ± 14.4 y) completed a validated web-based food frequency questionnaire (webFFQ) and had their height and weight measured (development sample). Participants were categorized arbitrarily according to diet quality (high: AHEI score ≥ 65/110, low: AHEI score < 65/110) based on dietary intake data from the webFFQ. The Brief Diet Quality Assessment Tool was developed using a classification and regression tree (CART) approach and individual answers to the webFFQ among participants considered to have a plausible energy intake (ratio of reported energy intake to basal metabolic rate ≥ 1.2 and < 2.4; n = 1040). A second sample of 3344 older adults (aged 66.5 ± 6.4 y) was used to test the external validity of the Brief Diet Quality Assessment Tool (external validation sample). RESULTS: The decision tree included sequences of 3 to 6 binary questions, yielding 21 different pathways classifying diet quality as being high or low. In the development sample, the area under the receiver operating characteristic (ROC) curve of the predictive model was 0.92, with sensitivity, specificity and agreement values of 89.5, 83.9 and 87.2%. Compared with individuals having a low-quality diet according to the Brief Diet Quality Assessment Tool (mean AHEI 56.7 ± 11.4), individuals classified as having a high-quality diet (mean AHEI 71.3 ± 11.0) were significantly older, and had lower BMI, percent body fat and waist circumference, and had lower blood pressure, triglycerides, cholesterol/HDL ratio and fasting insulin as well as higher HDL-cholesterol concentrations (all P < 0.05). Similar results were observed in the external validation sample, although overall performance of the Brief Diet Quality Assessment Tool was slightly lower than in the development sample, with an area under the ROC curve of 0.79 and sensitivity, specificity and agreement values of 73.0, 69.0 and 71.3%, respectively. CONCLUSION: The CART approach yielded a simple and rapid Brief Diet Quality Assessment Tool that identifies individuals at risk of having a low-quality diet. Further studies are needed to test the performance of this tool in primary care settings.


Assuntos
Inquéritos sobre Dietas/normas , Dieta/estatística & dados numéricos , Valor Nutritivo/fisiologia , Inquéritos e Questionários/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque
18.
Environ Pollut ; 254(Pt A): 112963, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377336

RESUMO

Whereas early life stages are usually considered as particularly sensitive to both organic and inorganic contaminants, field studies assessing contaminant bioaccumulation in these stages are scarce. Selenium (Se) is thought to counteract Hg toxic effects when it is found at Se:Hg molar ratios above 1. However, the variation of this ratio in key fish tissues of different early life stages is mostly unknown. The present study therefore aimed to assess Hg and Se content in gravid female tissues (gonads, muscle, liver, gut, and brain) and different life stages (egg masses, newly hatched larvae (NHL), larvae and juvenile) of Yellow Perch (YP) in a large fluvial lake (Lake Saint-Pierre, Québec, Canada). Se:Hg molar ratios were measured for each compartment in order to fill associated knowledge gaps. Total Hg (THg) and methylmercury (MeHg) concentration varied between tissue according to the following trend: Muscle > Liver > Gut > Brain > Gonads. During YP early life stages, MeHg values increased according to an ontogenetic pattern (mg/kg dw) (mean ±â€¯SEM): Egg masses (0.01 ±â€¯0.002) < NHL (0.015 ±â€¯0.001) < Larvae (0.14 ±â€¯0.01) < Juveniles (0.18 ±â€¯0.01). Se concentrations in different YP tissues showed the following trend (mg/kg dw) (mean ±â€¯SEM): Gut (3.6 ±â€¯0.1) > Liver (2.5 ±â€¯0.1) > Gonads (1.92 ±â€¯0.06) > Brain (1.26 ±â€¯0.03) > Muscle (1.23 ±â€¯0.06). In YP early life stages, Se concentrations were highest in NHL (3.0 ±â€¯0.2), and then decreased as follows: Egg masses (2.8 ±â€¯0.1) > Larvae (1.37 ±â€¯0.04) > Juveniles (0.93 ±â€¯0.05). Se:Hg molar ratios varied considerably and were systematically above 1. This is the first study to simultaneously report Hg and Se bioaccumulation through fish life cycle.


Assuntos
Monitoramento Ambiental , Mercúrio/metabolismo , Percas/fisiologia , Selênio/metabolismo , Poluentes Químicos da Água/metabolismo , Animais , Canadá , Gônadas , Lagos , Fígado/química , Mercúrio/análise , Compostos de Metilmercúrio , Músculos/química , Quebeque , Alimentos Marinhos , Selênio/análise , Poluentes Químicos da Água/análise
19.
Sci Total Environ ; 693: 133414, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31377351

RESUMO

Mixing regime and CO2 availability may control cyanobacterial blooms in polymictic lakes, but the underlying mechanisms still remain unclear. We integrated detailed results from a natural experiment comprising an average-wet year (2011) and one with heat waves (2012), a long-term meteorological dataset (1960-2010), historical phosphorus concentrations and sedimentary pigment records, to determine the mechanistic controls of cyanobacterial blooms in a eutrophic polymictic lake. Intense warming in 2012 was associated with: 1) increased stability of the water column with buoyancy frequencies exceeding 40 cph at the surface, 2) high phytoplankton biomass in spring (up to 125 mg WW L-1), 3) reduced downward transport of heat and 4) depleted epilimnetic CO2 concentrations. CO2 depletion was maintained by intense uptake by phytoplankton (influx up to 30 mmol m-2 d-1) in combination with reduced, internal and external, carbon inputs during dry, stratified periods. These synergistic effects triggered bloom of buoyant cyanobacteria (up to 300 mg WW L-1) in the hot year. Complementary evidence from polynomial regression modelling using historical data and pigment record revealed that warming explains 78% of the observed trends in cyanobacterial biomass, whereas historical phosphorus concentration only 10% thereof. Together the results from the natural experiment and the long-term record indicate that effects of hotter and drier climate are likely to increase water column stratification and decrease CO2 availability in eutrophic polymictic lakes. This combination will catalyze blooms of buoyant cyanobacteria.


Assuntos
Mudança Climática , Cianobactérias/fisiologia , Temperatura Alta/efeitos adversos , Lagos/análise , Fitoplâncton/fisiologia , Dióxido de Carbono/análise , Sedimentos Geológicos/química , Lagos/química , Lagos/microbiologia , Fósforo/análise , Quebeque , Estações do Ano
20.
J Environ Manage ; 248: 109271, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31377540

RESUMO

Algal blooms, whether they are harmful or more akin to a nuisance, do pose negative impacts on human well-being. In the province of Quebec, excessive phosphorus that contributes to the problem of cyanobacterial blooms comes mainly from non-point sources. Limited regulation on the management of this nutrient leads to its strong accumulation in soils and, combined to climate change effects, contributes to increasing the magnitude of the effects of algal blooms on humans and the environment. The presence of cyanobacteria in water has impacts on its colour, texture and odour, in addition to posing threats to the health of recreationists, as some cyanobacteria are known to release toxins during blooms. This research focuses on studying the impacts of algal bloom events on recreationists and people living close to affected waterbodies. More specifically, we explore the preferences of individuals for different ecosystem services (ES), mainly cultural ES, provided by waterbodies (i.e., recreational activities, aesthetic aspects, and ecological health). We also estimate the average willingness to pay, financed through an increase in municipal taxation, for mechanisms that would allow the resolution of this issue. To achieve these objectives, we use a choice experiment approach, enclosed in a questionnaire that was carried out in person to 252 people. Conditional logit with and without interactions, and a random parameter logit (mixed logit) are alternatively used. Results show that individuals value first their ability to perform recreational activities, followed by the ecological health of waterbodies, and the aesthetic aspects (i.e., odour and visual aspects). Interestingly, the fact that people reported taking part in fishing activities influenced the way they prioritized ES in the choice modelling exercises. Based on the most robust model, we estimate the average willingness to pay at CA$353/household per year to fund a suite of solutions aimed at improving overall water quality.


Assuntos
Cianobactérias , Ecossistema , Água Doce , Humanos , Quebeque , Água
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA