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1.
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
2.
BMC Public Health ; 19(1): 1121, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416433

RESUMO

BACKGROUND: Chronic back disorders (CBD) are a global health problem and the leading cause of years lived with disability. The present study aims to examine overall and specific trends in CBD in the Canadian population aged 18 to 65 years. METHODS: Data from the Canadian Community Health Survey (CCHS), a cross-sectional study, from 2007 to 2014 (8 cycles) were used to calculate CBD prevalence across gender, age, geographical area (urban/rural and ten provinces and northern territories), and physical activity levels. CBD was defined in the CCHS as having back problems, excluding fibromyalgia and arthritis, which have lasted or are expected to last six months or more and that have been diagnosed by a health professional. Prevalence of CBD using survey weights and associated 95% confidence intervals (95% CI) were calculated yearly using balanced repeated replications technique. Trend tests were calculated using joinpoint regressions; ArcGIS software was used for mapping. RESULTS: Age-standardized CBD prevalence in 2007 and 2014 were 18.9% (95% CI = 18.4;19.5) and 17.8% (95% CI = 17.2,18.4), respectively. CBD prevalence was consistently higher in women, older age groups, rural dwellers, and people classified as inactive. Crude and age-standardized CBD prevalence decreased faster in people classified as physically active compared to those who were inactive (p < 0.006). Although CBD slightly decreased over time, no statistically significant trends were found overall or by gender, area of residence, province or level of physical activity. The prevalence of CBD remained consistently high in the province of Nova Scotia, and consistently low in the province of Quebec over the eight CCHS cycles. CONCLUSION: Despite prevention efforts, such as the Canadian back pain mass media campaign, CBD prevalence has remained stable between 2007 and 2014. Tailored prevention and management of CBD should consider gender, age, and geographical differences. Further longitudinal studies could elucidate the temporal relationship between potentially modifiable risk factors such as physical activity and CBD.


Assuntos
Dor nas Costas/epidemiologia , População Rural/tendências , População Urbana/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Canadá/epidemiologia , Doença Crônica , Estudos Transversais , Exercício , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nova Escócia/epidemiologia , Prevalência , Quebeque/epidemiologia , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
3.
Knee ; 26(5): 1080-1087, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31420209

RESUMO

BACKGROUND: With the aging population and an increasing number of total knee arthroplasties (TKAs) performed yearly worldwide, revision surgeries for many causes (septic or aseptic loosening, periprosthetic femoral fractures (PDFF), non-unions, malunions) are more frequent and challenging. Distal femoral replacement (DFR) is sometimes the only option to restore knee function and quality of life. DFR in non-oncologic patient is still a rare indication and few reports are published on this topic, with a non-consistent variety of functional results, complication rates and survivorship. METHODS: We present a retrospective series of patients who underwent a DFR for a non-oncologic indication between 2010 and 2017. Nineteen patients were available for a full evaluation (clinical and radiological) with a mean follow-up of 48.3 months (range 15-99). Goniometry was performed at the six-week postoperative visit. Complications were reported. Osteolysis and/or signs of aseptic loosening were described using the Knee Society Radiographic Evaluation. Survivorship was calculated for aseptic loosening, infection, and revision for any cause. RESULTS: The mean Knee Society Score was good for the pain score (42.2, range 10-50) and fair for the function score (60.6, range 0-100). Four deep infections (21.1%) were successfully treated with mobile parts exchange and debridement. Three patients presented femoral osteolysis ≥5 years after the DFR. Survivorship for aseptic loosening was 100% at four years, 81.8% after five years and 53.3% after eight years. CONCLUSIONS: TKA with DFR is a valuable option for patients with a severe bone loss and poor bone quality in the distal femur. DFR restores an acceptable quality of life but is related to an important complication rate.


Assuntos
Artroplastia do Joelho/métodos , Fêmur/cirurgia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Humanos , Incidência , Articulação do Joelho/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Quebeque/epidemiologia , Radiografia , Estudos Retrospectivos , Fatores de Tempo
4.
J Otolaryngol Head Neck Surg ; 48(1): 40, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462328

RESUMO

BACKGROUND: Reported rates of thyroid cancer in Graves' disease (GD) vary widely. The aim of this study was to evaluate the prevalence of papillary thyroid carcinoma (PTC), including aggressive forms, in GD compared to matched controls undergoing thyroidectomy. Furthermore, it seeks to elucidate any patient- or tumour-associated factors predictive of malignancy or an aggressive course. METHODS: We performed a matched cohort study of GD patients undergoing thyroidectomy at our institution between 2006 to 2018. Clinicodemographic factors, preoperative characteristics, surgical factors, final histopathology as well postoperative course were collected. Aggressive PTC was defined as evidence of lymph node metastasis, extrathyroidal extension, gross vascular invasion and/or aggressive histologic variants. Prevalence of PTC was compared with sex, age and nodule size-matched euthyroid patients that underwent thyroidectomy in the same time period. RESULTS: A total of 132 patients were included in the study with a mean age of 46 (±14) years. Malignancy was identified in 36/66 (55%) patients with GD; 20/66 (30%) were incidental carcinomas and 9/66 (14%) were associated with aggressive pathologic features. In the aggressive group, lymph node metastasis to the central compartment was present in 8 (12%) cases, extrathyroidal extension in 4 (6%) cases and one (1.5%) patient had a diffuse sclerosing tumor variant. No significant differences in outcome were found between the two groups. GD patients were more likely to have incidental carcinomas (p = 0.035). Adjusting for baseline patient characteristics, GD patients demonstrated an increased likelihood of harbouring a malignancy (odds ratio (OR) = 2.67; 95% confidence interval (CI) 1.00-7.18) compared to controls. CONCLUSION: More than half of patients with GD undergoing thyroidectomy had concurrent thyroid malignancy with aggressive features present in 14% of patients. GD may confer a heightened risk of thyroid cancer; thyroid nodules should therefore be carefully investigated.


Assuntos
Doença de Graves/complicações , Doença de Graves/cirurgia , Câncer Papilífero da Tireoide/epidemiologia , Câncer Papilífero da Tireoide/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Prevalência , Quebeque/epidemiologia , Estudos Retrospectivos , Tireoidectomia
5.
Rev Epidemiol Sante Publique ; 67(5): 285-294, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31353238

RESUMO

BACKGROUND: A significant proportion of childhood sexual abuse victims suffer from psychological sequelae in adulthood. Factors that provide a better understanding for the reasons why some victims develop these sequelae remain under-explored. In this context, the main objective is to examine the specific contribution of the contextual characteristics of childhood sexual abuse, multitype childhood maltreatment and adolescent suicide attempts on the development of depression and post-traumatic stress disorder in adulthood among sexually abused women as children. A secondary objective aimed to establish the prevalence of various forms of childhood maltreatment, adult onset post-traumatic stress disorder and depression among those women. METHODS: The sample included 479 women victims of childhood sexual abuse who participated in two separate surveys taken by women in the province of Quebec. RESULTS: More than half of these women reported at least one other form of childhood maltreatment, 30% of them presented post-traumatic disorder and 40% suffered from depression in adulthood. Regression analysis indicates that post-traumatic stress disorder was associated with early onset childhood sexual abuse and intergenerational continuity of sexual victimization, as well as childhood physical maltreatment and negligence. Depression was associated with childhood psychological maltreatment and negligence, a non-supportive response following child sexual abuse related disclosure and suicide attempt in adolescence. CONCLUSION: These results confirm the need to consider the cumulative effects of various childhood adversity factors in the psychosocial assessment of sexually abused women in early life, thus helping to better understand and treat their psychological sequelae.


Assuntos
Adultos Sobreviventes de Eventos Adversos na Infância , Abuso Sexual na Infância , Vítimas de Crime , Depressão , Transtornos de Estresse Pós-Traumáticos , Adolescente , Adulto , Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Adultos Sobreviventes de Eventos Adversos na Infância/estatística & dados numéricos , Idoso , Criança , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Abuso Sexual na Infância/psicologia , Abuso Sexual na Infância/estatística & dados numéricos , Pré-Escolar , Vítimas de Crime/psicologia , Vítimas de Crime/estatística & dados numéricos , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/etiologia , Violência Doméstica/psicologia , Violência Doméstica/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Acontecimentos que Mudam a Vida , Pessoa de Meia-Idade , Prevalência , Quebeque/epidemiologia , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Estresse Psicológico/complicações , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem
6.
Congenit Heart Dis ; 14(5): 735-744, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207185

RESUMO

BACKGROUND: The number of women with congenital heart disease (CHD) of reproductive age is increasing, yet a description of trends in pregnancy and delivery outcomes in this population is lacking. OBJECTIVE: To assess secular trends in pregnancy rates, delivery outcomes, and related health care utilization in the adult female CHD population in Quebec, Canada. METHODS: The Quebec CHD database was used to construct a cohort with all women with CHD aged 18-45 years between 1992 and 2004. Pregnancy and delivery rates were determined yearly and compared to the general population. Secular trends in pregnancy and delivery rates were assessed with linear regression. The cesarean delivery rate in the CHD population was compared to the general population. Predictors of cesarean section were determined with multivariable logistic regression. Cox regression, adjusted for comorbidities, was used to analyze the impact of cesarean sections on 1-year health care use following delivery. RESULTS: About 14 878 women were included. A total of 10 809 pregnancies were identified in 5641 women, of whom 4551 (80%) and 2528 (45%) experienced at least one delivery and/or abortion, respectively. Absolute yearly numbers and rates of pregnancies and deliveries increased during the study period (P < .05). The increment in cesarean section rates was more pronounced among women with CHD than among the general population. Gestational diabetes (OR 1.50, 95% CI [1.13, 1.99]), gestational hypertension (OR 1.81, 95% CI [1.27, 2.57]), and preeclampsia (OR 1.59, 95% CI [1.11, 2.8]) were independent predictors of cesarean delivery. Cesarean sections were associated with postpartum cardiac-hospitalization within 1 year following delivery (HR = 2.35, 95% CI [1.05, 5.28]). CONCLUSIONS: Yearly numbers and rates of pregnancies and deliveries in adult females with CHD rose significantly during the study period. Cesarean sections led to increased health care utilization. Further research is required to determine causes of high cesarean section rates in this patient population.


Assuntos
Aborto Espontâneo/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Cardiopatias Congênitas/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações Cardiovasculares na Gravidez/epidemiologia , Taxa de Gravidez/tendências , Sistema de Registros , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Quebeque/epidemiologia , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-31052452

RESUMO

The aim of this study is to document climate change adaptation interventions targeting Lyme disease at the municipal level in the province of Quebec (Canada). This exploratory study relies on the theory of planned behavior and certain constructs from the health belief model to identify the factors leading municipal authorities to implement preventive interventions for Lyme disease (PILD). Data were obtained from an online survey sent, during the summer of 2018, to municipal officers in 820 municipalities in Quebec, in all health regions where the population is at risk of contracting Lyme disease (response rate = 36%). The questionnaire was used to measure the implementation of PILD, the intention to implement these interventions, attitudes, perceived social pressure, perceived control (levers and barriers) over interventions, perceived effectiveness of preventive measures, risk, and perceived vulnerability. Results of structural equation analyses showed that attitudes were significantly associated with municipal authorities' intention to implement PILD, while the intention to implement PILD was a significant predictor of the implementation of PILD. Additional analyses showed that perceived barriers added a moderating effect in the intention-implementation relationship. The prediction of behaviors or practices that municipal authorities could implement to prevent Lyme disease will enable the evaluation over time of the evolution of Quebec municipalities' adaptation to Lyme disease. Moreover, the examination of the associations of specific psychosocial factors revealed important implications for the design of effective behavior-change interventions, which would allow health officials doing awareness work to create personalized interventions better suited to municipal officers and their specific contexts.


Assuntos
Doença de Lyme/prevenção & controle , Feminino , Processos Grupais , Humanos , Intenção , Doença de Lyme/epidemiologia , Masculino , Quebeque/epidemiologia , Inquéritos e Questionários
9.
Nutr Metab Cardiovasc Dis ; 29(7): 684-691, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31078363

RESUMO

BACKGROUND AND AIMS: The "Life's Simple 7" (LS7) metrics were developed by the American Heart Association (AHA) to assess and promote cardiovascular health in the American population. The purpose of this study was to assess the overall cardiovascular health of French-speaking adults from the Province of Quebec using the LS7 score. METHODS AND RESULTS: A total of 777 age and sex-representative participants of five different administrative regions in the Province of Quebec (387 men and 390 women; mean age ± SEM: 41.9 ± 0.1 years) were included in these analyses. Metrics of the LS7 score (smoking, physical activity, diet, body mass index, blood pressure, fasting total cholesterol and blood glucose) were analysed to generate a final score ranging from 0 to 7. Only 0.5% of participants met all criteria for ideal cardiovascular health. The diet metric showed the lowest prevalence of "ideal" scores (4.8%) whereas not smoking was the metric with the highest prevalence (88.1%). Women had a higher LS7 score than men, while age and education level (negative and positive association, respectively; p < 0.0001) were also associated with the LS7 score. CONCLUSION: Consistent with studies conducted among other populations, very few French-speaking adults from the Province of Quebec achieve an ideal cardiovascular health. These data indicate that further public health efforts aimed at promoting the LS7 metrics, focusing primarily on diet, are urgently needed. Specific groups, including older adults and those with lower levels of education, should be targeted when developing cardiovascular health promotion interventions.


Assuntos
American Heart Association , Doenças Cardiovasculares/prevenção & controle , Indicadores Básicos de Saúde , Nível de Saúde , Estilo de Vida Saudável , Linguagem , Prevenção Primária , Comportamento de Redução do Risco , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Colesterol/sangue , Estudos Transversais , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Proteção , Quebeque/epidemiologia , Medição de Risco , Fatores de Risco , Abandono do Hábito de Fumar , Estados Unidos , Adulto Jovem
10.
Drug Alcohol Depend ; 200: 133-138, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31129483

RESUMO

BACKGROUND: Previous studies provide conflicting evidence of a link between maternal substance use and risk of childhood cancer. METHODS: We analyzed a cohort of 785,438 newborns in Quebec (2006-2016). We identified infants whose mothers had problematic illicit drug, tobacco, or alcohol use before or during pregnancy. The primary outcomes were childhood hematopoietic cancer or solid tumors within 0-5 years of age. Using Cox proportional hazards models, we computed hazard ratios (HR) and 95% confidence intervals (CI) for the association between maternal substance use and childhood cancer, adjusted for potential confounders. RESULTS: A total of 925 cases of cancer occurred during 3.5 million person-years of follow-up. Children exposed to any maternal substance use had marginally elevated cancer incidence rates compared with unexposed children (29.4 vs. 26.1 per 100,000 person-years). Maternal illicit drug use was associated with the risk of acute lymphoblastic leukemia (HR 1.63, 95% CI 0.79-3.36) and fibrosarcoma (HR 2.11, 95% CI 0.86-5.16). Maternal tobacco use was associated with acute myeloid leukemia (HR 2.01, 95% CI 0.72-5.60) and fibrosarcoma (HR 2.13, 95% CI 1.05-4.32), but a weak association with neuroblastoma (HR 1.21, 95% CI 0.61-2.40) and renal tumors (HR 1.14, 95% CI 0.42-3.13) also appeared to be present. CONCLUSIONS: We found a potential association between maternal substance use and certain types of early childhood cancer. Although effects were modest, maternal substance use may contribute to some types of childhood cancer, especially leukemia and fibrosarcoma.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Neoplasias/epidemiologia , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Uso de Tabaco/epidemiologia , Adulto , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias/diagnóstico , Gravidez , Complicações na Gravidez/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Quebeque/epidemiologia , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
11.
Pregnancy Hypertens ; 16: 32-37, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31056157

RESUMO

OBJECTIVES: To evaluate the associations of a combined indicator of gestational diabetes mellitus (GDM) and gestational hypertension (GH) with diabetes and with hypertension in parental couples as a 'unit'. STUDY DESIGN: Utilizing administrative health data, GH was identified in matched pairs (GDM vs. no GDM) of mothers with singleton live births (Quebec, Canada; cohort inception 1990-2007). Couples were categorized based on GDM/GH status s ('neither'; 'either'; or 'both'). Using validated administrative health database definitions, associations of this indicator with diabetes and with hypertension in both members of the couple (12 weeks postpartum to March 31, 2012) were evaluated through adjusted Cox proportional hazard models. RESULTS: In 63,438 couples over a mean of 12.8 years (SD 5.4), diabetes risk was 9-fold higher (HR: 8.9; 95% CI 6.4, 12.2) in couples with either GDM/GH and 16-fold higher (HR 16.0; 95% CI 10.9, 23.5) in couples with both conditions compared to those with neither. Hypertension risk was 2-fold higher (HR: 1.8; 95% CI 1.5, 2.0) in couples either GDM/GH and 6-fold higher (HR 5.8; 95% CI 4.9, 7.0) in couples with both conditions compared to those with neither condition. CONCLUSIONS: GDM/GH predict diabetes and hypertension in couples as a unit underscoring the concept of shared couple risk. These findings may help foster couple collaboration for cardiovascular risk reduction in the household.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional , Hipertensão Induzida pela Gravidez , Hipertensão/epidemiologia , Pais , Transtornos Puerperais/epidemiologia , Adulto , Estudos de Coortes , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/etiologia , Feminino , Humanos , Hipertensão/etiologia , Masculino , Gravidez , Modelos de Riscos Proporcionais , Transtornos Puerperais/etiologia , Quebeque/epidemiologia , Estudos Retrospectivos , Medição de Risco
12.
Fertil Steril ; 112(1): 112-119, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31056305

RESUMO

OBJECTIVE: To provide information on the birth outcomes of future intrauterine pregnancies in women whose first pregnancy was ectopic. DESIGN: Population-based longitudinal cohort study. SETTING: All hospitals in Quebec, Canada, 1989-2013. PATIENT(S): Group surgically treated for an ectopic first pregnancy: 15,823 women; comparison group with an intrauterine first pregnancy: 1,101,748 women. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Repeat ectopic pregnancy, future delivery of a live infant, stillbirth, cesarean delivery, preterm birth, low birth weight, preeclampsia, gestational diabetes, and postpartum hemorrhage as well as other outcomes of pregnancy. RESULT(S): The overall prevalence of ectopic first pregnancy was 14.2 per 1,000 women, of whom 10% of women with an ectopic first pregnancy had a future ectopic. Regardless of age, women with ectopic first pregnancies had an increased risk of adverse birth outcomes at future intrauterine pregnancies, including 1.27 times the risk of preterm birth (95% confidence interval [CI], 1.18-1.37), 1.20 times the risk of low birth weight (95% CI, 1.10-1.31), 1.21 times the risk of placental abruption (95% CI, 1.04-1.41), and 1.45 times the risk of placenta previa (95% CI, 1.10-1.91). Older women with a prior ectopic pregnancy had particularly elevated risks of placental abruption (risk ratio 1.42; 95% CI, 1.16-1.69). CONCLUSION(S): Women with ectopic first pregnancies have an increased risk of adverse birth outcomes during subsequent intrauterine pregnancies. These women may benefit from closer clinical management in pregnancy to prevent adverse birth outcomes.


Assuntos
Fertilidade , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez Ectópica/epidemiologia , Adulto , Cesárea , Feminino , Humanos , Nascimento Vivo , Estudos Longitudinais , Gravidez , Complicações na Gravidez/diagnóstico , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/fisiopatologia , Prevalência , Quebeque/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
13.
Environ Int ; 127: 243-252, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30928848

RESUMO

Selenium (Se) is a trace mineral essential to human health, and is especially abundant in marine foods consumed by Inuit populations in Nunavik (northern Quebec, Canada), leading to exceptionally high whole blood Se levels. While most epidemiological studies to date examine plasma or whole blood Se, little is known about the health implications of specific Se biomarkers (e.g. selenoproteins and small Se compounds). Selenoneine, a novel Se compound, is found in high concentrations in marine foods (and particularly beluga mattaaq) and the red blood cells (RBCs) of populations that consume them. We report here RBC selenoneine concentrations in a population of Inuit adults (n = 885) who participated in the Qanuippitaa? 2004 survey. Simple associations between RBC selenoneine and other Se and mercury (Hg) biomarkers were assessed using Spearman correlations and linear regressions. Wilcoxon ranksum tests were used to examine differences in biomarkers and characteristics between tertiles of RBC selenoneine concentration. A multiple linear regression analysis was used to determine factors (sociodemographic, lifestyle, and dietary) associated with RBC selenoneine concentrations. Selenoneine comprised a large proportion of whole blood Se and RBC Se in this population. Age and sex-adjusted geometric mean RBC selenoneine concentration was 118 µg/L (range: 1-3226 µg/L) and was much higher (p = 0.001) among women (150.3 µg/L) than men (87.6 µg/L) across all regions of Nunavik after controlling for age, region, and diet. RBC selenoneine was highly correlated with RBC Se (rs = 0.96, p < 0.001) and whole blood Se (rs = 0.89, p < 0.001), but only weakly correlated with plasma Se (rs = 0.13, p < 0.001). Overall, increasing age (standardized ß = 0.24), higher body-mass index (BMI; ß = 0.08), female sex (ß = 0.10), living in a Hudson Strait community (compared to Hudson Bay and Ungava Bay; ß = 0.38), and consuming beluga mattaaq (g/day; ß = 0.19) were positively associated with RBC selenoneine. Meanwhile, consumption of market meats (g/day; ß = -0.07) was negatively associated with RBC selenoneine. RBC selenoneine is an important biomarker of Se dietary intake from local marine foods in Inuit populations. Further studies are needed to examine the health effects of selenoneine intake and the underlying mechanisms for sex differences among Inuit populations.


Assuntos
Eritrócitos/química , Histidina/análogos & derivados , Compostos Organosselênicos/análise , Adolescente , Adulto , Canadá , Dieta , Feminino , Histidina/análise , Humanos , Inuítes , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estado Nutricional , Quebeque/epidemiologia , Selênio/análise , Inquéritos e Questionários , Adulto Jovem
14.
Rev Epidemiol Sante Publique ; 67(3): 181-187, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30954324

RESUMO

BACKGROUND: Prohibition of tobacco sales to minors is a provision of the World Health Organization Framework Convention on tobacco control. This measure is effective to reduce youth tobacco use, if the legislation adopted is properly implemented and enforced. Through the examples of France and Quebec, the objective of this study is to compare legislative frameworks prohibiting tobacco sales to minors, their enforcement, and possible impact on underage smoking. METHODS: Identification of legislative instruments, reports from public health authorities, and articles addressing the focused question was performed trough Medline and Google. RESULTS: Selling tobacco products to minors under 18 years of age has been banned by the law since 1998 in Quebec and 2009 in France. In 2011, in France for individuals aged 17, compliance with the law was 15%. In 2017 in France, 94% of 17-year-old daily smokers regularly bought their cigarettes in a tobacco store. Law enforcement controls and sanctions are non-existent. In 2013 in Quebec, 23% of underage smoking students usually bought their own cigarettes in a business. The compliance rate with the prohibition law rose from 37% in 2003 to 92.6% in 2017. An approach of underage "mystery shoppers" attempting to purchase tobacco products and dedicated inspectors has been implemented, and progressive sanctions are applied in case of non-compliance. In 2013, 12.2% of Quebec high school students and, in 2017, 34.1% of French 17 year olds reported using tobacco products in the last 30 days. CONCLUSION: Only an improved law enforcement, through the training of tobacco retailer's, inspections and effective deterrent penalties for non-compliance, leads to an effective legislative measure in terms of public health.


Assuntos
Comércio/legislação & jurisprudência , Aplicação da Lei , Menores de Idade/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Prevenção do Hábito de Fumar , Produtos do Tabaco/legislação & jurisprudência , Adolescente , Comportamento do Adolescente , Criança , Comércio/estatística & dados numéricos , França/epidemiologia , Humanos , Aplicação da Lei/métodos , Legislação Médica , Menores de Idade/estatística & dados numéricos , Política Pública , Quebeque/epidemiologia , Fumar/epidemiologia , Fumar/legislação & jurisprudência , Prevenção do Hábito de Fumar/legislação & jurisprudência , Prevenção do Hábito de Fumar/organização & administração , Prevenção do Hábito de Fumar/normas , Prevenção do Hábito de Fumar/estatística & dados numéricos , Indústria do Tabaco/economia , Indústria do Tabaco/legislação & jurisprudência , Produtos do Tabaco/economia , Tabagismo/economia , Tabagismo/epidemiologia
15.
CMAJ ; 191(15): E410-E417, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30988041

RESUMO

BACKGROUND: Indicators of childhood- and youth-onset diabetes may be useful for early detection of diabetes; there is a known association between composite exposure of parental type 2 diabetes and gestational diabetes mellitus with childhood- and youth-onset diabetes. We examined associations between gestational diabetes mellitus and incidence of childhood- and youth-onset diabetes in offspring. METHODS: Using public health insurance administrative databases from Quebec, Canada, we randomly selected singleton live births with maternal gestational diabetes mellitus (1990-2007) and matched them 1:1 with singleton live births without gestational diabetes mellitus. Follow-up was to Mar. 31, 2012. We examined associations of diabetes in offspring with maternal gestational diabetes mellitus through unadjusted and adjusted Cox proportional hazards models. In secondary analyses, we separately considered age groups ranging from birth to age 12 years, and age 12 to 22 years. RESULTS: Incidence of pediatric diabetes (per 10 000 person-years) was higher in offspring born to mothers with gestational diabetes mellitus (4.52, 95% confidence interval [CI] 4.47-4.57) than in mothers without gestational diabetes mellitus (2.4, 95% CI 2.37-2.46). In an adjusted Cox proportional hazards model, maternal gestational diabetes mellitus was associated with development of pediatric diabetes overall (birth to age 22 yr: hazard ratio [HR] 1.77, 95% CI 1.41-2.22), during childhood (birth to age 12 yr: HR 1.43, 95% CI 1.09-1.89), and in youth (age 12 to 22 yr: HR 2.53, 95% CI 1.67-3.85). INTERPRETATION: Gestational diabetes mellitus is associated with incident diabetes in offspring during childhood and adolescence. Future studies are needed to examine longer-term outcomes in patients with pediatric diabetes with a maternal history of gestational diabetes mellitus, to ascertain how they compare with other patients with childhood- or youth-onset diabetes, in terms of disease severity and outcomes.


Assuntos
Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Diabetes Gestacional/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Gravidez , Modelos de Riscos Proporcionais , Quebeque/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-30965571

RESUMO

BACKGROUND: Social aspects play an important role in individual health and should be taken into consideration in the long-term care for people with multimorbidity. PURPOSES: To describe social vulnerability, to examine its correlation with the number of chronic conditions, and to investigate which chronic conditions were significantly associated with the most socially vulnerable state in patients with multimorbidity. METHODS: Cross-sectional analysis from the baseline data of the Patient-Centred Innovations for Persons with Multimorbidity (PACEinMM) Study. Participants were patients attending primary healthcare settings in Quebec, Canada. A social vulnerability index was applied to identify social vulnerability level. The index value ranges from 0 to 1 (1 as the most vulnerable). Spearman's rank correlation coefficient was calculated for the correlation between the social vulnerability index and the number of chronic conditions. Logistic regression was applied to investigate which chronic conditions were independently associated with the most socially vulnerable state. RESULTS: There were 301 participants, mean age 61.0 ± 10.5, 53.2% female. The mean number of chronic health conditions was 5.01 ± 1.82, with the most common being hyperlipidemia (78.1%), hypertension (69.4%), and obesity (54.2%). The social vulnerability index had a median value of 0.13 (range 0.00⁻0.78). There was a positive correlation between the social vulnerability index and the number of chronic conditions (r = 0.24, p < 0.001). Obesity, depression/anxiety, and cardiovascular diseases were significantly associated with the most socially vulnerable patients with multimorbidity. CONCLUSIONS: There was a significant correlation between social vulnerability and the total number of chronic conditions, with depression/anxiety, obesity, and cardiovascular diseases being the most related to social vulnerability.


Assuntos
Multimorbidade , Populações Vulneráveis , Adulto , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doença Crônica , Estudos Transversais , Depressão/complicações , Depressão/epidemiologia , Feminino , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/epidemiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Atenção Primária à Saúde , Quebeque/epidemiologia
17.
Occup Environ Med ; 76(6): 414-421, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30981995

RESUMO

OBJECTIVES: The healthy worker survivor effect (HWSE) usually leads to underestimation of the effects of harmful occupational exposures. HWSE is characterised by the concomitance of three associations: (1) job status-subsequent exposure, (2) job status-disease and (3) previous exposure-job status. No study has reported the coexistence of these associations in the relationship between psychosocial work-related factors and health. We assessed if HWSE is present when measuring the effects of cumulative exposure to psychosocial work-related factors on the prevalence of hypertension in white-collar workers. METHODS: Data were obtained from two timepoints (1991-1993 at baseline and 1999-2001 at follow-up) of a prospective cohort study. At baseline, the population was composed of 9188 white-collar employees (women: 49.9%) in Quebec City. Job strain as psychosocial work-related factor and blood pressure were measured using validated methods. Job status (retirees vs employees) at follow-up was self-reported. Multiple multilevel robust Poisson regressions were used to estimate prevalence ratios of hypertension and risk ratios of retirement separately by gender. We performed multiple imputations to control selection bias due to missing values. RESULTS: Retirement eliminated the subsequent exposure to job strain de facto and was associated with the reduction in the prevalence of hypertension in younger (-33%) and older (-11%) men and in older women (-39%). Job strain was associated with job status in younger men and in women of any age. CONCLUSION: Data showed the presence of HWSE in younger men and older women given the coexistence of the three structural associations.


Assuntos
Efeito do Trabalhador Sadio , Hipertensão/diagnóstico , Psicologia/estatística & dados numéricos , Sobreviventes/psicologia , Adolescente , Adulto , Idoso , Pressão Sanguínea , Determinação da Pressão Arterial/métodos , Estudos de Coortes , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Estudos Prospectivos , Quebeque/epidemiologia , Fatores de Risco
18.
Int J Circumpolar Health ; 78(1): 1599269, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30924406

RESUMO

Otitis media (OM) and their sequelae are a major health issue in the Inuit population of Nunavik, Quebec. Hypotheses of the study were: (i) early onset OM leads to repeated OM; (ii) repeated OM episodes leads to middle ear abnormalities (MEA) at age 5 years, (iii) pneumococcal conjugate vaccines (PCVs) may reduce multiple OM and MEA. Immunisation cards, medical records and audiology screening tests at age 5 years in a sample of 610 children born in 1994-2010 in 3 communities were reviewed. Children were classified into three categories using a score based on audiology screening tests: no abnormality, minor, or major MEA. The average number of OM episodes before age 5 years was 5.0 and 30% had minor and 17% major MEA at age 5 years. Community residency predicted both frequent (≥ 8) OM episodes and MEA. Early onset OM (age <6 months) was a predictor of frequent OM (RR = 1.71; 95%CI: 1.50-1.95) whereas PCV (≥1 dose ≥ age 2 months) has no significant effect. Frequent OM episodes were associated with major MEA (RR = 2.16; 95%CI: 1.20-3.85). Although associations were not statistically significant, there was a trend towards a protective effect of PCV administration on frequent OM and minor MEA, but not major MEA. In conclusion, results support an association between early onset OM, frequent OM and MEA that could represent a causal pathway.


Assuntos
Orelha Média/anormalidades , Inuítes , Otite Média/etnologia , Idade de Início , Pré-Escolar , Doença Crônica , Feminino , Testes Auditivos , Humanos , Masculino , Otite Média/patologia , Otite Média/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Quebeque/epidemiologia , Recidiva , Vacinas Conjugadas
19.
CMAJ ; 191(11): E299-E307, 2019 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885968

RESUMO

BACKGROUND: Comorbidity indexes derived from administrative databases are essential tools of research in global health. We sought to develop and validate a novel cardiac-specific comorbidity index, and to compare its accuracy with the generic Charlson-Deyo and Elixhauser comorbidity indexes. METHODS: We derived the cardiac-specific comorbidity index from consecutive patients who were admitted to hospital at a tertiary-care cardiology hospital in Quebec. We used logistic regression analysis and incorporated age, sex and 22 clinically relevant comorbidities to build the index. We compared the cardiac-specific comorbidity index with refitted Charlson-Deyo and Elixhauser comorbidity indexes using the C-statistic and net reclassification improvement to predict in-hospital death, and the Akaike information criterion to predict length of stay. We validated our findings externally in an independent cohort obtained from a provincial registry of coronary disease in Alberta. RESULTS: The novel cardiac-specific comorbidity index outperformed the refitted generic Charlson-Deyo and Elixhauser comorbidity indexes for predicting in-hospital mortality in the derivation population (n = 10 137): C-statistic 0.95 (95% confidence interval [CI] 0.94-0.9) v. 0.81 (95% CI 0.77-0.84) and 0.86 (95% CI 0.82-0.89), respectively. In the validation population (n = 17 877), the cardiac-specific comorbidity index was similarly better: C-statistic 0.92 (95% CI 0.89-0.94) v. 0.76 (95% CI 0.71-0.81) and 0.82 (95% CI 0.78-0.86), respectively, and also numerically outperformed the Charlson-Deyo and Elixhauser comorbidity indexes for predicting 1-year mortality (C-statistic 0.78 [95% CI 0.76-0.80] v. 0.75 [95% CI 0.73-0.77] and 0.77 [95% CI 0.75-0.79], respectively). Similarly, the cardiac-specific comorbidity index showed better fit for the prediction of length of stay. The net reclassification improvement using the cardiac-specific comorbidity index for the prediction of death was 0.290 compared with the Charlson-Deyo comorbidity index and 0.192 compared with the Elixhauser comorbidity index. INTERPRETATION: The cardiac-specific comorbidity index predicted in-hospital and 1-year death and length of stay in cardiovascular populations better than existing generic models. This novel index may be useful for research of cardiology outcomes performed with large administrative databases.


Assuntos
Comorbidade , Cardiopatias/mortalidade , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Quebeque/epidemiologia , Centros de Atenção Terciária
20.
Infect Control Hosp Epidemiol ; 40(3): 307-313, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30887941

RESUMO

OBJECTIVE: BACTOT, Quebec's healthcare-associated bloodstream infection (HABSI) surveillance program has been operating since 2007. In this study, we evaluated the changes in HABSI rates across 10 years of BACTOT surveillance under a Bayesian framework. DESIGN: A retrospective, cohort study of eligible hospitals having participated in BACTOT for at least 3 years, regardless of their entry date. Multilevel Poisson regressions were fitted independently for cases of HABSI, catheter-associated bloodstream infections (CA-BSIs), non-catheter-associated primary BSIs (NCA-BSIs), and BSIs secondary to urinary tract infections (BSI-UTIs) as the outcome and log of patient days as the offset. The log of the mean Poisson rate was decomposed as the sum of a surveillance year effect, period effect, and hospital effect. The main estimate of interest was the cohort-level rate in years 2-10 of surveillance relative to year 1. RESULTS: Overall, 17,479 cases and 33,029,870 patient days were recorded for the cohort of 77 hospitals. The pooled 10-year HABSI rate was 5.20 per 10,000 patient days (95% CI, 5.12-5.28). For HABSI, CA-BSI, and BSI-UTI, there was no difference between the estimated posterior rates of years 2-10 compared to year 1. The posterior means of the NCA-BSI rate ratios increased from the seventh year until the tenth year, when the rate was 29% (95% confidence interval, 1%-89%) higher than the first year rate. CONCLUSIONS: HABSI rates and those of the most frequent subtypes remained stable over the surveillance period. To achieve reductions in incidence, we recommend that more effort be expended in active interventions against HABSI alongside surveillance.


Assuntos
Infecção Hospitalar/epidemiologia , Bacteriemia/epidemiologia , Teorema de Bayes , Infecções Relacionadas a Cateter/epidemiologia , Estudos de Coortes , Infecção Hospitalar/sangue , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Vigilância em Saúde Pública , Quebeque/epidemiologia , Estudos Retrospectivos , Infecções Urinárias/epidemiologia
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