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1.
Environ Monit Assess ; 194(2): 52, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34985591

RESUMO

Comprehensive studies of the impact of hydropower on coastal environments are rare. This study examines the impact of commissioning the hydropower plants of the Romaine complex on the freshwater discharge of the Rivière Romaine near its estuary and on the Chenal de Mingan ecosystem in the summers of 2015, 2017 and 2019. Continuous temperature, salinity and chlorophyll a data were obtained from two instrumented buoys, and nutrients as well as the phytoplankton and zooplankton communities were sampled five times a year at 11 stations. The results demonstrate the major influence of offshore waters on temperature and salinity in the study area, and the decreasing influence of the Rivière Romaine with distance from its mouth. Nutrient concentrations in the estuary did not covary with river discharge or with nutrient concentrations in the river. Importantly, impoundment of the reservoirs of the complex had no measurable effect on nutrient stoichiometry in the Chenal de Mingan. Overall, the chlorophyll a concentrations ranged from 0.1 to 7.6 µg L-1 in the channel, the community was dominated by diatoms, and phytoplankton growth was either nitrate limited or under predation pressure. The zooplankton community has been composed of the same groups of species and has been dominated by cyclopoids and calanoids since 2015. Our study underlines the importance of including regional meteorological trends in the analysis to avoid biased conclusions on the impact of hydropower projects. The study concluded that modulation of the Rivière Romaine discharge and related changes in water quality did not lead to measurable change in plankton production in the Chenal de Mingan.


Assuntos
Ecossistema , Plâncton , Clorofila A , Monitoramento Ambiental , Fitoplâncton , Quebeque , Estações do Ano , Água do Mar
2.
Med Care ; 60(1): 56-65, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34882109

RESUMO

BACKGROUND: Given the wide range of uses for antidepressants, understanding indication-specific patterns of prescription filling for antidepressants provide valuable insights into how patients use these medications in real-world settings. OBJECTIVE: The objective of this study was to determine the association of antidepressant prescription filling with treatment indication, as well as prior prescription filling behaviors and medication experiences. DESIGN: This retrospective cohort study took place in Quebec, Canada. PARTICIPANTS: Adults with public drug insurance prescribed antidepressants using MOXXI (Medical Office of the XXIst Century)-an electronic prescribing system requiring primary care physicians to document treatment indications and reasons for prescription stops or changes. MEASURES: MOXXI provided information on treatment indications, past prescriptions, and prior medication experiences (treatment ineffectiveness and adverse drug reactions). Linked claims data provided information on dispensed medications and other patient-related factors. Multivariable logistic regression models estimated the independent association of not filling an antidepressant prescription (within 90 d) with treatment indication and patients' prior prescription filling behaviors and medication experiences. RESULTS: Among 38,751 prescriptions, the prevalence of unfilled prescriptions for new and ongoing antidepressant therapy was 34.2% and 4.1%, respectively. Compared with depression, odds of not filling an antidepressant prescription varied from 0.74 to 1.57 by indication and therapy status. The odds of not filling an antidepressant prescription was higher among adults filling < 50% of their medication prescriptions in the past year and adults with an antidepressant prescription stopped or changed in the past year due to treatment ineffectiveness. CONCLUSION: Antidepressant prescription filling behaviors differed by treatment indication and were lower among patients with a history of poor prescription filling or ineffective treatment with antidepressants.


Assuntos
Antidepressivos/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Cooperação e Adesão ao Tratamento/psicologia , Antidepressivos/farmacologia , Estudos de Coortes , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Prevalência , Quebeque , Estudos Retrospectivos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos
3.
BMC Health Serv Res ; 21(1): 1345, 2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34915871

RESUMO

BACKGROUND: In 2016, Quebec, a Canadian province, implemented a program to improve access to specialized health services (Accès priorisé aux services spécialisés (APSS)), which includes single regional access points for processing requests to such services via primary care (Centre de répartition des demandes de services (CRDS)). Family physicians fill out and submit requests for initial consultations with specialists using a standardized form with predefined prioritization levels according to listed reasons for consultations, which is then sent to the centralized referral system (the CRDS) where consultations with specialists are assigned. We 1) described the APSS-CRDS program in three Quebec regions using logic models; 2) compared similarities and differences in the components and processes of the APSS-CRDS models; and 3) explored contextual factors influencing the models' similarities and differences. METHODS: We relied on a qualitative study to develop logic models of the implemented APSS-CRDS program in three regions. Semi-structured interviews with health administrators (n = 9) were conducted. The interviews were analysed using a framework analysis approach according to the APSS-CRDS's components included in the initially designed program, Mitchell and Lewis (2003)'s logic model framework, and Chaudoir and colleagues (2013)'s framework on contextual factors' influence on an innovation's implementation. RESULTS: Findings show the APSS-CRDS program's regional variability in the implementation of its components, including its structure (centralized/decentralized), human resources involved in implementation and operation, processes to obtain specialists' availability and assess/relay requests, as well as monitoring methods. Variability may be explained by contextual factors' influence, like ministerial and medical associations' involvement, collaborations, the context's implementation readiness, physician practice characteristics, and the program's adaptability. INTERPRETATION: Findings are useful to inform decision-makers on the design of programs like the APSS-CRDS, which aim to improve access to specialists, the essential components for the design of these types of interventions, and how contextual factors may influence program implementation. Variability in program design is important to consider as it may influence anticipated effects, a next step for the research team. Results may also inform stakeholders should they wish to implement similar programs to increase access to specialized health services via primary care.


Assuntos
Serviços de Saúde , Encaminhamento e Consulta , Canadá , Humanos , Pesquisa Qualitativa , Quebeque
4.
CMAJ ; 193(49): E1868-E1877, 2021 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-34903591

RESUMO

BACKGROUND: The COVID-19 pandemic has disproportionately affected health care workers. We sought to estimate SARS-CoV-2 seroprevalence among hospital health care workers in Quebec, Canada, after the first wave of the pandemic and to explore factors associated with SARS-CoV-2 seropositivity. METHODS: Between July 6 and Sept. 24, 2020, we enrolled health care workers from 10 hospitals, including 8 from a region with a high incidence of COVID-19 (the Montréal area) and 2 from low-incidence regions of Quebec. Eligible health care workers were physicians, nurses, orderlies and cleaning staff working in 4 types of care units (emergency department, intensive care unit, COVID-19 inpatient unit and non-COVID-19 inpatient unit). Participants completed a questionnaire and underwent SARS-CoV-2 serology testing. We identified factors independently associated with higher seroprevalence. RESULTS: Among 2056 enrolled health care workers, 241 (11.7%) had positive SARS-CoV-2 serology. Of these, 171 (71.0%) had been previously diagnosed with COVID-19. Seroprevalence varied among hospitals, from 2.4% to 3.7% in low-incidence regions to 17.9% to 32.0% in hospitals with outbreaks involving 5 or more health care workers. Higher seroprevalence was associated with working in a hospital where outbreaks occurred (adjusted prevalence ratio 4.16, 95% confidence interval [CI] 2.63-6.57), being a nurse or nursing assistant (adjusted prevalence ratio 1.34, 95% CI 1.03-1.74) or an orderly (adjusted prevalence ratio 1.49, 95% CI 1.12-1.97), and Black or Hispanic ethnicity (adjusted prevalence ratio 1.41, 95% CI 1.13-1.76). Lower seroprevalence was associated with working in the intensive care unit (adjusted prevalence ratio 0.47, 95% CI 0.30-0.71) or the emergency department (adjusted prevalence ratio 0.61, 95% CI 0.39-0.98). INTERPRETATION: Health care workers in Quebec hospitals were at high risk of SARS-CoV-2 infection, particularly in outbreak settings. More work is needed to better understand SARS-CoV-2 transmission dynamics in health care settings.


Assuntos
COVID-19/epidemiologia , Doenças Profissionais/epidemiologia , SARS-CoV-2 , COVID-19/sangue , COVID-19/etiologia , Estudos Transversais , Demografia , Pessoal de Saúde , Hospitais , Humanos , Incidência , Doenças Profissionais/sangue , Doenças Profissionais/etiologia , Pandemias , Quebeque/epidemiologia , Fatores de Risco , Estudos Soroepidemiológicos , Inquéritos e Questionários
5.
Nutrients ; 13(12)2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34959742

RESUMO

The implications of maternal gestational weight gain (GWG) and vitamin D status to neonatal bone health are unclear. We tested whether maternal 25-hydroxyvitamin D (25(OH)D) and GWG relate to neonatal bone mineral content (BMC) and bone mineral density (BMD). Healthy term appropriate for gestational age breastfed neonates (n = 142) and their mothers were recruited 24-36 h after delivery and followed at 1.0 ± 0.5 month. At birth, obstetric data were collected and newborn serum 25(OH)D was measured. At 1 month, neonatal whole-body (WB) BMC, WB BMC relative to body weight (WB BMC/kg), lumbar spine BMC and BMD, maternal and neonatal 25(OH)D concentrations, and anthropometry were measured. Infant BMC and BMD between maternal 25(OH)D (<50, ≥50 nmol/L) and GWG (insufficient, adequate, and excessive) categories were compared. Maternal 25(OH)D was not related to infant whole-body BMC, BMC/kg, lumbar spine BMC, and BMD. Infants in the excessive maternal GWG category had greater (p = 0.0003) whole-body BMC and BMC/kg and lumbar spine BMC and BMD than inadequate GWG, and greater (p = 0.0063) whole-body BMC/kg and lumbar spine BMC and BMD than adequate GWG. These results suggest that maternal GWG, but not vitamin D status, modestly relates to bone mass in neonates.


Assuntos
Densidade Óssea , Ganho de Peso na Gestação , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Vitamina D/análogos & derivados , Adulto , Aleitamento Materno , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Vértebras Lombares/fisiologia , Mães/estatística & dados numéricos , Gravidez , Quebeque , Nascimento a Termo , Vitamina D/sangue
6.
Nutrients ; 13(12)2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34959748

RESUMO

Bread is a highly consumed food and an important source of nutrients in the diet of Canadians, underlining the need to improve its nutritional quality. The Food Quality Observatory (Observatory) aimed to evaluate the nutritional value of the sliced bread products available in Quebec (Canada), according to their grain type and main flour. Analyses included comparing the bread's sodium content to Health Canada's daily values (DV) and sodium voluntary targets, comparing the bread's fibre content thresholds with the source of fibre mentioned, and assessing whether the main flour was associated with the nutrient content. The nutritional values of 294 sliced breads available in Quebec were merged with sales data (from October 2016 to October 2017), with 262 products successfully cross-referenced. The results showed that 64% of the breads purchased were 'low' in fibre (i.e., below 2 g per two slices), while 47% were 'high' in sodium (i.e., above 15% DV per two slices). Attention should be paid to 100% refined grain bread and to bread with refined flour as the main flour, since they are great sellers, while showing a less favourable nutrient content. This study shows that there is room for improvement in the nutritional content of Quebec's bread offer, particularly regarding sodium and fibre content.


Assuntos
Pão/análise , Fibras na Dieta/análise , Grão Comestível , Valor Nutritivo , Sódio na Dieta/análise , Humanos , Quebeque
7.
CMAJ Open ; 9(4): E1232-E1241, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34933881

RESUMO

BACKGROUND: Limited space and resources are potential obstacles to infection prevention and control (IPAC) measures in in-centre hemodialysis units. We aimed to assess IPAC measures implemented in Quebec's hemodialysis units during the spring of 2020, describe the characteristics of these units and document the cumulative infection rates during the first year of the COVID-19 pandemic. METHODS: For this cross-sectional survey, we invited leaders from 54 hemodialysis units in Quebec to report information on the physical characteristics of the unit and their perceptions of crowdedness, which IPAC measures were implemented from Mar. 1 to June 30, 2020, and adherence to and feasibility of appropriate IPAC measures. Participating units were contacted again in March 2021 to collect information on the number of COVID-19 cases in order to derive the cumulative infection rate of each unit. RESULTS: Data were obtained from 38 of the 54 units contacted (70% response rate), which provided care to 4485 patients at the time of survey completion. Fourteen units (37%) had implemented appropriate IPAC measures by 3 weeks after Mar. 1, and all 38 units had implemented them by 6 weeks after. One-third of units were perceived as crowded. General measures, masks and screening questionnaires were used in more than 80% of units, and various distancing measures in 55%-71%; reduction in dialysis frequency was rare. Data on cumulative infection rates were obtained from 27 units providing care to 4227 patients. The cumulative infection rate varied from 0% to 50% (median 11.3%, interquartile range 5.2%-20.2%) and was higher than the reported cumulative infection rate in the corresponding region in 23 (85%) of the 27 units. INTERPRETATION: Rates of COVID-19 infection among hemodialysis recipients in Quebec were elevated compared to the general population during the first year of the pandemic, and although hemodialysis units throughout the province implemented appropriate IPAC measures rapidly in the spring of 2020, many units were crowded and could not maintain physical distancing. Future hemodialysis units should be designed to minimize airborne and droplet transmission of infection.


Assuntos
COVID-19/prevenção & controle , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Controle de Infecções , Diálise Renal , COVID-19/epidemiologia , Estudos Transversais , Humanos , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Quebeque/epidemiologia , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Inquéritos e Questionários
8.
Soins ; 66(860): 39-43, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34838211

RESUMO

Quality of life at work (QWL) is an issue of great importance, particularly in the health sector. In Quebec, organizations attach particular importance to this issue, which is reflected in specific human resources practices. This has led to some changes in terms of expectations, but also in terms of effects and issues, particularly with regard to the employer-employee relationship.


Assuntos
Qualidade de Vida , Humanos , Quebeque
9.
J Otolaryngol Head Neck Surg ; 50(1): 65, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34784978

RESUMO

BACKGROUND: The COVID-19 pandemic has deeply impacted healthcare and education systems, including resident education. The impact of the pandemic on the different types of pedagogical activities, and the displacement of pedagogical activities to online modalities have not yet been quantified. We sought to evaluate the impact of the COVID-19 pandemic on formal pedagogic components of otorhinolaryngology-head and neck surgery (ORL-HNS) residency, the switch to distance learning and program director's perceptions of the future of teaching and learning. METHODS: A nationwide online survey was conducted on Canadian ORL-HNS program directors. The use of standard didactic activities in-person and online, before and during the pandemic was rated with Likert scales. Perceptions of the pandemic were described with open-ended questions. RESULTS: A total of 11 of the 13 program directors contacted responded. The analysis were conducted using nonparametric statistics. There was a significant drop in overall didactic activities during the pandemic, regardless of the teaching format (3.5 ± 0.2 to 3.1 ± 0.3, p < 0.05). The most affected activities were simulation and in-house lectures. Online activities increased dramatically (0.5 ± 0.2 to 5.0 ± 0.5, p < 0.001), including attendance to lectures made by other programs (0.5 ± 0.3 to 4.0 ± 0.8, p < 0.05). Respondents stated their intention to maintain the hybrid online and in-person teaching model. CONCLUSIONS: These findings suggest that hybrid online and in-person teaching is likely to persist in the post-pandemic setting. A balanced residency curriculum requires diversity in academic activities. The pandemic can have positive consequences if higher education institutions work to better support distance teaching and learning.


Assuntos
COVID-19/epidemiologia , Currículo , Transmissão de Doença Infecciosa/prevenção & controle , Educação à Distância/métodos , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Otolaringologia/educação , Adolescente , Adulto , COVID-19/transmissão , Canadá , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , Quebeque/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
10.
Open Heart ; 8(2)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34782369

RESUMO

OBJECTIVE: To determine the prevalence of cardiac abnormalities and their relationship to markers of myocardial injury and mortality in patients admitted to hospital with COVID-19. METHODS: A retrospective and prospective observational study of inpatients referred for transthoracic echocardiography for suspected cardiac pathology due to COVID-19 within a London NHS Trust. Echocardiograms were performed to assess left ventricular (LV), right ventricular (RV) and pulmonary variables along with collection of patient demographics, comorbid conditions, blood biomarkers and outcomes. RESULT: In the predominant non-white (72%) population, RV dysfunction was the primary cardiac abnormality noted in 50% of patients, with RV fractional area change <35% being the most common marker of this RV dysfunction. By comparison, LV systolic dysfunction occurred in 18% of patients. RV dysfunction was associated with LV systolic dysfunction and the presence of a D-shaped LV throughout the cardiac cycle (marker of significant pulmonary artery hypertension). LV systolic dysfunction (p=0.002, HR 3.82, 95% CI 1.624 to 8.982), pulmonary valve acceleration time (p=0.024, HR 0.98, 95% CI 0.964 to 0.997)-marker of increased pulmonary vascular resistance, age (p=0.047, HR 1.027, 95% CI 1.000 to 1.055) and an episode of tachycardia measured from admission to time of echo (p=0.004, HR 6.183, 95% CI 1.772 to 21.575) were independently associated with mortality. CONCLUSIONS: In this predominantly non-white population hospitalised with COVID-19, the most common cardiac pathology was RV dysfunction which is associated with both LV systolic dysfunction and elevated pulmonary artery pressure. The latter two, not RV dysfunction, were associated with mortality.


Assuntos
COVID-19/etnologia , Cardiopatias/etnologia , Ventrículos do Coração/diagnóstico por imagem , Vigilância da População , Comorbidade , Estudos Transversais , Ecocardiografia Doppler , Cardiopatias/diagnóstico , Hospitalização/tendências , Humanos , Pandemias , Prevalência , Quebeque/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências
11.
PLoS One ; 16(10): e0258466, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34637465

RESUMO

Lyme disease (LD) is an emerging public health threat in Canada, associated with the northward range expansion of the black-legged tick (Ixodes scapularis). To address this, public health authorities have been carrying out surveillance activities and awareness campaigns targeting vulnerable populations such as outdoor workers. Implementing these measures is time-consuming and resource-intensive, prompting the assessment of alternatives. Our goal was to evaluate the feasibility and implementation of a training-of-trainers-inspired approach in raising awareness about LD risk and prevention among workers and general population, as well as to evaluate its potential to contribute to provincial LD surveillance efforts. We trained a group of workers from publicly-accessible outdoor parks of the province of Québec to become "LD education ambassadors". Ambassadors were trained to raise tick and LD awareness, share information on preventive measures in their respective communities, and lead tick sampling activities using a standardised protocol similar to that used by Public Health authorities. Ambassador-led outreach activities, public reach, sampling activities and collected ticks were documented, as well as ambassadors' satisfaction with the training using forms and semi-structured interviews. In total, 18 ambassadors from 12 organizations were trained. Between June and September 2019, they led 28 independent outreach activities, reaching over 1 860 individuals (from occupational and general public settings) in seven public health units. Ambassadors led 28 tick samplings, together collecting 11 I. scapularis ticks. This study suggests that an adapted training-of-trainers is a feasible approach to raising tick and LD risk awareness among Québec outdoor workers and public. Trained ambassadors have the potential of reaching a large portion of the population visiting or working in outdoor parks while also providing much-needed outreach regarding risk and prevention. Pushing this concept further to include other types of workers and jurisdictions may contribute to national LD surveillance efforts.


Assuntos
Doença de Lyme/prevenção & controle , Voluntários/educação , Adulto , Animais , Canadá , Feminino , Humanos , Ixodes/fisiologia , Doença de Lyme/parasitologia , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Quebeque
12.
BMC Psychiatry ; 21(1): 491, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620134

RESUMO

BACKGROUND: Administrative data have several advantages over questionnaire and interview data to identify cases of depression: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential classification errors. However, the validity of administrative data in the correct identification of depression has not yet been studied in general populations. The present study aimed to 1) evaluate the sensitivity and specificity of administrative cases of depression using the validated Composite International Diagnostic Interview - Short Form (CIDI-SF) as reference standard and 2) compare the known-groups validity between administrative and CIDI-SF cases of depression. METHODS: The 5487 participants seen at the last wave (2015-2018) of the PROQ cohort had CIDI-SF questionnaire data linked to hospitalization and medical reimbursement data provided by the provincial universal healthcare provider and coded using the International Classification of Disease. We analyzed the sensitivity and specificity of several case definitions of depression from this administrative data. Their association with known predictors of depression was estimated using robust Poisson regression models. RESULTS: Administrative cases of depression showed high specificity (≥ 96%), low sensitivity (19-32%), and rather low agreement (Cohen's kappa of 0.21-0.25) compared with the CIDI-SF. These results were consistent over strata of sex, age and education level and with varying case definitions. In known-groups analysis, the administrative cases of depression were comparable to that of CIDI-SF cases (RR for sex: 1.80 vs 2.03 respectively, age: 1.53 vs 1.40, education: 1.52 vs 1.28, psychological distress: 2.21 vs 2.65). CONCLUSION: The results obtained in this large sample of a general population suggest that the dimensions of depression captured by administrative data and by the CIDI-SF are partially distinct. However, their known-groups validity in relation to risk factors for depression was similar to that of CIDI-SF cases. We suggest that neither of these data sources is superior to the other in the context of large epidemiological studies aiming to identify and quantify risk factors for depression.


Assuntos
Depressão , Depressão/diagnóstico , Depressão/epidemiologia , Humanos , Lactente , Entrevista Psicológica , Estudos Prospectivos , Quebeque , Padrões de Referência
13.
Int J Circumpolar Health ; 80(1): 1935594, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34596482

RESUMO

In a project aiming to develop community-led resources for families in northern Quebec, Canada, members (Inuit and non-Inuit) of the project decided to meet with Inuit parents to hear their experiences and needs, and to better understand how family dynamics might be related to ways of using resources within communities. In this article, we present secondary analyses of interviews conducted in 2015 with 14 parents living in a community of Nunavik, northern Quebec, accompanied by participatory analysis sessions. A dual data analysis strategy was adopted. Non-Inuit researchers and research assistants with significant lived experience in Nunavik explored what they learned from the stories that Inuit parents shared with them through the interviews and through informal exchanges. Inuit partners then discussed the large themes identified by the research team to guide non-Inuit researchers in their analysis. The aim was to better inform non-Inuit service providers and people whose mandate it is to support community mobilisation in relation to the heterogeneous realities of Inuit families, and the ways in which they can be of support to families based on their specific realities and needs.


Assuntos
Promoção da Saúde , Inuítes , Canadá , Relações Familiares , Humanos , Quebeque
14.
Sante Ment Que ; 46(1): 97-118, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34597490

RESUMO

Context Despite the considerable resources devoted and the efforts of the many actors involved, the gap between the production of scientific knowledge and its use in practice remains a challenge. The use of information and communication technologies (ICTs) is a valuable tool for reducing this gap. To address this challenge, a demonstration project focusing on the use of technology for knowledge translation was implemented with 23 community support teams in 5 regions of Quebec (2016-2018). More than 324 mental health professionals, team leaders and managers have benefited from the initiative "At your fingertips, best recovery-oriented practices." Objective This article presents the results of a satisfaction survey of team leaders responsible for clinical support in the community support teams under study. The purpose of this study is to enhance the understanding of issues identified during implementation and to make recommendations for the sustainable scaling up of the implemented knowledge translation program. Method A qualitative design in this evaluative research was adopted. At the end of the program implementation process, 2 group interviews were conducted with the team leaders. A content analysis following an inductive approach with 3 levels of coding was performed. Results The results show a significant digital gap within the Quebec health and social services network compared to other sectors of activity. Participants underlined the importance of adopting mechanisms for knowledge exchange and transfer that are integrated into organizational practices (dedicated time, formal clinical supervision, etc.) and which make use of ICTs. Conclusion Despite the significant technology upgrade required, the results suggest the relevance of using techno-pedagogy as the primary means of supporting knowledge translation and practice transformation. The tools developed and the support mechanisms explored appear to facilitate access to and adoption of best practices in mental health.


Assuntos
Pessoal de Saúde , Saúde Mental , Humanos , Quebeque , Serviço Social , Inquéritos e Questionários
15.
Health Promot Chronic Dis Prev Can ; 41(10): 306-314, 2021 Oct.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-34668685

RESUMO

INTRODUCTION: We compared smoking initiation and cessation in Quebec versus the rest of Canada as possible underpinnings of the continued higher cigarette smoking prevalence in Quebec. METHODS: Data were drawn from the Canadian Community Health Survey (CCHS). We compared average and sex-stratified prevalence estimates of (1) current cigarette smoking in persons aged 15 years and older; (2) past-year initiation of cigarette smoking in those aged 12 to 17 and 18 to 24 years; and (3) past-year cessation in adults aged 25 years and older in Quebec versus the other nine Canadian provinces in each two-year CCHS cycle from 2007/08 to 2017/18. RESULTS: The prevalence of current smoking decreased from 25% to 18% among adults aged 15 years and older in Quebec from 2007/08 to 2017/18, and from 22% to 16% in the rest of Canada. Initiation among those aged 12 to 17 years decreased from 9% to 5% in Quebec, and from 7% to 3% in the rest of Canada. Neither initiation among people aged 18 to 24 (at 6% and 7%, respectively) nor cessation among adults aged 25 and older (approximately 8%) changed over time in Quebec or in the rest of Canada. In each two-year CCHS cycle, past-year initiation among those 12 to 17 years of age was consistently higher in Quebec than in the rest of Canada, but there were no substantial or sustained differences in initiation among people aged 18 to 24 or in past-year cessation. Findings were similar when stratified by sex. CONCLUSION: Higher levels of smoking initiation among youth aged 12 to 17 years could be a proximal underpinning of the continuing higher prevalence of smoking in Quebec versus the rest of Canada.


Assuntos
Fumar , Adolescente , Adulto , Canadá/epidemiologia , Inquéritos Epidemiológicos , Humanos , Prevalência , Quebeque/epidemiologia , Fumar/epidemiologia
16.
Can J Surg ; 64(5): E527-E533, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34649920

RESUMO

BACKGROUND: The Inuit people residing in Nunavik, Quebec, are vulnerable to major trauma owing to environmental and social factors; however, there is no systematic data collection for trauma in Nunavik, and, apart from data regarding patients who are transferred to tertiary care centres, no data enter the Quebec trauma registry directly from Nunavik. We performed a study to characterize the epidemiologic features of trauma in Nunavik, and describe indications for transfer and outcomes of patients referred to the tertiary trauma centre. METHODS: We collected data retrospectively for all patients with trauma admitted to the Centre de santé Tulattavik de l'Ungava in Kuujjuaq from 2005 to 2014. Sociodemographic, injury and health services data were extracted. The data were analyzed in conjunction with coroners' reports on death from trauma in Nunavik. RESULTS: A total of 797 trauma cases were identified. The most common causes of injury were motor vehicle collisions (258 cases [32.4%]), falls (137 [17.2%]) and blunt assault (95 [11.9%]). One-third of patients (262 [32.9%]) were transferred to the tertiary care centre in Montréal. The incidence rate of major trauma (Injury Severity Score > 12) was 18.1 and 21.7 per 10 000 person-years in the Kuujjuaq region and the Puvirnituq region, respectively, which translates to a relative risk (RR) of 4 compared to the Quebec population. The disparity observed in trauma mortality rate was even greater, with an RR of 47.6 compared to the Quebec population. CONCLUSION: The study showed major disparity in trauma incidence and mortality rate between Nunavik and the province of Quebec. Our findings allow for a better understanding of the burden of injury and regional trauma mortality in Nunavik, and recommendations for optimization of the trauma system in this unique setting.


Assuntos
Inuítes/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Incidência , Quebeque/epidemiologia , Estudos Retrospectivos , Comportamento Autodestrutivo/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Violência/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Ferimentos não Penetrantes/epidemiologia
17.
Emerg Infect Dis ; 27(11): 2810-2817, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34670643

RESUMO

This retrospective multicenter cohort study assessed temporal changes in the severity and mortality rate of blastomycosis in Quebec, Canada, and identified risk factors for death in patients with blastomycosis in 1988-2016. The primary outcome was 90-day all-cause deaths. Among 185 patients, 122 (66%) needed hospitalization and 30 (16%) died. We noted increases in the proportion of severe cases, in age at diagnosis and in the proportion of diabetic and immunocompromised patients over time. Independent risk factors for death were age (adjusted odds ratio [aOR] 1.04, 95% CI 1.00-1.07), immunosuppression (aOR 4.2, 95% CI 1.5-11.6), and involvement of >2 lung lobes (aOR 5.3, 95% CI 1.9-14.3). There was no association between the Blastomyces genotype group and all-cause mortality. The proportion of severe cases of blastomycosis has increased in Quebec over the past 30 years, partially explained by the higher number of immunosuppressed patients.


Assuntos
Blastomyces , Blastomicose , Blastomicose/epidemiologia , Estudos de Coortes , Humanos , Quebeque/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença
18.
Am J Bot ; 108(10): 2066-2095, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34664712

RESUMO

PREMISE: Cladoxylopsids formed Earth's earliest forests and gave rise to the ancestors of sphenopsids and ferns. Lower Devonian (Emsian) strata of the Battery Point Formation (Quebec, Canada) contain new anatomically preserved cladoxylopsids, one of which is described in this article. To assess the phylogenetic position of this fossil and address questions of cladoxylopsid phylogeny, we conducted a comprehensive phylogenetic study. METHODS: Permineralized axes were studied in serial sections using the cellulose acetate peel technique. We evaluated phylogenetic relationships among cladoxylopsids using a data set of 36 new morphological characters and 31 species, in parsimony-constrained analyses. RESULTS: We describe Adelocladoxis praecox gen. et sp. nov., a cladoxylopsid with small actinostelic axes bearing dichotomously branched, helically arranged ultimate appendages and fusiform sporangia. Adelocladoxis provides the oldest evidence of cladoxylopsid anatomy, including ultimate appendages and sporangia. In agreement with non-phylogenetic classification schemes, our phylogenetic analysis resolves a basal grade of iridopterids and a clade of cladoxylopsids s.s., which includes a pseudosporochnalean cladoxylopsid clade, a cladoxylalean cladoxylopsid clade, and Adelocladoxis. CONCLUSIONS: Our phylogenetic analysis illuminates aspects of tempo and mode of evolution in the cladoxylopsid plexus. Originating prior to the Emsian, cladoxylopsids reached global distribution by the Frasnian. Iridopterids and cladoxylopsids s.s. radiated in the Emsian-Eifelian. The sequence of character change recovered by our phylogeny supports a transition from actinostelic protosteles to dissected steles, associated with an increase in xylem rib number and medullation generating a central parenchymatous area.


Assuntos
Gleiquênias , Fósseis , Evolução Biológica , Filogenia , Quebeque , Esporângios
19.
Prev Vet Med ; 197: 105510, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34695649

RESUMO

The objectives of this retrospective analysis were to: 1) estimate the diagnostic sensitivity (Se) and specificity (Sp) of bacterial culture of environmental samples for determining Mycobacterium avium subsp. paratuberculosis (MAP) infection status in Québec dairies, using a Bayesian Latent Class Model (BLCM); and 2) determine the association between the number of positive environmental samples and the individual fecal culture (IFC) apparent and true MAP within-herd prevalence. Environmental and individual fecal samples were collected from 87 commercial dairy herds participating in previous research projects. Environmental samples included two composite samples of 20 g collected from different locations within each of the following sites: an area where manure from the majority of adult cattle accumulates, a manure storage area and another site of manure accumulation chosen by the veterinarian. Samples were cultured using the MGIT Para TB culture liquid media and the BACTEC MGIT 960 system. The Se and Sp of environmental sampling were estimated using a one-test-one-population BLCM. Herds were considered positive for environmental sampling if at least one out of the six samples collected was positive. The apparent and true IFC within-herd MAP prevalence estimates for each herd were obtained using a two-stage cluster BLCM, then merged in a single dataset with the environmental sample results. The association between the within-herd MAP prevalence results (apparent and true), and the number of positive environmental samples was assessed using a zero-inflated negative binomial (ZINB) model. In all BLCMs, median posterior estimates and 95 % Bayesian credible intervals (BCI) were obtained with OpenBUGS statistical freeware. Se and Sp of environmental sampling were 43.7 % (95 % BCI: 32.5-55.5) and 96.2 % (95 % BCI: 84.2-99.8), respectively. Overall, the number of positive environmental samples increased with the apparent and true MAP within-herd prevalence. The true prevalence was higher than the apparent prevalence for a given number of positive environmental samples. The probability of not observing a positive environmental sample decreased with the prevalence. Despite its imperfect accuracy, environmental sampling is an inexpensive and non-invasive sampling method to determine MAP infection status in tie-stall herds that can be used as a proxy to estimate the true within-herd prevalence. The absence of positive environmental samples in a single sampling visit is likely an indicator of a very low within-herd prevalence rather than being MAP exempt.


Assuntos
Doenças dos Bovinos , Paratuberculose , Animais , Teorema de Bayes , Bovinos , Doenças dos Bovinos/diagnóstico , Doenças dos Bovinos/epidemiologia , Indústria de Laticínios , Ensaio de Imunoadsorção Enzimática/veterinária , Fezes , Paratuberculose/diagnóstico , Paratuberculose/epidemiologia , Prevalência , Quebeque/epidemiologia , Estudos Retrospectivos
20.
Genome Med ; 13(1): 169, 2021 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-34706766

RESUMO

BACKGROUND: Québec was the Canadian province most impacted by COVID-19, with 401,462 cases as of September 24th, 2021, and 11,347 deaths due mostly to a very severe first pandemic wave. In April 2020, we assembled the Coronavirus Sequencing in Québec (CoVSeQ) consortium to sequence SARS-CoV-2 genomes in Québec to track viral introduction events and transmission within the province. METHODS: Using genomic epidemiology, we investigated the arrival of SARS-CoV-2 to Québec. We report 2921 high-quality SARS-CoV-2 genomes in the context of > 12,000 publicly available genomes sampled globally over the first pandemic wave (up to June 1st, 2020). By combining phylogenetic and phylodynamic analyses with epidemiological data, we quantify the number of introduction events into Québec, identify their origins, and characterize the spatiotemporal spread of the virus. RESULTS: Conservatively, we estimated approximately 600 independent introduction events, the majority of which happened from spring break until 2 weeks after the Canadian border closed for non-essential travel. Subsequent mass repatriations did not generate large transmission lineages (> 50 sequenced cases), likely due to mandatory quarantine measures in place at the time. Consistent with common spring break and "snowbird" destinations, most of the introductions were inferred to have originated from Europe via the Americas. Once introduced into Québec, viral lineage sizes were overdispersed, with a few lineages giving rise to most infections. Consistent with founder effects, the earliest lineages to arrive tended to spread most successfully. Fewer than 100 viral introductions arrived during spring break, of which 7-12 led to the largest transmission lineages of the first wave (accounting for 52-75% of all sequenced infections). These successful transmission lineages dispersed widely across the province. Transmission lineage size was greatly reduced after March 11th, when a quarantine order for returning travellers was enacted. While this suggests the effectiveness of early public health measures, the biggest transmission lineages had already been ignited prior to this order. CONCLUSIONS: Combined, our results reinforce how, in the absence of tight travel restrictions or quarantine measures, fewer than 100 viral introductions in a week can ensure the establishment of extended transmission chains.


Assuntos
COVID-19/transmissão , COVID-19/epidemiologia , COVID-19/virologia , Canadá/epidemiologia , Europa (Continente)/epidemiologia , Genoma Viral , Humanos , Epidemiologia Molecular , Pandemias , Filogenia , Saúde Pública , Quebeque/epidemiologia , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Viagem
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