Institute National Of Sante Publique Du Quebec
Institute National Of Sante Publique Du Quebec
Dube E.,Institute National Of Sante Publique Du Quebec
Human vaccines | Year: 2011
Acute otitis media (AOM) is one of the most common bacterial infectious diseases among children and is a leading cause of child healthcare visits and antibiotic prescriptions. Few vaccines have the potential to prevent AOM. The newer pneumococcal conjugate vaccines (PCV) offer a larger spectrum of protection against AOM, as well as preventing severe diseases. The main aim of this study was to assess pediatricians' opinions regarding AOM and its prevention by immunization. Response rate was 50%. Around 60% of respondents estimated that more than 50% of their patients under the age of 3 years would suffer from at least one episode of AOM in the following year. Most respondents (79%) rated consequences of AOM as moderate. Almost all physicians (99%) considered the newer PCV as safe and effective. Most respondents considered their knowledge of the new vaccines was sufficient. More than 90% had a firm intention to recommend newer PCV to their patients. Perceived benefits of AOM prevention by immunization were: reduction of antibiotic administration and reduction of post-AOM complications. More than half of respondents (53%) considered the risk of adverse events as a barrier to AOM prevention by immunization. In multivariate analysis, the main determinant of pediatricians' intention to recommend newer PCV was perceived safety and efficacy of the vaccines (partial R2 = 0.40, p < 0.0001). Results of this survey show that AOM is perceived as an important health problem by paediatricians. Information about the increased protection against AOM offered by newer PCV should be disseminated to physicians. A self-administered, anonymous, mail-based questionnaire based upon the Health Belief Model and the Analytical framework for immunization programs was sent to all 1,852 Canadian pediatricians.
Valcke M.,University of Montréal |
Valcke M.,Institute National Of Sante Publique Du Quebec |
Krishnan K.,University of Montréal
Regulatory Toxicology and Pharmacology | Year: 2011
The objective of this study was to assess the impact of the exposure route on the human kinetic adjustment factor (HKAF), for which a default value of 3.16 is used in non-cancer risk assessment. A multi-route PBPK model was modified from the literature and used for computing the internal dose metrics in adults, neonates, children, elderly and pregnant women following three route-specific scenarios to chloroform, bromoform, tri- or per-chloroethylene (TCE or PERC). These include 24-h inhalation exposure, body-weight adjusted oral exposure and 30min dermal exposure to contaminated drinking water. Distributions for body weight (BW), height (BH) and hepatic cytochrome P450 2E1 (CYP2E1) content were obtained from the literature, whereas model parameters (flows, volumes) were calculated from BW and BH. Monte Carlo simulations were performed and the HKAF was calculated as the ratio of the 95th percentile value of internal dose metrics in subpopulation to the 50th percentile value in adults. On the basis of the area under the parent compound's arterial blood concentration vs time curve (AUC pc), highest HKAFs were obtained in neonates for every scenario considered, and were the highest for bromoform (range: 3.6-7.4). Exceedance of the default value based on AUC PC was also observed for an oral exposure to chloroform in neonates (4.9). In all other cases, HKAFs remained below the default value. Overall, this study has pointed out the dependency of the HKAF on the exposure route, dose metrics and subpopulation considered, as well as characteristics of the chemicals investigated. © 2010 Elsevier Inc.
Valcke M.,University of Montréal |
Valcke M.,Institute National Of Sante Publique Du Quebec |
Krishnan K.,University of Montréal
Toxicology | Year: 2011
The objective of this study was to evaluate the magnitude of the human kinetic adjustment factor (HKAF) as a function of physico- and bio-chemical characteristics impacting the systemic clearance of chemicals. This factor is intended to replace the default value of 3.16 in non-cancer risk assessments and aims at accounting for interindividual variability in toxicokinetics. A steady-state algorithm was used to compute the internal dose metrics (blood concentration (Cblood) and rate of metabolite produced/L liver (RAM)) of hypothetical chemicals in neonates, adults, elderly, and pregnant women. After evaluating the algorithm with chemical-specific experimental data, Cblood and RAM were calculated for hypothetical chemicals exhibiting blood:air partition coefficients (Pb) between 1 and 10,000 and hepatic extraction ratios in the average adult (E) between 0.01 and 0.99. Based on Monte Carlo simulation results, HKAF values were computed as the ratio of the 95th percentile value for each subpopulation to the 50th percentile value in adults. The highest HKAF among those obtained for each subpopulation was reported in route-, pathway-, and dose metric-specific HKAF matrices as a function of Pb and E. These matrices allowed the recognition of cases where the default HKAF could be exceeded, and these occurred in neonates based on Cblood in two situations. First, when the average adult-to-neonate ratio of body weight-adjusted systemic clearance was at least equal to 2.2 for a given systemic exposure (i.e., for CYP1A2 substrates only). Second, when E=0.01-0.2 and Pb≥300 or when E=0.3-0.7 and Pb≥100 for inhalation exposures to CYP2E1 substrates, with comparable values for the other substrates (higher for CYP1A2). Overall, this study showed the dependency of the HKAF on the dose metrics, chemical characteristics, metabolic pathways, and subpopulations considered. © 2011 Elsevier Ireland Ltd.
Li C.,University of Kansas Medical Center |
Lu L.,University of Kansas Medical Center |
Murphy D.G.,Institute National Of Sante Publique Du Quebec |
Negro F.,University of Geneva |
Okamoto H.,Jichi Medical University
Journal of General Virology | Year: 2014
We characterized the full-length genomes of nine hepatitis C virus genotype 3 (HCV-3) isolates: QC7, QC8, QC9, QC10, QC34, QC88, NE145, NE274 and 811. To the best of our knowledge, NE274 and NE145 were the first full-length genomes for confirming the provisionally assigned subtypes 3d and 3e, respectively, whereas 811 represented the first HCV-3 isolate that had its extreme 3′ UTR terminus sequenced. Based on these full-length genomes, together with 42 references representing eight assigned subtypes and an unclassified variant of HCV-3, and 10 sequences of six other genotypes, a timescaled phylogenetic tree was reconstructed after an evolutionary analysis using a coalescent Bayesian procedure. The results indicated that subtypes 3a, 3d and 3e formed a subset with a common ancestor dated to ~202.89 [95 % highest posterior density (HPD): 160.11, 264.6] years ago. The analysis of all of the HCV-3 sequences as a single lineage resulted in the dating of the divergence time to ~457.81 (95 % HPD: 350.62, 587.53) years ago, whereas the common ancestor of all of the seven HCV genotypes dated to ~780.86 (95 % HPD: 592.15, 1021.34) years ago. As subtype 3h and the unclassified variant were relatives, and represented the oldest HCV-3 lineages with origins in Africa and the Middle East, these findings may indicate the ancestral origin of HCV-3 in Africa. We speculate that the ancestral HCV-3 strains may have been brought to South Asia from Africa by land and/or across the sea to result in its indigenous circulation in that region. The spread was estimated to have occurred in the era after Vasco da Gama had completed his expeditions by sailing along the eastern coast of Africa to India. However, before this era, Arabians had practised slave trading from Africa to the Middle East and South Asia for centuries, which may have mediated the earliest spread of HCV-3. © 2014 The Authors.
Levesque J.-F.,Institute National Of Sante Publique Du Quebec |
Harris M.F.,University of New South Wales |
Russell G.,Monash University
International Journal for Equity in Health | Year: 2013
Background: Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services. Methods. A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework. Results: Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage. Conclusions: This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels. © 2013 Levesque et al.; licensee BioMed Central Ltd.
Pai N.P.,McGill University |
Balram B.,McGill University |
Shivkumar S.,McGill University |
Martinez-Cajas J.L.,Queen's University |
And 4 more authors.
The Lancet Infectious Diseases | Year: 2012
Background: The focus on prevention strategies aimed at curbing the HIV epidemic is growing, and therefore screening for HIV has again taken centre stage. Our aim was to establish whether a convenient, non-invasive, HIV test that uses oral fluid was accurate by comparison with the same test with blood-based specimens. Methods: We did a systematic review and meta-analysis to compare the diagnostic accuracy of a rapid HIV-antibody-based point-of-care test (Oraquick advance rapid HIV-1/2, OraSure Technologies Inc, PA, USA) when used with oral versus blood-based specimens in adults. We searched five databases of published work and databases of five key HIV conferences. Studies we deemed eligible were those focused on adults at risk of HIV; we excluded studies in children, in co-infected populations, with self-reported inferior reference standards, and with incomplete reporting of key data items. We assessed the diagnostic accuracy of testing with oral and blood-based specimens with bivariate regression analysis. We computed positive predictive values (PPVs) in high-prevalence and low-prevalence settings with Bayesian methods. Findings: In a direct head-to-head comparison of studies, we identified a pooled sensitivity about 2% lower in oral (98·03%, 95% CI 95·85-99·08) than in blood-based specimens (99·68%, 97·31-99·96), but similar specificity (oral 99·74%, 99·47-99·88; blood 99·91%, 99·84-99·95). Negative likelihood ratios were small and similar (oral 0·019, 0.009-0·040; blood 0·003, 0·001-0·034), but positive likelihood ratios differed (oral 383·37, 183·87-799·31; blood 1105·16, 633·14-2004·37). Although in high-prevalence settings PPVs were similar (oral 98·65%, 95% credible interval 85·71-99·94; blood 98·50, 93·10-99·79), in low-prevalence settings PPVs were lower for oral (88·55%, 77·31-95·87) than blood (97·65%, 95·48-99·09) specimens. Interpretation: Although Oraquick had a high PPV in high-prevelence settings in oral specimens, the slightly lower sensitivity and PPV in low-prevalence settings in oral specimens should be carefully reviewed when planning worldwide expanded initiatives with this popular test. Funding: Canadian Institutes for Health Research (CIHR KRS 102067). © 2012 Elsevier Ltd.
Panic M.,Institute National Of Sante Publique Du Quebec |
Ford J.D.,McGill University
International Journal of Environmental Research and Public Health | Year: 2013
Climate change is likely to have significant implications for human health, particularly through alterations of the incidence, prevalence, and distribution of infectious diseases. In the context of these risks, governments in high income nations have begun developing strategies to reduce potential climate change impacts and increase health system resilience (i.e., adaptation). In this paper, we review and evaluate national-level adaptation planning in relation to infectious disease risks in 14 OECD countries with respect to "best practices" for adaptation identified in peer-reviewed literature. We find a number of limitations to current planning, including negligible consideration of the needs of vulnerable population groups, limited emphasis on local risks, and inadequate attention to implementation logistics, such as available funding and timelines for evaluation. The nature of planning documents varies widely between nations, four of which currently lack adaptation plans. In those countries where planning documents were available, adaptations were mainstreamed into existing public health programs, and prioritized a sectoral, rather than multidisciplinary, approach. The findings are consistent with other scholarship examining adaptation planning indicating an ad hoc and fragmented process, and support the need for enhanced attention to adaptation to infectious disease risks in public health policy at a national level. © 2013 by the authors; licensee MDPI, Basel, Switzerland.
Naimi A.I.,McGill University |
Auger N.,Institute National Of Sante Publique Du Quebec
American Journal of Public Health | Year: 2015
Objectives. We assess whether population-wide folic acid fortification policies were followed by a reduction of preterm and early-term birth rates in Québec among women with short and optimal interpregnancy intervals. Methods. We extracted birth certificate data for 1.3 million births between 1981 and 2010 to compute age-adjusted preterm and early-term birth rates stratified by short and optimal interpregnancy intervals. We used Joinpoint regression to detect changes in the preterm and early term birth rates and assess whether these changes coincide with the implementation of population-wide folic acid fortification. Results. A change in the pretermbirth rate occurred in 2000 among women with short (95% confidence interval [CI] = 1994, 2005) and optimal (95% CI = 1995, 2008) interpregnancy intervals. Changes in early term birth rates did not coincide with the implementation of folic acid fortification. Conclusions. Our results do not indicate a link between folic acid fortification and early term birth but suggest an improvement in preterm birth rates after implementation of a nationwide folic acid fortification program. © 2015, American Public Health Association Inc. All rights reserved.
Blouin K.,Institute National Of Sante Publique Du Quebec
Sexually Transmitted Diseases | Year: 2016
BACKGROUND: Recent analyses have shown an emerging positive association between sex work and human immunodeficiency virus (HIV) incidence among people who inject drugs (PWIDs) in the SurvUDI network. METHODS: Participants who had injected in the past 6 months were recruited across the Province of Quebec and in the city of Ottawa, mainly in harm reduction programs. They completed a questionnaire and provided gingival exudate for HIV antibody testing. The associations with HIV seroconversion were tested with a Cox proportional hazard model using time-dependent covariables including the main variable of interest, sexual activity (sex work; no sex work; sexually inactive). The final model included significant variables and confounders of the associations with sexual activity. RESULTS: Seventy-two HIV seroconversions were observed during 5239.2 person-years (py) of follow-up (incidence rates: total = 1.4/100 py; 95% confidence interval [CI], 1.1–1.7; sex work = 2.5/100 py; 95% CI, 1.5–3.6; no sex work = 0.8/100 py; 95% CI, 0.5–1.2; sexually inactive = 1.8/100 py; 95% CI, 1.1–2.5). In the final multivariate model, HIV incidence was significantly associated with sexual activity (sex work: adjusted hazard ratio [AHR], 2.19; 95% CI, 1.13–4.25; sexually inactive: AHR, 1.62; 95% CI, 0.92–2.88), and injection with a needle/syringe used by someone else (AHR, 2.84; 95% CI, 1.73–4.66). CONCLUSIONS: Sex work is independently associated with HIV incidence among PWIDs. At the other end of the spectrum of sexual activity, sexually inactive PWIDs have a higher HIV incidence rate, likely due to more profound dependence leading to increased vulnerabilities, which may include mental illness, poverty, and social exclusion. Further studies are needed to understand whether the association between sex work and HIV is related to sexual transmission or other vulnerability factors. © Copyright 2016 American Sexually Transmitted Diseases Association
Pampalon R.,Institute National Of Sante Publique Du Quebec |
Hamel D.,Institute National Of Sante Publique Du Quebec |
Gamache P.,Institute National Of Sante Publique Du Quebec
Health and Place | Year: 2010
Social health inequalities are smaller in rural than urban areas because, some argue, people's social conditions are estimated at a small-area level, hiding variability at the individual or household level. This paper compares inequalities in survival according to an individual and area-based version of a deprivation index among a large sample of Canadians living in various urban and rural settings. Results show that survival inequalities in small towns and rural areas are lower than elsewhere when an area-based index is used, except in the remote hinterland, but of equal magnitude when the individual version of this index is considered. Crown Copyright © 2009.