Ministere de la Sante et des Services Sociaux du Quebec

Montréal, Canada

Ministere de la Sante et des Services Sociaux du Quebec

Montréal, Canada
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Ouhoummane N.,Institute National Of Sante Publique Du Quebec | Steben M.,Institute National Of Sante Publique Du Quebec | Steben M.,University of Montréal | Vuong T.,Jewish General Hospital | And 5 more authors.
Cancer Epidemiology | Year: 2013

Background: Infection with high risk human papillomavirus (HPV) is strongly associated with anal cancer. However, detailed studies on HPV type distribution by gender and age are limited. Methods: Retrospective study of 606 invasive anal cancers diagnosed between 1990 and 2005 in two large urban areas of the province of Québec, Canada. Cases were identified from hospitalization registry. Patient characteristics were collected from medical files. Archived anal squamous cancer specimens were available from 96 patients and were tested for HPV DNA and typing. Variant analysis was performed on 16 consecutive and 24 non-consecutive HPV16-positive samples to assess potential contamination during amplification. Results: Among the 606 patients with anal cancers, 366 (60%) were women. Median age at diagnosis was 63 years. HPV was detected in 88/96 (92%) of cases. HPV16 was the most frequent type detected in 90% of HPV-positive specimens. Other types including 6, 11, 18, 33, 52, 53, 56, 58, 62 and 82 were also found. HPV 97 was not detected. HPV prevalence was associated with female gender and younger age. No contamination occurred during amplification as shown by the subset of 41 HPV16-positive samples, as 37, 2 and 1 isolates were from the European, African and Asian lineages, respectively. The most frequent variants were G1 (n= 22) and the prototype (n= 12). Conclusions: Women with anal cancer are at higher risk for anal HPV infection, and HPV infection, especially HPV16, is strongly associated with squamous anal cancer. Therefore, HPV vaccine could potentially prevent the occurrence of anal cancer in both men and women. © 2013 Elsevier Ltd.


Rouleau I.,University of Québec | De Serres G.,University of Québec | De Serres G.,Institute National Of Sante Publique Du Quebec | Drolet J.P.,University of Québec | And 6 more authors.
Vaccine | Year: 2013

Background: Anaphylaxis after trivalent influenza vaccination is typically reported at a rate of <1 per million doses. In Quebec, Canada, anaphylaxis following administration of the monovalent AS03-adjuvanted H1N1pdm09 vaccine was reported through passive surveillance at a rate of 8 per million doses administered. This was 20 times higher than the reporting rate for non-adjuvanted trivalent vaccines administered during the six previous seasons. However, adequate estimation of the incidence of anaphylaxis is hindered by wide variations in definitions and diagnosis. Methods: Using the Brighton collaboration case definition of anaphylaxis, all cases with allergic symptoms (AS) reported to public health were reviewed to estimate the incidence of anaphylaxis following AS03-adjuvanted H1N1pdm09 vaccine. Results: Among 752 reports of allergic symptoms, 33 were initially reported as anaphylaxis of which 20/33 (60%) met the Brighton definition (19/20 with certainty levels 1 or 2). A total of 38 additional cases with onset within 1. h of vaccination also met the Brighton definition of anaphylaxis (27 (71%) with certainty levels 1 or 2). The 58 cases meeting Brighton Level 1 or 2 criteria for anaphylaxis represent a 75% increase over the 33 passively reported and an incidence of 13 per million doses administered. Conclusion: A substantial number of patients with early-onset allergic symptoms met the most specific levels of the Brighton case definition but were not reported as anaphylaxis. Based on this specific case definition, the incidence of anaphylaxis after AS03-adjuvanted H1N1pdm09 vaccine substantially exceeded that reported with seasonal influenza vaccines, a signal that warrants better understanding. © 2013 Elsevier Ltd.


PubMed | Institute National Of Sante Publique Du Quebec, Université de Sherbrooke and Ministere de la Sante et des Services sociaux du Quebec
Type: Journal Article | Journal: American journal of infection control | Year: 2014

A decrease in seasonal influenza vaccine uptake was observed after the influenza A(H1N1) pandemic in 2009. The goal of our study was to assess seasonal influenza vaccine uptake in 2011-2012, 2 years after the influenza A(H1N1) pandemic mass immunization campaign and to identify the main reasons for having or not having received the vaccine.A telephone survey using random-digit dialing methodology was conducted. Case-weights were assigned to adjust for disproportionate sampling and for nonresponse bias. Descriptive statistics were generated for all variables.Seasonal influenza vaccine uptake was 57% among adults aged 60 years, 35% among adults with chronic medical conditions, and 44% among health care workers. The main reasons given for having been vaccinated were to be protected from influenza and a high perceived susceptibility to influenza, whereas low perceived susceptibility to influenza and low perceived severity of influenza were the main reasons for not having been vaccinated.An increase in seasonal influenza vaccine uptake was observed 2 years after the influenza A(H1N1) pandemic. However, vaccine coverage is still below the target level of 80%. More efforts are needed to develop effective strategies to increase seasonal influenza vaccine uptake.


PubMed | Institute National Of Sante Publique Du Quebec, Revivre Quebec Anxiety, Ordre des infirmieres et infirmiers du Quebec, Université de Sherbrooke and 5 more.
Type: Journal Article | Journal: Journal of evaluation in clinical practice | Year: 2016

Mental health services for patients with a major depressive disorder are commonly delivered by primary care. To support the uptake of clinical practice guidelines in primary care, we developed and disseminated a practice protocol for depression tailored for a multidisciplinary audience of primary mental health care providers with the ADAPTE methodology. The research questions addressed in this study aimed at examining the experience of the development process of a mental health practice protocol in terms of adaptation, facilitation and implementation.We present a descriptive case study of the development and implementation of a practice protocol for major depressive disorder for primary mental health care in the organizational and cultural context of the province of Qubec (Canada), following the steps of the ADAPTE methodology. An expert committee composed of general practitioners, mental health specialists, health care administrators and decision makers at regional and provincial levels participated in the protocol development process.The practice protocol was based on two clinical practice guidelines: the NICE guideline on the treatment and management of depression in adults (2009, 2010) and the Canadian Network for Mood and Anxiety Treatments clinical guidelines for the management of major depressive disorder in adults (2009). A stepped care model was embedded in the protocol to facilitate the implementation of clinical recommendations in primary mental health care. A multifaceted dissemination strategy was used to support the uptake of the protocol recommendations in clinical practice.The ADAPTE methodology provided structure, rigour and efficiency to the trans-contextual adaptation of guideline recommendations. We will share the challenges associated with the adaptation of clinical recommendations and organizational strategies for a mental health guideline, and the dissemination of the practice protocol in primary care.


Savard N.,Ministere de la Sante et des Services sociaux du Quebec | Levallois P.,Laval University | Levallois P.,Institute National Of Sante Publique Du Quebec | Rivest L.P.,Laval University | Gingras S.,Institute National Of Sante Publique Du Quebec
Chronic Diseases and Injuries in Canada | Year: 2016

Background: In Quebec, women living on low income receive a number of additional prenatal care visits, determined by their area of residence, of both multi-component and food supplementation programs. We investigated whether increasing the number of visits reduces the odds of the main outcome of small for gestational age (SGA) birth (weight o 10th percentile on the Canadian scale). Methods: In this ecological study, births were identified from Quebec’s registry of demographic events between 2006 and 2008 (n = 156 404; 134 areas). Individual characteristics were extracted from the registry, and portraits of the general population were deduced from data on multi-component and food supplement interventions, the Canadian census and the Canadian Community Health Survey. Mothers without a high school diploma were eligible for the programs. Multilevel logistic regression models were fitted using generalized estimating equations to account for the correlation between individuals on the same territory. Potential confounders included sedentary behaviour and cigarette smoking. The odds ratios (ORs) were adjusted for mother’s age, marital status, parity, program coverage and mean income in the area. Results: Mothers eligible for the programs remain at a higher odds of SGA than non-eligible mothers (OR = 1.40; 95% confidence interval [CI]: 1.30-1.51). Further, areas that provide more visits to eligible mothers (4-6 food supplementation visits) seem more successful at reducing the frequency of SGA birth than those that provide 1-2 or 3 visits (OR = 0.86; 95% CI: 0.75-0.99). Conclusions: Further studies that validate whether an increase in the number of prenatal care interventions reduces the odds of SGA birth in different populations and evaluate other potential benefits for the children should be done. © 2016, Public Health Agency of Canada. All rights reserved.


Haiek L.N.,Ministere de la Sante et des Services Sociaux du Quebec
Public Health Nutrition | Year: 2012

Objective: The WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) is an effective strategy to increase breast-feeding exclusivity and duration but many countries have been slow to implement it. The present paper describes the development of a computer-based instrument that measures policies and practices outlined in the BFHI. Design: The tool uses clinical staff/managers' and pregnant women/mothers' opinions as well as maternity unit observations to assess compliance with the BFHI's Ten Steps to Successful Breastfeeding (Ten Steps) and the International Code of Marketing of Breastmilk Substitutes (Code) by measuring the extent of implementation of two to fourteen indicators for each step and the Code. Composite scores are used to summarize results. Setting: Examples of results from a 2007 assessment performed in nine hospitals in the province of Québec are presented to illustrate the type of information returned to individual hospitals and health authorities. Subjects: Participants included nine to fifteen staff/managers per hospital randomly selected among those present during the interviewer-observer's 12 h hospital visit and nine to forty-five breast-feeding mothers per hospital telephoned at home after being randomly selected from birth certificates. Results: The Ten Steps Global Compliance Score for the nine hospitals varied between 2·87 and 6·51 (range 0-10, mean 5·06) whereas the Code Global Compliance Score varied between 0·58 and 1 (range 0-1, mean 0·83). Instrument development, examples of assessment results and potential applications are discussed. Conclusions: A methodology to measure BFHI compliance may help support the implementation of this effective intervention and contribute to improved maternal and child health.


De Serres G.,Institute National Of Sante Publique Du Quebec | De Serres G.,Laval University | Markowski F.,Ministere de la Sante et des Services Sociaux du Quebec | Toth E.,Ministere de la Sante et des Services Sociaux du Quebec | And 9 more authors.
Journal of Infectious Diseases | Year: 2013

Background. The largest measles epidemic in North America in the last decade, occurred in 2011 in Quebec, Canada, where rates of 1-and 2-dose vaccine coverage among children 3 years of age were 95%-97% and 90%, respectively, with 3%-5% unvaccinated.Methods. Case patients identified through passive surveillance and outbreak investigation were contacted to determine clinical course, vaccination status, and possible source of infection.Results. There were 21 measles importations and 725 cases. A superspreading event triggered by 1 importation resulted in sustained transmission and 678 cases. The overall incidence was 9.1 per 100 000; the highest incidence was in adolescents 12-17 years old (75.6 per 100 000), who comprised 56% of case patients. Among adolescents, 22% had received 2 vaccine doses. Outbreak investigation showed this proportion to have been an underestimate; active case finding identified 130% more cases among 2-dose recipients. Two-dose recipients had milder illness and a significantly lower risk of hospitalization than those who were unvaccinated or single-dose recipients.Conclusions. A chance superspreading event revealed an overall level of immunity barely above the elimination threshold when unexpected vulnerability in 2-dose recipients was taken into account. Unvaccinated individuals remain the immunization priority, but a better understanding of susceptibility in 2-dose recipients is needed to define effective interventions if elimination is to be achieved. © 2013 The Autho.


Ly A.,Ministere de la Sante et des Services Sociaux du Quebec | Latimer E.,McGill University | Latimer E.,Douglas Institute Research Center
Canadian Journal of Psychiatry | Year: 2015

Objective: Housing First (HF) programs for people who are chronically or episodically homeless, combining rapid access to permanent housing with community-based, integrated treatment, rehabilitation and support services, are rapidly expanding in North America and Europe. Overall costs of services use by homeless people can be considerable, suggesting the potential for significant cost offsets with HF programs. Our purpose was to provide an updated literature review, from 2007 to the present, focusing specifically on the cost offsets of HF programs. Method: A systematic review was performed on MEDLINE and PsycINFO as well as Google and the Homeless Hub for grey literature. Study characteristics and key findings were extracted from identified studies. Where available, impact on service cost associated with HF (increase or decrease) and net impact on overall costs, taking into account the cost of HF intervention, were noted. Results: Twelve published studies (4 randomized studies and 8 quasi-experimental) and 22 unpublished studies were retained. Shelter and emergency department costs decreased with HF, while impacts on hospitalization and justice costs are more ambiguous. Studies using a pre-post design reported a net decrease in overall costs with HF. In contrast, experimental studies reported a net increase in overall costs with HF. Conclusions: While our review casts doubt on whether HF programs can be expected to pay for themselves, the certainty of significant cost offsets, combined with their benefits for participants, means that they represent a more efficient allocation of resources than traditional services. © 2015 Pfizer Canada Inc. Kirkland, Quebec.


PubMed | Institute National Of Sante Publique Du Quebec, Ministere de la Sante et des Services sociaux du Quebec and Laval University
Type: Journal Article | Journal: Health promotion and chronic disease prevention in Canada : research, policy and practice | Year: 2016

In Quebec, women living on low income receive a number of additional prenatal care visits, determined by their area of residence, of both multi-component and food supplementation programs. We investigated whether increasing the number of visits reduces the odds of the main outcome of small for gestational age (SGA) birth (weight < 10th percentile on the Canadian scale).In this ecological study, births were identified from Quebecs registry of demographic events between 2006 and 2008 (n = 156 404; 134 areas). Individual characteristics were extracted from the registry, and portraits of the general population were deduced from data on multi-component and food supplement interventions, the Canadian census and the Canadian Community Health Survey. Mothers without a high school diploma were eligible for the programs. Multilevel logistic regression models were fitted using generalized estimating equations to account for the correlation between individuals on the same territory. Potential confounders included sedentary behaviour and cigarette smoking. The odds ratios (ORs) were adjusted for mothers age, marital status, parity, program coverage and mean income in the area.Mothers eligible for the programs remain at a higher odds of SGA than non-eligible mothers (OR = 1.40; 95% confidence interval [CI]: 1.30-1.51). Further, areas that provide more visits to eligible mothers (4-6 food supplementation visits) seem more successful at reducing the frequency of SGA birth than those that provide 1-2 or 3 visits (OR = 0.86; 95% CI: 0.75-0.99).Further studies that validate whether an increase in the number of prenatal care interventions reduces the odds of SGA birth in different populations and evaluate other potential benefits for the children should be done.


PubMed | Ministere de la Sante et des Services sociaux du Quebec
Type: Journal Article | Journal: Public health nutrition | Year: 2012

The WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) is an effective strategy to increase breast-feeding exclusivity and duration but many countries have been slow to implement it. The present paper describes the development of a computer-based instrument that measures policies and practices outlined in the BFHI.The tool uses clinical staff/managers and pregnant women/mothers opinions as well as maternity unit observations to assess compliance with the BFHIs Ten Steps to Successful Breastfeeding (Ten Steps) and the International Code of Marketing of Breastmilk Substitutes (Code) by measuring the extent of implementation of two to fourteen indicators for each step and the Code. Composite scores are used to summarize results.Examples of results from a 2007 assessment performed in nine hospitals in the province of Qubec are presented to illustrate the type of information returned to individual hospitals and health authorities.Participants included nine to fifteen staff/managers per hospital randomly selected among those present during the interviewer-observers 12 h hospital visit and nine to forty-five breast-feeding mothers per hospital telephoned at home after being randomly selected from birth certificates.The Ten Steps Global Compliance Score for the nine hospitals varied between 2.87 and 6.51 (range 0-10, mean 5.06) whereas the Code Global Compliance Score varied between 0.58 and 1 (range 0-1, mean 0.83). Instrument development, examples of assessment results and potential applications are discussed.A methodology to measure BFHI compliance may help support the implementation of this effective intervention and contribute to improved maternal and child health.

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