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Ratnayake R.,Public Health Agency of Canada | Ratnayake R.,Montreal Health and Social Services Agency | Allard R.,Montreal Health and Social Services Agency | Allard R.,McGill University | And 2 more authors.
Epidemiology and Infection | Year: 2012

Historically, Shigella sonnei has dominated other Shigella species infection in men who have sex with men (MSM) in Montreal. In early 2010, Toronto reported increased proportions of the more pathogenic S. flexneri, HIV co-infection and MSM in shigellosis cases since 2009. Analytical methods were used to assess whether S. flexneri had dominated Montreal's MSM cases since 2009 and whether changes had occurred in notifications in MSM and HIV-co-infected MSM. S. flexneri increased by 67% per month since 2007 and predominated in MSM since 2009 without changes in HIV co-infection or similar shifts in the general population. The results suggest that the surveillance of Shigella species in order to detect species shifts is beneficial for surveillance, given the potential for increased transmission and severity of S. flexneri in HIV-positive MSM. © Copyright Cambridge University Press and the Government of Canada, represented by the Public Health Agency of Canada 2012.


Fuller D.,University of Montréal | Gauvin L.,University of Montréal | Kestens Y.,University of Montréal | Kestens Y.,Montreal Health and Social Services Agency | And 5 more authors.
American Journal of Preventive Medicine | Year: 2011

Background: Cycling contributes to physical activity and health. Public bicycle share programs (PBSPs) increase population access to bicycles by deploying bicycles at docking stations throughout a city. Minimal research has systematically examined the prevalence and correlates of PBSP use. Purpose: To determine the prevalence and correlates of use of a new public bicycle share program called BIXI (name merges the word BIcycle and taXI) implemented in May 2009 in Montreal, Canada. Methods: A total of 2502 adults were recruited to a telephone survey in autumn 2009 via random-digit dialing according to a stratified random sampling design. The prevalence of BIXI bicycle use was estimated. Multivariate logistic regression allowed for identification of correlates of use. Data analysis was conducted in spring and summer 2010. Results: The unweighted mean age of respondents was 47.4 (SD=16.8) years and 61.4% were female. The weighted prevalence for use of BIXI bicycles at least once was 8.2%. Significant correlates of BIXI bicycle use were having a BIXI docking station within 250 m of home, being aged 1824 years, being university educated, being on work leave, and using cycling as the primary mode of transportation to work. Conclusions: A newly implemented public bicycle share program attracts a substantial fraction of the population and is more likely to attract younger and more educated people who currently use cycling as a primary transportation mode. © 2011 American Journal of Preventive Medicine.


Tousignant P.,Agency Systems | Tousignant P.,McGill University | Diop M.,Agency Systems | Fournier M.,Montreal Health and Social Services Agency | And 4 more authors.
Annals of Family Medicine | Year: 2014

PURPOSE In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (personal provider continuity, KPC-PP).METHODS Patients with diabetes or cardiovascular disease (N = 765) were approached in the waiting rooms of 28 primary care clinics in 3 regions of the province of Quebec, Canada; answered a survey questionnaire measuring relational continuity, interpersonal communication, coordination within the clinic, coordination with specialists, and overall coordination; and gave permission for their medical records to be reviewed and their medical services utilization data for the previous 2 years to be accessed to measure KPC. Using generalized linear mixed models, we assessed the association between KPC and the patients’ responses.RESULTS Among the 5 different patient-reported measures or their combination, KPC-MP was significantly related with overall coordination of care: for high continuity, the odds ratio (OR) = 2.02 (95% CI, 1.33-3.07), and for moderate continuity, OR = 1.61 (95% CI, 1.06-2.46). KPC-MP was also related with the combined continuity score: for high continuity, OR = 1.52 (95% CI, 1.11-2.09), and for moderate continuity, OR = 1.48 (95% CI, 1.10-2.00). KPC-PP was not significantly associated with any of the survey measures.CONCLUSIONS The KPC-MP measure, based on readily available administrative data, is associated with patient-perceived overall coordination of care among multiple physicians. KPC measures are potentially a valuable and low-cost way to follow the effects of changes favoring group practice on continuity of care for entire populations. They are easy to replicate over time and across jurisdictions.


MacDonald J.-A.M.,University of Prince Edward Island | Gagnon A.J.,McGill University | Mitchell C.,McGill University | Di Meglio G.,McGill University | And 2 more authors.
Qualitative Health Research | Year: 2011

Encouraging youth voice, visibility, and active participation in adolescent-related research is strongly advocated in the literature. In this article, we describe how participatory approaches informed by arts-based methods (e.g., reflective writing, dramatization) were used with adolescents to enhance the research process in an exploratory study designed to develop and evaluate prevention resources for sexual risk-taking behaviors.Youth aged 15 to 17 years participated in iterative focus groups conducted over a 1-year period in school settings in Prince Edward Island, Canada. Descriptions of our experiences, strategies, and insights provide evidence for guiding practice to optimize adolescent participation in research. © 2011 The Author(s).


Roy E.,Université de Sherbrooke | Roy E.,Montreal Health and Social Services Agency | Arruda N.,University of Québec | Vaillancourt E.,Université de Sherbrooke | And 5 more authors.
Drug and Alcohol Review | Year: 2012

Introduction and Aims. A study was undertaken to verify reports of an increasing presence of crack in downtown Montréal, and to investigate the influence of crack availability on current drug use patterns among street-based cocaine users. Design and Methods. The study combined both qualitative and quantitative methods. These included long-term intensive participant observation carried out by an ethnographer familiar with the field and a survey. The ethnographic component involved observations and unstructured interviews with 64 street-based cocaine users. Sampling was based on a combination of snowballing and purposeful recruitment methods. For the survey, structured interviews were conducted with a convenience sample of 387 cocaine users attending HIV/HCV prevention programs, downtown Montréal. Results. A gradual shift has occurred in the last 10years, with the crack street market overtaking the powder cocaine street market. Although the data pointed to an increase in crack smoking, 54.5% of survey participants both smoked and injected cocaine. Drug market forces were major contributing factors to the observed modes of cocaine consumption. While the study focused primarily on cocaine users, it became apparent from the ethnographic fieldwork that prescription opioids (POs) were very present on the streets. According to the survey, 52.7% of participants consumed opioids, essentially POs, with 88% of them injecting these drugs. Discussion and Conclusions. Despite the increased availability of crack, injection is still present among cocaine users due at least in part to the concurrent increasing popularity of POs. © 2011 Australasian Professional Society on Alcohol and other Drugs.


Allard R.,Montreal Health and Social Services Agency | Allard R.,McGill University | Allard R.,University of Montréal | Leclerc P.,Montreal Health and Social Services Agency | And 4 more authors.
Diabetes Care | Year: 2010

OBJECTIVE - To confirm the existence of an increased risk of complications from influenza A (H1N1)p among patients with diabetes. RESEARCH DESIGN AND METHODS - Using data from an enhanced influenza surveillance project in Montreal, Canada, and age/sex-specific population estimates of diabetes prevalence, we estimated the risk of hospitalization among persons with diabetes. Comparing hospitalized patients admitted or not to an intensive care unit (ICU), we estimated the risk of ICU admission associated with diabetes, controlling for other patient characteristics. RESULTS - Among 239 hospitalized patients with PCR-confirmed influenza A (H1N1)p, 162 (68%) were interviewed, of whom 22 had diabetes, when 7.1 were expected (prevalence ratio 3.10 [95% CI 2.04-4.71]). The odds ratio for ICU admission was 4.29 (95% CI 1.29-14.3) among hospitalized patients with diabetes compared to those without. CONCLUSIONS - Diabetes triples the risk of hospitalization after influenza A (H1N1)p and quadruples the risk of ICU admission once hospitalized. © 2010 by the American Diabetes Association.


Miranda-Moreno L.F.,McGill University | Strauss J.,McGill University | Morency P.,Montreal Health and Social Services Agency
Transportation Research Record | Year: 2011

This paper proposes a new approach to represent cyclist risk exposure. This approach considers disaggregate motor vehicle and cyclist flows and develops cyclist injury frequency models. Three definitions of risk exposure were used in this research, including aggregated flows, motor vehicle flows aggregated by movement type, and potential conflicts between motor vehicles and cyclists. As an application environment, a large sample of signalized intersections on the island of Montreal, QCbec, Canada, was used, along with data that comprised disaggregate motor vehicle and cyclist flows. Several negative binomial models were fitted to the data. This study showed that cyclist collisions were sensitive to changes in both cyclist and motor vehicle flows. A 10% increase in bicycle flow was associated with a 4.4% increase in the frequency of cyclist injuries. A 10% increase in the total number of motor vehicles that passed through the intersection would result in a 3.4% increase in cyclist injury occurrence. When motor vehicle flows were considered on the basis of movement type, right-turn movements had a great effect on injury occurrence. Similar results, which identified right turns as having the greatest effect on cyclist injuries, were produced when the impact of potential conflicts was determined. The number of bus stops in the proximity of the intersection increased cyclist injury occurrence. Some geometric design factors, such as the presence of a median, parking entrance, and the number of intersection legs, were tested. The effect, however, was found to be statistically nonsignificant.


Haggerty J.L.,McGill University | Roberge D.,Université de Sherbrooke | Levesque J.-F.,Montreal Health and Social Services Agency | Levesque J.-F.,Institute National Of Sante Publique Du Quebec Inspq | And 3 more authors.
Health and Place | Year: 2014

Comparing accessibility between urban and rural areas requires measurement instruments that are equally discriminating in each context. Through focus groups we explored and compared care-seeking trajectories to understand context-specific accessibility barriers and facilitators. Rural care-seekers rely more on telephone access and experience more organizational accommodation but have fewer care options. Urban care-seekers invoke the barrier of distance more frequently. Four consequences of accessibility problems emerged across settings which could be used for valid comparisons of access: having to restart the care-seeking process, abandoning it, using emergency services for primary care, and health deterioration due to delay. © 2014 Elsevier Ltd.


Tremblay M.-C.,University of Montréal | Richard L.,University of Montréal | Brousselle A.,Université de Sherbrooke | Brousselle A.,Charles yne Hospital Research Center | Beaudet N.,Montreal Health and Social Services Agency
Health Promotion International | Year: 2014

In recent decades, reflexivity has received much attention in the professional education and training literature, especially in the public health and health promotion fields. Despite general agreement on the importance of reflexivity, there appears to be no consensus on how to assess reflexivity or to conceptualize the different forms developed among professionals and participants of training programs. This paper presents an analysis of the reflexivity outcomes of the Health Promotion Laboratory, an innovative professional development program aimed at supporting practice changes among health professionals by fostering competency development and reflexivity. More specifically, this paper explores the difference between two levels of reflexivity (formative and critical) and highlights some implications of each for practice. Data were collected through qualitative interviews with participants from two intervention sites. Results showed that involvement in the Health Promotion Laboratory prompted many participants to modify their vision of their practice and professional role, indicating an impact on reflexivity. In many cases, new understandings seem to have played a formative function in enabling participants to improve their practice and their role as health promoters. The reflective process also served a critical function culminating in a social and moral understanding of the impacts on society of the professionals' practices and roles. This type of outcome is greatly desired in health promotion, given the social justice and equity concerns of this field of practice. By redefining the theoretical concept of reflexivity on two levels and discussing their impacts on practice, this study supports the usefulness of both levels of reflexivity. ©The Author (2013).


Richard L.,University of Montréal | Kosatsky T.,Montreal Health and Social Services Agency | Renouf A.,Montreal Health and Social Services Agency | Renouf A.,University of Quebec at Montréal
Health Education Research | Year: 2011

Extreme ambient heat is a serious public health threat, especially for the elderly and persons with pre-existing health conditions. Although much of the excess mortality and morbidity associated with extreme heat is preventable, the adoption of effective preventive strategies is limited. The study reported here tested the predictive power of selected components of the Health Belief Model for air-conditioning (AC) use among 238 non-institutionalized middle-aged and older adults with chronic heart failure and/or chronic obstructive pulmonary disease living in Montréal, Canada. Respondents were recruited through clinics (response rate 71%) and interviews were conducted in their homes or by telephone. Results showed that 73% of participants reported having a home air conditioner. The average number of hours spent per 24-hour period in air-conditioned spaces during heat waves was 14.5 hours (SD = 9.4). Exploratory structural equation modeling showed that specific beliefs about the benefits of and drawbacks to AC as well as internal cues to action were predictive of its level of use, whereas the perceived severity of the effects of heat on health was not. The findings are discussed in light of the need to adequately support effective response to extreme heat in this vulnerable population. © The Author 2010. Published by Oxford University Press. All rights reserved.

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