Louis Rochette - Academia.edu (original) (raw)
Papers by Louis Rochette
Cmaj Canadian Medical Association Journal Journal De L Association Medicale Canadienne, Feb 17, 2004
rinary tract infection (UTI), one of the most frequent infectious diseases in older women, is ass... more rinary tract infection (UTI), one of the most frequent infectious diseases in older women, is associated with significant morbidity. 1 Factors contributing to the higher incidence of UTI with age include urinary tract anomalies, changes in hormonal status, decline in the immune system, and high rates of incontinence, malnutrition, functional disability and coexisting illnesses. 2 The optimal duration of antibiotic therapy in older women is still a matter of debate. 3-5 A short course of therapy (e.g., 3 days) appears generally effective in young women, 6,7 but this approach has not been validated in older women, possibly because of concerns about the vulnerability of this population. In many geriatric settings, the typical duration of treatment ranges from 5 to 10 days. A shorter course of treatment might offer significant advantages in terms of improved compliance and fewer drug interactions and side effects, but efficacy must be clearly demonstrated before this approach is implemented. The objective of this randomized controlled double-blind noninferiority trial was to compare 3-day and 7-day courses of oral antibiotic therapy (ciprofloxacin) for the management of uncomplicated symptomatic UTI in older women.
Canadian Journal of Public Health, 2003
Objectif : Une enquete postale a ete realisee au Quebec pour connaitre les facteurs associes a un... more Objectif : Une enquete postale a ete realisee au Quebec pour connaitre les facteurs associes a une vaccination incomplete a l'âge de 2 ans. Methodes : Les parents de 430 enfants completement vaccines et 266 enfants incompletement vaccines ont ete selectionnes a partir des registres de vaccination. Resultats : Le fait de ne pas avoir recu simultanement le 2e RRO et le 4e DCT-P-Hib prevus a l'âge de 18 mois etait responsable de 46 % des incompletudes au calendrier vaccinal. Les caracteristiques suivantes etaient egalement associees au statut vaccinal incomplet : la monoparentalite, etre dans une famille de 2 enfants ou plus, l'âge au premier vaccin (≥3 mois), la preference des parents de ne pas faire donner 2 vaccins le meme jour, la perception d'un manque d'information et un desaccord avec les recommandations vaccinales. Conclusion: Le fait saillant de cette etude est l'impact de ne pas administrer le meme jour les deux vaccins prevus a 18 mois. La monoparentalite et l'âge tardif au premier vaccin pourraient etre utilisees comme marqueurs pour intervenir precocement aupres des enfants plus a risque de ne pas completer leur calendrier vaccinal. On constate aussi que meme si les parents sont generalement favorables a la vaccination, ils ont besoin d'etre bien informes sur les avantages et les risques associes.
The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses
Revue d Épidémiologie et de Santé Publique
We analyzed data from the notifiable diseases data base in Québec to document the incidence of gi... more We analyzed data from the notifiable diseases data base in Québec to document the incidence of giardiasis. The objectives were to perform a descriptive analysis of the cases of giardiasis and to verify the relation between their incidence and the quality of drinking water. The Québec notifiable diseases data-base contained 4273 cases of giardiasis declared between January 1st, 1990 and December 31st, 1995. Incidence rates were adjusted for age and calculated monthly. The sources and kinds of treatment of drinking water permitted to elaborate a vulnerability scale for classifying contamination by Giardia sp. into four categories. Incidence of giardiasis was examined in relation with this vulnerability scale. Other socioeconomic indicators possibly associated with the incidence of giardiasis were also analyzed. Analysis showed that there were few annual variations in the incidence of giardiasis and that there were no epidemic peaks during the study period. According to age, the incide...
The province of Quebec, as many other jurisdicons, is concerned with the probable dramatic effec... more The province of Quebec, as many other jurisdicons, is concerned with the probable dramatic effects of climate change on its population health. Beyond emergency preparedness, one of the main challenges of public health instuons is to implement prevenve acons that are adequate in terms of their efficiency in the reducon of morbidity and mortality, but also in terms of their financial costs. Promong urban green spaces conservaon and expansion is one such prevenve acon with mulple beneficial impacts for health and other co‐benefits. We present here a research project related to the posive effect of green spaces on popula‐ on health in urbanized regions in the province of Quebec. We developed green spaces aracveness models based on mulple qualitave variables. We used a retrospecve populaon cohort of 16 years follow‐up with 10 631 587 individuals to develop spaal models describing the relationship between green space and cardiovascular morbidity and mortality at zip co...
Ce rapport présente les résultats du volet nutritionnel de l’Enquête sur la santé dans les collec... more Ce rapport présente les résultats du volet nutritionnel de l’Enquête sur la santé dans les collectivités canadiennes (ESCC 2.2) qui a été réalisée en 2004 auprès d’un échantillon représentatif de Québécois. Les résultats présentés concernent les adultes québécois âgés de 19 ans et plus et ont été obtenus par l’analyse des données recueillies à partir de rappels alimentaires de 24 heures. Le volet nutritionnel de l’ESCC 2.2 représente ainsi une importante source de données qui ont permis d’actualiser les connaissances sur la consommation alimentaire et les apports nutritionnels des adultes québécois.
International journal of circumpolar health, 2011
To assess the prevalence and main types of anemia present among non-pregnant Inuit women of Nunav... more To assess the prevalence and main types of anemia present among non-pregnant Inuit women of Nunavik using a representative sample. A cross-sectional population-based study. Methods. Iron status was assessed in 466 women aged 18-74 who participated in the 2004 Nunavik Inuit Health Survey. The presence of different types of anemia has been evaluated based on available biochemical indicators of vitamins and of iron status. The correlation between iron status indicators, vitamin status parameters, inflammation markers and heavy metal concentrations was also assessed. Anemia was present in 43% of the Inuit women in Nunavik and 21% suffered from iron deficiency anemia (IDA). The main type of anemia present among women 18-49 years old was IDA (61% of anemia cases) while anemic women 50 years and over suffered mainly from anemia related to chronic inflammation (ACI) (42%). Over 99% of women had normal values for vitamin A, vitamin B12 and folate. Of interest is that ferritin was positively ...
Chronic diseases and injuries in Canada, 2012
Studies suggest that hypertension is more prevalent in the most deprived. Our objective was to ex... more Studies suggest that hypertension is more prevalent in the most deprived. Our objective was to examine the association between incident hypertension and deprivation in Quebec based on different modes of case identification, using two administrative databases. We identified new incident cases of hypertension in 2006/2007 in the population aged 20 years plus. Socio-economic status was determined using a material and social deprivation index. Negative binomial regression analyses were carried out to examine the association between incident hypertension and deprivation, adjusting for several covariates. We found a positive and statistically significant association between material deprivation and incident hypertension in women, irrespective of the identifying database. Using the hospitalization database, the incidence of hypertension increased for both sexes as deprivation increased, except for social deprivation in women. However, whether using the physician billing data base or the va...
Zoonoses and public health, 2012
In Nunavik, common practices and food habits such as consumption of raw meat and untreated water ... more In Nunavik, common practices and food habits such as consumption of raw meat and untreated water place the Inuit at risk for contracting zoonotic diseases. The aim of this study was to determine the seroprevalence of seven zoonotic infections among the permanent residents of Nunavik. The study was conducted in the fall 2004 as part of the Nunavik Health Survey. Blood samples from adults aged 18-74 years (n = 917) were collected and analysed for the presence of antibodies against Trichinella spp., Toxocara canis, Echinococcus granulosus, Brucella spp., Coxiella burnetii, Leptospira spp. and Francisella tularensis. Information on sociodemographic characteristics, traditional activities, drinking water supply and nutrition was gathered using english/inuktitut bilingual questionnaires. The chi-squared test was used to evaluate associations between seropositivity and other measured variables. Statistically significant variables were included in a multivariate logistic regression model to...
The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses, 2002
To characterize the incidence and duration of hospitalization due to diarrhea and to assess the p... more To characterize the incidence and duration of hospitalization due to diarrhea and to assess the proportion of hospitalizations that are attributed to rotavirus-associated diarrhea. Retrospective study of hospitalization data. Hospitals located in Quebec. Children from one to 59 months of age who were discharged from hospital from April 1, 1985 to March 31, 1998. There were 63,827 hospitalizations for diarrhea over the study period, for an average of 4910 hospitalizations/year. The epidemic curve showed a periodicity with regular alternation of high and low annual peaks. The number of hospitalizations for rotavirus-associated diarrhea was estimated according to three different methods. The estimates varied between 1353 and 1849 hospitalizations due to rotavirus-associated diarrhea/year over the 13-year period, with good agreement between the results of the three methods for a one-month to five years of age incidence of 320 hospitalizations for rotavirus-associated diarrhea/100,000 ch...
Canadian journal of public health = Revue canadienne de santé publique
A survey was conducted in the Province of Quebec to document the factors associated with an incom... more A survey was conducted in the Province of Quebec to document the factors associated with an incomplete immunization status among 2-year-old children. Parents of 430 completely and 266 partially vaccinated children selected from the computerized vaccination register agreed to participate. The non-simultaneous administration of the 2nd MMR and 4th DPT-P-Hib at 18 months of age was responsible for 46% of incompleteness. The following characteristics were significantly associated with an incomplete immunization status: being a single parent, > or = 2 children in the family, an older age at first immunization (> or = 3 months), parent's preference for postponing the second vaccine when two injections are scheduled for the same visit, perception of lack of information about vaccination, and disagreement with immunization recommendations. One of the key points of this study is the impact of the non-simultaneous administration of the two vaccines at 18 months. Factors such as bein...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 17, 2004
The optimal duration of antibiotic therapy in older patients with uncomplicated urinary tract inf... more The optimal duration of antibiotic therapy in older patients with uncomplicated urinary tract infection (UTI) is still a matter of debate. The aim of this randomized controlled double-blind noninferiority trial was to compare the efficacy and safety of 3-day and 7-day courses of oral ciprofloxacin for uncomplicated symptomatic UTI in older women. A total of 183 women at least 65 years of age with acute uncomplicated UTI were recruited from ambulatory clinics and hospital acute care units. Patients with pyelonephritis, contraindications to fluoroquinolones, recent use of antibiotics, urinary tract abnormalities and diabetes mellitus were excluded. Women were randomly assigned to receive either ciprofloxacin 250 mg twice daily orally for 3 days followed by placebo for 4 days (the 3-day group, 93 patients) or ciprofloxacin 250 mg twice daily orally for 7 days (the 7-day group, 90 patients). Bacterial eradication, clinical improvement and occurrence of adverse events were determined 2 d...
Zoonoses and Public Health, 2009
As a result of their intimate contact with the land and their nutritional habits, the Inuit of Nu... more As a result of their intimate contact with the land and their nutritional habits, the Inuit of Nunavik are considered to be at risk from zoonotic infections. To better understand the risk factors for Toxoplasma gondii infection, a serosurvey was conducted in Nunavik, Québec, in September 2004. A representative sample of the Inuit adult population of Nunavik participated in this cross-sectional study (n = 917). Antibodies (IgG) against T. gondii were detected by immunoassay. Information on sociodemographic characteristics, traditional activities, domestic environment and nutrition was gathered by questionnaire and explored as variables explanatory of seropositive results. Associations found to be statistically significant in univariate analyses were assessed by multivariable logistic regression to control for confounding factors. Almost two thirds (59.8%) of the Inuit of Nunavik were found to be seropositive for T. gondii. In multivariate analyses, risk factors for seropositivity were: increasing age, gender (women > men), lower level of education, consumption of potentially contaminated water (determined by an index of risk from waterborne infections), frequent cleaning of water reservoirs, and consumption of seal meat and feathered game. There was some variation in seroprevalence between the Ungava Bay coast (52.3%) and the Hudson Bay coast (65.6%), the two main regions of Nunavik, but this variation was not significant in the multivariable logistic regression model. This cross-sectional study demonstrated high T. gondii seroprevalence in the Inuit population and revealed that age, gender, schooling and community of residence all influence serostatus in this population. Variables related to drinking water and food choices may also influence the risk of infection. These results raise important questions about T. gondii transmission in Nunavik including possible links between terrestrial and marine cycles.
Vaccine, 2003
We assessed the occurrence of oculo-respiratory syndrome (ORS) following two influenza vaccines: ... more We assessed the occurrence of oculo-respiratory syndrome (ORS) following two influenza vaccines: Fluviral ® (Shire Biologics) or Vaxigrip ® (Aventis Pasteur). ORS was identified amongst 5.3 and 4.6% of recipients, respectively (P = 0.54). With both vaccines, the risk of ORS was much greater in individuals who had ORS the previous year (2000) than in those without such history. In multivariate analysis, the odds ratio for ORS for patients with a prior history of ORS varied between 9.4 and 9.6 (P < 0.001) whereas that comparing Fluviral ® and Vaxigrip ® varied between 1.5 and 1.9 (P = 0.02-0.05). ORS is an adverse event that is present with more than one vaccine and may be present with any influenza vaccines to a greater or lesser degree.
Vaccine, 2005
Oculo-respiratory syndrome (ORS) following influenza vaccination was identified in Canada in 2000... more Oculo-respiratory syndrome (ORS) following influenza vaccination was identified in Canada in 2000. This report describes trends of ORS reported during four consecutive seasons 2000, 2001, 2002 and 2003 in the province of Quebec, Canada. Data come from the vaccine-associated adverse event (VAAE) passive reporting system of the Province of Quebec. The rate of ORS reported per 100000 doses distributed declined from 46.6 in 2000 to 34.2, 20.6 and 9 in 2001, 2002 and 2003, respectively. There was no significant difference in rates for ORS between the two vaccines in use in Canada (Fluviral and Vaxigrip) both in 2001 and 2002. During the 4 years, incidence was highest in people aged 40-59 years and declined in older age groups. The clinical profile of ORS has remained remarkably stable over years. Overall, ocular, respiratory symptoms or facial edema were reported by 58%, 84% and 31% of patients, respectively, and 15% had symptoms including all three symptom categories. ORS lasted more than a week in 8-13% of the cases. ORS is an adverse event that occurred with both influenza vaccines used in Canada. Its frequency has declined substantially but is still present after 4 years. It constitutes a clinical entity distinct from anaphylactic allergy. Unlike anaphylaxis, ORS does not constitute an absolute contraindication to further doses.
Vaccine, 2002
A syndrome of red eyes and respiratory symptoms was noted following receipt of influenza vaccine ... more A syndrome of red eyes and respiratory symptoms was noted following receipt of influenza vaccine in Canada during the 2000-2001 influenza season. We conducted intra-dermal skin testing to determine if oculo-respiratory syndrome (ORS) was related to failure of the splitting process during vaccine manufacturing, if it was associated with a particular viral strain and to identify individuals at risk for subsequent ORS reaction. Skin testing with minute quantities of vaccine antigen induced ORS symptoms at a higher rate amongst persons previously affected by this syndrome compared to previously unaffected persons. Skin test reaction size or quality could not identify persons at risk of ORS. Skin testing could not identify a specific strain or the stage in the manufacturing process during which the trigger may have been introduced.
The Journal of Infectious Diseases, 2000
The effect of age on the clinical presentation of pertussis was assessed in 664 adolescent and ad... more The effect of age on the clinical presentation of pertussis was assessed in 664 adolescent and adult cases. Complications were more frequent in adults than in adolescents (28% vs. 16%). Pneumonia occurred in 2% of patients !30 years old but in 5%-9% of older patients. Urinary incontinence occurred in 34% of women у50 years old. Duration of cough, risk of sinusitis, and number of nights with disturbed sleep increased with smoking and asthma. The secondary attack rate in other household members у12 years was 11%. Pertussis in secondary case patients was less severe than in index case patients but presented with classic symptoms. The main source of infection in adolescents was schoolmates or friends; in adults it was workplace or their children. Teachers and health care workers had a greater risk of pertussis than did the general population. The burden of disease appears to increase with age, with smoking, and with asthma. Pertussis was long considered a childhood illness; however, in the last 2 decades, there has been increasing evidence that pertussis affects not only children but adolescents and adults [1-14]. Although the morbidity of pertussis and the frequency of complications are well-known in children, there are fewer data about the changes that occur with increasing age. The 2 largest published pertussis adult case series included 64 and 79 persons у18 years old (mean, 31 and 36 years, respectively), which were insufficient to compare the morbidity by age [6, 7]. This study documents the morbidity of pertussis in 280 adolescent (12-17 years old) and 384 adult (у18 years old) case patients and the susceptibility of their adolescent and adult household contacts. Methods Setting and outbreak. In Quebec, the second largest Canadian province (7 million people), universal vaccination against pertussis was introduced in 1946. Thereafter, the number of cases steadily decreased and stabilized between 1970 and 1989, when a mean of 318 cases was reported annually. Since 1990, there has been a re
Journal of Advanced Nursing, 2005
Improving the psychosocial work environment Aim. This paper reports a pilot project to evaluate t... more Improving the psychosocial work environment Aim. This paper reports a pilot project to evaluate the effectiveness of a participatory organizational intervention to improve the psychosocial work environment in one long-term care unit. Background. Since the early 1990s, health care institutions in Quebec have been constantly changing in order to improve the efficiency of the health care system. These changes have affected the work environment and have contributed to higher rates of burnout and absenteeism among nurses and other health care workers. Method. The study participants were health care workers in a long-term care unit (n ¼ 60). The participatory organizational intervention was based on a contract and carried out by a work team. Work constraints were identified, and an action plan implemented, The effectiveness of the intervention was evaluated by pre-and postintervention questionnaires: the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire and Psychiatric Symptom Index. Results. There was a significant increase in reward (P £ 0AE01) and a significant decrease in Effort-Reward Imbalance (P £ 0AE01) following the intervention. Absenteeism rates decreased from 8AE26% to 1AE86% over the study period, but in the rest of the institution remained the same. However, there was a significant decrease in social support from supervisors (P < 0AE05) at post-test.
Emerging Infectious Diseases, 2003
Cmaj Canadian Medical Association Journal Journal De L Association Medicale Canadienne, Feb 17, 2004
rinary tract infection (UTI), one of the most frequent infectious diseases in older women, is ass... more rinary tract infection (UTI), one of the most frequent infectious diseases in older women, is associated with significant morbidity. 1 Factors contributing to the higher incidence of UTI with age include urinary tract anomalies, changes in hormonal status, decline in the immune system, and high rates of incontinence, malnutrition, functional disability and coexisting illnesses. 2 The optimal duration of antibiotic therapy in older women is still a matter of debate. 3-5 A short course of therapy (e.g., 3 days) appears generally effective in young women, 6,7 but this approach has not been validated in older women, possibly because of concerns about the vulnerability of this population. In many geriatric settings, the typical duration of treatment ranges from 5 to 10 days. A shorter course of treatment might offer significant advantages in terms of improved compliance and fewer drug interactions and side effects, but efficacy must be clearly demonstrated before this approach is implemented. The objective of this randomized controlled double-blind noninferiority trial was to compare 3-day and 7-day courses of oral antibiotic therapy (ciprofloxacin) for the management of uncomplicated symptomatic UTI in older women.
Canadian Journal of Public Health, 2003
Objectif : Une enquete postale a ete realisee au Quebec pour connaitre les facteurs associes a un... more Objectif : Une enquete postale a ete realisee au Quebec pour connaitre les facteurs associes a une vaccination incomplete a l'âge de 2 ans. Methodes : Les parents de 430 enfants completement vaccines et 266 enfants incompletement vaccines ont ete selectionnes a partir des registres de vaccination. Resultats : Le fait de ne pas avoir recu simultanement le 2e RRO et le 4e DCT-P-Hib prevus a l'âge de 18 mois etait responsable de 46 % des incompletudes au calendrier vaccinal. Les caracteristiques suivantes etaient egalement associees au statut vaccinal incomplet : la monoparentalite, etre dans une famille de 2 enfants ou plus, l'âge au premier vaccin (≥3 mois), la preference des parents de ne pas faire donner 2 vaccins le meme jour, la perception d'un manque d'information et un desaccord avec les recommandations vaccinales. Conclusion: Le fait saillant de cette etude est l'impact de ne pas administrer le meme jour les deux vaccins prevus a 18 mois. La monoparentalite et l'âge tardif au premier vaccin pourraient etre utilisees comme marqueurs pour intervenir precocement aupres des enfants plus a risque de ne pas completer leur calendrier vaccinal. On constate aussi que meme si les parents sont generalement favorables a la vaccination, ils ont besoin d'etre bien informes sur les avantages et les risques associes.
The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses
Revue d Épidémiologie et de Santé Publique
We analyzed data from the notifiable diseases data base in Québec to document the incidence of gi... more We analyzed data from the notifiable diseases data base in Québec to document the incidence of giardiasis. The objectives were to perform a descriptive analysis of the cases of giardiasis and to verify the relation between their incidence and the quality of drinking water. The Québec notifiable diseases data-base contained 4273 cases of giardiasis declared between January 1st, 1990 and December 31st, 1995. Incidence rates were adjusted for age and calculated monthly. The sources and kinds of treatment of drinking water permitted to elaborate a vulnerability scale for classifying contamination by Giardia sp. into four categories. Incidence of giardiasis was examined in relation with this vulnerability scale. Other socioeconomic indicators possibly associated with the incidence of giardiasis were also analyzed. Analysis showed that there were few annual variations in the incidence of giardiasis and that there were no epidemic peaks during the study period. According to age, the incide...
The province of Quebec, as many other jurisdicons, is concerned with the probable dramatic effec... more The province of Quebec, as many other jurisdicons, is concerned with the probable dramatic effects of climate change on its population health. Beyond emergency preparedness, one of the main challenges of public health instuons is to implement prevenve acons that are adequate in terms of their efficiency in the reducon of morbidity and mortality, but also in terms of their financial costs. Promong urban green spaces conservaon and expansion is one such prevenve acon with mulple beneficial impacts for health and other co‐benefits. We present here a research project related to the posive effect of green spaces on popula‐ on health in urbanized regions in the province of Quebec. We developed green spaces aracveness models based on mulple qualitave variables. We used a retrospecve populaon cohort of 16 years follow‐up with 10 631 587 individuals to develop spaal models describing the relationship between green space and cardiovascular morbidity and mortality at zip co...
Ce rapport présente les résultats du volet nutritionnel de l’Enquête sur la santé dans les collec... more Ce rapport présente les résultats du volet nutritionnel de l’Enquête sur la santé dans les collectivités canadiennes (ESCC 2.2) qui a été réalisée en 2004 auprès d’un échantillon représentatif de Québécois. Les résultats présentés concernent les adultes québécois âgés de 19 ans et plus et ont été obtenus par l’analyse des données recueillies à partir de rappels alimentaires de 24 heures. Le volet nutritionnel de l’ESCC 2.2 représente ainsi une importante source de données qui ont permis d’actualiser les connaissances sur la consommation alimentaire et les apports nutritionnels des adultes québécois.
International journal of circumpolar health, 2011
To assess the prevalence and main types of anemia present among non-pregnant Inuit women of Nunav... more To assess the prevalence and main types of anemia present among non-pregnant Inuit women of Nunavik using a representative sample. A cross-sectional population-based study. Methods. Iron status was assessed in 466 women aged 18-74 who participated in the 2004 Nunavik Inuit Health Survey. The presence of different types of anemia has been evaluated based on available biochemical indicators of vitamins and of iron status. The correlation between iron status indicators, vitamin status parameters, inflammation markers and heavy metal concentrations was also assessed. Anemia was present in 43% of the Inuit women in Nunavik and 21% suffered from iron deficiency anemia (IDA). The main type of anemia present among women 18-49 years old was IDA (61% of anemia cases) while anemic women 50 years and over suffered mainly from anemia related to chronic inflammation (ACI) (42%). Over 99% of women had normal values for vitamin A, vitamin B12 and folate. Of interest is that ferritin was positively ...
Chronic diseases and injuries in Canada, 2012
Studies suggest that hypertension is more prevalent in the most deprived. Our objective was to ex... more Studies suggest that hypertension is more prevalent in the most deprived. Our objective was to examine the association between incident hypertension and deprivation in Quebec based on different modes of case identification, using two administrative databases. We identified new incident cases of hypertension in 2006/2007 in the population aged 20 years plus. Socio-economic status was determined using a material and social deprivation index. Negative binomial regression analyses were carried out to examine the association between incident hypertension and deprivation, adjusting for several covariates. We found a positive and statistically significant association between material deprivation and incident hypertension in women, irrespective of the identifying database. Using the hospitalization database, the incidence of hypertension increased for both sexes as deprivation increased, except for social deprivation in women. However, whether using the physician billing data base or the va...
Zoonoses and public health, 2012
In Nunavik, common practices and food habits such as consumption of raw meat and untreated water ... more In Nunavik, common practices and food habits such as consumption of raw meat and untreated water place the Inuit at risk for contracting zoonotic diseases. The aim of this study was to determine the seroprevalence of seven zoonotic infections among the permanent residents of Nunavik. The study was conducted in the fall 2004 as part of the Nunavik Health Survey. Blood samples from adults aged 18-74 years (n = 917) were collected and analysed for the presence of antibodies against Trichinella spp., Toxocara canis, Echinococcus granulosus, Brucella spp., Coxiella burnetii, Leptospira spp. and Francisella tularensis. Information on sociodemographic characteristics, traditional activities, drinking water supply and nutrition was gathered using english/inuktitut bilingual questionnaires. The chi-squared test was used to evaluate associations between seropositivity and other measured variables. Statistically significant variables were included in a multivariate logistic regression model to...
The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses, 2002
To characterize the incidence and duration of hospitalization due to diarrhea and to assess the p... more To characterize the incidence and duration of hospitalization due to diarrhea and to assess the proportion of hospitalizations that are attributed to rotavirus-associated diarrhea. Retrospective study of hospitalization data. Hospitals located in Quebec. Children from one to 59 months of age who were discharged from hospital from April 1, 1985 to March 31, 1998. There were 63,827 hospitalizations for diarrhea over the study period, for an average of 4910 hospitalizations/year. The epidemic curve showed a periodicity with regular alternation of high and low annual peaks. The number of hospitalizations for rotavirus-associated diarrhea was estimated according to three different methods. The estimates varied between 1353 and 1849 hospitalizations due to rotavirus-associated diarrhea/year over the 13-year period, with good agreement between the results of the three methods for a one-month to five years of age incidence of 320 hospitalizations for rotavirus-associated diarrhea/100,000 ch...
Canadian journal of public health = Revue canadienne de santé publique
A survey was conducted in the Province of Quebec to document the factors associated with an incom... more A survey was conducted in the Province of Quebec to document the factors associated with an incomplete immunization status among 2-year-old children. Parents of 430 completely and 266 partially vaccinated children selected from the computerized vaccination register agreed to participate. The non-simultaneous administration of the 2nd MMR and 4th DPT-P-Hib at 18 months of age was responsible for 46% of incompleteness. The following characteristics were significantly associated with an incomplete immunization status: being a single parent, > or = 2 children in the family, an older age at first immunization (> or = 3 months), parent's preference for postponing the second vaccine when two injections are scheduled for the same visit, perception of lack of information about vaccination, and disagreement with immunization recommendations. One of the key points of this study is the impact of the non-simultaneous administration of the two vaccines at 18 months. Factors such as bein...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 17, 2004
The optimal duration of antibiotic therapy in older patients with uncomplicated urinary tract inf... more The optimal duration of antibiotic therapy in older patients with uncomplicated urinary tract infection (UTI) is still a matter of debate. The aim of this randomized controlled double-blind noninferiority trial was to compare the efficacy and safety of 3-day and 7-day courses of oral ciprofloxacin for uncomplicated symptomatic UTI in older women. A total of 183 women at least 65 years of age with acute uncomplicated UTI were recruited from ambulatory clinics and hospital acute care units. Patients with pyelonephritis, contraindications to fluoroquinolones, recent use of antibiotics, urinary tract abnormalities and diabetes mellitus were excluded. Women were randomly assigned to receive either ciprofloxacin 250 mg twice daily orally for 3 days followed by placebo for 4 days (the 3-day group, 93 patients) or ciprofloxacin 250 mg twice daily orally for 7 days (the 7-day group, 90 patients). Bacterial eradication, clinical improvement and occurrence of adverse events were determined 2 d...
Zoonoses and Public Health, 2009
As a result of their intimate contact with the land and their nutritional habits, the Inuit of Nu... more As a result of their intimate contact with the land and their nutritional habits, the Inuit of Nunavik are considered to be at risk from zoonotic infections. To better understand the risk factors for Toxoplasma gondii infection, a serosurvey was conducted in Nunavik, Québec, in September 2004. A representative sample of the Inuit adult population of Nunavik participated in this cross-sectional study (n = 917). Antibodies (IgG) against T. gondii were detected by immunoassay. Information on sociodemographic characteristics, traditional activities, domestic environment and nutrition was gathered by questionnaire and explored as variables explanatory of seropositive results. Associations found to be statistically significant in univariate analyses were assessed by multivariable logistic regression to control for confounding factors. Almost two thirds (59.8%) of the Inuit of Nunavik were found to be seropositive for T. gondii. In multivariate analyses, risk factors for seropositivity were: increasing age, gender (women &amp;gt; men), lower level of education, consumption of potentially contaminated water (determined by an index of risk from waterborne infections), frequent cleaning of water reservoirs, and consumption of seal meat and feathered game. There was some variation in seroprevalence between the Ungava Bay coast (52.3%) and the Hudson Bay coast (65.6%), the two main regions of Nunavik, but this variation was not significant in the multivariable logistic regression model. This cross-sectional study demonstrated high T. gondii seroprevalence in the Inuit population and revealed that age, gender, schooling and community of residence all influence serostatus in this population. Variables related to drinking water and food choices may also influence the risk of infection. These results raise important questions about T. gondii transmission in Nunavik including possible links between terrestrial and marine cycles.
Vaccine, 2003
We assessed the occurrence of oculo-respiratory syndrome (ORS) following two influenza vaccines: ... more We assessed the occurrence of oculo-respiratory syndrome (ORS) following two influenza vaccines: Fluviral ® (Shire Biologics) or Vaxigrip ® (Aventis Pasteur). ORS was identified amongst 5.3 and 4.6% of recipients, respectively (P = 0.54). With both vaccines, the risk of ORS was much greater in individuals who had ORS the previous year (2000) than in those without such history. In multivariate analysis, the odds ratio for ORS for patients with a prior history of ORS varied between 9.4 and 9.6 (P < 0.001) whereas that comparing Fluviral ® and Vaxigrip ® varied between 1.5 and 1.9 (P = 0.02-0.05). ORS is an adverse event that is present with more than one vaccine and may be present with any influenza vaccines to a greater or lesser degree.
Vaccine, 2005
Oculo-respiratory syndrome (ORS) following influenza vaccination was identified in Canada in 2000... more Oculo-respiratory syndrome (ORS) following influenza vaccination was identified in Canada in 2000. This report describes trends of ORS reported during four consecutive seasons 2000, 2001, 2002 and 2003 in the province of Quebec, Canada. Data come from the vaccine-associated adverse event (VAAE) passive reporting system of the Province of Quebec. The rate of ORS reported per 100000 doses distributed declined from 46.6 in 2000 to 34.2, 20.6 and 9 in 2001, 2002 and 2003, respectively. There was no significant difference in rates for ORS between the two vaccines in use in Canada (Fluviral and Vaxigrip) both in 2001 and 2002. During the 4 years, incidence was highest in people aged 40-59 years and declined in older age groups. The clinical profile of ORS has remained remarkably stable over years. Overall, ocular, respiratory symptoms or facial edema were reported by 58%, 84% and 31% of patients, respectively, and 15% had symptoms including all three symptom categories. ORS lasted more than a week in 8-13% of the cases. ORS is an adverse event that occurred with both influenza vaccines used in Canada. Its frequency has declined substantially but is still present after 4 years. It constitutes a clinical entity distinct from anaphylactic allergy. Unlike anaphylaxis, ORS does not constitute an absolute contraindication to further doses.
Vaccine, 2002
A syndrome of red eyes and respiratory symptoms was noted following receipt of influenza vaccine ... more A syndrome of red eyes and respiratory symptoms was noted following receipt of influenza vaccine in Canada during the 2000-2001 influenza season. We conducted intra-dermal skin testing to determine if oculo-respiratory syndrome (ORS) was related to failure of the splitting process during vaccine manufacturing, if it was associated with a particular viral strain and to identify individuals at risk for subsequent ORS reaction. Skin testing with minute quantities of vaccine antigen induced ORS symptoms at a higher rate amongst persons previously affected by this syndrome compared to previously unaffected persons. Skin test reaction size or quality could not identify persons at risk of ORS. Skin testing could not identify a specific strain or the stage in the manufacturing process during which the trigger may have been introduced.
The Journal of Infectious Diseases, 2000
The effect of age on the clinical presentation of pertussis was assessed in 664 adolescent and ad... more The effect of age on the clinical presentation of pertussis was assessed in 664 adolescent and adult cases. Complications were more frequent in adults than in adolescents (28% vs. 16%). Pneumonia occurred in 2% of patients !30 years old but in 5%-9% of older patients. Urinary incontinence occurred in 34% of women у50 years old. Duration of cough, risk of sinusitis, and number of nights with disturbed sleep increased with smoking and asthma. The secondary attack rate in other household members у12 years was 11%. Pertussis in secondary case patients was less severe than in index case patients but presented with classic symptoms. The main source of infection in adolescents was schoolmates or friends; in adults it was workplace or their children. Teachers and health care workers had a greater risk of pertussis than did the general population. The burden of disease appears to increase with age, with smoking, and with asthma. Pertussis was long considered a childhood illness; however, in the last 2 decades, there has been increasing evidence that pertussis affects not only children but adolescents and adults [1-14]. Although the morbidity of pertussis and the frequency of complications are well-known in children, there are fewer data about the changes that occur with increasing age. The 2 largest published pertussis adult case series included 64 and 79 persons у18 years old (mean, 31 and 36 years, respectively), which were insufficient to compare the morbidity by age [6, 7]. This study documents the morbidity of pertussis in 280 adolescent (12-17 years old) and 384 adult (у18 years old) case patients and the susceptibility of their adolescent and adult household contacts. Methods Setting and outbreak. In Quebec, the second largest Canadian province (7 million people), universal vaccination against pertussis was introduced in 1946. Thereafter, the number of cases steadily decreased and stabilized between 1970 and 1989, when a mean of 318 cases was reported annually. Since 1990, there has been a re
Journal of Advanced Nursing, 2005
Improving the psychosocial work environment Aim. This paper reports a pilot project to evaluate t... more Improving the psychosocial work environment Aim. This paper reports a pilot project to evaluate the effectiveness of a participatory organizational intervention to improve the psychosocial work environment in one long-term care unit. Background. Since the early 1990s, health care institutions in Quebec have been constantly changing in order to improve the efficiency of the health care system. These changes have affected the work environment and have contributed to higher rates of burnout and absenteeism among nurses and other health care workers. Method. The study participants were health care workers in a long-term care unit (n ¼ 60). The participatory organizational intervention was based on a contract and carried out by a work team. Work constraints were identified, and an action plan implemented, The effectiveness of the intervention was evaluated by pre-and postintervention questionnaires: the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire and Psychiatric Symptom Index. Results. There was a significant increase in reward (P £ 0AE01) and a significant decrease in Effort-Reward Imbalance (P £ 0AE01) following the intervention. Absenteeism rates decreased from 8AE26% to 1AE86% over the study period, but in the rest of the institution remained the same. However, there was a significant decrease in social support from supervisors (P < 0AE05) at post-test.
Emerging Infectious Diseases, 2003