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Housing characteristics and indoor concentrations of nitrogen dioxide and formaldehyde in Quebec City, Canada.

Concentrations of nitrogen dioxide and formaldehyde were determined in a study of 96 homes in Quebec City, Canada, between January and April 2005. In addition, relative humidity, temperature, and air change rates were measured in homes, and housing characteristics were documented through a questionnaire to occupants. Half of the homes had ventilation rates below 7.5 L/s person. Nitrogen dioxide (NO2) and formaldehyde concentrations ranged from 3.3 to 29.1 microg/m3 (geometric mean 8.3 microg/m3) and from 9.6 to 90.0 microg/m3 (geometric mean of 29.5 microg/m3), respectively. The housing characteristics documented in the study explained approximately half of the variance of NO2 and formaldehyde. NO2 concentrations in homes were positively correlated with air change rates (indicating a significant contribution of outdoor sources to indoor levels) and were significantly elevated in homes equipped with gas stoves and, to a lesser extent, in homes with gas heating systems. Formaldehyde concentrations were negatively correlated with air change rates and were significantly elevated in homes heated by electrical systems, in those with new wooden or melamine furniture purchased in the previous 12 months, and in those where painting or varnishing had been done in the sampled room in the previous 12 months. Results did not indicate any significant contribution of indoor combustion sources, including wood-burning appliances, to indoor levels of formaldehyde. These results suggest that formaldehyde concentrations in Quebec City homes are caused primarily by off-gassing, and that increasing air change rates in homes could reduce exposure to this compound. More generally, our findings confirm the influence of housing characteristics on indoor concentrations of NO2 and formaldehyde.

Air Movements↗

Classic Kaposi's sarcoma in the Inuit of northern Quebec.

BACKGROUND: Classic Kaposi's sarcoma (KS) is predominantly a disease of eastern Mediterranean and Ashkenazi Jewish elderly men. Nevertheless, the disease has been reported to occur in people from various other ethnic and regional backgrounds. OBJECTIVE: We report, for the first time, the occurrence of classic KS in five Inuit people living in northern Quebec, Canada. METHODS AND RESULTS: We describe the case of a 69-year-old Inuit man with classic KS, and report four other cases of KS in the Inuit population, identified by a review of our hospital's dermatopathology records. CONCLUSION: The discovery of classic KS in the Inuit population of northern Quebec brings with it new questions as to the origins of the KS-associated herpes virus in this population. It is our belief that the answers to these questions are in the genotype of the virus that is present in this community.

Aged↗

Prevalence and clinical phenotype of the p.Val226Met glucokinase gene mutation in French Canadians in Quebec, Canada.

Our objectives were to describe the clinical phenotype of maturity-onset diabetes of the young (MODY) type 2 in a group of French Canadians and estimate its prevalence in this population. Index cases were identified by an abnormal fasting blood glucose (FBG) upon metabolic evaluation for dyslipidemia. Mutational analyses confirmed that all probands and affected family members were positive for the same glucokinase mutation, p.Val226Met. The prevalence of this mutation was estimated from a representative sample of French Canadians. Eleven individuals in 5 different families were diagnosed with MODY 2. Four of the five families originated from the same region in Quebec. In affected children (n = 6), the median age at diagnosis was 7.6 years (range = 2.9-9.4). All were asymptomatic. The range of FBG was 4.4-7.0 mmol/L; 5 out of the 6 pediatric patients had normal FBG values during the course of follow-up. One child presented with consistently normal FBG. Four of the adults who screened positive for MODY 2 had been previously misdiagnosed with type 2 DM, and one female had a history of gestational DM. The estimated prevalence of heterozygotes for the p.Val226Met mutation in French Canadians was 0.057% (95%CI 0.01-0.32%). In conclusion, this report presents the first confirmed case of MODY 2 with persistently normal FBG. In children and adolescents, a normal FBG does not allow for the exclusion of a MODY 2 diagnosis. Our results are consistent with a founder effect for the p.Val226Met glucokinase gene mutation in Quebec, Canada.

Adult↗

Linkage disequilibrium and founder effect analysis of the NF1 gene in French Canadians from the Quebec population.

We genotyped 19 neurofibromatosis type 1 (NF1) families from French Canadians of the Quebec population with four intragenic microsatellites (IVS26-2.3, IVS27AC28.4, IVS27AC33.1, and IVS38GT53.0). Linkage analysis of the four microsatellite markers among the 19 NF1 families indicates that the four microsatellites are strongly linked with NF1 disease (LOD = 2.76-3.64). The four markers are associated (P = 0-0.077) except marker pair IVS26-2.3/IVS27AC33.1 (P = 0.18 or 0.17). However, perhaps due to the high mutation rate of the NF1 gene, no founder effect for NF1 was detected in the Quebec French Canadians.

Founder Effect↗

The 1891-1920 birth cohort of Quebec chrysotile miners and millers: development from 1904 and mortality to 1992.

This paper draws together the mortality experience for a cohort of some 11000 male Quebec Chrysotile miners and millers, reported at intervals since 1971 and now again updated. Of the 10918 men in the complete cohort, 1138 were lost to view, almost all never traced after employment of only a month or two before 1935; the other 9780 men were traced into 1992. Of these, 8009 (82%) are known to have died: 657 from lung cancer, 38 from mesotheliona, 1205 from other malignant disease, 108 from pneumoconiosis and 561 from other non-malignant respiratory diseases (excluding tuberculosis). After early fluctuations. SMRs (all causes) against Quebec rates have been reasonably steady since about 1945. For men first employed in Asbestos, mine or factory, they were very much what might have been expected for a blue collar population without any hazardous exposure. SMRs in the Thetford Mines area were almost 8% higher, but in line with anecdotal evidence concerning socio-economic status. At exposures below 300 (million particles per cubic foot) x years, (mpcf.y), equivalent to roughly 1000 (fibres/ml) x years-or, say, 10 years in the 1940s at 80 (fibres/ml)-findings were as follows. There were no discernible associations of degree of exposure and SMRs, whether for all causes of death or for all the specific cancer sites examined. The average SMRs were 1.07 (all causes), and 1.16, 0.93, 1.03 and 1.21, respectively, for gastric, other abdominal, laryngeal and lung cancer. Men whose exposures were less then 300 mpcf.y suffered almost one-half of the 146 deaths from pneumoconiosis or mesothelioma; the elimination of these two causes would have reduced these men's SMR (all causes) from 1.07 to approximately 1.06. Thus it is concluded from the viewpoint of mortality that exposure in this industry to less than 300 mpcf.y has been essentially innocuous, although there was a small risk or pneumoconiosis or mesothelioma. Higher exposures have, however, led to excesses, increasing with degree of exposure, of mortality from all causes, and from lung cancer and stomach cancer, but such exposures, of at least 300 mpcf.y, are several orders of magnitude more severe than any that have been seen for many years. The effects of cigarette smoking were much more deleterious than those of dust exposure, not only for lung cancer (the SMR for smokers of 20+ cigarettes a day being 4.6 times higher than that for non-smokers), but also for stomach cancer (2.0 times higher), laryngeal cancer (2.9 times higher), and-most importantly-for all causes (1.6 times higher).

Aged↗

Characterization and identification of a "mystery" oil spill from Quebec (1999).

This paper describes a case study in which advanced chemical fingerprinting and data interpretation techniques were used to characterize the chemical compositions and determine the source of an unknown spilled oil from Quebec. On 28 February 1999, significant amounts of oil was reported on the river banks of St. Laurence River in front of a company named "Thermex" (in a town - Beauharnois, Quebec, about 50 km northwest of Montreal). The spilled oil was suspected to be released from a nearby factory. In response to this specific site investigation needs, a tiered analytical approach using GC-MS and GC-flame ionization detection was applied. A variety of diagnostic ratios of "source-specific marker" compounds, in particular isomers of biomarkers and alkylated series of polycyclic aromatic hydrocarbons within the same alkylation groups, were determined and analyzed. The hydrocarbon analysis results reveal the following: (1) the spilled oil is very "specific", and is significantly different from most crude oils in chemical composition; (2) the oil in samples come from the same source, however, the spill sample 2569 was identified to contain a small amount (approximately 10%) of diesel; (3) the spilled oil was relatively "fresh", its chemical composition has not undergone significant alteration yet; (4) the spilled oil showed unusually high concentration of the US Environmental Protection Agency priority polycyclic aromatic hydrocarbons (PAHs). The "Pyrogenic Index" values were determined to be as high as 0.11-0.13, significantly higher than crude oils (<0.010) and heavy Bunker type fuels (0.015-0.060). This indicates significant contribution of PAH composition from pyrogenic components; (5) biomarkers were also detected, but their concentrations were unusually low in comparison to most crude oils.

Chromatography, Gas↗

Effect of preoperative delay on survival in patients with bladder cancer undergoing cystectomy in Quebec: a population based study.

PURPOSE: In Canada there is growing concern that waiting time for cancer surgery has been increasing. We used population based data to estimate the average PD for RC in Quebec and assess whether delayed surgery has a negative impact on long-term survival. MATERIALS AND METHODS: We used the provincial billing database of the maladie du Quebec to identify all patients with bladder cancer 18 years or older who underwent RAMQ from 1990 to 2002. PD was calculated as the time elapsed between the most recent transurethral resection and the date of RC. Patients were categorized according to PD tertiles into 3 groups, namely 1) 20 or less, 2) 21 to 47 and (C) 48 days or greater. Cox proportional hazards models were used to assess the effect of PD on overall survival, while adjusting for patient and provider factors. RESULTS: During the study period 1,592 radical cystectomies were performed. Overall median PD was 33 days (95% CI 30 to 35). Median PD increased from 23 days in 1990 to 50 in 2002. After adjusting for calendar year, and patient and provider variables there were no significant differences in survival among the 3 delay categories. However, patients subject to greater than 12 weeks of delay were at 20% greater risk for dying (95% CI 1.0 to 1.5, p = 0.051). CONCLUSIONS: In line with previous reports PD greater than 12 weeks seems to be associated with a worse long-term prognosis.

Adult↗

Occurrence of THMs and HAAs in experimental chlorinated waters of the Quebec City area (Canada).

Haloacetic acids (HAAs) and trihalomethanes (THMs) were generated in bench-scale chlorination experiments using treated waters (prior to final chlorination) of the three major drinking water utilities of the Quebec City area. The purpose was to investigate the formation and occurrence of these chlorination by-products (CBPs) on a seasonal basis. Data for HAAs, THMs and other physico-chemical parameters were produced through a six-month sampling program with variable conditions of water quality, water temperature, applied chlorine dose and reaction time. In waters from the three utilities, chloroform (THM specie), dichloroacetic and trichloroacetic acid (HAA species) were the most prevalent compounds due to the low concentrations of bromide in the utilities' raw waters. Significant differences in CBP occurrence were noted between the three utilities' chlorinated waters, mainly due to the type of disinfectant applied to raw water. The use of pre-ozonation, as opposed to pre-chlorination (or direct chlorination) in one of the utilities appears to be the major factor contributing to that utility's potential for compliance with current THM and future HAA standards. Seasonal variations in THMs and HAAs were mainly associated with variations in organic precursors and to changes in water temperature (two parameters which vary widely on a seasonal basis in surface waters of southern Quebec), with CBP occurrence at its highest in spring. Statistical correlations between HAAs and THMs were moderate and only temperature appeared to affect the preponderance of one CBP or the other. Finally, a regression analysis was carried out aimed at associating each CBP to water quality and the experimental parameters. Thanks to their predictive ability, multivariate models seem to be the tools with the best potential for decision-making purposes.

Acetates↗

PCBs and dioxin-like compounds in plasma of adult Inuit living in Nunavik (Arctic Quebec).

Inuit people residing in the Arctic are unusually exposed to organochlorines through their traditional diet which includes large quantities of sea mammal fat. Recently, 499 Inuit adults from Nunavik (Arctic Quebec) participated in a large health survey and donated a blood sample for organochlorine and heavy metal analysis. Twenty pooled plasma samples were formed, each made of individual samples from the same age group, sex, and region of residence, to allow for dioxin-like compound determination. The mean total concentration of PCBs and dioxin-like compounds (the latter expressed in 2,3,7,8-TCDD toxic equivalents) were respectively 4.1 mg/kg lipids and 184.2 ng/kg lipids, compared to 0.13 mg/kg lipids and 26.1 ng/kg lipids for three control pooled plasma samples from Southern Quebec. Total PCBs and dioxin-like compound concentrations were strongly correlated (r = 0.98; p < 0.0001), increased with age and were greater in men than in women. Although the body burdens of PCBs and dioxin-like compounds are close to those which induced adverse health effects in laboratory animals, dietary benefits from the sea-food based diet still outweigh the hypothetical health risks.

Adult↗

Women physicians in Quebec.

This article presents the results of a qualitative study on women physicians in Quebec which aimed to go beyond a mere statistical description of the tendencies observed in their practices. It proposes an interpretation of their discourses on their practice and its context bringing to light the interdependence of individual strategies and structural constraints. We met 30 women physicians and eight men physicians asking them to talk freely about their personal and professional experience. The data reveal how the individual characteristics and interests of women physicians prevail in their decisions at key moments in their lives which have repercussions on the shaping of their practice. These moments include admission into the faculty of medicine, training, professional orientation and the choice of a specialized field, organization of professional practice and personal life. The medical practice of women is constructed through these choices and the gender variable plays a more or less significant role at each stage of this construction. Their distinctive choices reflect how gender relations are reproduced in the private sphere and the interactions between their private and professional lives. According to our participants, a difference lies in the place occupied by their profession in women and men physicians' lives. The private life of women physicians appears to be closely linked to their decisions regarding the organization of their professional life and as a result to the health services they provide, suggesting they have their own way of "being a physician". The individual nature of the strategies they adopt can have, at a collective level, consequences on the planning and the distribution of medical resources in the publicly managed health care system in Quebec while raising the global issue of gendered division of labor.

Adaptation, Psychological↗

Teaching cardiopulmonary resuscitation to CEGEP students in Quebec--a pilot project.

In order to increase CPR training in Quebec, we designed a pilot study to test out the efficacy of training CEGEP (junior college) students in CPR. We tried out four different methods of teaching CPR on students (Group A 'control', 4 h course, manikin to student ratio 1:4; Group B, 4 h course, manikin to student ratio 1:1; Group C, 2 h course, manikin to student ratio 1:1; Group D, video-assisted CPR instruction, manikin to student ratio 1:1). CPR skills were tested on a computerized manikin at the end of the initial course and again at the end of the semester in order to evaluate short and long-term retention of skills. There were no significant differences between the test groups and the control group in terms of compressions or ventilations at the beginning and end of the semester, however groups C and D performed significantly better primary surveys (Airway, Breathing, Circulation - ABC sequences) during the initial testing. The most common reasons reported by students for not taking CPR courses were the cost of courses (49.2%) and the inconvenience of courses (26.2%), similarly the two most common incentives which could get students to take CPR courses were; free courses (65.6%) and greater accessibility of courses (54.1%). Video-assisted CPR training appears to be feasible, enjoyable and as, if not more effective than traditional CPR courses. Instituting a mandatory video-assisted CPR program in the CEGEP system in Quebec and in high schools and colleges throughout the world, would be a cost-effective way to train massive amounts of young people in CPR.

Adult↗

[Management and prevention of abuse in Quebec: a program of sociolegal pediatrics at the Sainte-Justine Hospital in Montreal].

In Quebec, the Child's Protection law protects the child from birth until 18 years of age when child abuse or neglect is suspected. Since 1990, the program of the Child Protection Clinic of Sainte-Justine Hospital (Montreal) offers a special unit for evaluation and prevention of child abuse and neglect, constituted by a multidisciplinary team including five pediatricians. About 500 children are referred each year in external consultations or from hospital units. In addition, the pediatricians participate in the "programme Santé-Enfance-Jeunesse", a prevention program in the Montreal area. They also act as expert witnesses in court. Thus Quebec's pediatricians fully participate in a child's protection with their activities in different levels of diagnosis, management and prevention of child abuse and neglect.

Adolescent↗

Assessing technology assessment. Early results of the Quebec experience.

The Quebec Council on Health Care Technology Assessment was created in 1988. Its functions are to promote, support, and produce health care technology assessments and to advise the Minister of Health. An independent review of the council's first four years of operation was commissioned. The evaluation team concluded that the council showed very good results in terms of the scope, quality, and impact of its production and succeeded in establishing its credibility. However, the evaluation team suggested that the council adopt a more active strategy toward the promotion and diffusion of its reports. Some critical determinants of success of the Quebec experience in technology assessment are discussed.

Diffusion of Innovation↗

The interaction model of anxiety and the threat of Quebec's separation from Canada.

The interaction model of anxiety was investigated by assessing trait and state anxiety in students at a Canadian university during the Quebec referendum. The results of Study 1 confirmed that the threat of separation by Quebec from Canada was perceived as an ambiguous, uncertain situation. In Study 2, reactions to this situation were assessed by having participants complete measures of anxiety and situation perception at Time 1 (i.e., 3 hr before the event) and Time 2 (i.e., 1 week after the vote). The results provide support for the interaction model; individuals who were high in trait anxiety in ambiguous situations and appraised the referendum situation as threatening were characterized by elevated state anxiety before the uncertain outcome of the vote. The results illustrate the need to examine trait anxiety and specific appraisals of situational threat in uncertain life situations.

Adaptation, Psychological↗

Hardiness, work support and psychological distress among nursing assistants and registered nurses in Quebec.

BACKGROUND: Although nursing assistants (NAs) represent a large segment of Canadian health care providers, little is known about psychosocial factors related to their physical and psychological well-being and how these compare with their registered nurse (RN) counterparts. AIM: Guided by Maddi and Kobasa's theoretical framework of Factors Affecting Health-Illness Status, the purpose of the present study was to examine relationships among hardiness, psychological distress and work support in NAs, and to compare results with those from a sample of RNs. METHOD: A random sample of 171 NAs in Quebec completed self-report questionnaires. The study instruments included validated French-Canadian versions of Kobasa's Hardiness Scale, Ilfeld's Psychiatric Symptom Index, and Moos' Work Relationship Index. RESULTS: As theoretically predicted, statistically significant correlations were found between hardiness and psychological distress (r = -0.42; P < 0.001), hardiness and work support (r = 0.27; P < 0.001), and between work support and psychological distress (r = -0.21; P < 0.001). Using a mediational model and multiple regression analyses, hardiness among NAs was found to be a significant mediator between work support and psychological distress. Comparative analyses revealed that whereas NAs and RNs reported similar levels of psychological distress (P = 0.25) and work support (P = 0.13), NAs reported significantly less hardiness (t = -5.58; P < 0.01). In addition, NAs and RNs reported significantly more psychological distress than the general population of Quebec, Canada (t = 9.07 and 22.84, P < 0.01, respectively). CONCLUSION: Results add support to Maddi and Kobasa's theoretical propositions linking personal and contextual resources to health-related outcomes and offer insights into specific factors that may affect the health and well-being of both NAs and RNs as well as their work climate.

Humans↗

Suboptimal duration of antidepressant treatments in the older ambulatory population of Quebec: association with selected physician characteristics.

OBJECTIVES: To assess the association between selected physician characteristics and suboptimal duration of antidepressant use in the older outpatient population. DESIGN: Follow-up of patients who were prescribed an antidepressant treatment by a cohort of physicians in Quebec. SETTING: Community-based older outpatient population in Quebec. PARTICIPANTS: Retrospective cohort of 1,301 general practitioners (GPs) and 236 psychiatrists followed from 1991 to 1997. MEASUREMENTS: Treatment duration of less than 180 days in 1996/97. RESULTS: Premature interruption of antidepressant treatment was very frequent (44.7%). GPs, physicians who practice in metropolitan or urban regions, and those who have a proportion of older patients in their practice of less than 50% show a higher rate of premature interruption. These associations could not be accounted for by the choice of products, dosage, or patient characteristics. CONCLUSION: We have identified physician characteristics that are associated with suboptimal duration of antidepressant use and conclude that further interventions should target subgroups of physicians.

Aged↗

Patient characteristics and costs of severe sepsis and septic shock in Quebec.

BACKGROUND: We investigated the cost of health care resources for the treatment of severe sepsis and/or septic shock patients. MATERIALS AND METHODS: One hundred retrospective chart abstractions from patients with severe sepsis or septic shock were included. The average cost, per episode, through day 28, as well as an analysis of a patient subset through 1 year was calculated. Mean values for all abstracted patient's costs and outcomes, as well as analyses of the survivor and nonsurvivor populations, were undertaken. Data from the Canadian Institute for Health Information and recent published literature were used to estimate the number of severe sepsis cases, and the resulting burden of illness for Quebec. RESULTS: The mean cost for all patients abstracted was $11,474 per episode of care ($1,064/day). The survivors had a mean cost for their treatment of $16,228 per episode of care ($877/day). The total cost per episode was $7,584 per nonsurvivor ($1,724/day). An average cost of $27,481 for survivors after day 28 through 1 year was calculated. The burden of severe sepsis was estimated to be $36.4 to $72.9 million per year, but higher if costs beyond day 28 are included. CONCLUSIONS: The cost of severe sepsis is a significant burden to the Quebec health care system.

Cost of Illness↗

Etiology of pleural calcification: a study of Quebec chrysotile asbestos miners and millers.

A review of 15,689 chest radiographs of Quebec chrysotile miners and millers, representing the latest film prior to November 1, 1966, for all such persons ever x-rayed, identified 206 men with pleural calcification. Of these, 198 had worked in the Thetford Mines area, 6 at Asbestos, and 2 at St. Remi de Tingwick; 2.5%, 0.08%, and 1% of the films from these areas, respectively. A series of case-control studies revealed that pleural calcification was concentrated in men employed at a small group of mines in Thetford Mines and occurred more often among miners and maintenance personnel than among millers. Calcification was not related to past history of illness or injury, place of residence, or employment in other industries. The distribution of pleural calcification in this Quebec industry suggests that it is related to some characteristic of airborne dust or mineral closely associated with the chrysotile that is encountered during mining in Thetford Mines but not in other mining areas. Possible minerals include mica, talc, and breunnerite.

Adult↗