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PubMed2004

HPA-5b (Bra) neonatal alloimmune thrombocytopenia in Quebec: incidence and clinical outcome in 31 cases.

BACKGROUND: Clinical detection of neonatal allo-immune thrombocytopenia (NAITP) is often less than the incidence predicted in prospective studies. The aims of this study were to calculate the observed and expected incidence of NAITP in Quebec, Canada, and to evaluate the clinical outcome of infants with anti-HPA-5b NAITP. STUDY DESIGN AND METHODS: Records from 1998 to 2002 of the only PLT serology laboratory for the province of Quebec were reviewed, as were hospital charts of all HPA-5 cases. The number of expected NAITP cases was estimated with known alloantigen gene frequencies. RESULTS: Ninety cases of NAITP were identified. The clinical detection rate was 1 in 4100, with 9 to 30 percent of expected HPA-1a and 11 to 23 percent of expected HPA-5b NAITP cases detected. Seventy-eight percent of cases of HPA-5b NAITP were asymptomatic. Sixty-three percent of all deliveries but 94 percent of HPA-5b cases occurred in hospitals performing cord blood PLT counts. CONCLUSION: The NAITP detection rate was 25 to 50 percent of the rate reported in prospective trials. The less severe clinical presentation of NAITP owing to HPA-5b was confirmed. The frequent routine determination of cord blood PLT counts may explain increased detection of asymptomatic NAITP involving anti-HPA-5b.

Adult↗

PubMed1989

Surveillance of invasive Streptococcus pneumoniae infection in Quebec, Canada, from 1984 to 1986: serotype distribution, antimicrobial susceptibility, and clinical characteristics.

Four hundred and sixty-eight strains of Streptococcus pneumoniae isolated from blood or normally sterile body fluids in 14 Quebec, Canada, hospitals between 1 July 1984 and 31 December 1986 were serotyped, their susceptibilities to antimicrobial agents were determined, and the laboratory data were correlated with the clinical information. The distribution pattern of the serogroups and serotypes was similar to that observed previously in Quebec and to that in other parts of Canada and in the United States. No regional variation was observed. The distribution of serogroups and serotypes was different in pediatric patients (less than 18 years old) when compared with that of adults (P less than 0.001). Overall, 94% of the strains were represented in 23-valent vaccine. The total mortality rate was 12.8% and increased with age: 1.6% in pediatric patients, 14.8% in patients 18 to 64 years old, and 31% in those greater than or equal to 65 years old (P less than 0.001). In patients 18 to 64 years old, the mortality rate was higher when an underlying condition that could have justified prior vaccination was present (P = 0.008). In patients greater than or equal to 65 years old, the mortality rates were similar in those with and those without underlying conditions, suggesting that vaccine use in all patients greater than or equal to 65 years old might be appropriate. Only six patients had received pneumococcal vaccine before infection. Only 15 strains (3.2%) were moderately susceptible or resistant to one or more of the antimicrobial agents tested. Six strains were moderately susceptible to penicillin G, and none was fully resistant.

Age Factors↗

PubMed2001

Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites: results of a 2-year (1996 to 1998) multicenter surveillance study in Quebec, Canada.

During a 2-year surveillance program (1996 to 1998) in Quebec, Canada, 442 strains of Candida species were isolated from 415 patients in 51 hospitals. The distribution of species was as follows: Candida albicans, 54%; C. glabrata, 15%; C. parapsilosis, 12%; C. tropicalis, 9%; C. lusitaniae, 3%; C. krusei, 3%; and Candida spp., 3%. These data, compared to those of a 1985 survey, indicate variations in species distribution, with the proportions of C. glabrata and C. parapsilosis increasing by 9 and 4%, respectively, and those of C. albicans and C. tropicalis decreasing by 10 and 7%, respectively. However, these differences are statistically significant for C. glabrata and C. tropicalis only. MICs of amphotericin B were > or =4 microg/ml for 3% of isolates, all of which were non-C. albicans species. Three percent of C. albicans isolates were resistant to flucytosine (> or =32 microg/ml). Resistance to itraconazole (> or =1 microg/ml) and fluconazole (> or =64 microg/ml) was observed, respectively, in 1 and 1% of C. albicans, 14 and 9% of C. glabrata, 5 and 0% of C. tropicalis, and 0% of C. parapsilosis and C. lusitaniae isolates. Clinical data were obtained for 343 patients. The overall crude mortality rate was 38%, reflecting the multiple serious underlying illnesses found in these patients. Bloodstream infections were documented for 249 patients (73%). Overall, systemic triazoles had been administered to 10% of patients before the onset of candidiasis. The frequency of isolation of non-C. albicans species was significantly higher in this group of patients. Overall, only two C. albicans isolates were found to be resistant to fluconazole. These were obtained from an AIDS patient and a leukemia patient, both of whom had a history of previous exposure to fluconazole. At present, it appears that resistance to fluconazole in Quebec is rare and is restricted to patients with prior prolonged azole treatment.

Amphotericin B↗

PubMed2004

Phenotypic and genetic characterization of a unique variant of serogroup C ET-15 meningococci (with the antigenic formula C:2a:P1.7,1) causing invasive meningococcal disease in Quebec, Canada.

Serogroup C Neisseria meningitidis belonging to the electrophoretic type (ET) ET-15, a variant of ET-37, is endemic in Canada. Like other serogroup C ET-37 meningococci, the endemic ET-15 strains are usually found to carry the serotype and serosubtype antigens of 2a:P1.5,2. In 2001, a sudden increase in the number of cases of serogroup C meningococcal disease in Quebec, Canada, was caused by an antigenic variant of the ET-15 strain. This antigenic variant carries the unique serosubtype marker of P1.7,1. Strains of C:2a:P1.7,1 meningococci were not isolated in Canada in large numbers prior to 2001, and the characteristics of these meningococcal strains linked to an outbreak in Quebec, Canada, are described in the present study.

Antigenic Variation↗

PubMed1996

Proxies for healthcare need among populations: validation of alternatives--a study in Quebec.

STUDY OBJECTIVE: To compare the use of a non-mortality based proxy for relative needs for healthcare among regional populations with a mortality based proxy for population relative needs and to evaluate the additional value of a proxy based on a combination of non-mortality and mortality based proxies. DESIGN: Analysis of cross sectional data on mortality, socioeconomic status, and self assessments of health taken from registrar general records, a population census, and a population health survey. SETTING: The province of Quebec, Canada. COVERAGE: The populations of the 15 health regions in Quebec. MAIN OUTCOME MEASURE: The levels of correlation of indicators based on mortality data, socioeconomic data, and combined data with a standardised indicator of self assessed health. RESULTS: Variations in scores of a proxy based on socioeconomic data among regions explain 37% of the observed variation in self assessed health, 4% more than the level of variation explained by the standardised mortality rate scores. A weighted combination of both mortality and socioeconomic based proxies explains 56% of variation in self assessed health. CONCLUSIONS: Justification of "deprivation weights" reflecting variations in socioeconomic status among populations should be based on empirical support concerning the performance of such weights as proxies for relative levels of need among populations. The socioeconomic proxy developed in this study provides a closer correlation to the self assessed health of the populations under study than the mortality based proxy. The superior performance of the combined indicator suggests that the development of social deprivation indicators should be viewed as a complement to, as opposed to a substitute for, mortality based measures in needs based resource allocation exercises.

Adolescent↗

PubMed1993

The 1891-1920 birth cohort of Quebec chrysotile miners and millers: mortality 1976-88.

A cohort of some 11,000 men born 1891-1920 and employed for at least one month in the chrysotile mines and mills of Quebec, was established in 1966 and has been followed ever since. Of the 5351 men surviving into 1976, only 16 could not be traced; 2508 were still alive in 1989, and 2827 had died; by the end of 1992 a further 698 were known to have died, giving an overall mortality of almost 80%. This paper presents the results of analysis of mortality for the period 1976 to 1988 inclusive, obtained by the subject-years method, with Quebec mortality for reference. In many respects the standardised mortality ratios (SMRs) 20 years or more after first employment were similar to those for the period 1951-75--namely, all causes 1.07 (1951-75, 1.09); heart disease 1.02 (1.04); cerebrovascular disease 1.06 (1.07); external causes 1.17 (1.17). The SMR for lung cancer, however, rose from 1.25 to 1.39 and deaths from mesothelioma increased from eight (10 before review) to 25; deaths from respiratory tuberculosis fell from 57 to five. Among men whose exposure by age 55 was at least 300 million particles per cubic foot x years (mpcf.y), the SMR (all causes) was elevated in the two main mining regions, Asbestos and Thetford Mines, and for the small factory in Asbestos; so were the SMRs for lung cancer, ischaemic heart disease, cerebrovascular disease, and respiratory disease other than pneumoconiosis. Except for lung cancer, however, there was little convincing evidence of gradients over four classes of exposure, divided at 30, 100, and 300 mpcf.y. Over seven narrower categories of exposure up to 300 mpcf.y the SMR for lung cancer fluctuated around 1.27 with no indication of trend, but increased steeply above that level. Mortality form pneumoconiosis was strongly related to exposure, and the trend for mesothelioma was not dissimilar. Mortality generally was related systematically to cigarette smoking habit, recorded in life from 99% of survivors into 1976; smokers of 20 or more cigarettes a day had the highest SMRs not only for lung cancer but also for all causes, cancer of the stomach, pancreas, and larynx, and ischaemic heart disease. For lung cancer SMRs increased fivefold with smoking, but the increase with dust exposure was comparatively slight for non-smokers, lower again for ex-smokers, and negligible for smokers of at least 20 cigarettes a day; thus the asbestos-smoking interaction was less than multiplicative. Of the 33 deaths from mesothelioma in the cohort to date, 28 were in miners and millers and five were in employees of a small asbestos products factory where commercial amphiboles had also been used. Preliminary analysis also suggest that the risk of mesothelioma was higher in the mines and mills at Thetford Mines than in those at Asbestos. More detailed studies of these differences and of exposure-response relations for lung cancer are under way.

Aged↗

PubMed1999

Highlights of the sexual activity of the heterosexual population in the province of Quebec.

OBJECTIVES: To describe and quantify the level of sexual activity of the heterosexually active population of Quebec. METHODS: The data analysed included 2889 heterosexually active individuals aged 15-60 (agemed = 32) from a 1996-7 survey on the sexual lifestyles of the general population of Quebec. Various probability distributions were studied to assess their capacity to describe and quantify the lifetime and yearly numbers of sexual partners of the sampled population. To estimate the annual rates of new partner acquisition, a generalised linear model was fitted to the number of lifetime sexual partners as a function of age, years of sexual activity, and sex. RESULTS: The mean and variance of the number of lifetime sexual partners for men (mean = 11, s2 = 163) is higher than for women (mean = 6, s2 = 72). The negative binomial and lognormal probability distributions give the most adequate fit to the lifetime number of partners for both agglomerated and stratified (by sex and age) data. The estimated annual rates of new partner acquisition provide two important results for prevention: (1) the first year of sexual activity represents the highest annual rate of new partner acquisition independent of age, (2) annual rates of new partner acquisitions increase through mid-life (ages 40-50) combined with a decrease in condom use. CONCLUSION: Problems caused by the use of large categories in the estimation of mean and variance cannot totally be overcome by fitting probability distributions to the empirical data despite good fits. Furthermore, we believe that adequate estimates of the annual rate of new partner acquisition should be a better measure of the risk of HIV infection than the number of partners since the first is a measure of incidence while the second is a measure of prevalence.

Adolescent↗

PubMed2006

Quebec model for low vision rehabilitation.

The increase in longevity (and secondary morbidity) in the Quebec population adds social and financial pressure to society, as it does elsewhere in Canada and in many western countries. This article gives a brief history of the evolution of vision rehabilitation services in Quebec and describes how services are provided for people with low vision throughout the province. Although numerous groups, associations, centres, and resources are available to assist people with vision impairments, such as the Canadian National Institute for the Blind-Québec, the majority of visual rehabilitation services are provided by government-sponsored rehabilitation centres, namely the Centres régionaux de réadaptation en déficience physique that are located strategically throughout the province. Low vision clinical evaluations in these centres are shared by 36 optometrists throughout the province. Between 5 and 7 ophthalmologists are involved in low vision care, half in university-affiliated hospitals, primarily in Montreal. There may be delays of up to 6 months to be seen in a funded low vision clinic. Statistics obtained from la Régie de l'assurance maladie du Québec show that there are approximately 8,000 requests for low vision aids every year, and that 80% of clients retain at least some level of visual function. Services are covered by Medicare and low vision aids are provided at no cost, although ophthalmologists cannot prescribe low vision aids through the Medicare-funded system. We must ensure that the capacity of our system continues to provide adequately for clientele in the future.

Health Resources↗

PubMed1982

Activity of California encephalitis group viruses in Entrelacs (province of Quebec, Canada).

During the summer of 1979, indicator rabbits were placed in three sites in Entrelacs (Laurentian area, province of Quebec) and mosquitoes were collected in order to monitor arbovirus activity in the area. Eight seroconversions to California encephalitis (CE) group viruses were detected in rabbits during June, July, and August. Twenty-five strains identified as members of the CE group were isolated: 3 were obtained from viremic rabbit sera, 1 from adult Aedes communis reared in the laboratory from field-collected larvae, and 21 from mosquito pools. Twenty-two of these were typed as snowshoe hare (SSH) virus. No evidence of La Crosse (LAC) virus was detected but three strains belonging to the CE group showed antigenic properties different from reference SSH, LAC, or Jamestown Canyon (JC) viruses. One isolate identified as Flanders virus was obtained from Culex pipiens. Three mosquito species (A. communis, A. punctor, and A. excrucians) were involved in the transmission cycle of SSH virus in Entrelacs. This is the first report, in the province of Quebec, of SSH isolation from animal sera and the first demonstration of its transovarial transmission.

Animals↗

PubMed1984

Ecological distribution of Legionellaceae in the Quebec city area.

One hundred environmental water samples, which were collected in the Quebec city area and cultured on buffered charcoal yeast extract medium and three selective media, were inoculated to guinea pigs and were screened by direct immunofluorescent staining (DFA) for the presence of Legionellaceae. Six isolates were made (four Legionella pneumophila and two Tatlockia (Legionella) micdadei: three by animal inoculation and three by culture). No samples were simultaneously positive by both methods. After screening by DFA, 43 of the 100 samples were positive for Legionellaceae and 27 of those contained more than one serogroup and (or) species of Legionellaceae. Legionella pneumophila (serogroups 1 to 6) was the most frequent species seen by DFA. These results clearly show that Legionellaceae are frequent members of the freshwater microbial flora of the Quebec city area.

Culture Media↗

PubMedDate not supplied

Management of new symptoms of dyspepsia in the elderly in Quebec.

OBJECTIVE: To use the Régie de l'assurance-maladie du Québec (RAMQ) database to study the clinical strategies used by Quebec physicians in the management of dyspepsia in the elderly. DESIGN: A 20% random sample of the RAMQ database for Quebec residents aged 65 years and older for the three years from July 1, 1991 to June 30, 1992 was used. Patients were placed in three cohorts according to the following treatment strategies: endoscopy, x-ray examination or drug therapy. Patients in each cohort were then categorized as either nonsteroidal anti-inflammatory drug (NSAID) users or non-NSAID users. The choice of drug treatment used to manage the dyspepsia in each cohort was recorded. Drug treatments were divided into the following six antidyspeptic categories: H2 blockers, omeprazole, sucralphate, misoprostol, prokinetic drugs or no drugs. The number of duodenal, oesophageal and stomach cancers diagnosed in each cohort was also counted. RESULTS: Drug therapy was the most frequently used strategy in all patients, and was used more frequently in NSAID users (87%) than in non-NSAID users (69%). A total of 22% of NSAID users in each group, and 46% of NSAID users in the drug therapy group, underwent investigation. H2 blockers were the most prescribed drug in all three treatment strategies, and omeprazole was the second most prescribed drug in the endoscopy and x-ray cohorts. Overall omeprazole was the least prescribed drug. There was a higher rate of cancer detection in the endoscopy and x-ray cohorts than in the drug therapy group. CONCLUSIONS: Previous NSAID use greatly influences the way in which physicians treat patients with dyspepsia.

Aged↗

PubMed2006

Community genetics and dignity in diversity in the Quebec Network of Genetic Medicine.

The Quebec Network of Genetic Medicine (QNGM), implemented in 1971, has been an integrated program of community genetics serving the population (approximately 7.5 million) of Quebec province in Canada. QNGM reported to the Minister of Social Affairs and operated under an umbrella of universal health insurance in the province. The Network's programs have been run by members of the four university medical schools of the province under the direction of a central committee. A global annual budget was awarded to QNGM from its inception. Among its many programs, QNGM supported: (1) two newborn screening programs (using blood and urine samples) for early diagnosis, treatment and research in phenylketonuria, hereditary tyrosinemia, congenital hypothyroidism, and in a large number of other hereditary metabolic diseases; (2) follow-up of confirmatory diagnostic tests at regional centers, followed by supervision of ambulatory treatment modalities; (3) carrier screening and reproductive counseling for Tay-Sachs and beta-thalassemia diseases; (4) a spectrum of feasibility (research) studies (e.g., screening for biotinidase deficiency, neuroblastoma, hemoglobinopathies, and cystic fibrosis) to inform policy decisions. QNGM performed economic analyses of its major programs and followed prevailing ethical guidelines. Its global budget and integrated structure terminated in 1994, although some of its programs continue independently.

Cystic Fibrosis↗

PubMed1991

Hereditary disorders in Saguenay-Lac-St-Jean (Quebec, Canada).

Saguenay-Lac-St-Jean is a geographically isolated region located in northeastern Quebec. Opened to the white settlement in 1938, its immigrants mainly came from Charlevoix, another isolated region of Quebec. The prevalence and/or incidence of several autosomal dominant and recessive disorders are very high. The overall birth prevalence of the recessive disorders was calculated at 1/207 living births and the overall carrier rate at 1/7 inhabitants. This situation may be explained by migration and social factors.

Genes, Dominant↗

PubMed1991

Founder effect in familial hyperchylomicronemia among French Canadians of Quebec.

Familial hyperchylomicronemia has reached a high prevalence in the French Canadian population of eastern Quebec. The birth places of 58 carriers identified through the birth of one affected child clustered in three regions. The genealogies of these 58 individuals showed that no founder was common to all of them. Three sets of founders were found, one for each region, with little overlapping between two regions. These results strongly suggest that more than one mutation, introduced by the French migrants in the 17th century, are segregating in the French Canadian population. Perche, a region situated between Paris and Normandy, appeared to be the most likely putative center of diffusion of at least one mutation in the lipoprotein lipase gene segregating in the modern-day French Canadian population of Quebec.

France↗

PubMed1991

Inbreeding in Saguenay-Lac-St-Jean (Quebec, Canada): a study of Catholic Church dispensations 1842-1971.

Saguenay-Lac-St-Jean (SLSJ) is a rather geographically isolated region of Quebec which shows a high occurrence of hereditary disorders. It has been suggested that high inbreeding might explain this situation. We studied the inbreeding in the SLSJ region by 10-year periods from 1842 till 1971 using the Catholic Church dispensations. The values of the mean inbreeding coefficient were found to be low during the whole period, reaching a peak of 22.94 x 10(-4) during the period 1902-1911. The values observed in the SLSJ were lower than those found in most regions of Quebec and similar to those reported in European populations.

Catholicism↗

PubMed1993

'Celtic' phenylketonuria chromosomes found? Evidence in two regions of Quebec Province.

We analyzed mutations, RFLP haplotypes (H), and a VNTR polymorphism at the phenylalanine hydroxylase locus (PAH) in 12 French-Canadian patients with phenylketonuria (PKU) from the eastern region of Quebec province and 13 non-French-Canadian PKU patients from the Montreal region. There were 10 different mutation/H/VNTR haplotype combinations on the 50 PKU chromosomes: one set of 5 and another of 8 accounted for 88 and 77% of these chromosomes in the French-Canadian and non-French-Canadian patients, respectively. The differences in PKU haplotypes between the two groups of probands reflect the different histories of the two populations. Three PKU haplotype combinations were shared by the two groups: IVS12nt1:H-3:VNTR-8, I65T:H-9:VNTR-8, and R408W:H-1:VNTR-8. The IVS12nt1 mutation (18% of the total sample) is prevalent in northern Europeans. The I65T-H-9 and R408W:H-1 haplotypes have seldom been reported in Europeans but when encountered tend to be found in northwestern regions. The R408W mutation is usually on H-2 in Europeans. In Quebec the R408W:H-1 and I65T:H-9 haplotypes accounted for 20% of PKU chromosomes, clustered in two geographic regions, and in every family where they occurred an Irish or Scottish ('Celtic') ancestor could be inferred. We propose that I65T:H-9:VNTR-8 and R408W:H-1:VNTR-8 chromosomes are markers for a diaspora of 'Celtic' descendants. Our findings predict the distributions of these unusual PKU haplotypes in contemporary Europeans.

Chromosomes, Human, Pair 12↗

PubMed2005

Area variations in the prevalence of substance use and gambling behaviours and problems in Quebec: a multilevel analysis.

OBJECTIVES: This study aimed to examine whether variations among regions in Quebec existed after we controlled for individual characteristics in the prevalence of 1) alcohol, cannabis, and gambling behaviours and 2) substance-related disorders and pathological gambling. METHODS: Using data derived from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), we nested 5332 respondents from the province of Quebec within 374 regions equivalent to census subdivisions (CSDs). Outcome variables included 1) drinking status (past 12 months), alcohol consumption (last week), and 12-month diagnosis of alcohol dependence; 2) cannabis use (past 12 months and lifetime) and diagnosis of illicit drug dependence; and 3) gambling status, severity of gambling problems, and number of reported gambling activities (past 12 months). Multilevel regression models with individuals (Level 1) nested in regions (CSDs, Level 2) assessed the variations among regions in the prevalence of various outcomes and disorders when individual characteristics were controlled for. RESULTS: Variance component models revealed that all alcohol-related variables, the prevalence of cannabis use (12 months), and problem gambling did not vary among areas. Gambling rates and the average number of reported gambling activities varied among areas, even when individual-level variables were accounted for in the models, whereas for lifetime cannabis use, variations among areas became nonsignificant. CONCLUSION: Intervention programs may need to address the environment as a relevant determinant of health-related behaviours and lifestyles.

Adolescent↗

PubMed1990

Psychiatric epidemiology in Quebec: an overview.

This paper reviews the development of psychiatric epidemiology in Quebec from 1960 to the present. The research in this area is divided into three periods: 1960 to 1980, 1980 to 1985, and 1985 onward. Child psychiatric epidemiology is addressed separately. The authors conclude that psychiatric epidemiology has been an active area of research in Quebec and will likely be even more so in the future given the increasing interest in the field.

Adult↗