Long-Term Consequences of COVID-19 in Predominantly Immunonaive Patients: A Canadian Prospective Population-Based Study.

Background: Lingering symptoms are frequently reported after acute SARS-CoV-2 infection, a condition known as post-COVID-19 condition (PCC). The duration and severity of PCC in immunologically naïve persons remain unclear. Furthermore, the long-term consequences of these chronic symptoms on work and mental health are poorly documented. Objective: To determine the outcome, the risk factors, and the impact on work and mental health associated with post-COVID-19 symptoms. Methods: This prospective population-based study assessed acute COVID-19 symptoms and their evolution for up to nine months following infection. Individuals aged 18 years and older with COVID-19 in three Canadian regions between 1 November 2020 and 31 May 2021 were recruited. Participants completed a questionnaire that was either administered by trained student investigators over the phone or self-administered online. Results: A total of 1349 participants with a mean age of 46.6 ± 16.0 years completed the questionnaire. Participants were mostly unvaccinated at the time of their COVID-19 episode (86.9%). Six hundred and twenty-two participants (48.0%) exhibited one symptom or more, at least three months post-COVID-19. Among participants with PCC, 23.0% to 37.8% experienced fatigue at the time of survey. Moreover, 6.1% expressed psychological distress. Risk factors for PCC and fatigue included female sex (OR = 1.996), higher number of symptoms (OR = 1.292), higher severity of episode (OR = 3.831), and having a mental health condition prior to the COVID-19 episode (OR = 5.155). Conclusions: In this multicenter cohort study, almost half (47%) of the participants reported persistent symptoms >3 months after acute infection. Baseline risk factors for PCC include female sex, number and severity of symptoms during acute infection, and a previous diagnosis of mental health disorder. Having PCC negatively impacted health-related quality of life and these patients were more likely to exhibit psychological distress, as well as fatigue.

Identification of an unusual cluster of human granulocytic anaplasmosis in the Estrie region, Québec, Canada in 2021.

Background: Human granulocytic anaplasmosis (HGA) is a potentially severe tick-borne infection caused by the bacterium Anaplasma phagocytophilum (A. phagocytophilum) of the genus Rickettsia. Here, we describe the epidemiological and clinical characteristics of an unusual cluster of HGA cases detected in the Estrie region in Québec, Canada, during the 2021 transmission season. Methods: Confirmed cases of HGA were defined as individuals with typical clinical manifestations and a positive polymerase chain reaction assay. The cases were interviewed using a structured questionnaire and clinical data was obtained from medical records. Results: A total of 25 confirmed cases were identified during the 2021 transmission season, thus constituting the largest known cluster of HGA in Canada. The most common symptoms reported were fever, fatigue and headaches. Laboratory investigations found that 20 (80%) of the patients had thrombocytopenia and 18 (72%) had leukopenia at presentation. Almost half of the patients required hospitalization (n=11, 44%), with a median duration of four days (interquartile range [IQR] 2.5-5 days), including one patient who required intensive care. No deaths were recorded during the study. Epidemiological investigation found that all cases were domestically acquired, and yard maintenance was the most prevalent at-risk activity identified. Only seven (28%) cases had been aware of a tick bite in the previous two weeks. Conclusion: Detection of this unusual cluster of HGA cases provides further evidence that A. phagocytophilum may now be established along the southern border of Québec. Clinicians should consider HGA when assessing patients with typical symptoms and recent exposure to high-risk environments for tick bite.

Rural and urban variation in psychological distress among adults: results of the 2014-2015 Eastern Townships Population Health Survey (ETPHS).

OBJECTIVE: A growing number of people live in urban areas. Urbanization has been associated with an increased prevalence of mental disorders, but which mechanisms cause this increase is unknown. Psychological distress is a good indicator of mental health. This study sought to examine the relationship between urbanization and distress among adults in the Eastern Townships (southern region of Quebec, Canada). METHOD: In the 2014-2015 Eastern Townships Population Health Survey (N = 10,687 adults living in one of the 96 Eastern Townships communities), distress was measured with the K6 distress scale (≥ 7). Urbanization was estimated by the residential density of the community treated in quintiles. Logistic regression analyses were carried out with adjustments for individual and environmental characteristics. RESULTS: Women, young people aged 18-24, single parents, those without diplomas, those without a job, those with < $20,000 in income, adults with two or more chronic physical illnesses, adults with bad perceived health, or those living in disadvantaged neighbourhoods exhibited more distress. The unadjusted estimate between density and distress is only significant for the fifth quintile when compared with the first quintile (OR 1.23; 95% CI: 1.06-1.42). The relationship is practically the same after controlling for individual characteristics but decreases considerably after controlling for environmental characteristics (lack of trees, social deprivation, intersection density, vegetation index, and land use mix). CONCLUSION: This study was the first to examine an association between urbanization and distress by considering individual and environmental characteristics. The latter seem to explain the relationship between these concepts.

RéSUMé: OBJECTIF: Un nombre croissant de personnes vivent en milieu urbain. L'urbanisation a été associée à une prévalence accrue de troubles mentaux, mais on ignore par quels mécanismes. La détresse psychologique est un bon indicateur de la santé mentale. Cette étude cherche à examiner le lien entre l'urbanisation et la détresse des adultes en l'Estrie (région dans le sud du Québec, Canada). MéTHODE: Dans l'Enquête de santé populationnelle estrienne 2014-2015 (N = 10 687 adultes, résidant dans l'une des 96 communautés estriennes), la détresse a été mesurée avec le Kessler-6 (score ≥7). L'urbanisation a été estimée par la densité résidentielle de la communauté traitée en quintiles. Des analyses de régression logistique ont été réalisées, avec ajustement pour des caractéristiques individuelles et environnementales. RéSULTATS: Les femmes, les 18-24 ans, les personnes monoparentales, celles ne possédant pas de diplôme, sans emploi, ayant un revenu < 20 000$, ayant deux maladies chroniques ou plus, ayant une mauvaise perception de leur santé, ou vivant dans les quartiers défavorisés présentent plus de détresse. La relation brute entre la densité et la détresse n'est significative que pour la dernière catégorie avec un RC 1,23; IC95% : 1,06­1,42 (Q5 vs Q1). En contrôlant pour les caractéristiques individuelles, la relation demeure pratiquement inchangée, mais diminue davantage après un contrôle pour les caractéristiques environnementales (manque d'arbres, défavorisation sociale, densité d'intersections, indice de végétation et mixité des sols). CONCLUSION: Cette étude est la première à examiner une association entre l'urbanisation et la détresse en considérant les caractéristiques individuelles et environnementales. Ces dernières semblent expliquer la relation entre ces concepts.

Promoting vaccination in maternity wards ─ motivational interview technique reduces hesitancy and enhances intention to vaccinate, results from a multicentre non-controlled pre- and post-intervention RCT-nested study, Quebec, March 2014 to February 2015.

BackgroundMany countries are grappling with growing numbers of parents who delay or refuse recommended vaccinations for their children. This has created a need for strategies to address vaccine hesitancy (VH) and better support parental decision-making regarding vaccination.AimTo assess vaccination intention (VI) and VH among parents who received an individual motivational-interview (MI) based intervention on infant immunisation during post-partum stay at a maternity ward between March 2014 and February 2015.MethodsThis non-controlled pre-/post-intervention study was conducted using the results from parents enrolled in the intervention arm of the PromoVaQ randomised control trial (RCT), which was conducted in four maternity wards across the Province of Quebec. Participants (n = 1,223) completed pre- and post-intervention questionnaires on VI and VH using Opel's score. Pre-/post-intervention measures were compared using McNemar's test for categorical variables and Wilcoxon signed-rank test for continuous variables.ResultsPre-intervention: overall VI was 78% and significantly differed across maternity wards (74%, 77%, 84%, 79%, p = 0.02). Post-intervention: VI rose significantly across maternity wards (89%, 85%, 95%, 93%) and the overall increase in VI was 12% (78% vs 90%, p < 0.0001). VH corroborated these observations, pre- vs post-intervention, for each maternity ward (28% vs 16%, 29% vs 21%, 27% vs 17%, 24% vs 13%). Overall, VH was curbed post-intervention by 40% (27% vs 16%; p < 0.0001).ConclusionsCompared with pre-intervention status, participants who received the MI-based intervention on immunisation displayed lower hesitancy and greater intention to vaccinate their infant at 2 months of age.

Determinants of vaccine hesitancy in Quebec: a large population-based survey.

Objectives: Vaccine hesitancy is a global phenomenon that needs to be measured and addressed. This study aimed to identify the determinants of vaccine hesitancy among a large regional population.Methods: A structured telephone survey was administered to a random digit sample in Quebec's Eastern Townships region. In addition to socioeconomic information, respondents were asked questions on several health topics such as knowledge and beliefs about immunization, medical consultations, health status, and life habits. Data were weighted according to age, sex, and territories. Statistically significant variables in the univariate analysis were introduced into a multivariate logistic regression model to determine independent factors for vaccine hesitancy (adjusted odds ratios [aOR] and 95% confidence intervals).Results: A total of 8,737 interviews were conducted (participation rate 48.3%). Among all respondents, 32.2% were vaccine-hesitant. Several beliefs were significantly associated with vaccine hesitancy: belief that children receive too many vaccines (aOR = 2.72; 2.32-3.18), belief that a healthy lifestyle can eliminate the need for vaccination (aOR = 2.48; 2.09-2.93), and belief that the use of alternative medicine practices can eliminate the need for vaccination (aOR = 1.39; 1.16-1.68). Other determinants associated with vaccine hesitancy were having consulted a massage therapist (aOR = 2.34; 1.46-3.75), not being vaccinated against influenza (aOR = 1.80; 1.49-2.16), having a low (<$30,000) (aOR = 1.58; 1.24-2.02) or moderate ($30,000-$79,000) (aOR = 1.37; 1.12-1.67) household income, distrust in public health authorities (aOR = 1.40; 1.21-1.63), perceived insufficient knowledge about immunization (aOR = 1.26; 1.04-1.51), and smoking (aOR = 1.22; 1.01-1.47).Conclusions: Many determinants are related to vaccine hesitancy. These determinants should be taken into account when health professionals engage with vaccine-hesitant individuals.

Monitoring Adverse Psychosocial Outcomes One and Two Years After the Lac-Mégantic Train Derailment Tragedy (Eastern Townships, Quebec, Canada).

INTRODUCTION: In July 2013, a train carrying 72 cars of crude oil derailed in the town of Lac-Mégantic (Eastern Townships, Quebec, Canada). This disaster provoked a major conflagration, explosions, 47 deaths, the destruction of 44 buildings, the evacuation of one-third of the local population, and an unparalleled oil spill. Notwithstanding the environmental impact, many citizens of this town and in surrounding areas have suffered and continue to suffer substantial losses as a direct consequence of this catastrophe. PROBLEM: To tailor public health interventions and to meet the psychosocial needs of the community, the Public Health Department of Eastern Townships has undertaken repeated surveys to monitor health and well-being over time. This study focuses on negative psychosocial outcomes one and two years after the tragedy. METHODS: Two cross-sectional surveys (2014 and 2015) were conducted among large random samples of adults in Lac-Mégantic and surrounding areas (2014: n = 811; 2015: n = 800), and elsewhere in the region (2014: n = 7,926; 2015: n = 800). A wide range of psychosocial outcomes was assessed (ie, daily stress, main source of stress, sense of insecurity, psychological distress, excessive drinking, anxiety or mood disorders, psychosocial services use, anxiolytic drug use, gambling habits, and posttraumatic stress symptoms [PSS]). Exposure to the tragedy was assessed using residential location (ie, six-digit postal code) and intensity of exposure (ie, intense, moderate, or low exposure; from nine items capturing human, material, or subjective losses). Relationships between such exposures and adverse psychosocial outcomes were examined using chi-squares and t-tests. Distribution of outcomes was also examined over time. RESULTS: One year after the disaster, an important proportion of participants reported human, material, and subjective losses (64%, 23%, and 54%, respectively), whereas 17% of people experienced intense exposure. Participants from Lac-Mégantic, particularly those intensely exposed, were much more likely to report psychological distress, depressive episode, anxiety disorders, and anxiolytic drug use, relative to less-exposed ones. In 2015, 67% of the Lac-Mégantic participants (76% of intensely exposed) reported moderate to severe PSS. Surprisingly, the use of psychosocial services in Lac-Mégantic declined by 41% from 2014 to 2015. CONCLUSION: The psychosocial burden in the aftermath of the Lac-Mégantic tragedy is substantial and persistent. Public health organizations responding to large-scaling disasters should monitor long-term psychosocial consequences and advocate for community-based psychosocial support in order to help citizens in their recovery process.

Promoting vaccination in the province of Québec: the PromoVaQ randomized controlled trial protocol.

BACKGROUND: Vaccination has a huge public health impact. Maintaining vaccine coverage is key to avoid the devastating consequences of resurgence. In the Province of Québec, vaccine coverage in young children are sub-optimal, mostly due to ambivalence toward vaccine safety and efficacy. We previously conducted a regional study in the Québec's Eastern Townships region, the PromoVac Study, to test a new educational intervention, based on motivational interviewing techniques, aimed at promoting infant vaccination. This first study evidenced that the intervention led to a marked increase in mothers' intention to vaccinate, and vaccine coverage in their infants. The current study protocol aims at scaling up these results at a provincial level using a randomized controlled trial design. METHODS: This pragmatic, randomized, controlled, parallel-group clinical trial will compare the effectiveness of the motivational interviewing to an educational intervention, including the distribution of an information flyer as standard of care on vaccination coverage in four maternity wards across the Province of Québec (PromovaQ). Adult mothers of children born in participating maternity wards were recruited between March 2014 and February 2015. Vaccination coverage will be assessed at 3-years of age, thus the trial is expected to be completed in March 2019. Statistical analyses will be conducted under the intention-to-treat principle. Vaccine coverage will be analyzed using Chi-squared distribution testing and logistic regression to identify determinant factors. Secondary outcomes will include vaccine hesitation and intention scores, mother's knowledge, attitudes and beliefs about immunization, and psychosocial determinants of intention to vaccinate. DISCUSSION: In the case results of this Provincial RCT be confirmed, serious consideration should then be given by Ministry of Health authorities to the possible implementation of MI-based strategies across provincial maternity wards. To ensure adequate input and secure implementation, study design and results will be reviewed with relevant stakeholders, including the children's families, and provincial and regional decision-makers. Results will be adapted and shared with all stakeholders. TRIAL REGISTRATION: ClinicalTrials.gov NCT02666872 (Retrospectively registered as January 28, 2016).

Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada.

BACKGROUND: Vaccine hesitancy (VH) is a growing problem. The first step in addressing VH is to have an understanding of who are the hesitant individuals and what are their specific concerns. The aim of this survey was to assess mothers' level of vaccine hesitancy and vaccination knowledge, attitudes, and beliefs. METHODS: Mothers of newly-born infants in four maternity wards in Quebec (Canada) completed a self-administered questionnaire. The questionnaire included items to assess VH and intention to vaccinate. VH scores were calculated using the Parents Attitudes about Childhood Vaccines (PACV) survey. Multivariate logistic regression was performed to determine variables associated with intention to vaccinate (OR; 95% CI). RESULTS: Overall, 2645 questionnaires were included in this analysis and 77.5% of respondents certainly intended to vaccinate their infant at 2 months of age. Based on the PACV 100-point scale, 56.4% of mothers had a 0 to ˂30 score (low level of VH); 28.6% had a 30 to ˂50 and 15.0% had a score of 50 and higher (high level of VH).The main determinants of mothers' intention to vaccinate were the perceived importance of vaccinating infants at 2 months of age (OR = 9.2; 5.9-14.5) and a low score of VH (OR = 7.4; 5.3-10.3). DISCUSSION: Although the majority of mothers held positive attitudes toward vaccination, a large proportion were moderately or highly vaccine hesitant. Mothers' level of VH was strongly associated with their intention to vaccinate their infants, showing the potential detrimental impact of VH on vaccine uptake rates and the importance of addressing this phenomenon.

Impact of a vaccination promotion intervention using motivational interview techniques on long-term vaccine coverage: the PromoVac strategy.

BACKGROUND: Delayed vaccinations at 2, 4, and 6 months are associated with a higher probability of delayed age-appropriate vaccination during childhood. This study aimed to assess the effectiveness of an information session on immunization during infancy. METHODS: An individual educational information session with motivational interview techniques for immunization of infants was conducted (experimental group) or not conducted (control group) during postpartum stay in a quasi-experimental cohort study. Immunization data were collected from the Eastern Townships Public Health registry at 3, 5, 7, 13, 19, and 24 months of age. Logistic regressions with repeated measures were performed to assess the intervention's impact. Relative risks (RR) were estimated. A multivariate model was obtained adjusted for confounding factors. RESULTS: The experimental and control groups included 1140 and 1249 families, respectively. In per protocol analysis, a significant increase in VC of 3.2, 4.9, 7.3, 6.7, 10.6, and 5.1% was observed at 3, 5, 7, 13, 19, and 24 months. Children from experimental group had 9% more chance at a complete vaccination status between 3 and 24 months compared to children from control group (RR (95% CI): 1.09 (1.05-1.13), p < .001). Children with complete vaccination status at 3 months were more likely to have a complete vaccination status at 24 months (82.3 vs. 48.1%, RR (95% CI): 2.72 (2.28-3.24), p < .001). After adjustment, the estimated RR of the intervention's impact was 1.05 (1.02-1.07), p < .001. CONCLUSIONS: An educational information session about immunization based on motivational interview techniques conducted during postpartum hospitalization could improve immunization during infancy.

The "Lac-Mégantic tragedy" seen through the lens of the EnRiCH Community Resilience Framework for High-Risk Populations.

SETTING: On July 6, 2013, a train carrying oil derailed in downtown Lac-Mégantic (Quebec, Canada), causing major human, environmental, and economic impacts. We aim to describe, and learn from, public health strategies developed to enhance community resilience following the train derailment though the lens of the EnRiCH Community Resilience Framework for High-Risk Populations. INTERVENTION: Annual population-level surveys were conducted in Lac-Mégantic and surrounding areas to assess the long-term impacts of the disaster. Findings suggested that a solid upstream investment towards the development of adaptive capacity was needed. A "Day of Reflection" bringing together local stakeholders and citizens was organized, inspiring the elaboration of an innovative action plan. Leaders advocated for funding to support its implementation, leading to a substantial investment from the provincial government. Through a wide range of actions, the plan aims to bring psychosocial services closer to people, stay connected with the community, and foster community engagement. OUTCOMES: Several lessons have been identified. After a disaster, there needs to be a balanced focus between the gaps/needs and strengths/capacities of a community. Moreover, public health actors must collaborate closely, all along the continuum of the upstream-downstream paradigm, with local organizations and citizens. IMPLICATIONS: This unique experience, supported by an empirically-based framework, suggests that three vital ingredients are required for success in recovering from a disaster: (1) fostering community strengths and valuing citizen participation, (2) a strong political commitment to support upstream actions, and (3) a public health team able to support these actions.

A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study.

BACKGROUND: Due to the increasing number of vaccine-hesitant parents, new effective immunization promotion strategies need to be developed to improve the vaccine coverage (VC) of infants. This study aimed to assess the impact of an educational strategy of vaccination promotion based on motivational interviewing (MI) techniques targeting parents and delivered at the maternity ward, for the VC of infants at 3, 5, and 7 months of age. METHODS: An individual educational information session, administered using MI techniques, regarding immunization of infants aged 2, 4, and 6 months was (experimental group) or was not (control group) proposed to parents during the postpartum stay at the maternity ward. Immunization data were obtained through the Eastern Townships Public Health registry for infants at 3, 5, and 7 months of age. Absolute VC increases at 3, 5, and 7 months in the experimental group were calculated and the relative risks with the respective 95% confidence intervals were computed using univariate logistic regression with the generalized estimating equations (GEE) procedure. Multivariate regression using GEE was used to adjust for confounding variables. RESULTS: In the experimental and control groups, 1140 and 1249 newborns were included, respectively. A significant increase in VC of 3.2, 4.9, and 7.3% was observed at 3, 5, and 7 months of age (P < 0.05), respectively. The adjusted relative risk of the intervention's impact on vaccination status at 7 months of age was 1.08 (95% confidence interval: 1.03-1.14) (P = 0.002). CONCLUSIONS: An educational strategy using MI techniques delivered at the maternity ward may be effective in increasing VC of infants at ages 3, 5, and 7 months. MI could be an effective tool to overcome vaccine hesitancy.

Determinants of influenza vaccination among a large adult population in Quebec.

OBJECTIVES: Very low uptake has been noted for influenza vaccination in the province of Quebec. This study aimed to identify the determinants of influenza vaccination among a large regional population. METHODS: A telephone survey was administered to a random digit sample in the Eastern Townships region (Quebec, Canada). Respondents were asked questions on several health topics such as perceived knowledge and beliefs about influenza immunization, medical consultations, perceived health status and life habits. Significant variables in the univariate analysis were introduced into a multivariate logistic regression model to determine independent factors for having received the influenza vaccine (aOR and 95% CI) among adults aged ≥60 years and younger adults with ≥1 chronic condition. RESULTS: A total of 4,620 interviews were analyzed. Among the target groups, 55.4% of adults aged ≥60 and 32.2% of adults aged 18-59 with at least one chronic disease had received the influenza vaccine during the 2013-2014 season. Several determinants were significantly associated with influenza vaccination in both groups such as having received a recommendation from a healthcare professional. Among adults aged ≥60, not having consulted a chiropractor over the last 12 months (aOR = 2.37; 1.09-5.19), non-smokers (aOR = 1.78; 1.22-2.59) and self-perceived poor health status (aOR = 1.45; 1.01-2.06) were significantly linked to flu vaccination. In the younger group, influenza vaccination was independently associated to low alcohol consumption (aOR = 2.14; 1.13-4.05) and being overweight (aOR = 1.63; 1.12-2.38). CONCLUSIONS: Many determinants influence the decision to get vaccinated against influenza. Specific messages should be tailored for high-risk groups to effectively increase influenza vaccine coverage.

Trends in severe gastroenteritis among young children according to socio-economic characteristics before and after implementation of a rotavirus vaccination program in Quebec.

OBJECTIVES: Following implementation of a publicly funded rotavirus immunization program in Quebec (Canada) in 2011, its impact on gastroenteritis hospitalization rates, a proxy for severe gastroenteritis, was assessed. METHODS: Using a tertiary hospital database and a regional vaccination registry, temporal trends in rates of hospitalization for acute gastroenteritis (AGE) and rotavirus gastroenteritis before the age of five years and rotavirus vaccine coverage were examined from June 2004 through May 2014 in a large retrospective birth cohort in the Eastern Townships region. The mean annual AGE hospitalization rate in post-program years (2011/2012-2013/2014) was compared with that in pre-program years (2004/2005-2010/2011) overall and according to the characteristics of the children, families and residential neighbourhoods at birth. RESULTS: The AGE hospitalization rate significantly decreased from 81/10,000 in the pre-program period to 46/10,000 in the post-program period (relative reduction = 43%). Following implementation of the program, vaccine coverage rapidly increased and reached 81%. All socio-economic categories showed a reduced hospitalization rate in the post-program period, but the lowest relative reductions were observed in children living in neighbourhoods with higher rates of unemployment, low-income families and single mothers. However, these disadvantaged subgroups did not have lower vaccine coverage. CONCLUSIONS: Three years following its introduction in a universal vaccination program, rotavirus vaccine significantly reduced severe gastroenteritis in young children. Despite similar vaccine coverage among all children, disadvantaged socio-economic groups appeared to have a less pronounced AGE reduction, suggesting that factors other than vaccination could partially influence the reduction of gastroenteritis morbidity in young children.

Effectiveness of rotavirus vaccine in preventing severe gastroenteritis in young children according to socioeconomic status.

In 2011, the monovalent rotavirus vaccine was introduced into a universal immunization program in Quebec (Canada). This retrospective cohort study assessed vaccine effectiveness (VE) in preventing acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) hospitalizations among children <3 y living in the Quebec Eastern Townships region according to socioeconomic status (SES). Data were gathered from a tertiary hospital database paired with a regional immunization registry. Three cohorts of children were followed: (1) vaccinated children born in post-universal vaccination period (2011-2013, n = 5,033), (2) unvaccinated children born in post-universal vaccination period (n = 1,239), and (3) unvaccinated children born in pre-universal vaccination period (2008-2010, n = 6,436). In each cohort, AGE and RVGE hospitalizations were identified during equivalent follow-up periods to calculate VE globally and according to neighborhood-level SES. Using multivariable logistic regression, adjusted odds ratios (OR) were computed to obtain VE (1-OR). Adjusted VE of 2 doses was 62% (95% confidence interval [CI]: 37%-77%) and 94% (95%CI: 52%-99%) in preventing AGE and RVGE hospitalization, respectively. Stratified analyses according to SES showed that children living in neighborhoods with higher rates of low-income families had significantly lower VE against AGE hospitalizations compared to neighborhoods with lower rates of low-income families (30% vs. 78%, p = 0.027). Our results suggest that the rotavirus vaccine is highly effective in preventing severe gastroenteritis in young children, particularly among the most well-off. SES seems to influence rotavirus VE, even in a high-income country like Canada. Further studies are needed to determine factors related to lower rotavirus VE among socioeconomically disadvantaged groups.

Using the evaluation process as a lever for improving health and healthcare accessibility: The case of HCV services organization in Quebec.

BACKGROUND: The evaluation process can be a lever to improve pathways of access to healthcare. The objective of this article is to show how an evaluation strategy can both contribute to knowledge development and have direct impacts on health services provision. We use the case of hepatitis C (HCV) services organization to illustrate the use and the value of this evaluative approach. METHOD: Inspired by empowerment evaluation, the transformative-participatory approach involved overlapping phases of knowledge development and discussion with stakeholders. We conducted several knowledge development activities to discern the needs of people with HCV, the resources available, and the facilitators and impediments along the care pathway, starting from prevention and screening, all the way through to treatment. Using an overlapping approach allowed us to regularly transfer acquired knowledge back to the participants in the study settings and also to gather their impressions, interpretations, and suggestions during periods of deliberation. RESULTS: The knowledge development activities made it possible to document the needs, resources, and experiences of people affected by HCV. In the discussion sessions, viable solutions were identified to improve health and healthcare access for people with HCV and to prioritize certain actions. This project demonstrated that using the evaluation process can enable an instrumental, conceptual use of results and, in fact, can have a transformative impact on services organization.

The public health response during and after the Lac-Mégantic train derailment tragedy: a case study.

On July 6th 2013, a train derailment occurred in the small town of Lac-Mégantic, Quebec, Canada, causing a major human and environmental disaster. In this case study, we comprehensively describe and analyze actions taken by the Public Health Department of the Eastern Townships, in close collaboration with community-based organizations, during both the impact phase emergency response and the post-impact recovery operations that continued for months. Due to the complexity of the event, public health actions needed to be broadly diversified. Preventive measures targeted chemical, physical, biological, and psychosocial hazards in the short-, medium- and long-term. Our analyses yielded valuable lessons that will improve and inform our response to future events while serving as a basis for developing a conceptual framework for public health emergency preparedness.

Predictors of crack cocaine initiation among Montréal street youth: a first look at the phenomenon.

BACKGROUND: Crack cocaine use is increasing in Montréal. However, initiation risk factors among street youth are unknown. The goal of this project is to estimate the incidence of first crack cocaine use among these youth and to identify the associated risk factors. METHODS: A prospective cohort study of HIV and hepatitis C incidence was conducted among street youth from 2001 to 2005. A questionnaire on sexual and drug use behaviours was administered every 6 months. Incidence was estimated (a) for youth who had never used crack cocaine at recruitment (n=203) and, among them, (b) for those who had snorted cocaine before (n=122). The risk factors for initiation of crack use as well for initiation into a new route of cocaine administration among youth who had snorted cocaine before were determined using Cox regression. RESULTS: Incidence rates for crack cocaine use were (a) 136.6/1000 person-years (p-y) (95% confidence interval [CI]: 104.5-175.5) and (b) 205.8/1000 p-y (95% CI: 150.2-275.3). The number of substance types used recently increased the risk of initiating crack use (adjusted hazard ratio [AHR]=1.84 per substance type, 95% CI: 1.55-2.18), whereas having a parent with a substance abuse problem decreased that risk (AHR=0.48, 95% CI: 0.26-0.89). The risk factors were identical among youth who had snorted cocaine before. CONCLUSIONS: Our analyses show a high incidence of crack use among street youth. It is important to delve more deeply into the phenomenon of initiation if we wish to develop effective prevention measures for these young people.

Cost-effectiveness of a 3-dose pneumococcal conjugate vaccine program in the province of Quebec, Canada.

In the province of Quebec, Canada, the pneumococcal 7-valent conjugate vaccine (PCV-7) was licensed in 2001 and a publicly funded program was implemented in 2004, recommending 3 doses for healthy children. An economic analysis was performed both from a health care and societal perspective. Outcomes possibly prevented by PCV-7 and observed in 2006-2007 were compared to expected frequencies based on rates measured before PCV-7 use. Annual program costs were close to $21M for the health system and $23M for society. Approximately 20,000 infections were prevented annually and estimated economic benefits were $5M for the health system and $23M for society, using a 3% per annum discounting rate. The incremental cost-effectiveness ratio was $18,000 per QALY gained for the health system and the program was close to the break-even threshold in a societal perspective.

[The immunization practices of nursing staff in local community health centers]. / Les pratiques vaccinales des infirmières au Québec: etendue, retombées et barrières a leur réalisation.

BACKGROUND: Nurses have an important role in keeping the youth of Quebec vaccinated. Little, however, is known about nurses' immunization practices. The purpose of this research is to identify the immunization practices of nursing staff in local community health centres who vaccinate children aged 0 to 5 years and to outline personal outcomes and barriers to performing these practices. METHODS: A Delphi consultation project was conducted with immunization experts in Quebec. The consultation included 4 phases during which participants expressed their opinions on concepts through a series of questionnaires. The research team created a consolidated common response at each stage in order to produce a final consensus. RESULTS: Eighteen specialists participated in at least 1 of the consultation phases. The consultation allowed for the identification of 35 ideal immunization practices which were grouped into 11 higher-order categories. Eleven expected outcomes were also identified as well as 51 barriers to ideal immunization practices which in turn were grouped into 7 higher-order categories. CONCLUSION: According to experts, immunization practices are varied and include technical acts as well as relational, organizational, and continuing education activities. These practices are expected to generate outcomes for professionals and their clientele. However, a number of barriers to achieving ideal vaccination practices are also observed. The picture of immunization practices by nurses in local community health centres and their perception of outcomes and barriers will be studied during the next stages of the project. This process will lead to developing intervention strategies with vaccinators.