The Montreal heat response plan: evaluation of its implementation towards healthcare professionals and vulnerable populations.

OBJECTIVES: Since 2004, the Montreal heat response plan (MHRP) has been developed and implemented on the Island of Montreal to reduce heat-related health effects in the general population. In this paper, we aimed to assess the barriers and facilitators to implementation of the MHRP and evaluate the awareness of key elements of the plan by healthcare professionals and individuals from vulnerable populations. METHODS: Data were gathered from monitoring reports and a questionnaire administered to managers of healthcare institutions and healthcare workers in Montreal-area health and social services institutions. Individual interviews and focus groups with healthcare workers and with individuals with schizophrenia or suffering from drug or alcohol dependencies were performed. Data were categorized according to predefined subthemes. Coding matrices were then used to determine the most frequently occurring elements in the subthemes. RESULTS: Our results indicate that actions are progressively implemented each year in the healthcare network. Intensification of surveillance for signs of heat-related illness is the most frequently reported measure. Identification and prioritization of clientele and homecare patients are identified as a challenge, as is ensuring the availability of sufficient personnel during a heat wave. Analysis of practice and awareness in healthcare professionals reveals that preventive measures are known and applied by the personnel. Individuals from vulnerable population groups were not uniformly aware of preventive measures, and consequently, variability was observed in their application. CONCLUSION: The framework proposed in this study revealed valuable information that can be useful to improve plans aimed at reducing heat-related health effects in the population.

Implementation of the Montreal heat response plan during the 2010 heat wave.

OBJECTIVES: The objective of this paper is to describe Montreal's heat response plan and its application during the July 2010 heat wave. PARTICIPANTS AND SETTING: The Montreal heat response plan is designed to ensure the surveillance of weather and health indicators during the summer season and to coordinate actions to be undertaken during this period to reduce morbidity and mortality due to heat, particularly when weather thresholds are reached or an increase in health indicators is observed. It was developed to coordinate and apply intervention measures on the Island of Montreal and has been in effect since 2004. INTERVENTION: In the beginning of July 2010, Montreal experienced a heat wave that lasted 5 days. During this period, health indicators such as total mortality, prehospital emergency transports, calls to the health information line and hospital admissions were monitored by the Montreal public health surveillance system. The decision to implement emergency interventions and actions performed by regional and local public health and municipal partners (intervention level) was made following attainment of a predetermined weather threshold and increases in health indicators. The significant increase in daily observed mortality from all causes and in particular people dying at home or in the community prompted the Director of public health to conduct a chart review of all people deceased from July 5 to July 11, 2010 to determine cause of death and underlying health conditions. OUTCOME: During the heat wave, there were 304 reported deaths from all causes in Montreal residents, of which 106 were probably or possibly heat-related. Major underlying health conditions in heat-related deaths included cardiovascular problems and mental health illness. Furthermore, in the case of people with mental illness who died during the heat wave, the chart review revealed that many were contacted 24 hours prior to their death by health care professionals, family members, neighbours or friends. CONCLUSION: Following the 2010 heat wave, the Montreal heat response plan and heat surveillance system were updated to include initiatives to better communicate preventive measures to the vulnerable populations and to intervene earlier during a heat wave.

Risk of childhood asthma prevalence attributable to residential proximity to major roads in Montreal, Canada.

OBJECTIVES: Exposure to traffic-related air pollutants plays a role in several health outcomes. A large body of evidence tends to link asthma in children with traffic exposure. Increasing asthma prevalence and incidence in children in Canadian cities has been of concern for public health authorities. The following study focuses on estimating the risk of asthma prevalence attributable to residing in proximity to major roads on the Island of Montreal, Canada. METHODS: Risk functions pertaining to asthma in children and residential proximity to major roads were selected from the literature and applied to Montreal. Asthma prevalence was taken from population-based studies. Population data were retrieved from Canadian census. Exposure was estimated using the proximity to major road and highway category of the Desktop Mapping Technologies Inc. database (DMTI Spatial Inc.). RESULTS: Based on different studies, the percentage of prevalent asthma cases attributable to residing within 50 metres of a major road or highway for children aged 2, 4 and 6 years varied between 2.4% (0-4.3), 5.6% (0.1-8.6) and 5.9% (0.1-9.0). For the 5-7 year age group residing within 75 m of a major road or highway, the percent of cases was 6.4% (2.6-9.3). For children aged 8 to 10 residing within 75 m of a highway only, the percent of cases was 0.7% (0.2-0.9). CONCLUSION: These numbers represent the best crude estimates and are an indication of a possible range of cases linked to residential proximity to major roads. As there are uncertainties linked to the application of exposure-response functions, these estimates will be reassessed as new evidence is gathered through further research.

Physiological modeling of age-specific changes in the pharmacokinetics of organic chemicals in children.

Age-specific changes in the pharmacokinetics of chemicals are primarily due to differences in physiological and biochemical factors. For integrating the available information on the age-dependent changes in the physiological and biochemical factors, and for evaluating their combined influence on the pharmacokinetics of chemicals, physiologically based pharmacokinetic (PBPK) models are potentially useful. The objectives of this study were, therefore, (1) to assemble information on age-specific differences in physiological parameters such as alveolar ventilation rate, cardiac output, tissue volumes, tissue blood flow rates, and tissue composition for children of various age groups, and (2) to incorporate these data within a PBPK model for simulating the inhalation pharmacokinetics of a highly metabolized, volatile organic chemical (furan) in children of specific age groups (6, 10, and 14 yr old). The age-specific data on various physiological parameters were assembled following a review of the relevant literature and the hepatic metabolism rate of furan was set equal to the liver blood flow rate in adults and children. The blood:air and tissue:blood partition coefficients were calculated using molecular structure information along with the data on the blood and tissue composition (lipid and water contents) in children and adults. The PBPK model was used to simulate the pharmacokinetics of furan in adults and children (6, 10, and 14 yr old) exposed continuously for 30 h to 1 microgram/L of this chemical in inhaled air. The model simulations suggest that, for the same exposure conditions, the blood concentration of furan is likely to be greater in children by a factor of 1.5 (at steady state) than in adults, and the maximal factor of adult-children differences in liver concentration of furan metabolite is about 1.25. The PBPK model framework developed in this study should be useful for predicting the adult-children differences in internal dose of chemicals for risk assessment applications.