Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Food insecurity (FI) is associated with depressive symptoms among HIV mono-infected people. Our objective was to examine to what extent this association holds among HIV-hepatitis C virus (HCV) co-infected people. We used data from a... more
Food insecurity (FI) is associated with depressive symptoms among HIV mono-infected people. Our objective was to examine to what extent this association holds among HIV-hepatitis C virus (HCV) co-infected people. We used data from a prospective cohort study of HIV-HCV co-infected people in Canada. FI was measured using the ten-item adult scale of Health Canada's Household Food Security Survey Module and was classified into three categories: food secure, moderate FI, and severe FI. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D-10) and was classified into absence or presence of depressive symptoms. FI, depressive symptoms, and other covariates were updated every 6 months. The association between FI and depressive symptoms was assessed using a stabilized inverse probability weighted marginal structural model. The study sample included 725 HIV-HCV co-infected people with 1973 person-visits over 3 years of follow up. At baseline,...
Research Interests:
There is a higher incidence of cervical cancer and prevalence of genital human papillomavirus (HPV) infection among the Inuit in Canada than the general population. Self-sampling of cervicovaginal cells for HPV testing has the potential... more
There is a higher incidence of cervical cancer and prevalence of genital human papillomavirus (HPV) infection among the Inuit in Canada than the general population. Self-sampling of cervicovaginal cells for HPV testing has the potential to increase cervical cancer screening coverage in this population, but only if it is acceptable to women. We sought to determine acceptance of and preference for self-collection of cervicovaginal samples for HPV testing in comparison with provider-collection, and to explore demographic characteristics of preference for self-collection among a sample of Inuit women from Nunavik, Quebec. Women aged 18–69 years were recruited from a previously formed cohort on the natural history of HPV in Nunavik. Both self-collected and provider-collected specimens were collected with polyester-tipped swabs, and women completed a short written questionnaire immediately after specimen collection. Logistic regression was used to estimate predictors of preference. Of the...
Research Interests:
Inuit interpreters are key players in end-of-life (EOL) care for Nunavik patients and families. This emotionally intensive work requires expertise in French, English and Inuit dialects to negotiate linguistic and cultural challenges.... more
Inuit interpreters are key players in end-of-life (EOL) care for Nunavik patients and families. This emotionally intensive work requires expertise in French, English and Inuit dialects to negotiate linguistic and cultural challenges. Cultural differences among medical institutions and Inuit communities can lead to value conflicts and moral dilemmas as interpreters navigate how best to transmit messages of care at EOL. Our goal was to understand the experience of Inuit interpreters in the context of EOL care in Nunavik in order to identify training needs. In the context of a larger ethnographic project on EOL care in Nunavik, we met with 24 current and former interpreters from local health centres and Montreal tertiary care contexts. Data included informal and formal interviews focusing on linguistic resources, experiences concerning EOL care, and suggestions for the development of interpretation training. Inuit working as interpreters in Nunavik are hired to provide multiple service...
Research Interests:
Food insecurity is defined as a limited or uncertain ability to acquire acceptable foods in socially acceptable ways, or limited or uncertain availability of nutritionally adequate and safe foods. While effective antiretroviral treatment... more
Food insecurity is defined as a limited or uncertain ability to acquire acceptable foods in socially acceptable ways, or limited or uncertain availability of nutritionally adequate and safe foods. While effective antiretroviral treatment can significantly increase CD4 counts in the majority of patients, there are certain populations who remain at relatively low CD4 count levels. Factors possibly associated with poor CD4 recovery have been extensively studied, but the association between food insecurity and low CD4 count is inconsistent in the literature. The objective is to systematically review published literature to determine the association between food insecurity and CD4 count among HIV-infected people. PubMed, Web of Science, ProQuest ABI/INFORM Complete, Ovid Medline and EMBASE Classic, plus bibliographies of relevant studies were systematically searched up to May 2015, where the earliest database coverage started from 1900. Studies that quantitatively assessed the associatio...
Research Interests:
Research Interests:
The effect of statins on cytokine-mediated inflammatory responses may impact on the prognosis of influenza. We assessed whether statin use decreases the incidence of adverse influenza-related outcomes. Additionally, we used a new-user... more
The effect of statins on cytokine-mediated inflammatory responses may impact on the prognosis of influenza. We assessed whether statin use decreases the incidence of adverse influenza-related outcomes. Additionally, we used a new-user study design to minimize healthy user bias. We further examined the possibility of non-causal associations by using unrelated outcomes. We used the UK Clinical Practice Research Datalink to identify all patients aged 30 or older diagnosed with influenza-like illness during 1997-2010. Statin users were compared with propensity score-matched patients not receiving statins. The outcome was hospitalization for influenza or pneumonia or death in the 30 days following influenza diagnosis. Logistic regression estimated cumulative incidence ratios. The study cohort included 5181 statin users matched to 5181 non-users. The 30-day incidence of hospitalization or death was 3.5% in statin users and 5.2% in non-users, resulting in a 27% lower incidence with statin ...
Research Interests: Cytokines, Inflammation, Bias, United Kingdom, Humans, and 14 moreHospitalization, Female, Pneumonia, Male, Follow-up studies, Incidence, Aged, Middle Aged, Adult, Public health systems and services research, Logistic Models, Pharmacoepidemiology and drug safety, Cohort Studies, and Pharmacology and pharmaceutical sciences
The use of oral and inhaled corticosteroids is associated with increases in the risk of infection, especially pneumonia. The risk of sepsis with corticosteroid treatment in patients with chronic obstructive pulmonary disease (COPD) has... more
The use of oral and inhaled corticosteroids is associated with increases in the risk of infection, especially pneumonia. The risk of sepsis with corticosteroid treatment in patients with chronic obstructive pulmonary disease (COPD) has been little studied, however. We assessed whether the use of inhaled and oral corticosteroids in COPD is associated with an increase in the risk of sepsis. We carried out a retrospective cohort study using the administrative health databases of the province of Quebec, Canada, over the period 1990-2007. The cohort of patients with COPD included patients aged 55 years or older who used respiratory medications. A quasi-cohort analysis was used to estimate the rate ratio (RR) of sepsis in current users of inhaled corticosteroids and oral corticosteroids separately, after adjusting for differences in COPD disease severity and co-morbid conditions. The cohort included 163,514 patients treated for COPD, including 1,704 who were hospitalized for or died with ...
Research Interests:
Increasing longevity for Inuit living in Nunavik, northern Quebec, has resulted in heightened rates of cancers and chronic diseases necessitating complex treatments. Consequently, end-of-life (EOL) care, once the domain of Inuit families... more
Increasing longevity for Inuit living in Nunavik, northern Quebec, has resulted in heightened rates of cancers and chronic diseases necessitating complex treatments. Consequently, end-of-life (EOL) care, once the domain of Inuit families and communities, has come to include professionalized healthcare providers with varying degrees of awareness of factors to consider in providing care to Inuit populations. To better understand the factors shaping EOL care in Nunavik to support the development of a sustainable model of care. Using focused ethnography, we conducted participant observations and informal and semistructured interviews with 103 participants (community members, healthcare practitioners, and administrators) across Nunavik and in Montreal, the affiliated tertiary care center. Data domains included the following: care trajectories; patient and family experiences receiving and providing EOL care; local and urban resources and challenges; and ways forward. Sociocultural, histor...
Research Interests:
OBJECTIVE To determine the risk of Clostridium difficile transmission from index cases with C. difficile infection (CDI) to their household contacts and domestic pets. DESIGN A prospective study from April 2011 to June 2013. SETTING... more
OBJECTIVE To determine the risk of Clostridium difficile transmission from index cases with C. difficile infection (CDI) to their household contacts and domestic pets. DESIGN A prospective study from April 2011 to June 2013. SETTING Patients with CDI from Canadian tertiary care centers. PARTICIPANTS Patients with CDI, their household human contacts, and pets. METHODS Epidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. Pulsed-field gel electrophoresis (PFGE) was performed on C. difficile isolates. Probable transmission was defined as the conversion of a C. difficile culture-negative contact to C. difficile culture-positive contact with a PFGE pattern indistinguishable or closely related to the index case. Possible transmission was defined as a contact with a positive C. difficile culture at baseline with a strain indistinguishable or closely related to the index case. RESULTS A total of 51 patients with CD...
Research Interests: Housing, Clostridium difficile, Adolescent, Cats, Dogs, and 15 moreCanada, Humans, Child, Birds, Female, Animals, Male, Infant, Aged, Family Health, Adult, Feces, Child preschool, Medical and Health Sciences, and Bird diseases
Although an increasing number of HIV infected people are accessing antiretroviral treatment, many do not achieve complete HIV viral suppression and remain at risk for AIDS and capable of HIV transmission. Food insecurity has been... more
Although an increasing number of HIV infected people are accessing antiretroviral treatment, many do not achieve complete HIV viral suppression and remain at risk for AIDS and capable of HIV transmission. Food insecurity has been identified as a potential risk factor for poor virologic response, but the association between these factors has been inconsistently documented in the literature. We systematically searched five electronic databases and bibliographies of relevant studies through April 2015 and retrieved 11 studies that met our inclusion criteria, of which nine studies were conducted in North America and the remaining two studies were in Brazil and Uganda respectively. Meta-analyzed results indicated that experiencing food insecurity resulted in 29% lower odds of achieving complete HIV viral suppression (OR = 0.71, 95% CI 0.61-0.82) and this significant inverse association was consistently found regardless of study design, exposure measurement, and confounder adjustment methods. These findings suggest that food insecurity is a potential risk factor for incomplete HIV viral suppression in people living with HIV.
Research Interests:
A common nonsense mutation in TBC1D4 was recently found to substantially increase the odds of type 2 diabetes in Greenlandic Inuit, leading to exclusively increased postprandial glucose. We investigated the frequency and effect of the... more
A common nonsense mutation in TBC1D4 was recently found to substantially increase the odds of type 2 diabetes in Greenlandic Inuit, leading to exclusively increased postprandial glucose. We investigated the frequency and effect of the TBC1D4 mutation on glucose metabolism and type 2 diabetes diagnosis among Canadian and Alaskan Inuit. Exome sequencing of the TBC1D4 variant was performed in 114 Inuit from Nunavik, Canada, and Sanger sequencing was undertaken in 1,027 Alaskan Inuit from the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) Study. Association testing evaluated the effect of the TBC1D4 variant on diabetes-related metabolic traits and diagnosis. The TBC1D4 mutation was present in 27% of Canadian and Alaskan Inuit. It was strongly associated with higher glucose (effect size +3.3 mmol/L; P = 2.5 x10(-6)) and insulin (effect size +175 pmol/L; P = 0.04) 2 h after an oral glucose load in homozygote carriers. TBC1D4 carriers with prediabetes and type 2 diabetes h...
Research Interests:
Research Interests:
Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac... more
Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac surgery on the subsequent risk of SSIs usually focused on antibacterial prophylaxis. The objective of the current study was to evaluate the effect of medications prescribed commonly to cardiac patients on the risk of incident SSIs. The study analyzed data on consecutive cardiac surgery patients undergoing median sternotomy at a McGill University teaching hospital between April 1, 2011 and October 31, 2013. Exposure of interest was use of medications for heart disease and cardiovascular conditions in the seven days prior to surgery and those for comorbid conditions. The main outcome was SSIs occurring within 90 d after surgery. Univariate and multivariate logistic regression (adjusted odds ratio [AOR]) was used to evaluate the effect. The cohort included 1,077 cardiac surgery patients, 79 of whom experienced SSIs within 90 d of surgery. The rates for sternal site infections and harvest site infections were 5.8 (95% confidence interval [CI]: 4.4-7.3) and 2.5 (95% CI: 1.4-3.7) per 100 procedures, respectively. The risk of SSI was increased with the pre-operative use of immunosuppressors/steroids (AOR 3.47, 95% CI: 1.27-9.52) and α-blockers (AOR 3.74, 95% CI: 1.21-1.47). Our findings support the effect of immunosuppressors/steroids on the risk of SSIs and add evidence to the previously reported association between the use of anti-hypertensive medications and subsequent development of infection/sepsis.
Research Interests:
Research Interests:
Research Interests: Prevention and Screening
Research Interests:
The present study deals with the infection dynamics of Diplostomum spathaceum and with the direct parasite-associated mortality of its experimental fish host, guppies (Lebistes reticulatis) and brook trout (Salvelinus fontinalis). The... more
The present study deals with the infection dynamics of Diplostomum spathaceum and with the direct parasite-associated mortality of its experimental fish host, guppies (Lebistes reticulatis) and brook trout (Salvelinus fontinalis). The relationship between exposure density and cercarial penetration of the hosts is essentially linear. There is a significant decrease in the proportion of penetrating cercariae that establish themselves in the fish lens at a high exposure density. The host death rate increases exponentially with parasite burden in both guppies and brook trout.
Research Interests:
We assessed temporal trend in the incidence and prevalence of genital warts (GWs) in the province of Quebec, Canada, between 1998 and 2007 as a baseline for future assessment of the impact of Quebec human papillomavirus vaccination... more
We assessed temporal trend in the incidence and prevalence of genital warts (GWs) in the province of Quebec, Canada, between 1998 and 2007 as a baseline for future assessment of the impact of Quebec human papillomavirus vaccination program. Data on GWs were obtained from the linkage of the physician service claims and the public insurance drug plan databases. Genital warts were identified through a prescription of podofilox, a medical procedure code specific to GWs or a diagnosis code for viral warts followed by a prescription of imiquimod or fluorouracil within 2 weeks. An episode was considered incident if it was preceded by a 12-month interval period free of GWs care. During the study period, a total of 27,138 episodes of GWs occurred among 24,267 individuals. The age-standardized incidence rate increased over time in men and women. The highest incidence was observed in women aged 20 to 24 years (391.9/100,000) and in men aged 25 to 29 years (383.3/100,000). Similar trends in prevalence were observed. The incidence and prevalence of GWs has increased among the population covered by the public insurance drug plan in Quebec.
Research Interests:
Research Interests:
Research Interests:
Research Interests: Genetics, Human Geography, Demography, Health, Risk assessment, and 29 moreAdolescent, Quebec, Probability, Multivariate Analysis, Humans, Female, Male, Regression Analysis, Young Adult, Incidence, Ethnic Groups, Spatial Pattern, Aged, Middle Aged, Geographic Variation, Adult, Regression Model, Retrospective Studies, Gastrointestinal Tract, Health surveys, Coefficient of Determination, Risk Assessment, Statistical Model, Genetic Susceptibility, Poisson Distribution, Environmental Exposure, Predictive value of tests, Crohn Disease, and Oral Contraceptive
Research Interests:
Research Interests:
Research Interests:
The incidence of active tuberculosis (TB) among the Cree, an Aboriginal population of Canada, is dropping, but it remains three times that of the general population. We analyzed data from tuberculin skin test (TST) surveys to determine... more
The incidence of active tuberculosis (TB) among the Cree, an Aboriginal population of Canada, is dropping, but it remains three times that of the general population. We analyzed data from tuberculin skin test (TST) surveys to determine estimates of prevalence of infection and annual risk of infection (ARI) in this population. TST surveys targeting 12-year-old students were conducted annually from 1993 to 1998. Students with no record of previous positive TST (> or = 10 mm) were offered TST (5 TU PPD-T). Data collected included result of previous TST reading for all students, readings of TSTs performed (mm induration) and BCG (bacille Calmette-Guérin) vaccination status for those positive on TST. A total of 1274 children were screened (participation rate 94%). TST reaction size frequency distribution plots a bimodal curve. The prevalence of infection among 12 year olds was 15.3% over this period. ARI estimates range from 0.6 to 2.4% (average ARI 1.4%). A significant downward linear trend in ARI was observed over the period (P < 0.001). Calculated ARI may be over-estimated due to prior BCG vaccination; however, the trend in ARI confirms decreasing transmission of TB infection. Better knowledge of human immunodeficiency virus seroprevalence among pregnant women is needed to complete the evaluation of the BCG program.
Research Interests:
In July 1989, 230 non-insulin-dependent subjects were identified in the James Bay Cree population through medical chart review of physician diagnosed diabetes mellitus cases. Data extracted from the medical files included type and rate of... more
In July 1989, 230 non-insulin-dependent subjects were identified in the James Bay Cree population through medical chart review of physician diagnosed diabetes mellitus cases. Data extracted from the medical files included type and rate of complications, life-style, anthropomorphic and metabolic descriptors as well as clinical care practices. Mean age at diagnosis was 48.3 years and mean duration of illness at time of study was 60.4 months. Furthermore, 77.3% were overweight and 65.4% obese. Microvascular disease (diabetic nephropathy or retinopathy) was the most frequent group of complications (19.6%). Moreover, 76.4% of the Cree diabetics showed poor glycemic control. Diet combined with oral hypoglycemic medication was the current treatment of choice. A medical practice profile was produced in order to provide a comparison basis with recommended baseline care. Diabetes is becoming a major illness in the native population of Canada. Health promotion strategies are of some urgency in order to contribute to the control of diabetes.
Research Interests:
Research Interests: Quebec, Humans, Female, Male, Aged, and 6 morePrevalence, Middle Aged, Adult, Sex Factors, Age Factors, and Type 2 Diabetes Mellitus
To determine the extent of non-compliance with antituberculosis treatment in Montreal and whether it is influenced by the characteristics of the health care setting. Retrospective medical and public health chart review of tuberculosis... more
To determine the extent of non-compliance with antituberculosis treatment in Montreal and whether it is influenced by the characteristics of the health care setting. Retrospective medical and public health chart review of tuberculosis patients reported to the Montreal-Centre Department of Public Health between 1992-1995. A non-compliant patient is defined as one who has taken less than 80% of prescribed antituberculosis medication. Among patients for whom the compliance status was available, 19.8% were non-compliant. In univariate analysis, risk factors significantly associated with non-compliance included: living alone, birth in an endemic country for tuberculosis, side effects related to the medication, and follow-up in a clinic not specialized for tuberculosis. In multivariate analysis, increase of age by one unit (OR: 1.1; 95% CI: 1.02-1.1), and risk factors such as alcoholism (OR: 33.8; 95% CI: 5.8-194.4) and being HIV positive (OR: 8.9; 95% CI: 2.9-26.6) were independently associated with non-compliance. Non-observance seemed to be associated with patients' characteristics rather than health care system characteristics.
Research Interests:
At the request of Native community-based organizations in Montreal, a needs assessment for an HIV and AIDS education and prevention program for urban Natives was initiated. A five-session focus group concerning HIV and AIDS was attended... more
At the request of Native community-based organizations in Montreal, a needs assessment for an HIV and AIDS education and prevention program for urban Natives was initiated. A five-session focus group concerning HIV and AIDS was attended by nine Native persons over a 2-month period. Data was collected using the guidelines of the HIV/AIDS Rapid Anthropological Assessment Procedures (AIDS RAP) developed by the Social and Behavioural Research Unit of the World Health Organization's Global Programme on AIDS. We followed these up with in-depth semistructured interviews with five different members of the Montreal Native community. The data were reviewed by a steering committee to ensure validity. Findings highlight the potential explosive route of transmission of HIV along networks of sexual interaction between persons in urban areas and then to rural partners. Maintaining control over the AIDS program planning within the community permits issues such as traditional values and healing practices to be discussed and taken into account.
Research Interests:
... Enteropathogenic Bacteria in James Bay Cree Indians, Quebec PAUL BRASSARD, M.Sc.,1 JOHN HOEY, MD,13 JOHANNE ISMAIL, B.Sc.,2 FLORIAN GOSSELIN, M.Sc.2 ... In certain communities (Poste de la Baleine, Eastmain, Wemindji) most houses... more
... Enteropathogenic Bacteria in James Bay Cree Indians, Quebec PAUL BRASSARD, M.Sc.,1 JOHN HOEY, MD,13 JOHANNE ISMAIL, B.Sc.,2 FLORIAN GOSSELIN, M.Sc.2 ... In certain communities (Poste de la Baleine, Eastmain, Wemindji) most houses lacked sewage facilities. ...
Research Interests:
To determine the rate of HIV testing among patients with tuberculosis (TB) in Montreal, and to identify patient characteristics associated with physician screening patterns. Knowledge of local patterns of HIV testing among patients with... more
To determine the rate of HIV testing among patients with tuberculosis (TB) in Montreal, and to identify patient characteristics associated with physician screening patterns. Knowledge of local patterns of HIV testing among patients with TB could be used to facilitate the development of strategies to improve compliance with recommendations that all patients with TB be screened for HIV. Retrospective chart review. All patients with TB reported to the Montreal Public Health Unit from 1992 to 1994 (ages 19 to 50) and from 1992 to 1995 (ages 18 and under) and for whom a chart could be reviewed. Patients with TB screened versus not screened for HIV infection, analyzed to determine which variables independently predict the likelihood of screening for HIV infection. Of the 376 patients with TB for whom data were available, 192 (51%) were screened for HIV. Of those, 33 (17%) had been tested before having received the diagnosis of TB. Multivariate analysis revealed that patients with TB who were male, aged 30 to 39, had a positive sputum smear, displayed at least 1 clinical symptom, received the TB diagnosis from a microbiologist or infectious disease specialist, or reported 1 or more HIV risk factors were more likely to be screened for HIV. HIV screening of patients with TB is selective, depending on both patient and physician characteristics. Physicians' awareness of recommendations needs to be increased to improve the diagnosis and treatment of TB/HIV co-infection.
Research Interests: Adolescent, Quebec, Multivariate Analysis, Tuberculosis, Humans, and 8 moreChild, Female, Male, Infant, Incidence, Middle Aged, Adult, and Retrospective Studies
Research Interests:
Research Interests:
Research Interests: Clinical Trial, Quebec, Multivariate Analysis, Drug Use, Humans, and 15 moreCongestive Heart Failure, Female, Male, Population based study, Continuity of Care, Patient Compliance, Myocardial Revascularization, Aged, Drug Therapy, Coronary Artery Disease, SECONDARY PREVENTION, Predictive value of tests, Confidence Interval, Cohort Studies, and Relative Risk
Foreign-born persons account for over 60% of Canadian tuberculosis (TB) incidence; immigrants with TB-related lung scarring ('inactive TB') are at particularly high risk, and represent an important target for preventive... more
Foreign-born persons account for over 60% of Canadian tuberculosis (TB) incidence; immigrants with TB-related lung scarring ('inactive TB') are at particularly high risk, and represent an important target for preventive efforts. To document the performance of the immigrant surveillance programme for inactive TB in Montreal. All immigrants arriving with inactive TB are referred by the public health department to the Montreal Chest Institute. We prospectively recorded clinical and radiographic data for those evaluated in 1999 and 2000. We examined physicians' adherence to Canadian guidelines. We also evaluated concordance of chest radiographic interpretation. Of 1444 immigrants notified, 792 (55%) were sent referral letters. Most of the others lacked valid addresses. Of the 654 (45%) who were examined, 322 (22%) were diagnosed with untreated latent TB, 215 (15%) were recommended therapy, and 156 (11%) completed it. Of 388 potential candidates for treatment of latent TB, 274 (71%) underwent tuberculin tests. Treatment decisions followed guidelines for 87% of patients with full testing. Agreement between clinicians and chest radiologists as to TB-related radiographic abnormalities was frequent (K 0.63). Six 'high volume' clinicians performed better than others with respect to management and radiographic interpretation. Centralised post-immigration surveillance requires more accurate referrals, and more consistent provider performance.
Research Interests:
A 25-year-old university student was diagnosed with cavitary pulmonary and laryngeal tuberculosis following symptoms of underlying cough of 6 months' duration. To estimate the hourly risk of infection (HRI) and examine the role of... more
A 25-year-old university student was diagnosed with cavitary pulmonary and laryngeal tuberculosis following symptoms of underlying cough of 6 months' duration. To estimate the hourly risk of infection (HRI) and examine the role of environmental factors, including room size and ventilation, in modulating this risk. Contact investigation. Of 1100 contacts identified, 78.3% (n = 896) received a tuberculin skin test (TST), of whom 27.5% had a positive result. Among 634 Canadian-born contacts tested, 22.7% had a positive TST. The independent risk factors for a positive TST among Canadian-born university students were: > 35 h spent with the index case (adjusted OR 6.6, 95% CI 1.0-44.9) and smaller classroom size (aOR 5.0, 95% CI 1.4-10.0). In the first school term, the HRI among Canadian-born student contacts was 0.9%; in the second term, it was 1.6%. There are inherent limitations in generalising findings from an outbreak investigation, due to the considerable variation in the infectiousness of cases. Nevertheless, in situations where the index case has a high degree of infectiousness, and there are numerous contacts with low expected prevalence of infection, the HRI can, together with ventilation measurements, be useful in guiding the extent of contact investigation needed.
Research Interests:
Regardless of their HIV status, injection drug users (IDUs) are at increased risk of developing active tuberculosis (TB) if they have latent TB infection (LTBI). We quantified the prevalence and predictors of LTBI and level of adherence... more
Regardless of their HIV status, injection drug users (IDUs) are at increased risk of developing active tuberculosis (TB) if they have latent TB infection (LTBI). We quantified the prevalence and predictors of LTBI and level of adherence to medical evaluation in a population of IDUs in Montreal. Participants were recruited from an ongoing dynamic cohort of IDUs followed for HIV seroconversion risk behaviour. Subjects with a tuberculin skin test (TST) of > or =5 mm were referred to designated TB clinics for medical evaluation. A financial incentive was provided for TST readings. Of the 262 subjects tested, 246 (94%) returned for TST reading. The overall prevalence of positive TSTs was 22% (5% in HIV-positive, 28% in HIV-negative participants). Older age at first injection drug use (OR per 10 year increase in age 1.4, 95%CI 1.2-1.8), duration of injection drug use (OR per 10 year increase 1.6, 9.5%CI 1.5-2.2) and negative HIV status (OR 11.2, 95%CI 3.2-4.0) were independent predictors of a positive TST. Nine per cent of all TST-positive participants completed LTBI treatment. TB screening activities with incentives can be successful in detecting TST-positive individuals, but better strategies are needed for medical follow-up in this high-risk group.
Research Interests:
xBxxaxcxkground. In addition to prevention guidelines already in place, the effectiveness of an antimicrobial dressing on the occurrence of surgical site infections (SSIs) among adult patients undergoing cardiac surgery was evaluated. A... more
xBxxaxcxkground. In addition to prevention guidelines already in place, the effectiveness of an antimicrobial dressing on the occurrence of surgical site infections (SSIs) among adult patients undergoing cardiac surgery was evaluated. A house-wide replacement of the plain postoperative gauze dressing with a sterile dressing impregnated with 0.2% polyhexamethylene biguanide directly on the incision after closure in the operation room was performed. From May 2005 to March 2007, 1658 patients were enrolled in this study. Surgical site infections were identified using the Centers for Disease Control and Prevention standard criteria. Of the 1658 patients enrolled, 1399 patients were included in the analysis, 692 with the plain dressing and 707 with antimicrobial dressing. The overall and leg site infection rate was significantly higher in the plain dressing group compared to the antimicrobial group but similar in the sternal site. Overall, the antimicrobial dressings significantly reduce...
Research Interests:
Define the burden of HIV-TB co-infection and predictors of HIV screening among incident TB cases.METHODS: Analysis of surveillance data on TB incident cases reported to Montreal's Public Health Department from 2004 to 2009. Among all... more
Define the burden of HIV-TB co-infection and predictors of HIV screening among incident TB cases.METHODS: Analysis of surveillance data on TB incident cases reported to Montreal's Public Health Department from 2004 to 2009. Among all reported TB cases, proportions of cases with HIV testing and HIV infection were calculated by patient characteristics. A test for linear trends was performed on the annual proportions of HIV-tested and HIV-positive cases. Adjusted odds ratios (AOR) for HIV testing at time of TB diagnosis were computed.RESULTS: A total of 778 incident TB cases were included in the analysis. HIV testing was reported for 50.8% (n=395) of cases. The proportion of HIV-tested cases increased significantly from 43% in 2004 to 70% in 2009. HIV-TB co-infection was found in 9.3% of patients with reported HIV status or in 4.2% of the overall cohort. HIV prevalence was high in men, individuals aged 40-59, those originating from Sub-Saharan Africa and the Caribbean, and the home...
Research Interests:
INTRODUCTION: Administrative databases are used extensively to describe the epidemiology, burden of disease and health outcomes of chronic diseases such as inflammatory bowel disease (IBD). Time-related biases may have been introduced in... more
INTRODUCTION: Administrative databases are used extensively to describe the epidemiology, burden of disease and health outcomes of chronic diseases such as inflammatory bowel disease (IBD). Time-related biases may have been introduced in studies using administrative databases to estimate the incidence of IBD. AIMS&METHODS: To illustrate and quantify the impact of time-related bias on estimates of IBD incidence rates using multiple validated case definitions. A population-based cohort study was conducted using the administrative databases of the Régie de l’Assurance Maladie du Québec to identify all people with an IBD diagnosis code associated with physician billings or hospital admissions during the period 1996-2009. The IBD cases occurring during follow-up were identified using 5 different case definitions validated for use with IBD administrative databases. The definitions had as criteria varying combinations of physician claims and hospital discharge summaries with an IBD diagnos...
To study the incidence, persistence, and determinants of human papillomavirus (HPV) infection in a population of Inuit women from Nunavik, Quebec, by overall HPV infection, Alphapapillomavirus (α) species, and oncogenic risk grouping. We... more
To study the incidence, persistence, and determinants of human papillomavirus (HPV) infection in a population of Inuit women from Nunavik, Quebec, by overall HPV infection, Alphapapillomavirus (α) species, and oncogenic risk grouping. We recruited a cohort of Inuit women living in communities in Nunavik when they presented for routine care. Baseline sociodemographic and lifestyle characteristics were collected and cervical specimens collected throughout the follow-up period were tested for HPV-DNA using the PGMY Line-blot assay. A total of 416 women were eligible for this analysis. Almost 40% of women acquired a new any-type HPV infection, at a rate of 14.44 infections per 1000 women-months. High-risk HPV infections were acquired at a higher rate than low-risk infections and persisted for longer durations. Multivariate logistic regression found age and marital status to be the most important predictors of overall HPV infection acquisition. Over the study period, 36.1% of women clear...