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Marx T, Moore L, Talbot D, Guertin JR, Lachapelle P, Blais S, Singbo N, Simonyan D, Lavallée J, Zada N, Shahrigharahkoshan S, Huard B, Olivier P, Mallet M, Létourneau M, Lafrenière M, Archambault P, Berthelot S. Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada. BMJ Open 2024; 14:e078566. [PMID: 38670620 DOI: 10.1136/bmjopen-2023-078566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To compare health outcomes and costs given in the emergency department (ED) and walk-in clinics for ambulatory children presenting with acute respiratory diseases. DESIGN A retrospective cohort study. SETTING This study was conducted from April 2016 to March 2017 in one ED and one walk-in clinic. The ED is a paediatric tertiary care centre, and the clinic has access to lab tests and X-rays. PARTICIPANTS Inclusion criteria were children: (1) aged from 2 to 17 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia or acute asthma. MAIN OUTCOME MEASURES The primary outcome measure was the proportion of patients returning to any ED or clinic within 3 and 7 days of the index visit. The secondary outcome measures were the mean cost of care estimated using time-driven activity-based costing and the incidence of antibiotic prescription for URTI patients. RESULTS We included 532 children seen in the ED and 201 seen in the walk-in clinic. The incidence of return visits at 3 and 7 days was 20.7% and 27.3% in the ED vs 6.5% and 11.4% in the clinic (adjusted relative risk at 3 days (aRR) (95% CI) 3.17 (1.77 to 5.66) and aRR at 7 days 2.24 (1.46 to 3.44)). The mean cost (95% CI) of care (CAD) at the index visit was $C96.68 (92.62 to 100.74) in the ED vs $C48.82 (45.47 to 52.16) in the clinic (mean difference (95% CI): 46.15 (41.29 to 51.02)). Antibiotic prescription for URTI was less common in the ED than in the clinic (1.5% vs 16.4%; aRR 0.10 (95% CI 0.03 to 0.32)). CONCLUSIONS The incidence of return visits and cost of care were significantly higher in the ED, while antibiotic use for URTI was more frequent in the walk-in clinic. These data may help determine which setting offers the highest value to ambulatory children with acute respiratory conditions.
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Affiliation(s)
- Tania Marx
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Lynne Moore
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Denis Talbot
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Jason Robert Guertin
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Philippe Lachapelle
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Sébastien Blais
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Narcisse Singbo
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - David Simonyan
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Jeanne Lavallée
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Nawid Zada
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Shaghayegh Shahrigharahkoshan
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Benoit Huard
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Pascale Olivier
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Myriam Mallet
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Mélanie Létourneau
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | | | - Patrick Archambault
- Département de médecine de famille et de médecine d'urgence, Université Laval, Québec, Québec, Canada
- Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, Québec, Canada
| | - Simon Berthelot
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine de famille et de médecine d'urgence, Université Laval, Québec, Québec, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, Québec, Canada
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Mésidor M, Sirois C, Guertin JR, Schnitzer ME, Candas B, Blais C, Cossette B, Poirier P, Brophy JM, Lix L, Tadrous M, Diop A, Hamel D, Talbot D. Effect of statin use for the primary prevention of cardiovascular disease among older adults: a cautionary tale concerning target trials emulation. J Clin Epidemiol 2024; 168:111284. [PMID: 38367659 DOI: 10.1016/j.jclinepi.2024.111284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVES Evidence concerning the effect of statins in primary prevention of cardiovascular disease (CVD) among older adults is lacking. Using Quebec population-wide administrative data, we emulated a hypothetical randomized trial including older adults >65 years on April 1, 2013, with no CVD history and no statin use in the previous year. STUDY DESIGN AND SETTING We included individuals who initiated statins and classified them as exposed if they were using statin at least 3 months after initiation and nonexposed otherwise. We followed them until March 31, 2018. The primary outcome was the composite endpoint of coronary events (myocardial infarction, coronary bypass, and percutaneous coronary intervention), stroke, and all-cause mortality. The intention-to-treat (ITT) effect was estimated with adjusted Cox models and per-protocol effect with inverse probability of censoring weighting. RESULTS A total of 65,096 individuals were included (mean age = 71.0 ± 5.5, female = 55.0%) and 93.7% were exposed. Whereas we observed a reduction in the composite outcome (ITT-hazard ratio (HR) = 0.75; 95% CI: 0.68-0.83) and mortality (ITT-HR = 0.69; 95% CI: 0.61-0.77) among exposed, coronary events increased (ITT-HR = 1.46; 95% CI: 1.09-1.94). All multibias E-values were low indicating that the results were not robust to unmeasured confounding, selection, and misclassification biases simultaneously. CONCLUSION We cannot conclude on the effectiveness of statins in primary prevention of CVD among older adults. We caution that an in-depth reflection on sources of biases and careful interpretation of results are always required in observational studies.
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Affiliation(s)
- Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.
| | - Caroline Sirois
- Centre de recherche du CHU de Québec, Université Laval, Québec, Canada; Faculté de pharmacie, Université Laval, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada
| | - Jason Robert Guertin
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Mireille E Schnitzer
- Faculté de pharmacie et Département de médecine sociale et préventive, Université de Montréal, Montréal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Bernard Candas
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Claudia Blais
- Faculté de pharmacie, Université Laval, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada
| | - Benoit Cossette
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Montréal, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Québec, Canada; Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - James M Brophy
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada; McGill University Hospital Center, Centre for Health Outcomes Research, Montréal, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mina Tadrous
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada
| | - Awa Diop
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Denis Hamel
- Institut national de santé publique du Québec, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
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Trenou KC, Mésidor M, Diorio C, Eslami A, Talbot D. [Effects of extended aromatase inhibitors in women with hormone-dependent breast cancer who have already received five years of adjuvant hormone therapy: A systematic review and meta-analysis]. Bull Cancer 2024; 111:356-362. [PMID: 38453587 DOI: 10.1016/j.bulcan.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Evaluating the benefits and risks of prolonged hormonal treatment with aromatase inhibitors (AIs) for treating hormone-dependent breast cancer. METHODS A systematic review and meta-analysis was conducted. Studies reporting on randomized clinical trials concerning prolongating hormonal therapy with AIs as compared to a placebo or no prolongation, after an initial five years of hormonal therapy, were eligible. RESULTS Seven clinical trials were included. Prolonged AI therapy was associated with a statistically significant improvement in disease-free survival (RR=0.70, 95% CI 0.60 to 0.80). A statistically significant increase was observed for osteoporosis (RR=1.17, 95% CI 1.03 to 1.33), hot flushes/flashes (RR=1.27, 95% CI 1.08 to 1.49), myalgia (RR=1.23, 95% CI 1.09 to 1.39), fractures (RR=1.26, 95% CI 1.09 to 1.45) and arthralgia (RR=1.17, 95% CI 1.10 to 1.25). However, no statistically significant association was observed between prolonged AI therapy and overall survival, cardiovascular events, and bone pain. DISCUSSION Prolonged AI therapy has significant benefits in terms of disease-free survival in women with hormone-dependent breast cancer. However, adverse effects and a lack of evidence for a benefit on overall survival must be considered in the decision-making process regarding adjuvant hormone therapy extension.
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Affiliation(s)
- Kossi Clément Trenou
- Département de médecine sociale et préventive, Université Laval, QC G1V 0A6 Québec, Canada; Axe santé des populations et pratiques optimales en santé, centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, QC G1V 0A6 Québec, Canada; Axe santé des populations et pratiques optimales en santé, centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Caroline Diorio
- Département de médecine sociale et préventive, Université Laval, QC G1V 0A6 Québec, Canada; Axe oncologie, centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Aida Eslami
- Département de médecine sociale et préventive, Université Laval, QC G1V 0A6 Québec, Canada; Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, QC G1V 0A6 Québec, Canada; Axe santé des populations et pratiques optimales en santé, centre de recherche du CHU de Québec - Université Laval, Québec, Canada.
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Ho NX, Malik AK, Moulding S, Farrow F, Talbot D, White S, Rix D, Sen G, Manas D, Amer A, Figuereido R, Wilson CH. Incidental lymphadenopathy in renal transplantation. Ann R Coll Surg Engl 2024; 106:245-248. [PMID: 37489513 PMCID: PMC10904257 DOI: 10.1308/rcsann.2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Iliac lymphadenectomy is performed to provide anastomotic access during the vascular implantation procedure in renal transplantation. Iliac lymph nodes (LNs) are often enlarged, but there are no standardised guidelines for the management of incidentally enlarged LNs during transplantation. We aimed to evaluate histological findings of LNs sent for examination at our unit. METHODS Patients were evaluated in two distinct date cycles. In the first cycle, lymphadenectomy and histological assessment were performed at the discretion of the transplanting surgeon. In the second cycle, all incidentally enlarged LNs were sent for histological assessment, regardless of size. RESULTS In the first cycle (n = 76), 11 patients (14.47%) had incidentally enlarged iliac LNs on lymphadenectomy and histology showed only reactive changes. In the second cycle (n = 165), eight patients (4.85%) had incidentally enlarged LNs on lymphadenectomy. One patient was found to have mature B cell chronic lymphocytic leukaemia. The patient was referred to haematology and a "watch and wait" approach was taken, with the patient still alive at last follow-up (511 days post-transplantation). DISCUSSION There are currently no published guidelines on the management of incidentally enlarged iliac LNs during transplantation. Current literature suggests that clinically significant lymphadenopathy needs to be investigated in all patients. Based on our centre's experience of a 5.26% (1 in 19) positive pathological LN sampling, we recommend that all incidental LNs with suspicious features and/or that are greater than 10mm in diameter should be considered for histological, microbiological and molecular assessment as appropriate.
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Affiliation(s)
- NX Ho
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - AK Malik
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - S Moulding
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - F Farrow
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - D Talbot
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - S White
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - D Rix
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - G Sen
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - D Manas
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - A Amer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - R Figuereido
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - CH Wilson
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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Gagnon ME, Talbot D, Tremblay F, Desforges K, Sirois C. Polypharmacy and risk of fractures in older adults: A systematic review. J Evid Based Med 2024; 17:145-171. [PMID: 38517979 DOI: 10.1111/jebm.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Fractures have serious health consequences in older adults. While some medications are individually associated with increased risk of falls and fractures, it is not clear if this holds true for the use of many medications (polypharmacy). We aimed to identify what is known about the association between polypharmacy and the risk of fractures in adults aged ≥65 and to examine the methods used to study this association. METHODS We conducted a systematic review with narrative synthesis of studies published up to October 2023 in PubMed, Embase, CINAHL, PsychINFO, Cochrane Library, Web of Science, and the grey literature. Two independent reviewers screened titles, abstracts, and full texts, then performed data extraction and quality assessment. RESULTS Among the 31 studies included, 11 different definitions of polypharmacy were used and were based on three medication counting methods (concurrent use 15/31, cumulative use over a period 6/31, daily average 3/31, and indeterminate 7/31). Overall, polypharmacy was frequent and associated with higher fracture risk. A dose-response relationship between increasing number of medications and increased risk of fractures was observed. However, only seven studies adjusted for major confounders (age, sex, and chronic disease). The quality of the studies ranged from poor to high. CONCLUSIONS Polypharmacy appears to be a relevant modifiable risk factor for fractures in older individuals that can easily be used to identify those at risk. The diversity of medication calculation methods and definitions of polypharmacy highlights the importance of a detailed methodology to understand and compare results.
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Affiliation(s)
- Marie-Eve Gagnon
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
- Department of Health Sciences, Université du Québec à Rimouski (UQAR), Rimouski, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, VITAM - Centre de recherche en sante durable, Québec, Québec, Canada
| | - Denis Talbot
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
- Faculty of Medicine, Université Laval, Québec, Québec, Canada
| | | | - Katherine Desforges
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
- Department of Pharmacy, McGill University Health Centre, Montréal, Québec, Canada
| | - Caroline Sirois
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Québec, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, VITAM - Centre de recherche en sante durable, Québec, Québec, Canada
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Schnitzer ME, Ortiz-Brizuela E, Carabali M, Talbot D. Bias-interpretability Trade-offs in Vaccine Effectiveness Studies Using Test-negative or Cohort Designs. Epidemiology 2024; 35:150-153. [PMID: 38290138 DOI: 10.1097/ede.0000000000001708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Mireille E Schnitzer
- From the Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Edgar Ortiz-Brizuela
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Mabel Carabali
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Université Laval, Québec City, Québec, Canada
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Brousseau N, Carazo S, Febriani Y, Padet L, Hegg-Deloye S, Cadieux G, Bergeron G, Fafard J, Charest H, Lambert G, Talbot D, Longtin J, Dumont-Blais A, Bastien S, Dalpé V, Minot PH, De Serres G, Skowronski DM. Single-dose Effectiveness of Mpox Vaccine in Quebec, Canada: Test-negative Design With and Without Adjustment for Self-reported Exposure Risk. Clin Infect Dis 2024; 78:461-469. [PMID: 37769158 PMCID: PMC10874272 DOI: 10.1093/cid/ciad584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION During the 2022 mpox outbreak, the province of Quebec, Canada, prioritized first doses for pre-exposure vaccination of people at high mpox risk, delaying second doses due to limited supply. We estimated single-dose mpox vaccine effectiveness (VE) adjusting for virus exposure risk based only on surrogate indicators available within administrative databases (eg, clinical record of sexually transmitted infections) or supplemented by self-reported risk factor information (eg, sexual contacts). METHODS We conducted a test-negative case-control study between 19 June and 24 September 2022. Information from administrative databases was supplemented by questionnaire collection of self-reported risk factors specific to the 3-week period before testing. Two study populations were assessed: all within the administrative databases (All-Admin) and the subset completing the questionnaire (Sub-Quest). Logistic regression models adjusted for age, calendar-time and exposure-risk, the latter based on administrative indicators only (All-Admin and Sub-Quest) or with questionnaire supplementation (Sub-Quest). RESULTS There were 532 All-Admin participants, of which 199 (37%) belonged to Sub-Quest. With exposure-risk adjustment based only on administrative indicators, single-dose VE estimates were similar among All-Admin and Sub-Quest populations at 35% (95% confidence interval [CI]:-2 to 59) and 30% (95% CI:-38 to 64), respectively. With adjustment supplemented by questionnaire information, the Sub-Quest VE estimate increased to 65% (95% CI:1-87), with overlapping confidence intervals. CONCLUSIONS Using only administrative data, we estimate one vaccine dose reduced the mpox risk by about one-third; whereas, additionally adjusting for self-reported risk factor information revealed greater vaccine benefit, with one dose instead estimated to reduce the mpox risk by about two-thirds. Inadequate exposure-risk adjustment may substantially under-estimate mpox VE.
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Affiliation(s)
- Nicholas Brousseau
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Sara Carazo
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Yossi Febriani
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Lauriane Padet
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Sandrine Hegg-Deloye
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Geneviève Cadieux
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Geneviève Bergeron
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Judith Fafard
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Hugues Charest
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Québec, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Jean Longtin
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | | | - Steve Bastien
- Mpox Awareness Team, RÉZO Community Organization, Montreal, QC Canada
| | - Virginie Dalpé
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Pierre-Henri Minot
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Gaston De Serres
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Danuta M Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Mésidor M, Liu Y, Talbot D, Skowronski DM, De Serres G, Merckx J, Koushik A, Tadrous M, Carazo S, Jiang C, Schnitzer ME. Test negative design for vaccine effectiveness estimation in the context of the COVID-19 pandemic: A systematic methodology review. Vaccine 2024; 42:995-1003. [PMID: 38072756 DOI: 10.1016/j.vaccine.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND During the height of the global COVID-19 pandemic, the test-negative design (TND) was extensively used in many countries to evaluate COVID-19 vaccine effectiveness (VE). Typically, the TND involves the recruitment of care-seeking individuals who meet a common clinical case definition. All participants are then tested for an infection of interest. OBJECTIVES To review and describe the variation in TND methodology, and disclosure of potential biases, as applied to the evaluation of COVID-19 VE during the early vaccination phase of the pandemic. METHODS We conducted a systematic review by searching four biomedical databases using defined keywords to identify peer-reviewed articles published between January 1, 2020, and January 25, 2022. We included only original articles that employed a TND to estimate VE of COVID-19 vaccines in which cases and controls were evaluated based on SARS-CoV-2 laboratory test results. RESULTS We identified 96 studies, 35 of which met the defined criteria. Most studies were from North America (16 studies) and targeted the general population (28 studies). Outcome case definitions were based primarily on COVID-19-like symptoms; however, several papers did not consider or specify symptoms. Cases and controls had the same inclusion criteria in only half of the studies. Most studies relied upon administrative or hospital databases assembled for a different (non-evaluation) clinical purpose. Potential unmeasured confounding (20 studies), misclassification of current SARS-CoV-2 infection (16 studies) and selection bias (10 studies) were disclosed as limitations by some studies. CONCLUSION We observed potentially meaningful deviations from the validated design in the application of the TND during the COVID-19 pandemic.
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Affiliation(s)
- Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Yan Liu
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada; University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Anita Koushik
- Département de médecine sociale et préventive, Université de Montréal, Québec, Canada
| | | | - Sara Carazo
- Institut national de santé publique du Québec, Québec, Canada
| | - Cong Jiang
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Mireille E Schnitzer
- Faculty of Pharmacy, Université de Montréal, Québec, Canada; Département de médecine sociale et préventive, Université de Montréal, Québec, Canada.
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9
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Diop A, Gupta A, Mueller S, Dron L, Harari O, Berringer H, Kalatharan V, Park JJH, Mésidor M, Talbot D. Assessing the performance of group-based trajectory modeling method to discover different patterns of medication adherence. Pharm Stat 2024. [PMID: 38327261 DOI: 10.1002/pst.2365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
It is well known that medication adherence is critical to patient outcomes and can decrease patient mortality. The Pharmacy Quality Alliance (PQA) has recognized and identified medication adherence as an important indicator of medication-use quality. Hence, there is a need to use the right methods to assess medication adherence. The PQA has endorsed the proportion of days covered (PDC) as the primary method of measuring adherence. Although easy to calculate, the PDC has however several drawbacks as a method of measuring adherence. PDC is a deterministic approach that cannot capture the complexity of a dynamic phenomenon. Group-based trajectory modeling (GBTM) is increasingly proposed as an alternative to capture heterogeneity in medication adherence. The main goal of this paper is to demonstrate, through a simulation study, the ability of GBTM to capture treatment adherence when compared to its deterministic PDC analogue and to the nonparametric longitudinal K-means. A time-varying treatment was generated as a quadratic function of time, baseline, and time-varying covariates. Three trajectory models are considered combining a cat's cradle effect, and a rainbow effect. The performance of GBTM was compared to the PDC and longitudinal K-means using the absolute bias, the variance, the c-statistics, the relative bias, and the relative variance. For all explored scenarios, we find that GBTM performed better in capturing different patterns of medication adherence with lower relative bias and variance even under model misspecification than PDC and longitudinal K-means.
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Affiliation(s)
- Awa Diop
- Core Clinical Sciences Inc., Vancouver, British Columbia, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Alind Gupta
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Louis Dron
- Cascade Outcomes Research Inc., Vancouver, British Columbia, Canada
| | - Ofir Harari
- Core Clinical Sciences Inc., Vancouver, British Columbia, Canada
| | - Heather Berringer
- Core Clinical Sciences Inc., Vancouver, British Columbia, Canada
- Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia, Canada
| | | | - Jay J H Park
- Core Clinical Sciences Inc., Vancouver, British Columbia, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
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10
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Sirois C, Gosselin M, Laforce C, Gagnon ME, Talbot D. How does deprescribing (not) reduce mortality? A review of a meta-analysis in community-dwelling older adults casts uncertainty over claimed benefits. Basic Clin Pharmacol Toxicol 2024; 134:51-62. [PMID: 37376746 DOI: 10.1111/bcpt.13921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/22/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
Some meta-analyses suggest that deprescribing may reduce mortality. Our aim was to determine the underlying factors contributing to this observed reduction. We analysed data from 12 randomized controlled trials included in the latest meta-analysis on deprescribing in community-dwelling older adults. Our analysis focused on deprescribed medications and potential methodological concerns. Only a third (4/12) of the trials aimed to study mortality, and that too as a secondary outcome. Five trials reported a reduction in total medications, potentially inappropriate medications or drug-related problems. Information on specific classes of deprescribed medications was limited, although a wide array was concerned (e.g., antihypertensive, sedative, gastro-intestinal medications and vitamins). Follow-up periods were ≤1 year in 11 trials, and five trials included ≤150 participants. Small sample sizes often resulted in imbalanced groups (e.g., comorbidities, number of potentially inappropriate medications), yet no trials presented multivariable analyses. In the two trials with the most weight in the meta-analysis, several deaths occurred before the intervention, making it difficult to draw conclusions about the impact of the deprescribing intervention on mortality. These methodological issues cast significant uncertainty on the benefits of deprescribing on mortality outcomes. Large-scale, well-designed trials are needed to address this issue effectively.
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Affiliation(s)
- Caroline Sirois
- Faculté de pharmacie, Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec and VITAM- Centre de recherche en santé durable, Québec, Canada
- Centre de recherche du CHU de Québec- Université Laval, Québec, Canada
| | - Maude Gosselin
- Centre d'excellence sur le vieillissement de Québec and VITAM- Centre de recherche en santé durable, Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | | | - Marie-Eve Gagnon
- Faculté de pharmacie, Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec and VITAM- Centre de recherche en santé durable, Québec, Canada
- Département des sciences de la santé, Université du Québec à Rimouski, Rimouski, Canada
| | - Denis Talbot
- Centre de recherche du CHU de Québec- Université Laval, Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
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11
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Moodie EEM, Talbot D. On "Reflections on the concept of optimality of single decision point treatment regimes". Biom J 2023; 65:e2300027. [PMID: 37797173 DOI: 10.1002/bimj.202300027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 06/22/2023] [Indexed: 10/07/2023]
Abstract
This is a discussion of "Reflections on the concept of optimality of single decision point treatment regimes" by Trung Dung Tran, Ariel Alonso Abad, Geert Verbeke, Geert Molenberghs, and Iven Van Mechelen. The authors propose a thoughtful consideration of optimization targets and the implications of such targets for the resulting optimal treatment rule. However, we contest the assertation that targets of optimization have been overlooked and suggest additional considerations that researchers must contemplate as part of a complete framework for learning about optimal treatment regimes.
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Affiliation(s)
- Erica E M Moodie
- Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
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12
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Mésidor M, Sirois C, Simard M, Talbot D. A Bootstrap Approach for Evaluating Uncertainty in the Number of Groups Identified by Latent Class Growth Models. Am J Epidemiol 2023; 192:1896-1903. [PMID: 37386696 DOI: 10.1093/aje/kwad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/14/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
The use of longitudinal finite mixture models such as group-based trajectory modeling has seen a sharp increase during the last few decades in the medical literature. However, these methods have been criticized, especially because of the data-driven modeling process, which involves statistical decision-making. In this paper, we propose an approach that uses the bootstrap to sample observations with replacement from the original data to validate the number of groups identified and to quantify the uncertainty in the number of groups. The method allows investigation of the statistical validity and uncertainty of the groups identified in the original data by checking to see whether the same solution is also found across the bootstrap samples. In a simulation study, we examined whether the bootstrap-estimated variability in the number of groups reflected the replicationwise variability. We evaluated the ability of 3 commonly used adequacy criteria (average posterior probability, odds of correct classification, and relative entropy) to identify uncertainty in the number of groups. Finally, we illustrate the proposed approach using data from the Quebec Integrated Chronic Disease Surveillance System to identify longitudinal medication patterns between 2015 and 2018 in older adults with diabetes.
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13
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Diop A, Sirois C, Guertin JR, Schnitzer ME, Candas B, Cossette B, Poirier P, Brophy J, Mésidor M, Blais C, Hamel D, Tadrous M, Lix L, Talbot D. Marginal structural models with latent class growth analysis of treatment trajectories: Statins for primary prevention among older adults. Stat Methods Med Res 2023; 32:2207-2225. [PMID: 37750253 PMCID: PMC10683348 DOI: 10.1177/09622802231202384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Latent class growth analysis is increasingly proposed as a solution to summarize the observed longitudinal treatment into a few distinct groups. When latent class growth analysis is combined with standard approaches like Cox proportional hazards models, confounding bias is not properly addressed because of time-varying covariates that have a double role of confounders and mediators. We propose to use latent class growth analysis to classify individuals into a few latent classes based on their medication adherence pattern, then choose a working marginal structural model that relates the outcome to these groups. The parameter of interest is defined as a projection of the true marginal structural model onto the chosen working model. Simulation studies are used to illustrate our approach and compare it with unadjusted, baseline covariates adjusted, time-varying covariates adjusted, and inverse probability of trajectory groups weighted adjusted models. Our proposed approach yielded estimators with little or no bias and appropriate coverage of confidence intervals in these simulations. We applied our latent class growth analysis and marginal structural model approach to a database comprising information on 52,790 individuals from the province of Quebec, Canada, aged more than 65 and who were statin initiators to estimate the effect of statin-usage trajectories on a first cardiovascular event.
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Affiliation(s)
- Awa Diop
- Departement de medecine sociale et preventive, Universite Laval, Quebec, Canada
- Centre de recherche du CHU de Quebec, Universite Laval, Canada
| | - Caroline Sirois
- Centre de recherche du CHU de Quebec, Universite Laval, Canada
- Faculte de pharmacie, Universite Laval, Quebec, Canada
| | - Jason Robert Guertin
- Departement de medecine sociale et preventive, Universite Laval, Quebec, Canada
- Centre de recherche du CHU de Quebec, Universite Laval, Canada
- Tissue Engineering Laboratory (LOEX), Canada
| | - Mireille E Schnitzer
- Faculte de pharmacie et Departement de medecine sociale et preventive, ESPUM, Universite de Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Bernard Candas
- Departement de medecine sociale et preventive, Universite Laval, Quebec, Canada
| | - Benoit Cossette
- Faculte de medecine et des sciences de la sante, Universite de Sherbrooke, Canada
| | - Paul Poirier
- Centre de recherche du CHU de Quebec, Universite Laval, Canada
| | - James Brophy
- Hospital Center Centre for Health Outcomes Research, McGill University, Montreal, Canada
| | - Miceline Mésidor
- Departement de medecine sociale et preventive, Universite Laval, Quebec, Canada
- Faculte de pharmacie, Universite Laval, Quebec, Canada
| | - Claudia Blais
- Institut National de la Sante Publique du Quebec (INSPQ), Canada
| | - Denis Hamel
- Institut National de la Sante Publique du Quebec (INSPQ), Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Denis Talbot
- Departement de medecine sociale et preventive, Universite Laval, Quebec, Canada
- Faculte de pharmacie, Universite Laval, Quebec, Canada
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14
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Pena-Gralle APB, Talbot D, Trudel X, Milot A, Gilbert-Ouimet M, Lavigne-Robichaud M, Ndjaboué R, Lesage A, Lauzier S, Vézina M, Siegrist J, Brisson C. Socioeconomic inequalities, psychosocial stressors at work and physician-diagnosed depression: Time-to-event mediation analysis in the presence of time-varying confounders. PLoS One 2023; 18:e0293388. [PMID: 37878641 PMCID: PMC10599565 DOI: 10.1371/journal.pone.0293388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES There is evidence that both low socioeconomic status (SES) and psychosocial stressors at work (PSW) increase risk of depression, but prospective studies on the contribution of PSW to the socioeconomic gradient of depression are still limited. METHODS Using a prospective cohort of Quebec white-collar workers (n = 9188 participants, 50% women), we estimated randomized interventional analogues of the natural direct effect of SES indicators at baseline (education level, household income, occupation type and a combined measure) and of their natural indirect effects mediated through PSW (job strain and effort-reward imbalance (ERI) measured at the follow-up in 1999-2001) on incident physician-diagnosed depression. RESULTS During 3 years of follow-up, we identified 469 new cases (women: 33.1 per 1000 person-years; men: 16.8). Mainly in men, low SES was a risk factor for depression [education: hazard ratio 1.72 (1.08-2.73); family income: 1.67 (1.04-2.67); occupational type: 2.13 (1.08-4.19)]. In the entire population, exposure to psychosocial stressors at work was associated with increased risk of depression [job strain: 1.42 (1.14-1.78); effort-reward imbalance (ERI) 1.73 (1.41-2.12)]. The estimated indirect effects of socioeconomic indicators on depression mediated through job strain ranged from 1.01 (0.99-1.03) to 1.04 (0.98-1.10), 4-15% of total effects, and for low reward from 1.02 (1.00-1.03) to 1.06 (1.01-1.11), 10-15% of total effects. DISCUSSION Our study suggests that PSW only slightly mediate the socioeconomic gradient of depression, but that socioeconomic inequalities, especially among men, and PSW both increase the incidence of depression.
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Affiliation(s)
- Ana Paula Bruno Pena-Gralle
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- VITAM – Centre de Recherche en Santé Durable, Québec, Québec, Canada
| | - Denis Talbot
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Xavier Trudel
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Alain Milot
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Mahée Gilbert-Ouimet
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Québec, Canada
| | - Mathilde Lavigne-Robichaud
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Ruth Ndjaboué
- School of Social Work, Sherbrooke University, Sherbrooke, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Michel Vézina
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Johannes Siegrist
- Faculty of Medicine, Department of Medical Sociology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Chantal Brisson
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- VITAM – Centre de Recherche en Santé Durable, Québec, Québec, Canada
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Carazo S, Denis G, Padet L, Deshaies P, Villeneuve J, Paquet-Bolduc B, Laliberté D, Talbot D, De Serres G. SARS-CoV-2 infection among healthcare workers: the role of occupational and household exposures during the first three pandemic waves in Quebec, Canada. Antimicrob Steward Healthc Epidemiol 2023; 3:e180. [PMID: 38028905 PMCID: PMC10654992 DOI: 10.1017/ash.2023.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 12/01/2023]
Abstract
Objective We described the evolution of SARS-CoV-2 source of infection in a cohort of healthcare workers (HCWs) of Quebec, Canada, during the first three pandemic waves. We also estimated their household secondary attack rate (SAR) and its risk factors. Design Cross-sectional surveys. Participants HCWs with a SARS-CoV-2 infection confirmed by polymerasa chain reaction and diagnosed between March 2020 and May 2021. Methods We collected demographic, clinical, vaccination, and employment information, self-reported perceived source of infection, and transmission to household members during the first three pandemic waves. SAR was calculated for households with ≥2 members where the HCW was the index case. A Poisson regression model estimated the association between risk factors and SAR. Results Among the 11,670 HCWs completing the survey, 91%, perceived their workplace as the source of infection during the first wave (March-July 2020), 71% during the second wave (July 2020-March 2021), and 40% during the third wave (March-May 2021). Conversely, HCWs reported an increasing proportion of household-acquired infections with each wave from 4% to 14% and 33%, respectively. The overall household SAR of 7,990 HCWs living with ≥1 person was 30% (95%CI: 29-30). SAR increased with the presence of symptoms, older age, and during Alpha-variant predominant period. Conclusions HCWs and their household members were largely affected during the first pandemic waves of COVID-19, but the relative importance of occupational exposure changed overtime. Pandemic preparedness in healthcare settings is essential to protect HCWs from emerging biological hazard exposures.
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Affiliation(s)
- Sara Carazo
- Biological and Occupational Risks Unit, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Geoffroy Denis
- School of Population and Global Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Public Health Department, CIUSSS Centre Sud de Montréal, Montreal, QC, Canada
- General Directorate of Public Health, Quebec Ministry of Health and Social Services, Quebec City, QC, Canada
| | - Lauriane Padet
- Biological and Occupational Risks Unit, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Pierre Deshaies
- Public Health Department, CISSS de Chaudière-Appalaches, Levis, QC, Canada
| | - Jasmin Villeneuve
- Biological and Occupational Risks Unit, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Bianka Paquet-Bolduc
- Infection Prevention and Control Unit, Institut Universitaire en cardiologie et pneumologie de Québec, Quebec City, QC, Canada
| | - Denis Laliberté
- Public Health Department, CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, QC, Canada
- CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
| | - Gaston De Serres
- Biological and Occupational Risks Unit, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, QC, Canada
- CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
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Souli Y, Trudel X, Diop A, Brisson C, Talbot D. Longitudinal plasmode algorithms to evaluate statistical methods in realistic scenarios: an illustration applied to occupational epidemiology. BMC Med Res Methodol 2023; 23:242. [PMID: 37853309 PMCID: PMC10585912 DOI: 10.1186/s12874-023-02062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Plasmode simulations are a type of simulations that use real data to determine the synthetic data-generating equations. Such simulations thus allow evaluating statistical methods under realistic conditions. As far as we know, no plasmode algorithm has been proposed for simulating longitudinal data. In this paper, we propose a longitudinal plasmode framework to generate realistic data with both a time-varying exposure and time-varying covariates. This work was motivated by the objective of comparing different methods for estimating the causal effect of a cumulative exposure to psychosocial stressors at work over time. METHODS We developed two longitudinal plasmode algorithms: a parametric and a nonparametric algorithms. Data from the PROspective Québec (PROQ) Study on Work and Health were used as an input to generate data with the proposed plasmode algorithms. We evaluated the performance of multiple estimators of the parameters of marginal structural models (MSMs): inverse probability of treatment weighting, g-computation and targeted maximum likelihood estimation. These estimators were also compared to standard regression approaches with either adjustment for baseline covariates only or with adjustment for both baseline and time-varying covariates. RESULTS Standard regression methods were susceptible to yield biased estimates with confidence intervals having coverage probability lower than their nominal level. The bias was much lower and coverage of confidence intervals was much closer to the nominal level when considering MSMs. Among MSM estimators, g-computation overall produced the best results relative to bias, root mean squared error and coverage of confidence intervals. No method produced unbiased estimates with adequate coverage for all parameters in the more realistic nonparametric plasmode simulation. CONCLUSION The proposed longitudinal plasmode algorithms can be important methodological tools for evaluating and comparing analytical methods in realistic simulation scenarios. To facilitate the use of these algorithms, we provide R functions on GitHub. We also recommend using MSMs when estimating the effect of cumulative exposure to psychosocial stressors at work.
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Affiliation(s)
- Youssra Souli
- Institute for Stochastics Johannes Kepler University, Linz, Austria
| | - Xavier Trudel
- Université Laval, Département de médecine sociale et préventive, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Awa Diop
- Université Laval, Département de médecine sociale et préventive, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Chantal Brisson
- Université Laval, Département de médecine sociale et préventive, Québec, Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Denis Talbot
- Université Laval, Département de médecine sociale et préventive, Québec, Canada.
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada.
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Lavigne-Robichaud M, Trudel X, Talbot D, Milot A, Gilbert-Ouimet M, Vézina M, Laurin D, Dionne CE, Pearce N, Dagenais GR, Brisson C. Psychosocial Stressors at Work and Coronary Heart Disease Risk in Men and Women: 18-Year Prospective Cohort Study of Combined Exposures. Circ Cardiovasc Qual Outcomes 2023; 16:e009700. [PMID: 37724474 PMCID: PMC10573112 DOI: 10.1161/circoutcomes.122.009700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/24/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Psychosocial stressors at work, like job strain and effort-reward imbalance (ERI), can increase coronary heart disease (CHD) risk. ERI indicates an imbalance between the effort and received rewards. Evidence about the adverse effect of combined exposure to these work stressors on CHD risk is scarce. This study examines the separate and combined effect of job strain and ERI exposure on CHD incidence in a prospective cohort of white-collar workers in Quebec, Canada. METHODS Six thousand four hundred sixty-five white-collar workers without cardiovascular disease (mean age, 45.3±6.7) were followed for 18 years (from 2000 to 2018). Job strain and ERI were measured with validated questionnaires. CHD events were retrieved from medico-administrative databases using validated algorithms. Marginal Cox models were used to calculate hazard ratios (HR) stratified by sex. Multiple imputation and inverse probability weights were applied to minimize potential threats to internal validity. RESULTS Among 3118 men, 571 had a first CHD event. Exposure to either job strain or ERI was associated with an adjusted 49% CHD risk increase (HR, 1.49 [95% CI, 1.07-2.09]). Combined exposure to job strain and ERI was associated with an adjusted 103% CHD risk increase (HR, 2.03 [95% CI, 1.38-2.97]). Exclusion of early CHD cases and censoring at retirement did not alter these associations. Among 3347 women, 265 had a first CHD event. Findings were inconclusive (passive job HR, 1.24 [95% CI, 0.80-1.91]; active job HR, 1.16 [95% CI, 0.70-1.94]; job strain HR, 1.08 [95% CI, 0.66-1.77]; ERI HR, 1.02 [95% CI, 0.72-1.45]). CONCLUSIONS In this prospective cohort study, men exposed to job strain or ERI, separately and in combination, were at increased risk of CHD. Early interventions on these psychosocial stressors at work in men may be effective prevention strategies to reduce CHD burden. Among women, further investigation is required.
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Affiliation(s)
- Mathilde Lavigne-Robichaud
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center (M.L.-R., X.T., D.T., A.M., M.G.-O., D.L., C.D., C.B.)
- Department of Social & Preventive Medicine (M.L.-R., X.T., D.T., C.D., C.B.), Université Laval, Quebec City, Canada
| | - Xavier Trudel
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center (M.L.-R., X.T., D.T., A.M., M.G.-O., D.L., C.D., C.B.)
- Department of Social & Preventive Medicine (M.L.-R., X.T., D.T., C.D., C.B.), Université Laval, Quebec City, Canada
| | - Denis Talbot
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center (M.L.-R., X.T., D.T., A.M., M.G.-O., D.L., C.D., C.B.)
- Department of Social & Preventive Medicine (M.L.-R., X.T., D.T., C.D., C.B.), Université Laval, Quebec City, Canada
| | - Alain Milot
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center (M.L.-R., X.T., D.T., A.M., M.G.-O., D.L., C.D., C.B.)
- Department of Medicine (A.M., G.R.D.), Université Laval, Quebec City, Canada
| | - Mahée Gilbert-Ouimet
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center (M.L.-R., X.T., D.T., A.M., M.G.-O., D.L., C.D., C.B.)
- Department of Health Sciences, Université du Québec à Rimouski (UQAR), Levis Campus, Canada (M.G.-O.)
| | - Michel Vézina
- Institut National de Santé Publique du Québec (M.V.)
| | - Danielle Laurin
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center (M.L.-R., X.T., D.T., A.M., M.G.-O., D.L., C.D., C.B.)
- Faculty of Pharmacy (D.L.), Université Laval, Quebec City, Canada
- VITAM, Centre de Recherche en Santé Durable, Quebec City, Canada (D.L., C.B.)
| | - Clermont E. Dionne
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center (M.L.-R., X.T., D.T., A.M., M.G.-O., D.L., C.D., C.B.)
- Department of Social & Preventive Medicine (M.L.-R., X.T., D.T., C.D., C.B.), Université Laval, Quebec City, Canada
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine (N.P.)
| | - Gilles R. Dagenais
- Department of Medicine (A.M., G.R.D.), Université Laval, Quebec City, Canada
- Quebec Heart and Lung Institute (G.R.D.), Université Laval, Quebec City, Canada
| | - Chantal Brisson
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center (M.L.-R., X.T., D.T., A.M., M.G.-O., D.L., C.D., C.B.)
- Department of Social & Preventive Medicine (M.L.-R., X.T., D.T., C.D., C.B.), Université Laval, Quebec City, Canada
- VITAM, Centre de Recherche en Santé Durable, Quebec City, Canada (D.L., C.B.)
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Massamba VK, Talbot D, Milot A, Trudel X, Dionne CE, Vézina M, Mâsse B, Gilbert-Ouimet M, Dagenais GR, Pearce N, Brisson C. Association between psychosocial work-related factors at midlife and arterial stiffness at older age in a prospective cohort of 1736 white-collar workers. BMJ Open 2023; 13:e073649. [PMID: 37758677 PMCID: PMC10537828 DOI: 10.1136/bmjopen-2023-073649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Arterial stiffness and exposure to psychosocial work-related factors increase the risk of developing cardiovascular disease. However, little is known about the relationship between psychosocial work-related factors and arterial stiffness. We aimed to examine this relationship. DESIGN Prospective cohort study. SETTING Public organisations in Quebec City, Canada. PARTICIPANTS The study included 1736 white-collar workers (women 52%) from 19 public organisations. PRIMARY AND SECONDARY OUTCOME MEASURES Association between psychosocial work-related factors from the job strain and effort-reward imbalance (ERI) models assessed at study baseline (1999-2001) with validated instruments and arterial stiffness assessed using carotid-femoral pulse wave velocity at follow-up, on average 16 years later (2015-2018). Generalised estimating equations were used to estimate differences in arterial stiffness between exposed and unexposed participants. Subgroup analyses according to sex, age, blood pressure (BP), cardiovascular risk score and employment status were conducted. RESULTS Among participants with high diastolic BP (≥90 mm Hg) at baseline, aged 47 on average, those exposed to high job strain had higher arterial stiffness (1.38 m/s (95% CI: 0.57 to 2.19)) at follow-up, 16 years later, following adjustment for a large set of potential confounders. The trend was similar in participants with high systolic BP (≥140 mm Hg) exposed to high job strain (0.84 m/s (95% CI: -0.35 to 2.03)). No association was observed for ERI in the total sample and counterintuitive associations were observed in subgroup analyses. CONCLUSIONS Job strain may have a long-term deleterious effect on arterial stiffness in people with high BP. Interventions at midlife to reduce job strain may mitigate arterial stiffness progression.
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Affiliation(s)
- Victoria K Massamba
- Department of Social and Preventive Medicine, Université Laval, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Université Laval, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Alain Milot
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Department of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Xavier Trudel
- Department of Social and Preventive Medicine, Université Laval, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Clermont E Dionne
- Department of Social and Preventive Medicine, Université Laval, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Michel Vézina
- Institut national de sante publique du Quebec, Quebec, Quebec, Canada
| | - Benoit Mâsse
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mahée Gilbert-Ouimet
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Gilles R Dagenais
- Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec, Quebec, Canada
| | - Neil Pearce
- Departments of Medical Statistics and Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Chantal Brisson
- Department of Social and Preventive Medicine, Université Laval, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
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Mésidor M, Talbot D, Simard M, Blais C, Boiteau V, Sirois C. Sex-specific medication trajectories in older adults newly diagnosed with diabetes. Explor Res Clin Soc Pharm 2023; 11:100294. [PMID: 37408840 PMCID: PMC10319302 DOI: 10.1016/j.rcsop.2023.100294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023] Open
Abstract
Background People with diabetes tend to use many medications to treat diabetes and comorbidities. Nevertheless, the evolution of polypharmacy in newly diagnosed males and females has been little studied. Objective The objective of this paper was to identify and describe medication trajectories in incident diabetes cases according to sex. Methods Data were obtained from the Quebec Integrated Chronic Disease Surveillance System. We built a population-based cohort of community-dwelling individuals aged >65 years diagnosed with diabetes in 2014 who were alive and covered with the public drug plan until March 31, 2019. Latent class models were used to identify medication trajectory groups in males and females separately. Results Of the 10,363 included individuals, 51.4% were males. Females were older and more likely to have more medication claims than males. Four trajectory groups were identified for males and five for females. Most trajectories showed sustained and stable number of medications over time. For each sex, only one of the trajectory groups included a mean annual number of medications lesser than five. Slight increasing trends of medication use were detected in the trajectories composed of very high users, which included older, more comorbid individuals frequently exposed to potentially inappropriate medications. Conclusions Most males and females with incident diabetes had a high burden of medication following the year of diagnosis and were classified in a group of sustained medication use over time. The largest increase in medication was among those who had higher level of polypharmacy of questionable quality at baseline, raising concerns about the innocuity of such medication trajectories.
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Affiliation(s)
- Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Pavillon Ferdinand-Vandry 1050, Avenue de la Médecine, Québec G1V 0A6, Canada
- Centre de Recherche du CHU de Québec – Université Laval, 2400 Av. D'Estimauville, Québec G1E 6W2, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Pavillon Ferdinand-Vandry 1050, Avenue de la Médecine, Québec G1V 0A6, Canada
- Centre de Recherche du CHU de Québec – Université Laval, 2400 Av. D'Estimauville, Québec G1E 6W2, Canada
| | - Marc Simard
- Département de médecine sociale et préventive, Université Laval, Pavillon Ferdinand-Vandry 1050, Avenue de la Médecine, Québec G1V 0A6, Canada
- Institut National de Santé Publique du Québec, 945, av Wolfe, Québec G1V 5B3, Canada
| | - Claudia Blais
- Faculté de Pharmacie, Université Laval, Pavillon Ferdinand-Vandry, 1050 Av. de la Médecine, Québec G1V 0A6, Canada
- Institut National de Santé Publique du Québec, 945, av Wolfe, Québec G1V 5B3, Canada
| | - Véronique Boiteau
- Institut National de Santé Publique du Québec, 945, av Wolfe, Québec G1V 5B3, Canada
| | - Caroline Sirois
- Centre de Recherche du CHU de Québec – Université Laval, 2400 Av. D'Estimauville, Québec G1E 6W2, Canada
- Faculté de Pharmacie, Université Laval, Pavillon Ferdinand-Vandry, 1050 Av. de la Médecine, Québec G1V 0A6, Canada
- Institut National de Santé Publique du Québec, 945, av Wolfe, Québec G1V 5B3, Canada
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Carazo S, Skowronski DM, Brisson M, Sauvageau C, Brousseau N, Fafard J, Gilca R, Talbot D, Ouakki M, Febriani Y, Deceuninck G, De Wals P, De Serres G. Effectiveness of previous infection-induced and vaccine-induced protection against hospitalisation due to omicron BA subvariants in older adults: a test-negative, case-control study in Quebec, Canada. Lancet Healthy Longev 2023; 4:e409-e420. [PMID: 37459879 DOI: 10.1016/s2666-7568(23)00099-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Older adults (aged ≥60 years) were prioritised for COVID-19 booster vaccination due to severe outcome risk, but the risk for this group is also affected by previous SARS-CoV-2 infection and vaccination. We estimated vaccine effectiveness against omicron-associated hospitalisation in older adults by previously documented infection, time since last immunological event, and age group. METHODS This was a population-based test-negative case-control study done in Quebec, Canada, during BA.1 dominant (December, 2021, to March, 2022), BA.2 dominant (April to June, 2022), and BA.4/5 dominant (July to November, 2022) periods using provincial laboratory, immunisation, hospitalisation, and chronic disease surveillance databases. We included older adults (aged ≥60 years) with symptoms associated with COVID-19 who were tested for SARS-CoV-2 in acute-care hospitals. Cases were defined as patients who were hospitalised for COVID-19 within 14 days after testing positive; controls were patients who tested negative. Analyses spanned 3-14 months after last vaccine dose or previous infection. Logistic regression models compared COVID-19 hospitalisation risk by mRNA vaccine dose and previous infection versus unvaccinated and infection-naive participants. FINDINGS Between Dec 26, 2021, and Nov 5, 2022, we included 174 819 specimens (82 870 [47·4%] from men and 91 949 [52·6%] from women; from 8455 cases and 166 364 controls), taken from 2951 cases and 48 724 controls in the BA.1 period; 1897 cases and 41 702 controls in the BA.2 period; and 3607 cases and 75 938 controls in the BA.4/5 period. In participants who were infection naive, vaccine effectiveness against hospitalisation improved with dose number, consistent with a shorter median time since last dose, but decreased with more recent omicron subvariants. Four-dose vaccine effectiveness was 96% (95% CI 93-98) during the BA.1 period, 84% (81-87) during the BA.2 period, and 68% (63-72) during the BA.4/5 period. Regardless of dose number (two to five doses) or timing since previous infection, hybrid protection was more than 90%, persisted for at least 6-8 months, and did not decline with age. INTERPRETATION Older adults with both previous SARS-CoV-2 infection and two or more vaccine doses appear to be well protected for a prolonged period against hospitalisation due to omicron subvariants, including BA.4/5. Ensuring that older adults who are infection naive remain up to date with vaccination might reduce COVID-19 hospitalisations most efficiently. FUNDING Ministère de la Santé et des Services Sociaux du Québec. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada.
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Marc Brisson
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Chantal Sauvageau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Nicholas Brousseau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Judith Fafard
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, QC, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Manale Ouakki
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Yossi Febriani
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Philippe De Wals
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
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21
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Carazo S, Villeneuve J, Laliberté D, Longtin Y, Talbot D, Martin R, Denis G, Ducharme F, Paquet-Bolduc B, Anctil G, Hegg-Deloye S, De Serres G. Risk and protective factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare workers: A test-negative case-control study in Québec, Canada. Infect Control Hosp Epidemiol 2023; 44:1121-1130. [PMID: 36082690 PMCID: PMC9530374 DOI: 10.1017/ice.2022.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In Québec, Canada, we evaluated the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection associated with (1) the demographic and employment characteristics among healthcare workers (HCWs) and (2) the workplace and household exposures and the infection prevention and control (IPC) measures among patient-facing HCWs. DESIGN Test-negative case-control study. SETTING Provincial health system. PARTICIPANTS HCWs with PCR-confirmed coronavirus disease 2019 (COVID-19) diagnosed between November 15, 2020, and May 29, 2021 (ie, cases), were compared to HCWs with compatible symptoms who tested negative during the same period (ie, controls). METHODS Adjusted odds ratios (aORs) of infection were estimated using regression logistic models evaluating demographic and employment characteristics (all 4,919 cases and 4,803 controls) or household and workplace exposures and IPC measures (2,046 patient-facing cases and 1,362 controls). RESULTS COVID-19 risk was associated with working as housekeeping staff (aOR, 3.6), as a patient-support assistant (aOR, 1.9), and as nursing staff (aOR, 1.4), compared to administrative staff. Other risk factors included being unexperienced (aOR, 1.5) and working in private seniors' homes (aOR, 2.1) or long-term care facilities (aOR, 1.5), compared to acute-care hospitals. Among patient-facing HCWs, exposure to a household contact was reported by 9% of cases and was associated with the highest risk of infection (aOR, 7.8). Most infections were likely attributable to more frequent exposure to infected patients (aOR, 2.7) and coworkers (aOR, 2.2). Wearing an N95 respirator during contacts with COVID-19 patients (aOR, 0.7) and vaccination (aOR, 0.2) were the measures associated with risk reduction. CONCLUSION In the context of the everchanging SARS-CoV-2 virus with increasing transmissibility, measures to ensure HCW protection, including vaccination and respiratory protection, and patient safety will require ongoing evaluation.
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Affiliation(s)
- Sara Carazo
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Jasmin Villeneuve
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Denis Laliberté
- Direction de la santé publique de la Capitale-Nationale, CIUSSS de la Capitale-Nationale, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Yves Longtin
- Infection Prevention and Control Unit, Jewish General Hospital, Montreal, Québec, Canada
- McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Denis Talbot
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- Centre de recherche du CHU de Québec—Université Laval, Québec, Québec, Canada
| | - Richard Martin
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Geoffroy Denis
- McGill University Faculty of Medicine, Montreal, Québec, Canada
- CIUSSS Centre Sud de Montréal, Montreal, Québec, Canada
| | - Francine Ducharme
- Faculté des sciences infirmières, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche de l’Institut de gériatrie de Montréal, Montreal, Québec, Canada
| | - Bianka Paquet-Bolduc
- Infection Prevention and Control Unit, Institut Universitaire en cardiologie et pneumologie de Québec, Québec, Québec, Canada
| | - Geneviève Anctil
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | | | - Gaston De Serres
- Institut national de santé Publique du Québec, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- Centre de recherche du CHU de Québec—Université Laval, Québec, Québec, Canada
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22
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Gosselin M, Talbot D, Simard M, Chiu YM, Mésidor M, Boiteau V, Carmichael PH, Sirois C. Classifying Polypharmacy According to Pharmacotherapeutic and Clinical Risks in Older Adults: A Latent Class Analysis in Quebec, Canada. Drugs Aging 2023; 40:573-583. [PMID: 37149556 DOI: 10.1007/s40266-023-01028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION The simplistic definition of polypharmacy, often designated as the concomitant use of five medications or more, does not distinguish appropriate from inappropriate polypharmacy. Classifying polypharmacy according to varying levels of health risk would help optimise medication use. OBJECTIVE We aimed to characterise different types of polypharmacy among older adults and evaluate their association with mortality and institutionalisation. METHODS Using healthcare databases from the Quebec Integrated Chronic Disease Surveillance System, we selected a community-based random sample of the population ≥ 66 years old covered by the public drug plan. Categorical indicators used to describe polypharmacy included number of medications, potentially inappropriate medications (PIMs), drug-drug interactions, enhanced surveillance medications, complex route of administration medications, anticholinergic cognitive burden (ACB) score and use of blister cards. We used a latent class analysis to subdivide participants into distinct groups of polypharmacy. Their association with 3-year mortality and institutionalisation was assessed with adjusted Cox models. RESULTS In total, 93,516 individuals were included. A four-class model was selected with groups described as (1) no polypharmacy (46% of our sample), (2) high-medium number of medications, low risk (33%), (3) medium number of medications, PIM use with or without high ACB score (8%) and (4) hyperpolypharmacy, complex use, high risk (13%). Using the class without polypharmacy as the reference, all polypharmacy classes were associated with 3-year mortality and institutionalisation, with the most complex/inappropriate classes denoting the highest risk (hazard ratio [HR] [95% confidence interval]: class 3, 70-year-old point estimate for mortality 1.52 [1.30-1.78] and institutionalisation 1.86 [1.52-2.29]; class 4, 70-year-old point estimate for mortality 2.74 [2.44-3.08] and institutionalisation 3.11 [2.60-3.70]). CONCLUSIONS We distinguished three types of polypharmacy with varying pharmacotherapeutic and clinical appropriateness. Our results highlight the value of looking beyond the number of medications to assess polypharmacy.
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Affiliation(s)
- M Gosselin
- Department of Social and Preventive Medicine, Faculty of medicine, Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- VITAM, Centre de recherche en santé durable, Québec, Canada
- CHU de Québec- Université Laval Research Centre, Québec, Canada
| | - D Talbot
- Department of Social and Preventive Medicine, Faculty of medicine, Université Laval, Québec, Canada
- CHU de Québec- Université Laval Research Centre, Québec, Canada
| | - M Simard
- Department of Social and Preventive Medicine, Faculty of medicine, Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- VITAM, Centre de recherche en santé durable, Québec, Canada
- CHU de Québec- Université Laval Research Centre, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
| | - Y M Chiu
- VITAM, Centre de recherche en santé durable, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
- Faculty of pharmacy, Université Laval, Québec, Canada
| | - M Mésidor
- Department of Social and Preventive Medicine, Faculty of medicine, Université Laval, Québec, Canada
- CHU de Québec- Université Laval Research Centre, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
| | - V Boiteau
- Institut national de santé publique du Québec, Québec, Canada
| | - P-H Carmichael
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - C Sirois
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada.
- VITAM, Centre de recherche en santé durable, Québec, Canada.
- CHU de Québec- Université Laval Research Centre, Québec, Canada.
- Institut national de santé publique du Québec, Québec, Canada.
- Faculty of pharmacy, Université Laval, Québec, Canada.
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23
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Hong I, Aneshansley E, Chaudhury K, Talbot D. Stochastic microcontact model for the prediction of gear mechanical power loss. Tribology International 2023; 183:108413. [DOI: 10.1016/j.triboint.2023.108413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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24
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Marx T, Moore L, Talbot D, Guertin JR, Lachapelle P, Blais S, Singbo N, Simonyan D, Lavallée J, Zada N, Shahrigharahkoshan S, Huard B, Olivier P, Mallet M, Létourneau M, Lafrenière M, Archambault PM, Berthelot S. A value-based comparison of the management of respiratory diseases in walk-in clinics and emergency departments. CAN J EMERG MED 2023; 25:394-402. [PMID: 37004679 DOI: 10.1007/s43678-023-00481-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/04/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES Our aim was to compare some of the health outcomes and costs associated with value of care in emergency departments (ED) and walk-in clinics for ambulatory patients presenting with an acute respiratory disease. METHODS A health records review was conducted from April 2016 through March 2017 in one ED and one walk-in clinic. Inclusion criteria were: (i) ambulatory patients at least 18 years old, (ii) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Primary outcome was the proportion of patients returning to any ED or walk-in clinic within three and seven days of the index visit. Secondary outcomes were the mean cost of care and the incidence of antibiotic prescription for URTI patients. The cost of care was estimated from the Ministry of Health's perspectives using time-driven activity-based costing. RESULTS The ED group included 170 patients and the walk-in clinic group 326 patients. The return visit incidences at three and seven days were, respectively, 25.9% and 38.2% in the ED vs. 4.9% and 14.7% in the walk-in clinic (adjusted relative risk (arr) of 4.7 (95% CI 2.6-8.6) and 2.7 (1.9-3.9)). The mean cost ($Cdn) of the index visit care was 116.0 (106.3-125.7) in the ED vs. 62.5 (57.7-67.3) in the walk-in clinic (mean difference of 56.4 (45.7-67.1)). Antibiotic prescription for URTI was 5.6% in the ED vs. 24.7% in the walk-in clinic (arr 0.2, 0.01-0.6). CONCLUSIONS This study is the first in a larger research program to compare the value of care between walk-in clinics and the ED. The potential advantages of walk-in clinics over EDs (lower costs, lower incidence of return visits) for ambulatory patients with respiratory diseases should be considered in healthcare planning.
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Affiliation(s)
- Tania Marx
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Lynne Moore
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Jason R Guertin
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Philippe Lachapelle
- Clinical and Organizational Performance Department of the CHU de Québec-Université Laval, Québec, QC, Canada
| | - Sébastien Blais
- Clinical and Organizational Performance Department of the CHU de Québec-Université Laval, Québec, QC, Canada
| | - Narcisse Singbo
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - David Simonyan
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Jeanne Lavallée
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Nawid Zada
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Shaghayegh Shahrigharahkoshan
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Benoit Huard
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Pascale Olivier
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Myriam Mallet
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Mélanie Létourneau
- Clinical and Organizational Performance Department of the CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Patrick M Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- Centre de Recherche du Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- VITAM - Centre de Recherche en Santé Durable, Université Laval, Québec, QC, Canada
| | - Simon Berthelot
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada.
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25
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Duchaine CS, Brisson C, Diorio C, Talbot D, Maunsell E, Carmichael PH, Giguère Y, Gilbert-Ouimet M, Trudel X, Ndjaboué R, Vézina M, Milot A, Mâsse B, Dionne CE, Laurin D. Work-Related Psychosocial Factors and Global Cognitive Function: Are Telomere Length and Low-Grade Inflammation Potential Mediators of This Association? Int J Environ Res Public Health 2023; 20:4929. [PMID: 36981836 PMCID: PMC10049148 DOI: 10.3390/ijerph20064929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
The identification of modifiable factors that could maintain cognitive function is a public health priority. It is thought that some work-related psychosocial factors help developing cognitive reserve through high intellectual complexity. However, they also have well-known adverse health effects and are considered to be chronic psychosocial stressors. Indeed, these stressors could increase low-grade inflammation and promote oxidative stress associated with accelerated telomere shortening. Both low-grade inflammation and shorter telomeres have been associated with a cognitive decline. This study aimed to evaluate the total, direct, and indirect effects of work-related psychosocial factors on global cognitive function overall and by sex, through telomere length and an inflammatory index. A random sample of 2219 participants followed over 17 years was included in this study, with blood samples and data with cognitive function drawn from a longitudinal study of 9188 white-collar workers (51% female). Work-related psychosocial factors were evaluated according to the Demand-Control-Support and the Effort-Reward Imbalance (ERI) models. Global cognitive function was evaluated with the validated Montreal Cognitive Assessment (MoCA). Telomere length and inflammatory biomarkers were measured using standardised protocols. The direct and indirect effects were estimated using a novel mediation analysis method developed for multiple correlated mediators. Associations were observed between passive work or low job control, and shorter telomeres among females, and between low social support at work, ERI or iso-strain, and a higher inflammatory index among males. An association was observed with higher cognitive performance for longer telomeres, but not for the inflammatory index. Passive work overall, and low reward were associated with lower cognitive performance in males; whereas, high psychological demand in both males and females and high job strain in females were associated with a higher cognitive performance. However, none of these associations were mediated by telomere length or the inflammatory index. This study suggests that some work-related psychosocial factors could be associated with shorter telomeres and low-grade inflammation, but these associations do not explain the relationship between work-related psychosocial factors and global cognitive function. A better understanding of the biological pathways, by which these factors affect cognitive function, could guide future preventive strategies to maintain cognitive function and promote healthy aging.
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Affiliation(s)
- Caroline S. Duchaine
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
| | - Chantal Brisson
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
| | - Caroline Diorio
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Denis Talbot
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Elizabeth Maunsell
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Pierre-Hugues Carmichael
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Yves Giguère
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Mahée Gilbert-Ouimet
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- Canada Research Chair in Sex and Gender in Occupational Health, Université du Québec à Rimouski, Campus de Lévis, Lévis, QC G6V 0A6, Canada
| | - Xavier Trudel
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
| | - Ruth Ndjaboué
- School of Social Work, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Michel Vézina
- Institut National de Santé Publique du Québec (INSPQ), Québec, QC G1V 5B3, Canada
| | - Alain Milot
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Benoît Mâsse
- École de Santé Publique de l’Université de Montréal, Montréal, QC H3N 1X9, Canada
| | - Clermont E. Dionne
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
| | - Danielle Laurin
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC G1V 0A6, Canada
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26
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Talbot D, Moodie EEM, Diorio C. Double robust estimation of optimal partially adaptive treatment strategies: An application to breast cancer treatment using hormonal therapy. Stat Med 2023; 42:178-192. [PMID: 36408723 DOI: 10.1002/sim.9608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/17/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
Precision medicine aims to tailor treatment decisions according to patients' characteristics. G-estimation and dynamic weighted ordinary least squares are double robust methods to identify optimal adaptive treatment strategies. It is underappreciated that they require modeling all existing treatment-confounder interactions to be consistent. Identifying optimal partially adaptive treatment strategies that tailor treatments according to only a few covariates, ignoring some interactions, may be preferable in practice. Building on G-estimation and dWOLS, we propose estimators of such partially adaptive strategies and demonstrate their double robustness. We investigate these estimators in a simulation study. Using data maintained by the Centre des Maladies du Sein, we estimate a partially adaptive treatment strategy for tailoring hormonal therapy use in breast cancer patients. R software implementing our estimators is provided.
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Affiliation(s)
- Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada.,Axe santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Québec, Canada
| | - Caroline Diorio
- Département de médecine sociale et préventive, Université Laval, Québec, Canada.,Axe oncologie, Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
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27
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Carazo S, Skowronski DM, Brisson M, Barkati S, Sauvageau C, Brousseau N, Gilca R, Fafard J, Talbot D, Ouakki M, Gilca V, Carignan A, Deceuninck G, De Wals P, De Serres G. Protection against omicron (B.1.1.529) BA.2 reinfection conferred by primary omicron BA.1 or pre-omicron SARS-CoV-2 infection among health-care workers with and without mRNA vaccination: a test-negative case-control study. Lancet Infect Dis 2023; 23:45-55. [PMID: 36152671 PMCID: PMC9491856 DOI: 10.1016/s1473-3099(22)00578-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is a paucity of data on vaccine-induced or infection-induced (hybrid or natural) immunity against omicron (B.1.1.529) subvariant BA.2, particularly in comparing the effects of previous SARS-CoV-2 infection with the same or different genetic lineage. We aimed to estimate the protection against omicron BA.2 associated with previous primary infection with omicron BA.1 or pre-omicron SARS-CoV-2, among health-care workers with and without mRNA vaccination. METHODS We conducted a test-negative case-control study among health-care workers aged 18 years or older who were tested for SARS-CoV-2 in Quebec, Canada, between March 27 and June 4, 2022, when BA.2 was the predominant variant and was presumptively diagnosed with a positive test result. We identified cases (positive test during study period) and controls (negative test during study period) using the provincial laboratory database that records all nucleic acid amplification testing for SARS-CoV-2 in Quebec, and used the provincial immunisation registry to determine vaccination status. Logistic regression models compared the likelihood of BA.2 infection or reinfection (second positive test ≥30 days after primary infection) among health-care workers who had previous primary infection and none to three mRNA vaccine doses versus unvaccinated health-care workers with no primary infection. FINDINGS 258 007 SARS-CoV-2 tests were done during the study period. Among those with a valid result and that met the inclusion criteria, there were 37 732 presumed BA.2 cases (2521 [6·7%] reinfections following pre-omicron primary infection and 659 [1·7%] reinfections following BA.1 primary infection) and 73 507 controls (7360 [10·0%] had pre-omicron primary infection and 12 315 [16·8%] had BA.1 primary infection). Pre-omicron primary infection was associated with a 38% (95% CI 19-53) reduction in BA.2 infection risk, with higher BA.2 protection among those who had also received one (56%, 95% CI 47-63), two (69%, 64-73), or three (70%, 66-74) mRNA vaccine doses. Omicron BA.1 primary infection was associated with greater protection against BA.2 infection (risk reduction of 72%, 95% CI 65-78), and protection was increased further among those who had received two doses of mRNA vaccine (96%, 95-96), but was not improved with a third dose (96%, 95-97). INTERPRETATION Health-care workers who had received two doses of mRNA vaccine and had previous BA.1 infection were subsequently well protected for a prolonged period against BA.2 reinfection, with a third vaccine dose conferring no improvement to that hybrid protection. If this protection also pertains to future variants, there might be limited benefit from additional vaccine doses for people with hybrid immunity, depending on timing and variant. FUNDING Ministère de la Santé et des Services Sociaux du Québec.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada.
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Marc Brisson
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Sapha Barkati
- Department of Medicine, Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Chantal Sauvageau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Nicholas Brousseau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Judith Fafard
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Manale Ouakki
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Vladimir Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Sherbrook University, Sherbrook, QC, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Philippe De Wals
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
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28
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Carazo S, Skowronski DM, Brisson M, Sauvageau C, Brousseau N, Gilca R, Ouakki M, Barkati S, Fafard J, Talbot D, Gilca V, Deceuninck G, Garenc C, Carignan A, De Wals P, De Serres G. Estimated Protection of Prior SARS-CoV-2 Infection Against Reinfection With the Omicron Variant Among Messenger RNA-Vaccinated and Nonvaccinated Individuals in Quebec, Canada. JAMA Netw Open 2022; 5:e2236670. [PMID: 36239934 PMCID: PMC9568797 DOI: 10.1001/jamanetworkopen.2022.36670] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE The Omicron variant is phylogenetically and antigenically distinct from earlier SARS-CoV-2 variants and the original vaccine strain. Protection conferred by prior SARS-CoV-2 infection against Omicron reinfection, with and without vaccination, requires quantification. OBJECTIVE To estimate the protection against Omicron reinfection and hospitalization conferred by prior heterologous non-Omicron SARS-CoV-2 infection and/or up to 3 doses of an ancestral, Wuhan-like messenger RNA (mRNA) vaccine. DESIGN, SETTING, AND PARTICIPANTS This test-negative, population-based case-control study was conducted between December 26, 2021, and March 12, 2022, and included community-dwelling individuals aged 12 years or older who were tested for SARS-CoV-2 infection in the province of Quebec, Canada. EXPOSURES Prior laboratory-confirmed SARS-CoV-2 infection with or without mRNA vaccination. MAIN OUTCOMES AND MEASURES The main outcome was laboratory-confirmed SARS-CoV-2 reinfection and associated hospitalization, presumed to be associated with the Omicron variant according to genomic surveillance. The odds of prior infection with or without vaccination were compared for case participants with Omicron infection and associated hospitalizations vs test-negative control participants. Estimated protection was derived as 1 - the odds ratio, adjusted for age, sex, testing indication, and epidemiologic week. Analyses were stratified by severity and time since last non-Omicron infection or vaccine dose. RESULTS This study included 696 439 individuals (224 007 case participants and 472 432 control participants); 62.2% and 63.9% were female and 87.4% and 75.5% were aged 18 to 69 years, respectively. Prior non-Omicron SARS-CoV-2 infection was detected for 9505 case participants (4.2%) and 29 712 control participants (6.3%). Among nonvaccinated individuals, prior non-Omicron infection was associated with a 44% reduction (95% CI, 38%-48%) in Omicron reinfection risk, which decreased from 66% (95% CI, 57%-73%) at 3 to 5 months to 35% (95% CI, 21%-47%) at 9 to 11 months postinfection and was below 30% thereafter. The more severe the prior infection, the greater the risk reduction. Estimated protection (95% CI) against Omicron infection was consistently significantly higher among vaccinated individuals with prior infection compared with vaccinated infection-naive individuals, with 65% (63%-67%) vs 20% (16%-24%) for 1 dose, 68% (67%-70%) vs 42% (41%-44%) for 2 doses, and 83% (81%-84%) vs 73% (72%-73%) for 3 doses. For individuals with prior infection, estimated protection (95% CI) against Omicron-associated hospitalization was 81% (66%-89%) and increased to 86% (77%-99%) with 1, 94% (91%-96%) with 2, and 97% (94%-99%) with 3 mRNA vaccine doses, without signs of waning. CONCLUSIONS AND RELEVANCE The findings of this study suggest that vaccination with 2 or 3 mRNA vaccine doses among individuals with prior heterologous SARS-CoV-2 infection provided the greatest protection against Omicron-associated hospitalization. In the context of program goals to prevent severe outcomes and preserve health care system capacity, a third mRNA vaccine dose may add limited protection in twice-vaccinated individuals with prior SARS-CoV-2 infection.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Danuta M. Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marc Brisson
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Chantal Sauvageau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Manale Ouakki
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Sapha Barkati
- Division of Infectious Diseases, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Judith Fafard
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Denis Talbot
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Vladimir Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Christophe Garenc
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Sherbrook University, Sherbrook, Quebec, Canada
| | - Philippe De Wals
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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O'Connor S, Blais C, Mésidor M, Talbot D, Poirier P, Leclerc J. Great diversity in the utilization and reporting of latent growth modeling approaches in type 2 diabetes: A literature review. Heliyon 2022; 8:e10493. [PMID: 36164545 PMCID: PMC9508412 DOI: 10.1016/j.heliyon.2022.e10493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The progression of complications of type 2 diabetes (T2D) is unique to each patient and can be depicted through individual temporal trajectories. Latent growth modeling approaches (latent growth mixture models [LGMM] or latent class growth analysis [LCGA]) can be used to classify similar individual trajectories in a priori non-observed groups (latent groups), sharing common characteristics. Although increasingly used in the field of T2D, many questions remain regarding the utilization of these methods. Objective To review the literature of longitudinal studies using latent growth modeling approaches to study T2D. Methods MEDLINE (Ovid), EMBASE, CINAHL and Wb of Science were searched through August 25th, 2021. Data was collected on the type of latent growth modeling approaches (LGMM or LCGA), characteristics of studies and quality of reporting using the GRoLTS-Checklist and presented as frequencies. Results From the 4,694 citations screened, a total of 38 studies were included. The studies were published beetween 2011 and 2021 and the length of follow-up ranged from 8 weeks to 14 years. Six studies used LGMM, while 32 studies used LCGA. The fields of research varied from clinical research, psychological science, healthcare utilization research and drug usage/pharmaco-epidemiology. Data sources included primary data (clinical trials, prospective/retrospective cohorts, surveys), or secondary data (health records/registries, medico-administrative). Fifty percent of studies evaluated trajectory groups as exposures for a subsequent clinical outcome, while 24% used predictive models of group membership and 5% used both. Regarding the quality of reporting, trajectory groups were adequately presented, however many studies failed to report important decisions made for the trajectory group identification. Conclusion Although LCGA were preferred, the contexts of utilization were diverse and unrelated to the type of methods. We recommend future authors to clearly report the decisions made regarding trajectory groups identification. There is a growing body of literature on trajectory modeling in type 2 diabetes. Latent class growth analysis can be used in many different contexts. The current reporting of methods used should be improved.
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Affiliation(s)
- Sarah O'Connor
- Research Centre, Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Ch. Ste-Foy, Quebec City, Quebec, G1V 4G5, Canada.,Faculty of Pharmacy, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada
| | - Claudia Blais
- Faculty of Pharmacy, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada.,Bureau D'information et D'études en Santé des Populations, Institut National de Santé Publique Du Québec, 945, Wolfe Avenue, Quebec City, Quebec, G1V 5B3, Canada
| | - Miceline Mésidor
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada.,Research Centre, CHU de Québec - Université Laval, 2400 D'Estimauville Avenue, Québec, QC, G1E 6W2, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada.,Research Centre, CHU de Québec - Université Laval, 2400 D'Estimauville Avenue, Québec, QC, G1E 6W2, Canada
| | - Paul Poirier
- Research Centre, Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Ch. Ste-Foy, Quebec City, Quebec, G1V 4G5, Canada.,Faculty of Pharmacy, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada
| | - Jacinthe Leclerc
- Research Centre, Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Ch. Ste-Foy, Quebec City, Quebec, G1V 4G5, Canada.,Faculty of Pharmacy, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada.,Department of Nursing, Université Du Québec à Trois-Rivières, 3351 des Forges Boulevard, Trois-Rivières, Quebec, G8Z 4M3, Canada
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30
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Carazo S, Talbot D, Boulianne N, Brisson M, Gilca R, Deceuninck G, Brousseau N, Drolet M, Ouakki M, Sauvageau C, Barkati S, Fortin É, Carignan A, De Wals P, Skowronski DM, De Serres G. Single-Dose Messenger RNA Vaccine Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 in Healthcare Workers Extending 16 Weeks Postvaccination: A Test-Negative Design From Québec, Canada. Clin Infect Dis 2022; 75:e805-e813. [PMID: 34460902 PMCID: PMC8522396 DOI: 10.1093/cid/ciab739] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Canada, first and second doses of messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were uniquely spaced 16 weeks apart. We estimated 1- and 2-dose mRNA vaccine effectiveness (VE) among healthcare workers (HCWs) in Québec, Canada, including protection against varying outcome severity, variants of concern (VOCs), and the stability of single-dose protection up to 16 weeks postvaccination. METHODS A test-negative design compared vaccination among SARS-CoV-2 test-positive and weekly matched (10:1), randomly sampled, test-negative HCWs using linked surveillance and immunization databases. Vaccine status was defined by 1 dose ≥14 days or 2 doses ≥7 days before illness onset or specimen collection. Adjusted VE was estimated by conditional logistic regression. RESULTS Primary analysis included 5316 cases and 53 160 controls. Single-dose VE was 70% (95% confidence interval [CI], 68%-73%) against SARS-CoV-2 infection; 73% (95% CI, 71%-75%) against illness; and 97% (95% CI, 92%-99%) against hospitalization. Two-dose VE was 86% (95% CI, 81%-90%) and 93% (95% CI, 89%-95%), respectively, with no hospitalizations. VE was higher for non-VOCs than VOCs (73% Alpha) among single-dose recipients but not 2-dose recipients. Across 16 weeks, no decline in single-dose VE was observed, with appropriate stratification based upon prioritized vaccination determined by higher vs lower likelihood of direct patient contact. CONCLUSIONS One mRNA vaccine dose provided substantial and sustained protection to HCWs extending at least 4 months postvaccination. In circumstances of vaccine shortage, delaying the second dose may be a pertinent public health strategy.
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Affiliation(s)
- Sara Carazo
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Denis Talbot
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
| | - Nicole Boulianne
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Marc Brisson
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - Rodica Gilca
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Geneviève Deceuninck
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Mélanie Drolet
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Manale Ouakki
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Chantal Sauvageau
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Sapha Barkati
- JD MacLean Centre for Tropical Diseases, McGill University Health Centre, McGill University, Montreal, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Élise Fortin
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Philippe De Wals
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
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Carazo S, Skowronski DM, Laforce R, Talbot D, Falcone EL, Laliberté D, Denis G, Deshaies P, Hegg-Deloye S, De Serres G. Physical, psychological and cognitive profile of post-COVID conditions in healthcare workers, Quebec, Canada. Open Forum Infect Dis 2022; 9:ofac386. [PMID: 35983264 PMCID: PMC9379818 DOI: 10.1093/ofid/ofac386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/29/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
The prevalence of post-COVID conditions (PCC) and associated physical, psychological and cognitive symptoms was assessed among Quebec healthcare workers (HCWs) with COVID-19.
Methods
This case-control study compared 6061 symptomatic HCWs with PCR-confirmed COVID-19 between July 2020 and May 2021 with a random sample of 4390 symptomatic HCWs who were test-negative controls. The prevalence of physical symptoms lasting ≥4 weeks (PCC4w) or ≥12 weeks (PCC12w) was estimated among hospitalized and non-hospitalized cases. In multivariate models, sociodemographic and clinical characteristics, as well as vaccine history, were evaluated as potential risk factors. Prevalence ratios compared four aspects of self-reported cognitive dysfunction among PCC cases to controls, adjusting for psychological distress and fatigue.
Results
PCC4w and PCC12w prevalences of 46% (2,746/5,943) and 40% (653/1,746), respectively, were observed among non-hospitalized cases and 76% (90/118) and 68% (27/37), respectively, among hospitalized cases. Hospitalization, female sex and age were associated with higher PCC risk.
A substantial proportion of non-hospitalized PCC4w cases often or very often reported cognitive dysfunction, including concentration (33%) or organizing (23%) difficulties, forgetfulness (20%) and loss of necessary items (10%). All four aspects of cognitive dysfunction were associated with PCC4w symptoms, psychological distress and fatigue.
Conclusion
PCC may be a frequent sequela of ambulatory COVID-19 in working-age adults, with important effects on cognition. With so many HCWs infected, the implications for quality healthcare delivery could be profound if cognitive dysfunction and other severe PCC symptoms persist in a professionally-disabling way. Further evaluation of PCC prevalence and prognosis is warranted.
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Affiliation(s)
- Sara Carazo
- CHU de Québec-Laval University Research Center , Quebec City, Quebec , Canada
- Biological and occupational risks unit. Institut national de santé publique du Québec , Quebec City, Quebec , Canada
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, BC Centre for Disease Control , Vancouver, British Columbia , Canada
| | - Robert Laforce
- Interdisciplinary Memory Clinic, Department of Neurological Sciences, CHU de Quebec, and Faculty of Medicine, Laval University , Quebec City, Quebec , Canada
| | - Denis Talbot
- CHU de Québec-Laval University Research Center , Quebec City, Quebec , Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University , Quebec City, Quebec, Canada
| | - Emilia L Falcone
- Department of Medicine, Faculty of Medicine, University of Montreal , Montreal, Quebec , Canada
- Center for Inflammation, Immunity and Infectious Diseases, Montreal Clinical Research Institute (IRCM) , Montreal, Quebec , Canada
| | - Denis Laliberté
- Social and preventive medicine department, Faculty of Medicine, Laval University , Quebec City, Quebec, Canada
- CIUSSS de la Capitale-Nationale , Quebec City, Quebec , Canada
| | - Geoffroy Denis
- CIUSSS Centre Sud de Montréal , Montreal, Quebec , Canada
- McGill University , Montreal, Quebec , Canada
| | | | | | - Gaston De Serres
- CHU de Québec-Laval University Research Center , Quebec City, Quebec , Canada
- Biological and occupational risks unit. Institut national de santé publique du Québec , Quebec City, Quebec , Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University , Quebec City, Quebec, Canada
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Gagnon M, Talbot D, Tremblay F, Tourville M, Sirois C. 209 - La polypharmacie et le risque de fracture chez les aînés: revue systématique. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Diop SA, Duchesne T, G. Cumming S, Diop A, Talbot D. Confounding adjustment methods for multi-level treatment comparisons under lack of positivity and unknown model specification. J Appl Stat 2022; 49:2570-2592. [PMID: 35757044 PMCID: PMC9225669 DOI: 10.1080/02664763.2021.1911966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Imbalances in covariates between treatment groups are frequent in observational studies and can lead to biased comparisons. Various adjustment methods can be employed to correct these biases in the context of multi-level treatments (> 2). Analytical challenges, such as positivity violations and incorrect model specification due to unknown functional relationships between covariates and treatment or outcome, may affect their ability to yield unbiased results. Such challenges were expected in a comparison of fire-suppression interventions for preventing fire growth. We identified the overlap weights, augmented overlap weights, bias-corrected matching and targeted maximum likelihood as methods with the best potential to address those challenges. A simple variance estimator for the overlap weight estimators that can naturally be combined with machine learning is proposed. In a simulation study, we investigated the performance of these methods as well as those of simpler alternatives. Adjustment methods that included an outcome modeling component performed better than those that focused on the treatment mechanism in our simulations. Additionally, machine learning implementation was observed to efficiently compensate for the unknown model specification for the former methods, but not the latter. Based on these results, we compared the effectiveness of fire-suppression interventions using the augmented overlap weight estimator.
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Affiliation(s)
- S. Arona Diop
- Département de mathématiques et de statistique, Université Laval, Québec, Canada
| | - Thierry Duchesne
- Département de mathématiques et de statistique, Université Laval, Québec, Canada
| | - Steven G. Cumming
- Département des sciences du bois et de la forêt, Université Laval, Québec, Canada
| | - Awa Diop
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
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Carazo S, Pelletier M, Talbot D, Jauvin N, De Serres G, Vézina M. Psychological Distress of Healthcare Workers in Québec (Canada) During the Second and the Third Pandemic Waves. J Occup Environ Med 2022; 64:495-503. [PMID: 35051960 PMCID: PMC9275796 DOI: 10.1097/jom.0000000000002487] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We aimed to measure the prevalence of psychological distress among Quebec healthcare workers (HCWs) during the second and third pandemic waves and to assess the effect of psychosocial risk factors (PSRs) on work-related psychological distress among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected (cases) and non-infected (controls) HCWs. METHODS A self-administered survey was used to measure validated indicators of psychological distress (K6 scale) and PSR (questions based on Karasek and Siegrist models, value conflicts, and work-life balance). Adjusted robust Poisson models were used to estimate prevalence ratios. RESULTS Four thousand sixty eight cases and 4152 controls completed the survey. Prevalence of high work-related psychological distress was 42%; it was associated with PSRs (mainly work-life balance, value conflicts, and high psychological demands) but not with SARS-CoV-2 infection. CONCLUSION Primary prevention measures targeting PSRs are needed to reduce mental health risks of HCWs.
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Affiliation(s)
- Sara Carazo
- From the Centre Hospitalier Universitaire de Québec-Laval University Research Center (Dr Carazo, Dr Talbot, Dr Serres); Biological and Occupational Risks Unit, Quebec National Institute of Public Health (Dr Carazo, Dr Pelletier, Dr Jauvin, Dr Serres, Dr Vézina); Social and Preventive Medicine Department, Faculty of Medicine, Laval University (Dr Talbot, Dr Serres, Dr Vézina), Québec, Québec, Canada
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Skowronski DM, Febriani Y, Ouakki M, Setayeshgar S, El Adam S, Zou M, Talbot D, Prystajecky N, Tyson JR, Gilca R, Brousseau N, Deceuninck G, Galanis E, Fjell CD, Sbihi H, Fortin E, Barkati S, Sauvageau C, Naus M, Patrick DM, Henry B, Hoang LMN, De Wals P, Garenc C, Carignan A, Drolet M, Jassem AN, Sadarangani M, Brisson M, Krajden M, De Serres G. Two-Dose Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Effectiveness With Mixed Schedules and Extended Dosing Intervals: Test-Negative Design Studies From British Columbia and Quebec, Canada. Clin Infect Dis 2022; 75:1980-1992. [PMID: 35438175 PMCID: PMC9047203 DOI: 10.1093/cid/ciac290] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Canadian coronavirus disease 2019 (COVID-19) immunization strategy deferred second doses and allowed mixed schedules. We compared 2-dose vaccine effectiveness (VE) by vaccine type (mRNA and/or ChAdOx1), interval between doses, and time since second dose in 2 of Canada's larger provinces. METHODS Two-dose VE against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or hospitalization among adults ≥18 years, including due to Alpha, Gamma, and Delta variants of concern (VOCs), was assessed ≥14 days postvaccination by test-negative design studies separately conducted in British Columbia and Quebec, Canada, between 30 May and 27 November (epi-weeks 22-47) 2021. RESULTS In both provinces, all homologous or heterologous mRNA and/or ChAdOx1 2-dose schedules were associated with ≥90% reduction in SARS-CoV-2 hospitalization risk for ≥7 months. With slight decline from a peak of >90%, VE against infection was ≥80% for ≥6 months following homologous mRNA vaccination, lower by ∼10% when both doses were ChAdOx1 but comparably high following heterologous ChAdOx1 + mRNA receipt. Findings were similar by age group, sex, and VOC. VE was significantly higher with longer 7-8-week versus manufacturer-specified 3-4-week intervals between mRNA doses. CONCLUSIONS Two doses of any mRNA and/or ChAdOx1 combination gave substantial and sustained protection against SARS-CoV-2 hospitalization, spanning Delta-dominant circulation. ChAdOx1 VE against infection was improved by heterologous mRNA series completion. A 7-8-week interval between first and second doses improved mRNA VE and may be the optimal schedule outside periods of intense epidemic surge. Findings support interchangeability and extended intervals between SARS-CoV-2 vaccine doses, with potential global implications for low-coverage areas and, going forward, for children.
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Affiliation(s)
- Danuta M Skowronski
- Correspondence: D. M. Skowronski, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada V5Z 4R4 ()
| | - Yossi Febriani
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Manale Ouakki
- Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada
| | - Solmaz Setayeshgar
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Shiraz El Adam
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Macy Zou
- BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Denis Talbot
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Natalie Prystajecky
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - John R Tyson
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Rodica Gilca
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Eleni Galanis
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada,University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Chris D Fjell
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada,BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Elise Fortin
- Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada,Université de Montréal, Département de Microbiologie, Infectiologie et Immunologie, Montreal, Quebec, Canada
| | - Sapha Barkati
- McGill University, Department of Medicine, Division of Infectious Diseases, McGill University Health Center, Montreal, Quebec, Canada
| | - Chantal Sauvageau
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Monika Naus
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada,University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - David M Patrick
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada,University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Bonnie Henry
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada,Office of the Provincial Health Officer, Ministry of Health, Victoria, British Columbia, Canada
| | - Linda M N Hoang
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Philippe De Wals
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Christophe Garenc
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada
| | - Alex Carignan
- Sherbrooke University, Department of Microbiology and Infectious Diseases, Sherbrooke, Quebec, Canada
| | - Mélanie Drolet
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Agatha N Jassem
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- BC Children’s Hospital Research Institute, Vaccine Evaluation Center, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pediatrics, Vancouver, British Columbia, Canada
| | - Marc Brisson
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
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Pararasa C, Messenger DJ, Barrett KE, Hyliands D, Talbot D, Fowler MI, Kawatra T, Gunn DA, Lim FL, Wainwright LJ, Jenkins G, Griffiths HR. Lower polyunsaturated fatty acid levels and FADS2 expression in adult compared to neonatal keratinocytes are associated with FADS2 promotor hypermethylation. Biochem Biophys Res Commun 2022; 601:9-15. [PMID: 35219001 PMCID: PMC8993048 DOI: 10.1016/j.bbrc.2022.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/06/2022] [Accepted: 02/16/2022] [Indexed: 11/27/2022]
Abstract
Keratinocytes produce lipids that are critical for the skin barrier, however, little is known about the impact of age on fatty acid (FA) biosynthesis in these cells. We have examined the relationship between keratinocyte FA composition, lipid biosynthetic gene expression, gene promoter methylation and age. Expression of elongase (ELOVL6 and 7) and desaturase (FADS1 and 2) genes was lower in adult versus neonatal keratinocytes, and was associated with lower concentrations of n-7, n-9 and n-10 polyunsaturated FA in adult cells. Consistent with these findings, transient FADS2 knockdown in neonatal keratinocytes mimicked the adult keratinocyte FA profile in neonatal cells. Interrogation of methylation levels across the FADS2 locus (53 genomic sites) revealed differential methylation of 15 sites in neonatal versus adult keratinocytes, of which three hypermethylated sites in adult keratinocytes overlapped with a SMARCA4 protein binding site in the FADS2 promoter.
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Affiliation(s)
- C Pararasa
- College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - D J Messenger
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - K E Barrett
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - D Hyliands
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - D Talbot
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - M I Fowler
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - T Kawatra
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - D A Gunn
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - F L Lim
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - L J Wainwright
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - G Jenkins
- Unilever R&D, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, UK
| | - H R Griffiths
- College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK; Faculty of Medicine, Health and Life Sciences, Swansea University, SA2 8PP, UK.
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Benasseur I, Talbot D, Durand M, Holbrook A, Matteau A, Potter BJ, Renoux C, Schnitzer ME, Tarride JÉ, Guertin JR. A Comparison of Confounder Selection and Adjustment Methods for Estimating Causal Effects Using Large Healthcare Databases. Pharmacoepidemiol Drug Saf 2021; 31:424-433. [PMID: 34953160 PMCID: PMC9304306 DOI: 10.1002/pds.5403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE Confounding adjustment is required to estimate the effect of an exposure on an outcome in observational studies. However, variable selection and unmeasured confounding are particularly challenging when analyzing large healthcare data. Machine learning methods may help address these challenges. The objective was to evaluate the capacity of such methods to select confounders and reduce unmeasured confounding bias. METHODS A simulation study with known true effects was conducted. Completely synthetic and partially synthetic data incorporating real large healthcare data were generated. We compared Bayesian Adjustment for Confounding, Generalized Bayesian Causal Effect Estimation, Group Lasso and Doubly Robust Estimation, high-dimensional propensity score, and scalable collaborative targeted maximum likelihood algorithms. For the high-dimensional propensity score, two adjustment approaches targeting the effect in the whole population were considered: full matching and inverse probability weighting. RESULTS In scenarios without hidden confounders, most methods were essentially unbiased. The bias and variance of the high-dimensional propensity score varied considerably according to the number of variables selected by the algorithm. In scenarios with hidden confounders, substantial bias reduction was achieved by using machine learning methods to identify proxies as compared to adjusting only by observed confounders. High-dimensional propensity score and Group Lasso performed poorly in the partially synthetic simulation. Bayesian Adjustment for Confounding, Generalized Bayesian Causal Effect Estimation, and scalable collaborative targeted maximum likelihood algorithms performed particularly well. CONCLUSIONS Machine learning can help to identify measured confounders in large healthcare databases. They can also capitalize on proxies of unmeasured confounders to substantially reduce residual confounding bias. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Imane Benasseur
- Département de mathématiques et de statistique, Université Laval, Québec, Qc, Canada.,Unité santé des populations et pratiques optimales en santé, CHU de Québec - Université Laval research center, Québec, Qc, Canada
| | - Denis Talbot
- Unité santé des populations et pratiques optimales en santé, CHU de Québec - Université Laval research center, Québec, Qc, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Qc, Canada
| | - Madeleine Durand
- Département de médecine, Université de Montréal, Montréal, Qc, Canada.,CHUM Research Center, Montreal, Qc, Canada
| | - Anne Holbrook
- Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Hamilton, On, Canada
| | - Alexis Matteau
- Département de médecine, Université de Montréal, Montréal, Qc, Canada.,CHUM Research Center, Montreal, Qc, Canada
| | - Brian J Potter
- Département de médecine, Université de Montréal, Montréal, Qc, Canada.,CHUM Research Center, Montreal, Qc, Canada
| | - Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research - Jewish General Hospital, Montreal, Qc, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Qc, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, Qc, Canada
| | - Mireille E Schnitzer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Qc, Canada.,Faculty of Pharmacy, Université de Montréal, Montréal, Qc, Canada.,École de santé publique - Département de médecine sociale et préventive, Université de Montréal, Montréal, Qc, Canada
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, On, Canada.,Programs for Assessment of Technology in Health, The Research Institute of St. Joseph's, Hamilton, On, Canada
| | - Jason R Guertin
- Unité santé des populations et pratiques optimales en santé, CHU de Québec - Université Laval research center, Québec, Qc, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Qc, Canada
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Sinyavskaya L, Schnitzer M, Renoux C, Guertin JR, Talbot D, Durand M. Evidence of the Different Associations of Prognostic Factors With Censoring Across Treatment Groups and Impact on Censoring Weight Model Specification: The Example of Anticoagulation in Atrial Fibrillation. Am J Epidemiol 2021; 190:2671-2679. [PMID: 34165152 DOI: 10.1093/aje/kwab186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/14/2023] Open
Abstract
Inverse probability of censoring weights (IPCWs) may reduce selection bias due to informative censoring in longitudinal studies. However, in studies with an active comparator, the associations between predictors and censoring may differ across treatment groups. We used the clinical example of anticoagulation treatment with warfarin or a direct oral anticoagulant (DOAC) in atrial fibrillation to illustrate this. The cohort of individuals initiating an oral anticoagulant during 2010-2016 was identified from the Régie de l'assurance maladie du Québec (RAMQ) databases. The parameter of interest was the hazard ratio (HR) of the composite of stroke, major bleeding, myocardial infarction, or death associated with continuous use of warfarin versus DOACs. Two strategies for the specification of the model for estimation of censoring weights were explored: exposure-unstratified and exposure-stratified. The HR associated with continuous treatment with warfarin versus DOACs adjusted with exposure-stratified IPCWs was 1.26 (95% confidence interval: 1.20, 1.33). Using exposure-unstratified IPCWs, the HR differed by 15% in favor of DOACs (1.41, 95% confidence interval: 1.34, 1.48). Not accounting for the different associations between the predictors and informative censoring across exposure groups may lead to misspecification of censoring weights and biased estimate on comparative effectiveness and safety.
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Trudel X, Tiwa Diffo E, Gilbert-Ouimet M, Mésidor M, Talbot D, Milot A, Brisson C. Low Social Support at Work and Ambulatory Blood Pressure in a Repeated Cross-sectional Study of White-Collar Workers. Ann Work Expo Health 2021; 66:348-355. [PMID: 34761261 DOI: 10.1093/annweh/wxab096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Previous studies on the effect of low social support at work on blood pressure showed mixed results. Few previous studies have used ambulatory blood pressure and examined whether the effect of low social support at work vary among men and women. The aim of this study was to examine the association between low social support at work, ambulatory blood pressure means and hypertension prevalence, in a sample of white-collar workers men and women. METHODS A repeated cross-sectional design was used. Data were collected three times during a 5-year period, among 3919 white-collar women and men. At each time, coworker and supervisor social support at work were measured using validated scales. Ambulatory blood pressure was measured every 15 min during a working day. General estimating equations were used. RESULTS In adjusted models, women exposed to low coworker (+0.6 mmHg) and low supervisor social support at work (+0.7 mmHg) had slightly higher diastolic blood pressure means when compared to unexposed women. In men, those with low coworker social support at work had higher diastolic (+0.7 mmHg) blood pressure while those with low supervisor social support had a higher prevalence of hypertension (prevalence ratio = 1.14, 95% CI: 1.04-1.24). CONCLUSIONS Men with low supervisor social support at work had a higher prevalence of hypertension. Low social support at work was associated with modest increases in diastolic blood pressure among men and women. Workplace prevention strategies aiming to increase social support at work could lead to beneficial effects on worker's cardiovascular health.
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Affiliation(s)
- Xavier Trudel
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University, 2400 Av. D'Estimauville, Québec, QC G1E 6W2, Canada.,Department of Social & Preventive Medicine, Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada
| | - Edwige Tiwa Diffo
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University, 2400 Av. D'Estimauville, Québec, QC G1E 6W2, Canada.,Department of Social & Preventive Medicine, Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada
| | - Mahée Gilbert-Ouimet
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University, 2400 Av. D'Estimauville, Québec, QC G1E 6W2, Canada.,Department of Health Science, Université du Québec à Rimouski, 1595 Bd Alphonse-Desjardins, Lévis, QC G6V 0A6, Canada
| | - Miceline Mésidor
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University, 2400 Av. D'Estimauville, Québec, QC G1E 6W2, Canada.,Department of Social & Preventive Medicine, Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada
| | - Denis Talbot
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University, 2400 Av. D'Estimauville, Québec, QC G1E 6W2, Canada.,Department of Social & Preventive Medicine, Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada
| | - Alain Milot
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University, 2400 Av. D'Estimauville, Québec, QC G1E 6W2, Canada.,Department of medicine, Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada
| | - Chantal Brisson
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University, 2400 Av. D'Estimauville, Québec, QC G1E 6W2, Canada.,Department of Social & Preventive Medicine, Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada
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40
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Supper W, Guay F, Talbot D. The Relation Between Television Viewing Time and Reading Achievement in Elementary School Children: A Test of Substitution and Inhibition Hypotheses. Front Psychol 2021; 12:580763. [PMID: 34733194 PMCID: PMC8558249 DOI: 10.3389/fpsyg.2021.580763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Research has focused on the relations between television (TV) viewing time and children’s reading achievement. Two hypotheses have been proposed to explain this relation. The substitution hypothesis proposes that TV viewing distracts students from activities that are important for their learning. The inhibition hypothesis proposes that watching television inhibits important affective/cognitive skills. In this study, we test both hypotheses by estimating the relation between TV viewing time and reading achievement. We use the frequency of students’ leisure reading and the frequency of interactions between students and their parents as potential mediators to test the substitution hypothesis, whereas for the inhibition one, we use students’ intrinsic motivation to read and their level of inattention. Data come from the Québec Longitudinal Study of Child Development (QLSCD). Designed by the Institut de la statistique du Québec, QLSCD covers a wide range of themes. The QLSCD is representative of children in Québec and contains 2223 participants who were followed from 0 to 21 years old. The four structural models tested are built as follows: the TV viewing time at 6 years old predicts the four mediating variables at 8 years old, which in turn predicts reading achievement at 10 years old. In addition, we have tested models’ gender invariance. Results indicate that TV viewing time is not directly or indirectly associated with reading achievement. Specifically, it is not associated with the mediating variables of child-parent interactions, intrinsic motivation, and inattention. However, the frequency of leisure reading is negatively associated with the time spent watching TV. This association is very small (−0.07) and has no indirect effect on reading achievement. Finally, results do not vary according to the gender of the participants. Our results are in line with those of previous studies in the field and cast some doubts on the potential negative effects of TV viewing time on reading achievement.
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Affiliation(s)
- Wilfried Supper
- Département des fondements et pratiques en éducation, Faculté des sciences de l'éducation, Université Laval, Quebec, QC, Canada
| | - Frédéric Guay
- Département des fondements et pratiques en éducation, Faculté des sciences de l'éducation, Université Laval, Quebec, QC, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec, QC, Canada
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Duchaine CS, Brisson C, Talbot D, Gilbert-Ouimet M, Trudel X, Vézina M, Milot A, Diorio C, Ndjaboué R, Giguère Y, Mâsse B, Dionne CE, Maunsell E, Laurin D. Psychosocial stressors at work and inflammatory biomarkers: PROspective Quebec Study on Work and Health. Psychoneuroendocrinology 2021; 133:105400. [PMID: 34488150 DOI: 10.1016/j.psyneuen.2021.105400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic low-grade inflammation has been associated with high risk of several chronic diseases such as cardiovascular diseases, diabetes, depression, and dementia. As low-grade inflammation could be present long before the apparition of the disease, identifying modifiable risk factors could allow to act upstream. Psychosocial stressors at work have been suggested as modifiable risk factors of low-grade inflammation, but few longitudinal studies have evaluated the association between these stressors and inflammatory biomarkers, such as C-reactive protein (CRP) and interleukin-6 (IL-6). OBJECTIVE This longitudinal study evaluate the associations between exposure to psychosocial stressors at work and CRP and IL-6, separately and combined into an inflammatory index. METHODS Data came from a cohort of 9188 white-collar workers recruited in 1991-1993 (T1) and followed-up after 8 (T2, 1999-2000) and 24 (T3, 2015-2018) years. Participants included in this study were randomly selected at T3 for serum biomarkers studies (n = 2557). CRP and IL-6 were measured using standardized protocols. Psychosocial stressors at work were assessed at T2 according to recognized models: Karasek's Demand-Control-Support model and Siegrist's Effort-Reward Imbalance (ERI) model, using validated questionnaires. High job strain was defined by an exposure to high psychological demand combined with low job control, and iso-strain was defined by an exposure to high job strain combined with low social support at work. ERI was defined by an imbalance between psychological demand and social, economic, and organizational reward. Several covariates were considered including sociodemographic, anthropometric, and lifestyle characteristics, and comorbidities. Prevalence ratios (PRs) and 95% confidence interval (CI) for the highest quartile of CRP, IL-6 and inflammatory index at T3 according to psychosocial stressors at work measured at T2 were calculated using generalized estimating equations. Multiple imputation and inverse probability of censoring weighting were done. RESULTS In men, an association was observed between exposure to iso-strain and the inflammatory index (PR of 1.42 (95% CI: 1.06;1.90)), mainly among men aged less than 65 years (PR of 2.00 (95% CI: 1.37;2.92)). In this same age group, associations with inflammatory biomarkers were also observed among men with exposure to ERI, and among women with exposure to low reward at work or moderate social support at work. CONCLUSION These results suggest that psychosocial stressors at work may increase low-grade inflammation. However, further studies are needed to corroborate these results and to clarify the potential differences between men and women. As these stressors are frequent and modifiable, their reduction is important for public health and could play a role in the primary prevention of chronic diseases.
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Affiliation(s)
- Caroline S Duchaine
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada; Institut sur le vieillissement et la participation sociale des aînés, Université Laval, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | - Chantal Brisson
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada.
| | - Denis Talbot
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Mahée Gilbert-Ouimet
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Department of Health Sciences, Université du Québec à Rimouski, 1595 boulevard Alphonse-Desjardins, Lévis, QC G6V 0A6, Canada.
| | - Xavier Trudel
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada.
| | - Michel Vézina
- Institut national de santé publique du Québec (INSPQ), 945 avenue Wolfe, Quebec City, QC G1V 5B3, Canada.
| | - Alain Milot
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Caroline Diorio
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Ruth Ndjaboué
- Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada.
| | - Yves Giguère
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Benoît Mâsse
- School of public health, University of Montreal, 7101 avenue du Parc, Montreal, QC H3N 1×9, Canada.
| | - Clermont E Dionne
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada; Institut sur le vieillissement et la participation sociale des aînés, Université Laval, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | - Elizabeth Maunsell
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Danielle Laurin
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada; Institut sur le vieillissement et la participation sociale des aînés, Université Laval, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Pharmacy, Laval University, 1050 ave de la Médecine, Quebec City, QC, G1V 0A6, Canada.
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Pena-Gralle APB, Talbot D, Trudel X, Aubé K, Lesage A, Lauzier S, Milot A, Brisson C. Validation of case definitions of depression derived from administrative data against the CIDI-SF as reference standard: results from the PROspective Québec (PROQ) study. BMC Psychiatry 2021; 21:491. [PMID: 34620134 PMCID: PMC8496029 DOI: 10.1186/s12888-021-03501-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Administrative data have several advantages over questionnaire and interview data to identify cases of depression: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential classification errors. However, the validity of administrative data in the correct identification of depression has not yet been studied in general populations. The present study aimed to 1) evaluate the sensitivity and specificity of administrative cases of depression using the validated Composite International Diagnostic Interview - Short Form (CIDI-SF) as reference standard and 2) compare the known-groups validity between administrative and CIDI-SF cases of depression. METHODS The 5487 participants seen at the last wave (2015-2018) of the PROQ cohort had CIDI-SF questionnaire data linked to hospitalization and medical reimbursement data provided by the provincial universal healthcare provider and coded using the International Classification of Disease. We analyzed the sensitivity and specificity of several case definitions of depression from this administrative data. Their association with known predictors of depression was estimated using robust Poisson regression models. RESULTS Administrative cases of depression showed high specificity (≥ 96%), low sensitivity (19-32%), and rather low agreement (Cohen's kappa of 0.21-0.25) compared with the CIDI-SF. These results were consistent over strata of sex, age and education level and with varying case definitions. In known-groups analysis, the administrative cases of depression were comparable to that of CIDI-SF cases (RR for sex: 1.80 vs 2.03 respectively, age: 1.53 vs 1.40, education: 1.52 vs 1.28, psychological distress: 2.21 vs 2.65). CONCLUSION The results obtained in this large sample of a general population suggest that the dimensions of depression captured by administrative data and by the CIDI-SF are partially distinct. However, their known-groups validity in relation to risk factors for depression was similar to that of CIDI-SF cases. We suggest that neither of these data sources is superior to the other in the context of large epidemiological studies aiming to identify and quantify risk factors for depression.
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Affiliation(s)
- Ana Paula Bruno Pena-Gralle
- CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC, Canada. .,Faculty of Medicine, Laval University, Québec, QC, Canada.
| | - Denis Talbot
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada
| | - Xavier Trudel
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada
| | - Karine Aubé
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada
| | - Alain Lesage
- grid.14848.310000 0001 2292 3357Département de Psychiatrie et d’addictologie, Université de Montréal, Montréal, Canada
| | - Sophie Lauzier
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Pharmacy, Laval University, Québec, QC Canada
| | - Alain Milot
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada
| | - Chantal Brisson
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, QC Canada
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Pena-Gralle APB, Talbot D, Duchaine CS, Lavigne-Robichaud M, Trudel X, Aubé K, Gralle M, Gilbert-Ouimet M, Milot A, Brisson C. Job strain and effort-reward imbalance as risk factors for type 2 diabetes mellitus: A systematic review and meta-analysis of prospective studies. Scand J Work Environ Health 2021; 48:5-20. [PMID: 34582561 PMCID: PMC8729162 DOI: 10.5271/sjweh.3987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives This systematic review and meta-analysis aimed to synthesize the available data on prospective associations between work-related stressors and the risk of type 2 diabetes mellitus (T2DM) among adult workers, according to the demand–control–support (DCS) and the effort–reward imbalance (ERI) models. Method We searched for prospective studies in PubMed, EMBASE, Web of Science, Scopus, CINHAL and PsychInfo. After screening and extraction, quality of evidence was assessed using the ROBINS-I tool adapted for observational studies. The effect estimates extracted for each cohort were synthesized using random effect models. Results We included 18 studies (reporting data on 25 cohorts) in meta-analyses for job strain, job demands, job control, social support at work and ERI. Workers exposed to job strain had a higher risk of developing T2DM when compared to unexposed workers [pooled rate ratio (RR) 1.16, 95% confidence interval (CI) 1.07–1.26]. This association was robust in several supplementary analyses. For exposed women relative to unexposed women, the RR was 1.35 (95% CI 1.12–1.64). The RR of workers exposed to ERI was 1.24 (95% CI 1.08–1.42) compared to unexposed workers. Conclusions This is the first meta-analysis to find an effect of ERI on the onset of T2DM incidence. It also confirms that job strain increases the incidence of T2DM, especially among women.
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Affiliation(s)
- Ana Paula B Pena-Gralle
- CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrément Hospital, 1050, Chemin Ste-Foy, Québec, QC, Canada G1S 4L8.
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Queiros Campos J, Checa-Fernandez BL, Marins JA, Lomenech C, Hurel C, Godeau G, Raboisson-Michel M, Verger-Dubois G, Bee A, Talbot D, Kuzhir P. Adsorption of Organic Dyes on Magnetic Iron Oxide Nanoparticles. Part II: Field-Induced Nanoparticle Agglomeration and Magnetic Separation. Langmuir 2021; 37:10612-10623. [PMID: 34436906 DOI: 10.1021/acs.langmuir.1c02021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This paper (part II) is devoted to the effect of molecular adsorption on the surface of magnetic iron oxide nanoparticles (IONP) on the enhancement of their (secondary) field-induced agglomeration and magnetic separation. Experimentally, we use Methylene Blue (MB) cationic dye adsorption on citrate-coated maghemite nanoparticles to provoke primary agglomeration of IONP in the absence of the field. The secondary agglomeration is manifested through the appearance of needlelike micron-sized agglomerates in the presence of an applied magnetic field. With the increasing amount of adsorbed MB molecules, the size of the field-induced agglomerates increases and the magnetic separation on a magnetized micropillar becomes more efficient. These effects are mainly governed by the ratio of magnetic-to-thermal energy α, suspension supersaturation Δ0, and Brownian diffusivity Deff of primary agglomerates. The three parameters (α, Δ0, and Deff) are implicitly related to the surface coverage θ of IONP by MB molecules through the hydrodynamic size of primary agglomerates exponentially increasing with θ. Experiments and developed theoretical models allow quantitative evaluation of the θ effect on the efficiency of the secondary agglomeration and magnetic separation.
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Affiliation(s)
- J Queiros Campos
- Université Côte d'Azur, CNRS UMR 7010 Institute of Physics of Nice (INPHYNI), Parc Valrose, 06108 Nice, France
| | - B L Checa-Fernandez
- Department of Applied Physics, University of Granada, Avenida de la Fuente Nueva, 18071 Granada, Spain
- CEIT-Basque Research and Technology Alliance (BRTA) and Tecnun, University of Navarra, 20018 Donostia/San Sebastián, Spain
| | - J A Marins
- Université Côte d'Azur, CNRS UMR 7010 Institute of Physics of Nice (INPHYNI), Parc Valrose, 06108 Nice, France
| | - C Lomenech
- Université Côte d'Azur, CNRS UMR 7010 Institute of Physics of Nice (INPHYNI), Parc Valrose, 06108 Nice, France
| | - Ch Hurel
- Université Côte d'Azur, CNRS UMR 7010 Institute of Physics of Nice (INPHYNI), Parc Valrose, 06108 Nice, France
| | - G Godeau
- Université Côte d'Azur, CNRS UMR 7010 Institute of Physics of Nice (INPHYNI), Parc Valrose, 06108 Nice, France
| | - M Raboisson-Michel
- Université Côte d'Azur, CNRS UMR 7010 Institute of Physics of Nice (INPHYNI), Parc Valrose, 06108 Nice, France
- Axlepios Biomedical, 1ere Avenue 5eme rue, 06510 Carros, France
| | - G Verger-Dubois
- Axlepios Biomedical, 1ere Avenue 5eme rue, 06510 Carros, France
| | - A Bee
- Sorbonne Université, CNRS, UMR 8234, PHENIX, 4 place Jussieu, 75252 Paris Cedex 5, France
| | - D Talbot
- Sorbonne Université, CNRS, UMR 8234, PHENIX, 4 place Jussieu, 75252 Paris Cedex 5, France
| | - P Kuzhir
- Université Côte d'Azur, CNRS UMR 7010 Institute of Physics of Nice (INPHYNI), Parc Valrose, 06108 Nice, France
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Abstract
BACKGROUND The change in estimate is a popular approach for selecting confounders in epidemiology. It is recommended in epidemiologic textbooks and articles over significance test of coefficients, but concerns have been raised concerning its validity. Few simulation studies have been conducted to investigate its performance. METHODS An extensive simulation study was realized to compare different implementations of the change in estimate method. The implementations were also compared when estimating the association of body mass index with diastolic blood pressure in the PROspective Québec Study on Work and Health. RESULTS All methods were susceptible to introduce important bias and to produce confidence intervals that included the true effect much less often than expected in at least some scenarios. Overall mixed results were obtained regarding the accuracy of estimators, as measured by the mean squared error. No implementation adequately differentiated confounders from non-confounders. In the real data analysis, none of the implementation decreased the estimated standard error. CONCLUSION Based on these results, it is questionable whether change in estimate methods are beneficial in general, considering their low ability to improve the precision of estimates without introducing bias and inability to yield valid confidence intervals or to identify true confounders.
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Affiliation(s)
- Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Unité santé des populations et pratiques optimales en santé, CHU de Québec – Université Laval research center, Québec, Canada
| | - Awa Diop
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Unité santé des populations et pratiques optimales en santé, CHU de Québec – Université Laval research center, Québec, Canada
- Département de mathématiques et de statistique, Université Laval, Université Laval, Québec, Canada
| | - Mathilde Lavigne-Robichaud
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Unité santé des populations et pratiques optimales en santé, CHU de Québec – Université Laval research center, Québec, Canada
| | - Chantal Brisson
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Unité santé des populations et pratiques optimales en santé, CHU de Québec – Université Laval research center, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
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Sirois C, Khoury R, Durand A, Deziel PL, Bukhtiyarova O, Chiu Y, Talbot D, Bureau A, Després P, Gagné C, Laviolette F, Savard AM, Corbeil J, Badard T, Jean S, Simard M. Exploring polypharmacy with artificial intelligence: data analysis protocol. BMC Med Inform Decis Mak 2021; 21:219. [PMID: 34284765 PMCID: PMC8290537 DOI: 10.1186/s12911-021-01583-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polypharmacy is common among older adults and it represents a public health concern, due to the negative health impacts potentially associated with the use of several medications. However, the large number of medication combinations and sequences of use makes it complicated for traditional statistical methods to predict which therapy is genuinely associated with health outcomes. The project aims to use artificial intelligence (AI) to determine the quality of polypharmacy among older adults with chronic diseases in the province of Québec, Canada. METHODS We will use data from the Quebec Integrated Chronic Disease Surveillance System (QICDSS). QICDSS contains information about prescribed medications in older adults in Quebec collected over 20 years. It also includes diagnostic codes and procedures, and sociodemographic data linked through a unique identification number for each individual. Our research will be structured around three interconnected research axes: AI, Health, and Law&Ethics. The AI research axis will develop algorithms for finding frequent patterns of medication use that correlate with health events, considering data locality and temporality (explainable AI or XAI). The Health research axis will translate these patterns into polypharmacy indicators relevant to public health surveillance and clinicians. The Law&Ethics axis will assess the social acceptability of the algorithms developed using AI tools and the indicators developed by the Heath axis and will ensure that the developed indicators neither discriminate against any population group nor increase the disparities already present in the use of medications. DISCUSSION The multi-disciplinary research team consists of specialists in AI, health data, statistics, pharmacy, public health, law, and ethics, which will allow investigation of polypharmacy from different points of view and will contribute to a deeper understanding of the clinical, social, and ethical issues surrounding polypharmacy and its surveillance, as well as the use of AI for health record data. The project results will be disseminated to the scientific community, healthcare professionals, and public health decision-makers in peer-reviewed publications, scientific meetings, and reports. The diffusion of the results will ensure the confidentiality of individual data.
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Affiliation(s)
- Caroline Sirois
- Faculty of Pharmacy, Université Laval, Quebec, QC, Canada. .,Quebec National Institute of Public Health, Quebec, QC, Canada. .,Centre d'excellence sur le vieillissement de Québec, Hôpital St-Sacrement, Local L2-28, 1050, chemin Ste-Foy, Quebec, QC, G1S 4L8, Canada.
| | - Richard Khoury
- Faculty of Science and Engineering, Department of Computer Science and Software Engineering, Université Laval, Quebec, QC, Canada
| | - Audrey Durand
- Faculty of Science and Engineering, Department of Computer Science and Software Engineering, Université Laval, Quebec, QC, Canada
| | | | | | - Yohann Chiu
- Faculty of Pharmacy, Université Laval, Quebec, QC, Canada
| | - Denis Talbot
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Alexandre Bureau
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Philippe Després
- Faculty of Science and Engineering, Department of Physics, Physical Engineering and Optics, Université Laval, Quebec, QC, Canada
| | - Christian Gagné
- Faculty of Science and Engineering, Department of Electrical and Computer Engineering, Université Laval, Quebec, QC, Canada
| | - François Laviolette
- Faculty of Science and Engineering, Department of Electrical and Computer Engineering, Université Laval, Quebec, QC, Canada
| | | | - Jacques Corbeil
- Faculty of Medicine, Department of Molecular Medicine, Université Laval, Quebec, QC, Canada
| | - Thierry Badard
- Faculty of Forestry, Geography and Geomatics, Department of Geomatic Science, Université Laval, Quebec, QC, Canada
| | - Sonia Jean
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Marc Simard
- Quebec National Institute of Public Health, Quebec, QC, Canada
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Ducrocq J, Ndao M, Yansouni CP, Proulx JF, Mondor M, Hamel D, Lévesque B, De Serres G, Talbot D. Epidemiology associated with the exposure to Toxoplasma gondii in Nunavik's Inuit population using the 2017 Qanuilirpitaa cross-sectional health survey. Zoonoses Public Health 2021; 68:803-814. [PMID: 34254450 DOI: 10.1111/zph.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/03/2021] [Indexed: 02/01/2023]
Abstract
Foci of high seroprevalence against Toxoplasma gondii are observed in Nunavik, the Inuit land of Northern Quebec (Canada). Considering the rare occurrence of felids in the region, exposure is suspected to be driven by water- and food-borne transmission routes. Hypotheses were that drinking untreated water from natural sources and eating country food mostly raw increased the risk of exposure to the parasite. Data from 1,300 Inuit participants of the 2017 Nunavik Health Survey were included in three weighted robust Poisson regression models. The effect of three types of exposure variables: (1) water treatment (yes/no) and if country food was mostly eaten raw (yes/no); (2) main source of drinking water (bottled/municipal/natural) and frequency of country food consumption (continuous) and (3) drinking water risk (low/intermediate/high) and frequency of a raw country food consumption (continuous), on the presence of Toxoplasma antibodies were estimated. Models were adjusted for age, sex and ecological region, with multiple sensitivity analyses being performed. Toxoplasma gondii seroprevalences were consistently correlated with age quadratically, sex (prevalence ratio = PRwoman/man ranged from 1.18 to 1.22), ecological region (PRHudsonBay/HudsonStrait ranged from 2.18 to 2.41; PRHudsonBay/UngavaBay ranged from 1.52 to 1.59) and consuming bivalve mollusc/urchin (PR varied from 1.02 to 1.21) across all three models. Each increase of two consumptions per month of beluga (PR ranged from 1.01 to 1.03), seal liver (PR ranged from 1.01 to 1.02) and goose (PR ranged from 1.01 to 1.02) were also associated with seropositivity, albeit more clearly in models 2 and 3, while drinking water mainly from natural (PR of 1.47) or municipal (PR = 1.42) sources compared to bottled water, was correlated with seroprevalence, although results were compatible with the null. Our results suggest that both the oocyst- (mollusc/urchin, drinking water) and cyst-borne (walrus, seal liver and goose) transmission pathways could be present in Nunavik.
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Affiliation(s)
- Julie Ducrocq
- Université Laval, Québec, QC, Canada.,CHU de Québec-Université Laval Research Center, Axe santé des populations et pratiques optimales en santé, Québec, QC, Canada
| | - Momar Ndao
- National Reference Centre for Parasitology, Montréal, QC, Canada.,J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montréal, QC, Canada
| | - Cedric P Yansouni
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montréal, QC, Canada
| | | | - Myrto Mondor
- CHU de Québec-Université Laval Research Center, Axe santé des populations et pratiques optimales en santé, Québec, QC, Canada
| | - Denis Hamel
- Institut national de santé publique du Québec, Québec, QC, Canada
| | - Benoit Lévesque
- Université Laval, Québec, QC, Canada.,Institut national de santé publique du Québec, Québec, QC, Canada
| | - Gaston De Serres
- Université Laval, Québec, QC, Canada.,Institut national de santé publique du Québec, Québec, QC, Canada
| | - Denis Talbot
- Université Laval, Québec, QC, Canada.,CHU de Québec-Université Laval Research Center, Axe santé des populations et pratiques optimales en santé, Québec, QC, Canada
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Duchaine CS, Brisson C, Talbot D, Gilbert-Ouimet M, Trudel X, Vézina M, Milot A, Diorio C, Ndjaboué R, Giguère Y, Mâsse B, Dionne CE, Maunsell E, Laurin D. Cumulative exposure to psychosocial stressors at work and global cognitive function: the PROspective Quebec Study on Work and Health. Occup Environ Med 2021; 78:884-892. [PMID: 34230195 DOI: 10.1136/oemed-2021-107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Psychosocial stressors at work have been proposed as modifiable risk factors for mild cognitive impairment (MCI). This study aimed to evaluate the effect of cumulative exposure to psychosocial stressors at work on cognitive function. METHODS This study was conducted among 9188 white-collar workers recruited in 1991-1993 (T1), with follow-ups 8 (T2) and 24 years later (T3). After excluding death, losses to follow-up and retirees at T2, 5728 participants were included. Psychosocial stressors at work were measured according to the Karasek's questionnaire. Global cognitive function was measured with the Montreal Cognitive Assessment. Cumulative exposures to low psychological demand, low job control, passive job and high strain job were evaluated using marginal structural models including multiple imputation and inverse probability of censoring weighting. RESULTS In men, cumulative exposures (T1 and T2) to low psychological demand, low job control or passive job were associated with higher prevalences of more severe presentation of MCI (MSMCI) at T3 (Prevalence ratios (PRs) and 95% CIs of 1.50 (1.16 to 1.94); 1.38 (1.07 to 1.79) and 1.55 (1.20 to 2.00), respectively), but not with milder presentation of MCI. In women, only exposure to low psychological demand or passive job at T2 was associated with higher prevalences of MSMCI at T3 (PRs and 95% CI of 1.39 (0.97 to 1.99) and 1.29 (0.94 to 1.76), respectively). CONCLUSIONS These results support the deleterious effect of a low stimulating job on cognitive function and the cognitive reserve theory. Psychosocial stressors at work could be part of the effort for the primary prevention of cognitive decline.
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Affiliation(s)
- Caroline S Duchaine
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada.,Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Québec, Canada
| | - Chantal Brisson
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada.,Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Québec, Canada
| | - Denis Talbot
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada
| | - Mahée Gilbert-Ouimet
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Health Sciences, Université du Québec à Rimouski Campus de Lévis, Lévis, Québec, Canada
| | - Xavier Trudel
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada
| | - Michel Vézina
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Alain Milot
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Medicine, Laval University, Faculty of medicine, Québec, Québec, Canada
| | - Caroline Diorio
- Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Oncology, CHU de Québec-Université Laval Research Center, Québec, Québec, Canada
| | - Ruth Ndjaboué
- Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada
| | - Yves Giguère
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Medicine, Laval University, Faculty of medicine, Québec, Québec, Canada
| | - Benoît Mâsse
- Médecine sociale et préventive, Université de Montréal, Montréal, Québec, Canada
| | - Clermont E Dionne
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada.,Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Québec, Canada
| | - Elizabeth Maunsell
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada
| | - Danielle Laurin
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada .,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada.,Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Québec, Canada.,Pharmacy, Laval University, Faculty of Pharmacy, Quebec, Quebec, Canada
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Trudel X, Brisson C, Talbot D, Gilbert-Ouimet M, Milot A. Reply: Job Strain and Recurrent Coronary Events. J Am Coll Cardiol 2021; 78:419. [PMID: 34294279 DOI: 10.1016/j.jacc.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
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50
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Supper W, Talbot D, Guay F. Association entre le temps d’écoute de la télévision et le rendement scolaire des enfants et des adolescents : Recension systématique et méta-analyse des études longitudinales réalisées à ce jour. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement 2021. [DOI: 10.1037/cbs0000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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