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Allard R, Leclerc P, Bergeron G, Cadieux G. Breakthrough cases of mpox: One-dose vaccination is associated with milder clinical manifestations. J Infect Public Health 2024; 17:676-680. [PMID: 38461797 DOI: 10.1016/j.jiph.2024.02.015] [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: 11/10/2023] [Revised: 01/15/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Very few studies have investigated the effectiveness of vaccination in decreasing the severity of breakthrough mpox. Our goal was to estimate the strength of the associations between recent mpox vaccination with MVA-BN and various clinical manifestations of the disease. METHODS Telephone interviews using standardized questionnaires, upon notification and 28 days later, of the 403 persons with mpox reported to Montreal Public Health in 2022. MVA-BN vaccination data were obtained from the provincial immunization registry. The main outcomes were numbers of skin lesions and body sites affected, other clinical manifestations (OCM) compatible with mpox, complications, and hospitalization. FINDINGS 155 persons with mpox (39% of 403) had received 1 dose of vaccine at least 14 days before symptom onset. One-dose vaccination, adjusting for age and HIV status, was significantly associated with fewer lesions, sites affected with lesions, and OCMs. HIV-positive persons with breakthrough mpox reported significantly more lesions, sites affected, and OCMs at initial interview, than HIV-negative ones. However, vaccination was associated with a lower risk of all outcomes to the same degree irrespective of HIV status. INTERPRETATION One dose of MVA-BN vaccine was about 60% effective in decreasing the frequency and extent of clinical manifestations, among both HIV-positive and HIV-negative persons with breakthrough mpox. Beyond preventing infection, mpox vaccination can be promoted to reduce clinical manifestations in persons at risk for mpox, even if HIV+ . FUNDING This work used data obtained as part of Montreal Public Health's 2022 mpox outbreak response and received no external funding.
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Affiliation(s)
- Robert Allard
- Montreal Public Health, Montréal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
| | | | | | - Geneviève Cadieux
- Montreal Public Health, Montréal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Périnet S, Cadieux G, Mercure SA, Drouin M, Allard R. Analysis of COVID-19 Risk Following a Ring Vaccination Intervention to Address SARS-CoV-2 Alpha Variant Transmission in Montreal, Canada. JAMA Netw Open 2022; 5:e2147042. [PMID: 35147688 PMCID: PMC8837915 DOI: 10.1001/jamanetworkopen.2021.47042] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Given limited COVID-19 vaccine availability early in the pandemic, optimizing immunization strategies was of paramount importance. Ring vaccination has been used successfully to control transmission of other airborne respiratory viruses. OBJECTIVE To assess the association of a ring vaccination intervention on COVID-19 spread in the initial epicenter of SARS-CoV-2 Alpha variant transmission in Montreal, Canada. DESIGN, SETTING, AND PARTICIPANTS This cohort study compared COVID-19 daily disease risk in 3 population-based groups of neighborhoods in Montreal, Canada, defined by their intervention-specific vaccine coverage at the neighborhood level: the primary intervention group (500 or more vaccinated persons per 10 000 persons), secondary intervention group (95 to 499), and control group (0 to 50). The groups were compared within each of 3 time periods: before intervention (December 1, 2020, to March 16, 2021), during and immediately after intervention (March 17 to April 17, 2021), and 3 weeks after the intervention midpoint (April 18 to July 18, 2021). Data were analyzed between June 2021 and November 2021. EXPOSURES Vaccination targeted parents and teachers of children attending the 32 schools and 48 childcare centers in 2 adjacent neighborhoods with highest local transmission (case counts) of Alpha variant shortly after its introduction. Participants were invited to receive 1 dose of mRNA vaccine between March 22 and April 9, 2021 (before vaccine was available to these age groups). MAIN OUTCOMES AND MEASURES COVID-19 risk in 3 groups of neighborhoods based on intervention-specific vaccine coverage. RESULTS A total of 11 794 residents were immunized, with a mean (SD) age of 43 (8) years (range, 16-93 years); 5766 participants (48.9%) lived in a targeted neighborhood, and 9784 (83.0%) were parents. COVID-19 risk in the primary intervention group was significantly higher than in the control group before (unadjusted risk ratio [RR], 1.58; 95% CI 1.52-1.65) and during (RR, 1.63; 95% CI, 1.52-1.76) intervention, and reached a level similar to the other groups in the weeks following the intervention (RR, 1.03; 95% CI, 0.94-1.12). A similar trend was observed when restricting to SARS-CoV-2 variants and persons aged 30 to 59 years (before: RR, 1.72; 95% CI, 1.63-1.83 vs after: RR, 1.01; 95% CI, 0.88-1.17). CONCLUSIONS AND RELEVANCE Our findings show that ring vaccination was associated with a reduction in COVID-19 risk in areas with high local transmission of Alpha variant shortly after its introduction. Ring vaccination may be considered as an adjunct to mass immunization to control transmission in specific areas, based on local epidemiology.
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Affiliation(s)
- Simone Périnet
- Direction régionale de santé publique de Montréal, Montreal, Quebec, Canada
- Canadian Field Epidemiology Program, Public Health Agency of Canada, Canada
| | - Geneviève Cadieux
- Direction régionale de santé publique de Montréal, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Mylène Drouin
- Direction régionale de santé publique de Montréal, Montreal, Quebec, Canada
- École de santé publique, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Allard
- Direction régionale de santé publique de Montréal, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Gómez–Hoyos DA, Seisdedos–de–Vergara R, Schipper J, Allard R, González–Maya JF. Potential effect of habitat disturbance on reproduction of the critically endangered harlequin frog Atelopus varius in Las Tablas, Costa Rica. Anim Biodiv Conserv 2020. [DOI: 10.32800/abc.2020.43.0001] [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: 11/08/2022]
Abstract
We studied a population of Atelopus varius in Las Tablas Protected Zone in southwest Costa Rica, where we estimated occupancy rates of tadpoles along the Cotón River. In addition, we report the first tadpoles observed in the wild in 20 years. Tadpole rate of occupancy was greater in habitat containing native forest than in disturbed areas bordering cattle pasture. This same pattern was also reflected in adult hotspots, where encounter rates were higher for adults in habitat surrounded by forest versus pasture. We present evidence for the potential effect of habitat modification on the presence and reproduction of A. varius and suspect that over time this modification impacts the species’ demography. However, further study is necessary before we can confirm that habitat change alone was the key factor involved in patterns of decline for the species.
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Affiliation(s)
| | | | - J. Schipper
- Arizona Center for Nature Conservation / Phoenix Zoo
| | - R. Allard
- Arizona Center for Nature Conservation / Phoenix Zoo
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Greenaway C, Azoulay L, Allard R, Cox J, Tran VA, Abou Chakra CN, Steele R, Klein M. A population-based study of chronic hepatitis C in immigrants and non-immigrants in Quebec, Canada. BMC Infect Dis 2017; 17:140. [PMID: 28193199 PMCID: PMC5307836 DOI: 10.1186/s12879-017-2242-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/02/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Immigrants originating from intermediate and high HCV prevalence countries may be at increased risk of exposure to hepatitis C infection (HCV) in their countries of origin, however they are not routinely screened after arrival in most low HCV prevalence host countries. We aimed to describe the epidemiology of HCV in immigrants compared to the Canadian born population. METHODS Using the reportable infectious disease database linked to the landed immigration database and several provincial administrative databases, we assembled a cohort of all reported cases of HCV in Quebec, Canada (1998-2008). Underlying co-morbidities were identified in the health services databases. Stratum specific rates of reported cases/100,000, rate ratios (RRs) and trends over the study period were estimated. RESULTS A total of 20,862 patients with HCV were identified, among whom 1922 (9.2%) were immigrants. Immigrants were older and diagnosed a mean of 9.8 ± 7 years after arrival. The Canadian born population was more likely to have behavior co-morbidities (problematic alcohol or drug use) and HIV co-infection. Immigrants from Sub-Saharan Africa, Asia and Eastern Europe had the highest HCV reported rates with RRs compared to non-immigrants ranging from 1.5 to 1.7. The age and sex adjusted rates decreased by 4.9% per year in non-immigrants but remained unchanged in immigrants. The proportion of HCV occurring in immigrants doubled over the study period from 5 to 11%. CONCLUSIONS Immigrants from intermediate and high HCV prevalence countries are at increased risk for HCV and had a mean delay in diagnosis of almost 10 years after arrival suggesting that they may benefit from targeted HCV screening and earlier linkage to care.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, 3755 Côte St. Catherine Road, Room E-0057, Montreal, PQ H3T 1E2 Canada
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Laurent Azoulay
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Oncology, McGill University, Montreal, Canada
| | - Robert Allard
- Department of Oncology, McGill University, Montreal, Canada
- Montreal Public Health Department, Montreal, Canada
| | - Joseph Cox
- Sexually Transmitted Infections Division, Montreal Public Health Department, Montreal, Canada
| | - Viet Anh Tran
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Claire Nour Abou Chakra
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Russ Steele
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Mathematics and Statistics, McGill University, Montreal, Canada
| | - Marina Klein
- Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Canada
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Hoffer D, Smith SM, Parlow J, Allard R, Gilron I. Adverse event assessment and reporting in trials of newer treatments for post-operative pain. Acta Anaesthesiol Scand 2016; 60:842-51. [PMID: 26991481 DOI: 10.1111/aas.12721] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/09/2016] [Accepted: 02/16/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Assessment and reporting of adverse events (AEs) in studies of perioperative interventions is critical given the potential for unintended and preventable iatrogenic morbidity and mortality. This focused review evaluated the quality of AE assessment and reporting in acute post-operative pain treatment trials. Since older analgesics (e.g., opioids, NSAIDs) already have a well-characterized safety profile, we concentrated on trials of pregabalin and gabapentin as a representative sample of studies where the perioperative safety profile was relatively unknown. METHODS We reviewed primary reports of trials of pregabalin and gabapentin for treatment of acute post-operative pain for: (1) adherence to the 10 recommendations from the 'CONSORT Extension for Harms,' (2) AE assessment method, (3) timing of AE assessment and reporting, and (4) assessment and reporting of AE severity. RESULTS We identified 31 trials of pregabalin and 59 of gabapentin. The median number of CONSORT harms recommendations that were satisfied was 7 of 10. The most common (41%) method of AE assessment was direct questioning about specific AEs by investigators. However, AE assessment method was not described in 18% of trials. AE assessments were reported for specified perioperative time points in only 24% of trials. Of greatest concern, no AE data were reported whatsoever in 8 of the included publications. CONCLUSIONS Considerable widespread improvements are needed in AE reporting for post-operative pain treatment trials. In addition to heightened awareness among clinical investigators, mandatory journal editorial policies may further facilitate improvements in safety assessment and reporting.
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Affiliation(s)
- D. Hoffer
- Anesthesiology and Perioperative Medicine; Queen's University; Kingston ON Canada
| | - S. M. Smith
- Anesthesiology; University of Rochester; Rochester NY USA
| | - J. Parlow
- Anesthesiology and Perioperative Medicine; Queen's University; Kingston ON Canada
| | - R. Allard
- Anesthesiology and Perioperative Medicine; Queen's University; Kingston ON Canada
| | - I. Gilron
- Anesthesiology and Perioperative Medicine; Queen's University; Kingston ON Canada
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Caron M, Allard R, Bédard L, Latreille J, Buckeridge DL. Enteric disease episodes and the risk of acquiring a future sexually transmitted infection: a prediction model in Montreal residents. J Am Med Inform Assoc 2016; 23:1159-1165. [PMID: 27026613 DOI: 10.1093/jamia/ocw026] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/11/2015] [Accepted: 12/12/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The sexual transmission of enteric diseases poses an important public health challenge. We aimed to build a prediction model capable of identifying individuals with a reported enteric disease who could be at risk of acquiring future sexually transmitted infections (STIs). MATERIALS AND METHODS Passive surveillance data on Montreal residents with at least 1 enteric disease report was used to construct the prediction model. Cases were defined as all subjects with at least 1 STI report following their initial enteric disease episode. A final logistic regression prediction model was chosen using forward stepwise selection. RESULTS The prediction model with the greatest validity included age, sex, residential location, number of STI episodes experienced prior to the first enteric disease episode, type of enteric disease acquired, and an interaction term between age and male sex. This model had an area under the curve of 0.77 and had acceptable calibration. DISCUSSION A coordinated public health response to the sexual transmission of enteric diseases requires that a distinction be made between cases of enteric diseases transmitted through sexual activity from those transmitted through contaminated food or water. A prediction model can aid public health officials in identifying individuals who may have a higher risk of sexually acquiring a reportable disease. Once identified, these individuals could receive specialized intervention to prevent future infection. CONCLUSION The information produced from a prediction model capable of identifying higher risk individuals can be used to guide efforts in investigating and controlling reported cases of enteric diseases and STIs.
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Affiliation(s)
- Melissa Caron
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave West, Montreal, Quebec, Canada, H3A 1A2
| | - Robert Allard
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave West, Montreal, Quebec, Canada, H3A 1A2.,Direction de santé publique, CIUSSS du Centre-Est-de-l'Île-de-Montréal, 1301 Sherbrooke St East, Montreal, Quebec, Canada, H2L 1M3
| | - Lucie Bédard
- Direction de santé publique, CIUSSS du Centre-Est-de-l'Île-de-Montréal, 1301 Sherbrooke St East, Montreal, Quebec, Canada, H2L 1M3.,École de santé publique, Université de Montréal, 7101 avenue du Parc, Montreal, Quebec, Canada, H3N 1X9
| | - Jérôme Latreille
- Direction de santé publique, CIUSSS du Centre-Est-de-l'Île-de-Montréal, 1301 Sherbrooke St East, Montreal, Quebec, Canada, H2L 1M3
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave West, Montreal, Quebec, Canada, H3A 1A2 .,Direction de santé publique, CIUSSS du Centre-Est-de-l'Île-de-Montréal, 1301 Sherbrooke St East, Montreal, Quebec, Canada, H2L 1M3
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Gray AP, Allard R, Paré R, Tannenbaum T, Lefebvre B, Lévesque S, Mulvey M, Maalouf L, Perna S, Longtin Y. Management of a hospital outbreak of extensively drug-resistant Acinetobacter baumannii using a multimodal intervention including daily chlorhexidine baths. J Hosp Infect 2016; 93:29-34. [PMID: 26876749 DOI: 10.1016/j.jhin.2015.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 10/16/2015] [Accepted: 12/11/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Extensively drug-resistant Acinetobacter baumannii (XDR-Ab) is an increasingly important cause of healthcare-associated infection. Uncertainties remain concerning optimal control measures for healthcare-associated outbreaks. AIM To describe the epidemiology and control of an XDR-Ab outbreak that involved multiple units of a large hospital from March 2012 to January 2014. METHODS Case-finding included screening of rectum, groin, throat, nose, wounds, iatrogenic portals of entry, and catheterized sites. Antimicrobial susceptibility was evaluated by disc diffusion and E-test. Resistance genes were detected by polymerase chain reaction. Clonality was assessed by pulsed-field gel electrophoresis. Charts of cases were reviewed to identify risk factors for invasive infection. Control measures included isolation and cohorting of cases, hand hygiene reinforcement, environmental decontamination, and source control with daily baths using wipes pre-impregnated with chlorhexidine gluconate. FINDINGS A single clonal strain of XDR-Ab colonized or infected 29 patients. Five patients died of XDR-Ab bacteraemia. Transmission occurred primarily on two wards. Colonization was detected at all anatomical screening sites; only 57% (16/28) of cases were rectal carriers. Advanced malignancy was a risk factor for bacteraemia (relative risk: 5.8; 95% confidence interval: 1.2-27.0). Transmission ended following implementation of the multimodal control strategy. No additional nosocomial cases occurred during the following 20 months. CONCLUSION Our study highlights the need to screen multiple anatomic sites to diagnose carriage and identifies risk factors for XDR-Ab bacteraemia. A multimodal intervention that included daily chlorhexidine baths for cases was rapidly followed by the termination of the outbreak. Hospitals should consider similar interventions when managing future XDR-Ab outbreaks.
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Affiliation(s)
- A P Gray
- Faculty of Medicine, McGill University, Montreal, Canada
| | - R Allard
- Faculty of Medicine, McGill University, Montreal, Canada; Montreal Public Health Department, Montreal, Canada
| | - R Paré
- Montreal Public Health Department, Montreal, Canada
| | - T Tannenbaum
- Faculty of Medicine, McGill University, Montreal, Canada; Montreal Public Health Department, Montreal, Canada
| | - B Lefebvre
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - S Lévesque
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - M Mulvey
- National Microbiology Laboratory, Winnipeg, Canada
| | - L Maalouf
- Infection Prevention and Control Unit, Jewish General Hospital-SMBD, Montreal, Canada
| | - S Perna
- Infection Prevention and Control Unit, Jewish General Hospital-SMBD, Montreal, Canada
| | - Y Longtin
- Faculty of Medicine, McGill University, Montreal, Canada; Infection Prevention and Control Unit, Jewish General Hospital-SMBD, Montreal, Canada.
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Poux J, Allard R, Citarda S, Galland R, Hallonet P, Guerraoui A, Caillette-Beaudoin A. Ostéopathie : une nouvelle approche non pharmacologique dans la prise en charge de la douleur en cours de séance d’hémodialyse ? Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.175] [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: 10/23/2022]
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Leslie K, McIlroy D, Kasza J, Forbes A, Kurz A, Khan J, Meyhoff CS, Allard R, Landoni G, Jara X, Lurati Buse G, Candiotti K, Lee HS, Gupta R, VanHelder T, Purayil W, De Hert S, Treschan T, Devereaux PJ. Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†. Br J Anaesth 2015. [PMID: 26209855 DOI: 10.1093/bja/aev255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS 10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxial block was defined as intraoperative spinal anaesthesia, or thoracic or lumbar epidural anaesthesia. Postoperative epidural analgesia was defined as postoperative epidural local anaesthetic and/or opioid administration. We used logistic regression with weighting using estimated propensity scores. RESULTS Neuraxial block was not associated with the primary outcome [7.5% vs 6.5%; odds ratio (OR), 0.89; 95% CI (confidence interval), 0.73-1.08; P=0.24], death (1.0% vs 1.4%; OR, 0.84; 95% CI, 0.53-1.35; P=0.48), myocardial infarction (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74-1.12; P=0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44-2.49; P=0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81-1.00; P=0.04). Postoperative epidural analgesia was not associated with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89-2.48; P=0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35-1.99; P=0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90-2.61; P=0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18-2.32; P=0.50] or clinically important hypotension (63% vs 36%; OR, 1.40; 95% CI, 0.95-2.09; P=0.09). CONCLUSIONS Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects.
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Affiliation(s)
- K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia Anaesthesia, Perioperative and Pain Medicine Unit Department of Pharmacology, University of Melbourne, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - D McIlroy
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Kurz
- Department of Outcomes Research, Cleveland Clinic, Cleveland, USA
| | - J Khan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesiology, University of Toronto, Toronto, Canada
| | - C S Meyhoff
- Department of Anaesthesiology, Herlev Hospital and University of Copenhagen, Herlev, Denmark
| | - R Allard
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, Canada
| | - G Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - X Jara
- Department of Anesthesiology, Clinica Santa Maria and Universidad de Los Andes, Santiago, Chile
| | - G Lurati Buse
- Department of Anaesthesiology, Juravinski Hospital, Hamilton, Canada
| | - K Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miami, USA
| | - H-S Lee
- Department of Anesthesiology, Sultanah Aminah Hospital, Johor Bahru, Malaysia
| | - R Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, India
| | - T VanHelder
- Department of Anesthesia, Hamilton General Hospital, Hamilton, Canada
| | - W Purayil
- Department of Anaesthesia, Westfort Hi-tech Hospital, Thrissur, India
| | - S De Hert
- Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium
| | - T Treschan
- Department of Anaesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - P J Devereaux
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, McMaster University, Hamilton, Canada
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Savard N, Bédard L, Allard R, Buckeridge DL. Using age, triage score, and disposition data from emergency department electronic records to improve Influenza-like illness surveillance. J Am Med Inform Assoc 2015; 22:688-96. [PMID: 25725005 DOI: 10.1093/jamia/ocu002] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/19/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Markers of illness severity are increasingly captured in emergency department (ED) electronic systems, but their value for surveillance is not known. We assessed the value of age, triage score, and disposition data from ED electronic records for predicting influenza-related hospitalizations. MATERIALS AND METHODS From June 2006 to January 2011, weekly counts of pneumonia and influenza (P&I) hospitalizations from five Montreal hospitals were modeled using negative binomial regression. Over lead times of 0-5 weeks, we assessed the predictive ability of weekly counts of 1) total ED visits, 2) ED visits with influenza-like illness (ILI), and 3) ED visits with ILI stratified by age, triage score, or disposition. Models were adjusted for secular trends, seasonality, and autocorrelation. Model fit was assessed using Akaike information criterion, and predictive accuracy using the mean absolute scaled error (MASE). RESULTS Predictive accuracy for P&I hospitalizations during non-pandemic years was improved when models included visits from patients ≥65 years old and visits resulting in admission/transfer/death (MASE of 0.64, 95% confidence interval (95% CI) 0.54-0.80) compared to overall ILI visits (0.89, 95% CI 0.69-1.10). During the H1N1 pandemic year, including visits from patients <18 years old, visits with high priority triage scores, or visits resulting in admission/transfer/death resulted in the best model fit. DISCUSSION Age and disposition data improved model fit and moderately reduced the prediction error for P&I hospitalizations; triage score improved model fit only during the pandemic year. CONCLUSION Incorporation of age and severity measures available in ED records can improve ILI surveillance algorithms.
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Affiliation(s)
- Noémie Savard
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Lucie Bédard
- Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Montréal, Québec, Canada Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada
| | - Robert Allard
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montréal, Québec, Canada Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Montréal, Québec, Canada
| | - David L Buckeridge
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montréal, Québec, Canada Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Montréal, Québec, Canada
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Allard R, Faubert J. No dedicated color motion system. J Vis 2014. [DOI: 10.1167/14.10.19] [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: 11/24/2022] Open
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Gaudreau C, Helferty M, Sylvestre JL, Allard R, Pilon PA, Poisson M, Bekal S. Campylobacter coli outbreak in men who have sex with men, Quebec, Canada, 2010-2011. Emerg Infect Dis 2013; 19:764-7. [PMID: 23647786 PMCID: PMC3647503 DOI: 10.3201/eid1905.121344] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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] [Indexed: 11/30/2022] Open
Abstract
During September 2010–November 2011, a cluster of erythromycin-susceptible, tetracycline- and ciprofloxacin-resistant Campylobacter coli pulsovar 1 infections was documented, involving 10 case-patients, in Montreal, Quebec, Canada. The findings suggested sexual transmission of an enteric infection among men who have sex with men.
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Affiliation(s)
- Christiane Gaudreau
- Centre Hospitalier de l'Université de Montréal–Hôpital Saint-Luc, Montreal, Quebec, Canada.
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Allard R, Faubert J. Zero-dimensional noise is not suitable for characterizing processing properties of detection mechanisms. J Vis 2013; 13:13.10.25. [DOI: 10.1167/13.10.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Renaud J, Allard R, Molinatti S, Faubert J. External noise paradigms, contrast sensitivity and aging. J Vis 2013. [DOI: 10.1167/13.9.274] [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: 11/24/2022] Open
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Hanssens JM, Allard R, Giraudet G, Faubert J. Visually induced postural reactivity is velocity-dependent at low temporal frequencies and frequency-dependent at high temporal frequencies. Exp Brain Res 2013; 229:75-84. [PMID: 23732950 PMCID: PMC3717165 DOI: 10.1007/s00221-013-3592-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 09/08/2012] [Accepted: 05/23/2013] [Indexed: 11/18/2022]
Abstract
Visual stimulation alone is sufficient to produce visually induced postural reactivity (VIPR). While some studies have shown that VIPR increases with the velocity of a moving visual stimulus, others have shown that it decreases with the temporal frequency of an oscillating visual stimulus. These results seem contradictory given that these two variables co-vary in the same direction. The purpose of this study is to determine whether the VIPR can be different depending on the frequency range being considered. Twelve subjects were placed standing up in a virtual reality environment that simulated a black and white checkerboard at floor level. This checkerboard oscillated at seven frequencies (0.03–2.0 Hz) and three amplitudes (2, 4, and 8°), corresponding to nine velocities (0.125–32°/s). The virtual floor oscillated from left to right (mediolateral) or from front to back (anteroposterior). We calculated the subjects’ mean velocity (Ω) based on data from electromagnetic sensors positioned on the head and lower back. Our experiment shows that for temporal frequencies below 0.12 Hz, VIPR is visually dependent and increases with stimulus velocity. When stimulus velocity becomes too high, the body becomes incapable of following, and the VIPR saturates between 0.12 and 0.25 Hz. In this frequency range, maximal postural oscillation seems to depend on biomechanical constraints imposed by the positioning of the feet. For frequencies above 0.5 Hz, the body can no longer maintain the same oscillation state. This saturation may be linked to proprioceptive feedback mechanisms in the postural system.
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Affiliation(s)
- J-M Hanssens
- Laboratoire de psychophysique et de perception visuelle, École d'optométrie, Université de Montréal, CP 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada
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Ratnayake R, Allard R. Challenges to the surveillance of meningococcal disease in an era of declining incidence in montréal, Québec. Can J Public Health 2013; 104:e335-9. [PMID: 24044476 PMCID: PMC6973802 DOI: 10.17269/cjph.104.3755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 05/27/2013] [Accepted: 04/08/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Though rare in Montréal, meningococcal disease continues to cause serious morbidity and mortality. In an era of declining incidence, our objective was to evaluate the sensitivity and the timeliness of case reporting and the capacity to statistically detect disease clusters. METHODS We used the public health department's reportable disease database (RDD) to calculate the timeliness of reporting by physicians and laboratories for the period 1995 to 2008. The sensitivity of case reporting was evaluated through capture-recapture estimation using the RDD and the hospitalization discharge database (MED-ECHO). To evaluate the detection of cases clustered by time and proximity, we applied scan statistics to the RDD with cases coded by time and geographic location for the period 1992 to 2008. RESULTS While the system sensitivity was judged to be high at 94%, physicians reported only 54% of cases. A total of 92.3% of cases were notified by physicians or laboratories within seven days, meaning that in theory, 13 cases were not notified in time to conduct thorough contact tracing and offer chemoprophylaxis to close contacts. In high-incidence years, scan statistics detected two statistically-significant clusters one to two weeks earlier than traditional detection through the manual monitoring of cumulative cases. CONCLUSIONS To improve system performance, we recommended increasing the emphasis of laboratory reporting, reinforcing early reporting by physicians and if incidence increases, using scan statistics to identify clusters that can add to a public health practitioner's initial "hunch" of an emerging outbreak.
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Affiliation(s)
- Ruwan Ratnayake
- 1. Canadian Field Epidemiology Program, Public Health Agency of Canada, Ottawa, Ontario, Canada 2. Public Health Department, Montréal Health and Social Services Agency, Montréal, Québec, Canada.
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Rivest P, Street MC, Allard R. Completion rates of treatment for latent tuberculosis infection in Quebec, Canada from 2006 to 2010. Can J Public Health 2013; 104:e235-9. [PMID: 23823888 DOI: 10.17269/cjph.104.3643] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 05/22/2013] [Accepted: 01/05/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Treatment of latent TB infection (LTBI) in high-risk populations has been identified as a priority activity for reducing TB incidence. Treatment completion rates are usually far from the 80% target. The objective of this study was to evaluate the proportion of individuals who obtained enough medication for standard LTBI treatment. METHODS Using the Régie de l'assurance maladie du Québec database, we extracted data on all prescriptions filled as part of the free anti-tuberculosis medication program. We calculated the proportion of patients who had obtained at least 270 doses among patients who had started treatment with isoniazid (INH), and the proportion of patients who had obtained at least 120 doses among patients who had started treatment with rifampin (RMP). RESULTS Among the 2,895 patients who had started INH, 907 (31.3%) obtained at least 270 doses. Among the 373 patients who had started RMP, 242 (64.9%) obtained at least 120 doses. Women were more likely to stop INH treatment before acquiring 270 doses of the medication than men (hazard ratio [HR] = 1.08; 95% confidence interval [CI]: 1.01-1.17). CONCLUSION Only 31.3% of patients who started treatment with INH had procured at least 270 doses. Completion rates are far below target values.
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Affiliation(s)
- Paul Rivest
- Direction de santé publique, Agence de la santé et des services sociaux, Montréal, QC, Canada.
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Allard R, Faubert J. No second-order motion system sensitive to high temporal frequencies. J Vis 2012. [DOI: 10.1167/12.9.773] [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: 11/24/2022] Open
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Khalil NJ, Allard R. Examining the association between neighbourhood characteristics and gonorrhea rates among women aged 15 to 24 years in Montreal, Canada. Can J Public Health 2012; 103:e390-e394. [PMID: 23617995 PMCID: PMC6974076 DOI: 10.1007/bf03404448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/24/2012] [Accepted: 07/18/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The reported incidence rate of gonorrhea has more than doubled from 2000 to 2010 in Montréal, increasing in both sexes and all age groups; however, the increase was particularly high in females aged 15 to 24 years. As the reasons for this increase among young women are not fully understood, we wanted to determine whether neighbourhood-level population characteristics were associated with incidence rates in this group, to help target intervention strategies. METHODS Incident gonorrhea cases were female residents of Montréal aged 15 to 24 years who met Québec's gonorrhea surveillance definition, with a notification date from 2002 to 2009. Adjusted incidence rate ratios (IRR) were estimated by negative binomial regression and show the change in the incidence of gonorrhea for each unit increase in neighbourhood-level independent variables, which included material and social deprivation indices (plus the latter's combination and components) and ethnic origin. In the final model, independent variables were normalized to facilitate comparison of their respective IRRs. RESULTS A total of 837 cases were reported (cumulative incidence rate 5.6 per 100,000). Higher proportions of persons of African, Aboriginal and Caribbean ethnicity were associated with higher rates of gonorrhea, even after adjustment for deprivation indices. CONCLUSION Customary methods for gonorrhea surveillance consider individual characteristics of cases as risk factors for disease. However, our results show that gonorrhea is clustered in neighbourhoods that have high proportions of three ethnic origin groups. Findings from this ecological approach suggest that although ethnicity may be strongly correlated with socio-economic status, there are factors in ethnicity that transcend poverty.
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Affiliation(s)
- Nashira J Khalil
- Canadian Field Epidemiology Program, Public Health Agency of Canada, Ottawa, ON.
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Allard R, Couillard M, Pilon P, Kafka M, Bédard L. Invasive bacterial infections following influenza: a time-series analysis in Montréal, Canada, 1996-2008. Influenza Other Respir Viruses 2012; 6:268-75. [PMID: 21985083 PMCID: PMC5779805 DOI: 10.1111/j.1750-2659.2011.00297.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 11/29/2022] Open
Abstract
BACKGROUND Shared seasonal patterns, such as between influenza and some respiratory bacterial infections, can create associations between phenomena not causally related. OBJECTIVES To estimate the association of influenza with subsequent bacterial infections after full adjustment for confounding by seasonal and long-term trends. METHODS Time series of weekly counts of notified cases of invasive infections with Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae and Streptococcus pyogenes, in Montréal, Canada, 1996-2008, were modelled by negative binomial regression, with terms representing seasonal and long-term trends and terms for numbers of positive laboratory tests for influenza A and B. RESULTS The associations of S. pneumoniae, H. influenzae and N. meningitidis with influenza disappeared after seasonal terms were added to the model. However, the influenza B count remained associated with the S. pyogenes counts for the same week and the following week: S. pyogenes incidence rate ratios were 1.0376 (95% CI: 1.0009-1.0757) and 1.0354 (0.9958-1.0766), respectively, for each increase of 1 in the influenza count. CONCLUSIONS Influenza B accounts for about 8 percnt; of the incidence of invasive S. pyogenes infections, over and above any effect associated with modellable seasonal and long-term trends. This association of influenza B with S. pyogenes infections can be attributed largely to the years 1997, 2001, 2007 and 2008, when late peaks in influenza B counts were followed by peaks in S. pyogenes notifications. This finding reinforces the case for universal immunization against influenza, as partial protection against the 'flesh eating disease'.
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Affiliation(s)
- R Allard
- Public Health Department, Montréal Health and Social Services Agency.
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Cox J, Allard R, Maurais E, Haley N, Small C. Predictors of methadone program non-retention for opioid analgesic dependent patients. J Subst Abuse Treat 2012; 44:52-60. [PMID: 22538172 DOI: 10.1016/j.jsat.2012.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 02/07/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
This study evaluates loss to follow-up in a methadone maintenance treatment (MMT) program for patients dependent on opioid analgesics in a community in eastern Canada. Data were collected using the Addiction Severity Index Lite. The probability of loss to follow-up was evaluated using a time-to-event analysis. Involuntary and voluntary program discharges were treated separately as the outcomes of interest. Multivariate Cox proportional hazards models were used to explore the role of various patient-related attributes. The probabilities of involuntary and voluntary discharges at 1 year were 20% and 14%, respectively. In this exploratory analysis, determinants of loss to follow-up were characteristics related to drug use history (e.g., use of sedatives) and its consequences (e.g., number of lifetime arrests), and differed for each outcome. Some determinants of involuntary discharge were modified by sex. Understanding predictors of specific loss to follow-up outcomes may help MMT programs improve patient retention.
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Affiliation(s)
- Joseph Cox
- Mental Health and Addiction Services, Cape Breton District Health Authority, Sydney, Nova Scotia, Canada B1P 1P3.
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Legault I, Allard R, Faubert J. Trained Older Observers Are Equivalent to Untrained Young Adults for 3D Multiple-Object-Tracking Speed Thresholds. J Vis 2011. [DOI: 10.1167/11.11.288] [Citation(s) in RCA: 4] [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: 11/24/2022] Open
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27
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Allard R, Faubert J. Color contribution to motion due to early expansive nonlinearities within the luminance pathway. J Vis 2011. [DOI: 10.1167/11.11.745] [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: 11/24/2022] Open
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Allard R, Dascal A, Camara B, Létourneau J, Valiquette L. Community-acquired Clostridium difficile-associated diarrhea, Montréal, 2005-2006: frequency estimates and their validity. Infect Control Hosp Epidemiol 2011; 32:1032-4. [PMID: 21931255 DOI: 10.1086/661911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A retrospective search for community-acquired Clostridium difficile-associated diarrhea in 15 hospitals revealed important discrepancies with numbers for the same period reported in real time to the surveillance system. Several of the observed problems could be solved by implementing case-by-case notification with subsequent investigation by local public health, as for other reportable diseases.
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Affiliation(s)
- Robert Allard
- Public Health Department, Montréal Health and Social Services Agency, Montréal, Québec, Canada.
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Khalil N, Allard R. P1-S4.12 Using neighbourhood-level population data to guide gonorrhoea intervention, MontrEal, QuEbec, Canada, 2002-2009. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.156] [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: 11/03/2022]
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Allard R, Plante C, Garnier C, Kosatsky T. The reported incidence of campylobacteriosis modelled as a function of earlier temperatures and numbers of cases, Montreal, Canada, 1990-2006. Int J Biometeorol 2011; 55:353-60. [PMID: 20661596 DOI: 10.1007/s00484-010-0345-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 01/01/2010] [Accepted: 06/07/2010] [Indexed: 05/03/2023]
Abstract
Previous studies have detected an effect of earlier temperatures on the incidence of campylobacteriosis in humans, but without adjustment for earlier numbers of cases of the disease. We estimated the effect of temperature on the number of cases notified by week in Montreal, Canada, from 1 January 1990 to 26 March 2006, simultaneously with the effect of the numbers of cases notified in the preceding weeks. The current campylobacteriosis count (week 0) was modelled by negative binomial regression, with earlier weekly average temperatures and earlier counts as predictors. Secular trends were accounted for by cubic spline functions and seasonal variations by sine-cosine functions. Indicator variables identified weeks with fewer than 5 working days. In the final statistical model, a 1°C increase in temperature above 10°C during any of weeks -1 to -6 was associated with a 0.8% (95% CI: 0.3% to 1.3%) increase in the current count. For each additional notified case during any of weeks -1 to -5 or -9 to -12, the increase in the current count was approximately 0.5% (95% CI: 0.2% to 1.0%). Thus, earlier temperatures and earlier counts have independent effects, that of temperatures being the larger one. The temperature effect is too small to require short term public health planning. However, in Montreal, an increase in average temperature of the order of 4.5°C, forecast by some for 2055, could produce a 23% increase in incidence, resulting in about 4,000 excess cases per year.
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Affiliation(s)
- Robert Allard
- Public Health Department, Montreal Health and Social Services Agency, Montreal, Canada.
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Allard R, Cavanagh P. Detection mechanisms selective to combinations of luminance- and contrast-modulations. J Vis 2010. [DOI: 10.1167/9.8.973] [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: 11/24/2022] Open
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Campbell T, Allard R, Preller R, Smedstad L, Wallcraft A, Sue Chen, Hao Jin, Gaberšek S, Hodur R, Reich J, Fry CD, Eccles V, Hwai-Ping Cheng, Cheng JRC, Hunter R, DeLuca C, Theurich G. Integrated Modeling of the Battlespace Environment. Comput Sci Eng 2010. [DOI: 10.1109/mcse.2010.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Nguyen-Tri D, Allard R, Faubert J. No impact of luminance noise on chromatic motion perception. J Vis 2010. [DOI: 10.1167/10.7.820] [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: 11/24/2022] Open
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Abstract
OBJECTIVE To confirm the existence of an increased risk of complications from influenza A (H1N1)p among patients with diabetes. RESEARCH DESIGN AND METHODS Using data from an enhanced influenza surveillance project in Montreal, Canada, and age/sex-specific population estimates of diabetes prevalence, we estimated the risk of hospitalization among persons with diabetes. Comparing hospitalized patients admitted or not to an intensive care unit (ICU), we estimated the risk of ICU admission associated with diabetes, controlling for other patient characteristics. RESULTS Among 239 hospitalized patients with PCR-confirmed influenza A (H1N1)p, 162 (68%) were interviewed, of whom 22 had diabetes, when 7.1 were expected (prevalence ratio 3.10 [95% CI 2.04-4.71]). The odds ratio for ICU admission was 4.29 (95% CI 1.29-14.3) among hospitalized patients with diabetes compared to those without. CONCLUSIONS Diabetes triples the risk of hospitalization after influenza A (H1N1)p and quadruples the risk of ICU admission once hospitalized.
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Affiliation(s)
- Robert Allard
- Public Health Department, Montreal Health and Social Services Agency, Montreal, Quebec, Canada.
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Januel JM, Harbarth S, Allard R, Voirin N, Lepape A, Allaouchiche B, Guerin C, Lehot JJ, Robert MO, Fournier G, Jacques D, Chassard D, Gueugniaud PY, Artru F, Petit P, Robert D, Mohammedi I, Girard R, Cêtre JC, Nicolle MC, Grando J, Fabry J, Vanhems P. Estimating attributable mortality due to nosocomial infections acquired in intensive care units. Infect Control Hosp Epidemiol 2010; 31:388-94. [PMID: 20156064 DOI: 10.1086/650754] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. OBJECTIVE To assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. SETTING Eleven ICUs of a French university hospital. DESIGN We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was defined as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. RESULTS Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%-14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. CONCLUSIONS ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.
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Affiliation(s)
- Jean-Marie Januel
- Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, Lyon, France.
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Tinjust D, Allard R, Faubert J. Impact of stereoscopic vision and 3D representation of visual space on multiple object tracking performance. J Vis 2010. [DOI: 10.1167/8.6.509] [Citation(s) in RCA: 4] [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: 11/24/2022] Open
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Lagace-Nadon S, Allard R, Faubert J. Exploring the spatiotemporal properties of fractal rotation. J Vis 2010. [DOI: 10.1167/8.6.596] [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: 11/24/2022] Open
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Hanssens JM, Moulin M, Allard R, Faubet J. The impact of aging on postural reactivity generated by simulated ophthalmic lenses distortions. J Vis 2010. [DOI: 10.1167/9.8.1130] [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: 11/24/2022] Open
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Zinszer K, Jauvin C, Verma A, Bedard L, Allard R, Schwartzman K, de Montigny L, Charland K, Buckeridge DL. Residential address errors in public health surveillance data: a description and analysis of the impact on geocoding. Spat Spatiotemporal Epidemiol 2010; 1:163-8. [PMID: 22749471 DOI: 10.1016/j.sste.2010.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The residential addresses of persons with reportable communicable diseases are used increasingly for spatial monitoring and cluster detection, and public health may direct interventions based upon the results of routine spatial surveillance. There has been little assessment, however, of the quality of address data in reportable disease notifications and of the corresponding impact of these errors on geocoding and routine public health practices. The objectives of this study were to examine address errors for a selected reportable disease in a large urban center in Canada and to assess the impact of identified errors on geocoding and the estimated spatial distribution of the disease. We extracted data for all notifications of campylobacteriosis from the Montreal public health department from 1995 to 2008 and used an address verification algorithm to determine the validity of the residential address for each case and to suggest corrections for invalid addresses. We assessed the types of address errors as well as the resulting positional errors, calculating the distance between the original address and the correct address as well as changes in disease density. Address errors and missing addresses were prevalent in the public health records (10% and 5%, respectively) and they influenced the observed distribution of campylobacteriosis in Montreal, with address correction changing case location by a median of 1.1 km. Further examination of the extent of address errors in public health data is essential, as is the investigation of how these errors impact routine public health functions.
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Affiliation(s)
- Kate Zinszer
- Department of Epidemiology & Biostatistics, McGill University, 1020 Pine Avenue West, Montreal, Que., Canada H3A 1A2.
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Legault I, Allard R, Faubert J. Adaptation to circular patterns influences the perception of distorted squares. J Vis 2010. [DOI: 10.1167/7.9.273] [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: 11/24/2022] Open
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Allard R, Faubert J. First- and second-order motion processing are separate at low temporal frequencies but common at high temporal frequencies. J Vis 2010. [DOI: 10.1167/7.9.1006] [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: 11/24/2022] Open
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Allard R, Faubert J. Contrast-modulated stimuli detection is unaffected by luminance-modulated noise. J Vis 2010. [DOI: 10.1167/6.6.378] [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: 11/24/2022] Open
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Legault I, Allard R, Faubert J. Curvature perception in aging. J Vis 2010. [DOI: 10.1167/6.6.197] [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: 11/24/2022] Open
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Hanssens JM, Allard R, Faubert J. Progressive lenses distortions effect on postural stability in virtual reality environment. J Vis 2010. [DOI: 10.1167/7.9.1026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Legault I, Allard R, Faubert J. Detecting curvature in first and second-order periodic line stimuli. J Vis 2010. [DOI: 10.1167/5.8.464] [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: 11/24/2022] Open
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Faubert J, Allard R, Hanssens JM. Effect of visual sway on postural balance in a full immersive environment. J Vis 2010. [DOI: 10.1167/5.8.320] [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: 11/24/2022] Open
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Allard R, Creach O, Faubert J. Different internal noise but same calculation efficiency for processing luminance-modulated (LM) and contrast-modulated (CM) stimuli. J Vis 2010. [DOI: 10.1167/5.8.483] [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: 11/24/2022] Open
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Cox J, Morissette C, De P, Tremblay C, Allard R, Graves L, Stephenson R, Roy E. Access to sterile injecting equipment is more important than awareness of HCV status for injection risk behaviors among drug users. Subst Use Misuse 2009; 44:548-68. [PMID: 19242863 PMCID: PMC2929254 DOI: 10.1080/10826080802544349] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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] [Indexed: 10/21/2022]
Abstract
Awareness of hepatitis C virus (HCV) infection status is expected to influence risk behaviors. In 2004-2005, injection drug users (IDUs) recruited from syringe exchange programs (SEPs) and methadone clinics in Montreal, Canada, were interviewed on drug use behaviors (past 6 months) and HCV testing. Subjects (n = 230) were classified as low/intermediate risk (20.4% borrowed drug preparation equipment only) and high risk (19.6% borrowed syringes), and 54.5% reported being HCV positive. Logistic regression modeling showed that compared to no risk (60% borrowed nothing), low/intermediate risk was associated with fewer noninjecting social network members, poor physical health, and problems obtaining sterile injecting equipment. High risk was associated with all of these factors except social networks. HCV status was not associated with any level of risk. Improved access to sterile injecting equipment may be more important than knowledge of HCV status in reducing injection risks among this IDU population. The study limitations are noted and recommendations discussed.
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Affiliation(s)
- Joseph Cox
- Direction de Santé publique, Agence de la Santé et des services Sociaux de Montreal, Montreal, Canada.
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