Background Studies have suggested that agreement between administrative health data and self-report for asthma status ranges from fair to good, but few studies benefited from administrative health data over a long period. We aimed to (1) evaluate agreement between asthma status ascertained in administrative health data covering a period of 30 years and from self-report, and (2) identify determinants of agreement between the two sources. Methods We used administrative health data (1983–2012) from the Quebec Birth Cohort on Immunity and Health, which included 81,496 individuals born in the province of Quebec, Canada, in 1974. Additional information, including self-reported asthma, was collected by telephone interview with 1643 participants in 2012. By design, half of them had childhood asthma based on health services utilization. Results were weighted according to the inverse of the sampling probabilities. Five algorithms were applied to administrative health data (having ≥ 2 physician claims over a 1-, 2-, 3-, 5-, or 30-year interval or ≥ 1 hospitalization), to enable comparisons with previous studies. We estimated the proportion of overall agreement and Kappa, between asthma status derived from algorithms and self-reports. We used logistic regression to identify factors associated with agreement. Results Applying the five algorithms, the prevalence of asthma ranged from 49 to 55% among the 1643 participants. At interview (mean age = 37 years), 49% and 47% of participants respectively reported ever having asthma and asthma diagnosed by a physician. Proportions of agreement between administrative health data and self-report ranged from 88 to 91%, with Kappas ranging from 0.57 (95% CI: 0.52–0.63) to 0.67 (95% CI: 0.62–0.72); the highest values were obtained with the [≥ 2 physician claims over a 30-year interval or ≥ 1 hospitalization] algorithm. Having sought health services for allergic diseases other than asthma was related to lower agreement (Odds ratio = 0.41; 95% CI: 0.25–0.65 comparing ≥ 1 health services to none). Conclusions These findings indicate good agreement between asthma status defined from administrative health data and self-report. Agreement was higher than previously observed, which may be due to the 30-year lookback window in administrative data. Our findings support using both administrative health data and self-report in population-based epidemiological studies.
The Indo-Pacific Ocean appears exponentially stratified between 1- and 3-km depth with a decay scale on the order of 1 km. In his celebrated paper “Abyssal recipes,” W. Munk proposed a theoretical explanation of these observations by suggesting a pointwise buoyancy balance between the upwelling of cold water and the downward diffusion of heat. Assuming a constant upwelling velocity w and turbulent diffusivity κ , the model yields an exponential stratification whose decay scale is consistent with observations if κ ∼ 10 ⁻⁴ m ² s ⁻¹ . Over time, much effort has been made to reconcile Munk’s ideas with evidence of vertical variability in κ , but comparably little emphasis has been placed on the even stronger evidence that w decays toward the surface. In particular, the basin-averaged w nearly vanishes at 1-km depth in the Indo-Pacific. In light of this evidence, we consider a variable-coefficient, basin-averaged analog of Munk’s budget, which we verify against a hierarchy of numerical models ranging from an idealized basin-and-channel configuration to a coarse global ocean simulation. Study of the budget reveals that the decay of basin-averaged w requires a concurrent decay in basin-averaged κ to produce an exponential-like stratification. As such, the frequently cited value of 10 ⁻⁴ m ² s ⁻¹ is representative only of the bottom of the middepths, whereas κ must be much smaller above. The decay of mixing in the vertical is as important to the stratification as its magnitude . Significance Statement Using a combination of theory and numerical simulations, it is argued that the observed magnitude and shape of the global ocean stratification and overturning circulation appear to demand that turbulent mixing increases quasi-exponentially toward the ocean bottom. Climate models must therefore prescribe such a vertical profile of turbulent mixing in order to properly represent the heat and carbon uptake accomplished by the global overturning circulation on centennial and longer time scales.
Objective In 2018, the sale of non-medical cannabis was authorized in the province of Quebec in Canada, within a public monopoly under the Société Québécoise du Cannabis (SQDC). The objective of this study was to offer a description of the cannabis-using population regarding the sources of cannabis supply and to explore whether at-risk individuals are purchasing cannabis at SQDC. Method We used data from a cross-sectional, representative population survey (age >18 years, n = 1799), the Enquête Québécoise sur le Cannabis, which was completed between February and June 2019. Analyses involved adjusted binary logistic regressions, incorporating population weights, to assess 7 potential indicators of harm. Results The vulnerability profiles of SQDC consumers (47.8%) and those acquiring their cannabis elsewhere (52.2%) were similar in terms of frequency of cannabis use (adjusted odds ratio [aOR] = 0.46; 95% confidence interval [CI] = 0.12-1.67), motivation to use (aOR = 0.62; 95% CI = 0.16-2.46), concomitant consumption of other substances (aOR = 0.80; 95% CI = 0.14-4.75), cannabis-impaired driving behaviours (aOR = 0.93; 95% CI = 0.26-3.36), psychological distress (aOR = 0.99; 95% CI = 0.26-3.79), and problematic cannabis use (aOR = 0.46; 95% CI = 0.13-1.64). However, SQDC consumers were more likely to be aware of the cannabinoid content of the product purchased compared to those who acquired their cannabis from other sources (aOR = 4.12; 95% CI = 1.10-15.40). Conclusions No association was detected between the source of cannabis supply and potential vulnerability indicators of cannabis-related harms, but SQDC consumers were more aware of the cannabinoid content of the products purchased. These results suggest that the regulated government supply in Quebec is reaching a substantial portion of those with potential high vulnerability to harm. Whether this knowledge translates into a reduction in the negative consequences related to consumption is still to be determined.
Growing Up in Québec, also known as the Québec Longitudinal Study of Child Development, 2nd edition (QLSCD 2), is a prospective cohort that began in spring 2021. Its goal is to follow the development of Québec children from the age of five months to adulthood in about 4,500 families. It is conducted by the Institut de la statistique du Québec and is based on the Québec Longitudinal Study of Child Development, 1st edition (QLSCD 1), which began in 1998 and is still ongoing. This article describes the Growing Up in Québec pilot study started in 2018, focusing on its objectives and key stages of completion, namely content selection, recruitment strategies and the retention plan, collection methods, adjustments to strategies made during collection, and methodology, including the construction of a socio-economic poverty indicator for population stratification. The article continues by presenting pilot results and their implications for the main survey. It ends with recommendations from the pilot study, exemplifying the wealth of experience gained from it.
Background The suitability of geospatial services for auditing neighbourhood features relevant to pediatric obesity remains largely unexplored. Our objectives were to (i) establish the measurement properties of a desk-based audit instrument that uses Google Street View ® to assess street- and neighbourhood-level features relevant to pediatric obesity (QUALITY-NHOOD tool, the test method) and (ii) comment on its capacity to detect changes in the built environment over an 8-year period. In order to do so, we compared this tool with an on-site auditing instrument (the reference method). Methods On-site audits of 55 street- and neighbourhood-level features were completed in 2008 in 512 neighbourhoods from the QUALITY cohort study. In 2015, both repeat on-site and desk-based audits were completed in a random sample of 30 of these neighbourhoods. Results Agreement between both methods was excellent for almost all street segment items (range 91.9–99.7%), except for road type (81.0%), ads/commercial billboards (81.7%), road-sidewalk buffer zone (76.1%), and road-bicycle path buffer zone (53.3%). It was fair to poor for perceived quality, safety and aesthetics items (range 59.9–87.6%), as well as for general impression items (range 40.0–86.7%). The desk-based method over-detected commercial billboards and road-sidewalk buffer zone, and generally rated neighbourhoods as less safe, requiring more effort to get around, and having less aesthetic appeal. Change detected over the 8-year period was generally similar for both methods, except that the desk-based method appeared to amplify the increase in the number of segments with signs of social disorder. Conclusions The QUALITY-NHOOD tool is deemed adequate for evaluating and monitoring changes in pedestrian- and traffic-related features applicable to pediatric populations. Applications for monitoring the obesogenic nature of neighbourhoods appear warranted.
Introduction: To assess the long-term effectiveness of a treat-and-extend (T&E) anti-vascular endothelial growth factor regimen in patients with neovascular age-related macular degeneration who remain on T&E and those switched from once-monthly (OM) dosing to T&E (OM-T&E). Methods: In this 12-month extension of the 2-year CANTREAT study, patients received intravitreal ranibizumab 0.5 mg in a T&E regimen. Main outcome measures included mean change in best-corrected visual acuity (BCVA) from baseline and from month 24 to month 36; percentages of patients who gained ≥5, ≥10, or ≥15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters or lost ≥5, ≥10, or ≥15 letters from baseline and from month 24 to month 36; and number of injections administered from baseline and from month 24 to month 36 for both groups. Results: Of the 139 patients (73 T&E, 66 OM-T&E) in the extension, 121 (68 T&E, 53 OM-T&E) completed 36 months. Mean (standard deviation [SD]) BCVA changes from baseline to the extension last visit (month 33-36) were +6.6 (11.4) letters in the T&E group and +4.8 (14.3) letters in the OM-T&E group, representing maintenance of 24-month gains. The mean (SD) numbers of injections during the extension were 7.3 (2.7) for T&E and 7.1 (2.8) for OM-T&E. Discussion/conclusion: These findings suggest that after 36 months of treatment, the mean BCVA improvement achieved at 24 months is maintained for both the patients exclusively treated with the T&E regimen and those that switched to T&E after 24 months in the OM regimen.
We propose a method called integrated diffusion for combining multimodal data, gathered via different sensors on the same system, to create a integrated data diffusion operator. As real world data suffers from both local and global noise, we introduce mechanisms to optimally calculate a diffusion operator that reflects the combined information in data by maintaining low frequency eigenvectors of each modality both globally and locally. We show the utility of this integrated operator in denoising and visualizing multimodal toy data as well as multi-omic data generated from blood cells, measuring both gene expression and chromatin accessibility. Our approach better visualizes the geometry of the integrated data and captures known cross-modality associations. More generally, integrated diffusion is broadly applicable to multimodal datasets generated by noisy sensors collected in a variety of fields.
Using field, numerical, and laboratory studies, we consider the roles of both shear and convection in driving mixing in the interior of the density‐stratified ocean. Shear mixing dominates when the Richardson number Ri < 0.25, convective mixing dominates when Ri > 1.0, and in the intermediate regime when 0.25 < Ri < 1.0 both shear and convection can contribute to mixing. For pure shear mixing the mixing efficiency Rif approaches 0.5, while for pure convective mixing the mixing efficiency Rif approaches 0.75. The diapycnal diffusivities for the two mechanisms are given by very different expressions. Despite these complexities, a simple mixing length model using the mean flow shear S provides robust estimates of diffusivity across the range 0 < Ri < 2. To account for the roles of both shear and convection over this range of Ri, we also formulate a modified version of the empirical KPP model for parameterizing ocean mixing in numerical models.
How household-level data from censuses and surveys are analyzed to study household structure is an issue that has received little attention. The present study proposes a new methodological approach to address this gap. Specifically, we introduce the idea of the household configuration as a mathematical representation of observations from the household roster that uses the tools of sequence analysis to study relationships between household members. This “household configuration approach” is statistically efficient, captures the heterogeneity of family forms in a population, and is computationally simple. An application to Canadian census data for Indigenous and non-Indigenous peoples shows that our approach can yield interesting insights into household structure, otherwise not readily obtained.
Exposure to oil can have long-term impacts on migratory birds. Following the 2010 Deepwater Horizon blowout in the Gulf of Mexico (GOM), we investigated potential impacts of oil exposure on a population of northern gannets (Morus bassanus) that breed on Bonaventure Island (Québec, Canada) and winter in GOM and along the U.S. Atlantic coast (AC). Blood and feather samples were collected from adults previously equipped with geolocators to determine wintering locations. Parent and alkylated polycyclic aromatic hydrocarbons (PAHs); trace metals; stable isotopes of carbon, nitrogen, and hydrogen; and immune, thyroid, steroid, retinoid, and genetic endpoints were measured. PAH and trace metal concentrations did not differ between gannets using different wintering sites. Feather stable isotope values varied significantly between birds from different wintering locations. Gannets wintering in GOM showed higher feather corticosterone and plasma thyroid hormone levels, which may indicate increased energetic demands and/or greater exposure to environmental stressors.
Previous research has documented substantial overqualification and an association with social disadvantage and fields of study. Overqualification persistence has been less studied. Persistence is more important than prevalence because skill and job matches are likely to involve lags. Our data set allows us to estimate the prevalence, the correlates, and the persistence of overqualification among Canadian postsecondary graduates using two different measures. We find: i) substantial overqualification and overqualification persistence; ii) the socially disadvantaged and those with less vocational diplomas were more likely to be overqualified but not more likely to move to a match; iii) mobility and academic performance seem to influence catch-up; iv) choice of overqualification measure has large effects on results.
Expanding on our previous results, we show that by partitioning the set of primes into a finite number of subsets of roughly the same size, we can create r -dimensional sequences of real numbers which are uniformly distributed modulo [0, 1) r .
Trends in the proportion of women reporting ever having perpetrated physical intimate partner violence (IPV) and factors associated with such IPV in Haiti between 2000 and 2012 were analyzed. We used datasets from Haitian couples in the 2000, 2005, and 2012 Demographic and Health Surveys. Physical IPV was assessed by the Conflict Tactics Scale. Trends were tested with the Cochrane–Armitage test. Women’s and spouses’ factors associated with physical IPV perpetration by women were estimated using binomial multivariable regressions. In 2000, 2005 and 2012, 3.5%, 3.4% and 3.2% women, respectively, reported perpetrating physical IPV (p for trend = 0.732). Factors associated with physical IPV by women included exposure to any IPV [Adjusted prevalence ratio (APR): 9.37; 95% Confidence Interval (CI): 5.05–17.38], living with a male partner who had a genital ulcer in the year preceding the survey [APR: 2.92; 95% CI: 1.11–7.65], living with a male partner who drank alcohol [APR: 2.58; 95% CI: 1.42–4.69], and having witnessed her father beating her mother during childhood [APR: 2.08; 95% CI: 1.14–3.81]. Exposure to IPV and history of genital ulcer in husbands/partners were the important factors associated with perpetration of physical IPV by women in Haiti over a 10-year period.
Objective: To explore the extent to which family health clinics in Ontario and the eastern regions of the province of Quebec provide palliative care. Design: A cross-sectional survey. Setting: Ontario and the eastern regions of Quebec. Participants: The clinic leads of a select group of family health clinics with patient enrolment models in Ontario and the eastern regions of Quebec. Main outcome measures: The types of palliative care services that the clinics provide, as well as the enablers of and barriers to providing palliative care within the 2 provinces. Results: The overall response rate was 32%. Clinics in both provinces reported providing palliative care to ambulatory patients (83% of Ontario clinics and 74% of Quebec clinics). Only 29 of 102 (28%) Ontario clinics provided on-call services themselves, compared with 31 of 34 (91%) Quebec clinics, with the resulting effect being that more patients were directed to emergency departments in Ontario. Access to palliative care specialist teams for support was higher in Ontario than in Quebec (67% vs 41%, respectively). In Ontario, 56% of practices indicated that they had access to palliative care physicians who could take over the care of their patients with palliative care needs, but a lower number (44%) actually handed over care to these physicians. Conclusion: A group of clinics are providing full palliative care services to their own patients with palliative care needs, including "on-call" services and home visits, and these serve as role models. In Ontario in particular, substantial gaps still exist with respect to clinics providing their own after-hours coverage and home visits; many rely on other services to provide that care. In Quebec, lack of access to palliative care specialist teams appears to be a key challenge in the areas included in this survey. This survey could help policy makers and funders of health care services ensure that appropriate conditions are put in place for optimal palliative care provision in these clinics, such as coordinating access to on-call coverage and support from palliative care specialist teams, as well as providing education to all physicians and adequate remuneration.
Un demi-siècle après les indépendances, les pénuries de personnel enseignant représentent toujours un obstacle majeur à la scolarisation primaire universelle dans plusieurs pays d’Afrique subsaharienne, et plus particulièrement dans les anciennes colonies françaises, où la situation est jugée critique. Pour comprendre ce qui explique cette situation, nous proposons de remonter dans le temps et d’adopter une perspective comparative. Nous avons cherché à comprendre pourquoi les pénuries de personnel enseignant sont un phénomène persistant dans un échantillon de huit pays anciennement colonisés par la France. Il ressort de nos analyses que la décennie 1980-1990, marquée par la mise en oeuvre des programmes d’ajustement structurel, a connu un important ralentissement des progrès des pays pour assurer une offre suffisante d’enseignantes et enseignants pour scolariser un maximum d’enfants. Quant à la période 2000-2015, associée aux objectifs de l’Éducation pour tous, elle a été marquée par une diminution des pénuries d’enseignants. Il apparaît toutefois que les pénuries persisteront dans l’ensemble des pays à l’étude d’ici 2030, notamment en raison des taux de croissance élevés de la population d’âge scolaire et des besoins créés par l’attrition du personnel enseignant.
Que ce soit dans l’application des mesures découlant du droit fiscal et social de la famille, ou dans le calcul des inégalités en bien-être économique sous-jacentes aux statistiques de pauvreté, le « revenu familial » joue un rôle central. Or, ce concept véhicule l’idée que les revenus des membres d’une famille sont mis en commun et également partagés, ce qui implique l’absence de toute inégalité intrafamiliale de ce bien-être. Pourtant, en mettant en évidence des modes de gestion individualisée des revenus dans les couples, la littérature suggère que cette inégalité intrafamiliale est importante et doit être prise en compte. Au moyen de simulations réalisées sur des échantillons de couples de moins de 65 ans, sans enfants, au Québec entre 1979 et 2014, nous tentons d’estimer cette inégalité en fonction de variantes d’un mode de gestion individualisée par lequel les conjoints retiennent hors d’un pot commun des parts plus ou moins élevées de leurs revenus respectifs. Les résultats montrent que l’inégalité intrafamiliale augmente en fonction de ces parts, à plus forte raison lorsqu’elles sont plus élevées pour le conjoint masculin. Aussi, cette inégalité était plus élevée en 1979 qu’en 2014 alors que les écarts de revenus à l’avantage des hommes étaient plus importants. Enfin, les biais dans l’estimation de l’inégalité totale qui résultent de la non prise en compte de l’inégalité intrafamiliale sont non négligeables.
Plusieurs études démontrent l’existence d’une association entre la mortalité et le statut socioéconomique : les personnes appartenant aux catégories sociales les plus favorisées ont une mortalité plus faible que celles appartenant aux catégories défavorisées. Les données nécessaires à ce type d’analyse ne sont pas toujours disponibles et des études sont parfois menées auprès des groupes professionnels spécifiques. Cet article fournit une estimation de la mortalité des hommes médecins au Québec faite à partir des données d’un fichier administratif du Collège des médecins du Québec. Les résultats obtenus montrent une diminution de la mortalité des hommes médecins au cours de la période étudiée (1993 à 2010), mais les différences ne sont significatives que pour les groupes d’âge à partir d’environ 60 ans. Lorsqu’on compare la mortalité des médecins à celle de l’ensemble de la population masculine québécoise, nous constatons une mortalité plus faible chez les hommes médecins inscrits au tableau des membres du Collège des médecins. Finalement, cette étude ne montre pas de différence significative entre la mortalité des hommes médecins omnipraticiens et celle des hommes médecins spécialistes.
Objective: We investigated the association between junk food consumption at lunchtime (JCL) and fast-food outlet access near school among secondary-school children in Quebec. Design: A geographic information system database was used to characterize the food environment around a sub-sample of 374 public schools in which 26 655 students were enrolled. The outcome variable was JCL during the previous week, dichotomized into low JCL (none or once) v. high JCL (twice or more). Access to fast-food outlets near school was assessed using an existing database of fast-food outlets in Quebec. Covariates included student (age, sex and self-rated perceived health), family (familial status and parental education) and school (urban/rural status and deprivation) variables. Hierarchical logistic regression models were employed for analyses using PROC GLIMMIX of SAS version 9.3. Setting: Province of Quebec, Canada. Subjects: We used data from the Quebec Health Survey of High School Students (QHSHSS) 2010-11, a survey of secondary-school Quebec students. Results: Exposure to two or more fast-food outlets within a radius of 750 m around schools was associated with a higher likelihood of excess JCL (OR=1·50; 95 % CI 1·28, 1·75), controlling for the characteristics of the students, their families and their schools. Conclusions: The food environment surrounding schools can constitute a target for interventions to improve food choices among secondary-school children living in the province of Quebec. Transforming environments around schools to promote healthy eating includes modifying zoning regulations that restrict access to fast-food outlets around schools.
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