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Vivion M, Reid V, Dubé E, Coutant A, Benoit A, Tourigny A. How older adults manage misinformation and information overload - A qualitative study. BMC Public Health 2024; 24:871. [PMID: 38515081 PMCID: PMC10956171 DOI: 10.1186/s12889-024-18335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic was characterized by an abundance of information, some of it reliable and some of it misinformation. Evidence-based data on the impact of misinformation on attitudes and behaviours remains limited. Studies indicate that older adults are more likely to embrace and disseminate misinformation than other population groups, making them vulnerable to misinformation. The purpose of this article is to explore the effects of misinformation and information overload on older adults, and to present the management strategies put in place to deal with such effects, in the context of COVID-19. METHODS A qualitative exploratory approach was adopted to conduct this research. A total of 36 semi-structured interviews were conducted with older adults living in Quebec, Canada. The interviews were fully transcribed and subjected to a thematic content analysis. RESULTS Participants said they could easily spot misinformation online. Despite this, misinformation and its treatment by the media could generate fear, stress and anxiety. Moreover, the polarization induced by misinformation resulted in tensions and even friendship breakdowns. Participants also denounced the information overload produced largely by the media. To this end, the participants set up information routines targeting the sources of information and the times at which they consulted the information. CONCLUSIONS This article questions the concept of vulnerability to misinformation by highlighting older adults' agency in managing misinformation and information overload. Furthermore, this study invites us to rethink communication strategies by distinguishing between information overload and misinformation.
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Affiliation(s)
- M Vivion
- Department of Social and Preventive Medecine, Université Laval, Quebec, Canada.
- CHU de Québec-Université Laval Research Center, Quebec, Canada.
| | - V Reid
- CHU de Québec-Université Laval Research Center, Quebec, Canada
- Laboratoire sur la communication et le numérique (LabCMO), Montreal, Canada
| | - E Dubé
- CHU de Québec-Université Laval Research Center, Quebec, Canada
- Department of Anthropology, Université Laval, Quebec, Canada
| | - A Coutant
- Laboratoire sur la communication et le numérique (LabCMO), Montreal, Canada
- Université du Québec à Montréal (UQAM), Montreal, Canada
| | - A Benoit
- GDR AREES (Groupe de recherche: Arctique: Enjeux pour l'environnement et les sociétés) du CRNS, Paris, France
| | - A Tourigny
- Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada
- VITAM Centre de recherche en santé durable, Quebec, Canada
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Ghesquière L, Bujold E, Dubé E, Chaillet N. Comparison of National Factor-based Models for Preeclampsia Screening. Am J Perinatol 2024. [PMID: 38490251 DOI: 10.1055/s-0044-1782676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE This study aimed to compare the predictive values of the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), and the Society of Obstetricians and Gynecologists of Canada (SOGC) factor-based models for preeclampsia (PE) screening. STUDY DESIGN We conducted a secondary analysis of maternal and birth data from 32 hospitals. For each delivery, we calculated the risk of PE according to the ACOG, the NICE, and the SOGC models. Our primary outcomes were PE and preterm PE (PE combined with preterm birth) using the ACOG criteria. We calculated the detection rate (DR or sensitivity), the false positive rate (FPR or 1 - specificity), the positive (PPV) and negative (NPV) predictive values of each model for PE and for preterm PE using receiver operator characteristic (ROC) curves. RESULTS We used 130,939 deliveries including 4,635 (3.5%) cases of PE and 823 (0.6%) cases of preterm PE. The ACOG model had a DR of 43.6% for PE and 50.3% for preterm PE with FPR of 15.6%; the NICE model had a DR of 36.2% for PE and 41.3% for preterm PE with FPR of 12.8%; and the SOGC model had a DR of 49.1% for PE and 51.6% for preterm PE with FPR of 22.2%. The PPV for PE of the ACOG (9.3%) and NICE (9.4%) models were both superior than the SOGC model (7.6%; p < 0.001), with a similar trend for the PPV for preterm PE (1.9 vs. 1.9 vs. 1.4%, respectively; p < 0.01). The area under the ROC curves suggested that the ACOG model is superior to the NICE for the prediction of PE and preterm PE and superior to the SOGC models for the prediction of preterm PE (all with p < 0.001). CONCLUSION The current ACOG factor-based model for the prediction of PE and preterm PE, without considering race, is superior to the NICE and SOGC models. KEY POINTS · Clinical factor-based model can predict PE in approximately 44% of the cases for a 16% false positive.. · The ACOG model is superior to the NICE and SOGC models to predict PE.. · Clinical factor-based models are better to predict PE in parous than in nulliparous..
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Affiliation(s)
- Louise Ghesquière
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Université de Lille, CHU de Lille, Lille, France
| | - Emmanuel Bujold
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Gynecology and Reproduction, CHU de Québec-Université Laval, Québec City, QC, Canada
| | - Eric Dubé
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
| | - Nils Chaillet
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Gynecology and Reproduction, CHU de Québec-Université Laval, Québec City, QC, Canada
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Chaillet N, Mâsse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser WD, Gagnon R, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Blouin S, Ducruet T, Girard M, Bujold E. Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial. Lancet 2024; 403:44-54. [PMID: 38096892 DOI: 10.1016/s0140-6736(23)01855-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. METHODS We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. FINDINGS 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52-0·99]; p=0·042; adjusted risk difference -1·2% [95% CI -2·0 to -0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33-0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. INTERPRETATION A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. FUNDING Canadian Institutes of Health Research (CIHR, MOP-142448).
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Affiliation(s)
- Nils Chaillet
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada.
| | - Benoît Mâsse
- School of Public Health, University of Montreal, Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Patrick Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Marylène Dugas
- Department of Health Sciences, Interdisciplinary Research Chair in Rural Health and Social Services, University of Quebec at Rimouski, Rimouski, QC, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Suzanne Demers
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Laval University, Quebec, QC, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Guy-Paul Gagné
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Diane Francoeur
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Louise Duperron
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Mira Johri
- School of Public Health, University of Montreal, Montreal, QC, Canada; University of Montreal Hospital Research Center, University of Montreal, QC, Canada
| | - Eric Dubé
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Simon Blouin
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | | | - Mario Girard
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Emmanuel Bujold
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
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Chaillet N, Masse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser W, Gagnon R, Monnier P, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Ducruet T, Girard M, Bujold E. A cluster-randomized trial to reduce perinatal morbidity among women with a prior cesarean delivery (PRISMA). Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.005] [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: 01/09/2023]
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Vivion M, Hennequin C, Verger P, Dubé E. Supporting informed decision-making about vaccination: an analysis of two official websites. Public Health 2020; 178:112-119. [DOI: 10.1016/j.puhe.2019.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 12/26/2022]
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Roberge S, Boutin A, Bujold E, Dubé E, Blouin S, Chaillet N. Impact of Audits and Multifaceted Intervention on Vaginal Birth After Caesarean: Secondary Analysis of the QUARISMA Trial. J Obstet Gynaecol Can 2019; 41:608-615. [PMID: 30642816 DOI: 10.1016/j.jogc.2018.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study estimated the effect that a multifaceted intervention aiming to improve the quality of obstetrical care and reduce Caesarean section (CS) had on the rate of vaginal birth after Caesarean (VBAC). METHODS This is a secondary analysis of the cluster randomized controlled trial Quality of Care, Obstetrics Risk Management, and Mode of Delivery involving (1) audits regarding the indications for CS, (2) provision of feedback to health professionals, and (3) implementation of best practices to reduce CS rates in Quebec. The impact of intervention on VBAC, trial of labour (TOL), and maternal and neonatal morbidity was reported using adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Out of 105 351 women who delivered during the pre- and postintervention period, 12 493 (11.9%) had a previous CS. We observed no significant impact of the multifaceted intervention on the rates of TOL (adjusted OR 1.22; 95% CI 0.96-1.56, P = 0.11) and VBAC (adjusted OR 1.20; 95% CI 0.97-1.48, P = 0.10) in women with one previous CS. However, the rate of TOL was reduced (adjusted OR 0.38; 95% CI 0.14-0.99) in women with more than one previous CS. The intervention has no influence on maternal and neonatal morbidity. CONCLUSIONS A multifaceted intervention including audits, feedback to health professionals, and implementation of best practices did not affect VBAC rates or maternal and neonatal morbidity. Our results pointed out the need for decision-making processand risk management tools specific to women with previous CS.
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Affiliation(s)
- Stéphanie Roberge
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC; Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Amélie Boutin
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC
| | - Emmanuel Bujold
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC; Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC
| | - Eric Dubé
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC
| | - Simon Blouin
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC
| | - Nils Chaillet
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC; Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC.
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Dubé E, Bonnefoy A, Merlen C, Castilloux JF, Cloutier S, Demers C, Sabapathy CA, St-Louis J, Vezina C, Warner M, Rivard GÉ. A prospective surveillance study of inhibitor development in haemophilia A patients following a population switch to a third-generation B-domain-deleted recombinant factor VIII. Haemophilia 2018; 24:236-244. [DOI: 10.1111/hae.13410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 01/04/2023]
Affiliation(s)
- E. Dubé
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
| | - A. Bonnefoy
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
| | - C. Merlen
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
| | - J.-F. Castilloux
- Centre Hospitalier Universitaire de Sherbrooke; Université Sherbrooke; Sherbrooke QC Canada
| | - S. Cloutier
- Centre Hospitalier Universitaire de Québec; Hôpital de l'Enfant Jésus; Québec QC Canada
| | - C. Demers
- Centre Hospitalier Universitaire de Québec; Hôpital de l'Enfant Jésus; Québec QC Canada
| | - C. A. Sabapathy
- McGill University Health Center; Montreal Children's Hospital; Montréal QC Canada
| | - J. St-Louis
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
- Hôpital Maisonneuve-Rosemont; Montréal QC Canada
| | - C. Vezina
- McGill University Health Center; Montreal Children's Hospital; Montréal QC Canada
| | - M. Warner
- McGill University Health Center; Montreal Children's Hospital; Montréal QC Canada
| | - G.-É. Rivard
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
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Chaillet N, Bujold E, Masse B, Grobman WA, Rozenberg P, Pasquier JC, Shorten A, Johri M, Beaudoin F, Abenhaim H, Demers S, Fraser W, Dugas M, Blouin S, Dubé E, Gauthier R. A cluster-randomized trial to reduce major perinatal morbidity among women with one prior cesarean delivery in Québec (PRISMA trial): study protocol for a randomized controlled trial. Trials 2017; 18:434. [PMID: 28931404 PMCID: PMC5608183 DOI: 10.1186/s13063-017-2150-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Rates of cesarean delivery are continuously increasing in industrialized countries, with repeated cesarean accounting for about a third of all cesareans. Women who have undergone a first cesarean are facing a difficult choice for their next pregnancy, i.e.: (1) to plan for a second cesarean delivery, associated with higher risk of maternal complications than vaginal delivery; or (b) to have a trial of labor (TOL) with the aim to achieve a vaginal birth after cesarean (VBAC) and to accept a significant, but rare, risk of uterine rupture and its related maternal and neonatal complications. The objective of this trial is to assess whether a multifaceted intervention would reduce the rate of major perinatal morbidity among women with one prior cesarean. Methods/design The study is a stratified, non-blinded, cluster-randomized, parallel-group trial of a multifaceted intervention. Hospitals in Quebec are the units of randomization and women are the units of analysis. As depicted in Figure 1, the study includes a 1-year pre-intervention period (baseline), a 5-month implementation period, and a 2-year intervention period. At the end of the baseline period, 20 hospitals will be allocated to the intervention group and 20 to the control group, using a randomization stratified by level of care. Medical records will be used to collect data before and during the intervention period. Primary outcome is the rate of a composite of major perinatal morbidities measured during the intervention period. Secondary outcomes include major and minor maternal morbidity; minor perinatal morbidity; and TOL and VBAC rate. The effect of the intervention will be assessed using the multivariable generalized-estimating-equations extension of logistic regression. The evaluation will include subgroup analyses for preterm and term birth, and a cost-effectiveness analysis. Discussion The intervention is designed to facilitate: (1) women’s decision-making process, using a decision analysis tool (DAT), (2) an estimate of uterine rupture risk during TOL using ultrasound evaluation of low-uterine segment thickness, (3) an estimate of chance of TOL success, using a validated prediction tool, and (4) the implementation of best practices for intrapartum management. Trial registration Current Controlled Trials, ID: ISRCTN15346559. Registered on 20 August 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2150-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Chaillet
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada. .,Faculté de Médecine, Département d'Obstétrique & Gynécologie, Université Laval, Centre de recherche du CHUQ, 2705, Boul. Laurier, local T-R-92, Quebec, QC, G1V 4G2, Canada.
| | - E Bujold
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - B Masse
- Department of Epidemiology and Biostatistics, University of Montréal, Montréal, QC, Canada
| | - W A Grobman
- Department of Obstetrics and Gynaecology, Northwestern University, Chicago, IL, USA
| | - P Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303, Poissy, France
| | - J C Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Quebec, QC, Canada
| | - A Shorten
- UAB School of Nursing, University of Alabama, Birmingham, AL, USA
| | - M Johri
- University of Montreal, Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - F Beaudoin
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - H Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Jewish Hospital, Montreal, QC, Canada
| | - S Demers
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - W Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Quebec, QC, Canada
| | - M Dugas
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec, QC, Canada
| | - S Blouin
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - E Dubé
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - R Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
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Dubé E. Addressing vaccine hesitancy: the crucial role of healthcare providers. Clin Microbiol Infect 2017; 23:279-280. [DOI: 10.1016/j.cmi.2016.11.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
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MacDougall DM, Langley JM, Li L, Ye L, MacKinnon-Cameron D, Top KA, McNeil SA, Halperin BA, Swain A, Bettinger JA, Dubé E, De Serres G, Halperin SA. Knowledge, attitudes, beliefs, and behaviors of university students, faculty, and staff during a meningococcal serogroup B outbreak vaccination program. Vaccine 2017; 35:2520-2530. [PMID: 28347501 DOI: 10.1016/j.vaccine.2017.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/12/2016] [Revised: 01/30/2017] [Accepted: 02/03/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES During an outbreak of invasive meningococcal B disease on a university campus, we explored the knowledge, attitudes, beliefs, and behaviors of members of the university community in relation to the disease, the vaccine, and the vaccination program. DESIGN All students, faculty and staff were invited by email to participate in a 71-item online survey, which was administered after completion of the mass clinics for the first and second doses of a meningococcal B vaccination program. RESULTS A total of 404 individuals responded to the survey; 75.7% were students. Knowledge about meningococcal disease and vaccine was generally high; more than 70% correct responses were received on each knowledge question except for one question about the different meningococcal serogroups. Gender (female) and higher knowledge scores were significantly associated with either being immunized or intending to be immunized (p<0.05). Positive attitudes about immunization, concern about meningococccal infection, a sense of community responsibility, and trust in public health advice also correlated with being vaccinated or intending to be vaccinated (p<0.05). CONCLUSIONS A successful mass vaccination program in a Nova Scotia university was associated with high levels of knowledge, positive attitudes toward vaccination, and positive attitudes toward public health recommendations.
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Affiliation(s)
- D M MacDougall
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada; School of Nursing, St. Francis Xavier University, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Nova Scotia, Canada.
| | - J M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - L Li
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada
| | - L Ye
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada
| | - K A Top
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - S A McNeil
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada; Department of Medicine, Dalhousie University, Nova Scotia, Canada
| | - B A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Nova Scotia, Canada; School of Nursing, Dalhousie University, Nova Scotia, Canada
| | - A Swain
- Acadia University, Nova Scotia, Canada
| | - J A Bettinger
- Vaccine Evaluation Center, British Columbia Children's Hospital, University of British Columbia, British Columbia, Canada
| | - E Dubé
- Institut national de santé publique du Québec, Université Laval, Québec, Canada
| | - G De Serres
- Institut national de santé publique du Québec, Université Laval, Québec, Canada
| | - S A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Nova Scotia, Canada; Department of Microbiology & Immunology, Dalhousie University, Nova Scotia, Canada
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Roberge S, Dubé E, Blouin S, Chaillet N. Reporting Caesarean Delivery in Quebec Using the Robson Classification System. Journal of Obstetrics and Gynaecology Canada 2017; 39:152-156. [DOI: 10.1016/j.jogc.2016.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/24/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022]
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Dubé E, Bettinger JA, Fisher WA, Naus M, Mahmud SM, Hilderman T. Vaccine acceptance, hesitancy and refusal in Canada: Challenges and potential approaches. Can Commun Dis Rep 2016; 42:246-251. [PMID: 29769995 PMCID: PMC5757714 DOI: 10.14745/ccdr.v42i12a02] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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
"Vaccine hesitancy" is a concept used frequently in vaccination discourse and is challenging previously held perspective that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. Given the importance of achieving high vaccine coverage in Canada to avoid vaccine preventable diseases and their consequences, vaccine hesitancy is an important issue that needs to be addressed. This article describes the scope and causes of vaccine hesitancy in Canada and proposes potential approaches to address it.
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Affiliation(s)
- E Dubé
- Institut national de santé publique du Québec, Québec, QC
| | - JA Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - WA Fisher
- University of Western Ontario, London, ON
| | - M Naus
- BC Centre for Disease Control, Vancouver, BC
| | - SM Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
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Langley JM, MacDougall DM, Halperin BA, Swain A, Halperin SA, Top KA, McNeil SA, MacKinnon-Cameron D, Marty K, De Serres G, Dubé E, Bettinger JA. Rapid surveillance for health events following a mass meningococcal B vaccine program in a university setting: A Canadian Immunization Research Network study. Vaccine 2016; 34:4046-9. [PMID: 27302338 DOI: 10.1016/j.vaccine.2016.06.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/17/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
An outbreak of Neisseria meningitidis serotype B infection occurred at a small residential university; public health announced an organizational vaccination program with the 4-component Meningococcal B (4CMenB) vaccine (Bexsero(TM), Novartis/GlaxoSmithKline Inc.) several days later. Since there were limited published data on reactogenicity of 4CMenB in persons over 17years of age, this study sought to conduct rapid surveillance of health events in vaccinees and controls using an online survey. Vaccine uptake was 84.7% for dose 1 (2967/3500) and 70% (2456/3500) for dose 2; the survey response rates were 33.0% (987/2967) and 18.7% (459/2456) in dose 1 and dose 1 recipients respectively, and 12% in unvaccinated individuals (63/533). Most students were 20-29years of age (vaccinees, 64.0%; controls, 74.0). A new health problem or worsening of an existing health problem was reported by 30.0% and 30.3% of vaccine recipients after doses 1 and 2 respectively; and by 15.9% of controls. These health problems interfered with the ability to perform normal activities in most vaccinees reporting these events (74.7% post dose 1; 62.6% post dose 2), and in 60% of controls. The health problems led to a health care provider visit (including emergency room) in 12.8% and 14.4% of vaccinees post doses 1 and 2, respectively and in 40% of controls. The most common reactions in vaccinees were injection site reactions (20.6% post dose 1, 16.1% post dose 20 and non-specific systemic complaints (22.6% post dose 1, 17.6% post dose 2). No hospitalizations were reported. An online surveillance program during an emergency meningococcal B vaccine program was successfully implemented, and detected higher rates of health events in vaccinees compared to controls, and high rates of both vaccinees and controls seeking medical attention. The types of adverse events reported by young adult vaccinees were consistent with those previously.
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Affiliation(s)
- J M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada.
| | | | - B A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - A Swain
- Acadia University, Wolfville, NS, Canada
| | - S A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - K A Top
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - S A McNeil
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority, Halifax, Nova Scotia (NS), Canada
| | - K Marty
- Vaccine Evaluation Centre, B.C. Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - G De Serres
- Institut National de Santé Publique du Quebec, Quebec, Canada
| | - E Dubé
- Institut National de Santé Publique du Quebec, Quebec, Canada
| | - J A Bettinger
- Vaccine Evaluation Centre, B.C. Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
In exchanges between health professionals and consultants in the West African context, the word malaria is often replaced by its equivalent in the local dialect. In the Nouna health district of Burkina Faso the term malaria is regularly translated as sumaya. Acknowledging that there may be important epistemological differences between malaria, a term issued from the biomedical epistemology, and sumaya, which is borrowed from traditional medicine epistemology, the possible mismatches between these two terms have been assessed to anticipate problems that may result from their translation by different health stakeholders. By consulting various traditional healers and other members of the communities about the local meaning of the term sumaya, it has been possible to compare the conceptualisation of sumaya to the biomedical conceptualisation of malaria and assess the gap between them. An investigation based on a sample of 13 traditional healers and over 450 individuals from Nouna's health district was conducted to document the meaning of the term sumaya. This paper demonstrates that the generally accepted translation of the word malaria as sumaya is a mistake when one looks at the different systems of belief and representations given to each of these two terms.
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Affiliation(s)
- Marylène Dugas
- a Bioethics Department , Dalhousie University , Halifax , Canada
| | - Eric Dubé
- b Centre de recherche du CHU Ste-Justine , Montréal , Canada
| | - Gilles Bibeau
- c Département d'anthropologie , Université de Montréal , Montréal , Canada
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Martillotti G, Boucoiran I, Damphousse A, Grignon A, Dubé E, Moussa A, Bouchard S, Morin L. Predicting Perinatal Outcome from Prenatal Ultrasound Characteristics in Pregnancies Complicated by Gastroschisis. Fetal Diagn Ther 2015; 39:279-86. [DOI: 10.1159/000440699] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022]
Abstract
Introduction: The objective of the study was to establish the predictive value of prenatal ultrasound markers for complex gastroschisis (GS) in the first 10 days of life. Material and Methods: In this retrospective cohort study over 11 years (2000-2011) of 117 GS cases, the following prenatal ultrasound signs were analyzed at the last second- and third-trimester ultrasounds: intrauterine growth restriction, intra-abdominal bowel dilatation (IABD) adjusted for gestational age, extra-abdominal bowel dilatation (EABD) ≥25 mm, stomach dilatation, stomach herniation, perturbed mesenteric circulation, absence of bowel lumen and echogenic dilated bowel loops (EDBL). Results: Among 114 live births, 16 newborns had complex GS (14.0%). Death was seen in 16 cases (13.7%): 3 intrauterine fetal deaths, 9 complex GS and 4 simple GS. Second-trimester markers had limited predictive value. Third-trimester IABD, EABD, EDBL, absence of intestinal lumen and perturbed mesenteric circulation were statistically associated with complex GS and death. IABD was able to predict complex GS with a sensitivity of 50%, a specificity of 91%, a positive predictive value of 47% and a negative predictive value of 92%. Discussion: Third-trimester IABD adjusted for gestational age appears to be the prenatal ultrasound marker most strongly associated with adverse outcome in GS.
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Dubé E, Gagnon D, Audet D, Bradet R, Boulianne N, Guay M, Sauvageau C. Promoting vaccination: implementation of targeted interventions to enhance access to vaccination services in Quebec (Canada). Public Health 2015; 129:1627-9. [PMID: 26390948 DOI: 10.1016/j.puhe.2015.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/22/2015] [Accepted: 07/13/2015] [Indexed: 11/18/2022]
Affiliation(s)
- E Dubé
- Institut national de santé publique du Québec (INSPQ), Québec, Québec, G1E 7G9, Canada; Centre de recherche du CHU de Québec, Québec, Québec, G1V 4G2, Canada; Université Laval, Québec, Québec, G1V 0A6, Canada.
| | - D Gagnon
- Institut national de santé publique du Québec (INSPQ), Québec, Québec, G1E 7G9, Canada
| | - D Audet
- Centre de recherche du CHU de Québec, Québec, Québec, G1V 4G2, Canada
| | - R Bradet
- Centre de recherche du CHU de Québec, Québec, Québec, G1V 4G2, Canada
| | - N Boulianne
- Institut national de santé publique du Québec (INSPQ), Québec, Québec, G1E 7G9, Canada; Centre de recherche du CHU de Québec, Québec, Québec, G1V 4G2, Canada
| | - M Guay
- Institut national de santé publique du Québec (INSPQ), Québec, Québec, G1E 7G9, Canada; Université de Sherbrooke, Sherbrooke, Québec, Québec, J1K 2R1, Canada; Direction de santé publique de Montérégie, Longueuil, Québec, Québec, J4K 2M3, Canada
| | - C Sauvageau
- Institut national de santé publique du Québec (INSPQ), Québec, Québec, G1E 7G9, Canada; Centre de recherche du CHU de Québec, Québec, Québec, G1V 4G2, Canada; Université Laval, Québec, Québec, G1V 0A6, Canada
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Chaillet N, Dumont A, Abrahamowicz M, Pasquier JC, Audibert F, Monnier P, Abenhaim HA, Dubé E, Dugas M, Burne R, Fraser WD. A cluster-randomized trial to reduce cesarean delivery rates in Quebec. N Engl J Med 2015; 372:1710-21. [PMID: 25923551 DOI: 10.1056/nejmoa1407120] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In Canada, cesarean delivery rates have increased substantially over the past decade. Effective, safe strategies are needed to reduce these rates. METHODS We conducted a cluster-randomized, controlled trial of a multifaceted 1.5-year intervention at 32 hospitals in Quebec. The intervention involved audits of indications for cesarean delivery, provision of feedback to health professionals, and implementation of best practices. The primary outcome was the cesarean delivery rate in the 1-year postintervention period. RESULTS Among the 184,952 participants, 53,086 women delivered in the year before the intervention and 52,265 women delivered in the year following the intervention. There was a significant but small reduction in the rate of cesarean delivery from the preintervention period to the postintervention period in the intervention group as compared with the control group (change, 22.5% to 21.8% in the intervention group and 23.2% to 23.5% in the control group; odds ratio for incremental change over time, adjusted for hospital and patient characteristics, 0.90; 95% confidence interval [CI], 0.80 to 0.99; P=0.04; adjusted risk difference, -1.8%; 95% CI, -3.8 to -0.2). The cesarean delivery rate was significantly reduced among women with low-risk pregnancies (adjusted risk difference, -1.7%; 95% CI, -3.0 to -0.3; P=0.03) but not among those with high-risk pregnancies (P=0.35; P = 0.03 for interaction). The intervention group also had a reduction in major neonatal morbidity as compared with the control group (adjusted risk difference, -0.7%; 95% CI, -1.3 to -0.1; P=0.03) and a smaller increase in minor neonatal morbidity (adjusted risk difference, -1.7%; 95% CI, -2.6 to -0.9; P<0.001). Changes in minor and major maternal morbidity did not differ significantly between the groups. CONCLUSIONS Audits of indications for cesarean delivery, feedback for health professionals, and implementation of best practices, as compared with usual care, resulted in a significant but small reduction in the rate of cesarean delivery, without adverse effects on maternal or neonatal outcomes. The benefit was driven by the effect of the intervention in low-risk pregnancies. (Funded by the Canadian Institutes of Health Research; QUARISMA Current Controlled Trials number, ISRCTN95086407.).
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Affiliation(s)
- Nils Chaillet
- From the Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire (CHU) de Sherbrooke, Sherbrooke, QC (N.C., J.-C.P., E.D., W.D.F.), Department of Epidemiology and Biostatistics, McGill University (M.A., R.B.), Department of Obstetrics and Gynecology, University of Montreal, Centre Hospitalier Universitaire Sainte-Justine (F.A.), Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital (P.M.), and Department of Obstetrics and Gynecology, McGill University, Jewish Hospital (H.A.A.), Montreal, and the Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec, QC (M.D.) - all in Canada; and the Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris (A.D.)
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Dugas M, Bédard E, Batona G, Kpatchavi AC, Guédou FA, Dubé E, Alary M. Outreach strategies for the promotion of HIV testing and care: closing the gap between health services and female sex workers in Benin. J Acquir Immune Defic Syndr 2015; 68 Suppl 2:S198-205. [PMID: 25723985 DOI: 10.1097/qai.0000000000000463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Regular voluntary counseling and testing is a key component of the fight against HIV/AIDS. In Benin, the project SIDA-1/2/3 established to decrease HIV/sexually transmitted infection (STIs) among female sex workers (FSWs), implemented a multifaceted intervention, including outreach activities. The objective of this article was to present potential advantages and limitations of 3 categories of outreach interventions designed to increase the use of testing services among FSWs in Benin. METHODS This analysis is based on ethnographic fieldwork conducted in Benin from June to December 2012. RESULTS Sixty-six FSWs and 24 health care workers were interviewed. Their narratives revealed 3 main factors impeding the development of appropriate HIV testing behavior. These negative elements can be positioned along a continuum of health care behaviors, with each stage of this continuum presenting its own challenges: fear or lack of motivation to use testing services, inaccessibility of care when the decision to go has been made, and a perceived lack of quality in the care offered at the health care center. Many of these needs seem to be addressed in the outreach strategies tested. However, the study also exposed some potential barriers or limitations to the success of these strategies when applied in this specific context, due to social disruption, mobility, access to care, and hard to reach population. CONCLUSIONS To increase the use of testing services, an outreach strategy based on community workers or peer educators, along with improved access to testing services, would be well adapted to this context and appreciated by both FSWs and health care workers.
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Affiliation(s)
- Marylène Dugas
- *Centre de recherche, CHU de Québec, Québec City, Québec, Canada; †Département des sciences infirmières, Université du Québec à Rimouski, Campus Lévis, Lévis, Québec, Canada; ‡Département des sciences infirmières, Université Laval, Québec City, Québec, Canada; §Faculté des lettres, arts et sciences humaines, Université d'Abomey-Calavi, Abomey-Calavi, Bénin; ‖Dispensaire IST, Cotonou, Bénin; ¶Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada; #Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada; and **Institut national de santé publique du Québec, Québec City, Québec, Canada
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Chaillet N, Bujold E, Dubé E, Grobman WA. Validation of a prediction model for predicting the probability of morbidity related to a trial of labour in Quebec. J Obstet Gynaecol Can 2014; 34:820-825. [PMID: 22971449 DOI: 10.1016/s1701-2163(16)35379-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pregnant women with a history of previous Caesarean section face the decision either to undergo an elective repeat Caesarean section (ERCS) or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC). Both choices are associated with their own risks of maternal and neonatal morbidity. We aimed to determine the external validity of a prediction model for the success of trial of labour after Caesarean section (TOLAC) that could help these women in their decision-making. METHODS We used a perinatal database including 185,437 deliveries from 32 obstetrical centres in Quebec between 2007 and 2011 and selected women with one previous Caesarean section who were eligible for a TOLAC. We compared the frequency of maternal and neonatal morbidity between women who underwent TOLAC and those who underwent an ERCS according to the probability of success of TOLAC calculated from a published model of prediction. RESULTS Of 8508 eligible women, including 3113 who underwent TOLAC, both maternal and neonatal morbidities became less frequent as the predicted chance of VBAC increased (P < 0.05). Women undergoing a TOLAC were more likely to have maternal morbidity than those who underwent an ERCS when the predicted probability of VBAC was less than 60% (relative risk [RR] 2.3; 95% CI 1.4 to 4.0); conversely, maternal morbidity was not different between the two groups when the predicted probability of VBAC was at least 60% (RR 0.8; 95% CI 0.6 to 1.1). Neonatal morbidity was similar between groups when the probability of VBAC success was 70% or greater (RR 1.2; 95% CI 0.9 to 1.5). CONCLUSION The use of a prediction model for TOLAC success could be useful in the prediction of TOLAC success and perinatal morbidity in a Canadian population. Neither maternal nor neonatal morbidity are increased with a TOLAC when the probability of VBAC success is at least 70%.
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Affiliation(s)
- Nils Chaillet
- Research Centre of Sainte-Justine Hospital, University of Montreal, Montreal QC
| | - Emmanuel Bujold
- Department of Obstetric and Gynaecology, University of Laval, Quebec QC
| | - Eric Dubé
- Research Centre of Sainte-Justine Hospital, University of Montreal, Montreal QC
| | - William A Grobman
- Department of Obstetric and Gynaecology, Northwestern University, Chicago IL
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Chaillet N, Dumont A, Bujold E, Pasquier JC, Audibert F, Dubé E, Dugas M, Burne R, Abrahamowicz M, Fraser W. 1: Quality of care, obstetrics risk management and mode of delivery in Quebec (QUARISMA): a cluster-randomized trial. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.034] [Citation(s) in RCA: 3] [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: 10/25/2022]
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Chaillet N, Bujold E, Dubé E, Grobman WA. Validation of a Prediction Model for Vaginal Birth After Caesarean. Journal of Obstetrics and Gynaecology Canada 2013; 35:119-124. [DOI: 10.1016/s1701-2163(15)31015-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dubé E, Bettinger JA, Halperin B, Bradet R, Lavoie F, Sauvageau C, Gilca V, Boulianne N. Determinants of parents' decision to vaccinate their children against rotavirus: results of a longitudinal study. Health Educ Res 2012; 27:1069-1080. [PMID: 22907535 DOI: 10.1093/her/cys088] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Rotavirus disease is a common cause of health care utilization and almost all children are affected by the age of 5 years. In Canada, at the time of this survey (2008-09), immunization rates for rotavirus were <20%. We assessed the determinants of a parent's acceptance to have their child immunized against rotavirus. The survey instruments were based on the Theory of Planned Behavior. Data were collected in two phases. In all, 413 and 394 parents completed the first and second interviews, respectively (retention rate 95%). Most parents (67%) intended to immunize their child against rotavirus. Factors significantly associated with parental intentions (Phase 1) were as follows: perception of the moral correctness of having their child immunized (personal normative belief) and perception that significant others will approve of the immunization behavior (subjective norm), perceived capability of having their child immunized (perceived behavioral control) and household income. At Phase 2, 165 parents (42%) reported that their child was immunized against rotavirus. The main determinant of vaccination behavior was parental intention to have their child vaccinated, whereas personal normative beliefs influenced both intention and behavior. The acceptability of the rotavirus vaccine will be higher if health promotion addresses parental knowledge, attitudes and beliefs regarding the disease and the vaccine.
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Affiliation(s)
- E Dubé
- Institut national de santé publique du Québec, Québec, Canada.
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Dubé E, Gilca V, Sauvageau C, Bettinger JA, Boucher FD, McNeil S, Gemmill I, Lavoie F, Ouakki M, Boulianne N. Clinicians' opinions on new vaccination programs implementation. Vaccine 2012; 30:4632-7. [PMID: 22580354 DOI: 10.1016/j.vaccine.2012.04.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 04/27/2012] [Indexed: 12/25/2022]
Abstract
In Canada, several new vaccines were recently approved for clinical use or are expected to be soon. Decision-makers are faced with the choice whether or not to include these vaccines in publicly funded vaccination programs. The aim of this study was to assess Canadian pediatricians' and family physicians' opinions regarding 7 new vaccines, and perceived priority for the introduction of new programs. A self-administered, anonymous, mail-based questionnaire was sent during fall 2009 to a random sample of 1182 family physicians and to all 1852 Canadian pediatricians. Responses to 8 statements regarding frequency and severity of the diseases, efficacy and safety of the vaccines as well as feasibility of immunization programs were used to calculate priority scores to rank the 7 potential new vaccination programs (calculated scores ranging from 0 to 100). Overall response rate was 43%. The majority of respondents perceived the health and economic burden of diseases prevented by the seven new vaccines as important and considered new vaccines to be safe and effective. More than 90% of physicians strongly agreed or agreed that the new vaccines would be or are currently well accepted by the public and by the health professionals who administer vaccines, except for the HPV and rotavirus vaccines (respectively 30% and 29% strongly agreed or agreed). Mean priority scores were: 77.4 out of 100 for the measles, mumps, rubella and varicella (MMRV) combined vaccine; 75.6 for the hexavalent (DTaP-IPV-Hib-HBV) vaccine; 73.1 for the new pneumococcal conjugate vaccines; 69.8 for the meningococcal ACYW135; 68.9 for the combined hepatitis A and B; 63.5 for the human papillomavirus vaccine and 56.9 for the rotavirus vaccine. Health professionals' opinion is an important element to consider in the decision-making process regarding implementation of new immunization programs. Without health professional support, the introduction of a new vaccination program may be unsuccessful. In this study, the MMRV and the hexavalent (DTaP-IPV-Hib-HBV) vaccines received the highest ratings.
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Affiliation(s)
- E Dubé
- Institut national de santé publique du Québec, 2400 d'Estimauville, Québec, Québec, Canada.
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Dugas M, Shorten A, Dubé E, Wassef M, Bujold E, Chaillet N. Decision aid tools to support women's decision making in pregnancy and birth: a systematic review and meta-analysis. Soc Sci Med 2012; 74:1968-78. [PMID: 22475401 DOI: 10.1016/j.socscimed.2012.01.041] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 12/21/2011] [Accepted: 01/30/2012] [Indexed: 11/15/2022]
Abstract
Support for a model of shared medical decision making, where women and their care providers discuss risks and benefits of their different options, reveal their preferences, and jointly make a decision, is a growing expectation in obstetric care. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of different decision aid tools compared to regular care for women facing several options in the specific field of obstetric care. We included published studies about interventions designed to aid mothers' decision making and provide information about obstetrical treatment or screening options. Following a search of electronic databases for articles published in English and French from 1994 to 2010, we found ten studies that met the inclusion criteria. In this systematic review and meta-analysis we found that all decision aid tools, except for Decision Trees, facilitated significant increases in knowledge. The Computer-based Information Tool, the Decision Analysis Tools, Individual Counseling and Group Counseling intervention presented significant results in reducing anxiety levels. The Decision Analysis Tools and the Computer-based Information tool were associated with a reduction in levels of decisional conflict. The Decision Analysis Tool was the only tool that presented evidence of an impact on the final choice and final outcome. Decision aid tools can assist health professionals to provide information and counseling about choices during pregnancy and support women in shared decision making. The choice of a specific tool should depend on resources available to support their use as well as the specific decisions being faced by women, their health care setting and providers.
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Affiliation(s)
- Marylène Dugas
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, 3175 chemin de la Côte Ste-Catherine, Montreal, QC, Canada.
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Dubé E, Gilca V, Sauvageau C, Bradet R, Bettinger J, Boulianne N, Boucher F, McNeil S, Gemmill I, Lavoie F. Canadian paediatricians’ opinions on rotavirus vaccination. Vaccine 2011; 29:3177-82. [DOI: 10.1016/j.vaccine.2011.02.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
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Dugas M, Dubé E, Kouyaté B, Sanou A, Bibeau G. Portrait of a lengthy vaccination trajectory in Burkina Faso: from cultural acceptance of vaccines to actual immunization. BMC Int Health Hum Rights 2009; 9 Suppl 1:S9. [PMID: 19828067 PMCID: PMC3226241 DOI: 10.1186/1472-698x-9-s1-s9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The global recognition of vaccination is strongly related to the fact that it has proved in the past able to dramatically reduce the incidence of certain diseases. Nevertheless, reactions regarding the practice of vaccination still vary among communities, affecting the worldwide vaccination coverage. Numerous studies, conducted from varying perspectives, have focused on explaining this active refusal or resistance to vaccination. Although in some cases low immunization coverage has been well explained by active refusal or resistance to vaccination, little is known about the reasons for low coverage where those reactions are absent or play a minor role, especially outside an epidemic context. This study attempts to explain this situation, which is found in the health district of Nouna in Burkina Faso. METHODS An in-depth ethnographic study was undertaken in the health district of Nouna in an effort to understand, from an anthropological point of view, the logic behind the parental decision-making process regarding the vaccination or non-vaccination of children, in a context where rejection of, and reservations concerning vaccination are not major obstacles. RESULTS Three elements emerged from the analysis: the empirical conceptions of childhood diseases, the perceived efficacy of vaccine and the knowledge of appropriate age for vaccination uptake; the gap between the decision-making process and the actual achievement of vaccination; and the vaccination procedure leading to vaccination uptake in the particular context of the health district of Nouna. CONCLUSION The procedures parents must follow in order to obtain vaccination for their children appear complex and constraining, and on certain points discord with the traditional systems of meaning and idioms of distress related to pregnancy, the prevention of childhood diseases and with the cultural matrix shaping decision-making and behaviour. Attention needs to be directed at certain promotional, logistical and structural elements, and at the procedure that must currently be followed to obtain vaccination for a child during routine vaccination sessions, which are currently limiting the active demand for vaccination. ABSTRACT IN FRENCH : See the full article online for a translation of this abstract in French.
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Affiliation(s)
- Marylène Dugas
- Dalhousie University, Bioethic department, Halifax, Canada.
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Dubé E, De Wals P, Gilca V, Boulianne N. Burden of Acute Otitis Media: Knowledge, Attitudes, and Beliefs of Canadian Parents. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.suppl_a.40a] [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: 11/14/2022] Open
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Dugas M, Dubé E, Kouyaté B, Bibeau G. [Evaluation of transfer of knowledge about malaria by health professionals to patients' mothers in Nouna, Burkina Faso]. Sante 2008; 18:149-154. [PMID: 19359236 DOI: 10.1684/san.2008.0122] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
To reduce the infant mortality rate associated with malaria, the WHO recommends preventive home treatment by antimalarial drugs for all children with fever. This practice requires some medical knowledge by mothers who want to treat their children. In Burkina Faso, the main source of the transmission of such knowledge and skills is the interaction between health professionals and mothers during consultations for their children. The main objective of this study was to assess the transfer of knowledge by health professionals to mothers about the causes, symptoms and treatment of malaria in the health district of Nouna, in the province of Kossi, Burkina Faso. The results showed that at the time of the interview very few mothers were able to recognize malaria and treat it adequately. Mothers' lack of malaria-related knowledge and skills was quite substantial and even more pronounced in the sample of mothers from villages. Many did not know the exact cause of malaria or how to treat it. In view of the factors that must be taken into account for the successful treatment of malaria at home (appropriate dose for age, appropriate duration of treatment, appropriate, i.e.,antimalarial, drugs, quality of drugs) it is estimated that only 3.5% of all interviewed mothers had the knowledge necessary to treat malaria correctly at home. Health professionals appeared to agree that the mothers lacked these skills, but our data revealed that they did not provide information to the mothers to address this lack. Specifically, they did not routinely provide information about prevention by mosquito nets, diagnosis based on key symptoms such as fever, the importance of rapid consultation, rules for antimalarial dosing according to age, the risks of under-medication or the dangers related to the purchase and consumption of street drugs that may be counterfeit or have expired.
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Affiliation(s)
- Marylène Dugas
- Département de bioéthique, Dalhousie University, Halifax NE, Canada, Département de médecine sociale et préventive, université de Montréal, Montréal QC, Canada.
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Houle V, Gagnon M, Dubé E, Hurtubise Y, Beauregard M. Impact of Glycosylation on Saccharomyces cerevisiae Endopolygalacturonase PGU1 Activity and Stability. ACTA ACUST UNITED AC 2008. [DOI: 10.2174/1874070700802010036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endopolygalacturonases are among the best selling enzymes for a number of commercial applications such as
food processing. For such enzymes, a potentially important component of production cost is glycosylation. This important
modification of endopolygalacturonase has been detected for a number of species, but its real importance has not been
thoroughly studied. Here we investigated endopolygalacturonase PGU1 from Saccharomyces cerevisiae CECT 1389 produced
in S. cerevisiae INVSc 1. Combinatorial mutagenesis of recombinant S. cerevesiae PGU1 putative glycosylation
sites was performed, where asparagines 318 and 330 were replaced with either aspartic acid or glutamine. Electrophoretic
analysis of the different recombinant enzymes studied here demonstrates that the putative sites 318 and 330 are indeed
glycosylated when produced in S. cerevesiae INVSc 1. The optimal activity of these enzymes was detected at pH 4.5 and
55-60 ºC. As for stability, all enzymes studied were less than 50% active after an incubation of two hours at 50 ºC and at
pH between 4.5 and 6.0. Glycosylation did not provide any significant stabilisation of PGU1, but the replacement of Asn
330 with Gln had a deleterious effect on stability. The secondary structure spectra are characteristics of proteins mostly
composed of beta sheets. The Tm values measured for PGU1, PGU1 deglycosylated with endo H, and three mutants
ranged from 53 to 55.4ºC, indicating that glycosylation had no impact on PGU1 conformation.
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Chaillet N, Dubé E, Dugas M, Francoeur D, Dubé J, Gagnon S, Poitras L, Dumont A. Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec. Bull World Health Organ 2007; 85:791-7. [PMID: 18038061 DOI: 10.2471/blt.06.039289] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2006] [Accepted: 03/14/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate obstetricians perceptions of clinical practice guidelines targeting management of labour and vaginal birth after previous caesarean birth, and to identify the barriers to, facilitators of and obstetricians solutions for implementing these guidelines in practice. METHODS This qualitative study was conducted in three hospitals in Montreal that represent around 10% of births in Quebec. Data was collected from 10 focus groups, followed by six semi-structured interviews. Two researchers jointly analysed the verbatim transcripts according to A manual for the use of focus groups. FINDINGS The identified barriers to and facilitators of the implementation of guidelines can be classified into four categories: 1) the hospital level, including management and hospital policies; 2) the departmental level, including local policies, leadership, organizational factors, economic incentive, and availability of equipment and staff; 3) the health professionals motivations and attitudes, including medico-legal concerns, skill levels, acceptance of guidelines and strategies used to implement recommendations; and 4) patients motivations. CONCLUSION Identifying the barriers to and facilitators of the adoption of recommendations is an important way to guide the development of efficient strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals perceptions are considered to make recommendations more acceptable and useful. Our findings also support the assumption that obstetricians seek to implement best practices, but require evidence tools and support to assess their practices and enhance their performance. In addition, peer review activities championed by opinion leaders have been identified by obstetricians as the most suitable strategy to improve the use of the guidelines in their practices.
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Affiliation(s)
- Nils Chaillet
- CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.
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Abstract
OBJECTIVE To estimate effective strategies for implementing clinical practice guidelines in obstetric care and to identify specific barriers to behavior change and facilitators in obstetrics. DATA SOURCES The Cochrane Library, EMBASE, and MEDLINE were consulted from January 1990 to June 2005. Additional studies were identified by screening reference lists from identified studies and experts' suggestions. METHODS OF STUDY SELECTION Studies of clinical practice guidelines implementation strategies in obstetric care and reviews of such studies were selected. Randomized controlled trials, controlled before-after studies, and interrupted time series studies were evaluated according to Effective Practice and Organization of Care criteria standards. TABULATION, INTEGRATION, AND RESULTS Studies were reviewed by two investigators to assess the quality and the efficacy of each strategy. Discordances between the two reviewers were resolved by consensus. In obstetrics, educational strategies with medical providers are generally ineffective; educational strategies with paramedical providers, opinion leaders, qualitative improvement, and academic detailing have mixed effects; audit and feedback, reminders, and multifaceted strategies are generally effective. These findings differ from data on the efficacy of clinical practice guidelines implementation strategies in other medical specialties. Specific barriers to behavior change in obstetrics and methods to overcome these barriers could explain these differences. The proportion of effective strategies is significantly higher among the interventions that include a prospective identification of barriers to change compared with standardized interventions. CONCLUSION Prospective identification of efficient strategies and barriers to change is necessary to achieve a better adaptation of intervention and to improve clinical practice guidelines implementation. In the field of obstetric care, multifaceted strategy based on audit and feedback and facilitated by local opinion leaders is recommended to effectively change behaviors.
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Affiliation(s)
- Nils Chaillet
- Research Centre of UHC Sainte-Justine, University of Montreal, Montreal, Quebec, Canada. nilsc@ wanadoo.fr
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Schoen A, Beck B, Sharma R, Dubé E. Arsenic toxicity at low doses: epidemiological and mode of action considerations. Toxicol Appl Pharmacol 2004; 198:253-67. [PMID: 15276404 DOI: 10.1016/j.taap.2003.10.011] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Accepted: 10/08/2003] [Indexed: 11/17/2022]
Abstract
Current approaches to risk assessment typically assume a linear dose-response for mutagenic compounds that directly interact with DNA or when the carcinogenic mechanism is unknown. Because the mode of action of arsenic-induced carcinogenesis is not well established, recent dose-response assessments for arsenic have assumed linearity at low doses despite evidence that arsenic is not a direct-acting mutagen. Several modes of action, including generation of oxidative stress, perturbation of DNA methylation patterns, inhibition of DNA repair, and modulation of signal transduction pathways, have been proposed to characterize arsenic's toxicity. It is probable that these mechanisms do not act in isolation, but overlap, and contribute to the complex nature of arsenic-induced carcinogenesis. All of the proposed mechanisms are likely to be nonlinear at low does. Furthermore, studies of populations outside the US exposed to arsenic in drinking water show increases in cancer only at relatively high concentrations, that is, concentrations in drinking water of several hundred micrograms per liter (microg/l). Studies in the US of populations exposed to average concentrations in drinking water up to about 190 microg/l do not provide evidence of increased cancer. Consideration of arsenic's plausible mechanisms and evidence from epidemiological studies support the use of nonlinear methods, either via biologically based modeling or use of a margin-of-exposure analysis, to characterize arsenic risks.
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Affiliation(s)
- Ari Schoen
- Gradient Corporation, Cambridge, MA 02142, USA
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Dubé E, Dugal LP, Royer A. Speeding-up Action of Oxalic Acid in Wound Healing. Can Med Assoc J 1946; 54:103-106. [PMID: 20323682 PMCID: PMC1582568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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