Training and Integrating Public Service Interpreters in a Refugee Health Clinic: A Mixed-Method Approach to Evaluate an Innovative Program

Language barriers can harm refugees’ health, and trained interpreters are a solution to overcome these barriers in all health consultations. This study trained interpreters and integrated them in a refugee clinic. Nepali-speaking migrants were recruited and underwent 50 hours of training to serve as interpreters for recently arrived Bhutanese refugees in Quebec City. To evaluate the project, mixed data were collected. At baseline and follow-up, patients’ health (as perceived by practitioners) and satisfaction were evaluated. Interpreters and practitioners were also interviewed and took part in joint discussion workshops. Patients’ health remained stable but, interestingly, patients were slightly less satisfied at follow-up. Practitioners and interpreters described both benefits and difficulties of the program. For example, integrating interpreters within the clinical team allowed for better collaboration and mutual knowledge of cultures. Challenges included work overload, conflicts between interpreters and practitioners, and role conflicts for interpreters. Overall, the full-time integration of trained interpreters in the clinic facilitated communication and case administration. This practice could be especially beneficial for refugee clients. In future interventions, interpreter roles should be better clarified to patients and practitioners, and particular attention should be paid to selection criteria for interpreters.

Complete Genome Sequences of Klebsiella michiganensis and Citrobacter farmeri, KPC-2-Producers Serially Isolated from a Single Patient

Carbapenemase-producing Enterobacterales, including KPC-2 producers, have become a major clinical problem. During an outbreak in Quebec City, Canada, KPC-2-producing Klebsiella michiganensis and Citrobacter farmeri were isolated from a patient six weeks apart. We determined their complete genome sequences. Both isolates carried nearly identical IncN2 plasmids with blaKPC-2 on a Tn4401b element. Both strains also carried IncP1 plasmids, but that of C. farmeri did not carry a Beta-lactamase gene, whereas that of K. michiganensis carried a second copy of blaKPC-2 on Tn4401b. These results suggest recent plasmid transfer between the two species and a recent transposition event.

Importance of Voting at the Municipal Level: The Seniors’ Voices

While municipal elections in Quebec are characterized by low voter turnout, it appears that people over 65 years old are the ones who vote in higher numbers. In fact, this is the case for both federal and provincial elections. However, the lack of individual data on municipal elections does not yet allow us to say that seniors vote more than younger people. This finding invites political scientists to look at the electoral behaviour of individual voters and the importance attached to the act of voting at this level of government. In addition, the majority of studies on elections focus on the behaviours of voters living in large cities such as Montreal or Quebec City. In Quebec, the few studies that have looked at medium size municipality voting behaviour have mainly studied the cities of Quebec City, but not Montreal. Based on 19 interviews conducted with people aged between 65 and 84 and living in one medium size cities, Saint-Jean-sur-Richelieu, our research illustrates the importance of the exercise of a duty, the access to political information, the proximity of electoral behaviour and the influential role of seniors. According to participants, it is easier to talk to municipal candidates and get to know the person who will become their official representative, compared to the provincial and federal levels where it is more difficult to talk to candidates. Also, their knowledge of the municipal political system is better than when they were younger. While voting is similarly important at each level of government, participants felt that voting at the municipal level is directly relevant to them because of the municipal services but also by the influence they can have on their councillor.

123 Reduction of asthma hospitalizations in children in a tertiary care center in Quebec during the early confinement period of the COVID-19 pandemic

Primary Subject area Respirology Background Asthma in children and adolescents is a major cause of urgent visits and hospitalizations. In preschoolers, viral infections remain the main cause of these exacerbations, although environmental factors may also play a role. In older children and adolescents, many other risk factors are present including respiratory allergies, exercise, strong emotions, active and passive smoking and poor adherence to recommended treatments. In the context of the COVID-19 pandemic, clinicians have been concerned about the possibility of a significant increase in urgent consultations for asthma in children. However, due to the confinement imposed on a large part of the population from March 2020, we have suspected a reduction in the number of viral infections leading to urgent visits and hospitalizations in pediatric patients. Objectives Our hypothesis was that the number of children hospitalized with asthma exacerbations during the pandemic lockdown declined significantly. Our objective was to determine if the number and severity of hospitalizations at the CME of the CHU de Québec for asthma exacerbations in children aged 1 to 17 had significantly decreased during the confinement period from April 1 to July 1, 2020 and to what extent, according to various clinical features. Design/Methods Retrospective study reviewing episodes of care in medical records in children aged 1 to 17 and hospitalized on all wards at the CME-CHU de Québec. All patients with primary diagnosis of asthmatic exacerbation according to the summary sheets between April 1 to July 1, 2020 for the study group and from April 1 to July 1, 2019 for the control group were included. We aimed to determine the number of hospitalizations for this diagnosis for each period and determine the length of stay on the various pediatric wards for each episode of care according to the established criteria. We have determined the presence of risk factors (asthma diagnosis, underlying condition, regular asthma medication, allergies, and other factors relevant to asthma).We have further determined the presence of gravity markers during the course of hospitalization (need for: IV corticosteroids, Mg sulfate, IV bronchodilators, non-invasive ventilation, intubation, ICU stay and radiological pneumonia) for each episode of care. The data was denominated and collated in an encoded file, and shareable only between the investigators. Results After exclusions, a total of 97 charts were analyzed. Between April 1 and July 1 2019, a total of 89 patients were admitted with a diagnosis of asthma exacerbation while only eight patients were admitted during the same period in 2020. The median age of patients admitted in 2020 was higher than in 2019 (53 vs 25 months). In 2019, 40 children (48%) had a previous diagnosis of asthma, of whom 28 used regular controller medications compared to 2 children (25%) in 2020, both taking regular controller medications. More patients had an associated diagnosis of upper respiratory tract infection in 2019 than in 2020 (92% vs 63%). Nine patients required intensive care in 2019 compared to none in 2020. Conclusion Compared to 2019, hospital admissions for asthma exacerbations in our tertiary care centre in Quebec City were significantly lower during the early phase of the 2020 pandemic. More research is required to determine the exact causes of this significant reduction.

Speaking Out: Housing Issues of Youth in Nunavik

Conference retranscription “Living in Northern Quebec,” 1 special session “Arctic Housing and Community Planning”2 organized by Mylène Riva and Geneviève Vachon. Arctic Change 2017 Conference, Quebec City, Convention Centre, December 14th, 2017.

Identifying Clinicopathological Factors Associated with Oncotype DX® 21-Gene Recurrence Score: A Real-World Retrospective Cohort Study of Breast Cancer Patients in Quebec City, Canada

Gene expression profiling tests such as the Oncotype DX (ODX) 21-gene recurrence score (RS) assay is increasingly used in clinical practice to predict the risk of recurrence and support treatment planning for early-stage breast cancer (BC). However, this test has some disadvantages such as a high cost and a long turnaround time to get results, which may lead to disparities in access. We aim to identify clinicopathological factors associated with ODX RS in women with early-stage BC. We conducted a retrospective cohort study of women identified in the medical database of the Deschênes-Fabia Breast Disease Center of Quebec City University, Canada. Our sample consists of 425 women diagnosed with early-stage BC who have obtained an ODX RS between January 2011 and April 2015. The ODX RS has been categorized into three levels as originally defined: low (0–17), intermediate (18–30), and high (>30). The mean RS was 17.8 (SD = 9.2). Univariate analyses and multinomial logistic regressions were performed to identify factors associated with intermediate and high RS compared with low RS. A total of 237 (55.8%) patients had low RS, 148 (34.8%) had intermediate RS, and 40 (9.4%) had high RS. Women with progesterone receptor (PR)-negative (ORs ranging from 3.51 to 10.34) and histologic grade II (ORs ranging from 3.16 to 23.04) tumors were consistently more likely to have intermediate or high RS than low RS. Similar patterns of associations were observed when the RS was categorised using redefined thresholds from (i.e., from the TAILORx study or dichotomized). This study provides evidence suggesting that histologic grade and PR status are predictive factors for intermediate or high RS in women with early-stage BC. If these results are confirmed in future studies, considering these clinicopathological factors could spare women the need to get such a test before the beginning of a possible adjuvant therapy. This option could be considered in settings where the cost of testing is an issue.

Regulation response of pilot operated diaphragm pressure reducing valves: laboratory testing and impact on the performance of pressure control modes in water distribution systems

Pressure control is recognized as an efficient measure to reduce leaks from water distribution systems. The effectiveness of various pressure control modes, by means of pilot operated diaphragm pressure reducing valves (PRVs), is evaluated in this paper taking into account the sensitivity of the valve to various settings. First, the response of a PRV to consecutive pressure settings variations was experimentally evaluated in the hydraulic simulation laboratory of National Institute for Scientific Research (INRS). These experiments revealed that the studied valve reacts only when the pressure setting variation corresponds to at least 1/6 turn of the pilot valve. Second, a real case study from Quebec City, Canada, was simulated in order to evaluate the impact of the PRV response on three pressure control modes: fixed control, time based control, and real time control (RTC). The results show that RTC of pressure leads to leakage rate reduction on the studied network but that the PRV operational constraints limit the expected performance of RTC.

Pain induced by investigations and procedures commonly administered to older adults in the emergency department: a prospective cohort study

BackgroundThis study aimed to assess the level of pain induced by common interventions performed in older adults consulting to the ED.MethodsWe conducted a prospective multicentre observational cohort study in two academic EDs (Quebec City, Canada) between June 2018 and December 2019. A convenience sample of well-oriented and haemodynamically stable older adults (≥65 years old) who underwent at least two interventions during their ED stay was recruited. The level of pain was assessed using an 11-point Numerous Rating Scale (NRS) and is presented using median and IQR or categorised as no pain (0), mild (1–3), moderate (4–6) or severe pain (7–10).ResultsA total of 318 patients were included. The mean age was 77.8±8.0 years old and 54.4% were female . The number of pain assessments per intervention ranged between 22 (urinary catheterisation) and 240 (intravenous catheter). All imaging investigations (X-rays, CT and bedside ultrasound) were associated with a median level of pain of 0. The median level of pain for other interventions was as follows: blood samplings (n=231, NRS 1 (IQR 0–3)), intravenous catheters (n=240, NRS 2 (IQR 0–4)), urinary catheterisations (n=22, NRS 4.5 (IQR 2–6)), cervical collars (n=50, NRS 5 (IQR 0–8)) and immobilisation mattresses (n=34, NRS 5 (IQR 0–8)). Urinary catheterisations (63.8%), cervical collars (56.0%) and immobilisation mattresses (52.9%) frequently induced moderate or severe pain.ConclusionsMost interventions administered to older adults in the ED are associated with no or low pain intensity. However, urinary catheterisation and spinal motion restriction devices are frequently associated with moderate or severe pain.