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Chronic musculoskeletal pain (CMP) is a common indication for pain medications, however opioids are not clearly recommended for this condition. We aimed at describing the trend of opioid initiation for CMP among adults covered by the Quebec public drug insurance between 2006 and 2021 and identifying their associated factors. We performed a retrospective cohort study. Opioid naïve population with 18 years and over was defined for each fiscal year between 2006 and 2021. Clinical indication of their new opioid prescription was first identified using an adapted hierarchical algorithm of Pasricha,2018. CMP was identified using administrative data codes. His age-standardized incidence was estimated. We performed a negative binomial poisson regression to estimate the adjusted annual percentage change (APC) of this incidence and to identify associated factors. This incidence decreased from 70 to 9 per 10,000 persons between 2006 and 2021. The most important decrease was observed between 2015 and 2018: APC=-25.0% [95CI%: -27.1% to -24.3%]. The factors statistically associated with opioid initiation for CMP were being female (RR= 1.17 [95%CI: 1.15 to 1.19]), age (RR=1.39 [95%CI: 1.34 to 1.44] for ≥75 years compared to 18 to 34 years) and prescriber’s specialty (RR= 2.05 [95%CI: 2.00 to 2.09] for family physicians and RR= 2.71 [95%CI: 2.64 to 2.79] for medical specialists compared to surgeons). This study shows that opioid initiation for CMP decreased substantially between 2006 and 2021 in Quebec, and that these drugs were more frequently prescribed by medical specialists, among women and those aged >75 years.

Objectives: Chronic respiratory diseases (CRD) put patients at increased risk of respiratory infection and antimicrobial use, but surveillance results on community antimicrobial use are generally not adjusted for this risk factor. The objective of this study was to demonstrate the importance of accounting for CRD when interpreting indicators of community antimicrobial use in people over 65 years old, in Québec, Canada. Methods: Retrospective cohort study of antimicrobial use according to CRD status in individuals over 65 years old covered by Québec’s public drug insurance plan between 2010 and 2015. Defined daily doses per 1000 person-days (DID) were computed per antimicrobial class and were further stratified according to chronic disease group, fiscal year, gender and age group. Results: Antimicrobial use was 2.3 times higher in the CRD group (29.7 DID) compared with the other chronic disease group (13.1 DID) and 3.1 times higher than in the no chronic disease group (9.6 DID). The same gradient was reflected as well in use per antimicrobial class, per age group, per gender, and in time. Antimicrobial use increased throughout the study period and was higher in older age groups and in women. Conclusions: Interpretation of results of antimicrobial use surveillance should consider the prevalence of CRD in populations. In order to identify opportunities for adapted interventions targeting inappropriate use, finer analyses are necessary.

Chaque année, 1,3 millions de patients subissent une fracture de la hanche dans le monde. Jusqu’à présent, peu d’auteurs se sont intéressés à la trajectoire postopératoire complète des patients avec fracture de la hanche, en termes de milieu de vie.

Objectives: To estimate associations between fine particulate matter (PM2.5) and ozone and the onset of systemic autoimmune rheumatic diseases (SARDs). Methods: An open cohort of over 6 million adults was constructed from provincial physician billing and hospitalization records between 2000 and 2013. We defined incident SARD cases (SLE, Sjogren’s syndrome, scleroderma, polymyositis, dermatomyositis, polyarteritis nodosa and related conditions, polymyalgia rheumatic, other necrotizing vasculopathies, and undifferentiated connective tissue disease) based on at least two relevant billing diagnostic codes (within 2 years, with at least 1 billing from a rheumatologist), or at least one relevant hospitalization diagnostic code. Estimated PM2.5and ozone concentrations (derived from remote sensing and/or chemical transport models) were assigned to subjects based on residential postal codes, updated throughout follow-up. Cox proportional hazards models with annual exposure levels were used to calculate hazard ratios (HRs) for SARDs incidence, adjusting for sex, age, urban-versus-rural residence, and socioeconomic status. Results: The adjusted HR for SARDS related to one interquartile range increase in PM2.5(3.97 µg/m3) was 1.12 (95% confidence interval 1.08–1.15), but there was no clear association with ozone. Indirectly controlling for smoking did not alter the findings. Conclusions: We found associations between SARDs incidence and PM2.5, but no relationships with ozone. Additional studies are needed to better understand interplays between the many constituents of air pollution and rheumatic diseases.

Objective.To estimate systemic autoimmune rheumatic disease (SARD) prevalence across 7 Canadian provinces using population-based administrative data evaluating both regional variations and the effects of age and sex.Methods.Using provincial physician billing and hospitalization data, cases of SARD (systemic lupus erythematosus, scleroderma, primary Sjögren syndrome, polymyositis/dermatomyositis) were ascertained. Three case definitions (rheumatology billing, 2-code physician billing, and hospital diagnosis) were combined to derive a SARD prevalence estimate for each province, categorized by age, sex, and rural/urban status. A hierarchical Bayesian latent class regression model was fit to account for the imperfect sensitivity and specificity of each case definition. The model also provided sensitivity estimates of different case definition approaches.Results.Prevalence estimates for overall SARD ranged between 2 and 5 cases per 1000 residents across provinces. Similar demographic trends were evident across provinces, with greater prevalence in women and in persons over 45 years old. SARD prevalence in women over 45 was close to 1%. Overall sensitivity was poor, but estimates for each of the 3 case definitions improved within older populations and were slightly higher for men compared to women.Conclusion.Our results are consistent with previous estimates and other North American findings, and provide results from coast to coast, as well as useful information about the degree of regional and demographic variations that can be seen within a single country. Our work demonstrates the usefulness of using multiple data sources, adjusting for the error in each, and providing estimates of the sensitivity of different case definition approaches.

Objective.Administrative data are increasingly being used for research and surveillance about rheumatic diseases. However, literature reviews have revealed a lack of consistency in methods for conducting observational rheumatic disease studies, a situation that can lead to findings that cannot be compared. Our purpose was to develop best-practice consensus statements about the use of administrative data for rheumatic disease research and surveillance in Canada.Methods.We convened 52 decision makers, epidemiologists, clinicians, and researchers to a 2-day workshop. Prior to this, participants formed working groups to examine 3 best-practice categories: case definitions, epidemiology methods, and comorbidity and outcomes measurement. The groups conducted systematic or scoping reviews on key topics. At the workshop, evidence from the reviews was presented and consensus-building techniques were used to develop the best-practice statements. The statements were presented, discussed, revised (as needed), and then subjected to voting.Results.Thirteen best-practice consensus statements were developed and endorsed by consensus. For the first category, these consensus statements addressed validation techniques for rheumatic disease case definitions and case ascertainment bias. The consensus statements for epidemiology methods focused on confounding and drug exposure measurement. For comorbidity and outcomes measurement, consensus statements were developed for multiple conditions, including osteoporosis and fragility fractures, cancer, infections, cardiovascular disease, and renal disease. Strengths and limitations of administrative data were identified in relation to each topic.Conclusion.Our best-practice consensus statements are consistent with other recent guidelines, including those for rheumatic disease biologics registries, but address additional issues specific to administrative data. Continuing work focuses on disseminating these consensus statements to multiple audiences.

Postnatal mortality in isolated congenital diaphragmatic hernia (CDH) is mainly related to the associated pulmonary hypertension (PH) and to right‐to‐left shunting.Endothelins (ETs) are potent vasoconstrictors and pro‐mitogenic peptides. Strong evidences support their participation in CDH and in the etiology of PH viathe activation of ETAreceptors (ETA‐Rs).Evaluation of the effect of ABT‐627, a selective non‐peptidic ETA‐R antagonist, given from −15 to 210 min post‐delivery (1 mg kg−1bolus +0.01 mg kg−1h−1infusion, i.v.), was conducted in the lamb model of CDH.Severity of CDH was assessed in comparison to untreated controls (n=5). Untreated CDH lambs (n=7) had a higher mean pulmonary arterial pressure (MPAP; P<0.0001), lower mean blood pressure (MBP; P=0.0004), higher MPAP / MBP ratio (P<0.0001), lower arterial pH (P<0.0001), higher paCO2(P<0.0001), lower paO2(P<0.0001) and lower post‐ductal pulsatile SaO2(P<0.0001) than untreated controls.Treated controls (n=7) showed a higher MPAP, lower MBP, higher MPAP/MBP ratio, lower arterial pH, higher paCO2, lower paO2, lower post‐ductal pulsatile SaO2and lower plasmatic ir‐ET ratios compared to untreated controls (P<0.0001).Treated CDH lambs (n=8) showed a higher MBP (P<0.0001), lower MPAP / MBP ratio (P<0.0001), higher arterial pH (P<0.0001), lower paCO2(P<0.0001), higher paO2(P=0.0228), higher post‐ductal pulsatile SaO2(P=0.0016) and lower plasmatic ir‐ET ratios (P=0.0247) when compared to untreated CDH lambs.These observations revealed that, although acute perinatal treatment with a selective non‐peptidic ETA‐R antagonist had some adverse effects in controls, it attenuated the progressive cardiopulmonary deterioration that occurred after birth in CDH lambs.

Our study aims at the characterization of H I gas cloud images for classification purposes using their brightness temperature distribution. The morphology and velocity structure of the gas cloud is not taken into account in this first study. The analysis is based on spatial contiguity at a chosen radial velocity value. It is assumed that the form brightness temperature distribution of each cloud is dependent on the physical process that created it. We wish to identify the existing relations between different clouds as a first step toward understanding the evolutionary and physical processes that form them. Our study starts with an exploratory analysis based on principal components analysis and on cluster analysis. Because the inherent signal in each image is noise, the characterization is then studied by using a method of density estimation by deconvolution. The clustering of the images is done by considering single linkage and complete linkage criteria of cluster aggregation.

Over the next few decades, hip fractures will be a major public health concern as the number of elderly, a population at high risk for osteoporosis, increases substantially. The rising incidence of hip fracture is a concern for both afflicted individuals and the health care system because these fractures are associated with significant morbidity, mortality, and costs. This study investigated trends of hip fractures in Canada from 1985 to 2005 through analysis of national databases on hospitalization and morbidity. The primary study outcome measures were age-specific and age-standardized hip fracture rates. The Cochran-Armitage test for linear trend was used to estimate yearly changes in age-specific hip fracture subgroups. Joinpoint regression analysis identified points at which a statistically significant change over time occurred in the linear slope of the trends in hip fracture rates.

Objective To investigate whether bariatric surgery increases the risk of fracture.Design Retrospective nested case-control study.Setting Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases.Participants 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls.Main outcome measures Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence.Results Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for biliopancreatic diversion.Conclusions Patients undergoing bariatric surgery were more likely to have fractures than were obese or non-obese controls, and this risk remained higher after surgery. Fracture risk was site specific, changing from a pattern associated with obesity to a pattern typical of osteoporosis after surgery. Only biliopancreatic diversion was clearly associated with fracture risk; however, results for Roux-en-Y gastric bypass and sleeve gastrectomy remain inconclusive. Fracture risk assessment and management should be part of bariatric care.