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Lyme disease (LD) is an emerging public health threat in Canada, associated with the northward range expansion of the black-legged tick (Ixodes scapularis). To address this, public health authorities have been carrying out surveillance activities and awareness campaigns targeting vulnerable populations such as outdoor workers. Implementing these measures is time-consuming and resource-intensive, prompting the assessment of alternatives. Our goal was to evaluate the feasibility and implementation of a training-of-trainers-inspired approach in raising awareness about LD risk and prevention among workers and general population, as well as to evaluate its potential to contribute to provincial LD surveillance efforts. We trained a group of workers from publicly-accessible outdoor parks of the province of Québec to become “LD education ambassadors”. Ambassadors were trained to raise tick and LD awareness, share information on preventive measures in their respective communities, and lead tick sampling activities using a standardised protocol similar to that used by Public Health authorities. Ambassador-led outreach activities, public reach, sampling activities and collected ticks were documented, as well as ambassadors’ satisfaction with the training using forms and semi-structured interviews. In total, 18 ambassadors from 12 organizations were trained. Between June and September 2019, they led 28 independent outreach activities, reaching over 1 860 individuals (from occupational and general public settings) in seven public health units. Ambassadors led 28 tick samplings, together collecting 11 I. scapularis ticks. This study suggests that an adapted training-of-trainers is a feasible approach to raising tick and LD risk awareness among Québec outdoor workers and public. Trained ambassadors have the potential of reaching a large portion of the population visiting or working in outdoor parks while also providing much-needed outreach regarding risk and prevention. Pushing this concept further to include other types of workers and jurisdictions may contribute to national LD surveillance efforts.

Lyme disease is an emerging public health threat in Canada. In this context, rapid detection of new risk areas is essential for timely application of prevention and control measures. In Canada, information on Lyme disease risk is collected through three surveillance activities: active tick surveillance, passive tick surveillance, and reported human cases. However, each method has shortcomings that limit its ability to rapidly and reliably identify new risk areas. We investigated the relationships between risk signals provided by human cases, passive and active tick surveillance to assess the performance of tick surveillance for early detection of emerging risk areas. We used regression models to investigate the relationships between the reported human cases, Ixodes scapularis (Say; Acari: Ixodidae) ticks collected on humans through passive surveillance and the density of nymphs collected by active surveillance from 2009 to 2014 in the province of Quebec. We then developed new risk indicators and validated their ability to discriminate risk levels used by provincial public health authorities. While there was a significant positive relationship between the risk signals provided all three surveillance methods, the strongest association was between passive tick surveillance and reported human cases. Passive tick submissions were a reasonable indicator of the abundance of ticks in the environment (sensitivity and specificity [Se and Sp] < 0.70), but were a much better indicator of municipalities with more than three human cases reported over 5 yr (Se = 0.88; Sp = 0.90). These results suggest that passive tick surveillance provides a timely and reliable signal of emerging risk areas for Lyme disease in Canada.

Contexte Le changement climatique est susceptible d’affecter la sante humaine, avec des effets specifiques ou aggraves sur la sante de certains professionnels. But Les travaux de l’Anses visaient a identifier les risques professionnels susceptibles d’etre impactes par le changement climatique. Methode L’Anses a coordonne cette expertise confiee a un groupe de travail multidisciplinaire, compose de scientifiques specialistes en climatologie, meteorologie, bioclimatologie et biometeorologie, ecologie et biodiversite, epidemiologie, medecine du travail. Dans le cadre d’une demarche prospective, nous avons etudie les effets sanitaires lies aux changements climatiques et environnementaux previsibles a court terme (5 ans) et a moyen terme (2050). L’exploitation de la litterature scientifique a permis d’identifier, d’une part, les changements climatiques et environnementaux deja observes, et d’autre part, les scenarios d’evolution climatique les plus probables. Nous nous sommes attaches a caracteriser les interactions entre climat, environnement et sante au travail. Afin de relier le changement climatique aux risques professionnels repertories, les connaissances sur les mecanismes d’impact du changement climatique sur la sante ont egalement ete examinees. Resultat Malgre des lacunes dans les connaissances concernant les processus d’impacts du changement climatique sur la sante des travailleurs, ces travaux montrent qu’a l’exception des risques lies au bruit et aux rayonnements artificiels, tous les risques professionnels sont et seront affectes par le changement climatique et les modifications environnementales. Des exemples de circonstances d’expositions professionnelles ont ete associes a chaque risque professionnel potentiellement accru par les modifications climatiques. Trois principales modifications climatiques et environnementales sont a l’origine des augmentations de risques professionnels identifies : hausse des temperatures, evolution de l’environnement biologique et chimique, modification de la frequence et de l’intensite de certains aleas climatiques. Les travaux de l’Anses mettent egalement en evidence la pertinence d’une approche dite par « circonstances d’exposition », qui permet de regrouper les professionnels en fonction de leurs expositions reelles et non pas en fonction de leur metier.

CONTEXT Lyme disease (LD) has become a major public health concern in Canada, with flannel-dragging being the gold-standard approach for active tick surveillance. Limited resources hinders proper d...

Évaluation des risques induits par le changement climatique sur la santé des travailleurs; L’Anses a été saisie le 28 octobre 2013, par la Direction générale de la santé (DGS) et la Direction générale du travail (DGT), pour réaliser une expertise sur les impacts potentiels liés au changement climatique sur la santé et la sécurité des travailleurs. Cette saisine s’inscrit dans le cadre du renforcement de la gestion des risques professionnels induits par le changement climatique, action prévue par le 1er Plan national d’adaptation au changement climatique (PNACC) présenté en juillet 2011.

Respiratory effects of ozone in the workplace have not been extensively studied. Our aim was to explore the relationship between daily average ozone levels and compensated acute respiratory problems among workers in Quebec between 2003 and 2010 using a time-stratified case-crossover design. Health data came from the Workers' Compensation Board. Daily concentrations of ozone were estimated using a spatiotemporal model. Conditional logistic regressions, with and without adjustment for temperature, were used to estimate odds ratios (ORs, per 1 ppb increase of ozone), and lag effects were assessed. Relationships with respiratory compensations in all industrial sectors were essentially null. Positive non-statistically significant associations were observed for outdoor sectors, and decreased after controlling for temperature (ORs of 0.98; 1.01 and 1.05 at Lags 0, 1 and 2 respectively). Considering the predicted increase of air pollutant concentrations in the context of climate change, closer investigation should be carried out on outdoor workers.

Background Predicted rise in global mean temperature and intensification of heat waves associated with climate change present an increasing challenge for occupational health and safety. Although important scientific knowledge has been gathered on the health effects of heat, very few studies have focused on quantifying the association between outdoor heat and mortality or morbidity among workers. Objective To quantify the association between occupational heat-related illnesses and exposure to summer outdoor temperatures. Methods We modeled 259 heat-related illnesses compensated by the Workers׳ Compensation Board of Quebec between May and September, from 1998 to 2010, with maximum daily summer outdoor temperatures in 16 health regions of Quebec (Canada) using generalized linear models with negative binomial distributions, and estimated the pooled effect sizes for all regions combined, by sex and age groups, and for different time lags with random-effect models for meta-analyses. Results The mean daily compensation count was 0.13 for all regions of Quebec combined. The relationship between daily counts of compensations and maximum daily temperatures was log-linear; the pooled incidence rate ratio (IRR) of daily heat-related compensations per 1 °C increase in daily maximum temperatures was 1.419 (95% CI 1.326 to 1.520). Associations were similar for men and women and by age groups. Increases in daily maximum temperatures at lags 1 and 2 and for two and three-day lag averages were also associated with increases in daily counts of compensations (IRRs of 1.206 to 1.471 for every 1 °C increase in temperature). Conclusion This study is the first to quantify the association between occupational heat-related illnesses and exposure to summer temperatures in Canada. The model (risk function) developed in this study could be useful to improve the assessment of future impacts of predicted summer outdoor temperatures on workers and vulnerable groups, particularly in colder temperate zones.

The potential impacts of climate change (CC) on Occupational Health and Safety (OHS) have been studied a little in tropical countries, while they received no attention in northern industrialized countries with a temperate climate. This work aimed to establish an overview of the potential links between CC and OHS in those countries and to determine research priorities for Quebec, Canada. A narrative review of the scientific literature (2005-2010) was presented to a working group of international and national experts and stakeholders during a workshop held in 2010. The working group was invited to identify knowledge gaps, and a modified Delphi method helped prioritize research avenues. This process highlighted five categories of hazards that are likely to impact OHS in northern industrialized countries: heat waves/increased temperatures, air pollutants, UV radiation, extreme weather events, vector-borne/zoonotic diseases. These hazards will affect working activities related to natural resources (i.e. agriculture, fishing and forestry) and may influence the socioeconomic context (built environment and green industries), thus indirectly modifying OHS. From this consensus approach, three categories of research were identified: 1) Knowledge acquisition on hazards, target populations and methods of adaptation; 2) Surveillance of diseases/accidents/occupational hazards; and 3) Development of new occupational adaptation strategies.

The toxicity of 3 chemical forms of beryllium (Be) was compared in this study. A total of 160 mice equally divided into 4 groups were exposed by inhalation (nose only) for 3 consecutive weeks, 5 d/week, 6 h/d. One group was used as control, while the 3 others were exposed to fine particles of Be metal, Be oxide (BeO), or Be aluminum (BeAl). Except for the controls, the target level of exposure was 250 μg/m3. In all, 35 mice/group were sacrificed 1 week postexposure and another 5 mice 3 weeks postexposure. The BeO group showed the highest lung Be concentration with higher interleukin 12 (IL-12) and interferon-γ (IFN-γ) levels, while the Be group produced the most severe lung inflammation and higher tumor necrosis factor-α (TNF-α) and CD4+ T cells levels. Data suggested that Be and BeO apparently produced more pulmonary toxicity than BeAl. However, this conclusion is not definitive, because of different confounding factors such as particle sizes, specific surface area, and solubility.

Objective To quantify the associations between occupational injury compensations and exposure to summer outdoor temperatures in Quebec (Canada). Methods The relationship between 374 078 injuries compensated by the Workers’ Compensation Board (WCB) (between May and September, 2003–2010) and maximum daily outdoor temperatures was modelled using generalised linear models with negative binomial distributions. Pooled effect sizes for all 16 health regions of Quebec were estimated with random-effect models for meta-analyses for all compensations and by sex, age group, mechanism of injury, industrial sector and occupations (manual vs other) within each sector. Time lags and cumulative effect of temperatures were also explored. Results The relationship between daily counts of compensations and maximum daily temperatures reached statistical significance for three health regions. The incidence rate ratio (IRR) of daily compensations per 1°C increase was 1.002 (95% CI 1.002 to 1.003) for all health regions combined. Statistically significant positive associations were observed for men, workers aged less than 45 years, various industrial sectors with both indoor and outdoor activities, and for slips/trips/falls, contact with object/equipment and exposure to harmful substances/environment. Manual occupations were not systematically at higher risk than non-manual and mixed ones. Conclusions This study is the first to quantify the association between work-related injury compensations and exposure to summer temperatures according to physical demands of the occupation and this warrants further investigations. In the context of global warming, results can be used to estimate future impacts of summer outdoor temperatures on workers, as well as to plan preventive interventions.

Background: Ambient air ozone (O3) is a pulmonary irritant that has been associated with respiratory health effects including increased lung inflammation and permeability, airway hyperreactivity, respiratory symptoms, and decreased lung function. Estimation of O3 exposure is a complex task because the pollutant exhibits complex spatiotemporal patterns. To refine the quality of exposure estimation, various spatiotemporal methods have been developed worldwide. Objectives: We sought to compare the accuracy of three spatiotemporal models to predict summer ground-level O3 in Quebec, Canada. Methods: We developed a land-use mixed-effects regression (LUR) model based on readily available data (air quality and meteorological monitoring data, road networks information, latitude), a Bayesian maximum entropy (BME) model incorporating both O3 monitoring station data and the land-use mixed model outputs (BME-LUR), and a kriging method model based only on available O3 monitoring station data (BME kriging). We performed leave-one-station-out cross-validation and visually assessed the predictive capability of each model by examining the mean temporal and spatial distributions of the average estimated errors. Results: The BME-LUR was the best predictive model (R2 = 0.653) with the lowest root mean-square error (RMSE ;7.06 ppb), followed by the LUR model (R2 = 0.466, RMSE = 8.747) and the BME kriging model (R2 = 0.414, RMSE = 9.164). Conclusions: Our findings suggest that errors of estimation in the interpolation of O3 concentrations with BME can be greatly reduced by incorporating outputs from a LUR model developed with readily available data. Citation: Adam-Poupart A, Brand A, Fournier M, Jerrett M, Smargiassi A. 2014. Spatiotemporal modeling of ozone levels in Quebec (Canada): a comparison of kriging, land-use regression (LUR), and combined Bayesian maximum entropy–LUR approaches. Environ Health Perspect 122:970–976; http://dx.doi.org/10.1289/ehp.1306566

Objectives To explore relationships between summer outdoor temperatures in Quebec (Canada) and occupational compensation statistics for heat-related illnesses. Method Daily compensation counts of heat-related illnesses (heat strain, heatstroke, loss of consciousness, etc.), occurring between May and September, were obtained from the workers’ compensation board of Quebec for each health region between 1998 and 2010. Regional daily maximum outdoor temperatures were obtained from Environment Canada. Associations between daily compensation counts and temperature were estimated using negative binomial or Poisson regression models for each region and were adjusted for relative humidity and temporal trends. Pooled effect sizes for Quebec (all health regions combined) were obtained using a fixed effect model for meta-analysis. Results In an average population of 3.7 million workers, 259 illnesses classified as heat-related were compensated between 1998 and 2010, giving an average annual rate of 0.11 case per 100 000 workers per summer month. During the study period, 63.0% of heat-related outcomes occurred on days with a maximum daily average temperature below 30oC. Occupations with the largest number of compensations were those of labourers (32%), firefighters (11%) and truck drivers (4%). The pooled incidence rate ratio (IRR) was 1.41 (95% CI 1.35–1.46) per 1oC increase in daily maximum temperature. Effects of barometric pressure and lag will be explored. Conclusions Heat-related illnesses do occur in temperate climates. Our results suggest that compensation statistics, albeit crude indicators of health effects, can be useful to identify industry sectors and occupations that would benefit from preventive interventions aimed at high risk workers.

Methylcyclopentadienyl manganese tricarbonyl (MMT) was used between 1990 and 2003 as an antiknock agent and as an octane booster in Canadian unleaded gasoline. Its combustion leads to Mn emissions. The objective of this research was to examine the variations in atmospheric Mn in Montreal (Canada) from 2001 to 2007, covering the period prior (2001–2003) to and following (2005–2007) MMT use. Three sampling stations were selected because of their proximity to roads with widely differing and well-known traffic patterns. Filters from 2001 to 2007 were obtained from the Montreal Urban Community. The first sample of each month was selected, and Mn analysis was performed by neutron activation analysis. Total suspended particulates (TSP) was calculated by weighing the filters before and after dust collection. Results show a significant decrease of Mn over time at each station, whereas TSP decreased significantly in two stations. Comparing atmospheric Mn during and after the period of use of MMT 2001–2003 vs 2005–2007 showed a significant decrease at all stations. For TSP, only one station showed borderline significant decline between these two periods. Overall, between the two periods, Mn and TSP decreased by 39% and 17%, respectively. These data suggest that the combustion of MMT led to an increase of airborne Mn of approximately 22%. These findings should help in decision-making processes concerning the use of MMT in gasoline in other countries.

Objectives Increased temperatures associated with climate change are likely to have impacts on occupational health and safety all over the world. We aimed to explore potential relationships between summer outdoor temperatures and occupational compensation statistics for heat-related morbidity and mortality. Methods Daily compensation counts in the region of Montreal for heat-related health outcomes (such as heat strain, heatstroke, loss of consciousness) were obtained from the workers’ compensation board of Quebec for the months of May to September over the period 2000–2010. Daily summer outdoor temperatures for the study period were obtained from Environment Canada. Associations between daily compensation counts and temperatures were analysed with regular Poisson and negative binomial regression models. Results There were 35 compensations for heat-related health outcomes during the 11-year period (for a working population of approximately 1.85 million). Incidence rate ratio (IRR) obtained from preliminary Poisson regression analyses was 1.76 (95% CI: 1.55–2.00) per 1 o C temperature increase. This large IRR translates into a small increase in compensations, given the low compensation base rate (0.002 compensation per day for heat-related health problems) at the average temperature of 18.4 o C. Virtually identical results were obtained with a negative binomial regression. Analyses will be carried out for other regions of Quebec and for indirect impacts of heat (e.g. accidents/injuries related to fatigue and lack of vigilance), with various metrics of temperature (e.g. maximum and minimum, Wet Bulb globe Index), and will be stratified by industrial sectors, age and sex when possible. Conclusions These preliminary results suggest that the effect of increases in summer temperatures can be detected in compensation statistics. The results of this work could prove useful for the surveillance of current and future occupational health and safety risks associated with outdoor temperatures and to orient interventions.