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Background: Two invasive group A streptococcus (iGAS) infection outbreaks occurred in Montreal in 2016 and 2017; one in a long-term care facility (typeemm118) and one in the community, primarily involving homeless people (typeemm74).Objective: To describe two recent iGAS outbreaks in Montréal and highlight the challenges in dealing with these outbreaks and the need to tailor the public health response to control them.Methodology: All cases of iGAS were investigated and the isolates were sent to the laboratory foremmtyping. In both outbreaks, cases of superficial group Astreptococcus(GAS) infection were identified, through 1) systematic case detection accompanied by screening for asymptomatic carriers among residents and employees of the long-term care facility and 2) sentinel surveillance among homeless people. Visits were made to community organizations providing homeless services (including shelters) and social networks were analyzed to establish whether there were any links among cases of GAS infection (both invasive and noninvasive) and locations frequented. In both outbreaks, recommendations were made to service providers regarding enhancement of infection prevention and control measures.Results: In the long-term care facility, five cases of typeemm118 iGAS were identified over a 22-month period, one of which resulted in death. All residents were screened and no carriers were identified. Among the employees, 81 (65%) were screened and fourcarriers were identified. Of those, one was a carrier of typeemm118 GAS. All carriers were treated, and subsequent follow-up sampling on three carriers (including the one withemm118) was negative.In the community, 23 cases of typeemm74 iGAS were detected over a 16-month period, four of which resulted in death. Half of the cases (n=12) were described as homeless, and six others were users of services for the homeless. Sentinel surveillance of superficial infections yielded 64 cultures with GAS, chiefly on the skin, including 51 (80%) of typeemm74. An analysis of the social networks revealed the large number and variety of resources for the homeless used by the cases. Visits to the community organizations providing homeless services revealed the heterogeneity and precariousness of some of these services, the difficulties encountered in applying adequate health and hygiene measures, and the high degree of mobility amongst those who use these services.Conclusion: The detection and control of iGAS outbreaks in both long-term care establishments and among community organizations providing homeless services are very complex. An outbreak of iGAS can develop in the background over a long time and be easily overlooked despite cases being admitted to the hospital.Emmtyping and systematic research of previous cases of iGAS are essential tools for the detection and characterization of outbreaks. Close cooperation among public health agencies, clinical teams, community organizations and laboratories is essential for proper monitoring and the reduction of GAS transmission in the community and health care settings. [ABSTRACT FROM AUTHOR]

Background: Two invasive group A streptococcus (iGAS) infection outbreaks occurred in Montreal in 2016 and 2017; one in a long-term care facility (type emm 118) and one in the community, primarily involving homeless people (type emm 74)., Objective: To describe two recent iGAS outbreaks in Montréal and highlight the challenges in dealing with these outbreaks and the need to tailor the public health response to control them., Methodology: All cases of iGAS were investigated and the isolates were sent to the laboratory for emm typing. In both outbreaks, cases of superficial group A streptococcus (GAS) infection were identified, through 1) systematic case detection accompanied by screening for asymptomatic carriers among residents and employees of the long-term care facility and 2) sentinel surveillance among homeless people. Visits were made to community organizations providing homeless services (including shelters) and social networks were analyzed to establish whether there were any links among cases of GAS infection (both invasive and noninvasive) and locations frequented. In both outbreaks, recommendations were made to service providers regarding enhancement of infection prevention and control measures., Results: In the long-term care facility, five cases of type emm 118 iGAS were identified over a 22-month period, one of which resulted in death. All residents were screened and no carriers were identified. Among the employees, 81 (65%) were screened and fourcarriers were identified. Of those, one was a carrier of type emm 118 GAS. All carriers were treated, and subsequent follow-up sampling on three carriers (including the one with emm 118) was negative.In the community, 23 cases of type emm 74 iGAS were detected over a 16-month period, four of which resulted in death. Half of the cases (n=12) were described as homeless, and six others were users of services for the homeless. Sentinel surveillance of superficial infections yielded 64 cultures with GAS, chiefly on the skin, including 51 (80%) of type emm 74. An analysis of the social networks revealed the large number and variety of resources for the homeless used by the cases. Visits to the community organizations providing homeless services revealed the heterogeneity and precariousness of some of these services, the difficulties encountered in applying adequate health and hygiene measures, and the high degree of mobility amongst those who use these services., Conclusion: The detection and control of iGAS outbreaks in both long-term care establishments and among community organizations providing homeless services are very complex. An outbreak of iGAS can develop in the background over a long time and be easily overlooked despite cases being admitted to the hospital. Emm typing and systematic research of previous cases of iGAS are essential tools for the detection and characterization of outbreaks. Close cooperation among public health agencies, clinical teams, community organizations and laboratories is essential for proper monitoring and the reduction of GAS transmission in the community and health care settings., Competing Interests: Conflict of interest: None.

Despite a publicly funded immunization program and continuous promotional efforts, vaccine uptake for seasonal influenza in Quebec (Canada) remains under its goal of 80%. Missed opportunities can explain the low influenza vaccine rates among chronically ill children. To address that, demonstration projects using the live attenuated influenza vaccine (LAIV) were implemented in 3 pediatric tertiary care hospitals to evaluate the feasibility and acceptability of implementing influenza immunization of chronically ill children in hospitals' outpatient clinics. A diary was used to document barriers and enabling factors regarding the implementation, and a questionnaire was distributed to healthcare professionals involved in the project in each hospital. Parent's knowledge, attitudes and behaviors (KAB) about influenza immunization and acceptability of immunization in outpatient clinics were also measured with a questionnaire. As part of the project, 2,478 children were immunized. Enabling factors included the financial support received from Quebec ministry of Health, the nasal mode of administration of the LAIV and the presence of a leader specifically dedicated to influenza immunization. Barriers to influenza immunization in outpatient clinics included difficulties of hiring extra staff to work in immunization clinics and additional tasks added to regular activities of the clinics. Results from both questionnaires illustrated a high level of acceptability of seasonal influenza immunization in hospitals' outpatient clinics by parents and healthcare professionals. Influenza immunization in pediatric tertiary care hospital is an effective way to reach chronically ill children and does not involve major feasibility or acceptability issues.

This article documents the addition of 112 microsatellite marker loci and 24 pairs of single nucleotide polymorphism (SNP) sequencing primers to the Molecular Ecology Resources Database. Loci were developed for the following species: Agelaius phoeniceus, Austrolittorina cincta, Circus cyaneus, Circus macrourus, Circus pygargus, Cryptocoryne × purpurea Ridl. nothovar. purpurea, Mya arenaria, Patagioenas squamosa, Prochilodus mariae, Scylla serrata and Scytalopus speluncae. These loci were cross-tested on the following species: Cryptocoryne × purpurea nothovar. purpurea, Cryptocoryne affinis, Cryptocoryne ciliata, Cryptocoryne cordata var. cordata, Cryptocoryne elliptica, Cryptocoryne griffithii, Cryptocoryne minima, Cryptocoryne nurii and Cryptocoryne schulzei. This article also documents the addition of 24 sequencing primer pairs and 24 allele-specific primers or probes for Aphis glycines., (© 2011 Blackwell Publishing Ltd.)

Objective: Describe the implementation of various activities suggested in the guide entitled Prevention, surveillance et contrôle de l'influenza en milieu d'hébergement et de soins de longue durée (CHSLD) au Quebec, distributed in 2000 to Montréal-area CHSLD., Method: The study was conducted in 2001 among 57 CHSLDs (39 public institutions and 18 private institutions under agreement) in Montréal. A self-administered questionnaire collected data on the characteristics of the centres and main activities recommended in the guide. The principal activities recommended were grouped into three components: influenza prevention, surveillance and control. Data were entered and analyzed using SPSS 10.0. A descriptive analysis was performed., Results: The overall rate of response was 81% (46/57). The proportion of centres that had carried out the various components was 35% (16/46) for prevention and 41% (19/46) for surveillance; only 2 centres had applied the influenza control component., Conclusion: Over half of CHSLDs in Montreal did not implement the influenza prevention, surveillance and control components. Gaps were noted, especially related to vaccine coverage of staff and rapid access to chemoprophylaxis. Several additional control measures recommended were also considered to be inapplicable. We must review our strategies to identify the barriers to optimal implementation of these measures.

We investigated contraceptive practices in the rural health district of Kaya in Burkina Faso with the aim of a) comparing the sociodemographic and cultural characteristics of individuals who were well and poorly informed concerning contraceptive methods; b) analyzing the pattern of use of these contraceptive methods by the populations. We carried out a two-level cluster survey by the Hendersen method. For each household investigated, the chief, his wife (or one wife selected at random in polygamous families) and an adolescent (or one adolescent selected at random if there was more than one adolescent) were interviewed. Significantly more men than women were well informed concerning contraceptive methods. Similarly, a higher proportion of male adolescents than of female adolescents were well informed concerning contraceptive methods. The individuals who were well informed concerning contraceptive methods differed from those who were not well informed in terms of age, religion, level of education and radio listening habits. The prevalence of use of contraceptive methods in this study was found to be 4 to 36%, depending on the group studied. The majority of individuals expressed an intention to use contraceptive methods in the future: 59 to 78%, depending on the group studied. The contraceptive methods chosen for current and future use were, in order: the pill, condoms and contraceptive implants and the intrauterine device. Current patterns of contraceptive use favor, in decreasing order of preference, abstinence, the pill, condoms and contraceptive implants. There was also a strong tendency for individuals to experiment with diverse contraceptive methods. Thus, in the future, there is likely to be a trend towards the abandoning of abstinence in favor of the pill, condoms and contraceptive implants. Of these newer methods, condoms are likely to be the least popular and their relegation to a lower level of importance is likely to have disastrous consequences in terms of the prevention of HIV transmission by the sexual route. The results of this study indicate that information campaigns concerning contraceptive methods should be refocused on women and adolescent girls, condom promotion and maintaining the use of the methods chosen in the population.

The Symptom Checklist-90-Revised (SCL-90-R) has often been used in studies of alcoholic populations. Based on findings reported in the literature and data gathered on 712 alcoholics in treatment, this paper investigates the general trends in the responses of alcoholics to the SCL-90-R. On global measures as well as on each of the symptom scales, the scores of alcoholic groups reveal a symptomatology two to five times as severe as that observed in the general population. The Psychoticism dimension shows the most marked divergence with the general population. In almost each of the study groups, the Depression Scale registers the highest scores, followed by Obsessive-Compulsive, Interpersonal Sensitivity, and Anxiety.

Endothelium-dependent relaxation of conductance coronary vessels involves nitric oxide formation from L-arginine. The present study examines whether a similar mechanism intervenes in the vasomotor control of resistance coronary vessels. In conscious dogs, the excess of coronary blood flow (CBF) created by intracoronary acetylcholine (3.0 ng/kg) averaged 7.2 +/- 1.1 ml. Intracoronary adenosine (100 ng/kg) increased CBF by 12.4 +/- 1.4 ml. Intracoronary nitroglycerin (175 ng/kg) increased CBF by 7.4 +/- 1.2 ml. CBF repayment-to-debt ratio after a 15-s coronary arterial occlusion averaged 2.8 +/- 0.2. After an intracoronary N omega-nitro-L-arginine dose (10 micrograms.kg-1.min-1 x 12 min) was given to inhibit nitric oxide formation, baseline CBF was not altered. CBF increases with acetylcholine averaged 2.4 +/- 0.5 and 6.4 +/- 0.7 ml with adenosine, both less (P less than 0.01) than responses before the arginine analogue. CBF increases with nitroglycerin averaged 7.2 +/- 1.1 ml, similar to control responses. CBF repayment-to-debt ratio during reactive hyperemic responses fell (P less than 0.01) to 1.7 +/- 0.1. L-Arginine (1.0 mg.kg-1.min-1 x 12 min) partially reversed the inhibitory effect of the arginine analogue on CBF responses to acetylcholine. Thus nitric oxide formed in resistance coronary vessels is a major mediator of coronary vasodilation to acetylcholine, adenosine and transient ischemia.