Initiatives de Promotion de la santé au travail : Un examen des enjeux et du contexte au Québec et au Canada

Les études sur les avantages financiers des initiatives de Promotion de la santé au travail (PST) se multiplient. L’intérêt pour ces études provient à la fois des entreprises et des gouvernements. D’une part, les entreprises perçoivent ces programmes comme un moyen potentiel d’augmenter leur productivité face à la concurrence mondiale qui s’intensifie. D’autre part, les gouvernements, cherchant des moyens de diminuer ou de freiner l’augmentation des coûts de la santé, voient ces initiatives comme un levier supplémentaire pour atteindre leurs objectifs budgétaires. Le constat qui ressort de ces études et qu’un dollar investi en PST génère en moyenne trois dollars comme bénéfice. Ces bénéfices prennent principalement la forme d’une diminution de l’absentéisme et de coûts d’assurance santé moindres. Les effets indirects sur la productivité sont moins étudiés. Malgré ces constatations, peu d’entreprises investissent dans la PST et de nombreux employés n’ont pas adhéré aux programmes existants. Au Canada, on constate une diminution récente du nombre d’entreprises participant aux initiatives de PST. Plusieurs raisons sont avancées pour expliquer ce manque d’implication. Une première explication repose sur le fait que les études existantes ne tiennent pas souvent compte de tous les facteurs expliquant la présence d’initiatives de PST en entreprise. En conséquence, bien que les entreprises qui implémentent des initiatives de PST en retirent des bénéfices, il n’est pas dit que celles où ces programmes sont absents retireraient les mêmes bénéfices advenant l’implantation de telles initiatives. Une deuxième explication avance que la faible incidence de ces programmes est causée par un manque général d’intérêt et de connaissances du public à ce propos, de ressources insuffisantes au sein des organisations et de faibles pressions politiques. Misant sur la seconde explication, plusieurs gouvernements tels les États-Unis et l’Allemagne ont adopté des mesures législatives qui encouragent la participation à la PST et récompensent les efforts à cet égard. Deux exemples de telles mesures sont la version modifiée du Healthy Workforce Act (loi concernant la santé de la main-d’œuvre), adoptée par le Sénat américain en 2010, et les modifications du German Tax Act (loi sur l’impôt de l’Allemagne) adoptées en 2009. Ces deux lois offrent des allégements fiscaux aux employeurs qui mettent en place certains programmes de PST. Néanmoins, nous concluons que des études supplémentaires seraient nécessaires pour bien évaluer les bénéfices nets de tels programmes.

Implications of differing input data sources and approaches upon forest carbon stock estimation

Site index is an important forest inventory attribute that relates productivity and growth expectation of forests over time. In forest inventory programs, site index is used in conjunction with other forest inventory attributes (i.e., height, age) for the estimation of stand volume. In turn, stand volumes are used to estimate biomass (and biomass components) and enable conversion to carbon. In this research, we explore the implications and consequences of different estimates of site index on carbon stock characterization for a 2,500-ha Douglas-fir-dominated landscape located on Eastern Vancouver Island, British Columbia, Canada. We compared site index estimates from an existing forest inventory to estimates generated from a combination of forest inventory and light detection and ranging (LIDAR)-derived attributes and then examined the resultant differences in biomass estimates generated from a carbon budget model (Carbon Budget Model of the Canadian Forest Sector (CBM-CFS3)). Significant differences were found between the original and LIDAR-derived site indices for all species types and for the resulting 5-m site classes (p < 0.001). The LIDAR-derived site class was greater than the original site class for 42{\%} of stands; however, 77{\%} of stands were within +/-1 site class of the original class. Differences in biomass estimates between the model scenarios were significant for both total stand biomass and biomass per hectare (p < 0.001); differences for Douglas-fir-dominated stands (representing 85{\%} of all stands) were not significant (p = 0.288). Overall, the relationship between the two biomass estimates was strong (R(2) = 0.92, p < 0.001), suggesting that in certain circumstances, LIDAR may have a role to play in site index estimation and biomass mapping

Successful treatment of HIV-associated multicentric Castleman's disease and multiple organ failure with rituximab and supportive care: a case report

<p>Abstract</p> <p>Introduction</p> <p>Multicentric Castleman's Disease (MCD), a lymphoproliferative disorder associated with Human Herpes Virus-8 (HHV-8) infection, is increasing in incidence amongst HIV patients. This condition is associated with lymphadenopathy, polyclonal gammopathy, hepato-splenomegaly and systemic symptoms. A number of small studies have demonstrated the efficacy of the anti-CD20 monoclonal antibody, rituximab, in treating this condition.</p> <p>Case presentation</p> <p>We report the case of a 46 year old Zambian woman who presented with pyrexia, diarrhoea and vomiting, confusion, lymphadenopathy, and renal failure. She rapidly developed multiple organ failure following the initiation of treatment of MCD with rituximab. Following admission to intensive care (ICU), she received prompt multi-organ support. After 21 days on the ICU she returned to the haematology medical ward, and was discharged in remission from her disease after 149 days in hospital.</p> <p>Conclusion</p> <p>Rituximab, the efficacy of which has thus far been examined predominantly in patients <it>outside </it>the ICU, in conjunction with extensive organ support was effective treatment for MCD with associated multiple organ failure. There is, to our knowledge, only one other published report of its successful use in an ICU setting, where it was combined with cyclophosphamide, adriamycin and prednisolone. Reports such as ours support the notion that critically unwell patients with HIV and haematological disease <it>can </it>benefit from intensive care.</p

Economic burden and health-related quality-of-life among infants with respiratory syncytial virus infection: a multi-country prospective cohort study in Europe

Background: Respiratory syncytial virus (RSV) causes a considerable disease burden in young children globally, but reliable estimates of RSV-related costs and health-related quality-of-life (HRQoL) are scarce. This study aimed to evaluate the RSV-associated costs and HRQoL effects in infants and their caregivers in four European countries. Methods: Healthy term-born infants were recruited at birth and actively followed up in four European countries. Symptomatic infants were systematically tested for RSV. Caregivers recorded the daily HRQoL of their child and themselves, measured by a modified EQ-5D with Visual Analogue Scale, for 14 consecutive days or until symptoms resolved. At the end of each RSV episode, caregivers reported healthcare resource use and work absenteeism. Direct medical costs per RSV episode were estimated from a healthcare payer's perspective and indirect costs were estimated from a societal perspective. Means and 95% confidence intervals (CI) of direct medical costs, total costs (direct costs + productivity loss) and quality-adjusted life-day (QALD) loss per RSV episode were estimated per RSV episode, as well as per subgroup (medical attendance, country). Results: Our cohort of 1041 infants experienced 265 RSV episodes with a mean symptom duration of 12.5 days. The mean (95% CI) cost per RSV episode was €399.5 (242.3, 584.2) and €494.3 (317.7, 696.1) from the healthcare payer's and societal perspective, respectively. The mean QALD loss per RSV episode of 1.9 (1.7, 2.1) was independent of medical attendance (in contrast to costs, which also differed by country). Caregiver and infant HRQoL evolved similarly. Conclusion: This study fills essential gaps for future economic evaluations by prospectively estimating direct and indirect costs and HRQoL effects on healthy term infants and caregivers separately, for both medically attended (MA) and non-MA laboratory-confirmed RSV episodes. We generally observed greater HRQoL losses than in previous studies which used non-community and/or non-prospective designs

Impact of model resolution on tropical cyclone simulation using the HighResMIP–PRIMAVERA multimodel Ensemble

A multimodel, multiresolution set of simulations over the period 1950–2014 using a common forcing protocol from CMIP6 HighResMIP have been completed by six modeling groups. Analysis of tropical cyclone performance using two different tracking algorithms suggests that enhanced resolution toward 25 km typically leads to more frequent and stronger tropical cyclones, together with improvements in spatial distribution and storm structure. Both of these factors reduce typical GCM biases seen at lower resolution. Using single ensemble members of each model, there is little evidence of systematic improvement in interannual variability in either storm frequency or accumulated cyclone energy as compared with observations when resolution is increased. Changes in the relationships between large-scale drivers of climate variability and tropical cyclone variability in the Atlantic Ocean are also not robust to model resolution. However, using a larger ensemble of simulations (of up to 14 members) with one model at different resolutions does show evidence of increased skill at higher resolution. The ensemble mean correlation of Atlantic interannual tropical cyclone variability increases from ~0.5 to ~0.65 when resolution increases from 250 to 100 km. In the northwestern Pacific Ocean the skill keeps increasing with 50-km resolution to 0.7. These calculations also suggest that more than six members are required to adequately distinguish the impact of resolution within the forced signal from the weather noise

Fine-scale population structure and connectivity of bottlenose dolphins, Tursiops truncatus, in European waters and implications for conservation

Funding: Fyssen post-doctoral fellowship, Fondation Total, a bridge funding from the School of Biology of the University of St Andrews and People’s Trust for Endangered Species (ML).1. Protecting species often involves the designation of protected areas, wherein suitable management strategies are applied either at the taxon or ecosystem level. Special Areas of Conservation (SACs) have been created in European waters under the Habitats Directive to protect bottlenose dolphins, Tursiops truncatus, which forms two ecotypes, pelagic and coastal. 2. The SACs have been designated in coastal waters based on photo‐identification studies that have indicated that bottlenose dolphins have relatively high site fidelity. However, individuals can carry out long‐distance movements, which suggests potential for demographic connectivity between the SACs as well as with other areas. 3. Connectivity can be studied using genetic markers. Previous studies on the species in this area used different sets of genetic markers and therefore inference on the fine‐scale population structure and demographic connectivity has not yet been made at a large scale. A common set of microsatellite markers was used in this study to provide the first comprehensive estimate of genetic structure of bottlenose dolphins in European Atlantic waters. 4. As in previous studies, a high level of genetic differentiation was found between coastal and pelagic populations. Genetic structure was defined at an unprecedented fine‐scale level for coastal dolphins, leading to identification of five distinct coastal populations inhabiting the following areas: Shannon estuary, west coast of Ireland, English Channel, coastal Galicia, east coast of Scotland and Wales/west Scotland. Demographic connectivity was very low among most populations with <10% migration rate, suggesting no demographic coupling among them. Each local population should therefore be monitored separately. 5. The results of this study have the potential to be used to identify management units for bottlenose dolphins in this region and thus offer a significant contribution to the conservation of the species in European Atlantic waters. Future studies should prioritize obtaining biopsies from free‐living dolphins from areas where only samples from stranded animals were available, i.e. Wales, west Scotland and Galicia, in order to reduce uncertainty caused by sample origin doubt, as well as from areas not included in this study (e.g. Iroise Sea, France). Furthermore, future management strategies should include monitoring local population dynamics and could also consider other options, such as population viability analysis or the incorporation of genetic data with ecological data (e.g. stable isotope analysis) in the designation of management units.PostprintPeer reviewe

Considerations for best practices in studies of fiber or other dietary components and the intestinal microbiome

Considerations for best practices in studies of fiber or other dietary components and the intestinal microbiome. Am J Physiol Endocrinol Metab 315: E1087–E1097, 2018. First published August 21, 2018; doi:10.1152/ajpendo.00058.2018.—A 2-day workshop organized by the National Institutes of Health and U.S. Department of Agriculture included 16 presentations focused on the role of diet in alterations of the gastrointestinal microbiome, primarily that of the colon. Although thousands of research projects have been funded by U.S. federal agencies to study the intestinal microbiome of humans and a variety of animal models, only a minority addresses dietary effects, and a small subset is described in sufficient detail to allow reproduction of a study. Whereas there are standards being developed for many aspects of microbiome studies, such as sample collection, nucleic acid extraction, data handling, etc., none has been proposed for the dietary component; thus this workshop focused on the latter specific point. It is important to foster rigor in design and reproducibility of published studies to maintain high quality and enable designs that can be compared in systematic reviews. Speakers addressed the influence of the structure of the fermentable carbohydrate on the microbiota and the variables to consider in design of studies using animals, in vitro models, and human subjects. For all types of studies, strengths and weaknesses of various designs were highlighted, and for human studies, comparisons between controlled feeding and observational designs were discussed. Because of the lack of published, best-diet formulations for specific research questions, the main recommendation is to describe dietary ingredients and treatments in as much detail as possible to allow reproduction by other scientists

Younger adult type 2 diabetic patients have poorer glycaemic control: A cross-sectional study in a primary care setting in Singapore

10.1186/1472-6823-13-18BMC Endocrine Disorders13-BEDM

LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie