Ariane Adam-Poupart

Spatiotemporal modeling of ozone levels in Quebec (Canada): a comparison of kriging, land-use regression (LUR), and combined Bayesian maximum entropy-LUR approaches.

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

Summer outdoor temperature and occupational heat-related illnesses in Quebec (Canada).

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.

Effect of summer outdoor temperatures on work-related injuries in Quebec (Canada)

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.

Immunotoxicity of 3 chemical forms of beryllium following inhalation exposure.

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.

Passive Tick Surveillance Provides an Accurate Early Signal of Emerging Lyme Disease Risk and Human Cases in Southern Canada

Abstract 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.

Practices of Lyme disease diagnosis and treatment by general practitioners in Quebec, 2008–2015

BackgroundLyme disease (LD), a multisystem infection caused by the spirochete Borrelia burgdorferi sensu stricto (B. burgdorferi), is the most reported vector-borne disease in North America, and by 2020, 80% of the population in central and eastern Canada could live in LD risk areas. Among the key factors for minimising the impact of LD are the accurate diagnosis and appropriate management of patients bitten by ticks. In this study, the practices of Quebec general practitioners (GPs) on LD diagnosis and management of patients bitten by infected ticks are described.MethodsEight years (2008 to 2015) of retrospective demographic and clinical data on patients bitten by infected Ixodes scapularis (I. scapularis) ticks and on the management of suspected and confirmed LD cases by Quebec GPs were analysed.ResultsAmong 50 patients, all the antimicrobial treatments of LD clinical cases were appropriate according to current guidelines. However, more than half (62.8%) of erythema migrans (EM) were possibly misdiagnosed, 55.6%, (n = 27) of requested serologic tests were possibly unnecessary and the majority (96.5%, n = 57) of prophylactic antimicrobial treatments were not justified according to current guidelines.ConclusionsThese observations underline the importance for public health to enhance the knowledge of GPs where LD is emerging, to minimise the impact of the disease on patients and the financial burden on the health system.

Association between outdoor ozone and compensated acute respiratory diseases among workers in Quebec (Canada)

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.

Evidence for increasing densities and geographic ranges of tick species of public health significance other than Ixodes scapularis in Québec, Canada

Climate change is driving emergence and establishment of Ixodes scapularis, the main vector of Lyme disease in Québec, Canada. As for the black-legged tick, I. scapularis Say, global warming may also favor northward expansion of other species of medically important ticks. The aims of this study were to determine (1) current diversity and abundance of ticks of public health significance other than I. scapularis, (2) sex and age of the human population bitten by these ticks (3), and the seasonal and geographic pattern of their occurrence. From 2007 to 2015, twelve tick species other than I. scapularis were submitted in the Québec passive tick surveillance program. Of these 9243 ticks, 91.2% were Ixodes cookei, 4.1% were Dermacentor variabilis, 4.0% were Rhipicephalus sanguineus and 0.7% were Amblyomma americanum. The combined annual proportion of submitted I. cookei, D. variabilis, R. sanguineus and A. americanum ticks in passive surveillance rose from 6.1% in 2007 to 16.0% in 2015 and an annual growing trend was observed for each tick species. The number of municipalities where I. cookei ticks were acquired rose from 104 to 197 during the same period. Of the 862 people bitten by these ticks, 43.3% were I. cookei ticks removed from children aged < 10 years. These findings demonstrate the need for surveillance of all the tick species of medical importance in Québec, particularly because climate may increase their abundance and geographic ranges, increasing the risk to the public of the diseases they transmit.

0322 The usefulness of compensation statistics to detect heat-related health outcomes in a temperate climate: the experience of Quebec0322 The usefulness of compensation statistics to detect heat-related health outcomes in a temperate climate: the experience of Quebec

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.

370 Can compensation statistics detect the impact of summer outdoor temperatures on workers’ health and safety? Preliminary results in Quebec (Canada)

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 1oC 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 oC. 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.