Claude Tremblay

Diabetes and the Severity of Pandemic Influenza A (H1N1) Infection

OBJECTIVE To confirm the existence of an increased risk of complications from influenza A (H1N1)p among patients with diabetes. RESEARCH DESIGN AND METHODS Using data from an enhanced influenza surveillance project in Montreal, Canada, and age/sex-specific population estimates of diabetes prevalence, we estimated the risk of hospitalization among persons with diabetes. Comparing hospitalized patients admitted or not to an intensive care unit (ICU), we estimated the risk of ICU admission associated with diabetes, controlling for other patient characteristics. RESULTS Among 239 hospitalized patients with PCR-confirmed influenza A (H1N1)p, 162 (68%) were interviewed, of whom 22 had diabetes, when 7.1 were expected (prevalence ratio 3.10 [95% CI 2.04–4.71]). The odds ratio for ICU admission was 4.29 (95% CI 1.29–14.3) among hospitalized patients with diabetes compared to those without. CONCLUSIONS Diabetes triples the risk of hospitalization after influenza A (H1N1)p and quadruples the risk of ICU admission once hospitalized.

Access to Sterile Injecting Equipment is More Important Than Awareness of HCV Status for Injection Risk Behaviors Among Drug Users

Awareness of hepatitis C virus (HCV) infection status is expected to influence risk behaviors. In 2004–2005, injection drug users (IDUs) recruited from syringe exchange programs (SEPs) and methadone clinics in Montreal, Canada, were interviewed on drug use behaviors (past 6 months) and HCV testing. Subjects (n = 230) were classified as low/intermediate risk (20.4% borrowed drug preparation equipment only) and high risk (19.6% borrowed syringes), and 54.5% reported being HCV positive. Logistic regression modeling showed that compared to no risk (60% borrowed nothing), low/intermediate risk was associated with fewer noninjecting social network members, poor physical health, and problems obtaining sterile injecting equipment. High risk was associated with all of these factors except social networks. HCV status was not associated with any level of risk. Improved access to sterile injecting equipment may be more important than knowledge of HCV status in reducing injection risks among this IDU population. The study limitations are noted and recommendations discussed.

Sexual Health of Adolescents in Quebec Residential Youth Protection Centres

ObjectivesTo document risk behaviours and prevalence of chlamydia and gonorrhoea infections among adolescents aged 14 to17 years entering care in Quebec Youth Protection Centres (YPC).MethodsFrom July 2008 to May 2009, adolescents residing in six YPCs completed a questionnaire during a face-to-face interview. Questions covered sexual and substance use behaviours prior to admission, as well as other health issues affecting respondents’ mental and physical health. Urine samples were tested for Chlamydia trachomatis genital infection (CTGI) and Neisseria gonorrhoea genital infection (NGGI).ResultsAmong 578 participants aged 14 to 17 years, 89% had had consensual sexual relations. Sexual risk behaviours included early sexual initiation (66% at <14 years); multiple partners (median lifetime number: girls 5, boys 8); 50% or more of sexual relations under the influence of drugs or alcohol (girls 43%, boys 48%); group sex (girls 38%, boys 43%); and sex in exchange for money or other goods (girls 27%, boys 8%). Only a quarter of boys and girls used double protection (condom and a contraceptive method) during the most recent vaginal relation. A history of pregnancy was reported by 28% of girls. Prevalence of CTGI was 9.3% (CI: 5.5–14.5) among girls and 1.9% (CI: 0.6–4.4) among boys. Prevalence of NGGI gonorrhoea was 1.7% (CI: 0.3–4.8) among girls and 0% (CI: 0.0–1.4) among boys.In multivariate analyses, factors significantly associated with chlamydia infection among sexually active girls were: hospitalization for alcohol intoxication; and a history of suicidal ideation with plan.ConclusionSexual risk behaviours are common among adolescents entering YPCs, resulting in high levels of chlamydia infection. Mental health issues such as substance misuse and serious depressive symptoms are associated with these high rates. A youth’s stay in these facilities is an opportune time to screen not only for sexual risk behaviours but also for mental health problems; appropriate risk reduction education and referrals can then be provided as needed.RésuméObjectifsDécrire les comportements à risque et la prévalence des infections à chlamydia et de la gonorrhée chez les adolescents de 14 à 17 ans placés dans les centres québécois de protection de la jeunesse (CPJ).MéthodeEntre juillet 2008 et mai 2009, des adolescents placés dans six CPJ ont rempli un questionnaire au cours d’une entrevue en personne. Les questions portaient sur les comportements sexuels des répondants, leur consommation de substances avant le placement et d’autres enjeux ayant une incidence sur leur santé physique et mentale. Des échantillons d’urine ont été prélevés pour détecter les infections génitales à Chlamydiae trachomatis (IGCT) et les infections génitales à Neisseria gonorrhoeae (IGNG).RésultatsSur les 578 participants de 14 à 17 ans, 89 % avaient eu des relations sexuelles consensuelles. Les comportements sexuels à risque étaient l’initiation sexuelle précoce (66 % à <14 ans); les partenaires multiples (nombre médian à vie: filles 5, garçons 8); 50 % ou plus de relations sexuelles avec facultés affaiblies par la drogue ou l’alcool (filles 43 %, garçons 48 %); les activités sexuelles en groupe (filles 38 %, garçons 43 %); et les relations sexuelles en échange d’argent ou de cadeaux (filles 27 %, garçons 8 %). Seulement le quart des garçons et des filles avaient utilisé une double protection (condom et méthode anticonceptionnelle) au cours de leur dernière relation vaginale. Des antécédents de grossesse ont été déclarés par 28 % des filles. La prévalence des IGCT était de 9,3 % (IC: 5,5-14,5) chez les filles et de 1,9 % (IC: 0,6-4,4) chez les garçons. La prévalence des IGNG était de 1,7 % (IC: 0,3-4,8) chez les filles et de 0 % (IC: 0,0-1,4) chez les garçons.Dans nos analyses multivariées, les facteurs présentant une corrélation significative avec les infections à chlamydia chez les filles sexuellement actives étaient: l’hospitalisation pour intoxication alcoolique; et des antécédents d’idées suicidaires avec des plans.ConclusionLes comportements sexuels à risque sont courants chez les adolescents placés dans les CPJ, ce qui entraîne des niveaux élevés d’infections à chlamydia. Des troubles de santé mentale, comme l’abus de substances et les symptômes de dépression grave, sont associés à ces taux élevés. Le séjour d’une ou d’un jeune dans ces centres est un moment opportun de dépister non seulement ses comportements sexuels à risque, mais aussi ses troubles de santé mentale; on peut alors sensibiliser la personne à la réduction des risques et la diriger vers les ressources appropriées.