Background Emerging research suggests that service providers experience dilemmas when implementing a harm reduction approach with pregnant or parenting people who use substances (PPPWUS). This study aims to (1) describe perinatal harm reduction practices (2) describe tensions that arise from applying a perinatal harm reduction framework and (3) examine how service providers negotiate these challenges. Methods This participatory qualitative study was co-developed with a perinatal substance use program in Montreal that operates from a harm reduction framework. We conducted 10 semi-structured interviews with interdisciplinary perinatal service providers and performed a reflexive thematic analysis informed by Dubet's sociology of experience framework. Results Providers experience tension due to divergent personal and professional values within themselves. Additionally, an important tension emerges between reporting to Child Protection Services and protecting the therapeutic alliance. These challenges are exacerbated by systemic injustices, social inequities, inefficiencies within health and social services, and collaborating with clinical partners who may have different commitments towards, or understandings of, harm reduction. Providers rely on team collaboration and re-ground themselves in the harm reduction ethic when confronted with opposing forces. Conclusions Results highlight a need to strengthen academic formation and ongoing interdisciplinary/interagency development for professionals who might interface with PPPWUS to gain a shared understanding of the harm reduction philosophy. Further, results support the importance for health and social services system to prioritize greater capacity, accessibility, and collaboration between services to support PPPWUS, mobilize their strengths, and reduce harms for families.
Bacterial genotyping can support outbreak investigations including skin and soft tissue infections point source outbreaks caused by Mycobacterium abscessus. This study presents an innovative approach that combines Nanopore long-read and Illumina short-read whole-genome sequencing (WGS) data using a novel bioinformatic pipeline to identify related M. abscessus isolates.Core-genome SNP phylogeny of Montreal M. abscessus isolatesThe core genome was estimated from open reading frames of the assembled outbreak isolates along with 220 additional isolates from the island of Montreal. M. abscessus subsp. massiliense isolates cultured from the skin infection outbreak patients exhibit high relatedness compared to the Montreal M. abscessus catalog. Physicians and public health authorities identified a potential skin and soft tissue infection outbreak in Montreal, Canada. Six isolates from four patients were retrieved and DNA was sequenced using both Illumina short-read and Oxford Nanopore long-read WGS platforms.Minhash k-mer distances to reference M. abscessus type strains were used to confirm taxonomic identity of clinical isolates. Complete genomes for each isolate were assembled using long-reads and polished using short-read data. Single nucleotide polymorphism (SNP) distances between clinical isolates and the putative earliest outbreak case were used to examine their relatedness. Outbreak isolates were also compared to 220 contemporary Montreal M. abscessus genomes using core-genome (cg) SNPs to assess their relatedness and clustering among locally circulating strains. All outbreak isolates were most closely related to M. abscessus subsp. massilliense. Short reads from the outbreak isolates showed 100% mapping coverage to the complete assembly of the earliest outbreak isolate. All outbreak isolates were found to be nearly identical, differing by only 0-2 SNPs. In comparison, using the more distantly related subspecies reference exaggerated SNP distances between isolates (32-50 SNPs), and between outbreak isolates and the reference (26612-26644 SNPs). The cgSNP phylogenetic tree shows the outbreak isolates are distinct to other Montreal M. abscessus genomes and to the M. abscessus subspecies reference genomes. Our findings indicate that this improved molecular approach leveraging both short and long read sequence data to produce complete genome assemblies of M. abscessus. This helped confirm the relatedness of epidemiologically linked cases and assess their bacterial isolates’ molecular clustering within an extended catalog of locally circulating strains. All Authors: No reported disclosures
Le présent rapport de surveillance porte sur les données du programme de surveillance provinciale des diarrhées à Clostridioides difficile dans les centres hospitaliers de soins généraux et spécialisés participants pour l’année 2024-2025. Il s’agit de l’un des rapports annuels parmi tous les programmes de surveillance.
This pilot study examined the underexplored reading and spelling skills of children with auditory processing disorder (APD). Based on previous research linking auditory and phonological deficits, it was hypothesized that children with APD experiencing literacy difficulties would exhibit a phonological vulnerability profile of dyslexia-dysorthographia (DD), characterized by phonological awareness impairments. Nineteen school-aged children with APD, seen in rehabilitation centers specialized in communication, were assessed with a test battery measuring auditory, reading, and spelling skills as well as cognitive vulnerability factors (e.g., phonological awareness, lexical orthographic memory). Among these participants, four performed within normal limits on the reading and spelling tasks or did not exhibit difficulties related to a DD. The other fifteen participants exhibited difficulties similar to those of children with DD, with thirteen showing results associated with a mnesic vulnerability profile, characterized by lexical orthographic memory deficits, and two showing a mixed profile, combining phonological and mnesic vulnerabilities. Findings of this pilot study highlighted a high rate of reading and spelling difficulties among these children. Their difficulties were not comparable to those seen in children with the phonological vulnerability profile, but with a mnesic profile, suggesting that auditory processing difficulties do not always lead to this profile of DD. These preliminary findings need to be extended to larger samples from various clinical settings to clarify interactions between auditory processing, cognitive vulnerability factors, and written language skills.
The rapid expansion of health data has led to unprecedented information availability within healthcare systems. Health information systems (HIS) play a central role in managing this data and enabling improvements in care delivery, system performance, and population health monitoring. Maximizing the value of HIS, however, requires effective information exchange across systems, making interoperability a critical prerequisite. Despite its recognized benefits, interoperability remains a major challenge within Quebec's Health and Social Services Network, largely due to the heterogeneity and fragmentation of HIS across healthcare institutions. This paper assessed how Quebec's Plan sante addressed interoperability challenges, using the dimensions from the Healthcare Information and Management Systems Society (HIMSS): foundational, structural, semantic, and organizational interoperability. This study highlighted initiatives aimed at strengthening infrastructure and information system architecture to support foundational interoperability and showed persistent challenges at the structural and semantic levels, particularly those related to the adoption of standardized data formats and harmonization of clinical terminologies. Finally, significant implementation challenges that require coordinated change management were identified regarding the organizational interoperability. Overall, while the Plan sante demonstrates a clear commitment to technological modernization, it does not fully address the interoperability multidimensional nature. Achieving meaningful interoperability will require sustained efforts across technical, normative, and organizational domains beyond the strategies currently outlined. Recent governance developments, including the creation of Sante Quebec, add complexity to this evolving context and raise further questions regarding the coordination of interoperability governance.
