Helicobacter pylori is a bacterium that may colonise and proliferate in human stomachs, leading invariably to chronic inflammation and, to a lesser extent, to peptic ulcers and cancer. The main objective of this study is to describe the epidemiology surrounding H. pylori in Nunavik's Inuit population using the 2004 and 2017 Health Surveys. Estimated prevalences were 70.9% for bacterial colonisation using a stool antigens test (SAT), 72.5% for anti-H. pylori antibodies, 12.7% for faecal occult blood in participants aged ≥ 50 and respectively of 28.4%, 11.2% and 2.4% for a prior diagnosis of colonisation, gastritis and peptic ulcer in the medical charts, with under five cases of gastric cancer reported. Variables associated with higher SAT+ prevalence were the number of household members (prevalence ratio [PR] = 1.03) and age (quadratic relationship), whereas mainly drinking municipal (PR = 0.84) and natural water (PR = 0.72) compared to bottled water, and increasing alcohol consumption (PR = 0.96) were associated with reduced prevalence. Despite current regional guidelines targeting high risk individuals in the context of high prevalence, Nunavik's health authorities must remain vigilant by following gastric cancer incidence and the rapid evolution of guidelines, while considering local realities.

Objectives To assess the prevalence of arterial hypertension among Inuit adults living in Nunavik (northern Quebec, Canada) in 2017 and identify its sociodemographic and lifestyle determinants. Methods We used data obtained from 1177 Inuit adults aged ≥ 18 years who participated in the cross-sectional Qanuilirpitaa? Nunavik Inuit Health Survey during late summer-early fall of 2017. Resting blood pressure (BP) and anthropometric characteristics were measured during a clinical session, while sociodemographic characteristics and lifestyle habits were documented using validated questionnaires. Information on current medication was retrieved from medical files. Sex-stratified population-weighted log-binomial regressions were conducted to identify determinants of hypertension, adjusting for potential confounders. Results Hypertension (systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mmHg or taking antihypertensive medication) was present in 23% of the adult population and was more frequent in men than women (29% vs. 18%). About a third of hypertensive individuals (34%) were taking antihypertensive medication. These estimates are prone to biases due to the relatively low participation rate (37%). As expected, the prevalence of hypertension increased with age, but values were surprisingly elevated in 18 to 29-year-old men and women (18% and 8%, respectively) compared with 20 to 39-year-old adults of the general Canadian population (3% in both sexes, according to data from the Canadian Health Measures Survey, 2012–2015). Hypertension was associated with obesity and alcohol consumption in both men and women, and with higher socioeconomic status among men. Conclusion This survey revealed a high prevalence of hypertension among young Nunavimmiut adults in 2017 and the need to improve hypertension diagnosis and treatment in the region. Curbing obesity and alcohol consumption, two actionable determinants of hypertension, will require improving food security and addressing the consequences of historical trauma linked to colonization.

Objectives Respiratory diseases are the leading cause of hospitalization in Nunavik (northern Québec, Canada) and contribute to disparities in life expectancy with the rest of Canada. As part of Qanuilirpitaa? 2017, a cross-sectional population-based health survey, we sought to describe the prevalence of respiratory health indicators, including the first estimate of airway obstruction based on spirometry in an Inuit population, and explore their associated characteristics. Methods We analyzed data from 1296 participants aged 16 years and older, using multivariate logistic regression to assess characteristics associated with spirometry-determined airway obstruction and self-reported respiratory symptoms, i.e., wheezing in the last year and chronic cough during at least 3 months. Results In this relatively young population (83% aged 16 to 54), the prevalences of wheezing, chronic cough, and airway obstruction were, respectively, 27% (95% CI 24–30), 21% (18–23), and 17% (14–20). These estimates are prone to biases due to the relatively low participation rate (about 37%). The most consistent associations were with smoking (≥ 15 pack-years; odds ratio [OR] 3.13, 3.39, and 2.86 for the three indicators, respectively) and food security (OR 0.55 with wheezing and OR 0.26 with chronic cough), as defined in the Household Food Security Survey Module. Wheezing was also associated with allergic sensitization to dogs (2.60) and obesity (2.18). Chronic cough was associated with respiratory infections during childhood (2.12), housing in need of major repairs (1.72), and housing crowding (1.50), and was negatively associated with participation to traditional activities (0.62) and going on the land (0.64). Airway obstruction was associated with being underweight (3.84) and post-secondary education (0.40). Among young adults and women, wheezing was also associated with any inhalation of solvents for recreational purposes during their lifetime (2.62 and 1.56, respectively), while airway obstruction was associated with regular marijuana use (2.22 and 1.84, respectively). Conclusion Smoking and food insecurity are both highly prevalent and strongly associated with respiratory symptoms in Nunavik. Together with essential smoking prevention and cessation programs, our findings suggest that solving food security and housing crises, improving socioeconomic conditions, and promoting traditional lifestyle may improve respiratory health in Nunavik.

Between 2007 and 2012, hospitalization rate related to respiratory system diseases in children ≤1-year-old was near 7 times higher in Nunavik compared with the whole province of Quebec. To assess the impact of poor indoor air quality (IAQ) in residential environments on children's respiratory health, the Nunavik's intervention study investigated the impact of the optimization of ventilation systems on the incidence rates of respiratory infections in children in Nunavik. Children under 10 years were recruited and categorized according to the type of ventilation system in their home: energy recovery ventilator (ERV), heat recovery ventilator (HRV), no HRV or ERV, and control groups. Children's' medical records were analyzed over a period of 50 weeks pre- and post-intervention. Clinical diagnoses were classified into 4 categories: upper respiratory infections, lower respiratory infections, otitis media, and asthma. A decrease in respiratory infections episodes was observed in all groups following intervention with the highest impact observed for HRV systems (-53.0%). Decreases in the ERV group were not significant (-21,7%) possibly due to the presence of some volatile organic compound (such as propylene glycol) and inerrant experimental bias. Nevertheless, no significant association was found between health episodes incidence and household's behaviors or IAQ.

Toxoplasma gondii is a globally distributed protozoan that mainly causes health issues in the fetuses of pregnant women who have never been exposed to this parasite and patients with deficient immune systems. Except in these vulnerable populations, the primary infection generally goes unnoticed in most healthy individuals. Apart from transplant/transfusion, congenital transmission, direct contact with infected cats or their feces, and environmental contamination (i.e., oocysts in food, water, and soil) pathways, humans can acquire the parasite through consumption of animal tissues infected by T. gondii. This meta-analysis estimated the risk of acquiring T. gondii by consuming raw or undercooked meat, regardless of which animal species are eaten. Using a random-effect model, crude and adjusted pooled measures of association (risk and odds ratio) were estimated according to study design (cohort, case-control, and cross-sectional studies). The meta-analysis included measures of heterogeneity as well as quality rating scales for each study design. Our results suggest that individuals who eat raw or undercooked meat have, respectively, 1.2-1.3 times the risk and 1.7-3.0 times the odds of T. gondii infection compared to those who thoroughly cook meat, regardless of the animal species they consume. These results align with the current understanding that adequately cooking meat inactivates the parasite and decreases the risk of transmission. Seroprevalence ranged from 1.3% to 88.6%, while the proportion of individuals eating raw or undercooked meat fluctuated from 0.7% to 98.3% across the studies in the meta-analysis. These numbers reflect various preferences with regard to eating meat (i.e., eating tartar, sausages, or salamis) as well as individual, cultural and religious food habits, and personal awareness.

Foci of high seroprevalence against Toxoplasma gondii are observed in Nunavik, the Inuit land of Northern Quebec (Canada). Considering the rare occurrence of felids in the region, exposure is suspected to be driven by water- and food-borne transmission routes. Hypotheses were that drinking untreated water from natural sources and eating country food mostly raw increased the risk of exposure to the parasite. Data from 1,300 Inuit participants of the 2017 Nunavik Health Survey were included in three weighted robust Poisson regression models. The effect of three types of exposure variables: (1) water treatment (yes/no) and if country food was mostly eaten raw (yes/no); (2) main source of drinking water (bottled/municipal/natural) and frequency of country food consumption (continuous) and (3) drinking water risk (low/intermediate/high) and frequency of a raw country food consumption (continuous), on the presence of Toxoplasma antibodies were estimated. Models were adjusted for age, sex and ecological region, with multiple sensitivity analyses being performed. Toxoplasma gondii seroprevalences were consistently correlated with age quadratically, sex (prevalence ratio = PRwoman/man ranged from 1.18 to 1.22), ecological region (PRHudsonBay/HudsonStrait ranged from 2.18 to 2.41; PRHudsonBay/UngavaBay ranged from 1.52 to 1.59) and consuming bivalve mollusc/urchin (PR varied from 1.02 to 1.21) across all three models. Each increase of two consumptions per month of beluga (PR ranged from 1.01 to 1.03), seal liver (PR ranged from 1.01 to 1.02) and goose (PR ranged from 1.01 to 1.02) were also associated with seropositivity, albeit more clearly in models 2 and 3, while drinking water mainly from natural (PR of 1.47) or municipal (PR = 1.42) sources compared to bottled water, was correlated with seroprevalence, although results were compatible with the null. Our results suggest that both the oocyst- (mollusc/urchin, drinking water) and cyst-borne (walrus, seal liver and goose) transmission pathways could be present in Nunavik.

Indoor air quality is a major issue for public health, particularly in northern communities. In this extreme environment, adequate ventilation is crucial to provide a healthier indoor environment, especially in airtight dwellings. The main objective of the study is to assess the impact of ventilation systems and their optimization on microbial communities in bioaerosols and dust in 54 dwellings in Nunavik. Dwellings with three ventilation strategies (without mechanical ventilators, with heat recovery ventilators, and with energy recovery ventilators) were investigated before and after optimization of the ventilation systems. Indoor environmental conditions (temperature, relative humidity) and microbiological parameters (total bacteria, Aspergillus/Penicillium, endotoxin, and microbial biodiversity) were measured. Dust samples were collected in closed face cassettes with a polycarbonate filter using a micro-vacuum while a volume of 20 m3 of bioaerosols were collected on filters using a SASS3100 (airflow of 300 L/min). In bioaerosols, the median number of copies was 4.01 × 103 copies/m3 of air for total bacteria and 1.45 × 101 copies/m3 for Aspergillus/Penicillium. Median concentrations were 5.13 × 104 copies/mg of dust, 5.07 × 101 copies/mg, 9.98 EU/mg for total bacteria, Aspergillus/Penicillium and endotoxin concentrations, respectively. The main microorganisms were associated with human occupancy such as skin-related bacteria or yeasts, regardless of the type of ventilation.

Abstract Coxiella burnetii is a zoonotic agent responsible for human Q fever, a potentially severe disease that can lead to persistent infection. This cross-sectional study aimed to estimate the seroprevalence to C. burnetii antibodies and its association with potential risk factors in the human population of five regions of Québec, Canada. A serum bank comprising sera from 474 dog owners was screened by an enzyme-linked immunosorbent assay followed by confirmation of positive or equivocal sera by an indirect immunofluorescence assay. Observed seroprevalences of 1.2% (95% confidence interval (CI): 0.0–6.6), 2.6% (95% CI: 0.5–7.4) and 5.9% (95% CI: 3.4–9.6) were estimated in the regions of Montréal, Lanaudière and Montérégie, respectively, which all included at least 83 samples. Having lived or worked on a small ruminant farm (prevalence odds ratio (POR) = 5.4; 95% CI: 1.6–17.7) and being a veterinarian or veterinary student (POR = 6.1; 95% CI: 1.6–24.0) were significantly associated with C. burnetii seropositivity. Antibodies against C. burnetii were detected in the human population of Québec. Although seropositivity to this agent was associated with occupational contact with domestic animals, antibodies were also detected in people with no reported professional exposure. No associations with ruminant farm proximity were identified.

Vibrio (V), a genus of marine bacteria, are common inhabitants of warm coastal waters and estuaries. Vibrio includes V. parahaemolyticus and V. vulnificus species that can cause human infections through the consumption of contaminated shellfish (as bivalve molluscs). The growth of pathogenic Vibrio is related to ambient water temperature and seems to increase at 15 degrees C and over. The expansion of Vibrio infection outbreak is increasing worldwide due to the increase of the sea surface temperature as a result of ocean warming. Canada's coast is not an exception to this worldwide Vibrio spread. Faced with this issue, this study focuses on modelling the future potential Vibrio growth risk along the coasts of the St. Lawrence Gulf and Estuary, where the shellfish industry is well developed. This is done using the adequate machine learning model with explanatory variables that include air temperature and wind speed for predicting future water temperatures. Based on the predicted future water temperature scenarios and a threshold of 15 degrees C to determine the conditions favorable to the growth of Vibrio bacteria, we modelled the Vibrio growth risk indicator, i.e. the number of days exceeding the minimum temperature for Vibrio pathogenic growth (15 degrees C), in the horizon 2040-2100. Simulations show that the number of days, where the minimum temperature (15 degrees C) will be reached, will increase spatially and even seasonally and all the shellfish beds would meet the temperature condition for Vibrio growth regardless of the climate scenario (optimistic and pessimistic).

Les changements climatiques sont associés à un établissement et à une expansion géographique des zoonoses. L’augmentation des cas humains de maladie de Lyme au Québec (Canada) représente un exemple bien documenté. Avec la hausse des températures observée au Québec, on s’attend à ce que plusieurs zoonoses soient touchées. Afin de répondre aux enjeux zoonotiques croissants auxquels font face les autorités de la santé publique, l’Observatoire multipartite québécois sur les zoonoses et l’adaptation aux changements climatiques (l’Observatoire) a été fondé en 2015 comme partie intégrante du Plan d’action 2013–2020 sur les changements climatiques du gouvernement du Québec. L’Observatoire a été créé dans le but de regrouper des décideurs de politiques publiques et des experts en santé humaine et animale ainsi qu’en sciences de l’environnement selon l’approche novatrice « Un monde, une santé ». Cet observatoire offre un espace de partage de connaissances et de recherche de consensus entre les représentants de décideurs de politiques publiques et les scientifiques. Ses objectifs principaux sont d’anticiper et de prioriser les enjeux potentiels associés aux zoonoses au Québec afin de soutenir la gestion des risques et l’adaptation aux changements climatiques. Le présent article décrit la structure de l’Observatoire, ce qu’il fait et résume ses plans pour l’avenir. Affiliations 1 Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal (Québec) 2 Groupe de recherche en épidémiologie des zoonoses et en santé publique, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe (Québec) 3 Direction de la santé publique, Centre intégré universitaire de santé et de services sociaux de l’Estrie-Centre hospitalier universitaire de Sherbrooke, Sherbrooke (Québec) 4 Laboratoire national de microbiologie, Agence de la santé publique du Canada, Saint-Hyacinthe (Québec) 5 Scénarios et services climatiques, Ouranos, Montréal (Québec) 6 Section d’épidémiologie et de surveillance de la santé des animaux terrestres, Direction des sciences de la santé des animaux, Agence canadienne d’inspection des aliments, Saint-Hyacinthe (Québec) 7 Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du Québec, Québec (Québec) 8 Direction de l’expertise sur la faune terrestre, l’herpétofaune et l’avifaune, Ministère des Forêts, de la Faune et des Parcs, Québec (Québec) 9 Direction de la vigie sanitaire, Ministère de la Santé et des Services sociaux, Montréal (Québec) 10 Direction de la santé animale, Ministère de l’Agriculture, des Pêcheries et de l’Alimentation, Québec (Québec) *Correspondance : genevieve.germain@inspq.qc.ca Citation suggérée : Germain G, Simon A, Arsenault J, Baron G, Bouchard C, Chaumont D, El Allaki F, Kimpton A, Lévesque B, Massé A, Mercier M, Ogden NH, Picard I, Ravel A, Rocheleau JP, Soto J. Observatoire multipartite québecois sur les zoonoses et l’adaptation aux changements climatiques. Relevé des maladies transmissibles au Canada 2019;45(5):159-64. https://doi.org/10.14745/ccdr.v45i05a05f Mots-clés : adaptation, changement climatique, Observatoire, Un monde, une santé, zoonoses, priorisation, anticipation

SETTING:Consumption of raw game meats is important for Inuit health and well-being but may sometimes increase risk of exposure to parasites. In Nunavik, following trichinellosis outbreaks in the 1980s caused by raw walrus consumption, a diagnostic test was developed for the region and offered to all Inuit communities by 1997. Despite this prevention program, an important trichinellosis outbreak occurred in 2013, affecting 18 inhabitants of Inukjuak.INTERVENTION:Because the classical outbreak investigation did not rapidly converge toward a common food source or specific event, a local response group, composed of four community members appointed by the Municipal Council as well as the regional public health physician, nurse and wildlife parasitologist, was created. Their objective was to investigate potential sources of infection related to the outbreak, hence the investigation of the types of meats consumed, the movement of meats between and within the community, and the local practices of processing game meat.OUTCOMES:Though the source of infection was not fully confirmed, this local investigation identified the distribution of transformed polar bear meat as the most probable source of infection. The creation of this unique, intersectoral and intercultural local response group fostered the use of local knowledge to better understand aspects of the modern food system, and is one of the most innovative outcomes of this investigation.IMPLICATIONS:Integrating multiple ways of knowing was critical for the management of this important public health issue and contributed to community members' mobilization and empowerment with respect to local food safety issues.

Contact with infected saliva through the bite of a rabid animal is the main route of infection with the rabies Lyssavirus in humans. Although a few individuals have survived the infection, rabies remains the most lethal zoonotic infection worldwide. Over the last century, the dogma that rabies is invariably fatal has been challenged by the survival and recovery of infected animals. In humans, 11 studies have found rabies virus-specific antibodies in unvaccinated individuals exposed to rabies virus reservoir species, suggesting the possibility of asymptomatic rabies virus infection, contact with non-infectious virus or exposure to the virus without viral replication. Two of these studies were conducted in Arctic hunters. Considering the extensive exposure of Nunavik's Inuit to potentially infected animals through hunting, trapping, skinning and the preparation of Arctic carnivores, we analysed archived serum samples from the 2004 Nunavik Inuit Health Survey for the presence of rabies virus-neutralizing antibodies (rVNA) in this sub-population. A total of 196 participants who were considered at highest risk for exposure to rabies virus were targeted. Serum samples were tested for the presence of rVNA using a variation of the fluorescent antibody virus neutralization test, an assay recommended for the quantification of neutralizing antibody titres following vaccination. Our study identified two seropositive individuals among the 196 participants but a review of their medical record and a phone interview revealed previous vaccination. Our results do not provide evidence for naturally acquired rVNA in Nunavik's Inuit population.

Objectives:The 'Mon habitat: plus qu'un simple toit' (MHPQST) survey was designed to identify public health risks and priorities for local decision makers in relation to housing. The aims of the present study were to describe the exposure of households to indoor air contaminants and to verify the relationship between these contaminants and respiratory symptoms/diseases. Study design: This is a cross-sectional study. Methods: MHPQST was conducted in Baie-Saint-Paul, a French Canadian municipality (7000 inhabitants) using a protocol adapted from the 'Large Analysis and Review of European Housing and Health Status' study performed in Europe in 2002-2003. Households were selected from two sectors (less favorable and more favorable). Data collection was achieved using three tools (two questionnaires and one inspection grid). Indoor air variables were analyzed in relation to respiratory symptoms/diseases using logistic regression models adjusted for age, gender, income, smoking status, and proximity. Results: A total of 161 dwellings (294 inhabitants) participated in the survey. Presence of mold on walls, ceilings, or floors was detected by the investigators in 21% of the dwellings. Nearly half of the households were in contact with a pet at home and 12% with environmental tobacco smoke. Exposure to these three determinants was significantly associated with certain respiratory symptoms/diseases. Conclusion: Molds, pets at home, and environmental tobacco smoke are environmental determinants that were associated with respiratory health in the present survey. These results enabled sensitizing local stakeholders regarding the importance of indoor air quality for the respiratory health of their population. (C) 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

A web survey was conducted among 870 lifeguards (current and former) to assess the relationship between exposure to indoor swimming pool environments and respiratory health. Associations between respiratory symptoms and asthma with varying lengths of occupational exposure were assessed by multiple logistic regression. Lifeguards exposed more than 500 hours in the previous 12months experienced more cough (adjustedOR=2.54, IC95%=1.51-4.25), throat (aOR=2.47, IC95%=1.44-4.24) and eye irritation (aOR=4.34, IC95%=2.52-7.50) during this period than non-exposed lifeguards. Upper and lower respiratory symptoms while on duty were related to duration of lifetime exposure (> 500days vs.50days: Upper aOR=5.84, IC95%=3.60-9.50; Lower aOR=2.53, IC95%=1.58-4.06). Physician-diagnosed asthma was high among lifeguards (23%). Highly exposed asthmatic lifeguards (> 500 hours) over the previous 12months had a significantly higher risk (aOR=3.74, IC95%=1.39-10.02) of suffering from asthma attack(s) than non-exposed asthmatic subjects. Exposure to indoor swimming pool environments is related to respiratory symptoms among lifeguards.

Using a political ecology perspective, this research examines the social issues of cyanobacteria. In Québec (Canada), public health officials issue warnings concerning water-related activities and water consumption. An ethnographic study was undertaken with the aim of gaining a better understanding of the attitudes of citizens toward cyanobacteria and public health measures. It enabled us to identify both the meanings attached to this phenomenon and the other driving forces behind the attitudes and, in particular, toward compliance with measures prescribed by the authorities. Focus groups and semidirected individual interviews involving several groups of social actors were conducted in 2009 and 2010 on three communities. This study points to the importance of considering natural phenomena such as the proliferation of cyanobacteria as sociocultural constructs, because this approach can be applied to address the impacts of such phenomena from a different perspective and therefore improve management practices to reduce these impacts.

BackgroundCryptosporidium is a leading cause of childhood diarrhea in low-resource settings, and has been repeatedly associated with impaired physical and cognitive development. In May 2013, an outbreak of diarrhea caused by Cryptosporidium hominis was identified in the Arctic region of Nunavik,Quebec. Human cryptosporidiosis transmission was previously unknown in this region, and very few previous studies have reported it elsewhere in the Arctic. We report clinical, molecular, and epidemiologic details of a multi-village Cryptosporidium outbreak in the Canadian Arctic.Methodology/Principal FindingsWe investigated the occurrence of cryptosporidiosis using a descriptive study of cases with onset between April 2013 and April 2014. Cases were defined as Nunavik inhabitants of any age presenting with diarrhea of any duration, in whom Cryptosporidiumoocysts were detected by stool microscopy in a specialised reference laboratory. Cryptosporidium was identified in stool from 51 of 283 individuals. The overall annual incidence rate (IR) was 420 /100,000 inhabitants. The IR was highest among children aged less than 5 years (1290 /100,000 persons). Genetic subtyping for stool specimens from 14/51 cases was determined by DNA sequence analysis of the 60 kDa glycoprotein (gp60) gene. Sequences aligned with C. hominis subtype Id in all cases. No common food or water source of infection was identified.Conclusions/SignificanceIn this first observed outbreak of human cryptosporidiosis in this Arctic region, the high IR seen is cause for concern about the possible long-term effects on growth and development of children in Inuit communities, who face myriad other challenges such as overcrowding and food-insecurity. The temporal and geographic distribution of cases, as well as the identification of C. hominis subtype Id, suggest anthroponotic rather than zoonotic transmission. Barriers to timely diagnosis delayed the recognition of human cryptosporidiosis in this remote setting.

Introduction : Built environments are known health determinants and they play a major role in health inequalities. Using the protocol of LARES (Large Analysis and Review of European Housing and Health Status), a survey conducted by the World Health Organisation (WHO) in 2002-2003, we realized a pilot project in a small French-Canadian municipality (population:7000). We wanted to inform local policy-makers about priorities related to health and empower them in decision-making to promote the development of sustainable solutions. Methods: The survey targeted a sample of 200 households in two different areas of the municipality (area 1: less favored; area 2: more favored). Data were collected with four tools (three questionnaires verifying perception of housing, health status and housing expenses, and a standardized grid for visual inspection). We evaluated the project using five different research questions with key informants verifying: 1.who were involved in the project (actual vs projected); 2. if the method was applied as projected; 3. what was the satisfaction of the participants; 4. if the transfer of the results was useful; 5. what were the resources needed to realize the project. This abstract concerns mainly the questions 4 and 5. Results: Data were collected on 161 households (area 1: n=92; area 2: n= 69). Even with a lower participation rate than expected, the survey served as a catalyst to guide public health decisions on a local basis. The results of the survey were used: 1. to animate discussions concerning people living in bad sanitary conditions; 2. in final drafting of the urban plan and the development of parks, green spaces and bike paths; 3. to allow the town to meet criteria for access to renovation programs. Conclusions: The survey identified health priorities and permitted to set these priorities on the agenda of policy-makers. For this municipality, it was an important public health tool.

• The relationship between exposure to endotoxins and health symptoms was examined. • Water contact with endotoxins was linked to gastrointestinal symptoms. • Mechanisms linking endotoxins and gastrointestinal symptoms should be investigated.

Large Analysis and Review of European Housing and Health Status (LARES) was conducted in Europe in 2002 to 2003 to study the relationship between citizens' health and built environments. One of its objectives was to put public health priorities on the agenda of local decision-makers to implement solutions for the community. We adapted the LARES protocol as a pilot project in a small French-Canadian town in Quebec Province in 2012. The distinguishing feature of this project was the collaborative approach taken with local actors, especially the municipality, which was committed a priori to using survey data from an urban planning perspective. The project produced interesting results that were used to motivate actions concerning people living in bad sanitary conditions; to draft the urban plan including the development of parks, green spaces, and bicycle paths; and to allow the municipality to meet eligibility criteria for access to renovation programs. If a partnership with the local actors and their commitment to promote and realize the project were obtained at the beginning, then the survey could be replicated in other communities.