BACKGROUND: Asthma education should be offered with priority to populations with the highest asthma-related morbidity. In the present study, the aim was to identify populations with high-morbidity for asthma from the Quebec Health Insurance Board Registry, a large administrative database, to help the Quebec Asthma and Chronic Obstructive Pulmonary Disease Network target its interventions. METHODS: All emergency department (ED) visits for asthma were analyzed over a one-year period, considering individual and medical variables. Age-and sex-adjusted rates, as well as standardized rate ratios related to the overall Quebec rate, among persons zero to four years of age and five to 44 years of age were determined for 15 regions and 163 areas served by Centres Locaux de Services Communautaires (CLSC). The areas with rates 50% to 300% higher (P<0.01) than the provincial rate were defined as high-morbidity areas. Maps of all CLSC areas were generated for the above parameters. RESULTS: There were 102,551 ED visits recorded for asthma, of which more than 40% were revisits. Twenty-one CLSCs and 32 CLSCs were high-morbidity areas for the zero to four years age group and five to 44 years age group, respectively. For the most part, the high-morbidity areas were located in the south-central region of Quebec. Only 47% of asthmatic patients seen in ED had also seen a physician in ambulatory care. CONCLUSION: The data suggest that a significant portion of the population seeking care at the ED is undiagnosed and undertreated. A map of high-morbidity areas that could help target interventions to improve asthma care and outcomes is proposed.

The diagnosis of acute promyelocytic leukemia (APL) relies on the identification of PML::RARA fusion. While the majority of APL cases harbor a typical t(15;17)(q24;q21), atypical genetic mechanisms leading to the oncogenic PML::RARA fusion have been reported yet their frequency and scope remain poorly characterized. We assessed the genetic findings of 831 cases with APL investigated with concurrent chromosome banding analysis and dual‐color dual‐fusion fluorescence in situ hybridization (D‐FISH) analysis at our institution over an 18.5‐year timeframe. Seven hundred twenty‐three (87%) cases had a typical balanced t(15;17) with both testing modalities. Atypical karyotypic results including complex translocations, unbalanced rearrangements and insertional events occurred in 50 (6%) cases, while 6 (0.7%) cases were cryptic by conventional chromosome studies despite PML::RARA fusion by D‐FISH evaluation. Atypical FISH patterns were observed in 48 (6%) cases despite apparently balanced t(15;17) on chromosome banding analysis. Two hundred fifty (30%) cases displayed additional chromosome abnormalities of which trisomy/tetrasomy 8 (37%), del(7q)/add(7q) (12%), and del(9q) (7%) were most frequent. Complex and very complex karyotypes were observed in 81 (10%) and 34 (4%) cases, respectively. In addition, 4 (0.5%) cases presented as an apparently doubled, near‐tetraploid stemline clone. This report provides the largest appraisal of cytogenetic findings in APL with conventional chromosome and PML::RARA D‐FISH analysis. By characterizing the frequency and breadth of typical and atypical results through the lens of these cytogenetic testing modalities, this study serves as a pragmatic source of information for those involved in the investigation of APL in both the clinical and research laboratory settings.

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This study investigated attachment security and behavior in 34 physically disabled infants and 26 non-disabled infants by using convergent, categorical (secure, avoidant and ambivalent) and continuous (Attachment Behavior Q-Set) measures of the relationship, based on the same set of home observations. Proportions of attachment classifications were not different for disabled and non-disabled infants, but insecure infants in the disabled group scored consistently lower on the AQS security score than nondisabled insecure infants. This result suggests that while proportions of attachment classifications may not vary as a function of infant status, insecure disabled infants are more insecure than insecure non-disabled infants. An analysis of 5 behavioral dimensions of the AQS showed that secure infants emitted the same kinds of attachment behaviors without regard for infant status. Insecure disabled infants, however, showed lower levels of secure base behavior and physical contact with mother than their non-disabled counterparts, and showed a marginal tendency to fuss more as well. Discussion focuses on the potential benefits of using convergent, categorical and continuous measures of attachment in the study of both typical and atypical groups of infants.

Brazilian labour unions have an excellent reputation in international trade union circles, often being depicted as one of the most dynamic and militant labour movements today. In Brazil, however, many scholars criticize the unions for having abandoned the struggle taken up in the late 1970s against the industrial relations system and the limits it imposes on their actions. Since its creation in the 1930s, the authoritarian corporatist labour relations system has, in fact, proven to be extremely resilient. It survived two periods of intense political upheaval-the trade union movement having played a predominant role in both-and radical change to the country's economic model without undergoing major transformations. The adoption of a new Constitution in 1988 introduced only minor alterations, leaving the pillars of the corporatist system intact until today.In this article, we put to the test a widespread, determinist vision of Brazilian trade unionism, according to which unions maintain a paradoxical yet atavistic relationship with the heavy body of laws that provides them with advantages while limiting their freedom. In order to reflect on this, we performed field enquiries on two trade unions carefully chosen for their archetypical profile. Our research activities were conducted in the midst of the debate (from June 2005 to July 2006) on the ambitious project to reform the industrial relations system, initiated by former trade union leader and Karen Lang is an independent researcher in Sao Paulo, Brazil (ruthylang@hotmail.com).

Résumé L'article vise à illustrer les liens entre les théories du syndicalisme et les modes d'appréhension sociologique de ce dernier. Partant d'une relecture des différentes approches du syndicalisme, Pauteure propose une typologie fondée sur les prémisses méthodologiques, implicites ou explicites, des chercheurs. Une discussion subséquente permet de suggérer des repères concernant une rethéorisation du syndicalisme et leurs conséquences méthodologiques.

Background.It is unclear if immunosuppression increases the likelihood of malignant transformation of monoclonal gammopathy of undetermined significance (MGUS) and whether adverse renal outcomes in kidney transplant recipients with MGUS are more frequent.Methods.We performed a retrospective cohort study of kidney transplant recipients at the Centre Hospitalier de l’Université de Montréal between 2000 and 2016.Results.Among 755 study participants, 13 (1.7%) were found to have MGUS before transplant. Two evolved to smoldering multiple myeloma and 2 presented paraprotein-induced allograft injury from light chain deposition disease. Forty-six patients developed posttransplant MGUS (2.5% 5-y cumulative incidence) of which 1 progressed to multiple myeloma and 1 experienced kidney allograft loss from light chain deposition disease. None of the patients with a malignant transformation or paraprotein-induced renal disease after transplantation had had a systematic workup before transplantation to exclude hematologic malignancies and paraprotein-related kidney injury. Nine posttransplant MGUS (21%) were transient. Multivariable analysis revealed that age at transplant (hazard ratio 1.05 per 1-y increase, 95% confidence intervals, 1.02-1.08) and prior cytomegalovirus infection (hazard ratio 2.22, 95% confidence intervals, 1.07-4.58) were associated with the development of MGUS after transplantation. Of 7 posttransplant lymphoproliferative disorders, none were preceded by MGUS.Conclusions.Our results suggest that the identification of MGUS in a transplant candidate should lead to further investigations to exclude a plasma cell neoplasm and monoclonal gammopathy of renal significance before transplantation. MGUS arising after transplantation appears to carry a favorable evolution.

Cet article propose une conceptualisation de l’action syndicale à l’échelle des milieux de travail illustrée par le cas québécois.La construction du concept de logique représentative permet de cerner les fondements de l’action syndicale. Des résultatsd’enquêtes de terrain, menées principalement dans le secteur manufacturier, sont utilisés pour décrire les changements à l’oeuvredans le champ des relations du travail. La description des conséquences de ces changements et l’analyse subséquente conduisentà proposer que la logique représentative traditionnelle des syndicats est ébranlée et qu’à terme, c’est le sens de l’actionsyndicale qui en est altéré.This paper proposes a conceptualization of trade union practices in the workplace, illustrated by the case of Quebec. Theconstruction of the concept of representative logic makes it possible to identify the basis of union practice. Results of fieldsurveys carried out mainly in the manufacturing sector are used to describe the changes at work in the field of labour relations.The description of the consequences of these changes and the subsequent analysis leads to proposing that the traditional representativelogic of unions has been weakened and, in the end, it is the meaning of union practices which have been altered.Este artículo es una conceptualización de la acción sindical a escala de los medios de trabajo, ilustrada con el caso quebequense.La construcción del concepto de lógica representativa permite delimitar los fundamentos de la acción sindical. Los resultadosde investigaciones de terreno llevadas a cabo principalemente en el sector manufacturero son utilizados para describirlos cambios que se están produciendo en el campo de las relaciones de trabajo. La descripción de las consecuencias de esoscambios y el análisis subsecuente conducen a proponer que la lógica representativa tradicional de los sindicatos está cuestionaday a largo plazo es el sentido mismo de la acción sindical que está alterado