Serum composition of PFAAs congeners in Nunavik pregnant women from the NQN study in 2016–2017 compared to women from the Canadian general population who participated in the Canadian Health Measure ...Survey (CHMS) cycle 5.
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•In pregnant women from Nunavik, exposure to long-chain PFAAs is increasing.•Nunavimmiut women exposure to PFOS, PFNA, PFDA and PFuDA was higher than in the Canadian general population.•The results suggest that 8:2 FTOH contributes to the exposure profile in the Arctic.•Marine country food consumption is associated with higher exposure to PFAAs.
Perfluoroalkyl acids (PFAAs) are persistent and ubiquitous environmental contaminants that potentially disrupt endocrine system functions. While some PFAAs (perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA)) are regulated, currently used fluorotelomer alcohols (FTOHs) can be transported to the Arctic and are degraded in a number of PFAAs which biomagnify in Arctic wildlife (e.g. perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUdA)).
From 2004 to 2017, 279 pregnant Inuit women were recruited as part of biomonitoring projects in Nunavik. Our goal was to evaluate: (i) time-trends in plasma/serum PFAAs levels in pregnant Nunavimmiut women between 2004 and 2017; (ii) compare plasma/serum PFAAs levels in Nunavimmiut women in 2016–2017 to those measured in women of childbearing age in the Canadian Health Measure Survey (CHMS); and (iii) evaluate the associations of PFAAs levels with the consumption of country foods and pregnancy and maternal characteristics during pregnancy in the 97 participants recruited in 2016–2017.
Individual blood sample were collected for serum or plasma PFAAs (PFOS, PFOA, pentafluorobenzoic acid (PFBA), perfluorohexanoic acid (PFHxA), perfluorobutanesulfonic acid (PFBS), perfluorohexane-1-sulfonic acid (PFHxS), PFNA, PFDA, PFUdA) analyses. Socio-demographic data, pregnancy and maternal characteristics and country foods consumption were documented using a questionnaire. Omega-3 and −6 polyunsaturated fatty acids (PUFA) were measured in red blood cell membranes and their ratio used as a biomarker of marine country foods consumption. Time-trends in PFAAs levels were evaluated using ANCOVA models adjusted for relevant co-variables. Serum/plasma levels of PFAAs in the 97 pregnant women aged 16 to 40 years old and recruited in 2016–2017 were compared to those measured in women aged 18 to 40 years old from the CHMS cycle 5 (2016–2017) using the geometric means (GM) and 95% confidence intervals (95% CI). Multivariate regression analyses were performed to examine associations between concentrations of PFAAs and country foods consumption data.
Statistically-significant downward time trends were noted for concentrations of PFOS, PFOA and PFHxS in pregnant Nunavik women between 2004 and 2017. Conversely, between 2011 and 2016–2017, PFNA, PFDA and PFUdA maternal serum levels increased by 19, 13 and 21% respectively. Among participants in 2016–2017, mean concentrations for PFNA (GM: 2.4 μg/L), PFDA (0.53 μg/L) and PFUdA (0.61 μg/L) were higher than those measured in women aged 18–40 years old in the Cycle 5 (2016–2017) of the CHMS. PFOA (0.53 μg/L) and PFHxS (0.26 μg/L) were lower than in CHMS, whereas PFBA, PFHxA and PFBS were not detected in 2016–2017. Ratios of serum/plasma levels of PFNA/PFOA, PFNA/PFOS, PFNA/PFHxS and PFUdA/PFDA were significantly higher in the 97 pregnant women from Nunavik recruited in 2016–2017 compared to CHMS, highlighting their distinct exposure profile. In multivariate models, PFHxS, PFOS, PFNA, PFDA and PFUdA levels in 2016–2017 were strongly associated with the omega-3/omega-6 PUFA ratio, indicating a positive association between marine country foods consumption and higher exposure to PFAAs.
The exposure of pregnant women to long-chain PFAAs (PFNA, PFDA and PFUdA) increased from 2004 to 2017 in Nunavik. Associations noted between PFAAs levels and the omega-3/omega-6 ratio highlights the importance of implementing additional strict regulations on PFAAs and their precursors to protect the high nutritional quality and cultural importance of country foods in Nunavik.
For many years, dietary quality among Canadians has been assessed using an index that gives criticized scores and does not allow for comparison with Americans. In Canadians aged ≥19 years, we aimed ...to (1) determine the dietary quality by using a more widely used evidence-based index that has shown associations with health outcomes, the alternative Healthy Eating Index (aHEI-2010); (2) assess changes in aHEI-2010 score and its components between 2004 and 2015; and (3) identify factors associated with aHEI-2010 score. We relied on the Canadian Community Health Survey 2004 (n = 35,107) and 2015 (n = 20,487). We used adjusted linear models with a time effect to compare the total aHEI-2010 score and its components. The overall aHEI-2010 score increased from 36.5 (95%CI: 36.2-36.8) in 2004 to 39.0 (95%CI: 38.5-39.4) in 2015 (
< 0.0001). Participants with less than a high school diploma showed the lowest score and no improvement from 2004 to 2015 (34.8 vs. 35.3,
= 0.4864). In each period, higher scores were noted among immigrants than non-immigrants (38.3 vs. 35.9 in 2004,
< 0.0001; 40.5 vs. 38.5 in 2015
< 0.0001), and lower scores were observed in current smokers (33.4 vs. 37.1 in 2004,
< 0.0001; 34.5 vs. 39.9 in 2015,
< 0.0001). The use of the aHEI-2010 tool suggests a lower score among Canadians than the previous index, more comparable to the score among Americans.
To document perfluoroalkyl acids (PFAA) and bisphenol-A (BPA) exposure in four First Nation communities in northern Quebec compared with the Canadian Health Measures Survey (CHMS Cycle 5 2016-2017) ...and examine the associations between dietary consumption and chemical exposure.
We used cross-sectional data from the JES-YEH! project conducted in collaboration with four First Nation communities in 2015. A FFQ collected information on diet, and PFAA and BPA were measured in biological samples. We used generalised linear models to test the associations between food intake and chemical biomarkers.
Northern Quebec.
Youth aged 3-19 years (
198).
Mean perfluorononanoic acid (PFNA) levels were significantly higher in JES-YEH! than CHMS, and BPA levels were higher among those aged 12-19 years compared with CHMS. Dairy products were associated with PFNA among Anishinabe and Innu participants (geometric mean ratio 95 % CI: 1·53 (95 % CI 1·03, 2·29) and 1·52 (95 % CI 1·05, 2·20), respectively). PFNA was also associated with ultra-processed foods (1·57 (95 % CI 1·07, 2·31)) among Anishinabe, and with wild fish and berries (1·44 (95 % CI 1·07, 1·94); 1·75 (95 % CI 1·30, 2·36)) among Innu. BPA was associated with cheese (1·72 (95 % CI 1·19, 2·50)) and milk (1·53 (95 % CI 1·02, 2·29)) among Anishinabe, and with desserts (1·71 (95 % CI 1·07, 2·74)), processed meats (1·55 (95 % CI 1·00, 2·38)), wild fish (1·64 (95 % CI 1·07, 2·49)) and wild berries (2·06 (95 % CI 1·37, 3·10)) among Innu.
These results highlight the importance of better documenting food-processing and packaging methods, particularly for dairy products, and their contribution to endocrine disruptors exposures as well as to promote minimally processed and unpackaged foods to provide healthier food environments for youth in Indigenous communities and beyond.
Papanicolaou smear screening has significantly reduced cervical cancer morbidity and mortality. However, inequalities still persist across different socioeconomic status (SES) groups. These ...inequalities have been associated with differential participation in screening. However, even with equal participation to screening, some women may still have greater risk of cervical cancer because of sexual behavior. We aim to identify the sociodemographic characteristics of women who reported greater sexual activity and/or screening underuse.
We used data from (i) the Canadian Community Health Survey-2005, a population-based survey of 130,000 Canadians, and (ii) a multicenter study including 952 women screened for cervical cancer.
Aboriginals and women with lower SES reported greater sexual activity and lower screening participation, which may produce synergetic effects toward higher cervical cancer risk. Women who did not complete high school and aboriginals were, respectively, 3.6 and 2.5 times more likely to report sexual debut before 15 years old compared with women with university degree and Caucasians. Women who did not complete high school were 2.2 times more likely to have never been screened compared with women with university degree. East and South Asian women were, respectively, 4.3 and 3.1 times more likely to have never been screened than Canadian-born women but reported lower levels of sexual activity and were adherent to screening guidelines when screened at least once.
The success of human papillomavirus vaccination at reducing cervical cancer and inequalities will depend on achieving high coverage among high-risk subpopulations.
These groups must be monitored closely, and if need be, targeted for additional interventions.
We evaluated whether cumulative exposure to job strain increases blood pressure.
A prospective study of 8395 white-collar workers was initiated during 1991 to 1993. At follow-up, 7.5 years later, 84% ...of the participants were reassessed to estimate cumulative exposure to job strain.
Compared with men who had never been exposed, men with cumulative exposure and those who became exposed during follow-up showed significant systolic blood pressure increments of 1.8 mm Hg (95% confidence interval CI=0.1, 3.5) and 1.5 mm Hg (95% CI=0.2, 2.8), respectively, and relative risks of blood pressure increases in the highest quintile group of 1.33 (95% CI = 1.01, 1.76) and 1.40 (95% CI = 1.14, 1.73). Effect magnitudes were smaller among women. Effects tended to be more pronounced among men and women with low levels of social support at work.
Among these white-collar workers, exposure to cumulative job strain had a modest but significant effect on systolic blood pressure among men. The risk was of comparable magnitude to that observed for age and sedentary behavior. Men and women with low levels of social support at work appeared to be at higher risk for increases in blood pressure.
To compare macular hole (MH) closure and visual acuity improvement after vitrectomy using SF6 versus C3F8 gas tamponade. The secondary purposes were to report the cumulative incidence of cataract ...development at 1 year after MH surgery and the proportion of complications.
Prospective, randomized study.
Thirty-one patients were prospectively randomized to the SF6 group and 28 patients to the C3F8 group.
Preoperative data included MH minimum diameter, Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA), cataract staging, and intraocular pressure (IOP) measurement. Postoperative data included optical coherence tomography confirmation of the closure at 6 weeks and 1 year, and ETDRS BCVA and cataract development/extraction, both 1 year after the MH surgery.
Primary MH closure was achieved in 93.3% in the SF6 group and 92.9% in the C3F8 group. Mean ETDRS BCVA improved by 17.7 letters in the SF6 and 16.9 letters in the C3F8 group. The difference in cumulative incidence of cataract development and extraction between both groups was not statistically significant. Regardless of the dye used, similar results were achieved. Finally, the proportion of adverse events was similar in both groups.
MH surgery with SF6 gas achieves results similar to C3F8 in terms of visual acuity improvement, MH closure, cataract development/extraction, and adverse events.
Comparer la fermeture de trous maculaires (TM) et l’amélioration de l’acuité visuelle après des vitrectomies avec tamponnement par gaz SF6 et avec tamponnement par gaz C3F8. Les objectifs secondaires étaient de faire état de l’incidence cumulative de développement de cataractes un an après la chirurgie du TM ainsi que de la proportion de complications.
Essai randomisé prospectif.
On a affecté, au hasard et prospectivement, 31 patients au groupe SF6 et 28 autres au groupe C3F8.
Les données préopératoires incluaient le diamètre minimum du TM, la meilleure acuité visuelle corrigée (MAVC) d’après l’échelle ETDRS, la stadification d’éventuelles cataractes et la pression intraoculaire (PIO). Les données postopératoires incluaient la confirmation par TCO (tomographie par cohérence optique) de la fermeture du TM après 6 semaines et après un an, de même que la MAVC d’après l’échelle ETDRS et le développement ou l’extraction de cataracte, dans ces deux cas un an après la chirurgie du TM.
Il y a eu fermeture du trou maculaire primaire dans 93,3 % des cas pour le groupe SF6 et dans 92,9 % des cas pour le groupe C3F8. La MAVC moyenne s’est améliorée de 17,7 lettres ETDRS pour le groupe SF6 et de 16,9 lettres ETDRS pour le groupe C3F8. L’écart d’incidence cumulative de développement et d’extraction de cataractes entre les deux groupes n’était pas statistiquement significatif. Les deux gaz de tamponnement ont donné des résultats similaires. Enfin, la proportion d’événements indésirables était comparable d’un groupe à l’autre.
Pour la chirurgie du TM, le tamponnement par gaz SF6 donne des résultats similaires au tamponnement par gaz C3F8 en ce qui concerne l’amélioration de l’acuité visuelle, la fermeture du trou maculaire, le développement ou l’extraction de cataracte et les événements indésirables.
Sciatica due to a herniated nucleus pulposus is an important medical and socioeconomic problem.
1
Although the majority of patients recover with conservative management, 10 to 15 percent need ...surgery.
2
Epidural corticosteroid injections were first used to treat sciatica in the early 1950s, as reported by Lièvre et al.
3
,
4
Of 12 controlled trials that have subsequently been reported, half found that the injections were more effective than the reference treatment,
5
–
10
and the other half found them to be no better or worse.
11
–
16
A critical analysis of these studies showed that most had methodologic deficiencies.
17
Reviews of the literature . . .
Abstract
Introduction: Multiple HER2-targeted therapies are now available and have significantly altered the natural course of HER2-positive metastatic breast cancer (mBC), with overall survival (OS) ...now exceeding 4 years. However, patients with HER2-positive mBC represent a heterogeneous population with some patients presenting with a history of a localized cancer and some with de novo metastatic disease. Our aim was to study the outcomes of HER-positive mBC in a real-life setting and compare the evolution between patients with “recurrent” breast cancer compared to those with “de novo” disease. Methods: In this single-center, retrospective study, we included patients with HER2-positive mBC treated at the Centre hospitalier universitaire (CHU) de Quebec using the local cancer registry and patients’ medical charts. We included all female patients > 18 years of age who received one or more anti-HER2 therapy for mBC. Patients whose follow-up at our center was incomplete were excluded. We identified patients who developed mBC after the occurrence of a localised disease (“Recurrent” group) and patients diagnosed with metastatic disease upon first presentation (“De novo” group). Primary outcome was OS. Secondary outcomes were progression-free survival (PFS) for each line of treatment and for each type of treatment (trastuzumab T, pertuzumab P, lapatinib L and trastuzumab emtansine T-DM1). We performed survival analysis using the Kaplan-Meier method and the log rank test. Results: A total of 106 patients in the Recurrent group and 58 patients in the De novo group were identified between May 2002 and December 2018 and data were collected between March and June 2019, by which time 97 (59.1%) had died. There were differences in baseline characteristics between the Recurrent and the De novo groups regarding age at first metastasis (50.7 vs 57.4 years, p=0.001). A total of 44.3 % vs 32.8 % of patients developed brain metastasis respectively (p=0.15). There was no statistical difference between the two groups regarding OS (3.8 years for Recurrent vs 4.2 years for De novo, p=0.17). PFS were also similar between the 2 groups for every anti-HER2 treatment available during the study period (Table 1). Median PFS could not be established for P in the De novo group since 80 % of patients were censured at the time of data collection. In the Recurrent group, P, L and T-DM1 had median PFS at least as long as those reported in landmark clinical trials. PFS were also similar between groups when comparing treatment lines (Table 2). Conclusion: In this retrospective study of patients from a real-world setting, anti-HER2 therapies offered similar OS between HER2-positive mBC patients with recurrent disease and with de novo metastatic disease. Median PFS are also equivalent between groups, with durations in the range of the PFS reported in major RCTs.
Table 1TreatmentRecurrent groupRecurrent groupDe novo groupDe novo groupP valuenMedian PFS (years)nMedian PFS (years)Trastuzumab741.7441.90.14Pertuzumab333.115-0.15Lapatinib290.7110.60.17T-DM1310.7120.70.52
Table 2LineRecurrent groupRecurrent groupDe novo groupDe novo groupP valuenMedian PFS (years)nMedian PFS (years)1sd1061.6582.00.142nd490.7200.60.273rd230.990.70.794th100.430.80.53
Citation Format: Vincent Douville, Christine Desbiens, Valérie Théberge, Caty Blanchette, Julie Lemieux. Real-world experience of patients treated for HER2-positive metastatic breast cancer at the centre hospitalier universitaire de Quebec: A retrospective cohort study abstract. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-37.
•HIV seroincidence decreased significantly between 1995 and 2018.•HCV seroincidence decreased significantly (1998–2011), but remains worryingly high since then.•The use of syringes already used by ...someone else decreased from 43.4 % in 1995 to 12.4 % in 2019.•Cocaine/crack injection decreased while opioids other than heroin injection and daily injection increased.
The SurvUDI network is a biobehavioural survey among people who inject drugs (PWID) in Eastern Central Canada.
The objectives were to describe HIV and HCV seroincidence trends, associated factors and changes in drug use behaviours.
The network was initiated in 1995 and targets hard-to-reach, mostly out-of- treatment PWID. Participants were recruited mostly in harm reduction programs, completed an interviewer-administered questionnaire, provided a sample of gingival exudate for HIV and HCV antibody testing and were identified using an encrypted code allowing identification of multiple participations. Time trends were examined for HIV and HCV seroincidence, selected characteristics and behaviours. Cox proportional hazard regression was used to examine factors associated to HIV and HCV seroincidence.
Between January 1995 and March 2020, 15,907 individuals have completed 31,051 questionnaires. HIV seroincidence decreased significantly from 5.0 per 100 person-years (p-y) in 1995 to 0.4 per 100 p-y in 2018. HCV seroincidence also decreased significantly between 1998 and 2011.
The use of syringes already used by someone else decreased significantly, from 43.4 % in 1995 to 12.4 % in 2019, as well as the use of equipment other than syringe already used by someone else. Cocaine/crack injection decreased significantly while “opioids other than heroin” injection increased, concomitant to daily injection.
Injection with syringes already used by someone else and cocaine as the most often injected drug were significantly associated with HIV seroincidence (1995–2020).
Injected opioid other than heroin, injected cocaine/crack, injected 100 or more times in the past month, injected for less than 3 years, injected with syringes or equipment already used by someone else, injected with someone else and reported client sex partners were significantly associated with HCV seroincidence (2004–2020).
HIV seroincidence and syringe/equipment sharing behaviour trends are encouraging, but HCV seroincidence remains high.
Halogenated organophosphate esters (OPEs) are increasingly used as flame retardants to replace polybrominated diphenyl ethers (PBDEs), which have been phased out due to their confirmed persistence, ...toxicity, and ability to undergo long range atmospheric transport. Non-halogenated OPEs are primarily used as plasticizers. While human exposure to PBDEs in the Canadian Arctic is well documented, it is not the case for OPEs. To assess the exposure to OPEs in Inuit living in Nunavik (northern Québec, Canada), we measured 16 metabolites of halogenated and non-halogenated OPEs in pooled urine samples from the last population health survey conducted in Nunavik, the Qanuilirpitaa? 2017 Inuit Health Survey (Q2017). Urine samples (n = 1266) were pooled into 30 pools by sex (female; male), age groups (16–19; 20–29; 30–39; 40–59; 60+ years old) and regions (Hudson Bay; Hudson Strait; Ungava Bay). Q2017 geometric means and 95 % confidence intervals were compared with data from the Canadian Health Measures Survey Cycle 6 (2018–2019) (CHMS). Halogenated OPEs were systematically detected and generally found at higher concentrations than non-halogenated OPEs in both Q2017 and CHMS. Furthermore, urinary levels of BCIPP and BDCIPP (halogenated) were lower in Q2017 compared to CHMS while concentrations of DPhP, DpCP and DoCP (non-halogenated) were similar between Q2017 and CHMS. Across the 16 metabolites measured in Q2017, BCIPHIPP (halogenated) had the highest levels (geometric mean: 1.40 μg/g creatinine). This metabolite was not measured in CHMS and should be included in future surveys. Overall, our results show that Inuit in Nunavik are exposed to lower or similar OPEs levels than the rest of the general Canadian population suggesting that the main current exposure to OPEs may be from consumer goods containing flame retardants and imported from the south rather than long-range atmospheric transport to the Arctic.
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•16 OPE urinary metabolites were measured in people 16y and older from Nunavik (Nunavimmiut).•OPE metabolite levels in Nunavimmiut are similar or lower than the Canadian general population.•This is the first biomonitoring study of OPE metabolites in Nunavimmiut.
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