1
|
Pan KY, van Tuijl L, Basten M, Rijnhart JJM, de Graeff A, Dekker J, Geerlings MI, Hoogendoorn A, Ranchor AV, Vermeulen R, Portengen L, Voogd AC, Abell J, Awadalla P, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Frank P, Galenkamp H, Garssen B, Hellingman S, Hollander M, Huisman M, Huss A, Keats MR, Kok AAL, Krokstad S, van Leeuwen FE, Luik AI, Noisel N, Payette Y, Penninx BWJH, Picavet S, Rissanen I, Roest AM, Rosmalen JGM, Ruiter R, Schoevers RA, Soave D, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Teyhan A, Twait EL, van der Willik KD, Lamers F. The mediating role of health behaviors in the association between depression, anxiety and cancer incidence: an individual participant data meta-analysis. Psychol Med 2024:1-14. [PMID: 38680088 DOI: 10.1017/s0033291724000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers). METHODS Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs). RESULTS Smoking (HRs range 1.04-1.10) and physical inactivity (HRs range 1.01-1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03-1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01). CONCLUSIONS Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.
Collapse
Affiliation(s)
- Kuan-Yu Pan
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lonneke van Tuijl
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maartje Basten
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors and Chronic Diseases program, Amsterdam, the Netherlands
| | | | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of General Practice, Amsterdam UMC, location UvA, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized Medicine, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Adelita V Ranchor
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Jessica Abell
- Department of Behavioral Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Philipp Frank
- Department of Behavioral Science and Health, University College London, London, UK
| | - Henrike Galenkamp
- Amsterdam Public Health, Health Behaviors and Chronic Diseases program, Amsterdam, the Netherlands
- Department of Public and Occupational Health, location University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bert Garssen
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Melanie R Keats
- Faculty of Health, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Almar A L Kok
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Steinar Krokstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Nolwenn Noisel
- CARTaGENE, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada
| | - Yves Payette
- CARTaGENE, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
| | - Susan Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Utrecht Bilthoven, the Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
| | - Judith G M Rosmalen
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Andrew Steptoe
- Department of Behavioral Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, location University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Twait
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized Medicine, Amsterdam, the Netherlands
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kimberly D van der Willik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, the Netherlands
| |
Collapse
|
2
|
DeClercq V, Wright RJ, Nearing JT, Langille MGI. Oral microbial signatures associated with age and frailty in Canadian adults. Sci Rep 2024; 14:9685. [PMID: 38678061 PMCID: PMC11055859 DOI: 10.1038/s41598-024-60409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/23/2024] [Indexed: 04/29/2024] Open
Abstract
This study aimed to assess the association between the oral microbiome, age, and frailty. Data and saliva samples were obtained from male and female participants aged 35-70 years (n = 1357). Saliva samples were analysed by 16S rRNA gene sequencing and differences in microbial diversity and community compositions were examined in relation to chronological age and the frailty index (FI). Most alpha diversity measures (Richness, Shannon Diversity, Faith's Phylogenetic Diversity) showed an inverse association with frailty, whereas a positive association was observed with age and Shannon Diversity and Evenness. A further sex-stratified analysis revealed differences in measures of microbial diversity and composition. Multiple genera were detected as significantly differentially abundant with increasing frailty and age by at least two methods. With age, the relative abundance of Veillonella was reduced in both males and females, whereas increases in Corynebacterium appeared specific to males and Aggregatibacter, Fusobacterium, Neisseria, Stomatobaculum, and Porphyromonas specific to females. Beta diversity was significantly associated with multiple mental health components of the FI. This study shows age and frailty are differentially associated with measures of microbial diversity and composition, suggesting the oral microbiome may be a useful indicator of increased risk of frailty or a potential target for improving health in ageing adults.
Collapse
Affiliation(s)
- Vanessa DeClercq
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Robyn J Wright
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jacob T Nearing
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Morgan G I Langille
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
3
|
Sud M, Sivaswamy A, Austin PC, Abdel-Qadir H, Anderson TJ, Khera R, Naimark DMJ, Lee DS, Roifman I, Thanassoulis G, Tu K, Wijeysundera HC, Ko DT. Validation of the European SCORE2 models in a Canadian primary care cohort. Eur J Prev Cardiol 2024; 31:668-676. [PMID: 37946603 PMCID: PMC11025037 DOI: 10.1093/eurjpc/zwad352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
AIMS Systematic Coronary Risk Evaluation Model 2 (SCORE2) was recently developed to predict atherosclerotic cardiovascular disease (ASCVD) in Europe. Whether these models could be used outside of Europe is not known. The objective of this study was to test the validity of SCORE2 in a large Canadian cohort. METHODS AND RESULTS A primary care cohort of persons with routinely collected electronic medical record data from 1 January 2010 to 31 December 2014, in Ontario, Canada, was used for validation. The SCORE2 models for younger persons (YP) were applied to 57 409 individuals aged 40-69 while the models for older persons (OPs) were applied to 9885 individuals 70-89 years of age. Five-year ASCVD predictions from both the uncalibrated and low-risk region recalibrated SCORE2 models were evaluated. The C-statistic for SCORE2-YP was 0.74 in women and 0.69 in men. The uncalibrated SCORE2-YP overestimated risk by 17% in women and underestimated by 2% in men. In contrast, the low-risk region recalibrated model demonstrated worse calibration, overestimating risk by 100% in women and 36% in men. The C-statistic for SCORE2-OP was 0.64 and 0.62 in older women and men, respectively. The uncalibrated SCORE2-OP overestimated risk by more than 100% in both sexes. The low-risk region recalibrated model demonstrated improved calibration but still overestimated risk by 60% in women and 13% in men. CONCLUSION The performance of SCORE2 to predict ASCVD risk in Canada varied by age group and depended on whether regional calibration was applied. This underscores the necessity for validation assessment of SCORE2 prior to implementation in new jurisdictions.
Collapse
Affiliation(s)
- Maneesh Sud
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- ICES, 2075 Bayview Ave, D-410, Toronto, M4N 3M5, Canada
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada
| | | | - Peter C Austin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- ICES, 2075 Bayview Ave, D-410, Toronto, M4N 3M5, Canada
| | - Husam Abdel-Qadir
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- ICES, 2075 Bayview Ave, D-410, Toronto, M4N 3M5, Canada
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada
- Women’s College Hospital, University of Toronto, 76 Grenville St, Toronto, M5S 1B2, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, 3310 Hospital Drive NW, Calgary, T2N 4N1, Canada
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Canada
| | - Rohan Khera
- Section of Cardiovascular Medicine, Departmentof Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Hospital, 20 York St, New Haven, CT 06510, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - David M J Naimark
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- ICES, 2075 Bayview Ave, D-410, Toronto, M4N 3M5, Canada
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada
| | - Douglas S Lee
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- ICES, 2075 Bayview Ave, D-410, Toronto, M4N 3M5, Canada
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, 661 University Ave, Toronto, M5G 1M1, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- ICES, 2075 Bayview Ave, D-410, Toronto, M4N 3M5, Canada
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada
| | - George Thanassoulis
- Department of Medicine, McGill University, 3605 Rue de la Montagne, Montréal, H3G 2M1, Canada
- Preventive and Genomic Cardiology, McGill University Health Centre, 1001 boul. Décarie, Montréal, H4A 3J1, Canada
| | - Karen Tu
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- Toronto Western Family Health Team, North York General Hospital, University Health Network, University of Toronto, 440 Bathurst Street, Toronto, M5T 2S6, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- ICES, 2075 Bayview Ave, D-410, Toronto, M4N 3M5, Canada
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada
| | - Dennis T Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, M5T 3M6, Canada
- ICES, 2075 Bayview Ave, D-410, Toronto, M4N 3M5, Canada
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada
| |
Collapse
|
4
|
Vasiliadis HM, Spagnolo J, Bartram M, Fleury MJ, Gouin JP, Grenier S, Roberge P, Shen-Tu G, Vena JE, Lamoureux-Lamarche C, Wang J. Factors associated with change in moderate or severe symptoms of anxiety and depression in community-living adults and older adults during the COVID-19 pandemic. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:230-243. [PMID: 38117417 PMCID: PMC11006639 DOI: 10.17269/s41997-023-00832-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/24/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Few are the longitudinal studies on the changes in moderate or severe symptoms of anxiety or depression (MSS-ANXDEP) from before to during the COVID-19 pandemic in Canada. The aim was to study the change in MSS-ANXDEP and associated sociodemographic, economic, psychosocial, health behaviour and lifestyle, and clinical factors. METHODS The current sample includes 59,997 adults aged ≥ 35 years participating in the 2018 and 2020 health surveys of the 5 established cohorts of the Canadian Partnership for Tomorrow's Health (CanPath). MSS-ANXDEP was based on a cutoff score ≥ 10 on the 7-item Generalized Anxiety Disorder Scale and Patient Health Questionnaire (PHQ-8). Change in MSS-ANXDEP was categorized as follows: no MSS-ANXDEP, remitted, incident, and persistent. Multinomial regressions were used to study MSS-ANXDEP as a function of sociodemographic, economic, psychosocial, health behaviours and lifestyle, and clinical factors. RESULTS Sociodemographic and economic (i.e. age, gender, cohort, race/ethnicity, lower income, decreased in income, work status, being an essential worker), lifestyle and health behaviours (i.e. smoking, cannabis and alcohol use, drinking more alcohol), psychosocial (i.e. provide help to others, information and instrumental support, and change in relationships with friends, family, and partner) and clinical factors (i.e. lifetime mental disorder and multimorbidity) were associated with remitted, incident, and persistent MSS-ANXDEP. CONCLUSION Health and socio-economic factors were associated with changes in symptoms of anxiety and depression during the pandemic, further increasing inequities in mental health needs. Public health campaigns on the importance of healthy behaviours should continue and health policies should reduce economic and social barriers to integrated substance use and mental health care.
Collapse
Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada.
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, Ontario, Canada
- School of Public Policy & Administration, Carleton University, Ottawa, Ontario, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Verdun, Québec, Canada
- McGill University, Montreal, Québec, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montreal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada
| | - Sébastien Grenier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Pasquale Roberge
- Département de médecine familiale et d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Catherine Lamoureux-Lamarche
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
5
|
Schwartz J, Rhodes RE, Oh P, Bredin SSD, Perotto MB, González AG, Warburton DER. Increasing Health Behaviors and Psychological Measures with an Adapted Version of the ACCELERATION Program. Int J Behav Med 2024:10.1007/s12529-024-10279-1. [PMID: 38557740 DOI: 10.1007/s12529-024-10279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Recent evidence highlights the importance of interventions tackling physical inactivity and unhealthy eating in lower-income countries. The purpose of this study was to examine the effectiveness of the Canadian ACCELERATION lifestyle program adapted to Brazilians. The main outcomes of the study were changes in the engagement in weekly moderate-to-vigorous physical activity (MVPA) and in the daily consumption of fruits/vegetables. METHODS The adapted intervention consisted of a 12-week quasi-randomized controlled trial delivered through email. The data from the original Canadian experimental group (CE, n = 194) and the two groups of Portuguese-speaking Brazilians living in Canada in the adapted program - Brazilian experimental (BE, n = 41) and Brazilian control (BC, n = 35) - were assessed at baseline and post-intervention. The data of the 270 participants were analyzed using two-way repeated measures factorial ANCOVA (group x time) for ratio variables and Chi-square and McNemar tests for the categorical variables. RESULTS The BE group had a significant increase in MVPA (mean difference, 95% CI: 86.3, 38.1-134.4 min/week) and fruits/vegetables intake (3.2, 1.4-5.1 servings/day) after the intervention (both p < 0.001). The proportion of participants engaging in ≥ 150 min of MVPA increased from 4.9% to 73.2%, while adoption of a healthy diet increased from 4.9% to 53.7% in the BE group (both p < 0.001). The CE group also improved on these variables (p < 0.05) with no difference vs the BE group (p > 0.05), whereas BC did not show changes (p > 0.05). CONCLUSION The Brazilian version of the ACCELERATION program effectively promoted positive health behavior changes in its participants and has the potential to contribute to the fight against risk factors for chronic diseases in Brazilians.
Collapse
Affiliation(s)
- Juliano Schwartz
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada.
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Shannon S D Bredin
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
| | - Maira B Perotto
- West Toronto Diabetes Education Program, LAMP Community Health Centre, Toronto, ON, Canada
| | - Alejandro Gaytán González
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Institute of Applied Sciences for Physical Activity and Sport, University of Guadalajara, Guadalajara, Mexico
| | - Darren E R Warburton
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
6
|
Vasiliadis HM, Spagnolo J, Fleury MJ, Gouin JP, Roberge P, Bartram M, Grenier S, Shen-Tu G, Vena JE, Wang J. Factors associated with mental health service use during the pandemic: Initiation and barriers. Int J Soc Psychiatry 2024; 70:59-69. [PMID: 37646244 PMCID: PMC10860360 DOI: 10.1177/00207640231194489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Scarce are the studies focusing on initiation of new mental health service use (MHSU) and distinguishing individuals who have sought services but have been unsuccessful in accessing these. AIMS Assessing the factors associated with initiating new MHSU as compared to no MHSU due to self-reported no need, no MHSU due to health system and personal barriers and MHSU using resources already in place. METHODS The sample included participants (n = 16,435) in the five established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) who responded to the CanPath COVID-19 health surveys (May-December 2020 and January-June 2021). Multinomial regression analyses were carried out to study MHSU since the pandemic (March 2020) as a function of predisposing, enabling and need factors. Analyses were carried out in the overall sample and restricted to those with moderate and severe symptoms (MSS) of depression and/or anxiety (n = 2,237). RESULTS In individuals with MSS of depression and/or anxiety, 14.4% reported initiating new MHSU, 22.0% had no MHSU due to barriers and personal reasons and 36.7% had no MHSU due to self-reported no need. Age, living alone, lower income, a decrease in income during the pandemic and health professional status were associated with MHSU. Younger adults were more likely to initiate MHSU during the pandemic than older adults who reported not being comfortable to seek mental health care or self-reported no need. Individuals living alone and with lower income were more likely to report not being able to find an appointment for mental health care. CONCLUSIONS Awareness campaigns focusing on older adults that explain the importance of seeking treatment is needed, as well as sensitising health professionals as to the importance of informing and aiding individuals at risk of social isolation and lower socio-economic status as to available mental health resources and facilitating access to care.
Collapse
Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, QC, Canada
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, QC, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Verdun, QC, Canada
- McGill University, Montreal QC, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montreal, QC, Canada
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Pasquale Roberge
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy & Administration, Carleton University, Ottawa, ON, Canada
| | - Sébastien Grenier
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
- Département de psychologie, Université de Montréal, Montréal, QC, Canada
| | - Grace Shen-Tu
- Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Jennifer E. Vena
- Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
7
|
Allen NE, Lacey B, Lawlor DA, Pell JP, Gallacher J, Smeeth L, Elliott P, Matthews PM, Lyons RA, Whetton AD, Lucassen A, Hurles ME, Chapman M, Roddam AW, Fitzpatrick NK, Hansell AL, Hardy R, Marioni RE, O’Donnell VB, Williams J, Lindgren CM, Effingham M, Sellors J, Danesh J, Collins R. Prospective study design and data analysis in UK Biobank. Sci Transl Med 2024; 16:eadf4428. [PMID: 38198570 PMCID: PMC11127744 DOI: 10.1126/scitranslmed.adf4428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
Population-based prospective studies, such as UK Biobank, are valuable for generating and testing hypotheses about the potential causes of human disease. We describe how UK Biobank's study design, data access policies, and approaches to statistical analysis can help to minimize error and improve the interpretability of research findings, with implications for other population-based prospective studies being established worldwide.
Collapse
Affiliation(s)
- Naomi E Allen
- UK Biobank Ltd, Stockport, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ben Lacey
- UK Biobank Ltd, Stockport, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Deborah A Lawlor
- Population Health Science, Bristol Medical School University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Scotland
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Elliott
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Chemical Radiation Threats and Hazards, Imperial College London, UK
| | - Paul M Matthews
- UK Dementia Research Centre Institute and Department of Brain Sciences, Imperial College London, London, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, Wales
| | - Anthony D Whetton
- Veterinary Health Innovation Engine, University of Surrey, Guildford, UK
| | - Anneke Lucassen
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Faculty of Medicine, Southampton University, Southampton, UK
| | - Matthew E Hurles
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | | | | | | | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Rebecca Hardy
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, Scotland
| | | | - Julie Williams
- UK Dementia Research Institute, Cardiff University, Cardiff, Wales
| | - Cecilia M Lindgren
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | | | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
| | - Rory Collins
- UK Biobank Ltd, Stockport, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
8
|
Chiu CJ, Hou SY, Wang CL, Tang HH, Kuo PC, Liang SF, Kuo PF. The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T): protocol for a multidimensional dataset of health and lifestyle. BMC Public Health 2024; 24:87. [PMID: 38178012 PMCID: PMC10765675 DOI: 10.1186/s12889-023-17552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults keep transforming with Baby Boomers and Gen Xers being the leading older population. Their lifestyle, however, is not well understood. The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T) collected both objective and subjective data to depict the health and lifestyle of this population. The objectives, design, and measures of the MOCHA-T study are introduced, and the caveats and future directions related to the use of the data are presented. METHODS People aged 50 and over were recruited from the community, with a subset of women aged 45-49 invited to supplement data on menopause and aging. Four instruments (i.e., self-reported questionnaires, diary, wrist actigraphy recorder, and GPS) were used to collect measures of sociodemographic, health, psychosocial, behavioral, temporal, and spatial data. RESULTS A total of 242 participants who returned the informed consent and questionnaires were recruited in the MOCHA-T study. Among them, 94.6%, 95.0%, and 25.2% also completed the diary, actigraphy, and GPS data, respectively. There was almost no difference in sociodemographic characteristics between those with and without a completed diary, actigraphy, and GPS data, except for age group and educational level for those who returned completed actigraphy data. CONCLUSION The MOCHA-T study is a multidimensional dataset that allows researchers to describe the health, behaviors, and lifestyle patterns, and their interactions with the environment of the newer generation of middle-aged and older adults in Taiwan. It can be compared with other countries with actigraphy and GPS-based lifestyle data of middle-aged and older adults in the future.
Collapse
Affiliation(s)
- Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Szu-Yu Hou
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Liang Wang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Han Tang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ching Kuo
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Fu Liang
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fen Kuo
- Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
9
|
Wiseman M, Hinks M, Hallett D, Blundell J, Sweeney E, Thorpe CM, Walling SG, Swift-Gallant A. Evidence that ovarian hormones, but not diet and exercise, contribute to the sex disparity in post-traumatic stress disorder. J Psychiatr Res 2023; 168:213-220. [PMID: 37918034 DOI: 10.1016/j.jpsychires.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Females are twice as likely as males to receive a diagnosis of post-traumatic stress disorder (PTSD). One hypothesis for this sex disparity is that ovarian hormones, including estrogen and progesterone, contribute to PTSD risk. Alternatively, sex differences in lifestyle factors, such as diet and exercise, may play a role in PTSD risk. Using data from the Atlantic Partnership for Tomorrow's Health (PATH) cohort (n = 16,899), the relationship between endogenous hormone fluctuations (e.g., menarche, pregnancy, and menopause), exogenous hormone use (e.g., hormonal contraception and hormone replacement therapy (HRT)) and lifestyle variables (diet and exercise habits, as measured by the Mediterranean Diet Adherence Screener, Healthy Eating Index, and International Physical Activity Questionnaire) with PTSD diagnosis and treatment were analyzed. While several hormonal variables, including contraceptive use, higher total number of pregnancies, younger menarche age, and having undergone menopause increased the risk of PTSD, no lifestyle variables contributed to an increased risk of PTSD diagnosis. These findings support the theory that ovarian hormones contribute to the sex-linked disparity in PTSD diagnosis.
Collapse
Affiliation(s)
- Megan Wiseman
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Meagan Hinks
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Darcy Hallett
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Jacqueline Blundell
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ellen Sweeney
- Atlantic PATH, Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Christina M Thorpe
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Susan G Walling
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ashlyn Swift-Gallant
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada.
| |
Collapse
|
10
|
van Tuijl LA, Basten M, Pan KY, Vermeulen R, Portengen L, de Graeff A, Dekker J, Geerlings MI, Hoogendoorn A, Lamers F, Voogd AC, Abell J, Awadalla P, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Frank P, Galenkamp H, Garssen B, Hellingman S, Huisman M, Huss A, de Jong TR, Keats MR, Kok AAL, Krokstad S, van Leeuwen FE, Luik AI, Noisel N, Onland-Moret NC, Payette Y, Penninx BWJH, Rissanen I, Roest AM, Ruiter R, Schoevers RA, Soave D, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Twait EL, Teyhan A, Verschuren WMM, van der Willik KD, Rosmalen JGM, Ranchor AV. Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis. Cancer 2023; 129:3287-3299. [PMID: 37545248 DOI: 10.1002/cncr.34853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/16/2023] [Accepted: 04/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Depression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium. METHODS The PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2). RESULTS No associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06-1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04-1.23). CONCLUSIONS Depression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. PREREGISTRATION NUMBER: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157677.
Collapse
Affiliation(s)
- Lonneke A van Tuijl
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Kuan-Yu Pan
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Aging & Later Life and Personalized Medicine, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Neurodegeneration and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Jessica Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philipp Frank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Bert Garssen
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Melanie R Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Almar A L Kok
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Steinar Krokstad
- Department of Public Health and Nursing, Trøndelag Health Study Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | | | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Yves Payette
- CARTaGENE, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Maasstad, Rotterdam, the Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Public Health and Nursing, Trøndelag Health Study Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma L Twait
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Aging & Later Life and Personalized Medicine, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Utrecht Bilthoven, the Netherlands
| | - Kimberly D van der Willik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adelita V Ranchor
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
11
|
Dapas M, Lee YL, Wentworth-Sheilds W, Im HK, Ober C, Schoettler N. Revealing polygenic pleiotropy using genetic risk scores for asthma. HGG ADVANCES 2023; 4:100233. [PMID: 37663543 PMCID: PMC10474095 DOI: 10.1016/j.xhgg.2023.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
In this study we examined how genetic risk for asthma associates with different features of the disease and with other medical conditions and traits. Using summary statistics from two multi-ancestry genome-wide association studies of asthma, we modeled polygenic risk scores (PRSs) and validated their predictive performance in the UK Biobank. We then performed phenome-wide association studies of the asthma PRSs with 371 heritable traits in the UK Biobank. We identified 228 total significant associations across a variety of organ systems, including associations that varied by PRS model, sex, age of asthma onset, ancestry, and human leukocyte antigen region alleles. Our results highlight pervasive pleiotropy between asthma and numerous other traits and conditions and elucidate pathways that contribute to asthma and its comorbidities.
Collapse
Affiliation(s)
- Matthew Dapas
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Yu Lin Lee
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
- Biological Sciences Collegiate Division, University of Chicago, Chicago, IL, USA
| | | | - Hae Kyung Im
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Nathan Schoettler
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
12
|
O'Sullivan DE, Hillier TWR, Brenner DR, Peters CE, King WD. Time spent in the sun and the risk of developing non-Hodgkin lymphoma: a Canadian cohort study. Cancer Causes Control 2023; 34:791-799. [PMID: 37264255 DOI: 10.1007/s10552-023-01719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE The objective was to explore the relationship of sun behavior patterns with the risk of developing non-Hodgkin lymphoma (NHL). METHODS Sun behavior information from Alberta's Tomorrow Project, CARTaGENE, and Ontario Health Study were utilized. The relationship between time in the sun during summer months and risk of NHL was assessed using Cox proportional hazard models with age as the time scale and adjustment for confounders. Cohorts were analyzed separately and hazard ratios (HR) pooled with random effects meta-analysis. Joint effects of time in the sun and use of sun protection were examined. Patterns of exposure were explored via combinations of weekday and weekend time in the sun. RESULTS During an average follow-up of 7.6 years, 205 NHL cases occurred among study participants (n = 79,803). Compared to < 30 min daily in the sun, we observed HRs of 0.84 (95% CI 0.55-1.28) for 30-59 min, 0.63 (95% CI 0.40-0.98) for 1-2 h, and 0.91 (95% CI 0.61-1.36) for > 2 h. There was suggestive evidence that > 2 h was protective against NHL with use of sun protection, but not without it. Compared to < 30 min daily, moderate exposure (30 min to 2 h on weekdays or weekend) was associated with a lower risk of NHL (HR 0.63, 95% CI 0.43-0.92), while intermittent (< 30 min on weekdays and > 2 h on weekends) and chronic (> 2 h daily) were not. CONCLUSION This study provides evidence of a protective effect of moderate time spent in the sun on NHL risk.
Collapse
Affiliation(s)
- Dylan E O'Sullivan
- Department of Oncology, University of Calgary, Calgary, AB, Canada.
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada.
- Holy Cross Centre, Box ACB, 2210 2nd St SW, Calgary, AB, T2S 3C3, Canada.
| | | | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Cheryl E Peters
- BC Centre for Disease Control & BC Cancer, Vancouver, BC, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| |
Collapse
|
13
|
Brossard M, Paterson AD, Espin-Garcia O, Craiu RV, Bull SB. Characterization of direct and/or indirect genetic associations for multiple traits in longitudinal studies of disease progression. Genetics 2023; 225:iyad119. [PMID: 37369448 DOI: 10.1093/genetics/iyad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
When quantitative longitudinal traits are risk factors for disease progression and subject to random biological variation, joint model analysis of time-to-event and longitudinal traits can effectively identify direct and/or indirect genetic association of single nucleotide polymorphisms (SNPs) with time-to-event. We present a joint model that integrates: (1) a multivariate linear mixed model describing trajectories of multiple longitudinal traits as a function of time, SNP effects, and subject-specific random effects and (2) a frailty Cox survival model that depends on SNPs, longitudinal trajectory effects, and subject-specific frailty accounting for dependence among multiple time-to-event traits. Motivated by complex genetic architecture of type 1 diabetes complications (T1DC) observed in the Diabetes Control and Complications Trial (DCCT), we implement a 2-stage approach to inference with bootstrap joint covariance estimation and develop a hypothesis testing procedure to classify direct and/or indirect SNP association with each time-to-event trait. By realistic simulation study, we show that joint modeling of 2 time-to-T1DC (retinopathy and nephropathy) and 2 longitudinal risk factors (HbA1c and systolic blood pressure) reduces estimation bias in genetic effects and improves classification accuracy of direct and/or indirect SNP associations, compared to methods that ignore within-subject risk factor variability and dependence among longitudinal and time-to-event traits. Through DCCT data analysis, we demonstrate feasibility for candidate SNP modeling and quantify effects of sample size and Winner's curse bias on classification for 2 SNPs identified as having indirect associations with time-to-T1DC traits. Joint analysis of multiple longitudinal and multiple time-to-event traits provides insight into complex traits architecture.
Collapse
Affiliation(s)
- Myriam Brossard
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto M5T 3L9, Ontario, Canada
| | - Andrew D Paterson
- Program in Genetics and Genome Biology, Hospital for Sick Children Research Institute, Toronto M5G 1X8, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto M5T 3M7, Ontario, Canada
| | - Osvaldo Espin-Garcia
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto M5T 3M7, Ontario, Canada
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto M5G 2C1, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto M5S 3G3, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London N6A 5C1, Ontario, Canada
| | - Radu V Craiu
- Department of Statistical Sciences, University of Toronto, Toronto M5S 3G3, Ontario, Canada
| | - Shelley B Bull
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto M5T 3L9, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto M5T 3M7, Ontario, Canada
| |
Collapse
|
14
|
Mahinpey N, Pollock NJ, Liu L, Contreras G, Thompson W. Self-harm and rurality in Canada: an analysis of hospitalization data from 2015 to 2019. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1161-1170. [PMID: 37029322 PMCID: PMC10081931 DOI: 10.1007/s00127-023-02463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE The incidence of self-harm is an important indicator in suicide surveillance and a target outcome for suicide prevention. Self-harm rates vary by geographic location and rurality appears to be a risk factor. The objectives of this study were to estimate rates of self-harm hospitalization in Canada over a 5-year period by sex and age group, and examine relationships between self-harm and rurality. METHODS Hospitalizations related to self-harm were identified in a national dataset (the Discharge Abstract Database) for all patients aged 10 years or older who were discharged from hospital between 2015 and 2019. Self-harm hospitalization rates were calculated and stratified by year, sex, age group, and level of rurality, as measured using the Index of Remoteness. A Poisson regression was fit to estimate rate ratios for the levels of rurality. RESULTS Rates of self-harm hospitalization were higher for females than males across all levels of rurality and increased with each level for both sexes, except for among young males. The widest rural-to-urban disparities were observed for the 10-19 and 20-34-year old age groups. Females aged 10-19 in very remote areas had the highest self-harm hospitalization rate. CONCLUSION The rate of self-harm hospitalization in Canada varied by sex, age group, and level of rurality. Clinical and community-based interventions for self-harm, such as safety planning and increased access to mental health services, should be tailored to the differential risks across geographic contexts.
Collapse
Affiliation(s)
- Newsha Mahinpey
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Nathaniel J Pollock
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
- School of Arctic and Subarctic Studies, Labrador Campus, Memorial University, Happy Valley-Goose Bay, NL, Canada.
| | - Li Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Gisèle Contreras
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| |
Collapse
|
15
|
Darvishian M, Moustaqim-Barrette A, Awadalla P, Bhatti P, Broet P, McDonald K, Murphy RA, Skead K, Urquhart R, Vena J, Dummer TJB. Provincial variation in colorectal cancer screening adherence in Canada; evidence from the Canadian Partnership for Tomorrow's Health. Front Oncol 2023; 13:1113907. [PMID: 37397357 PMCID: PMC10313193 DOI: 10.3389/fonc.2023.1113907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Although colorectal cancer (CRC) screening program is proven to reduce CRC incidence and mortality, understanding patterns and predictors of suboptimal adherence in screening program requires further investigation in Canada. Methods We used self-reported data from five regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath), namely the BC Generations Project (BCGP), Alberta's Tomorrow Project (ATP), the Ontario Health Study (OHS), Quebec's CARTaGENE, and the Atlantic Partnership for Tomorrow's Health Study (Atlantic PATH). We stratified participants into the following four risk categories: 1) age 50-74 years, 2) family history in a first-degree relative, 3) personal history of chronic inflammatory bowel disease and/or polyps, and 4) co-existence of personal risk and family history. Multivariable logistic regression was used to identify predictors of adherence to the screening guidelines. Results Adherence to CRC screening varied considerably between regions, ranging from 16.6% in CARTaGENE to 47.7% in OHS. Compared to the largest cohort OHS, the likelihood of non-adherence to CRC screening was significantly higher in BCGP (OR 1.15, 95% CI 1.11-1.19), the Atlantic PATH (OR 1.90, 95% CI 1.82-1.99) and CARTaGENE (OR 5.10, 95% CI 4.85-5.36). Low physical activity, current smoking, presence of personal risk, family history of CRC significantly reduced the likelihood of adherence to screening recommendations. Discussion/conclusion Compared to the national target of ≥ 60% for participation in CRC screening, adherence to regular CRC screening was suboptimal in this cohort of Canadians and varied by region. Further efforts are needed to identify the specific barriers to screening adherence in different provinces and across risk categories.
Collapse
Affiliation(s)
- Maryam Darvishian
- Cancer Control Research, British Columbia (BC) Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amina Moustaqim-Barrette
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia (BC) Centre for Disease Control, Vancouver, BC, Canada
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Parveen Bhatti
- Cancer Control Research, British Columbia (BC) Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Philippe Broet
- Department of Preventive and Social Medicine, École de Santé Publique, Université de Montréal, Montreal, QC, Canada
- Research Centre, CHU Sainte Justine, Montreal, QC, Canada
| | - Kelly McDonald
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Rachel A. Murphy
- Cancer Control Research, British Columbia (BC) Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kimberly Skead
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Vena
- Alberta Health Services, Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Edmonton, AB, Canada
| | - Trevor J. B. Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
16
|
Hood KM, Sweeney E, Ilie G, Keltie E, Kim JS. Toenail arsenic species and metallome profiles associated with breast, cervical, prostate, and skin cancer prevalence in the Atlantic Partnership for Tomorrow's Health cohort. Front Public Health 2023; 11:1148283. [PMID: 37397723 PMCID: PMC10308375 DOI: 10.3389/fpubh.2023.1148283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/28/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Chronic exposure to arsenic through drinking water has been linked to several cancers. The metabolism of arsenic is thought to play a key role in arsenic-related carcinogenesis as metabolites of varying toxicity are produced and either stored in or excreted from the body. Atlantic Canada has the highest age-standardized incidence rates of all cancers in the country. This may be due to its high levels of environmental arsenic and the prevalence of unregulated private wells for water consumption. Here, we aimed to characterize the profiles of arsenic species and metallome in the toenails of four cancer groups, compare them to healthy participants (N = 338), and assess potential associations between the profiles with cancer prevalence. Methods This study employed a case-control design. Toenail samples and questionnaire data from cases (breast, cervical, prostate, and skin cancers) and controls were sourced from the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. The levels of arsenic species were measured using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) paired with High Performance Liquid Chromatography (HPLC) and total concentrations of metallome (23 metals) were determined by ICP-MS separately. Multivariate analyses were conducted to compare cases with controls within each cancer group. Results Arsenic speciation profiles varied by cancer type and were significantly different between cases and controls in the breast (p = 0.0330), cervical (p = 0.0228), and skin (p = 0.0228) cancer groups. In addition, the profiles of metallome (nine metals) were significantly differentiated in the prostate (p = 0.0244) and skin (p = 0.0321) cancer groups, with higher zinc concentrations among cases compared to controls. Conclusion History of cancer diagnosis was associated with specific profiles of arsenic species and metallome. Our results indicate that arsenic methylation and zinc levels, as measured in toenails, may be an important biomarker for cancer prevalence. Further research is needed to use toenails as a prognostic measure of arsenic-and other metal-induced cancer.
Collapse
Affiliation(s)
- Kalli M. Hood
- Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ellen Sweeney
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Atlantic Partnership for Tomorrow’s Health (PATH), Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Gabriela Ilie
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Erin Keltie
- Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jong Sung Kim
- Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Atlantic Partnership for Tomorrow’s Health (PATH), Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Occupational and Environmental Health, College of Public Health, The University of Iowa, Iowa City, IA, United States
| |
Collapse
|
17
|
Yoo S, Garg E, Elliott LT, Hung RJ, Halevy AR, Brooks JD, Bull SB, Gagnon F, Greenwood C, Lawless JF, Paterson AD, Sun L, Zawati MH, Lerner-Ellis J, Abraham R, Birol I, Bourque G, Garant JM, Gosselin C, Li J, Whitney J, Thiruvahindrapuram B, Herbrick JA, Lorenti M, Reuter MS, Adeoye OO, Liu S, Allen U, Bernier FP, Biggs CM, Cheung AM, Cowan J, Herridge M, Maslove DM, Modi BP, Mooser V, Morris SK, Ostrowski M, Parekh RS, Pfeffer G, Suchowersky O, Taher J, Upton J, Warren RL, Yeung R, Aziz N, Turvey SE, Knoppers BM, Lathrop M, Jones S, Scherer SW, Strug LJ. HostSeq: a Canadian whole genome sequencing and clinical data resource. BMC Genom Data 2023; 24:26. [PMID: 37131148 PMCID: PMC10152008 DOI: 10.1186/s12863-023-01128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/22/2023] [Indexed: 05/04/2023] Open
Abstract
HostSeq was launched in April 2020 as a national initiative to integrate whole genome sequencing data from 10,000 Canadians infected with SARS-CoV-2 with clinical information related to their disease experience. The mandate of HostSeq is to support the Canadian and international research communities in their efforts to understand the risk factors for disease and associated health outcomes and support the development of interventions such as vaccines and therapeutics. HostSeq is a collaboration among 13 independent epidemiological studies of SARS-CoV-2 across five provinces in Canada. Aggregated data collected by HostSeq are made available to the public through two data portals: a phenotype portal showing summaries of major variables and their distributions, and a variant search portal enabling queries in a genomic region. Individual-level data is available to the global research community for health research through a Data Access Agreement and Data Access Compliance Office approval. Here we provide an overview of the collective project design along with summary level information for HostSeq. We highlight several statistical considerations for researchers using the HostSeq platform regarding data aggregation, sampling mechanism, covariate adjustment, and X chromosome analysis. In addition to serving as a rich data source, the diversity of study designs, sample sizes, and research objectives among the participating studies provides unique opportunities for the research community.
Collapse
Affiliation(s)
- S Yoo
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - E Garg
- Simon Fraser University, Burnaby, BC, Canada
| | - L T Elliott
- Simon Fraser University, Burnaby, BC, Canada
| | - R J Hung
- University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - A R Halevy
- The Hospital for Sick Children, Toronto, ON, Canada
| | - J D Brooks
- University of Toronto, Toronto, ON, Canada
| | - S B Bull
- University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - F Gagnon
- University of Toronto, Toronto, ON, Canada
| | - Cmt Greenwood
- McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - J F Lawless
- University of Waterloo, Waterloo, ON, Canada
| | - A D Paterson
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - L Sun
- University of Toronto, Toronto, ON, Canada
| | | | - J Lerner-Ellis
- University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - Rjs Abraham
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - I Birol
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - G Bourque
- McGill University, Montreal, QC, Canada
| | - J-M Garant
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - C Gosselin
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - J Li
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - J Whitney
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - J-A Herbrick
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M Lorenti
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M S Reuter
- The Hospital for Sick Children, Toronto, ON, Canada
| | - O O Adeoye
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S Liu
- The Hospital for Sick Children, Toronto, ON, Canada
| | - U Allen
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - F P Bernier
- University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital, Calgary, AB, Canada
| | - C M Biggs
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - A M Cheung
- University Health Network, Toronto, ON, Canada
| | - J Cowan
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Herridge
- University Health Network, Toronto, ON, Canada
| | | | - B P Modi
- BC Children's Hospital, Vancouver, BC, Canada
| | - V Mooser
- McGill University, Montreal, QC, Canada
| | - S K Morris
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - M Ostrowski
- University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - R S Parekh
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - G Pfeffer
- University of Calgary, Calgary, AB, Canada
| | | | - J Taher
- University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - J Upton
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - R L Warren
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Rsm Yeung
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - N Aziz
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S E Turvey
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | | | - M Lathrop
- McGill University, Montreal, QC, Canada
| | - Sjm Jones
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - S W Scherer
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - L J Strug
- The Hospital for Sick Children, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
18
|
Vasiliadis HM, Spagnolo J, Fleury MJ, Gouin JP, Roberge P, Bartram M, Grenier S, Shen-Tu G, Vena JE, Wang J. Mental health service use and associated predisposing, enabling and need factors in community living adults and older adults across Canada. BMC Health Serv Res 2023; 23:357. [PMID: 37046270 PMCID: PMC10091342 DOI: 10.1186/s12913-023-09335-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES Using Andersen's model of health care seeking behavior, we examined the predisposing, enabling, and need factors associated with mental health service use (MHSU) during the first wave of the COVID-19 pandemic across Canada. METHODS The sample included n = 45,542 participants in the 5 established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) and who responded to the CanPath COVID-19 health survey (May-December 2020), with complete data on MHSU. Multivariable logistic regression analyses were carried out to study MHSU as a function of predisposing, enabling, and need factors. Analyses were stratified by regional cohort. RESULTS Among the need factors, individuals reporting moderate/severe symptoms of depression and anxiety and poorer self-rated mental health were more likely to report MHSU. Among the enabling factors, receipt of informational/financial/practical support was associated with increased MHSU. While income was not consistently associated with MHSU, reported decrease in income was marginally associated with reduced MHSU. Among the predisposing factors, identifying as female or other gender minority was associated with increased MHSU, as was the presence of past-year cannabis use. In contrast, older age and alcohol consumption were associated with reduced MHSU. CONCLUSION Need factors were consistently associated with MHSU. Although income inequities in MHSU were not observed, changes such as reduced income during the pandemic may lead to barriers in accessing mental health services. Future research should focus on better identifying contextual enabling factors and policies that overcome financial barriers to MHSU.
Collapse
Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada.
- Centre de recherche Charles-Le Moyne, 150, place Charles‑Le Moyne, C. P. 200, J4K 0A8, Longueuil (Québec), Canada.
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada
- Centre de recherche Charles-Le Moyne, 150, place Charles‑Le Moyne, C. P. 200, J4K 0A8, Longueuil (Québec), Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, 6875 boul., H4H 1R3, LaSalleVerdun (Québec), Canada
- McGill University, 845 Sherbrooke St W, H3A 0G4, Montreal (Québec), Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, 7141 Sherbrooke West, H4B 1R6, Montreal (Québec), Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4545 Queen Mary Rd, H3W 1W6, Montreal (Québec), Canada
| | - Pasquale Roberge
- Département de médecine familiale et d'urgence, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, 12e Avenue N Porte 6, J1H 5N4, Sherbrooke (Québec), Canada
| | - Mary Bartram
- Mental Health Commission of Canada, 350 Albert St #1210, K1R 1A4, Ottawa (Ontario), Canada
- School of Public Policy & Administration, Carleton University, 1125 Colonel By Drive, K1S 5B6, Ottawa (Ontario), Canada
| | - Sébastien Grenier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4545 Queen Mary Rd, H3W 1W6, Montreal (Québec), Canada
- Département de psychologie, Université de Montréal, 90, avenue Vincent d'Indy, H2V 2S9, Montréal (Québec), Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, 1820 Richmond Road SW, T2T 5C7, Calgary (Alberta), Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, 1820 Richmond Road SW, T2T 5C7, Calgary (Alberta), Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, B3H 1V7, Halifax (Nova Scotia), Canada
| |
Collapse
|
19
|
Shah S, Mu C, Moossavi S, Shen-Tu G, Schlicht K, Rohmann N, Geisler C, Laudes M, Franke A, Züllig T, Köfeler H, Shearer J. Physical activity-induced alterations of the gut microbiota are BMI dependent. FASEB J 2023; 37:e22882. [PMID: 36943402 DOI: 10.1096/fj.202201571r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/31/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
Physical inactivity is one of the leading causes of chronic metabolic disease including obesity. Increasing physical activity (PA) has been shown to improve cardiometabolic and musculoskeletal health and to be associated with a distinct gut microbiota composition in trained athletes. However, the impact of PA on the gut microbiota is inconclusive for individuals performing PA in their day-to-day life. This study examined the role of PA and hand-grip strength on gut microbiome composition in middle-aged adults (40-65 years, n = 350) with normal (18.5-24.9 kg/m2 ) and overweight (25-29.9 kg/m2 ) body mass index (BMI). PA was recorded using the International Physical Activity Questionnaire, and hand-grip strength was measured using a dynamometer. Serum samples were assessed for lipidomics while DNA was extracted from fecal samples for microbiome analysis. Overweight participants showed a higher concentration of triacylglycerols, and lower concentrations of cholesteryl esters, sphingomyelin, and lyso-phosphotidylcholine lipids (p < .05) compared with those with normal BMI. Additionally, overweight participants had a lower abundance of the Oscillibacter genus (p < .05). The impact of PA duration on the gut microbiome was BMI dependent. In normal but not overweight participants, high PA duration showed greater relative abundance of commensal taxa such as Actinobacteria and Proteobacteria phyla, as well as Collinsella and Prevotella genera (p < .05). Furthermore, in males with normal BMI, a stronger grip strength was associated with a higher relative abundance of Faecalibacterium and F. prausnitzii (p < .05) compared with lower grip strength. Taken together, data suggest that BMI plays a significant role in modeling PA-induced changes in gut microbiota.
Collapse
Affiliation(s)
- Shrushti Shah
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Chunlong Mu
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shirin Moossavi
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Control Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Kristina Schlicht
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Nathalie Rohmann
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Corinna Geisler
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Matthias Laudes
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Thomas Züllig
- Core Facility Mass Spectrometry, Medical University of Graz, Graz, Austria
| | - Harald Köfeler
- Core Facility Mass Spectrometry, Medical University of Graz, Graz, Austria
| | - Jane Shearer
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
20
|
Gilham K, Gadermann A, Dummer T, Murphy RA. Mental health, cancer risk, and the mediating role of lifestyle factors in the CARTaGENE cohort study. PLoS One 2023; 18:e0281588. [PMID: 36787319 PMCID: PMC9928103 DOI: 10.1371/journal.pone.0281588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Evidence on the association between mental health disorders and cancer risk is inconclusive, despite well-established associations between mental health disorders and lifestyle factors such as smoking. This study examines the relationships between depression, anxiety and cancer risk, and the potential mediating effects of lifestyle factors. METHODS A study of 34,571 participants aged 40-69 years in the CARTaGENE cohort was conducted. Depression was defined by questionnaire (PHQ-9), antidepressant use, and a composite of questionnaire, antidepressant use, or lifetime self-reported physician diagnosis. Anxiety was defined by questionnaire (GAD-7). Co-morbid depression and anxiety was also assessed. Cox regression models were used to investigate associations between mental health and risk of prostate, lung, and all cancers combined. Mediating effects of lifestyle factors were assessed using Baron and Kenny mediation criteria. RESULTS There were positive associations between mental health disorders, all cancers and lung cancer risk, however with the exception of anxiety and lung cancer in women (Hazard Ratio [HR] = 1.67, 95% CI: 1.01-2.76), associations were attenuated with adjustment for sociodemographics, health status and lifestyle factors. In the mediation analysis, smoking accounted for 27%, 18%, and 26%, of the total effect between depression (PHQ-9), anxiety, and co-morbidity and lung cancer, respectively in women. In men, smoking accounted for 17% of the total effect between depression (PHQ-9, antidepressant, or lifetime self-report of physician diagnosis) and all cancers. CONCLUSIONS Positive associations were observed between mental health disorders, all cancer and lung cancer risk, however most relationships were attenuated with adjustment for lifestyle factors. Smoking status mediated a significant proportion of the relationships between mental health disorders and cancer risk.
Collapse
Affiliation(s)
- Kaitlyn Gilham
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Gadermann
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Human Early Learning Partnership, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Trevor Dummer
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel A. Murphy
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- * E-mail:
| |
Collapse
|
21
|
Wang Y, Namba S, Lopera E, Kerminen S, Tsuo K, Läll K, Kanai M, Zhou W, Wu KH, Favé MJ, Bhatta L, Awadalla P, Brumpton B, Deelen P, Hveem K, Lo Faro V, Mägi R, Murakami Y, Sanna S, Smoller JW, Uzunovic J, Wolford BN, Willer C, Gamazon ER, Cox NJ, Surakka I, Okada Y, Martin AR, Hirbo J. Global Biobank analyses provide lessons for developing polygenic risk scores across diverse cohorts. CELL GENOMICS 2023; 3:100241. [PMID: 36777179 PMCID: PMC9903818 DOI: 10.1016/j.xgen.2022.100241] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 08/28/2022] [Accepted: 12/03/2022] [Indexed: 01/06/2023]
Abstract
Polygenic risk scores (PRSs) have been widely explored in precision medicine. However, few studies have thoroughly investigated their best practices in global populations across different diseases. We here utilized data from Global Biobank Meta-analysis Initiative (GBMI) to explore methodological considerations and PRS performance in 9 different biobanks for 14 disease endpoints. Specifically, we constructed PRSs using pruning and thresholding (P + T) and PRS-continuous shrinkage (CS). For both methods, using a European-based linkage disequilibrium (LD) reference panel resulted in comparable or higher prediction accuracy compared with several other non-European-based panels. PRS-CS overall outperformed the classic P + T method, especially for endpoints with higher SNP-based heritability. Notably, prediction accuracy is heterogeneous across endpoints, biobanks, and ancestries, especially for asthma, which has known variation in disease prevalence across populations. Overall, we provide lessons for PRS construction, evaluation, and interpretation using GBMI resources and highlight the importance of best practices for PRS in the biobank-scale genomics era.
Collapse
Affiliation(s)
- Ying Wang
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Shinichi Namba
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
| | - Esteban Lopera
- Department of Genetics, UMCG, University of Groningen, Groningen, the Netherlands
| | - Sini Kerminen
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Kristin Tsuo
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Kristi Läll
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Masahiro Kanai
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Wei Zhou
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Kuan-Han Wu
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48103, USA
| | | | - Laxmi Bhatta
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Ben Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7030 Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7600 Levanger, Norway
- Clinic of Medicine, St. Olav’s Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Patrick Deelen
- Department of Genetics, UMCG, University of Groningen, Groningen, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7030 Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Valeria Lo Faro
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Clinical Genetics, Amsterdam University Medical Center (AMC), Amsterdam, the Netherlands
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Yoshinori Murakami
- Division of Molecular Pathology, Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Serena Sanna
- Department of Genetics, UMCG, University of Groningen, Groningen, the Netherlands
- Institute for Genetics and Biomedical Research (IRGB), National Research Council (CNR), 09100 Cagliari, Italy
| | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Brooke N. Wolford
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48103, USA
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Cristen Willer
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Biostatistics and Center for Statistical Genetics, and Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Eric R. Gamazon
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nancy J. Cox
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ida Surakka
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC) and Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita 565-0871, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo 113-0033, Japan
| | - Alicia R. Martin
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Jibril Hirbo
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
22
|
Population-Based Recalibration of the Framingham Risk Score and Pooled Cohort Equations. J Am Coll Cardiol 2022; 80:1330-1342. [PMID: 36175052 DOI: 10.1016/j.jacc.2022.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Framingham Risk Score (FRS) and Pooled Cohort Equations (PCEs) overestimate risk in many contemporary cohorts. OBJECTIVES This study sought to determine if recalibration of these scores using contemporary population-level data improves risk stratification for statin therapy. METHODS Five-year FRS and PCEs were recalibrated using a cohort of Ontario residents alive January 1, 2011, who were 30 to 79 years of age without cardiovascular disease. Scores were externally validated in a primary care cohort of routinely collected electronic medical record data from January 1, 2010, to December 31, 2014. The relative difference in mean predicted and observed risk, number of statins avoided, and number needed to treat with statins to reduce a cardiovascular event at 5 years were reported. RESULTS The FRS was recalibrated in 6,938,971 Ontario residents (51.6% women, mean age 48 years) and validated in 71,450 individuals (56.1% women, mean age 52 years). Recalibration reduced overestimation from 109% to 49% for women and 131% to 32% for men. The recalibrated FRS was estimated to reduce statin prescriptions in up to 26 per 1,000 low-risk women and 80 per 1,000 low-risk men, as well as reduce the number needed to treat from 61 to 47 in women and from 53 to 41 in men. In contrast, after recalibration of the PCEs, risk remained overestimated by 217% in women and 128% in men. CONCLUSIONS Recalibration is a feasible solution to improve risk prediction but is dependent on the model being used. Recalibration of the FRS but not the PCEs reduced overestimation and may improve utilization of statins.
Collapse
|
23
|
Kirsh VA, Skead K, McDonald K, Kreiger N, Little J, Menard K, McLaughlin J, Mukherjee S, Palmer LJ, Goel V, Purdue MP, Awadalla P. Cohort Profile: The Ontario Health Study (OHS). Int J Epidemiol 2022; 52:e137-e151. [PMID: 35962976 DOI: 10.1093/ije/dyac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Victoria A Kirsh
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (formerly for N.K.)
| | - Kimberly Skead
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Kelly McDonald
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Nancy Kreiger
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (formerly for N.K.).,Prevention and Cancer Control, Ontario Health, Cancer Care Ontario, Toronto, ON, Canada
| | - Julian Little
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Karen Menard
- Office of Institutional Research and Planning, University of Guelph, Guelph, ON, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (formerly for N.K.)
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Lyle J Palmer
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Vivek Goel
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (formerly for N.K.).,Office of the President, University of Waterloo, Waterloo, ON, Canada
| | - Mark P Purdue
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (formerly for N.K.).,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
24
|
Keltie E, Hood KM, Cui Y, Sweeney E, Ilie G, Adisesh A, Dummer T, Bharti V, Kim JS. Arsenic Speciation and Metallomics Profiling of Human Toenails as a Biomarker to Assess Prostate Cancer Cases: Atlantic PATH Cohort Study. Front Public Health 2022; 10:818069. [PMID: 35875010 PMCID: PMC9301242 DOI: 10.3389/fpubh.2022.818069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic exposure to inorganic arsenic and trace metals has been linked to prostate cancer, and altered arsenic methylation capacity may have an important role in arsenic carcinogenesis. Biomarkers may be able to elucidate this role. Our objectives were to characterize profiles of arsenic species and metallome in toenails and urine samples, compare profiles between prostate cancer cases and controls, and determine the discriminant ability of toenail and urine biomarkers. Toenail samples (n = 576), urine samples (n = 152), and questionnaire data were sourced from the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. Healthy controls were matched to prostate cancer cases (3:1 ratio) on sex, age, smoking status, and the province of residence. Metallome profiles and proportions of arsenic species were measured in toenail and urine samples. Analysis of covariance (ANCOVA) was used to compare the mean percent monomethylarsonic acid (%MMA), dimethylarsonic acid (%DMA), inorganic arsenic (%iAs), primary methylation index (PMI, MMA/iAs), and secondary methylation index (SMI, DMA/MMA). Multivariate analysis of covariance (MANCOVA) was used to compare selected metal concentrations. Mean %MMA was significantly lower and SMI was significantly higher in toenails from prostate cancer cases compared to controls in unadjusted and adjusted models. Proportions of arsenic species were correlated with total arsenic in toenails. Arsenic speciation in urine was not different between cases and controls, nor were metallome profiles in toenails and urine. Our results indicate that toenails are a viable biomarker for altered arsenic speciation in prostate cancer cases and may have greater utility than urine in this context.
Collapse
Affiliation(s)
- Erin Keltie
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada,Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kalli M. Hood
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada,Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health (PATH), Dalhousie University, Halifax, NS, Canada
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health (PATH), Dalhousie University, Halifax, NS, Canada
| | - Gabriela Ilie
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Anil Adisesh
- Division of Occupational Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada,Department of Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Trevor Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Veni Bharti
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada,Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jong Sung Kim
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada,Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada,*Correspondence: Jong Sung Kim
| |
Collapse
|
25
|
Christie CD, Friedenreich CM, Vena JE, Turley L, McCormack GR. Cross-sectional and longitudinal associations between the built environment and walking: effect modification by socioeconomic status. BMC Public Health 2022; 22:1233. [PMID: 35729509 PMCID: PMC9210749 DOI: 10.1186/s12889-022-13611-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although socioeconomic status (SES) has been shown to modify associations between the neighborhood built environment and physical activity, contradictory results exist. Objectives of this cross-sectional and longitudinal analysis were to: 1) examine whether overall neighborhood walkability and specific built characteristics were associated with walking among adults at a single point in time and after they relocate neighborhoods, and 2) test for effect modification of these associations by SES. METHODS We linked longitudinal data from 703 adults who relocated urban neighborhoods between two waves of Alberta's Tomorrow Project (2008-2015) to neighborhood built environment data. We created a walkability index from measures of population counts, street connectivity, and destination diversity within 400 m of participants' homes. In cross-sectional analyses, we used generalized linear models to estimate associations between built characteristics and minutes walked per week at baseline. For the longitudinal analyses, we used fixed-effects linear regression models to estimate associations between changes in built characteristics and minutes walked per week. We also assessed if indicators of SES (individual education or household income) modified both sets of associations. RESULTS Most cross-sectional and longitudinal associations were small and statistically non-significant. Neighborhood population count (b = 0.03, 95% CI: 0.01, 0.07) and street connectivity (b = - 1.75, 95% CI: - 3.26, - 0.24) were cross-sectionally associated with walking duration among the overall sample. None of the longitudinal associations were statistically significant among the overall sample. There was limited evidence of effect modification by SES, however, we found negative cross-sectional associations between street connectivity and walking among adults with lower education and income, and a positive association between percent change in walkability and change in walking among lower educated adults. CONCLUSIONS Despite population count and street connectivity being associated with walking at baseline, changes in these built environment variables were not associated with changes in walking following residential relocation. Our findings also provide evidence, albeit weak, that changes in neighborhood walkability, resulting from residential relocation, might more strongly affect walking among low SES adults. Further longitudinal research is needed to examine built environment characteristics with walking for different purposes and to test for inequitable socioeconomic impacts.
Collapse
Affiliation(s)
- Chelsea D Christie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| | - Christine M Friedenreich
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, 2210 2nd St SW, Calgary, Alberta, T2S 3C3, Canada
| | - Jennifer E Vena
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada
| | - Liam Turley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Gavin R McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,School of Architecture, Planning and Landscape, University of Calgary, 2500 University Dr NW, Calgary, Alberta, T2N 4N1, Canada
| |
Collapse
|
26
|
Substituting bouts of sedentary behavior with physical activity: adopting positive lifestyle choices in people with a history of cancer. Cancer Causes Control 2022; 33:1083-1094. [PMID: 35699799 PMCID: PMC9194779 DOI: 10.1007/s10552-022-01592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/22/2022] [Indexed: 11/23/2022]
Abstract
Purpose To determine in people with a history of cancer, whether substituting sitting time with other daily activities (i.e., sleeping, walking, moderate and vigorous physical activity) was associated with changes in waist circumference (WC), an important surrogate marker of cardiometabolic risk. Methods Cross-sectional analyses from the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) cohort was conducted using isotemporal substitution models to explore the associations of substituting sedentary time, physical activity behavior (International Physical Activity Questionnaire), or sleep (Pittsburgh Sleep Quality Index) with changes in WC. Analyses were conducted using sex-specific WC classifications. Results In 3,684 people with a history of cancer [mean age (SD) 58.2 (7.3) years; BMI 28.9 (5.2) kg m−2; 71% female], reallocating 10 min of sleep or sedentary time for 10 min of walking was associated with lower WC in women (p < 0.01). In men, PA intensity appeared to be more strongly associated with a reduced WC. Replacing 10 min of sedentary time with 10 min of moderate or vigorous PA and replacing 10 min of sleep with moderate PA were associated with a significantly reduced WC (p < 0.001). The largest effect was when 10 min of moderate PA was replaced with vigorous PA, a reduction in WC (p < 0.01) was evident. Conclusion For people with a history of cancer, adopting small but positive changes in lifestyle behaviors could help reduce WC and potentially offset negative health-related outcomes associated with higher WC. Further research is required to examine whether such an intervention may be acceptable and manageable among this population.
Collapse
|
27
|
Lifestyle factors and lung cancer risk among never smokers in the Canadian Partnership for Tomorrow's Health (CanPath). Cancer Causes Control 2022; 33:913-918. [PMID: 35302182 DOI: 10.1007/s10552-022-01566-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although smoking is the primary risk factor for lung cancer, 15-25% of lung cancers occur in never smokers. Emerging evidence suggests lifestyle factors are associated with lung cancer risk, but few studies among never smokers exist. METHODS A case-control study of never smokers within the Canadian Partnership for Tomorrow's Health was conducted. At recruitment, participants provided data on lifestyle, health history and sociodemographic factors. Incident lung cancers were identified through linkage with administrative health records. Cases (n = 190) were matched to controls (n = 760) on age, sex, and follow-up time. Logistic regression analyses, adjusted for matching factors and annual income, were used to identify associations between lifestyle factors and lung cancer risk. RESULTS Consumption of < 5 servings of fruits and vegetables/day was associated with higher risk of lung cancer (OR 1.50, 95% CI 1.03-2.17). Short or long sleep (≤ 6 or > 9 h/night) was also associated with increased risk of lung cancer (OR 1.52, 95% CI 1.01-2.29). No associations were observed for obesity measures, alcohol consumption, or physical activity. CONCLUSION Our findings provide evidence of a potential role between sleep, fruits and vegetable consumption, and lung cancer risk in a pan-Canadian, non-smoking population. However, the sample size is modest, and further investigation is needed.
Collapse
|
28
|
Sweeney CL, Smith NK, Sweeney E, Cohen AM, Kim JS. Analysis of human serum and urine for tentative identification of potentially carcinogenic pesticide-associated N-nitroso compounds using high-resolution mass spectrometry. ENVIRONMENTAL RESEARCH 2022; 205:112493. [PMID: 34896088 DOI: 10.1016/j.envres.2021.112493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/11/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
Human serum and urine samples were analyzed for a suite of nitrosatable pesticides and potentially carcinogenic pesticide-associated N-nitroso (PANN) compounds. Formation of PANN compounds may occur in vivo after consumption of food or water containing trace amounts of nitrosatable pesticide residues and nitrate. Using a modified version of the Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) method, nine nitrosatable pesticides and byproducts were extracted from serum and urine from 64 individuals from two different sample populations in Atlantic Canada: (i) Prince Edward Island, a region where nitrate and trace amounts of nitrosatable pesticides have been detected in groundwater; and (ii) Halifax, Nova Scotia, a non-agricultural urban area. Samples were then analyzed using ultra-high pressure liquid chromatography (UHPLC) coupled with high-resolution accurate mass (HRAM) single-stage orbitrap mass spectrometry (MS), which allows for semi-targeted analysis and tentative identification of a virtually limitless number of exposure biomarkers. Two nitrosatable target analytes, ethylenethiourea (ETU) and 3,5,6-trichloro-2-pyridinol (TCPy) were found in serum, while atrazine (ATR) and ETU were detected in urine. Five and six PANN compounds were tentatively identified in serum and urine, respectively. The two PANN compounds that were most frequently tentatively identified in serum were N-nitroso dimethoate (N-DIM) and N-nitroso omethoate (N-OME) with detection frequencies of 78% and 95%, respectively. This is the first biomonitoring study of its kind to investigate PANN compounds in human serum and urine.
Collapse
Affiliation(s)
- Crystal L Sweeney
- Interdisciplinary PhD Program, Faculty of Graduate Studies, Dalhousie University, Halifax, NS, Canada; Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Nathan K Smith
- Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ellen Sweeney
- Atlantic PATH, Dalhousie University, Halifax, NS, Canada
| | - Alejandro M Cohen
- Proteomics and Mass Spectrometry Core Facility, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jong Sung Kim
- Health and Environments Research Centre (HERC) Laboratory, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| |
Collapse
|
29
|
Jantzen R, Maltais M, Broët P. Socio-Demographic Factors Associated With COVID-19 Vaccine Hesitancy Among Middle-Aged Adults During the Quebec's Vaccination Campaign. Front Public Health 2022; 10:756037. [PMID: 35372193 PMCID: PMC8971569 DOI: 10.3389/fpubh.2022.756037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The objective of this study was to characterize the combinations of demographic and socioeconomic characteristics associated to the unwillingness to receive the COVID-19 vaccines during the 2021 Quebec's vaccination campaign. Materials and Methods In March-June 2021, we conducted an online survey of the participants of the CARTaGENE population-based cohort, composed of middle-aged and older adults. After comparing the vaccinated and unvaccinated participants, we investigated vaccine hesitancy among participants who were unvaccinated. For identifying homogeneous groups of individuals with respect to vaccine hesitancy, we used a machine learning approach based on a hybrid tree-based model. Results Among the 6,105 participants of the vaccine cohort, 3,553 (58.2%) had at least one dose of COVID-19 vaccine. Among the 2,552 participants, 221 (8.7%) did not want to be vaccinated (91) or were uncertain (130). The median age for the unvaccinated participants was 59.3 years [IQR 54.7–63.9]. The optimal hybrid tree-based model identified seven groups. Individuals having a household income lower than $100,000 and being born outside of Canada had the highest rate of vaccine hesitancy (28% [95% CI 19.8–36.3]). For those born in Canada, the vaccine hesitancy rate among the individuals who have a household income below $50,000 before the pandemic or are Non-retired was of 12.1% [95% CI 8.7–15.5] and 10.6% [95% CI 7.6–13.7], respectively. For the participants with a high household income before the pandemic (more than $100,000) and a low level of education, those who experienced a loss of income during the pandemic had a high level of hesitancy (19.2% [8.5–29.9]) whereas others who did not experience a loss of income had a lower level of hesitancy (6.0% [2.8–9.2]). For the other groups, the level of hesitancy was low of around 3% (3.2% [95% CI 1.9–4.4] and 3.4% [95% CI 1.5–5.2]). Discussion Public health initiatives to tackle vaccine hesitancy should take into account these socio-economic determinants and deliver personalized messages toward people having socio-economic difficulties and/or being part of socio-cultural minorities.
Collapse
Affiliation(s)
- Rodolphe Jantzen
- CARTaGENE, Research Center, CHU Sainte-Justine, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
- *Correspondence: Rodolphe Jantzen
| | - Mathieu Maltais
- CARTaGENE, Research Center, CHU Sainte-Justine, Montreal, QC, Canada
- Faculté des Sciences de l'Activité Physique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Philippe Broët
- CARTaGENE, Research Center, CHU Sainte-Justine, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
- University Paris-Saclay, CESP, INSERM, Villejuif, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Hôpital Paul Brousse, Villejuif, France
- Philippe Broët
| |
Collapse
|
30
|
The BC Generations Project as a Tumor Tissue Resource for Cancer Research. Curr Oncol 2022; 29:1262-1268. [PMID: 35200606 PMCID: PMC8870926 DOI: 10.3390/curroncol29020107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Population-based cohort studies can be a resource for tumor specimens, annotated with demographic, lifestyle, and health history data, that support innovative studies of cancer. Our aim was to establish and test a process for accessing tumor samples, held at pathology laboratories around British Columbia (BC), for participants of the BC Generations Project (BCGP). Through the BC Cancer Registry, we identified pathology reports for 1100 (93%) of the 1180 incident solid cancer cases diagnosed in BCGP as of 2019. Using manually abstracted data from the reports, we successfully retrieved 183 (92%) of the 200 formalin-fixed, paraffin-embedded (FFPE) blocks (breast, lung, bladder, and pancreas cancer cases) that we requested from pathology laboratories. No important differences in retrieval rates by cancer site, sample location (Greater Vancouver vs. Outside Greater Vancouver), sample type (biopsy vs. excision) or year of diagnosis were identified. A text mining solution recently implemented by the Registry will allow us to automate the process for data abstraction and should capture pathology reports for 100% of all newly diagnosed BCGP cancer cases moving forward. This will further enhance the utility of BCGP as a high-quality tumor tissue research resource.
Collapse
|
31
|
DeClercq V, Nearing JT, Langille MGI. Investigation of the impact of commonly used medications on the oral microbiome of individuals living without major chronic conditions. PLoS One 2021; 16:e0261032. [PMID: 34882708 PMCID: PMC8659300 DOI: 10.1371/journal.pone.0261032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Commonly used medications produce changes in the gut microbiota, however, the impact of these medications on the composition of the oral microbiota is understudied. METHODS Saliva samples were obtained from 846 females and 368 males aged 35-69 years from a Canadian population cohort, the Atlantic Partnership for Tomorrow's Health (PATH). Samples were analyzed by 16S rRNA gene sequencing and differences in microbial community compositions between nonusers, single-, and multi-drug users as well as the 3 most commonly used medications (thyroid hormones, statins, and proton pump inhibitors (PPI)) were examined. RESULTS Twenty-six percent of participants were taking 1 medication and 21% were reported taking 2 or more medications. Alpha diversity indices of Shannon diversity, Evenness, Richness, and Faith's phylogenetic diversity were similar among groups, likewise beta diversity as measured by Bray-Curtis dissimilarity (R2 = 0.0029, P = 0.053) and weighted UniFrac distances (R2 = 0.0028, P = 0.161) were non-significant although close to our alpha value threshold (P = 0.05). After controlling for covariates (sex, age, BMI), six genera (Saprospiraceae uncultured, Bacillus, Johnsonella, Actinobacillus, Stenotrophomonas, and Mycoplasma) were significantly different from non-medication users. Thyroid hormones, HMG-CoA reductase inhibitors (statins) and PPI were the most reported medications. Shannon diversity differed significantly among those taking no medication and those taking only thyroid hormones, however, there were no significant difference in other measures of alpha- or beta diversity with single thyroid hormone, statin, or PPI use. Compared to participants taking no medications, the relative abundance of eight genera differed significantly in participants taking thyroid hormones, six genera differed in participants taking statins, and no significant differences were observed with participants taking PPI. CONCLUSION The results from this study show negligible effect of commonly used medications on microbial diversity and small differences in the relative abundance of specific taxa, suggesting a minimal influence of commonly used medication on the salivary microbiome of individuals living without major chronic conditions.
Collapse
Affiliation(s)
- Vanessa DeClercq
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
| | - Jacob T. Nearing
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Morgan G. I. Langille
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
32
|
Durrani R, Friedrich MG, Schulze KM, Awadalla P, Balasubramanian K, Black SE, Broet P, Busseuil D, Desai D, Dummer T, Dick A, Hicks J, Iype T, Kelton D, Kirpalani A, Lear SA, Leipsic J, Li W, McCreary CR, Moody AR, Noseworthy MD, Parraga G, Poirier P, Rangarajan S, Szczesniak D, Szuba A, Tardif JC, Teo K, Vena JE, Zatonska K, Zimny A, Lee DS, Yusuf S, Anand SS, Smith EE. Effect of Cognitive Reserve on the Association of Vascular Brain Injury With Cognition: Analysis of the PURE and CAHHM Studies. Neurology 2021; 97:e1707-e1716. [PMID: 34504021 PMCID: PMC8605614 DOI: 10.1212/wnl.0000000000012765] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine whether cognitive reserve attenuates the association of vascular brain injury with cognition. METHODS Cross-sectional data were analyzed from 2 harmonized studies: the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM) and the Prospective Urban and Rural Epidemiology (PURE) study. Markers of cognitive reserve were education, involvement in social activities, marital status, height, and leisure physical activity, which were combined into a composite score. Vascular brain injury was defined as nonlacunar brain infarcts or high white matter hyperintensity (WMH) burden on MRI. Cognition was assessed using the Montreal Cognitive Assessment Tool (MoCA) and the Digit Symbol Substitution Test (DSST). RESULTS There were 10,916 participants age 35-81. Mean age was 58.8 years (range 35-81) and 55.8% were female. Education, moderate leisure physical activity, being in a marital partnership, being taller, and participating in social groups were each independently associated with higher cognition, as was the composite cognitive reserve score. Vascular brain injury was associated with lower cognition (β -0.35 [95% confidence interval [CI] -0.53 to -0.17] for MoCA and β -2.19 [95% CI -3.22 to -1.15] for DSST) but the association was not modified by the composite cognitive reserve variable (interaction p = 0.59 for MoCA and p = 0.72 for DSST). CONCLUSIONS Both vascular brain injury and markers of cognitive reserve are associated with cognition. However, the effects were independent such that the adverse effects of covert vascular brain injury were not attenuated by higher cognitive reserve. To improve cognitive brain health, interventions to both prevent cerebrovascular disease and promote positive lifestyles are needed.
Collapse
Affiliation(s)
- Romella Durrani
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Matthias G Friedrich
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Karleen M Schulze
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Philip Awadalla
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Kumar Balasubramanian
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Sandra E Black
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Philippe Broet
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - David Busseuil
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Dipika Desai
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Trevor Dummer
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Alexander Dick
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Jason Hicks
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Thomas Iype
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - David Kelton
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Anish Kirpalani
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Scott A Lear
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Jonathon Leipsic
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Wei Li
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Cheryl R McCreary
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Alan R Moody
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Michael D Noseworthy
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Grace Parraga
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Paul Poirier
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Sumathy Rangarajan
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Dorota Szczesniak
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Andrzej Szuba
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Jean-Claude Tardif
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Koon Teo
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Jennifer E Vena
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Katarzyna Zatonska
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Anna Zimny
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Douglas S Lee
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Salim Yusuf
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Sonia S Anand
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada
| | - Eric E Smith
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada.
| |
Collapse
|
33
|
van Tuijl LA, Voogd AC, de Graeff A, Hoogendoorn AW, Ranchor AV, Pan KY, Basten M, Lamers F, Geerlings MI, Abell JG, Awadalla P, Bakker MF, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Galenkamp H, Garssen B, Hellingman S, Huisman M, Huss A, Keats MR, Kok AAL, Luik AI, Noisel N, Onland-Moret NC, Payette Y, Penninx BWJH, Portengen L, Rissanen I, Roest AM, Rosmalen JGM, Ruiter R, Schoevers RA, Soave DM, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Teyhan A, Vaartjes I, van der Willik KD, van Leeuwen FE, van Petersen R, Verschuren WMM, Visseren F, Vermeulen R, Dekker J. Psychosocial factors and cancer incidence (PSY-CA): Protocol for individual participant data meta-analyses. Brain Behav 2021; 11:e2340. [PMID: 34473425 PMCID: PMC8553309 DOI: 10.1002/brb3.2340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/12/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking-related, and alcohol-related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer. METHODS The psychosocial factors and cancer incidence (PSY-CA) consortium was established involving experts in the field of (psycho-)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two-stage individual participant data (IPD) meta-analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta-analyses will be performed on the risk estimates (stage 2). CONCLUSION PSY-CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta-analyses.
Collapse
Affiliation(s)
- Lonneke A van Tuijl
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Adri C Voogd
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Epidemiology, GROW, Maastricht University, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center University Medical Center, University of Utrecht, Utrecht, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Adelita V Ranchor
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Kuan-Yu Pan
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Femke Lamers
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Jessica G Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andy Boyd
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Bert Garssen
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Martijn Huisman
- Amsterdam UMC, Department of Epidemiology & Data Science, Amsterdam Public Health institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Melanie R Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Almar A L Kok
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Epidemiology & Data Science, Amsterdam Public Health institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Nolwenn Noisel
- CARTaGENE, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, Canada
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Yves Payette
- CARTaGENE, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, Canada
| | - Brenda W J H Penninx
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Judith G M Rosmalen
- Departments of Psychiatry and Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Maasstad, Rotterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - David M Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Teyhan
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Kimberly D van der Willik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rutger van Petersen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Utrecht, the Netherlands
| | - Frank Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Joost Dekker
- Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, The Netherlands.,Department of Rehabilitation Medicine and Department of Psychiatry, Amsterdam UMC - VUMC, Amsterdam, Noord-Holland, The Netherlands
| |
Collapse
|
34
|
Zhang Z, Wang J, Kwong JC, Burnett RT, van Donkelaar A, Hystad P, Martin RV, Bai L, McLaughlin J, Chen H. Long-term exposure to air pollution and mortality in a prospective cohort: The Ontario Health Study. ENVIRONMENT INTERNATIONAL 2021; 154:106570. [PMID: 33892223 DOI: 10.1016/j.envint.2021.106570] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Air pollution has been associated with increased mortality. However, updated evidence from cohort studies with detailed information on various risk factors is needed, especially in regions with low air pollution levels. We investigated the associations between long-term exposure to air pollution and mortality in a prospective cohort. METHODS We studied 88,615 participants aged ≥30 years from an ongoing cohort study in Ontario, Canada from 2009 to 2017. Exposure to ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) was estimated at participants' residence. Cox proportional hazard models were used to investigate the associations between air pollution and non-accidental, cardiovascular, and respiratory mortality, adjusted for a wide array of individual-level and contextual covariates. Potential effect modification by socio-demographic and behavioral factors was also examined in exploratory stratified analyses. RESULTS The fully adjusted hazard ratios (HRs) per 1 µg/m3 increment in PM2.5 were 1.037 [95% confidence interval (CI): 1.018, 1.057]¸ 1.083 (95% CI: 1.040, 1.128) and 1.109 (95% CI: 1.035, 1.187) for non-accidental, cardiovascular, and respiratory mortality, respectively. Positive associations were also found for NO2; the corresponding HRs per 1 ppb increment were 1.027 (95% CI: 1.021, 1.034), 1.032 (95% CI: 1.019, 1.046) and 1.044 (95% CI: 1.020, 1.068). We found suggestive evidence of stronger associations in physically active participants, smokers, and those with lower household income. CONCLUSIONS Long-term exposure to PM2.5 and NO2 was associated with increased risks for non-accidental, cardiovascular, and respiratory mortality, suggesting potential benefits of further improvement in air quality even in low-exposure environments.
Collapse
Affiliation(s)
- Zilong Zhang
- Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - John Wang
- Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Perry Hystad
- College of Public Health and Human Studies, Oregon State University, Corvallis, OR, USA
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA
| | - Li Bai
- ICES, Toronto, ON, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hong Chen
- Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
| |
Collapse
|
35
|
Sweeney E, Cui Y, Yu ZM, Dummer TJB, DeClercq V, Forbes C, Grandy SA, Keats MR, Adisesh A. The association between mental health and shift work: Findings from the Atlantic PATH study. Prev Med 2021; 150:106697. [PMID: 34175348 DOI: 10.1016/j.ypmed.2021.106697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/13/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
We evaluated the relationship between mental health and shift work in the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. In a matched study with 12,413 participants, including 4155 shift workers and 8258 non-shift workers, we utilized general linear models and logistic regression models to assess the differences in depression, anxiety, and self-rated health. Shift workers reported higher levels of each of the mental health-related domains compared to non-shift workers. There was a significant increased risk of depression (OR = 1.13, 95% CI, 1.00-1.27) and poor self-rated health (OR = 1.13, 95% CI, 1.14-1.55) among shift workers compared to non-shift workers. Shift workers were more likely to have increased rates of depression and poor self-rated health, as well as depressive and anxiety symptom scores compared to non-shift workers. As a result, shift workers may be at increased risk of comorbidity, poor quality of life, missed work, and early retirement.
Collapse
Affiliation(s)
- Ellen Sweeney
- Atlantic PATH, Dalhousie University, Halifax, Canada.
| | - Yunsong Cui
- Atlantic PATH, Dalhousie University, Halifax, Canada
| | | | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | | | - Scott A Grandy
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Melanie R Keats
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Anil Adisesh
- Occupational Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
36
|
Ilie G, Rutledge R, Sweeney E. Post-Treatment Adverse Health Correlates among Prostate Cancer Survivors in a Sample of Men Residing in Atlantic Canada. Curr Oncol 2021; 28:2812-2822. [PMID: 34436012 PMCID: PMC8395491 DOI: 10.3390/curroncol28040246] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Recent large population-based studies have shed light on an association between prostate cancer (PCa) survivorship and mental health, which emerged when the comparison group was either men without a history of cancer or those with any other type of cancer except prostate. Here we examine the role of surgery alone, compared to other types of treatment modalities in this association in a population-based sample of men with prostate or other types of cancer. METHODS A cross-sectional analysis was conducted on a subsample of 632 male participants aged 36-69 from the 2009-2015 survey cycle of the Atlantic PATH cohort study. The primary outcomes were the presence of mild, moderate or severe depression or anxiety indicators and were assessed using the seven-item generalized anxiety disorder (GAD-7) scale and the nine-item Patient Health Questionnaire (PHQ-9), respectively. The presence of a lifetime history of PCa or other form of cancer (except PCa) was the main predictor variable and was assessed in cancer treatment modality (surgery or other types of treatment modalities) stratified analyses. Covariates included age, marital status, household income, comorbidity, and survivorship time. RESULTS The presence of depression in this sample was prevalent among 17.7% of men, and of anxiety among 9.3% of men. Survivors who were treated with surgery for their PCa diagnosis had 7.55 statistically significantly higher odds of screening positive for current depression symptoms compared with those of other forms of cancer in controlled analyses. These differences were not observed for anxiety. CONCLUSIONS These findings emphasize the need for multidisciplinary survivorship care plans among PCa patients, especially those who undergo surgery. Targeted programming aimed at prioritizing and delivering comprehensive mental health support to PCa survivors early in the survivorship journey is justified.
Collapse
Affiliation(s)
- Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Robert Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Ellen Sweeney
- Atlantic PATH, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| |
Collapse
|
37
|
Age and Sex-Specific Associations in Health Risk Factors for Chronic Disease: Evidence from the Atlantic Partnership for Tomorrow's Health (PATH) Cohort. Can J Aging 2021; 41:164-175. [PMID: 34266509 DOI: 10.1017/s0714980821000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to discern health risk factors for chronic disease by age and sex in a Canadian cohort. Participants of the Atlantic Partnership for Tomorrow's Health (PATH) cohort with health risk factor data (physical activity, smoking, alcohol consumption, diet, body mass index [BMI]) were included (n = 16,165). Multivariable logistic regression models were used to evaluate the relationship among health risk factors, age, and sex. Regression analysis revealed that the odds of engaging in high levels of physical activity and having a BMI ≥ 25 was lower for females than males across all age groups, whereas the odds of abdominal obesity was substantially higher for females of all ages than for males. The odds of habitually consuming alcohol was lower for females of all ages than for males, and the odds of being a former/current smoker was lower for older (57-74 years of age) females than for males. The odds of consuming five or more servings of fruit and vegetables per day was higher for females of all ages than for males. There are evident differences in health risk factors for males and for females, as well as across age groups, and public health efforts need to account for the role played by sex and age in addressing chronic disease burden in Canadian adults.
Collapse
|
38
|
Chauhan V, Leblanc J, Sadi B, Burtt J, Sauvé K, Lane R, Randhawa K, Wilkins R, Quayle D. COHERE - strengthening cooperation within the Canadian government on radiation research. Int J Radiat Biol 2021; 97:1153-1165. [PMID: 34133252 DOI: 10.1080/09553002.2021.1941379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Canadian Organization on Health Effects from Radiation Exposure (COHERE) is a government initiative to better understand biological and human health risks from ionizing radiation exposures relevant to occupational and environmental settings (<100 mGy, <6 mGy/h). It is currently a partnership between two federal agencies, Health Canada (HC) and the Canadian Nuclear Safety Commission (CNSC). COHERE's vision is to contribute knowledge to reduce scientific uncertainties from low dose and dose-rate exposures. COHERE will advance our understanding by bridging the knowledge gap between human health risks and linkages to molecular- and cellular-level responses to radiation. Research focuses on identifying sensitive, early, and key molecular events of relevance to risk assessment. CONCLUSIONS The initiative will address questions of relevance to better apprize Canadians, including radiation workers and members of the public and Indigenous peoples, on health risks from low dose radiation exposure and inform radiation protection frameworks at a national and international level. Furthermore, it will support global efforts to conduct collaborative undertakings and better coordinate research. Here, we describe a historical overview of the research conducted, the strategic research agenda that outlines the scientific framework, stakeholders, opportunities to harmonize internationally, and how research outcomes will better inform communication of risk to Canadians.
Collapse
Affiliation(s)
- Vinita Chauhan
- Radiation Protection Bureau, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Julie Leblanc
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Baki Sadi
- Radiation Protection Bureau, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Julie Burtt
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Kiza Sauvé
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Rachel Lane
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Kristi Randhawa
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Ruth Wilkins
- Radiation Protection Bureau, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Debora Quayle
- Radiation Protection Bureau, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| |
Collapse
|
39
|
Pader J, Basmadjian RB, O'Sullivan DE, Mealey NE, Ruan Y, Friedenreich C, Murphy R, Wang E, Quan ML, Brenner DR. Examining the etiology of early-onset breast cancer in the Canadian Partnership for Tomorrow's Health (CanPath). Cancer Causes Control 2021; 32:1117-1128. [PMID: 34173131 DOI: 10.1007/s10552-021-01460-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/11/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Breast cancer incidence among younger women (under age 50) has increased over the past 25 years, yet little is known about the etiology among this age group. The objective of this study was to investigate relationships between modifiable and non-modifiable risk factors and early-onset breast cancer among three prospective Canadian cohorts. METHODS A matched case-control study was conducted using data from Alberta's Tomorrow Project, BC Generations Project, and the Ontario Health Study. Participants diagnosed with breast cancer before age 50 were identified through provincial registries and matched to three control participants of similar age and follow-up. Conditional logistic regression was used to examine the association between factors and risk of early-onset breast cancer. RESULTS In total, 609 cases and 1,827 controls were included. A body mass index ≥ 30 kg/m2 was associated with a lower risk of early-onset breast cancer (OR 0.65; 95% CI 0.47-0.90), while a waist circumference ≥ 88 cm was associated with an increased risk (OR 1.58; 95% CI 1.18-2.11). A reduced risk was found for women with ≥ 2 pregnancies (OR 0.76; 95% CI 0.59-0.99) and a first-degree family history of breast cancer was associated with an increased risk (OR 1.95; 95% CI 1.47-2.57). CONCLUSIONS In this study, measures of adiposity, pregnancy history, and familial history of breast cancer are important risk factors for early-onset breast cancer. Evidence was insufficient to conclude if smoking, alcohol intake, fruit and vegetable consumption, and physical activity are meaningful risk factors. The results of this study could inform targeted primary and secondary prevention for early-onset breast cancer.
Collapse
Affiliation(s)
- Joy Pader
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Robert B Basmadjian
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dylan E O'Sullivan
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nicole E Mealey
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Christine Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rachel Murphy
- Department of Epidemiology, Biostatistics and Public Health Practice, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Edwin Wang
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - May Lynn Quan
- Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Oncology and Community Health Sciences, University of Calgary, Heritage Medical Research Building, 3300 Hospital Dr NW, Room 382B, Calgary, AB, T2N 4Z6, Canada.
| |
Collapse
|
40
|
Qi J, Spinelli JJ, Dummer TJB, Bhatti P, Playdon MC, Levitt JO, Hauner B, Moore SC, Murphy RA. Metabolomics and cancer preventive behaviors in the BC Generations Project. Sci Rep 2021; 11:12094. [PMID: 34103643 PMCID: PMC8187402 DOI: 10.1038/s41598-021-91753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 05/21/2021] [Indexed: 12/24/2022] Open
Abstract
Metabolomics can detect metabolic shifts resulting from lifestyle behaviors and may provide insight on the relevance of changes to carcinogenesis. We used non-targeted nuclear magnetic resonance to examine associations between metabolic measures and cancer preventive behaviors in 1319 participants (50% male, mean age 54 years) from the BC Generations Project. Behaviors were dichotomized: BMI < 25 kg/m2, ≥ 5 servings of fruits or vegetables/day, ≤ 2 alcoholic drinks/day for men or 1 drink/day for women and ≥ 30 min of moderate or vigorous physical activity/day. Linear regression was used to estimate coefficients and 95% confidence intervals with a false discovery rate (FDR) of 0.10. Of the 218 metabolic measures, 173, 103, 71 and 6 were associated with BMI, fruits and vegetables, alcohol consumption and physical activity. Notable findings included negative associations between glycoprotein acetyls, an inflammation-related metabolite with lower BMI and greater fruit and vegetable consumption, a positive association between polyunsaturated fatty acids and fruit and vegetable consumption and positive associations between high-density lipoprotein subclasses with lower BMI. These findings provide insight into metabolic alterations in the context of cancer prevention and the diverse biological pathways they are involved in. In particular, behaviors related to BMI, fruit and vegetable and alcohol consumption had a large metabolic impact.
Collapse
Affiliation(s)
- J Qi
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - T J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - P Bhatti
- Cancer Control Research, BC Cancer, 2-107, 675 W 10th Ave, Vancouver, BC, V5Z 1L3, Canada
| | - M C Playdon
- Department of Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT, USA.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - J Olin Levitt
- Department of Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT, USA.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - B Hauner
- Department of Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT, USA.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - S C Moore
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, MD, USA
| | - R A Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. .,Cancer Control Research, BC Cancer, 2-107, 675 W 10th Ave, Vancouver, BC, V5Z 1L3, Canada.
| |
Collapse
|
41
|
Jantzen R, Noisel N, Camilleri-Broët S, Labbé C, Malliard TD, Payette Y, Broët P. Epidemiological characteristics of the COVID-19 spring outbreak in Quebec, Canada: a population-based study. BMC Infect Dis 2021; 21:435. [PMID: 33971843 PMCID: PMC8107425 DOI: 10.1186/s12879-021-06002-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background By mid-July 2020, more than 108,000 COVID-19 cases had been diagnosed in Canada with more than half in the province of Quebec. In this context, we launched a study to analyze the epidemiological characteristics and the socio-economic impact of the spring outbreak in the population. Method We conducted an online survey of the participants of the CARTaGENE population-based cohort, composed of middle-aged and older adults. We collected information on socio-demographic, lifestyle, health condition, COVID-19 related symptoms and COVID-19 testing. We studied the association between these factors and two outcomes: the status of having been tested for SARS-CoV-2 and the status of having received a positive test. These associations were measured with univariate and multivariate analyses using a hybrid tree-based regression model. Results Among the 8,129 respondents from the CARTaGENE cohort, 649 were tested for COVID-19 and 41 were positive. Medical workers and individuals having a contact with a COVID-19 patient had the highest probabilities of being tested (32% and 42.4%, respectively) and of being positive (17.2% and 13.0%, respectively) among those tested. Approximately 8% of the participants declared that they have experienced at least one of the four COVID-19 related symptoms chosen by the Public Health authorities (fever, cough, dyspnea, anosmia) but were not tested. Results from the tree-based model analyses adjusted on exposure factors showed that the combination of dyspnea, dry cough and fever was highly associated with being tested whereas anosmia, fever, and headache were the most discriminant factors for having a positive test among those tested. During the spring outbreak, more than one third of the participants have experienced a decrease in access to health services. There were gender and age differences in the socio-economic and emotional impacts of the pandemic. Conclusion We have shown some discrepancies between the symptoms associated with being tested and being positive. In particular, the anosmia is a major discriminant symptom for positivity whereas ear-nose-throat symptoms seem not to be COVID-19 related. The results also emphasize the need of increasing the accessibility of testing for the general population. Supplementary Information The online version contains supplementary material available at (10.1186/s12879-021-06002-0).
Collapse
Affiliation(s)
- Rodolphe Jantzen
- CARTaGENE, CHU Ste-Justine Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, H3T1C5, Canada. .,Université de Montréal, Montréal, Canada.
| | - Nolwenn Noisel
- CARTaGENE, CHU Ste-Justine Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, H3T1C5, Canada.,Université de Montréal, Montréal, Canada
| | | | - Catherine Labbé
- CARTaGENE, CHU Ste-Justine Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, H3T1C5, Canada
| | - Thibault de Malliard
- CARTaGENE, CHU Ste-Justine Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, H3T1C5, Canada
| | - Yves Payette
- CARTaGENE, CHU Ste-Justine Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, H3T1C5, Canada
| | - Philippe Broët
- CARTaGENE, CHU Ste-Justine Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, H3T1C5, Canada.,Université de Montréal, Montréal, Canada.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, 94807, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, Villejuif, 94807, France
| |
Collapse
|
42
|
Newell M, Ghosh S, Goruk S, Pakseresht M, Vena JE, Dummer TJB, Field CJ. A Prospective Analysis of Plasma Phospholipid Fatty Acids and Breast Cancer Risk in 2 Provinces in Canada. Curr Dev Nutr 2021; 5:nzab022. [PMID: 33889794 PMCID: PMC8049855 DOI: 10.1093/cdn/nzab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Studies suggest that fatty acid status influences breast cancer etiology, yet the roles of individual fatty acids in breast cancer risk are unclear, specifically when central adiposity and menopausal status are considered. OBJECTIVES This study examined the associations of fatty acid status with breast cancer risk including location, menopausal status, and waist-to-hip ratio as key variables. METHODS Prediagnostic plasma phospholipid fatty acids were measured in women with breast cancer (n = 393) and age-matched controls (n = 786) from a nested case-control prospective study within Alberta's Tomorrow Project (ATP) and British Columbia Generations Project (BCGP) cohorts. Binary logistic regression models were used to evaluate associations of fatty acids and breast cancer risk with subgroup analysis for menopausal status and waist-to-hip ratio. RESULTS Women from BCGP had a higher n-3 (ɷ-3) fatty acid status compared with the ATP (6.4% ± 0.08% vs. 5.3% ± 0.06%; P < 0.001), so subsequent analysis was blocked by cohort. Overall, fatty acids had inconsistent associations with risk. In the ATP among premenopausal women, total long-chain n-3 fatty acids (ORQ4vsQ1 = 1.78; 95% CI: 0.58, 5.43; P-trend = 0.007, P-interaction = 0.07) were positively associated with breast cancer risk, whereas in BCGP, DHA (ORQ4vsQ1 = 0.66; 95% CI: 0.28, 1.53; P-trend = 0.03, P-interaction = 0.05) and total long-chain n-3 fatty acids (ORQ4vsQ1 = 0.66; 95% CI: 0.28, 1.54; P-trend = 0.03) were associated with decreased cancer risk when the waist-to-hip ratio was <0.85. CONCLUSIONS Our findings suggest that regional variations in fatty acid status influence breast cancer risk, resulting in positive associations of total long-chain n-3 fatty acids in premenopausal ATP women and negative associations of these fatty acids in BCGP women with a waist-to-hip ratio below guidelines. This study highlights the complexity and difficulty in using fatty acid status to predict breast cancer risk in diverse populations without the consideration of other risk factors.
Collapse
Affiliation(s)
- Marnie Newell
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, University of Alberta, Edmonton, Canada
| | - Susan Goruk
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Canada
| | - Mohammedreza Pakseresht
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Canada
| | - Jennifer E Vena
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Canada
- Alberta's Tomorrow Project, CancerCare Alberta, Alberta Health Services, Calgary, Canada
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Cancer Control Research, BC Cancer, Vancouver, Canada
| | - Catherine J Field
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Canada
| |
Collapse
|
43
|
Norberg SJ, Toohey AM, Jones S, McDonough R, Hogan DB. Examining the municipal-level representativeness of the Canadian Longitudinal Study on Aging (CLSA) cohort: an analysis using Calgary participant baseline data. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 41:48-56. [PMID: 33599444 DOI: 10.24095/hpcdp.41.2.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The Canadian Longitudinal Study on Aging (CLSA) is a rich, nationally representative population-based resource that can be used for multiple purposes. Although municipalities may wish to use CLSA data to address local policy needs, how well localized CLSA cohorts reflect municipal populations is unknown. Because Calgary, Alberta, is home to one of 11 CLSA data collection sites, our objective was to explore how well the Calgary CLSA sample represented the general Calgary population on select sociodemographic variables. METHODS Baseline characteristics (i.e. sex, marital status, ethnicity, education, retirement status, income, immigration, internal migration) of CLSA participants who visited the Calgary data collection site between 2011 and 2015 were compared to analogous profiles derived from the 2011 National Household Survey (NHS) and 2016 Census datasets, which spanned the years when data were collected on the CLSA participants. RESULTS Calgary CLSA participants were representative of the Calgary population for age, sex and Indigenous identity. Discrepancies of over 5% with the NHS and/or 2016 Census were found for marital status, measures of ethnic diversity (i.e. immigrant status, place of birth, non-official language spoken at home), internal migration, income, retirement status and education. CONCLUSION Voluntary studies face challenges in recruiting fully representative cohorts. Communities opting to use CLSA data at a municipal level, including the 10 other CLSA data collection sites, should exercise caution when interpreting the results of these analyses, as CLSA participants may not be fully representative of the local population on select characteristics of interest.
Collapse
Affiliation(s)
- Samantha J Norberg
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada.,Brenda Strafford Centre on Aging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ann M Toohey
- Brenda Strafford Centre on Aging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sian Jones
- Calgary Neighbourhoods, The City of Calgary, Calgary, Alberta, Canada
| | - Raynell McDonough
- Calgary Neighbourhoods, The City of Calgary, Calgary, Alberta, Canada
| | - David B Hogan
- Brenda Strafford Centre on Aging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
44
|
Keats MR, Cui Y, DeClercq V, Grandy SA, Sweeney E, Dummer TJB. Associations between Neighborhood Walkability, Physical Activity, and Chronic Disease in Nova Scotian Adults: An Atlantic PATH Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228643. [PMID: 33233809 PMCID: PMC7699929 DOI: 10.3390/ijerph17228643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
Background: While neighborhood walkability has been shown to positively influence health behaviors, less is known about its impact on chronic disease. Our aim was to examine the association between walkability and self-reported physical activity in relation to chronic health conditions in an Atlantic Canadian population. Methods: Using data from the Atlantic Partnership for Tomorrow's Health, a prospective cohort study, we employed both a cross-sectional and a prospective analytical approach to investigate associations of walkability and physical activity with five prevalent chronic diseases and multimorbidity. Results: The cross-sectional data show that participants with the lowest neighborhood walkability were more likely to have reported a pre-existing history of cancer and depression and least likely to report chronic respiratory conditions. Participants with low physical activity were more likely to have a pre-existing history of diabetes, chronic respiratory disease, and multimorbidity. Follow-up analyses showed no significant associations between walkability and chronic disease incidence. Low levels of physical activity were significantly associated with diabetes, cancer and multimorbidity. Conclusions: Our data provides evidence for the health protective benefits of higher levels of physical activity, and a reduction in prevalence of some chronic diseases in more walkable communities.
Collapse
Affiliation(s)
- Melanie R. Keats
- Faculty of Health, School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Correspondence: ; Tel.: +1-(902)-494-7173
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow’s Health, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (Y.C.); (V.D.); (E.S.)
| | - Vanessa DeClercq
- Atlantic Partnership for Tomorrow’s Health, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (Y.C.); (V.D.); (E.S.)
| | - Scott A. Grandy
- Faculty of Health, School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow’s Health, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (Y.C.); (V.D.); (E.S.)
| | - Trevor J. B. Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| |
Collapse
|
45
|
Hall RE, Tusevljak N, Wu CF, Ibrahim Q, Schulze K, Khan AM, Desai D, Awadalla P, Broet P, Dummer TJ, Hicks J, Tardif JC, Teo KK, Vena J, Lee D, Friedrich M, Anand SS, Tu JV. The Canadian Alliance for Healthy Hearts and Minds: How Well Does It Reflect the Canadian Population? CJC Open 2020; 2:599-609. [PMID: 33305220 PMCID: PMC7711015 DOI: 10.1016/j.cjco.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The intent of the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort is to understand the early determinants of subclinical cardiac and vascular disease and progression in adults selected from existing cohorts-the Canadian Partnership for Tomorrow's Health, the Prospective Urban and Rural Evaluation (PURE) cohort, and the Montreal Heart Institute Biobank. We evaluated how well the CAHHM-Health Services Research (CAHHM-HSR) subcohort reflects the Canadian population. METHODS A cross-sectional design was used among a prospective cohort of community-dwelling adults aged 35-69 years who met the CAHHM inclusion criteria, and a cohort of adults aged 35-69 years who responded to the 2015 Canadian Community Health Survey-Rapid Response module. The INTERHEART risk score was calculated at the individual level with means and proportions reported at the overall and provincial level. RESULTS There are modest differences between CAHHM-HSR study participants and the 2015 Canadian Community Health Survey-Rapid Response respondents in age (56.3 vs 51.7 mean years), proportion of men (44.9% vs 49.3%), and mean INTERHEART risk score (9.7 vs 10.1). Larger differences were observed in postsecondary education (86.8% vs 70.2%), Chinese ethnicity (11.0% vs 3.3%), obesity (23.2% vs 29.3%), current smoker status (6.1% vs 18.4%), and having no cardiac testing (30.4% vs 55.9%). CONCLUSIONS CAHHM-HSR participants are older, of higher socioeconomic status, and have a similar mean INTERHEART risk score, compared with participants in the Canadian Community Health Survey. Differing sampling strategies and missing data may explain some differences between the CAHHM-HSR cohort and Canadian community-dwelling adults and should be considered when using the CAHHM-HSR for scientific research.
Collapse
Affiliation(s)
- Ruth E. Hall
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Quazi Ibrahim
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Karleen Schulze
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Philip Awadalla
- Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, Toronto, Ontario, Canada
| | - Philippe Broet
- Department of Preventive and Social Medicine, School of Public Health, Montré University, Montreal, Quebec, Canada
- Research Centre, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Trevor J.B. Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jason Hicks
- Atlantic PATH, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Koon K. Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Vena
- Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Douglas Lee
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Matthias Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jack V. Tu
- ICES, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
46
|
Fleming DEB, Crook SL, Evans CT, Nader MN, Atia M, Hicks JMT, Sweeney E, McFarlane CR, Kim JS, Keltie E, Adisesh A. Assessing arsenic in human toenail clippings using portable X-ray fluorescence. Appl Radiat Isot 2020; 167:109491. [PMID: 33121893 DOI: 10.1016/j.apradiso.2020.109491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/20/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022]
Abstract
Arsenic is a toxic metalloid which has been associated with a wide range of health effects in humans including skin abnormalities and an elevated risk of skin, bladder, kidney, and lung cancer, diabetes, and cardiovascular disease. The measurement of arsenic concentration in nail clippings is often used in population studies as an indicator of arsenic exposure. Portable X-ray fluorescence (XRF) is an emerging technique for measuring arsenic in nail clippings. In the current study, single toenail clippings from 60 Atlantic Canadian participants were assessed for arsenic using a new portable XRF approach. A mono-energetic portable XRF system using doubly curved crystal optics was used to measure each clipping for a total of 900 s. Energy spectra from each clipping were analyzed for arsenic characteristic X-rays to provide a normalized arsenic signal. The same clippings were then analyzed for arsenic concentration using a "gold standard" method of inductively coupled plasma mass spectrometry (ICP-MS). Nail clipping arsenic concentrations measured by ICP-MS ranged from 0.030 μg/g to 2.57 μg/g, with a median result of 0.14 μg/g. Portable XRF results for arsenic were compared against ICP-MS arsenic concentrations, with a linear equation of best fit determined between the two variables. A correlation coefficient of r = 0.77 was found from the 59 nail clippings returning an ICP-MS arsenic concentration above the limit of quantitation. When the comparison was limited to the 20 clippings having an XRF normalized signal at least twice as large as the associated uncertainty of measurement, the correlation coefficient was r = 0.89. With the selection of an arsenic concentration of 0.1 μg/g as a cut-off value between "exposed" and "non-exposed" individuals, the XRF method provided a test sensitivity of 76% and a specificity of 81%. The corresponding positive predictive value was 88% and the negative predictive value was 65%. The portable XRF technique used in this study shows promise as a means of assessing arsenic concentration in toenail clippings.
Collapse
Affiliation(s)
- David E B Fleming
- Physics Department, Mount Allison University, Sackville, New Brunswick, Canada.
| | - Samantha L Crook
- Physics Department, Mount Allison University, Sackville, New Brunswick, Canada
| | - Colby T Evans
- Physics Department, Mount Allison University, Sackville, New Brunswick, Canada
| | - Michel N Nader
- Physics Department, Mount Allison University, Sackville, New Brunswick, Canada
| | - Manuel Atia
- Medical Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason M T Hicks
- Atlantic PATH, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ellen Sweeney
- Atlantic PATH, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jong Sung Kim
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Erin Keltie
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anil Adisesh
- Atlantic PATH, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine, Division of Occupational Medicine, University of Toronto, Toronto, Ontario, Canada; Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
| |
Collapse
|
47
|
Diet Quality and Neighborhood Environment in the Atlantic Partnership for Tomorrow's Health Project. Nutrients 2020; 12:nu12103217. [PMID: 33096731 PMCID: PMC7588981 DOI: 10.3390/nu12103217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
An understanding of relationships between different constructs of the neighbourhood environment and diet quality is needed to inform public health interventions. This study investigated associations between material deprivation, social deprivation and population density with diet quality in a cohort of 19,973 Canadian adults aged 35 to 69 years within the Atlantic PATH cohort study. Diet quality, a metric of how well diet conforms to recommendations was determined from a 24-item food frequency questionnaire. Neighbourhood environment data were derived from dissemination area level Census data. Two deprivation indices were evaluated: material and social deprivation, which reflect access to goods and amenities and social relationships. Multi-level models were used to estimate relationships (mean differences and 95% CI) between neighbourhood environment and diet quality, adjusting for covariates. Mean diet quality was lower in the most socially deprived neighbourhoods compared to the least socially deprived: −0.56, 95% CI (−0.88, −0.25). Relationships between diet quality and population density differed between urban and rural areas (p-interaction < 0.0001). In rural areas, diet quality was higher in intermediate-density neighbourhoods: 0.54, 95% CI (0.05, 1.03). In urban areas, diet quality was lower in intermediate-density and the most-dense neighbourhoods: −0.84, 95% CI (−1.28, −0.40) and −0.72, 95% CI (−1.20, −0.25). Our findings suggest socially deprived and high-density neighbourhoods are associated with lower diet quality and possible urban-rural differences in neighbourhood environment-diet quality relationships. Additional studies are needed to determine the temporal nature of relationships and whether differences in diet quality are meaningful.
Collapse
|
48
|
Doiron D, Setton EM, Shairsingh K, Brauer M, Hystad P, Ross NA, Brook JR. Healthy built environment: Spatial patterns and relationships of multiple exposures and deprivation in Toronto, Montreal and Vancouver. ENVIRONMENT INTERNATIONAL 2020; 143:106003. [PMID: 32763633 DOI: 10.1016/j.envint.2020.106003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/11/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Various aspects of the urban environment and neighbourhood socio-economic status interact with each other to affect health. Few studies to date have quantitatively assessed intersections of multiple urban environmental factors and their distribution across levels of deprivation. OBJECTIVES To explore the spatial patterns of urban environmental exposures within three large Canadian cities, assess how exposures are distributed across socio-economic deprivation gradients, and identify clusters of favourable or unfavourable environmental characteristics. METHODS We indexed nationally standardized estimates of active living friendliness (i.e. "walkability"), NO2 air pollution, and greenness to 6-digit postal codes within the cities of Toronto, Montreal and Vancouver. We compared the distribution of within-city exposure tertiles across quintiles of material deprivation. Tertiles of each exposure were then overlaid with each other in order to identify potentially favorable (high walkability, low NO2, high greenness) and unfavorable (low walkability, high NO2, and low greenness) environments. RESULTS In all three cities, high walkability was more common in least deprived areas and less prevalent in highly deprived areas. We also generally saw a greater prevalence of postal codes with high vegetation indices and low NO2 in areas with low deprivation, and a lower greenness prevalence and higher NO2 concentrations in highly deprived areas, suggesting environmental inequity is occurring. Our study showed that relatively few postal codes were simultaneously characterized by desirable or undesirable walkability, NO2and greenness tertiles. DISCUSSION Spatial analyses of multiple standardized urban environmental factors such as the ones presented in this manuscript can help refine municipal investments and policy priorities. This study illustrates a methodology to prioritize areas for interventions that increase active living and exposure to urban vegetation, as well as lower air pollution. Our results also highlight the importance of considering the intersections between the built environment and socio-economic status in city planning and urban public health decision-making.
Collapse
Affiliation(s)
- Dany Doiron
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Eleanor M Setton
- Geography Department, University of Victoria, Victoria, British Columbia, Canada
| | - Kerolyn Shairsingh
- Southern Ontario Centre for Atmospheric Aerosol Research, Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
| | - Nancy A Ross
- Department of Geography, McGill University, Montreal, Quebec, Canada
| | - Jeffrey R Brook
- Southern Ontario Centre for Atmospheric Aerosol Research, Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
49
|
Price TR, Friedenreich CM, Robson PJ, Li H, Brenner DR. High-sensitivity C-reactive protein, hemoglobin A1c and breast cancer risk: a nested case-control study from Alberta's Tomorrow Project cohort. Cancer Causes Control 2020; 31:1057-1068. [PMID: 32959132 DOI: 10.1007/s10552-020-01329-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 07/24/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Our aim is to examine the associations between high-sensitivity C-reactive protein (hsCRP) and hemoglobin A1c (HbA1c), common biomarkers of inflammation and insulin resistance, respectively, with breast cancer risk, while adjusting for measures of excess body size. METHODS We conducted a nested case-control study within the Alberta's Tomorrow Project cohort (Alberta, Canada) including 197 incident breast cancer cases and 394 matched controls. The sample population included both pre- and postmenopausal women. Serum concentrations of hsCRP and HbA1c were measured from blood samples collected at baseline, along with anthropometric measurements, general health and lifestyle data. Conditional logistic regression was used to evaluate associations between hsCRP, HbA1c, and breast cancer risk adjusted for excess body size (body fat percentage) and other risk factors for breast cancer. RESULTS Higher concentrations of hsCRP were associated with elevated breast cancer risk (odds ratio [OR] 1.27; 95% confidence interval [95% CI] 1.03-1.55). The observed associations were unchanged with adjustment for body fat percentage. Higher HbA1c concentrations were not significantly associated with an increased breast cancer risk (OR 1.22; 95% CI 0.17-8.75). CONCLUSION These data suggest that hsCRP may be associated with elevated breast cancer risk, independent of excess body size. However, elevated concentrations of HbA1c did not appear to increase breast cancer risk in apparently healthy women.
Collapse
Affiliation(s)
- Tiffany R Price
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Paula J Robson
- Cancer Research & Analytics, CancerControl Alberta, Alberta Health Services, Edmonton, AB, Canada
| | - Haocheng Li
- Department of Mathematics and Statistics, University of Calgary, Calgary, AB, Canada
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada.
| |
Collapse
|
50
|
Zhao N, Smargiassi A, Hatzopoulou M, Colmegna I, Hudson M, Fritzler MJ, Awadalla P, Bernatsky S. Long-term exposure to a mixture of industrial SO 2, NO 2, and PM 2.5 and anti-citrullinated protein antibody positivity. Environ Health 2020; 19:86. [PMID: 32727483 PMCID: PMC7391811 DOI: 10.1186/s12940-020-00637-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Studies of associations between industrial air emissions and rheumatic diseases, or diseases-related serological biomarkers, are few. Moreover, previous evaluations typically studied individual (not mixed) emissions. We investigated associations between individual and combined exposures to industrial sulfur dioxide (SO2), nitrogen dioxide (NO2), and fine particles matter (PM2.5) on anti-citrullinated protein antibodies (ACPA), a characteristic biomarker for rheumatoid arthritis (RA). METHODS Serum ACPA was determined for 7600 randomly selected CARTaGENE general population subjects in Quebec, Canada. Industrial SO2, NO2, and PM2.5 concentrations, estimated by the California Puff (CALPUFF) atmospheric dispersion model, were assigned based on residential postal codes at the time of sera collection. Single-exposure logistic regressions were performed for ACPA positivity defined by 20 U/ml, 40 U/ml, and 60 U/ml thresholds, adjusting for age, sex, French Canadian origin, smoking, and family income. Associations between regional overall PM2.5 exposure and ACPA positivity were also investigated. The associations between the combined three industrial exposures and the ACPA positivity were assessed by weighted quantile sum (WQS) regressions. RESULTS Significant associations between individual industrial exposures and ACPA positivity defined by the 20 U/ml threshold were seen with single-exposure logistic regression models, for industrial emissions of PM2.5 (odds ratio, OR = 1.19, 95% confidence intervals, CI: 1.04-1.36) and SO2 (OR = 1.03, 95% CI: 1.00-1.06), without clear associations for NO2 (OR = 1.01, 95% CI: 0.86-1.17). Similar findings were seen for the 40 U/ml threshold, although at 60 U/ml, the results were very imprecise. The WQS model demonstrated a positive relationship between combined industrial exposures and ACPA positivity (OR = 1.36, 95% CI: 1.10-1.69 at 20 U/ml) and suggested that industrial PM2.5 may have a closer association with ACPA positivity than the other exposures. Again, similar findings were seen with the 40 U/ml threshold, though 60 U/ml results were imprecise. No clear association between ACPA and regional overall PM2.5 exposure was seen. CONCLUSIONS We noted positive associations between ACPA and industrial emissions of PM2.5 and SO2. Industrial PM2.5 exposure may play a particularly important role in this regard.
Collapse
Affiliation(s)
- Naizhuo Zhao
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC Canada
| | - Audrey Smargiassi
- Département de Santé Environnementale et de Santé au Travail, Université de Montréal, Montréal, QC Canada
- Institut National de Santé Publique du Québec, Montréal, QC Canada
- Centre de Recherche en Santé Publique de l’Université de Montréal (CReSP), Montréal, QC Canada
| | | | - Ines Colmegna
- Department of Medicine, McGill University, Montréal, QC Canada
- Division of Rheumatology, McGill University Health Center, Montréal, QC Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montréal, QC Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC Canada
| | - Marvin J. Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC Canada
- Department of Medicine, McGill University, Montréal, QC Canada
- Division of Rheumatology, McGill University Health Center, Montréal, QC Canada
- Centre for Outcomes Research & Evaluation, 5252 boul de Maisonneuve Ouest, (3F.51), Montreal, QC H4A 3S5 Canada
| |
Collapse
|