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Chaillet N, Mâsse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser WD, Gagnon R, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Blouin S, Ducruet T, Girard M, Bujold E. Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial. Lancet 2024; 403:44-54. [PMID: 38096892 DOI: 10.1016/s0140-6736(23)01855-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. METHODS We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. FINDINGS 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52-0·99]; p=0·042; adjusted risk difference -1·2% [95% CI -2·0 to -0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33-0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. INTERPRETATION A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. FUNDING Canadian Institutes of Health Research (CIHR, MOP-142448).
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Affiliation(s)
- Nils Chaillet
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada.
| | - Benoît Mâsse
- School of Public Health, University of Montreal, Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Patrick Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Marylène Dugas
- Department of Health Sciences, Interdisciplinary Research Chair in Rural Health and Social Services, University of Quebec at Rimouski, Rimouski, QC, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Suzanne Demers
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Laval University, Quebec, QC, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Guy-Paul Gagné
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Diane Francoeur
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Louise Duperron
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Mira Johri
- School of Public Health, University of Montreal, Montreal, QC, Canada; University of Montreal Hospital Research Center, University of Montreal, QC, Canada
| | - Eric Dubé
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Simon Blouin
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | | | - Mario Girard
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Emmanuel Bujold
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
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Simard MN, Lepage C, Gaudet I, Paquette N, Doussau A, Poirier NC, Beauchamp MH, Côté SM, Pinchefsky E, Brossard-Racine M, Mâsse B, Gallagher A. A Parent-child yoga intervention for reducing attention deficits in children with congenital heart disease: the Yoga for Little Hearts Feasibility Study Protocol. BMJ Open 2023; 13:e079407. [PMID: 37848299 PMCID: PMC10582886 DOI: 10.1136/bmjopen-2023-079407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Preschoolers and school-aged children with congenital heart disease (CHD) are at higher risk of attention deficit hyperactivity disorder (ADHD) compared with the general population. To this day, no randomised controlled trial (RCT) aiming to improve attention has been conducted in young children with CHD. There is emerging evidence indicating that parent-child yoga interventions improve attention and reduce ADHD symptoms in both typically developing and clinical populations. METHODS AND ANALYSIS This is a single-blind, two-centre, two-arm trial during which 24 children with CHD and their parents will be randomly assigned to (1) a parent-child yoga intervention in addition to standard clinical care or (2) standard clinical care alone. All participants will undergo standardised assessments: (1) at baseline, (2) immediately post-treatment and (3) 6 months post-treatment. Descriptive statistics will be used to estimate the feasibility and neurodevelopmental outcomes. This feasibility study will evaluate: (1) recruitment capacity; (2) retention, drop-out and withdrawal rates during the yoga programme and at the 6-month follow-up; (3) adherence to the intervention; (4) acceptability of the randomisation process by families; (5) heterogeneity in the delivery of the intervention between instructors and use of home-based exercises between participants; (6) proportion of missing data in the neurodevelopmental assessments and (7) SD of primary outcomes of the full RCT in order to determine the future appropriate sample size. ETHICS AND DISSEMINATION Ethical approval has been obtained by the Research Ethics Board of the Sainte-Justine University Hospital. The findings will be disseminated in peer-reviewed journals and conferences and presented to the Canadian paediatric grand round meetings. TRIAL REGISTRATION NUMBER NCT05997680.
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Affiliation(s)
- Marie-Noëlle Simard
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
| | - Charles Lepage
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Gaudet
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Health Sciences, Universite du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Natacha Paquette
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Amélie Doussau
- Clinique d'investigation neurocardiaque, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Nancy C Poirier
- Clinique d'investigation neurocardiaque, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Surgery, Division of Cardiac Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Miriam H Beauchamp
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sylvana M Côté
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Elana Pinchefsky
- Clinique d'investigation neurocardiaque, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, Centre universitaire de santé McGill, Montréal, Québec, Canada
- Institut de recherche, Centre universitaire de santé McGill, Montréal, Québec, Canada
| | - Benoît Mâsse
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
- Institut de recherche clinique et appliquée, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Anne Gallagher
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
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3
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Duchaine CS, Brisson C, Diorio C, Talbot D, Maunsell E, Carmichael PH, Giguère Y, Gilbert-Ouimet M, Trudel X, Ndjaboué R, Vézina M, Milot A, Mâsse B, Dionne CE, Laurin D. Work-Related Psychosocial Factors and Global Cognitive Function: Are Telomere Length and Low-Grade Inflammation Potential Mediators of This Association? Int J Environ Res Public Health 2023; 20:4929. [PMID: 36981836 PMCID: PMC10049148 DOI: 10.3390/ijerph20064929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
The identification of modifiable factors that could maintain cognitive function is a public health priority. It is thought that some work-related psychosocial factors help developing cognitive reserve through high intellectual complexity. However, they also have well-known adverse health effects and are considered to be chronic psychosocial stressors. Indeed, these stressors could increase low-grade inflammation and promote oxidative stress associated with accelerated telomere shortening. Both low-grade inflammation and shorter telomeres have been associated with a cognitive decline. This study aimed to evaluate the total, direct, and indirect effects of work-related psychosocial factors on global cognitive function overall and by sex, through telomere length and an inflammatory index. A random sample of 2219 participants followed over 17 years was included in this study, with blood samples and data with cognitive function drawn from a longitudinal study of 9188 white-collar workers (51% female). Work-related psychosocial factors were evaluated according to the Demand-Control-Support and the Effort-Reward Imbalance (ERI) models. Global cognitive function was evaluated with the validated Montreal Cognitive Assessment (MoCA). Telomere length and inflammatory biomarkers were measured using standardised protocols. The direct and indirect effects were estimated using a novel mediation analysis method developed for multiple correlated mediators. Associations were observed between passive work or low job control, and shorter telomeres among females, and between low social support at work, ERI or iso-strain, and a higher inflammatory index among males. An association was observed with higher cognitive performance for longer telomeres, but not for the inflammatory index. Passive work overall, and low reward were associated with lower cognitive performance in males; whereas, high psychological demand in both males and females and high job strain in females were associated with a higher cognitive performance. However, none of these associations were mediated by telomere length or the inflammatory index. This study suggests that some work-related psychosocial factors could be associated with shorter telomeres and low-grade inflammation, but these associations do not explain the relationship between work-related psychosocial factors and global cognitive function. A better understanding of the biological pathways, by which these factors affect cognitive function, could guide future preventive strategies to maintain cognitive function and promote healthy aging.
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Affiliation(s)
- Caroline S. Duchaine
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
| | - Chantal Brisson
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
| | - Caroline Diorio
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Denis Talbot
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Elizabeth Maunsell
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Pierre-Hugues Carmichael
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Yves Giguère
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Mahée Gilbert-Ouimet
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- Canada Research Chair in Sex and Gender in Occupational Health, Université du Québec à Rimouski, Campus de Lévis, Lévis, QC G6V 0A6, Canada
| | - Xavier Trudel
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
| | - Ruth Ndjaboué
- School of Social Work, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Michel Vézina
- Institut National de Santé Publique du Québec (INSPQ), Québec, QC G1V 5B3, Canada
| | - Alain Milot
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Benoît Mâsse
- École de Santé Publique de l’Université de Montréal, Montréal, QC H3N 1X9, Canada
| | - Clermont E. Dionne
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
| | - Danielle Laurin
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC G1V 0A6, Canada
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Guillot M, Synnes A, Pronovost E, Qureshi M, Daboval T, Caouette G, Olivier F, Bartholomew J, Mohamed I, Massé E, Afifi J, Hendson L, Lemyre B, Luu TM, Strueby L, Cieslak Z, Yusuf K, Pelligra G, Ducruet T, Ndiaye ABKT, Angoa G, Sériès T, Piedboeuf B, Nuyt AM, Fraser W, Mâsse B, Lacaze-Masmonteil T, Lavoie PM, Marc I. Maternal High-Dose DHA Supplementation and Neurodevelopment at 18-22 Months of Preterm Children. Pediatrics 2022; 150:188230. [PMID: 35652296 DOI: 10.1542/peds.2021-055819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine whether maternal supplementation with high-dose docosahexaenoic acid (DHA) in breastfed, very preterm neonates improves neurodevelopmental outcomes at 18 to 22 months' corrected age (CA). METHODS Planned follow-up of a randomized, double-blind, placebo-controlled, multicenter trial to compare neurodevelopmental outcomes in breastfed, preterm neonates born before 29 weeks' gestational age (GA). Lactating mothers were randomized to receive either DHA-rich algae oil or a placebo within 72 hours of delivery until 36 weeks' postmenstrual age. Neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development third edition (Bayley-III) at 18 to 22 months' CA. Planned subgroup analyses were conducted for GA (<27 vs ≥27 weeks' gestation) and sex. RESULTS Among the 528 children enrolled, 457 (86.6%) had outcomes available at 18 to 22 months' CA (DHA, N = 234, placebo, N = 223). The mean differences in Bayley-III between children in the DHA and placebo groups were -0.07 (95% confidence interval [CI] -3.23 to 3.10, P = .97) for cognitive score, 2.36 (95% CI -1.14 to 5.87, P = .19) for language score, and 1.10 (95% CI -2.01 to 4.20, P = .49) for motor score. The association between treatment and the Bayley-III language score was modified by GA at birth (interaction P = .07). Neonates born <27 weeks' gestation exposed to DHA performed better on the Bayley-III language score, compared with the placebo group (mean difference 5.06, 95% CI 0.08-10.03, P = .05). There was no interaction between treatment group and sex. CONCLUSIONS Maternal DHA supplementation did not improve neurodevelopmental outcomes at 18 to 22 months' CA in breastfed, preterm neonates, but subgroup analyses suggested a potential benefit for language in preterm neonates born before 27 weeks' GA.
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Affiliation(s)
- Mireille Guillot
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Anne Synnes
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Etienne Pronovost
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Mosarrat Qureshi
- Division of Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Thierry Daboval
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Georges Caouette
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | | | - Julie Bartholomew
- Department of Neonatology, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Ibrahim Mohamed
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Edith Massé
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Quebec, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada
| | - Leonora Hendson
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Lannae Strueby
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Zenon Cieslak
- Department of Pediatrics, Royal Columbian Hospital, New Westminster, British Columbia Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Gustavo Pelligra
- Department of Maternity Care & Pediatrics, Victoria General Hospital, Island Health, Victoria, British Columbia, Canada
| | - Thierry Ducruet
- Unité de Recherche Clinique Appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | | | - Georgina Angoa
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Thibaut Sériès
- School of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Bruno Piedboeuf
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Anne Monique Nuyt
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec Canada
| | - Benoît Mâsse
- Unité de Recherche Clinique Appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada.,School of Public Health, Université de Montréal, Montréal, Quebec, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Pascal M Lavoie
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Isabelle Marc
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
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Balegamire SJ, McClymont E, Croteau A, Dodin P, Gantt S, Besharati AA, Renaud C, Mâsse B, Boucoiran I. Prevalence, incidence, and risk factors associated with cytomegalovirus infection in healthcare and childcare worker: a systematic review and meta-analysis. Syst Rev 2022; 11:131. [PMID: 35754052 PMCID: PMC9235282 DOI: 10.1186/s13643-022-02004-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) is transmitted by direct contact with body fluids from infected individuals. Transmission of CMV in households, particularly those with young children, contributes significantly to CMV infection in the general population. However, little is known about the contribution of occupational healthcare or childcare exposure to risk of CMV infection. OBJECTIVES To determine CMV seroprevalence, incidence of primary infection, and associated risk factors in healthcare and childcare workers. METHODS Six electronic databases were searched systematically for publications on CMV infection in healthcare and childcare workers until March 7, 2022. Two authors independently evaluated the literature for quality and inclusion in our analyses. The pooled results for seroprevalence, incidence, and relative risk (RR) were determined using a random effects model. Heterogeneity among studies was quantified and further investigated in subgroup analysis and meta-regression. Publication bias was assessed using funnel plot. Statistical analyses were preformed using R version 4.05. RESULTS Forty-eight articles were included in this meta-analysis (quality assessment: 18 good, 14 fair, and 16 poor). Pooled CMV seroprevalence was 59.3% (95% CI: 49.8-68.6) among childcare workers and 49.5% (95% CI: 40.3-58.7) among healthcare workers, and pooled incidences of primary CMV infection per 100 person-years were respectively 7.4 (95% CI: 3.9-11.8) and 3.1 (95% CI: 1.3-5.6). RR for primary infection compared to controls were 3.4 (95% CI: 1.3-8.8) and 1.3 (95% CI: 0.6-2.7) for healthcare and childcare workers, respectively. The odds of CMV seropositivity were 1.6 (95% CI: 1.2-2.3) times higher for childcare workers compared to controls, but not significantly different between healthcare workers and controls (0.9; 95% CI: 0.6-1.2). CMV seropositivity in both groups was significantly associated with having one or more children residing at home, marital status, ethnicity, and age. CONCLUSIONS Childcare workers, but not healthcare workers, have an increased risk of prevalent and incident CMV infection, a risk that is further increased with the presence of at least one child living at home. These findings suggest that enforcing simple, conventional hygienic measures in childcare settings could help reduce transmission of CMV, and that special precautionary measures for preventing CMV infection may not be required for pregnant healthcare workers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020139756.
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Affiliation(s)
- Safari Joseph Balegamire
- Department of Social and Preventive Medicine, École de Santé Publique de Université de Montréal, Montreal, QC, Canada. .,Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, QC, Canada.
| | - Elisabeth McClymont
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Agathe Croteau
- National Institute of Public Health of Québec, Québec City, QC, Canada
| | - Philippe Dodin
- Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, QC, Canada
| | - Soren Gantt
- Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, QC, Canada.,Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Amir Abbas Besharati
- Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, QC, Canada
| | - Christian Renaud
- Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, QC, Canada.,Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Benoît Mâsse
- Department of Social and Preventive Medicine, École de Santé Publique de Université de Montréal, Montreal, QC, Canada.,Applied Clinical Research Unit, CHU Sainte Justine Research Center, Montreal, QC, Canada
| | - Isabelle Boucoiran
- Department of Social and Preventive Medicine, École de Santé Publique de Université de Montréal, Montreal, QC, Canada.,Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, QC, Canada.,Division of Maternofetal Medicine, Department of Obstetrics and Gynecology, Université de Montréal, Montreal, QC, Canada
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6
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Ndiaye AB, Mohamed I, Pronovost E, Angoa G, Piedboeuf B, Lemyre B, Afifi J, Qureshi M, Sériès T, Guillot M, Simonyan D, Yusuf K, Lavoie PM, Fraser WD, Mâsse B, Nuyt AM, Lacaze‐Masmonteil T, Marc I. Use of SMOF Lipid Emulsion in Very Preterm Infants Does Not Affect the Incidence of Bronchopulmonary Dysplasia‐Free Survival. JPEN J Parenter Enteral Nutr 2022; 46:1892-1902. [DOI: 10.1002/jpen.2380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022]
Affiliation(s)
| | - Ibrahim Mohamed
- Department of Pediatrics Université de Montréal, CHU Sainte‐Justine Montréal Canada
| | - Etienne Pronovost
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
| | - Georgina Angoa
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
| | - Bruno Piedboeuf
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
| | - Brigitte Lemyre
- Division of Neonatology Children's Hospital of Eastern Ontario Ottawa Canada
| | - Jehier Afifi
- Department of Pediatrics Dalhousie University Halifax Canada
| | - Mosarrat Qureshi
- Division of Neonatology Royal Alexandra Hospital Edmonton Canada
| | - Thibaut Sériès
- School of Psychology Université du Québec à Trois‐Rivières, Trois‐Rivières Canada
| | - Mireille Guillot
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Centre de recherche du CHU de Québec‐Université Laval Québec Canada
| | - Kamran Yusuf
- Department of Pediatrics, Cumming School of Medicine University of Calgary Calgary Canada
| | - Pascal M. Lavoie
- Department of Pediatrics University of British Columbia Vancouver Canada
| | - William D. Fraser
- Department of Obstetrics and Gynecology Centre de recherche du CHU de Sherbrooke Sherbrooke Canada
| | - Benoît Mâsse
- Unité de Recherche Clinique Appliquée, CHU Sainte‐Justine Montréal Canada
- School of Public Health Université de Montréal, Montréal Canada
| | - Anne Monique Nuyt
- Department of Pediatrics Université de Montréal, CHU Sainte‐Justine Montréal Canada
| | - Thierry Lacaze‐Masmonteil
- Department of Pediatrics, Cumming School of Medicine, Foothills Medical Centre University of Calgary Calgary Canada
| | - Isabelle Marc
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
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7
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Affiliation(s)
- Benoît Mâsse
- Université de Montréal, Montreal, Quebec, Canada
- Unité de Recherche Clinique Appliquée, Direction de la Recherche, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Nancy Robitaille
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Transfusion Medicine, Héma-Québec, Montreal, Quebec, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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8
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Angoa G, Pronovost E, Ndiaye ABKT, Lavoie PM, Lemyre B, Mohamed I, Simonyan D, Qureshi M, Afifi J, Yusuf K, Sériès T, Guillot M, Piedboeuf B, Fraser WD, Nuyt AM, Mâsse B, Lacaze-Masmonteil T, Marc I. Effect of Maternal Docosahexaenoic Acid Supplementation on Very Preterm Infant Growth: Secondary Outcome of a Randomized Clinical Trial. Neonatology 2022; 119:377-385. [PMID: 35413719 DOI: 10.1159/000524147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/17/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The aim of the study was to determine the effect of a maternal docosahexaenoic acid (DHA) supplementation during lactation, compared with a placebo, on the neonatal growth profile of breastfed very preterm infants. METHODS Preterm infants' growth profile, growth velocity from birth to 36 weeks' postmenstrual age (PMA), and growth at 36 weeks' PMA were pre-specified secondary outcomes of a randomized placebo-controlled trial conducted in 16 Canadian neonatal intensive care units (2015-2018). Lactating mothers who delivered before 29 weeks' gestation were given 1.2 g of DHA daily or a placebo within 72 h of delivery and up to 36 weeks' PMA. Analyses were performed using a linear regression model with generalized estimating equations. RESULTS 461 mothers and their 528 infants (DHA, N = 273; placebo, N = 255) were included with mean gestational age of 26.5 weeks (standard deviation [SD] = 1.6); 275 (52.1%) were males; mean birth weight was 895 g (SD = 240). DHA interaction with sex was significant on weight profile (interaction p < 0.001), weight velocity (interaction p = 0.05), and weight at 36 weeks' PMA (interaction p = 0.02). Females in the DHA group gained more weight compared to the placebo group (mean difference [MD], 52.6 g [95% confidence interval [CI]: 24.5-80.8], p < 0.001). Weight velocity was significantly higher in females of the DHA group (MD, 3.4 g/kg/day [95% CI: 0.6-6.2], p = 0.02). At 36 weeks' PMA, the weight of males in the DHA group was significantly smaller (MD, -88.9 g [95% CI: -166.2 to -11.6], p = 0.02). CONCLUSION DHA positively affected female infants' neonatal weight profile and velocity and negatively affected male infants' weight at 36 weeks' PMA.
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Affiliation(s)
- Georgina Angoa
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Etienne Pronovost
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | | | - Pascal M Lavoie
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brigitte Lemyre
- Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ibrahim Mohamed
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Mosarrat Qureshi
- Division of Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Thibaut Sériès
- School of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Mireille Guillot
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - William Donald Fraser
- Department of Obstetrics and Gynecology, Centre de recherche du CHU de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Monique Nuyt
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Benoît Mâsse
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine, Montréal, Québec, Canada.,School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Isabelle Marc
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
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9
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Duchaine CS, Brisson C, Talbot D, Gilbert-Ouimet M, Trudel X, Vézina M, Milot A, Diorio C, Ndjaboué R, Giguère Y, Mâsse B, Dionne CE, Maunsell E, Laurin D. Psychosocial stressors at work and inflammatory biomarkers: PROspective Quebec Study on Work and Health. Psychoneuroendocrinology 2021; 133:105400. [PMID: 34488150 DOI: 10.1016/j.psyneuen.2021.105400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic low-grade inflammation has been associated with high risk of several chronic diseases such as cardiovascular diseases, diabetes, depression, and dementia. As low-grade inflammation could be present long before the apparition of the disease, identifying modifiable risk factors could allow to act upstream. Psychosocial stressors at work have been suggested as modifiable risk factors of low-grade inflammation, but few longitudinal studies have evaluated the association between these stressors and inflammatory biomarkers, such as C-reactive protein (CRP) and interleukin-6 (IL-6). OBJECTIVE This longitudinal study evaluate the associations between exposure to psychosocial stressors at work and CRP and IL-6, separately and combined into an inflammatory index. METHODS Data came from a cohort of 9188 white-collar workers recruited in 1991-1993 (T1) and followed-up after 8 (T2, 1999-2000) and 24 (T3, 2015-2018) years. Participants included in this study were randomly selected at T3 for serum biomarkers studies (n = 2557). CRP and IL-6 were measured using standardized protocols. Psychosocial stressors at work were assessed at T2 according to recognized models: Karasek's Demand-Control-Support model and Siegrist's Effort-Reward Imbalance (ERI) model, using validated questionnaires. High job strain was defined by an exposure to high psychological demand combined with low job control, and iso-strain was defined by an exposure to high job strain combined with low social support at work. ERI was defined by an imbalance between psychological demand and social, economic, and organizational reward. Several covariates were considered including sociodemographic, anthropometric, and lifestyle characteristics, and comorbidities. Prevalence ratios (PRs) and 95% confidence interval (CI) for the highest quartile of CRP, IL-6 and inflammatory index at T3 according to psychosocial stressors at work measured at T2 were calculated using generalized estimating equations. Multiple imputation and inverse probability of censoring weighting were done. RESULTS In men, an association was observed between exposure to iso-strain and the inflammatory index (PR of 1.42 (95% CI: 1.06;1.90)), mainly among men aged less than 65 years (PR of 2.00 (95% CI: 1.37;2.92)). In this same age group, associations with inflammatory biomarkers were also observed among men with exposure to ERI, and among women with exposure to low reward at work or moderate social support at work. CONCLUSION These results suggest that psychosocial stressors at work may increase low-grade inflammation. However, further studies are needed to corroborate these results and to clarify the potential differences between men and women. As these stressors are frequent and modifiable, their reduction is important for public health and could play a role in the primary prevention of chronic diseases.
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Affiliation(s)
- Caroline S Duchaine
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada; Institut sur le vieillissement et la participation sociale des aînés, Université Laval, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | - Chantal Brisson
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada.
| | - Denis Talbot
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Mahée Gilbert-Ouimet
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Department of Health Sciences, Université du Québec à Rimouski, 1595 boulevard Alphonse-Desjardins, Lévis, QC G6V 0A6, Canada.
| | - Xavier Trudel
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada.
| | - Michel Vézina
- Institut national de santé publique du Québec (INSPQ), 945 avenue Wolfe, Quebec City, QC G1V 5B3, Canada.
| | - Alain Milot
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Caroline Diorio
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Ruth Ndjaboué
- Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada.
| | - Yves Giguère
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Benoît Mâsse
- School of public health, University of Montreal, 7101 avenue du Parc, Montreal, QC H3N 1×9, Canada.
| | - Clermont E Dionne
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada; Institut sur le vieillissement et la participation sociale des aînés, Université Laval, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada.
| | - Elizabeth Maunsell
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Medicine, Laval University, 1050 ave de la Médecine, Quebec City, QC G1V 0A6, Canada.
| | - Danielle Laurin
- CHU de Québec-Laval University Research Center, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; VITAM, Centre de recherche en santé durable, 2525 chemin de la Canardière, Quebec City, QC G1J 0A4, Canada; Institut sur le vieillissement et la participation sociale des aînés, Université Laval, 1050 Chemin Ste-Foy, Quebec City, QC G1S 4L8, Canada; Faculty of Pharmacy, Laval University, 1050 ave de la Médecine, Quebec City, QC, G1V 0A6, Canada.
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10
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Duchaine CS, Brisson C, Talbot D, Gilbert-Ouimet M, Trudel X, Vézina M, Milot A, Diorio C, Ndjaboué R, Giguère Y, Mâsse B, Dionne CE, Maunsell E, Laurin D. Cumulative exposure to psychosocial stressors at work and global cognitive function: the PROspective Quebec Study on Work and Health. Occup Environ Med 2021; 78:884-892. [PMID: 34230195 DOI: 10.1136/oemed-2021-107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Psychosocial stressors at work have been proposed as modifiable risk factors for mild cognitive impairment (MCI). This study aimed to evaluate the effect of cumulative exposure to psychosocial stressors at work on cognitive function. METHODS This study was conducted among 9188 white-collar workers recruited in 1991-1993 (T1), with follow-ups 8 (T2) and 24 years later (T3). After excluding death, losses to follow-up and retirees at T2, 5728 participants were included. Psychosocial stressors at work were measured according to the Karasek's questionnaire. Global cognitive function was measured with the Montreal Cognitive Assessment. Cumulative exposures to low psychological demand, low job control, passive job and high strain job were evaluated using marginal structural models including multiple imputation and inverse probability of censoring weighting. RESULTS In men, cumulative exposures (T1 and T2) to low psychological demand, low job control or passive job were associated with higher prevalences of more severe presentation of MCI (MSMCI) at T3 (Prevalence ratios (PRs) and 95% CIs of 1.50 (1.16 to 1.94); 1.38 (1.07 to 1.79) and 1.55 (1.20 to 2.00), respectively), but not with milder presentation of MCI. In women, only exposure to low psychological demand or passive job at T2 was associated with higher prevalences of MSMCI at T3 (PRs and 95% CI of 1.39 (0.97 to 1.99) and 1.29 (0.94 to 1.76), respectively). CONCLUSIONS These results support the deleterious effect of a low stimulating job on cognitive function and the cognitive reserve theory. Psychosocial stressors at work could be part of the effort for the primary prevention of cognitive decline.
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Affiliation(s)
- Caroline S Duchaine
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada.,Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Québec, Canada
| | - Chantal Brisson
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada.,Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Québec, Canada
| | - Denis Talbot
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada
| | - Mahée Gilbert-Ouimet
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Health Sciences, Université du Québec à Rimouski Campus de Lévis, Lévis, Québec, Canada
| | - Xavier Trudel
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada
| | - Michel Vézina
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Alain Milot
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Medicine, Laval University, Faculty of medicine, Québec, Québec, Canada
| | - Caroline Diorio
- Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Oncology, CHU de Québec-Université Laval Research Center, Québec, Québec, Canada
| | - Ruth Ndjaboué
- Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada
| | - Yves Giguère
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Medicine, Laval University, Faculty of medicine, Québec, Québec, Canada
| | - Benoît Mâsse
- Médecine sociale et préventive, Université de Montréal, Montréal, Québec, Canada
| | - Clermont E Dionne
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada.,Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Québec, Canada
| | - Elizabeth Maunsell
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada.,Social and Preventive Medicine, Laval University, Faculty of Medicine, Québec, Québec, Canada
| | - Danielle Laurin
- Population Health and Optimal Health Practices Unit, CHU de Québec-Laval University Research Center, Québec, Québec, Canada .,Centre d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.,VITAM, Centre de recherche en santé durable, Québec, Québec, Canada.,Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Québec, Canada.,Pharmacy, Laval University, Faculty of Pharmacy, Quebec, Quebec, Canada
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11
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Balegamire SJ, Renaud C, Mâsse B, Zinszer K, Gantt S, Giguere Y, Forest JC, Boucoiran I. Frequency, timing and risk factors for primary maternal cytomegalovirus infection during pregnancy in Quebec. PLoS One 2021; 16:e0252309. [PMID: 34170911 PMCID: PMC8232530 DOI: 10.1371/journal.pone.0252309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Maternal Cytomegalovirus (CMV) infection in the first trimester (T1) of pregnancy is a public health concern, as it increases the risk of severe neurodevelopmental outcomes associated with congenital infection compared to infections occurring later during pregnancy. OBJECTIVES To determine CMV seroprevalence in T1 of pregnancy, its trend, risk factors and the incidence rate of primary infection during pregnancy. METHODS Using the biobank of the prospective cohort "Grossesse en Santé de Québec" collected between April 2005 and March 2010 at the Québec-Laval Hospital, Québec, Canada, maternal CMV serology was determined using Abbott Architect Chemiluminescence microparticle immunoassays for immunoglobulin G(IgG), immunoglobulin M(IgM) titration and IgG avidity testing. Changepoint detection analysis was used to assess temporal trends. Risk factors associated with seropositivity were determined by multivariable logistic regression. RESULTS CMV seroprevalence in T1 of pregnancy was 23.4% (965/4111, 95% CI, 22.1-24.7%). The incidence rate for CMV primary infection during pregnancy was 1.8 (95% CI, 1.2-2.6) per 100 person-years. No changepoint was identified in the maternal CMV-seroprevalence trend. Multivariable analyses showed that T1 maternal CMV seropositivity was associated with having one child OR 1.3 (95% CI, 1.10-1.73) or two or more children OR 1.5 (95%CI, 1.1-2.1), ethnicity other than Caucasian OR 2.1 (95% CI, 1.1-3.8) and country of birth other than Canada and the USA OR 2.8 (95% CI, 1.5-4.9). CONCLUSIONS In this cohort, maternal seroprevalence in T1 of pregnancy and seroconversion rate were low. This information and identified risk factors could help guide the development and implementation of preventive actions and evidence-based health policies to prevent CMV infection during pregnancy.
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Affiliation(s)
- Safari Joseph Balegamire
- Department of Social and Preventive Medicine, École de Santé Publique de Université de Montréal, Montreal, QC, Canada
- Women and Children’s Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada
| | - Christian Renaud
- Women and Children’s Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Benoît Mâsse
- Department of Social and Preventive Medicine, École de Santé Publique de Université de Montréal, Montreal, QC, Canada
- Applied Clinical Research Unit, CHU Sainte Justine Research Center, Montreal, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, École de Santé Publique de Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique, Université de Montréal, Montreal, Canada
| | - Soren Gantt
- Women and Children’s Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Yves Giguere
- CHU de Québec-Université Laval Research Center, Quebec City, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Jean-Claude Forest
- CHU de Québec-Université Laval Research Center, Quebec City, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Isabelle Boucoiran
- Department of Social and Preventive Medicine, École de Santé Publique de Université de Montréal, Montreal, QC, Canada
- Women and Children’s Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, Université de Montréal, Montreal, Canada
- * E-mail:
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Trudel X, Gilbert-Ouimet M, Vézina M, Talbot D, Mâsse B, Milot A, Brisson C. Effectiveness of a workplace intervention reducing psychosocial stressors at work on blood pressure and hypertension. Occup Environ Med 2021; 78:738-744. [DOI: 10.1136/oemed-2020-107293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Abstract
ObjectivesTo assess the effectiveness of a workplace intervention reducing psychosocial stressors at work in lowering blood pressure and hypertension prevalence.MethodsThe study design was a quasi-experimental pre–post study with an intervention group and a control group. Post-intervention measurements were collected 6 and 36 months after the midpoint of the intervention. Participants were all white-collar workers employed in three public organisations. At baseline, the intervention and the control groups were composed of 1088 and 1068 workers, respectively. The intervention was designed to reduce psychosocial stressors at work by implementing organisational changes. Adjusted changes in ambulatory blood pressure and hypertension prevalence were examined.ResultsBlood pressure and hypertension significantly decreased in the intervention group while no change was observed in the control group. The differential decrease in systolic blood pressure between the intervention and the control group was 2.0 mm Hg (95% CI: −3.0 to –1.0). The prevalence of hypertension decreased in the intervention group, when compared with the control group (prevalence ratio: 0.85 (95% CI: 0.74 to 0.98)).ConclusionsFindings suggest that psychosocial stressors at work are relevant targets for the primary prevention of hypertension. At the population level, systolic blood pressure reductions such as those observed in the present study could prevent a significant number of premature deaths and disabling strokes.
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13
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Wu Y, Marc I, Bouchard L, Ouyang F, Luo ZC, Fan J, Dubois L, Mâsse B, Zhang J, Leung PCK, Liao XP, Herba CM, Booij L, Shen J, Lewin A, Jiang H, Wang L, Xu J, Wu W, Sun W, Wu J, Li H, Lei C, Kozyrskyj A, Semenic S, Chaillet N, Fortier I, Masse L, Zhan J, Allard C, Knoppers B, Zawati M, Baillargeon JP, Velez MP, Zhang H, Yu Y, Yu W, Ding Y, Vaillancourt C, Liu H, Tetu A, Fang W, Zhang R, Zhao X, Jin Y, Liu XM, Zhang H, Chen Z, Yang X, Hao YH, Abdelouahab N, Fraser W, Huang HF. Study protocol for the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI): a multicentre, cluster-randomised, parallel-group, superiority trial of a multifaceted community-family-mother-child intervention to prevent childhood overweight and obesity. BMJ Open 2021; 11:e045192. [PMID: 33795307 PMCID: PMC8021741 DOI: 10.1136/bmjopen-2020-045192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk. METHODS AND ANALYSIS This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study. ETHICS AND DISSEMINATION The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie-CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation. TRIAL REGISTRATION NUMBER ChiCTR1800017773. PROTOCOL VERSION November 11, 2020 (Version #5).
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Affiliation(s)
- Yanting Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
- Key Laboratory of Embryo Molecular Biology, Ministry of Health, Shanghai, China
| | - Isabelle Marc
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Luigi Bouchard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Fengxiu Ouyang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai, China
| | - Zhong-Cheng Luo
- Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jianxia Fan
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Lise Dubois
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benoît Mâsse
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Jun Zhang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai, China
| | - Peter C K Leung
- The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Xiang Peng Liao
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - C M Herba
- Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
- CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Linda Booij
- CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
- Department of Psychology, Concordia University, Montreal, Québec, Canada
| | - Jian Shen
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Antoine Lewin
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Hong Jiang
- Department of Maternal and Child Care, School of Public Health, Fudan University, Shanghai, China
| | - Liping Wang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Jian Xu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Weibin Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Wenguang Sun
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Jiahao Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Chen Lei
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Anita Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | - N Chaillet
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Isabel Fortier
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Louise Masse
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Janelle Zhan
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Catherine Allard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Bartha Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Québec, Canada
| | - Ma'n Zawati
- Centre of Genomics and Policy, McGill University, Montreal, Québec, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Hanqiu Zhang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yamei Yu
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wen Yu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan Ding
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Caroline Vaillancourt
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Han Liu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Amelie Tetu
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Wenli Fang
- Changing Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Rong Zhang
- Department of Obstetrics and Gynecology, Shanghai Fengxian Central Hospital, Shanghai, China
| | - Xinzhi Zhao
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan Jin
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Xin-Mei Liu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Huijuan Zhang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Zhirou Chen
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Xi Yang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan-Hui Hao
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Nadia Abdelouahab
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - William Fraser
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - He-Feng Huang
- International Peace Maternity and Child Health Hospital, Shanghai, China
- Key Laboratory of Embryo Molecular Biology, Ministry of Health, Shanghai, China
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Hassan GM, Wyse JM, Paquin SC, Gariepy G, Albadine R, Mâsse B, Trottier H, Sahai AV. A randomized noninferiority trial comparing the diagnostic yield of the 25G ProCore needle to the standard 25G needle in suspicious pancreatic lesions. Endosc Ultrasound 2021; 10:57-61. [PMID: 33402551 PMCID: PMC7980691 DOI: 10.4103/eus.eus_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Objectives The aim of the study was to perform the first randomized trial comparing the diagnostic yield, bloodiness, and cellularity of the 25G standard needle (25S) and the 25G ProCore™ needle (25P). Materials and Methods All patients referred to the tertiary care referral center for EUS guided fine-needle aspiration (EUS-FNA) of suspicious solid pancreatic lesions were eligible. EUS-FNA was performed in each lesion with both 25S and 25P needles (the choice of the first needle was randomized), using a multipass sampling pattern, without stylet or suction. Rapid on-site evaluation was used when possible. Pap-stained slides were read by a single experienced cytopathologist, blinded to the needle type. Results One hundred and forty-three patients were recruited. Samples were positive for cancer in 122/143 (85.3%) with the 25S needle versus 126/143 (88.1%) with the 25P needle, negative in 17/143 (11.9%) with the 25S needle versus 13/143 (9.1%) with the 25P needle, and suspicious in 4/143 (2.8%) with each needle. There was no difference in any outcome based on the type of the first needle. No carryover effect was detected (P = 0.214; NS). Cumulative logistic regression analyses showed no associations between the type of needle and diagnostic yield for cancer, cellularity, or bloodiness. The difference in the yield for cancer was 2.9% (-4.2; 10.1%); with the confidence interval upper within the predetermined noninferiority margin of 15%. Conclusion The 25S needle is noninferior to the 25P needle for diagnosing cancer in suspicious pancreatic lesions.
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Affiliation(s)
- Galab M Hassan
- Division of Gastroenterology, Department of Medicine, Réseau Hospitalier Neuchâtelois, Switzerland; Department of social and preventive Medicine, School of Public Health, Université de Montréal, Québec, Canada
| | - Jonathan M Wyse
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Sarto C Paquin
- Division of Gastroenterology, Centre Hospitalier Universitaire de Montréal, Québec, Canada
| | - Gilles Gariepy
- Department of pathology, Centre Hospitalier Universitaire de Montréal, Québec, Canada
| | - Roula Albadine
- Department of pathology, Centre Hospitalier Universitaire de Montréal, Québec, Canada
| | - Benoît Mâsse
- Department of social and preventive Medicine, School of Public Health, Université de Montréal, Québec, Canada; Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Québec, Canada
| | - Helen Trottier
- Department of social and preventive Medicine, School of Public Health, Université de Montréal, Québec, Canada; Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Québec, Canada
| | - Anand V Sahai
- Division of Gastroenterology, Centre Hospitalier Universitaire de Montréal, Québec, Canada
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15
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Marc I, Piedboeuf B, Lacaze-Masmonteil T, Fraser W, Mâsse B, Mohamed I, Qureshi M, Afifi J, Lemyre B, Caouette G, Bartholomew J, Nuyt AM, Julien P, Synnes A, Lucas M, Perreault T, Strueby L, Cieslak Z, Yusuf K, Pelligra G, Massé E, Larsen B, de Cabo C, Ruth C, Khurshid F, Lavoie PM. Effect of Maternal Docosahexaenoic Acid Supplementation on Bronchopulmonary Dysplasia-Free Survival in Breastfed Preterm Infants: A Randomized Clinical Trial. JAMA 2020; 324:157-167. [PMID: 32662862 PMCID: PMC7361648 DOI: 10.1001/jama.2020.8896] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Maternal docosahexaenoic acid (DHA) supplementation may prevent bronchopulmonary dysplasia, but evidence remains inconclusive. OBJECTIVE To determine whether maternal DHA supplementation during the neonatal period improves bronchopulmonary dysplasia-free survival in breastfed infants born before 29 weeks of gestation. DESIGN, SETTING, AND PARTICIPANTS Superiority, placebo-controlled randomized clinical trial at 16 Canadian neonatal intensive care units (June 2015-April 2018 with last infant follow-up in July 2018). Lactating women who delivered before 29 weeks of gestation were enrolled within 72 hours of delivery. The trial intended to enroll 800 mothers, but was stopped earlier. INTERVENTIONS There were 232 mothers (273 infants) assigned to oral capsules providing 1.2 g/d of DHA from randomization to 36 weeks' postmenstrual age and 229 mothers (255 infants) assigned to placebo capsules. MAIN OUTCOMES AND MEASURES The primary outcome was bronchopulmonary dysplasia-free survival in infants at 36 weeks' postmenstrual age. There were 22 secondary outcomes, including mortality and bronchopulmonary dysplasia. RESULTS Enrollment was stopped early due to concern for harm based on interim data from this trial and from another trial that was published during the course of this study. Among 461 mothers and their 528 infants (mean gestational age, 26.6 weeks [SD, 1.6 weeks]; 253 [47.9%] females), 375 mothers (81.3%) and 523 infants (99.1%) completed the trial. Overall, 147 of 268 infants (54.9%) in the DHA group vs 157 of 255 infants (61.6%) in the placebo group survived without bronchopulmonary dysplasia (absolute difference, -5.0% [95% CI, -11.6% to 2.6%]; relative risk, 0.91 [95% CI, 0.80 to 1.04], P = .18). Mortality occurred in 6.0% of infants in the DHA group vs 10.2% of infants in the placebo group (absolute difference, -3.9% [95% CI, -6.8% to 1.4%]; relative risk, 0.61 [95% CI, 0.33 to 1.13], P = .12). Bronchopulmonary dysplasia occurred in 41.7% of surviving infants in the DHA group vs 31.4% in the placebo group (absolute difference, 11.5% [95% CI, 2.3% to 23.2%]; relative risk, 1.36 [95% CI, 1.07 to 1.73], P = .01). Of 22 prespecified secondary outcomes, 19 were not significantly different. CONCLUSIONS AND RELEVANCE Among breastfed preterm infants born before 29 weeks of gestation, maternal docosahexaenoic acid supplementation during the neonatal period did not significantly improve bronchopulmonary dysplasia-free survival at 36 weeks' postmenstrual age compared with placebo. Study interpretation is limited by early trial termination. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02371460.
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Affiliation(s)
- Isabelle Marc
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Benoît Mâsse
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ibrahim Mohamed
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Mosarrat Qureshi
- Division of Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brigitte Lemyre
- Division of Neonatology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Georges Caouette
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Julie Bartholomew
- Department of Neonatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anne Monique Nuyt
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Pierre Julien
- Department of Endocrinology and Nephrology, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Anne Synnes
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Michel Lucas
- Department of Social and Preventive Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Hôpital du Saint-Sacrement, Quebec City, Quebec, Canada
| | - Thérèse Perreault
- Division of Neonatology, Montréal Children’s Hospital, McGill University, Montreal, Quebec, Canada
| | - Lannae Strueby
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Zenon Cieslak
- Department of Pediatrics, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gustavo Pelligra
- Department of Maternity Care and Pediatrics, Victoria General Hospital, Island Health, Victoria, British Columbia, Canada
| | - Edith Massé
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Quebec, Canada
| | - Bodil Larsen
- Faculty of Agricultural, Life, and Environmental Sciences, University of Alberta, Edmonton, Canada
| | - Cecilia de Cabo
- Department of Pediatrics and Child Health, Max Rady School of Medicine, University of Manitoba, Winnipeg, Canada
| | - Chelsea Ruth
- Department of Pediatrics and Child Health, Max Rady School of Medicine, University of Manitoba, Winnipeg, Canada
| | - Faiza Khurshid
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
| | - Pascal M. Lavoie
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, Canada
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16
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Gilbert-Ouimet M, Trudel X, Aubé K, Ndjaboue R, Duchaine C, Blanchette C, Mâsse B, Vézina M, Milot A, Brisson C. Differences between women and men in the relationship between psychosocial stressors at work and work absence due to mental health problem. Occup Environ Med 2020; 77:603-610. [PMID: 32467313 DOI: 10.1136/oemed-2019-106242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Women have a higher incidence of mental health problems compared with men. Psychosocial stressors at work are associated with mental health problems. However, few prospective studies have examined the association between these stressors and objectively measured outcomes of mental health. Moreover, evidence regarding potential differences between women and men in this association is scarce and inconsistent. This study investigates whether psychosocial stressors at work are associated with the 7.5-year incidence of medically certified work absence due to a mental health problem, separately for women and men. METHODS Data from a prospective cohort of white-collar workers in Canada (n=7138; 47.3% women) were used. We performed Cox regression models to examine the prospective association between self-reported psychosocial stressors at work (job strain model) at baseline and the 7.5-year HR of medically certified work absence of ≥5 days due to a mental health problem. RESULTS During follow-up, 11.9% of participants had a certified work absence, with a twofold higher incidence among women. Women (HR 1.40, 95% CI 1.01 to 1.93) and men (HR 1.41, 95% CI 0.97 to 2.05) exposed to high strain (high demands and low control) had a higher incidence of work absence compared with those unexposed. Among women only, those exposed to an active job situation (high demands and high control) also had a higher risk (HR 1.82, 95% CI 1.29 to 2.56). CONCLUSIONS Prevention efforts aimed at reducing psychosocial stressors at work could help lower the risk of work absence for both women and men. However, important differences between women and men need to be further studied in order to orient these efforts.
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Affiliation(s)
- Mahée Gilbert-Ouimet
- Population Health and Optimal Health Practices Unit, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada .,Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada
| | - Xavier Trudel
- Population Health and Optimal Health Practices Unit, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Karine Aubé
- Population Health and Optimal Health Practices Unit, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Ruth Ndjaboue
- Department of Social and Preventive Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Caroline Duchaine
- Population Health and Optimal Health Practices Unit, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Caty Blanchette
- Population Health and Optimal Health Practices Unit, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Benoît Mâsse
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada
| | - Michel Vézina
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Alain Milot
- Population Health and Optimal Health Practices Unit, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Chantal Brisson
- Population Health and Optimal Health Practices Unit, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
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17
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Langlois A, Lavergne MH, Leroux H, Killer K, Azzano P, Paradis L, Samaan K, Lacombe-Barrios J, Eiwegger T, Upton J, Sussman G, Poder T, Mâsse B, Roches AD, Bégin P. Correction to: Protocol for a double-blind, randomized controlled trial on the dose-related efficacy of omalizumab in multi-food oral immunotherapy. Allergy Asthma Clin Immunol 2020; 16:38. [PMID: 32477416 PMCID: PMC7240927 DOI: 10.1186/s13223-020-00435-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandra Langlois
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | | | - Hélène Leroux
- Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada
| | - Kerstin Killer
- Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada
| | - Pauline Azzano
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | - Louis Paradis
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada.,3Department of Allergy and Immunology, Centre Hospitalier de l'Université de Montréal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC H3T1C5 Canada
| | - Kathryn Samaan
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | - Jonathan Lacombe-Barrios
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | - Thomas Eiwegger
- 4Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, ON Canada
| | - Julia Upton
- 4Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, ON Canada
| | | | - Thomas Poder
- 6Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, QC Canada.,7Research Center of the Institut Universitaire de Santé Mentale de Montréal, Montreal, QC Canada
| | - Benoît Mâsse
- Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada.,8School of Public Health, Université de Montréal, Montreal, QC Canada
| | - Anne Des Roches
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada.,Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada
| | - Philippe Bégin
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada.,Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada.,3Department of Allergy and Immunology, Centre Hospitalier de l'Université de Montréal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC H3T1C5 Canada
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Langlois A, Lavergne MH, Leroux H, Killer K, Azzano P, Paradis L, Samaan K, Lacombe-Barrios J, Mâsse B, Des Roches A, Bégin P. Protocol for a double-blind, randomized controlled trial on the dose-related efficacy of omalizumab in multi-food oral immunotherapy. Allergy Asthma Clin Immunol 2020; 16:25. [PMID: 32328115 PMCID: PMC7165401 DOI: 10.1186/s13223-020-00419-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/16/2020] [Indexed: 12/17/2022] Open
Abstract
Background Previous proof-of-concept studies have shown that a short course of omalizumab can safely accelerate the oral immunotherapy schedule for multiple allergens simultaneously. Considering the high cost of medication, the dose-related efficacy of omalizumab at decreasing the duration of oral immunotherapy up-dosing phase must be objectively quantified before cost–benefit analyses can be performed. The primary objective of this trial will be to compare the efficacy of 2 omalizumab dosages to placebo at decreasing time-to-maintenance dose during a symptom-driven multi-food OIT protocol. Methods A total of 90 participants aged 6 to 25 with multiple food allergies (3 or more) will be enrolled at four sites in Canada. Participants will be randomized to: (A) Omalizumab 8 mg/kg per month (n = 36); (B) Omalizumab 16 mg/kg per month (n = 36); or (C) Placebo (n = 18). Study drug will be administered at full dosage for 12 weeks, then progressively tapered at 50% dosage (8 mg/kg vs 4 mg/kg vs placebo) for 4 weeks and at 25% dosage (4 mg/kg vs 2 mg/kg vs placebo) for another 4 weeks. After a pre-treatment period of 8 weeks, participants will undergo an initial food escalation (IFE) to an OIT mix containing 3 allergens and start daily home dosing with biweekly increases until a target daily maintenance of 1500 mg protein is achieved. The amount escalated at each visit will vary based on treatment tolerance according to a standardized up-dosing algorithm. Participants will be followed for at least 12 months following the initial food escalation. The primary endpoint will be time from IFE to the target maintenance dose of 1500 mg protein. Time-to-event analytic methods, including the log-rank test, will be used to compare the 3 arms. Discussion This trial uses a novel pragmatic approach to compare OIT with omalizumab to OIT without omalizumab in a blinded manner, which allows to single out the effect of this anti-IgE medication on treatment effectiveness speed without the recourse to predetermined schedules. The innovative patient-centered up-dosing algorithm allows to maximise treatment effectiveness speed without compromising patient safety, regardless of whether the patient is on omalizumab or not. This study will also provide novel prospective data to inform on the optimal and most cost-effective dosage for this indication. Trial registration ClinicalTrials.gov, NCT04045301, Registered 5 August 2019, https://clinicaltrials.gov/ct2/show/NCT04045301
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Affiliation(s)
- Alexandra Langlois
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | | | - Hélène Leroux
- 3Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada
| | - Kerstin Killer
- 3Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada
| | - Pauline Azzano
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | - Louis Paradis
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada.,2Department of Allergy and Immunology, Centre Hospitalier de l'Université de Montréal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC H3T1C5 Canada
| | - Kathryn Samaan
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | - Jonathan Lacombe-Barrios
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | - Benoît Mâsse
- 3Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada.,4School of Public Health, Université de Montréal, Montreal, QC Canada
| | - Anne Des Roches
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada.,3Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada
| | - Philippe Bégin
- 1Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada.,2Department of Allergy and Immunology, Centre Hospitalier de l'Université de Montréal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC H3T1C5 Canada.,3Centre Hospitalier Sainte-Justine Research Center, Montreal, QC Canada
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19
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Flahault A, Paquette K, Fernandes RO, Delfrate J, Cloutier A, Henderson M, Lavoie JC, Mâsse B, Nuyt AM, Luu TM, Alos N, Bertagnolli M, Bigras JL, Curnier D, Dartora DR, Ducruet T, El-Jalbout R, Girard-Bock C, Gyger G, Hamel P, Lapeyraque AL, Mian MOR, Orlando V, Xie LF. Increased Incidence but Lack of Association Between Cardiovascular Risk Factors in Adults Born Preterm. Hypertension 2020; 75:796-805. [DOI: 10.1161/hypertensionaha.119.14335] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Preterm birth incurs an increased risk of early cardiovascular events and death. In the general population, cardiovascular risk factors cluster in the context of inflammation and oxidative stress. Whether this also occurs in young adults born preterm is unknown. We analyzed 101 healthy young adults (ages 18–29) born preterm (≤29 weeks of gestation) and 105 full-term controls, predominantly (90%) white. They underwent a comprehensive clinical and biological evaluation, including measurement of blood pressure, lung function (spirometry), glucose metabolism (fasting glucose, glycated hemoglobin, and oral glucose tolerance test), as well as biomarkers of inflammation and oxidative stress. Individuals born preterm were at higher risk than those born full-term of stage ≥1 hypertension (adjusted odds ratio, 2.91 [95% CI, 1.51–5.75]), glucose intolerance (adjusted odds ratio, 2.22 [95% CI, 1.13–4.48]), and airflow limitation (adjusted odds ratio, 3.47 [95% CI, 1.76–7.12]). Hypertension was strongly associated with adiposity and with glucose intolerance in participants born full-term but not in those born preterm. We did not find any group difference in levels of biomarkers of inflammation and oxidative stress. In individuals born preterm, inflammation, and oxidative stress were not related to hypertension or glucose intolerance but were associated with adiposity. In those born preterm, cardiovascular risk factors were not related to each other suggesting different pathophysiological pathways leading to the development of cardiovascular risk following preterm birth. Clinicians should consider screening for these abnormalities irrespectively of other risk factors in this at-risk population.
Clinical Trial Registration
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT03261609.
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Affiliation(s)
- Adrien Flahault
- From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Katryn Paquette
- From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Rafael Oliveira Fernandes
- From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Jacques Delfrate
- From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Anik Cloutier
- From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Mélanie Henderson
- From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Jean-Claude Lavoie
- Department of Nutrition (J.-C.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Benoît Mâsse
- Department of Social and Preventive Medicine, School of Public Health (B.M.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Anne Monique Nuyt
- From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
| | - Thuy Mai Luu
- From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada
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20
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Humphries B, Lauzier S, Drolet M, Coyle D, Mâsse B, Provencher L, Robidoux A, Maunsell E. Wage losses among spouses of women with nonmetastatic breast cancer. Cancer 2020; 126:1124-1134. [PMID: 31821547 DOI: 10.1002/cncr.32638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the wage losses incurred by spouses of women with nonmetastatic breast cancer in the 6 months after the diagnosis. METHODS A prospective cohort study of spouses of women diagnosed with nonmetastatic breast cancer who were recruited in 8 hospitals in the province of Quebec (Canada) was performed. Information for estimating wage losses was collected by telephone interviews conducted 1 and 6 months after the diagnosis. Log-binomial regressions were used to identify personal, medical, and employment characteristics associated with experiencing wage losses, and generalized linear models were used to identify characteristics associated with the proportion of usual wages lost. RESULTS Overall, 829 women (86% participation) and 406 spouses (75% participation) consented to participate. Among the 279 employed spouses, 78.5% experienced work absences because of breast cancer. Spouses were compensated for 66.3% of their salary on average during their absence. The median wage loss was $0 (mean, $1820) (2003 Canadian dollars). Spouses were more likely to experience losses if they were self-employed or lived 50 km or farther from the hospital. Among spouses who experienced wage losses, those who were self-employed or whose partners had invasive breast cancer lost a higher proportion of wages. CONCLUSIONS Although spouses took some time off work, for many, the resulting wage losses were modest because of compensation received. Still, the types of compensation used may hide other forms of burden for families facing breast cancer.
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Affiliation(s)
- Brittany Humphries
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health and Optimal Health Practices Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Sophie Lauzier
- Population Health and Optimal Health Practices Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.,Centre des Maladies du Sein (Center for Breast Diseases) CHU de Québec-Université Laval, Saint-Sacrement Hospital, Quebec City, Quebec, Canada
| | - Mélanie Drolet
- Population Health and Optimal Health Practices Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Douglas Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benoît Mâsse
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Louise Provencher
- Centre des Maladies du Sein (Center for Breast Diseases) CHU de Québec-Université Laval, Saint-Sacrement Hospital, Quebec City, Quebec, Canada.,Oncology Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - André Robidoux
- Centre Intégré du Cancer du Sein CHUM, Montreal, Quebec, Canada
| | - Elizabeth Maunsell
- Centre des Maladies du Sein (Center for Breast Diseases) CHU de Québec-Université Laval, Saint-Sacrement Hospital, Quebec City, Quebec, Canada.,Oncology Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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21
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Jensen ME, Ducharme FM, Alos N, Mailhot G, Mâsse B, White JH, Sadatsafavi M, Khamessan A, Tse SM, Alizadehfar R, Bock DE, Daigneault P, Lemire C, Yang C, Radhakrishnan D. Vitamin D in the prevention of exacerbations of asthma in preschoolers (DIVA): protocol for a multicentre randomised placebo-controlled triple-blind trial. BMJ Open 2019; 9:e033075. [PMID: 31892662 PMCID: PMC6955525 DOI: 10.1136/bmjopen-2019-033075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Preschoolers have the highest rate of emergency visits and hospitalisations for asthma exacerbations of all age groups, with most triggered by upper respiratory tract infections (URTIs) and occurring in the fall or winter. Vitamin D insufficiency is highly prevalent in Canadian preschoolers with recurrent asthma exacerbations, particularly in winter. It is associated with more URTIs and, in patients with asthma, more oral corticosteroid (OCS) use. Although evidence suggests that vitamin D supplements significantly decrease URTIs and asthma exacerbations requiring OCS, there is insufficient data in preschoolers. This study aims to determine the impact of vitamin D3 supplementation on exacerbations requiring OCS, in preschoolers with recurrent URTI-induced asthma exacerbations. METHODS AND ANALYSIS This is a phase III, randomised, triple-blind, placebo-controlled, parallel-group multicentre trial of vitamin D3 supplementation in children aged 1-5 years, with asthma triggered by URTIs and a recent history of frequent URTIs and OCS use. Children (n=865) will be recruited in the fall and early winter and followed for 7 months. They will be randomised to either the (1) intervention: two oral boluses of 100 000 international unit (IU) vitamin D3 (3.5 months apart) with 400 IU vitamin D3 daily; or (2) control: identical placebo boluses with daily placebo. The primary outcome is the number of exacerbations requiring OCS per child, documented by medical and pharmacy records. Secondary outcomes include number of laboratory-confirmed viral URTIs, exacerbation duration and severity, parent functional status, healthcare use, treatment deintensification, cost and safety. ETHICS AND DISSEMINATION This study has received ethical approval from all sites. Results will be disseminated via international conferences and manuscripts targeting paediatricians and respirologists, and to families of asthmatic children via our Quebec parents-partners outreach programme. If proven effective, findings may markedly influence the management of URTI-induced asthma in high-morbidity preschoolers and could be directly implemented into practice with an update to clinical guidelines. TRIAL REGISTRATION NUMBER NCT03365687.
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Affiliation(s)
- Megan E Jensen
- Priority Research Centre Grow Up Well, School of Medicine & Public Health, Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Francine M Ducharme
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Nathalie Alos
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Pediatric Endocrinology Service, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Geneviève Mailhot
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Benoît Mâsse
- Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
- School of Public Health, University of Montreal, Montreal, Québec, Canada
| | - John H White
- Department of Physiology, McGill University, Montreal, Québec, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Khamessan
- Euro-Pharm International Canada Inc, Montreal, Québec, Canada
| | - Sze Man Tse
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Reza Alizadehfar
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Dirk E Bock
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Patrick Daigneault
- Department of Pediatrics, Centre Mère-Enfant du CHU de Québec, Quebec City, Quebec, Canada
| | - Chantal Lemire
- Division of Allergy and Immunology, Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Connie Yang
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Dhenuka Radhakrishnan
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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22
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Brisson J, Bérubé S, Diorio C, Mâsse B, Lemieux J, Duchesne T, Delvin E, Vieth R, Yaffe MJ, Chiquette J. A Randomized Double-Blind Placebo-Controlled Trial of the Effect of Vitamin D 3 Supplementation on Breast Density in Premenopausal Women. Cancer Epidemiol Biomarkers Prev 2017; 26:1233-1241. [PMID: 28515107 DOI: 10.1158/1055-9965.epi-17-0249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/28/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022] Open
Abstract
Background: This double-blind, placebo-controlled parallel group trial assessed whether oral supplementation with 1,000, 2,000, or 3,000 IU/day vitamin D3 over one year reduces percent mammographic breast density in premenopausal women.Methods: The trial was conducted between October 2012 and June 2015, among premenopausal female volunteers from Quebec City (Quebec, Canada). Women were randomized with ratio 1:1:1:1 to one of four study arms (1,000, 2,000, or 3,000 IU/day vitamin D3 or placebo). The primary outcome was mean change in percent mammographic breast density. Participants and research team were blinded to study arm assignment.Results: Participants (n = 405) were randomized to receive 1,000 (n = 101), 2,000 (n = 104), or 3,000 IU/day (n = 101) vitamin D3, or a placebo (n = 99). The primary analysis included 391 participants (96, 99, 100, and 96, respectively). After the one-year intervention, mean ± SE change in percent breast density in the arms 1,000 IU/day (-5.5% ± 0.5%) and 2,000 IU/day (-5.9% ± 0.5%) vitamin D3 was similar to that in the placebo arm (-5.7% ± 0.5%) (P values = 1.0). In the 3,000 IU/day vitamin D3 arm, percent breast density also declined but slightly less (-3.8% ± 0.5%) compared with placebo arm (P = 0.03). Adherence to intervention was excellent (92.8%), and reporting of health problems was comparable among study arms (P ≥ 0.95). All participants had normal serum calcium.Conclusions: In premenopausal women, one-year supplementation with 1,000, 2,000, or 3,000 IU/day vitamin D3 resulted in a reduction of percent breast density no greater than that seen with the placebo.Impact: At doses of 1,000-3,000 IU/day, vitamin D supplementation will not reduce breast cancer risk through changes in breast density. Cancer Epidemiol Biomarkers Prev; 26(8); 1233-41. ©2017 AACR.
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Affiliation(s)
- Jacques Brisson
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada. .,Département de Médecine Sociale et Préventive, Centre de Recherche sur le Cancer, Université Laval, Québec, Canada.,Centre des Maladies du sein Deschênes-Fabia, Hôpital du St-Sacrement, Québec, Canada
| | - Sylvie Bérubé
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Caroline Diorio
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada.,Département de Médecine Sociale et Préventive, Centre de Recherche sur le Cancer, Université Laval, Québec, Canada.,Centre des Maladies du sein Deschênes-Fabia, Hôpital du St-Sacrement, Québec, Canada
| | - Benoît Mâsse
- Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche du CHU Sainte-Justine, Montréal, Québec, Canada
| | - Julie Lemieux
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada.,Centre des Maladies du sein Deschênes-Fabia, Hôpital du St-Sacrement, Québec, Canada
| | - Thierry Duchesne
- Département de Mathématiques et de Statistique, Université Laval, Québec, Canada
| | - Edgar Delvin
- Centre de Recherche du CHU Sainte-Justine, Montréal, Québec, Canada
| | - Reinhold Vieth
- Departments of Laboratory Medicine and Pathobiology and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Martin J Yaffe
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyne Chiquette
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada.,Centre des Maladies du sein Deschênes-Fabia, Hôpital du St-Sacrement, Québec, Canada
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23
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Duchaine CS, Ndjaboué R, Levesque M, Vézina M, Trudel X, Gilbert-Ouimet M, Dionne CE, Mâsse B, Pearce N, Brisson C. Psychosocial work factors and social inequalities in psychological distress: a population-based study. BMC Public Health 2017; 17:91. [PMID: 28100221 PMCID: PMC5241997 DOI: 10.1186/s12889-017-4014-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022] Open
Abstract
Background Mental health problems (MHP) are the leading cause of disability worldwide. The inverse association between socioeconomic position (SEP) and MHP has been well documented. There is prospective evidence that factors from the work environment, including adverse psychosocial work factors, could contribute to the development of MHP including psychological distress. However, the contribution of psychosocial work factors to social inequalities in MHP remains unclear. This study evaluates the contribution of psychosocial work factors from two highly supported models, the Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models to SEP inequalities of psychological distress in men and women from a population-based sample of Quebec workers. Methods Data were collected during a survey on working conditions, health and safety at work. SEP was evaluated using education, occupation and household income. Psychosocial work factors and psychological distress were assessed using validated instruments. Mean differences (MD) in the score of psychological distress were estimated separately for men and women. Results Low education level and low household income were associated with psychological distress among men (MD, 0.56 (95% CI 0.06; 1.05) and 1.26 (95% CI 0.79; 1.73) respectively). In men, the contribution of psychosocial work factors from the DCS and the ERI models to the association between household income and psychological distress ranged from 9% to 24%. No clear inequalities were observed among women. Conclusions These results suggest that psychosocial work factors from the DCS and the ERI models contribute to explain a part of social inequalities in psychological distress among men. Psychosocial factors at work are frequent and modifiable. The present study supports the relevance of targeting these factors for the primary prevention of MHP and for health policies aiming to reduce social inequalities in mental health. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4014-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline S Duchaine
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8, QC, Canada. .,Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6, QC, Canada.
| | - Ruth Ndjaboué
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8, QC, Canada.,Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6, QC, Canada
| | - Manon Levesque
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8, QC, Canada.,Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6, QC, Canada
| | - Michel Vézina
- Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6, QC, Canada
| | - Xavier Trudel
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8, QC, Canada.,Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6, QC, Canada
| | - Mahée Gilbert-Ouimet
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8, QC, Canada.,Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6, QC, Canada
| | - Clermont E Dionne
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8, QC, Canada.,Rehabilitation department, Faculty of Medicine, Laval University, 1050 avenue de la médecine, Quebec city, G1V 0A6, QC, Canada
| | - Benoît Mâsse
- Social and preventive medicine department, Public Health School, Montreal University, 7101 avenue du Parc, Montreal, H3N 1X9, QC, Canada.,Research Center CHU-Ste-Justine, 3175 Côte Ste-Catherine, Montréal, H3T 1C5, Québec, Canada
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Chantal Brisson
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Saint-Sacrement Hospital, 1050 chemin Sainte-Foy, Quebec city, G1S 4L8, QC, Canada.,Social and preventive medicine department, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec city, G1V 0A6, QC, Canada
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Godin G, Michaud F, Alary M, Otis J, Mâsse B, Fortin C, Gagnon MP, Gagnon H. Evaluation of an HIV and STD Prevention Program for Adolescents in Juvenile Rehabilitation Centers. Health Educ Behav 2016; 30:601-14. [PMID: 14582600 DOI: 10.1177/1090198103255368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate a sexual and STD/AIDS prevention program tailored for adolescents with social adaptation difficulties in juvenile rehabilitation facilities. The impact of the intervention on the psychosocial determinants of condom use were assessed, using a pretest post-test quasi-experimental design. A total of 296 adolescents participated in the program (experimental group) while 240 adolescents did not receive the intervention (control group). The program led to positive outcomes among participants with respect to several of the main psychosocial determinants of condom use for sexual intercourse with a new partner. The results suggest that interventions that draw upon a combination of theoretical knowledge and consideration of the specific characteristics of the milieu could be efficient in promoting safer sexual practices among adolescents in juvenile rehabilitation centers.
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May SL, Ali S, Plint A, Mâsse B, Neto G, Auclair MC, Drendel AL, Khadra C, Ballard A, Villeneuve E, Parent S, McGrath P, Gouin S. A Randomized Controlled Trial on Oral Analgesic Utilization for Children Presenting With A Musculoskeletal Trauma in the Emergency Department. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: A single-agent approach to children’s moderate to severe pain is often inadequate. To date, no studies have evaluated the combined use of oral morphine and ibuprofen for optimal pain management of children presenting to an emergency department (ED) for muscu-loskeletal (MSK) trauma.
OBJECTIVES: To assess the efficacy of a combination of oral morphine and ibuprofen for pain management in children with MSK trauma in the ED.
DESIGN/METHODS: A double-blind, placebo-controlled, multi-centered, three-arm, randomized clinical trial of 500 patients was conducted at three pediatric tertiary care EDs. Patients were randomized (in a 2:1:1 ratio) to receive (orally): (a) morphine (0.2mg/kg) + ibuprofen (10mg/kg) (Group MOR + IBU) or (b) morphine (0.2 mg/kg) + placebo (Group MOR) or (c) ibuprofen (10mg/kg) + placebo (Group IBU). Patients 6 to 17 years of age, who presented to the ED with a MSK trauma, and a score >30 mm on the 100mm visual analogue scale were eligible to participate. Primary outcome was pain intensity score under 30 mm (mild pain) at 60-minutes (T-60) after treatment administration.
RESULTS: A total of 456 patients were included in analyses: 177 (MOR + IBU), 188 (MOR), 91 (IBU). Mean age was 11.9±2.7 years, with a majority of boys (55.3%) and Soft tissue injuries (62%). There were no differences in baseline characteristics in the three groups. Baseline mean pain score was 60.9±16.2 mm. Only 30% (MOR + IBU), 29% (MOR) and 30% (IBU) of patients reached a pain score under 30 mm at T-60 (p=0.83). Mean pain scores at T-60 were 42.3±23.2 mm (MOR + IBU), 43.8 + 23.1 mm (MOR) and 42.3±23.3 mm (IBU) (p=0.83). No severe adverse events were observed in any of the groups, at any of the study measurement points.
CONCLUSION: Combination of morphine with ibuprofen did not provide any additional pain relief for children with MSK injuries, in the ED. None of the study medication provided optimal pain management, as the majority of children did not reach the WHO definition of mild pain. Alternative analgesic combinations should be investigated to optimize pain relief of children who present to the ED with MSK injuries.
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Gravel J, Gouin S, Chalut D, Crevier L, Décarie JC, Elazhary N, Mâsse B. Derivation and validation of a clinical decision rule to identify young children with skull fracture following isolated head trauma. CMAJ 2015; 187:1202-1208. [PMID: 26350911 DOI: 10.1503/cmaj.150540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 07/30/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is no clear consensus regarding radiologic evaluation of head trauma in young children without traumatic brain injury. We conducted a study to develop and validate a clinical decision rule to identify skull fracture in young children with head trauma and no immediate need for head tomography. METHODS We performed a prospective cohort study in 3 tertiary care emergency departments in the province of Quebec. Participants were children less than 2 years old who had a head trauma and were not at high risk of clinically important traumatic brain injury (Glasgow Coma Scale score < 15, altered level of consciousness or palpable skull fracture). The primary outcome was skull fracture. For each participant, the treating physician completed a standardized report form after physical examination and before radiologic evaluation. The decision to order skull radiography was at the physician's discretion. The clinical decision rule was derived using recursive partitioning. RESULTS A total of 811 patients (49 with skull fracture) were recruited during the derivation phase. The 2 predictors identified through recursive partitioning were parietal or occipital swelling or hematoma and age less than 2 months. The rule had a sensitivity of 94% (95% confidence interval [CI] 83%-99%) and a specificity of 86% (95% CI 84%-89%) in the derivation phase. During the validation phase, 856 participants (44 with skull fracture) were recruited. The rule had a sensitivity of 89% and a specificity of 87% during this phase. INTERPRETATION The clinical decision rule developed in this study identified about 90% of skull fractures among young children with mild head trauma who had no immediate indication for head tomography. Use of the rule would have reduced the number of radiologic evaluations by about 60%.
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Affiliation(s)
- Jocelyn Gravel
- Départements de pédiatrie (Gravel, Gouin), chirurgie (Crevier) and radiologie (Décarie), Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal; Department of Pediatrics (Chalut), Montréal Children's Hospital, McGill University, Montréal, Que.; Département d'urgence (Elazhary), Hôpital Fleurimont (CHU Sherbrooke), Université de Sherbrooke, Sherbrooke, Que.; Centre de recherche du CHU Sainte-Justine (Mâsse), Université de Montréal, Montréal, Que.
| | - Serge Gouin
- Départements de pédiatrie (Gravel, Gouin), chirurgie (Crevier) and radiologie (Décarie), Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal; Department of Pediatrics (Chalut), Montréal Children's Hospital, McGill University, Montréal, Que.; Département d'urgence (Elazhary), Hôpital Fleurimont (CHU Sherbrooke), Université de Sherbrooke, Sherbrooke, Que.; Centre de recherche du CHU Sainte-Justine (Mâsse), Université de Montréal, Montréal, Que
| | - Dominic Chalut
- Départements de pédiatrie (Gravel, Gouin), chirurgie (Crevier) and radiologie (Décarie), Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal; Department of Pediatrics (Chalut), Montréal Children's Hospital, McGill University, Montréal, Que.; Département d'urgence (Elazhary), Hôpital Fleurimont (CHU Sherbrooke), Université de Sherbrooke, Sherbrooke, Que.; Centre de recherche du CHU Sainte-Justine (Mâsse), Université de Montréal, Montréal, Que
| | - Louis Crevier
- Départements de pédiatrie (Gravel, Gouin), chirurgie (Crevier) and radiologie (Décarie), Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal; Department of Pediatrics (Chalut), Montréal Children's Hospital, McGill University, Montréal, Que.; Département d'urgence (Elazhary), Hôpital Fleurimont (CHU Sherbrooke), Université de Sherbrooke, Sherbrooke, Que.; Centre de recherche du CHU Sainte-Justine (Mâsse), Université de Montréal, Montréal, Que
| | - Jean-Claude Décarie
- Départements de pédiatrie (Gravel, Gouin), chirurgie (Crevier) and radiologie (Décarie), Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal; Department of Pediatrics (Chalut), Montréal Children's Hospital, McGill University, Montréal, Que.; Département d'urgence (Elazhary), Hôpital Fleurimont (CHU Sherbrooke), Université de Sherbrooke, Sherbrooke, Que.; Centre de recherche du CHU Sainte-Justine (Mâsse), Université de Montréal, Montréal, Que
| | - Nicolas Elazhary
- Départements de pédiatrie (Gravel, Gouin), chirurgie (Crevier) and radiologie (Décarie), Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal; Department of Pediatrics (Chalut), Montréal Children's Hospital, McGill University, Montréal, Que.; Département d'urgence (Elazhary), Hôpital Fleurimont (CHU Sherbrooke), Université de Sherbrooke, Sherbrooke, Que.; Centre de recherche du CHU Sainte-Justine (Mâsse), Université de Montréal, Montréal, Que
| | - Benoît Mâsse
- Départements de pédiatrie (Gravel, Gouin), chirurgie (Crevier) and radiologie (Décarie), Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal; Department of Pediatrics (Chalut), Montréal Children's Hospital, McGill University, Montréal, Que.; Département d'urgence (Elazhary), Hôpital Fleurimont (CHU Sherbrooke), Université de Sherbrooke, Sherbrooke, Que.; Centre de recherche du CHU Sainte-Justine (Mâsse), Université de Montréal, Montréal, Que
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Gravel J, Gouin S, Chalut D, Crevier L, Décarie JC, Elazhary N, Mâsse B. 26: A Clinical Decision Rule to Identify Skull Fracture Among Young Children with Isolated Head Trauma. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e42b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gravel J, Carrière B, D'Angelo A, Crevier L, Beauchamp M, Mâsse B. 153: Ondansetron for Pediatric Concussion: A Pilot Randomized Controlled Trial. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e89b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, Palanee T, Nakabiito C, van der Straten A, Noguchi L, Hendrix CW, Dai JY, Ganesh S, Mkhize B, Taljaard M, Parikh UM, Piper J, Mâsse B, Grossman C, Rooney J, Schwartz JL, Watts H, Marzinke MA, Hillier SL, McGowan IM, Chirenje ZM. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med 2015; 372:509-18. [PMID: 25651245 PMCID: PMC4341965 DOI: 10.1056/nejmoa1402269] [Citation(s) in RCA: 982] [Impact Index Per Article: 109.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reproductive-age women need effective interventions to prevent the acquisition of human immunodeficiency virus type 1 (HIV-1) infection. METHODS We conducted a randomized, placebo-controlled trial to assess daily treatment with oral tenofovir disoproxil fumarate (TDF), oral tenofovir-emtricitabine (TDF-FTC), or 1% tenofovir (TFV) vaginal gel as preexposure prophylaxis against HIV-1 infection in women in South Africa, Uganda, and Zimbabwe. HIV-1 testing was performed monthly, and plasma TFV levels were assessed quarterly. RESULTS Of 12,320 women who were screened, 5029 were enrolled in the study. The rate of retention in the study was 91% during 5509 person-years of follow-up. A total of 312 HIV-1 infections occurred; the incidence of HIV-1 infection was 5.7 per 100 person-years. In the modified intention-to-treat analysis, the effectiveness was -49.0% with TDF (hazard ratio for infection, 1.49; 95% confidence interval [CI], 0.97 to 2.29), -4.4% with TDF-FTC (hazard ratio, 1.04; 95% CI, 0.73 to 1.49), and 14.5% with TFV gel (hazard ratio, 0.85; 95% CI, 0.61 to 1.21). In a random sample, TFV was detected in 30%, 29%, and 25% of available plasma samples from participants randomly assigned to receive TDF, TDF-FTC, and TFV gel, respectively. Independent predictors of TFV detection included being married, being older than 25 years of age, and being multiparous. Detection of TFV in plasma was negatively associated with characteristics predictive of HIV-1 acquisition. Elevations of serum creatinine levels were seen more frequently among participants randomly assigned to receive oral TDF-FTC than among those assigned to receive oral placebo (1.3% vs. 0.2%, P=0.004). We observed no significant differences in the frequencies of other adverse events. CONCLUSIONS None of the drug regimens we evaluated reduced the rates of HIV-1 acquisition in an intention-to-treat analysis. Adherence to study drugs was low. (Funded by the National Institutes of Health; VOICE ClinicalTrials.gov number, NCT00705679.).
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Affiliation(s)
- Jeanne M Marrazzo
- From the University of Washington (J.M.M.) and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (B.A.R., J.Y.D., B. Mâsse) - both in Seattle; the HIV Prevention Research Unit, Medical Research Council (G.R., S.G.), and the Centre for AIDS Programme of Research in South Africa (CAPRISA), Durban (G.N.), Witwatersrand Reproductive Health and HIV Research Institute (T.P.) and Perinatal HIV Research Unit (B. Mkhize), Johannesburg, and the AURUM Institute, Klerksdorp (M.T.) - all in South Africa; FHI 360, Durham, NC (K.G.); University of Zimbabwe-University of California San Francisco Research Programme, Harare, Zimbabwe (N.M., Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (C.N.); Women's Global Health Imperative, Research Triangle Institute (RTI) International, San Francisco (A.S.); Magee-Womens Research Institute, University of Pittsburgh Medical Center, Pittsburgh (L.N., U.M.P., S.L.H., I.M.M.); Johns Hopkins University School of Medicine, Baltimore (C.W.H., M.A.M.); Division of AIDS, National Institute of Allergy and Infectious Diseases (J.P.), National Institutes of Mental Health (C.G.), and the Eunice Shriver Kennedy National Institute of Child Health and Human Development (H.W.), National Institutes of Health - all in Bethesda, MD; Gilead Sciences, Foster City, CA (J.R.); CONRAD, Arlington, VA (J.L.S.); and Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal (B. Mâsse)
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Lauzier S, Lévesque P, Mondor M, Drolet M, Coyle D, Brisson J, Mâsse B, Provencher L, Robidoux A, Maunsell E. Out-of-pocket costs in the year after early breast cancer among Canadian women and spouses. J Natl Cancer Inst 2013; 105:280-92. [PMID: 23349250 DOI: 10.1093/jnci/djs512] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We lack comprehensive information about the extent of out-of-pocket costs after diagnosis of early breast cancer and their effects on the family's financial situation. METHODS This longitudinal study assessed out-of-pocket costs and wage losses during the first year after diagnosis of early breast cancer among Canadian women and spouses. Out-of-pocket costs for treatments and follow-up, consultations with other practitioners, home help, clothing, and natural health products were estimated, with information collected from telephone interviews. Generalized linear models were used to identify women at risk of having higher costs and the effects of out-of-pocket costs on perceptions of the family's financial situation. RESULTS Overall, 829 women (participation, 86.2%) and 391 spouses participated. Women's median net out-of-pocket costs during the year after diagnosis were $1002 (2003 Canadian dollars; mean = $1365; SD = $1238), and 74.4% of these costs resulted from treatments and follow-up. Spouses' median costs were $111 (mean = $234; SD = $320), or 9% of couples' total expenses. In multivariable analyses, the percentage of women with out-of-pocket costs of $1773 or more (upper quartile) was statistically significantly associated with higher education, working at diagnosis, living more than 50 km from the hospital where surgery was performed, and having two and three different types of adjuvant treatment (all 2-sided P values ≤ .01). However, when considered simultaneously with wage losses, out-of-pocket costs were not associated with perceived deterioration in the family's financial situation; rather, wage losses were the driving factor. CONCLUSIONS Overall, out-of-pocket costs from breast cancer for the year after diagnosis are probably not unmanageable for most women. However, some women were at higher risk of experiencing financial burden resulting from these costs.
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Affiliation(s)
- Sophie Lauzier
- Unité de recherche en santé des populations (URESP), Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Québec, QC, Canada, G1S 4L8.
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Boily MC, Dimitrov D, Abdool Karim SS, Mâsse B. The future role of rectal and vaginal microbicides to prevent HIV infection in heterosexual populations: implications for product development and prevention. Sex Transm Infect 2011; 87:646-53. [PMID: 22110117 PMCID: PMC3332062 DOI: 10.1136/sextrans-2011-050184] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To compare the potential impact of rectal (RMB), vaginal (VMB) and bi-compartment (RVMB) (applied vaginally and protective during vaginal and anal intercourse) microbicides to prevent HIV in various heterosexual populations. To understand when a RMB is as useful than a VMB for women practicing anal intercourse (AI). METHODS Mathematical model was used to assess the population-level impact (cumulative fraction of new HIV infections prevented (CFP)) of the three different microbicides in various intervention scenarios and prevalence settings. We derived the break-even RMB efficacy required to reduce a female's cumulative risk of HIV infection by the same amount than a VMB. RESULTS Under optimistic coverage (fast roll-out, 100% uptake), a 50% efficacious VMB used in 75% of sex acts in population without AI may prevent ∼33% (27, 42%) new total (men and women combined) HIV infections over 25 years. The 25-year CFP reduces to ∼25% (20, 32%) and 17% (13, 23%) if uptake decreases to 75% and 50%, respectively. Similar loss of impact (by 25%-50%) is observed if the same VMB is introduced in populations with 5%-10% AI and for RR(RAI)=4-20. A RMB is as useful as a VMB (ie, break-even) in populations with 5% AI if RR(RAI)=20 and in populations with 15%-20% AI if RR(RAI)=4, independently of adherence as long as it is the same with both products. The 10-year CFP with a RVMB is twofold larger than for a VMB or RMB when AI=10% and RR(RAI)=10. CONCLUSIONS Even low AI frequency can compromise the impact of VMB interventions. RMB and RVMB will be important prevention tools for heterosexual populations.
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Affiliation(s)
- Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
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Lauzier S, Levesque P, Drolet M, Coyle D, Brisson J, Mâsse B, Robidoux A, Robert J, Maunsell E. Out-of-pocket costs for accessing adjuvant radiotherapy among Canadian women with breast cancer. J Clin Oncol 2011; 29:4007-13. [PMID: 21931023 DOI: 10.1200/jco.2011.35.1007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with breast cancer incur out-of-pocket costs when they receive adjuvant radiation. These treatments are administered in dedicated centers on a daily basis over 4 to 5 weeks. We assessed the extent of out-of-pocket costs to access radiotherapy and identified women at risk of experiencing higher costs. PATIENTS AND METHODS This prospective study was conducted among 800 women from eight Quebec hospitals (participation, 86%), of whom 693 women received adjuvant radiotherapy. Costs to access treatment (transportation, parking, lodging, and meals) were estimated on the basis of information collected by telephone interviews. Generalized linear models were used to identify women at risk of having higher costs. RESULTS Mean and median total costs (including financial aid received) to access radiotherapy were 445 Canadian dollars (Can$; standard deviation, Can$407) and Can$311, respectively. Women who lived at home but far from the radiotherapy center had the highest risk of experiencing weekly costs of at least Can$122 (highest quartile; prevalence ratio [PR], 5.8; 95% CI, 4.7 to 7.1) followed by women who lived away from home and farther from the center (PR, 4.5; 95% CI, 3.4 to 6.0) and by women who lived away from home and closer to the center (PR, 2.14; 95% CI, 1.3 to 3.5). When women stayed at a cancer lodge during treatment, costs were reduced by 80%. CONCLUSION Considered in and of themselves, out-of-pocket costs for access to radiotherapy appeared relatively modest. Financial assistance initiatives for women who lived away from home during treatments contributed to a substantial reduction of access costs. These efforts should be maintained, but financial assistance should also target patients with cancer who live at home during treatments but have to travel relatively long distances on a daily basis.
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Affiliation(s)
- Sophie Lauzier
- Centre Hospitalier Affilié Universitaire de Québec, Québec, Québec, Canada
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Beigi R, Noguchi L, Parsons T, Macio I, Kunjara Na Ayudhya RP, Chen J, Hendrix CW, Mâsse B, Valentine M, Piper J, Watts DH. Pharmacokinetics and placental transfer of single-dose tenofovir 1% vaginal gel in term pregnancy. J Infect Dis 2011; 204:1527-31. [PMID: 21930612 DOI: 10.1093/infdis/jir562] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED Tenofovir (TFV) 1% vaginal gel has been found to decrease sexual transmission of human immunodeficiency virus. To initiate investigations during pregnancy, 16 healthy pregnant women scheduled for cesarean delivery received a single application of TFV gel preoperatively. Maternal serum drug concentrations were determined and fetal cord blood, amniotic fluid, placental tissue, and endometrial tissue specimens were collected. The median maternal peak concentration and cord blood TFV concentrations were 4.3 and 1.9 ng/mL, respectively (∼100- and 40-fold lower than after TFV oral dosing, respectively). No adverse events were related to the use of TFV gel. These findings support ongoing and future investigations of TFV gel in pregnancy. CLINICAL TRIAL REGISTRATION NCT00572273. http://www.clinicaltrials.gov/ct2/show/NCT00540605?term=mtn-002&rank=1.
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Affiliation(s)
- Richard Beigi
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abdool Karim SS, Richardson BA, Ramjee G, Hoffman IF, Chirenje ZM, Taha T, Kapina M, Maslankowski L, Coletti A, Profy A, Moench TR, Piwowar-Manning E, Mâsse B, Hillier SL, Soto-Torres L. Safety and effectiveness of BufferGel and 0.5% PRO2000 gel for the prevention of HIV infection in women. AIDS 2011; 25:957-66. [PMID: 21330907 PMCID: PMC3083640 DOI: 10.1097/qad.0b013e32834541d9] [Citation(s) in RCA: 193] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the safety and effectiveness of BufferGel and 0.5% PRO2000 microbicide gels for the prevention of male-to-female HIV transmission. DESIGN Phase II/IIb, randomized, placebo-controlled trial with three double-blinded gel arms and an open-label no gel arm. METHODS Study participants from Malawi, South Africa, Zambia, Zimbabwe, and the USA were instructed to apply study gel up to 1 h before each sex act and safety, sexual behavior, pregnancy, gel adherence, acceptability, and HIV serostatus were assessed during follow-up. RESULTS The 3101 enrolled women were followed for an average of 20.4 months with 93.6% retention and 81.1% self-reported gel adherence. Adverse event rates were similar in all study arms. HIV incidence rates in the 0.5% PRO2000 gel, BufferGel, placebo gel, and no gel arms were 2.70, 4.14, 3.91, and 4.02 per 100 women-years, respectively. HIV incidence in the 0.5% PRO2000 gel arm was lower than the placebo gel arm (hazard ratio = 0.7, P = 0.10) and the no gel arm (hazard ratio = 0.67, P = 0.06). HIV incidence rates were similar in the BufferGel and both placebo gel (hazard ratio = 1.10, P = 0.63) and no gel control arms (hazard ratio = 1.05, P = 0.78). HIV incidence was similar in the placebo gel and no gel arms (hazard ratio = 0.97, P = 0.89). CONCLUSION The 0.5% PRO2000 gel demonstrated a modest 30% reduction in HIV acquisition in women. However, these results were not statistically significant and subsequent findings from the Microbicide Development Programme (MDP) 301 trial have confirmed that 0.5% PRO2000 gel has little or no protective effect. BufferGel did not alter the risk of HIV infection. Both products were well tolerated.
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Affiliation(s)
- Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, South Africa.
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Mbopi-Keou FX, Trottier S, Omar RF, Nkele NN, Fokoua S, Mbu ER, Giguere JF, Domingo MC, Piret J, Tsague L, Zekeng L, Mwatha A, Mâsse B, Bergeron MG. A randomized, double-blind, placebo-controlled safety and acceptability study of two Invisible Condom® formulations in women from Cameroon. Contraception 2009; 80:484-92. [DOI: 10.1016/j.contraception.2009.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 03/05/2009] [Accepted: 03/31/2009] [Indexed: 11/16/2022]
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Lauzier S, Maunsell E, Drolet M, Coyle D, Hébert-Croteau N, Brisson J, Mâsse B, Abdous B, Robidoux A, Robert J. Wage losses in the year after breast cancer: extent and determinants among Canadian women. J Natl Cancer Inst 2008; 100:321-32. [PMID: 18314472 DOI: 10.1093/jnci/djn028] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Wage losses after breast cancer may result in considerable financial burden. Their assessment is made more urgent because more women now participate in the workforce and because breast cancer is managed using multiple treatment modalities that could lead to long work absences. We evaluated wage losses, their determinants, and the associations between wage losses and changes for the worse in the family's financial situation among Canadian women over the first 12 months after diagnosis of early breast cancer. METHODS We conducted a prospective cohort study among women with breast cancer from eight hospitals throughout the province of Quebec. Information that permitted the calculation of wage losses and information on potential determinants of wage losses were collected by three pretested telephone interviews conducted over the year following the start of treatment. Information on medical characteristics was obtained from medical records. The main outcome was the proportion of annual wages lost because of breast cancer. Multivariable analysis of variance using the general linear model was used to identify personal, medical, and employment characteristics associated with the proportion of wages lost. All statistical tests were two-sided. RESULTS Among 962 eligible breast cancer patients, 800 completed all three interviews. Of these, 459 had a paying job during the month before diagnosis. On average, these working women lost 27% of their projected usual annual wages (median = 19%) after compensation received had been taken into account. Multivariable analysis showed that a higher percentage of lost wages was statistically significantly associated with a lower level of education (P(trend) = .0018), living 50 km or more from the hospital where surgery was performed (P = .070), lower social support (P = .012), having invasive disease (P = .086), receipt of chemotherapy (P < .001), self-employment (P < .001), shorter tenure in the job (P(trend) < .001), and part-time work (P < .001). CONCLUSION Wage losses and their effects on financial situation constitute an important adverse consequence of breast cancer in Canada.
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Affiliation(s)
- Sophie Lauzier
- Unité de recherche en santé des populations, Centre de recherche du Centre Hospitalier Affilié Universitaire de Québec, Québec, Canada
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Aboa-Eboulé C, Brisson C, Maunsell E, Mâsse B, Bourbonnais R, Vézina M, Milot A, Théroux P, Dagenais GR. Job strain and risk of acute recurrent coronary heart disease events. JAMA 2007; 298:1652-60. [PMID: 17925517 DOI: 10.1001/jama.298.14.1652] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT There is evidence that job strain increases the risk of a first coronary heart disease (CHD) event. However, little is known about its association with the risk of recurrent CHD events after a first myocardial infarction (MI). OBJECTIVE To determine whether job strain increases the risk of recurrent CHD events. DESIGN, SETTING, AND PATIENTS Prospective cohort study of 972 men and women aged 35 to 59 years who returned to work after a first MI and were then followed up between February 10, 1996, and June 22, 2005. Patients were interviewed at baseline (on average, 6 weeks after their return to work), then after 2 and 6 years subsequently. Job strain, a combination of high psychological demands and low decision latitude, was evaluated in 4 quadrants: high strain (high demands and low latitude), active (high demands and high latitude), passive (low demands and low latitude), and low strain. A chronic job strain variable was constructed based on the first 2 interviews, and patients were divided into those exposed to high strain at both interviews and those unexposed to high strain at 1 or both interviews. The survival analyses were presented separately for 2 periods: before 2.2 years and at 2.2 years and beyond. MAIN OUTCOME MEASURE The outcome was a composite of fatal CHD, nonfatal MI, and unstable angina. RESULTS The outcome was documented in 206 patients. In the unadjusted analysis, chronic job strain was associated with recurrent CHD in the second period after 2.2 years of follow-up (hazard ratio [HR], 2.20; 95% CI, 1.32-3.66; respective event rates for patients exposed and unexposed to chronic job strain, 6.18 and 2.81 per 100 person-years). Chronic job strain remained an independent predictor of recurrent CHD in a multivariate model adjusted for 26 potentially confounding factors (HR, 2.00; 95% CI, 1.08-3.72). CONCLUSION Chronic job strain after a first MI was associated with an increased risk of recurrent CHD.
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Affiliation(s)
- Corine Aboa-Eboulé
- Unité de Recherché en Santé des Populations, Université Laval, Québec, Canada
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Trottier S, Omar RF, Désormeaux A, Drouin J, Gagnon MT, Vezina F, Guilbert E, Mâsse B, Bergeron MG. Safety, tolerance and acceptability of the Invisible Condom® and its vaginal applicator in healthy women and their male sexual partners. Contraception 2007; 76:117-25. [PMID: 17656181 DOI: 10.1016/j.contraception.2007.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Revised: 04/02/2007] [Accepted: 04/26/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The study was conducted to evaluate the safety and acceptability of the Invisible Condom when applied once or twice daily for 14 days in healthy women and their male sexual partners. STUDY DESIGN Forty-one women and 23 men divided into three cohorts were enrolled. Cohort 1:14 sexually abstinent women applying gel twice daily for 14 days; Cohort 2:14 sexually active women with tubal ligation applying gel once daily for 14 days and their 14 sexual partners who did not use gel; Cohort 3:13 women on oral contraceptive applying gel once daily for 14 days and 9 of their sexual partners. RESULTS No serious adverse events (AEs) were reported. Colposcopy showed no genital ulceration nor epithelial lesions. No major changes in vaginal flora or vaginal pH were detected. None of the women had to stop product application because of AEs. The majority of AEs were mild. Common AEs were itching, dryness, burning sensation, erythema and discharge. Satisfaction questionnaire showed that the gel and applicator were acceptable. CONCLUSION The Invisible Condom and applicator were safe, well tolerated and acceptable when applied intravaginally for 14 days. Thus, expanded safety and effectiveness evaluation is warranted.
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Affiliation(s)
- Sylvie Trottier
- Infectious Diseases Research Centre, Université Laval, Québec, QC, Canada G1V 4G2
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Zhang Y, Shan H, Trizzino J, Ruan Y, Beauchamp G, Mâsse B, Ma J, Rui B, Wang J, Liu M, Wang Y, He Y, Poundstone K, Jiang Y, Jackson JB, Shao Y. HIV incidence, retention rate, and baseline predictors of HIV incidence and retention in a prospective cohort study of injection drug users in Xinjiang, China. Int J Infect Dis 2007; 11:318-23. [PMID: 17321184 DOI: 10.1016/j.ijid.2006.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 08/16/2006] [Accepted: 09/04/2006] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine HIV seroincidence, study participant retention rate, and baseline predictors of HIV incidence and study retention among high-risk injection drug users (IDUs) in Xinjiang, China. METHODS A total of 508 eligible seronegative high-risk IDUs were enrolled. Study participants were tested for HIV-1 and counseled at the baseline, 6-month, and 12-month follow-up visits. Sociodemographic and behavioral data were collected during each study visit. The HIV-1 incidence rate and the retention rate were analyzed as a function of sociodemographic, behavioral, and recruitment variables. RESULTS At 12 months of follow-up, the HIV-1 incidence rate was 8.8 per 100 person-years (95% CI 6.3-12.0%) and the participant retention rate was 93%. Marital status at baseline was the only predictor of HIV incidence. No baseline variables were predictive of study retention. CONCLUSIONS HIV incidence is high among IDUs in Xinjiang, China. Baseline predictors of incidence and retention were minimal. The participant retention rate in this study is promising for the undertaking of future HIV intervention studies.
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Affiliation(s)
- Yuanzhi Zhang
- Xinjiang Center for Disease Control and Prevention, Urumqi, China
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40
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Brisson J, Bérubé S, Diorio C, Sinotte M, Pollak M, Mâsse B. Synchronized Seasonal Variations of Mammographic Breast Density and Plasma 25-Hydroxyvitamin D. Cancer Epidemiol Biomarkers Prev 2007; 16:929-33. [PMID: 17507618 DOI: 10.1158/1055-9965.epi-06-0746] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Dietary vitamin D has been associated with lower mammographic breast density, a strong biomarker for breast cancer risk. Blood 25-hydroxyvitamin D [25(OH)D] is an integrated measure of vitamin D status (from food, supplements, and sun exposure) and varies with season. Our objective was to assess seasonal variations of breast density and compare such variations, if any, with that of 25(OH)D. METHODS This cross-sectional study includes 741 premenopausal women recruited at screening mammography. Plasma 25(OH)D at recruitment was measured by RIA. Breast density was evaluated using a computer-assisted method. Seasonal variations were modeled using multivariate linear regression and semi-parametric cubic smoothing splines. RESULTS Season was strongly associated with 25(OH)D (P < 0.0001). The highest smoothed mean 25(OH)D levels were seen at the end of July (81.5 nmol/L) and the lowest in mid-April (52.4 nmol/L). Breast density showed modest seasonal variations (P = 0.028). The lowest smoothed mean breast density was observed in early December (38.5%) and the highest at the beginning of April (44.3%). When a 4-month lag time was presumed, seasonal variations of breast density appeared to be a mirror image of those of 25(OH)D, and the correlation of daily smoothed estimates of mean breast density and 25(OH)D was negative and strong (r = -0.90). CONCLUSION In premenopausal women, changes in blood vitamin D seem to be inversely related to changes in breast density with a lag time of about 4 months. This finding encourages further investigation of the possibility that vitamin D could reduce breast density and breast cancer risk.
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Affiliation(s)
- Jacques Brisson
- Unité de recherche en Santé des Populations, Hôpital St-Sacrement du Centre hospitalier affilié universitaire de Québec, 1050 Chemin Sainte-Foy, Quebec, Canada.
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George C, Alary M, Hogg RS, Otis J, Remis RS, Mâsse B, Turmel B, Leclerc R, Lavoie R, Vincelette J, Parent R, Chan K, Martindale S, Miller ML, Craib KJP, Schechter MT. HIV and ethnicity in Canada: is the HIV risk-taking behaviour of young foreign-born MSM similar to Canadian born MSM? AIDS Care 2007; 19:9-16. [PMID: 17129852 DOI: 10.1080/09540120600909398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a dearth of information on the HIV risk-taking behaviour of foreign-born men who have sex with men (MSM) in Canada. This study focused on identifying sexual risk behaviour among MSM who immigrated to Canada and compared them to MSM who were born in Canada. Baseline data from the Omega Cohort in Montreal and the Vanguard Project in Vancouver were combined to form four ethnicity/race analytical categories (n = 1,148): White born in Canada (WBIC), White born outside of Canada, non-White born in Canada (NBIC) and non-White born outside of Canada (NBOC). Psychological, demographic and sexual behaviour characteristics of the groups were similar except: NBOC were more likely to be unemployed, less likely to be tattooed, had fewer bisexual experiences and less likely worried of insufficient funds. WBOC were more likely to report unprotected sex with seropositives and more likely to have had unprotected sex while travelling. NBIC were more likely to have ever sold sex and to have had body piercing. WBOC are at high risk of acquiring as well as transmitting HIV. It is important to consider place of birth in addition to ethnicity when developing programmes to prevent the transmission of HIV.
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Affiliation(s)
- C George
- St. Michael's Hospital, Toronto, Ontario
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Liu W, Chen J, Rodolph M, Beauchamp G, Mâsse B, Wang S, Li R, Ruan Y, Zhou F, Leung MK, Lai S, Shao Y, Jackson JB. HIV prevalence among injection drug users in rural Guangxi China. Addiction 2006; 101:1493-8. [PMID: 16968351 DOI: 10.1111/j.1360-0443.2006.01557.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To determine the HIV-1 seroprevalence, risk behaviors and demographic characteristics associated with HIV-1 infection among injection drug users (IDU) in rural Guangxi, China. DESIGN AND SETTING Between July and November 2002, 702 IDU were screened for HIV-1 antibody through community outreach in rural Guangxi, China for enrollment in an HIV sero-incidence study. PARTICIPANTS A total of 702 active high-risk IDU were screened. High-risk injection was defined as anyone who reported injecting drugs at least three times per week in the last month or injected drugs with shared equipment on at least three occasions in the last 3 months. MEASUREMENTS HIV-1 antibody testing with confirmation by Western blot was performed on all subjects. Demographic and risk assessment survey data were collected at screening from everyone whose baseline HIV antibody status was known. FINDINGS HIV-1 antibody prevalence among 702 IDU at baseline was 25% with a median age of 26.7 years (18.2-43.2). Based on a multivariate logistic regression model using risk factors identified in univariate analyses, the following risk factors were associated significantly with an increase in risk for HIV seropositivity: age > 26 years (OR 1.50; 95% CI 1.04, 2.17), sharing of rinse water (OR = 1.24; 95% CI 1.09, 1.40), not having sex in the last 6 months (OR = 1.62; 95% CI 1.08, 2.43). CONCLUSIONS HIV infection among IDU in Guangxi, one of China's major HIV epidemic regions, is high and the infection occurs predominantly among older IDU males who share rinse water.
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Affiliation(s)
- Wei Liu
- Guangxi Centers for Disease Control and Prevention, Nanning, China
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Guimont C, Brisson C, Dagenais GR, Milot A, Vézina M, Mâsse B, Moisan J, Laflamme N, Blanchette C. Effects of job strain on blood pressure: a prospective study of male and female white-collar workers. Am J Public Health 2006; 96:1436-43. [PMID: 16809603 PMCID: PMC1522116 DOI: 10.2105/ajph.2004.057679] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated whether cumulative exposure to job strain increases blood pressure. METHODS A prospective study of 8395 white-collar workers was initiated during 1991 to 1993. At follow-up, 7.5 years later, 84% of the participants were reassessed to estimate cumulative exposure to job strain. RESULTS Compared with men who had never been exposed, men with cumulative exposure and those who became exposed during follow-up showed significant systolic blood pressure increments of 1.8 mm Hg (95% confidence interval [CI]=0.1, 3.5) and 1.5 mm Hg (95% CI=0.2, 2.8), respectively, and relative risks of blood pressure increases in the highest quintile group of 1.33 (95% CI = 1.01, 1.76) and 1.40 (95% CI = 1.14, 1.73). Effect magnitudes were smaller among women. Effects tended to be more pronounced among men and women with low levels of social support at work. CONCLUSIONS Among these white-collar workers, exposure to cumulative job strain had a modest but significant effect on systolic blood pressure among men. The risk was of comparable magnitude to that observed for age and sedentary behavior. Men and women with low levels of social support at work appeared to be at higher risk for increases in blood pressure.
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Affiliation(s)
- Chantal Guimont
- Unité de recherche en santé des populations, Quebec City, Quebec, Canada
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George C, Alary M, Otis J, Demers E, Remis RS, Mâsse B, Lavoie R, Vincelette J, Parent R, Leclerc R, Turmel B. Nonnegligible increasing temporal trends in unprotected anal intercourse among men who have sexual relations with other men in montreal. J Acquir Immune Defic Syndr 2006; 42:207-12. [PMID: 16645547 DOI: 10.1097/01.qai.0000200664.24968.4c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine temporal trends in unprotected anal intercourse (UAI) among men who have sex with men (MSM) participating in the Omega Cohort Study, 1997 through 2003. METHODS The Omega Cohort Study was a longitudinal study of HIV-negative MSM aged 16 years or older and living in Montreal. Participants completed self-administered questionnaires and interviews every 6 months. Trend analysis using the generalized estimating equation was done for length of cohort membership (visits) and by calendar time for all visits per type of sexual partner. Odds ratios (ORs) were calculated to measure the odds of increasing UAI per 6-month period. RESULTS Among subjects who were followed for at least 4 years, UAI increased with regular seroconcordant partners (OR = 1.06, 95% confidence interval [CI]: 1.04 to 1.09) and any type of partner (OR = 1.05, 95% CI: 1.03 to 1.07). There was a nonnegligible increase in UAI with casual partners (OR = 1.05, 95% CI: 1.01 to 1.09). For the analysis by calendar time, there were increases in UAI between regular seroconcordant partners (OR = 1.04, 95% CI: 1.02 to 1.05) and any type of partner (OR = 1.03, 95% CI: 1.02 to 1.04). There were nonnegligible increases in UAI with casual partners (OR = 1.03, 95% CI: 1.00 to 1.05) and with any type of partner except a regular seroconcordant partner from 15.7% to 18.8% (OR = 1.02, 95% CI: 1.00 to 1.04). CONCLUSIONS There was a nonnegligible and consistent increase in UAI among Omega Cohort Study participants between 1997 and 2003. Continuous trend analysis is important because it allows us to follow UAI closely and to implement intervention strategies that may help to stop or reduce the present trend.
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Affiliation(s)
- Clemon George
- Mental Health Services, St. Michael's Hospital, Toronto, Ontario, Canada
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45
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Zhang Y, Shan H, Trizzino J, Ruan Y, Beauchamp G, Mâsse B, Ma J, Gu Y, He Y, Rui B, Wang J, Poundstone K, Jiang Y, Brooks Jackson J, Shao Y. Demographic characteristics and risk behaviors associated with HIV positive injecting drug users in Xinjiang, China. J Infect 2006; 54:285-90. [PMID: 16831464 DOI: 10.1016/j.jinf.2006.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 05/31/2006] [Accepted: 06/01/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the demographic characteristics and risk behaviors associated with HIV positive and negative injection drug users (IDUs) who were screened for inclusion in a prospective cohort study to estimate HIV incidence in Xinjiang, China. METHODS Data analyses were performed on the demographic and risk assessment data collected at screening from high-risk IDUs, defined as anyone who reported injecting drugs at least three times per week in the last month or injected drugs after sharing equipment on at least three occasions in the last three months. RESULTS HIV antibody prevalence among 781 IDUs at baseline survey was 29%. The following factors were significantly associated with an increase in risk for HIV infection: age > or =26years (OR=3.16, 95% CI [2.02;4.94]), lack of college education (OR=2.32, 95% CI [1.02;5.25]), frequency of heroin use (OR=1.23, 95% CI [1.02;1.47]) and sharing of rinse water (OR=1.47, 95% CI [1.18;1.84]). Female gender (OR=0.44, 95% CI [0.22;0.86]), being Han vs Uighur ethnicity (OR=0.18, 95% CI [0.11;0.27]), and other race vs Uighur ethnicity (OR=0.23, 95% CI [0.12;0.44]) were significantly associated with a lower risk of HIV infection. CONCLUSIONS HIV infection among high risk IDUs in Xinjiang, China is high and is associated with older male Uighur IDUs who lack college education, frequently inject heroin, and/or share rinse water. There is a great potential for HIV transmission from IDUs to the general population. Therefore, related risk behaviors in IDUs, especially their sexual behavior, should be closely monitored.
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Affiliation(s)
- Yuanzhi Zhang
- Xinjiang Center for Disease Control and Prevention, 48 Beijing South Road, Urumqi 830011, China
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46
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El-Sadr WM, Mayer KH, Maslankowski L, Hoesley C, Justman J, Gai F, Mauck C, Absalon J, Morrow K, Mâsse B, Soto-Torres L, Kwiecien A. Safety and acceptability of cellulose sulfate as a vaginal microbicide in HIV-infected women. AIDS 2006; 20:1109-16. [PMID: 16691061 DOI: 10.1097/01.aids.0000226950.72223.5f] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few studies of topical microbicides have assessed their safety in HIV-infected women. We conducted this study to evaluate the safety and acceptability of 6% cellulose sulfate (CS) gel as a vaginal microbicide in sexually abstinent and active HIV-infected women. METHODS Fifty-nine HIV-infected women were enrolled in a randomized double-blind placebo-controlled study comparing 6% CS to placebo gel used for 14 days. Sexually abstinent women applied gel once or twice daily and sexually active women used gel once daily. RESULTS CS gel was safe with no reported severe or life-threatening adverse events (AE). Thirty-nine (66%) of the participants experienced urogenital AE judged as probably or possibly related to gel. The majority (51%) of these participants reported only mild events. Fewer women (62%) who used CS experienced urogenital AE than those assigned to placebo gel (70%) (P = 0.59). Eleven (19%) women experienced intermenstrual bleeding judged to be probably or possibly related to gel use (four in the CS and seven in the placebo gel group). There was no increase in AE by frequency of gel use or sexual activity with the exception of abdominal/pelvic pain which was noted more frequently with twice daily use among sexually abstinent women. Women and men found the gel highly acceptable. CONCLUSIONS This Phase I study demonstrated that CS vaginal gel was safe, well tolerated and acceptable by HIV-infected women and their male partners. Thus, further development of CS is warranted as a potential method to prevent HIV transmission and acquisition.
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Affiliation(s)
- Wafaa M El-Sadr
- Harlem Hospital Center, 506 Lenox Avenue, New York, NY 10037, USA.
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47
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George C, Alary M, Otis J, Demers E, Mâsse B, Lavoie R, Remis RS, Turmel B, Vincelette J, Parent R, LeClerc R. Nonnegligible Increasing Temporal Trends in Unprotected Anal Intercourse Among Men Who Have Sexual Relations With Other Men in Montreal. J Acquir Immune Defic Syndr 2006; 41:365-70. [PMID: 16540939 DOI: 10.1097/01.qai.0000209904.97502.2b] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study is to determine temporal trends in unprotected anal intercourse (UAI) among men who have sex with other men (MSM) participating in the Omega Cohort Study, 1997-2003. METHODS The Omega Cohort Study was a longitudinal study of HIV-negative MSM aged 16 years or older and living in Montreal. Participants completed self-administered questionnaires and interviews every 6 months. Trend analysis using the generalized estimating equation was done for length of cohort membership (visits) and by calendar time for all visits, per type of sexual partner. Odds ratios (ORs) were calculated to measure the odds of increasing UAI per 6-month period. RESULTS Among subjects who were followed for at least 4 years, UAI increased with regular seroconcordant partners (OR, 1.06, 95% CI 1.04-1.09), and any type of partner (OR, 1.05, 95% CI 1.03- 1.07). There was a nonnegligible increase in UAI with casual partners (OR, 1.05; 95% CI, 1.01-1.09). For the analysis by calendar time, there were increases in UAI between with regular seroconcordant partners (OR, 1.04; 95% CI, 1.02-1.05) and any type of partner (OR, 1.03; 95% CI, 1.02-1.04). There were nonnegligible increases in UAI with casual partners (OR, 1.03; 95% CI, 1.00-1.05) and with any type of partner except regular seroconcordant partner from 15.7% to 18.8% (OR, 1.02; 95% CI, 1.00-1.04). CONCLUSIONS There was a nonnegligible and consistent increase in UAI among Omega participants, between 1997 and 2003. Continuous trend analysis is important because it allows us to closely follow UAI and to implement intervention strategies that may help to stop or reduce the present trend.
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Affiliation(s)
- Clemon George
- Mental Health Services, St. Michael's Hospital, Toronto, Ontario, Canada
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48
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Mayer KH, Maslankowski LA, Gai F, El-Sadr WM, Justman J, Kwiecien A, Mâsse B, Eshleman SH, Hendrix C, Morrow K, Rooney JF, Soto-Torres L. Safety and tolerability of tenofovir vaginal gel in abstinent and sexually active HIV-infected and uninfected women. AIDS 2006; 20:543-51. [PMID: 16470118 DOI: 10.1097/01.aids.0000210608.70762.c3] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To establish the highest practical dose and frequency (HPDF) of 0.3% or 1% tenofovir vaginal gel applied once or twice daily by sexually abstinent HIV-uninfected women, and to evaluate the safety, tolerability and systemic pharmacokinetics of the HPDF in abstinent and sexually active HIV-negative and HIV-infected women. METHODS Eighty-four women, enrolled in sequential cohorts, used the study product for 14 consecutive intermenstrual days. Safety laboratory assessments and pelvic examinations were carried out during five study visits, with colposcopy at enrollment and on day 14. Samples for pharmacokinetics were collected before and after the initial tenofovir gel use and at day 13. RESULTS The 1% tenofovir gel used twice daily was as well tolerated as other regimens used by the 48 HIV-negative sexually abstinent women, establishing the HPDF. Although 92% of the women reported at least one adverse event, the majority were mild (87%) and involved the genitourinary tract (70%). One possibly product-related severe adverse event involving lower abdominal cramping was reported by a sexually abstinent woman who used 0.3% gel twice daily. Serum tenofovir levels were low but detectable in 14 of the 25 women. No new HIV RNA resistance mutations were detected after 2 weeks of tenofovir gel in the 24 HIV-infected participants. No significant systemic toxicity was detected. CONCLUSION A 2-week course of 1% tenofovir vaginal gel used twice daily was well tolerated in sexually abstinent and sexually active HIV-negative and HIV-positive women. Systemic tenofovir absorption occurred. Expanded safety and effectiveness testing is warranted.
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Affiliation(s)
- Kenneth H Mayer
- Miriam Hospital/Brown University, Providence, Rhode Island 02906, USA.
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Diorio C, Pollak M, Byrne C, Mâsse B, Hébert-Croteau N, Yaffe M, Coté G, Bérubé S, Brisson J. Levels of C-peptide and mammographic breast density. Cancer Epidemiol Biomarkers Prev 2006; 14:2661-4. [PMID: 16284393 DOI: 10.1158/1055-9965.epi-05-0466] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Members of the insulin-like growth factor family have been associated with breast cancer risk and mammographic breast density, one of the strongest known breast cancer risk indicators. The aim of this cross-sectional study was to examine the association of levels of C-peptide (a marker of insulin secretion) with mammographic breast density among 1,499 healthy women recruited during screening mammography examinations. At time of mammography, blood samples and time since last meal were collected. Plasma C-peptide levels were measured by ELISA method, and mammographic breast density by a computer-assisted method. Spearman's partial correlation coefficients, adjusting for age and time since last meal (when necessary), were used to evaluate the associations. High body mass index and waist-to-hip ratio measurements were independently correlated with high levels of C-peptide (r(s) = 0.173 and r(s) = 0.252, respectively; P < 0.0001) or low breast density (r(s) = -0.389 and r(s) = -0.142, respectively; P < 0.0001). High levels of C-peptide were correlated with low breast density (r(s) = -0.210, P < 0.0001). However, the strength of the negative correlation was substantially reduced and was no longer significant after further adjustment for body mass index and waist-to-hip ratio (r(s) = -0.022, P = 0.41). These results suggest that C-peptide levels are not associated with breast density after complete adjustment for adiposity. Thus, the insulin/C-peptide-breast density relation does not seem to mirror the insulin/C-peptide-breast cancer association.
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Affiliation(s)
- Caroline Diorio
- Unité de recherche en santé des populations Centre hospitalier affilié universitaire de Québec, Hôpital Saint-Sacrement, 1050 Chemin Sainte-Foy, Quebec, Canada G1S 4L8
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50
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Diorio C, Bérubé S, Byrne C, Mâsse B, Hébert-Croteau N, Yaffe M, Coté G, Pollak M, Brisson J. Influence of Insulin-like Growth Factors on the Strength of the Relation of Vitamin D and Calcium Intakes to Mammographic Breast Density. Cancer Res 2006; 66:588-97. [PMID: 16397276 DOI: 10.1158/0008-5472.can-05-1959] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diets with higher vitamin D and calcium contents were found associated with lower mammographic breast density and breast cancer risk in premenopausal women. Because laboratory studies suggest that the actions of vitamin D, calcium, insulin-like growth factor (IGF)-I, and IGF-binding protein-3 (IGFBP-3) on human breast cancer cells are interrelated, we examined whether IGF-I and IGFBP-3 levels could affect the strength of the association of vitamin D and calcium intakes with breast density. Among 771 premenopausal women, breast density was measured by a computer-assisted method, vitamin D and calcium intakes by a food frequency questionnaire, and levels of plasma IGF-I and IGFBP-3 by ELISA methods. Multivariate linear regression models were used to examine the associations and the interactions. The negative associations of vitamin D or calcium intakes with breast density were stronger among women with IGF-I levels above the median (beta = -2.8, P = 0.002 and beta = -2.5, P = 0.002, respectively) compared with those with IGF-I levels below or equal to the median (beta = -0.8, P = 0.38 and beta = -1.1, P = 0.21; P(interaction) = 0.09 and 0.16, respectively). Similar results were observed within levels of IGFBP-3 (P(interaction) = 0.06 and 0.03, respectively). This is the first study to report that the negative relation of vitamin D and calcium intakes with breast density may be seen primarily among women with high IGF-I or high IGFBP-3 levels. Our findings suggest that the IGF axis should be taken into account when the effects of vitamin D and calcium on breast density (and perhaps breast cancer risk) are examined at least among premenopausal women.
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Affiliation(s)
- Caroline Diorio
- Unité de recherche en santé des populations, Centre hospitalier affilié universitaire de Québec, Québec, Canada
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