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Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their child(ren). Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation., Objective: This study aimed to evaluate the impact of online reinformation on vaccine hesitancy. Specifically, our goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination., Methods: We conducted a web-based randomized controlled trial (RCT) by recruiting English-speaking Canadians aged 18 years and above from across Canada through the Qualtrics paid opt-in panel system. Participants were randomly assigned to one of four distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general., Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the four news article versions. Chi-square (χ2) analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article (χ21 = 37.79, P<.0001). The effect size was small to moderate, with Cramer's V = 0.27. An interaction was found between vaccine attitude and writing style (χ²₁ = 6.17, P= 0.01), with a small effect size, Cramer's V = 0.11. Additionally, a Pearson correlation revealed a significant moderate-to-strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523) = .48, P<.0001. The coefficient of determination (r²) was 0.23, indicating that 23% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen's d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups., Conclusions: Exposure to an online news article conveying misinformation may not be sufficient to change an individual's level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals' perception of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one's opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness., Clinicaltrial: The study was part of a broader initiative with a registered protocol. The protocol was recorded on October 17, 2022, under the International Registered Report Identifier (IRRID): DERR1-10.2196/41012., International Registered Report: RR2-10.2196/41012.

Purpose: This study investigated sex and age differences in patterns of psychotropic medication use before and after the initial diagnosis of Cluster B personality disorders (PDs) and analyzed trends over time., Methods: Analyzing data from the Quebec Integrated Chronic Disease Surveillance System for individuals newly diagnosed with Cluster B PD (≥ 14 years) between 2002 and 2018 and under the provincial public drug plan, we calculated yearly and monthly proportions of individuals exposed to psychotropic medications during the year before and after their diagnosis by sex and age. Robust Poisson regression models assessed the association between sex and exposure to psychotropic medications after the diagnosis of Cluster B PD., Results: Among 87,778 individuals with a first Cluster B PD diagnosis (mean age: 44.5 years; 57.5% women), the proportion of users increased post-diagnosis. Notably, after diagnosis, females were more likely to receive psychiatric medications (between 78.9% and 83.7% during the study period vs. 72.8% and 76.8%). Males were less likely than females to receive antidepressants (adjusted prevalence ratio (aPR): 0.83; 99% confidence interval (CI): 0.82-0.85) and anxiolytics (aPR: 0.86; 99%CI: 0.84-0.88), whereas they had higher exposure to antipsychotics (aPR: 1.04; 99%CI: 1.02-1.06) and ADHD medications (aPR: 1.14; 99%CI: 1.07-1.2). Age-specific trends showed increased ADHD medication use among younger patients (14-24 years), and anxiolytic use predominated in those aged ≥ 65 years., Conclusions: Psychotropic medication use was high among Cluster B PD patients, with differences in medication classes according to age and sex. The marked sex and age differences in psychotropic medication use among Cluster B PD patients underscore the need for a sex-sensitive and age-specific approach in psychiatric care., (© 2024. The Author(s).)

Background: Little is known about the trends in morbidity and mortality at the population level that followed the introduction of newer once-daily long-acting bronchodilators for COPD. The purpose of the study was to evaluate whether the availability of new bronchodilators was associated with changes in the temporal trends in severe COPD exacerbations and mortality between 2007 and 2018 in the older population with COPD; and whether this association was homogeneous across sex and socioeconomic status classes., Methods: We used an interrupted time-series and three segments multivariate autoregressive models to evaluate the adjusted changes in slopes (i.e., trend effect) in monthly severe exacerbation and mortality rates after 03/2013 and 02/2015 compared to the tiotropium period (04/2007 to 02/2013). Cohorts of individuals > 65 years with COPD were created from the nationally representative database of the Quebec Integrated Chronic Disease Surveillance System in the province of Quebec, Canada. Whether these trends were similar for men and women and across different socioeconomic status classes was also assessed., Results: There were 130,750 hospitalizations for severe exacerbation and 104,460 deaths, including 24,457 (23.4%) respiratory-related deaths, over the study period (928,934 person-years). Significant changes in trends were seen after 03/2013 for all-cause mortality (-1.14%/month;95%CI -1.90% to -0.38%), which further decreased after 02/2015 (-1.78%/month;95%CI -2.70% to -0.38%). Decreases in respiratory-related mortality (-2.45%/month;95%CI -4.38% to -0.47%) and severe exacerbation (-1,90%/month;95%CI -3.04% to -0.75%) rates were only observed after 02/2015. These observations tended to be more pronounced in women than in men and in higher socioeconomic status groups (less deprived) than in lower socioeconomic status groups (more deprived)., Conclusions: The arrival of newer bronchodilators was chronologically associated with reduced trends in severe exacerbation, all-cause and respiratory-related mortality rates among people with COPD > 65 years. Our findings document population benefits on key patient-relevant outcomes in the years following the introduction of newer once-daily long-acting bronchodilators and their combinations, which were likely multifactorial. Public health efforts should focus on closing the gap between lower and higher socioeconomic status groups., (© 2024. The Author(s).)

Ambient air pollution has been associated with asthma onset and exacerbation in children. Whether improvement in air quality due to reduced industrial emissions has resulted in improved health outcomes such as asthma in some localities has usually been assessed indirectly with studies on between-subject comparisons of air pollution from all sources and health outcomes. In this study we directly assessed, within small areas in the province of Quebec (Canada), the influence of changes in local industrial fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and sulfur dioxide (SO 2 ) concentrations, on changes in annual asthma onset rates in children (≤12 years old) with a longitudinal ecological design. We identified the yearly number of new cases of childhood asthma in 1282 small areas (census tracts or local community service centers) for the years 2002, 2004, 2005, 2006, and 2015. Annual average concentrations of industrial air pollutants for each of the geographic areas, and three sectors (i.e., pulp and paper mills, petroleum refineries, and metal smelters) were estimated by the Polair3D chemical transport model. Fixed-effects negative binomial models adjusted for household income were used to assess associations; additional adjustments for environmental tobacco smoke, background pollutant concentrations, vegetation coverage, and sociodemographic characteristics were conducted in sensitivity analyses. The incidence rate ratios (IRR) for childhood asthma onset for the interquartile increase in total industrial PM 2.5 , NO 2 , and SO 2 were 1.016 (95% confidence interval, CI: 1.006-1.026), 1.063 (1.045-1.090), and 1.048 (1.031-1.080), respectively. Positive associations were also found with pollutant concentrations from most individual sectors. Results suggest that changes in industrial pollutant concentrations influence childhood asthma onset rates in small localities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Cluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the real-world utilization of psychotropics for cluster B PD individuals., Objective: We aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs., Methods: We conducted a population-based observational study using Quebec's health services register. We identified Quebec residents aged ≥14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use., Results: We identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6-54.7%), antipsychotics (35.9-45.2%), mood stabilizers (14.8-17.0%), and ADHD medications (5.1-5.9%), and remained relatively stable for anxiolytics (41.4-41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants., Conclusion: Psychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lunghi, Cailhol, Massamba, Laouan Sidi, Sirois, Rahme, Rochette, Renaud, Villeneuve, Koch, Biskin, Martineau, Vincent, David and Lesage.)

Background: Given the importance in prevention of lower extremity amputations (LEAs) associated with diabetes or peripheral artery disease (PAD), we sought to document the trends of primary LEA in Québec, Canada, from years 2006 to 2019., Methods: Using the Québec Integrated Chronic Disease Surveillance System, we calculated crude and age-standardized annual incidence rates of primary LEA associated with diabetes and PAD among adults ≥ 40 years (99% confidence intervals [CI]), and all-cause 1-year mortality proportion trends following a primary LEA (95% CI), stratified by minor or major as the highest level of LEA during the same hospital stay and age groups. Trends were assessed using multivariate regression models., Results: In 2019, the crude rate of primary LEA was 116.0 per 100,000 (n = 825) with 93.7 and 21.9 per 100,000 of minor (n = 665) and major (n = 160) LEA, respectively. A tendency of decrease by 8% (-15.0 to 0.4%) of age-standardized incidence of primary LEA was observed between 2006 and 2019, while the absolute number of primary LEA increased from 610 to 825 cases. Minor LEA increased by 14.2% (3.7 to 25.9%) and major LEA decreased by 49.5% (-57.1 to -40.5%). Incidence trends remained stable among the 40 to 64 years, and declined by 14.6% and 20.1% for the 65 to 79 and ≥ 80 years of age groups, respectively. Major LEA decreased in all age groups, whereas minor LEA increased by 26.2% among the patients 40 to 64 years of age only. Age-standardized 1-year mortality decreased by 35.1% (95% CI, -43.4 to -25.7%) between 2006 and 2019, with a crude 1-year mortality of 11.3% in 2019., Conclusions: The reduction of major LEA and 1-year mortality are encouraging, although increased minor LEA, especially in younger age groups, emphasizes the importance to improve preventive care further., (Copyright © 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Asthma is the most prevalent chronic respiratory disease in children. The role of ultrafine particles (UFPs) in the development of the disease remains unclear. We used a population-based birth cohort to evaluate the association between prenatal and childhood exposure to low levels of ambient UFPs and childhood-onset asthma., Methods: The cohort included all children born and residing in Montreal, Canada, between 2000 and 2015. Children were followed for asthma onset from birth until <13 years of age. Spatially resolved annual mean concentrations of ambient UFPs were estimated from a land use regression model. We assigned prenatal exposure according to the residential postal code at birth. We also considered current exposure during childhood accounting for time-varying residence location. We estimated hazard ratios (HRs) using Cox proportional hazards models adjusted for age, sex, neighborhood material and social deprivation, calendar year, and coexposure to ambient nitrogen dioxide (NO 2 ) and fine particles (PM 2.5 )., Results: The cohort included 352,966 children, with 30,825 children developing asthma during follow-up. Mean prenatal and childhood UFP exposure were 24,706 particles/cm 3 (interquartile range [IQR] = 3,785 particles/cm 3 ) and 24,525 particles/cm 3 (IQR = 3,427 particles/cm 3 ), respectively. Both prenatal and childhood UFP exposure were not associated with childhood asthma onset in single pollutant models (HR per IQR increase of 0.99 [95% CI = 0.98, 1.00]). Estimates of association remained similar when adjusting for coexposure to ambient NO 2 and PM 2.5 ., Conclusion: In this population-based birth cohort, childhood asthma onset was not associated with prenatal or childhood exposure to low concentrations of UFPs., Competing Interests: The authors declare that they have no conflicts of interest with regard to the content of this report., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved.)

Bisphenol A (BPA), a phenolic chemical incorporated into many plastic products, has been found to act as an endocrine disruptor that potentially is linked to adverse neurodevelopmental outcomes. Prenatal BPA concentration levels were assessed in 10 English-speaking Caribbean countries by randomly selecting 15 maternal urine samples from approximately 50 pregnant women samples collected in each island and then comparing the findings with comparable data from Canada and the U.S. BPA was detected in all samples ranging from a low geometric mean of 1.46 μg/L (St. Lucia) to a high of 4.88 μg/L (St. Kitts & Nevis). All of the Caribbean islands sampled had geometric mean concentration levels that were higher than those recorded in two Canadian biomonitoring surveys (1.26 μg/L and 0.80 μg/L) and the U.S. NHANES survey (1.39 μg/L). This first biomonitoring survey of BPA concentration levels in maternal urine samples taken from Caribbean countries clearly points to the need for Caribbean governments and public health officials to first engage in legislative and regulatory efforts to ban or minimize the importation and use of BPA products used the Caribbean and, second, to continue to conduct biomonitoring surveys so as to ensure that these laws and regulations are indeed leading to a decrease of BPA concentrations in Caribbean populations., Competing Interests: The authors declare no conflict of interest.

Objectives: To estimate associations between fine particulate matter (PM 2.5 ) and ozone and the onset of systemic autoimmune rheumatic diseases (SARDs)., Methods: An open cohort of over 6 million adults was constructed from provincial physician billing and hospitalization records between 2000 and 2013. We defined incident SARD cases (SLE, Sjogren's syndrome, scleroderma, polymyositis, dermatomyositis, polyarteritis nodosa and related conditions, polymyalgia rheumatic, other necrotizing vasculopathies, and undifferentiated connective tissue disease) based on at least two relevant billing diagnostic codes (within 2 years, with at least 1 billing from a rheumatologist), or at least one relevant hospitalization diagnostic code. Estimated PM 2.5 and ozone concentrations (derived from remote sensing and/or chemical transport models) were assigned to subjects based on residential postal codes, updated throughout follow-up. Cox proportional hazards models with annual exposure levels were used to calculate hazard ratios (HRs) for SARDs incidence, adjusting for sex, age, urban-versus-rural residence, and socioeconomic status., Results: The adjusted HR for SARDS related to one interquartile range increase in PM 2.5 (3.97 µg/m 3 ) was 1.12 (95% confidence interval 1.08-1.15), but there was no clear association with ozone. Indirectly controlling for smoking did not alter the findings., Conclusions: We found associations between SARDs incidence and PM 2.5 , but no relationships with ozone. Additional studies are needed to better understand interplays between the many constituents of air pollution and rheumatic diseases., (© 2022. The Author(s).)

Background: Available guidance values to interpret individual-level biomonitoring data (ILBD) for the sum of urinary inorganic-related arsenic species (SUIAS) are generally based on population statistical descriptors and not on a predetermined exposure level that should not be exceeded. The objective of this study was thus to propose a range of SUIAS concentrations, reflecting an exposure corresponding to WHO's provisional guideline value (PGV) for arsenic in drinking water (10 μg/L), within which an exposure-based biomonitoring guidance value can be identified. METHOD A comprehensive literature review was carried out in order to identify studies that were relevant to the determination of a guidance value. Drinking water arsenic exposure and urinary biomonitoring concentrations obtained from selected studies were used to conduct a structural equation modeling meta-analysis, from which regression coefficients were obtained to derive an interpretative guidance range. RESULTS Individuals exposed to the arsenic background level comparable to North American and European countries and to a water source contaminated at the WHO's PGV, would have, on average, urinary SUIAS between 9 and 20 μg/L, with the most probable value being 15 μg/L. To address the associated uncertainty, the final guidance value selection within this range may be based on a targeted sensitivity and specificity towards detecting overexposed individuals. Indeed, spans of sensitivity of 60-82%, and of specificity of 58-85%, were estimated for the proposed range based on drinking water exposure raw data from the literature. CONCLUSION The range of guidance values obtained appears suitable for interpreting and communicating ILBD in any population biomonitoring studies in which background exposure is comparable to the North American and European context. Before selecting a single value within the proposed range, it will be important for Public Health officials to assess the possible consequences of this selection on the management and communication of the biomonitoring results., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

The Inuit of Nunavik (Northern Quebec, Canada) are exposed to polychlorinated biphenyls (PCBs) and mercury (Hg) through their consumption of marine country foods. A temporal trend study was initiated in 1992 to monitor circulating levels of PCBs and Hg in pregnant Inuit women, since the fetus is most at risk of adverse health effects. We set out (1) to describe temporal trends of PCBs and Hg levels in pregnant Nunavik women between 1992 and 2017; (2) to determine the prevalence of participants exceeding the guidance values in 2017; (3) to investigate relations between marine country food intake and contaminant levels over the study period. A total of 559 pregnant women provided a blood sample for contaminant analysis from 1992 to 2017. PCB congeners were quantified in plasma (serum) by gas chromatography (GC) coupled to electron capture detection or mass spectrometry (MS). We determined whole blood mercury concentration by cold vapor atomic absorption or inductively-coupled plasma MS. We performed multilevel modeling to assess temporal trends in contaminant levels and relations with marine country food consumption. Concentrations of total PCBs and Hg decreased by 84% and 65% between 1992 and 2017, respectively. Nevertheless, 10% and 22% of women in 2017 exceeded guidance values for PCBs and Hg, respectively. While the decline in marine country food intake is the only factor associated with decreasing Hg levels, other factors may explain the decline in PCB levels. Despite the significant decline in PCBs and Hg levels from 1992 to 2017, exposure to these contaminants is still quite prevalent among pregnant Nunavik women. Most of the decline in Hg exposure is likely due to a shift away from marine country foods to store-bought foods, which is a concern given the cultural and nutritional importance of country foods and the high food insecurity that prevails in Nunavik., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: Anemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but few data are available in Quebec. The present study aimed to characterize anemia and ID prevalence and associated protective and risk factors among First Nations youth in Quebec., Methods: The 2015 First Nations (JES!-YEH!) pilot study was conducted among children and adolescents (3 to 19 years; n = 198) from four First Nations communities in Quebec. Blood and urine samples and anthropometric measurements were collected. Hemoglobin (Hb), serum ferritin (SF), plasma hs-CRP, and urinary cotinine levels were measured. Factors associated with anemia and ID (including traditional and market food consumption) were assessed using an interview-administered food frequency questionnaire, based on which nutritional intakes were calculated. Structural equation models were used to test associations., Results: The prevalence of anemia and ID was elevated (16.8% and 20.5% respectively). Traditional meat, fruit, and fruit juice (natural and powdered)-via their positive association with vitamin C intake-were the only food variables positively associated with SF (coefficient [95% CI] 0.017 [0.000, 0.114]; 0.090 [0.027, 0.161]; and 0.237 [0.060, 0.411]). Male sex was also associated with higher SF (0.295 [0.093, 0.502]). Inflammation status (hs-CRP > 5 mg/L) was inversely associated with Hb (- 0.015 [- 0.025, - 0.005]), whereas SF was positively associated with Hb (0.066 [0.040, 0.096]). Fruit and juice consumption was also positively associated with Hb, via vitamin C intake and SF (0.004 [0.001, 0.010]; 0.008 [0.003, 0.017])., Conclusions: Interventions fostering healthier food environments as well as higher consumption of traditional meats and foods naturally rich in vitamin C, which is known to enhance iron absorption, and fighting inflammation could contribute to decrease the high prevalence of anemia and ID in this young Indigenous population.

Cadmium (Cd), lead (Pb) and mercury (Hg) are known nephrotoxicants that have been associated with the risk of developing type-2 diabetes (T2D). The aim of this pilot study was to explore relations between biomarkers of Cd, Pb and Hg exposure, early urinary biomarkers of renal dysfunction (kidney-injured molecule-1 (KIM-1), N-acetylglucosaminidase and retinol-binding protein (RBP)) and plasma biomarkers deemed predictive of the risk of developing T2D (adiponectin, leptin, branched-chain and aromatic amino acids), among 70 participants (age range: (46-87 yrs)) from the Canadian Longitudinal Study on Aging (CLSA) with normal glycemic control (glycated haemoglobin ≤ 6.5%) in all but four of them. Significant (p < 0.05) Spearman correlation coefficients were obtained between: plasma adiponectin and RBP (r = 0.42), urinary Cd (r = 0.32), blood Cd (r = 0.36); KIM-1 and CdU (r = 0.33) as well as HgU (r = 0.37); RBP and isoleucine (r = -0.28), leucine (r = -0.33), tyrosine (r = -0.3) and valine (r = -0.44); CdU and isoleucine and valine (r = -0.27 for both). Multiple linear regression analyses showed that some T2D-related biomarkers are confounders of associations between RBP and Hg or Cd biomarkers. Path analyses support a mediating effect of adiponectin on the relation between urinary Cd and RBP. Concluding, this pilot study originally investigated a comprehensive set of biomarkers on complex interactions between toxic metal exposure, renal function and T2D in a group of aging Canadians. Its findings warrant further investigation of longitudinal data in a greater number of participants., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Perfluoroalkyl substances (PFASs) are found in several consumer goods. Exposure to PFASs in children has been associated with alteration in thyroid hormones, which have critical roles in brain function., Objective: In 2015, 198 children and youth (3-19 y) were recruited as part of the pilot project Jeunes, Environnement et Santé/Youth, Environment and Health (JES!-YEH!), realized in collaboration with four First Nation communities in Quebec. We aimed to evaluate serum concentrations of PFASs in relation to concentrations of thyroid-stimulating hormone (TSH), free thyroxine (T4) and thyroglobulin while adjusting for relevant confounders., Methods: PFASs (PFOS, PFOA, PFHxS, PFNA), 2,2',4,4'-Tetrabromodiphenyl ether (PBDE-47) thyroid parameters (TSH, free T4, and thyroglobulin) were measured in serum samples of 186 participants. Iodine, creatinine, and cotinine were measured in urine samples. Serum levels of PFASs were compared to those measured in the general Canadian population and elsewhere. Multivariate regression analyses were performed to determine associations between PFASs and TSH, free T4 and thyroglobulin., Results: PFOS, PFOA and PFHxS serum concentrations were low. However, PFNA concentrations among participants aged 12 to 19 years old from Anishinabe communities were three times higher than those measured in the Canadian Health Measures Survey (2009-2011) for the same age group (Geometric Means: 3.01 μg/L and 0.71 μg/L, respectively) and were particularly higher in the Anishinabe participants aged 6 to 11 years old (GM: 9.44 μg/L). Few participants had levels of TSH, free T4, and thyroglobulin outside age-specific paediatric ranges. When adjusted for relevant covariates and other contaminants, PFNA serum concentrations were positively associated with free T4 levels (Adjusted β = 0.36; p = 0.0014), but not with TSH and thyroglobulin levels. No association was observed between the other PFAS and thyroid hormones parameters., Conclusion: This pilot project reveals among the highest exposure to PFNA in children reported until today, and suggests effects of PFNA as an endocrine disruptor, highlighting the importance of investigating the sources and effects of disproportionate exposure to emerging contaminants in some indigenous communities and ban all PFAS at the international scale., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.toxlet.2019.05.020. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal., (Copyright © 2019 Elsevier Ireland Ltd. All rights reserved.)

Objective: We examined the relationships between socio-economic characteristics and mercury (Hg) and polychlorinated biphenyl (PCB) concentrations among pregnant Inuit women from Nunavik., Method: We used biomonitoring data from 208 pregnant Inuit women recruited in the 14 villages of Nunavik between September 2011 and December 2013. Blood samples were collected to monitor levels of blood Hg and serum congener PCB-153 (surrogate of total PCB concentration). Ratio of omega 3/omega 6 polyunsaturated fatty acids, a validated biomarker of marine country food consumption, was also measured in red blood cell membranes to determine maternal dietary profile. Data on socio-economic characteristics (income and education), health-related lifestyles, and reproductive history were collected through questionnaires. Association between socio-economic characteristics and contaminant concentrations was assessed using linear regressions., Results: We observed a significant inverse relationship between education and Hg levels. Lower concentrations of Hg were observed among women who had completed high school compared to women who had not completed high school. However, no association was observed between level of education and concentration of PCBs., Conclusion: Socio-economic disparities in maternal exposure to Hg exist in Nunavik. Further research is needed to determine whether environmental health inequalities also exist in other subgroups of the Nunavik population and in other Indigenous communities in Canada.

Objective: To assess associations between three diet quality indices and metabolic syndrome (MetS) in the Cree (Eeyouch) of northern Québec, Canada, as well as to evaluate their pertinence in this Indigenous context., Design: The alternative-Healthy Eating Index 2010 (aHEI-2010), the Food Quality Score (FQS) and the contribution of ultra-processed products (UPP) to total daily dietary energy intake using the NOVA classification were calculated from 24 h food recalls. MetS was determined with the latest harmonized definition. Logistic regressions assessed the relationship between quintiles of dietary quality scores with MetS and its components., Setting: Study sample from the 2005-2009 cross-sectional Nituuchischaayihititaau Aschii Environment-and-Health Study., Subjects: Eeyouch (n 811) from seven James Bay communities (≥18 years old)., Results: MetS prevalence was 56·6 % with 95·4 % abdominal adiposity, 50·1 % elevated fasting plasma glucose, 43·4 % hypertension, 38·6 % elevated TAG and 44·5 % reduced HDL cholesterol. Comparing highest and lowest quintiles of scores, adjusted OR (95 % CI) of MetS was 0·70 (0·39, 1·08; P-trend=0·05) for aHEI-2010, 1·06 (0·63, 1·76; P-trend=0·87) for FQS and 1·90 (1·14, 3·17; P-trend=0·04) for the contribution of UPP to total daily dietary energy intake., Conclusions: Although diet quality indices have been associated with cardiometabolic risk, only the dietary intake of UPP was significantly associated with MetS in the Eeyouch. Indices tailored to the food environment of northern communities are essential to further understand the impact of diet quality in this context.

Background and Aims: Inuit populations have lower levels of cardiometabolic risk factors for the same level of body mass index (BMI) or waist circumference (WC) compared to Europeans in cross-sectional studies. We aimed to compare the longitudinal associations of anthropometric measures with cardiovascular disease (CVD) and all-cause mortality in Inuit and Europeans., Methods: Using pooled data from three population-based studies in Canada, Greenland and Denmark, we conducted a cohort study of 10,033 adult participants (765 Nunavik Inuit, 2960 Greenlandic Inuit and 6308 Europeans). Anthropometric measures collected at baseline included: BMI, WC, waist-to-hip-ratio (WHR), waist-to-height-ratio (WHtR) and a body shape index (ABSI). Information on CVD and death was retrieved from national registers or medical files. Poisson regression analyses were used to calculate incidence rates for CVD and all-cause mortality., Results: During a median follow-up of 10.5 years, there were 642 CVD events and 594 deaths. Slightly higher absolute incidence rates of CVD for a given anthropometric measure were found in Nunavik Inuit compared with Greenlandic Inuit and the Europeans; however, no cohort interactions were observed. For all-cause mortality, all anthropometric measures were positively associated in the Europeans, but only ABSI in the two Inuit populations. In contrast, BMI and WC were inversely associated with mortality in the two Inuit populations., Conclusions: Inuit and Europeans have different absolute incidences of CVD and all-cause mortality, but the trends in the associations with the anthropometric measures only differ for all-cause mortality. Previous findings of a lower obesity-associated cardiometabolic risk among Inuit were not confirmed., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) from fish are known modulators of cardiometabolic risk factors., Objective: To examine fatty acids (FAs) status and the relationship between n-3 LC-PUFA and cardiometabolic risk factors in Cree participants., Design: We analyzed data from a cross-sectional study (n=829) conducted in Cree adults (aged 18-74 years) from 7 communities of the James Bay territory of Quebec (Canada) in 2005-2009. Sociodemographic, lifestyle, clinical and anthropometric data were collected. FAs were quantified in red blood cells (RBCs) under fasting conditions., Results: A total of 89% of the participants were overweight (with 69% obesity), 33% had hypertriglyceridemia, 44% had low plasma HDL-c and 77% had fasting plasma insulin ≥90 pmol/l. Total n-3 PUFAs accounted for 6% of total FAs and were higher among older participants, while n-6 PUFAs accounted for 31% of total FAs and were higher among younger participants. According to the adjusted multiple linear regression models, n-3 LC-PUFA was associated (p<0.05) with higher total cholesterol, LDL-c and apo B-100, and was also associated (p<0.05) with lower blood glucose., Conclusion: Overall, this study showed that n-3 LC-PUFA levels measured in the RBCs of the Cree adults are relatively low and tend towards lower levels among youth. These levels might be insufficient to offset the prevalence of cardiometabolic risk factors.

Pesticides are commonly used in tropical regions such as the Caribbean for both household and agricultural purposes. Of particular concern is exposure during pregnancy, as these compounds can cross the placental barrier and interfere with fetal development. The objective of this study was to evaluate exposure of pregnant women residing in 10 Caribbean countries to the following commonly used classes of pesticides in the Caribbean: organophosphates (OPs), carbamates, phenoxy acids, and chlorophenols. Out of 438 urine samples collected, 15 samples were randomly selected from each Caribbean country giving a total of 150 samples. Samples were analyzed for the following metabolites: six OP dialkylphosphate metabolites [dimethylphosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphate (DMDTP), diethylphosphate (DEP), diethylthiophosphate (DETP) and diethyldithiophosphate (DEDTP)]; two carbamate metabolites [2-isopropoxyphenol (2-IPP) and carbofuranphenol]; one phenoxy acid 2,4-dichlorophenoxyacetic acid (2,4-D); and five chlorophenols [2,4-dichlorophenol (DCP), 2,5-dichlorophenol (2,5-DCP), 2,4,5-trichlorophenol (TCP), 2,4,6-trichlorophenol (2,4,6-TCP), and pentachlorophenol (PCP)]. OP metabolites were consistently detected in ≥60% of the samples from Antigua and Barbuda, Bermuda, and Jamaica. Of the carbamate metabolites, 2-IPP was detected in seven of the 10 Caribbean countries with a detection frequency around 30%, whereas carbofuranphenol was detected in only one sample. The detection frequency for the phenoxy acid 2,4-D ranged from 20% in Grenada to a maximum of 67% in Belize. Evidence of exposure to chlorophenol pesticides was also established with 2,4-DCP by geometric means ranging from 0.52 μg L(-1) in St Lucia to a maximum of 1.68 μg L(-1) in Bermuda. Several extreme concentrations of 2,5-DCP were detected in four Caribbean countries-Belize (1100 μg L(-1)), Bermuda (870 μg L(-1)), Jamaica (1300 μg L(-1)), and St Kitts and Nevis (1400 μg L(-1)). 2,4,5-TCP, 2,4,6-TCP, and pentachlorophenol were rarely detected. This biomonitoring study underscores the need for Caribbean public health authorities to encourage their populations, and in particular pregnant women, to become more aware of the potential routes of exposure to pesticides and to utilize these chemicals more cautiously given the possible adverse effects such exposures can have on their unborn children and infants.

Objective: To ascertain the relationship between cannabis use, obesity, and insulin resistance., Methods: Data on 786 Inuit adults from the Nunavik Inuit Health Survey (2004) were analyzed. Information on cannabis use was obtained from a self-completed, confidential questionnaire. Fasting blood glucose and insulin and homeostasis model assessment of insulin resistance (HOMA-IR) served as surrogate markers of insulin resistance. Analysis of covariance and multivariate logistic regression ascertained relationships between cannabis use and outcomes., Results: Cannabis use was highly prevalent in the study population (57.4%) and was statistically associated with lower body mass index (BMI) (P < 0.001), lower % fat mass (P < 0.001), lower fasting insulin (P = 0.04), and lower HOMA-IR (P = 0.01), after adjusting for numerous confounding variables. Further adjustment for BMI rendered fasting insulin and HOMA-IR differences statistically nonsignificant between past-year cannabis users and nonusers. Mediation analysis showed that the effect of cannabis use on insulin resistance was indirect, through BMI. In multivariate analysis, past-year cannabis use was associated with 0.56 lower likelihood of obesity (95% confidence interval 0.37-0.84)., Conclusions: Cannabis use was associated with lower BMI, and such an association did not occur through the glucose metabolic process or related inflammatory markers. The association between cannabis use and insulin resistance was mediated through its influence on weight., (© 2014 The Obesity Society.)

Maternal mercury (Hg) and lead (Pb) blood concentrations were measured in a total of 442 samples taken from pregnant and delivering women in 10 Caribbean countries. Hg was detected in all 10 countries with the geometric mean ranging from a low of 0.83 μg L(-1) (Jamaica) to a high of 3.13 μg L(-1) (Grenada). When compared to comparable U.S. and Canadian data, Hg concentrations in Caribbean women are on average more than 2 times higher. With the exception of St. Kitts & Nevis, Pb was detected in at least one of the samples taken from the other 9 countries with two countries-Grenada and St. Vincent - having Pb detected in ≥60% of those sampled. In these two countries, the Pb concentrations ranged from a low of 1.17 μg dL(-1) (Grenada) to a high of 1.98 μg dL(-1) (St. Vincent). Compared to comparable U.S. and Canadian data, Pb concentrations in Caribbean women are generally higher than that measured in North America. This study confirms that neonates in the Caribbean are being exposed to both Hg and Pb and highlights the need to implement surveillance programs that continuously monitor, intervene, and evaluate the levels of these toxic elements to ensure that they are reduced as far as possible.

Background: Estimation of relative contribution of Body Mass Index (BMI) and waist circumference (WC) on health outcomes requires a regression model that includes both obesity metrics. But, multicollinearity could yield biased estimates., Methods: To address the multicollinearity issue between BMI and WC, we used the residual model approach. The standard WC (Y-axis) was regressed on the BMI (X-axis) to obtain residual WC. Data from two adult population surveys (Nunavik Inuit and James Bay Cree) were analysed to evaluate relative effect of BMI and WC on four cardiometabolic risk factors: insulin, triglycerides, systolic blood pressure and high-density lipoprotein levels., Results: In multivariate models, standard WC and BMI were significantly associated with cardiometabolic outcomes. Residual WC was not linked with any outcomes. The BMI effect was weakened by including standard WC in the model, but its effect remained unchanged if residual WC was considered., Conclusions: The strong correlation between standard WC and BMI does not allow assessment of their relative contributions to health in the same model without a risk of making erroneous estimations. By contrast with BMI, fat distribution (residual WC) does not add valuable information to a model that already contains overall adiposity (BMI) in Inuit and Cree., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Prenatal exposures to legacy persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs) and dioxin-like compounds (DLC), as well as polybrominated diphenyl ethers (PBDE), were analyzed in pregnant women from 10 Caribbean countries. A total of 438 samples were collected and descriptive statistics calculated and compared to comparable Canadian Health Measure Survey (CHMS) and U.S. National Health and Nutritional Examination Survey (NHANES) datasets. Maternal POPs blood concentrations were found to be generally relatively low in the Caribbean samples compared with the U.S. and Canada datasets. Evidence of exposure to DLC and PBDE was established. DLC levels ranged from a geometric mean low of 3.96 pg/g lipids in Antigua and Barbuda to a high of 11.4 pg/g lipids in St. Lucia. Several of the PBDEs (15, 17, 25, 28, 33, 100) were detected in less than 60% of the country' samples. For PBDE-47, significantly higher levels were found in Bermuda, while Jamaica recorded a significantly low level. The overall calculated concentration of PBDE-47 for the Caribbean (5.33 μg/kg lipids) was significantly lower than the concentrations measured for the U.S. (10.83 μg/kg lipids) and Canada (23.90 μg/kg lipids). This study confirms that prenatal expose to multiple environmental chemicals is taking place in the Caribbean and highlights the need to implement surveillance programs that continuously monitor, intervene, and evaluate the levels of these toxic environmental contaminants to ensure that they are reduced as much as possible and that the health risk to humans, in particular the unborn child, are minimized., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Household crowding is an important problem in some aboriginal communities that is reaching particularly high levels among the circumpolar Inuit. Living in overcrowded conditions may endanger health via stress pathophysiology. This study examines whether higher household crowding is associated with stress-related physiological dysregulations among the Inuit., Methods: Cross-sectional data on 822 Inuit adults were taken from the 2004 Qanuippitaa? How are we? Nunavik Inuit Health Survey. Chronic stress was measured using the concept of allostatic load (AL) representing the multisystemic biological 'wear and tear' of chronic stress. A summary index of AL was constructed using 14 physiological indicators compiled into a traditional count-based index and a binary variable that contrasted people at risk on at least seven physiological indicators. Household crowding was measured using indicators of household size (total number of people and number of children per house) and overcrowding defined as more than one person per room. Data were analysed using weighted Generalised Estimating Equations controlling for participants' age, sex, income, diet and involvement in traditional activities., Results: Higher household crowding was significantly associated with elevated AL levels and with greater odds of being at risk on at least seven physiological indicators, especially among women and independently of individuals' characteristics., Conclusions: This study demonstrates that household crowding is a source of chronic stress among the Inuit of Nunavik. Differential housing conditions are shown to be a marker of health inequalities among this population. Housing conditions are a critical public health issue in many aboriginal communities that must be investigated further to inform healthy and sustainable housing strategies.

Pyrethroid pesticides are commonly used in tropical regions such as the Caribbean as household insecticides, pet sprays, and where malaria is endemic, impregnated into mosquito-repellent nets. Of particular concern is exposure during pregnancy, as these compounds have the potential to cross the placental barrier and interfere with fetal development, as was shown in limited animal studies. The objective of this study was to evaluate exposure to pyrethroids to pregnant women residing in 10 English-speaking Caribbean countries. Pyrethroid exposures were determined by analyzing five pyrethroid metabolites in urine samples from 295 pregnant women: cis-DBCA, cis-DCCA, trans-DCCA, 3-PBA, and 4-F-3-PBA. Pyrethroid metabolite concentrations in Caribbean pregnant women were generally higher in the 10 Caribbean countries than levels reported for Canadian and U.S. women. In Antigua & Barbuda and Jamaica participants the geometric mean concentrations of cis-DBCA was significantly higher than in the other nine countries together (p<0.0001 and <0.0012 respectively). For cis- and trans-DCCA, only Antigua & Barbuda women differed significantly from participants of the other nine Caribbean countries (p<0.0001). Urinary 4-F-3-PBA and 3-PBA levels were significantly higher in Antigua & Barbuda (p<0.0028 and p<0.0001 respectively) as well as in Grenada (p<0.0001 and p<0.007 respectively). These results indicate extensive use of pyrethroid compounds such as permethrin and cypermethrin in Caribbean households. In Antigua & Barbuda, the data reveals a greater use of deltamethrin. This study underscores the need for Caribbean public health authorities to encourage their populations, and in particular pregnant women, to utilize this class of pesticides more judiciously given the potentially adverse effects of exposure on fetuses and infants., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To evaluate subclinical atherosclerosis in Nunavik Inuit and its correlation to traditional cardiovascular disease risk factor., Method: The intima-media thickness (IMT) of 12 segments of the carotid arteries (IMT(12&#95;seg)) free of plaque were assessed in randomly selected 40 years old and older Inuit from. Clinical assessment was performed which included fasting plasma glucose, fasting insulin, systemic blood pressure, body mass index, smoking, circulating blood lipids and oral glucose tolerance test. In addition, documented presence of ischemic heart disease (IHD), stroke, diabetes mellitus, hypertension and dyslipidemia were determined from medical files., Results: The average age of the 287 participants was 51.2 ± 0.6 years (56.8% women). Mean IMT(12&#95;seg) was 0.80 ± 0.17 mm (range: 0.55-1.47 mm). Compared with disease free Inuit, individuals with history of stroke showed greater carotid internal IMT (0.68 ± 0.01 mm vs. 0.96 ± 0.15 mm respectively; p<0.005) but no difference was observed for IHD. Hypertensive and dyslipidemic Inuit had higher IMT(12&#95;seg) compared to risk factor free individuals but no difference was observed in diabetics. None of the clinical assessments were associated with IMT(12&#95;seg). In a multivariate backward elimination model, only age, gender, and medically documented history of hypertension were found to be predictors of IMT(12&#95;seg) (adjusted r-square of 0.54; p<0.0001)., Conclusion: Compared with disease free Nunavik Inuit, subclinical signs of atherosclerosis determined by IMT was higher in individual diagnosed with stroke. Independent predictors of IMT(12&#95;seg) in our group were age, gender and history of hypertension. No other traditional risk factors imparted IMT., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Inuit and Cree populations are known for high obesity rates despite markedly different rates of type 2 diabetes (T2DM). To document this apparent discrepancy we evaluated the impact of body size parameters and fasting insulin (FI) on several T2DM risk factors among Inuit and Cree populations (Québec, Canada). A total of 1,104 adults (≥18 years) Inuit and Cree individuals participated in a cross-sectional investigation. Interestingly, across both genders, across all levels of waist circumference (WC), Inuit showed lower levels of FI (age-adjusted, P < 0.0001) and fasting glucose (P < 0.0001) than Cree individuals. In both groups, a comparison of multi-sample structural equation models confirmed the predominant influence of WC on other traditional risk factors, compared to BMI. A preponderant direct impact of WC was observed on blood pressure (BP) parameters (P < 0.0001), high-density lipoprotein cholesterol (HDL-C) (P < 0.0001), and FI (P < 0.0001). Fasting glucose level appear to be influenced by WC via FI in both ethnic groups (P < 0.0001), while triacylglycerol (TAG) level was predominantly impacted by WC via FI, but only in Cree individuals (P < 0.0001). The main ethnic difference found was the strength of the impact of WC on FI, which was considerably higher among the Cree (λ = 2.4, P < 0.0001) than the Inuit (λ = 1.8, P < 0.0001). These results confirm the predominant role of abdominal adiposity in the complex and tenuous links of different traditional T2DM determinants. However, the ethnic difference in the impact of abdominal obesity on insulin levels across all WCs needs to be explored further.

Objectives: The aim of this study was to provide analytical overviews of anthropometric measurements and their relationships with type 2 diabetes and cardiovascular disease (CVD) risk factors within the Inuit population, given that few studies have focused on this issue. Study design. Cross-sectional study., Methods: Anthropometric and biological data were obtained from 867 Inuit participants from Nunavik (≥18 years)., Results: Obesity prevalence for men and women, respectively, was 25.1% and 31.3% according to body mass index (BMI: >30 kg/m2); 20.2% and 55.3% according to waist circumference (WC: >102 cm for men and >88 cm for women); 22.4% and 22.5% according to body fat percentage (%BF: ≥30 in men and ≥40 in women). There was substantial agreement between anthropometric obesity measurements, except for the waist-to-hip ratio (WHR) which showed the lowest agreement with the other measurements. All risk factors were significantly associated with anthropometry. The prevalence of abnormal values for risk factors increased across quartiles of BMI and WC. Among obese participants, as defined by the WC cutoff, 22% had metabolic syndrome based on the National Cholesterol Education Program in the Adult Treatment Panel III (NCEP-ATPIII) definition and 64.8% of them were also insulin resistant., Conclusion: Obesity rates among Inuit are high, especially among women. Inuit women display especially high rates of abdominal obesity. Further longitudinal work is needed to evaluate the effects of central and global obesity among Inuit.

Objective: We evaluated the prevalence of type 2 diabetes, obesity and metabolic syndrome according to International Diabetes Federation criteria in the First Nations Cree community of Mistissini, Quebec., Methods: A cross-sectional study of 172 adults was performed as part of a broader regional environmental study., Results: Type 2 diabetes, hyperinsulinemia and abdominal obesity were documented in 20%, 70% and 91% of participants, respectively. The prevalence of metabolic syndrome was 54%, with the main profile including abnormal plasma glucose levels (60%) associated with high triacylglycerol (40%). Women displayed the highest prevalence of abdominal obesity (99%). In both sexes, waist circumference was clearly associated with other metabolic parameters, such as blood glucose and lipid profile (p<0.0001). However, a significant proportion of the population (13%), especially women, showed high waist circumference with no metabolic disturbances., Conclusion: Among the Cree population of Mistissini, the results suggest that the high prevalence of abdominal obesity occurs most frequently in women, and earlier in women than in men. Subsequent metabolic disturbances associated with metabolic syndrome develop with age, supporting the core role of abdominal obesity in the cascade of events leading to diabetes and cardiovascular disease., (Copyright © 2009 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)