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Context: The prognostic importance of local failure after definitive radiotherapy (RT) in National Comprehensive Cancer Network intermediate- and high-risk prostate cancer (PCa) patients remains unclear. Objective: To evaluate the prognostic impact of local failure and the kinetics of distant metastasis following RT. Evidence acquisition: A pooled analysis was performed on individual patient data of 12 533 PCa (6288 high-risk and 6245 intermediate-risk) patients enrolled in 18 randomized trials (conducted between 1985 and 2015) within the Meta-analysis of Randomized Trials in Cancer of the Prostate Consortium. Multivariable Cox proportional hazard (PH) models were developed to evaluate the relationship between overall survival (OS), PCa-specific survival (PCSS), distant metastasis-free survival (DMFS), and local failure as a time-dependent covariate. Markov PH models were developed to evaluate the impact of specific transition states. Evidence synthesis: The median follow-up was 11 yr. There were 795 (13%) local failure events and 1288 (21%) distant metastases for high-risk patients and 449 (7.2%) and 451 (7.2%) for intermediate-risk patients, respectively. For both groups, 81% of distant metastases developed from a clinically relapse-free state (cRF state). Local failure was significantly associated with OS (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.06–1.30), PCSS (HR 2.02, 95% CI 1.75–2.33), and DMFS (HR 1.94, 95% CI 1.75–2.15, p < 0.01 for all) in high-risk patients. Local failure was also significantly associated with DMFS (HR 1.57, 95% CI 1.36–1.81) but not with OS in intermediate-risk patients. Patients without local failure had a significantly lower HR of transitioning to a PCa-specific death state than those who had local failure (HR 0.32, 95% CI 0.21–0.50, p < 0.001). At later time points, more distant metastases emerged after a local failure event for both groups. Conclusions: Local failure is an independent prognosticator of OS, PCSS, and DMFS in high-risk and of DMFS in intermediate-risk PCa. Distant metastasis predominantly developed from the cRF state, underscoring the importance of addressing occult microscopic disease. However a “second wave” of distant metastases occurs subsequent to local failure events, and optimization of local control may reduce the risk of distant metastasis. Patient summary: Among men receiving definitive radiation therapy for high- and intermediate-risk prostate cancer, about 10% experience local recurrence, and they are at significantly increased risks of further disease progression. About 80% of patients who develop distant metastasis do not have a detectable local recurrence preceding it.

Background: The relative benefits of radiotherapy (RT) dose escalation and the addition of short-term or long-term androgen deprivation therapy (STADT or LTADT) in the treatment of prostate cancer are unknown. Objective: To perform a network meta-analysis (NMA) of relevant randomized trials to compare the relative benefits of RT dose escalation ± STADT or LTADT. Design, setting, and participants: An NMA of individual patient data from 13 multicenter randomized trials was carried out for a total of 11 862 patients. Patients received one of the six permutations of low-dose RT (64 to

Background: Randomised trials have investigated various androgen deprivation therapy (ADT) intensification strategies in men receiving radiotherapy for the treatment of prostate cancer. This individual patient data meta-analysis of relevant randomised trials aimed to quantify the benefit of these interventions in aggregate and in clinically relevant subgroups. Methods: For this meta-analysis, we performed a systematic literature search in MEDLINE, Embase, trial registries, the Web of Science, Scopus, and conference proceedings to identify trials with results published in English between Jan 1, 1962, and Dec 30, 2020. Multicentre randomised trials were eligible if they evaluated the use or prolongation of ADT (or both) in men with localised prostate cancer receiving definitive radiotherapy, reported or collected distant metastasis and survival data, and used ADT for a protocol-defined finite duration. The Meta-Analysis of Randomized trials in Cancer of the Prostate (MARCAP) Consortium was accessed to obtain individual patient data from randomised trials. The primary outcome was metastasis-free survival. Hazard ratios (HRs) were obtained through stratified Cox models for ADT use (radiotherapy alone vs radiotherapy plus ADT), neoadjuvant ADT extension (ie, extension of total ADT duration in the neoadjuvant setting from 3–4 months to 6–9 months), and adjuvant ADT prolongation (ie, prolongation of total ADT duration in the adjuvant setting from 4–6 months to 18–36 months). Formal interaction tests between interventions and metastasis-free survival were done for prespecified subgroups defined by age, National Comprehensive Cancer Network (NCCN) risk group, and radiotherapy dose. This meta-analysis is registered with PROSPERO, CRD42021236855. Findings: Our search returned 12 eligible trials that provided individual patient data (10 853 patients) with a median follow-up of 11·4 years (IQR 9·0–15·0). The addition of ADT to radiotherapy significantly improved metastasis-free survival (HR 0·83 [95% CI 0·77–0·89], p

Càncer de pròstata; Teràpia de privació d'andrògens Cáncer de próstata; Terapia de privación de andrógenos Prostate cancer; Androgen-deprivation therapy PURPOSE The sequencing of androgen-deprivation therapy (ADT) with radiotherapy (RT) may affect outcomes for prostate cancer in an RT-field size-dependent manner. Herein, we investigate the impact of ADT sequencing for men receiving ADT with prostate-only RT (PORT) or whole-pelvis RT (WPRT). MATERIALS AND METHODS Individual patient data from 12 randomized trials that included patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (4-6 months) with RT for localized disease were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium. Inverse probability of treatment weighting (IPTW) was performed with propensity scores derived from age, initial prostate-specific antigen, Gleason score, T stage, RT dose, and mid-trial enrollment year. Metastasis-free survival (primary end point) and overall survival (OS) were assessed by IPTW-adjusted Cox regression models, analyzed independently for men receiving PORT versus WPRT. IPTW-adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer–specific mortality. RESULTS Overall, 7,409 patients were included (6,325 neoadjuvant/concurrent and 1,084 concurrent/adjuvant) with a median follow-up of 10.2 years (interquartile range, 7.2-14.9 years). A significant interaction between ADT sequencing and RT field size was observed for all end points (P interaction < .02 for all) except OS. With PORT (n = 4,355), compared with neoadjuvant/concurrent ADT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, hazard ratio [HR], 0.65; 95% CI, 0.54 to 0.79; P < .0001), DM (subdistribution HR, 0.52; 95% CI, 0.33 to 0.82; P = .0046), prostate cancer–specific mortality (subdistribution HR, 0.30; 95% CI, 0.16 to 0.54; P < .0001), and OS (HR, 0.69; 95% CI, 0.57 to 0.83; P = .0001). However, in patients receiving WPRT (n = 3,049), no significant difference in any end point was observed in regard to ADT sequencing except for worse DM (HR, 1.57; 95% CI, 1.20 to 2.05; P = .0009) with concurrent/adjuvant ADT. CONCLUSION ADT sequencing exhibits a significant impact on clinical outcomes with a significant interaction with field size. Concurrent/adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with PORT. Funding support for this study comes from the Prostate Cancer Foundation and ASTRO to AUK. AUK also thanks generous donations from the DeSilva, McCarrick, and Bershad families. A.T. acknowledges support from Cancer Research UK (C33589/A28284 and C7224/A28724) the National Institute for Health Research (NIHR) Cancer Research Network. This project represents independent research supported by the National Institute for Health research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. N.G.Z. is supported by the American Cancer Society – Tri State CEOs Against Cancer Clinician Scientist Development Grant, CSDG‐20‐013‐01‐CCE (2020).

The role of androgen deprivation therapy (ADT) in combination with radiotherapy (RT) in intermediate-risk prostate cancer (IRPC) remains controversial, particularly in patients receiving dose-escalated RT (DERT). We compared outcomes between patients with IRPC treated with ADT and two different doses of RT vs. RT alone.From December 2000 to September 2010, 600 patients with IRPC were randomised to a three-arm trial consisting of 6 months of ADT plus RT 70 Gy (ADT + RT70) vs. ADT plus a DERT of 76 Gy (ADT + DERT76) vs. DERT of 76 Gy alone (DERT76). Primary end-point was biochemical failure (BF), and secondary end-points were overall survival (OS) and toxicity. RT toxicity was assessed by Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria.With a median follow-up of 11.3 years (interquartile range: 10.9-11.7), patients receiving DERT76 alone, compared with patients receiving ADT + RT70 and ADT + DERT76, had higher rates of BF (32%, 18% and 14%, respectively, p 0.001), higher rates of prostate cancer progression (12%, 4.5% and 3.3%, respectively, p = 0.001) and more deaths due to prostate cancer (6.5%, 3.0% and 1.5%, respectively, p = 0.03) with no significant difference seen between ADT + RT70 and ADT + DERT76. There was no significant difference in OS between the 3 arms. A higher dose of RT (76 Gy) increased late gastrointestinal (GI) toxicity grade ≥ II compared with lower dose (70 Gy) (16% vs 5.3%, p 0.001) with no statistical difference for late genitourinary toxicity.In IRPC, the addition of 6 months of ADT to RT70 or DERT76 significantly improves BF and appears to decrease the risk of death from prostate cancer compared with DERT76 alone with no difference in OS. In the setting of IRPC, ADT plus RT 70 Gy yields effective disease control with a better GI toxicity profile. Clinicaltrials.gov#NCT00223145.

The Short-Form 6-Dimension version 2 (SF-6Dv2) is the newest version of the Short-Form 6-Dimension (SF-6D) that is widely used to calculate quality-adjusted life-years (QALYs). The aim of this study was to produce Quebec population norms from the SF-6Dv2.An online survey was conducted in the adult general population. Data was stratified by various sociodemographic characteristics, such as age, sex, body mass index, history of illness, and health problems.A total of 4175 respondents completed the SF-6Dv2. Mean (95% confidence interval) and median (interquartile range) utility scores were 0.692 (0.684-0.700) and 0.780 (0.607-0.866), respectively. Floor and ceiling effect corresponded to 0.05% and 3.1%, respectively. Men, nonsmoker, higher education, and employed people had significantly higher scores, while lower scores were found for those with a history of illness and a lower life satisfaction. Those reporting a health problem presented significant lower mean utility scores ranging from 0.340 (nervous problem) to 0.623 (diabetes) for men and from 0.207 (genitourinary) to 0.578 (diabetes) for women as compared with those without health problem (0.793 for men and 0.750 for women).This study is the first to provide utility score norms for SF-6Dv2 in the adult general population of Quebec. It also highlighted significant differences among various health problems that can be used to compare populations in studies that do not have a control group.

Background Cost utility analysis is important for measuring the impact of chronic disease and helps clinicians and policymakers in patient management and policy decisions, but generic preference-based measures are not always considered in clinical studies. Objective To evaluate if health-related quality-of-life (HRQoL)-specific questionnaires used in chronic low back pain (CLBP) can predict EQ-5D-5L utility scores. Methods The data come from an online survey on low back pain conducted between October 2018 and January 2019. Health utility scores for EuroQol Five Dimensions Five Levels (EQ-5D-5L) were calculated with the recommended model of Xie et al. The EQ-5D-5L health states ranged from −0.148 for the worst (55555) to 0.949 for the best (11111). Univariate and multivariate linear regression were performed to predict EQ-5D-5L with Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ) and clinical variables. Results Analyses were performed in 408 subjects who completed the questionnaires EQ-5D-5L, ODI or RMDQ. Median (range) of EQ-5D-5L was 0.622 (−0.072 to 0.905). There was high correlation between EQ-5D-5L and ODI (r=−0.78, p

Population norms for the EQ-5D-5L were published in Canada but only for Alberta province. The purpose of this study was to derive Quebec population norms from the EQ-5D-5L.The data came from a larger study conducted between September 2016 and March 2018 using elicitation techniques for a quality-adjusted life-year project. The online survey was distributed randomly in the province of Quebec. To best describe the entire population, data were stratified by various sociodemographic characteristics such as age, gender, urban and rural populations, whether disadvantaged or not, immigrant or nonimmigrant, and health problems.A total of 2704 (53.8%) respondents completed the EQ-5D-5L. Mean (95% confidence interval) and median (interquartile range) utility scores were 0.824 (0.818-0.829) and 0.867 (0.802-0.911), respectively. The EQ-VAS scores were estimated at 75.9 (75.2-76.6) and 80 (69-90). Subjects with lower scores were those who had a low or high body mass index; were smokers; were single, divorced, or widowed; had no children; were unemployed or sick; had lower education or lower annual income; and had a family or personal history of serious illness. Immigrants had higher scores. There was no difference in gender and urban or rural population. The score logically decreased with worsening health status, from a mean score of 0.896 (0.884-0.908) to 0.443 (0.384-0.501; P.0001. Similar results were observed for subjects' satisfaction with their health or life. Subjects with lower scores were less willing to take risks. Subjects who declared they were affected by health problems presented significant lower utility scores, ranging from 0.554 (nervous problem) to 0.750 (cancer), compared with those without health problems (0.871; confidence interval: 0.867-0.876).This is the first study to present utility score norms for EQ-5D-5L for the Quebec population. These results will be useful for comparison with quality-adjusted life-year studies to better interpret their results. Moreover, utility norms were provided for 21 health problems, which was rarely done.

No discrete choice experiment study has been conducted to elicit women's preferences for water immersion during labor and birth.An online survey including sociodemographic questions and choice cards was conducted to explore women's preferences (i.e., factors that may influence their decision). Each participant responded to 12 choice cards with 6 attributes/factors (i.e., birth mode, duration of the labor phase, pain sensation, risk of severe perineal tears, risk of death of the newborn, and newborn general condition). Utilities were estimated using logit, latent class, and hierarchical Bayesian analyses.A total of 1088 subjects completed the survey in 2019. The risk of death of the newborn was given high priority by women in all but one analyses, while the risk of severe perineal tears was always considered the least important attribute. The latent class analysis clearly revealed three classes of women. The largest class including 52.9% of women was interested in water birth if it could reduce pain and would be risk-free for the newborn. The second class included 30.8% of women interested in water immersion but only during the labor phase. Finally, the third class (16.2%) did not want to consider water immersion during labor and birth, regardless of its risks and benefits. Follow-up questions revealed that many women were interested in water birth only if they could be assured that there would be no risk for the newborn.This study provided insights in favor of water immersion during labor and birth contingent upon the safety of the procedure for the newborn.No discrete choice experiment on women's preference for water immersion during childbirth was previously conducted. Six attributes/factors were used for the discrete choice experiment. Water immersion is poorly used in Quebec with only 49 (7.9%) women over 621 with childbirth experience reporting such immersion. A majority of women (70-80%) were in favor of water immersion.

Objective The aim was to improve distressing patient-reported outcomes (PROs) that persisted in RA patients with clinically controlled inflammation (controlled RA). Methods In a pragmatic pilot study, we offered mindfulness-based stress reduction (MBSR), a group intervention, to controlled RA patients who had high (≥16) Centre for Evaluation Studies depression (CES-D) scores and/or patient general assessment of disease activity (PGA) at least 2/10 larger than evaluator general assessment (EGA) (PGA-EGA: Delta). Evaluations before, 6 and 12 months after MBSR included CES-D, PGA, modified HAQ, simple disease activity index (SDAI), anxiety (general anxiety disorder 7; GAD-7), coping strategies (coping with health injuries and problems; CHIP), sleep disturbance and pain. Facilitators and obstacles to recruitment and participation were identified. A subset of patients was interviewed for qualitative analysis of their experience. Results Out of 306 screened patients, 65 were referred, 39 (60%) agreed and 28 (43%) completed MBSR. Anticipated burden, timing and frequency of group meetings, commuting issues, age extremes and co-morbidities were barriers to participation. Up to 12 months after MBSR, anxiety, depression, emotion-oriented coping, sleep and function significantly improved. Nonetheless, no significant impact was observed on pain, PGA, Delta or SDAI. The interviews revealed that benefits, including integration of effective coping strategies, were maintained. Conclusion We addressed MBSR feasibility issues and selection of outcomes in controlled RA patients with distressing PROs. For patients who chose to participate in MBSR, lasting benefits were evident for anxiety, depression, sleep and function. Larger studies are required to evaluate the weaker impact of MBSR on RA-related pain and PGA.

300 Background: To determine the rate and time of testosterone (T) recovery to normal level in patients (pts) with prostate cancer treated with radiotherapy plus 6, 18 or 36 months of androgen deprivation therapy (ADT) and considered cured from their disease. Methods: We randomized 1230 pts with prostate cancer, into two phase III trials: 600 with intermediate risk and 630 with high-risk. We selected those considered cured to avoid subsequent T variations due to reintroduction of ADT for recurrence. We excluded the following pts: no ADT at all (126) or not receiving exactly 6, 18 or 36 months of ADT (69), survival less than one year (21), no T measured at baseline or during follow-up (75), biochemical failure (195) or evidence of metastatic/recurrent disease (137).T recovery rate was compared between baseline normal/abnormal T (values below biochemical normal range) and by ADT duration with Chi-square test or Fisher's exact test. A multivariable logistic regression model to predict the probability of recovering normal T was performed by including normal/abnormal T at baseline, age, Zubrod, comorbidities and ADT duration. A second model was performed by replacing ADT duration with baseline PSA, Gleason score and stage. The median time to T recovery was calculated only on pts who recovered normal T. Results: Results are reported with a median follow-up of 14 years. 607 pts fit the criteria and are available for analysis: 309 pts in the 6 months ADT schedule, 185 in the 18 and 113 in the 36. Overall, 76.7%, 54.6% and 45.1% pts recovered normal T on the 6, 18 or 36 months schedule, respectively (p

Delayed vaccinations at 2, 4, and 6 months are associated with a higher probability of delayed age-appropriate vaccination during childhood. This study aimed to assess the effectiveness of an information session on immunization during infancy.An individual educational information session with motivational interview techniques for immunization of infants was conducted (experimental group) or not conducted (control group) during postpartum stay in a quasi-experimental cohort study. Immunization data were collected from the Eastern Townships Public Health registry at 3, 5, 7, 13, 19, and 24 months of age. Logistic regressions with repeated measures were performed to assess the intervention's impact. Relative risks (RR) were estimated. A multivariate model was obtained adjusted for confounding factors.The experimental and control groups included 1140 and 1249 families, respectively. In per protocol analysis, a significant increase in VC of 3.2, 4.9, 7.3, 6.7, 10.6, and 5.1% was observed at 3, 5, 7, 13, 19, and 24 months. Children from experimental group had 9% more chance at a complete vaccination status between 3 and 24 months compared to children from control group (RR (95% CI): 1.09 (1.05-1.13), p .001). Children with complete vaccination status at 3 months were more likely to have a complete vaccination status at 24 months (82.3 vs. 48.1%, RR (95% CI): 2.72 (2.28-3.24), p .001). After adjustment, the estimated RR of the intervention's impact was 1.05 (1.02-1.07), p .001.An educational information session about immunization based on motivational interview techniques conducted during postpartum hospitalization could improve immunization during infancy.

Purpose The impacts of high blood eosinophil count (HBEC) at admission for COPD exacerbation on posthospitalization outcomes are still unclear. Previous studies have focused on its associations with first readmission rates; yet, its impacts on longitudinal outcomes such as subsequent readmissions still have to be explored. The main objective of this study is to investigate outcomes associated with HBEC following a first hospitalization for COPD exacerbation. Patients and methods This is an observational cohort study design. We retrospectively analyzed data of patients with a first hospitalization within 5 years for COPD exacerbation between April 2006 and March 2013. Patients were stratified into the HBEC group if the blood eosinophil count at admission was ≥200 cells/µL and/or ≥2% of the total white blood cells. With information on exact dates of subsequent hospitalizations and death, we modeled readmissions and death as states in a multi-state Markov model and estimated transition probabilities to the next states. Sensitivity analyses were performed by varying thresholds for the definition of HBEC (≥300 cells/µL and/or ≥3%). Results A total of 479 patients were included, of which 173 had HBEC. The transition probabilities for a first readmission was 74% (95% CI, 66%-83%) for patients with HBEC vs 70% (95% CI, 63%-77%) for patients with normal blood eosinophil count (NBEC). The transition probabilities for a second readmission were 91% (95% CI, 84%-100%) for HBEC patients in contrast with 83% (95% CI, 74%-92%) for NBEC patients. Meanwhile, transition probability for death was lower in patients with HBEC. The differences enlarged in sensitivity analyses with higher cutoff. Conclusion Greater blood eosinophil cell counts during a first hospitalization for COPD predict increased susceptibility to up to two readmissions. These patients may however have a lower risk of death.

BackgroundTransdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care.MethodsIn a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18–65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis.ResultsA total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79].ConclusionsOur findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.

Purpose To identify patients with intermediate-risk prostate cancer (IRPC) benefiting from de-escalation of androgen deprivation therapy (ADT) and/or dose escalated radiation therapy (DERT), we performed a secondary analysis of a phase 3 trial by measuring biochemical failure (BF), distant metastases, prostate cancer–specific mortality, overall survival (OS), and distant metastases-free survival (DMFS) rates according to prognostic intermediate risk factors (IRF). Methods and Materials The initial trial randomized 600 patients with IRPC to a 3-arm trial with 200 patients per arm, consisting of 6 months of ADT plus 70 Gy radiation therapy (ADT + RT70) versus ADT plus a DERT of 76 Gy (ADT + DERT76) versus DERT of 76 Gy alone (DERT76). We performed an analysis based on IRF: clinical stage, prostate-specific antigen level, Gleason score, percentage of positive biopsy cores (PBC) ≥50%, and Gleason pattern. Patients were allocated to 2 groups: favorable intermediate risk (FIR), defined as patients with only 1 IRF without Gleason pattern 4 + 3 or PBC ≥50%; and unfavorable intermediate risk (UIR), defined as all other patients. BF, distant metastases, prostate cancer–specific mortality, OS, and DMFS were compared between FIR and UIR. Results The median follow-up was 11.3 years (interquartile range, 10.9-11.7). In the FIR cohort, BF and OS were not significantly different between arms. UIR patients had significantly worse DMFS (hazard ratio [95% confidence interval], 1.61 [1.20-2.15]; P = .026) and OS (1.51 [1.12-2.04]; P = .0495) and a nonsignificant higher cumulative incidence of BF rate (1.55 [0.98-2.47]; P = .08). In UIR patients, a significant improvement in BF was seen in the arms receiving ADT compared to DERT76 alone. On multivariable analysis, Gleason pattern 4 + 3 and prostate-specific antigen >10 ng/mL independently affected BF and OS, regardless of the treatment arm. Conclusions In IRPC, therapeutic optimization appears possible. To avoid ADT side effects, DERT76 alone appears sufficient in patients harboring only 1 risk factor without Gleason pattern 4 + 3 and PBC ≥50% (FIR). All other UIR patients seem to benefit from ADT + DERT76.

Objectives: To identify attributes (i.e., characteristics describing a scenario) and levels (i.e., each characteristic may be defined by a different level) that would be included in a discrete choice experiment (DCE) questionnaire to evaluate women’s preferences for water immersion during labor and birth. Methods: A mixed-method approach, combining systematic reviews of the literature and patient focus groups to identify attributes and levels explaining women’s preferences. After the focus groups, preference exercises were conducted and led to the creation of the questionnaire, including the DCE. A qualitative validation of the questionnaire was conducted with women from the focus groups and with medical experts. Results: The literature reviews provided 26 attributes to be considered for childbirth in water, and focus groups identified 14 additional attributes. From these 40 attributes, preference exercises allowed us to select four for the DCE, in addition to the birth mode. Labor duration was also included, even if it was not well ranked, as it is the main clinical outcome in the literature. Validation with experts and women did not change the choice of attributes but slightly changed the levels selected. The final six attributes were: birth mode, duration of the labor phase, pain sensation, risk of severe tears in the perineum during the expulsion of the newborn, risk of death of the newborn, and general condition of the newborn (Apgar) score at 5 minutes. Conclusion: This study allowed us to detail all the stages for the design of a DCE questionnaire. To date, this is the first study of this kind in the context of women’s preferences for water immersion during labor and birth.

Background: Generic preference-based measures are used to evaluate disability and health-related quality of life (HRQoL). Objective: To evaluate if Short Form Six-Dimensions (SF-6Dv2) is correlated with specific current questionnaires used in chronic low back pain (CLBP) and if a predictive equation of SF-6Dv2 could be established. Methods: Between October 2018 and January 2019, an online survey on CLBP was conducted. HRQoL was measured with two specific questionnaires, i.e. Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ), and with the new version of the SF-6Dv2 as a generic preference-based measure. Results: 402 subjects completed at least two of the three HRQoL questionnaires. Mean (95% confidence interval) of SF-6Dv2, ODI, or RMDQ were, respectively, 0.561 (0.553–0.569), 43.7 (42.1–45.2), and 10.3 (9.8–10.8). SF-6Dv2 was moderately correlated with ODI and RMDQ (r = −0.635 and r = −0.542, p Conclusion: This study demonstrated that SF-6Dv2 was moderately correlated with ODI and RMDQ and that ODI was a better predictor. There was a strong correlation between actual and predicted SF-6Dv2 from multivariate models. These results suggest that the model can be used in similar studies to estimate the SF-6Dv2 when it was not measured.

Background Long-term androgen deprivation therapy (ADT) combined with radiotherapy (RT) is a standard treatment for patients with localized high-risk prostate cancer (HRPC). However, the optimal duration of ADT is not yet defined. Objective The aim of this superiority randomized trial was to compare outcomes of RT combined with either 36 or 18 mo of ADT. Design, setting and participants From October 2000 to January 2008, 630 patients with HRPC were randomized, 310 to pelvic and prostate RT combined with 36 mo (long arm) and 320 to the same RT with 18 mo (short arm) of ADT. Outcome measurements and statistical analysis Overall survival (OS) and quality of life (QoL) were primary end points. OS rates were compared with Cox Regression model and QoL data were analyzed through mixed linear model. Results and limitations With a median follow-up of 9.4 yr, 290 patients had died (147 long arm vs 143 short arm). The 5-yr OS rates (95% confidence interval) were 91% for long arm (88–95%) and 86% for short arm (83–90%), p=0.07. QoL analysis showed a significant difference (p Conclusions In localized HRPC, our results support that 36 mo is not superior to 18 mo of ADT. ADT combined with RT can potentially be reduced to 18 mo in selected men without compromising survival or QoL. Thus, 18 mo of ADT appears to represent a valid option in HRPC. Patient summary In this study, we report outcomes from high-risk prostate cancer patients treated with radiotherapy and either 36 or 18 mo of androgen deprivation therapy. There was no difference in survival between the two groups, with the 18-mo group experiencing a better quality of life.

Background Several preference based measures are validated for adults in cost utility analysis, but less are available for children and many researchers have criticized the quality of pediatric economic studies. The objective of this study was to perform a Canadian French translation and linguistic validation of the Child Health Utility 9D (CHU9D) that was conceptually equivalent to the original English version for use in Canada. Methods The translation and linguistic validation were realized by ICON Clinical Research (UK) Limited in association with the developer of the CHU9D and Canadian collaborators. This was done in accordance with industry standards and the guidance of the Food and Drug Administration (FDA) for patient-reported outcome (PRO) instruments. Five steps were considered: concept elaboration; forward translation; back translation; linguistic validation; proofreading and final verification. Results The CHU9D Canadian French translation and linguistic validation were realized without any major difficulties. Only 3 changes were made after the forward translation and 5 after the back translation. The result of back translation was very similar to the original English version. Six additional changes suggested by the developer team were accepted and the linguistic validation with five children led to 2 additional changes. Most changes were generally to change one word to better sounding Canadian French. Conclusion We produced a Canadian French translation and cross-cultural adaptation of the Child Health Utility 9D (CHU9D). Before being used in clinical settings and research projects, the final Canadian French translation needs to be validated for metrological qualities of reliability and validity. Electronic supplementary material The online version of this article (10.1186/s12955-018-0998-4) contains supplementary material, which is available to authorized users.

Background Due to the increasing number of vaccine-hesitant parents, new effective immunization promotion strategies need to be developed to improve the vaccine coverage (VC) of infants. This study aimed to assess the impact of an educational strategy of vaccination promotion based on motivational interviewing (MI) techniques targeting parents and delivered at the maternity ward, for the VC of infants at 3, 5, and 7 months of age. Methods An individual educational information session, administered using MI techniques, regarding immunization of infants aged 2, 4, and 6 months was (experimental group) or was not (control group) proposed to parents during the postpartum stay at the maternity ward. Immunization data were obtained through the Eastern Townships Public Health registry for infants at 3, 5, and 7 months of age. Absolute VC increases at 3, 5, and 7 months in the experimental group were calculated and the relative risks with the respective 95% confidence intervals were computed using univariate logistic regression with the generalized estimating equations (GEE) procedure. Multivariate regression using GEE was used to adjust for confounding variables. Results In the experimental and control groups, 1140 and 1249 newborns were included, respectively. A significant increase in VC of 3.2, 4.9, and 7.3% was observed at 3, 5, and 7 months of age (P < 0.05), respectively. The adjusted relative risk of the intervention’s impact on vaccination status at 7 months of age was 1.08 (95% confidence interval: 1.03–1.14) (P = 0.002). Conclusions An educational strategy using MI techniques delivered at the maternity ward may be effective in increasing VC of infants at ages 3, 5, and 7 months. MI could be an effective tool to overcome vaccine hesitancy. Electronic supplementary material The online version of this article (10.1186/s12889-018-5724-y) contains supplementary material, which is available to authorized users.

Interventions targeting patients with recent fragility fracture and their physician were most successful at initiating osteoporosis treatment during the first 12 months. This window of opportunity had already closed after 1 year. The reasons for declining or accepting the intensive intervention were explored in patients still untreated at 12 months. A fragility fracture (FF) event identifies patients most likely to benefit from osteoporosis treatment. Nonetheless, most FF patients go untreated. Our objective was to determine how long an incident FF remains a strong incentive to initiate osteoporosis treatment. A total of 1086 men and women over age 50 with a recent FF event were assigned to either standard care (SC), to minimal (MIN), or intensive (INT) interventions targeting patients and their family physician to initiate osteoporosis treatment. Inpatients with FF (mainly hip) evaluated by rheumatologists were also included in a specialized group (SPE; n = 324). At 1 year, untreated patients in both the SC and the MIN groups were offered an INT intervention. The cohort was followed through 48 months. A qualitative analysis of patient-centered decision-making associated with initiation of treatment was conducted. In MIN and INT groups, osteoporosis treatment was initiated in 41.0 and 54.3% of untreated patients by 12 months, respectively, compared to 68.4% in SPE and 18.9% in SC groups; initiation rates drastically dropped thereafter. Over 4863 patient-years of follow-up, the rates of new FF were 3.4 per 100 patient-years, without significant differences between patients with initial major or minor FF, nor between control or intervention groups. Failure by patients and physicians to recognize FF as a sign of underlying bone disease contributed the most to lack of treatment. While incident FFs are an ideal opportunity for starting osteoporosis treatment, 1 year later, the therapeutic window of opportunity has already closed.

While fragility fractures (FFs) are one of the strongest predictors of subsequent osteoporotic fractures, it remains unclear whether low-trauma ankle fractures have this ability. The aim of the study was to identify the characteristics of patients with low-trauma ankle FFs who develop subsequent FFs. The OPTIMUS initiative is a strategy to improve osteoporosis treatment post-FF in orthopedic clinics. FRAX scores without BMD (FRAX-BMI) were calculated at time of inclusion. Recurrent FFs were recorded over a 48-month follow-up. All FFs were X-ray-confirmed. A total of 265 patients with initial ankle FF were included (190 women; mean age 62.8 ± 9.6 years), of whom 15 developed new FFs. Patients with ankle FFs had longer time until recurrence and lower 2-year incidence of recurrent FFs (3.2%) compared with those having wrist FFs (9.0%) or other initial FFs (9.6%), and 4-year incidence rates of 6.2, 13.4, and 15.3%, respectively (log-rank test, p = 0.001). With an ankle FF at inclusion, recurrent FFs were more frequent in patients with previous FF (6.2 per 100 patient-years; p

Background: Within the wider education industry, a large quantity of ideas, practices and products are routinely promoted as useful innovations. These innovations span many forms such as software applications, open source courseware, online learning platforms and web 2.0 technologies. Coupled with this promotion, there is increasing interest and debate around the possibilities that novel innovations can have on changing education practice and providing more effective learning solutions. The media plays an important role in facilitating the travel of educational ideas: the advent of the Internet and social media technologies allows for an abundance of innovation to be promoted and shared with and between educators, and, in classroom settings, the increasing use of technologies such as tablets results in the advertisement of numerous new education applications. For the educator, there is the difficult challenge of knowing how to sift through this material and separate those innovations that may hold...

Background Although most studies have shown that little haemolysis is induced by infusion pumps, there are some notable exceptions. Only limited data are available on the actual infusion pumps that are most used in hospitals in Quebec and elsewhere, namely, the Infusomat® Space (peristaltic), Plum A+™ (piston) and Colleague® CXE (shuttle) pumps. Methods Haemolysis and potassium levels were compared before and after the use of the three different infusion pumps. Using 135 units of packed red blood cells (RBCs) aged from 10 to 28 days, 27 measurements were taken for each pump at various flow rates (30, 60, 150, 300 and 450 ml/h) and were compared with measurements taken before using the pumps. The range of flow rates was chosen to cover those of paediatric and adult transfusions. Results The shuttle- and piston-type pumps resulted in low haemolysis levels. The peristaltic-type pump produced significantly more haemolysis, which worsened at low flow rates, but the absolute value of haemolysis remained within the range recommended by the regulatory agencies in North America and Europe. Approximately two-thirds of the haemolysis produced by the peristaltic-type pump seemed to be secondary to the use of an antisiphon valve (ASV) on the transfusion line recommended by the manufacturer. Potassium levels did not increase with the use of the pumps. Conclusion Modern infusion pumps widely used in hospitals in Quebec and elsewhere produce non-threatening levels of haemolysis during the transfusion of packed RBCs aged from 10 to 28 days. ASVs appear to induce additional haemolysis, and we do not recommend using them for blood transfusion.

Background Cost utility analysis is important for measuring the impact of chronic disease and helps clinicians and policymakers in patient management and policy decisions, but generic preference-based measures are not always considered in clinical studies. Objective To evaluate if health-related quality-of-life (HRQoL)-specific questionnaires used in chronic low back pain (CLBP) can predict EQ-5D-5L utility scores. Methods The data come from an online survey on low back pain conducted between October 2018 and January 2019. Health utility scores for EuroQol Five Dimensions Five Levels (EQ-5D-5L) were calculated with the recommended model of Xie et al. The EQ-5D-5L health states ranged from −0.148 for the worst (55555) to 0.949 for the best (11111). Univariate and multivariate linear regression were performed to predict EQ-5D-5L with Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ) and clinical variables. Results Analyses were performed in 408 subjects who completed the questionnaires EQ-5D-5L, ODI or RMDQ. Median (range) of EQ-5D-5L was 0.622 (−0.072 to 0.905). There was high correlation between EQ-5D-5L and ODI (r=−0.78, p

Purpose The impacts of high blood eosinophil count (HBEC) at admission for COPD exacerbation on posthospitalization outcomes are still unclear. Previous studies have focused on its associations with first readmission rates; yet, its impacts on longitudinal outcomes such as subsequent readmissions still have to be explored. The main objective of this study is to investigate outcomes associated with HBEC following a first hospitalization for COPD exacerbation. Patients and methods This is an observational cohort study design. We retrospectively analyzed data of patients with a first hospitalization within 5 years for COPD exacerbation between April 2006 and March 2013. Patients were stratified into the HBEC group if the blood eosinophil count at admission was ≥200 cells/µL and/or ≥2% of the total white blood cells. With information on exact dates of subsequent hospitalizations and death, we modeled readmissions and death as states in a multi-state Markov model and estimated transition probabilities to the next states. Sensitivity analyses were performed by varying thresholds for the definition of HBEC (≥300 cells/µL and/or ≥3%). Results A total of 479 patients were included, of which 173 had HBEC. The transition probabilities for a first readmission was 74% (95% CI, 66%–83%) for patients with HBEC vs 70% (95% CI, 63%–77%) for patients with normal blood eosinophil count (NBEC). The transition probabilities for a second readmission were 91% (95% CI, 84%–100%) for HBEC patients in contrast with 83% (95% CI, 74%–92%) for NBEC patients. Meanwhile, transition probability for death was lower in patients with HBEC. The differences enlarged in sensitivity analyses with higher cutoff. Conclusion Greater blood eosinophil cell counts during a first hospitalization for COPD predict increased susceptibility to up to two readmissions. These patients may however have a lower risk of death.

Resume But de l’etude Identifier les facteurs associes a la poursuite de l’allaitement a trois mois de vie de l’enfant dont la sensibilite maternelle et les symptomes depressifs dans une region parisienne. Methode Un devis prospectif de type descriptif correlationnel a ete utilise. Un total de 241 meres parisiennes ayant allaite ont ete recrutees a 48 heures de vie de l’enfant. Un questionnaire autoadministre a ete complete a 48 heures (T0) et a trois mois de vie de l’enfant (T1). Resultats L’âge moyen des meres etait de 33 ± 5 ans, 93,8 % etaient en couple et 71 % etaient originaires de France. D’ordre general, les participantes manifestaient peu de symptomes depressifs et la sensibilite maternelle etait elevee. La prevalence de l’allaitement a trois mois de vie etait de 66,7 %. Les resultats ont permis de demontrer que la sensibilite maternelle (OR [IC 95 %] = 2,78 [1,29–5,98], p = 0,009), le sexe feminin du bebe (OR = 2,56 [1,19–5,50], p = 0,016), l’absence de complement lacte a la naissance (OR = 2,62 [1,19–5,74], p = 0,016) sont associes a la poursuite de l’allaitement. Conclusion L’allaitement maternel est un processus complexe influence par differents facteurs. L’approche preconisee par les intervenants devrait etre non seulement axee sur une approche technique et educative mais aussi sur une approche de soutien qui prend en compte la sensibilite maternelle.

ObjectiveTo describe how chronic low back pain (CLBP) impacts on utility scores and which patients’ characteristics most affect these scores in the province of Quebec.SettingsProvince of Quebec, Canada.Participants569 adult patients with CLBP.Methods and outcomesAn online survey on low back pain was conducted between October 2018 and January 2019. The EuroQol Five Dimensions (EQ-5D-5L) and the Short Form Six Dimensions version 2 (SF-6Dv2) are two generic preference-based measures used to evaluate health-related quality of life (HRQoL) and provide quality-adjusted life-year utility values.ResultsThe number of subjects who agreed to participate was 610, but 41 were excluded because 8 had low back pain for less than 3 months and 33 did not start the survey. A total of 569 subjects were analysed, but only 410 completed the survey up to the EQ-5D-5L or SF-6Dv2 sections. Median (range) of EQ-5D-5L was 0.622 (−0.072 to 0.905), and mean (range) of SF-6Dv2 and EQ-Visual Analogue Scale was 0.561 (0.301–0.829) and 51.0 (0–100), respectively. In all multivariate models, health or life satisfaction increased the health utility score, while pain reduced it. Co-occurring health problems were present for a majority (68%) of participants, mainly fatigue/insomnia (57.4%), musculoskeletal disorder (56.2%) and mental disorder (44%).ConclusionThis study provided utility scores with EQ-5D-5L and SF-6Dv2 in patients with CLBP in Quebec, and results were similar to other studies conducted in different settings. These values were well below those reported in the Quebec general population and highlight the association between CLBP and HRQoL.

Background:Despite available highly effective pharmacological treatments, up to 30% of current rheumatoid arthritis (RA) patients remain in quasi-remission, where inflammation is controlled but patients still report unacceptable levels of negative impact of RA (high Patient Global Assessment (PGA) on a 0-10 visual analog scale). PGA levels correlated with depressive symptoms assessed by Center for Epidemiologic Studies- Depression (CES-D) scores. Mindfulness-Based Stress Reduction (MBSR) is relatively inexpensive and reduces both anxiety and depression in several conditions.Objectives:To complete a feasibility and acceptability study paving the way for a randomized controlled trial (RCT) of MBSR to improve depressive symptoms and clinical outcomes in RA patients in quasi-remission.Methods:A standardized 8-week MBSR program in adults with controlled inflammatory disease (stable SJC ≤ 2/66 and normal CRP; stable treatments) but high CES-D scores (2 groups), high CES-D or anxiety scores (1 group), or PGA higher than Physician Evaluation of Disease Activity (EVA) by ≥2 (1 group). Feasibility was documented using process indicators. Outcomes were measured at baseline and 6 months after the end of MBSR. Disease activity scores (SDAI) and questionnaires on depressive symptoms (CES-D), HAQ, sleep (VAS), fatigue and pain (SF-36), anxiety (GAD-7), PGA were collected. Qualitative interviews based on a theoretical framework of acceptability were conducted following the post-MBSR evaluation.Results:We report on the first 21 patients (mean age 59, 91% females) having completed their 6-month follow up evaluation. Factors leading to higher recruitment rates were 1) using pragmatic scores to identify eligible patients (e.g. EVA and PGA), 2) no formal clinical evaluation of mental health and no emphasis on depression in the recruitment material.MBSR had a highly significant positive impact on depressive symptoms (p=0.003) and anxiety (p=0.025) (Figure), and positive impact on quality of sleep and HAQ. No change in SDAI or joint counts was noted.During a qualitative interview of 13 participants, most reported that MBSR helped them control their reactions to daily stressful situations. Perceptions were almost uniformly positive towards MBSR, and most appeared to have integrated some part of it in their daily life. No side effects were reported.Conclusion:Although recruitment was challenging, a MBSR trial in RA patients in quasi-remission was found acceptable and feasible. Positive impacts on mood and on clinical outcomes were observed. Anxiety and depression scores appear the most sensitive to change and are recommended as the primary outcome for an eventual RCT. MBSR added to conventional treatments might help empower RA patients towards self-management.Acknowledgments:Grant support from Canadian Initiative for Outcomes in Rheumatology cAre (CIORA)Disclosure of Interests:Marie-Claude Beaulieu: None declared, Isabelle Gaboury: None declared, Nathalie Carrier: None declared, Patricia Dobkin: None declared, France Gervais: None declared, Françoise Gendron: None declared, Pasquale Roberge: None declared, Pierre Dagenais: None declared, Sophie Roux: None declared, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer

Background:Since July 1998, the Early Undifferentiated PolyArthritis (EUPA) cohort recruited consecutive adults with recent-onset immune-mediated polyarthritis1,2. Patients were treated aiming at 0 swollen joint.Objectives:To analyze the impact of biomarkers over 20 years on baseline variables, treatments, comorbidities and outcomes over the first 5 years of follow up.Methods:Variables and Outcomes were collected over 5 years in consecutive patients fulfilling RA criteria, grouped according to date of inclusion (Period 1: 1998-2004; Period 2: 2005-2010; Period 3: 2011-2018). Comparisons of baseline characteristics, treatment, and outcomes over 5 years between the 3 Periods were previously presented (ACR 2018 and 2019). Erosive damage was scored according to Sharp/van der Heijde; erosive status was defined as ≥5 Erosion units. We now present observed associations between the presence of baseline prognostic biomarkers (anti-CCP2 (ACPA), RF, anti-Sa, and erosive status) with concomitant and subsequent disease activity levels, radiographic scores, comorbidities and impact of treatment. False discovery rate correction was used to adjust p-values for multiple comparisons.Results:753 patients were included: 247, 263 and 243 in Periods 1, 2 and 3, respectively. Variables at baseline. No biomarkers, including erosive status, were associated with demographics or disease activity. Erosive disease was more prevalent in ACPA+ (19.9% vs 13.9%, p=0.0417). Current smoking decreased by period (20.6, 17.2, 8.6%; p=0.02) in ACPA negatives only, remaining stable among ACPA+ (25.3, 20.9, 18.8%, NS). All comorbidities were significantly more present in ACPA negatives vs positives (RR between 1.55 and 1.99). Prevalence of cardiovascular (CV; 44.8, 55.0, 60.0%; p=0.036) and cancer (4.1, 7.1, 13.1%; p=0.02) comorbidities increased over time in ACPA negatives and remained stable in ACPA+ (CV: 33.0, 30.8, 40.7, NS; cancer: 3.0, 4.4, 6.2, NS). RF positivity decreased by period (47.8, 36.9, 36.7%, p=0.03), but ACPA+ remained stable (40.8, 35, 35.4% NS).Outcomes over 5 years of follow up.There was no link between the presence of any biomarker and subsequent disease activity scores. Positive ACPA, RF and anti-Sa at baseline predicted development of more erosive status (RR = 1.50; 1.37 and 1.52, all pConclusion:In this cohort of recent onset RA recruited over 20 years, we observed a constant drift towards RF-negative arthritis at baseline with decreasing smoking rates and increasing comorbidities in seronegative patients. Positive antibodies were associated more cardiovascular comorbidities accrual. Autoantibody positive (especially ACPA+) patients developed more erosive disease and had better erosion outcomes with biologic treatments. Irrespective of the presence or absence of biomarkers, marked improvements in control of disease activity and in remission rates occured over each period.References:[1]Boire G, et al.Arthritis Res Ther2005;7:R592-R603;[2]Carrier N, et al. Arthritis Res Ther2016;18:37Disclosure of Interests:Nathalie Carrier: None declared, Sophie Roux: None declared, Ariel Masetto: None declared, Artur J. deBrum Fernandes: None declared, Patrick Liang: None declared, Meryem Maoui Employee of: Bristol Myers Squibb Canada, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer

Patients with rheumatoid arthritis (RA) have very different outcomes, particularly with regard to bone erosions. Since osteoclasts are responsible for bone destruction adjacent to rheumatoid synovium, profiling osteoclasts from circulating precursors in RA could help identify patients at risk for bone destruction. In this study, we sought to determine whether the functional characteristics of osteoclasts generated from their blood precursors were modified by RA activity or were intrinsic to osteoclasts and associated with the RA phenotype (erosive or not). Osteoclasts were generated in vitro from peripheral blood mononuclear cells (PBMCs) of subjects with RA (n = 140), as well as sex- and age-matched healthy controls (n = 101). Osteoclastic parameters were analyzed at baseline and during the follow-up for up to 4 years, with regular assessment of RA activity, bone erosions, and bone mineral density (BMD). As a validation cohort, we examined RA patients from the Early Undifferentiated PolyArthritis (EUPA) study (n = 163). The proportion of CD14+ PBMC was higher in RA than in control subjects, but inversely correlated with the 28-joint disease activity score (DAS28). Also surprisingly, in osteoclast cultures from PBMCs, active RA was associated with lower osteoclastogenic capacity, while in vitro bone resorption per osteoclast and resistance to apoptosis were similar in both active and quiescent RA. In a small subgroup analysis, osteoclasts from subjects with recent RA that had progressed at four years to an erosive RA exhibited at baseline greater resistance to apoptosis than those from patients remaining non-erosive. Our findings establish that when RA is active, circulating monocytes have a reduced potential to generate osteoclasts from PBMCs in vitro. In addition, osteoclasts associated with erosive disease had resistance to apoptosis from the start of RA., Highlights • Osteoclasts are derived in vitro from circulating monocytes in rheumatoid arthritis. • Blood CD14+ monocytes (%) are higher but inversely correlated with disease activity. • Active rheumatoid arthritis is associated with reduced osteoclast formation in vitro. • Inflammation alters the ability to generate osteoclasts from circulating monocytes. • Osteoclast resistance to apoptosis is stable and associated with long-term erosions.

Maryse Bélanger,1,2 Simon Couillard,1,2 Josiane Courteau,1 Pierre Larivée,1,2 Thomas G Poder,1,3,4 Nathalie Carrier,1 Kim Girard,1 Felix-Antoine Vézina,1,2 Alain Vanasse1,4 1Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada; 2Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; 3Health Technology Assessment Unit, UETMIS, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada; 4Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada Purpose: Current evidence suggests that a higher blood eosinophil cell count at admission for acute exacerbation of COPD (AECOPD) is associated with a favorable response to systemic steroids. However, the impact of blood eosinophil counts at admission on post-hospitalization outcomes is still unclear. The main objective of this study is to investigate readmission outcomes associated with blood eosinophilia following severe COPD exacerbation in patients with infrequent COPD hospitalizations. Patients and methods: This is an observational cohort study design. We retrospectively analyzed data of patients with a first hospitalization within 5years for COPD exacerbation between April 2006 and March 2013. Patients were stratified into the eosinophilic group if the blood eosinophil count on admission was ≥200 cells/µL and/or ≥2% of the total white blood cell (WBC) count. The primary outcome was 1-year COPD-related readmission. Secondary outcomes included 1-year all-cause mortality, 1-year all-cause readmission, length of stay, time to COPD-related readmission, and number of 1-year COPD-associated emergency department (ED) and ambulatory visits. Results: A total of 479 patients were included. Of whom, 173 were stratified into the eosinophilic group. Higher blood eosinophil cell count was associated with an increased risk of 1-year COPD-related readmission (OR, 1.83 [95% CI, 1.16–2.89]; P

Thomas G Poder1–3 Nathalie Carrier,1 Maryse Bélanger,1,4 Simon Couillard,1,4 Josiane Courteau,1 Pierre Larivée,1,4 Alain Vanasse1,3 1Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada; 2Health Technology Assessment Unit, UETMIS, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada; 3Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; 4Respirology Service Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada Background: Exacerbations explain much of the cost of COPD. Higher blood eosinophil cell counts at admission for acute exacerbation of COPD increase the risk of subsequent exacerbations and hospitalizations. However, there is no literature on the economic burden of patients with this inflammatory profile. The objective of this study is to assess the cost of health-care service utilization according to different counts of blood eosinophils.Methods: The observational retrospective cohort included all first hospitalizations for COPD exacerbation between April 2006 and March 2013. The eosinophilic group was defined by blood eosinophil counts on admission ≥200 cells/µL and/or ≥2% of the total white blood cell count. Study outcomes were: total costs (2016 Canadian dollars) (index hospitalization and 1-year follow-up), total index hospitalization costs, total 1-year costs (all-cause readmissions, ambulatory and emergency service use), and 1-year COPD-related costs (only cost for COPD after initial discharge). Sensitivity analyses were conducted to evaluate the impact of different eosinophil cut-offs on outcomes.Results: In total, 479 patients were included, 173 in the eosinophilic group (92 in the higher cut-off). The average total cost was $18,263 ($6,706 for the index hospitalization), without significant difference between groups (P=0.3). The average 1-year COPD-related cost was higher in the eosinophilic group ($3,667 vs $2,472, P=0.006), with an adjusted mean difference of $1,416. Analysis of data using the higher cut-off of ≥400 cells or ≥3% was associated with a slightly larger difference in 1-year COPD-related costs between groups ($4,060 vs $2,629, P=0.003), with an adjusted mean difference of $1,640.Conclusion: A higher blood eosinophil cell count at admission for a first hospitalization is associated with an increase in total 1-year COPD-related costs. Keywords: chronic obstructive pulmonary disease, exacerbations, health-care utilization, cohort study, Canada, Quebec

L’allaitement maternel est reconnu comme l’aliment par excellence pour la sante de la mere et de l’enfant. Le temperament de l’enfant est l’un des facteurs qui peuvent expliquer la poursuite de l’allaitement. Peu d’instruments sont disponibles en francais pour mesurer ce facteur. L’objectif de l’etude est de presenter et valider la traduction francaise de l’echelle Infant Behavior Questionnaire (IBQ). L’echantillon est constitue de 193 femmes primipares ou multipares ayant accouche dans une maternite parisienne. Le questionnaire sur le temperament de l’enfant a ete envoye par voie postale trois mois apres l’accouchement. Le meme questionnaire a ete envoye a un sous-echantillon de 30 femmes 15 jours plus tard. Des analyses ont ete realisees pour evaluer la stabilite temporelle, l’homogeneite interne, la validite de construit et predictive. Les differents resultats tendent a montrer une validite satisfaisante de la version francaise de l’echelle. Cette premiere validation en langue francaise de l’instrument IBQ merite d’etre poursuivie afin de confirmer la structure factorielle de l’echelle et de participer ainsi aux etudes visant a soutenir les meres dans leur projet d’allaitement.

Background 14–3-3η is a joint-derived serum protein that up-regulates pro-inflammatory factors. We have previously reported that baseline 14–3-3η levels ≥0.50 ng/ml (HIGH 14–3-3η) were predictive of radiographic progression over 5 years. Objectives Our objective was to verify if the persistence of HIGH 14–3-3η at 18 months in recent-onset polyarthritis patients in REMISSION predicts more rapid radiographic progression over the following years, up to 42 months. Methods Serum 14–3-3η titres were assessed at baseline and at 18 months into disease, a median of 14 months after diagnosis and initiation of treatment. Three definitions of “clinical remission” at 18 months were used: Swollen Joint Count (SJC) =0; SJC + Tender Joint Count (TJC) =0; ACR/EULAR Boolean definition. The progression of radiographic damage (Erosion and Total Sharp/van der Heijde (SvH) scores) in patients with LOW ( Results Out of 331 patients, 36.0% of which had HIGH 14–3-3η at Baseline, 308 had complete data up to 5 years. Median age was 60 years, 62% women. Depending on the stringency of the definition used, variable numbers of patients reached remission at 18 months: 162 (53%) had SJC=0; 108 (35%) SJC+TJC=0; and 56 (18%) Boolean. Remission at 18 months was negatively associated with persistence of HIGH 14–3-3η since HIGH 14–3-3η were then present in 32/162 (19.7%) SJC=0 patients; 22/108 (20.4%) SJC+TJC=0 and 13/56 (23.2%) Boolean. Compared to patients in remission with LOW 14–3-3η, patients in remission with HIGH 14–3-3η at 18 months had numerically faster subsequent progression with all definitions. For example, in patients with Boolean remission, mean (SD) erosion progression over 42 months was 7.2±13.1 vs 1.5±3.3 and mean (SD) progression of Total score 9.2±14.5 vs 2.8±4.4 units (Figure). However, due to low numbers and limited power, differences in progression were statistically significant only for the less strict definitions of remission and only over the following year: Erosions (SJC=0, p=0.0042, SJC+TJC=0, p=0.0236), Total score (SJC=0, p=0.0146; with a trend for SJC+TJC=0, p=0.077). None of the comparisons over 42 months or of those involving Boolean reached significance. Conclusions The persistence of 14–3-3η levels ≥0.50 ng/ml appears to be associated with a lower probability of reaching remission in polyarthritis patients. 14–3-3η levels ≥0.50 ng/ml in patients in clinical remission appear to be associated with more rapid radiographic (especially erosive) progression over the following year. A larger study is required to validate these findings, especially with the most stringent criterion of Boolean remission. Disclosure of Interest N. Carrier: None declared, M.-P. Garant: None declared, A. Marotta Employee of: Augurex Life Sciences Corp., A. De Brum Fernandes Grant/research support from: AJdBF is part of the Centre de Recherche Clinique from the CHUS, which received a team grant from the Fonds de Recherche en Sante-Quebec, P. Liang: None declared, A. Masetto: None declared, Y. Gui Employee of: Augurex Life Sciences Corp., J. Savill Employee of: Augurex Life Sciences Corp., S. Michienzi Employee of: Augurex Life Sciences Corp., W. Maksymowych Consultant for: Augurex Life Sciences Corp., G. Boire Grant/research support from: GB is part of the Centre de Recherche Clinique from the CHUS, which received a team grant from the FRSQ. GB is the recipient of CIHR grant MOP-110959. Since 2007, the Sherbrooke EUPA cohort has also received financial support from the Canadian ArTritis CoHort (CATCH), a study designed and implemented by investigators and financially supported via unrestricted research grants initially by Amgen Canada Inc

The World Health Organization Fracture Risk Assessment tool (FRAX) was developed to identify patients at risk of sustaining a fragility fracture (FF).The objective of the study was to evaluate estimated FRAX probabilities of FF at the time of a FF and to compare them with the observed incidence of recurrent FF.A prospective cohort included men and women older than 50 years at the time of a FF. FRAX scores without bone mineral density [FRAX-body mass index (BMI)] were calculated prior to and after the inclusion FF. Recurrent FFs were recorded over a 4-year follow-up. Determinants associated with recurrent FF were determined by univariate and multivariate analyses.FRAX-BMI scores were available in 1399 of the 1409 recruited patients. A high-risk FRAX-BMI score was present in only 42.7% patients before and 56.4% after the incident FF. Most FF patients at low or moderate risk before their initial FF were men, younger than 65 years, or without previous FF. Over a median follow-up of 3 years, recurrent FF occurred in 108 patients (2.69 per 100 patient-years). The overall sensitivity of post-FF FRAX to predict a recurrent FF was 71.3% and was specifically lower in patients younger than 65 years (13%) and without previous FF (63%) at inclusion.The FRAX-BMI scores were below the Canadian threshold for treatment in more than half the patients at the time of a FF and in close to a third of patients with recurrent FF. FRAX-BMI severely underestimates the FF risk in patients younger than 65 years old and after a single FF.