Updated Analysis of Radon Exposure and Lung Cancer Mortality in the Cohort of Newfoundland Fluorspar Miners (1950-2016).

The commercial mining of fluorspar in St. Lawrence Newfoundland began in 1933. Miners who worked underground were exposed to high levels of radon progeny, especially before ventilation was introduced into the mines in 1960. The mean cumulative radon exposure for underground miners in this cohort was 380.9 working level months (WLM). A series of studies of this cohort have characterized the increased risks of lung cancer mortality due to radon. We have extended the follow-up of this cohort an additional 15 years to provide additional insights on the risks of low levels of radon exposure, and the modifying effects of time since exposure, age at first exposure, attained age, duration of exposure, and cigarette smoking. The cohort consisted of 1,735 underground and 315 male surface miners who, combined, accrued 81,650 person-years of follow-up. The mortality experience of the cohort was determined from 1950-2016 through record linkage to Canadian national death data. Individual-level estimates of exposure to radon progeny, in WLMs, were determined for each year of employment. We compared the mortality experience of the underground miners to Newfoundland men using the standardized mortality ratio (SMR). Poisson regression models were fit to estimate excess relative risks (ERR) per 100 WLM. There were 236 lung cancer deaths identified, and of these, 221 occurred among underground workers. The SMR for lung cancer among underground miners compared to Newfoundland men was 2.67 (95% CI: 2.33, 3.04). The ERR per 100 WLM for lung cancer mortality, assuming a 5-year exposure lag, was 0.41 (95% CI: 0.23, 0.59). Attained age and time since exposure were important modifiers to the radon-lung cancer relationship. The joint relationship between smoking and radon on lung cancer risk was sub-additive, however, the smoking data were limited and available for only half of the cohort.

Barriers to oral care: a cross-sectional analysis of the Canadian longitudinal study on aging (CLSA).

BACKGROUND: Oral health plays a role in overall health, indicating the need to identify barriers to accessing oral care. The objective of this study was to identify barriers to accessing oral health care and examine the association between socioeconomic, psychosocial, and physical measures with access to oral health care among older Canadians. METHODS: A cross-sectional study was conducted using data from the Canadian Longitudinal Study on Aging (CLSA) follow-up 1 survey to analyze dental insurance and last oral health care visit. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between socioeconomic, psychosocial, and physical measures with access to oral care, measured by dental insurance and last oral health visit. RESULTS: Among the 44,011 adults included in the study, 40% reported not having dental insurance while 15% had not visited an oral health professional in the previous 12 months. Several factors were identified as barriers to accessing oral health care including, no dental insurance, low household income, rural residence, and having no natural teeth. People with an annual income of <$50,000 were four times more likely to not have dental insurance (adjusted OR: 4.09; 95% CI: 3.80-4.39) and three times more likely to report not visiting an oral health professional in the previous 12 months (adjusted OR: 3.07; 95% CI: 2.74-3.44) compared to those with annual income greater than $100,000. CONCLUSIONS: Identifying barriers to oral health care is important when developing public health strategies to improve access, however, further research is needed to identify the mechanisms as to why these barriers exist.

Oral Health Problems among Canadians Aged 45 to 85: Data from the Canadian Longitudinal Study on Aging Baseline Survey (2011-2015).

Oral health is a critical component of overall health. The objective of this study was to describe oral health problems among 47,581 adults aged 45 to 85 in the Canadian Longitudinal Study on Aging (CLSA) among those who have at least one natural tooth (92%) and those without natural teeth across various demographic categories. Among the 47,581 participants in the study, 92% reported having at least one natural tooth (dentate). Among those without teeth, 63% reported an income less than CAD 50,000 versus 39% among those with teeth. Whether they had teeth or not, over 30% of people reported two or more oral health problems. Older adults appear to be retaining their natural teeth (28.9%), but still report experiencing oral health problems. As the population ages, loss of all teeth may not be the most useful proxy for poor oral health, and a population-level understanding of oral health problems may help to better define poor oral health.

Circulatory system disease mortality and occupational exposure to radon progeny in the cohort of Newfoundland Fluorspar Miners between 1950 and 2016.

OBJECTIVES: Exposure to ionizing radiation may increase the risk of circulatory diseases, including heart disease. A limited number of cohort studies of underground miners have investigated these associations. We previously reported a positive but non-statistically significant association between radon progeny and heart disease in a cohort of Newfoundland fluorspar miners. In this study, we report updated findings that incorporate 15 additional years of follow-up. METHODS: The cohort included 2050 miners who worked in the fluorspar mines from 1933 to 1978. Statistics Canada linked the personal identifying data of the miners to Canadian mortality data to identify deaths from 1950 to 2016. We used previously derived individual-level estimates of annual radon progeny exposure in working-level months. Cumulative exposure was categorized into quantiles. We estimated relative risks and their 95% confidence intervals using Poisson regression for deaths from circulatory, ischemic heart disease and acute myocardial infarction. Relative risks were adjusted for attained age, calendar year, and the average number of cigarettes smoked daily. RESULTS: Relative to the Newfoundland male population, the standardized mortality ratio for circulatory disease in this cohort was 0.82 (95% CI 0.74-0.91). Those in the highest quantile of cumulative radon progeny exposure had a relative risk of circulatory disease mortality of 1.03 (95% CI 0.76-1.40) compared to those in the lowest quantile. The corresponding estimates for ischemic disease and acute myocardial infarction were 0.99 (95% CI 0.66-1.48), and 1.39 (95% CI 0.84-2.30), respectively. CONCLUSIONS: Our findings do not support the hypothesis that occupational exposure to radon progeny increases the risk of circulatory disease.

Longitudinal associations between bullying and alcohol use and binge drinking among grade 9 and 10 students in the COMPASS study.

OBJECTIVES: Adolescents involved in bullying are at increased risk for alcohol use; however, much of this research has been cross-sectional. The aim of this work was to therefore examine the longitudinal associations between bullying and future alcohol use. METHODS: Data were drawn from the COMPASS study. The current study used a 2-year linked sample of grade 9 and 10 students from 2015 to 2017 (n = 6005). Students were asked to report their involvement with bullying as well as alcohol use and binge drinking behaviours. Generalized estimating equations regression analyses were used to examine the relationship between bullying involvement at baseline and alcohol use and binge drinking at follow-up. RESULTS: Overall, 20% of students in grades 9 and 10 reported involvement in bullying. There was evidence of a modest longitudinal association between bullying and binge drinking. Being a bully or bully-victim at baseline was associated with increased odds of initiating future binge drinking. CONCLUSIONS: Being a bully or bully-victim in grade 9 or 10 was associated with initiating binge drinking within the following 2 years. Targeted alcohol use prevention programming may benefit these groups.

RéSUMé: OBJECTIFS: Les adolescents impliqués dans l'intimidation courent un risque accru de consommation d'alcool. Cependant, une grande partie de cette recherche a été transversale. Cette étude vise à examiner les associations longitudinales entre l'intimidation et la consommation future d'alcool. MéTHODES: Les données provenaient de l'étude COMPASS. La présente étude utilise un échantillon d'élèves de 9e et 10e années qui ont été suivi de 2015 à 2017 (n = 6 005). Les élèves ont été invités à signaler leur implication dans l'intimidation, la consommation d'alcool et la consommation excessive d'alcool. Des modèles d'équations d'estimation généralisées ont servi à examiner la relation entre la participation à l'intimidation au départ, et la consommation d'alcool et la consommation excessive d'alcool occasionnelle dans les deux années suivantes. RéSULTATS: 20 % des élèves de 9e et 10e années ont déclaré avoir été victimes d'intimidation. Il y avait des preuves d'une modeste association longitudinale entre l'intimidation et la consommation excessive d'alcool. Être un intimidateur ou une victime d'intimidation au départ était associé à une probabilité accrue de consommation excessive d'alcool occasionnelle par la suite. CONCLUSION: Être un intimidateur ou victime d'intimidation était associé à une consommation excessive d'alcool occasionnelle deux ans plus tard chez les élèves de la 9e et la 10e année. Des programmes ciblés de prévention de la consommation d'alcool pourraient bénéficier à ces groupes.

Assessing Dysglycemia Risk Among Younger Adults: A Validation of the Canadian Diabetes Risk Questionnaire.

OBJECTIVES: The Canadian prevalence and incidence of diabetes has increased by the greatest extent in young adulthood. The original Canadian Diabetes Risk Questionnaire (CANRISK) was created to assess dysglycemia risk among adults ≥40 years of age, but it has not been validated among younger adults. Furthermore, it is unclear whether a young adult-specific risk score would better identify dysglycemia in this age group. METHODS: Analyses were done on participants who completed the self-administered CANRISK and underwent anthropometric and blood glucose measurements, were 18 to 39 years of age, were not pregnant and had no previous diabetes diagnosis. A risk model was generated from a lenient stepwise function fit with predictors identified through univariate analyses. Risk scores were produced from adjusted odds ratios. Model performance was internally validated using bootstrap methods and compared with the original CANRISK prognostic tool. RESULTS: Of the 3,334 participants included in the study, 194 (5.8%) and 51 (1.5%) were living with prediabetes or undiagnosed diabetes, respectively. The model displayed an area under the curve of 73.0%, adjusted to 72.9% after bootstrapping; however, using the original CANRISK model resulted in similar results (area under the curve, 71.4%). Sensitivity and specificity of the new and original models were also comparable (78.8% vs 77.1% and 54.0% vs 55.0%, respectively). CONCLUSIONS: The original CANRISK score performed well among young adults, even when compared with a young adult-specific model. We suggest that the cut point be lowered for young adults and the tool be permitted for use in this age group.

Assessing the Impact of School-Based Greenness on Mental Health Among Adolescent Students in Ontario, Canada.

Neighbourhood greenness has been frequently associated with improved mental health in adulthood, yet its impact among youth is less clear. Additionally, though youth spend large portions of time at school, no study has investigated associations between school-based measures of greenness and students' mental health in Canada. We addressed this gap by linking participant responses from the 2016-2017 Ontario Student Drug Use and Health Survey to school-based features of the built environment. Our analyses included 6313 students, ages 11-20. Measures of greenness were the mean and max of the annual mean Normalized Difference Vegetation Index within 500 m and 1000 m from the centroid of the school postal code. Measures of mental health included: serious psychological distress (Kessler 6-item Psychological Distress Scale), self-rated mental health (using a five-point Likert scale), suicide ideation, and suicide attempt. In our study population, the prevalence of serious psychological distress and low self-rated mental health was 16.7% and 20.3%, respectively. Suicide ideation was reported by 13.5% of participants, while 3.7% reported a suicide attempt. Quantity of greenness was similar between schools in the lower and upper quartiles. In logistic regressions, we found no association between objective school-based greenness and mental health, as assessed by multiple measures, both before and after adjustment. Null findings held true after stratification by season, as well. Whether other characteristics of school greenness (such as type, quality, or access and use) are more impactful to students' mental health should be a focus of future analyses.

At-a-glance - Supervised Injection Services: a community-based response to the opioid crisis in the City of Ottawa, Canada. / Aperçu - Services d'injection supervisée : mesure d'intervention communautaire en réponse à la crise des opioïdes à Ottawa (Canada).

In response to the current opioid crisis in Canada, establishing safe injection services (SIS) in high risk communities has become more prevalent. In November 2017, The Trailer opened in Ottawa, Canada and tracks client use, overdose treatment and overdoses reversed. We analyzed data collected between November 2017 and August 2018. During peak hours, demand for services consistently exceeded The Trailer's capacity. Overdoses treated and reversed in this facility increased substantially during this period. Results suggest The Trailer provided an important though not optimal (due to space restrictions) harm reduction service to this high-risk community.

The Trailer (supervised injection service) was established as a response to the opioid crisis in Ottawa, Canada. The Trailer offers a 24-hour service to clients. Overdose reversals during the tracking period increased significantly. The demand for services has consistently exceeded capacity.

La Roulotte (service d'injection supervisée) a été établie en réponse à la crise des opioïdes à Ottawa, Canada. La Roulotte offre un service 24 heures sur 24 aux clients. Le nombre d'inversions des effets d'une surdose effectuées a augmenté considérablement au cours de la période de suivi. La demande de services a constamment dépassé la capacité de La Roulotte.

Evaluating the utility of self-reported questionnaire data to screen for dysglycemia in young adults: Findings from the US National Health and Nutrition Examination Survey.

Dysglycemia, including prediabetes and type 2 diabetes, is dangerous and widespread. Yet, the condition is transiently reversible and sequelae preventable, prompting the use of prediction algorithms to quickly assess dysglycemia status through self-reported data. However, as current algorithms have largely been developed in older populations, their application to younger adults is uncertain considering associations between risk factors and dysglycemia vary by age. We sought to identify sex-specific predictors of current dysglycemia among young adults and evaluate their ability to screen for prediabetes and undiagnosed diabetes. We analyzed 2005-2014 data from the National Health and Nutrition Examination Survey for 3251 participants aged 20-39, who completed an oral glucose tolerance test (OGTT), had not been diagnosed with diabetes, and, for females, were not pregnant. Sex-specific stepwise logistic models were fit with predictors identified from univariate analyses. Risk scores were developed using adjusted odds ratios and model performance was assessed using area under the curve (AUC) measures. The OGTT identified 906 (27.9%) and 78 (2.4%) participants with prediabetes or undiagnosed diabetes, respectively. Predictors of dysglycemia status for males were BMI, age, race, and first-degree family history of diabetes, and, in addition to those, education, delivered baby weight, waist circumference, and vigorous physical activity for females. Our male- and female-specific models demonstrated improved validity to assess dysglycemia presence among young adults relative to the widely-used American Diabetes Association test (AUC = 0.69 vs. 0.61; 0.92 vs. 0.71, respectively). Thus, age-specific scoring algorithms employing questionnaire data show promise and are effective in identifying dysglycemia among young adults.

Effectiveness of the CANRISK tool in the identification of dysglycemia in a Canadian South Asian Population. / Efficacité de l'outil CANRISK pour détecter la dysglycémie au sein d'une population d'origine sud-asiatique au Canada.

INTRODUCTION: South Asians have a higher than average risk of developing type 2 diabetes. We ascertained the effectiveness of CANRISK, an existing diabetes risk assessment tool, examining its sensitivity and specificity at two different predetermined scoring cut-off points comparing those participants under the age of 40 and those 40 and over. We examined the predictive ability of a model based on CANRISK variables, comparing ethno-specific body mass index (BMI) and waist circumference (WC) cut-off points with the original BMI and WC cut-off points to see if predictive ability could be improved for this population. METHODS: Canadian South Asians of unknown diabetes status, age 18 to 78, were recruited across seven provinces from various community or health centers. CANRISK variables were collected followed by oral glucose tolerance testing. Descriptive analysis, logistic regression including alternative ethno-specific BMI and WC cut-off points, and sensitivity and specificity analyses were performed. RESULTS: 832 participants were recruited (584 under age 40). Using the entire study sample, logistic regression models including CANRISK variables predicted dysglycemia effectively (AUC of 0.80). However, by using alternative BMI/WC cut-off points with the scoring algorithm, predictive power via AUC was not improved. Sensitivity and specificity of CANRISK using the original pre-determined "high risk" cut-off point of 33 points in individuals age 40 years or over were 93% and 35%, respectively; in individuals under 40, these were 33% and 92%, respectively. Using the lower pre-determined "moderate risk" cut-off point of 21 points improved the sensitivity to 77% and specificity to 53% in the younger age group. CONCLUSION: The existing CANRISK is an adequate risk assessment tool for dysglycemia in Canadian South Asians for those age 40 years and over; however, the tool does not work as well for individuals under 40. The lower cut-off of 21 points may be warranted for younger individuals to minimize false negatives. Ethno-specific BMI/WC cutoff points did not improve predictive ability of the CANRISK scoring algorithm as measured by AUC.

INTRODUCTION: Les personnes d'origine sud-asiatique présentent un risque supérieur à la moyenne de développer un diabète de type 2. Nous avons vérifié l'efficacité de CANRISK, un outil d'évaluation du risque de diabète, en examinant sa sensibilité et sa spécificité en fonction de deux seuils de cotation différents prédéfinis et en comparant les participants de 40 ans et plus et ceux de moins de 40 ans. Nous avons examiné la valeur prédictive d'un modèle fondé sur les variables de CANRISK en comparant des seuils ethnospécifiques de l'indice de masse corporelle (IMC) et du tour de taille (TT) avec les seuils originaux d'IMC et de TT, afin de voir l'on pouvait améliorer cette valeur prédictive au sein de cette population. MÉTHODOLOGIE: On a recruté, dans diverses communautés et divers centres de santé de sept provinces, des Canadiens d'origine sud-asiatique âgés de 18 à 78 ans dont l'état diabétique était inconnu. On a recueilli les données de CANRISK puis réalisé une épreuve d'hyperglycémie provoquée par voie orale. On a procédé à une analyse descriptive, à une régression logistique incluant des seuils ethnospécifiques d'IMC et de TT et à des analyses de sensibilité et de spécificité. RÉSULTATS: On a recruté 832 participants (dont 584 de moins de 40 ans). Sur l'ensemble de l'échantillon, les modèles de régression logistique fondés sur les données de CANRISK ont prédit la dysglycémie de manière efficace (aire sous la courbe [ASC] de 0,80). En revanche, en utilisant différents seuils d'IMC et de TT avec l'algorithme de cotation, la valeur prédictive fondée sur l'ASC ne s'est pas améliorée. La sensibilité et la spécificité de CANRISK avec le seuil prédéterminé « risque élevé ¼ original à 33 points étaient de respectivement 93 % et 35 % chez les 40 ans ou plus et de respectivement 33 % et 92 % chez les moins de 40 ans. L'utilisation du seuil prédéterminé « risque modéré ¼ à 21 points a permis d'améliorer la sensibilité à 77 % et la spécificité à 53 % au sein du groupe d'âge plus jeune. CONCLUSION: Le questionnaire actuel CANRISK est un outil d'évaluation du risque adéquat pour la dysglycémie chez les Canadiens d'origine sud-asiatique âgés de 40 ans et plus, mais il ne fonctionne pas aussi bien pour les moins de 40 ans. Utiliser un seuil plus faible à 21 points est pertinent chez les plus jeunes afin de diminuer les faux négatifs. Les seuils d'IMC et de TT fondés sur l'origine ethnique n'ont pas permis d'améliorer la valeur prédictive de l'algorithme de cotation de CANRISK que mesure l'ASC.

Childhood cancer incidence in Canada: demographic and geographic variation of temporal trends (1992-2010). / Incidence du cancer chez les enfants au Canada : variations démographiques et géographiques des tendances (1992-2010).

INTRODUCTION: Surveillance of childhood cancer incidence trends can inform etiologic research, policy and programs. This study presents the first population-based report on demographic and geographic variations in incidence trends of detailed pediatric diagnostic groups in Canada. METHODS: The Canadian Cancer Registry data were used to calculate annual age-standardized incidence rates (ASIRs) from 1992 to 2010 among children less than 15 years of age by sex, age and region for the 12 main diagnostic groups and selected subgroups of the International Classification of Childhood Cancer (ICCC), 3rd edition. Temporal trends were examined by annual percent changes (APCs) using Joinpoint regression. RESULTS: The ASIRs of childhood cancer among males increased by 0.5% (95% confidence interval (CI) = 0.2-0.9) annually from 1992 to 2010, whereas incidence among females increased by 3.2% (CI = 0.4-6.2) annually since 2004 after an initial stabilization. The largest overall increase was observed in children aged 1-4 years (APC = 0.9%, CI = 0.4-1.3). By region, the overall rates increased the most in Ontario from 2006 to 2010 (APC = 5.9%, CI = 1.9-10.1), and increased non-significantly in the other regions from 1992 to 2010. Average annual ASIRs for all cancers combined from 2006 to 2010 were lower in the Prairies (149.4 per million) and higher in Ontario (170.1 per million). The ASIRs increased for leukemias, melanoma, carcinoma, thyroid cancer, ependymomas and hepatoblastoma for all ages, and neuroblastoma in 1-4 year olds. Astrocytoma decreased in 10-14 year olds (APC = -2.1%, CI = -3.7 to -0.5), and among males (APC = -2.4%, CI = -4.6 to -0.2) and females (APC = -3.7%, CI = -5.8 to -1.6) in Ontario over the study period. CONCLUSION: Increasing incidence trends for all cancers and selected malignancies are consistent with those reported in other developed countries, and may reflect the changes in demographics and etiological exposures, and artefacts of changes in cancer coding, diagnosis and reporting. Significant decreasing trend for astrocytoma in late childhood was observed for the first time.

INTRODUCTION: La surveillance des tendances de l'incidence du cancer chez les enfants peut éclairer la recherche, les politiques et les programmes en matière d'étiologie. Cette étude donne lieu au premier rapport sur les variations démographiques et géographiques des tendances de l'incidence de groupes diagnostiques détaillés chez les enfants de la population générale au Canada. MÉTHODOLOGIE: Les données du Registre canadien du cancer ont servi à calculer les taux d'incidence normalisés selon l'âge (TINA) annuels de 1992 à 2010 chez les enfants de moins de 15 ans selon le sexe, l'âge et la région pour les 12 principaux groupes et certains sous­groupes diagnostiques de la 3e édition de la Classification internationale du cancer chez les enfants (CICE). Les tendances temporelles ont été examinées à partir des variations annuelles en pourcentage (VAP) au moyen d'une régression Joinpoint. RÉSULTATS: Les TINA annuels du cancer chez les enfants ont augmenté de 0,5 % (intervalle de confiance [IC] à 95 % = 0,2 à 0,9) chez les garçons chaque année entre 1992 et 2010, tandis que l'incidence chez les filles a augmenté de 3,2 % (IC = 0,4 à 6,2) chaque année depuis 2004 après une stabilisation initiale. L'augmentation globale la plus importante a été observée chez les enfants de 1 à 4 ans (VAP = 0,9 %, IC = 0,4 à 1,3). Par région, c'est en Ontario entre 2006 et 2010 que les taux globaux ont le plus augmenté (VAP = 5,9 %, IC = 1,9 à 10,1) et ils ont augmenté de façon non significative dans les autres régions entre 1992 et 2010. On a mesuré en 2006-2010 les TINA annuels moyens de tous les cancers confondus les plus faibles dans les Prairies (149,4 pour 1 million) et les plus élevés en Ontario (170,1 pour 1 million). Les TINA des leucémies, du mélanome, des carcinomes, du cancer de la thyroïde, des épendymomes et de l'hépatoblastome ont augmenté dans tous les groupes d'âge, et les TINA du neuroblastome ont augmenté chez les enfants de 1 à 4 ans. L'incidence de l'astrocytome a diminué chez les enfants de 10 à 14 ans (VAP = −2,1 %, IC = −3,7 à −0,5) ainsi que chez les garçons (VAP = −2,4 %, IC = −4,6 à −0,2) et les filles (VAP = −3,7 %, IC = −5,8 à −1,6) en Ontario au cours de la période étudiée. CONCLUSION: Les tendances à la hausse de l'incidence de tous les cancers confondus et de certaines tumeurs malignes correspondent aux tendances signalées dans d'autres pays développés. Elles sont explicables par des variations démographiques, par des variations de l'exposition aux facteurs étiologiques ou par des changements apportés aux méthodes de codification, de diagnostic et de déclaration du cancer. Une baisse significative de la tendance de l'astrocytome chez les 10 à 14 ans a été observée pour la première fois.

Effectiveness of the CANRISK tool in the identification of dysglycemia in First Nations and Métis in Canada. / Efficacité de l'outil CANRISK pour détecter la dysglycémie chez les membres des Premières Nations et les Métis au Canada.

INTRODUCTION: First Nations/Métis populations develop diabetes earlier and at higher rates than other Canadians. The Canadian diabetes risk questionnaire (CANRISK) was developed as a diabetes screening tool for Canadians aged 40 years or over. The primary aim of this paper is to assess the effectiveness of the existing CANRISK tool and risk scores in detecting dysglycemia in First Nations/Métis participants, including among those under the age of 40. A secondary aim was to determine whether alternative waist circumference (WC) and body mass index (BMI) cut-off points improved the predictive ability of logistic regression models using CANRISK variables to predict dysglycemia. METHODS: Information from a self-administered CANRISK questionnaire, anthropometric measurements, and results of a standard oral glucose tolerance test (OGTT) were collected from First Nations and Métis participants (n = 1479). Sensitivity and specificity of CANRISK scores using published risk score cut-off points were calculated. Logistic regression was conducted with alternative ethnicity-specific BMI and WC cut-off points to predict dysglycemia using CANRISK variables. RESULTS: Compared with OGTT results, using a CANRISK score cut-off point of 33, the sensitivity and specificity of CANRISK was 68% and 63% among individuals aged 40 or over; it was 27% and 87%, respectively among those under 40. Using a lower cut-off point of 21, the sensitivity for individuals under 40 improved to 77% with a specificity of 44%. Though specificity at this threshold was low, the higher level of sensitivity reflects the importance of the identification of high risk individuals in this population. Despite altered cut-off points of BMI and WC, logistic regression models demonstrated similar predictive ability. CONCLUSION: CANRISK functioned well as a preliminary step for diabetes screening in a broad age range of First Nations and Métis in Canada, with an adjusted CANRISK cutoff point for individuals under 40, and with no incremental improvement from using alternative BMI/WC cut-off points.

INTRODUCTION: Le diabète touche en plus grande proportion et à un plus jeune âge la population des Premières Nations et des Métis que le reste de la population canadienne. Cet article vise principalement à évaluer l'efficacité et les scores de risque de CANRISK (Questionnaire canadien sur le risque de diabète, un outil de dépistage du diabète destiné aux Canadiens de 40 ans et plus) pour détecter la dysglycémie chez les participants issus des Premières Nations et d'origine métisse en incluant les moins de 40 ans. L'objectif secondaire de cette étude est de déterminer si une modification des seuils relatifs au tour de taille (TT) et à l'indice de masse corporelle (IMC) améliore la valeur prédictive de modèles de régression logistique lorsque les variables du questionnaire CANRISK sont utilisées pour prédire la dysglycémie. MÉTHODOLOGIE: Nous avons recueilli auprès de 1479 participants métis et des Premières Nations des données provenant d'un questionnaire CANRISK autoadministré, de mesures anthropométriques et de résultats d'épreuve standard d'hyperglycémie provoquée par voie orale (HGPO). Nous avons calculé la sensibilité et la spécificité des scores CANRISK en appliquant les seuils usuels de classification des risques. Une régression logistique a été effectuée en utilisant des seuils tenant compte de l'origine ethnique pour l'IMC et le TT pour prédire la dysglycémie à l'aide des variables CANRISK. RÉSULTATS: Appliqué aux résultats de l'épreuve d'HGPO, le score seuil CANRISK à 33 points a conduit à une sensibilité et une spécificité de l'outil CANRISK de respectivement 68 % et 63 % chez les 40 ans et plus, et de respectivement 27 % et 87 % chez les moins de 40 ans. L'utilisation d'un seuil inférieur, à 21 points, a fait monter à 77 % la sensibilité chez les moins de 40 ans, avec une spécificité de 44 %. Malgré la faible spécificité correspondant à ce seuil, l'augmentation de la sensibilité montre son importance à identifier les personnes à risque au sein de cette population. Après modification des seuils d'IMC et de TT, les modèles de régression logistique ont présenté une valeur prédictive comparable. CONCLUSION: L'utilisation du questionnaire CANRISK s'est révélée efficace comme première étape de dépistage du diabète chez les membres des Premières Nations et les Métis d'un large éventail d'âge au Canada, dans la mesure où le seuil CANRISK a été adapté aux moins de 40 ans, et sans que l'on constate d'amélioration différentielle en modifiant les seuils d'IMC et de TT.

Ethnic dependent differences in diagnostic accuracy of glycated hemoglobin (HbA1c) in Canadian adults.

AIM: Previous studies have shown varying sensitivity and specificity of hemoglobin A1c (HbA1c) to identify diabetes and prediabetes, compared to 2-h oral glucose tolerance testing (OGTT) and fasting plasma glucose (FPG), in different ethnic groups. Within the Canadian population, the ability of HbA1c to identify prediabetes and diabetes in First Nations, Métis and Inuit, East and South Asian ethnic groups has yet to be determined. METHODS: We collected demographic, lifestyle information, biochemical results of glycemic status (FPG, OGTT, and HbA1c) from an ethnically diverse Canadian population sample, which included a purposeful sampling of First Nations, Métis, Inuit, South Asian and East Asian participants. RESULTS: Sensitivity and specificity using Canadian Diabetes Association (CDA) recommended cut-points varied between ethnic groups, with greater variability for identification of prediabetes than diabetes. Dysglycemia (prediabetes and diabetes) was identified with a sensitivity and specificity ranging from 47.1% to 87.5%, respectively in Caucasians to 24.1% and 88.8% in Inuit. Optimal HbA1c ethnic-specific cut-points for dysglycemia and diabetes were determined by receiver operating characteristic (ROC) curve analysis. CONCLUSIONS: Our sample showed broad differences in the ability of HbA1c to identify dysglycemia or diabetes in different ethnic groups. Optimal cut-points for dysglycemia or diabetes in all ethnic groups were substantially lower than CDA recommendations. Utilization of HbA1c as the sole biochemical diagnostic marker may produce varying degrees of false negative results depending on the ethnicity of screened individuals. Further research is necessary to identify and validate optimal ethnic specific cut-points used for diabetic screening in the Canadian population.

Assessment of dysglycemia risk in the Kitikmeot region of Nunavut: using the CANRISK tool. / Évaluation du risque de dysglycémie dans la région de Kitikmeot (Nunavut) au moyen de l'outil CANRISK.

INTRODUCTION: The Public Health Agency of Canada adapted a Finnish diabetes screening tool (FINDRISC) to create a tool (CANRISK) tailored to Canada's multi-ethnic population. CANRISK was developed using data collected in seven Canadian provinces. In an effort to extend the applicability of CANRISK to northern territorial populations, we completed a study with the mainly Inuit population in the Kitikmeot region of Nunavut. METHODS: We obtained CANRISK questionnaires, physical measures and blood samples from participants in five Nunavut communities in Kitikmeot. We used logistic regression to test model fit using the original CANRISK risk factors for dysglycemia (prediabetes and diabetes). Dysglycemia was assessed using fasting plasma glucose (FPG) alone and/or oral glucose tolerance test. We generated participants' CANRISK scores to test the functioning of this tool in the Inuit population. RESULTS: A total of 303 individuals participated in the study. Half were aged less than 45 years, two-thirds were female and 84% were Inuit. A total of 18% had prediabetes, and an additional 4% had undiagnosed diabetes. The odds of having dysglycemia rose exponentially with age, while the relationship with BMI was U-shaped. Compared with lab test results, using a cut-off point of 32 the CANRISK tool achieved a sensitivity of 61%, a specificity of 66%, a positive predictive value of 34% and an accuracy rate of 65%. CONCLUSION: The CANRISK tool achieved a similar accuracy in detecting dysglycemia in this mainly Inuit population as it did in a multi-ethnic sample of Canadians. We found the CANRISK tool to be adaptable to the Kitikmeot region, and more generally to Nunavut.

INTRODUCTION: L'Agence de la santé publique du Canada a adapté un outil finlandais de dépistage du diabète (FINDRISC) dans le but de créer un outil, CANRISK, conçu sur mesure pour la population multiethnique du Canada. Cet outil a été élaboré à partir de données recueillies dans sept provinces canadiennes. Dans le but d'élargir son applicabilité aux populations des territoires nordiques, nous avons réalisé une étude auprès de la population majoritairement inuite de la région de Kitikmeot (Nunavut). MÉTHODOLOGIE: Nous avons recueilli des questionnaires CANRISK, des mesures physiques et des échantillons de sang auprès de participants vivant dans cinq collectivités de la région de Kitikmeot. Nous avons utilisé une régression logistique pour évaluer l'ajustement du modèle à l'aide des facteurs de risque de l'outil CANRISK d'origine associés à la dysglycémie (prédiabète et diabète). La dysglycémie a été évaluée au moyen d'un test de glycémie plasmatique à jeun (GPJ) administré seul ou avec une épreuve d'hyperglycémie provoquée par voie orale. Nous avons mis au point les scores CANRISK des participants pour tester le fonctionnement de cet outil au sein d'une population inuite. RÉSULTATS: Au total, 303 personnes ont participé à l'étude. La moitié d'entre elles avaient moins de 45 ans, les deux tiers étaient des femmes et 84 % étaient inuites. Sur les 303 participants, 18 % étaient atteints de prédiabète et 4 % avaient un diabète non diagnostiqué. La probabilité de présenter un état dysglycémique augmentait de façon exponentielle avec l'âge et la relation avec l'indice de masse corporelle (IMC) suivait une courbe en U. Par rapport aux résultats d'analyse en laboratoire, l'outil CANRISK avec un seuil de 32 points a présenté une sensibilité de 61 %, une spécificité de 66 %, une valeur prédictive positive de 34 % et un taux d'exactitude de 65 %. CONCLUSION: L'outil CANRISK a permis de détecter la dysglycémie au sein de cette population très majoritairement inuite avec une exactitude comparable à celle obtenue avec un échantillon de Canadiens présentant une diversité multiethnique. L'outil CANRISK est donc utilisable pour la région de Kitikmeot, et plus généralement au Nunavut.

A Case-Control Study of Risk Factors for Salivary Gland Cancer in Canada.

Aim. To assess the effect of various lifestyle risk factors on the risk of salivary gland cancer in Canada using data from a population-based case-control study. Methods. Data from a population-based case-control study of 132 incident cases of salivary gland cancer and 3076 population controls were collected through self-administered questionnaire and analysed using unconditional logistic regression. Results. Four or more servings/week of processed meat product was associated with an adjusted odds ratio (OR) and corresponding 95% confidence interval (CI) of 1.62 (1.02-2.58). Nonsignificantly increased ORs were also related to obesity, >7 drinks/week of alcohol consumption, and occupational exposure to radiation. Furthermore, nonsignificantly decreased ORs were found to be associated with high education level (>12 years) (OR = 0.65), high consumption of spinach/squash (OR = 0.62) and all vegetables/vegetable juices (OR = 0.75), and >30 sessions/month of recreational physical activity (OR = 0.78). Conclusions. This study suggests positive associations with consumption of processed meat, smoking, obesity, alcohol drinking, and occupational exposure to radiation as well as negative associations with higher education, consumption of spinach/squash, and physical activity, which suggest a role of lifestyle factors in the etiology of salivary gland cancer. However, these findings were based on small number of cases and were nonsignificant. Further larger studies are warranted to confirm our findings.

The Impact of Using Different Methods to Assess Completeness of 24-Hour Urine Collection on Estimating Dietary Sodium.

The standard for population-based surveillance of dietary sodium intake is 24-hour urine testing; however, this may be affected by incomplete urine collection. The impact of different indirect methods of assessing completeness of collection on estimated sodium ingestion has not been established. The authors enlisted 507 participants from an existing community study in 2009 to collect 24-hour urine samples. Several methods of assessing completeness of urine collection were tested. Mean sodium intake varied between 3648 mg/24 h and 7210 mg/24 h depending on the method used. Excluding urine samples collected for longer or shorter than 24 hours increased the estimated urine sodium excretion, even when corrections for the variation in timed collections were applied. Until an accurate method of indirectly assessing completeness of urine collection is identified, the gold standard of administering para-aminobenzoic acid is recommended. Efforts to ensure participants collect complete urine samples are also warranted.

Preface.

TITRE: Préface. INTRODUCTION: Ce rapport présente une estimation jusqu'en 2032 du fardeau du cancer pour l'ensemble du Canada ainsi que pour les provinces et les territoires. Ces estimations sont fondées sur les tendances actuelles et, compte tenu de la période de latence de la plupart des cancers, ne sont pas déraisonnables. Le document fournit des points de repère actualisés permettant de mesurer les progrès réalisés et devrait se révéler utile pour la lutte contre le cancer et la planification des soins.