Le cancer de la prostate est le cancer le plus fréquemment diagnostiqué chez les hommes canadiens. Aucun facteur de risque modifiable n’a été identifié, mais l’alimentation pourrait être impliquée. Les profils alimentaires, décrivant l’ensemble de l’apport alimentaire, constituent une approche de recherche prometteuse. L’objectif général de cette thèse était d’évaluer le rôle des profils alimentaires et du niveau de transformation des aliments sur le risque de cancer de la prostate. Les données colligées dans une vaste étude cas-témoins populationnelle menée chez les résidents montréalais ont été utilisées. Les 1919 cas incidents histologiquement confirmés étaient âgés de 75 ans ou moins et avaient été diagnostiqués entre 2005 et 2009. Les 1991 témoins ont été sélectionnés aléatoirement à partir de la liste électorale, puis appariés aux cas selon l’âge (± 5 ans). Les informations concernant l’alimentation ont été recueillies avec un questionnaire de fréquence alimentaire documentant la consommation deux ans avant le diagnostic ou l’entrevue. Le premier objectif visait à identifier des profils alimentaires parmi les témoins francophones ainsi que les caractéristiques associées à ces profils. Une analyse en composantes principales a permis d’identifier les profils alimentaires Santé, Occidental modifié - Salé et Occidental modifié - Sucré. Le profil Santé a été associé à des niveaux plus élevés de revenu et d’éducation, à un niveau modéré d’activité physique et à un faible niveau de tabagisme. Le profil Occidental modifié - Salé a été associé avec des ethnicités française, européenne (autre que française) ou latine, avec le fait d’être marié ou en union libre, et était inversement associé avec l’âge. Le profil Occidental modifié - Sucré était plus commun chez les hommes d’origine française et chez les consommateurs de suppléments de vitamines et minéraux. Le deuxième objectif visait à évaluer les associations entre les profils alimentaires et le cancer de la prostate. Les rapports de cotes (RC) et intervalles de confiance (IC) à 95% ont été obtenus par régression logistique non conditionnelle ajustée pour les facteurs de confusion. Le profil Santé était inversement associé au risque de cancer de la prostate (RC= 0,76 [IC 95% = 0,61-0,93], en comparant le quartile supérieur au quartile inférieur). Le profil Occidental - Sucré et Boissons était associé à une augmentation du risque de cancer de la prostate (RC= 1,35 [IC 95% =1,10-1,66], quartile supérieur vs inférieur). Ces résultats sont novateurs. Aucune association n’a été observée avec le profil Occidental - Salé et Alcool. Le troisième objectif visait à évaluer l’association entre le niveau de transformation des aliments et le cancer de la prostate. Les aliments transformés étaient associés à une augmentation du risque (RC= 1,32 [IC 95% =1,07-1,62], quartile supérieur vs inférieur) et l’association était légèrement plus prononcée pour les cancers agressifs. En conclusion, ces résultats suggèrent que les profils alimentaires et le niveau de transformation des aliments jouent un rôle dans le développement du cancer de la prostate. Il s’agit d’informations importantes pour soutenir la promotion de saines habitudes de vie et la prévention du cancer de la prostate. / Prostate cancer is the most commonly diagnosed cancer among men in Canada. No modifiable risk factor has been identified, but diet is suspected to play a role. Dietary patterns, which describe the overall dietary intake rather than the consumption of specific foods or nutrients, represent a promising research approach. The general objective of this thesis was to assess the role of dietary patterns and the level of food processing on the risk of prostate cancer. Data collected in a large population-based case-control study conducted among Montreal residents were used. The 1919 histologically confirmed incident cases were 75 years of age or younger and had been diagnosed between 2005 and 2009. Concurrently, the 1991 controls were randomly selected from the electoral list and frequency-matched to cases by age (± 5 years). Food consumption was assessed using a food frequency questionnaire focusing on the period two years before diagnosis or interview. The first objective was to identify dietary patterns among the French-speaking controlsas well as the characteristics associated with these patterns. Principal component analysis led to the identification of three dietary patterns: Healthy, Western modified - Salty and Western modified - Sweet. The Healthy pattern was associated with higher income, education, moderate levels of recreational physical activity and lower levels of smoking. The Western modified – Salty pattern was positively associated with French, other European (other than French), and Latino ancestries, and with married and common-law relationships, whereas it was inversely associated with age. Finally, the Modified Western – Sweet pattern was more common among men of French ancestry and users of vitamin/mineral supplements. The second objective was to assess associations between the different dietary patterns and prostate cancer. Odds ratios (OR) and 95% confidence interval (95% CI) were obtained by unconditional logistic regression adjusting for confounders. The Healthy dietary pattern was inversely associated with prostate cancer (OR = 0,76 [95% CI = 0,61-0,93], highest vs lowest quartile), whereas the Western - Sweet and beverages pattern increased the risk of this cancer (OR = 1,35 [95% CI = 1,10-1,66], highest vs lowest quartile). Both results are novel. The Western - Salty and alcohol pattern was not associated with prostate cancer risk. The third objective was to assess the association between the level of food processing and prostate cancer. The level of food processing in the diet was assigned using the NOVA food classification. Processed foods were associated with an increased risk (OR = 1,32 [95% CI] = 1,07-1,62], highest vs lowest quartile) of prostate cancer, and the association was slightly more pronounced for high-grade prostate cancers. In conclusion, these results suggest that dietary patterns and the level of food processing play a role on the risk of developing prostate cancer. This information is important for promoting a healthy lifestyle and for prostate cancer prevention.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Lyme disease is an emerging tick-borne illness in Canada, with human case numbers increasing 15- to 20-fold since Lyme disease became nationally notifiable in 2009 until the present. In Ontario, Canada's largest province by population, average Lyme disease incidence across the province is similar to that of national estimates. However, in eastern Ontario, which is near tick endemic regions in the northeastern Unites States, Lyme disease incidence is disproportionately higher compared to the rest of the province. The objectives of this thesis are to identify environmental Lyme disease risk areas in Ontario, to explore spatiotemporal trends in Lyme disease emergence, and to identify neighbourhood-level socioecological risk factors for Lyme disease. In addition, this thesis also aims to assess the risk of other tick-borne illnesses that are transmitted by the blacklegged tick, Ixodes scapularis, which is also the main vector for Lyme disease in Canada. Using maximum entropy species distribution modelling to correlate blacklegged tick occurrence data with environmental variables, predictive risk models for I. scapularis and the Lyme disease pathogen, Borrelia burgdorferi, were developed. The model prediction was used to classify low and high environment risk areas and, using a case-control epidemiological study, we assessed that residence in risk areas was a strong predictor of Lyme disease. However, this relationship was modulated by socioecological factors linked to higher overall rurality of the locality of home residence. Spatial cluster analyses further revealed that human Lyme disease cases clustered in regions with the high numbers of reported B. burgdorferi-infected ticks in the environment. Many individuals residing in large metropolitan regions, like the City of Ottawa, reported tick exposures outside their public health unit of residence; however, local clusters of Lyme disease were also detected in suburban regions near conservation areas, trails, and urban woodlands. The prevalence of other tick-borne pathogens was low, although several pathogens of public health significance including Borrelia miyamotoi and Anaplasma phagocytophilum were detected at multiple sites surveyed for ticks between 2017-2021. Overall, this thesis identify patterns in Lyme disease emergence (and potentially other tick-borne illnesses), defines environmental risk areas for Lyme disease in Ontario, and highlights important socioecological risk factors for Lyme disease in eastern Ontario.

The comprehensive cancer control approach is used by state, tribes, tribal organizations, territorial and Pacific Island Jurisdiction cancer coalitions to spur local implementation of cancer plans to reduce the burden of cancer in jurisdictions across the country. There is a rich diversity of models and approaches to the development of relationships and scope of planning for cancer control activities between coalitions and advocates in local communities. The national comprehensive cancer control philosophy provides an operational framework while support from the Centers for Disease Control and Prevention enables coalitions to act as catalysts to bring local partners together to combat cancer in communities. This manuscript describes multiple characteristics of cancer coalitions and how they are organized. Two models of how coalitions and local partners collaborate are described. A case study method was used to identify how five different state and tribal coalitions use the two models to organize their collaborations with local communities that result in local implementation of cancer plan priorities. Conclusions support the use of multiple organizing models to ensure involvement of diverse interests and sensitivity to local cancer issues that encourages implementation of cancer control activities.

Contexte: Les agents de nettoyage sont des substances qui aident l'eau dans le processus de nettoyage. Les biocides comprennent les substances utilisées pour désinfecter, désodoriser, stériliser et assainir. L'utilisation d'agents de nettoyage, de biocides et d'autres produits liés au nettoyage est omniprésente. Certaines études suggèrent que l'exposition professionnelle à des substances liées au nettoyage peut être associée au cancer du poumon. Objectif: Examiner l'association entre le risque de cancer du poumon et l'exposition professionnelle aux agents de nettoyage, aux biocides et à d'autres agents de nettoyage. Méthodes: Cette étude utilise les données de deux études cas-témoins basées sur la population sur le cancer du poumon (étude 1: 1979-1986; étude 2: 1996-2001) menées à Montréal. Dans les deux études, les cas comprenaient des hommes ayant reçu un diagnostic de cancer du poumon confirmé histologiquement dans 18 hôpitaux métropolitains de Montréal. Dans les deux études, un ensemble de témoins de population sélectionnés au hasard à partir de la liste électorale du Québec a été établi (étude 2: 762 cas et 899 témoins); tandis que dans l'étude 1, un groupe témoin de cancer supplémentaire a été sélectionné à partir d'un groupe d'autres patients diagnostiqués avec un autre cancer incident (857 cas, 533 témoins de population, 1349 témoins de cancer). Dans les deux études, des antécédents professionnels détaillés ont été recueillis au cours des entretiens; une équipe de chimistes et d'hygiénistes industriels a ensuite évalué l'exposition professionnelle à de nombreuses substances professionnelles, notamment des agents de nettoyage, des biocides, des alcools aliphatiques, de l'ammoniac, de la soude caustique, des cires et des produits de polissage. Une régression logistique multivariée nonconditionnelle a été utilisée pour estimer les ratios des côtes et les intervalles de confiance à 95% du risque de cancer du poumon associé à diverses mesures de l'exposition professionnelle à ces six agents, tout en ajustant pour les facteurs de risque établis. Les interactions selon l'intensité du tabagisme et l'état d'asthme ont été explorées avec l'inclusion de termes de produits croisés. Résultats: Dans l'ensemble, il n'y avait pas d'association cohérente soutenant le rôle de l'exposition professionnelle aux agents de nettoyage, aux biocides et à d'autres agents de nettoyage dans l'étiologie du cancer du poumon. Bien qu'il y ait eu des preuves que l'intensité du tabagisme peut modifier l'association entre la soude caustique et le risque de cancer du poumon dans l'étude 1; où, chez les fumeurs de faible intensité, une augmentation du risque par trois a été observée par rapport à une association nulle observée chez les fumeurs d'intensité moyenne à forte (pInteraction=0,03). Alors que, dans l'étude 2, les personnes exposées professionnellement à des alcools aliphatiques et qui ont déjà souffert d'asthme ont connu quatre fois du risque de cancer du poumon par rapport à une association nulle observée chez ceux qui n'ont jamais eu d'asthme (pInteraction = 0,04). Conclusion: Pris ensemble, les résultats de cette étude ne soutiennent pas le rôle de l'exposition professionnelle aux agents de nettoyage, aux biocides et à d'autres produits de nettoyage dans l'étiologie du cancer du poumon. / Background: Cleaning agents are materials that aid water in the cleaning process. Biocides include materials used to disinfect, deodorize, sterilize, and sanitize. The use of cleaning agents, biocides, and other cleaning-related agents is ubiquitous. Some studies suggest that occupational exposure to cleaning-related substances may be associated with lung cancer. Objective: To examine the association between lung cancer risk and occupational exposure to cleaning-related agents. Methods: This study uses data from two population-based case-control studies on lung cancer (Study 1: 1979-1986; Study 2: 1996-2001) carried out in Montreal. In both studies, cases included men diagnosed with incident histologically confirmed lung cancer identified across 18 Montreal metropolitan hospitals. In both studies, a set of population-based controls randomly selected from the Quebec electoral list was established (Study 2: 762 cases and 899 controls); while in Study 1, an additional cancer control group was selected from a pool of other patients diagnosed with incident cancer (857 cases, 533 population controls, 1349 cancer controls). In both studies, detailed lifetime job histories were collected during interviews; a team of chemists and industrial hygienists then evaluated occupational exposure to many occupational substances including cleaning agents, biocides, aliphatic alcohols, ammonia, caustic soda, and waxes and polishes. Unconditional multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals for lung cancer risk associated with various metrics of occupational exposure to these six agents, while adjusting for established risk factors. Interactions by smoking intensity and asthma status were explored with the inclusion of cross-product terms. Results: Overall, there was no consistent association supporting a role of occupational exposure to cleaning agents, biocides, and other cleaning-related agents in lung cancer etiology. Though there was some evidence that smoking intensity may modify the association between caustic soda and lung cancer risk in Study 1, where, among never-low intensity smokers, a threefold increase in risk was observed in comparison to a null association observed among medium-heavy intensity smokers (pInteraction=0.03). While, in Study 2, those occupationally exposed to aliphatic alcohols and who have ever had asthma experienced a four-fold increase in lung cancer risk in comparison to a null association observed among those who have never had asthma (pInteraction = 0.04). Conclusion: Taken together, the results of this study do not support the role of occupational exposure to cleaning agents, biocides, and other cleaning-related agents in lung cancer etiology.

Objectif Estimer les associations entre les expositions professionnelles aux fibres/poussières textiles et le risque de cancer du sein post-ménopausique. Méthodes Une étude cas-témoins populationnelle menée à Montréal (20082011) a identifié les cas incidents (N=695) dans les hôpitaux et les témoins (appariés par groupe d’âge) sur la liste électorale provinciale (N=608). Les renseignements sur leurs facteurs de risque personnels et leurs antécédents professionnels ont été recueillis lors d’entrevues. Des hygiénistes du travail ont évalué ces antécédents afin d’attribuer des expositions professionnelles à plusieurs fibres naturelles et synthétiques. Les indices d'exposition calculés comprenaient: toute exposition antérieure (exposée/non-exposée), intensité cumulative moyenne d’exposition et exposition cumulative moyenne. Pour l’ensemble des tumeurs et selon leur classification biomoléculaire, une régression logistique a été utilisée pour calculer les rapports de cotes (RC) et les intervalles de confiance à 95% (IC95%), avec différents modèles incluant divers facteurs de confusion. Des analyses de sensibilité ont permis d’évaluer la robustesse des estimations. Résultats Une association a été trouvée pour toute exposition antérieure au polyester (RCmodèle8=0,55; IC95%:0,33-0,91). Quelques tendances ont été trouvées pour le même indice d’exposition avec les fibres synthétiques (RCmodèle8=0,63; IC95%:0,38-1,05) et le coton (RCmodèle8=1,42; IC95%:0,95-2,16), et, dans une analyse de sensibilité n’incluant que les expositions avant l'âge de 36 ans ou la première grossesse à terme, avec les fibres naturelles (RCmodèle8=1,59; IC95%:0,95-2,74) et les fibres traitées (RCmodèle2=1,39; IC95%:0,97-2,01). L’analyse par sous-type biomoléculaire n’a révélé aucune tendance. Conclusion Notre étude suggère la possibilité d’associations entre l’exposition professionnelle à certaines fibres textiles et le risque de cancer du sein post-ménopausique. / Objective To estimate the associations between occupational exposures to textile fibers/dusts, and postmenopausal breast cancer risk. Methods A population-based case-control study conducted in Montreal (20082011) identified incident cases (N = 695) in hospitals and frequency age-matched controls from the provincial electoral list (N = 608). Information on subjects’ personal risk factors and occupational history were collected through interviews. Occupational hygienists assessed these histories to attribute occupational exposures to several natural and synthetic fibers. Exposure indices included: any previous exposure (exposed/unexposed), average cumulative intensity of exposure and average cumulative exposure, among others. For all tumors and according to their biomolecular classification, logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95%CI), with different models including various confounders. Sensitivity analyses were used to assess the robustness of the estimates. Results An association was found for any previous exposure to polyester (ORmodel8=0.55; 95%CI: 0.33-0.91). Some trends were found for the same exposure index with synthetic fibers (ORmodel8=0.63; 95%CI: 0.38-1.05) and cotton (ORmodel8=1.42, 95%CI: 0.95-2.16), and, in the sensitivity analysis including only exposures before the age of 36 or before the first full-term pregnancy, with natural fibers (ORmodel8=1.59; 95%CI: 0.95-2.74) and treated textile fibers (ORmodel2=1.39; 95%CI: 0.97-2.01). Analysis by tumor biomolecular subtype revealed no differences. Conclusion Our study suggests possible associations between occupational exposure to certain textile fibers and postmenopausal breast cancer risk.

No description available.

Contexte. L’insuffisance cardiaque (IC) touche 1 à 2% de la population et sa prévalence menace d’augmenter dans la population vieillissante. L’IC et ses nombreux facteurs de risque ont une forte composante héréditaire. Il existe plusieurs phénotypes d’IC qui se démarquent par leurs mécanismes physiopathologiques et leur pronostic. Objectif. Ce mémoire vise dans un premier temps à faire état des connaissances actuelles sur la pharmacogénomique de l’IC et, dans un deuxième temps, à décrire une cohorte de patients atteints d’IC montée dans la cadre d’une étude cas-contrôle. Les caractéristiques descriptives de différents sous-groupes de patients sont présentées et comparées avec les données épidémiologiques actuelles. Résultats. 829 patients atteints d’IC qui ont participé au projet de la Biobanque de l’Institut de cardiologie de Montréal étaient éligibles à notre étude. L’âge moyen de ces cas est de 66,1 ± 10,2 ans et 76,6% sont des hommes. La fraction d’éjection du ventricule gauche (FEVG) médiane est 38% (intervalle interquartile : 28–52%) et 55,0% des cas sont d’étiologie ischémique. L’IC à FEVG réduite représente 55,4% des sujets; les phénotypes d’IC à FEVG intermédiaire et préservée représentent 11,2% et 33,4%, respectivement. Conclusion. Le phénotype d’IC à FEVG préservée est sous-représenté dans notre cohorte par rapport à ce qui est décrit dans la littérature scientifique, avec un nombre plus élevé d’hommes et l’étiologie ischémique majoritaire. Ceci s’explique par le fait que l’Institut de cardiologie est un centre référent de greffe. Toutefois, les caractéristiques des principaux phénotypes d’IC concordent avec la littérature scientifique, ce qui suggère que les phénotypes d’IC dans notre cohorte sont représentatifs de ces sous-populations. / Context. Heart failure (HF) affects 1 to 2% of the population and its prevalence is expected to increase in the aging population. Recent evidence suggests that HF and associated risk factors are heritable. HF has multiple phenotypes each associated with different risk factors, pathophysiology and prognosis. Objective. This project presents the current knowledge on HF pharmacogenomics found in the scientific literature and describes a cohort of HF patients who participated in a case-control study. The characteristics of different subgroups are presented and compared to current epidemiologic data. Results. We recruited 829 HF patients who participated in the Montreal Heart Institute biobank project. The mean age is 66,1 ± 10,2 years and 76,6% are male. The median left ventricular ejection fraction (LVEF) is 38% (interquartile range: 28–52%) and ischemic etiology accounts for 55,0% of HF cases. The HF with a reduced LVEF phenotype represents 55,4% of participants while 11,2% and 33,4% of cases have HF with a mid-range LVEF and HF with a preserved LVEF, respectively. Conclusion. The HF with a preserved LVEF phenotype was underrepresented in our cohort compared to what is expected in the scientific literature. We report more men and ischemic etiology, which could be explained by the fact that the Montreal Heart Institute is a reference center for transplantation. Characteristics of the major HF phenotypes are consistent with those reported in the scientific literature, thus suggesting that our cohort is representative of these sub-groups.

No / BACKGROUND: The potential pathogenesis between the presence and severity of chronic cerebrospinal venous insufficiency (CCSVI) and its relation to clinical and imaging outcomes in brain parenchyma of multiple sclerosis (MS) patients has not yet been elucidated. The aim of the study was to investigate the relationship between CCSVI, and altered brain parenchyma venous vasculature visibility (VVV) on susceptibility-weighted imaging (SWI) in patients with MS and in sex- and age-matched healthy controls (HC). METHODS: 59 MS patients, 41 relapsing-remitting and 18 secondary-progressive, and 33 HC were imaged on a 3T GE scanner using pre- and post-contrast SWI venography. The presence and severity of CCSVI was determined using extra-cranial and trans-cranial Doppler criteria. Apparent total venous volume (ATVV), venous intracranial fraction (VIF) and average distance-from-vein (DFV) were calculated for various vein mean diameter categories: < .3 mm, .3-.6 mm, .6-.9 mm and > .9 mm. RESULTS: CCSVI criteria were fulfilled in 79.7% of MS patients and 18.2% of HC (p < .0001). Patients with MS showed decreased overall ATVV, ATVV of veins with a diameter < .3 mm, and increased DFV compared to HC (all p < .0001). Subjects diagnosed with CCSVI had significantly increased DFV (p < .0001), decreased overall ATVV and ATVV of veins with a diameter < .3 mm (p < .003) compared to subjects without CCSVI. The severity of CCSVI was significantly related to decreased VVV in MS (p < .0001) on pre- and post-contrast SWI, but not in HC. CONCLUSIONS: MS patients with higher number of venous stenoses, indicative of CCSVI severity, showed significantly decreased venous vasculature in the brain parenchyma. The pathogenesis of these findings has to be further investigated, but they suggest that reduced metabolism and morphological changes of venous vasculature may be taking place in patients with MS.

No / The purpose of this article is to investigate characteristics of cine phase contrast-calculated cerebrospinal fluid (CSF) flow and velocity measures in patients with relapsing-remitting (RR) multiple sclerosis (MS) receiving standard medical treatment who had been diagnosed with chronic cerebrospinal venous insufficiency (CCSVI) and underwent percutaneous transluminal angioplasty (PTA). This case-controlled, magnetic resonance (MR) imaging-blinded study included 15 patients with RR MS who presented with significant stenoses (>/=50% lumen reduction on catheter venography) in the azygous or internal jugular veins. Eight patients underwent PTA in addition to medical therapy immediately following baseline assessments (case group) and seven had delayed PTA after 6 months of medical therapy alone (control group). CSF flow and velocity measures were quantified over 32 phases of the cardiac cycle by a semiautomated method. Outcomes were compared between groups at baseline and at 6 and 12 months of the study by mixed-effect model analysis. At baseline, no significant differences in CSF flow or velocity measures were detected between groups. At month 6, significant improvement in flow (P<.001) and velocity (P = .013) outcomes were detected in the immediate versus the delayed group, and persisted to month 12 (P = .001 and P = .021, respectively). Within-group flow comparisons from baseline to follow-up showed a significant increase in the immediate group (P = .033) but a decrease in the delayed group (P = .024). Altered CSF flow and velocity measures were associated with worsening of clinical and MR outcomes in the delayed group. PTA in patients with MS with CCSVI increased CSF flow and decreased CSF velocity, which are indicative of improved venous parenchyma drainage.