Anxiety and depression symptoms in adult males in Atlantic Canada with or without a lifetime history of prostate cancer.

Authors: Gabriela Ilie, Robert Rutledge, Ellen Sweeney Abstract Objective: Prostate cancer (PCa) is the most prevalent form of cancer among men and has one of the most favorable survival rates among all cancers. Here we examine the association between depression and anxiety symptoms in a population‐based sample of men. Methods: A cross‐sectional analysis was conducted on a subsample of 6 585 male participants aged 49‐69 from 2009 to 2015 survey cycle of the Atlantic PATH. Mild, moderate or severe depression or anxiety indicators were primary outcomes and were assessed using the Generalized Anxiety Disorder (GAD‐7) scale and the Patient Health Questionnaire (PHQ‐9). The presence of a lifetime history of PCa, other forms of cancer (except PCa) or absence of either was the main predictor variable. Results: An estimated 3.9% of men self‐identified as having had a history of PCa diagnosis, 11.3% of men identified as having had a history of other forms of cancer and 84.9% reported never having had a diagnosis of cancer in their lifetime, respectively. Survivors of PCa had 2.45 or 2.05 statistically significantly higher odds of screening positive for current anxiety or depressive symptoms, respectively, compared with those who identified as without a lifetime history of any form of cancer in controlled analyses (including survivorship time). Conclusions: Increased rates of anxiety and depression among men with a history of PCa highlight the need for mental health screening among PCa survivors. The findings highlight the importance of a multidisciplinary effort to prioritize and deliver comprehensive mental health support to PCa survivors. Link: https://onlinelibrary.wiley.com/doi/full/10.1002/pon.5244

The Association between Physical Activity and Self-Rated Health in Atlantic Canadians.

Authors: Yunsong Cui, Ellen Sweeney, Cynthia Forbes, Vanessa DeClercq, Scott Grandy, Melanie Keats, Louise Parker, Zhijiie Michael Yu, Trevor JB Dummer Abstract The population of Atlantic Canada is aging rapidly and has among the highest rates of chronic disease in the country. This cross-sectional study drew data from the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) study to investigate the association between physical activity and self-rated health among adults in this population. The results suggest that physical activity is associated with and may help to improve perceived health status of individuals with one or more chronic conditions. The findings support literature suggesting that physical activity can be beneficial for adults as they age with chronic disease. Link: https://www.tandfonline.com/doi/abs/10.1080/08952841.2020.1735286?journalCode=wjwa20

Burden of multimorbidity and polypharmacy among cancer survivors: a population-based nested case-control study

Authors: Melanie Keats, Yunsong Cui, Vanessa DeClercq, Scott Grandy, Ellen Sweeney, Trevor JB Dummer Abstract: Purpose: Individuals living with cancer have been shown to have a higher burden of comorbid disease and multimorbidity in comparison to their cancer-free counterparts consequently, leaving them at risk of polypharmacy (i.e., ≥ 5 medications) and its potential negative effects. The primary aim of the current study was to examine the self-reported prevalence of and association between multimorbidity and prescription medication use in a population-based sample of adult cancer survivors (CS). Methods: This retrospective, nested case–control study drew participant data from the Atlantic Partnership for Tomorrow’s Health cohort. CS (n = 1708) were matched to 4 non-cancer controls (n = 6832) by age and sex. Prevalence of polypharmacy by number of chronic conditions and age was estimated with 95% CI. Logistic regression was used to examine the association between multimorbidity and polypharmacy while adjusting for sociodemographic and lifestyle factors. The comorbidity–polypharmacy score was also calculated as an estimate of disease burden. Results: Multimorbidity was common in both CS (53%) and non-cancer controls (43%); however, a significantly higher percentage of CS reported multimorbidity (p < 0.001). Prescription medication use was also found to be significantly higher among CS (2.3 ± 2.6) compared to non-cancer controls (1.8 ± 2.3; p < 0.0001). Exploratory comorbidity–polypharmacy score analyses indicated that CS had a significantly higher overall disease burden than the age/sex-matched non-cancer controls. Conclusions: As CS appear to be at a higher risk of multimorbidity and polypharmacy and by extension, increased healthcare burden, ongoing education on the prevention of medication-related harm, and interventions to reduce the occurrence of both co-morbid disease and unnecessary medications are warranted. Link: https://link.springer.com/article/10.1007/s00520-020-05529-3

Portable X-ray Fluorescence of Zinc Applied to Human Toenail Clippings

Authors: David Fleming, Samantha Crook, Colby Evans, Michael Nader, Manuel Atia, Jason Hicks, Ellen Sweeney, Christopher McFarlane, Jong Sung Kim, Erin Keltie, Anil Adisesh Abstract: Zinc is an essential trace element in humans. Zinc deficiency can result in a range of serious medical conditions which include effects on growth and development, the immune system, the central nervous system, and the gastrointestinal system. Diagnosis of zinc deficiency is often precluded by the lack of a noninvasive and reliable biomarker. Zinc concentration in nail is considered an emerging biomarker of zinc status in humans. Whether zinc in nail accurately reflects zinc status is beyond the scope of the current study, but is an important research question. The development of a portable method to quickly assess zinc concentration from a single nail clipping could be a useful advance. In this study, single toenail clippings from 60 individuals living in Atlantic Canada were measured for zinc using a portable X-ray fluorescence (XRF) technique. These samples were obtained from the Atlantic PATH cohort, part of the largest chronic disease study ever performed in Canada. Each toenail clipping was measured using three 300 s trials with a mono-energetic portable XRF system. Results were then assessed using two different approaches to the XRF analysis: (1) factory-calibrated zinc concentrations were output from each trial, and (2) energy spectra were analyzed for the characteristic X-rays resulting from zinc. Following the measurement of zinc using the non-destructive portable XRF method, the same clippings were measured for zinc concentration using the “gold standard” technique of inductively coupled plasma-mass spectrometry (ICP-MS). A linear equation of best fit was determined for the relationship between average XRF output zinc concentration and ICP-MS zinc concentration, with a correlation coefficient r = 0.60. Similarly, a linear equation of best fit was found for the relationship between a normalized XRF energy spectrum zinc signal and ICP-MS zinc concentration, with a correlation coefficient r = 0.68. Individual ICP-MS zinc concentrations ranged from 32 μg/g to 140 μg/g, with a population average of 85 μg/g. The results of this study indicate that portable XRF is a sensitive method for the measurement of zinc in a single nail clipping, and provides a reasonable estimation of zinc concentration. Further method development is required before portable XRF be considered a routine alternative to ICP-MS for the assessment of zinc in nail clippings. Link: https://www.sciencedirect.com/science/article/pii/S0946672X20301681

CanPath Awarded $2.1 million CIHR Grant for SUPPORT-Canada COVID-19 Initiative

The SUPPORT-Canada initiative will capture data and biospecimens in order to identify factors contributing to COVID-19 susceptibility, severity and outcomes in Canada. June 25, 2020 – Toronto, Ontario CanPath (the Canadian Partnership for Tomorrow’s Health) has been awarded a $2.1 million grant from the Canadian Institutes of Health Research (CIHR) through their COVID-19 Rapid Research Funding competition. The initiative, titled SUrveying Prospective Population cOhorts for COVID-19 pRevalence and ouTcomes in Canada (SUPPORT-Canada), aims to capture data and biospecimens to enable population-level surveillance. SUPPORT-Canada will enable researchers and clinicians to find factors contributing to COVID-19 susceptibility, severity and outcomes, thus identifying factors predisposing individuals or communities across Canada to a high risk of infection. “The integration of clinical programs with our broader existing population cohort infrastructure creates the opportunity to rapidly assess patterns across Canada, while discovering and tracking critical biological and environmental determinants of disease susceptibility and severity for COVID-19,” says Dr. Philip Awadalla, lead Principal Investigator for the SUPPORT-Canada Initiative and National Scientific Director of CanPath. SUPPORT-Canada will be built out from CanPath, Canada’s largest population cohort, in partnership with the Toronto-based University Health Network (UHN), along with support from numerous research platforms, industry collaborators and service providers. This collaborative effort has been designed to integrate with national and global research efforts, including the COVID-19 Host Genetics Initiative, to support clinical, immunological and genetic studies of COVID-19. SUPPORT-Canada aims to: Capture population and clinical-level COVID-19 data and outcomes to support personalized risk profiling, and inform adaptive social and public health responses; Create capacity for world-leading research in immunophenotyping, seroprevalence and host-viral genetics; and Explore the role that genetics, co-morbidities and the environment play in shaping the pathophysiology of COVID-19 severity, susceptibility and immunological response. “Accurate estimates of SARS-CoV-2 antibodies across Canada, which act as markers of infection, are needed to guide ongoing public health measures, particularly those being developed in anticipation of a second wave of disease. This characterization of the evolution of the COVID-19 infection will prove vital in decision-making about immunization and protection strategies,” says Dr. Philippe Broët, who is leading the serological surveillance aspect of the grant and is Co-Scientific Director of CARTaGENE, a member cohort of CanPath. Preliminary evidence indicates that increased air pollution is both a risk factor for COVID-19 and associated with increased disease virulence, while other features of the built environment, such as green space and neighbourhood walkability, are thought to be risk factors. “Given current resource shortages, the healthcare system would benefit from patient-specific algorithms to distinguish who is likely to develop severe disease and identify biomarkers to predict future complications, as the long-term outcomes remain unknown and pose a significant threat for the future burden of disease in the population,” says Dr. Trevor Dummer, who is leading the third aim of the project and serves as Co-Scientific Director of the BC Generations Project and National Scientific Co-Director of CanPath. “Surveying our large number of engaged participants across the country powers us to determine specific genetic and environmental interactions that together may be used to identify hotspots of risk across Canada”, adds Dr. Awadalla, who is also Executive Scientific Director of the Ontario Health Study. CanPath launched a survey in April that captures not only COVID-19 testing information, but also symptoms, clinical history, and asks participants how the pandemic has affected their mental health. CanPath’s initiative is one of 139 research projects that have received more than $109M in funding  from CIHR for COVID-19 research. This investment supports research teams from across the country to focus on accelerating the development, testing, and implementation of measures to mitigate the rapid spread of COVID-19 and its negative consequences on people, communities, and health systems. The SUPPORT-Canada research team includes co-investigators from all of CanPath’s regional cohorts, as well as experts in immunology, genomics and biobanking from the Ontario Institute for Cancer Research, University Hospital Network and Mount Sinai Hospital. The CIHR grant will be awarded through the Ontario Institute for Cancer Research, which is a partner with the University of Toronto’s Dalla Lana School of Public Health in supporting CanPath.  

Atlantic PATH Anti-Racism Statement

It is well established that race is a key determinant of health. We know that race affects health outcomes and that BIPOC communities have been disproportionately affected by COVID-19 and by environmental racism, including in Atlantic Canada. This is clear evidence of the inequity in our society.   Intersectionality should be a core tenet of health research. We recognize that racism exists within the research community and that there is much work to be done. #BlackInTheIvory We support Dalhousie University’s Vice-Provost, Equity and Inclusion, Dr. Theresa Rajack-Talley and the formal acknowledgement that “we have an obligation to provide an education and a community that works together to address systematic anti-Black racism and all forms of discrimination and intolerance.” Atlantic PATH is committed to being an anti-racist organization. We are dedicated to providing equal access to data and to supporting researchers throughout the research process.  We aim to continually reflect on our policies and practices so that we may do our part in working towards an equitable research community.

FOLLOW-UP SURVEY DATA AVAILABLE

Questionnaire data from the first Atlantic PATH follow-up survey is now available to researchers!   Between 2016-2019 participants were invited to complete the first follow-up questionnaire. More than 21,000 Atlantic PATH participants completed the follow-up questionnaire. That data underwent a harmonization process across all the cohorts and is now available to researchers.   The questionnaire seeks information about a person’s health that may have changed since the first time they provided information.   The follow-up dataset includes the following: Demographic Mental Health Health status Medical history Prescribed medication Family health history Behaviours (sleep, alcohol, tobacco, marijuana use, and e-cigarette use) Working status Household income Anthropometric measurements   More information about the questionnaires can be found here.  Learn more about the Data Access Process.

The relationship between anthropometric measures and cardiometabolic health in shift work: findings from the Atlantic PATH Cohort Study.

Authors: Sweeney, E., Yu, Z.M., Dummer, T.J.B., Cui, Y., DeClercq, V., Forbes, C., Grandy, S., Keats, M., Parker, L., Adisesh, A. (2019) Abstract: Purpose: To evaluate the relationship between anthropometric measures and cardiometabolic health in shift workers compared to non-shift workers. Methods: A population health study was conducted with 4155 shift workers and 8258 non-shift workers from the Atlantic Partnership for Tomorrow’s Health (PATH) cohort. Linear and logistic regression models were used to assess the differences in anthropometric measures (body adiposity) and self-reported cardiometabolic disease outcomes (obesity, diabetes, and cardiovascular disease) between shift workers and non-shift workers. Results: There was a significant increased risk of cardiovascular disease, obesity, and diabetes among shift workers compared to matched controls despite higher levels of physical activity and lower levels of sedentary behaviour. Shift workers were 17% more likely to be obese (95% CI 7–27) and 27% more likely to have diabetes (95% CI 8–51). The strength of this association was demonstrated by also controlling for body mass index and fat mass index. Conclusions: Shift work is associated with obesity, cardiovascular disease, and diabetes despite higher levels of physical activity and lower levels of sedentary behaviour. The association between shift work and cardiometabolic health was independent of body mass index for cardiovascular disease and diabetes, and independent of fat mass index for diabetes. Link:  https://doi.org/10.1007/s00420-019-01459-8.

The Canadian Partnership for Tomorrow Project: a pan-Canadian platform for research on chronic disease prevention

Authors: Trevor J.B. Dummer, Philip Awadalla, Catherine Boileau, Camille Craig, Isabel Fortier, Vivek Goel, Jason M.T. Hicks, Sébastien Jacquemont, Bartha Maria Knoppers, Nhu Le, Treena McDonald, John McLaughlin, Anne-Marie Mes-Masson, Anne-Monique Nuyt, Lyle J. Palmer, Louise Parker, Mark Purdue, Paula J. Robson, John J. Spinelli, David Thompson, Jennifer Vena, Ma’n Zawati and with the CPTP Regional Cohort Consortium BACKGROUND: Understanding the complex interaction of risk factors that increase the likelihood of developing common diseases is challenging. The Canadian Partnership for Tomorrow Project (CPTP) is a prospective cohort study created as a population-health research platform for assessing the effect of genetics, behaviour, family health history and environment (among other factors) on chronic diseases. METHODS: Volunteer participants were recruited from the general Canadian population for a confederation of 5 regional cohorts. Participants were enrolled in the study and core information obtained using 2 approaches: attendance at a study assessment centre for all study measures (questionnaire, venous blood sample and physical measurements) or completion of the core questionnaire (online or paper), with later collection of other study measures where possible. Physical measurements included height, weight, percentage body fat and blood pressure. Participants consented to passive follow-up through linkage with administrative health databases and active follow-up through recontact. All participant data across the 5 regional cohorts were harmonized. RESULTS: A total of 307 017 participants aged 30–74 from 8 provinces were recruited. More than half provided a venous blood sample and/or other biological sample, and 33% completed physical measurements. A total of 709 harmonized variables were created; almost 25% are available for all participants and 60% for at least 220 000 participants. INTERPRETATION: Primary recruitment for the CPTP is complete, and data and biosamples are available to Canadian and international researchers through a dataaccess process. The CPTP will support research into how modifiable risk factors, genetics and the environment interact to affect the development of cancer and other chronic diseases, ultimately contributing evidence to reduce the global burden of chronic disease. Link:  https://doi.org/10.1503/cmaj.170292