Methods and Software to Analyze Gene-Environment Interactions under a Case-Mother-Control-Mother Design with Partially Missing Child Genotype.

INTRODUCTION: The case-mother-control-mother design allows to study fetal and maternal genetic factors together with environmental exposures on early life outcomes. Mendelian constraints and conditional independence between child genotype and environmental factors enabled semiparametric likelihood methods to estimate logistic models with greater efficiency than standard logistic regression. Difficulties in child genotype collection require methods handling missing child genotype. METHODS: We review a stratified retrospective likelihood and two semiparametric likelihood approaches: a prospective one and a modified retrospective one, the latter either modeling the maternal genotype as a function of covariates or leaving their joint distribution unspecified (robust version). We also review software implementing these modeling alternatives, compare their statistical properties in a simulation study, and illustrate their application, focusing on gene-environment interactions and partially missing child genotype. RESULTS: The robust retrospective likelihood provides generally unbiased estimates, with standard errors only slightly larger than when modeling maternal genotype based on exposure. The prospective likelihood encounters maximization problems. In the application to the association of small-for-gestational-age babies with CYP2E1 and drinking water disinfection by-products, the retrospective likelihood allowed a full array of covariates, while the prospective likelihood was limited to few covariates. CONCLUSION: We recommend the robust version of the modified retrospective likelihood.

Associations between cadmium levels in blood and urine, blood pressure and hypertension among Canadian adults.

BACKGROUND: Cadmium has been inconsistently related to blood pressure and hypertension. The present study seeks to clarify the relationship between cadmium levels found in blood and urine, blood pressure and hypertension in a large sample of adults. METHODS: The study sample included participants ages 20 through 79 from multiple cycles of the Canadian Health Measures Survey (2007 through 2013) with measured blood cadmium (n=10,099) and urinary cadmium (n=6988). Linear regression models examined the association between natural logarithm transformed cadmium levels and blood pressure (separate models for systolic and diastolic blood pressure) after controlling for known covariates. Logistic regression models were used to examine the association between cadmium and hypertension. Models were run separately by sex, smoking status, and body mass index category. RESULTS: Men had higher mean systolic (114.8 vs. 110.8mmHg, p<0.01) and diastolic (74.0 vs. 69.6mmHg, p<0.01) blood pressure compared to women. Although, geometric mean blood (0.46 vs. 0.38µg/L, p<0.01) and creatinine-adjusted standardized urinary cadmium levels (0.48 vs. 0.38µg/L, p<0.01) were higher among those with hypertension, these differences were no longer significant after adjustment for age, sex and smoking status. In overall regression models, increases in blood cadmium were associated with increased systolic (0.70mmHg, 95% confidence interval [CI]=0.25-1.16, p<0.01) and diastolic blood pressure (0.74mmHg, 95% CI=0.30-1.19, p<0.01). The associations between urinary cadmium, blood pressure and hypertension were not significant in overall models. Model stratification revealed significant and negative associations between urinary cadmium and hypertension among current smokers (OR=0.61, 95% CI=0.44-0.85, p<0.01), particularly female current smokers (OR=0.52, 95% CI=0.32-0.85, p=0.01). CONCLUSION: This study provides evidence of a significant association between cadmium levels, blood pressure and hypertension. However, the significance and direction of this association differs by sex, smoking status, and body mass index category.

Barriers to the use of toxicogenomics data in human health risk assessment: A survey of Canadian risk assessors.

Regulatory agencies worldwide need to modernize human health risk assessment (HHRA) to meet challenges of the 21st century. Toxicogenomics is at the core of this improvement. Today, however, the use of toxicogenomics data in HHRA is very limited. The purpose of this survey was to identify barriers to the application of toxicogenomics data in HHRA by human health risk assessors. An online survey targeting Canadian risk assessors gathered information on their knowledge and perception of toxicogenomics, their current and future inclusion of toxicogenomics data in HHRA, and barriers to the use of such data. Twenty-nine (29) participants completed a questionnaire after 2 months of solicitation. The results show that the application of toxicogenomics data in Canada is marginal, with 85% of respondents reporting that they never or rarely used such data. Knowledge of toxicogenomics by Canadian risk assessors is also limited: about two-thirds of respondents (68%) were not at all or only slightly familiar with the concept. Lack of guidelines for toxicogenomics data interpretation, data quality assessment and on their use in HHRA, were found to be major barriers. In conclusion, there is a need for interventions aimed at facilitating the use of toxicogenomics data in HHRA, when available.

Cadmium levels and sources of exposure among Canadian adults.

BACKGROUND: Cadmium is a heavy metal found naturally in the environment that has been associated with negative health outcomes. The present study examines levels of blood cadmium (BCd), urinary cadmium (UCd), and the main sources of cadmium exposure among Canadians aged 20 to 79. DATA AND METHODS: The data are from cycles 1 (2007 to 2009) and 2 (2009 to 2011) of the Canadian Health Measures Survey (CHMS), including measures of BCd and UCd, markers of smoking status (self-reported and second-hand smoke exposure), and self-reported consumption of foods known to be high in cadmium. The relationship between sources of exposure and cadmium levels was examined descriptively. The magnitude of the contribution of different exposure sources was examined in regression models. RESULTS: Age and smoking status were the greatest contributors to BCd and UCd: older people and current smokers had the highest cadmium levels. Dietary exposure, while significant, was a modest contributor overall, but a more important source of cadmium among never-smokers. INTERPRETATION: Smoking was the greatest contributor to cadmium levels among Canadians aged 20 to 79. Dietary differences explained a small percentage of variation in cadmium levels.

Women exposure during pregnancy to haloacetaldehydes and haloacetonitriles in drinking water and risk of small-for-gestational-age neonate.

BACKGROUND: Past studies have examined the effects of maternal exposure to water chlorination disinfection by-products (DBPs), such as trihalomethanes (THMs) and haloacetic acids (HAAs) during pregnancy. However, no human-based study has yet evaluated the effect of emerging DBPs, such as haloacetaldehydes (HAs) and haloacetonitriles (HANs) on small-for-gestational-age (SGA) status in newborns. OBJECTIVE: This study aims to assess the association between maternal multiroute exposure to HAs and HANs during the third trimester of pregnancy and SGA status at birth, among neonates delivered by women residing in the Quebec City area (Province of Quebec, Canada). We also evaluated the interaction between exposure to these emerging unregulated by-products and regulated DBPs also found in drinking water (THMs and HAAs), for which a positive association with adverse reproductive outcomes has been suggested in previous studies. METHODS: We conducted a population-based case-control study in the Quebec City area. SGA newborns (n=330) were compared to 1100 controls, with matching based on calendar week of birth. HA and HAN concentrations in drinking water at participant's tap were estimated using spatio-temporal strategy based on bimonthly measurements carried out at several locations in the participant's distribution system. A computer-assisted telephone interview was completed to collect information on individual habits of water consumption and water related activities in order to determine individual multiroute exposure. This enabled us to estimate the dose of HAs and HANs absorbed daily by each participant. Associations between total HA, HAN concentrations in drinking water and SGA were analyzed. Associations between the daily-absorbed doses of these emerging DBPs and SGA were also analyzed. Odds ratios (ORs) comparing the 4th quartile of exposure to the reference group (the first three quartiles) were obtained by means of conditional logistic regression, and controlling for potential confounders. RESULTS: Globally, no evidence of increased risk of SGA was found with total HA and HAN concentrations in tap water when participants in the 4th quartile of exposure were compared to the first three quartiles (OR=1.0; 95% CI [0.7-1.5] and OR=0.8; 95% CI [0.6-1.2], respectively). Similarly, no association was found with the daily-absorbed doses of total HAs or HANs (OR=0.9; 95% CI [0.6-1.3] and OR=1.1; 95% CI [0.7-1.6], respectively). However, a small non statistically significant association was found between the dose of brominated HA and SGA (OR=1.4; 95% CI [0.9-2.1]). Also, in spite of the lack of interaction between other DBP classes, an unexpected negative interaction was observed between concentration of chloral hydrate (CH) (which represents the main HA species), and regulated DBPs (P=0.006). CONCLUSION: In this population, exposure to low levels of HAs and HANs during the third trimester of pregnancy through drinking water was not associated to SGA status in newborns. Nonetheless, more research is needed to clarify possible effect of brominated compounds and interaction between different DBPs.

Association between blood lead and blood pressure: Results from the Canadian Health Measures Survey (2007 to 2011).

BACKGROUND: Hypertension is the leading risk factor for cardiovascular disease, but its cause is not always known. Interest is increasing in the potential role of environmental chemicals, including lead. DATA AND METHODS: Data are from the first two cycles of the Canadian Health Measures Survey. Lead in whole blood (PbB), and systolic (SBP) and diastolic (DBP) blood pressure were measured and hypertension status was derived for 4,550 respondents aged 40 to 79. Linear regression estimated associations between PbB and SBP and DBP. Logistic regression estimated associations between PbB and hypertension. Adjusted least squares geometric means of PbB were estimated for hypertensive versus non-hypertensive individuals. RESULTS: Compared with non-hypertensive individuals, those with hypertension had higher average PbB levels, were older, more likely to be male, and more likely to have other hypertension risk factors (diabetes, family history of high blood pressure). In adjusted regression models, a modest association emerged between PbB levels and SBP among 40- to 54-year-olds, and between PbB levels and DBP for the overall population. No association emerged between PbB levels and hypertension prevalence. INTERPRETATION: A modest association was observed between blood lead levels and blood pressure, but not with hypertension, in Canadian adults aged 40 to 79.

Assessing and monitoring agroenvironmental determinants of recreational freshwater quality using remote sensing.

Diverse fecal and nonfecal bacterial contamination and nutrient sources (e.g. agriculture, human activities and wildlife) represent a considerable non-point source load entering natural recreational waters which may adversely affect water quality. Monitoring of natural recreational water microbial quality is most often based mainly on testing a set of microbiological indicators. The cost and labour involved in testing numerous water samples may be significant when a large number of sites must be monitored repetitively over time. In addition to water testing, ongoing monitoring of key environmental factors known to influence microbial contamination may be carried out as an additional component. Monitoring of environmental factors can now be performed using remote sensing technology which represents an increasingly recognized source of rigorous and recurrent data, especially when monitoring over a large or difficult to access territory is needed. To determine whether this technology could be useful in the context of recreational water monitoring, we evaluated a set of agroenvironmental determinants associated with fecal contamination of recreational waters through a multivariable logistic regression model built with data extracted from satellite imagery. We found that variables describing the proportions of land with agricultural and impervious surfaces, as derived from remote sensing observations, were statistically associated (odds ratio, OR = 11 and 5.2, respectively) with a higher level of fecal coliforms in lake waters in the southwestern region of Quebec, Canada. From a technical perspective, remote sensing may provide important added-value in the monitoring of microbial risk from recreational waters and further applications of this technology should be investigated to support public health risk assessments and environmental monitoring programs relating to water quality.

Multilevel analysis of childhood nonviral gastroenteritis associated with environmental risk factors in Quebec, 1999-2006.

Childhood nonviral gastroenteritis is a priority for various public health authorities. Given that waterborne transmission is sometimes incriminated during investigation of gastroenteritis outbreaks, the authors hypothesized that watershed characteristics may influence the occurrence of this disease and could contribute additional insights for better prevention and control. The study described here aimed to investigate watershed characteristics in relation to nonviral gastroenteritis and specifically three bacterial and parasitic forms of childhood gastroenteritis to assess their relative importance in the province of Quebec, Canada. Information on children aged 0-4 years with bacterial or parasitic enteric infections reported through ongoing surveillance between 1999 and 2006 in the province of Quebec was collected. Factors measured at the municipal and watershed levels were analyzed using multilevel models with a Poisson distribution and log link function. Childhood nonviral gastroenteritis, giardiasis, and campylobacteriosis were positively associated with small ruminants and cattle density. Childhood salmonellosis was positively associated with cattle density. Also, childhood campylobacteriosis incidence was positively associated with larger watershed agricultural surface. In addition to local agroenvironmental factors, this analysis revealed an important watershed effect.

Spatial and temporal occurrence of N-nitrosamines in seven drinking water supply systems.

The spatiotemporal presence of eight N-nitrosamines in the water of seven supply systems in Quebec considered to be susceptible to these emerging disinfection by-products was evaluated. This is the first study on the presence of N-nitrosamines in drinking water utilities in Quebec. Seven sampling campaigns were carried out at several sampling points in each of the systems over a period of 1 year. The results show that N-nitrosamines, primarily N-nitrosodimethylamine (NDMA), were not commonly detected in the water of the facilities under study (10 % of samples). The concentrations measured were lower than those reported in recent North American studies. None of the 195 samples taken exceeded the Ontario standard of 9 ng/L for NDMA (maximum value observed of 3.3 ng/L). N-nitrosomethylethylamine and N-nitrosopiperidine were detected once, with concentrations of 3.7 and 6.0 ng/L, respectively. Chloramination was identified as being the main risk factor regarding the presence of N-nitrosamines, but water quality and some operating parameters, in particular disinfectant residual, also seem to be related to their presence. NDMA concentrations at the end of the distribution systems were generally higher than water leaving the plant. No seasonal trends were observed for the formation of N-nitrosamines in the investigated supply systems. Finally, an association between the presence of N-nitrosamines and the levels of trihalomethanes and haloacetic acids was observed in some facilities.

Maternal exposure to drinking-water chlorination by-products and small-for-gestational-age neonates.

BACKGROUND: There is concern about possible effects of disinfection by-products on reproductive outcomes. The purpose of this study was to evaluate the association between maternal exposure to chlorination by-products and the risk of delivering a small for-gestational-age (SGA) neonate. METHODS: We conducted a population-based case-control study in the Québec City (Canada) area. Term newborn cases with birth weights <10th percentile (n = 571) were compared with 1925 term controls with birth weights ≥10th percentile. Concentrations of trihalomethanes and haloacetic acids in the water-distribution systems of participants were monitored during the study period, and a phone interview on maternal habits was completed within 3 months after childbirth. We estimated chlorination by-products ingestion during the last trimester of pregnancy and trihalomethanes doses resulting from inhalation and dermal exposure. We evaluated associations between chlorination by-products in utero exposure and SGA by means of unconditional logistic regression with control of potential confounders. RESULTS: When total trihalomethanes and the 5 regulated haloacetic acids concentrations were divided into quartiles, no clear dose-response relationship was found with SGA. However, increased risk was observed when haloacetic concentrations were above the fourth quartile and when either trihalomethanes or haloacetic acids concentrations were above current water standards (adjusted OR= 1.5 [95% confidence interval = 1.1-1.9] and 1.4 [1.1-1.9], respectively). Inhalation and dermal absorption of trihalomethanes did not contribute to this risk, but a monotonic dose-response was found with haloacetic acids ingestion. CONCLUSION: Oral exposure to high levels of chlorination by-products in drinking water could be a risk factor for term SGA.

A study of the association between characteristics of CLSCs and the risk of small for gestational age births among term and preterm births in Quebec, Canada.

OBJECTIVES: The objective of this study was to describe whether the social environment of the territory of residence is associated with indicators of foetal growth retardation. METHODS: All newborns (n = 667,254) from 143 Centres locaux de services communautaires (CLSC) territories of Quebec, Canada, 2000-2008 were included in this study. Small for gestational age (SGA), very small for gestational age (VSGA) and SGA-preterm births were identified. Social characteristics and access to medical services of the population in the CLSCs were obtained from the Canadian Community Health Survey. Data on material deprivation, racial diversity and social isolation were obtained from the 2001 and 2006 Canadian censuses. A compromise between two methods, stepwise and best subset, was used to select variables for multivariate logistic modelling. The model was fitted on each studied outcome: SGA, VSGA and SGA among preterm births. RESULTS: When investigating material deprivation, racial diversity, social isolation, proportion of sedentary residents and proportion with fair or poor availability of health care services in the CLSC territories, material deprivation, racial diversity, social isolation and sedentary residents showed increased adjusted risk of SGA. Results of the model fit on VSGA birth and on SGA among preterm births were similar. CONCLUSION: CLSC characteristics of material deprivation, racial diversity, social isolation as well as the contextual variable of sedentary lifestyle were associated with indicators of foetal growth retardation. Further work on features of the CLSCs could help understand how the outcome of SGA is associated with contextual factors and identify groups for intervention.

Antimicrobial-resistant Escherichia coli in public beach waters in Quebec.

INTRODUCTION: Human exposure to antimicrobial-resistant bacteria may result in the transfer of resistance to commensal or pathogenic microbes present in the gastrointestinal tract, which may lead to severe health consequences and difficulties in treatment of future bacterial infections. It was hypothesized that the recreational waters from beaches represent a source of antimicrobial-resistant Escherichia coli for people engaging in water activities. OBJECTIVE: To describe the occurrence of antimicrobial-resistant E coli in the recreational waters of beaches in southern Quebec. METHODS: Sampling occurred over two summers; in 2004, 674 water samples were taken from 201 beaches, and in 2005, 628 water samples were taken from 177 beaches. The minimum inhibitory concentrations of the antimicrobial-resistant E coli isolates against a panel of 16 antimicrobials were determined using microbroth dilution. RESULTS: For 2004 and 2005, respectively, 28% and 38% of beaches sampled had at least one water sample contaminated by E coli resistant to one or more antimicrobials, and more than 10% of the resistant isolates were resistant to at least one antimicrobial of clinical importance for human medicine. The three antimicrobials with the highest frequency of resistance were tetracycline, ampicillin and sulfamethoxazole. DISCUSSION: The recreational waters of these beaches represent a potential source of antimicrobial-resistant bacteria for people engaging in water activities. Investigations relating the significance of these findings to public health should be pursued.

INTRODUCTION: L'exposition humaine à des bactéries résistant aux antimicrobiens peut provoquer le transfert de la résistance à des microbes commensaux ou pathogènes présents dans le tube digestif, ce qui peut avoir de graves conséquences sur la santé et compliquer le traitement de futures infections bactériennes. On a soulevé l'hypothèse que les eaux de baignade des plages représentent une source d'infection à l'Escherichia coli résistant aux antimicrobiens pour les personnes qui s'adonnent à des activités aquatiques. La présente étude visait principalement à décrire l'occurrence d'E coli résistant aux antimicrobiens dans les eaux de baignade du sud du Québec. MÉTHODOLOGIE: Les chercheurs ont procédé à l'échantillonnage sur deux étés. En 2004, ils ont prélevé 674 échantillons d'eau sur 201 plages, et en 2005, 628 échantillons d'eau sur 177 plages. Ils ont établi les concentrations inhibitrices minimales des isolats d'E coli résistant aux antimicrobiens par rapport à un groupe de 16 antimicrobiens au moyen d'une dilution en bouillon. RÉSULTATS: En 2004 et en 2005, respectivement, 28 % et 38 % des plages échantillonnées comptaient au moins un échantillon d'eau contaminée par l'E coli résistant à au moins un antimicrobien, et plus de 10 % de ces isolats résistaient à un moins un antimicrobien d'importance clinique en médecine humaine. La tétracycline, l'ampicilline et le sulfaméthoxazole étaient les trois antimicrobiens les plus touchés par la résistance. EXPOSÉ: Les eaux de baignade de ces plages représentent une source potentielle de bactéries résistant aux antimicrobiens pour les personnes qui s'adonnent à des activités aquatiques. Il faudrait poursuivre les recherches sur la signification de ces observations en matière de santé publique.

Spatial variations of human health risk associated with exposure to chlorination by-products occurring in drinking water.

During disinfection, chlorine reacts with organic matter present in drinking water and forms various undesirable chlorinated by-products (CBPs). This paper describes a study of the spatial variability of human health risk (i.e., cancer effects) from CBP exposure through drinking water in a specific region. The region under study involves nine drinking water distribution systems divided into several zones based on their characteristics. The spatial distribution of cancer risk (CR) was estimated using two years of data (2006-2008) on various CBP species. In this analysis, trihalomethanes (THMs) and haloacetic acids (HAAs) served as surrogates for CBPs. Three possible routes of exposure (i.e., via ingestion, inhalation and dermal contact) were considered for each selected compound. The cancer risk assessment involved estimating a unit risk (R(T)) in each zone of the selected distribution systems. A probabilistic analysis based on Monte Carlo simulations was employed. Risk assessment results showed that cancer risk varied between systems, but also within individual systems. As a result, the population of the same region was not exposed to the same risk associated with CBPs in drinking water. Unacceptable levels (i.e., R(T) > 10(-4)) for the estimated CR were determined for several zones in the studied region. This study demonstrates that a spatial-based analysis performed to represent the spatial distribution of risk estimates can be helpful in identifying suitable risk management strategies. Suggestions for improving the risk analysis procedure are also presented.

Multi-level modelling of chlorination by-product presence in drinking water distribution systems for human exposure assessment purposes.

During drinking water treatment and distribution, chlorine reacts with organic matter occurring in water to form various chlorination by-products (CBPs) such as trihalomethanes (THMs) and haloacetic acids (HAAs). This paper presents the occurrence of THMs and HAAs in different water distribution systems (DS) of the same region and their modelling for exposure assessment purposes. This study was conducted in eight DS supplying chlorinated water to the population of Québec City, Canada. These systems differ in type of water source (i.e. surface, ground or mixed water), in treatment applied at the plant, and in size and structure of the DS. Two spatio-temporal databases for THMs and HAAs were implemented, one for model development and the other for model validation. The analysis of the data demonstrates significant seasonal and spatial variations of these compounds. A multi-level statistical modelling approach was applied to estimate the ranges for occurrence of THMs and HAAs in the eight DS (i.e. a single model for the study region for each CBP species). The modelling approach integrates available or easily measurable parameters. For both THMs and HAAs, a two-level model considering a sampling-site random effect was selected among various models initially developed. The model capacity for estimating the presence of THMs and HAAs in drinking water and its usefulness for exposure assessment purposes in the studied region was demonstrated.

A probabilistic toxicokinetic modeling approach to the assessment of the impact of daily variations of lead concentrations in tap water from schools and daycares on blood lead levels in children.

The aim of this study was to assess the impact of exposure to tap water lead concentration ([Pb]TW) occurring in schools or daycares on blood lead level (BLL) of attending children. Given the potentially wide variations in space and time of ([Pb]TW) documented in the literature, a simple probabilistic toxicokinetic (STK) model that allows the simulation of the time-varying evolution of BLL in response to these variations was developed. Thus, basic toxicokinetic equations were assembled to simulate BLL in a typical infant, toddler and pupil. The STK model's steady-state BLL predictions showed good correspondence when validated against Integrated Exposure and Uptake BioKinetic model predictions for comparable [Pb]TW values. Exposures to three distributions of [Pb]TW in specific sets of Canadian schools and daycares documented in the scientific literature were simulated probabilistically with Monte Carlo simulations. For the highest distribution of [Pb]TW simulated (median, 90th percentile = 24, 412 µg/L), average annual BLL (median, 97.5th percentile) varies between 1.5 and 6.4 µg/dL in infant and 1.1 and 3 µg/dL in pupils. Toddler's results were midway between those from the infants and pupils. Under this exposure scenario, the infant may present BLL > 5 µg/dL for a significant number of days over the course of the academic year (median; 97.5th: 17; 227 days). However, peak exposure may remain unnoticed if rare and drowned out by the background BLL. In conclusion, even if they may be sparse, peak exposure episodes to [Pb]TW in schools and daycares may suffice to increased BLL in attending individuals. This finding emphasizes the need for further characterization of [Pb]TW in schools and daycares in order to identify potentially problematic institutions and therefore avoid undesirable exposures for the children attending them.

The assessment of population exposure to chlorination by-products: a study on the influence of the water distribution system.

BACKGROUND: The relationship between chlorination by-products (CBPs) in drinking water and human health outcomes has been investigated in many epidemiological studies. In these studies, population exposure assessment to CBPs in drinking water is generally based on available CBP data (e.g., from regulatory monitoring, sampling campaigns specific to study area). Since trihalomethanes (THMs) and haloacetic acids (HAAs) are the most documented CBP classes in drinking water, they are generally used as indicators of CBP exposure. METHODS: In this paper, different approaches to spatially assign available THM and HAA concentrations in drinking water for population exposure assessment purposes are investigated. Six approaches integrating different considerations for spatial variability of CBP occurrence within different distribution systems are compared. For this purpose, a robust CBP database (i.e., high number of sampling locations selected according to system characteristics) corresponding to nine distribution systems was generated. RESULTS AND CONCLUSION: The results demonstrate the high impact of the structure of the distribution system (e.g., presence of intermediary water infrastructures such as re-chlorination stations or reservoirs) and the spatial variability of CBPs in the assigned levels for exposure assessment. Recommendations for improving the exposure assessment to CBPs in epidemiological studies using available CBP data from water utilities are also presented.

The association between farming activities, precipitation, and the risk of acute gastrointestinal illness in rural municipalities of Quebec, Canada: a cross-sectional study.

BACKGROUND: Increasing livestock density and animal manure spreading, along with climate factors such as heavy rainfall, may increase the risk of acute gastrointestinal illness (AGI). In this study we evaluated the association between farming activities, precipitation and AGI. METHODS: A cross-sectional telephone survey of randomly selected residents (n = 7006) of 54 rural municipalities in Quebec, Canada, was conducted between April 2007 and April 2008. AGI symptoms and several risk factors were investigated using a phone questionnaire. We calculated the monthly prevalence of AGI, and used multivariate logistic regression, adjusting for several demographic and risk factors, to evaluate the associations between AGI and both intensive farming activities and cumulative weekly precipitation. Cumulative precipitation over each week, from the first to sixth week prior to the onset of AGI, was analyzed to account for both the delayed effect of precipitation on AGI, and the incubation period of causal pathogens. Cumulative precipitation was treated as a four-category variable: high (> or = 90th percentile), moderate (50th to <90th percentile), low (10th to <50th percentile), and very low (<10th percentile) precipitation. RESULTS: The overall monthly prevalence of AGI was 5.6% (95% CI 5.0%-6.1%), peaking in winter and spring, and in children 0-4 years old. Living in a territory with intensive farming was negatively associated with AGI: adjusted odds ratio (OR) = 0.70 (95% CI 0.51-0.96). Compared to low precipitation periods, high precipitation periods in the fall (September, October, November) increased the risk of AGI three weeks later (OR = 2.20; 95% CI 1.09-4.44) while very low precipitation periods in the summer (June, July, August) increased the risk of AGI four weeks later (OR = 2.19; 95% CI 1.02-4.71). Further analysis supports the role of water source on the risk of AGI. CONCLUSIONS: AGI poses a significant burden in Quebec rural municipalities with a peak in winter. Intensive farming activities were found to be negatively associated with AGI. However, high and very low precipitation levels were positively associated with the occurrence of AGI, especially during summer and fall. Thus, preventive public health actions during such climate events may be warranted.

Recreational physical activity and the risk of adult leukemia in Canada.

OBJECTIVE: To examine the association between adult onset leukemia and recreational physical activity. METHODS: We analysed data obtained from a population-based case-control study conducted in seven Canadian provinces. Risk estimates were generated by applying multivariate logistic regression methods to 653 incident histologically confirmed leukemia cases and 3,106 controls aged 20-74. RESULTS: We observed a 25% risk reduction for adult leukemia associated with the highest category of vigorous physical activity (adjusted odds ratio (OR) = 0.75; 95% confidence interval [CI] = 0.57-0.99). This reduction was stronger among men (OR = 0.64; 95% CI = 0.41-0.95), than among women (OR = 0.82; 95% CI = 0.52-1.29). For women, reduced risk estimates were observed for all levels of vigorous activity; for men, reduced risk estimates were restricted to the highest category of vigorous activity High levels of vigorous activity were associated with some degree of risk reduction for each of the five histological subtypes except chronic myeloid leukemia. Risk reductions associated with high levels of vigorous activity were more pronounced with higher body mass index (BMI): BMI < 25 (OR 0.93; 95% CI = 0.61-1.40); BMI > 25 to <30 (OR 0.75; 95% CI = 0.40-1.21); BMI > or = 30 (OR = 0.50; 95% CI = 0.28-0.95). CONCLUSION: Our study suggests that higher categories of vigorous physical activity may decrease the risk of adult leukemia.

Risk of diarrhea with adult residents of municipalities with significant livestock production activities.

BACKGROUND: The intensification of livestock production has led to situations where the amount of manure that is produced exceeds the amounts needed in some areas. The objective of this study was to evaluate the relationship between the intensity of livestock activities and manure products, particularly in swine farms, and the prevalence of diarrhea in adults. METHODS: A survey was carried out on 8702 adults living in 161 municipalities in Quebec areas with intensive farming activities. Data were collected by a telephonic interview on diarrheal symptoms that occurred during the previous week of the interview, on water consumption and on selected risk factors. Statistical analysis was performed using a 'generalized estimating equations' model. RESULTS: Prevalence of diarrhea was found to be highest in adults aged between 25 and 34 years. No association was found between swine density or liquid manure application and diarrheal prevalence. There was also no association between cattle or total animal density and diarrheal prevalence. In the areas studied, there was no increase in risk associated with the consumption of tap water with suboptimal treatment and susceptible to microbiologic contamination. CONCLUSION: Significant livestock production and excess of manure were not associated with the risk of diarrhea in adults.

Drinking Water Quality and Human Health: An Editorial.

Drinking water quality is paramount for public health [...].