No abstract

Perfluorooctanesulfonate (PFOS) and brominated organic compounds (BOCs) have been found in biota and humans worldwide with levels of BOCs being the highest in North America. PFOS and BOC exposure of remote populations that consume species of a marine food web for their subsistence has seldom been investigated. In 2004, we determined the concentrations of these contaminants in 883 Nunavik Inuit adults from the Canadian Arctic and investigated the demographic and dietary factors associated with them. Demographic and dietary information were collected by questionnaires. Multiple linear regressions were conducted to investigate predictors of exposure to those contaminants. Polychlorinated biphenyl (PCB) congener 153 concentrations are presented for comparative purposes. PFOS and PCB 153 were detected in all samples, with plasma concentrations several times higher than BOCs. The consumption of fish and marine mammals appears to be an important contributor to PFOS exposure among Nunavik Inuit. While PBDE 153 also appears as a persistent PBDE congener, exposure to PBDE 47 seems to be more recent in this population. Adoption of a westernized lifestyle seems to be related to an increased exposure to PBDE 47, but specific sources remain to be elucidated. In conclusion, we found that the remote geographical location and traditional lifestyle of the Nunavik Inuit population do not protect them against exposure to emerging POPs, particularly PFOS.

Aim To examine medical practices and training needs of Québec family physicians with respect to pain management and opioid prescription for chronic noncancer pain (CNCP). Methodology An online survey was carried out in 2016. Results Of 636 respondents (43.0% men; 54.3% ≥ 50 years old), 15.2% and 70.9% felt very or somewhat confident that they could properly prescribe opioids for CNCP. Concerns related to abuse (72.5% strongly/somewhat agree), dependence (73.2%), and lack of support (75.4%) were the main barriers reported. Only 19.7% always/often screened their patients for risks of abuse and dependence using a screening tool. About two-thirds of participants (65.7%) had recently (last five years) taken part in continuing education programs on opioid use for CNCP and 73.4% on CNCP management. Patient evaluation and differential diagnoses of chronic pain syndromes were rated as a top priority for further training. Conclusions This study provides insights into Québec family physicians' concerns, practices, and needs with respect to the management of CNCP. Physicians' difficulties around the application of strategies to mitigate the problem of opioid abuse and addiction are worrying. The need to better train physicians in the field of pain and addiction cannot be emphasized enough.

We conducted an interlaboratory study which differed from the typical study of this type because of its emphasis on comparing intralaboratory variability in results. We sent specimens to six laboratories experienced in the analysis of perfluorinated alkyl compounds in blood matrices and that use stringent procedures to control and assure accuracy and precision. Each received an identical set of 60 plasma specimens that were analyzed in six completely independent batches. Split specimens were included so that within- and between-batch coefficients of variation could be calculated. All laboratories used liquid chromatography-tandem mass spectrometry (LC-MS/MS). The concentrations of perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorohexanesulfonate (PFHxS) measured in the specimens in general showed a high level of agreement, although in some cases the agreement was only moderate. The average within- and between-batch coefficient of variation for PFOS was 9.1% and 9.3%; for PFOA was 14.5% and 14.5%; and for PFHxS was 14.5% and 17.0%. The recent availability of labeled internal standards, among other advances, has facilitated improvement in the accuracy and precision of the assays. Considering the degree of between-subject variation in levels among people in background-exposed populations, the results indicate that biomarker-based epidemiologic studies of associations with health could have reasonable precision.

Surface contamination by cyclophosphamide, ifosfamide and methotrexate in Canadian hospitals is improving both in terms of the proportions of positive samples and in terms of the surface concentration of antineoplastic drugs. A local 75th percentile value should be use to assess local contamination and interpret local results.