Paul Brassard

McGill University Health Centre · Epidemiology Clinic

Human papillomavirus (HPV) can be vertically transmitted. Our objective was to measure the association between the mode of delivery and the detection of HPV in infants. We used data collected from pregnant women during the HERITAGE study. Self-collected vaginal samples from the first and third trimester were obtained for HPV testing. Specimens from...

Background: Previous studies suggested a link between various infectious pathogens and the development of Alzheimer’s disease (AD), posing the question whether infectious disease could present a novel modifiable risk factor. Objective: To assess whether infectious disease burden due to clinically apparent infections is associated with an increased...

Background Rectal bleeding and increased stool frequency are the most common symptoms patients with UC report, and they are key components in most of disease activity scores. It is unclear whether the severity of patient reported outcomes (rectal bleeding or diarrhea) correlate with endoscopic or histological disease activity. The aim of this prosp...

INTRODUCTION Our population‐based study assessed whether clinically apparent Helicobacter pylori infection (CAHPI) is associated with the risk of Alzheimer's disease (AD). METHODS We assembled a population‐based cohort of all dementia‐free subjects in the United Kingdom's Clinical Practice Research Datalink (UK CPRD), aged ≥50 years (1988–2017). U...

Background: Most rectal cancer patients experience bowel symptoms post-restorative proctectomy. The incidence of mental health disorders post-restorative proctectomy and its association with bowel symptoms are unknown. Objectives: The objectives of our study are: a) to describe the incidence of mental health disorders in patients who underwent r...

Importance: The prevalence of human papillomavirus (HPV) infection during pregnancy and its risk of transmission to newborns are not well documented. Objective: To ascertain the prevalence of HPV in pregnant women, the risk of HPV detection in the placenta and in children at birth, and the probability that HPV detected at birth may persist in ne...

The rate of cervical cancer among Canadian Inuit women is higher than the national average. To date, early detection remains the best strategy for reducing the incidence of cervical cancer and its consequences. Thus, the aim of this study was to explore the barriers and facilitators in implementing human papillomavirus (HPV) self-sampling as a prim...

Background Observational studies suggesting that immunizations may strongly decrease the risk of dementia had several methodological limitations. Thus, we assessed whether common vaccines are associated with the risk of dementia. Methods We assembled a population-based cohort of dementia-free individuals in the UK’s CPRD aged ≥50 years between 198...

The growing evidence for an infectious etiology of dementia supports the investigation of immunization as a preventative intervention. Prior observational studies suggesting that common vaccines are associated with an up to 60% decreased risk of dementia had several methodological limitations. Thus, to provide evidence for this question, we assesse...

This article presents an overview of past and current grief rituals and practices and existing grassroots and institutional initiatives seeking to address the complex, prolonged, and traumatic grief experienced by many Inuit living in Quebec. While conducting a study seeking to identify the strengths, resources, and challenges for Nunavik's Inuit c...

Objectives: Endoscopic healing is currently considered the main target in the management of ulcerative colitis (UC). There is conflicting data about the role of histology as a stricter treatment objective. We aim at evaluating the additional benefit of histologic remission over endoscopic remission. Methods: We performed a prospective observatio...

Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on...

Objective Human papillomavirus (HPV) has been associated with adverse pregnancy outcomes but placental HPV infection has been rarely studied. The objective was to determine the proportion of HPV-positive placentas and the associated risk factors among HPV-positive women during pregnancy. Methods We analysed data from pregnant women enrolled in HER...

Background: Chronic inflammatory diseases are linked to an increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is controversial. We therefore examined the risk of and risk factors for myocardial infarction (MI) and stroke in IBD patients. Methods: We used the public health administrative datab...

Background The purpose of this study was to describe postoperative bowel dysfunction after restorative proctectomy, and to identify factors associated with its development. Methods Patients who underwent restorative proctectomy for rectal cancer between April 1998 and November 2018 were identified from the Hospital Episode Statistics database and...

Importance Preterm birth remains a leading cause of perinatal mortality and lifelong morbidity worldwide. The cause of most preterm births is unknown, although several infectious processes have been implicated. Objective To assess whether human papillomavirus (HPV) infection, a frequent infection among women of childbearing age, is associated with...

Objective: Owing to the potential role of the gut-lung axis in carcinogenesis, we assessed the incidence of gastric cancer in patients with chronic obstructive pulmonary disease (COPD). Methods: Using Quebec's administrative databases, we assembled a cohort of 118 913 patients aged 40 years and older with COPD from 1995 to 2015. We calculated ag...

Background The specific contribution of anti-TNF therapy to the onset of herpes zoster (HZ) in patients with inflammatory bowel disease (IBD) remains uncertain. Thus, the purpose of this nested case-control study was to explore whether the use of anti-TNF therapy is associated with an increased risk of HZ. Methods Using the Regie de l’Assurance Ma...

Background: Previous studies suggested a link between various infectious pathogens and the development of Alzheimer's disease (AD), posing the question whether infectious disease could present a novel modifiable risk factor. Objective: To assess whether infectious disease burden due to clinically apparent infections is associated with an increas...

Indigenous women have higher rates of cervical cancer and cervical cancer mortality compared to non-Indigenous women, as well as unique challenges to accessing screening services. Human papillomavirus (HPV) self-sampling has been demonstrated as an effective measure to reach under-screened women. A scoping review identified 19 sources matching sele...

Background Crohn disease (CD) and ulcerative colitis (UC) have high health care expenditures because of medications, hospitalizations, and surgeries. We evaluated disease outcomes and treatment algorithms of patients with inflammatory bowel disease (IBD) in Québec, comparing periods before and after 2010. Methods The province of Québec’s public he...

Background: Among Canadian Inuit, cervical cancer incidence and mortality rates are up to three times higher than the Canadian average. Cervical cancer is preventable through regular screening which, in Quebec, is opportunistic and requires physical examination and Papanicolaou ("Pap") smears. Since Human Papillomavirus (HPV) is the necessary caus...

Background Patients with RA are at increased risk of infection compared with the general population, but it is unclear whether this is due to the underlying disease or to immunosuppressive medications used to manage the disease. ¹ Some biologic DMARDs (bDMARDs) have been associated with an increased risk of serious infection. ² A large cohort study...

Background: There is a paucity of data on the dynamics of human papillomavirus (HPV) antibodies in children. We aimed to describe the vertical transmission and clearance of antibodies against HPV6, 11, 16 and 18 in children. Methods: We used data from pregnant women recruited into the HERITAGE cohort study between 2009 and 2012 who were positive fo...

Food insecurity may lead to depressive symptoms, which are known to be associated with poor HIV related health outcomes. However, it is unclear to what extent food insecurity ‘directly’ affects these outcomes. We used data from the Food Security & HIV–HCV Sub-Study of the Canadian Co-Infection Cohort to assess the controlled direct effect. People e...

Background Chronic inflammatory diseases have been linked to increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is conflictive. We, therefore, examined the risk of and risk factors for myocardial infarction (MI) and stroke in patients with IBD in Quebec. Methods We used the public health admini...

HPV vaccination efficacy has been shown in clinical trials but it is important to verify population level vaccine effectiveness (VE). We aimed to explore VE and herd effect using HPV infection data from a cohort study of Canadian pregnant women. We analyzed the baseline data of the HERITAGE study, which includes pregnant women recruited in Montreal...

Introduction: Faecal calprotectin [FC] is a reliable surrogate marker for disease activity in ulcerative colitis [UC]; however, there are no consensus cut-off values for remission. The study aim was to correlate FC with Mayo Endoscopic Score [MES] and histological disease activity of UC patients in clinical remission. Methods: Our study recruite...

Abstract Background: More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2...

Objectives To explore the trends and the predictors of incident malignant cancer among patients with inflammatory bowel disease (IBD). Methods We identified a cohort of all patients with incident IBD in Quebec, Canada, from 1998 to 2015, using provincial administrative healthcare databases (RAMQ and Med-Echo). Annual incidence rates (IRs) of cance...

Background Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are associated with high healthcare expenditures related to medications, hospitalisations, and surgeries. Our aim was to analyse disease outcomes and treatment algorithms in newly diagnosed IBD patients in Québec over the past 2 decades, compar...

Intratypic DNA polymorphism has been described for human papillomavirus (HPV) types infecting Inuit women in Nunavik, Quebec, a high-risk population for HPV infection and cervical cancer, but there is no previous research on the association between HPV polymorphism and infection persistence in Inuit women. Polymorphism of HPV types 16, 18 and 52 wa...

Background The aberrant immune response in inflammatory bowel disease (IBD) and immunosuppression may intrinsically predispose patients to infectious complications, such as herpes zoster (HZ). We quantified the incidence of HZ in IBD patients in the province of Quebec, Canada. Methods We performed a descriptive study using the provincial “Regie de...

Background & aims: Although the incidence of inflammatory bowel diseases (IBD) varies with age, few studies have examined variations between the sexes. We hypothesize that sex hormones are implicated in IBD pathogenesis. We therefore used population data from established cohorts to analyze sex differences in IBD incidence according to age of diagn...

Background: Whole genome sequencing (WGS) studies can enhance our understanding of the role of patients with asymptomatic Clostridium difficile colonization in transmission. Methods: Isolates obtained from patients with Clostridium difficile infection (CDI) and colonization identified in a study conducted during 2006 - 2007 at six Canadian hospi...

Depressive symptoms are associated with poor HIV viral control and immune recovery among people living with HIV. However, no prior studies assessed this association exclusively among people co-infected with HIV-hepatitis C virus (HCV). While people with HIV only and those with HIV-HCV co-infection share many characteristics, co-infected people may...

Objective: To investigate whether fungus-derived statins are associated with a lower risk of incident Alzheimer disease (AD) compared with synthetic statins using real-world clinical practice data. Methods: We identified a population-based retrospective cohort of patients aged ≥60 years newly prescribed a statin between January 1, 1994, and Dece...

Food insecurity (FI) is associated with depressive symptoms among HIV mono-infected people. Our objective was to examine to what extent this association holds among HIV–hepatitis C virus (HCV) co-infected people. We used data from a prospective cohort study of HIV–HCV co-infected people in Canada. FI was measured using the ten-item adult scale of H...

Background: In Québec, Canada, a public school-based and catch-up HPV vaccination programs with the quadrivalent vaccine have been introduced in September 2008 for girls aged 9-17 years. We assessed the early impact of the HPV vaccination program on the incidence of anogenital warts (AGW) in the Quebec general population. Methods: We used the pr...

Limited studies have associated metformin with a reduced risk of viral associated cancers, however these had a number of methodological shortcomings. This study investigated whether the use of metformin is associated with a reduced risk of viral associated cancers in patients with type 2 diabetes. A cohort of 137,754 patients newly-prescribed non-i...

Background: Inuit interpreters are key players in end-of-life (EOL) care for Nunavik patients and families. This emotionally intensive work requires expertise in French, English and Inuit dialects to negotiate linguistic and cultural challenges. Cultural differences among medical institutions and Inuit communities can lead to value conflicts and mo...

Although an increasing number of HIV infected people are accessing antiretroviral treatment, many do not achieve complete HIV viral suppression and remain at risk for AIDS and capable of HIV transmission. Food insecurity has been identified as a potential risk factor for poor virologic response, but the association between these factors has been in...

Background: Increasing longevity for Inuit living in Nunavik, northern Quebec, has resulted in heightened rates of cancers and chronic diseases necessitating complex treatments. Consequently, end-of-life (EOL) care, once the domain of Inuit families and communities, has come to include professionalized healthcare providers with varying degrees of...

Background: Endoscopic healing (EH), has become the target endpoint of successful ulcerative colitis (UC) management while the role of histology remains to be clarified. Clinical and biochemical markers are not sufficient to predict which UC patients are in EH. Fecal calprotectin (FC) has been demonstrated to be useful surrogate marker, however, th...

Background Among patients with inflammatory bowel disease (IBD), age is a strong and well-known determinant of disease risk. Although peak incidence rates according to age have been widely reported, little is known about how these estimates vary according to sex. We aimed to explore the incidence of Crohn's disease (CD) and ulcerative colitis (UC)...

The use of oral and inhaled corticosteroids is associated with increases in the risk of infection, especially pneumonia. The risk of sepsis with corticosteroid treatment in patients with chronic obstructive pulmonary disease (COPD) has been little studied, however. We assessed whether the use of inhaled and oral corticosteroids in COPD is associate...

Purpose: The effect of statins on cytokine-mediated inflammatory responses may impact on the prognosis of influenza. We assessed whether statin use decreases the incidence of adverse influenza-related outcomes. Additionally, we used a new-user study design to minimize healthy user bias. We further examined the possibility of non-causal association...

Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence amo...

Objective: A common nonsense mutation in TBC1D4 was recently found to substantially increase the odds of type 2 diabetes in Greenlandic Inuit, leading to exclusively increased postprandial glucose. We investigated the frequency and effect of the TBC1D4 mutation on glucose metabolism and type 2 diabetes diagnosis among Canadian and Alaskan Inuit....

OBJECTIVE To determine the risk of Clostridium difficile transmission from index cases with C. difficile infection (CDI) to their household contacts and domestic pets. DESIGN A prospective study from April 2011 to June 2013. SETTING Patients with CDI from Canadian tertiary care centers. PARTICIPANTS Patients with CDI, their household human conta...

Perinatal route of transmission of human papillomavirus (HPV) has been demonstrated in several small studies. We designed a large prospective cohort study (HERITAGE) to better understand perinatal HPV. The objective of this article is to present the study design and preliminary data. In the first phase of the study, we recruited 167 women in Montre...

Food insecurity is defined as a limited or uncertain ability to acquire acceptable foods in socially acceptable ways, or limited or uncertain availability of nutritionally adequate and safe foods. While effective antiretroviral treatment can significantly increase CD4 counts in the majority of patients, there are certain populations who remain at r...

Background: Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac surgery on the subsequent risk of SSIs usually focused on antibacterial prophylaxis. The objective...

The biennial CSEB National Student Conference is a Canadian conference for students by students. The hosting university changes every year, and the conference attracts highly motivated graduate students in the fields of epidemiology and biostatistics to disseminate their current research methods and findings. The conference provides a platform for...

The aim of our study was to better understand the end of life (EOL) services offered in Nunavik and to identify whether there were ways to improve the quality of EOL care for patients and families. We interviewed patients and family members, healthcare providers, community members, and others who were involved in EOL care. Areas of inquiry included...

Patients with chronic obstructive pulmonary disease (COPD) have higher incidence and prevalence of other chronic inflammatory diseases, including inflammatory bowel disease (IBD). We assessed whether IBD onset increases mortality risk in patients with COPD or asthma-associated COPD. Two population-based cohorts of COPD and asthma-COPD subjects wer...

ABSTRACT Background. Inuit communities in northern Quebec have high rates of human papillomavirus (HPV) infection, cervical cancer and cervical cancer–related mortality as compared to the Canadian population. HPV types can be further classified as intratypic variants based on the extent of homology in their nucleotide sequences. There is limited i...

Background: Mortality rates greater than in the general population have been reported in the population with Crohn's disease (CD), but reports for ulcerative colitis (UC) are conflicting. Trends with time were rarely described. We aimed to assess whether CD and UC mortality in Quebec differs from that in the general population and to describe the t...

To study the incidence, persistence, and determinants of human papillomavirus (HPV) infection in a population of Inuit women from Nunavik, Quebec, by overall HPV infection, Alphapapillomavirus (α) species, and oncogenic risk grouping. We recruited a cohort of Inuit women living in communities in Nunavik when they presented for routine care. Baselin...

Clostridium difficile (CD) is the leading cause of health care-associated diarrhea and can result in asymptomatic carriage. Rates of asymptomatic CD colonization on hospital admission range from 1.4%-21%. The objective of this study was to evaluate host and bacterial factors associated with colonization on admission. The Consortium de recherche qué...

The objective of the study was to assess whether the incidences of Crohn’s disease and ulcerative colitis are increased in patients with asthma and chronic obstructive pulmonary disease (COPD) compared to the general population. A population-based retrospective cohort study was conducted using the administrative health databases of Québec, Canada....

Objectives: Systemic corticosteroids are among the most common anti-inflammatory treatments in elderly-onset inflammatory bowel disease (IBD) patients. Steroid use and older age each independently predisposes to infections, and infections increase mortality in hospitalized older IBD patients. Therefore, our objective was to examine the risk of ser...

Objective: Define the burden of HIV-TB co-infection and predictors of HIV screening among incident TB cases. Methods: Analysis of surveillance data on TB incident cases reported to Montreal's Public Health Department from 2004 to 2009. Among all reported TB cases, proportions of cases with HIV testing and HIV infection were calculated by patient...

BACKGROUND:: Among 10 provinces in Canada, Québec has the second highest incidence of Crohn's disease (CD), based on data collected more than a decade ago. To date, there are no reports on the occurrence of ulcerative colitis (UC) and no updates on the occurrence of CD in Québec. We sought to describe trends in the annual incidence and prevalence o...

Background: Recent experimental data show that exposure to microbes during early childhood can confer immunological tolerance and protect against Crohn's disease (CD). Epidemiological evidence for this link, however, remains controversial. Using prospective data, we examined the link between this hypothesis and risk for CD in children and young ad...

Background and purpose: Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks' follow-up. Materials and methods: We randomly assigned 56 subjects to re...

INTRODUCTION: Administrative databases are used extensively to describe the epidemiology, burden of disease and health outcomes of chronic diseases such as inflammatory bowel disease (IBD). Time-related biases may have been introduced in studies using administrative databases to estimate the incidence of IBD. AIMS&METHODS: To illustrate and quantif...

Purpose: Among 10 provinces in Canada, Québec has the second highest incidence of Crohn’s disease (CD), based on data collected more than a decade ago. To date, there are no reports on the occurrence of ulcerative colitis (UC), and no updates on the occurrence of CD in Québec. Th e aim of the present study is to describe trends in the annual incide...

Purpose: Infl ammatory bowel disease (IBD) and airway diseases may be associated through common infl ammatory pathways, genetic, and environmental factors. Th e prevalence of both Crohn’s disease (CD) and ulcerative colitis (UC) seems to be increased among patients with airway diseases. Québec is the province with the second highest incidence and p...

The human leukocyte antigen (HLA)-G molecules act as negative regulators of the immune response. We analyzed the associations between HLA G polymorphisms and human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) in Inuit women from Nunavik, northern Quebec. Cervical specimens from a cohort study of 548 Inuit women were tes...

Human leukocyte antigen (HLA) alleles code for proteins that are involved in the recognition of foreign antigens and activation of the immune system. The frequency of HLA alleles varies across different populations. To describe the frequency of HLA alleles in a population of Inuit women of Nunavik, Quebec, Canada. A cohort of women was recruited fr...

Certain types of the Human Papillomavirus (HPV) are sexually transmitted and highly associated with development of cervical dysplasia and cervical cancer but the distribution of HPV infection in the North, particularly amongst First Nations, Metis, and Inuit peoples, is little known. The purposes of the study are to identify the prevalence of type-...

xBxxaxcxkground. In addition to prevention guidelines already in place, the effectiveness of an antimicrobial dressing on the occurrence of surgical site infections (SSIs) among adult patients undergoing cardiac surgery was evaluated. A house-wide replacement of the plain postoperative gauze dressing with a sterile dressing impregnated with 0.2% po...

There is a higher incidence of cervical cancer and prevalence of genital human papillomavirus (HPV) infection among the Inuit in Canada than the general population. Self-sampling of cervicovaginal cells for HPV testing has the potential to increase cervical cancer screening coverage in this population, but only if it is acceptable to women. We soug...

The results of a tuberculin skin test (TST) screening program offered to employees of services for homeless people in Montréal from 1998 to 2005 were analyzed to assess the occupational risk of tuberculosis (TB) infection. Employees with no known contact with TB were selected among volunteer participants. They were followed in two dynamic cohorts:...

Objective: Certain types of the human papillomavirus (HPV) are highly associated with cervical cancer or dysplasia, but its prevalence is largely unknown in northern Canada where there is significant aboriginal representation and unique barriers to accessing care. This study determined the prevalence of HPV infection and its association with cervi...

Background The Canadian circumpolar Inuit population has a higher incidence rate of cervical cancer than the general population and the majority of cases occur among underscreened women. The objectives of this study were to determine Pap smear utilization rates and to determine factors associated with time-inappropriate use of cervical cancer scree...

In some regions, Aboriginal women have higher rates of cervical cancer compared to other Canadian women. However, little data are available regarding the co-factors of HPV infection in the Aboriginal population of Canada. We examined factors associated with high-risk human papillomavirus (HR-HPV) infection in a population of women (both Aboriginal...

The association between polymorphism of human papillomavirus type 52 (HPV52) andhigh-grade cervical intraepithelial neoplasia (CIN2,3) was investigated in Canadianwomen. HPV-52-positive endocervical specimens collected from 216 women selectedfrom a total of 3614 participants recruited in two case-control and two cohort studiesconducted in Canada we...

A higher incidence of cervical cancer and human papillomavirus (HPV) infection has been reported in northern Canada and in First Nation, Métis and Inuit women, with some evidence to suggest that the HPV type distribution in these populations may be different from the rest of Canada. The objective of this study was to measure the HPV type prevalence...

Objective: We assessed temporal trend in the incidence and prevalence of genital warts (GWs) in the province of Quebec, Canada, between 1998 and 2007 as a baseline for future assessment of the impact of Quebec human papillomavirus vaccination program. Materials and methods: Data on GWs were obtained from the linkage of the physician service clai...

To assess the comparability of self-collected cervicovaginal samples and provider-collected cervical samples for the detection of human papillomavirus (HPV) DNA among Inuit women in Nunavik, Quebec, avoiding the use of liquid-based storage and transport of the self-collected samples. Ninety-three women aged 18-69 years were recruited from a previou...

To describe the attitudes about and experiences with cervical cancer, Pap smear screenings and the HPV vaccine among a sample of Inuit women from Nunavik, Quebec, Canada. We also evaluated demographic and social predictors of maternal interest in HPV vaccination. A mixed method design was used with a cross-sectional survey and focus group interview...

We compared the performance of 8 Clostridium difficile enzyme immunoassays to cell cytotoxicity neutralization assay and toxigenic culture. The effect of strain type on assay performance was also examined. There were a total of 71 (14.4%) samples in which C. difficile was recovered; 58 (81.7%) of 71 were toxigenic. Compared to a composite reference...