ABSTRACT
Background: Ending the HIV Epidemic by 2030 initiative includes phylogenetics as a molecular framework to track patterns of HIV spread. In this study, phylogenetics was combined with available epidemiological data to elucidate track evolving trends in HIV-1 spread among Men having Sex with Men (MSM) and Heterosexual (HET) populations in Quebec. Methods: Phylogenetic linkage analysis was performed using MEGA-10 and HIV-TRACE/Microbe-TRACE methodologies. New infections genotyped between 2014-2020 were stratified into groups: i) Subtype B MSM (subtype B male singletons/male-male clusters, n=1812);ii) Subtype B Heterosexual (female singletons/female-male clusters, n=432), including migrants from the Caribbean and Americas;and iii) Non-B subtype (n=737) epidemics. Test requisition data and clinical data from Clinique Actuel (n=141 and 50, 2016-2018) monitored epidemiological features in a subset of newly diagnosed persons. Results: Among MSM, annual new infections declined by 20% and 40% over the 2015-2017 and 2018-2020 periods, respectively. Overall, 45% of new infections in MSM were associated with 20 active large clusters, adding 8-96 infections/clusters from 2014-2020. Clinical data showed 37% newly diagnosed MSM were born outside Canada, 28% of whom were linked to large cluster outbreaks. Among heterosexuals with subtype B infections, there was a 31% increase from 2015-2017 followed by a 36% decline from 2018-2020 post-COVID. Of note, large cluster HET outbreaks occurred in Quebec City, Richelieu, and Northern Quebec Overall, non-B subtype infections remained steady (median 100 annually) over the 2014 to 2020 period. Several non-B subtype clusters reflect the domestic introduction and spread of subtype CRF02- AG variants. Cluster membership and cluster size was associated with recent stage infection, viral sequence recency (based on % mixed base calls) and younger age of members within individual clusters. Conclusion: Annual numbers of new HIV-1 infections have steadily declined among MSM post-2008, concomitant to improved HIV prevention paradigms. Epidemic control among MSM and HET groups has been thwarted by large cluster outbreaks. Recent arrivals to Quebec accounted for a growing number of subtype B and non-B subtype infections. HIV prevention efforts must continue in the post-COVID era, tailored to avert transmission cascades in younger persons and recent migrant populations.
ABSTRACT
The vegetable sector plays an important role in ensuring food security. Vegetable trade flows in Romania have become a major concern due to constant trade balance deficits despite the country’s agricultural potential. Taking into account the paradox between what could be considered an abundance of factor endowments and poor trade balance results, the objective of this research was to study the linkage between vegetable trade flows and chain competitiveness. Spatial panel econometric methods were used to study the impact of the international vegetable market on the demand in Romania, while the Balassa index and Porter’s diamond modelling techniques were used to study the competitiveness of the vegetable chain at both county and national levels. By applying the spatial regression method to the international trade and national production panel data, it was found that an increase in the quantity of vegetables imported into Romania would cause an even greater decrease in national vegetable production. The results show that Romanian vegetable production is highly and negatively influenced by the growing appetite for imports—therefore leading to a national dependence on the global vegetable chain. Porter’s diamond model results confirm that: (a) growing vegetables is profitable in Romania and the average profit margin is higher in this economic sector than in many others;(b) there is a lack of competitiveness caused by the post-communist excessively fragmented agrarian land structure and poor performance of the irrigation, warehousing, and transportation sectors;(c) the national production of vegetables is generally self-sufficient with the exception of three counties that resort to importing and account for more than 70% of Romania’s total vegetable imports;(d) factor endowments cannot be fully harnessed, and this contributes to the deepening of the trade balance deficits. Improvement is possible by fostering competitiveness through increasing the performance of supporting industries and the logistics infrastructure, as well as removing market access barriers for the many small farmers.
ABSTRACT
Background: Social isolation has been identified as a substantial health concern in aging populations, associated with adverse chronic disease outcomes and health inequalities; however, little is known about the interconnections between social capital, diabetes management, and hospital burdens. This study aimed to assess the role of community belonging with the risk of potentially avoidable hospitalization among aging adults living with diabetes in Canada. Methods: The study leveraged a novel resource available through Statistics Canada's Social Data Linkage Environment: the Canadian Community Health Survey linked to administrative health records from the hospital Discharge Abstract Database. A population-representative sample of 13,580 community-dwelling adults aged 45 and over with diabetes was identified. Multiple logistic regression was used to assess the association of individuals' sense of community belonging with the risk of diabetes-related hospitalization over the period 2006-2012. Results: Most (69.9%) adults with diabetes reported a strong sense of belonging to their local community. Those who reported weak community belonging were significantly more likely to have been hospitalized for diabetes (χ2 = 13.82; p < 0.05). The association between weak community attachment and increased risk of diabetes hospitalization remained significant [adjusted OR: 1.80 (95%CI: 1.12-2.90)] after controlling for age, education, and other sociodemographic and behavioral factors. Conclusion: The COVID-19 pandemic has resurfaced attention to the need to better address social capital and diabetes care in public health strategies. While the causal pathways are unclear, this national study highlighted that deficits in social attachments may place adults with diabetes at greater risk of acute complications leading to hospitalization.