RESUMEN
A tuberculosis (TB) case was reported May 2008 in Kelowna, British Columbia, leading to a multi-year outbreak in homeless persons. The epidemiological characteristics and social networks of cases are described. Outbreak-related cases were identified from epidemiological information in medical records and from genotyping of TB isolates. Social network information from case interviews were used to identify potential locations of TB transmission, where symptom screening and tuberculin skin testing was conducted. Fifty-two cases that were predominantly male (47/52), Canadian-born (44/50), and were homeless or associated with homeless individuals (42/52) were reported from May 2008 to May 2014. Many isolates (40/49) had partial resistance to isoniazid. Transmission primarily occurred at two homeless shelters, with potential further transmission at sites visited by the general population. TB outbreaks in homeless populations can occur in small, low-incidence cities. Social network information helped prioritize sites for TB screening, thereby improving detection of persons with TB disease or latent infection for treatment.
Asunto(s)
Brotes de Enfermedades , Personas con Mala Vivienda/estadística & datos numéricos , Apoyo Social , Tuberculosis Pulmonar/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Antituberculosos/uso terapéutico , Colombia Británica/epidemiología , Trazado de Contacto , Farmacorresistencia Bacteriana , Femenino , Vivienda , Humanos , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/fisiología , Resultado del Tratamiento , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Tuberculosis/microbiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología , Adulto JovenRESUMEN
We conducted a case-control study examining risk factors for ciprofloxacin resistance in Campylobacter infections that were reported in 2004 and 2005 in two health regions in southern Alberta. The study questionnaire included questions about recent travel and antibiotic use, food consumption frequency, use of household and personal hygiene products with antibacterial agents, contact with animals, and potential misuse of antibiotics. Of the 210 patients who participated, 31.0% had ciprofloxacin-resistant Campylobacter infections. Foreign travel was the strongest predictor of resistance. Surprisingly, possession of antibiotics for future use was identified as a risk factor for resistance. We also examined the potential for participation bias and resistance misclassification to affect the resulting multivariable models. Participation bias appears to have had a substantial effect on the model results, but the estimated misclassification effect due to the use of different ciprofloxacin susceptibility testing methods was only slight.
Asunto(s)
Antibacterianos/farmacología , Infecciones por Campylobacter/microbiología , Campylobacter/efectos de los fármacos , Campylobacter/aislamiento & purificación , Ciprofloxacina/farmacología , Farmacorresistencia Bacteriana , Adulto , Anciano , Anciano de 80 o más Años , Alberta/epidemiología , Infecciones por Campylobacter/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios , ViajeAsunto(s)
Guarderías Infantiles , Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157/aislamiento & purificación , Alberta/epidemiología , Niño , Preescolar , Estudios de Cohortes , Métodos Epidemiológicos , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Incidencia , Lactante , Masculino , Recursos HumanosRESUMEN
BACKGROUND: Pertussis is increasingly recognized as an important cause of cough illness in adolescents and adults. PURPOSE: To evaluate the safety and antibody response to a single dose of an adult formulation of a five component (pertussis toxoid, filamentous hemagglutinin, pertactin, fimbriae 2 and 3) acellular pertussis vaccine (aP) combined with diphtheria and tetanus toxoids (TdaP) and inactivated poliovirus vaccine (TdaP-IPV) in adolescents and adults and to assess the response to a second dose of the acellular pertussis vaccine in a subset of the adults. POPULATION AND SETTING: The study addressed 1207 healthy participants (736 adults and 466 adolescents) recruited in five Canadian communities. STUDY DESIGN: In a randomized, observer-blind, controlled clinical trial, adult participants received Td followed at a separate visit by aP, TdaP followed by IPV or TdaP-IPV; adolescents received Td-IPV followed at a separate visit by aP or TdaP-IPV. A subgroup of adults was given a booster of aP 1 month after TdaP. OUTCOME MEASURES: Antibody titers measured before and 1 month after each immunization; adverse events enumerated at 24 h, 72 h and 8 to 10 days. RESULTS: The aP vaccine given by itself was associated with adverse events less frequently than were Td, Td-IPV, TdaP or TdaP-IPV vaccines, but reaction rates did not differ significantly among the latter products. The antibody response against Bordetella pertussis antigens was vigorous in all groups, although adults given the TdaP-IPV vaccine had lower antibody titers against filamentous hemagglutinin, pertactin, diphtheria and tetanus antibodies than those given TdaP vaccine. Similarly adolescents given TdaP-IPV had lower antibody titers against pertussis toxin, filamentous hemagglutinin, fimbriae and agglutinins than those given Td-IPV and aP alone. A second dose of acellular pertussis vaccine was not associated with increased adverse events in adults but elicited increased antibody titers over that achieved by a single dose only against pertussis toxin. CONCLUSIONS: This adult formulation five component aP vaccine given as TdaP-IPV is safe and immunogenic in adolescents and adults and is a candidate vaccine for adolescent and adult immunization programs.
Asunto(s)
Toxoide Diftérico/inmunología , Vacuna Antipolio de Virus Inactivados/inmunología , Toxoide Tetánico/inmunología , Toxoides/inmunología , Adolescente , Adulto , Anciano , Formación de Anticuerpos/inmunología , Química Farmacéutica , Niño , Intervalos de Confianza , Toxoide Diftérico/administración & dosificación , Toxoide Diftérico/efectos adversos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vacuna Antipolio de Virus Inactivados/administración & dosificación , Vacuna Antipolio de Virus Inactivados/efectos adversos , Sensibilidad y Especificidad , Toxoide Tetánico/administración & dosificación , Toxoide Tetánico/efectos adversos , Toxoides/administración & dosificación , Toxoides/efectos adversos , Vacunación/métodos , Vacunas Combinadas/efectos adversos , Vacunas Combinadas/inmunología , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/efectos adversos , Vacunas de Productos Inactivados/inmunologíaRESUMEN
Pertussis is increasingly being recognized as an important cause of cough illness in adolescents and adults. To evaluate the safety and immunogenicity of an adult formulation of a five-component (pertussis toxoid, filamentous hemagglutinin, pertactin, fimbriae 2 and 3) acellular pertussis vaccine combined with diphtheria and tetanus toxoids, we randomly allocated 749 healthy adolescents and adults from 12-54 years of age recruited from five Canadian communities to receive either tetanus-diphtheria vaccine (Td), acellular pertussis vaccine (aP) or combined diphtheria-tetanus-acellular pertussis vaccine (TdaP). Subjects and personnel were unaware of the vaccine allocation. Antibody levels were measured before and one month postimmunization; adverse events were collected at 24 and 72 h and 8 to 10 days. Adverse events were reported in similar frequency amongst the three vaccine groups. Moderate pain at the injection site was reported less frequently in the aP group than the TdaP group (10.7% compared to 19.4%; relative risk 0.6, 95% confidence interval 0.3-0.9). Chills were reported less frequently after Td (5.3%) than after TdaP (12.5%; relative risk 0.4, 95% confidence interval 0.2-0.9). There were no statistically significant differences between recipients of Td and TdaP in tetanus and diphtheria antitoxin levels achieved. Antibody response against Bordetella pertussis antigens was vigorous in all groups although recipients of aP alone had higher levels of antibody levels against pertussis toxoid, fimbriae, and agglutinins and lower antibody levels against pertactin than did TdaP recipients. We conclude that this adult formulation 5-component acellular pertussis vaccine is safe and immunogenic in adolescents and adults and is a candidate vaccine for adolescent and adult immunization programs.
Asunto(s)
Toxoide Diftérico/inmunología , Vacuna contra la Tos Ferina/inmunología , Toxoide Tetánico/inmunología , Adolescente , Adulto , Anticuerpos/análisis , Anticuerpos/sangre , Formación de Anticuerpos , Demografía , Toxoide Diftérico/efectos adversos , Método Doble Ciego , Femenino , Humanos , Inmunidad , Masculino , Vacuna contra la Tos Ferina/efectos adversos , Toxoide Tetánico/efectos adversos , Vacunas Combinadas/efectos adversos , Vacunas Combinadas/inmunologíaRESUMEN
The correlates of suicide rates were determined by conducting a multivariate study of sociodemographic indicators and suicide rates of 261 Canadian census divisions. Twenty-one sociodemographic variables were entered into a stepwise multiple linear regression to develop a model for suicide rates. The important variables were mortality rate for all causes of death, the age of the population, average family income, population density, proportion with no religious affiliation, proportion of Francophones, unemployment, immigration, proportion of Native people, a regional effect for British Columbia and the north, and growth by mobility, explaining 62% of the observed variation. This spatial ecologic analysis highlights the importance of cultural differences in explaining the variation of suicide rates. The analysis supports the previously found negative relationship between income and suicide while contrasting from previous studies in determining a inverse relationship with unemployment and an inverse relationship with the age distribution.
Asunto(s)
Demografía , Factores Socioeconómicos , Suicidio/estadística & datos numéricos , Canadá/epidemiología , Causas de Muerte , Estudios Transversales , Humanos , Incidencia , Factores de Riesgo , Suicidio/psicología , Prevención del SuicidioRESUMEN
The risk of mortality related to occupation was determined for commercial fishermen in the Canadian Atlantic coast provinces of Nova Scotia, New Brunswick, and Prince Edward Island. The subjects were a cohort of 31,415 fishermen licensed by the Canadian Department of Fisheries during 1975-83. Mortality and cause of death were obtained from the Canada Mortality Data Base and the Marine Casualty Investigation Unit (MCI), and were confirmed by examination of death certificates. Eighty four deaths likely to be related to fishing were recorded over 183,378 person-years of exposure for an annual mortality of 45.8 (95% confidence interval (CI) 36.0-55.6) per 100,000 fishermen. The rate of potential years of life lost up to age 75 was 1583 per 100,000 person-years of exposure. Inclusion of 14 additional deaths, which were possibly related to occupation, would increase these rates further. Bias in this study is likely to underestimate the risks. It is concluded that fishing is one of the most hazardous occupations in terms of mortality related to work.
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Accidentes de Trabajo/mortalidad , Explotaciones Pesqueras , Adolescente , Adulto , Anciano , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Nuevo Brunswick/epidemiología , Nueva Escocia/epidemiología , Isla del Principe Eduardo/epidemiología , Factores de RiesgoRESUMEN
Suicide rates in Canada rapidly increased during the 1960s and 1970s. More recent analysis of these trends indicates that in males suicide rates have stabilized and in females a notable decrease has been identified. The greatest changes in suicide rates have occurred among the youngest age groups (15 to 19), while little change has occurred in suicide mortality rates for males aged 50 years and over. The age-specific death rates in 1986 are uniformly distributed in males above age 20, while in females an inverted "U" curve is demonstrated with the peak at age 45-50. Males continue to have higher rates and the difference between males and females is expanding. A birth cohort analysis indicates that the contribution of the birth cohort to explaining suicide rates has diminished and been replaced by a more recent period effect. Suicide remains the second most important cause of death of persons between 15 and 34 years of age. Provincial variation is discussed through geographic variation, cause-specific rankings and potential years of life lost. In contrast to national trends, suicide mortality in Alberta, Quebec and New Brunswick continues to increase. An atlas is provided to display Canadian census divisions that exhibit elevated rates of suicide.
Asunto(s)
Suicidio/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Canadá/epidemiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Razón de Masculinidad , Factores de TiempoRESUMEN
The authors of this study examine the demographic and clinical characteristics of hospitalized long-term active psychiatric patients in a metropolitan Canadian region. Their characteristics are compared to other hospitalized patients. Problems inherent in using a cross sectional methodology are reviewed. It was expected that this study's findings will help in identifying the needs of the long-term patients in planning appropriate resources and maintaining them in the community.
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Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Investigación sobre Servicios de Salud/tendencias , Cuidados a Largo Plazo/estadística & datos numéricos , Trastornos Mentales/epidemiología , Población Urbana , Adulto , Anciano , Enfermedad Crónica , Estudios Transversales , Femenino , Recursos en Salud/estadística & datos numéricos , Humanos , Incidencia , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Ontario/epidemiología , Revisión de Utilización de RecursosRESUMEN
We conducted a telephone survey of 102 randomly selected Ottawa family physicians to determine their attitudes and practices regarding the treatment of hypercholesterolemia. Of the 102, 56% routinely measured serum cholesterol levels in all their patients over the age of 30 years, and 24% did so for patients in more restricted age ranges. The level at which they started dietary therapy averaged 6.95 mmol/L (270 mg/dl); for 25% it was less than 6.22 mmol/L (240 mg/dl). The level at which they started drug therapy averaged 8.9 mmol/L (345 mg/dl); for only 15% was it 7.23 mmol/L (280 mg/dl) or less. Two-thirds were unable to give numerical values to the serum cholesterol levels at which they started diet therapy, and 38% used the upper limits of laboratory normal values as an indication to start therapy. Our findings contrast markedly with results reported for US family physicians, who treat hypercholesterolemia much more aggressively. The variability in practices must be addressed if public campaigns to lower serum cholesterol levels are to be undertaken.
Asunto(s)
Actitud del Personal de Salud , Colesterol/sangre , Hipercolesterolemia/dietoterapia , Médicos de Familia , Adulto , Canadá , Gemfibrozilo/uso terapéutico , Humanos , Hipercolesterolemia/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Estados UnidosRESUMEN
The increasing number of accidents associated with off-road motor vehicles used for recreational purposes prompted this prospective study. During 1985 the records of victims of all motor vehicle accidents who were seen at the Hudson Bay Union Hospital, Hudson Bay, Sask., were studied; patients involved in on-road vehicle accidents were included for comparison. Emphasis was placed on age, vehicle type, mechanism of accident, injury severity and the use of safety features. Almost half of the victims of off-road vehicle accidents were under 16 years of age. The poor adherence to government legislation and manufacturer recommendations was evident in the number of people who did not wear helmets or use headlights.