Economy, community and mortality in British Columbia, Canada

Stimulated by the growing body of literature relating economic inequalities to inequalities in health, this article explores relationships between various economic attributes of communities and mortality rates among 24 coastal communities in British Columbia, Canada. Average household income, a measure of community wealth, was negatively related and the incidence of low incomes, a measure of poverty, was positively related to age-standardized mortality. Both were more strongly related to female than male mortality. Mean and median household income, the incidence of low incomes and a lack of disposable income, and the proportion of total income dollars derived from government sources were significantly related to mortality rates for younger and middle-aged men but not for elderly men. Mortality rates for younger and middle-aged women were not explicated by these economic attributes of communities: among elderly women only, mortality rates were higher in communities with a lower average household income and in those with a higher incidence of low incomes. Finally, a higher concentration in white-collar industries was related to higher mortality rates for females, even after controlling for other economic attributes of communities. These results do not obviously support a psychosocial argument for an individual-level relationship between income and health that assumes residents perceive their status primarily in relation to other members of the same community, but do provide moderate support for the materialist argument and moderate support for the psychosocial argument that assumes community residents perceive their status in relation to an encompassing reference group. Other viable interpretations of these relationships pertain to ecological characteristics of communities that are related to both economic well-being and population health status; in this instance, concentration in specific economic industries may help to understand the ecological relationships presented here.     

Cryptococcus gattii dispersal mechanisms, British Columbia, Canada

Recent Cryptococcus gattii infections in humans and animals without travel history to Vancouver Island, as well as environmental isolations of the organism in other areas of the Pacific Northwest, led to an investigation of potential dispersal mechanisms. Longitudinal analysis of C. gattii presence in trees and soil showed patterns of permanent, intermittent, and transient colonization, reflecting C. gattii population dynamics once the pathogen is introduced to a new site. Systematic sampling showed C. gattii was associated with high-traffic locations. In addition, C. gattii was isolated from the wheel wells of vehicles on Vancouver Island and the mainland and on footwear, consistent with anthropogenic dispersal of the organism. Increased levels of airborne C. gattii were detected during forestry and municipal activities such as wood chipping, the byproducts of which are frequently used in park landscaping. C. gattii dispersal by these mechanisms may be a useful model for other emerging pathogens.     

HIV/HCV混合感染的研究进展

本文就人免疫缺陷病毒(HIV)感染与丙型肝炎病毒(HCV)混合感染的流行病学、两者相互影响及治疗原则等方面的研究进展进行了综述。     

Effectiveness of community-directed diabetes prevention and control in a rural Aboriginal population in British Columbia, Canada

This report presents the process and summative evaluation results from a community-based diabetes prevention and control project implemented in response to the increasing prevalence and impact of non-insulin-dependent diabetes mellitus (NIDDM) in the Canadian Aboriginal population. The 24-month project targeted the registered Indian population in British Columbia's rural Okanagan region. A participatory approach was used to plan strategies by which diabetes could be addressed in ways acceptable and meaningful to the intervention community. The strategies emphasised a combination of changing behaviours and changing environments. The project was quasi-experimental. A single intervention community was matched to two comparison communities. Workers in the intervention community conducted interviews of individuals with or at risk for diabetes during a seven-month pre-intervention phase (n = 59). Qualitative analyses were conducted to yield strategies for intervention. Implementation began in the eighth month of the project. Trend measurements of diabetes risk factors were obtained for 'high-risk' cohorts (persons with or at familial risk for NIDDM) (n = 105). Cohorts were tracked over a 16-month intervention phase, with measurements at baseline, the midpoint and completion of the study. Cross-sectional population surveys of diabetes risk factors were conducted at baseline and the end of the intervention phase (n = 295). Surveys of community systems were conducted three times. The project yielded few changes in quantifiable outcomes. Activation of the intervention community was insufficient to enable individual and collective change through dissemination of quality interventions for diabetes prevention and control. Theory and previous research were not sufficiently integrated with information from pre-intervention interviews. Interacting with these limitations were the short planning and intervention phases, just 8 and 16 months, respectively. The level of penetration of the interventions mounted was too limited to be effective. Attention to process is warranted and to the feasibility of achieving effects within 24 months.     

HIV感染者合并丙型肝炎病毒及乙丙型肝炎病毒混合感染的临床分析

近年来,艾滋病（AIDS）发病率不断上升。而HIV、HCV和HBV有相似的传播途径。为了解HIV、HCV和HBV之间的相互影响,现对武汉市传染病医院近年来收治的AIDS患者HCV感染情况进行分析。以了解两者的相互作用。     

Salmonella enterica Serovar Agbeni, British Columbia, Canada, 2011

TO THE EDITOR: Infection with Salmonella enterica serovar Agbeni is rare. In Canada, it was reported 8 times during 2000-2010 and never in the province of British Columbia (2011 population?4.5 million) (Public Health Agency of Canada, unpub. data). In June 2011, an outbreak of S. enterica ser. Agbeni affecting 8 persons was identified in British Columbia; pulsed-field gel electrophoresis patterns for all isolates were identical. Although no specific source was identified, 2 features were noted: 1) diagnosis through urine specimens for 3 of 8 persons and 2) a longer than typical incubation period for Salmonella spp. infection.     

Work-related injury among direct care occupations in British Columbia, Canada

Objectives

To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada.

Methods

Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full‐time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care).

Results

CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%).

Conclusions

Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.Direct care occupations comprise the largest proportion (58%) of healthcare employees in Canada and consist of registered nurses (RNs), licensed practical nurses (LPNs) and care aides (CAs).^1,2,3 Engkvist et al. (1998) describe a similar grouping of nursing occupations in Sweden with general RNs, state registered nurses (LPNs) and auxiliary nurses (CAs).⁴ Such employees work in various settings (acute care, nursing homes and community care) across the healthcare system. These settings, providing care specific to the needs of patients/residents/clients, have very differing task requirements. Due to shortages in the direct care occupations, workers have more opportunities to choose where they prefer to work. While wage differentials may influence recruitment and retention, as Spetz (2003) has noted, wage increases are not viable solutions for resolving the workforce shortages; work conditions were more important for recruiting and retaining personnel.⁵ Thus a study of differential risk of injuries for the various direct care occupations in different health settings is warranted.RNs can work as independent practitioners in all settings or as team members that assign clients and/or client care functions appropriately. LPNs do not work in isolation but as team members and must exercise clinical judgment in accepting assigned client care functions within their own level of competence.⁶ In many nursing homes, LPNs have been used interchangeably with CAs. CAs must work with the support of RNs and LPNs in providing help to patients/residents/clients with their activities of daily living (such as assistance with personal hygiene, dressing, eating and mobility). This often involves lifting, transferring and repositioning of patients/residents/clients.In the health sector across Canada in 2004, 62.5% of RNs were working in acute care, whereas 13.4% were working in community health and 10.5% in nursing homes.⁷ Jansen et al. (2000) reports that LPNs were predominantly (57%) in acute care, 33% in nursing homes and 10% in community care.⁸ CAs were predominantly working in nursing homes with some in community care and a smaller proportion in acute care.⁹ In the future, it is likely that more nurses will be required to work in nursing homes or community care because of policy changes that focus on reducing the number of chronic care residents in acute care settings, and an ageing population who will need ongoing care whether in their home, assisted living or nursing homes. RNs and LPNs may choose not to work in these settings if they perceive these work environments have higher injury risks than acute care.Changes in the nature of care provided to patients/residents/clients and shifts in work patterns have a great impact on the nursing profession.¹⁰ Because of the different tasks and roles for the three nursing occupations within different care settings, each nursing occupation may have different injury experiences.^8,11,12 Identifying these different patterns of injury through subgroup analysis by care types may allow for more effective targeting of prevention efforts, as well as help nursing staff make informed decisions. The aim of the present study was to examine how injury characteristics and incidence among the three nursing occupations differ in relation to acute care, nursing homes and community care settings in British Columbia (BC), Canada. Time‐at‐risk data can provide more accurate injury rates than general rates published by Workers'' Compensation Boards in Canada and the USA.     

Support for a vaccination documentation mandate in British Columbia,Canada

BackgroundIn recent years, Canadian provinces have been discussing, implementing, and tightening vaccination “mandate” policies for school enrolment. British Columbia (BC), Canada’s westernmost province, implemented a Vaccination Status Reporting Regulation (VSRR) in September 2019, which requires the vaccination status of children in public, private, and home schooling be reported to a provincial vaccination registry and education for parents who refuse to vaccinate. Legal vaccination mandates can carry the risk of backlash, thereby making it important to monitor public attitudes across policy implementation windows. The present study aimed to evaluate public support for this new provincial mandate following implementation.MethodsAn online panel of BC adults (n = 1301) was surveyed about 15 vaccine-promotion policy options in April 2020 following mandate implementation. Respondents were representative of the provincial population by gender, age, geographic residence, and percentage of households with children younger than 19 years of age. Poisson regression was used to estimate predictors of policy endorsement, and support for the VSRR.ResultsStrong support existed for the VSRR with 88.2% of respondents agreeing or strongly agreeing that parents should be required to provide their children’s immunization records at school entry, and 74.6% supporting required education sessions for parents who refuse to vaccinate their children. Overall, the sample was supportive of vaccination, and pro-vaccine attitudes were associated with strong agreement for nearly all vaccine policy options. Policies to impose rewards (e.g., tax credits) and penalties (e.g., fines) were the least likely to receive strong agreement from respondents.ConclusionsNear the end of the first school year in British Columbia subject to the Vaccination Status Reporting Regulation, support for both the mandated documentation and mandated education elements of the policy are high, and associated with pro-vaccine attitudes. There are not marked differences in strong support based on gender, age, parenting, education level, or income.     

Risk factors for Cryptococcus gattii infection, British Columbia, Canada

To determine whether particular environmental, medical, or behavioral risk factors existed among Cryptcoccus gattii-infected persons compared with the general population, we conducted a sex-matched case-control study on a subset of case-patients in British Columbia (1999-2001). Exposures and underlying medical conditions among all case-patients (1999-2007) were also compared with results of provincial population-based surveys and studies. In case-control analyses, oral steroids (matched odds ratio [MOR] 8.11, 95% confidence interval [CI] 1.74-37.80), pneumonia (MOR 2.71, 95% CI 1.05-6.98), and other lung conditions (MOR 3.21, 95% CI 1.08-9.52) were associated with infection. In population comparisons, case-patients were more likely to be ≥50 years of age (p<0.001), current smokers (p<0.001), infected with HIV (p<0.001), or have a history of invasive cancer (p<0.001). Although C. gattii is commonly believed to infect persons with apparently healthy immune systems, several immunosuppressive and pulmonary conditions seem to be risk factors.     

红河州HIV/HCV合并感染者HCV基因亚型多样性及种系进化研究

目的探讨云南省红河州地区HIV/HCV合并感染者HCV基因亚型多样性及种系进化情况,为本地区HIV/HCV合并感染者合理的抗病毒治疗提供科学依据,同时监测该类患者体内的HCV是否存在遗传进化的新变异。方法扩增55名红河州内HIV/HCV合并感染的HCV病毒载量阳性的丙型肝炎患者C/E1和NS5B 2个基因位点,通过测序分析和种系进化分析以明确研究对象所感染的HCV病毒的基因型和亚型。结果综合2个外显子序列分析,结果显示红河州HIV/HCV合并感染患者的HCV以3b亚型最多见(40.0%),其次是3a(20.0%)、6a(16.4%)、6n(12.7%)、1b(9.1%)、双重感染(1.8%)。课题组做本地区HCV基因亚型遗传进化分析时发现红河州地区流行的6a亚型毒株序列均与越南的HCV 6a亚型毒株的参考序列丛集。结论 HCV 6a亚型是越南和红河州内静脉吸毒人群(intravenous drug uses,IDUs)中高流行的病毒亚型,由于与越南接壤,红河州可能是HCV 6a亚型通过静脉吸毒途径由越南传入中国流行的一个传入点,进而再传入昆明或中国的其它地区。     

Challenges of Investigating Community Outbreaks of Cyclosporiasis, British Columbia, Canada

Investigations of community outbreaks of cyclosporiasis are challenged by case-patients’ poor recall of exposure resulting from lags in detection and the stealthy nature of food vehicles. We combined multiple techniques, including early consultation with food regulators, traceback of suspected items, and grocery store loyalty card records, to identify a single vehicle for a cyclosporiasis outbreak in British Columbia, Canada, in 2007.     

Income inequality and health. Coastal communities in British Columbia,Canada

OBJECTIVE: An imbalance in the distribution of economic resources, i.e., income inequality, is a characteristic of a community that may influence the aggregate health of the population. In North America, income inequality seems to be strongly related to mortality rates among American communities such as states and metropolitan areas but largely irrelevant for health at similar levels of geopolitical aggregation in Canada. This article summarizes relevant international and North American evidence and then explores relationships between income inequality and mortality rates among coastal communities in the province of British Columbia, Canada. METHODS: Cross-sectional analysis was conducted among twenty-four coastal communities in British Columbia, utilizing four measures based on the 1996 Census to measure income inequality and crude, age-standardized and age- and gender-specific mortality rates averaged over the five-year period 1994-98 to measure health. RESULTS: The three valid measures of income inequality were positively and significantly related to the crude mortality rate but were not significantly related to the age-standardized mortality rate. Two of the inequality measures were related to mortality rates for males aged 0-44 and for males aged 45-64 before but not after controlling for mean household income. DISCUSSION: Health researchers have yet to report a meaningful relationship between income inequality and population health within Canada. At the risk of committing the ecological fallacy, these findings provisionally support a psycho-social interpretation of the individual-level relationship between income and health wherein members of these communities compare themselves to an encompassing community, e.g., all Canadians.     

直接抗病毒药物在丙型肝炎病毒及合并艾滋病病毒感染中的应用进展

在过去几年中,抗丙型肝炎病毒（hepatitis C virus,HCV）治疗药物的研发取得了突破性进展。大量基础和临床研究证实,针对病毒蛋白的直接抗病毒药物（direct-acting antivirals,DAAs）能有效治疗HCV感染,获得高达90%以上的持续病毒应答（sustained viral response,SVR）。然而,由于诸多因素的影响,HCV合并人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染的患者尚未得到有效的抗HCV治疗。在此将重点简述了DAAs的分类、作用机制及其临床试验效果;此外,还介绍了宿主靶向药物（host-targeting agents,HTAs）的研发情况,以及DAAs在HCV合并HIV患者中的临床应用进展。