Tick-Borne Relapsing Fever in British Columbia, Canada: First Isolation of Borrelia hermsii

The spirochete that causes tick-borne relapsing fever, Borrelia hermsii, was isolated in pure culture during 1995 and 1996 from three acutely ill human patients infected in southern British Columbia, Canada. The geographic area of exposure is a known focus of this disease dating back to 1930 when the first case was recognized in a human. Analyses of plasmid DNA, protein profiles, and reactivity with a species-specific monoclonal antibody identified the new isolates of spirochetes as B. hermsii, all of which were most similar to an isolate of this spirochete from northern California described previously. These are the first reported isolates of B. hermsii from Canada.     

Medicinal plant treatments for fleas and ear problems of cats and dogs in British Columbia,Canada

Research conducted in 2003/2004 documented and validated (in a non-experimental way) ethnoveterinary medicines used by small-scale, organic livestock farmers in British Columbia (BC), Canada. Interviews were conducted with 60 participants who were organic farmers or holistic medicinal/veterinary practitioners. A workshop was held with selected participants to discuss the plant-based treatments. This paper reports on the medicinal plants used for fleas in cats and dogs. Fleas and flies are treated with Artemisia vulgaris L. (Asteraceae), Citrus x limon (L.), Juniperus communis L. var. depressa Pursh. (Cupressaceae), Lavandula officinalis L. (Labiatae), Melissa officinalis L. (Lamiaceae), and Thuja plicata Donn ex D. Don (Cupressaceae). All of the plants used have insecticidal activity. Ear problems are treated with Achillea millefolium L., Calendula officinalis L., and Helichrysum angustifolium (Roth.) G. Don. (Asteraceae), Allium sativum L. (Alliaceae), Berberis aquifolium Pursh./Mahonia aquifolium (Berberidaceae), Glycyrrhiza glabra L. (Fabaceae), Lobelia inflata L. (Campanulaceae), Matricaria recutita L., Melaleuca alternifolia L. (Myrtaceae), Origanum vulgare L. (Labiatae), Ricinus communis L. (Euphorbiaceae), Syzygium aromaticum (L.) Merr. & L. M. Perry (Myrtaceae), Thymus vulgaris L. (Lamiaceae), and Verbascum thapsus L. (Scrophulariaceae).     

中加两国精神障碍患者无责任能力评定跨文化比较研究

目的 :对中国湖南省和加拿大BC省两地无责任能力精神障碍患者人口学等资料进行比较 ,探讨不同的法律体系中无责任能力的精神障碍患者的基本特点。方法 :对两地已有的精神障碍患者责任能力评定数据库进行整合 ;共提取年龄、性别、婚姻、教育、犯罪史、精神病史、鉴定时案型、诊断 8个变量进行统计处理 ;BC组和湖南组入组病例数分别为 2 73例和 35 4例。结果 :除性别和精神病史外 ,其他各变量差异显著。BC组的离婚率、犯罪史、最高教育程度明显高于湖南组 ,评估时年龄明显大于湖南组 ;而湖南组的严重犯罪和精神分裂症的诊断比例明显高于BC组 (P均 <0 .0 1)。结论 :不同的法律体系、制度和社会文化背景是造成两地无责任能力精神障碍患者不同特点的主要原因     

Dermal nematodosis in commercially captured rockfish (Sebastes spp) from coastal British Columbia,Canada

Members of an Ahousaht First Nations community of Vancouver Island, Canada have developed a market for wild-caught species of indigenous rockfish (Sebastes spp.). The fish, which are caught by hook and line, are transported live to fish markets in Vancouver. Recently, market place downgrading of the fish has occurred due to a syndrome referred to as "black-mould", characterized by linear black disfigurations, and erosions, of the skin. Samples from 14 wild-caught rockfish were examined to determine the cause. On the basis of sub-gross and histological examination, the black-mould syndrome was attributed to intraepithelial deposition of eggs from a trichuroid nematode of the genus Huffmanela, coupled with an inflammatory response. The eggs observed in the tissues of the rockfish differed in size and morphology from those described for other species of Huffmanela. This is the first report of Huffmanela spp. infection in rockfish, probably due to a previously undescribed species.     

Travel-Related Carbapenemase-Producing Gram-Negative Bacteria in Alberta,Canada: the First 3 Years

We describe here the characteristics of Alberta, Canada, patients with infections or colonizations with carbapenemase-producing Gram-negative bacteria during 2010 to 2013 that were linked to recent travel outside Canada. Antimicrobial susceptibility was determined by broth microdilution, and isolates were characterized using PCR, sequencing, and multilocus sequencing typing. A broth mating study was used to assess the transferability of resistance plasmids, which were subsequently characterized. All the patients (n = 12) included in our study had contact with a health care system while abroad. Most of the patients presented with urinary tract infections (UTIs) and were admitted to hospitals within weeks after their return to Alberta. Secondary spread occurred in 1 case, resulting in the death of another patient. The carbapenemase-producing bacteria (n = 17) consisted of Escherichia coli (sequence type 101 [ST101], ST365, ST405, and ST410) with NDM-1, Klebsiella pneumoniae (ST15, ST16, ST147, ST258, ST340, ST512, and ST972) with NDM-1, OXA-181, KPC-2, and KPC-3, Acinetobacter baumannii with OXA-23, Providencia rettgeri with NDM-1, Enterobacter cloacae with KPC-2, and Citrobacter freundii with NDM-1. The bla_NDM-1 gene was associated with various narrow- (i.e., IncF) and broad- (i.e., IncA/C and IncL/M) host-range plasmids with different addiction factors. Our results show that NDM-producing K. pneumoniae, belonging to a variety of sequence types with different plasmid scaffolds, are regularly imported from India into Alberta. Clinical microbiology laboratories should remain vigilant in detecting bacteria with carbapenemases.     

Cutaneous diphtheria in the urban poor population of Vancouver, British Columbia, Canada: a 10-year review

Between 1998 and 2007, records from 33 patients with cutaneous diphtheria from Vancouver's inner city were reviewed. Cases were associated with injection drug use and poverty. Coinfections with Staphylococcus aureus, Streptococcus pyogenes, and Arcanobacterium haemolyticum occurred. Corynebacterium diphtheriae is endemic in Vancouver's urban core, with strains of multilocus sequence type (MLST) 76 predominating.     

Improving primary care in British Columbia,Canada: evaluation of a peer-to-peer continuing education program for family physicians

Background

An innovative program, the Practice Support Program (PSP), for full-service family physicians and their medical office assistants in primary care practices was recently introduced in British Columbia, Canada. The PSP was jointly approved by both government and physician groups, and is a dynamic, interactive, educational and supportive program that offers peer-to-peer training to physicians and their office staff. Topic areas range from clinical tools/skills to office management relevant to General Practitioner (GP) practices and “doable in real GP time”. PSP learning modules consist of three half-day learning sessions interspersed with 6–8 week action periods. At the end of the third learning session, all participants were asked to complete a pen-and-paper survey that asked them to rate (a) their satisfaction with the learning module components, including the content and (b) the perceived impact the learning has had on their practices and patients.

Methods

A total of 887 GPs (response rates ranging from 26.0% to 60.2% across three years) and 405 MOAs (response rates from 21.3% to 49.8%) provided responses on a pen-and-paper survey administered at the last learning session of the learning module. The survey asked respondents to rate (a) their satisfaction with the learning module components, including the content and (b) the perceived impact the learning has had on their practices and patients. The psychometric properties (Chronbach’s alphas) of the satisfaction and impact scales ranged from .82 to .94.

Results

Evaluation findings from the first three years of the PSP indicated consistently high satisfaction ratings and perceived impact on GP practices and patients, regardless of physician characteristics (gender, age group) or work-related variables (e.g., time worked in family practice). The Advanced Access Learning Module, which offers tools to improve office efficiencies, decreased wait times for urgent, regular and third next available appointments by an average of 1.2, 3.3, and by 3.4 days across all physicians. For the Chronic Disease Management module, over 87% of all GP respondents developed a CDM patient registry and reported being able to take better care of their patients. After attending the Adult Mental Health module: 94.1% of GPs agreed that they felt more comfortable helping patients who required mental health care; over 82% agreed that their skills and their confidence in diagnosing and treating mental health conditions had improved; and 41.0% agreed that their frequency of prescribing medications, if appropriate, had decreased. Additionally for the Adult Mental Health module, a 3–6 month follow-up survey of the GPs indicated that the implemented changes were sustained over time.

Conclusion

GP and medical office assistant participant ratings show that the PSP learning modules were consistently successful in providing GPs and their staff with new learning that was relevant and could be implemented and used in “real-GP-time”.

     

Gaucher disease: molecular screening of the glucocerebrosidase 1601G and 1601A alleles in Victoria, British Columbia, Canada.

Gaucher disease is the most prevalent lysosomal storage disease and it results from inherited deficient glucocerebrosidase activity. The glucocerebrosidase gene from normal people was sequenced by several laboratories and it was noted that a G or A nucleotide may be present at cDNA position 1601, resulting in 495arginine or 495histidine in the glucocerebrosidase polypeptide. In order to rule out the possibility of cloning error and to elucidate the genetic status of the two genotypes and their distribution in the population, we have developed a convenient and reliable method for the molecular screening of the 1601G and 1601A genotypes in the population. This method uses PCR amplification of glucocerebrosidase genomic DNA in blood samples, followed by BsaHI restriction fragment length polymorphism analysis. Out of the 256 subjects without Gaucher disease and 15 Gaucher patients surveyed, the 1601G genotype was present in the homozygous form in all of the asymptomatic subjects and 14 Gaucher patients. In one Gaucher patient who was diagnosed as having type 1 (non-neuropathic) Gaucher disease with the A1226G/T1366G mutations, the heterozygous 1601G/A genotype was detected. These findings indicate that the 1601G genotype which encodes 495arginine of the glucocerebrosidase polypeptide is not a cloning error. Instead, it constitutes the normal as well as predominant genotype in the population in the municipality of Greater Victoria, British Columbia. The 1601A genotype, on the other hand, appears to be quite infrequent in this population. The availability of our restriction enzyme based method has allowed the screening and frequency determination of these two alleles in other populations.     

Providing predictive testing for Huntington disease via telehealth: results of a pilot study in British Columbia,Canada

Predictive testing (PT) for Huntington disease (HD) usually requires several in‐person appointments which acts as a barrier to testing for those from remote regions. This pilot study reports the use of telehealth PT to examine whether such telehealth testing improves access to HD PT while maintaining quality of care and support. Individuals underwent PT via the telehealth protocol or standard in‐person protocol and were asked to complete surveys regarding their experience. Results reveal no significant differences between the in‐person‐tested and telehealth‐tested groups with respect to quality of care, information, counselling and support. The majority of participants in both groups stated that pre‐test counselling had provided them with sufficient knowledge about the advantages and disadvantages of undergoing testing, the opportunity to ask questions, and the ability to make an informed decision. The majority of participants in both groups were satisfied by the manner in which results were delivered and stated they had received sufficient information regarding the implications of these results. This study reveals that telehealth PT improves access while maintaining quality of care and support.     

When access is an issue: exploring barriers to predictive testing for Huntington disease in British Columbia,Canada

Predictive testing (PT) for Huntington disease (HD) requires several in-person appointments. This requirement may be a barrier to testing so that at risk individuals do not realize the potential benefits of PT. To understand the obstacles to PT in terms of the accessibility of services, as well as exploring mechanisms by which this issue may be addressed, we conducted an interview study of individuals at risk for HD throughout British Columbia, Canada. Results reveal that the accessibility of PT can be a barrier for two major reasons: distance and the inflexibility of the testing process. Distance is a structural barrier, and relates to the time and travel required to access PT, the financial and other opportunity costs associated with taking time away from work and family to attend appointments and the stress of navigating urban centers. The inflexibility of the testing process barrier relates to the emotional and psychological accessibility of PT. The results of the interview study reveal that there are access barriers to PT that deter individuals from receiving the support, information and counseling they require. What makes accessibility of PT services important is not just that it may result in differences in quality of life and care, but because these differences may be addressed with creative and adaptable solutions in the delivery of genetic services. The study findings underscore the need for us to rethink and personalize the way we deliver such services to improve access issues to prevent inequities in the health care system.     

Multisite Evaluation of Cepheid Xpert Carba-R Assay for Detection of Carbapenemase-Producing Organisms in Rectal Swabs

Rapid identification of patients who are colonized with carbapenemase-producing organisms (CPO) is included in multiple national guidelines for containment of these organisms. In a multisite study, we evaluated the performance of the Cepheid Xpert Carba-R assay, a qualitative diagnostic test that was designed for the rapid detection and differentiation of the bla_KPC, bla_NDM, bla_VIM, bla_OXA-48, and bla_IMP-1 genes from rectal swab specimens. A double rectal swab set was collected from 383 patients admitted at four institutions (2 in the United States, 1 in the United Kingdom, 1 in Spain). One swab was used for reference culture (MacConkey broth containing 1 mg/liter of meropenem and subcultured to a MacConkey agar plate with a 10-μg meropenem disk) and for sequencing of DNA obtained from carbapenem-nonsusceptible isolates for carbapenemase identification. The other swab was used for the Xpert Carba-R assay. In addition to the clinical rectal swabs, 250 contrived specimens (108 well-characterized CPO and 142 negative controls spiked onto negative rectal swabs) were tested. Overall, 149/633 (23.5%) samples were positive by the Xpert Carba-R assay. In 6 samples, multiple targets were detected (4 VIM/OXA-48, 1 IMP-1/NDM, and 1 NDM/KPC). The Xpert Carba-R assay detected 155 targets (26 IMP-1, 30 VIM, 27 NDM, 33 KPC, 39 OXA-48) within a time range of 32 to 48 min. The sensitivity, specificity, and positive and negative predictive values of the Xpert Carba-R assay compared to those of the reference culture and sequencing results were 96.6% (95% confidence interval [CI], 92.2% to 98.9%), 98.6% (95% CI, 97.1% to 99.4%), 95.3%, and 99.0%, respectively. The Cepheid Xpert Carba-R assay is an accurate and rapid test to identify rectal colonization with CPO, which can guide infection control programs to limit the spread of these organisms.     

Genotypic and Epidemiologic Trends of Norovirus Outbreaks in the United States, 2009 to 2013

Noroviruses are the leading cause of epidemic acute gastroenteritis in the United States. From September 2009 through August 2013, 3,960 norovirus outbreaks were reported to CaliciNet. Of the 2,895 outbreaks with a known transmission route, person-to-person and food-borne transmissions were reported for 2,425 (83.7%) and 465 (16.1%) of the outbreaks, respectively. A total of 2,475 outbreaks (62.5%) occurred in long-term care facilities (LTCF), 389 (9.8%) in restaurants, and 227 (5.7%) in schools. A total of 435 outbreaks (11%) were typed as genogroup I (GI) and 3,525 (89%) as GII noroviruses. GII.4 viruses caused 2,853 (72%) of all outbreaks, of which 94% typed as either GII.4 New Orleans or GII.4 Sydney. In addition, three non-GII.4 viruses, i.e., GII.12, GII.1, and GI.6, caused 528 (13%) of all outbreaks. Several non-GII.4 genotypes (GI.3, GI.6, GI.7, GII.3, GII.6, and GII.12) were significantly more associated with food-borne transmission (odds ratio, 1.9 to 7.1; P < 0.05). Patients in LTCF and people ≥65 years of age were at higher risk for GII.4 infections than those in other settings and with other genotypes (P < 0.05). Phylogeographic analysis identified three major dispersions from two geographic locations that were responsible for the GI.6 outbreaks from 2011 to 2013. In conclusion, our data demonstrate the cyclic emergence of new (non-GII.4) norovirus strains, and several genotypes are more often associated with food-borne outbreaks. These surveillance data can be used to improve viral food-borne surveillance and to help guide studies to develop and evaluate targeted prevention methods such as norovirus vaccines, antivirals, and environmental decontamination methods.     

The uses of provincial administrative health databases for research on palliative care: Insights from British Columbia,Canada

Background  

Research indicating that people increasingly prefer to die at home suggests that palliative care is likely to play a more prominent role in the future of Canada's health care system. Unfortunately, at a time when research evidence should be informing policy and service delivery, little is known about health service utilization by Canadians at the end of life. One existing mechanism that can help address this gap is provincial administrative health data. The purpose of this study was to explore the potential of administrative health data to identify characteristics of palliative care users, patterns of formal service utilization and predictors of palliative care use.     

Thalassemia carrier screening and prenatal diagnosis among the British Columbia (Canada) population of Chinese descent

The goal of thalassemia screening is the identification, prior to the conception or birth of an affected child, of couples where both partners are thalassemia carriers. When both partners are identified as carriers for alpha- or beta-thalassemia, the risk of having a fetus who is homozygous or compound heterozygous for the abnormal gene is 25%. A study was performed to identify whether routine screening for thalassemia is indicated for the Chinese population in British Columbia (BC). In a population of 783 subjects, studied either prospectively or retrospectively, 5.0% were alpha-thalassemia carriers and 1.7% were beta-thalassemia carriers. In addition, a review of all BC cases of prenatal diagnosis for thalassemia over a 6-year period indicated that 26% of couples were identified as alpha-thalassemia carriers because of a second or third trimester diagnosis of fetal hydrops, and 17% of couples referred for beta-thalassemia already had an affected child. The experience with prenatal diagnosis shows that a significant proportion of at-risk couples are not identified prior to or early in a pregnancy. The prevalence of carriers for thalassemia would warrant a program of education and routine screening for this condition in the BC Asian population.     

Preliminary studies on the isolation of bacteria from sea lice, Lepeophtheirus salmonis, infecting farmed salmon in British Columbia, Canada

Using standard OIE bacteriological screening protocols, we sampled the external carapace and internal stomach contents of motile stages (preadult and adult) of Lepeophtheirus salmonis collected from farmed Atlantic salmon from May 2007 to April 2008 in British Columbia, Canada. Three potentially pathogenic bacteria (Tenacibaculum maritimum, Pseudomonas fluorescens, and Vibrio spp.) were isolated from external (58–100%) and internal (12.5–100%) samples of sea lice. The prevalence of bacteria was higher from lice collected during the months with higher water temperatures and among adult lice. These preliminary results have led to a comprehensive, multi-year study where we plan to examine the possible role of sea lice as a vector for disease.