Impact of COVID-19 on hospital visits for non-traumatic dental conditions in Ontario, Canada

BACKGROUND AND RATIONALE

As general health care is publicly funded in Canada and oral health care is not, many people seek care from hospitals for their dental problems. This study assessed if the unprecedented times of Coronavirus disease (COVID-19) affected the hospital visits for dental emergencies, making disadvantaged populations further vulnerable for attendance of their dental problems.

METHODS

Data from IntelliHealth Ontario for emergency department (ED) visits, day surgery visits, and hospitalizations associated with non-traumatic dental conditions (NTDCs) were retrieved for years 2016 to 2020 to assess trends before COVID-19 and changes, if any, for the year 2020. Trends by month, for the years 2019 and 2020, to make straight comparisons and understand the effects of lockdown in Ontario, was also analyzed.

RESULTS

In the year 2020, there was a reduction of 40% in day surgeries, 21% in ED visits and 8% in hospitalizations compared to 2019. Stratified by month, largest reductions were observed in April 2020: 96% in day surgeries; 50% in ED visits; and 38% reductions in hospitalizations when compared to the same month of 2019. In May 2020, day surgeries and ED visits though remained reduced, hospitalization rates increased by 31%.

CONCLUSION

Hospital EDs are inefficient avenues for handling dental emergencies. Nevertheless, they do remain a care setting that is sought by many for dental problems, and if the need for hospitalization and day surgery is there, this care setting is an important avenue for dentally related medical care. Perhaps unsurprisingly, COVID-19 has lessened the opportunity and capacity for such care.

PRACTICAL IMPLICATIONS

Administrators and policy makers can utilize this information to strategize on augmenting community infrastructure for building more effective, and cost-efficient avenues of care for timely management of dental problems.

Descriptive study of enteric zoonoses in Ontario, Canada, from 2010 - 2012

BACKGROUND

Contact with animals and their environment has long been recognized as an important source of enteric zoonoses. However, there are limited data available on the burden of illness associated with specific types of animals in Canada. This study describes the overall burden of enteric zoonoses in Ontario, Canada from 2010 to 2012.

METHODS

Confirmed cases of seven enteric zoonotic diseases (campylobacteriosis, cryptosporidiosis, giardiasis, listeriosis, salmonellosis, verotoxin-producing E. coli (VTEC) infection, and yersiniosis) with episode dates from 2010 to 2012 were extracted from the integrated Public Health Information System (iPHIS). Reported exposures were categorized as animal contact, foodborne, waterborne and 'other', with animal contact grouped into nine sub-categories based on the type of animal or transmission setting. Overall incidence rates and proportions by animal exposure categories, age and sex-specific incidence rates and hospitalization and death proportions were calculated and sex proportions compared.

RESULTS

Our study found that approximately 26% of the enteric pathogens assessed during the 2010 to 2012 period reported contact with animals and their environments as the mode of transmission. Of enteric disease cases reporting animal contact, farm exposures were reported for 51.3%, dog or cat exposures for 26.3%, and reptile or amphibian exposures for 8.9%.

CONCLUSIONS

Contact with animals was reported more frequently during the period 2010 to 2012 in comparison to the period 1997 to 2003 when 6% or less of enteric cases were associated with animal contact. Public health professionals, stakeholders associated with animals and their related industries (e.g., pet treats, mobile zoos, abattoirs), and the public should recognize that animal contact is an important source of enteric illnesses in order to take measures to reduce the burden of illness from animal sources.

Encephalitis, Ontario, Canada, 2002-2013

The epidemiology of encephalitis in Ontario is remarkably similar to that in England.

Encephalitis, a brain inflammation leading to severe illness and often death, is caused by >100 pathogens. To assess the incidence and trends of encephalitis in Ontario, Canada, we obtained data on 6,463 Ontario encephalitis hospitalizations from the hospital Discharge Abstract Database for April 2002–December 2013 and analyzed these data using multiple negative binomial regression. The estimated crude incidence of all-cause encephalitis in Ontario was ≈4.3 cases/100,000 persons/year. Incidence rates for infants <1 year of age and adults >65 years were 3.9 and 3.0 times that of adults 20–44 years of age, respectively. Incidence peaks during August–September in 2002 and 2012 resulted primarily from encephalitis of unknown cause and viral encephalitis. Encephalitis occurred more frequently in older age groups and less frequently in women in Ontario when compared to England, but despite differences in population, vector-borne diseases, climate, and geography, the epidemiology was overall remarkably similar in the two regions.

Population-based passive tick surveillance and detection of expanding foci of blacklegged ticks Ixodes scapularis and the Lyme disease agent Borrelia burgdorferi in Ontario, Canada

We identified ticks submitted by the public from 2008 through 2012 in Ontario, Canada, and tested blacklegged ticks Ixodes scapularis for Borrelia burgdorferi and Anaplasma phagocytophilum. Among the 18 species of ticks identified, I. scapularis, Dermacentor variabilis, Ixodes cookei and Amblyomma americanum represented 98.1% of the 14,369 ticks submitted. Rates of blacklegged tick submission per 100,000 population were highest in Ontario's Eastern region; D. variabilis in Central West and Eastern regions; I. cookei in Eastern and South West regions; and A. americanum had a scattered distribution. Rates of blacklegged tick submission per 100,000 population were highest from children (0-9 years old) and older adults (55-74 years old). In two health units in the Eastern region (i.e., Leeds, Grenville & Lanark District and Kingston-Frontenac and Lennox & Addington), the rate of submission for engorged and B. burgdorferi-positive blacklegged ticks was 47× higher than the rest of Ontario. Rate of spread for blacklegged ticks was relatively faster and across a larger geographic area along the northern shore of Lake Ontario/St. Lawrence River, compared with slower spread from isolated populations along the northern shore of Lake Erie. The infection prevalence of B. burgdorferi in blacklegged ticks increased in Ontario over the study period from 8.4% in 2008 to 19.1% in 2012. The prevalence of B. burgdorferi-positive blacklegged ticks increased yearly during the surveillance period and, while increases were not uniform across all regions, increases were greatest in the Central West region, followed by Eastern and South West regions. The overall infection prevalence of A. phagocytophilum in blacklegged ticks was 0.3%. This study provides essential information on ticks of medical importance in Ontario, and identifies demographic and geographic areas for focused public education on the prevention of tick bites and tick-borne diseases.

The epidemiology of travel-related Salmonella Enteritidis in Ontario, Canada, 2010-2011

BACKGROUND

Increases in the number of salmonellosis cases due to Salmonella Enteritidis (SE) in 2010 and 2011 prompted a public health investigation in Ontario, Canada. In this report, we describe the current epidemiology of travel-related (TR) SE, compare demographics, symptoms and phage types (PTs) of TR and domestically-acquired (DA) cases, and estimate the odds of acquiring SE by region of the world visited.

METHODS

All incident cases of culture confirmed SE in Ontario obtained from isolates and specimens submitted to public health laboratories were included in this study. Demographic and illness characteristics of TR and DA cases were compared. A national travel survey was used to provide estimates for the number of travellers to various destinations to approximate rates of SE in travellers. Multivariate logistic regression was used to estimate the odds of acquiring SE when travelling to various world regions.

RESULTS

Overall, 51.9% of SE cases were TR during the study period. This ranged from 35.7% TR cases in the summer travel period to 65.1% TR cases in the winter travel period. Compared to DA cases, TR cases were older and were less likely to seek hospital care. For Ontario travellers, the adjusted odds of acquiring SE was the highest for the Caribbean (OR 37.29, 95% CI 17.87-77.82) when compared to Europe. Certain PTs were more commonly associated with travel (e.g., 1, 4, 5b, 7a, Atypical) than with domestic infection. Of the TR cases, 88.9% were associated with travel to the Caribbean and Mexico region, of whom 90.1% reported staying on a resort. Within this region, there were distinct associations between PTs and countries.

CONCLUSIONS

There is a large burden of TR illness from SE in Ontario. Accurate classification of cases by travel history is important to better understand the source of infections. The findings emphasize the need to make travellers, especially to the Caribbean, and health professionals who provide advice to travellers, aware of this risk. The findings may be generalized to other jurisdictions with travel behaviours in their residents similar to Ontario residents.

Self-reported pH1N1 influenza vaccination coverage for Ontario

In the fall of 2009, Canada undertook a mass vaccination campaign against pH1N1. This report provides an overview of self-reported pH1N1 vaccination coverage of the Ontario population, building on an existing random digit-dialling telephone survey, in which 9,010 Ontario adults participated. Based on the results, 34.5% of Ontario residents were vaccinated: 33.3% of adults aged 18 or older and 38.6% of children and adolescents younger than age 18. Respondents reporting high-risk chronic conditions were significantly more likely to report being vaccinated than were people who did not report such conditions. Determining vaccination uptake for the Ontario population is important in the evaluation of the province's pH1N1 prevention program.

Isolation and symbiotic characteristics of two Tn5-derived phage-resistant Bradyrhizobium japonicum strains that nodulate soybean

Using transponson Tn5 mutagenesis, two transconjugants of Bradyrhizobium japonicum with the properties of both phage resistance and ability to induce nodulation were isolated at the frequency of 0.02%. These transconjugants were tested for their symbiotic performance on soybean cv. JS335 under greenhouse and field conditions. Both phage-resistant mutants induced nodules (nod (+)), but the transconjugant B. japonicum E13 was ineffective in nitrogen fixation (fix (-)). Rhizobiophage presence in the inoculum of phage-resistant mutants did not influence the symbiotic effectiveness. The mixture of wild strain and phage in the inoculum caused reduced symbiotic performance under controlled conditions, while under a field environment phage (100 and 500 mul of approximately 10(8) particles ml(-1)) presence did not have any recognizable effect on increased nodule dry weight, nitrogenase activity, or foliar N(2) content. On the basis of restriction fragment length polymorphism analysis, phage-sensitive, less effective, homologous bradyrhizobia belonging to B. japonicum were detected in root nodules of both inoculated and uninoculated plants. Inoculation of a higher concentration of phage in the inoculum significantly reduced the symbiotic performance, while the lower concentration of phage did not show any effect on phage-susceptible, less effective, homologous bradyrhizobia or, thus, symbiotic efficiency under field conditions. The phage-resistant mutant B. japonicum A49 showed effective symbiosis as efficient as that of the wild strain. Inoculation of phage-resistant mutants with lytic phage may reduce the occupancy of phage-susceptible, ineffective/less effective/mediocre homologous bradyrhizobia strains under natural complex soil conditions.

Morphology and general characteristics of lytic phages infective on strains of Bradyrhizobium japonicum

Biological characteristics of three isolated phages (SR1, SR2, and SR3) lytic against three Bradyrhizobium japonicum strains were studied. These phages had no cross-infectivity among the host strains. Phage morphology indicates that they belonged to Siphoviridae (long noncontractile tail; SR1 and SR2) and Podoviridae (short tail; SR3) classes of bacteriophages. Lytic cycle of phages studied under identical conditions showed a distinct adsorption rate (67.3-99.1%), latent period (150-300 min), rise period (60-150 min), and burst size (110-200 pfu/cell). Stability in liquids and inactivation by osmotic shock, thermal, and ultraviolet irradiation were also distinct in this heterogeneous phage group. Influence of soil factors such as temperature, soil moisture, soil pH, and degree of phage adsorption to the soil on phage survival was determined. Major percent of free infective phages were obtained after desorption of phages from soil. Overall, temperature appeared to be the most important parameter affecting rhizobiophage survival in the soil.

Phage typing of indigenous soybean-rhizobia and relationship of a phage group strains for their asymbiotic and symbiotic nitrogen fixation

A total of 354 indigenous bradyrhizobia were isolated from soybean nodules collected from five major crop grown regions. Host-specific 12 phages, each active on particular strains were selected. Factors, which influence the interaction between the host and phage, were examined. Four different types of plaques were detected. Nearly 17% of isolates were found resistant to all phages. Phage sensitivity patterns revealed a total of 32 distinct phage genotype groups. Different set of phage combinations expressed variation in specificity for parasitizing against particular group of rhizobia. Distributions of isolates in each phage types differed markedly between regions. Interestingly, nine strains belonging to phage group 16 exhibited high ex planta nitrogenase activity in culture. However, no correlation could be established between high ex planta nitrogenase activity and their symbiotic effectiveness with soybean cultivars. Soybean cv. JS335 showed relatively superior performance than Bragg and Lee with indigenous bradyrhizobial strains. Phage typing revealed the existence of large genetic diversity among native rhizobia and selection of the superior bradyrhizobial strains can also be possible for a given soil-climate-cultivar complex.

Host range nodulation and adaptation in frenchbean rhizobia

The host range nodulation efficiency of four genetically marked frenchbean rhizobial strains (HURR-3, Raj-2, Raj-5 and Raj-6) was studied with five legume hosts namely, frenchbean (Phageolus vulgaris L.), pigeonpea [Cajanus cajan (L.) Millsp.], mungbean [Vigna radiata (L.) Wilezek.], urdbean [Vigna mungo (L.) Hepper.] and soybean [Glycine max (L.) Merril.]. Except soybean and pigeonpea, all other legume hosts were nodulated by two or more frenchbean rhizobial strains tested. Rhizobia were isolated from nodules produced by strains, HURR-3 and Raj-5, on main (frenchbean) and different (mungbean and urdbean) hosts. There was marked improvement in host range nodulation and nitrogen fixation efficiency of rhizobial strains, HURR-3 and Raj-5. after their isolation from chance nodules on different hosts. This is clearly evident from the ability of such isolates to form nodules on pigeonpea besides mungbean and urdbean, and higher nodulation in all the above three different hosts. The phage-susceptibility pattern and intrinsic antibiotic resistance (used as markers) of the two strains did not change after their passage through different hosts. The results indicate that frenchbean rhizobia had undergone some modification in symbiotic behaviour to adapt to wide host range during their passage through different (alternate?) hosts.

Nodulation competitiveness between contrasting phage phenotypes of pigeonpea rhizobial strains

Competitiveness between (I) lysogenic vs. phage-indicator strains, (II) phage-resistant vs phage-sensitive strains, and (III) large plaque vs. small plaque developing strains was examined under laboratory and field conditions in order to study the involvement of these crucial phage sensitivity patterns in the competition for nodule occupancy of pigeonpea rhizobia. The phage-indicator strain (A039) exhibited higher competitiveness over the lysogenic strain (A025 Sm(r)); the phage sensitive strain (IHP-195) over the phage resistant strain (IHP 195 Sm(r)V(r)); and the large plaque developing strain (A059) over the small plaque developing strain (IHP195 Sm(r)) in association with pigeonpea cv. bahar both under laboratory and field conditions. Dual inoculation of A025 Sm(r) + A039 and A059 + IHP195 Sm(r) (mixed in equal proportion just before treatment) improved the nodule occupancy by inoculant strains against native rhizobia and resulted into higher plant dry weight and yield as compared to their application as single inoculum. The phage-resistant mutant IHP195 Sm(r)V(r) showed reduced competitiveness against native rhizobia, compared to its parental strain. The dual inoculation of parental strain and phage-resistant mutant gave the same result as the inoculation of parental strain alone.

Newborn anthropometry and its relationship with maternal factors

A cross sectional study was conducted in a public maternity hospital, Dhaka, Bangladesh on 316 pregnant women and their newborns. The study aimed at examining the relationship between birth weight and maternal sociodemographic, anthropometric and haematological factors. The study revealed that about 15% of babies were of low birth weight (LWB). The mean birth weight was found to be 2889 +/- 468g. The LBW was more common in younger (< 20 years) and older (> or = 30 years) mothers, low income group, day labourer and those with little or no education. The mean birth weight of male babies was on an average 138g more than that of female babies (p < 0.032). The babies of the mothers who had at least three antenatal visits, found to be 191g heavier than those who had less than three or no visit. The study showed that birth weight increased linearly as gestational age increased. The mean birth weight of babies of primi para was 107g less than those of multi para. The incidence of LBW were found to be 23.3% and 10.4% respectively for maternal heamoglobin level of < 9g/dl and > or = 12g/dl. It was revealed that higher maternal anthropometric means were associated with higher birth weights. Logistic regression analysis supports that the gestational age at birth, maternal haemoglobin level and post partum weight were the important determinants of low birth weight.

Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh

OBJECTIVE

To investigate the extent of tobacco expenditures in Bangladesh and to compare those costs with potential investment in food and other essential items.

DESIGN

Review of available statistics and calculations based thereon.

RESULTS

Expenditure on tobacco, particularly cigarettes, represents a major burden for impoverished Bangladeshis. The poorest (household income of less than $24/month) are twice as likely to smoke as the wealthiest (household income of more than $118/month). Average male cigarette smokers spend more than twice as much on cigarettes as per capita expenditure on clothing, housing, health and education combined. The typical poor smoker could easily add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure. An estimated 10.5 million people currently malnourished could have an adequate diet if money on tobacco were spent on food instead. The lives of 350 children could be saved each day.

CONCLUSION

Tobacco expenditures exacerbate the effects of poverty and cause significant deterioration in living standards among the poor. This aspect of tobacco use has been largely neglected by those working in poverty and tobacco control. Strong tobacco control measures could have immediate impact on the health of the poor by decreasing tobacco expenditures and thus significantly increasing the resources of the poor. Addressing the issue of tobacco and poverty together could make tobacco control a higher priority for poor countries.

Isolation and characterization of bacteriophages specific for Rhizobium leguminosarum biovar phaseoli

Two lytic phages, designated as H3V and R2V, specific for Rhizobium leguminosarum biovar phaseoli, were isolated and characterized. Phage H3V was active against four indigenous isolates (HURR-3, HURR-21, HURR-35, and HURR-56) and two standard strains (RCR-3605 and USDA-2669) whereas R2V was specific to one indigenous (Raj-2) and one standard (USDA-2676) strain; there was no cross infectivity. Both phages had distinct morphology; phage H3V had an oblate polyhedral head (58 × 76 nm) and a flexible noncontractile tail (120 × 10 nm), while phage R2V had a hexagonal head (56 nm wide) and a very short tail (11 × 10 nm). The lytic cycle of phage R2V requires Ca2+ ions (1 mM), which considerably reduce its latent period and burst size. Adsorption and one-step growth experiments of phages revealed that H3V had a slower adsorption rate (0.56 × 10−9 cm3/min), a longer latent period (255 min), and a higher burst size (240 plaque-forming units/cell) than R2V, which had an adsorption rate of 0.94 × 10−9 cm3/min, a 210-min latent period, and a burst size of 200 plaque-forming units/cell. Inactivation of these phages by heat, osmotic shock, and uv irradiation showed that phage H3V was comparatively more sensitive than R2V. These phages were frequently detected in healthy nodules of French beans (Phaseolus vulgaris) at two different field locations and no correlation between phage titer and nodule size or colour was observed. Phage titer varied from 2.8 × 102 to 1.2 × 106 plaque-forming units/nodule.Key words: Rhizobium, phages, morphology.

Morphology and general characteristics of viruses active against cowpea Rhizobium CB756 and 32H1

Two newly isolated viruses, RS1 and RS2, infective on two strains of cowpea Rhizobium capable of N2-fixation in vitro, were characterized. RS1 parasitizes CB756 but RS2 infects both 32H1 and CB756. RS1 has an isometric, polyhedral head and a long contractile tail, while RS2 has an oblate, polyhedral head and a long flexible non-contractile tail; RS1 is considerably larger than RS2. The phages were relatively stable between pH 5 and 9 (1 hour incubation). RS1 appeared to be more thermal sensitive and exhibited one component inactivation, while RS2 showed two component inactivation at 58, 60 and 62 degrees C. RS1 had a slower adsorption rate (3.3 X 10(-10) ml minutes-1) than RS2 (1.2 X 10(-9) ml minutes-1, on 32H1). The latent period of RS1 and RS2 was 180 and 225 minutes, and the burst size was 15 and 9 particles/cell, respectively.