Unmet healthcare needs among migrants without medical insurance in Montreal, Canada

While access to healthcare for permanent residents in Canada is well known, this is not the case for migrants without healthcare coverage. This is the first large-scale study that examines the unmet healthcare needs of migrants without healthcare coverage in Montreal. 806 participants were recruited: 436 in the community and 370 at the NGO clinic. Proportions of individuals reporting unmet healthcare needs were similar (68.4% vs. 69.8%). The main reason invoked for these unmet needs was lacking money (80.6%). Situations of not working or studying, not having had enough food in the past 12 months, not having a medical prescription to get medication and having had a workplace injury were all significantly associated with higher odds of having unmet healthcare needs. Unmet healthcare needs were more frequent among migrants without healthcare coverage than among recent immigrants or the citizens with health healthcare coverage (69%, 26%, 16%). Canada must take measures to enable these individuals to have access to healthcare according to their needs in order to reduce the risk of worsening their health status, something that may have an impact on the healthcare system and population health. The Government of Quebec announced that all individuals without any healthcare coverage will have access to COVID-19 related health care. We hope that this right, the application of which is not yet obvious, can continue after the pandemic for all health care.

Infectious and congenital syphilis in Canada, 2010-2015

BACKGROUND

Syphilis is the third most commonly reported notifiable sexually transmitted infection (STI) in Canada, following chlamydia and gonorrhea, respectively. Rates of this STI have been rising rapidly in Canada since 2001.

OBJECTIVE

To summarize trends observed in syphilis rates for 2010 to 2015 in Canada.

METHODS

Laboratory-confirmed cases of infectious syphilis and early congenital syphilis were reported to the Public Health Agency of Canada by all of the Canadian provinces and territories. National infectious syphilis rates were computed, as were rates per sex, age group and province/territory. Rates of congenital syphilis were also calculated.

RESULTS

From 2010 to 2015, the rate of infectious syphilis in Canada increased by 85.6%, from 5.0 to 9.3 cases per 100,000 population. In 2015, a total of 3,321 cases of infectious syphilis were reported, mainly in males (93.7%), among whom the rate was 17.5 cases per 100,000 males versus 1.2 per 100,000 females. The rate also rose faster among males in 2010-2015, a 90.2% increase versus 27.8% among females. Individuals aged 20-39 years had the highest rates. Across the provinces and territories, the highest rates of infectious syphilis were in Nunavut, British Columbia and Manitoba.​: The rate of congenital syphilis decreased from 2010 to 2014 (1.6 to 0.3 cases per 100,000 live births) before increasing to 1.5 cases per 100,000 live births in 2015, which corresponds to six reported cases.

CONCLUSION

Rates of syphilis continue to rise in Canada, especially among young men, and this is consistent with trends in the United States of America and European Union. Based on data from Canada and from these regions, the sexual behaviour of men who have sex with men (MSM) is thought to be a major risk factor for syphilis.

The professional competence profile of Finnish nurses practising in a forensic setting

Forensic nurses in Finland work in the two state-maintained forensic hospitals. The main function of these hospitals is to perform forensic psychiatric evaluation and provide treatment for two groups of patients: violent offenders found not guilty by reason of insanity, and those too dangerous or difficult to be treated in regional hospitals. Although the forensic nurses work with the most challenging psychiatric patients, they do not have any preparatory special education for the work. This paper describes the development of nurses who participated in a 1-year further education programme that was tailored to them. The nurses experienced that the 1-year education had a significant impact on their overall competence level. They found that their skills for observing, helping, teaching and caring for their patients had increased during the education. Conversely, it was found that the nurses collaborated little with their patients' family members. They were also not familiar with utilizing research findings in improving their care of patients. Forensic nursing is a global and relatively young profession that combines nursing care and juridical processes. There are, however, significant differences in the qualifications of forensic nurses internationally. The aim of the study was to describe the professional competence profile of practising forensic nurses in Finland and to explore the effects of a 1-year further education programme on that competence profile. The data were collected in 2011-2012 using the Nurse Competence Scale comprising seven competence categories, and analysed using the software package SPSS version 19.0 (SPSS, Inc., Armonk, NY, USA). The participants were 19 forensic nurses and their 15 head nurses. The assessed overall scores from both informant groups indicated a high level of competence across the seven categories. The nurses felt that the overall competence level had increased during the education programme. The increase seen by the head nurses was smaller. The less frequent competence items included utilization of research and involvement of family in care. It can be stated that the 1-year further education programme was effective in developing the nurses' competence profile and, in particular, affected their professional self-confidence. It will, however, be essential to strengthen their skills for working with families and their awareness of evidence-based forensic nursing.

Association between nutritional status and the immune response in HIV + patients under HAART: protocol for a systematic review

BACKGROUND

Over 850 million people worldwide and 200 million adults in Sub-Saharan Africa suffer from malnutrition. Countries most affected by HIV are also stricken by elevated rates of food insecurity and malnutrition. HIV infection and insufficient nutritional intake are part of a vicious cycle that contributes to immunodeficiency and negative health outcomes. However, the effect of the overlap between HIV infection and undernutrition on the immune response following antiretroviral initiation remains unclear. A possible explanation could be the lack of consensus concerning the definition and assessment of nutritional status. Our objectives are to investigate the existence of an association between undernutrition and immune response at antiretroviral treatment initiation and the following year in low- and middle-income countries where malnutrition is most prevalent.

METHODS/DESIGN

Our systematic review will identify studies originating from low- and middle-income countries (LMICs) published from 1996 onwards, through searches in MEDLINE (PubMed interface), EMBASE (OVID interface), Cochrane Central (OVID interface) and grey literature. No language restrictions will be applied. We will seek out studies of any design investigating the association between the nutritional status (for example, undernourished versus well nourished) and the immune response, either in terms of CD4 count or immune failure, in seropositive patients initiating antiretroviral therapy or in their first year of treatment. Two reviewers will independently screen articles, extract data and assess scientific quality using standardized forms and published quality assessment tools tailored for each study design. Where feasible, pooled measures of association will be obtained through meta-analyses. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. This protocol has been registered in the PROSPERO database (registration number: CRD42014005961).

CONCLUSION

Undernutrition and weight loss are prevalent amongst highly active antiretroviral therapy (HAART)-treated patients in LMICs and contribute to excess early mortality. A possible intermediate pathway could be poor immune reconstitution secondary to deficient nutritional status. In the face of limited access to second line treatments, raising HIV resistance and cut backs to HIV programs, it is crucial to identify the factors associated with suboptimal response and therapeutic failure in order to better customize the care strategies employed in LMICs.

Prevalence of HIV, human papillomavirus type 16 and herpes simplex virus type 2 among female sex workers in Guinea and associated factors

Female sex workers are at high risk for HIV infection. Sexually transmitted infections are known to be co-factors for HIV infection. Our aims were (1) to assess the prevalence of HIV and other sexually transmitted infections in this population; (2) to determine the association between sociodemographic characteristics, behavioural variables, and variables related to HIV prevention and HIV infection. A cross-sectional study was conducted in Conakry, Guinea, among a convenience sample of 223 female sex workers. A questionnaire on sociodemographic characteristics, risk factors, and exposure to prevention was administered. Screening for HIV, herpes simplex virus type 2, human papillomavirus type 16, Neisseria gonorrhoeae, and Chlamydia trachomatis was performed. Prevalences of HIV, herpes simplex virus type 2, human papillomavirus type 16, N. gonorrhoeae, and C. trachomatis were 35.3%, 84.1%, 12.2%, 9.0%, and 13.6%, respectively. Having a child, lubricant use, and human papillomavirus type 16 infection were associated with HIV infection. Interventions that promote screening and treatment of sexually transmitted infections are needed in order to achieve successful interventions to prevent HIV among female sex workers in resource-limited settings.

High acceptability of HIV voluntary counselling and testing among female sex workers: impact of individual and social factors

OBJECTIVES

Voluntary counselling and testing (VCT) for HIV infection is an important tool for prevention of HIV infection and AIDS in high-risk groups. Our goal was to describe the acceptability and consequences of VCT among a stigmatized and vulnerable group, female sex workers (FSWs), in Conakry, Guinea.

METHODS

Acceptance of the test and return for test results at baseline and consequences of testing 1 year later were described. The perceived risk of HIV infection and perceived benefits and barriers to testing were examined using quantitative and qualitative methods.

RESULTS

All 421 FSW participants agreed to undergo VCT and most participants (92%) returned for their results. The main reason cited for VCT acceptance was the wish to know their HIV status. However, some managers of FSW worksites urged FSWs to be tested, curtailing FSWs' free decision-making. One year later, status disclosure was common (90% of the 198 individuals who knew their results among those who participated in the follow-up part of the study). Positive consequences of testing were far more frequently reported than negative consequences (98% vs. 2%, respectively). Negative life events included banishment from the worksite (one case) and verbal abuse (two cases).

CONCLUSION

Acceptability of VCT appears high in the FSW population in Conakry as a consequence of both perceptions of high individual risk and social pressures.

Load carrying walking test and its relationships to endurance and neuromuscular capabilities in women and men of different ages

The aim of this study was to examine load carrying walking test (TMload) performance on the treadmill and its associations to endurance and neuromuscular capabilities in women and men of different ages. Sixty participants (aged 28 to 71 years) were divided into young, middle-aged and old groups of both genders. Clinical stress test was performed by stationary cycle ergometer (CEload). Peak oxygen uptake (VO2peak), heart rate and lactate concentration were measured using maximal TMload test. Isometric strength and EMG-activity of upper and lower extremities were measured before and after TMload. VO2peak of TMload correlated significantly with TMload exercise time (ET) in all other groups (r=0.67 to 0.91 and p ≤ 0.05 to p<0.001) except old men. Leg extension force decreased (p ≤ 0.05 to p<0.001) after TMload in all groups, grip force in young groups (p ≤ 0.05), while plantar flexion force and all EMGs remained unchanged. In men VO2peak explained 81% and in women VO2peak and age explained 87% of the total variation of the TMload ET. In conclusion, ET of TMload is associated with high VO2peak, but not with muscle strength or its changes during the loading. The present load carrying walking test may be used for testing workers with heavy loading in their occupation or in rehabilitation purposes. Further research is needed to examine in more detailed the loading model of the present study as well as the effects of different types of training on load carrying performance.

Biological validation of self-reported condom use among sex workers in Guinea

Self-reported condom use may be prone to social desirability bias. Our aim was to assess the validity of self-reported condom use in a population of female sex workers using prostate specific antigen (PSA) as a gold standard biomarker of recent unprotected vaginal intercourse. We collected data on 223 sex-workers in Conakry, Guinea in order to assess the sensitivity and specificity of self-reported condom use as well as to examine the predictors of discordance between self-report and PSA presence. PSA was detected in 38.4% of samples. Sensitivity of self-reported condom use was 14.6% and its specificity was 94.7%. Self-perceived high risk of HIV infection was the only significant independent predictor of misreported condom use. PSA could be useful to validate self-reported condom use in surveys and to allow a better understanding of factors associated with social desirability in sexual behaviour reporting.

Electronic patient record systems and the general practitioner: an evaluation study

We studied how well electronic patient record (EPR) systems meet the needs of general practitioners (GPs) and other health-care professionals for specific information. GPs in eight health centres in the South-Ostrobothnia region of Finland were invited to participate. They used three types of EPR system. They were asked to access EPRs to obtain 20 types of information for patients receiving anticoagulant treatment. In total 2,389 patient cases were studied. All of the information requested was available for 73% of the cases (range 55-93%). There was a significant difference between the type of EPR system and the percentage of patients for whom information was available through the EPR. However, further analysis showed that differences in performance between EPR systems probably reflected differences in the way EPRs were used by different organizations. Great care should be taken in attempts to rank EPR systems based on their performance.

Genomic polymorphism of human papillomavirus type 52 predisposes toward persistent infection in sexually active women

We investigated the role of human papillomavirus (HPV) type 52 polymorphism in the persistence of HPV infection, which is a predictor for cervical lesions. Cervical samples obtained at 6-month intervals were tested for HPV-52 in 1055 women; 41, 12, and 58 women had persistent, transient, and unclassified HPV-52 infections, respectively. HPV-52 isolates were analyzed by polymerase chain-reaction sequencing of the long control region (LCR), E6, and E7 genes. Although age (odds ratio [OR], 0.90 [95% confidence interval [CI], 0.81-0.99]), nonprototypic LCR (OR, 9.26 [95% CI, 2.1-41.7]), and E6 variant (OR, 7.04 [95% CI, 1.4-37]) were associated, in univariate analysis, with the persistence of HPV-52 infection, a nonprototypic LCR variant was the only independent predictor of it (OR, 14.1 [95% CI, 1.1-200]). In the latter variants, the loss of a binding site for a repressor of HPV expression was associated with the persistence of HPV infection (OR, 7.25 [95% CI, 1.67-31.25]).

Evaluation of a convenient enzyme immunoassay to assess the quality of genital specimens submitted for the detection of human papillomavirus DNA by consensus PCR

BACKGROUND

In the PGMY-line blot assay, a human beta-globin fragment is co-amplified with human papillomavirus (HPV) DNA, and both analytes are detected by hybridization with probes fixed on a strip in a linear array. The beta-globin DIG-MWP test also detects beta-globin amplicons, but in a microtiter plate-based enzyme immunoassay format. Although the PGMY-line blot assay detected 50 cells per test, the beta-globin DIG-MWP test generated a signal above the detection cut-off with five cells per test.

OBJECTIVE

The performance of the beta-globin DIG-MWP assay to detect beta-globin DNA was assessed.

STUDY DESIGN

The beta-globin DIG-MWP assay was compared to a standard beta-globin PCR and to the PGMY-line blot strips on 401 genital specimens. Overall, the three beta-globin assays were compared on 325 undiluted lysates, 14 diluted lysates and DNA extracted from 62 lysate samples.

RESULTS

Concordance between the PGMY-line blot and the standard beta-globin assay reached 99.5% (399 of 401 results), for a kappa value of 0.95. Concordant results were also obtained between the beta-globin DIG-MWP assay and PGMY-line blot assay for 387 (96.5%) of 401 test results, for a kappa value of 0.57. Discordant results were due to the increased sensitivity of the DIG-MWP assay. Using a cut-off for positivity at 1.500 optical density (OD) units for beta-globin DIG-MWP, concordance improved to 100% (401 of 401 results, kappa at 1.00).

CONCLUSION

The beta-globin DIG-MWP assay was adequate to screen for sample adequacy for HPV analysis in genital specimens.

Molecular analysis of human papillomavirus type 52 isolates detected in the genital tract of human immunodeficiency virus-seropositive and -seronegative women

Human papillomavirus (HPV) type 52 DNA was detected in cervicovaginal lavage samples from 91 (12.4%) of 732 human immunodeficiency virus (HIV)-seropositive women and 23 (7.1%) of 323 HIV-seronegative women (P=.0004). HIV infection was an independent predictor for HPV-52 infection when controlling for age and sexual activity (odds ratio, 2.21; 95% confidence interval, 1.30-3.75: P=.003). We describe the genomic polymorphism of 114 HPV-52 isolates. Long control region (LCR) mutations defined 27 HPV-52 variants. Nearly 32% of HPV-52 isolates carried deletions in the LCR. E6 and E7 mutations defined 17 and 9 variants, respectively. Five nonsynonymous E6 mutations were clustered from amino acids 92 to 94, near the putative p53 binding area. White women were more frequently infected by the prototype strain than were women of African descent (P=.0001). The genetic diversity of HPV-52 should facilitate the investigation of the role of genomic variations in cervical disease.

Consumer managed co-operative--a solution for progressing wastewater management in rural areas

In Finland the question of appropriate wastewater treatment in rural areas has become very prominent during the last years. The new Environmental Protection Act stipulates that wastewaters must be treated to the extent that they cannot have a negative impact on nature. The Ministry of the Environment is currently preparing a decree specifying the requirements. The draft of the decree proposes that on-site treatment units should decrease the BOD load by 90, total phosphorus load by 85 and total nitrogen load by 40 per cent. To meet the new requirements, the old systems that include septic tanks only need more efficient wastewater treatment methods. Whatever technical solution is selected, the house owner must pay for it. At the moment, even the septic tanks are emptied and maintained irregularly. More sophisticated wastewater treatment methods definitely need more maintenance, which cannot be made the sole duty of the house owners. One potential organisational alternative for managing wastewater treatment in rural areas is the co-operative. Finland has one such pioneering co-operative formed for on-site sanitation. Varsinais-Suomi Water Services Co-operative provides the house owner with professional assistance in wastewater treatment at a reasonable cost. Suvisaari Water Services Co-operative is another new organisation selling sewerage services to its members. But its technology is different: this co-operative operates an LPS-sewerage system instead of on-site treatment.

Heart rate and cardiac arrhythmia during high-Gz flight

Twenty-four pilots (age 20-32 years) were monitored with a Holter monitor during 26 hours including a high-Gz flight in order to evaluate heart rate (HR) and cardiac rhythm. Flight experience did not predict the mean in-flight HR (range 69-121 beats/minute), which decreased with increasing age and correlated to the maximum HR during sleep. We recorded maximally 27 ventricular and 97 supraventricular ectopic beats, 10 junctional rhythms, 5 gray-out, 1 vestibular symptom, and 1 instance of numbness of the feet during the flight. No causal relationship between HR, cardiac arrhythmia, or symptoms was found. Adaptation to in-flight +Gz stress takes place without significant arrhythmia and at a submaximal age-related HR.

Injuries associated with the use of ejection seats in Finnish pilots

During the years 1958-91 17 Finnish pilots were forced to use ejection seats. The aircraft types were as follows: a) BA Hawk in 6 instances; b) a Mig 21-F-13 in 4; c) a Mig-21-Bis in 3; d) a Gnat Folland in 2; e) a Vampire Trainer in 1; and f) a MU-3 in 1 case. There were 3 ejections completed successfully, 12 pilots sustained slight injuries, and 5 pilots suffered major injuries--3 from compression fractures of the thoracic spine, 1 from fracture of the femur, and 1 from rupture of the medial collateral ligament of the knee. All major injuries were associated with Soviet aircraft. One BA-Hawk pilot died due to a direct impact against a tree after a low-altitude ejection. Two pilots launched the seat under negative G-forces. One of these became temporarily blind, and suffered a partial loss of vision for 3 months. Four Hawk pilots were saved during landing phase by a tandem ejection, receiving only minor injuries.

Contact lenses in hypoxia

Seven women with soft contact lenses were examined during a 4 h period in a decompression chamber. The atmospheric pressure was lowered from the normal value of 1000 millibars (750 mmHg) to 560 millibars (420 mmHg), which corresponds to the altitude of 4000 m above sea level. The humidity, temperature, percentage of carbon acid and illumination were attempted to be kept even. Five test subjects developed subjective, and all the 7 also developed objective eye symptoms. It was concluded that hypoxia itself may cause eye discomfort for aircraft passengers with contact lenses. The most serious objective findings were corneal erosions in 3 and opacities of corneal stroma in 5 test persons. The control group without contact lenses did not develop any symptoms during the test.

Drug treatment of motion sickness: scopolamine alone and combined with ephedrine in real and simulated situations

In two placebo-controlled, double-blind, randomized trials scopolamine (0.3 mg) alone or combined with ephedrine (25 mg) was tested for its effectiveness in the prevention of seasickness during 24 h at sea and of motion sickness in rotating chair tests in a laboratory. Scopolamine was effective both alone and in combination with ephedrine, which supports the hypothesis on central cholinergic overactivity in the pathogenesis of motion sickness. Ephedrine did not markedly increase the effectiveness of scopolamine. Side-effects were slight and did not disturb the operating ability of the volunteers.

On the microwave exposure

During the last decades the use of microwaves has been common in the industry, medicine, household and armed forces. According to the literature microwaves may especially cause lens opacities and other serious health disturbances. The authors of this paper examined 121 radar workers, but nothing was found which could be connected to microwaves. For example, the amount of lens opacities had correlation only to the age of the patients, but not to the exposure time of microwaves. The exposure duration varied from 0 to 28 years and the age of the patients between 18 and 59 years.

On the significance of heterophoria for stereoscopic vision

This study was undertaken to explain the possible correlation between heterophoria and stereopsis because, in the literature, there are different opinions. The subjects were 806 recruits. They were trained as rangefinder men, of whom a perfect stereopsis is required. The permitted maximal limits of heterophoria were 1 prism diopter (PrD) vertically, of esophoria 5 PrD, and of exophoria 6 PrD. Soldiers wit abnormal stereopsis, myopia, hyperopia more than 1.75, or astigmatism over 0.50 diopters, were omitted. The heterophoria was tested with Herschel's prism to 5 m distance. The stereoscopic vision was investigated using Pulfrich's device and the so-called three-needle test. No statistically significant correlation could be demonstrated between heterophoria and the degree of stereopsis. Surprisingly, it could be noticed that persons with esopheria finshed Pulfrich's test more quickly than those with exophoria. This difference was statistically highly significant. In the three-needle test, the results had the same trend. This might have some importance to rangefinder men and to pilots if it can be confirmed in the military practice.

Host-parasite interface of the fluke Collyriclum faba (Bremser in Schmalz, 1831) as revealed by light and electron microscopy

Light and electron microscopy of Collyriclum faba reveals that the dorsal tegument is highly convoluted, containing regular groups of between one and five spines. The thinner ventral covering has a less spiny surface with shallow infoldings. The lining of the capsule is characterized by numerous layers of collagen reflecting a strong cellular response by the host.

Heterophoria--its influence on stereopsis and the importance of cycloplegia in refraction testing of pilot applicants

Heterophoria, its influence on stereopsis, and the importance of cycloplegia in refraction testing of pilot applicants were studied. Distant heterophoria was found in 94.5-100% while near heterophoria was found in 86.9-98.1% of the cases, depending on the test used. Hyperphoria of over 1 prism diopter was extremely rare. No statistically significant correlation between distant heterophoria and the degree of stereopsis could be demonstrated at a range of up to at least 6 prism diopters. Cycloplegia induced a mean difference of +0.75 diopter in refraction before and during cycloplegia. Eight percent of the applicants failed because of refractive errors (spherical extremes, -0.75 diopter and +4.50 diopters; cylindrical extreme, 1.25 diopters). It is concluded that stereopsis does not seem to be affected much by heterophoria within moderate limits, and that cycloplegia in refraction testing of young pilot applicants must be considered relatively important.