Tuberculosis drug resistance in Canada: 2017.

BACKGROUND: Drug-resistant tuberculosis (TB) is a global public health issue. To monitor this in Canada, surveillance systems have been in place for the last 20 years. OBJECTIVE: To describe drug resistance patterns among TB isolates in Canada in 2017 by type of resistance as well as geographic location, demographic data and origin and to compare current data to those of the previous 10 years. METHODS: Data were derived and analyzed from two sources. The Canadian Tuberculosis Laboratory Surveillance System (CTBLSS) is an isolate-based laboratory surveillance system and was used to obtain information on the results of drug susceptibility testing (DST) as well as province or territory, sex and age of the individual from which the sample originated. The Canadian Tuberculosis Reporting System (CTBRS) is a case-based surveillance system with information on active and retreatment TB cases in Canada and was used to derive origin data, which is defined as either foreign-born, Canadian-born Indigenous or Canadian-born non-Indigenous. Analysis was descriptive and compared with data from these two sources for 2007-2016. RESULTS: In 2017, 1,515 TB isolates were tested for resistance to anti-TB drugs, with 123 (8.1%) demonstrating resistance to any first-line anti-TB drug. Of these, 103 were monoresistant, six were polyresistant and 14 were multidrug-resistant tuberculosis (MDR-TB). No extensively drug-resistant tuberculosis (XDR-TB) isolates were reported. Drug resistance was reported in seven provinces/territories (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and New Brunswick). There were 63 isolates from females with drug resistance (9.5%) and 60 isolates from males with drug resistance (7.0%). Drug resistance was found in a greater percentage of isolates among those aged 25-34 (n=29, 23.6%). By origin, 1,072 (11%) foreign-born TB cases reported between 2005 and 2015 were drug-resistant. Among the Canadian-born non-Indigenous and Canadian-born Indigenous TB cases, 143 (9%) and 54 (2%) were drug-resistant, respectively. Compared with previous years, the number of isolates tested increased slightly (from 1,267 to 1,515); however, there was a decrease in the percentage of isolates with reported drug resistance (from 10.5% in 2007 to 8.1% in 2017). CONCLUSION: In 2017, TB drug resistance rates remained low in Canada.

Tuberculosis in Canada, 2016.

BACKGROUND: Tuberculosis (TB) is a major global health problem that affected an estimated 10.4 million people worldwide in 2016. The Public Health Agency of Canada (PHAC) monitors active TB disease through a national surveillance system, which is a collaborative effort withthe provinces and territories. OBJECTIVE: This article presents an epidemiological summary of the active TB disease cases reported from 2006 to 2016, with a focus on 2016. Treatment outcomes for cases diagnosed in 2015 are also presented. METHODS: The Canadian Tuberculosis Reporting System (CTBRS) is a case-based surveillance system that maintains non-nominal data on people diagnosed with active TB disease in Canada. Data are collected annually from the provinces and territories, analyzed by PHAC and validated by each province and territory. RESULTS: The number of active TB disease cases increased from 1,642 in 2015 to 1,737 in 2016, corresponding to an increase in incidence rate from 4.6 to 4.8 per 100,000 population. Foreign born individuals continued to make up the majority of cases reported (70%) and the incidence rate remained highest among Canadian born Indigenous people (23.5 per 100,000 population) and was particularly high within the Inuit population (170.1 per 100,000 population). Over the past decade, there was a slight decrease in the number of cases among children and the proportion of re-treatment cases declined from 8.3% of cases in 2006 to 5.4% of cases in 2016. CONCLUSION: Although tuberculosis incidence rates in Canada are low in the global context and have been relatively stable over the last decade, there has been a slight increase in rates over the last three years, especially in the foreign born population which accounts for the majority of cases. The decrease in cases among children suggests less active transmission and the low proportion of re-treatment cases suggests effective treatment and adherence.

Trends in the use of laboratory tests for the diagnosis of Clostridium difficile infection and association with incidence rates in Quebec, Canada, 2010-2014.

BACKGROUND: Several Clostridium difficile infection (CDI) surveillance programs do not specify laboratory strategies to use. We investigated the evolution in testing strategies used across Quebec, Canada, and its association with incidence rates. METHODS: Cross-sectional study of 95 hospitals by surveys conducted in 2010 and in 2013-2014. The association between testing strategies and institutional CDI incidence rates was analyzed via multivariate Poisson regressions. RESULTS: The most common assays in 2014 were toxin A/B enzyme immunoassays (EIAs) (61 institutions, 64%), glutamate dehydrogenase (GDH) EIAs (51 institutions, 53.7%), and nucleic acid amplification tests (NAATs) (34 institutions, 35.8%). The most frequent algorithm was a single-step NAAT (20 institutions, 21%). Between 2010 and 2014, 35 institutions (37%) modified their algorithm. Institutions detecting toxigenic C difficile instead of C difficile toxin increased from 14 to 37 (P < .001). Institutions detecting toxigenic C difficile had higher CDI rates (7.9 vs 6.6 per 10,000 patient days; P = .01). Institutions using single-step NAATs, GDH plus toxigenic cultures, and GDH plus cytotoxicity assays had higher CDI rates than those using an EIA-based algorithm (P < .05). CONCLUSIONS: Laboratory detection of CDI has changed since 2010. There is an association between diagnostic algorithms and CDI incidence. Mitigation strategies are warranted.

Tuberculosis drug resistance in Canada: 2006-2016.

BACKGROUND: Drug-resistant strains of tuberculosis (TB) pose a serious threat to TB prevention and control efforts. The Canadian Tuberculosis Laboratory Surveillance System (CTBLSS) was created in 1998 to monitor emerging trends and patterns in TB drug resistance in Canada. OBJECTIVE: To present a descriptive overview of TB drug resistance data collected through the CTBLSS for the years 2006 to 2016 in Canada, with a focus on 2016. METHODS: The CTBLSS is an isolate-based surveillance system designed to collect data on TB drug resistance across Canada. Each year, data are collected and analyzed by the Public Health Agency of Canada (PHAC) and then validated by the submitting laboratory. RESULTS: In 2016, anti-tuberculosis drug susceptibility test results were reported for 1,452 isolates. The proportion of TB drug-resistant strains remained relatively stable with 108 (7.4%) of the isolates classified as monoresistant, five (0.3%) isolates as polyresistant and 17 (1.2%) as multidrug-resistant TB (MDR-TB) strains. In 2016, there were no extensively drug-resistant TB (XDR-TB) isolates identified. Males accounted for 792 (54.5%) of all reported isolates and 64 (49.2%) of the resistant strains and females accounted for 11 (64.7%) of the MDR-TB strains. Between 2006 and 2016, individuals between 15 and 44 years of age comprised 47.4% of all reported isolates, 54.0% of isolates showing any resistance and 72.3% of MDR-TB strains. CONCLUSION: TB drug resistance levels have been relatively low and stable over the past 11 years and have remained below the global average since national surveillance began. However, with growing worldwide concern about drug resistance and the emergence of XDR-TB, the CTBLSS will remain vital to the monitoring of TB drug resistance in Canada.

Correlates of well-being among Canadians with mood and/or anxiety disorders. / Corrélats du bien-être chez les Canadiens présentant des troubles de l'humeur ou d'anxiété.

INTRODUCTION: Our objective was to examine variables associated with well-being as measured by high self-rated mental health (SRMH) and life satisfaction (LS), among Canadian adults (aged 18+) living with a mood and/or an anxiety disorder. METHODS: We used nationally representative data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component (SLCDC-MA) to describe the association between well-being and self-management behaviours (physical activity, sleep and meditation) as well as perceived stress, coping and social support. We used multivariate logistic regression to model the relationship between these factors and measures of well-being. RESULTS: Approximately one in three individuals with mood and/or anxiety disorders reported high SRMH. The logistic regression models demonstrated that several characteristics such as being older, and reporting higher self-rated general health, fewer functional limitations, lower levels of perceived life stress, higher levels of perceived coping and higher levels of perceived social support were associated with higher levels of wellbeing. Self-management behaviours (including starting physical activity, meditation, adopting good sleep habits and attaining a certain number of hours of nightly sleep) were not significantly associated with measures of well-being in our multivariate model. CONCLUSION: Canadian adults with mood and/or anxiety disorders who reported lower levels of perceived stress and higher levels of social support and coping were more likely to report high levels of well-being. This study contributes evidence from a representative population-based sample indicating well-being is achievable, even in the presence of a mood and/or an anxiety disorder.

INTRODUCTION: Notre objectif visait à étudier les variables liées au bien-être, mesurées par une autoévaluation de la santé mentale (AESM) très positive et une satisfaction élevée à l'égard de la vie (SV) chez des adultes canadiens (âgés de 18 ans et plus) présentant un trouble de l'humeur ou d'anxiété. MÉTHODOLOGIE: Nous avons utilisé des données nationales représentatives tirées de l'Enquête sur les personnes ayant une maladie chronique au Canada ­ Composante des troubles de l'humeur et d'anxiété (EPMCC-TAH) de 2014 afin de décrire l'association entre bien-être et comportements d'autogestion (activité physique, sommeil et méditation) ainsi que stress, adaptation et soutien social perçus. Nous avons eu recours à une régression logistique multivariée pour modéliser la relation entre ces facteurs et les mesures du bien-être. RÉSULTATS: Environ une personne sur trois atteinte d'un trouble de l'humeur ou d'anxiété a fait état d'une AESM positive. Les modèles de régression logistique ont révélé que plusieurs caractéristiques, comme un âge plus avancé, une autoévaluation de la santé générale positive, des limitations fonctionnelles moins nombreuses ainsi que la perception d'un moindre stress à l'égard de la vie, de meilleures capacités d'adaptation et d'un plus grand soutien social, étaient associées à des niveaux de bien-être plus élevés. Les comportements d'autogestion (entamer une activité physique, méditer, adopter de saines habitudes de sommeil et atteindre un certain nombre d'heures de sommeil chaque nuit) n'étaient pas significativement associés à des mesures du bien-être dans notre modèle multivarié. CONCLUSION: Les adultes canadiens souffrant de troubles de l'humeur ou d'anxiété qui ont déclaré percevoir un niveau de stress plus faible, un plus grand soutien social et une meilleure capacité d'adaptation étaient plus susceptibles de déclarer également des scores de bien-être plus élevés. Cette étude a fourni des données probantes à partir d'un échantillon représentatif de la population montrant qu'il est possible de vivre dans un état de bien-être même en présence d'un trouble de l'humeur ou d'anxiété.

Describing the population health burden of depression: health-adjusted life expectancy by depression status in Canada. / Description du fardeau de la dépression sur la santé de la population au Canada : utilisation de l'espérance de vie ajustée en fonction de la santé.

INTRODUCTION: Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL) on the overall population. Health-adjusted life expectancy (HALE) is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population. METHODS: We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS) participants 20 years and older (n = 12 373) were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007-2009). The Canadian Community Health Survey (2009/10) provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex. RESULTS: For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2-43.8) compared to 57.0 years (95% CI: 56.8-57.2) for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5-41.5) for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6-54.0) for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The 14.8 fewer years of HALE observed for men with depression equated to a 13.0-year HRQOL gap and a 1.8-year mortality gap. CONCLUSION: The population of adult men and women with depression in Canada had substantially lower healthy life expectancy than those without depression. Much of this gap is explained by lower levels of HRQOL, but premature mortality also plays a role.

INTRODUCTION: Peu d'études ont évalué, dans l'ensemble d'une population, les conséquences de la dépression en matière de pertes dues à la mortalité prématurée d'une part et à la qualité de vie liée à la santé (QVLS) d'autre part. L'espérance de vie ajustée en fonction de la santé (EVAS) est une mesure synthétique de la santé de la population qui combine la morbidité et la mortalité en une seule statistique succincte décrivant l'état de santé d'une population à un moment donné. MÉTHODOLOGIE: Nous avons estimé la QVLS de la population canadienne adulte en fonction de la présence ou non de dépression. Nous avons effectué un suivi de la mortalité, de 1994 à 2009, des participants à l'Enquête nationale sur la santé de la population (ENSP) (n = 12 373) de 20 ans et plus, là aussi en fonction de la présence ou non de dépression. La dépression a été définie comme l'état d'une personne susceptible d'avoir connu au cours de l'année précédente un épisode dépressif majeur au sens du formulaire abrégé de l'Entrevue composite diagnostique internationale. L'espérance de vie a été estimée en créant des tables abrégées de mortalité selon le sexe et l'état dépressif à l'aide des risques relatifs de mortalité de l'ENSP et des données sur la mortalité du Système canadien de surveillance des maladies chroniques (2007 à 2009). L'Enquête sur la santé dans les collectivités canadiennes (2009-2010) a fourni des estimations de la prévalence de la dépression, et l'indice de l'état de santé Health Utilities Index a permis de mesurer la QVLS. L'EVAS de la population adulte a été mesurée en fonction de la présence ou non de dépression et en fonction du sexe à l'aide des estimations combinées de la mortalité, de la prévalence de la dépression et de la QVLS. RÉSULTATS: Chez les femmes ayant connu récemment un épisode de dépression majeure, l'EVAS à 20 ans était de 42,0 ans (IC à 95 % : 40,2 à 43,8), contre 57,0 ans (IC à 95 % : 56,8 à 57,2) chez les femmes n'ayant pas vécu récemment d'épisode de dépression majeure. Au sein de la population masculine canadienne, l'EVAS à 20 ans était de 39,0 ans (IC à 95 % : 36,5 à 41,5) chez ceux qui avaient connu récemment un épisode de dépression majeure, contre 53,8 ans (IC à 95 % : 53,6 à 54,0) chez ceux n'ayant pas connu récemment d'épisode de dépression majeure. La différence de 15 ans dans l'EVAS des femmes avec et sans épisode récent de dépression majeure peut se décomposer en 12,3 ans attribuables à l'écart de la QVLS et 2,7 ans à l'écart observé en matière de mortalité. Les 14,8 années de moins d'EVAS chez les hommes ayant souffert de dépression correspondent à un écart de la QVLS de 13 ans et à un écart de mortalité de 1,8 an. CONCLUSION: La population canadienne adulte atteinte de dépression au Canada avait une espérance de vie en santé considérablement plus faible que celle ne souffrant pas de dépression, chez les hommes comme chez les femmes. Si la majeure partie de cet écart s'explique par des niveaux moins élevés de la QVLS, la mortalité prématurée joue également un rôle.

Monitoring positive mental health and its determinants in Canada: the development of the Positive Mental Health Surveillance Indicator Framework.

INTRODUCTION: The Mental Health Strategy for Canada identified a need to enhance the collection of data on mental health in Canada. While surveillance systems on mental illness have been established, a data gap for monitoring positive mental health and its determinants was identified. The goal of this project was to develop a Positive Mental Health Surveillance Indicator Framework, to provide a picture of the state of positive mental health and its determinants in Canada. Data from this surveillance framework will be used to inform programs and policies to improve the mental health of Canadians. METHODS: A literature review and environmental scan were conducted to provide the theoretical base for the framework, and to identify potential positive mental health outcomes and risk and protective factors. The Public Health Agency of Canada's definition of positive mental health was adopted as the conceptual basis for the outcomes of this framework. After identifying a comprehensive list of risk and protective factors, mental health experts, other governmental partners and non-governmental stakeholders were consulted to prioritize these indicators. Subsequently, these groups were consulted to identify the most promising measurement approaches for each indicator. RESULTS: A conceptual framework for surveillance of positive mental health and its determinants has been developed to contain 5 outcome indicators and 25 determinant indicators organized within 4 domains at the individual, family, community and societal level. This indicator framework addresses a data gap identified in Canada's strategy for mental health and will be used to inform programs and policies to improve the mental health status of Canadians throughout the life course.

TITRE: Surveillance de la santé mentale positive et de ses facteurs déterminants au Canada : élaboration d'un cadre d'indicateurs de surveillance de la santé mentale positive. INTRODUCTION: D'après la Stratégie en matière de santé mentale pour le Canada, la collecte de données sur la santé mentale au Canada a besoin d'être améliorée. La mise en place de systèmes de surveillance sur la maladie mentale n'a pas suffi à combler toutes les lacunes statistiques relevant de la santé mentale positive et de ses facteurs déterminants au Canada. L'objectif de ce projet était d'élaborer un Cadre d'indicateurs de surveillance de la santé mentale positive, dans le but de dresser un portrait de la santé mentale positive au Canada, ainsi que de ses facteurs déterminants. Les données recueillies grâce à ce cadre de surveillance serviront de référence pour l'établissement des programmes et des politiques d'amélioration de la santé mentale des Canadiens. MÉTHODOLOGIE: Un examen de la littérature et une analyse contextuelle ont été réalisés afin de fournir une base théorique au cadre et de sélectionner divers critères d'évaluation de la santé mentale positive et de ses facteurs de risque et de protection. La définition de la santé mentale positive adoptée par l'Agence de la santé publique du Canada a servi de référence conceptuelle lors de l'élaboration du cadre. À partir de la liste exhaustive des risques et des facteurs de protection qui a été réalisée, des experts en santé mentale, des partenaires gouvernementaux et des intervenants indépendants ont été invités à classer les indicateurs choisis par ordre de priorité. Ces groupes ont ensuite été invités à sélectionner les méthodes de mesure les plus prometteuses pour chacun des indicateurs. RÉSULTATS: Le cadre conceptuel de surveillance de la santé mentale positive et de ses facteurs déterminants qui a été ainsi élaboré contient 5 indicateurs de résultats et 25 indicateurs de déterminants, répartis en 4 niveaux contextuels : « individu ¼, « famille ¼, « communauté ¼ et « société ¼. Ce cadre d'indicateurs vise à combler les lacunes en matière de données relevées par la Stratégie en matière de santé mentale pour le Canada, et il servira de référence pour l'établissement des programmes et des politiques d'amélioration de la santé mentale des Canadiens tout au long de leur vie.

Hospitalization of pregnant women with pandemic A(H1N1) 2009 influenza in Canada.

This article describes the epidemiology of pandemic A(H1N1) 2009 influenza in all Canadian pregnant women admitted to hospital, and compares it with historical inter-pandemic influenza activity. We used weekly hospitalization and death counts of laboratory-confirmed pandemic A(H1N1) influenza cases reported to the Public Health Agency of Canada's (PHAC) 2009-2010 national pandemic influenza surveillance programme. Pregnant women infected and admitted with the pandemic strain were described and compared with: (1) confirmed admissions of all women of reproductive age; (2) all admitted cases reported to PHAC; and (3) to a historical average of inter-pandemic seasonal influenza admissions, and pneumonia and influenza (P&I) admissions for pregnant women. During the pandemic, 263 pregnant women with confirmed infections were admitted; four died in their third trimester. The median age for admitted pregnant cases was 27.5 years, which is consistent with the median age of the 3-year historical inter-pandemic pregnant comparison group. Aboriginal women appeared to be overrepresented but ethnicity was unavailable for 15.2% of all pregnant cases. Overall admission volumes were higher than those for seasonal influenza in the historical comparison group but were lower than those for P&I admissions. Despite increased admission volumes, severe outcomes in pregnant women were proportionally fewer than in all cases admitted for influenza A(H1N1) infection during the pandemic.

Scanning-less wide-field single-photon counting device for fluorescence intensity, lifetime and time-resolved anisotropy imaging microscopy.

A scanning-less single-photon counting system for FLIM and fluorescence anisotropy wide-field imaging is described and characterized in this paper. The two polarizations of the fluorescence are divided by a Glan prism and acquired at the same time by the Q(A) detector. Fluorescence decay profiles can be reconstructed for any desired area up to each pixel and used to calculate time-resolved fluorescence anisotropy decays.

Effectiveness of commercial disinfectants for inactivating hepatitis A virus on agri-food surfaces.

Six commercial disinfectants were tested for their efficacy in inactivating hepatitis A virus in solution or attached to agri-food surfaces. Disinfectant I contains 10% quaternary ammonium plus 5% glutaraldehyde; disinfectant II contains 12% sodium hypochlorite; disinfectant III contains 2.9% dodecylbenzene sulfonic acid plus 16% phosphoric acid; disinfectant IV contains 10% quaternary ammonium; disinfectant V contains 2% iodide; and disinfectant VI contains 2% stabilized chlorine dioxide. Among these, disinfectants I and II were shown to be the most effective in inactivating hepatitis A virus in solution. The efficacy of these disinfectants was further tested against hepatitis A virus attached to common agri-food surfaces, including polyvinyl chlorine, high-density polyethylene, aluminum, stainless steel, and copper. Disinfectant II was shown to be the most effective, with a maximum inactivation level of about 3 log10. The inactivation efficacy was shown to be affected by the concentration of the active ingredient, the contact time between the disinfectant and the contaminated surfaces, and the incubation temperature. In general, hepatitis A virus was shown to be highly resistant to most disinfectants tested, and high concentrations of active ingredient were needed to achieve acceptable inactivation levels.

Inactivation of foodborne pathogens in milk using dynamic high pressure.

Improving the microbiological safety of perishable foods is currently a major preoccupation in the food industry. The aim of this study was to investigate the inactivation of three major food pathogens (Listeria monocytogenes [LSD 105-1], Escherichia coli O157:H7 [ATCC 35150], and Salmonella enterica serotype Enteritidis ATCC [13047]) by dynamic high pressure (DHP) in order to evaluate its potential as a new alternative for the cold pasteurization of milk. The effectiveness of DHP treatment against L. monocYtogenes, E. coli O157:H7, and Salmonella Enteritidis was first evaluated in 0.01 M phosphate-buffered saline (PBS) at pH 7.2 as a function of applied pressure (100, 200, and 300 MPa) and of the number of passes (1, 3, and 5) at 25 degrees C. A single pass at 100 MPa produced no significant inactivation of the three pathogens, while increasing the pressure up to 300 MPa or the number of passes to five increased inactivation. From an initial count of 8.3 log CFU/ml, complete inactivation of viable L. monocytogenes was achieved after three successive passes at 300 MPa, while 200-MPa treatments with three and five passes completely eliminated viable Salmonella Enteritidis and E. coli O157:H7, respectively. The effectiveness of DHP for the inactivation of these pathogens was compared to that of hydrostatic high pressure (HHP) using the same pressure (200 MPa, single pass at 25 degrees C). In general, two additional log reductions in viable count were obtained with DHP DHP was less effective against L. monocytogenes and E. coli O157:H7 in raw milk than in PBS. After five passes at 200 MPa, an 8.3-log reduction was obtained for E. coli O157:H7, while a reduction of about 5.8 log CFU/ml was obtained for L. monocytogenes exposed to 300 MPa for five passes. Exposing milk or buffer samples to mild heating (45 to 60 degrees C) prior to dynamic pressurization enhanced the lethal effect of DHP The inactivation of pathogens also depended on the initial bacterial concentration. The highest reduction was obtained when the bacterial load did not exceed 10(5) CFU/ml. In conclusion, DHP was shown to be very effective for the destruction of the tested pathogens. It offers a promising alternative for the cold pasteurization of milk and possibly other liquid foods.

Productivity outcomes of individuals with spinal cord injury.

STUDY DESIGN: Cross-sectional study by mail survey of participation in productive activities of individuals who sustained a spinal cord injury (SCI) in Quebec from 1970 to 1993. OBJECTIVES: To determine the level of productivity outcomes of a representative sample and to determine the relationship between the productivity outcomes and some personal and environmental variables. SETTINGS: Quebec, Canada. METHODS: Four hundred and eighteen subjects (mean of age=42.1+/-11. 8) were included in this study. Overall productivity was assessed by the participation into five categories of activities (gainful employment, studies, homemaking and family activities, community organizations and leisure activities). RESULTS: Depending on the severity of injury, 30% to 51% of the variance in productivity outcomes can be explained by a set of ten variables: education, ability to drive a car vehicle, other transportation indices, age related variables and type of locomotion. A discriminant analysis was undertaken to classify the subjects into three levels of productivity (low, moderate and high). The percentage of subjects correctly classified was moderate (54% to 71%) to high (72% to 81%) depending on the productivity levels. CONCLUSION: The results confirm the significant contribution of education and transportation to explain the productivity outcomes. SPONSORSHIP: This project was funded by the 'Société d'Assurance Automobile du Québec', the 'Commission de la Santé et de la Sécurité du Travail' and the 'Fondation André Senécal'.

Validity of the heart rate deflection point as a predictor of lactate threshold during running.

During an incremental run test, some researchers consistently observe a heart rate (HR) deflection at higher speeds, but others do not. The present study was designed to investigate whether differences in test protocols could explain the discrepancy. Additionally, we sought to determine whether the HR deflection point accurately predicts lactate threshold (LT). Eight trained runners performed four tests each: 1) a treadmill test for maximal O(2) uptake, 2) a Conconi test on a 400-m track with speeds increasing approximately 0.5 km/h every 200 m, 3) a continuous treadmill run with speeds increasing 0.5 km/h every minute, and 4) a continuous LT treadmill test in which 3-min stages were used. All subjects demonstrated an HR deflection on the track, but only one-half of the subjects showed an HR deflection on the treadmill. On the track the shortening of stages with increasing speeds contributed to a loss of linearity in the speed-HR relationship. Additionally, the HR deflection point overestimated the LT when a continuous treadmill LT protocol was used. In conclusion, the HR deflection point was not an accurate predictor of LT in the present study.

Muscle strength changes as measured by dynamometry following functional rehabilitation in individuals with spinal cord injury.

OBJECTIVE: To objectively quantify muscle strength changes over the course of functional rehabilitation and up to 15 months postdischarge in individuals with spinal cord injury (SCI). METHOD: Hand-held dynamometry was used to evaluate the strength of six muscle groups in 31 individuals after acute SCI (tetraplegia, n = 13, paraplegia, n = 18). Assessment was performed by a single research therapist at admittance and discharge from functional rehabilitation and 3 months and 15 months after discharge. RESULTS: There were significant increases of mean strength values for all muscle groups between admittance and discharge in individuals with parapalegia (median value between 13% and 22%) and tetraplegia (median value between 33% and 83%). Three months after discharge, only individuals with tetraplegia continued to significantly improve their mean strength for four muscle groups (elbow flexors-extensors and shoulder flexors-extensors). One year later, elbow flexors were significantly improved in both paraplegic and tetraplegic persons, while shoulder extensors showed significant gains only in individuals with paraplegia. Study results showed a large variability in the individual profiles of upper limb strength recovery, particularly in tetraplegic individuals. Although some individuals showed strength gains exceeding 200%, some strength decreases were noted. CONCLUSION: Recovery of muscle strength in individuals with tetraplegia over individuals with parapalegia continues for a longer period since it depends initially on recovery of muscle innervation. This study quantified strength improvements during rehabilitation and clearly showed that these gains can be maintained or even increased when the person returns to community living.

Comparison of three methods to assess muscular strength in individuals with spinal cord injury.

The aim of the project was to compare three methods for measuring muscle strength in individuals with SCI: the manual muscle test (MMT), the hand-held myometry and the isokinetic dynamometry (Cybex). Thirty-eight (38) subjects, 31 men and seven women (age range = 14-63; lesion from C5 to L3) were included in this project. Muscle strength assessment of upper limbs was performed at admittance and discharge using MMT and myometry for the left and right side, and using Cybex dynamometer for the stronger side. The testing sessions were at least a day apart and performed by a single evaluator (trained physiotherapist). Significant and non-significant differences of myometry mean strength values were observed between consecutive levels of MMT. However, the range of myometry scores within each MMT grade led to significant overlaps between two adjacent MMT grades of each muscle group. Variables correlations were observed between the strength values measured by MMT and myometry with paraplegia (0.26 < or = r < or = 0.67) and tetraplegia (0.50 < or = r < or = 0.95). Similar results were observed when compared MMT and Cybex with the stronger side. Moderate to strong correlations were observed between the strength values measured by myometry and Cybex with paraplegia (0.70 < or = r < or = 0.90) and tetraplegia (0.57 < or = r < or = 0.96). These results suggest that the MMT method does not seem to be sufficiently sensitive to assess muscle strength, at least for grade 4 and higher and to detect small or moderate increases of strength over the course of rehabilitation. Since outcome measures is an important issue in rehabilitation, objective measurements of strength should be used in clinical settings. Considering cost and assessment time, the myometry technique seems to be highly valuable.

Pathogenicity of Streptomyces scabies Mutants Altered in Thaxtomin A Production.

ABSTRACT To investigate the role of thaxtomin A in the pathogenicity of Streptomyces scabies, mutants altered in thaxtomin A production were obtained by N-methyl-N'-nitro-N-nitrosoguanidine mutagenesis. Mutants of S. scabies EF-35 could be differentiated according to levels of thaxtomin production. Mutants M1, M8, and M19 produced 2 to 20 times less thaxtomin A in oat bran medium than did EF-35. M1 and M19 were deficient in tryptophan catabolism. Thaxtomin production was reduced by about 300 times in mutant M16, which was a glutamic acid auxotroph. No thaxtomin A was detected in M13 culture supernatant. This mutant had a normal growth rate, was prototrophic, and catabolized tryptophan. Pathogenicity of mutants was tested on radish and potato. Mutants M1, M8, and M19 were pathogenic but, in most cases, less virulent than EF-35. M13 and M16 were nonpathogenic. These results suggest that thaxtomin A is an important pathogenicity determinant in S. scabies.

Energy cost of stair climbing and descending on the college alumnus questionnaire.

In calculating the physical activity index (PAI) on the college alumnus questionnaire, it is assumed that 8 kcal are expended for every 20 steps climbed. This value is equal to an energy cost of 0.40 kcal.step-1. Since it is assumed that subjects climb and descend an equal number of stairs, the total value reflects the energy cost of stepping up (estimated at 0.30 kcal.step-1) and stepping down (estimated at 0.10 kcal.step-1). However, these values appear to be based on theoretical calculations rather than empirical observation. The purpose of this study was to quantify the energy cost of stair climbing and stair descending by measuring oxygen uptake. Twenty subjects performed continuous stair-climbing and stair-descending on an escalator at a stepping rate of 70 step.min-1. Heart rate was monitored by telemetry, and oxygen uptake was measured by the Douglas bag technique from 5 to 7 min. Results showed that the gross energy cost of stair climbing is 8.6 METs, and that of stair descending is 2.9 METs. Thus, for a 70-kg person the gross caloric costs of ascending stairs (0.15 kcal.step-1) and descending stairs (0.05 kcal.step-1) are one-half of the values previously assumed. In conclusion, the algorithm for calculating PAI on the college alumnus questionnaire should be modified to reflect a total cost of 0.20 kcal for going up and down one step. Even more precise estimates can be obtained by adjusting for body weight (going up and down one flight of stairs requires 1.63 MET.min).

In-flight stabilization of oxygen saturation by control of altitude for severe respiratory insufficiency.

A 4,907-mile medical air transport recently took place between Vancouver, Canada, and London, England. The patient was a 6-year-old boy with multiple pleural, pulmonary, and pericardial hemangiomata who required heart-lung transplant. Because his respiratory function was so poor (including oxygen-induced hypercarbia and sleep-induced hypoxia), a Lear 35 was used. The aircraft made a low altitude flight possible, allowing adjustment of cabin pressure to overcome the child's sensitivity to any significant reduction in partial pressure and to minimize his need for supplemental oxygen. Clinical observation and monitoring using oximetry and transcutaneous blood gas measurements were carried out en route to warn of excessive altitude effects. Sequential increases in altitude were made once oxygenation had stabilized at each cabin pressure. Cabin pressure was not allowed to rise above 3,700 ft to ensure an oxygen saturation level of at least 80%. The transport was accomplished successfully with no requirement for intervention. This approach to in-flight management has applications for other aero-medical transports.

[Congenital coronary-left ventricular fistulae. Review of the literature]. / Les fistules congénitales coronaro-ventriculaires gauches. Revue de la littérature.

Congenital communications of fistulae between coronary arteries of aortic origin and the left ventricle present two types of anatomo-coronarographic appearance, in accordance with embryological theories: single fistulae and multiple or micro-fistulae. These fistulae are marked by the absence of a continuous murmur and they can be distinguished from each other by their clinical expression: either a picture of aortic incompetence or signs of coronary insufficiency: these are the conclusions from a review of 62 cases in the literature.