A Population-Based Cohort Study of Mycobacterium tuberculosis Beijing Strains: An Emerging Public Health Threat in an Immigrant-Receiving Country?

Mycobacterium tuberculosis Beijing strains are frequently associated with tuberculosis outbreaks and drug resistance. However, contradictory evidence and limited study generalizability make it difficult to foresee if the emergence of Beijing strains in high-income immigrant-receiving countries poses an increased public health threat. The purpose of this study was to determine if Beijing strains are associated with high risk disease presentations relative to other strains within Canada.This was a retrospective population-based study of culture-confirmed active TB cases in a major immigrant-receiving province of Canada in 1991 through 2007. Of 1,852 eligible cases, 1,826 (99%) were successfully genotyped. Demographic, clinical, and mycobacteriologic surveillance data were combined with molecular diagnostic data. The main outcome measures were site of disease, lung cavitation, sputum smear positivity, bacillary load, and first-line antituberculosis drug resistance.A total of 350 (19%) patients had Beijing strains; 298 (85%) of these were born in the Western Pacific. Compared to non-Beijing strains, Beijing strains were significantly more likely to be associated with polyresistance (aOR 1.8; 95% CI 1.0-3.3; p = 0.046) and multidrug-resistance (aOR 3.4; 1.0-11.3; p = 0.049). Conversely, Beijing strains were no more likely than non-Beijing strains to be associated with respiratory disease (aOR 1.3; 1.0-1.8; p = 0.053), high bacillary load (aOR 1.2; 0.6-2.7), lung cavitation (aOR 1.0; 0.7-1.5), immediately life-threatening forms of tuberculosis (aOR 0.8; 0.5-1.6), and monoresistance (aOR 0.9; 0.6-1.3). In subgroup analyses, Beijing strains only had a significant association with multidrug-resistant tuberculosis (aOR 6.1; 1.2-30.4), and an association of borderline significance with polyresistant tuberculosis (aOR 1.8; 1.0-3.5; p = 0.062), among individuals born in the Western Pacific.Other than an increased risk of polyresistant or multidrug-resistant tuberculosis, Beijing strains appear to pose no more of a public health threat than non-Beijing strains within a high-income immigrant-receiving country

Assessing Health Research and Innovation Impact: Evolution of a Framework and Tools in Alberta, Canada

Publicly funded research and innovation (R&I) organizations around the world are facing increasing demands to demonstrate the impacts of their investments. In most cases, these demands are shifting from academically based outputs to impacts that benefit society. Funders and other organizations are grappling to understand and demonstrate how their investments and activities are achieving impact. This is compounded with challenges that are inherent to impact assessment, such as having an agreed understanding of impact, the time lag from research to impact, establishing attribution and contribution, and consideration of diverse stakeholder needs and values. In response, many organizations are implementing frameworks and using web-based tools to track and assess academic and societal impact. This conceptual analysis begins with an overview of international research impact frameworks and emerging tools that are used by an increasing number of public R&I funders to demonstrate the value of their investments. From concept to real-world, this paper illustrates how one organization, Alberta Innovates, used the Canadian Academy of Health Sciences (CAHS) impact framework to guide implementation of its fit-for-purpose impact framework with an agnostic international six-block protocol. The implementation of the impact framework at Alberta Innovates is also supported by adopting emerging web-based tools. Drawing on the lessons learned from this continuous organizational endeavor to assess and measure R&I impact, we present preliminary plans for developing an impact strategy for Alberta Innovates that can be applied across sectors, including energy, environment and agriculture, and may possibly be adopted by other international funders

Towards the elimination of paediatric tuberculosis in high-income, immigrant-receiving countries: a 25-year conventional and molecular epidemiological case study

The epidemiology of tuberculosis (TB) in high-income countries is increasingly dictated by immigration. The influence of this trend on paediatric TB and TB elimination are not well defined. We undertook a 25-year conventional and molecular epidemiologic study of paediatric TB in Alberta, one of four major immigrant-receiving provinces in Canada. All isolates of Mycobacterium tuberculosis were DNA fingerprinted using standard methodology. Between 1990 and 2014, 176 children aged 0–14 years were diagnosed with TB. Foreign-born children or Canadian-born children of foreign-born parents accounted for an increasingly large proportion of total cases during the study period (from 32.1% to 89.5%). Of the 78 culture-positive cases, 35 (44.9%) had a putative source case identified by conventional epidemiology, with 34 (97.1%) having a concordant molecular profile. Of the remaining 43 culture-positive cases, molecular profiling identified spatially and temporally related sources in six cases (14.0%). These six children, along with four other children whose source cases were discovered through reverse-contact tracing, had a high morbidity and mortality. The increasing burden of paediatric TB in both foreign-born children and Canadian-born children of foreign-born parents calls for more timely diagnosis of source cases and more targeted screening for latent TB infection

Who's talking? Communication between health providers and HIV-infected adults related to herbal medicine for AIDS treatment in western Uganda

Communication between patients and physicians about herbal medicine is valuable, enabling physicians to address issues of potential herb-drug interactions and ensuring appropriate medical care. As seemingly harmless herbal remedies may have detrimental interactions with various HIV antiretroviral drugs, the importance of communication is intensified, but often stifled around the use of herbal medicine in the treatment of HIV/AIDS. In western Uganda, 137 HIV-infected adults attending conventional HIV/AIDS treatment programmes (67 of whom were receiving antiretroviral therapy) shared their experiences and perceptions about traditional herbal medicine and related patient-physician communication issues through interviews and focus group discussions. Although close to 64% of respondents reported using herbal medicine after being diagnosed with HIV, only 16% of these respondents had informed their conventional medical practitioners about using these herbs. Furthermore, only 13% of antiretroviral therapy recipients had inquired about concurrent herb-antiretroviral drug use with their HIV/AIDS treatment providers, largely because they perceived a low acceptance and support for herbal medicine by conventional medical practitioners. Importantly however, almost 68% of HIV-infected adults indicated they would be willing to discuss herbal medicine use if directly asked by a conventional medical practitioner, and the overwhelming majority (91%) said they were amenable to following physician advice about herbal medicine. As such, improved patient-physician communication about herbal medicine is needed, and we recommend that herbal medicine histories be completed when patient histories are taken. Also, HIV/AIDS treatment programmes should be encouraged to develop specific patient-physician communication standards and best practice guidelines to ensure that patients can make informed decisions about herb and pharmaceutical drug co-therapy based on known risks, particularly in the case of AIDS patients receiving antiretroviral therapy. Communication about herbal medicine usage should be viewed as a timely and cost-effective component of antiretroviral therapy programmes, one which may contribute to the overall success of AIDS treatment in Africa.Herbal medicine Communication HIV/AIDS Antiretroviral Africa Uganda Traditional medicine

Transmission of Mycobacterium tuberculosis Beijing Strains, Alberta, Canada, 1991–2007

Beijing strains are speculated to have a selective advantage over other Mycobacterium tuberculosis strains because of increased transmissibility and virulence. In Alberta, a province of Canada that receives a large number of immigrants, we conducted a population-based study to determine whether Beijing strains were associated with increased transmission leading to disease compared with non-Beijing strains. Beijing strains accounted for 258 (19%) of 1,379 pulmonary tuberculosis cases in 1991–2007; overall, 21% of Beijing cases and 37% of non-Beijing cases were associated with transmission clusters. Beijing index cases had significantly fewer secondary cases within 2 years than did non-Beijing cases, but this difference disappeared after adjustment for demographic characteristics, infectiousness, and M. tuberculosis lineage. In a province that has effective tuberculosis control, transmission of Beijing strains posed no more of a public health threat than did non-Beijing strains

Association between <i>M. tuberculosis</i> lineage and disease presentation in Alberta, 1991 to mid-2007.

<p>Abbreviations: OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; INH, isoniazid; RMP, rifampin; PZA, pyrazinamide; EMB, ethambutol; STM, streptomycin; MDR-TB, multidrug-resistant TB.</p>*<p>Non-Beijing strains are the reference group; –, logistic regression could not be completed due to cell count(s) of zero.</p>†<p>Association between Beijing lineage and each disease presentation after adjusting for sex, age, and population group; non-Beijing strains are the reference group.</p>‡<p>There were 1301 respiratory TB cases with data related to airway secretions, 1057 (81.2%) and 244 (18.8%) being attributed to non-Beijing and Beijing lineages, respectively.</p>§<p>There were 321 respiratory TB cases diagnosed after 1992 that had sputum smear-positive specimens collected on or before the date of diagnosis.</p>**<p>p = 0.053.</p>††<p>p = 0.046.</p>‡‡<p>p = 0.049.</p

Marked Disparity in the Epidemiology of Tuberculosis among Aboriginal Peoples on the Canadian Prairies: the Challenges and Opportunities

BACKGROUND: While it is established that Aboriginal peoples in the prairie provinces of Canada are disproportionately affected by tuberculosis (TB), little is known about the epidemiology of TB either within or across provincial borders

Association between <i>M. tuberculosis</i> lineage and disease presentation based on age at diagnosis.

<p>Abbreviations: aOR, adjusted odds ratio, CI, confidence interval; TB, tuberculosis; MDR-TB, multidrug-resistant tuberculosis; –unable to calculate.</p>*<p>Independent of sex and origin; non-Beijing strains are the reference group.</p>†<p>Of respiratory cases, 371 cases among those aged <35 years and 929 cases among those aged ≤35 years had smear microscopy data.</p>‡<p>p = 0.042.</p>§<p>There were 76 respiratory TB cases diagnosed after 1992 that had sputum smear positive specimens collected on or before the date of diagnosis among those born in the Western Pacific and 245 cases among those born elsewhere.</p>∥<p>p = 0.072.</p

Annual incidence rates of Beijing and non-Beijing lineage strains by population group.

<p>In each panel: rates are per 100,000 person-years (y-axis); time corresponds to the year of diagnosis (x-axis); bars with dark grey shading are cases with Beijing strains; and bars with light grey shading are cases with non-Beijing strains. The panels represent total cases (panel A) as well as cases within the foreign-born Western Pacific (panel B), foreign-born ‘other’ (panel C) and Canadian-born (panel D) populations.</p