Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study

Cardiovascular diseases, which include coronary heart diseases (CHD), remain the leading cause of death in Canada and other industrialized countries. This qualitative study used photo-elicitation, focus groups and in-depth interviews to understand health behaviour change from the perspectives of 38 people who were aware of their high risk for CHD and had received information about cardiovascular risk modification while participating in a larger intervention study. Participants were drawn from two selected regions: Sudbury and District (northern Ontario) and the Greater Toronto Area (southern Ontario). Analysis drew on concepts of place and space to capture the complex interplay between geographic location, sociodemographic position, and people’s efforts to understand and modify their risk for CHD. Three major sites of difference and ambiguity emerged: 1) place and access to health resources; 2) time and food culture; and 3) itineraries or travels through multiple locations. All participants reported difficulties in learning and adhering to new lifestyle patterns, but access to supportive health resources was different in the two regions. Even within regions, subgroups experienced different patterns of constraint and advantage. In each region, “fast” food and traditional foods were entrenched within different temporal and social meanings. Finally, different and shifting strategies for risk modification were required at various points during daily and seasonal travels through neighbourhoods, to workplaces, or on vacation. Thus health education for CHD risk modification should be place-specific and tailored to the needs and resources of specific communities

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

<p>Abstract</p> <p>Background</p> <p>Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso.</p> <p>Methods</p> <p>A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team.</p> <p>Results</p> <p>The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks).</p> <p>Conclusion</p> <p>The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

Giardia CWP2 : determining its immunogenic[i]ty and its potential as a candidate for vaccine against giardiasis

In this study, we determined the immunogenicity of CWP2 and its potential as a vaccine candidate against giardiasis. CWP2 was expressed as a recombinant protein with an hexa-histidine affinity tag and was isolated from inclusion bodies. When BALB/c mice were immunized with CWP2, a specific IgA was detected in the feces. When mice were immunized with CWP2 + cholera toxin, as an adjuvant, IgA in the feces, and IgA, IgG1, and IgG2a in the serum, all specific to CWP2, were detected. Also, CD-1 mice were infected with G. muris and presence of specific IgA antibodies to CWP2 were detected in the feces. This result indicated that CWP2 was recognized by the immune system in a natural infection. IL-4 and IL-5 were released from Peyer's patches (PP) and mesenteric lymph nodes (MLN) cells when stimulated with concanavalin A. In spleen cells, IFN-gamma, IL-4, and IL-5 were released when stimulated with concanavalin A. However, in PP, MLN and spleen cells, the levels of cytokines were barely detectable when stimulated with CWP2. The presence of IgG2a (Th1), IgA and IgG1 (Th2) as the production of IFN-gamma (Th1), IL-4 and IL-5 (Th2) confirmed that CWP2, when presented orally to mice, stimulates both a Th1 and Th2 type immune response, locally and systemically

Randomized controlled trial of mebendazole plus iron supplement versus placebo plus iron supplementation during pregnancy

Objective. The aim of the study was to assess the effectiveness of antenatal mebendazole plus iron supplementation versus placebo plus iron supplementation on birthweight in a highly hookworm-endemic area.Methods. This study was a double-blind randomized controlled trial set in rural and peri-urban communities in the Peruvian Amazon region. A total of 1042 second trimester pregnant women between the ages of 18 and 44 years were recruited from April to November 2003, and followed to July 2004. Women were randomly assigned to receive either mebendazole (500 mg single dose) plus iron supplements (60 mg elemental iron daily) or placebo plus iron supplements. The primary outcome was mean infant birthweight and secondary measures included proportion of low birthweight (&lt;2500g) and maternal anemia. Adverse birth outcomes were also recorded.Results. The prevalence of hookworm infection was 47.5%. There were no differences between intervention groups in mean birthweight (3104 g vs 3090 g, p=0.629), proportion of low birthweight (8.1% vs 8.7%, p=0.755) or maternal anemia in the 3rd trimester (33.0% (158/479) vs 32.3% (152/471), p=0.815). However, the proportion of very low birthweight (&lt;1500g) was significantly lower in the mebendazole group (0% (0/479) vs 1.5% (7/471), p=0.007). No statistically significant difference (p=0.664) in adverse birth outcomes (miscarriages, malformations, stillbirths, early neonatal deaths and premature babies) was found between the mebendazole group and the placebo group (28 versus 31, respectively).Conclusion. This trial provides additional evidence for the use of anthelminthics, over and above iron supplementation, within antenatal care programs in hookworm-endemic areas

A clinical return-to-work rule for patients with back pain

BACKGROUND: Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions (and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings. METHODS: This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers (participation, 68.4% of potential participants expected to be eligible) aged 18–64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was “return to work in good health” at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest. RESULTS: The best predictive model included 7 baseline variables (patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome (negative predictive value 78%– 94%). INTERPRETATION: A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome

Association between <i>Trichuris</i> intensity in the second trimester and anemia risk in the third trimester.

1<p>Adjusted for hookworm infection intensity and for the time interval between the first and second assessments.</p