Prognostic indicators of hepatitis A severity during the 1994-1996 outbreak in the Montreal-Centre region

Objective. To describe the factors predictive of hepatitis A disease severity.Design and setting. Cross-sectional study of hepatitis A cases during the recent HAV outbreak in the Montreal gay community.Subjects. All 631 hepatitis A cases documented in the Montreal-Centre region between November 1994 and December 1996.Outcome measures. Hepatitis A severity was operationalized as (1) the need for hospitalization and (2) a symptom severity index (vomiting, dark urine and abdominal pain).Results. Subjects were predominantly male (84%). Homosexual behaviour was reported in 68% of cases. Prevalence of a high severity index was 8%, and 12% of cases required hospitalization. Non parenteral drug use was the only factor predictive of both hospitalization status and severity index. Our data could not establish homosexual behaviour as a determinant of disease severity.Conclusion. Non parenteral drug users are at increased risk of suffering from a severe disease when infected with the hepatitis A virus. In addition to the current recommendation for routine vaccination of travelers and of homosexual men, drug users could benefit from immunization against this virus

Cultural Safety Training for Health Professionals Working with Indigenous Populations in Montreal, Québec

Urban Indigenous populations face some of the most significant barriers to access to health services out of any population in Canada. The Indigenous community in Montreal developed a cultural safety training program to help decrease some of these barriers. An extensive review of published literature on cultural safety in health care was performed. A training program was developed to: describe the diversity of Indigenous populations in Montreal; explain historic and present-day determinants of health inequities in this population; develop competencies to respect clients’ diversity and promote cultural safety in care. A pre-test survey was circulated to participants to establish baseline knowledge and attitudes towards Indigenous populations. The program was divided into 3 half-day sessions. After each session, a satisfaction evaluation grid survey was circulated to participants. The Indigenous Cultural Safety Training Program was presented to a total of 45 nurses, social workers, and physicians with frequent interactions with the Indigenous community in Montréal. Having an Elder and community member present appeared to have been successful in increasing participants level of awareness of the importance of improving the quality of health care services provided. Challenges were identified regarding the transmission of the political aspect of the cultural safety concept, and the importance of decolonizing health care systems. Reflections on how to address these in the future will be discussed. Cultural safety training for health professionals is challenging, yet, a necessity to improve access to care and improve health outcomes in urban Indigenous populations