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Background: In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). We tested the utility of a health centre (HC)/ community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda. Methods: The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatmentnaïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/ community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL) after two years of treatment. Adherence was determined through weekly pill counts. Results: Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospitalbased cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p=0.12), and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560). In multivariate analysis patients in the HC/ community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04). Conclusion: Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a hospital-based ART program run primarily by doctors. [ABSTRACT FROM AUTHOR]

Introduction: 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. Methods: This was a retrospective population-based study of culture-confirmed active TB cases in a major immigrantreceiving 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. Results: 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 multidrugresistant 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objectives: This representative, cross-sectional study conducted in Kabarole District, Western Uganda, determined the nutritional status of children 6–59 months of age and established a trend in the childhood stunting rates. Methods: A multi-stage random cluster sampling was performed to select 322 children and their principal caregivers. Anthropometric measurements were taken from the children and compared with a reference population and the children’s principle caregivers were interviewed. Results: Childhood stunting was high with 43.0% of all children having a z-score of less than or equal to −2. Predictive factors for stunting were a low economic status of the household, poor health of the child’s caregiver, residence located at a long distance from a health unit and use of a contaminated water source. The comparison of our study results with an earlier nutritional study in Kabarole District revealed that there is an increasing trend of childhood stunting over the years of 28.0% [95% confidence interval (CI) 22.1–33.1%] in 1989 vs 43% (95% CI 37.6–48.8%) in 2006 and that stunting rates in Kabarole District were much higher compared to national data. Conclusion: The high stunting rates in children and the increasing trend in stunting needs further investigations. It should also be determined why stunting rates in children in Kabarole District are much higher than the national average. There is a need for better nutritional interventions as part of the district’s public health programs. [ABSTRACT FROM AUTHOR]

Background. Information regarding the prevention and treatment of travelers’ diarrhea (TD) is available to the public from various sources, such as medical personnel, travel clinics, personal contacts, and the Internet. This type of information may help travelers avoid this illness or help those afflicted minimize its duration. Methods. We collected questionnaire data from 104 travelers at departure gates for flights to Mexico from Calgary, Alberta on their knowledge of symptoms and treatment of TD and food risks associated with this illness and sources of information used. Results. Almost half reported they received some information on travel-related diseases and on TD prior to the flight. When education level was controlled for, the mean score for people who had obtained information on TD was significantly higher than that for those who did not have such information. College or university-educated travelers scored better than did other travelers. A high proportion of travelers correctly identified risk levels associated with specific foods consumed during travel, and many recognize that they are at an increased risk of acquiring diarrheal illness while traveling in a developing country. Conclusions. Information on TD appears to improve the level of knowledge on its prevention and treatment among travelers from southern Alberta. [ABSTRACT FROM AUTHOR]

Cancer registry data for San Francisco (1974-85) were used to identify women at greater risk of late diagnoses for breast and cervical cancers by age and ethnicity. For breast cancer, Black women were at greater risk for late diagnoses. For cervical cancer, women of all ethnic groups ages 50-69 years and Japanese and Filipino women were at greater risk for late diagnoses. (Am J Public Health 1989; 79:69-70.) [ABSTRACT FROM AUTHOR]