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OBJECTIVE: The HIV/AIDS epidemic disproportionately involves socially vulnerable populations. Since 2001, the proportion of foreign-born patients served by the Northern Alberta HIV Program has increased. Our study aimed to evaluate antiretroviral therapy (ART) outcomes among HIV-infected foreign-born patients in northern Alberta, Canada, prescribed once-daily ART. METHODS: We utilized a two-part retrospective cohort study to compare ART outcomes of foreign-born and Canadian-born Aboriginal patients compared to Canadian-born non-Aboriginal patients. Part 1 utilized logistic regression to compare the odds of experiencing initial virological suppression of foreign-born (40%) and Canadian-born Aboriginal patients (27%) compared with Canadian-born non-Aboriginal patients (33%). Part 2 used survival analysis to compare the rate of ART failure by country of origin among patients who achieved initial virological suppression in Part 1. RESULTS: Our study sample included 322 treatment-naive patients (122 foreign-born). For Part 1, 261 patients achieved initial virological suppression within six months of initiating ART. After controlling for age, treatment regimen, HIV risk exposure, and calendar year compared to Canadian-born non-Aboriginal patients, the odds of achieving initial virological suppression were significantly lower for Canadian-born Aboriginal patients (OR=0.44, 95% CI: 0.20-0.96); and similar for foreign-born patients (OR=0.76, 95% CI: 0.33-1.73). Part 2 included 261 patients who were followed for 635.1 person-years. Adjusting for age, sex, baseline CD4 cell count, and drug regimen, compared to Canadian-born non-Aboriginal patients, Canadian-born Aboriginal and foreign-born patients had similar rates of virological failure after achieving initial virological suppression (HR=1.54, 95% CI: 0.38-6.18; HR=0.49, 95% CI: 0.11-2.20, respectively). CONCLUSIONS: Our study indicated that ART outcomes among Alberta-based foreign-born patients are similar to those among Canadian-born non-Aboriginal patients. Our results, however, suggested that Canadian-born Aboriginal patients had poorer treatment outcomes compared to Canadian-born non-Aboriginal patients. It is imperative, therefore, that clinicians, researchers and community members better understand reasons for poor ART outcomes among Canadian-born Aboriginal patients in northern Alberta. KEY WORDS: Antiretroviral therapy; emigrants and immigrants; HIV-1; treatment outcomes; Canada OBJECTIF: L'epidemie de VIH et de sida frappe demesurement les populations socialement vulnerables. Depuis 2001, la proportion de patients nes a l'etranger servis par le programme de lutte contre le VIH du nord de l'Alberta a augmente. Notre etude visait a evaluer les effets de la therapie antiretrovirale (TAR) dans le nord de l'Alberta, au Canada, chez des patients infectes par le VIH nes a l'etranger auxquels on avait prescrit une dose quotidienne d'antiretroviraux. METHODE: Nous avons utilise une etude de cohorte retrospective en deux volets pour comparer les effets de la TAR chez les patients nes a l'etranger et les patients autochtones nes au Canada et chez les patients non autochtones nes au Canada. Le 1er volet a fait appel a la regression logistique pour comparer la probabilite d'une suppression virale initiale chez les patients nes a l'etranger (40%) et les patients autochtones nes au Canada (27%) et chez les patients non autochtones nes au Canada (33%). Le 2e volet a fait appel a l'analyse de survie pour comparer le taux d'echec de la TAR selon le pays d'origine des patients ayant obtenu une suppression virale initiale durant le 1er volet. RESULTATS: Notre echantillon d'etude comportait 322 patients naifs de traitement (dont 122 nes a l'etranger). Pour le 1er volet, 261 patients ont obtenu une suppression virale initiale moins de six mois apres le debut de la TAR. Compte tenu de l'age, du schema therapeutique, du risque d'exposition au VIH et de l'annee civile, comparativement aux patients non autochtones nes au Canada, la probabilite d'obtenir une suppression virale initiale etait significativement plus faible chez les patients autochtones nes au Canada (RC=0,44, IC de 95%: 0,20-0,96); et similaire a celle des patients nes a l'etranger (RC=0,76, IC de 95%: 0,33-1,73). Le 2e volet incluait 261 patients, suivis sur 635,1 annees-personne. Compte tenu de l'age, du sexe, de la numeration des lymphocytes CD4 au depart et du regime posologique, comparativement aux patients non autochtones nes au Canada, les patients autochtones nes au Canada et les patients nes a l'etranger avaient des taux d'echec virologique similaires apres la suppression virale initiale (indice de risque (IR)=1,54, IC de 95%: 0,38-6,18; IR=0,49, IC de 95%: 0,11-2,20, respectivement). CONCLUSIONS: Notre etude indique que les effets de la TAR chez les patients de l'Alberta nes a l'etranger sont semblables a ceux observes chez les patients non autochtones nes au Canada. Par contre, nos resultats donnent a penser que chez les patients autochtones nes au Canada, les effets du traitement sont moins bons que chez les patients non autochtones nes au Canada. Il est donc imperatif que les cliniciens, les chercheurs et le public comprennent mieux les raisons de l'inefficacite relative de la TAR chez les patients autochtones du nord de l'Alberta nes au Canada. MOTS CLES: therapie antiretrovirale; emigrants et immigrants; VIH-1; effets physiologiques des medicaments; Canada, The HIV/AIDS epidemic disproportionately impacts vulnerable populations. In 2012, persons born in HIV-endemic countries comprised approximately 2.2% of the Canadian population but accounted for 13% of newly diagnosed HIV cases. [...]

The Beijing lineage of Mycobacterium tuberculosis (also referred to as the East Asian lineage or lineage 2) is an emerging public health threat (1,2). The Beijing lineage accounts for 13% [...]

OBJECTIVE: We compared the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV patients after they started highly active antiretroviral therapy (HAART) in Edmonton, Alberta and investigated whether clinical status (CD4 cell count and viral load) might explain any observed differences. METHODS: In 2006-2007, eligible patients who started HAART in 1997-2005 completed the MOS-HIV to measure HRQL. Using multiple linear regression models, we compared physical (PHS) and mental (MHS) health summary scores across four groups: Aboriginals infected with HIV via injection drug use (AB/IDUs); Aboriginal non-IDUs (AB/non-IDUs); non- Aboriginal IDUs (non-AB/IDUs); and non-Aboriginal non-IDUs (non-AB/non-IDUs). To assess whether clinical status could explain any observed group differences, we fitted a model adjusting for socio-demographics (age and sex) and years since starting HAART only and then additionally adjusted for current clinical status. RESULTS: Ninety-six patients were eligible (35% Aboriginal, 42% IDU). Adjusting for socio-demographics and years since starting HAART, AB/IDUs (p=0.008), AB/non-IDUs (p=0.002), and non-AB/IDUs (p=0.002) had lower PHS scores than non- AB/non-IDUs. After additionally adjusting for clinical status, these relationships remained significant for AB/non-IDUs (p=0.027) and non-AB/IDUs (p=0.048) but not for AB/IDUs (p=0.12). AB/IDUs and non AB/IDUs tended to have worse MHS scores than non-AB/non-IDUs, but these relationships were not statistically significant and weakened after adjusting for current clinical status. CONCLUSIONS: AB/IDU, AB/non-IDUs, and non-AB/IDUs had significantly poorer physical HRQL than non-AB/non-IDUs. These differences appear to be partially explained by poorer clinical status, especially for AB/IDUs, which suggests that observed inequalities in physical HRQL may be diminished by improving patients' clinical status; for example, through improved adherence to HAART. KEY WORDS: Aboriginal populations; antiretroviral therapy, highly active; intravenous drug users; treatment outcomes; health-related quality of life OBJECTIF : Nous avons compare la qualite de vie liee a la sante (QVLS) de patients autochtones et non autochtones atteints du VIH apres le debut d'une therapie antiretrovirale hautement active (TAHA) a Edmonton (Alberta) et cherche a savoir si leur etat clinique (numeration des lymphocytes CD4 et charge virale) pouvait expliquer les differences observees. METHODE : En 2006-2007, des patients admissibles ayant entame une TAHA en 1997-2005 ont rempli le questionnaire MOS-HIV, qui mesure la QVLS. A l'aide de modeles de regression lineaire multiple, nous avons compare les cotes sommaires de sante physique (CSP) et de sante mentale (CSM) de quatre groupes : les Autochtones infectes par le VIH via l'utilisation de drogues par injection (Aut./UDI); les Autochtones non-UDI (Aut./non-UDI); les non-Autochtones UDI (non-Aut./UDI); et les non-Autochtones non-UDI (non-Aut./non-UDI). Pour determiner si l'etat clinique pouvait expliquer les differences observees entre ces groupes, nous avons adapte un modele en tenant compte des caracteristiques sociodemographiques (age et sexe) et du nombre d'annees depuis le debut de la TAHA seulement, puis en tenant compte, en plus, de l'etat clinique actuel. RESULTATS : Quatre-vingt-seize patients etaient admissibles (35 % d'Autochtones, 42 % d'UDI). Compte tenu des caracteristiques sociodemographiques et du nombre d'annees depuis le debut de la TAHA, les Aut./UDI (p=0,008), les Aut./non-UDI (p=0,002) et les non-Aut./UDI (p=0,002) avaient des cotes CSP inferieures a celles des non-Aut./non-UDI. En tenant aussi compte de l'etat clinique, ces relations demeuraient significatives pour les Aut./non-UDI (p=0,027) et les non-Aut./UDI (p=0,048), mais pas pour les Aut./UDI (p=0,12). Les Aut./UDI et les non-Aut./UDI avaient tendance a presenter des CSM inferieures a celles des non-Aut./non-UDI, mais ces relations n'etaient pas significatives, et elles s'affaiblissaient apres la prise en consideration de l'etat clinique actuel. CONCLUSION : La QVLS physique des Aut./UDI, des Aut./non-UDI et des non-Aut./UDI etait significativement inferieure a celle des non-Aut./non-UDI. Ces differences semblent s'expliquer en partie par un moins bon etat clinique, surtout pour les Aut./UDI, ce qui laisse entendre que les inegalites observees dans la QVLS physique peuvent etre reduites si l'on ameliore l'etat clinique des patients, par exemple en ameliorant l'observance de la TAHA. MOTS CLES : populations autochtones; therapie antiretrovirale hautement active; toxicomanie intraveineuse; resultat therapeutique; qualite de vie liee a la sante, In Canada, Aboriginals and non-Aboriginals infected with HIV do not appear to receive equal benefit from highly active antiretroviral therapy (HAART). After starting HAART, Aboriginals have been shown to experience [...]

Background: Bicycle trauma is a common cause of recreational death and disability and helmets have been shown to reduce fatal and non-fatal head and face injuries. This study evaluated the effect of mandatory bicycle helmet legislation for all ages in St. Albert, Alberta. Methods: We observed bicyclists from June to September of 2006 in St. Albert, a community subject to both provincial ( Results: HP increased from 45% to 92% (PR=2.03; 95% CI: 1.72-2.39) post-legislation. Controlling for other covariates, children were 53% (PR=1.53; 95% CI: 1.34-1.74) and adolescents greater than 6 times (PR=6.57; 95% CI: 1.39-31.0) more likely to wear helmets; however, adults (PR=1.26; 95% CI: 0.96-1.66) did not show a statistically significant change post-legislation. Restricting the analysis to high socio- economic status areas, adult helmet prevalence increased in St. Albert from 58% to 73% post-legislation compared with a 52% to 57% change across the province; this effect was not statistically significant. Conclusions: Helmet legislation in St. Albert was associated with a significant increase in helmet use among child and adolescent cyclists. A larger increase in HP was observed for adults in St. Albert than in other areas of the province; however, this difference was not statistically significant, which may reflect the small sample size or insufficient time passage after bylaw enactment. Key words: Bicycling; head protective device; legislation; prevalence Contexte : Les traumatismes dus aux accidents de bicyclette sont une cause courante de mortalite et d'invalidite survenues dans le cadre d'activites de loisirs, et l'on sait que le port du casque reduit les blessures mortelles et non mortelles a la tete et au visage. Nous avons evalue l'effet des lois sur le port obligatoire du casque de cycliste a tout age a St. Albert, en Alberta. Methode : De juin a septembre 2006, nous avons observe des cyclistes a St. Albert, une municipalite assujettie a la fois a la loi provinciale ( Resultats : La PPC est passee de 45 % a 92 % (RP=2,03; IC de 95 % = 1,72-2,39) apres l'adoption des mesures legislatives. Si l'on tient compte des effets d'autres covariables, les enfants etaient plus susceptibles dans une proportion de 53 % (RP=1,53; IC de 95 % = 1,34-1,74), et les adolescents plus de 6 fois plus susceptibles (RP=6,57; IC de 95 % = 1,3931,0) de porter un casque; cependant, la loi ne semble pas avoir eu d'effet significatif sur le port du casque chez les adultes (RP=1,26; IC de 95 % = 0,96-1,66). En limitant notre analyse aux quartiers de statut socioeconomique eleve, la prevalence du port du casque chez les adultes a augmente a St. Albert, passant de 58 % a 73 % apres les mesures legislatives; a l'echelle de la province, elle est passee de 52 % a 57 %; cet effet n'etait pas statistiquement significatif. Conclusion : A St. Albert, les mesures legislatives sur le port du casque etaient associees a une hausse significative du port du casque de cycliste chez les enfants et les adolescents. Une plus forte hausse de la PPC a ete observee chez les adultes de St. Albert que dans d'autres parties de la province, mais cet ecart n'etait pas significatif, ce qui peut s'expliquer par la petite taille de l'echantillon ou par le fait qu'il ne s'etait pas ecoule suffisamment de temps apres l'adoption du reglement municipal. Mots cles : cyclisme; dispositifs de protection de la tete; legislation; prevalence, Bicycle riding is a popular recreational and transportation activity in Canada; (1) however, injuries do occur and may result in emergency department (ED) visits, hospitalizations (2-5) and even deaths. (6,7) [...]

Background: Aboriginals are over-represented in Canada's HIV epidemic and are commonly infected with HIV via injection drug use (IDU); however, little is known about the impact of Aboriginal ethnicity on mortality after starting highly active antiretroviral therapy (HAART). Therefore, we compared mortality rates between Aboriginal and non-Aboriginal HIV patients and between IDU and non-IDU HIV patients after they initiated HAART. Methods: We conducted a retrospective cohort study of antiretroviral-naive patients starting HAART January 1999-June 2005 (baseline), followed until December 2005. We constructed two Cox proportional hazards models, one to estimate all-cause and one to estimate HIV-related mortality hazard ratios (HRs), considering sex, and baseline age, CD4 cell count, HIV RNA level, calendar year, and HAART regimen as potential confounders. Results: The 548 study patients were followed for 1,889.8 person-years; 194 (35%) were Aboriginal, 255 (46%) were IDUs. We observed 55 deaths; 47% were HIV-related. In multivariable models, Aboriginals experienced higher all-cause (HR=1.85, 95% CI=1.05-3.26, p=0.034) and HIV-related (HR=3.47, 95% CI=1.36-8.83, p=0.009) mortality rates compared to non-Aboriginals; and, compared to patients with other exposures, IDUs experienced higher all-cause (HR=2.45, 95% CI=1.31-4.57, p=0.005) but similar HIV-related (p=0.27) mortality rates. Conclusions: Compared to non-Aboriginals, Aboriginal HIV patients suffer higher all-cause and HIV-related mortality rates after starting HAART. The strongest and most significant predictor of higher all-cause mortality was IDU. Future research should examine reasons for the observed poorer survival of Aboriginal and IDU HIV patients after initiating HAART to develop interventions to improve the prognosis for these vulnerable populations. Key words: Antiretroviral therapy, highly active; mortality; Aboriginal populations; intravenous drug use Contexte : Les Autochtones sont surrepresentes dans l'epidemie de VIH qui sevit au Canada, le plus souvent en raison de l'utilisation de drogues par injection (UDI); pourtant, on sait peu de choses sur l'impact de l'ethnicite autochtone sur la mortalite apres le debut d'une therapie antiretrovirale hautement active (TAHA). C'est pourquoi nous avons compare les taux de mortalite de patients autochtones et non autochtones atteints du VIH et ceux d'UDI et de non-UDI atteints du VIH apres le debut d'une TAHA. Methode : Nous avons mene une etude de cohortes retrospective aupres de patients naifs de traitement antiretroviral ayant entame une TAHA entre janvier 1999 et juin 2005 (groupe de reference), que nous avons suivis jusqu'en decembre 2005. Nous avons construit deux modeles de Cox (modeles des risques proportionnels), l'un pour estimer les coefficients de danger (QD) pour toutes les causes de mortalite et l'autre pour la mortalite liee au VIH, en tenant compte des facteurs confusionnels possibles (sexe, age au depart, numeration des lymphocytes CD4, niveaux d'ARN VIH, annee civile et regime TAHA). Resultats : Les 548 patients a l'etude ont ete suivis sur 1 889,8 personnes-annees; 194 (35 %) etaient Autochtones, et 255 (46 %) etaient des UDI. Nous avons observe 55 deces, dont 47 % lies au VIH. Dans les modeles multivaries, les Autochtones affichaient des taux superieurs pour la mortalite toutes causes confondues (QD=1,85, IC de 95 %=1,05-3,26, p=0,034) et la mortalite liee au VIH (QD=3,47, IC de 95 %=1,36-8,83, p=0,009) comparativement aux Non-Autochtones. Par rapport aux patients ayant d'autres expositions, les UDI affichaient des taux superieurs de mortalite toutes causes confondues (QD=2,45, IC de 95 %=1,31-4,57, p=0,005), mais leurs taux de mortalite liee au VIH etaient semblables (p=0,27). Conclusion : A comparer aux Non-Autochtones, les patients autochtones atteints du VIH ont des taux superieurs de mortalite toutes causes confondues et de mortalite liee au VIH apres le debut d'une TAHA. La variable predictive la plus forte et la plus significative de la mortalite toutes causes confondues etait le statut d'UDI. Dans les futurs travaux de recherche, il faudrait se pencher sur les raisons des moins bons taux de survie observes chez les patients autochtones et les UDI atteints du VIH apres le debut d'une TAHA afin d'elaborer des interventions susceptibles d'ameliorer le pronostic de ces populations vulnerables. Mots cles : therapie antiretrovirale hautement active; mortalite; population d'origine amerindienne; toxicomanie intraveineuse, Highly active antiretroviral therapy (HAART) has dramatically reduced mortality among human immunodeficiency virus (HIV)-infected individuals. (1,2) However, since the introduction of HAART, higher rates of mortality have been observed among [...]

Background. It is largely unknown whether functional recovery following hip fracture differs between long-term care (LTC) and community-dwelling residents. Our primary purpose was to compare recovery between these patients 6 months following hip fracture, controlling for known prognostic factors. Secondarily, we examined the contribution of residential status, in addition to patient characteristics, to functional recovery. Methods. We studied a population-based inception cohort of 451 hip fracture patients [greater than or equal to] 65 years old admitted to one Canadian health region hospital between July 1999 and September 2000. Participants completed the Modified Barthel Functional Index (MBI) in hospital and again via telephone interviews 6 mont lected on surgery and rehabilitation timing, length of hospital stay (LOS). and discharge destination. Relative change from prefracture function adjusting for known prognostic factors, and the proportion of participants ret were compared between the LTC and community-dwelling residents. Results. LTC residents (n = 115) were older, with lower function prefracture, more comorbidities, and increased dementia than community-dwelling residents (n = 336). Six months postfracture, 17 (22%) LTC and 180 (71%) community-dwelling residents had regained prefracture function (p < .001). LTC residents had 33% lower (-40.6, -27.2) and community-dwelling residents 11.6% lower (-14.8, 8.4) 6-month MBI scores relative to prefracture scores alter risk adjustment. Residential status was significantly associated with risk-adjusted functional recovery (p < .001). Median LOS was 4 days less for LTC than for community-dwelling residents (p < .001). Twelve (10%) LTC and 266 (79%) community-dwelling residents were discharged to inpatient rehabilitation (p < .001). Conclusion. Following hip fracture, most LTC residents do not regain prefracture function irrespective of known prognostic factors. Further investigation is needed as to the extent to which personal and environmental characteristics contribute to outcome after hip fracture.

The trends in the attitudes and behaviors of youth in western Uganda are monitored with respect to prevention of HIV/AIDS. The results have shown positive changes in the sexual behavior of secondary school students in western Uganda, thereby declining the HIV prevalence rates among young people from this region.

In many areas of health care, randomized controlled trials (the best evidence regarding the effectiveness of health care interventions) are lacking and decision-makers have to rely on evidence from nonrandomized studies (NRS). We conducted a Medline search to identify English-language articles describing instruments for assessing the quality of NRS of health care interventions. These instruments varied greatly in scope, in the number and types of items and in developmental rigor. Items commonly included were those related to specification of study questions, allocation method, comparability of groups, and blinding of outcome assessment. We do not support the development of a generic scale to evaluate the methodological quality of nonrandomized intervention studies. Instead, further study should be directed to investigate the degree to which, and the circumstances under which, different methodological characteristics are associated with bias. This information will assist researchers in identifying apriori which methodological characteristics need careful evaluation in particular studies. Keywords: systematic reviews, nonrandomized studies, validity

Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making. [ABSTRACT FROM AUTHOR]