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L’Agence de la santé publique du Canada a modernisé son approche en matière de sur¬veillance de l’activité physique en élargissant la portée de cette dernière de façon à englober le comportement sédentaire et le sommeil. La première étape a consisté à éla¬borer un cadre conceptuel couvrant toute la gamme de l’activité : activité physique d’intensité modérée à élevée, activité physique de faible intensité, comportement séden¬taire et sommeil. Ce cadre tient compte de l’environnement dans lequel ces comporte¬ments surviennent (à la maison, au travail ou à l’école, durant le transport entre différents lieux, et dans la communauté) et adopte une approche socioécologique intégrant les facteurs individuels et les indicateurs portant, plus largement, sur les milieux bâti, social et sociétal. Nous avons également conçu un modèle visuel de ce cadre conceptuel pour en faciliter la diffusion.

IntroductionHealth Canada is committed to the modernization of the use of real-world data (RWD) and evidence (RWE) to support regulatory decisions. As such, telephone interviews with stakeholders, including government decision makers, health technology assessment (HTA) producers, industry, and patients, to understand their experiences with and perspectives on how to enhance RWE use for medical devices were performed.MethodsThirty-four semi-structured telephone interviews with forty key informants were conducted. Transcripts were reviewed independently by one individual to identify, define, and categorize key concepts and were verified by a second reviewer.Key FindingsThere are expectations for Health Canada to provide a framework and guidance on RWE use, identify relevant outcomes for data collection and criteria for data quality, conduct post-market surveillance more systematically, and partner with HTA organizations to develop methods for RWE generation. Stakeholders interviewed support the RWE use for regulatory decisions and HTA recommendations. Moreover, robust scientific methods for RWE generation will be critical to ensure that relevant questions are asked and rigorous statistical analyses are done to answer them. Patients are likely to consent to share their anonymized or de-identified medical information for nonprofit purposes.ConclusionsKey concepts from the interviews centered on the current and future RWE use for medical devices, considerations for the organizational, medical, scientific, and legal aspects and privacy issues of RWD collection or RWE generation, and options to implement the use of RWD and RWE. Our study findings will help inform the development of an RWE framework for regulatory decisions and HTA recommendations.

Introduction Sleep is essential for both physical and mental well-being. This study investigated sociodemographic, lifestyle/behavioural, environmental, psychosocial and health factors associated with sleep duration among Canadians at different life stages. Methods We analyzed nationally representative data from 12 174 Canadians aged 3–79 years in the Canadian Health Measures Survey (2009–2013). Respondents were grouped into five life stages by age in years: preschoolers (3–4), children (5–13), youth (14–17), adults (18–64) and older adults (65–79). Sleep duration was classified into three categories (recommended, short and long) according to established guidelines. Logistic regression models were used to identify life stage–specific correlates of short and long sleep. Results The proportion of Canadians getting the recommended amount of sleep decreased with age, from 81% of preschoolers to 53% of older adults. Statistically significant factors associated with short sleep included being non-White and having low household income among preschoolers; being non-White and living in a lone-parent household among children; and second-hand smoke exposure among youth. Boys with a learning disability or an attention-deficit/hyperactivity disorder and sedentary male youth had significantly higher odds of short sleep. Among adults and older adults, both chronic stress and arthritis were associated with short sleep. Conversely, mood disorder and poor/fair self-perceived general health in adults and weak sense of community belonging in adults and older men were associated with long sleep. Conclusion Our population-based study identified a wide range of factors associated with short and long sleep at different life stages. This may have implications for interventions aimed at promoting healthy sleep duration.

With growing awareness about traumatic brain injuries (TBI), there is limited information about population level patterns of TBI care in Canada.We examined data from the Canadian Community Health Survey (years 2004, 2009, and 2014) among all respondents ages 12 years and older. TBI management characteristics examined included access to care within 48 hours of injury, point of care, hospital admission, and follow-up.We observed that many Canadians sought care within 48 hours of their injury, with no changes over time. We found a significant decline in the proportion of Canadians opting to visit an emergency department (p = 0.03, all ages), and a significant increase in youth opting to visit a doctor's office (p0.01).TBIs are an important and growing health concern in Canada. Care for such injuries appears to have shifted towards the use of health care professionals outside the hospital environment, including primary care doctors.Malgré une plus grande sensibilisation aux traumatismes crâniens, nous disposons de peu de renseignements à l’échelle de la population sur les types de soins prodigués en lien avec les traumatismes crâniens au Canada.Nous avons examiné les données de l’Enquête sur la santé dans les collectivités canadiennes (années 2005, 2009 et 2014) portant sur les répondants de 12 ans et plus. Les variables sélectionnées en lien avec la prise en charge des traumatismes crâniens ont été l’accès à des soins dans les 48 heures suivant la blessure, le point de service, l’admission à l’hôpital et les soins de suivi.Nous avons constaté qu’un grand nombre de Canadiens avaient bénéficié de soins médicaux dans les 48 heures suivant leur blessure, sans changement dans cette proportion au fil du temps. Nous avons aussi observé un déclin significatif de la proportion de Canadiens ayant décidé de se rendre au service des urgences (p = 0,03, tous âges confondus) et une augmentation significative du nombre de jeunes ayant décidé de consulter un médecin (p0,01).Les traumatismes crâniens sont un problème de santé important et en augmentation au Canada. Ces blessures semblent de plus en plus être traitées par des professionnels de la santé en dehors des hôpitaux, en particulier par des médecins de première ligne.

Introduction Le sommeil est essentiel à la fois au bien-être physique et au bien-être mental. Cette étude a examiné les facteurs sociodémographiques, comportementaux, environnementaux, psychosociaux et les facteurs de santé associés à la durée du sommeil chez les Canadiens à différentes étapes de la vie. Méthodologie Nous avons analysé des données de l’Enquête canadienne sur les mesures de la santé (2009-2013), représentatives à l’échelle nationale et portant sur 12 174 Canadiens de 3 à 79 ans. En fonction de leur âge, les répondants ont été distribués en cinq groupes correspondant à cinq étapes de vie : les enfants préscolaires (3 et 4 ans), les enfants (5 à 13 ans), les adolescents (14 à 17 ans), les adultes (18 à 64 ans) et les aînés (65 à 79 ans). La durée du sommeil a été classée en trois catégories (recommandée, courte et longue) suivant les directives établies. Des modèles de régression logistique ont été utilisés pour dégager des corrélats d’une durée de sommeil courte ou longue propres à chaque étape de vie. Résultats La proportion de Canadiens jouissant de la quantité recommandée de sommeil diminue avec l’âge, de 81 % chez les enfants préscolaires à 53 % chez les aînés. Les facteurs statistiquement significatifs associés à un sommeil court sont une ethnicité non blanche et un revenu familial faible chez les enfants préscolaires, une ethnicité non blanche et la résidence avec un seul parent chez les enfants et l’exposition à la fumée secondaire chez les adolescents. Les garçons ayant un trouble d’apprentissage ou un trouble du déficit de l’attention avec hyperactivité et les garçons adolescents sédentaires avaient des chances significativement plus élevées de connaître un sommeil court. Chez les adultes et les aînés, le stress chronique et l’arthrite ont été associés tous deux à un sommeil court. Le sommeil long a été quant à lui associé à un trouble de l’humeur et une autoperception d'une mauvaise santé générale ou passable chez les adultes et à un faible sens d’appartenance communautaire chez les adultes ainsi que chez les aînés de sexe masculin. Conclusion Notre étude de population a dégagé une grande variété de facteurs associés à un sommeil court ou long à différentes étapes de la vie, ce qui pourrait jouer un rôle dans l'élaboration des interventions visant à promouvoir une durée de sommeil saine.

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Introduction La santé mentale positive est de plus en plus reconnue comme un élément central des politiques et des programmes en matière de santé publique. On a déterminé au Canada que le Continuum de santé mentale – Questionnaire abrégé (CSM-QA) constituait un outil de mesure prometteur qu’il fallait intégrer aux enquêtes d’évaluation de la santé mentale positive de la population. Ce questionnaire vise à évaluer un modèle à trois facteurs de santé mentale positive : le bien-être émotionnel, le bien-être social et le bien-être psychologique. Cette étude a pour but de déterminer si le CSM-QA offre une mesure adéquate de la santé mentale positive des Canadiens adultes. Méthodologie Nous avons réalisé une analyse factorielle confirmatoire (AFC) à l’aide des données de l’Enquête sur la santé dans les collectivités canadiennes – Santé mentale de 2012 (ESCC-SM). Nous avons également effectué une validation croisée du modèle à l’aide des données de l’Enquête sur la santé dans les collectivités canadiennes – Composante annuelle (ESCC – Composante annuelle) de 2011-2012. Nous avons examiné la validité reliée à un critère dans le cadre d’analyses de corrélation entre les scores des sous-échelles du CSM-QA et les concepts positifs (comme la satisfaction à l’égard de la vie) et négatifs (comme la détresse psychologique) associés. Résultats Nous avons confirmé la validité du modèle à trois facteurs du bien-être émotionnel, social et psychologique dans le cadre d’une AFC de deux échantillons distincts, et ce, après avoir intégré les quatre erreurs corrélées entre les questions relatives à l’échelle du bien-être social. Nous avons observé, comme prévu, des corrélations significatives entre le bien-être émotionnel, psychologique et social et les concepts associés. Le coefficient alpha de Cronbach était de 0,82 pour les sous-échelles du bien-être émotionnel et du bien-être psychologique et de 0,77 pour le bien-être social. Conclusion Notre étude suggère que le CSM-QA permet de rendre compte du modèle à trois facteurs de la santé mentale positive de la population canadienne. Toutefois, la prudence est de mise lorsque l’on utilise l’échelle du bien-être social, qui ne s’est pas avérée aussi efficace que les autres facteurs, comme l’ont mis en évidence la nécessité d’ajouter plusieurs termes d’erreur corrélés afin d’obtenir un ajustement adéquat du modèle, le pourcentage plus élevé de données manquantes pour ces questions et les corrélations plus faibles avec les concepts connexes. Comme le bien-être social constitue un élément important d’une évaluation exhaustive de la santé mentale positive, la tenue d’autres recherches est recommandée.

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Excess weight is a key risk factor for chronic disease, and the systematic collection, analysis and reporting of key trends are important to surveillance of overweight and obesity.We used univariate analyses to calculate current prevalence estimates of excess weight among Canadian children and youth.Almost 1 in 7 children and youth is obese. Rates vary based on sociodemographic factors such as age, sex, socioeconomic status and place of residence. Overall, the rates of excess weight have been relatively stable over the past decade.Ongoing monitoring of childhood obesity will provide useful information to assist with sustained actions to promote healthy weights.L’excès de poids est un facteur de risque important de maladies chroniques. La collecte, l’analyse et la diffusion systématiques des tendances clés dans ce domaine sont importantes pour la surveillance de l’embonpoint et de l’obésité.Nous avons utilisé des analyses univariées pour calculer des estimations de la prévalence actuelle de l’excès de poids chez les enfants et les jeunes canadiens.Près d’un enfant ou jeune sur sept est obèse. Les taux varient en fonction de facteurs sociodémographiques comme l’âge, le sexe, le statut socioéconomique et le lieu de résidence. Dans l’ensemble, les taux d’excès de poids sont demeurés relativement stables depuis dix ans.Faire le suivi de l’obésité juvénile fournit des renseignements utiles à la prise de mesures à long terme pour la promotion d’un poids santé.

Introduction L’excès de poids est un facteur de risque important de maladies chroniques. La collecte, l’analyse et la diffusion systématiques des tendances clés dans ce domaine sont importantes pour la surveillance de l’embonpoint et de l’obésité. Méthodologie L’excès de poids est un facteur de risque important de maladies chroniques. La collecte, l’analyse et la diffusion systématiques des tendances clés dans ce domaine sont importantes pour la surveillance de l’embonpoint et de l’obésité. Résultats Près d’un enfant ou jeune sur sept est obèse. Les taux varient en fonction de facteurs sociodémographiques comme l’âge, le sexe, le statut socioéconomique et le lieu de résidence. Dans l’ensemble, les taux d’excès de poids sont demeurés relativement stables depuis dix ans. Conclusion Faire le suivi de l’obésité juvénile fournit des renseignements utiles à la prise de mesures à long terme pour la promotion d’un poids santé.

Introduction : D’après la Stratégie en matière de santé mentale pour le Canada, la collecte de données sur la santé mentale au Canada a besoin d’être améliorée. La mise en place de systèmes de surveillance sur la maladie mentale n’a pas suffi à combler toutes les lacunes statistiques relevant de la santé mentale positive et de ses facteurs déterminants au Canada. L’objectif de ce projet était d’élaborer un Cadre d’indicateurs de surveillance de la santé mentale positive, dans le but de dresser un portrait de la santé mentale positive au Canada, ainsi que de ses facteurs déterminants. Les données recueillies grâce à ce cadre de surveillance serviront de référence pour l’établissement des programmes et des politiques d’amélioration de la santé mentale des Canadiens. Méthodologie : Un examen de la littérature et une analyse contextuelle ont été réalisés afin de fournir une base théorique au cadre et de sélectionner divers critères d’évaluation de la santé mentale positive et de ses facteurs de risque et de protection. La définition de la santé mentale positive adoptée par l’Agence de la santé publique du Canada a servi de référence conceptuelle lors de l’élaboration du cadre. À partir de la liste exhaustive des risques et des facteurs de protection qui a été réalisée, des experts en santé mentale, des partenaires gouvernementaux et des intervenants indépendants ont été invités à classer les indicateurs choisis par ordre de priorité. Ces groupes ont ensuite été invités à sélectionner les méthodes de mesure les plus prometteuses pour chacun des indicateurs. Résultats : Le cadre conceptuel de surveillance de la santé mentale positive et de ses facteurs déterminants qui a été ainsi élaboré contient 5 indicateurs de résultats et 25 indicateurs de déterminants, répartis en 4 niveaux contextuels : « individu », « famille », « communauté » et « société ». Ce cadre d’indicateurs vise à combler les lacunes en matière de données relevées par la Stratégie en matière de santé mentale pour le Canada, et il servira de référence pour l’établissement des programmes et des politiques d’amélioration de la santé mentale des Canadiens tout au long de leur vie.

The Mental Health Strategy for Canada identified a need to enhance the collection of data on mental health in Canada. While surveillance systems on mental illness have been established, a data gap for monitoring positive mental health and its determinants was identified. The goal of this project was to develop a Positive Mental Health Surveillance Indicator Framework, to provide a picture of the state of positive mental health and its determinants in Canada. Data from this surveillance framework will be used to inform programs and policies to improve the mental health of Canadians.A literature review and environmental scan were conducted to provide the theoretical base for the framework, and to identify potential positive mental health outcomes and risk and protective factors. The Public Health Agency of Canada's definition of positive mental health was adopted as the conceptual basis for the outcomes of this framework. After identifying a comprehensive list of risk and protective factors, mental health experts, other governmental partners and non-governmental stakeholders were consulted to prioritize these indicators. Subsequently, these groups were consulted to identify the most promising measurement approaches for each indicator.A conceptual framework for surveillance of positive mental health and its determinants has been developed to contain 5 outcome indicators and 25 determinant indicators organized within 4 domains at the individual, family, community and societal level. This indicator framework addresses a data gap identified in Canada's strategy for mental health and will be used to inform programs and policies to improve the mental health status of Canadians throughout the life course.Surveillance de la santé mentale positive et de ses facteurs déterminants au Canada : élaboration d’un cadre d’indicateurs de surveillance de la santé mentale positive.D’après la Stratégie en matière de santé mentale pour le Canada, la collecte de données sur la santé mentale au Canada a besoin d’être améliorée. La mise en place de systèmes de surveillance sur la maladie mentale n’a pas suffi à combler toutes les lacunes statistiques relevant de la santé mentale positive et de ses facteurs déterminants au Canada. L’objectif de ce projet était d’élaborer un Cadre d’indicateurs de surveillance de la santé mentale positive, dans le but de dresser un portrait de la santé mentale positive au Canada, ainsi que de ses facteurs déterminants. Les données recueillies grâce à ce cadre de surveillance serviront de référence pour l’établissement des programmes et des politiques d’amélioration de la santé mentale des Canadiens.Un examen de la littérature et une analyse contextuelle ont été réalisés afin de fournir une base théorique au cadre et de sélectionner divers critères d’évaluation de la santé mentale positive et de ses facteurs de risque et de protection. La définition de la santé mentale positive adoptée par l’Agence de la santé publique du Canada a servi de référence conceptuelle lors de l’élaboration du cadre. À partir de la liste exhaustive des risques et des facteurs de protection qui a été réalisée, des experts en santé mentale, des partenaires gouvernementaux et des intervenants indépendants ont été invités à classer les indicateurs choisis par ordre de priorité. Ces groupes ont ensuite été invités à sélectionner les méthodes de mesure les plus prometteuses pour chacun des indicateurs.Le cadre conceptuel de surveillance de la santé mentale positive et de ses facteurs déterminants qui a été ainsi élaboré contient 5 indicateurs de résultats et 25 indicateurs de déterminants, répartis en 4 niveaux contextuels : « individu », « famille », « communauté » et « société ». Ce cadre d’indicateurs vise à combler les lacunes en matière de données relevées par la Stratégie en matière de santé mentale pour le Canada, et il servira de référence pour l’établissement des programmes et des politiques d’amélioration de la santé mentale des Canadiens tout au long de leur vie.

Objective: To determine the prevalence and distribution of type-specific human papillomavirus (HPV) infections and their association with cytological outcomes in women living in the Canadian territory of Nunavut. Methods: Surveillance of type-specific HPV infection was conducted. Cervical specimens of all Inuit, First Nations and non-Aboriginal women in Nunavut who presented for a Pap test in any clinical setting between January 2008 and March 2009 were tested for HPV infection. The association between high-grade cervical lesions and HPV type was also examined. Results: HPV results were available for 4,043 individual women (13 to 77 years). Of those with known ethnicity (N=4,033), 89.2% were Inuit, 0.4% were First Nations and 10.4% were non-Aboriginal. First Nations women were included in all analyses except those making comparisons by ethnicity, due to the small number of individuals in this group. Overall, 29.9% of women were found to be infected with HPV (any type) and 19.9% with any high-risk HPV (type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 or 59). Most often, women were infected with HPV 16 (6.4%) followed by HPV 31 (3.1%). There were no statistically significant differences between Inuit and non-Aboriginal (reference group) women 20 years of age and older regarding the prevalence of any HPV (odds ratios (OR): 1.19, 95% confidence intervals (CI): 0.92-1.54), high-risk HPV (OR: 1.06, 95% CI: 0.78-1.44) or HPV 16 and 18 (OR: 0.81, 95% CI: 0.51-1.27). HPV 31 was the only type that was significantly more frequent among Inuit than non-Aboriginal women (OR: 3.95, 95% CI: 1.24-12.54). There was no difference in the overall occurrence of cervical abnormalities between non-Aboriginal and Inuit women (p-value = 0.17). HPV 16 was strongly associated with cervical dysplasia, being present in 50.9% of specimens with a high-grade lesion. Conclusion: HPV is a significant public health issue in the territory of Nunavut. The findings presented in this article are similar to those in other studies among Inuit women, with prevalence of HPV being higher than in studies conducted among non-Inuit women in other regions of Canada. These results provide a baseline of HPV prevalence that precedes the introduction of the Nunavut HPV Immunization Program in 2010 and will allow for future evaluation. The high prevalence of HPV infection among women living in Nunavut can be reduced through immunization and associated high-grade cervical abnormalities mitigated by regular cervical screening.

The prevalence of obesity, defined as body mass index (BMI) of 30 kg/m2 or higher for adults and as 2 standard deviations above the World Health Organization growth standard mean for children, has increased in many parts of the world. Obese adults are at an increased risk of certain chronic conditions, including hypertension, type 2 diabetes, cardiovascular diseases and some cancers, and of premature death. Obese children have increased cardiometabolic risk, including dyslipidemia, insulin resistance and elevated blood pressure. Excess childhood body weight that continues into adulthood can affect quality of life, educational attainment and earnings over the lifecourse. The Public Health Agency of Canada has projected an annual direct health care cost (including physician, hospitalization and medication costs) of those categorized as obese in Canada in constant 2001 Canadian dollars. Calculated as $7.0 billion in 2011, this annual direct health care cost is projected to rise to $8.8 billion by 2021, based on simulated average direct health care costs, which are higher among the obese ($2,283) than the overweight ($1,726), the underweight ($1,298) and those at normal weight ($1,284). Canadian estimates from 2006 and 2008 that used different methodologies place the annual economic burden (direct and indirect costs) of obesity between $4.6 billion and $7.1 billion. The purpose of this evidence brief is to show current Canadian obesity prevalence rates and estimates for the future using objectively measured height and weight to calculate BMI. The use of objectively measured height and weight to derive BMI is strongly recommended, especially for children and adolescents, as self- or proxy-reported height and weight tend to underestimate actual weight and consequently BMI and obesity prevalence.Synthèse portant sur les données probantes - Tendances et projections relatives à l’obésité chez les Canadiens.La prévalence de l’obésité – soit un indice de masse corporelle (IMC) supérieur ou égal à 30 kg/m2 chez les adultes ou deux écarts-types au-dessus de la médiane de la norme de croissance de l’Organisation mondiale de la santé chez les enfants – a augmenté dans de nombreuses régions du monde. Les adultes obèses sont plus susceptibles d’être atteints de certaines affections chroniques, notamment d’hypertension, de diabète de type 2, de cardiopathies et de certains cancers, ainsi que de mourir prématurément. Les enfants obèses présentent aussi un risque cardiométabolique accru (dyslipidémie, résistance à l’insuline et hypertension artérielle). Un excès pondéral pendant l’enfance qui se poursuit à l’âge adulte peut nuire à la qualité de vie, au rendement scolaire et au revenu tout au long de la vie. L’Agence de la santé publique du Canada a estimé les coûts annuels directs, en dollars canadiens constants de 2001, des soins de santé (coûts liés aux médecins, aux hospitalisations et aux médicaments) pour les personnes classées comme obèses au Canada. Évalués à 7,0 milliards de dollars en 2011, ils devraient atteindre 8,8 milliards de dollars d’ici 2021, d’après un calcul à partir des moyennes actuelles qui font qu’ils sont plus élevés chez les obèses (2 283 $) que chez les personnes en surpoids (1 726 $), les personnes en insuffisance pondérale (1 298 $) et les personnes de poids normal (1 284 $). Des estimations canadiennes antérieures, de 2006 et 2008 et obtenues par des méthodologies différentes, ont évalué le fardeau économique annuel (coûts directs et indirects) de l’obésité dans une fourchette allant de 4,6 à 7,1 milliards de dollars. Cette synthèse fondée sur des données probantes vise à présenter les taux de prévalence de l’obésité au Canada à la fois actuels et projetés, à partir d’un calcul de l’IMC reposant sur des mesures objectives de la taille et du poids. L’utilisation de mesures objectives de la taille et du poids pour calculer l’IMC est fortement recommandée, particulièrement chez les enfants et les adolescents, car lorsque la taille et le poids sont autodéclarés ou obtenus par procuration, le poids réel est généralement sous-estimé, ce qui fait que l’IMC et la prévalence de l’obésité le sont également.

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Treponema pallidumsubsp.pallidumand/or its nucleic acid can be detected by various methods such as microscopy, rabbit infectivity test or polymerase chain reaction (PCR) tests. The rabbit infectivity test forT. pallidum, although very sensitive, has been discontinued from most laboratories due to ethical issues related to the need for animal inoculation with liveT. pallidum, the technically demanding procedure and long turnaround time for results, thus making it impractical for routine diagnostic use. Dark-field and phase-contrast microscopy are still useful at clinic- or hospital-based laboratories for near-bedside detection ofT. pallidumin genital, skin or mucous lesions although their availability is decreasing. The lack of reliable and specific anti-T. pallidumantibodies and its inferior sensitivity to PCR may explain why the direct fluorescent antibody test forT. pallidumis not widely available for clinical use. Immunohistochemical staining forT. pallidumalso depends on the availability of specific antibodies, and the method is only applicable for histopathological examination of biopsy and autopsy specimens necessitating an invasive specimen collection approach. With recent advances in molecular diagnostics, PCR is considered to be the most reliable, versatile and practical for laboratories to implement. In addition to being an objective and sensitive test for direct detection ofTreponema pallidumsubsp. pallidumDNA in skin and mucous membrane lesions, the resulting PCR amplicons from selected gene targets can be further characterized for antimicrobial (macrolide) susceptibility testing, strain typing and identification ofT. pallidumsubspecies.

Positive mental health is increasingly recognized as an important focus for public health policies and programs. In Canada, the Mental Health Continuum-Short Form (MHC-SF) was identified as a promising measure to include on population surveys to measure positive mental health. It proposes to measure a three-factor model of positive mental health including emotional, social and psychological well-being. The purpose of this study was to examine whether the MHC-SF is an adequate measure of positive mental health for Canadian adults.We conducted confirmatory factor analysis (CFA) using data from the 2012 Canadian Community Health Survey (CCHS)-Mental Health Component (CCHS-MH), and cross-validated the model using data from the CCHS 2011-2012 annual cycle. We examined criterion-related validity through correlations of MHC-SF subscale scores with positively and negatively associated concepts (e.g. life satisfaction and psychological distress, respectively).We confirmed the validity of the three-factor model of emotional, social and psychological well-being through CFA on two independent samples, once four correlated errors between items on the social well-being scale were added. We observed significant correlations in the anticipated direction between emotional, psychological and social well-being scores and related concepts. Cronbach's alpha for both emotional and psychological well-being subscales was 0.82; for social well-being it was 0.77.Our study suggests that the MHC-SF measures a three-factor model of positive mental health in the Canadian population. However, caution is warranted when using the social well-being scale, which did not function as well as the other factors, as evidenced by the need to add several correlated error terms to obtain adequate model fit, a higher level of missing data on these questions and weaker correlations with related constructs. Social well-being is important in a comprehensive measure of positive mental health, and further research is recommended.La santé mentale positive est de plus en plus reconnue comme un élément central des politiques et des programmes en matière de santé publique. On a déterminé au Canada que le Continuum de santé mentale – Questionnaire abrégé (CSM-QA) constituait un outil de mesure prometteur qu’il fallait intégrer aux enquêtes d’évaluation de la santé mentale positive de la population. Ce questionnaire vise à évaluer un modèle à trois facteurs de santé mentale positive : le bien-être émotionnel, le bien-être social et le bienêtre psychologique. Cette étude a pour but de déterminer si le CSM-QA offre une mesure adéquate de la santé mentale positive des Canadiens adultes.Nous avons réalisé une analyse factorielle confirmatoire (AFC) à l’aide des données de l’Enquête sur la santé dans les collectivités canadiennes – Santé mentale de 2012 (ESCC-SM). Nous avons également effectué une validation croisée du modèle à l’aide des données de l’Enquête sur la santé dans les collectivités canadiennes – Composante annuelle (ESCC – Composante annuelle) de 2011-2012. Nous avons examiné la validité reliée à un critère dans le cadre d’analyses de corrélation entre les scores des sous-échelles du CSM-QA et les concepts positifs (comme la satisfaction à l’égard de la vie) et négatifs (comme la détresse psychologique) associés.Nous avons confirmé la validité du modèle à trois facteurs du bien-être émotionnel, social et psychologique dans le cadre d’une AFC de deux échantillons distincts, et ce, après avoir intégré les quatre erreurs corrélées entre les questions relatives à l’échelle du bien-être social. Nous avons observé, comme prévu, des corrélations significatives entre le bien-être émotionnel, psychologique et social et les concepts associés. Le coefficient alpha de Cronbach était de 0,82 pour les sous-échelles du bien-être émotionnel et du bien-être psychologique et de 0,77 pour le bien-être social.Notre étude suggère que le CSM-QA permet de rendre compte du modèle à trois facteurs de la santé mentale positive de la population canadienne. Toutefois, la prudence est de mise lorsque l’on utilise l’échelle du bien-être social, qui ne s’est pas avérée aussi efficace que les autres facteurs, comme l’ont mis en évidence la nécessité d’ajouter plusieurs termes d’erreur corrélés afin d’obtenir un ajustement adéquat du modèle, le pourcentage plus élevé de données manquantes pour ces questions et les corrélations plus faibles avec les concepts connexes. Comme le bien-être social constitue un élément important d’une évaluation exhaustive de la santé mentale positive, la tenue d’autres recherches est recommandée.

Obesity is a complex risk factor for chronic disease that is associated with a number of socioecological determinants. In this status report, we provide an overview of the socioecological framework that is now guiding our ongoing surveillance efforts in the area of childhood overweight and obesity. This framework considers individual risk and protective factors (sociodemographic, lifestyle, psychosocial and early-life) through the lens of the life stage, levels of influence and environments in which these factors play a role.Using data from the Canadian Community Health Survey and the Canadian Health Measures Survey, univariate and bivariate analyses were used to report on behavioural, psychosocial, and early life factors associated with excess weight among Canadian children.Estimates of early-life (e.g. breastfeeding), behavioural (e.g. physical activity), and psychosocial factors (e.g. sense of community) are presented as they relate to age group, sex, income adequacy and weight status.Building upon our recent reporting on trends in and sociodemographic factors associated with childhood obesity in Canada, this work illustrates the remaining risk and protective factors shown in our surveillance framework. This analysis supports the shift towards a holistic appraisal of determinants related to healthy weights.L’obésité est un facteur de risque complexe des maladies chroniques associé à un certain nombre de déterminants socioécologiques. Ce rapport d’étape fournit un aperçu du cadre socioécologique qui guide actuellement nos efforts de suivi de l’embonpoint et de l’obésité chez les enfants. Ce cadre intègre différents facteurs de risque et de protection (facteurs sociodémographiques, liés au mode de vie, psychosociaux et en début de vie) et tient compte de l'étape de vie, des niveaux d’influence et de l'environnement au sein desquels ces facteurs jouent un rôle.Nous avons effectué des analyses univariées et bivariées fondées sur les données de l’Enquête sur la santé dans les collectivités canadiennes et de l’Enquête canadienne sur les mesures de la santé pour rendre compte des facteurs comportementaux, des facteurs psychosociaux et des facteurs en début de vie associés à un surplus de poids chez les enfants canadiens.Les estimations liées aux facteurs en début de vie (p. ex. l’allaitement), aux facteurs comportementaux (p. ex. l’activité physique) et aux facteurs psychosociaux (p. ex. le sentiment d’appartenance à la collectivité) sont présentées en fonction du groupe d’âge, du sexe, de la suffisance du revenu et du poids.Cette étude, qui s’appuie sur notre publication récente sur les tendances en matière d’obésité chez les enfants au Canada et les facteurs sociodémographiques qui y sont associés, présente les facteurs de risque et de protection intégrés à notre cadre de surveillance. D'après notre analyse, une évaluation plus globale des déterminants associés au maintien d’un poids santé est nécessaire.

Background: Laboratory-enhanced surveillance is critical for rapidly detecting the potential re-emergence of Ebola virus disease. Rapid diagnostic tests (RDT) for Ebola antigens could expand diagnostic capacity for Ebola virus disease. Objectives: The Guinean National Coordination for Ebola Response conducted a pilot implementation to determine the feasibility of broad screening of patients and corpses with the OraQuick® Ebola RDT. Methods: The implementation team developed protocols and trained healthcare workers to screen patients and corpses in Forecariah prefecture, Guinea, from 15 October to 30 November 2015. Data collected included number of consultations, number of fevers reported or measured, number of tests performed for patients or corpses and results of confirmatory RT-PCR testing. Data on malaria RDT results were collected for comparison. Feedback from Ebola RDT users was collected informally during supervision visits and forums. Results: There were 3738 consultations at the 15 selected healthcare facilities; 74.6% of consultations were for febrile illness. Among 2787 eligible febrile patients, 2633 were tested for malaria and 1628 OraQuick® Ebola RDTs were performed. A total of 322 OraQuick® Ebola RDTs were conducted on corpses. All Ebola tests on eligible patients were negative. Conclusions: Access to Ebola testing was expanded by the implementation of RDTs in an emergency situation. Feedback from Ebola RDT users and lessons learned will contribute to improving quality for RDT expansion.

Introduction The Public Health Agency of Canada developed the Chronic Disease Indicator Framework (the Framework) with the goal of systematizing and enhancing chronic disease surveillance in Canada by providing the basis for consistent and reliable information on chronic diseases and their determinants. Methods Available national and international health indicators, frameworks and national health databases were reviewed to identify potential indicators. To make sure that a comprehensive and balanced set of indicators relevant to chronic disease prevention was included, a conceptual model with "core domains" for grouping eligible indicators was developed. Specific selection criteria were applied to identify key measures. Extensive consultations with a broad range of government partners, non-governmental organizations and public health practitioners were conducted to reach consensus and refine and validate the Framework. Results The Framework contains 41 indicators organized in a model comprised of 6 core domains: social and environmental determinants, early life / childhood risk and protective factors, behavioural risk and protective factors, risk conditions, disease prevention practices, and health outcomes/status. Also planned is an annual release of updated data on the proposed set of indicators, including national estimates, breakdowns by demographic and socioeconomic variables, and time trends. Conclusions Understanding the evidence related to chronic diseases and theirdeterminants is key to interpreting trends and crucial to the development of public health interventions. The Framework and its related products have the potential of becoming an indispensable tool for evidence-informed decision making in Canada.

Background Considerable HIV transmission occurs among injection drug users (IDUs) in Pakistan and recently the HIV prevalence has been increasing among male (MSW), hijra (transgender; HSW) and female (FSW) sex workers. We describe past and estimate future patterns of HIV emergence among these populations in several cities in Pakistan. Methods The density of these key populations per 1000 adult men was calculated using 2011 mapping data from Karachi, Lahore, Faisalabad, Larkana, Peshawar and Quetta, and surveillance data were used to assess bridging between these key populations. We used the UNAIDS Estimation and Projection Package model to estimate and project HIV epidemics among these key populations in Karachi, Lahore, Faisalabad and Larkana. Results The density and bridging of key populations varied across cities. Lahore had the largest FSW population (11.5/1000 adult men) and the smallest IDU population (1.7/1000 adult men). Quetta had the most sexual and drug injection bridging between sex workers and IDUs (6.7%, 7.0% and 3.8% of FSW, MSW and HSW, respectively, reported injecting drugs). Model evidence suggests that by 2015 HIV prevalence is likely to reach 17–22% among MSWs/HSWs in Karachi, 44–49% among IDUs in Lahore and 46–66% among IDUs in Karachi. Projection suggests the prevalence may reach as high as 65–75% among IDUs in Faisalabad by 2025. HIV prevalence is also estimated to increase among FSWs, particularly in Karachi and Larkana. Conclusions There is a need to closely monitor regional and subpopulation epidemic patterns and implement prevention programmes customised to local epidemics.

We characterized HIV-1 subtypes among 204 persons newly diagnosed with HIV in Ontario from 2003 to 2005 using samples from the Canadian HIV Strain and Drug Resistance Surveillance Program. We examined HIV-1 subtype by demographic characteristics and exposure category, and determined independent predictors of infection with a non-B HIV subtype using multivariate logistic regression. The distribution of HIV subtypes was: B 77.0%, C 10.3%, AG 4.9%, A 2.5%, AE 2.5% and others 3.0%. Overall, 23.0% were non-B, greater in women than in men (62.8% versus 12.4%, P < 0.0001) and persons under 35 years (31.1% versus 18.5% in those ≥35, P = 0.04). Non-B subtype was predominant (78.9%) among persons from HIV-endemic regions and considerable (28.6%) among other persons infected heterosexually. In multivariate modelling adjusted for gender, non-B subtype was significantly associated with birth in an HIV-endemic region (adjusted odds ratio [aOR] 59.2, P < 0.0001) and heterosexual exposure (aOR 6.3, P = 0.02). Additionally, compared with men who had sex with men, non-B subtype was greater among heterosexual women (aOR 17.8, P < 0.001) and women who injected drugs (injection drug use, aOR 13.4, P = 0.01). We found a non-negligible proportion of non-B subtypes among women infected heterosexually not from HIV-endemic countries, providing interesting insights into HIV transmission patterns.

Objectifs L'objectif de cette étude est l'analyse de la prévalence des infections dues au virus du papillome humain (VPH) dans un échantillon opportuniste de femmes résidant au Manitoba (Canada). Nous avons examiné les facteurs de risque associés aux infections par le VPH et avons établi des liens entre les résultats du typage du VPH et les antécédents de dépistage du cancer du col utérin des participantes. Méthodologie La population étudiée comprenait 592 femmes ayant fréquenté une clinique de dépistage utilisant le test de Papanicolaou (Pap). Après avoir signé un formulaire de consentement, les participantes répondaient à un questionnaire auto-administré sur les facteurs de risque et ont subi un test de Pap classique. Les cellules résiduelles des tests de Pap ont été recueillies et envoyées pour un typage du VPH. Résultats L'âge moyen de la population était de 43 ans. En tout, 115 participantes (19,4 %) étaient infectées par le VPH, 89 d'entre elles ayant obtenu un résultat normal au test de Pap. Parmi celles qui étaient positives pour le VPH, 61 (10,3 %) étaient infectées par un VPH à risque élevé (Groupe 1). Le VPH-16 était le type le plus répandu (15/115 : 13,0 % des infections). Les facteurs de risque d'infection par le VPH les plus fréquents étaient le jeune âge, l'origine autochtone, un nombre plus élevé de partenaires sexuels au cours de la vie et un nombre plus élevé de partenaires sexuels au cours de l'année précédente. Conclusion La prévalence des types de VPH au Manitoba correspond aux distributions signalées dans d'autres provinces ou territoires. Ces données fournissent des renseignements de base sur la prévalence du VPH de chaque type dans une population non vaccinée et peuvent aider à évaluer l'efficacité du programme de vaccination contre le VPH. En outre, ces données permettent d'effectuer une validation de principe du couplage d'un registre de tests de Pap basé sur une population avec les résultats de tests de laboratoire et une enquête sur les comportements à risque en vue d'évaluer les effets précoces et tardifs de l'infection par le VPH. Cette méthodologie pourrait être appliquée à d'autres provinces ou territoires au Canada disposant de ressources similaires.

Objectives We conducted a study to investigate the prevalence of human papillomavirus (HPV) infections in an opportunistic sample of women in Manitoba, Canada. We inquired about risk factors associated with HPV infections and linked the HPV typing results with the cervical cancer screening history of the participants. Methods The study population included 592 women attending Papanicolaou (Pap) test clinics. After signing a consent form, participants were given a self-administered questionnaire on risk factors and received a conventional Pap test. Residual cells from the Pap tests were collected and sent for HPV typing. Results The mean age of the population was 43 years. A total of 115 participants (19.4%) had an HPV infection, 89 of whom had a normal Pap test. Of those who were HPV-positive, 61 (10.3%) had high-risk (Group 1) HPV. HPV-16 was the most prevalent type (15/115: 13.0% of infections). The most consistent risk factors for HPV infection were young age, Aboriginal ethnicity, higher lifetime number of sexual partners and higher number of sexual partners in the previous year. Conclusion The prevalence of HPV types in Manitoba is consistent with the distributions reported in other jurisdictions. These data provide baseline information on type-specific HPV prevalence in an unvaccinated population and can be useful in evaluating the effectiveness of the HPV immunization program. An added benefit is in the validation of a proof of concept which links a population-based Pap registry to laboratory test results and a risk behaviour survey to assess early and late outcomes of HPV infection. This methodology could be applied to other jurisdictions across Canada where such capacities exist.

Men who have sex with men (MSM) may benefit from human papillomavirus (HPV) vaccine due to increased risk for HPV infection and related disease. We assessed HPV vaccine acceptability and sexual experience prior to disclosure to Health Care Providers (HCP) to understand implications of targeted vaccination strategies for MSM.From July 2008 to February 2009, 1169 MSM aged ≥19 years were recruited at community venues in Vancouver. We assessed key variables from a self-administered questionnaire and independent predictors of HPV vaccine acceptability using multivariate logistic regression.Of 1041 respondents, 697 (67.0%) were willing to receive HPV vaccine and 71.3% had heard of HPV. Significant multivariate predictors of higher vaccine acceptability were (adjusted odds ratio [95% CI]): previous diagnosis of genital warts (1.7 [1.1, 2.6]), disclosure of sexual behavior to HCP (1.6 [1.1, 2.3]), annual income at least $20,000 (1.5 [1.1, 2.1]), previous hepatitis A or B vaccination (1.4 [1.0, 2.0]), and no recent recreational drug use (1.4 [1.0, 2.0]). Most MSM (78.7%) had disclosed sexual behavior to HCP and median time from first sexual contact with males to disclosure was 6.0 years (IQR 2-14 years); for men ≤26 years these were 72.0% and 3.0 years (IQR 1-8 years) respectively.Willingness to receive HPV vaccine was substantial among MSM in Vancouver; however, acceptability varied by demographics, risk, and health history. HPV vaccine programs delivered by HCP would offer limited benefit given the duration of time from sexual debut to disclosure to HCP.

Rates of Chlamydia trachomatis (CT) infection in Canada have been increasing since the mid-1990s. We sought to estimate the burden of CT in this population.We developed an age- and sex-structured mathematical model parameterized to reproduce trends in CT prevalence between 1991 and 2009 in the Canadian population aged 10 to 39 years. Costs were identified, measured, and valued using a modified societal perspective and converted to year 2009 Canadian dollars. Cost-effectiveness of the implemented policy of enhanced screening for asymptomatic infections was estimated by comparison with model-projected trends in the absence of increased screening. Main outcome measures were current net cost and burden of illness attributable to CT infection, and incremental cost-effectiveness ratios.Under base case model assumptions, there was a trend of increasing detection of CT cases (due to increases in screening), despite an underlying stabilization of actual CT infections. Average estimated costs associated with CT infection over this period were $51.4 million per year. Costs of screening and treatment of asymptomatic infections as a proportion of total CT costs were estimated to have increased over time, whereas costs of long-term sequelae associated with untreated infections declined over the same period. Compared with no change in screening, enhanced screening was estimated to be highly cost-effective, with an incremental cost-effectiveness ratio of $2910 per quality-adjusted life year.Despite increases in screening, the economic burden of CT in Canada remains high. Further investigation of trends in chlamydia-associated complications is required to better understand the impact of screening on incidence.

Quantitative HIV RNA viral load (QVL) assays (Roche Diagnostics) were sensitive and specific when used to diagnose HIV infection in (i) HIV-exposed infants (sensitivity of 100% [63.1 to 100%] and specificity of 100% [97.9 to 100%]) and (ii) suspected acute HIV infection patients with a negative/indeterminate Western blot (sensitivity of 97.6% [91.6 to 99.7%] and specificity of 100% [96.1 to 100%]). No false-positive QVL results were identified.

Genital herpes (GH) is the most common cause of genital ulceration, but is not reportable in Canada. Research in the United States has found that less than 10% of seropositive persons reported a diagnosis of GH. The present article investigates the rates of diagnosed cases of GH in Canada from 2002 to 2007.Primary case diagnosis data on GH for the period between 2002 and 2007 were obtained from the Canadian Disease and Therapeutic Index, a proprietary database maintained by Intercontinental Medical Statistics (IMS) Health Canada. Of the 45,000 to 49,000 office-based physicians in Canada, IMS Health collected diagnosis-specific prescription diaries from a sample of 652, stratified according to geographic region and representing all major specialties, during this period.Between 2002 and 2007, there were approximately 84,398 to 122,456 medically attended GH cases annually in Canada. Approximately 74% to 93% of these diagnosed cases made one physician visit per year. The annual rate of medically attended GH cases ranged from 261.2 per 100,000 population to 386.6 per 100,000 population.The present report is the first time that administrative data have been used to estimate the annual rate of medically attended GH cases in Canada. The data include both incident and prevalent cases and are likely an underestimate of the actual number of cases because they only represent diagnosed cases presenting for medical care. Further seroepidemiological and clinical research studies would be helpful to assess the burden of infection and to plan appropriate diagnostic, treatment and preventive counselling services.Genital herpes (GH) is the most common cause of genital ulceration, but is not reportable in Canada. Research in the United States has found that less than 10% of seropositive persons reported a diagnosis of GH. The present article investigates the rates of diagnosed cases of GH in Canada from 2002 to 2007.Primary case diagnosis data on GH for the period between 2002 and 2007 were obtained from the Canadian Disease and Therapeutic Index, a proprietary database maintained by Intercontinental Medical Statistics (IMS) Health Canada. Of the 45,000 to 49,000 office-based physicians in Canada, IMS Health collected diagnosis-specific prescription diaries from a sample of 652, stratified according to geographic region and representing all major specialties, during this period.Between 2002 and 2007, there were approximately 84,398 to 122,456 medically attended GH cases annually in Canada. Approximately 74% to 93% of these diagnosed cases made one physician visit per year. The annual rate of medically attended GH cases ranged from 261.2 per 100,000 population to 386.6 per 100,000 population.The present report is the first time that administrative data have been used to estimate the annual rate of medically attended GH cases in Canada. The data include both incident and prevalent cases and are likely an underestimate of the actual number of cases because they only represent diagnosed cases presenting for medical care. Further seroepidemiological and clinical research studies would be helpful to assess the burden of infection and to plan appropriate diagnostic, treatment and preventive counselling services.L’herpès génital (HG) est la principale cause d’ulcération génitale, mais il n’est pas à déclaration obligatoire au Canada. D’après des recherches menées aux États-Unis, moins de 10 % des personnes séropositives ont déclaré un diagnostic d’HG. Le présent article porte sur le taux de cas d’HG diagnostiqués au Canada entre 2002 et 2007.Les chercheurs ont obtenu les données diagnostiques des cas primaires d’HG entre 2002 et 2007 dans l’Index canadien des maladies et traitements, une base de données commerciale qu’exploite Intercontinental Medical Statistics (IMS) Health Canada. Pendant cette période, IMS Health a colligé les carnets de prescriptions propres aux diagnostics auprès d’un échantillon de 652 des 45 000 à 49 000 médecins en pratique privée du Canada, stratifié selon la région géographique et représentant toutes les grandes spécialités.Entre 2002 et 2007, on a recensé chaque année de 84 398 à 122 456 cas d’HG suivis par un médecin au Canada. De 74 % à 93 % de ces cas diagnostiqués rendaient visite au médecin une fois par année. Le taux annuel de cas d’HG suivis par un médecin oscillait entre 261,2 personnes sur 100 000 habitants et 386,6 personnes sur 100 000 habitants.On expose pour la première fois, dans le présent rapport, le recours à des données administratives pour évaluer le taux annuel de cas d’HP suivis par un médecin au Canada. Les données incluent à la fois les cas incidents et prévalents et, selon toute probabilité, elles sous-évaluent le véritable nombre de cas, car elles représentent seulement les cas diagnostiqués qui consultent pour obtenir des soins médicaux. Il serait utile de mener d’autres projets de recherche systématiques, nationaux, séroépidémiologiques et cliniques pour évaluer le fardeau de l’infection et planifier des services diagnostiques, thérapeutiques et préventifs pertinents.

OBJECTIVE : The objectives of the study were to estimate the severity of urge urinary incontinence (UUI) after surgery for stress incontinence and identify factors associated with symptom severity. METHODS : Four hundred thirty-eight women who underwent surgery for stress incontinence over a 10-year period completed a mailed questionnaire protocol that included validated instruments to assess lower urinary tract function and mental and physical well-being. Bivariate analysis and generalized linear models were used to identify factors associated with severity of UUI as measured by the urge incontinence domain of the Incontinence Symptom Index. RESULTS : Urge urinary incontinence was experienced daily by 35.9% of patients. Factors independently associated with higher UUI severity scores were preoperative mixed urinary incontinence (P = 0.006), depression (P < 0.001), aging (P < 0.001), and longer follow-up times (P = 0.01). Pubovaginal sling (P = 0.001) and urethral vaginal suspension (P = 0.04) had higher severity scores than Tension-Free Vaginal Tape. CONCLUSIONS : Daily episodes of UUI are experienced by slightly more than one third of women after surgery for stress incontinence. Identification of factors associated with UUI may help physicians to modify treatment and patient expectations.

Despite universal access to screening for syphilis in all pregnant women in Canada, cases of congenital syphilis have been reported in recent years in areas experiencing a resurgence of infectious syphilis in heterosexual partnerships. Antenatal screening in the first trimester continues to be important and should be repeated at 28 to 32 weeks and again at delivery in women at high risk of acquiring syphilis. The diagnosis of congenital syphilis is complex and is based on a combination of maternal history and clinical and laboratory criteria in both mother and infant. Serologic tests for syphilis remain important in the diagnosis of congenital syphilis and are complicated by the passive transfer of maternal antibodies which can affect the interpretation of reactive serologic tests in the infant. All infants born to mothers with reactive syphilis tests should have nontreponemal tests (NTT) and treponemal tests (TT) performed in parallel with the mother's tests. A fourfold or higher titre in the NTT in the infant at delivery is strongly suggestive of congenital infection but the absence of a fourfold or greater NTT titre does not exclude congenital infection. IgM tests for syphilis are not currently available in Canada and are not recommended due to poor performance. Other evaluation in the newborn infant may include long bone radiographs and cerebrospinal fluid tests but all suspect cases should be managed in conjunction with sexually transmitted infection and/or pediatric experts.Même si toutes les femmes du Canada ont accès au test de dépistage de la syphilis, des cas de syphilis congénitale ont été déclarés ces dernières années dans des régions où l’on constate une résurgence de la syphilis infectieuse chez des partenaires hétérosexuels. Il est toujours important de procéder à un dépistage anténatal pendant le premier trimestre, de le reprendre entre 28 et 32 semaines de grossesse, puis à l’accouchement chez les femmes très vulnérables à la syphilis. Le diagnostic de syphilis congénitale est complexe. Il repose sur l’histoire de la mère ainsi que sur des critères cliniques et des critères de laboratoire à la fois chez la mère et le nourrisson. Les tests sérologiques de la syphilis s’imposent toujours pour diagnostiquer la syphilis congénitale, mais ils sont compliqués par le transfert passif des anticorps maternels qui peut nuire à l’interprétation des résultats réactifs chez le nourrisson. Tous les nourrissons nés d’une mère dont les tests de syphilis sont réactifs devraient subir des tests non tréponomiques (TNT) et des tests tréponomiques (TT) conjointement aux tests de la mère. Un titrage du TNT au moins quatre fois plus élevé que la normale chez le nourrisson à l’accouchement est fortement évocateur d’une infection congénitale, mais l’absence d’un tel résultat n’en exclut pas la possibilité. Les tests d’IgM pour déceler la syphilis ne sont pas offerts au Canada. Ils ne sont pas recommandés en raison de leurs piètres résultats. Parmi les autres évaluations du nouveau-né, soulignons les radiographies des os longs et les tests du liquide céphalorachidien, mais il faut prendre en charge tous les cas présumés conjointement avec des pédiatres ou des spécialistes des infections transmises sexuellement.

Although nucleic acid amplification testing (NAAT) for West Nile virus (WNV) is useful in screening blood donors, such methods have not been studied in symptomatic patients. For diagnosis of WNV infection, 1.0 mL of plasma was tested by NAAT, and WNV-specific immunoglobulin M was assayed. Of 276 WNV cases, 191 were tested by both serology and NAAT. Of these, 86 (45.0%), 111 (58.1%), and 180 (94.2%) were detected by NAAT, serology, and combined NAAT and serology, respectively. NAAT-based screening was most useful within 8 days of the onset of symptoms. Viremia is common in early symptomatic WNV infection, and NAAT enhances diagnostic yield.

The purpose of the study was to determine the magnitude and predictors of first-time and repeat testing for HIV infection among newly diagnosed cases in Alberta, Canada, and to determine the extent of co-infection with hepatitis C (HCV) and hepatitis B (HBV). Using the Provincial Laboratory for Public Health (PLPH) database, all newly diagnosed HIV cases in Alberta between 2000 and 2001 were identified and the testing history for HIV, HCV, and HBV among these cases since 1992 was reviewed. Significant differences in the characteristics of first-time and repeat testers were identified using the chi test, and where appropriate, the Fisher exact test. The independent variables examined included age, gender, risk factors, area and population of residence, testing agency, and co-infection with HCV and HBV. Logistical regression analyses were conducted to further explore independent factors associated with first-time vs. repeat testing for HIV infection. Of the 398 cases, 278 (69.8%) were newly diagnosed at their first test for HIV infection, 73.1% during 2000 and 67.3% during 2001 (P = 0.81). Among repeat testers, the mean number of previous negative tests was 3.4 (range = 2-11 tests). The median interval between the last negative and first positive test was 648 days (range = 53-2678 days). Repeat testers were 1.9 times more likely to be injecting drug users and 1.8 times more likely to reside in Northern Alberta. Among those with a laboratory test result in the PLPH database, 53.7% were positive for HCV, 47.7 and 64.5% of first-time and repeat testers, respectively; and 19.1% were positive for HBV, 22 and 13.6% of first-time and repeat testers, respectively. A high proportion of HIV cases newly diagnosed between 2000 and 2001 in Alberta had no previous testing history for HIV infection. Even among repeat testers, HIV testing was sought infrequently. There are significant regional differences within Alberta in the characteristics of the HIV epidemic and associated test-seeking behaviors. These data reinforce the need to make the most of each test-seeking event with proper counseling and other relevant support services. Given the high prevalence of co-infection with HCV, these results clearly support the need for testing and counseling strategies to take into account additional risks associated with HCV infections.

The Ebola virus disease (Ebola) epidemic in West Africa began in Guinea in early 2014. The reemergence of Ebola and risk of ongoing, undetected transmission continues because of the potential for sexual transmission and other as yet unknown transmission pathways. On March 17, 2016, two new cases of Ebola in Guinea were confirmed by the World Health Organization. This reemergence of Ebola in Guinea is the first since the original outbreak in the country was declared over on December 29, 2015. The prefecture of Forécariah, in western Guinea, was considerably affected by Ebola in 2015, with an incidence rate of 159 cases per 100,000 persons. Guinea also has a high prevalence of malaria; in a nationwide 2012 survey, malaria prevalence was reported to be 44% among healthy children aged ≤5 years. Malaria is an important reason for seeking health care; during 2014, 34% of outpatient consultations were related to malaria.

To estimate population size of hard-to-reach groups such as injecting drug users and men who have sex with men.Several different methods were used to estimate the size of these populations in Canada's three largest cities (Toronto, Montreal and Vancouver).A novel method (referred to as the indirect method) was developed for use in Toronto and Vancouver that combines HIV serodiagnostic information with data on HIV testing behavior. Population size estimates were obtained by dividing the number of injecting drug users or men who have sex with men recorded in HIV serodiagnostic databases in a given year by the proportion of the corresponding group that reported being tested in a 1-year period. Results of this method were compared with four other methods: (1) population surveys; (2) capture-recapture (for injecting drug users only); (3) a modified Delphi technique; and (4) a method based on the proportion of never-married men aged 45 and over (for men who have sex with men only). Only these other methods were used in Montreal.The survey method gave the lowest estimates which are best viewed as minimum estimates given the relative inability of surveys to access these populations and the reluctance of participants to admit to sensitive behaviors. The indirect method produced results more closely comparable with those obtained by other methods, but they are probably slight overestimates, at least for injecting drug users, due to possible underestimation of the proportion tested for HIV. Point estimates using the indirect method were 17,700 and 17,500 for injecting drug users in Toronto and Vancouver, respectively, and 39,100 and 15,900 for men who have sex with men. In Toronto, results for the other methods ranged from 12,300-13,360 for injecting drug users and 18,800-35,000 for men who have sex with men. For Vancouver, these ranges were 6400-11,670 and 7000-26,500, respectively. In Montreal, ranges were 4300-12,500 for injecting drug users and 18,500-40,000 for men who have sex with men.This novel method provides estimates of population size of hard-to-reach groups such as injecting drug users and men who have sex with men that are comparable with results derived by other methods. These estimates may be useful for the purposes of planning, implementing and evaluating prevention and care services, especially when they are combined with the results of other estimation methods to improve the degree of confidence in the resulting estimates.

Rapid Assessment and Response (RAR) is proposed as a useful tool to undertake rapid assessments of injection drug use and its adverse effects on health, and to suggest an appropriate action plan (World Health Organization, 1998). Friedman has presented a cautionary argument, emphasising that RAR is as yet unproven and asking some pointed questions about its merit (Friedman, 1999). We have piloted an RAR approach in a developed country setting (Ottawa, Canada) where a significant problem of injection drug use exists, especially regarding HIV infection among injection drug users (IDUs) (Alary et al., 1999). Although this setting likely has more resources and more pre-existing data than do many developing country settings, we learned some valuable lessons that are general and therefore pertinent to the points made by Friedman. Friedman’s first point is a most important one: does RAR lead to outcomes that improve public health? To answer this question, proper evaluation is indeed needed, but such evaluation is not easy for community-level interventions. Certainly, Friedman is correct in saying that this question has not yet been answered and more research is needed. However, more research is also needed on how best to use the type of information produced by RAR. In general, information derived from qualitative and from ethnographic studies is not used as much as it should be to inform health programmes and policies at the local, regional, and national levels. The rapid assessment methodology is able to generate relevant qualitative and quantitative information pertaining to health care and disease control, and we need to understand better how to best use these diverse types of information for improved prevention and care. Is RAR ‘‘second-rate science’’? Of course it is, or else it would not be rapid; after all, even a cake cannot be both possessed and eaten. First-rate science proceeds at a slow, * Corresponding author. Present address: Division of HIV Epidemiology, Brooke Claxton Building, Room 0108B, Tunney’s Pasture 0900B1, Ottawa, Canada K1A OL2. Fax: +1613-954-5414. E-mail address: chris–archibald@hc-sc.gc.ca (C.P. Archibald)

The clinical features associated with West Nile virus (WNV) infections are described based on data collected from history forms submitted with samples during a province‐wide WNV testing programme. Age 40–59 years (OR 1.7, p

The dental pathogen Streptococcus mutans persists and causes diseases in highly dynamic environments and gains a selective ecological advantage in environmental conditions that frequently exceed the limits for growth of the organism, particularly with regard to environmental pH. The goal of this study was to begin a molecular genetic analysis of a major stress protein, DnaK/Hsp70, to begin to understand how stress responses are regulated in this lactic acid bacterium and to establish a relationship between dnaK gene expression and exposure to acidic environments. Cloning and nucleotide sequence analysis revealed that the dnaK gene is preceded by, and is in an operon-like arrangement with, the hrcA and grpE genes, although intergenic spacing was unlike that described in other bacteria. An inverted repeat (a CIRCE element) was identified by sequence analysis and, using primer extensions, a heat shock-responsive, sigmaA-type promoter, P1, 5' to the hrcA gene, and a sigmaB-type promoter, 5' to the grpE translational start site, were identified. No promoters were detected between grpE and dnaK. A strain carrying a strongly polar insertion in the hrcA gene had markedly diminished levels of dnaK mRNA, indicating that dnaK was transcribed as part of an operon from P1, and to a lesser extent from P2. Results from physiological manipulation of S. mutans in continuous chemostat culture demonstrated that steadystate levels of S. mutans dnaK mRNA and DnaK protein were (i) increased in response to acid shock; (ii) elevated in acid 'adapted' cells; and (iii) induced in response to alkali shock of acid 'adapted' cells. In all cases, increased amounts of dnaK mRNA could be correlated with enhanced transcription from P1. This study provides the first detailed analysis of the expression of a heat shock gene from an oral isolate, and the evidence provided suggests that sigmaB-like promoters may also be involved in class I heat shock gene expression in some Gram-positive organisms.

The primary objectives of this study were to assess the changing demographic characteristics of female sex workers (FSWs) in the urban Bangalore district, India, and trends in programme coverage, HIV/sexually transmitted infection prevalence rates and condom use. Cross-sectional, integrated behavioural and biological assessments of FSWs were conducted in 2006, 2009 and 2011. Univariate and multivariate analyses were used to describe trends over time. The results indicate the mean age of initiation into sex work has increased (26.9 years in 2006 vs 27.6 years in 2011, p0.01), a higher proportion of FSWs reported being in 'stable' relationships in 2011 (70.2% vs 43.2% in 2006, p0.01) and having conducted sex work outside the district in the past 6 months (10.0% in 2011 vs 16.0% in 2006 p=0.01). There was an increase in the proportion of FSWs using cellphones to solicit clients (4.4% in 2006 vs 57.5% in 2011, p0.01) and their homes for sex work (61.4% in 2006 vs 77.8% in 2011, p0.01). Reactive syphilis prevalence declined (12.6% in 2006 to 4% in 2011, p=0.02), as did high-titre syphilis prevalence (9.5% in 2006 to 2.5% in 2011, p=0.01). HIV prevalence declined but not significantly (12.7% in 2006 and 9.3% in 2011, p=0.39). Condom use remained above 90% increasing significantly among repeat (paying) clients (66.6% in 2006 to 93.6% in 2011, p0.01). However, condom use remained low with non-paying partners when compared with occasional paying partners (17.6% vs 97.2% in 2011, p0.01). Given the changing dynamics in the FSW population at multiple levels, there is a need to develop and customise strategies to meet local needs.

Introduction Certain types of the Human Papillomavirus (HPV) are sexually transmitted and highly associated with development of cervical dysplasia and cervical cancer but the distribution of HPV infection in the North, particularly amongst First Nations, Metis, and Inuit peoples, is little known. The purposes of the study are to identify the prevalence of type-specific HPV infections and the association of different HPV types with cervical dysplasia among women in Northern Canada. Methods This was a cross-sectional study with attendants of the routine or scheduled Pap testing program in the Northwest Territories (NWT), Nunavut, Labrador and Yukon, Canada. Approximately half of each sample was used for Pap test and the remaining was used for HPV genotyping using a Luminex-based method. Pap test results, HPV types, and demographic information were linked for analyses. Results Results from 14,598 specimens showed that HPV infection was approximately 50% higher among the Aboriginal than the non-Aboriginal population (27.6% vs. 18.5%). Although the most common HPV type detected was HPV 16 across region, the prevalence of other high risk HPV types was different. The age-specific HPV prevalence among Aboriginal showed a ‘U’ shape which contrasted to non-Aboriginal. The association of HPV infection with cervical dysplasia was similar in both Aboriginal and non-Aboriginal populations. Conclusions The HPV prevalence was higher in Northern Canada than in other Areas in Canada. The prevalence showed a higher rate of other high risk HPV infections but no difference of HPV 16/18 infections among Aboriginal in comparison with non-Aboriginal women. This study provides baseline information on HPV prevalence that may assist in surveillance and evaluation systems to track and assess HPV vaccine programs.