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PubMed2003

Corpus callosum development in childhood-onset schizophrenia.

OBJECTIVE: Corpus callosum (CC) size and interhemispheric communication differences have been reported between patients with schizophrenia and normal controls. Childhood-onset schizophrenia (COS) is a severe form of the disorder that is continuous with later-onset disorder. Corpus callosal area was examined for COS at initial scan and prospectively through adolescence, and related to other developmental abnormalities for this group. METHOD: A total of 113 anatomic brain MRI scans were obtained from 55 COS (22 female) and 110 scans from 56 age- and gender-matched healthy volunteers (22 female), across ages 8-24. Baseline and prospective rescans were obtained at approximately 2-year intervals. The midsagittal areas for total corpus callosum and seven subregions were calculated using an automated system. Cross-sectional and longitudinal data were combined using mixed model regression analysis to compare developmental changes for the two groups. RESULTS: No diagnostic differences were seen at time of initial scan. Longitudinally, and in contrast to healthy volunteers, patients with schizophrenia showed a significant difference in developmental trajectory for the area of the splenium, both before (p=0.012) and after (p=0.05) adjustment for total cerebral volume. The area of the splenium becomes significantly smaller in COS, starting at about age 22. CONCLUSION: Patients with schizophrenia showed a significant difference in developmental trajectory for the splenial area, which seems to decline for COS. If replicated, this may reflect anticipated late occipital and extrastriate changes in brain regions.

Adolescent↗
PubMed2006

Evaluation of measures to reduce international spread of SARS.

Mathematical models are used to quantify the effect of border control measures in reducing the international spread of SARS. Border screening is shown to play a relatively minor role in reducing disease spread. Assuming detection rates similar to those reported for arrival screening in Australia, screening can detect up to 10% (95% CI 3-23) of infected travellers, and reduce the probability of a large outbreak by up to 7% (95% CI 2-17). Rapid reductions in the time to diagnosis and effective facilities for the isolation of cases are essential to ensure that there will not be a large outbreak, and each week of delay in responding to imported infection approximately doubles the total number of cases. While the control response is being developed in a currently uninfected region, border screening can provide up to one week's additional time in which to improve methods for early isolation of cases.

Australia↗
PubMedDate not supplied

Epidural analgesia and risk of anastomotic leakage.

BACKGROUND AND OBJECTIVES: Based on case reports of early anastomotic leakage in patients receiving epidural analgesia with local anesthetic and data to document a stimulatory effect of epidural block on gastrointestinal motility, it has been suggested that continuous infusion of epidural local anesthetic may lead to an increased incidence of anastomotic leakage. Therefore, we examined the association between continuous epidural local anesthetic and anastomotic leakage by reviewing the literature. METHODS: Review of controlled, randomized clinical trials aiming to investigate postoperative complications in which continuous postoperative epidural local anesthetic was administered in patients scheduled for colorectal surgery with an anastomosis. Data were obtained from a Medline search (1966-May 2000), previous review articles, references cited in original papers, and personal communication with investigators. Twelve trials including a total of 562 patients met the inclusion criteria. RESULTS: Sixteen of 266 patients (6.0%, 95% confidence interval [CI]: 3.5% to 9.6%) receiving postoperative epidural local anesthetic or epidural local anesthetic-opioid mixtures developed anastomotic leakage, compared with 10 of 296 patients (3.4%, 95% CI: 1.6% to 6.1%) receiving epidural or systemic opioid-based analgesia (P >.05 between groups, Fisher's test). The risk of overlooking a significant difference (type II error) was approximately 67% (power: 33%). Studies including more than 1,037 patients in each group are needed to demonstrate an increased risk of anastomotic leakage from 3.4% to 6.0% with 80% power and 2alpha = 0.05. There was no significant difference (P >.05 between groups, Fisher's test) between subgroups of study design: Epidural local anesthetic-versus systemic or epidural opioid, or epidural local anesthetic-opioid mixtures versus systemic or epidural opioid. CONCLUSIONS: So far, there is no statistically significant evidence from randomized trials to indicate epidural analgesia with local anesthetic to be associated with an increased risk of anastomotic breakdown. However, relatively few patients have been included in randomized trials, indicating a need for more studies to secure valid conclusions.

Analgesia, Epidural↗
PubMed2003

Responding to a bioterrorist attack: environmental investigation of anthrax in New Jersey.

A bioterrorism attack using the United States postal system to deliver a hazardous biological agent to specific targets created multiple environmental and occupational exposure risks along the path of the anthrax-containing letters. On October 18, 2001, a suspected case of cutaneous anthrax was confirmed in a postal worker from the Trenton Processing and Distribution Center where at least four suspect letters were postmarked. Over the next three weeks, a team of investigators collected samples at 57 workplaces in New Jersey as part of a comprehensive environmental investigation to assess anthrax contamination as a result of this bioterrorist attack. A total of 1369 samples were collected with positive sample results found in two mail processing and distribution centers, six municipal post offices, and one private company. This large-scale epidemiological and public health investigation conducted by state and federal agencies included environmental evaluations utilizing general industrial hygiene principles. Issues of sampling strategy, methods, agency cooperation and communication, and site assessment coordination are discussed.

Anthrax↗
PubMed1992

Radiology on the air. A continuing medical education experiment.

RATIONALE AND OBJECTIVES: The purpose of Radiology on the Air was to assess the technical and educational feasibility of providing radiologic continuing medical education via a fully interactive live telecommunications network. METHODS: Thirty-nine radiologic conferences were broadcast over the communications network of the Microelectronics Center of North Carolina (MCNC). Category 1 credit for the Physicians Recognition Award of the American Medical Association was available to participants who returned a completed program evaluation sheet by mail. RESULTS: Three participating academic institutions regularly offered the programming to a total of 684 participants, of whom 129 viewed programs at distant sites. Despite adequate-to-excellent technical quality and positive feedback concerning educational content, no continuing medical education (CME) credits were issued by the parent institution. CONCLUSIONS: The Radiology on the Air experiment suggests that a live telecommunications network is a capable vehicle for providing CME in radiology.

Education, Medical, Continuing↗
PubMed2026

Effectiveness of a digi-physical tool and working method for paediatric obesity treatment in Abu Dhabi: a non-inferiority intervention study using an external historical comparator.

BACKGROUND: Effective paediatric obesity treatment requires high intensity, scalable interventions. A digi-physical tool for paediatric obesity treatment has shown positive results in Stockholm, Sweden. This study evaluates whether the same treatment method is effective in a different cultural setting. METHODS: This non-inferiority intervention study, using an external historical comparator, included 60 consecutively recruited children aged 6-15.9 years with obesity who initiated treatment at Sheikh Shakhbout Medical City in Abu Dhabi between June and December 2023. Patients were treated with Evira, a digi-physical tool and working method enabling high intensity individualized care, real-time monitoring, and interactive patient-clinician communication. The primary outcome was BMI z-score change at 26 weeks. Non-inferiority was assessed using a predefined margin of 0.10 BMI z-score, with outcomes compared to a prior published trial in Stockholm (n = 107). RESULTS: A total of 112 children were included in the analysis (Abu Dhabi cohort, n = 35; Stockholm cohort, n = 77). The adjusted mean change in BMI z-score was - 0.20 (95% CI: - 0.28, - 0.12) in the Abu Dhabi cohort and - 0.20 (- 0.26, - 0.14) in the Stockholm cohort (p = 0.88). Non-inferiority was confirmed, (predefined margin 0.10 was not exceeded). A clinically significant BMI z-score reduction (≥ 0.20 units) was achieved by 45.7% of participants in Abu Dhabi and 36.4% in Stockholm (p = 0.35). Non-retention rates at 26 weeks were 41.7% vs. 28.0%, respectively (p = 0.07). CONCLUSIONS: The findings provide promising evidence that treatment outcomes achieved with the digi-physical treatment tool were comparable in the Abu Dhabi and Stockholm cohorts, supporting its feasibility in a second cultural and healthcare setting.

Humans↗
PubMed2005

Robotic long-distance telementoring in neurosurgery.

OBJECTIVE: To test the feasibility of long-distance telementoring in neurosurgery by providing subspecialized expertise in real time to another neurosurgeon performing a surgical procedure in a remote location. METHODS: A robotic telecollaboration system (Socrates; Computer Motion, Inc., Santa Barbara, CA) capable of controlling the movements of a robotic arm, of handling two-way video, and of audio communication as well as transmission of neuronavigational data from the remote operating room was used for the telementoring procedures. Four integrated services digital network lines with a total speed of transmission of 512 kilobytes per second provided telecommunications between a large academic center (Halifax, Nova Scotia) and a community-based center (Saint John, New Brunswick) located 400 km away. RESULTS: Long-distance telementoring was used in three craniotomies for brain tumors, a craniotomy for an arteriovenous malformation, a carotid endarterectomy, and a lumbar laminectomy. There were no surgical complications during the procedures, and all patients had uneventful outcomes. The neurosurgeons in the remote location believed that the input from the mentors was useful in all of the cases and was crucial in the removal of a mesial temporal lobe glioma and resection of an occipital arteriovenous malformation. CONCLUSION: Our initial experience with long-distance robotic-assisted telementoring in six cases indicates that telementoring is feasible, reliable, and safe. Although still in its infancy, telementoring has the potential to improve surgical care, to enhance neurosurgical training, and to have a major impact on the delivery of neurosurgical services throughout the world.

Academic Medical Centers↗
PubMed2003

Background and educational characteristics of prelingually deaf children implanted by five years of age.

PURPOSE: This study documents child, family and educational characteristics of a large representative sample of 8- to 9-yr-old prelingually deaf children who received a cochlear implant by 5 yr of age. Because pre-existing factors such as the child's gender, family characteristics, additional handicaps, age at onset of deafness and at implant, may affect postimplant outcomes, these variables must be accounted for before the impact of educational factors on performance with an implant can be adequately determined. Classroom variables that may affect postimplant outcomes include placement in public or private, mainstream or special education, oral or total communication environments. Other intervention variables include type and amount of individual therapy, experience of the therapist and parent participation in therapy. Documenting these characteristics for a large representative sample of implanted children can provide clinicians and researchers with insight regarding the types of families who sought early cochlear implantation for their children and the types of educational programs in which they placed their children after implantation. It is important to undertake studies that control for as many of these factors as possible so that the relative benefits of specific educational approaches for helping children to get the most benefit from their cochlear implant can be identified. METHOD: Over a 4-yr period, 181 children from across the US and Canada, accompanied by a parent, attended a cochlear implant research camp. Parents completed questionnaires in which they reported the child's medical and educational history, characteristics of the family, and their participation in the child's therapy. The parent listed names and addresses of clinicians who had provided individual speech/language therapy to the child and signed permission for these clinicians to complete questionnaires describing this therapy. RESULTS: To the extent that this sample is representative of those families seeking a cochlear implant for their child, especially during the initial period of device availability, this population can be characterized as follows. Most parents had normal hearing, were of majority (white) ethnicity and had more education and higher incomes than the general population. The families tended to be intact with both a mother and a father who involved their hearing-impaired child in family activities on a regular basis. The children were enrolled in the full range of educational placements available across the United States and Canada. Fairly even distributions of children from public and private schools, special education and mainstream classes and oral and total communication methodologies were represented. Educational placement changed as children gained increased experience with a cochlear implant. They received an increased emphasis on speech and auditory skills in their classroom settings and tended to move from private school and special education settings to public school and mainstream programs. These data support the position that early cochlear implantation is a cost effective procedure that allows deaf children to participate in a normal school environment with hearing age mates.

Canada↗
PubMed1976

Cochlear implants.

All presently devised single channel devices generate a primitive sensation of hearing by the mechanism of 'periodicity pitch'. No 'place pitch' encoding is possible. Although some enhancement of communicative skills with lip reading results, unaided speech discrimination is not possible. Definite psychological advantages for the totally deaf have been observed with these simple devices. Multiple segments of auditory nerve must be stimulated in a manner which will simulate the complex patterns of neural activity necessary for speech discrimination. Electrode optimization and the pathophysiological consequences of electrical stimulation of the auditory nerve can best be determined in animals. The perceptual consequences of electrical stimulation of the auditory nerve, however, can best be determined in man. How much we will have to innovate the methods of aural rehabilitation will depend upon how well we can generate perceptual speech patterns by electrical excitation of the auditory nerve.

Acoustic Stimulation↗
PubMedDate not supplied

Intraocular pressure change after neodymium:YAG capsulotomy.

PURPOSE: To study intraocular pressure (IOP) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy in eyes that had phacoemulsification, anterior continuous curvilinear capsulotomy, in-the-bag intraocular lens (IOL) implantation, and no apparent communication between the aqueous and vitreous compartments after the Nd:YAG capsulotomy. SETTING: Northwest Kansas Eye Clinic, Hays, Kansas. METHODS: This study comprised 101 eyes. All patients received one drop of apraclonidine hydrochloride 0.5% (lopidine) 30 to 60 minutes before and then after Nd:YAG capsulotomy, intraocular pressure was measured preoperatively before administration of lopidine and at 1 to 3 and 24 hours, 1 week, and 1 month postoperatively. RESULTS: Within 24 hours after the Nd:YAG capsulotomy, no significant IOP elevations occurred. Although there was one case of modest IOP elevation at 1 week postcapsulotomy, none was seen at 4 weeks. There was no relation between change in IOP and number of laser pulses, energy per pulse, or total energy. CONCLUSION: The results indicate that lack of communication between the aqueous and vitreous compartments with an intact capsulorhexis over the lens optic rim prevented obstruction of the trabecular network by cellular debris or vitreous. This, coupled with the reduction in aqueous formation by lopidine, prevented significant IOP elevation. In patients meeting the study criteria, routine IOP measurements 1 to 3 hours and 1 day after capsulotomy may not be necessary.

Aged↗
PubMed2003

Does the admitting officer system reduce the time taken to arrange an emergency admission to hospital?

AIM: Communication is an important feature of admitting acutely ill patients to hospital in both New Zealand and Australia. The mechanisms used to facilitate communication between the general practitioner (GP) and the admitting hospital differ between the two countries. The relative effectiveness of each of these systems has never been formally studied. Our aim was to compare the efficiency of the admitting officer system for arranging hospital admissions (used in Australia) with that of direct referral by the GP to the specialist registrar (the system used in New Zealand). METHODS: Five metropolitan hospitals of comparable size from each country were selected and the time taken to contact the relevant doctor in order to arrange admission of an acutely ill patient was documented. RESULTS: A total of 120 contact attempts were made, 60 in each country. The total time taken to contact the admitting doctor in order to arrange an emergency assessment for a patient was significantly longer in New Zealand than it was in Australia (p <0.05). CONCLUSIONS: When arranging an emergency patient assessment for a patient in the community, the total time taken to contact the appropriate doctor is less in Australia, where the admitting officer system is used, than it is in New Zealand, using the specialist registrar system. Consideration should be given by acute hospitals in New Zealand to streamlining their communications processes in order to minimise delays to referring doctors and their patients.

Australia↗
PubMedDate not supplied

Testing emergency medical personnel response to patients with suspected infectious disease.

OBJECTIVES: In the United States (US), hospitals are required to have disaster plans and stage drills to test these plans in order to satisfy the Joint Accreditation Commission of Healthcare Organizations. The focus of this drill was to test if emergency response personnel, both prehospital and hospital, would identify a patient with a potentially communicable infectious disease, and activate their respective disaster plan. METHODS: Twelve urban/suburban emergency departments (ED) received patients via car and ambulance. Patients were moulaged to imitate a smallpox infection. Observers with checklists recorded what happened. The drill's endpoints were: (1) predetermined end time; (2) identification of the patient and hospital "lock-down"; and (3) breach of drill protocol. RESULTS: None of the ambulance personnel correctly identified their patients. Of the total 13 mock patients assessed in the ED, seven (54%) were identified by the ED staff as possibly being infected with a highly contagious agent and, in turn, the hospital's biological agent protocol was initiated. Of the correctly identified patients, five (71%) were placed in isolation, and the remaining two (29%), although not isolated, were identified prior to their ED discharge and the appropriate protocol was activated. The six remaining mock patients (46%) were incorrectly diagnosed and discharged. Of the hospitals that had correctly identified their "infected" patients, only two (29%) followed their notification protocol and contacted the local health department. CONCLUSION: This drill was successful in identifying this area's shortcomings, highlighted positive reactions, and raised some interesting questions about the ability to detect a patient with a possibly highly contagious disease.

Adolescent↗
PubMed2001

Rapid communication: L-folinic acid versus folic acid for the treatment of hyperhomocysteinemia in hemodialysis patients.

BACKGROUND: The hyperhomocysteinemia found in most hemodialysis patients is refractory to combined oral B-vitamin supplementation featuring supraphysiological doses of folic acid (FA). We evaluated whether a high-dose L-folinic acid-based regimen provided improved total homocysteine (tHcy)-lowering efficacy in chronic hemodialysis patients, as suggested by a recent uncontrolled report. METHODS: We block-randomized 48 chronic, stable hemodialysis patients based on their screening predialysis tHcy levels, sex, and dialysis center into two groups of 24 subjects treated for 12 weeks with oral FA at 15 mg/day or an equimolar amount (20 mg/day) of oral L-folinic acid (FNA) [L-5-formyltetrahydrofolate]. All 48 subjects also received 50 mg/day of oral vitamin B6 and 1.0 mg/day of oral vitamin B12. RESULTS: The mean percentage (%) reductions (with 95% CIs) in predialysis tHcy were not significantly different [FNA = 22.1% (11.8 to 31.4%), FA = 20.7% (11.7 to 30.5%), P = 0.950 by paired t test]. Final on-treatment values (mean with 95% CI) were as follows: FNA, 15.9 micromol/L (14.0 to 18.0); FA, 16.9 micromol/L (14.8 to 18.8). Moreover, in those subjects with baseline tHcy levels >/=14 micromol/L, neither treatment resulted in "normalization" of tHcy levels (that is, final on-treatment values <12 micromol/L) among a significantly different or clinically meaningful number of patients [FNA = 2 out of 22 (9.1%); FA = 2 out of 24 (8.3%); Fisher's exact test of between groups difference, P = 1.000]. CONCLUSIONS: Relative to high-dose FA, high-dose oral L-folinic acid-based supplementation does not afford improved tHcy-lowering efficacy in hemodialysis patients. The preponderance of hemodialysis patients (that is,> 90%) exhibits mild hyperhomocysteinemia refractory to treatment with either regimen.

Aged↗
PubMed2006

Understanding cardiopulmonary resuscitation decision making: perspectives of seriously ill hospitalized patients and family members.

BACKGROUND: To improve communication and decision making related to cardiopulmonary resuscitation (CPR), a greater understanding of the perspectives of hospitalized patients with advanced diseases and their family members are needed. METHODS: In five Canadian hospitals, we administered a face-to-face questionnaire to older inpatients with end-stage cancer and advanced medical diseases and, where possible, to one of their family members, regarding information needs, the deliberation process, and their preferred decisional role. FINDINGS: A total of 440 of 569 patients (78%) and 160 of 176 available caregivers (91%) agreed to participate. Most patients (61%) had thought about what treatment they wanted if their heart stopped, few patients (11.3%) could describe more than two components of CPR, and only 2.7% of patients thought that the success rate of CPR was < 10%. A minority of patients (34%) had discussed CPR with their physician; 37% did not want to discuss their preferences with their doctor. Patients who felt that end-of-life issues were relevant to them were 5.5 times more likely to want a discussion with the physician regarding resuscitation (odds ratio, 5.5; 95% confidence interval, 2.5 to 12.0). The preferred role in decision making was variable, but most patients (59.7%) and family members (81.6%) preferred some degree of shared decision making that included the family member. There were no significant differences between cancer and medical patients in their preferred decisional role. INTERPRETATION: Seriously ill hospitalized patients have poor knowledge about CPR, and variable preferences for deliberation and their role in the decision-making process regarding their treatment. Strategies that improve understanding of CPR and foster discussions that involve patients, family members, and physicians in the decision-making process may improve the quantity and quality of communication and decision making about CPR.

Aged↗
PubMed2003

Patient expectations regarding eye care: focus group results.

BACKGROUND: Increasing emphasis on patient-centered care and other recent developments should make patient expectations increasingly important in ophthalmology. Motivated by the pivotal role of patient expectations in quality-of-care assessments and by the limited knowledge about patients' expectations regarding eye care, we initiated a pilot study using focus groups to determine a relevant set of concerns that patients express as expectations. METHODS: A total of 6 focus groups were conducted with patients at Duke University Eye Center (Durham, NC). Focus groups ranged in size from 4 to 10 people. The average group size was 6. RESULTS: Content analysis of transcripts from the 6 focus groups yielded 22 areas of expectations for eye care, which were classified into 5 categories: communication, interpersonal manner, physician's skill, logistics, and other. The 6 areas that appeared to be of greatest importance to focus group participants were the following: (1) honesty, (2) information about diagnosis and prognosis, (3) explanation in clear language, (4) ophthalmologist's experience and reputation, (5) empathy, and (6) listening and addressing concerns. CONCLUSIONS: In general, ophthalmology patients in the focus groups emphasized expectations related to communication and interpersonal manner. In contrast to previous studies with primary care patients, however, ophthalmology patients expressed few expectations for technical interventions, such as medication prescriptions, physical examination, or diagnostic testing.

Focus Groups↗
PubMed2005

Patients' experiences related to anti-viral treatment for hepatitis C.

OBJECTIVE: To conduct a qualitative study to elicit patients' descriptions of their own experiences with treatment for hepatitis C (HCV). METHODS: Focus groups were conducted until thematic saturation was reached. RESULTS: A total of 40 patients (80% male) participated in eight focus groups. The themes that emerged most frequently during the focus groups centered on adverse effects and quality of care. The discussions highlighted discrepancies between patients' anticipated effects of drug toxicity versus their actual experiences, gaps in communication between physicians, and the lack of social support as important shortcomings in the healthcare of HCV patients. CONCLUSIONS: The issues raised by the participants in this study highlight several important areas that may lead to improved care for patients with HCV. PRACTICE IMPLICATIONS: This study suggests that care for patients with HCV might be improved by using patient testimonials to improve accuracy of expectations, having both the primary care physician and liver specialist devise a plan to treat symptoms arising during the course of therapy, and ensuring that patients have the option of participating in a support group.

Adaptation, Psychological↗
PubMedDate not supplied

A transcutaneous energy and information transfer system for implanted medical devices.

During the last four decades there has been a rapid increase in the development and usage of medical devices. Currently, there are more than 500,000 devices on the market and 25,000 new devices enter the market each year. Many medical devices are now designed to be implantable (pacemakers, defibrillators, circulatory assist devices, artificial hearts, cochlear implants, neuromuscular stimulators, biosensors, etc.). Almost all of the active devices (those that perform work) and many of the passive devices (those that do not perform work) require a source of power. In addition, these devices need to be monitored and controlled, which can be accomplished by utilizing remote communication methods. A transcutaneous energy transfer system combined with a remote communications system has been developed and evaluated in vitro and in vivo (bovine, porcine, and human cadaver experiments). The energy transfer system can deliver up to 60 W with power transfer efficiencies between 60 and 83%. An automatically tuned, resonant frequency tracking method is used to obtain optimum power transfer over a range of operating conditions. The remote communications system can transfer digital data bidirectionally through intact skin at rates up to 9600 baud. The system transmits information by frequency modulating an 890 nm infrared carrier signal. The system has demonstrated satisfactory performance during multicenter evaluation with ventricular assist and total artificial heart devices. Design improvements have been identified, which will be implemented to produce an optimized system for energy transfer to and remote communications with various implantable medical devices.

Animals↗
PubMed2005

Seroprevalence of hepatitis A infection in a low endemicity country: a systematic review.

BACKGROUND: In Canada--a low endemicity country, vaccines for hepatitis A virus (HAV) are currently recommended to individuals at increased risk for infection or its complications. Applying these recommendations is difficult because the epidemiology of HAV infection is poorly defined, complex, and changing. This systematic review aimed to 1) estimate age-specific prevalence of HAV antibody in Canada and 2) evaluate infection-associated risk factors. METHODS: MEDLINE (1966-2005) and EMBASE (1980-2005) were searched to identify relevant studies for the systematic review. Archives for the Canada Diseases Weekly Report (1975-1991) and Canada Communicable Disease Report (1992-2005) were searched for relevant public health reports. Data were abstracted for study and participants' characteristics, age-specific prevalence, and risk factors. RESULTS: A total of 36 reports describing 34 unique studies were included.The seroprevalence in Canadian-born children was approximately 1% in ages 8-13, 1-6% in 20-24, 10% in 25-29, 17% in 30-39, and increased subsequently. In age groups below 20 and 20-29, age-specific seroprevalence generally remained constant for studies conducted across geographic areas and over time. Compared to Canadian-born individuals, subjects born outside Canada were approximately 6 times more likely to be seropositive (relative risk: 5.7 [95% CI 3.6, 9.0]). Travel to high risk areas in individuals aged 20-39 was associated with a significant increase in anti-HAV seropositivity (RR 2.8 [1.4, 5.5]). Compared to heterosexuals, men having sex with men were only at a marginally higher risk (adjusted odds ratio 2.4 [0.9, 6.1]). High risk for seropositivity was also observed for Canadian First Nations and Inuit populations. CONCLUSION: Results from the current systematic review show that in this low endemicity country, disease acquisition occurs in adulthood rather than childhood. The burden of disease is high; approximately 1 in 10 Canadians had been infected by ages 24-29. The increase in prevalence in young adults coincides with disease importation and increasing frequency of risk factors, most likely behavioral-related ones. Gaps in seroprevalence data were identified rendering the application of current immunization recommendations difficult. A nationwide prevalence survey for all Canadians is needed. This is essential to quantify the effectiveness of current recommendations and conduct cost-effectiveness evaluations of alternative immunization programs, if necessary.

Age Factors↗