In recognition of the growing challenge that food insecurity has on population health, a multisectoral partnership in Nova Scotia has been working since 2001 to address province-wide accessibility to a nutritious diet. The participatory food costing (PFC) model has been at the forefront of provincial and national efforts to address food insecurity; a local foods component was incorporated in 2004. This model has engaged community partners, including those affected by food insecurity, in all stages of the research, thereby building capacity at multiple levels to influence policy change and food systems redesign. By putting principles of participatory action research into practice, dietitians have contributed their technical, research, and facilitation expertise to support capacity building among the partners. The PFC model has provided people experiencing food insecurity with a mechanism for sharing their voices. By valuing different ways of knowing, the model has facilitated much-needed dialogue on the broad and interrelated determinants of food security and mobilized knowledge that reflects these perspectives. The development of the model is described, as are lessons learned from a decade of highly productive research and knowledge mobilization that have increased stakeholders' understanding of and involvement in addressing the many facets of food security in Nova Scotia.
Division of Pathogenic Neisseria, Syphilis Diagnostics, and Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba R3E 3R2, Canada.
Although detection of Treponema pallidum DNA in whole-blood specimens of syphilis patients has been reported, it is uncertain at what stage of the disease such specimens are most suitable for the molecular diagnosis of syphilis. Also, few studies have directly compared the different gene targets for routine laboratory diagnostic usage in PCR assays. We examined 87 specimens from 68 patients attending two urban sexually transmitted disease clinics in Alberta, Canada. PCR was used to amplify the T. pallidum tpp47, bmp, and polA genes as well as a specific region of the 23S rRNA gene linked to macrolide antibiotic susceptibility. In primary syphilis cases, PCR was positive exclusively (75% sensitivity rate) in ulcerative swabs but not in blood specimens, while in secondary syphilis cases, 50% of the blood specimens were positive by PCR. Four out of 14 (28.6%) of our PCR-positive syphilis cases were found to be caused by an azithromycin-resistant strain(s). Our results confirmed that swabs from primary ulcers are the specimens of choice for laboratory diagnostic purposes. However, further research is required to determine what specimen(s) would be most appropriate for molecular investigation of syphilis in secondary and latent syphilis.
After the introduction of reverse sequence syphilis screening in Alberta, Canada, there was an increase in the diagnosis of late latent syphilis in individuals screening positive with the treponemal test; these cases required additional public health follow-up.
Few data exist on the serologic outcome of treponemal tests in congenital syphilis.
A chart review was conducted on all confirmed early congenital syphilis cases in Edmonton, Canada, from 2005-2010.
Of the 16 cases identified, 11 (69%) infants seroreverted their treponemal tests by 18 months. Cases that did not serorevert their treponemal tests were statistically more likely to have delayed treatment and to have higher maternal rapid plasma reagin titers at birth.
Our data suggest that the majority of early congenital syphilis cases will serorevert their treponemal tests by 18 months.
Injection drug users (IDUs) are at risk for acquiring human immunodefiency virus (HIV) and hepatitis C virus (HCV) via parenteral and sexual transmission. We determined the seroprevalence and correlates of HIV and HCV for IDUs recruited in Edmonton, Alberta.
Edmonton was one site of a multi-site, national survey (I-Track Study). From April to June 2005, IDUs were recruited and administered a questionnaire collecting information on demographics, drug use, sexual behaviours, and HIV/HCV testing behaviours. Finger-prick blood samples were collected for serology testing. Seroprevalence of HIV and HCV was determined and correlates of infection were assessed using logistic regression.
Of 275 IDUs, 68% were male, the median age was 38 years and 70.6% were Aboriginal. HIV prevalence was 23.9%, HCV prevalence was 66.1% and HIV/HCV co-infection was 22.8%. Cocaine (36.9%) was reported to be the drug injected most often in the previous six months. Correlates for HIV were sex trade (OR 2.9, 95% CI 1.0-8.3) for women, and older age (OR 1.1, 95% CI 1.0-1.2) and needle exchange program (NEP) use (OR 5.7, 95% CI 1.3-23.7) for men. For women, having a casual sex partner was protective for HCV (OR 0.28, 95% CI 0.10-0.78). Independent correlates for HCV among males included age (AOR 1.2, 95% CI 1.1-1.3) and younger age of first injection (AOR 0.92, 95% CI 0.87-0.96).
The high HIV and HCV prevalence found in this study among IDUs in Edmonton highlights the complex needs of the IDU community and the continued need for targeted programming.
Resurgence of syphilis in Canada and worldwide requires laboratories to update their methods for molecular epidemiology investigation and surveillance. This study utilizes polymerase chain reaction diagnostic tests for syphilis, identifies macrolide resistance, and uses a molecular typing system to characterize Treponema pallidum clinical strains causing syphilis in Alberta and Northwest Territories, Canada.
In total 449 specimens including genital swabs, whole blood, sera, and cerebrospinal fluid were obtained from 374 patients with suspect syphilis in Alberta and Northwest Territories. Molecular subtyping was based on genetic characterization of treponemal repeat genes, arp and tpr. Detection of macrolide resistance was accomplished by identification of the 23S rRNA gene mutation associated with the resistance pattern.
Forty-nine specimens obtained from 43 patients were found to be positive for T. pallidum DNA using bmp, tpp47 and polA polymerase chain reaction assays. Four molecular subtypes were identified, with one type, 14d, accounting for 70% of all cases and 83% of typeable strains. Seven patients (16%) were found to be infected by macrolide-resistant strains, of which 6 were men who have sex with men and 1 whose infection was acquired in China.
A single molecular type of T. pallidum, characterized as 14d, caused the majority of the syphilis cases identified in this study. A more discriminatory typing method would be required to determine if these strains are clonal. Treatment of infectious syphilis with macrolide antibiotics should be restricted to patient populations where resistance is rare and clinical and serological follow up of patients is possible.