Examining the impacts of a syphilis awareness campaign among gay, bisexual, and other men who have sex with men (gbMSM) in British Columbia, Canada

OBJECTIVES

Syphilis rates have increased in BC and disproportionately affect gay, bisexual, and other men who have sex with men (gbMSM). A social marketing campaign (Syphistory) ran from January to September 2017 with the primary goal of increasing syphilis knowledge and a secondary goal of increasing syphilis screening among gbMSM in BC.

METHODS

We used pre- and post-campaign surveys to assess changes in syphilis knowledge from a convenience sample of clients attending STI clinics using one-sided t-tests. We used online Piwik metrics to examine the campaign reach, and provincial testing data to examine trends in syphilis screening. We used data from the Engage Study to examine factors associated with campaign awareness and associations with syphilis testing.

RESULTS

Of the 2155 visitors to the Syphistory website with known geography, 79.4% were from BC. Moreover, STI clinic participants who saw the campaign demonstrated a greater knowledge of syphilis (9.7/12, 80.8%) than those who did not see the campaign (mean 8.9/12, 74%) (p < 0.001). Provincial syphilis testing rates were 8764 and 9749 in the 12 months before and after the campaign; however, we did not find an overall trend in testing before versus after the campaign (p = 0.147). Among Engage participants, 12.7% reported seeing the campaign and we found an association between campaign exposure and recent syphilis testing (aOR = 2.73; 95% CI = 1.51, 4.93).

CONCLUSION

gbMSM who saw the campaign were more likely to report being tested for syphilis in the previous 6 months. STI clinic attendees who reported seeing the campaign also had higher syphilis knowledge compared to those who did not.

Population-Level Outcomes of Partner Notification Among Gay, Bisexual, and Other Men Who Report Sex With Men Diagnosed With Infectious Syphilis in British Columbia, Canada

BACKGROUND

Syphilis testing, treatment, and partner notification (PN) are centrally coordinated in British Columbia (BC), Canada. Public health (PH) nurses (PHNs) contact almost all syphilis patients and either notify partners of syphilis exposure (PH-initiated PN) or support patients to notify their own partners (patient-initiated PN). In the context of an ongoing syphilis epidemic among gay, bisexual, and other men who report sex with men (gbMSM), we measured population-level yields and compared PN approaches to inform prevention and control efforts.

METHODS

All gbMSM diagnosed with infectious syphilis in 2016 in BC were included. We calculated indicators of engagement with PN among patients and PN outcomes among notifiable partners using a cascade-of-care framework. χ2 Tests compared indicators between PN approaches.

RESULTS

Of the 759 syphilis diagnoses, 85.4% (648/759) were among gbMSM and 94.7% (614/648) were treated within 30 days of testing (mean [SD], 5.5 [5.2] days). Among patients, 87.7% (568/648) discussed PN with PHNs and 49.5% (281/568) named at least 1 notifiable partner, for a total of 1094 partners (mean [SD], 3.9 [5.5] partners/patient). Compared with PH-initiated PN, patient-initiated PN resulted in a greater proportion of partners notified (70.1% [573/817] vs. 89.8% [211/235]; P = 1.88 × 10-9), but there was no difference in the proportion of partners tested and/or treated (90.2% [517/573] vs. 86.7% [183/211]; P = 0.203), and diagnosed (12.8% [66/517] vs. 16.4% [30/183]; P > 0.271).

CONCLUSIONS

Public health- and patient-initiated PN had similarly high yields of partners tested and/or treated, and diagnosed, demonstrating that gbMSM can contribute to syphilis PN when supported by resource-equipped PHNs.

Human Immunodeficiency Virus Seropositivity and Early Syphilis Stage Associated With Ocular Syphilis Diagnosis: A Case-control Study in British Columbia, Canada, 2010-2018

BACKGROUND

The incidence of syphilis has been increasing worldwide in the last 20 years, disproportionately impacting those living with human immunodeficiency virus (HIV). Alongside this increase, several jurisdictions have reported increasing incidences of syphilis-related complications, including ocular syphilis. We sought to characterize ocular syphilis cases in British Columbia (BC), Canada.

METHODS

This case-control study compared ocular syphilis cases, matched (1:4) to syphilis controls, that were diagnosed in BC between January 2010 and December 2018. Multivariable logistic regression was used to identify potential correlates of ocular syphilis, where variables were included in the final model if significant (P ≤ .05).

RESULTS

During the study period, there were 6716 syphilis diagnoses, including 66 (0.98%) ocular syphilis cases. The median age of cases was 49.5 years (interquartile range 39-59). Most (87.8%) patients were male, where 54.6% identified as men who have sex with men. The most common ophthalmologic diagnosis was panuveitis (42.4%). Of ocular syphilis patients, 48.5% were living with HIV at the time of their syphilis diagnosis, compared to 26.4% of controls (P = .001). The proportion of syphilis cases with ocular syphilis increased from 0.48% in 2010 to 0.83% in 2018. The final multivariable model demonstrated correlates between ocular syphilis and early syphilis stage, including primary/secondary (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.86-13.24) and early latent (OR 4.29, 95% CI 1.62-11.34) stages, and HIV serostatus (OR 2.16, 95% CI 1.14-4.09).

CONCLUSIONS

Ocular syphilis increased over the study period, both in absolute numbers and as a proportion of all syphilis cases, a finding consistent with other jurisdictions. These findings highlight the importance of vigilance for ocular syphilis, to avoid diagnostic and treatment delays.

A descriptive analysis of blood mercury test results in British Columbia to identify excessive exposures

OBJECTIVE

The objective of this study was to describe who in British Columbia (BC) is tested for blood mercury, the distribution of their results, and the adequacy of follow-up testing.

METHODS

The BC Centre for Disease Control (BCCDC) obtained records of clinician-ordered analyses of blood mercury conducted by BC laboratories during 2009 and 2010. We conducted a descriptive analysis with statistical testing of who was tested, the distribution of their blood mercury concentrations, whose results exceeded Health Canada's proposed guidance values (8 μg/L (40 nmol/L) for children/adolescents ≤ 18 years and women 19-49 years, and 20 μg/L (100 nmol/L) for other adults), and patterns of repeat testing.

RESULTS

Mercury test results for 6487 individuals were reviewed. Adults ≥ 50 years had the highest testing rates. The median blood mercury concentration for all tested persons was 1.8 μg/L. Nine percent of women aged 19-49 years had results exceeding Health Canada's provisional guidance value of 8 μg/L. Data from one of BC's two biomarker laboratories indicated that some residents of Vancouver and nearby suburbs have higher exposure to mercury than other BC residents. Of 127 individuals who had results in 2009 exceeding provisional guidance values, only 45% were tested again within 12 months.

CONCLUSION

Collating and analyzing all clinical biomarker testing such as blood mercury at a provincial population level allows for assessment of the adequacy and appropriateness of follow-up testing and suggests which regional and demographic strata are at higher levels of exposure.

Malaria risk factors in North West Tanzania: the effect of spraying, nets and wealth

Malaria prevalence remains high in many African countries despite massive scaling-up of insecticide treated nets (ITN) and indoor residual spraying (IRS). This paper evaluates the protective effect of pyrethroid IRS and ITNs in relation to risk factors for malaria based on a study conducted in North-West Tanzania, where IRS has been conducted since 2007 and universal coverage of ITNs has been carried out recently. In 2011 community-based cross-sectional surveys were conducted in the two main malaria transmission periods that occur after the short and long rainy seasons. These included 5,152 and 4,325 children aged 0.5–14 years, respectively. Data on IRS and ITN coverage, household demographics and socio-economic status were collected using an adapted version of the Malaria Indicator Survey. Children were screened for malaria by rapid diagnostic test. In the second survey, haemoglobin density was measured and filter paper blood spots were collected to determine age-specific sero-prevalence in each community surveyed. Plasmodium falciparum infection prevalence in children 0.5–14 years old was 9.3% (95%CI:5.9–14.5) and 22.8% (95%CI:17.3–29.4) in the two surveys. Risk factors for infection after the short rains included households not being sprayed (OR = 0.39; 95%CI:0.20–0.75); low community net ownership (OR = 0.45; 95%CI:0.21–0.95); and low community SES (least poor vs. poorest tertile: OR = 0.13, 95%CI:0.05–0.34). Risk factors after the long rains included household poverty (per quintile increase: OR = 0.89; 95%CI:0.82–0.97) and community poverty (least poor vs. poorest tertile: OR = 0.26, 95%CI:0.15–0.44); household IRS or high community ITN ownership were not protective. Despite high IRS coverage and equitable LLIN distribution, poverty was an important risk factor for malaria suggesting it could be beneficial to target additional malaria control activities to poor households and communities. High malaria prevalence in some clusters and the limited protection given by pyrethroid IRS and LLINs suggest that it may be necessary to enhance established vector control activities and consider additional interventions.

[Barium ion blockade on an inward rectifying potassium current in oocytes of the frog Xenopus laevis]

The effect of barium (Ba2+) on inward rectifier K+ current endogenous (IRK-endo) was characterized in Xenopus laevis oocytes with two microelectrodes voltage clamp technique. Varying [K+]o caused a shift in the reversal potential and a change in the straight pert of the slope as expected for K+ current. External Ba2+ blocked IRK-endo displayed lower affinity in the channel in two different forms. The blockade of the peak current was voltage independent, and had a Kd of 0.9 +/- 0.1 mM. In contrast, a second effect on the late current (80 ms). Was both time and voltage dependent, with a Kd that display monoexponential voltage dependence (tau = 50 +/- mV.) These observations suggest the presence of two different binding sites for Ba2+, one in the external vestibule of the channel and another lying within the channel. Our results demonstrate the existence of an endogenous K+ current in Xenopus laevis oocytes with characteristics that resemble other inward rectifier K+ channels found in other species.

[Effects of adenosine on automaticity and post-potential oscillations in Purkinje fibers of mammals]

The aim of the present paper was to study the effects of adenosine (ADO) on automaticity and after potential oscillations on canine cardiac Purkinje fibers. ADO concentrations from 10(-8) to 10(-5) M were used. The intracellular electrical activity was recorded with conventional microelectrodes. ADO increased during the first two minutes the basic cycle length (BLC) with concentrations higher than 10(-8) M, to a value 50% above control, later there is a progression to a steady state. The dose-response curve in the steady state is sigmoidal and resembles those of receptor occupation. The slopes of pacemaker potentials have a tendency to decrease along with the increase in BLC length. After potential oscillations decrease with 10(-8) M of ADO but not with larger concentrations. There results supports the hypothesis that ADO produces an increase in the time independent potassium current similar to the one described for atrial and ventricular myocytes. This effect probably depends on specific receptor stimulation. The biphasic time course suggests the existence of subtypes of A1 receptor with different dissociation constants and affinities but with similar actions. The idea that the ADO effects depend mainly on the potassium currents and not on I(f) is supported by the absence of a dose-dependent effects in the oscillatory after potentials.

Intake and subsequent fate of a ceramic particle containing 2.85 microCi 241Am: a case study

Intake of 241Am was reported in a young female technologist. External monitoring, whole body counting, urinalysis and fecal analysis were performed to determine the subsequent fate of the contaminant. Five days later, more than 99.5% of the radioactivity was voided in a fecal sample. A single particle, containing 2.85 microCi of 241AmO2 incorporated in a ceramic matrix, was isolated from the fecal sample. Brief descriptions of the radioanalytical results and dosimetry implications are presented. A shadow shield whole body counter was conveniently used to make an early estimate of the intake. This initial estimate enabled staff to decide that it was not necessary to artifically remove the contaminant. It was estimated that the lower large intestine was the organ which received the highest dose due to the passage of the ceramic particle. Systemic uptake of 241Am was indicated by urinalysis. The fractional transfer of 241Am from the GI tract to the blood was estimated to be less than 6 X 10(-5). This maximum estimate is limited by the MDA of the analytical procedures used. The fractional transfer of the 241Am from the GI tract to blood in this case is about an order of magnitude less than recent ICRP recommendations for "all compounds of americium".

Engagement with an old theory

The co-author of Disengagement Theory restates the central propositions, suggests new studies that might test its usefulness, and examines some of the controversy that has been generated over the years either by the theory itself or the context in which it was set forth. The four key propositions focus upon decreasing life space with advancing age, the individual's own anticipation and participation in this process, a change in style of interaction, and the momentum of the disengagement process once it has begun. Although some useful research has been done, the theory remains poorly operationalized and largely untested. A measure of life space variety is proposed, and attention also directed to neuro-physiological findings. Several misunderstandings and misapplications of Disengagement Theory are discussed, including the erroneous idea that disengaged people necessarily are either higher or lower in morale than others, and the unenlightening controversy over "activity versus disengagement."

LETHAL EFFECT OF ABSORBED RADIOISOTOPES ON PLANTS

The lethal dose of P32 and Sr90 for wheat, barley, and sunflower seeds is approximately 1.4 microcuries per seed (0.05 rd.). Radioautographs indicate that at five weeks' growth the distribution of phosphorus in a wheat plant is fairly uniform whereas that of strontium is very uneven, practically all the strontium being concentrated in the first two leaves.