This study examines a cohort of persons quarantined during the 2003 SARS outbreak in Canada and describes their understanding of, difficulties and compliance with, and the psychological impact of the quarantine experience. A mailed questionnaire was administered to 1912 eligible adults and included the Impact of Events Scale - Revised (IES-R) to assess symptoms of post-traumatic stress disorder (PTSD). Self-reported compliance with all required quarantine measures was low (15.8+/-2.3%), although significantly higher when the rationale for quarantine was understood (P=0.018). Health-care workers (HCW) experienced greater psychological distress, including symptoms of PTSD (P<0.001). Increasing perceived difficulty with compliance, HCW, longer quarantine and compliance with quarantine requirements were significant contributors to higher IES-R scores. The low compliance with quarantine requirements introduces concerns about the effectiveness of quarantine as a public health measure. Improvements in compliance and reduced psychological distress may be possible by minimizing duration, revising requirements, and providing enhanced education and support.

BackgroundIn the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission.MethodsA retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission.Results45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90%) participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004) or ECG (OR = 3.52, p = .002), unprotected eye contact with secretions (OR = 7.34, p = .001), patient APACHE II score ≥20 (OR = 17.05, p = .009) and patient Pa02/Fi02 ratio ≤59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients.ConclusionClose contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients.

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OBJECTIVES. Our objectives were (1) to describe an analysis of the spatial pattern of cancer incidence in Ontario and (2) to discuss the quality of data in the Ontario Cancer Registry with respect to the accuracy of local cancer rates. METHODS. Cancer incidence rates were calculated for 22 cancer sites in 49 counties of Ontario during 1976 to 1986. Capture-recapture methods were used to estimate completeness of case registration, and completeness of residence information was also assessed. Spatial autocorrelation was used in measuring the geographic pattern of incidence rates. Comparisons were also made between sexes and with earlier data from 1966 to 1975. RESULTS. The quality of the geographic data in the registry appeared good, and corrections for incomplete or inaccurate registration had little impact. About one third of the sex-site combinations showed some evidence of spatial patterning in the cancer rate. Particularly strong regional variation was noted for cancers of the stomach, lung, uterus, and prostate. CONCLUSIONS. The analysis revealed a number of cancers with significant spatial patterning of risk. Further work is needed to relate the cancer data to other information on potential life-style and environmental factors.

his guideline from the Canadian Task Force on Preventive Health Care focuses on screening for thyroid dysfunction among asymptomatic nonpregnant adults in primary care beyond usual care and vigilance for signs and symptoms of thyroid dysfunction. Thyroid dysfunction is diagnosed based on abnormal levels of serum thyroid-stimulating hormone (TSH) and can be characterized as either hypo-or hyperthyroidism. Hypothyroidism results from impaired thyroid hormone production (i.e., thyroxine [T 4 ] or triiodothyronine [T 3 ]), leading to elevated levels of TSH. Hypothyroidism is often caused by autoimmune disorders (e.g., Hashimoto thyroiditis) or occurs as a sequela of hyperthyroidism treatment, which can render the thyroid gland nonfunctional. 1 Hyperthyroidism results from an overproduction of thyroid hormone, leading to the suppression of TSH. 1 Causes of hyperthyroidism include Graves disease, toxic multinodular goitre and toxic adenoma. 2 Signs and symptoms of thyroid dysfunction are variable between patients and often nonspecific. For hypothyroidism, symptoms may include tiredness, sensitivity to cold, dry skin, hair loss, weight gain and slowed movements and thoughts. 1,3-6 For hyperthyroidism, symptoms may include sinus tachycardia, atrial fibrillation, hyperactivity or irritability, intolerance to heat, tremor and weight loss. 1,2,7 Some people with thyroid dysfunction are asymptomatic. 8 If left untreated, hypothyroidism may increase the risk of cardiac dysfunction, hypertension, dyslipidemia, cognitive impairment and, in rare cases, myxedema coma. 3,9 Untreated hyperthyroidism may increase the risk of cardiac conditions (e.g., atrial fibrillation, heart failure) or bone fractures, and could lead to thyroid storm, an uncommon, life-threatening condition associated with tachycardia, extreme fatigue, fever and nausea. 2,10 Minor variations in thyroid function as measured by abnormal levels of TSH are often self-limiting. Observational studies have reported that levels of TSH appear to revert to normal without treatment in 37%-62% of patients with initially elevated levels and 51% with initially low levels, particularly for milder cases of thyroid dysfunction (mean follow-up 32-60 mo). 11,12 Screening is intended to detect thyroid dysfunction in asymptomatic patients in order to prevent adverse consequences of untreated thyroid dysfunction. 13 Screening is done by performing a blood test for TSH. Abnormal levels of TSH are followed up with additional diagnostic testing that often includes blood tests to measure thyroid hormone levels or other tests (e.g., ultrasound) as warranted. An estimated 10% of Canadians aged 45 years or older report that they have been diagnosed with thyroid dysfunction, and prevalence is higher in women (16%) than in men (4%). 14 Prevalence has also been reported to be higher in adults older than 85 years (16%), 14 GUIDELINE HEALTH SERVICES CPD

Congenital tuberculosis is uncommon, and nosocomial transmission from a congenitally infected infant to another infant has not been reported in the English literature. We report an investigation of 2 infants with tuberculosis who were cared for in the same neonatal intensive care unit. Isolates from both infants were genetically indistinguishable. Transmission between the 2 infants was likely due to contaminated respiratory equipment.