Institution
Toronto Public Health
Government•Toronto, Ontario, Canada•
About: Toronto Public Health is a government organization based out in Toronto, Ontario, Canada. It is known for research contribution in the topics: Public health & Population. The organization has 287 authors who have published 331 publications receiving 10696 citations.
Topics: Public health, Population, Health promotion, Health care, Outbreak
Papers published on a yearly basis
Papers
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TL;DR: The majority of cases in the SARS outbreak in the greater Toronto area were related to hospital exposure, and several features of the clinical presentation will be useful in raising the suspicion of SARS.
Abstract: ContextSevere acute respiratory syndrome (SARS) is an emerging infectious disease
that first manifested in humans in China in November 2002 and has subsequently
spread worldwide.ObjectivesTo describe the clinical characteristics and short-term outcomes of
SARS in the first large group of patients in North America; to describe how
these patients were treated and the variables associated with poor outcome.Design, Setting, and PatientsRetrospective case series involving 144 adult patients admitted to 10
academic and community hospitals in the greater Toronto, Ontario, area between
March 7 and April 10, 2003, with a diagnosis of suspected or probable SARS.
Patients were included if they had fever, a known exposure to SARS, and respiratory
symptoms or infiltrates observed on chest radiograph. Patients were excluded
if an alternative diagnosis was determined.Main Outcome MeasuresLocation of exposure to SARS; features of the history, physical examination,
and laboratory tests at admission to the hospital; and 21-day outcomes such
as death or intensive care unit (ICU) admission with or without mechanical
ventilation.ResultsOf the 144 patients, 111 (77%) were exposed to SARS in the hospital
setting. Features of the clinical examination most commonly found in these
patients at admission were self-reported fever (99%), documented elevated
temperature (85%), nonproductive cough (69%), myalgia (49%), and dyspnea (42%).
Common laboratory features included elevated lactate dehydrogenase (87%),
hypocalcemia (60%), and lymphopenia (54%). Only 2% of patients had rhinorrhea.
A total of 126 patients (88%) were treated with ribavirin, although its use
was associated with significant toxicity, including hemolysis (in 76%) and
decrease in hemoglobin of 2 g/dL (in 49%). Twenty-nine patients (20%) were
admitted to the ICU with or without mechanical ventilation, and 8 patients
died (21-day mortality, 6.5%; 95% confidence interval [CI], 1.9%-11.8%). Multivariable
analysis showed that the presence of diabetes (relative risk [RR], 3.1; 95%
CI, 1.4-7.2; P = .01) or other comorbid conditions
(RR, 2.5; 95% CI, 1.1-5.8; P = .03) were independently
associated with poor outcome (death, ICU admission, or mechanical ventilation).ConclusionsThe majority of cases in the SARS outbreak in the greater Toronto area
were related to hospital exposure. In the event that contact history becomes
unreliable, several features of the clinical presentation will be useful in
raising the suspicion of SARS. Although SARS is associated with significant
morbidity and mortality, especially in patients with diabetes or other comorbid
conditions, the vast majority (93.5%) of patients in our cohort survived.Published online May 6, 2003 (doi:10.1001/jama.289.21.JOC30885).
1,269 citations
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TL;DR: SARS appears to be of viral origin, with patterns suggesting droplet or contact transmission, and the role of human metapneumovirus, a novel coronavirus, or both requires further investigation.
Abstract: background Severe acute respiratory syndrome (SARS) is a condition of unknown cause that has recently been recognized in patients in Asia, North America, and Europe. This report summarizes the initial epidemiologic findings, clinical description, and diagnostic findings that followed the identification of SARS in Canada. methods SARS was first identified in Canada in early March 2003. We collected epidemiologic, clinical, and diagnostic data from each of the first 10 cases prospectively as they were identified. Specimens from all cases were sent to local, provincial, national, and international laboratories for studies to identify an etiologic agent. results The patients ranged from 24 to 78 years old; 60 percent were men. Transmission occurred only after close contact. The most common presenting symptoms were fever (in 100 percent of cases) and malaise (in 70 percent), followed by nonproductive cough (in 100 percent) and dyspnea (in 80 percent) associated with infiltrates on chest radiography (in 100 percent). Lymphopenia (in 89 percent of those for whom data were available), elevated lactate dehydrogenase levels (in 80 percent), elevated aspartate aminotransferase levels (in 78 percent), and elevated creatinine kinase levels (in 56 percent) were common. Empirical therapy most commonly included antibiotics, oseltamivir, and intravenous ribavirin. Mechanical ventilation was required in five patients. Three patients died, and five have had clinical improvement. The results of laboratory investigations were negative or not clinically significant except for the amplification of human metapneumovirus from respiratory specimens from five of nine patients and the isolation and amplification of a novel coronavirus from five of nine patients. In four cases both pathogens were isolated. conclusions SARS is a condition associated with substantial morbidity and mortality. It appears to be of viral origin, with patterns suggesting droplet or contact transmission. The role of human metapneumovirus, a novel coronavirus, or both requires further investigation.
1,125 citations
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Canadian Science Centre for Human and Animal Health1, Defence Research and Development Canada2, Public Health Agency of Canada3, Toronto Public Health4, North York General Hospital5, University of Toronto6, Mount Sinai Hospital7, Women's College, Kolkata8, Toronto East General Hospital9, Ontario Ministry of Health and Long-Term Care10
TL;DR: These data provide the first experimental confirmation of viral aerosol generation by a patient with SARS, indicating the possibility of airborne droplet transmission, which emphasizes the need for adequate respiratory protection, as well as for strict surface hygiene practices.
Abstract: Severe acute respiratory syndrome (SARS) is characterized by a risk of nosocomial transmission; however, the risk of airborne transmission of SARS is unknown. During the Toronto outbreaks of SARS, we investigated environmental contamination in SARS units, by employing novel air sampling and conventional surface swabbing. Two polymerase chain reaction (PCR)-positive air samples were obtained from a room occupied by a patient with SARS, indicating the presence of the virus in the air of the room. In addition, several PCR-positive swab samples were recovered from frequently touched surfaces in rooms occupied by patients with SARS (a bed table and a television remote control) and in a nurses' station used by staff (a medication refrigerator door). These data provide the first experimental confirmation of viral aerosol generation by a patient with SARS, indicating the possibility of airborne droplet transmission, which emphasizes the need for adequate respiratory protection, as well as for strict surface hygiene practices.
403 citations
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Cancer Council New South Wales1, University of Liverpool2, University of Las Palmas de Gran Canaria3, University of Gothenburg4, Toronto Public Health5, University of Brasília6, University of Hamburg7, Harokopio University8, Durham University9, University of Alberta10, Mount Sinai St. Luke's and Mount Sinai Roosevelt11
TL;DR: Because of the proven connections between food advertising, preferences, and consumption, the findings lend support to calls for regulation of food advertising during children's peak viewing times.
Abstract: Objectives. We compared television food advertising to children in several countries.Methods. We undertook a collaboration among 13 research groups in Australia, Asia, Western Europe, and North and South America. Each group recorded programming for 2 weekdays and 2 weekend days between 6:00 and 22:00, for the 3 channels most watched by children, between October 2007 and March 2008. We classified food advertisements as core (nutrient dense, low in energy), noncore (high in undesirable nutrients or energy, as defined by dietary standards), or miscellaneous. We also categorized thematic content (promotional characters and premiums).Results. Food advertisements composed 11% to 29% of advertisements. Noncore foods were featured in 53% to 87% of food advertisements, and the rate of noncore food advertising was higher during children's peak viewing times. Most food advertisements containing persuasive marketing were for noncore products.Conclusions. Across all sampled countries, children were exposed to high vol...
398 citations
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TL;DR: The experience of home quarantine during the severe acute respiratory syndrome (SARS) outbreak in Toronto in 2003 followed a trajectory of stages beginning before quarantine and ending after quarantine, which has implications for public health policy and practice in planning for future public health emergencies.
Abstract: Objective: The purpose of this study was to explore the experience of home quarantine during the severe acute respiratory syndrome (SARS) outbreak in Toronto in 2003. Design: Qualitative descriptive design. Sample: Stratified random sampling techniques were used to generate a list of potential participants, who varied in terms of gender and closeness of exposure to someone with suspected SARS (contact level). Twenty-one individuals participated in the study. Measurements: All interviews were audiotaped and followed a semistructured interview guide. Participants were invited to describe their experience of quarantine in detail including their advice for Public Health. Results: The experience followed a trajectory of stages beginning before quarantine and ending after quarantine. Despite individual differences, common themes of uncertainty, isolation, and coping intersected the data. Conclusions: Public Health has a dual role of monitoring compliance and providing support to people in quarantine. This study has implications for public health policy and practice in planning for future public health emergencies in terms of the information and the resources required to mount an effective response.
292 citations
Authors
Showing all 287 results
Name | H-index | Papers | Citations |
---|---|---|---|
Donald E. Low | 88 | 359 | 24384 |
Meera Jain | 47 | 72 | 7243 |
Tony Mazzulli | 47 | 231 | 8284 |
Susan E. Richardson | 46 | 166 | 7046 |
Frances B. Jamieson | 39 | 154 | 5108 |
Steven J. Drews | 38 | 174 | 4703 |
Jonathan B. Gubbay | 37 | 172 | 5817 |
Roberto G. Melano | 35 | 95 | 3255 |
Nahuel Fittipaldi | 34 | 100 | 3009 |
Samir N. Patel | 34 | 125 | 3235 |
Amy E. Wright | 33 | 132 | 3290 |
Vanessa Allen | 28 | 86 | 2754 |
Dylan R. Pillai | 23 | 53 | 2758 |
Erin B. Kennedy | 21 | 45 | 1774 |
Alireza Eshaghi | 21 | 60 | 1907 |