Tuberculosis and homelessness in Montreal a retrospective cohort study 英文参考文献.docVIP

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Tuberculosis and homelessness in Montreal a retrospective cohort study 英文参考文献.doc

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Tuberculosis and homelessness in Montreal a retrospective cohort study 英文参考文献

TandeBibianaetal.BMCPublicHealth2011,11:833 /1471-2458/11/833 RESEARCH ARTICLE OpenAccess TuberculosisandhomelessnessinMontreal: aretrospectivecohortstudy JasonTandeBibiana1,CarmineRossi1,2,PaulRivest3,4,AliceZwerling1,2,LouiseThibert5,FionaMcIntosh6, MarcelABehr6,7,8,DickMenzies1,2,9 andKevinSchwartzman1,9* Abstract Background:MontrealisCanada’ssecond-largestcity,wheremeanannualtuberculosis(TB)incidencefrom1996 to2007was8.9/100,000.TheobjectivesofthisstudyweretodescribetheepidemiologyofTBamonghomeless personsinMontrealandassesspatternsoftransmissionandsharingofkeylocations. Methods:Werevieweddemographic,clinical,andmicrobiologicdataforallactiveTBcasesreportedinMontreal from1996to2007andidentifiedpersonswhowerehomelessintheyearpriortoTBdiagnosis.Wegenotypedall availableMycobacteriumtuberculosisisolatesbyIS6110restrictionfragmentlengthpolymorphism(IS6110-RFLP)and spoligotyping,andusedageographicinformationsystemtoidentifypotentiallocationsfortransmissionbetween personswithmatchingisolates. Results:Therewere20casesofTBinhomelesspersons,outof1823totalreportedfrom1996-2007.17/20were Canadian-born,including5Aboriginals.Homelesspersonsweremorelikelythannon-homelesspersonstohave pulmonaryTB(20/20),smear-positivedisease(17/20,oddsratio(OR)=5.7,95%confidenceinterval(CI):1.7-20),HIV co-infection(12/20,OR=14,95%CI:4.8-40),andahistoryofsubstanceuse.Themediandurationfromsymptom onsettodiagnosiswas61daysforhomelesspersonsvs.28daysfornon-homelesspersons(P=0.022).Eleven homelesspersonswithTBbelongedtogenotype-definedclusters(OR=5.4,95%CI:2.2-13),andtenpotential locationsfortransmissionwereidentified,includinghealthcarefacilities,homelessshelters/drop-incentres,andan Aboriginalcommunitycentre. Conclusions:TBcasesamonghomelesspersonsinMontrealraiseconcernsaboutdelayeddiagnosisandongoing localtransmission. Background congregate in crowded and poorly ventilated buildings, As the overall incidence rate of tuberculosis (TB) in such as dormitories and shelters. They may have large Ca