Preliminary epidemiological study of latent tuberculosis in Mexican agricultural workers in the Niagara region, Canada

It is well documented that the majority of Tuberculosis (TB) cases diagnosed in Canada are related to foreign-bom persons from TB high-burden countries. The Canadian seasonal agricultural workers program (SAWP) operating with Mexico allows migrant workers to enter the country with a temporary work permit for up to 8 months. Preiimnigration screening of these workers by both clinical examination and chest X-ray (CXR) reduces the risk of introducing cases of active pulmonary TB to Canada, but screening for latent TB (LTBI) is not routinely done. Studies carried out in industrialized nations with high immigration from TBendemic countries provide data of lifetime LTBI reactivation of around 10% but little is known about reactivation rates within TB-endemic countries where new infections (or reinfections) may be impossible to distinguish from reactivation. Migrant populations like the SAWP workers who spend considerable amounts of time in both Canada and TBendemic rural areas in Mexico are a unique population in terms of TB epidemiology. However, to our knowledge no studies have been undertaken to explore either the existence of LTBI among Mexican workers, the probability of reactivation or the workers' exposure to TB cases while back in their communities before returning the following season. Being aware of their LTBI status may help workers to exercise healthy behaviours to avoid TB reactivation and therefore continue to access the SAWP. In order to assess the prevalence of LTBI and associated risk factors among Mexican migrant workers a preliminary cross sectional study was designed to involve a convenience sample of the Niagara Region's Mexican workers in 2007. Research ethics clearance was granted by Brock University. Individual questionnaires were administered to collect socio-demographic and TB-related epidemiological data as well as TB knowledge and awareness levels. Cellular immunity to M tuberculosis was assessed by both an Interferon-y release assay (lGRA), QuantiFERON -TB Gold In-Tube (QFf™) and by the tuberculin skin test (TSn using Mantoux. A total of 82 Mexican workers (out of 125 invited) completed the study. Most participants were male (80%) and their age ranged from 22 to 65 years (mean 38.5). The prevalence of LTBI was 34% using TST and 18% using QFTTM. As previously reported, TST (using ~lOmm cut-off) showed a sensitivity of 93.3% and a specificity of 79.1 %. These findings at the moment cannot predict the probability of progression to active TB; only longitudinal cohort studies of this population can ascertain this outcome. However, based on recent publications, lORA positive individuals may have up to 14% probability of reactivation within the next two years. Although according to the SA WP guidelines, all workers undergo TB screening before entering or re-entering Canada, CXR examination requirements showed to be inconsistent for this population: whereas 100% of the workers coming to Canada for the first time reported having the procedure done, only 31 % of returning participants reported having had a CXR in the past year. None of the participants reported ever having a CXR compatible with TB which was consistent with the fact that none had ever been diagnosed with active pulmonary TB and with only 3.6% reporting close contact with a person with active TB in their lifetime. Although Mexico reports that 99% of popUlation is fully immunized against TB within the first year of age, only 85.3% of participants reported receiving BOC vaccine in childhood. Conversely, even when TST is not part of the routine TB screening in endemic countries, a suqDrisingly high 25.6% reported receiving a TST in the past. In regards to TB knowledge and awareness, 74% of the studied population had previous knowledge about (active) TB, 42% correctly identified active TB symptomatology, 4.8% identified the correct route of transmission, 4.8% knew about the existence of LTBI, 3.6% knew that latent TB could reactivate and 48% recognized TB as treatable and curable. Of all variables explored as potential risk factors for LTBI, age was the only one which showed statistical significance. Significant associations could not be proven for other known variables (such as sex, TB contact, history of TB) probably because of the small sample size and the homogeneity of the sample. Screening for LTBI by TST (high sensitivity) followed by confirmation with QFT''"'^ (high specificity) suggests to be a good strategy especially for immigrants from TB high-burden countries. After educational sessions, workers positive for LTBI gained greater knowledge about the signs and symptoms of TB reactivation as well as the risk factors commonly associated with reactivation. Additionally, they were more likely to attend their annual health check up and request a CXR exam to monitor for TB reactivation.

Vitamin D status and latent tuberculosis infection : a preliminary study in a group of healthy Mexican agricultural workers

Vitamin D metabolites are important in the regulation of bone and calcium homeostasis, but also have a more ubiquitous role in the regulation of cell differentiation and immune function. Severely low circulating 25-dihydroxyvitamin D [25(OH)D] concentrations have been associated with the onset of active tuberculosis (TB) in immigrant populations, although the association with latent TB infection (LTBI) has not received much attention. A previous study identified the prevalence of LTBI among a sample of Mexican migrant workers enrolled in Canada's Seasonal Agricultural Workers Program (SA WP) in the Niagara Region of Ontario. The aim of the present study was to determine the vitamin D status of the same sample, and identify if a relationship existed with LTBI. Studies of vitamin D deficiency and active TB are most commonly carried out among immigrant populations to non-endemic regions, in which reactivation of LTBI has occurred. Currently, there is limited knowledge of the association between vitamin D deficiency and LTBI. Entry into Canada ensured that these individuals did not have active TB, and L TBI status was established previously by an interferon-gamma release assay (IGRA) (QuantiFERON-TB Gold In-Tube®, Cellestis Ltd., Australia). Awareness of vitamin D status may enable individuals at risk of deficiency to improve their nutritional health, and those with LTBI to be aware of this risk factor for disease. Prevalence of vitamin D insufficiency among the Mexican migrant workers was determined from serum samples collected in the summer of 2007 as part of the cross sectional LTBI study. Samples were measured for concentrations of the main circulating vitamin D metabolite, 25(OH)D, with a widely used 1251 250HD RIA (DiaSorin Inc.®, Stillwater, MN), and were categorized as deficient «37.5 nmoI/L), insufficient (>37.5 nmollL, < 80 nmol/L) or sufficient (2::80 nmoI/L). Fisher's exact tests and t tests were used to determine if vitamin D status (sufficiency or insufficiency) or 25(OH)D concentrations significantly differed by sex or age categories. Predictors of vitamin D insufficiency and 25(OH)D concentrations were taken from questionnaires carried out during the previous study, and analyzed in the present study using multiple regression prediction models. Fisher's exact test and t test was used to determine if vitamin D status or 25(OH)D concentration differed by LTBI status. Strength of the relationship between interferongamma (IFN-y) concentration (released by peripheral T cells in response to TB antigens) and 25(OH)D concentration was analyzed using a Spearman correlation. Out of 87 participants included in the study (78% male; mean age 38 years), 14 were identified as LTBI positive but none had any signs or symptoms of TB reactivation. Only 30% of the participants were vitamin D sufficient, whereas 68% were insufficient and 2% were deficient. Significant independent predictors of lower 25(OH)D concentrations were sex, number of years enrolled in the SA WP and length of stay in Canada. No significant differences were found between 25(OH)D concentrations and LTBI status. There was a significant moderate correlation between IFN-y and 25(OH)D concentrations ofLTBI-positive individuals. The majority of participants presented with Vitamin D insufficiency but none were severely deficient, indicating that 25(OH)D concentrations do not decrease dramatically in populations who temporarily reside in Canada but go back to their countries of origin during the Canadian winter. This study did not find a statistical relationship between low levels of vitamin D and LTBI which suggests that in the presence of overall good health, lower than ideal levels of 2S(OH)D, may still be exerting a protective immunological effect against LTBI reactivation. The challenge remains to determine a critical 2S(OH)D concentration at which reactivation is more likely to occur.

Transmission of West Nile virus in the Niagara Region among a population at risk for exposure

Background. West Nile Virus (WNV), a mosquito-borne flavivirus, is one of an increasing number of infectious diseases that have been emerging or re-emerging in the last two decades. Since the arrival ofWNV to Canada to present date, the Niagara Region has only reported 30 clinical cases, a small number compared to the hundreds reported in other regions of similar conditions. Moreover, the last reported human case in Niagara was in 2006. As it has been demonstrated that the majority of WNV infections are asymptomatic, the question remains whether the lack of clinical cases in Niagara truly reflects the lack of transmission to humans or if infections are still occurring but are mostly asymptomatic. Objectives. The general objective of this study was to establish whether or not active WNV transmission could be detected in a human population residing in Niagara for the 2007 transmission season. To fullfil this objective, a cross-sectional seroprevalence study was designed to investigate for the presence of anti-WNV antibodies in a sample of Mexican migrant agricultural workers employed in farms registered with the Seasonal Agricultural Workers Program (SAWP). Due to the Mexican origin of the study participants, three specific research objectives were proposed: a) determine the seroprevalence ofanti-WNV antibodies as well as anti-Dengue virus antibodies (a closely related virus prevalent in Mexico and likely to confound WNV serology); b) analyze risk factors associated with WNV and Dengue virus seropositivity; and c) assess the awareness of study participants about WNV infection as well as their understanding of the mode of transmission and clinical importance of the infection. Methodology: After obtaining ethics clearance from Brock University, farms were visited and workers invited to participate. Due to time constraints, only a small number of farms were enrolled with a resulting convenience and non-randomized study sample. Workers' demographic and epidemiological data were collected using a standardized questionnaire and blood samples were drawn to determine serum anti-WNV and anti- Dengue antibodies with a commercial ELISA. All positive samples were sent to the National Microbiology Laboratory in Winnipeg, Manitoba for confirmation with the Plaque Reduction Neutralization Test (PRNT). Data was analyzed with Stata 10.0. Antibody determinations were reported as seroprevalence proportions for both WNV and Dengue. Logistic regression was used to analyze risk factors that may be associated with seropositivity and awareness was reported as a proportion of the number of individuals possessing awareness over the total number of participants. Results and Discussion. In total 92 participants working in 5 farms completed the study. Using the commercial ELISA, seropositivity was as follows: 2.2% for WNV IgM, 20.7% for WNV IgG, and 17.1 % for Dengue IgG. Possible cross-reactivity was demonstrated in 15/20 (75.0%) samples that were positive for both WNV IgG and Dengue IgG. Confirmatory testing with the PRNT demonstrated that none of the WNV ELISA positive samples had antibodies to WNV but 13 samples tested positive for anti-Dengue antibodies (14.1 % Dengue sereoprevalence). The findings showed that the ELISA performance was very poor for assessing anti-WNV antibodies in individuals previously exposed to Dengue virus. However, the ELISA had better sensitivity and specificity for assessing anti-Dengue antibodies. Whereas statistical analysis could not be done for WNV seropositivity, as all samples were PRNT negative, logistic regression demonstrated several risk factors for Dengue exposure_ The first year coming to Canada appeared to be significantly associated with increased exposure to Dengue while lower socio-economic housing and the presence of a water basin in the yard in Mexico appeared to be significantly associated with a decreased exposure to Dengue_ These seemingly contradictory results illustrate that in mobile populations such as migrant workers, risk factors for exposure to Dengue are not easily identified and more research is needed. Assessing the awareness of WNV and its clinical importance showed that only 23% of participants had some knowledge of WNV, of which 76% knew that the infection was mosquito-borne and 47% recognized fever as a symptom. The identified lack of understanding and awareness was not surprising since WNV is not a visible disease in Mexico. Since WNV persists in an enzootic cycle in Niagara and the occurrence of future outbreaks is unpredictable, the agricultural workers remain at risk for transmission. Therefore it important they receive sufficient health education regarding WNV before leaving Mexico and during their stay in Canada. Conclusions. Human transmission of WNV could not be proven among the study participants even when due to their occupation they are at high risk for mosquito bites. The limitations of the study sample do not permit generalizable conclusions, however, the study findings are consistent with the absence of clinical cases in the Niagara Region, so it is likely that human transmission is indeed neglible or absent. As evidenced by our WNV serology results, PRNT must be utilized as a confirmatory test since false positivity occurs frequently. This is especially true when previous exposure to Dengue virus is likely.

Lini Richarda Grol Fonds, 1946-2007

Lini Richarda Grol was originally born in Nijmegen, Netherlands in 1913 and immigrated to Canada in 1954 after working as a nurse in South America for three years from 1951 to 1954. She was granted her first Canadian passport in 1961 and worked full-time as nurse at the Welland County Hospital. While nursing she would enroll in writing courses at McMaster University and Ryerson Polytechnical Institute, now Ryerson University. Eventually she decided to dedicate herself to her writing and artwork and began to only work as a nurse part-time and then later opened the Fonthill Studio to devote herself to her writing and artwork full-time. Her status as an immigrant and career as a nurse provided inspiration for much of her writing and she frequently tackles the experience of the female immigrant in her works. Her first publication was in 1938 in a small literary and women’s magazines in Holland and Belgium and her first work of poetry was entitled Stive Gedachten. None of these publications exist in this archive. Her most well-known publication, Liberation, centers around her experiences leading up to and after the liberation of Holland during World War II. Grol was, and continues to be a prolific writer in the Niagara Region and has been published in the Welland Tribune, Pelham Herald, Thorold News, Parent Magazine, Dunville Chronicle, and various Christian publications and literary newsletters and journals. Grol also started her own poetry magazine entitled Canadian Poets Pen Club to help aspiring writers get published. Perhaps her most recognized achievement was the inclusion of one of her poems and the recognition of her novel Liberation into the Thank You Canada Day celebration in May 1970. Grol participated in many local writers’ groups such as the Welland Writer’s Club, and the Canadian Author’s Association. Grol was membership secretary for the Canadian Author’s Association in 1984. She also founded a writer’s club in 1995 in her retirement home, Holland Christian Homes where members meet to talk about their poems and short stories either in English or Dutch. Participating in and creating a writers’ community is integral to Grol’s identity as an author and can be related to the feelings of isolation she felt as an immigrant to Canada. Grol also hosted her own television shows entitled Discovery with Lini Grol which featured guests, usually local artists and writers, and Holland en Hollanders a cultural program for Dutch immigrants. Grol’s most recent activities include the publication of a one act play entitled Peppermint Problems [1996] and a short story entitled “When our War started in Rotterdam” [2004]. In 1994, she moved to Brampton, Ontario into a Christian retirement center called Holland Christian Homes. For further biographical information about Grol see two books contained within this collection Women of Action [1976] and Something About the Author [1976].

Photograph - William Bliss Carman and Miss M. B. Stevenson, September 1927

A photograph of poet William Bliss Carman and M. B. Stevenson in New Canaan, Connecticut. The photograph from September 1927 was sent to fellow poet Ethelwyn Wetherald in 1932. It was included in a four page letter from Carman to Wetherald. Carman, also Canadian, spent most of his years in the United States, but in his letter he mentions that he "regrets" he cannot keep in closer touch with his fellow Canadian poets.

Letter - Bliss Carman to Ethelwyn Wetherald, 15 Decemer 1897

This letter from William Bliss Carman to Ethelwyn Wetherald in 1897, includes a photo of Carman with Miss M. B. Stevenson from the year 1927. Carman, originally from Canada, had great success as

Job Demands and Organizational Citizenship Behavior: The Roles of Organizational Commitment and Social Interaction

Drawing from the Job Demands-Resources (JD-R) model and research on social exchange relationships, this study investigates the impact of three job demands (work overload, interpersonal conflict, and dissatisfaction with the organization’s current situation) on employees’ organizational citizenship behavior (OCB), the hitherto unexplored mediating role of organizational commitment in the link between job demands and organizational citizenship behavior (OCB), as well as how this mediating effect might be moderated by social interaction. Using a multi-source, two-wave research design, surveys were administered to 707 employees and their supervisors in a Mexican-based organization. The hypotheses were tested with hierarchical regression analysis. The results indicate a direct negative relationship between interpersonal conflict and OCB, and a mediating effect of organizational commitment for interpersonal conflict and dissatisfaction with the organization’s current situation. Further, social interaction moderates the mediating effect of organizational commitment for each of the three job demands such that the mediating effect is weaker at higher levels of social interaction. The study suggests that organizations aiming to instill OCB among their employees should match the immediate work context surrounding their task execution with an internal environment that promotes informal relationship building.

Dorothy Rungeling fonds, 1887-2013, n.d.

Dorothy Rungeling was born in 1911 and raised in Fenwick, Ontario, by her adopted mother, Ethelwyn Wetherald. After graduating high school, she attended Fort Erie business College. She worked briefly in Toronto and then Hamilton, but eventually took a job with Brown Brothers’ Nursery in Pelham to be closer to home. Dorothy pursued many interests, learning to play the violin, saxophone and clarinet. She met her husband Charles at a local dance where she was playing. In 1939, they opened an automobile and farm machinery business in Welland. In their spare time, they were active in skeet and trap shooting, for which Dorothy won many trophies. In the early 1940s, Dorothy developed a passion for horses, training and showing them in addition to teaching riding at the Welland Riding Club, as well as judging at horse shows. By the late 1940s her interest in horses was waning, but she soon after discovered and pursued a new interest: flying. She joined the Welland Flying Club, obtained a flying licence, and in 1949 purchased her first plane. She proceeded to obtain a Commercial Pilot Licence in 1951, an Instructor’s Licence in 1953, and a Senior Commercial Licence in 1954. She participated in many air races in the 1950s, including the All Women’s International Air Races, the Women’s Transcontinental Air Races, and the Canadian Governor-General’s Cup Air Race. Some of the most notable races were the 1954 International Air Race, where Dorothy met with President Batista of Cuba, and the Governor-General’s Cup Air Race, where she won 1st place in 1953 and 1956 (and was the only woman competing). In 1958, she was also the first Canadian woman to solo pilot a helicopter. That same year she obtained her Airline Transport Licence. She also wrote several articles on aviation, contributing to publications such as Canadian Aviation and Air Facts, a U.S. aviation magazine. In addition to these articles, Dorothy authored several books about her life, as well as a selection of poems and articles by Ethelwyn Wetherald. As planes became more expensive, Dorothy spent less time flying, instead pursuing an interest in sailing. She and her husband bought a sailboat and became members of the Niagara-on-the-Lake Sailing Club. In 2003, Dorothy was awarded the Order of Canada for her accomplishments. She also wrote a regular column for the Voice of Pelham in 2012-2013, called A Century in Pelham. Dorothy celebrated her 100th birthday in 2011, and remains an active member of the community.