PubMed · 15238480
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Catherine Gerbelli. 2004-07-06. Elective cesarean section.. https://doi.org/10.1503/cmaj.1040638
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BACKGROUND: Health systems worldwide face persistent health workers challenges including nursing shortages, workforce strain, and inequities. In Canada, these challenges have prompted renewed national and provincial reforms to strengthen recruitment, retention, leadership, and sustainability. This paper compares nursing workforce policy directions across Canada, and international jurisdictions to inform policy and planning. METHODS: A cross-country comparative analysis of policies building on a comprehensive national funded review that included an umbrella review of 69 systematic reviews, a comparative policy review of nursing workforce strategies in five jurisdictions, and validation through national horizon-scanning and policy dialogues (n >100). Evidence was analyzed across system, organizational, and individual levels. RESULTS: At the system level, international jurisdictions demonstrate comprehensive, legislated approaches integrating data, governance, and multi-year funding have advanced key nursing strategies. In Canada, the advances show the importance of strategies to have national and provincial/territorial alignment emphasizing leadership, flexibility, and inclusion as key levers. Organizational and individual-level reforms such as mentorship, leadership development, and wellness initiatives are expanding but remain variably evaluated. Experts identified national workforce data strategies and policy integration with embedded evaluation as key enablers to inform scalability and sustainability of implemented strategies. CONCLUSIONS: Canada's nursing workforce reforms are advancing toward coordinated, equity-driven, and evidence-informed strategies. Continued investment in evaluation, leadership, and national integrated data systems along with integrating nursing workforce planning within broader intersectoral planning will consolidate these gains and position Canada as an international leader in sustainable nursing workforce policy.
The possible association of specific fatty acid (FA) intake and pancreatic cancer risk was investigated in a population-based case-control study of 462 histologically confirmed cases and 4721 frequency-matched controls in eight Canadian provinces between 1994 and 1997. Dietary intake was assessed by means of a self-administered food frequency questionnaire. Unconditional logistic regression was used to assess associations between dietary FAs and pancreatic cancer risk. After adjustment for age, province, body mass index, smoking, educational attainment, fat and total energy intake, statistically significant inverse associations were observed between pancreatic cancer risk and palmitate (odds ratios (ORs)=0.73; 95% confidence intervals (CIs) 0.56-0.96; P-trend=0.02), stearate (OR=0.70; 95% CI 0.51-0.94; P-trend=0.04), oleate (OR=0.75; 95% CI 0.55-1.02; P-trend=0.04), saturated FAs (OR=0.67; 95% CI 0.50-0.91; P-trend=0.01), and monounsaturated FAs (OR=0.72; 95% CI 0.53-0.98; P-trend=0.02), when comparing the highest quartile of intake to the lowest. Significant interactions were detected between body mass index and both saturated and monounsaturated FAs, with a markedly reduced risk associated with intake of stearate (OR=0.36; 95% CI 0.18-0.70; P-trend=0.001), oleate (OR=0.36; 95% CI 0.19-0.72; P-trend=0.002), saturated FAs (OR=0.35; 95% CI 0.18-0.67; P-trend=0.002), and monounsaturated FAs (OR=0.32; 95% CI 0.16-0.63; P-trend<0.0001) among subjects who are obese. The results suggest that substituting polyunsaturated FAs with saturated or monounsaturated FAs may reduce pancreatic cancer risk, independently of total energy intake, particularly among obese subjects.
The environmental impacts of gasoline additives such as lead (Pb) and Methyl Tertiary Butyl Ether (MTBE) are well documented, leading to the phasing out of these additives. In contrast, little is known about the health and environmental impacts of potential replacement chemicals such as Methylcyclopentadienyl Manganese Tricarbonyl (MMT). The combustion of MMT in gasoline leads to the formation of MnPO4 and MnSO4 and MMT is considered a recent source of inorganic Mn in urban landscapes particularly in high traffic areas. The main objective of this study is to estimate the automotive deposition of Mn from MMT relative to the traffic volume at sites near a major highway in the Greater Toronto Area of Canada, where MMT is currently being used. Manganese emission levels were estimated for two sites that varied according to Annual Average Daily Traffic (AADT) density, fuel consumption, distance traveled by automobiles, and Mn concentration (mg l(-1)) in gasoline. Multiple regression analysis was used to predict the AADT volume from year 2002-2010. Comparison of the mass balance between the ANOVA means of 15% Mn emitted from the automobile tailpipes at 10, and 18 mg of Mn l(-1) in gasoline was conducted for both study sites. The percentage difference between the Mn input at the selected concentrations of Mn in gasoline and output into surface soil were found to be 99% significant for both sites. Thus the predicted 15% tailpipe emission levels for 10 mg of Mn l(-1) of gasoline used in automobiles, which represented 1290.03 g/year for site 1 and 555.94 g/year for site 2, will add 5.73 and 2.47 mg/kg of Mn annually, respectively. These input levels are considered negligible when compared to the natural abundance of Mn in soil. Based on these data, it could take more than 95-256 years of continuous MMT usage in the region to double the content of Mn in surface soils at the respective sites.