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mtDNA from fossils reveals a radiation of Hawaiian geese recently derived from the Canada goose (Brantacanadensis).

Phylogenetic analysis of 1.35 kb of mtDNA sequence from fossils revealed a previously unknown radiation of Hawaiian geese, of which only one representative remains alive (the endangered Hawaiian goose or nene, Branta sandvicensis). This radiation is nested phylogenetically within a living species, the Canada goose (Branta canadensis) and is related most closely to the large-bodied lineage within that species. The barnacle goose (Branta leucopsis) is also nested within the Canada goose species and is related most closely to the small-bodied lineage of Canada geese. The peripheral isolation of the barnacle goose in the Palearctic apparently allowed the evolution of its distinctive plumage pattern, whereas the two Nearctic lineages of Canada geese share a primitive plumage pattern. The Hawaiian lineage of Canada geese diverged more dramatically, splitting into at least three species that differ in body size, body proportions, and flight ability. One fossil species, limited to the island of Hawaii, was related closely to the nene but was over four times larger, flightless, heavy-bodied and had a much more robust cranium. Application of a rate calibration to levels of DNA divergence suggests that this species evolved on the island of Hawaii in less than 500,000 years. This date is consistent with the potassium/argon-based age of the island of Hawaii of 430,000-500,000 years. The giant Hawaii goose resembles the moa-nalos, a group of massive, extinct, flightless ducks that lived on older Hawaiian Islands and thus is an example of convergent evolution of similar morphologies in island ecosystems.

Animals↗

Cronkhite-Canada syndrome containing colon cancer and serrated adenoma lesions.

We describe a case of Cronkhite-Canada syndrome associated with sigmoid colon cancer, and provide a literature review. A 77-year-old man was diagnosed with sigmoid colon cancer after presenting with hypoproteinemia, nail atrophy, loss of scalp hair, hyperpigmentation, and gastrointestinal polyposis. The findings were consistent with Cronkhite-Canada syndrome. The colon polyps were histologically serrated adenomas, whose crypts showed a saw-toothed growth pattern with dysplasia, or tubular adenoma. Cronkhite-Canada syndrome associated with colon cancer has been reported in 31 cases. The availability of histologic material permitted reexamination of 25 of these cases. Serrated adenoma of the polypoid lesions was retrospectively found in 10 (40%) of the 25 cases. By comparison, the incidence of serrated adenomas has been estimated to occur in about 1% of all general polyps. Taken together, it is suggested that Cronkhite-Canada syndrome associated with colorectal cancer frequently has polyps containing serrated adenoma lesions. In the case described here, microsatellite instability and overexpression of the p53 protein were found in the cancer lesion and serrated adenoma lesions, and none of the lesions showed a loss of heterozygosity of various genes or K-RAS mutations. Thus, genetic alterations between the serrated adenoma and the colorectal cancer was correlated in this case. These findings suggested the possibility of a serrated adenoma-carcinoma sequence in this case of Cronkhite-Canada syndrome.

Adenoma↗

Learning needs of nurses working in Canada's First Nations communities and hospitals.

BACKGROUND: What are the learning needs of nurses providing services to Canada's First Nations Communities and Hospitals? First Nations (or Indian Band) are similar to communities except some comprise more than one geographic Native community. Aboriginal (or Native) individuals are members of the North American Indian, Inuit, or Métis peoples of Canada; those who reported being a Treaty or Registered Indian (with the Federal Government); or those who are members of an Indian Band/First Nation. METHOD: A Canada-wide survey was completed to determine the learning needs of nurses working with Canada's Aboriginal persons. RESULTS: Nurses indicated both broad and specific aspects of their clinical practice, which were important to their continuing education (CE) needs. Broad thematic areas for continuing education included the following: emergency/acute care and obstetrics/gynecology clinical skills, health and physical assessment, mental health, and prenatal and postnatal care. Specific areas nurses cited for CE included issues related to: victims of violence; non-compliant clients; substance abuse; and fetal alcohol syndrome. CONCLUSION: This study examined the learning needs of nurses working with Canada's Native people and provided a basis for comparing and contrasting CE issues of these nurses to other nurses working in remote locations around the world.

Adult↗

Antigenic relations of Rickettsia prowazekii and Rickettsia canada, established in the study of sera of patients with Brill's disease.

Sera of patients with Brill's disease and of healthy persons with spotted fever in their past history were examined in the complement fixation reaction (CFR) to determine antigenic relations between R. prowazekii and R. canada. R. canada was found to have common antigenic determinants with R. prowazekii and R. mooseri. However, the antigenic determinants of R. canada differed from those of the mentioned rickettsiae. The titres of complement-fixing antibodies in the sera of patients with Brill's disease with the antigen of R. mooseri were lower than the titres with the homologous antigen within the range of 1-2 twofold dilutions of the serum. However, the oscillations of the titres with the antigen of R. canada in the study of the same sera were expressed in 1-5 twofold dilutions. In serological identification of canada rickettsiosis, antigens of rickettsiae of the spotted fever group should invariably be included in the investigation of the sera.

Antigens↗

[Luminescent-serologic analysis of the antigenic interrelationship between R. canada and classic representatives of rickettsiae of the typhus group].

The results of studying the antigenic relationships of R. canada, a new Rickettsia species, and classical Rickettsia species of the typhus group are presented. The study was carried out by luminescent serological analysis with the use of corpuscular antigens and the live infectious agent cultures. R. canada and Rickettsiae of the typhus group were similar in their antigenic structures; this, however, could be revealed only in the study of the live cultures of the infectious agents. The study of corpuscular antigens revealed unilateral relationship: R. prowazeki antigen could be detected with homologous and heterologous sera, R. canada antigen with homologous serum only. In the CFT and the agglutination test corpuscular R. canada antigen reacted with homologous and heterologous sera. The study of the live cultures of the infectious agents revealed that different R. prowazeki and R. typhi strains vary in the degree of their similarity to R. canada.

Agglutination Tests↗

Antituberculosis drug resistance in immigrants to Alberta, Canada, with tuberculosis, 1982-1994.

SETTING: Provincial Tuberculosis Service, Alberta, Canada. OBJECTIVE: To estimate resistance rates of Mycobacterium tuberculosis to antituberculosis drugs in relation to previous treatment, country of origin, age and duration of residence in Canada. DESIGN: Retrospective chart review of all culture-positive tuberculosis diagnosed between 1982 and 1994 in immigrants to Alberta. RESULTS: A total of 753 immigrants with culture-positive tuberculosis were studied; 131 patients (17.4%, 95% Confidence Interval [CI] 14.7, 20.1) had strains resistant to one or more of the first-line medications (isoniazid [INH], rifampin [RIF], ethambutol [EMB], pyrazinamide [PZA], and streptomycin [SM]). Initial and secondary resistance rates were 16.4% and 30.3%, respectively (P = 0.003, Odds ratio [OR] 2.2, 95% CI 1.3, 3.8). Resistance occurred in 22.2% of patients 40 years of age and under, and in 13.8% of those over 40 years of age (P = 0.005, OR 1.8, 95% CI 1.2, 2.6). Resistant M. tuberculosis was isolated from 20.4% of those who had lived in Canada for less than 15 years, and in 9.0% of those who had immigrated to Canada more than 15 years before diagnosis (P < 0.001; OR 2.4, 95% CI 1.3, 4.2). Resistance rates to individual medications in all immigrants were as follows: INH 9.9% (95% CI 7.8, 12.0), RIF 0.8% (95% CI 0.2, 1.4), EMB 1.9% (95% CI 1.0, 2.8), PZA 1.9% (95% CI 0.3, 3.5), and SM 12.9% (95% CI 10.4, 15.4). Immigrants from Vietnam, China, and the Philippines had tuberculosis strains that were resistant to one or more of the first line medications in 30.2%, 21.8%, and 15.5% of cases, respectively (P = 0.04). CONCLUSION: In industrialized countries such as Canada where most cases of tuberculosis are diagnosed among the foreign-born, drug resistance surveys continue to be an important part of an effective tuberculosis control program.

Adolescent↗

2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada.

OBJECTIVE: To revise and expand the 1996 Osteoporosis Society of Canada clinical practice guidelines for the management of osteoporosis, incorporating recent advances in diagnosis, prevention and management of osteoporosis, and to identify and assess the evidence supporting the recommendations. OPTIONS: All aspects of osteoporosis care and its fracture complications - including classification, diagnosis, management and methods for screening, as well as prevention and reducing fracture risk - were reviewed, revised as required and expressed as a set of recommendations. OUTCOMES: Strategies for identifying and evaluating those at high risk; the use of bone mineral density and biochemical markers in diagnosis and assessing response to management; recommendations regarding nutrition and physical activity; and the selection of pharmacologic therapy for the prevention and management of osteoporosis in men and women and for osteoporosis resulting from glucocorticoid treatment. EVIDENCE: All recommendations were developed using a justifiable and reproducible process involving an explicit method for the evaluation and citation of supporting evidence. VALUES: All recommendations were reviewed by members of the Scientific Advisory Council of the Osteoporosis Society of Canada, an expert steering committee and others, including family physicians, dietitians, therapists and representatives of various medical specialties involved in osteoporosis care (geriatric medicine, rheumatology, endocrinology, obstetrics and gynecology, nephrology, radiology) as well as methodologists from across Canada. BENEFITS, HARM AND COSTS: Earlier diagnosis and prevention of fractures should decrease the medical, social and economic burdens of this disease. RECOMMENDATIONS: This document outlines detailed recommendations pertaining to all aspects of osteoporosis. Strategies for identifying those at increased risk (i.e., those with at least one major or 2 minor risk factors) and screening with central dual-energy x-ray absorptiometry at age 65 years are recommended. Bisphosphonates and raloxifene are first-line therapies in the prevention and treatment of postmenopausal osteoporosis. Estrogen and progestin/progesterone is a first-line therapy in the prevention and a second-line therapy in the treatment of postmenopausal osteoporosis. Nasal calcitonin is a second-line therapy in the treatment of postmenopausal osteoporosis. Although not yet approved for use in Canada, hPTH(1-34) is expected to be a first-line treatment for postmenopausal women with severe osteoporosis. Ipriflavone, vitamin K and fluoride are not recommended. Bisphosphonates are the first-line therapy for the prevention and treatment of osteoporosis in patients requiring prolonged glucocorticoid therapy and for men with osteoporosis. Nasal or parenteral calcitonin is a first-line treatment for pain associated with acute vertebral fractures. Impact-type exercise and age-appropriate calcium and vitamin D intake are recommended for the prevention of osteoporosis. VALIDATION: All recommendations were graded according to the strength of the evidence; where the evidence was insufficient and recommendations were based on consensus opinion alone, this is indicated. These guidelines are viewed as a work in progress and will be updated periodically in response to advances in this field.

Adult↗

A decade of surgery in Canada, England and Wales, and the United States.

Between 1966 and 1976, overall surgical rates in Canada remained relatively unchanged and consistently 60% higher than those in England and Wales. Overall United States rates were the highest of the three countries and increased 25% over the ten years. Numbers of surgeons per capita increased in both Canada and England and Wales but overall surgical rates in the two operative rates increased. During the decade, Canada had more hospital beds per capita than the United States while England and Wales had the fewest. Since 1970, the percentage of gross national product spent on health care has been greatest in the United States, intermediate in Canada, and lowest in England and Wales. These expenditures may better reflect national priorities and value and, thus be more important than per capita numbers of hospital beds or surgeons in explaining the cross-national difference in rates of surgery.

Aged↗

Comparison of the site distribution of melanoma in New Zealand and Canada.

A comparison of the site distribution of cutaneous malignant melanoma in New Zealand and Canada was performed. This series deals with 41,331 incident cases registered between 1968 and 1990 and is the largest to date to evaluate the influence of age and gender on the site distribution of melanoma. Site-specific, age-standardized rates per unit surface area and relative tumour density were assessed by gender and country and differences compared with statistical techniques adapted to this context. The age-standardized rates for all sites were higher in New Zealand than in Canada, the ratio being 3.2 for men and 3.8 for women. Occurrence of melanoma was denser for chronically than intermittently exposed sites in both New Zealand and Canada. The highest incidence rate per unit area was for the ears in men which was more than 5 times the rate for the entire body in each country. For each gender, melanomas were relatively commoner on the trunk and the face in Canada, and on the lower limbs in New Zealand. The variations in the site distribution were similar in each country and consistent with the effect of differential patterns of sun exposure between genders. Our results show that the levels of risk of melanoma between phenotypically comparable populations exposed to different amount of UV radiation vary in a site-specific manner, especially for intermittently exposed sites. This suggests that both environmental conditions and lifestyle factors influence the site distribution of melanoma in these two populations.

Canada↗

A comparison of regulatory approval times for new chemical entities in Australia, Canada, Sweden, the United Kingdom, and the United States.

Regulatory approval times of new chemical entities (NCEs) in Australia, Canada, Sweden, the United Kingdom (UK), and the United States (US) were compared. The approval times of a set of common 25 NCEs and a larger set of unmatched NCEs were very similar in Australia, Canada, Sweden and the US, with median approval times from 23 to 29 months. The median approval time in the UK was approximately 11 months. Analysis of the data showed that the approval times in Australia, Sweden, and the UK were not significantly affected by the therapeutic classification of the drug, the amount of additional data requested and received, or the submission date. In Canada, the date the drug submission was received and the frequency of additional data requests significantly affected the approval times. In the US, the date the drug submission was received and the frequency of additional data received significantly affected the approval times. The therapeutic classification of the drug did not significantly affect the approval time in Canada or the US.

Australia↗

PCR-based species identification tools for wireworms (Coleoptera: Elateridae) of economic importance in Canada.

BACKGROUND: Coexistence of pest and non-pest wireworms (Coleoptera: Elateridae) in agricultural fields makes species-level identification critical to determine when pest management measures are required. However, morphological identification of wireworms (larval stage of click beetles) is challenging, as larvae are difficult to distinguish based on morphological features and misidentifications are common. Here, we developed species-specific primers for 15 click beetle species to be used in PCR-based species-level identification for agricultural fields across Canada. RESULTS: Partial sequences of the gene regions cytochrome c oxidase I (COXI), 16S, 12S, 28S, 18S, internal transcribed spacer 2 (ITS2), cytochrome-b (CYTB), elongation factor 1 (EF1), ATP6/8, NADH dehydrogenase 1 (ND1), NADH dehydrogenase 2 (ND2), NADH dehydrogenase 3 (ND3), NADH dehydrogenase 4 (ND4), NADH dehydrogenase 5 (ND5) and NADH dehydrogenase 6 (ND6) were generated for elaterid species of interest. Of these gene regions, primers were designed on the mitochondrial gene regions COXI, CYTB and ND1 that had sufficient variation to discriminate among species and tested for species specificity using additional pest and non-pest species from the families Elateridae, Carabidae, Scarabidae and Silphidae. Specificity testing confirmed that all primer sets were species-specific. CONCLUSION: The novel primers designed in this study allow for PCR-based species identification of 15 economically important click beetle pest species in Canada. Further testing is needed to validate the assay for use outside of Canada. Accurate species-level identification will benefit pest management professionals by informing management decisions and reducing the use of insurance insecticide applications due to difficulties with identifications of wireworm pest species. &#xa9; 2026 His Majesty the King in Right of Canada and The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. Reproduced with the permission of the Minister of Agriculture and Agri-Food.

Animals↗

No net loss of fish habitat: a review and analysis of habitat compensation in Canada.

The achievement of No Net Loss (NNL) through habitat compensation has rarely been assessed in Canada. Files relating to 124 Fisheries Act Section 35(2) authorizations issued by Fisheries and Oceans Canada for the harmful alteration, disruption, and destruction of fish habitat (HADD) were collected and reviewed. Data extracted from these files were pooled and analyzed to provide an indication of the types of HADDs that have been authorized in Canada, what habitats have been affected, and what habitat management approaches have been used when compensating for HADDs and monitoring and ensuring the success of the compensation. Determinations regarding the effectiveness of habitat compensation in achieving NNL were made. Impacts to 419,562 m2 of fish habitat from the 124 authorized HADDs were offset by 1,020,388 m2 of compensatory habitat. Eighty percent of the authorizations had compensation ratios (compensation area:HADD area) of 2:1 or less, and 25% of the authorizations had a compensation ratio that was less than 1:1. In-channel and riparian habitat were the most frequently impacted habitats. Urban development and roads and highways resulted in the greatest areal loss of habitat. The compensation option that was most often selected was the creation of in-kind habitat. The mean duration of post-construction monitoring programs was 3.7 years. Determinations of NNL could only be made for 17 authorizations as a result of poor proponent compliance with monitoring requirements and the qualitative assessment procedures used by the monitoring programs. Adequate resources, proper training, and standardized approaches to data management and monitoring programs are required to ensure that the conservation goal of NNL can be achieved in Canada.

Animals↗

Compliance with Canada's Fisheries Act: a field audit of habitat compensation projects.

Loss of fish habitat in North America has occurred at an unprecedented rate through the last century. In response, the Canadian Parliament enacted the habitat provisions of the Fisheries Act. Under these provisions, a "harmful alteration, disruption, or destruction to fish habitat" (HADD) cannot occur unless authorised by Fisheries and Oceans Canada (DFO), with legally binding compensatory habitat to offset the HADD. The guiding principle to DFO's conservation goal is "no net loss of the productive capacity of fish habitats" (NNL). However, performance in achieving NNL has never been evaluated on a national scale. We investigated 52 habitat compensation projects across Canada to determine compliance with physical, biological, and chemical requirements of Section 35(2) Fisheries Act authorisations. Biological requirements had the lowest compliance (58%) and chemical requirements the highest (100%). Compliance with biological requirements differed among habitat categories and was poorest (19% compliance) in riparian habitats. Approximately 86% of authorisations had larger HADD and/or smaller compensation areas than authorised. The largest noncompliance in terms of habitat area occurred in riverine habitat in which HADDs were, on average, 343% larger than initially authorised. In total, 67% of compensation projects resulted in net losses of habitat area, 2% resulted in no net loss, and 31% achieved a net gain in habitat area. Interestingly, probable violations of the Fisheries Act were prevalent at half of the projects. Analyses indicated that the frequency of probable Fisheries Act violations differed among provinces. Habitat compensation to achieve NNL, as currently implemented in Canada, is at best only slowing the rate of habitat loss. In all likelihood, increasing the amount of authorised compensatory habitat in the absence of institutional changes will not reverse this trend. Improvements in monitoring and enforcement are necessary to move towards achieving Canada's conservation goals.

Animals↗

Community-based environmental management in Atlantic Canada: the impacts and spheres of influence of the Atlantic Coastal Action Program.

The Atlantic Coastal Action Program (ACAP) is a unique, community-based program initiated by Environment Canada in 1991 to help Atlantic Canadians restore and sustain watersheds and adjacent coastal areas. ACAP is the eastem-most Environment Canada Ecosystem Initiative. The ACAP family is currently made up of 14 ecosystem-based organizations in the four Atlantic provinces. Each one of these non-profit organizations operates independently, but is formally linked under the umbrella of ACAP to represent a force stronger than the individual parts. In Environment Canada's experience, the program consistently demonstrates the value of a community-based approach and produces results on an ecosystem basis. This paper will examine some of the impacts of ACAP in terms of economics, credible community science, and environmental results which most often align with Environment Canada's objectives. It will explore the influences of the community-based approach to environmental management on multiple scales (local, regional, etc.). Through examples, the paper will demonstrate the effectiveness of ACAP in influencing some of the policies, programs and attitudes of various levels of government and industry in the region, as well as describe how the community-based model has been exported internationally. The paper will conclude with a discussion on a planned path forward for ACAP.

Atlantic Ocean↗

Risk assessment of use of cracked eggs in Canada.

In 1992, Agriculture and Agri-Food Canada (AAFC) amended its Egg Regulations to restrict movement of Canada C eggs (cracks) to federally registered processed egg stations for pasteurization. This was questioned by egg producers and some provinces on economic grounds. It was also in conflict with long-standing practices of marketing eggs in some provinces to retail stores, bakeries, restaurants and institutions or at the farm gate. In order to determine how much of a risk these eggs were to human health, AAFC requested that the Health Protection Branch (HPB) of Health Canada (HC) conduct a risk assessment. On the basis of outbreak data, the main hazard in these eggs was identified as Salmonella. Salmonellae may occasionally be present on shell eggs even after washing, and any Salmonella reaching the membranes can be transferred to an egg mixture through breaking, and will rapidly grow under improper storage conditions. A Relative Risk analysis showed that cracked eggs are 3 to 93 times more likely than uncracked shell eggs to cause outbreaks. A probability of illness of 1 in 3800 was derived from the 40 million cracked eggs produced in Canada and not pasteurized and the probable 10,500 illnesses arising from these. This was for the general population, but this would be greater for those who consume many shell eggs or would do so in an unsafe manner, or are more likely to be infected (5% of consumers who eat raw or lightly cooked eggs daily, rural communities with more opportunities for obtaining cracked eggs, and those who are immunocompromised and in institutions). Even though it is not possible to precisely determine the risk of salmonellosis through cracked eggs, this assessment indicated that there was enough of a concern that a management strategy was needed. Eight options for managing the risk were considered and ranked for acceptability by both HC and AAFC. Ideally, all cracked eggs should be broken and pasteurized, but this is impractical in certain regions of the country, and other options, such as sales to food processors operating under Good Manufacturing Practices (GMP), and at the farm gate in marked cartons and under controlled conditions, were considered to be acceptable, whereas sales to institutions and bakeries were not. This is the first fromal food-related microbiological risk assessment that HC has completed. Although this is a Canadian problem, any country producing eggs has to recognise that despite any regulations controlling the use of cracked eggs, economics will dictate that some of these will be consumed as whole eggs or egg products, and a management plan is desirable to limit hazardous practices associated with these eggs.

Canada↗

Health risk assessment of Listeria monocytogenes in Canada.

In this review, the major steps used in the formulation of a health risk assessment for Listeria monocytogenes in foods are discussed. Data is given on the numbers of human listeriosis cases reported in Canada along with the current Canadian regulatory policy on L. monocytogenes. Four major steps in the health risk assessment of this organism in foods, namely, hazard identification, hazard characterization, exposure assessment and risk characterization, were examined. For hazard characterization, since it is known that no direct human dose response data is available for L.monocytogenes, a flexible dose response model called the Weibull-Gamma model was evaluated. For the exposure assessment, pâté and soft cheese, both high-risk foods in terms of listeriosis infection, were used as prototypes in some of the models that were used. Using disappearance data for cheese and 100 g as a typical serving, the data suggested an average of 102 servings per capita, per year in Canada. As a rough approximation, for L. monocytogenes, reference ID10 and ID90 dose levels of response for both normal and high risk populations were given as 10(7) and 10(9) for normal individuals, and 10(5) and 10(7) for high-risk people. The corresponding dose response models were graphically displayed. These models exhibited a higher degree of susceptibility and less host/pathogen heterogeneity for the higher risk group. The range of doses between the ID10 and ID90 reference values corresponded roughly to levels associated with cases of listeriosis. In the risk characterization stage, dose response data was combined with some predictive growth modeling data of L. monocytogenes on pâté, assuming an initial exposure of a single cell for food stored at 4 degrees and 8 degrees C. Storage of pâté at 4 degrees C for more than 35 days resulted in a rapidly increasing risk for the high risk population, while storage at 8 degrees C produced a similar risk after about 13 days. In addition, an equation, used to calculate the average probability of acquiring human listeriosis in Canada from soft and semi-soft cheese consumption, was formulated. Computations derived from this equation indicated a substantial level consistency between reported data and assumptions of the risk assessment model. An important part of risk characterization or possibly risk management is characterizing the economic and social consequences of estimated risks. The total annual estimated cost of listeriosis illnesses and deaths in Canada was estimated to be between 11.1 and 12.6 million dollars.

Canada↗

Recent trends in expenditures on physicians' services in Canada.

Analysis of Canada's restraints on the growth in volume of physicians' services can help shape the framework and direction of policy development in other countries. This paper analyzes trends in recent expenditures on physicians' services in Canada from 1982 to 1987. Growth in payments to physicians who were paid fee-for-service is broken down into three component parts in Canada nationwide and in four provinces: Ontario, Quebec, Nova Scotia and British Columbia. The three component parts are: (1) growth in the number of services billed; (2) physician service prices; and (3) the mixture of high- and low-priced services billed. Expenditure increases are disaggregated according to some major categories of medical services, both per physician and per capita. Increases in growth in physician payments were explained mainly by increases in prices, while some evidence of an increase in higher priced services per physician was found. The varying payment restraint policies across Canadian provinces were manifested in different patterns with respect to components of payment change. Higher rates of payment and volume growth were found for diagnostic/therapeutic and office medical services than for surgeries, although a few contrary patterns across provinces occurred. Interprovincial utilization growth, both per physician and per capita, was variable. This suggests that Canada's regionally administered system is neither uniform nor monolithic.

Canada↗

Anesthesia in Canada's health care system.

Much has been written about Canada's health care system as all countries wrestle with rising health costs. Few, however, have attempted to describe the influence of a system of health care on a nonprimary care specialty such as anesthesia. The purpose of this review is to describe the Canadian system, contrast it with that of the United States, and outline the impact that Canadian Medicare has had on anesthetic practice. A centrally controlled health care system is potentially blessed with the stability (and rigidity) inherent in any program perceived by the public as being their right and privilege. Changes are slow to occur, be they changes of new technology or alterations in the form of physician reimbursement. However, such stability means that control of health care costs can be achieved without intrusion into physician-patient relationships and professional freedom is preserved. Similarly, the acquisition of technological support for the practice of anesthesia, necessary to ensure a high standard of public safety, has not been perceived as a problem in Canada. Anesthesia in Canada is a physician-only specialty, and nurse-administered anesthesia does not exist. It is highly dependent on the functioning of the hospitals, for widespread development of freestanding health care institutions has not occurred. Compensation is on a fee-for-service basis, although alternative compensation for certain aspects of practice exists in some jurisdictions. In general, fees are indexed to the surgical procedure at hand, with time (duration) modifiers, as well as modifiers for specific techniques. Overhead is minimal, so although fees for a given procedure are lower than in the United States, the disparity in earned income is reduced. Unfortunately, recent initiatives to control physician use have limited the ability of the profession to compensate completely for this North American discrepancy in fees. Since health care in Canada is a provincial responsibility, there are eleven separate plans linked only by the guiding principles of the National Health Act of 1971. Each provincial medical association is responsible for negotiating the fee schedules with the provinces on behalf of its members. Since these associations must respond to the majority of their members, it has been the perception of specialty groups such as anesthesia that the emphasis of allocations in recent years has been on primary care fields. Anesthetists have therefore found themselves increasingly involved with the collective negotiation process as an unwanted necessity of practice.(ABSTRACT TRUNCATED AT 400 WORDS)

Anesthesia↗