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PubMedDate not supplied

The use of clinical practice guidelines for community-acquired pneumonia in hospitals in Atlantic Canada.

BACKGROUND: Clinical practice guidelines (CPGs) have been shown to improve the care of patients presenting to hospital with community-acquired pneumonia (CAP) and are considered the 'standard of care'. The extent of adoption of CPGs in Canada is unclear. OBJECTIVE: To determine the use of CPGs by hospitals in Atlantic Canada (Newfoundland, Nova Scotia, New Brunswick, Prince Edward Island). METHODS: Telephone survey of all hospitals listed in the Canadian Medical Directory as being situated in Atlantic Canada. Hospitals were included if they had all three of the following: an emergency department, x-ray facilities and acute care inpatient beds. RESULTS: Of 143 hospitals, 93 were included for analysis. Of these, 41 (44.1%) used CAP CPGs. Hospitals were less likely to be using CAP CPGs if they were smaller, rural or community hospitals, or if they did not have an intensive care unit. Of the four provinces, New Brunswick had the most hospitals using CAP CPGs (73.1%), while Newfoundland had the least (17.2%). CONCLUSIONS: Although larger teaching hospitals are using CAP CPGs, the degree of adoption of CPGs in smaller hospitals in Atlantic Canada is low. Efforts to produce standard CPGs that can be adapted to different sites, as well as implementation strategies, are indicated.

Canada↗
PubMedDate not supplied

Differences in the location and multiplicity of mandibular fractures in Kuwait, Canada and Finland during the 1990s.

OBJECTIVE: To compare the location and multiplicity of mandibular fractures in Kuwait, Canada and Finland during the 1990s. SUBJECTS AND METHODS: Data were collected from several hospitals in Kuwait (1991-2000), Toronto General Hospital in Canada (1995-2000) and Oulu University Hospital in Finland (1990-1999). The data were analyzed statistically using chi-square test, ANOVA, t test and logistic regression. RESULTS: Condylar fractures were more common in Finnish patients (41%) than Canadian (35%) or Kuwaiti patients (21%). Condylar fractures caused by falls were about 3.4 times more common in Kuwait and Finland compared to Canada. In Finland the risk of road traffic accidents caused by condylar fracture was about 4 times higher than those caused by other etiologies. In Canada male gender was about 2 times higher for the condylar fracture than female gender. Female patients often had more multiple injuries than men in all three countries and multiple fractures were observed especially in traumas caused by falling. CONCLUSION: Differences in location and multiplicity of mandibular fractures are due to differences in etiologies and demographic patterns.

Accidental Falls↗
PubMed2004

Why is off-pump coronary surgery uncommon in Canada? Results of a population-based survey of Canadian heart surgeons.

BACKGROUND: Off-pump coronary artery bypass (OPCAB) is proposed to improve clinical outcomes and decrease resource use. However, off-pump surgery is not widely used in Canada. The purpose of this study was to determine the current use of OPCAB in Canada and determine why surgeons have not adopted this technique. METHODS AND RESULTS: The study was a population-based survey of all adult Canadian cardiac surgeons in practice >1 year. Eligible division heads and surgeons were contacted by mail. Of 19 806 isolated coronary bypass surgeries performed by respondents in Canada last year, 3164 (16.0%) were performed off-pump. More than 50% of Canadian surgeons performed OPCAB in <5% of coronary cases, and only 17% of surgeons performed OPCAB in >25% of coronary cases. Only 4 responding centers performed OPCAB in >25% of cases. Respondents were divided into those who performed <5% of cases off-pump (nonadopters), 5% to 25% off-pump (intermediate users), or >25% off-pump (enthusiasts). Mean number of distal anastomoses in off-pump cases were 1.7+/-0.6, 1.6+/-0.6, and 3.3+/-0.5 for nonadopters, intermediate users, and enthusiasts, respectively (P=0.001). Eleven percent of nonadopters, 55% of intermediate users, and 81% of enthusiasts believed OPCAB improved clinical outcomes (P<0.0001). Only 23% of all respondents felt OPCAB use would increase in the next 5 years. CONCLUSIONS: Concerns regarding incomplete revascularization and lack of proven clinical benefit have limited OPCAB to being performed routinely by only a small number of surgeons in Canada.

Attitude of Health Personnel↗
PubMed2004

Long-term mortality of patients with acute myocardial infarction in the United States and Canada: comparison of patients enrolled in Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-I.

BACKGROUND: In a previous substudy of the GUSTO-I trial, we observed better functional and quality-of-life outcomes among patients in the United States (US patients) compared with patients in Canada. Rates of invasive therapy were significantly higher in the United States and were associated with a small mortality benefit (0.4%, adjusted P=0.02). We sought to determine whether Canadian-US differences in practice patterns in GUSTO-I had an impact on 5-year mortality. METHODS AND RESULTS: Mortality data for 23,105 US and 2898 Canadian patients enrolled in GUSTO-I were obtained from national mortality databases. Median follow-up was 5.46 years in the US and 5.33 years in the Canadian cohort. Five-year mortality rate was 19.6% among US and 21.4% among Canadian patients (P=0.02). After baseline adjustment, enrollment in Canada was associated with a higher hazard of death (1.17; 95% confidence interval, 1.07 to 1.28, P=0.001). Revascularization rates during the index hospitalization in the United States were almost 3 times those in Canada: 30.5% versus 11.4% for angioplasty and 13.1% versus 4.0% for bypass surgery (P<0.01 for both). After accounting for revascularization status as a time-dependent covariate, country was no longer a significant predictor of long-term mortality. These results were confirmed in a propensity-matched analysis. CONCLUSIONS: Our results suggest, for the first time, that the more conservative pattern of care with regard to early revascularization in Canada for ST-segment elevation acute myocardial infarction may have a detrimental effect on long-term survival. Our results have important policy implications for cardiac care in countries and healthcare systems wherein use of invasive procedures is similarly conservative.

Aged↗
PubMed2003

Hypertension treatment and control in five European countries, Canada, and the United States.

Levels of hypertension treatment and control have been noted to vary between Europe and North America, although direct comparisons with similar methods have not been undertaken. In this study, we sought to estimate the relative impact of hypertension treatment strategies in Germany, Sweden, England, Spain, Italy, Canada, and the United States by using sample surveys conducted in the 1990s. Hypertension was defined as a blood pressure of 160/95 mm Hg or 140/90 mm Hg, plus persons taking antihypertensive medication. "Controlled hypertension" was defined as a blood pressure less than threshold among persons taking antihypertensive medications. Among persons 35 to 64 years, 66% of hypertensives in the United States had their blood pressure controlled at 160/95 mm Hg, compared with 49% in Canada and 23% to 38% in Europe. Similar discrepancies were apparent at the 140/90 mm Hg threshold, at which 29% of hypertensives in the United States, 17% in Canada, and </=10% in European countries had their blood pressure controlled. At the 140/90 mm Hg cutpoint, two thirds to three quarters of the hypertensives in Canada and Europe were untreated compared with slightly less than half in the United States. Although guidelines vary among countries, resulting in different case definitions, this does not account entirely for the varying success of different national control efforts. Low treatment and control rates in Europe, combined with a higher prevalence of hypertension, could contribute to a higher burden of cardiovascular disease risk attributable to elevated blood pressure compared with that in North America.

Adolescent↗
PubMed2006

Improvement in stroke mortality in Canada and the United States, 1990 to 2002.

BACKGROUND: In the United States and Canada, folic acid fortification of enriched grain products was fully implemented by 1998. The resulting population-wide reduction in blood homocysteine concentrations might be expected to reduce stroke mortality if high homocysteine levels are an independent risk factor for stroke. METHODS AND RESULTS: In this population-based cohort study with quasi-experimental intervention, we used segmented log-linear regression to evaluate trends in stroke-related mortality before and after folic acid fortification in the United States and Canada and, as a comparison, during the same period in England and Wales, where fortification is not required. Average blood folate concentrations increased and homocysteine concentrations decreased in the United States after fortification. The ongoing decline in stroke mortality observed in the United States between 1990 and 1997 accelerated in 1998 to 2002 in nearly all population strata, with an overall change from -0.3% (95% CI, -0.7 to 0.08) to -2.9 (95% CI, -3.5 to -2.3) per year (P=0.0005). Sensitivity analyses indicate that changes in other major recognized risk factors are unlikely to account for the reduced number of stroke-related deaths in the United States. The fall in stroke mortality in Canada averaged -1.0% (95% CI, -1.4 to -0.6) per year from 1990 to 1997 and accelerated to -5.4% (95% CI, -6.0 to -4.7) per year in 1998 to 2002 (P< or =0.0001). In contrast, the decline in stroke mortality in England and Wales did not change significantly between 1990 and 2002. CONCLUSIONS: The improvement in stroke mortality observed after folic acid fortification in the United States and Canada but not in England and Wales is consistent with the hypothesis that folic acid fortification helps to reduce deaths from stroke.

Adult↗
PubMed2004

Major depression and mental health care utilization in Canada: 1994 to 2000.

BACKGROUND: Major depression makes an important contribution to disease burden in Canada. In principle, the burden of major depression can be reduced by the provision of treatment within the health care system. In a previous data analysis, the National Population Health Survey (NPHS) reported an increase in antidepressant (AD) use between 1994 and 1998. In this paper, the analysis is extended to 2000, and additional aspects of health care utilization are described. METHODS: The NPHS provides a unique source of longitudinal data concerning major depression and its treatment in Canada. In this survey, probable cases of major depression were identified using a brief predictive instrument; health care utilization was evaluated using additional survey items; and the latest data release from Statistics Canada (that is, 2000) was used to make weighted estimates of the frequency of health care utilization in relation to major depression status. RESULTS: The use of ADs has continued to escalate. These increases have been largest in men and in persons aged under 35 years. There has been an increase in polypharmacy: in 2000, almost 9% of persons taking an AD reported taking more than 1 AD medication-a tripling since 1994. The frequency of consultations with alternative practitioners has also grown. Although the overall proportion of persons with major depression who report consulting with health professionals about their mental health has not increased, the number of persons with major depressive disorder reporting 6 or more visits to nurses, social workers, and psychologists may have. CONCLUSION: The provision of AD treatment continues to expand in Canada. This probably represents a changing pattern of practice, because the frequency of professional consultation has not increased. More detailed data are required to evaluate the extent to which treatment needs are being met.

Adult↗
PubMed1982

The psychiatric certification examination in Canada and the United States: views of two recent candidates.

The psychiatry certification process in both Canada and the United States is compared. Three important and interrelated areas are delineated: 1) the role of mandatory certification in Canada versus voluntary certification in the United States; 2) the differing emphasis of neurology and the medical model in the two exam procedures; and 3) the effect of the speciality exam on professional development. Compulsory certification in Canada has the potential to steer candidates in a direction that may not be immediately consonant with career plans and population needs. On the other hand, the American Board examination by its optional character does not seem to reach a large percentage of psychiatrists, an issue that has implications for the education of medical professionals. The ambiguity of the American Board's quasi-public position is portrayed. Competence in neurology appears as a distinct area for evaluation in the American Board of Psychiatry and Neurology examination. The emphasis on neurology in the Canadian Royal College exam is less marked. These issues lead to a discussion of psychiatry in Canada as a discipline in its own right as contrasted to the mixed loyalties to neurology and psychotherapy perceived in the American system. Finally, this paper sheds light on how the certification examination of both countries plays an important role in the passage to full professional status.

Canada↗
PubMed2003

Feasibility of using existing Statistics Canada surveys to describe the health and work of nurses.

Reorganization of nurses' work has raised questions about the effects of working conditions on their health. Nurses, for example, are more likely to miss work because of illness and disability than employees in other occupations. The overall purpose of this descriptive study was to investigate the feasibility of using existing Statistics Canada surveys regularly to describe and monitor the health and working conditions of nurses. Our findings identified significant limitations in existing Statistics Canada surveys, for the study of nurses, including nonspecific or no occupational coding, small samples and partial content related to the work environment. As a result, some estimates would need to be accompanied by statements indicating that the findings do not meet quality standards and that the conclusions would be unreliable and most likely invalid. Additional data are required for a comprehensive assessment of the health status of nurses and the work environment factors that influence their health. These data can be obtained through several vehicles, including using over-sampling strategies for extant and recurring Statistics Canada surveys, adding additional content to those surveys or implementing new surveys specific to nurses and their work. The authors describe the advantages and disadvantages of each of these approaches and conclude that monitoring the health and work environment of nurses in Canada in sufficient detail to inform policy decisions requires a dedicated national survey.

Bias↗
PubMed2005

Diagnostic imaging in Canada.

In Ontario, between 1993 and 2003, the annual number of MRI scans performed increased by more than 600 percent (Iron et al. 2003), and the number of CT scans increased threefold (Tu et al. 2005). Despite these massive increases, the Fraser Institute reported a median wait of five weeks for CT and thirteen weeks for MRI scanning in 2004 (Esmail and Walker 2004), and Canadians are increasingly concerned about the length of time they wait for diagnostic imaging. Because of this, politicians have made decreasing wait times for diagnostic imaging one of their top priorities (Health Canada 2004). This raises several interesting questions. Have the indications for CT and MRI really expanded that rapidly, or was there just a huge pent-up demand because Canada had fallen so far behind in acquiring modern imaging machines? Are physicians relying more on diagnostic imaging technologies and less on clinical skills? Are an increasing number of patients undergoing scans when there is a small likelihood that the results will change their management or improve their outcomes? Supporters of the view that Canada needs to expand its diagnostic imaging capacity point to the fact that we rank well behind many developed countries in terms of the number of diagnostic imaging machines per population (Canadian Institute for Health Information 2003: 33), and that improvements in imaging quality have expanded the indication for imaging. Supporters of the view that there is an increased and inappropriate reliance on technology over clinical skill point to the findings of a recent American study showing that the regions that spent the most on healthcare did not have better outcomes than the regions that spent less--indeed, the trend was toward poorer outcomes in the highest-spending regions (Fisher et al. 2003a, 2003b). One of the greatest differences between the highest- and lowest-spending regions was their expenditure on a variety of diagnostic tests, suggesting that more testing did not lead to better outcomes on a population basis. It may in fact have led to iatrogenic illnesses because of the workup of false positive results, and diverted attention away from simple interventions that have been shown to be effective (Fisher et al. 2003a). The truth is likely a combination of many factors. Some patients with clear indications for diagnostic imaging undoubtedly wait too long for their tests in Canada. At the same time, a number of patients undergo tests whose results have a very small likelihood of changing their management, which itself contributes to the access problem. Unfortunately there are no evidence-based benchmarks for the appropriate rate of diagnostic testing that can be used to determine the optimal supply of diagnostic machines and radiological personnel. In this article we discuss the reasons it has been so difficult to determine the optimal imaging capacity needed for a population, describe some factors that are "inappropriately" increasing the rate of imaging and suggest some solutions. Although many of our examples deal with CT and MRI scanning, our remarks apply more broadly to many other diagnostic tests.

Attitude of Health Personnel↗
PubMed2004

The public/private debate in the funding, administration and delivery of healthcare in Canada.

To help clarify the confusing debate concerning the public-private divide in Canada and the respective positions of the Romanow and Kirby reports, a new approach is proposed. The funding, administration and delivery of the healthcare "system" is split into distinct analytical categories and then applied to three major coverage groupings: universal public (Canada Health Act) coverage for medically necessary/required services; mixed coverage for drug care, home and long-term care; and private health goods and services. While there were no fundamental differences between Romanow and Kirby concerning the funding of public healthcare in Canada, there were some important differences on issues of administration. In particular, the Romanow report recommended that home mental healthcare services become universally covered under the Canada Health Act as well as fundamental changes to the regulation and administration of prescription drug care. The reports also differed in terms of framing the private delivery question, with the Romanow report questioning whether the evidence justified private-for-profit delivery replacing current private not-for-profit or public arm's length delivery modes.

Canada↗
PubMed2006

Ageing in a foreign country: voices of Iranian women ageing in Canada.

Older Iranian women, who immigrated to Canada in later adulthood, experience unique issues as they age. In order to better understand this experience, in-depth, personal and semi-structured interviews were conducted with five immigrant/refugee Iranian women who immigrated to Canada in their later life. Analysis revealed that although each woman's story conveyed individual differences and idiosyncrasies, all the stories highlighted the critical interweaving of the aging experience and the immigration experience: neither experience could be understood in isolation of the other; each aspect gave meaning to the other experience. Two interrelated messages dominated the women's stories: first was the importance of each woman's immigration story for grounding her experience of the aging process in Canada. Second, each woman's personal story suggested that the immigration experiences were accorded priority for accounting for her experiences in Canada. Specifically, cultural identity (i.e., social class, education, religious affiliation and immigration status) offered a valuable cloak for overshadowing the force of the aging process and the aging process emerged as an elusive force that lurked in the background without ever being fully acknowledged or given power in their lives. The implications of these findings in relation to theory development on intersectionality and professional practice are discussed.

Aged↗
PubMed2004

Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996.

BACKGROUND: The reduction of socioeconomic inequalities in health is an explicit objective of health policy in Canada, yet rates of death from cervical cancer are known to be higher among women of low socioeconomic status than among those of higher socioeconomic status. To evaluate progress toward the World Health Organization's goal of "Health for All," we examined whether income-related differentials in cervical cancer mortality diminished from 1971 to 1996. METHODS: Death registration data for Canada's census metropolitan areas in 1971, 1986, 1991 and 1996 were assigned to census tracts through postal code, and the tracts were in turn assigned to income quintiles based on their proportion of the population below the Statistics Canada low-income cutoff values. We compared age-standardized death rates (using the 1966 world population standard) in the female population (excluding those in institutions) across the 5 income quintiles and calculated interquintile rate ratios (poorest over richest) and interquintile rate differences (poorest minus richest). RESULTS: From 1971 to 1996, the overall age-standardized cervical cancer death rate per 100 000 women (and 95% confidence interval) declined from 5.0 (4.5-5.6) to 1.9 (1.7-2.1), the interquintile rate ratio diminished from 2.7 (1.8-4.2) to 1.7 (1.1- 2.6), and the interquintile rate difference decreased from 4.6 (2.8- 6.4) to 1.1 (0.2-1.9). INTERPRETATION: The income-related disparity in rates of death from cervical cancer as measured by rate ratios and rate differences diminished markedly in urban Canada from 1971 to 1996. Among the numerous factors that may have contributed to the decline (including decline in fertility and improvement in diet), one important factor was probably the implementation of effective screening programs.

Adult↗
PubMedDate not supplied

Reducing the rate of teen pregnancy in Canada: a framework for action.

In partnership with the Young/Single Parent Support Network of Ottawa-Carleton and Timmin's Native Friendship Centre, the Canadian Institute of Child Health has completed a framework to reduce the rate of teen pregnancy in Canada. The final document is called Pro-Action, Postponement, and Preparation/Support: A Framework for Action to Reduce the Rate of Teen Pregnancy in Canada. The objectives were to learn what is currently being done and what needs to be done on this issue across the country, and to explore the potential role of projects funded by the federal Canada Action Program for Children (CAPC) and Canada Prenatal Nutrition Program (CPNP) in reducing the rate of teen pregnancy. Being an extremely complex and sensitive issue, the report was a culmination of a number of research methods: over 40 key informants from diverse backgrounds and expertise were interviewed to determine the scope of the problem and potential solutions; a detailed literature review identified existing date and documentation on the topic, using both Canadian and international studies; youth surveys and focus groups were conducted in both on-reserve Aboriginal communities and non-Aboriginal communities.

Adolescent↗
PubMedDate not supplied

Analysis of prevalence, triggers, risk factors and the related socio-economic effects of childhood asthma in the Student Lung Health Survey (SLHS) database, Canada 1996.

The purpose of this study was to provide information to improve the management of childhood asthma in Canada. The Student Lung Health Survey (SLHS) was conducted as a stratified and multi-staged cluster survey across Canada in 1996. It included a total of 136 public, private and separate schools in nine health units. The target study population was schoolchildren aged 5 to 19 years. Among all 5-19 years old students, the prevalence of asthma was 13.0%, with the prevalence for males being higher than for females, the adjusted Odds Ratio (OR) was 1.17, (95% CI 1.14-1.19) for males, in comparison with females. The prevalence in the 15-19 age group was higher than that in the 5-9 and 10-14 age group in females, but it was higher in the 5-9 and 10-14 age group than in the 15-19 age group in males. The mean delay from the onset of symptoms to time of first diagnosis was 1, 0.4 and 0.3 years for the 1-4, 5-9 and 10-14 age group respectively. However, there was no delay in the 15-19 group. The prevalence of asthma in Prince Edward Island (17.9%), Halifax (17.1%), and Kingston (16.1%) was higher than that in Saskatoon (10.0%). Sherbrooke (9.7%) and Kelowna (11.9%). The proportion of asthma for students who smoked more than 11 cigarettes per day (OR = 1.41), were exposed to passive smoke in home (OR = 7.29), in car (OR = 4.71), and in school (OR = 4.24) or had a family income less than CAN$40,000 (OR = 1.19), was significantly higher than groups without those factors. Risk factors and socio-economic status such as living conditions and environment, pets or plants in the home, parental education levels also affected the morbidity of asthma. The results of the SLHS study demonstrated the serious burden of childhood asthma, and asthma triggers, living and environmental conditions and lifestyle influence the prevalence and the effects of childhood asthma diagnosis, treatment, and education in Canada. Asthma is still a serious chronic condition for students and it influences their academic performance and their quality of life. The diagnostic methods and the practice guidelines for asthma control are useful for preventing and controlling asthma. These findings provide indications of interventions are being used for the control of asthma in Canada.

Adolescent↗
PubMedDate not supplied

Childhood asthma management and control. Analysis of the Student Lung Health Survey (SLHS) database, Canada 1996.

UNLABELLED: The objective of this study was to estimate the severity of childhood asthma in Canada, identify the effects of asthma interventions in different target groups, and to profile asthma management and control practices by geographic area, sex, age, and severity groups. METHODS: The SLHS was conducted as a stratified and multi-staged cluster survey across Canada in 1996. It included a total of 136 public, private and separate schools in nine health units (Prince Edward Island, Halifax, Sherbrooke, Kingston, Guelph, Winnipeg, Saskatoon, Edmonton, and Kelowna). The target study population was schoolchildren aged 5 to 19 years. Descriptive analyses were used to calculate the severity of childhood asthma for the different groups. Logistic regression was then employed to measure the quality of asthma intervention and control. Multivariate logistic regression was also used to compare the severity and treatment of asthma with age, sex and lifestyle, living and housing conditions. Using existing Clinical Practice Guidelines as a reference, the study also evaluated the effectiveness of interventions such as treatment, and asthmatic education. RESULTS: Based on the Canadian Consensus Recommendations of definition of asthma control, among all 5-19 years old students, 39.9% were well controlled, 33.8% were acceptably controlled and 26.3% were poor controlled. The rates of intermittent and mild asthma were 44.8% and 11.6% compared with moderate (15.3%) and severe (0.9%). Students with asthma reported receiving more advantaged information from a demonstration of inhaler users (OR = 7.51, 95% CI = 5.65-8.94), during a medical visits (OR = 6.33, 95% CI = 5.11-7.83), from the pamphlet/brochures (OR = 6.22, 95% CI = 5.05-7.76) or from a demonstration of the correct use of medicine (OR = 5.62, 95% CI = 4.62-6.82). More students visited a family doctor (40.3%, OR = 5.52, 95% CI = 4.95-6.64) and medical specialists (31.0%, OR = 3.69, 95% CI = 2.58-4.78) than other specialist when they had respiratory problems. CONCLUSIONS: The results of the SLHS study demonstrated variations in the management and control of childhood asthma across Canada. The interventions and the practice guidelines for asthma control are useful for preventing and controlling asthma. These findings provide indications of interventions that are being used for the control of asthma in Canada.

Adolescent↗
PubMed2000

The Matthew effect: infant mortality in Canada and internationally.

OBJECTIVE: To examine whether the magnitude of improvement in the health status of a population over time is dependent on the previous health status of that population. DESIGN AND SETTING: A study of infant mortality rates in Canada's 12 provinces and territories between the periods 1961-1965 and 1991-1995, and of infant mortality rates in 133 countries between 1960 and 1995. MAIN OUTCOME MEASURES: Spearman's rank correlations, relative risks, and risk differences to measure the relationship between infant mortality in the 1960s and changes in infant mortality between the 1960s and 1990s. RESULTS: In Canada, regional rankings based on infant mortality rates in 1961-1965 were strongly correlated (inversely) with rankings based on the percent change in infant mortality between 1961-1965 and 1991-1995 (correlation coefficient = -.85). In contrast, internationally, rankings based on infant mortality rates in 133 countries in 1960 were positively correlated with percent change between 1960 and 1995 (correlation coefficient =.56). Regional differences in infant mortality rates, measured using relative risks, declined in Canada (highest relative risk: 4.2, compared with Ontario in the 1960s; highest relative risk: 2.2, compared with Ontario in the 1990s) but increased globally (highest relative risk: 5.0, compared with industrialized countries in 1960; highest relative risk: 15.1, compared with industrialized countries in 1995). CONCLUSIONS: Canadian regions with higher infant mortality rates in 1961-1965 achieved larger improvements compared with regions with initially lower infant mortality rates. The pattern observed within Canada is unlike the pattern observed internationally.

Canada↗
PubMed2006

Ixodes scapularis ticks collected by passive surveillance in Canada: analysis of geographic distribution and infection with Lyme borreliosis agent Borrelia burgdorferi.

Passive surveillance for the occurrence of the tick Ixodes scapularis Say (1821) and their infection with the Lyme borreliosis spirochaetes Borrelia burgdorferi s.l. has taken place in Canada since early 1990. Ticks have been submitted from members of the public, veterinarians, and medical practitioners to provincial, federal, and university laboratories for identification, and the data have been collated and B. burgdorferi detected at the National Microbiology Laboratory. The locations of collection of 2,319 submitted I. scapularis were mapped, and we investigated potential risk factors for I. scapularis occurrence (in Quebec as a case study) by using regression analysis and spatial statistics. Ticks were submitted from all provinces east of Alberta, most from areas where resident I. scapularis populations are unknown. Most were adult ticks and were collected in spring and autumn. In southern Québec, risk factors for tick occurrence were lower latitude and remote-sensed indices for land cover with woodland. B. burgdorferi infection, identified by conventional and molecular methods, was detected in 12.5% of 1,816 ticks, including 10.1% of the 256 ticks that were collected from humans and tested. Our study suggests that B. burgdorferi-infected I. scapularis can be found over a wide geographic range in Canada, although most may be adventitious ticks carried from endemic areas in the United States and Canada by migrating birds. The risk of Lyme borreliosis in Canada may therefore be mostly low but more geographically widespread than previously suspected.

Animals↗