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PubMed2006

Cost effectiveness of the sirolimus-eluting stent in high-risk patients in Canada: an analysis from the C-SIRIUS trial.

BACKGROUND: The cost effectiveness of drug-eluting stents in Canada is debated and deserves further evaluation in high-risk patients. METHODS: We performed an economic analysis from the third-party payer perspective based on the clinical results and resource-utilization data of the C-SIRIUS (The Canadian Study of the Sirolimus-Eluting Stent in the Treatment of Patients with Long De Novo Lesions in Small Native Coronary Arteries) trial, which examined the safety and efficacy of sirolimus-eluting stents (SES) versus bare metal stents (BMS) in high-risk patients with single long de novo lesions in small coronary arteries. Only inpatient costs were considered, including physician fees. We postulated that the incremental cost required to avoid a repeat revascularization (RR) procedure with BMS versus simple balloon angioplasty (BA) could be considered the willingness to pay (WTP) to avoid restenosis in Canada. We assessed the incremental cost-effectiveness ratio (ICER) of SES compared with BMS in these high-risk patients compared with WTP. Results are expressed in 2003 Canadian dollars. RESULTS: With a 7% absolute reduction in the need for RR compared with BA, BMS are associated on average with an ICER of US dollars 12,551/RR avoided (RRA) in Canada. In C-SIRIUS, SES further reduced the need for RR at 1 year from 22% to 4% (p = 0.015) compared with BMS. With a 1.5 stent-to-lesion (STL) ratio and an SES retail price of US dollars 2,700 compared with US dollars 700 for BMS, the ICER of SES versus BMS was US dollars 11,275/RRA -- borderline cost effective compared with the implicit WTP of US dollars 12,551 for such health benefit in Canada. Using a lower STL ratio (1.2) would improve the ICER to US dollars 7941/RRA. CONCLUSIONS: Treatment of long lesions in small vessels with SES increases net healthcare costs. However, the ICER for SES compares favorably with the currently accepted comparator, i.e. BMS, to reduce coronary restenosis -- at least for higher risk patients undergoing single-vessel revascularization.

Adult↗
PubMed1987

Corporatization and deprivatization of health services in Canada.

Canada's system of health services has been shaped by the forces and values in the Canadian political, cultural, social, and economic environment; these forces continue to place constraints on future changes. We distinguish between "corporatization" and "privatization", and the implications of each for improved efficiency of the system. Although the organization of health services is, in certain provinces, undergoing significant structural changes, there is evidence that rather than privatizing, the system may actually be continuing to experience what we have termed deprivatization, as the scope of government involvement expands to include a more comprehensive definition of health care. Trends in Canada differ considerably from those in the United States; universal health insurance has curbed the ability and desire of institutions to exclude members of some socioeconomic groups from receiving care. U.S.-based models, if applied to Canada, could lead to both higher costs and lower quality of care. Considerable efficiencies can be realized within Canada's current system.

Canada↗
PubMed2006

Beijing and beyond: women's health and gender-based analysis in Canada.

On the tenth anniversary of the Fourth World Conference on Women, held in Beijing, this article evaluates Canada's progress in the area of women's health by critically examining the Women's Health Strategy. Introduced in 1999 by Health Canada, the Strategy is considered Canada's key response to its international commitments for promoting women's health and in particular for implementing a gender-based analysis in all programs, services, policies, and research. By reviewing each objective of the Strategy, the article illustrates the limited progress that has been made to date. It provides arguments for why and how all levels of government should work to improve their response to women's health in Canada and, specifically, how the Women's Health Strategy can be redesigned to be more effective in attending to the needs and concerns of all Canadian women.

Canada↗
PubMed1995

The timeliness of new drug approvals in Canada.

In a recent article, Lexchin asks "who needs faster drug approval times in Canada?" and, on the basis of extremely limited and selective data, draws the conclusion that neither the public nor the pharmaceutical industry does. Whether the Canadian system is really slower is investigated by comparing Canadian and U.S. marketing approval dates and by using information on regulatory approval times from the two countries and elsewhere. Marketing approval dates in Canada are significantly later than those in the United States, although not consistently across all therapeutic categories; anti-cancer and gastrointestinal drugs have earlier approval dates in Canada. However, Canadian and U.S. regulatory approval times are not significantly different, indicating that marketing applications are submitted later in Canada, but both are considerably longer than those in the United Kingdom. The evidence shows that Canadians need faster drug approval times if individuals requiring the medications are not to suffer unnecessarily. A significant decrease in drug approval times and the establishment of comprehensive and effective postmarketing surveillance would reduce the time it takes for new drugs to be made available to Canadians while, at the same time, providing a high level of drug safety.

Canada↗
PubMed1986

Workplace health and safety: report from Canada.

This article represents a critical analysis of the major policy responses to workplace health and safety in Canada. It examines the deficiencies inherent in the legislative development of Joint Health and Safety Committees in most Canadian jurisdictions, the limitations regarding standard-setting of worker exposure to contaminants, and disincentive for employers to positively improve the workplace because of Workers Compensation legislation. Collective bargaining agreements in Canada have had only limited positive effects, while the ultimate legal sanction of criminal prosecution by the regulatory agencies has weakened enforcement and compliance of existing regulations. There has never been a successful criminal prosecution of an employer in Canada, even for multiple deaths. The article suggests the following four reasons for this "underdevelopment" of occupational health and safety in Canada: the concealment of the dimension of the incidence of industrial disease based on Workers Compensation Board statistics; the application of an incorrect theory of causation of both industrial disease and injury by both managers and government administrators of occupational health and safety programs; the resistance of both senior and middle managers against increased worker participation in both work organization and job design questions; and the general "moral underdevelopment," rather than ignorance, of managers in favoring economic considerations or values at the expense of worker health and safety. In light of the magnitude of the problem and the deficiencies of existing policy approaches, the author proposes the need for greater workplace democratization of production and industry as a necessary and sufficient reform of workplace health and safety.

Accident Prevention↗
PubMed2002

Diabetes care in the U.S. and Canada.

OBJECTIVE: To compare the glycemic control of patients with type 1 diabetes treated in the U.S. and Canada. RESEARCH DESIGN AND METHODS: A large multicenter randomized clinical trial conducted in the U.S. and Canada was analyzed. Patients with type 1 diabetes, screened from 1983 to 1989 for enrollment in the Diabetes Control and Complications Trial (DCCT), were categorized as treated in the U.S. (n = 2,604) or Canada (n = 245). HbA(1c) levels were compared between U.S. and Canadian patients, both before and after adjustment for predictors of HbA(1c). RESULTS: In general, volunteers screened for the DCCT were highly educated and following healthy lifestyles. Canadians were somewhat younger (25 vs. 27 years of age, P = 0.002), less likely to be college educated (62 vs. 71%, P = 0.002), more likely to receive care through a family doctor (41 vs. 28%, P = 0.001), and had a higher frequency of out-patient visits (4 vs. 3 per year, P = 0.004). Despite these differences in health care delivery, the mean HbA(1c) at baseline was identical in the two countries (8.9 vs. 9.0, P = 0.40). Adjustment for demographic, lifestyle, and clinical predictors of HbA(1c) yielded similar findings (9.0 vs. 9.2, P = 0.15). Equal percentages of American and Canadian patients who were screened ultimately entered the trial (21 vs. 19%, P = 0.20), and those randomized to conventional care achieved similar mean HbA(1c) levels (9.1 vs. 9.2, P = 0.50). CONCLUSIONS: Differences in care delivery patterns do not yield large differences in glycemic control for patients with type 1 diabetes who were recruited in the U.S. and Canada for a large randomized trial.

Adolescent↗
PubMed2006

Demographics of corneal transplantation in Canada in 2004.

BACKGROUND: Penetrating keratoplasty (PKP) is the most frequently performed transplant surgery, and one of the most successful, yet no national study on the demographics of corneal transplantation in Canada has been published to date. The objectives of this study were to determine demographics of Canadian corneal transplant surgeons, donor tissue availability and waitlist length for each province, and limiting factors for the number of PKPs performed in Canada. METHODS: An anonymous voluntary survey of all Canadian corneal transplant surgeons was conducted between June and September 2004, with a concurrent voluntary survey of all eye banks in Canada. RESULTS: In 2004, there were 76 corneal transplant surgeons distributed as follows: British Columbia 17.1%, Alberta 11.8%, Saskatchewan 3.9%, Manitoba 7.9%, Ontario 36.8%, Quebec 17.1% and the Atlantic provinces 5.3%. The response rate of the Canadian corneal transplant surgeon survey was 69.7%. On average, each respondent performed 1 (SD 1) PKP/week, 40 (33) PKPs/year, and had a waitlist of 50 (63) patients. The mean wait time from date of referral to initial consultation was 10 (SD 7) weeks and from time of diagnosis to PKP was 51 (32) weeks. The most significant contributing factor to PKP waitlist selected by respondents in all provinces except Ontario was donor tissue shortage (64.7%); Ontario respondents (81.0%) believed that insufficient operating room time was the main factor. Ontario was the only province where all corneal transplant surgeons scheduled PKP electively and where surplus corneal tissue was regularly exported. INTERPRETATION: Recommendations include standardizing the criteria for acceptable donor tissue across all eye banks in Canada to increase efficiency of distribution, introducing and properly implementing mandatory referral and request legislation to increase donor rates, and increasing availability of operating room time for corneal transplant surgeons, especially in Ontario.

Adult↗
PubMed1997

"Its baneful influences are too well known": debates over drug use in Canada, 1867-1908.

This article examines the debates about drug addiction, as presented by medical and non-medical reformers in Victorian Canada, to explain the emergence of anti-narcotic legislation in the early twentieth century. Most of the studies of drug prohibition in Canada emphasize the anti-Chinese issues surrounding the drafting of the 1908 Opium Act. This study asserts that in order to understand why parliament unanimously accepted this legislation, we must look beyond the issue of anti-Chinese sentiment. It explores the discussions of drug addiction rhetoric. It concludes that the concern over both addiction in Canada and the Chinese in Canada drew upon parallel issues of freedom versus slavery, racial purity, and the need to protect the integrity of a moral and strong nation.

Asian People↗
PubMed2005

The formation and continuance of lesbian families in Canada.

What makes a lesbian family? It has been said that the last few decades have seen a "lesbian baby boom" as reproductive choices have opened up for lesbians; but has this been true for lesbians in Canada? This article explores how lesbian families have formed and grown in Canada since the 1970s. It looks at the various types of lesbian families in Canada and explores lesbians' past and current access to reproductive technologies and adoption across Canada. Current Canadian literature is presented, including information on lesbians' and their families' experience with the medical profession.

Adoption↗
PubMed2002

First report of piscine nodavirus infecting wild winter flounder Pleuronectes americanus in Passamaquoddy Bay, New Brunswick, Canada.

Piscine nodaviruses (Betanodaviridae) are frequently reported from a variety of cultured and wild finfishes. These non-enveloped, single-stranded RNA virions cause viral encephalopathy and retinopathy (VER), also known as viral nervous necrosis (VNN) or fish encephalitis. Recently, nodavirus infections have posed serious problems for larval and juvenile cultured halibut Hippoglossus hippoglossus in Norway and Scotland. To date, no such viruses have been described from any cultured or wild pleuronectid in Atlantic Canada. Obviously, there exists a need to survey wild populations of pleuronectids to assess the risk of potential transfer of nodavirus from wild to caged fishes. This paper presents the results of monthly surveys (April 2000 to March 2001) of viruses from wild winter flounder Pleuronectes americanus collected from Passamaquoddy Bay, New Brunswick, Canada. Tissue samples from wild flounder were screened initially on commercial cell lines (EPC, SSN-1, SHK and CHSE-214) for any evidence of cytopathic effect (CPE). After confirmation of CPE, nodavirus identification was achieved using reverse transcription polymerase chain reaction (RT-PCR) analysis. We detected nodavirus from only 1 out of 440 flounder (0.23%) examined. This is the first report of piscine nodavirus isolated from wild winter flounder in Atlantic Canada, and although this prevalence may seem low, we discuss the implications of this finding for Canada's emerging halibut aquaculture industry.

Amino Acid Sequence↗
PubMed1987

Caribbean immigrants in Britain and Canada: socio-demographic aspects.

This is an overview of demographic characteristics of migrants from the Caribbean to Great Britain and Canada, based on official data. "In 1981 there were approximately 295,000 Caribbean born persons living in Britain and 211,000 in Canada. In addition there was a 'second generation' of about 250,000 in Britain and 50,000 in Canada. Immigration from the Caribbean reached its peak in Britain in 1961 and in 1974 for Canada. The latter country was more selective in terms of education and includes a francophone group from Haiti. There is substantial residential segregation in the inner cities of London and Birmingham, but a greater degree of dispersion within Montreal and Toronto. There are growing problems of unemployment among Black youths, in both countries." (SUMMARY IN FRE)

Black or African American↗
PubMed2003

Cost-effectiveness of a targeted disinfection program in household kitchens to prevent foodborne illnesses in the United States, Canada, and the United Kingdom.

Foodborne illnesses impose a substantial economic and quality-of-life burden on society by way of acute morbidity and chronic sequelae. We developed an economic model to evaluate the potential cost-effectiveness of a disinfection program that targets high-risk food preparation activities in household kitchens. For the United States, Canada, and the United Kingdom, we used published literature and expert opinion to estimate the cost of the program (excluding the educational component); the number of cases of Salmonella, Campylobacter, and Escherichia coli O157:H7 infections prevented; and the economic and quality-of-life outcomes. In our primary analysis, the model estimated that approximately 80,000 infections could be prevented annually in U.S. households, resulting in 138 million dollars in direct medical cost savings (e.g., physician office visits and hospitalizations avoided), 15,845 quality-adjusted life-years (QALYs) gained, 788 million dollars in program costs, and a favorable cost-effectiveness ratio of 41,021 dollars/QALY gained. Results were similar for households in Canada and the United Kingdom (21,950 dollars Can/QALY gained and 86,341 pounds sterling/QALY gained, respectively). When we evaluated implementing the program only in U.S. households with high-risk members (those less than 5 years of age, greater than 65 years of age, or immunocompromised), the cost-effectiveness ratio was more favorable (10,163 dollars/QALY gained). Results were similar for high-risk households in Canada and the United Kingdom (1,915 dollars Can/QALY gained and 28,158 pounds sterling/QALY gained, respectively). Implementing a targeted disinfection program in household kitchens in the United States, Canada, and the United Kingdom appears to be a cost-effective strategy, falling within the range generally considered to warrant adoption and diffusion (<100,000 dollars/QALY gained).

Age Distribution↗
PubMed1992

Universal access in Canada. Questions of equity remain.

Health/PAC readers will remember Samuel Wolfe's previous Bulletin article about Canada's national health care system ("Importing Health Care Reform? Issues in Transposing Canada's Health Care System to the United States," Summer 1990), in which he described the uniqueness of our northern neighbor's experience. At that time, Wolfe expressed doubt that a Canadian-like model could find sufficient political and social momentum to be propelled south. In this latest article, Wolfe is joined by his long-time colleague, Robin Badgley, to discuss the inequity and inequality they believe still exists within the Canadian system. Wolfe and Badgley's insightful analysis of what they see as shortcomings of the Canadian model and suggestions for their remedy are especially welcome given the questionable validity of most criticism of the Canadian system that Americans hear. Their work helps us understand the real problems that remain in the still-evolving Canadian system. As Americans discuss the various possibilities for progressive single-payer reform, many envision of state-based system. Wolfe and Badgley point out that demographically rooted inequalities and the lingering health burdens of social class may interfere with truly national universal access. They also alert us to the dangers that federal retreat from adequate levels of support would pose to such a state strategy. Samuel Wolfe has a unique background as a country doctor, psychiatrist, and public health official who attended the difficult birth of Saskatchewan's provincial health plan--the prototype for Canada's national health insurance. A respected teacher, researcher, and community health activist, Wolfe has taught in the United States for more than 25 years. He will soon move back to Canada and the welcome security of its universal health care system.

Canada↗
PubMed1976

[The relative therapeutic value of drugs in international comparison: differences between Switzerland and Canada].

In Switzerland the relative therapeutic value of various drugs (e.g. pyrazolone analgesics, phenacetin, clindamycine, clioquinol) is placed demonstrably higher than in Canada. In Canada, rare but possibly dangerous complications of drug therapy are considered to be of greater importance. Two factors might be responsible for these differences: 1. Compared with similar publications in Canada, drug advertisements in Swiss medical journals contain fewer warnings of untoward effects. This can be interpreted as an "information lag". 2. Since the link between an untoward effect and a drug is very difficult to establish with absolute certainty, it may be concluded that the drug is relatively inoffensive. This conclusion is drawn more often in Switzerland than in Canada. Uniformization of the way in which the physician is presented with information concerning untoward drug effects would be an important step towards the establishment of internationally accepted standards of drug therapeutic value.

Analgesics↗
PubMed1999

Canada's health system.

AIM: To examine the Canadian health system, in particular as it relates to health care, and to assess the functions of the provincial and federal governments in relation to health care, spending, funding, and reform. METHODS: Description and analysis of the Canadian health care system, including the overall structure, funding and spending, history, necessary reforms, and future of the system. RESULTS: Canada's health care system, through funding from both the federal and provincial/territorial governments, provides insured hospital and medical care services to all eligible Canadian residents. In order for the provinces to receive funding from the federal government, five criteria as stated in the Canada Health Act, must be met, namely: public administration, comprehensiveness, universality, accessibility, and portability. Funding is provided primarily through taxation, with some provinces also utilizing ancillary funding methods, such as health care premiums. In the latest review of Canada's health care system, the National Forum on Health reported in 1997 that the system must become more efficient, effective, and reflective of contemporary practices in health care delivery. CONCLUSIONS: The benefits of our system can be seen in the favorable health status of Canadians. Canada has been successful in its efforts to contain health expenditures and begin the process of reallocating resources. Health care is recognized as only one element of a larger health system, encompassing a broader range of services, providers, and delivery sites.

Canada↗
PubMed1999

Fatal work-related farm injuries in Canada, 1991-1995. Canadian Agricultural Injury Surveillance Program.

BACKGROUND: Studies from other developed countries have shown that agriculture is among the most dangerous occupational sectors in terms of work-related deaths. The authors describe the occurrence of fatal work-related farm injuries in Canada and compare these rates with those in other Canadian industries. METHODS: The authors present a descriptive, epidemiological analysis of data from the recently established Canadian Agricultural Injury Surveillance Program. The study population comprised Canadians who died from work-related farm injuries between 1991 and 1995. Crude, age-standardized, age-specific and provincial rates of such injuries are presented, as are overall death rates in other Canadian industries. Other factors examined were the people involved, the mechanism of injury, and the place and time of injury. RESULTS: There were 503 deaths from work-related farm injuries during the study period, for an overall annual rate of 11.6 deaths per 100,000 farm population. Modest excesses in this rate were observed in Ontario, Quebec and the Atlantic provinces. High rates were observed among men of all ages and among elderly people. Among the cases that listed the person involved, farm owner-operators accounted for 60.2% of the people killed. There was no substantial increase or decrease in the annual number of deaths over the 5 years of study. The leading mechanisms of fatal injury included tractor rollovers, blind runovers (person not visible by driver), extra-rider runovers, and entanglements in machinery. Compared with other industries, agriculture appears to be the fourth most dangerous in Canada in terms of fatal injury, behind mining, logging and forestry, and construction. INTERPRETATION: Canada now has a national registry for the surveillance of fatal farm injuries. Farming clearly is among the most dangerous occupations in Canada in terms of fatal work-related injuries. Secondary analyses of data from this registry suggest priorities for prevention, continued surveillance and in-depth research.

Accidents, Occupational↗
PubMedDate not supplied

Trends in reported illegal narcotic use in Canada: 1956-1973.

Information on reported narcotic users aids in the development of drug control policy as well as programmes of prevention, treatment, and rehabilitation. In Canada, such information may be obtained from a narcotic users index which classifies known narcotic drug users into three categories: "illicit", "licit", and "professional". This paper presents trend data on known narcotic users in Canada from 1956 to 1973 by category, location, initially reported drug, sex and age. Between 1956 and 1973, the number of known "licit" and "professional" narcotic drug users steadily decreased, while the number of "illicit" narcotic drug users increased by 283 per cent, with the greatest increase taking place after 1969. Heroin was the most frequent initially reported drug (representing between 80 per cent and 89 per cent of known "illicit" narcotic drug users). Cocaine, as an initially reported "narcotic", had the largest proportional increase from 1956 to 1973. There were generally more reported male users than female in all age groups, a trend that increased over the time span considered. There were recent dramatic increases in the numbers and rates of reported users in the 20-24 year-old group, which has become the dominant pattern among new cases in recent years. Although the index on which this paper is based does not provide figures on total narcotic use in Canada, it is a valuable resource for epidemiologic research. This narcotic user index may be used to make minimum estimates of the extent and geographic and social distribution of narcotic-related problems in Canada.

Adolescent↗
PubMedDate not supplied

Population health in Canada: issues and challenges for policy, practice and research.

The population health movement has gained prominence in Canada and elsewhere with policy makers, program planners and researchers taking note that health is strongly influenced by factors that lie largely beyond the health-care system. The development of population health in Canada was the focus of the National Conference on Shared Responsibility for Health & Social Impact Assessments: Advancing the Agenda held May 2-3 1999 in Vancouver, Canada. A longer version of this paper was distributed to conference participants to provide some common knowledge and vocabulary. It also introduced and discussed definitional, normative, logistical, political, methodological, structural and resource considerations with respect to furthering the population health agenda in Canada.

Canada↗