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PubMed2000

Canine heartworm testing in Canada: are we being effective?

Mass testing of dogs in Canada for the presence of Dirofilaria immitis has been ongoing since 1977. Since that time, there have also been changes in the diagnostic tests available to detect the presence of heartworm and changes in the therapy for heartworm, which necessitate a reevaluation of heartworm screening as currently practiced in Canada. The principles of evidence-based medicine were used to determine the prevalence of heartworm infection in various dog populations, and the effectiveness of screening these populations. The annual surveys of heartworm testing have shown that Canada is a low prevalence area (0.16%), with most of the test-positive dogs located in southern Ontario (0.19%), southern Manitoba (0.18%), southern Quebec (0.09%), and the southern Okanagan Valley (0.04%). Foci of higher prevalence are found within these 4 main geographic areas. Furthermore, the prevalence of heartworm infection is higher in the population of dogs not on preventative medication (0.62%), when compared to the population of dogs on preventative medication (0.04%). The evidence indicates that a heartworm diagnostic test applied to an asymptomatic dog on preventative medication contributes little information regarding the heartworm infection status of that dog. However, testing of a dog characterized as being high risk will provide clinically useful information. Recommendations regarding the testing of dogs for heartworm in Canada are derived on the basis of available evidence.

Animals↗
PubMed2002

Survey of radiation oncologists: practice patterns of the management of stage I seminoma of testis in Canada and a selected group in the United States.

OBJECTIVE: To evaluate practice patterns of the management of stage I seminoma of testis in Canada and a selected group in the United States. MATERIALS AND METHODS: Survey among radiation oncologists treating genitourinary (GU) tumors in Canada and the RTOG GU committee members in the United States between January and March 2001. RESULTS: Response rate was 78% (73/93) in Canada and 67% (24/36) in the United States. Eighty-four percent described their clinical practice as a university affiliated teaching center, and 16% as community-based or private practice. Sixty-two percent, 31% and 7% would manage 1-5, 6-10 and > oe = 11 cases per year respectively. Almost all would perform chest x-ray (99%) and CT scan of abdomen and pelvis (100%) as staging investigation following radical inguinal orchiectomy. Forty percent also arranged CT scan of chest, while only 18% routinely obtained lymphangiogram. Seventy-eight percent offered surveillance as a management option and estimated that 20% (median) of patients would choose surveillance in their practice. Among four management options: (1. surveillance, 2. radiotherapy (RT) to the para-aortic region, 3. RT to the para-aortic and ipsilateral pelvis ('dog-leg'), 4. single-agent chemotherapy), the order of first preference was option 1 (44%), 2 (42%), and 3 (14%) for patients who wish to preserve fertility. When fertility was not a major concern, it was option 2 (43%), 3 (39%), and 1 (17%). The commonest dose-fractionation schedule was 25 Gy/20 fractions (68%). Others included 25 Gy/15 f (15%), and 25.5 Gy/17 f (4%). Forty-five percent chose the para-aortic region, while 53% used the 'dog-leg' as RT volume. Twenty-nine percent reduced RT volume from the 'dog-leg' to the para-aortic region as the result of MRC Phase III study published in 1999. CONCLUSION: There are significant variations in the practice pattern of the management of stage I seminoma of testis among radiation oncologists in Canada and a selected group in the United States.

Canada↗
PubMed1990

Immigrants from the European socialist countries in the U.S.A. and Canada: socio-demographical aspects.

The author analyzes changes in the rate of migration and choice of destination among migrants from socialist countries in eastern and southern Europe to the United States and Canada during the period 1941-1990. "The data presented show that in the period in question the immigrants from the European socialist countries constituted only 2.9% of the total number of immigrants to the U.S.A. while their proportion in the total number of immigrants to Canada was 6.6%.... In comparison with the decades 1961-70 and 1971-80, in the middle of the 80's the proportion of immigrants from the examined countries in the U.S.A. and Canada increased.... The proportion of Poles among the emigrants from the East European countries in the U.S.A. and Canada is comparatively the highest...." (SUMMARY IN SCR)

Americas↗
PubMed1997

Geographically indirect immigration to Canada: description and analysis.

"This article is concerned with geographically indirect immigration to Canada over the period 1968-1988. A geographically indirect immigrant is an individual legally admitted to Canada whose country of last permanent residence differs from country of birth. Records maintained by Employment and Immigration Canada on every immigrant legally admitted over the period were used in the study. Relative to geographically direct immigrants, geographically indirect immigrants tend to be older, more educated, and more highly skilled. Moreover, if they were not born in an English or French speaking country, indirect immigrants are more likely to speak English and/or French capably than direct migrants born in such countries. The study also contains bivariate logit estimates of a model of geographically indirect Canadian immigration. This model suggests that indirect migrants tend to be influenced by personal characteristics (age, sex, marital status, occupation, language ability), as well as by various characteristics of the country of birth (distance from Canada, income level, political conditions)."

Americas↗
PubMed1990

Two neglected categories of immigrants to Canada: temporary immigrants and returning Canadians.

Results are presented from an attempt to improve Canadian statistics on international migration so as to comply with U.N. guidelines by including data on long-term residents with temporary status and Canadian citizens and permanent residents returning from abroad. "The estimation procedures involve extensive operations on three Canadian administrative data systems: the Visitors Immigration Data System of Employment and Immigration Canada; the Family Allowances Files of Health and Welfare Canada; and the Customs and Excise Files of Revenue Canada. These data are used to produce the number of immigrants in both of the neglected categories, as well as to calculate the geographic (origin and destination) and demographic (sex, age, marital status) structures of these groups. Results of the analysis of estimates for the period 1982-1988 show that, due to their size and characteristics, both of these neglected categories of immigrants constitute a significant part of immigration to Canada, and their importance has and will continue to increase over time."

Americas↗
PubMed2003

Intravenous immune globulin use in Canada.

OBJECTIVES: To determine the amount of intravenous immune globulin (IVIG) used across indications in Canada and which Canadian medical specialties prescribe IVIG. To assess the proportion of IVIG that was used in appropriate off-label and labelled indications versus those deemed to be inappropriate off-label indications. METHODS: In Canada, all IVIG is distributed by the Canadian Blood System to Canadian blood banks within the hospital setting. Hospital blood banks then dispense IVIG to individual patients as it is prescribed and, as such, many institutions maintain a comprehensive database inventory on IVIG use. This study is a retrospective review of IVIG use as obtained from 10 teaching and community hospital blood bank databases in Ontario, Quebec, Alberta and British Columbia. Two of these 10 institutions were pediatric teaching hospitals whereas the remaining eight centres were adult care sites. Product usage was assessed between 1997 and 1999 in adult care sites, and 1997 and 1998 in the pediatric hospitals. The information collected included the number of grams of IVIG dispensed, the indications, the prescribing physician's specialty and the number of patients treated for a given indication, all assessed on an annual basis. A separate analysis was performed to determine the appropriateness of IVIG use where appropriateness was based on the published 1997 and 1999 Canadian Consensus Guidelines for IVIG use. RESULTS: IVIG was prescribed for 90 different indications, six of which are licensed in Canada. When considered as separate populations, adult and pediatric use accounted for 61 and 65 different indications, respectively. Licensed use for all known indications represented approximately 47% and 62% in adult and pediatric settings, respectively. Twenty-nine per cent of IVIG use in adult and 17% in pediatric settings was not reported and is therefore unknown. Although off-label use by definition is approximately 53% in adults and 38% in pediatrics, the majority of overall IVIG use (89% in both populations) is considered appropriate by guideline definition. Hematologists and neurologists were the most prevalent prescribers of IVIG. CONCLUSIONS: Based on guideline definition, appropriate off-label use of IVIG is very high in Canada.

Adolescent↗
PubMed1992

Results of CHICA-Canada survey of long term care infection control practitioners.

Recognizing the unique and varied needs of infection control practitioners (ICPs) in long term care (LTC) facilities across Canada, CHICA-Canada established a task group to explore this area of practice and to determine the needs that could be met by CHICA-Canada. In March 1992 surveys were sent to CHICA-Canada members practicing in LTC facilities. Surveys were also sent to LTC associations in each province for distribution to their member agencies. A copy of the survey was published in The Canadian Journal of Infection Control in Summer 1992. As of August 31, 1992, 271 surveys have been returned from both members and nonmembers. The findings of the survey depict the special needs, unique practice settings and varied roles of ICPs in LTC facilities.

Canada↗
PubMed1992

A statistical chronicle of tuberculosis in Canada: Part I. From the era of sanatorium treatment to the present.

This report marks over 50 years of publication by Statistics Canada of annual reports on tuberculosis statistics. These years have witnessed what has been described as a conquest of tuberculosis in Canada. To quote George Jasper Wherrett in The Miracle of the Empty Beds: One hundred years ago the word consumption (as tuberculosis was then called) struck horror in human hearts. Today, in the western world, it barely evokes any emotion save a too easy surprise that it still exists. This statistical chronicle of tuberculosis in Canada is divided into two parts. Part I: From the Era of Sanatorium Treatment to the Present pulls together data from yellowed-with-age reports on tuberculosis and vital statistics, historical accounts and modern computer files, to document the changes in tuberculosis incidence and mortality over past decades to the present. Part II: Risk Today and Control takes a closer look at those most vulnerable to contracting tuberculosis. It also looks at the future, the need for maintaining and, indeed, strengthening vigilance, and the work yet to be done to eradicate tuberculosis in Canada. The fight against tuberculosis is far from over.

Adolescent↗
PubMed1992

Family medicine education in Canada.

Within the sphere of health and welfare, Canada has more in common with the Scandinavian countries than with the United States. This article describes and discusses the unique role of the College of Family Physicians of Canada and the education and training for family medicine, both on the undergraduate and postgraduate levels in Canada. The development of the Master of Clinical Science in Family Medicine degree programme at the University of Western Ontario is considered to be an important vehicle for strengthening academic family medicine in Canada. The amalgamation of current knowledge not only from clinical sciences and educational research, but also from the social sciences, is seen as fundamental to the continued improvement of this discipline.

Canada↗
PubMed1992

A statistical chronicle of tuberculosis in Canada: Part II. Risk today and control.

This report marks over 50 years of publication by Statistics Canada of annual reports on Tuberculosis Statistics. These years have witnessed what has been described as a conquest of tuberculosis in Canada. To quote George Jasper Wherrett in the Miracle of the Empty Beds: One hundred years ago the word consumption (as tuberculosis was then called) struck horror in human hearts. Today, in the western world, it barely evokes any emotion save a too easy surprise that it still exists. This statistical chronicle of tuberculosis in Canada is divided into two parts. Part I: From the Era of Sanatorium Treatment to the Present pulls together data from yellowed-with-age reports on tuberculosis and vital statistics, historical accounts, and modern computer files, to document the changes in tuberculosis incidence and mortality over past decades to the present. Part II: Risk Today and Control takes a closer look at those most vulnerable to contracting tuberculosis. It also looks at the future, the need for maintaining and, indeed, strengthening vigilance, and the work yet to be done to eradicate tuberculosis in Canada. The fight against tuberculosis is far from over.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Outcomes after aortic and mitral valve replacement surgery in Canada: 1994/95 to 1999/2000.

BACKGROUND: Although outcomes after coronary artery bypass grafting (CABG) have been studied extensively across Canada, using both clinical and administrative databases, studies examining outcomes after valve surgery in Canada have been restricted to regional investigations using clinical data sources of limited scope. The objective of the present study was to report on observed and risk-adjusted in-hospital mortality rates after aortic valve replacement (AVR) and mitral valve replacement (MVR) across Canada between 1994/95 and 1999/2000 using administrative data. METHODS: All cases of AVR and MVR (with and without concomitant CABG) performed between 1994/95 and 1999/2000 were identified using hospital discharge abstract data obtained from the Canadian Institute for Health Information. Rates of in-hospital mortality were risk-adjusted using logistic regression modelling techniques to account for variations in sociodemographic, comorbidity, and disease-specific indicators of average severity of illness across years and provinces. Risk-adjusted outcomes were unavailable for the province of Quebec. RESULTS: The overall in-hospital mortality rate, excluding Quebec, between 1994/95 and 1999/2000 after isolated AVR with or without CABG was 3.7% and isolated MVR with or without CABG was 5.7%. Although risk-adjusted in-hospital mortality rates by year were unchanged between 1994/95 and 1999/2000, significant interprovincial variation did exist, ranging from 2.6% to 6.8% for AVR with or without CABG and 2.5% to 13.0% for MVR with or without CABG. CONCLUSION: In-hospital mortality rates after valve surgery have remained stable over time. However, significant variation in outcomes was noted between provinces. The results of this study provide the first comprehensive account of valve surgery outcomes across Canada.

Adult↗
PubMed2004

Chronic wasting disease in Canada: Part 1.

The purpose of part 1 is to provide an overview of published literature (1980-2002) on chronic wasting disease (CWD) to inform Canadian readers about the disease and to explain Canadian regulatory approaches to the surveillance and control of CWD. Much of the scientific information is drawn from American publications obtained from internet searches in PubMed and Medline databases. The following keywords were used: chronic wasting disease, prion, diagnosis, transmissible spongiform encephalopathies, CWD and deer, CWD and elk, and CWD and environment. The article also presents information from Canadian publications and unpublished observations, Canadian Food Inspection Agency (CFIA) documents, and both government and nongovernment internet Web sites. The article highlights some different features of CWD in Canada, as compared with the situation in the United States, and mentions public health implications of the disease. It also describes the basis for development of Canada's surveillance and control program. Part 2 will detail the activities and results of the surveillance and control program during 2000 to 2002 and discuss factors that will influence the feasibility of eradicating CWD. Chronic wasting disease appears to have been introduced into Canada through the importation of infected farmed elk from the United States in the late 1980s and early 1990s, at a time when little was known about the disease. Since then, eradication efforts in Canada have led to the control of the spread of CWD in the farmed elk industry. Still, management of this disease, especially in free-ranging cervids, is a challenge.

Animals↗
PubMedDate not supplied

From stool to statistics: reporting of acute gastrointestinal illnesses in Canada.

BACKGROUND: Limitations associated with the under-reporting of enteric illnesses have long been recognized but the extent and variation of this under-reporting in Canada has not been examined. Given the public health value of surveillance data, a closer examination of under-reporting of enteric illnesses in Canada was warranted. METHODS: Paper-based surveys were administered (a) to all laboratories in Canada licensed to process stool specimens and (b) to all local public health authorities in two provinces. RESULTS: Of the laboratories surveyed, 67% (n=274) conducted on-site testing of stool specimens for enteric bacteria, 31% (n=126) for parasites and 10% (n=42) for viruses. In the year 2000, these laboratories processed 459,982 stool specimens, of which 5%, 15%, 8% and 19% were positive for enteric bacteria (excluding C. difficile), C. difficile, parasites and viruses, respectively. Variations in laboratory testing and health authority reporting protocols and policies were identified. Of the laboratory-confirmed cases of AGI reported to local public health authorities, 5% (n=846) were not reported to provincial counterparts. CONCLUSION: A significant proportion of AGI cases submitting stool specimens are not captured in Canada's passive surveillance system due to unknown etiology. A much smaller proportion of laboratory-confirmed cases reported to local public health authorities are not captured at the provincial or national level. Given that the number of laboratory-confirmed AGI cases represents such a small fraction of all community cases, strategies to compensate for under-reporting and efforts directed at harmonizing laboratory and local public health authority policies and practices would be welcomed.

Acute Disease↗
PubMed2005

Canada Health Infoway - Towards a National Interoperable Electronic Health Record (EHR) Solution.

Canada Health Infoway Inc. (Infoway) is leading Canada's initiative to develop interoperable electronic health records (EHRs) and accelerate their adoption nationwide. Specifically, Infoway's core business is to invest with its partners-primarily provincial and territorial governments-in the development of robust, interoperable EHR solutions and in their deployment and replication across Canada. This partnership approach produces results faster, more cost-efficiently and more effectively than if any one partner acted alone.This chapter presents a high-level view of Infoway's seven-year plan to have the basic elements of interoperable EHRs in place across 50 percent of Canada by the end of 2009. In particular, the chapter discusses the business and technical approaches that have been developed to pursue Infoway's aggressive goal. These approaches allow individual jurisdictions to deliver local and regional solutions cost-effectively while contributing to a larger, interoperable national system.

Canada↗
PubMedDate not supplied

Residents' experiences in, and attitudes toward, the care of persons with AIDS in Canada, France, and the United States.

OBJECTIVE: To evaluate resident physicians' experiences in, and attitudes toward, the care of persons with the acquired immunodeficiency syndrome (AIDS) in Canada, France, and the United States. DESIGN: Cross-sectional survey, using a self-administered, mailed questionnaire to residents in 10 American states, three French regions, and all 10 Canadian provinces, with follow-up surveys of nonresponders in France and the United States. SUBJECTS: Systematic samples of residents in the last year of internal medicine or family medicine residencies prior to subspecialization or entry into medical practice. RESULTS: While the majority of residents had provided inpatient and outpatient care to persons with AIDS, most believed that their training in ambulatory care of persons with AIDS had been deficient. The rate of blood-contaminated needle-sticks from human immunodeficiency virus-infected patients ranged from 4% for internal medicine residents in Canada to 14% in the United States (P less than .05). The majority recognized an ethical obligation to treat AIDS, but 4% in France, 14% in Canada, and 23% in the United States indicated that they would not care for persons with AIDS if they had a choice (P less than .001). A substantial minority of US physicians reported that a patient of theirs had been refused care by a medical specialist (19%) or a surgeon (39%), but less than 10% of French physicians reported such refusals (P less than .001). CONCLUSION: Concerns about caring for AIDS patients were common and many physicians reported that patients were refused care. While most residents acknowledged an obligation to treat human immunodeficiency virus infection, many did not, and viewpoints varied considerably across the countries studied. The lower level of reluctance to treat AIDS patients in France and Canada makes it clear that the higher rate in the United States is far from optimal and needs to be addressed.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Advances in rural medical education in three countries: Canada, The United States and Australia.

INTRODUCTION: This article documents a number of rural medical education initiatives in Australia, Canada and the United States. A typology is created reflecting the centrality the rural mandate and characterizing different features of each school's program. Interviews with school officials are drawn on to reflect the challenges these schools face. METHOD: Seven schools noted for their rural programs were selected from the three countries and interviews were conducted with senior officials. The interview data was supplemented by published material on the schools. RESULTS: The Typology: Three kinds of school are distinguished: Mixed Urban/Rural Schools (University of Washington, US, the University of British Columbia, Canada, and Flinders University, Australia); DeFacto Rural Schools (University of New Mexico, US and Memorial University, Canada) and Stand Alone Rural Schools (James Cook University, Australia and the Northern Ontario School of Medicine, Canada). The Pipeline Approach: All of the schools adopted in varying degrees a pipeline approach to meeting the need for rural doctors focusing on: (a) early recruitment; (b) admissions; (c) locating clinical education in rural settings; (d) rural health focus to curriculum; and (e) support for rural practice. CONCLUSION: The analysis does not strongly favor one model over others, although the Stand-Alone Rural schools had more opportunities to adopt innovative curricula reflecting rural health issues and to foster positive views of rural practice. Government funding targeting rural health needs will remain critical in the development of all these programs.

Australia↗
PubMed2005

Regional variation in self-reported heart disease prevalence in Canada.

BACKGROUND: Cardiovascular disease is the leading cause of death in Canada. OBJECTIVE: To provide an analysis of the self-reported prevalence of heart disease and three specific cardiac conditions--myocardial infarction (MI), angina and congestive heart failure (CHF)--in subgroups of the Canadian population. METHODS: Data from the Public Use Microdata File from Statistics Canada's 2000/2001 Canadian Community Health Survey (CCHS) were used to estimate the crude self-reported prevalence of heart disease, MI, angina and CHF in Canada. The data are reported by age and sex groups, as well as by province or territory and health region. RESULTS: Based on the 2000/2001 CCHS data, it was estimated that among Canadians 12 years of age and older, 5.0% (n=1,286,000) have heart disease, 2.1% (n=537,000) have had a heart attack, 1.9% (n=483,000) have angina and 1.0% (n=264,000) have CHF. Marked variation in the prevalence of heart disease and the other specific cardiac conditions exists across age and sex groups, and across geographical regions. The prevalence of heart disease is low among those younger than 50 years; thereafter, the prevalence of heart disease increases and is more common among men than among women. By 70 years of age, at least one in four men and one in five women report having heart disease. Large differences in the burden of heart disease were observed across provinces, territories and health regions. Comparison of the highest and lowest prevalence rates among provinces and territories revealed a 1.9-fold difference for heart disease, a 2.8-fold difference for MI, a 2.3-fold difference for angina and a 3.3-fold difference for CHF. CONCLUSIONS: Large regional differences in the prevalence of heart disease and other specific cardiac conditions were observed across Canada. These data may assist health system planners to identify those regions and population subgroups most affected by heart disease, and to support the development of heart disease prevention and treatment programs.

Adolescent↗
PubMed2006

Sexual disorders and associated help-seeking behaviors in Canada.

OBJECTIVES: To study sexual activity, the prevalence of sexual difficulties and related help-seeking behaviors, among mature adults in Canada. MATERIALS AND METHODS: A telephone survey (random digit dialed) was conducted in Canada in 2001 to 2002. Interviews were based on a standardized questionnaire, including demographics, general health, relationships, and sexual behaviors, attitudes and beliefs. The survey was completed by a total of 1007 individuals (500 men and 507 women) aged 40 to 80 years in Canada. RESULTS: Overall, 83% of men and 71% of women had engaged in sexual intercourse during the 12 months preceding the interview, and 42% of men and 36% of women engaged in sexual intercourse more than once a week. Early ejaculation (23%) and erectile difficulties (16%) were the sexual problems most frequently reported by men. The sexual problems most frequently reported by women were a lack of sexual interest (30%) and lubrication difficulties (24%). Older age (60 to 80 years compared with 40 to 49 years) and diagnoses of depression and diabetes were all significant predictors of erectile difficulties in men. More than 75% of men and women had sought no help for their sexual problem(s) from a health professional. CONCLUSIONS: Many middle aged and older adults in Canada report continued sexual interest and activity. Although a number of sexual problems are highly prevalent in this population, few individuals seek medical help for these problems. This may be partly because they are not sufficiently bothered by the problem or do not think that it is serious.

Adult↗