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PubMedDate not supplied

Canada on the Move: an intensive media analysis from inception to reception.

BACKGROUND: Research evaluating mediated physical activity campaigns uses an unsophisticated conceptualization of the media and would benefit from the application of a media studies approach. The purpose of this article is to report on the application of this type of analysis to the Canada on the Move media campaign. METHODS: Through interviews and document analysis, the press release surrounding Canada on the Move was examined at four levels: inception, production, transmission and reception. Analytic strategies of thematic and textual analysis were conducted. RESULTS AND CONCLUSION: The press release was well received by journalists and editors and was successfully transmitted as inferred from national and local television coverage, although there was no national print pickup. Canada on the Move was perceived by sampled audience members as a useful and interesting strategy to encourage walking. A holistic approach to media analysis reveals the complex and frequently messy process of this mediated communication process. Implications for future media disseminations of Canada on the Move are discussed.

Canada↗
PubMed2006

The health care philosophy that nearly destroyed Medicare in Canada in a single decade.

BACKGROUND: In 1989, governments in Canada perceived an economic crisis in health care funding and commissioned two economists, Drs. Barer and Stoddart, to review policies. They indicated that major costs were caused by physicians and recommended cutting physician training and hospital facilities. In 1991 governments selectively implemented their recommendations. The Federally established Romanow Commission 're-reviewed' the problem and reported in 2002. OBJECTIVES: To examine whether there was an economic crisis and to assess the effects of reductions in funding on the provision of health care in Canada. METHOD: We analyzed data from Statistics Canada, the Association of Canadian Medical Colleges, and the Canadian Institute of Health Information, the Canadian Nurses Association, and Health Canada. We focus exclusively on public health care spending. RESULTS: Publicly financed health care spending remained stable as percentage of Gross Domestic Product in the five years leading up to the commissioning of the Barer-Stoddart report (1986-1990). An increase in the elderly population partly explained rising costs. By 2000, people over 65 accounted for 48% of overall health costs. Emerging from the report's recommendations, between 1990 and 2000 medical students and residents as a proportion of the population were cut by 17% and 12% respectively and hospital beds by a third. Nurses per 100,000 fell 12%. Home care remained under-funded, less than 4% of the total health budget. CONCLUSION: There was no economic health care crisis in the early 1990s. Growing costs were principally due to increased patient need. Funding reductions resulted in inadequate care, including the creation of prolonged wait lists that have resulted in legalizing private care, thereby threatening the universal equal care principle.

Canada↗
PubMed2006

Natural health product use in Canada: analysis of the National Population Health Survey.

BACKGROUND: The use of natural health products (NHPs) in Western countries has increased dramatically over the past two decades. Although prevalence estimates have been published in the U.S. and elsewhere, little is known about the characteristics of persons who use NHPs. OBJECTIVES: To measure the prevalence of NHP use among adults in Canada, identify the most commonly used agents, and determine the socioeconomic, demographic, and health-related correlates of use. METHODS: NHP use by adults was assessed using the 2000-2001 National Population Health Survey (NPHS), a biennial general health survey conducted by Statistics Canada. A total of 11,424 adults completed the survey in 2000-2001. NHPs were defined as botanical and naturally-derived non-botanical products, excluding essential vitamins and minerals. Prevalence of use estimates were calculated nationally, and by age, gender, socioeconomic status, disease states, and health care practices. Multivariate logistic regression modeling was used to simultaneously assess the correlations of these variables with NHP use. RESULTS: The prevalence of past 2-day NHP use in Canada was 9.3% in 2000-2001. Fifty-seven percent of users also reported taking a conventional medicine in the same period. Glucosamine, echinacea, and garlic were the most frequently used products. Women reported NHP use more frequently than men (11.5% vs. 7.1%). As compared to young adults, NHP use was about 50% higher in middle-aged and older Canadians. There were no associations with either income or education level. Several disease states were associated with a high prevalence of NHP use: respondents with fibromyalgia (23.3%), inflammatory bowel disease (17.4%), and urinary incontinence (16.8%) were most likely to be NHP users. However, in the multivariate analysis, age and the use of vitamins or minerals were most predictive of NHP use, while health status variables were of less importance. CONCLUSIONS: NHP use is an important health phenomenon in Canada. Although respondents in poor health were more likely to use NHPs, a significant proportion of healthy Canadians also reported NHP use. The use of NHPs also cut across different socioeconomic groups. Concurrent use of conventional medications was common and suggests a need for health professionals to monitor for potential interactions.

Adult↗
PubMed2006

The importance of foreign-trained physicians to Canada.

PURPOSE: To examine the proportion of Canada's physicians who are foreign-trained (non-Canada, non-US), and to determine if there was a relationship between this number and the net change in physicians of each province as affected by inter-provincial migration. METHODS: Data were obtained from the Canadian Medical Association, based on information contained within the Southam Medical Database of the Canadian Institute for Health Information (1987-2003). Information on the net change in the number of physicians lost or gained due to inter-provincial migration was obtained for each province, as well as the percentage of physicians that are foreign-trained (non-Canada, non-US). A correlation between the net change in physician supply and the proportion of foreign-trained physicians was explored. RESULTS: Foreign-trained physicians comprised from 19% (Prince Edward Island) to 55% (Saskatchewan) of the provincial physician supply. There was a strong linear correlation between the net change in physician supply due to inter-provincial migration and the proportion of foreign-trained physicians (r2 0.546; P=0.0146). DISCUSSION: Canada continued to rely heavily on foreign-trained physicians. This was particularly true for provinces which lost the greatest number of physicians to inter-provincial migration. Such 'poaching' of physicians may have important ramifications for the source countries.

Canada↗
PubMedDate not supplied

Chronic airways obstruction leading to chronic hypoxemic respiratory failure: an estimate of the size and trend of the problem in Canada.

Chronic airways obstruction is a common cause of morbidity and mortality in Canada. It may progress to hypoxic respiratory failure and then to death. Only a few studies of the prevalence of chronic airways obstruction have been reported from Canada, but a number of studies have been reported from the United States and the United Kingdom, countries with similar socioeconomic conditions and ethnic compositions to those in Canada. The prevalence of chronic airflow limitation in these studies averages 9.3%. In each study, tobacco smoke exposure is the most prominent etiologic agent. Other contributing factors identified in the studies are air pollution, occupational exposure, respiratory infections and childhood respiratory illness. Endogenous modifiers of these risk factors demonstrated in the published studies include age, elevated peripheral blood leukocyte count and familial factors. Although epidemiologic studies have been able to identify the prevalence of functional impairment associated with chronic airways obstruction, risk factors associated with its development and modifiers of these risk factors, it is not possible to determine the prevalence of severe chronic airways obstruction resulting in hypoxemic respiratory failure. An estimate of this prevalence has been calculated based on certain assumptions. It was assumed that patients dying of chronic airways obstruction were likely, in a high proportion of cases, to have hypoxemic respiratory failure. It has been demonstrated that only one-half of all patients dying of chronic airways obstruction are correctly designated on death certificates. It was assumed, conservatively, that the median survival of patients with hypoxemic respiratory failure is two years. From these assumptions, it was estimated that the prevalence of hypoxemic respiratory failure in 1986 in Canada was 100 per 100,000 population. This is higher than the present rate of oxygen therapy, indicating that some patients currently eligible for this treatment may not be receiving it.

Canada↗
PubMed1991

Trends in cesarean section deliveries in Canada.

Recent trends in cesarean section deliveries in Canada were explored using 1970-1988/89 hospitalization data from Statistics Canada's morbidity data base. The rate in Canada increased from 5.8 cesarean sections per 100 hospital deliveries in 1970 to 19.5 in 1988/89 and paralleled the increase in rates seen in the United States, which went from 5.5 to 24.7 during the same period. Canada had the second highest rate among the countries studied and in the last year of the study the Canadian rate was almost double that of the United Kingdom. Provincially the rates were highest in Newfoundland (23.3) and lowest in Manitoba (15.5). Cesarean sections were more frequent among women aged 35+ (27.3 per 100 hospital deliveries) compared with (13.9) for women under 20 years of age. Vaginal births after a previous cesarean increased significantly during the last 10 years from 3 per 100 previous cesarean sections in 1979/80 to 15.6 in 1988/89, perhaps indicating a significant shift in obstetric practice.

Adult↗
PubMedDate not supplied

The use of chewing tobacco and snuff in Canada, 1986.

This paper reviews current data relating to the use of smokeless tobacco products in Canada. Sources of data include production, disposition, and sales statistics; special population surveys, and estimates obtained from the 1986 Labour Force Survey smoking supplement. In Canada, the use of smokeless tobacco products is confined to the male population. About 0.7% of males over age 15 use chewing tobacco and 0.4% use snuff. The pattern of use is similar to that of the United States in the early 70s. Prevalence rates for both substances tend to be higher in older age groups. Men employed in outdoor occupations are more likely to use chewing tobacco or snuff. Chewing tobacco use tends to be more prevalent in eastern Canada and snuff use in western Canada. The low national prevalence estimates conceal the relatively high usage rates among sub-populations. Among Inuit youth in the Northwest Territories in 1982, 25% of the 10-14 age group used smokeless tobacco.

Adolescent↗
PubMedDate not supplied

Contraceptive use in Canada, 1984.

Canada's first national fertility survey, carried out by telephone in 1984, found that 68 percent of all women aged 18-49-73 percent of currently married women, 69 percent of the previously married women and 57 percent of single women--are practicing contraception. Overall, the most widely used method of birth control in Canada is sterilization (male and female), which is relied on by almost 60 percent of all married users and 66 percent of previously married users. Among single women, the preferred method is the pill, chosen by seven out of 10 of such users. Among all women, the major determinant of method choice is age: The pill is overwhelmingly chosen by women under 25, and sterilization, by those 30 and over. While the IUD and the condom are used by roughly 10-14 percent of women in their 20s who practice contraception, these methods decline in importance with increasing age. Highly educated women are less likely than those with little education to elect sterilization, and more likely to rely on barrier methods. Differences in contraceptive prevalence and patterns of use between Catholics and Protestants have all but disappeared in Canada, but church attendance and country of birth appear to exert a modest influence on method choice. As might be anticipated, women whose family size is complete have considerably higher levels of contraceptive use than those who expect to have more children. The survey reveals no difference in contraceptive use between Quebec women and those in the rest of Canada, thus confirming both the accuracy of earlier Quebec studies showing extremely high levels of sterilization and the applicability of these findings to all other Canadian women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Costs associated with gunshot wounds in Canada in 1991.

OBJECTIVE: To estimate the costs (in 1993 dollars) associated with gunshot wounds in Canada in 1991. DESIGN: Cost analysis using separate estimates of gunshot incidence rates and costs per incident for victims who died, those who survived and were admitted to hospital and those who survived and were treated and released from emergency departments. Estimates were based on costs for medical care, mental health care, public services (i.e., police investigation), productivity losses, funeral expenses, and individual and family pain, suffering and lost quality of life. SETTING: Canada. OUTCOME MEASURES: Costs per case, costs by type of incident (e.g., assault, suicide or unintentional shooting) and costs per capita. RESULTS: The total estimated cost associated with gunshot wounds was $6.6 billion. Of this, approximately $63 million was spent on medical and mental health care and $10 million on public services. Productivity losses exceeded $1.5 billion. The remaining cost represented the value attributed to pain, suffering and lost quality of life. Suicides and attempted suicides accounted for the bulk of the costs ($4.7 billion); homicides and assaults were the next most costly ($1.1 billion). The cost per survivor admitted to hospital was approximately $300,000; this amount included just over $29,000 for medical and mental health care. CONCLUSION: Costs associated with gunshot wounds were $235 per capita in Canada in 1991, as compared with $595 in the United States in 1992. The differences in these costs may be due to differences in gun availability in the two countries. This suggests that increased gun control may reduce Canada's costs, especially those related to suicide.

Canada↗
PubMed1995

Regionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes.

OBJECTIVE: To determine how regionalization of facilities for coronary artery bypass surgery (CABS) affects geographic access to CABS and surgical outcomes. DESIGN: Computerized hospital discharge records were used to measure hospital CABS volume and in-hospital post-CABS mortality rates. Relationships between surgical volume and age- and sex-adjusted mortality rates were compared using chi 2 tests. Small-area analysis of the association between CABS rates and distances to nearest CABS hospital was performed using multivariate linear regression methods. SETTING: All nonfederal hospitals in New York, California, Ontario, Manitoba, and British Columbia. PATIENTS: All adult residents of the five jurisdictions who underwent CABS in a hospital in their jurisdiction from 1987 through 1989. RESULTS: In New York and Canada, approximately 60% of all CABS operations took place in hospitals performing 500 or more CABS operations per year, compared with only 26% in California. The highest mortality rates were found among California hospitals performing fewer than 100 CABS operations per year (adjusted 14-day in-hospital mortality was 4.7% compared with 2.4% in high-volume California hospitals, P < .001). The percentage of the population residing within 25 miles of a CABS hospital was 91% in California, 82% in New York, and less than 60% in Canada. Eliminating very low-volume (< 100 cases per year) CABS hospitals in California would increase travel distances to a CABS hospital only slightly for a small number of residents. The Canadian degree of regionalization was not associated with lower CABS rates within provinces for populations living at more remote distances from the nearest CABS hospital. CONCLUSION: Regionalization of CABS facilities in New York and Canada largely avoids the problem of low-volume outlier hospitals with high postoperative mortality rates found in California. New York has avoided the redundancy of facilities that exists in California while still providing residents a geographically convenient selection of CABS hospitals. Stricter regionalization in Canada may leave residents with a more narrow choice of facilities, but does not disproportionately affect access to surgery for populations living at remote distances from CABS facilities.

Canada↗
PubMedDate not supplied

New and prevalent patients with end-stage renal disease in Canada. A portrait of the year 2000.

The number of patients initiating treatment for end-stage renal disease (ESRD) has increased dramatically in Canada and other countries. To assist healthcare planners, the prevalence of ESRD in Canada has been projected to the year 2000 using a Markov modelling technique. Significant increases in ESRD are expected in Canada during the next decade, particularly among the elderly and diabetic populations: estimated increases in prevalence rates of ESRD between 1992 and the year 2000 were 78% and 154% for non diabetic and diabetic populations respectively. These expected increases did not differ significantly between the treatment groups, except among patients with diabetes, in whom projected increases in the prevalence of functioning transplant was smaller than for hemodialysis or peritoneal dialysis. Because the current Canadian prevalence rates are lower than those of some other countries, such as the United States and Japan, these expected trends in prevalence appear reasonable, and illustrate the growing healthcare needs of the ESRD population in Canada during the next decade.

Adolescent↗
PubMed1995

Midwifery in Canada: the struggle for recognition.

The pattern of development of midwifery as a profession in Canada and the UK has been similar, but Canada is nearly 75 years behind. Despite its size and international stature, Canada is one of only eight countries in the world where midwifery has not yet been legally recognised nationally. Each of the 12 provincial governments of Canada enacts its own legislation. So far, four provinces have passed appropriate legislation. Midwifery degree programmes are now under way in some provinces.

Canada↗
PubMed1995

Research institute tries to ease brain drain by bringing researchers back to Canada.

The lack of research opportunities in Canada and the large number of them in the US have cost Canada some of its brightest young researchers. The Robarts Research Institute in London, Ont., is trying to reverse that trend by bringing some of these researchers back home. However, Dr. Mark Poznansky says the repatriation efforts will mean little if research budgets keep getting cut in Canada. He says the budget of the Medical Research Council of Canada is barely adequate for today's needs.

Academies and Institutes↗
PubMed1996

A detailed comparison of physician services for the elderly in the United States and Canada.

OBJECTIVE: To assess the relative volume and price of physician services in Canada and the United States. DESIGN: A comparative analysis of 1992 claims data from Canadian provincial ministries of health and from the US Health Care Financing Administration. PATIENTS: All elderly individuals in the 3 largest Canadian provinces, Ontario, Quebec, and British Columbia, and a 1% random sample of US elderly Medicare beneficiaries not enrolled in health maintenance organizations. MAIN OUTCOME MEASURE: The volume of physician services measured in terms of the relative value units used in the Medicare fee schedule to calculate payments, with services disaggregated into clinically meaningful categories. RESULTS: Canadian elderly receive a higher volume of physician services than US elderly. Because the provinces examined paid a much lower price per service, Canada had overall lower expenditures per elderly person than the United States. Canadian elderly received 44% more evaluation and management services, but 25% fewer procedures. Canada has a disproportionately lower volume of procedures for which there is low clinical consensus as to when they are indicated. Such procedures include cataract extractions and knee replacements. CONCLUSION: The lower prices for physician services in Canada permit Canadian elderly to receive a higher volume of evaluation and management services, on the other hand, are constrained by both price and volume. These differences in the volume of physician services may be the result of differences in facility and physician supply.

Aged↗
PubMed1995

Estimating the cost of lung cancer diagnosis and treatment in Canada: the POHEM model.

Because lung cancer is a major health care problem in Canada, it would be useful to identify the direct health care costs of diagnosing and treating this disease and to create an analytic framework within which diagnostic and therapeutic options can be assessed. This paper describes a method of modelling the costs of care for lung cancer. The perspective of the costing model is that of the government as payer in a universal health care system. Clinical algorithms were developed to describe the management of non-small cell (NSCLC) and small cell (SCLC) lung cancer. Patients were allocated to the treatment algorithms in the model, based on a knowledge of the stage distribution of cases within provincial cancer registries and an estimate of the use of therapeutic modalities, according to lung cancer experts. A microsimulation model (POHEM) developed at Statistics Canada was used to integrate data on risk factors, disease onset and progression, health care resource utilization and direct medical care costs. The model incorporates survival data on patients, according to cell type and stage, based on published studies. Relapse and terminal care costs were assigned during the year of death, in order to determine the cost of continuing care and the cumulative cost of lung cancer management over time. Patients surviving five years were assumed to be cured. The model estimates that the total five year cost to provide care to the 15,624 cases of lung cancer diagnosed in Canada in 1988 was in excess of $328 million. Over 82% of this total was spent in the first year for diagnostic tests, therapy (surgery, chemotherapy, radiation therapy, or combinations of these), hospitalization and follow-up costs. The average five year cost per case was $21,000, and ranged from a high of $29,860 for limited disease SCLC, to a low of $16,500 for Stage IV NSCLC. The actual cost of providing care, including the management of complications, is unknown and our estimates should be regarded as an idealized estimate of the cost of lung cancer management. However, the POHEM model has a level of sophistication which, we believe, reasonably reflects the cost per case and total costs of treating lung cancer by stage and therapeutic modality in Canada.

Age of Onset↗
PubMed1997

Recent trends in infant mortality rates and proportions of low-birth-weight live births in Canada.

OBJECTIVE: To identify spatial patterns of changes in infant mortality rates and proportions of low-birth-weight live births observed in 1994. SETTING: Canada. SUBJECTS: Live births and infant deaths in Canada between 1987 and 1994. Data for Newfoundland were unavailable for 1987 through 1990. OUTCOME MEASURES: Annual infant mortality rates (crude and after excluding live newborns weighing less than 500 g); proportion of live births by low-birth-weight category (500-2499 g). RESULTS: Nova Scotia, New Brunswick, Quebec and Manitoba had lower crude and adjusted infant mortality rates in 1994 than in 1993. Newfoundland, Saskatchewan, Alberta and British Columbia had higher rates in 1994 than in 1993. The crude rate in Ontario was lower, and the adjusted rate higher, in 1994 than in 1993. A downward trend in the proportion of low-birth-weight live births was observed in Quebec (chi(2) for trend = 29.2, p < 0.01). Conversely, an upward trend was observed in Ontario (chi(2) for trend = 241.3, p < 0.01). However, the increase may have been due to data errors, especially in 1993 and 1994, involving truncation of ounces in 2 digits to 1 digit (e.g., 5 pounds 10 ounces became 5 pounds 1 ounce). CONCLUSIONS: Although the marginal increases in infant mortality observed in several provinces could be the result of random variation, future trends should be closely monitored. The proportion of low-birth-weight live births in Canada (excluding Ontario) appears to be stable, with Quebec showing significant reductions. The errors in data for Ontario need to be corrected before trends can be estimated for that province and for Canada as a whole.

Birth Weight↗
PubMed1997

Medical classification systems in Canada: moving toward the year 2000.

The use of different standards for coding diagnoses and procedures has been identified as a major obstacle to the collection and analysis of data across the various jurisdictions in Canada. In this article the authors briefly describe the current and future situation of medical classification systems in Canada and discuss some of the potential benefits and implications of adopting the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and a revised procedure classification, the Canadian Classification of Health Interventions, as national standards for classification systems in Canada. They further describe some of the key features of the proposed new classification systems and highlight some of the actions being taken by the Canadian Institute for Health Information to support implementation of these standards in Canada over the next few years.

Canada↗
PubMed1998

Modifications to the National Dental Examining Board of Canada's certification process.

Following a lengthy and intense consultation with stakeholders, and an analysis of the present certification process, the National Dental Examining Board of Canada (NDEB) and the 10 provincial licensing authorities recently approved major changes to the certification process for dental licensure in Canada. As of January 1997, graduates of dental programs accredited by the American Dental Association's Commission on Dental Accreditation (ADA Commission) must complete successfully the same examinations as graduates of programs accredited by the Commission on Dental Accreditation of Canada (CDAC) to be licensed to practice in Canada. In addition, NDEB's examination system for graduates of dental programs that are not accredited by CDAC or the ADA Commission (i.e. international programs) will be discontinued on December 31, 1999. As of January 1, 2000, graduates of non-accredited programs will be required to complete a CDAC accredited, university-based qualifying program to be eligible to participate in the same certification process as graduates of ADA Commission and CDAC accredited dental programs.

Accreditation↗