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Alberta RN demographics.

In 2000 more than one-quarter of the Alberta RN labour force was older than 50 years of age, while close to one-half was between 36 and 50 years of age. While this age distribution denotes a mature RN cadre, with considerable valuable practice experience, it also signals a need for an increased number of new RN graduates to replace those soon to be retiring. Although possibly age-related, the proportion of Alberta RNs working regular full-time is less than half--only 45 per cent. Concomitantly, more than half of all Alberta RNs are employed casually and part-time. Especially in a time of RN shortage, reasons for such limited full-time employment warrant examination. As in the past, three-quarters of Alberta RNs work in institutional settings--hospitals and nursing homes--while only eight per cent work in community health. The shift to health promotion and disease prevention has yet to happen in Alberta. In 2000, almost 80 per cent of all Alberta RNs were employed in direct care giving, and less than 10 per cent were employed in management, administration and education. In 2000, almost two-thirds of all Alberta RNs held a diploma in nursing. Of the slightly more than 8,000 Alberta RNs with a baccalaureate degree, the overwhelming majority--85 per cent--worked in direct patient care, and only 13 per cent were employed in administration and teaching. Increasingly, we can expect to see more RNs with baccalaureate degrees at the bedside, in part because of the recent significant shift toward new graduates entering practice with a degree. Since 1997, the number of new RNs entering practice with a degree has been four times greater than the number entering with a diploma. Increased government funding of degree nursing programs aimed at alleviating the current nursing shortage means this trend will continue.

Alberta↗

Infant and preschool immunization delivery in Alberta and Ontario: a partial cost-minimization analysis.

This paper is a partial cost-minimization analysis of preschool immunization delivery in Alberta and Ontario. Public health nurses deliver such immunization in Alberta while in Ontario it is usually provided by private physicians. In constant 1986 dollars, labour costs were 2.9 times higher in Ontario than in Alberta. Alberta and Ontario achieved equal success in preventing diphtheria, tetanus and poliomyelitis in the target population of zero to four years of age. Ontario's pertussis rates were higher than Alberta's from 1980 to 1986 inclusive (p less than 0.01). Rubella rates were higher in Alberta from 1980 to 1986 inclusive (p less than 0.05) but the congenital rubella rates for the same period were not. During 1980, Ontario's measles rate was higher (p less than 0.01) while for 1982 and 1986, Alberta's measles rates were higher. In 1986, Alberta's mumps rate was higher than Ontario's (p less than 0.01). The findings argue in favour of the less costly public health nurse approach to immunization delivery. A more definitive conclusion could have been reached had the provinces maintained more detailed age-specific disease incidence data.

Alberta↗

Functional and subunit assembly properties of hemoglobin Alberta (alpha 2 beta 2(101) Glu----Gly).

Hemoglobin Alberta has an amino acid substitution at position 101 (Glu----Gly), a residue involved in the alpha 1 beta 2 contact region of both the deoxy and oxy conformers of normal adult hemoglobin. Oxygen equilibrium measurements of stripped hemoglobin Alberta at 20 degrees C in the absence of phosphate revealed a high affinity (P50 = 0.75 mm Hg at pH 7), co-operative hemoglobin variant (n = 2.3 at pH 7) with a normal Bohr effect (- delta log P50/delta pH(7-8) = 0.65). The addition of inositol hexaphosphate resulted in a decrease in oxygen affinity (P50 = 8.2 mm Hg at pH 7), a slight increase in the value of n and an enhanced Bohr effect. Rapid mixing experiments reflected the equilibrium results. A rapid rate of carbon monoxide binding (l' = 7.0 X 10(5) M-1 S-1) and a slow rate of overall oxygen dissociation (k = 15 s-1) was seen at pH7 and 20 degrees C in the absence of phosphate. Under these experimental conditions the tetramer stability of liganded and unliganded hemoglobin Alberta was investigated by spectrophotometric kinetic techniques. The 4K4 value (the liganded tetramer-dimer equilibrium dissociation constant) for hemoglobin Alberta was found to be 0.83 X 10(-6) M compared to a 4K4 value for hemoglobin A of 2.3 X 10(-6) M, indicating that the Alberta tetramer was less dissociated into dimers than the tetramer of hemoglobin A. The values of 0K4 (the unliganded tetramer-dimer equilibrium dissociation constant) for hemoglobin Alberta and hemoglobin A were also measured and found to be 2.5 X 10(-8) M and 1.5 X 10(-10) M, respectively, demonstrating a greatly destabilized deoxyhemoglobin tetramer for hemoglobin Alberta compared to deoxyhemoglobin A. The functional and subunit dissociation properties of hemoglobin Alberta appear to be directly related to the dual role of the beta 101 residue in stabilizing the tetrameric form of the liganded structure, while concurrently destabilizing the unliganded tetramer molecule.

Allosteric Regulation↗

A comparison of intensive care unit utilization in Alberta and western Massachusetts.

OBJECTIVE: To analyze differences in intensive care unit (ICU) utilization between a Canadian province and a U.S. area. DESIGN: Retrospective data analysis of hospital discharge data and existing data from an international study of severity of illness in ICU patients. SETTING: Administrative data for the province of Alberta and the four counties of western Massachusetts for the years 1990 to 1991 were used. Detailed data on consecutive ICU admissions from two Alberta hospitals, one western Massachusetts hospital, and 24 other U.S. hospitals for 3 months in 1991 were used. MEASUREMENTS AND MAIN RESULTS: ICU use and hospital mortality rates were compared for 50,030 hospital admissions divided into 11 patient groups. ICU days per million population were two to three times as great in western Massachusetts as in Alberta. The primary reason was higher ICU incidence (percent of hospitalized patients treated in the ICU) rather than a difference in hospital admission rate or length of ICU stay. ICU incidence in western Massachusetts was significantly higher in ten of 11 patient groups--for the coronary bypass surgery group, there was no difference. The hospital mortality rate in western Massachusetts was similar to, or higher than, the mortality rate in Alberta. In Alberta, a much higher proportion of ICU patients received mechanical ventilation. For elective surgery patients, the ICU severity of illness was lower in western Massachusetts and in other U.S. hospitals than in Alberta. CONCLUSIONS: Western Massachusetts hospitalized patients are more likely to be treated in an ICU than are similar patients in Alberta. There is no evidence that the greater ICU utilization in western Massachusetts led to a lower hospital mortality rate.

Aged↗

The evolution of integrated chronic disease prevention in Alberta, Canada.

BACKGROUND: Recognition of the common risk factors for leading chronic diseases in Canada has contributed to the development of integrated chronic disease prevention and health promotion approaches. The Alberta Heart Health Project studied the capacity of health organizations in Alberta, Canada, to engage in heart health promotion. This article describes how the Alberta Heart Health Project acted on emerging research findings describing the preliminary stages of integrated chronic disease prevention in Alberta to provide leadership to encourage provincial chronic disease prevention efforts. CONTEXT: Political support for integrated chronic disease prevention was evident at the provincial and federal levels in Canada. As a result of organizational restructuring, loss of key health promotion champions, and decreased funding allocations, Alberta's regional health authorities sought increased efficiency in their chronic disease prevention efforts. METHODS: Descriptive data were derived from a brief questionnaire on regional health authorities' chronic disease prevention priorities and activities, an inventory of regional health authority health promotion programs and services, content analysis of key regional health authority documents, and focus groups with regional health authority staff, management, and policymakers. CONSEQUENCES: In 2002, the Alberta Heart Health Project data revealed that many regional health authorities were beginning to engage in integrated chronic disease prevention. However, little collaboration occurred across the health organizations; provincial leadership to facilitate collaboration and networking for integrated chronic disease prevention was needed. INTERPRETATION: Results supported the growing momentum for provincial leadership to enhance collaboration for integrated chronic disease prevention, which contributed to the development of the Alberta Healthy Living Network. The government's assistance is also needed to support the intersectoral collaborations essential for integrated chronic disease prevention.

Alberta↗

Asymmetric hybrids between hemoglobin Alberta (alpha 2 beta 2 101 Glu replaced by Gly) and hemoglobins A, A2 or F1 in different liganded states.

Isoelectric focusing in cylindrical polyacrylamide gels has been used to demonstrate the formation of asymmetric hybrids between an abnormal hemoglobin, Hb Alberta (alpha 2 beta 2 101 Glu replaced by Gly), and Hb A (alpha 2 beta 2), Hb A2 (alpha 2 delta 2) or Hb F1 (alpha 2 gamma 2 Acetyl). There was no discernible difference in the stabilities of the three hybrids (alpha 2 beta A beta Alberta, alpha 2 delta beta Alberta and alpha 2 gamma Acetyl beta Alberta) in the oxy, carboxy or cyanmet hemoglobin forms. Two mixed liganded hybrids, (alpha beta A)oxy (alpha beta Alberta)cyanmet and (alpha beta A)cyanmet (alpha beta Alberta)oxy were also demonstrated and found to have stabilities similar to that of the Hb Alberta hybrids.

Drug Stability↗

Leilani Muir versus the philosopher king: eugenics on trial in Alberta.

The Province of Alberta in Canada was the only jurisdiction in the British Empire where a eugenic sterilization law was passed (in 1928) and vigorously implemented. The pace of sterilization orders accelerated during the Nazi era and remained high after World War II, terminating only in 1972 when the Sexual Sterilization Act was repealed. The Alberta Eugenics Board operated away from public and legislative scrutiny, and many things done in the name of eugenics were clearly illegal. Eugenics was put on trial in Alberta in 1995 and a judge of the Court of Queen's Bench ruled in 1996 that the government had wrongly sterilized Leilani Muir. After hearing evidence about the history of the eugenics movement, the origins of Alberta's Sexual Sterilization Act, the operation of the Eugenics Board, and details of Muir's life, Madam Justice Joanne B. Veit found that 'the damage inflicted by the operation was catastrophic', the 'wrongful stigmatization of Ms. Muir as a moron ... has humiliated Ms. Muir every day of her life', and 'the circumstances of Ms. Muir's sterilization were so high-handed and so contemptuous of the statutory authority to effect sterilization, and were undertaken in an atmosphere that so little respected Ms. Muir's human dignity that the community's, and the court's, sense of decency is offended'. Veit awarded Muir damages of $740,780 CAD and legal costs of $230,000 CAD. The order for Muir's sterilization was signed by John M. MacEachran, founder of the Department of Philosophy and Psychology at the University of Alberta and chairman of the Eugenics Board from 1929 to 1965. An exponent of Platonic idealism, MacEachran believed sterilization of children with a low IQ test score was a means of 'raising and safeguarding the purity of the race'. However, the Alberta Sterilization Act was passed and implemented with cavalier disregard for the principles of genetics as well as the rights of children.

Adult↗

Cancer incidence patterns among Chinese immigrant populations in Alberta.

This study examines the incidence of cancer among Chinese immigrants to Alberta in comparison to the incidence in Canadian-born Alberta residents and in people of Chinese origin still living in China. Cancer cases among Chinese immigrants and Canadian-born Alberta residents were identified from the Alberta Cancer Registry (1974-1993). Incidence rates for Shanghai (1975-1992) were obtained from the International Agency for Research on Cancer (IARC) publications. Direct age-standardized incidence rates (ASIRs) were calculated using the "world standard population." Descriptive analysis and Poisson regression modelling were employed to obtain the rate ratios for certain cancer sites among the three populations. For males, the overall incidence of cancer (excluding non-melanoma skin cancer) was lowest in Chinese immigrants while being similar in Canadian-born Alberta residents and Chinese living in Shanghai (197 vs. 224 and 232/100,000). For females, the overall incidence in Chinese immigrants was lower than Canadian-born Alberta residents but similar to that in Chinese living in Shanghai (154 vs 200 and 150/100,000). For cancers that are common in China (stomach and esophagus), the incidence rates for Chinese immigrants were more similar to those for Canadian-born residents than to rates for Shanghai. However, the incidence of liver cancer was very high in the immigrants, suggesting the possible presence of an initiating event during childhood or early adulthood. For cancers that are traditionally uncommon in China (breast and prostate), rates for immigrants were mid-way between those of the two comparison groups. This study supports observations that the risk of cancer in immigrants tends towards the risk of people in the new host country.

Alberta↗

Socio-economic status and types of childhood injury in Alberta: a population based study.

BACKGROUND: Childhood injury is the leading cause of mortality, morbidity and permanent disability in children in the developed world. This research examines relationships between socio-economic status (SES), demographics, and types of childhood injury in the province of Alberta, Canada. METHODS: Secondary analysis was performed using administrative health care data provided by Alberta Health and Wellness on all children, aged 0 to 17 years, who had injuries treated by a physician, either in a physician's office, outpatient department, emergency room and/or as a hospital inpatient, between April 1st. 1995 to March 31st. 1996. Thirteen types of childhood injury were assessed with respect to age, gender and urban/rural location using ICD9 codes, and were related to SES as determined by an individual level SES indicator, the payment status of the Alberta provincial health insurance plan. The relationships between gender, SES, rural/urban status and injury type were determined using logistic regression. RESULTS: Twenty-four percent of Alberta children had an injury treated by physician during the one year period. Peak injury rates occurred about ages 2 and 13-17 years. All injury types except poisoning were more common in males. Injuries were more frequent in urban Alberta and in urban children with lower SES (receiving health care premium assistance). Among the four most common types of injury (78.6% of the total), superficial wounds and open wounds were more common among children with lower SES, while fractures and dislocations/sprains/strains were more common among children receiving no premium assistance. CONCLUSION: These results show that childhood injury in Alberta is a major health concern especially among males, children living in urban centres, and those living on welfare or have Treaty status. Most types of injury were more frequent in children of lower SES. Analysis of the three types of the healthcare premium subsidy allowed a more comprehensive picture of childhood injury with children whose families are on welfare and those of Treaty status presenting more frequently for an injury-related physician's consultation than other children. This report also demonstrates that administrative health care data can be usefully employed to describe injury patterns in children.

Adolescent↗

Variations in treatment of femoral neck fractures in Alberta.

OBJECTIVES: To examine, in the province of Alberta, temporal trends, regional variations in treatment options and in-hospital death rates after a femoral neck fracture. DESIGN: A retrospective cohort study. PATIENTS: Six years' data were abstracted from the Alberta Morbidity File, the Alberta Health Stakeholder File and the Alberta Health Care Claims File. Patients were included if they were Alberta residents, aged 65 years or older, had sustained a femoral neck fracture and had undergone internal fixation, hemiarthroplasty or total hip arthroplasty. MAIN OUTCOME MEASURES: Death rates, arthroplasty rates and hospital stay. RESULTS: In-hospital death rates were similar across hospitals, with risks being higher for men, patients aged 80 years or older and those with more comorbid conditions. Arthroplasty rates varied from 58% to 77% among hospitals, and hospital stays associated with arthroplasty were significantly longer than those associated with internal fixation. The chance of undergoing arthroplasty varied from hospital to hospital by gender and by the number of comorbid conditions. CONCLUSION: Regional variations suggest lack of agreement among Alberta's surgeons as to how best to treat femoral neck fractures.

Aged↗

Alberta euthanasia survey: 1. Physicians' opinions about the morality and legalization of active euthanasia.

OBJECTIVE: To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Of the respondents 44% did believe that it is sometimes right to practice active euthanasia; 46% did not. Moral acceptance of active euthanasia correlated with type of practice and religious affiliation and activity. In all, 28% of the physicians stated that they would practice active euthanasia if it were legalized, and 51% indicated that they would not. These opinions were significantly related to sex, religious affiliation and activity, and country of graduation. Just over half (51%) of the respondents stated that the law should be changed to permit patients to request active euthanasia. Requests (usually from patients) were reportedly received by 19% of the physicians, 78% of whom received fewer than five. CONCLUSIONS: This survey revealed severely disparate opinions among Alberta physicians about the morality of active euthanasia. In particular, religious affiliation and activity were associated with the polarized opinions. The desire for active euthanasia, as inferred from requests by patients, was not frequent. Overall, there was no strong support expressed by the physicians for the personal practice of legalized active euthanasia. These data will be vital to those involved in health education and public policy formation about active euthanasia in Alberta and the rest of Canada.

Alberta↗

Alberta biodiversity monitoring program - monitoring effectiveness of sustainable forest management planning.

A conceptual model of sustainable forest management is described based on three connected and necessary components: Policy/Strategic Planning, Operational Planning, and Effectiveness Monitoring/Science. Alberta's proposed Forest Management Planning Standard is described as an example of operational planning. The standard utilizes coarse and fine filter approaches to conserving biodiversity and sets requirements for implementation monitoring. The Alberta Biodiversity Monitoring Program (ABMP) is described as an example of effectiveness monitoring supporting Operational Planning. The ABMP is a rigorous science-based initiative that is being developed to monitor and report on biodiversity status and trends throughout the province of Alberta, Canada. The basic survey design consists of 1656 sites, 20 km apart, evenly spaced on a grid pattern across Alberta. Sites will be sampled over a five-year period at a rate of 350 sites/year. Standardized sampling protocols will be used to cover a broad range of species and habitat elements within terrestrial and aquatic environments, as well as broader landscape-level features. Trends and associations detected by ABMP products will be validated through cause-effect research. ABMP focuses research on critical issues and informs both operational planning and the development of policy and strategic-level plans. The Alberta Forest Management Planning Standard and the ABMP are described as key components to implementing resource planning based on ecosystem management principles.

Alberta↗

Legalized, regulated, but unfunded: midwifery's laborious professionalization in Alberta, Canada, 1975-99.

In 1992, Alberta became the second Canadian province to legalize midwifery. This happened even though there were only approximately 20 midwives in practice at the time, and despite strong opposition from the medical and nursing professions. Between 1992 and 1999. Alberta established a regulatory framework for midwifery as a profession but. unlike Ontario and British Columbia, failed to pay midwives out of the provincial health care budget. This sent midwifery in Alberta into a crisis as many midwives closed their practices. This article first considers why midwifery was legalized and then professionalized in Alberta. Our answer emphasizes the leading role of state health bureaucrats in promoting midwifery as part of the state's challenge to medical dominance. Second. the article addresses why midwifery received so little governmental support at the same time that it attained professional status. This analysis includes a comparison with how midwifery developed in Ontario and British Columbia. Our conclusion is that midwifery in Alberta became a victim in the post-1993 period when a new Right government set aside bureaucratic initiatives in health care and committed itself to major cuts in government spending.

Alberta↗

Magnitude and determinants of first-time and repeat testing among individuals with newly diagnosed HIV infection between 2000 and 2001 in Alberta, Canada: results from population-based laboratory surveillance.

The purpose of the study was to determine the magnitude and predictors of first-time and repeat testing for HIV infection among newly diagnosed cases in Alberta, Canada, and to determine the extent of co-infection with hepatitis C (HCV) and hepatitis B (HBV). Using the Provincial Laboratory for Public Health (PLPH) database, all newly diagnosed HIV cases in Alberta between 2000 and 2001 were identified and the testing history for HIV, HCV, and HBV among these cases since 1992 was reviewed. Significant differences in the characteristics of first-time and repeat testers were identified using the chi test, and where appropriate, the Fisher exact test. The independent variables examined included age, gender, risk factors, area and population of residence, testing agency, and co-infection with HCV and HBV. Logistical regression analyses were conducted to further explore independent factors associated with first-time vs. repeat testing for HIV infection. Of the 398 cases, 278 (69.8%) were newly diagnosed at their first test for HIV infection, 73.1% during 2000 and 67.3% during 2001 (P = 0.81). Among repeat testers, the mean number of previous negative tests was 3.4 (range = 2-11 tests). The median interval between the last negative and first positive test was 648 days (range = 53-2678 days). Repeat testers were 1.9 times more likely to be injecting drug users and 1.8 times more likely to reside in Northern Alberta. Among those with a laboratory test result in the PLPH database, 53.7% were positive for HCV, 47.7 and 64.5% of first-time and repeat testers, respectively; and 19.1% were positive for HBV, 22 and 13.6% of first-time and repeat testers, respectively. A high proportion of HIV cases newly diagnosed between 2000 and 2001 in Alberta had no previous testing history for HIV infection. Even among repeat testers, HIV testing was sought infrequently. There are significant regional differences within Alberta in the characteristics of the HIV epidemic and associated test-seeking behaviors. These data reinforce the need to make the most of each test-seeking event with proper counseling and other relevant support services. Given the high prevalence of co-infection with HCV, these results clearly support the need for testing and counseling strategies to take into account additional risks associated with HCV infections.

AIDS Serodiagnosis↗

Gender and professional identity in psychiatric nursing practice in Alberta, Canada, 1930-75.

This paper examines gender-specific transformations of nursing practice in institutional mental health-care in Alberta, Canada, based on archival records on two psychiatric hospitals, Alberta Hospital Ponoka and Alberta Hospital Edmonton, and on oral histories with psychiatric mental health nurses in Alberta. The paper explores class and gender as interrelated influences shaping the work and professional identity of psychiatric mental health nurses from the 1930s until the mid-1970s. Training schools for nurses in psychiatric hospitals emerged in Alberta in the 1930s under the influence of the mental hygiene movement, evolving quite differently for female nurses compared to untrained aides and male attendants. The latter group resisted their exclusion from the title 'nurse' and successfully helped to organize a separate association of psychiatric nurses in the 1950s. Post-World War II, reconstruction of health-care and a de-institutionalization policy further transformed nurses' practice in the institutions. Using social history methods of analysis, the paper demonstrates how nurses responded to their circumstances in complex ways, actively participating in the reconstruction of their practice and finding new ways of professional organization that fit the local context. After the Second World War more sophisticated therapeutic roles emerged and nurses engaged in new rehabilitative practices and group therapies, reconstructing their professional identities and transgressing gender boundaries. Nurses' own stories help us to understand the striving toward psychiatric nursing professionalism in the broader context of changing gender identities and work relationships, as well as shifting perspectives on psychiatric care.

Alberta↗

Multidrug-resistant tuberculosis in Alberta and British Columbia, 1989 to 1998.

OBJECTIVE: To describe the extent of the problem of multidrug-resistant tuberculosis (MDR-TB) in Alberta and British Columbia from 1989 to 1998. DESIGN: A retrospective, population-based descriptive study of all notified MDR-TB cases in the context of all notified TB cases, all notified culture-positive TB cases and all notified drug-resistant TB cases. SETTING: Provinces of Alberta and British Columbia, and their TB registries. PATIENTS: All people with TB reported to the TB registries of Alberta and British Columbia between January 1, 1989 and June 30, 1998. MAIN OUTCOME MEASURES: Drug susceptibility testing was performed in all cases of culture-positive TB. Demographic, clinical and laboratory data on all cases of MDR-TB were recorded. RESULTS: Of 4606 notified cases of TB, 3553 (77.1%) were culture positive. Of these, 365 (10.3%) were drug resistant; of the drug-resistant cases, 24 (6.6%) were MDR. Most MDR-TB patients were foreign-born; of the four Canadian-born patients, two were infected while travelling abroad. Although foreign-born patients were significantly more likely to harbour drug-resistant strains, 14.3% versus 4.8%, respectively (P<0.001), among those who were harbouring a drug-resistant strain, the proportion of Canadian-born versus foreign-born patients with an MDR strain was the same (6.7% versus 6. 6%, respectively). From 1994 to 1998 versus 1989 to 1993, the proportion of all drug-resistant strains that were MDR was greater (9.0% versus 4.3%, respectively), but the difference was not statistically significant. Isolates from 16 of the 24 MDR-TB cases had been archived. Each of these was fingerprinted and found to be unique. Most MDR-TB cases (88%) were respiratory. Of those tested for human immunodeficiency virus (n=17), only one was seropositive. MDR-TB was 'acquired' in 67% and 'primary' in 33% of cases. Eight (33%) of the MDR-TB cases received curative courses of treatment, six (25%) are still being treated, and the remainder have either died (five, 21%), transferred out (four, 17%) or become 'chronic' (one, 4%). No secondary case of MDR-TB has been identified in Alberta and British Columbia. CONCLUSIONS: Most MDR-TB in Alberta and British Columbia is imported. The proportion of all drug-resistant cases that are MDR appears to be increasing, but not because of disease acquired from recent contact with MDR-TB in Canada.

Adult↗

Mortality from airways disorders in Alberta, 1927-1987: an expanding epidemic of COPD, but asthma shows little change.

Mortality from asthma has been reported to be increasing in recent years in many countries, including Canada. Alberta, and the prairie provinces generally, appear to have an excess of deaths from asthma compared to other provinces. We studied mortality from asthma and from chronic obstructive pulmonary disease (COPD) generally in Alberta between 1927 and 1987 using a data set compiled and recorded from Alberta Vital Statistics to describe birth cohorts' age-specific mortality rates. We also present the distribution of deaths in the years since 1987. There was a clear and sustained increase in mortality from COPD since 1950 after age 40 but no evidence to support the proposition that deaths from asthma were increasing in recent years; more recent data from Alberta Vital Statistics show no sustained increase since 1987, either. There was great variability from year to year and sporadically increased rates in a given year that were not sustained. These transient increases were observed particularly among females aged 10-14, 15-19, and 25-29 and among males aged 15-19, 25-29, and 80-84; however, there were also comparable decreases in asthma mortality of similar magnitude during the same time period in different age groups or in the other sex in the age group 10-14. We conclude that there is no excess of deaths from asthma over those expected by historical trends in Alberta at the present time but that the smoking-related epidemic of deaths from COPD continues unabated. The "smoothness" and consistency of the mortality trends suggest that physicians certifying deaths from these causes are using implicit diagnostic criteria that have not changed abruptly.

Adolescent↗

Geographic variations in the prevalence rates of Parkinson's disease in Alberta.

Parkinson's disease prevalence rates were examined for the Province of Alberta by age, sex and census division. Using the claims administrative data from the Alberta Health Care Insurance Plan, a cohort of all registered individuals (2.4 million) was extracted and followed for the five year period, April 1, 1984 to March 31, 1989. No new members were added to the cohort and an attrition rate averaging 6% per year was observed. The overall crude prevalence rates of 248.9 and 239.8 per 100,000 population were noted for males and females respectively. Both sexes were found to have a statistically significant variation across Alberta's 19 census divisions. For males, examination of standardized morbidity ratios found a low risk of Parkinson's disease associated with five census divisions, of which two contained Alberta's two largest cities. An excess risk was associated with four primarily rural census divisions. Females, on the other hand, had a low risk associated with one rural census division and excess risk in four census divisions. The uneven distribution within Alberta offers support for an environmental theory of etiology which may be associated with rural living.

Aged↗