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PubMed1995

Recent trends in the use of inhaled beta 2-adrenergic agonists and inhaled corticosteroids in Saskatchewan.

OBJECTIVE: To examine recent trends in the use of inhaled beta 2-adrenergic agonists and inhaled corticosteroids for the treatment of asthma among Saskatchewan residents and to determine whether these trends are in keeping with widely publicized guidelines recommending a reduction in the use of agents to treat symptoms (i.e., inhaled beta 2-adrenergic agonists) and increased use of prophylactic agents (i.e., inhaled corticosteroids). DESIGN: Descriptive pharmacoepidemiologic study conducted with the use of data from the computerized database of the Saskatchewan Prescription Drug Plan. SETTING: Saskatchewan. PATIENTS: Saskatchewan residents 5 to 54 years of age who received one or more outpatient prescriptions for drugs to treat asthma (inhaled drugs, ingested beta 2-adrenergic agonists and ingested methylxanthines) from 1989 to 1993. OUTCOME MEASURES: Epidemiologic trends, calculated for each year: number of prescriptions per 1,000 persons; number of patients who received prescriptions for inhaled corticosteroids, inhaled beta 2-adrenergic agonists and any type of drug to treat asthma; mean number of such prescriptions per patient; and weighted mean amount of salbutamol, fenoterol and beclomethasone dispensed per patient. RESULTS: There has been an increase in the proportion of the population receiving prescriptions for drugs to treat asthma. The number of patients receiving these drugs per 1,000 people rose during the study period from 33.38 to 46.59 for any drug to treat asthma, from 24.70 to 33.77 for inhaled beta 2-adrenergic agonists and from 6.1 to 19.9 for inhaled corticosteroids. The mean number of prescriptions per patient decreased steadily for all drugs to treat asthma (from 5.34 in 1989 to 3.88 in 1993), for inhaled beta 2-adrenergic agonists (from 4.35 to 3.09) and for inhaled corticosteroids (from 2.98 to 2.25). The weighted mean amount of inhaled salbutamol dispensed per patient per year decreased by 40%, from 178.08 mg in 1989 to 109.14 mg in 1993. The weighted amount of fenoterol dispensed per patient per year declined even more, by 58%, from 387.91 mg in 1989 to 164.00 mg in 1993. Conversely, the weighted amount of inhaled beclomethasone dispensed per patient per year increased by 35% from 46.95 mg in 1989 to 63.50 mg in 1992, then dropped to 56.17 mg per year in 1993. CONCLUSION: These data demonstrate a substantial change in Saskatchewan in the prescribing of drugs to treat asthma; they suggest that many physicians responded to current guidelines advocating increased attention to prevention of airway inflammation in the treatment of asthma.

Administration, Inhalation↗
PubMed1996

Career changes among Saskatchewan physicians.

OBJECTIVE: To determine how often Saskatchewan physicians changed career paths during medical training and practice. DESIGN: Population survey (mailed questionnaire). SETTING: Saskatchewan. PARTICIPANTS: All 1077 active members of the Saskatchewan Medical Association were sent a questionnaire; 493 (45.8%) responded. OUTCOME MEASURES: Long-term career goal or plan in next-to-last year of undergraduate medical school, probable choice of career if forced to choose at that time, and number of physicians who changed their field of training or practice at any time since graduation. RESULTS: In all, 57.8% (237/410) of the respondents were currently practising in a field different from that planned in their next-to-last year of medical school, 63.5% (275/436) were not practising in the field they would have chosen if forced to at that time, and 42.9% (211/492) had changed their field of training or practice at some time since graduation. Older physicians, those who graduated outside of Canada and specialists were the most likely to have changed career paths, family physicians, and those who graduated in Saskatchewan were the least likely to have changed. CONCLUSION: The current system of postgraduate training in Canada does not permit career changes of the sort made by most of the practising Saskatchewan physicians in the survey sample. The implications of this new system are as yet unknown but require careful monitoring.

Adult↗
PubMed2003

First in fear and dread: Cancer control in Saskatchewan, the first decade - 1929-1939.

In 1931 Saskatchewan became the first jurisdiction in Canada to introduce a province-wide program for the control of cancer. The program was conceived in 1929 by the cancer committee of the Saskatchewan Medical Association. The provincial government promptly took up the committee's recommendations for centralization of cancer care in two clinics and emphasis on radiotherapy as a mode of treatment. The following year the Saskatchewan Assembly approved The Saskatchewan Cancer Commission Act, as prepared by Health Minister F.D. Munroe, himself a physician. The Regina Cancer Clinic opened at the end of 1931 and the Saskatoon Cancer Clinic at the beginning of 1932. This initial phase of the conception and introduction of cancer control in Saskatchewan is notable for the harmony of agreement among its planners and for the rapidity with which it was introduced. Progress during the remainder of the first decade was much slower, as competing interests and priorities among a larger group of individuals and institutions, together with the Depression, help back the initial momentum. Initially, however, weaknesses accompanied the strengths of the program. Weaknesses included the reluctance of some physicians to cooperate wholeheartedly as they feared the perceived effects of the incursion of a government agency in patient care plus the increasing financial burden placed on the hospitals. The strengths of the program included the existence of the program where none had been present earlier, the availability of a diagnostic and therapeutic service for patients, and a comprehensive system of patient records. In particular, the cancer control program in its first decade was the basis for notable progress in later decades and a model for other jurisdictions.

Canada↗
PubMed2001

The closure of rural hospitals in Saskatchewan: method or madness?

On April 14, 1993 the Minister of Health of the Province of Saskatchewan announced the closure of 52 of the 112 small hospitals using the criteria of: size, utilization for two consecutive years and distance to the nearest-neighbouring hospital. Amazingly, that government was re-elected. This study compared two models of reasons for hospital closure: the government criteria; and historical population, resource, and utilization factors, gathered for the year prior to closure and a decade earlier. Of the 112 small hospitals in Saskatchewan, the 10 hospitals in the frontier area were not included. Hospitals in the settled part of the province were divided into two distinct zones. The Northern zone, with 53 hospitals is characterized by rich dark soil and prosperous trade centres and the Southern zone, with 49 hospitals is characterized by light brown sandy soil and oil and gas exploration centres. Two discriminant models were developed. The government model consisted of size, two years of utilization and distance. The historical model consisted of population, resource, and utilization factors for the years 1981/1982 and 1991/1992. The dependent variable for both models was hospital status (open = 1 and closed = 0). The government model accurately predicted 91.18% of the closure decisions. The historical model had a classification accuracy of 95.10% for the whole of settled Saskatchewan, 96.23% for the Northern zone, and 95.92% for the Southern zone. The historical model was more accurate than the government model. Closing a hospital is a sad event. The manner in which the government closed nearly half of the small hospitals in Saskatchewan and gained re-election is an important account of responsible public policy. The historical model developed to examine this story takes public policy one step further in that it is possible for governments to recognize signals that indicate when communities should undertake orderly transitions in the operation of their health services facilities.

Decision Making, Organizational↗
PubMed1994

Menopausal hormone usage and breast cancer in Saskatchewan: a record-linkage cohort study.

The association between the occurrence of carcinoma of the breast and previous usage of menopausal estrogens, progestins, and oral contraceptives is examined in a record-linkage study using the Saskatchewan Health Prescription-Drug-Plan Database. Saskatchewan Health is a governmental agency that funds publicly insured health care for essentially all residents of the province. For this study, all women aged 43-49 years in 1976 resident in Saskatchewan were identified from the Saskatchewan Health master registration file. These women were linked by registration beneficiary number to the Drug-Plan Database for the period from January 1976 to June 1987 and to the Provincial Cancer Registry Database for the period from March 1960 to December 1990. The fact and date of death or emigration from the province were obtained through the annual updates of the health plan. Of the 33,003 women initially in the cohort, 213 had a breast cancer diagnosed before 1976 and were omitted from this analysis. Between 1976 and 1990, 742 new primary breast cancer cases occurred. Women taking estrogens unopposed by progestins had an elevated risk of breast cancer, the risk increasing by 7% (relative risk = 1.072, 95% confidence interval 1.02-1.13; p = 0.008) for each 252 tablets used (approximately 1 year of use). Usage of estrogens opposed by progestins showed no association with risk (p = 0.48). Women taking oral contraceptives during this follow-up period also had a higher risk, increasing by 14% (relative risk = 1.144, 95% confidence interval 1.05-1.24; p = 0.002) for every 252 tablets used. These 1-year risk elevations are small but become appreciable at longer durations. For example, at 5 years of unopposed estrogen use, the relative risk is 1.42; for 5 years of oral contraceptive use, it is 1.96.

Adult↗
PubMedDate not supplied

Unconventional therapy use among children with cancer in Saskatchewan.

The study aimed to estimate the prevalence of unconventional therapy use among children with cancer in Saskatchewan, including identification of the most commonly used therapies, and to describe families' expectations and experiences in doing so. Researchers used a cross-sectional survey design with semi-structured telephone interviews to suit the descriptive and exploratory inquiry and the population focus. The personal telephone interviews occurred during the fall and winter of 1996 to 1997, with the parents coming from a wide range of geographic areas in the province of Saskatchewan. Parents of all children who were aged 14 years or younger when diagnosed with cancer during 1994 and 1995 in Saskatchewan and still living at the time of the study were identified through the provincial cancer registry with the assistance of the Saskatchewan Cancer Agency. Of the 44 families participating (92% of those eligible), 36% reported using unconventional therapy for their child's cancer; another 21% considered it. Reasons included complementing medical treatment, coping with side effects; making the child stronger; and stopping the cancer. Experiences were generally positive. Reasons for not using unconventional therapies included the child doing well and parents placing confidence in the medical system. Parents identified a need for better quality information about unconventional therapies. Unconventional therapies play a substantial complementary role in cancer care for children. Families need support to identify safe and potentially helpful therapies when they choose that route. This requires: more research about therapies' effectiveness; more accessible, quality information; and more training for health professionals in understanding and discussing unconventional therapies. There is considerable research showing that use of unconventional therapies, also known as complementary or alternative therapies, is high among adult cancer patients. Although it is likely reasonable to assume this may also be true for children, there is almost no research on children's use of unconventional therapies for cancer. Knowing the extent of children's use of unconventional therapies and whether those experiences have been beneficial or harmful is essential for parents and health professionals making quality care decisions for children.

Adolescent↗
PubMed2004

Effect of age on hospitalized machine-related farm injuries among the Saskatchewan farm population.

Machinery-related injuries are the leading cause of fatal and hospitalized injuries on Canadian farms. In Saskatchewan, the proportion of all farm injuries related to farm machinery exceeds that reported for all of Canada. This project examined the relationship between age and various factors associated with farm machine-related injuries in Saskatchewan. A retrospective review of hospital discharge data from the administrative data set of Saskatchewan Health was conducted using external cause of injury codes to identify cases of farm machinery injury that occurred in Saskatchewan during the period April 1, 1990, to March 31, 2000. Log linear estimates of association of various factors in four age groups were derived. There were 1,493 hospitalizations attributed to farm machinery-related injuries. Among the injured cohort, age was a predictor of the rate of injury. Significant association for nature of injury, mechanism of injury, and type of machine varied by age group. These data provide insights for a case-control study of farm machinery-related injuries with the objective of determining personal, environmental, and machine-related factors that are responsible for this serious public health issue.

Accidents, Occupational↗
PubMedDate not supplied

An evaluation of Think First Saskatchewan: a head and spinal cord injury prevention program.

OBJECTIVES: To identify youth behaviour with regards to injury prevention, to assess the awareness of severity and susceptibility to brain and spinal cord injury, and to evaluate the impact of the Think First Saskatchewan school visit program on students' knowledge of brain and spinal cord injury prevention. METHODS: A controlled, pre- and post-test design, self-report questionnaire was administered to 1,257 grade 6 and 7 students. Descriptive statistics and chi-square were used for data analysis. P-values less than 0.05 were considered significant. RESULTS: Saskatchewan youth participate in activities that put them at risk for brain and spinal cord injury. The Think First Saskatchewan school visit program statistically improved self-reported knowledge of the students receiving the Think First message. DISCUSSION: Think First Saskatchewan is a brain and spinal cord injury prevention program that significantly improves youth knowledge pertaining to injury prevention. Further evaluation of the program to include a more delayed survey of retention of knowledge, changes to behaviour, and reduction of brain and spinal cord injury are necessary.

Adolescent↗
PubMed2004

The digital readiness of imaging facilities in Saskatchewan.

OBJECTIVE: To determine the digital readiness of Saskatchewan's imaging facilities. METHODS: A questionnaire was mailed to all 173 imaging facilities in Saskatchewan, ranging from small private clinics to tertiary care hospitals. The 129 responses were received, tabulated and summarized. RESULTS: Of the 129 facilities that responded, only 2 had picture archiving and communication systems (PACS). Both were private, urban imaging facilities. Six facilities had digital radiology information systems, 12 had digital hospital information systems and 8 had digital patient records. Only 42 sites had Internet access in their facilities. CONCLUSION: Only a small minority of Saskatchewan imaging facilities have any digital capability whatsoever. None are prepared to make the transition to a fully digital environment at this time. The infrastructure required to send or receive high-quality digital images among imaging facilities in Saskatchewan does not exist. A strategy to address the implementation of digital imaging and PACS should be developed at a provincial level.

Diagnosis, Computer-Assisted↗
PubMed1998

Non-diabetic end-stage renal disease among Saskatchewan aboriginal people.

OBJECTIVE: To determine the rates, causes and outcomes of non-diabetic end-stage renal disease (ESRD) among aboriginal and non-aboriginal people in Saskatchewan. DESIGN: Retrospective population-based study using data from the Canadian Organ Replacement Register. SETTING: Saskatchewan. SUBJECTS: All patients with non-diabetic ESRD diagnosed between Jan. 1, 1981, and Dec. 31, 1990. MAIN OUTCOME MEASURES: Age- and sex-specific as well as age-adjusted incidence rates of non-diabetic ESRD among aboriginal and non-aboriginal people in Saskatchewan, causes of non-diabetic ESRD, mortality rates, causes of death and renal transplantation rates. RESULTS: The 10-year incidence rates of non-diabetic ESRD were higher in all age groups among aboriginal people than among non-aboriginal people. The overall risk ratio for aboriginal people was 2.56. Aboriginal people experienced non-diabetic ESRD at an earlier age and were twice as likely to have a form of glomerulonephritis as a cause. Crude mortality rates, causes of death and transplantation rates were similar in the 2 populations, although we were unable to adjust these for differences in age. CONCLUSION: Although diabetes is the most common cause of ESRD among aboriginal people in Saskatchewan, this population also experiences an excessive burden of non-diabetic ESRD, which is largely explained by a higher rate of glomerulonephritis.

Age Factors↗
PubMedDate not supplied

Antihypertensive drug therapy in Saskatchewan: patterns of use and determinants in hypertension.

BACKGROUND: The benefits of continuous treatment of hypertension have been extensively documented in randomized controlled trials. However, clinical trials may not reflect actual drug use in the population. OBJECTIVE: To examine the distribution and determinants of patterns of use of antihypertensive agents in the first 5 years of hypertension treatment in Saskatchewan. METHODS: Patterns of use and modifications to therapy were derived from a careful examination of medication use in a cohort of 19 501 subjects aged 40 to 79 years, without recognized cardiac disease and initiating therapy with an angiotensin-converting enzyme inhibitor, a calcium antagonist, or a beta-blocker in Saskatchewan between 1990 and 1993. RESULTS: Angiotensin-converting enzyme inhibitors (37.4%), followed by calcium antagonists (27.5%) and beta-blockers (26.4%), were the most commonly prescribed agents to initiate treatment in our study population. Patients with diabetes were less likely to be dispensed a beta-blocker, as were younger and female patients. Previous visits to a cardiologist decreased the likelihood of receiving combination therapy or angiotensin-converting enzyme inhibitors but increased that of using calcium antagonists. Apart from dose adjustment, 89% of study subjects underwent at least 1 modification to their initial regimen, at a median time of 134 days. After 1 year, only 33.8% of patients were still using their initial drug. An early decrease in the proportion of patients continuing to receive initial therapy was noted, especially among beta-blocker users. CONCLUSIONS: Erratic drug-taking behaviors were observed in this Saskatchewan population. In addition, initial drug use does not seem to be in accordance with the stepped-care approach to hypertension therapy recommended in the Canadian guidelines.

Adrenergic beta-Antagonists↗
PubMed2001

Ethical issues in pharmacoepidemiologic research using Saskatchewan administrative health care utilization data.

PURPOSE: To describe the process of obtaining access to the administrative health care utilization data of the Canadian province of Saskatchewan and the ethical issues involved. METHODS: The report focuses on the process of obtaining data for two recent studies. In the first, associations between aplastic anemia and agranulocytosis and prior drug use were evaluated, while the second is an examination of anti-arrhythmia drug utilization. In these studies, data from files containing computerized information on prescription drug use, hospitalizations, physician services and cancer registrations were linked together and also with information from hospital charts, physician records and death registrations. RESULTS: Data on individual patients are available from the Saskatchewan data-files after the removal of identifying variables, and access to external information from hospitals, physicians, death registrations and the patients themselves is possible. However, researchers must accept that data considered to be only indirectly relevant to the objectives of the study or which, due to small numbers, may potentially identify either patients or physicians will only be released in aggregate form. CONCLUSIONS: Access to the Saskatchewan data-files and to external information from hospitals, physicians and death registrations is normally straightforward. Restrictions that are applied are discussed.

Access to Information↗
PubMed1986

Early onset Parkinson's disease in Saskatchewan--environmental considerations for etiology.

The cause of idiopathic Parkinson's Disease (PD) is not known but it is believed to be related to some environmental agent(s). Given a long preclinical interval and onset of symptomatology around age 60 years, it becomes impossible to identify and analyze all prior environmental factors satisfactorily. To circumvent these difficulties we evaluated the childhood environment in those PD patients whose symptoms began at age 40 years or earlier. Twenty-one such cases were born and raised in the province of Saskatchewan. Nineteen of these 21 patients spent the first 15 years of life exclusively in rural Saskatchewan. Detailed population analysis indicates a strong predisposition to early onset idiopathic Parkinson's Disease (EPD) in those raised in rural areas (p = 0.0154). All but one case utilized exclusively well water for the first 15 years of life--a trait significantly different from that expected in the provincial population. It is concluded that rural Saskatchewan environments contribute to EPD and that well water used in childhood should be considered as a potential vehicle for the etiological agent.

Age Factors↗
PubMed2000

Prostate cancer in Saskatchewan Canada, before and during the PSA era.

OBJECTIVES: The purpose of this study was to describe changes in the incidence of prostate cancer and in survival of diagnosed cases, as well as prostate cancer-specific mortality, during a period spanning the introduction of prostate specific antigen (PSA) testing in Saskatchewan in 1990. METHODS: All cases of neoplasms of the prostate (ICD-O = C61.9) diagnosed in Saskatchewan from 1970 to 1997 inclusive, were identified in the Saskatchewan Cancer Registry. A subgroup of adenocarcinomas was defined for further study. Age-adjusted and age-specific incidence rates, and actuarial and relative survival were calculated according to time period of diagnosis. Age-adjusted and age-specific mortality rates from prostate cancer were also calculated for each time period, using Vital Statistics data. RESULTS: The age-adjusted incidence of prostate cancer was 60.5 per 10(5) in 1970, rising gradually to 101.5 per 10(5) in 1989. In 1990, incidence rose much more sharply, reaching a peak of 163.1 per 10(5) in 1993, after which it began to fall. This sharp increase coincided with the introduction and increasing use of the PSA test in the province. Relative survival of prostate cancer patients was stable from the late 1970s through the 1980s, then improved markedly in the 1990-94 period. After the introduction of the PSA test, the relative risk of death for prostate cancer patients was only about 60% of what it had been throughout the previous 15 years. Prostate cancer-specific death rates did not change from the early 1980s to the end of the study period. CONCLUSIONS: The above data are consistent with earlier diagnosis of prostate cancer due to PSA screening. Because mortality has not yet changed, it is premature to recommend widespread screening of asymptomatic men.

Aged↗
PubMed1990

Incidence of hip fracture in Saskatchewan, Canada, 1976-1985.

The authors ascertained the incidence of hip fracture in Saskatchewan, Canada, residents aged 65 years or older for the 10 years 1976-1985 from computerized hospital discharge records and compared it with rates for several other populations in Northern Europe and the United States. In Saskatchewan, the average annual incidence was 5.5 per 1,000 person-years. The incidence in women was twice that in men, the incidence in urban areas was 27% greater than that in nonurban areas, and there was no secular trend of increasing rates. The incidence of hip fracture in Saskatchewan was lower than that for populations in Scandinavia and the United States but was comparable to rates in English populations. Further study is needed to elucidate the genetic, environmental, and behavioral factors responsible for this variation.

Aged↗
PubMed1990

Education for rural health in Saskatchewan.

The Canadian Province of Saskatchewan, like its American counterparts, is experiencing a steady urbanization of its population particularly by young adults. This has been accompanied by progressive decrease in the availability of health services to an aging rural population. Physicians, and, in particular, Saskatchewan graduates, find rural practice unattractive. Unlike the American experience, level of income is not the issue. Not only is rural practice unattractive to Saskatchewan graduates, but medicine as a career is not attracting students from rural areas. The need for a comprehensive overall strategy ranging from recruitment to reorganization of rural health care is proposed.

Attitude of Health Personnel↗
PubMed2000

The factors associated with neck pain and its related disability in the Saskatchewan population.

STUDY DESIGN: Population-based, cross-sectional mailed survey. OBJECTIVE: To identify factors associated with neck pain and its related disability in Saskatchewan adults. SUMMARY OF BACKGROUND INFORMATION: Little is known about the etiology of neck pain and its related disability. Previous cross-sectional population-based studies have suggested that neck pain may be associated with age, female gender, lower socioeconomic status, physically demanding work, and other comorbidities. METHODS: The Saskatchewan Health and Back Pain Survey was mailed to 2184 randomly selected Saskatchewan adults 20 to 69 years of age. Fifty-five percent of the study population participated. The survey collected demographic, socioeconomic, and health-related information. Neck pain and its related disability was classified into four categories using the Chronic Pain Questionnaire: no neck pain (Grade 0), low intensity/low disability neck pain (Grade I), high intensity/low disability neck pain (Grade II), and high disability neck pain (Grades III-IV). Polytomous logistic regression was used to identify associations between demographic, socioeconomic, and health-related variables and various grades of neck pain severity. RESULTS: Of the 1131 respondents, 54% had experienced neck pain at some point in the 6 months before the survey, and almost 5% were highly disabled by neck pain. The prevalence of Grade I neck pain was lower in individuals with low education attainment, but higher for those reporting headaches, low back pain, better general health, and a history of neck injury resulting from a motor vehicle collision, some of whom may have received compensation for their injury. Grade II neck pain was strongly associated with headache, low back pain, and a history of neck injury during a motor vehicle collision and weakly associated with digestive disorders and current cigarette smoking. Grades III-IV neck pain was strongly associated with low back pain, headaches, cardiovascular disorders, digestive disorders, and a history of neck injury during a motor vehicle collision. CONCLUSION: This study suggests that important associations exist between comorbidities, a past history of neck injury resulting from a motor vehicle collision, and graded neck pain. Importantly, individuals who are significantly disabled by neck pain also have comorbidities that have a moderate or severe impact on their health, suggesting that chronic disorders tend to cluster in some individuals.

Accidents, Traffic↗
PubMed2002

The six-month incidence of clinically significant low back pain in the Saskatchewan adult population.

STUDY DESIGN: A population-based, longitudinal, mailed survey was conducted. OBJECTIVE: To investigate the 6-month incidence and determinants of clinically significant low back pain in the Saskatchewan adult population. SUMMARY OF BACKGROUND DATA: Few studies have investigated the incidence of significant low back pain in general populations. When available, such studies often differ in the assessment of pain severity. This lack of consensus in measuring pain severity results in large differences in incidence rates. METHODS: A questionnaire requesting information on low back pain and other health conditions was mailed to randomly chosen individuals, ages 20 to 69, residing in the province of Saskatchewan, Canada. Of the 1131 (55%) who responded at baseline, 848 had not experienced clinically significant low back pain during the past 6 months. Clinically significant low back pain was assessed using the Chronic Pain Questionnaire, a 7-item scale that measures the intensity of chronic pain and associated disability. Individuals with no clinically significant low back pain were followed up at 6 months. RESULTS: At the follow-up assessment, 50 individuals reported clinically significant low back pain, representing a cumulative incidence of 8% (95% confidence interval, 6-10.4). In logistic regression models, marital status, rural residency, and history of back and neck pain were associated with the onset of clinically significant low back pain. CONCLUSIONS: The 6-month incidence of clinically significant low back pain is high in Saskatchewan. It is important to prevent this condition because of the high economic and social costs associated with it.

Adult↗