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PubMed1985

Limitation of exposure to natural radioactivity in Canada.

The jurisdictional responsibility for natural radioactivity in Canada is divided between the federal and provincial governments. The desire for uniform standards has resulted in the formation of a scientific group to advise governments concerning the desirability of standards for exposure to natural radioactivity. The various types of exposure are reviewed with emphasis on naturally occurring radon in homes. The scientific Committee could not agree either philosophically or practically on the control level for radon in homes. To resolve this impasse, it undertook a calculation designed to illustrate for Canada, the potential cancers saved each year compared to the actual lung cancer rate, with an estimate of the cost for each limit derived. A second calculation reviewed the cost of modifying the building code and estimated the long term effect by comparing avoided cancers and cost. The calculations are based on cross-Canada surveys, intensive long term investigation of smaller groups of homes and national housing statistics. The results are discussed and serve to illustrate development of the proposed policy.

Canada↗
PubMed1996

PM10 in Canada.

Annual mean PM10 concentrations in Canadian cities are between five and eight times estimated background levels. Federal and Provincial agencies in Canada are currently reviewing particulate standards, and considering replacing current total suspended particulate (TSP) standards with standards to regulate PM10 (thoracic particles) because epidemiological research suggests that this size fraction is active in the production of adverse health impacts. This paper documents the spatial and temporal variability of current particulate levels in Canada, and compares them with TSP standards presently implemented in Canada and PM10 standards as applied by the US EPA, state of California and the World Health Organization (WHO). Twenty-four-hour averaged PM10 data from the 52 sites described here exceed the standard as applied in California on up to 35% of monitoring days. The threshold suggested by the WHO for 24-h averaged concentrations is passed at the majority of the sites on approximately 5% of monitoring days.

Air Pollutants↗
PubMed1994

Mining in northern Canada: expanding the industry while protecting Arctic fishes--a review.

Northern Canada has a long tradition of mining activity with a poor record of environmental protection. Pollution is acknowledged as the biggest issue currently facing the mining industry. The arctic and subarctic fishes of this region are very sensitive to heavy metals, trace elements, and other contaminants in mine wastes. High sensitivity, combined with an inherently low capacity for recovery, make this aquatic resource particularly vulnerable to impacts. At least 22 fish species with major commercial, recreational, or subsistence value may be affected as the mining industry expands. The number of mines in northern Canada is steadily increasing and a metals-mining boom is expected to take place during the next decade. Prudent planning based on comprehensive mine-site evaluation, biological risk assessment, and research is essential to reduce the threat of environmental damage. There are several progressive mining techniques that can help make mining compatible with sensitive northern fisheries while also maintaining the profitability and growth of the mining industry. Thus far, this technology has been used very little in northern Canada.

Animals↗
PubMed1994

The history of pharmacology in Canada.

Pharmacology training in Canada was initiated at McGill University in Montréal in 1824, and there are now 17 pharmacology departments in Canada offering graduate training to more than 500 students. In this article, Gerald Marks reviews the growth of pharmacology in Canada since the early 19th century in both academic establishments and in the pharmaceutical industry.

Canada↗
PubMed1989

Costs of acute bacterial foodborne disease in Canada and the United States.

Bacterial foodborne disease is increasing in industrialized as well as developing countries. For Canada and the United States many millions of cases are believed to occur each year, based on extrapolations of survey data, human enteric isolations and reported foodborne disease cases. The economic impact of such a large number is probably in billions of dollars but the precise figure is difficult to calculate. Medical costs and lost income are easier to determine than losses to food companies, legal awards and settlements, value of lost leisure time, pain, grief, suffering and death. The evaluation of costs at the national level for Canada and the United States based on all available costs for 61 incidents showed that company losses and legal action are much higher than medical/hospitalization expenses, lost income or investigational costs. It was reckoned that on an annual basis an estimated 1 million cases of acute bacterial foodborne illness in Canada cost nearly $1.1 billion and 5.5 million cases in the United States cost nearly $7 billion. The value of deaths was a major contributor to the overall costs especially for diseases like listeriosis, salmonellosis, Vibrio infections, and haemorrhagic colitis. Salmonellosis is the economically most important disease because it affects all parts of the food system, unlike typhoid fever and botulism, which are largely controlled by public health authorities and the food industry.

Canada↗
PubMed1994

Medical device regulation in Canada: direction for change.

The medical device regulatory programme in Canada was first instituted in 1975. Recently this programme underwent a review. This paper first describes the system of regulations as it has been administered by the Health Protection Branch of the government of Canada. The rationale for the establishment of the Medical Devices Review Committee, its deliberations and report are then discussed. Finally, the paper examines measures currently being taken to implement recommendations that will take the regulatory programme for medical devices in Canada into the twenty-first century.

Canada↗
PubMed1996

The economics of lung cancer management in Canada.

Because lung cancer is a major health care problem in Canada, it is imperative to understand how resources are used to diagnose and treat this disease. This paper describes a method of modelling the direct patient care costs for lung cancer from the perspective 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 their distribution by cell type and stage in Canadian cases. A microsimulation model developed by Statistics Canada was used to integrate the data on type of lung cancer, extent of disease, clinical management, survival and health care resource utilization. The direct care costs for diagnosis and treatment of NSCLC ranged from $Cdn 17 889 for the surgery/post-operative radiotherapy treatment of Stages I and II to $Cdn 6333 for supportive care for patients with Stage IV disease. The costs of determining relapse for NSCLC were estimated to be $Cdn 1528 and terminal care costs, made up largely of hospitalization charges and some palliative radiotherapy, were $Cdn 10 331. Direct care costs for the diagnosis and initial treatment of SCLC ranged from $Cdn 18 691 for management of limited stage disease to $Cdn 4739 for the supportive care of patients with extensive disease. The cost of determining relapse for SCLC was estimated to be $Cdn 1590 and terminal care costs averaged $Cdn 9966. For all 15 624 cases of lung cancer diagnosed in Canada in 1988, it was estimated that the total cost of providing treatment and follow-up, and managing relapse over 5 years was $Cdn 328 million. Despite the large total cost of lung cancer management, estimates of cost effectiveness of therapy showed that the cost per life year gained was approximately $Cdn 11 000 for NSCLC and $Cdn 19 560 for SCLC. These estimates of the direct health care costs assume that all patients have access to care, treatment is uncomplicated and practice is standard, and must be viewed as an idealized assessment of the cost of lung cancer management. The microsimulation model, however, does provide a useful framework for evaluating the costs of new diagnostic procedures, treatment strategies and new drugs.

Canada↗
PubMed1985

Hospital system management in France and Canada: national pluralism and provincial centralism.

Since the mid-1960s, France and Canada have developed different ways of managing their hospital systems. In Canada, each provincial government has gradually imposed technocratic control with the aim of planning the allocation of health-care resources. In spite of attempts to do the same in France, the hospital system has grown with few restrictions other than those set by the medical profession itself. Consequently, health expenditures have risen at one of the fastest paces in Europe. The provincial monopoly over hospital care in Canada contrasts with the juxtaposition of local 'cartels' throughout France resulting, for the latter, in a much more uncoordinated system. After a description of each country's hospital system and its historical origins, the advantages and disadvantages of each system are assessed so as to understand current public debate in each country.

Canada↗
PubMed1988

Socioeconomic status and health status: a study of males in the Canada Health Survey.

The relationships between education/occupation/income and health status have been well documented in the international epidemiological and sociological literature for many years, however, specific studies on the subject are scarce in Canada. Even when relationships have been demonstrated, the reasons for these relationships are much debated. This study presents an analysis of the relationship between socioeconomic status (SES) and health status. The study is based on analysis of data from a sample of nearly 2000 male principal income earners from the 1978 Canada Health Survey. Firstly, is there a relationship between an individual's SES and health status in Canada? Secondly, what aspects of SES--education, occupational status, and/or income--are most important? Thirdly, what are the possible explanations of the observed relationship? That is, is it possible to disaggregate the relationship and thereby infer possible causal mechanisms? The findings indicated a direct positive relationship between SES and health status, i.e. the higher an individual's SES, the better that person's health. The major exception to this was the SES/fitness relationship. In this instance, the higher the SES, the lower the level of fitness. Though age was an important control variable as SES, fitness and illness are age related, the findings relating SES to the health measures remained even when age was controlled for. Of the three SES measures, income was consistently the best correlate of health status. Occupational status showed the most inconsistent relationships with health status. The findings supported both the social causation and social selection hypotheses. That is, social position can have an effect on health status (social causation), while health status can affect one's social position (social selection).

Adolescent↗
PubMed1995

Equity in health care: methodological contributions to the analysis of hospital utilization within Canada.

The main objective of this paper is to determine whether the distribution of hospital service utilization corresponds to the distribution of needs within Canada. This is accomplished by identifying the factors affecting the relationship between the incidence and quantity of hospital services and self-assessed need for such care in Canada. The data were derived from the General Social Survey (Statistics Canada, 1987) which is a weighted random sample of the Canadian population aged 15 and over. Employing methodological extensions over previous studies, the results indicate that although variation in quantity of hospital use is largely independent of income, household income has a significant positive effect on the incidence of hospital utilization. Additionally, variations in both incidence and quantity of use of hospital services are associated with variations in need and other factors within the model.

Adolescent↗
PubMed1994

North American (United States and Canada) comparative susceptibility of two fluoroquinolones: ofloxacin and ciprofloxacin. A 53-medical-center sample of spectra of activity. North American Ofloxacin Study Group.

Ofloxacin, a newer broad-spectrum fluoroquinolone, was evaluated against > 12,000 clinical isolates in a multicenter surveillance trial in the United States and Canada using the standardized disk diffusion method. A total of 53 geographically diverse clinical microbiology laboratories contributed zone diameter results for ofloxacin, ciprofloxacin, and norfloxacin for urinary tract infection (UTI) isolates; and ofloxacin and ciprofloxacin for respiratory tract infection (RTI) isolates, skin and soft tissue infection (SSTI) isolates, and genital tract pathogen isolates. In both the USA and Canada, ofloxacin was shown to have the wide spectrum of activity as follows: RTI isolates, ofloxacin (92.2%-93.8% susceptible) > ciprofloxacin (89.5%-90.4%); SSTI isolates, ofloxacin (87.1%-93.6%) > ciprofloxacin (78.8%-90.4%); UTI isolates, ofloxacin (91.6%-92.5%) > norfloxacin (87.3%-91.7%) > ciprofloxacin (86.4%-89.7%); and genital tract isolates, ofloxacin (94.0%) > ciprofloxacin (85.4%) (Canada only). US strains resistant to ofloxacin were confirmed by reference laboratory tests. Confirmed ofloxacin resistance, other than among staphylococci or nonenteric bacilli, was rare. The species most often found to be resistant to both ofloxacin and ciprofloxacin were methicillin-resistant staphylococci, Acinetobacter spp., and Enterococcus spp. From these contributing US and Canadian laboratory studies, ofloxacin appears to have a balanced spectrum of potential clinical use (91.8% susceptible aerobic isolates), particularly against Gram-positive pathogens and some species resistant to ciprofloxacin. The combined overall isolate (12,241 isolates) rates of susceptibility for ciprofloxacin (four infection sites) and norfloxacin (UTI only) were 87.3% and 88.8%, respectively. Monitoring for increasing fluoroquinolone resistance should be considered, however, as greater use of drugs in this class develops.

Bacteria↗
PubMed2005

Assisted reproductive technologies (ART) in Canada: 2001 results from the Canadian ART Register.

OBJECTIVE: To present the success rates of assisted reproductive technologies (ART) cycles performed in 2001 in Canada. DESIGN: Retrospective cohort study. SETTING: Nineteen of 22 ART centers in Canada. PARTICIPANTS: Couples undergoing ART treatment in Canada during 2001. METHODS: Data on each ART cycle performed during 2001 were submitted electronically to the Canadian ART Register (CARTR) by participating centers. MAIN OUTCOME MEASURE(S): Clinical pregnancy and live birth rate per cycle started, multiple birth rate. RESULT(S): A total of 7,884 ART cycles was reported to CARTR. There were 5,393 in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles using the woman's own oocytes. Per cycle started, the pregnancy rate was 28.3%, and the live birth rate was 23.1%; the multiple birth rate per delivery was 32.8%. Of cycles with oocytes retrieved, IVF was performed in 44% and ICSI in 56%; the outcomes were similar with the two procedures. There were 301 IVF/ICSI cycles using donor oocytes. The pregnancy rate was 29.2%, and the live birth rate was 22.4%; the multiple birth rate was 43.5%. There were 1,936 frozen embryo transfer cycles using the woman's own oocytes. The pregnancy rate was 18.9%, and the live birth rate was 15.4%; the multiple birth rate was 24.9%. CONCLUSION(S): For 2001, CARTR achieved 86% voluntary participation from Canadian ART centers. Pregnancy and live birth rates comparable to those of other countries were achieved.

Adult↗
PubMed2006

Assisted reproductive technologies (ART) in Canada: 2002 results from the Canadian ART Register.

OBJECTIVE: To present the success rates of assisted reproductive technology (ART) cycles performed in 2002 in Canada. This is the second annual report of Canadian ART outcomes. DESIGN: Prospective cohort study. SETTING: Twenty-one of 22 ART centers in Canada. PATIENT(S): Couples undergoing ART treatment in Canada during 2002. INTERVENTION(S): Assisted reproductive technology treatments, including IVF, intracytoplasmic sperm injection (ICSI), frozen embryo transfer (FET), and oocyte donation. MAIN OUTCOME MEASURE(S): Clinical pregnancy, live birth, and multiple birth rates. RESULT(S): A total of 9,188 ART cycles was reported to the Canadian ART Register. There were 6,547 IVF/ICSI cycles using the woman's own oocytes. Per cycle started, the clinical pregnancy rate was 29.9% (36.0% per ET procedure) and the live birth rate was 23.8%; the multiple birth rate per delivery was 34.8%. Of cycles with oocytes retrieved, IVF was performed in 46% and ICSI in 54%; the outcomes were similar with the two procedures. There were 325 IVF/ICSI cycles using donor oocytes. The clinical pregnancy rate was 34.8% and the live birth rate was 24.6%; the multiple birth rate was 34.6%. There were 2,083 FET cycles using the woman's own oocytes. The clinical pregnancy rate was 20.9% and the live birth rate was 16.3%; the multiple birth rate was 25.2%. CONCLUSION(S): For 2002, the Canadian ART Register achieved 95% voluntary participation from Canadian ART centers. Clinical pregnancy and live birth rates comparable to those of other countries were achieved. Success rates were higher in 2002 than in the previous year.

Adult↗
PubMed2004

Medical savings accounts and the Canada Health Act: complimentary or contradictory.

The publicly funded health system in Canada, almost since inception, has been the focus of numerous critiques, matched only by the solutions offered, and the secondary problems generated. One of the proposed solutions is the use of medical savings accounts (MSAs). It is reasoned that MSAs will make Canadians more accountable for the health services they utilize, yield cost containment, and potential savings. However, before a nation-wide, public MSA can be considered further, there is need to reconcile the following: (a) empirical evidence in support of MSAs that is not as compelling as some of its proponents argue; (b) the scale and complexity of a MSA if integrated into a publicly funded, nation-wide health system in a country the size of Canada; (c) whether the cost to formulate, implement, and operate a nation-wide Canadian MSA would yield the net gains to warrant such an expenditure; (d) the fact that implementation of a nation-wide MSA potentially may contravene the Canada Health Act.

Canada↗
PubMed2006

Health disparities in Canada today: some evidence and a theoretical framework.

This paper documents contemporary evidence on patterns of health disparities in Canada and suggests theoretical mechanisms that give rise to these patterns. The overall health of Canadians, as measured by life expectancy or mortality, has improved dramatically over the past 30 years and some disparities have diminished slightly (e.g., life expectancy by income group for men), while others have increased (e.g., diabetes for Aboriginal peoples). Arguably the most egregious health disparities in Canada are those existing between Aboriginals and the rest of the Canadian population. This paper focuses specifically on three social determinants and their effects on disparities in health; Aboriginal status, income, and place. Overall we take the approach that disparities in health could be alleviated by reducing inequities in the distribution of these determinants. We further argue that these social determinants are proxies for opportunities, resources and constraints; all of which influence health outcomes. We suggest that policies focus on reducing the social inequities that lead to health disparities in Canada, rather than focusing on the disparities in health alone. Since the social determinants described here have been found to influence an array of disease outcomes, tackling them, rather than their outcomes, may have a greater overall influence on the health of the population.

Aged↗
PubMed2006

Deficiencies of cross-training between pediatrics and otolaryngology: a survey of specialists in Canada.

OBJECTIVE: Conditions relating to the ear, nose and throat are very frequent problems encountered by general pediatricians. Similarly, a major percentage of patients seen and operated on by the general otolaryngologist are of the pediatric age group. The pilot study demonstrated that pediatric program directors of both specialties in Canada have identified a deficiency of cross-training and desire the need for more cross-training. The aim of this study was to survey practicing physicians of both specialties for their input. METHODS: Surveys were sent to a large cross-section of pediatricians and otolaryngologists in Canada. They were asked to complete a questionnaire relating to their training experience, their desired training, important topics and general comments. Demographic data were collected including generalist versus sub-specialist, the year that residency was completed and country of training. Results were tabulated and analyzed. RESULTS: The response rate was high, being 70.6% and 76.2% for pediatricians and otolaryngologists, respectively. One hundred percent of pediatricians indicated that formal training by otolaryngologists was necessary, while 95% of otolaryngologists indicate a need for formal training by pediatricians during residency. Pediatricians desire more training using all three educational venues, namely lectures, clinics and rotations. While they are receiving lectures more often, they indicate that clinics are the most important mode of education. Otolaryngologists desire more formal training by pediatricians in the areas of lectures and clinics. They indicate the most important mode of education is lectures. There was no significant difference between generalists and sub-specialists or based on country of training for either group. There is some indication, in both specialties, of an increase of cross-training occurring within the past five years. CONCLUSIONS: This study has shown that there is a perceived deficiency of cross-training between the two specialties. Both pediatricians and otolaryngologists have indicated that they need more formal cross-training. This is a very important area to address, as this study relates directly to the optimum health of children in Canada and worldwide.

Canada↗
PubMed2004

Influence of outdoor aeroallergens on hospitalization for asthma in Canada.

BACKGROUND: The risk of hospitalization for asthma caused by outdoor aeroallergens is largely unknown. OBJECTIVE: The objective of this study was to determine the association between changes in outdoor aeroallergens and hospitalizations for asthma from the Pacific coast to the Atlantic coast of Canada. METHODS: A daily time series analysis was done to test the association between daily changes in aeroallergens and daily changes in hospitalizations for asthma during a 7-year period between 1993 and 2000 in 10 of the largest cities in Canada. Results were adjusted for long-term trends, day of the week, climate, and air pollution. RESULTS: A daily increase, equivalent to the mean value of each allergen, was associated with the following percentage increase in asthma hospitalizations: 3.3% (95% CI, 2.3 to 4.1) for basidiomycetes, 3.1% (95% CI, 2.8 to 5.7) for ascomycetes, 3.2% (95% CI, 1.6 to 4.8) for deuteromycetes, 3.0% (95% CI, 1.1 to 4.9) for weeds, 2.9% (95% CI, 0.9 to 5.0) for trees, and 2.0% (95% CI, 1.1 to 2.8) for grasses. After accounting for the independent effects of trees and ozone, the combination of the 2 was associated with an additional 0.22% increase in admissions averaged across cities (P <.05). CONCLUSION: These findings provide evidence for the hypothesis that aeroallergens are an important cause of severe asthma morbidity across Canada, and in some situations there might be a modest synergistic adverse effect of ozone and aeroallergens combined.

Adolescent↗
PubMed2005

National audit of the recent utilization of endovascular abdominal aortic aneurysm repair in Canada: 2003 to 2004.

OBJECTIVES: Worldwide, increasing proportions of aortic aneurysms are repaired electively via the endovascular route. The purpose of this study was to report the recent utilization of endovascular repair in Canada by reviewing a national administrative database. METHODS: The Canadian Institute for Health Information database (a collection of all acute care hospitalizations) was reviewed to identify patients who received nonemergent repair of an abdominal aortic aneurysm (AAA) between April 1, 2003 and March 31, 2004. During this 1-year period, differentiation between endovascular (EVAR) and open repair was possible using ICD-10-CA procedural codes in eight of ten provinces. Case volumes, patient age, length of hospitalization, and mortality were stratified by method of repair, province, and size and teaching status of hospitals. RESULTS: In this 1-year period, 1996 patients in eight provinces (representing 72% of Canada's population) underwent open repair (n = 1818, 91.1%) or EVAR (n = 178, 8.9%) of a nonruptured AAA. National utilization rates were 8.4 and 0.8 per 100,000 population for open repair and EVAR. These rates were more constant for EVAR (0 to 1.3) then for open repair (4 to 18.3) when analyzed on a provincial basis. Mean patient age did not differ between EVAR and open repair (73.7 vs 71.9 years, P = 0.4) while mean length of stay (5.8 vs 11.9 days, P = 0.03) and in-hospital mortality (0.6% vs 4.6%, P = .025) were significantly lower for EVAR than for open repair. Most EVAR (96%) and more than half of open repairs (56%) were performed in academic teaching centers. CONCLUSIONS: Although EVAR results in significant reductions in length of hospitalization and early mortality, it continues to be underutilized in Canada compared with other national reports involving administrative databases.

Aged↗