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PubMed1999

Sex differences in renal transplantation in Canada.

To determine if a patient's sex influences access to renal transplantation in Canada, transplant recipient data for first cadaveric unrelated renal transplants were obtained from the Canadian Organ Replacement Register (CORR) for the period 1985-1992. There were 4683 first unrelated cadaveric transplant recipients during this time. Differences in the proportion of men and women registered with CORR who received a renal transplant were analyzed. In Canada between 1985 and 1992, 25% of males 40 years and older on dialysis received renal transplants compared with 18% of females (p < 0.0001, RR 1.54, 95% CI 1.40-1.67). There was no difference in the rates of transplants in males and females who were under 40 years of age. Adjusting for panel-reactive antibody data did not change the significance of the difference in transplant rates between the sexes. In Canada from 1985 to 1992, male patients with end-stage renal disease received proportionately more transplants than females.

Adult↗
PubMed1998

Two routes to privacy protection: a comparison of health information legislation in Canada and the United States.

The privacy of health information is a subject of great sensitivity in both Canada and the United States. As a result of public demands for more effective protection of such information as medical records, Canada and, particularly, its provincial governments, have implemented extensive legislation. The United States, on the other hand, has largely confined its efforts to private sector initiatives that are more reflective of voluntary codes than legal statutes. Because new technologic developments facilitate data sharing in the medical field, especially in the face of a continual reduction of healthcare budgets, the concern for privacy protection in this domain has intensified. Correspondingly, there has been a gradual theoretical shift in protective health information policies on both sides of the border. As Canada pushes to extend its federal and provincial legislation to the private sector, the United States is on the brink of approving a national bill that would protect the privacy of personal medical records. It is becoming evident that efforts to secure the privacy of health information in both countries are converging.

Canada↗
PubMed1998

Telemedicine and telehealth in Canada: forty years of change in the use of information and communications technologies in a publicly administered health care system.

The Canadian climate and geography are particularly well suited to the adoption of communications technologies for long-distance medical care and education. Canada has a long history of use of telemedicine applications, and in recent years, the number and variety of telehealth activities in Canada have increased dramatically. Using information gathered for a competitive framework study of the telehealth industry in Canada, this article documents these changes. The trends observed have been encouraged by the development of provincial and national infrastructure for the health information highway, changes in the health care system, increased technological capacity and speed, and government intervention and assistance. The pace of growth is apparent in the increases in the number of projects, the number of companies offering telehealth products and services, the adoption by public organizations of telehealth technologies for a wider range of applications, and the increasing amount of research being undertaken. The article concludes with comments on the role of government intervention in fostering these developments.

Canada↗
PubMed2004

Telepediatrics in Canada: an overview.

Telehealth in Canada is undergoing phenomenal growth owing to recent federal and provincial funding to implement the use of information and communication technologies to improve access to health care for all Canadians. This funding has been a significant factor in establishing telehealth networks in the 10 provinces and 3 territories, thus increasing access to specialty and subspecialty care from urban tertiary care centers. Every province and territory in Canada is now part of a functioning telehealth network. For tertiary pediatric centers, this offers new opportunities for providing support and outreach services to children in remote and northern communities. This article provides a broad overview of development of telepediatrics in Canada.

Canada↗
PubMed1999

Surface contamination with antineoplastic agents in six cancer treatment centers in Canada and the United States.

The level of contamination by antineoplastic agents in drug preparation and administration areas in cancer treatment centers in Canada and the United States was determined. Sampling locations at three cancer treatment centers in Canada and three centers in the United States were selected (biological safety cabinets, countertops, and floors in and adjacent to preparation areas; tabletops, chairs, and floors in administration areas). A solution of sodium hydroxide (0.03 M) was spread over the surface of each area. The surface was wiped with one or two absorbent tissues, which were then stored in plastic screw-top containers. Samples were stored at -40 degrees C before analysis of ifosfamide content (U.S. centers only) and cyclophosphamide content by gas chromatography in tandem with mass spectroscopy-mass spectroscopy and fluorouracil content by reverse-phase high-performance liquid chromatography with ultraviolet-light detection. Measurable amounts of the antineoplastic agents were detected in 75% of the pharmacy samples and 65% of the administration samples. In general, the levels of contamination were higher in the pharmacy areas than in the drug administration areas. The pharmacy area at the site with the highest number of drug preparations had considerably more drug contamination than the other sites. The results were similar for Canadian and U.S. centers. Substantial levels of contamination from three antineoplastic agents were detected on a variety of surfaces in pharmacy drug preparation areas and drug administration areas in six cancer treatment centers in Canada and the United States.

Antineoplastic Agents↗
PubMed2002

Perceived importance and self-assessment of the skills of Canada's health-system pharmacy managers.

The relationship between the perceived importance of managerial skills and self-assessed proficiency in each skill among health-system pharmacy managers in Canada was examined, and the demographic characteristics associated with pharmacy managers who lack these skills were analyzed. Surveys were mailed to 514 health-system pharmacy managers in Canada in July 2000. The survey listed 61 specific managerial skills, under seven general categories. The respondents were asked to rate the level of importance that each of the skills had in their job and rate their proficiency in each skill. Ratings were based on a five-point Likert scale ranging from very high importance or skill level to very low importance or skill level. The response rate was 52.7%. Of the 61 specific managerial skills considered, the majority of respondents identified "Demonstrating ethical conduct" as both the most important skill and their greatest strength. "Understand the operating principles of managed care" was viewed as the least important skill, while "Participating in the implementation of a marketing program" was respondents' greatest weakness. There were significant differences in the mean self-assessed skill levels of the respondents according to their educational background, size of the institution in which they work, and years of managerial experience. Health-system pharmacy managers with a master of business administration degree had a significantly higher overall mean perceived skill level than managers in all other "Education" categories. Managers with a bachelor of science degree in pharmacy had a significantly lower overall mean perceived skill level than those with a bachelor of science degree in pharmacy plus "other" degrees, while managers employed in institutions of 500 or more inpatient beds had a significantly higher overall self-rated mean skill level than managers employed in institutions of 51-100 inpatient beds. A national survey of health-system pharmacy managers in Canada revealed a pressing need for better training in managerial skills for these pharmacists.

Analysis of Variance↗
PubMedDate not supplied

Impact of measles in Canada.

The reported incidence of measles in Canada in 1981 was reduced 97% from the average annual rates during the prevaccine period, 1949-1958. Throughout recent years the age-specific incidence of reported cases of measles has remained highest in the group five to nine years of age, but there has been a definite increase in the proportion of cases of measles in persons greater than 10 years of age. During the extensive measles epidemic in Alberta in 1979, a high proportion of the reported cases occurred in adolescents and young adults previously vaccinated with killed vaccine, and the majority of these developed atypical measles syndrome. In Canada, from five to 36 patients per 100,000 population have required hospitalization annually for complications due to measles over the past 16 years. Measles-related deaths have declined in a pattern similar to that for reported incidence. Despite favorable trends in the control of measles in Canada, the social and economic impacts of this disease remain substantial and warrant a nationwide effort to eliminate indigenous infection.

Adolescent↗
PubMed1994

Prevalence of migraine headache in Canada: a population-based survey.

BACKGROUND: The aim of the present study was to estimate the prevalence of migraine headache among Canadian adults (aged > or = 18 years) and analyse variation by age, gender, household income and province of residence. METHODS: A population-based survey was undertaken using telephone interviews with 2922 adults who were randomly selected from households across Canada by stratified regional sampling. The questionnaire asked about frequency and characteristics of headaches experienced and other symptoms. The diagnostic criteria of the International Headache Society were used to classify people as migraineurs (with or without aura), headachers or non-headachers. RESULTS: Of 8921 random calls to households, 4235 were eligible and 2922 interviews were successfully completed (response rate 66%). The prevalence of migraineurs, headachers and non-headachers among males was 7.8%, 76.1%, 16.1% and among females was 24.9%, 65.6%, 9.4%. For females prevalence appears to increase with age, peaking at 40-44 years and declining thereafter. Sex-specific prevalence for males and females, controlling for age, was significantly lower in the province of Quebec compared to other provinces. We found no association between migraine prevalence and household income. Of 500 people classified by IHS criteria as migraineurs only 232 (46%) reported any migraine diagnosis by a physician. CONCLUSION: We estimate that 2.6 million adult females and 0.8 million adult males in Canada are migraineurs, but only half are likely to have been diagnosed by a physician. Contrary to a recent US survey, people from lower income households in Canada are not at greater risk of migraine. The lower prevalence of migraine in Quebec was unexpected and remains unexplained, but it may be influenced by language/translation problems.

Adult↗
PubMed2006

The role of horizontal gene transfer in the spread of trimethoprim-sulfamethoxazole resistance among uropathogenic Escherichia coli in Europe and Canada.

OBJECTIVES: To describe the distribution of trimethoprim-sulfamethoxazole resistance genes and the role of horizontal gene transfer and clonal expansion in recent increases of antibiotic resistance rates among uropathogenic Escherichia coli in Europe and Canada. METHODS: We identified antibiotic resistance alleles sul1, sul2, sul3 and dfr along with type 1 and type 2 integrons among 350 uropathogenic E. coli isolates from a cross-sectional study of acute, uncomplicated, community-acquired urinary tract infections in 16 western European countries and Canada (ECOSENS). RESULTS: Trimethoprim resistance gene distributions showed no regional dependency (P = 0.84). The most common trimethoprim resistance gene was dfrA1, which occurred in 37.9% of dfr containing isolates. Similarly, the sulfamethoxazole resistance gene distributions did not vary significantly by region (P = 0.20). sul2, the most common sulfamethoxazole resistance gene, was found in 77.9% of sulfamethoxazole-resistant isolates. The distribution of type 1 and type 2 integrons varied slightly by region (P = 0.04) with type 1 integrons being the more common (85.9%). We observed 34 combinations of the sul genes, dfr genes and integron types; the most common combinations were broadly disseminated across every region examined. CONCLUSIONS: Horizontal gene transfer plays a larger role than clonal expansion in the increase of trimethoprim-sulfamethoxazole resistance levels in Europe and Canada.

Anti-Bacterial Agents↗
PubMed1998

Perspective from Western Canada and the Canadian meat industry.

The Canadian broiler chicken and turkey industries are distributed approximately according to human population. Individual components of these industries tend to be smaller than their U.S. counterparts and not to be vertically integrated. The outlook of the poultry meat industries is positive because of increasing per capita consumption of chicken and the potential for gains in turkey consumption. The number of permanently employed poultry scientists at publicly funded institutions has declined in Western Canada. University training in Poultry Science is restricted to four major institutions where it has been integrated into Animal Science and Veterinary Medicine programs. For the most part, poultry scientists have developed successful research programs and this research has been enhanced by scientists employed in term positions. Publicly funded poultry extension has declined but this reduction has been compensated to some degree by industry-sponsored programs and the private sector. The majority of research funding, which was once derived from government, is now provided by industry; government contributions are frequently contingent on initial industry support. The consequence of this type of funding arrangement is a trend to more short-term and less long-term research. Canada has no strategic plan regarding poultry training, research, or extension and this needs to be addressed before there is a further reduction in the country's infrastructure. Modern communication technology offers promise to reduce the isolation of scientists in different parts of Canada.

Agriculture↗
PubMed2004

The annual effective dose from natural sources of ionising radiation in Canada.

A review and analysis of published information combined with the results of recent gamma ray surveys were used to determine the annual effective dose to Canadians from natural sources of radiation. The dose due to external radiation was determined from ground gamma ray surveys carried out in the cities of Toronto, Ottawa, Montreal and Winnipeg and was calculated to be 219 microSv. A compilation of airborne gamma ray data from Canada and the United States shows that there are large variations in external radiation with the highest annual outdoor level of 1424 microSv being found in northern Canada. The annual effective inhalation dose of 926 microSv from 222Rn and 220Rn was calculated from approximately 14,000 measurements across Canada. This value includes a contribution of 128 microSv from 222Rn in the outdoor air together with 6 microSv from long-lived uranium and thorium series radionuclides in dust particles. Based on published information, the annual effective dose due to internal radioactivity is 306 microSv. A program developed by the Federal Aviation Administration was used to calculate a population-weighted annual effective dose from cosmic radiation of 318 microSv. The total population-weighted average annual effective dose to Canadians from all sources of natural background radiation was calculated to be 1769 microSv but varies significantly from city to city, largely due to differences in the inhalation dose from 222Rn.

Background Radiation↗
PubMed1995

The Medical Council of Canada's key features project: a more valid written examination of clinical decision-making skills.

In 1986 the Medical Council of Canada (MCC) commissioned a six-year research and development project to create a new, more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. At that time, the qualifying examination consisted of three booklets of multiple-choice questions and one booklet of patient management problems administered over a two-day period. All graduates of Canadian and foreign medical schools must pass this examination before practicing medicine anywhere in Canada except Québec. The project was undertaken because (1) numerous studies do not support the use of patient management problems (PMPs) to assess clinical decision-making skills, and (2) research results on the characteristics of clinical decision-making skills offered guidance to develop new approaches to their assessment. In particular, research suggested that these skills are specific to the case or problem encountered and are contingent on the effective manipulation of a few elements of the problem that are crucial to its successful resolution--the problem's key features. The problems developed by this project focused only on the assessment of these key features. The project was implemented in three overlapping phases over a six-year period, 1986-1992, each containing a development component followed by a pilot test through which the research studies were carried out. The pilot tests were conducted by presenting sets of new key feature problems to classes of graduating students in medical schools across Canada.(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗
PubMed1996

Education for rural practice in Canada and Australia.

Better education, recruitment, and retention of rural doctors are priorities in Canada and Australia. All medical schools in both countries offer some training in rural areas. In Canada, postgraduate training is provided by university medical schools, which have produced a variety of rural educational initiatives in response to regional needs and resources. In Australia, postgraduate training is provided by the Royal Australian College of General Practitioners (RACGP) and specialty colleges, and the RACGP's Faculty of Rural Medicine has established a national training program for rural medicine. In both countries, a wide variety of continuing medical education (CME) courses are being developed for rural doctors, and funding resources and local programs are offered to make it easier for rural doctors to attend CME courses. Both countries continue to struggle to ensure high-quality, accessible medical care for rural populations. Although the two countries differ both in their health and in medical education systems, Canada and Australia are similar geographically and in their population distributions, and can benefit from and build on each other's experiences and advances.

Australia↗
PubMed2002

The emerging role of advanced nursing practice in acute pain management throughout Canada.

The purpose of this study was to describe the role qualifications and responsibilities related to advanced nursing practice in acute pain management across Canada. The Canadian Nurses Association national framework on advanced nursing practice was used as a guide to identify role components for nurses within this specialty. A self-administered questionnaire of fixed choice and open-ended questions was mailed to nurses in acute pain management throughout Canada. Respondents identified their primary role responsibilities as clinical, educational, and administrative. Role challenges included lack of administrative/colleague support, complexity of pain problems, role definition, and acceptance. Key areas of positive outcomes involved the patient as well as interdisciplinary and nursing teams. Nurses described the ability to provide continuity of care, patient and staff education, and leadership in pain management as important and rewarding. The role of advanced nursing practice in acute pain management throughout Canada is evolving. The affect of this role promises to enhance the quality of pain management for healthcare professionals and their patients.

Adult↗
PubMed1995

Differences in the treatment of myocardial infarction between the United States and Canada. A survey of physicians in the GUSTO trial.

Treatment of acute myocardial infarction differs between the United States and Canada, but the reasons for these practice pattern differences remain elusive. To investigate whether physician beliefs and access to procedures account for these differences in the treatment of acute myocardial infarction, a random sample of physicians involved in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries trial in the United States (n = 332) and Canada (n = 200) was surveyed. We found that American physicians recommend coronary angiography after uncomplicated infarction significantly more (median: 7 versus 3 of 11 possible indications, P = 0.0001). Coronary angiography, angioplasty, and bypass surgery were available in-hospital to more American than Canadian physicians (77% versus 41%), and the reported waiting period for cardiac procedures in a stable patient was longer in Canada (angiography: 28 versus 1.5 days; angioplasty: 30 versus 2 days; bypass surgery: 84 versus 3 days, all P < 0.001). More American than Canadian physicians were cardiologists (88% versus 74%), and more were interventional cardiologists (61% versus 26%). American physicians more highly rated the importance of patient requests, malpractice, and insurance coverage, whereas Canadians more highly rated availability of cardiac procedures as influencing clinical decisions. After statistical adjustment for these factors, however, Americans remained significantly more likely to recommend coronary angiography.

Adult↗
PubMed1990

Skull trepanation among the early Indians of Canada and the United States.

The authors reviewed anthropological reports of skull trepanation (trephination) among the early Indians of Canada and the United States of America. Published reports of 20 trepanations in 19 skulls are reviewed. All were believed to have been performed ante mortem. Most were from the pre-Columbian era. Eleven were from Canada (8 from British Columbia) and 8 from the United States. The location of skull perforation was parietal in 9 cases and less often frontal (3) or occipital (3). The average skull opening was oval or oblong, with a diameter of 3.0 cm. The method of trepanation was probably gradual scraping in most cases. Skull fractures were not present in any case. About 90% of the trepanations showed evidence of healing, indicating survival. The authors discuss the evidence for skull trepanation in the United States and Canada, and compare these findings to the better studied South and Central American material.

Canada↗
PubMed1997

Characteristics of occupational medicine practitioners and practice in Canada.

To obtain baseline information with respect to occupational medicine practice in Canada, a questionnaire survey of members of the Occupational and Environmental Medical Association of Canada was carried out by mail in 1993. One hundred eighty-six responses were received (56% of the membership). The average age of the respondents was 49.5, 12% were female, and 55% worked full-time in occupational medicine. Practice types included corporate settings (58%), clinics (23%), government agencies (14%), worker's compensation boards (7%) and academic settings (5%). Sixty percent had some formal training in occupational medicine, and 46% had occupational medicine certification by either the Royal College of Physicians and Surgeons of Canada, the Canadian Board of Occupational Medicine, or the American Board of Preventive Medicine. Younger physicians were more likely to be female and have gone directly into occupational medicine. Women were more likely to be working full-time in occupational medicine but worked fewer hours per week. Those physicians with specialty qualifications were older and more likely to be working full-time in occupational medicine and be active in professional activities. The Association intends to continue surveying its members on a triennial basis, identifying trends in the practice profiles and continuing education needs.

Adult↗
PubMed2003

Combining data sources to monitor the HIV epidemic in Canada.

This article describes the methods, results and future perspectives of four information sources used to monitor the HIV epidemic in Canada: AIDS case surveillance, HIV case surveillance, HIV sentinel serosurveillance, and behavioral surveillance. Synthesizing data from these multiple sources provides a more comprehensive picture of the HIV epidemic than any one source alone could provide. In Canada, there has been a shift over time from an epidemic dominated by men who have sex with men to one where more than half of new infections are attributed to other groups, such as injection drug users and non-injecting heterosexuals. The available evidence also suggests increasing HIV infections among Aboriginal persons and among women. Surveillance data have been used in Canada to guide prevention and care programs and to formulate policy. In particular, these data have been used to support the development of an HIV testing program in pregnancy, to re-direct community work toward injection drug users and the young, and to demonstrate the effectiveness of new treatments for HIV. The main challenge now is to continue to improve the monitoring of the shifting HIV epidemic with more accurate data and to use the resulting information to inform appropriate prevention and care responses.

AIDS Serodiagnosis↗