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PubMedDate not supplied

Practice patterns of respirologists in Canada.

The demographics and practice patterns of respirologists in Canada have not been studied. To evaluate the demographic characteristics of respirologists in practice, appraise current respirology manpower and ascertain the utilization of invasive diagnostic and therapeutic procedures (interventional pulmonology), a mail survey of all Canadian respirologists was conducted. The questionnaires were completed by 62% (n=355) of 573 possible participants. Of the respirologists who responded, 69.2% were younger than 50 years of age, 70.3% had been in practice for fewer than 20 years, 64.4% were in full- or part-time academic practice, and 72.9% were based in urban centres with a catchment population of more than 250,000. The current ratio of respirologists to population in Canada, assuming a total population of 31,000,000, is 1:54,101. In the present survey, only 68.3% respirologists practised clinical respirology for 50% or more of their time, and half (49.5%) of respirologists devoted more than 50% of their time on nonrespirology or nonclinical activities. Thus, the more precise respirologist to population ratio appears to be 1:81,000. The current ratio meets the Royal College of Physicians and Surgeons of Canada recommendations, and the current training programs meet present manpower requirements. With respect to the procedures performed, most specialists carried out bedside procedures and flexible bronchoscopy; a much smaller number did invasive procedures such as rigid bronchoscopy (20.8%), transbronchial needle biopsy of lung (43%), transbronchial biopsy of mediastinal lymph nodes (38%), therapeutic bronchoscopy using laser, cryotherapy and stents (8.7%), transthoracic needle biopsy (22.2%) and thoracoscopy (11.3%). Because 97% of pulmonary specialists would like to perform invasive procedures, fellowship programs, mini-residencies and practical courses should provide the necessary training.

Adult↗
PubMed2005

The use of noninvasive mechanical ventilation for the treatment of acute exacerbations of chronic obstructive pulmonary disease in Canada.

BACKGROUND: Noninvasive mechanical ventilation (NIMV) is accepted as a life-saving treatment for patients presenting to the emergency department and other acute care settings with severe exacerbations of chronic obstructive pulmonary disease (COPD). OBJECTIVES: It was hypothesized that there is marked national variability in the use of NIMV. Therefore, the use of NIMV for COPD exacerbations in urban centres across Canada was evaluated. METHODS: All Canadian hospitals affiliated with a university training program were surveyed, and a request for involvement in this survey was posted on the Canadian Society of Respiratory Therapy professional practice listserv. Survey information was received from all 33 sites (100%) that were contacted. RESULTS: Marked differences in the application of NIMV were identified across all regions in Canada, ranging from requiring extensive monitoring in the intensive care unit to application on a general internal medical unit with intermittent noninvasive blood pressure monitoring. There were sites that rarely used NIMV for COPD exacerbations and others where it was routine practice. CONCLUSIONS: NIMV is a life-saving treatment for acute exacerbations of COPD. Despite clear clinical evidence, its use has not penetrated throughout all the larger urban hospitals in Canada. This may be more problematic in sites without 24 h respiratory therapy support. There are barriers to the routine application of NIMV that can be overcome using established guidelines and available evidence.

Acute Disease↗
PubMed2002

Compulsory drug treatment in Canada: historical origins and recent developments.

In Canada, illicit drug use and addiction have traditionally been considered as a criminal justice problem and have been addressed from a legal perspective. Over the past century, a medical approach to drug addiction has slowly crept into the criminal justice processing of drug offenders. This has happened through the combination of principles of punishment with principles of addiction treatment in the sentencing of drug offenders to create a distinct application of 'compulsory drug treatment' in Canada. However, this evolution has occurred sporadically over time, with punishment and coercion as predominantly the main approach to dealing with this population. This evolution has recently culminated in Canada with the development of two criminal justice approaches to dealing with the substance use problems of drug offenders that incorporate concepts of punishment and treatment more equally than ever before - conditional sentencing and drug courts. This paper outlines the historical evolution of concepts of 'compulsory treatment', discusses such examples of contemporary 'compulsory treatment' as conditional sentencing and drug courts, and analyses the implications, concerns and challenges associated with these tools currently used in the sentencing of drug offenders in the Canadian context.

Canada↗
PubMed2006

Regional differences in process of care and outcomes for older acute myocardial infarction patients in the United States and Ontario, Canada.

BACKGROUND: Previous comparisons of acute myocardial infarction (AMI) treatment between the United States and Canada are limited because they compared selected patients from randomized trials, used administrative data that lacked clinical detail, or did not consider regional differences in AMI treatment. METHODS AND RESULTS: We compared medication use, invasive cardiac procedure use, and 30-day risk-standardized mortality rates of 38,886 fee-for-service Medicare beneficiaries hospitalized with AMI in the United States and 5634 similarly aged patients in Ontario, Canada, from 1998 and 2001. Baseline characteristics and illness severity across the US regions and Ontario were not substantially different. Cardiac catheterization use in AMI patients was significantly higher in the United States compared with Ontario (38.7% versus 16.8%, P<0.001), but significant regional variations existed, in which the northeastern United States had significantly lower utilization rates (25.6%) compared with other US regions. Beta-blocker use among ideal candidates was highest in the northeastern United States (77.6% versus 69.7% in the United States as a whole, P<0.001) and angiotensin-converting enzyme inhibitor use was highest in Ontario (69.1% versus 58.2% in the United States, P<0.001). Risk-standardized mortality rates at 30 days were not substantially different across the regions. CONCLUSIONS: Previous studies have suggested a clear divergence in invasive cardiac therapy for AMI patients between the United States and Canada on the basis of health care financing and structural differences. Our findings of similar treatment patterns in the northeastern United States and Ontario suggest that regional practices may have a greater impact on treatment patterns than the respective health care delivery systems.

Aged↗
PubMed2001

Geographic variation in the rate of carotid endarterectomy in Canada.

UNLABELLED: Background and Purpose-- Carotid endarterectomy (CEA) is an important method of stroke prevention, but its usage in Canada is not well known. The indications for CEA have been well informed by the recent clinical trials, but the impact of this information on the rate and regional variation in the rate of CEA is unknown. This study sought to determine the rate and the regional variation in the rate of CEA in Canada, its provinces, and census divisions for 1994-1997. METHODS: Discharge data from all hospitals in Canada except Quebec were obtained from the Canadian Institute for Health Information for 1994-1997 and were searched for CEA by residential site. Rates and variations in rates were calculated. RESULTS: The national age- and sex-adjusted rate per 100 000 people of CEA for those aged >/=40 years rose from 31.7 in 1994 to 40.5 in 1997. Provincial rates in 1997 varied from a low of 25.7 in Saskatchewan to high of 82.8 in Prince Edward Island. The census division rates varied even more, from a low of 0 in several divisions to a high of 179. CONCLUSIONS: The recent slight increase in CEA rates may reflect the release of new efficacy results for CEA, especially for asymptomatic carotid stenosis, but the rates are still far below US levels. The marked regional variation in rates may reflect differing views on the appropriateness of indications such as asymptomatic carotid stenosis for CEA and the inconsistency of published clinical practice guidelines.

Adult↗
PubMed1994

The ICD-10 clinical field trial for mental and behavioral disorders: results in Canada and the United States.

OBJECTIVE: To help evaluate the impact of proposed revisions to the chapter on mental and behavioral disorders for ICD-10, the World Health Organization (WHO) Division of Mental Health organized an international clinical field trial to evaluate draft clinical descriptions and diagnostic guidelines. The authors compare interrater diagnostic reliability results from this field trial for clinicians in Canada and the United States of American with those from all other clinicians worldwide, as well as with those from field trials conducted to evaluate drafts of DSM-III. METHOD: Two or more clinicians at each clinical center independently evaluated each patient, following a study protocol that allowed clinicians to list up to six diagnoses. In Canada and the United States, 96 clinicians completed 1,781 assessments among 491 patients, and elsewhere in the world 472 clinicians completed 7,495 assessments among 1,969 patients. RESULTS: Summary kappa coefficients at two-, three-, and four-character ICD-10 code levels were 0.76, 0.65, and 0.52, respectively, for Canadian and U.S. clinicians and 0.83, 0.75, and 0.62 for clinicians elsewhere. The mean number of diagnoses per assessment for Canadian and U.S. clinicians was 2.1; for clinicians elsewhere it was 1.7. More multiple coding of diagnoses for substance use disorders, mood (affective) disorders, and personality disorders by Canadian and U.S. clinicians accounted for much of the difference in diagnostic coding and in interrater reliability between them and clinicians elsewhere. CONCLUSIONS: Interrater diagnostic reliability in Canada and the United States was similar to that of clinicians worldwide and also to results from the DSM-III field tests. Use of more multiple coding of selected disorders by Canadian and U.S. clinicians may reflect the influence of DSM-III and DSM-III-R, which encourage multiple diagnostic entries and the use of separate multiaxial coding for personality disorders, and may have reduced interrater concurrence for some categories. Further, collaborative development of ICD-10 with DSM-IV has aligned these two systems more closely.

Adult↗
PubMed2002

Psychoanalytic patients in the U.S., CANADA, and Australia: I. DSM-III-R disorders, indications, previous treatment, medications, and length of treatment.

To determine the demographics, DSM-III-R disorders diagnosed, indications used in recommending psychoanalysis, previous treatment histories, use of medication, and length of treatment in patients in psychoanalysis in the U.S., Canada, and Australia, a mail survey of practice was sent to every other active member of the American Psychoanalytic Association and every member of the Australian Psychoanalytical Society. This supplemented an earlier survey sent to all Ontario psychoanalysts. The response rates were 40.1 % (n = 342) for the U.S., 67.2% (n = 117) for Canada, and 73.9% (n = 51) for Australia. Respondents supplied data on 1,718 patients. The employment rate for patients increases as analysis progresses (p < .0001). The mean number of concurrent categories of disorders (Axis I, Axis II, and Disorders First Evident in Childhood) per patient at the start of treatment is 5.01 (SD = 3.66; median = 4; mode = 3). There are no statistically significant differences across countries. Mood, anxiety, sexual dysfunction, and personality disorders are most common. American Psychiatric Association / American Psychoanalytic Association peer review criteria for indicating psychoanalysis are followed for 86.5% of patients. Over 80% of patients in all three countries had undergone previous treatments prior to analysis. In the U.S., 18.2% of analysands are on concurrent psychoactive medication; in Australia, 9.6%. The mean length of analyses conducted in the U.S. is 5.7 years, in Australia 6.6, and in Canada 4.8. Psychoanalytic patients in all three countries have similar rates of DSM-III-R psychopathology, and many indications of chronicity.

Adult↗
PubMed2001

The history of occupational therapy assistants in Canada: a comparison with the United States.

In the middle of the twentieth century, the role of occupational therapy assistant was introduced in North America. Although the role, utilization and training of assistant personnel have raised much controversy and debate within the profession, Canada and the United States have taken very different paths in terms of dealing with these issues. This paper focuses on the history of occupational therapy assistants in Canada, using the experience in the United States for comparison purposes. The occupational therapy literature and official documents of the professional associations are used to present a chronology of major historical events in both countries. Similarities and differences emerge in relation to historical roots; training model and standards of education; certification, regulation, and standards of practice; career laddering and career mobility; and professional affiliation. The paper concludes with a summary of issues which require further exploration, debate and resolution if the profession is to move forward in Canada.

Allied Health Personnel↗
PubMed2002

Predicting the use of occupational therapy services among people with multiple sclerosis in Atlantic Canada.

This secondary analysis examined the factors that predicted the use of occupational therapy services since diagnosis and over the past year among people with multiple sclerosis in Atlantic Canada. Data were gathered through a mail-out survey of members of the Multiple Sclerosis Society of Canada (Atlantic Division) in the winter of 1997/98. The Behavioral Model of Health Services Utilization (Andersen & Newman, 1973) was used to guide the analysis. Seeing greater numbers of health professionals, having a hospitalization in the past year, and having more functional limitations all increased the likelihood of seeing an occupational therapist, both since diagnosis and over the past year. These findings suggest that the organization and structure of the service system play a large role in the likelihood that a person with multiple sclerosis will see an occupational therapist in Atlantic Canada.

Adult↗
PubMed2007

Quality of life of older adults in Canada and Brazil.

In this study, we examined the factors contributing to quality of life (QOL) of older adults in regions of Canada and Brazil. The WHOQOL-BREF and a demographic data sheet were administered to random samples of 202 older adults from Canada and 288 from Brazil. Ratings on overall QOL and on the physical, psychological, and environmental domains were higher in the Canadian sample. Social domain scores were not significantly different. The authors found the same pattern of factors (health satisfaction, enough money, meaning in life, and opportunities for leisure activities) contributed to the variance of QOL in both countries, except for physical environment, which was significant in Brazil and not in Canada. Health satisfaction was the strongest contributor to QOL in both samples, and satisfaction with personal relationships was not significant in either country.

Activities of Daily Living↗
PubMed1994

Cancer mortality in Italian migrants to Canada.

The present study reports on the analysis of cancer mortality in Italian first-generation migrants resident in Canada, deceased in the period between 1964-1985 (5,801 males: 3,267 females). Mortality in migrants is compared to that of the host population as well as to that in the migrants' country of origin. This is carried out both on a national level (Italy), and on a regional level with those regions that have made the greatest contribution to the Italian migratory flow (Southern Italy). Compared with the Canada-born population, significantly higher risks were evident for nasopharynx, stomach, liver and gallbladder tumors in migrants. Lower risks were observed for the oral cavity, esophagus, colon, rectum, pancreas (females), larynx, lung, melanoma, breast, ovary, prostate, bladder (females), and non-Hodgkin's lymphoma in migrants. This is consistent with that evidenced in the comparison between Italy and Canada. The data are discussed in relation to the results of other studies on Italian migrants and the prevalence of main risk factors.

Age Distribution↗
PubMed2002

Progress against major depression in Canada.

BACKGROUND: Generally, public health strategies for major depression have focused on case-finding, public and professional education, and disease-management strategies. In principle, increased rates of treatment utilization and improved treatment outcomes should lead to improved mental health at the population level. Progress of this sort, however, has been difficult to confirm. METHODS: The National Population Health Survey (NPHS) is a large-scale longitudinal study of a representative sample drawn from the Canadian population. To date, Statistics Canada has released data from 3 NPHS cycles: 1994-1995, 1996-1997, and 1998-1999. Treatment utilization and major depression measures were employed in the NPHS survey, providing a unique source of longitudinal Canadian data. In this study, major depression point prevalence (defined using a predictive instrument for annual major depressive episode [MDE] prevalence and responses from a distress scale) and associated treatment utilization were evaluated over time. RESULTS: Between 1994-1995 and 1995-1996, the proportion of persons with depression receiving antidepressant treatment increased dramatically, from 18.2% (12.3% to 22.1%) in 1994-1995 to 32.6% (23.0% to 42.2%) in 1998-1999. Point prevalence of major depression was 2.4%, 1.8%, and 1.9% in the 3 NPHS iterations. CONCLUSIONS: Data from the NPHS suggest public health progress against major depression in Canada. More people with major depression in Canada are receiving treatment, and these changes may have been associated with improved population health status. However, both random variation and extraneous societal factors could account for the observed trends in prevalence. It is impossible to relate changes in utilization directly to population health status using the NPHS data.

Antidepressive Agents↗
PubMed2002

Electroconvulsive therapy training in Canada: a call for greater regulation.

OBJECTIVE: A national survey of senior psychiatric residents' experience of electroconvulsive therapy (ECT) training was undertaken in Canada in 1989. Since then, guidelines have been published in Canada and the US with respect to ECT training in psychiatry residency programs. This study examines whether there has been any change in the Canadian resident ECT training experience through a second national survey. METHODS: Confidential questionnaires assessing the training in and the attitudes toward ECT were sent to all 133 psychiatric residents-in their final year of training in Canadian medical schools. RESULTS: We attained a response rate of 68.3%. Of respondents, 88% felt that theoretical and practical ECT training should be a mandatory component of psychiatric residency programs. No marked improvements have occurred with respect to didactic and bedside training in ECT, compared with the original 1989 study. Only 18% of respondents reported that they feel completely competent administering ECT. Despite this, 59.3% anticipate working in an inpatient setting. CONCLUSIONS: The publication of training guidelines has made little impact on training in and attitudes toward ECT in senior psychiatric residents in Canada. Despite senior residents' acknowledgement of ECT's value, few feel competent to administer ECT after completing their training.

Canada↗
PubMed2006

Factors explaining career satisfaction among psychiatrists and surgeons in Canada.

BACKGROUND: The career satisfaction of specialists is affected by many variables ranging from family responsibilities, stress, the quality of services and facilities available to patients, professional rewards, and how the work is organized. OBJECTIVE: To articulate models that explain a substantial portion of the variance associated with career satisfaction among surgeons and psychiatrists in Canada. METHODS: Of 4958 eligible physicians across Canada, 2810 (56.7%) completed a 12-page survey between January and March 2004, following which the responding 148 surgeons and 231 psychiatrists were selected for this study. We checked response bias and found it was negligible. Hierarchical regression analysis was used to record cumulative R2, Standardized beta, and significance levels as each predictor was entered. We applied weighting factors to reflect the actual physician population in Canada. RESULTS: The models explained 90.4% of the variance in career satisfaction for surgeons and 81.0% of the variance in career satisfaction for psychiatrists. The explanatory variables consisted of distress and coping, role in community activities, access to and quality of health care services, intrinsic and extrinsic rewards, workload, and organizational structure. CONCLUSIONS: The study demonstrated that variance associated with career satisfaction can be explained using various factors reported directly by physicians. The study also confirmed that relative differences in the importance of these factors do occur among specialties. Surgeons prefer to delegate more responsibility in the management of their practices on an informal basis, whereas psychiatrists prefer to be more involved in the management of their practices and use more formal structures.

Adaptation, Psychological↗
PubMed1986

On the differences in the historical development of psychoanalysis in the United States and Canada.

Psychoanalysis developed differentially in Canada and the United States. In the United States it was geared to the model of having only physicians train in psychoanalysis, which was followed from the very beginning but in Canada the standard of the International Psycho-Analytic Association was used allowing the training of some lay analysts as well as physicians. In Canada, though very Freudian, a more integrated view of many different schools of psychoanalysis was taught as adjuncts to the Freudian view, this being based to a large degree on the British psychoanalytic model. The American Psychoanalytic suffered many splits on the issues on social factors and to some degree on political issues in the twenties and the thirties. This was avoided by the Canadian societies and institutes. The main similarities and differences in historical development are outlined and discussed.

Academies and Institutes↗
PubMed1999

The economic burden of schizophrenia in Canada.

OBJECTIVE: To estimate the financial burden of schizophrenia in Canada in 1996. METHOD: Using a prevalence-based approach, all direct health care costs, administrative costs of income assistance plans, and costs of incarceration attributable to schizophrenia were determined. Also included was the value of lost productivity associated with premature mortality and morbidity. In addition to using published papers and documents, direct contact was made with representatives from various provincial and federal programs for estimates of the direct health care and non-health care costs. RESULTS: The estimated number of persons with schizophrenia in Canada in 1996 was 221,000, with equal distribution between males and females. The direct health care and non-health care cost was estimated to be $1.12 billion in 1996. In addition, another $1.23 billion in lost productivity associated with morbidity and premature mortality was attributable to schizophrenia. CONCLUSIONS: The total financial burden of schizophrenia in Canada was estimated to be $2.35 billion in 1996. The largest category of cost was morbidity (52%), followed by acute care and psychiatric hospital admissions (14% and 10% respectively). Given the magnitude of these cost estimates, there are large potential cost savings with more effective management and control of this debilitating disease.

Adolescent↗
PubMedDate not supplied

Giving birth: the voices of Orthodox Jewish women living in Canada.

OBJECTIVE: To describe the meaning of the childbirth experience to Orthodox Jewish women living in Canada. DESIGN: In this phenomenologic study, audiotaped interviews were conducted. Tapes were transcribed verbatim and analyzed for emergent themes. Demographic data also were collected. SETTING AND PARTICIPANTS: Thirty Orthodox Jewish women who had given birth to healthy full-term newborns at a university-affiliated Jewish hospital in Montreal, Canada, participated in the study. Data were collected within 2 weeks after childbirth, either in the mother's postpartum hospital room or in her home. RESULTS: The following themes reflecting spiritual/cultural dimensions of the childbirth experience were identified: (a) birth as a significant life event, (b) birth as a bittersweet paradox, (c) the spiritual dimensions of giving birth, (d) the importance of obedience to rabbinical law, and (e) a sense of support and affirmation. CONCLUSION: This study documents cultural, religious, and spiritual dimensions of the childbirth experience of Orthodox Jewish women living in Canada. Knowledge and appreciation of the multiple dimensions of childbirth reflected by this study's findings can contribute to holistic and culturally competent nursing care of women and newborns.

Adolescent↗
PubMed1998

Undergraduate dermatology education in Canada: a survey.

BACKGROUND: Two reviews done in the 1980's showed that many Canadian medical schools scheduled relatively little time for dermatological teaching. Many students did not have a real clinical exposure to dermatology. OBJECTIVE: The purpose of this study was to obtain new data to reevaluate the undergraduate training in dermatology in Canada. METHODS: A survey was sent to the coordinators of undergraduate dermatology of all 16 Canadian medical schools. RESULTS: The survey of medical schools demonstrates the current status of dermatology undergraduate teaching across Canada. Although many improvements have been made in the way dermatology is taught to medical students, many of the problems noticed in the 1980s remain unresolved. CONCLUSION: Because dermatological care in Canada is often rendered by nondermatologists, the dermatologists should emphasize the importance of undergraduate training in their specialty.

Canada↗