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PubMed1999

[Epidemic disease and regulation of migration in Canada].

Beginning with the French Revolution and the Napoleonic Wars, the Parliament of Lower Canada adopted a rational and scientific mechanism for regulating migratory movements within its territory. Other than internal imperatives pertaining to security, this mechanism revolved around a prophylactic control of these movements of population. With the great migrations of 1830-1834 and 1847, the politicians of Lower Canada and the United Canada subsequently needed to revisit their regulatory mechanism in order to render it more efficient. In truth, new arrivals were frequently the spreaders of infectious diseases. Yet more importantly, the great epidemics, such as that of cholera in 1832, or of typhus in 1847, were not merely physically lethal, but were potentially disastrous to the social order. How then to resolve the potential pathological threats to the physical body with those to the political body? The political powers of the day adopted an entire method of thinking and a vocabulary which was more scientific, replete with medical references. Adopted under the seal of an emergency, these new measures of state control of prophylaxis were greatly inspired by those medical theories concerning infection and contagion which were prevalent prior to the arrival of the Pasteurian model of medicine. Those in power then used this new framework to analyze the question as a rational political problem. In the end, they would establish a tighter mechanism of state-controlled prophylaxis through the law, through regulations, and through devices for surveillance and control such as quarantine. The guarantor of social discipline through the erosion of individual freedom, this mechanism of state-run prophylaxis of migratory movements would, from that point forward, be justified by the health demands of the Cité organique, of the public health.

Canada↗
PubMed1999

Geriatric mental health education in Canada SKIPs into the 21st century.

The Skills Immersion Program (SKIP) provides an educational opportunity for staff nurses who face the challenge of caring for residents who present with psychiatric and behavioral problems in long-term care (LTC) facilities within British Columbia, Canada. With the aging population and an increase in the number of individuals waiting for placement in care facilities, care providers are in substantial need of advanced education and training in the field of geriatric psychiatry nursing. Nurses working in LTC facilities in Canada are not prepared to manage the changing acuity levels and complex needs of their residents. The SKIP was developed by nurses, primarily for nurses, at St. Vincent's Hospital in Vancouver, British Columbia, Canada. Nurses who participate in the SKIP acquire an enhanced knowledge base in geriatric psychiatry nursing and gain access to assessment tools that will assist staff to increase the quality of care for their residents.

Canada↗
PubMed2000

Brucellosis in ringed seals and harp seals from Canada. lforbes@em.agr.ca.

A novel Brucella sp. was isolated from lymph nodes of four ringed seals (Phoca hispida) collected near Pangnirtung (Baffin Island, Canada) in January and February 1995 and in one harp seal (Phoca groenlandica) collected near the Magdalen Islands (Gulf of St. Lawrence, Canada) in March 1996. Bacteriological characteristics were the same for all five isolates. The colonies were typical of Brucella spp., but took 2 to 5 days longer than the traditional species to appear on primary isolation media. Biotyping results did not match any of the known biovars of Brucella, but were similar to isolates of the genus Brucella previously reported from marine mammals inhabiting other areas of the northern hemisphere. This is the first confirmed report of brucellosis in marine mammals from Canada, and the first report of this organism in ringed and harp seals.

Animals↗
PubMedDate not supplied

Factors influencing enrollment in a physiotherapy degree-completion program in Atlantic Canada: a survey.

The purpose of this study was to identify factors that influence enrollment in Dalhousie University's BSc (PT) degree-completion program. A geographically stratified, random sample of 100 nondegree physiotherapists practising in Atlantic Canada was surveyed by mail. The questionnaire solicited information on demographic data, program awareness and attitudes towards degree-completion programs. The response rate was 63 percent. More than 65 percent of respondents were trained in Canada, were older than 30 years, and had at least one child. Ninety percent of respondents were aware of the Dalhousie program; seven were currently enrolled. Ninety-three percent of respondents were confident they could continue to practise without a degree and 70 percent were confident they could meet academic standards required to complete a degree. Respondents were least certain on whether employers valued experience over a degree. Family responsibilities, age over 50, and job security were deterrents to enrollment. Nondegree physiotherapists in Atlantic Canada may not choose to upgrade to a degree because of the regional manpower shortage and job security. A strong pool of degree-completion students was not identified.

Canada↗
PubMed1994

Toward effectiveness assessment of health management education in Canada.

A growing theme in the management education literature is that of effectiveness assessment. Integrated effectiveness assessment systems represent an important challenge in health management education in Canada. This article examines the service effectiveness paradigm that evolved from comprehensive auditing developments in the public domain. It presents an integrated model of effectiveness assessment systems and the barriers that currently impede its full development and implementation in Canada. Finally, the evolving effectiveness assessment challenge--which will fundamentally change health management education in Canada--is examined.

Canada↗
PubMed1997

Home care in Canada.

This is an overview of the home care sector's evolution in Canada, including current models and delivery structures, funding, eligibility criteria, and services provided. Cost escalations of the traditional healthcare system and a reduction in federal funding has driven health reform in Canada. This has been accompanied by a major but sporadic expansion of the home care sector across the country. For the home care sector to develop in a more rational, cost-effective and client-focused manner, the development of common standards, a common database and programme evaluation will be required. This will also be necessary for political, planning, and administrative officials to understand and justify the reallocation of resources from institutional to community health sectors. Addressing issues such as the impact of health reform, the role of the private sector, realignment of system incentives, and developing effective partnerships with hospitals is critical if home care is to be recognized as an essential, cost-effective component in Canada's healthcare system.

Canada↗
PubMed1999

End-stage renal disease in Canada: prevalence projections to 2005.

BACKGROUND: The incidence and prevalence of end-stage renal disease (ESRD) have increased greatly in Canada over the last 2 decades. Because of the high cost of therapy, predicting numbers of patients who will require dialysis and transplantation is necessary for nephrologists and health care planners. METHODS: The authors projected ESRD incidence rates and therapy-specific prevalence by province to the year 2005 using 1981-1996 data obtained from the Canadian Organ Replacement Register. The model incorporated Poisson regression to project incidence rates, and a Markov model for patient follow-up. RESULTS: Continued large increases in ESRD incidence and prevalence were projected, particularly among people with diabetes mellitus. As of Dec. 31, 1996, there were 17,807 patients receiving renal replacement therapy in Canada. This number was projected to climb to 32,952 by the end of 2005, for a relative increase of 85% and a mean annual increase of 5.8%. The increased prevalence was projected to be greatest for peritoneal dialysis (6.0% annually), followed by hemodialysis (5.9%) and functioning kidney transplant (5.7%). The projected annual increases in prevalence by province ranged from 4.4%, in Saskatchewan, to 7.5%, in Alberta. INTERPRETATION: The projected increases are plausible when one considers that the incidence of ESRD per million population in the United States and other countries far exceeds that in Canada. The authors predict a continued and increasing short-fall in resources to accommodate the expected increased in ESRD prevalence.

Adult↗
PubMed1998

Health informatics in Canada: a vision for the next millennium.

Around the world, informatics has been cited as a key enabler of health sector reform. Recent reform programs in Canada, reflecting this global consensus, have emphasized the importance of quality information and information technology in achieving their goals. This paper describes the current status of health informatics in Canada and provides a vision for the evolution of Canada's health information infrastructure.

Canada↗
PubMed1999

Higher rates of coronary angiography and revascularization following myocardial infarction may be associated with greater survival in the United States than in Canada. The CARS Investigators (Coumadin/Aspirin Reinfarction Study).

BACKGROUND: Significant differences are known to exist between the United States and Canada with respect to coronary catheterization and intervention. In a post hoc analysis, it was hypothesized that these differences may have the greatest impact on outcome in patients at risk for recurrent events such as those following myocardial infarction (MI). PATIENTS AND METHODS: The hypothesis was tested in a nonrandomized comparison of the catheterization and revascularization patterns for patients following acute MI in 7029 patients in the United States and 1774 patients in Canada who participated in the Coumadin/Aspirin Reinfarction Study (CARS). CARS tested the effectiveness of low dose warfarin in combination with acetylsalicylic acid (ASA) versus ASA alone in reducing cardiovascular morbidity and mortality. RESULTS: Before study enrollment (median day 7 to 8), 84.5% of the American patients underwent coronary angiography compared with only 7.7% in Canada (P<0.01). CARS patients in the United States underwent significantly more frequent angioplasty during their hospital admission before study enrollment than their Canadian counterparts (55.8% versus 3.0%, respectively, P<0.01), and there was a more frequent use of intravenous heparin among American CARS patients (96% versus 88%, respectively, P<0.01) but less frequent administration of thrombolytic therapy (44% versus 49%, respectively, P<0.01). For follow-up of up to 32 months, American CARS patients had significantly fewer primary events (cardiovascular deaths, nonfatal MI, nonfatal ischemic stroke) than Canadian patients. Cumulative estimate of a primary end point comparing American with Canadian patients was, respectively, 2.0% versus 3.1% at one month, 8.0% versus 11.3% at one year and 11.6% versus 15.0% at two years. Thus, time to the primary event was significantly longer in American patients (P=0.0001). All-cause mortality estimates at 12 months were 2.2% and 4.0%, respectively, for the American and Canadian CARS subgroups. When management for the index MI (ie, angiography and angioplasty) is included in the model, the risk of death for Canadian versus American subgroups of CARS is not statistically different (0.9, 95% CI 0.6 to 1.2, P=0.40). CONCLUSION: Among study participants, American patients experienced a better outcome than Canadian patients, which may be attributable to more aggressive management based on early coronary angiography and angioplasty. However, angioplasty before study enrollment in American patients may have resulted in enrollment of lower risk patients. This selection bias limits the scope of the comparison.

Aged↗
PubMed2000

Characterization of university-level introductory genetics courses in Canada.

We conducted survey research with the intent to characterize post-secondary introductory genetics (IG) education in Canada during the 1996-1997 academic year. At least a minimum data set was obtained from 47 institutions through responses to a mailed questionnaire and on-line resources. The total reported enrollment (TRE) for IG was 10,500. Over half of the TRE used one particular text. A core curriculum of topics was identified as those given more than 30 min of lecture time in at least half of reporting institutions. Slightly more than half of the TRE had laboratory exercises associated with their IG course. Laboratory exercises tended to emphasize classical transmission genetics with very few exercises in molecular genetics. For the determination of academic equivalency between institutions, particular attention should be given to the breadth and duration of the tutorial and (or) laboratory components. The majority of personnel teaching IG were trained in Canada within the previous 15 years. We suggest mechanisms by which the Genetics Society of Canada could work to promote genetical literacy.

Canada↗
PubMedDate not supplied

Contraceptive use in Canada: 1984-1995.

CONTEXT: In every country, contraceptive behavior has important implications for fertility and the prevalence of sexually transmitted diseases (STDs). There has been relatively little attention to contraceptive practices in Canada, however, particularly how patterns of method use may have changed. METHODS: Data on contraceptive use were collected from 5,315 women in the 1984 Canadian Fertility Survey, and from 3,220 women and 3,449 men in the 1995 General Social Survey. RESULTS: Among Canadian women aged 15-49, current contraceptive use declined from 69% to 60% between 1984 and 1995. Pill use dropped from 19% to 17%, and IUD use declined from 6% to 3%. However, during the same period, condom use increased from 6% to 10%; tubal ligation declined from 24% to 17%, while vasectomy increased. In addition, the proportion of women sterilized for reasons other than contraception rose between 1984 and 1995. Men were less likely to rely on sterilization than were women (31 % vs. 40%). Men reported higher levels of condom use (22%), but lower levels of pill use among their partners (9%), than did women (10% and 17%, respectively). CONCLUSIONS: Contraceptive behavior in Canada is unique: The decline in contraceptive use over the last decade has left Canada's overall contraceptive prevalence among the lowest in the industrialized world, and the rate of sterilization among the highest These changes in contraceptive behavior complicate efforts to plan for social and health needs, particularly policy decisions focusing on reducing infections with STDs.

Adolescent↗
PubMed2000

Prescriptions, power and politics: the turbulent history of methadone maintenance in Canada.

Illicit opiate addiction has emerged as a major problem in many Western countries in the second half of this century, and its social harm implications have become much exacerbated with the onset of the HIV epidemic in the 1980s. By now, most Western jurisdictions have resorted to methadone treatment as the most effective and best researched intervention against the negative consequences of opiate addiction including mortality, morbidity, crime, and loss of social functioning. Methadone treatment in Canada features a long, turbulent, and instructive history as an exemplary case study in public policy. While both Britain and the U.S. experimented with opiate prescription treatment in the first half of the century, Canadian proposals for such programs initially never made it beyond the discussion stage, largely due to the influential resistance from the law enforcement sector. However, in light of growing influence from an emerging addictions treatment sector, Canada became the first Western jurisdiction to experiment with methadone prescription for the treatment of opiate addiction forty years ago. Methadone treatment became quickly and widely established as an effective treatment modality through the 1960s. But in the early 1970s, resistance from the law and health sectors evolved, and triggered the government to establish a set of comprehensive and restrictive federal methadone treatment regulations, which have dominated its realities until today. Almost completely regulated out of existence by the end of the 1970s, methadone treatment's prevalence gradually increased again through the 1980s, and recent decentralization efforts to provincial levels earlier this decade have had dramatic effects on treatment availability. Significant events in the Canadian history of methadone treatment and its regulation reflect developments in the U.S., and substantial recent domestic treatment expansion developments--as well as renewed sparks of resistance--are reminiscent of methadone treatment's patterns of history as they developed in the late 1960s. This paper traces the turbulent history of methadone treatment, regulation and policy in Canada with particular attention to institutional, professional and political determinants at the complex intersection of health, law, and addiction.

Canada↗
PubMedDate not supplied

A review of trichinellosis in people and wildlife in Canada.

Repeated serological and parasitological analyses of commercially raised swine have shown the Canadian swine herd to be free of Trichinella in recent years in all regions of the country except for sporadic cases from one community in Nova Scotia. Nevertheless, approximately 18 cases of human trichinellosis are reported each year in Canada. Cases are generally attributed to the consumption of infected meat from wildlife. Many surveys for Trichinella in wildlife have been conducted but their results are frequently limited to a few hosts or are limited in geographic range; nonetheless, they suggest that in some regions of Canada, trichinellosis appears to be common in some wildlife species. This literature review identifies two regions of Canada where sylvatic trichinellosis is prevalent and correlates with human cases. The occurrence of Trichinella in wildlife is significant from the point of view of public health as all known biotypes of the parasite can infect people.

Animals↗
PubMed2000

Temporal evolution in the management of acute ST elevation myocardial infarction: the seven-year GUSTO experience from canada and the united states. The North American GUSTO-I and GUSTO-III investigators.

BACKGROUND: Temporal changes in baseline characteristics, treatment and clinical outcomes of patients presenting with acute ST elevation myocardial infarction in Canada and the United States have not been examined comprehensively over time. OBJECTIVES: To evaluate baseline characteristics, process of care and clinical outcomes. Also, to explore whether earlier process-of-care differences between Canada and the United States had changed and, if so, whether they influenced clinical outcomes. PATIENTS AND METHODS: A total of 13, 888 American and 3011 Canadian patients enrolled in 184 American and 38 Canadian hospitals that participated in both the Global Utilization of Streptokinase and Tissue Plasminogen Activator (alteplase) for Occluded Coronary Arteries (GUSTO-I) trial (1990 to 1993) and the Global Utilization of Strategies to Open Occluded Coronary Arteries (GUSTO-III) trial (1995 to 1997) were studied. Logistic regression was used to identify significant prognostic factors, to assess illness severity at hospital presentation and to classify trends between Canada and the United States. RESULTS: In both countries, illness severity on admission increased, door-to-needle time for thrombolysis was reduced, intensive care unit stay was shortened and hospital stay decreased from GUSTO-I to GUSTO-III. Whereas the administration of oral nitrates, calcium blockers and beta-blockers at discharge converged over time between countries, the disparity in the use of angiography and revascularization widened; the rise in American revascularization rate was most evident in patients without in-hospital ischemia. The 30-day and one-year mortality rates were comparable and declined nonsignificantly in both countries. CONCLUSIONS: Despite increased illness severity and varying medication and procedure rates, there was no increase over time in 30-day or one-year mortality; this remained comparable between countries throughout the seven-year observation period.

Aged↗
PubMed2000

Performance of screening mammography in organized programs in Canada in 1996. The Database Management Subcommittee to the National Committee for the Canadian Breast Cancer Screening Initiative.

BACKGROUND: The results of randomized trials show that breast cancer screening by mammography reduces breast cancer mortality by up to 40% in women aged 50-69 years. Because of these results, by 1998, 22 countries, including Canada, had established population-based organized screening programs. This paper presents the results of screening mammography in 1996 for 7 provincially organized breast cancer screening programs in Canada. METHODS: Analyses of interim performance indicators for screening mammography have been calculated from data submitted to the Canadian Breast Cancer Screening database. The data set consisted of data from 7 provincial programs and was limited to mammographic screens for women aged 50-69 years (n = 203,303). Screening outcomes and performance indicators were calculated for abnormalities detected by screening mammography only. RESULTS: The abnormal recall rate was 9.5% for first screens and 4.6% for subsequent screens, and the cancer detection rate per 1000 women screened was 6.9 for first screens and 3.8 for subsequent screens. The positive predictive value (i.e., the proportion of women who tested positive by mammography who were found to have breast cancer on screen-initiated diagnostic work-up) increased from 7.2% at the first screen to 8.2% at subsequent screens. Estimated participation rates within organized programs varied from 10.6% to 54.2%, depending on the province. INTERPRETATION: For 1996, organized breast cancer screening programs met or exceeded many of the interim measures used in international programs. It is possible to translate the benefits of breast cancer screening by mammography, as demonstrated in randomized trials, into population-based community programs. Screening mammography through organized programs should increase to allow more comprehensive monitoring in Canada.

Aged↗
PubMed2000

The economic burden of physical inactivity in Canada.

BACKGROUND: About two-thirds of Canadians are physically inactive. As a risk factor for several chronic diseases, physical inactivity can potentially be a substantial public health burden. We estimated the direct health care costs attributable to physical inactivity in Canada, the number of lives lost prematurely each year that are attributable to a sedentary lifestyle and the effect that a reduction of 10% in inactivity levels (a Canadian objective for 2003) could have on reducing direct health care costs. METHODS: We calculated summary relative risk (RR) estimates from prospective longitudinal studies of the effects of physical inactivity on coronary artery disease, stroke, colon cancer, breast cancer, type 2 diabetes mellitus and osteoporosis. We then computed the population-attributable fraction (PAF) for each illness from the summary RR and the prevalence of physical inactivity (i.e., 62%) and applied the PAF to the total direct health care expenditures for 1999 and to the number of deaths in 1995 associated with each disease to determine the health care costs and lives lost prematurely that were directly attributable to physical inactivity. RESULTS: About $2.1 billion, or 2.5% of the total direct health care costs in Canada, were attributable to physical inactivity in 1999. A sensitivity analysis (simultaneously varying each of the health care costs and PAF by +/- 20%) indicated that the costs could be as low as $1.4 billion and as high as $3.1 billion. About 21,000 lives were lost prematurely in 1995 because of inactivity. A 10% reduction in the prevalence of physical inactivity has the potential to reduce direct health care expenditures by $150 million a year. INTERPRETATION: Physical inactivity represents an important public health burden in Canada. Even modest reductions in inactivity levels could result in substantial cost savings.

Adolescent↗
PubMed2000

A quantitative ranking of Canada's research output of original human studies for the decade 1989 to 1998.

BACKGROUND: Since 1987 research articles have been catalogued with the author's affiliation address in the 40 databases of the Medical Literature Analysis and Retrieval System (MEDLARS) of the National Library of Medicine, Bethesda, Md. The present study was conducted to examine the Canadian entries in MEDLARS to interpret past and future trends and to combine the MEDLARS demographic data with data from other sources to rank Canadian research output of human studies both nationally and internationally. METHODS: The PubMed Web site of the National Library of Medicine was used to count medical articles archived in MEDLARS and published from Jan. 1, 1989, through Dec. 31, 1998. The articles attributed to Canadian authors were compared by country, province, city, medical school, hospital, article type, journal and medical specialty. RESULTS: During the study period Canadian authors contributed on average 3% (standard deviation [SD] 0.2%) of the worldwide MEDLARS content each year, which translated to a mean of 11,067 (SD 1037) articles per year; 49% were human studies, of which 13% were clinical or controlled trials, and 55% involved people aged 18 years or less. In total, 68% of the articles were by authors affiliated with Canadian medical schools; those affiliated with the University of Toronto accounted for the greatest number (8604), whereas authors affiliated with McGill University had the greatest rate of annual increase in the quantity published (8%). Over one-third (38%) of the articles appeared in Canadian journals. When counted by specialty, 17% of the articles were by authors with clinical specialties, 5% by those with surgical specialties and 3% by those with laboratory specialties. INTERPRETATION: The annual rate of increase in research output for Canada was more than 3 times higher than that seen world wide. Canada is now ranked seventh among countries contributing human studies to MEDLARS. The increase indicates that Canada's medical schools are productive, competitive in making contributions to medical science and are supporting Canadian journals.

Canada↗
PubMed2000

Canada loses appeal of WTO panel ruling on minimum patent terms.

In the last issue, we reported on a ruling of a Panel of the World Trade Organization (WTO) that Canada was in breach of the international Agreement on Trade-Related Aspects of Intellectual Property Rights (the TRIPS Agreement). The Panel found that Canada's Patent Act does not provide the minimum patent terms required by the trade agreement. Canada appealed that decision, but on 18 September 2000 the WTO Appellate Body upheld the Panel ruling.

Anti-HIV Agents↗