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PubMed2002

Urinary incontinence in Canada. National survey of family physicians' knowledge, attitudes, and practices.

OBJECTIVE: To determine current knowledge, attitudes, and management of urinary incontinence among family physicians in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Family physicians in Canada. PARTICIPANTS: A random sample of 1500 members of the College of Family Physicians of Canada. MAIN OUTCOME MEASURES: Self-assessed knowledge, self-reported attitudes, and rating of various tests and treatments in the investigation and management of incontinence. RESULTS: The overall unadjusted response rate was 43.3% (650/1500). Although most respondents reported that urinary incontinence was common in their practices, less than half (46.0%, 284/617) indicated that they clearly understood incontinence and just 37.9% (232/612) had an organized plan for incontinence problems. Only 35.0% (214/612) of respondents felt very comfortable dealing with incontinence. Physical examination, urodynamic studies, urinalysis, and testing blood sugar levels were all considered important investigations by more than 90% of respondents. CONCLUSION: There are wide variations in knowledge, attitudes, practices, and comfort level among family physicians dealing with urinary incontinence.

Adult↗
PubMed2002

Under-reporting of maternal mortality in Canada: a question of definition.

In Canada, maternal mortality reporting is based on information contained on death certificates. To examine the extent to which maternal deaths are under-reported in Canada and whether this is likely to change under the 10th revision of the International Classification of Diseases (ICD), we linked live birth and stillbirth registrations to In Canada death registrations of women aged 10 to 50 for 1988 through 1992. We reviewed the death certificates of women found to have died while pregnant or within a year of the termination of pregnancy. The officially reported maternal mortality ratio for the study years was 3.7 deaths per 100,000 live births. Depending on whether we included deaths not certified as maternal deaths at the time the deaths occurred, revised ratios under ICD-9 ranged from 4.9 to 5.1 per 100,000 live births for deaths from direct obstetric causes and from 0.5 to 1.2 per 100,000 live births for deaths from indirect obstetric causes. Reflecting changes in classification criteria, revised ratios under ICD-10 were lower than those under ICD-9 for deaths from direct obstetric causes - ranging from 3.9 to 4.1 per 100,000 live births - and higher for deaths from indirect obstetric causes ranging from 2.0 to 3.0 per 100,000 live births. Of deaths from direct obstetric causes, those from cerebrovascular disease were the most numerous and also the most likely to be underreported. Deaths from pulmonary embolism and indirect obstetric causes were the next most likely to be underreported. In a companion article we report an investigation of whether deaths from causes not directly related to pregnancy -such as injury, infectious disease and epilepsy - are more or less likely to occur among pregnant and recently pregnant women.

Canada↗
PubMedDate not supplied

Trends of hepatitis B and hepatitis C mortality in Canada, 1979-1997.

Mortality data from Statistics Canada were analyzed to measure the temporal trends and burden of illness attributed to viral hepatitis in Canada. Analysis of age-standardized mortality rates from 1979 to 1997 showed an increasing trend in mortality for both hepatitis B and non-A, non-B hepatitis (NANBH), most of which are attributed to hepatitis C infections. Hepatitis B and NANBH age-standardized mortality rates increased respectively, from 0.03 and 0.12 deaths per 100,000 population in 1979 to 0.26 and 0.41 deaths per 100,000 in 1997. Male mortality rates were consistently higher than female for both diseases. Among deaths from chronic liver disease, over 1,000 deaths were estimated to have been caused by hepatitis B and hepatitis C annually. Although the hepatitis B or NANBH recorded deaths largely underestimate the true burden of HBV and HCV in Canada, the temporal trends are useful as they reflect changes in the impact of both diseases.

Canada↗
PubMed2002

Vaccination against foot-and-mouth disease: the implications for Canada.

Vaccination of susceptible animals against foot-and-mouth disease (FMD) is a well established strategy for helping to combat the disease. Traditionally, FMD vaccine has been used to control a disease incursion in countries where the disease has been endemic rather than in countries considered free of the disease. In 2001, the use of vaccine was considered but not implemented in the United Kingdom (1), whereas vaccine was used to help to control FMD in The Netherlands (2,3). Canadian contingency plans provide for the use of vaccine; Canada is a member of the North American Foot-and-Mouth Disease Vaccine Bank, which could supply vaccine if needed. This article explains why Canada might use FMD vaccine to combat an outbreak and the factors that are relevant to the disposal of vaccinated animals and their products. It concludes that vaccination is an important mechanism in Canada's preparedness for an outbreak of FMD and that products from vaccinated animals are safe for human consumption.

Animals↗
PubMed1988

Earnings in Canada: the roles of immigrant generation, French ethnicity, and language.

"The effects of immigrant status, French ethnicity, and language fluency in Canada has received relatively little attention in the economics literature. Moreover, the coverage of the few studies available is highly selective, and the results often conflict. This paper seeks to correct these deficiencies by using data from the 1971 and 1981 Censuses of Canada to analyze the labor market adjustment of immigrants and French Canadians, as well as the role of language in the Canadian labor market. The analysis is conducted in a manner which will facilitate comparison with previous studies of immigrants and their children in Canada and in other countries. In addition, by comparing 1971 and 1981 Census data, the paper highlights the similarity and changes in patterns over the decade."

Acculturation↗
PubMed1990

[Ukrainian immigration in Canada: some aspects of socio-demographic integration].

The author examines social and demographic characteristics of Ukrainians living in Canada, with a focus on acculturation levels and trends. "Among the indices which confirm the notion that members of the group have integrated themselves into the social-demographic structure of Canadian society, the author notices: dispersive settlement (in all the provinces and territories of the country), urbanisation which recently has surpassed the Canadian average; an increase in the number of persons born in Canada (87.5%); a growing similarity between the employment structure of the able-bodied population and the employment structure typical for Canada as a whole; growth of the incomes of Ukrainian families;...[and] increases in the level of education...." (SUMMARY IN ENG AND SCR)

Acculturation↗
PubMed1995

Post-1945 international migration: New Zealand, Australia and Canada compared.

"New Zealand's immigration policies and trends since 1945 are compared with those of Canada and Australia. For most of this period, Australia has pursued the more expansive immigration policy while Canada and New Zealand have tended to link immigration intakes to fluctuations in labor demand. All three countries initially discriminated against non-European immigrants but gradually moved towards nondiscriminatory policies based on similar selection criteria and means of assessment. New Zealand has traditionally been more cautious than both Canada and Australia in terms of how many immigrants it accepted and from what sources, but it has recently followed the other two in raising immigration targets encouraging migration from nontraditional sources, particularly Asian countries. Historical, global and national factors are drawn upon to explain the degree of convergence between these three societies."

Americas↗
PubMed1994

[The family environment of children in France and Canada].

"Two fundamental changes have influenced family demographics in both France and Canada over the past 25 years: the rise in the number of births to unmarried parents and the rapid growth in the proportion of children separated from one parent or another before they reach adulthood. The impact of these changes on the family life of children must, however, be seen in perspective. Parents not married at the time of the child's birth nevertheless tend to live together. As well, the separation of birth parents allows for the formation of new families, giving the child a stepmother or stepfather and step-siblings. International or interregional comparisons give a further dimension to these phenomena; for example, Quebec, France and the rest of Canada rank in that order for the frequency of births outside marriage, while Quebec and the rest of Canada come ahead of France with a higher frequency of separations." (SUMMARY IN ENG AND SPA)

Adolescent↗
PubMed2002

Antimicrobial resistance in Canada.

Antibiotic resistance has increased rapidly during the last decade, creating a serious threat to the treatment of infectious diseases. Canada is no exception to this worldwide phenomenon. Data from the Canadian Nosocomial Infection Surveillance Program have revealed that the incidence of methicillin-resistant Staphylococcus aureus, as a proportion of S. aureus isolates, increased from 1% in 1995 to 8% by the end of 2000, and vancomycin-resistant enterococcus has been documented in all 10 provinces since the first reported outbreak in 1995. The prevalence of nonsusceptible Streptococcus pneumoniae in Canada in 2000 was found to be 12%. Human antimicrobial prescriptions, adjusted for differences in the population, declined 11% based on the total number of prescriptions dispensed between 1995 and 2000. There was also a 21% decrease in beta-lactam prescriptions during this same period. These data suggest that systematic efforts to reduce unnecessary prescribing of antimicrobials to outpatients in Canada, beginning after a national consensus conference in 1997, may be having an impact. There is, however, still a need for continued concerted efforts on a national, provincial and regional level to quell the rising tide of antibiotic resistance.

Anti-Bacterial Agents↗
PubMedDate not supplied

Hepatitis A, B, and C in Canada. Results from the National Sentinel Health Unit Surveillance System, 1993-1995.

OBJECTIVES: To estimate the incidence of and to describe the risk factors that were associated with the acquisition of hepatitis A, B, and C in well-defined Canadian populations from the Sentinel Health Unit Surveillance System (SHUSS). METHODS: We used the 1993 to 1995 data on hepatitis A, B, and C infection in Canada, collected by SHUSS, a national surveillance system established by the Laboratory Centre for Disease Control in Health Canada in 1993, through consultation and collaboration with provincial partners. We calculated the rates of, and described and discussed the risk factors that were associated with, hepatitis A, B, and C infection, based on the SHUSS surveillance data. RESULTS: From 1993 to 1995, SHUSS reported 92 cases of hepatitis A, 89 hepatitis B, and 720 hepatitis C, yielding a rate of 3.9, 3.8, and 30.3 per 100,000, respectively. The reported rates varied substantially among participating health units, ranging from 0.8 to 8.1 per 100,000 for hepatitis A, 0.0 to 9.0 for hepatitis B, and 5.4 to 73.3 for hepatitis C. The most frequently reported risk factor for hepatitis A was a history of street drug use, followed by recent international travel and household contact with a hepatitis A case, household crowding, and a history of raw or undercooked shellfish consumption. The most frequently reported risk factors for the acquisition of hepatitis B included history of street drug use and occupational exposure. The most frequently reported risk factor for the acquisition of hepatitis C was a history of street drug use, followed by health care exposure and occupational exposure. Only 5% of persons with hepatitis B infection had a history of hepatitis B immunization. INTERPRETATION: Despite the limitations of possible bias due to selective participation of SHUSS and the lack of information on risk factors among controls, the high exposure to known risk factors and the low rate of vaccination among hepatitis patients can provide useful information for the development of public health policies to control hepatitis A, B, and C infection in Canada.

Canada↗
PubMed2003

Cost effectiveness in Canada of eptifibatide treatment for acute coronary syndrome patients using PURSUIT subgroup analysis.

OBJECTIVE: To evaluate the cost effectiveness of eptifibatide, a new glycoprotein IIb/IIIa receptor inhibitor, for the treatment of acute coronary syndromes (ACS) in Canada. DESIGN: A model was created to analyze the cost effectiveness of eptifibatide using outcomes and resource utilization data from the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, an international, placebo controlled, randomized clinical study evaluating the efficacy of eptifibatide in treating ACS. Cost data were derived from Canadian sources. Clinical outcomes were derived from published survival analyses based on North American PURSUIT data. SETTING: The present analysis is representative of the Canadian health care setting. Data for resource use reflected actual resources used by patients in the Canadian arm of the PURSUIT study. PATIENTS: Patients included in the PURSUIT study were hospitalized for non-ST segment elevation ACS between November 1995 and January 1997. INTERVENTIONS: Eptifibatide or placebo treatment was randomly assigned in addition to standard treatment with acetylsalicylic acid and heparin. MAIN RESULTS: Per patient costs for hospitalization, medical procedures and medications associated with standard treatment plus placebo were 10,265 dollars compared with 10,691 dollars with eptifibatide, in 1995 Canadian dollars. Eptifibatide patients had lower rehospitalization rates in the six months following treatment. Discounting future health outcomes by 3%, the cost effectiveness of treating ACS patients with eptifibatide in Canada was estimated as 5,165 dollars per year of life gained. CONCLUSIONS: Considering both the cost of eptifibatide therapy over standard treatment and the health benefits associated with it, eptifibatide is a cost effective, economically attractive pharmacological option for the treatment of ACS patients in Canada.

Angina, Unstable↗
PubMed2003

Outcomes after coronary artery bypass graft surgery in Canada: 1992/93 to 2000/01.

BACKGROUND: The authors have previously reported on Canada-wide outcomes of coronary artery bypass graft (CABG) surgery for 1992/93 through 1995/96. OBJECTIVE: To provide an updated Canada-wide CABG surgery outcome report with outcome data organized by province and by year for 1992/93 through 2000/01. METHODS: Hospital discharge abstract data were obtained from the Canadian Institute for Health Information and were used to identify all patients who underwent isolated CABG surgery in eight provinces from fiscal year 1992/93 through 2000/01. Crude data from Quebec hospitals were available for calendar years 1998 and 1999. Logistic regression modelling was used to calculate risk-adjusted in-hospital mortality rates by year and province. RESULTS: Patients undergoing CABG surgery in the later years studied were on average older and had more comorbidities than did patients undergoing this surgery in earlier years. Despite increasing case complexity, risk-adjusted mortality rates decreased significantly from 3.5% (95% CI 3.2% to 3.8%) to 2.0% (95% CI 1.8% to 2.3%). Risk-adjusted mortality rates varied between provinces. Provincial risk-adjusted mortality rates ranged from 2.0% to 3.3%. However, all provinces studied had either persistently low mortality rates (Nova Scotia) or declining mortality rates across years studied, such that all provinces achieved risk-adjusted mortality rates of 2.7% or lower in 2000/01. CONCLUSIONS: This evaluation of Canadian CABG surgery outcomes demonstrates a pattern of either steadily improving or persistently favourable provincial in-hospital mortality rates after isolated CABG surgery. These favourable provincial outcome trends have been achieved despite an accompanying increase in the average case complexity of patients undergoing CABG in Canada.

Age Distribution↗
PubMed2003

In-hospital outcomes after percutaneous coronary intervention in Canada: 1992/93 to 2000/01.

BACKGROUND: Despite existing research on outcomes of cardiac care in Canada, little is known about Canada-wide trends and interprovincial differences in outcomes after percutaneous coronary intervention (PCI). OBJECTIVES: To examine Canadian trends in rates of in-hospital mortality and same-admission coronary artery bypass grafting (CABG) after PCI and to compare provincial risk-adjusted in-hospital death and same-admission CABG rates. METHODS: Hospital discharge abstract data were obtained from the Canadian Institute for Health Information and were used to identify cohorts of patients who underwent PCI in eight provinces in fiscal years 1992/93 through 2000/01. Crude data from Quebec hospitals were available for calendar years 1998 and 1999. Logistic regression modelling was used to calculate risk-adjusted in-hospital death and same-admission CABG rates by year and province. RESULTS: A total of 127,103 PCI cases performed in 23 hospitals across eight provinces were examined, with an overall unadjusted death rate of 1.4% and an overall unadjusted CABG rate of 1.6%. A national trend of stable in-hospital mortality rates was observed with a risk-adjusted death rate of 1.4% in 1992/93 versus 1.4% in 2000/01. An overall decline was seen in rates of same-admission CABG with a risk-adjusted rate of 2.7% in 1992/93 versus 0.9% in 2000/01 (relative decrease 67%, P<0.01). New Brunswick, Manitoba and British Columbia achieved overall declines in risk-adjusted death rates over the study period, while the other provinces experienced a slight increase (Newfoundland, Nova Scotia, Ontario, Alberta and Saskatchewan). All provinces displayed a similar decline in risk-adjusted same-admission CABG rates post-PCI. INTERPRETATION: Risk-adjusted rates of in-hospital death after PCI in Canada have remained stable over nine years, while risk-adjusted rates of same-admission CABG have decreased. The presence of interprovincial differences in risk-adjusted outcomes raises the possibility of variable quality of care for patients undergoing PCI across the Canadian provinces.

Adult↗
PubMed2003

Burden of cardiovascular disease in Canada.

BACKGROUND: This report updates the death estimates for cardiovascular disease (CVD) in Canada and introduces a population-based perspective on disease prevalence and health-related quality of life (HRQOL) burden. METHODS: The Canadian Mortality Database was used to estimate the mortality of men and women in different age groups for the 139 Canadian health regions from 1950 to 1999. Heart disease prevalence and its impact on HRQOL were estimated using the 2000-2001 Canadian Community Health Survey (CCHS). Life table techniques were used to estimate the impact of heart disease on life and health expectancy. RESULTS: Although CVD remains the leading cause of death in Canada, between 1950 and 1999 the death rates from CVD dropped from 702 per 100,000 to 288 per 100,000 men, and from 562 per 100,000 to 175 per 100,000 women. Results from the CCHS indicated that 5.4% of men and 4.6% of women reported having heart disease as diagnosed by a medical professional. Of these individuals, 14% of men and 21% of women reported difficulty ambulating - about six times more than people without heart disease. In total, 4.5 years of life expectancy and 2.8 years of health expectancy were lost due to CVD. The study also found large differences in the burden of CVD among men and women and across the 139 Canadian health regions. CONCLUSIONS: CVD is a major disease burden in terms of both mortality and HRQOL and is an important source of health inequalities between populations in Canada. Any attempt to improve the health of Canadians or to reduce health inequalities should include interventions to reduce CVD mortality and morbidity. Given the present impact of CVD on HRQOL, reducing or eliminating heart disease may potentially result in an increase in life expectancy that will be larger than the gains in health expectancy.

Activities of Daily Living↗
PubMed1992

Demographic trends of marriages in Canada: 1921-1990.

This paper mainly describes levels and trends of marriages and rates and its relationship with demographic and social conditions in Canada from 1921 to 1990. In Canada, the propensity to marry was much higher in the 1960s and early 1970s than in the 1980s. A similar tendency was observed for a few years prior to, and at the beginning of, World War II and a couple of years after. The number of marriages peaked at an all time high of 200,470 in 1972 with a rate of 44.3 per 1,000 unmarried population aged 15-59. By 1986 the number of marriages had declined by 12.4% and the rate by 33.2%, but both the number of marriages and the rate increased marginally in the following three years. Since 1921 the average age at marriage has increased by 3.6 years for brides and 1.7 years for grooms. The proportion of marriages by previously divorced persons increased sharply after 1968. The changes in marriage rates in Canada parallel those exhibited in the United States and other developed countries in the western hemisphere.

Adolescent↗
PubMed1992

Economic impact of HIV infection and coronary heart disease in immigrants to Canada.

OBJECTIVE: To compare the direct health care costs of illnesses associated with the human immunodeficiency virus (HIV) and of coronary heart disease (CHD) in immigrants to Canada. DESIGN: Comparative cost analysis. PARTICIPANTS: All people who immigrated to Canada in 1988. The numbers with HIV infection and CHD were estimated from country-specific HIV seroprevalence data and national CHD mortality statistics and data from the Framingham study. Health care costs, projected over the 10 years after immigration, were calculated on the basis of data from the Hospital Medical Records Institute and provincial fee schedules. RESULTS: Of the 161,929 immigrants in 1988, 484 were estimated to be HIV positive. The total cost of treatment of HIV-related illnesses from 1989 to 1998 (discounted at 3%) would be $18.5 million: $17.1 million would be spent on the outpatient and inpatient care of the HIV-positive immigrants, $1.0 million on care of the subsequently infected sexual partners and $0.4 million on care of the HIV-positive children born to seropositive immigrant women. In comparison, CHD would develop in 2558 immigrants during the same 10-year period. The total CHD costs would be $21.6 million: $8.4 million would be spent on treating myocardial infarction, $3.2 million on coronary artery bypass grafting, $1.6 million on pacemaker insertion and $8.4 million on treating other CHD events. CONCLUSIONS: The economic impact of HIV infection in immigrants to Canada is similar to that of CHD. This comparison identifies an important shortcoming in current immigration policy: economic considerations can be arbitrarily applied to certain diseases, thereby discriminating against specific groups of immigrants.

Adult↗
PubMed2002

House of Commons committee releases report on Canada's drug strategy.

On 17 May 2001, the House of Commons created a Special Committee on Non-Medical Use of Drugs based on a motion introduced by Randy White, Canadian Alliance MP (Langley-Abbottsford) and gave it a very broad mandate to study "the factors underlying or relating to the non-medical use of drugs in Canada" and to propose recommendations aimed at reducing "the dimensions of the problem involved in such use." In December 2002, the Committee released its report, entitled Policy for the New Millennium: Working Together to Redefine Canada's Drug Strategy. The report contains many good recommendations, but fails to deal adequately with the fundamental harms caused by Canada's drug laws and federal government inaction. Far better is the supplementary report written by NDP MP Libby Davies (Vancouver East), which contains an excellent, informed critique of the report. The supplementary report from the official opposition, written by MPs Randy White and Kevin Sorenson (Crowfoot, Alberta) also makes for interesting, if troubling, reading--it is based nearly exclusively on fiction rather than facts and science.

Canada↗
PubMed2002

Canada refuses to issue a visa to an HIV-positive worker on antiretroviral drugs.

Citizenship and Immigration Canada has denied an application for a visa from an HIV-positive man even though he is in good health. The man was seeking to fill a two-year work term in Canada. The case raises concerns about Canada's immigration policies for people with HIV and about the ability of organizations working in AIDS to hire HIV-positive foreign workers.

Anti-HIV Agents↗