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PubMed2003

Canada Health Infoway - a pan-Canadian approach.

Canada Health Infoway is a non-profit corporation created and funded by the federal government of Canada in 2000. Its initial focus is to accelerate the implementation of an electronic health record (EHR) on a pan-Canadian basis as well as produce an EHR blue print by 2007. The organization is a major investment for Canadians with a $1.1 billion budget, but substantial long-term healthcare savings are expected due to Canada Health Infoway's involvement.

Canada↗
PubMed2002

Drug policy in Canada--the way forward.

This article is one of a series commissioned to mark the tenth anniversary of the Canadian HIV/AIDS Legal Network, discussing past developments and future directions in areas of policy and law related to HIV/AIDS. It takes a critical look at Canada's drug policy. Despite calls for a balanced approach focused on reducing drug-related harm, Canada's method of dealing with problems of illicit drug use has remained prohibitionist in nature, and by far the greatest part of federal funding is devoted to supply-reduction initiatives. Considerable changes in policy and law are needed to significantly reduce the harms associated with injection drug use in Canada. These include developing a comprehensive and integrated strategy, exploring alternative legal frameworks, piloting innovative approaches to reducing injection-related harms, and investing in broad social policies that address the determinants of injection drug use.

Canada↗
PubMedDate not supplied

Overweight and obesity mortality trends in Canada, 1985-2000.

OBJECTIVES: To investigate the temporal trends in the mortality burden attributed to overweight and obesity in Canada between 1985 and 2000. DESIGN: Overweight and obesity prevalence data from six cross-sectional national population surveys, including the 1985 and 1990 Health Promotion Surveys, 1994, 1996 and 1998 National Population Health Surveys, and 2000 Canadian Community Health Survey, in conjunction with one published prospective cohort study on overweight, obesity and mortality. PARTICIPANTS: Adults 20-64 years of age. MAIN OUTCOME MEASURE: The number of deaths attributable to overweight and obesity at the national and provincial levels. Attributable deaths were estimated using the Population Attributable Risk (PAR), which combined the prevalence data with the relative risks of mortality associated with overweight and obesity. A two-way sensitivity analysis was conducted by simultaneously varying the population prevalences and relative risk estimates by +/-10%. RESULTS: Between 1985 and 2000, the national PAR for overweight and obesity increased from 5.1% to 9.3%, and the annual number of deaths attributable to overweight and obesity increased from 2,514 (966-4,061) to 4,321 (2,114-6,542). Cumulatively, 57,181 (25,075-89,227) deaths were attributed to overweight and obesity between 1985 and 2000. Although overweight- and obesity-related mortality is increasing in every province, the problem is particularly pronounced in Eastern Canada. CONCLUSIONS: Overweight and obesity are important public health problems in Canada, accounting for approximately 57,000 deaths over the last 15 years. Immediate and sweeping public health campaigns and interventions are required to slow or reverse the recent trends.

Adult↗
PubMed2002

[Medicine and health in French Canada: a historiography (1987-2000)].

In 1987, historian Jacques Bernier estimated that despite the publication between 1876 and 1986 of a number of prominent papers, the history of medicine and health in French Canada was still in its infancy. Since then, this particular field of study has boomed. The present article examines published studies gathered according to the various themes which have been favored from 1987 to 2002 and concern the history of medicine and health in French Canada, so as to illustrate the gains of the past sixteen years. In our conclusion, we shall discuss the advancement of the history of medicine and health in French Canada in connection with the various elements suggested by historians Ludmilla Jordonova and Thomas Brown when considering the maturity of a given field of study. We shall identify a number of factors limiting its consolidation.

Canada↗
PubMed2004

Suicide in Canada's immigrant population.

OBJECTIVES: This article compares suicide in the immigrant and Canadian-born populations. DATA SOURCES: The suicide data are from the Canadian Vital Statistics Data Base and the World Health Statistics Annual of the World Health Organization. The socio-demographic information used to determine denominators for suicide rates in Canada comes from the Census of Population. ANALYTICAL TECHNIQUES: Age-standardized suicide rates by sex and place of residence were calculated for the immigrant and Canadian-born populations, as were age- and sex-specific suicide rates. Three-year average rates, centred on census years 1991 and 1996, were used. A weighted data set based on 8 of the top 10 countries of birth for immigrants to Canada was created for international comparisons. Differences between rates were tested for statistical significance. MAIN RESULTS: Suicide rates for the immigrant population were about half those for the Canadian-born. Among immigrants, suicide rates increase with age; among the Canadian-born, suicide is a "younger" phenomenon. Although male suicide rates exceeded female rates in both populations, the difference was less pronounced among immigrants. The pattern of suicide among immigrants was more like that in their countries of origin than that of the Canadian-born population. Immigrants living in Toronto, Montréal and Vancouver had lower suicide rates than immigrants in other parts of Canada.

Age Factors↗
PubMedDate not supplied

Health status of older Chinese in Canada: findings from the SF-36 health survey.

BACKGROUND: Despite the fact that the Chinese belong to the largest visible minority group in Canada, there is little research findings on their health status, particularly the aging adults. This research aimed at bridging the knowledge gap by examining the health status of this population and comparing the health status between the Chinese aging population and the general aging population in Canada. METHODS: Secondary data analysis of data obtained from a multi-site study, Health and Well Being of Older Chinese in Canada, and from the Medical Outcomes Study 36-item Short Form (SF-36). The SF-36 published scores obtained from the same age cohorts in the Canadian Multicentre Osteoporosis Study were used for comparison purposes. Independent samples t-tests were used to compare the statistical significance of the two groups. RESULTS: Overall, older Chinese-Canadians reported better physical health than all older adults in the Canadian population. However, the older Chinese in all age and gender groups scored lower in the mental component summary (MCS). Despite the age differences, Chinese women reported statistically poorer health than the Chinese men in all of the 8 health domains. CONCLUSION: The data are useful for forming baselines for monitoring the effectiveness of future health interventions for this population. Efforts by service providers to address the health needs of older Chinese-Canadian women, the most vulnerable subgroup in this study, are essential. Interventions are also needed to address the poor mental health status in this ethnic minority group.

Age Distribution↗
PubMed2004

Fibrinolytic therapy in acute myocardial infarction: time to treatment in Canada.

BACKGROUND: Fibrinolytic therapy has become the standard therapy for acute myocardial infarction with ST segment elevation. Many clinical trials have established that early administration of therapy correlates with improved outcomes. However, there are very few published data analyzing time to treatment in Canadian hospitals. OBJECTIVES: To examine all time intervals from onset of symptoms to treatment with fibrinolytic therapy in patients in Canada. METHODS: Using the FASTRAK II database, time intervals in 11,574 patients treated with fibrinolytic therapy in 106 contributing institutions across Canada from 1998 to 2000 were studied. Variables contributing to long delays in starting fibrinolytic therapy were analyzed. RESULTS: The mean time from onset of symptoms to arrival at hospital was 162 min (2.7 h). Only 6.3% of patients received fibrinolytic therapy within 1 h of symptom onset. Time from hospital arrival to acquisition of first 12 lead electrocardiogram was 14 min. Mean time from diagnostic electrocardiogram to decision to treat was 29.7 min, and time from decision to treat to administration of fibrinolytic therapy was 11 min. The overall average time from arrival at hospital to administration of fibrinolytic therapy was 69 min. CONCLUSION: In Canada, time from onset of symptoms to hospital presentation precludes early fibrinolytic therapy administration in the majority of cases. Time intervals from arrival in the emergency department to administration of fibrinolytic therapy are longer than the published and accepted standards. Strategies to alter health care seeking behaviour and to minimize in-hospital delays are needed.

Canada↗
PubMed1992

Legislation on alcohol detection in alcohol-related traffic accidents involving casualties in Japan and Canada.

A comparative study of the law concerning the arrest and conviction of alcohol-related casualty traffic accident was made between Japan and Canada. In Japan, the incidence of alcohol-related traffic accident has declined since 1970, but the number of fatal traffic accidents remains unchanged over the last 6 years, and amount to 9% of the total number of fatalities in traffic accidents. Hence, an effort is being made to reduce this number. According to the Road Traffic Act, a driver can be convicted for drunken driving if his or her blood alcohol level is above 0.5 mg/ml or above 0.25 mg/l in exhaled air, and if driver is judged as a drunken state by sobriety test. Unlike Canada, however, police officer cannot demand a blood sample from a suspected drunken driver. Instead, they must rely on the breath analysis and sobriety test. These tests are considered to be less accurate than blood test. These drawbacks are reflected in a number of court cases which are related to the relationship between alcohol concentration and the state of driving. In Canada, the operation of a motor vehicle with a blood alcohol level of over 0.8 mg/ml is a criminal offense punishable by fine or imprisonment or both, and results in the suspension of driving privileges for 6 months. Initially, a breath alcohol analysis is performed on everyone suspected of motor vehicle after consuming alcohol within the preceding two hours. Subsequently, with the suspect's consent, a police officer is allowed to request a blood sample for further analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed2004

Population rates of hospitalization for atrial fibrillation/flutter in Canada.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent sustained cardiac dysrhythmia and constitutes a major public health problem. AF significantly increases the risk of stroke, and anticoagulation has been shown to reduce this risk. However, Canadian data on the prevalence of AF and the use of warfarin in these patients are lacking. METHODS: International Classification of Diseases, ninth revision, codes for admissions to acute care hospitals in Canada were used to estimate the prevalence of hospitalization for AF between 1997/1998 and 1999/2000, and subsequent readmissions for stroke in all 10 provinces and overall in Canada. Warfarin use was obtained by linkage with drug benefit plans in Alberta, British Columbia, Nova Scotia and Ontario, for patients 65 years and older. RESULTS: The overall rate of hospitalization with AF between April 1, 1997, and March 31, 2000, was 582.7 per 100,000 population. The age- and sex-standardized rate rose from 513.4 to 555.3 during the three-year period of observation. The mean age was 74.4 years and 51.8% of patients were male. Of those discharged alive, 2.7% were readmitted for stroke within one year. Overall, less than one-half of the patients with AF filled a prescription for warfarin within 90 days of discharge, with only a small increase in warfarin use over the study time period. CONCLUSIONS: The rate of hospitalization with AF is increasing in Canada and is more frequent in men than in women across all age groups. Consistent with reports from other countries, warfarin use was lower than one might expect given its efficacy, with only a small increase in use over time.

Adult↗
PubMed1992

Rates of cardiac catheterization, coronary angioplasty and open-heart surgery in adults in Canada.

OBJECTIVE: To determine the rates of and waiting lists for cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA) and open-heart surgery in adults in Canada between Apr. 1, 1988, and Mar. 31, 1989. DESIGN: Mail survey. PARTICIPANTS: The directors of all 48 adult cardiac catheterization laboratories and the chiefs of all 33 adult cardiovascular surgery programs in Canada. MAIN RESULTS: A total of 61,116 cardiac catheterization procedures were performed, a rate of 236 per 100,000 population. The mean waiting times for elective procedures were weighted to reflect more accurately the differences between centres in the number of patients awaiting the procedures. The mean wait for elective cardiac catheterization was 8.5 weeks. There were 10,097 PTCA procedures done, a rate of 39 per 100,000 population. The mean wait for elective PTCA was 11.0 weeks, the longest wait occurring in Quebec (15.4 weeks). A total of 16,240 open-heart procedures were performed, a rate of 63 per 100,000 population. The mean wait for elective open-heart surgery was 22.6 weeks, the longest wait occurring in Quebec and British Columbia (more than 32 weeks). The rates for all three procedures were much lower in Canada than in the United States. CONCLUSIONS: The results suggest that the cumulative wait for coronary angiography and PTCA or open-heart surgery may lead to major losses of productivity, delayed rehabilitation and reduced probability of return to previous levels of productivity. Regular collection of data such as ours should help to understand better the resources required for these specialized cardiac procedures.

Adult↗
PubMedDate not supplied

Declining use of mastectomy for invasive breast cancer in Canada, 1981-2000.

OBJECTIVE: To evaluate the rate and magnitude of change in surgical practice for breast cancer in Canada in relation to publication dates of clinical trials and consensus conferences. METHODS: Hospital separations with a diagnosis of invasive breast cancer were extracted from the Hospital Morbidity File from 1981 to 2000. Age-standardized rates of in-patient procedures for breast-conserving surgery and mastectomy were analyzed by province and age group and by geographic region. RESULTS: In Canada, mastectomy rates decreased from 62.2 to 37.9 per 100,000 between 1981 and 2000; declines were largest between 1984 and 1985, following publication of the NSABP B-06 clinical trial in March 1985, and between 1991 and 1993, after the US NIH Consensus Conference in February 1991. Mastectomy rates plateaued between 1985 and 1991, and from 1993 to 2000; the transitory peak in 1988 corresponded to publicity surrounding Nancy Reagan's choice of mastectomy in 1987. Regional variations from the main pattern led to increasingly divergent mastectomy rates over time. Women aged 80+ were less likely to be treated by any surgery. INTERPRETATION: Publication of clinical trial results and consensus conferences were associated with changes in surgical treatment for breast cancer in Canada. However, divergent mastectomy rates among Canadian regions point to inconsistent adoption of less invasive therapy despite a publicly-funded health care system and national consensus guidelines.

Adult↗
PubMed2004

The role of knowledge translation for cancer control in Canada.

The definition and scope of cancer control has been evolving since its inception. The most recent model of cancer control in Canada has acknowledged the importance of knowledge translation to ensure that research results are implemented in practice and will be used to inform policy. However, without effort, the process of translation does not happen on a consistent basis. Knowledge translation focusses on improving the adoption of an innovation, e.g., research results. A number of health organizations in Canada have identified knowledge translation as an important activity and have begun to develop departments or initiatives dedicated to its achievement. As the emphasis in cancer control is on the application of knowledge, knowledge translation has a role to play in attaining the objectives of cancer control in Canada. It is an ideal time for the Canadian Strategy for Cancer Control and other Canadian cancer control initiatives to determine where they will locate knowledge translation in relation to their objectives.

Biomedical Research↗
PubMed2004

The occurrence of abruptio placentae in Canada: 1990 to 1997.

Abruptio placentae is a serious obstetric condition associated with an increased incidence of perinatal mortality and morbidity. Despite this, there is little information on the occurrence of abruptio placentae in Canada. The Discharge Abstract Database from the Canadian Institute for Health Information was used to identify a cohort of women who had singleton live or stillbirth deliveries in Canada between 1990 and 1997 (n = 2,162,815). Rates of abruptio placentae and abruptio placentae ending in stillbirth were examined by calendar year, province, maternal age and urban/rural status. There is a trend towards an increasing rate of abruptio placentae by year, from 10.9 (95 % confidence interval [CI] 10.5-11.3) cases/1000 deliveries in 1990 to a high of 12.1 (95% CI 11.6-12.5) cases/1000 deliveries in 1996, while the rate ending in stillbirth remained relatively constant. The abruptio placentae rate was highest in mothers over 40 years of age and the case-fatality rate highest in those under 20. These results provide a baseline reference for rates of abruptio placentae in Canada.

Abruptio Placentae↗
PubMed2004

The practice of thoracic surgery in Canada.

The objective of the consensus conference of the Canadian Association of Thoracic Surgeons (CATS) was to define the scope of thoracic surgery practice in Canada, to develop standards of practice, to define training and resource requirements for the practice of thoracic surgery in Canada and to determine appropriate waiting times for thoracic surgery care. A meeting of the CATS membership was held in September 2001 to address issues facing thoracic surgeons practising in Canada. The discussion was facilitated by an expert panel of surgeons and supplemented by a survey. At the end of the meeting, consensus was reached by the membership regarding the issues outline above. The membership agreed that the scope of practice includes diagnosis and management of conditions of the lungs, mediastinum, pleura and foregut. They agreed that appropriate training in thoracic surgery included completion and certification in general or cardiac surgery prior to completing a 2-year program in thoracic surgery. The membership supported the Canadian Society of Surgical Oncology recommendations for management of cancer patients that new patients should be seen within 2 weeks of referral and cancer therapy initiated within 2 weeks of consultation. Thoracic surgical care is best delivered by 2 or 3 fully certified thoracic surgeons, in regional centres linked to a cancer centre and trauma unit. The establishment of a critical mass of thoracic surgeons in each centre would lead to improved quality and delivery of care and allow for adequate coverage for on-call and continuing medical education.

Canada↗
PubMedDate not supplied

Regulatory and compliance activities to protect food-allergic consumers in Canada: research in support of standard setting and consumer protection.

An overview is presented of the activities of Health Canada and the Canadian Food Inspection Agency (CFIA) in the area of food allergens. Since the 1990s, changes were made in the Food and Drug Regulations in order to better protect allergic consumers by imposing labeling requirements to clearly identify sources of priority food allergens in prepackaged foods. Policies of application as well as risk management strategies are discussed with some statistics on allergen-related food recalls in Canada for the years 1997--2001. Health Canada's allergen method development program is a pioneering research initiative that was developed in the early 1990s in support of the changing Canadian regulatory environment. The objectives and some of the accomplishments of this program are presented. The development of the Canadian Compendium of Allergen Methodologies under a Web-based application to compile data on evaluated allergen detection methods will provide further support to compliance activities nationally, as well as to the international analytical community in both government and the food industry. Some emerging techniques for the confirmation of results generated by enzyme-linked immunosorbent assays are also discussed.

Allergens↗
PubMed2005

Acute treatment of myocardial infarction in Canada 1999-2002.

BACKGROUND: Therapy for management of acute myocardial infarction (AMI) varies according to patient, prescriber and geographical characteristics. OBJECTIVES: To describe the in-hospital use of reperfusion therapy for ST elevation MI (STEMI) and discharge use of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs) and statins in patients presenting with either STEMI or non-STEMI in Canada from 1999 to 2002. METHODS: Four Canadian registries (FASTRAK II, Canadian Acute Coronary Syndromes, Enhanced Feedback for Effective Cardiac Treatment and Improving Cardiovascular Outcomes in Nova Scotia) were used to identify patients with AMI in Canada and to measure in-hospital reperfusion and medication use. Use rates were compared by age, sex, time period and geographical area, according to available data. RESULTS: Use rates for reperfusion in STEMI patients ranged from 60% to 70%, primarily representing fibrinolytic therapy. A delay in presentation to hospital after symptom onset represented an impediment to timely therapy, which was particularly pronounced for women and elderly patients. Overall, less than 50% of patients met the door-to-needle target of less than 30 min. Medication use rates at discharge increased from 1999/2000 to 2000/2001 across the different data sources: acetylsalicylic acid, 83% to 88%; beta-blockers, 74% to 89%; ACEIs, 54% to 67%; statins, 41% to 53%; and calcium antagonists, 21% to 32%. CONCLUSIONS: Canadian and provincial rates of use of evidence-based medications for the treatment of AMI have increased over time, although there remains room for improvement. A single, comprehensive data source would supply better insights into the management of AMI in Canada.

Adrenergic beta-Antagonists↗
PubMed2005

Community factors, hospital characteristics and inter-regional outcome variations following acute myocardial infarction in Canada.

BACKGROUND: While various community and hospital characteristics have been demonstrated to have an impact on individual cardiovascular outcomes, the extent to which such factors account for inter-regional and interhospital outcome variations following acute myocardial infarction (AMI) remains unknown. OBJECTIVES: To examine the impact of community and hospital factors on individual AMI outcomes and procedure use, and to determine the extent to which such characteristics account for inter-regional and interinstitutional AMI outcome and procedure variations across Canada. METHODS: Patients hospitalized with AMI between April 1, 1997, and March 31, 2000, across Canada were examined. The community and hospital characteristics studied included three indicators of socioeconomic status, two indicators of ethnicity, rural-urban status of residence, hospital academic affiliation, and the presence or absence of on-site angiography or revascularization capabilities at the admitting institution. Outcomes included in-hospital mortality, one-year cardiac readmissions and 30-day revascularization rates post-AMI. All analyses were adjusted for age, sex and age-sex interaction. The relationships between community/hospital factors and individual outcomes were examined using random-effects hierarchical logistic regression analysis, while the relationships between community/hospital characteristics and inter-regional/hospital risk-adjusted outcomes were examined using least squares regression and the coefficient of determination (r2). RESULTS: After adjusting for demographic factors, a patient's neighbourhood socioeconomic status was inversely correlated with the likelihood of death and downstream cardiac readmissions (P<0.001); patients residing in lower educated regions were less likely to receive revascularization post-AMI (P<0.001). Patients living in regions with higher concentrations of new immigrants and/or visible minorities, as well as those admitted to academically affiliated hospitals or hospitals with on-site procedural capacity, had fewer cardiac readmissions (P<0.001) and greater use of revascularization post-AMI (P<0.001) after adjusting for age and sex. Despite their associations with outcomes on an individual patient level, community and hospital factors explained no more than 7% of the variation in the risk-adjusted outcomes across hospitals or regions. Finally, adjustments for community and hospital factors and procedure use, beyond adjustments for age and sex alone, had marginal impact on a province's risk-adjusted outcomes. CONCLUSIONS: While community and hospital factors are important determinants of individual outcomes after AMI, they account for only a minimal degree of outcome variation across regions. Further studies are required to examine whether AMI outcome variations in Canada are explained by differences in patient clinical profiles and/or by differences in the decision-making behaviours of providers across jurisdictions.

Adult↗
PubMed2004

Steps forward, backward, and sideways: Canada's bill on exporting generic pharmaceuticals.

In May 2004 Canada's Parliament passed Bill C-9, amending the Patent Act to provide for the compulsory licensing of patented pharmaceutical products. The bill allows generic manufacturers to make cheaper, generic versions of patented products and export them to countries that do not have sufficient capacity to produce their own. Canada thus became the first country to pass legislation implementing a World Trade Organization (WTO) Decision that relaxed WTO rules on pharmaceutical patents. Civil society organizations campaigned to enhance the bill before it passed, and succeeded in obtaining significant improvements. However, the final bill is marred by flaws that mean it falls short of being a "model" that should simply be replicated elsewhere. This article is the second in a series tracing the evolution of Canada's legislation. It reviews the developments leading up to the adoption of Bill C-9 in its final form, and analyzes its positive and negative aspects. Hopefully, other advocates can learn from this experience and other countries can avoid replicating the negative aspects as they implement the WTO Decision.

Canada↗