Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CANADA”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 649 records · Page 36Linked to original sources

A perspective on forage production in Canada.

Over the past decade, the cattle industry has experienced practically a full circle. With the promising beef prices in the early 1970s, with the glut of grain and a generous assist from government incentive programs, the forage acreage and cattle population have increased at a record rate. By 1974, the tide began to turn - grain prices went up sharply and beef prices became sluggish - and by 1976 a major crisis faced the producers. The cattle industry which had been developing on a cheap grain economy was now obliged to rely more on forage for its survival. Unfortunately, the forage was not existent and the only salvation of the industry was the gift of Providence - weather patterns that provided ample moisture conditions and above normal forage crops, the utilization of cereals and the intervention of government cow-calf support programs. Over the past year, the cycle was completed and record beef prices again prevail. The barley bins are full again and the cattlemen are gearing up for a few fat years. Demands for forage seed are brisk and the seeding down of forage acreage is bound to increase substantially over the next few years. And with this increase, cattle population expansion is bound to follow: how much expansion can the economy support? The production cost factors will determine the extent, but one can almost be certain that any expansion will either be modest or of short duration. At least, it should be. If the cattle industry is to establish solid foundations, it cannot be dependent upon the instability of a grain surplus-shortage position. With the present resources and the potential for developing it in direct competition with other crops, one can only expect a small and steady expansion over a long time span. One must agree with the range researchers and specialists of the Canada Research Stations at Lethbridge and Swift Current that pasture and range will continue to be the limiting factors of cattle expansion as they have been for the past 50 years. It is interesting to note that in the Prairie Provinces at least, the number of livestock raised each year has not changed since 1930 although cattle have largely replaced the horses. It is easy to speculate on paper that Canada can double in the next 20 years its forage and cattle production on its large expanses of land on the fringes of the agriculturally settled areas. It is true that these lands, while marginal for cash crops, could produce excellent forage. But at what cost? And what kind of pasture could we grow on them?It is easy to speculate that our livestock geneticists can breed a ruminant-type animal that will feed on poplar saplings and poplar leaves, or develop a new breed of cattle with buffalo vigor that will thrive in the extreme north. But looking at the musk-ox experience in the Northwest Territories and the history of the Wood Buffalo National Park leaves little room for optimism. The present generation is not likely to see in its lifetime the cattle population go beyond the 20 million mark. We can look, however, with good assurance on the present cattle numbers remaining stable and can look forward to gradual increase brought about by normal improvement in both forage and cattle management.Hopefully, both the cattle producer and the veterinarian will be able to reap the benefits of this most important segment of Canada's agricultural industry.

Animal Feed↗

Role of the general practitioner in the delivery of surgical and anesthesia services in rural western Canada.

OBJECTIVE: To determine the present role of general practitioners (GPs) in the delivery of surgical and anesthesia services in rural western Canada. DESIGN: Survey by mailed questionnaire in November 1993, with telephone follow-up of nonresponders. SETTING: Rural British Columbia, Alberta, the Yukon Territory and the Northwest Territories. PARTICIPANTS: Administrators of 148 rural hospitals; of the 121 who completed it 101 represented hospitals that met the inclusion criteria (fewer than 51 beds and serving a population of 15,000 or less). OUTCOME MEASURES: Hospital characteristics, type of practitioners providing surgical and anesthesia services, length and location of GPs', surgical and anesthesia training, types of surgical procedures performed by GPs and opinions of administrators regarding the delivery of surgical services in their community. RESULTS: Surgical services were provided by 56 (55%) of the 101 hospitals; at 45 (80%) they were provided by GPs, and at 33 (59%) they were provided by GPs with limited additional surgical training. Fifteen (27%) of the 56 hospitals were said to rely solely on GPs with limited surgical training for surgical services. At 45 (80%) of the 56 hospitals anesthesia services were provided by GPs, all of whom had limited additional training in anesthesia; 36 (64%) were said to rely solely on GPs for anesthesia services. Just over three quarters (76% [74/98]) of the administrators felt that their community's surgical needs were well met. CONCLUSION: GPs with limited specialty training continue to play a role in providing surgical and anesthesia services in rural western Canada. This has implications for postgraduate training programs in Canada.

Alberta↗

Surgical care in rural Canada: training and planning for the future.

The survey results reported by Chiasson and Roy in this issue (see pages 1447 to 1452) document a growing problem with the provision of surgical services in rural western Canada. Recognizing the need to improve access to surgical services in rural communities, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada have proposed guidelines for training family physicians in resuscitative and surgical techniques as well as in the safe transfer of seriously ill patients to specialized facilities. It is hoped that these guidelines will provide the basis of a national policy for general-practice training that will improve the standard of surgical care in rural communities.

Canada↗

Hemophilia and von Willebrand's disease: 2. Management. Association of Hemophilia Clinic Directors of Canada.

OBJECTIVE: To present current strategies for the treatment of hemophilia and von Willebrand's disease. OPTIONS: Prophylactic and corrective therapy with hemostatic and adjunctive agents: DDAVP (1-desamino-8-D-arginine vasopressin [desmopressin acetate]), recombinant coagulation products (human Factor VIII and human Factor VIIa) or virally inactivated plasma-derived products (high- or ultra-high-purity human Factor VIII or human Factor VIII concentrate containing von Willebrand factor activity, porcine Factor VIII, high-purity human Factor IX, human prothrombin-complex concentrate, human activated prothrombin-complex concentrate), adjunctive antifibrinolytic agents, topical thrombin and fibrin sealant. The induction of immune tolerance in patients in whom inhibitors develop should also be considered. OUTCOMES: Morbidity and quality of life associated with bleeding and treatment. EVIDENCE: Relevant clinical studies and reports published from 1974 to 1994 were examined. A search was conducted of our reprint files, MEDLINE, citations in the articles reviewed and references provided by colleagues. In the MEDLINE search the following terms were used singly or in combination: "hemophilia," "von Willebrand's disease," "Factor VIII," "Factor IX," "von Willebrand factor," "diagnosis," "management," "home care," "comprehensive care," "inhibitor," "AIDS," "hepatitis," "life expectancy," "complications," "practice guidelines," "consensus statement" and "controlled trial." The in-depth review included only articles written in English from North America and Europe that were relevant to human disease and pertinent to a predetermined outline. The availability of treatment products in Canada was also considered. VALUES: Minimizing morbidity and maximizing functional status and quality of life were given a high value. BENEFITS, HARMS AND COSTS: Proper prophylactic or early treatment with appropriate hemostatic agents minimizes morbidity and functional disability and improves quality of life. Economic gains are realized through the reduction of mortality and morbidity and their associated costs. The patient has a better opportunity to contribute to society through gainful employment and the fulfillment of social roles. Potential harms include HIV infection, hepatitis B, hepatitis C and the development of inhibitor antibodies to clotting-factor concentrates. The risk of viral transmission has been minimized through the development of procedures for the viral inactivation of plasma-derived clotting-factor concentrates and through the use of recombinant coagulation-factor concentrates and other non-plasma-derived hemostatic agents. RECOMMENDATIONS: DDAVP is the drug of choice for patients with mild hemophilia or type 1 or 2 (except 2B) von Willebrand's disease whose response to DDAVP in previous testing has been found to be adequate. Therapeutic blood components of choice include recombinant products and virally inactivated plasma-derived products. In Canada the recommended products are recombinant Factor VIII for hemophilia A, high-purity plasma-derived Factor IX for hemophilia B and plasma-derived Factor VIII concentrates containing adequate von Willebrand factor (e.g., Haemate P) for von Willebrand's disease. Dosages vary according to specific indications. Adjunctive antifibrinolytic agents, topical thrombin and fibrin sealant are useful for the treatment of oral or dental bleeds and localized bleeds in accessible sites. In patients with inhibitor antibodies, high-dose human or porcine Factor VIII is usually effective when the inhibitor titre is less than 5 Bethesda units/mL. In nonresponsive patients, or in those whose inhibitor titre is higher, "bypassing" agents (e.g., activated prothrombin-complex concentrate and recombinant Factor VIIa) are useful. Long-term management may include immune-tolerance induction. VALIDATION: These recommendations were reviewed and approved by the Association of Hemophilia Clinic Directors of Canada (AHCDC) and the Medical and Scientific Advisory Committee of the Canadian Hemophilia Society. No similar consensus statements or practice guidelines are available for comparison. SPONSORS: These recommendations were developed at the request of the Canadian Blood Agency, which funds the provision of all coagulation-factor concentrates for people with congenital bleeding disorders, and were developed and endorsed by the AHCDC and the Medical and Scientific Advisory Committee of the Canadian Hemophilia Society.

Antifibrinolytic Agents↗

The development of national vital statistics in Canada: Part 1--From 1605 to 1945.

This article describes the key events in the development of the national vital statistics system in Canada. Particular emphasis is placed on the role played by Statistics Canada, known as the Dominion Bureau of Statistics from 1918 to 1971. There were many obstacles to uniform national compilations, including differences in provincial legislation, the incomplete registration of vital events, a lack of uniform standards in classification and methods of presentation, the omission of important data, the use of fiscal instead of calendar years, and periodic breaks in the annual publications prepared by the provinces and territories. To overcome these obstacles, collaboration among federal and provincial/territorial governments was necessary. This two-part article chronicles the evolution of this collaboration, which led to the production of national vital statistics in Canada. Part 1 covers the years 1605 to 1945, from the time explorers, the Catholic Church and census takers first recorded details about the European population in New France, to the establishment of a system of national vital statistics. It ends by noting the important role national vital statistics played in launching Family Allowances in 1945. Part 2, scheduled to appear in a future issue of Health Reports, will cover the years 1945 to the present. It will focus on the creation of the National Vital Statistics Index, the Vital Statistics Council, computerization, record linkage, and occupational and environmental health statistics.

Canada↗

The history of vascular surgery in Canada.

The clinical specialty of vascular surgery in Canada began before the Second World War with the introduction of heparin into clinical practice by Gordon Murray of Toronto. He showed that heparin could prevent thrombosis during the repair of blood vessels and was useful in the treatment of spontaneous arterial and venous occlusion. The unfavourable war experience with arterial ligation for trauma led to an interest in the direct repair of vascular injuries by surgeons returning to civilian practice. Embolectomy, first performed in the late 1940s, was the other early vascular operation. Aortic surgery initially depended upon the use of cadaver homografts, and a number of programs were started in the early 1950s, only to be abandoned as synthetic grafts became available. Infrainguinal bypass grafting with saphenous vein evolved in clinics set up to treat varicose veins and varicose ulcers. The first in-situ grafts were done by Paul Cartier of Montreal in 1960. By this time, reconstruction for aneurysmal and occlusive disease was well established throughout Canada. Specific fellowships in vascular surgery were first offered in the 1970s, as clinical units were set up in teaching hospitals. Surgeons concentrating on vascular disease founded the Canadian Society for Vascular Surgery (CSVS) in 1978 and approached the Royal College of Physicians and Surgeons of Canada to establish training requirements in their specialty. The first qualifying examination was held in 1983, and by 1994 certificates of special competence had been awarded to 178 candidates. The pioneers in Canadian vascular surgery are acknowledged and their contributions summarized.

Canada↗

The changing epidemiology of invasive meningococcal disease in Canada, 1985 through 1992. Emergence of a virulent clone of Neisseria meningitidis.

OBJECTIVE: To describe the occurrence of invasive meningococcal disease (IMD) in Canada with respect to demographic variables and characteristics of the isolated strains of Neisseria meningitidis. DESIGN: National surveillance case series. SETTING: Canada, 1985 through 1992. OUTCOME MEASURES: Morbidity and mortality. MAIN RESULTS: The incidence of IMD averaged 1.38 per 100,000 person-years, with considerable regional variation. In 1988, serogroup C organisms became more common, with one strain of the electrophoretic type 37 (ET-37) complex of N meningitidis, termed ET-15, the predominant group C strain identified. With the increase in group C disease, a greater proportion of cases were older than 5 years. By 1991, ET-15 was the most common strain identified in most parts of the country. Electrophoretic type 15 had a case fatality of 17.8% vs 8.1% for all other IMD (P < .001). Among cases 20 years and older the case fatality for ET-15 was 22.4%. CONCLUSIONS: The group C, ET-15 strain of N meningitidis, first identified in Canada, was more virulent than other prevalent strains during this period. Active surveillance, rapid identification, and typing of N meningitidis will assist public health decision making in the control of emerging strains.

Adolescent↗

Surveillance for stroke in Canada.

The goal of surveillance is to identify patterns of disease occurrence, detect disease outbreaks, develop clues about possible risk factors, find persons that need further investigation, and anticipate health service needs. Two sources of data are available for the purposes of surveillance: primary data, such as those arising from health surveys or local population-based registries; and secondary data, arising from large administrative databases. The effectiveness of any program to monitor the health of a community can be judged by the application of three "r's": right (accuracy), reasonable (cost) and rapid (speed). Programs using primary sources of data satisfy only one of the three "r's," that of accuracy. Programs using secondary sources sacrifice accuracy for speed and cost. The challenge for Canada in setting up surveillance for stroke is that there is a relatively small population unevenly distributed over a very large geographical area. To date, surveillance in Canada has consisted of a combination of individually initiated research projects and government sponsored programs. The main focus has been to tackle the issue of the accuracy of the large databases by validating the discharge codes listed in the provincial hospital discharge databases. Three provinces have carried out independent validation studies yielding remarkably similar results, and this lends confidence that hospital discharge databases will provide a means of carrying out surveillance for at least this one aspect of stroke. It is likely that any program for stroke surveillance in Canada will be multifaceted, involving the use of large computerized databases supplemented by hospital-based registries set up in a few highly motivated local centres. Stroke surveillance will best be accomplished by a joint effort between government and researchers to ensure that the end product is of high quality and will meet the needs of improving the health of Canadians.

Aged↗

Net economic costs of dementia in Canada.

OBJECTIVE: To estimate the net economic costs of dementia in Canada in 1991 by comparing costs related to elderly patients with dementia with those related to elderly people without dementia. DESIGN: Cost-of-illness study. DATA SOURCES: Most of the data analysed in this study were from the Canadian Study of Health and Aging (CSHA), in which 10,263 Canadians aged 65 years and over were randomly selected, surveyed and, when appropriate, given clinical examinations. Data on patients with dementia and on people without cognitive impairment (control subjects) were used for this analysis. Data on activities of daily living (ADLs) were taken from a separate study under the CSHA, in which the principal caregivers of the subjects in the prevalence study were interviewed. SETTING: Community and institutional settings in Canada, excluding those in the territories. PATIENTS: All patients with dementia 65 years and older as determined from the CSHA. Patients with dementia under 65 were also considered. OUTCOME MEASURES: Costs of paid and unpaid services in the community, care in long-term care institutions, drugs, hospitalization, diagnosis and research. RESULTS: The total annual net cost of dementia was estimated to be over $3.9 billion. Costs associated with elderly patients in the community were estimated to be $1.25 billion ($615 million for paid services, $636 million for unpaid services), whereas costs for patients in long-term care institutions were $2.18 billion. Costs were about $74 million for drugs, hospitalization and diagnosis, $10 million for research and $389 million related to patients under age 65. CONCLUSION: The annual net economic cost of dementia in Canada is at least $3.9 billion. The most significant component of the total cost was for care in long-term care institutions and for assistance with ADLs by professionals, family and friends in the community. The economic burden of dementia is significant not only for patients, their families and friends, but also for society.

Aged↗

Suicide and homicide rates in Canada and the United States.

Suicide and homicide rates by age were analyzed for Canada and the United States, indicating that suicide is higher in Canada and that homicide is higher in the United States. Results indicated a positive association between homicide and suicide rates in the United States but these two rates of death were not significantly associated in Canada. Holinger (1987) had associated the relative size of the cohort to the rates of suicide and homicide in young people in the United States. The more current data in both countries did not support Holinger's results. Using the measure devised by Easterlin (1980) and Ahlburg and Schapiro (1984)-that is, the proportion of youths aged 15-24 relative to adults aged 25-64-the correlation between the size of the youth cohort and the suicide rate of youths aged 15-24 was negative. It is concluded that the two patterns in these two countries may be explained from a historical perspective.

Adolescent↗

Trends in rates of admission to hospital and death from asthma among children and young adults in Canada during the 1980s.

OBJECTIVE: To update reports of increases in the rates of admission to hospital and death from asthma among children and young adults in Canada during the 1970s by examining data for the 1980s. DESIGN: Age-standardized rates were calculated from data for people less than 35 years of age at the time of death from asthma, bronchitis or other respiratory conditions (from 1980 through 1989) and at the time of admission to hospital for treatment of these diseases (from 1980 through 1988). Standardized mortality ratios were calculated with the death rate for Canada as the expected rate. SETTING: Data for all of Canada were examined by sex, age group and province. RESULTS: In contrast to sharp increases in the rate of death from asthma observed from 1970 through the early 1980s among Canadians less than 35 years of age, the rate showed no net change between 1980 and 1989; on average, there were 58 deaths in this age group annually. During the decade, the rates of death from asthma were three times higher in Saskatchewan and Alberta than in Newfoundland. The national rate of hospital admission/separation for asthma, however, increased greatly, though changes in the rate varied by province. Increases of over 90% were observed in Prince Edward Island and New Brunswick, whereas little overall change occurred in Newfoundland, Manitoba and Saskatchewan. The rate of hospital admission/separation for asthma was highest in Prince Edward Island and lowest in Manitoba and British Columbia. Although the rates of hospital admission/separation for asthma among boys aged less than 15 years of age were consistently 50% higher than those among girls of that age, the rate among people aged 15 through 34 years was twice as high among females as males. A slight decrease in the rates of death from respiratory conditions other than asthma was observed, together with a steady, fairly substantial decline in the rates of hospital admission/separation for these conditions. CONCLUSIONS: Whether there is any relation between increases in rates of admission to hospital for asthma and trends in the rates of death from asthma during the decade will require further study.

Adolescent↗

Academic family medicine in Canada.

Fifty years ago family practice in Canada had no academic presence. Stimulated by a number of general practitioners and with the support of the Canadian Medical Association, the College of General Practitioners of Canada (CGPC) was founded in 1954. In 1962, conferences on education for general practice attended by the Association of Canadian Medical Colleges and the CGPC led to pilot postgraduate residencies in family practice supported by Department of National Health and Welfare. The first certification examination was held in 1969 and, by 1974, all Canadian medical schools had a family medicine residency program. Today departments of family medicine contribute substantially to undergraduate education in all 16 schools. In Canada, the medical profession, governments and the medical schools have demonstrated the importance they place on appropriate education for family physicians.

Canada↗

The epidemiology of HIV and AIDS in Canada: current perspectives and future needs.

There is little doubt the HIV epidemic is of enormous public health importance for Canadians. Currently, it is estimated that between one and two in 1,000 adult Canadians are infected with HIV. Compared to other industrialized countries, Canada is a country of intermediate incidence. Much effort has gone into developing and maintaining the AIDS surveillance system as well as carrying out HIV seroprevalence studies in selected populations. In spite of under-reporting of AIDS cases (estimated to be 12-25%), the available data provide a general picture of the HIV epidemic in Canada. Nevertheless, a number of questions remain unanswered, and we need more information to plan preventive interventions and provide services to persons who are already infected. In this article, we present a brief overview of the epidemiology of AIDS and HIV in Canada. We identify some disturbing trends in the epidemic and reiterate the need for more information to improve our preventive efforts and help set research priorities to help plan future studies.

Acquired Immunodeficiency Syndrome↗

HIV/AIDS in the context of culture: selection of ethnocultural communities for study in Canada.

This article reports on the methodology used to select six ethnocultural communities invited to participate in subsequent phases of the project on HIV/AIDS in the context of culture in Canada. Selection was based on quantitative data on demography, qualitative assessment of ethnocultural cohesion; and quantitative data and qualitative data of exposure to risk for sexually transmitted disease. A principle of partnership insured that the final selection was completed by interaction between the investigators and the National Advisory Committee representing ethnocultural communities in Canada. The six communities asked to participate in Phase II of the study were: in Montreal, the Latin American and the Arabic-speaking communities; in Toronto, the English-speaking Caribbean communities and communities from the Horn of Africa; in Vancouver, the Chinese and the South Asian communities. The results are significant for the future both of research on ethnicity in Canada and of control of HIV and AIDS.

Acquired Immunodeficiency Syndrome↗

Medical workforce policy making in Canada: are we creating more problems for the future?

The current approach to the management of physician resources in Canada needs to be re-examined by all concerned. Canada is about to enter a phase of accelerating depletion of physicians as the result of two separate and evolving circumstances. Because of the unusually large number of physicians who graduated from Canadian medical schools in the late 1960s and early 1970s, a significantly larger than usual number of practising physicians will reach their normal retirement age in the decade ahead. In addition, if the recent surge in the emigration of Canadian physicians continues, the loss of so many physicians will exaggerate the impact of the expected increase in retirements. Therefore, the decision to cut medical school class sizes in the 1990s would have been more suitable in the early 1980s. Existing physician work force policies may be leading to unexpected or undeclared consequences for health care across Canada. On the basis of current trends, the author concludes that policy makers now should reconsider current physician workforce policies in anticipation of a possible shortfall of physicians beginning in the early decades of the next century.

Canada↗

Surgical rates in subprovincial areas across Canada: rankings of 39 procedures in order of variation.

OBJECTIVE: To rank 39 surgical procedures in order of variation of inpatient surgical rates, according to a new index of variation and to test the hypothesis that there is greater variation for primarily discretionary operations than for primarily non-discretionary operations. DESIGN: A population-based retrospective cohort study. SETTING: Nine provinces (99.19% of Canada's population). PARTICIPANTS: All hospital inpatients who underwent any of 39 types of surgery and were separated from hospital between Apr. 1, 1988 and Mar. 31, 1990 (the most recent time period for which Canada-wide data were available at the subprovincial level analysed). MAIN OUTCOME MEASURE: Rankings of the 39 procedures according to the index of variation, calculated from inpatient surgery rates in 255 census divisions across Canada. RESULTS: The 13 procedures with the greatest variation were all primarily discretionary. Thirteen of the 14 procedures with the lowest variation were primarily non-discretionary. All but one of the procedures whose degree of discretion was deemed intermediate were in the middle third of the rankings. CONCLUSIONS: The greatest variation is found in primarily discretionary operations. Further investigation should be focused on identified geographical locations where rates for operations that are primarily discretionary are unusually high or low, and particularly on those operations for which there is disagreement regarding the indications for surgery.

Canada↗

Is Canada's sex ratio in decline?

In this issue (see pages 37 to 41) Dr. Bruce B. Allan and associates report a small but statistically significant decrease--of about 0.2%--in the proportion of male live births in Canada over the period 1970-90. In this editorial, factors that have been reported in the literature to influence sex ratio are examined within a Canadian context. The authors suggest that although the reasons for the apparent decline in the sex ratio in Canada are unclear, the increasing use of ovulation induction may be a contributing factor. Data from the Nova Scotia Atlee Perinatal Database are discussed with a view to explaining the trend observed in Atlantic Canada, but no obvious explanation emerges. The authors argue that when the period of observation is extended no overall change in the sex ratio is apparent. This would suggest a tendency toward stabilization rather than decline.

Abortion, Spontaneous↗

The effect of tobacco tax cuts on cigarette smoking in Canada.

OBJECTIVE: To assess the effect of the tobacco tax cuts made in 1994 on the smoking habits of Canadians. DESIGN: Population-based retrospective cohort study. DATA: Data from the Survey on Smoking in Canada conducted by Statistics Canada on 11,119 respondents 15 years of age and older, who were interviewed about their smoking habits on 4 occasions, approximately every 3 months from January 1994 to February 1995. OUTCOME MEASURES: Changes in smoking prevalence, incidence, quit rates and mean number of cigarettes smoked per day in the provinces where tobacco taxes were cut and in those where taxes were not cut. RESULTS: During the survey, smoking prevalence decreased in all provinces, whether or not cigarette taxes had been cut. However, the prevalence of smoking was greater in the provinces where tobacco taxes had been cut than in those where they had not, and this difference increased from 2.0% at the beginning of the survey to 3.4% by the end (p < 0.001). In addition, rates of starting cigarette smoking were higher and smoking quit rates were lower in the provinces where taxes had been cut than in those where taxes had not been cut. CONCLUSION: Although smoking rates are declining in Canada, tobacco tax cuts appear to have slowed the rate of decline by inducing more nonsmokers to take up smoking and leading fewer smokers to quit.

Adolescent↗