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PubMed1997

Patterns of geographic mobility of persons with AIDS in Canada from time of AIDS index diagnosis to death.

OBJECTIVE: To characterize migration patterns of persons with AIDS in Canada during the period from AIDS diagnosis to death. DESIGN: Descriptive, population-based study. SETTING: Canada. PATIENTS: Canada's AIDS Case Reporting Surveillance System (ACRSS) was linked to deaths in the Canadian Mortality Data Base (CMDB). Probabilistic linkage was based on initials, date of birth, date of death, birthplace, and location at diagnosis and at death. Analysis was restricted to AIDS cases reported from Jan. 1, 1982, to Sept. 30, 1994, and to deaths reported from Jan. 1, 1982, to Dec. 31, 1992. MAIN OUTCOME MEASURES: Change in usual place of residence; migration rates by region and community size. RESULTS: A total of 5755 AIDS cases recorded in the ACRSS were linked to deaths in the CMDB. Of these linked cases, 5366 (93%) included information on province or territory of usual residence or community size. A total of 160 (3.0%) persons with AIDS changed their province or territory of residence between the time of their AIDS diagnosis and death. Multivariate analysis indicated that those who changed residences between AIDS index diagnosis and death were more likely than other persons with AIDS to live in provinces other than British Columbia, Ontario and Quebec (p < 0.001), to be diagnosed earlier (p = 0.004), to be younger (p < 0.001) and to be gay or bisexual (p = 0.042). CONCLUSIONS: Our analysis revealed that only a small proportion of persons changed their residence between AIDS diagnosis and death. Geographic mobility was the greatest among persons with AIDS residing outside of the regions where the overwhelming majority of persons with AIDS in this country reside.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Cost-effectiveness of simvastatin in the secondary prevention of coronary artery disease in Canada.

OBJECTIVE: To determine the cost-effectiveness of simvastatin in the secondary prevention of coronary artery disease (CAD) in Canada. DESIGN: Cost-effectiveness model based on results from the Scandinavian Simvastatin Survival Study (45 study) and cost and resource utilization data from Canadian sources to simulate the economic impact of long-term simvastatin treatment (15 years). PATIENTS: Subjects with mean age of 59.4 years at recruitment into 4S study. OUTCOME MEASURES: Overall death rate and incidence of 5 major nonfatal events associated with CAD: myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, stroke and transient ischemic attack. Direct medical costs associated with CAD were assessed from the perspective of provincial ministries of health (i.e., costs borne by the ministries); the impact of simvastatin treatment on these costs was determined. RESULTS: The 4S study, with a median follow-up of 5.4 years, showed significantly reduced mortality and morbidity among the patients given simvastatin compared with the control subjects. Three premises were designed to predict the consequences of simvastatin treatment of CAD in Canada over 15 years, 10 years beyond the end of the 4S study. The 2 most probable premises, which assumed that the clinical benefits of simvastatin would be cumulative for either the first 10 years or the full 15 years of the model, had incremental costs per year of life gained (cost-effectiveness ratio) of $9867 and $6108 respectively. CONCLUSION: This model suggests that simvastatin provides a cost-effective approach to the long-term prevention of secondary CAD in Canada.

Aged↗
PubMed1997

Herbal products in Canada. How safe are they?

OBJECTIVE: To examine existing evidence and inform family physicians about issues concerning herbal product use in Canada. QUALITY OF EVIDENCE: The Canadian Food and Drug Act and findings of an Expert Advisory Committee on Herbs and Botanical Preparations were consulted to provide an overview of the issues regarding herbal product regulation in Canada. Case reports of herbal toxicity were identified to illustrate some of the hazards of herbal products, and references provided to guide health professional in searching the literature for clinical trials that evaluate these drugs' efficacy. MAIN FINDINGS: Herbal products not registered as drugs in Canada are sold as foods and are exempt from the drug review process that evaluates product efficacy and safety. This places the public at risk of unwanted effects from the use of herbal products that are adulterated with other substances and of forgoing effective conventional therapy. Moreover, consumers are exposed to a plethora of information portraying herbal products as harmless. Some progress has been made to address these concerns by facilitating the registration of herbal products as drugs. CONCLUSIONS: Most herbal products that were evaluated were unsafe or ineffective, or no information was available to evaluate their efficacy. Despite the perception that herbal products are innocuous, family physicians need to be aware that herbal therapy can be harmful in order to help their patients make informed choices.

Canada↗
PubMed1997

The cost of smoking in Canada, 1991.

In 1991, smoking-attributable health care costs in Canada were $2.5 billion (CAN). Additional smoking-attributable costs included $1.5 billion for residential care, $2 billion due to workers' absenteeism, $80 million due to fires and $10.5 billion due to lost future income caused by premature death. Adjustments for future costs if smoking had not occurred and smokers had not died were estimated to be $1.5 billion. According to this analysis, smokers cost society about $15 billion while contributing roughly $7.8 billion in taxes. The results indicate that smoking-attributable costs in Canada have increased steadily since 1966 to the 1991 value of $15 billion. Nevertheless, while the determination of smoking-attributable costs is important, the issue continues to be public health. In addition, for the first time in Canada, the smoking-attributable cost for residential care has been estimated.

Adolescent↗
PubMed1997

Update: outbreaks of cyclosporiasis -- United States and Canada, 1997.

Since April 1997, CDC has received reports of outbreaks of cyclosporiasis in the United States and Canada (1,2). As of June 11, there have been 21 clusters of cases of cyclosporiasis reported from eight states (California, Florida, Maryland, Nebraska, Nevada, New York, Rhode Island, and Texas) and one province in Canada (Ontario). These clusters were associated with events (e.g., receptions, banquets, or time-place-related exposures [meals in the same restaurant on the same day]) that occurred during March 19-May 25 and comprise approximately 140 laboratory-confirmed and 370 clinically defined cases of cyclosporiasis. In addition, four laboratory-confirmed and approximately 220 clinically defined cases have been reported among persons who, during March 29-April 5, were on a cruise ship that departed from Florida. Approximately 70 laboratory-confirmed sporadic cases (i.e., cases not associated with events, the cruise, or recent overseas travel) have been reported in the United States and Canada. The most recent laboratory-confirmed sporadic case occurred in a person who had onset of symptoms on June 3.

Animals↗
PubMed1997

A new primary care rostering and capitation system in Norway: lessons for Canada?

Providing every patient with a personal primary care physician or, from the physician's perspective, establishing a stable roster or list of patients is currently being actively debated in Canada. Norway's system of primary care medicine, similar to Canada's, faces many of the same problems. In 1992 a trial rostering system with blended funding (capitation, fee-for-service and user fees) was established in 4 Norwegian municipalities. After 3 years of close monitoring, the results of system evaluations have attracted strong interest. This article reports on the benefits and problems encountered with the new rostering system in Norway. If Canada is moving in the same direction, some of the lessons learned may be helpful.

Canada↗
PubMedDate not supplied

Private health care in Canada: savior or siren?

In canada, health care is publicly insured and available to all at no charge. Recently, financial pressures have threatened the system and led to considerable debate about how to save it. One proposal is to permit privately funded health care alongside the public system, resulting in what is popularly called a two-tiered system. This paper presents some of the arguments for and against two-tiered health care. Using as an example cataract surgery-a procedure that is available both publicly and privately-the authors look at some common beliefs about private health care in Canada. They conclude that the growth in private sector cataract surgery does not appear to be related to cutbacks or rationing, that private access does not necessarily shorten waiting times, and that, contrary to popular belief, it is not only the well-to-do who pay for private surgery in Canada.

Canada↗
PubMed1997

Status of Trichinella spiralis in domestic swine and wild boar in Canada.

Evidence of the status of trichinellosis in Canada's national swine herd is provided from data acquired through national surveillance programs and from a prevalence study of Trichinella in wild boar and domestic swine. More than 500,000 swine tested at abattoirs in ongoing animal health surveys since 1980 and 2 national swine serological surveys (1985 and 1990) showed no evidence of Trichinella infection, except for 3 occurrences in a small infected zone in Nova Scotia. The prevalence study of domestic swine and wild boar was conducted for the prevalence of Trichinella after an epidemiological investigation of a 1993 outbreak of human trichinellosis in Ontario showed that the disease was linked to the consumption of wild boar meat originating from 2 farms in the province. Sera and tissues were collected from 391 wild boar and 216 domestic swine originating from 228 farms in Quebec, Ontario, Manitoba and Saskatchewan. The survey examined approximately 37% of the wild boar slaughtered in Canada in 1994. A pepsin-HCl digestion test of the tissues and an ELISA performed on the sera did not yield any positive results. These findings and the lack of human cases of Trichinella from the consumption of Canadian pork for nearly 2 decades suggest that the parasite has been rare in domestic swine and wild boar raised in Canada. Trichinella spiralis has only been found sporadically in swine in a small region within Nova Scotia.

Animal Husbandry↗
PubMed1997

The health of Canada's elderly population: current status and future implications.

The growing size of Canada's elderly population and its use of health care services has generated much discussion in policy circles and the popular press. With data from the National Population Health Survey, undertaken in 1994-95, the authors examine the health status of Canada's elderly population using 3 sets of measures: level of activity limitations, prevalence of chronic illnesses and self-assessment of overall health. They also analyse the utilization of physician and institutional services. The profile of this population the authors develop is in many respects not much different from that of the remaining adult population, until the age of 75. People aged 75 and over are much more likely than other adults to have health problems and use health care services. Also, elderly women living alone and with low income are identified as an especially vulnerable group who need access to medical and nonmedical services if they are to remain in the community. Using Statistics Canada projection data the authors discuss some aspects of the elderly population's health status in the future. Their look into the future raises issues about the preparedness of health care providers and our health care system to meet the challenges of tomorrow's elderly population.

Activities of Daily Living↗
PubMedDate not supplied

The case for a heroin substitution treatment trial in Canada.

Illicit opiate use in Canada causes considerable harm and social cost. Methadone substitution treatment, which has been proven effective in reducing the negative effects associated with opiate use, has been used in Canada, but so far only on a small scale. Recent research suggests that, while expanding the availability of methadone substitution is certainly in the public health interest, it would not be sufficient in itself to reduce to a minimum the harms from illicit opiate use. On the basis of the epidemiology of opiate use and of related harms, and building on the experience of intervention efforts currently underway elsewhere, this paper argues for the establishment of a heroin substitution trial in Canada. Such a trial should have the goal of investigating the potential of heroin substitution to significantly reduce the health and social costs to Canadians from illicit opiate use.

Canada↗
PubMed1998

Relation between hospital HIV/AIDS caseload and mortality among persons with HIV/AIDS in Canada.

OBJECTIVE: To assess the relation between HIV/AIDS hospital caseload and mortality in Canada. DESIGN: Descriptive, population-based study. SETTING: All hospitals in Canada that admitted any patients with HIV or AIDS between Mar. 31, 1987, and Apr. 1, 1994. PATIENTS: All patients with a diagnostic code on their hospital discharge abstract for HIV infection, AIDS, or with positive serological or viral culture findings for HIV (International Classification of Diseases, 9th revision, 042, 043, 044 or 795.8). MAIN OUTCOME MEASURE: In-hospital mortality. RESULTS: Over the study period, 38,075 admissions attributed to HIV/AIDS (33,380 of men and 4695 of women) were recorded in 513 Canadian hospitals. Of these hospitals, 230 (45%) had fewer than 1 admission per year of patients with HIV/AIDS; 200 (39%) had between 1 and 9; 68 (13%) had between 10 and 99; and 15 (3%) had 100 or more. HIV/AIDS-related admissions ending in death were independently associated with the patient being admitted to lower-volume hospitals, being hospitalized for longer periods of time, and being older, male and at a more advanced stage of disease. During the study period, hospitals with 100 or more admissions per year reported 36% lower mortality among patients with HIV/AIDS than those that had fewer than 1 admission per year. CONCLUSION: There is an inverse relation between hospital caseload and in-hospital mortality among patients with HIV/AIDS in Canada. We attribute this association at least in part to the propensity of high-volume hospitals to deal more effectively with seriously ill patients with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Trends and variations in length of hospital stay for childbirth in Canada.

BACKGROUND: Early discharge after childbirth is widely reported. In this study the authors examined trends in maternal length of hospital stay in Canada from fiscal year 1984-85 through fiscal year 1994-95. They also examined variations in length of stay in 1994-95 in most of the Canadian provinces and the territories. METHODS: Epidemiologic analyses of the temporal and geographic variations in maternal length of hospital stay in Canada from 1984-85 to 1994-95 (even years only), based on hospital discharge data collected by the Canadian Institute for Health Information, with a total of 1,456,800 women for the 6 study years. RESULTS: Mean length of hospital stay decreased during the decade, from 5.3 days in 1984-85 to 3.0 days in 1994-95, with similar trends for both cesarean and vaginal delivery. The decrease resulted from both increasing rates of short stay (less than 2 days) and decreasing rates of long stay (more than 4 days). Substantial temporal and interprovincial variations in several medical and obstetric complications were also observed but did not explain the corresponding variations in length of stay. The reduction in length of hospital stay was not restricted to uncomplicated cases: there was an equivalent decrease in cases with complications. In 1994-95 the average length of hospital stay in Alberta was 2.6 days, 0.3 to 1.7 days shorter than in the other provinces and the territories. INTERPRETATION: Length of hospital stay for childbirth has decreased substantially in Canada in recent years, but there remain important interprovincial variations. These trends and variations are not likely due to changes or differences in patient-specific factors.

Canada↗
PubMed1998

Alcohol and the U.S.-Canada border: trade disputes and border traffic problems.

The public health interest in trade and in cross-border traffic of alcoholic beverages is considered in general terms. Within this framework, three specific issues in U.S.-Canada trade and borders are discussed: cross-border drinking and driving in both directions, particularly by youth; smuggling from the U.S. to Canada; and the "beer wars" and other U.S.-Canada trade disputes involving alcoholic beverages. While problems can be alleviated on each of these fronts, it is concluded that an important step internationally would be to establish that, because of the problems they entail, alcoholic beverages should be exempt from trade agreements, or else provision should be made for the public health interest to be represented in negotiations and dispute resolution involving alcoholic beverage controls.

Alcoholic Beverages↗
PubMed1998

Coronary artery bypass grafting in Canada: national and provincial mortality trends, 1992-1995.

BACKGROUND: Despite a body of research on outcomes of coronary artery bypass grafting (CABG) in Canada, little is known about Canada-wide outcome trends and interregional differences in outcome. The objectives of this study were to examine Canadian trends in rates of in-hospital death after CABG and to compare provincial risk-adjusted death rates. METHODS: Hospital discharge data were obtained from the Canadian Institute for Health Information and were used to identify complete cohorts of patients who underwent CABG in 8 provinces in fiscal years 1992/93 through 1995/96. Data from Quebec hospitals were not available. A logistic regression model was used to calculate risk-adjusted death rates by year, province, and province and year. RESULTS: A total of 50,357 CABG cases were studied, with an overall death rate of 3.6%. A national trend of decreasing mortality was found, with a risk-adjusted death rate of 3.8% in 1992/93 versus 3.2% in 1995/96 (relative decrease of 17%) (p < 0.001 for difference across years). Some provinces (e.g., Alberta, Manitoba and Ontario) achieved overall declines in death rates over the study period, whereas others (e.g., British Columbia and Saskatchewan) did not. The average severity of illness of patients who underwent CABG differed considerably across provinces. Despite risk adjustment for these differences, provincial death rates varied significantly (p < 0.001). INTERPRETATION: Rates of death after CABG in Canada decreased significantly in a relatively short period. Despite this encouraging finding, there were interprovincial differences in severity of illness and risk-adjusted death rates. This finding raises the possibility of unequal access to CABG and variable quality of care for patients undergoing the surgery across Canadian provinces.

Age Factors↗
PubMed1977

Cronkhite-Canada syndrome. Case report.

The case report of a 72-year-old man with the characteristic clinical and pathologic-anatomic picture of the Cronkhite-Canada syndrome is presented. The clinical features and the radiographic appearance of the gastrointestinal tract suggested Ménétrier's disease. Subtotal gastrectomy was performed and at the subsequent pathologic-anatomic examination, the diagnosis of Cronkhite-Canada syndrome was made. The patient slowly recovered over the following five months while being treated with the so-called astronaut diet (Vivasorb) supplemented with vitamins, iron and electrolytes. He died five months after surgery from intercurrent disease. The differential diagnosis of gastrointestinal polyposis with or without mucocutaneous pigmentation is briefly discussed. The histochemical characteristics of the epithelium in the gastric and colonic polyps was studied in some detail. The authors believe that the gastrointestinal polyps in the Cronkhite-Canada syndrome are regenerative and non-neoplastic in nature.

Aged↗
PubMed2004

Predictors of receipt of a fluoroquinolone versus trimethoprim-sulfamethoxazole for treatment of acute pyelonephritis in women in Manitoba, Canada.

PURPOSE: The increasing and comparatively high proportion of uropathogens in Canada resistant to trimethoprim-sulfamethoxazole (TMP-SMX) may be partially responsible for the increasing use of fluoroquinolones. A number of patient-specific variables have been identified as risk factors for infections caused by antibiotic-resistant pathogens. However, variables unrelated to need, have also been associated with receipt of broad-spectrum antibiotics. We identified patient variables associated with receipt of a fluoroquinolone versus TMP-SMX for treatment of acute pyelonephritis. METHODS: Healthcare claims from the province of Manitoba, Canada for the period February 1996 to March 1999 were examined to identify episodes of pyelonephritis in non-pregnant females between 18 and 65 years of age treated with TMP-SMX or a fluoroquinolone. Patient variables were identified based on healthcare claims review and data from Statistics Canada. Logistic regression was used to model the probability of receipt of a fluoroquinolone. RESULTS: A total of 1084 women met inclusion criteria; 653 treated with TMP-SMX and 431 treated with a fluoroquinolone. Age, income, rural residence, recent antibiotic use, recent hospitalization and presentation to an emergency room (ER) were positively associated with receipt of a fluoroquinolone. CONCLUSIONS: Patient variables reportedly associated with an increased probability of resistant organisms (e.g., age, recent antibiotic use and recent hospitalization) were significantly associated with an increased probability of receipt of fluoroquinolones. However, variables unrelated to antibiotic resistance (e.g., income, rural residence and presentation to an ER) were also significantly associated with receipt of a fluoroquinolone.

Acute Disease↗
PubMed2006

Socioeconomic status influences care of patients with acne in Ontario, Canada.

BACKGROUND: Canada's universal health care system is designed to ensure equitable access to medical care based on need rather than socioeconomic status, although a number of studies indicate a preferential access and greater use of specialist services for those patients in higher socioeconomic groups. OBJECTIVES: The primary objective of this study was to determine whether socioeconomic status influences access to specialist care by a dermatologist for the management of acne in Ontario, Canada. A secondary objective was to determine whether the urban-rural dwelling status of patients affects access to specialty care. METHODS: We conducted a population-based cohort study using administrative health care databases covering more than 12 million residents of Ontario. Individuals age 12 to 27 years with a new diagnosis of acne by a general practitioner were identified as belonging to 1 of 5 socioeconomic groups based on median annual neighborhood household income. Patients were then observed for 2 years after the index visit to identify visits to a dermatologist. The main outcome measure was visitation to a dermatologist within 2 years of an initial diagnosis of acne. RESULTS: The study cohort consisted of 295,469 patients given a diagnosis of acne by their primary care physician of which 59,799 (20%) were subsequently referred to a dermatologist. Of those in the lowest income group of less than Can dollars 20,000, 17% were referred to a dermatologist, as compared with 24% in the highest income group of greater than Can dollars 80,000 (P value for trend < .001). Furthermore, patients living in an urban area had a 43% greater likelihood of being referred to a dermatologist (odds ratio 1.43, 95% confidence interval 1.39-1.48) as compared with patients in a rural location. LIMITATIONS: Limitations of our study include imputing socioeconomic status of patients on the basis of median income at the neighborhood level rather than on the basis of data on individual patients. Furthermore, our use of administrative databases did not allow us to characterize the severity of acne in our population cohort and whether that would affect referral patterns. CONCLUSION: Within Canada's universal health care system, those likely to be in lower socioeconomic groups are significantly less likely to visit a dermatologist for specialist consultation.

Acne Vulgaris↗
PubMed1996

Elder abuse in Canada and Australia: implications for nurses.

This paper examines the issue of elder abuse from a Canadian and Australian perspective. A research project was undertaken in Canada and Australia to identify registered nurses' knowledge about the types of abuse, skill at recognition and comfort counselling and intervening in cases of elder abuse. Although a phenomenon that has probably been in existence for many years, it is only during the last decade that elder abuse has come into prominence as an important aspect of family violence. A recent Canadian report records that elder abuse today is at the same level of publicity as wife abuse 10 years ago (Canadian Nurses Association, 1993). It is estimated that as many as 4% of the elderly population in each country are exposed to elder abuse (Podneiks and Pillemer, 1990, National Survey on Abuse of the Elderly in Canada. Ryerson Polytechnic Inst., Toronto; Kurrle et al., 1992, Modern Med. Austral., September, pp. 58-71). This takes the form of physical, emotional as well as financial abuse. Each country has an increasingly ageing population. By the year 2000 the percentage of the population over the age of 65 is predicted to be 13.6% in Canada and 11.7% in Australia (Gnaedinger, 1989, National Forum on Family Violence; Rowland, 1991, Ageing in Australia, Longman Cheshire, Melbourne). Nurses in both community practice and health care facilities have a responsibility to this elderly population to identify those being abused and those at greatest risk. This study questioned a small sample of registered nurses in both countries to identify whether nurses were adequately prepared to identify, intervene and manage patients in an abusive situation. Results show that nurses in both countries were not knowledgeable about the types of abuse, or comfortable and skilled when dealing with the types of elder abuse.

Aged↗