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PubMed2000

Upper Ordovician and Lower Silurian chitinozoans from central Nevada and Arctic Canada.

Late Ordovician and Early Silurian chitinozoans from the uppermost Vinini Formation, and the Hanson Creek Formation in central Nevada and the lower Cape Phillips Formation, Cape Manning section, in Arctic Canada have been re-investigated and a new chitinozoan biozonation is proposed. The Upper Ordovician of central Nevada can easily be correlated to that of Arctic Canada through the common occurrence of the Ordochitina nevadensis biozone in both regions. No such correlation, however, is possible with the Late Ordovician of Anticosti Island in eastern Canada because of the absence of the index Upper Ordovician chitinozoan zonal species of central Nevada such as Belonechitina tenuispinata sp. nov, Ordochitina nevadensis sp. nov. and Nevadachitina vininica gen. nov., sp. nov. in the former area.One new genus, Nevadachitina, and nine new species, Eisenackitina ripae, Belonechitina martinica, Nevadachitina vininica, Nevadachitina praevininica, Ordochitina nevadensis, Belonechitina tenuispinata, Belonechitina parvispinata, Tanuchitina laurentiana, Angochitina hansonica are described and illustrated in this paper and four species are left in open nomenclature.

Journal Article↗
PubMed2000

Modeling assessment of transport and deposition patterns of anthropogenic mercury air emissions in the United States and Canada

In December 1997, the U.S. Environmental Protection Agency submitted its mercury study report to Congress, which included a modeling assessment of the long-range transport and deposition of mercury from various residential and industrial sources within the United States, based on numerical simulations of elemental mercury gas, divalent mercury gas and particulate mercury, using a special version of the Regional Lagrangian Model of Air Pollution (RELMAP). Observations of the deposition of total precipitated mercury at several locations within the U.S. were compared to the modeling results in order to evaluate the accuracy of the RELMAP simulations. However, the lack of Canadian mercury emissions data in the RELMAP modeling limited the usefulness of this model evaluation at locations near the Canadian border. An inventory of Canadian mercury emissions obtained from Environment Canada has now been added to the RELMAP mercury modeling, and the previous simulations and evaluation of modeled wet deposition have been repeated. The results indicate that emissions of mercury from Canada, as represented by the new inventory, do not significantly impact simulated wet deposition over the United States, nor the general results of the previous model evaluation. Analyses of the simulated transport and deposition patterns of mercury emissions from both the United States and Canada are presented, along with the simulated fraction of total mercury wet deposition, separately attributable to sources within each nation.

Journal Article↗
PubMedDate not supplied

What accounts for physician opinions about midwifery in Canada?

The objective of this study was to identify the characteristics of physicians practicing obstetrics in the province of Quebec, Canada and relate these to their opinions about midwifery practice. A self-administered questionnaire was sent to a systematic random sample of 844 physicians; 597 physicians answered (response rate = 71%). Results show that physicians who were more open to midwives had a more client-centered approach to maternity care. They had attended premed school outside Canada but received their specialty training in Canada. They also had often collaborated with midwives since they had begun practicing. Physicians who were more open to midwives were less demanding in terms of level of midwife training. They agreed that midwives should be self-regulating. It is concluded that greater knowledge of midwives' practice, gained through collaboration in the workplace and interdisciplinary education, could help physicians to better understand the significant contributions that midwives can make to the health care system.

Adult↗
PubMed2002

Social and political factors influencing the functioning of regional health boards in British Columbia (Canada).

Health reform is associated with changes in the way the health system works and in the roles of major stakeholders, such as governments, health professionals, and the lay public. This paper reviews the immediate relevance of these social and political elements to health boards, particularly those with lay board members; source documents include peer-reviewed articles, and government documents and news releases in Canada especially. Also presented are the perceptions of 130 regional health board members in British Columbia (BC), Canada, who responded to our 1996 survey questionnaire. Two sets of social and political factors are identified and discussed in this paper. The first set deals with the composition of health board members (qualifications, representation, and selection). Our findings suggest that there is now less attention focusing on the composition of health boards in BC. This may contribute to a re-focusing of attention on the boards' effectiveness in working with stakeholders and in influencing the health system. The other set of social and political factors deals with the relations of health boards with key stakeholder groups. The responses to our questionnaire suggest that the health boards in BC may have had some success in addressing the concerns of various stakeholder groups. However, the respondents also suggested that the stakeholder groups needed to be more understanding and involved in the regionalization (decentralization) process. Health boards that have lay representatives, including regional health authorities in Canada, face similar social and political factors immediate to their operation.

British Columbia↗
PubMed2000

Mercury in the traditional diet of indigenous peoples in Canada.

Traditional food of indigenous people in Canada, particularly fish and marine mammal meat, has mercury (Hg) concentrations exceeding the Canadian consumption guideline level of 0.5 microg/g. Health effects of Hg in traditional food are, therefore, a concern. We conducted contaminant exposure assessments in 28 indigenous communities in Canada. Hg exposure was greatest among communities with high use of marine mammals as food. Exposure among other communities was variable. Recent adoption of a lower intake guideline for women of reproductive age and by Health Canada may decrease the use of traditional food, and could result in other health problems, such as increased risk of diabetes and cardiovascular disease.

Journal Article↗
PubMed2000

Respiratory tract pathogens isolated from patients hospitalized with suspected pneumonia: frequency of occurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (United States and Canada, 1997).

Thirty-seven sentinel hospitals (29 in the United States [US]; eight in Canada) collected bacterial isolates from hospitalized patients with a diagnosis of pneumonia. The antimicrobial susceptibility patterns of these pathogens were determined to more than 60 agents (40 reported) using the reference broth microdilution method described by the National Committee for Clinical Laboratory Standards. The five most frequently recorded species among the 2757 isolates collected during the study were (no. tested/%): Staphylococcus aureus (632/22.9%), Pseudomonas aeruginosa (498/18. 1%), Haemophilus influenzae (284/10.3%), Klebsiella spp. (240/8.7%), and Streptococcus pneumoniae (213/7.7%). There was a significant difference in the susceptibility to antimicrobials between the US and Canada for S. aureus to oxacillin (50.1% versus 93.8% susceptible, respectively), gentamicin (78.7% versus 97.8%), and fluoroquinolones (49.5 to 53.0% versus 89.8 to 94.9%). Amikacin (92. 8% susceptible) was the most active antimicrobial agent against P. aeruginosa, and meropenem was the most potent beta-lactam. Against H. influenzae, most drugs retained a high level of activity, whilst against the S. pneumoniae, only the newer fluoroquinolones (gatifloxacin, levofloxacin, sparfloxacin) remained highly effective in vitro. Only two antimicrobial agents (imipenem and meropenem) were >99% active against the Klebsiella spp. and Enterobacter spp. isolated in this survey (possess extended spectrum beta-lactamases or hyperproduction of Amp C cephalosporins); cefepime (95.6-100.0% susceptible) was significantly more active than other cephalosporins tested. Clonal, epidemic outbreaks of multiply resistant strains were very rare in monitored hospitals. In conclusion, important differences exist between the US and Canada in the susceptibility patterns of some respiratory tract pathogens to commonly used antimicrobial agents with Canadian strains generally being more susceptible to currently available antimicrobial agents.

Anti-Bacterial Agents↗
PubMed2001

Incidence of second primary breast cancer among women with a first primary in Manitoba, Canada.

Second primary breast cancer is of importance because of the increasing incidence of first primary breast cancer and improved survival. There is lack of information on the disease in Canada. We studied 14,220 women with a first primary breast cancer (invasive only) diagnosed during the period from 1970 to 1997, in Manitoba, Canada. A breast cancer was considered to be a second primary if it was an invasive lesion diagnosed at least six months after the diagnosis of an initial primary breast cancer. The incidence rate of second primary breast cancer was approximately six per 1,000 person-years, and the cumulative incidence during the 28-year study period was 14.3%. Average age at diagnosis of first primary breast cancer had increased significantly since 1970. The incidence was higher in 1975-1979, and there was no significant difference among other study periods after adjustment for the age at diagnosis of first primary breast cancer. Standardized incidence ratios showed no significant difference among six age groups after adjusting for calendar year. However, women with a first primary breast cancer had an increased risk of developing a second primary breast cancer compared with the risk of developing a first primary breast cancer among the general female population. The SIR was markedly greater among women who had a first primary breast cancer before the age of 40 years, and decreased significantly with increasing age at diagnosis of first primary breast cancer. The data provide epidemiological information on second primary breast cancer risk for the general female population in Manitoba, Canada.

Adult↗
PubMed2001

Detection of anthrax spores in endemic regions of northern Canada.

AIMS: To determine the level of anthrax spore contamination in endemic regions of northern Canada between outbreaks. METHODS AND RESULTS: Bacterial endospores were extracted from specimens via flotation and cultured on selective PLET medium. Of 588 environmental specimens collected, 11 (1.9%) contained viable anthrax spores. CONCLUSION: High environmental concentrations of anthrax spores in northern Canada appear limited to scavenger faeces and anthrax carcass sites. Burial and cremation appear equally effective at removing anthrax spores from the immediate environment, though cremation may be improved by re-burning cremation sites containing unburned animal hair. SIGNIFICANCE AND IMPACT OF THE STUDY: This study describes an effective anthrax spore detection system. It provides the first bacteriological evidence that mammalian scavengers can disseminate anthrax spores in northern Canada, and its results may be compared with future environmental studies of untreated anthrax carcass sites to help improve government response plans.

Animals↗
PubMed2001

[Colorectal carcinoma in Cronkhite-Canada syndrome].

We report a 63-year-old lady with Cronkhite-Canada syndrome, who developed colorectal cancer. A hemicolectomy was performed, and the tumor specimen was prepared for DNA-analysis and immunohistochemical screening. We found a mutation of p53 gene without APC- and ras-gene alteration and expression of erbB2-protooncogen. The polyps in non-hereditary Cronkhite-Canada-syndrom are neither adenomatous nor hyperplastic, but patients often develop colorectal cancers. The steps of mutation do not follow the adenoma-carcinoma sequence, first described by Vogelstein 1988. This and previous observations suggest that carcinogenesis in Cronkhite-Canada syndrome follows another independent sequence.

Adenocarcinoma↗
PubMed1997

Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada.

BACKGROUND: Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of cardiac procedures and outcomes after acute myocardial infarction in elderly patients in the two countries. METHODS: We compared the use of invasive cardiac procedures and the mortality rates among 224,258 elderly Medicare beneficiaries in the United States and 9444 elderly patients in Ontario, Canada, each of whom had a new acute myocardial infarction in 1991. RESULTS: The U.S. patients were significantly more likely than the Canadian patients to undergo coronary angiography (34.9 percent vs. 6.7 percent, P< 0.001), percutaneous transluminal coronary angioplasty (11.7 percent vs. 1.5 percent, P<0.001), and coronary-artery bypass surgery (10.6 percent vs. 1.4 percent, P<0.001) during the first 30 days after the index infarction. These differences in the use of cardiac procedures narrowed but persisted through 180 days of follow-up. The 30-day mortality rates were slightly but significantly lower for the U.S. patients than for the Canadian patients (21.4 percent vs. 22.3 percent, P=0.03). However, the one-year mortality rates were virtually identical (34.3 percent in the United States vs. 34.4 percent in Ontario, P= 0.94). CONCLUSIONS: Short-term mortality after an acute myocardial infarction was slightly lower in the United States than in Ontario, but these differences did not persist through one year of follow-up. The strikingly higher rates of use of cardiac procedures in the United States, as compared with Canada, do not appear to result in better long-term survival rates for elderly U.S. patients with acute myocardial infarction.

Aged↗
PubMed2001

Deposition of Mn from automotive combustion of methylcyclopentadienyl manganese tricarbonyl beside the major highways in the greater Toronto area, Canada.

Methylcyclopentadienyl manganese tricarbonyl (MMT) has been used in Canada since 1976 as an antiknock agent in gasoline, completely replacing Pb in 1990. An early study of much higher Mn concentrations in gasoline showed that the combustion of MMT leads to the formation of inorganic manganese oxides, especially Mn3O4. Recent emission testing by Lawrence Livermore National Laboratory for Ethyl Corp. has shown that Mn is primarily emitted as a phosphate or sulfate along with minor amounts of oxides. The main objective of this research was to analyze the deposition of Mn from MMT to the terrestrial environment beside the major highways in the greater Toronto area (GTA), Canada. The results were compared with Pb and other trace elements such as Al, Ca, Fe, Mg, Cu, Zn, Na, and the Cl ion (water extractable) to study the behavior of Mn in soil. The study area was located near major Toronto highways 401 (urban) and 400 (rural), at 43 degrees 67' N and 79 degrees 37' W (latitude and longitude) (278,560 and 47,835 cars/day), respectively. Surface soil samples (0-5 cm depth) were collected at distances up to 40 m from the roadside. Parameters evaluated included total and available Mn and other trace elements, particle size, pH, organic content, and cation exchange capacity. Based on high traffic density along 401, higher Mn deposition was expected. No significant differences were found between the 401 and 400 Barrie (E(+1)) sites, attributable to the natural background levels of Mn or its contribution by other sources such as Mn-enriched road dust or naturally occurring crustal Mn. However, the 400 King City (E(+2)) site had significantly lower Mn levels than did the other three sites, 401 and 400 Barrie. This may be explained by the types of soil along the 401 and 400 sites. The King City site along 400 was found to be higher in sand content than were the 401 sites. A higher sand content could result in higher leaching of Mn to the bottom layer of the soil. Although MMT has been used continuously for approximately 25 years in Canada, its contribution to the terrestrial environment has been very low and has not significantly increased Mn levels along the highways, as demonstrated by this study.

Air Pollutants↗
PubMed2000

The impact of diabetes mellitus among the Métis of western Canada.

OBJECTIVES: To examine the impact of diabetes mellitus on the lives of the Métis of western Canada, and to determine the extent of co-morbidity among Métis with diabetes. DESIGN: The source of data was the Aboriginal Peoples Survey (APS), conducted by Statistics Canada in 1991. The survey was administered to a representative sample of Aboriginal peoples throughout Canada. Analysis was completed on self-identified Métis participants from the Canadian provinces of Manitoba, Saskatchewan and Alberta. RESULTS: Métis participants with diabetes were more likely than those without diabetes to report their health status as poor. Significantly greater numbers of Métis with diabetes reported activity limitations at work, at home and in leisure activities, the need for assistance with activities of daily living and difficulties with ambulation than did those without diabetes. The extent of co-morbidity was also significant. Métis with diabetes were almost three times more likely to report hypertension and heart problems and twice as likely to report sight impairments than were those without diabetes. CONCLUSIONS: This research represents the first account of the effects of diabetes on the lives of the Métis. The APS data have provided a clear picture of the impairments in physical functioning experienced by the Métis with diabetes and the impact upon quality of life. In addition, the strong associations between diabetes and hypertension, heart problems and sight impairments suggest profound morbidity in this population that warrants prompt attention.

Adult↗
PubMed2001

Postsanatorium pattern of antituberculous drug resistance in the Canadian-born population of western Canada: effect of outpatient care and immigration.

Concurrent with the shift in tuberculosis case management from sanatorium to outpatient setting was a shift in the continent of origin (Europe to Asia) of most new immigrants to CANADA: To assess the impact of these two events on antituberculous drug resistance in the Canadian-born population, the authors reviewed the results of six drug resistance surveys conducted in the two westernmost provinces of Canada between 1963 and 1994. Survey data were complemented by new molecular diagnostic and contact tracing data collected over 5 years (1994--1998) in one of the three large urban centers of the region. Over the time spanned by the surveys, there was no increase in the proportion of all Canadian-born tuberculosis cases who relapsed or the proportion of all Canadian-born relapsed cases who were drug resistant (approximately 12--13%). In addition, the prevalence of primary drug resistance among Canadian-born cases did not increase; rates consistently averaged between 2% and 5% despite a doubling of primary resistance rates among foreign-born cases. Molecular diagnostic and contact tracing data strongly supported the survey findings. The authors concluded that outpatient care and immigration have thus far had no measurable impact on the pattern of antituberculous drug resistance in the Canadian-born population of western CANADA:

Adolescent↗
PubMed1992

Canada's health care system provides lessons for NPs.

With increasing economic pressures, swaying public opinion and new government policies rationing health care resources, nurses in Canada are again challenging physicians for room to practice as nurse practitioners. Although the last Canadian nurse practitioner program was discontinued in 1983, and it was argued that the death of the role was inevitable in Canada's health care system, nurse practitioners have not vanished. Social plans in the United States are drawing heavily on the Canadian model of universal access and a government-funded health care system, and dramatic changes are taking place in Ontario's health care system. Now more than ever it is important that nurse practitioners understand Canada's health care system, why the NP role in Ontario has not been highly successful, and why the time is right for reintroduction of nurse practitioners into Ontario's health care system.

Cost Control↗
PubMed2006

Socioeconomic status and receipt of obstetric services in Canada.

OBJECTIVE: To examine differences in labor induction and cesarean delivery rates by socioeconomic status in Nova Scotia, Canada. METHODS: We studied all women in Nova Scotia who delivered between 1988 and 1995 after a singleton pregnancy. Information was obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax (T1) Family Files maintained by the Small Area and Administrative Data Division of Statistics Canada (n = 76,440). Labor induction and cesarean delivery rates were contrasted by family income and other indices, with adjustment for risk factors carried out using logistic models. RESULTS: Maternal characteristics and other factors varied by socioeconomic status; in the lowest income group 4.4% of women were aged 35 years or older, and 49.4% were nonsmokers, whereas in the highest income group 17.7% were aged 35 years or older, and 88.7% were nonsmokers. Crude induction rates were similar across income groups (17.7% compared with 18.1% in the lowest compared with highest income groups), but there were significant differences in crude cesarean (17.7% compared with 21.2%) and crude primary cesarean rates (12.5% compared with 17.0%). Controlling for differences in risk factors altered these relationships. Adjusted rate ratios, 95% confidence intervals (CIs) and P values contrasting the lowest compared with highest income groups were labor induction 1.09 (95% CI 1.00-1.19), P = .05; overall cesarean delivery 1.12 (95% CI 1.03-1.23), P = .01; primary cesarean delivery 1.09 (95% CI 0.98-1.21), P = .12. CONCLUSION: Affluent women in Canada are not more likely to have labor induction or cesarean delivery compared with less affluent women. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed1995

Low-dose bacille Calmette-Guérin (BCG) therapy in superficial high-risk bladder cancer: a phase II study with the BCG strain Connaught Canada.

OBJECTIVE: To evaluate low-dose bacille Calmette-Guérin (BCG) therapy, with the Connaught Canada strain, in patients with superficial transitional cell carcinoma (STCC) of the urinary bladder. PATIENTS AND METHODS: Between September 1990 and December 1992 25 patients were entered into a phase II study to evaluate the feasibility, response and toxicity of BCG immunotherapy for patients with high-risk STCC. Therapy consisted of six, weekly instillations of 27 mg (3 x 10(8) colony-forming units) of the BCG strain Connaught Canada. Maintenance therapy was administered monthly for 1 year with the same dosage. RESULTS: Of 25 eligible patients, 84% had complete responses after the initial cycle with low-dose BCG and had stable disease. Four patients had no response, three of whom subsequently underwent radical cystectomy. The mean length of follow-up was 30.8 months (25-36). Toxicity included profound local reactions such as severe dysuria, frequency and gross haematuria. No systemic infections, except fever, were seen; none of the patients needed isoniazid. All reactions were treated symptomatically. CONCLUSIONS: The results of this study suggest that low-dose BCG with the strain Connaught Canada can be successfully used in the treatment of patients with high-risk STCC. Toxicity was not reduced substantially by the lower dosage of BCG used.

Administration, Intravesical↗
PubMed2004

Phylogenetic analysis of the hypervariable region of the 18S rRNA gene of Cryptosporidium oocysts in feces of Canada geese (Branta canadensis): evidence for five novel genotypes.

To assess genetic diversity in Cryptosporidium oocysts from Canada geese, 161 fecal samples from Canada geese in the United States were analyzed. Eleven (6.8%) were positive for Cryptosporidium spp. following nested PCR amplification of the hypervariable region of the 18S rRNA gene. Nine PCR products from geese were cloned and sequenced, and all nine diverged from previously reported Cryptosporidium 18S rRNA gene sequences. Five sequences were very similar or identical to each other but genetically distinct from that of Cryptosporidium baileyi; two were most closely related to, but genetically distinct from, the first five; and two were distinct from any other sequence analyzed. One additional sequence in the hypervariable region of the 18S rRNA gene isolated from a cormorant was identical to that of C. baileyi. Phylogenetic analysis provided evidence for new genotypes of Cryptosporidium species in Canada geese. Results of this study suggest that the taxonomy of Cryptosporidium species in geese is complex and that a more complete understanding of genetic diversity among these parasites will facilitate our understanding of oocyst sources and species in the environment.

Animals↗
PubMed2006

Molecular analysis of Clostridium difficile PCR ribotype 027 isolates from Eastern and Western Canada.

The prevalence and characteristics of PCR ribotype 027 strains of Clostridium difficile have come into question following recent outbreaks in Eastern Canada and elsewhere. In order to determine the distribution of this strain in other regions in Canada, we screened a bank of 1,419 isolates recovered from three different Canadian health regions between 2000 and 2004. Among isolates from a Montreal area hospital, PCR ribotype 027 strains represented 115/153 strains (75.2%) from 2003 to 2004, but ribotype 027 strains were absent in 2000 and 2001. In Calgary, by contrast, ribotype 027 rates have remained relatively stable over 4 years of surveillance, representing 51/685 (7.4%) hospital isolates and 62/373 (16.6%) strains from the community (P < 0.001). PCR ribotype 027 accounted for 8/135 (5.9%) hospital isolates in the Fraser Health Region in 2004. repetitive extragenic palindromic PCR was used to subtype a random selection of 027 isolates from each region. All 10 of the isolates from Quebec were of a single subtype, which was also dominant among isolates from Alberta (8/10 isolates) and British Columbia (6/8 isolates). Comparative sequencing of the tcdC repressor gene confirmed the documented 18-bp deletion and identified a second, single-base-pair deletion at position 117. Both deletions were conserved across all three provinces and were identified in a United Kingdom reference strain. The presence of a frameshift in the early portion of the tcdC gene implies serious functional disruption and may contribute to the hypervirulence of the 027 phenotype. PCR ribotype 027 strains appear to be widely distributed, to predate the Montreal outbreak, and to have measurable community presence in Western Canada.

Alberta↗