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PubMed1993

An update of an epidemiology study at a hydrometallurgical nickel refinery in Fort Saskatchewan, Alberta.

A five-year extension to an ongoing epidemiology study has been undertaken. Mortality information was updated for an additional five years through 1985-1989 for 715 male hydrometallurgical nickel refinery employees who worked at Sherritt Gordon Limited in Fort Saskatchewan, Alberta, during the years 1954 to 1978. Mortality ascertainment was obtained using the Canadian Mortality Data Base, maintained by Statistics Canada, and covered the years 1954 through 1989. Cause-specific mortality analyses were accomplished for males, by age group and calendar year of death, for Canada and the province of Alberta. Total mortality was significantly below expectation (42 observed vs. 70 expected deaths for Canada, and 66 expected for Alberta). Statistically fewer observed deaths were found for circulatory disease while multiple myeloma and lymphoid malignancies demonstrated a statistically significant increase of observed deaths. Specific focus was directed at cancers of the respiratory system because of previous reports linking these conditions with exposure to nickel compounds in some workforces. No deaths due to nasal cavity or paranasal sinus cancer were detected among cohort or study group members. Four lung cancer deaths were found with five deaths expected for Canada and four expected for Alberta. To date, no association between exposure to nickel concentrate or metallic nickel and the subsequent development of respiratory cancer has been found in this study. The hydrometallurgical refinery operation is an enclosed process in contrast to other refinery processes such as pyrometallurgical and electrolytic.

Adolescent↗
PubMed1995

A survey of the selenium status of beef cows in Alberta.

An epidemiological survey was conducted in Alberta to measure the selenium status in blood of beef cows during the fall and to determine the risk of selenium deficiency among specific geographic regions of Alberta. Three census divisions of Alberta based on the Statistics Canada Census of Agriculture were chosen as the study areas for the project. Soils and plants in area A (Edmonton area) and area B (Calgary area) were known to be deficient in selenium, while soils and plants in area C (southeast corner of Alberta) were known to have adequate levels of selenium. Blood samples were collected from 335 cows on 29 farms from the 3 study areas. These samples were collected from cows that had recently been removed from pasture in October and November 1992. Answers to a short questionnaire pertaining to various herd characteristics and management practices were also obtained for each herd. The average value of selenium for all cows sampled was 2.20 mumol/L. The average value of selenium of cows in areas A and B was 1.93 mumol/L. The average value of selenium of cows in area C was significantly (P < 0.05) higher at 2.70 mumol/L. Nine percent of the cows in the study were considered marginal or deficient in selenium (< 1.27 mumol/L selenium). Herds located in area C, herds that were provided with supplemental feed on pasture, and herds that were pregnancy checked had higher average herd selenium values than did other herds. Cow-calf producers located in areas with selenium-deficient soils should pay particular attention to selenium supplementation for their cows. Some of the negative "geographic" effects on selenium values can be overcome by more progressive management practices.

Alberta↗
PubMed1996

Alberta Euthanasia Survey: 3-year follow-up.

OBJECTIVE: To determine whether the opinions of Alberta physicians about active euthanasia had changed and to assess the determinants of potential changes in opinion. DESIGN: Follow-up survey (mailed questionnaire) of physicians included in the 1991 Alberta Euthanasia Survey. SETTING: Alberta. PARTICIPANTS: Of the 1391 physicians who participated in the 1991 survey 1291 (93%) had indicated that they were willing to take part in a follow-up survey. A follow-up questionnaire was mailed in 1994 to 1146 physicians who could be traced through the 1994 Medical Directory of the provincial college of physicians and surgeons; 25 questionnaires were returned because they could not be delivered. OUTCOME MEASURES: Physicians' opinions about (a) the morality of active euthanasia, (b) changes in the law to permit active euthanasia and (c) the practice of legalized euthanasia. RESULTS: Of the 1121 physicians sent a follow-up questionnaire 866 (77%) returned it completed. The responses of these same 866 physicians in 1991 provided a basis for comparison. Of the 866, 360 (42%) stated in the 1994 survey that it is sometimes right to practise active euthanasia; a similar proportion (384 [44%]) gave this response in 1991. However, other opinions changed significantly. In 1991, 250 of the respondents (29%) indicated that they would practise active euthanasia if it were legalized, as compared with 128 (15%) in 1994 (p < 0.01). In 1991, 429 (50%) of the respondents thought that the law should be changed to permit active euthanasia, as compared with 316 (37%) in 1994 (p < 0.01). Religious activity was the most important characteristic associated with changes in opinion. Despite the decrease in support for the practice and legalization of active euthanasia between 1991 and 1994, in both surveys at least 70% of those who responded to this question indicated that active euthanasia, if it were legalized, should be performed only by physicians and should be taught at medical sites. CONCLUSION: Alberta physicians' support for the practice and legalization of active euthanasia decreased considerably between 1991 and 1994. However, most physicians remain in favour of restricting active euthanasia, if it were legalized, to the medical profession. These results suggest a need for caution and deliberation when changes in the law concerning active euthanasia are examined.

Adult↗
PubMed1996

Frontier nursing: nursing work and training in Alberta, 1890-1905.

This article analyzes the relationship of nursing work and training from 1890 to 1905 in that part of the North West Territory which in 1905 became the province of Alberta. Primary (archival) and secondary (published) data are analyzed to determine the nature of salaried nursing work, how nurses were recruited, the conditions of employment, how women were prepared for nursing work, and the relationship between hospital training programs and the salaried work of graduate nurses. Prior to 1905, most graduate nurses in Alberta were employed in hospitals. Their work involved administration as well as attending to patients and assisting physicians. Hospital boards had difficulty recruiting graduate nurses and began training programs to remedy their labour shortage. Programs were begun by the Medicine Hat General Hospital in 1894 and the Calgary General Hospital in 1895. Hospitals with training programs soon came to rely on pupil nurses for staffing. The success of these programs stimulated other Alberta hospitals to begin training programs, and by 1915 there were 10 programs in existence. Graduates of hospital programs were expected to be entrepreneurs, seeking employment in private practice and being reimbursed on a free-for-service basis by their patients. Although they were not designed to prepare nurses for private practice, hospital training programs did achieve some integration between hospital and home nursing work, partly because the primitive conditions of Alberta hospitals matched those of the ranches, homesteads, and even town homes. Pupil nurses became oriented to private duty when they were "hired out" during their period of training to care for ill individuals in their homes.

Alberta↗
PubMed1997

Review of the screening history of Alberta women with invasive cervical cancer.

OBJECTIVE: To conduct a failure analysis of cervical cancer screening among women with invasive cervical cancer in Alberta. DESIGN: Descriptive study. Review of demographic, staging and treatment information from cancer registry records; generation of documented screening history from Alberta Health billing records and self-reported history from subjects who agreed to be interviewed; and comparison of findings in initial cytology reports with those from subsequent review by at least 2 pathologists of all cytology slides for each patient for the 5 years before diagnosis. Cases were assigned to 1 of 6 categories of identified screening failure. SETTING: Alberta. SUBJECTS: All women with diagnosis of invasive cervical cancer reported to a population-based provincial cancer registry from January 1990 to December 1991. OUTCOME MEASURES: Demographic, staging and treatment information; documented and self-reported screening histories; correlation of test results in initial cytology report with those generated from slide review; category of identified screening failure. RESULTS: Of the 246 women identified with invasive cancer of the cervix, 37 (15.0%) had stage IA disease; 195 (79.3%) had squamous-cell carcinoma, and 35 (14.2%) had adenocarcinoma. According to the categories of screening failure, 74 women (30.1%) had never been screened, 38 (15.4% had not been screened within 3 years before diagnosis, 42 (17.1%) had had a false-negative cytology result, and 20 (8.1%) had been managed outside of conventional protocols. Of the 23 women (9.3%) who had been screened appropriately and had true-negative results, 19 had smears that were considered technically limited. It was not possible to classify 49 (19.9%) of the cases. Agreement between the documented and the self-reported screening histories was exact for only 39 (36.1%) of the 108 women interviewed. CONCLUSIONS: Despite widespread use of opportunistic cervical screening, many women in Alberta are still not being screened adequately. In most cases women are being screened too infrequently or not at all. Self-reported screening histories are unreliable because many women may overestimate the number of smears. An organized approach to screening, as recommended by the National Workshop in Cervical Cancer Screening, may assist in reducing the incidence of invasive cervical cancer.

Adenocarcinoma↗
PubMedDate not supplied

Towards the professional status of dental hygiene in Alberta.

Presently, despite formal advances toward professional status and the acquisition of some professional attributes, dental hygiene may or may not be recognized as a profession. While dental hygienists in Alberta have a professional association that regulates the practice of dental hygiene, other professional attributes have yet to be attained. As the province's dental hygiene leaders begin to prepare recommendations to the Alberta government for the practice and direction of dental hygiene in Alberta, it is valuable for them to understand the different perceptions held by those affected. The study reported in this paper investigated the perceptions of Alberta dental hygienists and dentists regarding the professional status of dental hygiene in the province. Dental hygienists were selected to participate according to employment setting, while dentists were randomly selected. The questionnaire consisted of both open and closed ended questions, including Likert Scale items. Data were collected from questionnaires returned by 111 dental hygienists and 109 dentists. Two main points emerged from this study. The first is that although all dental hygienists recognize dental hygiene as an emerging profession, perceptions held by dental hygienists employed in private practice settings vary from those held by dental hygienists employed in traditional community care or alternative practice settings. The second recurrent theme is that dentists, while recognizing the expertise of dental hygienists, wish to retain economic control of dental hygiene. The article concludes by offering recommendations designed to increase the development of dental hygiene as a profession.

Adult↗
PubMed1994

Infection caused by Escherichia coli O157:H7 in Alberta, Canada, and in Scotland: a five-year review, 1987-1991.

Infections and life-threatening complications due to verotoxin-producing Escherichia coli (VTEC) have been increasingly recognized as a public health problem in recent years. Through enhanced surveillance in Alberta, Canada, and in Scotland, 1,993 cases of VTEC infection and 115 cases of hemolytic-uremic syndrome (HUS) were detected in 1987-1991 in a combined population of more than 7.5 million; there were 24 deaths. The mean annual rates of VTEC infection were 12.1/100,000 and 2.0/100,000 for Alberta and Scotland, respectively. One case of HUS occurred for every 14 (Scotland) to 19 (Alberta) cases of VTEC infection. Rates of VTEC infection were highest among children < 5 years of age, while rates of resultant hospitalization were highest among the elderly. Male-to-female ratios for patients with VTEC infection varied with the age group. The incidence of this infection was highest in the summer: 64.0%-81.7% of cases occurred between May and September. Hamburger was the most common source reported. Unexplained geographic variation in prevalence was evident in both Alberta and Scotland. Most cases were sporadic, although several community and point-source outbreaks were identified in Scotland. HUS exhibited similar epidemiological patterns. Infections with VTEC impose a substantial preventable clinical and public health burden. Routine monitoring of these infections is considered worthwhile in order to elucidate their epidemiology and modes of transmission and ultimately to control them more effectively.

Adolescent↗
PubMed2001

Prevalence of mental disorders in children living in Alberta, Canada, as determined from physician billing data.

BACKGROUND: The prevalence of mental disorders is often assessed using survey techniques. Although providing good estimates of prevalence, these techniques are time-consuming and expensive. OBJECTIVE: To estimate the prevalence of mental disorders among children aged 0 to 17 years living in Alberta, Canada, using health care administrative data. DESIGN: This was a cross-sectional study. International Classification of Diseases, Ninth Revision, Clinical Modification chapter 5 diagnostic codes from physician billing data were used. Codes were grouped into 10 categories. Prevalence rates for each category were calculated, stratified by age, sex, and premium subsidy status (a proxy for socioeconomic status). The age pattern, times of greatest risk, and the effect of sex on type and prevalence of mental disorder were estimated. SETTING: All fee-for-service health care venues in Alberta between April 1, 1995, and March 31, 1996, providing services to children registered with the Alberta Health Care Insurance Commission on March 31, 1996. RESULTS: Prevalence of mental disorders varied by disorder category, age, sex, and premium subsidy status. For boys, maximum prevalence of 9.5% occurred at age 10 years; for girls, maximum prevalence of 12.0% occurred at age 17 years. Mental disorders were most common in young boys and adolescent girls and among children receiving welfare. Distinct patterns of disorder were evident and comorbidity was common. CONCLUSIONS: Administrative data can be used to estimate the prevalence of mental disorders in a pediatric population. The estimates made are lower than those obtained by using surveys of similar populations, perhaps indicating the difference between treated and untreated prevalence. Strengths of this study are that the estimates reflect the entire population, are more easily and obtained at less cost, and are useful for the planning of mental health services.

Accounts Payable and Receivable↗
PubMed1977

The increasing incidence of breast cancer in Alberta 1953-1973.

The incidence of female breast cancer in Alberta increased steadily by one case per 100,000 per year from 1953 to 1973 to a current rate of 68.6 per year when adjusted to the 1950 U.S. population. Incidence rates of breast cancer in Alberta and Saskatchewan were identical after population adjustment. The incidence increased in women over 40, implicating an increase in the postmenopausal type of breast cancer. Birth cohort analysis showed increased age-specific incidence rates in middle-aged women occurring in successive cohorts from 1903 to 1918, a result similar to that found in Saskatchewan, Connecticut, and Finland. The menopausal hook is disappearing in Alberta data, apparently due to cohort-specific increases in incidence. Possible etiological factors involved in these incidence changes are discussed; a detailed analysis of specific etiological factors is currently underway on over 3,000 patients with malignant or benign breast disease who were examined at the Dr. W. W. Cross Cancer Institute in Edmonton from 1971 to 1974.

Adult↗
PubMed2003

An investigation of noise levels in Alberta sawmills.

BACKGROUND: Noise exposure in the sawmill industry is an area of concern. This study documents the level of noise exposure in nine sawmills in the province of Alberta, Canada. METHODS: Personal noise monitoring data were collected in nine Alberta sawmills, in winter and in summer (n = 213). Exposures were considered in light of an estimated "real world" noise reduction rating (NRR) calculation assuming use of conventional hearing protection. Limited comparisons were made with spot area monitoring data. RESULTS: Only 10% of the personal monitoring measurements were below the Alberta 8-hr exposure limit of 85 dBA. Twenty-seven percent of the personal monitoring measurements were 95 dBA or higher. Worker enclosures played a large role in reducing noise exposure. There were no significant differences between seasons in noise category distributions (P = 0.61). The planermen and planer infeed operators had the highest percentage of personal monitoring measurements 95 dBA or higher (62% and 82%, respectively). CONCLUSIONS: Based on a conservative formula, a risk of excess noise exposure could exist even when wearing required hearing protection due to very high noise levels found in planing operations in sawmills.

Alberta↗
PubMed1988

Nursing education at a distance: using technology to advantage in undergraduate and graduate degree programs in Alberta, Canada.

Two applications of distance education methods at the undergraduate and graduate levels are described in this article. The experiment in graduate education employed video-conferencing to teach a course in the Master of Nursing program at the University of Alberta. Centres connected by a coaxial cable in two cities with 8-10 students in each were used. In the project which followed in undergraduate education, the Faculty of Nursing undertook to provide an entire post-R.N. degree program to centres in central and northern Alberta primarily through the use of distance methods. Arts and science courses are taken through Athabasca University and regular nursing courses in the B.Sc.N program are provided using video-enhanced teleconferencing with several centres on line along with instructors and students on the main campus in Edmonton, Alberta. Details of this very successful program are discussed in the text.

Alberta↗
PubMedDate not supplied

Health care reform and emergency outpatient use of rural hospitals in Alberta, Canada.

We describe Alberta's publicly funded system of rural hospital emergency outpatient services just before the profound impact of major health care reforms. From a rural physician's perspective, we descriptively analyze a unique government database that contains the number of emergency outpatient visits to all Alberta hospitals in the fiscal year 1992/93. We found that most people in rural Alberta had ready access to an extensive system of physician-based rural hospital emergency outpatient services, that 50% of all emergency visits were made to rural hospitals, and that 70% of physicians providing hospital-based emergency services were rural. There were significant differences in the emergency outpatient use of large urban, regional urban, and rural hospitals, and between rural hospitals that were close, middle, or remote distances from tertiary or secondary care centers. We identify some clinically important factors that are not described by available data, but which should be considered by the reform movement.

Alberta↗
PubMed2005

The changing epidemiology of chickenpox in Alberta.

BACKGROUND: Varicella vaccine was licensed in Canada in 1998. The province of Alberta introduced a universal publicly funded varicella vaccination program in 2001. PURPOSE: To describe the epidemiology of non-fatal cases of chickenpox for which publicly funded health services were utilized for the period 1986-2002. METHODS: We used the records of Alberta's universal, publicly funded health care insurance system to identify cases of chickenpox for the period 1986-2002. The earliest dated utilization of a health service for which there was an ICD9-CM code of 052.xx or an IC10-CA code of B01.xx was used as the date of illness onset. Denominators for rates were estimated using mid-year population estimates from the Alberta Health Care Insurance Registry. Age-specific rates were estimated for each year. RESULTS: The crude incidence of chickenpox significantly declined over the period 1994-2002, most steeply after the year 2000. The incidence of chickenpox varied by age group and year and there was evidence of age-group-year interaction. Among those aged 5-19 years, chickenpox incidence began to decline prior to vaccine licensure in Canada. Among those aged less than one year and those aged 1-4 years, the incidence increased until 1999 when a decline began. Over the period 0.8% of cases were hospitalized. CONCLUSION: Chickenpox rates began to decline prior to the introduction of the publicly funded vaccination program; however the declines in rates among the youngest age-groups are consistent with a vaccination program effect.

Adolescent↗
PubMed2003

A small area study of motor vehicle crash fatalities in Alberta, Canada.

This study examined the small area variation in motor vehicle crash fatality rates in the province of Alberta, Canada. Motor vehicle crash fatality rates per 100000 population (1995-1997, inclusive) were determined for five geographic areas in the province. The rates showed substantial, statistically significant variation across areas, with fatality rates lowest in the urban areas of Calgary and Edmonton, and highest in the rural areas (south, central, and northern Alberta). Examination of area-level predictors-population density, impaired driving citation rates, education level, unemployment levels, and ethnicity-showed that population density and impaired driving rates were associated with motor vehicle crash fatality rates. There was a five-fold difference in annual motor vehicle crash fatality rates between rural (22.9/100000) and urban areas (4.4/100000), whereas annual impaired driving rates were around 1.8% in rural areas, compared with 0.6% in urban areas. Because of multicollinearity problems, it was not possible to estimate a multivariable Poisson regression model. In conclusion, rural areas in the province of Alberta demonstrate a significantly higher motor vehicle crash fatality rate, compared with urban areas.

Accidents, Traffic↗
PubMed2005

Anophthalmia and microphthalmia in the Alberta Congenital Anomalies Surveillance System.

BACKGROUND: A higher than expected rate of anophthalmia/microphthalmia (A/M) for 1999 was noted in both the Alberta Congenital Anomalies Surveillance System (ACASS) and the Canadian Congenital Anomalies Surveillance System (CCASS). Since this increase was at variance with the previous 19 years, we performed a review to determine whether the increase was true and, if so, the possible explanation. METHODS: We reviewed the records of the cases of A/M in the ACASS together with the accompanying attachments (e.g., consultant, autopsy and chromosome reports) for 1991-2001. In addition, we contacted all 91 registered ophthalmologists in Alberta. Letters were also written to the Edmonton and Calgary offices of the Canadian National Institute for the Blind (CNIB). RESULTS: Sixty cases of A/M were ascertained over the study period. Of the 88 active ophthalmologists in the province, 21 (24%) replied, but no new cases were ascertained from this source. No replies were received from the CNIB. We constructed five categories of clinical phenotypes for the 60 cases: 20 had a chromosomal etiology, 13 had a recognized syndrome or association, 16 had extraocular malformations, 5 had other eye anomalies, and 6 had A/M only. Pregnancy terminations were not included. The higher rate in 1999 was mainly due to cases with a chromosomal etiology or a recognized syndrome or association. There was no indication that a teratogen was causing a cluster of A/M cases, as our annual rates were comparable to those for other jurisdictions not only in Canada but also in other countries. INTERPRETATION: Our review confirmed that the rate of A/M in Alberta in 1999 was high but that the increase was mainly due to five cases of trisomy 13 together with one case associated with a syndrome (Meckel-Gruber). Our findings provide reassurance that there was no environmental cause of clustering of anophthalmia or microphthalmia. This review demonstrates the importance of ongoing population-based surveillance in providing baseline birth prevalence rates for evaluating trends and clusters.

Alberta↗
PubMed1998

Managing change in the context of health reform: lessons from Alberta.

A qualitative field study of health system reform in Alberta was undertaken to identify, describe, compare and contrast the processes of change management adopted and implemented as a result of legislated health policy shift. Chairs and chief executives of the new regional health authorities and provincial leaders managing the change processes within Alberta's health care system were interviewed. Components of change strategies important to the structure, process and impact of the health policy shift to a regionalized system of care were identified and analyzed. Stakeholders involved in managing change inside Alberta's health care system were able to consistently identify a range of issues important to beginning and sustaining health policy shift. These issues and insights did not come from the literature, but rather from experience. To test and share this experience further, it will be important to study more consciously the management of change in relation to expected outcomes. With so many natural experiments altering health care systems across Canada and beyond, a window of opportunity exists for researching both the quality and quantity of such change, comparing and sharing findings over time and, eventually, linking process to outcome.

Alberta↗
PubMed1995

Development, testing and implementation of an emergency services methodology in Alberta.

Alberta was the first province in Canada to mandate reporting of hospital-based emergency services. This reporting is based on a workload measurement system that groups emergency visits into five discreet workload levels/classes driven by ICD-9-CM diagnoses. Other related workload measurement variables are incorporated, including admissions, transfers, maintenance monitoring, nursing and non-nursing patient support activities, trips, staff replacement, and personal fatigue and delay. The methodology used to design the reporting system has been subjected to extensive testing, auditing and refinement. The results of one year of province-wide data collection yielded approximately 1.5 million emergency visits. These data reveal consistent patterns/trends of workload that vary by hospital size and type. Although this information can assist in utilization management efforts to predict and compare workload and staffing levels, the impetus for establishing this system derived from its potential for funding hospital-based emergency services. This would be the first time that such services would be funded on a systemic, system-wide basis whereby hospitals would be reimbursed in relation to workload. This proposed funding system would distribute available funding in a consistent, fair and equitable manner across all hospitals providing a similar set of services, thus achieving one of the key goals of the Alberta Acute Care Funding Plan. Ultimately, this proposed funding methodology would be integrated into a broader Ambulatory Care Funding system currently being developed in Alberta.

Alberta↗
PubMed1992

Hospital reimbursement in Alberta: outcomes management is on the way.

The Alberta government has initiated a process to alter fundamentally the way it pays hospitals. As with most provinces, Alberta has been paying hospitals for what they spend. The new Alberta model will initially pay hospitals for what they do and ultimately will pay hospitals for what they ought to do; that is, for the outcomes that should be achieved. This article describes the initial step of what is expected to be a lengthy journey. The principles underlying the model are: it should be a prospective case-based system; there should be performance linkages between types of hospitals; severity should be incorporated into the model; and cost or cost proxies should be used where possible in weight development and clinical concerns, both nursing and medical, should be addressed. For the past two years funding adjustments have been made on the basis of the calculation of a Hospital Performance Index (HPI). The HPI is the average predicted cost per case divided by the unweighted average actual cost per case. The HPI is intended as an interim measure only. Ultimately, the system will evolve into a true prospective case-based system with volume controlled via role statements and linked to clinical outcomes.

Alberta↗