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PubMed1997

Heart health in rural Saskatchewan.

In Saskatchewan, as in the rest of Canada, cardiovascular disease (CVD) is the leading cause of death and hospitalization. Indeed, the rate of decline in mortality has been slower in Saskatchewan than in most other provinces. So when the federal-provincial Canadian Heart Health Initiative was established in 1986, the province set up the Saskatchewan Heart Health Program both to form part of the national initiative and to take advantage of the opportunities implicit in it.

Cardiovascular Diseases↗
PubMedDate not supplied

Hospital utilization of Saskatchewan people with fetal alcohol syndrome.

We describe the hospital utilization of 194 Saskatchewan persons with Fetal Alcohol Syndrome (88% Aboriginal), born between 1973-92. Complete provincial hospitalization data were obtained for 128 patients; partial data for 29 patients. Proportionately more persons missing data were adopted, not living with biological family members or were deceased. The hospital separation rates for the children with FAS, pooled from 1987-91, compared to the 1989-90 Saskatchewan rates were significantly higher (95% level of confidence) for males and females < 1 year, 1-4 years and 5-14 years of age. Relative to Saskatchewan Registered Indians, significantly higher hospitalization rate ratios were observed for males with FAS in all age groups and for females only age 5-14 years. Rate ratios for younger females may not have achieved significance because of missing data. Higher hospitalization rates in children with FAS may not be explained solely by factors associated with ethnicity.

Adolescent↗
PubMed1976

Saskatchewan dial-access drug information service.

In September 1974 the colleges of pharmacy and medicine of the University of Saskatchewan began offering a drug information service to the pharmacists and physicians of Saskatchewan without charge. With the help of a radio-page system, calls are taken immediately by experienced pharmacists and pharmacologists. The cost of long-distance phone calls is borne by grants from the Saskatchewan medical and pharmaceutical associations. During the 1st year of operation 415 requests for information were received. Of 93 persons who called up to Feb. 28, 1975, 76% responded to an evaluation questionnaire; virtually all described the service as very valuable. The information received resulted in the alteration of drug therapy in one third of calls requesting information to assist in current treatment of a patient.

Drug Information Services↗
PubMed2002

Prevalence of Giardia and Cryptosporidium and characterization of Cryptosporidium spp. isolated from wildlife, human, and agricultural sources in the North Saskatchewan River Basin in Alberta, Canada.

The environmental distribution of Giardia spp. and Cryptosporidium spp. is dependent upon human, agricultural, and wildlife sources. The significance of each source with regard to the presence of parasites in the environment is unknown. This 2-year study examined parasite prevalence in human sewage influent, wildlife, and agricultural sources associated with the North Saskatchewan River Basin in Alberta, Canada. Fecal samples were collected from cow-calf, dairy, and hog operations in the watershed area. Sewage-treatment facilities were sampled bimonthly during the 2-year study, and wildlife scat was collected at locations along tributaries of the North Saskatchewan River. All samples were analyzed for the presence of Giardia and Cryptosporidium, using sucrose-gradient separation followed by immunofluorescent microscopy. Giardia and Cryptosporidium were detected in all three sources. The lowest prevalence of both Giardia (3.28%) and Cryptosporidium (0.94%) was found in wildlife, with 6 of 19 species testing positive. Sewage influent had the highest prevalence of Giardia (48.80%) and Cryptosporidium parvum-like oocysts (5.42%); however, the concentration of both parasites was minimal compared with the concentration detected in cattle feces. Cow-calf sources contained the highest concentration of Giardia (mean 5800/g feces, P < 0.01), and dairy sources contained the highest concentration of C. parvum-like oocysts (mean 295/g feces, P < 0.01). Although prevalence and concentration are higher in cattle feces than in sewage, the Giardia and Cryptosporidium in animal manure do not have direct access to water draining into the North Saskatchewan River. PCR-based characterization of rDNA from isolates of Cryptosporidium collected from Alberta human, pig, calf, mature steer, dog, cat, and beaver hosts revealed distinct genetic differences that may reflect host specificity.

Animals↗
PubMed2001

Nursing and native peoples in Northern Saskatchewan: 1930s-1950s.

The aim of this research is to investigate the role of nurses in northern Saskatchewan Aboriginal communities in Canada between 1930 and the 1950s. During and after the war, the federal government began sharing its responsibilities for delivering health services to Indian communities with a growing system of provincial Public Health nursing stations. In northern Saskatchewan, interaction between Aboriginal peoples and the state health care system occurred primarily through provincial Public Health nurses permanently stationed at these outpost clinics. What was the role of nurses in these communities? How did federal Indian health policy influence nurses' behaviour? Based on the record available for Saskatchewan, it appears the outpost clinics delivered standard nursing care. It also appears that the federal government was eager to devolve its responsibilities for Indian health care to the province, and that its tenuous commitment to providing health care caused confusion in the treatment of patients.

Canada↗
PubMed1997

Reliability of the recording of schizophrenia and depressive disorder in the Saskatchewan health care datafiles.

Administrative data have long been used in psychiatric epidemiology and outcomes evaluation. This article examines the reliability of the recording of schizophrenia and depressive disorder in three Saskatchewan administrative health care utilization datafiles. Due to their comprehensive nature, these datafiles have been used in a wide range of epidemiologic studies. Close agreement was found between hospital computer data and patients' charts for personal and demographic factors (> or = 94.7%). Diagnostic concordance between computerized hospital data and medical charts was very good for schizophrenia (94%) but poor for depressive disorder (58%). Appropriate physician services were identified for 60% and 72% of hospital discharges for schizophrenia and depressive disorder, respectively, and exact diagnostic agreement between hospital and physician datafiles was 62% for schizophrenia and 66% for depressive disorder. Appropriate provincial mental health branch services were found for 83% and 38% of hospital discharges for schizophrenia and depressive disorder, respectively; exact diagnostic concordance between these datafiles was 75% for schizophrenia and 0% for depressive disorder. A significant number of patients with major or neurotic depression appeared to be wrongly coded as having depressive disorder in the hospital file. The differences in diagnostic agreement may also be partly a function of how the two conditions are differentially treated in the health system. These findings suggest that more specific and severe psychiatric diagnoses are likely to be recorded accurately and consistently in the Saskatchewan datafiles. However, disorders with multiple manifestations or those for which there are several possible codes should be examined with caution and ways sought to validate them. Attention should also be paid to which service sectors are involved in the treatment of specific disorders.

Adolescent↗
PubMed1999

Skeletal metastases in colorectal carcinomas: a Saskatchewan profile.

PURPOSE: Colorectal cancer is the third leading cause of cancer-related deaths in the world. Death is usually attributed to progress of the disease with recurrence and metastases. Skeletal metastases in primary colorectal cancer is an uncommon event. When such an event occurs, it is usually a late manifestation of the disease. In our study this phenomenon is analyzed in a population-based database. METHODS: This report is a 25-year retrospective review that covers patients with skeletal metastases secondary to colorectal carcinomas registered at The Saskatchewan Cancer Foundation from 1970 to 1995. The latter is the sole registration agency of all cancers in the one million population base of the province of Saskatchewan. RESULTS: A total of 5,352 cases of primary colorectal carcinomas were seen between 1970 and 1995. Of these, 355 had skeletal metastases. The incidence of osseous metastases in our institution is 6.6 percent. Among the latter, 60 cases (16.9 percent) had skeletal metastases only, whereas 295 cases (83.1 percent) had skeletal metastases in combination with lung, liver or brain metastases. This is in keeping with the fact that solitary skeletal metastases from a primary colonic carcinoma is a rare event, with an incidence of 1.1 percent in our institution. The disease-free interval from the time of diagnosis of the cancer to the onset of skeletal metastases ranged from 10 days to 5,309 days. Thirty-eight percent of the cases with skeletal metastases only were alive at the end of five years in comparison with 16 percent of the cases with skeletal and other metastases. However, there was no significant difference in the ten-year survival curves from the onset of osseous metastases in the two groups. The majority were diagnosed by a bone scan or plain radiography or both. Most cases in our institution received a multimodal treatment consisting of radiotherapy in conjunction with palliative surgery or chemotherapy or both. Radiotherapy was, however, the most effective therapy for painful skeletal metastases. CONCLUSION: Skeletal metastasis is a rare event in primary colorectal carcinomas. Among these cases there is an emerging trend of a different clinical-biological behavior pattern between patients who develop solitary skeletal metastases vs. patients with skeletal and other organ metastases.

Adult↗
PubMedDate not supplied

Trends in invasive cutaneous melanoma in Saskatchewan 1970-1999.

BACKGROUND: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possible anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. OBJECTIVE: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. METHODS: Information about cases of primary cutaneous melanoma for the 30-year period 1970-1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. RESULTS: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors tht predicted excess mortality at five years were tumor thickness, Clark level, and gender. CONCLUSION: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristic (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.

Chi-Square Distribution↗
PubMed1975

Mercury levels in whole blood of Saskatchewan residents.

The study was undertaken to establish whole blood mercury levels in the Saskatchewan population and to identify characteristics of individuals with higher blood levels. The mean blood mercury level was 6.7 ng/ml, the median level 5 ng/ml and the range 1 to 42 ng/ml. Native persons living in northern Saskatchewan who had recently eaten local fresh-water fish had the higher levels. A greater consumption of fish and higher blood mercury levels were recorded during the fresh-water fishing season.

Adolescent↗
PubMed1988

Fatal upper gastrointestinal hemorrhage or perforation among users and nonusers of nonsteroidal anti-inflammatory drugs in Saskatchewan, Canada 1983.

We report a cohort study of fatal upper GI hemorrhage and/or perforation in relation to use of nonsteroidal anti-inflammatory drugs (NSAIDs) among the one million residents of Saskatchewan Canada in 1983. All hospitalized cases of GI hemorrhage and/or perforation with a fatal outcome were identified using the records linkage system of the Saskatchewan Department of Health. Discharge summaries and autopsy records were reviewed to select the cases of upper GI hemorrhage or upper GI perforation and to exclude cases in which known risk factors were present. The 134,060 residents who filled one or more prescriptions for an NSAID in 1983 were identified and individually linked to their hospital records by patient identification number. The age- and gender-specific incidence of fatal upper GI hemorrhage and/or perforation in the absence of risk factors in users was compared to that in nonusers, controlling for recent history of upper GI disease. Fatal upper GI hemorrhage or perforation in temporal association with NSAIDs is extremely rare in persons younger than 75 years of age. No temporally-related cases occurred in male NSAID users age 75 and older, but NSAID usage in this group was limited. Among women age 75 and older, the rate in users was higher than in nonusers, with the highest rate being in female NSAID users age 75 and older with a recent history of upper GI disease. Total mortality among women age 75 and older was slightly lower among users than among nonusers. Physicians who prescribe NSAIDs to patients age 75 and older should be aware of the potential risks, particularly in those with predisposing factors such as a history of upper GI disease.

Adult↗
PubMed1993

Record linkage to conduct an epidemiologic study on the association of rheumatoid arthritis and lymphoma in the Province of Saskatchewan, Canada.

The objective of this effort was to assess the utility of the large automated database in Saskatchewan as a resource for pharmacoepidemiologic studies. To this end a study was undertaken to test the hypothesis that rheumatoid arthritis (RA) increases the risk of cancer, especially lymphoma. This was done by performing a retrospective cohort study based on record linkage data from Saskatchewan Health. From hospital discharge diagnoses in the hospital file an exposed group (RA) and two comparison groups matched to the RA group by age and sex were identified: (1) the RA group consisted of people with a discharge diagnosis of rheumatoid arthritis; (2) the osteoarthritis (OA) group consisted of people with OA discharge diagnoses; and (3) a comparison (CN) group consisted of hospitalized people with no discharge diagnoses of arthritis. Drug exposures were determined by linkage with the Prescription Drug File, cancer outcomes were determined by linkage with the Cancer Foundation file, and length of eligibility in the health plan and demographics information were determined by linkage with the registration file. The data were checked for quality of linkages across files and consistency with study definitions. Of 13,333 identified subjects, 2.8% were excluded because of apparent incorrect assignment to study group or age group or because of ineligibility in health plan during the study period. In order to decrease the possibility of misclassification of exposure (rheumatoid arthritis), hospital discharge diagnoses were used to exclude subjects with any inflammatory rheumatic diseases (IRD) from the CN (7.8%) and OA (8.3%) groups and subjects with IRD other than rheumatoid arthritis (4.6%) from the RA group. To decrease selection bias, those who had cancer within 1 year of enrollment (to exclude those in hospital because of symptoms of undiagnosed cancer) were excluded. Because RA subjects hospitalized by a rheumatologist were most likely to have valid rheumatoid arthritis diagnoses, each analysis was run twice: once with the entire RA group (N = 1210) and once with those in the RA group who were rheumatologist-hospitalized (N = 646). Logistic regression of incidence was used to control for age, sex, and use of individual disease-modifying anti-rheumatoid drugs (DMARDs). For the rheumatologist-hospitalized RA group compared to the CN group, a significant 4-fold greater risk for lymphoma/myeloma was detected when DMARD use was not controlled for, and a 3.4-fold increase in risk was detected even when use of individual DMARDs was controlled for.(ABSTRACT TRUNCATED AT 400 WORDS)

Arthritis, Rheumatoid↗
PubMed1995

Increased asthma hospitalizations among registered Indian children and adults in Saskatchewan, 1970-1989.

We investigated asthma morbidity in children and adults among Registered Indians in Saskatchewan using hospitalization data for 1970-1989. In Registered Indians, significant increases were observed in the asthma hospitalization rates from 1979 to 1989 in boys and girls under 4 years, boys aged 5-14 years, and female adults aged 15-34 years respectively. In children under 4 years, the asthma hospitalization rates increased from 12.7 per 1000 in 1979 to 21.7 per 1000 in 1989. Asthma hospitalizations were higher among Indian boys than girls in the age group 0-4 years but this was reversed in the age groups 15-34 and 35-64 years. When compared with other Saskatchewan populations, the Indian population in age groups 0-4 and 35-64 years had significantly increased risk for hospitalization for asthma. Even though asthma was reported to be rare among Indians before 1975, we observed increases in asthma morbidity in recent years among Indian children and young adults.

Adolescent↗
PubMed1999

Closing rural hospitals in Saskatchewan: on the road to wellness?

Rising health care costs at a time of economic stagnation, federal cutbacks to Medicare, and an obsession with budget deficits at all levels of government have contributed to a sense of urgency to reform the Canadian health care system. Accompanying these economic and political motivations for reform, has been a shift in our understanding of health and well-being that lays less emphasis on the institutionalization and medicalization of health care. As part of its wellness approach to health, the Saskatchewan government in 1992 announced the closure and conversion of 52 small rural hospitals to wellness centres as part of a shift from institutional care to community based care. While the health costs and benefits of this shift are contested, the paradox is that closing rural hospitals may have unrealized health and social costs because of the psychological and community importance of hospitals to the meaning of place. This paper begins with a review of the meaning and importance of local institutions for communities. It is clear from this starting point that the debate about the economic and health benefits and costs of rural hospital closures is a limited basis for understanding hospital closures. Finally, the history of Saskatchewan hospitals and a narrative of the recent closures of rural hospitals drawn from a sampling of provincial newspapers and oral discussions highlights the need to understand the hospital closure in terms of its impact on health irrespective of the medical impacts.

Health Facility Closure↗
PubMed2000

Assessing the Saskatchewan database for outcomes research studies of depression and its treatment.

This study was conducted to evaluate the validity of using the Saskatchewan Health administrative claims databases for conducting depression research. To develop a claims-based definition of depression, we identified a cohort of individuals who began a "new" period of antidepressant use (no use 180 days prior) from which we selected a stratified random sample (n = 600) for medical record abstraction. The medical record diagnosis was used as the gold standard for judging our database definitions of depression. After defining a primary database definition of depression, we tried to refine it using medically probable scenarios and assessed refinement by agreement statistics. Defining depression with ICD9 codes 296 (affective disorders), 309 (adjustment reaction), and 311 (depressive disorders), the sensitivity (Se), specificity (Sp), positive (PV+) and negative predictive (PV-) values were: 71%, 85%, 86%, and 70%, respectively. Algorithms that limited the number of false-negatives resulted in: Se = 84% and PV- = 77% whereas those that limited false-positives resulted in: Sp = 90% and PV+ = 86%. Although our depression definition requires treatment with antidepressants, this definition will allow us to conduct future studies of depression and its treatment using the Saskatchewan Health databases.

Adult↗
PubMed1977

Effect of surveillance on the number of hysterectomies in the province of Saskatchewan.

In 1972 the College of Physicians and Surgeons of Saskatchewan appointed a committee to study hysterectomies because the Saskatchewan Department of Health had data showing that the annual number of hysterectomies carried out in the province had increased by 72.1 per cent between 1964 and 1971, whereas the number of women over 15 years of age had increased by 7.6 per cent. The committee compiled a list of indications for hysterectomy. Any hysterectomy carried out for one of these reasons was classified as justified, and the remainder as unjustified. Five hospitals were reviewed in 1970 and a further two in 1973. In 1974, all seven hospitals were reviewed again. In these hospitals, the average proportion of unjustified hysterectomies had dropped from 23.7 per cent at the time of the first review to 7.8 per cent in 1974. The total number of hysterectomies in the province dropped by 32.8 per cent between 1970 and 1974.

Adolescent↗
PubMed1990

Statistical analysis of gamma-emitting radionuclide concentrations for three fields in southern Saskatchewan, Canada.

During 1988, the spatial variability of the natural gamma-emitting radionuclides (238U, 232Th, and 40K) and the artificial radionuclide 137Cs were studied in three near-level unfertilized fields in Saskatchewan, Canada. One field was used as a native (uneroded) control site; the other two sites have been cultivated, one since 1979 and the other since at least the 1940s. The two cultivated sites have been eroded by aeolian processes and tillage practices. Autocorrelation analysis indicated that most of the radionuclides were not serially correlated for the two depth increments sampled (0-15 cm and 15-30 cm). Autocorrelation is a necessary procedure when equally spaced transect sampling is employed, since sample independence cannot be assumed. Robust and nonrobust statistical summaries are presented for the selected gamma-emitting radionuclide concentrations. Robust statistical estimates of location and dispersion are favored when distributions are not normal or when the distribution is skewed. Median concentrations for the three fields indicated that 238U, 232Th, 40K, and 137Cs were similar to areas in the U.S. and to other areas in southern Saskatchewan. Median 238U activity concentrations were between 31.4 and 34.1 Bq kg-1; 232Th concentrations were between 29.6 and 31.2 Bq kg-1; 40K concentrations were between 471 and 502 Bq kg-1; and 137Cs concentrations were between 10.0 and 12.6 Bq kg-1. The variability of natural radionuclides in a given field for a specific depth increment was generally low, with coefficients of variation less than or equal to 10%. The variability of 137Cs concentrations was greater, ranging from 18% to 23%. Nonparametric tests indicated a significant decrease in 214Bi concentration (238U indicator corrected for 222Rn) with depth of the 1979 field, and an increase in 228 Ac (232Th) with depth in the 1940s field. Significant differences in concentration between fields were indicated for all radionuclides except for 228 Ac. The possible reasons for differences in depth and between fields are briefly discussed.

Cesium Radioisotopes↗
PubMed1995

Cohort study of incidence of sudden unexplained death in persons with seizure disorder treated with antiepileptic drugs in Saskatchewan, Canada.

To measure the incidence of sudden unexplained death in treated persons with epilepsy (SUDEP) and to identify risk factors for SUDEP, a cohort of 6,044 persons aged 15-49 years with more than four prescriptions for antiepileptic drugs (AEDs) was identified from the Saskatchewan Health prscription drug file. To exclude subjects whose sudden deaths (SUDs) might be misattributed to another chronic underlying disease, subjects with hospitalizations for cancer or heart problems were excluded. To exclude subjects without epilepsy, subjects with > 2-year AED treatment followed by AED-free time and subjects receiving < 1 U/day were excluded. The final cohort consisted of 3,688 subjects. Follow-up was started at the first AED prescription listed in the prescription drug file and ended at the earliest of the following: age 50 years, death, or last registration in the Saskatchewan Health. For 153 of 163 deaths occurring in the cohort, copies of anonymized death certificates were obtained and copies of anonymized autopsy reports of potential SUDEP cases were examined. There were 18 definite/probable SUDs and 21 possible SUDEPs, yielding a minimum incidence of 0.54 SUDEP per 1,000 person-years and a maximum of 1.35 SUDEP per 1,000 person-years. SUDEP incidence increased with male sex, number of AEDs ever prescribed, and prescription of psychotropic drugs and was highest in males with a history of treatment with three or more AEDs and four or more psychotropic drug prescriptions. Poisson regression showed a 1.7-fold increase in risk of SUDEP for each increment in maximum number of AEDs administered, a likely surrogate for severity and persistence of seizures.

Adolescent↗
PubMed2004

What doesn't kill you makes you stronger: determinants of stress resiliency in rural people of Saskatchewan, Canada.

PURPOSE: This article discusses a research study that explored how rural people in Saskatchewan, Canada, respond to stressful events and adversity, without outside interventions. METHODS: In-depth interviews were conducted with 17 individuals who were living or had lived on a farm in Saskatchewan. The participants' definitions of resiliency, their experiences with resiliency or lack of resiliency, and what they identified as the barriers to and enhancers of resiliency in their lives were discussed. FINDINGS: Resiliency was defined as a process and interactive model that included "bouncing back" from adversity, coping, and acquiring skills, such as problem solving and learning. Resiliency was dynamic, temporal, and relational and was both proactive and reactive. There were both internal and external barriers to and enhancers of resiliency. Barriers to resiliency included fear, isolation, and depopulation, whereas enhancers included resources, support, and control. CONCLUSIONS: Traditional resiliency models are not sufficient for understanding resiliency. It is clear that social, political, and economic factors play an important role in the resiliency and health of people who live in rural areas. A conceptualization of resiliency must be embedded in a social context and include community factors. Recommendations for enhancing resiliency, such as sustaining rural life, supporting families, and providing services, are also discussed.

Adaptation, Psychological↗