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PubMed2003

Increasing incidence of non-Hodgkin's lymphoma in Canada, 1970-1996: age-period-cohort analysis.

Previous studies have shown that the incidence of non-Hodgkin's lymphoma (NHL) has increased in many parts of the world in recent decades. Using data obtained from the Canadian Cancer Registry, the present study examined time trends in NHL incidence in Canada between 1970 and 1996 and the effects of age, period of diagnosis and birth cohort on incidence patterns for each sex separately. Results showed that overall age-adjusted incidence rates increased substantially, from 7.3 and 5.2 per 100,000 in 1970-1971 to 14.0 and 10.0 per 100,000 in 1995-1996 in males and females, respectively. Diffuse lymphoma was the major histological subtype, accounting for approximately 76% of NHL cases over the 27-year period. The data suggest that period effects have played a major role, although birth cohort effects may also have been involved. Sex-specific patterns of the incidence were similar over the time period of diagnosis but were distinct among recent birth cohorts. In conclusion, there is in fact a marked increase in NHL in Canada which cannot be explained in terms of improvements in diagnosis, changes in NHL classification and the increase in AIDS-associated NHL alone. The birth cohort effect in NHL suggests that changes in risk factors may have contributed to the observed increase.

Adolescent↗

PubMedDate not supplied

The economic impact of smoking in Canada.

A cost-benefit analysis of smoking, using an attributable risk approach, has been carried out for Canada and for three regions within Canada. The total cost of the consequences of tobacco use--in terms of extra deaths, disability, hospitalization, physician services, and fire losses due to tobacco use--in all cases exceeded the total consumer expenditure for tobacco products. The excess was estimated to have a range from $14 to $127 (1983 Canadian dollars) per person per year. This represents the amount that an individual in society would gain, on average, if tobacco use was eliminated from the society for one year. Tobacco use was also found to be responsible for 12 to 17 per cent of all adult deaths, 4 to 5 per cent of all adult disability days, 12 to 14 per cent of all days of hospitalization, and 2 to 3 per cent of all physician visits.

Canada↗

PubMed1992

Breast cancer in Canada: to screen or not to screen?

Lomas (1988) and Sabatier (1987) have suggested models by which to examine the roles that values, scientific knowledge, institutions, and the learning process play in the formulation of both national and clinical health-care policies. Utilizing their frameworks, this article offers an explanation for the development of high-volume screening mammography policies in Canada, despite the suggested inefficacy of screening technologies for 'unavoidable' illnesses such as carcinoma in the breast. The preliminary results of Canada's National Breast Screening Study further complicate this tissue. Inappropriate framing of the 'problem' in the policy-making process, by actors highly influenced by societal values and scientific evidence, is identified as the reason for present and planned policies and practices contradicting the first principles of health-policy analysis.

Adult↗

PubMed1976

Mortality from cancer of the uterus in Canada and its relationship to screening for cancer of the cervix.

Age-standardized death rates at ages 30-64 from cancer of the uterus in the 10 provinces of Canada have been assessed in 1950-52, 1960-62 and 1970-72, and changes in rats over these periods related to screening for cancer of the cervix and variables derived from the censuses of 1961 and 1971. Death rates at the county and census division level have also been assessed for the provinces of Nova Scotia, Quebec, Ontario, Manitoba and Alberta for 1960-62 and 1970-72 and related to screening and census-derived variables. There is little indication of a contribution of screening to the fall in death rates that occurred in eight of the 10 provinces from 1950-52 to 1960-62. There is, however, evidence of an important and significant contribution of the intensity of screening (as indicated by the number of cervical cytology examinations conducted in 1966 expressed as a rate per 1,000 female population aged 20 or more) to the fall in death rates at both the provincial and county or census division levels from 1960-62 to 1970-72, and this effect is not abolished by taking the census-derived variables into account. It is concluded that a significant effect of intensity of screening on the reduction in mortality from cancer of the uterus in Canada in the age-group 30-64 over the period 1960-62 to 1970-72 has been demonstrated.

Adult↗

PubMed1981

The effect of hysterectomies and screening on mortality from cancer of the uterus in Canada.

The trends in mortality from cancer of the uterine cervix, cancer of the endometrium and all uterus in Canada and the ten Canadian Provinces from 1951-53 to 1974-76 at ages 30-64 have been re-evaluated in relation to screening for cancer of the cervix in 1966 and 1971 and hysterectomies for non-malignant conditions from 1969 to 1976. By means of series of mathematical models, the effect of different prior extrapolations of the numbers of hysterectomies performed by age and province has enabled the potential impact of hysterectomies on the trends of mortality from uterine cancer to be evaluated by relating deaths to "uteri at risk" rather than "women at risk" irrespective of the presence of an intact uterus. It has been found that the numbers of hysterectomies performed have little impact on the fall in mortality certified to cancer of the cervix or to all uterine cancer, but in the decade 1964-66 to 1974-66 they convert an apparent fall in mortality from cancer of the endometrium to stability. Re-evaluation of the fall in mortality from 1960-62 to 1970-72 in relation to the intensity of screening shows little impact of the hysterectomies performed on the significant correlation reported previously. However, after extension of the analysis to 1974-76 the correlation disappears. This finding may indicate a more limited potential for the application of screening, as practised in Canada, to reduce mortality from cancer of the cervix, than has been anticipated previously.

Adolescent↗

PubMed1990

On being ethnic: the politics of identity breaking and making in Canada, or, nevra on Sunday.

The creation of ethnically sensitive health care is a major federal and provincial government concern in Canada at present. The concept of multiculturalism is used to reinforce the notion of rights for minority groups and the Canadian mozaic is explicitly contrasted with the American melting pot. In this paper, the lives of Greek immigrant women in Montreal are used to illustrate how class and gender are as relevant to the immigrant experience as is ethnicity. It is shown how values which were central to female identify in Greece can become a liability after immigration and how the notion of Greek identity in Canada is a fluid category which is subject to repeated transformations. It is suggested that medical anthropologists who ignore the complexity of social categories and whose focus is limited to the cultural construction of illness and the expression of distress are in danger of reinforcing a notion of the "quaint ethnic," a stereotype to which the concept of multiculturalism is often reduced.

Acculturation↗

PubMedDate not supplied

Health care system and medical education in Canada. 1. Review of the health care context in a time of change.

Over the past three decades Canada has developed an exemplary system of universal health care. However, current financial constraints threaten to undermine the very foundation of the system that represents Canada's respect for social justice. The first of these two articles (Part 1) discusses the unique characteristics of the system, a comparative view of universal health care systems, the reaction of the medical profession to governmental control, and finally the funding and manpower shortages that are compelling a review of the values and organization that have sustained the system thus far. The second article (Part 2) reviews the organization and funding of medical education and the impact of some critical changes in the health care system on postgraduate medical education. Issues related to new licensure and certification requirements, changing population demographics and approaches to health care delivery, manpower needs, and the attitude and expectations of the public are discussed.

Canada↗

PubMedDate not supplied

Health care system and medical education in Canada. 2. Impact of changes in the health care system on medical education.

Canada↗

PubMed1991

Review of human and animal cases of coccidioidomycosis diagnosed in Canada.

The first Canadian case of coccidioidomycosis in a human was reported in 1952 and 11 more cases since then. This study provides details of other cases of coccidioidomycosis that have been diagnosed in Canada. Based on clinical details, isolation of Coccidioides immitis, detection of a specific antibody (F band) for coccidioidomycosis by macro- or microimmunodiffusion tests, concurrently used with the complement fixation procedure, and histopathological findings, 116 more cases of this disease were verified. The great majority (94%) of these cases were diagnosed in the western Canadian provinces of British Columbia, Alberta, Saskatchewan and Manitoba, and the others in Quebec, Ontario and Nova Scotia (5, 1, and 1 cases, respectively). Available information indicates that the C. immitis infections were contracted during visits to endemic areas in the United States (Arizona, California and New Mexico), Mexico, and Bolivia. Pulmonary infections were the most common type of coccidioidomycosis (93%) followed by the disseminated or meningeal types C. immitis infections occurred in individuals with or without predisposing factor(s) and were more common in males than in females. The exoantigen procedure was very useful and reliable in the accurate and rapid identification of suspected C. immitis isolates. Two cases of coccidioidomycosis were reported in animals in Ontario, Canada.

Aged↗

PubMed1988

A case report on a minor contamination of nivalenol in cereals harvested in Canada.

An investigation for the occurrence of nivalenol (NIV), deoxynivalenol (DON) and zearalenone (ZEN) in cereals (ten wheat, one rye and one corn) harvested in Canada have been carried out using a procedure, which is rapid and sensitive for Fusarium mycotoxins. NIV, DON and ZEN were detected in 4, 9 and 9 out of ten wheat samples, and their average levels in the positives were 23 ng/g, 1257 ng/g and 9 ng/g, respectively. One rye and one corn were also contaminated with a minor amount of NIV. This is the first evidence for the natural occurrence of NIV in cereals grown in Canada, though its level was far less than DON.

Canada↗

PubMed1994

Pulmonary penicillosis marneffei: report of the first imported case in Canada.

A 57-year-old female, born in Laos and who had lived in Thailand prior to immigrating to Canada in 1989, was seen by her physician with a chief complaint of cough and dyspnea. Her chest X-ray showed bilateral pulmonary air fluid levels. A fungus, with a diffusible red pigment, tentatively identified as Penicillium marneffei, was isolated from the patient's bronchial washings and sputum specimens. At 37 degrees C, the fungus converted to a yeast form when cultured on brain heart infusion agar. Microscopic examination of this culture revealed yeast cells that reproduced by fission. The identity of the patient's isolate was confirmed as P. marneffei with an exoantigen test. The patient's serum demonstrated specific antibodies to P. marneffei antigen. Treatment with amphotericin B and ketoconazole resulted in clinical improvement, clearing of chest X-rays and conversion to sero-negativity. Our case is the first recorded diagnosis of imported penicillosis marneffei in Canada. The minimal inhibitory concentrations recorded for the patient's isolate to fluconazole, 5-fluorocytosine, itraconazole and miconazole were 12.5, 0.39, < 0.195 and < 0.195 micrograms/ml, respectively.

Amphotericin B↗

PubMed1979

Universal health insurance in Canada: history, problems, trends.

This paper describes the universal health insurance program in Canada and identifies the historical events and social values leading to its adoption. Universal hospital insurance was adopted in 1958, ten years before medical insurance, as a result hospital-based patterns of practice were solidified. Through cost sharing, the federal government influenced the provinces to enact relatively uniform universal plans. From 1951 to 1971 health care expenditures rose rapidly to 7.3% of the gross national product (GNP), but have since decreased and stabilized at about 6.9%. In contrast, health care in the United States represents 8.6% of GNP. Hospital use also increased rapidly in Canada to 1970 but appears to have stabilized and decreased slightly in this decade. Physician incomes rose rapidly before 1971, but since then the increases have slowed and relative incomes of physicians have fallen. Althouth the percent of GNP spent for health care has leveled, there are still substantial annual increases in expenditures that are paid for by government. Two federal initiatives, Bill C-37 and the Lalonde Report, have their roots in cost containment; Bill C-37 transfers greater taxing authority from the federal government to the provinces. To meet the goal of containing costs, provincial governments are moving in the direction of regionalization, decentralization, and greater coordination. In the short term, the provinces have limited hospital budgetary increases to percentages less than the rate of inflation. Cost constraints may be long overdue. Imposing fiscal limits encourages rational planning. It does not appear that the health of Canadians will be adversely affected or essential benefits curtailed by present budgetary restrictions or reorganization.

Adult↗

PubMed1994

Pandemic planning in Canada.

A Canadian plan for pandemic influenza was completed by the National Advisory Committee on Immunization in 1988. Its development took several years and involved consultation with provincial public health and laboratory authorities, the licensing body, manufacturers of influenza vaccine and antiviral agents, and representatives in the USA and UK. Key decisions in creating the pandemic plan include: (1) aiming for federal-provincial consensus on use of vaccine and antiviral drugs, (2) a selective vaccination approach (high-risk persons plus essential workers), (3) bulk purchasing and distribution of vaccine through the public sector, (4) leaving antiviral drugs on the open market, (5) careful planning of the communications strategy, and (6) increasing inter-pandemic use of flu vaccine in target groups. The plan addresses recognition of a pandemic; activation of a Pandemic Influenza Committee whose membership and responsibilities are spelled out; the federal-provincial decision making process; influenza vaccine considerations; amantadine and other antiviral agents; estimates of target group size, vaccine uptake, manufacturing capabilities and time frames; and communication considerations. Since 1988, influenza vaccine use has increased considerably in Canada and experience has been gained with amantadine. Manufacturing capability within Canada for influenza vaccine has also been enhanced. It is now time to update the plan, especially the targets, and to make sure that everyone involved remains aware of the assigned roles.

Amantadine↗

PubMed1994

Malpractice in pediatric radiology: a survey in the United States and Canada.

A survey of the chairmen of pediatric radiology departments in children's hospitals in Canada and the United States was undertaken to gain data on the subject of malpractice in pediatric radiology. Sixty-two members of the Society of Chairmen of Radiology in Children's Hospitals (SCORCH) were surveyed. Forty-two surveys (65%) were returned for analysis. Malpractice premiums paid per pediatric radiologist per year ranged from $499-$29,000 (mean $8,630). Twenty-eight malpractice claims were reported from 1980 to 1992. The largest number of claims involved gastrointestinal/abdomen and chest examinations, areas that were perceived as low risk by the respondents. The incidence of lawsuits against pediatric radiologists in the midwest was statistically higher compared to Canada (p < 0.05). Private practice models had a statistically greater incidence of malpractice suits compared to university practice models (p < 0.04). No statistical difference between the number of malpractice suits and the number of examinations performed per year or the number of pediatric radiologists in the group was found. We concluded that pediatric radiologists run the risk of malpractice claims. This data may aid in lessening this risk in the future.

Analysis of Variance↗

PubMed1980

St. René: the Patron Saint of Anaesthetists and a Patron Saint of Canada.

René Goupil, the Patron Saint of Anaesthetists, and a Patron Saint of Canada, was born in Angers, France in 1608 and studied surgery. He joined the Jesuits as a donné or volunteer worker in 1640 and served in the then tiny colony of Quebec as one of the first medical workers of Canada. After earning meritorious praise for his skills, he again volunteered to attend the Hurons at Sainte Marie, a mission far beyond the frontiers. René's canoe party was ambushed. He was captured by the Mohawks and endured eight weeks of cruel torture before being killed on September 29, 1642. René was the first of eight North American martyrs whose dedication was recognized by canonization in 1930. St. René was appointed Patron Saint of Anaesthetists in 1951.

Anesthesiology↗

PubMed1978

Major issues facing academic departments of anaesthesia in Canada.

Two conditions must be present for a successful and strong department: (1) the utilization of operating rooms must be efficient, patient volume must be adequate and turnover rate be rapid, if the clinical income of academic staff is to be equal to that of nonacademic anaesthetists. This is really difficult with the surgical teaching that takes place in teaching hospital operating rooms. But if university hospital operating rooms are not comparably efficient, clinical incomes for academic anaesthetists are not competitive to private practice. (2) the university (i.e. the provincial government) must pay staff adequately for their academic time so that high-grade people will accept and stay in academic posts. Part-time staff deserve to be remunerated for their contributions, whatever the magnitude, or motivation to do it is minimal. If these basic criteria of financing a department are fulfilled, development of the academic functions will follow. Strong academic departments will be producing the capable anaesthetists to fulfill the manpower needs of our specialty in Canada. If not, more departments will atrophy and the manpower situation for anaesthetists in Canada will be in an acute crisis.

Anesthesiology↗

PubMed1980

Anaesthesia for day-care surgery: a symposium (I). Day-care surgery in Canada: evolution, policy and experience of provinces.

Day-care surgery is a good alternative to conventional inpatient surgery. In Canada, all the provinces have day-care surgery programmes and British Columbia has a highly developed province-wide programme accounting for about 27 per cent of all operations; approximately 44 per cent of all operations in British Columbia could be done in day-care. Extrapolation of these figures nationally for the year 1975 indicates that Canadians could have saved approximately $209 million in hospital care by day-care surgery for all operations of the 25 procedures most commonly done in day-care. Further, if five other procedures which are suitable for day-care surgery had been so managed, there would have been a further potential of saving $62 million in Canada. Apart from economic justification, day-care surgery provides high quality care and is acceptable to patients and providers.

Ambulatory Surgical Procedures↗

PubMed1993

Anaesthesia equipment safety in Canada: the role of government regulation.

Medical device problems as detected by the Health Protection Branch (HPB) of Health and Welfare Canada were studied in order to examine the frequency and safety priority of problems in the subgroup of anaesthesia devices. Data pertaining to the time period from April 1, 1987 to November 30, 1992 were gathered from the Medical Devices Notification Database and the DAFFY Reporting System. The Medical Devices Notification Database contains all notifications for newly marketed medical devices in Canada and the DAFFY Reporting System keeps record of all submitted problem reports and manufacturer recalls along with their designated safety priority status. When an important safety hazard is associated with a medical device as determined from information submitted to HPB, an Alert-Medical Devices may be issued to inform hospitals and health care professionals of the problem. During the studied time period, the percentages of problem reports and recalls as well as Alerts were compared with the percentage of newly marketed anaesthesia devices. It was found that although only 2.3% of the newly marketed medical devices were classified as anaesthesia devices, 8.6% of all problem reports/recalls and 37.5% of all Alerts originated from the field of anaesthesia devices. Comparison of the percentages of problem reports/recalls (8.6%) and Alerts (37.5%) with the percentage of marketed devices for anaesthesia (2.3%) showed differences (P < 0.05). As well, the percentage of class I priority (the highest safety priority) problem reports/recalls for anaesthesia devices was 10.2% compared with 4.9% for non-anaesthesia devices (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesiology↗