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PubMed2000

Vision standards for driving in Canada and the United States. A review for the Canadian Ophthalmological Society.

We review the vision requirements for driving with the goal of revising current Canadian Ophthalmological Society (COS) recommendations for vision standards for driving. The report comprises two sections. In the first section we report the results of a survey of transportation authorities in Canada and the United States conducted on behalf of the COS to determine the current standards and medical review procedures. The results suggest that although the standards in Canada are more consistent than those in the United States, few of the standards in either country are evidence-based. In the second section we review the recent literature on visual function and driving. We conclude from this review that adequate contrast sensitivity is as important as, if not more important than, good visual acuity for driving and that there is little evidence to support a monocular standard for acuity, contrast sensitivity or visual field. Although there is evidence that the extent of a visual field defect is related to the ability to perform driving tasks, there is little evidence to suggest a relation between the location of the visual field defect and fitness to drive.

Automobile Driving↗
PubMed1996

Survey of clinical pharmacology training in the United States and Canada.

A survey of 139 medical schools in the United States and Canada was conducted in 1993-1994 to determine where active training programs in clinical pharmacology were located. A secondary survey of clinical pharmacology program directors followed in 1994-1995. Thirty-nine active programs were identified where 113 fellows (84 physicians and 29 nonphysicians) were enrolled. Sixty-eight percent of current physician fellows were trained in internal medicine before they entered their clinical pharmacology program. Forty-four percent of trainees were reported to be U.S. citizens. Fewer than 20 fellows complete training each year. The reported content of training programs was 12% didactic, 72% research, 12% clinical service, and 9% supervised teaching. Funding sources for trainees varied considerably. Nearly 50% of trainees were supported all or in part by funds from the National Institutes of Health (NIH), and approximately 40% relied on international sources of support. No correlation between salary and funding source or fellow degree was found. Nearly two-thirds of recent program graduates obtained employment in an academic setting, whereas 15% entered the pharmaceutical industry. These data indicate that subspecialty training in clinical pharmacology is available at 39 medical schools in the United States and Canada. Current fellowship training is primarily research based and nearly equally supported by NIH and international sources.

Canada↗
PubMed2003

Trauma-care systems in Canada.

Injury is a leading cause of morbidity and mortality in Canada and health-care costs associated with injury and trauma are significant. Trauma systems and standards have been defined by the Trauma Association of Canada. A National Trauma Registry has also been introduced, which has become an important resource for measuring the impact of this condition. The Registry has also been an important tool for trauma-centre quality control and assessment. The strengths of organized Canadian trauma care are described, as are current challenges.

Adult↗
PubMed2000

Attitudes, management and consequences of nausea and vomiting of pregnancy in the United States and Canada.

BACKGROUND: Nausea and vomiting of pregnancy (NVP) affects a large proportion of pregnant women. In 1983, Bendectin((R)), the only FDA-approved drug for NVP, was removed from the market by its manufacturer due to legal costs based on claims of teratogenicity, which were subsequently proven to be unsubstantiated. In Canada, a generic form of Bendectin (Diclectin; a doxylamine/pyridoxine combination) has continued to be available, with increasing use over the last few years. OBJECTIVE: To characterize the attitudes, management and consequences of NVP among pregnant women in the USA, where no approved drug for NVP is available, and in Canada, where such a drug is available. DESIGN: Prospective, observational study. RESULTS: Women suffering from NVP (N = 1444) were interviewed, of which 42% were American and 58% were Canadian. The two groups had similar maternal characteristics and a similar distribution of severity of NVP, although among Canadian women the NVP continued for slightly longer. American respondents were treated significantly more often by an obstetrician as their primary caregiver, were more commonly advised by their caregiver to change their diet and/or lifestyle and to use non-pharmacological agents to manage their NVP, and more often perceived anti-emetics as posing an increased risk for malformations (all P < 0.001). Canadian respondents reported a family physician as their primary caregiver significantly more often, were more commonly advised to take anti-emetic medications and perceived their NVP as causing a concern to their unborn (all P < 0.001). American women experienced significantly larger weight loss, more hospitalizations and more time lost from paid work. CONCLUSIONS: Lack of an approved drug for symptoms of NVP may be associated with unwarranted and preventable adverse health effects. Because this is an observational study, these associations do not necessarily prove causation.

Adult↗
PubMed2002

The experiences of professional nurses who have migrated to Canada: cosmopolitan citizenship or democratic racism?

This interpretive research analyses the discourse of nurses who migrated to Canada and experienced racism. They also experienced reprisals when they formally complained about racism in a context of denial of the problem of racism by colleagues and employers. The present work focuses on two issues arising from the data: the problem of how to make racism visible among those who have a vested interest in denying its existence and the emotional cool of those filing grievances or complaints in contrast with the hot reaction of those being challenged when racism is named. We introduce two theoretical perspectives to address these phenomena called democratic racism and cosmopolitan citizenship, respectively. The former, as defined by Henry et al. (The Colour of Democracy: Racism in Canadian Society. Harcourt Brace, Canada, Toronto, 1996), describes the coexistence of both democratic values and practices that discount people of colour advertently or inadvertently. We outline the notion of cosmopolitan citizenship that is argued by Turner (Politics of the Global City. Routledge, London, 2000) to be an orientation resulting from global microcosms in cities teeming with diversity. The characteristic orientations of cool and stewardship are useful for describing some of the discourse expressed by each participant in our study all of whom challenged racism practices, not on nationalistic grounds, but rather out of concern for universal human rights. Their characteristics qualify them for cosmopolitan citizenship under Turner's perspective. We suggest that anti-racist activists have been cosmopolitan citizens for decades and argue that while cosmopolitan citizenship may have taken root in neo-liberal movements, it appears to have tactical attributes in the struggle with democratic racism. In conclusion, we advocate for a cosmopolitan citizenship ethic to facilitate a rational move toward racial integration in the profession through the sharing of power and privilege. One goal in confronting racism is the accountability for whiteness: immunity from responsibility or apology.

Attitude↗
PubMed2003

Polycyclic aromatic musk compounds in sewage treatment plant effluents of Canada and Sweden--first results.

Polycyclic musk fragrances (PMF) are widely used fragrances for cosmetics and other personal and household care products. Quantitative data on PMF (HHCB-Galaxolide, AHTN-Tonalide, ATTI-Traseolide, AHMI-Phantolide, ADBI-Celestolide, and DPMI-Cashmeran) and the most prominent nitro musks (Musk Xylene-MX, and Musk Ketone-MK) in different wastewater treatment effluents in Canada and Sweden are presented to provide preliminary information on the variations within the emission pattern of these compounds. In all samples HHCB and AHTN were detected at concentrations of up to 1300 and 520 ngl(-1), respectively. ADBI, AHMI were also present, but close to the detection limit. The other PMF DPMI, ATTI, and more surprisingly musk ketone and musk xylene were not detected in any sample analysed. In comparison the samples from Canada were contaminated at a higher level than the Swedish samples, by a maximum factor of ca 10 for HHCB and AHTN.

Canada↗
PubMed2001

Cost savings from emergency contraceptive pills in Canada.

OBJECTIVE: To estimate cost savings from emergency contraceptive pills in Canada. METHODS: We modeled cost savings when a single emergency contraceptive treatment was provided after unprotected intercourse and when women were provided emergency contraceptive pills in advance. RESULTS: Each dollar spent on a single treatment saved $1.19--$2.35 (in Canadian currency), depending on the regimen and on assumptions about savings from costs avoided by preventing mistimed births. The dedicated products Preven (Shire Canada, Inc., Oakville, Ontario) and Plan B (Paladin Labs, Inc., Montreal) were cost-saving even under the least favorable assumption that mistimed births prevented today occur 2 years later. Each dollar spent on advance provision of Preven saved $1.24--$12.23, depending on the regular contraception method, on how consistently emergency contraception was used when needed, and on whether mistimed births were averted forever or simply delayed. Plan B was almost always cost-saving, although less so. CONCLUSION: Emergency contraception was cost-saving whether provided when the emergency occurred or in advance to be used as needed. More extensive use of emergency contraception could save considerable medical costs by reducing unintended pregnancies.

Adolescent↗
PubMed2003

Releases from copper smelters and refineries and zinc plants in Canada: human health exposure and risk characterization.

In these assessments of releases from copper smelters and refineries and from zinc plants as Priority Substances under the Canadian Environmental Protection Act (CEPA), available data were critically evaluated to determine if environmental exposure to selected components of these releases poses a risk to human health. The data on airborne levels of a variety of toxic substances near these facilities in Canada were obtained from the companies or provinces and systematically analyzed. Monitoring of ambient air near the Canadian copper smelters and refineries and zinc plants indicates that releases from these facilities result in increased potential for inhalation exposure of local human populations to several components of releases (As, Cd, Cr, Ni, Pb, SO(2) and PM(10)). Airborne levels in the vicinity of these metal-processing operations overlap those associated with cardiorespiratory effects for PM(10), and exceed health-based guidelines for SO(2) and, near some facilities, Pb. In addition, the margin between levels of As, Cd, Cr and Ni near these facilities in Canada and carcinogenic potency for each of these metals is relatively small near copper smelters, larger near copper refineries, and intermediate near zinc plants. On this basis, the risk to human health from environmental exposure to releases from these facilities is considered to be high compared with other Priority Substances assessed under CEPA, especially for facilities where copper is smelted.

Air Pollutants↗
PubMed2003

Exercise counselling by family physicians in Canada.

BACKGROUND: Exercise counselling is not frequently conducted by family physicians in several countries. Little is known about the exercise counselling practices of family physicians in Canada. The objective of this study was to assess physician confidence, current versus desired practice, and barriers related to the counselling of exercise by family physicians in Canada. METHODS: The study was a cross-sectional survey that included a random selection of family physicians in six provinces. A total of 330 family physicians completed the questionnaire, resulting in a response rate of 61.1%. A family physician was defined as a physician who practices family medicine at least 75% of their practice time. RESULTS: A total of 58.2% believed only 0-25% of their patients would respond to their counselling and 42.4% felt "moderately knowledgeable" to exercise counsel. Only 11.8% counselled 76-100% of their patients about exercise, but 43.3% thought they should be counselling 76-100% of their patients. Barriers to exercise counselling that rated most important included lack of time (65.7%) and lack of exercise education in medical school (64.8%). CONCLUSIONS: Family physicians indicated their current level of exercise counselling is suboptimal and confidence levels in exercise counselling were not high. Future educational opportunities for physicians may assist in improving exercise counselling.

Canada↗
PubMed2000

Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE)

BACKGROUND: Cardiovascular disease rates vary greatly between ethnic groups in Canada. To establish whether this variation can be explained by differences in disease risk factors and subclinical atherosclerosis, we undertook a population-based study of three ethnic groups in Canada: South Asians, Chinese, and Europeans. METHODS: 985 participants were recruited from three cities (Hamilton, Toronto, and Edmonton) by stratified random sampling. Clinical cardiovascular disease was defined by history or electrocardiographic findings. Carotid atherosclerosis was measured with B-mode ultrasonography. Conventional (smoking, hypertension, diabetes, raised cholesterol) and novel risk factors (markers of a prothrombotic state) were measured. FINDINGS: Within each ethnic group and overall, the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease. South Asians had the highest prevalence of this condition compared with Europeans and Chinese (11%, 5%, and 2%, respectively, p=0.0004). Despite this finding, Europeans had more atherosclerosis (mean of the maximum intimal medial thickness 0.75 [0.16] mm) than South Asians (0.72 [0.15] mm), and Chinese (0.69 [0.16] mm). South Asians had an increased prevalence of glucose intolerance, higher total and LDL cholesterol, higher triglycerides, and lower HDL cholesterol, and much greater abnormalities in novel risk factors including higher concentrations of fibrinogen, homocysteine, lipoprotein (a), and plasminogen activator inhibitor-1. INTERPRETATION: Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors.

Arteriosclerosis↗
PubMedDate not supplied

Decision making of nurses practicing in intensive care in Canada, Finland, Northern Ireland, Switzerland, and the United States.

In this study, our intention was to describe the decision making of nurses practicing in intensive care, and the differences of nurses' decision making in Canada, Finland, Northern Ireland, Switzerland, and the United States. The instrument used in the study was a 56-item Likert-type questionnaire that has been used in previous studies and has proved to be a reliable tool. The target group comprised a nonrandom sample of nurses (N = 314) from five countries. The samples are not representative; therefore, the results in these cases cannot be generalized. The results showed that the decision making of nurses practicing in intensive care was broadly based, and that there were some country differences in data collection, problem definition, and planning. In contrast, decision making related to the implementation and evaluation of nursing is quite similar in the different countries. Canada and the United States on the one hand, and Finland, Northern Ireland, and Switzerland on the other, showed more similarities with each other in data collection, problem definition, and nursing planning related to decision making. Neither experience nor nurse's knowledge structure was associated with different decision-making approaches.

Canada↗
PubMed2000

Savings in the cost of caring for patients with Alzheimer's disease in Canada: an analysis of treatment with rivastigmine.

OBJECTIVE: To estimate per-patient potential cost savings using rivastigmine in the treatment of Alzheimer's disease (AD) in Canada. BACKGROUND: In recent years, new members of a class of pharmaceuticals known as cholinesterase inhibitors have been introduced for the treatment of patients with AD. Two recent studies conducted in the United Kingdom and the United States estimated potential cost savings from the new cholinesterase inhibitor rivastigmine. The present study combined the disease-progression model used in those 2 studies with Canadian costs to estimate per-patient potential savings resulting from the treatment of AD in Canada. METHODS: Efficacy data from 2 pivotal, phase III clinical trials of rivastigmine were used in a hazard model of disease progression to estimate long-term differences in cognitive functioning between patients receiving rivastigmine and patients receiving no treatment. We used the Mini-Mental State Examination (MMSE) score as our measure of disease progression. We also used Canadian costs of AD care, estimated as a function of MMSE score, to estimate cost savings experienced by treated patients compared with patients receiving no treatment. All costs and cost savings are presented in 1997 Canadian dollars. We used a societal perspective in this analysis. RESULTS: Rivastigmine was estimated to delay the transition to more severe stages of AD by up to 188 days for patients with mild AD after 2 years of treatment. For patients with mild-to-moderate and moderate disease, this delay was estimated to be 106 and 44 days, respectively. For patients with the mild stage of AD, estimated average daily cost savings (excluding the cost of rivastigmine) ranged from Can $0.45 per patient per day at 6 months to Can $6.44 per patient per day after 2 years of treatment. For all patients, these estimated average daily cost savings ranged from a low of Can $0.71 per patient per day after 6 months of treatment to a high of Can $4.93 per patient per day after 2 years. CONCLUSION: On average, treatment with rivastigmine yields savings in the direct cost of caring for AD patients that exceed the cost of the drug after 2 years of treatment.

Aged↗
PubMed2002

Clustering of reported cases of leptospirosis among dogs in the United States and Canada.

A retrospective study was conducted to determine whether cases of leptospirosis diagnosed among dogs in the United States and Canada were clustered in time, space, or time-and-space. The study population was estimated--based on first examination of each dog--to consist of 1,035,366 dogs examined at 22 veterinary teaching hospitals between 1983 and 1998. The veterinary medicine database was searched for records of dogs in which a diagnosis of leptospirosis was made during the study period. The scan statistic (Poisson model) was used to examine for clustering of cases, using recorded date of diagnosis and the location of the veterinary teaching hospital at which the diagnosis was made. Three-hundred and forty dogs diagnosed with leptospirosis were identified. Cases were clustered in the period of 1992-1998. A cluster of dogs diagnosed at three veterinary teaching hospitals located in the midwest of the United States was identified. The composition of this spatial cluster was influenced by the age and gender distribution of the population at-risk. A cluster of cases involving 143 dogs diagnosed with leptospirosis between 9 April 1993 and 14 December 1998 at six veterinary teaching hospitals located in the midwest of the United States was identified. This time-space cluster was not influenced by the age, gender or breed distribution of the population of dogs presented at veterinary teaching hospitals during the study period. Leptospirosis was clustered during the 1990s in the midwest of the United States. Dog risk factors (age, gender, breed) do not explain the clustering that was observed. Leptospira serovar or environmental factors might be responsible for the clustering of canine leptospirosis in the United States and Canada.

Age Distribution↗
PubMed1998

Current microbiological status of 'health foods' sold in Canada.

A follow-up survey was conducted across Canada to evaluate the current status of 'health foods' sold in Canada. A total of 1239 sample units of 'health foods' were analysed for a variety of bacteria, including aerobic colony counts (ACC), coliforms, aerobic and anaerobic sporeformers, Escherichia coli and Bacillus cereus. Results presented indicate that 16.8-18.4% of the 'health foods' exceed ACC guidelines, 16.0-17.8% exceeded coliform guidelines, 35.7% exceeded aerobic sporeformer guidelines, 81.4% exceeded anaerobic sporeformer guidelines, and 9% exceeded B. cereus guidelines. Some ACC were further identified and found to be opportunistic pathogens, including the genera Bacillus, Enterococcus, and Staphylococcus. It was concluded that more extensive surveillance of this industry by health officials is needed.

Bacillus↗
PubMed2003

Co-ordinating health technology assessment in Canada: a European perspective.

Health Technology Assessment (HTA) is well-established in Canada, with both a national co-ordinating office for HTA and several provincial HTA organisations. The success of and relationship between these agencies, may provide useful lessons for policy-makers considering how to facilitate increased co-operation and harmonisation of HTA activity across Europe. Interviews were conducted with a number of key individuals associated with HTA in Canada to identify achievements, examine the relationship between the provincial agencies and the national co-ordinating office, and detect barriers to the increased use of HTA knowledge in decision-making.

Canada↗
PubMed2003

Income inequality and mortality: time series evidence from Canada.

In this paper, we apply the standard model used in the income strand of the socio-economic status (SES)-population health literature to explain the relationship between mortality and income to pooled cross-section time-series data for Canada. The use of time-series data increases the available degrees of freedom and allows for the possibility that the effects of inequality take time to translate into poorer health outcomes. In light of recent criticisms of aggregate level studies, we do not attempt to differentiate between the absolute and relative inequality hypotheses, but test for the existence of a relationship between mortality and a measure of income inequality. We find that whether an exogenous trend is incorporated or an auto-regressive distributed lag form is used, the coefficients on mean income and the Gini are not significantly different from zero, which contradicts the findings in other parts of the literature, but which is consistent with earlier cross-section evidence for Canada. The results suggest that models that focus exclusively on income as a measure of the impact of SES on mortality are not complete and that health spending and unemployment may be even more important than income growth and dispersion.

Age Factors↗
PubMed1987

Lyme disease in Canada with possible transmission by an insect.

The first documented case of Lyme disease to have originated in Canada is presented. A 51-year old French female nurse visited Quebec, Canada from 20 July to 5 August, 1984 and contracted Lyme disease. She reported an insect bite on 3 August 1984 on the back of her knee with erythema chronicum migrans appearing at the site of the bite on 5 August 1984. The patient presented with meningeal lymphocytic reaction near the end of September, 1984. Total Ig serum titers in indirect immunofluorescence tests on 1 October 1984, 10 October 1984, and 10 January 1985 were 1/512, 1/2048 and 1/16,384, respectively.

Animals↗
PubMed2002

A regionally segmented national scale multimedia contaminant fate model for Canada with GIS data input and display.

Regional scale mass balance models are valuable tools for describing the fate of chemicals in areas with defined and fairly homogeneous environmental characteristics and chemical use patterns. These models often show that contaminant inflows from outside the region of interest are significant compared with local emissions. This is most likely for persistent chemicals and those that are efficiently transported in air or water. As a result regional levels of environmental contamination are controlled by external factors and meaningful evaluation requires assessment of contaminant fate in neighboring regions. A linked set of regional models thus has the potential to describe quantitatively the impact of chemical emissions over a wider geographic scale with significant spatial differences in environmental characteristics and chemical use patterns. We describe here a national scale contaiminant fate model for Canada based on the existing 24-region ChemCAN model. The ecological regions, which were previously treated individually, are linked with flows of air and water deduced from GIS analysis to provide a comprehensive description of contaminant fate over the entire country, including long-range transport between regions. The model is applied to describe the national-scale fate of three chemicals in Canada, benzene, trichloroethene, and diethylhexyl phthalate, exploiting GIS analysis for interpretation and presentation of model results. Agreement between predicted multimedia environmental concentrations and measured values is satisfactory for all three chemicals. In total this work represents an initial attempt to address the different processes of both linking a regional model and using GIS as a tool for data analysis and management.

Air Movements↗