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PubMed2005

An illustration of the "inverse care law": A commentary on giving birth in Canada: providers of maternity and infant care.

The recent Canadian Institute for Health Information (CIHI) report Giving Birth in Canada: Providers of Maternity and Infant Care highlights the limited availability of obstetrical resources. The efficient allocation of these resources is likely to disadvantage the rural and remote areas of Canada, where individual need may be greatest. This situation is a contemporary illustration of the "inverse care law" described by Julian Tudor Hart in 1971.

Canada↗
PubMed2003

Mother-to-child transmission of HIV in Canada: a population health risk management perspective.

The standard of prenatal care in Canada for preventing transmission of the human immunodeficiency virus (HIV) from mother to infant is universal counselling and voluntary testing of pregnant women for the virus. Appropriate treatment of HIV-positive women reduces the risk of viral transmission to the infant to less than 1%. Despite this, too many children in Canada are born with HIV because their mothers were not tested. The barriers to screening include lack of appropriate resources and lack of training in this area. As a result, physicians find HIV test-counselling too time-consuming or believe that testing is not relevant to their patient population. Risk management strategies to improve screening rates and decrease transmission, including community action and technological strategies such as vaccines and rapid testing kits, are reviewed. The "advisory" option, the process of risk communication between health-care providers, the government, and the public, for the purpose of making recommendations, is a key component toward the success of universal screening. A shift to simplified screening and "opt-out" testing procedures is recommended.

AIDS Serodiagnosis↗
PubMed2006

Sperm donation: implications of Canada's Assisted Human Reproduction Act 2004 for recipients, donors, health professionals, and institutions.

BACKGROUND: On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase of sperm or eggs from donors in Canada. In response to the concerns of medical professionals and some consumers that prohibiting payment would lead to a decline in the number of gamete donors, Health Canada commissioned research on altruistic donor recruitment and recruitment strategies. METHODS: Twenty-two studies of sperm donors were located and their findings reviewed. The studies spanned 23 years (1980-2003), were undertaken in a range of countries, and were chosen on the merit of their relevance to the development of recruitment strategies within a policy of altruistic sperm donation. Observations were derived from assessing and comparing the purposes, findings, and implications of the 22 studies. RESULTS: Payment for providing sperm was made in all but three studies, although participants in 15 studies indicated clearly that their motivations were primarily altruistic. Observations indicate that men who are more willing to be identified to offspring in the future share demographic characteristics, such as age and parental status, with those who are prepared to donate altruistically. These characteristics appear to be a factor in motivation to donate altruistically. CONCLUSION: The studies show that there are men who are prepared to donate sperm without financial payment. The findings suggest that a change is required in the culture of sperm donation, specifically the adoption of a new approach to donor recruitment.

Altruism↗
PubMed2000

Health technology assessment in Canada. A decade in review.

OBJECTIVES: Since 1988, four government-funded health technology assessment (HTA) agencies have been established in Canada. This paper is a descriptive review of reports issued by these organizations during the period from 1988 to 1998. METHODS: Publications from the national and three provincial HTA agencies in Canada were obtained and reviewed. Only the 117 assessment reports that were reported to have undergone external review were included in this analysis. Each report was classified on a standard abstraction form according to criteria such as technology type(s), assessment focus, whether a specific policy question was clearly stated and relevant decision maker(s) identified, description of search strategy and selection criteria, sources of data and assessment methods used, whether recommendations or conclusions were made, and duplication or overlap of reports. The trends in these qualities over the 10-year period were also examined. RESULTS: Therapeutic technologies have received the most attention from all four agencies, although the focus on devices, drugs, and procedures varied between agencies. The policy question under investigation was clearly identified in 82% of reports, and 71% clearly identified the decision maker toward whom the assessment was targeted. Efficacy or effectiveness was examined in 81% of reports, and costs were assessed in 65% of studies. These were the two most frequently examined aspects. Almost all assessments were descriptive literature reviews; 9% included meta-analyses and 32% had cost analyses or economic evaluations. Forty-four percent of reports had a clear description of the literature search strategy, and selection criteria were clearly specified in 38% of studies, but there was considerable variation among agencies in the level of description of these methods. Conclusions were clearly stated in 83% of the assessments' conclusions, and 13% had recommendations. When analyzed longitudinally, it is apparent that the quality of reports has improved markedly during the past decade. This was determined by examining the clarity of specifying the policy question(s) under investigation, the identification of the target audience of decision makers for the information, and by evaluating the thoroughness of the description of the methods used in the assessment. CONCLUSIONS: Canadian government agencies have contributed a considerable quantity of health technology assessments. There has been very little duplication of technologies evaluated, and the quality of the assessment reports has markedly improved during the past decade.

Canada↗
PubMed2006

Data collection on patients in emergency departments in Canada.

OBJECTIVE: Relatively little is known about the ability of Canadian emergency departments (EDs) and the federal, provincial and territorial governments to quantify ED activity. The objectives of this study were to determine the use of electronic patient data in Canadian EDs, the accessibility of provincial data on ED visits, and to identify the data elements and current methods of ED information system (EDIS) data collection nationally. METHODS: Surveys were conducted of the following 3 groups: 1) all ED directors of Canadian hospitals located in communities of >10,000 people, 2) all electronic EDIS vendors, and 3) representatives from the ministries of health from 13 provincial and territorial jurisdictions who had knowledge of ED data collection. RESULTS: Of the 243 ED directors contacted, 158 completed the survey (65% response rate) and 39% of those reported using an electronic EDIS. All 11 EDIS vendor representatives responded. Most of the vendors provide a similar package of basic EDIS options, with add-on features. All 13 provincial or territorial government representatives completed the survey. Nine (69%) provinces and territories collect ED data, however the source of this information varies. Five provinces and territories collect triage data, and 3 have a comprehensive, jurisdiction-wide, population-based ED database. Thirty-nine percent of EDs in larger Canadian communities track patients using electronic methods. A variety of EDIS vendor options are available and used in Canada. CONCLUSION: The wide variation in methods and in data collected presents serious barriers to meaningful comparison of ED services across the country. It is little wonder that the majority of information regarding ED overcrowding in Canada is anecdotal, when the collection of this critical health information is so variable. There is an urgent need to place the collection of ED information on the provincial and national agenda and to ensure that the collection of this information consistent, comprehensive and mandatory.

Canada↗
PubMed2001

Bioaccumulation of persistent organic pollutants in lichen-caribou-wolf food chains of Canada's Central and Western Arctic.

While biomagnification of persistent organic pollutants (POPs) in aquatic food chains is well documented, there have been few investigations of the trophodynamics of POPs in Arctic terrestrial food chains. This study presents field-collected concentration data and corresponding fugacities of various hydrophobic organic chemicals (ranging in octanol-water partition coefficients or K(OW) from approximately 10(3.8) to 10(9)) in two lichen species (Cladina rangiferina and Cetraria nivalis), willow leaves (Salix glauca), barren-ground caribou (Rangifer tarandus), and wolves (Canis lupus) from Canada's Central and Western Arctic region. The results show that, in contrast to aquatic food chains, persistent substances including beta-hexachlorocyclohexane and 1,2,4,5-tetrachlorobenzene with a K(OW) <10(5) can substantially biomagnify in lichen-caribou-wolf food chains in Canada's Central and Western Arctic. Strong positive correlations between the biomagnification factor and the octanol-air partition coefficients (K(OA)) of nonmetabolizable compounds were observed in wolves. In caribou, the biomagnification factors dropped slightly with increasing K(OA). K(OA) proved to be a better indicator of biomagnification than K(OW). Current management policies that consider only chemicals with K(OW) values >10(5) as bioaccumulative substances fail to identify substances that have the potential to biomagnify in Arctic terrestrial food chains despite a low K(OW) because of a high K(OA).

Animals↗
PubMed2004

Atmospheric mercury accumulation rates between 5900 and 800 calibrated years BP in the High Arctic of Canada recorded by peat hummocks.

In this paper, we present the first comprehensive long-term record of preanthropogenic rates of atmospheric mercury accumulation in dated peat deposits for the High Arctic of Canada. Geochemical studies of two peat hummocks from Bathurst Island, Nunavut reveal substantial inputs from soil dust (titanium), marine aerosols (bromine), and mineral-water interactions (uranium). Mercury, however, was supplied to these peat mounds exclusively by atmospheric deposition. Mercury concentration measurements and age dating of the peat profiles indicate rather constant natural "background" mercury flux of ca. 1 microgram per square meter per year from 5900 to 800 calibrated years BP. These values are well within the range of the mercury fluxes reported from other Arctic locations, but also by peat cores from southern Canada that provide a record of atmospheric Hg accumulation extending back 8000 years. Thus, preanthropogenic Hg fluxes in the Arctic were not significantly different from atmospheric Hg fluxes in the temperate zone. In preindustrial times, therefore, the High Arctic was no more important as a sink for global atmospheric mercury than was the temperate zone.

Arctic Regions↗
PubMed2005

Long-term change of polycyclic aromatic hydrocarbon deposition to peatlands of eastern Canada.

To date, studies about historic PAH (polycyclic aromatic hydrocarbons) deposition at a regional scale have rarely been published. To address this research gap, we sampled 17 ombrotrophic peatlands across eastern Canada. The peat cores from hollows were dated with 210Pb for the period of about 1850-2000 and analyzed fortheir PAH concentration, so PAH deposition could be reconstructed. Peat samples were extracted by accelerated solvent extraction (ASE). The extracts were purified by column chromatography with aluminum oxide and silica gel. PAH were measured by gas chromatography-tandem mass spectrometry (GC-MS/MS). Overall reconstructed deposition rates of sigma-11 PAH ranged from 4 to 1432 microg m(-2) year(-1). Three different long-term trends in PAH deposition could be distinguished: sites with two separated periods of maximum PAH deposition, sites with one period of maximum PAH deposition, and sites with no clearly separated period of maximum PAH deposition. Increasing PAH depositions were caused by rapid industrialization accompanied by extensive use of fossil fuels; decreasing PAH depositions were caused by substitution of these fuels and movements of PAH emitting industry to different regions. At all sites either phenanthrene (20-60%) or benzo[b+k]fluoranthene (10-40%) was the predominant PAH. Detailed analysis of three bogs suggested that combustion of coal and vehicle exhausts mainly contributed to the peat PAH burden. The temporal trends of PAH deposition indicated that increases in the PAH deposition rates followed the industrial development in Canada, particularly in the periods 1880-1910 and 1940-1960. Recent abatement efforts were reflected in decreased PAH deposition rates to about 15% of the maximum.

Canada↗
PubMed2006

PCBs, PCDD/Fs, and organochlorine pesticides in farmed Atlantic salmon from Maine, eastern Canada, and Norway, and wild salmon from Alaska.

Farmed Atlantic salmon (Salmo salar) from Maine and eastern Canada, wild Alaskan Chinook salmon (Oncorhynchus tshawytscha), and organically farmed Norwegian salmon samples were analyzed for the presence of polychlorinated biphenyls (PCBs), dioxin-like PCBs, polychlorinated dibenzo-p-dioxins (PCDDs), dibenzo-p-furans (PCDFs), and chlorinated pesticides. PCDD and PCDF congeners were not detected in > 80% of the samples analyzed. Total PCB concentrations (7.2-29.5 ng/g, wet weight, ww) in the farmed salmon were significantly higher than those in the wild Alaskan Chinook samples (3.9-8.1 ng/g, ww). Concentrations of PCBs, WHO PCB TEQs, and chlorinated pesticides varied significantly by region. PCB and WHO PCB TEQ concentrations in farmed salmon from eastern Canada were lower than those reported in samples collected two years earlier, possibly reflecting recent industry efforts to lower contaminant concentrations in feed. Organically farmed Norwegian salmon had the highest concentrations of PCBs (mean: 27 ng/g, ww) and WHO PCB TEQs (2.85 pg/g,ww); their TEQ values are in the higher range of those reported in farmed salmon from around the world. Removal of skin from salmon fillets resulted in highly variable reductions of lipids and contaminants, and in some skin-off samples, contaminant levels were higher, suggesting that skin removal does not protect the consumer from health risks associated with consumption of farmed salmon.

Alaska↗
PubMed1999

Incorporating ethics in priority setting: a case study of a regional health board in Canada.

The authors were involved in developing an ethical framework to assist the Queens Region Board (Prince Edward Island, Canada) set priorities in health and health care. Two and one half years after the adoption of this framework, the authors undertook an evaluation of the framework. This paper will discuss: (a) the historical background of regionalization in Canada, and in particular the circumstances leading up to the institution of regional boards in Prince Edward Island; (b) the sorts of ethical issues facing the Queens Regional Board; (c) issues arising in connection with the use and development of ethics frameworks for managing ethical issues in priority setting; (d) the framework adopted by the Queens Board and the process that led to its development; (e) issues arising as concerns implementation of the framework; (f) questions and issues pertinent to other boards and bodies considering similar initiatives.

Canada↗
PubMed2002

Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire.

The Rome II criteria and questionnaires developed to identify functional gastrointestinal disorders have not been evaluated. Our objectives were to determine the prevalence of functional gastrointestinal disorders in Canada, compare our results with data from other published studies, assess concordance of Rome I and Rome II criteria for irritable bowel syndrome, and suggest improvements in the Rome II questionnaire. An independent research firm was employed to conduct a random digit dial national survey, inviting household members > or = 18 years of age to participate in a study examining personal health issues. Subjects recruited by telephone, who agreed to participate, were mailed a questionnaire, and the data were retrieved by a follow-up phone call. The Rome II questionnaire and algorithms were used and where possible Rome I algorithms were also applied. At least one functional gastrointestinal disorder occurred in 61.7% of 1149 respondents (65.6% female versus 57.6% male; P < 0.05). The most prevalent were the functional bowel disorders at 41.6% followed by esophageal disorders at 28.9%. Irritable bowel syndrome prevalence by Rome II and I criteria were 12.1% and 13.5%, respectively (kappa = 0.76). Because the Rome II criteria have added exclusion items that are not present in the Rome I criteria, the prevalence of esophageal, gastroduodenal, and anorectal disorders is lower than the figures from a US market survey. In conclusion, functional gastrointestinal disorders are highly prevalent in Canada, with a significantly higher rate in women. There is substantial agreement between Rome I and Rome II criteria for irritable bowel syndrome. Rome criteria and questionnaire remain works in progress.

Adolescent↗
PubMedDate not supplied

Assessing potential for recovery of biotic richness and indicator species due to changes in acidic deposition and lake pH in five areas of southeastern Canada.

Biological damage to sensitive aquatic ecosystems is among the most recognisable, deleterious effects of acidic deposition. We compiled a large spatial database of over 2000 waterbodies across southeastern Canada from various federal, provincial and academic sources. Data for zooplankton, fish, macroinvertebrate (benthos) and loon species richness and occurrence were used to construct statistical models for lakes with varying pH, dissolved organic carbon content and lake size. pH changes, as described and predicted using the Integrated Assessment Model (Lam et al., 1998; Jeffries et al., 2000), were based on the range of emission reductions set forth in the Canada/US Air Quality Agreement (AQA). The scenarios tested include 1983, 1990, 1994 and 2010 sulphate deposition levels. Biotic models were developed for five regions in southeastern Canada (Algoma, Muskoka, and Sudbury, Ontario, southcentral Quebec, and Kejimkujik, Nova Scotia) using regression tree, multiple linear regression and logistic regression analyses to make predictions about recovery after emission reductions. The analyses produced different indicator species in different regions, although some species showed consistent trends across regions. Generally, the greatest predicted recovery occurred during the final phase of emission reductions between 1994 and 2010 across all taxonomic groups and regions. The Ontario regions, on average, were predicted to recover to a greater extent than either southcentral Quebec or the Kejimkujik area of Nova Scotia. Our results reconfirm that pH 5.5-6.0 is an important threshold below which damage to aquatic biota will remain a major local and regional environmental problem. This damage to biodiversity across trophic levels will persist well into the future if no further reductions in sulphate deposition are implemented.

Acid Rain↗
PubMedDate not supplied

Monitoring the conservation of grassland habitats, Prairie Ecozone, Canada.

The Prairie Ecozone contains 5% of Canada's land area and represents 16% of the Great Plains of North America. Current estimates indicate that 25-30% of original Canadian grassland habitats remain, largely concentrated in southeastern Alberta and southwestern Saskatchewan with fragments distributed throughout southern Manitoba. The size, distribution and condition of native grasslands serve as valuable indicators of the ecological integrity and the sustainability of those landscape types. With so little native grasslands remaining, areas that conserve grasslands serve as core sites for indicators such as gaps in ecosystem and wildlife habitat protection, i.e. which ecosystems are well-represented, poorly represented or have no representation. Such gap analyses helps to determine where protection efforts need to be placed in the future. Overall, about 3.5% of the Prairie Ecozone of Canada is under some form of conservation area status. This paper reports, relative to the ecoregions and political jurisdictions of the Prairie Ecozone, on the amount and distribution of various types of conservation areas and native grasslands. Relationships between the occurrence of conservation areas and grasslands are presented. Implications for conservation area planning and management are discussed within regional, national and international contexts. The issue of which characteristics of conservation areas should be assessed and monitored to address conservation objectives for sustainability is also discussed.

Canada↗
PubMedDate not supplied

Plant phenology in western Canada: trends and links to the view from space.

One feature of climate change is the trends to earlier spring onset in many north temperate areas of the world. The timing of spring flowering and leafing of perennial plants is largely controlled by temperature accumulation; both temperature and phenological records illustrate changes in recent decades. Phenology studies date back over a century, with extensive databases existing for western Canada. Earlier spring flowering has been noted for many woody plants, with larger trends seen for species that develop at spring's start. Implications for ecosystems of trends to earlier spring arrival include changes in plant species composition, changes in timing and distribution of pests and disease, and potentially disrupted ecological interactions. While Alberta has extensive phenology databases (for species, years, and geographic coverage) for recent decades, these data cannot provide continuous ground coverage. There is great potential for phenological data to provide ground validation for satellite imagery interpretation, especially as new remote sensors are becoming available. Phenological networks are experiencing a resurgence of interest in Canada (www.plantwatch.ca) and globally, and linking these ground-based observations with the view from space will greatly enhance our capacity to track the biotic response to climate changes.

Canada↗
PubMed2004

Communication beliefs about youth and old age in Asia and Canada.

Two cross-cultural studies compared beliefs in Asia and Canada about communication in later life. With an expanded version of the Language in Adulthood Questionnaire, respondents rated a young or old adult target on communication skills selected to elicit both negative and positive stereotypes. Chinese, Chinese-Canadian, and Canadian participants were compared in Study 1 while younger and older respondents from South Korea and Canada were contrasted in Study 2. All groups showed negative beliefs about hearing and memory in old age. Positive communication beliefs were also evident for empathy, storytelling and social skills. Participants in Asia showed less stereotyping overall, for both negative and positive beliefs. Significant age interactions in Study 2 reflected positive communication beliefs only for the older participants. In line with recent investigations of the multidimensional impact of Eastern traditions, greater positivity toward older adults was not observed in Asia. This work highlights the importance of assessing both positive and negative age beliefs in cross-cultural comparisons.

Adult↗
PubMed1997

Inmate suicides in the Correctional Service of Canada.

This article presents descriptive statistics on the 66 suicides occurring in federal institutions in Canada over a 4-year period. Criminological and institutional factors of those who committed suicide included lengthy involvement in the criminal justice system, a greater likelihood of being incarcerated for robbery or murder, and involvement in institutional incidents of a serious nature. In addition, 62% of the inmates who committed suicide had been transferred from other institutions within 6 months prior to suicide, though 59% evidenced no indicators of suicidal intent and 44% were not considered to be depressed at the time of suicide. Family problems (29%) were the most commonly hypothesized motivating factor in the suicides, followed by denial of a request for appeal, parole, or transfer (26%), fear of other inmates (24%), and substance abuse problems (21%). Current and planned suicide prevention and intervention strategies of the Correctional Service of Canada are discussed in the context of these findings.

Adult↗
PubMed2004

Obesity research in Canada: literature overview of the last 3 decades.

OBJECTIVE: To identify research published on obesity in Canada, to explore the range of areas studied, and to identify gaps and areas that merit future research attention. RESEARCH METHODS AND PROCEDURES: Medline and International Pharmaceutical Abstracts databases were searched from 1970 onwards. Original articles were identified and categorized by areas of interest. RESULTS: A total of 1186 relevant articles were identified: 17, 136, 687, and 346 articles during the 1970s, 1980s, 1990s, and 2000 to 2003, respectively. Of the articles, 816 were considered original studies and accepted for this analysis. Twelve research areas were identified: basic science involving animal experiments (29%), human experiments (16%), populations surveys (14%), obesity-related comorbidities (13%), diagnostic/surgical issues (11%), nonpharmacological approaches (7%), drug-related issues (4%), anthropometrics (2%), impact of weight loss (2%), cost/healthcare use (1%), attitudes/perceptions (0.9%), and models/procedures (0.5%). Two-thirds of all research was conducted in Quebec (34%) and Ontario (33%). DISCUSSION: Given the multifactorial nature of obesity, Canadian obesity research covers a broad range of areas with a predominance of basic science but lesser emphasis on community and primary care studies. Furthermore, there was a paucity of research on either clinical management of medical conditions in obese patients or clinical aspects that go beyond weight loss. Thus, although Canada appears well represented in basic research, more attention to exploration of clinical issues and healthcare delivery for obese patients appears warranted.

Canada↗
PubMed2002

Trends in overweight and obesity among adults in Canada (1970-1992): evidence from national surveys using measured height and weight.

PURPOSE: To examine secular trends in obesity and overweight among Canadian adults between 1970 and 1992. The impact of education level and smoking on weight trends is explored. DATA: Adults aged 20-69 participating in three national health surveys which obtained measured height and weight: the Nutrition Canada Survey conducted between 1970 and 1972 (analysis sample n=5963); the Canada Health Survey of 1978-1979 (analysis sample n=3622); and the Canadian Heart Health Surveys conducted between 1986 and 1992 (analysis sample n=17 699). METHODS: Comparison of percentage overweight (age-standardized body mass index (BMI) 25.0-29.9) and obese (age-standardized BMI > or = 30.0) by sex, education level and smoking status across the three surveys. RESULTS: Among men, the proportion overweight and obese increased steadily from 1970-1972 to 1986-1992. Among women, there was a substantial increase in the proportion overweight and obese between 1970-1972 and 1978-1979, then an increase in proportion obese, but not overweight, between 1978-1979 and 1986-1992. Although the prevalence of obesity increased in all education levels, the sub-groups with the greatest relative increase are men in the primary education category, and women in the secondary and post-secondary between 1970-1972 and 1986-1992. An increase in the prevalence of obesity was greatest among current smokers and, to a lesser extent, among former smokers. CONCLUSION: While excess weight has become an increasing public health problem among Canadian adults, the rate of increase in prevalence of obesity since 1970 varied with sex, education level and smoking status. There is a need for new data on measured heights and weights of Canadian adults and children and youth to update trends.

Adult↗