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PubMed2005

Serious adverse events associated with bacille Calmette-Guérin vaccine in Canada.

BACKGROUND: Targeted Bacille Calmette-Guérin (BCG) vaccination is offered to neonates in some First Nations and Inuit (FNI) communities in Canada. Serious adverse events associated with BCG vaccine prompted a review to assess causality. METHODS: The Immunization Monitoring Program Active (IMPACT), a pediatric hospital-based active surveillance network, reported admissions for BCG-related adverse events between 1993 and April 2002. The Canadian Advisory Committee on Causality Assessment (ACCA) reviewed the reports to assess causality. Data between 1987 and September 2002 from the Vaccine-Associated Adverse Event Surveillance (VAAES) Program, a passive national reporting system, were also reviewed. RESULTS: IMPACT identified 21 pediatric cases; 19 were Canadian-born, and 18 were FNI. Six disseminated BCG cases were identified; 5 were FNI infants who subsequently died. All had immunodeficiencies and concurrent infections. Other adverse events included 2 cases of osteomyelitis, BCG abscesses and lymphadenitis. ACCA reviewed the 21 cases and determined that 14 were very likely associated with the vaccine, including the 6 disseminated BCGs; 5 were probably associated and 1 was possibly associated with the vaccine; 1 was unclassifiable. The VAAES program identified 157 adverse events. No additional serious systemic adverse events (disseminated BCG or osteomyelitis) were identified. CONCLUSIONS: Serious BCG vaccine-associated complications continue to occur in Canada. The numbers of FNI children with disseminated disease was greater than expected from reported rates in the literature.

Adverse Drug Reaction Reporting Systems↗

PubMed2007

The effect of changing from whole-cell to acellular pertussis vaccine on the epidemiology of hospitalized children with pertussis in Canada.

BACKGROUND: Between July 1997 and April 1998, universal childhood immunization programs in Canada changed from using a whole-cell pertussis to a 5-component acellular pertussis-containing vaccine. To assess effects on pertussis epidemiology of this nationwide change, we analyzed hospitalizations during 1991-2004 using the Canadian Immunization Monitoring Program, Active (IMPACT) pertussis database. METHODS: IMPACT is an active surveillance network based in 12 pediatric tertiary-care hospitals across Canada. Characteristics of hospitalized cases of pertussis were compared by type of vaccine received or by birth date (if immunization records were unavailable or the child was unvaccinated). Age-stratified incidence rates were calculated by year and vaccine type. RESULTS: Two thousand ninety-six cases of pertussis were admitted to IMPACT centers, 1174 during the whole-cell vaccine program (WCV-P) and 842 during the acellular vaccine program (ACV-P). Pertussis incidence among children <5 years old decreased significantly during the ACV-P, causing an increase in the residual proportion of cases either too young to be immunized (<2 months old: ACV-P 39% versus WCV-P 26.1%; P < 0.0001) or too young for a second dose (2-3 months old: 42.9% versus 34.2%, respectively; P < 0.0001). A significantly smaller proportion of cases (ACV-P 15.1% versus WCV-P 27.3%) occurred in infants who were old enough (4-11 months of age) to have received 2 or 3 doses of vaccine. CONCLUSIONS: With ACV-P, pertussis hospitalizations in children 4-59 months old decreased in frequency, consistent with improved vaccine effectiveness, but remained prominent among very young infants. Improved control strategies are needed to reduce infections among infants too young for pertussis vaccination.

Adolescent↗

PubMed2004

Drug spending in Canada: recent trends and causes.

BACKGROUND: Canadians spent almost dollars 15 billion, over dollars 460 per capita, on prescription drugs in 2002, yet there is little published evidence regarding the nature and causes of these expenditures. OBJECTIVE: : The objective of this study was to describe the nature and determinants of prescription drug expenditures in Canada during a recent period of rapid expenditure inflation, 1998 to 2002. RESEARCH DESIGN: : Trends in overall expenditures and investment in specific therapeutic categories are decomposed using nonstochastic index-theoretical methods. MEASURES: Changes in per capita expenditures on oral solid prescription drugs are attributed to the cost-impact of changes in the 6 determinants that fall into 3 broad categories: volume effects, price effects, and therapeutic choices. RESULTS: A majority of spending was concentrated among only 5 therapeutic classes. After adjusting for generic drug use, prices for unchanged drugs declined over the period of analysis. Increased utilization of prescription drugs explained over half of the overall increase in per capita spending. Changes in therapeutic choice also contributed to cost increases. CONCLUSIONS: Findings suggest that the combined affect of federal price regulations, provincial price freezes, and generic substitution policies are controlling price-related determinants of drug spending in Canada. However, the cost-impact of increased drug utilization and changes in therapeutic choices illustrate the potential pitfalls of cost-management strategies that focus primarily on prices.

Canada↗

PubMed2006

Characterization of proline, citrulline, and uracil auxotrophic plasmid-carrying Neisseria gonorrhoeae strains in Canada, 1993-2003.

BACKGROUND AND OBJECTIVE: Proline, citrulline, and uracil (PCU) Neisseria gonorrhoeae is a common auxotroph in Canada and resistance to antibiotics in this auxotroph is rare. GOAL: The goal of this study was to determine the characteristics of the PCU strains that have plasmids. STUDY DESIGN: PCU strains sent between 1993 and 2003 for reference work to the National Microbiology Laboratory were analyzed for their plasmid profiles and antimicrobial susceptibilities. PCU strains containing plasmids and/or antimicrobial resistant were serotyped, and por and tbpB genes were sequenced to determine their antigenic types. RESULTS: Forty strains containing plasmids were identified; serotype IB-11 and por/tbpB sequence type 2 was the most common pattern (28 of 40 strains [70%]). One strain had plasmids that conferred resistance to penicillin and tetracycline and 4 plasmidless strains were resistant to tetracycline. CONCLUSION: PCU auxotrophic N. gonorrhoeae carrying plasmids and/or that have chromosomal genes mutated to resist antimicrobials have been identified in Canada. This shows the competency of this pathogen to survive under antimicrobial pressure and the importance of continuous surveillance.

Anti-Bacterial Agents↗

PubMed2001

Using simulation and budget models to scale-up nitrogen leaching from field to region in Canada.

Efforts are underway at Agriculture and Agri-Food Canada (AAFC) to develop an integrated, nationally applicable, socioeconomic/biophysical modeling capability in order to predict the environmental impacts of policy and program scenarios. This paper outlines our Decision Support System (DSS), which integrates the IROWCN (Indicator of the Risk of Water Contamination by Nitrogen) index with the agricultural policy model CRAM (Canadian Regional Agricultural Model) and presents an outline of our methodology to provide independent assessments of the IROWCN results through the use of nitrogen (N) simulation models in select, data-rich areas. Three field-level models--DSSAT, N_ABLE, and EPIC--were evaluated using local measured data. The results show that all three dynamic models can be used to simulate biomass, grain yield, and soil N dynamics at the field level; but the accuracy of the models differ, suggesting that models need to be calibrated using local measured data before they are used in Canada. Further simulation of IROWCN in a maize field using N_ABLE showed that soil-mineral N levels are highly affected by the amount of fertilizer N applied and the time of year, meaning that fertilizer and manure N applications and weather data are crucial for improving IROWCN. Methods of scaling-up simulated IROWCN from field-level to soil-landscape polygons and CRAM regions are discussed.

Agriculture↗

PubMed2004

Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review.

BACKGROUND: Analysis of differences in the incidence and duration of breastfeeding across countries may provide information about practices that encourage breastfeeding. This comparative review examines variation in the incidence and duration of breastfeeding for term infants that has been reported in studies from Canada, the United States, Europe, and Australia. METHODS: Searches were conducted in PubMed, MEDLINE (from 1966), CINHAL (from 1982), and the Cochrane Database of Systematic Reviews. Studies were limited to nonexperimental and observational research that addressed term infants (>37 weeks gestational age), performed in developed countries, written in the English language, and published since 1990. Additional studies were located from reference lists of meta-analyses, systematic reviews, and previous articles. All studies that met study criteria were included in the review, regardless of the quality of methodology. RESULTS: Although studies had methodological limitations that precluded conducting a formal systematic review or meta-analysis, this comparative review revealed consistent differences among countries. For example, Europe and Australia reported a higher initiation and duration of breastfeeding term infants compared with Canada and the United States. CONCLUSIONS: Studies that examined reasons for a higher incidence and duration of breastfeeding term infants consistently document that women who initiate and continue to breastfeed are older, married, better educated, and have higher family incomes than women who do not breastfeed.

Australia↗

PubMedDate not supplied

Experience with providing drugs for seniors in Canada.

The provincial and territorial governments in Canada are responsible for the provision of health care to all Canadians and, as part of this mandate, they provide drug coverage to all hospitalized patients regardless of age, and to seniors and patients with certain diagnoses, dependent on some forms of means testing. The federal government is responsible for regulation and setting standards for health care. It provides financial subsidies to the provincial programs as well as direct funding for specific groups of individuals. This article reviews the roles of each level of government in the provision of pharmaceuticals to seniors in Canada.

Aged↗

PubMed2006

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors.

Migration has become a profound global phenomenon in this century. In Canada, uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services, present barriers to immigrant women caregivers. The purpose of this paper is to share relevant insights from individual and group interviews with immigrant women family caregivers, service providers and policy influencers, and discuss these in relation to immigration, health and social policy, and programme trends in Canada. The present authors conducted individual interviews with immigrant women family caregivers (n = 29) in phase 1, followed by two group interviews with women family caregivers (n = 7), and two group interviews with service providers and policy-makers (n = 15) in phase 2. Using an inductive approach, the authors employed thematic content data analysis. Immigrant women experienced barriers to health and social services similar to Canadian-born family caregivers, particularly those who have low incomes, jobs with limited flexibility and heavy caregiving demands. These immigrant women family caregivers avoided certain formal services for a variety of reasons, including lack of cultural sensitivity. However, their challenges were compounded by language, immigration and separation from family in the home country. The identified barriers to support reinforce the importance of modifying and expanding policies and programmes affecting immigrant women's ability to care for family members with illnesses or disabilities within the context of Canadian society. Participants recommended changes to policies and programmes to deal with information, transportation, language, attitudinal and network barriers. The various barriers to services and programmes which were experienced by immigrant women caregivers underscore the importance of reviewing policies affecting immigration, caregiving, and access to health and social services. Intersectoral collaboration among agencies is essential to reduce the barriers identified in the present study, and to establish services which are linguistically and culturally appropriate.

Asian People↗

PubMed1989

Nursing education in Canada: historical 'progress'--contemporary issues.

Contemporary concerns in nursing education in Canada suggest that the earlier educational pathways have not always represented progress. The persistence of alternate routes for the preparation of registered nurses, and the continuing divisiveness among nurses with differing educational backgrounds are problem areas that still require resolution. Some problems, such as the development of the nursing curriculum, have been shared across educational settings. Nurse educators in Canada, as in other countries, have vested tremendous energy into this aspect of nursing education. In retrospect, it is recognized that much of this effort has been misdirected. Efforts to strengthen the theoretical underpinnings of the curriculum have resulted in the incorporation of borrowed theory from other disciplines, often without critical examination of the context in which the theory developed, or of its consistency with the philosophical perspectives of nursing. Attempts to build curricula around the major nursing models have also met with limited success. Separation of education and practice, persistence of multiple levels of preparation in nursing, and a continual search for viable curriculum models have led to uncertainty, to detours in the development of nursing education, and to occasional reconsideration of previous approaches.

Canada↗

PubMed1995

Nursing practice in Canada: the influence of current and proposed legislation.

Nursing practice in Canada is regulated by separate acts in each of the 10 provinces and two territories. These acts grant self-governance to the nursing profession, define a scope of practice, and establish mechanisms for registration and quality assurance. The Canada Health Act 1984, the Agreement on Internal Trade (1994) between provinces, and the North American Free Trade Agreement have potentially great effects on Canadian nursing by altering the regulation of professionals within the various jurisdictions.

Canada↗

PubMed1982

The effects of taking a practice examination on scores in the Qualifying Examination of the Medical Council of Canada.

A practice examination has been prepared annually at the University of Toronto for use by those who will take the Qualifying Examination of the Medical College of Canada. Passing the Qualifying Examination is an important step in gaining the Licentiate of the Medical College of Canada (the LMCC) and thus in becoming licensed. The effect of taking the practice examination on scores on the LMCC exam was investigated. The practice examination is a smaller replica of the LMCC exam, with questions spanning major medical specialties presented in both multiple-choice and patient management problem (PMP) format. It was conjectured that the effect of practice would be greater on the PMP score than on the multiple-choice score. Analysis of covariance was used to compare the LMCC examination scores of senior students, who had taken the practice examination, with the scores of those who had not. The comparison was performed for two graduating classes, separately, and involved the use of a score summarizing each student's performance in the third year of the curriculum as a covariate. In each graduating class, the practice effect on PMP scores is statistically significant. In neither class alone is the practice effect on multiple-choice scores statistically significant, although a combination of results in the two classes is statistically significant. The presence of practice effects can be taken to indicate a flaw in the testing process. The elimination of practice effects, through experiences like the practice examination, would make the entire testing process more valid.

Canada↗

PubMed1997

Primary, return and onward migration in the U.S. and Canada: is there a difference?

"Using microdata sources available from the U.S. Census Bureau and Statistics Canada, this paper contrasts primary, return and onward migration in the two countries. These classifications are based on information on the region (state or province) of birth and region of residence at the start and end of the census period. To study the propensities to make a primary, return or onward migration, rates are calculated...and compared with previous census periods. Analysis reveals that both countries have experienced similar temporal patterns, and that primary, return and onward migration patterns tend to be similar. Analysis using a nested logit model further reveals that return and onward migration in both countries can be similarly explained." Data are from the Public Use Micro Sample (PUMS) for the United States and the Public Use Micro File (PUMF) for Canada.

Americas↗

PubMed1998

Issues for nurses in rural and remote Canada.

Canada is a vast country with great diversity in its landscape, industry, culture and communities. The healthcare issues and concerns of people living in rural and remote areas are as fully diverse as the people and the landscape. This article describes the context of rural and remote nursing practice in Canada and discusses issues of health status and the social determinants of health, geographical isolation, professional isolation and cultural safety. It concludes with current initiatives in practice, education, research and policy. Particular issues facing nurses in rural and remote First Nations communities are highlighted.

Canada↗

PubMed2005

An analysis of the development of a successful medical collaboration to create and sustain family physician anaesthesiology capacity in rural Canada.

BACKGROUND: Initial efforts to increase the availability of training positions, standardise training, and obtain national recognition for family physicians who wished to practise anaesthesia had stalled. OBJECTIVE: To describe the work undertaken to create and sustain family medicine anaesthesiology capacity in Canada. METHODS: In our review, we examined the critical aspects of successful intersectoral work, namely, involvement by key stakeholders; the development of decision-making mechanisms; clearly defined objectives, roles and responsibilities; official support and legitimisation from participating organisations and adequate resources for partnership building. SETTING: Canadian rural family medicine anaesthesiology practice. RESULTS: A small steering committee obtained funding for a national meeting of stakeholders and subsequent committee work over an 18-month period. The national meeting brought together the necessary stakeholders to review and discuss the issues and agree on a group-determined agenda, determine a work plan, identify priority areas and allow the College of Family Physicians of Canada to be the lead organisation in moving the work ahead. Within 18 months, the boards of the key organisations had accepted a common set of standards for training and a national curriculum. Work remains in the longer term to identify sustainable funding for training of family physician as well as the provision of continuing medical education for those trained. CONCLUSIONS: Appropriate attention to the key components of successful intersectoral work may enable previously stalled and complex work to move ahead despite opposition.

Anesthesiology↗

PubMed2006

Clinical features and pharmacological treatment of migraine patients referred to headache specialists in Canada.

We set out to examine selected clinical characteristics of migraine patients referred to neurologists specializing in headache in Canada, and to document their pharmacological therapy both before and after consultation with the neurologist. Demographic, clinical and pharmacotherapy data were collected at the time of consultation for 606 patients referred to five headache clinics and who were given a migraine diagnosis by the neurologist. Data were analysed as part of the Canadian Headache Outpatient Registry and Database (CHORD) Project. The mean age of the migraine patients was 39.7 years; and 82.5% were female. The majority of patients suffered severe impact from their headaches. Prior to consultation, 48.7% were taking a triptan; after consultation, 97.2% were on a triptan. Before consultation, 30.9% were on a prophylactic drug; after consultation, 70.4% were. 20.8% of patients were medication overusers. Of these medication overusers, 42.4% were overusing an opiate, usually in combination with other analgesics; 21.6% were overusing a triptan. Medication changes made by the neurologists at consultation included a large increase in the use of both triptans and prophylactic medications. Medication overuse, particularly opiate overuse, remains a significant problem in patients with migraine in Canada.

Adolescent↗

PubMed2005

Dermatologic surgery practice and skin cancer treatment in Canada: results of a national survey.

BACKGROUND: Although traditionally considered a medical subspecialty, dermatology has rapidly evolved over the past two decades to encompass a wide variety of cutaneous surgical procedures. OBJECTIVE: The study was carried out to evaluate the status of dermatologic surgery practice and skin cancer treatment in Canada. METHODS: In 2003, 550 practicing Canadian dermatologists were surveyed. RESULTS: Two hundred fifty-one dermatologists responded to the questionnaire, with the majority practicing in an urban part-time academic, part-time private setting. Statistics are presented on the types and demographics of dermatosurgical and cosmetic procedures performed, as well as on the specific dermatosurgical therapies used in the treatment of various cutaneous malignancies. CONCLUSIONS: The survey provides a current picture of dermatologic surgery practice and skin cancer treatment in Canada. The data suggest that Canadian dermatologists are further embracing surgical and cosmetic procedures.

Adult↗

PubMed2004

Under-utilization of mechanical circulatory support in Canada: why and what can be done?

In October of 2002, a workshop was held as part of the Canadian Cardiovascular Congress in Edmonton, Canada, entitled "Under-Utilization of Mechanical Circulatory Support in Canada. Why and What Can Be Done?" The workshop examined various issues related to the use of mechanical circulatory support devices in the Canadian context. Representatives from all Canadian centers with active mechanical circulatory support programs were invited to participate and participants included surgeons and cardiologists, as well as other affiliated health professionals. Opinions were solicited from the workshop participants and a series of recommendations were formulated.

Assisted Circulation↗

PubMed1986

Integrated university training program in geriatric medicine accredited and evaluated by the Royal College of Physicians and Surgeons of Canada.

The Federated Council for Internal Medicine recommended in 1981 "increased emphasis on geriatric medicine in the medical school curriculum, the medical residency, and continuing medical education." In the same year the first examination for a Certificate of Special Competence in Geriatric Medicine was held in Canada. This was the culmination of a process begun in 1974 to establish the subject as a subspecialty within Internal Medicine. The Royal College of Physicians and Surgeons of Canada set up a Specialty Committee which developed criteria for the accreditation of training programs. Candidates have to be eligible to sit for the certification examination in Internal Medicine before they can sit for the Certificate of Special Competence in Geriatric Medicine which is awarded only after passing both examinations. Thirty-nine individuals sat for the examination in its first five years of whom 26 were successful. These now form a nucleus of well-qualified internist-geriatricians who are developing academic programs in geriatric medicine in Canadian Medical Schools.

Canada↗