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PubMed1991

Emergence of a virulent clone of Neisseria meningitidis serotype 2a that is associated with meningococcal group C disease in Canada.

Multilocus enzyme electrophoresis was used to characterize 378 isolates of Neisseria meningitidis serogroup C recovered during a period of an increase in group C meningococcal disease in Canada. Thirty-four enzyme electrophoretic types were found among the isolates, which were predominantly (96.0%) serotype 2a. One clone (ET 15), characterized by a rarely occurring allele for the enzyme fumarase, was responsible for a focal outbreak in Ontario followed by the spread of group C disease across the province. This clone, which occurred infrequently among strains isolated in 1986, accounted for over 65% of group C strains associated with meningococcal disease in Canada in 1990.

Bacterial Typing Techniques↗
PubMed2003

Phage-based typing scheme for Salmonella enterica serovar Heidelberg, a causative agent of food poisonings in Canada.

Salmonella enterica serovar Heidelberg is perhaps the second most frequent Salmonella serovar isolated from humans and the most common isolated from animals in Canada. This pathogen has shown increasing resistance to antimicrobial agents and mimics the multidrug resistance observed in S. enterica serovar Typhimurium strain DT 104. However, unlike for serovar Typhimurium, a rapid and inexpensive subtyping method has not been available for large-scale surveillance efforts. We developed a phage typing scheme and subtyped 2,523 strains of serovar Heidelberg from outbreaks, sporadic infections, and environmental sources in Canada between January 1991 and December 2000. All strains were sensitive to one or more phages and could be subdivided into 49 phage types. A total of 196 isolates from 13 major outbreaks could be subtyped into six phage types, while 86 strains from family outbreaks were assigned to seven phage types. All strains were typeable, and epidemiologically related strains isolated from patients and implicated foods had identical phage types, antibiograms, and pulsed-field gel electrophoresis (PFGE) patterns. Combining PFGE with phage typing increased the discriminatory power of the analysis beyond that of either method alone. We concluded that this phage typing scheme, in conjunction with PFGE, enhances subtyping of serovar Heidelberg strains. Furthermore, this phage typing scheme is a rapid, economical, stable, and reliable epidemiologic tool for tracing the origin of food-borne disease and for the surveillance of sporadic infections.

Bacterial Typing Techniques↗
PubMed2005

An antidote to the emerging two tier organ donation policy in Canada: the Public Cadaveric Organ Donation Program.

In Canada, as in many other countries, there exists an organ procurement/donation crisis. This paper reviews some of the most common kidney procurement and allocation programmes, analyses them in terms of public and private administration, and argues that privately administered living donor models are an inequitable stopgap measure, the good intentions of which are misplaced and opportunistic. Focusing on how to improve the publicly administered equitable cadaveric donation programme, and at the same time offering one possible explanation for its current failure, it is suggested that the simple moral principle of "give and you shall receive", already considered by some, be extended further. This would allow for those who are willing to sign up to be a public cadaveric donor be given a priority for receiving an organ donation should they ever require it. It is argued that this priority may provide the motivation to give that is so far lacking in Canada. This model is called the Public Cadaveric Organ Donation Program.

Attitude↗
PubMed1999

Surveillance of potential associations between occupations and causes of death in Canada, 1965-91.

OBJECTIVE: To detect unsuspected associations between workplace situations and specific causes of death in Canada. METHODS: An occupational surveillance system was established consisting of a cohort of 457,224 men and 242,196 women employed between 1965 and 1971, constituting about 10% of the labour force in Canada at that time. Mortality between 1965 and 1991 has been determined by computerised record linkage with the Canadian mortality database. Through regression analysis, associations between 670 occupations and 70 specific causes of death were measured. RESULTS: There were almost 116,000 deaths among men and over 26,800 deaths among women. About 28,000 comparisons were made between occupations and specific causes of death. With various reporting criteria, several potential associations were highlighted, including: infectious disease mortality among barbers and hairdressers; laryngeal cancer among male metal fitters and assemblers; lung cancer among female waiters; breast cancer among female metal fitters and assemblers; brain cancer among female nursing assistants and male painters; and ischaemic heart disease among female inspectors and foremen and among male taxi drivers and chauffeurs. CONCLUSIONS: When excess risk of mortality is apparent, the intention of this occupational surveillance system is to spark further studies to gain aetiological knowledge.

Adult↗
PubMed1994

Sexually transmitted diseases in Canada, 1800-1992.

The history of sexually transmitted diseases in Canada from 1800 to the present reflects the changing views and values of citizens, medical experts, politicians and bureaucrats. During the colonial period, the military devoted attention to the problem but strict moral codes and social conventions prevented public discussion. Although middle class reformers began to pressure the federal government for funding and direction after 1900, World War I was the catalyst for involvement. Health education through a voluntary group and federal-provincial cost-shared funding for treatment facilities across Canada were introduced to control STDs. Public perception of STD patients as marginalised or deviant limited the impact of these efforts. Social changes during the 1960s, new STDs appearing in the 1970s and the AIDS epidemic of the 1980s have redirected the STD campaign to focus on high risk groups and prevention rather than the moralistic curative efforts of the past.

Attitude to Health↗
PubMed2006

Comparison of different control strategies for foot-and-mouth disease: a study of the epidemics in Canada in 1951/52, Hampshire in 1967 and Northumberland in 1966.

The measures used to control the epidemics of foot-and-mouth disease in Canada in 1951/52 (29 outbreaks) were compared with those used in the epidemic in Hampshire in 1967 (29 outbreaks). In both epidemics the disease spread more from premises where the disease was reported late and the imposition of quarantine or restrictions on infected premises was delayed. In Hampshire, area restrictions were imposed, susceptible livestock on infected premises and on premises in direct contact were slaughtered, and contacts were traced. In Canada, the initial diagnosis was vesicular stomatitis, no area restrictions were imposed, no tracing was carried out and the animals on infected premises were allowed to recover. However, apart from the disease's spread through infected meat and by unknown or airborne routes, it did not spread from infected premises once quarantine was imposed, partly owing to the low population density of livestock in the area. The effects of the slaughter of infected premises and direct contacts in the Fareham area of Hampshire in 1967 and in the Chathill area of Northumberland in 1966 were compared with what might have happened if, in addition, culling on contiguous premises or culling on premises within 3 km or emergency vaccination had been put into effect. The slaughter of cattle, sheep, goats and pigs on premises within 3 km two days after confirmation of the first outbreak would have resulted in fewer outbreaks and a shorter period to complete slaughter, but more animals would have been slaughtered. In the Chathill area, the slaughter of sheep, goats and pigs only on premises within 3 km two days after confirmation of the first outbreak would not have resulted in fewer outbreaks and more animals would have been slaughtered. Fewer premises and animals would have been slaughtered by a contiguous cull than by a 3 km cull but more than by the slaughter of infected premises and direct contacts. Emergency vaccination within 3 km, providing protection at four days (but not to animals already infected before the development of immunity), would have resulted in the fewest animals being slaughtered and could have reduced the number of outbreaks in the Fareham area by one and in the Chathill area by two or three. All the procedures would have had a greater effect the sooner they were introduced. However, with many foci of infection, priorities for action would have had to have been established. Earlier tracing of the last outbreak in the Fareham area could have shortened the Hampshire epidemic. Surveillance of a farm identified as at risk through animal movements and by the use of an airborne-prediction model could have eliminated the source of further outbreaks in the Chathill area.

Animals↗
PubMed1980

A survey of Clostridium perfringens enterotoxin antibody in human and animal sera in western Canada.

Sera from human, cattle, sheep, swine, and horse populations in western Canada were tested for the presence of Clostridium perfringens enterotoxin antibody by the passive hemagglutination (PHA) test, supplemented by an immunodiffusion test and by counterimmunoelectrophoresis. A total of 224 human, 345 cattle, 165 sheep, 620 swine, and 768 horse serum samples were examined. Low-titer reactions in the PHA test were detected in human, cattle, horse, and swine sera, in that order, with no titers demonstrated in sheep. The titers in human sera ranged up to 1:128 and three of these samples were also positive in the other two serological tests. The significance of this antibody is not clear, but it is suggested that the low prevalence of the antibody may reflect a low prevalence of enterotoxigenic C. perfringens strains in western Canada. Such serological surveys may be applicable to epidemiological studies involving enterotoxigenic C perfringens.

Animals↗
PubMed1980

Serotypes among Neisseria meningitidis serogroups B and C strains isolated in Canada.

Antisera made to prototype serogroup B strains of Neisseria meningitidis were used to serotype, by agar gel double diffusion, 262 meningococcal serogroups B and C strains isolated in Canada. The strains included 93 from patients and 169 from carriers. Serotype 2 was associated with 39 of 75 (52%) of group B strains and 14 of 18 (77.8%) of group C strains isolated from patients. The group B strains were mainly (87.2%) serotype 2b, while the majority (92.2%) of group C strains was serotype 2a. Other serotypes (including a new provisional serotype) represented 25.3 and 5.5% of groups B and C strains, respectively. The new serotype accounted for 13% of the group B strains. Approximately 23% of the strains isolated from patients were nontypable. The distribution of serotype 2, nontype 2 (other serotypes), and nontypable strains isolated from carriers was 2.1, 36.6, and 61.3%, respectively, for group B meningococci and 22.2, 29.6, and 48.25, respectively, for group C meningococci. Serotype 11 was the most prominent of the strains isolated from carriers. Approximately 7% of all the strains were multiple serotypes. Serotype 2 is an important virulence marker associated with meningococcal groups B and C disease in Canada, with serotypes 2a and 2b being markedly associated with groups C and B meningococcal disease, respectively.

Antigens, Bacterial↗
PubMed1981

Yersinia enterocolitica isolated from throats of swine in eastern and western Canada.

Examination of the throat flora from swine in Ontario for Yersinia enterocolitica found the incidence of serotype O:3 to vary from 20% from tonsils to 50% for throat swabs and 55% for tongues. In contrast, there were no isolations of serotype O:3 from throat swabs taken from swine in the western provinces of British Columbia and Alberta. This incidence of serotype O:3 in swine correlates well with the human incidence of the same serotype which is 81% for all human isolations of Y. enterocolitica in the eastern provinces and 4% in the western provinces of Canada. The opposite relationship is true for serotype O:5,27, which was not isolated from Ontario swine but occurred with a frequency of 3% in British Columbia swine and 24% in Alberta swine. The relative incidence in humans for serotype O:5,27 is 5% of all isolations of Y. enterocolitica in Ontario, 8% in British Columba, and 26% in Alberta. Serotype O:8, the most common human serotype in the western provinces (40% of all isolations), was not isolated from swine in this survey. The majority of Y. enterocolitica cultures of biotype 4 (serotype O:3) and biotype 2 (serotype O:5,27) were positive for autoagglutination, a test which has been associated with virulence, whereas all cultures of biotype 1 were negative. The results from this study strongly suggest that swine are an important source of human infections with both serotype O:3 and O:5,27 of Y. enterocolitica. The source of human infections in western Canada with serotype O:8 remains unidentified.

Animals↗
PubMed1986

Microbiological quality of bottled water sold in Canada.

The microbiological quality of bottled water sold in Canada was evaluated. A total of 114 lots of bottled water, both domestic and imported, were analyzed for aerobic colony count, coliforms, fecal coliforms, and Escherichia coli. No fecal coliforms or E. coli were found. Nineteen (46%) of the 41 lots of domestic purified water were found to exceed aerobic colony count standards and another lot exceeded coliform standards. One lot each of domestic and imported mineral water exceeded coliform standards. If mineral water were governed by the aerobic colony count standards for bottled water, then five lots each of both domestic and imported mineral water would have been found to be unsatisfactory. More surveillance of the bottled water industry in Canada is recommended.

Canada↗
PubMed2002

Predicting survival of a genetically engineered microorganism, Pseudomonas chlororaphis 3732RN-L11, in soil and wheat rhizosphere across Canada with linear multiple regression models.

Pseudomonas chlororaphis 3732RN-L11 survival rates in soil and wheat rhizosphere were measured using intact soil core microcosms representing 23 sites across Canada. Linear multiple regression (LMR) models were developed to predict the survival rate of this genetically engineered microorganism (GEM) as a function of soil parameters measured at the time of microcosm inoculation. LMR models were tested by comparing their predicted survival rates with observed survival rates from environmental introductions of the GEM by Gagliardi et al. (2001) at five field sites across Canada over two years. No soil parameter (e.g., % clay) was highly correlated with GEM survival rates in soil or wheat rhizosphere. Total fungal colony-forming units (CFUs), % soil titanium (positive correlations), and % soil magnesium (negative correlation) were found to be the best LMR predictors of GEM survival rates in soil over two years. Total soil bacterial CFUs, nitrate, % soil potassium (positive correlations), and exchangeable magnesium (negative correlation) were found to be the best LMR predictors of GEM survival rate in wheat rhizosphere over two years. While LMR models were statistically significant, they were unable to reliably predict the survival rate of the GEM in field trial introductions. The results indicate that there can be considerable uncertainty associated with predicting GEM survival for multi-site environmental introductions.

Canada↗
PubMed2003

Characterization of Neisseria meningitidis strains isolated from invasive meningococcal disease cases in Canada in 2001.

With the recent introduction of polysaccharide-protein conjugated vaccines for the control of serogroup C meningococcal disease and the emergence of different variants of serogroup C meningococci, it is likely the epidemiology of meningococcal disease in many countries may be affected. We have therefore analysed and reported the characteristics of Neisseria meningitidis strains collected in 2001 from the Canadian surveillance program on invasive meningococcal disease. Only strains collected from normally sterile clinical sites of patients were studied. Of the 289 isolates obtained from individual patients, 173 (59.9%) were serogroup C, 76 (26.3%) were serogroup B, 30 (10.4%) were serogroup Y, and 10 (3.5%) were serogroup W135. Ninety-six percent of the serogroup C isolates belonged to the ET-15 clone, with an additional 2.3% belonging to other electrophoretic types within the ET-37 clonal complex. Different antigenic variants of the endemic serogroup C ET-15 clone were responsible for localized outbreaks in different parts of the country. One novel variant with the antigenic composition of C:2a:P1.1,7 was reported in two provinces, Quebec and Ontario. Eighteen percent of the meningococci isolated from patients in Ontario belonged to serogroup Y, compared with only 8% in the rest of Canada. The current data highlight the importance of strain characterization by serogroup, serotype, and serosubtype antigens in providing useful information for the surveillance of meningococcal disease in Canada.

Bacterial Typing Techniques↗
PubMed1999

Mammography in the 1990s: the United States and Canada.

PURPOSE: To evaluate trends in mammography quality before and after the implementation of the Mammography Quality Standards Act (MQSA) of 1992 and to compare technical data collected in the United States with corresponding data obtained from the first survey of mammography facilities conducted in 1994-1995 in Canada. MATERIALS AND METHODS: Data from MQSA inspections conducted in 1995-1997 were analyzed and compared with survey data on U.S. mammography facilities acquired before the MQSA. Technical indicators of mammography quality such as radiation dose phantom image score, film processing, and darkroom fog were analyzed. RESULTS: In the United States, phantom image scores, along with other technical measures of performance such as film processing, darkroom fog, and x-ray beam quality, have improved continuously since 1985. The U.S. mean glandular dose has increased to 1.6 mGy compared with the Canadian dose of 1.1 mGy. The mean total phantom image score with artifact subtraction was 11.1 in Canada in 1994-1995 and 11.8 in the U.S. in 1997. CONCLUSION: Mammography quality is better today than it has been at any other time in the United States. With the exception of radiation dose. Canadian technical measures of performance are comparable to measures before MQSA in the United States.

Canada↗
PubMed2002

Chronic pain in Canada--prevalence, treatment, impact and the role of opioid analgesia.

OBJECTIVE: To assess the prevalence, treatment and impact of chronic pain in Canada. METHODS: A stratified random sample of 2012 adult Canadians (weighted by sex, age and region according to 1996 census data) was surveyed by telephone in 2001 to determine the prevalence of chronic pain, defined as continuous or intermittent pain for at least six months. A second sample of 340 chronic pain sufferers who were taking prescription medication for their pain was studied in detail to determine current therapeutic approaches and to assess the social and economic impact of chronic pain. RESULTS: Chronic noncancer pain was reported by 29% of the respondents, with increased frequency in women and older age groups. The average duration of pain was 10.7 years and the average intensity was 6.3 (on a scale from 1 to 10), with 80% reporting moderate or severe pain. Anti-inflammatory agents were prescribed for 49% of respondents and opioid analgesics were prescribed for 22% (two-thirds of these were codeine). Almost 70% were worried about addiction potential, and one-third felt that strong analgesics should be reserved for terminal illnesses. Almost one-half were unable to attend social and family events, and the mean number of days absent from work in the past year due to chronic pain was 9.3. INTERPRETATION: Chronic noncancer pain is common in Canadian adults and has a major social and economic impact. Despite growing evidence supporting the efficacy and safety of major opioid analgesics for chronic noncancer pain, less than 10% of chronic pain patients taking prescription medication were treated with a major opioid. Chronic pain is undertreated in Canada, and major opioid analgesics are probably underutilized in the management of moderate to severe pain as part of a multidisciplinary treatment program.

Adolescent↗
PubMed2005

The lack of association between bacille Calmette-Guerin vaccination and clustering of Aboriginals with tuberculosis in western Canada.

BACKGROUND: Tuberculosis (TB) remains a major health problem for Aboriginal people in Canada, with high rates of clustering of active TB cases. Bacille Calmette-Guerin (BCG) vaccination has been used as a preventive measure against TB in this high-risk population. OBJECTIVES: The study was designed to determine if BCG vaccination in Aboriginal people influenced recent TB transmission through an analysis of the clustering of TB cases. METHODS: A retrospective analysis of all culture-positive Mycobacterium tuberculosis cases in Aboriginal people in western Canada (1995 to 1997) was performed. Isolates were analyzed using standard methodology for restriction fragment length polymorphism and spoligotyping. RESULTS: Of 256 culture-positive Aboriginal TB cases, BCG status was confirmed in 216 (84%) cases; 34% had been vaccinated with BCG, 57% were male and 56% were living on-reserve. Patients who had been vaccinated with BCG were younger than unvaccinated individuals (mean age 32.4+/-1.65 years versus 45.0+/-1.8 years, P<0.0001). Clustering was found in 62% of cases: 59% of non-BCG vaccinated cases were clustered versus 68% of those vaccinated with BCG (P=0.16). Younger patients (younger than 60 years of age) were more likely to be clustered in the univariate analysis (P<0.01). When age, sex, province, and HIV and reserve status were controlled for, BCG vaccination was not associated with clustering (OR 1.3, 95% CI 0.7 to 2.6). CONCLUSIONS: BCG vaccinated Aboriginal people were no less likely to have active TB from recently transmitted disease. BCG vaccination appears to have limited value in preventing clustering of TB cases within this high-risk community.

Adolescent↗
PubMedDate not supplied

Geographic and temporal distribution of mortality rates for multiple sclerosis in Canada, 1965-1994.

Statistics Canada data were used to calculate multiple sclerosis (MS) mortality rates per 100,000 population in the Canadian provinces from 1965 to 1994. For the period 1965-1994, the highest average annual MS mortality rates were in Quebec (4.4) and Ontario (3.9), while the Western Provinces had an intermediate rate (2.1) and the Atlantic Provinces had the lowest rate (1.2). Female mortality rates exceeded male rates in each of the four regions. Average annual MS mortality rates in Canada overall fluctuated during the past 30 years, with rates of 3.4 in 1965-1969, 4.2 in 1970-1974, 3.2 in 1975-1979, 2.3 in 1980-1984, 2.8 in 1985-1989 and 3.9 in 1990-1994. Female mortality rates exceeded male rates during each 5-year period. The highest mortality rates for both genders were in the 65 years plus age group. Rates in the under 45 years age group have remained stable, while rates in both the 45-64 and 65 years plus age groups have fluctuated. There is no apparent relationship between prevalence and mortality rates among the Canadian provinces.

Adult↗
PubMed2005

Policy conflicts: gene patents and health care in Canada.

Several recent gene patent controversies have energized and refocused the human gene patent debate in Canada. These include the use of the Myriad test for breast cancer by the provinces, patenting of the Severe Acute Respiratory Syndrome virus and a recent Supreme Court decision rejecting the patenting of 'higher life forms'. These cases place the emerging policy conflicts between the innovation and commercialization agenda of the government and the desire to provide equitable access to health care in sharp focus. Another challenge faced by Canada is the powerful influence of the United States in policy decisions. Although these issues have raised awareness about the possibility of reforming the patent system, Parliament has yet to consider any of the suggested reforms of the Canadian patent system and there are no formal proposals pending.

Animals↗
PubMed1996

Hospitalization and case-fatality rates for stroke in Canada from 1982 through 1991. The Canadian Collaborative Study Group of Stroke Hospitalizations.

BACKGROUND AND PURPOSE: The purpose of this study was to estimate rates of hospitalization and in-hospital case-fatality for cerebral infarction and intracerebral hemorrhage in Canada and to describe variation in rates by age, sex, and calendar period. METHODS: Data were obtained from hospitalization databases for each of Canada's 10 provinces for the 10 fiscal years of 1982 through 1991. All hospitalizations of persons 15 years of age or older with a primary diagnosis at discharge coded 431, 434, or 436 according to the International Classification of Disease, 9th Revision, were included. Rates per 100,000 population were calculated for intracerebral hemorrhage and cerebral infarction, for men and women, and for five age groups. Annual age- and sex-specific, 30-day, in-hospital case-fatality rates were also calculated. RESULTS: A total of 335,283 discharges for stroke were enumerated over the 10-year period (309,631 cerebral infarctions and 25 652 intracerebral hemorrhages). A significant decline of approximately 1% per year was observed for the rate of cerebral infarctions. For hemorrhages, the reverse was seen. For men there was a 44% increase over the 10-year period, and for women there was a 34% increase. In-hospital case-fatality rates for cerebral infarctions increased with age but did not differ by sex when age was considered. For the five age groups of 15 to 54, 55 to 64, 65 to 74, 75 to 84 and > or = 85 years, rates were 6%, 8%, 12%, 18% and 27%, respectively. For intracerebral hemorrhage, the in-hospital case-fatality rates declined significantly over time from approximately 36% to 29%, 55% to 37%, 49% to 41%, 66% to 45%, and 72% to 59% for the five age groups, respectively. CONCLUSIONS: The possibility that these changes are artifactual could not be ruled out, but because there is no obvious risk in assuming that they are not, it would be prudent to investigate their causes further.

Adolescent↗