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PubMed2006

The scope and impact of treatment of latent tuberculosis infection in the United States and Canada.

RATIONALE: The scope of treatment of latent tuberculosis infection (LTBI) in the United States and Canada is unknown. Identifying the types of clinics that administer such treatment and patients who receive it could guide resource utilization and improve treatment initiation and completion. OBJECTIVES: Estimate the number of persons started on LTBI treatment; describe the types of clinics that treat LTBI. METHODS: The Tuberculosis Epidemiologic Studies Consortium, consisting of 19 United States and 2 Canadian sites, conducted a survey among clinics that initiated LTBI treatment for>or=10 patients in 2002. RESULTS: Study catchment areas from the 19 United States sites represented 8.6% of the United States population and 12.7% of all tuberculosis cases in 2000. An estimated 37,857 patients started LTBI treatment during 2002 at 244 clinics surveyed. Of these treatment starts, 29,970 (79%) occurred at general public health clinics; immigrant/refugee clinics (2,409; 6.4%) and correctional/detention facilities (2,325; 6.1%) were the next most common sites. Based on these data, United States tuberculosis case rates, and United States population data, the estimated total number of LTBI treatment starts in the United States was 291,000-433,000. When the 37,145 persons who initiated LTBI treatment in the United States were extrapolated to the entire United States population, with a 5% lifetime risk of tuberculosis without treatment, and 20-60% treatment effectiveness, approximately 4,000-11,000 tuberculosis cases were prevented in the United States. CONCLUSIONS: LTBI treatment is initiated among a substantial number of persons in the United States and Canada, primarily in the public sector. Treatment of LTBI can significantly decrease the tuberculosis burden.

Adolescent↗
PubMed2001

Cultural competence in New Zealand and Canada: occupational therapy students' reflections on class and fieldwork curriculum.

The first year of a twin study undertaken between two occupational therapy programs in Canada and New Zealand is described. The primary aims of the study were to illuminate the lived experiences of students as they learn about cultural difference and had contact with clients of differing cultural backgrounds to themselves during fieldwork placements. While there are similarities between educational programs and the demographic profiles of the two cohorts of students, there are curricular differences primarily based on the described socio-political content of the two countries; Aotearoa/New Zealand as a bicultural society and Canada as multicultural. The paper discusses how these cultural differences interweave with other aspects of the students' educational program, as perceived and experienced by the students. Narrative data was thematically analyzed to reflect the experiences and the attendant thoughts and feelings of the participants.

Adult↗
PubMed2002

The impact of reimbursement systems on occupational therapy practice in Canada and the United States of America.

Different funding and cost-control mechanisms in Canada and the United States of America (USA) have a powerful influence on occupational therapy practice in each country. Canada's public health insurance system emphasizes access to health care services based on medical need. Costs are controlled at the provincial government level by limiting the capacity of facilities and personnel. Occupational therapists in publicly-funded settings have considerable professional autonomy to use occupational therapy theoretical models and to be client-centred. The measurement of outcomes is not always required and the interventions of individual occupational therapists are infrequently scrutinized. The USA has no universal, publicly-funded, comprehensive health insurance. Health care policies are driven by financial priorities and cost control occurs at the service delivery level. Insurance companies define the scope of occupational therapy practice by identifying what services they will pay for and they scrutinize occupational therapy interventions. The emphasis on effectiveness and efficiency leads to critical examination of interventions by therapists. Canadian occupational therapists can learn much from their colleagues in the USA in this area.

Canada↗
PubMed2002

Will students be prepared? Current status of gerontological content in entry-level occupational therapy programs in Canada.

By the year 2020, 20% of the Canadian population is expected to be over the age of 65 (Statistics Canada, 1997). It is important that future clinicians are prepared to meet the increased demand for occupational therapy services by older adults. The purpose of this study was to examine the present status of gerontological content within Canadian occupational therapy programs. A survey was sent out to all twelve entry-level occupational therapy university programs in Canada via electronic mail. This survey asked questions about the programs' focus on gerontological content within their coursework and clinical fieldwork. All ten responding programs indicated that they had gerontological content within their curricula. However, the amount and content varied throughout the programs.

Aged↗
PubMed2003

Changing times: trials and tribulations of the move to Master's entry-level education in Canada.

BACKGROUND: Most health care professions are reviewing issues related to the changing nature of professional education and practice. Social work, physical therapy, speech-language pathology, audiology, and recently occupational therapy, have raised the entry-level training requirements to the graduate level to enhance formal education programs. PURPOSE AND SCOPE: In the past few years, this trend has generated considerable debate and discussion within the occupational therapy profession both in Canada and internationally. In November, 2001 the Canadian Association of Occupational Therapists (CAOT) announced that Canadian universities must convert to entry-level Master's programs by 2008 to receive re-accreditation (CAOT, 2002a). This paper describes the historical evolution of Canadian occupational therapy education, outlines several issues within occupational therapy that are impacting the move, and discusses benefits and challenges to Master's level training. PRACTICE IMPLICATIONS: Recommendations are presented for the development of Master's entry-level occupational therapy training programs in Canada.

Accreditation↗
PubMed1997

Oral hygiene habits of 11-year-old schoolchildren in 22 European countries and Canada in 1993/1994.

This study is part of the Cross-National Survey on Health Behaviour in School-aged Children--a WHO Collaborative Study, which started in 1982. The aim of the study was to describe the oral hygiene habits (toothbrushing and flossing) of 11-year-old schoolchildren in 22 European countries (Austria, Belgium, the Czech Republic, Denmark, Estonia, FInland, France, Germany, Greenland, Hungary, Israel, Latvia, Lithuania, Northern Ireland, Norway, Poland, Russia, Scotland, the Slovak Republic, Spain, Sweden, and Wales) and Canada. The data were collected from standardized anonymous questionnaires in school classrooms during the 1993-1994 school year. At least 1300 school children, representing the whole country, participated in the study in each country. Oral hygiene habits were analyzed according to gender, age, country, school performance, and family economy. The children brushed most favorably in Sweden, Denmark, German, Austria, and Norway (83-73% brushed twice a day). More-than-once-a-day toothbrushing was especially uncommon (from 26 to 33%) among boys in Finland, Lithuania, Russia, Estonia, and Latvia. Toothbrushing frequency differed significantly according to school performance in Canada, the Czech Republic, Scotland, Poland, Northern Ireland, and Wales and between different socio-economic groups in Northern Ireland, Wales, the Czech Republic, Scotland, Poland, and Russia. Use of dental floss was rare. In general, flossing was less frequent among boys than among girls. Daily flossing was most common among Canadian adolescents (25%). In conclusion, there are considerable differences in toothbrushing frequency among children in European countries.

Achievement↗
PubMed1998

Living arrangements and residential overcrowding among older immigrants in Canada.

"Because older immigrants arriving in Canada are not eligible for government transfer payments or welfare benefits for up to 10 years, many of them choose to live with their relatives or sponsors in crowded three- or more than three-generation households. Cultural preferences also influence this tendency and the propensity of immigrant groups from developing regions to live in three- or more than three-generation households ranges up to 18 times those of their Canadian-born and immigrant counterparts from the developed regions. Variables such as average income, percent receiving Old Age Security payments, percent widowed and duration of residence in Canada are significantly associated with proportions of immigrants living in such arrangements, and explain about 84 percent of birthplace variation for males and 81 percent for females."

Adult↗
PubMedDate not supplied

Prescribing rationale and budgetary outcomes associated with the introduction of a combined formulation of diclofenac sodium and misoprostol in Canada.

The budgetary impact of prescribing a combined formulation of diclofenac sodium and misoprostol to patients previously using nonsteroidal anti-inflammatory agents (NSAIDs), cytoprotective agents, or a combination of agents from both therapeutic categories is assessed, as is the clinical rationale for prescribing the combined formulation. Analysis of data for Canada on claims paid by third parties showed that the use of the combined formulation in Canada had resulted in significant initial overall savings and that the greatest cost savings were made for those who had previously used both an NSAID and a cytoprotective concomitantly. The inclusion of shadow costs (secondary costs) indicates that the use of the combined formulation over a 6-month period involves very low shadow costs (medical expenses related to ulcer treatment) compared with other NSAIDs: the shadow cost multiplication factor was 1.03 for the combined formulation compared with 1.22 to 3.47 for other NSAIDs. Pharmaceutical costs alone are insufficient for evaluating total budgetary impacts.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Descriptive epidemiology of major depression in Canada.

OBJECTIVE: The Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) is the first national study to use a full version of the Composite International Diagnostic Interview. For this reason, and because of its large sample size, the CCHS 1.2 is capable of providing the best currently available description of major depression epidemiology in Canada. Using the CCHS 1.2 data, our study aimed to describe the epidemiology of major depression in Canada. METHOD: All estimates used appropriate sampling weights and bootstrap variance estimation procedures. The analysis consisted of estimating proportions supplemented by logistic regression modelling. RESULTS: The lifetime prevalence of major depressive episode was 12.2%. Past-year episodes were reported by 4.8% of the sample; 1.8% reported an episode in the past 30 days. As expected, major depression was more common in women than in men, but the difference became smaller with advancing age. The peak annual prevalence occurred in the group aged 15 to 25 years. The prevalence of major depression was not related to level of education but was related to having a chronic medical condition, to unemployment, and to income. Married people had the lowest prevalence, but the effect of marital status changed with age. Logistic regression analysis suggested that the annual prevalence may increase with age in men who never married. CONCLUSIONS: The prevalence of major depression in the CCHS 1.2 was slightly lower than that reported in the US and comparable to pan-European estimates. The pattern of association with demographic and clinical variables, however, is broadly similar. An increasing prevalence with age in single (never-married) men was an unexpected finding.

Adolescent↗
PubMed2006

Cost-effectiveness of cognitive-behavioural therapy for mental disorders: implications for public health care funding policy in Canada.

OBJECTIVE: Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy. METHOD: We searched the literature for economic analyses of CBT in the treatment of mental disorders. RESULTS: We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use. CONCLUSIONS: International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada.

Canada↗
PubMed1983

The DSM-III in Canada: a survey.

A survey of the membership of the Canadian Psychiatric Association (CPA) was completed for the Scientific Council to discover, first, the reaction of the members to the Diagnostic and Statistical Manual, Third Edition (DSM-III) and second, the support given to the CPA Policy of not endorsing a particular classification system. A total of 26.3% responded. It was noted that 66.6% had studied the DSM-III in detail. Whereas the ICD-9 and DSM-II were the most used systems in the past (28.5% and 25.9% respectively), first choice systems for the future were DSM-III, 42.0% and ICD-9, 16.3%. Furthermore, the DSM-III was recommended to be used as the sole system to various associations, (Statistics Canada, Royal College, Medical Council of Canada and Postgraduate Programs) 45.9% to 51.4%, depending on which association (vs. 8.7% to 13.4% for the ICD-9). Of those responding to the question, 70.8% had a favourable impression of the DSM-III and a similar percentage wanted an ICD-10 which would incorporate features of the DSM-III. A survey of directors of postgraduate psychiatric training programs gave similar results. A total of 54.8% of the members supported changing the CPA "non-endorsement" policy. As well, 39.7% voted to maintain the policy and 5.5% did not respond. The survey provides information for the CPA in its consideration of policy about the use of classification systems. Should the policy be changed, and one system endorsed, the DSM-III receives the most support.

Canada↗
PubMed1987

Some calculations on the prevalence of dementia in Canada.

The epidemiology of dementia in Canada is not known. However, we report figures on the frequency of dementia in institutions in Ontario based upon the use of a multidimensional observation scale for the assessment of the elderly. These findings on institutionalized patients can be extrapolated to the whole elderly population, but the procedure is clearly too conservative by comparison with findings in other countries and in the light of the known occurrence of numbers of demented patients outside institutions. Ratios in different studies for the numbers of patients with dementia outside institutions and within institutions range from 1:1 to 6:1. Using a ratio of 2:1 and applying it to age specific population figures, a prevalence of dementia in Canada of 222,324 for those over 65 is obtained with a rate of 9.4% in that age group. When the figures projected in this way are compared with five epidemiological studies for the rate of dementia elsewhere, the Canadian figure which we have obtained ranks fourth out of six. This estimate provides potential figures on which to base the planning of services, provided that the inferential nature of the estimates is fully recognized.

Aged↗
PubMed1989

Viewpoint: development of mental health services and psychiatry in Canada: lessons from the past: problems of the present; and the future.

The history of mental health services in Canada has been characterized by great frustration for those dedicated to the development of programs to meet the needs of the mentally ill. Acceptance of these services by the public at large has been limited and characterized by suspicion and lack of trust. In recent decades these two trends have contributed to the present situation in which it is difficult to recruit competent, well-motivated clinical staff for our more isolated mental hospitals and there is increasing emphasis on legalistic aspects of individual civil rights, compulsory treatment and related factors with little attention to the patient's entitlement to and need for adequate treatment. It is hypothesized that more understanding and progress may come from an insightful review of the historical development of Canadian Mental Health Services and the goals of organized Psychiatry in Canada than will result from developing a defensive and confrontational attitude towards current events in the field.

Canada↗
PubMed1989

Mental hospital depopulation in Canada: patient perspectives.

This paper reviews briefly the history of mental health depopulation in Canada over the past 30 years. The term "deinstitutionalization" is often used but is unsatisfactory. Using an exploratory, qualitative, methodological approach, data were collected on the problems encountered by a disproportionate, stratified random sample of 139 formerly institutionalized patients living in various geographical locales in Eastern Canada. Adopting a symbolic interactionist theoretical approach, this study, in an effort to fill a neglect in the literature, attempted to discover what the everyday world(s) of Canadian ex-mental patients was really like. Problems encountered related to stigma, poor housing, lack of back living skills, poverty, unemployment and aftercare. Quotations from patients are provided to illustrate such themes. The findings are discussed.

Activities of Daily Living↗
PubMed1992

Psychiatric problems among Iranian immigrants in Canada.

The number of Iranian immigrants in Canada has been increasing since 1979. This study is the result of a review of 111 charts of Iranian patients who were referred for psychiatric treatment between 1985 and 1988. Ninety-eight percent of them arrived in Canada after the Iranian revolution, which started in 1979, and the Iran-Iraq war of 1980. Ten percent were experiencing trauma as a result of their involvement with the revolutionary government or the war. The symptoms were in accordance with the DSM-III-R criteria for post-traumatic stress disorder. Sixty percent met the criteria for adjustment disorder with depressed or anxious mood. Six percent had been subjected to physical and psychological torture and confinement. This is the first study that looks at the prevalence of psychiatric illness among Iranians and illustrates the effect of migration and displacement in the integrity of the psychic life of this population.

Canada↗
PubMed1994

Research funding of psychiatric disorders in Canada: a snapshot, 1990-1991.

Although mental illness accounts for up to 14% of total direct health care costs and an estimated cost of over five billion dollars annually, research funding of psychiatric disorders is regarded as underfunded relative to other biomedical research. This study was conducted to determine the amount of funds allotted to the research of specific psychiatric disorders in Canada. Data was obtained from a national database of peer-reviewed health research funding. Based on the title of the research grant, all projects that pertained to psychiatric disorders were identified and classified according to diagnosis. Research funding for psychiatric disorders totalled $16,391,000 from 1990 to 1991, or 3.7% of all biomedical research funding for that period. The relative contributions of federal, provincial and private (nonprofit) agencies to the funding total were 54%, 39% and 8%, respectively. Research funding for mental illness remains disproportionately low relative to other medical illnesses. The role of private nonprofit agencies, in particular, is much more limited for psychiatric disorders than for other identified medical illnesses. These data suggest that increased attention to research advocacy is required to increase psychiatric research support. Advocacy strategies should include: 1. publicizing the value and scope of psychiatric research in Canada; 2. working to de-stigmatize mental illness; 3. strengthening personal and professional affiliations with patient advocacy groups; 4. increasing the number and the qualifications of psychiatric researchers; 5. improving the scientific quality of research programs; and 6. organizing national research collaborations.

Canada↗
PubMed1998

The first asylums in Canada: a response to neglectful community care and current trends.

OBJECTIVE: Humane treatment and care of mentally ill people can be viewed from a historical perspective. Intramural (the institution) and extramural (the community) initiatives are not mutually exclusive. METHOD: The evolution of the psychiatric institution in Canada as the primary method of care is presented from an historical perspective. A province-by-province review of provisions for mentally ill people prior to asylum construction reveals that humanitarian motives and a growing sensitivity to social and medical problems gave rise to institutional psychiatry. The influence of Great Britain, France, and, to a lesser extent, the United States in the construction of asylums in Canada is highlighted. The contemporary redirection of the Canadian mental health system toward "dehospitalization" is discussed and delineated. RESULTS: Early promoters of asylums were genuinely concerned with alleviating human suffering, which led to the separation of mental health services from the community and from those proffered to the criminal and indigent populations. While the results of the past institutional era were mixed, it is hoped that the "care" cycle will not repeat itself in the form of undesirable community alternatives. CONCLUSION: Severely psychiatrically disabled individuals can be cared for in the community if appropriate services exist.

Canada↗
PubMed1988

Regulation of pesticides in Canada.

Pesticides are registered in Canada under the authority of the Pest Control Products Act (PCP), administered by the Department of Agriculture. The Department of Agriculture calls upon various federal departments, including Health & Welfare Canada, to provide expert advice on hazards which may be associated with the use of the product. The Department of Health and Welfare requires and reviews a range of toxicological studies to assess potential health hazards which may be associated with exposure to the chemical. Studies required include acute, sub-acute, chronic, reproduction, teratology and metabolism. In addition, exposure studies are also required to provide estimates of anticipated human exposure during typical field use of the chemical. In summary, the various steps involved in the registration of pesticides will be discussed and the relationship between the predictive toxicology as determined through animal testing and exposure estimates for estimating hazard will be shown.

Animals↗