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PubMed2006

Neonatal herpes simplex virus infections in Canada: results of a 3-year national prospective study.

OBJECTIVE: The goal was to determine incidence, determinants, and morbidity and mortality rates of neonatal herpes simplex virus infections in Canada. METHODS: From October 1, 2000, to September 30, 2003, reports of neonatal herpes simplex virus infection were solicited actively from all Canadian pediatricians and pediatric subspecialists on a monthly basis. RESULTS: Fifty-eight cases of neonatal herpes simplex virus were reported (5.9 cases per 100,000 live births). Cesarean section was performed in 24.6% of cases, 28.1% of patients were born prematurely, 28.6% had birth weights of < 2500 g, and 7.5% had Apgar scores of < 7 at 5 minutes of life. Mothers < 20 years of age and those reporting Aboriginal ethnicity were affected disproportionately; 40% of mothers had no history of genital herpes before delivery, and intrapartum genital lesions were present in only 1 of 58 cases. Of cases with known herpes simplex virus type, 62.5% were herpes simplex virus-1. Localized infections accounted for 59.6% of cases, whereas disseminated disease and central nervous system disease were reported for 17.5% and 22.8%, respectively. Localized infections were more likely to be herpes simplex virus-1 and disseminated and central nervous system infections herpes simplex virus-2. Nine of 58 cases were fatal. All cases with known treatment information (n = 55) were treated with intravenously administered acyclovir. CONCLUSIONS: This is the first study to examine the national incidence of neonatal herpes simplex virus in Canada. Many women had no genital herpes simplex virus history before delivery, and the majority of cases were herpes simplex virus-1, which has implications for prenatal screening and vaccine/drug development. Follow-up monitoring of case subjects is being performed annually for 3 years, to be completed in October 2006.

Canada↗
PubMedDate not supplied

Reforming health care in Canada: current issues.

This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government's clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are out-moded in light of new knowledge, new fiscal realities and the evolution of power among stake-holders. They recommend decentralized governance and restructuring for better management and more citizen participation. Although Canada's health care system remains committed to safe-guarding its guiding principles, the balance of power may be shifting from providers to citizens and "technocrats". Also, all provinces are likely to increase their pressure on physicians by means of salary caps, by exploring payment methods such as capitation, limiting access to costly technology, and by demanding practice changes based on evidence of cost-effectiveness.

Canada↗
PubMed2003

Addressing social and gender inequalities in health among seniors in Canada.

Although canadian seniors enjoy economic security and good health and have made substantial gains in recent decades, this well-being is not equally shared among socioeconomic groups and between men and women. As for younger age groups, income predicts health status in later life, but less powerfully. Potential alternative explanations include an overriding influence of the aging process, the subjective effects of income loss at retirement and the attenuation of the poverty gap owing to public retirement income. Older women are more likely to age in poverty than men, to live alone and to depend on inadequately resourced chronic health care and social services. These differences will hold as well for the next cohort of seniors in Canada. Addressing these disparities in health requires a comprehensive, multisectoral approach to health that is embodied in Canada's population health model. Application of this model to reduce these disparities is described, drawing upon the key strategies of the population health approach, recent federal government initiatives and actions recommended to the government by federal commissions.

Aged↗
PubMed1980

Professional encroachment: a comparison of the emergence of denturists in Canada and Oregon.

In 1978, supporters of denturism in Oregon succeeded in passing an initiative which allows denturists to provide dentures directly to the public. The steps which led to the referendum included three unsuccessful attempts to have the state legislature enact a law legalizing denturism. After capturing broad-based consumer support, the issue was placed on the ballot and passed by an overwhelming margin. Both the denturists and the dentists in Oregon adopted strategies similar to those used in Canada over 20 years ago when the issue was raised in a number of provinces. As was the case in Canada, the denturists prevailed. Denturists stressed the price differential and the issue of freedom of choice. Dentists stressed health and safety issues. The public perceived the dentists' campaign as negative and self-serving. This perception may have contributed to the election results. In order to avoid this tarnished image, dentists must anticipate the public's needs, and formulate strategies to meet such needs.

Canada↗
PubMed1983

Health expectancy in Canada, late 1970s: demographic, regional, and social dimensions.

Based on estimates of activity restriction from the Canada Health Survey, institutional data on long-term care, and survival data from vital statistics, we have calculated an index of health expectancy (life expectancy in each state of health), and a summary of these indices which we have called quality-adjusted life expectancy. At birth, expected years of long-term institutionalization were 0.8 for men and 1.5 for women. Expected years of activity restriction not involving long-term institutionalization were 10.8 for men and 14.0 for women; 3.0 of the expected years of activity restriction for men and 1.3 of these years for women were in the most severe category of restriction (unable to do major activity). For both sexes together, quality-adjusted life expectancy was 1.4 years greater in Ontario and the Prairies than in the Atlantic region, 3.2 years greater in Canada's three largest cities than in rural areas and small towns, and 7.7 years greater among persons from high-income families than among persons from low-income families.

Activities of Daily Living↗
PubMed1995

Pediatric mortality and hospital use in Canada and the United States, 1971 through 1987.

Since 1971 pediatric mortality rates have decreased markedly but differently in Canada and the United States. These trends were examined in light of changes in hospital use and health care financing. Annual mortality and hospital use rates for children aged 14 years and younger were calculated. Between 1971 and 1987, all-cause mortality in Canada fell from 165 to 74 per 100,000; the American rate fell from 172 to 96 per 100,000. American hospitalization rates remained essentially constant until 1983 and then fell by 27.5%, while Canadian hospitalization rates declined throughout. In 1987 Canadian children had higher hospitalization rates, while American children had higher mortality rates. These differences may be associated with differences in health financing; the adoption of US prospective payment systems was temporally coincident with sharp declines in hospitalization rates for American children.

Adolescent↗
PubMed2003

Health care reform: lessons from Canada.

Although Canadian health care seems to be perennially in crisis, access, quality, and satisfaction in Canada are relatively high, and spending is relatively well controlled. The Canadian model is built on a recognition of the limits of markets in distributing medically necessary care. Current issues in financing and delivering health care in Canada deserve attention. Key dilemmas include intergovernmental disputes between the federal and provincial levels of government and determining how to organize care, what to pay for (comprehensiveness), and what incentive structures to put in place for payment. Lessons for the United States include the importance of universal coverage, the advantages of a single payer, and the fact that systems can be organized on a subnational basis.

Canada↗
PubMed2004

In-hospital cost of total hip arthroplasty in Canada and the United States.

BACKGROUND: There is little information comparing the costs of specific surgical procedures performed in Canada and those done in the United States. The objective of this study was to compare the in-hospital costs associated with primary total hip arthroplasty performed in the two countries. METHODS: In-hospital costs of 1679 consecutive patients (940 Canadian and 739 American patients) who underwent total hip arthroplasty were extracted from three Canadian and three United States teaching hospitals between 1997 and 2001. Participating hospitals used the same cost accounting system to provide per-patient demographic, clinical, and cost data. Canadian dollar costs were converted to United States dollar costs with use of purchasing power parities. RESULTS: The baseline clinical characteristics of patients undergoing total hip arthroplasty in Canada and the United States were similar. The American patients were a mean of 4.6 years older than the Canadian patients (mean [and standard deviation], 67.8 +/- 12.4 years compared with 63.2 +/- 14.9 years). The median cost for the primary arthroplasty was $6080 (mean [and standard error of the mean], $6766 +/-$119) at the three Canadian hospitals and $12,846 (mean, $13,339 +/-$131) at the United States hospitals (p < 0.0001). The mean length of stay (and standard deviation) was 7.2 +/- 4.7 days for the Canadian patients and 4.2 +/- 2.0 days for the American patients. Implants at one hospital in the United States were found to be four times more costly than those in a Canadian hospital. CONCLUSIONS: Higher in-hospital costs were found for the American hospitals despite the fact that they had a significantly shorter patient length of stay compared with Canadian centers (p < 0.0001). Canadian hospitals should follow the lead of their counterparts in the United States and implement strategies to decrease the length of stay in the hospital, while institutions in the United States should revisit their ability to better manage the costs related to a primary total hip arthroplasty, particularly by controlling unit costs.

Aged↗
PubMed2005

The impact of deficit reduction on the nursing labour market in Canada: unintended consequences of fiscal reform.

INTRODUCTION: Beginning in 1992, governments throughout Canada began reducing expenditures in an effort to eliminate fiscal deficits and reduce their alarmingly high debt burden. As part of this deficit-fighting era, governments reduced hospital expenditure levels quite dramatically. Some of the current problems in the Canadian healthcare system - the recent unrest in the nursing labour market in particular - are often attributed to this hospital downsizing era. METHODS: This article examines trends in the labour market for registered nurses in Canada during the hospital downsizing period. Of particular interest is the effect of hospital spending reforms on nurse employment levels in hospitals and on the age structure of the nursing workforce. After identifying the trends, the main factors driving the trends are discussed. RESULTS: Results indicate that a decrease in the demand for nursing labour resulted in large staff layoffs during the restructuring period, particularly among the youngest age groups. DISCUSSION/CONCLUSION: The evidence does not support the claim that deteriorating wages and working conditions in hospitals led nurses to quit their jobs during the hospital downsizing period.

Adult↗
PubMed1989

The implications of work organization for occupational health policy: the case of Canada.

This article examines occupational health and safety developments in Canada during the decade of the 1970s when most government jurisdictions replaced former factory Acts with new health and safety legislation recognizing the right of workers to be involved in work environment matters. During the latter part of the 1970s, health and safety "activists" and trade unionists began to perceive the need for a wider conception of occupational health and safety. Canadian reformers were influenced by Scandinavian developments, especially the research of Dr. Bertil Gardell and his associates. Unfortunately, during the late 1970s Canada experienced a recession and a political shift to conservatism. Consequently, during the 1980s there have been no meaningful workplace health and safety reforms. Further, the article suggests that there is strong resistance by management and government to extension of worker rights in occupational health and safety. All major political parties ground their work environment policies in utilitarian concepts that trade worker health and safety for economic considerations. The author, therefore, argues for the development of an "ethics of the work environment" based upon egalitarian principles, and the transformation of the primary work group into a community of workers who can shape the character of their work environment. Ideally, the relationship between the major "actors" in our industrial relations system ought to be based on obligation instead of the present language of worker protest based on rights. Nonetheless, there is a need to extend and deepen worker rights in the workplace. Finally, the author argues that the appropriate relationship in industry to reflect a democratic work environment is "partnership"--the coming together of the primary work groups as equals.

Accident Prevention↗
PubMed1979

Convenience and the occurrence of births: induction of labor in the United States and Canada.

This paper, using data for the United States and Canada on number of births by day of the week, presents indirect evidence for the widespread incidence of the practice of elective induction. For both the United States and Canada, it is found that substantially fewer births occur on Saturdays, Sundays, and holidays than on weekdays. Controlling for such factors as prenatal care, race, education, legitimacy, birth weight, and time trend strongly suggests that the induction of labor is responsible for the patterns found. The paper concludes by discussing the framework within which the practice of elective induction of labor should be evaluated and justified.

Appointments and Schedules↗
PubMed1983

Medical dominance in Canada in historical perspective: the rise and fall of medicine?

Freidson's concept of medical dominance is compared to the alternative conceptions of neo-Marxist writers. Dominance is then examined in historical perspective, using medicine in Canada (mainly Ontario) as a case study. Medicine emerged as the dominant health occupation in Canada in the late 19th and early 20th centuries, consolidating its power between World War I and the Saskatchewan doctors' strike of 1962. The authors argue that medical dominance has declined since that time due to such factors as the involvement of the state in health insurance, the rise of other health occupations, increasing public or at least elite skepticism, and possible internal fragmentation. The underlying social explanation for this historical process is sought in changes in the Canadian class structure, specifically the spread of the capitalist mode of production, the decline of the petite bourgeoisie, and the rise of the state. It is suggested that Freidson's specific accounts of the history of medicine must be incorporated for explanatory purposes within the broader neo-Marxist view of medicine as an intermediary rather than an ultimately determining institution.

Canada↗
PubMed2006

Health care access in three nations: Canada, insured America, and uninsured America.

This analysis provides new statistics for one of the oldest and fiercest debates in American health policy: whose residents have better access to health care, the United States' or Canada's? Data from the 2002-2003 Joint Canada U.S. Survey of Health show that, despite major differences in their health systems, most Canadians and Americans get the care they need. However, one group of Americans is much more likely to report serious access barriers--the uninsured. About one-third of currently or recently uninsured Americans, aged 18 to 64, said they could not get needed health care (over three times the rate of insured Americans or Canadians). Compared with Canadians and insured Americans, the uninsured are less likely to use hospital or physician services, and those who do are less satisfied with the care they receive. They are also less likely to purchase prescribed medications, due to cost. From a consumer perspective, the most salient feature of the Canadian system is its universality. In contrast, insured Americans under age 65 are at risk of losing their insurance and facing substantial access barriers.

Adolescent↗
PubMed2001

International trade regulation and publicly funded health care in Canada.

The World Trade Organization (WTO) creates new challenges for the Canadian health care system, arguably one of the most "socialized" systems in the world today. In particular, the WTO's enhanced trade dispute resolution powers, enforceable with sanctions, may make Canadian health care vulnerable to corporate penetration, particularly in the pharmaceutical and private health services delivery sectors. The Free Trade Agreement and its extension, the North American Free Trade Agreement, gave multinational pharmaceutical companies greater freedom in Canada at the expense of the Canadian generic drug industry. Recent challenges by the WTO have continued this process, which will limit the health care system's ability to control drug costs. And pressure is growing, through WTO's General Agreement on Trade in Services and moves by the Alberta provincial government to privatize health care delivery, to open up the Canadian system to corporate penetration. New WTO agreements will bring increasing pressure to privatize Canada's public health care system and limit government's ability to control pharmaceutical costs.

Canada↗
PubMed2005

Achievements and challenges of medicare in Canada: Are we there yet? Are we on course?

Health care policy in Canada is based on providing public funding for medically necessary physician and hospital-based services free at the point of delivery ("first-dollar public funding"). Studies consistently show that the introduction of public funding to support the provision of health care services free at the point of delivery is associated with increases in the proportionate share of services used by the poor and in population distributions of services that are independent of income. Claims about the success of Canada's health care policy tend to be based on these findings, without reference to medical necessity. This article adopts a needs-based perspective to reviewing the distribution of health care services. Despite the removal of user prices, significant barriers remain to services being distributed in accordance with need-the objective of needs-based access to services remains elusive. The increased fiscal pressures imposed on health care in the 1990s, together with the failure of health care policy to encompass the changing nature of health care delivery, seem to represent further departures from policy objectives. In addition, there is evidence of increasing public dissatisfaction with the performance of the system. A return to modest increases in public funding in the new millennium has not been sufficient to arrest these trends. Widespread support for first-dollar public funding needs to be accompanied by greater attention to the scope of the legislation and the adoption of a needs-based focus among health care policymakers.

Canada↗
PubMed1993

Pharmaceuticals, patents, and politics: Canada and Bill C-22.

In response to high drug prices, the Canadian government amended the country's patent act in 1969 to allow for compulsory licensing to import pharmaceuticals. As a result of the legislation, by 1983 drug costs in Canada were over $200 million lower than they would otherwise have been. The multinational drug industry was strongly opposed to compulsory licensing, despite any evidence that its economic position had been harmed. Restoration of patent protection for drugs was one of the key U.S. demands during free-trade negotiations between Canada and the United States in 1985-1987. The result was Bill C-22, which gave new drugs protection from compulsory licensing for seven to ten years. This article analyzes the impact of Bill C-22 on the generic industry, the creation of jobs in research and development, drug prices, and research and development expenditures. It concludes with an examination of future demands from the pharmaceutical industry.

Canada↗
PubMed1998

Clinical or industrial pharmacy? Case studies of hospital pharmacy automation in Canada and France.

Automated medication dispensing systems for hospital pharmacies, heralded as an important means of reducing drug errors and improving labor productivity, have also been seen as a means of furthering the transformation of the pharmacy profession from its role in dispensing prescriptions to a clinical profession concerned with treatments and patient outcomes. Automation aids this transformation by transferring the responsibility for routine dispensing to technicians performing rationalized and computer-mediated tasks. Not all pharmacists agree with these trends. Some fear a loss of professional status and employment as their knowledge is expropriated and incorporated into machinery operated by those with lesser qualifications. They fear an industrial rather than a clinical future. Their concerns are compounded by health care cutbacks. These issues were studied at two hospitals in Canada and one in France, all mid-sized public hospitals with automated unit dose drug delivery systems installed in the late 1980s and early 1990s. Preliminary results indicated national differences in approaches to hospital pharmacy automation. In Canada, pharmacists have resisted major changes in their control of the dispensing process and in their traditional roles vis à vis doctors and pharmacy technicians. In France, where hospital pharmacy as a profession is less developed than in North America, automation has brought about a far more radical substitution for pharmacists' labor.

Automation↗
PubMed2002

Prevalence of and risk factors for leptospirosis among dogs in the United States and Canada: 677 cases (1970-1998).

OBJECTIVE: To determine whether there was a temporal trend in prevalence of leptospirosis among dogs in the United States and Canada and to determine whether age, sex, and breed were risk factors for the disease. DESIGN: Retrospective study. ANIMALS: 1,819,792 dogs examined at 22 veterinary teaching hospitals between 1970 and 1998. PROCEDURES: The Veterinary Medical Data Base was searched for records of dogs in which a diagnosis of leptospirosis was made, and hospital prevalence was calculated. Logistic regression was used to examine the association between leptospirosis and age, sex, and breed. RESULTS: 677 dogs with leptospirosis were identified. Thus, hospital prevalence was 37 cases/100,000 dogs examined. A significant increase in leptospirosis prevalence between 1983 and 1998 was identified. Male dogs were at significantly greater risk of leptospirosis than were female dogs; dogs between 4 and 6.9 years old and between 7 and 10 years old were at significantly greater risk than dogs < 1 year old; and herding dogs, hounds, working dogs, and mixed-breed dogs were at significantly greater risk than companion dogs. CONCLUSIONS AND CLINICAL RELEVANCE: The prevalence of leptospirosis among dogs examined at veterinary teaching hospitals in the United States and Canada has increased significantly since 1983. Male dogs of working and herding breeds were at greater risk.

Age Factors↗