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PubMed1986

Shaping the future of health institutions in Canada.

The development of the Health Institutions of the Future Forum will represent an important innovation in health planning in Canada. With every major planing decision, especially related to health institutions, there are many uncertainties. Some of these uncertainties are due to lack of time or resources required to gather information from economic, medical technological, and administrative research sources. Other uncertainties are due to lack of information about what is happening now (and in Canada, our data problems, though slowly being remedied, often lead us to resort to best guesses or judgements. Finally the remaining uncertainty is due to lack of ability to divide the future. The latter cannot be entirely remedied by better observation or measurement, but the degree of uncertainty can be estimated using varied reasonable assumptions about how driving forces may change. Once established, the Health Institutions of the Future Forum will aim to improve decision-makers' access to available information and to help them understand the range of uncertainty in the future. The Forum represents an important organisational adaptation to change and to specialisation. People from several different sectors have come together better to prepare for the future. Their cooperative and creative spirit combined with incisive research and analysis could become an important impetus for change on the Canadian health scene.

Academies and Institutes↗
PubMed1985

Dietetic internship programs in Canada: a comparison between 1935 and 1985.

Dietetic internships for most Canadian university graduates in 1935 were only available in the United States. The first priority of the student training committee established by CDA in 1936 was to integrate the isolated attempts at student training in Canada and standardize the training programs. Fifteen hospitals were tentatively approved by the committee and a standard course outline developed. Internship program development in 1985 continues to emphasize the establishment of national standards and the administration and accreditation of dietetic programs. Many changes have occurred in dietetic training programs between 1935 and 1985 to meet the increasing demands on our profession. The founding members of our Association recognized the need to establish and maintain quality dietetic practice in 1935. Their foresight, determination, and search for excellence in those early years ensured the future of the dietetic profession in Canada.

Canada↗
PubMedDate not supplied

Birth cohort effects underlying the increasing testicular cancer incidence in Canada.

PURPOSE: To examine the pattern of testicular cancer incidence by age, time period and birth cohort since 1969 in Canada. METHODS: In addition to analyses of the secular trends by age group and birth cohort separately, an age-period-cohort model and the submodels with standard Poisson assumptions were fitted to the data. RESULTS: The overall age-adjusted incidence of testicular cancer increased in Canada, from 2.8 per 100,000 males in 1969-71 to 4.2 in 1991-93. The younger age groups showed much higher absolute incidence rates in the recent period compared with those in the early period. Age-period-cohort modelling of data restricted to males aged 20-84 years suggested that the observed increase in testicular cancer could be largely attributed to a birth cohort effect. A steady increase in risk was observed among men born since 1945; those born between 1959 and 1968 were 2.0 (95% CI, 1.5-2.6) times as likely to develop testicular cancer as those born between 1904 and 1913. CONCLUSION: The risk of testicular cancer has increased over time and changing exposure to environmental factors early in life may be responsible for this.

Adolescent↗
PubMed1998

The consultation to develop a national strategy for cancer staging in Canada.

The lack of uniform recording of stage is a continued barrier to the success of cancer control activities. To review the role of staging, in 1997 the Canadian Committee on Cancer Staging (CCCS) of the National Cancer Institute of Canada (NCIC) formalised a national Consultation initiative with the input of Canadian oncology leaders and international experts on staging. A document was created from prior background work by the Committee and pre-circulated for comment. The document described the importance of cancer staging to patient care, epidemiological and clinical research, and cancer control programs. The document was refined through an iterative process over much of a year which included a formal workshop of the participants and other meetings. The Consultation reaffirmed, with evidence, the central role of staging in all aspects of cancer management. The report of the Consultation, endorsed by the Board of Directors of NCIC, included the following recommendations: 1) the recording of TNM stage by the treating physician should be a standard of care for every cancer patient in Canada where TNM applies, 2) the Canadian Council on Health Services Accreditation should include the TNM stage for every cancer patient as a requirement for hospital accreditation. In conclusion, this process represents an effective method for raising awareness about important medical issues such as staging which are fundamental to the management and control of cancer.

Academies and Institutes↗
PubMed1998

Issues in the implementation of cancer staging in Canada.

All sectors of the cancer control community in Canada agree that cancer staging is useful, and that stage should be assigned to every new case. At present, however, staging is not always recorded in the patient's records and treatment patterns and outcomes are rarely reported in terms of stage. This paper discusses what needs to be done to promote the use of staging in Canada. It is concluded that multifaceted programs of interventional continuing education (CE), tailored to meet the needs of the particular institution, offer the best prospect of success but the necessary organizational structure and information systems have to be put into place in advance. Implementation programs should be based on a thorough evaluation of the particular needs of the institution or community, and should be evaluated carefully in a few institutions before an attempt is made to disseminate them more widely. We recommend a phased approach to implementation which will first target institutions that already have the necessary infrastructure, i.e., provincial cancer centres. Demonstration of the feasibility and value of staging in that setting is seen as a means of promoting the adoption of staging in other institutions.

Academies and Institutes↗
PubMed1999

Effect of furosemide on performance of Thoroughbreds racing in the United States and Canada.

OBJECTIVE: To determine the effect of furosemide on performance of Thoroughbreds racing on dirt surfaces at tracks in the United States and Canada. DESIGN: Cross-sectional study. ANIMALS: All Thoroughbreds (n = 22,589) that finished a race on dirt surfaces at tracks in the United States and Canada between June 28 and July 13, 1997 in jurisdictions that allowed the use of furosemide. PROCEDURE: Race records were analyzed by use of multivariable ANOVA procedures and logistic regression analyses to determine the effect of furosemide on estimated 6-furlong race time, estimated racing speed, race earnings, and finish position. Principal component analysis was used to create orthogonal scores from multiple collinear variables for inclusion in the models. RESULTS: Furosemide was administered to 16,761 (74.2%) horses. Horses that received furosemide raced faster, earned more money, and were more likely to win or finish in the top 3 positions than horses that did not. The magnitude of the effect of furosemide on estimated 6-furlong race time varied with sex, with the greatest effect in males. When comparing horses of the same sex, horses receiving furosemide had an estimated 6-furlong race time that ranged from 0.56 +/- 0.04 seconds (least-squares mean +/- SE) to 1.09 +/- 0.07 seconds less than that for horses not receiving furosemide, a difference equivalent to 3 to 5.5 lengths. CONCLUSIONS AND CLINICAL RELEVANCE: Because of the pervasive use of furosemide and its apparent association with superior performance in Thoroughbred racehorses, further consideration of the use of furosemide and investigation of its effects in horses is warranted.

Age Factors↗
PubMed1999

Work-related mortality among older farmers in Canada.

OBJECTIVE: To describe the frequency and circumstances of work-related, fatal injuries among older farmers in Canada (1991 to 1995). DESIGN: Descriptive, epidemiologic analysis of data from the Canadian Agricultural Injury Surveillance Program. SETTING: Canada. PARTICIPANTS: Farmers aged 60 and older who died from work-related injuries from 1991 through 1995. METHOD: Age-adjusted mortality rates were calculated using the Canadian farm population as a standard for people involved, mechanism of injury, and place and time of injury. MAIN FINDINGS: The 183 work-related fatalities observed produced an overall mortality rate of 32.8 per 100,000 population per year. Higher fatality rates were observed in Quebec and the Atlantic Provinces. Almost all of those who died (98%) were men. Farm owner-operators accounted for 82.8% of the deaths (where the relationship of the person to the farm owner was reported). Leading mechanisms of fatal injury included tractor rollovers, being struck or crushed by objects, and being run over by machinery. Many older farmers appeared to be working alone at the time of injury. CONCLUSIONS: The data suggest that older farmers died while performing tasks common to general farm work, that most were owner-operators, and that many were working alone at the time of death. Innovative ways to reduce work-related injuries in this population must be found.

Accidents, Occupational↗
PubMed2000

Bovine respiratory disease: commercial vaccines currently available in Canada.

Bovine respiratory disease (BRD) remains a significant cost to both the beef and dairy industries. In the United States, an estimated 640 million dollars is lost annually due to BRD. Losses are largely a result of pneumonic pasteurellosis ("shipping fever"), enzootic pneumonia of calves, and atypical interstitial pneumonia. In Canada, over 80% of the biologics licensed for use in cattle are against agents associated with BRD. The objectives of this paper were (a) to summarize information available concerning commercial vaccines currently used in Canada for protection against BRD, and (b) to provide an easily accessible resource for veterinary practitioners and researchers. Information from the most recent Compendium of Veterinary Products has been tabulated for each vaccine by trade name, according to vaccine type, and the pathogens against which they are designed to protect. Additional information from published articles (peer-reviewed and other) has been provided and referenced.

Animals↗
PubMed2000

Update: raccoon rabies epizootic--United States and Canada, 1999.

In 1977, an outbreak of raccoon rabies was detected in an area on the West Virginia-Virginia border. Since then, the area affected by this distinct variant of rabies virus associated with raccoons has spread to Ohio in the west and New York, Pennsylvania, Vermont, New Hampshire, and Maine in the north. In addition, the once separate epizootics of rabies among raccoons in the southeastern and mid-Atlantic states converged in North Carolina. In July 1999, the raccoon rabies virus variant was reported from Ontario, Canada, on the New York border. This report describes the spread of this epizootic of raccoon rabies through mid-Atlantic and northeastern states and into Canada.

Animals↗
PubMed1999

Pediatric research and the parens patriae jurisdiction in Canada and England.

This paper considers the issue of enrolling non-autonomous minors as participants in pediatric research in light of two high court decisions concerning the sterilization of non-autonomous individuals in Canada and England. In particular, this paper looks at the 1986 case of Re Eve in which the Supreme Court of Canada found that sterilization of such persons under the parens patriae jurisdiction can be justified only if direct, therapeutic benefit to the person has been established. It is compared to the 1987 decision in Re B (a minor), in which the English Law Lords repudiated the Canadian decision and upheld the broader, traditional interpretation of the parens patriae jurisdiction which allowed best interests as justification for the non-therapeutic sterilization of non-autonomous persons. With reference to differences in the interpretations of the parens patriae jurisdiction by these two courts, it is suggested that until such time that the Canadian courts consider a case directly on point, pediatric researchers in that country must presume greater restrictions when enrolling non-autonomous subjects in research protocols than in countries such as England.

Canada↗
PubMed2000

Pharmaceutical policies in Canada: another example of federal-provincial discord.

Pharmaceutical policy in Canada is set at both the federal and provincial levels of government. The federal government is responsible for intellectual property rights of manufacturers (patents) and the initial approval and labelling of prescription drugs and for ensuring overall market competitiveness. The provincial government has responsibility and jurisdiction over the funding of all health care services, including pharmaceuticals. Various interactions between the pharmaceutical industry, the federal and provincial governments and consumers have shaped the current landscape for prescription drugs in Canada. One key failing of the system is that the federal government is almost completely insulated from the impact of its policies because, although it regulates drug prices, it does not buy any drugs. In contrast, provincial governments have no jurisdiction over market competitiveness or pricing, yet end up paying for most of the drug expenditures incurred.

Canada↗
PubMed2000

Non-Hodgkin's lymphoma and occupational exposure to chemicals in Canada. Canadian Cancer Registries Epidemiology Research Group.

BACKGROUND: The incidence of non-Hodgkin's lymphoma (NHL) has been increasing in Canada. This study assessed the effect of occupational exposure to specific chemicals on the risk of NHL. PATIENTS AND METHODS: Mailed questionnaires were used to obtain data on 1469 newly diagnosed, histologically confirmed NHL cases and 5073 population controls between 1994 and 1997 in eight Canadian provinces. Data was collected on socioeconomic status, life-style, diet, occupation, and years of exposure to any of 17 chemicals. Odds ratios (OR) and 95% confidence intervals (95% CI) were derived by logistic regression. RESULTS: The study found an increased risk of NHL among males exposed to benzidine, mineral, cutting, or lubricating oil, pesticides, and herbicides. Compared with non-exposure to each specific chemical, the adjusted ORs were 1.9 (95% CI: 1.1-3.4) for benzidine, 1.3 (95% CI: 1.0-1.5) for mineral, cutting, or lubricating oil, 1.3 (95% CI: 1.0-1.6) for herbicides, and 1.3 (95% CI: 1.0-1.6) for pesticides. Excess risk of NHL among females was associated with exposure to pesticides and wood dust. ORs increased with increasing exposure in years to benzidine and herbicides for males and with increasing exposure years to wood dust for females. These trends were statistically significant (P < 0.05). CONCLUSIONS: The findings in this study suggest that occupational exposure to specific chemicals plays an important role in the development of NHL in Canada.

Adult↗
PubMedDate not supplied

The physician's role in Canada's disaster response system.

The most recent tragedy in Manitoba illustrates that disasters can strike any community. Within Canada, a tiered disaster response system exists. Even though physicians often play an integral role in the disaster plan, few participate in the planning process or even appreciate their potential role in the event a disaster should occur. Physician involvement would guarantee health matters be appropriately addressed resulting in reduced mortality and decreased morbidity. There are ample opportunities to become involved in disaster planning and response at all levels of government. The objective of this paper is to inform physicians about the disaster planning infrastructure that exists in Canada, show them where they may get involved, and urge them to do so.

Canada↗
PubMedDate not supplied

Increased neonatal readmission rate associated with decreased length of hospital stay at birth in Canada.

PURPOSE: To assess the potential impact of early post birth discharge in Canada. METHODS: Neonatal readmission was examined, based on hospital discharge data from the Canadian Institute for Health Information, with a total of 2,144,205 infants from fiscal year 1989/90 to fiscal year 1996/97. RESULTS: Neonatal readmission rates increased from 27.3 per 1,000 in 1989/90 to 38.0 per 1,000 in 1996/97, while mean length of hospital stay at birth decreased from 4.2 days to 2.7 days during the same period. The increase in readmission rate was more evident for dehydration and jaundice. The provinces and territories with decreased length of hospital stay at birth usually had increased neonatal readmission rate and earlier age at readmission. Between 1994/95 and 1996/97, compared with Newfoundland, the risks for neonatal readmission for dehydration were 5.7 and 5.5, and for jaundice were 4.5 and 2.7, respectively, for Alberta and Ontario. CONCLUSION: Neonatal readmission rates for several conditions have increased substantially, associated with early post birth discharge policies adopted in Canada.

Canada↗
PubMed2000

[Report of Sata Clinical Fellowship; brain death and organ donation in hospital for sick children, Toronto, Canada].

I have experienced two cases of pediatric organ donation from the brain dead patients in Hospital for Sick Children in three months. First case was a 9-year-old boy after a traffic accident. Second case was an 11-year-old boy with intracranial hemorrhage. Brain death is diagnosed by clinical criteria alone in Canada, as in many of developed countries. EEG or brain flow studies are not mandatory. In the first case, brain death was confirmed after additional brain flow study, EEG, and SSEP because of cervical spinal injury. Second case was diagnosed as brain death by clinical criteria alone, and cardiopulmonary resuscitation was performed after brain death diagnosis. MORE (multiple organ receival and exchange program of Ontario), Organ Donation Team (critical care physicians, nurses, organ donation coordinators, social workers and chaplains) in HSC, and volunteers play the important role to help the family and to make the organ transplantation successful. In Canada, pediatric brain death and organ donation are widely accepted, but there remains an imbalance between the demand for transplantation and the number of organs available.

Age Factors↗
PubMed2000

The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada.

BACKGROUND: In 1996 the number of deaths and admissions to hospital in Canada that could be attributed to the use of alcohol, tobacco and illicit drugs were estimated from 1992 data. In this paper we update these estimates to the year 1995. METHODS: On the basis of pooled estimates of relative risk, etiologic fractions were calculated by age, sex and province for 90 causes of disease or death attributable to alcohol, tobacco or illicit drugs; the etiologic fractions were then applied to national mortality and morbidity data for 1995 to estimate the number of deaths and admissions to hospital attributable to substance abuse. RESULTS: In 1995, 6507 deaths and 82,014 admissions to hospital were attributed to alcohol, 34,728 deaths and 194,072 admissions to hospital were attributed to tobacco, and 805 deaths and 6940 admissions to hospital were due to illicit drugs. INTERPRETATION: The use and misuse of alcohol, tobacco and illicit drugs accounted for 20.0% of deaths, 22.2% of years of potential life lost and 9.4% of admissions to hospital in Canada in 1995.

Alcohol Drinking↗
PubMed2000

Hepatitis C lookback in Canada.

BACKGROUND AND OBJECTIVES: Since March 1990, all blood donations in Canada are screened by enzyme-linked immunosorbent assay (EIA) for antibodies to HCV, with confirmatory testing done using a recombinant immunoblot assay (RIBA). Because HCV may cause chronic asymptomatic hepatitis, in 1995, the Canadian Red Cross began targeted HCV lookback studies on all confirmed positive donations. These have been continued by the two new operators of the blood system in Canada, Héma-Québec and the Canadian Blood Services. Subsequent to recommendations made in the public inquiry into the Canadian blood system, led by judge Krever, general lookback through letter notification of all patients transfused in the years prior to the introduction of anti-HCV testing was initiated in several pediatric hospitals, and later in several Canadian provinces. MATERIALS AND METHODS: Targeted HCV lookback was done for all donors confirmed positive by RIBA testing from the start of HCV testing in 1990. In 1999, stored RIBA 2 indeterminate samples were re-tested by RIBA 3, and lookback performed on confirmed positive donations. In the province of Quebec, hospitals were surveyed to determine methods and resources involved in lookback. Provinces performing general letter notification entered hospital transfusion records into a central transfusion data bank, and performed linkage with other provincial data banks to remove deceased patients and obtain current addresses. RESULTS: As of January 2000, targeted lookback had been completed on 4,859 components of 1,628 anti-HCV positive repeat donors. 2,991 recipients were deceased, and 451 were not found or tested. Of the 1,422 recipients tested, 954 (67%) were anti-HCV positive. Approximately half were already aware of their HCV status. Lookback efforts in hospitals were hampered by lack of resources and manual records. General letter notification in British Columbia (BC) and Prince Edward Island (PEI) led to the testing of 38,960 and 1,953 recipients respectively, with 5.0 and 2.2% of tested recipients found to be anti-HCV positive. CONCLUSION: In completed targeted lookback investigations, 19% of components are eventually linked to an anti-HCV positive recipient. These results are very similar to those obtained in other countries, such as Denmark and the UK. In general letter notification lookbacks, the frequency of anti-HCV in the tested recipients is approximately twice the frequency of the general population.

Antibodies, Viral↗
PubMed2000

Commentary. monitoring tobacco use in canada: the need for a surveillance strategy.

Smoking behaviour has been monitored nationally through population surveys for 35 years in Canada, but these surveys have not been as consistent or rigorous as the magnitude of the smoking problem demands. Inconsistent methods and irregular survey intervals are just two of the characteristics that have made it difficult to know exactly how smoking is changing. Further, an absence of routine data on tobacco control policies (other than the price of cigarettes) has hampered understanding of the determinants of changing prevalence. The advent of two survey series--Canadian Tobacco Use Monitoring Survey (CTUMS) and Canadian Community Health Survey (CCHS) promises to change this situation for the better. We suggest that both are critical elements of a national smoking surveillance system and that, with a commitment to CTUMS in particular, Health Canada could set a new international standard for surveillance.

Canada↗