Nursing practice standards and competencies for nurses beginning to practice in Alberta. Alberta Association of Registered Nurses May 1991.
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The incidence of female breast cancer in Alberta increased steadily by one case per 100,000 per year from 1953 to 1973 to a current rate of 68.6 per year when adjusted to the 1950 U.S. population. Incidence rates of breast cancer in Alberta and Saskatchewan were identical after population adjustment. The incidence increased in women over 40, implicating an increase in the postmenopausal type of breast cancer. Birth cohort analysis showed increased age-specific incidence rates in middle-aged women occurring in successive cohorts from 1903 to 1918, a result similar to that found in Saskatchewan, Connecticut, and Finland. The menopausal hook is disappearing in Alberta data, apparently due to cohort-specific increases in incidence. Possible etiological factors involved in these incidence changes are discussed; a detailed analysis of specific etiological factors is currently underway on over 3,000 patients with malignant or benign breast disease who were examined at the Dr. W. W. Cross Cancer Institute in Edmonton from 1971 to 1974.
Hb-Alberta has been found in a 51 year old Caucasian male with erythrocytosis. The substitution in this variant involves the glutamyl residue in position 101(G3) of the beta chain which is replaced by a glycyl residue. Hb-Alberta accounts for about 45% in the heterozygote, and readily forms hybrid tetramers with other hemoglobins. The oxygen affinity of Hb-Alberta is greatly increased, its Bohr effect reduced, and its subunit interaction greatly diminished.
OBJECTIVES: To determine (a) trends in the cesarean section rate in Alberta from April 1979 to March 1988, (b) the contribution of different primary indications to the overall increase in the cesarean section rate and (c) trends in the cesarean section rate by residence of the mother. DESIGN: Retrospective study. PARTICIPANTS: Women who gave birth in acute care hospitals in Alberta during the study period. Indications for cesarean section were defined by a hierarchic classification system. Geographic regions were identified according to the mother's residence. MAIN RESULTS: The crude cesarean section rate increased from 13.2 to 17.3 per 100 deliveries between 1979-80 and 1987-88. Previous cesarean section accounted for 54% of the increase, breech presentation for 17%, fetal distress for 17% and dystocia for 10%. The contribution of previous cesarean section was due to the substantial increase in the number of women presenting with a previous cesarean section. The cesarean section rate among women who had previously had the procedure decreased from 96.7% in 1979-80 to 84.6% in 1987-88. The crude cesarean section rates by region varied from 10.3 to 22.3 per 100 deliveries. CONCLUSIONS: Further efforts to reduce the rate of cesarean section among women who have previously undergone the procedure are needed to control the rate of cesarean section in Alberta. Decreasing the rate of primary cesarean section is also an important goal.
Five-year survival rates for all 519 women with breast carcinoma in northern Alberta in 1971 and 1972 were analysed with the use of data from the computerized northern Alberta breast registry and the Alberta cancer registry. The relative 5-year survival was 73%, which is higher than most rates reported from other centres. Lymph node involvement was significant as a prognostic factor, with the relative 5-year survival falling from 92% in the group without lymph node involvement to 58% in the group with three or more involved nodes. The prognosis was also significantly affected by the stage of the disease according to the 1973 TNM classification: the 5-year survival rates ranged from 88% for patients with stage 1 disease to 17% for those with stage IV disease. Women 40 to 59 years of age had a higher survival rate (79%) than those under 40 years (65%) or over 60 years (66%) of age. Analyses by 5-year age groups showed that women 35 to 39 years old had a particularly poor survival rate (59%). Postmenopausal women less than 55 years old had a higher survival rate than did perimenopausal or premenopausal women in the same age group. Further follow-up is indicated to correlate possible high-risk factors with survival.
Members of a religious isolate who live in approximately 240 farming colonies in the Canadian prairie provinces and the United States border states were studied. The sect's 6,700 members living in the province of Alberta, Canada, comprise more than 30% of this sect's population of North America. The numbers of their cancer cases ascertained from 1953 to 1974 in Alberta were compared to those expected from Alberta Cancer Registry rates. The overall incidence of registered cases of cancer among the religious isolate's females was significantly less than expected (48 observed, 74.2 expected), and in the males the overall incidence of cancer did not differ from that expected (52 observed, 56.5 expected). Significantly fewer cases of lung cancer than expected were found in males, and significantly fewer cases of carcinoma in situ of the cervix uteri were found in females. Finally, significantly higher incidence of stomach cancer was found in the sect's males. Data on a family with two cases of stomach cancer contributed to this observed excess of stomach cancer.
Previous studies in the US have suggested that the risk of tuberculosis is increased among elderly residents of nursing homes. This registry-based study determined and compared the tuberculosis incidence rate for the elderly in nursing homes and community dwellings in Alberta, Canada, over the 5-year period 1979-1983. Rate ratios (RR) using the community elderly rate as baseline, were estimated for all notified cases and for culture positive cases only. Adjustment was made for the variables age, sex, and ethnicity. The nursing home elderly in Alberta did not have an increased risk of tuberculosis: adjusted RR = 1.09, 95% CI : 0.38-1.80.
The mortality experience of 716 male hydrometallurgical nickel refinery employees who worked at Sherritt Gordon Limited in Fort Saskatchewan, Alberta for at least 12 continuous months during the years 1954 to 1978 was examined. Mortality ascertainment was obtained utilizing the Canadian Mortality Data Base maintained by Statistics Canada and covered the years 1954 through 1984. Cause-specific mortality analyses were accomplished using male, age and calendar-year adjusted death rates for Canada and the province of Alberta. Total mortality was significantly below expectation (27 observed vs. 47 expected). Statistically significant fewer observed deaths were found for circulatory disease while multiple myeloma demonstrated a statistically significant increase of observed deaths. No deaths due to nasal cavity or paranasal sinus cancer were detected. Only one lung cancer death was found with three deaths expected (SMR 33). No association was found in this study between exposure to nickel concentrate or metallic nickel and the subsequent development of respiratory cancer.
Since 1973 the government of Alberta, a Canadian province of 2.4 million people, has funded a dental care plan for all residents over 64 years old and their dependents. It is the only dental plan in North America that covers all seniors and their dependents residing in a state or province. Under this plan, just over 270,000 persons (in 1990-91) are eligible for comprehensive, premium-free dental services provided by dentists and denturists in private practice on a fee-for-service basis. The plan's design, administration, utilization, and costs are reviewed. Utilization increased from 27 percent of eligibles using the plan in 1974-75 to 44 percent in 1990-91, and the mean number of services per user rose from 4.9 to 6.9 during the same time period. Although the cost per eligible person has increased about 200 percent, from Canadian (C) $42 to C $131, these costs only began to exceed the rate of inflation in 1986-87. Even though just 12 percent of the two main providers participating in the plan are denturists, nearly 22 percent of plan patients attended denturists rather than dentists for their complete dentures. Fees paid to dentists by the plan have decreased over time relative to the standard fees for the various services listed annually in the Alberta Dental Association fee guide. The apparent growth of direct additional billing by dentists of plan users to recover the difference between their usual fees and those paid by the plan and the effects of greater plan utilization are discussed, as are future potential difficulties in the plan's administration.
This paper is the first report of health knowledge among Native Indian youth in central Alberta and, in the absence of comparable information for Native youth in other regions of Canada, provides a unique basis for comparison of the health knowledge of Native youth attending junior high school with that of non-Native young Canadians included in the Canada Health Knowledge Survey. The results of our survey of 229 Native Indian youth from seven different reserves in central Alberta indicate that a higher proportion of the Native youth were more knowledgeable about dental health, fire safety, and the effects of smoking, alcohol and drugs. However, they generally scored lower on items related to knowledge of first aid for burns, nutrition, communicable diseases, and personal health. Factors contributing to these differences and suggestions for future action are suggested on the basis that accurate information of this kind is essential for health promotion efforts directed toward reducing risky health behaviours and promoting healthier lifestyles among youth of Native Indian communities.
Analysis of data from 643 breast cancer patients seen between 1971 and 1973 in northern Alberta was undertaken as a preliminary study leading towards a comprehensive breast registry. Age at first treatment and menopausal status were found to be related significantly to the clinical stage of the disease. Other data reported included age at menarche, lymph node involvement and methods of primary treatment. A decline in use of the radical mastectomy was noted. The comprehensive breast registry, which will be used to identify high-risk groups, assess treatment modalities, test hypotheses and generate ideas, has a high probability of success because of compulsory registration of new cases of breast cancer in Alberta and collection of data by the same four individuals.
Data on occupations and life styles of patients with cancer have been collected since 1983. To investigate cancer patterns and risks in farmers in Alberta, all farmers were abstracted and compared with nonfarmers in the data base, using case-control analysis. Controls were patients with cancer at any site except the index site. Significantly elevated odds ratio (OR), adjusted for age and smoking, were found among the farmers for cancers of the lip (OR = 3.22, 95% confidence interval [CI] = 2.14 to 4.84) and prostate (OR = 1.31, 95% CI = 1.11 to 1.55). Crude risk for lung cancer was significantly lower in farmers, but statistical significance disappeared when risk was adjusted for smoking (OR = 0.81, 95% CI = 0.65 to 1.02). Farmers were at considerably lower risk of malignant melanoma of the skin, compared with nonfarmers (OR = 0.57, 95% CI = 0.36 to 0.91).
The frequency of hereditary nonpolyposis colorectal cancer was evaluated in a group of colorectal cancer patients under age 50 diagnosed in southern Alberta between 1973 and 1987. Families were identified as positive for this syndrome if three first-degree relatives in the kindred had colorectal cancer. Of the 390 patients with adenocarcinoma, 318 patients participated. The frequency of hereditary nonpolyposis colorectal cancer was 3.1% (12 families) in this group (Ci95 1.6-5.3%). Clinical characteristics reported on from the index patients include tumor location, Dukes stage at presentation, frequency of synchronous and metachronous tumors, frequency of second primaries, and survival. The 5- and 10-year actuarial survival was 86% and 69%, respectively.
This study represents a survey of the nursing quality assurance programs in 12 hospitals in Alberta. The objectives of the study were: to identify the nature, content and costs of the programs, to determine the extent of nurse involvement in the design and operation of the programs, and the value and importance nurses place on their programs. The major findings of the study tend to support the view that the principles of organizational change theory have not been adequately addressed in terms of nursing quality assurance programs. Generally, nurses reported that they were insufficiently informed concerning their programs. Among the study recommendations is a call for improvements in the audit tools used, with greater emphasis being placed on the patient and the nurse providing the care and more decentralization of programs to the unit level to improve staff involvement and program relevancy.
Human infection with Mycobacterium bovis is rare in developed countries because of milk pasteurisation and the slaughter of infected cattle. An epizootic of M bovis infection in domesticated elk (Cervus elaphus) in Alberta, Canada, which started in April, 1990, prompted us to seek human contacts of elk herds. There were 446 identified contacts, in 394 of whom tuberculin skin tests were done. Of 81 contacts who were skin-test positive, 50 had been in contact with culture-positive animals. 6 of 106 subjects tested a second time became tuberculin positive. 1 case of active M bovis infection was diagnosed by sputum culture. The mode of transmission of M bovis from these farm animals to man is likely to be aerosolisation of infected particles. Because of the apparent susceptibility of farmed Cervidae (deer) to M bovis infection, and the evidence of spread to man, control measures to prevent human infection should be developed.
An outbreak of 1089 cases of infectious syphilis (primary, secondary and early latent) which occurred in the province of Alberta from 1981 to 1987 was analysed by stage of disease, age, sex, sexual preference and geographic distribution. The majority of cases occurred between 1983 and 1985 inclusive. Men accounted for 75.8% of the study population. The majority of men (71%) and women (98.5%) were heterosexual. Of the infected women, 58.7% were North American Indians and many worked as prostitutes. There was clustering in urban locations with 71.8% and 17.7% of cases reported in Edmonton and Calgary, respectively. Clinical signs of syphilis were more commonly present in men than women. Contact tracing played an important role in controlling the outbreak with 15.9% of men and 44.7% of women being diagnosed and treated as a result of this activity.