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Manitoba virus, a new rhabdovirus isolated from Culex tarsalis mosquitoes collected in Manitoba, Canada.

A rhabdovirus, Mn 936-77, was isolated from a pool of two Culex tarsalis collected on August 16, 1977, from Morris, Manitoba. Isolate Mn 936-77 was not pathogenic for suckling Swiss white mice inoculated by the intracerebral route. The virus propagated in three vertebrate cell lines (Vero, primary chick embryo, mouse neuroblastoma), but apparently not in Aedes albopictus C6/36 cells. Isolate Mn 936-77 did not react by amplified enzyme-linked immunosorbant assay with 230 viruses of proven or possible arbovirus etiology or by immunofluorescence with 88 members of the family Rhabdoviridae. Isolate Mn 936-77 appears to be a newly discovered virus for which the name Manitoba virus is proposed.

Animals

Breast-feeding promotion in Manitoba. Committee on Breast-feeding, Manitoba Pediatric Society.

During the International Year of the Child the Manitoba Pediatric Society undertook professional and public education activities to promote breast-feeding in that province. The objective was a 100% increase in the proportion of mothers who breast-fed their infants for 2 months or longer. Surveys conducted before and after the campaign showed no significant increase in the rate of breast-feeding either at the time of hospital discharge or 2 months later. The infants of Winnipeg residents were more likely to be breast-fed than those of women living on Indian reservations or in any other part of the province (termed "rural"). The rate of bottle-feeding was significantly greater among infants of young unmarried mothers. Future programs to promote breast-feeding should be longer and more intensive, should be directed to the young, to rural residents and to Indian women, and should focus on social and emotional factors as well as nutrition and health benefits.

Adolescent

Reducing imaging costs in Manitoba, Canada.

Manitoba, Canada, has serious debt and deficit problems and spends one-third of its revenue on health care. Manitoba Health, the single government carrier, has requested a 5-year management plan from the Provincial Imaging Advisory Committee to maintain and improve the present services within reduced funding [1]. The committee members are radiologists, nuclear medicine specialists, physicists, physicians, hospital officials, and senior government staff. In 1993, each Manitoba hospital prepared a 5-year plan for imaging equipment purchases based on projected patient and attending staff needs. The requests for services and new imaging technology exceed planned resource allocations. I was asked by Manitoba Health in July 1993 to prepare a cost restraint position paper with a target of 10% savings to help with government restraint and to allow some transfer of resources for continuing growth in imaging. The approach was to consult widely and to seek methods of significant cost savings that Canadian society might accept (Table 1). Areas of potential savings now are being considered by ad hoc committees appointed by hospitals and Manitoba Health. Several are being implemented on a trial basis.

Contrast Media

Nontertiary surgery in Manitoba: comparison of provincial and teaching-hospital data.

Do the teaching hospitals in Manitoba provide a suitable spectrum and sufficient numbers of operations to prepare surgeons for practice in Manitoban communities? To answer these questions, the author reviewed the types and frequencies of all operations performed in Manitoba during 1985 and 1986 and compared them with all operations performed in the two Manitoba teaching hospitals for the same years. The 189,380 operations studied were categorized according to the surgical specialist who usually performed each operation in the teaching hospitals. For some procedures commonly performed in the province as a whole, there were too few operations performed in the teaching hospitals to provide sufficient experience for the trainees. A breakdown of nontertiary operations performed in Manitoba revealed that 39% were in the category of general surgery, 29% were in gynecology and operative obstetrics, 17% were in orthopedics, 10% were in urology and 4% were in plastic surgery. The author concludes that a surgeon going to a smaller community as the only surgical specialist requires training of a broader scope than is provided currently in the standard general-surgery training programs in Manitoba.

Hospitals, Teaching

Seroprevalence and demographic information of patients at risk for human immunodeficiency virus (HIV) infection in Manitoba, Canada.

Two hundred fifty individuals from high risk categories were enrolled in a seroprevalence survey for human immunodeficiency virus (HIV) infections in Winnipeg. The overall seroprevalence in the Manitoba AIDS Virus Epidemiology Study (MAVES) was 5.2%. Of 2651 diagnostic and screening specimens in the province of Manitoba submitted over a similar period, 103 were positive (3.9%). HIV seropositivity in Manitoba was noted mainly in homosexual/bisexual males (especially those who were also intravenous drug abusers), hemophiliacs, and individuals from endemic regions of the world. Individuals whose only risk factor was intravenous drug abuse, those with sexually transmitted diseases, or those with high risk sex contacts have not demonstrated HIV seropositivity in Manitoba to date. Manitoba is currently a low seroprevalence region for HIV infection. Our study demonstrated that the awareness level of people at risk for HIV infections was low. In our study population, one-on-one counseling was demonstrated to be an effective way to improve short-term knowledge about HIV infections. Appropriate education approaches must be considered for Native/Metis peoples (26.4% of our MAVES study population), who were younger and had a lower educational and employment level compared to Caucasian/other racial groups.

Acquired Immunodeficiency Syndrome

Haemophilus influenzae meningitis in Manitoba and the Keewatin District, NWT: potential for mass vaccination.

A community-based surveillance study of all central nervous system infections was carried out in Manitoba and the Keewatin District, NWT, between Apr. 1, 1981, and Mar. 31, 1984. There were 201 cases of bacterial meningitis in Manitoba over the study period, 81 (40%) caused by Haemophilus influenzae; all but one isolate tested were type b (Hib). There were nine cases of H. influenzae meningitis in the Keewatin District. The overall annual incidence rate of H. influenzae meningitis in Manitoba was 2.5/100,000; for children under 5 years the rate was 32.1/100,000. For the Keewatin District the corresponding rates were 69.6/100,000 and 530/100,000. A total of 85% and 100% of the cases of H. influenzae meningitis occurred by 24 months of age in Manitoba and the Keewatin District respectively. The age at onset was earlier in native Indian children (22 cases) and Inuit children (9 cases) than in non-native children (59 cases) (p less than 0.005); thus, vaccine prevention of Hib meningitis will likely be more difficult in native Indian and Métis children. Without evaluating the increased potential of H. influenzae vaccines to prevent nonmeningitic forms of disease, we concluded that mass childhood vaccination with polyribosylribitolphosphate (PRP) vaccine is not warranted in Manitoba or the Keewatin District. Immunogenicity studies suggest that administration of conjugated Hib vaccines such as PRP-D in infancy may prevent approximately one-third to two-thirds of cases of H. influenzae meningitis; these vaccines warrant consideration for use in mass childhood vaccination programs.

Age Factors

Prescribing patterns for elderly community-dwelling heavy medicinal drug users in Manitoba, Canada and Jämtland, Sweden.

Patterns of drugs prescribed for elderly community-dwelling heavy medicinal drug users were determined from random samples of data bases and compared between Manitoba, Canada and Jämtland, Sweden for the year 1981. Qualitatively, there was 80% concordance between the 20 most frequently prescribed drugs in Manitoba and in Jämtland. Gender differences were rare, but there were notable quantitative differences for prescription of specific drugs between the two jurisdictions. Drugs to treat cardiovascular diseases were prominent in both groups with thiazides, triamterene and alpha-methyldopa more frequently prescribed for Manitoba patients, and furosemide, potassium supplements and digoxin more frequently prescribed for patients from Jämtland. The frequent prescribing of codeine in combination analgesics in Manitoba and phenothiazines in Jämtland appears to represent geographically disparate approaches to the use of these drugs. Overall, the concordance of prescribed drugs for elderly heavy medicinal drug users from these two jurisdictions appears to outweigh the differences. These results indicate that data from studies of heavy medicinal drug users, at least in the industrialized world, may be more widely applicable than to the geographical location from where they were obtained.

Aged

Seroepidemiology of Q fever in New Brunswick and Manitoba.

A seroepidemiological survey, using an indirect immunofluorescence test, was carried out on serum samples obtained from New Brunswick and Manitoba blood donors during 1986. The antigens were Coxiella burnetii phase I and phase II from strain Nine Mile. Eighty of the 503 (15.9%) Manitoba blood donors had a phase II antibody titer of greater than or equal to 1:8, while 41 (4.2%) of the 966 New Brunswick blood donors had such antibodies. We have recently diagnosed three cases of Q fever in New Brunswick but none have been diagnosed in Manitoba. Our data suggest that Q fever may be increasing in New Brunswick and repeated seroepidemiological studies are indicated. It is likely that undetected cases of Q fever are occurring in Manitoba.

Antibodies, Bacterial

Acute myocardial infarction. A feasibility study using record-linkage of routinely collected health information to create a two-year patient profile. Manitoba, 1984-85 and 1985-86.

Manitoba's hospital separations and physician medical files were linked for the fiscal years 1984-85 and 1985-86. The result was a study file consisting of records for 5,293 males and 3,143 females, who, during this period, suffered an Acute Myocardial Infarction (AMI), commonly called a heart attack. Merging the two types of files created a comprehensive data base for these AMI victims. The Manitoba age-sex standardized AMI rate was 38.0 per 10,000 population. Age-specific rates were higher for males than for females for all age groups. Hospitalized cases accounted for 7,201 individuals or 85.4% of AMI victims. Age-sex standardized rates of hospitalization per 10,000 population ranged from 27.1 in the Central region to 36.0 in the Westman region. The Manitoba age-specific rates of hospitalization for males in the 35-54 and 55-64 age groups were about three times the female rates for the same age groups. One quarter of AMI hospitalized victims died in hospital. The Manitoba age-specific death rates for males in the 35-54, 55-64 and 65-74 age groups were double the rates for females in the same age groups. Of the 8,436 AMI victims under study, 86.4% had at least one other concurrent medical condition such as angina, other forms of ischemic heart disease, diabetes, or hypertension. Of AMI victims, 93.8% underwent at least one of the following procedures: coronary artery bypass surgery, angiogram, electrocardiogram, cardiac catheterization, arteriography, or blood cholesterol testing. A higher percentage of procedures was performed on males than on females.

Acute Disease

Variation in length of stay as a measure of efficiency in Manitoba hospitals.

OBJECTIVE: To examine the efficiency of Manitoba hospitals by analysing variations in length of stay for patients with similar characteristics. DESIGN: Retrospective study. Multiple regression analyses were used to adjust for patient (case-mix) characteristics and to identify differences in length of stay attributable to the hospital of admission for 14 specific, frequently encountered diagnostic categories and for all acute admissions. SETTING: The eight major acute care hospitals in Manitoba. PARTICIPANTS: Manitoba residents admitted to any one of the eight hospitals during the fiscal year 1989-90, 1990-91 or 1991-92. Patients transferred to or from another institution, those with atypically long stays and those who died in hospital were excluded. OUTCOME MEASURE: Length of hospital stay. RESULTS: The length of stay was strongly influenced by hospital of admission, even after adjustment for key patient characteristics. Excluding the most seriously ill patients and those with the longest stays, approximately 186 beds could potentially have been saved if each hospital had discharged its patients as efficiently as the hospital with the shortest overall length of stay. CONCLUSIONS: A substantial proportion of days currently invested in treating acute care patients could be eliminated. At least some bed closures in Manitoba hospitals could be accommodated simply through more efficient treatment of patients in the remaining beds, without decreasing access to hospital care.

Acute Disease

Occupational doses in radiation oncology in Manitoba--1980 to 1986.

The province of Manitoba (population of 1.0 million) has two radiotherapy centers employing a number of people, of whom about 60 are exposed to radiation during the course of their work. The individual and collective radiation doses to these workers, as recorded by thermoluminescent dosimeter plaques, were reviewed for the period 1980 to 1986. Whole-body doses to radiotherapy technologists responsible for operating the treatment machines and brachytherapy afterloading procedures ranged from 0.5 to 2.5 mSv y-1, whereas the corresponding doses to nursing staff working on a hospital brachytherapy ward were about 1.0 mSv y-1. The collective occupational dose from radiotherapy in Manitoba was approximately 70 person-mSv. Trends show individual operator and collective doses to be increasing at a higher rate than the number of patients undergoing radiotherapy. Occupational exposure in radiotherapy in this province was found to be comparable to that encountered in nuclear medicine in Manitoba and greater than that in diagnostic radiology.

Brachytherapy

Reasons for involuntary commitment in Manitoba and Ontario.

This paper concerns itself with the question of involuntary commitment of psychiatric patients in southwestern Manitoba. The purpose was to survey the reasons given for involuntary psychiatric hospitalization by a group of Manitoba physicians in 1979, and to compare these reasons with those given by their Ontario counterparts, as described in the Page and Yates (1) and Page and Firth (2) studies. Particularly, the aim was to compare the relative emphasis given to dangerousness/self-harm reasons, in view of the fact that Manitoba's Mental Health Act makes no explicit reference to the dangerousness criterion, while Ontario's legislation has increasingly specified this factor as a necessary condition for civil commitment.

Commitment of Persons with Psychiatric Disorders

The centralization of operations and access to treatment: total hip replacement in Manitoba.

The impact of centralized facilities on access to care was tested by studying total hip arthroplasty in the Province of Manitoba, Canada. Data from the Manitoba Health Services Commission, which insures costs of all medical services in the Province, show that the availability of this surgical procedure has increased steadily over the 1973-78 period at a rate similar to that elsewhere in North America. Although Manitoba's population is geographically dispersed, specialized orthopedic services are concentrated in two urban centers. No important difference in access to care for this condition was found between urban center residents and residents distant from the surgical facilities.

Adult

Postsurgical mortality in Manitoba and New England.

Per capita hospital expenditures in the United States exceed those in Canada, but little research has examined differences in outcomes. We used insurance databases to compare postsurgical mortality for 11 specific surgical procedures, both before and after adjustment for case mix, among residents of New England and Manitoba who were over 65 years of age. For low- and moderate-risk procedures, 30-day mortality rates were similar in both regions, but 6-month mortality rates were lower in Manitoba. For the two high-risk procedures, concurrent coronary bypass/valve replacement and hip fracture repair, both 30-day and 6-month mortality rates were lower in New England. Although no consistent pattern favoring New England for cardiovascular surgery was found, the increased mortality following hip fracture in Manitoba was found for all types of repair and all age groups. We conclude that for low- and moderate-risk procedures, the higher hospital expenditures in New England were not associated with lower perioperative mortality rates.

Aged

Innovation, centralization, and growth. Coronary artery bypass graft surgery in Manitoba.

Innovation and diffusion of new surgical procedures are limited in Manitoba, Canada by restrictions on which hospitals are allowed to perform particular surgical programs. Programs centralizing performance of certain operations in a few hospitals have the potential for controlling costs and quality of care but may limit access for individuals living in other areas. Such issues are highlighted in this analysis of coronary artery bypass graft surgery in Manitoba. Patterns of growth and access are first examined; then regional variations in rates of bypass surgery are compared with rates for coronary angiography and valve surgery. Physician reluctance to refer patients to Winnipeg appears to be responsible for the lower rates of these procedures in Western Manitoba. The implications for studies of centralization/regionalization of medical services, physician decision-making, and diffusion of technology are explored.

Adult

Relative efficiency of Manitoba traps and adhesive panels for the capture of the common cleg, Haematopota pluvialis (Meigen) (Diptera: Tabanidae).

A comparative study of four traps was made in Argyll, Scotland, over a period of two months for the collection of Haematopota pluvialis. An adhesive trap was shown to be three times more efficient than a standard Manitoba trap, or versions of a Manitoba trap in which the target black ball was replaced by an adhesive black ball or a pair of adhesive panels. The reduced efficiency of the Manitoba trap is attributed to the plastic canopy which appears white in colour, particularly when wet.

Adhesives

Implementation of Canadian Standards Association Z168.3-M 1980 Anaesthetic Gas Machine Standard: the Manitoba experience.

The Province of Manitoba Anaesthetic Machine Program, completed in June 1980, accommodated Canadian Standards Association Standard Z168.3-M 1980. "Continuous Flow Inhalation Anesthetic Apparatus (Anesthetic Machines) for Medical Use". The goal of the program was to have all anaesthetic machines in hospitals in the province with the same basic design and safety features: "oxygen right"; characteristic oxygen knob profile; oxygen supply pressure failure device and alarm; standardized "oxygen flush" mechanism; pipeline inlets and pressure gauges; uniform color coding; standardized common gas outlet; pin indexed cylinder yokes; descriptive labels concerning safety devices; check valves within machine piping. Open group-purchase tenders were invited for both machine upgrading and replacement. Of 212 machines surveyed, 127 were upgraded (cost $100,000), 65 were replaced (cost $175,000), three were already satisfactory, and 17 were no longer required and were removed permanently from service. The Manitoba Program provided a satisfactory solution to a most important problem.

Anesthesia, Inhalation