Providing mental health services in northern Newfoundland, Labrador a unique challenge.
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Humans↗
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Are metal mining effluent regulations adequate: identification of a novel bleached fish syndrome in association with iron-ore mining effluents in Labrador, Newfoundland.
Water quality guidelines for industrial effluents are in place in many countries but they have generally evolved within a limited ecotoxicological framework. Effluents from iron-ore mines have traditionally been viewed by regulatory bodies as posing little or no risk to the aquatic environment. However, it was recently reported that lake trout taken from a large iron-ore contaminated Lake in Labrador (Wabush Lake) had elevated levels of DNA oxidative damage and were markedly depleted in levels of vitamin A (Payne et al., 1998) in comparison with fish from a Lake (Shabogamo Lake) receiving lesser levels of effluents. Through further observations, it has now been established that the lake trout in Wabush Lake are commonly affected with a marked skin bleaching syndrome in comparison with fish in Shabogamo Lake and a nearby Lake (Ashuanipi) which does not receive effluents. To the authors' knowledge such a syndrome which is characterized by marked reduction in skin pigmentation and overall increase in skin whitening has not been reported before in any fish population in association with contamination. Preliminary information for liver histopathological and blood cell differences have also been obtained in fish in Wabush Lake in comparison with Ashuanipi Lake. It has also been observed through studies on phosphatidyl liposomes that iron-ore leachate contains redox-active material (iron but possibly other transition metals) that has considerable potential for causing oxidative damage to cellular constituents. Using the weight of evidence approach it is indicated that iron-ore effluents may pose more of a risk to the aquatic environment than traditionally considered by regulatory agencies.
Fish Diseases↗
Coronary artery bypass graft surgery in Newfoundland and Labrador.
BACKGROUND: Newfoundland and Labrador, like other health care jurisdictions, is faced with widening gaps between the demands for health care and a strained ability to supply the necessary resources. The authors carried out a study to determine the rates of appropriate and inappropriate coronary artery bypass grafting (CABG) in the province and the waiting times for this surgery. METHODS: This retrospective cohort study was performed in the tertiary care hospital that receives all referrals for coronary angiography and coronary artery revascularization for Newfoundland and Labrador. By reviewing the hospital records, the authors identified 2 groups of patients: those in whom critical coronary artery disease was diagnosed on the basis of coronary angiography and who were referred for CABG between Apr. 1, 1994, and Mar. 31, 1995, and those who actually underwent the procedure during that period. By applying specific criteria developed by the RAND Corporation, the authors determined the appropriateness and necessity of CABG in each case. They also compared waiting times for CABG with optimal waiting times; as determined by a consensus-based priority score. RESULTS: A total of 338 patients underwent CABG during the study period. The cases were characterized by multivessel disease and late-stage angina symptoms. Almost all of the patients had high appropriateness scores (7-9), and nearly 95% had high necessity scores (7-9). However, during the study period, the waiting list increased by about 20%, because a total of 391 patients were referred by the weekly cardiovascular surgery conference; the authors identified these and an additional 31 patients as having necessity scores of 7 or more. Only 7 (23%) of 31 patients for whom CABG was considered very urgent underwent surgery within the recommended 24 hours, and only 30 (24%) of the 122 patients for whom CABG was considered urgent underwent surgery within the recommended 72 hours. INTERPRETATION: These results provide evidence that the cardiac surgery program in Newfoundland and Labrador is performing CABG in patients for whom surgical revascularization is highly appropriate and necessary. Access to CABG is less than ideal, however, since the waiting list continues to expand, and many patients wait beyond the recommended time for surgery.
Cohort Studies↗
Availability of thrombolytic therapy in rural Newfoundland and Labrador.
OBJECTIVE: To determine the availability of thrombolytic therapy in rural Newfoundland and Labrador. DESIGN: Self-administered questionnaire mailed to staff at health care facilities. Respondents were sent two reminders by mail, and questionnaires not returned were completed through telephone interviews. SETTING: Rural health care facilities, including hospitals, 24-hour clinics and satellite clinics. PARTICIPANTS: All chief medical officers, nursing supervisors and administrators in the 34 government-funded rural health care facilities in Newfoundland and Labrador. OUTCOME MEASURES: Number of facilities offering thrombolytic therapy to patients with acute myocardial infarction (AMI) in 1992. For each facility: number of patients presenting with AMI during that year, number of these patients who received thrombolytic therapy, number of staff trained in advanced cardiac life support, travel time to the nearest referral centre, population served and number of beds. RESULTS: Of the 34 rural health care facilities in Newfoundland and Labrador, 91% (31/34) responded to the survey. Thrombolytic therapy was offered in 93% (13/14) of the rural hospitals, 22% (2/9) of the 24-hour clinics and none of the single-physician satellite clinics. In 1992, 390 patients with AMI presented to these health care facilities; 39% of these patients presented to facilities that did not offer thrombolytic therapy. CONCLUSIONS: Thrombolytic therapy has been successfully introduced in many of the rural and isolated health care facilities in Newfoundland and Labrador. An important factor in this success is continuing medical and nursing education on the effectiveness of thrombolytic therapy and the skills needed to provide it. Cost-effectiveness data are needed to determine whether it is reasonable to offer this therapy in isolated, low-volume clinics. More research on the outcomes in patients receiving thrombolytic therapy in rural facilities is also needed.
Humans↗
The impact of spina bifida on the medical services of Newfoundland and Labrador.
This institution receives all live spina bifida patients from Newfoundland and Labrador. The aim of this study is to determine the outcome of these patients and the impact on the medical system. On a retrospective chart review, 274 patients born between 1967 and 1990 were studied. An analysis of the statistical variables showed that the incidence per 1,000 live births has remained stationary in Newfoundland and Labrador; there is a slight female predominance; 64% were born to young mothers and the peak incidence occurred in March, April, and May. A total of 179 patients of 254 who underwent surgery were alive and underwent rehabilitation programmes. Only 35% are wheelchair bound; the rest are ambulatory. One hundred sixty-one are of school age or older, 78 are in regular high school (3 dropouts), 36 are in special education, 6 graduated from high school, 4 are in university, 15 had no neurological deficit, 7 were lost in follow-up, 5 died, 9 had gross mental retardation, and 1 is the mother of three normal children. To attain these results these patients had multiple admissions and surgical procedures and the patients are seen twice a year in a rehabilitation and multidisciplinary clinic. From this study, the utilization of the medical services and impact on the community is great. However, the majority of these patients appear to attain a surprisingly high quality of life.
Female↗
The Newfoundland and Labrador Heart Health Program dissemination story: the formation and functioning of effective coalitions.
Newfoundland and Labrador is the most easterly province of Canada (O'Loughlin et al., Figure 1) with a population of 537,000. Rural in nature, 50% of the population resides in widely-dispersed communities of less than 2500 people. The economy traditionally relied on the fishing industry, but with the closure of the once lucrative cod fishery in 1991, the poorest province in Canada faced a difficult economic climate with up to 20% unemployment rates. With little funding available to supplement or sustain expensive initiatives, the Demonstration Phase of the Newfoundland and Labrador Heart Health Program (1990-1996) focused on how community-based programs are developed and sustained, with a view to diffusion throughout the province. The whole province was defined as the demonstration site for the project, and a community mobilization strategy was used with extensive reliance on community health professionals and volunteer contributions.
Cardiovascular Diseases↗
Prevalence of Trichinella spiralis in black bears (Ursus americanus) from Newfoundland and Labrador, Canada.
Tongue and diaphragm samples from 158 black bears (Ursus americanus) from Newfoundland and Labrador were examined for Trichinella spiralis. No larvae were detected in samples from the island of Newfoundland but one animal from the Labrador samples was infected. The results of this and other studies suggest a lack of involvement of the black bear in a sylvatic cycle of T. spiralis in eastern Canada.
Animals↗
Adolescent and pre-adolescent suicide in Newfoundland and Labrador.
This study investigated suicides by people aged ten to 19 in Newfoundland and Labrador from 1977 to 1988. It is the first study of suicide in the province to use the records of death from all eight hospital pathology departments in the province and from the office of the Chief Forensic Pathologist. Cases were selected for the study using standardized criteria, independent of the manner of death recorded on the death certificate. A suicide rate of 4.37 per 100,000 was found. This rate and the age- and sex-specific suicide rates are lower than the official figures for Canada but higher than those reported in earlier Newfoundland studies. The rate for males was nearly five times the female rate, and the rate for people aged 15 to 19 was nearly six times that of people aged ten to 14. Suicide rates for Labrador were higher than for the island portion of the province for both Native and for non Native adolescents. Extremely high rates of suicide were found only among the Native population living in Northern Labrador, while none were recorded for Native people elsewhere. Firearms accounted for 54% and hanging for 33% of all suicides. Thirty percent of suicides occurred on a Saturday. Only 36 of the 63 deaths included in this study were designated as suicide on death certificates. The higher rate of under-reporting of suicide than in other jurisdictions suggests that official rates may not be useful for comparisons. The reasons for the high rate of under-reporting are discussed.
Adolescent↗
Identifying the needs of Innu and Inuit patients in urban health settings in Newfoundland and Labrador.
BACKGROUND: Labrador's Innu and Inuit live in nine small, isolated villages, and must travel to the urban centres of Goose Bay, Labrador and/or St. John's, Newfoundland for most health services. This study responds to anecdotal evidence of Aboriginal dissatisfaction with these services from the St. John's Native Friendship Centre Association (SJNFCA); it describes Aboriginal experiences and identifies relevant needs. METHODS: The study consisted of qualitative interviews (N = 143), conducted by trained local researchers, and nine focus groups. The interviews were narrative-based, appropriate to the Aboriginal culture of participants. Participants were recruited from the client list of the SJNFCA. FINDINGS: Almost all study participants experience significant difficulties including profound disorientation, language and communication difficulties, inadequate accommodations, and altered diets. Cross-cultural relations are particularly problematic for the Innu. CONCLUSIONS: These findings, and 19 recommendations made to the provincial government (8 main recommendations appear in Table II), could lead to improved services for Innu and Inuit using urban health services. Workshops in development could mean more awareness among health care practitioners.
Adolescent↗
A minimal prevalence study of diagnosed diabetes in Newfoundland and Labrador.
A two-stage random probability sampling survey of the medical charts of family physicians in Newfoundland and Labrador was done; the first stage sampled physicians randomly, in proportion to the 5 health districts of the province; the second stage took a quota sample of the physicians' charts. The survey revealed a total population minimal prevalence rate of diagnosed diabetics of 3.55% (95% confidence limits 2.55, 4.55). This rate is higher than that found in the only other provincial survey done in Canada (the Prince Edward Island survey). Of diagnosed diabetics, 40% were found to be using insulin. This proportion is higher than other rates in North America. The prevalence rate was slightly higher in males (3.7%) than in females (3.4%).
Age Factors↗
A single-case foodborne botulism outbreak caused by Clostridium botulinum type A1(B5) in diced garlic in Newfoundland and Labrador, 2024.
Foodborne botulism is a severe neuroparalytic disease caused by ingestion of foods containing botulinum neurotoxins, produced by Clostridium botulinum. In 2024, a 74-year-old woman from Newfoundland and Labrador with complete bilateral flaccid paralysis and respiratory distress was hospitalized and required intubation. From the broader differential diagnosis list, botulism was favoured prior to laboratory confirmation. Serum and feces samples initially tested negative for botulinum neurotoxins by mouse bioassay, yet viable C. botulinum type A was recovered from the feces. Food history investigation included some diced garlic in a repurposed coffee container that tested negative for botulinum neurotoxins by mouse bioassay, but viable C. botulinum type A was recovered from the sample. Both the fecal and garlic enrichment cultures were positive for bont/A and bont/B genes by real-time PCR. Whole genome sequencing revealed that both fecal and garlic isolates were highly similar with conserved gene synteny, including an intact bont/A1 gene and a disrupted (silent) bont/B5 gene encoded on the chromosome. This single-case foodborne botulism outbreak from Newfoundland and Labrador in 2024 was caused by C. botulinum type A1(B5) in diced garlic.
Aged↗
Pulmonary tuberculosis in northern Newfoundland and Labrador.
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Humans↗
Prescribing practices for the management of headache in Newfoundland and Labrador.
To assess the impact of sumatriptan in clinical practice, we undertook a retrospective analysis of the government of Newfoundland and Labrador's prescription drug program data base for 35 consecutive patients prescribed sumatriptan. The number of doses of all drugs prescribed ranged from 121 to 18,874 on from 4 to 357 prescriptions per patient over 1 to 19 months. The mean number of doses of analgesic drugs prescribed before sumatriptan therapy was 56 per month and after initiation of sumatriptan was 46 per month. The prescribing of multiple analgesics was common; 79% received three or more different analgesics. Twenty-two (63%) patients were prescribed medications indicated for the prophylaxis of migraine concomitantly with drugs indicated for symptomatic treatment. Twenty-four (69%) patients were prescribed medication capable of inducing migraine. We conclude that sumatriptan did not have a major impact on the outcomes of these patients judged by their use of analgesics. The simplest explanation is that many of the patients were suffering from analgesic-induced headache rather than migraine. In addition, we conclude that there were deficiencies in prescribing practices including numbers, quantities, and choice of analgesics; the use of analgesics concomitantly with drugs indicated for migraine prophylaxis; and the use of drugs capable of inducing migraine. Further research is required to validate these findings.
Analgesics↗
Peninsula pupil. Anomaly unique to Newfoundland and Labrador?
Forty cases of an unusual form of iris atrophy that results in a characteristically oval pupil have been seen in Newfoundland and Labrador. The anomaly is an atrophy of part of the sphincter pupillae, is confined to the iris, and is not associated with any systemic disorder. The great majority of those affected are male, and all have blue eyes. We suggest that it may be an inherited trait.
Aged↗
Development of an RNFA program: a Newfoundland and Labrador adventure.
This inquiry was to determine the feasibility of creating a nursing role for first assisting in the cardiac operating room in Newfoundland and Labrador. A committee was struck to review the role as it existed in the United States and Canada. Following this, the committee gained approval from appropriate professional associations and began developing the program. The result is that three nurses are currently working as RNFA's in Cardiac Surgery and two nurses are piloting a RNFA Program for General Surgery.
Cardiac Surgical Procedures↗
Lack of evidence of hepatitis D (delta) infection in Newfoundland and Labrador.
Epidemiologic knowledge of hepatitis D virus (HDV) infection is limited. A seroepidemiologic study was undertaken to determine the prevalence of the infection in Newfoundland and Labrador. Between October 1983 and October 1985 over 200 people were recognized through routine serodiagnosis and screening as having hepatitis B seromarkers. A total of 223 serum samples from 186 of these people were tested for anti-HDV. The subjects were mainly asymptomatic carriers of hepatitis B surface antigen or patients with acute or chronic hepatitis B from the native Indian and Inuit and the non-native populations. None of the serum samples were positive for anti-HDV. The absence of anti-HDV in a substantial number of people in the province who are infected with hepatitis B virus is strong evidence that HDV infection is not prevalent in the local population, including native people.
Acute Disease↗
State of the marine environment at Little Bay Arm, Newfoundland and Labrador, Canada, 10 years after a "do nothing" response to a mine tailings spill.
In 1989, the tailings pond dam at the site of a former copper mine near Little Bay, Newfoundland and Labrador, Canada, ruptured and tailings spilled into Little Bay Arm. At the time, no action was taken to arrest the flow of tailings or to mitigate the effects of the spill. To date, no action has been taken to repair the dam and tailings continue to flow into Little Bay Arm. As a result, the marine environment around Little Bay Arm has become contaminated with heavy metals from the tailings. However, the tailings are not the only source of heavy metals to the ecosystem. An old slag heap and what is presumably concentrated copper ore spilled during the loading of ore freighters, are also contributing to the ecosystem's metal load. Marine sediment throughout the Arm contained elevated concentrations of Cu, Ni, Zn, As, V, Co, and Mn. Beach material also contained elevated concentrations of metals with material near the slag heap being the most contaminated. At this site, Cu concentrations were in excess of 5000 mg kg(-1) dry weight, Zn greater than 3000 mg kg(-1) and Co concentrations exceeded 700 mg kg(-1). The highest concentrations of metals in biota were found near the slag heap, near the tailings dam breach, and at the site of the former concentrate loading dock. Despite elevated metal concentrations, the tailings and nearby sediment were not devoid of life. Bivalves and seaweed were abundant in the area and there were no obvious signs of tissue damage or disease in soft shell clams (Mya arenaria) living in the tailings. These clams may be suffering from chronic exposure to the tailings, however, evidence of lipid peroxidation in the clams was inconclusive.
Accidents↗
The incidence and prevalence of multiple sclerosis in Newfoundland and Labrador, 1960-1984.
A study of the incidence and prevalence of multiple sclerosis on the island of Newfoundland between 1960 and 1984 has yielded a current overall prevalence rate of 55.2 per 100,000, but wide variation is noted in the rates for different parts of the island (range, 15.9 to 105.0 per 100,000). The annual incidence rates for St. John's and the Avalon region of Newfoundland show cyclical variation on an approximate five- or six-year cycle. Suggestive evidence for a temporal link between varying incidence rates in these areas and recurrent local outbreaks of canine distemper was obtained.
Adolescent↗