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Trends in incidence and mortality from acute myocardial infarction in Nova Scotia and Saskatchewan 1974 to 1985. The Nova Scotia-Saskatchewan Cardiovascular Disease Epidemiology Group.

OBJECTIVE: To compare trends in incidence and case fatality of acute myocardial infarction (AMI) in Nova Scotia and Saskatchewan, provinces with the highest and lowest rates, respectively. DESIGN: Provincial hospital separation files were linked with mortality files and searched to identify incident cases in 1977, 1981 and 1985. The diagnoses were validated on a random sample of hospital charts with discharge codes 410 and 411 to 414 of the International Classification of Diseases of the World Health Organization. RESULTS: In spite of persisting differences between Nova Scotia and Saskatchewan, standardized AMI mortality and incidence rates in males and females have decreased, although at a slower rate in Saskatchewan. In both provinces the greatest decrease has occurred in male deaths prior to any hospital admission--likely representing cases of sudden death. Excess mortality in Nova Scotia is due predominantly to out-of-hospital deaths. Case fatality rates have declined in both provinces. The proportion of definite and possible AMI was similar in Nova Scotia and Saskatchewan in 1977, but not thereafter. CONCLUSIONS: Along with a decline in ischemic heart disease mortality, there appears to be a decline in AMI incidence in Nova Scotia. Parallel studies of risk factor changes, interventive care and access to care are required to explain the observed phenomena.

Adult

Mortality study of Canadian male farm operators: cancer mortality and agricultural practices in Saskatchewan.

The present investigation involved an analysis of approximately 70,000 male Saskatchewan farm operators, a subset of the 365,000 Canadian farm operators to be investigated in the Canadian Farm Operator Mortality Study. The results of the Saskatchewan analysis indicate that during the interval studied, overall mortality among Saskatchewan farmers was 25% lower than that for all Saskatchewan men, and that, during the same time interval, the risk of death from all types of cancer was also about 25% lower among Saskatchewan farmers than to all Saskatchewan men. Although the present study indicates that overall mortality of death from cancer was 25% lower among Saskatchewan male farmers, there was a relationship between non-Hodgkin's lymphoma mortality and acres sprayed for weeds; a similar risk relationship between expenditures on fuel oil and risk of death from non-Hodgkin's lymphoma was also evident. The magnitude of risk for Saskatchewan farmers is probably greater than that reflected in the estimates in this study, due to the likelihood of misclassification of exposure. There is a particular need for further studies in this area to improve the quantification of farming-related exposures, and to study the exposure history of individuals who develop non-Hodgkin's lymphoma.

Adult

Incidence of hip fracture in Saskatchewan, Canada, 1976-1985.

The authors ascertained the incidence of hip fracture in Saskatchewan, Canada, residents aged 65 years or older for the 10 years 1976-1985 from computerized hospital discharge records and compared it with rates for several other populations in Northern Europe and the United States. In Saskatchewan, the average annual incidence was 5.5 per 1,000 person-years. The incidence in women was twice that in men, the incidence in urban areas was 27% greater than that in nonurban areas, and there was no secular trend of increasing rates. The incidence of hip fracture in Saskatchewan was lower than that for populations in Scandinavia and the United States but was comparable to rates in English populations. Further study is needed to elucidate the genetic, environmental, and behavioral factors responsible for this variation.

Aged

Education for rural health in Saskatchewan.

The Canadian Province of Saskatchewan, like its American counterparts, is experiencing a steady urbanization of its population particularly by young adults. This has been accompanied by progressive decrease in the availability of health services to an aging rural population. Physicians, and, in particular, Saskatchewan graduates, find rural practice unattractive. Unlike the American experience, level of income is not the issue. Not only is rural practice unattractive to Saskatchewan graduates, but medicine as a career is not attracting students from rural areas. The need for a comprehensive overall strategy ranging from recruitment to reorganization of rural health care is proposed.

Attitude of Health Personnel

A population-wide profile of prescription drug use in Saskatchewan, 1989.

OBJECTIVE: To measure the prevalence of prescription drug use in Saskatchewan in 1989. DESIGN: Retrospective study. PARTICIPANTS: A total of 961,203 Saskatchewan residents (including those who died or were born during the study year) who were eligible for coverage under the Saskatchewan Prescription Drug Plan. The study population represented 94% of the province's total population; those excluded were mostly status Indians (for whom a federal plan is available). MAIN RESULTS: At least one prescription was received by 66.0% of the study population in 1989. The mean number of prescriptions per patient was 8.2, and the mean cost of drug material per prescription was $13.95. Females received substantially more prescriptions than males; the difference was particularly notable for cardiovascular agents, antidepressants and benzodiazepines. In the senior population 80.8% received at least one prescription; the mean number of prescriptions per patient was 18.4. The most commonly dispensed drug for the entire study population was amoxicillin (290 prescriptions per 1000 people); triazolam was the most frequently dispensed central nervous system drug (74 prescriptions per 1000 people). Regional variation in overall drug use was remarkably small, although it increased at the drug-class level, especially for tranquillizers. The use of cardiovascular drugs was 27% to 32% higher (depending on how use was measured) per Regina resident than per Saskatoon resident. Benzodiazepines were commonly used on a long-term basis, despite recommendations to the contrary. CONCLUSIONS: The results quantify the prevalence of prescription drug use, underscore the importance of careful management of drug therapy by physicians and pharmacists (especially for seniors), illustrate substantial variation in drug therapy strategies and raise questions about utilization of benzodiazepines and cardiovascular drugs.

Age Factors

Drug prescribing for the elderly in Saskatchewan during 1976.

Over 11% of Saskatchewan's population is 65 years of age or older. To study patterns of prescribing for the elderly a computer file of more than 3.6 million prescriptions filled in Saskatchewan in 1976 was reviewed. The elderly population (aged 65 years or more) that year was 102 070, and 77.3% received at least one prescription drug listed in the Saskatchewan Formulary. In comparison with a "middle-aged" group (persons between the ages of 35 and 54 years) the elderly showed moderately higher average numbers of prescriptions filled and drugs used per person that year. However, the prescription of antihypertensive agents and diuretics increased dramatically with age, and barbiturates, in view of their potential toxicity, appeared to be overprescribed for the elderly.

Adult

Saskatchewan dial-access drug information service.

In September 1974 the colleges of pharmacy and medicine of the University of Saskatchewan began offering a drug information service to the pharmacists and physicians of Saskatchewan without charge. With the help of a radio-page system, calls are taken immediately by experienced pharmacists and pharmacologists. The cost of long-distance phone calls is borne by grants from the Saskatchewan medical and pharmaceutical associations. During the 1st year of operation 415 requests for information were received. Of 93 persons who called up to Feb. 28, 1975, 76% responded to an evaluation questionnaire; virtually all described the service as very valuable. The information received resulted in the alteration of drug therapy in one third of calls requesting information to assist in current treatment of a patient.

Drug Information Services

Mercury levels in whole blood of Saskatchewan residents.

The study was undertaken to establish whole blood mercury levels in the Saskatchewan population and to identify characteristics of individuals with higher blood levels. The mean blood mercury level was 6.7 ng/ml, the median level 5 ng/ml and the range 1 to 42 ng/ml. Native persons living in northern Saskatchewan who had recently eaten local fresh-water fish had the higher levels. A greater consumption of fish and higher blood mercury levels were recorded during the fresh-water fishing season.

Adolescent

Effect of surveillance on the number of hysterectomies in the province of Saskatchewan.

In 1972 the College of Physicians and Surgeons of Saskatchewan appointed a committee to study hysterectomies because the Saskatchewan Department of Health had data showing that the annual number of hysterectomies carried out in the province had increased by 72.1 per cent between 1964 and 1971, whereas the number of women over 15 years of age had increased by 7.6 per cent. The committee compiled a list of indications for hysterectomy. Any hysterectomy carried out for one of these reasons was classified as justified, and the remainder as unjustified. Five hospitals were reviewed in 1970 and a further two in 1973. In 1974, all seven hospitals were reviewed again. In these hospitals, the average proportion of unjustified hysterectomies had dropped from 23.7 per cent at the time of the first review to 7.8 per cent in 1974. The total number of hysterectomies in the province dropped by 32.8 per cent between 1970 and 1974.

Adolescent

Statistical analysis of gamma-emitting radionuclide concentrations for three fields in southern Saskatchewan, Canada.

During 1988, the spatial variability of the natural gamma-emitting radionuclides (238U, 232Th, and 40K) and the artificial radionuclide 137Cs were studied in three near-level unfertilized fields in Saskatchewan, Canada. One field was used as a native (uneroded) control site; the other two sites have been cultivated, one since 1979 and the other since at least the 1940s. The two cultivated sites have been eroded by aeolian processes and tillage practices. Autocorrelation analysis indicated that most of the radionuclides were not serially correlated for the two depth increments sampled (0-15 cm and 15-30 cm). Autocorrelation is a necessary procedure when equally spaced transect sampling is employed, since sample independence cannot be assumed. Robust and nonrobust statistical summaries are presented for the selected gamma-emitting radionuclide concentrations. Robust statistical estimates of location and dispersion are favored when distributions are not normal or when the distribution is skewed. Median concentrations for the three fields indicated that 238U, 232Th, 40K, and 137Cs were similar to areas in the U.S. and to other areas in southern Saskatchewan. Median 238U activity concentrations were between 31.4 and 34.1 Bq kg-1; 232Th concentrations were between 29.6 and 31.2 Bq kg-1; 40K concentrations were between 471 and 502 Bq kg-1; and 137Cs concentrations were between 10.0 and 12.6 Bq kg-1. The variability of natural radionuclides in a given field for a specific depth increment was generally low, with coefficients of variation less than or equal to 10%. The variability of 137Cs concentrations was greater, ranging from 18% to 23%. Nonparametric tests indicated a significant decrease in 214Bi concentration (238U indicator corrected for 222Rn) with depth of the 1979 field, and an increase in 228 Ac (232Th) with depth in the 1940s field. Significant differences in concentration between fields were indicated for all radionuclides except for 228 Ac. The possible reasons for differences in depth and between fields are briefly discussed.

Cesium Radioisotopes

The Saskatchewan program for rational drug therapy: effects on utilization of mood-modifying drugs.

In 1978, the Joint Committee on Drug Utilization (JCDU) was appointed by the Saskatchewan Minister of Health to identify and analyze concerns related to drug use and to recommend appropriate methods for dealing with such concerns. Emphasis was placed on the quality of healthcare in the province and on the provision of information as a basis for education of the public and health professionals. Since 1978, 14 committee reports providing drug utilization statistics and specific recommendations for improving drug therapy have been distributed to Saskatchewan health professionals. The main focus has been on utilization studies of "mood-modifying" drugs (analgesics, minor and major tranquilizers, sedative/hypnotics, stimulants, and antidepressants). The JCDU initiated a program whereby drug profiles of certain patients were released to selected health professionals. Individuals who received daily doses in excess of JCDU guidelines for mood-modifying drugs over a three-month period were categorized as extreme users. Patient medication profiles of their drug use were forwarded on a quarterly basis to physicians who prescribed and the primary pharmacy that dispensed mood-modifying drugs to these patients. From the time of the first profiles (October-December 1979) until 1983, there was a 15 percent decrease in the number of extreme users. Between 1977 and 1985, there was a decrease in the percentage of the overall population receiving any prescriptions for these drugs (from 20 to 17.4 percent).

Adolescent

Physician management of hyperlipidemia in Saskatchewan: temporal trends and the effect of a CME program.

OBJECTIVE: To assess current trends in the management of hyperlipidemia by Saskatchewan physicians, and to evaluate the effect of a specific continuing medical education (CME) program. DESIGN: Using a quasi-experimental design, physicians in an intervention area received the CME program while those in a comparison area did not. Management of hyperlipidemia was assessed before and after the program via a self-administered questionnaire. SETTING: All family physicians, general internists and cardiologists practising in the two areas were eligible. SUBJECTS: Of 439 eligible physicians, 308 (70%) completed the first survey, while 268 of 447 (60%) completed the second survey. Analysis was conducted on the 221 physicians who completed both surveys. INTERVENTION: Physicians in the intervention area received printed materials and attended a series of seminars between November 1988 and February 1989. Program content was based upon the recommendations of the Canadian Consensus Conference on Cholesterol (1988). MAIN RESULTS: Over the study period the mean level of serum cholesterol considered 'ideal' for a 40- to 60-year-old male decreased significantly from 5.43 to 5.03 mmol/L (P less than 0.001). The mean level at which diet therapy was begun decreased from 6.60 to 5.78 mmol/L (P less than 0.001) with a significantly greater proportion of physicians in the intervention area (58.0%) than in the comparison area (43.2%) initiating therapy in the 5.2 to 5.6 mmol/L range (P = 0.03). The mean level of serum cholesterol at which drug therapy is begun also decreased from 7.59 to 6.82 mmol/L (P less than 0.001), with a significantly greater proportion of physicians in the intervention (41.6%) than in the comparison area (25.0%) starting therapy in the 6.2 to 6.6 mmol/L range (P = 0.03). CONCLUSIONS: The management of hyperlipidemia reported by physicians in Saskatchewan changed dramatically between July 1988 and March 1989. The effect of the CME program is modest in comparison with this large temporal trend. The study provides further evidence that significant changes in the practice patterns of groups of physicians will only occur when the educational process is highly focused and personalized.

Adult

Pregnancy outcome among native Indians in Saskatchewan.

OBJECTIVE: To determine the difference in pregnancy outcome between native Indians and the provincial population in Saskatchewan. DESIGN: Retrospective analysis of data collected from all birth and death registration forms. SETTING: Saskatchewan. MAIN OUTCOME MEASURES: Incidence of low birth weight and rates of stillbirth and of neonatal and infant death. RESULTS: The neonatal death rate was higher in the Indian population than in the provincial population during the study period; the difference between the two groups in the rate decreased markedly after 1982. The rates of stillbirth and infant death were also higher among the Indians, and the difference persisted during the study period. The incidence of low birth weight and the rate of stillbirth were highest in the youngest and oldest maternal groups in the provincial population; however, the pattern was markedly different among the Indians, teenaged mothers having the best outcomes. CONCLUSION: Further studies are needed to determine the relation between maternal age and fetal outcome among native Indians.

Adolescent

Survival following renal transplantation in Saskatchewan, 1970--74: follow-up study using medical insurance records.

The patient history file of a medical care insurance plan can be used for statistical purposes in many ways. This is illustrated by the use of the records of the Saskatchewan Medical Care Insurance Commission to study the survival of patients receiving kidney transplants in the period 1970--74. During this period 48 males and 23 females received at least one renal transplant; these patients represented 34% of all males and 28% of all females undergoing regular renal dialysis. These period prevalence estimates are consistent with calculations based on incidence and point prevalence reported elsewhere. Life-table calculations showed the 4-year survival rate following first kidney transplantation in Saskatchewan to be 45% for all patients, 55% for those less than 45 years of age and 26% for those 45 years of age or older.

Actuarial Analysis

A serological survey of Leptospira interrogans serotype pomona in Saskatchewan horses.

Leptospira interrogans serotype pomona antibody titres of 1:100 or greater were detected in 12.8% of 408 adult horses from seven of eight sampled herds in Saskatchewan. The geographical distribution of the seropositive horses was widespread throughout the agricultural area of the province. The geographical distribution and the cumulative increase in prevalence with age suggested that serotype pomona is enzootic in the equine population of Saskatchewan.

Animals

Serum IgE levels in white and metis communities in Saskatchewan.

Serum IgE levels and the prevalence of certain atopic diseases have been studied in 819 individuals in 176 white families living in central Saskatchewan and in 275 individuals in 58 Metis families living in northern Saskatchewan. The geometric mean serum IgE level in the white community (81.3) u/ml) was lower than that in the Metis community (275.4 u/ml). The prevalence of asthma, eczema and urticaria was greater in the white than in the Metis community and contrasted with the increased prevalence of helminth infestation as well as of other untreated viral and bacterial diseases in the Metis community. It is suggested that atopic disease is the price paid by some members of the white community for their relative freedom from diseases due to viruses, bacteria and helminths.

Adolescent

Risk factors for squamous cell carcinoma of the skin in Saskatchewan, Canada.

Completed questionnaires regarding suspected risk factors for skin cancer were completed by 178 cases of SCC of the skin in Saskatchewan, Canada, and 284 age- sex- and location-matched controls. Significant risk factors identified using chi2 analyses were: farming, family history of skin cancer, light eye color, blond or red hair color, skin types I or II, obvious freckles in childhood, history of severe sunburn, and the use of the herbicide 2,4-Dichlorophenoxy acetic acid. The following relative risks were identified: (1) All cases of SCC of the skin and matched controls: agricultural occupation 1.49, history of severe sunburn 1.49. (2) All men with SCC of the skin and matched controls: history of severe sunburn 1.36 (3) All women with SCC of the skin and matched controls: agricultural occupation 1.83, and skin types I or II 1.48. No association was noted on our study between a history of psoriasis and development of SCC. Neither was an association between smoking and SCC found.

Carcinoma, Squamous Cell

A cluster-focus of multiple sclerosis at Henribourg, Saskatchewan.

This study presents the clinical characteristics of 8 victims of multiple sclerosis from the hamlet of Henribourg, Saskatchewan with a population of less than 75 people. A diligent victim of the disease had observed that six female classmates from the early 1940's had later developed multiple sclerosis. Two male military personnel who had also resided briefly in close proximity, during the same common exposure time, also later developed multiple sclerosis. The mean onset time of developing the disease after leaving the area was 20 years. This cluster-focus suggests a common exposure to an environmental factor or a common infective agent in the etiology of multiple sclerosis.

Adult