Mortality experience among employees at a hydrometallurgical nickel refinery and fertiliser complex in Fort Saskatchewan, Alberta (1954-95). (41/878)

OBJECTIVE: To study the mortality experience of workers at a hydrometallurgical nickel refinery and fertiliser complex in Fort Saskatchewan, Alberta, Canada. METHODS: A total of 1649 male employees of Sherritt International who worked for at least 12 continuous months during the years 1954 to 1978 at the Fort Saskatchewan, Alberta hydrometallurgical nickel refinery and fertiliser complex were followed up for an additional 17 years. Mortality was ascertained from the Canadian mortality data base maintained by Statistics Canada and covered the years 1954-95. Statistics were analysed with Monson's computer program. RESULTS: Total mortality, when compared with the Canadian population, was significantly below expectation. Fewer deaths were found for circulatory disease, ischaemic heart disease, respiratory disease, neoplasms, digestive cancer, and accidents, poisonings, and violence. Among the 718 men in the group exposed to nickel, there were no deaths due to nasal cavity or paranasal sinus cancer. Fewer deaths were found for all causes, circulatory disease, ischaemic heart disease, neoplasms and digestive cancer. Lower death rates were observed than expected for respiratory malignancies and cancer of the bronchus and lung. CONCLUSION: No association was found in this study between exposure to nickel concentrate or metallic nickel in the hydrometallurgical refining process and the subsequent development of respiratory cancer.  (+info)

Ethics and the Alberta family physician. (42/878)

Ethics, the science of moral decision making, is a part of every medical decision, though little consideration is given to this fact in relation to the mundane affairs of everyday practice. Physicians, for the most part, have received little formal instruction in ethics, and often make moral decisions in an ;intutive' way. In this article, the authors review the results of a study they conducted, in which they attempted to determine the level of education in ethical decision making that physicians practising in Alberta have received, as well as the physicians' knowledge of the Hippocratic Oath and the Canadian Medical Association Code of Ethics.  (+info)

Confidentiality of medical information: a study of Albertan family physicians. (43/878)

The author of this paper examines physicians' regard for the confidentiality of medical information in the light of their perception of their own role. Five case studies of increasing complexity of medical management and ethical issues, derived from practice and accompanied by questions relating to confidentiality and medical management, were submitted to randomly selected family physicians in Alberta. Analysis of the replies to determine attitudes to confidentiality and how the respondents perceived patients' best interests, and statements of how they would act in certain situations, disclosed that a substantial minority of the physicians were still prepared to breach confidentiality and exercise Hippocratic professional judgement in certain situations. The bases of confidentiality of medical information are reviewed, together with changing modes of medical ethics and the increasing trend to rights derived from patients, autonomy, and the ways in which these factors may affect the physician-patient relationship.  (+info)

Characterization of Salmonella associated with pig ear dog treats in Canada. (44/878)

In the summer of 1999, the incidence of Salmonella enterica serotype Infantis infections in Alberta rose dramatically. Subsequent laboratory and epidemiological investigations established that an outbreak of human disease caused by this organism was occurring across Canada and was associated with pet treats for dogs produced from processed pig ears. Laboratory investigations using phage typing and pulsed-field gel electrophoresis (PFGE) established that isolates of Salmonella serotype Infantis from pig ear pet treats and humans exposed to pig ear pet treats comprised a well-defined subset of all isolates analyzed. Of the 53 subtypes of Salmonella serotype Infantis obtained around the time of the outbreak as defined by PFGE and phage typing, only 6 subtypes were associated with both human infection and isolation from pig ears. Together with information from epidemiological studies, these investigations established pig ear pet treats as the cause of the Salmonella serotype Infantis outbreak. The results are consistent with a model in which contaminated pig ear pet treats constitute a long-term, continuing vehicle for infection of the human population rather than causing temporally delimited point-source outbreaks. During the course of this outbreak, several other Salmonella serotypes were also isolated from pet treats, suggesting these products may be an important source of enteric infection in both humans and dogs. Though isolates of Salmonella serotypes other than Salmonella serotype Infantis from pet treats were also subjected to PFGE and phage typing, no link with human disease could be definitively established, and the contribution of pig ear pet treats to human disease remains unclear. Elimination of bacterial contamination from pet treats is required to reduce the risk of infection from these products.  (+info)

Prevalence and determinants of tuberculin reactivity among physicians in Edmonton, Canada: 1996-1997. (45/878)

BACKGROUND: Health care workers (HCW) have historically borne a heavy burden of tuberculosis (TB) infection and disease. Unfortunately, physicians are rarely included in HCW surveys of tuberculin exposure and infection. METHODS: The prevalence and risk factors for tuberculin reactivity were determined for a sample of the 1732 licensed physicians in Edmonton. Stratified random sampling was used to select 554 specialists and 219 general practitioners. These physicians were contacted by means of an introductory letter and a follow-up telephone call to solicit participation. All eligible physicians were asked to complete a questionnaire and those with either no recorded positive tuberculin test or a previously negative result were two-step tuberculin skin tested. RESULTS: In total, 560 physicians (72.4 %) participated in the study. The overall tuberculin reactivity for this population was 45.9%. Using logistic regression analysis, we determined that risk factors for reactivity were aged over 45 years, of foreign-birth, previous Bacillus Calmette-Guerin (BCG) vaccination, foreign practice experience, and being a respiratory medicine specialist. CONCLUSION: The prevalence of tuberculin reactivity among physicians is considerably higher than estimates for the general Canadian population. This observed excess risk may be associated with factors linked to their medical practice. The high participation rate suggests physician willingness to participate in this type of research, and emphasizes the need to include them in routine HCW surveillance.  (+info)

Incidence and predictors of bleeding events after fibrinolytic therapy with fibrin-specific agents: a comparison of TNK-tPA and rt-PA. (46/878)

BACKGROUND: Fibrinolytic therapy increases the risk of bleeding events. TNK-tPA (tenecteplase) is a variant of rt-PA with greater fibrin specificity and reduced plasma clearance that can be given as a single bolus. We compared the incidence and predictors of bleeding events after treatment with TNK-tPA and rt-PA. METHODS AND RESULTS: In the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT)-2 trial, 16 949 patients with acute myocardial infarction were randomly assigned a single weight-adjusted bolus of TNK-tPA or a 90-min infusion of rt-PA. A total of 4.66% of patients in the TNK-tPA group experienced major non-cerebral bleeding, in comparison with 5.94% in the rt-PA group (P=0.0002). This lower rate was associated with a significant reduction in the need for blood transfusion (4.25% vs 5.49%, P=0.0003) and was consistent across subgroups. Independent risk factors for major bleeding were older age, female gender, lower body weight, enrolment in the U.S.A. and a diastolic blood pressure <70 mmHg. Females at high risk (age >75 years and body weight <67 kg) were less likely to have major bleeding when treated with TNK-tPA even after other risk factors were taken into account. A total of 0.93% of patients in the TNK-tPA and 0.94% of patients in the rt-PA group experienced an intracranial haemorrhage. Female patients >75 years of age who weighed <67 kg tended to have lower rates of intracranial haemorrhage when treated with TNK-tPA (3/264, 1.14% vs 8/265, 3.02%). CONCLUSIONS: The increased fibrin specificity and single bolus administration of TNK-tPA do not increase the risk of intracranial haemorrhage but are associated with less non-cerebral bleeding, especially amongst high-risk patients.  (+info)

Location of family medicine graduates' practices. What factors influence Albertans' choices? (47/878)

OBJECTIVE: To examine factors that influence family medicine graduates' choice of practice location. DESIGN: Cross-sectional, retrospective survey employing a self-administered, mailed questionnaire. SETTING: Family medicine residency programs at the University of Alberta (U of A) and the University of Calgary (U of C) in Alberta. PARTICIPANTS: Graduates (n = 702) who completed the family medicine residency program at U of A or U of C between 1985 and 1995. MAIN OUTCOME MEASURES: Current practice location; 23 factors influencing current practice location; physicians' sex; community lived in until 18 years of age. RESULTS: Response rate was 63% (442 graduates completed the questionnaire). Overall, the most influential factors in attracting graduates to their current practice locations were spousal influence, type of practice, and proximity to extended family. Type of practice, income, community effort to recruit, medical need in the area, and loan repayments had a substantial influence on family physicians' decisions to practise in rural areas. Male physicians ranked type of practice, whereas female physicians ranked spousal influence, as having the most influence on choice of practice location. Significantly more female than male physicians identified working hours, familiarity with the medical community or resources, and availability of support facilities and personnel as having a moderate or major influence on their decisions. CONCLUSION: Differences between rural and metropolitan residents and between sexes affect family medicine graduates' choices of practice location. These differences should be taken into account in recruitment strategies.  (+info)

Impact of preeclampsia and gestational hypertension on birth weight by gestational age. (48/878)

The predominant etiologic theory of preeclampsia is that reduced uteroplacental perfusion is the unique pathogenic process in the development of preeclampsia. Decreased uteroplacental blood flow would result in lower birth weights. To date, no study has assessed the effect of preeclampsia on birth weight by gestational age. Thus, the authors conducted a retrospective cohort study based on 97,270 pregnancies that resulted in delivery between 1991 and 1996 at 35 hospitals in northern and central Alberta, Canada. Differences in mean birth weight between women with preeclampsia and normotensive women ranged from -547.5 g to 239.5 g for gestational age categories ranging from < or = 32 weeks to > or = 2 weeks. The birth weights were statistically significantly lower among mothers with preeclampsia who delivered at < or = 37 weeks, with an average difference of -352.5 g. However, the birth weights were not lower among preeclamptic mothers who delivered after 37 weeks (average difference of 49.0 g). In Alberta, 61.2% of preeclamptic patients gave birth after 37 weeks of gestation. The authors conclude that babies born to mothers with preeclampsia at term have fetal growth similar to that of babies born to normotensive mothers. This finding does not endorse the currently held theory that reduced uteroplacental perfusion is the unique pathophysiologic process in preeclampsia.  (+info)