Legalized, regulated, but unfunded: midwifery's laborious professionalization in Alberta, Canada, 1975-99.

In 1992, Alberta became the second Canadian province to legalize midwifery. This happened even though there were only approximately 20 midwives in practice at the time, and despite strong opposition from the medical and nursing professions. Between 1992 and 1999. Alberta established a regulatory framework for midwifery as a profession but. unlike Ontario and British Columbia, failed to pay midwives out of the provincial health care budget. This sent midwifery in Alberta into a crisis as many midwives closed their practices. This article first considers why midwifery was legalized and then professionalized in Alberta. Our answer emphasizes the leading role of state health bureaucrats in promoting midwifery as part of the state's challenge to medical dominance. Second. the article addresses why midwifery received so little governmental support at the same time that it attained professional status. This analysis includes a comparison with how midwifery developed in Ontario and British Columbia. Our conclusion is that midwifery in Alberta became a victim in the post-1993 period when a new Right government set aside bureaucratic initiatives in health care and committed itself to major cuts in government spending.     

HQCA: Building a credible,transparent, and independent healthcare quality and safety organization in Alberta

In the early 2000s, the Alberta government established the roots of what is now the Health Quality Council of Alberta. Ultimately, the Health Quality Council of Alberta's goal is to provide the information it gathers, particularly from the voice of Albertans to healthcare system leaders, in a way that informs their strategic decision making to enable tangible changes that can improve health service quality and patient safety.     

Pain, medication, and injury in older farmers

BACKGROUND: Agricultural work continues to be a dangerous occupation. Older farmers experience high risks for work-related injury. The purpose of this research was to determine if there is a relationship between medication use and injury among older male farmers in Alberta. METHODS: Using probabilistic linkage between an Alberta Agriculture government registry of farm operators and the Alberta Health Plan registry file, older farmers (aged 66 and older) were identified. Farm related injuries were identified using an E-code search of both hospitalization and emergency department separations for a 3-year period. Cases were matched to controls on age, geographic health region, and index injury date at a ratio of 1:5. Co-morbidity and medication use for each of the cases and controls were derived from population based health system utilization files. Conditional logistic regression was used to determine which medications were related to injury. RESULTS: Overall, a total of 282 farm related injuries were suffered by the linked group. Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.37 [95% CI:4.95, 17.72]) and non-steroidal anti-inflammatories (OR = 2.40 [95% CI:1.43, 4.03]) 30 days prior to the date of injury were at risk of injury. Those farmers taking sedatives up until the date of injury were also at risk (OR = 3.01 [95 CI:1.39, 6.52]). In addition, those suffering from incontinence/urinary tract disorders (OR = 2.95 [95% CI:1.30, 6.71]), and prior injury (OR = 1.42 [95% CI:1.04, 1.95]) were also at greater risk of injury. CONCLUSIONS: The relationship of medication use and injury in this population is different from those observed in studies of falls in older persons. We hypothesize that distraction from either pain or co-morbidity may play an important role in the etiology of injuries suffered in this active older working population. Further investigations in this area are required to confirm these findings.     

The use of outbreak information in the interpretation of clustering of reported cases of Escherichia coli O157 in space and time in Alberta, Canada, 2000-2002

We obtained a list of all reported cases of Escherichia coli O157 in Alberta during the 2000-2002 period, and using scan statistics we identified yearly temporal and spatial clusters of reported cases of E. coli O157 during the summer and in southern Alberta. However, the location of the spatial cluster in the south was variable among years. The impact of using both outbreak and sporadic data or only sporadic data on the identification of spatial and temporal clusters was small when analysing individual years, but the difference between spatial clusters was pronounced when scanning the entire study period. We also identified space-time clusters that incorporated known outbreaks, and clusters that were suggestive of undetected outbreaks that we attempted to validate with molecular data. Our results suggest that scan statistics, based on a space-time permutation model, may have a role in outbreak investigation and surveillance programmes by identifying previously undetected outbreaks.     

An updated reference for age-sex-specific birth weight percentiles stratified for ethnicity based on data from all live birth infants between 2005 and 2014 in Alberta,Canada

ObjectiveThis study aims to update the current reference for sex-specific birth weight percentiles by gestational age, overall and for specific ethnic groups, based on data from all singleton live-birth deliveries from 2005 to 2014 in Alberta, Canada.MethodsInfant and maternal information were captured in the Alberta Vital Statistics-Births Database for 473,115 singleton infants born to 311,800 women between January 1, 2005 and December 31, 2014. Within each sex, and each sex-ethnic group, birth weights were modelled by gestational age using generalized additive models and natural cubic splines. Crude and corrected estimates for birth weight percentiles including cut-off values for large for gestational age (LGA) and small for gestational age (SGA) were calculated by sex and sex-ethnic group, and gestational age for singleton live births.ResultsLGA and SGA cut-offs were lower for females than for males for all gestational ages. The SGA and LGA percentiles were greater for both male and female very preterm infants in Alberta compared to previous national references. Ethnicity-specific LGA and SGA cut-offs for term Chinese and preterm and at-term South Asian infants were consistently lower than those for both the general population in Alberta and the previous national reference. South Asian infants had lower birth weights at almost all gestational ages compared with the other groups.ConclusionThe updated birth weight percentiles presented in this study highlight the differences in SGA and LGA cut-offs among infants from South Asian, Chinese, and the general population, which may be important for clinical perinatal care.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00520-9.     

Planning to meet the care need challenge in Alberta, Canada

The Canadian province of Alberta faces challenges in ensuring an adequate supply of nurses to meet care needs. This paper describes the approach adopted by Alberta Health Services (the public health care provider in Alberta) to address this challenge. Planning was undertaken on the basis of care needs rather than starting from a particular professional perspective and highlighted that the needs could be met by Registered Nurses, Licensed Practical Nurses or Healthcare Aides. Six scenarios, representing different potential mixes of Registered Nurses, Licensed Practical Nurses and Healthcare Aides were identified and used as the basis of stakeholder consultations. The paper identifies the workforce outcomes and needs for the different scenarios and the outcomes of the workforce planning process. Copyright © 2012 John Wiley & Sons, Ltd.     

Knowledge, attitudes and behaviours related to climate change in Alberta, Canada: implications for public health policy and practice

Climate change has received recent extensive media attention (e.g., Kyoto Protocol) and is currently on the international public health agenda. The purpose of this study was to survey knowledge, attitudes and behaviours related to climate change in the province of Alberta, Canada. A random sample of 600 Alberta households, using proportional quotas based on the Canada Census of the Alberta population, was surveyed on knowledge, attitudes and behaviours related to climate change using a computer-assisted telephone interviewing protocol. Albertans are highly concerned, particularly about health problems related to the environment and air pollution; yet are only moderately informed about a variety of environmental issues. While the great majority of Albertans appear to be engaged in environmental behaviours at home, fewer consider energy efficiency when purchasing consumer goods. An even smaller percentage makes environmentally conscious transportation decisions. To encourage the population to make recommended environmental behaviours, mass media approaches may do well to target the specific beliefs that were deemed salient (e.g., promote the association between environment issues and health). The public health sector has a major role in working with inter-sectoral groups to address this significant public health issue.     

#65 Medication use,co-morbidity and injury in older male farmers

PURPOSE: The purpose of this research was to determine if there is a potentially causal relationship between medication use and injury among older male farmers in Alberta.METHODS: Using probabilistic linkage between an Alberta Agriculture government registry of farm operators and the Alberta Health Plan registry file, older farmers (aged 66 and older) were identified. Farm related injuries were identified using an E-code search of both hospitalization and emergency department separations for a 3-year period. Cases were matched to controls on age, geographic health region, and index injury date at a ratio of 5:1. Co-morbidity and medication use for each of the cases and controls were derived from population based health system utilization files. Conditional logistic regression was used to determine which medications were related to injury.RESULTS: Over a 3-year period, a total of 282 farm related injuries were suffered by the linked group. Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.85[95%CI:5.14,18.86]) and non-steroidal anti-inflammatories (OR = 2.36[95%CI:1.40,3.98]) 30 days prior to the date of injury were at increased risk. Those farmers taking sedatives and hypnotics right up until the date of injury were also at increased risk (OR = 3.12[95CI:1.41,6.89]).. In addition, those suffering from incontinence (OR = 3.71[95%CI:1.60,8.59]) and osteoporosis (OR = 4.78[95%CI:1.34,16.99]) were also at increased risk.CONCLUSION: The relationship of medication use and injury in this population is different from those observed in studies of falls in older persons. These data indicate that distraction from either pain or co-morbidity may play a factor in injuries suffered in this active older working population.     

Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population,Alberta, Canada, 2003–2017

The incidence of invasive group A Streptococcus (iGAS) disease in the general population in Alberta, Canada, has been steadily increasing. To determine whether rates for specific populations such as First Nations are also increasing, we investigated iGAS cases among First Nations persons in Alberta during 2003–2017. We identified cases by isolating GAS from a sterile site and performing emm typing. We collected demographic, social, behavioral, and clinical data for patients. During the study period, 669 cases of iGAS in First Nations persons were reported. Incidence increased from 10.0 cases/100,000 persons in 2003 to 52.2 cases/100,000 persons in 2017. The 2017 rate was 6 times higher for the First Nations population than for non–First Nations populations (8.7 cases/100,000 persons). The 5 most common emm types from First Nations patients were 59, 101, 82, 41, and 11. These data indicate that iGAS is severely affecting the First Nations population in Alberta, Canada.     

Pandemic influenza planning: using the U.S. Centers for Disease Control FluAid Software for small area estimation in the Canadian context

PURPOSE: The U.S. Centers for Disease Control and Prevention (CDC) developed software (FluAid 2.0) to provide estimates of pandemic impact (deaths, hospitalizations, and outpatient visits). We wished to develop inputs for Alberta, Canada to use in place of program default values. We also wished to examine how FluAid output could be better contextualized for local users. METHODS: We developed distributions for age and age-sex specific proportions of population in groups at high risk of influenza complications for Alberta, Canada. In addition, we developed interpandemic influenza rates for Alberta, Canada. We used FluAid with this local data to obtain estimations of both pandemic and interpandemic impacts of influenza. The ratio of these impacts presents a context for understanding the FluAid outputs. RESULTS: There were differences in both the pattern and the magnitude of the Alberta rates from the FluAid defaults. For a pandemic estimate at a 25% attack rate (most likely) compared to an interpandemic year, the pandemic would result in 3.7 times as many outpatient visits, 3.9 times as many hospitalizations and 8.2 times as many deaths. CONCLUSIONS: We recommend that health service planners who use FluAid develop estimates for interpandemic influenza to provide crucial contextual information for pandemic planning.     

Infant and preschool immunization delivery in Alberta and Ontario: a partial cost-minimization analysis

This paper is a partial cost-minimization analysis of preschool immunization delivery in Alberta and Ontario. Public health nurses deliver such immunization in Alberta while in Ontario it is usually provided by private physicians. In constant 1986 dollars, labour costs were 2.9 times higher in Ontario than in Alberta. Alberta and Ontario achieved equal success in preventing diphtheria, tetanus and poliomyelitis in the target population of zero to four years of age. Ontario's pertussis rates were higher than Alberta's from 1980 to 1986 inclusive (p less than 0.01). Rubella rates were higher in Alberta from 1980 to 1986 inclusive (p less than 0.05) but the congenital rubella rates for the same period were not. During 1980, Ontario's measles rate was higher (p less than 0.01) while for 1982 and 1986, Alberta's measles rates were higher. In 1986, Alberta's mumps rate was higher than Ontario's (p less than 0.01). The findings argue in favour of the less costly public health nurse approach to immunization delivery. A more definitive conclusion could have been reached had the provinces maintained more detailed age-specific disease incidence data.     

Tuberculosis among institutionalized elderly in Alberta, Canada.

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.     

Shingles in Alberta: Before and after publicly funded varicella vaccination

Purpose: A universal publicly funded chickenpox vaccination program was implemented in Alberta in 2002. We examine the epidemiology of medically attended shingles in Alberta from 1994 to 2010.     

Human rabies--Alberta, Canada, 2007

On April 26, 2007, a patient from Alberta, Canada, died after 9 weeks in an intensive care unit (ICU) from encephalitis caused by a rabies virus variant associated with silver-haired bats. This report summarizes the clinical course of disease in that patient, who was treated using the Milwaukee Protocol, an experimental treatment protocol similar to one used for the rabies survivor described in 2005. This report also describes the subsequent epidemiologic investigations by three regional public health departments in Alberta. Rabies continues to be a cause of human death in the developed and developing world. The findings in this report underscore the need for continued public education that promotes rabies prevention and postexposure prophylaxis while emphasizing the importance of bat exposure in rabies transmission.     

Factors and Barriers Associated with Early Adoption of Nutrition Guidelines in Alberta,Canada

ObjectiveTo identify factors that influenced early adoption and implementation of the Alberta Nutrition Guidelines for Children and Youth (ANGCY) in schools in Alberta, Canada; and to identify healthy eating strategies that were implemented as a result of the guidelines. Barriers and facilitators were also investigated.DesignMultiple case study design (n = 3). Semi-structured interviews and direct observations were used to collect data.Setting and ParticipantsThree schools in Alberta were selected for individual case studies. Eighteen key informants were interviewed from the 3 cases.Phenomenon of InterestTo investigate how the motivation shown by school administration and stakeholders for the ANGCY influenced the early adoption and implementation of the guidelines.AnalysisContent analysis was used to analyze data.ResultsVarious healthy eating strategies were implemented within the 3 cases after uptake of the guidelines. Support from the school superintendent and the work of a health champion facilitated the adoption and implementation of the guidelines, whereas parents posed some barriers to the adoption and implementation of the ANGCY.Conclusions and ImplicationsThis study reinforces the importance of identifying a health champion to oversee healthy eating strategies in schools, and of involving parents in the promotion of children's healthy lifestyles.     

A survey in Alberta and Quebec of the telehealth applications that physicians need

We studied the utility of various telehealth applications to support practice in rural and remote regions from the physicians' point of view. A postal survey was conducted among physicians from rural and remote regions of Alberta and Eastern Quebec. A total of 321 questionnaires were returned (13% response rate), comprising 180 from Quebec (16%) and 141 from Alberta (11%). Differences in the perceived utility of telehealth applications were explored using univariate and multivariate analyses. Telehealth applications were grouped into four categories: (1) asynchronous; (2) synchronous; (3) education; and (4) access to health information. The perceived utility of each application varied significantly between provinces. However, the two categories of telehealth applications perceived to be the most relevant were the same in both provinces: access to health information and applications for tele-education.     

Tracking Emergence and Spread of SARS-CoV-2 Omicron Variant in Large and Small Communities by Wastewater Monitoring in Alberta,Canada

Wastewater monitoring of SARS-CoV-2 enables early detection and monitoring of the COVID-19 disease burden in communities and can track specific variants of concern. We determined proportions of the Omicron and Delta variants across 30 municipalities covering >75% of the province of Alberta (population 4.5 million), Canada, during November 2021–January 2022. Larger cities Calgary and Edmonton exhibited more rapid emergence of Omicron than did smaller and more remote municipalities. Notable exceptions were Banff, a small international resort town, and Fort McMurray, a medium-sized northern community that has many workers who fly in and out regularly. The integrated wastewater signal revealed that the Omicron variant represented close to 100% of SARS-CoV-2 burden by late December, before the peak in newly diagnosed clinical cases throughout Alberta in mid-January. These findings demonstrate that wastewater monitoring offers early and reliable population-level results for establishing the extent and spread of SARS-CoV-2 variants.     

Advancing Indigenous primary health care policy in Alberta,Canada

For Indigenous people worldwide, accessing Primary Health Care (PHC) services responsive to socio-cultural realities is challenging, with institutional inequities in healthcare and jurisdictional barriers encumbering patients, providers, and decision-makers. In the Canadian province of Alberta, appropriate Indigenous health promotion, disease prevention, and primary care health services are needed, though policy reform is hindered by complex networks and competing interests between: federal/provincial funders; reserve/urban contexts; medical/allied health professional priorities; and three Treaty territories each structuring fiduciary responsibilities of the Canadian government.In 2015, the Truth and Reconciliation Commission (TRC) of Canada released a final report from over six years spent considering impacts of the country's history of Indian residential schools, which for more than a century forcibly removed thousands of children from their families and communities. The TRC directed 94 calls to action to all levels of society, including health systems, to address an historical legacy of cultural assimilationism against Indigenous peoples. To address TRC calls that Indigenous health disparities be recognized as resulting from previous government policies, and to integrate Indigenous leadership and perspectives into health systems, PHC decision-makers, practitioners, and scholars in the province of Alberta brought together stakeholders from across Canada. The gathering detailed here explored Indigenous PHC models from other Canadian provinces to collaboratively build relationships for policy reform and identify opportunities for PHC innovations within Alberta.     

The Relationship Between Peer, Social, and School Factors, and Delinquency Among Youth

ABSTRACT: This article examines the relationships between self-reported delinquency and peer, social, and school factors among junior and senior high school students in Calgary, Alberta, Canada, using both cross-tabulation and multiple-regression analyses. A greater number of ninth grade students were delinquent compared to students in the other grades studied. Predictably, peers' level of delinquency correlated strongly and positively with students' level of delinquency. Strong, positive correlations with delinquency also were found for students reporting high levels of involvement in sports, and high levels of involvement in commercial/entertainment activities. Multivariate analyses indicated the strongest predictor of delinquent behavior within the group of peer and social variables was peer delinquency. Within the group of school variables, the strongest predictors of delinquent behavior were how often classes were skipped and the number of times students were suspended from school. However, students' grades in school did not significantly increase the accuracy of the regression eqution.     

Utilization of hospital services by cardiovascular patients, Alberta, Canada.

Using hospital discharge records, and United States DRG (diagnosis related groups) data, we studied hospital utilization by cardiovascular patients, associated hospital expenditures, and the per capita cost of treating cardiovascular diseases in Alberta, Canada between 1971 and 1986. Expressed in constant 1984 Canadian dollars, the estimated total hospital cost increased from $84 million in 1971 to $131 million in 1986; during this period the Province of Alberta spent about $51 Canadian per resident each year for cardiovascular hospital services. It was noted that rural residents consumed a higher volume of resources per capita than their urban counterparts. A patient origin-destination analysis indicated an increasing dependence of rural patients on urban hospitals for secondary or tertiary care, underscoring the effects of medical technology on referral patterns.