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Accounting for vulnerability to illness and social disadvantage in pandemic critical care triage.

https://arctichealth.org/en/permalink/ahliterature96997
Source
J Clin Ethics. 2010;21(1):23-9
Publication Type
Article
Date
2010
Author
Chris Kaposy
Author Affiliation
Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada. christopher.kaposy@med.mun.ca
Source
J Clin Ethics. 2010;21(1):23-9
Date
2010
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Critical Care
Cultural Characteristics
Disaster Planning - trends
Disease Outbreaks
Health Care Rationing - ethics
Health Policy - trends
Humans
Indians, North American - statistics & numerical data
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - ethnology - mortality - virology
Intensive Care Units - organization & administration - standards
Inuits - statistics & numerical data
Newfoundland and Labrador - epidemiology
Patient Selection - ethics
Prognosis
Risk assessment
Social Class
Triage - methods - organization & administration - standards - trends
Vulnerable Populations
Abstract
In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador.
PubMed ID
20465071 View in PubMed
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Alcohol in Canada: reducing the toll through focused interventions and public health policies.

https://arctichealth.org/en/permalink/ahliterature136996
Source
CMAJ. 2011 Mar 8;183(4):450-5
Publication Type
Article
Date
Mar-8-2011
Author
Norman Giesbrecht
Timothy Stockwell
Perry Kendall
Robert Strang
Gerald Thomas
Author Affiliation
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ont. norman_giesbrecht@camh.net
Source
CMAJ. 2011 Mar 8;183(4):450-5
Date
Mar-8-2011
Language
English
Publication Type
Article
Keywords
Alcohol-Related Disorders - epidemiology - prevention & control
Canada - epidemiology
Evidence-Based Medicine
Health Policy
Health Promotion - organization & administration
Humans
Public Health
Risk factors
Notes
Cites: J Stud Alcohol Drugs. 2007 May;68(3):345-5217446973
Cites: Addiction. 2007 Sep;102(9):1345-917645431
Cites: Addiction. 2009 Feb;104(2):179-9019149811
Cites: Drug Alcohol Rev. 2009 May;28(3):301-2319489992
Cites: Lancet. 2009 Jun 27;373(9682):2223-3319560604
Cites: MMWR Morb Mortal Wkly Rep. 2010 Oct 8;59(39):1274-920930706
Cites: Lancet. 2009 Jun 27;373(9682):2247-5719560606
Cites: Alcohol Alcohol. 2009 Sep-Oct;44(5):500-1619734159
Cites: Addiction. 2009 Nov;104(11):1827-3619681801
Cites: Addiction. 2009 Dec;104(12):2023-3219922569
Cites: Addiction. 2010 Aug;105(8):1323-520653610
Cites: Lancet. 2009 Jun 27;373(9682):2234-4619560605
PubMed ID
21324848 View in PubMed
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An assessment of US and Canadian smoking reduction objectives for the year 2000.

https://arctichealth.org/en/permalink/ahliterature204593
Source
Am J Public Health. 1998 Sep;88(9):1362-7
Publication Type
Article
Date
Sep-1998
Author
C. Pechmann
P. Dixon
N. Layne
Author Affiliation
Graduate School of Management, University of California, Irvine 92697, USA. cpechman@uci.edu
Source
Am J Public Health. 1998 Sep;88(9):1362-7
Date
Sep-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Canada - epidemiology
Female
Forecasting
Goals
Health Policy - trends
Humans
Male
Middle Aged
Prevalence
Probability
Sex Distribution
Smoking - epidemiology - trends
Smoking Cessation - statistics & numerical data
Stochastic Processes
United States - epidemiology
Abstract
This study assessed whether US and Canadian smoking reduction objectives for the year 2000 are attainable. The United States seeks to cut smoking in its population to 15%; the Canadian goal is 24%.
Smoking data were obtained for the United States (1974-1994) and Canada (1970-1995) for the overall populations and several age-sex subpopulations. Analyses estimated trends, future prevalences, and the likelihood of goal attainment. Structural time-series models were used because of their ability to fit a variety of trends.
The findings indicate that smoking has been declining steadily since the 1970s, by approximately 0.7 percentage points a year, in both countries. Extrapolating these trends to the year 2000, the US prevalence will be 21% and the Canadian prevalence 24%.
If the current trends continue, the Canadian goal seems attainable, but the US goal does not. The US goal is reachable only for 65-to 80-year-olds, who already have low smoking prevalences. It appears that both countries must increase their commitment to population-based tobacco control.
Notes
Cites: JAMA. 1989 Jan 6;261(1):49-552908994
Cites: JAMA. 1989 Jan 6;261(1):61-52908996
Cites: Can J Public Health. 1992 Nov-Dec;83(6):404-61286438
Cites: Prev Med. 1990 Sep;19(5):552-612235922
Cites: Med Clin North Am. 1992 Mar;76(2):289-3031548962
Cites: CMAJ. 1990 Nov 1;143(9):905-62224718
PubMed ID
9736877 View in PubMed
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An evidence-based policy prescription for an aging population.

https://arctichealth.org/en/permalink/ahliterature135586
Source
Healthc Pap. 2011;11(1):8-18
Publication Type
Article
Date
2011
Author
Neena L Chappell
Marcus J Hollander
Author Affiliation
Centre on Aging and Department of Sociology, University of Victoria.
Source
Healthc Pap. 2011;11(1):8-18
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Delivery of Health Care, Integrated - economics - organization & administration
Evidence-Based Practice
Forecasting
Health Care Costs
Health Policy
Health services needs and demand
Health Services for the Aged - economics - organization & administration - supply & distribution
Healthy People Programs - economics - organization & administration
Humans
Middle Aged
Abstract
In this paper, the authors provide a policy prescription for Canada's aging population. They question the appropriateness of predictions about the lack of sustainability of our healthcare system. The authors note that aging per se will only have a modest impact on future healthcare costs, and that other factors such as increased medical interventions, changes in technology and increases in overall service use will be the main cost drivers. They argue that, to increase value for money, government should validate, as a priority, integrated systems of care delivery for older adults and recognize such systems as a major component of Canada's healthcare system, along with hospitals, primary care and public/population health. They also note a range of mechanisms to enhance such systems going forward. The authors present data and policy commentary on the following topics: ageism, healthy communities, prevention, unpaid caregivers and integrated systems of care delivery.
Notes
Comment In: Healthc Pap. 2011;11(1):20-4; discussion 86-9121464623
Comment In: Healthc Pap. 2011;11(1):25-9; discussion 86-9121464624
Comment In: Healthc Pap. 2011;11(1):30-5; discussion 86-9121464625
Comment In: Healthc Pap. 2011;11(1):41-5; discussion 86-9121464627
Comment In: Healthc Pap. 2011;11(1):52-8; discussion 86-9121464629
Comment In: Healthc Pap. 2011;11(1):59-61; discussion 86-9121464630
Comment In: Healthc Pap. 2011;11(1):62-8; discussion 86-9121464631
Comment In: Healthc Pap. 2011;11(1):69-75; discussion 86-9121464632
Comment In: Healthc Pap. 2011;11(1):76-83; discussion 86-9121464633
Comment In: Healthc Pap. 2011;11(1):36-40; discussion 86-9121464626
Comment In: Healthc Pap. 2011;11(1):46-51; discussion 86-9121464628
PubMed ID
21464622 View in PubMed
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Anniversaries--but what have we learned?

https://arctichealth.org/en/permalink/ahliterature181638
Source
Can HIV AIDS Policy Law Rev. 2002 Jul;7(1):5-7
Publication Type
Article
Date
Jul-2002
Author
Michael Kirby
Source
Can HIV AIDS Policy Law Rev. 2002 Jul;7(1):5-7
Date
Jul-2002
Language
English
Publication Type
Article
Keywords
Anniversaries and Special Events
Canada - epidemiology
Developed Countries
HIV Infections - epidemiology
Health Policy
Humans
PubMed ID
14765476 View in PubMed
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Arctic health policy: contribution of scientific data.

https://arctichealth.org/en/permalink/ahliterature4335
Source
Int J Hyg Environ Health. 2003 Aug;206(4-5):351-62
Publication Type
Article
Date
Aug-2003
Author
James E Berner
Andrew Gilman
Author Affiliation
Office of Community Health, Alaska Native Tribal Health Consortium, Anchorage, Alaska 99508, USA. jberner@anthc.org
Source
Int J Hyg Environ Health. 2003 Aug;206(4-5):351-62
Date
Aug-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alaska - epidemiology
Arctic Regions - epidemiology
Canada - epidemiology
Centers for Disease Control and Prevention (U.S.)
Child
Child, Preschool
Comparative Study
Environmental health
Female
Health Policy
Health Status Indicators
Humans
Infant
Infant, Newborn
International Cooperation
Male
Middle Aged
Mortality
National Health Programs
Norway - epidemiology
Oceanic Ancestry Group - statistics & numerical data
United States
Abstract
In Western Hemisphere arctic regions, scientific findings in humans, wildlife, and the environment have resulted in major governmental policy formulations. Government policy resulted in establishment of an effective international organization to address scientifically identified problems, including health disparities in arctic indigenous populations. Western scientific data and indigenous knowledge from initial international programs led to international agreements restricting certain persistent organic pollutants. In recent years, scientific data, and indigenous traditional knowledge, have resulted in governmental policy in the United States, Canada, and Nordic countries that includes the full participation of indigenous residents in defining research agendas, interpreting data, communicating information, and local community policy formulation.
PubMed ID
12971690 View in PubMed
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As Canadians butt out, the developing world lights up.

https://arctichealth.org/en/permalink/ahliterature214091
Source
CMAJ. 1995 Oct 15;153(8):1111-4
Publication Type
Article
Date
Oct-15-1995
Author
A. Phillips
D. de Savigny
M M Law
Source
CMAJ. 1995 Oct 15;153(8):1111-4
Date
Oct-15-1995
Language
English
Publication Type
Article
Keywords
Agriculture
Canada - epidemiology
Developing Countries
Economics
Health Policy
Humans
Tobacco Use Disorder - epidemiology
Abstract
Although rates of tobacco smoking in Canada have dropped dramatically over the last 30 years this is not a global trend. For every tonne of tobacco that Canadian adults gave up between 1970 and 1990, aggressive marketing by multinational tobacco companies has ensured that an additional 20 tonnes is now consumed in developing countries. The authors describe the dilemma faced by policymakers in their efforts to control the epidemic of tobacco smoking in the developing world: although tobacco consumption leads to increased rates of mortality and morbidity and lost productivity, its production creates employment, generates tax revenue and earns foreign exchange. Canadian experience has proved that trends in tobacco consumption can be reversed through policies that address not only health issues but also economic social and agricultural concerns. The authors propose a framework for harnessing expertise in the service of worldwide tobacco control.
Notes
Cites: BMJ. 1994 Oct 8;309(6959):937-97950669
Cites: Alcohol. 1994 May-Jun;11(3):219-238060522
Cites: Tuber Lung Dis. 1994 Feb;75(1):8-248161771
Cites: Lancet. 1981 May 16;1(8229):1090-36112456
PubMed ID
7553519 View in PubMed
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Ashes to ashes: the significance of preventing lung cancer through primary prevention and health promotion.

https://arctichealth.org/en/permalink/ahliterature197004
Source
Can Oncol Nurs J. 2000;10(2):69-73
Publication Type
Article
Date
2000

Barriers to optimizing investments in the built environment to reduce youth obesity: policy-maker perspectives.

https://arctichealth.org/en/permalink/ahliterature141275
Source
Can J Public Health. 2010 May-Jun;101(3):237-40
Publication Type
Article
Author
Jill L Grant
Kathryn C MacKay
Patricia M Manuel
Tara-Leigh F McHugh
Author Affiliation
School of Planning, Dalhousie University, Box 1000, Halifax, NS B3J 2X4. jill.grant@dal.ca
Source
Can J Public Health. 2010 May-Jun;101(3):237-40
Language
English
Publication Type
Article
Keywords
Adolescent
Automobile Driving
Canada - epidemiology
Child
Cultural Characteristics
Diet
Environment
Female
Focus Groups
Health Policy
Humans
Life Style
Male
Obesity - epidemiology - prevention & control
Residence Characteristics
Socioeconomic Factors
Abstract
To identify factors which limit the ability of local governments to make appropriate investments in the built environment to promote youth health and reduce obesity outcomes in Atlantic Canada.
Policy-makers and professionals participated in focus groups to discuss the receptiveness of local governments to introducing health considerations into decision-making. Seven facilitated focus groups involved 44 participants from Atlantic Canada. Thematic discourse analysis of the meeting transcripts identified systemic barriers to creating a built environment that fosters health for youth aged 12-15 years.
Participants consistently identified four categories of barriers. Financial barriers limit the capacities of local government to build, maintain and operate appropriate facilities. Legacy issues mean that communities inherit a built environment designed to facilitate car use, with inadequate zoning authority to control fast food outlets, and without the means to determine where schools are built or how they are used. Governance barriers derive from government departments with distinct and competing mandates, with a professional structure that privileges engineering, and with funding programs that encourage competition between municipalities. Cultural factors and values affect outcomes: people have adapted to car-oriented living; poverty reduces options for many families; parental fears limit children's mobility; youth receive limited priority in built environment investments.
Participants indicated that health issues have increasing profile within local government, making this an opportune time to discuss strategies for optimizing investments in the built environment. The focus group method can foster mutual learning among professionals within government in ways that could advance health promotion.
PubMed ID
20737817 View in PubMed
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Breast cancer in Canada: to screen or not to screen?

https://arctichealth.org/en/permalink/ahliterature223434
Source
Int J Health Plann Manage. 1992 Jul;7(3):171-83
Publication Type
Article
Date
Jul-1992
Author
D W Taylor
E. Little
Author Affiliation
McMaster University, Hamilton, Ontario.
Source
Int J Health Plann Manage. 1992 Jul;7(3):171-83
Date
Jul-1992
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - epidemiology - prevention & control
Canada - epidemiology
Female
Health Policy
Humans
Mammography - standards - utilization
Mass Screening - standards
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Policy Making
Abstract
Lomas (1988) and Sabatier (1987) have suggested models by which to examine the roles that values, scientific knowledge, institutions, and the learning process play in the formulation of both national and clinical health-care policies. Utilizing their frameworks, this article offers an explanation for the development of high-volume screening mammography policies in Canada, despite the suggested inefficacy of screening technologies for 'unavoidable' illnesses such as carcinoma in the breast. The preliminary results of Canada's National Breast Screening Study further complicate this tissue. Inappropriate framing of the 'problem' in the policy-making process, by actors highly influenced by societal values and scientific evidence, is identified as the reason for present and planned policies and practices contradicting the first principles of health-policy analysis.
PubMed ID
10123302 View in PubMed
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133 records – page 1 of 14.