Recent Writing on Health Care History in Canada

C’est une période heureuse pour l’histoire des soins de santé au Canada. On voit régulièrement des articles sur la santé publiés dans des périodiques d’histoire canadiens et internationaux. Le Bulletin canadien d’histoire de la médecine est un périodique vivant et important, et le nombre de monographies est en augmentation constante. Cet article discute de plusieurs problématiques de recherche en émergence qui caractérisent l’écriture de l’histoire de la santé au Canada, incluant l’histoire des hôpitaux, des infirmières, de la santé mentale et explore la santé et la médecine chez les aborigènes. L’article cherche à mettre en évidence les réalisations de ce domaine de recherche, tout en signalant les lacunes à combler.These are halcyon days for health care history in Canada. One routinely sees articles pertaining to health in leading Canadian and international history journals. The Canadian Bulletin of Medical History is a vibrant and important vehicle and there are a growing number of monographs. This essay reviews several of the maturing content areas that now characterize the writing of health history in Canada, including hospital history, nursing history, the history of mental health, and health and medicine in aboriginal settings. This essay seeks to highlight the accomplishments of the field, while reviewing some of the gaps

"Once a Therapist, Always a Therapist": The Early Career of Mary Black, Occupational Therapist

Mary Black was an internationally-known weaver and a key figure in Nova Scotia's craft renaissance during the 1940s and 1950s. The early years of her worklife, however, remain unexplored, despite her place as a pioneering occupational therapist in Nova Scotia and in the United States during the 1920s and 1930s.Mary Black est une tisseuse de renommee intemationale et une personne cle de la renaissance de l'artisanat en Nouvelle-Ecosse durant les annees 40 et les annees 50. Les premieres annees de sa carriere, demeurent encore inexplorees, malgre sa place en tant qu'ergotherapeute pionniere en Nouvelle-Ecosse et aux Etats-Unis durant les annees 20 et les annees 30

Education, Expertise, Experience and the Making of Hospital Workers in Canada, 1920-1960

Beginning in the 1920s, many Canadian hospitals underwent an extensive period of modernization. A wide variety of workers, generally termed "allied health professionals," began to work alongside physicians and nurses. This paper examines the history of two such groups, x-ray and laboratory technicians, paying particular attention to the ways in which technical education was transformed and, through this transformation, new occupational identities forged. Initially, those who staffed the laboratory and x-ray departments were given quick, practical instruction. In many cases, these workers continued to work in various settings across the hospital. The informal instruction of the 1920s and 1930s was displaced by formal, accredited training programs, replete with national examinations linked to a practice registry in the 1940s. Hospital administrators, the Canadian Medical Association and technicians themselves were all engaged in this transformation. At the same time, national organizations such as the Canadian Society of Laboratory Technologists or the Canadian Society of Radiological Technicians, founded in the late 1930s and early 1940s respectively, attempted to create a common professional identity with a clear scope of practice. Despite this, technical workers' professional identity remained malleable and highly dependent upon context long after the creation of supposedly national accreditation standards.Les années 1920 marquent le début d’une longue phase de modernisation pour de nombreux hôpitaux canadiens. Un grand nombre d’employés, généralement qualifiés de « personnel paramédical », commencent à collaborer avec les médecins et le personnel infirmier. Cet article observe l’évolution de deux de ces deux groupes, soit les techniciens en radiologie et les techniciens de laboratoire. Il met l’accent sur le développement d’une formation technique et, à travers celle-ci, de l’établissement de nouvelles identités professionnelles. Au début, le personnel des laboratoires et des services de radiologie reçoit une formation rapide et pratique. Dans de nombreux cas, ces personnes poursuivent leur travail dans plusieurs autres services de l’hôpital. La formation informelle fournie dans les années 1920 et 1930 est ensuite remplacée par une formation formelle au moyen de programmes accrédités, complétés par des examens nationaux qui donnent lieu à l’établissement d’un registre des pratiques dans les années 1940. Les directeurs d’hôpitaux, l’Association médicale canadienne et les techniciens eux-mêmes participèrent à cette évolution. En même temps, les organisations nationales telles que la Société canadienne des technologistes de laboratoire ou la Société canadienne des techniciens en radiologie, fondées respectivement à la fin des années 1930 et au début des années 1940, tentent de créer une identité professionnelle commune ancrée dans un ensemble de pratiques clairement identifiables. Malgré cela, longtemps après la création des prétendues accréditations nationales, l’identité professionnelle des techniciens demeure flexible et extrêmement tributaire de l’environnement local

The "Celebrated Indian Herb Doctor": Francis Tumblety in Saint John, 1860

Francis Tumblety, the "Celebrated Indian Herb Doctor," arrived in Saint John in the summer of 1860. He quickly became embroiled in conflict with the established medical community and even stood accused of manslaughter. This article examines Tumblety’s brief stay in Saint John as a way of illustrating the contested nature of medical practice in the mid-19th century. Understanding the career of such a practitioner provides insight into the range of therapeutic choices that were available during these years and into the struggle of orthodox medicine to limit these choices. Résumé Francis Tumblety, le « célèbre docteur spécialiste des herbes indiennes », arriva à Saint John à l’été de 1860. Il fut vite en conflit avec la communauté médicale établie et fut même accusé d’homicide involontaire. Cet article s’intéresse au bref séjour de Tumblety à Saint John comme une façon d’illustrer le caractère contesté de la pratique de la médecine au milieu du 19e siècle. La carrière d’un tel praticien jette un éclairage sur l’éventail des choix thérapeutiques qui étaient offerts durant ces années et sur la lutte livrée par la médecine conventionnelle pour limiter ces choix

Age-dependent maintenance of motor control and corticostriatal innervation by death receptor 3

Death receptor 3 is a proinflammatory member of the immunomodulatory tumor necrosis factor receptor superfamily, which has been implicated in several inflammatory diseases such as arthritis and inflammatory bowel disease. Intriguingly however, constitutive DR3 expression has been detected in the brains of mice, rats, and humans, although its neurological function remains unknown. By mapping the normal brain expression pattern of DR3, we found that DR3 is expressed specifically by cells of the neuron lineage in a developmentally regulated and region-specific pattern. Behavioral studies on DR3-deficient (DR3(ko)) mice showed that constitutive neuronal DR3 expression was required for stable motor control function in the aging adult. DR3(ko) mice progressively developed behavioral defects characterized by altered gait, dyskinesia, and hyperactivity, which were associated with elevated dopamine and lower serotonin levels in the striatum. Importantly, retrograde tracing showed that absence of DR3 expression led to the loss of corticostriatal innervation without significant neuronal loss in aged DR3(ko) mice. These studies indicate that DR3 plays a key nonredundant role in the retention of normal motor control function during aging in mice and implicate DR3 in progressive neurological disease

Spatiotemporal mapping of malaria prevalence in Madagascar using routine surveillance and health survey data.

Malaria transmission in Madagascar is highly heterogeneous, exhibiting spatial, seasonal and long-term trends. Previous efforts to map malaria risk in Madagascar used prevalence data from Malaria Indicator Surveys. These cross-sectional surveys, conducted during the high transmission season most recently in 2013 and 2016, provide nationally representative prevalence data but cover relatively short time frames. Conversely, monthly case data are collected at health facilities but suffer from biases, including incomplete reporting and low rates of treatment seeking. We combined survey and case data to make monthly maps of prevalence between 2013 and 2016. Health facility catchment populations were estimated to produce incidence rates from the case data. Smoothed incidence surfaces, environmental and socioeconomic covariates, and survey data informed a Bayesian prevalence model, in which a flexible incidence-to-prevalence relationship was learned. Modelled spatial trends were consistent over time, with highest prevalence in the coastal regions and low prevalence in the highlands and desert south. Prevalence was lowest in 2014 and peaked in 2015 and seasonality was widely observed, including in some lower transmission regions. These trends highlight the utility of monthly prevalence estimates over the four year period. By combining survey and case data using this two-step modelling approach, we were able to take advantage of the relative strengths of each metric while accounting for potential bias in the case data. Similar modelling approaches combining large datasets of different malaria metrics may be applicable across sub-Saharan Africa

Mapping malaria by sharing spatial information between incidence and prevalence data sets

As malaria incidence decreases and more countries move towards elimination, maps of malaria risk in low-prevalence areas are increasingly needed. For low-burden areas, disaggregation regression models have been developed to estimate risk at high spatial resolution from routine surveillance reports aggregated by administrative unit polygons. However, in areas with both routine surveillance data and prevalence surveys, models that make use of the spatial information from prevalence point-surveys might make more accurate predictions. Using case studies in Indonesia, Senegal and Madagascar, we compare the out-of-sample mean absolute error for two methods for incorporating point-level, spatial information into disaggregation regression models. The first simply fits a binomial-likelihood, logit-link, Gaussian random field to prevalence point-surveys to create a new covariate. The second is a multi-likelihood model that is fitted jointly to prevalence point-surveys and polygon incidence data. We find that in most cases there is no difference in mean absolute error between models. In only one case, did the new models perform the best. More generally, our results demonstrate that combining these types of data has the potential to reduce absolute error in estimates of malaria incidence but that simpler baseline models should always be fitted as a benchmark

Global estimation of anti-malarial drug effectiveness for the treatment of uncomplicated Plasmodium falciparum malaria 1991-2019.

BACKGROUND: Anti-malarial drugs play a critical role in reducing malaria morbidity and mortality, but their role is mediated by their effectiveness. Effectiveness is defined as the probability that an anti-malarial drug will successfully treat an individual infected with malaria parasites under routine health care delivery system. Anti-malarial drug effectiveness (AmE) is influenced by drug resistance, drug quality, health system quality, and patient adherence to drug use; its influence on malaria burden varies through space and time. METHODS: This study uses data from 232 efficacy trials comprised of 86,776 infected individuals to estimate the artemisinin-based and non-artemisinin-based AmE for treating falciparum malaria between 1991 and 2019. Bayesian spatiotemporal models were fitted and used to predict effectiveness at the pixel-level (5 km × 5 km). The median and interquartile ranges (IQR) of AmE are presented for all malaria-endemic countries. RESULTS: The global effectiveness of artemisinin-based drugs was 67.4% (IQR: 33.3-75.8), 70.1% (43.6-76.0) and 71.8% (46.9-76.4) for the 1991-2000, 2006-2010, and 2016-2019 periods, respectively. Countries in central Africa, a few in South America, and in the Asian region faced the challenge of lower effectiveness of artemisinin-based anti-malarials. However, improvements were seen after 2016, leaving only a few hotspots in Southeast Asia where resistance to artemisinin and partner drugs is currently problematic and in the central Africa where socio-demographic challenges limit effectiveness. The use of artemisinin-based combination therapy (ACT) with a competent partner drug and having multiple ACT as first-line treatment choice sustained high levels of effectiveness. High levels of access to healthcare, human resource capacity, education, and proximity to cities were associated with increased effectiveness. Effectiveness of non-artemisinin-based drugs was much lower than that of artemisinin-based with no improvement over time: 52.3% (17.9-74.9) for 1991-2000 and 55.5% (27.1-73.4) for 2011-2015. Overall, AmE for artemisinin-based and non-artemisinin-based drugs were, respectively, 29.6 and 36% below clinical efficacy as measured in anti-malarial drug trials. CONCLUSIONS: This study provides evidence that health system performance, drug quality and patient adherence influence the effectiveness of anti-malarials used in treating uncomplicated falciparum malaria. These results provide guidance to countries' treatment practises and are critical inputs for malaria prevalence and incidence models used to estimate national level malaria burden