The Role of the Practising Physician in Medical Student Recruitment

The role that the practitioner of medicine can play in assisting recruitment to medical schools is examined. Although the total enrolment in universities has increased sharply in the past decade, the group applying to enter medicine has decreased. The output of Canada''s 12 schools of medicine—850 graduates per year-falls significantly short of the number of new physicians required to maintain the present physician:population ratio. With the expanded output of physicians required in future, an active program of recruitment will be necessary. The recruitment program organized by the practising physicians of British Columbia and the Faculty of Medicine at the University of British Columbia is outlined.     

Reference-based pricing: Will other provinces follow the BC lead?

REFERENCE-BASED PRICING has had a major impact on medical practice in British Columbia. Anne Mullens discusses the new system''s first 2 years. She says physicians outside BC should pay attention, because RBP may be heading their way. It is set to land in Australia next month.     

Accuracy of registration of invasive cervical cancer.

The quality of the data recorded by the British Columbia Cancer Registry for 521 new cases of invasive cervical cancer was evaluated. The registry''s pathological diagnosis in all new registrations of invasive cervical cancer diagnosed in British Columbia between 1977 and 1979 was compared with a best estimate of the true diagnosis, which was determined from the results of the provincial cervical cytology screening program and the clinical charts at the Cancer Control Agency of British Columbia. The registry''s data overestimated the true incidence of invasive cervical cancer by approximately 55%, since 184 (35%) of the cases were incorrectly registered. Of the 184, 141 (77%) were cases of preinvasive cervical cancer, 26 (14%) did not meet the criteria for a true case (i.e., they were not newly diagnosed in British Columbia between 1977 and 1979) and 17 (9%) were cases of invasive cancer of another primary site. In addition, 28 cases of invasive cervical cancer diagnosed in the province during the study period had not been reported to the registry. Thus, both over-reporting and under-reporting occurred. There is a need for constant evaluation of registry data if cancer registries are to fulfil their potential contribution to cancer control programs and research.     

Requirements of British universities for higher medical degrees.

OBJECTIVE--To examine the requirements and opportunities for obtaining a doctor of medicine or master of surgery degree from a university in the United Kingdom other than the graduate''s own, particularly in the case of foreign graduates. DESIGN--Review of regulations governing the award of doctor of medicine and master of surgery degrees in British universities. SETTING--All 19 universities in the United Kingdom offering clinical courses. MAIN OUTCOME MEASURE--Availability of degrees to graduates of other universities. RESULTS--Opportunities for obtaining a degree differed widely among the medical schools, one university (Edinburgh) not admitting graduates of other universities in any circumstance. Of the remaining universities, none would consider a graduate who had not worked in the area where the medical school was located. CONCLUSION--The wide differences in opportunity among the medical schools may put some foreign graduates at a disadvantage compared with other graduates. This problem may become more severe as the number of graduates from the European Community who settle in Britain increases.     

Indicators for demonstrating sustainable forest management in British Columbia,Canada: An international review

Many organizations and individuals are developing sustainable forestry criteria and indicator (C&I) research and monitoring initiatives at various scales. In support of Canada's international commitments, the Canadian Council of Forest Ministers (CCFM) recently (2003) revised a set of national C&I, broadly based on the Montreal Process. Meanwhile, the Province of British Columbia, Canada, has implemented new, results-based, legislation, the Forest and Range Practices Act 2003, which sets objectives for 11 public ‘Values’ that require appropriate C&I for effectiveness evaluation. At the local-level, British Columbia's forest industry requires indicators to achieve third-party certification. Each of these parties seeks to assess and report on performance. There is, therefore, a recognized desire to define a collaborative approach to C&I research and monitoring frameworks in British Columbia. This paper discusses the results of a rigorous review of indicators related to sustainable forest management (SFM) in British Columbia. Based on the 6 CCFM indicators, 47 SFM questions were developed to guide the selection of potential indicators for British Columbia. A hierarchical framework of proposed SFM indicators was then proposed to provide trend information on resource condition at both the macro (landscape) and local (management unit) levels of forest management. However, a number of key challenges remain for British Columbia as it continues towards a scientifically sound, useful, and effective indicator framework that will demonstrate progress towards SFM at the provincial level. These include stakeholder consultation, practicality, data interpretation and long-term commitment.     

The British Columbia Positive Women's Survey: a detailed profile of 110 HIV-infected women

OBJECTIVE: To describe the health, social environment, medical care received and satisfaction with medical care of HIV-infected women in British Columbia. DESIGN: Self-administered 75-item questionnaire distributed by mail or in person between March 1994 and February 1996 through community AIDS organizations and physicians'' offices. SETTING: British Columbia. PARTICIPANTS: A total of 110 HIV-positive women. OUTCOME MEASURES: Sociodemographic data, risk factors for HIV infection, details about HIV testing, health status and medical treatment, use of health care services, degree of satisfaction with medical care and psychosocial stressors. RESULTS: Most of the women surveyed were aged 25 to 39 years (70.0%), were Canadian born (76.4%) and were white (80.9%). Over one-third did not complete high school, and half had an annual household income of less than $20,000. Of the 110 women 51.8% had children, who were HIV-positive in 12.3% of cases. The most frequently reported risk factor for HIV infection was sex with a man (49.1%); 19.1% reported both sex with a man and injection drug use, and 12.7% reported injection drug use only. Seventy-five women indicated that they had become infected through sex with a man, with or without injection drug use. Of these, 65 indicated whether or not this was the result of sexual assault or rape; 8 (12.3%) answered affirmatively. Of the 81 women who responded to the question regarding prior sexual assault or abuse, 43 (53.1%) reported being sexually assaulted as an adult, 35 (43.2%) reported being sexually abused as a child, and 22 (27.2%) reported being sexually abused or assaulted both as a child and as an adult. Women who were sexually abused as a child were more likely than those who were not abused as a child to have injection drug use as a risk factor (54.3% v. 7.5%). Menstrual cycle changes were reported by 70.1% of the respondents. Most women stated that they had not received adequate pre- or post-test counselling, and 47.0% were not satisfied with their doctor''s care. Psychosocial concerns identified to be of greatest importance were financial problems, lack of intimacy or satisfying sexual relationship, and fear of rejection or discrimination. CONCLUSION: Several important concerns for HIV-positive women were identified, including dissatisfaction with medical care, fear of discrimination, violence and abuse, and poverty.     

Six medical students in a community hospital

This paper describes part of an education experiment at the University of British Columbia at Vancouver.Six final-year medical students spent approximately 12 weeks in a community. Their time was divided between the hospital and various doctors'' offices. They answered a simple questionnaire to describe their experiences and commented favourably upon the opportunities for direct patient contact, learning basic skills, informal teaching by both family physicians and consultants, and the variety of work available.They had the opportunity to follow up the progress of the patient and learn the natural history of common illnesses. They achieved their basic objectives. We conclude from their reports and informal conversation that the experiment was successful and recommend other institutions to try similar programs.     

Mobilizing physicians to conduct clinical intervention in tobacco use through a medical-association program: 5 years' experience in British Columbia.

During the last 5 years, a program run by the medical association in British Columbia has recruited 23% of the province''s general practitioners (GPs) to take an active, systematic approach to clinical intervention in tobacco use. Another 9% of GPs (considered "semi-active") regularly use the program''s educational materials for patients, and another 25% have been trained in intervention or have been given intervention materials or both. If the cessation rate (rate of patients who quit smoking who would not otherwise have done so) was 4% among physicians actively involved in intervention and 2% among physicians considered semi-active, in 1995 an estimated 4700 smokers quit and were followed by their GPs as a result of the program. Another 135,000 smokers received brief counselling from their GPs and were also followed. This article reviews the strategies and methods used in this program to mobilize physicians.     

High genetic diversity in the blue-listed British Columbia population of the purple martin maintained by multiple sources of immigrants

To assess genetic diversity in the blue-listed purple martin (Progne subis) population in British Columbia, we analysed mitochondrial control region sequences of 93 individuals from British Columbia and 121 individuals collected from seven localities of the western and eastern North American subspecies P. s. arboricola and P. s. subis, respectively. Of the 47 haplotypes we detected, 34 were found exclusively in western populations, and 12 were found only in eastern populations. The most common eastern haplotype (25) was also found in three nestlings in British Columbia and one in Washington. Another British Columbia nestling had a haplotype (35) that differed by a C to T transition from haplotype 25. Coalescent analysis indicated that these five nestlings are probably descendents of recent immigrants dispersing from east to the west, because populations were estimated to have diverged about 200,000–400,000 ybp, making ancestral polymorphism a less likely explanation. Maximum likelihood estimates of gene flow among all populations detected asymmetrical gene flow into British Columbia not only of rare migrants from the eastern subspecies in Alberta but also a substantial number of migrants from the adjacent Washington population, and progressively lower numbers from Oregon in an isolation-by distance pattern. The influx of migrants from different populations is consistent with the migrant-pool model of recolonization which has maintained high genetic diversity in the small recovering population in British Columbia. Thus, the risk to this population is not from genetic erosion or inbreeding following a severe population crash, but from demographic stochasticity and extinction in small populations.     

Ecological factors drive differentiation in wolves from British Columbia

Aim Limited population structure is predicted for vagile, generalist species, such as the grey wolf (Canis lupus L.). Our aims were to study how genetic variability of grey wolves was distributed in an area comprising different habitats that lay within the potential dispersal range of an individual and to make inferences about the impact of ecology on population structure. Location British Columbia, Canada – which is characterized by a continuum of biogeoclimatic zones across which grey wolves are distributed – and adjacent areas in both Canada and Alaska, United States. Methods We obtained mitochondrial DNA control region sequences from grey wolves from across the province and integrated our genetic results with data on phenotype, behaviour and ecology (distance, habitat and prey composition). We also compared the genetic diversity and differentiation of British Columbia grey wolves with those of other North American wolf populations. Results We found strong genetic differentiation between adjacent populations of grey wolves from coastal and inland British Columbia. We show that the most likely factor explaining this differentiation is habitat discontinuity between the coastal and interior regions of British Columbia, as opposed to geographic distance or physical barriers to dispersal. We hypothesize that dispersing grey wolves select habitats similar to the one in which they were reared, and that this differentiation is maintained largely through behavioural mechanisms. Main conclusions The identification of strong genetic structure on a scale within the dispersing capabilities of an individual suggests that ecological factors are driving wolf differentiation in British Columbia. Coastal wolves are highly distinct and representative of a unique ecosystem, whereas inland British Columbia grey wolves are more similar to adjacent populations of wolves located in Alaska, Alberta and Northwest Territories. Given their unique ecological, morphological, behavioural and genetic characteristics, grey wolves of coastal British Columbia should be considered an Evolutionary Significant Unit (ESU) and, consequently, warrant special conservation status. If ecology can drive differentiation in a highly mobile generalist such as the grey wolf, ecology probably drives differentiation in many other species as well.     

Down's syndrome in British Columbia Indians

An investigation into the incidence of Down''s syndrome in British Columbia Indians disclosed that this was little different from that in the non-Indian population. The clinical features of the condition are common to both groups.     

INTRASPECIFIC VARIATION IN ABIES LASIOCARPA FROM BRITISH COLUMBIA AND WASHINGTON

Sixteen natural stands of Abies lasiocarpa (Hook.) Nutt. were sampled from British Columbia and Washington to investigate patterns of intraspecific variation in this species and to evaluate Hunt and von Rudloff's recognition of two species of subalpine fir. Principal components analysis and canonical variates analysis were performed separately on seed-cone data, needle morphology data, and needle flavonoid data. Analysis of cone data indicated no geographical patterning of populations, but eastern and western groups of populations were segregated in both the needle morphology and flavonoid analyses. With the exception of the Vancouver Island population, three geographic groups were discerned based on their needle morphology: 1) populations from the coastal mountains of British Columbia, 2) those from the Cascade Mountains of Washington, and 3) those from the eastern interior of British Columbia. Although the Vancouver Island population was grouped with the interior British Columbia populations based on needle morphology, it was similar to the other coastal populations based on flavonoid data. These inconsistent results among the three different types of taxonomic evidence underscore the need to consider a variety of traits when drawing taxonomic conclusions in Abies. Although the delineation of eastern and western groups is not wholly consistent for the different data sets, the results support recognition of coastal and interior varieties of subalpine fir.     

Accidental Deaths Among British Columbia Indians

A statistical and epidemiological review of British Columbia native Indian and non-Indian mortality revealed that accidents were the leading cause of death among Indians but ranked only fourth among non-Indians. Comparison of accidental death rates by age and sex showed that, without exception, the rates among Indians were considerably higher than the corressponding rates for non-Indians. While the Indians represented some 2% of the total population of British Columbia, they accounted for over 10% of the total accident fatalities, 29% of drownings, and 21% of fatal burns.Socioeconomic, environmental and psychosocial factors and excessive drinking are considered the chief causes responsible for this rather unusual epidemiological phenomenon.This study revealed certain hazardous conditions which are specific to the Indian''s present way of life. In the authors'' opinion the recognition of these specific hazards is imperative for the planning of effective preventive campaigns.     

Characterization of environmental sources of the human and animal pathogen Cryptococcus gattii in British Columbia, Canada, and the Pacific Northwest of the United States

Cryptococcus gattii has recently emerged as a primary pathogen of humans and wild and domesticated animals in British Columbia, particularly on Vancouver Island. C. gattii infections are typically infections of the pulmonary and/or the central nervous system, and the incidence of infection in British Columbia is currently the highest reported globally. Prior to this emergence, the environmental distribution of and the extent of colonization by C. gattii in British Columbia were unknown. We characterized the environmental sources and potential determinants of colonization in British Columbia. C. gattii was isolated from tree surfaces, soil, air, freshwater, and seawater, and no seasonal prevalence was observed. The C. gattii concentrations in air samples were significantly higher during the warm, dry summer months, although potentially infectious propagules (<3.3 microm in diameter) were present throughout the year. Positive samples were obtained from many different areas of British Columbia, and some locations were colonization "hot spots." C. gattii was generally isolated from acidic soil, and geographic differences in soil pH may influence the extent of colonization. C. gattii soil colonization also was associated with low moisture and low organic carbon contents. Most of the C. gattii isolates recovered belonged to the VGIIa genetic subtype; however, sympatric colonization by the VGIIb strain was observed at most locations. At one sampling site, VGIIa, VGIIb, VGI, and the Cryptococcus neoformans serotype AD hybrid all were coisolated. Our findings indicate extensive colonization by C. gattii within British Columbia and highlight an expansion of the ecological niche of this pathogen.     

Long distance kelp rafting impacts seaweed biogeography in the Northeast Pacific: the kelp conveyor hypothesis

Routine DNA barcoding of the Haida Gwaii seaweed flora revealed “endemic species” attributed initially to this region's past as a glacial refugium. However, subsequent barcode records from central California rapidly eroded this list leaving species characterized by disjunct distributions (DD) between California and Haida Gwaii. This observation prompted a more detailed look at species for California and British Columbia and revealed that 33 of 180 DNA‐barcoded genetic groups in common between these regions (~18%) predominantly displayed DD between California and northern British Columbia. A previous discovery that a red abalone shell found in Haida Gwaii (far north of its range) had a float‐bearing kelp (Nereocystis luetkeana) holdfast attached to it prompted a closer consideration of the COI‐5P barcode data in support of a “kelp conveyor hypothesis.” The hypothesis posits that there has been a net migration of Californian species to northern British Columbia the vector being species growing on substrata carried along with kelp rafts on the winter Davidson Current.     

The Response of Physicians to a Mailed Questionnaire: A Study in Ontario,Manitoba and British Columbia

During 1965, 1585 questionnaires were sent to physicians in British Columbia, Manitoba and Ontario to elicit information about persons who had died and in whom a chronic non-specific respiratory disease had been recorded on the registration of death. The response rate to the first letter of enquiry was 54.1%. This was improved to 76.5% when the enquiry was sent by registered mail, and to 90.6% by a registered special appeal. The final response rate was 93.8% for British Columbia, 92.8% for Manitoba and 89.5% for Ontario. Although response varied with the time of the year, there was no evident relationship between response rate and characteristics of the physician. Physician characteristics studied were place and year of graduation and the nature of practice. Acceptable and high response rates to mailed questionnaires eliciting clinical data from physicians can be obtained if the investigator''s concern is demonstrated by sending the request in successive waves to the diminishing group of non-respondents.     

Population Structure and Stock Identification of Eulachon (Thaleichthys pacificus), an Anadromous Smelt, in the Pacific Northwest

The genetic structure of eulachon (Thaleichthys pacificus) populations was examined in an analysis of variation of 14 microsatellite loci representing approximately 1900 fish from 9 sites between the Columbia River and Cook Inlet, Alaska. Significant genetic differentiation occurred among the putative populations. The mean F_ST for all loci was 0.0046, and there was a significant correlation between population genetic differentiation (F_ST) and geographic distance. Simulated mixed-stock samples comprising populations from different regions suggested that variation at microsatellite loci provided reasonably accurate estimates of stock composition for potential fishery samples. Marine sampling indicated that immature eulachons from different rivers, during the 2 to 3 years of prespawning life in offshore marine waters, do not mix thoroughly. For eulachons captured incidentally in offshore trawl fisheries, there was a clear geographic cline in relative abundance of eulachons from different geographic areas. The sample from northern British Columbia was dominated by northern and central coastal populations of British Columbia, the sample from central British Columbia was composed of eulachons from all regions, and the sample from southern British Columbia was dominated by Columbia River and Fraser River populations. These results have implications for the management of trawl fisheries and conservation of spawning populations in some rivers where abundance is at historically low levels.     

A Prospectus for Canadian Studies in Medical Education

The need for factual information on all phases of medical education is widely recognized. In the United States the Association of American Medical Colleges has initiated an extensive program of research in medical education. No comparable program exists in Canada.On the basis of studies of medical students at the University of British Columbia and the University of Saskatchewan, a prospectus for Canadian studies in medical education is suggested. Such studies might include an annual census of Canadian medical students as well as detailed studies of specific problems. Until such studies have been undertaken in Canada, only an incomplete picture of the various problems in medical education will be available.     

The importance of plankton to Cassin's auklets during breeding

The breeding chronology, food habits, growth and reproductivesuccess of Cassin's Auklets, Ptychoramphus aleuticus, were investigatedon Triangle Island, British Columbia. The breeding of Cassin'sAuklets coincides with the plankton bloom in the eastern NorthPacific. Cassin's Auklets in British Columbia feed their youngmostly large copepods, Calanus cristatus, and euphausiids, chieflyThysanoessa spinifera, but fish was an important food item inone summer. Chicks which hatched early, grew and survived betterthan late-hatched chicks and this may relate to food availability.Adults and chicks on Triangle Island were heavier than thoseon South Farallon Island, California. The heavier weight andgreater numbers of Cassin's Auklets in British Columbia as comparedwith regions to the south may relate to Calanus cristatus availabilityand abundance in northern areas.     

Characterization of Environmental Sources of the Human and Animal Pathogen Cryptococcus gattii in British Columbia, Canada, and the Pacific Northwest of the United States

Cryptococcus gattii has recently emerged as a primary pathogen of humans and wild and domesticated animals in British Columbia, particularly on Vancouver Island. C. gattii infections are typically infections of the pulmonary and/or the central nervous system, and the incidence of infection in British Columbia is currently the highest reported globally. Prior to this emergence, the environmental distribution of and the extent of colonization by C. gattii in British Columbia were unknown. We characterized the environmental sources and potential determinants of colonization in British Columbia. C. gattii was isolated from tree surfaces, soil, air, freshwater, and seawater, and no seasonal prevalence was observed. The C. gattii concentrations in air samples were significantly higher during the warm, dry summer months, although potentially infectious propagules (<3.3 μm in diameter) were present throughout the year. Positive samples were obtained from many different areas of British Columbia, and some locations were colonization “hot spots.” C. gattii was generally isolated from acidic soil, and geographic differences in soil pH may influence the extent of colonization. C. gattii soil colonization also was associated with low moisture and low organic carbon contents. Most of the C. gattii isolates recovered belonged to the VGIIa genetic subtype; however, sympatric colonization by the VGIIb strain was observed at most locations. At one sampling site, VGIIa, VGIIb, VGI, and the Cryptococcus neoformans serotype AD hybrid all were coisolated. Our findings indicate extensive colonization by C. gattii within British Columbia and highlight an expansion of the ecological niche of this pathogen.