A Tissue Digestion Protocol for Measuring Sarcoptes scabiei (Astigmata: Sarcoptidae) Density in Skin Biopsies

Sarcoptic mange is a parasitic skin disease caused by the burrowing mite Sarcoptes scabiei that affects a diversity of mammals, including humans, worldwide. In North America, the most commonly affected wildlife includes wild canids, such as coyotes and red foxes, and more recently American black bears in the Mid-Atlantic and Northeast United States. Currently, surveillance for sarcoptic mange in wildlife is syndromic, relying on detection of clinical signs and lesions, such as alopecia and crusting of skin. When possible, skin scrapes are used to identify the causative mite. While skin scrapes are a valuable diagnostic tool to identify mites, this approach has significant limitations when used for quantification of mite burden. To further investigate mite burden in cases of sarcoptic mange, 6-mm punch biopsies were collected from affected skin of red foxes (Vulpes vulpes Linnaeus [Carnivora: Canidae]), a species historically affected by sarcoptic mange, frequently with high mite burdens and severe skin disease, and validated on skin tissue from mange-affected American black bears (Ursus americanus Pallas [Carnivora: Ursidae]) and coyotes (Canis latrans Say [Carnivora: Canidae]). Biopsies were digested by incubating the tissue in potassium hydroxide (KOH) at 55°C. The greatest tissue clearance and lowest mite degradation resulted after 12 h of tissue digestion. The purpose of this manuscript is to describe a methodology for host tissue digestion and mite quantification in cases of sarcoptic mange. This method will provide a valuable surveillance and research tool to better understand sarcoptic mange in wild and domestic animals, with applications to a diversity of other ectoparasitic diseases.

RELATIVE DISSOLUTION RATES OF RADIOACTIVE MATERIALS USED AT AWE

A simple in vitro dissolution test was used to provide a semi-quantitative comparison of the relative dissolution rates of samples of radioactive materials used at Atomic Weapons Establishment in a lung fluid surrogate (Ringer's solution). A wide range of dissolution rates were observed for aged legacy actinides, freshly produced actinide alloys and actinides from waste management operations.

A review of patient-centred post-fracture interventions in the context of theories of health behaviour change

The purpose of this literature review is to determine whether and to what extent current post-fracture osteoporosis interventions utilize theories of health behaviour change and whether those that are theory-based are more successful in producing desired behaviour changes. Studies were identified by applying additional criteria to the final selection stage of a systematic review of non-surgical osteoporosis interventions in the orthopaedic environment. We identified 42 primary studies targeted at patients and improving post-fracture osteoporosis care. As well as describing the studies (in terms of design, population, interventions, outcomes), we focused on theoretical framework and elements of behaviour change models. The 42 studies included in this review utilized a variety of post-fracture interventions; however, none of them reported using an underlying theoretical base. Only three studies drew on what we felt to be elements of a theoretical framework. The lack of theoretically based studies points to a currently under-utilized area of behaviour change research that could be applied to post-fracture interventions in order to make them more effective. Despite an abundance of literature supporting theories of behaviour change, post-fracture osteoporosis interventions do not report utilizing these theories. Theories of behaviour change could be applied to post-fracture osteoporosis interventions to explain why patients initiate osteoporosis management. Future research should explore the application of theories of health behaviour change to post-fracture interventions.

Improving health and social care relationships for harm reduction

This paper explores elements of the relationships that develop between people who use illicit drugs and people who provide services to them. It focuses on expectations people who use drugs and service providers have of health and social care relationships for harm reduction, as well as facilitators and barriers to effective and ineffective interactions, and to what governments might better do to help strengthen interactions. Prior to Canada's inaugural national harm reduction conference, informal discussion groups were organized to source local views regarding policy reform for harm reduction. One component of these discussion groups focused upon improving health and social care relationships for harm reduction. Community-based organizations providing services for harm minimisation were consulted to help develop themes and questions. Discussion groups conducted in French or English were held in 10 cities across Canada. Groups were audio-recorded, transcribed and thematically analysed. Disjuncture between understandings of the nature of health and social care relationships for harm reduction were found. Interpersonal and structural factors functioned both for and against the development of effective interactions. Differences in expectation sets held by illicit drug users and service providers may reflect the fluid experience of boundaries as a population on society's margins moves between harm-causing and harm-reducing behaviours and identities. The research described in this paper targeted those most directly involved in receiving, developing and delivering harm reduction programmes across a very diverse nation. It did so by including representatives of those most directly involved in utilizing and providing services within the research process itself. By incorporating a process that was community-based, user-driven, and which strived to be non-judgmental, the research was able to explore suggestions for improving health and social care relationships for harm reduction proffered by professionals actively providing services, as well as a variety of users, including some isolated or structurally excluded from service access by geography, illiteracy and/or street-involvement.

UK laboratory intercomparison on internal dosimetry

A laboratory intercomparison for internal dose assessment from a variety of intake scenarios is described. This is the first UK intercomparison using the revised ICRP Human Respiratory Tract and biokinetic models. Four United Kingdom laboratories participated and six cases were assessed. Overall, the agreement in internal dose assessments between laboratories was considered satisfactory with 79% of the assessed committed effective doses, e(50), for cases within a band of +/- 40% of the median value. The range (highest/lowest) in e(50) estimated by the laboratories was smallest (1.2) for a case involving inhalation of 137Cs. The range was greatest (6.0) for a case involving a wound with, and possible inhalation of, 238Pu, 239Pu and 241Am; the variation between laboratories in assessment of intakes could not be considered to be satisfactory in this case. Judgements on the most appropriate data to use in estimating intakes, choice of parameter values for use with the ICRP models and allowing for the effects of treatment with DTPA were important sources of variability between laboratories.

Factors of the innovation, organization, environment, and individual that predict the influence five systematic reviews had on public health decisions

OBJECTIVE

To determine the extent to which systematic reviews of public health interventions influenced public health decisions and which factors were associated with influencing these decisions.

METHODS

This cross-sectional follow-up survey evaluated the use of five systematic reviews in public health decision making. Independent variables included characteristics of the innovation, organization, environment, and individual. Primary data were collected using a telephone survey and a self-administered organizational demographics questionnaire. Public health decision makers in all 41 public health units in Ontario were invited to participate in the study. Multiple linear regression analyses on the five program decisions were conducted.

RESULTS

The systematic reviews were perceived as having the greatest amount of influence on decisions related to program justification and program planning, and the least influence on program evaluation decisions. The greater the perception that one's organization valued the use of research evidence for decision making and that ongoing training in the critical appraisal of research literature was provided, the greater the perception of the influence the systematic review had on public health decisions.

CONCLUSIONS

Organizational characteristics are important predictors of the use of systematic reviews in public health decision making. Future dissemination strategies need to promote the value of using systematic reviews for program decision making as well as promote ongoing training in critical appraisal among intended users in Ontario.

Women and men managers in pharmacy: gender issues

This paper examines the backgrounds, behaviours, and attitudes of a representative sample of male and female pharmacy managers in Ontario, Canada. It shows that the female managers are younger than their male colleagues, and spend significantly more time on childcare activities. There were no differences between the male and female managers in terms of work commitment and job responsibilities, but the female managers spent more time in direct patient contact, an activity that the qualitative analysis indicated was important to them. Female managers were also more supportive of strategies that would encourage additional patient counseling. For faculty in health administration programs, the results suggest that the importance that females place on the psycho-social aspects of their jobs as managers needs to be recognized and supported in the development and delivery of courses of study.

Factors affecting the utilization of systematic reviews. A study of public health decision makers

OBJECTIVE

To determine the extent to which public health decision makers used five systematic reviews to make policy decisions, and to determine which characteristics predict their use.

METHODS

This cross-sectional follow-up study of public health decision makers in Ontario collected primary data using a telephone survey and a short, self-administered organizational demographics questionnaire completed by the administrative assistant for each Medical Officer of Health. Independent variables included characteristics of the innovation, organization, environment, and individual. Data were entered into a computerized database developed specifically for this study, and multiple logistic regression analysis was conducted.

RESULTS

The participation rate was very high, with 85% of public health units and 96% of available decision makers completing the survey. In addition, 63% of respondents stated they had used at least one of the systematic reviews in the previous 2 years to make a decision. The most important predictors of use were one's position, expecting to use a review in the future, and perceptions that the reviews were easy to use and that they overcame the barrier of limited critical appraisal skills.

CONCLUSIONS

Utilization of the systematic reviews in Ontario was very high. The utilization rates found in this study were significantly higher than those reported in previous utilization studies. One's position was found to be the strongest predictor of use, identifying program managers and directors as the most appropriate audience for systematic reviews.

The role of policy in community pharmacies' response to injection-drug use: results of a nationwide Canadian survey

The response rate to this survey reflects the salience of the topic and the professional concern about and interest in issues presented by HIV. The HIV/AIDS epidemic has presented pharmacists with one of the greatest challenges to their professional training, ethics, and practice. It further expedites a current re-examination that is occurring among community pharmacies concerning their roles in community health practices. In response to HIV there have been dramatic and unprecedented changes in pharmacy policy and practices. Clearly, some community pharmacies have led the way and influenced policy and practices. In view of the recent introduction of many of these policies and practices, it is likely that change will continue. Survey respondents were, in general, very comfortable with an expanded role involving counseling, health promotion, and disease prevention, consistent with a broader role for community pharmacies in general that has been recently advocated. Community pharmacies serve all areas of the country, in communities large and small; many are open seven days a week, and some provide extended hours of service. Community pharmacies may provide an important complement to community outreach programs as a source of clean needles and syringes for IDUs in most communities, and as an alternative service in some communities where more elaborate programs are not feasible. Safer needle use, as part of a health-promotion approach, is divergent from conventional practice. While major changes have occurred, it appears that there has been some polarization of attitudes and response. The explanation for this is not simple, and further analysis is required to determine the full impact from several ethical perspectives that include professional, business, and public health viewpoints. We have highlighted the role that policy has in moving toward preventive and harm-reduction approaches. From a policy perspective, we have found that support from the federal government, regulatory bodies, and professional associations may be an important catalyst to pharmacists' participation in programs. Further, it does not appear to be possible to implement such policies without professional development and continuing education, and collaboration with the community. Based on data on knowledge and educational need, we believe that our study population's lowest levels of information were in such areas as the role of methadone in HIV prevention and the availability of needle-exchange programs. As with other health-promotion campaigns, additional skills training may be important. Movement forward with expanded preventive and harm-reduction strategies by pharmacies will require careful planning. It is anticipated that change in this area will be incremental in nature, and that it is necessary to introduce programs and services into community pharmacies gradually. Successful implementation will require extensive community development and collaboration with other health professionals, public health officials, police, groups who represent IDUs, and persons living with HIV/AIDS. Careful monitoring and evaluation of these programs will be necessary to enhance their effectiveness.

The reliability and validity of two health status measures for evaluating outcomes of home care nursing

The reliability, validity, and sensitivity of the Medical Outcome Study Short Form (SF-36) and the Quality of Life Profile: Senior Version (QOLPSV) for measuring outcomes of home care nursing were evaluated. Data were collected from 50 clients receiving home care nursing services. Twenty-two registered nurses and six registered practical nurses collected client and nursing data on each home visit. Client baseline and outcome measures were collected by two independent evaluators at admission and discharge from the home care service. Internal consistency reliability ranged from.76 to.94 for the eight subscales of the SF-36. Internal consistency reliability ranged from.47 to.82 for the nine subscales of the QOLPSV. The subscales of both instruments had minimal problems with missing responses. The SF-36 was found to be more sensitive than the QOLPSV to change over time. In addition, the subscales of the SF-36 were found to be more sensitive than the subscales of the QOLPSV to several of the nursing variables, such as intensity of the client's nursing condition and skill mix.

Adoption of a managerial innovation: a study of physician impact analysis

This article examines the adoption of physician impact analysis (PIA) among active treatment hospitals in Ontario, Canada. The influence of variables from three different levels of analysis (individual, organizational and contextual) were included as well as measures of key stakeholders' (Chief Executive Officer (CEO) and Medical Chief of Staff) assessments of the attributes of the innovation. A number of conclusions were drawn. First, by adding information about the perceived attributes of the innovation the model was able to account for a larger percentage of explained variance than has been seen in related work. Secondly, the adoption of PIA within a context of written guidelines agreed to by senior management, specifying process and structure concerns, is most likely in organizations which are large and where the CEO positively evaluates the innovation.

Determining Ontario's supply and requirements for ophthalmologists in 2000 and 2005: 2. A comparison of projected supply and requirements

BACKGROUND

To determine whether the projected supply of ophthalmologists in 2000 and 2005 in Ontario will be matched by the predicted requirements.

METHODS

Described in the accompanying paper (page 74).

RESULTS

Multiple regression analysis predicted a supply of 485 +/- 15 full-time-equivalent (FTE) ophthalmologists in 2000 and 476 +/- 14 FTEs in 2005. Except for the needs-based method of determining requirements, which generated a figure of 524 +/- 16 to 533 +/- 16 FTEs, the requirement methods yielded estimates that were within the range of the projected supply for 2000 (physician:population ratio method 458, utilization-based method 500 +/- 15 and substitution method 470 +/- 14 to 490 +/- 15). For 2005, only the physician:population ratio method gave an FTE requirement estimate (489) that was in keeping with the projected supply. The other models gave FTE estimates that were higher than the projected supply (utilization-based model 559 +/- 17, substitution model 526 +/- 16 to 548 +/- 16, and needs-based model 585 +/- 18 to 596 +/- 18).

INTERPRETATION

The reduction in the number of ophthalmology residents in Ontario that began in 1994 will not affect the short-term requirements for ophthalmologists but may result in fewer ophthalmologists than will be necessary to fulfil Ontario's requirements in 2005 and beyond. Possible solutions include doubling the number of residency positions beginning in 1999.

Determining Ontario's supply and requirements for ophthalmologists in 2000 and 2005: 1. Methods

BACKGROUND

We performed a study to determine the supply of and requirements for ophthalmologists in Ontario in 2000 and 2005. In this paper we describe our methods.

METHODS

The future supply of ophthalmologists was estimated by means of iterative multiple regression analysis using the baseline number of ophthalmologists, the number of ophthalmology residents and the numbers of ophthalmologists entering and exiting the workforce between 1989 and 2004. Data were obtained from the Ontario Physician Human Resource Data Centre, Statistics Canada, the Ontario Ministry of Finance and residency program directors of Ontario universities. We calculated requirements using four models. The physician:population ratio method used an ophthalmologist:population ratio (1:29,650) proposed by the Royal College of Physicians and Surgeons of Canada and Statistics Canada population projections for 2000 and 2005. The utilization-based, substitution and needs-based models used Ontario Health Insurance Plan data for 1995. The supply and requirements are expressed as full-time equivalents, defined as the average number of minutes worked by ophthalmologists in 1995. The 401 ophthalmologists practising in Ontario in 1995 accounted for 452 full-time equivalents.

INTERPRETATION

Incorporating the results of several requirement models increases the reliability and acceptability of estimates of physician workforce requirements.

Physician characteristics and the physician-patient relationship. Impact of sex, year of graduation, and specialty

OBJECTIVE

To examine the association of physician sex, medical specialty, and year of graduation from medical school with attitudes and behaviours that define physician-patient relationships. Hypotheses tested are that women physicians, family physicians, and recent graduates spend more time discussing lifestyle and general health issues during patients' first visits; are more likely to report behaviours that are empathetic and that encourage communication with patients; are less likely to view their role as directive and problem-oriented; and are more supportive of patients' rights to information and participation in decision making.

DESIGN

A survey was mailed to a stratified random sample of physicians between February and June 1996.

SETTING

Physician practices in Ontario.

PARTICIPANTS

Of 714 practising Ontario physicians, 405 (57%) responded.

MAIN OUTCOME MEASURES

Proportion of time and actual time spent discussing a patient's lifestyle during a first visit, communication style, attitudes regarding a directive approach to care, and attitudes regarding patients' rights.

RESULTS

Women physicians and family physicians spent significantly more time discussing lifestyle during a first visit. Women, family physicians, and recent graduates were significantly more likely to report an empathetic communication style. Women and recent graduates were significantly less likely to have a directive, problem-oriented approach to care. Family physicians were significantly less supportive of patients' rights than medical and surgical specialists were.

CONCLUSIONS

Physicians in this study reported empathetic communication styles and attitudes that support information sharing and patients' rights.

Gender and income in pharmacy: human capital and gender stratification theories revisited

This is a case study of gender and earnings in pharmacy--a profession characterized by its rapid recruitment of female practitioners. We try to account for disparities in earnings between male and female pharmacists in Ontario with the aid of human capital theory and gender stratification theory. Data is drawn from a random sample of 463 Ontario pharmacists. We find a consistent sex gap in earnings regardless of occupational level of practitioners (i.e. owner, manager or employee) and net of such factors as hours worked, commitment to work, hours devoted to childcare, absences from the labour market, and years since graduation. Instead, the main reason why women in pharmacy earn less than males is because they remain employees throughout their careers. However, we are less successful at identifying the additional factors responsible for the depressed earnings of female practitioners. We discuss our findings in light of the claims of gender stratification and human capital theory.

Community pharmacist perspectives on HIV/AIDS and interventions for injection drug users in Canada

In several countries, community pharmacies play a major role in the provision of HIV prevention services to injection drug users (IDUs). In this study, results from a national Canadian Survey of Community Pharmacies and HIV/AIDS Prevention are used to describe pharmacists' perspectives on HIV/AIDS and services to IDUs, and explore the relationship between personal and organizational characteristics and the level of support for HIV/AIDS prevention initiatives. A mailed questionnaire was directed to a random sample of 2,017 pharmacist owner-managers. The response rate was 84.6%. Results suggest that current services to IDUs primarily are limited to discretionary needle and syringe sales to non-diabetics, with almost three-quarters supportive. Staff safety was an important consideration in the provision of this service (77%), while remuneration was the lowest (27%). Community pharmacists were most comfortable with the provision of counselling, advice and literature (X = 2.6) and environmental and technological interventions (X = 2.4) and least supportive of provision of services as part of a programme (X = 1.6) and legalization of drugs or prescription of methadone (X = 1.9). Female pharmacists were more likely to support preventive measures such as the provision of counselling or advice, and males were more likely to promote legislative change. Pharmacists appear generally willing to expand their services in the fight against HIV/AIDS. However, it is not feasible to expect uniform programmes to be immediately introduced. While organizational, educational and policy changes may facilitate programme development, individual pharmacy and pharmacist discretion remains important.

Condom use among Aboriginal people in Ontario, Canada

A survey of 658 Aboriginal men and women living in 11 reserve communities in Ontario, Canada, was utilized to collect data on patterns of condom use. Individuals who had sexual intercourse in the previous 12 months were included in the analysis (n=400). Descriptive statistics and multiple logistic regression were used to analyse condom use in the previous 12 months. Eight per cent always, 31% sometimes, and 61% never used condoms. Rates of condom use differed with the number of sex partners in the last year, age, gender, having a steady sex partner, and marital status. Multiple logistic regression revealed that people most likely to use condoms were under the age of 30, male, did not have a long-term steady sex partner, had more than one sex partner, worried about pregnancy, were knowledgeable about HIV/AIDS, and were not embarrassed to obtain condoms. Condom users who were knowledgeable about HIV/AIDS and who knew someone with HIV/AIDS were more likely to always use condoms. The most common reason for not using a condom was 'I was with my steady sex partner'. These results have implications for STD prevention efforts and for future research of sexual and STD preventive behaviour among Aboriginal people.

Innovation theory and its applicability to our understanding of the diffusion of new management practices in health care organizations

There has been a longstanding interest in understanding how new management practices and organizational structures are diffused through the health care system. This article reviews current literature on innovation and diffusion to provide insight into how new management practices and organizational structures are introduced into the system. Understanding the process may help in accommodating new developments and provide managerial opportunities to take a more active role in encouraging or discouraging their further evolution.

Differences in sexual risk-taking behavior with state of inebriation in an aboriginal population in Ontario, Canada

OBJECTIVE

This article describes the self-reported use of substances, participation in unprotected intercourse and differences in sexual risk-taking behavior with state of inebriation among a group of aboriginal (First Nations) people in Ontario. And, in so doing, attempts to answer some of the questions about the association between the use of alcohol and sexual risk taking in this population.

METHOD

The project was developed in a partnership between an aboriginal steering committee and university researchers. Data were collected via interview from 658 randomly selected status First Nations people living within 11 reserve communities in the province.

RESULTS

Of the 426 individuals included in the within subject analysis 9.6% reported variation in their participation in sex, 13.8% variation in their participation in intercourse and 10.3% variation in their participation in unprotected intercourse with inebriation. An examination of individual behavior across "sober" and "drunk or high" states showed that there were almost equal proportions of respondents who only participated in unsafe sex when sober and respondents who only participated in unsafe sex when drunk or high. Where significant differences occurred, individuals were more likely to report a shift towards no sex or no intercourse with inebriation, not towards unprotected intercourse.

CONCLUSIONS

Since a large proportion of individuals in this study engage in unprotected intercourse, the small proportion of individuals reporting different sexual behavior were more likely to report participation in a safe activity rather than an unsafe activity while "drunk or high." Stereotypes and assumptions may lead educators and researchers to feel the need to focus their messages on the relationship between drug and alcohol consumption and unsafe sex; however, the amount of unsafe sexual intercourse that occurs only while individuals are inebriated suggests that this focus is not of principal concern.

Physician impact analysis predictions in Ontario hospitals: does the emperor have clothes?

Physician impact analysis (PIA) is a human resource planning tool used to predict the impact on hospital resources of adding a new or replacement physician to a hospital's medical staff. This article describes the findings of a study which examined the extent to which PIAs are used in Ontario acute care hospitals and the accuracy of PIA predictions. The results suggest that although PIA appears to be widely used, there is no evidence that it meets the intended policy objective of accurately predicting physician hospital resource use.

Interest among occupational therapy managers in measuring workload for case costing

OBJECTIVES

Interest in costing health care delivery on an individual case basis has increased in recent years as concern with overall health care costs has heightened. Costing exercises have been largely oriented around medical classification systems. Measures to incorporate the contributions of allied health activities such as occupational therapy are relatively recent. The objective of this study was to examine the attitudes and opinions of senior occupational therapy managers toward workload measurement on the basis of case mix.

METHOD

A survey was sent to all 198 senior occupational therapy managers in accredited Canadian facilities, which was completed by 182 respondents for a response rate of 92%. The questionnaire asked about workload measurement system(s) currently used, satisfaction with the system(s), and needs and expectations of workload systems in general.

RESULTS

The majority of respondents were using a time recording workload measurement system and expressed relatively low levels of satisfaction with it. Current systems were unable to provide costing data, which respondents ranked as very important for themselves as managers. The majority of respondents believed that it would be useful or very useful to be able to cost occupational therapy services by a diagnostic grouping system and to establish standard protocols per diagnosis, standard times per procedure per institution, and standard times per procedure for the profession.

CONCLUSION

There is support for developing or expanding current methods of measuring workload. Senior occupational therapy managers would like to be able to predict their workload prospectively, a step that will accommodate the move toward case costing and program management.

Responding to workload measurement needs

Workload measurement is a way of capturing and recording the time and/or activities of personnel in the performance of their health care duties. The traditional focus of workload systems in occupational therapy has been on resource allocation, activity tracking and long range planning. The systems are not organized to link with other institutional, financial and management tools to identify and cost client and programme resource use. The position taken in this paper is that occupational therapy workload measurement systems must be expanded to meet these new managerial responsibilities. Occupational therapists must be able to prospectively predict their workload to accommodate the move towards case costing and programme management. The paper also provides information from a national survey which indicates that there is support from the field for this position.

Measuring nursing workload for case costing

It is important for nurse executives to understand the consequences of different methods of measuring nursing costs in determining total patient care costs. Nursing is the largest component of a case cost and the study reported in this article examined the impact of using different nursing workload measurement systems in developing case costs and how they relate to nurse executives. The considerable consequences of these findings for case costing are discussed.

Surviving the management game: workload measurement systems in a cost-conscious environment

Using a procedure-based occupational therapy workload measurement system developed at, and applied by, Sunnybrook Health Science Centre, this paper explores the objectives of such a system from the point of view of the occupational therapy manager. It also takes into account the synergistic relationship between the occupational therapist and the administrative/business aspect of health care, paying special attention to past and present trends in health-care accountability. In this paper it is argued that occupational therapy managers must relate their procedures and overhead costs to actual client care, if they are to be included in programme management and client costing. The process used by occupational therapy to describe its own procedures for the system is outlined. The system was then developed in conjunction with other institutional, financial and management tools for the client cost conversion process. By using a procedure based workload measurement system, occupational therapy is able to accurately describe client costing, thereby articulating our role in client care.

A survey of workload measurement systems: the occupational therapy manager's perspective

Interest in measuring workload for budget specific purposes has increased in recent years as health care managers are being forced to cope with the demands of cost containment and fiscal accountability. This paper reports on a survey of senior occupational therapy managers of Ontario facilities accredited by the Canadian Association of Occupational Therapists (CAOT). Respondents were surveyed on their experiences with, and attitudes toward, occupational therapy workload measurement systems and the ability of these systems to assist in management activities. The survey found that most departments were using the National Hospital Productivity Improvement Program (NHPIP) system. Seventy eight percent of managers indicated they were somewhat or very satisfied with the system, but 60% also indicated that it did not adequately meet all of their management needs. In terms of desirable features of a revised workload system, 87% of managers reported wanting a system based on diagnostic or case mix group recording. Client variables (91%), physical and psychosocial aspects of client care (89%) and therapist variables (85%) were also rated as important factors to address in developing new workload systems.

Different systems, different costs? An examination of the comparability of workload measurement systems

This study examines the equivalence of the hours of care estimates of four patient classification/workload measurement systems. Although the hours of care estimates of the systems were similar, differences between the estimates could be as great as 4.53 hours per day for the same patient. The researchers developed relational statements that made hours of care estimates equivalent for all systems studied. System differences can have a profound impact on nursing unit and department budgets, if not adjusted.

Regulation and hospital strategic planning in Canada

Constraints on resources push hospitals into strategic planning. Although this process is accelerating in the United States, Canadian hospitals need to approach planning according to the provincial structure. This study included a literature and policy review as well as interviews of key stakeholders. Decisions toward centralized planning versus hospital-initiated development were found to depend on the availability of planning and policy staff, and the views of the elected representatives. Implications for Canadian health care planners were offered.

Risk factors by onset age in multiple sclerosis

Some investigators have suggested that there are different forms of multiple sclerosis (MS) based on onset age, and that each has a different etiology. 173 Canadian MS patients were matched to controls on age, gender, race and risk zone prior to age 15. Data were collected on: age at onset, gender, initial symptom, disability level, residence history and family background. Three onset age subgroups (early, intermediate and late) were derived. Matched-pair logistic regression analysis indicated that rural residence, use of well water and an MS family history distinguished between patients and controls overall, but showed no significant interaction with onset age. A family history of diabetes distinguished between patients and controls with evidence of age interaction, in that this risk factor decreased in importance as onset age increased.

Emotional stress and coping in multiple sclerosis (MS) exacerbations

Ninety-five pairs of MS patients in exacerbation and remission were compared on emotional stress in the previous three months. Patients in exacerbation scored higher on emotional disturbance and intensity of stressful events than patients in remission, but lower on frequency of compensating uplifts. There was also a tendency for more patients in exacerbation than remission to favour emotion-focused coping techniques over problem-solving or social support. Whether patients building to an exacerbation over-react to various events or unresolved emotional stress precipitates exacerbations, MS patients might benefit from counselling in stress reduction techniques.