This article investigates the manner by which a physician adapts his decision on referral to hospital and length of hospital stay to variations in the pressure (access) to hospital beds. An index of adaptation is developed which measures the adaptation to pressure from standard bed-use statistics. An example of the index is given for psychiatric bed use in Canada.
Cites: Med Care. 1973 Mar-Apr;11(2):104-204688477
Cites: Med Care. 1984 Feb;22(2):150-96700275
Cites: Health Serv Res. 1984 Aug;19(3):333-556746296
This study examined inter-beverage differences in the relationship between alcohol consumption and health status as reported by 17 249 respondents to the Canada Health Survey. Self-reported morbidity rates (bed-days, activity loss, doctor visits) were computed for consumers of beer, wine, liquor and for those with no specific beverage preference. These rates were compared with the level of expected morbidity based on each group's demographic attributes. Subsequently, dose-response relationships were described relating frequency and quantity of consumption to a standardized morbidity rate for each beverage-preference group. In general, the results supported the importance of inter-beverage differences as an intervening variable in the relationship of consumption to morbidity. Overall morbidity rates and both frequency and quantity dimensions of the dose-response relationship varied markedly as a function of type of beverage consumed. Beer drinkers, in particular, varied from other consumers they had significantly lower rates of morbidity than expected. Increases in frequency of beer drinking were associated with reductions in morbidity, but mildly deleterious effects were associated with excessive consumption.
Changes in Canadian rates of mortality from barbiturates are examined, and their relation to barbiturate use in the general population is discussed. While the number of deaths attributed to barbiturates quadrupled, from 63 in 1950 to 232 in 1963, there has been a concomitant decrease in the number of deaths from inhalation of utility gas.Combined rates for deaths from utility gas and barbiturates declined steadily for most age groups between 1950-52, 1955-57, and 1959-63. It is possible that the increased mortality from barbiturates represents a change in fashion in regard to method of suicide. Changed mortality from barbiturates is not a valid measure of the extent to which consumption of barbiturates has increased in the Canadian population.
This is the first "impact" type of economic study of psychiatric/counseling services from general practitioners. The paper analyzes a province-wide database that collates statistical data from all inpatient and outpatient psychiatric services as well as from private physicians. This paper asks whether psychiatric services from family physicians also reduce the overall costs of medical care. This research supports the general research findings that medical costs are lower after psychiatrists' care. ECT patients show a marked reduction in their medical costs. Patients with psychotherapy/counseling from family physicians did not show statistically significant reductions in overall medical costs. We need new classifications for the kinds of mental disorders seen in primary care settings.
Comment In: Gen Hosp Psychiatry. 1990 Jan;12(1):8-102295438
Recent ECT practices in Canada are reviewed from a historical perspective with respect to specific criticisms. Utilization is decreasing; utilization rates vary widely between Provinces and between regions; disproportionate numbers of females have been receiving ECT; a substantial group of patients diagnosed as neurotic and schizophrenic continue to receive ECT; criteria and guidelines for its use are not consistently applied. Expected rates of ECT used are estimated, based on theory and practice as well as on published data on the epidemiology of affective disorders. Data on actual Canadian usage are reviewed and compared with an estimated minimum ratio of 30-45+ cases per year of non bi-polar depression per 100,000 population requiring ECT. Results show that there may be a substantial number of patients in some Provinces for whom ECT is the best available treatment and who are not receiving it. There is some ethical concern associated with possible under-use of ECT as the best therapy available for certain patient groups. Clinical cases and patterns of care should be reviewed at the hospital level to determine how best to effect improvements in the use of this treatment.
Much more understanding is needed of the epidemiology of narcotic-related problems. This paper describes a research strategy which is responsive to the heterogeneous nature of such problems. It is suggested that it is feasible and useful to establish, for defined geographic areas, epidemiologic field units which would have continuity, be comprehensive and develop programmatically relevant information on a timely basis. The possible areas of inquiry and the components of such a unit are discussed.
As a response to the challenge posed by an increasing number of agitated and violent patients, there is in Canada a growing number of psychiatric intensive care units (PICUs), in both general and psychiatric hospital settings. In this article, the functioning of such a unit in a general hospital context is reviewed. Statistically significant changes in average length of stay (LOS) were observed, with an increase from 5.8 to 7.3 days over the period studied. The factors influencing the functioning and LOS of this PICU are analyzed. A possible "deskilling" of the staff in other wards is discussed, and alternative explanations are hypothesized in an attempt to shed light on the interaction between this unit and its environment.
This paper is based on a comparative, psychologically informed ethnographic study of maternal goals and infant care during the first year of life for 20 mothers and infants in each of three Western settings: Stockholm, Sweden, outside Rome, Italy, and suburban Boston, in the United States. Two research questions were posed to consider cultural ideas and ideals about mothering; How was the 'good mother' defined? How did sample women themselves, mother? Research hypotheses were that definitions of a good mother would be culture-specific with minimal within-culture variance. Furthermore, the frequency of maternal behaviors would also exhibit culture specific patterns. Research methods included event based behavioral observations of infant-caregiver interactions in the home, daily routine questionnaires, maternal attitude interviews, and ethnographic observations of community and family life. Research hypothesis were confirmed. Results revealed culture-specific variation in conceptions of the 'good mother'. Cultural differences were reflected in the short- and long-term goals which the sample women described for their children. Patterns of infant care, in turn, were consistent with the cultural values expressed, as well as the cultural norms of social interaction.