Contextualizing ethics: ventilators, H1N1 and marginalized populations.

If the H1N1 pandemic worsens, there may not be enough ventilated beds to care for all persons with respiratory failure. To date, researchers who explicitly discuss the ethics of intensive care unit admission and the allocation of ventilators during an influenza pandemic have based criteria predominantly on the principles of utility and efficiency, that is, promoting actions that maximize the greatest good for the greatest number of people. However, haphazardly applying utility and efficiency potentially disadvantages marginalized populations who might be at increased risk of severe reactions to H1N1.

Public perceptions of quarantine: community-based telephone survey following an infectious disease outbreak.

Background: The use of restrictive measures such as quarantine draws into sharp relief the dynamic interplay between the individual rights of the citizen on the one hand and the collective rights of the community on the other. Concerns regarding infectious disease outbreaks (SARS, pandemic influenza) have intensified the need to understand public perceptions of quarantine and other social distancing measures.

Methods: We conducted a telephone survey of the general population in the Greater Toronto Area in Ontario, Canada.

Trends in health services utilization, medication use, and health conditions among older adults: a 2-year retrospective chart review in a primary care practice.

Background: Population aging poses significant challenges to primary care providers and healthcare policy makers. Primary care reform can alleviate the pressures, but these initiatives require clinical benchmarks and evidence regarding utilization patterns. The objectives of this study is to measure older patients' use of health services, number of health conditions, and use of medications at the level of a primary care practice, and to investigate age- and gender-related utilization trends.

Research ethics review in humanitarian contexts: the experience of the independent ethics review board of Médecins Sans Frontières.

Doris Schopper and colleagues describe the functioning of the Médecins Sans Frontières independent ethics review board and the framework used for ethics review, and discuss challenging ethical issues encountered by the board since its inception.

The effect of universal influenza immunization on antibiotic prescriptions: an ecological study.

The Canadian province of Ontario introduced universal influenza immunization in 2000, offering free vaccines to the entire population. We compared changes in rates of influenza-associated respiratory antibiotic prescriptions before and after universal immunization in Ontario with corresponding changes in other provinces. Universal influenza immunization is associated with reduced influenza-associated antibiotic prescriptions.

Ethics of conducting research in conflict settings.

Humanitarian agencies are increasingly engaged in research in conflict and post-conflict settings. This is justified by the need to improve the quality of assistance provided in these settings and to collect evidence of the highest standard to inform advocacy and policy change. The instability of conflict-affected areas, and the heightened vulnerability of populations caught in conflict, calls for careful consideration of the research methods employed, the levels of evidence sought, and ethical requirements.

Primary care physicians' attitudes towards cognitive screening: findings from a national postal survey.

Objective: The objectives of this paper are: (a) to determine Canadian family physicians' attitudes towards cognitive screening, (b) to identify what cognitive screening tools are being used, (c) to investigate how they rate these tools' effectiveness and (d) to identify the attributes of an ideal cognitive screening tool for the primary care setting.

Method: Postal survey questionnaire of a random sample of 249 practicing members of the College of Family Physicians of Canada.

Results: Response rate was 52%.

Making the grade: assuring trustworthiness in evidence.

Despite evidence-based medicine's (EBM's) significant evolution and maturation from its revolutionary origins to its current form as the preeminent means of practicing medicine, there are still good reasons to be unsatisfied with EBM. This essay explores two important new developments in EBM: recently articulated accounts of the scientific basis of EBM, and the related writings of the GRADE Working Group to create standards for interpretation of the medical literature and evaluation of recommendations. A review of Karanicolas, Kunz, and Guyatt's (2008) three-step articulation of EBM's scientific basis demonstrates that the supposed soundness of each principle is not attributable to its scientific status; instead, the normative language of each principle highlights EBM's grounding in an only partially articulated philosophical framework.

Global health ethics for students.

As a result of increased interest in global health, more and more medical students and trainees from the 'developed world' are working and studying in the 'developing world'. However, while opportunities to do this important work increase, there has been insufficient development of ethical guidelines for students. It is often assumed that ethics training in developed world situations is applicable to health experiences globally.

Priority setting: what constitutes success? A conceptual framework for successful priority setting.

Background: The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean.

Determining use of preventive health care in Ontario: comparison of rates of 3 maneuvers in administrative and survey data.

Objective: To examine rates of influenza vaccination, mammography, and Papanicolaou smear by comparing data obtained from the Ontario Health Insurance Plan administrative database with rates as self-reported in the Canadian Community Health Survey.

Design: Retrospective cohort study using data from Statistics Canada's 2000-2001 Canadian Community Health Survey and from the Ontario Health Insurance Plan administrative database for the same period.

Setting: Ontario.

Health care service utilization among the elderly: findings from the Study to Understand the Chronic Condition Experience of the Elderly and the Disabled (SUCCEED project).

Rationale And Objectives: Age-related effects on health service utilization are not well understood. Most previous studies have examined only a single specific health care service or disease condition or have focused exclusively on economic variables. We aim to measure age-related change in health care utilization among the elderly.

The effect of universal influenza immunization on mortality and health care use.

Background: In 2000, Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free influenza vaccines for the entire population aged 6 mo or older. Influenza immunization increased more rapidly in younger age groups in Ontario compared to other Canadian provinces, which all maintained targeted immunization programs. We evaluated the effect of Ontario's UIIP on influenza-associated mortality, hospitalizations, emergency department (ED) use, and visits to doctors' offices.

Dual loyalty of physicians in the military and in civilian life.

The concept of the dual loyalty physicians may have to both a patient and a third party is important in elucidating the obligations of physicians. The extent to which loyalty may be deflected from a patient to a third party (e.g.

Utilization patterns of diagnostic imaging across the late life course: a population-based study in Ontario, Canada.

Objectives: Due to the aging baby boom population, utilization rates of diagnostic imaging (i.e., X-ray, CT, and MRI scanning) have risen rapidly relative to other health services.

The ethics of mandatory vaccination against influenza for health care workers.

Vaccination of health care workers (HCW) in long-term care results in indirect protection of patients who are at high-risk for influenza. The voluntary uptake of influenza vaccination among HCW is generally low. We argue that institutions caring for frail elderly have the responsibility to implement voluntary programmes for vaccination against influenza of HCW.

Spatio-temporal analysis of pneumonia and influenza hospitalizations in Ontario, Canada.

Pneumonia and influenza represent a significant public health and health care system burden that is expected to increase with the aging of developed nations' populations. The burden of these illnesses is far from uniform however, with recent studies showing that they are both highly spatially and temporally variable. We have combined spatial and time-series analysis techniques to examine pneumonia and influenza hospitalizations in the province of Ontario, Canada, to determine how temporal patterns vary over space, and how spatial patterns of hospitalizations vary over time.