Is the canadian health care system suffering from abuse? A commentary.

The authors suggest that more attention must be paid to acting on information about the effectiveness of diagnostic and therapeutic procedures, their cost-effectiveness, and their net benefit to Canadians. Canadian health professionals and policy-makers must translate information on ineffective procedures, poor use of effective procedures, and the relative cost of services delivered in different settings by different personnel into changes in use levels and patterns. Another challenge, which involves the general public as well, is to achieve an informed social consensus about the level of health care spending and its distribution across types of services.

Career interruptions and hours practiced: comparison between young men and women physicians.

This study compares current level of workforce participation and number, type and length of career interruptions since entering medical school reported by young men and women physicians. By 10 years from medical school entry, one third of the women studied had taken a maternity/child care leave and 24% had taken time away from their careers for other reasons while only 11% of men had interrupted their careers. The average time taken and reasons given for non-maternity-related career interruption were similar for men and women.

Medical-legal concerns among Canadian anaesthetists.

This paper reports the results of a national survey of anaesthetists which was undertaken to determine the effect of liability concerns on the practice of anaesthesia. Four hundred seventy-six anaesthetists from four regions (East, Quebec, Ontario and the West) (overall usable response rate of 73.3 per cent) responded to a series of questions on sources of liability information, changes in practice patterns over the past five years, changes in style of practice and attitudes towards the physician-patient relationship and to medical-legal concerns.

Charting the winds of change: evaluating innovative medical curricula.

The increased interest, in North America and around the world, in problem-based and community-oriented medical curricula has sparked interest in the evaluation of these innovative programs. In January 1989, the Josiah Macy Jr. Foundation sponsored a conference to consider designs for evaluation studies and the potential distinctive outcomes of the innovative curricula that might be foci of these studies.

Viral and toxoplasma gondii infections in children after liver transplantation.

The incidence and morbidity of viral and Toxoplasma gondii infections were studied in 40 children who underwent liver transplantation between December 1983 and February 1988. The incidence of primary and reactivated cytomegalovirus (CMV) infection was 19% and 47%, respectively; primary infection caused clinical disease in all five cases affected and was fatal in one. Primary Epstein-Barr virus (EBV) infection occurred in 10 (26%) recipients but caused only mild disease.

Retinochoroiditis in acute Epstein-Barr virus infection.

The case is reported of a 17-year-old male with secondary glaucoma and retinochoroiditis complicating acute clinical infectious mononucleosis. The diagnosis was confirmed by Epstein-Barr virus specific serology. Toxoplasmic infection was initially suspected.

Correlates of certification in family medicine in the billing patterns of Ontario general practitioners.

There is conflicting evidence as to whether physicians who are certified in family medicine practise differently from their noncertified colleagues and what those differences are. We examined the extent to which certification in family medicine is associated with differences in the practice patterns of primary care physicians as reflected in their billing patterns. Billing data for 1986 were obtained from the Ontario Health Insurance Plan for 269 certified physicians and 375 noncertified physicians who had graduated from Ontario medical schools between 1972 and 1983 and who practised as general practitioners or family physicians in Ontario.

Non-immune hydrops fetalis: rapidity of onset and usefulness of prenatal ultrasonography.

Non-immune hydrops fetalis (NIHF) has become more common than immune hydrops fetalis as a cause of fetal hydrops and its contribution to the total perinatal mortality rate has increased from 0.1% to 3.0% for the 10 years to 1979.

Methodologic note for child epidemiological surveys: the effects of instructions on estimates of behavior prevalence.

This paper examines the effects of a change in the wording of the Child Behavior Checklist (CBCL) instructions for the 0 category on the reported prevalence of behaviors among normal children by their parents. Convenience samples of parents were randomly allocated to complete CBCL items using either the standard instructions "not true" or "never or not true" to describe the 0 category. Adding the word "never" to describe the 0 category decreased parents' use of that category and increased their use of the adjacent, 1, category.

The concentration dependence of the diffusion coefficient for bovine pancreatic trypsin inhibitor: a dynamic light scattering study of a small protein.

This paper reports the use of dynamic light scattering to investigate the concentration dependence of the diffusion coefficient for bovine pancreatic trypsin inhibitor (BPTI). BPTI is a small molecular weight protein (6511 Da) that has been the subject of numerous experimental studies. In addition to addressing questions that remain in the literature concerning the aggregation behavior of BPTI, we show that dynamic light scattering can be practically applied to proteins as small as BPTI, and that it can provide a useful means of parameterizing the solution behavior for proteins.

Effect of medicolegal liability on patterns of general and family practice in Canada.

As part of the Federal/Provincial/Territorial Review on Liability and Compensation Issues in Health Care, in 1988 we surveyed Canadian general practitioners and family physicians to determine the effect of liability concerns on their practices in the previous 5 years. Questionnaires were sent to a random, stratified national sample of 1295 physicians, with a response rate of 64.6%.

The McMaster M.D. program: a case study of renewal in medical education.

This paper presents four aspects of health professions education at McMaster University: (1) a review of the key elements of the history and distinctive approach of the Doctor of Medicine (M.D.) program; (2) a description of the process and substance of curriculum change over the past decade, focusing on a major revision of the M.

Ureteric obstruction by the gravid uterus.

This paper reports the only 6 cases of ureteric obstruction apparently caused by the gravid uterus diagnosed at the Mercy Maternity Hospital in the past 17 years, during which time there were 82,836 confinements. In 3 of the 6 cases there was clear radiographic evidence that the level of obstruction was at the pelvic brim. The rapid resolution of the ureteric obstruction shortly after delivery strongly suggested that the gravid uterus was the cause of the obstruction.

Determination of 3H-labelled cytosine arabinoside and eight metabolites in cell extracts by high-performance liquid chromatography and scintillation spectrometry.

We have developed a method for the separation and quantitation of radiolabeled cytosine arabinoside and its eight metabolites in cell extracts by anion-exchange gradient high-performance liquid chromatography. Baseline separation of cytosine arabinoside and uracil arabinoside and their respective 5'-mono-, di- and triphosphates, as well as cytosine arabinoside diphosphocholine was obtained with the shortest interval between peaks being 3 min. This degree of separation was found to be essential for quantitation of 3H-labeled metabolites by scintillation counting of 1-min fractions.

Men and women choose different careers in medicine: causes and consequences.

WOMEN MEDICAL GRADUATES OF MCMASTER UNIVERSITY WERE DIVIDED INTO TWO GROUPS: those in the fields traditionally chosen by women (primary care, general internal medicine, pediatrics, psychiatry, and anesthesia), and those in nontraditional fields (surgery, subspecialties of medicine, and academic medicine). The careers of the two groups of women were then compared with matched groups of men physicians. More women choosing traditional careers worked in another field, frequently health-related, before deciding to enter medicine than women entering nontraditional careers.

Energy balance in rats given chronic hormone treatment. 2. Effects of corticosterone.

1. Sprague-Dawley rats were given corticosterone for 4 to 14 d either by subcutaneous injection (50 mg/kg body-weight per d) or as a higher dose in the diet (1 g/kg diet). Energy balance was calculated using the comparative carcass technique.

Energy balance in rats given chronic hormone treatment. 1. Effects of long-acting insulin.

1. Sprague-Dawley rats were injected for 16 d with long-acting insulin, and energy balance was calculated using the comparative carcass technique. Two experiments were carried out with females (starting weights 150 and 90 g respectively), and one with males (starting weight 150 g).

Escherichia coli thioredoxin folds into two compact forms of different stability to urea denaturation.

The urea-induced denaturation of Escherichia coli thioredoxin and thioredoxin variants has been examined by electrophoresis on urea gradient slab gels by the method of Creighton [Creighton, T. (1986) Methods Enzymol. 131, 156-172].

Ontario Child Health Study: patterns of ambulatory medical care utilization and their correlates.

Data from a large epidemiologic survey of Ontario children 4 to 16 years of age are presented concerning the frequency and correlates the use of ambulatory medical care services during a 6-month period in which a universal, first-dollar health insurance plan was used. Patterns of use of ambulatory medical care are described for three settings: doctor's offices, emergency rooms, and hospital outpatient departments. A group of children who are frequent users of ambulatory medical care (defined as using three or more services in 6 months) consumed nearly two thirds of all services.