The new face of health care in Ontario

Canada is experiencing a dramatic increase in the number of older people in its population. Adopting strategies that involve physician actions, a societal approach and individual participation may substantially improve the health of senior citizens. This article presents ways to improve the quality of life and reduce the risk of premature death through manoeuvres that can be initiated by physicians in the context of the periodic health examination. The authors highlight the role of evidence in choosing the most appropriate interventions, speculate on areas of future importance and emphasize a societal approach to population health.     

Taking health care to factory floor proves smart move for growing Ontario company

A fully equipped, state-of-the-art wellness centre that employs physicians and other health care providers to meet the health needs of more than 1200 employees is being credited with giving a Canadian company a leg up on the competition.     

Successive Ontario governments forced to grapple with problem of health care fraud.

Albert Shu of Willowdale, Ont., is the 1995 winner of the Amy Chouinard Memorial Essay Contest. Named in memory of long time CMAJ and Canadian Journal of Surgery contributor Amy Chouinard, the competition is intended to stimulate interest in medical and health-related writing among journalism students. The winning essay, written prior to Ontario''s 1995 provincial election, examined health care fraud in the province and the impact of the photo health card that was introduced by the New Democrats party government.     

Integrating mental health into primary health care in Iraq

The Ministry of Health in Iraq is undertaking a systematic programme to integrate mental health into primary care in order to increase population access to mental health care. This paper reports the evaluation of the delivery of a ten day interactive training programme to 20% of primary care centres across Iraq. The multistage evaluation included a pre- and post-test questionnaire to assess knowledge, attitudes and practice in health workers drawn from 143 health centres, a course evaluation questionnaire and, in a random sample of 41 clinics, direct observation of health workers skills and exit interviews of patients, comparing health workers who had received the training programme with those from the same clinics who had not received the training. Three hundred andseventeen health workersparticipated in the training, which achieved an improvement in test scores from 42.3% to 59%. Trained health workers were observed by research psychiatrists to have a higher level of excellent skills than the untrained health workers, and patient exit interviews also reported better skills in the trained rather than untrained health workers. The two week course has thus been able to achieve significant change, not only in knowledge, but also in subsequent demonstration of trained practitioners practical skills in the workplace. Furthermore, it has been possible to implement the course and the evaluation despite a complex conflict situation.     

Hydroseral development in southern Ontario: patterns and controls

Palaeoecological data from a range of wetland types were synthesized in order to study the development of wetland ecosystems in southern Ontario. The present-day nature of the wetland system occurring in a topographically defined basin was shown to be controlled in part by basin morphology. Stratigraphic and vegetational (pollen and macrofossil analysis) data were used to compare the sequence of communities occupying basins during the postglacial. In systems where terrestrial peat overlies lake sediment, the broad stages of development were relatively uniform (from a lake to a shallow open water wetland to a herbaceous marsh or fen to a woody plant-dominated community), although the exact nature of each stage varied widely between basins. The accumulation rate of sediment within such basins varied by up to two orders of magnitude during the postglacial. Allogenic and autogenic factors have been acting on these systems throughout the postglacial, and the sensitivity of individual sites to changes in these environmental conditions will also have varied. Even the widespread land clearance associated with European settlement in the area in recent centuries has not affected some wetland systems detectably, while others have either been destroyed or profoundly changed. The patterns of hydroseral development, both timing and direction, were compared with known regional environmental changes.