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Aim: COVID‐19 has had significant mental health impacts internationally and anxiety rates are estimated to have tripled during the pandemic, but the specific causes remain underexplored. This study's purpose was to investigate the associations of sociodemographic factors, COVID‐19‐related policies, and COVID‐19 case/mortality rates with levels of anxiety among Canadians during the pandemic. Methods: This study used linear regression models populated with three integrated sources of data: a repeated cross‐sectional survey (n = 7008), Oxford COVID‐19 Government Response Tracker data, and COVID‐19 case/mortality rates. Sociodemographic factors included were age, gender, race, province, income, education, rurality, household composition, and factors related to employment. Results: Local COVID‐19 case and mortality rates and stay‐at‐home orders were positively associated with anxiety symptom severity. Anxiety was most severe among those who: were female, Indigenous, or Middle Eastern; had postsecondary education; lived with others; and became unemployed or had working hours altered during the pandemic. Anxiety was less severe among: older adults; male, Caucasians, and black individuals; those with high incomes, and; those for whom employment did not change during the pandemic. Conclusion: Anxiety was primarily driven by socioeconomic factors among Canadians during the COVID‐19 pandemic. Policies that alleviate socioeconomic uncertainty for groups that are most vulnerable may reduce the long‐term harm of the pandemic and associated lockdown policies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a stratified screening process for the early identification of axial spondyloarthritis (SpA) with consideration of the following: 1) wait times from primary care to rheumatology screen, 2) incremental precision and accuracy from primary care to rheumatology screening, and 3) diagnostic delay. Methods: Adults with low back pain attending primary care at low back pain clinics prospectively underwent a primary standardized clinical screening. Patients with low back pain of >3 months who experienced symptom onset at age <50 years were referred for a comprehensive secondary screening by a physical therapist with advanced rheumatology training. At secondary screening, patients with features of inflammation were classified as being at a low, medium, or high risk for axial SpA versus no risk for axial SpA. Precision and accuracy of this screening strata were measured against a rheumatologist with expertise in axial SpA. Results: Overall, 405 patients underwent primary and secondary screening in the present study. The study cohort had a mean ± SD age of 36.9 ± 9.9 years, and 55% were women. HLA–B27 was present in 14.4% of patients. Median wait time from primary screening to secondary screening was 15 days. Axial SpA risk assignment by rheumatologist was 64.9% for no risk or low risk for axial SpA and 35.1% for medium risk or high risk for axial SpA. The best combination of sensitivity (68%), specificity (90%), positive predictive values (80%), and negative predictive values (84%) was evident in the secondary screening. In this cohort, 15.6% of patients received a final diagnosis of axial SpA. Median low back pain duration from symptom onset to diagnosis was 2 years for nonradiographic axial SpA and 7 years for ankylosing spondylitis. Conclusion: A stratified interprofessional screening process can facilitate rapid diagnosis of persistent low back pain with high precision and accuracy in patients who have axial SpA. [ABSTRACT FROM AUTHOR]

Objectives To compare two methods of allocating general dentists to Canadian Armed Forces ( CAF) dental detachments: a dentist-to-population ratio model and a needs-based model. Methods Data obtained from CAF sources were analysed to compare models. Times assigned to treatment plan procedures were used as a proxy for treatment needs. Full-time equivalents ( FTEs) were used as an indicator for the number of dentists allocated to each detachment. FTE values were adjusted for military dentists to account for time spent on compulsory nonclinical duties. The paired-samples t test was used to assess differences between the models for all clinics (dental detachments) and by clinic size. Results The dentist-to-population ratio model for the CAF population (n=68 183) estimated an allocation of 83.25 FTE general dentists to CAF dental detachments. Based on a systematic sample of the CAF population (n=2226), the needs-based model estimated the requirement for 64.71 FTE general dentists. The average difference between models was 0.71 FTE ( SE=0.273), which was statistically significant ( P=0.015). In terms of differences by clinic size, differences were more pronounced in clinics serving more than 4000 CAF personnel (2.63 FTEs, SE=0.613, P=0.008). Conclusions The findings reveal differences between estimation models of <1 FTE, with higher estimates produced from the dentist-to-population ratio model. A larger difference was found in clinics with larger populations. The perceived overestimation of dental human resource requirements suggests that changing to a needs-based model may result in cost savings. [ABSTRACT FROM AUTHOR]

Some 280,000 people died in the Indian Ocean tsunami on 26 December 2004. This cohort study examined its impact on mental health one and two years later. It did so by investigating the association between six consequent variables (personal injury, loss of home, loss of business, death of a family member, injury to a family member, or loss of a family member's business) and mental health, as measured by the 36-item Short Form Health Survey (SF-36), among residents in four provinces of Thailand. One year later, participants who suffered a personal injury, the loss of a business, or the loss of a family member reported poorer mental health than those who were unaffected. Two years later, participants who experienced the loss of a family member reported poorer mental health than those who were unaffected. This research shows that such a disaster may have long-lasting ramifications for mental health, and that diverse losses may influence mental health differently. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) are a common secondary complication experienced by community dwelling individuals with spinal cord injury (SCI). There is a paucity of literature on the health economic impact of PU in SCI population from a societal perspective. The objective of this study was to determine the resource use and costs in 2010 Canadian dollars of a community dwelling SCI individual experiencing a PU from a societal perspective. A non-comparative cost analysis was conducted on a cohort of community dwelling SCI individuals from Ontario, Canada. Medical resource use was recorded over the study period. Unit costs associated with these resources were collected from publicly available sources and published literature. Average monthly cost was calculated based on 7-month follow-up. Costs were stratified by age, PU history, severity level, location of SCI, duration of current PU and PU surface area. Sensitivity analyses were also carried out. Among the 12 study participants, total average monthly cost per community dwelling SCI individual with a PU was $4745. Hospital admission costs represented the greatest percentage of the total cost (62%). Sensitivity analysis showed that the total average monthly costs were most sensitive to variations in hospitalisation costs. [ABSTRACT FROM AUTHOR]

A massive earthquake off the west coast of Sumatra in Indonesia triggered a tsunami on 26 December 2004. At least five million people around the world were affected, and the total number of deaths exceeded 280,000. In Thailand, the tsunami struck six southern provinces, where the disaster's immediate impact was catastrophic. Based on ethnographic fieldwork in Phang Nga Province (2007), this paper provides an overview of the disaster's psychosocial consequences for Thai health service providers, the vast majority of whom were bypassed by regional post-tsunami mental health initiatives. The available tsunami literature only briefly attends to health providers' experience of professional 'burn-out', rather than explores the tsunami's wide spectrum of psychosocial effects. This research aims to remedy such oversights through 'critical medical' and 'interpretive phenomenological' analysis of the diverse and culturally-situated ways in which health providers' experienced the tsunami. The paper concludes by arguing for disaster-related psychosocial interventions to involve health providers explicitly. [ABSTRACT FROM AUTHOR]

As people continue to age and receive complex health care services at home, concern has arisen about the availability of family caregivers and their ability to combine employment with caregiving. This article evaluates the international research on unpaid caregivers and their labor market choices, highlighting three conclusions: first, caregivers in general are equally as likely to be in the labor force as noncaregivers; second, caregivers are more likely to work fewer hours in the labor market than noncaregivers, particularly if their caring commitments are heavy; and finally, only those heavily involved in caregiving are significantly more likely to withdraw from the labor market than noncaregivers. Policy recommendations are targeting greater access to formal care for “intensive” caregivers and developing workplace policies for employed caregivers. [ABSTRACT FROM AUTHOR]

In most developed countries, as the largest population cohorts approach the age of sixty-five, the impact of population aging on health care expenditures has become a topic of growing interest. This articles examines trends in elderly disability and end-of-life morbidity, estimations of the cost of dying, and models of expenditures as a function of both age and time-to-death and finds broad improvement in mortality and morbidity among the elderly in the developed world. Reduced mortality and low growth in the costs associated with dying could reduce forecasted expenditures, but high growth in expenditures for those not close to death and for nonhospital services could create new economic pressures on health care systems. [ABSTRACT FROM AUTHOR]

: Although rarely life-threatening, postoperative vomiting (POV) is a distressing complication. The incidence of POV ranges from 34 to 90% in children undergoing strabismus surgery when antiemetics are not administered prophylactically. : In this study, a cost-consequence analysis (CCA) is used to estimate the economic benefit of ondansetron and dimenhydrinate as antiemetics administered prophylactically in children undergoing strabismus surgery. This retrospective study was conducted at The Hospital for Sick Children based on a review of 70 charts. : Ondansetron was more effective with 45.3 POV-free patients (PFP) in an adjusted cohort of 100, while dimenhydrinate resulted in 38.2 PFP in an adjusted cohort of 100. The costs were significantly different between the two groups, CAD$ 185.90 (±26.37, 95% CI, CAD$ 173,89; CAD$ 197.90) and CAD$ 232.90 (±CAD$ 66.84, 95% CI, CAD$ 198.53; CAD$ 267.27) per patient for ondansetron and dimenhydrinate, respectively. The length of stay in the postanesthetic care unit (PACU) represented over 97% of total costs, and the mean lengths of stay in the PACU for ondansetron and dimenhydrinate were significantly different, 3.43 and 4.41 h, respectively. : This study should serve as a pilot for a large-scale investigation on the correlation between the length of stay in the PACU and the antiemetic agent used. [ABSTRACT FROM AUTHOR]

Background: The advantages of breastfeeding have been well established for both mothers and their infants. Existing research reports equivocal effects of early discharge and postpartum home care on breastfeeding success. The purpose of this study was to compare the effects of breastfeeding support offered in hospital and home settings on breastfeeding outcomes and maternal satisfaction for mothers of term and near-term newborns who experienced standard or early discharge. Methods: In a randomized controlled trial with prognostic stratification for gestational age, 101 term and 37 near-term (35–37 weeks’ gestational age) mother-newborn pairs were randomized to either a standard care group (standard care and standard length of hospitalization) or an experimental group (standard hospital care with early discharge and home support from nurses who were certified lactation consultants). Data collection occurred before randomization, at discharge from hospital, and from 5 to12 days postpartum. Primary outcomes included breastfeeding rates and maternal satisfaction. Results: More mothers of term newborns in the experimental group were breastfeeding exclusively at follow-up (p=0.02) compared with the control group. No significant breastfeeding differences occurred among mothers with near-term newborns in the experimental and standard care groups. Conclusions: In-home lactation support appears to facilitate positive breastfeeding outcomes for mothers of term newborns. This may also be a beneficial model of postpartum care for mothers of near-term newborns; however, further research is required. The findings suggest implications for health caregivers and policy makers with respect to postpartum lactation and health care services. (BIRTH 29:4 December 2002). [ABSTRACT FROM AUTHOR]

This paper outlines the structure of healthcare in Canada and describes trends in health expenditures. Particular attention is paid to trends in Canada's most populous province, Ontario. Three temporal episodes of health expenditure growth in Ontario are identified: 1980-91, a period of rapid growth; 1991-98, a period of restraint; and 1998-present, a period of expenditure resurgence. Health policy initiatives designed to enhance the efficient, effective and equitable access to healthcare services are briefly reviewed. [ABSTRACT FROM AUTHOR]

Examines the effects of fee bundling on dental insurance utilization in the United States. Guidelines for improvement of fee-for-service mechanisms; Definition of the recall data set; Dentists behavior under fee bundling; Impact of bundling on unit visit and user payments.

In the absence of labor supply constraints, this paper shows that an increase in wage-rate uncertainty alters the optimal supply of individual hours but leaves the decision to participate unchanged. In the presence of these constraints, it is shown that if researchers are concerned with obtaining consistent parameter estimates of the labor supply function, then it is important to correctly specify the type of uncertainty faced by workers. Specifically, a mean preserving increase in wage-rate uncertainty lowers the participation rate, while an increase in non-wage income uncertainty raises participation. [ABSTRACT FROM AUTHOR]

This paper develops a model of spatial price discrimination by two-part pricing when sellers cannot discriminate between consumers by bearing freight or by nonlinear pricing. Sellers can be interpreted as clubs with which consumers become members or non-members, The two-pan tariff comprises a membership fee and a price for each time a seller's facility or store is used. When the fixed cost per store is low. a monopolist adopts compulsory memberships and builds stores closer together than is socially optimal. With higher fixed cost, the monopolist offers consumers a choice between membership and non-membership at a higher price, and builds stores too far apart. Nearby consumers become members and the rest non-members. Competition with free entry and costless relocation leads to closer spacing than monopoly. Welfare is lower than under monopoly except at high levels of fixed cost per store. [ABSTRACT FROM AUTHOR]

We investigate a consumer's decision of whether or not to join a bookclub, and once his/her contractual obligations are fulfilled, whether to remain as a member, cancel his/her membership outright, or cancel his/her membership and subsequently rejoin the bookclub. Since the consumer's subscription strategy depends on the transaction costs of purchasing books and on the marketing strategy adopted by bookclubs, we investigate why bookclubs make introductory offers and/or enforce minimum purchase requirements. Introductory offers allow bookclubs to price discriminate between consumers who self-select alternative subscription strategies Minimum purchase requirements increase the bookclub's profit by appropriating part of the consumer surplus. [ABSTRACT FROM AUTHOR]

This paper employs a maximizing framework, consistent with the axioms of consumer preference, to analyse local government's choice of spending on different social services. Within this framework it is possible to include both block-funding and cost-sharing intergovernmental transfer schemes. Canada's movement to block-funding from the cost-sharing method of financing provincial expenditures on hospitals, medical care, and post-secondary education is analysed. The results indicate that the provincial governments' actions are generally consistent with a standard maximizing model of consumer behaviour and that the change to block-funding had a significant impact on real provincial funding of some previously cost-shared social services. [ABSTRACT FROM AUTHOR]

This paper uses constituency-level political campaign expenditures to analyse the impact of competition on advertising. A theoretical model, based on expected utility maximization, predicts an uncertain impact of increased competition on campaign spending. The direction of this impact is tested using data from the 1979 and 1980 Canadian federal elections. Competition is found to have a positive effect on spending, and several other plausible hypotheses of expenditure determination are rejected. These include constant spending per voter or per constituency, the random allocation of funds, and spending based on incumbency, ministerial status, or the spending of other political parties. [ABSTRACT FROM AUTHOR]

Without disputing the importance of the 'special characteristics' found in the market for medical services, it is argued in this paper that the standard economic model of maximizing behaviour, rather than an idiosyncratic theoretical formulation unique to the medical profession, is well suited to this market. This conclusion is based on analysis in which the technique of equalizing differences is used to define a competitive equilibrium that provides the possibility of both price and non-price competition. The maximizing model developed provides an alternative theoretical explanation of the limit placed on supplier-induced demand to that offered by the target-income model of physician behaviour or that offered by the arguments based on medical ethics. [ABSTRACT FROM AUTHOR]

Focuses on a theoretical model of unregulated hospital sector that provides a conceptual framework for the examination of various regulatory programs. Derivation of consumer's indifference curves and their marginal rate of substitution; Analysis of the behavior of hospitals towards their consumers; Equilibrium within the hospital sector.

The contribution of this paper is threefold. First, the technique of equalizing differences is used to develop a unified economic model of the hospital sector. The competitive equilibrium is characterized by implicit contracts between consumers and hospitals. In equilibrium, these contracts are determined so that consumers and hospitals are perfectly matched since these economic agents base their decisions on maximizing behavior. Second, the model offers insights into a number of interesting questions concerning the internal operation of the hospital sector, the equilibrium locus of medical services, and alternative methods of financing hospitals. These insights are systematically related to, and are not contradicted by, the available empirical evidence. Third, the availability hypothesis and the existence of market segmentation each receive theoretical support and are proven formally in the context of the model presented. [ABSTRACT FROM AUTHOR]

The present paper combines these screening mechanisms and examines the impact of each upon the optimal employment contract. Second, although the existing literature on employment contracts offers a general framework for analysis, it is not directly amenable to empirical verification. The present paper rectifies these short-comings by developing a model which incorporates both screening mechanisms under asymmetric information, and thereby provides a model conducive to empirical verification. In this paper, uncertainty arises since human capital is unobservable. If worker productivity is positively related to human capital, then employers have an incentive to screen employees. These screens (or probationary contracts) act as employment filters by discouraging applications from those who believe their probability of passing the test is low. [ABSTRACT FROM AUTHOR]

Objective: To examine prospectively the predictors of time to total joint arthroplasty (TJA)., Methods: This was a prospective cohort study with a median followup time of 6.1 years. We included participants from an existing population-based cohort of 2,128 individuals, ages 55 years and older with disabling hip and/or knee arthritis and no prior TJA, from 2 regions of Ontario, Canada, 1 urban with low TJA rates and 1 rural with high rates. The main outcome measure was the occurrence of a TJA based on procedure codes in the hospital discharge abstract database., Results: At baseline, the mean age of the patients was 71.5 years, 67.9% had a high school education or higher, 73.4% were women, the mean arthritis severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) score was 41.1 (maximum possible score 100), and 20.0% were willing to consider TJA. Greater probability of undergoing TJA was associated with higher (worse) baseline WOMAC scores (hazard ratio [HR] 1.22 per 10-unit increase, P < 0.001), age (compared with age or=82 years; P < 0.05 for all), better health (HR 1.14 per 10-unit increase in Short Form 36 general health survey score, P < 0.001), and willingness to consider TJA (HR 4.92, P < 0.001). When willingness was excluded from the model, education level, but not sex or income, became a significant predictor of TJA receipt., Conclusion: Willingness to consider TJA was the strongest predictor of the time to first TJA. Given that previous research indicates that willingness is largely explained by perceptions of the indications for and risks associated with TJA and not disease severity, this finding supports the need for population education about arthritis treatments, including TJA.

Background: The advantages of breastfeeding have been well established for both mothers and their infants. Existing research reports equivocal effects of early discharge and postpartum home care on breastfeeding success. The purpose of this study was to compare the effects of breastfeeding support offered in hospital and home settings on breastfeeding outcomes and maternal satisfaction for mothers of term and near-term newborns who experienced standard or early discharge., Methods: In a randomized controlled trial with prognostic stratification for gestational age, 101 term and 37 near-term (35-37 weeks' gestational age) mother-newborn pairs were randomized to either a standard care group (standard care and standard length of hospitalization) or an experimental group (standard hospital care with early discharge and home support from nurses who were certified lactation consultants). Data collection occurred before randomization, at discharge from hospital, and from 5 to 12 days postpartum. Primary outcomes included breastfeeding rates and maternal satisfaction., Results: More mothers of term newborns in the experimental group were breastfeeding exclusively at follow-up (p = 0.02) compared with the control group. No significant breastfeeding differences occurred among mothers with near-term newborns in the experimental and standard care groups., Conclusions: In-home lactation support appears to facilitate positive breastfeeding outcomes for mothers of term newborns. This may also be a beneficial model of postpartum care for mothers of near-term newborns; however, further research is required. The findings suggest implications for health caregivers and policy makers with respect to postpartum lactation and health care services.