Ontario County Research Articles

Agreement between self-reported and routinely collected health-care utilization data among seniors.

To examine the agreement between self-reported and routinely collected administrative health-care utilization data, and the factors associated with agreement between these two data sources. A representative sample of seniors living in an Ontario county within Canada was identified using the Ontario Ministry of Health's Registered Persons Data Base in 1992. Health professional billing information and hospitalization data were obtained from the Ontario Ministry of Health and Long-Term Care (OMH) and the Ontario Health Insurance Plan (OHIP). A cross-sectional survey was carried out to assess any contact and frequency of contacts with health professionals and hospital admissions. Similar information was obtained from routinely collected administrative data. The level of agreement was assessed using the proportion of absolute agreement, Cohen's kappa statistic (kappa), and the intraclass correlation coefficient (ICC). Logistic and linear regressions were used to identify factors that were associated with the magnitude and direction of disagreement respectively. Telephone interviews were conducted on 1,054 seniors, and complete data were available for 1,038 seniors. Each respondent's personal health number was used to electronically link survey data with health professional billing and hospitalization databases. Substantial to almost perfect agreement was found for the contact utilization measures, while agreement on volume utilization measures varied from poor to almost perfect. In surveys, seniors overreported contact with general practitioners and physiotherapists or chiropractors, and underreported contact with other medical specialists. Seniors also underreported the number of contacts with general practitioners and other medical specialists. The odds of agreement decreased if respondents were male, aged 75 years and older, had incomes of less than $25,000, had poor/fair/good self-assessed health status, or had two or more chronic conditions. The findings of this study indicate that there are substantial discrepancies between self-reported and administrative data among older adults. Researchers seeking to examine health-care use among older adults need to consider these discrepancies in the interpretation of their results. Failure to recognize these discrepancies between survey and administrative data among older adults may lead to the establishment of inappropriate health-care policies.

Great Lakes Educational Needs Assessment: Teachers’ Priorities for Topics, Materials, and Training

Teachers have an opportunity to create awareness of the importance of the Great Lakes by incorporating lake examples of major science/social concepts into their curricula. A survey of 300 middle school science teachers in watershed counties of Great Lakes states and Ontario revealed topics that were highest priority and that teachers wanted to know more about: water quality, environmental responsibility, water uses and conservation, and toxic chemicals. Topics of lowest priority were those dealing with shipping, water diversion, human history, careers and hobbies, and aesthetics (art, music, and literature of the lakes). Reasons for not including low priority topics were primarily based on their not being a part of the assigned curriculum for the responding science teachers. Responses regarding topic priorities and knowledge did not differ significantly by state/province, gender, grade level taught, early vs. late response, or whether the teachers had participated in a Great Lakes education workshop, with the primary exception that teachers who had been in a workshop generally rated exotic species as more important and were teaching more about it. Teachers claim to get most of their Great Lakes information from workshops and classes, with newspapers as the primary mass media source. They prefer to receive instructional materials in the form of classroom-ready activities and units, and when they seek additional education they prefer one-day or summer workshops for college credit. Providers of Great Lakes education resources should consider teacher preferences in designing materials and experiences, and consider infusion as a means of introducing non-science topics into science classes.

Physician and population determinants of rates of middle-ear surgery in Ontario.

Small-area variations in surgical rates raise concerns about access to care, treatment appropriateness, and the quality and cost of care. To measure small-area variations in rates of myringotomy with insertion of tympanostomy tubes (TTs) and to identify determinants of rate variation. Retrospective analyses using hospital discharge data for patients who had undergone a myringotomy with insertion of TT by county in Ontario between April 1, 1996, and March 31, 1999. Information on possible determinants was taken from a survey of otolaryngologists and primary care physicians in 1996 and from the 1996 Canadian census and physician demographic databases for 1996-1999. A total of 75 358 hospitalizations for TT placement of children and adolescents (aged </=14 years). Small-area variation in rates of TT. An almost 10-fold difference between the areas with the highest and lowest rates was found (extremal quotient, 9.6; 95% confidence interval [CI], 8.2-11.1; P<.001). Higher rates occurred in counties with higher percentages of high school graduates (parameter estimate, 0.01; 95% CI, 0-0.02; P =.049); and where referring physicians were more likely to be male (parameter estimate, 0.01; 95% CI, 0-0.02; P =.01), North American-trained (parameter estimate, 0.01; 95% CI, 0.01-0.02; P<.001), and have higher propensities to refer for surgery (parameter estimate, 0.40; 95% CI, 0.09-0.72; P =.02). Otolaryngologist opinion was not a significant predictor. Substantial area variation in TT rates was observed. The opinion of primary care physicians was the dominant modifiable determinant, suggesting an area of research that may be important in reducing area variation in TT procedures.

A multivariate analysis of bird species composition and abundance between crop types and seasons in southern Ontario, Canada

Many farmland bird species are declining in North America and Europe, yet there are few data documenting bird use of agricultural landscapes, especially in Canada. This information is needed in order to identify candidate factors contributing to declines. We examined the influence of crop type and adjacent habitat on birds in fields of four crop types in three southern Ontario counties during the 1988 breeding (May-July) and 1987 and 1988 migration (August-September) seasons, using canonical correspondence analysis (CCA). Crops included apple Malus spp. orchards in Norfolk, soybeans Glycine max in Essex, vineyards Vitae spp. in Niagara and corn Zea mays (maize) in all three counties. Bird assemblages differed between counties because corn in Norfolk had more adjacent wetlands and woodlands than those in Essex. During the breeding season (1988), significant habitat variables explaining variation in bird assemblages (in order of importance) were adjacent apple orchards, wetlands, and “other” wooded habitats and apple as the crop (as distinct from adjacent apple orchards). During migration, apple as the crop was most important, followed by crop type corn (distinct from adjacent corn), adjacent wetlands and adjacent other crops in 1988. Apple as the crop was most important, followed by grape as the crop (distinct from adjacent vineyards) and wetlands in 1987. Based on median vector distances in ordination space as a measure of the difference between breeding and migration periods, bird assemblages in soybean and corn in Essex changed most, while birds assemblages in apple orchards changed least, although differences were not significant among crops. Our results emphasize the importance of non-crop and crop habitats for birds during both breeding and migration seasons.

Using Healthy Life Years (HeaLYs) to Assess Programming Needs in a Public Health Unit

In December 1997, public health units in Ontario received revised mandatory program guidelines from the Ministry of Health in advance of the downloading of public health to municipalities. Public health units face difficult decisions in allocating municipal resources to meet the Province's mandated programs. To set priorities for resource allocation, it is critical to assess need across program areas and to use a common unit in doing so. This paper applies the Healthy Life Years (HeaLYs) method in assessing health need related to the mandatory programs for the population of Wellington and Dufferin counties in Ontario. The HeaLYs method incorporates duration and severity of ill-health, incidence and mortality in calculating years of healthy life lost (YHLL). For Wellington-Dufferin, the leading causes of YHLL were concentrated in the program areas of chronic disease, injury, and substance abuse and included four areas not addressed in the MPG (suicide, depression, dementia, and osteoarthritis).

Sources of Cigarettes for High School Students in Two Ontario Counties: Implications for Developing a Community Response

Sources of Cigarettes for High School Students in Two Ontario Counties: Implications for Developing a Community Response

Age, Physical Impairment, and Symptoms of Anxiety: A Test of Mediating and Moderating Factors

This study examines the processes linking physical impairment with symptoms of anxiety. Analyses are based on a representative sample of 967 physically disabled adults (ages 20 to 90) from ten counties of southwestern Ontario, Canada Several hypotheses test the intervening role of disability characteristics, perceived health care efficacy, personal attributes, and social stratification resources. Ordinary least squares (OLS) regression analyses included sets of those intervening variables entered sequentially. Adjustment produces a significant reduction in the association between symptoms of anxiety and impairment--confirming the intervening role of healthcare efficacy and mastery. Moreover, impairment and mastery have synergistic effects such that higher mastery buffers against the anxiety associated with higher impairment. Other findings raise important questions about age, impairment, and the sense of mastery in the contest of healthcare and gender.

Is community-based treatment an add-on or a substitution for hospital treatment of alcoholism? Some evidence from Canada.

This study determined whether the development of community treatment of alcohol problems acted as an add-on or a substitution for the utilization of inpatient hospital services in Ontario. Complex modelling and graphic analyses using econometric multiple regression techniques were performed on data for the 48 counties of Ontario (Canada) for the period 1972 to 1988, combining both cross-sectional and time series analysis. After controlling for differences in alcohol consumption, in health care characteristics such as the supply of physicians or hospital occupancy rates, and in socioeconomic characteristics of the population, when community treatment became available, hospital utilization for the treatment of alcohol problems decreased and community services were substituting for hospital treatment. In addition, nonresidential services had an overall greater importance in producing this effect (elasticities at the mean of -0.11 to -0.14 depending on the region) than community-based residential treatment. The effect was larger in the southern than in the northern counties of Ontario. Testing of the modelling techniques showed statistically significant and satisfactory modelling of the forces at work. Where community-based treatment was available, it was used in preference to inpatient hospital treatment; however, there may be a slightly more complex relationship present in the southern urban counties (which contain the larger metropolitan areas) than in the northern and southern rural counties..

Socioeconomic and environmental covariates of premature mortality in Ontario

This paper contributes to debates on the broad determinants of health and on the policy shift from curative to preventive and protective interventions. It addresses empirically the relative importance of influences on health with a multiple regression analysis of ecologic data from the 49 counties of Ontario. One model achieved high predictive power (that is, Adj R2>75%, p<0.0001). Educational levels were a strong predictor of population health, showing a consistent inverse relationship with premature mortality ratios for both sexes and it was the strongest predictor for females. A low income variable supplied the strongest prediction for male mortality. This variable displayed a positive association with male mortality. Municipal expenditures on environmental protection exerted a negative effect on male mortality. These findings raise questions about the current directions of health policy in Ontario where the provincial government has reduced funding to social and environmental programs, while promising to maintain health care funding.

RESISTANCE AMONG EX-PSYCHIATRIC PATIENTS

Symbolic interaction has increasingly emphasized cultural domination and resistance, human agency, and the variety of ways power and inequality are reproduced. How subjects construct social meanings under oppressive conditions has become a major research focus. This study reconceptualizes deviance in light of the above. Descriptive data were collected during two periods of research (1980-85; 1989-1991) on the posthospital worlds of psychiatric patients by means of participant observation, informal interviewing, and semiformal interviewing with 410 nonchronic and chronic ex-psychiatric patients residing in Southern Ontario, Canada, and central counties of Michigan. Using the concepts of ritual and a culture of resistance, we portray deviants constructing meaning under structures of domination, renegotiating meaningful self-images, identities, and overall conceptions of self. Expressive and instrumental rituals that lead to a culture of resistance are examined.

Environmental Equity in Canada: An Empirical Investigation into the Income Distribution of Pollution in Ontario

In this paper, we attempt to contribute to the growing environmental justice debate by exploring environmental equity in the forty-nine counties of Ontario, Canada. We use multiple regression analysis to address a central research question: what variables predict the location of pollution emissions? Data were extracted from the 1993 National Pollutant Release Inventory and the 1991 Census of Canada to assess relationships among socioeconomic class variables, industrial and land-use variables, and pollution emissions. The results agree with the findings of recent US studies. Manufacturing employment, urbanization variables, dwelling value, and household income were all significantly related to pollution emissions. These relationships took the same direction as in most of the US studies. In total, the four variables account for about 63% of the variation in pollution emissions (adjusted R2 = 0.626, p&lt; 0.0001). Contrary to a hypothesis of environmental inequity, the household income variable displayed a positive relationship with pollution emissions. A conceptual model of the development process is formulated to explain the positive relationship between pollution emissions and income levels. We conclude the paper with suggestions for future research.

Sisters/Strangers

I first heard about the community play concept in 1989 when I attended at a workshop at the Bread and Butter Popular Theatre Festival. The workshop was led by Dale Hamilton who told us about her experiences as a community play student in the Colway Theatre Trust in England, showed slides and a video, and talked about The Spirit of Shivaree, the project she was starting to produce in Eramosa County in Ontario. I found her accounts of the community play process fascinating, particularly the concern of these plays with history and the fact that often people got the chance to play their own ancestors, their great grandfathers, their grandmothers... What an appealing idea!

Screening of Fungal Isolates Against Diamondback Moth Larvae, 1995

Abstract Fifty-five isolates of four fungi, Beauveria bassiana (Balsamo) Vuillemin, Fursarium sp.,Metarhizium anisopliae (Metschnikoff) Sorokin and Paecilomyces farinosus (Holm ex SF Gray) Brown &amp; Smith, were obtained from the USDA-ARS Collection of Entomopathogenic Fungal Cultures (Ithaca, NY). Isolates were subcultured once after retrieval from liquid nitrogen storage. Cultures were maintained on Subouraud dextrose agar plus 2% yeast extract (SDAY) at 24° Cunder a photoperiod of 15:9 h (L:D) for 14 to 21 d. Conidia were scraped from the culture surface and suspended in 0.01 % Tween 80 by vortexting for 2 min. Suspensions were filtered through 16 layers of sterile cheesecloth to remove conidial clumps and hyphal fragments. Spore concentrations were estimated using a hemacytometer and then adjusted to 312,500 spores/ml. Three to 7 isolates were screened against isolate ARSEF 4543 as a standard derived from a single infected DBM larva collected in Ontario County, NY, in 1994. First instars of DBM maintained on wheat germ diet. Fifteen 2nd instars were placed 2–3 h prior to inoculation in a petri dish containing filter paper moistened with deionized water and incubated at 4° C. Dishes were assigned randomly to treatments with 4 replicates each for each isolate. Insects were inoculated at room temperature (–22° C) using a Bergergon spray tower equipped with a Spraying Systems 2850 noz-zle, calibrated to deliver 312.5 spores/cm2 using 5 ml suspension at a concentration of 312,500 spores/ml. DBM larvae treated only with the suspending medium (0.01% Tween 80) served as checks. (Mortality in the checks was minimal and no evidence of fungal infection was detected.) After spraying the insects, two discs of DBM larval diet (Bioserv Premix) were placed in each dish which was then sealed with parafilm and incubated at 25° C in darkness for 24 h. Thereafter, the insects were transferred to a sterile petri dish with fresh diet and incubated at 25° C under a photoperiod of 15:9 h (L:D). Larvae were monitored daily and diet was replaced as needed for 7 d. Dead larvae were transferred to petri dishes containing a piece of moistened filter paper. Mycosis was confirmed by observing characteristic mycelial eruption from cadavers and subsequent sporulation. To confirm viability of spore suspensions and dosage, 5 ml of each was sprayed on SDAY plates which were incubated at 25° Cunder a photoperiod of 15:9 h (L:D) for 3 d until identifiable fungal colonies were counted. To estimate the potency of each isolate relative to the standard (ARSEF 4543), the percentage mortality due to fungus infection was divided by the percentage mortality due to infection by the standard within that experiment. Average survival times were also estimated for all fungus-killed larvae for each isolate from records of the number of days from inoculation to death.

Borderline Justice: Choosing Juries in the Two Niagaras

This paper examines the use of juries in criminal cases in Canada and the United States. It is part of a larger study of the administration of criminal justice in Niagara County, Ontario and Niagara County, New York. The basic question examined is why persons accused of serious crimes in the United States usually select a jury, whereas persons in similar circumstances in Canada normally select trial by a judge alone. An investigation of this question will enable us to see some significant differences between the administration of criminal justice in the United States and Canada. It will also show how changes in specific procedural rules may affect other practices. There is a complex interplay between procedural rules. The paper concludes by showing that the widespread use of juries in the United States is consistent with the more populist grass-roots approach in American society which tends to distrust government, compared with the traditional respect for authority, including the authority of judges, in Canada.

Asbestos‐associated cancers in the Ontario refinery and petrochemical sector

Asbestos has been widely used in the refinery and petrochemical sector. Mesothelioma has occurred among maintenance employees, and it was hypothesized that mesothelioma is a marker for exposures which might increase lung cancer risk. A death certificate-based case-control study of mesothelioma and lung cancer from 1980 to 1992 was conducted in an Ontario county with a substantial presence of these industries. Each of the 17 men who died of mesothelioma and 424 with lung cancer were matched with controls who died of other causes. The Job and Industry fields on the death certificates were abstracted. Employment as a maintenance worker in the refinery and petrochemical sector was associated with an increased risk of mesothelioma (odds ratio: 24.5; 90% confidence interval 3.1–102). The risk of lung cancer among petrochemical workers, in comparison with all other workers in the county, was 0.88. In an internal comparison of maintenance employees with other blue-collar workers in the refinery and petrochemical sector, the odds ratio for lung cancer was 1.73 (90% confidence interval 0.83–3.6). This finding is consistent with no difference in risk between maintenance and other employees, but it is also compatible with study power being too low to achieve statistical significance. The hypothesis of increased lung cancer risk could be examined more fully with nested case-control studies in existing cohorts. Meanwhile, it would be prudent to reinforce adherence to asbestos control measures in the refinery and petrochemical sector. © 1996 Wiley-Liss, Inc.

Asbestos-associated cancers in the Ontario refinery and petrochemical sector.

Asbestos has been widely used in the refinery and petrochemical sector. Mesothelioma has occurred among maintenance employees, and it was hypothesized that mesothelioma is a marker for exposures which might increase lung cancer risk. A death certificate-based case-control study of mesothelioma and lung cancer from 1980 to 1992 was conducted in an Ontario county with a substantial presence of these industries. Each of the 17 men who died of mesothelioma and 424 with lung cancer were matched with controls who died of other causes. The Job and Industry fields on the death certificates were abstracted. Employment as a maintenance worker in the refinery and petrochemical sector was associated with an increased risk of mesothelioma (odds ratio: 24.5; 90% confidence interval 3.1-102). The risk of lung cancer among petrochemical workers, in comparison with all other workers in the county, was 0.88. In an internal comparison of maintenance employees with other blue-collar workers in the refinery and petrochemical sector, the odds ratio for lung cancer was 1.73 (90% confidence interval 0.83-3.6). This finding is consistent with no difference in risk between maintenance and other employees, but it is also compatible with study power being too low to achieve statistical significance. The hypothesis of increased lung cancer risk could be examined more fully with nested case-control studies in existing cohorts. Meanwhile, it would be prudent to reinforce adherence to asbestos control measures in the refinery and petrochemical sector.

The geographic variation of cancer incidence in Ontario.

Our objectives were (1) to describe an analysis of the spatial pattern of cancer incidence in Ontario and (2) to discuss the quality of data in the Ontario Cancer Registry with respect to the accuracy of local cancer rates. Cancer incidence rates were calculated for 22 cancer sites in 49 counties of Ontario during 1976 to 1986. Capture-recapture methods were used to estimate completeness of case registration, and completeness of residence information was also assessed. Spatial autocorrelation was used in measuring the geographic pattern of incidence rates. Comparisons were also made between sexes and with earlier data from 1966 to 1975. The quality of the geographic data in the registry appeared good, and corrections for incomplete or inaccurate registration had little impact. About one third of the sex-site combinations showed some evidence of spatial patterning in the cancer rate. Particularly strong regional variation was noted for cancers of the stomach, lung, uterus, and prostate. The analysis revealed a number of cancers with significant spatial patterning of risk. Further work is needed to relate the cancer data to other information on potential life-style and environmental factors.

Community-based facilities may be replacing hospitals for the treatment of alcoholism: the evidence from Ontario.

We examined hospital utilization and use of community facilities for the treatment of alcohol problems in Ontario using Statistics Canada, Hospital Medical Records Institute records, and other administrative records. Between 1974 and 1986 there was a large drop in utilization of hospital services for treatment of alcohol problems. Rates of alcohol inpatient cases in general hospitals dropped by 47% and in mental hospitals by 33%. At the same time, there was an increase in overall availability of hospital beds and bed-days of care for all medical conditions, and no change in the total number of hospital discharges (1.3 million) and occupancy rates (80-85%). Also at the same time, the number of community-based programs for the treatment of alcohol problems increased, as did the number of persons or cases treated by them. This was associated with a drop of inpatient cases treated for alcohol problems in 38 out of 48 counties in Ontario (P < .0005). Multiple regression techniques were used to take into account the effect of the slight decline in overall alcohol consumption in this period. We found that after controlling for changes in alcohol consumption, the addition of one community-based alcohol treatment program was associated with a reduction in the number of cases treated on a hospital inpatient basis for alcohol-related problems, with a short-run drop of 27.1 hospital cases within 1 year of a community facility's availability and a long-run reduction of 52.2 cases. (P < .005).

The Spread of the Moss Hyophila involuta in Ontario

The moss Hyophila involuta (Hook.) Jaeg. was discovered on the calcareous walls of most ofthe locks in the Rideau Canal system in southeastern Ontario. The species, known in Canada only from Ontario, apparently has been spread northwards in the water and on the boats travelling through the locks from more southern localities in the United States to its northernmost Ontario locality of 45025 'N latitude. The moss Hyophila involuta (Hook.) Jaeg. (Pot- tiaceae) has always been a rare species in Canada, and at present, is known there only from Ontario. It was first collected in this country by John Ma- coun, who discovered it on limestone rocks in the Bruce Peninsula, along the Sydenham River, Owen Sound, Grey Co., 17 September 1890 (CANM 198186). Kindberg (Macoun & Kindberg 1892) de- scribed the plants two years later as Leptodontium canadense Kindb. in Mac. & Kindb., which Chen (1941) synonymized with H. involuta. Ireland and Cain (1975), in a checklist of Ontario mosses, re- ported its occurrence in three counties: Essex, Lin- coln, and Grey. Later collections added three more counties: Hastings, Peterborough, and Welland. Within each of these counties Hyophila has been collected from only 1-3 localities, all in the Caro- linian (Deciduous) and Great Lakes-St. Lawrence Forest Regions in the southeastern part of the prov- ince. In Ontario, as elsewhere, the plants grow in or near water, on wet limestone or calcareous sand- stone rock or boulders in and along creeks and rivers and also near waterfalls. In Essex County, the south- ernmost county in Ontario, the species is known only from two islands in Lake Erie: East Sister and Pelee.

Planting dates and seeding rates for soft white winter wheat in eastern Ontario

A study was made to determine optimum fall planting dates and rates of seeding of soft white winter wheat (Triticum aestivum L.) in three counties in eastern Ontario. This area is considered marginal for winter survival of the crop, although yield potential is high. Plots were sown at Douglas (lat. 45°33′), Ottawa (lat. 45°23′) and Kemptville (lat. 45°00′). Four planting dates were used at Douglas and Ottawa (dates 1 to 4) and five dates at Kemptville. These were: date 1, 27 August; date 2, 10 September; date 3, 24 September; date 4, 8 October; and date 5, 22 October. Split-plot designs were used, with dates as main plots and with rates and cultivars randomized as subplots. Harvest years were between 1983 and 1987. Winter survival was generally reduced below 60% in later plantings, but survival remained high from the date 4 planting in two years at Ottawa. Grain yields were increased by early plantings. Maximum yields at Douglas were obtained from dates 1 and 2; at Ottawa and Kemptville, from dates 1 to 3. A significant advantage of date 2 planting was recorded at Kemptville. Kernel weight and test weight were reduced by late planting dates. Grain yields and winter survival were highly correlated at seven of nine location-years. At Ottawa, there was a significant yield increase from the 160 kg ha−1 seeding rate, compared with 130 kg ha−1, the currently recommended rate. Yield increases from higher seeding rates were greater at later planting dates. Cultivar effects on grain yields were frequently significant, but were less so on winter survival. The cultivar Houser produced the highest yield in five of nine location-years.Key words: Winter survival, wheat (winter), sowing date, sowing rate