Molecular self-organization in cylindrical nanocavities.

We studied molecular organization in cylindrical nanocavities using liquid crystals. NMR analysis shows high surface-induced ordering way above the bulk critical temperature. The surface-order evolution reveals replacement of the isotropic phase by a paranematic phase and surface-induced disordering in the nematic phase. Due to strong surface potential and nanoconfinement, complete wetting and continuous evolution of the surface-order parameter are observed through the nematic-paranematic transition. As we show, the counter-intuitive absence of complete phase transition at the interface while an abrupt phase transition was measured in the averaged order parameter is in good agreement with established theories.

Polarization-selective switching in holographically formed polymer dispersed liquid crystals.

We have developed an optical stack of holographically formed polymer dispersed liquid-crystal (H-PDLC) devices that is fully operational with nonpolarized light sources. The device consists of two H-PDLC transmission gratings separated by a passive polarization rotator that can output a diffracted s-polarized, p-polarized, or s- and p-polarized beam simultaneously.

Wealth, equity and health care: a critique of a "population health" perspective on the determinants of health. Critical Social Science Group.

In this paper we examine the recent ascendancy of a "population health" perspective on the "determinants of health" in health policy circles as conceptualized by health economists and social epidemiologists such as Evans and Stoddart [Evans and Stoddart (1990) Producing health, consuming health care. Social Science & Medicine 31(12), 1347 1363]. Their view, that the financing of health care systems may actually be deleterious for the health status of populations by drawing attention away from the (economic) determinants of health, has arguably become the "core" of the discourse of "population health". While applauding the efforts of these and other members of the Canadian Institute for Advanced Research for "pushing the envelope", we nevertheless have misgivings about their conceptualization of both the "problem" and its "solutions", as well as about the implications of their perspective for policy. From our critique, we build an alternative point of view based on a political economy perspective. We point out that Evans and Stoddart's evidence is open to alternative interpretations--and, in fact, that their conclusions regarding the importance of wealth creation do not directly reflect the evidence presented, and are indicative of an oversimplified link between wealth and health. Their view also lacks an explicit substantive theory of society and of social change, and provides convenient cover for those who wish to dismantle the welfare state in the name of deficit reduction. Our alternative to the "provider dominance" theory of Evans and Stoddart and colleagues stresses that the factors or forces producing health status, which Evans and Stoddart describe, are contained within a larger whole (advanced industrial capitalism) which gives the parts their character and shapes their interrelationships. We contend that this alternative view better explains both how we arrived at a situation in which health care systems are as costly or extensive as they are, and suggests different policy avenues to those enunciated by Evans, Stoddart and their confrères.

Smoking control in the workplace: is workplace size related to restrictions and programs?

Regarding smoking control in the workplace, small independent operations may differ from large workplaces or from small worksites that are branch units of large companies/organizations. We examined the relationships of worksite and company size to workplace smoking restrictions and programs, using data from a population-based telephone survey. Three worker groups, differentiated by worksite and company size, were compared. Small workplace workers were least knowledgeable about smoking restrictions, reported fewer restrictions in place, and were least willing to intervene in coworkers' smoking. As well, smoking-related programs, although generally uncommon, were reported least often by these workers. Branch workers were not uniformly similar to either small or large workplace workers. In policy and program interventions, organizational influences and/or attributes of individuals drawn to different-size work settings should be considered.

Canadian approaches to the promotion of health in small workplaces.

The promotion of health in small workplaces is particularly challenging. Research was conducted to identify the types of agencies offering prevention and promotion services to small workplaces, and to describe the activities and strategies used to engage this "hard-to-reach" population. This paper reports on a survey of 58 agencies located across Canada. Agencies were mostly of recent origin, many having arisen in response to legislative and other government initiatives, and of two essential types: those that used the workplace as a site for addressing general lifestyle health behaviours, and those addressing the occupational determinants of health. Their location, staffing and program focus reflected their orientation. Factors believed by respondents to influence program effectiveness are summarized. The paper notes the top-down origins of many prevention/promotion efforts, their inherent management bias, and the differing perspectives that underlie the lifestyle and occupational approaches to workplace health. A call for integration of the two approaches is made.

Back problems are for life: Perceived vulnerability and its implications for chronic disability.

As part of a qualitative research study of the experience of work-related back problems, a series of in-depth ethnographic interviews were conducted with 15 workers receiving treatment for back injuries. Analysis of these data revealed that the workers perceived their back problems as lifelong problems. Many believed that their back injuries had permanently heightened their vulnerability to reinjury and chronic disability. Accommodating this sense of physical vulnerability required a redefinition of one's self and one's future. For some workers, the perceived threat of future back problems was itself disabling and appeared to discourage a return to normal social roles. Workers' interactions with the health care system shaped their perceptions of their bodies and their notions of the appropriate means to cope with their physical vulnerability. Implications of the perception of permanence for the development of chronic disability among workers who experience back problems are examined.

A critical perspective on research and knowledge development in health promotion.

The paper addresses four issues that pervaded conference deliberations: the relevance of qualitative approaches to research, the importance of community participation in the research process, the need to broaden the disciplinary base of health promotion, and the possibilities for a critical research perspective. The paper suggests why the idea of qualitative methods is so appealing to health promotion researchers, and what may prevent such methods from living up to the expectations held of them. The emphasis on community participation in research expresses an attempt to make research more relevant and accountable, but it also may inhibit the theoretical grounding of research, and create strain between pragmatic and scientific interests. The field of health promotion is inherently multidisciplinary, but it remains unclear if and how different disciplines can be effectively combined or integrated. The relative absence of critical thought at the conference is noted, and the authors argue that a critical perspective is needed in both "research of" and "research for" health promotion.

Leaving it up to the workers: sociological perspective on the management of health and safety in small workplaces.

Small workplaces present particular challenges for the promotion of occupational health and safety. However, little is known about the social organization of work in such settings and how it relates to matters of health and safety. The research on which this article is based relates patterns of occupational health behavior to the nature of social relationships within the workplace. From a qualitative analysis of interviews with 53 small business owners, the author describes the most common approach to managing workplace health and safety: leaving it up to the workers. This posture is explained in terms of the owners' perception of risk, particularly their understanding of workplace hazards, and their assessment of the social costs of ignoring or addressing such issues. Owners tended to discount or normalize health hazards, and to believe that management intervention in employee health behavior was paternalistic and inconsistent with prevailing patterns of labor relations and norms respecting individual autonomy. Many owners understood health and safety not as a bureaucratic function of management but as a personal moral enterprise in which they did not have legitimate authority. The conceptualization of the owners' responses in terms of "social rationality" has implications for addressing problems of health and safety in small workplaces.

Physicians' perception of personal risk of HIV infection and AIDS through occupational exposure.

Physicians' response to acquired immune deficiency syndrome (AIDS) is poorly understood and often attributed to fear of human immunodeficiency virus (HIV) infection through occupational exposure. We surveyed 268 physicians from three geographic regions in North American with different specialties and responsibilities for HIV-positive patients. An important difference was found between the published risk and the physicians' perceived risk of infection after a single occupational exposure. Almost half of the respondents stated that they feared contracting AIDS more than other diseases. The physicians who perceived themselves to be at high physical risk were more likely than the others to report that AIDS had changed the way they interact with their patients (r = 0.26, p less than 0.001). No relation was found between the perception of physical risk and the number of HIV-infected patients (r = -0.07, p = 0.15). However, the perception of social risk showed a small inverse correlation (r = -0.15, p less than 0.02), in which the physicians with more HIV-infected patients reported less concern about negative social consequences. The physicians who perceived themselves to be at high personal risk were more likely than the others to report that surgeons have the right to refuse patients who do not wish to undergo HIV antibody testing (r = -0.16, p less than 0.01 for physical risk; r = -0.29, p less than 0.001 for social risk). Multiple regression analyses indicated that physicians' perception of physical risk was not related to age or sex but was modestly related to income source. The perception of social risk was related to sex and income source. Physicians' perception of personal risk is a crucial, yet often unacknowledged, component of the fight against AIDS. Our findings suggest that lack of attention to this issue is seriously compromising initiatives designed to facilitate physician participation in AIDS care.

Children's health and illness behaviour: the single working mother's perspective.

This study explored how single working mothers perceive and deal with concerns about their children's health. "Grounded theory" analysis of data from interviews with single mothers in a wide variety of circumstances suggested that contextual factors including the mother's work situation, child care and social network are important to understanding the health and illness behaviour of these families. Children's use of health services appeared to reflect the single mother's attempts to manage her roles as mother (nurturer) and worker (provider), and her sense of role flexibility. A sense of flexibility appeared to mitigate role conflict and to interact with other known influences of health services utilization including the quality of the client/practitioner relationship. The mother's sense of flexibility appeared to vary with her income, child care arrangement, work situation (e.g., emphathetic supervisor), access to tangible support (e.g., child care) and social network (i.e., proximity to her family of origin).

Understanding physicians' response to AIDS.

Attempts to comprehend physicians' extreme reaction to AIDS (acquired immune deficiency syndrome) have met with great difficulty since the disease brings into question traditional norms and assumptions. As the medical profession struggles to develop guidelines and policies to help it deal with this disease, it can draw on very little systematic research on the effect of AIDS on physicians' attitudes and practices. We suggest a framework developed from the literature on physicians' and society's response to other disorders that would provide a basis for organizing the ever-increasing amount of information on physicians and AIDS and would guide systematic research aimed at understanding and predicting physicians' participation in the prevention and management of AIDS. Within this framework we consider how characteristics of the disease, elements of the health care system and physicians' attitudes interact to influence clinical and personal practices. AIDS had led to new delineations of physicians' responsibility, modification of prevailing beliefs about physician autonomy and thus a redefinition of the role of the physician in North America.

Factors associated with enrollment in an employee fitness center.

Employee fitness programs may be evaluated by comparing program participants with nonparticipants on program outcome variables. This study was designed to identify how participants in an employee fitness program may selectively differ from nonparticipants. Joiners were more likely to have engaged in prior fitness activity, to consider fitness a high priority, and to have more positive attitudes about keeping fit. Traditional factors such as demographic or health status variables were not different between joiners and nonjoiners. Although the fitness center was not systematically selecting the more fit employee, participants were different from nonparticipants in terms of attitudinal and behavioral factors which reflect a health promotion orientation.

Hospital power structure and the democratization of hospital administration in Quebec.

In 1973, the Canadian Province of Quebec 'democratized' its hospital boards of directors by replacing the previous 'elite' boards by boards representative of the hospitals' major interest groups. This study looks at the impact of these participatory boards on the distribution of power within hospitals, particularly their effect on the hospital administrators' position of control in relation to their boards of directors and medical staff. Findings include a deterioration in the administrators' sense of organizational control, a weakening of the boards' authority over physicians, and a concentration of decision-making outside of the boardroom.

Survival of the fittest? The democratization of hospital administration in Quebec.

In 1973 the Canadian Province of Quebec "democratized" its hospital boards of directors by replacing their traditional lay community or religious members with individuals more representative of the hospitals' major interest groups. In the province's English-speaking hospitals, patients, community organizations, physicians and nonprofessional hospital employees elected representatives to boards that were formerly comprised mostly of business executives. After a brief description of the social organization of the former "elite" boards and their role in the distribution of power within hospitals, the paper demonstrates how the "elite" board members and hospital administrators retained control despite "democratization." Several theoretical explanations for this outcome are critically examined in the light of these empirical findings. One suggestion is that the "elite" administration survived democratization because it was "fitter" in terms of ability to influence the hospitals' major economic and political constraints.