The evaluation of the effectiveness of routine restaurant inspections and education of food handlers: restaurant inspection survey.

To determine restaurant inspection and food handler education practices in Canada, a survey of 141 jurisdictions was conducted. The response rate was 100%. All jurisdictions inspected restaurants, but the frequency of routine inspection varied from none to six or more times per year. The frequency of violations found on routine inspection was associated with foodborne illness. However, the frequency of inspection was not correlated with disease or with violations. Food handler education courses were mandatory in 32% of jurisdictions. Most courses were one to two days. No correlation was found between the numbers of individuals trained in the past year and violations or reported foodborne disease. This lack of reduction in reported foodborne illness may be due to the ecological nature of the survey or to the lack of effectiveness of food handler education or of routine restaurant inspections in reducing violations.

Routine restaurant inspections and education of food handlers: recommendations based on critical appraisal of the literature and survey of Canadian jurisdictions on restaurant inspections and education of food handlers.

Inspection of restaurants and education of food handlers are two methods used by regulatory agencies to ensure food served in restaurants is safe to eat. The variation which exists in the implementation of these programs suggests that the programs' effectiveness is lacking or is not clear. Recommendations based on the Community Health Practice Guideline methodology, the results of a critical review of the literature, the results of a survey of practices, and expert opinion were developed. The recommendations include: continuation of routine inspections at a frequency of one to two inspections per year per restaurant and the continuation of education programs. The evidence on which these recommendations are based is scant and more research is needed to ensure programs are needed, effective and efficient.

Measuring health status: what are the necessary measurement properties?

The different measurement properties necessary for instruments whose goal is to detect differences between subjects at a single point in time (discriminative instruments) and those whose goal is to detect longitudinal change within subjects (evaluative instruments) is becoming increasingly recognized. Up to now, requirements for evaluative instruments have been presented as reproducibility, validity, and responsiveness (i.e. the ability to detect change over time). An alternative conceptualization would characterize any instrument as requiring two crucial measurement properties. One is validity, the other a high ratio of signal to noise. For discriminative instruments, the signal to noise ratio can be summarized in a reliability coefficient; for evaluative instruments, in a responsiveness index or coefficient. This formulation can simplify and clarify the understanding and teaching of issues in health status measurement.

Methodological standards for assessing therapeutic equivalence.

This paper reviews issues related to defining and demonstrating therapeutic equivalence. A set of guidelines are proposed to critically review clinical trials to determine whether there is sufficient evidence to conclude that an experimental therapy is therapeutically equivalent to a standard one. These guidelines include criteria for assessing whether imprecision pertaining to the measurement of outcomes impinges on the validity of an equivalence test.

Comparison between the prevalence and treatment of wheezing and coughing in Brampton and Mississauga children.

An analysis of hospital discharge data showed that Brampton children 4 years and under had higher rates of hospital admissions for asthma, bronchitis and upper respiratory infections than children in the same age group living in Mississauga and other Ontario municipalities. The present study was done to compare the prevalence and treatment of wheezing and coughing between Brampton and Mississauga children 4 and 5 years of age. The study showed that increased use of pediatricians on the part of Mississauga children in comparison to Brampton children resulted in a higher proportion being placed on anti-asthmatic medications even though the underlying prevalence rate of wheezing and coughing was the same in the two samples. Further study is required to determine whether differences in primary care between the two samples can explain a two-fold increase in hospital admission rates for lower respiratory illness among Brampton preschool children in comparison to their counterparts in Mississauga.

A methodological framework for assessing health indices.

Tests or measures in clinical medicine or the social sciences can be used for three purposes: discriminating between subjects, predicting either prognosis or the results of some other test, and evaluating change over time. The choices made at each stage of constructing a quality of life index will differ depending on the purpose of the instrument. We explore the implications of index purpose for each stage of instrument development: selection of the item pool, item scaling, item reduction, determination of reliability, of validity, and of responsiveness. At many of these stages, not only are the requirements for discriminative, predictive, and evaluative instruments not complementary, they are actually competing. Attention to instrument purpose will clarify the choices both for those developing quality of life measures and for those selecting an appropriate instrument for clinical studies.

Assessing symptom control in palliative home care.

Control of symptoms in cancer patients on a home care program was studied, to identify problems related to caring for these patients at home. The study was based on independent physician assessments of patients' medical charts, as well as interviews with the home care providers. The results showed problems in control of pain, nausea and constipation; the causes were less than optimal care and non-compliance. There is an urgent need to improve palliative care to home care patients and to provide better, more frequent reassessment of patients with uncontrolled symptoms.