The effects of inspection frequency and food handler education on restaurant inspection violations.

The effectiveness of restaurant inspections and food handler education are not known. Consequently, the optimal frequency of neither has been determined. Thirty randomly selected restaurants from seven health units in three provinces were inspected by one of three senior inspectors. A questionnaire was used to collect the data. The violation score worsened when the time since last inspection was greater than 12 months, but did not worsen when the interval was shorter. Those restaurants in which supervisors and food handlers had completed food handler education courses had better inspection scores than those without. Restaurants whose food handlers had food service education had better scores only for time and temperature violations. These outcomes were all significant in a multiple regression model. The duration of most education courses was under five days. The time since the last food service education course was not significant. Routine inspections should be done yearly. Food service education should be offered to both supervisors and food handlers.

Asthma attack periodicity: a study of hospital emergency visits in Vancouver.

Attendances at the emergency departments of the nine acute care hospitals serving the Vancouver region, with a population of just under a million people, were recorded from July 1, 1984 to October 31, 1986. Of about 25,500 visits a month, 2.7% were for respiratory conditions; and of these, 41.3% were for asthma. Data from 11 air monitoring stations were also tabulated on a daily basis, giving mean maximal hourly values for SO2, NO2, and O3; daily aerosol sulfate measurements from one station were also analyzed, together with daily temperature data and measurements of the coefficient of haze. In 3 consecutive years, a peak in asthma attendances was noted, starting in the last week of September, and continuing for 3 weeks. In these periods, weekly visits for asthma reached 130 patients; during the rest of the year, the weekly visits for asthma varied between 30 and 90. This peak affected children and adults between the ages of 15 and 60, but no increase was seen in those over 60 years. Although pollution levels increased sharply in the fall, a day-by-day analysis showed that the rise in asthma attendances preceded the increase in NO chi and SO2 levels for the region, expressed as the mean of the hourly maxima across all stations. It seems unlikely that a specific pollen is responsible for this, or that house mite replication is the cause. Soya beans are not shipped out of Vancouver. The cause of the peak has not been identified. Variations in emergency visits by day of the week have been recorded; in children and in those aged 15-60, more visits occur on Sundays than on other days, but this does not occur in those over 60. There is no significant variation in environmental data by day of the week. Intercorrelations between environmental variables and emergency visits have been calculated separately for the periods May 1 to October 31, and November 1 to April 31. SO2, NO2, and SO4 are strongly intercorrelated in both periods; ozone is strongly related to temperature, but less strongly correlated to sulfate than is the case in Southern Ontario. In summer, total emergency visits (but not respiratory visits) are strongly correlated with temperature in all age groups (the hotter the day, the more visits occur); but respiratory visits are not related to temperature, ozone, or NO2 levels. However, in the 15-60 age group, asthma and respiratory visits are correlated in summer with SO2 and SO4 levels (P = less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)

Health belief and compliance with screening for fecal occult blood.

Additional data regarding compliance with screening for occult bowel neoplasm using hemoccult II is reported in this paper. The effects of 'health beliefs' and 'barriers to compliance' among a subset of 256 compliers and 166 noncompliers drawn from the population of 5003 patients previously screened were analyzed. Health belief variables as predictors of compliance were found to be age related. Being 'too busy' was frequently given as the reason for noncompliance in all age groups. The percentage of patients correctly classifies as to compliance was appreciably higher than in the earlier study which considered demographic data and the effect of diet restriction. These findings carry implications extending into clinical practice.

Practice patterns of family physicians with 2-year residency v. 1-year internship training: do both roads lead to Rome?

Are there differences in patterns of practice between actively practising physicians who have been certified after a 2-year family practice residency and matched physicians without certification who have completed the standard 1-year internship? With the use of billing files prepared by the British Columbia Medical Association a group of 65 family practice certificants in active practice in British Columbia was compared with a control group of 130 internship trainees matched by year and school of graduation, category of billing (i.e., solo or group) and region. A wide range of practice features was assessed for the fiscal years 1984-85, 1985-86 and 1986-87. No differences were detected between the groups in 1986-87 for the following practice variables: number of patients (1888 and 1842 respectively), number of personal services billed for (7265 and 7173), number of personal services per patient (3.9), amount of funding for personal services ($140,192 and $140,100) and amount per patient for personal services ($77 and $79). Age-adjusted costs for male and female patients were similar in the two groups. Of six services thought to be influenced by type of training, only maternity care generated a significantly higher number of billings in the study group (341 v. 249). These results suggest that there is no demonstrable effect of training on patterns of practice. However, the question of the effect of training on quality of care and whether the 2-year residency may have a longer effect on practice patterns should be the focus of future research.

The Ontario Air Pollution Study: identification of the causative agent.

Previously published data from the Ontario Air Pollution study are reviewed. It has been shown that there is a consistent association in summer between hospital admissions for respiratory disease in Southern Ontario, and daily levels of SO4, O3, and temperature. No association exists for a group nonrespiratory conditions. Multiple regression analyses are presented that show all environmental variables account for 5.6% of the variability in respiratory admissions and that if temperature is forced into the analysis first, it accounts for 0.89% of the variability only. Distribution plots of standardized residuals are presented. In June of 1983, there were an exceptional number of ozone episodes (defined as occasions when ozone was greater than 82 ppb for 3 or more hours in a calendar day) in this region. A separate analysis of hospital admissions for acute respiratory diseases for the month of June for several years shows no demonstrable excess in June of 1983; previously regional analyses have indicated that ozone is associated with increased levels in July and August over a 9-year period. It has also been found that daily SO4 data collected at one monitoring site in the center of the region are not correlated with respiratory admissions, whereas the SO4 values collected every sixth day, on different days of the week, at 17 stations in the region had the highest correlation with respiratory admissions.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient compliance with screening for fecal occult blood in family practice.

Thirty-two family physicians in British Columbia collaborated in a study to evaluate their patients' compliance when offered testing for fecal occult blood (FOB) with Hemoccult II as a screening test for asymptomatic colorectal cancer. Of the 5003 eligible patients 71% complied. Thirteen variables were investigated. Compliance was found to be directly related to age in a linear manner (chi-squared value for trend = 180.4, p less than 0.0001), age alone correctly classifying 58.5% of the patients as complying or not complying. The association with other variables was less strong. Restricting the consumption of red meat during the test period had no effect on compliance.

Air pollution and hospital admissions in Southern Ontario: the acid summer haze effect.

Air pollution data from 17 sampling stations between Windsor and Peterborough in Southern Ontario, for January, February, July, and August in 1974 and 1976 to 1983, have been analyzed. Each station reported O3, NO3, SO2, and the coefficient of haze (COH) every hour and aerosol sulfates for a 24-hr period every sixth day using glass-fiber filters. Data on mean daily temperature and relative humidity for the region were also recorded. It is shown that there are high correlations between different pollutants and between these and temperature in the summer. In the summer, sulfate levels were significantly correlated with relative humidity. In winter, the highest correlation was between COH and NO2. Over the 9-year period, SO2 levels in both winter and summer have fallen considerably; there have been no significant trends in O3, NO3, or COH data. Aerosol sulfates increased between 1976 and 1980 in both summer and winter and have since declined slightly. Hospital admission data for the 79 acute care hospitals serving the region, which contains about 5.9 million people, have been analyzed on a daily basis for the same months of the same years. Total admissions and total respiratory admissions have declined about 15% over the period, but asthma admissions appear to have risen. The asthma category of admissions is complicated by the effects of a change in ICD coding in 1979. It has been shown that significant correlations exist between O3, SO4, SO2, and temperature, on the one hand, and deviations from the mean respiratory admissions for that day of the week, for that season, for that year, on the other. These correlations exist if asthma is excluded from the diagnoses. In winter, asthma admissions are correlated with temperature only. A group of nonrespiratory conditions showed no correlations with air pollutants in winter or summer. Stepwise multiple regression analysis based on each year considered individually indicates that in summer SO4 and temperature account for about 5% of the variance in respiratory or asthma admissions. It is shown that the mean of the hourly ozone maxima has a high correlation with the maximal 8-hr average for ozone, and that using this index instead of the mean of the hourly maxima does not increase the correlation coefficient with respiratory disease. Another analysis has been performed by grouping the hospitals and sampling stations into nine separate regions.(ABSTRACT TRUNCATED AT 400 WORDS)

The effect of triphasic and biphasic oral contraceptive preparations on HDL-cholesterol and LDL-cholesterol in young women.

Lipid changes were measured during two consecutive studies on efficacy, side effects, and metabolic changes of oral contraceptive (OC) preparations. The mean lipid values of women on OCs at the start of the two studies were compared to those of women who had not taken OCs for at least 3 months. It was found that LDL-cholesterol (LDL-C) mean values of the women on OCs were higher than the mean values of women who had not taken OCs for at least 3 months. In study #1, women received the OC preparation Triphasil. In study #2, women were randomised to one of 3 OC preparations (Triphasil, Ortho 777 or Ortho 10/11). HDL-cholesterol (HDL-C) and LDL-C were measured over time at six months and at 12 months after receiving the study medications. The results show that HDL-C increased in women on Ortho 777 and 10/11 and decreased in women on Triphasil at six months, and these changes were not found at 12 months. The results showed change over time for the LDL-C mean values, in that women not on OCs at the start of the studies had increased LDL-C mean values, and women on OCs at the start of the studies had decreased LDL-C mean values. Further the LDL-C mean values in women not on OCs at the start of the studies who received Triphasil (containing the gonane progestin dl-norgestrel) increased over time, whereas the combined mean values of those who received Ortho 777 and Ortho 10/11 (containing the estrane progestin norethindrone) did not increase over time.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: Lipid changes were measured during 2 consecutive studies on efficacy, side effects, and metabolic changes of oral contraceptive (OC) preparations. The mean lipid values of women on OCs at the start of the 2 studies were compared to those of women who had not taken OCs for at least 3 months. It was found that LDL-cholesterol (LDL-C) mean values of the women on OCs were higher than the mean values of women who had not taken Ocs for at least 3 months. In study 1, women received the OC preparation T riphasil. In study 2, women were randomized to 1 of 3 OC prep arations (Triphasil; Ortho 777; or Orhto 10/11). HDL cholesterol (HDL-C) and LDL-C were measured over time at 6 months and at 12 months after receiving the study medications. The results show that HDL-C increased in women on Ortho 777 and 10/11 and decreased in women on Triphasil at 6 months, and these changes were not found at 12 months. The results showed change over time for the LDL-C mean values, in that women not on OCs at the start of the studies had increased LDL-C mean values, and women on OCs at the start of the studies had decreased LDL-C mean values. Further the LDL-C mean values in women not on OCs at the start of the studies who received Triphasil (containing the gonane progestin dl-norgestrel) increased over time, whereas the combined mean values of those who received Ortho 777 and Ortho 10/11 (containing the estrane progestin norethindrone) did not increase over time. Since blood samples were taken at random during the menstrual cycle, analyses were performed to determine if this variable would have confounded the results. A week negative correlation was found with LDL-C values in women after 6 months on the study medication. No other significant correlation was detected for this variable in the data.

Occult blood testing for early detection of colorectal cancer: diagnostic outcomes.

Three thousand five hundred and fifty-four asymptomatic persons from 32 family practices returned hemoccult II tests for colorectal cancer; 2.2% of these returned tests were positive. The diagnoses for the 47 persons with positive tests which were done while on meat restriction included six cancers (1.7/1000) and five polyps (1.4/1000); 18 were diagnosed with other known sources, and 18 were undiagnosed. All polyps and four of six cancers were diagnosed by combined barium enema with sigmoidoscopy or by colonoscopy. Five of six cancers were diagnosed at early stages. Meat restriction, the method of returning the test for analysis, the number of holes completed in the test, and the delay time from completing the test to analysis did not influence the likelihood of a positive test.

Metabolic effects of two triphasic formulations containing ethinyl estradiol and dl-norgestrel.

The metabolic effects of two triphasic oral contraceptive (OC) preparations containing dl-norgestrel (dlN) and ethinyl estradiol (EE) were studied in young women. The marked difference in the two preparations was in the progestogen content, allowing the study of the metabolic effects of high and low progestogen in oral contraception. The results suggest that high progestogen increases serum sodium, potassium, blood urea nitrogen, creatinine, total protein, albumen, and lactic dehydrogenase. An increase in aspartate transaminase and a decrease in alkaline phosphatase were probably estrogen-related. High progestogen significantly reduced the fasting blood glucose levels (p less than .001). Both preparations significantly increased the levels of cholesterol and triglycerides in women who had not taken OCs for 3 or more months, and with the low progestogen preparation these increases are dissimilar to the effects reported in the triphasic preparations containing levonorgestrel.

PIP: The metabolic effects of 2 triphasic oral contraceptives (OCs) containing dl-norgestrel (dlN) and ethinyl estradiol (EE) were studied in young women. The marked difference in the 2 preparations was progestogen content, allowing the study of the metabolic effects of high and low progestogen in OCs. The results suggest that high progestogen increases serum sodium, potassium, blood urea nitrogen, creatinine, total protein, albumen, and lactic dehydrogenase. An increase in aspartate transaminase and a decrease in alkaline phosphatase were probably estrogen-related. High progestogen significantly reduced the fasting blood glucose levels (P.001). Both preparations significantly increased the levels of cholesterol and triglycerides in women who had not taken OCs for 3 or more months, and with the low progestogen preparation, these increases are dissimilar to the effects reported in the triphasic preparations containing levonorgestrel.