The prevalence of obesity, defined as body mass index (BMI) of 30 kg/m2 or higher for adults and as 2 standard deviations above the World Health Organization growth standard mean for children, has increased in many parts of the world. Obese adults are at an increased risk of certain chronic conditions, including hypertension, type 2 diabetes, cardiovascular diseases and some cancers, and of premature death. Obese children have increased cardiometabolic risk, including dyslipidemia, insulin resistance and elevated blood pressure. Excess childhood body weight that continues into adulthood can affect quality of life, educational attainment and earnings over the lifecourse. The Public Health Agency of Canada has projected an annual direct health care cost (including physician, hospitalization and medication costs) of those categorized as obese in Canada in constant 2001 Canadian dollars. Calculated as $7.0 billion in 2011, this annual direct health care cost is projected to rise to $8.8 billion by 2021, based on simulated average direct health care costs, which are higher among the obese ($2,283) than the overweight ($1,726), the underweight ($1,298) and those at normal weight ($1,284). Canadian estimates from 2006 and 2008 that used different methodologies place the annual economic burden (direct and indirect costs) of obesity between $4.6 billion and $7.1 billion. The purpose of this evidence brief is to show current Canadian obesity prevalence rates and estimates for the future using objectively measured height and weight to calculate BMI. The use of objectively measured height and weight to derive BMI is strongly recommended, especially for children and adolescents, as self- or proxy-reported height and weight tend to underestimate actual weight and consequently BMI and obesity prevalence.

Beginning in 2010, the Public Health Agency of Canada partnered to develop two models to estimate future health and economic burden from the increasing trend in body mass index (BMI) among Canadians, and to build an evidence base to compare the effectiveness of alternative courses of public health action. The two complementary approaches: 1) An aggregate approach based on a "top-down" analysis, which employs a multiple cohort model. The Canadian ACE-BMI model, developed with the University of Queensland, adapted the Australian BMI model from the Assessing Cost Effectiveness (ACE) Prevention project for Canadian data and context. 2) A dynamic microsimulation approach based on "bottom-up" incorporation of Canadian micro-data into Statistics Canada's Population Health Model (POHEM). POHEM simulates open Canadian populations and supports cohort analyses. With Statistics Canada, a revised and improved BMI module was developed (POHEM-BMI). Both models estimate health (obesity prevalence; disease incidence/prevalence/mortality; life expectancy), health-related quality of life (health/disability adjusted life years) and economic (direct costs) effects of the rising BMI trend. Both allow simulation of counterfactual scenarios to project health outcomes short and long-term time horizons. They differ with respect to the simulated populations: POHEM simulates future open Canadian populations whereas the Canadian ACE-BMI model simulates the cohort's future. This workshop will examine modelling as a tool for policy and program development. It will also introduce both modelling approaches and compare and contrast the models' inputs, outputs, underlying process, assumptions and relevant questions each can reliably address.

In 2010-11, Statistics Canada and the Public Health Agency of Canada (PHAC) collaborated to develop a dynamic Population HEalth Microsimulation model for Body Mass Index (POHEM-BMI) of the impact of BMI and health outcomes and costs averted for Canada to estimate the relative effectiveness (net health outcomes and costs avoided) of obesity interventions. To guide decisions to address trends in childhood obesity in Canada, PHAC required evidence of child interventions and quantitative estimates of their effect. This research report will introduce participants to POHEM-BMI as an accessible planning tool for evidence-based policy on childhood obesity in Canada. It will also introduce participants to a project that aimed to compile a preliminary quantitative evidence base of interventions for addressing childhood obesity to be used to specify a set of alternative scenarios for POHEM-BMI, and to consider future needs for the application of POHEM-BMI as an accessible planning tool for evidence-based policy action. Evidence was prioritized to include intervention evidence reviews (vs. correlation research or single studies) with BMI as an outcome measure. A total of 14 study findings fell within five broad types of interventions: reducing food advertising to children (2), reducing screen time (3), school-based (4) and non-school-based (4) interventions to increase physical activity and healthy eating, and a school-based intervention to reduce consumption of carbonated drinks (1). Future needs for strengthening the capacity of the POHEM-BMI model to contribute to evidence-based policy relate to search strategies, reporting intervention characteristics, developing child population databases, and creating a POHEM-BMI user guide.

BACKGROUND:Computer simulation modeling makes it possible to project physical activity levels and the prevalence of related health outcomes. Such projections can help to inform programs that aim to increase physical activity levels and improve population health.DATA AND METHODS:The Population Health Model (POHEM) platform was used to develop a dynamic microsimulation model of physical activity among Canadian adults. Key parameters were derived from the National Population Health Survey (1994/1995 to 2006/2007) and the 2000/2001 Canadian Community Health Survey. To assess the validity of the physical activity module (POHEM-PA), estimates from the simulation projections were compared with results from nationally representative surveys.RESULTS:Trends over time in physical activity levels, chronic disease prevalence, and Health Utilities Index based on POHEM-PA projections were similar to those based on data from subsequent cycles of the Canadian Community Health Survey.INTERPRETATION:The addition of a physical activity module to POHEM provides a tool that can improve understanding of the complex dynamics underlying the relationship between physical activity and health outcomes as a population ages.

A recent joint Statistics Canada-Public Health Agency of Canada initiative enhanced the proven POpulation HEalth Model (POHEM) to better simulate the dynamics of body mass index (BMI). Whereas POHEM-BMI generates rich information on projected patterns of BMI, chronic diseases, health outcomes, and health-care costs, such "desktop" tools are rarely used by decision-makers to assess policy options. A concise translation of the decision-space defined by these simulations, however, provides a visual aid for positioning the evidence-base of proven actions (what can be achieved) in the context of what needs to be achieved. We constructed the decision-space from the parameter-ranges that specify intervention: reduction in mean BMI (efficacy x population uptake; 0% to 100%; duration), target cohort (age-sex grouping, youth, adult, all), and policy-horizon (years). Applying these scenarios to POHEM-BMI generates alternative patterns of disease, outcomes, and costs summarized as proportional change from the status quo. Using this aid, the evidence-base is translated into projected lifecourse health-gains and cost-savings for comparison against the expectations of policy. This aid focuses the attention of decision-makers on: intervention- where the reducing childhood BMI requires maintenance during adulthood to achieve meaningful gains and savings; demographics- where the impact of population-based action is driven by middle-aged adults and the effect of reducing childhood BMI is diluted over time by the overarching aging of the population; time- where immediate gains and savings from reducing childhood obesity are offset by the impact of future patterns of disease, disability, and mortality experienced by the survivors.

The first drug treatment court in Canada began operation in Toronto in December of 1998. This paper describes some aspects of the evolution, structure, and operation of this court. In addition, the federally-funded evaluation of the new program has produced data from the first 18 months of its full operation when 198 drug-dependent individuals were admitted. These preliminary results are described and compared to the findings of an Australian study and to select American studies. Important differences in sentencing practices and options for drug offenses between Canada and the United States are highlighted. Even at this early stage of development, it is suggested that the types of clients retained and more successful in this Canadian experiment may be quite different from the more typical American drug treatment court clientele. The need for careful monitoring and more complete, long-term information is emphasized before the viability of this approach is established for Canada.

Using cost-of-illness methodology applied to a comprehensive survey of 114 daily opiate users not currently in or seeking treatment for their addiction, we estimated the 1996 social costs of untreated opioid dependence in Toronto (Ontario, Canada). The survey collected data on social and demographic characteristics, drug use history, physical and mental health status, the use of health care and substance treatment services, drug use modality and sex-related risks of infectious diseases, sources of income, as well as criminality and involvement with the law enforcement system. The annual social cost generated by this sample, calculated at Canadian $5.086 million, is explained mostly by crime victimization (44.6%) and law enforcement (42.4%), followed by productivity losses (7.0%) and the utilization of health care (6.1%). Applying the $13,100 cost to the estimated 8,000 to 13,000 users and 2.456 million residents living in Toronto yields a range of social cost between $43 and $69 per capita.

BACKGROUND:The authors used a nursing task inventory system to assess nursing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU).METHODS:Over 3 months, 2,031 patients were observed, and each task/activity related to direct patient care was recorded and assigned points according to the Project Research in Nursing (PRN) workload system. PRN values for each patient were merged with data from an anesthesia database containing demographics, anesthesia technique, and postoperative adverse events. Mean and median PRN points were determined by age, sex, duration of procedure, and mode of anesthesia for patients with and without adverse events in the PACU. Three theoretical models were developed to determine the effect of differing rates of adverse events on the requirements for nurses in the PACU.RESULTS:The median workload (PRN points) per patient was 31.0 (25th-75th percentile, 25-46). Median workload was 26 points for patients with no postoperative events and 155 for > or = six adverse events. Workload varied by type of postoperative event (e.g., unanticipated admission to the intensive care unit, median workload = 95; critical respiratory event = 54; and nausea/vomiting = 33). Monitored anesthesia care or general anesthesia with spontaneous ventilation used less resources compared with general anesthesia with mechanical ventilation. Modeling various scenarios (controlling for types of patients) showed that adverse events increased the number of nursing personnel required in the PACU.CONCLUSIONS:Nursing care documentation based on requirements for individual patients demonstrates that the rate of postoperative adverse events affects the amount of nursing resources needed in the PACU.

Regulations in Ontario, Canada, as in most provinces and states in North America, require human tissues (with few exceptions) removed at surgery to be sent to a pathology laboratory for examination and report. We hypothesized that this practice is inconsistently followed and that routine pathological consultation is costly and rarely results in a change in treatment for patients undergoing knee arthroscopy. Chiefs of pathology, orthopaedic surgeons, and orthopaedic operating room nurse managers in Ontario hospitals that perform arthroscopic knee surgery were surveyed for compliance. We determined cost using pathology department procedure codes and evaluated effectiveness as the correlation between the postoperative diagnoses of orthopaedic surgeons and pathologists for 1,036 consecutive knee arthroscopy cases. In only one case (0.1%) was it felt that pathology consultation had the potential to significantly alter patient care. The total cost of pathology consultation for the 1,036 cases reviewed was $234,147.00 (mean cost per case, $226.00). Ninety percent of hospitals do not comply with the regulations regarding the processing of these tissues. Poor compliance is justified by the lack of diagnostic value and the need to contain health care costs.

We evaluated the use of utility measurements to assess the quality of life of patients with Crohn's disease. Utility scores were obtained using the Time Trade-Off (TTO), Standard Gamble, and Visual Analog Scale (VAS) methods in 180 consecutive patients with Crohn's disease. The mean utility scores of patients with a spectrum of disease severity were compared with other measures of disease activity to assess the operating properties of these instruments. All methods of utility estimation yielded lower mean scores in patients with more severe disease. (Remission versus chronically active, therapy resistant disease: TTO 0.96 versus 0.88; Standard Gamble 0.88 versus 0.74; VAS 0.84 versus 0.61). TTO scores were consistently higher than those derived by the other methods (p = 0.001). The utility scores were reliable in patients who were stable (intraclass correlation coefficient 0.55-0.84), but were less responsive than the Crohn's Disease Activity Index (responsiveness ratio 0.97-1.3 versus 2.10) to changes in disease severity. Patients with active Crohn's disease have decreased quality of life as measured by utility scores. Although utilities are valid and reliable quality of life assessments, they are less responsive than other measures of outcome used for clinical trials.

Chez les aînés, les cataractes séniles sont une des causes principales des diverses incapacités dues à la cécité. Le nombre de chirurgies pour des cataractes, opération permettant au patient de recouvrer la vue, augmentera probablement compte tenu du vieillissement de la population canadienne, des attentes grandissantes des patients et des progrès technologiques. Une des méthodes suggérées pour améliorer l'efficacité du traitement serait de réduire la durée traditionnelle du séjour post-opératoire. Cet article examine l'efficacité clinique et détermine le coût de différentes modalités de soins post-opératoires, du point de vue du système ontarien de soins de santé, des patients, de leurs aides, et de la société. Les coûts et les conséquences sont comparés en utilisant une méthodologie analytique de minimisation de côuts. Bien qu'un séjour post-opératoire écourté semble permettre de réaliser des économies, les conséquences distributionnelles qui surviennent lorsque le séjour post-opératoire à l'hôpital est remplacé par les soins à domicile pourraient ralentir son adoption. Dans le but d'éviter ces conséquences distributionnelles, il faudrait déduire les sommes destinées préalablement aux hôpitaux et les confier aux agences de soins communautaires et aux aides des patients. Compte tenu du fait qu'une chirurgie pratiquée dans un service de consultation externe semble être tout aussi efficace qu'une chirurgie pratiquée en milieu hospitalier, les responsables politiques devraient étudier les stratégies qui permettraient de bénéficier de ces économies possibles.

Clinical information systems (CIS) are health care technologies that can assist clinicians and clinical managers to improve the performance of health care organizations. However, failure to consider scientific evidence of efficacy, effectiveness, and efficiency when selecting CISs is one factor explaining the adoption of systems that do not improve either the quality or efficiency of patient care. This paper discusses a technology assessment framework that can assist decision-makers to evaluate alternative CISs. Existing methodologies developed to evaluate diagnostic and therapeutic technologies can be used by researchers to provide evidence needed by decision-makers at each step of the framework. The rigorous evaluation of CISs prior to their implementation can help decision-makers to avoid adopting "white elephants."

The shortage of registered nurses for hospital work is a serious concern to health care providers, managers and planners (Meltz, 1988; Rachlis & Kush-ner, 1989). This shortage is related to a variety of factors, including absenteeism and turnover among nurses and the productivity of nurses on the job. There are both tangible (Cascio, 1982; Jones, 1990a, 1990b; Spencer, 1986; Wolf, 1981) and intangible (Mowday, Porter & Steers, 1982; Wolf, 1981) costs associated with both absenteeism and turnover; the reduction of them is thus a key component of planning for nurse staffing in many hospitals. The improvement of job satisfaction among nurses can play a role in the reduction of absenteeism (Bechtold, Szilagyi & Sims, 1980; Price & Mueller, 1986; Redfern, 1978), the reduction of turnover (Bechtold et al., 1980; Cotton & Tuttle, 1986; Curry & Wakefield, 1985; Kosmoski & Calkin, 1986; Moore & Simendinger, 1989; Petty, McGee & Cavender, 1984; Pres-cott, 1986; Price & Mueller, 1986), and in the improvement of productivity (Bechtold et al., 1980; Petty et al., 1984). There are many factors that influence work satisfaction (MacPhail, 1988; Mottaz, 1988). This paper is a study of one of them, the compatibility of nurses with the work available on the units on which they work. It is a widely accepted premise of those who study organizational behaviour (eg. Gibson, Ivancevich & Donnelly, 1988) that the outcomes of work (such as productivity, job satisfaction, turnover and absenteeism) depend upon the matching of the worker with the work. For example, if the worker and work are poorly matched with respect to skills, so that the worker does not have the skills necessary to do the job properly, productivity will be low and the worker will probably experience frustration and dissatisfaction with the job. Absenteeism and turnover can result. Workers and work can also be poorly matched with respect to need satisfaction. It can happen that the day to day execution of the work provides no intrinsic satisfaction to the worker, even though the worker is capable of doing the work. In this case also, productivity