State mediation of conflicts over work refusals: the role of the Ontario Labour Relations Board.

A key feature of occupational health and safety legislation is that it has sought to compartmentalize health and safety issues by creating structures and processes that depart from "typical" social relations of production. The Ontario Labour Relations Board, in adjudicating disputes concerning work refusals, faces the difficult, if not impossible, task of defining and maintaining a sphere in which workers have an uncommon latitude and power. Analysis of cases before the Board during the 1980s shows how it errs on the side of caution and uses criteria related to "typical" social relations of production to define convincing testimony and assess workers' entitlement to redress. Similarly, employers' interests and the requirements of the labor process are a reference point in the Board's definition of the scope of workers' rights and what constitute legitimate penalties for the "abuse" of these. Yet decisions are not wholly biased toward employers; dissenting opinions reveal important differences and progressive rulings establish precedents that could be a basis for future decisions.     

Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands

BACKGROUND: Variations in the relationships among income, use of mental health services, and sector of care are examined by comparing data from 3 countries that differ in the organization and financing of mental health services. METHODS: Data come from the 1990-1992 National Comorbidity Survey (n = 5,384), the 1990-1991 Mental Health Supplement to the Ontario Health Survey (n = 6,321), and the 1996 Netherlands Mental Health Survey and Incidence Study (n = 6031). Analysis of the association between income and use of mental health services was carried out for the population that was between ages 18 and 54 years. Differential use of mental health treatment was examined in 3 sectors: the general medical sector, the specialty sector, and the human services sector. RESULTS: No significant association between income and probability of any mental health treatment was observed for persons with psychiatric disorders in any of the 3 countries. However, there were significant differences among countries in the association between income and sector of mental health care treatment. In the United States, income is positively related to treatment being received in the specialty sector and negatively related to treatment being received in the human services sector. In the Netherlands, patients in the middle-income bracket are less likely to receive specialty care, while those in the high-income bracket are less likely to be seen in the human service sector. Income is unrelated to the sector of care for patients in Ontario. CONCLUSIONS: Future research should examine whether differential access to the specialty sector for low-income people in the United States is associated with worse mental health outcomes.     

Large Meningioma Complicating Pregnancy

EDITORIAL COMMENT: This case report was accepted for publication because of the clinical lesson it delivers, namely that intracranial tumours, although rare in pregnancy, may as the authors state 'produce a wide variety of symptoms that are difficult to distinguish from the more common symptoms of pregnancy, including nausea, vomiting and headache'. This case suggests that examination of the optic fundi is essential in patients with neurological symptoms even when/especially when there is a history of psychiatric illness.     

Uterine myomas and factors associated with hysterectomy in premenopausal women

OBJECTIVE: Our purpose was to describe clinical characteristics in premenopausal women with uterine myomas and to identify factors associated with hysterectomy.STUDY DESIGN: Data were collected by chart abstraction in 421 premenopausal women with myomas and analyzed by univariate and multivariable regression.RESULTS: Over a median follow-up period of 29 months, 86% of women had symptoms associated with myomas and 40% had an increase in uterine size of >2 gestational weeks. By multivariable regression, bleeding symptoms at presentation and previous surgical history of cholecystectomy and adhesiolysis were significantly associated with greater odds of hysterectomy. There was a significant interaction between age and uterine size, so that as age increased, uterine size had a greater impact on the likelihood of hysterectomy.CONCLUSIONS: In this cohort of premenopausal women myomas were associated with symptoms in almost all women over the follow-up period. Hysterectomy was performed in 22% of women overall. (Am J Obstet Gynecol 1997;176:1213-9.)     

Associations of substance use, abuse, and dependence with subsequent suicidal behavior

General population survey data are used to disaggregate the associations of substance use disorders with suicide attempts in order to evaluate a number of hypotheses about the processes leading to these associations. Data are from the US National Comorbidity Survey (1990-1992). Discrete-time survival analysis is used to study the effects of retrospectively reported temporally prior substance use, abuse, and dependence in predicting first onset of suicidal behavior. Alcohol and drug use predict subsequent suicide attempts after controlling for sociodemographics and comorbid mental disorders. Previous use is not a significant predictor among current nonusers. Abuse and dependence are significant predictors among users for three of the 10 substances considered (alcohol, inhalants, and heroin). The number of substances used is more important than the types of substances used in predicting suicidal behavior. Disaggregation shows that the effects of use are largely on suicidal ideation and nonplanned attempts among ideators. In comparison, the effects of use on suicide plans and planned attempts among ideators are not significant. Clinicians need to be aware that current substance use, even in the absence of abuse or dependence, is a significant risk factor for unplanned suicide attempts among ideators.     

Heating and pain sensation produced in human skin by millimeter waves: comparison to a simple thermal model

Cutaneous thresholds for thermal pain were measured in 10 human subjects during 3-s exposures at 94 GHz continuous wave microwave energy at intensities up to approximately 1.8 W cm(-2). During each exposure, the temperature increase at the skin's surface was measured by infrared thermography. The mean (+/- s.e.m.) baseline temperature of the skin was 34.0+/-0.2 degrees C. The threshold for pricking pain was 43.9+/-0.7 degrees C, which corresponded to an increase in surface temperature of approximately 9.9 degrees C (from 34.0 degrees C to 43.9 degrees C). The measured increases in surface temperature were in good agreement with a simple thermal model that accounted for heat conduction and for the penetration depth of the microwave energy into tissue. Taken together, these results support the use of the model for predicting thresholds of thermal pain at other millimeter wave (length) frequencies.     

A comparison of cause of death determination in men previously diagnosed with prostate cancer who died in 1985 or 1995

PURPOSE: We quantified the agreement between the underlying cause of death determination from information in hospital medical records and on death certificates, and determined whether the frequency of assigning death from prostate cancer had changed since the introduction of testing for prostate specific antigen. MATERIALS AND METHODS: We retrospectively reviewed and analyzed the information in hospital medical records and on death certificates for men previously diagnosed with prostate cancer who died in 1985 or 1995. RESULTS: The underlying cause of death determinations from a review of 201 hospital medical records agreed with those from information on part 1 of the death certificate in 87% of cases and with those using the International Classification of Diseases-9 system coding rules in 80%. Agreement was higher in men who were older than those who were younger at the time of death, and higher in those diagnosed with prostate cancer several years before death than in those diagnosed shortly before death. CONCLUSIONS: There was a high level of agreement concerning the underlying cause of death after a review of the information in hospital medical records and on death certificates for men with prostate cancer when cause of death was viewed as a dichotomous variable. The International Classification of Diseases-9 coding rules concerning the underlying cause of death favor overreporting rather than underreporting prostate cancer deaths compared with a review of hospital medical records. Cause of death determination does not appear to have changed after the introduction of prostate specific antigen testing.