Severe acute respiratory syndrome (SARS), a new, highly contagious, viral disease, emerged in China late in 2002 and quickly spread to 32 countries and regions causing in excess of 774 deaths and 8098 infections worldwide. In the absence of a rapid diagnostic test, therapy or vaccine, isolation of individuals diagnosed with SARS and quarantine of individuals feared exposed to SARS virus were used to control the spread of infection. We examine mathematically the impact of isolation and quarantine on the control of SARS during the outbreaks in Toronto, Hong Kong, Singapore and Beijing using a deterministic model that closely mimics the data for cumulative infected cases and SARS-related deaths in the first three regions but not in Beijing until mid-April, when China started to report data more accurately. The results reveal that achieving a reduction in the contact rate between susceptible and diseased individuals by isolating the latter is a critically important strategy that can control SARS outbreaks with or without quarantine. An optimal isolation programme entails timely implementation under stringent hygienic precautions defined by a critical threshold value. Values below this threshold lead to control, but those above are associated with the incidence of new community outbreaks or nosocomial infections, a known cause for the spread of SARS in each region. Allocation of resources to implement optimal isolation is more effective than to implement sub-optimal isolation and quarantine together. A community-wide eradication of SARS is feasible if optimal isolation is combined with a highly effective screening programme at the points of entry.

Approximately 1.5% of Ontario' s population, represented by the top 5% highest cost-incurring users of Ontario' s hospital and home care services, account for 61% of hospital and home care costs. Similar studies from other jurisdictions also show that a relatively small number of people use a high proportion of health system resources. Understanding these high-cost users (HCUs) can inform local healthcare planners in their efforts to improve the quality of care and reduce burden on patients and the healthcare system. To facilitate this understanding, we created a profile of HCUs using demographic and clinical characteristics. The profile provides detailed information on HCUs by care type, geography, age, sex and top clinical conditions. RésuméEnviron 1,5 % de la population ontarienne, qui correspond à 5 % des usagers qui génèrent le plus de coûts pour les services hospitaliers et les soins à domicile en Ontario, comptent pour 61 % des frais hospitaliers et de frais pour les soins à domicile. Des études semblables menées ailleurs montrent également qu'un nombre relativement petit de personnes utilisent une grande partie des ressources du système de santé. Une meilleure compréhension des usagers qui coûtent cher peut aider les planificateurs à améliorer la qualité des services et à réduire le fardeau sur les patients et sur le système de santé. Afin de faciliter cette compréhension, nous avons brossé un profil des usagers qui coûtent cher à l' aide de caractéristiques cliniques et démographiques. Ce profil donne des renseignements détaillés sur ces patients, en fonction du type de soins, de la géographie, de l' âge, du sexe et des principaux états cliniques.

Objective To examine the potential effectiveness and efficiency of different guidelines for statin treatment to reduce deaths from coronary heart disease in the Canadian population.

To measure primary care access on an ongoing basis, the Ontario ministry of Health and Long-Term Care implemented the Primary Care Access survey (PCAs) in 2006. The PCAs, a cross-sectional telephone survey, samples approximately 8,400 Ontario adults each year. It collects information on access to a family doctor, use of services, health status and socio-demographics. Analysis of the -2008 shows that 7.1% of Ontario' s adults were without a family doctor (i.e., unattached). The attached and unattached populations differed on socio-demographic and health characteristics. Emergency department use was similar between the two groups, but walk-in clinic use was higher among the unattached. The unattached were less likely to have used care for immediate issues but accessed care in a more timely fashion than the attached. This initial exploration of the PCAs provides a better understanding of some of the differences between the attached and unattached populations in Ontario.

We develop a compartmental mathematical model to address the role of hospitals in severe acute respiratory syndrome ( SARS ) transmission dynamics, which partially explains the heterogeneity of the epidemic. Comparison of the effects of two major policies, strict hospital infection control procedures and community-wide quarantine measures, implemented in Toronto two weeks into the initial outbreak, shows that their combination is the key to short-term containment and that quarantine is the key to long-term containment.