The implications of the Canadian Stroke Best Practice Recommendations for design and allocation of rehabilitation after hospital discharge: a problematization.

Introduction: Implementation of the Canadian Stroke Best Practice Recommendations has improved inpatient rehabilitation. As attention is turned to the design and allocation of rehabilitation after hospitalization, examination of their implications for post-discharge rehabilitation could help optimize service planningMethods: Critical discourse analysis modeled on Alvesson and Sandberg's method of problematization was conducted to determine how the Canadian Stroke Best Practice Recommendations envision and shape post-discharge rehabilitation, and identify any tensions and potential ways to resolve them.Results: Within the Canadian Stroke Best Practice Recommendations post-discharge rehabilitation is implicitly viewed as a continuation of inpatient rehabilitation. Rehabilitation is largely envisioned as a set of biomedical procedures aimed at normalization through correction of impairment. There is potential tension between this implicit goal and the explicit goal of providing patient and family-centered care and promoting reengagement in valued activities and roles.Conclusion: An alternate vision of post-discharge rehabilitation could help resolve this tension. Post-discharge rehabilitation could be envisioned as a self-management intervention. Rather than primarily an expert-driven process of measuring impairment and applying procedures aimed at normalization, rehabilitation would be considered facilitation of self-management with the goal of reengaging in forms of participation that comprise a satisfying life.Implications for RehabilitationImplicit assumptions within best practice guidelines powerfully influence recommendations. These ideas are difficult to examine because they seem self-evident.Implicit assumptions in the Canadian Stroke Best Practice Guidelines envision post-discharge stroke rehabilitation as an expert-driven, impairment-focused biomedical procedure.This biomedical image makes it difficult to provide care that meets the guideline's explicit goals of client- and family-centeredness.Reimagining post-discharge stroke rehabilitation as a chronic self-care management intervention aimed at developing a satisfying life after stroke could improve patient care.

Child and adolescent health in Northern Ontario: a quantitative profile for public health planning.

Health in Northern Ontario is poorer than in the province of Ontario. Late childhood is the period in which adult habits and health behaviours are solidified, thus, health indicators are important to guide the development and implementation of disease prevention strategies. The Northern Ontario Child and Youth Health Report evaluated the health of children in Northern Ontario. The importance of public health planning is presented with the value of health status information for youth. The hospitalization rate for Northern Ontario youths was higher than for Ontario. In both areas, injuries and poisonings were the leading cause of hospitalization (7-13 year olds), however rates in the North were higher. Hospitalizations for injuries and poisonings were double the provincial rate in 14-19 year olds. The mortality rate for all youth was significantly higher. Health risk behaviour prevalence (e.g., alcohol consumption) was higher in the region. Current data emphasize the need for primordial and primary prevention in regional health planning and are also useful in secondary and tertiary prevention. Data for public health planning is critical to address population health needs and prevent chronic diseases.