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The author reflects on the health care system in Canadian provinces as of February 2015. Topics discussed include the adoption of universal hospital insurance, the setting of rates based on income and the major gaps in publicly funded services that contradict the principle of comprehensiveness embodied in the Canada Health Act. Also mentioned are the problems in drug coverage and the interprovincial collaboration to reduce generic-drug prices. INSETS: Myocardial Infarction;Pregnancy and Childbirth.

Abstract: Diagnostic criteria for postmenopausal osteoporosis using central dual-energy X-ray absorptiometry (DXA) T-scores have been widely accepted. The validity of these criteria for other populations, including premenopausal women and young men, has not been established. The International Society for Clinical Densitometry (ISCD) recommends using DXA Z-scores, not T-scores, for diagnosis in premenopausal women and men aged 20–49yr, though studies supporting this position have not been published. We examined diagnostic agreement between DXA-generated T-scores and Z-scores in a cohort of men and women aged 20–49yr, using 1994 World Health Organization and 2005 ISCD DXA criteria. Four thousand two hundred and seventy-five unique subjects were available for analysis. The agreement between DXA T-scores and Z-scores was moderate (Cohen''s kappa: 0.53–0.75). The use of Z-scores resulted in significantly fewer (McNemar''s p <0.001) subjects diagnosed with “osteopenia,” “low bone mass for age,” or “osteoporosis.” Thirty-nine percent of Hologic (Hologic, Inc., Bedford, MA) subjects and 30% of Lunar (GE Lunar, GE Madison, WI) subjects diagnosed with “osteoporosis” by T-score were reclassified as either “normal” or “osteopenia” when their Z-score was used. Substitution of DXA Z-scores for T-scores results in significant diagnostic disagreement and significantly fewer persons being diagnosed with low bone mineral density. [Copyright &y& Elsevier]

Regulatory decisions should be made in the most expert and informed way since they are precipitated by real and perceived threats to human health, under the glare of public scrutiny. In 1994, the National Research Council (NRC) reported that the U.S. Environmental Protection Agency's (USEPA's) overall approach to assessing risks is fundamentally sound, but the Agency must more clearly establish the scientific and policy basis for risk estimates and better communicate the associated uncertainties. On March 21, 1995, USEPA issued a risk characterization policy and guidance. In this policy, an effective risk characterization must fully and clearly characterize risks and disclose the scientific analysis, uncertainties, assumptions, and science policy that underlie decisions throughout the risk assessment process. A number of regulatory reform bills which required risk characterization as part of all Federal risk assessments were introduced by the 104th Congress. The purpose of this workshop was to familiarize Society of Toxicology members with: (1) key elements to be considered in risk characterization and (2) new advances in risk characterization addressed by Federal and State agencies, industry, academia, NRC, and Presidential/Congressional Commission on Risk Assessment and Risk Management. Furthermore, the main objective was to engage the audience in discussing the proper role of science in risk assessment-risk management interlace to make informed decisions in the face of scientific uncertainty. [ABSTRACT FROM AUTHOR]

Argues that the Canadian medical profession has failed to provide adequate support for public medical care in relation to the Supreme Court decision of June 9, 2005. Comment on the support of the provision for single-tier health care; Areas in the Canadian health care system that need reform; Factors which contribute to the poor performance of organized medicine in the country.

Looks at the status of the health care system in Canada. Allegation that the country's health care system as of 2004 is unsustainable; Identify the areas of the country's health care system that are performing excellent; Suggestion on how to tackle the problems or flaws of the country's health care system.

Offers observations on studies of Canadian clinical practice guidelines (CPGs). Reference to an article by Graham et al in this issue; Use of the Appraisal Instrument for Clinical Guidelines to assess CPGs; Suggestion that all CPGs should be judged more on the basis of the quality of their recommendations than on the explicit processes of their creation; Conclusion that there should be one nationally-produced and federally-funded guideline for each area.

The World Health Assembly (WHA) approved the Intersectoral Global Action Plan (IGAP) in 2022. This ambitious project, formally called the Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders, is a 10-year plan to enhance neurology implementation worldwide and to raise the status of brain health and neurology services for patients with neurological diseases. The IGAP has 5 important components: relation with policy makers, therapy, prophylaxis, research, and public health. The implementation of IGAP is a challenge, not only for the specialty of neurology but for the whole neurological community, encompassing patients, carers, healthcare providers, and the public. The lack of a unified definition of neurology and the great variety of health systems, as well as the dependency on socioeconomic status, will necessitate custom-made solutions in all regions. [ABSTRACT FROM AUTHOR]