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The article focuses on the mercury exposure management in northern Canadian communities. Topics mentioned include the physiological effects of mercury exposure, the importance of public health management, and the effects of food insecurity and nutritional concerns on the efforts to reduce mercury exposure. Also mentioned was the survey on the blood mercury concentrations to selected women and children.

Background: Syncope can be caused by serious conditions not evident during initial evaluation, which can lead to serious adverse events, including death, after disposition from the emergency department. We sought to develop a clinical decision tool to identify adult patients with syncope who are at risk of a serious adverse event within 30 days after disposition from the emergency department.Methods: We prospectively enrolled adults (age ≥ 16 yr) with syncope who presented within 24 hours after the event to 1 of 6 large emergency departments from Sept. 29, 2010, to Feb. 27, 2014. We collected standardized variables at index presentation from clinical evaluation and investigations. Adjudicated serious adverse events included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, serious hemorrhage and procedural interventions within 30 days.Results: We enrolled 4030 patients with syncope; the mean age was 53.6 years, 55.5% were women, and 9.5% were admitted to hospital. Serious adverse events occurred in 147 (3.6%) of the patients within 30 days after disposition from the emergency department. Of 43 candidate predictors examined, we included 9 in the final model: predisposition to vasovagal syncope, heart disease, any systolic pressure reading in the emergency department < 90 or > 180 mm Hg, troponin level above 99th percentile for the normal population, abnormal QRS axis (< -30° or > 100°), QRS duration longer than 130 ms, QTc interval longer than 480 ms, emergency department diagnosis of cardiac syncope and emergency department diagnosis of vasovagal syncope (C statistic 0.88, 95% confidence interval [CI] 0.85-0.90; optimism 0.015; goodness-of-fit p = 0.11). The risk of a serious adverse event within 30 days ranged from 0.4% for a score of -3 to 83.6% for a score of 11. The sensitivity was 99.2% (95% CI 95.9%-100%) for a threshold score of -2 or higher and 97.7% (95% CI 93.5%-99.5%) for a threshold score of -1 or higher.Interpretation: The Canadian Syncope Risk Score showed good discrimination and calibration for 30-day risk of serious adverse events after disposition from the emergency department. Once validated, the tool will be able to accurately stratify the risk of serious adverse events among patients presenting with syncope, including those at low risk who can be discharged home quickly. [ABSTRACT FROM AUTHOR]

The article deals with the diagnosis and management of viral bronchiolitis in infants. Guidelines suggest that viral bronchiolitis is a very common illness with no treatment options. The argument for considering bronchiolitis as an early episode of asthma. The prevalence of wheezing in infants with viral bronchiolitis is discussed.

Background: Comprehensive systems for surveilling prescription opioid-related harms provide clear evidence that deaths from prescription opioids have increased dramatically in the United States. However, these harms are not systematically monitored in Canada. In light of a growing public health crisis, accessible, nationwide data sources to examine prescription opioid-related harms in Canada are needed. We sought to examine the performance of 5 algorithms to identify prescription opioid-related deaths from vital statistics data against data abstracted from the Office of the Chief Coroner of Ontario as a gold standard.Methods: We identified all prescription opioid-related deaths from Ontario coroners' data that occurred between Jan. 31, 2003, and Dec. 31, 2010. We then used 5 different algorithms to identify prescription opioid-related deaths from vital statistics death data in 2010. We selected the algorithm with the highest sensitivity and a positive predictive value of more than 80% as the optimal algorithm for identifying prescription opioid-related deaths.Results: Four of the 5 algorithms had positive predictive values of more than 80%. The algorithm with the highest sensitivity (75%) in 2010 improved slightly in its predictive performance from 2003 to 2010.Interpretation: In the absence of specific systems for monitoring prescription opioid-related deaths in Canada, readily available national vital statistics data can be used to study prescription opioid-related mortality with considerable accuracy. Despite some limitations, these data may facilitate the implementation of national surveillance and monitoring strategies. [ABSTRACT FROM AUTHOR]

Calls for the Canadian government to create a truly independent national public health agency. Criticism of the leadership of Minister of State for Public Health Carolyn Bennett; Type of chief public health officer needed to enhance public health administration; Budget needed to boost public health services.

Examines research into causes of death among the Canadian male inmate population. Statistics suggesting higher rates of death by poisoning, suicide, homicide and natural causes in prison population compared with rates among Canadian male population; Discussion of illicit drug use and suicide as major health problems in prisons; Benefits to prison medical services achieved by reporting death rates.

Comments on debate in Canada about whether to allow for-profit hospitals. Increase in the number of for-profit hospitals in the U.S.; Concern about a study which found that for-profit hospitals had a higher mortality rate than non-profit private hospitals; Opinion that Canada should not adopt for-profit hospitals.

Reports on a survey posted on the Canadian Medical Association Journal's web site to determine demographic information on its users. Wide range of ages, nationalities, and professional interests of the respondents; Willingness of the users to pay for access to the online journal; Feedback from readers regarding what they thought of the journal.

Focuses on worker's compensation boards (WCB), primary financiers for medical care for workers in Canada. Plausible reasons for significant increase in costs of health care, occupational rehabilitation, and indemnity benefits provided by the WCB; Methods of reform to counteract expenditures by the WCB; Effect of reform on physicians.

Focuses on the issue of serious spinal injuries in amateur and professional hockey in Canada. Causes of the injuries; Need to fund studies that resolve whether better equipment encourages players to take greater risks; Differences in the rate of hockey injuries; Need for improved surveillance systems, better data, more analyses, and mechanisms.

Offers a report that updates a Canadian registry of spinal injuries sustained while playing hockey in amateur and professional leagues. Statistics relating to the types of injuries and the type of games; Definition of spinal injury.

Patients also worry about potential treatment-related costs and whether aducanumab will be accessible to all patients for whom it is potentially indicated. In Canada, 190 000 people are living with mild Alzheimer-type dementia and 532 000 to 799 000 people are living with amnestic mild cognitive impairment.[1]-[4] Developing treatments for Alzheimer disease is challenging, with few effective therapies that only target symptoms. [Extracted from the article]

The article reports on health care laureates who were inducted into the Canadian Medical Hall of Fame (CMHF) which include physicians Alan Bernstein, Judith G. Hall and Bernard Langer.

Background: Previous research has suggested that obstetric outcomes are similar for deliveries by family physicians and obstetricians, but many of these studies were small, and none of them adjusted for unmeasured selection bias. We compared obstetric outcomes between these provider types using an econometric method designed to adjust for unobserved confounding.Methods: We performed a retrospective population-based cohort study of all Canadian (except Quebec) hospital births with delivery by family physicians and obstetricians at more than 20 weeks gestational age, with birth weight greater than 500 g, between Apr. 1, 2006, and Mar. 31, 2009. The primary outcomes were the relative risks of in-hospital perinatal death and a composite of maternal mortality and major morbidity assessed with multivariable logistic regression and instrumental variable-adjusted multivariable regression.Results: After exclusions, there were 3600 perinatal deaths and 14,394 cases of maternal morbidity among 799,823 infants and 793,053 mothers at 390 hospitals. For deliveries by family physicians v. obstetricians, the relative risk of perinatal mortality was 0.98 (95% confidence interval [CI] 0.85-1.14) and of maternal morbidity was 0.81 (95% CI 0.70-0.94) according to logistic regression. The respective relative risks were 0.97 (95% CI 0.58-1.64) and 1.13 (95% CI 0.65-1.95) according to instrumental variable methods.Interpretation: After adjusting for both observed and unobserved confounders, we found a similar risk of perinatal mortality and adverse maternal outcome for obstetric deliveries by family physicians and obstetricians. Whether there are differences between these groups for other outcomes remains to be seen. [ABSTRACT FROM AUTHOR]

Background: With the exception of Canada, all countries with universal health insurance systems provide universal coverage of prescription drugs. Progress toward universal public drug coverage in Canada has been slow, in part because of concerns about the potential costs. We sought to estimate the cost of implementing universal public coverage of prescription drugs in Canada. Methods: We used published data on prescribing patterns and costs by drug type, as well as source of funding (i.e., private drug plans, public drug plans and out-of-pocket expenses), in each province to estimate the cost of universal public coverage of prescription drugs from the perspectives of government, private payers and society as a whole. We estimated the cost of universal public drug coverage based on its anticipated effects on the volume of prescriptions filled, products selected and prices paid. We selected these parameters based on current policies and practices seen either in a Canadian province or in an international comparator. Results: Universal public drug coverage would reduce total spending on prescription drugs in Canada by $7.3 billion (worst-case scenario $4.2 billion, best-case scenario $9.4 billion). The private sector would save $8.2 billion (worst-case scenario $6.6 billion, best-case scenario $9.6 billion), whereas costs to government would increase by about $1.0 billion (worst-case scenario $5.4 billion net increase, best-case scenario $2.9 billion net savings). Most of the projected increase in government costs would arise from a small number of drug classes. Interpretation: The long-term barrier to the implementation of universal pharmacare owing to its perceived costs appears to be unjustified. Universal public drug coverage would likely yield substantial savings to the private sector with comparatively little increase in costs to government. [ABSTRACT FROM AUTHOR]

Editorial. Asserts that the Canadian government should fund in vitro fertilization. The need for infertile couples to be given information about chances for live birth, risks and costs; Health of people who were conceived in vitro; The belief that concern over intracytoplasmic sperm injection safety is unfounded; Canadian health care spending on infertility and its status as an illness; Canadian policy on what is considered an insured service and which services couples must pay for.

Editorial. Discusses legislated resuscitation in terminally ill patients in Ontario. How paramedics can resuscitate a patient despite do-not-resuscitate (DNR) orders; Need for physicians to educate caregivers of DNR patients not to call 911; Need for a DNR protocol.

Editorial. Discusses the study by Michelle R. Wise et al in the same issue which reports that extremely low numbers of women with cardiovascular disease are using hormone replacement therapy (HRT) as suggested by Canadian guidelines. Lack of adoption of guidelines by physicians; Low number of women aware of HRT treatment.

Reports on a conference attended by rural Canadian physicians and other professionals. How the doctors and nurse practitioners (NPs) reached a consensus on how they can work together to provide quality health care in rural parts of Canada; Consideration of the expanded roles that NPs are playing; Principles agreed upon. INSET: Society for rural MDs hits recruiting trail, by Jane Stewart.

The article reports on the plan of the federal government to restructure sick leave policy for public sector in Canada in 2014, which is aimed at reducing the rate of absenteeism and productivity loss. Public servants in Canada receive 15 paid sick leaves a year and can accumulate unused days indefinitely. Policy reforms are launched in other countries to curb high rates in absenteeism with varying degree of success.

The article discusses Bill C-7 or Protecting Canadians From Unsafe Drugs Act, a legislation introduced into the Canadian Parliament in December 2013 to regulate prescription drugs for patient safety. Elements in the proposed regulation include the power to recall drugs, the power to overcome information asymmetries and the power to enforce conditions on market authorizations and compel changes to product labels.

To enhance public understanding of the outcomes of cannabis legalization in Canada and avoid this skewed situation, provincial and territorial governments must become more transparent with their cannabis data. Despite the many potential impacts of the legalization of cannabis in Canada, provincial and territorial governments' poor disclosure of data about their recreational sales hinders researchers' efforts to study the the medical and social effects of legalization. [Extracted from the article]

The article discusses the decrease in Clostridium difficile infection rates in Canada as of 2013. It mentions the number of people who died from the diarrhea-causing bacterium in Quebec in 2003. Factors contributing to reduced infection rates include mandatory reporting and tighter guidelines on hygiene and antibiotic use. Some physicians express doubt that mandatory public reporting has actually improved patient outcomes.

Background: The relation between place of residence and risk of postpartum depression is uncertain. We evaluated the relation between place of residence and risk of postpartum depression in a population-based sample of Canadian women. Methods: Female postpartum respondents to the 2006 Canadian Maternity Experiences Survey (n = 6126) were classified as living in rural (< 1000 inhabitants or population density < 400/km²), semirural (nonrural but < 30 000 inhabitants), semiurban (30 000-499 999 inhabitants) or urban (≥ 500 000 inhabitants) areas. We further subdivided women living in rural areas based on the social and occupational connectivity of their community to larger urban centres. We compared the prevalence of postpartum depression (score of ≥ 13 on the Edinburgh Postnatal Depression Scale) across these groups and adjusted for the effect of known risk factors for postpartum depression. Results: The prevalence of postpartum depression was higher among women living in urban areas than among those living in rural, semirural or semiurban areas. The difference between semiurban and urban areas could not be fully explained by other measured risk factors for postpartum depression (adjusted odds ratio 0.60, 95% confidence interval 0.42-0.84). In rural areas, there was a nonsignificant gradient of risk: women with less connection to larger urban centres were at greater risk of postpartum depression than women in areas with greater connection. Interpretation: There are systematic differences in the distribution of risk factors for postpartum depression across geographic areas, resulting in an increased risk of depression among women living in large urban areas. Prevention programs directed at modifiable risk factors (e.g., social support) could specifically target women living in these areas to reduce the rates of postpartum depression. [ABSTRACT FROM AUTHOR]

The article deals with past attempts to promote competitive pricing for generic drugs in Canada. It relates the emergence of compulsory licensing that allow generic firms to produce versions of on-patent drugs. It discusses the implementation of regulated price caps following the elimination of compulsory licensing in 1992. It outlines lessons for seeking competitive process through competitive bidding.

Background: Routine eye examinations for healthy adults aged 20-64 years were delisted from the Ontario Health Insurance Plan in 2004, but they continue to be insured for people with diabetes regardless of age. We sought to assess whether the delisting of routine eye examinations for healthy adults had the unintended consequence of decreasing retinopathy screening for adults with diabetes. Methods: We used administrative data to calculate eye examinations for people with diabetes ages 40-64 years and 65 years and older in each 2-year period from 1998 to 2010. We examined differences by sex, income, rurality and type of health care provider. We used segmented linear regression to assess the change in trend before and after 2004. Results: For people with diabetes aged 65 years and older, eye examinations rose gradually from 1998 to 2010, with no substantial change between 2004 and 2006. For people with diabetes aged 40-65 years, there was an 8.7% (95% confidence interval [CI] 6.3%- 11.1%) decrease in eye examinations between 2004 and 2006. Results were similar for all population subgroups. Ophthalmologic examinations decreased steadily for both age groups during the study period, and there was a decline in optometry examinations for people ages 40-65 years after 2004. Interpretation: The delisting of routine eye examinations for healthy adults in Ontario had the unintended consequence of reducing publicly funded retinopathy screening for people with diabetes. More research is needed to understand whether patients are being charged for an insured service or to what degree misunderstanding has prevented patients from seeking care. [ABSTRACT FROM AUTHOR]

The article focuses the issue of providing graduated drivers' licenses to seniors in Canada. It states that with this approach, a full driver's license defaults automatically to a restricted license which allows seniors to continue driving only under favorable road conditions. It cites the paper "In defence of older drivers" by Hauer E. in the 2012 current issue which argues that the relation between advanced age and driving risk is complex and influenced by individual contributing factors.

Background: Despite the high prevalence of smoking among Aboriginal youth, there is a paucity of research related to tobacco use and other risk behaviours among Aboriginal youth living off-reserve in Canada. We used data from the national Youth Smoking Survey to characterize non-traditional tobacco use, exposure to second-hand smoke, and alcohol and drug use among Aboriginal youth living off-reserve. We examined whether these youth were at increased health risk compared with non-Aboriginal youth. Methods: We examined cigarette smoking behaviour, use of other tobacco products, use of alcohol and other drugs, and exposure to second-hand smoke among 2620 Aboriginal youth living off-reserve and 26 223 non-Aboriginal youth in grades 9 to 12 who participated in the 2008/09 Youth Smoking Survey. Results: The prevalence of current smoking among the Aboriginal youth was more than double that among non-Aboriginal youth (24.9% v. 10.4%). Aboriginal youth also had a higher prevalence of regular exposure to second-hand smoke at home (37.3% v. 19.7%) and in cars (51.0% v. 30.3%). Aboriginal youth were more likely than non-Aboriginal youth to be current smokers, to be regularly exposed to second-hand smoke, to have tried marijuana and other illicit drugs, and to engage in binge drinking. They were less likely than non- Aboriginal youth to have tried to quit smoking. Interpretation: Current national estimates of smoking, and alcohol and illicit drug use among youth underestimate the prevalence of these behaviours among Aboriginal youth living off-reserve. Our findings highlight the need for culturally appropriate prevention and cessation policies and programs for this at-risk population. [ABSTRACT FROM AUTHOR]

Background: The prevalence of frailty increases with age in older adults, but frailty is largely unreported for younger adults, where its associated risk is less clear. Furthermore, less is known about how frailty changes over time among younger adults. We estimated the prevalence and outcomes of frailty, in relation to accumulation of deficits, across the adult lifespan. Methods: We analyzed data for community- dwelling respondents (age 15-102 years at baseline) to the longitudinal component of the National Population Health Survey, with seven two-year cycles, beginning 1994-1995. The outcomes were death, use of health services and change in health status, measured in terms of a Frailty Index constructed from 42 self-reported health variables. Results: The sample consisted of 14 713 respondents (54.2% women). Vital status was known for more than 99% of the respondents. The prevalence of frailty increased with age, from 2.0% (95% confidence interval [CI] 1.7%-2.4%) among those younger than 30 years to 22.4% (95% CI 19.0%-25.8%) for those older than age 65, including 43.7% (95% CI 37.1%-50.8%) for those 85 and older. At all ages, the 160-month mortality rate was lower among relatively fit people than among those who were frail (e.g., 2% v. 16% at age 40; 42% v. 83% at age 75 or older). These relatively fit people tended to remain relatively fit over time. Relative to all other groups, a greater proportion of the most frail people used health services at baseline (28.3%, 95% CI 21.5%-35.5%) and at each follow-up cycle (26.7%, 95% CI 15.4%-28.0%). Interpretation: Deficits accumulated with age across the adult lifespan. At all ages, a higher Frailty Index was associated with higher mortality and greater use of health care services. At younger ages, recovery to the relatively fittest state was common, but the chance of complete recovery declined with age. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at the fourth annual CEO Forum on February 17, 2010 in Montréal, Quebec on patient charter which aims to improve the health care services is presented. Robert Ouellet, former president of Canadian Medical Association, cites that the panel must plan on how to form and finance the charter. Adalsteinn Brown of Ontario's Ministry of Health and Long-Term Care says that Canada will not be the first country to adopt patient charter.

The article presents a reprint of the article "And Then They Took Away the Pigeon Holes," which appeared at www.cmaj.ca. It explores the serious change in the health care system in Canada. It mentions that in the 1980s, it eliminated inefficiencies and duplication of services. Over the next few years, it faced an era of reduced spending and some doctors were leaving for the U.S. It adds that physicians are already paid for the administrative functions they are used to provide voluntarily.

A personal narrative is presented which explores the author's love for stem cell research in Canada.

The article reports on the action of Canadian medical school administrators which concern the development of guidelines governing pharmaceutical and medical devices industry handouts for undergraduate, postgraduate and continuing medical education. It notes that the Canadian Association for Medical Education will have an assembly with the Association of American Medical Colleges for the review and advancement on the said issue before determining their next course of action. Also includes notions from recently appointed member on the Canadian Association for Medical Education working group, Dr. Michael Allen, including discussions on the details of the topic in relation to its outcome.

A letter to the editor is presented which discusses the need for interprofessional collaboration among Canadian health care providers and professionals to enhance the health services provided to individuals, patients and the population.

The article offers information regarding changes in the health care industry for the types of products it uses and its waste disposal practices. It presents a recent environmental data on health care in Canada which shows greenhouse gas emissions and solid waste disposal. It discusses several innovative strategies and technologies emerged to substantiate more sustainable operating room practices without compromising patient care.

The article discusses the differences between the previous and updated Canadian guidelines for breast cancer screening in practice. It examines how average risk is defined by the Task Force on Preventive Health Care. It cites changes in the updated guidelines on breast cancer screening. The article also offers information on how screening should be done for women at higher risk.

Background: Heart failure is a leading cause of admission to hospital, but whether the incidence of heart failure is increasing or decreasing is uncertain. We examined temporal trends in the incidence and outcomes of heart failure in Ontario, Canada. Methods: Using population-based administrative databases of hospital discharge abstracts and physician health insurance claims, we identified 419 551 incident cases of heart failure in Ontario between Apr. 1, 1997, and Mar. 31, 2008. All patients were classified as either inpatients or outpatients based on the patient's location at the time of the initial diagnosis. We tracked subsequent outcomes through linked administrative databases. Results: The age- and sex-standardized incidence of heart failure decreased 32.7% from 454.7 per 100 000 people in 1997 to 306.1 per 100 000 people in 2007 (p < 0.001). A comparable decrease in incidence occurred in both inpatient and outpatient settings. The greatest relative decrease occurred in patients aged 85 and over. Over the study period, 1-year risk-adjusted mortality decreased from 17.7% in 1997 to 16.2% in 2007 (p = 0.02) for outpatients, with a nonsignificant decrease from 35.7% in 1997 to 33.8% in 2007 (p = 0.1) for inpatients. Interpretation: The incidence of heart failure de creased substantially during the study period. Nevertheless, the prognosis for patients with heart failure remains poor and is associated with high mortality. [ABSTRACT FROM AUTHOR]

Background: There has been much discussion about whether female feticide occurs in certain immigrant groups in Canada. We examined data on live births in Ontario and compared sex ratios in different groups according to the mother's country or region of birth and parity. Methods: We completed a population-based study of 766 688 singleton live births between 2002 and 2007. We used birth records provided by Ontario Vital Statistics for live births in the province between 23 and 41 weeks' gestation. We categorized each newborn according to the mother's country or region of birth, namely Canada (n = 486 599), Europe (n = 58 505), South Korea (n = 3663), China (n = 23 818), Philippines (n = 15 367), rest of East Asia (n = 18 971), Pakistan (n = 18 018), India (n = 31 978), rest of South Asia (n = 20 695) and other countries (n = 89 074). We calculated male:female ratios and 95% confidence intervals (CIs) for all live births by these regions and stratified them by maternal parity at the time of delivery (0, 1, 2 or ≥ 3). Results: Among infants of nulliparous women, the male:female ratio was about 1.05 overall. As parity increased, the ratio remained unchanged among infants of Canadian-born women. In contrast, the male:female ratio was significantly higher among infants of primiparous women born in South Korea (1.20, 95% CI 1.09.1.34) and India (1.11, 95% CI 1.07.1.15) than among infants of Canadian-born primiparous women. Among multiparous women, those born in India were significantly more likely than Canadian-born women to have a male infant (parity 2, ratio 1.36, 95% CI 1.27. 1.46; parity ≥ 3, ratio 1.25, 95% CI 1.09.1.43). Interpretation: Our study of male:female ratios in Ontario showed that multiparous women born in India were significantly more likely than multiparous women born in Canada to have a male infant. [ABSTRACT FROM AUTHOR]

The article presents questions and answers related to medical care of pancytopenia patients in Canada including laws on consent to treatment, management of patient care.

Background: Suicide is the second leading cause of death for young Canadians (10-19 years of age) -- a disturbing trend that has shown little improvement in recent years. Our objective was to examine suicide trends among Canadian children and adolescents. Methods: We conducted a retrospective analysis of standardized suicide rates using Statistics Canada mortality data for the period spanning from 1980 to 2008. We analyzed the data by sex and by suicide method over time for two age groups: 10-14 year olds (children) and 15-19 year olds (adolescents). We quantified annual trends by calculating the average annual percent change (AAPC). Results: We found an average annual decrease of 1.0% (95% confidence interval [CI] -1.5 to -0.4) in the suicide rate for children and adolescents, but stratification by age and sex showed significant variation. We saw an increase in suicide by suffocation among female children (AAPC = 8.1%, 95% CI 6.0 to 10.4) and adolescents (AAPC = 8.0%, 95% CI 6.2 to 9.8). In addition, we noted a decrease in suicides involving poisoning and firearms during the study period. Interpretation: Our results show that suicide rates in Canada are increasing among female children and adolescents and decreasing among male children and adolescents. Limiting access to lethal means has some potential to mitigate risk. However, suffocation, which has become the predominant method for committing suicide for these age groups, is not amenable to this type of primary prevention. [ABSTRACT FROM AUTHOR]

The article presents the author's insights on the ethical guidelines for research involving humans in Canada and in the U.S. He says that in Canada requires compliance to the Tri-Council Policy Statement for research involving human participants while the U.S. uses the Common Rule. He also mentions that the two nations have similar systems of ethical review and with similar problems.

Background: Coroners in Australia, Canada, New Zealand and other countries in the Commonwealth hold inquests into deaths in two situations. Mandatory inquests are held when statutory rules dictate they must be; discretionary inquests are held based on the decisions of individual coroners. Little is known as to how and why coroners select particular deaths for discretionary inquests. Methods: We analyzed the deaths investigated by Australian coroners for a period of seven and one-half years in five jurisdictions. We classified inquests as mandatory or discretionary. After excluding mandatory inquests, we used logistic regression analysis to identify the factors associated with coroners' decisions to hold discretionary inquests. Results: Of 20 379 reported deaths due to external causes, 1252 (6.1%) proceeded to inquest. Of these inquests, 490 (39.1%) were mandatory and 696 (55.6%) were discretionary. In unadjusted analyses, the rates of discretionary inquests varied widely in terms of age of the decedent and cause of death. In adjusted analyses, the odds of discretionary inquests declined with the age of the decedent; the odds were highest for children (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.54-3.06) and lowest for people aged 65 years and older (OR 0.38, 95% CI 0.28-0.51). Using poisoning as a reference cause of death, the odds of discretionary inquests were highest for fatal complications of medical care (OR 12.83, 95% CI 8.65-19.04) and lowest for suicides (OR 0.44, 95% CI 0.30-0.65). Interpretation: Deaths that coroners choose to take to inquest differ systematically from those they do not. Although this vetting pro cess is invisible, it may influence the public's understanding of safety risks, fatal injury and death. [ABSTRACT FROM AUTHOR]

The article presents the author's insights on the disclosure of information on medical devices and drug safety by Health Canada. He argues that results of clinical trials such as the adverse effect of selective serotonin reuptake inhibitors (SSRIs) to patients below 19 years old, must be disclosed to preserve public trust and protect Canadians from harm. He adds that disclosure of findings and registration of clinical trials should be mandated by the Food and Drugs Act like in the U.S.

The article discusses the significance to integrate administrative health data for the surveillance of interventions associated to alcohol-related harm among young people in Canada. It highlights the growing concerns on binge drinking in young people that led to a range of policy initiatives and community-based programs. It adds that the range for acute alcohol-related indices must be included in the surveillance techniques. INSETS: Key points;Search terms used to retrieve articles through MEDLINE ….

The article presents information on the new principles of collaborative team medical practices proposed by delegates to the Canadian Medical Association (CMA) 140th General Council on in Vancouver, British Columbia on August 21, 2007. The delegates demanded to check pharmacists from the rights of independent prescribing. According to medical personal Don Pugsley, collaborative care Canadian governments should not permit to substitute medical care provider for another simply because one is more or less costly than the other. Several Canadian provinces including Alberta, New Brunswick, and Nova Scotia allow pharmacists to initiate or modify prescriptions.

The article presents information about the Canadian Medical Equipment Loan Service run by the Canadian Red Cross. The service has been providing Canadians of all ages with essential medical equipment like wheelchairs, walkers and crutches. These items of medical equipment are provided on a short-term basis to people who are living in their homes and recovering from their injury or surgery.

The article presents information about a provision in Canada's 2006 federal budget regarding gifting publicly traded securities to registered charities. The provision allows one to gift publicly traded securities without paying capital gains tax. Now one can gift equities, bonds and mutual funds to, say, the Canadian Medical Foundation.

The article reports that the MD Financial organization is providing financial helps to medical students in Canada. When undergraduate medical tuition fees are going northward, the financial assistance from the organization is considered crucial. The organization works in tandem with the Canadian Medical Association's subsidiaries. The organization has made a contribution of $250,000 to the Canadian Medical Association.

The article focuses on the role of physicians in advocating a national suicide prevention strategy in Canada. It states that three national suicide prevention strategies from Ireland, Australia, and Scotland have undergone systematic evaluation, all showed reduction in suicide level. The role of physicians is to be aware in developing effective strategies in suicide prevention that may affect the development of clinical services.

The article discusses the harmonization of the clinical practice guidelines that prevent and treat cardiovascular disease in Canada. It states that the Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE) initiative was developed to harmonize the 400 recommendations into 89 key recommendations through using a consensus model. It mentions that the initiative proposes an outcome evaluation plan for tracking of clinical and health system outcomes.