Canada's Medicare--At the crossroads?

Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced. One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field. Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

History, Politics, and Transformational Change in Canadian Health Care: A Rejoinder.

Our rejoinder addresses two common themes raised in the responses by Arnett et al (see record 2004-17185-005), by Hunsley and Crabb (see record 2004-17185-006) and by Mikail and Tasca (see record 2004-17185-007) to our article (see record 2003-09748-001) concerning the potential role of psychological services in the future of public health care in Canada. The first concerns the current system's capacity to evolve beyond the medical-hospital illness model of the 1960s to incorporate psychological treatments aimed at illness prevention and health promotion. This would be more likely if psychologists were to participate directly in primary-care and home-based mental health-care reform. The second theme is the presumed negative role of "politics" rather than scientific evidence in decisions concerning public coverage or subsidy. We argue that democratic decision-making is the proper basis upon which decisions concerning public coverage are made, but it need not be in opposition to evidence-based decision-making. As recommended in the final report of the Commission on the Future of Health Care in Canada, the Health Council of Canada along with applied research institutes can make politicians and policy-makers more aware of the growing body of evidence supporting the efficacy of psychological treatments relative to the alternatives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between visibility aid use and motor vehicle related injuries among bicyclists presenting to emergency departments

Background

Little is known about the effectiveness of visibility aids (VAs; e.g., reflectors, lights, fluorescent clothing) in reducing the risk of a bicyclist–motor-vehicle (MV) collision.

Purpose

To determine if VAs reduce the risk of a bicyclist–MV collision.

Methods

Cases were bicyclists struck by a MV and assessed at Calgary and Edmonton, Alberta, Canada, emergency departments (EDs) from May 2008 to October 2010. Controls were bicyclists with non-MV injuries. Participants were interviewed about their personal and injury characteristics, including use of VAs. Injury information was collected from charts. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for VAs during daylight and dark conditions, and adjusted for confounders using logistic regression. Missing values were imputed using chained equations and adjusted OR estimates from the imputed data were calculated.

Results

There were 2403 injured bicyclists including 278 cases. After adjusting for age, sex, type of bicycling (commuting vs. recreational) and bicyclist speed, white compared with black (OR 0.52; 95% CI 0.28, 0.95), and bicyclist self-reported light compared with dark coloured (OR 0.67; 95% CI 0.49, 0.92) upper body clothing reduced the odds of a MV collision during daylight. After imputing missing values, white compared with black (OR 0.57; 95% CI: 0.32, 0.99) and bicyclist self-reported light compared with dark coloured (OR 0.71; 95% CI 0.52, 0.97) upper body clothing remained protective against MV collision in daylight conditions. During dark conditions, crude estimates indicated that reflective clothing or other items, red/orange/yellow front upper body clothing compared with black, fluorescent clothing, headlights and tail lights were estimated to increase the odds of a MV collision. An imputed adjusted analysis revealed that red/orange/yellow front upper body clothing colour (OR 4.11; 95% CI 1.06, 15.99) and tail lights (OR 2.54; 95% CI: 1.06, 6.07) remained the only significant risk factors for MV collisions. One or more visibility aids reduced the odds of a bicyclist MV collision resulting in hospitalization.

Conclusions

Bicyclist clothing choice may be important in reducing the risk of MV collision. The protective effect of visibility aids varies based on light conditions, and non-bicyclist risk factors also need to be considered.     

Dynamics of TCP traffic over ATM networks

Investigates the performance of transport control protocol (TCP) connections over ATM networks without ATM-level congestion control and compares it to the performance of TCP over packet-based networks. For simulations of congested networks, the effective throughput of TCP over ATM can be quite low when cells are dropped at the congested ATM switch. The low throughput is due to wasted bandwidth as the congested link transmits cells from “corrupted” packets, i.e., packets in which at least one cell is dropped by the switch. The authors investigate two packet-discard strategies that alleviate the effects of fragmentation. Partial packet discard, in which remaining cells are discarded after one cell has been dropped from a packet, somewhat improves throughput. They introduce early packet discard, a strategy in which the switch drops whole packets prior to buffer overflow. This mechanism prevents fragmentation and restores throughput to maximal levels     

Latent hardening in cyclic deformation of copper single crystals

In order to explore latent hardening produced by cyclic deformation, single crystals of copper oriented for single slip were first cycled at strain amplitudes corresponding to those of the plateau in the cyclic stress-strain curve, and subsequently sectioned for compression testing. The specimens were cycled enough to form persistent slip bands, and orientations in the secondary test were chosen to excite selectively coplanar or non-coplanar slip systems. Coplanar systems were found to be similar in hardening to the primary system, but non-coplanar systems showed a latent hardening ratio of about 1.25. If the plastic shear strain amplitude of the initial cycling was greater than 2×10⁻³ (the threshold for producing secondary slip), then the hardening rate in the secondary test was high. If the cyclic strain amplitude was less than 2×10⁻³, the latent yield stress was high because of the frictional effect of the loop patches, but the hardening rate was found to be low.     

Severe bicycling injury risk factors in children and adolescents: A case–control study

Background

Bicycling is the most common cause of sports and recreation injury in children and adolescents; yet, there is limited evidence on the factors associated with severe bicycling injuries in youth.

Methods

Case–control study of injured bicyclists less than 18 years old seen in seven emergency departments (EDs) from May 2008 to October 2010. Cases were bicyclists hospitalized after their ED visit (severe injury). Controls were bicyclists seen and discharged from the ED (non-severe injury). Personal, environmental, and crash characteristics were collected by interview. Injury data were collected from medical charts. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to estimate the odds of hospitalization associated with risk factors. Multiple imputation techniques were employed to address missing data.

Results

There were 1470 participants including 119 cases. Those ages 13–17 had the highest proportion (23%) of severe injuries resulting from motor vehicle [MV] collision. In models including age, sex and MV collision, being male (OR: 2.02; 95% CI: 1.21–3.38), not wearing a helmet (OR: 2.18; 95% CI: 1.43–3.31) and MV collision (OR: 3.91; 95% CI: 2.26–6.78) were significant risk factors for severe injury. Riding on a paved surface (OR: 0.63; 95% CI: 0.41–0.97) and utilitarian (school, work) bicycling (OR: 0.44; 95% CI: 0.2–0.94) decreased injury risk. Results were similar, apart from utilitarian bicycling (OR: 0.49; 95% CI: 0.22–1.06), after imputation for missing data.

Conclusion

Bicycle–MV collisions increase severe injury risk in youth, and adolescents are often injured in these events. This suggests separating bicyclists from MVs or traffic calming strategies could improve safety.     

Le régime d'assurance-maladie du Canada--Arrive-t-il à un tournant?

Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced. One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field. Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now. (PsycINFO Database Record (c) 2010 APA, all rights reserved)