Federalism and Health Care in Canada: A Troubled Romance?

Canadian federalism fragments health system governance. Although the Constitution has been interpreted as providing shared jurisdiction over health generally, with respect to health care, the courts have interpreted it as giving direct jurisdiction to the provinces. The federal role in health care is therefore indirect, but nevertheless potentially powerful. For example, the federal government has used its spending powers to establish the Canada Health Act (CHA), which commits funding to provinces on condition they provide first-dollar public coverage of hospital and physician services. However, in recent times, as federal contributions have declined, the CHA has been weakly enforced. Further, the failure to broaden the CHA to include prescription drugs, dentistry, and other important aspects of health care have contributed to Canada’s abysmal record on Aboriginal health and its increasingly poor rankings in international comparisons. Progress requires enforcement of an adequately funded CHA, national pharmacare, and concerted action on Aboriginal health

Federalism and Health Care in Canada: A Troubled Romance?

Canadian federalism fragments health system governance Although the Constitution has been interpreted as providing shared jurisdiction over health generally with respect to health care specifically the courts have interpreted the Constitution as giving direct jurisdiction to the provinces The Federal role in health care is therefore indirect but nevertheless potentially powerful For example the Federal government has used its spending powers to establish the Canada Health Act CHA which commits funding to provinces on condition they provide firstdollar public coverage of hospital and physician services However in recent times as federal contributions have declined the CHA has been weakly enforced Further the failure to broaden the CHA to include prescription drugs dentistry and other important aspects of health care have contributed to Canada\u27s abysmal record on aboriginal health and its increasingly poor rankings in international comparisons Progress requires enforcement of an adequately funded CHA national pharmacare and concerted action on aboriginal health It requires bolder federal action and a panCanadian approach to governance in which federalism again becomes a laboratory of experimentation including on health human resource planning drug utilization and safety health emergency readiness health technology assessment electronic health information systems and systemlevel quality assuranc

Test Characteristics of Urinary Lipoarabinomannan and Predictors of Mortality among Hospitalized HIV-Infected Tuberculosis Suspects in Tanzania.

Tuberculosis is the most common cause of death among patients with HIV infection living in tuberculosis endemic countries, but many cases are not diagnosed pre-mortem. We assessed the test characteristics of urinary lipoarabinomannan (LAM) and predictors of mortality among HIV-associated tuberculosis suspects in Tanzania. We prospectively enrolled hospitalized HIV-infected patients in Dar es Salaam, with ≥2 weeks of cough or fever, or weight loss. Subjects gave 2 mLs of urine to test for LAM using a commercially available ELISA, ≥2 sputum specimens for concentrated AFB smear and solid media culture, and 40 mLs of blood for culture. Among 212 evaluable subjects, 143 (68%) were female; mean age was 36 years; and the median CD4 count 86 cells/mm(3). 69 subjects (33%) had culture confirmation of tuberculosis and 65 (31%) were LAM positive. For 69 cases of sputum or blood culture-confirmed tuberculosis, LAM sensitivity was 65% and specificity 86% compared to 36% and 98% for sputum smear. LAM test characteristics were not different in patients with bacteremia but showed higher sensitivity and lower specificity with decreasing CD4 cell count. Two month mortality was 64 (53%) of 121 with outcomes available. In multivariate analysis there was significant association of mortality with absence of anti-retroviral therapy (p = 0.004) and a trend toward association with a positive urine LAM (p = 0.16). Among culture-negative patients mortality was 9 (75%) of 12 in LAM positive patients and 27 (38%) of 71 in LAM negative patients (p = 0.02). Urine LAM is more sensitive than sputum smear and has utility for the rapid diagnosis of culture-confirmed tuberculosis in this high-risk population. Mortality data raise the possibility that urine LAM may also be a marker for culture-negative tuberculosis

A multimodal corpus of speech to infant and adult listeners

An audio and video corpus of speech addressed to 28 11-month-olds is described. The corpus allows comparisons between adult speech directed towards infants, familiar adults and unfamiliar adult addressees, as well as of caregivers’ word teaching strategies across word classes. Summary data show that infant-directed speech differed more from speech to unfamiliar than familiar adults; that word teaching strategies for nominals versus verbs and adjectives differed; that mothers mostly addressed infants with multi-word utterances; and that infants’ vocabulary size was unrelated to speech rate, but correlated positively with predominance of continuous caregiver speech (not of isolated words) in the input

Children's Medicines in Tanzania: A National Survey of Administration Practices and Preferences.

The dearth of age-appropriate formulations of many medicines for children poses a major challenge to pediatric therapeutic practice, adherence, and health care delivery worldwide. We provide information on current administration practices of pediatric medicines and describe key stakeholder preferences for new formulation characteristics. We surveyed children aged 6-12 years, parents/caregivers over age 18 with children under age 12, and healthcare workers in 10 regions of Tanzania to determine current pediatric medicine prescription and administration practices as well as preferences for new formulations. Analyses were stratified by setting, pediatric age group, parent/caregiver education, and healthcare worker cadre. Complete data were available for 206 children, 202 parents/caregivers, and 202 healthcare workers. Swallowing oral solid dosage forms whole or crushing/dissolving them and mixing with water were the two most frequently reported methods of administration. Children frequently reported disliking medication taste, and many had vomited doses. Healthcare workers reported medicine availability most significantly influences prescribing practices. Most parents/caregivers and children prefer sweet-tasting medicine. Parents/caregivers and healthcare workers prefer oral liquid dosage forms for young children, and had similar thresholds for the maximum number of oral solid dosage forms children at different ages can take. There are many impediments to acceptable and accurate administration of medicines to children. Current practices are associated with poor tolerability and the potential for under- or over-dosing. Children, parents/caregivers, and healthcare workers in Tanzania have clear preferences for tastes and formulations, which should inform the development, manufacturing, and marketing of pediatric medications for resource-limited settings

The psychopathology p factor: will it revolutionise the science and practice of child and adolescent psychiatry?

The psychopathology p factor has emerged from a series of strong empirical studies, largely in the adult psychiatry literature. Here, some of the recent findings relating to the p factor in children and adolescents are considered and the implications for child and adolescent psychiatry are discussed. Is it essential to covary for ‘p’ when we study specific domains of psychopathology? Do neurodevelopmental conditions make up part of the psychopathology p factor? How do we treat the ‘p factor’ in clinics? This editorial considers some of the contributions from this issue of Journal of Child Psychology and Psychiatry together with the wider literature that speak to these issues

The exposure of autoantigens by microparticles underlies the formation of potent inflammatory components: the microparticle-associated immune complexes

Immunoglobulins, antigens and complement can assemble to form immune complexes (IC). ICs can be detrimental as they propagate inflammation in autoimmune diseases. Like ICs, submicron extracellular vesicles termed microparticles (MP) are present in the synovial fluid from patients affected with autoimmune arthritis. We examined MPs in rheumatoid arthritis (RA) using high sensitivity flow cytometry and electron microscopy. We find that the MPs in RA synovial fluid are highly heterogeneous in size. The observed larger MPs were in fact MP-containing ICs (mpICs) and account for the majority of the detectable ICs. These mpICs frequently express the integrin CD41, consistent with platelet origin. Despite expression of the Fc receptor FcγRIIa by platelet-derived MPs, we find that the mpICs form independently of this receptor. Rather, mpICs display autoantigens vimentin and fibrinogen, and recognition of these targets by anti-citrullinated peptide antibodies contributes to the production of mpICs. Functionally, platelet mpICs are highly pro-inflammatory, eliciting leukotriene production by neutrophils. Taken together, our data suggest a unique role for platelet MPs as autoantigen-expressing elements capable of perpetuating formation of inflammatory ICs

Designation processes and semantic substitutions used by european portuguese children in a vocabulary test

This research study focus on the designation processes and semantic substitutions of each word on the vocabulary sub-task from the language test for children – ABFW, standardized in Brazil and adapted to European Portuguese, as well as the comparison of the results obtained in the two countries, to analyze the relevance of their extensibility to the Portuguese population. Methods: The test was applied to 150 children from 5 to 6 years old, of typical development. The test consists of 9 conceptual categories. Each category consists of different words, which were always assessed in the same sequential order. Results: The sample of this study showed a lower performance only in clothes, places and food semantic categories. All the other categories have outperformed the standard. The categories of vocabulary with higher percentage in the right designation of the words were colors and shapes, animals and toys and music instruments. The categories with a higher percentage of substitution processes, from the reference results, were: food and locations. The most recurrent substitution processes were the co-hyponym, words that designate semantic attributes, valorization of the visual stimulus, hypernym and parasynonyms Conclusion: Given the homogeneity of the results of this study with the results obtained with other studies in Brazil, this test reveal potentiality as an instrument for vocabulary assessment in Portugal.Objetivo: Este estudo teve por objetivo a análise e quantificação dos processos de designação e substituição semântica apresentados na prova do vocabulário do Teste de Linguagem Infantil ABFW, padronizado no Brasil e adaptado para Português Europeu (PE), assim como a comparação dos resultados obtidos nos dois países, de forma a analisar a pertinência da sua extensibilidade à população portuguesa. Métodos: A prova foi aplicada a 150 crianças de 5 e 6 anos de idade, de desenvolvimento típico, na Região Norte de Portugal. A prova é constituída por nove categorias conceituais e cada categoria formada por diferentes vocábulos, que foram avaliados sempre pela mesma ordem sequencial. Resultados: A amostra mostrou desempenho inferior, em relação à norma, apenas nas categorias semânticas vestuário, locais e alimentos. Todas as outras categorias revelaram desempenho superior. As categorias do vocabulário que apresentaram maior percentagem de respostas corretas foram: animais, formas e cores e brinquedos e instrumentos musicais. As categorias que apresentaram percentagem superior de processos de substituição, em relação à norma, foram alimentos e locais. Os processos de substituição mais utilizados foram: substituição por co-hipônimo, vocábulos que designam atributos semânticos, valorização do estímulo visual, hiperônimos e parassinônimos. Conclusão: Dada a homogeneidade dos resultados deste estudo com os resultados obtidos em outros estudos no Brasil, esta prova revela potencialidades como instrumento de avaliação do vocabulário em Portugal.This work is funded by CIEd – Research Centre on Education, projects UID/CED/1661/2013 and UID/CED/1661/2016, Institute of Education, University of Minho, through national funds of FCT/MCTESPT.info:eu-repo/semantics/publishedVersio

Therapeutic recreation as a developing profession in South Africa

South Africa experiences socio-economic challenges with a high prevalence of poverty resulting in disability and non-communicable diseases affecting the health and welfare of communities. Health services are not always accessible or available to citizens, especially those of previously disadvantaged or rural communities. The South African National Plan for Development 2030 aims to address these inequality and health issues. One focus area of this plan is the inclusion of recreation, leisure and sport as an important service sector to improve the health and well-being of all individuals. Therapeutic recreation could play an important role in this regard. In South Africa, therapeutic recreation is in its developmental stages. This paper aims to provide the reader with an overview of therapeutic recreation in South Africa as a developing profession. An overview of the current status of the profession is discussed in terms of standard of practice and as it relates to health professions and recreation service providers, programmes with therapeutic value and training needs. The study concludes that there is still groundwork to be done, calling for interested parties to embark on an aggressive advocacy and strategic planning process to develop therapeutic recreation as a profession in South Africa.Scopu