CMAJ: Canadian Medical Association Journal articles from August 2006

CMAJ: Canadian Medical Association Journal archives from August 2006

Twenty-five years of AIDS./Vingt-cinq ans de sida.(Guest Editorial/Editorial invite)
August 1, 2006... AIDS simmered for years in Africa before it was recognized in the United States in 1981 as an epidemic among homosexual men. Its origin is no longer a mystery. Thanks to the high science of gene sequencing and phylogenetic analysis, we can...

Ibuprofen should go behind-the-counter says expert panel.(News)
August 1, 2006... A Health Canada expert advisory panel says ibuprofen should go behind-the-counter at pharmacies due to new evidence showing that at prolonged high doses its risk of cardiovascular incident is comparable to prescription COX-2 drugs, such as...

Vioxx should be allowed back on the market advises expert panel.
August 1, 2006... Rofecoxib (Vioxx) ought to be allowed back on the market, concludes Health Canada's Expert Advisory Panel on the Safety of COX-2 Selective Non-steroidal Anti-Inflammatory Drugs (NSAIDs). After Merck & Co. withdrew rofecoxib from the world...

Cervical cancer vaccine may come soon to Canada.(News)
August 1, 2006... A new vaccine against cervical cancer that could save hundreds of thousands of lives worldwide each year may soon be available in Canada. Gardasil (quadrivalent human papillomavirus types 6, 11, 16, 18, recombinant vaccine) was approved in...

National resident match emerges for IMGs.(international medical graduates )
August 1, 2006... A "pan-Canadian" approach for matching international medical graduates (IMGs) to residency positions in the nation's postgraduate medical training system has inched a step closer to reality as a result of reforms to the Canadian Resident...

Shorter wait times.(News @ a glance)(hip surgeries )(Brief article)
August 1, 2006... Shorter wait times: Median wait times for hip surgeries in British Columbia are down 15% to 19 weeks in 2005-06 compared with the previous year, while wait times for knee surgery are down 12% to 25.6 weeks. The province has invested $60.5...

Flashback.(News @ a glance)(Ontario Medical Association, Ontario doctors' strike over the province's ban on extra billing )(Brief article)
August 1, 2006... Flashback: The 20th anniversary of the Ontario doctors' strike over the province's ban on extra billing passed quietly last month. The Ontario Medical Association had labelled the legislation "an act of violence against the medical profession"...

Weed killer and cancer.(News @ a glance)(Brief article)
August 1, 2006... Weed killer and cancer: Canada's most popular weed killer, 2,4-D, is "persuasively linked" to cancer, neurological impairment and reproductive problems, according to a new study (Paediatrics and Child Health 2006;11:229-34). The Pest Management...

Physician shortfall.(News @ a glance)(Brief article)
August 1, 2006... Physician shortfall: Nearly 4 million Canadians, or 14.3% of the population, didn't have a regular physician in 2005, according to Statistics Canada's Canadian Community Health Survey. In the 2003 survey, 14% of Canadian lacked a physician....

Invest in healthy kids.(News @ a glance)(Health Council of Canada asks government)
August 1, 2006... Invest in healthy kids: The Health Council of Canada is asking government to increase spending on childhood development and develop a pan-Canadian child and youth health strategy. A June 22 report indicates that 3% of Canadian children live...

Canadian Cardiovascular Atlas.(Canadian Cardiovascular Atlas: Is There a Geographic Difference in Cardiovascular Disease in Canada?)(Brief article)(Book review)
August 1, 2006... Canadian Cardiovascular Atlas: Is there a geographic difference in cardiovascular disease in Canada? Award-winning research indicates an East-to-West gradient (highest in the East in term of burden and risk factors, then generally falling as...

New faces.(News @ a glance)(Canada Health Council)(Brief article)
August 1, 2006... New faces: In June, Michael Decter stepped down as founding chairman of the Canada Health Council to pursue his interest in the environment. The council was set up nearly 3 years ago to oversee improvements to Canada's health care system....

Autoimmunity against eye-muscle antigens may explain thyroid-associated ophthalmopathy.(Analysis)(Table)
August 1, 2006... The ophthalmopathy associated with Graves' hyperthyroidism and Hashimoto's thyroiditis is an autoimmune disorder of the extraocular muscle and the surrounding orbital connective tissue (OCT) and fat Box 1). Its most appropriate name is...

A woman with an unusual case of hemoptysis.(Teaching Case Report)
August 1, 2006... The Case: A 40-year-old woman presented to the emergency department with complaints of hemoptysis and epistaxis that had occurred off and on since childhood, as well as symptoms of dyspnea on exertion, fatigue and oligomennorrhea. She reported...

Visceral leishmaniasis in Afghanistan.
August 1, 2006... Despite being the third most important vector-borne diseases worldwide in terms of burden of disease, the leishmaniases are one of the so-called "neglected diseases." Since the massive humanitarian reconstruction efforts began after the...

Acute splenic infarction.
August 1, 2006... Although no intense pelvic symptoms were found during the physical exam, the CT scan showed a wedge-like hypodense area in the spleen (Fig. 1, arrow) consistent with acute splenic infarction. Results of a hypercoagulable work-up were normal....

A blistering disease: bullous erysipelas.
August 1, 2006... This patient with non-insulin-dependent diabetes mellitus had initially come to the emergency department. His diagnosis at that time was cellulitis, which was treated with a course of intravenous cefazolin and oral probenecid. By 4 days...

Dextrocardia: with sinus solitus.(Clinical Vistas Briefs)(Clinical report)
August 1, 2006... A routine physical examination of this apparently well teenage girl revealed a right-sided cardiac apex. Chest radiography confirmed that her heart was in the right chest and that the cardiac apex pointed to the right. The aortic arch was on...

Contamination: a comparison of 2 personal protective systems.(Research)
August 1, 2006... Abstract Background: The purpose of this study was to examine the difference in self-contamination rates and levels of contact and droplet protection associated with enhanced respiratory and contact precautions (E-RCP) and a personal...

Milestones in the natural course of onset of cigarette use among adolescents.(Research)
August 1, 2006... Abstract Background: The natural course of onset of cigarette use has been conceptualized as progressing sequentially through 5 stages (preparation, trying, irregular use, regular use, nicotine-dependent smoking). However, recent studies...

Adolescents and smoking: The first puff may be the worst.(Commentary)
August 1, 2006... Tobacco use is the leading cause of preventable death globally, contributing to more than 5 million estimated deaths every year. (1) Nicotine is a highly addictive substance, and tobacco remains the only legal product that, when used as...

Personal protective equipment for preventing respiratory infections: what have we really learned?(Commentary)
August 1, 2006... The use of personal protective equipment (PPE) for health care workers (HCWs) has evolved from the isolation precautions first implemented years ago for patients with communicable diseases such as smallpox, tuberculosis and diphtheria. (1) The...

Neuropathic pain: a practical guide for the clinician.(Clinical report)
August 1, 2006... Abstract Neuropathic pain, caused by various central and peripheral nerve disorders, is especially problematic because of its severity, chronicity and resistance to simple analgesics. The condition affects 2%-3% of the population, is...

Rosiglitazone and macular edema.(Letter to the editor)
August 1, 2006... As noted in Box 1 in the article by Claire Kendall and Eric Wooltorton, (1) long-standing diabetes mellitus, poor diabetes control and insulin therapy are by themselves risk factors for macular edema. Furthermore, only 1 of the 9 cases of...

SMART therapy.(Letter to the editor)
August 1, 2006... The Salmeterol Multicenter Asthma Research Trial (SMART)1 reinforces important lessons regarding the appropriate use of long-acting ?-agonists. The trial was stopped early because of increased hazard of asthma, respiratory death or...

Corrections.(Correction notice)
August 1, 2006... A recent issue of CMAJ mistakenly included a death notice for Dr. Archibald McNeill Johnson. We sincerely regret this error. REFERENCE (1.) Deaths. CMAJ 2006;174(13):1935. DOI:10.1503/cmaj.060824 In a recent News article, (1)...

The cult of Carr.(Emily Carr: New Perspectives, exhibition)
August 1, 2006... Emily Carr: New Perspectives Curators Charles Hill, Ian Thom and Johanne Lamoureux National Gallery of Canada Until Sept. 4, 2006 Canadians embrace Emily Carr (1871-1945) for her vision of our country, her documentation and, later,...

It takes a global village.(Room for a view)(HIV/AIDS infection )
August 1, 2006... From here in Nigeria, it seems the whole world is losing its fight against HIV/AIDS. The rapid spread of HIV/AIDS infection is decimating this country's adult population: 3.8 million of our population are infected with HIV/AIDS. (1) ...

Deaths.(Jean-Claude D'Amours, John Howard Dixon, Francois Dufour)(Obituary)
August 1, 2006... Notice Readers are invited to submit brief remembrances of recently departed colleagues. Colourful writing is encouraged, but please limit your notice to 150 worlds. Send to pubs@cma.ca; fax 613 565-5471. D'Amours, Jean-Claude, Levis,...

Query.(anxiety)(Column)
August 1, 2006... Anxiety. It's been plaguing me recently, yet I can't really attribute it to anything new. Nothing has changed in my life--I continue to work hard, perhaps too hard, but that's not new. My marriage is sputtering, faltering, perhaps even...

More than ramps: accessible health care for people with disabilities/L'acces aux soins de sante pour les personnes handicapees: plus que des lieux accessibles.(Column)
August 15, 2006... One in 8 Canadians--a number in excess of 3.5 million people--lives with a disability. (1) Advances in the provision of acute health care and an aging population mean that the number of people in Canada with disabilities will continue to grow....

CMAJ and editorial autonomy.(Canadian Medical Association Journal )
August 15, 2006... Editorial autonomy is paramount in journalism, and the Canadian Medical Association Journal (CMAJ) must be as free of editorial interference as possible, a panel of experts concluded in its report on a new governance structure for the...

Privatization key issue for new CMA president.(Colin McMillan, Canadian Medical Association)
August 15, 2006... Dr. Colin McMillan can recall having lively debates with his father, "Dr. Joe," about the merits of medicare. Dr. Joe, a staunch opponent of government-funded health care, once squared off with David Lewis in a CBC TV debate in the '60s, and...

Pandemic threat overblown by both experts and media.(bird flu)
August 15, 2006... The current threat of pandemic posed by the H5N1 avian flu is a "fraud," Ontario's former chief medical officer of health (1987-97) told 186 public health and media professionals at a Toronto conference on June 27. "I am more frightened by the...

Pharmacies receiving massive rebates from generic drug-makers.
August 15, 2006... Revelations about massive rebates to pharmacies from generic drug manufacturers rocked committee hearings on the Ontario government's controversial Transparent Drug System for Patients Act 2006. The legislation, passed in late June, aims to...

Systemic changes needed to resolve queues.
August 15, 2006... Systemic changes to the health care system are the only long-term means of ensuring that Canadians aren't forever queuing up for medical procedures once the current $5.5-billion fund to fix wait-time problems runs dry, Federal Advisor on Wait...

CMA presidency challenge.(Canadian Medical Association)(Brief article)
August 15, 2006... CMA presidency challenge: Delegates to this month's annual general meeting of the CMA face an unexpected choice as Vancouver family physician Dr. Jack Burak will now challenge British Columbia Medical Association nominee Dr. Brian Day for the...

NPs by the number.(nurse practitioners)(Brief article)
August 15, 2006... NPs by the number: The number of nurse practitioners increased 17% between 2004 and 2005, states a new report from the Canadian Institute for Health Information. There were 1026 NPs in 2005, up from 878 the year before.

Cost of waiting.(hospital waiting list)(Brief article)
August 15, 2006... Cost of waiting: Excessive waits for treatment constitute an enormous drain on the economy, concludes a study by the Centre for Spatial Economics for the Canadian Medical Association and British Columbia Medical Association. The study projects...

Webaholics.(Internet addiction disorder)(Brief article)
August 15, 2006... Webaholics: People with Internet addiction disorder (IAD) will likely start flooding physicians and psychotherapists offices in coming years, predicts a nursing professor at LaSalle University in Philadelphia. Dr. Diane Wieland states that IAD...

Brand-name drug companies fail to meet R&D commitments.
August 15, 2006... When the federal government enhanced patent protection for drugs roughly 2 decades ago, critics feared the end result would be soaring drug costs and conversion of the Canadian industry into little more than a re-packager of import bulk...

Is there another way to take account of noncompliance in randomized controlled trials?
August 15, 2006... Noncompliance is an important issue in the design and conduct of randomized controlled trials (RCTs). It arises when participants do not receive the treatment or intervention to which they were randomly allocated. For example, some participants...

Inappropriate secretion of thyroid-stimulating hormone.
August 15, 2006... The Case: A 39-year-old man presented with fatigue and persistently elevated thyroid-stimulating hormone (TSH), free thyroxine (free [T.sub.4]) and free triiodothyrionine (free [T.sub.3]) levels. He was euthyroid by symptoms, and he did not...

A teenager with fever, rash and arthritis.(Clinical Vistas)(Clinical report)
August 15, 2006... A14-year-old boy presented after 5 days of fever, painful polyarthritis in his shoulders, wrists, knees and ankles, and a rash over both lower limbs. He had been caring for 2 pet rats for 3 weeks before his admission but had not been bitten by...

Visual loss with erectile dysfunction medications.(Health and Drug Alerts)(Drug overview)
August 15, 2006... Reason for posting: Phosphodiesterase type 5 (PDE5) inhibitors, including sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra), are drugs used to treat erectile dysfunction that have long been recognized to cause temporary, minor...

National and provincial retention of medical graduates of Memorial University of Newfoundland.
August 15, 2006... Abstract Background: Memorial University of Newfoundland (MUN) established its medical school in 1967 to meet the growing demand for physicians and alleviate the reliance on other Canadian and international medical schools for physicians....

Revascularization in patients with heart failure.
August 15, 2006... Abstract Background: Although practice guidelines recommend coronary revascularization for patients with heart failure, the evidence to support this recommendation is weak. The objective of our study was to determine the association of...

Autoimmune pancreatitis associated with renal lesions mimicking metastatic tumours.
August 15, 2006... Abstract Autoimmune pancreatitis is a chronic inflammatory disorder that is often misdiagnosed as pancreatic cancer. Since autoimmune pancreatitis is benign and responds to steroid management, it is important to diagnose it to avoid...

What makes medical graduates practise close to home?(Column)
August 15, 2006... As with sea turtles who disappear into the ocean from their natal beaches to reappear years later and be counted, it would be nice to radio-tag physicians to find out where they come from and where they go. The research reported by Mathews and...

To revascularize or not to revascularize: a dilemma in heart failure.(Column)
August 15, 2006... In developed nations, the leading cause of heart failure is coronary artery disease. (1) Established treatment options for ischemic heart failure include medical therapy, revascularization and cardiac transplantation. Cardiac resynchronization...

Patent nonsense: evidence tells of an industry out of social control.
August 15, 2006... What enables the patent-dependent pharmaceutical companies to set the prices they do? Two factors. The first is economic: the companies that make (or at least secure the right to) the discoveries in this marketplace of ideas reap the rewards....

Probiotics for pediatric antibiotic-associated diarrhea: a meta-analysis of randomized placebo-controlled trials.
August 15, 2006... Background: Antibiotic treatment is known to disturb gastrointestinal microflora, which results in a range of clinical symptoms--most notably, diarrhea. This is especially important in children, for whom antibiotics are prescribed frequently....

ADRs and smart health cards.(Letter to the editor)
August 15, 2006... The commentary by Paula Rochon and colleagues (1) highlights the importance of information technology in drug safety. In recent years medication error has received considerable attention, because it causes substantial mortality and morbidity...

<<Oui>> a l'independence editoriale, <<non>> a l'ingerence politique.(Letter to the editor)
August 15, 2006... L'autonomie editoriale est garante de la liberte d'expression et de l'integrite d'une revue scientifique, dont la reputation et la credibilite dependent en grande partie de l'adhesion a ce principe. En congediant sans motif valable une equipe...

Accountability in CMAJ.(Letter to the editor)
August 15, 2006... One of the questions arising from the recent firing of CMAJ's editor and senior deputy editor is "To whom should the Journal and its editorial board be accountable?" (1) If the CMAJ is directly accountable to its publisher, CMA Media Inc.,...

Chronic fatigue.(Letter to the editor)
August 15, 2006... Jacques Cornuz and colleagues, (1) in Box 2 of their case report, list 11 initial laboratory tests for patients with prolonged or chronic fatigue. Given that hypocortisolism is one of the most frequently reported abnormalities of patients with...

Barriers to tobacco cessation.(Survey)
August 15, 2006... Physicians and other health care providers play an important role in tobacco cessation efforts, providing valuable tools and advice to cigarette smokers. (1) One of the key tools is nicotine replacement therapy (NRT), but some smokers are...

Corrections.(Correction notice)
August 15, 2006... In a recent letter to the editor, (1) the second paragraph should have begun as follows: "Dr. Pijak [as opposed to Dr. Khan] raises several important issues...." REFERENCE (1.) Lee SS, Wong T. Hepatitis C: reviewing the options...

Jacques Ferron: transcending solitudes.(Le Cabinet du docteur Ferron )(Movie review)
August 15, 2006... Le Cabinet du docteur Ferron A film by Jean-Daniel Lafond National Film Board of Canada; 2003 82 min. French, with English subtitles Jacques Ferron (1921-1985), a general practitioner, was born in Louiseville, in Maskinonge County, Quebec....

Beware the long flight home.(disaster medicine, Pakistan earthquake relief)
August 15, 2006... October 8, 2005. An immense earthquake jars northern Pakistan and India. There are initial images of schools and houses crumbling, and people being buried, rescued, injured and killed--tens of thousands dead with tolls rising rapidly. A...

Deaths.(Vlad Iorgulescu Avram, Norman Joseph Carriere, C. John Chacko )(Obituary)
August 15, 2006... Avram, Vlad Iorgulescu, Toronto; Institutul de Medicina si Farmacie, Bucuresti, RO, 1983, psychiatry. Died Mar. 10, 2006, aged 50. Carriere, Norman Joseph, Nanaimo, BC; University of Alberta, 1954, psychiatry. Died May 11, 2006, aged 77....

Query.(medical advice to family and friends)(Column)
August 15, 2006... When I was in my first year of medical school, one of my relatives approached me with a health problem. In this I know I'm not alone; every medical student has been in a similar position, and it continues after graduation. In my case it was my...

Anti-inflammatory drugs: What is safe?/Les anti-inflammatoires peuvent-ils etre sans risque?(Column)
August 29, 2006... Some risks of the traditional NSAIDs were well known before the development of selective cyclooxygenase-2 (COX-2) inhibitors (coxibs). Sixteen thousand deaths a year in the United States and 1900 a year in Canada were blamed on NSAID-induced...

Editorial independence for CMAJ: signposts along the road./L'independance de la redaction du JAMC: des signes positifs.
August 29, 2006... The CMAJ Governance Review Panel, formed in March 2006 to "review the CMAJ's governance structure and to provide objective recommendations to further the CMAJ's continued commitment to editorial independence and maintaining excellence in...

Eleven satellite campuses enter orbit of Canadian medical education.(News)
August 29, 2006... At its core lies the simple proposition that outcome matters more than style. Of course, some would argue style significantly impacts on outcome and when the end product is supposed to be a physician who's adequately trained to deliver...

Building Namibia's HIV and mental health services.
August 29, 2006... University of Toronto faculty and students are breaking through the stigma of mental health and HIV by enhancing services for HIV-positive people in Namibia. Members of 11 faculties at the University of Toronto together with colleagues at...

Alberta pharmacists may get prescribing powers.(Alberta. Health Professions Act)
August 29, 2006... Confusion and accusations of conflict-of-interest surround new regulations that would give Alberta's roughly 3500 pharmacists the broadest scope of practice in Canada and one of the broadest in the developed world. The regulations will...

Crisis in US emergency departments.(News)
August 29, 2006... US emergency departments (EDs) are dangerously overburdened, underfunded and unprepared to cope with mass casualties from hurricanes, pandemics or terrorist attacks, according to 3 landmark reports issued in June. A nearly 3-year...

Cervical vaccine approved.(News @ a glance)(Gardasil, Health Canada )(Brief article)
August 29, 2006... Cervical vaccine approved: The first-ever vaccine against cervical cancer, was approved by Health Canada in July. Gardasil (quadrivalent human papillomavirus types 6, 11, 16, 18, recombinant vaccine) was approved for use on females age 9 to 26...

Hep C compensation.(News @ a glance)(Brief article)
August 29, 2006... Hep C compensation: Eight years after its initial settlement, the federal government has set aside nearly $1 billion to compensate the estimated 5500 people who were infected with hepatitis C from tainted blood before Jan. 1, 1986, and after...

Fewer smokers.(News @ a glance)(Brief article)
August 29, 2006... Fewer smokers: Fewer than 5 million Canadians (19%) aged 15 or older reported smoking daily or occasionally in 2005, reported the Canadian Tobacco Use Monitoring Survey by Statistics Canada. This is down slightly from 2004, when 20% of the...

Canada's physician density remains stagnant.
August 29, 2006... Bucking a trend that has seen most countries significantly bolster their physician ranks over the past 15 years, Canada continues to have one of the Organisation for Economic Co-operation and Development's (OECD) lowest ratios of practising...

Dientamoeba fragilis: an emerging role in intestinal disease.
August 29, 2006... First described in 1918 by Jepps and Dobell, Dientamoeba fragilis is a binucleated, unflagellated protozoan related to the trichomonads, 1 readily identified in stool specimens by means of routine iron-hematoxylin stains. First observed in 7...

Why every office needs a tennis ball: a new approach to assessing the clumsy child.
August 29, 2006... The Case: A 7-year-old boy is brought to your office by his mother at the urging of his school. Although he reads extremely well and seems to understand material that is taught, he has great difficulty producing written work, initiating and...

Postoperative iliac-crest avulsion fracture.(Clinical Vistas Briefs)
August 29, 2006... This patient, a smoker with cervical spondylotic myeloradiculopathy, had required a C4-C5 anterior cervical discectomy and fusion with a tricortical autograft harvested with a sagittal saw and osteotome from her left anterior iliac crest, and...

Polymicrobial sepsis.(Clinical Vistas Briefs)
August 29, 2006... Our patient was not febrile, which is often the case for septic elderly patients (Am J Med 1996;100:65-70), but blood tests revealed leukocytosis (16.2 x [10.sup.9]/L; normal 4.0-10.0 x [10.sup.9]/L) and an elevated neutrophil cell count (16.0...

Drop metastases.
August 29, 2006... Intradural extramedullary spinal metastases that arise from intracranial lesions are called drop metastases. This rare complication occurs in about 1% of patients who have glioblastoma multiforme (GBM), the most common form of malignant primary...

Residence location and likelihood of kidney transplantation.
August 29, 2006... Abstract Background: In a universal, public health care system, access to kidney transplantation should not be influenced by residence location. We determined the likelihood of kidney transplantation from deceased donors among Canadian...

Two successive outbreaks of mumps in Nova Scotia among vaccinated adolescents and young adults.(Research)
August 29, 2006... Abstract Background: Before the widespread use of vaccine, mumps was the most common cause of viral meningitis (up to 10% of mumps infections). Vaccination programs have resulted in a drop of more than 99% in the number of reported mumps...

Kidney transplantation in Canada: unequal access.(Column)
August 29, 2006... Kidney transplantation in Canada is limited by the availability of organs, not by financial constraints. Inherent in transplantation is the ethical tension of allocating a scarce resource. Every new patient placed on a transplant waiting list...

Mumps vaccine: is it time to re-evaluate our approach?
August 29, 2006... In the last decade, mumps outbreaks have occurred in various countries: a sustained outbreak in the United Kingdom, (1) a large one in the American Midwest, (2) and Canadian outbreaks in Nova Scotia (2005), (3) Alberta (2002), (4) Montreal...

Introducing the National Collaborating Centres for Public Health.(Public Health)
August 29, 2006... As part of the federal government's commitment to renew and strengthen public health across Canada, 6 National Collaborating Centres for Public Health (NCCs) have recently been established. Their purpose is to make research on public health...

Sperm DNA damage: clinical significance in the era of assisted reproduction.
August 29, 2006... Abstract Evidence suggests that damage to human sperm DNA might adversely affect reproductive outcomes and that the spermatozoa of infertile men possess substantially more sperm DNA damage than do the spermatozoa of fertile men. This is...

Use of memantine to treat Alzheimer's disease.(Letter to the editor)
August 29, 2006... The regulatory approval of memantine for use in the symptomatic treatment of moderate to severe Alzheimer's disease has led to high hopes among patients and their families. However, many physicians are still unsure about how best to use this...