Highlights of this issue
Combined hypertension and hyperlipidemia
Where do you start?
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What's the optimal strategy for managing a patient who has hypertension and hyperlipidemia? Sylvie Perreault and colleagues studied the prevalence of a host of risk factors for coronary artery disease in a random sample of over 11 000 Canadians aged 3574 years. Hyperlipidemia, obesity and a sedentary lifestyle were more common among patients with than among those without hypertension. Using a validated cardiovascular life expectancy model, the authors estimated that more deaths from coronary artery disease could be prevented among subjects with treated but uncontrolled hypertension by modifying lipid levels than by further reducing blood pressure for men aged 3554 (reduction of 50 v. 29 deaths per 100 000) and 5564 (reduction of 171 v. 104 deaths per 100 000) and for women aged 3554 (reduction of 44 v. 39 deaths per 100 000). Among subjects aged 3574 with untreated hypertension, they estimated that more deaths could be prevented by starting antihypertensive therapy than by modifying lipids.
Resistance to antimicrobials among E. coli isolates in children
What are the risk factors?
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Of over 1600 consecutive urinary tract Escherichia coli isolates obtained from 967 children seen at the Children's Hospital of Eastern Ontario, Upton Allen and colleagues found that 45% were resistant to ampicillin, 31% to trimethoprimsulfamethoxazole (T-S) and almost 2% to both ampicillin and gentamicin. In a casecontrol study they matched 274 children whose isolates were resistant to T-S with 274 whose isolates were sensitive to T-S. One of the strongest predictors of resistance was the use of antimicrobials for more than 4 weeks in the previous 6 months (odds ratio [OR] 23.4). Other factors included genitourinary tract abnormalities (OR 2.4) and hospital admission in the previous year (OR 2.3 for 1 admission and 3.2 for 2 or more admissions). The authors question the wisdom of using inexpensive first-line agents such as T-S and ampicillin in the outpatient treatment and prophylaxis of urinary tract infections in children, especially those who have recently received antimicrobial therapy, because their use may lead to the development of resistant organisms.
Quality of care in unlicensed nursing homes
Generally adequate, but problems remain
See also:
- Evidence: Quality of care in unlicensed homes for the aged in the Eastern Townships of Quebec
- Editorial: "Mine own countree": quality of care in nursing homes
Gina Bravo and colleagues report on the quality of care provided to 301 impaired elderly residents in 52 unlicensed and 36 licensed Quebec nursing homes. Using a standardized tool to assess quality of care, they found that, although the unlicensed homes performed worse in 2 areas of care (physical and medical management), overall the quality was similar in the unlicensed and licensed facilities. However, 25% of the facilities, both licensed and unlicensed, were found to have provided inadequate care to at least one resident. In an accompanying editorial Jean Chouinard argues for the establishment of ongoing assessments of quality of care in all nursing homes.
Obesity in Canada
Comorbidities and resource utilization
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Kostas Trakas and colleagues determined the prevalence of obesity, the associated comorbidities and the patterns of resource utilization among over 12 000 Canadians aged 2064. As expected, about one-third of men and about one-quarter of women were obese. Compared with nonobese subjects, obese subjects were more likely to suffer activity restrictions (adjusted odds ratio [OR] 1.39) and a number of chronic diseases including diabetes, hypertension, heart disease and asthma. They were also more likely to consult with physicians (adjusted OR 1.32) and to be prescribed various medications. There is no doubt that the burden of obesity on health and health care resources in Canada is substantial.
