Highlights of this issue
Prostate cancer: a look ahead
Emerging approaches in prostate cancer therapy may provide hope
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Continuing our Clinical Basics series on prostate cancer, Trachtenberg and colleagues provide a glimpse into the future. The new strategies they review include interstitial microwave thermoablation, 3-dimensional conformal radiotherapy, interstitial brachytherapy and new concepts in treating hormone-refractory prostate cancer.
The price we pay for obesity
The physical and financial costs are high, and effective methods for prevention and treatment elusive
See also:
- Evidence: The cost of obesity in Canada
- Education: Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity
- Editorial: Call for action: preventing and managing the expansive and expensive obesity epidemic
Using data from the National Population Health Survey and from the Canadian Institute of Health Information and Health Canada, Birmingham and colleagues have calculated the direct costs attributable to obesity for 10 comorbidities identified in the medical literature. They estimate that the total direct cost of obesity in Canada in 1997 was over $1.8 billion, or 2.4% of the total health care expenditures for all diseases during that year. Hospital care accounted for $581.9 million, drug therapy for $578.7 million and physician services for $235.4 million. The most expensive comorbidities were hypertension, type 2 diabetes and coronary artery disease.
To examine prevention and treatment of this problem, Douketis and colleagues, wit the Canadian Task Force on Preventive Health CAre, systematically reviewed numerous studies. They found insufficient evidence to recommend for or against weight-reduction therapy for obese adults without obesity-related diseases, but they did find evidence to support these interventions in patients who already suffer from obesity-related diseases, to alleviate symptoms and reduce drug therapy requirements.
Although the task force also found insufficient evidence to suggest that community-based prevention programs are effective, editorialist Lau insists that, because weight-reduction efforts are notoriously unsuccessful, research must focus on creative approaches to prevention and on novel markers to assess health risks.
Candidemia in Canada
Patients at risk of death from blood-borne infection with Candida species
See also:
- Evidence: Candidemia at selected Canadian sites: results form the Fungal Disease Registry, 1992–1994
Yamamura and colleagues used blood culture surveillance and chart reviews to collect clinical information on all patients with candidemia in 14 metropolitan Canadian areas between March 1992 and February 1994. They identified 415 cases, 88% in adults and 12% in children. Most infections (69%) were caused by C. albicans. Treatment was administered in 85% of cases, and of the treated patients, most (69%) received amphotericin B. The overall mortality rate was 46%, and the rate of deaths related clinically to candidemia was 19%. The mortality rate was lower among children than among adults. The most important risk factors for death were age greater than 60 years and stay in an intensive care unit.
It's in the bag
Symptoms of infection after transfusion may be caused by bacterial contamination of blood components
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In our Public Health column, Health Canada epidemiologists Slinger and Giulivi alert physicians to the occurrence of infectious febrile transfusion reactions and provide recommendations for their detection and management.
Journey to Chiapas
A health sciences student reflects on self-determination and health
See also:
- The Left Atrium: Chiapas: a state of health in a state of siege
In The Left Atrium, we travel to Chiapas, Mexico, with Tanya Zakrison and witness "a state of health in a state of siege."
