Highlights of this issue
CMAJ 1999;161:673
Trends in the hypertension prevalance and treatment
- Trends in the prevalence and treatment of hypertension in Halifax County from 1985 to 1995 [Evidence]
- The treatment of hypertension in Canada: Are we making progress? [Editorial]
Hermann Wolf and colleagues in Nova Scotia have compared the data from 2 surveys conducted in 1985 and 1995 on hypertension and medication. In both random samples, blood pressure and medication use were measured. There was a shift toward monotherapy and an increase in the use of calcium-channel blockers (from 2.1% to 19.7%) and angiotensin-converting-enzyme inhibitors (from 5.2% to 25.4%), with an associated increase in the daily cost of medication (from $0.48 to $0.85 per patient). The rate of uncontrolled hypertension among patients receiving treatment increased for both men (from 32.6% to 57.4%) and women (from 38.0% to 42.6%). Finlay McAlister comments on the increase in costs without concomitant improvements in blood pressure control.
Quick Medical Reference as a diagnostic tool
How well does computer technology mimic a physician's integration of clinical information? Jane Lemaire and colleagues assess the diagnostic effectiveness of the computer program Quick Medical Reference (QMR). Two physicians used abstracted chart data and QMR to derive lists of the most likely diagnoses. The correct diagnosis was obtained in 43% and 36% of the cases. The authors observed that rare diseases were absent from the QMR knowledge base, that in some cases over 150 diagnoses were suggested and that comorbidities created a challenge for the program. They wonder whether using QMR in an iterative fashion might improve its effectiveness.
Attitudes toward alternative perinatal care
- Attitudes of Canadian women toward birthing centres and midwife care for childbirth [Research letter]
Shi Wu Wen and colleagues report the results of the 1994 National Population Health Survey of women's attitudes toward perinatal care. Of the 3438 respondents, aged 2044, 21% said that they would allow a nurse or midwife to deliver their baby, 31% would go to a birthing centre rather than a hospital, and 85% would allow a nurse or midwife to give postpartum care. Education, immigration status and language influenced attitudes. The authors recommend that future surveys be targeted more specifically.
Hepatitis B on the street
The lifestyle of street youths puts them at increased risk of STDs and blood-borne infections. In 1996 a cross-sectional anonymous study was conducted by Élise Roy and colleagues to estimate the prevalence of hepatitis B virus (HBV) markers and risk behaviours among Montreal street youths. Of the 437 participants, aged 1425 years, 45.8% had injected drugs, 24.5% had engaged in prostitution, and 8.7% reported having a sexual partner with a history of unspecified hepatitis. The prevalence rate of HBV markers was 9.2%. Innovative hepatitis B vaccination programs are urgently needed for this vulnerable population.
Physicians' knowledge of HRT
The knowledge of Ontario physicians of hormone replacement therapy (HRT) is consistent with the literature. This is the conclusion of Lynn Elinson and colleagues after analysing the surveyed responses of 327 physicians to 3 hypothetical cases concerning HRT. The vast majority identified the importance of osteoporosis (97.4%), coronary artery disease (89.3%) and breast cancer (97.3%) risks. Most said that they would prescribe HRT for 12 years or more (73.3%) and follow up patients every 12 years (70.6%). Although 97.0% said that they would prescribe estrogenprogestin for a woman with an intact uterus, 13.6% indicated that they would do so for a woman with no uterus. This is of concern since questions about long-term progestin use are unanswered.
© 1999 Canadian Medical Association
