Highlights of this issue [CMAJ

Highlights of this issue

CMAJ 2000;162:305

Anemia in Cree infants

Prevalence of anemia among James Bay Cree infants of northern Quebec [Research]
Breast-feeding and anemia: Let's be careful [Commentary]

In 1995, 6 Cree communities in the James Bay region introduced a screening program to identify anemia in infants. Noreen Willows and colleagues have reviewed the charts of 386 of these children and discovered that 31.9% of the hemoglobin (Hb) concentrations documented at 9 months of age were less than 110 g/L. Babies fed formula at 9 months had a higher mean Hb concentration (118.5 [standard deviation (SD) 9.9] g/L) than those exclusively breast-fed (109.9 [SD 10.0] g/L) or cow's milk (112.5 [SD 10.1] g/L). According to editorialist John Godel, these findings prompt 2 questions: What is anemia in this age group? And how well is a breast-fed 9-month-old baby protected against iron deficiency?

Equity and health

Equity in health [Commentary]

The evidence of a direct, almost linear, relation between health and wealth is mounting, yet the precise mechanisms by which social inequities produce health inequities are unclear. Barbara Starfield announces the formation of the International Society for Equity in Health, whose purpose will be to encourage advances in knowledge about equity and health and to promote the application of knowledge to activities directed at this goal. The society's inaugural meeting will be held in June in Havana, Cuba.

Evidence and the Internet

The Internet and evidence-based decision-making: a needed synergy for efficient knowledge management in health care [Review]

Alejandro Jadad and colleagues comment on the early signs of convergence between evidence-based decision-making and the Internet. They cite examples such as the Cochrane Collaboration, which uses the Internet to make tools available and to provide access to peer review, the CATmaker, which helps physicians produce summaries of articles called "critically appraised topics" (CATs), and the ScHARR Internet site, which offers calculators for interpreting studies as well as regularly updated links to evidence-based resources around the world. According to the authors these advances represent merely the transition from paper-based to electronic media. They foresee a true revolution with technological advances in information processing and "ubiquitous" computing. Collaboration and rigorous evaluation will be necessary, they conclude, to ensure that Internet-related developments in health and health care are taking us in the right direction.

Rational restraints

Use of physical and chemical restraints in medical teaching units [Research Letter]

Janet Kow and David Hogan call for guidelines on the rational use of restraints after reviewing the charts of 156 patients admitted to a medical teaching unit. A total of 18 patients (11.5%) were either physically or chemically restrained, or both. The indications for restraint use were not well documented, and no orders had any time limits established. Although physicians tended to decide whether restraints should be used, nurses tended to decide when to apply them.

Trying to find a balance

Gay and lesbian physicians in training: a qualitative study [Research]

Gay and lesbian medical students and residents expend considerable energy assessing their teaching environments, trying to find a balance between self-disclosure and protection. This is one conclusion drawn by Cathy Risdon and colleagues after conducting a qualitative study of the experiences of 29 gay and lesbian physicians in training. The participants articulated competing tensions between being honest and true to their selves and risking negative reactions from peers or threats to their future careers. The most successful strategy for many struggling with the task of integration was the use of professional and peer role models.