Highlights of this issue
CMAJ 2000;163(5):493
Population, consumption and human health
- Environment and health: an overview [Commentary]
- Environment and health: 1. Population, consumptin and human health [Review]
In the inaugural article of our series on Environment and Health Joseph Speidel examines population, consumption and human health. According to the most conservative realistic projection of fertility rates, the world population is estimated to increase to 9.5 billion by 2100. In the developing world high fertility rates correlate with poor population health, environmental degradation, and high perinatal morbidity and mortality. Education, particularly of women, and access to family planning are rewarded by declining fertility rates and improved community health. In the developed world, high consumption contributes to pollution, environmental degradation and global warming. Political and economic reform will be needed to transform unsustainable to sustainable production, and provide a model for developing economies.
HPV infection and cervical cancer
- Prevalence and predictors of human papillomavirus infection in women in Ontario, Canada [Research]
- Comparison of self-collected vaginal, vulvar and urine samples with physician-collected cervical samples for human papillomavirus testing to detect high-grade squamous intraepithelial lesions [Research]
An estimated 82% of cervical cancers in the developed world can be attributed to sexually transmitted human papillomavirus (HPV) infection. The proportion is even higher (91%) in the developing world, where physician scarcity is one limitation of screening programs. In the first of 2 articles in this issue, John Sellors and colleagues analysed the prevalence of HPV infection among Ontario women. The highest rate (24%) was among women aged 20–24, and there was a strong association between HPV and abnormal cervical cytology results. In their second paper, the authors performed their analysis for HPV on vulvar, vaginal and urine specimens collected by the women themselves. The specimens proved adequate, the methods were acceptable, and 86.2% of women with biopsy-proven high-grade cervical intraepithelial neoplasia were identified through vaginal swabs. This approach may offer a viable alternative to women in the developing world and to others reluctant to present for Pap smears.
Screening controversy
- Colorectal cancer screening: Now is the time [Commentary]
- Population-based fecal occult blood screening for colon cancer: Will the benefits outweigh the harm? [Commentary]
- Rebuttal by S.J. Winawer, A.G. Zauber [Commentary]
- Rebuttal by K.G. Marshall [Commentary]
The results of 3 randomized trials showing a decrease in colon cancer mortality with fecal occult blood screening have prompted some provincial cancer control agencies to recommend screening. Ken Marshall dissents, citing a systematic review which demonstrates that 1000 people would need to be screened for about 10 years to prevent a single death from colon cancer. Marshall is taking the wrong perspective, according to Sidney Winawer and Ann Zauber, by whose calculations 12 325 life-years would be saved for every 100 000 people screened.
Type 2 diabetes in Canada's First Nations
Diabetes, once rare in Aboriginal peoples, is now a significant health problem for them, accompanied as it is by high rates of retinopathy, renal disease and infection. T. Kue Young and colleagues describe the prevalence of diabetes in Canada's First Nations and current hypotheses for its emergence, from the "thrifty genotype" to lifestyle changes. They also outline particular considerations for health care providers, including the need to ensure access for patients living in remote areas and the need for culturally appropriate education and treatment programs. Traditional medicines are a yet-unexplored source of potential therapies.
Urinary tract infections in children
Urinary tract infections occur in 1%–8% of children up to 11 years old, of whom 30%–40% suffer recurrence. Febrile urinary tract infections are associated with a risk of renal scarring and subsequent development of hypertension. Antibiotic prophylaxis has been used to suppress the growth of contaminating bacteria in the bladder, but there are side effects and concerns about selection for resistant species. In a systematic review of the literature Nicole Le Saux and colleagues find that the supportive evidence for antibiotic use is limited for children with normal urinary tracts or neurogenic bladder, and lacking for children with reflux. They emphasize the need for well-defined randomized clinical trials.
© 2000 Canadian Medical Association or its licensors
