Highlights of this issue [CMAJ

Canadian Medical Association Journal

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Highlights of this issue

CMAJ 2000;163(8):949

Hungry children in Canada

Child hunger in Canada: results of the 1994 National Longitudinal Survey of Children and Youth [Research]
Child hunger: semi-starvation study repeated in Canada [Commentary]

The 1994 National Longitudinal Survey of Children and Youth included questions about children's experience of hunger. Lynn McIntyre and colleagues have reviewed the data and report that, of the more than 13 000 households surveyed, 1.2% (representing 57 000 Canadian families) reported going hungry because of lack of money for food. The affected families were more likely than the others to be led by a single parent, to be receiving social assistance or welfare, to be Aboriginal families living off-reserve and to have low income. The health of the primary caregivers and their children was also more likely to be poorer in the families reporting hunger. Parents reported coping by fasting, reducing food quantity and variety, or seeking help from relatives, food banks or friends. Few applied to social programs. In an accompanying commentary Laird Birmingham emphasizes the long-term health consequences of prolonged food deprivation and the need to recognize hunger and malnutrition in patients.

Noninvasive positive-pressure ventilation

Noninvasive positive-pressure ventilation (NIPPV) has been shown to decrease mortality and the need for endotrachial intubation in patients with respiratory failure. Tasnim Sinuff and colleagues conducted an observational cohort study involving 91 consecutive patients with respiratory failure managed with NIPPV. The most common indications were pulmonary edema (44.2%) and exacerbation of chronic obstructive pulmonary disease (24.2%). The mortality was 28.6%, higher than that reported in randomized trials; decreased level of consciousness was found to be a significant predictor of death. The study identified the need for an educational program and clinical practice guidelines to optimize NIPPV use. In an accompanying commentary Sheldon Magder addresses the pitfalls of extrapolating from the clinical trial to the hospital ward.

Detecting delirium in elderly patients

Prevalence and detection of delirium in elderly emergency department patients [Research]

Delirium is an acute confusional state that, in elderly people, is associated with increased mortality and long hospital stays. It can often be reversed by treatment of the underlying cause; however, the delirium must first be identified. Michel Élie and colleagues performed a cross-sectional study and chart review to determine the prevalance and detection rates of delirium among elderly patients seen in the emergency department. Overall, 10% of the patients were found to have delirium, as diagnosed by a research psychiatrist using the Confusion Assessment Method; in only 35% of cases was delirium diagnosed in the emergency department using chart review or a mental status checklist.

Venous thromboembolism

Hereditary abnormalities in proteins involved in the clotting cascade are associated with increased risk of venous thromboembolism; however, certain of these, such as Factor V Leiden, are prevalent in the asymptomatic population. What, then, is the significance of an abnormal laboratory result? What should drive decision-making about prophylactic anticoagulation, with its attendant side effects? In this issue Susan Solymoss reviews the risk factors for thromboembolism, while Shannon Bates and colleagues consider the current state of knowledge about the reliability of laboratory assays in predicting risk and propose criteria by which to evaluate new laboratory tests.

The environment and cancer

Environment and health: 4. Cancer [Review]

Current estimates attribute 5% of cancer deaths to occupational factors and 2% to environmental pollution. In terms of the estimated lifetime risk of any cancer (40% for men and 35% for women), this represents a substantial burden of disease. Furthermore, the incidence is rising for certain types of cancer, including melanoma and non-Hodgkin's lymphoma, both of which are associated with environmental causes. In the fourth article in the Environment and Health series, Richard Clapp reviews the relationship between environmental exposure and cancer, its implications for cancer prevention and the physician's role in screening for hazardous exposure.