Highlights of this issue

CMAJ 1999;161:785

• Slapping and spanking in childhood and its association with lifetime prevalence of psychiatric disorders in a general population sample [Evidence]

Harriet MacMillan and colleagues have estimated the prevalence of a history of spanking in a general population sample and its association with psychiatric disorders by analysing a subset of the Ontario Health Supplement survey data. Of the 4888 people aged 15­64 without a history of physical of sexual abuse during childhood, 5.5% reported that they had been slapped or spanked "often," 33.4% "sometimes," 40.9% "rarely" and 20.2% "never." Those who responded "often" or "sometimes" had higher lifetime rates of anxiety disorders (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.04­1.96), alcohol abuse or dependence (adjusted OR 2.02, 95% CI 1.27­3.21) and externalizing problems (e.g., illicit drug abuse or antisocial behaviour) (OR 2.08, CI 1.36-3.16) than those who reported "never."

• Is it time to ban corporal punishment of children? [Editorial]

Murray Straus ponders the implications that spanking might be harmful. Is it time to join Sweden in banning the corporal punishment of children, or is there a critical threshold for spanking that is safe if not exceeded? Because unanswered questions remain and existing data suggest that the majority of physicians regard spanking as sometimes necessary, should physicians counsel parents to stop spanking? Might parents resort to verbal abuse or abandon discipline altogether? Or might they sensitize to the vulnerability of children and attend more closely to their child's behaviour?

• Fairness in the coronary angiography queue [Evidence]
• Waiting for medical care: Is it who you know that counts? [Editorial]

David Alter and colleagues followed 357 patients booked for coronary angiography at the Sunnybrook site of Toronto's Sunnybrook & Women's College Health Sciences Centre in order to identify determinants of waiting time. They compared processes of care according to the referring physicians' hospital affiliation (physicians at Sunnybrook, those who practised elsewhere but performed angiography at Sunnybrook and those with no previous association with Sunnybrook). Although 65.3% (201) of the patients received angiography within the recommended maximum waiting time, physician affiliation was an independent and significant factor, explaining 9.3% of the variation between the 3 groups of patients. The mean inpatient waiting times were 1.0, 5.7 and 8.0 days (p < 0.003) and the mean outpatient waiting times were 58.5, 28.6 and 85.2 days respectively for the 3 groups (p < 0.001). In his editorial S.E.D. Shortt emphasizes the need for scholarly scrutiny of fairness in queue management systems.

• Tuition fees for residents: one physician's perspective [Editorial]

Brian Cummings offers his perspective as a resident and a chartered accountant. The fact that tuition fees represent only 20% of the true cost of education and that professions earn high incomes upon completion of training are arguments supporting tuition. Countering these are the incurred costs of undergraduate medical education (estimated to be over $116 000 for the class of 2003 at the University of Western Ontario) and the potential earnings lost during years of training. If tuition rises to meet market levels, should residents' wages not similarly rise to reflect the amount of training required, the skills demanded, the responsibilities undertaken and the time expended?

Sir William Osler
• Reputation unrevised: celebrating the Osler sesquicentennial
• William Osler at 150
• Tea with Sir William Osler
• Did Osler suffer from "paranoia antitherapeuticum baltimorensis"?
• Osler's unusual case — Was it Churg­Strauss syndrome?
• Osler usque ad mare: The SS William Osler

Sir William Osler, the world's most famous physician at the beginning of the century, has become a dim legend at its end. This year is the sesquicentennial of Osler's birth in Bond Head, Canada West. In his editorial Charles Roland commemorates Osler. Five subsequent articles reflect on the "Saint's" contributions to medicine, his musings on the recent medical revolution, his reputation as a therapeutic nihilist, his connection with the mare and his presentation of a case now recognized as Churg­Strauss syndrome.

© 1999 Canadian Medical Association or its licensors