Highlights of this issue [CMAJ

Highlights of this issue

CMAJ 2000;163(3):257

Smoking and pregnancy

The natural history of smoking during pregnancy among women in Nova Scotia [Research Letter]
Smoking and women's health: opportunities to reduce the burden of smoking during pregnancy [Commentary]

Susan Kirkland and colleagues have analysed data from routinely collected perinatal records of 8528 women in Nova Scotia whose smoking status before pregnancy was known. Overall, 33.1% smoked before their pregnancy; of these, 69.9% smoked throughout the pregnancy, 13% quit by their first prenatal visit and maintained their nonsmoking status, and 8% were smoking at the time of their first prenatal visit but quit by the time of delivery. In an accompanying commentary Shahul Ebrahim and colleagues review the steps physicians can take to increase the rate of smoking cessation among pregnant women.

Treating asymptomatic bacteriuria

Despite compelling evidence not to treat asymptomatic bacteruiria in elderly residents of long-term care facilities, such cases frequently are treated. To discover why, Susan Walker and colleagues conducted 4 focus groups with physicians and nurses. Ambiguous signs such as foul-smelling urine and subtle changes in patient behaviour were identified as signals for ordering urine cultures and antibiotic therapy. Physicians did not appear to appreciate that the presence of pyuria in this population is of no diagnostic value. The results generated several research questions, one being, "Do interpretive comments issued with the results of urine screening tests or cultures reduce the frequency of prescribing antibiotics for asymptomatic bacteriuria?" In an accompanying commentary, Lindsay Nicolle identifies the opportunities to move from evidence to practice on this matter.

DNA amplification and infectious diseases

The role of DNA amplification technology in the diagnosis of infectious diseases [Review]

In the past decade molecular techniques to amplify and detect minute amounts of nucleic acid sequences from tissues and body fluids have been developed. The most widely used and well known of these is the polymerase chain reaction (PCR), which involves denaturing, annealing and extending DNA fragments. Marie Louie and colleagues review this laboratory process and illustrate the clinical applications of PCR in the rapid detection of infections due to Chlamydia, mycoplasmas, mycobacteria, herpesviruses and enteroviruses.

Canadian normative data for the SF-36

Canadian normative data for the SF-36 health survey [Research]
The Canadian SF-36 health survey: Normative data add to its value [Commentary]

The Medical Outcomes Study 36-item Short Form (SF-36) is a widely cited measure of health-related quality of life. A team of scientists has established Canadian normative data for the SF-36 using data from the Canadian Multicentre Osteoporosis Study, a prospective cohort study involving 9423 men and women. They report that men scored higher than women on all domains of the SF-36 and that Canadians scored higher than US and UK counterparts on several domains. These differences confirm the necessity of Canadian norms for comparative purposes. In an accompanying commentary Sharon Wood-Dauphinee agrees but cautions that some of the differences between countries may be due to different samples or versions of the SF-36.

Solving a staff shortage problem

In response to a shortage of house staff, the Department of Pediatrics at Toronto's Hospital for Sick Children introduced a clinical departmental fellowship program to address the problem of after-hours clinical care for inpatients. The program has expanded from 3 fellows in the first year (1996) to 20 fellows in 1999/2000. The fellows, drawn from around the world, have been productive both academically and clinically. In an accompanying commentary Richard Goldbloom acknowledges that on its own merit the program is laudable but wonders to what extent it is generalizeable to other Canadian academic centres.