Highlights of this issue
CMAJ 2000;163(6):693
In praise of tomatoes
Oxidative damage to cells is thought to be part of the mechanism of several chronic diseases. Bodily defenses include endogenous enzymes and dietary antioxidants. Lycopene, a carotenoid pigment found in red fruits and vegetables, is one of the most potent antioxidants known. Unlike most carotenoids, it does not exert its protective effect through the vitamin A pathway. Sanjiv Agarwal and Akkinappally Venketeshwer Rao review the mechanism of action and the evidence for the protective effect of a diet high in lycopene.
HPV testing, continued In the last issue 2 articles appeared on the prevalence of human papillomavirus (HPV) infection among Ontario women and the suitability of self-collected specimens for analysis. In this issue a third article from the same group reports the results of a randomized controlled trial comparing the performance of immediate HPV DNA testing with delayed (6-month) repeat Pap testing in detecting high-grade cervical intraepithelial neoplasia (CIN 2 or 3). Among the 159 women who completed the trial, 17 had histologically confirmed CIN 2 or 3. HPV DNA testing identified CIN 2 or 3 in 87.5% (7/8) of these women. In the repeat Pap test group, smears showing high-grade squamous intraepithelial lesions (HSIL) identified only 11.1% (1/9) of the confirmed cases, and smears showing any abnormality (atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesions or HSIL) identified 55.6% (5/9). Corresponding specificities were 50.6%, 95.2% and 55.6%. HPV DNA testing proved more costly, but there was significantly less loss to follow-up.
Global climate change and health
In the second article in our series on environment and health, Andrew Haines and colleagues examine the impact of global warming on world health. Direct effects include morbidity and mortality from heat waves, drought, floods, storms and the breakdown of systems in the aftermath of weather disasters. Indirect effects are mediated through decreased crop productivity owing to pests and climate change, changing water availability, lower air quality, rising sea levels and altered distribution of zoonotic disease vectors. The authors warn that these effects may no longer be entirely avoidable and conclude with recommendations for action to minimize their impact.
Urban v. remote family medicine training
Recent initiatives to improve physician supply to underserviced areas have included the establishment of family medi-cine residency training programs in remote communities. In contrast to their urban counterparts, rural residents train primarily in community medical practices and rural hospitals and there is often only one trainee at each site. Are the 2 types of training equivalent? Robert McKendry and colleagues analyzed the examination results for 1013 Ontario family medicine residents (922 in urban programs, 91 in remote programs). They found no consistent, significant differences in examination performance between the 2 groups.
Faculty wellness
Although physicians are suspected of being at higher risk for suicide, alcohol abuse and marital discord than the general population, at least in part as a result of workplace stress, they may also be less likely to seek or receive help. Concerned colleagues are inhibited by lack of knowledge and by privacy concerns, whereas affected physicians are torn between the desire to maintain confidentiality by seeking help outside their own professional circle and uncertainty about the competence of experts whom they do not know. Noni MacDonald and Simon Davidson report on the work of the Task Force on Faculty Stress at the University of Ottawa, which was assembled to address these problems among academic physicians and develop an early detection, outreach and intervention program that faculty would use.
© 2000 Canadian Medical Association or its licensors
