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Highlights of this issue
Tuition fees: a historical perspective
Apolipoprotein B and cardiovascular risk
Risk of cardiovascular disease is currently assessed by measuring levels and ratios of high-density, low-density and very low-density lipoproteins and triglycerides. The complexity of this system may in part explain why only a minority of patients who begin lipid-lowering treatment reach target levels and stay on therapy. Allan Sniderman and colleagues describe the results of 2 important recent studies that identify apolipoprotein B (apo B) as the single most valuable predictor of cardiovascular risk. Importantly, apo B levels in one of the studies continued to predict risk during lipid-lowering treatment. These results may offer a means to simplify the identification of patients at risk and the monitoring of treatment effect. Undiagnosed diabetes: Does it matter?
The 1998 Canadian clinical practice guidelines for the management of diabetes lowered the cutoff point for an abnormal fasting blood glucose level from 7.8 to 7.0 mmol/L. Kue Young and Cameron Mustard used database linkage to study outcomes of people considered to have diabetes under the new guidelines, but not under the old, in a cohort of adults originally included in the 1990 Manitoba Heart Health Survey. The prevalence of undiagnosed diabetes was 2.2%, about one-third of all diabetes cases. Compared with normoglycemic people, individuals with undiagnosed diabetes had an additional 1.35 physician visits per year (95% confidence interval [CI] 0.931.96) and were more likely to be admitted to hospital at least once (odds ratio 1.23, 95% CI 0.403.79); they also had unfavourable lipid profiles and higher blood pressure and obesity indices. The authors conclude that undiagnosed diabetes represents a clinically and socially important burden of disease. Violence in a psychiatric emergency service
Adam Oster and colleagues evaluated predictors of violence among patients referred to the psychiatric emergency services of the Calgary General Hospital over a 4-year period. Violent incidents ranged from verbal aggression to physical assault involving injury. The strongest predictors of violence were a history of violence (risk ratio [RR] 2.73, 95% confidence interval [CI] 2.343.18), a diagnosis of schizophrenia or psychotic disorder not otherwise specified (RR 1.91, 95% CI 1.622.26) and a low score (< 26) on the DMS-IV Global Assessment of Functioning Scale (RR 3.10, 95% CI 2.593.71). Intoxication and a history of alcohol or substance abuse were weaker predictors. The frequency of violence was similar among men and women. Species loss and human health
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