Highlights of this issue

CMAJ 2001;164(1):9

• What goes around, comes around: a history of medical tuition [Commentary]

Tuition fees for Ontario medical students were deregulated in 1997. From 1997 to 1999 tuition at 3 Ontario medical schools rose more swiftly than at any time in the past 150 years. Jacalyn Duffin takes a historical look at the rise and fall of tuition fees, surveying past experiences in privately and publicly funded medical education. She wonders whether higher fees restrict accessibility and points to evidence that suggests they might. Duffin invites readers to question current trends and ask whether medical tuition in Ontario might restrict the intellectual quality of our future physicians.

• Apolipoprotein B versus lipoprotein lipids: vital lessons from the AFCAPS/TexCAPS trial [Commentary]

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? [Research]

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] 0.93–1.96) and were more likely to be admitted to hospital at least once (odds ratio 1.23, 95% CI 0.40–3.79); 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.

• Determinants of violence in the psychiatric emergency service [Research]

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] 2.34–3.18), a diagnosis of schizophrenia or psychotic disorder not otherwise specified (RR 1.91, 95% CI 1.62–2.26) and a low score (< 26) on the DMS-IV Global Assessment of Functioning Scale (RR 3.10, 95% CI 2.59–3.71). Intoxication and a history of alcohol or substance abuse were weaker predictors. The frequency of violence was similar among men and women.

• Environment and health: 7. Species loss and ecosystem disruption — the implications for human health [Review]

Copyright 2001 Canadian Medical Association or its licensors