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Highlights of this issue
Cognitive psychology in medicine
Health care suffrage in Saskatchewan
Predictors of mammography use Women aged 5069 are currently advised to undergo mammography every 2 years. To determine whether these women are receiving appropriate screening, Colleen Maxwell and colleagues analyzed data from the 1996/97 National Population Health Survey. In all, 79.1% (95% confidence interval [CI] 76.9%81.2%) of the women in this age group reported ever having had a mammogram, and 53.6% (95% CI 51.4%55.9%) had had a recent one (< 2 years before the survey). Of those who had not had a recent mammogram, over 50% thought it was unnecessary. Only 28.2% of those who had never had a mammogram planned to have one within 2 years. Significant predictors of nonparticipation included age over 69, residence in a rural area, Asia as birth place, no involvement in volunteer groups, no regular physician or recent medical consultations, current smoking, infrequent physical activity and no hormone replacement therapy. Sustainable health care for the environment Our Environment and Health series continues with an examination of the impact of health care on the environment. Health care consumes natural resources, involves complex manufacturing systems that can emit toxic by-products, requires energy-expensive buildings and transportation systems, and generates vast quantities of infectious, toxic and radioactive waste. Andrew Jameton and Jessica Pierce describe initiatives toward making health care environmentally sustainable. They also examine the ethical principles involved in balancing human interests with those of the environment in health care planning and development. Vitamin C and cancer reconsidered
One of the durable controversies in medicine concerns the treatment of cancer with vitamin C. Early optimism prompted by remissions observed in a few patients with advanced, untreatable cancer was not supported by later results from randomized controlled trials. One of the principal criticisms of vitamin C treatment is that the early trials involved intravenous administration and the later ones, oral. Increasing understanding of the absorption and metabolism of vitamin C, reviewed by Sebastian Padayatty and Mark Levine, suggests that the 2 routes of administration are not equivalent. In a related commentary, John Hoffer reflects on the need for "rules of engagement" in the debate between alternative and clinical medicine, to ensure that alternative therapies are appropriately evaluated.
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