Highlights of this issue
========================


**Hypertension and diabetes in First Nations people** 

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/174/9/1241.1/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/174/9/1241.1/F1)

Figure. Photo by: CP Images/Yoav Levy

To find optimal strategies for blood pressure control in First Nations people with diabetes and hypertension, Tobe and colleagues conducted a randomized controlled trial to assess whether a drug treatment strategy implemented by home care nurses in addition to nonpharmacologic management is more effective than nonpharmacologic management by the nurses and follow-up care by a primary care physician. Both groups experienced similar and significant reductions in systolic blood pressure. In a related commentary, Salisbury and Fahey advocate for a “stepped-care” approach to hypertension management that can be implemented by all health professionals in various community settings.

**See pages** [1267](http://www.cmaj.ca/lookup/volpage/174/1267) **and** [1285](http://www.cmaj.ca/lookup/volpage/174/1285)

**The impact of maternal milk restriction on birth weight** 

Mannion and colleagues involved 279 pregnant women in a study to compare the birthweights of babies born to women who drank less or more than 250 mL (1 cup) of milk daily during their pregnancy. They report that women who restricted their milk consumption had lower intakes of vitamin D and bore smaller babies. Each additional cup of milk per day was associated with a 41-g increase in birthweight; each additional microgram of vitamin D, with an 11-g increase. In a related commentary, Hollis and Wagner remind us that vitamin D is not really a vitamin but a preprohormone, part of a complex endocrine system that begins with the skin. Much about this system is still unknown, including the amount of vitamin D3 required for human development, growth and health. Given the roles that vitamin D may have in fetal skeletal formation, neurodevelopment, immune function and chronic disease susceptibility, low maternal intake might have profound long-term implications.

**See pages** [1273](http://www.cmaj.ca/lookup/volpage/174/1273) **and** [1287](http://www.cmaj.ca/lookup/volpage/174/1287)

**Warfarin interaction with chamomile** 

*Matricaria chamomilla* is thought to be a coumarin constituent. Segal and Pilote report on a case of an elderly woman receiving warfarin therapy who experienced rectus sheath and retroperitoneal hematomas after using chamomile skin lotion and tea to relieve upper respiratory symptoms.

**See page** [1281](http://www.cmaj.ca/lookup/volpage/174/1281)

**Obesity and chronic respiratory disease** 

Obesity is an established risk factor for cardiovascular disease, diabetes, arthritis, cancer — and chronic respiratory diseases. Although weight loss is associated with important symptomatic improvement for patients with respiratory disease, it is difficult to achieve among patients whose physical activity levels are low because of shortness of breath. Poulain and colleagues review the therapeutic implications of obesity for chronic obstructive pulmonary disease, asthma, obstructive sleep apnea and obesity hypoventilation syndrome.

**See page** [1293](http://www.cmaj.ca/lookup/volpage/174/1293)

**Analysis • Practice** 

Many **legal residents** of Canada are without insured health care during **mandatory waiting periods** or while they appeal status decisions. The need in this population, particularly for emergent and prenatal care, is great. Caulford and Vali suggest a number of possible remedies, starting with elimination of provincial 3-month waiting periods (page [1253](http://www.cmaj.ca/lookup/volpage/174/1253)). Shojania has formulated a set of simple steps to reduce **drug-related errors**, from prescription through monitoring, especially in outpatient settings (page [1257](http://www.cmaj.ca/lookup/volpage/174/1257)).

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/174/9/1241.1/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/174/9/1241.1/F2)

Figure. Photo by: US Centers for Disease Control and Prevention

Weir recounts the “bumps” on the road to **eliminating measles** in Canada, and who is (and is not) immune (page [1259](http://www.cmaj.ca/lookup/volpage/174/1259)). Rakovich gives us a glimpse at **Dieulafoy's lesion**, a rare cause of upper gastrointestinal bleeding (page [1261](http://www.cmaj.ca/lookup/volpage/174/1261)). Kendall and Murray comment on a recent study comparing the **safety of watchful waiting** with that of surgical repair as therapeutic options for minimally symptomatic inguinal hernias (page [1263](http://www.cmaj.ca/lookup/volpage/174/1263)).

![Figure3](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/174/9/1241.1/F3.medium.gif)

[Figure3](http://www.cmaj.ca/content/174/9/1241.1/F3)

Figure. Photo by: Courtesy of Dr. George Rakovich