News Release November 24, 2008

Embargoed until December 1, 2008, 4:30 PM EST
Please credit CMAJ, not the Canadian Medical Association. CMAJ is an independent medical journal; views expressed here do not necessarily reflect those of its owner, the CMA.

CMAJ Headlines:

  • Maternal exposure to folic acid antagonists increases risks
  • Respiratory fluoroquinolones effective in treating pneumonia
  • Stroke supplement — Best practices and new recommendations to improve care 
  • Reforming health care in Chile
  • Statins, indication creep and risks for children and youth
  • Management of severe Alzheimer disease

Maternal exposure to folic acid antagonists increases risks

Exposure to folic acid antagonists during pregnancy is associated with a higher risk of placenta-mediated adverse outcomes such as preeclampsia, placental abruption, fetal growth restriction or fetal death reports a retrospective cohort study published in CMAJ.

Folic acid antagonists include a broad range of drugs used to treat epilepsy, mood disorders, hypertension and infections. As approximately 50% of pregnancies in industrialized countries like Canada are unplanned, there is a risk of unintended exposure to these medications.

The study, conducted by researchers from Ottawa, Montreal, Saskatoon and Hunan, China looked at 14 982 women who had taken folic acid antagonists one year prior to delivery and 59 825 women who did not. Dr. Shi Wu Wen and co- researchers found that maternal exposure to folic acid antagonists was associated with a slightly higher risk of adverse pregnancy outcomes. They suggest re-classifying some folic acid antagonists and recommend increased folic acid supplements for women requiring folic acid antagonists during pregnancy.

In a related commentary, Dr. Joel Ray suggests the research study presents some "thought-provoking findings, but the results may not be ready for adoption by clinical practitioners or drug policy makers." He cites some real concerns with the study design and the need for clinically relevant finding as cautions about translating findings into practice.

Respiratory fluoroquinolones effective in treating pneumonia

Fluoroquinolones are highly effective in treating community-acquired pneumonia compared with ß-lactams and marolides and result in fewer adverse outcomes, found a meta-analysis conducted by a team of researchers from the Alfa Institute of Biomedical Sciences in Greece and Tufts University in Boston, Massachusetts. These antibiotics are also effective in treating severe forms of pneumonia that require hospitalization.

"Fluoroquinolones may be considered for the treatment of community-acquired pneumonia, particularly for the more severe forms as well as for patients who require admission to hospital and initial intravenous treatment," write Dr. Matthew Falagas and coauthors.

In a related commentary, Dr. Donald Lowe outlines treatment options for community-acquired pneumonia based on recommendations by the Infectious Diseases Society of America and the American Thoracic society.

Stroke supplement — Best practices and new recommendations to improve care

A special stroke supplement containing 27 best practice recommendations, including 4 new topics, such as emergency medical services care of stroke patients before hospital arrival, management of minor strokes, vascular cognitive impairment and others is featured in CMAJ  with the full document available online. These best practices are part of the Canadian Stroke Strategy, an initiative of the Canadian Stroke Network and Heart and Stroke Foundation of Canada.  A commentary accompanies the supplement.

Reforming health care in Chile

Chile has maintained a dual health care system in which citizens can opt for coverage with either the public National Health Insurance Fund or a private health insurance company. However, the two systems operate essentially separate from each other rather than collaborating on common health care goals.

Low-income and high-risk populations are generally served by the public system, while low-risk and high-income people are usually treated in the private system. These inequities have spurred the Chilean government to implement health care reforms to correct this imbalance. An analysis in CMAJ by researchers based in Chile and the UK outlines the current situation and some of the challenges in reforming the system.

Statins, indication creep and risks for children and youth

Editorial

There is a dearth of direct evidence regarding the safety and efficacy of statins and other drugs in children and youth, and caution and alternative management tools should be applied, write Drs. Michael Rieder, Noni MacDonald, Matthew Stanbrook and on behalf of the CMAJ editorial team. Drugs that are safe in adults are often prescribed for children without data on how they affect children, who may react differently to the same drug.

Management of severe Alzheimer disease

An evidence-based approach to the management of severe Alzheimer disease is included as part of CMAJ's dementia series. These recommendations are designed to enhance quality of life for both the patient and caregiver. Severe Alzheimer disease requires frequent monitoring by health care professionals.

Media contact: Kim Barnhardt, CMAJ, 1-800-663-7336 or 613-731-8610 ext. 2224, kim.barnhardt{at}cma.ca