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


## Hockey-related spinal injuries

FIGURE 1 At least 243 people suffered spinal injuries while playing hockey in Canada during 1966-1996, according to registry data updated by Charles Tator and colleagues. The authors report an alarmingly low median age of injured players (17 years) and a wide regional variation in reporting (52% of the cases were in Ontario and only 9% were in Quebec). In his commentary Barry Pless wonders whether board checks and checks from behind should be made illegal. He comments on the generally poor quality of Canadian data collected about these injuries and suggests that it reflects the indifference of health officials and the neglect of government.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/162/6/749/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/162/6/749/F1)

Figure 1. 

**See pages 787 and 792** 

## Diabetes in elderly Canadians

Kenneth Rockwood and colleagues have conducted a secondary analysis of the data collected for the Canadian Study of Health and Aging cohort to describe the epidemiology of diabetes mellitus in the elderly population. By identifying new cases of diabetes in phase 2 of the study, they estimate the incidence of diabetes to be 9.5 per 1000 among subjects aged 65-74 years, 7.9 per 1000 among those 75-84 and 3.1 per 1000 among those 85 years and older.

**See page 769** 

## Programs for international medical graduates

Following a hunger strike by international medical graduates (IMGs) in British Columbia in 1991, the provincial government set up a licensure program for IMGs, providing 2 entry positions per year for postgraduate training. Rodney Andrew and Joanna Bates describe the program and the 26 successful candidates to date, who represent 22 countries and 6 continents. Twenty have completed the postgraduate training and have achieved full licensure; 6 are still in training. Recent graduation from medical school seems to predict success. In her commentary Louise Nasmith addresses the need for national standards for IMG accreditation. News and Features editor Patrick Sullivan discusses the IMG issue with medical students attending "Canada's 17th medical school" in Ireland. FIGURE 2

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/162/6/749/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/162/6/749/F2)

Figure 2. 

**See pages 795, 801 and 868** 

## Kawasaki disease

By surveying all Ontario hospitals and pediatric cardiologists, Ra Han and colleagues identified 430 cases of Kawasaki disease in Ontario diagnosed between 1995 and 1997. A diagnosis of typical Kawasaki disease is established in children with a fever and at least 4 of 5 principal clinical features. Yet in the Ontario survey 31% of the children less than 1 year and more than 9 years old had atypical disease. The authors provide a comprehensive review of this leading cause of acquired heart disease in children in the developed world. FIGURE 3

![Figure3](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/162/6/749/F3.medium.gif)

[Figure3](http://www.cmaj.ca/content/162/6/749/F3)

Figure 3. 

**See page 807** 

## Waiting for coronary artery bypass surgery

David Naylor and colleagues have compared mortality rates to determine whether patients in Ontario waiting for coronary artery bypass grafting (CABG) are at greater risk of death than those alive at least 6 months after an acute myocardial infarction (AMI). Matched by age and sex to the general provincial population, those awaiting CABG had a standardized mortality ratio of 2.92 (95% confidence interval [CI] 2.29-3.55); those in the post-AMI cohort had a ratio of 3.84 (95% CI 3.54-4.14). Patients awaiting CABG are at a much greater risk of death than the general population; however, when compared with thousands of other people living with coronary artery disease, they are at decreased risk. In his commentary David Hadorn discusses the extent to which mortality rates emanating from such studies could be meaningfully interpreted without patient-level adjustments.

**See pages 775 and 794** 

## Footnotes

*   March 21, 2000