Highlights of this issue

Death behind bars

Figure. Photo by: Alan King

Dostoevsky once wrote that the degree of civilization in a society can be judged by entering its prisons. An unfortunate truth is that many who enter Canada's prison system never have an opportunity to leave. Previous data on causes of death during incarceration have largely been extrapolated from the United States. Wendy Wobeser and colleagues studied the causes of death among people in custody in Ontario over a 10-year period. They found a disproportionately high risk of violent death, with fatal overdose being 20 to 50 times more common than in the general male population, and a surprisingly high number of cardiovascular deaths in young men. These findings differ somewhat from those from the United States and should make us reflect on the question “How civilized are we?”

In an associated commentary, Stefan Fruehwald and Patrick Frottier attempt to answer this question by drawing on the literature from other countries and their own experience in Austria.

See pages 1109 and 1127

Bone mineral density in 2002: take-home messages

Figure. Photo by: Health Canada

This article summarizes the consensus reached by a Canadian panel that recently looked at standards and guidelines on assessing bone density. Bone densitometry is an invaluable tool for this purpose, as it allows one to diagnose and quantify osteoporosis before the occurrence of fractures that enable a clinical diagnosis. Using a case study, Aliya Khan and colleagues describe indications and contraindications for the use of this technique and how best to interpret the results.

See page 1141

Waiting times for hip arthroplasty and postoperative quality of life

Figure. Photo by: Digital Stock

Previous waiting list studies have not properly assessed the relation between the entire wait for surgery and postoperative quality of life. It is possible that those who wait longer not only suffer more because of the greater waiting time but might also have poorer outcomes afterward. Jeffrey Mahon and colleagues test this hypothesis and look for clinically important changes between the time of referral and hip arthroplasty.

See page 1115

COX-2 inhibitors

In 2000, “limited use” approval was granted for COX-2 inhibitors on the Ontario Drug Benefit formulary. Muhammad Mamdani and coworkers used drug claims data to describe drug use and costs after these medications were listed as “limited use” products. A substantial and immediate impact on expenditures on NSAIDs in Ontario is apparent, primarily driven by an increase in prescriptions for COX-2 inhibitors. Arguments are made for the cost-effective use of these drugs for individuals with suitable indications.

In an associated review, James Wright describes the appropriate use of these medicines. He examines the safety and efficacy of NSAIDs in general and the advantages and disadvantages of COX-2 inhibitors, and he interprets the results of 2 large, recent randomized trials that may influence the way these drugs are prescribed.

See pages 1125 and 1131