Highlights of this issue

Maternal education v. neighbourhood income for birth outcomes

Maternal socioeconomic status (SES) is an important determinant of inequity in maternal and fetal health. Luo and colleagues show how consistent large-population data collecting is useful to determine priorities for programs to reduce SES inequalities in maternal–fetal health. Using province of Quebec birth registration forms (1991–2000), along with maternal postal codes (as links to enumeration data), this retrospective study examines the association between maternal SES and adverse birth outcomes using both an individual marker (maternal level of education) and community marker (neighbourhood income level) as means to determine SES. In a related commentary, Nybo Andersen and Mortensen support the importance of routine collecting of data on birth outcomes and maternal SES.

See pages 1415 and 1429

Antithrombotic therapy in acute MI — What's best?

The optimal antithrombotic therapy in cases of acute ST-elevation myocardial infarction (STEMI) continues to be a focus of research and discussion. In this issue Armstrong and colleagues undertake a pooled analysis of ASSENT-3 and ASSENT-3 PLUS (Assessment of the Safety and Efficacy of a New Thrombotic Regimen) trials. The ASSENT 3/3 PLUS studies compared the use of tenecteplase in combination with either enoxaparin or unfractionated heparin. The pooled analysis demonstrates the substantial therapeutic efficacy of enoxaparin on the occurrence of recurrent myocardial infarction and refractory ischemia during the hospital course. It also provides new information concerning interaction between age, female gender and enoxaparin, as it relates to the risk of intracranial hemorrhage. In a related commentary, Bailey and Steinhubl discuss in depth the findings of the pooled analysis.

See pages 1421 and 1431

Management of portal hypertension and its complications

The pathophysiology of portal hypertension and the current management of complications of advanced cirrhosis and portal hypertension are extensively reviewed. The emphasis is on prophylaxis and treatment of variceal bleeding and ascites. Treatment of varices includes pharmacological therapies, endoscopic techniques and transjugular intrahepatic portosystemic shunt (TIPS). Current management of ascites includes uncomplicated ascites, hepatorenal syndrome and spontaneous bacterial peritonitis.

See page 1433

Analysis • Practice

Many Canadian communities are implementing smoke-free bylaws. Rosenfield and colleagues suggest the Smoking Regulatory Index (SRI) as a simple public health tool to measure the effectiveness of smoke-free regulations across different jursidictions. The SRI is particularly useful in comparing municipal regulations and assessing the costs and benefits of tobacco control options (page 1403).

With a prevalence of greater than 10% and a lifetime recurrence rate of approximately 70%, the treatment of nephrolithiasis can alleviate both economic and physical morbidity. Several dietary and pharmacologic approaches to reduce calcium stone activity are reviewed, with emphasis on available evidence (page 1407). Baylisascaris procyonis is a ubiquitous intestinal roundworm found in raccoon feces. Human infection occurs by ingestion of Baylisascaris infected eggs found in dirt, and can cause an encephalitis in children. The first case in Canada was diagnosed last year. The diagnosis, treatment and preventive measures related to this disease are reviewed (page 1410). A dramatic presentation of angiosarcoma in an immunocompromised patient is the background for a review of the variable and deceptive presentations this aggressive tumour can have (page 1412).