Highlights of this issue

Outbreak of community-acquired MRSA reported in Calgary

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infections and is increasingly recognized as a cause of community outbreaks. In this paper, Gilbert and colleagues report on a Canadian outbreak of the USA300 strain of MRSA. The 2004 Calgary Health Region MRSA outbreak found that individuals at highest risk were those with histories of illicit drug use, homelessness or recent incarceration.

The emergence of these community-acquired MSRA strains and their outbreak potential is thought to pose a threat to public health. In a related commentary, Allen reviews the background of MRSA in Canada and the United States, as well as reflecting on the implications for public health and individual case management.

See pages 149 and 161

Is there room for bodychecking in minor hockey?

Hockey Canada changed its minor hocky age classifications in 2002, moving 11-year-old players up to the Peewee division, in which bodychecking is allowed. Hagel and colleagues compared injury data from all emergency departments in Edmonton for 10-, 11- and 12-year-old hockey players during the 2 years before and the 2 years after the policy change. The injury rate was significantly higher among the 11-year-old players in the Peewee division than among those who played without bodychecking. The injury rates among the 10- and 12-year-old players changed little over time. In a related commentary, King and LeBlanc argue for the elimination of bodychecking from minor hockey programs.

See pages 155 and 163

Type 1 diabetes: a review

Type 1 diabetes presents a major clinical and economic burden in Western countries. Gillespie reviews recent insights into the pathogenesis and natural history of the disease, including genetic factors, the possible role of environmental influences and the identification of those at greatest risk of the disease. She also discusses emerging therapeutic interventions that may succeed in preventing or delaying the onset of type 1 diabetes.

See page 165

Analysis • Practice

After cleaning old animal pelts, a man develops furunculosis, which worsens despite oral cloxacillin. Could it be a zoonotic infection? Culture results solve the clinical puzzle (page 143).

The Public Health section expands on practical steps that the practitioner can take to ensure early recognition of MSRA infections, particularly community-acquired strains, as well as appropriate investigation, treatment and reportage (page 145).