Highlights of this issue

Does where patients live affect their chances of kidney transplantation?

With Canada's large size and relatively few transplant centres, do dialysis patients have equal access to kidney transplantation? Tonelli and associates report on the variations they found in the likelihood of transplantation among Canadian dialysis patients living in 7 geographic regions. They also looked at distance from the patients' residence to the closest transplant centre within each region as a contributing factor and were surprised by their findings. In a related commentary, Zaltzman addresses the causes for the variations in access to kidney transplantation across Canada.

See pages 478 and 489

Mumps outbreaks a public health concern

Two successive outbreaks of mumps have occurred that involved vaccinated adolescents and young adults in Nova Scotia. Watson-Creed and coauthors report on public health investigations into these outbreaks and question the efficacy of the MMR vaccine. The predominance of individuals of university age suggests a potential environment for increased transmission of the mumps virus. In a related commentary, Gemmill notes the increased incidence of mumps contagions around the world, and emphasizes the need for Canadian physicians to be vigilant in monitoring patients with mumps, to ensure appropriate outbreak-prevention measures and early detection of new cases.

See pages 483 and 491

New national public health centres

Six National Collaborating Centres for Public Health have been established as part of the federal government's commitment to renew and strengthen public health. Although all of the centres have a national mandate, each will focus on a specialized area of public health. Medlar and colleagues describe the role of the centres, including their central function of conducting environmental scans and synthesizing scientific evidence into structured reviews and other summaries of current knowledge and best practices.

See page 493

Sperm DNA damage and infertility

Semen analysis is the cornerstone of the evaluation of male infertility. However, conventional semen parameters generally fall short in predicting reproductive outcomes. Testing sperm DNA damage may be a more accurate measure. Zini and Libman outline the current understanding of sperm DNA, what causes sperm DNA damage, what impact this damage has on infertility and whether tests of sperm DNA damage are clinically useful.

See page 495

Analysis • Practice

There is increasing evidence that Dientamoeba fragilis, long considered nonpathogenic, in fact causes a plethora of abdominal complaints. In their Analysis, Lagacé-Wiens and colleagues review the epidemiology, transmission and treatment of this intestinal parasite (page 468).

Missiuna and coworkers describe a new approach to the assessment and diagnosis of children with developmental coordination disorder (page 471).

Clinical Vistas Briefs features a spinal MRI of a patient with new back pain and an inability to walk; a radiograph of an autograft harvest site in the iliac crest that later became painful; and a photomicrograph of pathogens in a peripheral blood smear (page 475).