Highlights of this issue

Methadone use and ethnic background

Methadone maintenance therapy is one of the most effective treatments for heroin addiction. Wood and colleagues investigate whether ethnic background influences the rate of methadone use among a cohort of injection drug users in Vancouver. They found that Aboriginal participants had a lower rate of methadone use compared with non-Aboriginal participants.

See page 37

Canada lags behind in the use of implants to prevent sudden cardiac death

A study from the Ottawa Heart Institute by Birnie and colleagues finds that implantation rates in Canada for implantable cardioverter defibrillators into survivors of cardiac arrest are increasing, but are lower than those in the United States. In a related commentary, Simpson examines the reasons behind the notable underuse of this therapy.

See pages 41 and 49

Universal health insurance: Is it sustainable?

Two commentaries look at the future of universal health insurance in Canada. Dhalla argues that Canada will benefit from a sustainability paradox, whereby universal health care is sustainable despite increasing expenditures. Béland examines how the use of a variety of data on the costs of health care influences the conclusions, creating “the myth of the unsustainability of universal health insurance.”

See pages 51 and 54

Practice

Typhoid fever: In this teaching case report, Szakacs and McCarthy describe a case of typhoid fever acquired at an all-inclusive resort and discuss the difficulty in making the diagnosis and the complications that this infectious disease can present (page 29).

After an uneventful labour and delivery, a woman with chest pain is found via a chest CT scan to have postpartum pneumomediastinum (Hamman's syndrome) (page 32).

In this issue's Public Health column, Singh and colleagues describe a recent outbreak of congenital syphilis in Alberta. The authors discuss the risk of transmission from mother to child, with recommendations for screening and management (page 33).