Highlights

The impact of anti-smoking legislation

Reductions in hospital admissions for acute myocardial infarction have occurred after smoking bans, but are there similar declines in admissions for respiratory or other cardiovascular conditions? Naiman and colleagues examined hospital admission rates before and after a phased smoking ban was implemented in Toronto, Ontario. Admissions for these conditions declined by about one third after smoking was prohibited in restaurants, but no consistent reductions were noted for bans in other settings. See Research, page 761

When is it right to use legislation to change people’s unhealthy habits? Maryon-Davis argues that comprehensive modelling and cost–benefit analyses that address a wide range of effects should be undertaken before decisions are made to use legislation. See Commentary, page 747

Botulinium toxin for tennis elbow

Espandar and colleagues postulate that inadequate paralysis induced by botulinum toxin may have contributed to conflicting trial results of its use for the management of chronic lateral epicondylitis (tennis elbow). In their randomized controlled trial involving 48 patients with this condition, they achieved adequate paralysis in all but one in the treatment group by using anatomic measurements to select the injection site. Compared with the placebo group, those given botulinum toxin had significant reductions in pain at rest. See Research, page 768

Although many treatments are available for lateral epicondylitis, Buchbinder and Richards remind us that there is limited evidence for their effectiveness. Development of a standardized set of outcome measures that are relevant from the patient’s perspective would advance research in this area. See Commentary, page 749

Cardiovascular risk in ethnic groups

Most studies on cardiovascular risk have been conducted in white populations. Using population surveys, Chiu and colleagues examined the prevalence of cardiovascular risk factors, heart disease and stroke in four ethnic groups (white, South Asian, Chinese and black) in Ontario. These groups had striking differences in cardiovascular risk profiles and prevalence of heart disease and stroke. See Research, page E301

Diabetes mellitus in immigrants

Recent immigrants, particularly women and those of South Asian and African origin, are at higher risk for diabetes mellitus than long-term residents. Creatore and colleagues come to this conclusion using linked administrative and immigration records to compare rates of diabetes among more than 1.1 million immigrants to Ontario with rates among long-term residents. See Research, page 781

Second-hand smoke in cars

The claim that second-hand smoke is 23 times more toxic in a vehicle than in a home has been widely reported in the media and academic literature. MacKenzie and Freeman traced the origin of this unsubstantiated figure to a press release in 1997. They caution that inaccurate reporting of health information can hurt a good cause. See Analysis, page 796

Urinary tract infection in young children

An otherwise healthy nine-month-old girl has had an elevated temperature for two days. After diagnosing and treating a urinary tract infection, should you investigate further for vesi-coureteral reflux? See Practice, page 800

Five things to know about the placement of nasogastric tubes

Auscultation may not differentiate between respiratory and gastrointestinal placement of a nasogastric tube. Lemyze emphasizes that radiography should be used to confirm placement. See Practice, page 802

Collapse of a hockey player

A 10-year-old boy who collapsed after a fall during hockey practice was found to have a ruptured aneurysm of the renal artery. See Clinical images, page 803