Alcohol and adolescent girls
Alcohol is not an equal-opportunity substance when it comes to its harmful effects on young women, argues Flegel. Physicians and parents should provide information and good role modelling about the healthy use of alcohol. See Editorial, page 859
Suicide may be catching
Exposure to suicide within the last 2 years was associated with suicidal thoughts and suicide attempts among Canadian youths. This finding is based on responses from 8766 children aged 12–17 years in a national survey carried out between 1998 and 2007. The findings support school-wide or community-wide interventions over targeted strategies following a suicide, say the authors. See Research, page 870
Commenting on the research article by Swanson and Colman, Bohanna argues that their study provides convincing evidence that all young people are at increased risk of suicidality following the suicide death of a schoolmate. Greater understanding of the cognitive and psychological mechanisms involved and more studies evaluating intervention strategies are urgently needed, says the author. See Commentary, page 861
Organized stroke care
Implementation of a province-wide strategy led to an improvement in care for people with stroke. Using administrative data, Kapral and colleagues measured processes of care and health outcomes and showed an increase in care at stroke centres from 40% to 46% and a decrease in mortality from hemorrhagic stroke after 30 days, from 38% to 34%. The authors call for further development and implementation of systems for organized care. See Research, page E483
Mammography screening
When a cancer is detected in its earliest stage, we usually don’t know whether it was ever destined to impact health or survival. In this population-based study, ductal carcinoma in situ of the female breast seems to be a typical illustration of this fact. This study implies, as do others, that we should proceed with caution in planning an intervention for a particular woman with such a cancer, especially for an older patient. See Research, page E492
Fluoroquinolones and renal risk
Use of fluoroquinolone antibiotics may be associated with a doubling of the risk of acute kidney injury. In their case–control analysis, based on a large health claims database, Bird and colleagues found a small increase in risk (6.5 cases per 10 000 people per year) associated with the use of fluoroquinolones but not other antibiotics. This finding raises the importance of vigilant prescribing. See Research, page E475
Preventing cognitive decline
Can we maintain our cognitive function as we get older? Up to 25% of people over the age of 70 experience some mild cognitive impairment. Many organizations and industries target the public with claims that their products will keep our minds sharp. Do these products work? In this review, Naqvi and colleagues tell us which interventions show promise and which do not. See Review, page 881
Isoniazid toxicity
A 5-year-old boy was started on isoniazid therapy for latent tuberculosis infection and monitored according to current guidelines. Yet, severe hepatotoxicity developed related to the isoniazid therapy, which required placement on a waiting list for liver transplantation. What went wrong? Science and colleagues review this case and its implications for clinical practice. See Practice, page 894
Psychotropic drugs and weight gain
Most psychotropic medications can induce weight gain, which may affect adherence to therapy and contribute to worsening of cardiometabolic risk factors. Dent and Gervais caution that second-generation antipsychotic agents can worsen these risk factors, even in the absence of weight gain. Monitoring for changes in cardiometabolic risk factors during treatment should be considered. See Practice, page 898