Understanding new strains of norovirus
A new strain of norovirus (GII.4 Sydney) is currently behind an epidemic of gastroenteritis. Lee and Pang describe the pattern of norovirus epidemics and the biological mechanisms that appear to underlie these epidemics. Ongoing, vigilant molecular surveillance of circulating norovirus strains is essential to prepare for epidemics and guide the development of vaccines now in progress, say the authors. See Commentary, page 1381
Do nootropics help mild disease?
Cognitive enhancers did not improve cognition or function among patients with mild cognitive impairment. This systematic review of 8 randomized controlled trials also found that these drugs were associated with greater risk of gastrointestinal harms. These results do not support the use of these drugs for mild disease. See Research, page 1393
Improved survival in Ontario hospitals
One-year survival for people admitted to hospital increased significantly from 1994–2009. Using administrative data, van Walraven examined the change in patient outcomes over time by studying trends in 1-year survival in all patients admitted to hospital in Ontario, adjusting for increased patient sickness and improved survival in the general population. These findings indicate improvements in health outcomes with a meaningful decrease in life-years lost. See Research, page E755
Chronic inflammation and aging
Chronic inflammation is associated with a range of unhealthy aging phenotypes and a decreased likelihood of successful aging. Using data for 3044 participants in the Whitehall II study, Akbaraly and colleagues showed that having a high interleukin-6 level twice over a 5-year period halved the odds of successful aging 10 years later and increased the odds of future cardiovascular disease and death from noncardiovascular causes. These findings suggest that assessing long-term chronic inflammation may help guide clinical practice to promote healthy aging. See Research, page E763
New antiplatelet agents for cardiovascular disease
Antiplatelet therapy, such as the use of acetylsalicylic acid and clopidogrel, has an established role in managing many medical diseases to decrease the risk of cardiovascular events. Where do the new antiplatelet agents, such as prasugrel and ticagrelor, fit in? Chua and Nishi take a look at what we know — and what we don’t know — about these agents in the management of cardiovascular disease. See Review, page 1405
Hepatitis B screening in immigrants
A 42-year-old Nigerian man living in Canada for the past 6 years presents with his 7-year-old daughter — who arrived in Canada a year ago — for her well-child visit. This immigrant family was likely not screened for hepatitis B infection or immunity before their arrival in Canada. Given their country of origin, members of the family are at increased risk of hepatitis B virus infection and would benefit from screening and vaccination, if susceptible. See Practice, page 1417
Femoroacetabular impingement
A 32-year-old woman presents with hip pain that is worse on flexion and rotation of her hip. The differential diagnosis for hip pain should include femoroacetabular impingement, particularly when the patient is a younger adult, say Hansen and colleagues. Early recognition and orthopedic referral may alter progression toward osteoarthritis. See Practice, page 1419
Electronic cigarettes
Electronic or e-cigarettes are not regulated or approved for sale in Canada. They have not been evaluated for their safety, and their efficacy as smoking cessation aids is not clear. Reed and colleagues update us on these increasingly popular devices. See Practice, page 1427