Highlights of this issue

Exercise interventions in breast cancer patients and survivors

Increasingly, cancer care is being directed toward developing interventions to improve overall quality of life as well as longevity. Physical exercise has been identified as a potential intervention to improve quality of life in women with breast cancer. This systematic review and meta-analysis summarizes the available evidence concerning the effects of exercise on breast cancer patients and survivors.

See page 34

Parathyroid hormone therapy for osteoporosis

Parathyroid hormone (PTH) was approved for the treatment of severe osteoporosis in 2004. Members of the Osteoporosis Canada Clinical Guidelines Committee conducted a systematic review of randomized clinical trials to assess the efficacy and safety of human PTH for fracture prevention in postmenopausal women and men with osteoporosis. They found level I evidence that human PTH (1-34) significantly increases bone mineral density at all skeletal sites except the radius and significantly reduces the risk of new vertebral and nonvertebral fractures in postmenopausal women with prior fractures. On the basis of these findings, the committee has developed a set of clinical practice guidelines for the use of the PTH teriparatide in the treatment of osteoporosis and presents them in a related commentary.

See pages 48 and 52

Type 2 diabetes and depression

Several cross-sectional investigations have reported that people with diabetes experience depression about 1.3 to 3 times as often as those without diabetes. However, little information is available that assesses the temporal relationship of diabetes as a risk factor for depression. In this large, population-based retrospective cohort study, newly identified type 2 diabetes was not associated with an increased risk of subsequent incident depression. Wexler discusses the effects of the study's inclusion and exclusion criteria on the findings, and the influence of comorbidities from type 2 diabetes on the risk of depression.

See pages 42 and 47

Analysis • Practice

Recent evidence shows that conflicts of interests among members of the US Food and Drug Administration's scientific advisory panels are frequent; Kondro describes the major internal review that the FDA hopes will forestall Congressional legislation to correct the problem (page 23).

A widened mediastinum revealed by a routine chest radiograph was the first intimation of an unusual upper-body venous anatomy, recounted by Marcu and colleagues in their teaching case report (page 27).

Careful when you throw that ball! Clinical Vistas Briefs draw upon dermatology and orthopedics cases, this issue — test your knowledge (page 31)!

Invasive group A streptococcal infections are relatively rare, but require prompt recognition and emergency treatment. Weir and Main review the etiology, clinical presentation and prevention of this infection (page 32).