Highlights of this issue

Screening and case-finding instruments for depression

In a systematic review of 16 randomized trials enrolling 7576 patients, Gilbody and colleagues found that use of screening or case-finding instruments in nonpsychiatric settings did not improve the recognition or management of depression. In a related commentary, Stewart discusses the need for more complex interventions to improve depression care.

See pages 997 and 1023

Antidepressant regulatory warnings and their outcomes

In a longitudinal population-based study, Katz and colleagues analyzed linked health records for 2.9 million people aged 5–24 before and after Health Canada issued a warning about risks associated with antidepressant use in children and adolescents. The warning was followed not only by decreased rates of antidepressant prescribing, but also by decreased rates of physician visits because of depression and, among children and adolescents, increased rates of completed suicide. In a related commentary, Mamdani argues that health advisories must mention the level of uncertainty in the data underlying their message.

See pages 1005 and 1025

Quality of asthma care

In this retrospective cross-sectional study of 24 616 people with asthma in Saskatchewan, Canada, Klomp and colleagues found that many patients with poor control received no or inadequate inhaled steroids or failed to receive an additional preventer medication when indicated. Using new quality-of-care indicators, they conclude that asthma management is suboptimal in this population. In a related commentary, Chapman discusses these findings in the broader context of evidence demonstrating widespread lack of asthma control.

See pages 1013 and 1027

Drinking water in Canada

In a guest editorial, Hrudey argues that the risk in Canada of public health crises related to water safety arises from flawed structural organization and widespread public indifference. He calls for greater advocacy from the public and health professionals to ensure community water supplies are maintained optimally.

See page 975

The Canadian Academy of Health Sciences

Schechter and Armstrong discuss the nature and purpose of the recently created Canadian Academy of Health Sciences. Modelled after the Institute of Medicine in the United States, the Academy of Medical Sciences in the United Kingdom and other academies, the Canadian academy will provide expert, unbiased and independent analysis of complex issues that arise in health and health care.

See page 1029

Changes in health outcomes in Cuba: lessons for Canada?

During the economic crisis Cuba experienced in the 1990s after the collapse of the Soviet Union, energy intake per capita gradually decreased and the proportion of physically active adults increased. The result was widespread modest weight loss and a decline in all-cause mortality and rates of death from diabetes and cardiovascular disease. Franco and colleagues discuss public health measures that could lead to population-wide reductions in body weight in countries such as Canada that are facing an obesity epidemic.

See page 1032

In practice

In this Teaching Case Report, Preshaw and colleagues describe how an over-the-counter medication for depression can mimic the symptoms and signs of a malignant disease (page 993).

In Interesting Images, Beatrice and Strebel provide an image showing giant calculi in a 45-year-old woman (page 994).

In Clinical Vistas Briefs, readers are asked to determine the cause of a 6-month history of low-back pain in a 67-year-old man (page 995).