Highlights

Clostridium difficile infection in the community

Community-acquired Clostridium difficile infection occurred in a significant proportion of elderly people who had not been recently exposed to antibiotics. Dial and coauthors found this in their matched, nested case–control study of linked data from 2 databases. See Research, page 767

Kuijper and van Dissel say that testing for C. difficile in patients with diarrhea who have no known risk factors is worthwhile because the absence of classic risk factors is unreliable for ruling out community-acquired infection by this organism. See Commentary, page 747

Pneumococcal vaccine and myocardial infarction

Vaccination against Streptococcus pneumoniae is associated with a decreased risk of myocardial infarction. Lamontagne and colleagues report this association in their hospital-based case–control study based on 2 databases. Cases were less likely than controls to have received a pneumococcal vaccine. See Research, page 773

In a related commentary, Madjid says that multiple mechanisms could contribute to the cardioprotective effect seen with pneumococcal vaccination. He discusses the pivotal role of inflammation in the development of acute coronary syndromes. See Commentary, page 749

Head injury and homeless people

Over half of homeless people have had a prior traumatic brain injury, and 12% of them had a moderate to severe brain injury. Hwang and colleagues report these findings from a survey of over 900 homeless people in Toronto, Ontario. They report that prior head injury is associated with poorer current health. See Research, page 779

Managing mild to moderate dementia

The management of mild to moderate dementia presents complex and evolving challenges. Hogan and colleagues provide practical guidance for clinicians based on the recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. See Review, page 787

What is “last observation carried forward”?

It is the most inappropriate analytical technique commonly used in research on drugs for the treatment of dementia, say Molnar and colleagues. The technique can introduce bias that may exaggerate the effectiveness of drugs or generate false-positive findings. See Commentary, page 751

Vulvar papules

What is the cause of multiple, tiny, filiform, rosy papules on the labia minora of a 24-year-old woman? See Practice, page 799

Gallstone ileus

Images reveal the triad of signs, including air in the biliary tree, that was used to diagnose gallstone ileus in an elderly woman. See Clinical images, page 859

Campaign Canada

In the run-up to the October election, Canada's political parties describe their views on pressing medical issues, including the physician shortage, pharmacare, progressive licensing, privatization and public health infrastructure. See News, page 757

Switching swine for simulators

In most Canadian provinces, training to manage trauma still involves the use of live pigs, primarily because the alternative, simulators, has long been viewed as excessively costly. What are the ethical, financial and pedagogic consequences of using swine or simulators? See News, page 759