Highlights
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*   © 2008 Canadian Medical Association

** *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](http://www.cmaj.ca/lookup/volpage/179/767?iss=8)

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/179/8/733/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/179/8/733/F1)

Photo by: Biomedical Imaging Unit, Southampton General Hospital/Science Photo Library

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](http://www.cmaj.ca/lookup/volpage/179/747?iss=8)

**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](http://www.cmaj.ca/lookup/volpage/179/773?iss=8)

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](http://www.cmaj.ca/lookup/volpage/179/749?iss=8)

**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](http://www.cmaj.ca/lookup/volpage/179/779?iss=8)

**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](http://www.cmaj.ca/lookup/volpage/179/787?iss=8)

**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](http://www.cmaj.ca/lookup/volpage/179/751?iss=8)

**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](http://www.cmaj.ca/lookup/volpage/179/799?iss=8)

**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](http://www.cmaj.ca/lookup/volpage/179/859?iss=8)

**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](http://www.cmaj.ca/lookup/volpage/179/757?iss=8)

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/179/8/733/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/179/8/733/F2)

Photo by: Photos.com

**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](http://www.cmaj.ca/lookup/volpage/179/759?iss=8)