Highlights

Quinolone-resistance in Neisseria gonorrhoeae infection

Canada's most populous province has experienced a rapid rise in the prevalence of quinolone-resistant N. gonorrhoeae infection, Ota and colleagues report. In their epidemiologic analysis of governmental laboratory records for Ontario, they found that the rate of resistance to quinolones in N. gonorrhoeae isolates rose from 2% in 2001 to 28% in 2006. Resistant strains of the disease were more likely to occur in men and patients over 30 years of age. See Research, page 287

A sustained and integrated international effort will be needed to reduce the rates of multidrug-resistant gonorrhea infection and the misuse of antibiotics, says Tapsall. See Commentary, page 268

Abortion in Peru

Even though abortion is generally illegal in Peru, the incidence of induced abortion is as high as or higher than the incidence in many countries where it is legal, find Bernabé-Ortiz and colleagues. In their large population-based survey of almost 8000 women aged 18–29 years in 20 cities in Peru, 11.6% of the women reported having had an induced abortion. See Research, page 298

Laws limiting access to abortion services do not reduce the number of abortions, only their safety, says Cook. See Commentary, page 272

Selective serotonin reuptake inhibitors and suicide

The relation between the use of selective serotonin reuptake inhibitors and risk of suicide is influenced by age, according to a systematic review of observational studies by Barbui and colleagues. The use of these drugs decreased the risk of suicide among adults and increased the risk among adolescents. See Research, page 291

The uncertainty about the safety and efficacy of selective serotonin reuptake inhibitors in youth with depression can only be resolved by large randomized controlled trials, which are not impossible to perform, says Mann. See Commentary, page 270

Neurobiology of depression

Aan hen Rot and colleagues describe how genes, psychological adversity in childhood, and ongoing or recent psychological stress may combine to have an impact on major depressive disorder. See Review, page 305

Cuba's approach to mother and child

Polyclinics, collaborative programs and research about government-run interventions are 3 elements in the Cuban model of health care that Canada could learn from, says Keon. See Analysis, page 314

Abdominal aortic pseudocoarctation

A 68-year-old woman with Waardenburg syndrome presented with pain in the chest and back. A computed tomography scan of her thoraco-abdominal cavity showed a rare configuration of the aorta suggestive of pseudocoarctation. See Practice, page 317

Superior vena cava syndrome

An overweight 72-year-old man complained of a swollen neck, increased snoring and daytime sleepiness. Computed tomography scans showed a mass compressing the superior vena cava. See Clinical images, page 355

Rapid rise of clinical trial costs

The estimated average cost of bringing a drug to market has increased from US$802 million in 2003 to between US$1.3 billion and $1.7 billion today. Some argue that these escalating costs limit innovation and burden society, which pays for these high development costs through higher drug prices. See News, page 277

Euthanasia debate reopened

A recent ruling by Britain's High Court on assisted suicide and a television documentary showing a man taking his own life have reopened debate on this subject in the United Kingdom and other European countries. See News, page 282