Highlights

Erythropoietin levels and old age

Among people 85 years and older, elevated levels of erythropoietin were associated with an increased risk of death, independent of hemoglobin levels. The authors report this finding from the Leiden 85-plus Study, in which erythropoietin levels and other baseline measurements were obtained for 428 people at age 86 and mortality data were collected over the following decade. The authors suggest that further research is needed to understand the mechanisms for this association and the clinical implications of raised erythropoietin levels in this age group. See Research, page 1953

Analyses of biomarkers in population-based studies may offer insight into the foundations of population health that previously could not come from clinical data alone. Repeating analyses with other data is crucial in understanding whether results are generalizable or are limited to a particular population with a particular history, say Glei and Weinstein. See Commentary, page 1943

Monounsaturated fats raise HDL cholesterol

People with hyperlipidemia consuming a very low fat diet had increases in HDL cholesterol when monounsaturated fatty acid foods were substituted for a portion of the carbohydrates in their diet. These favourable findings were observed in a small, closely monitored pilot randomized controlled trial, set up to measure the lipid metabolism of 24 patients with hyperlipidemia. The long-term feasibility of such strict diets and their effect on cardiovascular outcomes remain to be determined, say the authors. See Research, page 1961

Second wave of pandemic influenza not as bad as the first

A smaller proportion of people with pandemic (H1N1) influenza had severe outcomes during the second wave and post-peak period of the 2009 pandemic than during the first wave. Helferty and colleagues base their finding on a review of the laboratory-confirmed cases of pandemic influenza reported to the Public Health Agency of Canada that resulted in hospital admission or death. The observed differences may have resulted from the public health and clinical interventions implemented between the first and second waves. See Research, page 1981

Guideline on reducing the pain of childhood vaccination

Childhood vaccinations often cause pain and distress. Untreated pain associated with vaccinations can have long-term consequences, including fear of needles and avoidance of health care. Taddio and colleagues recommend a variety of simple, cost-effective, evidence-based strategies for pain relief based on pharmacologic, physical and psychological factors. See Review, page 1989

Aftershocks of an earthquake on Haitian children

Before the 2010 earthquake, demographic data documented the conditions faced by vulnerable children, including the high incidence of restavéks (child slaves) and physical and sexual violence. In the aftermath of the disaster, authors Gupta and Agarwal anticipate an increase in gender-based violence, sex trafficking and abandoned or neglected children of HIV-positive caregivers. They point to the opportunity to develop strategies focused on promoting caregiver health and reducing violence. See Analysis, page 1997

Emergency reversal of warfarin anticoagulation

Emergency reversal of warfarin is required when a patient has major bleeding or needs an urgent procedure. Prothrombin complex concentrate, rather than fresh frozen plasma, is the preferred choice. However, like frozen plasma, it has only a temporary effect. Vitamin K is also required. See Practice, page 2004

Holiday Reading

A semi-confessional reflection on blood donation; a challenging pharma puzzle; a poetic riff on declaring conflicts of interest; satirical research on the benefits of smoking for athletes; and a twisted take on knowledge translation. Laughs and much more await you. See Holiday reading, pages 2008, 2010, 2011