Highlights

Sex-selective abortion in Asian countries

In China, son preference and sex-selective abortion have led to 32 million excess males under the age of 20 years. According to Hesketh and colleagues, men for whom marriage is unavailable may bind together in an outcast culture and turn to antisocial behaviour and organized crime. The excess of males may also contribute to an expansion of the sex industry. On a positive note, this imbalance is already contributing to less discrimination against girls and lower female mortality in India, South Korea and China. See Analysis, page 1374

Varenicline and the heart

Varenicline taken to aid smoking cessation is associated with an increased risk of serious adverse cardiovascular events compared with placebo. Singh and colleagues report this finding from their meta-analysis of 14 randomized controlled trials involving 8216 participants. Their analysis raises safety concerns and suggests that 1 in every 28 patients receiving varenicline would experience a serious cardiovascular event. See Research, page 1359

Varenicline should continue to be used with appropriate caution to limit adverse effects, while capitalizing on its benefits for smoking cessation. See Commentary, page 1346

Radial nerve palsy in the newborn

Isolated radial nerve palsy in the newborn is uncommon but carries a much better prognosis than other causes of upper limb weakness such as brachial plexus injury. In this series of 25 cases of radial nerve palsy, Alsubhi and colleagues describe the features and prognosis of this condition as well as other diagnoses with which it may be confused. See Research, page 1367

Physicians need to be aware of isolated radial palsy, as it appears to have a good prognosis if the history and clinical examination suggest a palsy related to intrauterine pressure. See Commentary, page 1348

Brand-name and generic drugs

There is no difference between the use of branded and generic amiodarone in the incidence of thyroid dysfunction, an adverse effect of this drug. Tsadok and colleagues used administrative databases to link drug prescriptions to hospital and outpatient physician claims with a diagnosis of thyroid dysfunction. These results should prove valuable to clinicians and policy-makers considering the merits of generic drugs. See Research, page E817

Most high-quality studies support the interchangeability of generic and brand-name drugs. Patients given lower-cost generic drugs are more likely to adhere to their treatment, suggests Kesselheim. See Commentary, page 1350

Trends in diabetes

The incidence and prevalence of diabetes is rising more slowly in the status Aboriginal population than in the general population. Oster and colleagues used the administrative databases of Alberta Health and Wellness to describe trends over time. Reasons for these trends, and for the lower rates in Alberta than in other provinces, need to be explored, say the authors. See Research, page E803

Clinical guidelines for immigrant health

Most immigrants to Canada arrive in good health, but some subgroups are at increased risk of certain diseases and conditions after arrival. The Canadian Collaboration for Immigrant and Refugee Health used an evidence-based clinical preventive approach to develop guidelines in four areas: infectious diseases, mental health and physical and emotional maltreatment, chronic and noncommunicable diseases, and women’s health. Immigrants’ access to health services needs to be improved. In the meantime, this initiative may provide a foundation for improved preventive health care for immigrants. See Guidelines, page E824

Dilating pupils

Funduscopy can be an important diagnostic tool in the hands of non-ophthalmologists. Although fear of precipitating acute angle-closure glaucoma with dilation may be a barrier to thorough funduscopy, the risk is very low, reassure Belliveau and Arthur. See Practice, page 1400