Breast cancer screening guidelines
The Canadian Task Force on Preventive Health Care has updated the previous guidelines on screening for breast cancer. Changes include recommending that the screening interval be lengthened to two to three years, and recommending against screening with breast self-examination and clinical breast examination. The task force also recommends against routine screening in women aged 40–49 years. See Guidelines, page 1991
Recovering from depression
Just under half of people with a new episode of major depression recover and remain well. Smokers and those who show low levels of mastery (i.e., feeling that life circumstances are beyond one’s control) are less likely than those without these factors to recover and remain well. These findings come from a six-year follow-up study involving 585 people identified in a survey as having major depression. Future research could assess whether interventions to improve mastery also reduce recurrence of depression, say the authors. See Research, page 1969
Strategies to manage depression should target patients with severe and recurrent forms of depression in the absence of more refined predictors, say Kurdyak and Cairney. See Commentary, page 1955
Suicide and the child welfare system
Rates of suicide attempts and hospital admissions declined after children and adolescents entered into care, although rates for this group were higher than among children and adolescents who were not in care. These findings come from an analysis of a population health data repository that included links to information from child and family services. Agencies need to know more about how to optimize services for this vulnerable population, say the authors. See Research, page 1977
Streamlining drug reviews
The proportion of drugs listed in provincial drug plans fell after the introduction of the Common Drug Review, and the time to listing also fell in some smaller provinces. Gamble and colleagues used a retrospective analysis of information in a monitoring and evaluation database to make these comparisons. The Common Drug Review may have contributed to streamlining the process for reviewing drugs in some jurisdictions, say the authors. See Research, page E1259
End-of-life care for children with cancer
Parents more strongly favour aggressive treatment, than do health professionals, for children whose cancer has no reasonable chance of being cured. This study used descriptive scenarios to elicit the views of parents and health professionals and threshold techniques to quantify these views and make comparisons. Understanding these differences between parents and health care professionals may aid communication and improve care, say the authors. See Research, page E1252
National strategy for suicide prevention
About 10 Canadians die every day by suicide, yet unlike many other countries, Canada does not have a national strategy for the prevention of suicide. According to Links, informed physicians can play an important role in advocating for such a strategy and in preventing suicide. Primary care physicians, for example, could provide collaborative care with mental health providers and improve community linkages after hospital stays. See Analysis, page 1987
Incomplete Kawasaki disease
Although most infants with fever will have a self-limited viral illness, a challenge for clinicians is to ensure that a more serious condition, such as Kawasaki disease, has not been missed. Harris and Hosking stress that incomplete Kawasaki disease should be considered when infants do not recover from febrile illnesses as expected. Cardiac sequelae in this condition can be minimized with prompt diagnosis and treatment. See Practice, page 2009