Highlights

Smoke-free policies in hospitals

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There are divergent views of tobacco use; some view it as a bad habit, others as an addiction. These findings come from an ethnographic study involving 186 people including patients, health staff and key policy-makers. A stay in hospital may be an opportune time to quit smoking, but effective management of withdrawal symptoms is necessary, say the authors. See Research, page E1334

Nicotine dependence should be acknowledged as an addiction and not considered a social habit. Clinical staff need to embed the management of nicotine dependence in routine care. See Commentary, page 2085

Aggressive children become sick adults

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Adults who were more aggressive than their classmates in childhood use more medical services and have more visits to hospitals due to injuries and lifestyle-related illnesses. These findings come from a study using routine health data to follow about 4000 children who completed psychometric questionnaires assessing aggression, withdrawal and likeability 30 years ago. Childhood aggression must be considered a physical health risk when seeking measures to improve public health, say the authors. See Research, page 2095

Aggressive behaviour in childhood is associated with impaired health in adult life. Parenting programs improve children’s behaviour, mental health and well-being, thus having the potential to improve adult health and reduce the costs of health care. See Commentary, page 2083

Improving practice management

Primary care practices that took part in an accreditation program showed improvements in the quality of their practice management over a three-year period. At the beginning and the end of the study period, 102 practices completed a self-assessment exercise covering many aspects of quality. Scores for the participating practices were compared with scores for 102 matched practices joining the program later. Accreditation can be an important part of a government approach to quality improvement in primary care, say the authors. See Research, page E1326

Thrombotic risk with contraceptives

Use of drospirenone is associated with a higher risk of deep vein thrombosis than is the case with third-generation combined oral contraceptives. This finding comes from a longitudinal study that counted thromboembolic events from routine health data for 330 000 women taking oral contraceptives over a seven-year period. Women should be informed of this slight increase in risk, especially if they are older or obese, say the authors. See Research, page E1319

Breast reconstruction after mastectomy

Most women who have had a mastectomy for breast cancer in Canada do not undergo breast reconstruction, yet this procedure is oncologically safe and can improve psychosocial outcomes. Platt and colleagues suggest that mastectomy with immediate breast reconstruction should be presented as an option to patients with in situ or early stage breast cancer. See Review, page 2109

Fractures in postmenopausal women

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A 68-year-old woman has low bone density on her recent bone mineral density test. Fung and Kendler show how to use two models to assess this patient’s risk of fracture and review the recommendations from the latest guidelines to decide what treatment is required. See Practice, page 2129

Holiday reading

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Satirical research that investigates win ratios, prize types and patterns of coffee consumption; how to avoid ever presenting rounds; and an entertaining play on words. CMAJ happily shares these treats this holiday season. See Holiday Reading, page 2149