Highlights

Pregnancy complications among women born preterm

Women who were themselves born preterm are at increased risk of pregnancy complications later in life. Nuyt and colleagues compared pregnancy complications such as gestational diabetes, hypertension, preeclampsia and eclampsia in 7405 women who were born preterm and 16 714 women who were born at term between 1976 and 1995 and had later pregnancies between 1987 and 2008. The impact of preterm birth on obstetric care should be taken into account in the management of pregnant patients, say the authors. See Research, page 1777

Prescription drug monitoring databases

Implementing a centralized prescription network was associated with a dramatic reduction in the number of potentially inappropriate prescriptions filled for opioids and benzodiazepines. Dormuth and colleagues used 5 years of routine pharmacy data to evaluate the introduction of the network, comparing trends among patients over 65 years of age and among patients receiving social assistance, as well as patterns for commonly prescribed nonsteroidal anti-inflammatory drugs. Wider use of such networks could reduce the misuse of some prescription drugs, say the authors. See Research, page E852

Prescription drug monitoring has the potential to prevent the misuse and abuse of controlled substances and fatal overdoses. However, to achieve optimal results, real-time access by health practitioners is essential, say Wilsey and Prasad. Real-time access allows clinicians to see when and from whom patients have received prescriptions for drugs, such as opioids, at the time the patient is being seen — information that can be helpful in making decisions about prescribing. See Commentary, page 1767

Alcohol may cause atrial fibrillation

Moderate to high alcohol consumption was associated with an increased incidence of atrial fibrillation among people aged 55 years or older with cardiovascular disease or diabetes. This result is based on the combined data from 2 large antihypertensive drug treatment trials involving more than 30 000 participants. Recommendations about the protective effects of moderate alcohol consumption may need to be tempered with these findings, say the authors. See Research, page E857

Diagnosing borderline personality disorder

Because individual symptoms of borderline personality disorder occur in other psychiatric disorders, patients with borderline personality disorder may receive treatment for other conditions for many years before a diagnosis is made. Aside from the ethical imperative of informing patients of their diagnosis, patients with borderline personality disorder benefit from an improved understanding of their condition, and this may help with avoiding improper treatments in the future, say Biskin and Paris. See Review, page 1789

Breast cancer screening guidelines

In the 2011 update of its guidelines on screening for breast cancer, the Canadian Task Force on Preventive Health Care has changed some of its previous recommendations. The authors of this primer review these changes, the evidence supporting them and their implications for practice. See Practice, page 1803

Unusual presentation of typhoid fever

Typhoid fever is a well characterized disease whose pathology has been known for 100 years. So, it is a surprise to report this case in which necrotizing granulomatous ileitis was associated and in which tuberculosis was excluded as a cause. See Practice, page 1808

Measles

Image courtesy of CDC/C.S. Goldsmith; W. Bellini

Most cases of measles in Canada are caused by community transmission after international importation, say Desai and colleagues. Vaccination programs, early identification of cases and prompt containment are essential to maintaining the absence of endemic measles in Canada. See Practice, page 1811