Highlights

Cervical screening in Aboriginal women

Recent data suggest that the rates of screening for cervical cancer among Aboriginal women are now similar to those among non-Aboriginal women in Canada. Whether this will translate to reduced incidence of cervical cancer and associated mortality is unknown, say Demers and colleagues. See Commentary, page 743

Is ADHD overdiagnosed in young boys?

Boys aged 6–12 years born in December, and hence the youngest in their grade, were 30% more likely to receive a diagnosis of attention-deficit/hyperactivity disorder than their older male classmates. Nearly one million children were included in this study, spanning 11 years, which identified relevant physician diagnoses and prescriptions. These findings raise concerns about the potential harms of overdiagnosis and overprescribing, say Morrow and colleagues. See Research, page 755

Statins may prevent pneumonia

Statin therapy modestly reduced the incidence of pneumonia among men over 50 years and women over 60 years of age. This finding comes from a secondary analysis of 17<802 participants in the JUPITER trial of the effect of a statin on cardiovascular outcomes. This trial supports findings from observational studies, say Novack and colleagues. See Research, page E367

The impact of a cerebral glioma

Patients with glioma frequently feel acute psychological and existential distress during the diagnostic process and again as the tumour progresses. Cavers and colleagues repeated interviews with patients and caregivers over two years in this longitudinal qualitative study. Each patient is different, but understanding the typical patterns of social, psychological and existential distress alongside physical decline enables the provision of supportive care and appropriate communication, say the authors. See Research, page E373

Doctors offer different levels of palliative sedation

Physicians who use mild palliative sedation gave similar reasoning for choosing this approach as did physicians who use deep palliative sedation. During this qualitative study from the Netherlands, 54 physicians were interviewed about their most recent experience of providing palliative sedation. Proportionality of sedation should be seen as a multidimensional notion that can result in different approaches, say the authors. See Research, page E360

Initiating insulin therapy

Although patients and physicians often have reservations about initiating insulin therapy in type 2 diabetes, insulin is a safe and effective agent in reducing glycated hemoglobin A_1c. Use of insulin is not associated with an increased risk of hypoglycemia in type 2 diabetes, say Lau and colleagues. Combination therapy that includes insulin and oral antihyperglycemic agents can reduce weight gain, insulin dose and the risk of hypoglycemia. See Review, page 767

Fever and multiorgan infarcts

A previously healthy 35-year-old man was brought to the emergency department by his family because he was confused. He also had experienced five days of fever, peripheral edema, orthopnea and blurred vision. He eventually underwent a surgical procedure, but the optimal timing required input from several specialties. See Practice, page 783

Linear psoriasis

A 69-year-old man presented with a 40-year history of recurrent scaly rashes in lines on the left side of his body. He was diagnosed with linear psoriasis, an unusual subtype of psoriasis characterized by a distribution of the rash along Blaschko lines. This condition is usually mild and responds well to topical treatment, say Li and Man. See Practice, page 789