Highlights

Obesity and diabetes linked to inactivity

Ownership of a television, car or computer was associated with obesity and type 2 diabetes mellitus in a cross-sectional survey of 154 000 people from high-, middle- and low-income countries. The association was clearer in low- and middle-income countries and was mediated in part by physical activity, sitting time and diet. The authors call for societal interventions to reduce sitting time, increase activity and reduce the use of these three common household devices. See Research, page 258

Well-being and disability in older age

People over 60 years of age who reported enjoyment of what they did and the company they kept, a sense of happiness and feeling full of energy had fewer functional impairments eight years later. These findings are based on a cohort study of 3199 men and women followed every two years for eight years to collect health and lifestyle information. Efforts to enhance well-being at older ages may have benefits, say the authors. See Research, page E150

Pregnant women not receiving flu shots

The rate of seasonal influenza vaccination during pregnancy was only 16% and lower still among single women, multiparous women and women who smoked during pregnancy. In this study of routine data for more than 12 000 pregnancies in one province, it was also found that receipt of seasonal influenza vaccine was associated with lower rates of preterm birth and low birth weight. This study adds to existing evidence supporting routine seasonal influenza vaccination for pregnant women. See Research, page E157

Managing papillary thyroid cancer

The management of papillary thyroid cancer continues to evolve owing to the understanding of the pathogenetic mechanism of the disease, improved risk stratification and more clinical trials. A “one-size-fits-all” approach to this disease is no longer appropriate. See Review, page 269

Drug cost a barrier to optimal care

Patient-borne expenses for prescription drugs can be a major barrier to optimal medical treatment. Tang and colleagues discuss how prescription drug prices are influenced by a number of players, including the federal and provincial governments and physicians themselves. The authors suggest the creation of a national drug agency and program, revision of copayment systems and physician education, among others, as potential solutions. See Analysis, page 276

Abdominal trauma in children

A four-year-old boy had a 1-cm laceration in the left upper quadrant of his abdomen after falling. Although computed tomography showed a foreign body that appeared to penetrate bowel, the boy had no signs of peritonitis and there was no evidence of organ injury or free air on imaging. Should he undergo laparotomy or laparoscopy? Anantha and colleagues describe what his physicians decided to do and why. See Practice, page 285

Graves disease

A 23-year-old woman reports palpitations, heat intolerance and weight loss over a two-month period. She has tachycardia, tremor and an enlarged, nontender thyroid, and her thyroid-stimulating hormone level is low. Does she need to go to the emergency department? What further investigations are required? Burch and Cooper address these and other questions about the diagnosis and management of Graves disease. See Practice, page 289

Amblyopia (lazy eye) in children

Failure to treat amblyopia in a timely fashion can result in lifelong visual impairment. Most commonly caused by refractive errors or strabismus, amblyopia affects about 3% of the general population. Vision screening in infants — including newborns — and toddlers is key to identification and early treatment. See Practice, page 292