Highlights

Brief interventions for alcohol misuse

New Canadian recommendations highlight the importance of tackling risky alcohol use. Moyer and Finney review the evidence for screening and brief interventions that can help health care providers who are not addiction specialists to identify individuals who drink and initiate interventions that may play a role in lowering risky alcohol use. See Review, page 502

The Canadian health care system provides inadequate access to effective treatment for at-risk drinking and alcohol use disorders. However, improved physician training combined with strategies to ensure better access to appropriate treatment would improve health outcomes and generate cost savings for the health system, say Spithoff and Turner. See Commentary, page 479

Estimated cost of universal pharmacare

Canada is the only country with universal health care coverage, but not universal pharmacare. Stanbrook argues that the moral case for universal pharmacare has always been apparent, and now with a strong economic case for pharmacare also evident, there can be no more excuses for delay. See Editorial, page 475

Implementing universal public coverage of prescription drugs in Canada is estimated to reduce total spending by $7.2 billion while increasing government costs by only $1.0 billion. This economic modelling study used recent nationally compiled data on drug use and spending patterns by therapeutic category and estimates of anticipated usage, price effects, product selection and patient copayments derived from experiences of Canadian provinces or international jurisdictions. See Research, page 491

Persistence of meningococcal immunity

Immunity to group B meningococcus among children who received a quadrivalent vaccine (4CMenB) was found to have declined by five years of age. This study evaluated children who were enrolled in infancy in a randomized trial of the vaccine, as well as a cohort newly vaccinated at 40 months and an additional, previously unvaccinated cohort at 60 months. The results suggest that immunization schedules involving more frequent doses in infancy may not provide greater immunity through early childhood than schedules with fewer doses, say the authors. See Research, page E215

Heart failure and ejection fraction

Heart failure was diagnosed in a 70-year-old woman with long-standing hypertension. On echocardiography, her ejection fraction was normal. Sharma and Nagarajan explain how the ejection fraction in heart failure changes the management of this condition. See Decisions, page 510

Management of chronic heart failure with reduced ejection fraction requires careful selection and titration of medications, adherence to medical advice by the patient and timely follow-up. Some patients may require mechanical circulatory support or cardiac transplantation, say Moayedi and Kobulnik. See Five things to know about …, page 518

Tremor in children

A 14-year-old boy had tremor affecting his arms during voluntary activity since he was six years old. A four-year-old girl had progressive intention tremor on her right side for a month. Liu and colleagues describe the approach to diagnosing and managing tremor in children, and review both common and uncommon causes. See Cases, page 512

Pitted keratolysis

A 23-year-old man presented with a one-year history of malodorous exudative lesions on the soles of both feet. He was diagnosed with pitted keratolysis, an infection of the stratum corneum by bacteria. Although topical antibiotics are first-line medical therapy, changing footwear and socks regularly is key to management, say Fernández-Crehuet and Ruiz-Villaverde. See Clinical images, page 519