Highlights

Family physicians and lifestyle counselling

We should do a better job of training physicians to help families to improve their nutrition and make beneficial lifestyle choices, argues Freedhoff. See Commentary, page 933

Irrigation or steam for sinus symptoms?

Daily nasal irrigation with saline helped to improve symptoms for patients with chronic or recurrent sinusitis, whereas daily steam inhalation did not. The findings are reported from a pragmatic randomized controlled trial of about 900 patients in 72 primary care practices. Significantly more patients who used nasal irrigation than those who did not use it achieved a 10-point difference from baseline on the Rhinosinusitis Disability Index, a measure of symptom improvement, after three months. See Research, page 940

Overweight/obesity in Canadian children

The prevalence of overweight and obesity among Canadian children decreased from 30.7% to 27.0% between 2004 and 2013, following a period of dramatic growth during 1978–2004. This study of cross-sectional trends over time compared national population-representative data for 14 014 children aged 3–19 years who participated in the 2004/05 cycle of the Canadian Community Health Survey and in the 2009–2011 and 2012/13 cycles of the Canadian Health Measures Survey. Although these findings attest to progress against this important public health challenge, ongoing surveillance and control measures must continue, say the authors. See Research, page E313

Predicting low testosterone in aging men

In men over 40, clinical signs and symptoms thought to be associated with low testosterone correlate poorly with testosterone levels. Threshold levels of testosterone used to identify deficiency vary widely. This systematic review pooled, via meta-analysis, 40 studies that compared one or more clinical findings with serum testosterone levels. These findings highlight substantial uncertainty about how age-related decline in testosterone should be defined and managed, say the authors. See Research, page E321

IgG4-related disease

Patients with IgG4-related disease may present to any clinical specialty with signs and symptoms of a multisystem fibroinflammatory process that can result in organ failure if left untreated. Diagnosis requires skillful correlation of clinical, biochemical, radiologic and histopathologic clues. Haldar and colleagues review current understanding of the cause, pathogenesis, diagnosis and management of IgG4-related disease. See Review, page 953

This article describes a 66-year-old man with IgG4-related disease in whom orbital involvement developed that responded to immunosuppression with prednisone. See Cases, page 967

A 78-year-old man presented with bilateral leg edema, pleural effusions and elevated cholestatic liver enzyme levels. One disease linked these disparate systems and signs: immunoglobulin G4–related disease. See Clinical images, page 972

Single-tablet HIV treatment

Single-tablet antiretroviral treatment taken once daily improves adherence and quality of life compared with multiple-pill regimens, say Adany and Gold. Choice of regimen depends on disease and patient factors. See Five things to know about …, page 971

Warren Sturgis McCulloch

American neuropsychiatrist and cybernetician Warren Sturgis McCulloch (1898–1969) typified an interdisciplinary mode of understanding the brain. See Medicine and Society, page 974