Radiation exposure from medical imaging
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Exposure to low doses of ionizing radiation during cardiac imaging and therapeutic procedures is associated with an increased risk of cancer. Using an administrative database, Eisenberg and colleagues identified a cohort of more than 80 000 people who had had an acute myocardial infarction, classified their level of exposure to radiation from diagnostic and therapeutic procedures, and compared subsequent diagnoses of new cancers. The authors call for caution and suggest that patients be monitored for cumulative exposure to radiation from medical procedures. See Research, page 430
The benefits to patients of a single cardiac imaging test probably outweigh any small excess risk of cancer. However, because cumulative effects may be important, exposure to ionizing radiation from medical imaging should be monitored, suggest Mercuri and colleagues. See Commentary, page 413
Cardiac resynchronization therapy
Adding cardiac resynchronization therapy to optimal medical therapy reduces mortality by more than 25% among patients with congestive heart failure. Wells and colleagues summarized evidence from 12 randomized controlled trials comparing the addition of cardiac resynchronization therapy to either optimal medical therapy or an implantable defibrillator and reported mortality as the primary outcome. Because the survival benefit was most evident among patients with milder heart failure, the authors suggest that this therapy be extended to a wider group of patients. See Research, page 421
Transmission of vaccine strain of yellow fever via breast milk
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It is unknown whether the vaccine strain of yellow fever is excreted in human breast milk. This is the second published report of possible transmission of this strain through breast-feeding to an infant, causing encephalitis. Infants under six months old appear to be more susceptible to neurotropic disease from vaccination for yellow fever than older children. See Research, page E243
Ability to work in midlife may predict function in later years
A poor ability to perform work in midlife is associated with increased mortality and disability in later life, and blue-collar workers fare worse than white-collar workers. Over 6000 workers were followed for 28 years by von Bonsdorff and colleagues, who used questionnaires to assess disabilities and the national population register to assess mortality. Current work ability of middle-aged employees may be considered as a predictor of future functioning in old age, say the authors. See Research, page E235
Unintentional weight loss in older adults
Unintentional weight loss is associated with an increased risk of death among older adults living at home or in care facilities. Many factors, including medications, functional limitations and reduced social activity, can contribute to this weight loss. Stajkovic and colleagues stress that there is minimal evidence to support use of specific nutritional interventions or pharmacologic therapy. See Review, page 443
Reducing the toll of alcohol
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Consumption of alcohol has risen in Canada while controls have been eroded, a situation that may increase an already high burden of harms that include acute and chronic disease, trauma and social problems. Giesbrecht and colleagues present evidence for a comprehensive response that includes restructured alcohol prices, controlled availability, curtailed marketing, lowered legal limits on blood alcohol concentration, improved access to services for high-risk drinkers and public education. See Analysis, page 450
Benign spotted bones
Spotted bones can sometimes be found incidentally on radiographs. Clinicians are then faced with determining whether there is a serious problem. What radiographic features are reassuring? What investigations, if any, are required? See Practice, page 456