Highlights
==========


## Waning pertussis vaccine effectiveness

The effectiveness of the new acellular pertussis vaccine wanes relatively rapidly after 4 years according to an analysis of linked laboratory and population-based data from Ontario. Despite estimated low effectiveness of the whole-cell pertussis vaccine, people who received 1 or more doses of whole-cell vaccine as an infant were significantly more likely to be protected against pertussis 10 years later. **See Research, page [E399](http://www.cmaj.ca/lookup/volpage/188/E399)**

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/16/1129/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/188/16/1129/F1)

After seeing a decrease in pertussis, we are now witnessing a resurgence of the disease despite good vaccine coverage in Canada and globally. The pertussis vaccination schedule needs careful reconsideration given emerging evidence, say Le Saux and Gemmill in their commentary. **See Commentary, page [1135](http://www.cmaj.ca/lookup/volpage/188/1135)**

## First Nations’ lifetime risk of diabetes

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/16/1129/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/188/16/1129/F2)

About 8 in 10 healthy First Nations people of young age in Alberta will develop diabetes in their remaining lifetime, as compared with about 5 in 10 non–First Nations people, according to the findings of this province-wide population-based study. **See Research, page [1147](http://www.cmaj.ca/lookup/volpage/188/1147)**

## Euthanasia in Belgium: recent trends

Although only about half of all euthanasia cases are reported in Belgium (despite a legal requirement to do so), the frequency of reported use of euthanasia is increasing annually. The increase is particularly notable among persons over age 80 and those with a nonterminal illness. **See Research, page [E407](http://www.cmaj.ca/lookup/volpage/188/E407)**

## Update on Parkinson disease

Parkinson disease remains a clinical diagnosis, based on motor symptoms and signs. Rizek and colleagues discuss what’s new in our understanding and treatment of this common neurodegenerative disorder. **See Review, page [1157](http://www.cmaj.ca/lookup/volpage/188/1157)**

## Arrhythmia risk in sudden death

![Figure3](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/16/1129/F3.medium.gif)

[Figure3](http://www.cmaj.ca/content/188/16/1129/F3)

A 15-year-old boy is referred for assessment of arrhythmia risk after his father died suddenly six weeks earlier. What factors are important on history-taking? Does the teen require any investigations? Is he safe to exercise? The authors discuss the approach to investigation and management of arrhythmia risk in first-degree relatives of younger people (< 50 yr) who die suddenly. **See Decisions, page [1172](http://www.cmaj.ca/lookup/volpage/188/1172)**

## Repetitive transcranial magnetic stimulation

At least one-third of patients with major depressive disorder do not respond to antidepressants or psychotherapy. Downar and colleagues describe the evidence supporting the use of repetitive transcranial magnetic stimulation in treating depression in these patients. **See Innovations, page [1175](http://www.cmaj.ca/lookup/volpage/188/1175)**

## Preeclampsia

![Figure4](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/16/1129/F4.medium.gif)

[Figure4](http://www.cmaj.ca/content/188/16/1129/F4)

Preeclampsia is a multiorgan syndrome, rather than a single disease, with proteinuria no longer a requirement to make the diagnosis. The authors tell us more about this complex condition. **See Five things to know about …, page [1178](http://www.cmaj.ca/lookup/volpage/188/1178)**

## Thoracic outlet syndrome

Thoracic outlet syndrome was diagnosed in a 28-year-old left-handed woman who presented with a six-month history of claudication in her left arm associated with pallor, paresthesia and coldness. Compression of the neurovascular bundle between the scalene muscles and first rib can result in pure neurogenic, vascular or a mixed neurovascular syndrome, say the authors. Treatment approaches vary by type. **See Clinical images, page [1179](http://www.cmaj.ca/lookup/volpage/188/1179)**

## Public grief: The Hip

The lyrics of The Tragically Hip have been with this physician for decades. “Our grief binds us together,” she writes in this humanities article. **See Encounters, page [1184](http://www.cmaj.ca/lookup/volpage/188/1184)**