Highlights
==========


## Canadian lifestyle choices

Through (mostly) no fault of their own, Mr. and Ms. Average Canadian have been transformed into overweight, hypertensive people because of federal inaction on simple public health interventions. **See Editorial, page [1461](http://www.cmaj.ca/lookup/volpage/183/1461)**

## Accuracy of screening for gastrointestinal bleeding

The immunochemical fecal occult blood test is specific enough for predicting lesions in the lower gastrointestinal tract but is not adequate for predicting lesions in the upper tract. In this diagnostic accuracy study, 2796 asymptomatic people underwent the immunochemical fecal test, followed by colonoscopy as well as endoscopy of the upper gastrointestinal tract to detect adenomas, cancers, ulcers and other lesions. These findings confirm what is known about the immunochemical fecal test’s performance in predicting lower gastrointestinal lesions and add new information about its performance in predicting lesions in the upper tract, say the authors. **See Research, page [1474](http://www.cmaj.ca/lookup/volpage/183/1474)**

## Married men seek care sooner

Being married is associated with various health benefits, including a lower risk of death, but the specific mechanisms are unknown. In a retrospective cohort analysis of 4403 patients seen in 82 Ontario hospitals, Atzema and colleagues found that married men experiencing acute myocardial infarction with chest pain presented for care significantly earlier than unmarried men. This benefit to marriage was not observed among women. Obtaining medical care earlier may be one reason why married men have a lower risk of cardiovascular death than their single counterparts. **See Research, page [1482](http://www.cmaj.ca/lookup/volpage/183/1482)**

## Aboriginal Canadians and H1N1 vaccine

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/183/13/1459/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/183/13/1459/F1)

Image courtesy of © 2011 Thinkstock

In this prospective cohort study, Rubinstein and colleagues show that adjuvanted pandemic (H1N1) 2009 influenza vaccine resulted in high antibody titres in vulnerable First Nations and Métis people. **See Research, page [E1033](http://www.cmaj.ca/lookup/volpage/183/E1033)**

## Counting medical disabilities

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/183/13/1459/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/183/13/1459/F2)

Image courtesy of © 2011 Thinkstock

Musculoskeletal conditions are the most common reasons people give for limitations in activities or participation in everyday life. However, a quarter of people do not give a specific medical diagnosis as a cause for their problems, preferring terms such as aging, pain and loss of vision or hearing. These findings come from a survey of 38 839 adults and 8954 children reporting limitation of activities due to a health condition. Acknowledging and better understanding patients’ beliefs about the cause of their problems may assist in a patient-centred approach to care, say Goodridge and colleagues. **See Research, page [E1017](http://www.cmaj.ca/lookup/volpage/183/E1017)**

## Legislative approaches and obesity

![Figure3](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/183/13/1459/F3.medium.gif)

[Figure3](http://www.cmaj.ca/content/183/13/1459/F3)

Image courtesy of © 2011 Thinkstock

If current trends continue, in 25 years half of all Canadians over the age of 40 will be obese. According to Eisenberg and colleagues, it is time to tackle obesity with legislative interventions. Measures might include implementing a “sin” or “junk food” tax, banning certain obesogenic foods or ingredients, and modifying the built environment to encourage walking or bicycling. Political will and adequate support of these and other innovative strategies could have a big impact on the obesity epidemic. **See Analysis, page [1496](http://www.cmaj.ca/lookup/volpage/183/1496)**

## Tremor: making the diagnosis

![Figure4](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/183/13/1459/F4.medium.gif)

[Figure4](http://www.cmaj.ca/content/183/13/1459/F4)

Image courtesy of © 2011 Thinkstock

Tremor can be tricky to diagnose. In part 1 of this two-part series, Kumar and Jog outline a simple stepwise approach for making the diagnosis in a patient who presents with “shaking.” **See Practice, page [1507](http://www.cmaj.ca/lookup/volpage/183/1507)**

## Pelvic abscess caused by bacille Calmette–Guérin

Bacille Calmette–Guérin (BCG) is used as adjuvant therapy for treating bladder cancer, the fourth most common cancer among Canadian men. Because BCG is a live *Mycobacterium* strain, Leis and coauthors warn that infection with BCG may occur, even long after treatment of bladder cancer is completed. **See Practice, page [1511](http://www.cmaj.ca/lookup/volpage/183/1511)**