Iron supplementation in children
Iron supplementation may improve growth and cognitive performance in primary-school–aged children. This finding comes from a systematic review and meta-analysis that included 32 randomized controlled trials involving 7089 children, primarily in low- or middle-income countries. Low and colleagues suggest that iron supplementation is a safe and well-tolerated measure to prevent iron deficiency anemia in this population, especially in developing areas where the condition is prevalent and testing may not always be feasible. See Research, page E791
Although routine iron supplementation for children may be beneficial in some countries, data on its safety are still lacking. Children with anemia show some cognitive improvement following iron supplementation, but there may be an increased risk of malaria that cannot be ruled out by current data. The best way to increase iron intake in children in low-income settings requires further study. See Commentary, page 1477
Drug adherence after retirement
Retirement was associated with a 1.3- to 2.4-fold increase in poor medication adherence for men and women with hypertension and men with type 2 diabetes. This Finnish study reviewed national registers from 1994 to 2011, following 3468 patients with hypertension and 412 with type 2 diabetes for 3 years before and 4 years after their retirement. These findings suggest a role for additional research in determining whether interventions to optimize medication adherence after retirement would improve treatment outcomes in this population. See Research, page E784
Head impact during falls in older adults
This study analyzes fall characteristics from video footage of 227 falls in 133 residents of 2 long-term care facilities over 3 years. Head impact was common during falls in older adults, particularly with forward falls. Rotating backward protected against head impact, but extending the hand in an effort to stop the fall did not. Emphasis on strengthening upper limbs and teaching rotational falling techniques may help reduce fall-related injuries in this population. See Research, page E803
Insomnia and sedatives in older patients
Between one-fifth and one-third of older adults living in the community use sedative-hypnotic drugs. McMillan and colleagues review effective options for discontinuing these agents and discuss interventions of proven benefit in improving sleep. Although hospital admission may play a pivotal role in the initiation of these drugs, it can also play an important role in their discontinuation. See Review, page 1499
Mobile remote-presence devices
An obstetrician in his office in Halifax was able to provide a complete prenatal ultrasonographic assessment of a pregnant woman in a remote area of the Bolivian Andes. Sound farfetched? Not with the use of a mobile remote-presence device with an attached portable ultrasound system. These devices are increasingly being used to connect primary care physicians or specialists with patients in remote and underserviced areas. Mendez and Van den Hof predict that these devices could revolutionize the way health care is delivered, even in areas with well-established health care services. See Practice, page 1512
Restless legs syndrome
A 68-year-old woman presents with fatigue, daytime sleepiness and difficulty falling asleep at night. She also reports that her legs “have to move” at bedtime. You suspect restless legs syndrome. Are any investigations needed to confirm the diagnosis or to look for associated conditions? Are there effective treatments? See Practice, page 1517
Acute vocal cord immobility
A 40-year-old woman suddenly experienced hoarseness associated with symptoms of potential aspiration when drinking thin liquids. Investigations showed that she had an immobile left vocal cord. Trottier and colleagues review the common causes of hoarseness and present an approach to investigations and initial management. See Practice, page 1520