Inhaled corticosteroids are the best medication for controlling asthma in preschool children. But to be effective, these drugs must be given regularly, for at least one season at a time, and not just during asthma attacks. That is one of the main messages from Canadian researchers affiliated with the Canadian Thoracic Society for Asthma who reviewed the most recent scientific evidence. They said that the pattern of asthma demonstrated by a child and whether it is transient or persistent may help predict whether he or she will outgrow it. Most children requiring a visit to the emergency department can be given bronchodilator therapy with a metered-dose inhaler and valved holding chamber. Before discharge, the researchers say, asthma education should be provided to the family on issues such as how to use the inhaler device and how to prevent further visits to the emergency department.

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An analysis of existing evidence on the use of helmets by alpine skiers and snowboarders finds no evidence that helmets increase the risk of neck injuries. It had been suggested that using helmets may increase neck injuries in a crash or fall, especially with children. Three University of Calgary researchers tested this hypothesis by evaluating all published research on helmet use in alpine situations. The analysis of 12 studies showed skiers and snowboarders who used helmets were significantly less likely to have a head injury and had no increased risk of neck injury. “Based on our findings we encourage the use of helmets among skiers and snowboarders,” the researchers concluded.

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Older women overestimate their height by an average of 2.5 cm, a French study has found. The analysis of 8610 postmenopausal women with a mean age of almost 71 years led researchers to conclude that physicians in primary care settings should take their own measurements rather than rely on estimates from patients. The study also found these women lost an average of 4.5 cm since early adulthood. Getting an accurate assessment of height loss in this population is important because it helps determine which women need further assessment because they may be at risk for fractures.

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Up to 65% of older patients will develop delirium when admitted to hospital because of a hip fracture, and once it develops, these patients do significantly worse. Only approaches that use multiple-component interventions have been shown to prevent delirium in older hospital patients. There is not sufficient evidence to support using drugs to prevent delirium in this group. These are the conclusions of a review of the available evidence from researchers based at the University of Calgary — that interventions that combine a comprehensive assessment and strategies that target risk factors for delirium are the best approach to take.

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How strong your grip is when you are very old is a good predictor of your general health. That’s the finding from researchers in the Netherlands who evaluated 555 inhabitants of the town of Leiden who were 85 years old at the beginning of the study. Handgrip strength was measured at enrolment into the study and again when subjects were 89 years old. These subjects were then followed for another 9.5 years. The researchers found those with the lowest handgrip strength at age 85 and 89 had the highest risk of dying from any cause. Subjects who lost the most grip strength between the 2 measurement periods also had an elevated risk of dying. McGill University geriatric specialist Dr. Allen Huang called the findings “intriguing.” He said the findings suggest handgrip strength may be a good indicator of functional capacity in the elderly and could be a simple and reliable assessment tool for use by physicians.

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A new assessment process has been developed by Canadian researchers to help physicians assess which children with minor head injuries need to undergo a computed tomography (CT) scan to further assess their injury. Such scans have become increasingly common in recent years and are expensive to the system, but can detect intracranial bleeding. The decision rule, developed by members of the Pediatric Emergency Research Canada Head Injury Study Group, suggests physicians only assess children at high or medium risk of serious injury. The rule was developed by evaluating 3866 children coming to 1 of 10 Canadian hospitals with blunt head trauma and symptoms such as amnesia, loss of consciousness or persistent vomiting.

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