No randomized controlled trial evidence was found to endorse universal provision of postpartum support to improve parenting, maternal mental health, maternal quality of life, or maternal physical health. There is some evidence that high-risk populations may benefit from postpartum support.

• The prevalence of undiagnosed prostate cancer at autopsy is high and increases with age (> 40% among men aged 40-49 yr to > 70% among men aged 70-79 yr).• Only a small proportion of men with prostate cancer have symptoms or die from the disease; most prostate cancers are slowly progressive and not life threatening.• Screening with the PSA test may lead to a small reduction in prostate cancer mortality but not a reduction in all-cause mortality.• Thresholds for PSA of 2.5 to 4.0 ng/mL are commonly used for screening; lower thresholds increase the probability of false-positive results, and no threshold completely excludes prostate cancer.• Harms associated with PSA screening (e.g., bleeding, infection, urinary incontinence, a false-positive result and overdiagnosis) are common.• The PSA test should not be used for screening without a detailed discussion with the patient, ideally with the use of decision aids to facilitate comprehension.

CMET he prevalence of obesity in adults has increased worldwide and has almost doubled in Canada, from 14% in 1978/79 1 to 26% in [2009][2010][2011]2 with 2% of men and 5% of women having a body mass index (BMI) score greater than 40 (Appendix 1, available at www .cmaj.ca/lookup/suppl/doi :10.1503/cmaj .140887 /-/DC1).3 Over two-thirds of Canadian men (67%) and more than half of Canadian women (54%) are overweight or obese, based on measured weight.2-4 Excess weight is a well-recognized risk factor for several common chronic conditions, such as cardiovascular disease, cancer, type 2 diabetes, osteoarthritis and back pain. 5About two-thirds of adults who are overweight or obese were in the healthy weight range as adolescents, but gained weight in adulthood (about 0.5-1.0 kg every two years on average). 6,7 Slow weight gain may go unnoticed until health problems develop in middle age. However, this overall mean increase masks substantial variation in the population, and some people remain weight stable over long periods, whereas others experience substantial gains and losses. Currently, we cannot predict future health effects of weight gain over the life course.The causes of obesity are complex. Although excess adiposity is ultimately the result of an imbalance in the amount of energy consumed and the amount of energy expended by an individual, there are many biological, behavioural, social and environmental factors that interact to affect this balance. The dramatic increase in obesity since the 1970s, however, suggests environmental causes are prominent and potentially amenable to interventions and prevention. 8,9 Possible approaches include a wide range of legislative and policy options, in addition to health-promotion advice to maintain a healthy weight, increase physical activity and eat a healthy diet.10 Primary care providers have an important role in preventing and managing obesity through services offered to patients.Overweight or obese status is commonly assessed using the BMI. The internationally recognized cut-off BMI values for adults are as follows: underweight (< 18.5), normal weight (18.5-24.9), overweight (25-29.9) and obese (≥ 30). The obese category is further broken down by BMI into class I (30.0-34.9), class II (35.0-39.9) and class III (≥ 40).11 Distribution of body fat is also an independent indicator of health risk, and high waist circumference is associated with an increased risk for cardiovascular disease and type 2 diabetes. 12Lifestyle interventions (e.g., behavioural therapies, and dietary and physical activity programming and support) are the first line of treatment for most patients with overweight or obesity. Pharmacotherapy and surgery are options for more severe cases of obesity. A weight loss of 5% is considered clinically important, 13 as many cardiovascular risk factors (e.g., elevated blood pres-

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Breastfeeding rates among low-income women in the east-south-central United States are among the lowest in the country. This study examined the effect of a peer counseling program on breastfeeding initiation and duration in a low-income rural population in West Tennessee. A postpartum survey and chart review were conducted with WIC clients at nine health departments. Response rate was 99% (291/293). Breastfeeding initiation and duration at 6 weeks were increased in the peer counselor group (n = 156) compared with women in the no-peer counselor group (n = 135) (53% vs. 33%, p < 0.001, and 26% vs. 13%, p = 0.006, respectively). Multivariate analysis revealed that women in the peer counselor group were significantly more likely to initiate breastfeeding (OR = 2.43, 95% CI = 1.23-4.67) and to be breastfeeding at 6 weeks (OR = 2.78, 95% CI = 2.08-9.51), than those in the no-peer counselor group.

Background: Palliative care is part of comprehensive family practice; however, many physicians do not feel confident in the biomedical and psychosocial realms. Although improving residency training to address this is necessary, there is little consensus on the best education methods. Objective: To conduct a systematic review of postgraduate curricula in palliative care to incorporate the most effective components into a family medicine education program. Methods: Studies of palliative care curricula conducted in postgraduate medical training programs that contained an evaluative component and published since 1980 were systematically examined by investigator pairs using standard selection criteria and data collection forms. Discrepancies were resolved by consensus. The outcomes examined were communication skills, knowledge, attitudes, and comfort/confidence level. Results: 28 studies were included after reviewing 174 abstracts. Most studies (n ¼ 21) used survey pre-post design with no control group. Outcomes were grouped into communication skills, knowledge and attitudes and confidence. Workshops with simulated patients or role plays improved communication skills. Relatively brief strategies such as short workshops showed objective improvements in focused knowledge areas. Either clinical rotations or multi-faceted interventions were required to produce improvements more broadly in knowledge base. Only a few studies examined the sustainability of outcomes. Conclusions: An effective palliative care curriculum will need to use a multifaceted approach, incorporating a variety of intentional strategies to address the multiple competencies required. There is a need for more rigorous curricular evaluation.

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S evere acute respiratory failure is the dominant cause of death in patients with coronavirus disease 2019 (CO-VID-19) (1). The pathophysiology and imaging features of severe COVID-19 pneumonia have been the focus of considerable interest from the outset of the pandemic. In early disease, widespread ground-glass opacification predominates at thoracic CT (2-6) and is supposedly associated with highly compliant lungs and disrupted vasoregulation (7). Vascular dysregulation is believed to be consequence of exaggerated activation of inflammatory and coagulation cascades (termed immunothrombosis) (1,(8)(9)(10)(11)(12). Later in the course of disease, CT more commonly shows consolidation and fibrosis associated with lower lung compliance (13).There is growing evidence from radiologic and pathologic studies of a significant vasculopathy in COVID-19 pneumonia (14-17); in a recent study of postmortem lungs in COVID-19, there were widespread microthromboses and striking new vessel formation (16). Furthermore, based on qualitative analyses, a number of studies have highlighted the potential role of dual-energy CT pulmonary angiography (DECTPA) (15,(18)(19)(20)(21). Accordingly, in the present study, we aimed to evaluate the relationships between a quantitative measure of perfusion at DECTPA (relative perfused blood volume [PBV], ie, PBV relative to pulmonary artery enhancement [PBV/PAenh]) ( 22) and (a) disease duration, (b) right ventricular dysfunction (RVD) at echocardiography, (c) d-dimer levels, and (d) obstruction score (23) in patients with severe COVID-19 pneumonia. A secondary aim was to compare PBV/PAenh in COVID-19 pneumonia to that of healthy volunteers.