quality of life

Restless Legs Syndrome (RLS) or Willis‑Ekbom Disease is a sensorimotor condition marked by an irresistible need to move the legs, typically accompanied by uncomfortable sensations that peak during periods of rest and disrupt nightly sleep. Early identification in primary care is essential, as timely intervention can dramatically improve the patient's quality of life. Diagnosis relies on a focused clinical history, guided by targeted questions that explore symptom timing, triggers, and relief measures. Management begins with non‑pharmacological strategies, such as optimizing sleep hygiene and correcting iron deficiency, before progressing to pharmacologic options like gabapentinoids or dopamine agonists when needed. By combining lifestyle modifications with tailored medication plans, clinicians can effectively reduce symptoms and improve sleep quality.

Fracture risk increases with advancing age, as a result of declining skeletal strength and increased risk of falling. In Canada, more than 2 million people live with osteoporosis.1 Every year in Canada, about 150 people per 100 000 suffer a hip fracture, which is considered among the most serious fractures associated with osteoporosis. Fractures lead to increased morbidity, excess mortality, decreased quality of life and loss of autonomy.2 Although osteoporosis is often considered a disease of older females, males are remarkably underevaluated and undertreated for the condition despite suffering worse outcomes following fracture,3 highlighting the importance of providing guidance in males.

Osteoporosis, defined as a bone mineral density (BMD) of 2.5 or more standard deviations below the peak bone mass (i.e., T-score ≤ −2.5), is an indicator of increased fracture risk; this risk is modified by age, sex and other factors.4 A clinical diagnosis of osteoporosis can be made in people aged 50 years and older if they have sustained a low-trauma hip, vertebral, humerus or pelvic fracture after the age of 40 years, or if they have an absolute fracture risk of 20% or more over the next 10 years, using a fracture risk assessment tool (FRAX or the Canadian Association of Radiologists and Osteoporosis Canada [CAROC]).5–7

Advances in risk assessment and nonpharmacologic and pharmacologic management warranted an update to the Osteoporosis Canada 2010 clinical practice guideline for the diagnosis and management of osteoporosis in Canada

Depression is common among adolescents in Canada and has the potential to negatively affect long-term function and quality of life; despite this, in most affected adolescents depression remains undetected and untreated.

Management requires a multimodal approach, including risk assessment, psychoeducation, psychotherapeutic and pharmacologic treatment, and interventions to address contributing factors.

Support from child and adolescent psychiatrists may be required in the case of diagnostic uncertainty and complex presentations, as well as for patients who do not respond to first-line treatments.

Importance: Intranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinusitis (CRS) in both adults and children, despite the lack of evidence regarding their efficacy in the pediatric population. Similarly, their effect on the sinonasal microbiome has not been well documented.

Objective: To assess the clinical, immunological, and microbiological effects of 12 weeks of an INC in young children with CRS.

Design, setting, and participants: This open-label randomized clinical trial was performed in a pediatric allergy outpatient clinic in 2017 and 2018. Children aged 4 to 8 years with CRS diagnosed by a specialist were included. Data were analyzed from January 2022 to June 2022.

Interventions: Patients were randomized to receive intranasal mometasone in an atomizer for 12 weeks (1 application per nostril, once per day) and supplemental 3-mL sodium chloride (NaCl), 0.9%, solution in a nasal nebulizer once a day for 12 weeks (INC group) or 3-mL NaCl, 0.9%, solution in a nasal nebulizer once a day for 12 weeks (control group).

Main outcomes and measures: Measures taken both before and after treatment included the Sinus and Nasal Quality of Life Survey (SN-5), a nasopharynx swab for microbiome analysis by next-generation sequencing methods, and nasal mucosa sampling for occurrence of innate lymphoid cells (ILCs).

Results: Of the 66 children enrolled, 63 completed the study. The mean (SD) age of the cohort was 6.1 (1.3) years; 38 participants (60.3%) were male and 25 (39.7%) were female. The clinical improvement reflected by reduction in SN-5 score was significantly higher in the INC group compared with the control group (INC group score before and after treatment, 3.6 and 3.1, respectively; control group score before and after treatment, 3.4 and 3.8, respectively; mean between-group difference, -0.58; 95% CI, -1.31 to -0.19; P = .009). The INC group had a greater increase in nasopharyngeal microbiome richness and larger decrease in nasal ILC3 abundance compared with the control group. A significant interaction was observed between change in microbiome richness and the INC intervention on the prediction of significant clinical improvement (odds ratio, 1.09; 95% CI, 1.01-1.19; P = .03).

Conclusions and relevance: This randomized clinical trial demonstrated that treatment with an INC improved the quality of life of children with CRS and had a significant effect on increasing sinonasal biodiversity. Although further investigation is needed of the long-term efficacy and safety of INCs, these data may reinforce the recommendation of using INCs as a first-line treatment of CRS in children.

Trial registration: ClinicalTrials.gov Identifier: NCT03011632.