Is there an optimum time of day to take antihypertensive medication?

20 Dec 2022Registered users

Evening dosing of antihypertensive medication does not improve major cardiovascular outcomes compared with morning dosing in patients with hypertension, a large UK clinical trial, published in the Lancet, has found.

Is there a long-term legacy effect of intensive blood pressure control?

25 Oct 2022Registered users

The Systolic Blood Pressure Intervention Trial (SPRINT) found that in patients with hypertension who were at increased cardiovascular risk, intensive control (lowering systolic blood pressure (SBP) to < 120 mm Hg) resulted in significant cardiovascular benefit, reducing the risk of incident CVD and all cause mortality, compared with routine BP control (lowering SBP to < 140 mm Hg). However, a secondary analysis showed that this benefit did not persist after completion of the trial.

Which smoking cessation aids are most effective in real-world settings?

26 Sep 2022Registered users

Varenicline is associated with increased odds of successful smoking cessation while data were inconclusive for the benefits of nicotine replacement therapy and e-cigarettes in helping smokers quit, a national population-based survey has found.

Higher number of daily steps associated with lower all-cause mortality

27 Jul 2022Registered users

People taking at least 7,000 steps a day have a 50-70% lower risk of mortality compared with those taking fewer daily steps, a large cohort study from the USA has found.

Surgery versus nonoperative treatment for Achilles’ tendon rupture

24 Jun 2022Registered users

Although nonoperative treatment for Achilles' tendon rupture produced similar outcomes to surgery (minimally invasive or open repair) with respect to patient-reported and clinically assessed function, rerupture rates were substantially lower in patients who underwent surgery, a study from Norway has found.

Psychological interventions with physiotherapy for low back pain

25 May 2022Registered users

Behavioural therapy delivered with physiotherapy, mainly structured exercise, was the most effective treatment in reducing pain in patients with chronic, non-specific low back pain, a systematic review and network meta-analysis has found. Pain education with physiotherapy produced sustainable improvements in physical function and fear avoidance.

Lung cancer screening improves early detection and survival

25 Apr 2022Registered users

Following the introduction of lung cancer screening in the USA there has been a stage shift towards patients being detected with early disease and improved survival, a large US study has found.

Multimorbidity in midlife linked to higher risk of dementia

25 Mar 2022Registered users

Developing two or more chronic conditions in middle age has a strong association with an increased incidence of dementia later on, 30-year follow-up data from the Whitehall ll study has shown.

Increased physical activity in over 65s reduces CVD risk and overall mortality

24 Feb 2022Registered users

Maintaining or commencing moderate to vigorous physical activity for at least 20 minutes a day in older people improves cardiovascular outcomes, and mortality, a 20-year follow-up cohort study from Italy has found. The greatest benefits were seen around the age of 70.

HPV vaccination programme reduces incidence of cervical cancer

20 Dec 2021Registered users

The national human papilloma virus (HPV) vaccination programme for girls in England has led to a substantial reduction in incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia, a register based observational study has shown.

Catheter ablation as first-line therapy for symptomatic paroxysmal AF

27 Oct 2021Registered users

Catheter ablation is more effective than antiarrhythmic drug therapy in reducing the recurrence of any atrial arrhythmias including symptomatic atrial arrhythmias in patients with symptomatic paroxysmal atrial fibrillation, a meta-analysis has found.

Cognitive stimulation at work may reduce dementia risk

24 Sep 2021Registered users

People who work in cognitively stimulating jobs are at lower risk of dementia than those who work in non-stimulating jobs, a large multicohort study has found.

Discontinuing rivaroxaban affects outcomes in atherosclerotic disease

26 Jul 2021Registered users

The combination of rivaroxaban and aspirin compared with aspirin alone significantly reduced cardiovascular outcomes in patients with chronic coronary artery disease or peripheral artery disease, a large study has shown. However, when rivaroxaban therapy was discontinued at the end of the trial the benefits were lost and a higher stroke rate was seen in those originally randomised to combination therapy.

Weighing up the risks and benefits of tight blood pressure control

25 Jun 2021Registered users

Intensive blood pressure (BP) control results in significantly better cardiovascular outcomes and lower all-cause mortality in those at increased risk compared with routine BP control, the Systolic Blood Pressure Intervention Trial (SPRINT) has found. However, serious adverse events such as hypotension, electrolyte abnormalities, acute kidney injury or failure, and syncope were also significantly more frequent in the intensive treatment group.

Are antidepressants effective for back pain and osteoarthritis?

25 May 2021Registered users

Serotonin-noradrenaline reuptake inhibitors (SNRIs) reduce both pain and disability in patients with low back pain and osteoarthritis (OA). However, the effect is small and not clinically relevant for back pain, although a clinically important effect for OA cannot be ruled out, a systematic review and meta-analysis has concluded.

Two out of three smokers consulting their GP do not receive smoking cessation support

22 Apr 2021Registered users

Just under half of smokers in England who reported visiting their GP in the past year recalled receiving advice on smoking cessation, and only one in three were offered support to quit, a national survey has found. However, current clinical guidelines suggest GPs should use every opportunity to ask patients about smoking and advise and encourage every smoker to stop. There is good evidence that brief advice from a GP helps smokers to quit.

What is the role of the Edinburgh Postnatal Depression Scale?

22 Mar 2021Registered users

The optimal cut-off score of the Edinburgh Postnatal Depression Scale is 11, a systematic review and meta-analysis has found. However 7-8 women out of 10 with a positive screen will not have major depression.

Loneliness a potential risk factor for depression

21 Feb 2021Registered users

Loneliness is associated with an increased risk of developing depression, a longitudinal cohort study has found. The English Longitudinal Study of Ageing (ELSA) recruited 11,391 participants aged 50 years and over who were living in a private household in 2002. Participants were followed up every two years until 2016/17.

Do statins raise the risk of depression?

25 Jan 2021Registered users

Statin use is associated with a reduced risk of depression and does not increase the risk of suicide, anxiety or seizures, a Swedish national cohort study has found.

Smaller bottle sizes may slow drinking and lower alcohol consumption

21 Dec 2020Registered users

Consuming wine at home from 50 cl bottles, compared with 75 cl bottles, may reduce both the amount of alcohol consumed and the rate of consumption, a study from the UK has found.

Cardiovascular risk assessment vital in patients with rheumatoid arthritis

24 Nov 2020Registered users

Patients with rheumatoid arthritis (RA) have an excess of stroke and heart failure which appears to accumulate in the five years before diagnosis, an English population-based study has found. The excess risk for further cardiovascular disease (CVD) events persisted after diagnosis and was not totally explained by differences in traditional CVD risk factors or RA-related risk factors at diagnosis.

Is opportunistic screening for AF in general practice worthwhile?

27 Oct 2020Registered users

Screening patients opportunistically in primary care does not improve detection of atrial fibrillation, compared with usual care, a cluster randomised controlled trial from the Netherlands has found.

Delirium linked to cognitive decline

24 Sep 2020

Delirium is associated with an increased risk of subsequent cognitive decline and there is evidence to suggest that the association is causal, a systematic review and meta-analysis has found. Every study found that those with delirium experienced greater cognitive decline than controls and the combined odds for a given cognitive decline were more than doubled in patients with delirium; OR 2.30. Subgroup analyses provided evidence that delirium is a causative factor rather than a marker of vulnerability to dementia.

Physical activity significantly reduces all-cause and cause-specific mortality

24 Jul 2020Registered users

Following recommendations for both aerobic and muscle strengthening activity can reduce all-cause mortality by up to 40%, a study of nearly half a million adults in the United States has shown. Individuals who met the target for aerobic activity only also had a significant reduction in all-cause mortality risk of 29% and those who participated in just muscle strengthening exercise at recommended levels had a reduction in risk of 11%.

Inactivity and depression in adolescence

22 Jun 2020Registered users

Sedentary behaviour during adolescence is associated with an increased risk of depressive symptoms at the age of 18, a UK study has found. Healthcare practitioners should ensure that parents and carers are aware of government advice on how much physical activity children and young people should be doing (i.e. at least 60 minutes of moderate-vigorous activity per day). Adolescents should be routinely asked about physical activity and sedentary behaviour levels, and every opportunity taken to emphasise the mental health benefits of physical activity.

Perinatal depression linked to psychosis in offspring

25 May 2020Registered users

The children of mothers who experience perinatal depression are more likely to report psychotic experiences at the age of 18, a UK prospective cohort study has found. A joint analysis found an association between maternal antenatal depression symptoms and both offspring psychotic experiences and depression at age 18. Most of those with psychotic symptoms will not go on to develop psychosis or schizophrenia. However, they are still at increased risk of low educational and occupational achievement, social impairment, harmful drinking and substance misuse.

COPD patients at high risk of lung cancer regardless of smoking status

23 Apr 2020Registered users

Chronic obstructive pulmonary disease (COPD) is a strong, independent risk factor for the development of lung cancer in patients who have never smoked, a large population-based cohort study from South Korea has found. The risk of lung cancer in COPD patients who had never smoked was higher than in smokers who did not have COPD.

One in three doctors suffer burnout

24 Mar 2020Registered users

Nearly a third of doctors who responded to an online survey had high levels of burnout, and just over a quarter had high levels of secondary traumatic stress, a UK study has found. Only 6% of doctors had the optimal combination of low burnout, low secondary traumatic stress and high compassion satisfaction, whereas 8% had the worst combination of high burnout, high secondary traumatic stress and low compassion satisfaction.

Infant vaccination schedule leads to significant fall in meningitis B

24 Feb 2020Registered users

The infant vaccination programme against meningitis B introduced in the UK in 2015 has been highly effective, a study from Public Health England has confirmed. The research team evaluated the effect of infant vaccination on the incidence of meningococcal group B disease during the first three years of the programme from September 2015 to August 2018. There was a 75% reduction in cases of meningitis B in age groups that were fully eligible for vaccination.

Target oral anticoagulant therapy in AF patients at high risk

23 Jan 2020Registered users

Almost 50% of atrial fibrillation patients at very low thromboembolic risk are treated with oral anticoagulants contrary to guideline recommendations, a large global study has found.

Physical activity for 1 hour a week lowers risk of type 2 diabetes

20 Dec 2019Registered users

Being at least moderately physically active for an hour or more a week lowers the risk of type 2 diabetes compared with being inactive, results from the Whitehall ll prospective cohort study have shown. In those who developed diabetes any duration of moderate to vigorous activity reduced the risk of all-cause mortality. In those participants with diabetes who achieved the recommended levels of moderate or vigorous physical activity there was a reduction in cardiovascular mortality.

Adherence to anticoagulants suboptimal in patients with AF

25 Nov 2019Registered users

Both adherence to, and persistence with, oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF) is poor, a UK study has found. The authors analysed data from The Health Information Network database between 2011 and 2016. Adherence (taking drugs as prescribed) for all OACs was 55.2%. One-year persistence (continuation of drugs) for all OACs was 65.9%. Although the direct oral anticoagulants generally fared better than vitamin K antagonists both adherence and persistence were suboptimal for all OACs.

Suicide risk in doctors

24 Oct 2019Registered users

Male doctors have a lower suicide risk than the general male population, an analysis of English death registrations from 2011 to 2015 has found. However, the risk for female doctors is comparable with that of the general female population, although the male preponderance of suicide meant that there were in fact more than twice as many male as female doctor suicides. There are differences between specialties: compared with physicians, GPs are more than three times as likely to commit suicide.

Childhood asthma peaks at the start of the school year

25 Sep 2019Registered users

Asthma exacerbations increase in children under 15 years, especially boys, when children return to school in September after the summer holidays, a UK study has found. The adjusted daily rate of GP in-hours asthma consultations in children was 2.5 to 3 times higher in the back to school excess period than in the baseline period.

What is the optimal antidepressant dose?

07 Aug 2019Registered users

The optimal dose of a second-generation antidepressant lies towards the lower end of its licensed dose range, a systematic review and dose-response meta-analysis has found.

Direct oral anticoagulants reduce all-cause mortality in AF

24 Jun 2019Registered users

Direct oral anticoagulant (DOAC) therapy in patients with non-valvular atrial fibrillation (AF) was associated with a significantly lower risk of death compared with no anticoagulation, in a retrospective cohort study, published in Heart. In this cohort of newly diagnosed patients with moderate- to high-risk non-valvular AF treated in routine clinical practice, DOAC therapy was associated with a 31% reduction in all-cause mortality.

HRT may increase the risk of Alzheimer’s disease

22 May 2019Paid-up subscribers

Postmenopausal women who take systemic hormone replacement therapy (HRT) are more likely to develop Alzheimer’s disease, although the increase in risk is modest, a Finnish nationwide case-control study has found.

HPV vaccination significantly reduces cervical disease

24 Apr 2019Registered users

A landmark study from Scotland has shown that bivalent HPV vaccine confers significant protection against cervical epithelial dyskaryosis and dysplasia, both precursors of invasive cervical cancer. This study reports statistically significant reductions in all grades of CIN, equating to vaccine effectiveness estimates of 80% or greater after routine immunisation of girls at age 12-13 years.

Diabetes triples risk for occlusive vascular events in women

25 Mar 2019Registered users

Diabetes is known to increase the risk of occlusive vascular events, and this is one of the main causes of premature death associated with the condition. A recent meta-analysis of nearly one million individuals has shown that the risk of occlusive events in diabetes is doubled for men but tripled for women. Importantly, this study was able to control for other major vascular risk factors.

Patients at increased suicide risk following cancer diagnosis

22 Feb 2019Paid-up subscribers

Cancer patients are at increased risk of suicide, particularly in the first six months after diagnosis, a national population-based study in England has found. Compared with the general population, cancer patients had a 20% increased risk of suicide; standardised mortality rate (SMR) 1.20. The risk of suicide was highest during the first six months after diagnosis, SMR 2.74 (95% CI: 2.52-2.98), but remained raised for three years.

Is exercise as effective as drug therapy in reducing systolic BP?

23 Jan 2019Paid-up subscribers

The systolic blood pressure lowering effect of endurance or dynamic resistance exercise among hypertensive populations appeared similar to that of commonly used antihypertensive medications (ACE inhibitors, angiotensin-2 receptor blockers, beta-blockers and diuretics) in a network meta-analysis.

Smoking still the leading cause of preventable illness and early death

20 Dec 2018Registered users

A steady decline in cigarette smoking in adults between 1993 and 2017 and a decrease in the number of both men and women drinking at harmful levels between 2011 and 2017 are key findings from the Health Survey for England (HSE) 2017. Nevertheless, smoking remains the leading cause of preventable illness and premature death and alcohol remains a causal factor in numerous medical and mental health conditions, including cancer, cirrhosis, hypertension, depression, and accidents and injuries.

Fish oil supplements fail to lower cardiovascular risk in diabetes

22 Nov 2018Registered users

Dietary supplementation with n-3 fatty acids (fish oils) in patients with diabetes is not associated with a reduction in cardiovascular events, a large randomised controlled study has found.  ‘These findings, together with results of earlier randomised trials involving patients with and those without diabetes, do not support the current recommendations for routine dietary supplementation with n-3 fatty acids to prevent vascular events,’ the study authors conclude.

Combined oral contraceptive pill lowers ovarian cancer risk

22 Oct 2018Paid-up subscribers

Women who use the combined oral contraceptive pill (COCP) are at reduced risk of developing ovarian cancer, a benefit that persists for several years after cessation, a nationwide cohort study from Denmark has found.

Abstinence and heavy drinking raise risk of dementia

24 Sep 2018Paid-up subscribers

The risk of dementia in old age is greater in individuals who abstain from alcohol and those who consume more than 14 units per week from midlife than for those who drink moderately, according to findings from a large prospective cohort study. For those drinking > 14 units/week, a 7 unit increase in weekly alcohol consumption was associated with a 17% increase in the risk of dementia.

Anticholinergic drugs and risk of dementia

25 Jul 2018Paid-up subscribers

Antidepressant, urological and anti-parkinsonian drugs with definite anticholinergic effects are associated with an increased risk of incident dementia up to 20 years after exposure, a UK nested case-control study has found. The study authors conclude: 'Clinicians should continue to be vigilant with respect to the use of anticholinergic drugs, and should consider the risk of long-term cognitive effects, as well as short-term effects, associated with specific drug classes when performing their risk-benefit analysis.'

GP auscultation a poor predictor of valvular heart disease

25 Jun 2018Paid-up subscribers

Auscultation has only limited accuracy in the detection of valve disease in asymptomatic patients and is a poor diagnostic screening tool in primary care, a UK study has found.

How effective are antidepressants?

22 May 2018Paid-up subscribers

All antidepressants are more efficacious than placebo in adults with major depressive disorder, a systematic review and meta-analysis has found. Double-blind, randomised controlled trials were identified from the Cochrane Central Register of Controlled Trials and other large databases. Placebo-controlled and head-to-head trials of 21 antidepressants (a selection of first-generation and all approved second-generation antidepressants) were included.

Intensive weight management can achieve remission in type 2 diabetes

23 Apr 2018Paid-up subscribers

Almost half the patients in a UK primary care-led weight management programme achieved remission of their type 2 diabetes after a year, a study in the Lancet has shown. Forty nine general practices in Scotland and Tyneside took part in the DiRECT study, an open label, cluster randomised trial.

Pre-eclampsia may raise risk of autism spectrum disorder

22 Mar 2018Registered users

Maternal pre-eclampsia is associated with an increased risk of autism spectrum disorder (ASD) in offspring, a meta-analysis has found. Compared with unexposed offspring, children who were exposed to pre-eclampsia in utero were 32% more likely to develop ASD.

Smoking just one cigarette a day raises risk of CHD and stroke

22 Feb 2018Registered users

Smoking one cigarette per day carries a risk for cardiovascular disease of around half that of those who smoke 20 per day, a systematic review and meta-analysis has found.

Should sertraline be used in CKD patients with depression?

23 Jan 2018Registered users

Sertraline is ineffective in patients with chronic kidney disease (CKD) and depression, a randomised controlled trial, from the USA, has found. This study suggests that the prescription of sertraline, and indeed any SSRI, to stage 3b-5 CKD patients with depression can no longer be justified. CBT is probably the best option and there is some evidence of its efficacy in end-stage CKD patients.

High sugar intake linked to raised risk of common mental disorders

20 Dec 2017Registered users

A high sugar intake is associated with an increased incidence of common mental disorders in men, but not in women, a UK prospective cohort study has found. The Whitehall II study recruited a cohort of 10,308 civil servants (6,895 men and 3,413 women) in 1985-88. During the 25-year follow-up period, diet was assessed on four occasions using a food frequency questionnaire. Compared with those in the lowest tertile, men in the highest tertile of sugar intake had significantly increased odds of incident common mental disorder five years later.

Bariatric surgery cuts admissions in obese patients with angina

23 Nov 2017Registered users

In obese adults with stable angina, the rate of hospitalisation for the condition was reduced by two-thirds after bariatric surgery, in a case series study from the United States.  The rate remained lower for at least two years.

Patients with paroxysmal AF at risk of stroke are undertreated

23 Oct 2017Registered users

Patients with paroxysmal atrial fibrillation (AF) eligible for anticoagulation are still less likely to receive anticoagulants than those with persistent or permanent AF, a UK study has found. Both national and European guidelines recommend that anticoagulants are offered to all patients with AF at increased risk of stroke, irrespective of the type of AF. Even in 2015 patients with paroxysmal AF eligible for anticoagulation were still almost 20% less likely to have these drugs prescribed than those patients with persistent or permanent AF.

Does metformin lower CVD risk in type 2 diabetes?

28 Sep 2017Registered users

A recent meta-analysis to evaluate the impact of metformin on cardiovascular disease has been unable to demonstrate convincingly that it is associated with a reduction of risk. The investigators searched Medline, Embase and the Cochrane Library for relevant papers in all languages.  The final yield was ten articles, reporting 13 trials of metformin, virtually all carried out in Northern Europe or North America. In total, 2,079 patients with type 2 diabetes were allocated to metformin and a similar number to comparison groups. All the outcomes, with the exception of stroke, favoured metformin but none achieved statistical significance.

PPIs with aspirin in older patients lowers risk of major bleeds

28 Jul 2017Registered users

A UK prospective population-based cohort study assessed the risk, time course, and outcomes of bleeding on antiplatelet treatment for the secondary prevention of cardiovascular disease in patients of all ages. The authors concluded that in secondary prevention with aspirin-based antiplatelet treatment without routine PPI use, the long-term risk of bleeding at age 75 years or older is higher and more sustained than in the younger age groups included in previous trials, with particularly high risks of disabling or fatal upper GI bleeding. 'Given that half of the major bleeds in patients aged 75 years or older were upper GI, the estimated NNT for routine PPI use to prevent major upper GI bleed is low and co-prescription should be considered in future secondary prevention guidelines,' they say.

Cognitive deficits and awareness of hypoglycaemia in type 1 diabetes

22 Jun 2017Registered users

A study of patients with type 1 diabetes has shown an association between impaired awareness of hypoglycaemia and cognitive deficits such as diminished learning, memory and pattern separation. This study compared cognitive function in type 1 diabetes patients who had normal awareness of hypoglycaemia with patients who had impaired awareness of hypoglycaemia. The study authors state: ‘It is possible that people with impaired awareness of hypoglycaemia have a diminished ability to distinguish cues that are specifically associated with hypoglycaemia and hence are unable to take appropriate action to avoid severe hypoglycaemia.'

Job strain may precipitate clinical depression

23 May 2017Registered users

Job strain, a combination of high demand and low control, is associated with an increased risk of subsequent clinical depression, a meta-analysis has found. Patients who report stress at work are both more likely to be depressed and more likely to become depressed. In the UK in 2015/16, work-related stress accounted for 37% of work-related ill health and 45% of working days lost. When helping patients get back to work it is important to discuss ways of reducing job strain and the demand control support model provides a helpful framework.

Practice nurses can improve insulin uptake in type 2 diabetes

24 Apr 2017Registered users

Achieving and maintaining glycaemic targets early on in type 2 diabetes has been shown to improve long-term outcomes. Delay in stepping up treatment, especially initiating insulin therapy is known to be a problem in primary care. A primary care study from Australia, in which practice nurses were trained to have an enhanced role, has shown improved rates of safe and effective insulin initiation compared with usual care.

Depression in adults linked to maltreatment in childhood

22 Mar 2017Registered users

Almost one in two depressed adult patients report maltreatment in childhood and are at increased risk of early onset, chronic or treatment-resistant depression, a meta-analysis has found. Maltreated individuals were between 2.45 times (childhood physical neglect) and 3.73 times (childhood emotional abuse) more likely than those who had not been maltreated to become depressed as adults. Childhood emotional abuse and neglect were most strongly associated with both risk of depression and depression severity.

MP-MRI could improve the diagnosis of prostate cancer

22 Feb 2017Registered users

Multi-parametric magnetic resonance imaging (MP-MRI) could play an important role in triaging men with a raised PSA for prostate biopsy and improve the detection of clinically significant prostate cancer, findings from a UK study suggest.

Risk of acute STEMI significantly increased in younger smokers

23 Jan 2017Registered users

Smoking is associated with an eight-fold increased risk of acute ST-segment elevation myocardial infarction (STEMI) in those under 50 compared with former and never smokers, a UK study has found.

Does testosterone therapy raise the risk of VTE?

16 Dec 2016Registered users

The evidence remains inconclusive as to whether testosterone increases the risk of VTE significantly. However, it would appear sensible, if initiating testosterone replacement, particularly in those with a past history of VTE or other significant risk factors, to mention the concern over this, and advise early reporting of any potential symptoms of VTE.

Take-home naloxone provision cuts opioid overdose deaths

23 Nov 2016Paid-up subscribers

Take-home naloxone programmes significantly reduce fatal outcomes of opioid overdose, a systematic review has found. In these programmes illicit opioid injectors, their peers, friends, relatives and carers are provided with overdose management training together with naloxone kits for emergency injection if someone they are with is suspected of having symptoms of opioid overdose, with a view to preventing death.

Active monitoring vs treatment for localised prostate cancer

24 Oct 2016

No significant difference in prostate cancer mortality was seen in men with localised prostate cancer who underwent active monitoring compared with surgery or radiotherapy at ten years’ follow-up in ProtecT, a large UK trial. However, both surgery and radiotherapy were associated with lower rates of metastasis and disease progression. ProtecT seems to support the use of active monitoring/surveillance in low-risk patients, but this does not mean that it is a sensible option for all men newly diagnosed with prostate cancer. Most men in ProtecT had low Gleason grade, low-risk disease and the findings must not be used to push men with more aggressive disease away from active treatment.

Abrupt smoking cessation more effective than cutting down

23 Sep 2016Paid-up subscribers

A large UK trial found clear evidence that quitting smoking abruptly was superior in both the short- and longer-term to gradual cessation. The researchers concluded that in clinical practice patients should be encouraged to stop smoking abruptly and not gradually. 

Chlamydia infection raises long-term risk of reproductive complications

01 Aug 2016Paid-up subscribers

Infection with chlamydia increases the risk of pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility by at least 30%, a nationwide study from Denmark has shown. The risk persisted throughout the 17 years of follow-up. Following a second infection the risk of PID was increased by a further 20%. Adjusted hazard ratio for each reproductive complication was 31-50% higher in women who tested positive for chlamydia compared with women who tested negative.

Does early introduction of foods protect against allergy?

23 Jun 2016Registered users

A UK study, published in the New England Journal of Medicine, set out to investigate whether introduction of six common dietary allergens from three months of age would prevent food allergies in breast-fed infants in the general population.

Antidepressants and cardiovascular risk

23 May 2016Registered users

Selective serotonin reuptake inhibitors are not associated with an increased risk of cardiovascular events in younger adults with depression, a large UK cohort study has found.

Sedentary behaviour associated with type 2 diabetes

25 Apr 2016Registered users

The findings of a large prospective cohort study suggest that sedentary behaviour increases the risk of developing metabolic syndrome and type 2 diabetes. When the data were analysed, increased sedentary time was associated with both metabolic syndrome and type 2 diabetes. An extra hour of sedentary time was associated with 22% increased odds of type 2 diabetes and 39% increased odds of metabolic syndrome, independent of high-intensity physical activity.

Women with bipolar disorder at high risk of relapse after childbirth

21 Mar 2016Registered users

One in three women with a previous diagnosis of bipolar disorder or postpartum psychosis will relapse during the postpartum period, a meta-analysis has found. Women with bipolar disorder or previous postpartum psychosis should be referred for specialist preconception advice.

Pill use before or during pregnancy does not raise risk of birth defects

22 Feb 2016Registered users

A study, using data from the Danish Medical Birth Register, confirms that oral contraceptive use does not significantly increase the risk of birth defects, whether just before or after the onset of pregnancy. The exposure to exogenous oestrogens is therefore unlikely to cause major birth defects in the developing fetus.

Active and passive smoking linked to infertility and early menopause

25 Jan 2016Registered users

Exposure to tobacco smoke through passive as well as active smoking is associated with an increased risk of infertility and menopause occurring before the age of 50, a large observational study has shown. This is the first study to assess the impact of second-hand smoking on infertility and age of menopause.

Sedentary behaviour is bad for your mental health

22 Dec 2015Registered users

The Christmas holidays are a time for sitting by an open fire to read or watch television. However, before we curl up with a good book we should consider the results of a recent crossover study which suggest that sitting down has a detrimental effect on our mental health.

How should GPs test for dementia?

25 Nov 2015Registered users

Most of the alternative dementia screening tests perform as well as the Mini-Mental State Examination (MMSE), a systematic review and meta-analysis has found. The Mini-Cog and Addenbrooke’s Cognitive Examination-Revised (ACE-R) were the most accurate tests with performances comparable with the MMSE.

Be vigilant for neonatal abstinence syndrome

21 Oct 2015Registered users

A large population-based study, involving 290,605 pregnant women, identified 1,705 cases of neonatal abstinence syndrome for women who had filled an opioid prescription while pregnant, representing an absolute risk of 5.9 cases per 1,000 deliveries. The risk was greater for long-term prescription opioid users. The majority (88%) took them short term. Babies of women who used prescription opioids during the last trimester had a significantly higher incidence of neonatal abstinence syndrome compared with those who used them in the first two trimesters only.

Androgen deprivation therapy and cardiovascular risk

24 Sep 2015Registered users

An awareness of CVD risk allows GPs to look proactively at modifiable risk factors in these men, to encourage smoking cessation, weight loss and increased exercise – all of which have been independently associated with improved prostate cancer outcomes in their own right – and to consider medical treatment for risk factors such as dyslipidaemia.

Bullying in adolescence linked to depression in young adults

05 Aug 2015Registered users

Children who are frequently bullied during adolescence are more than twice as likely to experience depression as young adults, a UK prospective cohort study has found.

Medical therapy ineffective for aiding passage of ureteric stones

22 Jun 2015Registered users

The findings from this large, well designed randomised controlled trial which showed no benefit for medical expulsive therapy in expectant management, together with the fact that both alpha-blockers and calcium channel blockers have a significant side-effect profile, make a case for changing clinical practice.

Risks vs benefits of paracetamol

21 May 2015Registered users

The safety of long-term paracetamol use has been called into question in a recent systematic review. However, until large scale well conducted trials of specific patient populations are available, the advice for the prescription of paracetamol should remain unchanged. The balance of risk and benefit to the individual patient has to be considered, and the subsequent efficacy and tolerability reviewed against the alternatives available.

Smoking-related deaths linked to a wider range of diseases

23 Apr 2015Registered users

Taking data from five large US cohort studies, the authors of this present study posed the question: ‘Do current official estimates underestimate the deaths caused by smoking?' Overall, the excess mortality for smokers within the study population was 2.8 times that of never smokers and 17% of excess mortality was related to diseases not formally associated with smoking.

Peanut allergy – is it time to change infant feeding practice?

23 Mar 2015Registered users

Early introduction of peanut into the diet of high-risk babies significantly decreases the frequency of peanut allergy at five years of age, a UK open label single-centre study has found. The present study was well designed and showed a strong effect in its primary outcome. The question many will ask is can these findings now be translated into advice for our patients? The answer is no.

Antipsychotics still prescribed inappropriately in primary care

23 Feb 2015Registered users

Less than half the patients prescribed antipsychotics have a diagnosis of severe mental illness, a UK primary care study has found. For patients without severe mental illness, the most commonly recorded mental health diagnoses were anxiety, depression, dementia, sleep disorder and personality disorder. Around 1 in 10 patients had no recorded mental health diagnosis.

DRE has vital role in early detection of prostate cancer

22 Jan 2015Registered users

Digital rectal examination is important, not just for reducing concern in men with urinary symptoms, large prostates and borderline PSA levels, but also because it is recognised that a significant number of men have clinically significant prostate cancer despite a normal PSA. [With external links to the evidence base]