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Abstinence and heavy drinking raise risk of dementia

24 Sep 2018Registered users

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 2018Registered users

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. However, the incidence of acute STEMI in former smokers was similar to that in those who had never smoked, adding further evidence to the benefits of quitting smoking.

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 (SSRIs) are not associated with an increased risk of cardiovascular events in younger adults with depression, a large UK cohort study has found. Compared with periods of no antidepressant treatment, periods of SSRI treatment were not associated with an increased risk of arrhythmia, stroke or TIA.

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]