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Nausea may affect adherence to varenicline

24 Sep 2020Registered users

Nausea during the first few weeks of varenicline therapy may reduce adherence, a study from North America has found. The authors analysed data on 870 adults receiving varenicline in two smoking cessation trials conducted at multiple sites in Canada and the USA.

Is air pollution associated with onset of asthma in childhood?

24 Sep 2020Registered users

A nationwide case-control study from Denmark has strengthened the evidence that parental asthma and smoking in pregnancy are risk factors for onset of asthma and persistent wheezing in children. The results also suggest that exposure to ambient small particles < 2.5 µm (PM2.5) may be a potential risk factor. However, this finding needs to be substantiated in future studies, the authors say.

Diet rich in whole grain foods may lower risk of diabetes

24 Sep 2020Registered users

Higher consumption of total whole grain foods, such as oatmeal, dark bread, brown rice or whole grain cereals can reduce the risk of developing type 2 diabetes, analysis of data from three large prospective cohort studies in the USA has shown.

Loneliness a risk factor for cardiovascular disease

24 Sep 2020Registered users

Loneliness but not social isolation appears to be an independent risk factor for cardiovascular disease, an analysis of data from the English Longitudinal Study of Ageing suggests.

Lifestyle intervention reduces risk factors in older patients with coronary artery disease

24 Jul 2020Registered users

Patients aged 65 years and over with coronary artery disease benefitted at least as much as younger patients in improving lifestyle risk factors in a community-based trial from the Netherlands. Older patients were more likely to achieve the weight loss target and stop smoking.

Asthma persisting from childhood to adulthood presents a distinct phenotype

24 Jul 2020Registered users

Asthma that starts in childhood and persists throughout adult life tends to be more severe and is associated with poorer lung function compared with adult-onset asthma, a study from Japan has concluded. The difference in clinical characteristics points to a distinct phenotype.

Evaluating therapies for depression in children and adolescents

24 Jul 2020Registered users

Fluoxetine, either alone or in combination with cognitive behaviour therapy, appears to be the most effective treatment for children and adolescents with moderate to severe depression, a systematic review and network meta-analysis has concluded. NICE recommends that antidepressants should not be initiated in primary care.

Patient safety incidents in opioid substitution therapy analysed

24 Jul 2020Registered users

Errors in prescribing, supervised or non-supervised dispensing, and monitoring and communication were responsible for patient safety incidents in opioid substitution treatment, a study from England and Wales has shown.

Healthy lifestyle associated with longer life expectancy free of diabetes

22 Jun 2020Paid-up subscribers

A large cohort study has demonstrated that a healthy lifestyle in midlife can increase life expectancy free of type 2 diabetes, as well as cardiovascular disease (CVD) and cancer.

Siblings of infants with sudden unexpected death at increased risk

22 Jun 2020Paid-up subscribers

An observational study using clinical case records has found a ten-fold increased risk of sudden unexpected death in infancy (SUDI) in siblings of SUDI cases.

Primary care intervention increases uptake of HCV testing

22 Jun 2020Paid-up subscribers

An electronic algorithm integrated with primary care clinical database systems achieved a modest increase in hepatitis C (HCV) case finding, a UK general practice-based study has found.

E-cigarette pilot study helps smokers quit

22 Jun 2020Paid-up subscribers

More than a third of smokers who completed a pilot study of e-cigarettes as a smoking cessation aid quit smoking.

Emollients do not prevent eczema in infancy

25 May 2020Paid-up subscribers

Daily emollient use for the first 12 months of life did not protect against the development of eczema in high-risk children, a UK study has found. Infants born at full term were recruited to a randomised controlled trial carried out at 12 hospitals and four primary care sites across the UK between 2014 and 2016. All the infants were deemed at high risk of developing eczema because of a family history of atopic disease i.e. at least one first-degree relative with parent reported eczema, allergic rhinitis, or asthma diagnosed by a doctor.

Abdominal obesity post MI raises risk of recurrent MI or stroke

25 May 2020Paid-up subscribers

Abdominal obesity is an independent risk factor for a further myocardial infarction (MI) or stroke in patients who have already suffered a first MI, an observational cohort study from Sweden has shown. A total of 22,882 MI patients from the SWEDEHEART registry (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) were recruited to the study.

SGLT2 inhibitors reduce risk of serious renal events

25 May 2020Paid-up subscribers

A Scandinavian observational study has shown that sodium-glucose co-transporter 2 (SGLT2) inhibitors are associated with a significant reduction in serious renal events compared with dipeptidyl peptidase-4 (DPP-4) inhibitors. The study used Scandinavian disease registry data to compare population outcomes in the general diabetic population rather than selected groups of high-risk patients.

Increased risk of fatal overdose or suicide associated with stopping opioids

25 May 2020Paid-up subscribers

Ceasing treatment with opioids is associated with an increased risk of death from overdose and suicide, an observational study from the United States has found.

Exercise improves function and mortality rates in older patients following ACS

23 Apr 2020Paid-up subscribers

A largely home-based exercise intervention improved grip strength, mobility, daily activities and quality of life in older patients after acute coronary syndrome, an Italian study has shown. Hospitalisation and death rates were also reduced by the intervention. A total of 235 patients, median age 76 years, range 73-81 years, were recruited to the trial conducted at three sites in Italy. They were randomised one month after their ACS event to the exercise or control group. All had reduced physical performance defined by the short physical performance battery with scores of 4-9.

Smoking in pregnancy increases fracture risk in infants

23 Apr 2020Paid-up subscribers

Intrauterine exposure to maternal smoking is associated with an increased risk of fractures in the first year of life, a national cohort study from Sweden has found. The study cohort comprised 1,680,307 live born singletons in Sweden, born between 1 January 1983 and 31 December 2000, followed up until 31 December 2014.

Substance use disorder raises risk of treatment resistant depression

23 Apr 2020Paid-up subscribers

Recent or current substance use disorder is associated with treatment resistance in patients who receive prescription treatment for depression, a nested case control study has found.

Exercise can improve functional status in diabetic neuropathy

24 Mar 2020Paid-up subscribers

Physiotherapy to improve ankle strength and balance produced sustained improvements in functional status in patients with diabetic peripheral neuropathy, in a study from Singapore.

Weight gain associated with accelerated lung function decline

24 Mar 2020Paid-up subscribers

Adults who put on weight over a 20-year period had a more rapid decline in FVC and FEV1, a large international population-based study has shown. However, weight loss was found to attenuate the decline.

LARC uptake increases in young women

24 Mar 2020Paid-up subscribers

There has been a significant increase in the use of long-acting reversible contraception in women under 25 over the past decade, a national survey has found. However, condoms and the oral contraceptive pill are still the most commonly used methods.

Are psychological techniques effective in patients at high risk of CVD?

24 Mar 2020Paid-up subscribers

Enhanced motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in patients at high risk of cardiovascular disease, a primary care study has shown.

How accurate are wearable electronic devices for monitoring atrial fibrillation?

24 Feb 2020Paid-up subscribers

A smartwatch-based patient device demonstrated only moderate diagnostic accuracy in detecting atrial fibrillation (AF) when compared with a 12-lead ECG, in a study from Australia. Accuracy was improved if the automated device diagnosis was combined with specialist interpretation of unclassified tracings.

Diabetes during pregnancy raises risk of early CVD in offspring

24 Feb 2020Paid-up subscribers

Diabetes of any type in pregnant women increases the risk of early onset cardiovascular disease (CVD) in their childen, a study from Denmark has found.

High rates of steatosis detected in young adults

24 Feb 2020Paid-up subscribers

One in five young people have steatosis, one in ten severe steatosis, and one in forty liver fibrosis, a recent UK study has found.

Varicella exposure only partially protective against herpes zoster infection

23 Jan 2020Registered users

Household exposure to varicella infection only offers modest protection against herpes zoster infection in adults, a large self-controlled case series study has shown. Data were derived from the Clinical Practice Research Datalink (CPRD) which covers 9% of the UK population registered at more than 700 general practices. A total of 9,604 adults  with a diagnosis of herpes zoster, documented in primary care or hospital records, between 1997 and 2018, and who had lived with a child with a diagnosis of varicella were identified for the study.

Overweight adolescents consult more frequently for respiratory symptoms

23 Jan 2020Paid-up subscribers

Overweight teenagers are more likely to consult their GP for asthma, and other respiratory symptoms, than those of normal weight, a study from the Netherlands has found. A total of 617 children, aged 2 to 18 years, were recruited to a prospective cohort study from 71 GP practices across the country. Height and weight were measured at recruitment and other health and social data collated from questionnaires sent to patients/parents. Children with disabilities or conditions affecting their weight were excluded. Details of subsequent consultations were obtained from the medical records.

Most deaths in patients on methadone are not drug related

23 Jan 2020Paid-up subscribers

Non drug-related morbidities are the most common cause of death as methadone-treated opioid dependent patients age, a study from Scotland has found. The study authors used information from the Community Health Index and data on methadone prescriptions held within the Scottish National Prescribing Information System for 36,606 patients who had received one or more methadone prescriptions between 2009 and 2015.

Tailor smoking cessation advice to the patient

20 Dec 2019Paid-up subscribers

Effectiveness of smoking cessation aids varies between different types of smokers, a survey-based UK study has found. The data presented in this large, representative sample may provide useful information for GPs and other treatment providers in tailoring quit smoking advice to individual patients.

Antihypertensive drugs most effective when taken at bedtime

20 Dec 2019Paid-up subscribers

Patients who took their blood pressure medication at bedtime had improved blood pressure control and lower risk of major cardiovascular disease events compared with those who took their drugs in the morning, a primary care study has shown.

Automated cough sound analysis shows promise as a diagnostic tool

20 Dec 2019Paid-up subscribers

Analysis of cough sounds captured on a smartphone can potentially be used to help diagnose common respiratory conditions in children, a study from Western Australia has shown. The study authors conclude: ‘We have demonstrated that automated cough analysis delivers good diagnostic accuracy in detecting common childhood respiratory diseases including pneumonia, RAD, croup, bronchiolitis, upper and lower respiratory tract disorders. It can be used as a diagnostic aid for childhood respiratory disorders.’

Quitting smoking in pregnancy lowers risk of preterm birth

25 Nov 2019Paid-up subscribers

Smoking cessation in pregnant women is associated with a reduced risk of preterm birth, a large study from the United States has shown. Information was obtained from live birth certificates issued between 2011 and 2017 as part of the US National Vital Statistics System. Overall, 25,233,503 pregnant women who delivered live neonates and had data recorded on pre-pregnancy and trimester-specific cigarette smoking frequency were included in the analysis.

Symptoms based approach to asthma may miss children at risk

25 Nov 2019Registered users

Abnormal spirometry and FeNO results are common in children with asthma managed in primary care and relate poorly to symptom scores, a UK study has shown.

Is the incidence of diabetes declining?

25 Nov 2019Paid-up subscribers

A recent systematic review, published in the BMJ, has concluded that in countries where data is available the incidence of diabetes has been stable or falling since 2006.

Where do patients seek help for genitourinary symptoms?

25 Nov 2019Paid-up subscribers

The majority of patients with genitourinary (GU) symptoms do not attend sexual health clinic (SHCs), although many would consult their GP, an analysis of Natsal-3 survey data has shown. Natsal-3 is a probability sample survey of sexual behaviour involving 15,162 women and men in Britain aged 16-74 years.

Flu vaccination reduces all-cause mortality in heart failure patients

24 Oct 2019Paid-up subscribers

Influenza vaccination was associated with a significantly lower risk of all-cause mortality in patients with heart failure, a meta-analysis has found. However, the effect on cardiovascular deaths and hospitalisations was not significant.

Breathlessness independently associated with obesity and weight gain in adult life

24 Oct 2019Paid-up subscribers

Middle-aged individuals with a high body mass index (BMI) and those whose BMI had significantly increased since the age of 20 had an increased prevalence of breathlessness, a population-based study has found.

Incidence of type 2 diabetes varies markedly between occupations

24 Oct 2019Paid-up subscribers

Men employed as professional drivers, and manufacturing or agricultural workers were three times more likely to develop type 2 diabetes compared with university teachers and architects, in a national study from Sweden.

Gonorrhoea may be transmitted by kissing in men who have sex with men

24 Oct 2019Paid-up subscribers

Men who have sex with men (MSM) may transmit oropharyngeal gonorrhoea to partners by kissing, a cross-sectional study from Australia has found.

Homelessness is an independent risk factor for mortality

01 Jun 2009Registered users

Although the higher mortality risk associated with homelessness can partly be explained by an increased prevalence of morbidity, homelessness itself confers an additional risk, a retrospective cohort study has shown. 'In this study, homelessness itself has been shown to be an independent risk factor for the high mortality seen in this group. In addition to interventions addressing morbidity in homeless people, intensive targeted social interventions directed to homelessness itself may be needed to lower mortality in this highly disadvantaged social group.'

Stroke risk similar in paroxysmal and sustained AF

23 Jan 2008Registered users

Current guidelines advise treating paroxysmal AF in the same way as sustained AF but the evidence is weak, with only one retrospective analysis comparing the risk of stroke in patients with paroxysmal AF vs chronic AF (analysis of the SPAF trials, performed 15 years ago and limited to patients treated with aspirin). The ACTIVE W trial showed that warfarin is more effective than aspirin plus clopidogrel for the prevention of vascular events (stroke, embolism, MI and vascular death) in patients with AF. A recent substudy of this trial looked at the risk of stroke in 1,202 patients with paroxysmal AF compared with 5,495 with sustained AF, and the effectiveness of thromboprophylaxis in these patients. ' This substudy has shown that the risk of stroke is similar, irrespective of whether AF is paroxysmal or sustained, and that anticoagulation therapy is equally effective in both groups. Other factors, such as age and cardiovascular comorbidity, remain central to the ultimate choice of thromboprophylaxis in these patients.'