Smoking hazards confirmed
A LARGE study of the hazards of smoking for women has found the benefits of stopping are greater than previous studies suggested, with smokers who stopped at around 30 years of age avoiding 97% of their excess risk of premature death, The UK study, published in The Lancet, showed that female smokers lose at least 10 years of lifespan, but that quitting before the age of 40 avoids more than 90% of the increased risk of smoking-related mortality. The study was published on Saturday (27 October) to mark the 100th anniversary of the birth of Sir Richard Doll, who identified the link between smoking and lung cancer. The study followed 1.3 million women aged 50 to 65 years for an average of 12 years, with 66 000 deaths recorded. Serious excess hazards remained for decades among those who smoked until age 40 years before stopping, but the hazards among those who continued smoking after age 40 years were 10 times higher. An accompanying comment said previous studies underestimated the full eventual impact of smoking on mortality in women, because of the time lag between smoking uptake by young women and disease onset in middle and old age.

HRT not recommended for chronic conditions
THE US Preventive Services Task Force has recommended against the use of combined oestrogen and progestin for the prevention of chronic conditions in postmenopausal women, saying the benefits do not outweigh the harms. In its recommendations published in the Annals of Internal Medicine, the task force also concluded there was moderate certainty that the chronic disease prevention benefits of oestrogen alone were unlikely to outweigh the harms in most postmenopausal women who have had a hysterectomy. It found convincing evidence that combined oestrogen and progestin therapy (specifically, oral conjugated equine oestrogen, 0.625 mg/day, plus medroxyprogesterone acetate, 2.5 mg/day) was of moderate benefit in reducing the risk of fractures in postmenopausal women. However, use was also associated with moderate harms, including an increase in the risk of stroke, dementia, gallbladder disease, and urinary incontinence, and a small increase in the incidence of invasive breast cancer.

Risks of peer victimisation
PEER victimisation increases the risk of suicidal ideation among adolescents, suggesting the need for victimisation assessments for all youth deemed to be at risk, according to a study published in Archives of Pediatric and Adolescent Medicine. Using longitudinal data involving 1186 youth aged from 10 to 17 years, the researchers found that the risk of suicide ideation was 2.4 times higher in youths who had experienced peer victimisation in the previous year, 3.4 times greater in those who had been sexually assaulted and 4.4 times greater in children who experienced maltreatment, compared with children not exposed to these forms of victimisation. The authors said their findings emphasised the need to include comprehensive victimisation assessment in adolescent suicide prevention and intervention efforts. Treatment responses to sexual assault, peer-perpetrated victimisation and child maltreatment should also recognise the increased risk of suicidal behaviour among victims.

Prostate cancer risk not linked to metabolic factors
ALONE or in combination, factors such as high body mass index (BMI), high blood pressure, and high blood glucose, triglyceride and cholesterol levels were not associated with an increased risk of prostate cancer, according to the results of a prospective study published in Cancer. However, the study, involving nearly 290 000 men, did find that high BMI and blood pressure, and a combination of metabolic factors were associated with a modest increase in the risk of death from prostate cancer. During the follow-up period of 12 years, 6673 men were diagnosed with prostate cancer and 961 died of the disease. Men with high levels of glucose and triglycerides were found to have a decreased risk of prostate cancer. The researchers said the results of the study added further evidence to the hypothesis that high levels of metabolic factors separately or combined were not related to the development of prostate cancer, but were related to an increased risk of disease progression.

Ablation generally no better for AF
RESEARCH published in the New England Journal of Medicine comparing radiofrequency ablation with antiarrhythmic drug therapy as an initial treatment in patients with paroxysmal atrial fibrillation (AF) has shown no significant difference between the two treatment strategies over a period of 2 years. The researchers randomly assigned 294 patients with AF and no history of antiarrhythmic drug use to an initial treatment strategy of either catheter ablation (146 patients) or therapy with class IC or class III antiarrhythmic agents (148 patients). While the cumulative burden of AF at 3, 6, 12 or 18 months was no different between the two treatment groups, at 24 months the burden of AF was significantly lower in the ablation group than in the drug-therapy group. The researchers said the results were valid for relatively young, symptomatic patients with no major coexisting conditions and should not be extrapolated to elderly patients, or those with persistent or permanent AF or severe heart disease. “Given the risk of complications with ablation, our data support the current guidelines recommending antiarrhythmic drugs as first-line treatment in most patients with paroxysmal atrial fibrillation”, they wrote.

Australians happy with health
A SURVEY of how Australians rate the health system and their own health shows that most rate both highly. The Menzies-Nous Australian Health Survey 2012 of 1200 people found 86% rated their health as excellent, very good or good, with younger Australians and those with higher levels of education more likely to rate their own health positively. Higher levels of financial stress were associated with lower ratings of personal health. GPs and pharmacies were the most highly used health care services in Australia between July 2011 and July 2012, with pharmacists having the highest rating of services regarded as good to excellent. Services offered by mental health providers received the lowest rating.

Posted 29 October 2012

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