Change in attitudes to pandemics
RESEARCHERS have found a significant shift in public attitudes to a future influenza pandemic since the 2009 H1N1 pandemic, raising concerns that people may be less willing to be vaccinated in future pandemics. The research, in the latest issue of the MJA, involved a cross-sectional, computer-assisted telephone survey of 2081 people in 2007 and 2038 people in 2010. It found the greatest change in attitudes during that time was in the perception of a public threat and anticipated responses to future influenza pandemics. “Although more people now appear to believe a future pandemic is more likely to occur compared with before the 2009 pandemic, there may be less concern for personal risk and a greater reluctance to engage in health-protective behaviours, particularly vaccination”, the researchers wrote. They said there were two plausible explanations for the decrease in concern for personal vulnerability to a future pandemic — the overwhelming public sense that the 2009 pandemic was mild, and the perception that it was effectively contained by the public health and community response.

Reductions in preterm birth limited
A COMPREHENSIVE report on preterm births in 39 high-income countries has highlighted the urgent need for research into the underlying mechanisms of preterm births and development of innovative interventions to prevent them. The research, published in The Lancet found that a relative reduction of 5% in preterm birth rates would be achieved by 2015 across the 39 countries if all could achieve annual preterm birth rate reductions as high those achieved in the best-performing countries. The main interventions used in the best-performing countries included smoking cessation and reducing elective Caesareans. The researchers said preterm birth was the leading cause of death in children aged under 5 years in high-income countries, and the second leading cause worldwide. “Shockingly, very little reduction [in preterm births] is currently possible”, they wrote. An accompanying comment called for research into the effects on the long-term health of the baby before widespread adoption of any new intervention to prevent preterm births.

Sciatic epidurals questioned
AUSTRALIAN researchers have questioned the use of epidural corticosteroid injections to reduce leg pain and disability in patients with sciatica after conducting a meta-analysis of randomised trials, published in Annals of Internal Medicine. The researchers said the 25 studies analysed showed only short-term relief of pain and disability, and the small size of treatment effects raised questions about the treatment. “Until the current evidence changes, we would recommend patients with acute sciatica receive a course of conservative care before any invasive treatment approach is considered”, the researchers wrote. They said in patients with persistent and disabling sciatica symptoms, epidural corticosteroids and surgery were available treatment options with short-term effects on clinical outcomes that need to be considered in the shared decision-making process.

Paracetamol overdose in hospitals
DESPITE policies and procedures to monitor and control patients’ paracetamol exposure, the incidence of supratherapeutic paracetamol dosing in hospitalised patients remains high, according to the results of a retrospective analysis published in Archives of Internal Medicine. The analysis found that 60.7% (14 411) of patients in two tertiary care hospitals were given paracetamol over a 3-month period, with 6.6% receiving more than the recommended daily dose of 4 g a day. Of all hospitalised adults, 4% received a supratherapeutic dose of paracetamol, not as isolated events but often successive and overlapping episodes. The researchers said although it was a challenge to keep track of the total paracetamol intake for each patient over a 24-hour period, computerised systems could mitigate these risks. An accompanying commentary said hospitals needed to move beyond electronic health records to “create a system that expands the use of business intelligence and analytics and produces technology-enabled solutions that improve quality, safety, and efficiency”.

Birth month and latitude dictate MS risk
MONTH of birth and degrees of latitude from the equator increase the risk of developing multiple sclerosis (MS), prompting calls from researchers for vitamin D supplements for pregnant women. In research published in the Journal of Neurology Neurosurgery and Psychiatry analysis of previously published data on 151 978 MS patients in the northern hemisphere found a significant increased risk of MS in those born in April and a reduced risk in those born in October and November. In addition there was a significant relationship between latitude and observed:expected birth ratio of MS patients in December, and borderline significant relationships in May and August. The researchers wrote that this was likely to be due to ultraviolet light exposure and maternal vitamin D levels. They said if future research showed a reversal of the month of birth defect in the southern hemisphere, this would strengthen their findings.

Patients overly optimistic
DOCTORS should be aware that many patients have overly optimistic expectations of the benefits of preventive interventions and screening, according to the authors of a small New Zealand study published in Annals of Family Medicine. The researchers said misperception might impair informed decision making about the use of such interventions, and decision aids should be considered when discussing interventions, particularly with older patients and those with a lower level of education. The research involved three GPs and 354 patients aged 50 to 70 years who completed questionnaires. The patients overestimated the effect of bowel cancer and breast cancer screening, and preventive medication for hip fracture and cardiovascular disease. “A lower level of education was a significant predictor for overestimating the benefit of breast cancer with bowel cancer screening and for cardiovascular disease prevention”, the researchers wrote.

Posted 19 November 2012

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