Strength predicts mortality in adolescents
A LOW level of muscular strength in late adolescence, as measured by knee extension and handgrip strength tests, is associated with all-cause premature mortality to a similar extent as classic risk factors such as body mass index or blood pressure, according to research published in the BMJ. The prospective cohort study of 1 142 599 Swedish male adolescents aged 16–19 years, who were followed for 24 years, found that adolescents in the lowest tenth of muscular strength showed by far the highest risk of mortality from different causes, with suicide one of the most frequent causes of death. All-cause mortality rates ranged between 122.3 per 100 000 person years for the weakest adolescents and 86.9 for the strongest. The researchers wrote that the data suggest that low muscular strength was associated with an increased risk of mortality due to suicide, supporting the notion that physically weaker people might also be mentally more vulnerable. “Low muscular strength should be considered an emerging risk factor for major causes of death in young adulthood”, they wrote.

Psoriasis in children increases adiposity risks
CHILDREN with psoriasis, regardless of severity, are more likely than those without to be overweight or obese and at increased risk for complications related to excess adiposity, according to a study published in Archives of Dermatology. The international, multicentre, cross-sectional study of 409 children with psoriasis found excess adiposity in 37.9% of the children compared with 20.5% of controls. The researchers wrote that, as the association of central adiposity was greatest in children with severe psoriasis, monitoring of these patients should be especially vigilant. “Should further studies show excess adiposity to be a precursor for psoriasis, attempts at early weight loss and lifestyle modification will be important, not only to decrease the risk of metabolic disease but also to modulate the course of pediatric psoriasis”, they wrote.

Aspirin resistance increases stroke severity
A SMALL Australian study, published in Archives of Neurology, has identified an association between aspirin resistance and stroke severity. The research included 90 acute stroke patients who had received at least 7 days of aspirin therapy (acetylsalicylic acid, 100 mg daily) before their stroke onset presenting to the Royal Melbourne Hospital stroke care unit. Just under a third of the patients were found to have aspirin resistance using a rapid platelet function assay. Patients with aspirin resistance had lower median Alberta Stroke Program Early CT Score (ASPECTS) scores (5.5 in the aspirin-resistant group compared with10 in the aspirin-sensitive group), although this difference decreased slightly when adjusted for vascular risk factors and cardioembolic stroke. The aspirin-resistant group was also significantly more likely to sustain a large stroke defined by an ASPECTS of 7 or less. “We recommend a randomized controlled study to compare alternative antiplatelet agents in patients with aspirin resistance”, the researchers wrote.

Adolescent diabetes screening cost “excessive”
RESEARCHERS evaluating the costs, effectiveness and efficiency of different screening strategies to identify children with diabetes and dysglycaemia say the cost of indentifying one adolescent with type 2 diabetes could be as high as US$831 000. Using a hypothetical cohort of 2.5 million overweight or obese children aged 10 to 17 years, the study, published in Archives of Pediatric and Adolescent Medicine, found that depending on the test type, the cost of screening for type 2 diabetes would range from US$312 000 to US$831 000 per case identified. The researchers said the finding was due to the low prevalence of type 2 diabetes in the US paediatric population. Among their hypothetical cohort, the researchers would expect to find 500 children with type 2 diabetes and 400 000 with dysglycaemia. They said screening would be more cost-effective if dysglcaemia was explicitly considered as a screening outcome.

Breast screening questions
NEW research published in the New England Journal of Medicine has raised “serious questions” about the value of screening mammography. The researchers used surveillance, epidemiology and end results data to examine US trends from 1976 to 2008 in the incidence of early-stage breast cancer (ductal carcinoma in situ and localised disease) and late-stage breast cancer (regional and distant disease) in women aged 40 years or older. Since screening mammography was introduced in the US the number of cases of early-stage breast cancer detected each year had doubled from 112 to 234 cases per 100 000 women, while the rate at which women present with late-stage cancer had decreased by 8%. The researchers estimated that in 2008, breast cancer was overdiagnosed in more than 70 000 women, accounting for 31% of all breast cancers diagnosed. They said the research clarified that the benefit of mortality reduction was probably smaller, and the harm of overdiagnosis probably larger, than previously recognised.

Posted 26 November 2012

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