Sunscreen stops the clock on skin ageing
DAILY application of sunscreen can protect against skin ageing in young and middle-aged adults, according to Queensland research published in the Annals of Internal Medicine. The study of about 900 men and women aged up to 55 years found that people randomly assigned to daily use of sun protection factor 15+ sunscreen were 24% less likely to show increased ageing than those assigned to discretionary sunscreen use over the 4.5 years of the study. The authors said the difference in skin ageing, which was assessed using microtopography, did not seem to be due to changes in outdoor behaviour or sun protection by the intervention group compared with the control group. The research also investigated the impact of beta-carotene on skin ageing, but found no benefit with supplementation. “The cost-effectiveness of promoting daily sunscreen use based on skin cancer prevention alone is probably substantially higher after accounting for the additional prevention of skin [photoageing]”, the researchers wrote.

Focus on fructose flawed
PUBLIC health efforts to curb rising obesity should focus on reducing intakes of all highly processed carbohydrates, not just refined sugars, says a US expert in childhood obesity in response to calls to replace fructose with glucose in processed foods. Writing in JAMA, Dr David Ludwig, of the Boston Children’s Hospital, said the recommendation to replace fructose with glucose was not supported by evidence. He said fructose consumed in its natural form — as whole fruit — was not associated with adverse effects, which he attributed to the slow digestion rate of whole fruit. However, he said, consumption of large amounts of rapidly absorbed fructose could overwhelm hepatic biochemical pathways, contributing to obesity and related diseases. Glucose was also problematic. “Rapidly absorbed forms of glucose — present in both sugar and high glycemic index starch — also contribute importantly to these diseases, especially considering their much greater caloric contribution to typical diets than fructose.”

Aspirin effective for thromboprophylaxis after hip replacement
ASPIRIN is a safe, effective and inexpensive alternative to low-molecular-weight heparin for extended thromboprophylaxis after total hip replacement, say Canadian researchers in the Annals of Internal Medicine. The randomised controlled trial of 778 patients who had elective unilateral total hip arthroscopy (THA) found that for patients who received 10 days of dalteparin after surgery, a subsequent 28 days of aspirin prophylaxis was non-inferior to and as safe as 28 days of dalteparin. “Given its low cost and greater convenience, aspirin may be considered a reasonable alternative for extended thromboprophylaxis after THA”, the researchers said. However, the they noted that the trial was halted prematurely due to slow enrolment and said the generalisability of the study might be questioned due to the availability of the newer oral anticoagulants.

Statin link to musculoskeletal adverse events
MUSCULOSKELETAL conditions, arthropathies, injuries and pain are more common among statin users than among statin nonusers, a study in JAMA Internal Medicine has found. The cohort study analysed the data of 46 249 users of a US military health care system between 1 October 2003 and 1 March 2010, propensity score-matching almost 7000 pairs of patients for statin use or non-use. Among matched pairs, statin users had higher odds ratios (1.19 for all possible musculoskeletal adverse events; 1.13 for strain and sprain of joints and adjacent muscles and dislocation; 1.09 for musculoskeletal pain; and 1.07 for arthropathies) than similar nonusers. “These findings are concerning because starting statin therapy at a young age for primary prevention of cardiovascular diseases has been widely advocated”, the authors wrote. “Our results indicate that the full spectrum of statin adverse effects has not been fully explored … Further investigations, including randomized clinical studies and larger-scale prospective studies, particularly in physically active individuals, are necessary to obtain a more complete risk-benefit assessment for statin therapy.”

Web-based medicine: one size does not fit all
ENTHUSIASM for web-based medical interventions must be tempered by the realities of patient education, interest and internet access, write the authors of a research letter in the latest JAMA Internal Medicine. The authors randomly allocated consecutive outpatients booked for colonoscopy to two groups. The intervention group (n = 387) was given instructions to view an instructional video about preparing for their colonoscopy. They also were mailed a card telling them where to find the video online, and a nurse reminded them to watch it. The control group (n = 350) received the standard written instructions. Among those told to watch the video, only 24 (6%) reported watching it. A majority (64%) of the total number of patients had internet access. The authors concluded that patients may be reluctant to make “additional efforts”; the reasons why patients fail to use online resources need to be assessed; more aggressive efforts to help them view the video may have helped; and internet-based resources may not be suitable for older or less-educated patients. An accompanying commentary said “physicians will likely need a menu of different resources using multiple modalities to most effectively education and communicate with their patients”.

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