Glaucoma therapies looking good
A SYSTEMATIC review has found high-level evidence that medical and surgical treatment of open-angle glaucoma decreases intraocular pressure (IOP) and protects against worsening visual field loss over the short to medium term. However, the comparative review, published in Annals of Internal Medicine, was not able to show if medical, surgical or laser treatments were best to prevent visual disability and improve patient-reported outcomes. The researchers wrote that prostaglandins were the most effective topical medications to decrease IOP, but were more likely to cause conjunctival hyperaemia than timolol. Studies examining laser trabeculoplasty consistently showed a decrease in IOP with treatment but were not adequate to show which type of laser or number of applications had the best results. The researchers wrote that treating with lasers decreased IOP and, when compared with medical treatment alone, reduced the number of medications needed to keep IOP at the same level. However, they said more randomised control trials comparing “so-called minimally invasive treatments” were “sorely needed to help guide clinicians in making treatment decisions”.

Maternal caffeine leads to smaller babies
NEW research published in BMC Medicine has found that maternal caffeine intake is consistently associated with babies born with decreased birthweight and increased odds of being small for gestational age (SGA). The research, based on pregnant women in Norway, found coffee, black tea, soft drinks and chocolate accounted for more than 98% of daily caffeine intake, with a median intake of 126 mg/day (IQR 40–254 mg/day) for all 59 123 pregnant women in the study, including 7406 who did not consume any caffeine. Many, but not all, women decreased caffeine consumption considerably during the first trimester but increased it again during the second trimester. The researchers found that coffee intake was associated with slightly increased gestational length but did not affect the odds for spontaneous preterm delivery. More than 10% of study participants exceeded the recommended maximum daily intake of caffeine and this subgroup had 20%‒60% higher odds ratios for SGA. “This might have clinical implications as even caffeine consumption below the recommended maximum (200 mg/day in the Nordic countries and USA, 300 mg/day according to the WHO) was associated with increased risk for SGA”, the researchers wrote.

Make war on antibiotic use, not drugs
A US philosopher has called on governments around the world to stop wasting money on the “unwinnable and morally dubious war on recreational drug users” and shift their attention to the serious threat of antibiotic resistance. In an essay published in the Journal of Medical Ethics, Associate Professor Jonny Anomaly, of the department of philosophy, politics and economics at Duke University, wrote that he had explored “morally salient differences” between antibiotics and narcotics, concluding that government action was more appropriate and more likely to be effective in regulating antibiotics than it is in criminalising narcotics. Despite the cost of investigating the use and sale of recreational drugs and the millions of people who had been imprisoned, use of these drugs had remained relatively constant, he wrote. He said the use of antibiotics created “a global, inter-generational collective action problem in which the consumption choices of each person have significant welfare effects on others. This suggests that there is a much stronger justification for governments to regulate the use of antimicrobial drugs than there is for regulating recreational drugs”.

Harms of too much TV
A NEW Zealand study has confirmed that excessive television viewing in childhood and adolescence is associated with increased antisocial behaviour in adulthood, including criminal behaviour. The research, published in Pediatrics, involved 1037 people born in 1972–1973 who were assessed regularly from birth to 26 years of age. Regression analysis was used to investigate associations between television viewing hours between age 5 and 15 years and criminal and violent convictions, antisocial personality disorders, and aggressive personality traits in early adulthood. The researchers found boys spent more time than girls watching television and were more likely to have a conviction or a personality disorder. After controlling for covariates, associations between viewing time and criminal conviction and antisocial personality disorder remained statistically significant, although the association between television viewing and violent convictions did not. Higher television viewing time also predicted higher negative emotionality, higher aggression and lower positive emotionality. “We believe that identifying ways to reduce children’s and adolescents’ television viewing should be considered a priority for public health”, the researchers wrote.

Better lung cancer screening
A MODIFIED lung cancer risk-prediction model has proved more accurate in detecting lung cancer and more efficient at identifying people who should be screened than the current US National Lung Cancer Screening Trial (NLCST), according to research published in the New England Journal of Medicine. The researchers compared the probability of a diagnosis of lung cancer among people who had ever smoked during a 6-year study period using the two risk prediction models. More than 14 000 high-risk people considered eligible for screening were included in each group. The modified model missed 41.3% fewer cancers than the NLCST. The modified model had improved sensitivity (83.0% compared to 71.1%) and positive predictive value (4.0% vs. 3.4%), without loss of specificity (62.9% vs. 62.7%). The modified model, based on the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, included the variables “race or ethnic group” and personal history of cancer status. “These additions are consistent with findings of other studies and modestly but significantly improved prediction”, the researchers wrote, saying the modified model would be more cost-effective.

Antioxidants in neurology doubts
RESEARCH published in Neurology has found no association between total overall antioxidants in the diet and the risk of dementia or stoke in the elderly. The prospective study included more than 5000 people aged 55 years and older who were free of dementia and stroke at baseline and who provided dietary information and underwent magnetic resonance imaging for brain volume. Participants were each assigned a ferric-reducing antioxidant power (FRAP) score as a measure of overall antioxidant intake. During a median 13.8 years of follow-up about 600 cases of dementia and stroke were identified. However, FRAP scores were not related to brain tissue volumes or dementia risk. The researchers wrote that their results suggested that individual antioxidants, or major food contributors to those antioxidants — not overall antioxidant capacity of the diet — probably contributed to lower risks of dementia and stroke. This assumption was based on previous studies showing positive results from antioxidants, such as greater intakes of vitamin C might be related to a lower risk of stroke and higher vitamin E intake might be associated with reduced risk of dementia.

Posted 25 February 2013

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