Getting physical staves off heart disease in women
AN Australian study has highlighted the importance of physical activity for women to reduce the risk of ischaemic heart disease (IHD), especially after age 30 years. The prospective study, published in the British Journal of Sports Medicine, examined the population attributable risk (PAR) of heart disease for four risk factors — high body mass index (BMI), smoking, high blood pressure (BP) and physical inactivity — across the adult lifespan of Australian women. It included participants in the Australian Longitudinal Study on Women’s Health, which tracks the long-term health of women born in 1973–1978, 1946–1951 and 1921–1926. The women completed a survey every 3 years on a rolling basis. The researchers found the relative risks (RRs) for IHD and prevalence estimates for each risk factor varied across the age groups. The self-reported prevalence of smoking fell from 28% in women age 22–27 years to 5% in 73–78 year olds, whereas the prevalence of inactivity and high BP increased steadily across the lifespan. BMI increased between ages 22 and 64 years, then declined in older age. Combining prevalence and RR data, the researchers found that up to the age of 30 years, smoking was the most important contributor to heart disease. However, from age 30 years until 85–90 years, low physical activity levels were responsible for higher levels of population risk than any of the other risk factors. The researchers estimated that if every woman aged between 30 and 90 years reached the recommended weekly exercise quota of at least 150 minutes of moderate intensity physical activity, the lives of more than 2000 middle-aged and older women could be saved each year in Australia. They wrote that the PAR for inactivity “outweighs that of the other leading risk factors, including high BMI, which is currently receiving much more attention in Australia than the ‘Cinderella’ risk factor, physical inactivity”.
    
Antimicrobials speed middle ear effusion resolution
RESEARCHERS have found middle ear effusion (MEE) disappeared significantly earlier in children receiving antimicrobial treatment for otitis media than in children who received placebo in a randomised, double-blind, placebo-controlled trial published in JAMA Pediatrics. The researchers found that in children who received amoxicillin–clavulanate, the mean duration of MEE was reduced by 2 weeks and the median duration of MEE by 3 weeks per acute otitis media (AOM) episode. The research involved 84 children aged from 1 month to 15 years with acute symptoms of respiratory infection and/or ear-related symptoms, and signs of tympanic membrane inflammation together with MEE detected by pneumatic otoscopy. Parents performed daily tympanometry at home and the study physician performed tympanometry and otoscopy after 3 and 7 days, and then weekly until both ears were healthy. The researchers wrote that their findings contradicted those of several randomised control trials and two meta-analyses, which had concluded that antimicrobial treatment had no impact on the duration of MEE evaluated either by tympanometry or otoscopy. “The most likely explanation for this discrepancy is that we obtained daily information on middle ear status. In this way, we had an accurate measure of the duration of MEE and avoided including new respiratory tract infections and the subsequent development of new MEE in the study population”, the researchers wrote. They speculated that hearing impairment could be resolved faster in children who were treated with antimicrobials.

Stressful relationships a killer
STRESSFUL social relations, particularly with a partner and children, have been associated with increased mortality risk among middle-aged men and women in research published in the Journal of Epidemiology & Community Health. The researchers found that unemployed people and men seemed especially vulnerable. The research was based on baseline data from a Danish longitudinal study on work, unemployment and health, including 9875 men and women aged 36–52 years, which was linked to the Danish Cause of Death Registry for information on all-cause mortality. The researchers examined associations between stressful social relations with partner, children, other family, friends and neighbours and all-cause mortality. During 11 years of follow-up, 196 women (4%) and 226 men (6%) died, with major causes of death being cancer (47%), cardiovascular disease (14%), liver disease due to alcohol abuse (8%) and violent deaths such as accidents or suicide (7%). The research revealed that 9% of the population reported always/often experiencing demands/worries from their partner, 10% from children, 6% from family and 2% from friends, with 6% reporting conflicts always/often with their partner, 6% with their children, 2% with their family and 1% with friends. The researchers wrote that experiencing frequent worries/demands from partner or children were associated with 50%–100% increased mortality risk, with frequent conflicts with any type of social relation associated with 2–3 times increased mortality risk. “Skills in handling worries and demands from close social relations as well as conflict management within couples and families and also in local communities may be important strategies for reducing premature deaths”, the researchers wrote.

Medicate to reduce violent crime?
A LARGE population-wide study found reductions in violent crime in patients with psychiatric illness prescribed antipsychotics and in patients with bipolar disorder receiving mood stabilisers. The research, published in The Lancet, linked Swedish national registers to study 82 647 patients prescribed antipsychotics or mood stabilisers, their psychiatric diagnoses, and subsequent criminal convictions in 2006–2009. The researchers found an association between antipsychotic drugs and reductions in the rate of violent crime in the same people when they were on medication compared with when they were not. During the study period, 6.5% (2657) of men and 1.4% (604) of women were convicted of a violent crime. Compared with periods when participants were not on medication, violent crime fell by 45% in patients receiving antipsychotics, and by 24% in patients prescribed mood stabilisers. When the two medications were combined, the researchers found no evidence of any further association with reduced violent crime. Mood stabilisers was associated with reductions in violent crime only in male patients with bipolar disorder. “Importantly, our approach accounted for confounding factors that remained stable within the same patient”, the researchers wrote, saying that “in addition to the effects of antipsychotics and mood stabilisers on relapse rates, their potential effects on violence and crime should also be taken into account in decisions about management for these groups of patients”. An accompanying commentary said the study “provides a basis for future clinical studies aiming to establish how antipsychotics and mood stabilisers can be used to reduce aggressive behaviour”.

Risk prediction after stopping bisphosphonate therapy
A POST hoc analysis of a prospective trial of postmenopausal women who received bisphosphonate therapy for 4–5 years has found that 22% of those who discontinued treatment experienced fracture in the following 5 years. The research, supported by contracts from Merck and Co and published in JAMA Internal Medicine, found older age and lower hip bone mineral density (BMD) at the time of discontinuation were associated with higher rates of clinical fracture during the next 5 years. However, neither 1-year changes in hip dual-energy x-ray absorptiometry (DXA) nor 1- and 3-year changes in bone turnover marker levels were associated with fracture risk. The prospective study randomised postmenopausal women aged 61–86 years who had been treated for 4–5 years with alendronate therapy to 5 more years of alendronate or placebo. The analysis included only the placebo group. Hip and spine DXA were measured when placebo treatment began and after 1–3 years of follow-up. “We did observe an increased risk of fracture among those with greater 2- or 3-year hip bone loss, but only 2-year change in total hip BMD was statistically significant”, the researchers wrote. They said that “clinicians and patients contemplating a drug holiday after 5 years of alendronate therapy should be aware that short-term monitoring to detect individuals at higher risk who might resume bisphosphonate therapy, or initiate another therapy, may not add to risk prediction over and above age and BMD measured at the time of discontinuation of therapy”.

Male genitalia bias in biology
A PERSPECTIVE article published in PLOS Biology has highlighted an overall male bias in evolutionary biology research that is getting worse. The authors wrote that studies exploring the diversity, variability and apparent rapid evolution of animal genitalia had dramatically increased in the past decade, rising from less than five studies a year in the early 1990s to more than 40 in 2012 alone. “These studies, however, exhibit a strong male bias, which has worsened since 2000, despite the fact that this bias has been explicitly pointed out in the past”, they wrote. “We argue that the persisting male bias in this field cannot solely be explained by anatomical sex differences influencing accessibility. Rather the bias reflects enduring assumptions about the dominant role of males in sex, and invariant female genitalia.” They said when the role of female genitalia was considered with that of males it revealed “extremely rich evolutionary dynamics”. “Studies addressing only one sex are at risk of examining just one side of a very complex equation and may be more prone to misinterpreting the highly complex coevolutionary dynamic that can occur between the sexes”, they wrote. “We argue that understanding genital evolution is hampered by an outdated single-sex bias.”

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