Proof in the pudding is safe
IN news that will delight health care professionals around the world who love Christmas pudding, Australian researchers have found that enjoying a slice of the fruity treat does not cause high blood alcohol content (BAC). The festive-themed research, published in the MJA, also proved that some — but not all — alcohol evaporated in the cooking process. The researchers used fractional distillation to analyse the ethanol content of five Christmas puddings, and then estimated the BAC of health care workers at Sydney’s Liverpool Hospital who had indulged in a 125 mg slice of the dessert during their lunch break. Analysis showed the amount of ethanol in the puddings ranged from 0.260 to 1.685 g per slice. The authors found that after pudding consumption, the estimated BAC of a typical 70 kg male and 60 kg female health care professional ranged from 0.001 to 0.004 g/dL and from 0.001 to 0.006 g/dL, respectively. The authors estimated that for an average health care professional to obtain a BAC of more than 0.05 g/dL, they “would need to eat in excess of 1 kg of the most potent Christmas pudding in a single setting”. “Hospital staff should feel confident that the enthusiastic consumption of Christmas pudding at work in the festive season is unlikely to affect their work performance or safety, impair their ability to make complex decisions or compromise the standard of patient care”, the authors wrote.

Polypill would “substantially” cut health costs
A COST analysis of polypill-based care for patients with cardiovascular disease (CVD) versus usual care with separate medications has shown a statistically significant saving in both medical and pharmaceutical costs. The analysis, published in the MJA, was based on the Kanyini Guidelines Adherence with the Polypill (GAP) pragmatic randomised controlled clinical trial within Indigenous and non-Indigenous urban, rural and remote primary care settings, which linked health service and medication administrative claims data from Medicare Australia. It found significant cost savings of $989 (95% CI, $648–$1331) to the taxpayer and Australian Government through the introduction of a CVD polypill strategy. The analysis found that the polypill was safe and effective in improving combination preventive treatment use by patients. “Using primary care expenditure data, our within-trial analysis provides evidence of significant cost savings through the introduction of a CVD polypill, showing its economic dominance over conventional individual therapies”, the authors wrote. However, they warned that challenges remained before large cost savings could be realised in Australia, such as the fact that no polypill had regulatory approval to date. “Given that over 600 000 Australians at high risk of CVD are currently prescribed antiplatelet, blood pressure and lipid-lowering medication, and a similar number are on partial treatment, this polypill has the potential to not only help to reduce the large gaps that exist in Australia between recommended and actual treatment for patients with CVD, but also to free up considerable amounts of pharmaceutical expenditure”, the authors wrote.

Preeclampsia severity flags autism risk
CHILDREN with autism spectrum disorder (ASD) were twice as likely to have been exposed in utero to pre-eclampsia than children with typical development (TD), research published in JAMA Pediatrics shows. The population-based, case–control investigation of ASD and/or developmental delay (DD) origins included 517 children with ASD, 194 with DD and 350 controls with TD, aged 24‒60 months at baseline. The researchers found the risk of ASD increased with greater pre-eclampsia severity. They wrote that placental insufficiency appeared responsible for the increase in DD risk associated with severe pre-eclampsia (adjusted odds ratio, 5.49). “Preeclampsia complicated the gestations of children with ASD more than twice as often as those of children with TD”, the researchers wrote. Mothers of children with ASD and DD were significantly more likely to have had placental insufficiency, severe pre-eclampsia, or both compared with mothers of children with TD. They wrote that although a single study could not establish causality, “the cumulative evidence supports efforts to reduce preeclampsia and diminish severity to improve neonatal outcomes”. They said optimising metabolic health before and throughout gestation could improve placental perfusion and should be investigated.

Pollution impacts on heart health
A CONSENSUS statement addressing the impact of air pollution on cardiovascular disease (CVD), published in the European Heart Journal, aims to raise awareness of the wide-ranging effects of air pollution on CVD, and provide guidelines on managing and mitigating the risks. The statement, presented on behalf of the European Society of Cardiology, was based on a review of research, which the authors said showed there was “now abundant evidence that air pollution contributes to the risk of cardiovascular disease and associated mortality, underpinned by credible evidence of multiple mechanisms that may drive this association”. The authors recommended that air pollution should be treated as one of several modifiable risk factors in the prevention and management of CVD. The statement suggested several simple measures to reduce exposure to airborne pollutants including travel by walking or public transport rather than by car, avoiding inefficient burning of biomass for domestic heating, installing ventilation and filtration systems in homes, and limiting time spent outdoors during highly polluted periods. The authors wrote that individuals at high risk of CVD be advised of “the importance of compliance with primary or secondary prevention medication in order to combat the potential effects of air pollution exposure”. Health professionals, including cardiologists, also had an important role to play in supporting educational and policy initiatives as well as counselling their patients, the authors said. They suggested that further research was needed to explore the optimal methods of air pollution reduction and document the effects of this on the incidence of CVD.

Tramadol warning over hypoglycaemia
TRAMADOL therapy for non-cancer pain is associated with an increased risk of hospitalisation for hypoglycaemia, particularly in the first 30 days of use, according to the results of a large UK case–control analysis published in JAMA Internal Medicine. The population-based cohort included 28 110 new users of tramadol and 305 924 new users of codeine, prescribed for non-cancer pain between 1998 and 2012. The researchers found that the use of tramadol increased more than eightfold during the study period, from 25 334 prescriptions in 1999 to 215 709 in 2011. Overall, both groups were similar in age, sex, comorbidities and prescription drug use, including antidiabetic medications, although tramadol users were more likely to have undergone surgery in the 90 days before cohort entry. There were 1105 hospitalisations for hypoglycaemia in the entire cohort, including 112 (10.1%) that were fatal. When each case was matched to 10 controls, tramadol use was associated with a 52% increased risk of hospitalisation for hypoglycaemia compared with codeine, with a secondary analysis showing the risk was highest in patients who initiated the treatment within 30 days of hospital admission. The increased risk was most pronounced among non-users of antidiabetic drugs. “The association between tramadol use and hypoglycemia is biologically plausible and may relate to its pharmacodynamic properties”, the authors wrote. “Although rare, tramadol-induced hypoglycemia is a potentially fatal adverse event”, they wrote, saying the “novel findings” required additional investigation. An accompanying commentary blamed increased prescribing of tramadol on “aggressive marketing” plus a perception that it was a safe analgesic not prone to misuse. “Whereas the drug’s analgesic effects are at best moderate, its toxic effects are dangerous and merit respect, particularly when doses are escalated”, the commentary authors wrote.

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