HPV vax effective against high-grade abnormalities
THE quadrivalent human papillomavirus (HPV) vaccine is 46% effective against high-grade cervical abnormalities and 34% effective against any other abnormalities, according to Australian research published in the BMJ. The study also found that the vaccine is more effective in younger than older women. The research involved 108 353 female Queensland residents aged 12–26 years in 2007 who were eligible for vaccination and who had their first cervical smear test between the national immunisation program’s introduction in April 2007 and March 2011. The participants included 1062 (1.0%) women with high-grade cervical abnormalities, 10 887 (10.0%) other cases, and 96 404 (89.0%) controls. The researchers found that the numbers needed to vaccinate to prevent one cervical abnormality at first screening were 125 for high-grade abnormalities and 22 for others. However, the authors warned that cervical screening would remain necessary in vaccinated populations. “Falling population prevalence of cervical abnormalities will reduce the sensitivity and positive predictive value of cytological testing, and screening programmes will need to adapt to maintain their effectiveness”, they wrote. “Our data suggest that this task is now becoming more urgent given the relatively rapid impact of the vaccine on disease in the real world setting.” They said Australia was currently conducting a comprehensive review of cervical screening.

Diabetes adds to stroke risk in women
DIABETES is a stronger risk factor for stroke in women than in men, according to Australian research published in The Lancet. The meta-analysis of 64 studies, which included 775 385 participants and 12 539 fatal and non-fatal strokes, found the relative risk (RR) of stroke associated with diabetes was 2.28 in women and 1.83 in men. “Compared with men with diabetes, women with diabetes had a 27% greater RR for stroke when baseline differences in other major cardiovascular risk factors were taken into account”, the researchers wrote. “This sex difference in diabetes-related stroke risk was apparent and consistent across a wide range of prespecified subgroups. These findings add to the accumulating evidence for appreciable and clinically relevant differences in how diabetes affects the risk of cardiovascular disease in men and women.” The researchers said that even though women had a more favourable cardiovascular risk profile than men, this pattern could be reversed with deterioration in glycaemic control. “We propose that the diabetes-related excess risk of stroke in women is due to their having a chronically raised cardiovascular risk profile in the prediabetic state, which is more likely to go undetected and therefore untreated than in men, rather than by any substantial sex difference in the effects and complications of diabetes per se”, the researchers wrote, calling for increased screening for prediabetes in women.

Doctors’ hospice choices
MOST doctors, particularly women and primary care physicians, would enrol in a hospice if they were diagnosed with terminal cancer, according to a research letter published in JAMA Internal Medicine. In a survey of 4368 doctors treating cancer patients, 64.5% strongly agreed they would enrol in hospice if they were terminally ill and 21.4% somewhat agreed. The researchers found that doctors who were female, caring for more terminally ill patients and who worked in managed care settings were more likely to strongly agree. Surgeons and radiation oncologists were less likely than primary care doctors to strongly agree. The authors also found that physicians with strong personal preferences for hospice were more likely to discuss hospice with their terminally ill patients earlier. More than a quarter said they would discuss hospice “now” with an asymptomatic patient, while almost half said they would wait until there were “no more treatments to offer”. “Physicians with negative views of hospice may consider pursuing additional education about how hospice may help their patients”, they wrote.

Screen time impacts on sleep highlighted
THREE studies published in JAMA Pediatrics have highlighted the effect accessibility to television and computer games has on sleep, weight gain and physical activity in children. An Australian study of 3427 children aged 4–5 years at baseline and followed up at 2 and 4 years, found that “bidirectional relationships” exist between sleep duration and screen time. The authors wrote that this was the most novel finding of the research — that sleep duration was inversely associated with subsequent screen time. They said less sleep could promote tiredness and fatigue, which made children less motivated to engage in active behaviours and, over time, this could result in more sedentary time, such as watching TV and using computers. They wrote that the results were important “given that shorter sleep durations and excessive media use predict a range of adverse social and health-related outcomes for children”. The second study found an association between having a TV in the bedroom and increased body mass index in adolescents “beyond the effect of television viewing time”. The third study randomly allocated 75 overweight or obese children to either a paediatric weight management program which included active video gaming or the program alone. The active-gaming group showed increases in moderate-to-vigorous and vigorous physical activity, while the program-only group showed a decrease or no change.

Alzheimer deaths “far exceed” official figures
DEATHS from Alzheimer disease (AD) dementia “far exceed” the numbers reported by the US Centers for Disease Control (CDC) and may be closer in magnitude to deaths reported from heart disease and cancer, according to the authors of a study published in Neurology. The researchers wrote that in 2010 AD dementia was listed as the sixth leading cause of death in the US, with 83 494 recorded deaths. They used data from two cohort studies on ageing and AD which included 2566 people aged 65 years and older without dementia at baseline. They found that over an average of 8 years of the participants  without dementia at baseline, 559 (21.8%) developed AD dementia, 31 (1.2%) were diagnosed with other forms of dementia and 1090 (42.4%) died. Of those who developed AD dementia 72% died compared with 34.5% of those who did not develop the disease. The authors found that the rate of death from AD dementia was five to six times higher than the 2010 CDC figures. They suggested that a valid estimate of deaths due to AD dementia would help assess the social burden of the disease, “informing government and private research priorities”.

Community care effective for schizophrenia
TREATMENT in the community, led by lay workers, is more effective at reducing disability and psychotic symptoms and improving medication compliance in patients with schizophrenia than standard facility-based care alone in a low- or middle-income setting, according to Indian research published in The Lancet. Individuals with schizophrenia were randomly assigned to receive community-based care plus facility-based care, or facility-based care alone. At 12 months’ follow-up, those in the intervention group had lower positive and negative syndrome scale scores and lower Indian disability evaluation and assessment scale scores although no difference was shown in the proportion of participants who had a reduction of more than 20% in overall symptoms. The authors also found a “significant reduction in symptom and disability outcomes” in community-based care among patients at the most rural of the three study sites. They concluded that “the study intervention is best implemented as an initial service in settings where services are scarce, for example in rural areas”. An accompanying comment said “ensuring continuity in supervision of community workers, safeguarding the physical health of patients, and embedding services within the local context and culture” were difficult issues in low- and middle-income countries.

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