Most antidepressants ineffective for youth
A major comprehensive comparison of commonly prescribed antidepressant drugs, published in The Lancet, has shown that most available antidepressants are ineffective, and some may be unsafe, for children and teenagers with major depression. The findings indicated that out of 14 antidepressant drugs, only fluoxetine was more effective at relieving the symptoms of depression than the placebo . However, the authors (from the UK and China) warned that the true effectiveness and risk of serious harms, such as suicidal thoughts and attempts, remained unclear. This is because of the small number and poor design of clinical trials assessing those antidepressants and the selective reporting of findings in published trials and clinical studies. The authors did a systematic review and network meta-analysis of all published and unpublished randomised trials comparing the effects of 14 antidepressants in young people with major depression up to the end of May 2015. They ranked antidepressants by efficacy, tolerability, acceptability and associated serious harms. They took into account the quality of included studies and also assessed the overall quality of the retrieved evidence. Analysis of 34 trials, involving 5260 participants (with an average age of 9 to 18 years), showed that the benefits outweighed the risks in terms of efficacy and tolerability only for fluoxetine. Nortriptyline was less efficacious than seven other antidepressants and placebo. Imipramine, venlafaxine and duloxetine had the worst profile of tolerability, leading to significantly more discontinuations than the placebo. Venlafaxine was linked with an increased risk of engaging in suicidal thoughts or attempts compared with the placebo and five other antidepressants. The authors warned that due to the lack of reliable data, it was not possible to comprehensively assess the risk of suicidality for all drugs. Twenty-two trials (65%) were funded by pharmaceutical companies. Ten trials (29%) were rated as high risk of bias, 20 (59%) as moderate and four (12%) as low.

RACGP takes stand on after-hours services
The Royal Australian College of General Practitioners (RACGP) believes that after-hours doctor services shouldn’t advertise to the general public and should only be accessed through their general practice. The recommendation is one of many in the college’s recently released position statement about after-hours services. RACGP President, Dr Frank R Jones, wrote in the college’s In Practice newsletter: “Many issues of concern were identified by practicing GPs, especially around quality clinical assessment and continuity of care, as the patients’ normal treating doctor often receives variable and limited information about their patients’ after-hours visit”. After-hours visiting services have become increasingly popular in recent years, which the college says coincides with an increase in the use of after-hours Medicare Benefits Schedule item numbers. For more on this story, visit doctorportal.

Humanity plagued by a single germ
The bubonic plague that decimated European populations during the mid-14th century, and numerous pandemics since, can be traced back to a single strain of bacteria, according to international research published in Cell Host and Microbe. Researchers from the Max Planck Institute for the Science of Human History looked at DNA taken from hundreds of plague-infected bodies, exhumed from mass graves in Spain, Germany and Russia, and concluded that the plague bacterium Yersinia pestis likely shifted from Asia to Europe and back again. This same strain sparked recurrent outbreaks on the continent over the 4 centuries following the Black Death before spreading to China, where it triggered the third plague pandemic in the late 19th century. The wave of plague that traveled to Asia later became the source population for modern-day epidemics around the globe. The researchers sequenced the genomes of these three ancient Y. pestis strains and compared them to 148 previously sequenced ancient and modern strains to reconstruct the Y. pestis phylogenetic tree. The phylogenetic analysis revealed no differences between their Black Death strain from Barcelona and previously genotyped strains from mid-14th century London. The simultaneous presence of the same strain in both southern and northern Europe suggests that Y. pestis entered the continent in a single wave rather than through multiple pulses during the Black Death. These Black Death strains from London and Barcelona around 1348 gave rise to a branch containing the Ellwangen strain and previously sequenced 18th-century strains from the Great Plague of Marseille, in France. Moreover, all three newly reconstructed genomes and previously sequenced genomes from the second plague grouped together in the same branch on the phylogenetic tree. Taken together, these findings suggest that a single Y. pestis lineage was responsible for the Black Death and subsequent second pandemic outbreaks throughout Europe.

Warning on flu vaccination for kids
The RACGP has warned its members to be wary when administering the influenza vaccine to children aged under 5 years. In a member communication, they have confirmed that there has been off-label usage of influenza vaccines Fluarix Tetra (GSK) and Fluvax (Seqirus) which poses a safety risk for children. The RACGP says Fluarix Tetra is being incorrectly administered to children under 3 years old (including half doses of the vaccine). The vaccine isn’t registered for this age group. Fluvax is also being incorrectly administered to children. According to the Department of Health, “Seqirus (previously bioCSL) Fluvax is not a registered influenza vaccine for use in children less than 5 years of age and must not be given in this age group”. The RACGP recommends ensuring children’s vaccines are quarantined and clearly labelled in the vaccine fridge, having two clinical staff check each vaccine before administration, reading the Australian Technical Advisory Group’s statement on influenza vaccines and discussing with your practice about practical steps to make sure that patients receive the correct vaccine every time. For more on this story visit doctorportal.

Ethnic differences in association between CV health and diabetes
A study published in Diabetologia shows that significant differences by race and ethnicity exist in the degree of association between measures of cardiovascular health (together constituting “ideal cardiovascular health”) and the risk of diabetes, and that as many as three out of five cases of diabetes may be attributable to poor cardiovascular health factors. Researchers from Johns Hopkins University School of Medicine in Baltimore examined the links between incident type 2 diabetes and cardiovascular health within a multi-ethnic population in the United States from 2002 to 2012. “Ideal cardiovascular health” (ICH) is based on seven health factors or behaviours which had been identified as being associated with healthy ageing without the burden of cardiovascular disease or other chronic diseases – total cholesterol, blood pressure, fasting plasma glucose, dietary intake, tobacco use, physical activity and body mass index. Participants in the study were drawn from the Multi-Ethnic Study of Atherosclerosis, a large population-based sample of 6814 men and women aged 45–84 years at baseline from four ethnic groups: non-Hispanic whites (NHW; 38%), African Americans (AA; 28%), Chinese Americans (CA; 12%), and Hispanic Americans (HA; 22%). Participants joined the study between 2000 and 2002, categorising themselves into one of the four racial and ethnic groups. Participants underwent a “baseline” exam consisting of a standardised questionnaire and a series of medical tests. The rates of incident diabetes developed during the follow-up period of the study were highest in HA and AA populations at 15.3 and 12.3 cases per 1000 people per year respectively, compared to 11.1 cases per 1000 person-year in the study population as a whole. CA had diabetes rates of 11.6 cases and NHW 8.3 cases per 1000 people per year. Every ICH goal that was achieved in the cohort as a whole as well as in the individual race and ethnic groups resulted in lower rates of incident diabetes. Participants categorised as having “intermediate” or “ideal” cardiovascular health had a 34% and 75% lower diabetes incidence, respectively, than individuals whose cardiovascular health was considered to be “poor”. In addition, the study discovered that the relationship between ICH components at baseline and diabetes risk varied significantly by race and ethnicity. The authors found that: “ideal versus poor cardiovascular health was associated with a greater reduction in diabetes risk in NHW and CA (87% and 88%) versus AA and HA (66% and 50%)”.

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