Chlamydia online success
INTERNET-based screening for chlamydia is a highly effective way to increase access to testing for young people at risk of sexually transmitted infections, according to research in the latest MJA. The researchers found that more than half of the 675 online chlamydia testing pathology forms downloaded between February 2010, when the program was launched, and June 2011 resulted in a test. Chlamydia was detected in 18% of those tested and they received appropriate clinical management, with 50% being treated within 7 days of specimen collection. More than half of those tested were men (55%) and 71% were aged less than 30 years. The researchers said internet-based chlamydia screening strategies were competitively cost-effective in comparison with traditional clinic-based screening.

Clopidogrel no benefit in stroke
ADDING clopidogrel to aspirin for patients with recent lacunar infarcts did not significantly reduce the risk of recurrent stroke but did significantly increase the risk of bleeding and death in a study of 3020 patients published in the New England Journal of Medicine. Patients were randomly assigned to receive 75 mg of clopidogrel or placebo daily and all patients received 325 mg of aspirin daily. After a mean follow-up of 3.4 years, the risk of recurrent stroke, recurrent ischaemic stroke or disabling or fatal stroke was not significantly reduced with the dual antiplatelet therapy compared with aspirin alone. However, the risk of major haemorrhage was almost doubled.

Pharmacists can help with OA
PHARMACISTS are uniquely placed to launch a multidisciplinary intervention for patients with knee osteoarthritis, according to a randomised, controlled trial involving Canadian pharmacies published in Arthritis Care & Research. Pharmacies provided either usual care or the intervention, which included a validated knee OA screening questionnaire, education, pain medication management, physiotherapy-guided exercise and communication with the primary care physician. Usual care consisted of an educational pamphlet. The researchers reported that at 3 and 6 months there were significant improvements for the intervention care group compared to usual care in pain and function, and daily activity scores. “Considering the rising prevalence of OA and the associated personal and societal costs, these findings have important implications for efficient referral to prevention and intervention programs”, the researchers said.

Midlife fitness worth it
RESEARCHERS have observed clinically significant associations between midlife fitness levels and chronic disease burden in later life in a study published in the Archives of Internal Medicine. They studied a cohort of 18 670 healthy middle-aged adults (21% women and median age of 49 years). During a 26-year follow-up, fitness at baseline was significantly associated with a lower risk of developing chronic disease outcomes. The researchers said the findings suggested that higher midlife fitness might be associated with the compression of morbidity in older age. An accompanying commentary said fitness might be a key to healthy ageing, but interpretation of the study findings required “some caution”.

Family decisions affect mortality
INPATIENT ischaemic stroke mortality is highly sensitive to patient and family preferences, with deaths occurring almost exclusively after decisions to limit potentially life-sustaining measures, according to research publish in Neurology. The researchers reviewed all ischaemic stroke mortalities at a US academic medical centre to better understand the causes of inpatient stroke mortality. They found decisions to withdraw or withhold interventions that might prevent or postpone mortality had considerable effects on hospital-based mortality rates, estimating that inpatient stroke mortality may be affected by more than 40%. However, they said variability in how different providers offer prognoses after ischaemic stroke warranted further study, especially as patients and families might decide to withhold or withdraw interventions based, at least in part, on these predictions.

Fistula needs recognition
OBSTETRIC fistula should be classified as one of the neglected tropical diseases (NTDs), according to an editorial in PLoS Neglected Tropical Diseases. The WHO has a list of NTDs — infectious diseases in resource-poor tropical countries — which includes hookworm, leprosy, lymphatic filariasis, Chagas disease, human African trypanosomiasis, ascariasis, dracunculiasis, onchocerciasis, schistosomiasis, trichuriasis, and trachoma. The editorial said obstetric fistula, like the other NTDs, was a preventable, treatable condition that causes suffering and lost productivity among the impoverished “bottom billion” of the world’s population. Although NTDs occurred primarily in the tropics, they were often linked more directly to poverty, economic insecurity and social instability, the editorial said.

Posted 3 September 2012

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