Methadone reduces HIV risk
A REVIEW of studies assessing the impact of opioid substitution treatment (OST) on the incidence of HIV in injecting drug users has found it was associated with a 54% reduction in risk of HIV infection. The analysis, published in the BMJ, included published and unpublished data from nine studies with 819 incident HIV infections over 23 608 person-years of follow-up. An editorial in the same issue by Australian pharmacologist Dr Linda Gowing, of the University of Adelaide, said OST had clear benefits for people who inject drugs and for the wider community. She wrote that OST should be endorsed by all governments as an important treatment option and public health measure. HIV/AIDS account for nearly a fifth of the burden of disease among people who use illicit drugs.

Fertility treatment increases MS activity
A SMALL study of patients with relapsing-remitting multiple sclerosis (MS), published in Annals of Neurology, has found a significant increase of disease activity after the use of assisted reproduction technology (ART). The before-and-after study followed 16 MS patients who underwent 26 treatment cycles with gonadotropin-releasing hormone agonists and recombinant follicle-stimulating hormone, and found a sevenfold increase in the risk of MS exacerbation following ART. The researchers said reproductive hormones appeared to exert an important role in regulating immune responses and suggested that different hormonal approaches could be used for MS patients undergoing ART. “However, neurologists should be aware of this risk, and discuss pros and cons of the procedure with MS patients”, they wrote.

High cost of insomnia
RESEARCH based on the America Insomnia Survey, published in the Archives of General Psychiatry, has shown a substantial association between insomnia and workplace accidents and errors. Based on a national cross-sectional telephone survey of 4991 employed people, the researchers demonstrated that the aggregate associations of insomnia with injuries were similar across age, sex and educational levels. The results suggested that workplace interventions aimed at screening for and treating insomnia to reduce workplace injuries, accidents and errors could have more broad-based effects, such as on absence due to sickness and work performance. Through simulations they estimated that insomnia was associated with 7.2% of all costly workplace accidents and errors and 23.7% of all the costs of these incidents — higher than for any other chronic condition.

Statins reduce glaucoma risks
PATIENTS with hyperlipidaemia taking statins have a significantly reduced risk of developing open-angle glaucoma (OAG) compared to those not taking statins, according to research published in Ophthalmology. The study of 524 109 people with hyperlipidaemia, enrolled in a US managed care network, showed that the longer a person was prescribed statins, the greater the protective effect. Of those in the study, 60% had been prescribed statins. The risk of developing OAG decreased 0.3% for every additional month of statin use. Those who took statins continuously for 2 years had an 8% decreased OAG risk compared to those not taking statin therapy and a 9% decreased risk of progressing from a diagnosis of glaucoma suspect to OAG. The researchers warned that the findings might not be generalisable to those who do not have hyperlipidaemia.

Help with low back pain
EVIDENCE-based templates to “assist practitioners with the sometimes confusing process of managing patients with acute low back pain” have been published in the Journal of the American College of Radiology. The authors recommended that patients be categorised into one of three groups — nonspecific low back pain, low back pain potentially associated with radiculopathy or spinal stenosis, or low back pain potentially associated with a specific cause. The templates provided “a logical method of choosing, developing, and implementing [clinical decision support] interventions that is based on the best available evidence”. The authors wrote the templates could also be used to develop transparent criteria to determine when imaging, medications, procedures and surgical interventions were required. Treatment costs for low back pain, one of the most common reasons for visits to doctors, had increased substantially due mainly to the use of medical imaging, they wrote.

Sunbed dangers confirmed
A SYSTEMIC review and meta-analysis, published in the BMJ, has confirmed that indoor tanning is associated with a significantly increased risk of both basal and squamous cell skin cancer. The review, based on 12 studies with 9328 cases of non-melanoma skin cancer, found the risk was higher among those who used tanning beds when aged less than 25 years. They wrote that the use of sunbeds was a modifiable risk factor that might account for hundreds of thousands of cases of non-melanoma skin cancer. An accompanying editorial by experts from the Queensland Institute of Medical Research said young people in particular should be made aware that using sunbeds for short-term cosmetic tanning carried a long-term price of an increased risk of skin cancer.

Posted 8 October 2012

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