Reproductive disorders impact on Indigenous men
A NEW study published in the MJA has provided an insight into the barriers to seeking help for reproductive disorders in Aboriginal and Torres Strait Islander communities and may point to ways of improving access to health services. The research, which involved 293 Aboriginal and Torres Strait Islander men aged 18 years and over from urban, rural and remote communities in the Northern Territory and Queensland, found the prevalence of moderate-to-severe erectile dysfunction increased across age groups, from about 10% in younger males (under 35 years) to 28% in men aged 55–74 years. The study, the first to address reproductive health disorders in Aboriginal and Torres Strait Islander men, confirmed that high rates of chronic disease coexisted with reproductive health problems, the authors wrote. “The earlier onset of chronic disease in Aboriginal and Torres Strait Islander men may explain the rates of [erectile dysfunction] among younger men, and provide opportunities for early identification of more serious conditions”, they wrote.

Call to screen for alcohol problems
THE authors of a study into doctors’ ability to identify patients with possible alcohol problems say the results affirm that “systems need to be in place, possibly through team-based care, to screen systematically for alcohol problems”. The study, published in Annals of Family Medicine and based on nearly 1700 patients visiting 94 primary care clinicians in the US, found that, when formally screened after a medical consultation, 171 (10.1%) of patients tested positive for hazardous drinking and 64 (3.8%) for harmful drinking. However, clinicians questioned after the same encounter suspected alcohol problems in 81 patients (hazardous drinking in 37, harmful drinking in 40, and both in four). The study authors said in most cases where the clinician suspected an alcohol problem, the patients independently acknowledged that they were drinking at hazardous or harmful levels.

Screening misses hearing loss
A RETROSPECTIVE review of the medical records of 314 children who had passed a universal newborn hearing screen (UNHS) has found that 78 were later diagnosed with hearing loss, including 37 with severe or profound hearing loss. The study, published in JAMA Otolaryngology – Head & Neck Surgery, found the mean age of diagnosis of severe to profound hearing loss was 4 years 7 months (range, 1 month to 9 years 4 months). It was slightly higher for moderate (5 years 6 months) and mild (6 years) hearing loss. “If their actual onset of hearing loss was early, these children are not benefiting from early intervention …”, the authors wrote. They said parents, paediatricians and family physicians might have a false sense of security from a normal newborn hearing screen result and may overlook signs of hearing loss. “This study highlights the importance of recognising the possibility that children who passed the UNHS may have hearing loss. Parents and medical care providers should recommend further audiologic testing in children with speech and language delay regardless of passing the UNHS”, the authors wrote.

Annual PSA predicts aggressive cancer
ANNUAL percentage changes in prostate specific antigen (PSA) are a better predictor of aggressive prostate cancer than single measurements of PSA alone, according to research published in the British Journal of Urology International. However, the retrospective study of 219 388 community-dwelling men aged 45 years and older found that the percentage change in PSA only marginally improved the prediction of prostate cancer overall. Men in the cohort experienced a 2.9% change in PSA levels per year on average and the rate of change in PSA increased modestly with age. The authors wrote that the annual percent changes in PSA accurately predicted the presence of prostate cancer and aggressive disease, and displayed more predictive accuracy when compared to a single measurement of PSA alone for aggressive disease. “Findings from this study provide insight into the utility of PSA velocity as a detection marker for prostate cancer and suggest that PSA velocity may be useful when screening for aggressive prostate cancer in general practice settings”, the authors wrote.

ICU conflict “significant” problem
A CROSS-SECTIONAL study of 2100 US surgeons on reported rates of conflict with intensivists and nurses in intensive care units has found conflict is a significant public health problem that diminishes quality of care for critically ill patients and their families. The research, published in JAMA Surgery, found that 43% of surgeons reported sometimes or always experiencing conflict about the postoperative goals of intensivists and conflict with nurses. Surgeons with fewer years of experience were 2.5 times more likely to report conflict. Those working in institutions with a closed model of ICU administration (where an intensive care physician, rather than the treating surgeon, was primarily responsible for all patients) were also more likely to report conflict. “The odds of reporting conflict with intensivists about goals of postoperative care were 40% lower for surgeons who primarily managed their intensive care unit patients than for those who worked in a closed unit”, the authors wrote. They said clinicians from all backgrounds “should focus on eliminating these interteam conflicts to allow energies to be spent more productively on other clinical issues affecting safety and quality”.

Ask about CAM use by kids
CANADIAN researchers have urged clinicians in hospital outpatient clinics to inquire about complementary and alternative medicine (CAM) use by children during routine history taking at every patient visit. In a study published in Pediatrics, researchers found that 71% of 704 paediatric patients surveyed at one Canadian hospital and 42% of 222 patients at another hospital reported CAM use. They found most parents agreed or strongly agreed that they felt comfortable discussing CAM in the clinic. The most common CAM products and practices used were multivitamins/minerals, herbal products, homeopathic remedies, massage, chiropractic, relaxation and aromatherapy. Respondents reported 80 adverse effects, and 55 (68.8%) of these were self-assessed as minor. Most felt that CAM use was helpful with few or no harms. However, the researchers said many patients using CAM with conventional medicines were still not discussing their CAM use with their physicians and were increasing the likelihood for potential interactions and preventable harms. “Parents would clearly like more information about CAM from their specialty clinics; such information would be easier to share if more primary data were available about the safety and effectiveness of commonly used therapies”, the researchers wrote.

Posted 21 January 2013

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