Low uptake of shingles vax
DESPITE its efficacy in preventing incident shingles in older people, a large US study published in PLOS Medicine shows the uptake rate of the herpes zoster vaccine is low in elderly people. The cohort study included more than 760 000 people aged 65 years and older. It found vaccine uptake was just 3.9%. The study also determined the incidence rates and hazard ratios for shingles and post-herpetic neuralgia (PHN) in vaccinated and unvaccinated people, finding that the overall zoster incidence rate was 10.0 per 1000 person-years in the unvaccinated group and 5.4 in those who had been vaccinated. This gave an adjusted vaccinated effectiveness rate against incident zoster of 0.48 (95% CI, 0.39–0.56). “Herpes zoster vaccination was associated with a significant reduction in incident herpes zoster and PHN in routine clinical use”, the authors wrote. “Despite strong evidence supporting its effectiveness, clinical use remains disappointingly low with particularly low vaccination rates in particular patient groups”, they wrote. “As PHN is the major complication of herpes zoster and is associated with highly significant morbidity and adverse impacts on quality of life, substantial efforts are needed to increase vaccine use in routine care of elderly individuals.”

IUD safe for teenagers
AN INTRAUTERINE device (IUD) is as safe for teenagers to use as it is for older women, with serious complications occurring infrequently in all groups, according to US research published in Obstetrics & Gynecology. The retrospective cohort study used the health insurance claims of 90 014 women who had an IUD inserted between 2002 and 2009. Serious complications, including ectopic pregnancy and pelvic inflammatory disease, occurred in less than 1% of women regardless of age or IUD type. Women aged 15–19 years were more likely than those aged 25–44 years, but not those aged 20–24 years, to have a claim for dysmenorrhoea, amenorrhoea, or normal pregnancy. “Overall, early discontinuation did not differ between teenagers and older women”, the researchers wrote. The use of levonorgestrel-containing devices was associated with fewer complications and less discontinuation than copper-containing IUDs. “Physician recommendations play an important role in their patients’ decision making, and their recommendation of the IUD could increase the use of this cost-effective and safe method of birth control among teenagers”, the authors wrote. “Thus, physicians should include information about this highly effective method when they counsel young patients on their contraceptive options to help reduce the unintended pregnancy rate among teenagers …”

Repeat complaints a major problem
AUSTRALIAN research published in BMJ Quality & Safety has found that half of all formal patient complaints made to health complaints units concern just 3% of the nation’s doctors, with 1% accounting for a quarter of all complaints. Male sex, older age, and working in surgical specialties were all associated with a higher risk of repeat complaints. However, the number of previous complaints was the strongest predictor, the authors wrote. The research was based on a national sample of almost 19 000 formal patient complaints filed against 11 148 doctors with health complaints commissions across Australia between 2000 and 2011. Most complaints (61%) concerned clinical aspects of care, while 23% concerned communication issues, including the doctor’s attitude and the quality or quantity of information provided. An accompanying editorial said few people would be surprised that a group of “frequent flier” doctors attract a disproportionate share of complaints. “What is surprising is the extent of the problem”, the editorial said.

Month-of-birth effect in MS explained
UK researchers have found that babies born in May have significantly less circulating 25-hydroxyvitamin D than those born in November, and speculate that this may explain the month-of-birth effect in multiple sclerosis (MS) through the effects on thymic development and T-cell production. Using cord blood obtained from 50 healthy white individuals born in November and 50 born in May between 2009 and 2010 in London, the research, published in JAMA Neurology, found that the month of birth had a significant effect on thymic output. “We hypothesized that birth month influences T-cell production and may impair T-cell central tolerance and/or T-regulatory/T-effector cell balance, predisposing to MS”, the researchers wrote. “Interestingly, the risk for immune conditions other than MS, including type 1 diabetes mellitus, rheumatoid arthritis, and ulcerative colitis, is also higher in spring-born individuals, suggesting the presence of shared etiologic pathways across these disorders.” The authors suggested long-term prospective studies be initiated to investigate the effect of gestational vitamin D supplementation on thymic output and, ultimately, the subsequent risk for MS.

Animal surveillance may predict new disease
WITH nearly two-thirds of emerging infectious diseases that affect humans being zoonotic, researchers in the US have analysed a database of mammal–virus associations to determine if surveillance targeting diseased animals is the best strategy to identify potentially zoonotic pathogens. The analysis, published in Emerging Infectious Diseases, found that three-quarters of zoonotic diseases originate in wildlife, making surveillance of wildlife for novel pathogens part of a logical strategy to prevent the future emergence of zoonotic emerging infectious. The results of their analysis pointed to a mixed strategy of targeted syndromic and healthy animal surveillance across host and virus taxonomies. “A mixed strategy could combine apparently healthy animal surveillance (particularly in [bats]) with syndromic surveillance in other wildlife and domestic animal hosts”, they wrote. The researchers recommended a holistic, probability-based approach to zoonotic virus discovery, and continued analysis of passively and actively reported deaths, with increased investment in broad surveillance of healthy wildlife. “The latter could be targeted geographically to those regions most likely to generate novel emerging infectious diseases or taxonomically to groups that are reservoirs for the highest proportion of zoonoses”, they wrote.

Shoe made for OA walking
THE use of a “mobility shoe”, intended to mimic the biomechanical effects of barefoot walking, can result in significant reductions in knee loads in patients with medial compartment knee osteoarthritis (OA), according to a small study published in Arthritis & Rheumatism. The researchers, who included two of the mobility shoe inventors, wrote that the research suggested use of flat, flexible footwear resulted in significant reductions in knee loading in subjects with OA. “By 24 weeks, there is evidence of a gait adaptation with sustained load reduction even when the mobility shoes are removed, suggesting that footwear may serve as a biomechanical training device to achieve beneficial alterations in gait mechanics for knee OA”, they wrote. The research included 12 men and women with medial compartment knee OA with a mean age of 57±10 years. The authors wrote that over 6 months, the mobility shoes were associated with significantly decreased knee adduction moment and adduction angular impulse compared to participants’ “own shoes” at baseline.

Posted 15 April 2013

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