STI consequences for first-time mums
AUSTRALIAN researchers have found that first-time mothers with a prior history of chlamydia or gonorrhoea infection have an increased risk of spontaneous preterm birth (SPTB). The research, published in Sexually Transmitted Infections, also found that a history of chlamydia was associated with stillbirth, but neither infection was associated with small for gestational age (SGA) infants. The research, based on records for 354 217 NSW women who had a singleton birth during 1999–2008, and linked to chlamydia and gonorrhoea notifications, found 1.0% (n = 3658) had a prior chlamydia notification and 0.06% (n = 196) had a prior gonorrhoea notification. However, when chlamydia notification records were confined to those who were aged under 25 years between 2005 and 2008, notifications increased to 4.6%. More than 80% of notifications occurred before the estimated conception date. The data showed 4.1% of women had a SPTB, 12.1% had a SGA baby and 0.6% a stillbirth. The researchers wrote that there was some evidence to suggest that the mechanisms that trigger SPTB and stillbirth are related to chronic inflammation and it was known that chlamydia and gonorrhoea infection could lead to chronic inflammation of the upper genital tract. “SPTB and stillbirth have major consequences for the mother and the child and our study demonstrates that the number of births affected in a high-income country such as Australia is still substantial, with 4.1% of first-time mothers having a SPTB and 0.6% a stillbirth. Preventative strategies in the preconception period may be an important area for further research”, they wrote.
Polypill boosts medication adherence
A POLYPILL in a fixed-dose combination (FDC) to control blood pressure (BP), cholesterol levels and platelet activity in patients with or at high risk of cardiovascular disease (CVD) significantly improved medication adherence compared with controls, according to research published in JAMA. The randomised, open label, blinded end point trial included 2004 patients in India and Europe. At baseline, mean BP was 137/78 mmHg, low-density lipoprotein cholesterol (LDL-C) was 91.5 mg/dL, and 1233 (61.5%) of patients reported the use of antiplatelet, statin and two or more BP-lowering medications. The FDC strategy was a polypill containing either 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril and 50 mg atenolol or 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril and 12.5 mg hydrochlorothiazide. At the median follow-up time of 15 months, the FDC group had improved adherence (86%) vs usual care (65%) with concurrent reductions in systolic BP (− 2.6 mmHg) and LDL-C (− 4.2 mg/dL). The biggest benefits were in patients with lower adherence at baseline, with 77% adherence in this group (727 participants) at the end of study, systolic BP reduced by 4.9 mmHg and LDL-C reduced by 6.7 mg/dL. No significant differences in serious adverse events or cardiovascular events were found in either group. “These data suggest that FDCs could play a role in increasing uptake of statins, aspirin, and combination blood pressure-lowering drugs in patients with CVD not currently receiving such treatment”, the authors wrote. An accompanying editorial noted several limitations in the study and said the precise advantage of the FDC strategy remained largely unproven. “Another way to reduce the number of pills patients are taking is to eliminate those medications for which the benefits are marginal”, it said.
Topical corticosteroids safe in pregnancy
UK research published in JAMA Dermatology has found no association between maternal exposure to topical corticosteroids and birth abnormalities. The population-based study included 2658 pregnant women aged 15–44 years who received one or more dispensed prescriptions for topical corticosteroids during pregnancy (including 757 exposed during the first 12 gestational weeks) and 7246 unexposed women. The researchers wrote that the study reassuringly showed no associations of topical corticosteroid exposure with orofacial cleft, preterm delivery, fetal death, low Apgar score or mode of delivery. There was a small risk of low birthweight (LBW) from limited use of strong topical corticosteroids, but the risk increased with heavy maternal use of strong topical corticosteroids. “Therefore, for pregnant women with a skin condition, mild or moderate topical corticosteroids are the preferred treatments if indicated”, the researchers wrote. “When potent or very potent topical corticosteroids are needed, the amounts used should be kept to a minimum, and fetal growth should be monitored.” They said the risk of LBW significantly increased when the dispensed amount of potent or very potent topical corticosteroids exceeded 300 g, but the use of less than 200 g did not confer an increased risk. “The results provide additional evidence to support the previously published guidelines”, the authors wrote.
High-quality diet as effective as statins
THE importance of a high-quality diet in cardiovascular disease has been confirmed with a study showing it lowers all-cause mortality in patients who survive myocardial infraction (MI). The research, published in JAMA Internal Medicine, found that a high-quality diet was associated with 30% lower all-cause mortality and 40% lower cardiovascular mortality in MI survivors. The research included 2258 women from the Nurses’ Health Study and 1840 men from the Health Professionals Follow-up Study. Participants had survived an initial MI and completed a pre- and post-MI food frequency questionnaire, with diet quality measured using Alternative Healthy Eating Index 2010 (AHEI2010). The median survival time after initial MI onset was 8.7 years for women and 9.0 years for men. The greatest improvement of diet quality from pre- to post-MI was an increase in whole grain intake and a reduction in consumption of trans fat, and red and processed meat. Sugar-sweetened beverages and fruit juice had the lowest component score on the post-MI diet. An accompanying commentary said although more research was needed there was compelling scientific evidence to recommend better diet choices for patients to live longer and healthier lives. “Just reflect on this: the protective effects of the post-MI AHEI2010 on cardiovascular mortality in patients with highest adherence and of Mediterranean diets on total cardiovascular disease in high-risk … participants neared a 30% reduction: this is as powerful as the effect of statins, without the adverse effects or costs”, the commentary said.
Rehab helps frail elderly
A SYSTEMATIC review of the effects of physical rehabilitation on activities of daily living (ADL) among elderly residents of long-term care facilities has found a small benefit, but it was not clear which interventions were most appropriate. The meta-analysis, published in Age & Ageing, included 2379 participants (79% female) with a mean age of 84 years. Interventions included group exercise classes, resistance training, mobility training, balance training, flexibility exercises and ball games, either delivered by rehabilitation professionals or by carers and volunteers. Most were delivered two or three times weekly. The researchers said although they found only small improvements in independence in ADL, these could be considered worthwhile and meaningful. “It is plausible that the small effect found is one of maintenance of function, rather than improvement, in a population that tends to become increasingly frail and dependent”, they wrote. Studies with interventions of longer duration could identify a larger effect on independence in ADL. “We recognise that physical rehabilitation is sometimes intended to improve other outcomes not considered here, such as mental health, social interaction, mood and well-being”, the researchers wrote.
Asthma prevalent in menopausal women
RESEARCHERS have found “a striking pattern” of asthma hospitalisations among menopausal women in the US. The research, published in Annals of Allergy, Asthma & Immunology, was based on national inpatient data for a principal diagnosis of asthma from 2000 to 2010 to calculate the ratio of female to male hospitalisation rates for different decades of adult life. There were 3 063 045 asthma hospitalisations in the study period and 2 233 849 were females. The mean age was 54.5 years. The researchers wrote that the distinct peaking in female to male ratio most manifested in the fifth to sixth decades of life. Female sex was significantly associated with this age grouping, even after adjusting for obesity, chronic obstructive pulmonary disease, race, insurance status, discharge year and smoking. “The more than 2-fold higher hospitalization rate in women from the fourth through the sixth decade of life suggests that efforts for better asthma control could be more focused on this subgroup of asthmatic adults with potential national cost savings”, the researchers wrote.