HPV vax coverage “remarkable”
AN assessment of the Australian National HPV (human papillomavirus) Vaccination Program has found 70% of 12–17-year-old girls are completely vaccinated, which it described as a “remarkable achievement”. The research, published in the MJA, measured HPV vaccine coverage by dose, age and state of residence. It found 83% of girls had received the first dose of the vaccine, 78% the second dose and 70% the third dose. The only group not achieving high rates of coverage were Indigenous girls in Queensland. The researchers said that the requirement to rapidly implement the HPV program had been challenging, yet the coverage achieved in adolescents through the predominantly school-based catch-up program “represents a remarkable achievement”. “Combined with the coverage achieved in the 18–26-year-old catch-up cohort, at least half of Australia’s females who were aged 12–26 years on 30 June 2007 are fully vaccinated”, they wrote. “This significant and rapidly achieved coverage has been correlated with a marked decline in genital warts, vaccine-type HPV prevalence and high-grade cervical disease in young women.” The researchers said identifying barriers to completing the three-dose program was important and that research was ongoing. “Hopefully the expansion of the program to include males will normalise receipt of HPV vaccination as just a routine part of the vaccination schedule”, they wrote.

Many trial results unpublished
MORE than 25% of large randomised clinical trials registered with ClinicalTrials.gov have not published any results in medical literature or in the registry database, according to research published in the BMJ. The researchers examined 585 registered trials with at least 500 participants and which had been completed by 2009. They found 171 trials with a total of almost 300 000 participants had not been published. Industry-sponsored trials were the most likely to remain unpublished. Of unpublished trials, 78% had no results available in ClinicalTrials.gov. For trials where the recruitment status was listed as “completed”, 26% (132/513) remained unpublished, and 29 trials were described as “active, not recruiting”; with 10 of these unpublished. The BMJ authors said trial investigators and sponsors had an ethical obligation to study participants to publish trial results. “The lack of availability of results from these trials contributes to publication bias and also constitutes a failure to honor the ethical contract that is the basis for exposing study participants to the risks inherent in trial participation”, they wrote. “Additional safeguards are needed to ensure timely public dissemination of trial data.”

Non-exercise activity worth doing
PROMOTING everyday non-exercise physical activity (NEPA) might be as important as recommending regular exercise for older adults, according to the authors of Swedish research published in the British Journal of Sports Medicine. They found a generally active daily life had important beneficial associations with cardiovascular health and longevity, regardless of regular exercise. The research involved 4232 people born in 1937 and 1938 whose NEPA and exercise habits were assessed from a self-administrated questionnaire, and cardiovascular health from physical examinations and laboratory tests. NEPAs included performing home repairs, cutting the lawn, car maintenance, taking bicycle rides, skiing, ice-skating, going hunting or fishing, and gathering mushrooms or berries. Participants were followed for an average of 12.5 years. The researchers found that those with high NEPA levels had a more preferable waist circumference, high-density lipoprotein cholesterol and triglycerides compared with those with low NEPA levels. Higher NEPA levels were also associated with significantly lower rates of metabolic syndrome, a lower risk of a first cardiovascular disease event and lower all-cause mortality. “As it is widely known that regular exercise has a major impact on health, these results have high clinical relevance”, the researchers wrote. “Our findings are particularly important for older adults, because individuals in this age group tend, compared to other age groups, to spend a relatively greater portion of their active day performing NEPA as they often find it difficult to achieve recommended exercise intensity levels.”

Online literature “difficult” for patients
A STUDY on the readability of online patient-focused literature specifically about ophthalmic diseases has assessed more than 80% of web pages as being “difficult”. The research, published in JAMA Ophthalmology, assessed the top 10 patient-oriented websites for 16 different ophthalmic diagnoses for readability, source (UK vs non–UK, not for profit vs commercial), and appropriateness for sight-impaired readers. The researchers used four validated readability formulas for the assessment. They found not-for-profit web pages were of significantly greater length than commercial web pages and UK-based web pages had slightly superior readability scores compared with non-UK web pages, depending on the readability formula used. Of all web pages evaluated, only 34% included the facility to adjust text size to assist visually impaired readers. The researchers said most online ophthalmic patient information, over a range of subspecialties, was written at a level above that which the average person can understand. “If online ophthalmic information for patients was readable at the recommended grade level, then there may be a number of benefits, including patient empowerment, increased understanding, and greater treatment compliance”, they wrote. “Although readability is only one aspect of how well a patient-oriented webpage may be comprehended, we recommend the use of readability scoring when producing such resources in the future.”

Skin disease a global burden
A SYSTEMATIC review of the global burden of disease has found an “enormous” burden of skin disease worldwide. The review, published in the Journal of Investigative Dermatology, included data from 1990 to 2010 for 187 countries, by age and sex. It found skin conditions were widespread, and among the most prevalent and disabling of diseases, resulting in a considerable loss of healthy life. The researchers, including from Australia, said the review showed many parameters determined the distribution of skin diseases, from genetic susceptibility to environmental factors, with social factors such as poverty, affluence, inequality, education and access to health care all playing an important role in the epidemiology of skin disease “These results confirm why, in all health settings, skin disease constitutes a major proportion of all diagnoses in primary care”, the researchers wrote. “It also affirms an urgent need for the inclusion of skin disease prevention and treatment in national and global health policies.” The researchers said that dermatologists should “prioritise the collection and analysis of epidemiological and disability data that allows comparison to be made with other diseases”. They also suggested dermatologists should “make known and disseminate widely” strategies to manage and control skin disease as an effective and necessary use of health resources.

Poverty impairs the brain
RESEARCHERS have found that exposure to poverty during early childhood impairs brain structure. The research, published in JAMA Pediatrics, included 145 preschool children who were assessed annually on psychosocial, behavioural and other developmental dimensions for 3–6 years before having a magnetic resonance imaging scan. The researchers found that living in poverty was associated with smaller white matter, cortical gray matter, and hippocampal and amygdala volumes measured at school age/early adolescence. “The effects of poverty on hippocampal volume were mediated by caregiving support/hostility on the left and right, as well as stressful life events on the left”, they wrote. The researchers said the study extended the data demonstrating the deleterious effects of poverty on child developmental outcomes. The findings also “add to and extend the literature underscoring the critical role of nurturance for childhood well-being”. This “further underscores the importance of high-quality early childhood caregiving, a task that can be achieved through parenting education and support, as well as through preschool programs that provide high quality supplementary caregiving and safe haven to vulnerable young children”, the researchers wrote. An accompanying editorial said that exposure to early life adversity “should be considered no less toxic than exposure to lead, alcohol, or cocaine, and, as such, it merits similar attention from public health authorities”.

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