Contraceptive guide for 40+ women
A REVIEW of the contraceptive needs of women over the age of 40 years published in CMAJ says that despite declining fertility, effective contraception is still needed to avoid pregnancy and that no single method is contraindicated by age alone. The authors recommended non-hormonal and progestin-only methods as safe options for women who should avoid contraceptives containing oestrogen. They also advised that menopausal status and lack of need for contraception could be assumed at age 55 years for women using hormonal contraceptives. The review of the risks and benefits of contraceptive methods for women aged over 40 was based on guidelines that used systematic reviews. The authors said their research raised several important questions about contraception for women in this age group that needed further investigation. “With the advent of newer contraceptive methods, such as the patch and vaginal ring, more information is needed on their noncontraceptive benefits”, they wrote.
AF–cognitive decline link confirmed
A META-ANALYSIS published in the Annals of Internal Medicine has been described by its authors as the most comprehensive evidence to date on the potential effects of atrial fibrillation (AF) on cognitive impairment. The researchers said the study also highlighted “critical gaps in our knowledge about the mechanisms underlying the association between AF and cognitive impairment”. The analysis included 21 prospective and non-prospective studies reporting adjusted risk estimates for the association between AF and cognitive impairment. It found a significant association between AF and cognitive impairment or dementia independent of stroke in patients with first-ever or recurrent stroke and in a broader population including patients with or without a history of stroke. “Restricting the analysis to dementia outcomes, which are more accurately diagnosed than cognitive impairment, eliminated the heterogeneity but did not change the significance of the association”, the authors wrote.
Anti-TNF therapy does not raise shingles risk
A LARGE US study has shown that patients with rheumatoid arthritis and other inflammatory diseases who take anti-tumour necrosis factor (anti-TNF) therapy are not at increased risk of shingles compared with patients using non-biologic disease-modifying anti-rheumatic drug (DMARD) therapies. The results, published in JAMA, included more than 59 000 patients who were either new users of TNF antagonists or patients initiating new non-biologic DMARDs. The researchers also detected no significant difference in shingles risk between etanercept and the monoclonal antibodies infliximab and adalimumab. Among the 33 324 new users of anti-TNF therapy the researchers identified 310 cases of shingles. Crude incidence rates among anti-TNF users were 12.1 per 1000 patient-years for rheumatoid arthritis, 11.3 per 1000 for inflammatory bowel disease, and 4.4 per 1000 for psoriasis, psoriatic arthritis, or ankylosing spondylitis. Patients with rheumatoid arthritis had similar adjusted incidence rates between anti-TNF and non-biologic DMARD initiators and comparable rates between the three anti-TNF therapies studied.
ADHD long term and chronic problem
RESEARCHERS in the US say attention deficit hyperactivity disorder (ADHD) should no longer be viewed as a disorder primarily affecting the behaviour and learning of children, but as a major health condition with increased risk for early death. In a prospective study, published in Pediatrics, the researchers found that childhood ADHD was a chronic health problem, with significant risk for mortality, persistence of ADHD and long-term morbidity in adulthood. Of the 232 childhood ADHD cases in the prospective assessment (mean age 27.0 years), ADHD persisted into adulthood for 29.3%. Adults who had childhood ADHD were more likely than the 335 controls (mean age 28.6 years) to have one or more other psychiatric disorders (56.9% vs 34.9%). The researchers said the results had important implications in meeting the needs of individuals with ADHD across the lifespan. “It is concerning that only a minority of children with ADHD reaches adulthood without suffering serious adverse outcomes, suggesting that the care of childhood ADHD is far from optimal. Our results also indicate that clinicians, insurers, and health care systems must be prepared to provide appropriate care for adults with ADHD”, they wrote.
HIV a significant heart risk
HIV-positive men have a significantly higher risk of acute myocardial infarction (AMI) than demographically and behaviourally similar uninfected men, even after adjustment for Framingham risk factors, comorbidities and substance use, according to a large cohort study published in JAMA Internal Medicine. The study authors said infection with HIV was associated with a 50% increased risk of AMI “beyond that explained by recognized risk factors”. They said although the results were consistent with prior studies, their analyses was “more definitive”. They analysed data on 82 459 participants with a median follow-up of 5.9 years. During that period there were 871 AMI events. Across all age groups, the mean AMI events per 1000 person-years was consistently and significantly higher for HIV-positive men compared with uninfected men. In those aged 40–49 years there were 2.0 events in HIV-positive men compared with 1.5 in uninfected men; 3.9 vs 2.2 for those aged 50–59 years, and 5.0 vs 3.3 in those aged 60–69 years. An accompanying commentary said the 50% increased risk of MI highlighted “the need for further research in women, research into the underlying mechanisms of the increased risk, and the development of specific interventions to reduce the risk of MI in HIV-positive populations”.
Murder risk for mentally ill
PEOPLE with mental disorders are at increased risk of being the victims of murder according to research published in the BMJ. Swedish and US researchers assessed mental disorders and homicides in more than 7 million Swedish adults between 2001 and 2008 and found 23% of 615 murders were among people with mental disorders — a 4.9-fold increased risk compared with people without mental disorders after adjusting for sociodemographic confounders, including being male, unmarried and of low socioeconomic status. The researchers found that although the risk of homicidal death was highest among people with substance use disorders (approximately ninefold), the risk was also increased with personality disorders (3.2-fold), depression (2.6-fold), anxiety disorders (2.2-fold), or schizophrenia (1.8-fold). An accompanying editorial said that a key implication of the findings was that clinicians should “assess risk for the full array of adverse outcomes that may befall people with mental health problems”.
Posted 11 March 2013