Thyroid cancer diagnosis triples
US researchers have called for action to reduce overdiagnosis and overtreatment of thyroid cancer after an analysis revealed the incidence of the cancer had nearly tripled from 4.9 to 14.3 per 100 000 people over 3 decades. The analysis, published in JAMA Otolaryngology–Head & Neck Surgery, looked at secular trends in patients diagnosed with thyroid cancer from 1975 to 2009. The researchers wrote that almost the entire increase in cancer diagnosis was attributable to papillary thyroid cancer, from 3.4 to 12.5 cases per 100 000 population over the time period. In women, the absolute increase in thyroid cancer diagnosis was almost four times that of men. The mortality rate of 0.5 deaths per 100 000 people had been stable. The researchers wrote that the US seemed to have an “epidemic of diagnosis” of thyroid cancer. “A simple way that physicians could begin today [to approach this problem] would be to openly share with patients the uncertainty surrounding small thyroid cancers — explaining that many will never grow and cause harm to a patient — but it is not possible to know with certainty which ones fall into that category”, they wrote.
Video improves whole-body skin checks in older men
MEN who receive an information video along with written material are more likely than those receiving written material alone to present to their physician for a whole-body clinical skin examination (CSE), according to Australian research published in JAMA Dermatology. The video included information on the seriousness of melanoma diagnosis, risk factors and the increased risk for men aged 50 years and older. The study of men aged 50 years and older found that those receiving written information only were as likely as those receiving the video and written material to have received a CSE at the 7-month follow-up interview (53% vs 56% respectively). However, those in the intervention video group were more likely to self-report a whole-body CSE, as recommended in the video, rather than a partial or spot exam (35% vs 27% respectively). They were also more likely to have a follow-up exam, to have been diagnosed with a malignant neoplasm, and to have had surgical management of a lesion. The authors wrote that while CSE screening would “place a burden” on the health care system their results supported “implementing behavioural interventions to encourage skin awareness” in men aged 50 years and older. An accompanying editorial said the study was a “major contribution to the work of identifying efficacious and cost-effective interventions” which increased engagement in healthy behaviour.
In-home exercises improve hip fracture function
CLINICALLY important improvements in mobility in older adults after hip fracture can be achieved by using an in-home exercise program after formal rehabilitation, according to research published in JAMA. The randomised clinical trial included 232 older “functionally limited” patients who had completed traditional rehabilitation after a hip fracture. An intervention group were given functionally oriented exercises taught by a physical therapist and performed independently by the participants in their homes for 6 months. The control group received home and telephone-based cardiovascular nutrition education. The researchers found patients in the intervention group showed significant improvement relative to the control group for function, mobility and daily activity, which continued for another 3 months after the intervention ended. They wrote that the traditional approach to rehabilitation for hip fracture left many patients with long-term functional limitations that could be reduced with extended rehabilitation. “However, it is unlikely that additional months of highly supervised rehabilitation can be provided to patients with hip fracture”, they wrote. The intervention “may provide a more effective way for these patients to continue to exercise in their own homes”, they said.
Sedentary life critical to disability in seniors
A STRONG association has been found between sedentary behaviour and an increased risk of disability in people aged 60 years and older, regardless of their participation in moderate to vigorous physical activity. The researchers said the results, published in the Journal of Physical Activity and Health, were evidence that sedentary behaviour was a separate disability risk factor and not a synonym for inadequate physical activity. A sample of 2286 US seniors were assessed for physical activity using accelerometers. The average time spent sedentary in waking hours was 8.9 hours and 3.6% reported activities of daily life (ADL) disability. The authors wrote that the “odds of ADL disability were 46% greater for each daily hour spent in sedentary behaviour”. They said the results showed that if two women of the same age engaged in identical moderate to vigorous hours of activity, but one spent an additional hour each day being sedentary, the odds of ADL disability would significantly increase by 60%. The authors concluded that their findings supported the development of public health programs which encouraged older adults to decrease sedentary behaviour regardless of engagement in moderate or vigorous activity.
Ear drops most effective for acute otorrhea
ANTIBIOTIC–glucocorticoid ear drops are more effective for the treatment of uncomplicated acute otorrhea in children with tympanostomy tubes than oral antibiotics or observation alone, according to Dutch research published in the New England Journal of Medicine. A cohort of 230 children, aged 1–10 years was assigned to receive hydrocortisone-bacitracin-colistin eardrops (76 children), oral amoxicillin-clavulanate suspension (77) or initial observation (77). At 2 weeks follow-up, 5% of eardrop-treated children still had otorrhea, compared with 44% of the oral antibiotic group, and 55% of the observation group. Median duration of treatment was also reduced (4 days, 5 days and 12 days respectively). The authors wrote that the lower rates of otorrhea with topical treatment might be explained by the use of eardrops containing both antibiotics and glucocorticoids, as well as by assessing the treatment effect at 2 weeks, rather than at 1 week. However, they also acknowledged that the antibiotic-glucocorticoid eardrops used in the research were not widely available outside the Netherlands and France. The authors wrote that since the trial included children who could be treated across various health care settings “we believe our findings are applicable to children with uncomplicated acute tympanostomy-tube otorrhea presenting in either primary or secondary care”.
Clinical depression markers identified
TWO easily measurable factors — high depressive symptom scores and elevated early-morning cortisol levels — are markers for the development of major depressive disorder (MD) in boys and young men, research published in PNAS has found. Data from two cohorts of young people from UK schools were analysed and four subtypes of adolescents were defined based on elevated cortisol or the presence of depressive symptoms using the 33-item version of the Moods and Feelings Questionnaire. The researchers identified one high-risk group of boys (17% of the cohort) with both high depressive symptoms and elevated early-morning cortisol who had significantly increased odds of developing MD compared with the reference group (low morning cortisol, low depressive symptoms). In girls, higher depressive symptoms alone were found to be a risk factor. “This clinical finding emphasizes the need for new lines of sex-differentiated inquiry into mechanisms that lead to MD”, the authors wrote. “In terms of public mental health strategy, early detection and intervention of [high-risk] adolescent boys … in the population at large could be valuable for reducing the longer-term burden of mental illness.”