Screen for coeliac disease after diabetes diagnosis
AUSTRALIAN researchers have recommended children with type 1 diabetes should be screened for coeliac disease (CD) at diagnosis and again within 2‒5 years. A systematic review, published in Pediatrics, included nine longitudinal cohort studies involving 11 157 children and adolescents with 587 cases of biopsy-proven CD found during a median follow-up period of 10 years. CD was diagnosed in 218 of 546 (40%) children diagnosed with diabetes within 1 year, in 55% within 2 years and in 79% within 5 years. Two of the studies reported higher rates of CD in children aged 5 years and under at diabetes diagnosis. The researchers also found that the frequency of CD screening progressively decreased with increased diabetes duration. They wrote that the prevalence of CD varied from 1.6% to 9.7%, with a weighted pooled prevalence of 5.1%. “Incidence density at 1, 2, and 5 years of diabetes duration was 43.4, 32.8, and 20.1 per 1000 patients-years, respectively, indicating that the risk of CD is highest within the first year of diabetes duration”, they wrote. The researchers noted considerable variation in the prevalence of CD in the studies, which they said could be due to ethnic differences across the study populations, as well as the varying impact of environmental influences across different countries. The highest prevalence rate was in Sweden at 9.7%. The researchers wrote that it was also notable that 85% of cases in the review presented asymptomatically. “The contemporaneous diagnosis of both conditions most likely describes the diagnosis of preexisting CD not previously recognized and may reflect the high background risk of the population studied”, they wrote. “Although CD can be diagnosed beyond 10 years after diabetes diagnosis, more research is required to establish the optimal screening frequency beyond 5 years of diabetes duration as well as the optimal screening frequency in adults with [type 1 diabetes].”
Strong family connection with tic disorders
TIC disorders are among the most heritable neuropsychiatric conditions, according to research published in JAMA Psychiatry, which found the disorders were strongly familial within the Swedish population. The population, multigenerational family cohort study identified 4826 individuals (76.2% male) diagnosed as having Tourette syndrome and chronic tic disorders in the Swedish National Patient Register between 1969 and 2009. The risk for tic disorders among relatives of those with tic disorders increased proportionally to the degree of genetic relatedness, with first-degree relatives having a significantly higher risk than for second-degree and third-degree relatives. The heritability of tic disorders was estimated to be 77%. The authors also noted the limitations of their research because it was based on register data. “Together with the previous family and twin literature, largely derived from clinical samples of European origin, our data confirm that tic disorders run in families primarily because of genetic factors”, they wrote.
Little pain benefit from knee surgery
ARTHROSCOPIC surgery for knee pain and degenerative knee disease in middle aged and older patients is associated with inconsequential benefits and potential harms, according to research published in The BMJ. The systematic review included nine studies of 1270 patients that assessed the benefits of arthroscopic surgery, including surgery with partial meniscectomy, debridement or both, compared with a variety of control treatments, which ranged from placebo surgery to exercise. The patients were aged 49.7‒62.8 years and follow-up time was 3‒24 months. The authors said that overall, surgery was associated with a small but statistically significant effect on pain at 3 and 6 months compared with control treatments. However, no pain benefit was observed at any later time points, and there was no significant benefit on physical function. In another nine studies reporting on harms, deep vein thrombosis was the most frequently reported adverse event from surgery. Other harms included infection, pulmonary embolism and death. The authors found the overall additional benefit on pain from arthroscopic surgery was comparable to the small pain relieving effect on knee pain seen from paracetamol, less than that of non-steroidal anti-inflammatory drugs and markedly smaller than the moderate-to-large pain relieving effect from exercise therapy as treatment for knee osteoarthritis. They said their review did not support the practise of arthroscopic surgery for middle aged or older patients with knee pain, with or without signs of osteoarthritis. An accompanying editorial said the review was a step towards the tipping point “where the weight of evidence against arthroscopic knee surgery for pain is enough to overcome concerns about the quality of the studies, confirmation bias, and vested interests”. Once that point was reached “we should anticipate a swift reversal of established practice”, the editorial said.
Sedentary behaviour linked to anxiety
SEDENTARY behaviour (SB) has been linked to an increased risk of anxiety in a meta-analysis conducted by Australian researchers and published in BMC Public Health. The review was based on nine observational studies (seven cross-sectional and two longitudinal) that investigated the association between SB and risk of anxiety. It found moderate evidence for a positive relationship between total SB and anxiety risk as well as for a positive relationship between sitting time and anxiety risk. Evidence for the relationship between screen time, television viewing time, computer use and anxiety risk was inconsistent. The researchers wrote that two of the studies included children/adolescents and seven included adults, with one longitudinal study examining adolescents with follow-up conducted during adulthood. Most studies were based on self-report methods. They said it was important to better understand the relationship between SB and anxiety as this information could help to develop lifestyle change strategies to reduce the risk of anxiety in different population groups. “It is clear from this review that the current body of evidence exploring the relationship between sedentary behaviour and risk of anxiety is limited”, they wrote. “This review further highlights the need for more high-quality longitudinal and intervention research to confirm and disentangle cross-sectional research findings.”
Better outcomes with robotic-assisted surgery
ROBOTIC-assisted cardiac surgery significantly reduces median length of stay in hospital, complications and mortality compared with non-robotic surgery, a US study has found. The research, published in JAMA Surgery, used national data to compare the results of patients who underwent cardiac operations involving the valves, septa and vessels, as well as other heart and pericardium procedures. They identified 1 374 653 cardiac cases between 2008 and 2011, which included 0.4% that were robotic assisted. The authors matched each robotic-assisted case with two non-robotic cases based on 14 patient characteristics. During the study period, the use of robotic-assisted surgery increased from 0.057% in 2008 to 0.390% in 2011. The authors found that robotic-assisted compared with non-robotic surgery had a higher median cost. However, robotic-assisted surgery was associated with a lower length of stay in hospital and significantly fewer complications for all operations types, which could lower the overall cost of robotic-assisted cases. The authors also found a significantly lower morality rate among patients who underwent robotic-assisted procedures, which they attributed to the improved visualisation by the surgeon using the robotic technology. They said their study indicated that “robotic-assisted surgery may be as safe as nonrobotic surgery and offers the surgeon an additional technique for performing cardiac surgery”. Further research was needed to show long-term benefits, including quality of life and pain scores associated with robotic-assisted operations, the authors said.
Chocolate deemed safe for cardiac patients
CULMULATIVE evidence suggests that a higher chocolate intake is associated with a lower risk of future cardiovascular events, according to research published in Heart. The authors conducted a prospective study based on 20 951 men and women living in Norfolk, UK, who were participating in the European Prospective Investigation into Cancer study (EPIC). Habitual chocolate intake was quantified with a food frequency questionnaire at baseline from 1993 to 1997, and cardiovascular end points were tracked to March 2008. A systematic review was performed to evaluate chocolate consumption and cardiovascular outcomes. The EPIC-Norfolk participants were followed up for a mean of 11.3 years, with 3013 people experiencing either an episode of fatal or non-fatal coronary disease, stroke or both (referred to as CVD). Among people who ate chocolate, the median intake was 7 g per day, and higher rates of consumption were associated with younger age and lower body mass index, lower waist-to-hip ratio, lower systolic blood pressure, lower prevalence of diabetes and more physical activity. Analysis showed higher chocolate consumption was associated with a statistically significant lower risk of CVD, and this association was stronger for CVD mortality than for total CVD (hospitalisation and mortality). Nine studies including 157 809 participants were included in their meta-analysis, which found that higher chocolate intake was associated with significantly lower coronary heart disease risk, stroke, composite cardiovascular adverse outcome, and cardiovascular mortality. The authors said their results were surprising given the expectation that the benefit of chocolate consumption would be mainly associated with dark chocolate rather than the products generally used in a British population, which were high in sugar and fat. “This may indicate that not only flavonoids, but also other compounds — possibly related to milk constituents, such as calcium and fatty acids — may provide an explanation for the observed association”, they wrote. The authors said there did not appear to be any evidence to suggest that chocolate should be avoided in those who are concerned about cardiovascular risk.

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