Bipolar increases birth risks
BABIES born to women with bipolar disorder have increased risks of preterm birth, irrespective of whether the mother had received mood stabilising drugs, according to research published in the BMJ. Swedish researchers used data from three national health registers to identify 320 mothers with treated bipolar disorder and 554 untreated mothers, who were compared with 331 263 other women who gave birth between 2005 and 2009. Both treated and untreated mothers with bipolar disorder had increased risks of caesarean delivery, instrumental delivery and a non-spontaneous start to delivery compared with other women. Untreated mothers were also more likely to give birth to a baby with microcephaly and with episodes of neonatal hypoglycaemia. An accompanying editorial said women with bipolar disorder must be properly counselled about the risks of treatment versus untreated psychiatric disorder, and that doctors should “encourage and facilitate social integration, especially for women from disadvantaged social groups and those who are isolated”.

Call to evaluate statin cancer benefits
RESEARCHERS have called for a prospective evaluation of the hypothesis that statin use prolongs the survival of patients with cancer after finding a 15% reduction in cancer-related mortality among patients who were taking statins when their cancer was diagnosed. The research, published in the New England Journal of Medicine, was based on mortality among nearly 300 000 Danish patients diagnosed with cancer between 1995 and 2007, who were followed up in 2009. The reduced cancer-related mortality in the 18 721 patients taking statins compared with those who never used statins was observed in each of 13 cancer types. An accompanying editorial said it would be useful to examine the results of existing statin trials to determine the agent, dose and duration of follow-up needed for “an efficient, powerful and convincing study of this important public health question” of whether statins were linked to cancer mortality.

Angioedema consensus
AN international consensus document on hereditary and acquired angioedema has been released, based on improved understanding of hereditary angioedema (HAE) and the recent introduction of five HAE-specific drugs. The International Collaboration in Asthma, Allergy and Immunology released the consensus to promote communication about the diagnosis and management of angioedema globally. The consensus document focuses on angioedema occurring without concomitant hives, and concentrates primarily on C1 inhibitor deficiency syndromes. It says elucidating the cause of angioedema involves a detailed history, careful physical examination and appropriate laboratory testing. Standard angioedema treatment modalities such as epinephrine, corticosteroids or antihistamines are not recommended, with the consensus recommending five new drugs. The consensus document recommends public health initiatives including educational programs for the public and health care professionals, improved access to laboratory tests, comprehensive access to evidence-based therapies and expanded activities by patient support groups to reach out to health care providers and affected patients and their families.

Exercise benefits in Parkinson disease
RESEARCHERS have called for further investigation into the benefits for patients with Parkinson disease of combined treadmill and resistance exercise. In a randomised clinical trial of three types of exercise by 67 patients with Parkinson disease, published in Archives of Neurology, the researchers found that exercise improved muscle strength, gait speed and fitness, Of the three types of exercise — lower- and higher-intensity treadmill, and stretching and resistance exercises performed three times a week for 3 months — lower-intensity treadmill was the single most effective training exercise for gait speed. Both the higher and lower-intensity treadmill exercises improved cardiovascular fitness, and only the stretching and resistance exercises improved muscle strength. However, lower-intensity treadmill exercise was the most feasible for patients with Parkinson disease, which had important implications for clinical practice, the researchers said. They said the combination of treadmill and resistance exercises may result in greater benefit and required further investigation. An accompanying editorial said exercise “puts the patient — not a pill — at the center of care, which is exactly where patients want and ought to be”.

Smokers light up in hospital
AN observational study of smokers admitted to a smoke-free hospital found that nearly one-fifth admitted to smoking during their hospital stay. The study, published in Archives of Internal Medicine, involved counsellors who visited and followed up 2185 smokers admitted to a Massachusetts hospital. Smoking at any time during the hospitalisation was reported by 18.4% of patients who were smokers, but less often during winter. The researchers said prescribing nicotine replacement therapy routinely at admission and ongoing monitoring of patients’ cigarette cravings might reduce smoking among admitted patients. They also recommended expansion of smoke-free policies to cover the entire hospital campus as a possible way to “improve patient safety, hospital efficiency, and clinical outcomes for hospitalized smokers”. An accompanying commentary said there was likely to be increasing regulatory pressure on hospitals to “do the right thing and help smokers quit”.

Offspring problems not due to mum smoking
SMOKING during pregnancy is not a causal influence on substance use and substance-related problems in offspring, according to research published in Archives of General Psychiatry. The researchers analysed prospective data from 6904 adolescents in the US and more than 1.1 million adolescents born in Sweden during a 13-year period, which showed familial background factors were more likely to be associated with substance use and problems. The same pattern emerged for each index of substance use and problems across the two samples. The researchers said their findings were consistent with a growing body of research on maternal smoking during pregnancy, which strongly suggested familial background factors were responsible for increased risk of childhood conduct problems, attention-deficit/hyperactivity disorder, lower intellectual abilities and academic achievement, suicidal behaviour, and adolescent and young adult criminality. They said this suggested that solely reducing maternal smoking during pregnancy might not ameliorate offspring cognitive, social, behavioural or drug problems.

Posted 12 November 2012

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