Big jump in pertussis testing
PATIENTS presenting to an Australian GP in the 12 months to March 2011 were seven times more likely to have been tested for pertussis than 10 years earlier, according to research published in the MJA. The researchers said their data suggest that increased testing, which was most likely due to expanding use of polymerase chain reaction (PCR) testing during the study period, “has almost certainly amplified the magnitude of notified pertussis activity in Australia”. The research was based on an analysis of Australian general practice encounters from the Bettering the Evaluation and Care of Health program on 13 “pertussis-related problem” (PRP) codes that were most likely to result in a pertussis laboratory test request, and Australian pertussis notifications data from the National Notifiable Diseases Surveillance System from April 2000 to March 2011. The researchers found that the proportion of PRP encounters resulting in a pertussis test request increased from 0.25% between April 2000 and March 2004 to 1.71% between April 2010 and March 2011. “This increase in testing might have led to identification of illness that would have otherwise gone undetected among age groups in which pertussis circulates widely or age groups in which pertussis had previously been largely left as a clinical diagnosis”, the researchers wrote. They said the findings had global implications, particularly for countries with high or expanding PCR availability. The findings also highlighted “the critical importance of analysing changes in infectious diseases using a range of surveillance systems” to determine whether increases in notifications for diseases such as pertussis were due to a true increase in disease, an increase in testing, or a combination of both.

Use of drugs in pregnancy ignored
AN editorial in the Drug and Therapeutics Bulletin has called on the pharmaceutical industry and medical regulatory bodies to improve information about the use of drugs in pregnancy, saying that a new approach is needed “so that we are not always saying ‘no’ or ‘don’t know’ to pregnant women who need medication”. The editorial said that indirect maternal deaths in the UK due to a new or pre-existing medical or mental health problem aggravated by pregnancy had almost doubled in the past 20 years, exceeding direct maternal deaths by 50%. “The leading causes include cardiac conditions, neurological disorders, sepsis, thromboembolism and mental health problems. Yet it is clear that prescribing of, and adherence to, medication in pregnancy can be poor; many patients being wary of taking medicines when there is so little published evidence on the risks and benefits”, the editorial said. “More input is needed from the pharmaceutical industry and medicine regulatory bodies with greater emphasis on research, registry data collection, wider availability of information, increased integration of information sources and the development of shared-decision aids for patients and healthcare professionals. Pregnancy is a natural state that has been ignored by the pharmaceutical industry for too long.”

Hearing loss linked to more hospitalisation
US researchers have found that in adults aged 70 years or older, hearing loss is independently associated with hospitalisation and poorer self-reported health. In a research letter published in JAMA, the researchers used data from the US National Health and Nutrition Examination Survey to compare individuals with normal hearing (n = 529) with those with hearing loss (n = 1140). Those with hearing loss were more likely to be older (mean age: 74.7 v 77.0 years), male, white, less educated, in lower income households, with a positive history for cardiovascular risk factors and a history of hospitalisation in the previous year (18.7% v 23.8%), and to have had more hospitalisations. When accounting for demographic and cardiovascular risk factors, hearing loss was significantly associated with any hospitalisation, number of hospitalisations, and more than 10 days of self-reported poor physical or poor mental health. “Future economic analyses may need to take into account these potential broader implications of [hearing loss] on the health and functioning of older adults”, they wrote.

Orthopaedic role in domestic violence
ORTHOPAEDIC fracture clinics are key to the identification of women subjected to severe intimate partner violence (IPV) who could be at increased risk of further injury and homicide, according to the authors of a multinational cross-sectional study, published in The Lancet. The research, which included 12 orthopaedic clinics in five countries, found that one in six women (455/2839) presenting to orthopaedic clinics disclosed a history of IPV within the past year, and one in three (882/2550) had experienced IPV in their lifetime. It found that 49 women (1.7%) attended a clinic as a direct consequence of IPV, yet only seven of these had been asked about IPV in a health care setting. The researchers said it could be argued that the severity of physical abuse among women presenting to orthopaedic clinics was higher than that seen in other specialties, such as in general practice and emergency medicine. An accompanying commentary by Associate Professor Kelsey Hegarty, of the General Practice and Primary Health Care Academic Centre in Melbourne, said the “important and comprehensive study should help orthopaedic clinicians to realise that they should suspect and ask about intimate partner violence if clinical indicators are present”.

Liver transplant outcomes improve for children
THE use of partial deceased donor (DD) liver transplantation in infants and young children is becoming less risky, with outcomes now comparable to whole liver transplantation, according to research published in Liver Transplantation. The researchers analysed 2679 first-time DD liver-alone recipients under the age of 2 years from 1995 to 2010, including 1114 DD partial livers and 1565 DD whole organs. They found that while there were significant differences in crude graft survival by graft type in 1995–2000, graft survival between partial and whole grafts was comparable by 2001–2005. The hazard ratios for partial graft failure and mortality were 1.40 (1.05–1.89) and 1.41 (0.95–2.09) respectively in 1995–2000, but became comparable in 2006–2010. “Infants continue to have the highest mortality rate on the liver waitlist”, the researchers wrote. “While this mortality rate has improved over time, it remains almost twice that of adult recipients. As size matched whole livers remain a scarce resource, maximizing the use of partial livers from both deceased and living donors will be the key to decreasing this high mortality rate.”

Dementia linked to hypos in diabetes
A PROSPECTIVE study of older adults with type 2 diabetes, published in JAMA Internal Medicine, has provided evidence for a bidirectional association between severe hypoglycaemia and dementia. Of the 783 study participants followed for a 12-year period, 61 (7.8%) reported a hypoglycaemic event and 148 (18.9%) developed dementia. Those who had a hypoglycaemic event had a twofold increased risk for developing dementia compared with those who did not (34.4% v 17.6%). Those who developed dementia had a greater risk for having a subsequent hypoglycaemic event compared with participants who did not develop dementia (14.2% v 6.3%). The association remained even after adjustment for age, sex, educational level, race/ethnicity, comorbidities and other covariates. “Hypoglycemia may impair cognitive health, and reduced cognitive function may increase the risk for a hypoglycemic event that could further compromise cognition, resulting in a detrimental cycle”, the authors wrote. “Cognitive function should be considered in the clinical management of older individuals with [diabetes].” An accompanying commentary said that insisting on lower targets for HbA1c in older patients “requires high-quality evidence that the benefits exceed the harms, costs, and burden”.

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