Bowel cancer screening numbers fall
A REPORT released last week by the Australian Institute of Health and Welfare (AIHW) shows that of 930 000 people invited to participate in the 2011–2012 National Bowel Cancer Screening Program, 35% returned a completed kit for analysis. The participation rate was slightly lower than for the previous monitoring period of 2008–2011. A pause in the program between January and June 2011 leading to uncertainty about whether the program would continue and reduced participant confidence was blamed for the lower rate. The latest report said about 22 500 (7%) who returned a valid test had a positive result. Of these, 72% had a colonoscopy, with a confirmed (68 participants) or suspected (336 participants) cancer diagnosis, and an advanced adenoma was found in 857 participants. Women were more likely to participate in the program than men, but men had higher overall rates of bowel cancer. Commenting on the AIHW report, the Cancer Council said the drop in the number of Australians screening for bowel cancer underscored why an implementation plan for the National Bowel Cancer Screening Program should be a federal election issue.

Benefits in delayed cord clamping
A COCHRANE review by Australian researchers has found that delaying clamping of the umbilical cord of healthy full-term babies leads to improved outcomes such as higher birthweight, early haemoglobin concentrations and increased iron reserves up to 6 months of age. The systematic review published in The Cochrane Library found these benefits had to be balanced against a small increased risk of jaundice. The review, which included 15 trials and involved 3911 women and infant pairs, found no significant differences between early and late clamping (defined as clamping more than one minute after the birth or when cord pulsation had ceased) on neonatal mortality or on most neonatal morbidity outcomes, such as an Apgar score of less than seven at 5 minutes or admission to the special care nursery or neonatal intensive care unit. Mean birthweight was significantly higher for infants in the late cord clamping group compared with early clamping. Haemoglobin concentration in infants at 24–48 hours was significantly lower in the early cord clamping group, although this difference was not seen at subsequent assessments. However, improvement in iron stores appeared to persist, with early cord clamping infants more than twice as likely to be iron deficient at 3–6 months compared with infants whose cord clamping was delayed. The WHO recommends clamping 1–3 minutes after birth. In the past, as part of an active management strategy, the umbilical cord was usually clamped in the first 30 seconds after birth, regardless of whether the cord pulsation had ceased.

Review confirms statin safety
A SYSTEMATIC review published in Circulation: Cardiovascular Quality and Outcomes has found that adverse outcomes from statin therapy are not common. The review included 55 placebo-controlled and 80 active-comparator trials involving 246 955 individuals. The researchers found no differences between individual statins and controls for discontinuation of medication due to adverse events, myalgia, creatine kinase elevation and cancer. However, statins as a class resulted in significantly higher odds of diabetes (odds ratio [OR], 1.09; 95% CI, 1.02‒1.16) and transaminase elevations (OR, 1.51; 95% CI, 1.24–1.84) compared with controls. The researchers also found that there were numerous statistically detectable differences in the trials favouring simvastatin and pravastatin. “This meta-analysis sheds new light on the discussion on the relation between statins and diabetes incidence and confirms that statin use is not associated with cancer incidence”, the researchers wrote. “… we acknowledge the complex nature of making prescribing decisions and urge prescribers to consider the findings of this analysis in light of the comparative benefit profiles of individual statins in preventing all-cause mortality in addition to cardiovascular and cerebrovascular events.”

Hospitalisations drop after pneumococcal vax
THE introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000 has been credited with a 43.2% annual decline in hospitalisations for childhood pneumonia in the US. Research published in the New England Journal of Medicine found that the annual rate of hospitalisation for pneumonia among children aged younger than 2 years declined by 551.1 per 100 000 children, which translated to 47 000 fewer annual hospitalisations than expected based on the rates before PCV7 was introduced. The researchers found there had been more modest and slower relative declines in hospitalisations for pneumonia among older adults. Rates for 18–39-year-olds declined by 8.4 per 100 000, 65–74year-olds by 85.3 per 100 000 and 75–84-year-olds by 359.8 per 100 000. However, rates for those aged 85 years or older declined by 1300.8 per 100 000, which translated to 73 000 fewer annual hospitalisations. “Overall, we estimated an age-adjusted annual reduction of 54.8 per 100,000 (95% CI, 41.0 to 68.5), or 168,000 fewer hospitalizations for pneumonia annually”, the researchers wrote. They said substantial reductions in rates of childhood pneumonia had also been reported in other countries after the introduction of PCV7. “In Australia, a time-series analysis showed reductions of 38% and 29% in pneumonia among children younger than 2 years of age and those 2 to 4 years of age, respectively, within 2 years after the introduction of the vaccine in 2005.”

Preterm birth link to abortion disappears
SCOTTISH research has found that an association between spontaneous preterm delivery and previous termination progressively declined between 1984 and 1999, and was no longer present from 2000 to 2008. The research, published in PLOS Medicine, also found that the proportion of surgical terminations without use of cervical pretreatment decreased from 31% in 1992 to 0.4% in 2008, while the proportion of medical terminations increased from 18% to 68% over the same period. An accompanying editor’s summary said the results suggested that surgical termination without cervical pretreatment was responsible for the increased risk of spontaneous preterm birth in subsequent pregnancies. However, the author warned that the researchers could not directly test whether the two trends were linked due to missing data on termination methods linked to subsequent birth outcomes for individual women. Still, “it is possible that using modern methods of termination of pregnancy (rather than purely surgical methods) could be a factor in reducing global rates of spontaneous preterm delivery in the future”.

Privacy warning for online searches
PATIENTS and physicians concerned about the privacy of their health-related online searches should confine themselves to government or professional societies’ websites, says a Californian researcher in a research letter published in JAMA Internal Medicine. The researcher visited 20 popular health-related websites between December 2012 and January 2013 using the key words “depression”, “herpes” and “cancer”. Using freely available privacy tools to detect third parties he found all sites had at least one third-party element, with typically six or seven on the sites. Thirteen sites had one or more tracker elements but no tracking elements were found on physician-oriented sites closely coupled to professional groups. Seven of the websites leaked information to the third-party tracking entities. The researcher recommended the use of free privacy tools such as DoNotTrackMe and Ghostery. “Failure to address these concerns [via legislation and regulation] may diminish trust in health-related websites and reduce the willingness of some people to access health-related information online”, the author warned. “Until strong consumer privacy legislation is enacted, individuals should take care how much trust they place in their anonymity and the confidentiality of their information when online.”


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