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HIV counselling questioned
QUESTIONS have been raised about the validity of counselling patients having a rapid HIV test after researchers found it did not reduce the subsequent rate of sexually transmitted infections (STIs). The research, published in JAMA, included 5012 patients from nine sexually transmitted disease clinics in the US undergoing rapid HIV testing, who were randomly allocated to receive brief patient-centred HIV risk reduction counselling or information about the test only. The participants were assessed for STIs at baseline and at 6 months follow-up, when 250 of 2039 incident STI cases (12.3%) were detected in the counselling group and 226 of 2032 (11.1%) in the information-only group. “Given the lack of observed superiority in outcomes, counseling is an inefficient use of resources in this setting”, the researchers wrote. “Our average costs per rapid test were higher than previous estimates because of the inclusion of overhead costs and, for risk-reduction counseling, ongoing training and quality assurance activities.” An accompanying editorial recommended against counselling as part of routine practice. “In an era of shrinking resources, clinicians and policymakers cannot ignore data that inform efficient clinical practice”, it said.
Dementia screening questions
A SYSTEMATIC review has found that although screening for cognitive impairment can identify patients with dementia, there is no empirical evidence on whether it improves subsequent decision making. The research, published in Annals of Internal Medicine, reviewed 1190 articles but found no trials that directly assessed whether screening for cognitive impairment in primary care could affect decision making, patient or caregiver, or societal outcomes, and no studies that directly addressed the adverse psychological effects of screening or adverse effects from false-positive or false-negative test results. “Despite a large body of evidence spanning decades of research, it is still unclear whether [Food and Drug Administration]-approved medications, caregiver interventions, cognitive interventions, or exercise interventions in persons with earlier detected cognitive impairment have a clinically significant effect”, the researchers wrote. They said there was promising, but limited, evidence that cognitive stimulation and exercise was useful in people with mild to moderate dementia or mild cognitive impairment.
Pertussis vax working
VACCINATING adolescents against pertussis has been partially effective in reducing hospitalisations of infants with the disease in the US, according to research published in Pediatrics. Tetanus–diphtheria–acellular pertussis (Tdap) vaccination was recommended in 2006 for all adolescents, recognised as a known source of pertussis in infants and, by 2011, 78% had been immunised. The researchers found that in 2000 the hospitalisation rate for infants with pertussis was 5.82 discharges per 10 000 infants, with significantly lower than expected rates in 2008, 2009 and 2011, but in 2010 the observed and expected rates were not significantly different. “Our findings suggest the possibility of a reduced burden of pertussis severe enough to warrant hospitalization among infants but not consistent enough to mitigate hospitalizations for infantile pertussis in 2010, the first peak year of pertussis incidence after Tdap was first recommended”, the researchers wrote. “Infection with pertussis can result in life-threatening and sometimes fatal illness for young infants.” They said rates of vaccination among adolescents needed to improve and that adults should also be vaccinated to prevent hospitalisation of infants on a more consistent basis.
Exercise boosts academic performance
MODERATE-vigorous intensity physical activity (MVPA) has been associated with higher academic achievement in adolescence in a population-based study published in the British Journal of Sports Medicine. The research, from an ongoing population-based study investigating a wide range of influences on health and development of children, found that MVPA at age 11 years was associated with higher subsequent academic attainment at ages 13 and 16 years, after controlling for total volume of physical activity and independent of a range of confounders. “This was true across all academic subjects, and all time points with some evidence for a dose response effect”, the researchers wrote. Evidence for a dose-response effect was found in males, with those doing the most MVPA having a higher predicted academic attainment at age 16 than those doing the least MVPA; with a similar pattern found with females. “The findings have implications for public health and education policy by providing schools and parents with a potentially important ‘stake’ in meaningful and sustained increases in physical activity”, the authors wrote.
Tapering regimen helps opioid users
A RANDOMISED double-blind trial has found a meaningful subset of prescription opioid users respond favourably to a brief but carefully crafted outpatient treatment involving buprenorphine detoxification, naltrexone maintenance and behavioural therapy. The results of the trial, published in JAMA Psychiatry, involved 70 opioid-dependent adults randomly assigned to 1-week (n = 24), 2-week (n = 24), or 4-week (n = 22) buprenorphine tapering regimens and subsequent naltrexone therapy. The researchers found the 4-week taper produced superior outcomes over briefer durations, saying 50% of participants were retained, abstinent and receiving naltrexone at the end of the study compared with 17% and 21% for the 2- and 1-week groups, respectively. “Additional controlled studies are needed to better understand the parameters of efficacious treatments for [prescription opioid] dependence, as well as to identify the individuals for whom brief vs longer term treatments are warranted”, they wrote.