Lifestyle steps to uncomplicated pregnancy
A LARGE prospective cohort study of healthy nulliparous women, including from Australia, has identified targeted lifestyle interventions that could increase the likelihood of normal pregnancy outcomes. The research, published in the BMJ, included 5628 healthy nulliparous women having a singleton pregnancy, with 3452 (61.3%) experiencing an uncomplicated birth. The researchers identified factors at 15–20 weeks gestation associated with uncomplicated pregnancy, which included optimising weight, diet and cardiovascular fitness, and not using illicit drugs. “Our study suggests that adoption of these choices seems to be beneficial in determining subsequent uncomplicated pregnancy”, they wrote. They said one example was the possible benefits a 5 mmHg reduction in maternal systolic blood pressure, which would increase the proportion of uncomplicated pregnancies by 3.1% from 58.6% to 61.7%. “If it were achieved through lifestyle interventions to produce fitter, healthier women of reproductive age with lower blood pressure, there would be likely additional benefits (for example, on body mass index and glucose metabolism) that are difficult to quantify”, they wrote. Detrimental factors that were not amenable to alteration included a history of hypertension while using oral contraception, socioeconomic index, family history of any hypertensive complications in pregnancy, vaginal bleeding during pregnancy and increasing uterine artery resistance index. An accompanying editorial advised against over-interpreting the findings, saying it “is probably too early to calculate the potential numerical benefit of population approaches to modifying risk factors”.

COPD management gaps
A REPORT from the Australian Institute of Health and Welfare suggests pulmonary rehabilitation and long-term oxygen therapy (LTOT) are underutilised in managing patients with chronic obstructive pulmonary disease (COPD). However, the report admits the full extent of service provision, utilisation and underutilisation is not known as there are no national data. The report, from the Australian Centre for Asthma Monitoring, said COPD was a major cause of death and disability in Australia, with about one in 13 people aged 40 years and over having lung function consistent with a diagnosis of COPD. It said pulmonary rehabilitation and LTOT were the key non-pharmacological interventions recommended in national and international clinical guidelines. “The first step in developing and informing a monitoring approach that could be used to evaluate the effectiveness, efficiency, accessibility and quality of service provision is to decide what is important to monitor”, the report authors wrote. “This report has identified and defined several access and utilisation indicators that would be a useful basis for the evaluation of pulmonary rehabilitation services and LTOT therapies.”

Clinic vision tests questioned
ADULTS have better vision in clinics than at home, often due to poor home lighting, according to research published in JAMA Ophthalmology. The researchers said that doctors often assumed vision measured in the clinic was equivalent to vision at home, yet many patients reported visual difficulties greater than expected based on their test results. The research included 126 patients with and 49 without glaucoma (aged 55‒90 years) who underwent clinic and home visits, with several aspects of vision measured. The mean scores for all vision tests were better in the clinic than at home, with glaucoma patients reading two or more lines on an eye chart better in the clinic than at home and 39% of advanced glaucoma patients reading three or more lines better in the clinic. Participants in the clinic also tested better in near visual acuity and contrast sensitivity with glare. Lighting was the largest factor associated with difference in vision between the clinic and home, with home lighting below recommended levels for more than 85% of participants. “Clinician awareness of these results may ease confusion regarding inconsistencies between a patient’s stated visual difficulties and their clinical examination”, the researchers wrote. They said the results from the study “challenge the ecological validity of vision testing in the clinic and emphasize the importance of measuring vision in the home to accurately evaluate the visual function of older adults in their home”.

Obesity cardio risk factors identified
A LARGE pooled analysis of studies examining cardiovascular risk factors has found nearly half of excess risk for coronary heart disease (CHD) and three-quarters of excess risk for stroke due to obesity is mediated through three metabolic risk factors — blood pressure, cholesterol and glucose. The analysis, published in The Lancet and including Australian authors, found control of blood pressure and cholesterol might help to lessen the cardiovascular effects of the global obesity epidemic. The pooled data from 97 prospective cohort studies included 1.8 million participants enrolled between 1948 and 2005, with 57 161 coronary heart disease and 31 093 stroke events. By looking at the hazard ratios for CHD and stroke for increasing body mass index, with and without adjustment for cholesterol, blood pressure and serum glucose, the researchers found the most important risk mediator was blood pressure, especially for stroke, accounting for two-thirds of the excess risk. They wrote that leveraging the potential to control risk factors was needed “to continue past efforts for the reduction of blood pressure and cholesterol, and to try to replicate these efforts in Asia where blood pressure remains high, serum cholesterol has increased, and stroke is a common cause of death”. The researchers said reliance on control of the metabolic mediators might be only a partial and temporary response to the obesity epidemic. “Rather, creative and bold strategies are needed that can curb and reverse rising adiposity so that the full benefits for cardiovascular disease and diabetes reduction can be achieved”, they wrote.

Too much sport may be bad
RESEARCHERS have advised doctors to follow up on how much sport adolescent patients play after finding that too much sport can be as bad as too little. The research, published in Archives of Disease in Childhood, considered the wellbeing, based on the WHO-5 Well-Being Index, of 1245 adolescents aged 16‒20 years, with about half male and a mean age of 17.95 years. They were categorised into four groups of sport practice each week — low (0‒3.5 hours), average (3.6‒10.5), high (10.6‒17.5) and very high (more than 17.5). The recommended level for adolescents is around 7 hours a week. The researchers found those in the low and very high groups were at higher risk of poor wellbeing, with those in the high group having a lower risk than those in the average group. “In the absence of randomised trials assessing this specific question, this study provides the best evidence, to date, on the threshold over which sport duration apparently ceases to be a protective factor and becomes an independent risk factor for poor well-being”, the researchers wrote. “These results highlight the importance for physicians, caring for adolescents, to follow-up their level of sport practice and concurrently inquire about their well-being.”

Statins “neutral” on cognition
A SYSTEMATIC review published in Annals of Internal Medicine has identified low- to moderate-quality evidence that suggests statins have no effect on cognitive outcomes. The meta-analysis followed a US Food and Drug Administration (FDA) adverse event warning that statins could impair cognitive function. The review, which included 25 studies (three randomised controlled trials, 16 cohort, four case-control and two cross-sectional studies), found that among statin users, low-quality evidence suggested no increased incidence of Alzheimer disease and no difference in cognitive performance in procedural memory, attention or motor speed. Moderate-quality evidence suggested no increased incidence of dementia or mild cognitive impairment, and no change in cognitive performance related to global cognitive performance scores, executive function, declarative memory, processing speed or visuoperception. The researchers also examined FDA postmarketing surveillance databases and found a low reporting rate for cognitive-related adverse events with statins that was similar to the rates seen with other commonly prescribed cardiovascular medications. “Larger and better-designed studies are needed to draw unequivocal conclusions about the effect of statins on cognition”, the researchers wrote. “Published data do not suggest an adverse effect of statins on cognition; however, the strength of available evidence is limited, particularly with regard to high-dose statins.”

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