Youth violence might not be increasing
TEENAGERS are no more likely to carry or use weapons than they were a decade ago, according to a study from Victoria, published online in the MJA. Researchers compared population-based self-report surveys completed by Victorian secondary school students in 1999 (n = 8984) and 2009 (n = 10 273). Both surveys found 15.0% reported carrying a weapon in the past 12 months and about 7.0% reported attacking someone with intent to harm. “In contrast to media portrayals and reported trends in violent offences, rates of students carrying weapons and attacking others with intent to harm have not changed between 1999 and 2009. These findings underline the importance of having national population-based data to regularly monitor the rates of these and related behaviours among young Australians”, the authors concluded.

Fetal death a major risk for pregnant women with diabetes
PRE-existing diabetes in pregnant women increases the risk of fetal death by more than four times and infant death is almost doubled compared with the risks for pregnant women without diabetes, according to research published in Diabetologia. The researchers used data from several long-standing population-based registers in the north of England to investigate the association between pre-existing diabetes and the risks of fetal and infant death in singleton offspring without congenital anomalies. They found no difference in the prevalence of fetal death or infant death between women with type 1 or type 2 diabetes. Increased periconception HbA1c concentration above 49 mmol/mol (6.6%), prepregnancy retinopathy and lack of prepregnancy folic acid consumption were all independently associated with increased odds of fetal and infant death. The connection with retinopathy suggested long-term poor glycaemic control. The researchers found that the risk of fetal and infant death had remained “stubbornly persistent” for more than 20 years. “To achieve any reduction in the [relative risk] of stillbirth and infant death in women with pre-existing diabetes, the barriers to uptake of preconception care and adequate preparation for pregnancy must be urgently understood and addressed”, the researchers wrote.

GPs underestimate care benefits for advanced cancer
GP referral decisions and assessment of treatment benefits for patients with advanced cancer often deviate from expert opinion, according to Australian research published in Family Practice. The researchers used a self-administered postal survey which included vignettes designed to portray different advanced cancer situations that were potentially suitable for palliative treatment (surgery, chemotherapy and/or radiotherapy). An expert team of a palliative care specialist, two radiation oncologists and two GPs were asked to review all 56 scenarios to produce an expert consensus about referral and the potential benefits for each treatment modality. Most of the 407 GP respondents were likely to refer patients presenting with advanced cancer for palliative treatment. GPs often chose to refer urgently (81%‒97%), which was consistent with the views of the expert panel. GP-related factors that impacted on overall referral included years in practice and training or experience in palliative care. Agreement with the expert panel on the potential benefits of treatment options was less consistent with the views of the panel, and varied the most for radiotherapy (31%‒80%). “GPs referral for radiotherapy may increase if the benefits of radiotherapy are emphasised and access to treatment is more readily available”, the researchers wrote.

Too many unnecessary Pap tests
DESPITE recommendations that women discontinue Pap testing if they have had a total hysterectomy or are older than 65 years, large numbers of women in the US are still being unnecessarily tested, according to research published in JAMA Internal Medicine. The researchers found that in 2010, nearly two-thirds of women reported a Pap test since their hysterectomy despite no history of cervical cancer and about half of women older than 65 years without a hysterectomy who had recent and ongoing normal results reported a test in the previous 3 years. The researchers conducted a cross-sectional study using data from the 2010 US National Health Interview Survey. The study sample included 9494 women 30 years and older, as women younger than 30 years were less likely to have had a hysterectomy. Among women reporting a hysterectomy, 64.8% reported a recent test since their hysterectomy. Among women aged 65 years and older without a hysterectomy, 58.4% reported having a Pap test in the previous 3 years, “together representing approximately 14 million women”, the researchers wrote. “Misuse of Papanicolaou testing continues despite [US Preventive Services Task Force] recommendations, and health care resources could be spent better elsewhere”, they wrote. “Targeted efforts are needed to reduce unnecessary testing among older women and women without a cervix in compliance with clinical recommendations for cervical cancer prevention.”

Better late than never for exercise
A SUSTAINED level of physical activity in older age is associated with improved overall health even if activity is started relatively late in life, according to research published in the British Journal of Sports Medicine. Participants were 3454 initially disease-free UK patients, aged an average of 64 years at baseline participating in the English Longitudinal Study of Ageing. Self-reported physical activity was measured at baseline (2002–2003) and through 8 years of follow-up (2010–2011). “Healthy ageing” was defined as those participants who survived without developing major chronic disease, depressive symptoms, physical or cognitive impairment. At follow-up 19.3% of subjects were defined as healthy ageing. Moderate or vigorous activity at least once a week was associated with healthy ageing, and even those who became active after baseline showed significant health benefits. “This study supports public health initiatives designed to engage older adults in physical activity, even those who are of advanced age”, the authors concluded.

Salty soluble drugs associated with adverse cardio events
TAKING soluble medications containing sodium is associated with a significantly increased risk of adverse cardiovascular events compared with consuming standard formulations of the same drugs, according to research published in the BMJ. The researchers used a UK clinical practice database to examine the prescription and medical records of 1 292 337 patients aged 18 years or over who were prescribed at least two prescriptions of sodium-containing formulations or matched standard formulations of the same drug between 1987 and 2010. Using a combined primary outcome of non-fatal myocardial infarction, non-fatal stroke or vascular death, the adjusted odds ratio for exposure to sodium-containing drugs was 1.16 (95% CI, 1.12-1.21). The median time from date of first prescription to first event was 3.92 years. “Sodium-containing formulations should be prescribed with caution only if the perceived benefits outweigh these risks”, the authors concluded.

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