Appointment discrimination
A CANADIAN study has shown discrimination against patients in low socioeconomic groups within a universal health care system, even in the absence of economic incentives to do so, which adversely affects access to primary care. The research, published in CMAJ, found that people of higher socioeconomic status were 50% more likely to be offered a doctor’s appointment than those of lower status. The research was based on two researchers — one male and one female — calling 375 general practices asking for an appointment with one of 568 doctors. The callers used one of four randomly allocated standardised scripts that identified the caller’s socioeconomic status and presence or absence of chronic health conditions. The primary outcome was whether the caller received an unconditional offer of an appointment. The research also found that people who mentioned chronic health problems when calling were more likely to receive an appointment. The researchers wrote that greater efforts were needed to ensure physicians and their office staff did not discriminate against people of lower socioeconomic status.

When to expect sex after childbirth
AUSTRALIAN researchers have found that most women do not resume vaginal sex until at least 6 weeks after the birth of their first child. The research, published in BJOG, involved nulliparous women recruited in early pregnancy and relied on hospital data and questionnaires completed at recruitment, and at 3, 6 and 12 months postpartum. Sexual activity resumed earlier than vaginal sex, and by 8 weeks 65% of women had attempted vaginal sex, increasing to 78% by 12 weeks and 94% by 6 months. Women who had an episiotomy, sutured perineal tear, assisted vaginal birth or caesarean section had raised odds of delaying resumption of sex compared with women who had a spontaneous vaginal birth. The researchers wrote that the study was the first large, multicentre prospective pregnancy cohort study to provide evidence about the method of birth, perineal trauma and the timing of resuming sex after the birth of a first child. “The study provides important new evidence to guide information given to women and their partners about what to expect after childbirth”, they wrote.

Animal therapy for autism
THE presence of an animal can significantly increase positive social behaviours in children with autism spectrum disorders (ASD) according to Australian research published in PLOS One. The researchers studied the behaviour of children with ASD and their school peers during free-play sessions with either two guinea pigs or toys. Two blinded observers coded the behaviour of the children aged between 5 and 13 years. The research found that, in particular, children with ASD talked more to people, looked more at human faces, and made more tactile contact with humans in the presence of the animals compared with toys. The children also received more social approaches from their typically developing (TD) peers in the presence of animals compared with toys. “These findings are of clinical value as they suggest that the inclusion of animals in therapeutic intervention, known as Animal-Assisted Intervention, may be an effective way to increase social interaction and enhance social behavioral outcomes”, the researchers wrote. “They also provide insight into a new strategy to increase interactions for children with ASD with their TD peers in the school classroom.”

Mammography screening discrepancies
A POLL on mammography screening has found geographic discrepancies in the support for beginning routine screening for women from the age of 40 years or 50 years. The New England Journal of Medicine asked readers to vote on whether they would recommend mammography screening at 50 years of age, at 40 years of age or would not recommend routine screening. Of the 1240 readers who voted, 39% supported screening at 40 years of age, 44% at 50 years and 17% did not support screening. Readers from Central and South America were the strongest supporters of starting screening at 40 years of age, while European readers were the most divided. Both US and European readers gave the most support to starting screening at age 50. An article about the poll said that there was agreement among clinicians that women who were known to be at greater risk of breast cancer should receive vigilant screening. “Unfortunately, the jury is still out as to what that screening should entail”, the article said.

Sedentary time biggest diabetes risk
A NEW study provides “novel objective evidence” that in people at high risk of type 2 diabetes sedentary time may be a more important indicator of cardiometabolic health than participation in moderate-to-vigorous activity (MVPA). The authors of the research, published in Diabetologia, said the results raised questions about the prescription of optimal daily human movement for health, with diabetes and cardiovascular prevention programs concentrating solely on MVPA possibly overlooking “an area that is of fundamental importance to cardiometabolic health”. The study involved data from two ongoing diabetes prevention programs in the UK involving 878 participants. The researchers wrote that in individuals with known risk factors for type 2 diabetes recruited from primary care, sedentary time was detrimentally associated with 2-hour plasma glucose, triacylglycerol and HDL-cholesterol, independent of measured confounders, and the results remained significant after further adjustment for measures of adiposity. It was also consistent across diverse age ranges. “Interestingly, sedentary time was shown to have stronger associations with several important cardiometabolic markers (2 h glucose, triacylglycerol and HDL-cholesterol) compared with total physical activity and MVPA, after adjustment for each other and other important confounders”, the researchers wrote.

Peptides linked to pancreatitis
ADULTS with type 2 diabetes treated with glucagonlike peptide 1 (GLP-1)-based therapies have an increased odds of being hospitalised for acute pancreatitis, according to new research published in JAMA Internal Medicine. The research involved 1269 adults aged 18–64 years with diabetes who were hospitalised with acute pancreatitis and 1269 matched controls. People hospitalised with pancreatitis were significantly more likely than controls to have hypertriglyceridaemia (12.92% vs 8.35%), alcohol use (3.23% vs 0.24%), gallstones (9.06% vs 1.34%), tobacco misuse (16.39% vs 5.52%), obesity (19.62% vs 9.77%), biliary and pancreatic cancer (2.84% vs 0%), cystic fibrosis (0.79% vs 0%), and any neoplasm (29.94% vs 18.05%). After adjusting for these factors and other diabetes medication use, current and recent past use of GLP-1-based therapies was associated with about twice the risk of pancreatitis compared with non-use. “We suggest that a self-controlled case series design that allows control for individual-level confounding by disease severity may offer additional insight”, the researchers wrote. “Further studies using new user designs should clarify the exact timing of these risks and determine whether susceptible subgroups, such as those with genetic mutations, or pancreatitis risks, such as obesity, may be at the highest risk.”

Posted 4 March 2013

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