News in brief

Viagra may increase melanoma risk
A LARGE prospective cohort study of US men has found that sildenafil (Viagra) may be associated with an increased risk of incident melanoma. The study, published in JAMA Internal Medicine, included more than 25 000 men from the Health Professionals’ Follow-up Study who did not have cancer at baseline. The cohort included 5.3% (1378 of 25 848) who reported taking sildenafil for erectile dysfunction (ED) recently and 6.3% (1618 of 25 848) who reported ever using the drug. The researchers found sildenafil users were more likely to be older and obese, and have a history of more severe or blistering sunburns. During the 10-year follow-up period, a total of 142 melanoma, 580 squamous cell carcinoma (SCC) and 3030 basal cell carcinoma (BCC) cases were documented. Both recent and ever use of sildenafil at baseline was associated with a significantly elevated risk of invasive melanoma, but no significantly altered risk of SCC or BCC. The association remained significant after excluding outcomes occurring in the first 2 years and excluding all users of other treatments for ED. An accompanying commentary said a prospective study with clearly defined inclusion and exclusion criteria and known doses of sildenafil taken was needed before a recommendation could be made to change men’s use of sildenafil. “Because primary care physicians are essentially the providers of care to patients older than 65 years, they are well positioned to detect early melanomas in the elderly”, the commentary said. “Melanoma screening could be performed by the physician when a sildenafil prescription is written for an older man with a history of sunburns.”

Cortisol response linked to teen crash rates
RESEARCH on young drivers in the US has found that those with a higher cortisol response to stress have lower crash or near-crash (CNC) rates and a faster decrease in CNC rates over time compared with those with a lower cortisol response. The research results, published in JAMA Pediatrics, held after accounting for the young drivers’ sex, suggesting it had no moderating role. The researchers continuously monitored the driving behaviour of 42 newly licensed 16-year-olds by adding kinematic sensors, cameras and a global positioning system to their vehicles. The participants’ cortisol response during a stress-inducing task was assessed at baseline, followed by measurement of their involvement in CNCs and driving exposure during their first 18 months as licensed drivers. The researchers said low cortisol response had previously been linked to risky behaviour, such as alcohol misuse, and aggressive and asocial behaviour, although the precise mechanisms of the link remained speculative. They posited that cortisol was a neurobiological marker of risky driving in some individuals, possibly explaining why general prevention strategies such as graduated driver licensing programs, media-delivered safety messages and increased parental management benefited some teenagers but not others. “Alternative risk-reduction strategies in young drivers with a neurobiological basis for their driving risk may be needed such as the use of in-vehicle technologies (eg, high g-force detection systems technology)”, they wrote.

NSAIDs linked to AF in older patients
THE use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased risk of atrial fibrillation (AF) in a population-based follow-up study published in BMJ Open. More than 8400 people, with a mean age of 68.5 years and without AF at baseline, were followed up for a mean period of about 13 years. Of the 857 participants who were diagnosed with AF during the follow-up period, 261 had never used NSAIDs, 554 had used NSAIDs in the past (47 within 30 days), and 42 were current users. Of the current users, the majority (n = 29) used a non-selective NSAID, five used a cyco-oxygenase-1 (COX-1) selective NSAID, and seven used a COX-2 selective NSAID. Current use of NSAIDs for 15–30 days was associated with an increased risk of AF compared with never use (HR [hazard ratio] 1.76; 95% CI, 1.07-2.88 adjusted for age, sex and cardiovascular risk factors) and past use within the preceding 30 days (HR 1.84; 95% CI, 1.34-2.51 adjusted). “Although higher dosages seemed to be associated with a higher risk of AF, this did not reach statistical significance”, the researchers wrote. They could not identify the underlying mechanism behind the association but said it “deserves further attention”. The results supported most previously published studies but also suggested that the increased risk occurred shortly after starting treatment and could disappear over time, they wrote.

Depression common in ICU survivors
POOR mental health and functional disability are common in patients who have been treated in intensive care units (ICUs) for respiratory failure or shock, with depression at least five times more common than post-traumatic distress disorder (PTSD) and driven by somatic symptoms, according to research published in The Lancet Respiratory Medicine. The research included 821 patients with a median age of 61 years assessed at either 3 months after discharge or at 12 months. The researchers found that 149 (37%) of 406 patients in the 3-month group reported at least mild depression, as did 116 (33%) of 347 patients at 12 months. They said the depression was mainly driven by somatic rather than cognitive–affective symptoms and was common even among individuals without a history of depression. Only 7% of patients overall had symptoms consistent with PTSD. The researchers found that patients, including many with no reported history of psychiatric treatment, had mental health and functional deficits across the spectrum of age, with functional disability and mental health quality of life worst with old age. However, they did not observe a consistent association with delirium. “Our investigation suggests that depression is substantially more prevalent than is post-traumatic distress disorder after critical illness, although these conditions are frequently comorbid (eg, almost all patients in our cohort who had symptoms of post-traumatic distress disorder also had depression)”, the researchers wrote. “Our study also suggests that individuals with more severe depression in the early post-critical illness recovery period (3 months) tend to have persistent depressive symptoms at 12 months, although symptom severity might decrease slightly.” An accompanying commentary said the research had important implications as patients were less likely to receive a diagnosis when depression manifested as physical symptoms. “As increasing numbers of patients survive critical illness, ways to treat or minimise the symptoms of post-intensive care syndrome need to be identified”, the commentary said.

Vegies may protect girls from breast disease
RESEARCHERS say they have found “intriguing preliminary evidence” that carrots and other carotenoid-rich vegetables eaten during adolescence may help to protect girls against benign breast disease (BBD). The researchers wrote that their findings, published in Pediatrics, suggested that BBD prevention in young women may be one of many positive health effects of fruit and vegetable consumption. The prospective study included 6593 adolescent girls and assessed intakes of a-carotene, b-carotene, b-cryptoxanthin, lutein/zeaxanthin and lycopene, based on food-frequency questionnaires in 1996, 1997 and 1998. Biopsy-confirmed BBD was reported by 122 participants on questionnaires in 2005, 2007 and 2010. The researchers found that girls with higher b-carotene intake were more physically active and were more likely to have a family history of breast cancer. “The highest intakes of a-carotene and lutein/zeaxanthin were suggestively inversely associated with BBD risk, although these associations did not reach statistical significance”, they wrote, saying the findings warranted further research.

Aspirin prophylaxis for pre-eclampsia
DAILY prophylaxis with low-dose aspirin in pregnant women beginning after the first trimester reduced risk for pre-eclampsia by 24% in high-risk women, preterm birth by 14% and intrauterine growth restriction (IUGR) by 20%, according to a systematic review published in the Annals of Internal Medicine. The researchers found aspirin use was associated with absolute risk reductions of 2%–5% for pre-eclampsia, 1%–5% for IUGR and 2%–4% for preterm birth. They found no significant perinatal or maternal harms from aspirin use but warned that rare harms could not be ruled out. “Our confidence in the magnitude of the pooled result, however, is tempered by evidence of small-study effects and modest findings in the 2 largest trials”, the researchers wrote. “Risk reductions closer to 10% for preeclampsia, IUGR, and preterm birth represent a more conservative interpretation of the results.” They wrote that their findings were generally consistent with the results from two previous reviews. “Although we did not find evidence of direct maternal health benefits, preventing preeclampsia could reduce medical intervention in pregnancy and delivery”, the researchers wrote. “Preventing poor perinatal health outcomes could also confer quality-of-life benefits. Preeclampsia is associated with poor psychosocial outcomes, the posttraumatic stress syndrome, and postpartum depression.” They said that based on the available evidence, in women at high risk for pre-eclampsia daily low-dose aspirin provided modest effects but important benefits to prevent the condition and consequent illness.