News in brief

Physical therapy no benefit in hip osteoarthritis
AN Australian study has found physical therapy for adults with painful hip osteoarthritis does not improve pain or function compared with a placebo treatment. The research, published in JAMA, was based on a 12-week multimodal physical therapy treatment, described as “typical of current practice for people with symptomatic hip osteoarthritis” compared with a sham intervention that included 10 individual sessions with a therapist and treatment that involved skin stimulation and touch. The researchers found the physical therapy did not confer additional benefits over the sham treatment that controlled for the therapeutic environment, therapist contact time and home tasks. Of 102 participants who were randomly assigned to physical therapy or sham therapy, 96 (94%) completed week 13 measurements and 83 (81%) completed week 36 measurements. Characteristics of the treatment groups were similar at baseline. The researchers wrote that both groups showed significant improvements in pain and function following treatment. However, those in the active group reported a significantly greater number of adverse events — 19 of 46 (41%) in the active group reported 26 adverse events and seven of 49 (14%) in the sham treatment group reported nine adverse events. The adverse events were described as relatively mild and transient, including increased hip pain or stiffness or pain in the back or in other regions. “The observed benefits, particularly in patient-reported outcomes, are consistent with meta-analysis findings of significant placebo effects in hip osteoarthritis, and the magnitude of these benefits are comparable with or larger than improvements seen in other hip osteoarthritis trials with exercise and analgesic drug therapies”, the researchers wrote. “These results question the benefits of such a physical therapy program for this patient population”, they concluded.

Big heart risk for women with diabetes
A LARGE systematic review published in Diabetologia has found that women with diabetes are 44% more likely to develop coronary heart disease (CHD) than men. The analysis used data from 64 studies conducted between 1966 and 2013, which included 858 507 people and more than 28 203 incident CHD events. The researchers found that women with diabetes were almost three times more likely to develop CHD — actual relative risk (RR) 2.82 — compared with women without diabetes, while men with diabetes were twice as likely (actual RR 2.16) to develop CHD than men without diabetes. The multiple-adjusted relative RR for incident CHD was 44% greater in women with diabetes than in men with diabetes (relative RR 1.44 [95% CI 1.27, 1.63]) with no significant heterogeneity between studies. Sex difference in diabetes RR for CHD were consistent across subgroups defined by age and region and remained unchanged after excluding non-fatal CHD events. “Higher levels of cardiovascular risk factors and relative undertreatment in women compared with men are unlikely to account for all of the excess risk observed in women”, the researchers wrote. “Instead, we propose that a greater deterioration in cardiovascular risk profile combined with more prolonged exposure to adverse levels of cardiovascular risk factors among prediabetic women compared with their male equivalents, possibly driven by greater levels of adiposity, may be responsible for the excess risk of diabetes related CHD in women.”

Functioning deficits in children with cochlear implants
RESEARCHERS have called for changes in early intervention for children with cochlear implants (CIs) after finding they are at two to fives times greater risk of clinically significant deficits in executive functioning, compared with children with normal hearing (NH). The prospective cross-sectional study, published in JAMA–Otolaryngology Head & Neck Surgery, included 73 children who had a CI before age 7 years and 78 children with NH, recruited in two age groups — preschool (3‒5 years) and school age (7‒17 years). The researchers demonstrated that children with CIs had executive functioning (EF) deficits, described as deficits in a set of diverse but related abilities, including concept formation, working memory, controlled attention, novel problem solving, planning, organisation, and mental efficiency and speed. Both preschool-aged and school-aged children with CIs were rated as having significantly more problems than children with NH. The researchers wrote that the study “provides important guidance for the evaluation and management of outcomes after cochlear implantation”. They said the contribution of auditory and language deprivation in their findings indicated broader samples of children with mild to moderate hearing loss and/or language delays could also be at risk for functional, day-to-day EF deficits. They called for increased awareness by parents, educators, health care professionals and speech-language pathologists of the risk of developing problems in EF for children with CIs; development of EF assessment instruments and protocols; and targeted interventions to improve EF skills. “Currently, habilitation and intervention after cochlear implantation focus primarily on speech and language; programs that target EF skills are also needed with this clinical population”, they wrote.

Better in-hours GP access reduces after-hours demand
BRITISH research has found that improving patient access to GP services during standard working hours could do more to reduce demand for out-of-hours care than extending opening times. The research, published in Emergency Medical Journal, included data from 567 049 respondents to the 2011‒2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months, with 7% also reporting use of after-hours primary care. The researchers explored associations between use of after-hours care and measures of in-hours access — ease of getting through on the telephone, ability to see a preferred GP, ability to get an urgent or routine appointment, and convenience of opening hours. They found worse access was independently associated with increased after-hours use for all measures except ease of telephone access. “Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal”, the researchers wrote. They said although the study highlighted the organisational aspect of access that could be targeted for interventions to reduce use of after-hours primary care, the estimated numbers “must be treated with a fair degree of caution”. “Research comparing patient experiences and objective measures of quality of care can provide invaluable insights into the factors that underpin patient preferences and satisfaction with the healthcare system, illuminating psychosocial and cognitive factors that may affect the use of in-hours GP services”, they wrote.

Big drop in hospital diabetes mortality
EXAMINATION of 11-year mortality trends among patients with and without diabetes hospitalised at a major US urban medical centre has found patients with diabetes have experienced a disproportionate reduction in in-hospital mortality and a complete reversal in risk of mortality relative to patients without diabetes. The research letter, published in JAMA Internal Medicine, was based on a “difference-in-differences approach”, comparing changes over time in in-hospital mortality in patients with and without diabetes to determine if patients with diabetes had a different time trend in their risk of in-hospital mortality. The researchers examined 322 938 hospitalisations, including 76 758 (23.8%) patients with diabetes. The overall mortality rate was 2.3% — 2.7% of patients with diabetes and 2.2% of patients without diabetes. “Unadjusted mortality among patients with diabetes decreased from 3.6% in 2000 to 2.2% in 2010 while mortality among patients without diabetes decreased from 2.4% in 2000 to 2.3% in 2010”, they wrote. “Each successive year was associated with a 4.5% reduction in the adjusted odds of mortality (odds ratio [OR], 0.96 [95% CI, 0.95-0.96]) for patients without diabetes compared with an 8.7% reduction for those with diabetes (OR, 0.91 [95% CI, 0.90-0.93]).” They found patients with diabetes had a significantly greater decline in risk of adjusted mortality of 4.4% per year, and the adjusted odds of mortality among patients with versus patients without diabetes decreased from 1.20 in 2000 to 0.78 in 2010. “This interesting trend warrants additional study to elucidate its origins”, the researchers wrote.

Cholesterol levels linked to fertility
A PROSPECTIVE cohort study involving couples who had stopped contraception to become pregnant has linked high cholesterol with reduced fertility based on a longer time to pregnancy (TTP). The researchers said their findings, published in the Journal of Clinical Endocrinology & Metabolism, were the first to demonstrate that select serum lipids were associated with reduced couple fecundity as measured by a longer TTP. Of the 501 couples studied 347 (69%) achieved pregnancy, 54 (11%) did not and 100 (20%) withdrew from the study. Mean age was 31.8 years for male and 30.0 years for female partners, with age significantly associated with free cholesterol levels for both men and women. Of the five lipid components evaluated, free cholesterol was robustly associated with reduced fecundity when modelling female serum lipids individually or in a couple-based approach independent of body mass index (BMI). Male free cholesterol concentrations were also an independent risk factor for reduced fecundability, irrespective of female lipid levels. Couple-specific select serum lipid components were associated with pregnancy status. Free cholesterol levels in men and women were significantly higher among couples who did not become pregnant compared with those who did. Male but not female total cholesterol levels were also associated with the absence of pregnancy. “The exact mechanisms remain elusive, but both male and female lipid concentrations were shown to be independent predictors of couple fecundity, after accounting for the role of body adiposity”, the researchers wrote. “These findings fill an important data gap regarding the association between lipid concentrations and couple fecundity, particularly in light of the increased prevalence of overweight couples attempting pregnancy.”

Exercise slows progression from gestational to type 2 diabetes
INCREASING physical activity helps to lower the risk of women with gestational diabetes mellitus (GDM) progressing to type 2 diabetes (T2DM), according to research published in JAMA Internal Medicine. The large prospective cohort study identified 635 incident cases of T2DM among 4554 women with a history of GDM in 59 287 person-years of follow-up. At baseline, women doing the most physical activity were leaner and less likely to be current smokers. They also had higher intakes of carbohydrates, alcohol and cereal fibre; a lower intake of fat; and better diabetes dietary scores. The researchers found that a higher level of physical activity was associated with a lower risk of T2DM independent of body mass index (BMI) and other major risk factors. “Engaging in physical activity over the minimum level recommended by the US federal guideline was related to an approximately 45% lower risk of progression from GDM toT2DM”, the researchers wrote. “Moreover, walking and vigorous activity were associated with similarly lower risk of T2DM. Because more women walk than engage in vigorous exercise (especially when they are getting older), these results are reassuring.” They also found that prolonged time spent watching television was associated with a higher T2DM risk, largely explained by increased BMI. “These findings suggest a hopeful message to women with a history of GDM, although they are at exceptionally high risk for T2DM, promoting an active lifestyle may lower the risk”, the researchers wrote. An accompanying commentary said that due to the urgency to address diabetes and obesity epidemics, the research was “a call to action for researchers and health systems to develop successful interventions to increase physical activity among women of reproductive age”.