News in brief

Antibiotic harms may be underreported
THE common antibiotic treatments amoxycillin and amoxycillin–clavulanic acid can cause diarrhoea and candidiasis, but these harms may be underreported, according to Australian research. The meta-analysis, published in CMAJ, included 45 randomised, placebo-controlled trials and found two significant harms — diarrhoea caused by the use of amoxycillin–clavulanic acid, and candidiasis caused by amoxycillin, both alone and in combination with clavulanic acid. Only 25 trials provided data suitable for assessment of harms. “Reported harms were fewer than we expected from clinical anecdotal experience and observationally derived data, which have primarily reported common harms as rashes … and gastrointestinal disturbance”, the authors wrote. They said that underreporting of harms in trials remained widespread, and “until that problem is addressed, under-reporting will flow to systematic reviews”. The authors said their results provided new information about the harms associated with common antibiotic treatments, which would contribute to better informed discussions about the benefits and harms of these medications. “However, it also highlights that the ability of clinicians and patients to make fully informed decisions about using amoxicillin and amoxicillin–clavulanic acid is hampered by poor measurement and reporting”, the authors wrote. An accompanying commentary said that amoxycillin had been widely used for decades, so it seemed “shameful that data on harms are missing from so many trials”.
    
Smoking linked to period pain
WOMEN who smoke are at significantly increased risk of developing chronic dysmenorrhoea, according to a prospective cohort study. The Australian research, published in Tobacco Control, drew data from the 1973–1997 cohort of the Australian Longitudinal Study on Women’s Health for 9067 young women followed from 2000 to 2012. Participants who reported their dysmenorrhoea status in at least three waves of the survey were included. Compared with women who had never smoked, smokers were more likely to experience severe and recurrent dysmenorrhoea, with those who had started smoking by 13 years of age showing 60% higher odds of developing symptoms. “Although the biological mechanisms of the effects of smoking on dysmenorrhoea have not been well elucidated, cigarette smoking has been shown to cause vasoconstriction, potentially resulting in dysmenorrhea. Alternatively, smoking is also suggested to have a direct effect on endocrine control of menstruation”, the authors wrote. The results provided evidence of the immediate and adverse reproductive health effects of smoking and “further strengthens the message that antismoking programmes should target young women, particularly teenagers”. The authors said further research was needed to confirm whether smoking cessation would benefit women suffering from dysmenorrhoea, and relieve their symptoms.

Improving medication adherence a hard task
THE lack of effective intervention methods to improve medication adherence has been revealed in a Cochrane review. The authors reviewed 182 randomised controlled trials (RCTs) comparing patients who received an intervention to improve their medicine adherence with patients who had no interventions. Trials were included if they measured both medicine adherence and a clinical outcome, such as blood pressure, and had at least 80% of patients in the trial when it finished. The authors wrote that the RCTs differed widely in regards to the included patients, adherence measurements and clinical outcomes, but the intervention methods mostly included support from family, peers or allied health professionals, who delivered education, counselling or daily treatment support. They found only 17 of these studies to be of high quality with a low risk of bias, and just five RCTs showed improvement in both medicine adherence and clinical outcomes. The most frequently targeted conditions in the RCTS were HIV/AIDS, psychiatric conditions, chronic obstructive pulmonary disease, cardiovascular disease and diabetes. Common characteristics for the success of these trials could not be identified. The authors said this highlighted that existing methods to improve medicine adherence for chronic health problems were mostly complex and largely ineffective, which meant the full benefits of treatment could not be realised. They wrote that future studies needed to develop more advanced methods to research ways of improving adherence, including the design of more feasible long-term intervention treatments and more objective measures.

“Golden hour” ambulances improve stroke outcomes
THE use of specialised ambulances to treat people with acute ischaemic stroke increases the number of patients receiving tissue plasminogen activator (tPA) treatments within the “golden hour” by almost 10-fold, according to a German study published in JAMA Neurology. The study authors compared the health outcomes of 6182 adults who were treated for suspected stroke between 2010 and 2014 by either specialist stroke emergency mobile units (STEMO) or conventional care. Each STEMO was equipped with a computed tomographic scanner plus a point-of-care laboratory and telemedicine connection, and was staffed by a neurologist trained in emergency medicine, a paramedic and technician. The authors found that 32.6% of patients with ischaemic stroke for whom STEMO was deployed received thrombolysis, compared with 22.2% of those who received conventional care. For patients who received thrombolysis, the proportion who received tPA within 60 minutes was -sixfold higher after STEMO deployment, the authors said. Compared with patients with a longer time between symptom onset and treatment, patients treated with thrombolysis in the golden hour did not have an increased risk of 7- or 90-day mortality, and were also more likely to be discharged home. The authors wrote that their findings highlighted the significance of the golden hour in acute stroke management and that “the rapid death of brain cells after blockage of cerebral blood supply makes immediate treatment to dissolve or remove clots indispensable”.

Pregnancy risks for kidney donors
WOMEN who have been kidney donors are at increased risk of gestational hypertension and pre-eclampsia, research has found. The retrospective study, published in the New England Journal of Medicine, compared the medical data of 85 Canadian women who were living kidney donors with that of 510 matched non-donors from the general population. Gestational hypertension or pre-eclampsia was diagnosed in a total of 53 women, with an incidence rate of 11% in the donor group compared with 5% for non-donors. Other important maternal and fetal outcomes did not differ significantly between the two groups, and there were no maternal or perinatal deaths recorded. Most women had uncomplicated pregnancies after kidney donation. The authors wrote that their results showed the probabilities of most serious maternal and fetal outcomes remained low and were not significantly increased after donation. However, it was unknown whether this was true in countries where women lacked access to a similar quality of health care to the donors in this study. “For this reason, there may be a role for government programs to cover the costs of recommended pregnancy care for donors who lack health insurance, including any costs related to the treatment of hypertension”, the authors wrote.

Cardiac risks for police officers
STRESSFUL law enforcement duties put police officers at risk of sudden cardiac death, according to US research. The study, published in The BMJ, used police databases to establish sudden cardiac deaths among more than 4500 police officers who died in the line of duty between 1984 and 2010, and estimated the relative risk of cardiac death while performing strenuous duties, compared with routine or non-emergency activities. A total of 441 sudden cardiac deaths were identified in the study group. Compared with routine duties, the risk of sudden cardiac death was 34‒69 times higher during restraints or altercations, 32‒51 times higher during the pursuit of suspects, 20‒23 times higher during physical training, and 6‒9 times higher during medical or rescue operations. The authors wrote that sudden cardiac death triggered by acute exposure to physical or psychological stress was “a pathophysiological mechanism shared by other occupations characterized by short bursts of stressful and physically demanding tasks”. They said their findings had public health implications and suggested that primary and secondary cardiovascular prevention efforts were needed among law enforcement officers. “Management of risk factors for cardiovascular diseases — including interventions to increase physical activity, promote smoking cessation, maintain a healthy weight, and treat hypertension and dyslipidemia — could be used to protect police officers from the triggering effects of stressful duties and also reduce rates of long term cardiovascular disease”, the authors wrote.