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I started blogging last October reporting health-related news that have hit the headlines.

One of the reasons that I develop a blog is that news can be posted as they break and readers can access it immediately over the Internet. You might like to read it whenever it suits you by browsing the archives. Anyone can respond to any post, whether writing an informal comment or adding information to it, so a blog could be a useful resource. You can also subscribe to the blog RSS feed, the orange icon with "subscribe", so that you receive the updates as they come in.
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Caesarean birth may double morbidity and mortality risk

A new study invovling 97,307 deliveries of babies during the three-month study period in some randomly selected countries has found that women who deliver through non-emergency caesarean birth have double the risk of morbidity and mortality for themselves and the babies as compared to those who go for a vaginal birth.

However, researchers found caesarean delivery prevented foetal deaths in breech born babies.

Source: "Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study" BMJ Online First, doi:10.1136/bmj.39363.706956.55 (published 30 October 2007)

Breaking the waters does not shorten labour

According to a Cochrane systematic review of 14 multicentre, randomised controlled trials involving 4893 women, amniotomy, also called breaking the waters, did not speed delivery.

Amniotomy, artificial rupture of the fetal membranes to induce labor, is one of the most commonly performed procedures to speed contractions, thereby shortening the length of labor. However, the reviewers said that there is little evidence that a shorter labor has benefits for either mother or child and concluded the evidence does not support the routine breaking the waters for women in spontaneous labour.

Source: "Amniotomy for shortening spontaneous labour" - Cochrane Database of Systematic Reviews 2007, Issue 4.

To err is human ...

Two US doctors made a documentary about the impact of medical errors by interviewing patients and families that had been affected by medical error and found that doctors and patients felt the same kind of guilt, fear and isolation after the medical errors occur.

"How can patients, families and clinicians move beyond these feelings and approach closure and forgiveness?" the authors wrote.

Read the free full text article : "Guilty, Afraid, and Alone — Struggling with Medical Error", NEJM 357(17):1682-1683.

Are doctors just playing hunches?

This is an interesting article about evidence-based medicine published by the Time magazine last February.

The author wrote,"The trend in medicine is increasingly to be guided by the data …..All patients would probably benefit if their doctors were abreast of the latest data, but none would benefit from being reduced to one of those statistical points".

Are doctors playing medical hunches?

More women choosing double mastectomies

In a study of 4,969 American women who chose contralateral prophylactic mastectomy (CMP), researchers report that the rate of preventive mastectomy in women with single-breast cancer rose 150% in six years although the actual number of women choosing double mastectomy is relatively small.


The lead author said such aggressive strategy may be unnecessary because the risk of cancer spread to other body sites is higher than the risk of getting cancer in the second breast. He emphasized that women may benefit from treating the known breast cancer first and thinking about other options later after their treatment is completed.

Source: "Increasing Use of Contralateral Prophylactic Mastectomy for Breast Cancer Patients: A Trend Toward More Aggressive Surgical Treatment". Journal of Clinical Oncology , 22 Oct 2007 (ahead of print)

Acupuncture - best therapy for back pain

I learned from a mailing list that there was a large number of queries about a trial published in the journal Archives of Internal Medicine, September 2007.

It was a randomized and blinded trial conducted across 340 practices in Germany involving 1162 adults who had suffered from lower back pain for an average of 8 years. Patients were randomly assigned to one of three treatment groups: verum acupuncture, sham acupuncture or conventional therapy. After 6 months, nearly half of the patients receiving acupuncture treatment showed significant improvements in back pain compared to about one-quarter receiving conventional treatment.


The finding has led to acupuncture being adopted in Germany as a covered benefit for chronic lower back pain treatment under statutory health insurance plans.

Source: "German Acupuncture Trials (GERAC) for Chronic Low Back Pain - Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups , Arch Intern Med. 2007;167:1892-1898 (Sept 27)

Read previous post on "Alternative medicine in the US medical curriculm" and the cut back on using complementary therapies in the UK.

Current evidence does not support aspirin therapy in IVF

Previous studies on the use of aspirin have shown conflicting evidence whether low-dose aspirin is beneficial in IVF.


According to a systematic review of 9 studies in different parts of the world involving more than 1400 women undergoing IVF or ICSI ( intracytoplasmic sperm injection) to treat infertility, currently available evidence does not support the use of aspirin in IVF or ICSI treatment. Further research into this treatment is needed.


Source: "Low-dose aspirin for in vitro fertilisation". Cochrane Database of Systematic Reviews 2007, Issue 4

A bowl of whole-grain breakfast cereal every day can cut the risk of heart failure

A new study comparing cereal intake and the risk of heart failure among more than 21,000 doctors who took part in the Physicians Health Study I found that men who ate whole-grain breakfast cereal regularly were less likely to develop heart failure than those who ate it rarely. The risks of heart failure were highest among those who never ate the cereal.


The researchers concluded that their data "demonstrate that a higher intake of whole grain breakfast cereals is associated with a lower risk of heart failure." The protective effect of whole-grain cereal against heart failure may be due to the beneficial effects of whole grains on heart disease risk factors, such as high blood pressure, heart attack risk, diabetes and obesity.

Source: "Breakfast Cereals and Risk of Heart Failure in the Physicians' Health Study I" Archives of Internal Medicine, Oct 2007; 167: 2080 - 2085 (Subscription required)

Aspirin - men's drug?

Aspirin has been linked to many health benefits, but a study which analysed 23 previously published clinical trials for the effect of aspirin in heart attack prevention, involving more than 113,000 patients found that women may be less responsive to aspirin than men for heart protection.


The researchers believe that gender may be one of the main influences on aspirin's protective powers. One UK expert said the finding is "potentially misleading" and that "taking aspirin in the months and years after a heart attack delivered equal benefits to men and women".


Source: "The influence of gender on the effects of aspirin in preventing myocardial infarction"
BMC Medicine 2007, 5:29 ( This is an open access journal article with full text )

GPs' antibiotic prescription not justified

Most antibiotic prescribing in the UK is in primary care for patients with respiratory tract infections, but guidelines advise against their routine use in patients with upper respiratory tract infections except for chest infections in elderly people.

A BMJ study found that antibiotics reduce the risk of serious complications which is rare after upper respiratory tract infections, but over 4000 courses would have to be needed to prevent one complication. However, only 39 elderly patients would have to be treated with antibiotics for a chest infection to prevent a case of pneumonia.

The study concluded that there is a "clear scope for reductions in antibiotic prescribing for upper respiratory tract infections" and " more research was needed to help doctors differentiate between chest infection and pneumonia"

Read the abstract "Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database" BMJ 2007, October

UK NHS fail on hygiene standards

In the UK, there are growing concerns among patients about C.difficile and MRSA infections following the C.difficile outbreak in Kent that had killed 90 patients between 2004 and 2006.

According to the Healthcare Commission report, 1 in 4 hospital trusts in England are failing to protect patients from deadly superbugs and to meet basic hygiene standards including cleaning hands and instruments.

See also the article "Doctors need a "sea change" in their attitude to C. difficile" BMJ 2007;335:790 (20 October).

MRSA more widespread than thought in US

A team of US researchers carried out a study to find out the incidence of invasive MRSA disease in specific American communities during 2005 and found that MRSA infections are more common than previously thought in the US. It is being found more frequently outside of health care settings and seems to affect certain populations such as the blacks, male and the 65+.


Based on the documented 8,987 cases of of invasive MRSA, the researchers estimated that there were 94,360 cases of invasive MRSA in the US in 2005, resulting in more than 18,000 deaths.


The researchers concluded " invasive MRSA disease is a major public health problem and is primarily related to health care but no longer confined to acute care. Although in 2005 the majority of invasive disease was related to health care, this may change".


Read the free full text article "Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States" JAMA. 2007;298(15):1763-1771 (Oct 17)

Household cleaning sprays raise asthma risk

A study of more than 3 500 people from 10 European countries found using household cleaning sprays and air fresheners as little as once a week raised the risk of asthma.

Researchers found that cleaning sprays, such as air fresheners, furniture cleaners and glass-cleaners had a particularly strong effect.

Source : "The Use of Household Cleaning Sprays and Adult Asthma: An International Longitudinal Study" Am. J. Respir. Crit. Care Med. 2007; 176(8) : 735-741

Don't smoke around babies

A Bristol research, to be published in the journal Early Human Development, studied the impact of exposure to smoking and its adverse effects both before and after birth.

It found that cot deaths linked to smoking have risen and the risk of death increased with each individual hour the baby was exposed to smoke. The author said "after delivery, the mother can reduce the risk by protecting her baby and not smoking near it".

The Foundation for the Study of Infant Deaths said "If no women smoked in pregnancy, about 60% of cot deaths could be avoided".

Extended benefits of statin therapy

A 15-year Glasgow study showed that patients who had been taking pravastatin for 5 years were still experiencing the benefits 10 years after they stopped taking the drug, with a significant reduced risk of heart attacks and other coronary events.


The extended benefits may be due to the lowering LDL cholesterol by early statin therapy and stabilizing existing plague therefore slowing the progress of coronary heart disease.


Source : "Long-Term Follow-up of the West of Scotland Coronary Prevention Study". NEJM 2007; 357(15):1477-1486 (October 11)

Stressful jobs increase risks of heart disease recurrence

Did you know that job stress was a major predictor of repeated heart attack when compared with other risk afctors such as smoking, alcohol consumption, and high blood pressure?

Previous studies have shown that job strain increases the risk of a first coronary heart disease (CHD) event. According to a new Canadian study of about 980 patients who returned to work after a heart attack, chronic job strain after a first MI was associated with an increased risk of recurrent CHD.

The author said preventive interventions should also take into account the person's work environment and "cardiologists and occupational health services be informed of this finding in order to reduce stressful work for those returning to work after a heart attack".

The ABC News said that workers should learn to manage stress at work to either change their thoughts or to change the situation.

Source: "Job Strain and Risk of Acute Recurrent Coronary Heart Disease Events" JAMA. 2007;298(14):1652-1660

fast treatment of small strokes can prevent major ones

According to a research at Oxford University, fast assessment and treatment of minor strokes or transient ischemic attacks (TIA) can reduce the risk of early recurrent stroke by 80%. Early treatment could help prevent 100,000 strokes each year in Britain, but researchers said "the vast majority of patients in Britain have not been getting treatment for the first few weeks."

The study "Effect of urgent treatment of transient ischemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison" was published in The Lancet (early online publication) October 9, 2007

Another study, "A transient ischemic attack clinic with round-the-clock-assess (SOS-TIA): feasibility and effects" published in The Lancet Neurology, also found that early treatment brought similar results in reducing the risk of a major stroke.

Medical grand rounds and free food

While I was searching for some CME resources for our Foundation Year doctors, I came accross an interesting research article "If you feed them, they will come: A prospective study of the effects of complimentary food on attendance and physician attitudes at medical grand rounds at an academic medical center" BMC Medical Education 2007, 7:22


It reports on the results of a prospective study of the effects of providing complimentary food on attendance at medical grand rounds (MGR) and a web-based survey that assessed the attitudes of attendees on the provision of complimentary food at MGRs.


The data suggest that faculty, fellows, and residents are more likely to attend MGR if free food is provided and less likely to attend if free food is not provided.


MGR is a central teaching activity in most departments of medicine at academic medical centers, but attendance by faculty, fellows, and residents appears to be decreasing. The study concludes that providing free food may be an effective strategy for increasing attendance at MGR.


What are your views and experience on the effects of free food on physicians' attendance to MGRs or other educational activities?

Microsoft's personal health records

Microsoft has just released a new "software and service platform" called HealthVault to allow consumers to collect, store and share health information online. It includes free web-based personal health records, Internet search tailored for health queries and a "connecetion center" that can be connected to many devices such as glucose and blood pressure monitors.

Microsoft said the personal information will be stored in a secure database and individuals have complete controls over what information goes in and who sees it. Microsoft HealthVault uses Windows Live ID and a "strong" password to authenticate patients' identity.

Some hospitals, The American Heart Association, Johnson & Johnson LifeScan that sells glucose monitors, are collaborating with Microsoft in this new venture.

Would you choose to use the Microsoft personal health record?

ACE inhibitor may diminish cardiac complications with Marfan Syndrome

A preliminary research of 17 patients suggests that use of the ACE inhibitor perindopril (Aceon), reduced aortic stiffness and dilation in systole and diastole in patients with Marfan Syndrome taking standard beta-blocker therapy.

However the benefits of perindopril in improving cardic risks with Marfan Syndrome need to be established in larger groups and longer term clinical trials because the study was limited by its small size and relatively short duration.

Source: "Effect of Perindopril on Large Artery Stiffness and Aortic Root Diameter in Patients With Marfan Syndrome :A Randomized Controlled Trial" JAMA. 2007;298(13) :1539-1547

Caesarean increases uterine rupture risk

A study of about 300,000 Swedish women found that a caesarean section increases the risk of uterus rupture during a subsequent vaginal delivery.


The study also found neonatal death rate of 51 per 1000, a 60-fold increase in risk. Other risk factors including inducing labour, high maternal age and birthweight significantly increase the risk of uterine rupture.

Read the BJOG release : "Risk Factors For Uterine Rupture And The Neonatal Consequences". BJOG 2007;114:1208-1214.

Early testing for familial cholesterol

According to a BMJ study, based on a review of 13 studies, the researchers suggested that children could be screened at about 15 months of age for familial high cholesterol because the disorder is often inherited.

If children are tested positive for high cholesterol, doctors would screen the parents and drug treatment could begin immediately for the adults.

Full text of the article "Child-parent screening for familial hypercholesterolaemia: screening strategy based on a meta-analysis". BMJ 2007;335(7620):599 is available with an Athens password at the HILO website.