Journals Watch - Birth defects and chronic fatigue

Too busy to read the journals? Let Dr Nicolette Price be your guide to the latest research.

RETURNING TO WORK AFTER CARPAL TUNNEL SURGERY - Occup Med 2006; 56: 46-50

This study from Israel attempted to determine reasons for prolonged sick leave after carpal tunnel surgery. Sick leave had been found to range from 4.3 days to over three months.

Fifty workers undergoing carpal tunnel surgery were assessed pre- and post-operatively, using questionnaires, telephone assessment of symptom severity, and other tests such as electromyography and grip strength.

Most subjects were female, aged 35-54, with manual or clerical jobs.

Subjects with chronic diseases and lower self-rated health tended to return later. The strongest predictor was the surgeons' recommendation for sick leave - varying from one to 36 days.

The authors concluded that workers will return to work in under three weeks if their surgeons advise them to do so.

VAGINAL RING AS EMERGENCY CONTRACEPTION - Contraception 2006; 73: 46-52

This phase-one clinical trial assessed the ethinylestradiol vaginal ring's suitability as emergency contraception. The authors looked at its ability to interfere with ovulation, studying 48 women who were protected against pregnancy by non-hormonal methods.

The ring was found to interfere with 87.5 per cent of ovulatory processes, thus being more effective than oral methods. Added advantages include preventing ovulation later in the same cycle and continued contraception if left in place.

CHECK MIGRAINE PATIENTS FOR DEPRESSION - Pain 2005; 118: 319-26

The recent Framig 3 study collected information on migraine from across France.

Half of the subjects with active migraine were found to suffer with anxiety or depression, or both.

The efficacy of treatments for migraine was found to be reduced in subjects with these disorders.

It was suggested that those consulting for migraine should be routinely assessed for anxiety and depression. Treatment could then improve their well-being during and between attacks.

NUCHAL TRANSLUCENCY THICKNESS AND CHROMOSOMAL DEFECTS - Obstet Gynecol 2006; 107; 6-10

This retrospective study of 11,315 singleton pregnancies where fetal karyotyping was performed following findings of increased nuchal translucency identified 2,168 abnormal karyotypes (about 19 per cent). Approximately half were trisomy 21.

The thickness of nuchal translucency was also associated with abnormality type: in most trisomy 21 cases the depth was under 4.5 mm; in Turner's syndrome it was over 8.5 mm.

The authors suggest that finding increased nuchal translucency in the first trimester should alert ultrasonographers to the possibility of chromosomal abnormality, and prompt further systematic examination to identify other detectable defects.

CHRONIC FATIGUE-TYPE ILLNESS IN CHILDREN - Br J Gen Pract 2006; 56; 43-47

In this study 116 children, aged five to 19, with chronic fatigue-type symptoms were studied to determine their characteristics and investigate how GPs manage such patients.

All ranges of severity were managed in primary care, and most patients were referred to a paediatrician (half within two months). A peak autumn onset was determined and over 50 per cent had missed over 20 weeks' schooling.

The authors concluded that the use of established diagnostic criteria would improve recognition of the condition by GPs.

- Dr Price is a medical examiner for the Department for Work and Pensions, a former GP in Hampshire, and a member of our team who regularly review the journals

INFORMING PATIENTS

Post-carpal tunnel surgery patients can return to work early if advised to do so.

Vaginal contraceptive rings are suitable for use as emergency contraception.

Migraine patients should be assessed for depression.

Ultrasound examination revealing increased nuchal translucency should prompt checks for chromosomal abnormalities.

Chronic fatigue in children needs clearer diagnostic criteria to aid its recognition.

RESEARCH OF THE WEEK

STIs trends in the UK - BMJonline doi: 10.1136/bmj.38726.404120.7c

In this population-based study a comparison was made between the incidence of STIs diagnosed and treated in general practice, and those diagnosed in genitourinary clinics in the UK during 1998-2000.

The percentage increase in infections diagnosed in primary care was greatest for chlamydia; a large number of men were treated without a microbiological diagnosis, using antibiotics appropriate for non-specific urethritis.

The authors found that the incidence of STIs in the UK is higher than previously believed, with GPs contributing increasingly to their management.

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