Journals watch: Carpal tunnel syndrome and migraine, divorce and risk of MI

Too busy to read the journals? Dr Tillmann Jacobi selects the latest papers of interest to GPs.

Carpal tunnel syndrome: research indicated an association with migraine (Mark Thomas/SPL)
Carpal tunnel syndrome: research indicated an association with migraine (Mark Thomas/SPL)
  • 0.5 CPD credits for 30 minutes of learning activity and reflection based on this article

Carpal tunnel syndrome and migraine headaches

Plast Reconstr Surg Glob Open 2015; 3(3): e333

It is known that some neuropathies are quite commonly associated with others. This study assessed a possible link between migraine and carpal tunnel syndrome (CTS), the most common compression neuropathy.

Data from 25,880 respondents in the cross-sectional 2010 National Health Interview Survey in the US were used to calculate nationally representative prevalence estimates and 95% CIs for CTS and migraine.

CTS appeared to be associated with older age, female gender, obesity, diabetes and smoking, and the prevalence in patients with migraine was 8%, compared with 3% in those without migraine.

Migraine showed an association with younger age, female gender, obesity, diabetes and current smoking, and the prevalence was 34% in those with CTS, compared with 16% in those without CTS.

Although this remains theoretical at present, it opens a possible new perspective on both conditions.

Post-deployment screening for mental disorders in the military

BMC Public Health 2015; 15(1): 338

Mental health problems in soldiers post-deployment are a frequently debated topic, with potential significant long-term implications.

This qualitative study examined the views of 21 currently serving UK military medical and welfare officers on the potential introduction of post-deployment screening for mental ill health using semi-structured interviews and a data-driven thematic analysis.

The resulting four themes were positive views of screening, reliability of responses, impact on workload and suggestions for implementation. Although they acknowledged that a routine screening tool might increase awareness of mental health problems, service personnel might give misleading responses, from fear of not being taken seriously or receiving help, which could affect the reliability of the results.

Overall, the officers were positive towards the possible introduction and implementation of such a screening programme, despite some concerns regarding impact on workload and resourcing.

Divorce and risk of acute MI

Circ Cardiovasc Qual Outcomes 2015 doi: 10.1161/CIRCOUTCOMES. 114.001291

Major life stressors have an impact on health and wellbeing. This prospective cohort study between 1992 and 2010, with more than 15,000 participants, examined the possible cumulative association between divorce and risks for acute MI.

Approximately 14% of men and 19% of women were divorced at baseline and more than one third of the cohort had more than one divorce in their lifetime. Overall, 8% (n = 1,211) had an acute MI, and age-specific rates of acute MI were consistently higher in those who were divorced compared with those who were continuously married (P <0.05).

Acute MI risk rose by 25% in all divorced women after one divorce and by 77% after two or more divorces.

If a woman remarried, her risk still remained elevated (35%) compared with continuously married women. In contrast, men only showed an increased risk of acute MI compared with continuously married men, when they had a history of two or more divorces (30% risk increase). A stable remarriage appeared so protective for them that the risk of acute MI practically disappeared.

The effectiveness of prescription pattern monitoring studies

Perspect Clin Res 2015; 6(2): 86-90

Prescription pattern monitoring studies (PPMS) are a common tool for assessing prescribing, dispensing and distribution of medicines.

They are used in many countries to encourage consistent, rational prescribing. However, there seems to be little published evidence about their effectiveness.

This data review of PPMS in India and other countries noted a wide diversity of different PPMS on varying classes of drugs, which indicates different agendas and areas of focus.

Most studies appeared to reveal that physicians generally do not adhere well to guidelines made by regulatory agencies, including national bodies or the WHO.

This may lead to irrational use of medicines, with increased risks of treatment failure, rising antimicrobial resistance and wasted resources. The study concludes that PPMS could be regarded as useful in integrating pharmacovigilance, evidence-based medicine, pharmacoeconomics and other factors for the rational use of drugs.

  • Dr Jacobi is a GP in York and a member of our team who regularly review the journals


These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Ask patients at registration for their current or previous profession, including any military service, and put this on their clinical notes.
  • Consider coding 'divorced' for relevant patients to include this in cardiovascular risk assessment - especially for women.
  • Review areas of prescribing where you may feel restricted by local guidance and consider a discussion with a CCG prescribing adviser or hospital pharmacist. You could log dilemmas as 'mini' significant events when you choose not to adhere to the guidance.

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