Journals Watch - Chlamydia and heart failure

Not had time to read the journals? Let Dr Gwen Lewis bring you up to date with the latest research.

Colposcopy showing CIN2: Chlamydia was shown to be a risk factor (Photograph: SPL)
Colposcopy showing CIN2: Chlamydia was shown to be a risk factor (Photograph: SPL)

Chlamydia infection and risk of CIN
Sex Transm Infect 2011; doi:10.1136/sti.2010.044354
HPV is known to be the primary cause of cervical cancer but chlamydia is also linked. In this study, the role of chlamydia as a potential co-factor in development of CIN2 or CIN3 was examined.

In Finland, a group of 8,441 women aged 15 to 26 years underwent cervical cytology and chlamydia testing at day one and every 12 months for four years. At baseline, 31.1 per cent tested positive for high-risk HPV and 4.2 per cent for chlamydia. Hazard ratios for developing CIN2 or higher in those with HPV 16/18 and without HPV 16/18 were 1.82 and 1.74 respectively.

Testing positive for chlamydia at baseline was an independent, albeit moderate risk factor for development of CIN2 in both those who were baseline HPV 16/18 positive and negative.

However, there was no increased risk for CIN3 in those who were chlamydia positive so it is possible that chlamydia may only be involved in early stages of cervical carcinogenesis.

Promoting contraceptive adherence in teenagers
J Fam Plann Reprod Health Care 2011; 37: 85-8
The UK has the highest rate of teenage pregnancy in western Europe, although there is evidence of a recent downward trend.

Eighty-seven young women aged 14 to 19 years attending for contraception in Sheffield, which has a higher than the national average level of deprivation, were given one-to-one behaviour change counselling in the form of 'if-when' planning.

This involves linking, for example, cleaning their teeth in the morning - 'if' with the instruction that they must then take their pill for that day - 'when'.

'If-when' planning has been shown to have beneficial effects for a range of health behaviours. These young women were then compared with a similar group of 79 who had received usual care. Clinicians received a day of training in order to be able to offer counselling.

It was found that consultations for emergency contraception and pregnancy testing were reduced by 15 per cent after making 'if-when' plans.

In addition, other positive behaviour changes were seen in more than half of this group.

Young people's views of contraceptive service delivery
J Fam Plann Reprod Health Care 2011; 37: 71-84
Despite the widespread availability of contraceptives in the UK, they are not always accessed by young people. This systematic review examined 59 papers reporting studies into the views of both young people and service providers.

Seven key themes were identified in many of the papers: anonymity and confidentiality; accessibility of services; embarrassment; the clinic environment; the consultation; perceptions of services and service organisation.

The most significant concern is anonymity and confidentiality so further work must be done to reassure young people regarding the confidentiality of services.

There was a great deal of diversity in young people's preferences for services so it remains important to maintain a choice of where and how to obtain contraception.

Mental health problems and fear of childbirth
BJOG 2011; doi:10.1111/j.1471-0528.2011.012967.x
An estimated 6 to 10 per cent of pregnant women have severe fear of childbirth. In this study from Finland, which ran from 1990 to 2008, 2,405 pregnant women were included because of severe childbirth fear. A control group of 4,676 pregnant women who were not worried were also studied.

Of those who had a fear of childbirth, 54 per cent had received psychiatric care during the study period compared with 33.6 per cent of the control group.

In addition, 35.6 per cent of those who were fearful underwent delivery by caesarean section as opposed to only 8.4 per cent of those in the control group, and there was also a higher risk of emergency caesarean section in the fearful group who were attempting vaginal delivery, and also greater use of medical pain relief.

Heart failure and comorbidities
Fam Pract 2011; 28: 128-33
Heart failure is often associated with other chronic diseases, and often exacerbates these illnesses.

This cross-sectional observational descriptive study of 198,670 patients in primary care in Madrid looked at the diagnosis of heart failure in electronic records. Prevalence of heart failure was quantified, and its association with another 25 chronic diseases analysed.

The prevalence of heart failure was found to be 6.9 per cent, and it was more common in women. There was a high risk of comorbidity with an average of 5.2 chronic diseases as well as heart failure.

Only 3 per cent had isolated heart failure while >60 per cent had four or more additional chronic diseases.

Of the other chronic diseases, the most common were hypertension, arrhythmias, hyperlipidaemia, obesity and diabetes.

Patients' perceptions of exercise as a treatment for depression
Br J Gen Pract 2011; 61: 254-5
Guidance recommends physical activity to manage patients with mild-to-moderate depression. This study aimed to explore patients' views of exercise for the treatment of depression. Interviews were held with 33 participants.

They found that patients view exercise as an effective treatment for depression.

Patients attributed improvements in mood to benefits including biochemical pathways, providing a source of distraction from negative thoughts, and a sense of purpose. Many participants reported low motivation and a lack of confidence as barriers to undertaking any physical activity.

This study suggests the need for GPs to elicit patients' views on physical activity as a treatment, and offer interventions that are tailored to the needs of individual patients.

  • Dr Lewis is a GP in Windsor, Berkshire and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

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

  • Develop a practice protocol to ensure that women who have abnormal cytology graded as CIN2 are tested for chlamydia.
  • Undertake a review of your provision of contraceptive services to young patients; how could you make it more accessible?
  • Share the findings about mental health and the fear of childbirth in pregnant women at a practice meeting, and discuss the benefits of asking pregnant women about their fears.

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