Journals Watch - Malaria, muscles and insomnia

Too busy to catch up on the latest research? Let Dr Simon Hunter update you on recent papers.

Importing malaria BMJ 2008; doi:10.1136/bmj.a120
With the increase in availability and the decrease in cost of long-haul flights, more and more surgery time is spent on travel clinic work.

I was under the impression it was accepted knowledge that before you go abroad you need to take anti-transmissible disease precautions, but it seems there is one group that is not getting or is ignoring the message.

This study examined cases of malaria in the UK between 1987 and 2006. Worryingly, it found that cases are on the rise and, even more worryingly, the ratio of the potentially fatal Plasmodium falciparum to Plasmodium vivax is increasing.

Migrants visiting their country of origin without obtaining malaria prophylaxis is one ccause of rising cases

This increase is concentrated in migrants to this country going back to visit their country of origin, in particular Nigeria and Ghana. It seems that these people are not using prophylaxis.

Whether it is the expense, the mistaken belief that they are immune or just the familiarity with the country making it seem unnecessary is not clear, but the message needs to get through to these travellers that they are putting themselves at risk and putting a strain on the health service.

Be strong - live long BMJ 2008; doi:10.1136/bmj.a439
We know that cardiovascular fitness prolongs life, but this prospective cohort study suggests muscle strength may also help us live longer. Over a period of nearly 19 years it compared the death rate of participants against their leg and bench press strength in 8,762 men aged 20-80.

Even after adjusting for cardiovascular fitness, smoking, alcohol, family history and medical conditions, there was a clear inverse correlation between muscle strength and death from cardiovascular disease, and also death from cancer in men (i.e. the greater the muscle strength, the lower the death rate by up to a third).

This could have an effect on lifestyle advice, which has mostly promoted cardiovascular exercise. With this study it looks like we should also expound the benefits of resistance exercise as well.

Z drugs versus benzodiazepines Br J Gen Pract 2008; 58: 417-22
Insomnia is not well served by modern medicine. The medications in the armamentarium are not especially effective, don't give refreshing sleep and may be abused.

For a long time the benzodiazepines were the only available drugs, then along came the 'Z drugs' (principally zopiclone and zolpidem), which were launched with a fanfare of additional benefits such as better sleep and less dependence.

In this study, patients prescribed a benzodiazepine or a Z drug were sent a questionnaire from which there was about a 60 per cent response, of whom three quarters were taking medication for insomnia.

A total of 40 per cent described at least one side-effect, and 22 per cent of patients on Z drugs and 12.3 per cent of those on benzodiazepines wanted to stop their drugs. There appeared to be no difference in beneficial or adverse effects between the two groups.

It surprised me to see that 92 per cent of respondents were getting repeat prescriptions. The proportion of drugs prescribed was also surprising with 46 per cent on zopiclone, 23 per cent on temazepam and 6 per cent on zolpidem.

There is obviously a great need for help with sleep, and the suggestion at the end of the study - use cognitive behavioural therapy - doesn't really cut the mustard in the real world.

Pre-competition cardiovascular tests BMJ 2008; doi:10.1136/bmj.a346
We are all aware of the well-publicised tragic cases when a young person dies competing in a sporting event.

In Italy, for the last 25 years anyone competing in officially sanctioned sports has had to have a resting and an exercise ECG. This study explored if it was a good idea.

Examining 30,065 people seeking to obtain clinical eligibility for competitive sports, they found ECG abnormalities in 6 per cent, but 80 per cent of these were insignificant. The exercise ECG showed abnormalities in 4 per cent of athletes in whom the resting ECG was normal.

In total, 0.6 per cent of participants were considered ineligible for competitive sport and the mean age of these people was 37 years.

The evidence presented here does not convince me that there is a good reason to start such a system in this country, given the current strain on resources.

Childhood obesity J Pub Health 2008; 30: 145-52
Overweight children become overweight adults. It is estimated that by 2010 there will be 12 million obese people in England alone.

This study looked at the heights and weights recorded for three-year-olds in Wales between 1995 and 2005. They found that although there was a great deal of year-to-year variability, the rate of increase in obesity was greater in the most economically deprived areas.

At the start of the study, these children had a lower rate of obesity compared with children from more affluent areas.

Winter admissions Br J Gen Pract 2008; 58: 400-2
Every winter, hospital admissions increase significantly and a large part of this increase is from respiratory illness, resulting in GPs getting warnings asking us not to admit patients.

This case-control study carried out in 79 general practices in central England examined the rate of admissions for respiratory illness.

Social and medical factors were examined by interview and using GP records. It was found that socio-economic class had surprisingly little effect on admissions.

The presence of COPD was responsible for a fourfold increase in the risk of admission, and even more so in the presence of co-morbidities.

Also increasing the risk of admission was having more than two courses of oral steroids in the last year, and social isolation. These data should help target those most likely to be admitted for respiratory illness.

Dr Hunter is a GP in Bishop's Waltham, Hampshire and a member of our team who regularly review the journals

The quick study

  • Malaria cases in the UK have steadily increased over the past 20 years.
  • Muscle strength in men is correlated with a longer life.
  • Z drugs and benzodiazepines are not found to be satisfactory by some insomnia patients.
  • ECGs used to assess fitness before a sporting event found just 0.6 per cent of participants to be ineligible.
  • Obesity rates appear to be increasing in economically deprived areas.
  • Hospital admissions for patients with respiratory illness are more likely if the patient has COPD and co-morbidities.

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