Journals watch: Sun protection, running footwear and Barrett's oesophagus

Dr Simon Hunter selects the latest papers of interest to GPs including sun protection, running footwear, PPIs help in Barrett's oesophagus and NSAIDs and CVD risk in rheumatoid arthritis.

Low compliance with sun protection tended to be male, under 20 or over 64 years of age
Low compliance with sun protection tended to be male, under 20 or over 64 years of age

Compliance with sun protection 

Br J Dermatol 2014; 170: 1327-35

It is known that sun protection campaigns can have short-term success, but the effect on long-term behaviour is very limited. This study in France looked at factors influencing patients’ UV exposure behaviour. Patients in a dermatology clinic who were given a sunblock were asked to fill in a multiple choice questionnaire asking about sun protection behaviour, sun protection knowledge, level of UV exposure and knowledge of UV exposure risks.

The researchers found that better compliance with sun protection measures was associated with better knowledge of the risks, but also with higher UV exposure.

Those with low compliance tended to be male, under 20 or over 64 years of age, with lower knowledge of the risks, but also lower UV exposure.

Minimalist running footwear and injury risk

Sports Med 2014; 48: 1257-62

There has been a trend recently for runners to use minimalist footwear. If you have not seen them, they look a bit like a glove for your feet. The argument is that they make you run in a manner similar to how we evolved to run – barefoot, with no heel raise and sole stiffness – and thus reduce injury risk.

This study compared the injury risk of minimalist versus conventional footwear for runners. Participants were established runners who were injury free at the outset of the study. The intervention group had two different makes of minimalist footwear and the control group had conventional running shoes. Both groups trained in a similar manner for a 10km race. 

There were 99 participants in this study. The conventional shoe group had four injuries and the partial minimal shoe group, 12. Those runners with full minimalist shoes reported the most shin and calf pain. The authors suggest caution in recommending this type of footwear.

Exercise to help quitting

Sports Med 2014; 48: 1263-4

Two-thirds of UK smokers want to stop, but only 5% will succeed unaided. This systematic review assessed evidence of the impact of short bursts of physical activity on cigarette craving. 

The researchers looked at published and unpublished studies, but excluded patients on cessation programmes or using other therapy. Exercise varied from vigorous walking to running, with cycling and isometric exercises. Duration varied from five to 40 minutes.

The authors found that exercise halved the desire to smoke (using the seven-point Likert scale). This was the same when only moderate exercise was included. There was heterogeneity in the results from the papers examined, with some studies showing huge benefits. All but one study showed some benefit. This seems to be an intervention that works.

PPIs help in Barrett’s oesophagus

Gut 2014; 63: 1229-37

Barrett’s oesophagus confers 30 to 125 times the risk of developing oesophageal adenocarcinoma (OAC). The incidence of OAC is rising and has high mortality. However, only a small proportion of those with Barrett’s oesophagus will develop OAC, so one strategy for patients found to have Barrett’s oesophagus has been routine endoscopic surveillance. 

This is expensive and has limited adherence and access, so an alternative strategy has been to use chemopreventive agents, such as PPIs and H2-receptor agonists (H2RAs). However, there are concerns about the oncogenic effect of long-term acid suppression.

This meta-analysis looked at the use of long-term PPIs and H2RAs in Barrett’s oesophagus, to determine their effect on developing OAC or high-grade dysplasia.

The authors found that long-term use of a PPI (more than two to three years) is associated with a 71% decrease in the risk of OAC or high-grade dysplasia. They found it to be cost-effective and not associated with an increased risk of cancer, and recommended it as a strategy for high-risk patients. There was insufficient evidence to pass judgment on H2RAs. 

NSAIDs and CVD risk in rheumatoid arthritis

Ann Rheum Dis 2014; 73: 1515-21

Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD), as are some NSAIDs. This is a 
double whammy, because patients with RA often require NSAIDs for pain control. 

There has been limited evidence that there is no extra CVD risk from taking NSAIDs in RA, probably owing to the cardioprotective effect of pain relief and greater mobility.

This study in Canada followed up nearly 100,000 patients on NSAIDs over five years. Those who had RA were compared with controls who did not have RA. 

The authors found the risk of CVD was significantly lower in the RA group compared with the controls, with a hazard ratio of 1.22. Other than diclofenac and rofecoxib, there was no significant increase in CVD risk in the RA patients taking an NSAID. 

Naproxen, ibuprofen and celecoxib were mentioned as lower-risk NSAIDs. The authors recommend that these NSAIDs should not automatically be ruled out because of CVD concerns. However, they cautioned about the availability of OTC diclofenac and the associated CVD risks.

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

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