Journals Watch - Vitamin D, smoking and stroke

Not had time to read the journals? Let Dr Louise Newson update you on the latest research

Nearly half of the children in the study presented with bowed legs (Photograph: Biophoto Associates/Science Photo Library)
Nearly half of the children in the study presented with bowed legs (Photograph: Biophoto Associates/Science Photo Library)

Symptomatic vitamin D deficiency in children
Arch Dis Child 2011; 96: 694-96

Recently, several studies have shown that the incidence of vitamin D deficiency is rising in the UK. This study identified 160 cases of symptomatic vitamin D deficiency in children who presented to a children's hospital in Glasgow over a six-year period.

It was shown that there were twice as many cases diagnosed in 2008 as in previous years. The median age was only two years and the majority of children were of South Asian, Middle Eastern or sub-Saharan descent. Nearly half of the children in this study presented with bowed legs and 12 per cent presented with a seizure.

This study illustrated that symptomatic vitamin D deficiency remains prevalent in the west of Scotland. Many patients with vitamin D deficiency had vague symptoms, meaning that it is often difficult to diagnose in primary care.

There has been a resurgence of vitamin D deficiency in the UK paediatric population.

The authors of the study state that there is a need for effective public health education, action and surveillance for vitamin D deficiency.

The effects of smoking on prostate cancer mortality
JAMA 2011; 305: 2548-55

Although it is well accepted that smoking has numerous detrimental effects with regard to cardiovascular disease (CVD), there are very few studies of smoking in relation to prostate cancer mortality or recurrence in prostate cancer patients.

This prospective observational study of 5,366 men with prostate cancer assessed the relationship of cigarette smoking and smoking cessation to overall, prostate cancer specific, and CVD mortality and biochemical recurrence among men with prostate cancer.

The results of this study demonstrated that in patients who have been given a diagnosis of prostate cancer, smoking is associated with increased overall and CVD mortality and prostate cancer mortality and recurrence. Men who had stopped smoking for at least 10 years had prostate cancer-specific mortality risks similar to those patients who have never smoked.

Patients who have prostate cancer should be informed of the harmful effects that smoking has on their cancer.

Predictors of emergency admission rates
Emerg Med J 2011; 28: 558-63

Emergency admission rates to UK hospitals are rising and they can be expensive and often unnecessary for many patients.

This cross-sectional study from Leicester was undertaken to identify the characteristics of general practices associated with emergency hospital admission rates and also to determine whether levels of performance and patient reports of access are associated with admission rates.

Two PCTs and 145 general practices were involved in the study. The results showed that practices which were a shorter distance from hospital and had a smaller list size were associated with higher admission rates.

In addition, those practices with a higher proportion of older people, white ethnicity, deprivation and female gender also had higher admission rates. There was no association with QOF domains.

There was, however, an association between patients reporting being able to see a particular GP and admission rates. As the proportion of patients able to consult a particular GP increased, emergency admission rates declined.

Acupuncture could be beneficial in treating PMS
BJOG 2011; 118: 899-915

Numerous treatments are available for women with premenstrual syndrome (PMS), some more effective than others. This review was undertaken to summarise and evaluate the current evidence for acupuncture as a treatment for PMS, because although acupuncture is widely applied in obstetrics and gynaecology, the evidence for its efficacy in treating PMS is still equivocal.

The review included 10 RCTs of women with PMS; these RCTs compared acupuncture with sham acupuncture, medication or no treatment.

Although the pooled results demonstrated that acupuncture is superior to all controls, most of the included studies demonstrated a high risk of bias in terms of random sequence generation, allocation concealment and blinding.

The authors concluded that further rigorous studies are needed before acupuncture can be properly recommended for these patients. Interestingly, no evidence of harm resulting from acupuncture was demonstrated in these studies.

Stratification of stroke risk in older patients with AF
BMJ 2011; 342: d3653

Different stratification scores for risk of stroke in older patients with AF are currently used in clinical practice. The CHADS2 score (congestive heart failure, hypertension, age 75 years or more, diabetes, previous stroke) is frequently used in primary care.

This study was a comparative cohort study of eight risk stratification scores. It included 665 AF patients aged 75 years or more, who were based in the community, randomised to the 'Birmingham AF in the aged' trial and not taking warfarin during the study period.

The distribution of patients who had an ischaemic stroke or a TIA was similar across three of the risk stratification scores (revised CHADS2, NICE guidelines and American College of Cardiology/American Heart Association/European Society of Cardiology guidelines), with most patients categorised as high risk and the remainder as moderate risk. The CHADS2 score, however, failed to show an increase in risk at the upper range of scores.

The authors suggest that given the undertreatment of older people with anticoagulation, and the relative safety of warfarin versus aspirin in those aged over 70 years, there could be a pragmatic rationale for classifying all patients aged over 75 years as high risk until better risk stratification scores are available.

  • Dr Newson is a GP in the West Midlands 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.

  • Carry out a search of patients in your practice with vitamin D deficiency. Hold a practice meeting to discuss ways of diagnosing vitamin D deficiency, because it is likely that this condition is underdiagnosed.
  • Consider having a meeting to discuss emergency admission rates in your area.
  • Review your patients with prostate cancer and determine the proportion who are smokers. Consider ways of encouraging them to stop smoking.

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