Research of the week
Antibiotic resistance
BJGP 2007; 57: 785-92
For as long as I can remember, we have been advised to reduce antibiotic prescribing to reduce the risk of antibiotic resistance, but I do not recall previously having seen a trial that provides any evidence that this works.
This study of 164,225 coliform UTIs in Wales over a seven-year period appears to offer vital evidence.
In those practices in the quartile having the greatest decrease in total antibiotic dispensing, there was a reduction of 5.2 per cent in antibiotic resistance to ampicillin, which compared with a reduction of just 0.3 per cent. The corresponding reductions in trimethoprim resistance were 3.4 per cent and 0.8 per cent, respectively in practices that reduced antibiotic dispensing the least.
I will think harder before prescribing for UTI in future.
Prevention of macular degeneration
BMJ, 2007; 335: 755-9
Age-related macular degeneration (AMD) is the main cause of severe visual loss in people over age 50 years in the developed world. Dietary antioxidants have long been suggested as useful in prevention of the disease.
However, this large systemic review and meta-analysis of the role of a range of dietary antioxidants, including vitamins A, C and E, zinc, lutein, zeaxanthin, alpha- and beta-carotene, and lycopene, showed insufficient evidence to support the role of dietary antioxidants and antioxidant supplements for primary prevention of AMD.
The authors conclude that smoking remains the only modifiable risk factor for primary prevention of AMD, and patient advice about AMD should be to stop smoking.
Can education cut obesity
BMJ, 2007;335: 762-4
With the promise of new schemes aimed at reducing obesity in the UK, this study was a disappointing read. It looked at the longer-term effects of an obesity prevention programme in schools.
I reviewed the results of the original study two years ago, which showed a good response to a year-long intervention of four focused education sessions describing a healthy diet and the harmful effects of fizzy drinks.
However, two years on, when the same children were reviewed again researchers found BMI, waist circumference and the prevalence of overweight had all sadly increased in both the education group and the control group, who received no educational input.
The reduction in the number of children becoming overweight or obese seen at 12 months was not sustained at three years. It was concluded that intervention may need to be continuous.
Medical training
J Fam Plann Reprod Health Care 2007: 33: 267-70
It is generally assumed that patients do not mind participating in medical training, but is this really the case?
In this trial, questionnaire surveys were given to 103 female patients attending family planning clinics who were invited to take part in the Diploma of the Faculty of Family Planning practical training. Patients were asked what they would like to know about the training.
Results showed that patients felt strongly that they wanted to know whether the doctor in training would conduct the consultation alone, the sex of the doctor (possibly less relevant in general practice than in a family planning setting) and the training doctor's level of experience.
I will now reconsider whether we need to give our patients more information about the doctors in training in our own practice.
STIs on the rise
Sex Transm Infect 2007; 83: 433-5
Based on data for UK GUM clinics in 2006, gonorrhoea diagnoses have fallen for the fourth consecutive year. Otherwise the news is less encouraging, with diagnoses of STIs continuing to rise, overall.
Chlamydia continued to be the most commonly diagnosed STI. This follows a sharp increase in new diagnoses of chlamydia over the past 10 years, which is thought to be due in part to an increase in the volume and accuracy of testing.
The highest rates of STI diagnoses continued to be in the 16-24-year-old age group, overall, and new diagnoses of genital herpes rose by 16 per cent in women within this age range.
We need to be aware of the increasing rates of infection, particularly in this young age group.
Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals
The quick study
Age-related macular degeneration is not prevented by antioxidants.
Obesity is not reduced in the long term by one-off educational interventions.
Patients want to know the sex and experience of a trainee doctor before they agree to take part in training.
STI diagnoses increased in 2006, with the exception of a reduction in the incidence of gonorrhoea.
