Colorectal cancer and HIV prevention

If you have little or no spare time to read the journals, allow Dr Raj Thakkar to give you a brief account

Chronic illness, colorectal cancer and life expectancy

Ann Intern Med 2006; 145: 646–53

This US retrospective study looked at 35,755 patients and aimed to determine the effect of age and chronic illness on life expectancy in patients with colorectal cancer. The stage of cancer was taken into account during the analysis.

The researchers found that life expectancy was significantly reduced in patients with chronic illness. Men with a diagnosis of stage 1 cancer at age 67 had 19.1 years life expectancy if they had no chronic illness, but 7.6 year expectancy if they had three or more chronic diseases. Men at age 81 with stage 1 cancer and no chronic illness had a 10.3 year expectancy.

These conclusions might look intuitive but the authors suggest that older adults with a shorter life expectancy may receive less benefit from colorectal cancer screening than younger, healthier patients.

Effect of pharmacy follow-up on adherence

JAMA; doi:10.1001/jama.296.21.joc60162

This randomised trial, based in the US, assessed whether education and regular follow-up from the pharmacist improved adherence, BP and cholesterol levels compared to standard management. Two hundred elderly patients, mean age of 78 years, taking cardiac medication were recruited in the study. All patients entered a six-month intervention phase with a pharmacist, followed by randomisation to either usual care or continued input from the pharmacist.

After six months overall adherence had increased from 61.2 per cent to 96.9 per cent. Adherence after the randomisation study period in those who continued having care from their pharmacist was 95.5 per cent but it fell to 69.1 per cent in the usual care group.

This translated to a significant reduction in BP among the pharmacy group although there were no significant differences in cholesterol levels. The importance of adherence can not be overstated.

Prevention of HIV and STIs

BMJ 2006; 333: 1,098–101

This fascinating Bulgarian study assessed the effectiveness of training leaders of Roma men about sexual health, especially HIV and STIs prevention. The leaders then counselled men in their own social networks Roma communities are usually distrustful of external authorities and can be culturally insular.

For this randomised controlled trial, 286 Roma men were recruited from 52 highly deprived social networks and were taught about risk behaviour and counselling techniques.

Follow-up demonstrated a significant reduction in unprotected intercourse at three and even 12 months post-intervention.

The reported prevalence of unprotected sex in the intervention group fell from 81 per cent to 65 per cent at three months. Behaviour modification has a major role to play in STIs and HIV prevention.

Knowledge of COPD and respiratory symptoms

Respir Med 2006; 100: 1,973–80

The authors of this Spanish study suggests people may not report respiratory symptoms to their doctor and aimed to look at knowledge of COPD and respiratory symptoms.

The researchers carried out a telephone survey of 6,758 people over the age of 40. Nearly a quarter of the sample admitted to having at least one respiratory symptom and almost a fifth were smokers.

Only 60 per cent of those with symptoms had seen their doctor. Less than one in 10 participants identified with the term COPD. The results of this study show that as GPs we have a long way to go to educate the population about significant health problems like COPD. With information, the people may be more inclined to stop smoking and seek advice about their symptoms.

Dr Thakkar is a GP in Wooburn Green, Buckinghamshire, and a member of our panel who review the journals

Research of the week

Climate impact on MI deaths

Heart 2006; 92: 1,747-51

CHD remains the number one killer in the western world.

This Athens-based study aimed to assess the effect of climate on deaths by acute MI in 2001, and analysed 3,126 deaths.

The winter months accounted for 31.8 per cent more deaths than the summer. Seasonal variation was noted to be higher in the elderly population.

Average temperature in the seven days before to the event was found to provide the most accurate meteorological prediction of death by MI. Humidity was also an important factor.

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