Research of the week
Influenza vaccination in patients with asthma
BJGP 2007; 538: 359–63
The starting point of this research at the Primary Care Research Group at the Peninsular Medical School was that patients with asthma should receive immunisation against flu and that many did not.
Furthermore, the numbers being immunised did not increase in the way that they did with other at-risk diseases.
The study looked for socioeconomic causes but came up with the self-evident results that those patients who felt more susceptible to flu and more at-risk of its complications were more likely to be immunised.
Similarly those patients who had greater confidence in the efficacy of the vaccine were more likely to accept it. They also found that those with concerns about vaccine safety and side-effects were less likely to accept vaccination. The conclusions? Well, apparently we need to address those health beliefs.
Osteoporosis and zoledronic acid
N Eng J Med 2007; 356: 1,809–22
This research was picked up by the lay press so I feel it is important that we have at least all heard of it. Californian doctors have shown that a single annual infusion of zoledronic acid will reduce the chance of vertebral fractures by 70 per cent over a three-year period compared with placebo (not including those taking concomitant osteoporosis medications) and of hip fracture by 41 per cent compared with placebo (all patients).
The sample size was good (3,889 study versus 3,876 placebo) and mean age an appropriate 73. But I was confused why there should have been a slightly different comparison group for the two fractures. What the press did not mention was the increased incidence of ‘serious atrial fibrillation’ — two and a half times as many in the study group.
The big plus is compliance and what is needed now is a head-to-head study of annual zoledronic acid against weekly or monthly bisphosphonates.
Once the patient is in the clinic and the 15-minute infusion is in you know you have compliance.
HPV vaccination and cervical cancer
JAMA 2007; 297: 1,921–3
This editorial concerns the question of compulsory immunisation for girls entering sixth grade in two US states and whether there is enough evidence of benefit to warrant such action.
What we already know is that quadrivalent vaccine is highly effective when administered to 16–20-year-olds, and that in the US an estimated 6.2 million people are infected annually resulting in a prevalence that increases through the teenage years to reach a maximum of 45 per cent by about 24 years of age. There are an estimated 11,000 new cases of cervical cancer in the US each year resulting in 3,700 deaths.
We also know that approximately 90 per cent of women with new HPV infections clear it within two years. This editorial is worth reading in its entirety.
Sexual health education
J Fam Plann Reprod Health Care 2007; 33: 99–105
Recent studies from UNICEF do not show the UK in a good light, this is particularly true in Northern Ireland where this study is from.
There are features about sexual health education in Northern Ireland that make the comparison with the rest of the UK informative. The legal age of consent for females is a year older (17), the 1967 Abortion Act does not extend to Northern Ireland and the education system and access to sexual health information is different from the rest of the UK.
This study questioned over 400 teenagers aged 14–18 years and found that while half the respondents were sexually active, only 68 per cent of these always used some form of contraception.
Comparison between Catholic and Protestant schools allowed some assessment to be made of the impact of structured sexual health education appropriate to the target population.
The message to the health professionals seems clear: keep the message going to the young of today in a language that is accessible and understandable to them.
AF in primary care
Heart 2007; 93: 606–12
It is rare to see a piece of primary care research published in Heart. This study set out to examine the epidemiology, primary care burden and treatment of AF in primary care.
Perhaps its greatest value was to point out what we should be achieving with treatment today.
I think we all know that most patients with AF should be anticoagulated. But there is still a tendency to prescribe for the digoxin especially in men and women over 75 years with AF.
However, the proportion of patients being treated with beta-blocker or rate-limiting calcium-channel blocker is increasing.
Dr Holliday is a GP in Eton, Berkshire and a member of our team of GP research reviewers