Journals Watch - Acupuncture, SSRIs and alcohol

Too busy to read all the journals? Let Dr Jonathan Holliday keep you up to date with the research.

Auricular acupuncture for low back pain in pregnancy - Am J Obstet Gynaecol 2009; 201: 271.e1-271.e9
This trial compared continuous auricular acupuncture at specified sites on the ear lobe with continuous auricular acupuncture at other sites not found to be beneficial ('sham' sites) and a control group who received no treatment. Subjects were pregnant women with gestational age between 25 and 38 weeks who had lower back pain and/or posterior pelvic pain.

The study group received continuous acupuncture at three points (kidney, analgesia and shenmen) for one week while the sham group used shoulder, wrist and extra-auricular points.

Results were assessed using the Visual Analogue Scale for Pain and Disability Rating Index. At day seven of follow up, 80 per cent of the acupuncture group reported a clinically significant reduction in pain, while 59 per cent of the sham group did so.

In the control group, 47 per cent were improved.

On the positive side it is a non-drug intervention for what can be a difficult group to treat. On the negative side these were self-selected subjects and the results are not fantastic.

HPV and penile carcinoma - J Clin Pathol 2009; 62: 870-2
Penile carcinoma is not common but I had not realised that there was any association with HPV.

This paper was a review of 31 studies worldwide, including 1,466 penile carcinomas. HPV prevalence among them was 46.9 per cent, with 74 per cent of those being HPV-16 and HPV-18 (60 per cent HPV 16).

What the authors could not say was what the influence of multiple infections was. However, there is an association in about half of penile tumours with HPV 16 and 18.

The authors concluded that available HPV vaccines are likely to be effective in penile tumours.

Penile tumour is relatively rare in developed countries, accounting for less than 1 per cent of adult male cancers in Europe and North America. It is much more common in certain other areas of the world, accounting for 10 per cent of all malignant tumours in men in South America, Africa and Asia. The authors conclude that about 7,000 cases would be prevented annually by the eradication of HPV 16 and 18.

Alcohol consumption and CHD in male physicians - Am J Cardiology 2009; 104: 932-5
Although so far clear of heart disease and hypertension, being a male physician I took notice of this study.

We know - and many of us tell our patients - that moderate drinking is associated with a decreased risk of cardiovascular disease, yet higher amounts of alcohol consumption are known to increase BP.

This US group interrogated data from the Physicians' Health Study, picking 5,164 participants who were apparently healthy and free of CHD at baseline.

From 1982 to 2008, 623 cases of MI occurred. The authors corrected for all sorts of variables, from breakfast cereals and multi-vitamin use to smoking, BMI and age, and came up with some reassuring answers.

Hazard ratios compared with drinking less than 1 drink per week were 1.05 for 1-4 drinks per week, 0.78 for 5-7 drinks per week, and 0.57 for more than eight drinks per week.

The weakness of the study is that it talks of drinks not units, and there is no mention of the upper limit.

SSRIs in pregnancy - BMJ 2009:339: b3,569
This population-based study looked at 493,113 children born in Denmark between 1996 and 2003 to investigate any association between SSRIs and congenital malformations.

SSRIs were not generally associated with major malformations, but they did appear to be linked with septal heart defects (odds ratio 1.99). Specifically sertraline had an odds ratio of 3.25, citalopram 2.5, and fluoxetine 1.34.

The window for exposure to an SSRI was calculated as between 28 days before and 112 days after the beginning of gestation. The risks appear to be even greater if there is a change of SSRI during the exposure window, or if a combination of SSRIs is used.

The authors expressed the view that this is probably a class effect. There is a general increase in the use of SSRIs, but perhaps prescribers should think twice before prescribing where pregnancy is a possibility.

Suicide risk and perceived and actual weight - JAdoles Health 2009; 45: 292-5
Suicide is the third leading cause of death among young people and the rate is increasing, particularly for young girls. These analyses were based on cross sectional data from the 2007 Youth Risk Behaviour Survey which included 14,000 US high school students.

Of the students, 62 per cent described themselves as not overweight and the figures the participants gave supported this; 9 per cent said they were not overweight, when they were; 11 per cent said they were overweight when they were not; and 18 per cent correctly said they were overweight.

Both those who perceived that they were overweight and those who were actually overweight carried an increased suicide risk, but the association was stronger for perceived excess weight (odds ratio 1.45).

Comparing those who perceived that they were overweight even though they were not with those who did not perceive themselves as overweight and were not overweight gave an even greater odds ratio at 1.73.

So, we should be aware to watch out for both excess weight and perceived excess weight when considering the mental health of teenagers.

Decline in MIs after the smoking ban - Circulation 2009: doi; 10.1161/CIRCULATIONHA.109. 870691
This was a meta-analysis to examine the impact of recent public and workplace smoking restriction laws.

The US has seen a significant drop in the rate of acute MI hospital admissions associated with the implementation of smoke-free legislation.

There was quite a variation in effect seen in different studies but the authors put this down to differences in the duration of the studies.

The pooled random-effects estimate of the rate of acute MI hospitalisation 12 months after implementation of the law was 0.83 (95% CI, 0.8-0.87), which is fantastic. Of course this benefit grows with time.

The authors are right to claim that 'passage of strong smoke-free legislation produces rapid and substantial benefits in terms of reduced myocardial infarctions', something to hold on to when people start talking too much about freedom of choice.

  • Dr Holliday is a GP in Eton, Berkshire, and a member of our team who regularly review the journals

The Quick study

  • Auricular acupuncture offered a clinically significant reduction in low-back pain in pregnancy.
  • Penile tumours are associated with HPV in about half of all cases.
  • CHD risk is not linked to alcohol consumption in hypertensive men.
  • SSRIs taken in pregnancy are associated with septal heart defects in the child.
  • Suicide risk is higher in teenage girls who perceive themselves as overweight.
  • MI admissions have decreased since the introduction of the smoking ban.

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