Journals Watch - Adiposity and sexual health

Too busy to catch up on the latest research? Let Dr Gwen Lewis update you on the leading articles.

Abdominal adiposity and risk of death N Engl J Med 2008; 359: 2,105-20
BMI is used to assess the association of adiposity with risk of death. Few studies have examined whether distribution of body fat contributes to prediction of death.

Waist circumference and waist-to-hip ratio were strongly associated with increased risk of death

This huge study involving 359,387 participants from nine countries in Europe looked at the association between BMI, waist circumference and waist-to-hip ratio and risk of death.

During the mean follow-up duration of 9.7 years, a total of 14,723 participants died. The lowest rates of death related to BMI were at a BMI of 25.3 for men and 24.3 for women.

Waist circumference and waist-to-hip ratio were strongly associated with risk of death.

Data suggest that both general and abdominal adiposity are linked to risk of death and support use of waist circumference or waist-to-hip ratio in addition to BMI for assessing risk.

Acceptability of long-acting reversible contraception J Fam Plann Reprod Health Care 2008; 34: 213-7

Long-acting reversible contraception (LARC) is both effective and cost-effective, but remains underused.

Discussion of LARC with patients will be included in the quality framework from next year, so GPs will benefit financially by encouraging use of these methods.

This study was part of a small campaign to increase awareness of LARC. It involved focus groups with 55 women in two centres in Scotland.

The women were asked about contraception in general, about condoms and pills in particular, and about LARC, both before and after having been given detailed information.

Generally, women were poorly informed about LARC, had firm but incorrect beliefs about its safety and side-effects and disliked any method that involved an invasive procedure. More information about LARC needs to be made available, such as ease of use and reversibility.

Ovulation incidence with oral contraceptives J Fam Plann Reprod Health Care 2008; 34: 237-46

Oral contraceptives are a commonly used method of contraception and are very effective if taken correctly. The combined oral contraceptive (COC) works by inhibiting ovulation but the progesterone-only pill (POP), with the exception of desogestrel (Cerazette), does not reliably inhibit ovulation.

An extensive literature search was undertaken to assess the incidence of ovulation with available COCs, traditional POPs and with desogestrel.

Many of the studies were hampered by inadequate ovulation criteria. The overall incidence of ovulation was 2 per cent with COCs containing 30-35 micrograms of estrogen and 1.1 per cent with 20 micrograms estrogen COCs.

Ovulation occurred in 1.25 per cent of those taking desogestrel and in 42.6 per cent of those taking traditional POPs.

The incidence of ovulation in those taking COCs was higher than I would have expected.

Sexual health services Sex Transm Infect 2008: 84 395-9
Sexual health will feature more prominently in the quality framework from next year and we as GPs are in an excellent position to be able to offer sexual health services.

Traditionally, contraceptive and STI services have been provided separately by family planning and GUM clinics, but providing both services in a 'one-stop' clinic at the GP surgery has been seen as a way to improve access to care.

By means of semi-structured interviews and focus groups, attitudes of young men towards services were assessed.

It was found that the concept of clinics dealing with both contraception and sexual infections in a single visit was preferred, although there was variation between different groups.

We must try to offer these services in order to improve sexual health services for patients.

Cost of genital wart treatment STI online 2008 doi:10.1136/sti.2008.033837
The UK's HPV vaccination programme commenced using Cervarix, the bivalent vaccine against the cervical-cancer causing HPV types 16 and 18.

Vaccination with the quadrivalent vaccine Gardasil would additionally have protected against genital warts (HPV 6 and 11), as well as cervical cancer.

In this study from south-west Ireland, the cost of treatment of each case of genital warts in sexual health clinics over a three-week period was calculated.

A total of 25.5 per cent of the attendances at clinics was for genital warts, at an average cost of EUR335 (approximately £284) per case. Treatment of women was slightly more expensive.

So there is a considerable cost associated with genital warts. The decision not to use the quadrivalent vaccine does seem to be a lost opportunity.

Information and continuity of care in general practice Br J Gen Pract 2008; 48: 784-9
Changes in general practice mean that patients are now less likely to see their own GP, as multi-physician clinics are encouraged. The availability and communication of medical information is now crucial as patients are increasingly being treated by doctors who do not know their medical history.

A rigorous systematic review of relevant databases was used to find out how informational continuity is developed in general practice.

Results show that informational continuity of care is developed using paper or electronic records and information remembered by the GP over a series of consultations.

Obstacles to informational continuity of care include doctors not recording patient information and patients not disclosing important details.

  • Dr Lewis is a GP in Windsor, Berkshire and a member of our team who review the journals.

The quick study

  • Waist circumference and waist-to-hip ratio are strongly associated with risk of death.
  • Long-acting reversible contraception should be promoted to women, with more information and advice available to patients.
  • Ovulation is suppressed by COCs but POPs are less effective.
  • Contraceptive and STI services from a 'one-stop' service would be appreciated by young men.
  • Genital warts had an average treatment cost of EUR335 per case.
  • Continuity of care can be improved by good record keeping.

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