Journals Watch - Anorexia, teen suicide, HPV and weight loss

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

Eating disorders among 5-13 year olds Med J Aust 2009; 190 (8): 410-4
This was a prospective study using the Australian Paediatric Surveillance Unit. Patients aged 5-13 years old with early-onset eating disorders were identified from a pre-selected population seeing child health specialists.

Criteria for diagnosing anorexia nervosa are not reliable in children

Of the 101 children, 75 per cent were girls. Overall, 80 per cent were hospitalised and stayed in for one month on average.

Of the in-patients, 70 per cent were admitted to specialist eating disorder units in paediatric teaching hospitals - I wonder whether we would manage so well in the UK.

A total of 37 per cent met the diagnostic criteria for anorexia nervosa but 61 per cent had life-threatening complications of malnutrition. This led the authors to suggest that the criteria for diagnosing anorexia nervosa are not reliable in this age group.

Most of the life-threatening complications occurred at admission and gave rise to the consideration that the correct diagnosis is being missed by general doctors on first presentation.

With 58 per cent receiving nasogastric feeding and 34 per cent receiving psychotropic medication they were keen to underline the severity of the condition, and the prevalence among boys. I think we are getting better at recognising that this disorder affects males too, however.

Teenage drinking, suicidal ideation and suicide attempts J Adolesc Health 2009; 44: 335-41
Data were examined from the Signs of Suicide (SOS) programme, which screened 31,953 US students in 2001/2002.

Two types of alcohol use were examined: heavy episodic drinking and drinking while 'down' (sad or depressed). Self-reported suicide attempts were regressed on suicidal ideation and both types of alcohol use.

Suicidal ideation is common in young people, with approximately one third of adolescents having experienced such thoughts in their lives. Indeed, suicide is the third leading cause of death for young people in the US aged 10-24.

I suppose that there is little surprise that drinking while down increased the risk of attempted suicide.

Perhaps less obviously, the association between heavy episodic drinking and risk of suicide attempt was equal among those who had and who had not reported suicidal ideation in the preceding year.

It seems we have another reason for enquiring about alcohol use among teenage patients.

HPV before coitarche Am J Obstet Gynaecol 2009; 200: 487e1-487.e5
The aim of this study was to find the prevalence and the natural course of anogenital HPV infections in girls prior to coitarche.

Specimens were taken from the anogenital region of 114 unselected 4-15 year olds referred consecutively for various gynaecology problems. Four girls were excluded because of sexual abuse but among the remaining 110, low-risk HPV-DNA was found in four girls and high-risk HPV-DNA in 15.

Of those 15 girls, after one year, two had persistent high-risk HPV-DNA and one girl had changed to low-risk HPV-DNA.

I had not expected any infection in this sexually naive group let alone among more than 10 per cent. The persistence in a small proportion of those affected may well be contributing to the reservoir for HPV-associated disease later in life.

Weight loss interventions in primary care Br J Gen Pract 2009; 59: 349-55
Pressure and expectations are growing for us to do something about the weight of our patients.

This pilot study looked at the success of structured interventions compared with usual care. It made no attempt to cost it. Despite being a small study, it does point the way to a possible successful intervention.

A total of 103 participants were followed up over a 12-week period. All were motivated to lose weight and all had BMIs in excess of 27.

Just under 20 per cent of the usual care group lost more than 5 per cent of their initial weight while 34 per cent of the structured intervention group did so.

The structured programme included topics for discussion, weight targets and advice on activity levels. Surprisingly the use of pedometers appeared not to influence weight loss, despite being seen by participants as an additional stimulus.

Distilling the essence of general practice Br J Gen Pract 2009; 59: 356-63
Apothecaries used to talk about the mystery and art of what is now general practice. The debate still goes on with those on one side proclaiming that if you cannot measure it, it must be no good, and those on the other that the relationship between patient and doctor is the conduit for all good things.

The Essence project, initiated by RCGP Scotland in conjunction with International Futures Forum four years ago, is a constructive response to the many changes that have occurred in general practice in recent years.

This discussion paper records the journeys taken by two groups of Scottish doctors and the subsequent discussion day to determine key roles for future GPs and a summary of personal qualities such GPs required.

It concluded that challenges for GPs include that of retaining their role in changing times and raising quality across the whole of the GP spectrum.

The paper suggested general practice should remain central to the development of healthcare because 'only general practice offers the key advantages of trust, co-ordination, continuity, flexibility, universal coverage and leadership'. The trouble is that little objective measurement remains available.

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

The quick study

  • Anorexia can be severe in children and a quarter of young patients are boys.
  • Teenage suicide attempts may be associated with alcohol.
  • HPV occurs in the absence of sexual exposure.
  • Weight loss might be improved with the help of a structured intervention.
  • GPs face a challenge of retaining their role in changing times and raising quality across the whole of the GP spectrum.

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