Journals Watch: Circumcision, chronic pain and PTSD

Don't have time to read the journals? Dr Nicolette Price provides a round up of the latest findings

Behavioural therapy for post-traumatic stress
JAMA 2007; 297: 820–30

Post-traumatic stress disorder (PTSD) is more common in women than men in the US, and as would be expected, is particularly high in women who have served in the military.

This randomised trial of women who have served in the US military compared the effects of prolonged exposure, a form of cognitive behavioural therapy (CBT) in which the patient is asked to repeatedly recount a traumatic event until their emotional response reduces, against a more supportive intervention in which therapists helped patients identify daily stresses, and discussed them in a non-directive, supportive fashion.

The authors noted that the event most commonly identified as the worst traumatic experience was sexual trauma.

CBT was found to be the more successful approach, producing a benefit that persists over time.

Male circumcision for HIV prevention
Lancet 2007; 369: 657–66

Almost 5,000 men aged 15 to 45 years were enrolled in this trial in Uganda. They received HIV testing, counselling and education, and were randomised to receive immediate or delayed circumcision.

The trial was stopped early when interim analyses showed significant efficacy of circumcision in reducing incidence rates of HIV infection. The authors concluded that circumcision can be recommended for HIV prevention in men, but stressed the need for careful attention to training of providers and provision of appropriate standards of care to minimise and manage complications. 

Risks factors for first-trimester miscarriage
BJOG 2007; 114: 170–86

Investigation into the risk factors associated with miscarriage was the aim of this study involving around 6,700 British women. Postal questionnaires were used to assess behavioural, socio-economic and other factors.

It was confirmed that eating healthily, vitamin supplementation and reducing stress levels all contributed to a decreased risk of miscarriage. There was no demonstrable link to caffeine consumption, social class, employment, strenuous exercise or, surprisingly, smoking.

Increased risk was associated with previous termination, stress, low pre-pregnancy weight and change of partner.

Researching the ‘good death’
BMJ 2007; 334: 521–4

This study was performed in direct response to an editorial in the BMJ in 2003 asking ‘What is a good death?’

Participants included a panel of 32 researchers, seven patients with cancer experience and four carers.

Difficulties surrounding researching end-of-life experiences included overzealous ‘gate keeping’ by health professionals, uncertainty about defining ‘end of life’ and patients lacking awareness of their prognosis.

The authors concluded that many people facing death may want to be included in research.

A larger study population, particularly of patients, would have helped me accept this conclusion.

Sleep quality and pain-related disability
Pain 2007; 127: 243–52

This study recruited 155 patients with chronic pain and asked them to complete several questionnaires relating to sleep quality and quantity, depression and pain.

Analysis of the data revealed that poor sleep pattern and quality was related to depression and pain-related disability.

Various mechanisms for the processes involved were suggested, but for me the take-home message is that anything done to help the patient sleep better may eventually help reduce pain-related disability.


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