Journals Watch - Down's syndrome, TB and CFS

Too busy to catch up on the research? Let Dr Lizzie Croton guide you through some recent papers.

National screening for Down's syndrome BMJ 2008; 337: a2,547
This Danish population-based cohort study evaluated the impact of a first trimester screening strategy for Down's syndrome on the numbers of chorionic villus samplings (CVS) and amniocenteses performed.

Photograph: Saturn Stilis/SPL

Danish researchers looked at the impact of screening for Down’s syndrome in the first trimester

Women were given a risk assessment, and those with a risk above the cut-off point were offered CVS or amniocentesis. The objectives were to determine detection and false positive rates.

The total number of CVS and amniocenteses halved from 2000-2006. The detection rate for Down's syndrome increased from 86 per cent in 2005 to 93 per cent in 2006. Corresponding false positive rates were 3.9 and 3.3 per cent.

The introduction of the combined risk assessment during the first trimester at a national level halved the number of infants born with Down's syndrome and resulted in a sharp decline in the number of CVS and amniocenteses performed.

Contribution of violence to health inequalities J Epidemiol Community Health 2008; 62: 1,064-71
This study used emergency hospital admissions for assault in England in order to determine assault demography and contribution to health inequalities.

From 2002 to 2006, rates of admission increased by 29.6 per cent. Admissions peaked on Saturdays (22.3 per cent) and Sundays (20.4 per cent).

Males were 5.59 times more likely to be admitted for assault with a peak in admissions between the ages of 15 and 29.

Study figures suggest that while attendances for assaults at A&E have fallen generally, there has been an increase in assaults requiring admission.

The study concludes there is a direct contribution made by violence to health inequalities. These levels of violence inhibit other interventions to improve the health of patients, such as the delivery of health-related services in affected areas.

Childhood TB treatment Arch Dis Child 2008; 93: 1,017-21
This surveillance study examined children <16 years old with TB in England and Wales. A total of 3,563 cases were reported between 1999 and 2006. Incidence rate was stable at 4.3 per 100,000.

Non UK-born patients had a higher incidence than those born in the UK, (37/100,000 versus 2.5/100,000) and this rate increased over the period. Rates were highest in the black African group (88/100,000).

Sixty per cent of children had pulmonary disease. Only 27 per cent of children had culture-confirmed TB.

The proportion of cases with rifampicin, isoniazid and multi-drug resistant isolates were 2.4, 9.3 and 2.3 per cent, respectively. Eighty-eight per cent of cases completed treatment and less than 1 per cent died.

Drug use in children BMJ 2008; 337: a2,245
A five-year retrospective cohort study (2000-2005) examined outpatient-prescribed drug use in children from the UK, the Netherlands and Italy. Data were obtained from primary care research databases.

The participants were 675,868 children aged up to 14 (Italy) or 18 (UK and the Netherlands). Outcome measures included the prevalence of use per year by drug class, prevalence of recurrent/chronic use defined as three or more prescriptions per year, and 'acute' use defined as fewer than three scrips per year.

Levels of drug use were identified: high (>10 per 100 children per year), moderate (one to 10 per 100 children per year) and low (<1 per 100 children per year).

In all ages, anti-infective, dermatological and respiratory drugs were in the high use group. Cardiovascular and neoplastic drugs were in the low use group. Emollients, topical steroids and asthma drugs had the highest prevalence of recurrent use.

In the top five highest prevalence drugs, topical, inhaled and systemic steroids, oral contraceptives, and topical or systemic antifungal drugs were most commonly used off label.

Data from this study may be useful to prioritise paediatric therapeutic research needs.

Endocrine symptoms and risk of breast cancer recurrence Lancet Oncol 2008; 9: 1,143-8
During endocrine treatment for breast cancer, symptoms of estrogen depletion may be predictors of treatment efficacy.

This retrospective analysis examined the relationship between reported incidence of vasomotor or joint symptoms and breast cancer recurrence in women with estrogen receptor positive tumours receiving either tamoxifen or anastrozole.

Of 3,964 eligible women, 1,486 (37.5 per cent) reported new-onset vasomotor symptoms at the three-month follow-up visit. These women also had lower recurrence than those who did not report these symptoms.

These figures were adjusted for age, BMI, previous HRT use, nodal status, and tumour size and grade. A greater decrease in cancer recurrence was also seen in women reporting new-onset joint symptoms at three months - 1,245 of 3,964 eligible women (31.4 per cent).

The emergence of new-onset endocrine symptoms may serve as reassurance to women of treatment efficacy and encourage perseverance and treatment compliance.

Depression in patients with chronic fatigue syndrome Fam Pract 2008; 25: 414-22
This study used the nationally representative Canadian Community Health Survey to determine the prevalence and correlates of depression among patients with chronic fatigue syndrome (CFS).

The survey contained an unweighted sample of 1,045 patients with a diagnosis of CFS together with data on associated depression. Of the patients with CFS, 369 (36 per cent) reported depression.

Among patients with CFS, depression was associated with lower levels of achievement and self-esteem.

Two-fifths of patients with depression had not received any professional mental health input in the preceding year and 22 per cent had seriously contemplated suicide in the past year. Depressed patients with CFS were heavy users of primary care with 11.1 GP visits per year (95 per cent CI 10.7-11.6).

The study emphasised the importance of assessing suicidal ideation in depressed CFS patients in the above high-risk groups.

  • Dr Croton is a salaried GP in Birmingham and a member of our panel who regularly review the journals

The quick study

  • Down's syndrome screening decreases the number of affected infants born.
  • Paediatric drug use may be assessed to help prioritise paediatric therapeutic research needs.
  • Childhood TB has a higher incidence in children born outside of the UK.
  • A&E admissions for violent assaults suggest a correlation between violence and health inequalities.
  • Breast cancer recurrence seems less likely in women experiencing treatment-related symptoms.
  • Chronic fatigue syndrome patients with depression should be assessed for suicidal ideation.

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