Journals Watch - Dummies, STIs and patient choice

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

Dummies and otitis media - Fam Pract 2008; 25: 233-6
Previous studies of limited methodology suggested that dummies, or pacifiers, are a possible risk factor for acute otitis media in children. This study from Holland hoped to prove or disprove this theory.

A total of 495 children aged between birth and four years were studied over a five-year period. At baseline, any use of a dummy was noted. Of the 216 children using a dummy, 76 (35 per cent) had at least one episode of acute otitis media, while 82 (32 per cent) of the 260 who did not use a dummy developed at least one episode. Although the incidences are similar, in recurrent acute otitis media dummy use was found to increase the risk.

Use of dummies or pacifiers may be a risk factor in recurrent otitis media and parents should be advised

It was concluded that use of a dummy appears to be a risk factor for recurrent acute otitis media and that this should be discussed with parents once an episode of acute otitis media is diagnosed.

Breastfeeding and socio-economic group - Med J Aust 2008; 189: 254-6
Breastfeeding is actively promoted on many health grounds by professionals. This Australian study is of relevance to the UK.

Between 1995 and 2004 the researchers investigated the relationship between socio-economic status and breastfeeding initiation and duration. Any change over the 10-year period was noted.

There was found to be little change over the study period in either rate of initiation of breastfeeding, with over 80 per cent initiation seen in 1995 and 2004, or in duration.

However, although overall duration of breastfeeding remained constant, a difference was seen between socioeconomic groups, with infants in higher socioeconomic groups more likely to be breastfed than in previous years. More effort needs to be invested in disadvantaged socioeconomic groups.

It would be interesting to see a similar study undertaken in the UK.

STIs in older adults - Sex Transm Infect 2008; 84: 312-7
We are all aware that STIs are on the increase, and under-25s are singled out as being the main problem. This study looked at the older population.

From 1996 to 2003, 4,445 episodes of STIs were reported in adults aged 45 years or over at clinics in the West Midlands. Rates in this age group more than doubled in 2003 compared with 1996 for all five infections studied: chlamydia, genital herpes, genital warts, gonorrhoea and syphilis.

Males and those aged 55-59 years were significantly more likely to be infected.

So although young people should remain our main focus, older people should not be ignored as it is clear that they too engage in risk-taking behaviour.

Attitudes toward HPV vaccination - J Adolesc Health 2008; 43: 239-45
The aim of this US study was to examine the attitudes of mothers towards the HPV vaccine.

In Texas, 153 mothers of young girls aged 11-17 years completed a questionnaire. Only 26 per cent of the girls had started the vaccination programme, while another 18 per cent had been offered the vaccination but had not received it. Some 56 per cent had not been offered the vaccine, but, of these, only 22 per cent planned to have the vaccination in the next 12 months.

Mothers were more likely to favour the vaccine if they had less than a high school degree, had a history of STIs and supervised their daughter when she was with peers. The sexual values of the mothers and the anticipated age of the girls' sexual initiation did not appear to have any relevance on the choice of whether to vaccinate or not.

Value of choice for patients - Br J Gen Pract 2008; 58: 609-13
Choice looms large on the government agenda for health but just how interested are patients in having choice? The aim of this study was to explore how patients understand choice in healthcare provision.

In Surrey, 22 participants were recruited and interviewed at length about choice in general and more specifically about choice involving healthcare. Four main themes about choice were identified: the positive aspects of choice, the appearance of choice on the agenda, unwanted choice and the role of information in choice.

Choice was valued in principle but, often, having to make a choice was unwanted and was even considered an indication of erosion of trust in the GP.

The warning of this study was that increasing choice in healthcare may be met with scepticism by the individual patient, which could ultimately undermine, rather than promote the doctor-patient relationship.

Do patients prefer same-day appointments? - Br J Gen Pract 2008; 58: 641-3
Patient access to a GP is much talked about. Recent policy initiatives such as Advanced Access have led to an increase in the number of GP appointments only available to be booked on the day, with the result that many patients are unable to book an appointment in advance.

This large study involving 12,825 patients in 47 practices looked at the relationship between the proportion of GP appointments reserved for same-day booking and patient satisfaction with appointment systems.

It found that a 10 per cent rise in the proportion of same-day appointments was associated with an 8 per cent decrease in the proportion of patients satisfied, particularly in older patients.

Practices should be cautious about increasing the proportion of same-day appointments, especially as the UK already has fast access times in comparison with other countries.

In my own practice, we found that patients were very unhappy when we trialled an appointment system in which the majority of appointments were only available to be booked on the same day, so we have now returned to a sensible mix of pre-bookable and same-day appointments. Both doctors and patients are much happier as a result.

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

The Quick Study

  • Recurrent acute otitis media appears to be linked to using a dummy.
  • Breastfeeding should be encouraged in lower socio-economic groups.
  • STI rates doubled in the 45 and over age group between 1996 and 2003.
  • HPV vaccination is chosen for girls regardless of the mother's sexual values.
  • Patient choice in healthcare may undermine the doctor-patient relationship.
  • Same-day appointments are not necessarily associated with patient satisfaction.

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