Journals Watch - H1N1 vaccine, obesity and hearing loss

Not had time to read the journals? Dr Jonathan Holliday brings you up to date with the latest research.

H1N1 vaccine did not lead to disease flare in ulcerative colitis (Photograph: SPL)
H1N1 vaccine did not lead to disease flare in ulcerative colitis (Photograph: SPL)

H1N1 vaccine in patients with inflammatory bowel disease
Gut 2011; doi: 10.1136/gut.2010.233981
This study aimed to evaluate symptoms associated with influenza H1N1 adjuvanted and non-adjuvanted vaccines in patients with inflammatory bowel disease (IBD) treated with immunomodulators and/or biological therapy and to assess the risk of flare of IBD after vaccination.

A total of 575 patients were enrolled (407 with Crohn's disease, 159 with ulcerative colitis and nine with indeterminate colitis).[QQ]Vaccination-related events up to one week after vaccination were recorded.

Of the participants, 34.6 per cent complained of local adverse effects (almost all pain, worse in those receiving vaccine with adjuvant than those without) and 15.5 per cent complained of systemic effects. These adverse effects did not appear to be worse in any particular treatment group

At four weeks post immunisation the absence of disease flare was observed in 96.7 per cent of patients, leading the researchers to conclude that the risk of IBD flare was probably not increased after the H1N1 vaccine.

Medication compliance aids
Br J Gen Pract 2011; 61: 93-100
This qualitative study aimed to assess the benefit of multicompartmental compliance aids (MCAs) in managing medication. There were 19 participants were interviewed.

Participants reported that the MCA enabled them to organise their medication, which improved the efficiency of medicine taking and saved time.

Although the MCA did not prompt patients to take their medication, they could see whether they had actually taken it or not, which alleviated their anxiety. The authors concluded that use of an MCA was beneficial, but advice and support for patients regarding how best to manage their medication and on the most appropriate design to suit their needs would be helpful.

Obesity and fatal CHD
Heart 2011; doi: 10.1136/hrt.2010.211201
The objective of this research was to see whether obesity was an independent risk factor for either fatal or non-fatal CHD. Data from the West of Scotland Coronary Prevention Study were used.

The study involved 6,082 men with hypercholesterolaemia (mean age 55 years), but with no history of diabetes or cardiovascular disease. After excluding patients who had any event in the first two years of the study, 1,027 non-fatal and 214 fatal CHD events occurred over the 14.7 years of follow up.

The risk of fatal events was increased in those with a BMI in excess of 30 (hazard ratio 1.60) despite allowance for cardiovascular disease risk factors and deprivation.

Therefore, obese middle-aged men had a 60 per cent increased risk of dying from MI than non-obese middle-aged men, independent of risk factors, such as high BP, diabetes and arterial disease.

On the other hand, the risk for these obese men seemed to be no worse than their non-obese counterparts when it came to non-fatal events.

Patellofemoral pain and the impact of foot orthoses
Br J Sports Med 2011; 45: 193-7
We are told that patellofemoral pain syndrome (PFPS) often results in reduced performance and now there is growing evidence that the use of foot orthoses can help alleviate some of the symptoms.

This Australian study set out to evaluate the immediate effect of the use of foot orthoses in this condition.

It involved 52 patients with PFPS who were prescribed prefabricated foot orthoses and were immediately evaluated using functional outcome measures.

These measures assessed the change in pain, the ease of a single-leg squat, the change in the number of pain-free step downs and the change in the number of single leg rises from sitting.

Prefabricated foot orthoses produced significant improvements for all functional outcome measures, and the more pronated the foot, the greater the benefit.

Treating chronic fatigue syndrome
Lancet 2011; doi: 10.1016/S0140-6736(11)60096-2
How should we treat our patients with chronic fatigue syndrome? Some patients' organisations suggest that cognitive behavioural therapy (CBT) and graded exercise therapy (GET) can be harmful and favour adaptive pacing therapy (APT) and specialist medical care (SMC).

This parallel group randomised trial set out to clarify the impact of these different treatments.

A total of 641 patients were recruited and randomly assigned to one of four groups (160 to APT, 161 to CBT, 160 to GET and 160 to SMC-alone).

Compared with SMC-alone, mean fatigue scores at one year were better for the CBT and GET groups but unchanged for the APT group. The same pattern was found for physical function scores.

The researchers concluded that CBT and GET could usefully be added to SMC to 'moderately improve outcome'. They suggest that APT is not an effective addition.

MP3 players and hearing loss
J Adolesc Health 2011; 48: 203-8
This study looked at the high frequency hearing sensitivity of 8,710 American teenage girls aged 12 to 20 years over a 24-year period.

All participants were of low socio-economic status and in residential foster care.

Data related to the use of personal listening devices (PLDs), daily hours of usage, occurrence of tinnitus and hearing thresholds between 1,000 and 8,000Hz over an eight-year period (2001-8) were obtained from the adolescents.

High frequency hearing loss (HFHL) increased over the 24-year period from 10 per cent in 1995 to 19 per cent in 2008.

Use of PLDs increased fourfold between 2001 (18 per cent) and 2008 (76 per cent). A positive association was found for HFHL, reported tinnitus, PLD use and hours of use.

  • Dr Holliday is a GP in Berkshire and a member of our team who regularly reviews the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • At a practice meeting, discuss the way in which medication reviews are being carried out and whether individual patient-need for MCAs is being considered and recorded.
  • Research the evidence base for treatment of patients with chronic fatigue syndrome and discuss your findings at a practice meeting.
  • Review the QOF data on the prevalence of obesity within your practice and consider what opportunities there are for intervention and change.

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