Hawthorn's anti-hypertensive effects
Br J Gen Pract 2006; 56: 437-43
More and more patients ask about herbal treatments and alternative therapies. Usually I have to plead lack of knowledge about their effects, so it was useful to read some positive findings about the effect of hawthorn on BP in patients with type-2 diabetes and hypertension. Hawthorn berries, flowers and leaves have been used widely throughout Europe to treat several cardiovascular diseases, including hypertension. The active components of hawthorn are flavonoids, as found widely in fruit and vegetables, and are known to have health benefits.
Anti-hypertension drugs were used by 71 per cent of the study population of 79. A mean intake of 4.4 drugs for hypertension and hyperglycaemia were being taken. Although hawthorn had no significant effect on systolic BP, it did have a significant effect in lowering diastolic BP, with mean diastolic BP reduced from 85.6mmHg to 83.0mmHg with minimal side-effects and no herb-drug interactions.
I shall happily be recommending it to my patients.
The importance of the personal GP
Fam Pract 2006; 23: 308-16
Every week we read about the moves to dismantle general practice. But what do patients want?
This study from Barcelona involved a search of all papers identifying attributes of family practice influencing primary healthcare outcome, as measured by user satisfaction, improvement in healthcare and in cost.
Nineteen articles were found, and the results established that user satisfaction was associated with accessibility, continuity of care, consultation time and the doctor-patient relationship. Improvement in healthcare was also related to all these factors, with the exception of accessibility.
Doctors and nurses on the high street will only provide easy access, so the government's plans would seem unlikely to help.
Chlamydia and associated long-term problems
Sex Transm Infect 2006; 82: 212-8
Chlamydia screening is being rolled out for 16-24-year-olds across the UK in order to reduce the long-term complications of pelvic infection, ectopic pregnancy and infertility, but how effective will this be?
Not as good as might be thought, according to this large Swedish study looking at long-term problems over 10 years. Cumulative incidence of pelvic infection was 3.9 per cent overall: 5.6 per cent in those who had ever tested positive for chlamydia; 4 per cent in those with negative tests; and 2.9 per cent in those never screened. Corresponding figures for ectopic pregnancy and infertility showed a slight increase too for those ever testing positive for chlamydia but not as great as might be expected.
Incidence of severe chlamydia-associated complications was lower than expected, which may mean that the benefits of chlamydia screening may have been overestimated.
Choice in bowel cancer screening
Med J Aust 2006; 184: 546-50
Screening for bowel cancer is soon to be introduced in the UK and also in Australia, where choice of screening test and participation rate in a screening programme was studied.
A random group of more than 1,300 people aged 50-54 years or 65-69 years were invited to participate by faecal occult blood testing (FOBT), FOBT and flexible sigmoidoscopy, CT colonography or colonoscopy, or were offered a choice of screening tool.
In total 20.9 per cent of people participated, with the highest participation in the FOBT group. Giving a choice did not greatly improve participation.
Yield of advanced colorectal cancer was higher in those screened by colonoscopy, so perhaps this should be considered as a screening tool.
- Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who reviews the journals
Diastolic BP is lowered by herbal hawthorn preparations but they have no effect on systolic BP.
Continuity of care is key to patient satisfaction.
Chlamydia screening might not reduce pelvic infection as much as expected.
Bowel cancer screening uptake is not increased by offering a choice of method.
RESEARCH OF THE WEEK
Uses of raloxifene
JAMA online doi:10.1001/jama.295.23. joc60074
We all know about tamoxifen's usefulness in reducing breast cancer risk, and I was aware that raloxifene has been shown to cut breast cancer risk when used in the treatment of osteoporosis, but I did not realise the extent.
This study found that raloxifene is as effective as tamoxifen in reducing breast cancer risk, with a lower risk of thromboembolic events and cataracts.
Sounds to me like an additional good reason to use raloxifene for treatment and prevention of osteoporosis.