Journals Watch - HPV, irritable bowel and liver disease

Too busy to read all the journals? Let Dr Lizzie Croton keep you up to date with the latest research.

Cervical cancer is associated with low socioeconomic status and low education levels
Cervical cancer is associated with low socioeconomic status and low education levels

Risk of cervical cancer and education level Br J Cancer 2009; 101: 865-70. doi:10.1038/sj.bjc.6605224
Cervical cancer is associated with poor education, even in an unscreened population. It is not known, however, whether HPV follows the same pattern.

This study used two large case-control studies of cervical cancer and HPV prevalence. Educational level was consistently associated with cervical cancer risk, with the odds ratio for cancer decreasing with formal education in excess of five years. There was no association seen between educational level and HPV infection.

The vast majority of women studied had never had a cervical smear.

The association between educational level and cervical cancer was most closely correlated by adjustment for age at first sexual intercourse and first pregnancy. Important confounding factors were parity and screening history (but not lifetime number of sexual partners or smoking history).

Cervical cancer in women with low socioeconomic status appears to be explained by early events in a woman's sexually active life that may modify the potential of HPV to cause cancer.

Fibre for IBS symptoms BMJ 2009; 339: b3154
This general practice-based study looked at the effects of increasing amounts of dietary soluble (psyllium) or insoluble fibre (bran) in patients with IBS. The focus was 275 patients aged 18-65 with IBS.

They received 12 weeks of treatment with psyllium, bran or rice flour used as a placebo. The primary endpoint was adequate symptom relief during at least two weeks of the previous month. Secondary endpoints included IBS symptoms severity scores, severity of abdominal pain and IBS quality of life scale.

Severity scores were reduced mostly in the psyllium group, with no differences between the groups with respect to quality of life. After three months, 64 per cent of patients allocated to psyllium, 56 per cent in the bran group and 60 per cent in the placebo group completed the three-month treatment period.

Early dropout was most common in the bran group, with the main reason being an increase in symptom severity.

Psyllium appears to offer benefits in patients with IBS.

Sex differences in ACS JAMA 2009; 302(8): 874-82
There is conflicting opinion as to whether sex differences influence short-term mortality following acute coronary syndrome (ACS).

This study pooled patients from 11 independent ACS clinical trials between 1993 and 2006. Of the 136,247 patients 28 per cent were women.

The 30-day mortality was 9.6 per cent in women and 5.3 per cent in men. After multivariate adjustment, mortality was not significantly different between men and women.

Short-term mortality was higher in women with STEMI (ST elevation myocardial infarction). In non-STEMI (non ST elevation MI) and unstable angina mortality was lower among women.

There was no difference in sex mortality after adjustment for angiographic disease severity, suggesting mortality appears to be affected by clinical differences in presentation rather than patient sex.

Therapy in generalised anxiety disorder Am J Psychiatry 2009; 166: 875-81
The aim of this study was to compare short-term psycho-dynamic psychotherapy with cognitive behavioural therapy (CBT) in the treatment of generalised anxiety disorder (GAD).

Patients with GAD were randomly assigned to receive CBT (29 patients) or short-term psychotherapy (28 patients). Treatments were given according to protocol and included up to 30 weekly sessions.

Results were measured according to the Hamilton Anxiety Rating Scale by researchers blind to the treatment received.

Both treatments revealed significant, large and stable improvements in symptoms of anxiety and depression with no significant difference between the two. However, CBT was superior with regards to symptoms of trait anxiety, worry and depression.

LFTs and risk of liver disease Fam Pract 2009; 26(4): 251-9; doi:10.1093/fampra/cmp025
Patients with abnormal LFTs but no obvious symptoms present a clinical conundrum in primary care. This Scottish population-based retrospective cohort study examined patients with abnormal LFTs and no clinically obvious liver disease at testing.

A total of 95,977 patients had 364,194 incident initial LFTs and were followed up for a median of 3.7 years. A total of 21.7 per cent of patients had at least one abnormal LFT and 1.15 per cent developed liver disease.

Elevated transaminases were strongly associated with liver disease. Elevated gamma-glutamyl transferase was also associated with the development of liver disease. Low albumin was strongly associated with all-case mortality.

All abnormal LFTs were predictive-markers for liver disease as well as general ill-health, although sensitivity was low.

The time taken for the development of liver disease provides an opportunity for clinical intervention.

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

The quick study

  • HPV shows no association with educational level, unlike cervical cancer.
  • IBS patients benefit from dietary soluble fibre.
  • ACS short-term mortality is not influenced by patient sex.
  • Psychodynamic psychotherapy and CBT are both useful in generalised anxiety disorder.
  • Abnormal LFTs are predictive markers for future liver disease.

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