Journals Watch - MI risk, depression and back pain

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

Resting heart rate predicts MI risk in women BMJ 2009; 338: b219 doi: 10.1136/bmj.b219
Here is good news from the Women's Health Initiative. This paper is based on a prospective cohort study of almost 130,000 postmenopausal women looking at cardiovascular events.

Coronary thrombus: high resting heart rate in women was associated with increased cornary events (Photograph: SPL)

Higher resting heart rate was independently associated with coronary events but not for stroke. The highest risk was having a heart rate over 76bpm and the lowest at 62bpm.

Ethnicity and diabetes had no additional effects.

This is an interesting outcome, and the authors point to the low tech and inexpensive measure of autonomic tone measurement, but is the risk factor modifiable and is it as important as other lifestyle measures?

TV exposure associated with depression in young adults Arch Gen Psychiatry 2009; 66 (2): 181-8
Trying to get my kids away from the TV, MP3 players, Playstation and Wii, is a daily ritual and the lack of exercise can't be good for them, but what other risks can too much media pose?

An investigation team from the US looked at the risk of depression in adolescents with different media exposures. The study design was a longitudinal cohort study over seven years following 4,142 young men and women.

The results suggested a higher rate of depression proportional to the time watching TV and other media but not to video, computer games or radio. A greater increase was noted in young men compared with women.

Group work does not increase breastfeeding BMJ 2009; 338: a3026 doi: 10.1136/bmj.a3026
On paper it would seem a good idea and bound to succeed. Provide money to run breastfeeding groups for pregnant and breastfeeding women and watch breastfeeding rates increase? Wrong.

Take a group of localities in Scotland in primary care and set up groups. Compare these with localities that already provide groups and you get a cluster randomised controlled trial to check the cost-effectiveness of the strategy.

The primary outcome measure was any breastfeeding at six to eight weeks, and the numbers involved were quite impressive with 27 groups involved and 1,310 women in the new group set up.

Unfortunately, there was no change, with just over a quarter of women breastfeeding at six to eight weeks in both new and old groups.

It is sad to see the initiative was a waste of time, but good to see someone is questioning the effectiveness of interventions that are usually implemented without any evidence of their benefit.

Plain lumbar X-rays not required in low back pain Lancet 2009: 373: 463-72
This meta-analysis of six studies compared immediate lumbar imaging with usual care in a patient with mechanical low back pain (this included MRI and CT).

The studies continued to 12 months looking at various outcome measures including patient satisfaction and improvement in a total of 1,800 patients. The analysis involved criteria based on the Cochrane Back Review Group.

The results showed no significant differences between immediate lumbar imaging and usual care without immediate imaging for primary outcomes at either short-term (up to three months, standardised mean difference 0.19, 95% CI -0.01 to 0.39 for pain and 0.11, -0.29 to 0.50 for function, negative values favour routine imaging) or long-term (six to 12 months, -0.04, -0.15 to 0.07 for pain and 0.01, -0.17 to 0.19 for function) follow-up.

Perhaps the take home message for this isn't for primary care but for those who continue to recommend X-rays in low back pain with no red flags.

Passive smoking may affect memory BMJ 2009; 338: b462 doi: 10.1136/bmj.b462
Passive smoking and the link to respiratory illness has been known for a while now, but this study from the UK looked at its effect on cognition.

The researchers used a cross-sectional analysis of a population from four cohorts of the Health Survey for England.

The 4,809 participants were aged 50 or older and non-smokers. They provided saliva samples and a smoking history.

The saliva samples were tested for cotinine as a biomarker of passive smoking and a battery of neuropsychological tests investigated memory loss.

A trend towards greater memory impairment was seen with increased concentrations of cotinine.

The authors recommended more work to ascertain the risk of dementia.

  • Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who regularly review the journals.

The quick study

  • Resting heart rate is a predicator of MI risk in women.
  • Depression in young adults is associated with excessive TV exposure in adolescence.
  • Breastfeeding rates are not improved by increased spending on group work.
  • Low back pain without red flag symptoms does not require X-rays.
  • Passive smoking may worsen memory.

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