Journals Watch - RA, depression, IUDs and alcohol

No time to read the journals? Allow Dr Nicolette Price to be your guide to the latest findings.

ALARM USE FOR CHILDREN WITH DAYTIME INCONTINENCE - J Urol 2006; 176: 325-7

This retrospective study considered whether a daytime alarm was helpful in the treatment of 63 children with persistent daytime wetting.

The files of these children - all of whom had a proven diagnosis of overactive bladder on video-urodynamic examination - were reviewed following treatment with an auditory or vibratory buzzer alarm. This consisted of a sensor strip inside the underwear fixed to the alarm device and was activated the moment a drop of urine wet the strip.

The children were taught by a physiotherapist to stop voiding when the alarm activated and then to go the toilet and void in the appropriate manner.

Results were encouraging, and suggest that the daytime alarm is a useful tool. At 12 months treatment failed in 32 per cent, was partially successful in 33 per cent and a complete success in 35 per cent.

SMOKING AND THE RISK OF RHEUMATOID ARTHRITIS IN WOMEN - Am J Med 2006; 119: 503-11

More reasons to deter young women from smoking were provided by this large study, which looked at data from records of 680 women with rheumatoid arthritis (RA). These cases were identified from within the large cohort of women (over 100,000) enrolled in the Nurses' Health study which began in 1976.

The study found that smoking, both past and present, contributes to the development of RA - particularly seronegative RA - and that the risk is proportional to both the daily amount and the number of years of smoking.

This risk was found to be elevated for 20 years following cessation of smoking, which is 10 years longer than has been previously found.

Will this data be effective in deterring young women from cigarettes?

In my opinion probably only if they know or are related to RA sufferers.

ACCEPTABILITY OF INTRAUTERINE DEVICES - J Fam Plan Reproduct HealthCare 2006; 32: 89-94

Around 5 per cent of contraceptive users in the UK use the IUD - fewer than in other areas of Europe.

The study involved semi-structured interviews with 10 women from an urban general practice - none had ever used IUDs but all had used other forms of contraception in the previous six months.

Data were analysed qualitatively and included references to body language such as wrinkling of the nose to indicate disgust at thoughts of insertion during menstruation.

Several unexpected factors were discovered. The women believed that the device had to be fitted during menstruation; they felt that IUDs were a risk for infection unrelated to STIs; and they felt concerned that because they could not see the device they could not be sure of its reliability.

The women also did not like the lack of control of contraception presented by the IUD.

I wonder if similar findings would be made from a larger, more diverse study population, involving many different practices.

OFFSPRING OF PARENTS WITH DEPRESSION - Am J Psychiatry 2006; 163: 6

The aim of this study of 220 offspring of parents with depression was to determine the magnitude and continuity of risk to their health.The subjects were followed up over 20 years.

The risks of anxiety disorder, major depression and substance dependence were around three times higher compared to offspring of parents without depression. Interestingly, higher rates of medical problems and mortality began to emerge in the offspring's approach to middle age.

This is another good reason to treat patients with depression optimally, and to be alert to health problems emerging in their children.

- Dr Price is a medical examiner for the Department for Work and Pensions, a former GP in Hampshire, and a member of our team who regularly review the journals

INFORMING PATIENTS

Daytime incontinence in children can be helped by use of an alarm.

RA risk in women is increased by smoking.

IUDs are unpopular with women because of concerns over infection and reliability.

Depression is three times more likely in offspring of parents with depression.

RESEARCH OF THE WEEK

Family factors in alcohol use - Addiction 2006; 101: 984-92

Parental predictors of problem alcohol use were considered in this study from Finland, which used questionnaires to assess the influence of socio-demographic factors and parental alcohol use on adolescent behaviour.

The researchers found that permanent separation from at least one biological parent was a significant factor, as were parents' alcohol use - particularly that of the father.

The authors suggest that extra support and information about model behaviour should be given to parents whose children are at particular risk.

I am unsure how applicable these data are to the UK population - particularly when I read that the authors considered drinking to be moderate if drink is taken once a month and heavy if taken more than once a week.

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