Journals watch: Self-tests, fortified milk and methadone

Too busy to read the journals? Let Dr Suzanne Hunter guide you through the latest findings

Self-testing kits
J Pub Health 2006; 28: 370–4 

A few years ago the expression ‘near-patient testing’ became a new buzz-word. Although the expression has been lost in the plague of newer, buzzier words, the concept has moved forward to a new dimension.

By doing a simple internet search, these researchers identified 104 unique self-test kits for 24 named conditions that a UK resident could buy over the internet, without recourse to a health professional. Some give a result immediately while others had to be posted to a laboratory.

Among the tests were prostate specific antigen, one for glandular fever, chlamydia and human papilloma virus (which at £76 was the most expensive).

They started at under £1 and 80 per cent were under £30.

Education and teenage pregnancy rates
BMJ 2007; 334: 133–7

The UK is not a world leader in many areas these days, but teenage pregnancies is one area where we are.

A programme called SHARE (sexual health and relationships) was set up in Scotland.

Teachers went on a five-day course where they learned a sociopsychological approach to teach children skills to negotiate sexual encounters, handle condoms and access services, primarily through the use of interactive video but also role playing.

Over a three year period this was compared with the conventional approach to sex education by comparing the teenage conception and termination rate between schools using the SHARE approach with those not.

The results showed that the SHARE intervention was ineffective at reducing conceptions. There were large differences in rates of conceptions and terminations between schools and there was a strong relation between conceptions and social deprivation.

Once again the main determinant of adverse events is deprivation.

Fortified milk reduces child illness
BMJ 2007; 334: 140–4 

It is known that deficiency in micronutrients is prevalent in pre-school children in developing countries and predisposes these children to common childhood infections.

In this study from India, children aged one to three years old were given supplementary milk fortified with zinc, iron, selenium, copper and vitamins A, C and E, and compared with controls receiving no fortification.

Children who received fortified milk compared with those who received the milk without had 18 per cent lower incidence of diarrhoea, 26 per cent lower incidence of pneumonia, 7 per cent fewer days with high fever and 15 per cent fewer days sick.

This is a significant reduction and it shows the importance of nutrition to health, particularly the micronutrients. 

Methadone deaths
J Pub Health 2006; 28: 318–23 

Using heroin leads to a 6-20 fold increase in the risk of death. The mainstay of treatment is methadone substitution, which was introduced in the 1970s. Initially, with the British system of administering it, the patients were unsupervised when taking it, they were often given tablets rather than syrup and many patients received a week’s supply at a time. It could be prescribed by any doctor. As a result, there were many methadone-related deaths, with a peak on Saturday, when patients were prescribed more for the weekend.

In 1996 a task force published guidelines to increase the safety and effectiveness of methadone prescribing, and these were revised in 1999.

This study examined the impact of these guidelines. While heroin-related deaths increased dramatically, methadone-related deaths fell. The Saturday effect was reduced.  

Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals 

Research of the week 

Obesity reduces accuracy
Int J of Obesity 2006; 30: 1,750-1,757 

It is known that obese individuals have a decreased postural stability and increased chance of falling.

This study tested whether obesity had a negative effect on upper limb movements by asking healthy obese and lean individuals to aim at a moving target after hearing a sound.

The obese group were slower and less accurate. It was concluded that obese workers may be less efficient and at greater risk of injury in certain work tasks.

This fails to explain how world darts champions tend to be ‘bigger boned’.

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