Journals watch: Smokefree law benefits, cancer survivors depression, understanding cardiovascular risk scores

Too busy to read all of the journals? Dr Louise Newson selects papers of interest to primary care.

Smoke free laws were associated with a reduction in asthma admissions
Smoke free laws were associated with a reduction in asthma admissions

Smokefree laws and emergency admissions for asthma 

- Thorax 2013; 68: 619-24

Numerous benefits have arisen from the introduction of the smokefree legislation.

This study was undertaken to investigate whether the introduction of smokefree legislation on 1 July 2007 was associated with an immediate reduction in emergency hospital admissions for asthma in the adult population, and whether any association differed across regions.

The results showed that smokefree legislation was associated with an immediate 4.9% reduction in emergency admissions for asthma in the adult population.

This implies that approximately 1,900 emergency admissions for asthma were prevented in each of the first three years after legislation was introduced. Interestingly, the reduction in admissions did not vary significantly across regions. This is obviously a hugely positive result from the smoking ban.

Depression and anxiety in cancer survivors and their spouses

- Lancet Oncol 2013 doi:10.1016/S1470-2045(13)70244-4

As the prognosis of many cancers has improved over the past few decades, there are now many more patients who are long-term survivors of cancer.

This systematic review and meta-analysis was undertaken to assess whether depression and anxiety are more common in long-term (at least two years) survivors of cancer compared with their spouses and with healthy controls.

The results indicated that the prevalence of depression was about 11%, which was actually only 1% greater than in healthy controls. However, the prevalence of anxiety in the cancer survivors was greater when compared with healthy controls (18% compared with 14%).

The results showed that spouses of cancer survivors were also more likely to have anxiety than depression - the spouses' scores of anxiety were similar to those of the cancer survivors.

It may therefore be worthwhile remembering to have a lower threshold for asking both cancer survivors and their spouses about any anxiety symptoms they may be experiencing.

Understanding cardiovascular risk scores in primary care

- Br J Gen Pract 2013; 63(611): e401-e407

We are all using cardiovascular risk scores in assessments for the primary prevention of cardiovascular disease, although I am still uncertain which one I should be using in practice and which is the most evidence based.

In view of my uncertainties, I was reassured to read this article, a qualitative study exploring GPs' understanding and use of cardiovascular risk scores.

The GPs questioned all expressed considerable uncertainty about how and whether to take account of existing drug treatment or other types of prior risk modification.

They were also unclear about the choice between the older scores, based on the Framingham study, and newer scores, such as QRISK.

There was substantial variation in opinion about whether scores could legitimately be used to illustrate to patients the change in risk as a result of treatment. The study concludes that there was considerable confusion about them.

The authors state that patients may be better served by simple advice for clinicians to use a Framingham score and exercise more clinical judgment, explaining to patients the imprecision of any individual estimate of risk. I tend to agree with this.

Women's awareness of potential ovarian cancer symptoms

- J Fam Plann Reprod Health Care 2013; 39: 163-71

There have been a few campaigns recently to try to improve awareness of symptoms of ovarian cancer, which is still often diagnosed at a late stage.

This UK population-based sample of women completed the Ovarian Cancer Awareness Measure by telephone interview. The questions measured symptom awareness (using recall and recognition), barriers to medical help-seeking and anticipated time to help-seeking.

Most women were unable to recall any symptoms of ovarian cancer but 99% recognised at least one. Recognition was lowest for difficulty eating and persistently feeling full.

Higher socioeconomic status was an independent predictor for a longer anticipated time to help-seeking for more symptoms.

Awareness of potential symptoms of ovarian cancer is still very low and even those women who recognise symptoms are leaving it too long before they see their doctor. More research needs to be done in this area.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

  • Dr Newson is a GP in the West Midlands and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Consider what clinical support cancer survivors and their families may need and how your practice can ensure these needs are met.
  • Hold a meeting with a local cardiologist to discuss the pros and cons of the various cardiovascular risk tables.

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