Journals Watch: SSRIs, malaria and knee pain

Running short of time to read the journals? Allow Dr Louise Newson to be your guide to the latest findings

Prescribing SSRIs in pregnancy must take account of safety and the high risk of congenital malformations
Prescribing SSRIs in pregnancy must take account of safety and the high risk of congenital malformations
RESEARCH OF THE WEEK 

Increased risk of breast cancer with the Pill
Mayo Clin Proc 2006; 81: 1,290-302

There has been some confusion in the past as to whether or not the Pill increases the risk of premenopausal breast cancer.

The results of this meta-analysis showed that although taking the Pill is a risk factor, the absolute risk is still very small.

This association between the use of the oral contraception and breast cancer was highest for parous women who had taken the Pill for at least four years before their first pregnancy. Reassuringly, 10 years after stopping the Pill, any increased risk is reversed. The benefits of the Pill should not be forgotten though.

Should we all be taking statins?
BMJ 2006; doi:10.1136/bmj.38993.731725.BE

As GPs we know and accept that statins are cost-effective for patients with CHD and also patients at high risk of CHD. This study used data from the Heart Protection Society and has shown that treatment with statins is cost-effective for a wider range of people than the current guidelines recommend.

Statin treatment was shown to be cost-effective for people as young as 35 years old and as old as 85 years, even with an annual risk of a major vascular event of 1 per cent.

The costs of statins, in this case 40mg simvastatin, were outweighed by the reduced costs of hospital admissions due to fewer vascular events. Maybe in the future the majority of the adult population will be encouraged to take a statin.

SSRIs in pregnancy
Epidemiol 2006; 17: 701-4

Some patients need to take their anti-depressants while they are pregnant and it is very difficult to know which one, if any, is safe to prescribe. Fluoxetine seems to be the SSRI with the most evidence of safety in pregnancy.

This study from Denmark has demonstrated that the use of SSRIs in pregnancy increases the risk of congenital malformations in the babies, especially when taken in the second and third months of pregnancy. Although there was no association with a specific malformation, there did seem to be a causal effect with the SSRIs.

Malaria risk in long-term travellers
JAMA 2006; 296: 2,234-44

The majority of patients only need malaria prophylaxis for their holidays of a few weeks' maximum duration. However, we should be concerned about patients who travel in malaria-endemic areas for six months or more because this report has shown that they may not be adequately protected. Long-term travellers were found to be at greater risk of malaria than short-term travellers. It may be that these people are not taking their medication regularly, rather than there being an actual problem with the medication itself. It is recommended that long-term travellers seek a specialist's opinion regarding malaria protection.

Weighing babies before and after a feed
Arch Dis Child Fetal Neonatal Ed 2006;91:F330-2

Although many health visitors will be disappointed to read the results of this study, many GPs will be relieved to discover that weighing newborn babies before and after a feed is an unreliable method of assessing milk intake. This has always seemed to put unnecessary pressure on a mother.

Babies were weighed before, immediately after, and 15 minutes after a measured feed in this study. There was a wide variation in the weights. The most likely reason for the differences was the insensitivity of the scales used, even though they were calibrated and showed increments of single grams. It would be more useful to measure weight over a longer time period, for example weekly.

Treating knee pain in primary care
BMJ 2006; 333: 995-8

Many patients with knee pain are poorly managed in primary care. In this study the impact of pharmacy review and physiotherapy on the management of people over 55 with pain in one or both knees was assessed.

The results showed that both physiotherapy and pharmacy review improved pain and function scores, improved patient satisfaction and reduced the need for anti-inflammatory medication. The standard treatment in the control involved an advice leaflet reinforced by a telephone call.

Dr Newson is a GP in Solihull, West Midlands and a member of our team who regularly reviews the journals

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