Journals Watch - Stroke centres, opiates and BMI

Not had time to read the journals? Let Dr Bryan Palmer bring you up to date on the latest research.

Stroke centres were associated with more frequent use of thrombolysis (after thrombolysis, right) (Photograph: SPL)
Stroke centres were associated with more frequent use of thrombolysis (after thrombolysis, right) (Photograph: SPL)

Stroke centre hospitalisation and mortality
JAMA 2011; 305(4): 373-80
Although stroke centres are widely supported, little is known about their effect on patient outcomes. This study was designed to examine the association between admission to stroke centres for acute ischaemic stroke and mortality.

Using data from New York, researchers compared mortality for patients admitted with acute ischaemic stroke (n= 30,947) between 2005 and 2006 to designated stroke centres and non-designated hospitals. Patients were followed up one year after the index hospitalisation.

Results showed lower 30-day all-cause mortality for patients admitted to stroke centres (10.1 per cent versus 12.5 per cent) and greater use of thrombolytic therapy (4.8 per cent versus 1.7 per cent). Differences in mortality also were observed at one-day, seven-day and one-year follow-up.

The study concluded that among patients with acute ischaemic stroke, admission to a designated stroke centre was associated with modestly lower mortality and more frequent use of thrombolytic therapy.

Opiates and mortality
Inj Prev 2011; doi:10.1136/ip.2010.029611

This observational study in Victoria, Australia, was carried out on the back of an emerging epidemic of opiate-related death in the US and Canada.

Decedents whose death was reported between 2000 and 2009 and where oxycodone was detected were included in the study.

The supply of oxycodone to Victoria increased nine fold from between 2000 and 2009. Detection of oxycodone in deaths increased from four in 2000 to 97 in 2009.

Of the 320 cases described, 53.8 per cent were the result of drug toxicity. Of these, 52.3 per cent were unintentional and 19.8 per cent were intentional self-harm.

The remaining 27.9 per cent are either still under investigation by the coroner or intent is unknown.

Drug toxicity deaths were over represented in both rural areas and areas with high levels of disadvantage.

Fortified bread improves folate levels
Med J Aust 2011; 194 (2): 65-7

In September 2009, legislation in Australia was brought in to include folic acid in flour. The authors of this study carried out a retrospective analysis of serum and red blood cell (RBC) folate levels of 20,592 blood samples collected between April 2007 and April 2010.

Between April 2009 and April 2010, there was a 77 per cent reduction in the prevalence of low serum folate levels. In April 2010, the prevalence of low RBC folate levels for females of childbearing age was 0.16 per cent for all samples.

There was a 31 per cent increase in mean serum folate level and a 22 per cent increase in mean RBC folate level.

The introduction of mandatory fortification with folic acid has reduced the prevalence of folate deficiency in Australia, including in women of childbearing age.

Internet use and adolescent health
Pediatrics 2011; doi: 10.1542/peds. 2010-1235

Many children now have internet access at home and school. This study examined the relationship between different internet-use intensities and adolescent mental and somatic health. Data were drawn from the 2002 Swiss multicenter adolescent survey on health, a nationally representative survey of adolescents aged 16 to 20 years.

From a self-administered questionnaire, 3,906 adolescent boys and 3,305 girls were categorised into four groups: heavy internet users (HIUs: >two hours/day), regular internet users (RIUs; several days per week and two hours/day), occasional users (one hour/week) and non-internet users (NIUs; no use in the previous month).

Health factors examined were perceived health, depression, weight, headaches, back pain and insufficient sleep.

HIUs of both genders were more likely to report higher depressive scores, whereas only male users were found at increased risk of being overweight and female users at higher risk of insufficient sleep.

This study provides evidence of a U-shaped relationship between intensity of internet use and poorer mental health of adolescents.

Trends in BMI since 1980
Lancet 2011; doi: 10.1016/S0140-6736(10)62037-5

This study looked at long-term global trends in mean BMI for adults over 20 years in 199 countries and territories. The authors obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9.1 million participants).

Between 1980 and 2008, mean BMI worldwide increased by 0.4kg/m2 per decade for men and 0.5kg/m2 per decade for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2kg/m2 per decade in nine countries in Oceania. The USA had the highest BMI of high-income countries.

In 2008, an estimated 1.46 billion adults worldwide had a BMI of 25kg/m2 or greater, of these 205 million men and 297 million women were obese. The researchers concluded that interventions and policies that can curb or reverse the increase are needed in most countries.

Family-focused treatment for overweight children
Pediatrics 2011; 127: 214-22

This Australian study was a single-blinded RCT of a parent-led healthy lifestyle intervention for prepubertal moderately obese children, aged five to nine years.

The six-month programme targeted parents as the agents of change for implementing family lifestyle changes. They measured BMI, waist z-scores and parenting constructs at baseline and six, 12, 18 and 24 months.Participants were randomised to a parenting skills plus healthy lifestyle group (n=85) or a healthy lifestyle-only group (n=84).

The results showed that there was no group effect but parent-focused interventions in these children can lead to a relative weight loss of approximately 10 per cent, which can be maintained for two years from baseline.

This strategy could be used to help reduce childhood obesity.

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

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

CPD IMPACT: EARN MORE CREDITS

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

  • Consider inviting a representative from your local stroke centre to present to the practice on the benefits of dedicated stroke centres.
  • Discuss opiate prescribing with colleagues and create a practice policy on safe prescribing of opiates.
  • Spend some time researching healthy eating interventions for overweight children in your local area. Think about how you can improve your management of young overweight patients.

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