Journals Watch: Stroke risk and cervical cancer

Not had time to read the journals? Let Dr Gwen Lewis bring you up to date with the latest research.

Long-term NSAID use was associated with increased stroke risk (Photograph: SPL)

Stroke risk and NSAID use
Med J Aust 2011: 195 (9): 525-9

This Australian retrospective cohort study of 162,065 veterans looked at NSAIDs and risk of stroke.

While the absolute risk of stroke was low at only 7.1 per 1,000 people per year, this risk was increased greatly by use of NSAIDs. Incident use of NSAIDs was associated with a 1.88 times increased risk of hospitalisation for stroke following first ever dispensing of an NSAID.

The more potent COX-2 selective NSAIDs were associated with the greatest risk of stroke. The increased risk of stroke ranged from 28% with ibuprofen to 86% with diclofenac.

This is another reason to use NSAIDs with great caution.

Depression, sexual behaviour and herpes simplex type 2
Sex Transm Infect 2011; doi: 10.1136/sextrans-2011-050138

Depression has been linked to risky sexual behaviour in adolescents but there has been little research in adults. This American study of adults aged between 20 and 59 years examined the association between depression and self-reported risky sexual behaviour and the association between depression and herpes simplex virus type 2 (HSV-2), a marker of risky sexual behaviour.

Data were obtained from the national health and nutrition examination survey between 2005 and 2008.

Of 5,273 adults studied, 7% had depression, 36% reported 10 or more lifetime sex partners, 15% had two or more sex partners in the past year and 13% had first sex before 15 years of age.

Women who had experienced each of these risky sexual activities were more likely to have depression, while this association was not seen in men.

Nineteen per cent tested positive for HSV-2 and these patients were more likely to be depressed.

Repeat abortion in the UK
J Fam Plann Reprod Health Care 2011; 37: 209-15

In the UK, one in three sexually active women has undergone an abortion in their lifetime and of these a further one in three will have had more than one. In 2009, there were 189,100 abortions of which 34% were repeat procedures.

This study used data from the second national survey of sexual attitudes and lifestyles. Characteristics of women presenting for a second or subsequent abortion were examined.

Obviously age was a factor, as was increasing parity. Those presenting for a repeat procedure were also more likely to be of black origin, and in fact 48% of black women were attending for a second abortion.

These women were also more likely to have left school early, live in rented accommodation, report an earlier age of first sexual relationship, less likely to use a reliable method of contraception and report a greater number of sexual partners.

Yoga for back pain
Ann Intern Med 2011; 155(9): 569-78

Studies have shown that yoga may be an effective treatment for chronic or recurrent low back pain. This study from 13 centres in the UK sought to clarify the use of yoga in back pain management.

In the study, 156 patients with low back pain were assigned to receive a 12-class yoga programme, gradually increasing in intensity over three months while 157 control patients received usual care. All patients were given a back pain booklet. Pain scores were measured at three, six and 12 months, as were general health indices and measures of function.

Those undertaking the yoga programme had better back function than those in the usual care group at three, six and 12 months but back pain and general health were similar in both groups at all times.

Gynaecological symptoms and cervical cancer diagnosis
Fam Pract 2011; 28(6): 592-8

Cervical cancer occurs at a younger age than most adult cancers, however screening does not begin until 25 years of age in England. Screening can detect premalignant abnormalities but in younger women cervical cancer can only be detected by symptoms.

This study aimed to identify the frequency of attendance for gynaecological symptoms in women aged 15 to 29 years.

A cohort of English women was taken from the GP research database. All gynaecological consultations were identified and divided into three age bands: 15 to 19, 20 to 24 and 25 to 29 years. The women were studied between 2003 and 2009.

The number of women studied annually varied from 32,968 to 45,807. In 2003, 11.3% of consultations were for gynaecological problems and this rose to 20.1% in 2009. Postcoital and intermenstrual bleeding, the two classic presentations of cervical cancer, were reported by 0.5% and 1.6% of women in 2009.

HIV testing and termination of pregnancy services
J Fam Plann Reprod Health Care 2011; 37: 201-3

In 2008, the national HIV testing guidelines recommended HIV testing for patients attending for colposcopy and termination of pregnancy services in order to reduce the time to diagnosis of HIV. Antenatal testing for HIV has been well received and is now accepted as routine.

There is evidence that HIV reduces effectiveness of standard treatment for CIN 2 and 3 and cervical cancer.

A retrospective case note review was undertaken for 60 women who were subsequently diagnosed with HIV over a period of 43 months.

Three women (5%) were diagnosed with CIN grade 2 or above prior to HIV diagnosis, while for a further three women (5%) HIV testing at the time of termination of pregnancy would have resulted in earlier diagnosis.

Forty-three of the 60 women were born in an African country while 10 were below the age at which routine cervical screening is offered.

HIV screening in these settings would seem to be of potential benefit.

  • Dr Lewis is a GP in Windsor, Berkshire, 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


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

  • Identify patients taking long-term NSAIDs and review their risk of stroke. Consider reviewing their medication.
  • Perform a search of patients who have undergone a termination of pregnancy and review their current contraception.
  • Present to colleagues at a practice meeting about the link between women with depression, risky sexual behaviour and risk of STIs.

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