Sunscreen and melanoma
JAMA 2011, doi: 10.1001/Jama.2011.990
Can sunscreen really prevent the development of melanoma? This is the first RCT on the effect of sunscreen use in melanoma prevention. In this study from Australia, 1,621 adults were randomly assigned to regular sunscreen use or discretionary use. Those who were to use it regularly were given an unlimited supply of sunscreen with sun protection factor 16 and instructed to apply it to their head, neck, arms and hands every morning, and to reapply after long periods in the sun and after bathing or heavy sweating.
Regular application over a five-year period reduced the incidence of new primary melanomas over a subsequent 10-year follow-up period. In the group of 812 subjects who used daily sunscreen, 11 new melanomas were identified, while 22 were found in the 809 subjects who used sunscreen at their discretion. The incidence of new melanomas was therefore reduced by 50 per cent by daily use of sunscreen. It sounds as though we should be encouraging greater use of sunscreen in our patients.
Awareness of stroke and TIA
Med J Aus 2011; 195: 16-19
Medical professionals are all aware that rapid action following a stroke improves prognosis, but how aware are the general public of the symptoms of stroke?
This study in Australia examined the knowledge of stroke warning signs and risk factors among the general public. A simple survey assessed this knowledge on three occasions – before, immediately following and three months after the National Stroke Foundation National Stroke Week in 2009. The public were asked about risk factors and warning signs for stroke, and what to do if presented with warning signs.
The surveys were completed by 251 members of the public. Hypertension and smoking were recognised as risk factors for stroke by 71 per cent and 53 per cent of respondents, respectively. Before National Stroke Week, slurred speech was identified by 51 per cent, and both slurred speech and upper limb sensory loss by 62 per cent, as warning signs to engage emergency services. However, upper limb weakness and numbness were identified by less than one-third of respondents. Perhaps the most disappointing finding was that there was no significant difference in survey results following National Stroke Week.
Risk of preterm birth following treatment for precancerous changes of the cervix
BJOG 2011; 118: 1031-41
This meta-analysis looked at whether treatment for precancerous cervical changes increases the risk of preterm delivery in pregnancy (less than 37 weeks gestation research published between 1950 and 2009 was examined 30 eligible studies identified.
Excisional treatment of precancerous changes of the cervix was associated with statistically significant increased risk of preterm birth when compared with an external comparison group. There is also new evidence that some types of ablative treatment may be associated with a small increased risk. Given these findings, perhaps we should counsel patients who have undergone cervical treatment when they first present in early pregnancy or at pre-pregnancy discussion.
Impact of BMI, physical activity and other clinical factors on cardiorespiratory fitness
Am J Cardiol 2011; 108: 34-9
Cardiorespiratory fitness (CRF) is widely seen as an important reversible cardiovascular risk factor. More than 20,000 patients presenting to a clinic in Texas for comprehensive medical examination over a 10-year period from 2000 had their CRF assessed by maximal treadmill exercise testing.
Age, gender, BMI and physical activity were the most important factors associated with CRF. Other factors, including smoking, BP, lipid profile and blood glucose, only minimally affected CRF. There was significant interaction between BMI and physical activity – patients with BMI <25kg/m2 achieved much higher CRF for a given level of physical activity compared with those whose BMI exceeded 30kg/m2. Percentage body fat was the key factor driving this interaction. This is yet another reason to encourage patients to lose weight.
Sex Transm Infect 2011; 87: 306-311
Who is being tested for chlamydia by the National Chlamydia Screening Programme (NCSP)? Data were collected for 558,119 men and women aged 16-24 years who were screened in 2008. Data were also collected from 2,180 interviewees in Britain’s second National Survey of Sexual Attitudes and Lifestyles (Natsal-2), of whom 644 had been tested for chlamydia. Behavioural and demographic differences, which might be important in understanding who the screening programme is reaching, were examined.
Compared with Natsal-2, the NCSP tested more women (67 per cent versus 49 per cent) and NCSP participants were likely to be younger, with 29 per cent in the 16-17 years age group. In addition, those in the NCSP were more likely to be from ethnic minority groups, less likely to use condoms and more likely to have had two or more sexual partners in the past 12 months.
So it would appear the NCSP is testing young people at higher risk of chlamydia and the impact of this testing bias on the effectiveness of the programme should be evaluated.
Accessing GUM clinics
J Fam Plann Reprod Health Care 2011; 37: 152-6
The 2004 White Paper 'Choosing Health: Making healthy choices easier' made improving sexual health a priority. Access targets were set and it was promised that ‘by 2008, patients referred to GUM clinics will be able to have an appointment within 48 hours’. This was achieved by 96 per cent of PCTs.
However, patients also need to be able to reach those services. This study examined the physical aspect of accessibility, that is, how long it takes individuals to travel to their nearest GUM clinic by road. No account was taken of the time taken to travel by public transport.
Overall, it is estimated that only 3 per cent of the population live more than 30 minutes from the nearest clinic. A number of studies of NHS accessibility have considered a travel time of 30 minutes or more as too long. So generally, accessibility for the country as a whole is good but there are regional variations, with excellent access in London and the south-east, while the south west and the east of England have the poorest accessibility. The latter regions, however, have an older population with a lower incidence of STIs.
In some areas of England, it is important to recognise the barriers to accessing sexual health services and that these services are more likely to be provided in primary care. Level two sexual health services are provided by 92 per cent of PCTs in the south west and by only 60 per cent in the east of England.
- Dr Gwen Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals
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