Journals Watch - Vitamin D, abortion and COPD

Not had time to read the journals? Dr Lizzie Croton brings you up to date on the latest research.

Vitamin D supplementation had a small effect on lumbar spine BMD (blue/purple: least dense areas) (Photograph: SPL)
Vitamin D supplementation had a small effect on lumbar spine BMD (blue/purple: least dense areas) (Photograph: SPL)

Vitamin D supplements and bone density in young people
BMJ 2011; 342: c7254

This double-blind systematic review and meta-analysis looked at studies involving healthy participants aged from one month to 20 years who had received vitamin D supplements for at least three months.

In six studies, a total of 343 participants received placebo and 541 received vitamin D.

Bone density was measured in both groups.

The study concluded that vitamin D supplementation had no statistically significant effects on total body bone mineral content or on bone mineral density (BMD) of the hip or forearm. However, there was a small effect on lumber spine BMD. There was a trend showing supplementation had a greater effect on BMD in participants with low vitamin D levels, but this was not significant (p=0.09).

In conclusion, vitamin D supplements are unlikely to be beneficial in children and adolescents with normal vitamin D levels.

First trimester abortion and risk of mental disorder
N Engl J Med 2011; 364: 332-9

This study looked at the risk of subsequent psychiatric problems in women undergoing first trimester abortion. Healthy women undergoing either first trimester abortion or first child birth between 1995 and 2007 were examined.

The authors then estimated rates of first-time psychiatric contact (an inpatient admission or outpatient visit) in the 12 months following the abortion or childbirth and compared these with rates in the nine months preceding the event.

The results showed a similar incidence rate of psychiatric contact both preand post-abortion. Interestingly in the childbirth group the relative risk of psychiatric contact significantly increased after childbirth.

Difficult patient encounters and patient outcomes
J Gen Intern Med 2011 doi: 10.1007/s11606-010-1620-6

This US study involved 750 adults presenting to a primary care walk-in centre with a physical symptom.

The study took into account both patient and physician factors when examining the effects of the consultation on patient outcomes.

The results found that 17.8 per cent of the 750 patients were perceived as 'difficult'. These patients were less likely to fully trust or be fully satisfied with their clinician and were more likely to have worsening symptoms at two weeks.

Difficult patients tended to have multiple symptoms, had experienced recent stress and had a concurrent depressive or anxiety disorder.

Clinicians involved in difficult patient encounters were less experienced and less able to appreciate the relationship between psychosocial factors and the physical presentation of illness.

Parkinson's disease and driving ability
J Neurol Neurosurg Psychiatry 2011; 82: 218-23

This study used a driving simulator to study the effects of Parkinson's disease (PD) on various aspects of driving. The study included 25 patients aged 58 to 76, with mild to moderate PD, and 25 healthy controls.

Neurophysiological tests were conducted to assess global cognitive abilities, updating, flexibility and information processing speed. Participants then carried out three different scenarios on the simulator.

The study found that drivers with PD have more difficulty recalling road signs that they had recently seen when compared with controls. However on other tests, such as braking when the car in front braked, they performed just as well.

Hip osteoarthritis and manual handling
Occup Environ Med 2011 doi: 10.1136/oem.2010.061390

This study from Finland used a nationally representative sample of 6,556 participants aged 30 to 97 (3,110 men and 3,446 women) and determined the presence of hip osteoarthritis (OA) via clinical examination.

They then asked about previous exposure to physical loading work. Logistic regression was used to estimate associations between work factors and hip OA.

The results showed that 1.9 per cent of men and 2.1 per cent of women had hip OA. Almost half of the men and a quarter of women had repeatedly handled heavy loads at work and those who had handled loads in excess of 20kg had a 1.8-fold increased risk of hip OA.

In subjects with hip replacement, the odds ratio was 1.7.

The risks of hip OA started to increase after 12 years of exposure. The authors concluded that work exposure to manual handling of heavy loads is strongly associated with hip OA.

Living and dying with COPD
BMJ 2011; 342: d142

This qualitative study of patients with COPD aimed to understand the perspectives of patients and their carers towards living and dying with a progressive illness. Twenty-one patients, 13 informal carers and 18 professional carers were interviewed.

Patients and informal carers adapted to the debilitating symptoms. Severe symptoms causing major disruption were accepted as a 'way of life' rather than an 'illness'.

Prognostic uncertainty and professional carers' familiarity with patients' conditions contributed to the difficulty in recognising and managing end-stage disease. Patients told a 'chaos narrative' describing their illness. Their stories were comparable with attitudes to death among an elderly population. The study findings challenge the current management policies in COPD of identifying a time for transition to palliative care.

Assessment of supportive and palliative care needs should be triggered at 'disease milestones' for COPD throughout a patient's lifetime.

  • Dr Croton is a GP in Birmingham 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.

  • Research the current evidence base for vitamin D supplementation in healthy children and adolescents, and summarise the main points to share with colleagues.
  • Examine the care plans of patients with COPD following a hospital admission for an exacerbation and make notes about improvements that can be made.
  • Hold a discussion group where GPs can bring up cases of 'difficult' patients to receive peer support and reflect on how they could change their practice.

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