In brief

Maternal balance during pregnancy
US researchers have investigated how pregnant women stay upright rather than tip forwards as the foetus shifts their centre of gravity. They say the female spine has evolved special features to balance the foetus in front of the hip joints. To compensate, a woman tilts backwards as she walks, thus her lumbar vertebrae are reinforced and slightly curved to offset back strain. The researchers note that neither men nor chimps have these modifications. However, they highlight that fossil vertebrae from our ancestors several million years ago indicate the same adaptations were present.
Whitcome KK, Shapiro LJ, Lieberman DE. Nature 2007; 450: 1075-8

Breast screening provides clear benefit
The breast cancer screening programme in East Anglia is achieving a 35 per cent reduction in breast cancer mortality. The Cancer Research UK study included data on 284 deaths from breast cancer in women diagnosed between the ages of 50 and 70 years, following the introduction of an East Anglian screening programme in 1989. These were matched with 568 controls (women from the same area who had not died of breast cancer). Adjusting for self-selection bias gave a mortality reduction estimate of 35 per cent associated with invitation to screening, while the effect of actually being screened was associated with a 48 per cent reduction in breast cancer mortality.
Allgood PC, Warwick J, Warren RM et al. Br J Cancer 2008; 98: 206-9

Women miss out on heart failure care
Women with heart failure are less likely than men to receive recommended care when admitted as an emergency, a major UK survey has revealed. It included data on 9,387 emergency heart failure admissions from October 2005 to March 2006, across 176 of the 177 acute trusts in England, Wales and Northern Ireland. Female admissions were an average five years older and were less likely to undergo echocardiography than men. If already diagnosed with heart failure, women were less likely to receive ACE inhibitors, beta-blockers or aldosterone antagonists on admission. They were also less likely to be prescribed heart failure medication, except diuretics, on discharge, although post-discharge care was found to be lacking for both sexes.
Nicol ED, Fittall B, Roughton M et al. Heart 2008; 94(2): 172-7

Menopausal therapy and vaginal bleeding
Tibolone causes less vaginal bleeding in the initial stages of treatment than low-dose combined HRT, according to a study undertaken in seven European countries. A cohort of 572 symptomatic postmenopausal women aged 45–65 years was randomised to receive 2.5mg tibolone or 1mg 17-beta-estradiol plus 0.5mg norethisterone acetate daily for 48 weeks. Vasomotor symptoms and vaginal atrophy were reduced to a similar degree in both groups compared with baseline, but prevalence
of breast tenderness was lower in those treated with tibolone. Furthermore, tibolone caused significantly less vaginal bleeding in the first three months, which the authors say is an important factor in terms of treatment adherence.
Hammar ML, van de Weijer P, Franke HR et al. BJOG 2007; 114: 1522-9

Efficacy and safety of osteoporosis drugs
Many drugs are effective at preventing osteoporotic fracture but US researchers say the data are insufficient to determine relative efficacy or safety, because few direct comparisons have been made. A review of 80 studies found good evidence to show that bisphosphonates, oestrogen, parathyroid hormone and raloxifene prevent vertebral fracture compared with placebo, and fair evidence for calcitonin. There was good evidence for hip fracture prevention for alendronate, risedronate and oestrogen and fair evidence for zoledronate. The effects of vitamin D varied. A safety analysis of 493 articles indicated that raloxifene, oestrogen and oestrogen-progestin increase the risk of thromboembolism, while bisphosphonates increase the risk of oesophageal and GI side-effects.
Maclean C, Newberry S, Maglione M et al. BJOG 2007; 114(12): 1522-9

Rapid chlamydia test shows promise
A point-of-care test for chlamydia has been shown to be quicker and more cost-effective than existing tests in a UK study of more than 1,300 women. Participants recruited at three clinics were advised on vaginal swab collection and given swabs and urine cups. Results were obtained within 30 minutes, allowing positive patients to be offered treatment while still at the clinic. For the rapid test, sensitivity and specificity were 83.5 per cent and 98.9 per cent respectively, compared with polymerase chain reaction assay, and 81.6 per cent and 98.3 per cent compared with strand displacement amplification assay. Mahilum-Tapay L, Laitila V, Wawrzyniak JJ et al. BMJ 2007; 335: 1190-4

DMARDs after methotrexate
Disease-modifying anti-rheumatic drugs are unlikely to benefit patients with rheumatoid arthritis who fail on methotrexate. Data collected as part of the BeSt study showed that 66 per cent of the 244 patients initially given methotrexate monotherapy discontinued after two years owing to lack of response or toxicity. Of these, 78 per cent then failed on sulfasalazine monotherapy or sulfasalazine plus methotrexate. Of those given leflunomide after sulfasalazine, 87 per cent failed to respond, while 64 per cent of those who had hydroxycholoroquine added to their methotrexate plus sulfasalazine regimen failed. A higher response rate (34 of 48 patients) was seen in patients subsequently given methotrexate plus infliximab.
Van der Kooij SM, de Vries-Bouwstra JK, Goekoop-Ruiterman YP et al. Ann Rheum Dis 2007; 66: 1356-62

Calcium supplements and risk of MI
Calcium supplements may increase the risk of MI in healthy postmenopausal women, the results of a randomised controlled trial suggest. Researchers in New Zealand randomised 732 postmenopausal women to a daily calcium supplement and 739 to placebo. Dietary calcium intake was assessed and women were seen every six months over five years. MI was more commonly reported in the calcium group (45 events in 31 women) than in the placebo group (19 events in 14 women). The composite endpoint of MI, stroke, or sudden death was also more common in the calcium group. The researchers say that the findings are concerning, but should be balanced against the likely benefits of calcium on bone.
Bolland MJ, Barber PA, Doughty RN et al. BMJ 2008, doi:10.1136/bmj.39440.525752.BE

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