In Brief

Uptake of HPV vaccine
Seven out of 10 girls from 36 secondary schools have received two out of three doses of the HPV vaccine in a Manchester-based pilot study. In total, 2,817 girls aged 12 to 13 years were offered the vaccine. Results show that 1,989 (70.6 per cent) received the first dose and 1,930 (68.5 per cent) the second. A third dose is needed at six months. The main reason for parents' refusal of the vaccination was insufficient information about the vaccine and its long-term safety. The researchers say their results are 'encouraging', but that success of the vaccination programme will depend on high coverage for the third dose.
Brabin L, Roberts SA, Stretch R et al. BMJ 2008; do1:10.1136/bmj.39541.534109.BE

Fish oil could cut RA drug burden
Cod liver oil supplements could be used as NSAID-sparing agents in rheumatoid arthritis (RA) patients, according to a study in Scotland. The double-blind, placebo-controlled trial randomised 97 RA patients to receive 10g cod liver oil containing 2.2g of n-3 essential fatty acids or placebo, daily. Fifty-eight patients completed the study. Of 49 patients in the cod liver oil group, 19 reduced their daily NSAID requirement by more than 30 per cent, compared with only five of the 48 patients in the placebo group. The researchers say this reinforces previous studies that have shown cod liver oil and its high omega-3 fatty acid content to have significant anti-inflammatory properties in RA.
Galarraga B, Ho M, Youssef HM et al. Rheumatology (Oxford) 2008; 47(5): 665-9

Too few women have antenatal screening
Only 5 per cent of women are screened for sickle cell and thalassaemia by the 10-week target, despite early confirmation of pregnancy, a UK study has shown. Researchers assessed data on 1,441 eligible women intending to proceed with pregnancy, whose carrier status was not known, from 25 general practices in two UK inner-city PCTs offering universal screening. Median gestational age at pregnancy confirmation was 7.6 weeks; 74 per cent presented before 10 weeks. However, median gestational age at screening was 15.3 weeks, with only 4.4 per cent being screened before 10 weeks. The researchers say the results show that the NHS has not yet come to grips with a new generation of genetic tests.
Dormandy E, Gulliford MC, Reid EP et al. Br J Gen Pract 2008; 58: 154-9

Bisphosphonates and AF
Bisphosphonates do not increase the risk of AF and flutter, researchers from Denmark have concluded. Their population-based case-control study involved 13,586 patients with AF and flutter (3.2 per cent of whom were current bisphosphonate users) and 68,054 controls (of whom 2.9 per cent were current users of bisphosphonates). There was no difference in the risk of AF and flutter between current or new users and non-users. Risk estimates were independent of the number of prescriptions and the position of the AF and flutter diagnosis in the discharge record, and were similar for inpatients and outpatients.
Toft Sorensen H, Christensen S, Mehnert F et al. BMJ 2008; 336: 813-16

Topical option for VIN
Imiquimod may be an effective alternative to surgery for vulval intraepithelial neoplasia (VIN), the results of a randomised controlled trial suggest. Fifty-two patients with VIN grade 2 or 3 were treated with topical imiquimod or placebo, applied twice weekly for 16 weeks. Lesion size was reduced by more than 25 per cent at 20 weeks in 21 of 26 patients (81 per cent) treated with imiquimod, compared with none of those given placebo. Histologic regression was significantly greater in the imiquimod group, while clearance of HPV from lesions was seen in 15 patients using imiquimod (58 per cent), but only two of the placebo group (8 per cent).
Van Seters M, van Beurden M, ten Kate FJ et al. N Engl J Med 2008; 358: 1465-73

Predicting the risk of miscarriage
Measuring levels of a naturally occurring 'cannabis' could indicate which women with threatened miscarriage are likely to go on to miscarry. Researchers from the University of Leicester measured the endocannabinoid anandamide in 45 women presenting with threatened miscarriage - bleeding in early pregnancy with a viable baby. Those with significantly higher levels of anandamide at the time of the test subsequently miscarried. Using a threshold defined from the study, the researchers predicted all those who subsequently miscarried and 94 per cent of those who had a live birth. They hope to develop a bedside test.
Habayeb OMH, Taylor AH, Finney M et al. JAMA 2008; 299: 1135-6

Testosterone spray and sexual satisfaction
Treating decreased sexual satisfaction in women with a testosterone spray has limited and equivocal effects, say researchers in Australia. They randomised 261 premenopausal women aged 35-45 with low sexual satisfaction to testosterone or placebo spray at one of three doses (one 56-microlitre spray, one 90-microlitre spray, two 90-microlitre sprays), once daily for 16 weeks. The difference in satisfactory sexual events over 28 days was only significant between treatment and placebo for the intermediate dose, which modestly increased the frequency of events by 0.8 per month on average relative to placebo.
Davis S, Papalia M, Norman RJ et al. Ann Intern Med 2008; 148: 569-77

Prolonged UK residence affects behaviour of immigrant mothers
The longer women from ethnic minorities live in the UK, the more likely they are to develop 'risky' health behaviour. Studies have shown that women from ethnic minorities are more likely to breastfeed than British/Irish white women. However, researchers from the Institute of Child Health in London have found that for every additional five years spent in the UK, immigrant mothers are 32 per cent more likely to smoke in pregnancy and 5 per cent less likely to breastfeed for at least four months. They say health professionals should not underestimate the likelihood of such behaviour among these women. The study involved 6,478 British/Irish white mothers and 2,110 mothers from ethnic minorities.
Hawkins SS, Lamb K, Cole TJ, Law C. BMJ 2008; doi:10.1136/bmj.39532.688877.25.

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