In brief

Fracture risk documented in heart failure
Heart failure (HF) is associated with an increased risk of subsequent orthopaedic fracture, according to a population-based cohort study. Researchers studied 16,294 patients with cardiovascular disease, aged 65 years or over, who had presented to emergency rooms in Alberta, Canada, between 1998 and 2001. A total of 2,041 patients with a new diagnosis of HF were compared with a control group of 14,253 patients with non-HF cardiovascular diagnoses. After adjustment, the researchers found that HF was independently associated with a fourfold increased risk of any orthopaedic fracture and just over a sixfold increased risk of hip fracture. They suggest that screening for, and treatment of, osteoporosis should be considered in patients with HF.
Van Diepen S, Majumdar SR, Bakal JA et al. Circulation 2008; doi:10.1161/CIRCULATIONAHA.108.784009

Vaccinating expectant mothers against flu
Maternal influenza immunisation has substantial benefits for mother and child, a study undertaken in Bangladesh has shown. Researchers randomised 340 mothers to receive either inactivated influenza vaccine or the 23-valent pneumococcal polysaccharide vaccine (control). Mothers were interviewed weekly to assess illness until 24 weeks after birth and any febrile respiratory illness was clinically assessed. Influenza vaccine was found to reduce proven influenza by 63 per cent in infants aged up to six months and to avert approximately one-third of all febrile respiratory illnesses in mothers and young infants.
Zaman K, Roy E, Arifeen SE et al. N Engl J Med 2008; 359: 1555-64

Cervical cancer and ethnicity
Targeted prevention of cervical cancer among certain immigrant groups has been proposed by researchers in Sweden after they found a higher RR of the disease in these groups. They followed 758,002 immigrants who resided in Sweden between 1968 and 2004. Immigrants had lower age-standardised incidence rates for cervical cancer than in their countries of origin, but overall, a slightly higher risk of disease (RR 1.13) than Swedish-born women. This was especially true for women from Denmark, Norway and Central America. However, women from east Africa, south central Asia and south western Asia had a lower risk of cervical cancer than Swedish women. Follow-up time and age at migration were important factors affecting the risk.
Azerkan F, Zendehdel K, Tillgren P et al. Int J Cancer 2008; 123: 2664-70

Vitamin D may affect chronic pain
A woman's vitamin D status is associated with the presence of chronic widespread pain, UK researchers have found. Blood samples and pain scores from almost 7,000 men and women aged 45 years were analysed. Smokers, non-drinkers, the overweight and underweight all reported higher rates of chronic pain. Vitamin D levels did not influence the extent of chronic pain in men. However, women with vitamin D levels of 75-99mmol/L had the lowest rates of chronic pain (just over 8 per cent), while those with levels below 25mmol/L had the highest rates (14.4 per cent). The researchers found a J-shaped relationship, with prevalence of widespread pain at 10 per cent or more among women with vitamin D levels above 99mmol/L.
Atherton K, Berry DJ, Parsons T et al. Ann Rheum Dis 2008; doi:10.1136/ard.2008.090456

Infertility treatment success scrutinised
Long-established medical interventions for infertility do not appear to result in more live births than expectant management. A total of 580 women at five hospitals in Scotland were randomised to expectant management (n = 193), oral clomifene citrate (n = 194) or unstimulated intrauterine insemination (n = 193) for six months. Live birth rates were 17 per cent, 14 per cent and 23 per cent, respectively. Compared with expectant management, the OR for a live birth was 0.79 (95% CI 0.45-1.38) after clomifene citrate and 1.46 (0.88-2.43) after unstimulated intrauterine insemination. However, more women randomised to an 'active' intervention found the process acceptable than those randomised to expectant management.
Bhattacharya S, Harrild K, Mollison J et al. BMJ 2008; 337: a716

Hormonal factors and joint surgery
Increasing parity, early puberty and HRT all raise the risk of joint surgery, especially knee replacement, UK researchers have found. Their prospective study examined the risks of hip and knee replacement for osteoarthritis among 1.3 million women aged an average 56 years at baseline. Over a mean 6.1 person-years follow-up, 12,124 women had a hip replacement and 9,977 women had a knee replacement. Current HRT use raised the risk of hip replacement by 38 per cent and knee replacement by 58 per cent. Early age at menarche raised the risk by 9 per cent and 15 per cent, respectively. Parity also had an effect, raising risk by 2 per cent and 8 per cent per birth, respectively.
Liu B, Balkwill A, Cooper C et al. Ann Rheum Dis 2008; doi 10.1136/ard.2008.095653

Exercise cuts cancer risk in lean women
Vigorous activity protects against breast cancer among women of normal weight, a US study has shown. Usual physical activity was assessed among 32,269 women at baseline using a self-administered questionnaire; participants were followed up for 11 years. The researchers found an inverse relationship between postmenopausal breast cancer and vigorous activity, but only among women with a BMI below 25kg/m2 (RR 0.68; 95% CI 0.54-0.85); there was no such association for overweight women. Vigorous activity was defined as heavy housework (for example, scrubbing floors, digging) and strenuous sports or exercise, such as fast jogging or aerobics.
Leitzmann MF, Moore SC, Peters TM et al. Breast Cancer Res 2008; 10: R92. doi:10.1186/bcr2190

Music helps pregnant women
Music can help to soothe stress and anxiety during pregnancy, say researchers in Taiwan. The study involved 236 women aged an average 30 years, who were between 18 and 34 weeks pregnant; 116 received two weeks of music therapy, while 120 received only general prenatal care. Psychological health was assessed using three self-report measures, including the Edinburgh Postnatal Depression Scale.The music group showed significant reductions in their stress, anxiety and depression scores, while the control group showed a much smaller reduction in stress, with little or no improvement in anxiety and depression scores.
Chang MY, Chen CH, Huang KF. J Clin Nurs 2008; 17: 2580-7

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