Interventions for postnatal depression
Health visitors can be trained to identify women with postnatal depression and offer effective treatment, according to a study involving more than 4,000 mothers from 101 general practices in England. Women received either a cognitive behavioural approach, person-centred care from specially trained health visitors, or health visitor usual care. At six and 12 months postnatally, those receiving care from trained health visitors showed greater reductions in depressive symptoms than those receiving usual care.
A second study, undertaken among 701 women at high risk of postnatal depression, has shown that telephone peer support (mother to mother) may halve the risk of developing depression.
Morrell CJ, Slade P, Warner R et al. BMJ 2009; 338: a3045
Dennis CL, Hodnett E, Kenton L et al. BMJ 2009; 338: a3064
Rheumatoid Arthritis in women
Rheumatoid arthritis (RA) appears to affect women more than men, the results of an international cohort study suggest. Clinical and questionnaire data were gathered on 6,004 patients from 70 sites in 25 countries. Gender differences were examined in relation to disease activity, fatigue, rheumatoid factor, nodules and erosions, and current use of RA medication. Although similar proportions of men and women were receiving different therapies, RA disease activity measures appeared to be worse in women. However, the researchers suggest the differences may originate from the measures of disease activity, rather than from RA disease activity itself.
Sokka T, Toloza S, Cutolo M et al. Arthritis Res Ther 2009; 11(1): R7 doi:10.1186/ar2591
Herbal remedies in the menopause
There is no strong evidence for or against several herbal remedies commonly taken to relieve menopausal symptoms, a review has concluded. The authors say clinical trial data on black cohosh are 'equivocal', that there is 'no convincing evidence' supporting the efficacy of red clover extract and little evidence one way or another for dong quai, evening primrose oil, wild yam, chaste tree, hops or sage. They add that published trials are often poorly designed, include too few participants, or are of too short duration to be of value; furthermore, the safety of herbal preparations has been under-researched.
Drug Ther Bull 2009; 47(1): 2-6
Complications of central neuraxial block
Data on the risk of epidurals and spinal anaesthetics suggest that central neuraxial block (CNB) has a low incidence of major complications, many of which resolve within six months. The Royal College of Anaesthetists' Third National Audit Project involved a two-week census that estimated the number of CNB procedures performed annually in the NHS; all major complications of CNBs performed over one year were reported. Data were interpreted 'pessimistically' and 'optimistically'. Incidence of permanent injury due to CNB was pessimistically 4.2 per 100,000 cases and optimistically 2.0 per 100,000. Incidence of paraplegia or death was pessimistically 1.8 per 100,000 and optimistically, 0.7. Two-thirds of initially disabling injuries fully resolved.
Cook TM, Counsell D, Wildsmith JA. Br J Anaesth 2009; 102(2): 179-90
Women seeking nutritional information
Preconception and pregnancy are times of increased interest, need and seeking for nutrition-related information, researchers in The Netherlands have found. They say this should be borne in mind when healthy nutrition promotion activities are being developed. Their cross-sectional study involved face-to-face interviews with four groups, each of about 100 nulliparous women: those trying to conceive and those in the first, second and third trimester of their first pregnancy. Women in their first trimester searched for information most frequently. Those wanting to conceive and women in their third trimester found more pregnancy-specific information topics than those in their first and second trimester. Overall, the internet, the midwife and books were the favourite information sources.
Szwajcer EM, Hiddink GJ, Maas L et al. Fam Pract 2008; 25: 99-104
Use of DMPA in adolescence
Adolescent girls receiving depot medroxyprogesterone acetate (DMPA) experience a significant loss in bone mineral density (BMD), but the rate of loss slows markedly after the first year of use. US researchers studied 433 females aged 12-18 years, who were on DMPA (n = 58), oral contraceptives (n = 187), or were untreated (188). Over 24 months, mean BMD fell 1.5 per cent in those on DMPA, but rose in the other two groups (4.2 per cent for oral contraceptives, 6.3 per cent for untreated). Mean percentage change in femoral neck BMD was -5.2 per cent for DMPA, +3.0 per cent for oral contraceptives and +3.8 per cent for those untreated. In the DMPA group, mean percentage change in spine BMD over the first 12 months was -1.4 per cent, but this slowed to -0.1 per cent over the second 12 months. No bone density loss reached the level of osteopenia.
Cromer BA, Bonny AE, Stager M et al. Fert Steril 2008; 90(6): 2060-7
Depression and bone metabolism
Endocrine and immune alteration secondary to depression may play a pathogenetic role in bone metabolism, the authors of a review study suggest. Their analysis of studies published between 1994 and 2007 has highlighted that the possible association between psychiatric illness, in particular depression, and osteoporosis has been the subject of a growing body of research. Furthermore, most studies have identified some effect on bone. The researchers say that data suggest low bone mineral density is disproportionately prevalent among people with psychiatric disorders and that current findings are of clinical relevance, given the health burden of both depression and osteoporosis.
Williams LJ, Pasco JA, Jacka FN et al. Psychother Psychosom 2009; 78: 16-25
Magnetic bra strap
A magnetically fastened bra has been developed for disabled and older women who have difficulties with dressing. CoreBra is front-fastening, comes in eight sizes and has large finger loops designed to make the process of dressing easier. Traditional hook fastenings have been replaced with magnets. The designer, who developed the bra with the help of Coventry University's Health Design and Technology Institute, says it is proving popular with carers.