Human papillomavirus on the wane. . . and other stories
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6182 (Published 23 November 2016) Cite this as: BMJ 2016;355:i6182
Vaccinating women against HPV also protects men
In Australia, high uptake of the vaccine for human papillomavirus has led to reductions in the prevalence of HPV genotypes 6/11/16/18 in women aged ≤25 years. At the same time, a study of self administered penile swabs shows a 78% decline in the prevalence of these genotypes in unvaccinated men of similar age, compared with older men (J Infect Dis doi:10.1093/infdis/jiw530). There was no such difference in the prevalence of papillomavirus genotypes that were not included in the vaccine.
Hemiplegic migraine and depression
A Dutch study compared 89 patients who had well defined hemiplegic migraine with 235 controls who were free of headache (Neurology doi:10.1212/WNL.0000000000003376). People with this rare form of migraine, where the aura is accompanied by focal motor weakness, are about four times more likely to experience depression in the course of their lives (odds ratio 3.73, 95% confidence interval 2.18 to 6.38).
Welsh slate and the lung
Across the northern half of Wales, ravaged mountainsides bear witness to the huge demand for slate by the British Empire when it was in its heyday. Slate mining took its toll on limbs and also on lungs and, according to an analysis of Medical Research Council data (Occup Med doi:10.1093/occmed/kqw147), the few Welshmen who continue to mine slate may still be more prone to chronic obstructive pulmonary disease than is accountable for by smoking or pneumoconiosis. The difference between miners (33%) and matched non-miners (26%) is small but statistically significant.
Elective sigmoidectomy for diverticulitis
Patients who had recurrent and persisting abdominal complaints after an episode of left sided diverticulitis were randomised to conservative management or to elective sigmoidectomy in the Dutch DIRECT trial (Lancet Gastroenterol Hepatol doi:10.1016/S2468-1253(16)30109-1). The 53 who underwent resection had a higher overall quality of life at six months, compared with the 56 who had conservative treatment, 13 of whom ended up having surgery anyway. More than a third of both groups had severe adverse events during those six months.
Talking about palliative chemo
Treatment at the end of life can be difficult to talk about, and a study of 60 videotaped consultations between oncologists and patients with cancer and a median life expectancy of less than a year shows how often gaps occur (Palliat Med doi:10.1177/0269216316676010). True dialogue about the effects of palliative chemotherapy treatment in relation to patient preferences occurred in just 51% of the recorded encounters.
Do antibiotics make kids obese?
Over a quarter of a million children’s records on the Kaiser Permanente Northern California database were analysed to address the vexed question of whether giving antibiotics to babies increases the likelihood of childhood obesity (Lancet Diabetes Endocrinol doi:10.1016/S2213-8587(16)30281-9). The authors conclude that while episodes of infection show a linear relation to the risk of child obesity, antibiotic prescribing in itself does not, but they suggest that this finding will need to be replicated in future studies.
Below knee deep vein thrombosis and new heparin
A publicly funded multinational randomised trial set out to determine if a low molecular weight heparin (nadroparin) might reduce clot extension or embolism in acute symptomatic deep vein thrombosis of the calf (Lancet Haematol doi:10.1016/S2352-3026(16)30131-4). Recruitment was slow, and the agent was withdrawn from the market half way through the trial, but not before the investigators were able to conclude that it was not superior to placebo in reducing the risk of proximal extension or venous thromboembolic events in low risk outpatients with symptomatic deep vein thrombosis of the calf, but it did increase the risk of bleeding.
Otorhinolaryngological gobbledegook
Laudable efforts are being made to improve the readability of a website for patients in the USA: the Patient Health Information section of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (Otolaryngol Head Neck Surg doi:10.1177/0194599816674711). But although investigators find recent improvements, they conclude that patient educational material available online is still too difficult for the average reader to understand. In their rigorous analysis, the researchers used six different instruments: the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook.
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