Obesity, Smoking and Opiate Use

By Glenesk, Alison

JOURNALS WATCH

Too busy to read the journals? Let Dr Alison Glenesk guide you through the latest research

Decreasing obesity in schoolchildren

Arch Dis Childhood2007; 92:153-4

It is encouraging to encounter a study that shows that something is improving. All school entrants to primary one from 17 Aberdeen primary schools were weighed and measured in the years 1997,2001 and 2004. Relevant percentages of children classed as Obese’were 14.7 per cent, 11.4 per cent and 10.2 per cent respectively, showing a significant downward trend, seemingly at variance with the present received wisdom that childhood obesity is increasing.

The authors speculate that the health education message may be getting through to adults.

Firstly, however, they would have to reduce consumption of our local delicacy, the Aberdeen ‘rowie’, a pastry composed almost entirely of fat and salt that is a major cause of obesity here.

Postnatal factors in failure to thrive

Arch Dis Childhood2007;92-115-9

In this longitudinal study 11,900 infants were assessed for failure to thrive up to eight weeks and from eight weeks to nine months of age (defined as adjusted weight gain below the fifth centile).

Under eight weeks,associated maternal factors were older age and short stature (< 160cm), but infant factors such as poor sucking, illness and hospital admissions were seen as more important.

Between eight weeks and nine months, all but 30 of these children recovered. Important factors in the 5.7 per cent with failure to thrive in this group were again infant-related, with slow feeding, breast-feeding after six months and poor intake of solids at six months being important.

The authors point out that WHO guidelines suggest delaying weaning until six months, but advise caution about the very narrow window for successful introduction of solids after this, and urge us to assess feeding behaviour first, in failure to thrive.

Incentives in smoking cessation

Tobacco Control 2007; 16(1): 15-21

This was a German study and recruited 572 patients in practices where GPs had had a tutorial on smoking cessation. Patients were put into one of four groups: a ‘usual care’ group; a group whose GP had been trained and would get euro130 for each patient smoke-free at one year; GP training and free nicotine replacement therapy products, bupropion, or a combination of the above. The first two groups were abstinent in only 3 per cent at one year. In the last two groups, 12 per cent and 15 per cent were abstinent respectively.

Strong opiates for non-cancer pain

Br J Gen Pract2007; 57:101-8

There is a reluctance to prescribe strong opiates for conditions such as severe arthritis or intractable back pain because of worries about side-effects, tolerance and dependence.

This study, of 10 subjects, was initiated by a patient who wished to find out about the experience of similar opiate-users. Practically, tolerance and dependence were not a problem.

The authors conclude that we should be less anxious about using strong opiates in non-cancer patients, provided we follow the guidelines.

Early breast cancer diagnosis and exercise

BMJ doi:10.1136/bmj.39094.648553.AE

This study recruited 203 patients with early breast cancer and allocated them to ‘exercise’ or ‘usual care’ groups.The exercise group were encouraged to attend an exercise class plus discussion, twice weekly for 12 weeks. At 12 and 24 weeks they were assessed for overall wellbeing using the ‘Functional Assessment of Cancer Therapy’ test. Improvement was found in the active group in all areas.

RESEARCH OF THE WEEK

Rate or rhythm in AF?

Stroke 2007; 38(Suppl 2): 615-9

The study looked at five randomised controlled trials comparing the adverse outcomes (death and thromboembolic events) of rate versus rhythm control in AF. Rhythm control, usually withamiodaroneor cardioversion, is the current treatment of choice.

Surprisingly, the outcomes forall parameters were worse for rhythm than rate control.

The authors suggest that patients who appear to be in sinus rhythm following treatment may in fact be having paroxysmal episodes ofAF, which can be disastrous because anticoagulants have usually been stopped by then.

They suggest that, at the very least, anticoagulation should continue in these patients even though they appear to be in sinus rhythm.

Health education might be working: the percentage of school children who are obese has reduced significantly in Aberdeen since 1997

The quick study

Childhood obesity seems to be decreasing in Aberdeen primary schools.

Failure to thrive is affected by feeding factors rather than socio-economic ones.

Smoking cessation is more successful when free NRT or bupropion is combined with GP training.

Opiates should be prescribed with more confidence in patients with non-cancer pain.

Exercise should be encouraged in patients with early breast cancer.

Dr Glenesk is a CP in Aberdeen and a member of our team who reviews the journals

Copyright Haymarket Business Publications Ltd. Mar 9, 2007

(c) 2007 GP. Provided by ProQuest Information and Learning. All rights Reserved.