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At the heart of general practice since 1960

Specialists leave GPs in limbo over costly drug

Pregnancy clue to cot death

The risk of sudden infant death syndrome is increased when mothers have elevated blood levels of alpha-fetoprotein during pregnancy, according to a new study.

Researchers linked a prenatal screening database for women in western Scotland with data on 214,532 births, including 114 cases of sudden infant death syndrome.

Women with the highest blood levels of alpha-fetoprotein during the second trimester were 2.8 times more likely to have a child who died from the syndrome than those with the lowest levels.

New England Journal of Medicine 2004;351:978-86

C-reactive protein test cuts antibiotics

Testing patients with sinusitis for C-reactive protein can significantly reduce antibiotic prescribing for the disease, a new study concludes.

Danish researchers conducted an observational study of 17,792 GP consultations for respiratory tract infections, including 1,444 where patients presented with sinusitis.

In the 77 per cent of GPs who tested for C-reactive protein to identify bacterial infection, the rate of antibiotic prescribing for sinisitus was 59 per cent, compared with 78 per cent among GPs who did not use the test.

British Journal of General Practice 2004;54:659-62

Fitness is best predictor of CHD risk

Women's fitness levels are better than obesity at predicting their cardiovascular risk, according to a new study.

Researchers recruited 906 women at four US medical centres, 76 per cent of whom were obese, 70 per cent had low functional exercise capacity and 39 per cent had obstructive coronary artery disease.

Women with low self-reported fitness levels were almost twice as likely to have CAD as those with high fitness, whereas obesity was more weakly related to cardiovascular risk factors.

JAMA 2004;292:1179-87

ECG voltages 'predict cardiac events'

Changes in electrocardiographic voltages during follow-up can predict subsequent cardiovascular events in elderly patients with systolic hypertension. In a Europe-wide trial, ECGs were taken at baseline and then annually during an average follow-up of 6.1 years.

Baseline ECG voltages averaged 3.1mV and a reading of 1mV over baseline was associated with a 15 per cent increase in cardiovascular mortality.

A subsequent 1mV drop in ECG values during preventive treatment was associated with a 14 per cent fall in the risk of cardiac events.

Hypertension 2004; early online publication

Lactobacillus doesn't halt vulvovaginitis

Lactobacillus does not prevent post-antibiotic vulvovaginal candidiasis and may even increase the risk of developing the disease.

Australian researchers studied 235 women who were randomised to receive oral or vaginal lactobacillus, or placebo, for four days from the completion of their course of antibiotics.

The risk of developing vulvovaginitis after antibiotic treatment was 6 per cent higher in women taking oral lactobacillus than placebo and 38 per cent higher in those taking vaginal lactobacillus, although neither increase was statistically significant.

BMJ 2004; 329:548-51

Obesity raises the risk of diarrhoea

Obesity increases the risk of diarrhoea and abdominal pain, new research shows.

The study examined the gastrointestinal health of 980 patients from New Zealand, 30 per cent of whom were overweight and 12 per cent obese.

After adjustment for gender, obese people were 80 per cent more likely than those of normal weight to suffer from diarrhoea and twice as likely to have abdominal pain from nausea and vomiting.

American Journal of Gastroenterology 2004;99:1807-14

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