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At the heart of general practice since 1960

Wider role for pharmacists worries GPs

Quit smoking schemes worthwhile

Smoking cessation programmes can have a substantial effect on long-term mortality, according to US and Canadian researchers.

The study of 5,887 middle-aged patients evaluated a 10-week programme including

discussions with a doctor, group sessions on behaviour modification and nicotine replacement therapy. Patients were followed up for up to 14.5 years and compared with usual care controls.

After five years, 21.7 per cent of the intervention group had stopped smoking but

only 5.4 per cent of controls had. At the end of

follow-up, all-cause mortality was 8.83 per 1,000 person-years in the intervention group and 10.38 in controls.

Annals of Internal Medicine 2005;142:233-9

Antibiotics for pneumonia compared

Antibiotics active against atypical pathogens do not appear to be any better than beta-lactam agents for treating non-severe community-acquired pneumonia.

New Zealand researchers analysed 18 trials including 6,749 patients and compared the two groups of antibiotics. In patients with Mycoplasma pneumoniae or Chlamydia pneumoniae, risk of treatment failure was not significantly lower for antibiotics active against atypical pathogens than for beta-lactam agents. Treatment failure was 60 per cent less likely in patients infected with legionella species, but these accounted for a minority of cases.

BMJ 2005 ;330:456-60

High homocysteine linked to CVD

High levels of homocysteine may increase the risk of dying from cardiovascular disease.

Finnish researchers followed 802 men aged 46-64 without a history of heart disease or stroke. Over an average of 10.8 years of follow-up, 50 men died from cardiovascular causes.

Men with the highest serum homocysteine levels were 80 per cent more likely to die from cardiovascular disease than those with the lowest levels. Elevated homocysteine particularly raised risk in patients who smoked or had high cholesterol levels.

Journal of Internal Medicine 2005;257:255

Supplements cut hip fracture risk

Folic acid and vitamin B12 can reduce the risk of hip fracture in elderly stroke patients, a study suggests.

Japanese researchers studied 628 patients aged 65 or older with residual hemiplegia recruited a year after a first ischaemic stroke.

The patients were randomised to receive daily treatment with folate and the B12 homolgne mecobalamin, or double placebo. There were 10 fractures per 1,000 patient-years in the treatment group and 43 in patients receiving placebo. Patients in the treatment group had an absolute risk reduction of 7.1 per cent.

Journal of the American Medical Association 2005;293:1082-8

Pneumonia a haemorrhage risk

Infection with Chlamydia pneumoniae may increase the risk of subarachnoid haemorrhage, a Japanese study suggests.

Researchers measured serum C. pneumoniae IgG and IgA antibodies in 52 patients with subarachnoid haemorrhage and 104 healthy age-matched controls.

Patients with subarachnoid haemorrhage were 3.6 times more likely to have IgG and IgA antibodies for C. pneumoniae than controls, and more likely to have hypertension.

Cerebrovascular Disease 2005;19:209-13

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