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| From recent issues of CMAJ |
Health news in the Canadian Medical Association Journal
Compiled by Pat Rich
Screening for Depression not Necessarily a Good Idea
Having primary care physicians check all patients for depression rather than just those who are clearly depressed or who report problems does not necessarily lead to better results. That’s the conclusion of a review of the existing evidence completed by a large research team led by Brett Thombs (PhD) from the School of Nursing at McGill University in Montreal. Such screening is currently recommended in Canada and the US in certain conditions, but not in the United Kingdom. The review noted that no studies have shown that patients undergoing screening have better outcomes than unscreened patients when the same treatments are available to both groups. The analysis said the lack of effect of screening everyone may be explained by the fact many people may be wrongly identified as having depression and that doctors are already good at treating those who have the condition.
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Kids with Terminal Cancer: Hope Important for Parents
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Parents of children with incurable cancer are more likely than health care professionals to favour chemotherapy rather than supportive care alone. The study by researchers based at the Hospital for Sick Children in Toronto also found that hope was one of the most important factors influencing the parents’ choice of treatment. Of the 77 parents interviewed, 54.5% said they favoured using palliative chemotherapy, while only 15.6% of 128 health care professionals preferred this option. A follow-up article by Caprice Knapp (PhD) and Dr. Kelly Komatz of the University of Florida said the difference in views suggests either a miscommunication between parents and health care professionals or unrealistic expectations on the part of the parents.
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Agents That Lower Cholesterol Effective in People at Low Risk for Heart Attack
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Statins — a popular class of drugs that lowers cholesterol and has proven to improve survival in patients at high risk for heart attack — are also effective in preventing death and poor outcomes in those at low risk. That’s the conclusion of a research team from the Alberta Kidney Disease Network that analyzed all studies investigating how statins affect low-risk populations. In their review of findings from 29 clinical trials involving 80,711 participants, they found those taking a statin were 10% less likely to die from any cause than patients not using these drugs. These patients were also less likely to suffer a non-fatal heart attack or stroke. This benefit was shown regardless of the strength of the drug. Individuals who are at low risk of heart attack should consider talking to their physician about the benefits of statins.
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Diabetes: Sulphonylureas Cost-Effective as Add-On Drug
In patients with type 2 diabetes, using a sulphonylurea (a drug that increases insulin levels such as Diabeta, Diamicron, Euglucon, Amaryl) is the most costeffective option when metformin (a drug commonly used to lower blood sugar) isn’t enough. Right now, there are several secondary options available for patients with diabetes when metformin and lifestyle changes alone can’t control the disease. An analysis by Dr. Scott Klarenbach from the University of Alberta and colleagues compared all the medications currently available to determine the best option. They said the low cost of sulphonylureas relative to other drugs, coupled with minor differences in blood sugar control and the low absolute risk of hypoglycemia, makes this type of drug the most costeffective option. Talk to your doctor about this medication if your current prescription is either ineffective or financially straining.
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Use of Some Anti-Inflammatory Drugs May Increase Abortion
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Use of some anti-inflammatory drugs other than Aspirin may increase the risk of spontaneous abortion, according to researchers based at the University of Montreal. This association was seen in an analysis involving 4705 women who had a spontaneous abortion and over 47,000 women who did not have a spontaneous abortion, all from Quebec. The analysis showed the use of certain anti-inflammatory drugs during early pregnancy was associated with an increased risk of having a spontaneous abortion regardless of type and dose of drug. The researchers suggest that these drugs should be used with caution during pregnancy.
