Sudden infant death and dummies

This paper was set up to examine the association between use of a dummy (pacifier) during sleep and the risk of sudden infant death syndrome (SIDS) in relation to other risk factors.

It was a population based case-control study set in seven counties in California. Mothers or carers of 185 infants whose deaths were attributed to SIDS and 312 randomly selected controls matched for race or ethnicity and age were chosen. The study looked at the use of a dummy during sleep determined through interviews.

The study found that the adjusted odds ratio for SIDS associated with using a dummy during the last sleep was 0.08. The use of a dummy was associated with a reduction in risk in every category of socio-demographic characteristics and risk factors examined.

The reduced risk associated with use seemed to be greater with adverse sleep conditions (such as sleeping prone or on one side and sleeping with a mother who smoked), although the observed interactions were not significant.

In addition, use of a dummy may reduce the impact of other risk factors for SIDS, especially those related to adverse sleep environment. For example, infants who did not use a dummy and slept prone or on their sides (v on their back) had an increased risk of SIDS (odds ratio: 2.61).

In infants who used dummies, there was no increased risk associated with sleeping position (OR = 0.66). While cosleeping with a mother who smoked was also associated with increased risk of SIDS among infants who did not use a dummy (OR=4.5), There was no association among those who did (OR=1.1)

The study concluded that use of a dummy seems to reduce the risk of SIDS and possibly reduces the influence of known risk factors in the sleep environment.

Web: Source

Back to top

NICE calls for wider use of statins

Treatment with statins should be considered in patients with clinical evidence of cardiovascular disease and in people with a 20% or greater risk of developing the disease within 10 years. This was the recommended guidance to the NHS in England and Wales published in January 2006, which will make an additional 3.3 million people eligible for these drugs.

The National Institute for Health and Clinical Excellence (NICE), the body that advises on the use of treatments by the NHS, reviewed all available studies on the efficacy and cost effectiveness of statins. NICE recommends use of statins in adults with clinical evidence of cardiovascular disease and in the primary prevention of the disease for adults with a 20% or greater 10 year risk than average of developing it.

Previous guidance recommended the use of statins in patients with a 30% risk and in people who already had symptoms of the disease. Lowering the risk threshold for statins will more than double the number of people who can be prescribed the drugs on the NHS, from the current two million in England and Wales.

The guidance recommended that treatment should usually be started with a low cost statin drug, taking into account the required daily dose and product price per dose. NICE estimated that the net cost to the NHS of increasing provision of the drugs would be about £8.5m a year.

David Barnett, the chairman of the independent appraisal committee that developed the guidance for NICE, said, "In terms of potential impact, this guidance is arguably one of the most significant to have come out of NICE since it started over six years ago.

It offers clear guidance about which patients should be started on treatment with a statin and how doctors should go about it." He added that lifestyle changes to reduce cardiovascular disease, such as stopping smoking, should also be considered when starting treatment with statins.

Web: Source

Back to top

Depression in older people in primary care

The IMPACT trial was conducted at 18 diverse primary care clinics across the United States. The 1801 study participants were self referred or referred by their doctor, or identified by systematic depression screening. Patients were aged 60 or older and met criteria for major depression or dysthymia, or both, according to the structured clinical interview for DSM-IV axis I disorders

(After a structured baseline interview, patients were randomised to IMPACT collaborative care or usual care. The aim of the study was to determine the long term effectiveness of collaborative care management for depression in late life.

The study was a two arm, randomised, clinical trial; with an intervention for one year and follow-up two years. It took place in 18 primary care clinics in eight US healthcare

organisations. There were 1801 primary care patients aged 60 and older with major depression, dysthymia, or both. Intervention Patients were randomly assigned to a 12 month collaborative care intervention (IMPACT) or usual care for depression. Teams including a depression care manager, primary care doctor, and psychiatrist offered education, behavioural activation, antidepressants, a brief, behaviour based psychotherapy (problem solving treatment), and relapse prevention geared to each patient’s needs and preferences.

The main outcome measure was conducted by interviews in person at baseline and by telephone at each subsequent follow-up. They measured depression (SCL-20), overall functional impairment and quality of life (SF-12), physical functioning (PCS-12), depression treatment, and satisfaction with care.

Overall the  IMPACT patients fared significantly (P < 0.05) better than controls regarding continuation of antidepressant treatment, depressive symptoms, remission of depression, physical functioning, quality of life, self efficacy, and satisfaction with care at 18 and 24 months.

One year after IMPACT resources were withdrawn, a significant difference in SCL-20 scores (0.23, P < 0.0001) favouring IMPACT patients remained.

It appeared that the tailored collaborative care actively engages older adults in treatment for depression and delivers substantial and persistent long term benefits. These include less depression, better physical functioning, and an enhanced quality of life.

The IMPACT model may show the way to less depression and healthier lives for older adults.

Web: Source

Back to top