Depression in pregnancy:
Last week's British Medical Journal indicates that depression during pregnancy is more common than postnatal depression. More than 9,000 pregnant women recorded their mood through pregnancy and after childbirth in a series of questionnaires. Any reported symptoms of depression were measured against a recognised depression scale. Depression scores were higher during pregnancy than after childbirth, with a peak at 32 weeks of pregnancy and a lowest value eight months after childbirth. The severity and nature of reported symptoms did not differ before and after childbirth, suggesting depression is no more likely after childbirth than it is during pregnancy, say the authors. They call for urgent research into "Offering treatment may be important for both the mother and the future well-being of the child and family," the authors conclude.
NEW HRT guidelines
The American Heart Association has issued revised guidelines on hormone replacement therapy for postmenopausal women. They reverse previous recoomendations and advise against the use of hormone replacement therapy for cardiovascular protection alone in postmenopausal women. The revised recommendations were issued because of a conflicting evidence about combined oestregen and progestogen therapy and its effects on the heart.
It has also recommended considering discontinuation of replacement therapy and instituting prophylaxis for venous thromobosis in women who develop an acute coronary event while taking oestregen-progesten replacement. Recommendations for the primary prevention of heart disease await the results of on-going trials, as there is currently insufficient data to support a role for hormone replacement therapy for primary prevention, according to the association.
Medicinal marijuana:
Users and growers of medical marijuana in Canada will be given identification cards to prevent police harassment under regulations unveiled last month. Doctors will have to approve the use of marijuana by the patient, who will then be entitled to possess 30 days' supply. The Canadian Medical Association is predicting that physicians will be reluctant to participate, due to the lack of credible scientific evidence supporting the use of medical marijuana, and because of its unknown side effects and concerns about unregulated supply of the drug. Doctors say they will have no way of knowing what grade or quality of marijuana their patients will be using. They are still awaiting the results of a five-year research programme, costing 7.5 million Canadian dollars (£4.2 million), to study the efficacy of marijuana in the treatment of wasting syndrome in HIV/AIDS patients. Until then, the Canadian medical world feels the expanded medical use of the drug is premature.
Feeling the strain:
Targets for preventing heart disease put huge strain on general practitioners in the United Kingdom. Primary-care teams there face a huge and unrealistic increase in workload in order to meet the goals of the national service framework for coronary heart disease, a recent study has found. Researchers at Nottingham University used computerised records from 18 general practices to identify two groups of patients aged 35-74: those with established coronary heart disease or stroke and those at high risk of developing coronary heart disease. Based on the list of standards described in the framework, the team estimated that in the average practice of 10,000 patients, more than 900 items will need recording and more than 2,000 disease-control measures will be needed, with profound implications for primary care, say the authors.
Healthy future?:
With increasing speculation about an insurance-based health system being introduced in the Republic, it is worth noting a recent survey that shows the number of uninsured Americans is growing. An estimated 17 per cent of children and 19 per cent of adults are uninsured, with the highest rates seen in black non-Hispanic ethnic groups.
lifelines@irish-times.ie