Preventive approach lowers c-section rates

NEW YORK (Reuters Health) A preventive strategy that uses the labour-inducing drug prostaglandin can safely reduce c-section rates, new research suggests.

C-section rates have been climbing in North America for a number of years, a trend that is concerning since complications can occur with the procedure, Dr. James M. Nicholson, from the University of Pennsylvania in Philadelphia, and colleagues note in the Annals of Family Medicine.

In the 1990s, the preventive induction approach was found to be useful in reducing c-section rates.

The goal of the present study was to compare c-section rates and delivery outcomes for doctors who did or did not use preventive induction. The study group included 794 women who had a doctor who used this approach and 1,075 women with a doctor who did not use this approach.

The researchers found that the induction group had a lower c-section rate compared with the group that did not undergo induction 5.3 percent versus 11.8 percent. There was no evidence that preventive induction raised the risk of any birth complications, the authors report.

In a related editorial, Dr. Aaron B. Caughey, from the University of California, San Francisco, comments that if further studies verify these results, preventive induction could be a useful technique for improving birth outcomes.

Panic with agoraphobia linked to alcohol

NEW YORK (Reuters Health) People who have panic disorder with agoraphobia often develop an alcohol use disorder, and vice versa each condition may directly contribute to the development of the other, according to a report in the Journal of Clinical Psychiatry.

Alcohol use disorders and panic disorder with or without agoraphobia tend to occur within the same individual," Dr. Eric J. L. Griez, of Maastricht University, the Netherlands, and colleagues write. Agoraphobia is the abnormal, obsessive, intense fear of open places or open areas. People with agoraphobia may become anxious by just thinking about a situation where it might be difficult to leave, and they will avoid the situations that trigger anxiety or panic, even if it means confinement to the home.

The cause of this agoraphobia-panic condition is controversial, the researchers note. Three explanations have been offered to explain these behaviours.

The first suggests that panic disorder with agoraphobia promotes excessive alcohol use as self-medication. Second, chronic alcohol abuse and alcohol withdrawal induce neurochemical changes that promote panic. The third possibility is the some people are genetically predisposed to developing both disorders.

The researchers conducted a review of epidemiological, family, and laboratory studies on alcohol and panic disorders. A total of 20 studies were included in the analysis.

Based on their analysis of the data, the investigators found that in patients with panic disorder with agoraphobia, alcohol appears to decrease the level of anxiety, which reduces the likelihood of panic.

In alcohol abusers, they found that alcohol increases carbon dioxide sensitivity, thereby promoting panic.

A clear pattern of family transmission was also found to contribute to the occurrence of both panic and alcohol use disorders.

Acetaminophen eases wisdom tooth pain

NEW YORK (Reuters Health) Paracetamol (Panadol), the pain killer known as acetaminophen in the US and sold under the trade names Tylenol in the US and Panadol in the UK, is an effective treatment for the pain following wisdom tooth extraction, according to a review of 21 studies that used the drug to placebo, or an inactive substance.

"It could be considered more readily by dentist and patients both as a first-choice analgesic, or to be taken alternately with doses of other analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs)," Dr. Kiaran Weil of The University of Manchester, UK, and colleagues conclude.

Paracetamol is commonly used to treat pain after wisdom tooth extraction, Weil and his team note. While the drug is frequently classified as an NSAID, they add, its anti-inflammatory effects are "relatively weak" compared to other drugs in the class. However, the drug is effective for pain relief and has few adverse effects.

The researchers conducted a review of the medical literature to gauge the effectiveness of paracetamol compared to placebo for pain relief after removal of the lower wisdom teeth and identify the best dosage and dosing time.

They analysed 21 trials including 1,968 patients. Four and six hours after taking the drug, the researchers found that patients reported significantly less pain than with placebo. The optimal dosage was 1,000 mg, which the researchers determined could be taken safely every six hours.

Brain abnormalities seen in writer's cramp

NEW YORK (Reuters Health) People who suffer from writer's cramp appear to have structural abnormalities in the cerebellum, the area of the brain involved in regulating movements, and in areas on the opposite side to the affected hand, researchers report in the journal Neurology.

"It's not clear whether these abnormalities are a cause or a result of the disease," senior author Dr. Stephane Lehericy, from Salpetriere Hospital in Paris, said in a statement. "The fact that the brain abnormalities are in the areas that control the affected hand suggests that these differences are specific to this problem."

It is possible that the sustained repetitive movement associated with writing led to the changes in brain structure, Lehericy noted.