Research highlights – 25 February 2011

Research questions “Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.

Alcohol: is it all bad news?
With conflicting messages about the bad and good effects of alcohol often present both in the medical literature and in the general media, what should clinicians be telling their patients? This week’s BMJ looks at both sides of the coin. The Practice section focuses on the harms of alcohol, with a summary of NICE guidance about risky drinking, accompanied by an alcoholic patient’s story. Meanwhile, Paul Ronksley and colleagues sought answers about the potential benefits of alcohol. Their systematic review and meta-analysis aimed to provide an up to date summary of current knowledge about the effect of drinking on a broad range of clinically important cardiovascular outcomes. The news was good—for those who consume light to moderate amounts of alcohol (2.5–14.9 g/day, or about ≤1 drink a day). Such consumption was associated with reduced risks of cardiovascular disease compared with non-drinkers. This conclusion was supported by further findings in a second paper by the group, which showed that moderate alcohol consumption was associated with favourable changes in several biomarkers of coronary heart disease. The evidence of a protective effect of alcohol is compelling, say the authors, and in the full length versions of the papers online they consider how these messages might be integrated into clinical practice and public health messages.

Women: worry away
Women who are struggling to conceive sometimes think that the stress and worry brought on by their infertility problems, or by other things going on in their life such as work or family issues, could be contributing to their lack of natural fertility or lack of success with fertility treatment. Tales of couples who conceive spontaneously on holiday or after adoption, when they aren’t under the strain of trying to conceive, only add to this belief.

Thankfully a new meta-analysis has shown that emotional distress has no effect on the likelihood of pregnancy after one cycle of assisted reproductive technology. The authors of this analysis looked at 14 studies of 3583 infertile women in 10 countries who were undergoing fertility treatment and found no significant difference in subsequent pregnancy between those who were anxious before treatment and those who were not. Whether women were undergoing treatment for the first time or had used an assisted reproductive technology before had no effect on this outcome either.

“This finding provides doctors with the evidence to reassure women that feelings of tension, worry, or depression experienced as a result of their fertility problem, its treatment, or other co-occurring life events are unlikely to further reduce chances of pregnancy,” write the authors.

Peer support for type 2 diabetes
Peer support could be a promising approach for diabetes care as it harnesses the ability of patients with diabetes to support each other in managing their everyday lives. However, there is limited evidence to date supporting its effectiveness. S Smith and colleagues did a pragmatic cluster randomised controlled trial examining the effectiveness of peer support in improving outcomes for people with type 2 diabetes. The intervention was based on social support and was delivered in groups based in general practices.

They found that although it was feasible to introduce the intervention into this setting, many patients were not interested in participating, and 18% of those who agreed to participate never attended any meetings. For those who took part, there was a trend towards improvements in clinical care but no significant improvements in diabetes or psychosocial outcomes, suggesting that peer support should not be widely adopted in clinical practice until further research is carried out.

Foundation programmes broaden access to medical school
Jonathan Mathers and colleagues did a cross sectional, population based analysis to determine whether new programmes developed to widen access to medicine in the UK have produced more diverse student populations. They report that medical school foundation programmes, which focus on students from ethnic and socioeconomic groups traditionally under-represented in medicine, are more likely to admit non-white students and those from lower socioeconomic classes than are traditional five year undergraduate medical courses (doi:10.1136/bmj.d918). However, foundation programmes are only offered by three of the 31 medical schools in the UK, leading the authors to conclude that “the implementation of ‘new’ admission routes to the profession does not seem to be bringing significant change.” In addition, students on four year graduate entry programmes were older than those on traditional courses but were more likely to be white, suggesting that graduate entry courses aren’t changing the socioeconomic profile of the UK medical student population.