Increased Drowning Risk Documented in Patients with Epilepsy

Internal Medicine World ReportNovember 2005

Increased Drowning Risk Documented in Patients with Epilepsy

PARIS—Epilepsy patients have a 15-fold higher risk of death by drowning compared with the general population, investigators said at the 2005 International Epilepsy Congress.

Athanasios Gaitatzis, MD, with the University College of London, and colleagues reviewed the death certificates of patients who died in England and Wales between September 1999 and August 2000 for whom epilepsy was recorded on their death certificate.

Overall, 22 of 2042 such deaths reported during the study period were identified as being the result of drowning, immersion, or submersion in water.

Standardized mortality ratios (SMRs) were calculated as the ratio of observed-to-expected number of deaths in this epilepsy population. The overall SMR was 15.3; in women, it was 23.9, and in men, it was 13. Only 5 deaths occurred during the summer months.

Dr Gaitatzis said that adequate seizure control and precautionary measures are critical in patients with epilepsy to reduce their chances of drowning.

Salmeterol/Fluticasone Tops Budesonide/Formoterol Adjustable Maintenance Dosing for Asthma Control

COPENHAGEN—New results suggest that patients treated with formoterol (Symbicort, not available in this country) adjustable maintenance dosing have nearly twice the rate of asthma attacks leading to hospital admission or oral steroid treatment as patients who receive salmeterol/fluticasone propionate (Advair Diskus) stable dosing.

The data, from the CONtrol CEntred Patient Treatment study, were reported at the European Respiratory Society annual congress.

The trial compared salmeterol/fluticasone propionate stable dosing with formoterol/budesonide adjustable maintenance dosing in 688 adults who experienced asthma symptoms on a routine basis.

During weeks 5 through 52, the median percentage of symptom-free days was significantly higher in the salmeterol/fluticasone propionate group than in the formoterol/budesonide adjustable maintenance dosing group (73.8% vs 64.9%, respectively; P =.030). This translates into an average additional 32 symptom-free days per year in the salmeterol/fluticasone propionate stable dosing group compared with the formoterol/budesonide adjustable maintenance dosing group.

The yearly mean flare-up rate was 0.18 and 0.33 for the 2 groups, respectively (P =.008), which amounts to a 47% flare rate reduction for patients receiving salmeterol/fluticasone propionate stable dosing compared with formoterol/budesonide adjustable maintenance dosing.

Mark Fitzgerald, MD, director of the center of clinical epidemiology and evaluation at the University of British Columbia, Vancouver, Canada, presented the data.

Smokers Don’t Quit Even After Coronary Event

ROTTERDAM, The Netherlands—Less than one half of patients who smoke decide to quit after sustaining a first coronary event, according to the results of a survey published in the European Heart Journal (doi:10.1093/eurheartj/ehi497).

For the survey, 5551 coronary patients up to 70 years of age in 47 hospitals in 15 European countries were interviewed about 16 months after the event or condition for which they had been hospitalized. Participants were asked if they had ever smoked, whether they had smoked in the month before hospital admission, and whether they currently smoked. Patients had undergone either coronary artery bypass surgery or balloon angioplasty and had sustained an acute myocardial infarction or had unstable angina.

Overall, 21% were still persistent smokers. Nearly all (99%) of the 2244 pre-event smokers had been counseled by a health professional to stop smoking, but only 48% had done so.

Results also showed that younger patients were less likely to quit; only 41% of those aged <50 years had stopped smoking. In addition, patients with angina were less likely to quit than those who had suffered a heart attack (38% vs 52%, respectively). Those with a lower level of education were less likely to stop than those with a university education.

Wilma Scholte op Reimer, MD, an epidemiologist at the Erasmus University Medical Centre in Rotterdam, said the results underscore the ongoing need for the development of more aggressive smoking cessation programs that target younger patients, those with lower levels of education, and those whose disease first manifests as angina.

Brits Fear Mugging More than Stroke Despite Higher Stroke Risk

LONDON—A total of 22% of British people feel that they are at risk of being the victim of a mugging, while only 6% are concerned about having a stroke, according to the results of a survey by the UK Stroke Association.

Such a low level of concern about a stroke and high level of concern about a potential mugging is way off the mark, said survey investigator Brian Chrichton, MD, a teaching fellow at Warwick University, Warwick, England.

In the United Kingdom, a mugging occurs every 13 minutes, while a stroke is diagnosed every 5 minutes.

Of the 2000 adults queried in the survey, >25% were smokers and nearly 1 out of 4 were binge drinkers. Both smoking and binge drinking significantly increase stroke risk.

Dr Crichton said that these findings corroborate the longstanding impression among general practitioners that more efforts must be made to improve awareness of risk factors for stroke and to encourage people to modify their lifestyle to decrease their risk.

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