Venereal vaccine

A human papillomavirus (HPV) vaccine will probably be the first licensed vaccine against a common sexually transmitted infection, say Finnish authors.1 They were commenting on the GlaxoSmithKline HPV Vaccine Study Group’s report of an efficacious HPV vaccine.2

The study randomised 1113 women between 15-25 years of age to receive 3 doses of either a bivalent HPV-16/18 virus-like particle vaccine or placebo at 0, 1 month and 6 months. In analyses, vaccine efficacy against incident and persistent cervical infection was greater than 90%. The vaccine was generally safe, well tolerated and highly immunogenic. However, a protective antibody level has not yet been established, nor are there sufficient data to estimate the duration of vaccine-induced protection.

1. Lancet 2004; 364: 1731
2. Lancet 2004; 364: 1757-1765

Seniors on the sea?

Some elderly people should consider living on a cruise ship when they can no longer manage to live independently, say US authors. They compared the features and costs of long-term cruising with those of moving into an assisted living centre (hostel) in the US, where government assistance with the cost of care is limited. Cruises were similarly priced but more cost-effective. As well as offering three meals a day with escorts, and housekeeping and laundering services, added benefits of cruise ship care included on-site doctors and nurses, and emergency care facilities. The authors said the ideal candidates for cruise ship care were seniors who enjoy travel and have good cognitive function but need some help in daily living.

J Am Geriatr Soc 2004; 52: 1951-1954

From the Age of reason

Some 18th-century data give us pause to reflect on the current high rates of childbirth intervention, according to a UK author. Emeritus Professor Dunn says that a Dutch midwife, Catherina Schrader, kept notes on about 4000 confinements which she attended between 1693 and 1745, including 64 twins and three triplets. Although she recorded some manual extractions and a few instrumental deliveries, 95% of deliveries were spontaneous and without intervention. Overall, maternal mortality was about 1 in 200, and 95% of the neonates survived childbirth.

Arch Dis Child 2004; 89: F560-F562

To the final frontier

Remote medicine, particularly in developed countries, may receive a boost after a special report of a recent, successful project conducted on, of all places, the International Space Station. US researchers said that, with minimal pre-flight training, an on-board "refresher" course and (almost) real-time, Earth-based expert guidance, non-experienced personnel could be trained to conduct a complex, clinically useful ultrasound examination of the shoulder in space. The total examination time required was about 15 minutes. The researchers said that, in space, this technique could be used to evaluate shoulder integrity in symptomatic astronauts after strenuous extravehicular activities, or to monitor microgravity-associated changes in musculoskeletal anatomy. However, this spaceflight-derived technique is also readily transferable to Earth, including for rural, military and emergency medical care.

Radiology 2004, 10.1148/radiol.2342041680

Acupuncture advantage

Acupuncture, used in addition to an NSAID, may assist in managing osteoarthritis of the knee, say Spanish researchers. In a controlled trial involving 97 outpatients with osteoarthritis of the knee, they randomised subjects to receive 12 weekly sessions of either acupuncture or placebo acupuncture. In placebo acupuncture, supported needles were placed over the same points as for acupuncture, but did not perforate the skin. All study subjects were prescribed diclofenac (50 mg, 8-hourly) with instructions to reduce the dose if symptoms improved. At trial completion, outpatients who received acupuncture took less diclofenac and had less stiffness and better physical function of the knee. Bruising after acupuncture occurred in three patients (at the same local point).

BMJ 2004; 329: 1216-1219