31st May 2013, Volume 126 Number 1375

Work stress and risk of cancer

Work-related stress is associated with many adverse health outcomes, such as coronary heart disease and depression. This meta-analysis evaluates the possibility that such stress might increase the risk of the common cancers. Data from 12 independent studies carried out in several European countries over a period of 23 years were incorporated.

The total included population comprised 116,056 men and women aged 17–70, who were free from cancer at study baseline. All participants had complete data on job strain, age, sex, socioeconomic position, body mass index (BMI), smoking, alcohol intake, and incident cancer outcomes. Median follow-up was 12 years. 5700 cancers were noted during the follow-up. Estimates were adjusted for cancer risk factors such as smoking. The researchers conclude that there is no relationship between work stress and the incidence of colorectal, lung, prostate or breast cancer.

BMJ 2013;346:f165.

Bowel cleansing before colonoscopy

Adequate bowel preparation for colonoscopy is essential to achieve adequate visualisation of the colonic mucosa. This study aimed to determine whether the interval between the end of bowel preparation and the start of colonoscopy influences preparation quality. 1785 colonoscopies were retrospectively analysed. The quality of bowel cleansing was compared between those who had a less than 8-h interval between the start of the procedure versus those who had a greater than 8-h interval.

The researchers report that “a shorter (<8 h) interval between end of bowel preparation and start of colonoscopy yielded better bowel cleansing than a longer (>8 h) interval. Adequate bowel preparation led to improved caecal intubation rates.”

Internal Medicine Journal 2013;43:162–68.

Fibrinolysis or primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction

PCI is recognised as the preferred reperfusion strategy for ST segment elevation myocardial infarction. However, many patients cannot have timely (within 1 hour) PCI as they do not live close enough to a PCI-capable hospital. This study involves 1892 such patients who were randomised to either primary PCI or fibrinolytic therapy. The conclusions reached in this study from Belgium were that prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding.

N Engl J Med 2013;368:1379–87.