The newspaper club

Annals Journal Club

Jul / Aug 2018: Association Between Alcohol Consumption and Night Cramps in the Leg

Elizabeth W. McIntosh, MD, Grant Family Medicine, and Michael E. Johansen, MD, MS,
Associate Editor

The Annals of Family Medicine encourages readers to develop a learning community to improve health care and health
through improved primary care. Participate by running a RADICAL Reading Club.
RADICAL means Read, Ask, Discuss, Query, Collaborate, Act and Learn. We encourage
various participants to think critically about important issues affecting primary
¹

HOW IT WORKS

In each issue, Annals selects an article and provides tips and discussion questions. Adopt a RADICAL approach
to these documents and post a summary of your conversation in our online discussion.
(Open the article and click on "TRACK Discussion / Submit a Comment.") Discussion
questions and information are online at: http://www.AnnFamMed.org/site/AJC/.

CURRENT SELECTION

Article to be discussed

Delacour C, Chambe J, Lefebrvre F, et al. Association between the consumption of alcohol
and night leg cramps in patients over 60 years of age: a case-control study. Ann Fam Med . 2018; 16 (4): 296-301.

Discussion tips

Case-control studies may be useful for exploring badociations when diseases are rare
or not well understood. ² Night cramps in the leg are a common but relatively self-limiting condition
pathophysiology, although badociations with various drugs (such as diuretics
and quinine) have been proposed. This case-control study explores an interesting
and a new badociation between night cramps in the legs and alcohol consumption.

Discussion Questions

• What is the question for this study and why is it important for a family doctor?
• What is a case-control study? ² How is this different from a cohort study?
• What are the strengths and weaknesses of a case-control study to answer a study
  question?

• How did the researchers find cases and correspond to control subjects? How did the case go?
  and control groups compare in terms of demographics and medical history?

• What are the main conclusions of the study? How were they calculated? What was the credibility
  interval around the point estimate?

• To what extent could the results be affected by:
  • How were patients selected, excluded or lost to follow-up?
  • The size of the study? How many matches have been included from 4 different combinations
    (Supplementary Annex 5)?

  • How was the main variable of alcohol consumption measured and categorized?
  • Confused (false attribution of causality because 2 variables were found to be badociated
    are actually badociated with a 3rd factor)?

  • Chance?
• What is a dose-response relationship? Did they find a dose-effect relationship with
  alcohol? Does this strengthen or weaken the results of the study?

• How similar is the sample of the study to patients in your practice who have a night leg?
  cramps?

• Is this study likely to change your clinical practice? How?
• What are the next steps to deepen these discoveries?

References

1. Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to have RADICAL. Ann Fam Med . 2006; 4 (3): 196-197. http://annfammed.org/content/4/3/196.full.
2. Coggon D, Rose G, Barker DJP. Case-control studies and cross-sectional studies. In: Epidemiology for the uninitiated . 4th ed. London, United Kingdom: The BMJ. https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/8-case-control-and-cross-sectional. Accessed April 12, 2018.