BMJ No 7143 Volume 316

Press Releases Saturday 16 May 1998

(1) ARE CHANGES IN GENDER ROLES CAUSING MORE MEN TO SUFFER FROM DEPRESSION?

(2) ARE DOCTORS EVER OFF DUTY - EVEN WHEN THEY'VE HAD A FEW TO DRINK?

(3) COMMUNITY BASED TREATMENT FOR LEG ULCERS MORE EFFECTIVE

(4) ARE WOMEN DISCRIMINATED AGAINST WHEN GIVEN PACEMAKERS?

(5) DANISH REFORM TO OUT OF HOURS SERVICE SEEMS SUCCESSFUL



(1) ARE CHANGES IN GENDER ROLES CAUSING MORE MEN TO SUFFER FROM DEPRESSION?

(Admission for depression among men in Scotland, 1980-95: retrospective
study)
http://www.bmj.com/cgi/content/full/316/7143/1496

It is well documented that a rising number of men are committing suicide,
but is this because there is an increase in the prevalence of depression in
men?  In this week's BMJ, Dr Polash Shajahan and Dr Jonathan Cavanagh from
the Royal Edinburgh Hospital in Scotland report the results of their study
into depression in men and women in Scotland.

The authors found that over the period the number of women admitted to
hospital for depression decreased, whilst the number of men increased, even
though overall the total number of women admitted was far higher than for
men.  The authors question whether or not this trend is a true reflection
of prevalence or whether it could be affected by a change in admission
criteria.

Shajahan and Cavanagh note that there have been important changes in gender
roles over the last 20 years.  These include a decrease in the number of
men in full time work and an increase in the number of women in both part
time and full time work.  For men, the resultant loss of status as sole
financial provider for the family, the perceived loss of social status and
the consequent social isolation could all be risk factors for depression.
But could the figures be down to a change in the way GPs treat depression
or have men altered their health seeking behaviour and become more willing
to accept psychiatric help?  The authors think not.

Contact:
Dr Polash Shajahan, Specialist Registrar, Medical Research Council Brain
Metabolism Unit, Royal Edinburgh Hospital, Edinburgh
email: polash.shajahan{at}ed.ac.uk
 

(2) ARE DOCTORS EVER OFF DUTY - EVEN WHEN THEY'VE HAD A FEW TO DRINK?

(Too drunk to care)
http://www.bmj.com/cgi/content/full/316/7143/1515

In an ethical debate in this week's BMJ Dr David Cressey, an anaesthetist
from the Royal Hallamshire Hospital in Sheffield, writes about a dilemma he
faced when confronted with a medical emergency at a sporting event, at
which he had been drinking.  He recalls the incident and the actions that
he took and poses the question as to whether or not he did the right thing.

The BMJ publishes three responses to Dr Cressey's dilemma. The issues that
the authors raise include:  Dr Cressey's mental functions might just as
easily have been impaired by a 20 hour shift or a new baby which had kept
him up all night; whether a clumsy lay person could put a patient in
greater jeopardy than a doctor who has had a drink;  it is unfair to expect
doctors never to drink socially just in case a medical emergency arises;
drawing up guidelines on alcohol use and treatment would be virtually
impossible;  for fear of being sued, should a doctor save his own skin at
the expense of patients needing treatment;  and when are you too drunk to
care?

Contact:
(Ethanol, emergencies and ethical dilemmas)
http://www.bmj.com/cgi/content/full/316/7143/1515#resp1
Dr David Cressey, Registrar, Anaesthetic Department, Royal Hallamshire
Hospital, Sheffield
email:  D.M.Cressey{at}Sheffield.ac.uk

(Commentary: Guidelines could never be developed)
http://www.bmj.com/cgi/content/full/316/7143/1515#resp2
Professor Henk Rigter, Director, Trimbos Institute, Po Box 725, 3500 As
Utrecht, Netherlands
email: hrigter{at}trimbos.nl

(Commentary: Balance the risk as best you can)
http://www.bmj.com/cgi/content/full/316/7143/1515#resp3
Dr Gareth Rees, Consultant, Bristol Oncology Centre, Bristol

(Commentary: Doctors can never have a moral holiday)
http://www.bmj.com/cgi/content/full/316/7143/1515#resp4
Dr Patricia Walsh, Lecturer in Medical Ethics, Centre in Medical Law and
Ethics, King's College, London.
email: patricia.walsh{at}kcl.ac.uk
 

(3) COMMUNITY BASED TREATMENT FOR LEG ULCERS MORE EFFECTIVE

(Cost effectiveness of community leg ulcer clinics:  randomised controlled
trial)
http://www.bmj.com/cgi/content/full/316/7143/1487

Complete healing of leg ulcers can take years and they can often recur.
Sufferers experience pain, which affects sleep, mobility and quality of
life.  The financial cost of ulcers in Britain has been estimated at
between £294 million and £650m each year.   In the past patients have
traditionally been treated in their own homes by a district nursing
service.  In this week's BMJ Jane Morrell et al from the School of Health
and Related Research at the University of Sheffield suggest that community
based leg ulcer clinics, using four layer compression bandaging, may be
more clinically and cost effective than traditional treatments.

Contact:
Jane Morrell, Research Fellow, School of Health and Related Research,
University of Sheffield, Sheffield.
email: j.morrell1{at}sheffield.ac.uk
 

(4) ARE WOMEN DISCRIMINATED AGAINST WHEN GIVEN PACEMAKERS?

(Sex differences in selection of pacemakers: retrospective observational
study)
http://www.bmj.com/cgi/content/full/316/7143/1492

In a study published in this week's BMJ, Dr Reinhart Schuppel et al from a
number of universities in Germany find that the use of pacemakers varies
between the sexes, despite guidelines suggested by professional bodies.
The authors discovered that women received less  sophisticated pacemakers
and they ask whether this is because women are discriminated against,
whether they describe their symptoms differently to men, or whether they
prefer simpler treatments.

Schuppel et al conclude that further research should be conducted into this
area to ascertain the reasons for the treatment differentiation they have
found.

Contact:
Dr Reinhart Schuppel, Lecturer, Department of Psychotherapy and
Psychosomatic Medicine, University of Ulm, Germany.
 

(5) DANISH REFORM TO OUT OF HOURS SERVICE SEEMS SUCCESSFUL

(Out of hours service in Denmark: evaluation five years after reform)
http://www.bmj.com/cgi/content/full/316/7143/1502

In this week's BMJ, a General Practice paper from Dr Bondo Christensen and
Frede Olesen examines the reformed out of hours GP service in Denmark, five
years after its introduction.  The authors have found that the system,
which has a fully trained general practitioner performing a telephone
triage function (six or seven doctors serve around 600,000 people), has led
to a fall in the number of hours on call for GPs.  Home visits have largely
been replaced by telephone consultations and despite an initial decrease in
patient satisfaction with the out of hours service, the system is
increasing in popularity.

Contact:
Dr Morten Bondo Christensen, Research Assistant, Research Unit for General
Practice, University of Aarhus, Aarhus, Denmark
email: MBC{at}alm.au.dk

FOR ACCREDITED JOURNALISTS

Embargoed press releases:
These are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;jshepher{at}bma.org.uk)
 
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science (http://www.eurekalert.org)
 
Please remember to credit the BMJ as source when publicising an article
and to inform your readers that they can read its full text on the
journal's web site (http://www.bmj.com).
 

Access jobs at BMJ Careers
Whats new online at Student BMJ