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(2) UNDERNOURISHED CHILDREN ARE BEST TREATED IN THE COMMUNITY
(3) PAIN IS NOT NECESSARILY A SYMPTOM OF HEART ATTACK
(4) THE FUTURE FOR PUBLIC HEALTH IN THE UK
(5) RISK OF INJURY HIGH AMONG WEST END PERFORMERS
(6) SICK BUILDING SYNDROME LINKED TO CERTIAN MOULDS
(7) LIFESTYLE FACTORS IMPORTANT IN THE DEVELOPMENT OF MALE BREAST CANCER
(1) GPS
CAN BE LIFE-SAVERS FOR HEART-STOPPERS
(Call to needle times after acute myocardial
infarction
in urban and rural areas in northeast
Scotland: prospective
observational study)
http://www.bmj.com/cgi/content/full/317/7158/558
Acute myocardial infarction (death of part of the heart
muscle)
is most often due to coronary thrombosis (a blood clot).
Thrombolytic treatment to try to dissolve the clot is
a matter
of urgency and, according to the British Heart Foundation
(BHF),
should be given to patients within 90 minutes of their
calling for
medical assistance.
In this week�s BMJ, Dr John Rawles and colleagues
from the
University of Aberdeen at Aberdeen Royal Infirmary and
Grampian Health Board, report the findings of the study
into how
best to provide thrombolytic treatment within the BHF
guidelines.
Their research, involving over 1000 (1046) patients,
was
undertaken in urban, suburban and rural areas in north-east
Scotland.
They found that the first contact that a patient had with
a medically
qualified person was most commonly with a general practitioner,
who was able to administer thrombolytic treatment before
the
patient was transported to hospital. They conclude that
for patients
in both urban and rural areas, contact with their GP
in the first
instance is the optimum means of receiving the essential
thrombolytic
treatment within 90 minutes.
Contact:
Prof Lewis Ritchie, University of Aberdeen, Aberdeen
Royal Infirmary,
Aberdeen
f: +44 1224 840683
email: l.d.ritchie{at}abdn.ac.uk
(2) UNDERNOURISHED
CHILDREN ARE BEST TREATED
IN THE COMMUNITY
(Effect of community based management in
failure to thrive:
randomised controlled trial)
http://www.bmj.com/cgi/content/full/317/7158/571
Poor weight gain, which is a common problem in young children
under the age of two years, has traditionally been managed
by hospital doctors. "Failure to thrive" may be due to
dietary,
organic or social factors and health visitors are usually
the
first to identify a child�s undernourished condition.
In this week�s
BMJ Dr Charlotte Wright and colleagues
from Newcastle University
and Newcastle City Health Trust suggest that rather than
sending
these children to hospital, their care should be managed
in the
community by health visitors with specialist support.
Their research has shown that care of undernourished
children
by health visitors led to significantly better long term
weight and
height gain than conventional management.
Contact:
Dr Charlotte Wright, First Assistant in Community Health,
Department of Child Health, Newcastle University,
Donald Court House, Gateshead
f: +44 191 477 0370 email: c.m.wright{at}ncl.ac.uk
(3) PAIN
IS NOT NECESSARILY A SYMPTOM OF
HEART ATTACK
(Pain is not only feature of heart attack)
http://www.bmj.com/cgi/content/full/317/7158/602
In a letter in this week�s BMJ, Professor
Tom Treasure from
St George�s Hospital in London writes that the word "pain"
is
a red herring when discussing symptoms of a heart attack.
He believes that it is medical staff who describe the
sensation
experienced when suffering a heart attack as "pain",
as opposed
to sufferers who usually gesture to the chest, neck and
arm and
grimace when trying to articulate what they have felt.
The myth
of a fat, red faced man gasping and clutching at his
tie needs to
be dispelled says Professor Treasure and people should
be
alerted to the fact that descriptions such as "tightening",
"a lump
in the throat", "pressure", "indigestion", "wind" and
"a need to
keep swallowing" are symptoms of a heart attack as well
as
the hallmark "15 minutes of chest pain".
Contact:
Professor Tom Treasure, Professor of Cardiothoracic Surgery,
St George�s Hospital, London
(4) THE FUTURE FOR PUBLIC HEALTH IN THE UK
(The 1848 Public Health Act and its
relevance to improving
public health in England now)
http://www.bmj.com/cgi/content/full/317/7158/596
On its 150th anniversary, the Chief Medical Officer Sir
Kenneth Calman
writes about the Public Health Act of 1848 in a personal
paper
in this week�s BMJ. He reflects on the
original issues which the
Act addressed and relates these to the current state
of public health
in the UK. He also highlights the challenges facing the
public health
sector now and makes recommendations as to how the nation
should tackle them. In particular he discusses the role
of the public
in health and says that "we need to explore better ways
of ensuring
full public participation in the process of changing
health.
The public are allies of the professions and politicians,
not enemies...
[we] ...must communicate effectively with... [them] ...on
a whole
range of issues - in particular, on risk and uncertainty".
Contact:
Sir Kenneth Calman, Chief Medical Officer, Department
of Health,
Richmond House, Whitehall, London
f: +44 171 210 5407
West End performers run a high risk of injury, finds a study in Occupational
and Environmental Medicine. Almost half of those performing in 20 West
End plays and musicals had sustained an injury during their current
production,
with raked (angled) stages a contributory factor, the study shows.
A survey of 269 cast members from 12 plays and eight musicals showed
that 46 per cent of them had sustained injuries�around two for every
thousand hours on stage in their current production. Sprains and strains
were the most common type of injury, followed by neck and back injuries.
Performers whose roles were physically very demanding were three times
as likely to sustain an injury. Women performers and those with a previous
injury were significantly more likely to be injured on stage. Almost
one in
five dancers and one in two actors were forced to miss at least one
performance as a result of their injuries.
Almost one injury in five, overall, was sustained while working on a
raked stage, which is angled down to improve the audience�s view and
can range in
gradient from 3 to 10 per cent. Raked stages, say the authors, can
increase the risk of
injury as a result of
performers accommodating a shift backwards in their centre of gravity.
Between five and ten performers a year in all West End productions
are disabled by their injuries and unable to complete their contracts.
Over 60 per cent of the performers surveyed thought their injuries
could have been prevented.
The findings are similar to the authors� 1996 study of Broadway productions.
Contact: Dr Randolph Evans, Department of Neurology,
University of Texas, Houston USA. Fax: +1 713 528 3628
Email: rwevans{at}danamail.com
or
Martin Brown, press officer, British Actors� Equity Association
Fax: +44 (0)171 379 6074
Certain types of fungal moulds seem to be strongly associated with sick
building syndrome, finds a study in Occupational and Environmental
Medicine. Sick building syndrome was first recognised in 1982 and as
yet no single cause has been identified. Symptoms typically include
allergic rhinitis, breathing difficulties, headaches, "flu" and watering
eyes.
Researchers analysed the indoor and outdoor air quality of 48 US
schools where complaints had been made about air quality in the buildings,
and where symptoms such as runny noses, congestion and itchy or
watering eyes were common. More than half the occupants of these
schools had also complained of increased levels of respiratory infections
such as tonsillitis, bronchitis and even pneumonia. Swabs and samples
were taken from areas of visible mould growth and dampness,
ventilation and heating systems, standing water, dead air spaces and
dusty surfaces.
The results showed that in complaint areas two types of
fungi�Penicillium and Stachybotrys�were significantly more
common in indoor air than in outdoor air samples or in non-complaint
areas. A high prevalence of Penicillium moulds was found in 25 schools;
and in 11 schools in areas of high humidity, Strachybotrys moulds were
found under damp carpets, on damp walls, and under vinyl wall coverings.
Cladosporium and Aspergillus species were also found, although to a
lesser
extent, in some of the other schools.
Penicillium species can easily adapt to most human environments, say
the authors. They can grow at mild temperatures (50°F or 10°C)
and
in conditions of relatively little moisture. The spores are small and
can
easily enter the lungs. Unattended water leaks and poorly main-tained
heating and ventilation systems can encourage the moulds to develop,
say the authors.
Contact: Dr David C Strauss, Department of Microbiology and
Immunology, Texas Tech University, Lubbock, USA.
Fax: +1 806 743 2334
Just like women, the more affluent a man is, the greater his risk
of developing breast cancer seems to be, suggests a study in
Occupational and Environmental Medicine. Breast cancer
in men is widely believed to be the same disease as that in women,
with the same tissue changes, gene mutations and hormonal factors.
When researchers in the USA examined the occupations and
socioeconomic status of 178 men who had died of breast
cancer, they found that those with relatively high family incomes
and higher education were twice as likely to develop the disease.
A significant increase in risk was also found for those employed
in blast furnaces, steel foundries, rolling mills and car plants,
for which there is no obvious explanation, say the authors.
But exposure to electromagnetic fields, high temperatures, pesticides
and solvents, all of which have been linked to the disease in the past,
were not associated with increased risk of breast cancer.
The female hormone, oestrogen, is likely to be an important factor,
say the authors. In men, this develops in fatty tissue, and from the
conversion of the male hormone, testosterone. Therefore, lifestyle
and occupational factors that affect the production and metabolism
of hormones may be just as important in men as they are in women,
suggest the authors�and diet may be one of these.
Contact: Dr Ann Hsing, Division of Cancer Epidemiology,
National Cancer Institute, Bethesda, Maryland, USA.
Fax: +1 301 402 0916;
Email: HsingA{at}epndce.nci.nih.gov
or
Dr R Hayes, Occupational Epidemiology, National Cancer Institute.
Fax:+1 301 402 1819
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