Press Releases Saturday 16 January 1999
No 7177 Volume 318
Please remember to credit the BMJ as source when publicising
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article and to tell your readers that they can read its full text on
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If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(1) NEW GUIDELINES ON SMOKING CESSATION IN ENGLAND LAUNCHED
(2) MATERNAL ANXIETY MAY AFFECT FETAL DEVELOPMENT
(3) MEDICAL STUDENTS ARE TAKING RISKS WITH HIV DURING ELECTIVE STUDIES
(4) LONG DISTANCE TRUCKERS IN INDIA ARE SPREADING HIV
(5) GLUTEN
INTOLERANCE IS UNDERDIAGNOSED
(1) NEW GUIDELINES ON SMOKING CESSATION IN ENGLAND LAUNCHED
(Smoking cessation: evidence based
recommendations for the healthcare
system)
http://www.bmj.com/cgi/content/full/318/7177/182
This week�s BMJ publishes a summary of
the new Smoking Cessation Guidelines
for Health Professionals which hope to
integrate effective and cost
effective practices to stop patients from
smoking within routine clinical
care, throughout the healthcare system
in England. Written by Professor
Martin Raw from King�s College School
of Medicine and Dentistry and
colleagues from the Health Education Authority
and St George�s Hospital in
London, the evidence based guidelines
attempt to combat the annual cost to
the NHS of treating smoking related diseases
which runs to £1500 million in
England alone.
The authors suggest that by adhering to
the guidelines, including the
utilisation of nicotine replacement therapy,
doctors could encourage a
further 75,000 people per year to quit
smoking. They say that nicotine
replacement therapy approximately doubles
cessation rates and that gum,
patch, nasal spray and inhilator alternatives
are all as safe and as
effective as each another.
Raw et al conclude that although the Smoking
Cessation Guidelines have been
commissioned for the healthcare system
in England, they have direct
relevance to other countries.
The Smoking Cessation Guidelines have been
published in full in a
supplement to the latest issue of Thorax
(December 1998, volume 53,
supplement 5), published by the BMJ Publishing
Group.
Contact:
Dean Mahoney,
Press Office, Health Education Authority,
Trevelyan House,
London
(2) MATERNAL ANXIETY MAY AFFECT FETAL DEVELOPMENT
(Association between maternal anxiety
in pregnancy and increased uterine
artery resistance index: cohort
based study)
http://www.bmj.com/cgi/content/full/318/7177/153
Although there are many contributors to
fetal growth and birth weight,
reduced blood flow through the uterine
arteries, which may be caused by
stress or anxiety, could partially explain
why women who are anxious during
pregnancy tend to have smaller babies.
This is the conclusion drawn by
Jerónima Teixeira and colleagues
from Queen Charlotte�s and Chelsea
Hospital in their study published in this
week�s BMJ.
In their study of 100 pregnant women the
authors found that women who were
more anxious during pregnancy had
significantly abnormal patterns of blood
flow though the uterine arteries.
They say that this suggests that the
psychological state of the mother may
affect fetal development and
therefore birth weight.
Contact:
Dr Vivette Glover,
Reader in Perinatal Psychobiology,
Centre for Fetal Care, Division of Paediatrics,
Obstetrics and Gynaecology,
Queen Charlotte�s and Chelsea Hospital,
London
email: vglover{at}rpms.ac.uk
or Professor Nicholas Fisk,
Professor of Obstetrics and Gynaecology,
Queen Charlotte�s and Chelsea Hospital,
London
(3) MEDICAL STUDENTS ARE TAKING RISKS WITH HIV DURING ELECTIVE STUDIES
(Medical students� risk of infection
with blood borne viruses at home and
abroad: questionnaire survey)
http://www.bmj.com/cgi/content/full/318/7177/158
(Provision of health advice for UK
medical students planning to travel
overseas for their elective study
period: questionnaire survey)
http://www.bmj.com/cgi/content/full/318/7177/161
Two papers in this week�s BMJ conclude
that medical students are not being
given adequate health advice and support
when undertaking their elective
studies in countries with a relatively
high prevalence of blood borne
viruses, such as HIV.
Medical students in the UK and in many
other countries have an elective
period as part of their training
during which they are encouraged to
pursue their clinical studies overseas,
with many opting to go to
developing countries.
In a study of 148 of such students, Claire
Gamester and colleagues from
Guy�s, King�s College and St Thomas�s
School of Medicine found that 42 per
cent of those who visited areas with a
relatively high prevalence of HIV
were unaware of this, all of whom had
visited areas other than sub-Saharan
Africa. It would seem, say that
authors, that these students and some of
their advisers are unaware of the increasing
prevalence of HIV infection in
South East Asia, the Indian Subcontinent,
Central America, the Caribbean
and South America.
The authors conclude that medical schools
should produce, regularly update
and implement guidelines regarding protection
from blood borne viruses
during clinical studies, including electives.
This view is supported in a
paper by Peter Moss and Nick Beeching,
also published in this week�s BMJ
who suggest that medical schools should
be more specific and consistent in
their pre-elective preparation for medical
students. They say that this
preparation could include a checklist
for each student to be signed by
their GP or doctor at a travel centre,
confirming that appropriate advice
has been given and followed.
Contact:
Dr Anthea Tilzey,
Consultant Virologist,
Guy�s, King�s College and St
Thomas�s School of Medicine,
St Thomas�s Campus, London
email: a.gem{at}umds.ac.uk
Dr Nick Beeching,
Senior Lecturer, Division of Tropical
Medicine,
Liverpool School of Tropical Medicine,
Liverpool
email: nbeeching{at}aol.com
(4) LONG DISTANCE TRUCKERS IN INDIA ARE SPREADING HIV
(Sexual lifestyle of long distance
lorry drivers in India: questionnaire
survey)
http://www.bmj.com/cgi/content/full/318/7177/162
The phenomenon of long distance truckers
spreading the HIV infection has
been well documented in Africa (the Kinshasa
Highway) and in Thailand. In
this week�s BMJ, Kootikuppala Surya Rao
and colleagues from the Child
Foundation of India report that the sexual
behaviour of long distance
truckers in India plays a fundamental
role in spreading HIV infection
throughout the country, in a short period
of time.
The researchers found that during journeys,
truckers stop at �dhabas�,
which are roadside hotels which usually
provide food, rest, sex workers,
alcohol and drugs. The truckers
pick up women here and then drop them at
the next dhaba along their route, where
they are then picked up by other
truckers or locals and so on and so forth.
Truckers have an HIV infection
rate of ten per 1000 which is far higher
than the national Indian average
of approximately 0.5 per 1000.
Dr Rao and colleagues found that men over
40 years were particularly
vulnerable and the potential for transmission
of sexual diseases by the
group is most threatening. They
conclude that condom use should be
promoted along truck routes by distributing
them freely along national
highways in condom dispensers. They
also suggest further research to find
effective strategies to persuade truckers
to change their hazardous sexual
behaviour.
Contact:
Dr Kootikuppala Surya Rao,
Director, AIDS Prevention Division,
Child Foundation of India,
Pradesh, India
(5) GLUTEN INTOLERANCE IS UNDERDIAGNOSED
(Coeliac disease in primary care:
case finding study)
http://www.bmj.com/cgi/content/full/318/7177/164
Underdiagnosis and misdiagnosis of coeliac
disease (gluten intolerance) are
not uncommon in general practice in the
UK and lead to unnecessary
suffering in patients, say Dr Harold Hin
and colleagues from Oxfordshire in
this week�s BMJ.
Sufferers of coeliac disease should avoid
products containing gluten, which
is a protein found in wheat, rye and some
other cereals. The symptoms of
coeliac disease include anaemia and feeling
tired all the time and is
particularly relevant in those with a
family history of the disease.
Misdiagnosing the tired patient as having
chronic fatigue syndrome is a
potential pitfall. Irritable bowel
syndrome is another, albeit rare,
presentation, say the authors. This
disease is treatable and has serious
preventable long term complications, such
as osteoporosis, infertility and
cancer.
In a selective survey of 1000 people in
central England, the authors found
that 30 patients had coeliac disease.
They found that the average age of
adult diagnosis was 44 years and they
refer to previous research which
suggests that almost half of patients
who are diagnosed with coeliac
disease in adult life have visited their
doctor for an average of 28 years
with unexplained symptoms or blood test
abnormalities.
Hin et al conclude that general practitioners
should consider testing
patients for coeliac disease using the
highly reliable antibody blood test
(endomysial), if they consult with them
about feeling tired all the time
and have unexplained anaemia.
Contact:
Dr Harold Hin,
General Practitioner,
Hightown Surgery,
Banbury, Oxfordshire
email: HaroldHin{at}pgec-horton.demon.co.uk
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