Releases Saturday 22 January 2000
No 7229 Volume 320
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(1) MONDAYS SEE PEAK DEATHS FROM CORONARY
HEART DISEASE IN SCOTLAND
(2) WARMING
BABIES' BOTTLES IN BOILING WATER
INCREASES RISK
OF SCALDING IN YOUNG
CHILDREN
(3) ANTIBIOTIC
RESISTANCE MAY BE PARTLY DUE
TO LACK OF
NEW CLASSES OF ANTIBACTERIALS
SINCE 1960s
(4) PHARMA
INDUSTRY SHOULD BE KEPT AT ARM'S
LENGTH FROM
THEIR DRUG TRIALS
(5) BEHAVIOURAL
TREATMENT MAY HELP SOLVE
CHILDHOOD SLEEP
PROBLEMS
(1) MONDAYS SEE PEAK DEATHS FROM CORONARY
HEART DISEASE IN SCOTLAND
("I don't like Mondays" - day of
the week of coronary heart
disease deaths in Scotland: study
of routinely collected data)
http://www.bmj.com/cgi/content/full/320/7229/218
Monday is the day of the week which sees
peak deaths from
coronary heart disease in Scotland and
this may be partly
attributable to increased drinking at
the weekend, say
researchers from Edinburgh and Glasgow
in this week's
BMJ.
Dr Christine Evans from the Information
and Statistics
Division at the National Health Service
in Scotland, along
with colleagues from the same organisation
and from the
University of Glasgow, studied deaths
from coronary heart
disease in Scotland from 1986-95 and found
that during this
period 91,193 men and 79,051 women died
from the
disease. When the authors investigated
which day of the
week each death occurred on, they found
an excess of
deaths on a Monday in both men and women,
but in
particular among those who had not previously
been admitted
to hospital with the disease, and who
had died outside
hospital.
Within this group, Evans et al found that
the Monday excess
of deaths was greatest in those under
the age of 50 years
(deaths in men were 19.2 per cent above
the daily average
and women 20 per cent). Men under the
age of 65 years also
showed a highly significant excess of
deaths on Saturday and
Sunday. Tuesday seemed to be the day of
week that saw the
least deaths from coronary heart disease
in both men and
women.
The authors conclude that the Monday peak
in deaths may
be partly attributable to increased drinking
at the weekend,
although other mechanisms, such as work
related stress, may
also be important. "The possible link
between binge drinking
and deaths from coronary heart disease
has potentially
important public health implications and
merits further
investigation," say Evans et al.
Contact:
Dr James Chalmers, Consultant in Public
Health Medicine,
Information and Statistics Division, National
Health Service in
Scotland, Edinburgh
Email: Jim.Chalmers{at}isd.csa.scot.nhs.uk
(2) WARMING BABIES'
BOTTLES IN BOILING WATER
INCREASES RISK OF SCALDING IN YOUNG
CHILDREN
(Warming milk - a preventable cause
of scalds in children)
http://www.bmj.com/cgi/content/full/320/7229/235
Using a bowl of boiling water to heat a
baby's bottle
increases the risk of scalds in young
children, say a team of
plastic surgeons and a paediatrician in
a "Lesson of the
Week" featured in this week's BMJ. Health
professionals
who deal with parents of young children
should be aware of
this hazard and it should also be noted
that the danger of
warming milk bottles in jugs or bowls
of boiling water could
be listed as a disadvantage of bottle
feeding that could be
avoided by breast feeding, say the authors.
Dr Steven Jeffery and colleagues from Queen
Victoria
Hospital in East Grinstead base their
comments on their
experiences with 23 young patients between
1995 and 1998,
of whom ten were left with permanent scarring
after a
scalding incident of this nature. These
23 incidents, suggest
Jeffrey et al, are however "probably the
tip of the iceberg", as
only a few children with scalds are referred
to the regional
specialist burns unit and fewer still
are admitted to hospital.
The perceived need to warm milk varies
from culture to
culture and many special care baby units
in the UK do not
routinely warm milk, say the authors.
In cultures where milk is
usually warmed, they say, parents are
often advised not to
use a microwave oven as it is feared that
uneven heating or
overheating of the milk using this method
may cause scalds to
the mouth or throat. However, according
to Jeffery et al
previous research has found that microwave
ovens are less
hazardous to children than conventional
ovens and - it is
possible that scalding is more likely
to occur when jugs or
bowls of hot water are used to heat milk
bottles than when a
microwave oven is used.
The authors conclude that health professionals
who deal with
parents of young children should be aware
of this hazard.
They also state that the danger of scalding
could be avoided
by breastfeeding.
Contact:
Mr Steven Jeffery, Specialist Registrar
in Plastic Surgery,
McIndoe Burn Centre, Queen Victoria Hospital,
East
Grinstead
Email: slajeffery{at}rcsed.ac.uk
(3) ANTIBIOTIC
RESISTANCE MAY BE PARTLY DUE
TO LACK OF NEW CLASSES OF ANTIBACTERIALS
SINCE 1960s
(The rise in bacterial resistance)
http://www.bmj.com/cgi/content/full/320/7229/199
(Bacteraemia and antibiotic resistance
of its pathogens
reported in England and Wales between
1990 and 1998:
trend analysis) BMJ Volume 320 22 January
2000 pp213-6
The rise in antibacterial resistance is
partly because there
have been no new classes of antibiotics
introduced since the
1960s report Professor Sebastion Amyes
in an editorial this
week's BMJ.
We now know, due to improved surveillance
methods, that
antibiotic resistance is rising inexorably
(see also, paper by
Reacher et al in the week's BMJ), says
Professor Amyes
from the University of Edinburgh. However,
it has taken a
long time to ascertain the extent of the
problem and we still
have a lot to learn about the mechanisms
through which
antibiotic resistance develops, he explains.
In his editorial Amyes quotes the surgeon
general of the
United States at the end of the 1960s
as saying that "we
could now close the book on infectious
diseases". "At the
start of a new century, some 30 years
later - we are facing a
potential treatment crisis for some infections,"
says Amyes
and this may be partly due to the fact
that no new clinically
useful structures of antibiotics were
discovered after 1961.
Almost all the drugs that have been launched
since the 1960s
have been modifications of antibiotics
we already have, he
says. He explains that this means that
bacteria that had
"learnt" how to resist one member of a
chemical drug class,
did not have to learn much more to overcome
later
modifications.
The author also considers the role that
the introduction of
organ transplantation has played in antibiotic
resistance
(aggressive antibacterial therapy was
required to protect
immunosuppressed patients against hospital
acquired
infections). He also speculates that multiresistant
bacteria may
have been facilitated by hospital designs
that move patients
closer together and rely on regular movement
of patients
around the hospital for their different
points of treatment.
Amyes concludes that as our knowledge of
molecular biology
increases and the bacterial genome projects
advance we will
obtain a greater understanding of resistance
and the
mechanisms through which it works.
Contact:
Professor Sebastian Amyes, Professor of
Microbiology,
Medical School, University of Edinburgh,
Email: s.g.b.amyes{at}ed.ac.uk
Reacher et al can be reached through Simon
Gregor, Press
Office, Public Health Laboratory Service,
London
Email: sgregor{at}phls.co.uk
(4) PHARMA INDUSTRY
SHOULD BE KEPT AT ARM'S
LENGTH FROM THEIR DRUG TRIALS
(Clinical trial safety committees:
the devil's spoon)
http://www.bmj.com/cgi/content/full/320/7229/244
Pharmaceutical industry sponsored clinical
research should be
run independently with an independent
data monitoring and
safety committee overseeing trials, argues
Professor John
Hampton in a personal paper in this week's
BMJ.
Doctors working in the pharmaceutical industry
must contend
with the competing demands of drug development
and patient
safety, says the author and this situation,
he suggests, was
borne out in the British Biotech affair,
which showed the
pharmaceutical industry "at its worst".
Hampton details what
happened at British Biotech and how in
the best interests of
the patients involved, Dr Andrew Millar,
the director of
clinical research at the company, blew
the whistle on drug
trials that were not going as well as
the company directors
had claimed.
To avoid this situation, Hampton suggests
that the
pharmaceutical industry "must be kept
at arm's length from
the development of its own drugs". He
concludes that a
means of achieving this is the appointment
of a data
monitoring and safety committee which
could protect patients
(both those included in a trial and those
with the disease in
question) and could ensure the integrity
of the study, yet have
no other responsibility to the pharmaceutical
sponsors.
Contact:
Professor John Hampton, Professor of Cardiology,
Division
of Cardiovascular Medicine, Queen's Medical
Centre,
Nottingham
Email: John.Hampton{at}nottingham.ac.uk
(5) BEHAVIOURAL
TREATMENT MAY HELP SOLVE
CHILDHOOD SLEEP PROBLEMS
(A systematic review of treatments
for settling problems and
night waking in young children)
http://www.bmj.com/cgi/content/full/320/7229/209
Difficulties in settling down to sleep
and waking during the
night are the most common sleep problems
in young children,
affecting about 20 per cent of children
aged one to three
years. In this week's BMJ a team of researchers
from Oxford
report that the most effective long term
treatments for such
problems are behavioural interventions,
using a variety of
psychological techniques, which teach
children appropriate
sleeping habits.
Dr Paul Ramchandani and colleagues from
the University of
Oxford Department of Psychiatry at the
Park Hospital for
Children reviewed nine studies previously
conducted into the
efficacy of drug and non-drug treatments
for children's sleep
problems . They found that overall drug
treatments (using
sedatives) seemed to be effective in the
short term but in the
longer term their efficacy was "unimpressive".
However, the
authors also found that behavioural interventions
were more
likely to be both effective in the short
term and to have
continuing benefits in the longer term.
The behavioural interventions that were
covered in their
review included:- "positive routines"
which involve creating a
20 minute winding down bedtime routine,
which is gradually
brought forward by 5-10 minutes per week
to an appropriate
bedtime; varying degrees of "extinction",
where a child is left
to cry and "scheduled wakes" where parents
wake their child
before they usually wake spontaneously
and then resettle
them to sleep in their usual manner.
Ramchandani et al conclude that given the
prevalence and
persistence of childhood sleep problems
and the effects they
can have on children and families, treatments
that have long
lasting benefits are more appealing and
these are likely to be
behavioural interventions.
Contact:
Dr Paul Ramchandani, Specialist Registrar,
Child and Family
Psychiatry Service, Sue Nicholls Centre
Aylesbury
Email: paulgulab{at}aol.com
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
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BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American
Association for the
Advancement of Science
(http://www.eurekalert.org)
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