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(2) TEENAGERS
WHO BECOME PREGNANT DO SEEK
CONTRACEPTIVE
ADVICE
(3) DOES
HOMOEOPATHY HAVE A THERAPEUTIC
EFFECT?
(4) PARENTS
NEED HELP TO TELL THEIR CHILDREN
ABOUT CANCER
(5) CHANGES
IN PSYCHIATRIC CARE BLAMED FOR
INCREASED DEATHS
AMONG SCHIZOPHRENIA
PATIENTS
(1) THIRD GENERATION
PILLS DO NOT INCREASE
RISK OF VENOUS CLOTTING
(Effect of 1995 pill scare on rates
of venous
thromboembolism among women taking
combined oral
contraceptives: analysis of General
Practice Research
Database)
http://bmj.com/cgi/content/full/321/7259/477
The newer types of combined oral contraceptive
pills do not
put women at increased risk of clots in
the veins, contrary to
previous information, a study in the BMJ
shows this week.
Since 1995 it has been believed that third
generation pills,
which contain gestodene or desogestrel,
can cause a twofold
increase in risk of venous clotting compared
to older
combined formulations.
The study compared the incidence of venous
clots in women
in the three years before and after the
1995 "pill scare" when
use of "third generation" oral contraceptives
fell from 54% to
14% in women aged 15-49 taking the pill.
Data was taken
from 304 general practices throughout
the country that fed
information to a central database. Women
who were at risk
of clots for other reasons were not included
in the figures.
The results show that although the use
of third generation oral
contraceptives fell during the period
after 1995, the rates of
venous clots among women taking the pill
did not change
significantly.
Contact:
Professor R D T Farmer, Postgraduate Medical
School,
University of Surrey, Guildford, Surrey
GU2 7DJ
Email: r.farmer@surrey.ac.uk
(2) TEENAGERS
WHO BECOME PREGNANT DO SEEK
CONTRACEPTIVE ADVICE
(Paper: Consultation patterns and
provision of contraception
in general practice before teenage
pregnancy: case-control
study)
http://bmj.com/cgi/content/full/321/7259/486
(Editorial: Never underestimate the
force of reproduction)
http://bmj.com/cgi/content/full/321/7259/461
Teenagers who become pregnant are not as
reluctant or ill
informed about contraception as previously
assumed. Most
teenagers who become pregnant have discussed
contraception with a health professional
in the year before
conception, according to a study in this
week's BMJ.
Looking at 240 cases of teenage pregnancy
in 14 general
practices in the Trent region, the study
found that 71% of
teenagers had discussed contraception
with a health
professional, and 50% had been prescribed
regular oral
contraception. In the 22% of cases resulting
in termination,
teenagers were more likely to have received
emergency
rather than regular oral contraception
in this year. Overall,
compared to others of their age, teenagers
who became
pregnant were found to consult their GP
more often, both
about contraception and unrelated matters.
The study shows that teenagers who become
pregnant are
not as reluctant or ill informed about
contraception as
previously assumed. The authors emphasise
a need for
adequate follow-up of teenagers receiving
emergency
contraception.
In an accompanying editorial, Professor
Basil Donovan of the
University of Sydney seeks to explain
these findings. He
suggests that teenagers may not be getting
the most out of
their consultations due to time pressures,
their own
embarrassment, or lack of rapport. Use
of oral contraception
in this age group is often sporadic and
therefore ineffective.
This warrants consideration of more permanent
reversible
methods of contraception.
Contacts:
[Paper] R Churchill, Clinical Lecturer,
Division of General
Practice, University of Nottingham Medical
School, Queen's
Medical Centre, Nottingham NG7 2UH
Email: dick.churchill@nottingham.ac.uk
[Editorial] Basil Donovan, Clinical Professor,
Department of
Public Health and Community Medicine,
University of
Sydney, Sydney Hospital, Sydney NSW, Australia
Email: donovanb@sesahs.nsw.gov.au
(3) DOES HOMOEOPATHY
HAVE A THERAPEUTIC
EFFECT?
(Paper: Randomised controlled trial
of homoeopathy versus
placebo in perennial allergic rhinitis
with overview of four trial
series)
http://bmj.com/cgi/content/full/321/7259/471
(Commentary: Larger trials are needed)
http://bmj.com/cgi/content/full/321/7259/471#resp1
Much scepticism exists about the effectiveness
of
homoeopathy, but the time may have come
to confront the
idea that homoeopathic treatment differs
from placebo - a
chemically inert substance given in place
of a drug -
according a new study published in this
week's BMJ.
Researchers in Glasgow randomly treated
50 patients
suffering from nasal allergies with either
a homoeopathic
preparation or placebo. Each day, for
four weeks, patients
measured their nasal air flow and recorded
symptoms such as
blocked, runny or itchy nose, sneezing
and eye irritation. Both
groups reported improvement in symptoms
but, on average,
patients who received homoeopathy had
significantly greater
improvement in nasal air flow - 28% compared
with 3%
among those in the placebo group.
Recent attempts to resolve the controversy
surrounding
homoeopathy have resulted in over 180
clinical trials to date.
Against this background, and combined
with results of three
similar studies, these findings further
strengthen the evidence
that homoeopathy shows some therapeutic
effect over
placebo, say the authors.
In an accompanying commentary, Tim Lancaster
at the
Institute of Health Sciences in Oxford
and Andrew Vickers at
the Sloane-Kettering Cancer Centre in
New York emphasise
the importance of high quality randomised
trials in the
evaluation of homoeopathy. They suggest
that the new
challenge "is to do the large trials that
really could change
thinking."
Contacts:
[Paper] David Reilly, Academic Departments,
Glasgow
Homoeopathic Hospital, Glasgow G12 0XQ
Email: davidreilly1@compuserve.com
[Commentary] Tim Lancaster, Clinical Reader
in General
Practice, Department of Primary Health
Care, Institute of
Health Sciences, Oxford OX3 7LF
Email: tim.lancaster@public-health.oxford.ac.uk
(4) PARENTS NEED
HELP TO TELL THEIR CHILDREN
ABOUT CANCER
(Paper: Qualitative interview study
of communication
between parents and children about
maternal breast cancer)
http://bmj.com/cgi/content/full/321/7259/479
(Editorial: Telling children about
a parent's cancer)
http://bmj.com/cgi/content/full/321/7259/462
Most parents diagnosed with cancer avoid
communicating
with their children in the hope of preventing
distress. Yet a
paper in this week's BMJ suggests that
parents need help to
think about how they might talk to their
children and how to
deal with their reactions.
Jacqueline Barnes and colleagues interviewed
32 mothers of
56 school age children, recently diagnosed
with breast
cancer, to explore why parents do or do
not talk to their
children about their illness and what
help parents have
received or might have liked. They found
that women were
most likely to begin talking to their
children once a definite
diagnosis was made, but a fifth of children
had still not been
told that their mother was ill at the
stage of surgery. The most
common reasons for not communicating was
to avoid facing
questions about cancer and death and preventing
children's
distress. One mother of a 9 year old stated:
"He'll say
±you've got cancer, are you going to die?"
Another said: "I
feel if I mentioned it to him he would
just worry so much."
Only a minority of mothers had been offered
any kind of help
with breaking bad news to their children,
say the authors.
More support is needed to help parents
think about whether,
what and how to tell their children to
avoid unnecessary
anxiety within the family, they conclude.
In an accompanying editorial, Duncan Keeley,
a general
practitioner in Oxfordshire, emphasises
the importance of
talking to children about painful events,
saying "that it is better
to talk badly about things than not to
talk about them at all."
He suggests that general practitioners
should be prepared to
assist parents in helping their children
to understand difficult
or painful truths.
Contact:
[Editorial] Duncan Keeley, General Practitioner,
The Health
Centre, Thame, Oxfordshire OX9 3JZ
(5) CHANGES IN
PSYCHIATRIC CARE BLAMED FOR
INCREASED DEATHS AMONG SCHIZOPHRENIA
PATIENTS
(Time trends in schizophrenia mortality
in Stockholm County,
Sweden: cohort study)
http://bmj.com/cgi/content/full/321/7259/483
Increased death rates among patients with
schizophrenia are
most probably due to fundamental changes
in psychiatric care
and a reduction in hospital beds, says
a study in this week's
BMJ.
Researchers in Sweden investigated the
date and cause of
death among residents of Stockholm County
who had been
diagnosed with schizophrenia between 1976
and 1995.
Overall, they found that death rates had
increased 1.7-fold in
men and 1.3-fold in women. Deaths from
natural and
cardiovascular causes increased 4.7-fold
in men and 2.7-fold
in women; suicide increased 1.6-fold in
men and 1.9-fold in
women and deaths from unspecified violence
increased
3.8-fold in men and 3.4-fold in women.
During the study period, there were important
changes in
psychiatric care offered to patients with
schizophrenia, say
the authors. For instance, outpatient
treatment replaced long
term patient care and, between 1976 and
1994, hospital
beds available for patients with schizophrenia
fell by 64%.
This, suggest the authors, is the most
probable explanation for
the rising mortality and emphasises the
importance of
monitoring trends in patient groups as
indicators of outcome
and quality of psychiatric and medical
care.
Contact:
Urban sby, Consultant, Department of Clinical
Neuroscience,
Karolinska Institute, S-171 76
Email: Urban.sby@nvso.sll.se
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