Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(2) WATER
FLUORIDATION: BENEFITS SHOULD BE
CONSIDERED
ALONGSIDE RISKS
(3) DO
PATIENTS WISH TO BE INVOLVED IN
TREATMENT DECISIONS?
(4) IMPORTANT
LESSONS FROM SCOTTISH NHSnet
INITIATIVE
(Community water fluoridation, bone
mineral density, and
fractures: prospective study of
effects in older women)
http://bmj.com/cgi/content/full/321/7265/860
(Editorial: Fluoridation, fractures,
and teeth)
http://bmj.com/cgi/content/full/321/7265/844
Long term exposure to fluoridation may
reduce the risk of
fractures of the hip and vertebrae in
older women, with
enormous importance for improving public
health, finds a
study in this week's BMJ.
Researchers in the United States identified
over 9000 women
aged at least 65 years. They compared
bone mineral density
and fracture rates for 2563 women with
no exposure to
fluoridated water during the past 20 years
and 3218 women
with continuous exposure over the same
period. They found
that women with continuous exposure had
a higher bone
mineral density at the hip (2.6%) and
at the lower spine
(2.5%) and had a 31% reduced risk of hip
fracture and a
27% reduced risk of vertebral fracture
than women with no
exposure. The risk of fracture in women
with mixed exposure
was similar to women with no exposure.
Because the burden of osteoporosis is largely
due to fractures
of the hip, water fluoridation may be
one of the most cost
effective methods for reducing these types
of fractures,
conclude the authors.
In an accompanying editorial, Professor
Hannu Hausen at the
University of Oulu in Finland, believes
that previously some
concerns have persisted about possible
adverse effects of
fluoride on bone. Some earlier studies
found higher rates of
fractures among communities exposed to
fluoridated water,
but they failed to account for potential
effects of other factors
known to be associated with fractures,
such as oestrogen
use, smoking and body weight, says Hausen.
Thus there
seems to be reasonably strong evidence
that an optimal
amount of fluoride in drinking water ±
either added or
occurring naturally ± does not increase
the risk of
osteoporotic fractures in elderly people,
which should
alleviate remaining concerns about the
safety of fluoridation,
he adds.
Contacts:
[Paper] Kathy Phipps, Associate Professor,
Oregon Health
Sciences University, USA
Email: phippsk@ohsu.edu
[Editorial] Professor Hannu Hausen, Institute
of Dentistry,
University of Oulu, Finland
E-mail: hannu.hausen@oulu.fi
(2) WATER FLUORIDATION:
BENEFITS SHOULD BE
CONSIDERED ALONGSIDE RISKS
(Systematic review of water fluoridation)
http://bmj.com/cgi/content/full/321/7265/855
(Editorial: Fluoridation, fractures,
and teeth)
http://bmj.com/cgi/content/full/321/7265/844
Adding fluoride to the public water supply
is associated with
a reduction in tooth decay, but this reduction
comes at the
expense of an increased level of fluorosis
(mottled teeth),
finds a study in this week's BMJ.
McDonagh and colleagues reviewed over 200
studies on the
health effects of water fluoridation.
Although these studies
were generally of poor quality, the authors
found a median
15% reduction in tooth decay ± or a median
2.25 fewer
decayed, missing, and filled primary/permanent
teeth -
amongst children living in fluoridated
areas compared to
non-fluoridated areas.
The prevalence of fluorosis was also highly
associated with
water fluoride concentration. At a fluoride
level of 1 part per
million, an estimated 12.5% of exposed
people would have
fluorosis that they would find aesthetically
concerning, say the
authors, although the effects of fluoride
from other sources
may also be playing a part, they add.
No clear evidence of
other potential adverse effects was found.
The evidence of a beneficial reduction
in tooth decay should
be considered together with the increased
level of fluorosis,
say the authors, and they stress the need
for future research
to improve the quality of the existing
evidence base.
These views are reiterated in an accompanying
editorial by
Professor Hannu Hausen at the University
of Oulu, Finland.
Research among 13-15 year olds in Finland
has shown that
the effect of fluoridation can vary strongly
depending on
different circumstances. The benefits
and potential risks of
fluoridation require careful and continuous
monitoring, he
says.
Contacts:
[Paper] Paul Wilson or Rachel Richardson,
NHS Centre for
Reviews and Dissemination, University
of York, UK
[Editorial] Professor Hannu Hausen, Institute
of Dentistry,
University of Oulu, Finland
E-mail: hannu.hausen@oulu.fi
(3) DO PATIENTS
WISH TO BE INVOLVED IN
TREATMENT DECISIONS?
(Do patients wish to be involved
in decision making in the
consultation? A cross sectional
survey with video vignettes)
http://bmj.com/cgi/content/full/321/7265/867
Patients favour a direct approach from
their doctor when
discussing physical problems, but prefer
to help decide their
treatment for psychiatric and lifestyle
problems, according to
a study in this week's BMJ .
Dr Brian McKinstry showed videos of common
consultation
scenarios - in which patients were or
were not involved in
deciding their management - to 410 patients
attending
surgeries in Lothian. The videos represented
five common
general practice consultations ± a bleeding
mole, a sprained
calf, chronic rheumatoid arthritis, depression
and smoking
advice.
The author found that patients preferred
consultations in
which the doctor largely decided treatment
for all the
scenarios except those for depression
and smoking advice.
For these two problems, more chose scenarios
that involved
the patient helping to decide on treatment.
Patients aged 61
years or older preferred a more direct
approach, says the
author. However, patients from higher
social classes
preferred a shared approach, as did patients
who smoked, he
adds.
These associations are far from absolute,
stresses the author.
Doctors need the skills, knowledge of
their patients, and
sufficient time in consultations to determine
how much
involvement each patient wants in decision
making, he
concludes.
Contact:
Brian McKinstry, Principal in General Practice,
Ashgrove
Health Centre, West Lothian, Scotland.
Email: brian.mckinstry@ed.ac.uk
(4) IMPORTANT
LESSONS FROM SCOTTISH NHSnet
INITIATIVE
(NHSnet in Scottish primary care:
lessons for the future)
http://bmj.com/cgi/content/full/321/7265/878
The success of the implementation of a
recent Scottish Office
initiative, which linked 99% of Scottish
general practices to
NHSnet (an electronic network for health
care professionals
across Britain), is called into question
in this week's BMJ.
The study provides useful lessons for
those embarking on a
similar exercise in England and Wales.
Willmot and colleagues evaluated this initiative
and found that,
although 56% of practices were accessing
NHSnet at least
once a week, local variations in the way
practices were
connected to the network, costs they incurred
and training
they received all caused discontent and
affected levels of use.
For instance, poor access discouraged people
from using
NHSnet in 19% of practices and caused
38% of practices to
restrict its use. Some practices paid
nothing for use, whereas
others had to pay for calls. As bills
escalate, these practices
may start to restrict use, warn the authors.
Training focused
on administration rather than use of the
internet and did not
target healthcare professionals. Only
14% of attendees were
general practitioners and 3% were practice
nurses, say the
authors. Interestingly, practices in areas
that provided more
detailed internet training locally were
more likely to make
regular use of NHSnet, emphasising the
importance of
targeting training.
Simply providing the necessary equipment
to access NHSnet
is not enough, say the authors. Comprehensive,
appropriate
education, targeted at the right individuals
is also required to
ensure that the potential of NHSnet to
support evidence
based practice is maximised. Important
lessons should be
learnt from the Scottish initiative, both
in Scotland and by
those embarking on a similar exercise
in England and Wales,
they conclude.
Contact:
Madeleine Willmot, Clinical Effectiveness
Coordinator, Forth
Valley Health Board, Stirling, Scotland
Email: madeleine.willmot@fvhb.scot.nhs.uk
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)