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(2) NOSEBLEEDS
MORE LIKELY TO OCCUR IN THE
MORNING
(3) DOCTORS'
FEAR OF SIDE EFFECTS FOR HEART
FAILURE TREATMENT
IS UNJUSTIFIED
(4) CELEBRATING
THE PAST AND SHAPING THE
FUTURE
(1) ARE MOBILE
PHONES REDUCING TEENAGE
SMOKING?
(Decline in teenage smoking with
rise in mobile phone
ownership: hypothesis)
http://bmj.com/cgi/content/full/321/7269/1155
Is there a link between the sharp decline
in teenage smoking
since 1996 and the dramatic rise in mobile
phone ownership
among teenagers over the same period?
A letter in this
week's BMJ argues that mobile phones may
be competing
successfully with cigarettes to meet certain
important teenage
needs.
Smoking among 15 year olds fell from 30%
to 23% between
1996 and 1999, while mobile phone ownership
among 15-17
year olds rose from low levels in 1996
to 70% by August
2000. Clive Bates and Anne Charlton hypothesise
that these
trends are related because some teenagers
will be unable to
afford both and that the mobile satisfies
the same teenage
needs as smoking - offering adult style
and aspiration,
individuality, sociability, rebellion,
and peer group bonding.
For teenagers, smoking may become seen
as "old
technology", suggest the authors, with
the bright new world of
text messaging, email and WAP becoming
the new
aspirational gateway to adult life.
Data on teenage smoking are not yet available
for 2000 but,
if the authors' hypothesis is correct,
the continued rise of the
mobile phone as a competitor to cigarettes
may drive teenage
smoking rates down further.
Further information including the original
data is available at:
www.ash.org.uk/?embargo
Contact:
Clive Bates, Director, Action on Smoking
and Health,
London, UK
Email: clive.bates@dial.pipex.com
(2) NOSEBLEEDS
MORE LIKELY TO OCCUR IN THE
MORNING
(Circadian variation in onset of
epistaxis: analysis of hospital
admissions)
http://bmj.com/cgi/content/full/321/7269/1112
Most nosebleeds seem to occur either in
the morning or the
evening, suggesting that nosebleeds follow
a 24-hour
(circadian) pattern similar to that of
blood pressure, finds a
study in this week's BMJ
Manfredini and colleagues reviewed all
cases of nosebleeds
from 1 January 1992 to 31 December 1998
in the emergency
department of St Anna Hospital in Ferrara,
Italy. For each of
the 1741 nosebleeds reported, the time
of onset was
calculated - either within a 30-minute
range or, where this
was not possible, a range of within three
hours. The age, sex
and details of any underlying diseases
amongst these patients
were also recorded.
The authors found a highly significant
circadian rhythm for
nosebleeds, with a primary peak in the
morning (8.24am) and
a smaller secondary peak in the evening.
This pattern was
similar in both men (8.12am) and women
(8.44am) say the
authors, but age had no influence on this
pattern, they add.
It is interesting that this biphasic pattern
closely resembles the
circadian rhythm of blood pressure, say
the authors,
suggesting that blood pressure might trigger
or contribute to
nosebleeds. Other factors related to venous
bleeding and that
might also show circadian variation deserve
further
investigation, they conclude.
Contact:
Roberto Manfredini, Professor of Emergency
Medicine
University of Ferrara Medical School,
Italy.
Email: r.manfredini@unife.it
(3) DOCTORS' FEAR
OF SIDE EFFECTS FOR HEART
FAILURE TREATMENT IS UNJUSTIFIED
(Safety and costs of initiating angiotensin
converting enzyme
inhibitors for heart failure in
primary care: analysis of
individual patient data from studies
of left ventricular
dysfunction)
http://bmj.com/cgi/content/full/321/7269/1113
(Editorial: Taking heart failure
seriously)
http://bmj.com/cgi/content/full/321/7269/1095
Doctors' fear of the side effects associated
with drugs to treat
heart failure may be a major barrier to
their use in general
practice, despite strong evidence for
their effectiveness,
according to a study in this week's BMJ.
Mason and colleagues examined the risks
associated with
starting treatment in patients with symptoms
of heart failure,
using data from previous large trials.
Over 7000 patients
received a test dose of the drug enalapril
(an angiotensin
converting enzyme inhibitor). Of these,
less than 2% reported
side effects severe enough to stop treatment.
More than 2500
patients were then randomly treated with
either enalapril or
placebo (a chemically inert substance
given in place of a
drug). During the first year of treatment,
there was no
difference in the rates of side effects
leading to dose reduction
or withdrawal between the enalapril and
placebo groups.
These findings show that the introduction
of angiotensin
converting enzyme inhibitors rarely cause
problems, and can
be safely started for patients with heart
failure in primary care,
say the authors. Doctors' perceptions
of the risks of these
drugs may sometimes be exaggerated, they
conclude.
In an accompanying editorial, Cleland and
colleagues argue
that lack of resources and expertise -
not fear of side effects -
are the great barriers to efficient treatment
of heart failure.
"Proper diagnosis and supervision of treatment
for Britain's
most common malignant disease should not
be beyond the
resources of our National Health Service,"
they conclude.
Contacts:
[Paper]: James Mason, Senior Research Fellow,
University
of York, UK
Email: jmm7@york.ac.uk
[Editorial]: Professor John Cleland, Castle
Hill Hospital,
Kingston upon Hull, UK
or
Andrew Clark, Department of Cardiology,
University of Hull,
UK
(4) CELEBRATING
THE PAST AND SHAPING THE
FUTURE
(Online patient-helpers and physicians
working together: a
new partnership for high quality
healthcare)
http://bmj.com/cgi/content/full/321/7269/1129
(The role of complementary and alternative
medicine)
http://bmj.com/cgi/content/full/321/7269/1133
(Safeguards for research using large
scale DNA collections)
http://bmj.com/cgi/content/full/321/7269/1146
The Millennium Festival of Medicine - a
programme of events
running throughout 2000 to celebrate innovation
and
achievement - holds its keynote conference
in London next
week. Several articles in this week's
BMJ are based on
presentations from this event, exploring
some of the
challenges and dilemmas medicine faces
as we enter the 21st
century.
As more and more patients make use of online
health
resources, there will be increasing demands
for physicians to
communicate electronically with their
patients, writes Tom
Ferguson, Professor of Health Informatics
at the University of
Texas. He reports on the benefits of communicating
with
patients online, and suggests that online
patient services can
help physicians provide better care in
less time.
The use of complementary and alternative
medicine is
currently around 20% in the UK and is
predicted to grow in
popularity, according to Edzard Ernst
at the University of
Exeter. He reports that much complementary
and alternative
medicine remains opinion based, and calls
for unbiased
scientific evaluation in the future to
ensure patients and
healthcare providers know which forms
are safe and
effective.
The recent controversy surrounding the
creation of a
population based DNA collection in Iceland
provides
important lessons for those embarking
on a similar exercise in
the UK, write Jane Kaye and Paul Martin.
They argue that
public debate concerning the possible
use and misuse of
sensitive genetic information and a clear
legal framework for
research activities are needed to avoid
public opposition to
the proposed UK Population Biomedical
Collection.
"Without widespread public support for
population genetic
studies, there is a real danger that human
genetics could
become the next biotechnology scare,"
they conclude.
For further information visit The Millennium
Festival of
Medicine website at: www.medicine2000.org
Contacts:
Tom Ferguson, Adjunct Associate Professor
of Health
Informatics, University of Texas-Houston,
USA
Email: doctom@doctom.com
Website: www.fergusonreport.com
Edzard Ernst, Director, Department of Complementary
Medicine, University of Exeter, UK
Email: E.Ernst@ex.ac.uk
Jane Kaye, Doctoral Student, St Catherine's
College,
University of Oxford, UK
Email: jane.kaye@law.ox.ac.uk
or
Paul Martin, Genetics and Society Unit,
School of Sociology
and Social Policy, University of Nottingham,
UK
Email: 100145.55@compuserve.com
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