Releases Saturday 6 January 2001
No 7277 Volume 322
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(1) Substantial increase in childhood obesity since 1984
(2) Antenatal units are unaware of genetic screening guidelines
(3) Lisinopril can prevent migraine attacks
(4) Women
still rarely raise the issue of family history of breast cancer with
general
practitioners or practice nurses
(5) Study questions value of genetic advice on breast cancer in primary care
(6) Blood glucose level can predict cardiovascular risk
(1) Substantial increase in childhood obesity since 1984
(Prevalence and trends in overweight
and obesity in three cross sectional
studies of British children, 1974-94)
http://bmj.com/cgi/content/full/322/7277/24
The prevalence of obesity in children is
low, but it has increased
substantially since 1984, according to
a study in this week's BMJ.
Using data from the national study of health
and growth, researchers from
King's College London identified 10,414
boys and 9,737 girls in England
and 5,385 boys and 5,219 girls in Scotland
aged 4 to 11 years in total
for 1974, 1984 and 1994. They calculated
the percentage of children
who were overweight or obese each year,
for each sex and country.
From 1974 to 1984 there was little overall
change. From 1984 to 1994
overweight increased from 5.4% to 9% in
English boys and from 6.4%
to 10% in Scottish boys. Values for girls
were 9.3% to 13.5% in English
girls and 10.4% to 15.8% in Scottish girls.
The increase was greatest in
the oldest age group (9-11 years) and
the prevalence of obesity
increased correspondingly.
Overweight in children is a serious public
health problem in Britain and
these results form a base from which trends
can be monitored, say the
authors. The rising trends in children
will almost certainly be reflected in
increases in adult obesity and in associated
adult illness, they conclude.
Contact:
Sue Chinn, Reader in Medical Statistics,
Department of Public Health
Sciences, King's College London, UK
Email: sue.chinn{at}kcl.ac.uk
(2) Antenatal units are unaware of genetic screening guidelines
(Existence and quality of written
antenatal screening policies in the United
Kingdom: postal survey)
http://bmj.com/cgi/content/full/322/7277/22
Antenatal units are generally unaware of
screening guidelines for women
at increased risk of having a baby with
genetic defects including Down's
syndrome and cystic fibrosis, finds research
in this week's BMJ. The
guidelines were issued by the Royal College
of Obstetricians and
Gynaecologists following a national confidential
inquiry of antenatal care.
In 1999, researchers at St Mary's Hospital
in Manchester surveyed 242
obstetricians and 273 midwives throughout
the UK about their
awareness of the national confidential
inquiry and its effects on practice.
Midwives were also asked to submit their
unit's written policies, which
were assessed using the Royal College's
written criteria.
Of 181 obstetricians who responded, 29
(16%) were aware of the
inquiry, 13 (7%) were aware of the specific
recommendations for
Down's syndrome and 6 (3%) aware of those
for cystic fibrosis. Of 160
midwives who responded, 33 (21%) were
aware of the inquiry, 27
(18%) were familiar with the recommendations
for Down's syndrome
and 9 (6%) those for cystic fibrosis.
Overall, 39 units (24%) lacked local
and regional policies for Down's syndrome,
55 (34%) for neural tube
defect, 104 (65%) for blood disorders
and 125 (78%) for cystic fibrosis.
Where written policies existed, they varied
widely in adherence to the
guidelines, and only one covered all five
points.
National guidelines and local written policies
should be adopted to
promote informed choice and equity of
service, say the authors. Units
without an identified person responsible
for antenatal screening face the
risk of being overwhelmed by advances
in the field, and national audits
will be compromised if no single person
can be approached for reliable
information, they conclude.
Contact:
Kirsty Challen, Research Assistant, Genetic
Enquiry Centre, St Mary's
Hospital, Manchester, UK
Email: kirstychallen{at}hotmail.com
(3) Lisinopril can prevent migraine attacks
(Prophylactic treatment of migraine
with angiotensin converting enzyme
inhibitor (lisinopril): randomised,
placebo controlled, crossover study)
http://bmj.com/cgi/content/full/322/7277/19
The drug Lisinopril - widely prescribed
for various cardiovascular
conditions - is an effective, preventive
treatment for frequent migraine
attacks, finds research in this week's
BMJ.
Sixty patients aged 19-59, who suffered
between two and six migraine
attacks a month, were given either Lisinopril
(active) or placebo
(inactive) for 12 weeks. The participants
kept a daily diary in which they
recorded the presence, severity and, if
appropriate, duration of
symptoms. In the 47 participants who completed
the treatment, Lisinopril
significantly decreased hours with headache,
days with headache, days
with migraine, and headache severity.
Days with migraine were fewer by
at least 50% in 14 participants for active
treatment versus placebo.
Lisinopril was also well tolerated and
adverse events were mild or
moderate.
Despite being one relatively small study
? albeit with a robust design ? the
positive outcomes and good tolerability
support the use of Lisinopril as a
useful preventive treatment for migraine
patients, conclude the authors.
Contact:
Harald Schrader, Professor of Neurology,
Norwegian University of
Science and Technology, Trondheim, Norway
Email: harald.schrader{at}medisin.ntnu.no
(4) Women still rarely
raise the issue of family history of breast cancer with
general practitioners or practice nurses
(Raising concerns about family history
of breast cancer in primary care
consultations: prospective, population
based study)
http://bmj.com/cgi/content/full/322/7277/27
In consultation with their general practitioners
and practice nurses,
women raise the issue of a family history
of breast cancer relatively
infrequently, report the Women's Concerns
Study Group in this week's
BMJ.
Following the availability of genetic tests
for breast cancer, genetic
centres have reported increasing referral,
often of women who are at low
risk by current knowledge, but who are
concerned about the implications
of their family history.
To inform better management in primary
care, all primary care
consultations between women (16 years
and over) and doctors and
nurses (clinicians) in 18 practices were
counted over 4 week periods
between August 1997 and July 1998. Mention
of a family history of
breast cancer was recorded in less than
4% of consultations. Clinicians
were 6.6 times more likely to raise the
issue than women. For each 1000
women on the practice list about 15 a
year will raise the issue of a family
history of breast cancer. Almost 10 times
that number (141) consult for
contraceptive advice, and three times
that number for menstrual
disorders.
Primary care teams might best manage the
relatively few women
consulting with specific concerns about
family history of breast cancer, by
referral within the team to a member trained
in genetic counselling,
possibly with computer support.
Contact:
Professor Ann Louise Kinmonth, General
Practice and Primary Care
Research Unit, University of Cambridge,
UK
Email: alk25{at}medschl.cam.ac.uk
(5) Study questions value of genetic advice on breast cancer in primary care
(How women with a family history
of breast cancer and their general
practitioners act on genetic advice
in general practice: prospective
longitudinal study)
http://bmj.com/cgi/content/full/322/7277/26
The value of giving genetic advice on breast
cancer in primary care is
questionable, according to a study in
this week's BMJ.
Researchers in the Netherlands studied
women's compliance with advice
provided by their general practitioner
that was based on assessment of
genetic risk and whether this genetic
advice was in line with the advice of
a clinical geneticist.
Their findings question the value of giving
genetic advice on breast cancer
in primary care. Firstly, women showed
a low level of compliance with
genetic advice given by their general
practitioner. Secondly, the
geneticist's advice was not followed by
the general practitioner in 30% of
the consultations and, thirdly, there
is no evidence that surveillance is
effective in women under 50. Nevertheless,
the authors believe that there
is a place for genetic advice in general
practice and that further research
could improve its effectiveness.
Contact:
Geertruida H de Bock, Epidemiologist, Leiden
University Medical
Centre, Leiden, Netherlands C/o Dirk Ketting
(the promotor of the
organisation LUMC)
e-mail: dketting{at}LUMC.NL
(6) Blood glucose level can predict cardiovascular risk
(Glycated haemoglobin, diabetes,
and mortality in men in Norfolk cohort
of European Prospective Investigation
of Cancer and Nutrition
(EPIC-Norfolk))
http://bmj.com/cgi/content/full/322/7277/15
A study in this week's BMJ shows that the
concentration of glucose in
the blood resembles blood pressure and
blood cholesterol in terms of
predicting cardiovascular risk. These
findings have important implications
for public health and may provide a practical
screening tool for diabetes
or impaired glucose tolerance.
Researchers in Cambridge identified 4,662
men aged 45-79 years who
had attended a health examination and
had their blood glucose
concentration measured as part of the
European Prospective
Investigation of Cancer and Nutrition
in Norfolk. Men with known
diabetes had greater risk of dying from
all causes, cardiovascular disease,
and ischaemic heart disease compared with
men without diabetes. Risk
of death increased with increasing blood
glucose concentrations. Even in
men without diabetes, blood glucose concentration
was related to risk of
death, with the lowest rates in those
with concentrations below 5%.
Blood glucose concentration seems to resemble
blood pressure and
blood cholesterol in terms of the continuous
relation with cardiovascular
risk, say the authors. These findings
have important implications for
public health: a reduction of just 0.1%
or 0.2% blood glucose
concentration in the whole population
would reduce total mortality by 5%
and 10% respectively, they explain.
Preventative efforts need to consider not
just those with established
diabetes, but whether it is possible to
reduce the population distribution
of blood glucose concentration through
simple lifestyle changes, such as
diet or physical activity, they conclude.
Contact:
Kay-Tee Khaw, Professor of Clinical Gerontology,
Institute of Public
Health, University of Cambridge, UK
Email: kk101{at}medschl.cam.ac.uk
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