Releases Saturday 10 February 2001
No 7282 Volume 322
Please remember to credit the BMJ as source when publicising
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(1) CHILDREN UNDER FOUR ARE BECOMING
HEAVIER
(2) LOW
DOSE ASPIRIN MAY HELP TO PREVENT
PRE-ECLAMPSIA
DURING PREGNANCY
(3) GREATER
SUICIDE RISK AMONGST RICH PEOPLE
WITH MENTAL
ILLNESS
(4) DELAYING
ANTIBIOTIC TREATMENT FOR EAR
INFECTIONS
IS A FEASIBLE AND ACCEPTABLE
STRATEGY
(1) CHILDREN UNDER
FOUR ARE BECOMING
HEAVIER
(Prevalence of overweight and obese
children between
1989 and 1998: population based
series of cross sectional
studies)
http://bmj.com/cgi/content/full/322/7282/326
More children under 4 years of age are
overweight and
obese than ever before, according to a
study in this week's
BMJ.
Bundred and colleagues analysed height
and weight
measurements of 35,662 infants aged 1-3
months and
28,768 children aged between 2 years 11
months and 4
years, routinely taken by health visitors
as part of the 6
week and preschool assessment. They found
that from
1989 to 1998 there was a highly significant
increasing trend
in the proportion of overweight and obese
children under 4
years of age.
Early intervention, including increased
activity and reduction
in high fat, high calorie foods, must
be targeted at this age
group if they are to have an impact, say
the authors. These
findings could be the impetus for a national
programme to
prevent and treat childhood obesity and
its long term
complications, they conclude.
Contact:
Peter Bundred, Reader in Primary Care,
University of
Liverpool, Liverpool, UK.
Email: peterb{at}liv.ac.uk
(2) LOW DOSE ASPIRIN
MAY HELP TO PREVENT
PRE-ECLAMPSIA DURING PREGNANCY
(Antiplatelet drugs for prevention
of pre-eclampsia and its
consequences: systematic review)
http://bmj.com/cgi/content/full/322/7282/329
A study in this week's BMJ shows that antiplatelet
drugs,
largely low dose aspirin, have small to
moderate benefits
when used for prevention of pre-eclampsia
and its
complications during pregnancy.
Duley and colleagues reviewed 39 trials,
involving over
30,000 women at risk of developing pre-eclampsia.
Their
findings suggest that antiplatelet drugs
are associated a
moderate (15%) reduction in the risk of
pre-eclampsia, a
14% reduction in the risk of stillbirth
or neonatal death, and
an 8% reduction in the risk of preterm
birth.
As the reductions in risk are moderate,
relatively large
numbers of women will need to be treated
to prevent the
death of one baby, explain the authors.
However, from a
public health perspective, even these
moderate benefits may
be worthwhile. Data from individual women
need to be
reviewed to identify which women are most
likely to
benefit, when treatment should be started,
and at what dose,
they conclude.
Contact:
Lelia Duley, Obstetric Epidemiologist,
Institute of Health
Sciences, Oxford, UK
Email: lelia.duley{at}ndm.ox.ac.uk
(3) GREATER SUICIDE
RISK AMONGST RICH PEOPLE
WITH MENTAL ILLNESS
(Risk of suicide in relation to income
level in people
admitted to hospital with mental
illness: nested case-control
study)
http://bmj.com/cgi/content/full/322/7282/334
(Commentary: Suicide and income �
is the risk greater in
rich people who develop serious
mental illness?)
http://bmj.com/cgi/content/full/322/7282/334#resp1
Rich people with a history of mental illness
are at greater
risk of committing suicide than their
lower income
counterparts, according to a study in
this week's BMJ.
These unexpected findings are at odds
with the general
pattern of suicide risk associated with
poverty.
Researchers in Denmark analysed data on
811 people who
had committed suicide between 1982 and
1994. Each
person who had committed suicide was matched
with
approximately 100 people of the same age
and sex who
were alive on the date of the suicide,
and information on
income, history of mental illness, and
marital status was
added. In contrast to findings in the
general population, the
suicide risk for patients admitted to
hospital with a mental
illness fell significantly with decreasing
income.
Greater stigma associated with mental illness
among rich
people may explain these findings, say
the authors. In
Denmark, there are no private psychiatric
hospitals.
Perhaps patients from higher income groups
are less likely
to be admitted to hospital, they add.
Further studies, which take into account
the severity of
illness, are needed to fully explain these
patterns of risk,
warns David Gunnell in an accompanying
commentary. The
greater resources available to richer
patients may enable
them to avoid admission to hospital. Equally,
less severe
illness in high income groups may be treated
in private
clinics. Thus, patients from high income
groups who are
admitted to public hospitals may have
more severe mental
illness than patients from lower income
groups.
Contacts:
[Paper] E Agerbo, Research Fellow, National
Center for
Register-based Research, University of
Aarhus, Denmark
Email: ea{at}ncrr.au.dk
[Commentary] David Gunnell, Department
of Social
Medicine, University of Bristol, UK
Email: D.J.Gunnell{at}bristol.ac.uk
(4) DELAYING ANTIBIOTIC
TREATMENT FOR EAR
INFECTIONS IS A FEASIBLE AND ACCEPTABLE
STRATEGY
(Pragmatic randomised controlled
trial of two prescribing
strategies for childhood acute otitis
media)
http://bmj.com/cgi/content/full/322/7282/336
A "wait and see" approach, compared to
immediate
prescription of antibiotics for acute
otitis media (ear
infection) in children, is feasible, acceptable
to parents, and
should substantially reduce use of antibiotics,
finds a study
in this week's BMJ.
Parents of 315 children, aged between 6
months and 10
years, attending general practices with
acute otitis media
were randomly offered two treatment strategies
�
immediate antibiotics or delayed antibiotics
(parents asked
to wait 72 hours after seeing the doctor
before considering
using the prescription). Immediate antibiotics
provided
benefits compared with delayed prescribing,
such as
reduced duration of illness and fewer
nights disturbed, but
mainly after the first 24 hours, when
distress and symptoms
were already improving. Immediate antibiotics
also
increased diarrhoea by 10% and increased
parents' belief in
their effectiveness.
Overall, 77% of parents given delayed prescriptions
were
very satisfied with the "wait and see"
approach.
Furthermore, fewer believed in the effectiveness
of
antibiotics and in the need to see their
doctor with the same
problem in future. This approach also
resulted in a 76%
reduction in the use of antibiotic prescriptions,
helping to
reduce the danger of antibiotic resistance,
conclude the
authors.
Contact:
Paul Little, MRC Clinician Scientist, Community
Clinical
Sciences (Primary Medical Care Group),
University of
Southampton, Aldermoor Health Centre,
Southampton, UK
Email: psl3{at}soton.ac.uk
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