Releases Saturday 17 February 2001
No 7283 Volume 322
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(1) CHILDREN WITH RUNNY NOSES ARE AT LESS
RISK OF DEVELOPING ASTHMA
(2) RADIOGRAPHY
SHOULD NOT BE RECOMMENDED
FOR LOW BACK
PAIN
(3) GRADED
EXERCISE BENEFITS PATIENTS WITH
CHRONIC FATIGUE
SYNDROME
(1) CHILDREN WITH
RUNNY NOSES ARE AT LESS
RISK OF DEVELOPING ASTHMA
(Early childhood infectious diseases
and the development of
asthma up to school age: a birth
cohort study)
http://bmj.com/cgi/content/full/322/7283/390
(Editorial: The protective effect
of childhood infections)
http://bmj.com/cgi/content/full/322/7283/376
Repeated viral infections early in life
may reduce the risk of
developing asthma up to school age by
stimulating the child's
immune system, finds a study in this week's
BMJ.
Researchers in Germany followed a group
of 1,314 children
at regular intervals from birth to the
age of 7 years to
investigate the association between different
types of early
childhood infections and the subsequent
development of
asthma. Among other questions, parents
were asked whether
their child had "a wheezy or whistling
noise while breathing"
since the previous follow up.
They found that a child with two or more
episodes of runny
nose before the age of 1 year was at half
the risk of having
asthma diagnosed by the age of 7 as were
children with one
or less episodes. Similarly, having one
or more herpes-type
viral infection before the age of three
years showed an inverse
relation with the development of asthma
by the age of 7.
However, repeated lower respiratory tract
infections in the
first three years of life showed a positive
association with
wheeze up to the age of 7 years, suggesting
that children
already predisposed to asthma might be
more likely to
develop these type of infections.
Our results suggest that repeated viral
infections other than
lower respiratory tract infections early
in life may stimulate the
immature immune system, thereby reducing
the risk for the
development of asthma up to school age,
conclude the
authors.
With increasing numbers of effective vaccines,
antiviral
treatments, and antibiotics and with increasing
affluence, how
can we prevent the continued rise in allergy
and asthma? ask
researchers at Imperial College School
of Medicine, in an
accompanying editorial. Knowing exactly
which "dirt"
provides the best education for the immune
system and how
to mimic its effects in a cleaner environment
seems to be the
key to reversing the rise in atopic diseases,
they conclude.
Contacts:
[Paper]: Sabina Illi, Research Assistant,
University Children's
Hospital, Munich, Germany.
Email: sabina.illi{at}kk-i.med.uni-muenchen.de
[Editorial]: Sebastian Johnston, Professor
of Respiratory
Medicine, Imperial College School of Medicine
at St Mary's,
London, UK.
Email: s.johnston{at}ic.ac.uk
(2) RADIOGRAPHY
SHOULD NOT BE RECOMMENDED
FOR LOW BACK PAIN
(Radiography of the lumbar spine
in primary care patients
with low back pain: randomised controlled
trial)
http://bmj.com/cgi/content/full/322/7283/400
Patients with low back pain who have radiography
treatment
report a longer duration of pain, more
severe pain, reduced
functioning, and an overall poorer health
status than those
who do not have radiography, finds a study
in this week's
BMJ. These findings have important implications
for
guidelines on managing low back pain,
many of which
currently recommend radiography.
Researchers in Nottingham identified 421
patients visiting their
general practitioner with low back pain.
In addition to
receiving the usual care provided by the
practice, a number of
patients were asked to attend their local
hospital for a
radiograph of the lumbar spine (intervention
group). At three
months, this group were more likely to
report low back pain,
perceived their overall health status
to be worse, and reported
higher pain scale scores. A higher proportion
of these patients
also consulted their doctor in the three
months after
radiography. Interestingly, after nine
months, satisfaction with
care was greater in the group receiving
radiography and,
overall, 80% of patients in both groups
would still have
chosen radiography.
One possible explanation for these findings
is that radiography
encourages or reinforces the patient's
belief that they are
unwell and may lead to greater reporting
of pain and greater
limitation of activities, say the authors.
Guidelines on managing
low back pain should be consistent about
not recommending
radiography, they conclude.
Contact:
Professor Mike Pringle, School of Community
Health
Sciences, University Park, Nottingham,
UK
Email: mike.pringle{at}nottingham.ac.uk
(3) GRADED EXERCISE
BENEFITS PATIENTS WITH
CHRONIC FATIGUE SYNDROME
(Randomised controlled trial of patient
education to
encourage graded exercise in chronic
fatigue syndrome)
http://bmj.com/cgi/content/full/322/7283/387
Many patients with chronic fatigue syndrome
have inaccurate
illness beliefs that may perpetuate their
condition. A study in
this week's BMJ finds that providing patients
with medical
explanations for symptoms to encourage
graded exercise can
substantially improve their condition.
A total of 148 patients diagnosed with
chronic fatigue
syndrome were randomised into four groups.
Patients in the
control group received standardised medical
care. Patients in
three intervention groups received various
degrees of
treatment including explanations of symptoms
that encouraged
home based graded exercise. At one year,
69% of patients in
the intervention groups had improved their
physical
functioning compared with 6% of patients
in the control
group. Similar improvements were seen
in fatigue, sleep,
disability and mood. Overall, the explanations
of their
symptoms convinced 94% of the patients
to carry out graded
activity.
This approach may be as effective as cognitive
(mental)
behaviour therapy, but is shorter and
requires less therapist
skill, conclude the authors.
Contact:
Richard Bentall, Professor of Experimental
Clinical
Psychology, University of Manchester,
UK
Email: bentall{at}psy.man.ac.uk
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London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
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(http://www.eurekalert.org)
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