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(2) DEPRESSED
PATIENTS SHOULD BE ALLOWED TO
CHOOSE THEIR
TREATMENT
(3) BENEFICIAL
EFFECT OF DIETARY CHANGE ON
HEART DISEASE
CAN TAKE TWO YEARS
(4) MEDICALLY
UNEXPLAINED SYMPTOMS NEED MORE
ATTENTION
(1) MEN WHO WERE
SMALL BABIES ARE LESS LIKELY
TO MARRY
(Prenatal growth and subsequent marital
status: longitudinal
study)
http://bmj.com/cgi/content/full/322/7289/771
Men who were small at birth are less likely
to marry, finds a
study in this week's BMJ. Although the
factors that lead men to
marry are complex, these findings raise
the possibility that early
growth restriction may influence the factors
involved in partner
selection.
Over 3,500 men, born at the Helsinki University
Central
Hospital, Finland, during 1924-33 were
studied. Birth data were
linked with school records of height and
weight at age 15 and
with census information on marital status,
social class, and
income in 1970.
The 259 men who had never married were
2 cm shorter, 2.4kg
lighter, and thinner than the other men
at age 15 years. These
men also tended to come from lower social
classes and had
lower income. Even after taking into account
all these factors, the
association between birth weight and marital
status remained
significant. These findings were also
confirmed by a study of over
1,600 men born in Hertfordshire, England
during 1920-30,
where a similar relation between weight
at birth and adult marital
status emerged.
Clearly, the factors that lead men to marry
are complex and
include both social and biological ones,
say the authors.
"However, our data raise the possibility
that early growth
restriction influences the factors involved
in partner selection,
which may include socialisation, sexuality,
personality, and
emotional responses," they conclude.
Contact:
David I W Phillips. Professor of Endocrine
and Metabolic
Programming, Medical Research Council
Environmental
Epidemiology Unit, Southampton General
Hospital, UK
Email: diwp@mrc.soton.ac.uk
(2) DEPRESSED
PATIENTS SHOULD BE ALLOWED TO
CHOOSE THEIR TREATMENT
(Antidepressant drugs and generic
counselling for treatment of
major depression in primary care:
randomised trial with patient
preference arms)
http://bmj.com/cgi/content/full/322/7289/772
(Editorial: Managing depression in
primary care)
http://bmj.com/cgi/content/full/322/7289/746
Generic counselling appears to be as effective
as antidepressant
drugs for major depression, although patients
given drugs may
recover more quickly, according to a study
in this week's BMJ.
The findings also shows that, given a choice,
patients who opt for
counselling may benefit more than those
with no strong
preference and therefore GPs should allow
patients to have their
preferred treatment.
Over 100 depressed patients were randomly
allocated either
antidepressants or counselling and a further
220 patients were
given their choice of treatment. After
12 months, the two
methods were equally effective, although
patients treated with
antidepressants recovered more quickly
than those receiving
counselling did. Most patients who were
given a choice opted
for counselling, and these patients did
better than those
randomised to counselling.
Despite some study limitations, the authors
recommend that
general practitioners should allow patients
to have their choice of
treatment.
Contact:
Dr Richard Churchill, University of Nottingham
Medical School,
Queen's Medical Centre, Nottingham, UK
Tel (mobile): +44
(0)973 278 547 Email: dick.churchill@nottingham.ac.uk
(3) BENEFICIAL
EFFECT OF DIETARY CHANGE ON
HEART DISEASE CAN TAKE TWO YEARS
(Dietary fat intake and prevention
of cardiovascular disease:
systematic review)
http://bmj.com/cgi/content/full/322/7289/757
The theory that dietary fat causes heart
disease remains central
to "healthy eating" strategies. A review
in this weeks BMJ shows
modest, yet important, reductions in cardiovascular
events, but
only in those remaining on a diet for
over two years.
Hooper and colleagues reviewed 27 trials,
involving over 30,000
healthy adult participants to assess the
effect of altering dietary
fat intake on cardiovascular events. They
found that
cardiovascular deaths were reduced by
9% and cardiovascular
events (such as heart attacks and strokes)
were reduced by
16%. There was little effect on total
mortality. Interestingly,
virtually all protection from cardiovascular
events occurred in
trials of at least two years duration.
Despite only limited and inconclusive evidence
for optimal
intakes of total or individual fats, say
the authors, these findings
suggest that less total fat or less of
any individual fatty acid
fraction in the diet is beneficial. These
results certainly support
the view that dietary fat plays a central
role in the development of
cardiovascular disease, they conclude.
Contact:
Lee Hooper, Research Associate, University
Dental Hospital of
Manchester, UK
Email: lee.hooper@man.ac.uk
(4) MEDICALLY
UNEXPLAINED SYMPTOMS NEED MORE
ATTENTION
(Medically unexplained symptoms in
frequent attenders of
secondary health care: retrospective
cohort study)
http://bmj.com/cgi/content/full/322/7289/767
(Editorial: Medically unexplained
symptoms in secondary care)
http://bmj.com/cgi/content/full/322/7289/745
More attention should be given to patients
who attend hospital
with symptoms that remain medically unexplained
after extensive
investigation, finds a study in this week's
BMJ.
Reid and colleagues reviewed the medical
records of 361
patients who most frequently attended
outpatient services in one
region of England during 1993-6. Of 971
consultations recorded
during this period, over a fifth remained
medically unexplained.
Symptoms that were particularly likely
to remain unexplained in
this group included abdominal pain, chest
pain, headache, and
back pain.
Given that frequent attenders in all medical
settings are
responsible for a disproportionate amount
of healthcare
resources, these patients should be considered
a focus for
attention, conclude the authors.
"The fact that a patient returns many times
despite being told
there is no medical explanation for his
or her symptoms reflects
continuing distress and concern," writes
Jane Turner, Senior
Lecturer in Psychiatry, in an accompanying
editorial. "Faced with
such behaviour, health professionals must
consider the possibility
of depression, anxiety or somatisation,"
she suggests.
Contacts:
[Paper]: Steven Reid, Clinical Research
Fellow, St Mary's
Hospital, London, UK
Email: steve.reid@kcl.ac.uk
[Editorial]: Jane Turner, Senior Lecturer
in Psychiatry, University
of Queensland, Australia
Email: j.turner@psychiatry.uq.edu.au
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