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(2) IMMUNISATION
IS NOT LINKED TO SUDDEN INFANT
DEATH
(3) SEX
INEQUALITIES FOUND IN PRIMARY CARE
TREATMENT OF
HEART DISEASE
(4) HOME
CHEMOTHERAPY IS A VIABLE ALTERNATIVE
TO HOSPITAL
TREATMENT
(5) FATIGUE
IS AN IMPORTANT FACTOR IN SERIOUS
ROAD CRASHES
(Longitudinal cohort study of childhood
IQ and survival up to
age 76)
http://bmj.com/cgi/content/full/322/7290/819
Children with higher IQs may live longer,
suggests a study in this
week's BMJ. These findings add to our
knowledge of the
personal traits in youth that contribute
to survival in adult life.
Results of an intelligence test, given
to all 11-year olds attending
Aberdeen schools in 1932, were used to
determine survival up
to 76 years. Of 2,230 subjects traced,
those who died before 1
January 1997 had a significantly lower
IQ at age 11 years than
those who were alive or untraced. This
suggests that high mental
ability in late childhood reduces the
chances of death up to age
76. The effect was weaker in men than
in women, partly because
men with high IQ were more likely to die
in active service during
the second world war.
The reason for this association is unclear,
say the authors, as the
effect of IQ is difficult to separate
from the effects of social class
and education. Future studies on the causes
of inequalities in
health and mortality should investigate
childhood mental ability as
one of the factors, they conclude.
Contacts:
Linda Menzies, Communications and Public
Affairs, University
of Edinburgh, Edinburgh, Scotland.
Email: Linda.Menzies@ed.ac.uk
Angela Begg, External Relations, University
of Aberdeen,
Aberdeen, Scotland.
Email: a.begg@abdn.ac.uk
(2) IMMUNISATION
IS NOT LINKED TO SUDDEN INFANT
DEATH
(The UK accelerated immunisation
programme and sudden
infant death in infancy: case-control
study)
http://bmj.com/cgi/content/full/322/7290/822
Vaccination against diphtheria, tetanus
and pertussis is now given
at ages 2, 3 and 4 months in the UK, which
coincides with the
peak age for the sudden infant death syndrome
(SIDS).
However, a study in this week's BMJ finds
that immunisation is
not linked to sudden unexpected death
in infancy and may even
protect against it.
All sudden unexpected deaths (both explained
and unexplained)
of infants aged 1 week to 1 year in five
regions of England were
investigated over a period of three years.
For each death,
parental interviews were conducted. Four
age-matched control
families were also visited within two
weeks of each death.
Immunisation uptake was lowest among the
infants who died,
even after taking account of all potential
bias. Furthermore, no
relation was found between the time of
vaccination and time of
death, signs and symptoms of illness before
death, or sudden
unexpected deaths due to explained causes,
particularly
infection. These results suggest that,
when all potentially
confounding factors are controlled for,
immunisation does not
contribute to the risk of SIDS and may
protect against it, say the
authors.
They conclude: "the accelerated immunisation
programme in the
United Kingdom is not associated with
sudden unexpected death
in infancy, whether the death is explained
or unexplained."
Contact:
Peter Fleming, Professor of Infant Health
and Developmental
Physiology, Institute of Child Health,
Royal Hospital for
Children, Bristol, UK
Email: peter.fleming@bris.ac.uk
(3) SEX INEQUALITIES
FOUND IN PRIMARY CARE
TREATMENT OF HEART DISEASE
(Sex inequalities in ischaemic heart
disease in general practice:
cross sectional survey)
http://bmj.com/cgi/content/full/322/7290/832
A study in this week's BMJ reports that
treatment of heart
disease in primary care is systematically
biased towards men,
despite no suggestion of sex differences
in the management of
these patients in England's national service
framework for
coronary heart disease.
Data for over 5,000 men and women with
ischaemic heart
disease in the Trent health region were
analysed. Men were
more likely than women to have cardiovascular
risk factors and
blood cholesterol levels recorded on computer.
Although a
higher proportion of women had raised
cholesterol levels, men
were more likely to have a diagnosis of
hyperlipidaemia, and
take cholesterol lowering drugs.
These differences persist when age and
other risk factors are
taken into account, say the authors, and
suggest a systematic
bias towards men compared with women in
terms of secondary
prevention of ischaemic heart disease.
Contact:
Julia Hippisley-Cox, Senior Lecturer in
General Practice,
Nottingham University, Nottingham, UK
Email: julia.hippisley-cox@nottingham.ac.uk
(4) HOME CHEMOTHERAPY
IS A VIABLE ALTERNATIVE
TO HOSPITAL TREATMENT
(Compliance, satisfaction, and quality
of life of patients with
colorectal cancer receiving home
chemotherapy or outpatient
treatment: a randomised controlled
trial)
http://bmj.com/cgi/content/full/322/7290/826
(Editorial: Home delivery: chemotherapy
and pizza?)
http://bmj.com/cgi/content/full/322/7290/809
Home chemotherapy is a safe and acceptable
alternative to
hospital treatment for patients with colorectal
cancer that may
improve compliance with treatment, according
to a study in this
week's BMJ.
Of 87 patients receiving chemotherapy for
colorectal cancer, 42
were treated at an outpatient clinic and
45 at home, over a
12-month period. The two groups were similar
in terms of age,
sex, site of cancer, and disease stage.
Home chemotherapy had
no effect on patients' quality of life.
However, compliance with
treatment and patient satisfaction, particularly
with regard to
nursing care, were higher in the home
treatment group.
Furthermore, home chemotherapy was not
associated with an
increased use of health services such
as primary care or
emergency departments.
Although these results may not apply to
newer or more
complicated chemotherapy regimens, this
study contributes to
the assessment of home care for cancer
patients and has shown
that home chemotherapy could be advantageous
for patients by
increasing satisfaction and compliance
with treatment, conclude
the authors.
Contacts:
Josep M Borras, Cancer Prevention and Control
Unit, Catalan
Institute of Oncology, Spain
Email: jmborras@ico.scs.es
Josep R Germà , Department of Pharmacy,
Catalan Institute of
Oncology, Spain
Email: jrgerma@ico.scs.es
(5) FATIGUE IS
AN IMPORTANT FACTOR IN SERIOUS
ROAD CRASHES
(Fatigue, alcohol, and serious road
crashes in France: factorial
study of national data)
http://bmj.com/cgi/content/full/322/7290/829
(Editorial: Fatigue: time to recognise
and deal with an old
problem)
http://bmj.com/cgi/content/full/322/7290/808
Fatigue, especially when combined with
alcohol, presents a
particularly high risk of road crashes
resulting in death or serious
injury, finds a study in this week's BMJ.
Data from the French Ministry of Transport
was used to
investigate the role of fatigue in serious,
single-vehicle crashes
during 1994-8. About 10% of the crashes
were related to
fatigue and 23% to alcohol. The risk of
death and severe injury
was highest when alcohol and fatigue were
combined.
During the daytime, fatigue, distraction
and weekend (versus
weekday) were significant factors associated
with non-alcohol
related crashes resulting in death. However,
for alcohol related
crashes resulting in death, only fatigue
was significant.
There was also a strong relation between
time of day and cause
of crash, with many alcohol related crashes
occurring at night,
say the authors. Given that crashes related
to fatigue can be
difficult to identify, police officers
are likely to attribute such
crashes only to alcohol, even when fatigue
is present, they
conclude.
Contact:
Pierre Philip, Consultant, Clinique du
Sommeil, Centre
Hospitalier Universitaire, Bordeaux, France
Email: pierrephilip@compuserve.com
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