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(2) OBESITY IN YOUNG CHILDREN CONTINUES TO RISE
(3) AGE
AT FIRST PERIOD HAS CHANGED LITTLE SINCE
1950s
(4) MANY
ASTHMATIC PATIENTS MAY HAVE
ABNORMAL BREATHING
PATTERNS
(5) BMJ
READERS TO DECIDE EDITOR'S FATE OVER
TOBACCO FUNDING
(1) HIV DRUG RESISTANCE IS INCREASING IN THE UK
(Analysis of prevalence of HIV-1
drug resistance in primary
infections in the United Kingdom)
http://bmj.com/cgi/content/full/322/7294/1087
(Editorial: Is transmitted drug resistance
in HIV on the rise?)
http://bmj.com/cgi/content/full/322/7294/1074
The prevalence of transmitted HIV drug
resistance in the United
Kingdom is increasing, according to a
study in this week's BMJ.
This finding emphasises the urgent need
for new approaches to
encourage safer sexual behaviour.
A total of 69 patients infected with HIV
between June 1994 and
August 2000 were evaluated for resistance
within 18 months of
their infection. Participants had received
no antiretroviral drugs at
the time of resistance testing. Drug resistance
was defined as the
presence of one or more key HIV-1 mutations
associated with
drug resistance.
Resistance was detected in 10 (14%) of
patients. In two of the
10 cases, resistance against two of the
three available classes of
antiretroviral agents was identified.
The risk of being infected
with drug resistant virus increased over
time, with an estimated
prevalence of 27% in people infected in
2000.
Methods to improve drug adherence in people
receiving
antiretroviral therapy, together with
evaluation of the impact of
drug resistance and new approaches to
encourage safer sexual
behaviour, are urgently needed conclude
the authors. They also
suggest that the impact of transmission
of resistance on
subsequent treatment response requires
full evaluation.
These views are reiterated in an accompanying
editorial by
Susan Little, Assistant Professor of Medicine
at the University of
California. She writes: "Drug resistance
testing in all recently
infected individuals is needed to monitor
changes in the
prevalence of transmitted drug resistance
among different risk
groups and to optimise initial treatment
choices."
Contacts:
[Paper]: Simon Gregor, PHLS Communications
Unit, London,
UK
Deenan Pillay, PHLS
Antiviral Susceptibility Reference Unit,
University of Birmingham
Medical School, Birmingham, UK
Email: d.pillay@bham.ac.uk
[Editorial]: Susan Little, Assistant Professor
of Medicine,
University of California Department of
Medicine, San Diego,
California, USA
Email: slittle@ucsd.edu
(2) OBESITY IN YOUNG CHILDREN CONTINUES TO RISE
(Increasing prevalence of obesity
in primary school children:
cohort study)
http://bmj.com/cgi/content/full/322/7294/1094
One in five 9 year olds and one in three
11 year old girls are
overweight, finds a study in this week's
BMJ, lending further
support to reports that levels of obesity
in Britain are increasing
in primary school children.
From 1996 to 1999, researchers in Leeds
measured 694
children in 10 primary schools in Leeds.
Height and weight were
measured and converted to body mass index,
and then cut-off
points were applied to define overweight
and obesity. Observed
levels of overweight and obesity were
then compared with
expected levels, relative to British children
using the 1990 UK
growth standards.
The team found a significant increase in
the proportion of
overweight and obese children in those
aged 9, 10, and 11
years, such that one in five 9 year olds
and one in three 11 year
old girls are overweight.
Given the links between childhood obesity
and increased
morbidity and mortality in adult life,
these findings are disturbing,
say the authors. This major public health
issue needs urgently
addressing in young children.
Contacts:
Mary Rudolf, Community Paediatrician, Leeds
Community and
Mental Health Trust, Leeds, UK
Email: Mrudolf@ulth.northy.nhs.uk
Pinki Sahota, Senior Lecturer in Nutrition
and Dietetics, Leeds
Metropolitan University, Leeds, UK
Email: p.sahota@lmu.ac.uk
(3) AGE AT FIRST
PERIOD HAS CHANGED LITTLE SINCE
1950s
(Age of menarche in contemporary
British teenagers: survey of
girls born between 1982 and 1986)
http://bmj.com/cgi/content/full/322/7294/1095
The average age of menarche (age at first
period) in British
teenagers has changed very little during
the past 20-30 years,
finds a study in this week's BMJ. Despite
this, almost one girl in
eight reaches menarche while still at
primary school, and this
must be taken into account when providing
sanitary facilities and
health information for female pupils,
report the authors.
Over 1,000 girls aged 12-16 in schools
across 10 British towns
completed a questionnaire about their
first period. The average
menarcheal age was 12 years 11 months,
with almost 12%
reporting that they had had their first
period before leaving
primary school. Average ages were similar
in different regions
and did not differ by social class or
ethnic group.
The results clearly show that any decrease
in average menarcheal
age during the past 20-30 years has been
small (almost certainly
less than six months), particularly when
compared with the
reduction of a year or more that occurred
in many European
countries (including Britain) between
the late 19th and mid 20th
centuries, conclude the authors.
Contact:
P H Whincup, Professor of Cardiovascular
Epidemiology, St
George's Hospital Medical School, London,
UK
Email: p.whincup@sghms.ac.uk
(4) MANY ASTHMATIC
PATIENTS MAY HAVE
ABNORMAL BREATHING PATTERNS
(Prevalence of dysfunctional breathing
in patients treated for
asthma in primary care: cross sectional
survey)
http://bmj.com/cgi/content/full/322/7294/1098
(Editorial: Dysfunctional breathing
and asthma)
http://bmj.com/cgi/content/full/322/7294/1075
Large numbers of asthmatic patients may
have abnormal
breathing patterns, finds a study in this
week's BMJ, suggesting
an important unrecognised diagnostic overlap
between asthma
and dysfunctional breathing.
All adults receiving treatment for asthma
in one general practice
were surveyed to assess symptoms associated
with abnormal
breathing. About a third of women and
a fifth of men had
symptoms suggestive of dysfunctional breathing.
The problem
affected patients at all levels of asthma
treatment but particularly
women and younger adults.
Further studies are needed to confirm these
findings, say the
authors. However, if dysfunctional breathing
is as common as
our data show, facilities for breathing
retraining need to be
available as part of the overall management
of asthmatic patients.
In an accompanying editorial, Duncan Keeley
and Liesl Osman
write: "we do not believe that nearly
a third of patients in general
practice with a diagnosis of asthma have
been wrongly
diagnosed." They acknowledge the overlap
between the
symptoms of asthma and anxiety with dysfunctional
breathing,
but stress that careful history taking,
examination, and
physiological measurements - together
with sympathetic
explanation and reassurance ? can help
to avoid misdiagnosis.
Contacts:
[Paper]: Mike Thomas, General Practitioner,
Surgery,
Minchinhampton, Stroud, Gloucestershire,
UK
Email: mikethomas@doctors.org.uk
[Editorial]: Duncan Keeley, General Practitioner,
Health Centre
Thame, Oxfordshire, UK
Email: yc23@dial.pipex.com
(5) BMJ READERS
TO DECIDE EDITOR'S FATE OVER
TOBACCO FUNDING
(For and against: Should Nottingham
University give back its
tobacco money?)
http://bmj.com/cgi/content/full/322/7294/1118
Tobacco is set to kill one billion people
in the 21st century, yet
Nottingham University has taken £3.8m
from British American
Tobacco (BAT) to fund an international
centre for the study of
corporate social responsibility. A debate
in this week's BMJ
discusses whether the university should
return the money and
whether the editor, Richard Smith, should
resign as professor of
medical journalism at the university if
it doesn't. Readers will be
asked to decide in a unique vote on bmj.com
The University's vice chancellor, Sir Colin
Campbell, explains
that corporate funding is a vital component
of university finance
and, in accepting funds from BAT, the
university followed, to the
letter, the published protocol agreed
between the Cancer
Research Campaign and the committee of
vice chancellors and
principals (now Universities UK). Investment
in the new centre
will build on the university's existing
research and teaching
strengths, he says.
Sir Colin acknowledges that people will
have different views on
the advisability of accepting funding
from tobacco companies,
but argues that in years to come, few
people will question the
fact that the University of Nottingham
accepted funds from the
tobacco industry. "What they will see
instead will be the high
quality, globally relevant input to corporate
social responsibility
led by the university's business school,"
he concludes.
By taking money from the tobacco industry,
the University of
Nottingham debases itself, argues Richard
Smith, editor of the
BMJ. He believes that the university has
crossed a dangerous
line, putting its reputation as a moral
institution and highly
respected research centre at risk.
He reminds us of the astronomical scale
of harm caused by
tobacco: 100 million people killed prematurely
in the 20th
century, and one billion set to die in
the 21st century, and
discusses the unethical behaviour of the
industry when it first
discovered that its product was killing
millions. "I believe that if
the leaders of Nottingham University could
begin to feel
emotionally the human misery caused by
tobacco then perhaps
BAT's money would be sent straight back,"
he writes.
Contacts:
Richard Smith, Editor, BMJ, BMA House,
London, UK
Email: editor@bmj.com
Colin Campbell, Vice Chancellor, University
of Nottingham,
Nottingham, UK
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