Releases Saturday 5 May 2001
No 7294 Volume 322

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(1) HIV DRUG RESISTANCE IS INCREASING IN THE UK

(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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