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(2)  HUGE INCREASE IN TOBACCO DEATHS IN
PROGRESS

(3)  NEW TEST CAN RULE OUT HEART DAMAGE
WITHIN SIX HOURS

(4)  MOTHER'S AGE AND BIRTH ORDER
INFLUENCE RISK OF CHILDHOOD DIABETES

(5)  SANITARY FACILITIES IN PRIMARY SCHOOLS
ARE INADEQUATE

(6)  EUROPEAN AUTHORITIES OVERLOOK
CANCER SCREENING GUIDELINES

(1)  SMALL EXCESS RISK OF BIRTH DEFECTS
ASSOCIATED WITH LIVING NEAR LANDFILL
SITES

(Risk of adverse birth outcomes in populations living
near landfill sites)
http://bmj.com/cgi/content/full/323/7309/363

(Editorial: Does exposure to landfill waste harm the
fetus?)
http://bmj.com/cgi/content/full/323/7309/351

Researchers in this week's BMJ report small excess
risks of birth defects and low birth weight among
people living near landfill sites in Great Britain. As 80%
of the British population lives within 2km of known
landfill sites, these results have important implications
and further work is needed to help explain them, say the
authors.

Postcodes within a 2km zone of all known landfill sites
in Great Britain were identified. Sites not operational
between 1982 and 1997 were excluded from the
analysis. National registers were used to identify live
births, stillbirths and congenital anomalies (including
terminations).

The team found a small excess risk of neural tube
defects, abdominal wall defects, surgical corrections of
certain anomalies, low and very low birthweight. There
was no association with stillbirth.

No precise explanation for these findings can be found,
say the authors. By including all landfill sites in the
country, we avoided the problem of selective reporting,
but problems with data quality and confounding factors
could have led to spurious associations. Further
understanding of the potential toxicity of landfill
emissions and possible exposure pathways is needed in
order to help interpret the epidemiological findings, they
conclude.

The question as to whether these results represent a
causal connection between residential landfill exposures
and adverse outcomes is unresolved, write two leading
experts in an accompanying editorial. Factors, such as
crude classification of exposure or residence, and under
reporting of anomalies among live and stillborn children
by district health authorities, could lead to over or under
estimation of the risks of exposure to landfill sites, they
conclude.

Contact:

Paul Elliott, Small Area Health Statistics Unit, Imperial
College, London, UK
Email: p.elliott{at}ic.ac.uk
 

(2)  HUGE INCREASE IN TOBACCO DEATHS IN
PROGRESS

(Mortality and smoking in Hong Kong: case control
study of all adult deaths in 1998)
http://bmj.com/cgi/content/full/323/7309/361

If current smoking patterns persist, tobacco is set to
cause one third of all deaths among middle aged men in
China over the next few decades, predict researchers in
this week's BMJ.

More than 27,000 ethnic Chinese people, aged 35 or
over, whose deaths were registered in Hong Kong in
1998 were identified. Information about the medical
cause of death and the dead person's smoking habits 10
years earlier was recorded and compared with living
people of the same age, who served as controls.

In the general population of Hong Kong in 1998
tobacco caused about 33% of all male deaths at ages
35-69 and 5% of all female deaths (25% of all deaths
at these ages). In male smokers only, tobacco caused
about half of all deaths at ages 35-69.

These risks are more than twice as big as has yet been
seen in mainland China. But, since cigarette
consumption in Hong Kong reached its peak 20 years
earlier than that in mainland China, these Hong Kong
findings may well foreshadow what will happen among
men throughout mainland China (and in other
developing countries) over the next few decades,
explain the authors.

Unless there is widespread cessation by adults who
already smoke, we predict a large increase in deaths
attributable to tobacco in China over the next few
decades, say the authors. Two thirds of all the young
men in China (but, as yet, few of the young women)
become smokers. Half the smokers who persist will
eventually be killed by their habit. Thus, on present
smoking patterns, about one third of all the young men
in China will eventually be killed by tobacco, they
conclude.

Contact:

T H Lam, Chair Professor in Community Medicine,
Department of Community Medicine, University of
Hong Kong
Email:  commed{at}hkucc.hku.hk
 

(3)  NEW TEST CAN RULE OUT HEART DAMAGE
WITHIN SIX HOURS

(Is it possible to exclude a diagnosis of myocardial
damage within six hours of admission to an emergency
department? Diagnostic cohort study)
http://bmj.com/cgi/content/full/323/7309/372

A new test to assess chest pain in UK emergency
departments can rule out the possibility of heart damage
within six hours, allowing safe discharge of patients and
reducing unnecessary admissions, finds a study in this
week's BMJ. The current approach requires admission
to hospital for a minimum of 24 hours.

Over a 12-month period, researchers at Manchester
Royal Infirmary identified patients, aged over 25 years,
attending the emergency department with chest pain.

The new test was compared with the current gold
standard for diagnosing heart damage in 292 patients.
Patients with a positive result were admitted to hospital.
All other patients were discharged to the care of their
general practitioners. Patients who were discharged
were asked to return after two days.

The new test is accurate and effective at ruling out heart
damage within six hours in these patients, say the
authors. This has important clinical and economic
implications as it would allow early discharge of patients
who were shown not to be at risk of heart attack and it
would facilitate early treatment of those who required it,
they conclude.

Contact:

Katrina Herren, Research Fellow, Department of
Emergency Medicine, Manchester Royal Infirmary,
Manchester, UK
Email:  kevin.mackway-jones{at}man.ac.uk
 

(4)  MOTHER'S AGE AND BIRTH ORDER
INFLUENCE RISK OF CHILDHOOD DIABETES

(Maternal and paternal age at delivery, birth order, and
risk of childhood onset type 1 diabetes: population
based cohort study)
http://bmj.com/cgi/content/full/323/7309/369

In firstborn children, risk of diabetes is not associated
with a mother's age, but among second or later born
children there is a positive association, finds a study in
this week's BMJ. Clearly the relation between a
mother's age, birth order, and risk of diabetes is more
complex than previously thought, say the authors.

All live births in Norway between 1974 and 1998 (1.4
million people) were followed for a maximum of 15
years and were linked to cases of type 1 diabetes
diagnosed between 1989 and 1998.

There was no association between a mother's age at
delivery and diabetes among firstborn children.
However, among fourthborn children, there was a 43%
increase in incidence of diabetes for each five-year
increase in maternal age.

Various sociodemographic and biological factors may
explain this effect, say the authors, but our findings
indicate that the relation between maternal age, birth
order, and risk of diabetes is more complex than
previously thought, they conclude.

Contact:

Lars Stene, Research Fellow, Diabetes Research
Centre, Aker and Ulleval University Hospitals, Oslo,
Norway
Email:  lars.christian.stene{at}folkehelsa.no
 

(5)  SANITARY FACILITIES IN PRIMARY SCHOOLS
ARE INADEQUATE

(Letter: National guidelines are needed to provide
sanitary facilities in primary schools)
http://bmj.com/cgi/content/full/323/7309/398

Provision of sanitary facilities in primary schools is
inadequate, despite recent evidence that almost one in
eight girls start their periods while still at primary school,
according to a letter in this week's BMJ.

Researchers in Bath sent a questionnaire to 344
randomly selected primary schools throughout the
United Kingdom. Although sanitary towels could be
obtained in 90% of schools, they were generally only
available from an adult (teacher, secretary, or school
nurse). Only 1% of schools had a machine in the girls
toilets. Disposal facilities were available within an
individual cubicle in only 43% of girls toilets.

Unless there are national guidelines, girls will continue to
be poorly provided for, say the authors. Although the
cost of providing facilities is an issue, particularly for
smaller primary schools, parents, school nurses and
paediatricians could help advocate for these girls by
lobbying both local authorities and central government,
they conclude.

Contact:

Fiona Finlay, Consultant Community Paediatrician, Bath
and North East Somerset Primary Care Trust,
Community Child Health Department, Bath, UK
Email:  Fiona.Finlay{at}banes-pct.nhs.uk
 

(6)  EUROPEAN AUTHORITIES OVERLOOK
CANCER SCREENING GUIDELINES

(Letter: European consensus on cancer screening
should be applied urgently by health ministers)
http://bmj.com/cgi/content/full/323/7309/396

European recommendations for cancer screening have
yet to be officially validated, despite a consensus
agreement by experts from all EU member states back
in November 1999, according to a letter in this week's
BMJ.

This lack of European policy will lead to a continuation
of inefficient opportunistic screening and will increase
the risk of uncontrolled new screening methods from
commercial lobbying, warn the authors.

The guidelines address screening for cervical, breast,
and colorectal cancer and recommend that screening be
offered only in organised programmes with quality
assurance at all levels, as well as good information
about benefits and risks. They also advise that
opportunistic screening activities should be discouraged
as they may not achieve the potential benefits but result
in negative side effects.

This issue needs to be high on the agenda of one of the
next meetings of European health ministers, conclude
the authors.

Contact:

Elsebeth Lynge, Institute of Public Health, University of
Copenhagen, Copenhagen, Denmark
Email: elsebeth{at}pubhealth.ku.dk
 

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