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(2) BULLYING
CAN LEAD TO EMOTIONAL
PROBLEMS, ESPECIALLY
IN GIRLS
(3) ACUPUNCTURE
IS A SAFE TREATMENT IN
SKILLED HANDS
(4) TEENAGERS
NOT AT HIGHER RISK DURING
FIRST BIRTH,
BUT A SECOND MAY LEAD TO
COMPLICATIONS
(5) DECISION
AIDS HELP PATIENTS CHOOSE
BEST TREATMENT
OPTIONS
(1) SEVENTEEN
PER CENT OF VETERANS
BELIEVE THEY HAVE GULF WAR SYNDROME
(Prevalence of Gulf war veterans
who believe they have
Gulf war syndrome: questionnaire
study)
http://bmj.com/cgi/content/full/323/7311/473
Seventeen per cent of Gulf war veterans
believe they
have Gulf war syndrome, find researchers
in this week's
BMJ. The study has implications for future
health
protection programmes intended to protect
against the
threat of chemical and biological warfare.
Questionnaires were sent to a large random
sample of
British service personnel who served in
the 1991 Gulf
war. Of 2961 respondents, 17% believed
they had Gulf
war syndrome. A combination of biological,
psychological, and sociological factors
were associated
with this belief. For instance, these
personnel were
more likely to have poor health, know
someone else
who also believed they had the condition,
and have
received a high number of vaccinations
before
deployment to the Gulf.
If this sample is representative, about
9,000 of 53,000
British service personnel believe they
have Gulf war
syndrome, say the authors. The future
health needs of
all service personnel should now be considered,
they
conclude.
Contact:
Trudie Chalder, Department of Psychological
Medicine,
Guy's, King's and St Thomas's School of
Medicine,
London, UK
Email: sphatrc@iop.kcl.ac.uk
(2) BULLYING CAN
LEAD TO EMOTIONAL
PROBLEMS, ESPECIALLY IN GIRLS
(Does bullying cause emotional problems?
A
prospective study of young teenagers)
http://bmj.com/cgi/content/full/323/7311/480
A history of bullying predicts the onset
of anxiety or
depressive symptoms, especially in young
teenage girls,
finds a study in this week's BMJ.
Over 2,600 secondary school students in
Victoria,
Australia were surveyed about bullying,
twice in year 8
(aged 13 years) and 12 months later, at
the end of year
9. Students were classified as victimised
if they
answered "yes" to four types of victimisation:
being
teased, having rumours spread about them,
being
deliberately excluded, or experiencing
physical threats
or violence.
The level of victimisation was high and
relatively stable
in this group. Two thirds of the students
who were
bullied recurrently in year 8 also reported
being bullied
in year 9. A history of victimisation
was a strong
predictor of self-reported symptoms of
anxiety and
depression, even after taking into account
other
measures of social relations. This was
especially the
case for girls.
Further work is needed to determine if
a reduction in
bullying can reduce the onset of anxiety
and depressive
symptoms in teenagers, say the authors,
but the
indications from this study are that such
a reduction
could have a substantial impact on the
emotional
wellbeing of young people, they conclude.
Contact:
Lyndal Bond, Centre for Adolescent Health,
Royal
Children's Hospital, Victoria, Australia
Email: bond@cryptic.rch.unimelb.edu.au
(3) ACUPUNCTURE
IS A SAFE TREATMENT IN
SKILLED HANDS
(Adverse events following acupuncture:
prospective
survey of 32 000 consultations with
doctors and
physiotherapists)
http://bmj.com/cgi/content/full/323/7311/485
(The York acupuncture safety study:
prospective survey
of 34 000 treatments by traditional
acupuncturists)
http://bmj.com/cgi/content/full/323/7311/486
(Editorial: The safety of acupuncture)
http://bmj.com/cgi/content/full/323/7311/467
Acupuncture is a relatively safe form of
treatment in the
hands of a competent practitioner, conclude
two
reports in this week's BMJ. Being the
first studies in the
United Kingdom to systematically examine
both the rate
and nature of adverse effects of acupuncture,
they
provide important evidence on public health
and safety
of acupuncture.
In the first study, 78 doctors and physiotherapists
who
performed acupuncture recorded any adverse
events
that occurred between June 1998 and February
2000.
They reported no serious adverse events
and 671 minor
adverse events per 10,000 acupuncture
consultations.
These rates are classified as minimal,
however, 14 per
10,000 of these minor events were reported
as
significant.
Some avoidable adverse events occurred,
and
acupuncturists might consider modifying
their practice to
reduce the incidence of such events, conclude
the
authors.
In the second study, 574 members of the
British
Acupuncture Council participated in a
postal audit of
treatments undertaken during a four week
period in
2000. No serious adverse events were reported
after
34,407 acupuncture treatments. Comparison
of this
adverse event rate with those of drugs
routinely
prescribed in primary care suggests that
acupuncture is
a relatively safe form of treatment, conclude
the authors.
Despite some study limitations, the conclusion
that, in
skilled hands, acupuncture is one of the
safer forms of
medical intervention seems justified,
writes Professor
Charles Vincent in an accompanying editorial.
Most
encouragingly, these studies represent
a serious and
systematic attempt by acupuncture practitioners
to
address the issue of patient safety, he
concludes.
Contacts:
[Paper 1]: Adrian White, Senior Lecturer,
Department
of Complementary Medicine, University
of Exeter, UK
Email: a.r.white@ex.ac.uk
[Paper 2]: Hugh MacPherson, Research Director,
Foundation for Traditional Chinese Medicine,
York,
UK
Email: hugh@ftcm.org.uk
[Editorial]: Charles Vincent, Professor
of Psychology,
Department of Psychology, University College
London,
UK
Email: c.vincent@ucl.ac.uk
(4) TEENAGERS
NOT AT HIGHER RISK DURING
FIRST BIRTH, BUT A SECOND MAY LEAD
TO
COMPLICATIONS
(Teenage pregnancy and risk of adverse
perinatal
outcomes associated with first and
second births:
population based retrospective cohort
study)
http://bmj.com/cgi/content/full/323/7311/476
Teenagers giving birth for the first time
are not at
increased risk of adverse pregnancy outcomes.
However, those having second births run
an almost
threefold risk of premature delivery and
stillbirth,
concludes a study in this week's BMJ.
Researchers at Glasgow University identified
over
110,000 non-smoking women, aged between
15 and
29 years, who gave birth for the first
or second time
between 1992 and 1998. Risks of adverse
outcomes,
such as low birth weight, premature birth,
still birth, and
emergency caesarean section were analysed
for two
age groups: women aged 15-19 and women
aged
20-29. Factors, such as smoking, social
deprivation,
and previous abortions were taken into
account.
They found that non-smoking women aged
15-19
having a first birth were not at higher
risk of adverse
pregnancy outcomes, compared with women
aged
20-29. By contrast, second births among
15-19 year
olds were associated with an almost threefold
risk of
extremely premature birth and stillbirth
compared with
older women.
These findings contradict previous studies,
which
suggested that first teenage births were
associated with
adverse pregnancy outcomes. However, these
studies
failed to account for important environmental
factors
such as maternal smoking, explain the
authors. The
current study is also the first to show
clearly that
teenagers having their second baby are
at significantly
increased risk of pregnancy complications.
This
appeared to be independent of environmental
factors
but further work will be required to confirm
or refute a
biological cause for these findings, they
conclude.
Contact:
Gordon Smith, Professor of Obstetrics and
Gynaecology, University of Cambridge,
UK
Email: gcs4@cornell.edu
(5) DECISION AIDS
HELP PATIENTS CHOOSE
BEST TREATMENT OPTIONS
(Randomised controlled trial of an
interactive
multimedia decision aid on hormone
replacement
therapy in primary care)
http://bmj.com/cgi/content/full/323/7311/490
(Randomised controlled trial of an
interactive
multimedia decision aid on benign
prostatic hypertrophy
in primary care)
http://bmj.com/cgi/content/full/323/7311/493
(Editorial: A key medical decision
maker: the patient)
http://bmj.com/cgi/content/full/323/7311/466
Interactive decision aids improves patient
knowledge
and can help patients play a more active
part in making
decisions about their treatment, suggest
two studies in
this week's BMJ.
In the first study, 205 women in the UK
considering
hormone replacement treatment were randomly
given
either normal clinical care or a computer-based
interactive decision aid by their general
practitioners.
The decision aid was acceptable to both
the patients
and their general practitioners. It enhanced
the women's
understanding of the effects of hormone
replacement
therapy and seemed to reduce decisional
conflict.
Patients who viewed the programme played
a more
active part in the decision making process
and were no
more anxious than those who received normal
care.
In the second study, much the same conclusions
were
drawn about a decision aid for men considering
treatment for prostate problems. Such
aids could be
introduced throughout the NHS at relatively
low cost by
using the internet, conclude the authors.
Nevertheless, many questions remain, writes
Professor
Richard Deyo in an accompanying editorial.
For
example, how can we ensure that presentations
are
objective and balanced, rather than designed
to lead
patients to a particular conclusion? How
will
programmes be continuously updated, and
who will
support this work?
If such questions can be addressed we might
expect to
have better informed patients, a more
meaningful
consent process, and more consistent practice
patterns,
he concludes.
Contact:
Angela Coulter, Chief Executive, Picker
Institute
Europe, Oxford, UK
Email: angela.coulter@pickereurope.ac.uk
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