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(2) GENES
ARE OF LITTLE IMPORTANCE IN
RHEUMATOID
ARTHRITIS
(3) VIBRATING
COMPUTER GAMES SHOULD
CARRY HEALTH
WARNINGS
(4) WOMEN
WANT TO BE ASKED ABOUT
DOMESTIC VIOLENCE
(5) SHOULD
WOMEN BE SCREENED FOR
DOMESTIC VIOLENCE?
(1) DEATHS AT
BRISTOL NOT EXPLAINED BY
LOW VOLUME OF OPERATIONS
(Mortality and volume of cases in
paediatric cardiac
surgery: retrospective study based
on routinely
collected data)
http://bmj.com/cgi/content/full/324/7332/261
Deaths among young children undergoing
heart surgery
are lower in hospitals that carry out
a high number of
these operations, even when data from
Bristol Royal
Infirmary are excluded, confirms a study
in this week's
BMJ. However, this does not explain the
high number
of deaths at Bristol, despite being a
hospital with a low
volume of cases.
David Spiegelhalter, a senior scientist
at the Institute of
Public Health in Cambridge, used data
from 12 English
hospitals carrying out heart surgery on
children from
1991 to 1995. His analysis excluded results
from
Bristol.
He found strong and consistent evidence
that hospitals
performing a higher number of open heart
operations in
children aged under 1 year tended to have
a lower
death rate. For instance, a hospital carrying
out 120
operations per year during this period
would be
expected to have a 25% lower death rate
than a
hospital carrying out only 40 such operations.
Including the results from Bristol strengthened
this
association. Furthermore, only a small
proportion (less
than a fifth) of the excess deaths seen
at the Bristol
over this period was due to the hospital's
lower volume
of surgery, adds the author.
Considerable caution is needed in interpreting
these
results and the policy implications are
unclear, stresses
the author. It does not necessary follow
that
concentrating resources in fewer centres
would reduce
deaths, he concludes.
Contact:
The author of this study is unavailable.
An alternative
contact is: The Society of Cardiothoracic
Surgeons of
Great Britain and Ireland, Royal College
of Surgeons
of England, Lincoln's Inn Fields, London,
UK
(2) GENES ARE
OF LITTLE IMPORTANCE IN
RHEUMATOID ARTHRITIS
(Relative importance of genetic effects
in rheumatoid
arthritis: historical cohort study
of Danish nationwide
twin population)
http://bmj.com/cgi/content/full/324/7332/264
Genes are of little importance in the development
of
rheumatoid arthritis, finds a study in
this week's BMJ.
Researchers in Denmark surveyed over 37,000
twins
about rheumatic diseases. Twin studies
are one of the
simplest ways to unravel the relative
importance of
genetic and environmental effects of a
disease. Twins
who reported that they had rheumatoid
arthritis were
invited to have a clinical examination.
Rheumatoid arthritis was verified in 13
identical and 36
non-identical twins. No identical twins
and only two
pairs of non-identical twins both had
rheumatoid
arthritis, suggesting that rheumatoid
arthritis is no more
common in identical twins than non-identical
twins.
Despite some study limitations, the authors
conclude
that environmental effects may be more
important than
genetic effects in the development of
rheumatoid
arthritis.
This study cannot disprove a genetic component
in
susceptability to rheumatoid arthritis,
writes Professor
Alan Silman in an accompanying commentary.
However, the results emphasise that the
genetic effects
are weak compared with environmental ones
in
explaining differences in occurrence of
disease.
Contact:
Anders Svendsen, Specialist Registrar,
Department of
Rheumatology, Odense University Hospital,
Denmark
Email: anders.svendsen@ouh.fyns-amt.dk
(3) VIBRATING
COMPUTER GAMES SHOULD
CARRY HEALTH WARNINGS
(Letter: Hand-arm vibration syndrome
may be
associated with prolonged use of
vibrating computer
games)
http://bmj.com/cgi/content/full/324/7332/301/a
Prolonged use of vibrating computer games
by children
may be linked to a condition known as
hand-arm
vibration syndrome and should carry health
warnings,
suggest researchers in this week's BMJ.
They describe a case of a 15 year old boy
who visited
hospital with a two year history of painful
hands. His
hands became white and swollen when exposed
to the
cold and then red and painful on warming.
The boy spent up to seven hours a day playing
computer games, and particularly enjoyed
driving
games using the vibration mode on the
hand held
control device.
His symptoms are typical of the hand-arm
vibration
syndrome caused by the prolonged use of
industrial
tools, such as gas powered chain saws
and pneumatic
tools, say the authors. This syndrome
was recognised
as an industrial disease in 1985 and has
led to changes
in working practices.
Injuries associated with the use of computers
or their
accessories include joystick digit and
mouse elbow,
but no cases of hand-arm vibration syndrome
linked to
prolonged use of vibrating hand held computer
devices
have previously been reported, they add.
"We believe that, with increasing numbers
of children
playing these devices, there should be
consideration for
statutory health warnings to advise users
and parents.
We encourage paediatricians encountering
health
related effects of using these devices
to report their
findings," they conclude.
Contacts:
Gavin Cleary, Specialist Registrar, Great
Ormond
Street Children's Hospital, London, UK
Email: gavin.cleary@talk21.com
Dr J Sills, Consultant Paediatric Rheumatologist,
Alder
Hey Children's Hospital, Liverpool, UK
(4) WOMEN WANT
TO BE ASKED ABOUT
DOMESTIC VIOLENCE
(Reported frequency of domestic violence:
cross
sectional survey of women attending
general practice)
http://bmj.com/cgi/content/full/324/7332/271
(Editorial: Preventing domestic violence)
http://bmj.com/cgi/content/full/324/7332/253
Doctors may be able to identify women who
experience domestic violence by asking
them if they
are afraid of their partner, finds a study
in this week's
BMJ.
Women attending 22 general practices in
Ireland were
surveyed about domestic violence. Of the
1,692
women who had ever had a sexual relationship
nearly
40% had experienced violent behaviour,
but only 5%
recalled being asked about it by their
doctor.
Yet, 77% of women said that it would be
"all right" for
their doctor to ask about violence in
relationships.
Women who reported domestic violence were
much
more likely to be afraid of their partner
and to have
experienced controlling behaviour (e.g.
being shouted
or screamed at) than women who did not
report such
violence.
For general practitioners and doctors in
accident and
emergency, asking women about fear of
their partner
and controlling behaviours may be an acceptable
and
effective way of identifying those who
are experiencing
domestic violence, conclude the authors.
Contact:
Tom O'Dowd, Professor of General Practice,
Trinity
College Centre for Health Sciences, Adelaide
and
Meath Hospital, Dublin, Ireland
Email: todowd@tcd.ie
(5) SHOULD WOMEN
BE SCREENED FOR
DOMESTIC VIOLENCE?
(Identifying domestic violence: cross
sectional study in
primary care)
http://bmj.com/cgi/content/full/324/7332/274
(Editorial: Preventing domestic violence)
http://bmj.com/cgi/content/full/324/7332/253
Over a third of women attending general
practices
have experienced physical violence, but
doctors and
nurses rarely ask about it. Researchers
in this week's
BMJ ask:
Should women be screened for domestic violence
when they visit their general practitioner?
Is there a high risk group of women for
whom
screening might be more appropriate?
Is screening acceptable to women?
A sample of women visiting 13 general practices
in
Hackney, east London were surveyed about
different
aspects of domestic violence. Of 1,035
women, 41%
had experienced physical violence from
a partner or
former partner. Yet, for most of these
women, definite
or suspected domestic violence was not
recorded in
their medical notes.
Pregnancy within the past 12 months doubled
the risk
of physical violence, suggesting that
pregnant women
are at high risk and that screening could
be more
appropriate for this group of women than
for other
groups, say the authors.
One in five women objected to routine questioning
about domestic violence. This limited
acceptability, and
the absence of evidence of benefit to
women from
screening for domestic violence, means
the case for
screening is not convincing and its introduction
would
be premature, say the authors.
In the meantime, health professionals should
maintain a
high level of awareness of the possibility
of domestic
violence, especially in pregnant women,
they conclude.
Contacts:
Jo Richardson, Research Fellow, Barts and
The
London, Queen Mary's School of Medicine
and
Dentistry, London, UK
Email: jo.richardson@gp-F84710.nhs.uk
Gene Feder, Professor of Primary Care Research
and
Development
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