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(2) PROBIOTICS
MAY PREVENT ANTIBIOTIC
ASSOCIATED
DIARRHOEA
(3) RATES OF GENITAL HERPES INFECTIONS RISE
(4) GOVERNMENTS
COMMITTING "PUBLIC HEALTH
MALPRACTICE"
OVER FLOUR FORTIFICATION
(5) MEDIA
UNDERMINE EFFORTS TO TACKLE
NICOTINE ADDICTION
(1) SERIOUS PHYSICAL
ILLNESS LINKED TO
SUICIDE IN LATER LIFE
(Burden of illness and suicide in
elderly people:
case-control study)
http://bmj.com/cgi/content/full/324/7350/1355
Most people who commit suicide late in
life suffer from
depression, but the role of physical illness
is less clear. A
study in this week's BMJ finds that serious
physical illness
also carries an increased risk of suicide
in elderly people.
Researchers in Sweden examined the records
of 46 men
and 39 women, aged 65 years and over,
who had
committed suicide. They compared these
with 84 men and
69 women of the same age, living in the
same area
(controls). Interviews were also conducted
with relatives of
the suicide victims and control persons.
They found that impaired vision, neurological
disorders,
and malignant disease were all independently
associated
with suicide. When the sexes were analysed
separately,
serious physical illness seemed to be
a stronger predictor in
men than in women.
Many elderly people who commit suicide
consult their
doctor a short time before their death,
but many fail to
communicate their despair, say the authors.
Further
research should focus on the detection
and treatment of
depression and suicidal ideation in the
context of physical
disease, they conclude.
Contacts:
Margda Waern, Research Fellow, Institute
of Clinical
Neuroscience, Gothenburg University, Sahlgrenska
University Hospital, Gothenburg, Sweden
Email: margda.waern@neuro.gu.se
(2) PROBIOTICS
MAY PREVENT ANTIBIOTIC
ASSOCIATED DIARRHOEA
(Probiotics in prevention of antibiotic
associated diarrhoea:
meta-analysis)
http://bmj.com/cgi/content/full/324/7350/1361
(Editorial: Managing antibiotic associated
diarrhoea)
http://bmj.com/cgi/content/full/324/7350/1345
Probiotics (microbes that protect their
host and can
prevent disease) can prevent diarrhoea
associated with the
use of antibiotics, finds a study in this
week's BMJ.
Researchers at the Hammersmith Hospital
in London
reviewed nine trials carried out to study
the benefits of
probiotics in the prevention of antibiotic
associated
diarrhoea. In all nine trials, the probiotics
were given in
combination with antibiotics and the control
groups
received placebo and antibiotics.
They found that probiotics are useful in
preventing
antibiotic associated diarrhoea. In particular,
the yeast S
boulardii and three strains of Lactobacillus
have the
potential to be used in this situation.
Commercially available strains are being
marketed in
capsules and yoghurt based drinks, but
these were not
tested in the above trials and their potential
benefit needs
further investigation, say the authors.
A large trial looking at the efficacy of
probiotics in
preventing antibiotic associated diarrhoea,
particularly in
elderly patients, with an emphasis on
the optimal dose and
cost benefits is needed, they conclude.
Contacts:
Aloysius D'Souza, Research Fellow or Christopher
Bulpitt,
Professor of Geriatric Medicine, Care
of the Elderly
Section, Faculty of Medicine, Imperial
College School of
Medicine, Hammersmith Hospital, London,
UK
Email: aloysius.dsouza@ic.ac.uk
(3) RATES OF GENITAL HERPES INFECTIONS RISE
(Longitudinal study of genital infection
by herpes simplex
virus type 1 in western Scotland
over 15 years)
http://bmj.com/cgi/content/full/324/7350/1366
Genital infections with Herpes simplex
virus type 1
(HSV-1) have risen in western Scotland
over the last 15
years, particularly among young women,
finds a study in
this week's BMJ.
Researchers reviewed all genital samples
of herpes simplex
processed between 1986 and 2000 at the
West of
Scotland Specialist Virology Centre.
Of the 3,181 swabs testing positive for
the virus, 63%
were from women and 37% were from men.
Twenty-nine
per cent of patients were aged 21-25 years.
In
1986-1988, 33% of all positive swabs were
due to
HSV-1, rising progressively to 56% in
1998-2000.
Both the number and percentage of HSV-1
infections have
risen, say the authors. Genital infection
with HSV-1 is also
strongly associated with being young (aged
less than 25
years) and being female.
Most new cases of genital HSV-1 infection
are likely to be
due to orogenital transmission, but there
is no evidence
suggesting that oral sex practices have
changed
substantially, say the authors. The occurrence
of HSV-1
infection in women is unexplained.
These results suggest that counselling
and clinical
management strategies may need to be revised,
say the
authors. Preventive strategies for genital
herpes should
focus on the risk of unprotected orogenital
intercourse,
which is frequently perceived as "safe"
in the context of
sexually transmitted infections, they
conclude.
Contact:
Anne Scoular, Consultant Physician, Department
of
Genitourinary Medicine, Sandyford Initiative,
Glasgow,
Scotland
Email: anne@scoular.demon.co.uk
(4) GOVERNMENTS
COMMITTING "PUBLIC HEALTH
MALPRACTICE" OVER FLOUR FORTIFICATION
(Editorial: Delaying folic acid fortification
of flour)
http://bmj.com/cgi/content/full/324/7350/1348
The failure of European governments, including
the United
Kingdom, to fortify flour with folic acid
has allowed a
continuing epidemic of preventable human
illness,
according to an editorial in this week's
BMJ.
Fortification could save as many lives
as are lost each year
in vehicle crashes, writes Professor Godfrey
Oakley of
Emory University in the United States.
Yet in Europe,
fortification has been delayed because
of erroneous
speculation of possible harm for elderly
people.
Recent evidence indicates that fortification
improves the
lives of adults, including elderly people,
and that it is safe.
In 1998 - the year in which fortification
was made
mandatory in the United States - deaths
from stroke and
heart attack declined by 3.4%.
Although fortification of flour is long
overdue in the United
Kingdom and the remainder of Europe, the
UK board of
the Food Standards Agency recently decided
against
mandatory folic acid fortification.
Ministers should not accept this recommendation,
argues
the author. Rather, they should follow
the advice of the
Department of Health committee on medical
aspects of
food and nutrition policy and require
universal fortification
of flour with folic acid. This prudent
action would improve
the health of children and adults.
Rare is the opportunity to implement a
sustainable,
inexpensive, and effective intervention
to prevent major
human diseases, says the author. Folic
acid fortification of
flour is one of those rare opportunities.
Governments that
do not ensure that flour is fortified
with folic acid are
committing public health malpractice,
he concludes.
Contact:
Godfrey Oakley, Visiting Professor, Department
of
Epidemiology, Rollins School of Public
Health of Emory
University, Atlanta, GA, USA
Email: gpoakley@mindspring.com
(5) MEDIA UNDERMINE
EFFORTS TO TACKLE
NICOTINE ADDICTION
(Editorial: The power of the press
in smokers' attempts to
quit)
http://bmj.com/cgi/content/full/324/7350/1346
Inaccurate media reports surrounding the
safety of new
smoking cessation drugs are undermining
the treatment of
nicotine addiction, according to an editorial
in this week's
BMJ.
Professor Linda Ferry presents two scenarios
that illustrate
the struggle between the press and medical
experts to
investigate and report concerns about
the safety of new
drugs for smoking cessation, and the effect
this struggle has
on reported attempts to quit smoking.
In the United Kingdom, bupropion hydrochloride
(Zyban)
was heralded by the media as a wonder
drug when it was
released in 2000. Not surprisingly, smokers
queued up in
waiting rooms, expecting their tobacco
addiction to be
vanish with this new pill.
The public enthusiasm changed abruptly
in February 2001
when a London newspaper profiled a few
dramatic reports
of deaths in smokers using bupropion.
Although experts
remain convinced of the safety of bupropion,
the demand
for treatment has declined.
A similar shift in public opinion followed
media reports in
the United States about an increased risk
of heart attack
associated with nicotine patches. A subsequent
trial
showed that patches were safe to use,
specifically in
patients with heart disease, but many
smokers still believe
the original media messages that "if I
use a patch and
smoke even one cigarette, I might have
a heart attack."
Clinicians should give clear messages to
their patients that it
is much safer to use either of these drugs
to help their
attempts to quit than to continue smoking,
says the author.
Unfortunately, much damage has been done.
Tobacco treatment specialists and public
health agencies
need to refute the inaccuracies of the
media and present a
clear picture of the enormous problem
of preventable
disability and the 120,000 tobacco related
deaths a year
from the 13 million smokers in the United
Kingdom, she
concludes.
Contact:
Linda Ferry, Associate Professor, Departments
of
Preventive Medicine and Family Medicine,
Loma Linda
University School of Medicine, Loma Linda,
CA, USA
Email: LHFerry@aol.com
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