This week in the BMJ
Volume 325, Number 7354, Issue of 6 Jul 2002Vitamin E does not help macular degeneration
Vitamin E does not help macular degeneration
A randomised trial in 1000 healthy volunteers by Taylor and colleagues (p 11) shows that daily supplementation with vitamin E for four years does not alter the incidence or progression of macular degeneration. A positive family history and cigarette smoking are the known risk factors, but oxidative stress has been suspected. The authors say the study shows that the antioxidant effect of vitamin E does not have a role in protecting against macular degeneration.
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(Credit: VITAMIN E CRYSTALS M W DANDSA/FLORIDA STATE UNIVERSITY) |
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When to give antibiotics in otitis media
Children with otitis media with a raised temperature and vomiting
are more likely to benefit from immediate treatment with antibiotics
than children with no fever or vomiting. Little and colleagues (p 22)
used data from a randomised controlled trial cohort of antibiotic
prescribing strategies for otitis media and identified predictors
of poor outcome. They then assessed benefit from treatment in these
subgroups. Children who did not have raised temperature and
vomiting were unlikely to have poor outcome and unlikely to benefit
from immediate antibiotics.
Aflatoxin causes stunting
Consumption of foods heavily contaminated with aflatoxins (toxic and carcinogenic fungal metabolites) is associated with stunting and being underweight. Gong and colleagues (p 20) examined the association between exposure to aflatoxin and growth in children in Benin and Togo, West Africa. The association between aflatoxin exposure and impaired growth, the authors say, could be due to aflatoxin toxicity or to consumption of food affected by fungus and of poor nutritional quality.
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| (Credit: TRYGVE BOLSTAD/PANOS) |
Methods for Down's screening questioned
New screening techniques for Down's syndrome are less effective than previously supposed, despite a government initiative to offer all pregnant women the new tests by 2004. Wellesley and colleagues (p 15) compared the effectiveness of different screening policies and found no evidence that the addition of serum and nuchal screening improves antenatal detection rates or reduces rates of invasive procedures. They say that new screening methods should be offered only as part of a controlled study until their benefit is proved.
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| (Credit: CNRI/SPL) |
Using emergency service saves time
Half of all patients with suspected stroke are not reaching hospital in
less than six hoursthe cut-off time for receiving the possible
benefit of thrombolysisreport Harraf and colleagues (p 17). Studying
the early management of 739 patients with acute stroke in 22 hospitals,
they show that the median delay between onset of symptoms and arrival
at hospital was two hours for patients using the emergency services and
seven hours for those referred by their GP. The authors say that
patients and general practitioners should use emergency services to
reduce delays in getting patients to hospital, thereby increasing the
number of patients eligible for therapies.
Doctors should disclose trial payments
Doctors are often paid to recruit patients to clinical
trials sponsored by pharmaceutical companies, yet such payments are often not disclosed to the patients. Rao and Cassia (p 36) argue that
this practice is unethical and damages efforts to involve patients more
fully in clinical trials. They believe that patients should be treated
as equal partners by doctors making full and frank disclosure of
payments that trial sponsors make to them for recruiting their patients.
Temple stay relieves psychosis
A brief stay at a healing temple in South India can improve the
symptoms of mental illness, according to research by Raguram and
colleagues (p 38). Assessing 31 people with serious mental disorders
staying at the temple of Muthuswamy in South India, the authors found a
reduction in thinking disturbance and hostile suspiciousness,
representing a clinical improvement matching that achieved with many
psychotrophic drugs. In the absence of any specific healing rituals,
the observed benefits seemed to result from a supportive,
non-threatening environment.
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