Releases Saturday 20 July 2002
No 7356 Volume 325
Please remember to credit the BMJ as source when publicising
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(1) EXERCISE CAN PREVENT FALLS IN OLDER
PEOPLE
(2) CONCERN
OVER RISING RATES OF
SYPHILIS IN
ENGLAND
(3) ELDERLY
DO NOT PLAN FOR SERIOUS
FUTURE ILLNESS
(4) WOMEN
WITH A HISTORY OF
PREGNANCY COMPLICATIONS
SHOULD
RECEIVE SCREENING
(1) EXERCISE CAN
PREVENT FALLS IN OLDER
PEOPLE
(Randomised factorial trial of falls
prevention among
older people living in their own
homes)
http://bmj.com/cgi/content/full/325/7356/128
A weekly exercise programme focusing on
balance
can prevent falls among older people living
at home,
finds a study in this week's BMJ.
Researchers identified 1,090 Australian
born adults
aged 70-84 years, living at home and in
good
health. Participants were assigned to
interventions
involving group based exercise, home hazard
management, and vision improvement, and
were
asked to report falls using a monthly
postcard
calendar system.
Exercise was the most effective single
intervention
tested, and the reduction in falls among
this group
seems to have been associated with improved
balance, say the authors. Neither home
hazard
management nor treatment of poor vision
showed a
significant effect when used alone, but
added value
when combined with the exercise programme.
All three interventions combined showed
the
strongest effect, producing an estimated
14%
reduction in the annual fall rate, they
add.
Although cost effectiveness is yet to be
examined,
these results show that a supervised exercise
programme for this group for one hour
a week for
15 weeks, supplemented with home exercise
for up
to 12 months, can reduce falls, say the
authors.
However, further trials may be needed
to examine
the effectiveness of interventions among
people who
are aged over 85 or in poorer health,
they conclude.
Contact:
Lesley Day, Senior Research Fellow, Accident
Research Centre, Monash University, Victoria,
Australia
Email: Lesley.Day{at}general.monash.edu.au
(2) CONCERN OVER
RISING RATES OF
SYPHILIS IN ENGLAND
(Syphilis: old problem, new strategy)
http://bmj.com/cgi/content/full/325/7356/153
Syphilis is on the increase again. In this
week's
BMJ, Lorraine Doherty and colleagues report
on
four recent outbreaks in England and discuss
the
public health measures needed to contain
it.
Between 1998 and 2000, the number of cases
of
infectious syphilis in England more than
doubled -
from 172 to 372 in men and 102 to 156
in women.
Rates were highest in London and in north
west
England.
These increases are largely due to several
localised
outbreaks, and indicate that unsafe sexual
behaviour
continues among both the heterosexual
and
homosexual populations in England, say
the authors.
Few general practitioners will have dealt
with a case
of infectious syphilis, but these outbreaks
emphasise
the importance of sustained multidisciplinary
public
health action in this area, they add.
The general public, certain groups at risk,
and
relevant health professionals should be
aware of the
risks of acquiring syphilis and the symptoms
and
signs of acute infection, they conclude.
Contacts:
Lorraine Doherty, Consultant Epidemiologist,
HIV/STI Division, PHLS Communicable Disease
Surveillance Centre, London, UK
Email: Lorraine.Doherty{at}dhsspsni.gov.uk
or
Public Health Laboratory Service Press
Office,
London, UK
Email: ecollins{at}phls.org.uk, sgregor{at}phls.org.uk
(3) ELDERLY DO
NOT PLAN FOR SERIOUS
FUTURE ILLNESS
(Planning for death but not serious
future illness:
qualitative study of housebound
elderly patients)
http://bmj.com/cgi/content/full/325/7356/125
Elderly patients may be reluctant to make
plans for
the future, particularly for serious illness,
finds a
study in this week's BMJ.
Researchers in the United States interviewed
20
chronically ill housebound patients, aged
over 75
years, about their views on advance planning
of
care.
Sixteen people said they did not think
about the
future or did not plan for the future.
Nineteen were
particularly reluctant to think about,
discuss, or plan
for serious future illness. Instead they
described a
"one day at a time," "what will be will
be" approach
to life, preferring to "cross that bridge"
when they
got to it.
Participants considered end of life matters
to be in
the hands of God, although 13 had made
wills and
19 had funeral plans. Although some had
completed
living wills, these were not well understood
and
were intended for use only when death
was near
and certain.
"Our findings contrast with a central tenet
of good
care at the end of life: that physicians
and patients
should make plans in advance about possible
future
illness," say the authors. "The elderly
people we
interviewed described a world view that
does not
easily accommodate such advance planning."
Despite some limitations, this study shows
that
scrupulous attempts to plan about care
in advance
will not, in all cases, solve the problem
of decision
making for seriously ill and incapacitated
patients,
they conclude.
Contacts:
Public Affairs, Johns Hopkins Bayview Medical
Center, USA
or
Joseph Carrese, Associate Professor of
Medicine,
Phoebe R Berman Bioethics Institute, Johns
Hopkins University, Baltimore, USA
Email: jcarrese{at}JHMI.edu
(4) WOMEN WITH
A HISTORY OF
PREGNANCY COMPLICATIONS SHOULD
RECEIVE SCREENING
(Pregnancy complications and maternal
cardiovascular risk: opportunities
for intervention
and screening?)
http://bmj.com/cgi/content/full/325/7356/157
Recent evidence suggests that women with
a history
of complications in pregnancy may be at
increased
risk of diabetes and heart disease in
later life.
Researchers in this week's BMJ suggest
that these
women should be screened and given relevant
health education.
Women who develop diabetes during pregnancy
(a
condition known as gestational diabetes)
are at
increased risk of diabetes and should
be screened
and given counselling and lifestyle advice,
say the
authors. Similarly, women with a history
of pre-term
delivery or women who have had a very
low
birthweight baby also seem to be at increased
risk,
and should be screened in their late 30s.
Screening and primary prevention strategies
should
also be offered to women with a history
of
pregnancy complications, such as pre-eclampsia.
To help ensure that appropriate women are
screened, adverse pregnancy outcomes could
be
used in general practitioners' computer
databases
for targeted health screening programmes,
suggest
the authors.
The potential for 'modifying' risk factors
before a
subsequent pregnancy or in early pregnancy
requires further investigation, add the
authors. For
example, studies have shown that increasing
exercise during pregnancy may increase
birth weight
and reduce the risk of gestational diabetes.
"Such data would suggest that complications
are not
simply genetically determined, but that
lifestyle
factors play a major role. At present,
this remains
speculative, and further research is needed
to
examine this important question," they
conclude.
Contact:
Naveed Sattar, Reader in Endocrinology
and
Metabolism, Glasgow Royal Infirmary University
NHS Trust, Glasgow, Scotland
Email: nsattar{at}clinmed.gla.ac.uk
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(http://www.eurekalert.org)
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