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(2) RISKS
AND BENEFITS OF ALCOHOL
CONSUMPTION
VARY WITH AGE AS WELL AS
SEX
(3) LONGER
DELAYS ASSOCIATED WITH BETTER
SURVIVAL
(4) EXERCISE
THERAPY IMPROVES
FIBROMYALGIA
(5) NEW
EC DIRECTIVE THREATENS LIFE-SAVING
TRIALS
(1) SMOKE-FREE
WORKPLACES PROTECT
NON-SMOKERS AND ENCOURAGE SMOKERS
TO QUIT
(Effect of smoke-free workplaces
on smoking behaviour:
systematic review )
http://bmj.com/cgi/content/full/325/7357/188
(Editorial: Banning smoking in the
workplace)
http://bmj.com/cgi/content/full/325/7357/174
Smoke-free workplaces not only protect
non-smokers
from the dangers of passive smoking, they
also encourage
smokers to quit or to reduce consumption,
concludes a
study in this week's BMJ.
Researchers in California reviewed 26 studies
on the
effects of smoke-free workplaces. Totally
smoke-free
workplaces were associated with reductions
in prevalence
of smoking of nearly 4%. The combined
effects of people
stopping smoking and reducing consumption
reduces total
cigarette consumption by 29%.
To achieve similar results through taxation
would require
an increase in the price of cigarettes
of 73%, say the
authors. Such an increase would require
cigarette taxes
per pack to increase from $0.76 to $3.05
in the United
States and from £3.44 to £6.59
in the United Kingdom.
If all workplaces became smoke-free, per
capita cigarette
consumption would drop by 4.5% in the
United States
and 7.6% in the United Kingdom, costing
the tobacco
industry $1.7 billion and £310 million
annually in lost sales,
they add. To achieve similar reductions,
tax per pack
would have to increase to $1.11 and £4.26.
While producing benefits for non-smokers
by eliminating
passive smoking, smoke-free workplaces
also make it
easier for smokers to reduce or stop smoking
and
substantially reduce tobacco industry
sales, say the
authors. This loss in revenues explains
why the industry
fights so hard against legislation to
ensure that workplaces
become smoke-free, they conclude.
Contact:
Stanton Glantz, Professor of Medicine,
Center for
Tobacco Control Research and Education,
University of
California, San Francisco, USA
Email: glantz@medicine.ucsf.edu
(2) RISKS AND
BENEFITS OF ALCOHOL
CONSUMPTION VARY WITH AGE AS WELL AS
SEX
(Alcohol consumption and mortality:
modelling risks for
men and women at different ages)
http://bmj.com/cgi/content/full/325/7357/191
The health benefits of alcohol only occur
in middle aged
and older people, finds a study in this
week's BMJ. For
men aged up to 35 and women aged up to
55 even light
drinkers have a higher risk of death than
those who do not
drink at all.
Researchers analysed the drinking habits
of men and
women in England and Wales for age bands
16-24,
25-34, 35-44, and so on up to over 85.
Using national
death statistics and international epidemiological
studies,
they then estimated the relation between
alcohol
consumption and risk of death, and how
this varies with
age and sex.
They found a direct dose-response relation
between
alcohol consumption and risk of death
in women aged
16-54 and in men aged 16-34. However,
the level at
which the risk of death was lowest increased
with age,
reaching 3 units a week in women aged
over 65 and 8
units a week in men aged over 65.
The level of alcohol consumption that carries
a 5%
increase in risk of death increases with
age from 8 to 20
units a week in women and from 5 to 34
units a week in
men, they add. To incur an increased risk
of no more than
5% they suggest that women would be advised
to limit
their drinking to 1 unit a day up to age
44, 2 units a day up
to age 74, and 3 units a day over age
75. Men would be
advised to limit their drinking to 1 unit
a day up to age 34,
2 units a day up to age 44, 3 units a
day up to age 54, 4
units a day up to age 84, and 5 units
a day over age 85.
Finally, as most deaths attributable to
alcohol at younger
ages are due to injuries, a greater focus
could be placed
on avoiding risky patterns of drinking
rather than on
reducing average alcohol consumption
Contact:
Ian White, Medical Statistician, Medical
Research Council
Biostatistics Unit, Institute of Public
Health, Cambridge,
UK
Email: ian.white@mrc-bsu.cam.ac.uk
(3) LONGER DELAYS
ASSOCIATED WITH BETTER
SURVIVAL
(The waiting time paradox: population
based retrospective
study of treatment delay and survival
of women with
endometrial cancer in Scotland)
http://bmj.com/cgi/content/full/325/7357/196
Patients who experience the longest delay
in treatment are
more likely to survive, despite the popular
assumption that
delay has a significant and harmful impact
on survival, finds
a study in this week's BMJ.
Researchers collected data from the case
notes of 703
women resident in Scotland who were diagnosed
between
1 January 1996 and 31 December 1997 as
having
endometrial cancer. They calculated time
intervals from
the dates of general practitioner referral
letters, clinic
appointments, investigations, and operations.
They found that delay and survival were
inversely related:
women with the shortest delay had more
advanced
disease and survival was least likely
for these patients.
The traditional view is that delay caused
by organisational
defects has an adverse effect on the disease:
this influences
survival. "Our study suggests that disease
influences delay,
and so delay is a confounding factor,"
say the authors.
The fact that the strongest effect between
delay and
survival is seen in the interval between
referral and the first
hospital visit suggests that general practitioners
communicate information related to presentation
in some
way to consultants, they add. This communication
ensures
that consultants respond faster to patients
who are at
higher risk.
Consultants seem to be able, from first
clinic visit, to
differentiate patients at greater risk
and to ensure that
cancer is diagnosed and treated faster,
they conclude.
Contact:
Simon Crawford, Specialist Registrar, Department
of
Gynaecological Oncology, Stobhill Hospital,
Glasgow,
Scotland
Email: S.C.Crawford@btinternet.com
(4) EXERCISE THERAPY
IMPROVES
FIBROMYALGIA
(Prescribed exercise in people with
fibromyalgia: parallel
group randomised controlled trial)
http://bmj.com/cgi/content/full/325/7357/185
Prescribed graded aerobic exercise is a
simple, cheap,
and effective treatment for people with
fibromyalgia
(medically unexplained chronic muscular
pain and joint
tenderness), finds a study in this week's
BMJ.
Researchers identified 132 patients with
fibromyalgia who
were attending a hospital rheumatology
clinic between
January 1997 and June 1998. Patients were
then
randomly assigned to either aerobic exercise
classes or
relaxation classes, twice weekly for 12
weeks. The
classes were carried out by personal trainers
with no
special experience in providing exercise
for people with ill
health.
Compared to relaxation, exercise led to
significantly more
participants rating themselves as much
or very much better
at three months. Benefits were also maintained
or
improved one year later.
These results show that a three month programme
of
prescribed graded aerobic exercise is
an effective
treatment that leads to improvements in
self reported
health status, say the authors. Furthermore,
prescribed
exercise can be undertaken effectively
in the community
by personal trainers previously inexperienced
in managing
people with ill health.
However, compliance with exercise treatment
is a
considerable problem, giving high drop
out rates, say the
authors. Future strategies to increase
the efficacy of
exercise as an intervention should confront
this issue, they
conclude.
Contact:
Selwyn Richards, Consultant Rheumatologist,
Poole
Hospital NHS Trust, Poole, Dorset, UK
Email: srichards@poole-tr.swest.nhs.uk
(5) NEW EC DIRECTIVE
THREATENS LIFE-SAVING
TRIALS
(Letter: Evaluation of treatments
is threatened by
EC directive)
http://bmj.com/cgi/content/full/325/7357/222
Europeans should wake up to the threat
of a new
European Directive, which will make many
potentially
life-saving studies performed in emergency
medicine
impossible, warn researchers in this week's
BMJ.
The Directive could stop trials of treatments
for patients
rendered suddenly mentally incapacitated
by, for example,
cardiac arrest, head injury, or stroke
because many of
these patients are in no position to give
the consent that
the directive demands for entry into a
clinical trial, write
the authors.
Sadly, in Scotland such trials may already
be impossible,
they add. The Adults with Incapacity (Scotland)
Act,
2000 requires consent from the adult's
proxy or next of
kin; this is despite numerous attempts
over four years by
medical researchers to explain the consequences
of this
restriction to the lawyers drafting the
bill.
Europeans should wake up to the threat
to the evaluation
of treatments for millions of future patients,
say the
authors. The lawyers and politicians must
sort out just
whose interest they are protecting when
framing European
legislation, they conclude.
Contact:
Dr Richard Lindley, Senior Lecturer, University
of
Edinburgh, Department of Clinical Neurosciences,
Western General Hospital, Edinburgh, Scotland.
Email: richard.lindley@ed.ac.uk
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