This week in the BMJ
Volume 325, Number 7357, Issue of 27 Jul 2002Exercise improves fibromyalgia
Exercise improves fibromyalgia
Graded aerobic exercise is a simple, cheap, and effective
treatment for people with fibromyalgia. Richards and Scott (p 185) report a randomised controlled trial of prescribed graded exercise against relaxation and flexibility training. After three months exercise led to significantly more participants rating themselves as
much or very much better, and the benefits were maintained or improved
at one year follow up. The exercise group also had greater reductions
in tender point counts. Exercise training does have limitations, the
authors say, due to poor compliance. Strategies to increase the
efficacy of exercise as an intervention would therefore need to
confront compliance issues through additional cognitive behaviour
therapy.
(Credit: ALFRED PASIEKA/SPL)
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Smoke-free workplaces cut smoking
Smoke-free workplaces not only protect non-smokers from the dangers of
passive smoking but also encourage smokers to quit. A systematic review
by Fichtenberg and Glantz (p 188) shows that totally free smoke-free
workplaces are associated with reductions in prevalence of smoking of
3.8%, and continuing smokers smoke 3.1 fewer cigarettes a day.
The combined effects reduce total cigarette consumption by 29%. To
achieve similar results through taxation would require an increase in
the price of cigarettes of 73%, so that cigarettes would cost £6.59
per pack in the United Kingdom.
Safe alcohol limit rises with age
A direct dose-response relation exists between alcohol
consumption and risk of death in women aged 16-54 and in men aged
16-34, whereas at older ages the relation is U shaped. White and
colleagues (p 191) use statistical models relating alcohol consumption
to the risk of death from single causes to estimate the all cause risk
for men and women of different ages. They suggest that women should
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 should limit their
drinking to 1 unit a day up to age 34, 2 units up to age 44, 3 units up
to age 54, and 4 units a day up to age 84.
Adult learners need different educational models
Increasing numbers of postgraduate entrants to medical school, greater
movement between specialities, and an influx of qualified doctors from
overseas means that there are increasing numbers of experienced
learners in the workforce. Penny Newman and Ed Peile (p 200) explore
the attributes of experienced adult learners and propose appropriate
educational models. These, they say, are models that emphasise a
facilitative approach, guided reflection, learning from experience, and
an adult to adult relationship between learner and trainer. Paternalism
in an adult educational relationship is rarely appropriate.
Sleeping sickness is re-emerging
Human African trypanosomiasis, or sleeping sickness, is a re-emerging
public health problem in many parts of rural Africa. The protozoan
Trypanosoma brucei is transmitted through the bite of a
tetse fly, and the clinical signs of the first stages of the disease
include fever, lymphadenopathy, and hepatomegaly. The second stage of
the disease results in chronic encephalopathy, and patients eventually
enter a terminal somnolent state, which gives the disease its name.
Stich and colleagues (p 203) review the condition and say that the
new epidemic can be controlled if the political will is there.
Anthropology is needed in health research
Findings from qualitative research have been deemed "thin,"
"trite," and "banal." Lambert and McKevitt (p 210) explain that the problems lie not in methods but in the misguided separation of
method from theory. They advocate the greater involvement of anthroplogy, which views the familiar afresh and tries to make the
strange comprehensible. The authors explain that this discipline has a
lot to contribute to qualitative research; it can foster true
multidisciplinary research by offering relevant conceptual frameworks,
substantive knowledge, and methodological insights.
"Jaundice hotline" improves care
An open referral, rapid access service for patients with jaundice can
shorten time to diagnosis and treatment and length of stay in hospital.
By installing a system for referring patients with acute jaundice
through a 24 hour telephone answering machine and fax line, Mitchell
and colleagues (p 213) reduced mean length of stay in hospital from
11.5 days to 6.1 days. The authors say that the most important lesson
they learnt was that, with a combination of teamwork and flexibility,
major improvements can be made in health service without the need for
extra resources.
Following guidelines is not efficient
Prioritising patients for assessment of cardiovascular disease on the
basis of previous estimates makes better use of staff time than
assessing all adults for their risk of cardiovascular disease.
Additionally, treating more patients with low cost drugs is more
efficient than prescribing costly drugs such as simvastatin and
enalapril for a few patients. Marshall and Rouse (p 197) make these
conclusions from the mathematical modelling of data from six strategies
for preventing cardiovascular disease. Authors of such strategies and
guidelines, they say, should make explicit statements about the
resource implications, health benefits, and efficacy of implementing
such strategies.
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