This week in the BMJ
Volume 325, Number 7367, Issue of 5 Oct 2002Prostate cancer patients want screening
Prostate cancer patients want screening
Men with suspected or confirmed prostate cancer have several
reasons for recommending routine testing for prostate specific antigen.
A qualitative study by Chapple and colleagues (p 737) shows that the
reasons why men with prostate cancer advocate screening include beliefs
about the benefit of early diagnosis, the need to have responsibility,
and a desire for equality with women regarding screening. Policy
makers, politicians, and doctors, the authors say, need to understand
why people want wider access to prostate specific antigen testing so
that they can find better ways of communicating information about risk.
![[To top]](/icons/back.gif){kind=icon}
Prostate cancer screening does not reduce mortality
More intensive screening and treatment for prostate cancer is not
associated with lower prostate cancer specific mortality. Lu-Yao and
colleagues (p 740) compared the Seattle-Puget Sound area in the United
States, where screening and aggressive treatment were adopted early,
with Connecticut, where adoption was slower. In 1987-90 men aged 65-79 in Seattle were five times as likely to undergo prostate specific
antigen testing and twice as likely to undergo biopsy, and rates of
radical prostatectomy and radiotherapy were also substantially higher.
Nevertheless, through 11 years of follow up, prostate cancer
mortality was similar in the two areas.
Flexible insulin treatment improves diabetic control
Training to adjust insulin doses to match food choice improves
the quality of life and glycaemic control of people with type 1 diabetes. In a randomised trial by the dose adjustment for normal eating (DAFNE) study group (p 746), patients attended a course teaching them to match their insulin requirements to carbohydrate intake on a meal by meal basis. The training programme improved glycaemic control and led to significant improvements in satisfaction with treatment, psychological wellbeing, and quality of life measures without severe hypoglycaemia or cardiovascular risk being worsened.
(Credit: PHN/SPL)
Back pain is increasing in adolescents
Back and neck pain is a common and increasing problem in Finnish
adolescents, especially girls. Hakala and colleagues (p 743) found
from two independent surveys of 12 year olds that prevalence increased
in the 1990s and most suddenly at the end of the decade. Musculoskeletal symptoms, the authors say, may be related to risk factors such as repetitive movements, static postures, and static muscular activation patterns in work with computer mice.
Small babies are more likely to be stressed as adults
Lower birth weight and poor weight gain up to the age of 7 years
are associated with higher levels of psychological distress as adults.
Cheung and colleagues (p 749) studied the psychological health of
British adults born in 1958. Data were collected from medical records,
clinical examination, face to face interviews, and questionnaires. The
study, the authors say, shows that psychological health in adults is
related to fetal growth and growth in early childhood.
(Credit: GRAHAM SMITH/REX)
Knee exercise can reduce knee pain
Home based exercise for 30 minutes a day over two years
significantly improves self reported knee pain. Thomas and colleagues (p 752) allocated patients with self reported knee pain to receive one
of four options: a home based exercise programme, telephone support,
exercise and telephone support, or standard care. Participants who
exercised reported a 12% reduction in knee pain compared with those who did not exercise.
(Credit: SATURN STILLS/SPL)
Qualitative methods improve trial recruitment
Changing the content and delivery of information about a study
can increase recruitment rates from 40% to 70%. A quality improvement report by Donovan and colleagues (p 766) shows how qualitative research methods can drive changes to the design and conduct of a
trial. Embedding randomised trials in qualitative research, the authors
say, may enable the most difficult evaluative questions to be tackled
and improve recruitment to trials generally.
Deaf lesbians and designer babies
Genetic tests for disabilities are increasingly becoming
available for couples with a family history of genetic disease to select healthy offspring. But some couples wish to select for disability. On p 771 Savulescu discusses the ethics of the case of a
deaf lesbian couple who deliberately created a child by using the sperm
of a deaf friend with five generations of deafness in his family.
Freedom, he writes, includes the freedom to do what others disapprove
of or judge wrong, provided the exercise of freedom does not harm others.
Obesity treatments are failing
New treatments for obesity have failed to control the global increase
in the number of overweight people. Hitchcock Noël and Pugh (p 757)
discuss the barriers that need to be overcome by healthcare
professionals and patients if weight reduction is to be achieved and
maintained. Ultimately, they say, control is likely to require
population based strategies to promote healthy eating and increase
physical activity. These will need to be integrated and
multidisciplinary, and they will need to involve complementary actions that work at a range of levels: individual, community, environment, and policy.
(Credit: SIPA/REX)
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
