This week in the BMJ
Volume 326, Number 7387, Issue of 1 Mar 2003Vitamin D three times a year can prevent fractures
Vitamin D three times a year can prevent fractures
Supplementation with vitamin D every four months for five years reduced
the number of first fractures in men and women aged 65 and older living
in the community. Trivedi and colleagues (p 469) found that
supplementation with 100 000 IU oral vitamin D reduced the incidence
of fracture by 22%. Most fracture prevention trials have focused on
clinically defined high risk groups and women, and many effective
interventions may not be feasible or cost effective in the general
population. This simple, safe, and low cost intervention may reduce
osteoporotic fractures in the general community.
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Is adjusted indirect comparison valid?
Results of adjusted indirect comparisons of evidence from randomised
controlled trials usually agree with those of the direct comparisons.
The increasing number of active interventions often coincides with a
lack of direct evidence from randomised trials about the relative
efficacy of competing interventions. Song and colleagues (p 472)
summarised empirical evidence about the validity of adjusted indirect
comparison using a sample of 44 meta-analyses from 28 systematic
reviews. They found moderate agreement between the statistical
conclusions from the direct and adjusted indirect comparison. Adjusted
indirect comparison may provide useful or supplementary information on
the relative efficacy of competing interventions.
(Credit: AMY ECKERT/PHOTONICA)
Changing partners reduces risk of prolonged pregnancy
The risk of recurrence of post-term delivery is reduced by nearly one
third in women with a previous prolonged pregnancy when consecutively
born children have different fathers. Olesen and colleagues (p 476)
reviewed the birth registry data for nearly 30 000 Danish mothers with
at least two births and found that length of pregnancy was reduced by
more than one week in women who had changed partners. The authors say
that paternal genes as expressed by the fetus may be partly responsible
for determining the timing of birth. Prolonged pregnancy
gestational
length of 294 days or moreis associated with an increased risk of
obstetric complications and perinatal morbidity, but to date little has been known of its aetiology.
Integrated cardiac rehabilitation service meets NSF targets
An approach to cardiac rehabilitation that integrates hospital
based services with nurse led secondary prevention clinics in primary
care achieves the targets of the national service framework (NSF) for
coronary heart disease. Dalal and Evans (p 481) report on an
innovative, integrated approach to cardiac rehabilitation that offered
patients a choice of home and hospital based cardiac rehabilitation.
Home rehabilitation with the Heart Manual, a structured guide for patients, was popular with patients, and it may increase the
uptake of cardiac rehabilitation in rural communities. The service
ensured good communication across the primary care-secondary care
interface, maximised uptake of cardiac rehabilitation, and optimised
secondary prevention measures.
AIDS in South Africa is more than polemics
Much has been made of South African president Mbeki's denial of a
connection between HIV and AIDS and his resistance to accepting antiretrovirals, but the political landscape is changing. Fassin and
Schneider (p 495) review the controversies of the AIDS crisis in South
Africa, and advocate a political and anthropological response to the
epidemic. Using a political analysis, they conclude that suspicion of
Western drugs and denial of the extent of AIDS in South Africa are
products of the apartheid regime.
(Credit: AP PHOTO/DENIS FARRELL)
Telephone consultations for review of asthma improve access
Conducting routine review by telephone rather than face to face in the
doctor's surgery enables more patients with asthma to be reviewed. In
the first UK trial to focus on the use of the telephone in the routine
care of chronic disease, Pinnock and colleagues (p 477) compared
telephone reviews with face to face consultations. As well as
increasing the proportion of patients with asthma who were
reviewed by 26%, telephone consultations were on average half as long
as face to face consultations, and patients were just as satisfied with
the telephone review, indicating that telephone consultations could be
a good way to deliver routine asthma
care.
(Credit: RICHARD GARDNER/REX)
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