Releases Saturday 19 April 2003
No 7394 Volume 326
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(1) HIGH BLOOD PRESSURE IN PREGNANCY
INCREASES RISK OF LATER HEART DISEASE
(2) COUNSELLING
CAN INCREASE FRUIT AND
VEGETABLE INTAKE
(3) IMPACT
OF ANTISOCIAL LIFESTYLE "HAS
BEEN NEGLECTED"
(4) PATIENT
INFORMATION CAN ENCOURAGE
OR LIMIT CHOICE
(1) HIGH BLOOD
PRESSURE IN PREGNANCY
INCREASES RISK OF LATER HEART DISEASE
(Hypertensive diseases of pregnancy
and risk of
hypertension and stroke in later
life: results from a cohort
study)
http://bmj.com/cgi/content/full/326/7394/845
Women who have high blood pressure (hypertension)
during pregnancy have an increased risk
of developing
cardiovascular disease in later life,
concludes a study in
this week's BMJ.
The study involved three groups of women,
selected
from the Aberdeen maternity databank,
and who were
living in Aberdeen during their first
pregnancy in the
years 1951 to 1970. One group had been
diagnosed
with pre-eclampsia or eclampsia during
their pregnancy,
the second had been diagnosed with high
blood
pressure, and the third group had no history
of raised
blood pressure.
The women were asked to complete a questionnaire
and
were invited to attend for a medical examination.
Women who experienced raised blood pressure
in
pregnancy had a long-term risk of hypertension,
an
increased risk of stroke and, to a lesser
extent, an
increased risk of ischaemic heart disease.
Long-term
cardiovascular risks were greatest for
women with
pre-eclampsia.
If greater awareness of this association
leads to earlier
diagnosis and improved management, there
may be
scope for reducing a proportion of the
illness and death
from such diseases, conclude the authors.
Contact:
Professor Cairns Smith, Department of Public
Health,
University of Aberdeen, Foresterhill,
Aberdeen,
Scotland
Email: w.c.s.smith{at}abdn.ac.uk
(2) COUNSELLING
CAN INCREASE FRUIT AND
VEGETABLE INTAKE
(Behavioural counselling to increase
consumption of fruit
and vegetables in low income adults:
randomised trial)
http://bmj.com/cgi/content/full/326/7394/855
Behavioural counselling can increase consumption
of fruit
and vegetables among deprived adults,
finds a study in
this week's BMJ.
Researchers identified 271 patients, aged
18-70 years,
from a health centre in a deprived, ethnically
mixed inner
city area.
Patients were randomly assigned to two
groups. One
group received behavioural counselling
(personalised
advice from a practice nurse and setting
of short and
long term goals). The other received nutrition
counselling
(education about the importance of increasing
consumption of fruit and vegetables).
Patients recorded the number of portions
of fruit and
vegetables eaten per day. Vitamin and
potassium levels,
were also assessed.
After 12 months, consumption of fruit and
vegetables
increased by 1.5 portions per day in the
behavioural
group and 0.9 portions per day in the
nutrition group.
The proportion of patients eating five
or more portions a
day increased by 42% and 27% in the two
groups.
There were no changes in vitamin C or potassium
concentrations. Levels of vitamin E and
beta-carotene
increased in both groups, but the rise
in beta-carotene
was greater in the behavioural group.
These findings show that brief individual
counselling is
feasible in primary care and can elicit
sustained increases
in consumption of fruit and vegetables
in low income
adults in the general population, conclude
the authors.
Contact:
Professor Andrew Steptoe, Department of
Epidemiology and Public Health, University
College
London, London, UK
Email: a.steptoe{at}ucl.ac.uk
(3) IMPACT OF
ANTISOCIAL LIFESTYLE "HAS
BEEN NEGLECTED"
(Editorial: The impact of antisocial
lifestyle on health)
http://bmj.com/cgi/content/full/326/7394/834
Evidence suggests that an antisocial lifestyle
is linked to
illness, injury, and premature death,
yet while links
between deprivation and health have been
widely
studied, links between antisocial lifestyle
and health have
been neglected, according to two experts
in this week's
BMJ.
The impact of an antisocial lifestyle on
health is
increasingly well understood, write Professors
Jonathan
Shepherd and David Farrington. For example,
early
contact with the police, truancy, school
misconduct, and
divorce are significant predictors of
premature death.
Studies have also found links between an
antisocial
lifestyle and injury, especially injury
sustained in assaults
at age 16-18 and on the roads or at work
at age 27 to
32.
Family, school, and police interventions
can reduce these
health risks, say the authors. For example,
pre-school
education and management training for
parents have
helped to reduce a range of antisocial
behaviours
including offending and alcohol or other
drug misuse.
Effective police interventions include
patrols targeted at
known hotspots of violence and arrest
of serious repeat
offenders, drunk drivers, and employed
suspects of
domestic violence.
Nowhere are the impacts of antisocial lifestyle
on health
more apparent than in prisons, add the
authors. The
recent transfer of responsibility for
prison health services
in England and Wales from the Home Office
to the
Department of Health is logical, and a
prompt both to
acknowledge relationships between crime,
injury, and
illness and to develop integrated prevention
and
treatment, they conclude.
Contact:
Jonathan Shepherd, Professor of Oral and
Maxillofacial
Surgery, University of Wales College of
Medicine,
Cardiff
Email: shepherdjp{at}cardiff.ac.uk
(4) PATIENT INFORMATION
CAN ENCOURAGE
OR LIMIT CHOICE
(Limits to patient choice: example
from anaesthesia)
http://bmj.com/cgi/content/full/326/7394/863
Patients have a right to information about
their care.
Good patient information should describe
what will
happen, explain why, and highlight possible
choices with
risks and benefits. Yet, a study in this
week's BMJ finds
that information is often poor and can
limit a patient's
ability to make choices about their care.
Researchers at the Royal Lancaster Infirmary
analysed
51 leaflets about fasting before surgery
from 267
anaesthetic departments in the United
Kingdom. They
identified three limiting factors:
Only 27 leaflets mentioned preoperative
fasting, and only
half of these included up to date evidence
on fasting
times. Such withholding of information
limits patient
choice because if evidence is not made
available to
patients they are unable to challenge
unnecessarily
prolonged fasts, write the authors.
The tone of language used in leaflets can
also limit patient
choice. Nine leaflets adopted a declarative
or punitive
tone, implying that the patient was a
passive recipient of
instructions rather than a partner in
decisions. Eighteen
leaflets were more explanatory, but some
contained
images and comparisons that may unintentionally
disturb
or threaten the reader.
Finally, the issue of safety may be used
to deny patient
choice, say the authors. Safety is a fluid
concept; it
changes over time and according to context.
For
instance, current evidence supports the
safety of fasting
times that were considered dangerous 20
years ago, and
things may change again in the future.
Since this study was conducted, the Royal
College of
Anaesthetists have taken steps to raise
the standard of
patient information in this area, add
the authors.
Acknowledging such uncertainties should
foster a
relationship of mutual confidence and
respect and allow
patients to understand why some choices
might not be
available to them, they conclude.
Contact:
Andrew Smith, Consultant Anaesthetist,
Department of
Anaesthesia, Royal Lancaster Infirmary,
Lancaster, UK
Email: andrew.smith{at}rli.mbht.nhs.uk
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