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(2) CONCERN
OVER DEATHS AFTER OPIATE
DETOXIFICATION
(3) CULTURALLY
SENSITIVE SMOKING
CESSATION PROGRAMMES
NEEDED
(4) SHOULD ALL HOSPITALS BE SMOKE FREE?
(5) CLEAR
PUBLIC HEALTH MESSAGE ON
CANNABIS NEEDED
(1) ADDING FATTY
ACIDS TO FORMULA MILK
MAY CUT HEART DISEASE IN LATER LIFE
(Long chain polyunsaturated fatty
acid supplementation
in infant formula and blood pressure
in later childhood:
follow up of a randomised controlled
trial)
http://bmj.com/cgi/content/full/326/7396/953
Adding long chain polyunsaturated fatty
acids to infant
formula milk is associated with lower
blood pressure
later in childhood, and may cut the risk
of heart disease
in adult life, finds a study in this week's
BMJ.
In a 1992 trial, 111 newborn infants were
fed with a
formula containing long chain polyunsaturated
fatty acids
(LCPUFAs) and 126 were given a formula
without
LCPUFAs but otherwise nutritionally similar.
A
reference group of breastfed children
also took part in
the study.
Six years later, the children's blood pressure
was
measured in a follow up study.
Mean blood pressure was significantly lower
in the
LCPUFA group than in the non-LCPUFA group.
The
diastolic pressure of the breastfed children
was
significantly lower than the non-LCPUFA
group but did
not differ from the LCPUFA formula group.
As blood pressure tends to track from childhood
into
adult life, early exposure to dietary
LCPUFAs,
preferably in breast milk, may reduce
cardiovascular risk
in adulthood, say the authors. These findings
are
therefore relevant to public health strategies
aimed at
improving long term health of the population,
they
conclude.
Contact:
Stewart Forsyth, Consultant Paediatrician,
Tayside
Institute of Child Health, University
of Dundee, Scotland
Email: j.stewart.forsyth@tuht.scot.nhs.uk
(2) CONCERN OVER
DEATHS AFTER OPIATE
DETOXIFICATION
(Loss of tolerance and overdose mortality
after inpatient
opiate detoxification: follow up
study)
http://bmj.com/cgi/content/full/326/7396/959
Opiate addicts who have successfully completed
detoxification treatment in hospital are
more likely than
other addicts to die within a year, reveals
a study in this
week's BMJ.
Researchers at the National Addiction Centre
in London
identified 137 opiate addicts who were
receiving
detoxification as part of a 28-day inpatient
treatment
programme. Five patients died within 12
months after
their discharge from the unit, three from
a drug overdose
within the first four months after discharge,
and two
unrelated to overdose.
To test whether loss of tolerance increased
the risk of
overdose, the team grouped the patients
into three
categories according to their opiate tolerance
at the point
of leaving treatment. Forty-three "still
tolerant" patients
who failed to complete detoxification;
57 "reduced
tolerance" patients who prematurely left
the treatment
programme; and 37 "lost tolerance" patients
who
completed the treatment programme.
The three overdose deaths that occurred
within four
months after treatment were all from the
"lost tolerance"
group. The two deaths unrelated to overdose
were one
"lost tolerance" patient and one "reduced
tolerance"
patient. No deaths occurred in the "still
tolerant" group.
The five patients who died were all men
and had
generally stayed longer in the inpatient
unit.
The clustering of the deaths from overdose
in the patients
who had successfully completed treatment
is
counterintuitive and illogical ? unless
it relates to loss of
tolerance and consequent unpredictability
of resumed
heroin use, say the authors.
If these results are confirmed by further
studies, they will
need to be urgently addressed within existing
inpatient,
residential, and custodial and associated
aftercare
programmes, they conclude.
Contact:
Professor John Strang, Director, National
Addiction
Centre, Institute of Psychiatry and the
Maudsley
Hospital, London, UK
Email: j.strang@iop.kcl.ac.uk
(3) CULTURALLY
SENSITIVE SMOKING
CESSATION PROGRAMMES NEEDED
(Understanding influences on smoking
in Bangladeshi
and Pakistani adults: community
based, qualitative study)
http://bmj.com/cgi/content/full/326/7396/962
Culturally sensitive smoking cessation
programmes for
South Asian people are needed, say researchers
in this
week's BMJ.
Recent surveys have shown that smoking
is particularly
common in Bangladeshi men, yet influences
on smoking
behaviour in South Asians in Britain are
poorly
understood.
In-depth interviews were conducted with
87 men and 54
women from Bangladeshi and Pakistani communities
in
Newcastle upon Tyne to understand their
attitudes and
behaviour in relation to smoking.
Four highly inter-related themes were found
to influence
views on smoking: gender, age, religion,
and tradition.
Smoking among Bangladeshi and Pakistani
men was
strongly seen as socially acceptable and
a "normal" part
of being a man. However, among women,
smoking was
associated with stigma and shame.
Peer pressure was an important influence
on smoking
behaviour in younger people, and opinions
differed on
how acceptable smoking was within the
Muslim religion.
Although these results show some similarities
with studies
of smoking behaviour in white people,
they also highlight
important differences, particularly the
influence of gender
and religion, say the authors.
Substantial effort and investment is needed
in culturally
sensitive smoking cessation interventions
for South Asian
people, involving the government and national
and local
health agencies, they conclude.
Contact:
Martin White, Senior Lecturer in Public
Health, School
of Population and Health Sciences, University
of
Newcastle, Newcastle upon Tyne, UK
Email: martin.white@ncl.ac.uk
(4) SHOULD ALL HOSPITALS BE SMOKE FREE?
(Editorial: smoke free hospitals)
http://bmj.com/cgi/content/full/326/7396/941
The recent decision by the Royal Victoria
Hospital in
Belfast to build seven smoking rooms for
patients and
staff at a cost of £500,000 provoked
condemnation
from many sources. In this week's BMJ
researchers
argue that these resources might have
been better used
to implement a smoking ban and expand
smoking
cessation activities.
The value of hospitals making a clear statement
on public
smoking can be seen from a recent study
showing that
total workplace bans would have an effect
equivalent to
an almost doubling of the price of cigarettes
in the United
Kingdom. Other considerations include
protection of
other patients and staff from exposure
to second hand
smoke, and a reduction in the risk of
fires and in cleaning
costs.
Some will argue that bans on smoking in
hospitals will
not work because of opposition by staff
or patients, yet
studies confirm that smoking bans can
work in NHS
hospitals if designed and implemented
appropriately.
But should hospitals go further and actively
help patients
to quit smoking either before coming into
hospital or
during and after their stay?
The potential benefits are considerable,
say the authors.
One trial found that 90% of patients who
received
counselling and nicotine replacement six
to eight weeks
before surgery either ceased or reduced
smoking, were
less likely to experience postoperative
complications,
and to need secondary surgery.
Another review found that behavioural interventions
with
patients admitted to hospital were associated
with higher
quit rates for at least a month afterwards.
Given this evidence, it is arguable that
resources
expended on smoking rooms might be better
used to
fund a concerted effort to implement a
smoking ban and
to expand smoking cessation activities,
say the authors.
Hopefully other hospitals facing a similar
situation will act
differently in the future.
Contacts:
Martin McKee, London School of Hygiene
and Tropical
Medicine, London, UK Mobile: +44 (0)7973
832 576
Email: martin.mckee@lshtm.ac.uk
Anna Gilmore, London School of Hygiene
and Tropical
Medicine, London, UK
Email: anna.gilmore@lshtm.ac.uk
(5) CLEAR PUBLIC
HEALTH MESSAGE ON
CANNABIS NEEDED
(Editorial: Comparing cannabis with
tobacco)
http://bmj.com/cgi/content/full/326/7396/942
Smoking cannabis, like smoking tobacco,
can be a
major public health hazard but, at present,
there is no
clear public health message about cannabis,
argue
researchers in this week's BMJ.
The number of cannabis smokers is increasing.
Between
1999 and 2001, the number of 14-15 year
olds who had
tried cannabis rose from 19% to 29% in
boys and 18%
to 25% in girls. A Home Office document
estimates that
3.2 million people in Britain smoke cannabis.
Regular use of cannabis is associated with
an increased
risk of mental illnesses, such as schizophrenia
and
depression. Smoking cannabis also causes
chronic
bronchitis, emphysema, and other lung
disorders, often in
young people. There are also reports of
lung, tongue,
and other cancers in cannabis smokers.
Despite these alarming facts, there is
no evidence at
present on whether smoking cannabis contributes
to the
progression of coronary artery disease,
as smoking
cigarettes does. More studies of the effects
of cannabis
are essential, say the authors.
One could calculate that if cigarettes
cause an annual
excess of 120,000 deaths among 13 million
smokers,
deaths among 3.2 million cannabis smokers
would be
30,000, assuming equity of effect, they
write. Even if the
number of deaths attributable to cannabis
turned out to
be a fraction of that figure, smoking
cannabis would still
be a major public health hazard.
When the likely mental health burden is
added, these
signals cannot be ignored, they conclude.
Contact:
Professor John Henry, Imperial College
School of
Medicine, St Mary's Hospital, London,
UK
Email: j.a.henry@ic.ac.uk
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