This week in the BMJ
Volume 326, Number 7396, Issue of 3 May 2003Fatty acid supplementation in infancy reduces blood pressure later in childhood
Fatty acid supplementation in infancy reduces blood pressure later in childhood
Adding long chain polyunsaturated fatty acids to infant formula milk
results in lower blood pressure later in childhood. In a study
following up a trial in which newborn infants were randomised to
receive either a supplemented formula or a formula without supplementation, Forsyth and colleagues (p 953) found that mean blood
pressure at the age of 6 years was lower among the children who had
received supplementation. It was similar to that of a reference group
of children who had been breast fed. Differences in blood pressure in
children tend to track through into adulthood, and so early dietary
intervention may reduce cardiovascular risk in later life.
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Using non-invasive ventilation in wards may save British hospitals money
Ward based non-invasive ventilation is a highly cost effective
treatment that reduces total costs and improves mortality in hospital.
The main reason for the cost saving is reduced use of intensive care
units, according to Plant and colleagues (p 956). They conducted an
economic analysis of a randomised controlled trial in 14 centres, which
included a total of 236 patients admitted to hospital with acute
exacerbations of chronic obstructive pulmonary disease and respiratory
acidosis. Twenty four patients randomised to receive standard treatment
died, compared with 12 randomised to non-invasive ventilation. The cost
saving in the group allocated to non-invasive ventilation was £49 000
($77 975; 
70 991).
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| (Credit: LARRY MULVEHILL/SPL) |
Valproic acid prescriptions are rising without evidence
Prescriptions for bipolar disorders in elderly patients have shifted
away from lithium and towards valproic acid (divalproex in North
America), but no evidence of the benefit of valproic acid exists. In a
large population study using linked prescription, hospitalisation, and
physician claims databases, Shulman and colleagues (p 960) examined
prescribing patterns in 9243 patients aged 65 and older in Ontario,
Canada, who had no history of convulsive disorders. Over an eight year
period, the number of new lithium users fell from 653 to 281, whereas
the number of new valproic acid users rose from 183 to 1090, a trend
that persisted when patients with a diagnosis of dementia were
eliminated. Although elderly patients often do not tolerate lithium,
evidence on the benefit and tolerability of valproic acid must be
sought, say the authors, before it is substituted in the treatment of
bipolar disorders.
Are telephone consultations too risky?
Speed, enhanced access, convenience, and cost savings are the selling points of telephone consultations, but controversy about the use of the telephone to deliver clinical care persists. In a review of the use of telephone consultations in both acute and chronic conditions, Car and Sheikh (p 966) describe how patients' enthusiasm for telephone consultations is not matched by healthcare professionals, who worry about medicolegal risks. They say that staff training, standardised protocols, dedicated telephone time, improved documentation, and a low threshold for organising face to face consultations will help enhance the quality and safety of telephone consultations.
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| (Credit: BSIP, LAURENT/SPL) |
Smoking is normal for south Asian men
Smoking habits and attitudes in Bangladeshi and Pakistani adults in Britain are best understood with cultural and gender contexts in mind. In a participatory, qualitative study of Bangladeshi and Pakistani adults living in Newcastle upon Tyne, Bush and colleagues (p 962) identified four themes that influence smoking attitudes and behaviour: gender, age, religion, and traditions. They found that smoking is a widely accepted practice in south Asian men and is associated with socialising, sharing, and male identity. Among women smoking is associated with stigma and shame. Interpretations of the acceptability of smoking within the Muslim religion varied. Although the researchers identified some similarities with smoking behaviour in white populations, many differences were found that will help improve culturally sensitive smoking cessation interventions.
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| (Credit: CHRIS STOWERS/PANOS) |
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