Releases Saturday 24 May 2003
No 7399 Volume 326
Please remember to credit the BMJ as source when publicising
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(1) STEPPING DOWN INHALED STEROIDS CAN
CUT SIDE EFFECTS
(2) SUICIDE
RATES IN THE DEVELOPING WORLD
ARE GROSSLY
UNDER-REPORTED
(3) PATIENTS
WITH PSYCHOSIS MORE
INTERESTED
IN PHYSICAL HEALTH THAN
ANTICIPATED
(4) CANCER
PATIENTS IN INDIA CHEATED OF
APPROPRIATE
CARE
(1) STEPPING DOWN
INHALED STEROIDS CAN
CUT SIDE EFFECTS
(Stepping down inhaled corticosteroids
in asthma:
randomised controlled trial)
http://bmj.com/cgi/content/full/326/7399/1115
A 'stepdown' approach to reduce doses of
inhaled
steroids in patients with chronic asthma
can cut the risk
of side effects without compromising asthma
control, say
researchers in this week's BMJ.
Reduced dosages have already been achieved
for
people with mild asthma, but this is the
first trial to look
at those with chronic asthma.
The study involved 259 patients in Scotland
with chronic
stable asthma, who were being treated
with high dose
inhaled corticosteroids. After a one month
run-in period,
patients were allocated to receive either
a 50% reduction
in their dose (stepdown group) or no alteration
to their
dose (control group).
After one year, the team found no significant
difference in
the rate of asthma exacerbations or asthma
events
between the two groups.
Inhaled corticosteroids are widely accepted
as the
treatment of choice for patients with
chronic asthma.
However, they have been associated with
a number of
dose related side effects including bruising,
cataracts,
and glaucoma, say the authors.
This finding shows that a stepdown approach
to inhaled
corticosteroids can reduce the risk of
steroid related side
effects in this group of patients without
compromising
asthma control, they conclude.
Contact:
Professor Neil Thomson, Department of Respiratory
Medicine, University of Glasgow, Western
Infirmary,
Glasgow, Scotland
Email: n.c.thomson{at}clinmed.gla.ac.uk
(2) SUICIDE RATES
IN THE DEVELOPING WORLD
ARE GROSSLY UNDER-REPORTED
(Evaluation of suicide rates in rural
India using verbal
autopsies)
http://bmj.com/cgi/content/full/326/7399/1121
Reported suicide rates for developing countries
are
misleading, concludes a study in this
week's BMJ.
Centred on 85 villages in the Kaniyambadi
region of
southern India, researchers used verbal
autopsies�an
agreement on cause of death by a local
team of health
workers�to gather data on deaths between
1994 and
1999.
The average suicide rate for the 6 year
period was 95
per 1000,000. Older men were more likely
to commit
suicide than younger men. Most women who
committed
suicide were aged 15-24 or older than
65. There were
more suicides among women than among men
in the
15-24 years age group.
This study shows that where coroners' verdicts
are not
available, verbal autopsies can give a
good idea of the
cause of death from suicide, say the authors.
Recent
studies in India have under-reported suicide
rates by 2 to
3 times.
To accurately monitor suicide in the developing
world,
however, sentinel centres are needed,
they conclude.
Contact:
Professor K S Jacob, Department of Psychiatry,
Christian Medical College, Vellore, India
Email: ksjacob{at}cmcvellore.ac.in
(3) PATIENTS WITH
PSYCHOSIS MORE
INTERESTED IN PHYSICAL HEALTH THAN
ANTICIPATED
(Participation in screening for cardiovascular
risk by
people with schizophrenia or similar
mental illnesses:
cross sectional study in general
practice)
http://bmj.com/cgi/content/full/326/7399/1122
People with serious mental illnesses may
be more willing
to look after their physical well-being
than anticipated,
according to a study in this week's BMJ.
Researchers in London invited patients
from seven inner
London general practices to a cardiovascular
risk
assessment at their practice. Their analysis
is based on
182 patients with psychosis and 313 people
without
psychosis.
Many more patients with psychosis accepted
the offer
than predicted. In fact, absolute differences
in uptake of
screening between the groups were small,
say the
authors.
Given that the risk of physical illness
is higher for people
with severe mental illnesses, these findings
may
encourage more assertive efforts to manage
the physical
health of these patients.
Contact:
David Osborn, MRC Research Fellow, Department
of
Psychiatry and Behavioural Sciences, University
College
London, London, UK
Email: dosborn{at}rfc.ucl.ac.uk
(4) CANCER PATIENTS
IN INDIA CHEATED OF
APPROPRIATE CARE
(Letter: Medical community may be
partly responsible
for cancer misery)
http://bmj.com/cgi/content/full/326/7399/1146
A letter in this week's BMJ charges the
medical
community in India with a "commercialisation
of suffering
and prolongation of lucrative illness."
Dr Chatuverdi, Assistant Surgeon at Tata
Memorial
Hospital in Mumbai states that, in a country
with 3
million cancer sufferers�of whom 80 per
cent are
incurable�there are only 20 dedicated
cancer centres
and 13 hospices. Those with advanced conditions
are
consequently made to feel they should
forego non-paying
resources, he claims. As a result, they
often undergo
unwarranted and ineffectual treatments
at the hands of
private practitioners.
The letter goes on to outline how aspects
of appropriate
care in developed countries�palliative
care, counselling,
rehabilitation, are rarely offered.
While a culture of promoting lucrative
but inappropriate
treatments prevails, he argues, medical
practitioners of
the future will follow suit.
Contact:
P Chaturvedi, Assistant Surgeon, Department
of Surgical
Oncology, Tata Memorial Hospital, Mumbai,
India
Email: pankajch37{at}yaho.com
FOR ACCREDITED JOURNALISTS
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London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
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Association for the
Advancement of Science
(http://www.eurekalert.org)
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