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(2) NEW
FLU DRUGS ARE EFFECTIVE BUT HAVE
IMPORTANT LIMITATIONS
(3) SOUTH
ASIAN PEOPLE ARE
UNDER-REPRESENTED
IN CLINICAL TRIALS
(4) MISCONCEPTIONS
ABOUT HEADLICE: WHAT
DOES THE RESEARCH
REALLY SHOW?
(5) NEW
WEB SERVICE TACKLES DEFICIENCIES
IN MEDICAL
CAREERS ADVICE
(1) PREGNANT WOMEN
CARRYING BOYS NEED
MORE ENERGY
(Average energy intake among pregnant
women carrying
a boy compared with a girl)
http://bmj.com/cgi/content/full/326/7401/1245
Pregnant women carrying boys have a 10%
higher
energy intake than those carrying girls,
finds a study in
this week's BMJ.
Researchers analysed the dietary intake
of 244 pregnant
women attending a large hospital in Boston,
United
States.
They found that women who were carrying
a male
embryo had an 8% higher intake of protein,
a 9% higher
intake of carbohydrates, an 11% higher
intake of animal
fats, and a 15% higher intake of vegetable
fats than
women who were carrying a female embryo.
These findings support the theory that
women carrying
male rather than female embryos may have
higher energy
requirements and that male embryos may
be more
susceptible to a low energy intake, say
the authors.
They suggest that the signal from the fetus
responsible for
the higher energy intake of women carrying
a boy could
be related to the strongly anabolic testosterone
secreted
by the fetal testicles, but other alternatives
deserve
scientific investigation.
Contacts:
Professor Dimitrios Trichopoulos, Department
of
Epidemiology, Harvard School of Public
Health, Boston,
USA (currently in Athens, Greece)
Email: dtrichop@hsph.harvard.edu
or
Rulla Tamimi, Doctoral Student, Department
of
Epidemiology, Harvard School of Public
Health, Boston,
USA
or
Kevin Myron, Communications Office, Harvard
School
of Public Health
Email: kmyron@hsph.harvard.edu
(2) NEW FLU DRUGS
ARE EFFECTIVE BUT HAVE
IMPORTANT LIMITATIONS
(Effectiveness of neuraminidase inhibitors
in treatment
and prevention of influenza A and
B: systematic review
and meta-analyses of randomised
controlled trials)
http://bmj.com/cgi/content/full/326/7401/1235
(Editorial: Preventing and treating
influenza)
http://bmj.com/cgi/content/full/326/7401/1223
Evidence suggests that two new antiviral
drugs
(oseltamivir and zanamivir) are effective
for treating and
preventing flu, but more research is needed
to clarify
who will benefit most from treatment,
concludes a study
in this week's BMJ.
Researchers analysed 17 treatment trials
and 7
prevention trials of oseltamivir and zanamivir
in three
population groups (children, high risk
adults, and
otherwise healthy adults). All trials
compared one of the
drugs against placebo or standard care.
They found that treating otherwise healthy
adults and
children with zanamivir and oseltamivir
reduced the
duration of symptoms by up to one day.
Giving zanamivir
and oseltamivir to prevent flu cuts the
odds of developing
flu by 70-90%, depending on the strategy
adopted and
the population studied.
The drugs also provided a 29% to 43% reduction
in the
odds of complications requiring antibiotics
when given
within 48 hours of onset of symptoms.
However, the results were less conclusive
in the high-risk
population, and little evidence exists
on serious
complications requiring admission to hospital
or causing
death or on adverse events, add the authors.
Although evidence supports the clinical
effectiveness of
both oseltamivir and zanamivir for the
treatment and
prevention of flu, research is needed
into the
comparative effectiveness of these drugs
with one
another and the potential "added value"
of these drugs
compared with or in combination with flu
vaccine, they
conclude.
Zanamivir and oseltamivir have been welcomed
as long
awaited additional tools for treatment
and prevention.
However, in terms of meeting public health
objectives,
they have important limitations, says
Klaus Stohr of the
World Health Organisation in an accompanying
editorial.
Promising research is under way to develop
new
neuraminidase inhibitors that are more
efficacious, cost
less, and are simpler to prescribe. It
is to be hoped that
they are available before the next pandemic
strikes, he
concludes.
Contact:
Nicola Cooper, Research Fellow, Department
of
Epidemiology and Public Health, University
of Leicester,
Leicester, UK
Email: njc21@le.ac.uk
(3) SOUTH ASIAN
PEOPLE ARE
UNDER-REPRESENTED IN CLINICAL TRIALS
(Representation of South Asian people
in randomised
clinical trials: analysis of trials'
data)
http://bmj.com/cgi/content/full/326/7401/1244
People of South Asian ethnic origin are
underrepresented in clinical trials, finds
a study in this
week's BMJ.
Researchers at Leeds University investigated
the
ethnicity profile of six clinical trials
recently conducted by
the Northern and Yorkshire Clinical Trials
and Research
Unit. All were large, randomised controlled
trials with
large numbers of participants and centres.
South Asian (Indian, Pakistani, and Bangladeshi)
people
comprised between 0% and 1.7% of total
participants in
the six trials. This under-representation
might be due to
investigator bias, inappropriate strategies
for recruitment,
or cost issues ? for example for translators
or translations
of information sheets, explain the authors.
Such inequality has important ethical and
scientific
ramifications because genetic predisposition,
dietary
intake, and exposure to environmental
and occupational
hazards lead to ethnic differences in
susceptibility of
diseases, they write. Furthermore, patients'
response to
drugs, and the side effects, can vary
between different
ethnic groups.
Increased awareness and monitoring of recruitment
and
retention of ethnic minority groups in
clinical trials are
needed, and analysis of data by ethnicity
of subjects
should be done consistently, add the authors.
More rigorous review by ethics committees
and
education of ethnic minority groups may
contribute to
attaining proportional representation
of ethnic minorities
in trials, they conclude.
Contact:
Mahvash Hussain-Gambles, Research Fellow,
Centre
for Research in Primary Care, University
of Leeds,
Leeds, UK
(4) MISCONCEPTIONS
ABOUT HEADLICE: WHAT
DOES THE RESEARCH REALLY SHOW?
(Clinical Review: Treating head lice)
http://bmj.com/cgi/content/full/326/7401/1256
A review article in this week's BMJ dispels
some of the
myths about treating head lice, using
the most up-to-date
medical research. For example, it shows
that:
Head lice are harmless
Head lice on clothing or
furniture cannot infect a person
Cutting hair, or tying it
back, is not helpful
Banning children with nits
from school is ineffective
Head lice are parasites that usually infest
the scalps of
school age children. Lice attach their
eggs to hair shafts
near the scalp and lay five to six eggs
a day.
According to the evidence, chemical treatments
such as
Malathion, Lindane, Permethrin and Pyrethrins
are likely
to work. Treatments that need further
study include
herbal preparations and aromatherapy,
and mechanical
removal of lice by combing.
There is no evidence to support the cleaning
of sheets
and clothing, or the treating of furniture
with insecticide
sprays, says author, Beth Nash. Lice seen
on chairs,
pillows, and hats are dead, sick, or elderly
or are cast
skins of lice and cannot infect a person.
Banning children with nits from school
does not make
sense, she adds. About half of children
sent home for
head lice don't have them and many public
health experts
believe that "no-nits" polices in schools
should be
abandoned.
Many people believe that cutting hair,
or tying it back,
will help, but this is not the case, and
may even increase
the incidence of infestation by making
it easier for lice to
move off and on to the scalp, she explains.
Head lice are
probably more common in girls because
girls are more
likely to have close contacts during play,
not because
they have longer hair.
Finally, head lice are harmless. If detached
from their
host they are vulnerable and effectively
dead.
The information in this article is an extract
from
BestTreatments* ± a web site for patients
and doctors
that tells you which treatments really
work.
Contact:
Dr Ian Burgess, Director, Insect Research
and
Development Limited, Cambridge, UK
Email: ian@insectresearch.com
*BestTreatments is produced by Unified
Limited, a
publishing company with an international
team of
experienced writers, editors and medical
experts. Unified
Ltd. is jointly owned by the British Medical
Journal
Publishing Group (BMJPG) and United HealthCare
Services Inc. This extract will remain
available at
bmj.com. The rest of the BestTreatments
website
(www.besttreatments.org) is currently
available only to
patients who are members of United Healthcare
plans in
the United States.
(5) NEW WEB SERVICE
TACKLES DEFICIENCIES
IN MEDICAL CAREERS ADVICE
(Editorial: Impartial career advice
for doctors and
medical students)
http://bmj.com/cgi/content/full/326/7401/1225
The majority of medical students and doctors
in training
are dissatisfied with the career advice
and guidance they
receive, according to a report in this
week's BMJ.
To help fill this important gap, BMJ Careers
has today
launched a new web based service, the
BMJ Careers
advice zone (www.bmjcareers.com/advicezone).
The report, Informing Choices: the need
for career
advice in medical training, reveals the
views and
experiences of 1,740 doctors and medical
students
working in England, and makes disturbing
reading. For
example:
Over half (55%) felt dissatisfied with
the career advice
they had received
Two thirds agreed that there were many
areas of
medicine they knew too little about
16% said that lack of advice had led them
to make
decisions that they later regretted
The advice zone aims to fill this void
by providing
doctors and medical students with accessible,
impartial
careers advice, say Rhona Macdonald and
Graham
Easton of Career Focus.
It can be used to submit a career query
to a panel of
over 200 advisers, search the database
of existing
questions and advice, and share career
experiences with
other users. So whether it's choosing
a career, what
training to do, or how to deal with work
related health
problems or discrimination, the advice
zone should be
able to help.
"We hope that all the questions and answers
we publish
from both readers and advisers will grow
into a first class
database of careers advice," add the authors.
"Judging
by the findings of this report, such a
service comes not a
moment too soon."
Contact:
Rhona Macdonald, Editor, Career Focus,
British
Medical Journal, London, UK
Email: rmacdonald@bmj.com
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