Releases Saturday 19 July 2003
No 7407 Volume 327
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(1) ANTI-INFLAMMATORY DRUGS LOWER RISK
OF ALZHEIMER'S
(2) INFANT
GIRLS IN INDIA TWICE AS LIKELY TO
DIE AS BOYS
(3) HOW
MUCH SHOULD ATHLETES DRINK
DURING EXERCISE?
(4) UK
MUST TACKLE MENTAL HEALTH NEEDS
OF REFUGEE
CHILDREN
(5) CONCERN
OVER CLINICAL VALUE OF NEW
MOOD DISORDER
DRUGS
(1) ANTI-INFLAMMATORY
DRUGS LOWER RISK
OF ALZHEIMER'S
(Effect of non-steroidal anti-inflammatory
drugs on risk
of Alzheimer's disease: systematic
review and
meta-analysis of observational studies)
http://bmj.com/cgi/content/full/327/7407/128
Non-steroidal anti-inflammatory drugs (NSAIDS)
lower
the risk of developing Alzheimer's disease,
claim
researchers in this week's BMJ.
The authors identified 15 studies published
between
1996 and October 2002 that examined the
role of
NSAID use in preventing Alzheimer's disease.
They
carried out three separate analyses to
quantify the risk of
Alzheimer's disease in NSAID users and
in aspirin users
and to determine any influence on duration
of use.
Their results show that NSAIDS offer some
protection
against the development of Alzheimer's
disease and that
the benefits may be greater the longer
NSAIDs are used.
They also suggest that aspirin has a protective
effect, but
this result was not significant, probably
because of the
small number of studies that specifically
evaluated the
effects of aspirin.
However, the appropriate dose, duration,
and the ratios
of risk to benefit are still unclear,
they conclude.
Contact:
Mahyar Etminan, Epidemiologist, Department
of Clinical
Epidemiology, Royal Victoria Hospital,
Montreal,
Quebec, Canada
Email: mahyar.etminan{at}mail.mcgill.ca
(2) INFANT GIRLS
IN INDIA TWICE AS LIKELY TO
DIE AS BOYS
(Community based retrospective study
of sex in infant
mortality in India)
http://bmj.com/cgi/content/full/327/7407/126
In India, infant girls are twice as likely
to die as boys
because girls are regarded and treated
less favourably.
There are also a large number of unexplained
female
deaths, which may be considered as deaths
under
suspicious circumstances, argue researchers
in this
week's BMJ.
Deaths among infants aged less than 1 year
in urban
India were examined over five years. Deaths
reported as
sudden and without any preceding illness
were
categorised as "unexplained deaths."
The sex ratio at birth was 869 females
per 1000 males.
Deaths were 1.3 times higher in females
than in males,
and most sudden unexplained deaths with
no preceding
history of illness were in girls. Twice
as many girls died
from diarrhoea, despite it being an easily
treatable
condition.
Could such deaths be an extension into
the early
neonatal period of female feticide? ask
the authors.
Though the Pre Natal Diagnostic Techniques
Act 1994
attempted to alter the adverse sex ratio
by banning sex
determination tests, this cannot change
the attitudes of
people towards female infants, add the
authors.
Improved access to healthcare and education
of health
professionals to pay attention to girls
would be
beneficial, they conclude.
Contact:
Amod Kumar, Senior Consultant and Head,
Department
of Community Medicine, St Stephen's Hospital,
Delhi,
India
Email: amodkumar{at}vsnl.com
(3) HOW MUCH SHOULD
ATHLETES DRINK
DURING EXERCISE?
(Editorial: Overconsumption of fluids
by athletes)
http://bmj.com/cgi/content/full/327/7407/113
Exercisers must be warned that the overconsumption
of
fluid (either water or sports drinks)
before, during, or
after exercise is unnecessary and can
have a potentially
fatal outcome, says a sports medicine
expert in this
week's BMJ.
The warning follows reports of several
deaths from a
severe lack of salt in the blood due to
excessive drinking
(hyponatraemic encephalopathy).
Until the late 1960s, athletes were advised
not to drink
during exercise since it was believed
that fluid ingestion
impaired athletic performance, writes
Timothy Noakes
of the Sports Science Institute of South
Africa. The
publication in 1969 of an incorrectly
titled article, 'The
danger of an inadequate water intake during
marathon
running' provided the impetus for change,
and led to
guidelines for ingestion of fluids during
exercise.
These guidelines make several assumptions
that are not
backed up by evidence. Nor were trials
undertaken to
ensure that these guidelines are always
safe, says the
author. The first reports of hyponatraemic
encephalopathy in athletes, military personnel,
and hikers
appeared shortly after.
Since the cause of the condition is now
known, absolute
prevention is possible. Perhaps the best
advice is that
drinking according to the personal dictates
of thirst
seems to be safe and effective, he adds.
Such fluid intake
typically ranges between 400 ml and 800
ml per hour in
most forms of recreational and competitive
exercise.
The recent adoption of these guidelines
by USA Track
and Field provides the hope that this
sad aberration has
finally run its tragic course, he concludes.
Contact:
Timothy David Noakes, Discovery Health
chair of
exercise and sports science, University
of Cape Town
and the Sports Science Institute of South
Africa, Cape
Town, South Africa
Email: noakes{at}iafrica.com
(4) UK MUST TACKLE
MENTAL HEALTH NEEDS
OF REFUGEE CHILDREN
(Mental health of refugee children:
comparative study)
http://bmj.com/cgi/content/full/327/7407/134
More than a quarter of refugee children
living in the UK
have significant psychological disturbance,
finds a study
in this week's BMJ.
Researchers examined the rates of psychological
disturbance in 101 refugee children attending
six schools
in Oxford and compared them with two control
groups
(children who were from an ethnic minority
but were not
refugees and indigenous white children).
More than a quarter of refugee children
had significant
psychological disturbance�greater than
in both control
groups and three times the national average.
These
refugee children show particular difficulties
in emotional
symptoms, write the authors.
These findings raise considerable concern
that refugee
children have large unmet mental health
needs that need
to be tackled, say the authors. The development
of
services should include collaboration
with schools,
primary health care, and community child
mental health
teams, they conclude.
Contact:
Mina Fazel, Clinical Lecturer, University
Department of
Psychiatry, Warneford Hospital, Oxford,
UK
Email: mina.fazel{at}psych.ox.ac.uk
(5) CONCERN OVER
CLINICAL VALUE OF NEW
MOOD DISORDER DRUGS
(Separation of anxiety and depressive
disorders: blind
alley in psychopharmacology and
classification of
disease)
http://bmj.com/cgi/content/full/327/7407/158
Recent changes to the classification of
psychiatric
disorders are encouraging pharmaceutical
companies to
develop new drugs that are of questionable
clinical value,
argue researchers in this week's BMJ.
Since 1980, anxiety and depression have
been split into
separate diseases. Drug development has
subsequently
been tailored to new "niche" diagnoses
such as panic,
social anxiety disorder, and post-traumatic
stress
disorder.
The proliferation of niche diagnoses is
liked by industry
because it creates new licensing opportunities
for phoney
new drugs, but it has also led to a slowdown
in
production of drugs for the most common
psychiatric
disorder of mixed anxiety and depression,
write the
authors.
"We believe that the failure to advance
the treatment of
anxiety and depression is related to wrong
classification,"
say the authors.
Companies must start developing drugs for
mixed
anxiety and depression and forget about
dividing this
giant illness segment into salami slices.
Doctors could
encourage this change by being more cynical
about
pitches from drug representatives claiming
to have "the
latest" medication to reduce anxiety,
they conclude.
Contacts:
Peter Tyrer, Head, Department of Psychological
Medicine, Imperial College Faculty of
Medicine, St
Mary's Campus, London, UK
Email: p.tyrer{at}imperial.ac.uk
Edward Shorter, Professor of the History
of Medicine,
Faculty of Medicine, University of Toronto,
Canada
Email: eshorter{at}sympatico.ca
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