Releases Saturday 9 August 2003
No 7410 Volume 327
Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(1) SHORT GAPS BETWEEN PREGNANCIES
LINKED TO COMPLICATIONS
(2) SUN
EXPOSURE SEEMS TO REDUCE RISK OF
MULTIPLE SCLEROSIS
(3) PRESCRIBING
HEROIN CAN HELP TREATMENT
RESISTANT ADDICTS
(4) SYSTEM
FAILURE AT HEART OF CHILD ABUSE
CASE DISASTERS
(1) SHORT GAPS
BETWEEN PREGNANCIES
LINKED TO COMPLICATIONS
(Interpregnancy interval and risk
of preterm birth and
neonatal death: retrospective cohort
study)
http://bmj.com/cgi/content/full/327/7410/313
Women with a very short interval between
pregnancies
are at an increased risk of complications
such as
premature birth, neonatal death, and low
birth weight,
say researchers in this week's BMJ.
The study involved over 89,000 women having
second
births in Scotland in 1992-8. Women whose
interval
between pregnancies was less than six
months were
much more likely to have had complicated
first births.
They were also more likely to be less
than 20 years old,
to smoke, and to live in an area of high
social and
economic deprivation.
Even among women with an uncomplicated
first birth,
and after taking account of social and
economic factors,
a short interval between pregnancies was
associated with
an increased risk of premature birth and
neonatal death.
The authors propose that women should be
informed of
a small but significantly higher risk
of premature birth and
death when they conceive shortly after
a birth.
Contraceptive advice should be targeted
towards
women who are most likely to have a short
interpregnancy interval, such as teenagers
and women
who have lost a newborn baby, they conclude.
Contact:
Professor Gordon Smith, Department of Obstetrics
and
Gynaecology, Cambridge University, The
Rosie
Hospital, Cambridge, UK
Email: gcss2{at}cam.ac.uk
(2) SUN EXPOSURE
SEEMS TO REDUCE RISK OF
MULTIPLE SCLEROSIS
(Past exposure to sun, skin phenotype,
and risk of
multiple sclerosis: case-control
study)
http://bmj.com/cgi/content/full/327/7410/316
Higher sun exposure during childhood and
early
adolescence is associated with a reduced
risk of multiple
sclerosis, finds a study in this week's
BMJ.
Multiple sclerosis is more common at higher
latitudes,
which generally have lower levels of ultraviolet
radiation.
The study was carried out in Tasmania,
which is located
at high latitude and has a high prevalence
of multiple
sclerosis. Researchers surveyed 136 patients
with
multiple sclerosis and 272 controls about
past sun
exposure, measures to protect against
the sun, use of
vitamin D supplements, medical history,
and other
factors thought to be associated with
multiple sclerosis.
Skin damage and skin colour were also
assessed.
They found that higher sun exposure when
aged 6-15
years (average 2-3 hours or more a day
in summer
during weekends and holidays) and greater
skin damage
was associated with a decreased risk of
multiple
sclerosis.
Higher exposure in winter seemed more important
than
higher exposure in summer and the associations
persisted
after adjusting for fair skin and exposure
after onset of
disease, say the authors.
They suggest that insufficient ultraviolet
radiation or
vitamin D, or both, may influence the
development of
multiple sclerosis.
Contacts:
Ingrid van der Mei, PhD student, Menzies
Centre for
Population Health Research, University
of Tasmania,
Hobart, Australia
Email: Ingrid.vanderMei{at}utas.edu.au
or
Nick Turner , Corporate Communications
(3) PRESCRIBING
HEROIN CAN HELP TREATMENT
RESISTANT ADDICTS
(Medical prescription of heroin to
treatment resistant
heroin addicts: two randomised controlled
trials)
http://bmj.com/cgi/content/full/327/7410/310
Supervised prescription of a combination
of methadone
plus heroin is feasible, safe, and effective
in reducing the
many physical, mental, and social problems
of heroin
addicts, according to Dutch researchers
in this week's
BMJ.
Researchers in the Netherlands carried
out two separate
trials involving 549 heroin addicts who
were not
responding to methadone maintenance treatment.
One
trial used inhalable heroin and the other
used injectable
heroin.
Participants received either 12 months
of methadone
alone (control group), 12 months of methadone
plus
heroin (experimental group), or six months
of methadone
alone followed by six months of methadone
plus heroin
(comparison group). Psychosocial treatment
was offered
throughout.
In both trials, 12 month treatment with
heroin plus
methadone was significantly more effective
than
treatment with methadone alone. Many physical,
mental,
and social problems improved and few serious
adverse
events occurred.
"Our study provides strong evidence of
the efficacy of
prescribed heroin for addicts who are
resistant to other
forms of treatment," conclude the authors.
Contact:
Professor Wim van den Brink, Central Committee
on the
Treatment of Heroin Addicts (CCBH), Utrecht,
Netherlands
Email: w.vandenbrink{at}amc.uva.nl
(4) SYSTEM FAILURE
AT HEART OF CHILD ABUSE
CASE DISASTERS
(Editorial: Suspected child abuse:
the potential for justice
to miscarry)
http://bmj.com/cgi/content/full/327/7410/299
System failure lies at the heart of the
current crisis
surrounding cases of suspected child abuse,
argues a
retired paediatrician in this week's BMJ.
The recent quashing of Sally Clark's conviction
for the
murder of two of her children and the
collapse of the
case against Trupti Patel have shaken
public confidence.
But we need to look less critically at
the people caught in
the spotlight, and more at the systems
failure involved,
writes Edmund Hey.
Instead, steps to reform the use of expert
testimony in
criminal cases and improve pathology services
in the UK
would help to minimise potential miscarriages
of justice.
Many paediatricians are also becoming increasingly
reluctant to become involved in child
protection work for
fear that this will trigger a formal complaint,
a disciplinary
hearing, and even litigation, adds the
author. There is a
temptation to avoid all involvement and
say that these
things are a matter for social services
or for the police.
However, he warns that uncertainty as
to where prime
responsibility lies has been at the heart
of many recent
disasters.
Ultimately it is for the courts to make
these difficult
judgements, but they cannot do this without
medical
help. Doctors, being human, will sometimes
give flawed
advice. There needs to be a robust system
in place, in all
our courts, to see that this does not
result in a
miscarriage of justice, he concludes.
Contact:
Edmund Hey, Retired Paediatrician, Newcastle,
UK
Available by email only: shey{at}easynet.co.uk
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American
Association for the
Advancement of Science
(http://www.eurekalert.org)
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
