Releases Saturday 30 August 2003
No 7413 Volume 327

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(1) PSYCHIATRIC DISORDERS MORE COMMON IN
CHIDREN BORN LATE IN THE SCHOOL YEAR

(2) PRISONS ARE DAMAGING THE MENTAL
HEALTH OF INMATES AND PRISON STAFF

(3) BISPHOSPHONATE DRUGS REDUCE THE RISK
OF BROKEN BONES IN BREAST CANCER
PATIENTS

(4) OFFICE WORKERS WITH NECK PAIN ARE
PRESCRIBED THERAPIES THAT DO NOT WORK

(5) BETTER TREATMENT IS NEEDED FOR
CONSTIPATION



(1) PSYCHIATRIC DISORDERS MORE COMMON IN
CHIDREN BORN LATE IN THE SCHOOL YEAR

(Child psychiatric disorder and relative age within school
year: cross sectional survey of large population sample)
http://bmj.com/cgi/content/full/327/7413/472

Research in this weeks BMJ reveals that being one of
the youngest children in your school year puts you at
greater risk of developing mental health problems.

The authors surveyed over 10,000 school children in
England, Scotland and Wales by using reports from
teachers, parents and the pupils themselves. The
questions probed aspects of the children's emotions,
behaviour, activity levels, peer relationships and social
behaviour. The answers were used to generate a
measure of their mental health.

In England and Wales the oldest children in the school
year are born in September and the youngest in August.
Comparison of their mental health scores showed that
children born in the summer months were much more
likely to have suffered from psychiatric disorders.

In Scotland, the oldest children in a school year are born
in March and the youngest in February. Despite the
differences in the education system a similar trend was
shown in Scotland confirming that it is the child's age,
relative to their peers, that influences mental health rather
than simply the season in which they were born.

The researchers concluded that encouraging teachers be
more aware of the age differences between students and
adopting a more flexible approach to a child's
progression through school may reduce the number of
children with psychiatric disorders.

Contact:

Professor Robert Goodman Department of Child and
Adolescent Psychiatry, Institute of Psychiatry, Kings
College, London, UK
Email: r.goodman@iop.kcl.ac.uk

(2) PRISONS ARE DAMAGING THE MENTAL
HEALTH OF INMATES AND PRISON STAFF

(Influence of environmental factors on mental health
within prisons: focus group study)
http://bmj.com/cgi/content/full/327/7413/480

A study in this week's BMJ suggests that many aspects
of prison life damage the mental health of both prisoners
and prison staff and that a better understanding of the
prison environment is needed if prisoners are to be
successfully rehabilitated into society

The research team set up focus groups in a prison in
southern England to look at how the prison environment
influences the mental health of prisoners and prison staff.
Prisoner and prison staff focus groups were attended by
31 (18 men, 13 women) and 21 (15 men, 6 women)
people respectively. The prisoner focus group included
sentenced and remand inmates as well as rule 45
prisoners (those at risk from harm from the general
population).

Some of the key factors influencing the mental health of
prisoners included isolation and lack of mental
stimulation, drug misuse, poor relations with prison staff,
bullying and a lack of family contact. Prison staff thought
that reduced staffing levels, a lack of management
support, a negative work culture and worries about their
safety all contributed to high levels of stress.

Prisoners also identified a cycle of negative attitudes that
exists between staff and prisoners. Prisoners who feel
harshly treated often make the prison officers life harder
causing more stress.

The authors conclude that factors which cause stress in
prisons need to be fully understood so that policy
makers can attempt to address the mental health
problems facing both prisoners and prison staff. The
current trend of increasing prison numbers will
exacerbate the problems identified in this study making
the long-term rehabilitation of prisoners back in to
society an much more difficult task.

Contact:

Dr Jo Nurse Consultant in Public Health, Southampton
Primary Care Trust, Oatlands House, Winchester Road,
Southampton, Hampshire, UK
Email: jonurse66@hotmail.com

(3) BISPHOSPHONATE DRUGS REDUCE THE RISK
OF BROKEN BONES IN BREAST CANCER
PATIENTS

(Systematic review of role of bisphosphonates on
skeletal morbidity in metastatic cancer)
http://bmj.com/cgi/content/full/327/7413/469

Bisphosphonate drugs reduce the risk of bone
complications when used in patients whose cancer has
spread to the bone, according to a new study in the
BMJ.

Researchers reviewed over 30 studies examining the
effect of bisphosphonates - a group of drugs commonly
used to treat osteoporosis - on complications of
secondary bone cancer. Cancers that commonly spread
to the bone include breast cancer, prostate cancer and
multiple myeloma.

They found that patients given bisphosphonate drugs
were much less likely to suffer from fractures, or need
orthopaedic surgery or radiotherapy. The researchers
also found that patients given bisphosphonate drugs
remained free of bone complications for a significantly
longer period of time compared to those who did not
receive the drug. However, patients given
bisphosphonates did not survive longer.

The authors conclude that these drugs should be given to
patients as soon as spread of cancer to the bone is
diagnosed. They also report that most of the available
evidence supports the use of amino-bisphosphonates,
given intravenously.

Contacts:

Dr Joy R Ross or Dr Yolande Saunders Department of
Palliative Medicine, Royal Marsden Hospital, London,
UK
Email: joy.ross@talk21.com

(4) OFFICE WORKERS WITH NECK PAIN ARE
PRESCRIBED THERAPIES THAT DO NOT WORK

(Effectiveness of dynamic muscle training, relaxation
training, or ordinary activity for chronic neck pain:
randomised controlled trial)
http://bmj.com/cgi/content/full/327/7413/475

A new study in this week's BMJ shows that two types of
physiotherapy commonly prescribed to treat female
office workers with neck pain do little to alleviate their
pain.

Researchers examined the progress of 393 female office
workers with chronic neck pain. These women were
divided into three groups who were prescribed either
dynamic muscle therapy or relaxation therapy, with a
third group continuing with everyday activities. The
patient's level of neck pain was assessed after twelve
weeks of treatment with follow-up assessments made
after three, six and twelve months.

The results showed that the levels of neck pain
experienced by women treated with dynamic muscle
therapy or relaxation therapy were no different to active
women receiving no treatment. Furthermore, there was
no difference in the intensity of the pain experienced by
the groups of women receiving the different treatments in
any of the follow-up assessments.

The authors conclude that the prescription of these
therapies to treat neck pain is not based on clinical
evidence calling into question whether these types of
physiotherapy should be prescribed to treat neck pain.

Contact:

Dr Matti Viljanen Tampere Regional Institute of
Occupational Health, Tampere, Finland
Email: matti.viljanen@ttl.fi

(5) BETTER TREATMENT IS NEEDED FOR
CONSTIPATION

(Editorial: Constipation and its management: options go
beyond laxatives and include behavioural treatment as
well as new drugs)
http://bmj.com/cgi/content/full/327/7413/459

Doctors need to consider new therapies to treat
constipation that go beyond the use of laxatives says a
leading gastroenterologist in this week's BMJ.

Constipation affects a quarter of the population at some
time, and has a variety of different causes including
dietary factors, disease and psychological problems. The
treatment of constipation is often limited to the
prescription of laxatives or in the most serious cases,
surgery. Dr Michael Kamm believes the treatment of
constipation needs to improve and suggests that
behavioural treatment and new drugs that aid bowel
movement should be considered.

Kamm explains that laxatives do not always provide
relief from constipation and increasing dietary fibre intake
can cause increased bloating with little improvement in
bowel function creating a need for new innovative
approaches to treating constipation.

Behavioural therapy aims to improve the control patients
have over their own bodies, and when used in
conjunction with exercises focused on the gut, reduced
use of laxatives and psychological support can be a very
effective treatment for constipation.

New drugs are also being developed that focus on a
process known as peristalsis that is critical to bowel
movements. These drugs are not yet widely available in
Europe, but they may soon offer new hope to those who
suffer from constipation.

The author concludes that it is time stop dismissing
constipation as a trivial complaint, when it has a major
impact of the quality of life of sufferers and requires
substantial investment in healthcare resources.

Contact:

Dr Michael A Kamm Professor of Gastroenterology, St
Marks Hospital, Harrow, UK
Email: m.kamm@imperial.ac.uk


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