This week in the BMJ
Volume 327, Number 7413, Issue of 30 Aug 2003Bisphosphonates reduce skeletal morbidity in cancer patients
Bisphosphonates reduce skeletal morbidity in cancer patients
In patients with metastatic bone disease bisphosphonates reduce skeletal morbidity and increase the time to first skeletal related event. In a systematic review of 30 randomised controlled trials, Ross and colleagues (p 469) found that bisphosphonates significantly decrease the risk of vertebral fractures, non-vertebral fractures, radiotherapy, and hypercalcaemia but not orthopaedic surgery or spinal cord compression. They also delay the time to first skeletal related event, suggesting that bisphosphonates should be started when bone metastases are diagnosed.
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Relative age in the school year influences mental health
The younger children in a school year are at greater risk of psychiatric disorders than the older children. Using data from a large British survey of more than 10 000 children, Goodman and colleagues (p 472) show that being younger in a school year is associated with more emotional and behavioural problems, whether assessed by parent report, teacher report, self report, or clinical diagnosis. Cross national comparisons suggest that this effect arises from the disadvantages of immaturity rather than from seasonal variation in biological risk. Although the effect is weak at an individual level, the authors state that it could prove important at a public health level.
Ordinary activity is as good as exercises or relaxation for neck pain
Dynamic muscle training and relaxation training are no better for neck pain or neck related disability than ordinary physical activity. Viljanen and colleagues (p 475) randomised 393 women office workers with chronic neck pain to dynamic muscle training, relaxation training, or ordinary activity (controls). The range of motion for rotation and lateral flexion in the neck region improved slightly more in the training groups than in the control group, but no other differences in neck pain were found between the three groups at three, six, or 12 months. Neck pain is common, affecting an estimated two thirds of people during their adult lives.
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Diagnosing autism can be done early
Early diagnosis of autism is possible and may improve long term outcomes for the child and ease parents' discomfort. In a clinical review, Baird and colleagues (p 488) discuss the increased attention placed on autism in the media and by the public, clarify its definitions and prevalence, and review how to identify the range of disorders characteristic of autism. Features that may signal autism in different stages of childhood are outlined, as well as common comorbidities and differential diagnoses. The authors state that diagnosis of autism requires careful history taking, focusing on the developmental story, presence of core behaviours, and observation of the child in several settings.
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Prison environment worsens mental health
Long periods of being locked up with little mental stimulation is bad for the mental health of prisoners. Nurse and colleagues (p 480) conducted focus groups with prisoners and prison staff in a medium security remand prison in southern England and found that long hours of social isolation contributed to feelings of anger, frustration, and anxiety. Prisoners attributed drug misuse to social isolation. Prison staff said that fewer staff, more prisoners, high staff sickness rates, and prison staff management styles increased their stress levels. The authors state that health professionals, primary care trusts, policy makers, and prison management need to address prison environmental factors and the mental health of prison staff to have an impact on the mental health of prisoners.
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