Releases Saturday 20 September 2003
No 7416 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
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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) STRESS MAKES MS SYMPTOMS WORSE
(2) CHRONIC
FATIGUE SYNDROME IS RARE IN
CHILDREN
(3) SHOULD
LIVING LIVER DONATION BE
AVAILABLE IN
THE NHS?
(4) LINK
BETWEEN CANNABIS AND DEATH STILL
NOT ESTABLISHED
(1) STRESS MAKES MS SYMPTOMS WORSE
(Self reported stressful life events
and exacerbations in
multiple sclerosis: prospective
study)
http://bmj.com/cgi/content/full/327/7416/646
For patients with multiple sclerosis, stressful
life events
seem to make their symptoms worse, finds
a study in this
week's BMJ.
Dutch researchers followed 73 patients
with
relapsing-remitting multiple sclerosis.
Regular visits were
scheduled every eight weeks and additional
visits were
arranged when patients reported symptoms
of infection
or exacerbation (a worsening of existing
symptoms or
appearance of new symptoms). Each week,
patients
recorded any stressful events that were
not related to
multiple sclerosis.
In total, 457 stressful life events were
reported that were
not related to multiple sclerosis. These
included job
stress, financial problems, or death of
a close family
member. Throughout the study, 134 exacerbations
occurred in 56 patients and 136 infections
occurred in
57 patients.
Stress was associated with double the risk
of an
exacerbation, but there was no evidence
of an increase
in infections after stressful events.
Possible explanations for these findings
are not yet fully
understood, say the authors, but the knowledge
that
stressful events are associated with disease
activity adds
important information to the limited insight
that patients
and their caregivers have on this unpredictable
disease.
Contact:
Rogier Hintzen, Neurologist, Department
of Neurology,
Erasmus MC, Rotterdam, Netherlands
Email: rhintzen{at}xs4all.nl
(2) CHRONIC FATIGUE
SYNDROME IS RARE IN
CHILDREN
(Epidemiology of chronic fatigue
syndrome and self
reported myalgic encephalomyelitis
in 5-15 year olds:
cross sectional study)
http://bmj.com/cgi/content/full/327/7416/654
There have been no proper estimates of
the numbers of
children with chronic fatigue syndrome
or myalgic
encephalomyelitis (CFS/ME) in the UK.
Estimates vary
from none at all to an epidemic that threatens
our
schools.
But researchers in this week's BMJ suggest
that contrary
to the more alarmist predictions, CFS/ME
is not very
common in children of school age.
However, for those unfortunate ones who
do develop
the condition, it is clear that the problems
are extremely
serious, affecting the child and family.
Despite the
relatively small numbers involved, it
remains a tragedy
that it is one of the commonest reasons
for long term
school absence, they say.
This paper also highlights the importance
of
psychological factors such as anxiety,
which may centre
around resuming school after sickness.
The principle
researcher Dr Trudie Chalder emphasised
that the
physical and psychological needs of children
with
CFS/ME should not be neglected.
Contact:
Trudie Chalder, Reader, Academic Department
of
Psychological Medicine, Guy's, King's
and St Thomas'
School of Medicine, London UK
Email: sphatrc{at}iop.kcl.ac.uk
(3) SHOULD LIVING
LIVER DONATION BE
AVAILABLE IN THE NHS?
(Role of living liver donation in
the United Kingdom)
http://bmj.com/cgi/content/full/327/7416/676
Living liver donation should be available
on the NHS,
although it should not be adopted without
full public
debate and agreement because of the risks
to donors,
argue researchers in this week's BMJ.
Living liver donation could benefit patients
who are likely
to die or deteriorate before a cadaveric
donor becomes
available. It involves a minimum graft
to donor weight
ratio of 1% and the donor's liver usually
regenerates
completely in about 12 months. It is currently
offered in
the United States and parts of Europe,
but not in the
UK.
The risk of illness to donors is 40-60%
and risk of death
is 0.5-1%. In comparison, living kidney
donors have a
risk of death of about 0.03%, with a 2%
risk of major
illness and a 10-20% risk of minor illness.
If living liver donation becomes available
in the NHS,
procedures must be set up to ensure that
donors are not
coerced and fully understand the risks
and benefits, and
it should not be introduced without public
debate and
approval, say the authors.
Making living liver donation available
in the NHS will
have a small but important effect on the
number of
people able to receive a graft. It is
time for a full public
debate on the risks and benefits, they
conclude.
Contact:
James Neuberger, Consultant Physician,
Liver Unit,
Queen Elizabeth Hospital, Birmingham,
UK
Email: j.m.neuberger{at}bham.ac.uk
(4) LINK BETWEEN
CANNABIS AND DEATH STILL
NOT ESTABLISHED
(Editorial: Comparing cannabis with
tobacco - again)
http://bmj.com/cgi/content/full/327/7416/635
Although the use of cannabis is not harmless,
its link with
death is still not established, argues
a senior researcher in
this week's BMJ.
Two large studies reported no increase
in death
associated with the use of cannabis. Even
diseases that
might be related to long term cannabis
use are unlikely to
have a sizeable public health impact because,
unlike
users of tobacco and alcohol, most people
who try
cannabis quit relatively early in their
adult lives, writes the
author.
Exposure to smoke is generally much lower
in cannabis
than in tobacco cigarette smokers, even
taking into
account the larger exposure per puff.
Existing studies do
not support a link between the use of
cannabis and heart
disease, the leading cause of death in
many Western
countries, he adds. Furthermore, cannabis
does not
contain nicotine, a chemical contained
in tobacco that is
addicting and contributes to the risk
of heart disease.
However, two caveats must be noted regarding
available
data, warns the author. Firstly, the studies
to date have
not followed cannabis smokers into later
adult life so it
might be too early to detect an increase
risk of chronic
diseases that are potentially associated
with the use of
cannabis.
Secondly, the low rate of regular cannabis
use and the
high rate of discontinuation during young
adulthood may
reflect the illegality and social disapproval
of the use of
cannabis. This means that we cannot assume
that
smoking cannabis would continue to have
the same small
impact on mortality if its use were to
be decriminalised or
legalised.
While the use of cannabis is not harmless,
our current
knowledge does not support the assertion
that it has an
adverse impact on death rates, says the
author. Common
sense should dictate measures to minimise
adverse
effects. These include discouraging use
by teenagers, not
using when driving or operating heavy
machinery, not
using excessively, and cautioning people
with known
coronary heart disease.
Contact:
Laura Marshall, Kaiser Permanente Media
Relations,
Oakland, California, USA
Email: laura.h.marshall{at}kp.org
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)
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