Releases Saturday 4 October 2003
No 7418 Volume 327

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(1) DIETARY FAT NOT LINKED TO RISK OF
STROKE

(2) DEATHS AFTER FRACTURE HAVE NOT
DECLINED IN 20 YEARS

(3) SEXUAL PLEASURE IMPROVES AFTER
HYSTERECTOMY

(4) ARE UK CONSENT RULES TOO RESTRICTIVE?



(1) DIETARY FAT NOT LINKED TO RISK OF
STROKE

(Dietary fat intake and risk of stroke in male US
healthcare professionals: 14 year prospective cohort
study: )
http://bmj.com/cgi/content/full/327/7418/777

Unlike heart disease, dietary fat does not seem to be
associated with risk of stroke, finds a study in this
week's BMJ.

Researchers followed 43,732 healthy middle-aged men
for 14 years to examine the association between intake
of total fat, specific types of fat, and cholesterol and the
risk of stroke. They assessed dietary intake by using
recognised food frequency questionnaires.

After adjusting for age, smoking, and other factors that
could affect the results, they found no evidence that the
amount or type of dietary fat affects the risk of
developing stroke.

They also evaluated risk of strokes according to
consumption of selected foods rich in fat or cholesterol,
including red meat, high fat dairy products, nuts and eggs
and found no significant link with stroke.

"These findings do not support associations between
intake of total fat, cholesterol, or specific types of fat and
risk of stroke in men," conclude the authors.

Contact:

Ka He, Department of Preventive Medicine,
Northwestern University, Feinberg School of Medicine,
Chicago, USA
Email: e-crown@northwestern.edu

(2) DEATHS AFTER FRACTURE HAVE NOT
DECLINED IN 20 YEARS

(Time trends and demography of mortality after fractured
neck of femur in an English population, 1968-98:
database study)
http://bmj.com/cgi/content/full/327/7418/771

Death rates among elderly people after fracturing a thigh
bone (neck of femur) have not declined appreciably
during the past 20 years, finds a study in this week's
BMJ.

Researchers analysed NHS statistics on hospital
admissions for 32,590 people aged 65 years or over
who were admitted with fractured neck of femur
between 1968 and 1998. They calculated death rates
during the first month and first year after fracture.

They found that death rates after fracture fell significantly
from the late 1960s to the early 1980s, but have not
declined any further in the past 20 years.

Death rates also rose sharply with increasing age, were
higher in men than women, and were higher in lower
social classes. In the first month after fracture, death
rates were 16 times higher in men and 12 times higher in
women than in the general population of the same age.

It is unclear whether death after fractured neck of femur
has declined to an irreducible minimum or whether there
is still scope for further reduction, say the authors.

The high death rates after fracture, and the fact that they
have not fallen in 20 years, reinforce the need for
measures to prevent osteoporosis and falls and their
consequences in elderly people, they conclude.

Contact:

Stephen Roberts, Statistician, Department of Public
Health, University of Oxford, UK
Email: stephen.roberts@uhce.ox.ac.uk

(3) SEXUAL PLEASURE IMPROVES AFTER
HYSTERECTOMY

(Hysterectomy and sexual wellbeing: prospective
observational study of vaginal hysterectomy, subtotal
abdominal hysterectomy, and total abdominal
hysterectomy)
http://bmj.com/cgi/content/full/327/7418/774

Many women are concerned that hysterectomy may
affect their sexual attractiveness, but a study in this
week's BMJ finds that sexual pleasure improves after
hysterectomy.

Researchers in the Netherlands compared the effects of
three types of hysterectomy (vaginal, subtotal abdominal,
and total abdominal hysterectomy) on the sexual
wellbeing of 413 women.

All women completed a questionnaire before and six
months after surgery about their sexuality, frequency of
sexual activity, and problems during sexual activity.

Sexual pleasure significantly improved in all patients,
regardless of the type of hysterectomy. The persistence
and development of bothersome problems during sexual
activity were also similar for all three surgical techniques,
conclude the authors.

Contact:

Jan-Paul Roovers, Registrar, Department of Obstetrics
and Gynaecology, University Medical Center, Utrecht,
Netherlands
Email: j_proovers@hotmail.com

(4) ARE UK CONSENT RULES TOO RESTRICTIVE?

(Editorial: Consent to using human tissue)
http://bmj.com/cgi/content/full/327/7418/759

Regulations on the use of human tissue in the United
Kingdom are now more restrictive than any other
European country. Is the UK leading the way or
overreacting to recent publicity about inadequate consent
procedures?

The new regulations require explicit consent from every
patient. Explicit consent is appropriate for the use of
emotionally important samples such as post-mortem
tissue, but the new regulations also apply to all samples
from living patients, including resected tumours, tiny
biopsies, even blood and urine.

Although this takes due account of the autonomy of the
few who object, it is now inhibiting work done for the
good of everyone and has other ethically undesirable
consequences, says Professor Peter Furness, in this
week's BMJ.

Recording the wishes of all patients whenever samples
are taken would resolve this problem but this has major
resource implications, he writes. So is implied consent -
asking the few who object to make their wishes known ±
a reasonable possibility for the use of tissue from living
patients for research?

Implied consent was recommended by the Nuffield
Council on Bioethics in 1995, but has since been
rejected by the Medical Research Council, despite
evidence that patients thought it was appropriate. The
Department of Health for England has so far taken a
similar line to the MRC.

"If we are serious about empowering patients to control
the use of their tissue samples, resources must be
allocated irrespective of whether implied or explicit
consent is regarded as appropriate," says the author.
"Without such resources our laboratories are forced into
paralysis or continuing paternalism. At present we have
both."

Contact:

Peter Furness, Professor of Renal Pathology,
Department of Pathology, Leicester General Hospital,
Leicester, UK
Email: pnf1@le.ac.uk


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