This week in the BMJ
Volume 328, Number 7430, Issue of 3 Jan 2004Prolonged starvation results in more cardiovascular disease
Prolonged starvation results in more cardiovascular disease
Prolonged starvation results, three to six decades later, in raised blood pressure and higher mortality from heart disease and stroke. Sparén and colleagues (p 11) followed up nearly 4000 men from St Petersburg (formerly Leningrad) from 1975 to 1999; a third had lived through the siege of the city during the second world war. They found that a higher proportion of those who had starved for a long time had cardiovascular diseases and increased mortality, particularly if they were aged 9 to15 at the time of the siege. Wars and starvation continue, and severe starvation, accompanied by stress and trauma, may increase cardiovascular disease, especially if it occurs during puberty.
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A stable partner slows progression of HIV
In people infected with HIV, having a stable partner slows the progression of disease. During three years' follow up of 3736 HIV positive Swiss patients who had received highly active antiretroviral therapy, Young and colleagues (p 15) found that 80% of the patients had a stable partner at some time, and these patients had a slower rate of progression to AIDS or death. Though having a stable partner results in lower mortality in HIV positive patients, the mechanisms responsible are not known.
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CT scanning in infancy may affect later learning
Receiving low doses of ionising radiation to the head in infancy may impair the developing brain and affect intellectual development. Hall and colleagues (p 19) studied 3094 men from Sweden who had received radiotherapy for cutaneous hemangioma before the age of 18 months. They analysed military records reporting the men's intellectual capacity at age 18 or 19 and found that exposure to doses of radiation greater than 100 mGy, the equivalent of a computed tomography scan, was negatively correlated with high school attendance and learning ability assessed by cognitive tests. The authors call for re-evaluating the use of computed tomography for minor head injuries in infants.
Poor reporting of trials does not mean poor quality trials
Poor reporting of methods may not reflect on a trial's quality. Soares and colleagues (p 22) compared the published reports of 56 randomised controlled trials conducted by the Radiation Therapy Oncology Group with the original research protocols. They found that important methods—sample size calculations, concealment of allocation, and intention to treat analysis—were often not mentioned in the final report but had been explicitly stated in the research protocol. The publication of protocols may improve the quality of conducting and reporting clinical research, the authors say, and contacting the trialists may provide additional information when the research is used in meta-analyses.
Volunteer support does not change breastfeeding rates
Support from volunteer counsellors failed to extend the period during which women breast fed. Graffy and colleagues (p 26) conducted a randomised controlled trial of 720 women who planned to breast feed their baby. The women were allocated either to additional volunteer support or usual care. The duration of breast feeding was the same in both groups, and less than two thirds of women were still breast feeding after six weeks. Many of those who stopped breast feeding did not contact their counsellor, but those women who did valued her support. The authors say that, particularly in the first few days after the birth, provision of support for breast feeding should be routine rather than depend on a call for help.
Omega 3 fatty acids can protect against heart disease
Omega 3 fatty acids, which are found in fish and fish oils, can protect against coronary heart disease, but optimal intake is not firmly established. In a clinical review, Din et al (p 30) examine the evidence regarding the intake of fish oils and the risk of coronary disease. They outline the mechanisms through which fish oils might confer cardiac benefits (reduced arryhthmias, enhanced stability of atherosclerotic plaque, and reduced platelet aggregation) and consider recent guidelines for fish consumption. Currently the evidence is strongest for patients who had myocardial infarction.
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