This week in the BMJ
Volume 328, Number 7439, Issue of 6 Mar 2004Efficacy of malaria treatment shows some decline
Efficacy of malaria treatment shows some decline
Sulfadoxine-pyrimethamine has good therapeutic efficacy but diminishing clinical and parasitological efficacy ten years after its introduction in Malawi. Plowe and colleagues (p 545) studied 1377 patients treated with sulfadoxine-pyrimethamine from 1998 to 2002 in Malawi. Although the clinical response in the first 14 days was adequate and did not change over the five years, the rates of parasite clearance declined over time. This may presage a decline in efficacy and new effective treatment may soon be required, the authors say.
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Diabetes may influence cognitive decline
In women, having type 2 diabetes makes poor cognitive function and substantial cognitive decline over time more likely. Logroscigno and colleagues (p 548) extracted data from the nurses' health study on more than 16 000 women aged 70-81 years, and assessed cognitive function twice over two years. They found that women with type 2 diabetes had poorer cognitive function and cognitive decline than women without diabetes, especially if they had had diabetes for more than 15 years. Women who where not taking drug treatment for diabetes were at higher risk, but those taking oral hypoglycaemic agents had a similar risk as women without diabetes.
High IQ in childhood may protect from cognitive decline
Good cognitive ability in childhood may protect against cognitive decline in mid-life. Using data from the British 1946 birth cohort, Richards and colleagues (p 552) analysed 3035 people who had various cognitive tests at age 15, 43, and 53. They found that measured ability in childhood was inversely associated with rate of decline in memory, speed, and concentration in mid-life, independent of social and health status. Ability in adulthood was similarly associated with decline in mid-life, independent of childhood ability. Cognitive ability may reflect properties of the central nervous system which regulate the decline associated with age, the authors say, particularly in tasks requiring effort and concentration.
Organisational downsizing affects sickness and mortality
Organisational downsizing may increase sickness absence and the risk of death in employees who keep their job. Vahtera and colleagues (p 555) studied 22 430 municipal employees in Finland, who kept their jobs at a time of profound economic decline and organisational downsizing. After 7.5 years of follow up, they found that major downsizing was associated with an increase in sickness absence among permanent (but not temporary) employees. Though the number of cardiovascular deaths was small, mortality doubled, especially in the first four years after downsizing.
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The internet changes patients' experience of cancer
Cancer patients use the internet to obtain information and support at different stages of their illness. Ziebland and colleagues (p 564) interviewed 175 patients with cancer, to explore how they used and perceived internet information on the disease. The internet allowed people to check the tests, treatment, and advice they received from health professionals, and patients gained expertise about their condition, which helped them to cope with their illness. The internet is rarely used by people who are socially disadvantaged, the authors say, and the challenge is to ensure that access is broadened to avoid an increase in social class divisions.
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Drug policy trials can be randomised
Randomised drug policy trials are feasible, and they may produce results in a short time, which are likely to concord with observational evaluations. Schneeweiss and colleagues (p 560) compared results of studies investigating the health effects of a new reimbursement policy for nebulised respiratory drugs. The randomised policy trial and an observational time trend analysis had similar results. Randomised policy trials provide rigorous results almost as soon as the data become available, avoiding the time delay caused by identifying controls and adjusting for confounding.
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