Press releases Saturday 22 May 2004

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(2) ACTION NEEDED TO TACKLE DRUG RELATED CRIME

(3) HALF THE POPULATION AT INCREASED RISK OF NEURAL TUBE DEFECTS

(4) DIABETES MAY BE GOING UNNOTICED IN MANY UK CHILDREN

(1) BIG RISE IN HOSPITAL ADMISSIONS FOR ANGINA AND CHEST PAIN

(Hospital discharge rates for suspected acute coronary syndromes between 1990 and 2000: population based analysis)
doi:10.1136/bmj.38111.650741.F7

Hospitalisation for angina and chest pain has risen dramatically in the last decade, with enormous financial and service implications, according to new research on bmj.com.

Researchers analysed hospital discharge records for Scottish residents aged at least 18 years with a first emergency hospitalisation for heart attack, angina, or other chest pain between 1990 and 2000.

Population hospitalisation rates for heart attack fell by a third between 1990 and 2000. In contrast, the rate for angina increased by 79%, for chest pain by 110%, and for any suspected acute coronary syndrome (heart attack, angina or chest pain) by 25%.

The decline in heart attack was much greater in men than in women in both young and older age groups. The increase in angina was slightly greater in men than in women in both age groups. For chest pain, the increases were comparable in men and women in both age groups.

The fall in hospitalisation rates for heart attack is consistent with reports from other countries, but contrasts with the rise in rates for angina and chest pain, say the authors.

The increase in hospitalisations for angina and chest pain has enormous implications for resources, finances, and services. For example, expansion of coronary intervention for increasing angina and development of observation units for chest pain to avoid admission of non-coronary chest pain, they conclude.

Contact:

Niamh Murphy, Research Fellow, Department of Cardiology, Western Infirmary, Glasgow, Scotland
Email: niamhmurphy@ireland.com

(2) ACTION NEEDED TO TACKLE DRUG RELATED CRIME

(Substance misuse and violent crime: Swedish population study)
http://bmj.com/cgi/content/full/328/7450/1233

Nearly a quarter (23%) of all violent crimes are committed by people who seriously misuse alcohol or drugs, finds a study from Sweden in this week's BMJ.

Interventions to reduce the risk of violence in these patients would help to cut the enormous costs of drug related crime, which is estimated to be around £1bn annually in the United Kingdom.

Researchers used national psychiatric and crime registers in Sweden from 1998 to 2000 to calculate the impact of substance misuse on violent crime in the Swedish population.

During 1998-2000, 16% of all violent crimes in Sweden were committed by people who were discharged from hospital with diagnoses of alcohol misuse, and more than a tenth of all violent crimes were committed by patients diagnosed as having misused drugs.

The overall proportion of violent crimes in the whole population that may be attributed to patients with substance misuse was 23%.

Integrating mental health and substance misuse services leads to improved outcomes. This integration should be extended to the criminal justice system, say the authors.

The costs to the criminal justice system of drug related crime are enormous. Interventions to reduce the risk of violence in patients who misuse alcohol and drugs could be highly cost effective, they conclude.

Contacts:

Martin Grann, Associate Professor, Centre for Violence Prevention, Karolinska Institute, Stockholm, Sweden
Email: martin.grann@cvp.se

or

Seena Fazel, Clinical Lecturer, Dept of Psychiatry, University of Oxford, Oxford, UK
Email: seena.fazel@psychiatry.oxford.ac.uk

(3) HALF THE POPULATION AT INCREASED RISK OF NEURAL TUBE DEFECTS

(Impact of the MTHFR C677T polymorphism on risk of neural tube defects: case control study)
doi:10.1136/bmj.38036.646030.EE

A genetic variant (MTHFR C677T) puts half the population at increased risk of neural tube defects, finds new research on bmj.com.

This finding underscores the importance of folic acid supplementation for all women of childbearing age to prevent neural tube defects.

Researchers in Ireland and the United States identified the genetic make-up (genotype) of 395 individuals born with neural tube defects (spina bifida or encephalocele) and 848 controls.

The TT (homozygous variant) form of the gene responsible for processing folate is associated with an increased risk of neural tube defects, but the team set out to investigate the possibility that the CT (heterozygous variant) form would also increase the risk of these malformations.

Both genotypes are linked to lower tissue concentrations of folate, higher levels of homocysteine (an amino acid), and lower enzyme activity than the wild CC genotype.

The CT genotype was responsible for at least as many neural tube defects in the population as the TT genotype. This is because a much greater proportion of the general population (38%) are CT compared with 10% who are TT.

The combined CT and TT genotypes account for about 26% of neural tube defects in Ireland, say the authors. Folate or folic acid is estimated to be involved in about 50-70% of these defects. Thus, up to half of the folate related neural tube defects may be explained by this single genetic variant.

Both the lower folate and higher homocysteine levels associated with CT and TT genotypes can be corrected by folic acid, explain the authors. Therefore, this study underscores the importance of public health intervention programmes of folic acid supplementation and food fortification targeted at all women of childbearing age to prevent neural tube defects.

Such intervention may also turn out to have other public health benefits, such as the prevention of heart disease, they conclude

Contact:

Peadar Kirke, Specialist in Public Health Medicine, Health Research Board, Dublin, Ireland
Email: pkirke@hrb.ie

(4) DIABETES MAY BE GOING UNNOTICED IN MANY UK CHILDREN

(Letter: Diabetes may be undetected in many children in the UK)
http://bmj.com/cgi/content/full/328/7450/1261-c

The true number of children with type 2 diabetes may be far larger than doctors realise, warn experts in this week's BMJ.

Cases of children with type 2 diabetes have been linked to the rising prevalence of childhood obesity. A recent BMJ study found that this is partly linked to the consumption of fizzy drinks.

A recent survey in England found 18% of schoolchildren to be overweight and a further 6% to be obese. On this basis, some 1,400 children in the United Kingdom would be currently diagnosed with type 2 diabetes and over 20,000 children with impaired glucose tolerance.

"That we are not recording these high numbers indicates that the problem may be hidden," say the authors.

"Children may not be aware of relevant symptoms or not realise that they should report them. We must be sure that, when children do express discomfort in some form, we listen to them. There are high costs associated with missing a case of diabetes through lack of attention, ignorance, or unconscious discrimination against overweight children," they conclude.

Contact:

Tim Lobstein, International Obesity Task Force, London, UK
Email: childhood@iotf.org

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