Press releases Saturday 29 May 2004

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(1) SOYA FOODS MAY HELP TO REDUCE CANCER OF THE WOMB

(2) FAITH IN CHILD PROTECTION SYSTEM MUST BE RESTORED

(1) SOYA FOODS MAY HELP TO REDUCE CANCER OF THE WOMB

(Soya food intake and risk of endometrial cancer among Chinese women in Shanghai: population based case-control study)
http://bmj.com/cgi/content/full/328/7451/1285

Regular intake of soya foods is associated with a reduced risk of endometrial cancer (cancer affecting the lining of the womb), finds a study among Chinese women in this week's BMJ.

Soya foods are a rich source of isoflavones, a major group of phytoestrogens, which act like oestrogen in the body. They also contain high amounts of dietary fibre.

Researchers interviewed 832 women who were diagnosed with endometrial cancer between 1997 and 2001 and were between the ages of 30 and 69 years in Shanghai, China. A further 846 healthy women of the same age were randomly selected as a control group. Soya food intake over five years was measured and current body measurements were taken.

Regular consumption of soya foods was associated with a reduced risk of endometrial cancer, particularly among overweight women.

Rates of endometrial cancer vary more than 10-fold worldwide. Asian women have a lower incidence of endometrial cancer and eat more soya food than their Western counterparts. These findings suggest that dietary factors may play an important role in this international variation, say the authors.

The indication that overweight women may benefit more from increased soya food intake needs to be verified in future studies, they conclude.

Contact: Professor Xiao Ou Shu, Department of Medicine, Vanderbilt University, Nashville TN, USA
Email: xiao-ou.shu@vanderbilt.edu

(2) FAITH IN CHILD PROTECTION SYSTEM MUST BE RESTORED

(Munchausen syndrome by proxy and sudden infant death)
http://bmj.com/cgi/content/full/328/7451/1309

Recent court cases into unexplained infant deaths have led to widespread confusion and have made many paediatricians reluctant to take part in child protection cases, warn experts in this week's BMJ.

They call for an urgent review of procedures to restore faith in the child protection systems.

The term Munchausen syndrome by proxy received publicity when in 1977 Meadow reported a case with deliberate fabrication of symptoms. Many manifestations of the syndrome are now recognised.

Yet recent events have raised questions about the diagnosis of the syndrome and have prompted some soul searching about the ways professionals respond to the unexpected death of an infant.

A non-adversarial approach needs to be introduced to deal with sudden infant deaths, say the authors. The emphasis must be first on assessing and minimising the risk to any other children cared for by the parents and secondly on management of the parents' needs. Professionals who offer expert evidence must also not promote ideas that are unsupported by research.

"We must restore the faith of the public and the professions in the child protection systems that are vital for a civilised society," say the authors. "Munchausen syndrome by proxy has captured the public imagination, but there is still much that we do not know about other aspects of child abuse.

"We urgently need to review procedures and to fund more research into the causes, mechanisms, and diagnosis of child abuse. And we call on journalists, lawyers, and the judiciary to ensure that they are well informed about the mass of evidence and data gathered over the past 40 years in child protection."

Contacts:

David Hall, Professor of Community Paediatrics, Institute of General Practice, Northern General Hospital, Sheffield, UK
Email: d.hall@sheffield.ac.uk

Alan Craft, Professor of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK

(3) GPS' BELIEFS ABOUT PATIENTS INFLUENCES TREATMENT

(General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study)
bmj.38078.503819.EE

General practitioners' beliefs and attitudes towards patients with chronic fatigue syndrome may be a barrier to effective treatment, finds new research available on bmj.com.

Researchers analysed group discussions between 46 general practitioners in England, based on a series of clinical scenarios involving patients with chronic fatigue syndrome or irritable bowel syndrome.

The participants tended to stereotype patients with chronic fatigue syndrome as having certain undesirable traits. Patients with chronic fatigue syndrome were seen as failing to conform to the work ethic and lacking in stoicism.

In contrast, patients with irritable bowel syndrome "seem to battle through it" and were rarely "debilitated to such an extent that they were off work."

Even though GPs recognised that both conditions were influenced by a combination of biological, social and psychological factors, many did not consider referral for mental health interventions because they were unfamiliar with the interventions or thought them unavailable or unnecessary. Mental health interventions may help patients who have not responded to management in primary care.

These findings indicate that general practitioners' perceptions about patients with either condition may be a barrier to effective management, say the authors. To overcome these barriers, doctors must recognise their deeply held beliefs that mediate their understanding of complex disease mechanisms. Such a change in perceptions will need to be supplemented by the establishment of locally available effective interventions.

Contact:

Rosalind Raine, MRC Clinician Scientist, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
Email: rosalind.raine@lshtm.ac.uk

(4) OFFENDING BY PSYCHIATRIC PATIENTS IS RARE

(Offending in psychiatric patients after discharge from medium secure units: prospective national cohort study)
bmj.38075.467569.EE

Despite great public concern, offending by psychiatric patients after discharge is rare, according to new research available on bmj.com.

Researchers collected data on all 959 patients discharged from medium secure units in England and Wales between 1997 and 1998 and used the offenders' index to find details of subsequent convictions.

In the two years after discharge, only 6% of psychiatric patients committed a violence offence. The strongest association with offending was previous offending.

Substance misuse and sexual abuse were associated with increased offending risk, although patients were less likely to be convicted after a lengthy admission or if they had a history of self harm. Aftercare is also effective in preventing reconviction.

The rate of violent offending is so low that there is little scope for overall reduction and it would be better concentrate on the identification of high risk patients, say the authors.

One American study identified a psychopathy "checklist" as the best single predictor of violence in psychiatric patients, and the authors recommend further exploration of its use in medium security hospitals in England and Wales.

Contact:

Anthony Maden, Professor of Forensic Psychiatry, Institute of Psychiatry, London, UK
Email: a.maden@ic.ac.uk

(5) GLOBAL WARMING: A FORMIDABLE CHALLENGE TO HEALTH

(Editorial: Global warming)
http://bmj.com/cgi/content/full/328/7451/1269

Global warming is a real concern to health experts, according to a senior scientist in this week's BMJ. His comments come as global warming gets the Hollywood treatment in the disaster movie The Day After Tomorrow.

Global warming means not just a gradual climb in temperature, but also an increased frequency and intensity of extreme weather events, such as heat waves, droughts, floods, and storms, says Professor Jonathan Patz of Johns Hopkins University.

Extreme weather events have claimed millions of lives during the past 20 years. Between 1972 and 1996, an average of 123,000 people were killed annually by natural disasters, most of them in Africa and Asia.

Growing evidence suggests that climate change will increase malnutrition and outbreaks of infectious diseases in the 21st century.

Although the doomsday scenarios in the film may be far from reality, the slower march of climate change still presents a formidable challenge for the health sector and society as a whole, writes the author.

The many health effects posed by climate change will arrive through numerous convoluted pathways and will require interdisciplinary analyses and integrated prevention planning, he concludes.

Contact:

Jonathan Patz, Assistant Professor, Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, USA
Email: jpatz@jhsph.edu

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