This week in the BMJ
Volume 329, Number 7465, Issue of 4 Sep 2004Isolation may reduce spread of MRSA
Isolation may reduce spread of MRSA
Intensive control measures, including isolation, may reduce MRSA colonisation among hospital patients. Reviewing 46 studies, Cooper and colleagues (p 533) found evidence supporting isolation and other concerted efforts to reduce MRSA colonisation and infection, but the quality of the studies was poor. We should continue to use isolation measures, say the authors, but weaknesses in published research mean that alternative explanations for the reduction of MRSA cannot be excluded. The emergence of glycopeptide resistant strains calls for better research on control measures.
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Medicine in the south Caucasus is changing
The widespread collapse of the healthcare system and unaffordable out of pocket costs have led to poor access to health care in the south Caucasus. On page 562 von Schoen-Angerer uses the example of Armenia to show the differences in the clinical approach between the former Soviet Union and the West, and tells how harmful practices are making health care unaffordable in this region. The preference for the Soviet style, which controls public health approaches in a collapsing and corrupt healthcare system, raises ethical and efficiency questions. Access is a fundamental problem in primary care, says Hovhannisyan (p 522) in an editorial. Health promotion was not particularly developed during the Soviet era and completely collapsed after independence. As a result of pressure from the World Health Organization and non-governmental organisations, changes are now slowly happening.
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Drinking no alcohol, or too much, increases the risk of cognitive impairment
Alcohol drinking habits in middle age affect the risk of cognitive impairment in old age. In Finland, Anttila and colleagues (p 539) re-examined 1464 men and women aged 65-79 after an average follow up of 23 years, and found that participants who drank no alcohol in midlife as well as those who drank alcohol frequently were twice as likely to have mild cognitive impairment in old age than those who drank alcohol infrequently. People who were carriers of the apolipoprotein e4 allele had an increased risk of dementia with increasing alcohol consumption.
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Mistrust blocks prevention of vertical HIV transmission
Poor communication between health workers and HIV positive pregnant women in Africa may increase the risk of mother to child transmission of the virus. Painter and colleagues (p 543) interviewed 27 HIV positive women in Côte d'Ivoire who refused prophylaxis, and found that dissatisfaction with the delivery of HIV tests and results, fears of stigma, lack of faith in treatment and in test results, or personal reasons were the most common barriers to treatment. A better understanding of women's needs and concerns may improve uptake of prevention, say the authors.
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Taking lactobacillus does not prevent vulvovaginitis
Lactobacillus preparations taken orally or vaginally during and for four days after antibiotics were not effective in preventing post-antibiotic vulvovaginitis. Pirotta and colleagues (p 548) randomised 273 women aged 18-50 who had started short term treatment with oral antibiotics for non-gynaecological infections giving them lactobacillus orally or vaginally, or both, or standard care in association with their antibiotic treatment. They found that, overall, 23% of the women developed post-antibiotic vulvovaginitis; compliance was high, but lactobacillus treatment was ineffective.
Bell's palsy responds best to immediate treatment
Patients with Bell's palsy should start treatment immediately and be referred to a specialist. Holland and Weiner (p 553) say that facial palsy improves with combined oral acyclovir and prednisolone, but treatment for patients with partial Bell's palsy is controversial. Treatment is probably more effective if started within 72 hours, and less effective if started after seven days. The most common cause of Bell's palsy is herpes viruses, but a fifth of the cases have an alternative cause that should be managed appropriately.
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