This week in the BMJ
Volume 329, Number 7467, Issue of 18 Sep 2004Socioeconomic condition does not affect mortality during winter
Socioeconomic condition does not affect mortality during winter
Elderly people are more likely to die during the winter, but being poor does not affect the risk of dying. In a population based study providing 119 389 person years of follow up in people age 75 or older, Wilkinson and colleagues (p 647) found that the risk of death, which was 7.8% higher during winter than other seasons, was higher for women and people with respiratory illnesses. They found no socioeconomic gradient related to mortality in winter.
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Immediate adenotonsillectomy is not always needed
Children with mild symptoms of throat infection or adenotonsillar hypertrophy may not require immediate adenotonsillectomy. Van Staaij and colleagues (p 651) randomised 300 children aged 2-8 years with these symptoms to adenotonsillectomy or watchful waiting and found that immediate surgery did not reduce episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life. Adenotonsillectomy was more effective in children who had three to six throat infections than in those who had up to two. Twelve children had complications after surgery. In a commentary (p 654) Little points out that a third of children initially treated medically required surgery. This study shows that immediate surgery is not effective, not that tonsillectomy in itself is ineffective, but more data are needed to optimise treatment.
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Hib infections are as common as ever
Haemophilus influenzae type b (Hib) infections in adults decreased after routine immunisation of infants was introduced in 1992 but this has not been sustained. Surveying the English population between 1991 and 2003, McVernon and colleagues (p 655) found that after an initial decrease in 1998, numbers of Hib infections rebounded. The resurgence was associated with an increase in cases in children and evidence of reduced immunity in older unimmunised people. The unanticipated reduction in herd immunity highlights the need for surveillance of vaccine preventable diseases across all age groups, say the authors.
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Influenza vaccine works in elderly people
Vaccination against influenza reduces deaths among elderly people. Armstrong and colleagues (p 660) followed up 24 535 people aged over 75 from Great Britain for more than four years, looking at responses to circulating influenza. During an outbreak of influenza, all cause mortality was lower in those who had the vaccine than in those who did not receive it. Unvaccinated people often died from respiratory or cardiovascular causes.
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UK targets for colonoscopy are attainable
National targets for colonoscopy can be met by adopting simple measures to improve organisation, preparation of patients, and utilisation of human resources. Ball and colleagues (p 665) audited the results of an endoscopy department in northern England and found that completion rate for colonoscopy (reaching the caecum) was 57%, well below the national target of 90%. They identified the short time available for each colonoscopy, poor bowel preparation, and a mismatch in operators' workload as the possible causes for the low completion rate; by implementing simple corrective measures they managed to improve it to 94%.
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Junior doctors are often bullied
Workplace bullying is reported by 18% of doctors in training. Surveying 3779 trainees in London north of the Thames, Paice and colleagues (p 658) found that 18% of the 2730 respondents had been bullied (range 6% to 38% in different trusts), often by consultants (27%), other trainees (26%), or nurses and midwives (19%). Women were bullied more often than men, and foreign doctors more than doctors from the United Kingdom. Only 32% of respondents had complained—many were afraid of the consequences of complaining.
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