This week in the BMJ
Volume 329, Number 7471, Issue of 16 Oct 2004Depression accompanies cognitive decline
Depression accompanies cognitive decline
People with cognitive impairment are more likely to become depressed, but depression does not increase the risk of developing cognitive impairment. Following up 500 Dutch residents aged 85, Vinkers and colleagues (p 881) found that after four years depressive symptoms had increased more quickly in those with poorer attention, immediate recall, and delayed recall at baseline. Having symptoms of depression was not related to accelerated cognitive decline.
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Nurses take on cardioversion
Nurses can carry out cardioversion in people with atrial fibrillation in a day surgery unit, saving acute hospital beds and junior doctors' time. Auditing a newly introduced, nurse led electrical cardioversion service in London, Currie and colleagues (p 892) found that, among 143 patients treated, 92% went back into sinus rhythm. Three had to be admitted to hospital, but for less than 24 hours; none had serious complications. Waiting times were reduced from 27 weeks to eight weeks.
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Family history increases the risk of incontinence
Women are more likely to develop urinary incontinence if their mothers or older sisters are incontinent. Hannestad and colleagues (p 889) followed up more than 15 000 women from Norway enrolled in the EPINCONT study and found that the risk of incontinence was 1.3-fold if their mother had incontinence and 1.6-fold if an older sister had incontinence. These women were also at greater risk of stress incontinence and mixed incontinence.
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Epidemiological studies may mislead
Analysis and reporting of epidemiological data may be inadequate and misleading. Reviewing 73 studies published in January 2001, Pocock and colleagues (p 883) found that some made exaggerated claims; statistical analysis was not always used appropriately; adjustment for confounders was often poorly explained; and subgroup analyses and multiple associations were overinterpreted. The choice of groupings and analysis for quantitative exposure variables was highly variable, and publication bias occurred. Overall, there is a serious risk that some epidemiological publications reach misleading conclusions, say the authors.
Elderly people are at greater risk of suicide
Elderly people have a higher risk of completed suicide than other age groups, and prevention and management should focus more on this group of people. In a review, O'Connell and colleagues (p 895) explain how psychiatric illnesses (most notably depression), certain personality traits, and neurological illnesses and malignancies are associated with a high risk of suicide. Social isolation and being divorced, widowed, or single also increase the risk. People who have attempted suicide are at higher risk of subsequently being successful.
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Use of stimulants for ADHD: is it always right?
Attention deficit hyperactivity disorder (ADHD) may generate poor self esteem and affect a child's development and functioning. Medical treatment with stimulants, and behavioural treatment, may be useful, but who should be treated and how? In a "For and Against" article (p 907), Coghill says that ADHD is undertreated: in England and Wales only 30% of children with the most severe form of the condition are treated. Markovich argues that current uncertainties about diagnosis and treatment mean that doctors should be more cautious about prescribing psychoactive drugs—if we were to follow American guidelines, as many as 17% of all children would be treated.
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Comorbidities at life's end need better care
People with progressive, life limiting illnesses often take drugs to treat or prevent long term conditions, but there is little guidance on how to manage chronic conditions in these patients. Stevenson and colleagues (p 909) argue that an active review of treatment will tackle the problem of diminishing benefits and increasing side effects. Weight loss and other changes may reduce the need for many drugs or alter their metabolism; although patients should take some drugs until death, others should be stopped as systemic changes occur.
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