This week in the BMJ
Volume 329, Number 7472, Issue of 23 Oct 2004Sedentary childhood increases the risk of CFS
Sedentary childhood increases the risk of CFS
Lower levels of exercise in childhood increase the risk of developing chronic fatigue syndrome (CFS). Viner and Hotopf (p 941) followed up more than 11 000 children from the 1970 British birth cohort and found that, at age 30, girls, children from a higher social class, and those with limiting conditions in childhood were more likely to report chronic fatigue syndrome. Contrary to previous evidence, children who exercised more, those with behavioural and psychological problems, and those with mothers with psychological problems were not at increased risk.
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Clinicians believe patients benefit from placebos
Three out of five doctors and head nurses surveyed in Israel prescribe placebo to their patients, believing it is useful. Nitzan and Lichtenberg (p 944) surveyed 58 doctors and 31 nurses from hospital and general practice, and found that among those using placebo, 62% used it at least once a month, and 94% thought it was generally or occasionally effective. Only one in 20 respondents would prohibit the use of placebo in all circumstances.
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Letters may save time
Not all patients referred to a haematologist need to be seen in clinic; a letter will often do. Tso and colleagues (p 946) analysed general practitioners' satisfaction with a letter containing advice on subsequent management, rather than formal outpatient review, for 121 of 274 patients who had been referred to a haematologist. These patients were not deemed to need further investigations or specialised treatment and had no evidence of a serious illness. Most general practitioners, and 72 patients who were interviewed, found a written response acceptable and helpful and would be satisfied with it in the future.
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More than one drug protects the stomach from NSAIDs
Different therapeutic options are available to protect the stomach in people using nonsteroidal anti-inflammatory drugs (NSAIDs). Reviewing more than 100 trials on gastroprotective strategies for people taking NSAIDs, Hooper and colleagues (p 948) found that misoprostol and COX-2 specific and selective NSAIDs (and probably proton pump inhibitors) reduce the risk of symptomatic ulcers. Misoprostol (and probably COX-2 NSAIDs) reduce the risk of serious gastrointestinal complications, but data quality is low. Data on H2 receptor antagonists and proton pump inhibitors are not conclusive.
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Young South Africans are affected by sexual violence
Misconceptions about sexual violence and the risk of HIV infection are common in young South Africans of both sexes. Andersson and colleagues (p 952) surveyed more than 269 000 South African pupils aged 10-19 years and found that around 11% of males and 4% of females claimed to have forced someone to have sex, and more than 60% of these had themselves been forced to have sex. A third of respondents thought they were HIV positive. Sixteen per cent said they would spread HIV infection intentionally; this response was more common among youths who had been forced to have sex.
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Sleep apnoea increases risks in general anaesthesia
Patients with obstructive sleep apnoea are at high risk of complications when having general anaesthesia. Den Herder and colleagues (p 955) say that undiagnosed sleep apnoea is common. Obesity (especially large neck circumference), increasing age, being male, and alcohol consumption predispose to sleep apnoea. Tailored premedication and intubation technique and careful post-extubation management are needed, including judicious use of pain relief medication, continuous positive airway pressure, and surveillance in an intensive care unit.
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