This week in the BMJ
Volume 329, Number 7474, Issue of 6 Nov 2004Outreach improves early psychosis
Outreach improves early psychosis
Patients with early psychosis maintain better contact with services and have fewer readmissions to hospital if they receive specialised care instead of standard care. Craig and colleagues (p 1067) randomised 144 people presenting to mental health services for the first or second time with non-organic, non-affective psychosis to assertive outreach or standard care. They found that patients who received the intervention were less likely to relapse, were readmitted fewer times, and were less likely to drop out of the study than those who received standard care.
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Paternal aging raises risk of schizophrenia
Children fathered by older men with no family history of schizophrenia are more likely than the children of younger men to develop schizophrenia. Analysing a cohort of 754 330 people born in Sweden between 1973 and 1980 and living in Sweden at age 16, Sipos and colleagues (p 1070) found that the overall hazard ratio for each 10 year increase in paternal age was 1.47 (95% confidence interval 1.23 to 1.76). They say that accumulation of sperm mutations might lead to this increased risk.
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Colour blindness screening may be unnecessary
Despite the increasing use of colour in teaching, children with congenital colour vision defects do as well as their peers at mathematics and reading, and probably do not need to be detected by screening. Following a 1958 British cohort for 33 years, Cumberland and colleagues (p 1074) found that almost 7% of boys and about 1% of girls had colour vision defects. Neither highest educational qualification at age 33 nor the risk of road injuries and work related injuries was associated with colour blindness.
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Overdoses fell after pack sizes were reduced
Cutting the size of packs of analgesics sold over the counter has been associated with fewer suicides. Hawton and colleagues (p 1076) report that suicide deaths from paracetamol and salicylates fell by 22% in the year after legislation and stayed low for the next two years. They also found a significant decrease in the number of tablets taken in non-fatal overdoses and a 30% drop in liver unit admissions due to paracetamol induced hepatotoxicity.
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Avoid being misled by claims in robust studies
Although guides on identifying weak studies are widely available, clinicians also need to be able to detect when authors of methodologically strong clinical research reports make misleading claims. Montori and colleagues (p 1093) present six helpful pointers and indicate that several strategies for spotting biased reporting are available. They warn that misleading reporting will always be with us, and clinicians need to stay armed.
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Global health monitoring could be better
Global collection of health information should be improved by using new technologies and methods of health measurement, strengthening national capacity to collect and analyse health data, establishing global norms and standards, and creating and disseminating optimal information, argue Murray and colleagues (p 1096). They challenge the role of the World Health Organisation in this and propose an independent monitoring body.
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