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Press releases Saturday 27 November 2004
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under titles).
(1) HIDING DRUGS IN FOOD IN NURSING HOMES IS COMMON
(2) NSAIDS ARE OF LIMITED USE FOR OSTEOARTHRITIS
(3) PARENTS FAILING TO RECOGNISE OBESITY IN THEIR CHILDREN
(4) NEW TREATMENTS FOR INFERTILITY ARE UNJUSTIFIED
(5) TESTOSTERONE
PATCH WILL TEST FDA'S DECISION MAKING
(1) HIDING DRUGS IN FOOD IN NURSING HOMES IS COMMON
Online First
(Concealment of drugs in food and beverages in nursing homes: cross
sectional study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38268.579097.55
The practice of concealing drugs in patients' food and drinks is common in nursing homes, claim researchers from Norway in a study published on bmj.com today.
And it seems that this practice is not just a Norwegian phenomenon - a British study in 2000 reported that 71% of residential, nursing, and inpatient units in southeast England at least sometimes administered drugs covertly in food and beverages.
They carried out interviews with professional carers of 1362 patients in 160 regular nursing homes, and 564 patients in 90 special care units for people with dementia in Norway. If any drugs had been concealed in the food or beverages during the previous seven days without the patient's knowledge or consent, it was recorded, along with the reason for hiding the drugs.
They found that 11% of the patients in regular nursing homes and 17% of the patients in special care units received drugs mixed in their food or beverages at least once during seven days. In 95% of cases, this practice was routine, but was poorly documented in the patients' records. The procedure for the decision to hide drugs also seems to be arbitrary.
Patients with severe mental (cognitive) impairment, reduced function in activities of daily living, or aggressive behaviour were more often subjected to covert administration. Patients in special care units also had a higher risk of being given drugs covertly. These patients were most often given sedatives, probably to control and sedate demented patients with disturbed behaviour, suggest the authors.
The low rate of documentation and the secrecy surrounding this practice in institutions are a cause for concern, they conclude.
Contact:
Oyvind Kirkevold, Research Scholar,
Norwegian Centre for Dementia Research, Vestfold Mental Health Care Trust,
Tonsberg, Norway
Email: oyvind.kirkevold@nordemens.no
(2) NSAIDS ARE OF LIMITED USE FOR OSTEOARTHRITIS
Online First
(Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2
inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo
controlled trials)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38273.626655.63
Patients with knee osteoarthritis should avoid long term use of non-steroidal anti-inflammatory drugs (NSAIDs), say researchers in a study published on bmj.com today.
Current guidelines recommend the use of oral NSAIDs in the treatment of knee osteoarthritis and they are used regularly by half of all patients with painful osteoarthritis.
Researchers in Norway analysed 23 trials to estimate the pain relieving effects of NSAIDs in patients with knee osteoarthritis. The final sample involved 10,845 patients, of whom 7767 received NSAIDs and 3078 received placebo.
The analysis revealed that NSAIDs can reduce short term pain slightly better than placebo, but it does not support long term use of NSAIDs for this condition, say the authors. The advantage of oral NSAIDs over placebo for short term pain relief is small and probably clinically insignificant, they add.
"As use of oral NSAIDs may incur serious adverse effects, they can only be recommended for limited use in osteoarthritis of the knee," they conclude.
Contact:
Jan Magnus Bjordal, Research Fellow,
Department of Public Health and Primary Health Care, University of Bergen,
Norway
Email: jmb@hib.no
(3) PARENTS FAILING TO RECOGNISE OBESITY IN THEIR CHILDREN
Online First
(Parents' awareness of their families being overweight: cross-sectional
study within a cohort)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38315.451539.F7
Many parents are failing to recognise obesity and overweight problems in their children, according to a study on bmj.com today.
Researchers surveyed the parents of 277 children and found that only a quarter recognised when their offspring were overweight. Where children were obese, a third of mothers and 57% of fathers thought their sons and daughters were "about right".
Parents were less likely to recognise overweight boys than girls in the study ? more than a quarter (27%) of boys who were overweight and obese were identified as such. This compares with more than half (54%) of parents recognising overweight and obese girls.
The study also revealed that some parents showed a lack of concern towards their children's weight problems. Although more than half of obese children's parents expressed some concern over their child's condition, only a quarter of parents of overweight children described themselves as even "a little worried" about it.
Misjudging weight problems was not confined to their children however. The researchers also found that of those parents who were overweight themselves, 40% of mothers and 45% of fathers judged their own weight to be "about right".
Contrary to previous findings, the study showed there were no differences between the highest and lowest socio-economic groups for the proportion of overweight parents, or for parents misjudging their children's weight. "The longstanding inverse relationship between social class and obesity has been lost in the UK", say the authors.
With more than half of British adults overweight, and obesity among preschool children up by 70% in a generation, these findings are alarming say the researchers. The apparent lack of parental concern about their overweight children is probably due to a lack of awareness, they conclude, but must be addressed if we are to halt an "impending health crisis".
Contact:
Alison Jeffery, Senior Research Nurse,
EarlyBird Research Centre, University Medicine, Derriford Hospital, Plymouth,
UK
Email: alison.jeffery@pms.ac.uk
(4) NEW TREATMENTS FOR INFERTILITY ARE UNJUSTIFIED
(Natural killer cells, miscarriage,
and infertility)
http://bmj.com/cgi/content/full/329/7477/1283
Women with recurrent miscarriage and infertility are undergoing tests and treatments that have no scientific rationale and are linked with known risks to mother and fetus, warn researchers in this week's BMJ.
Fertility clinics are increasingly offering women tests to measure the number and activity of natural killer (NK) cells circulating in their blood. These cells are found in the womb (uterus) and accumulate in large numbers during early pregnancy, but their function is completely unknown.
The tests are based on the speculation that women with recurrent miscarriage and infertility have raised levels of NK cells. As a result, many women are offered powerful treatments, such as steroids or immune suppressant drugs, to reduce the levels of NK cells.
But the authors argue that, not only do these tests give no useful information about what is happening in the uterus, these treatments are not appropriate for use in reproductive medicine without shown benefit as they are associated with known risks to mother and fetus.
Recent guidelines from the Royal College of Obstetricians and Gynaecologists, plus two randomised studies, have also concluded that there is no evidence to show they are beneficial.
Understanding the function of uterine NK cells is certainly a major challenge in human reproduction, they say. However, until more is known about their role in normal pregnancy, there is no evidence of any benefit in offering NK cell testing in women with recurrent miscarriage and infertility outside of properly controlled studies.
"This unfortunate group of women are particularly vulnerable to financial exploitation, and of being exposed to powerful treatments that have, as yet, no rational scientific basis," they conclude.
Contact:
Ashley Moffett, King's College medical
fellow, Department of Pathology, University of Cambridge, UK
Email: am485@cam.ac.uk
(5) TESTOSTERONE PATCH WILL TEST FDA'S DECISION MAKING
(Reviews: Fix for low sex
drive puts reporters in a bad patch)
http://bmj.com/cgi/content/full/329/7477/1294
(News: Drug maker urges medical
group to lobby FDA on testosterone patch for women)
http://bmj.com/cgi/content/full/329/7477/1255
The Food and Drug Administration (FDA) has granted a fast track review of testosterone patches for women with low sex drive, despite concerns about insufficient data and potentially misleading marketing by their manufacturer Proctor & Gamble, claim two articles in this week's BMJ.
The patch is the first drug to be assessed for a controversial condition called hypoactive sexual desire disorder. Proctor & Gamble claims that the patch can increase sexual activity by 74%, which has generated enthusiastic media coverage. It has also urged an international medical society, which it sponsors, to endorse the patch at the FDA regulatory hearing.
But the marketing has caused concern among some sex researchers by failing to state that in absolute terms, the patch may only increase sexual activity by one "episode," or less, per month.
Although an increase of one sexual episode a month may be of value clinically to some women, this is overshadowed by serious doubts about the long term safety of testosterone, say experts.
Rosemary Basson, one of the leading authorities in the field of women's sexual difficulties, says much caution is needed in prescribing testosterone to women. Meanwhile, others have raised serious questions about the disorder because women's sexual "symptoms" may often be healthy adaptive responses and should not be regarded as evidence of dysfunction.
A second article charges media outlets with exaggerating the benefits of the patch in their search for sexy stories.
None of the key clinical trials of Proctor & Gamble's testosterone patch have been published in peer reviewed journals, yet for a year or more excited media reports have sung the praises of the latest panacea for women's "low sex drive," writes author, Ray Moynihan, who recently won an award from the British Medical Journalists' Association, for his BMJ articles on entanglement between doctors and drug companies.
"Given the strong evidence that studies funded by drug companies tend to find more favourable results than independent studies, together with the increasingly common scandals over drug safety and conflicts of interest and the fact that key data on the patch have not yet been peer reviewed and published, the excited media stories tell us much more about their reporters' and editors' lack of interest in journalism than the latest remedy for a lack of interest in sex," he concludes.
Contact:
Ray Moynihan, BMJ Visiting Editor,Washington
DC, USA
Email: raymond.moynihan@verizon.net
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