This week in the BMJ
Volume 329, Number 7477, Issue of 27 Nov 2004Screening for aneurysm fails to reduce mortality
Screening for aneurysm fails to reduce mortality
Screening for abdominal aortic aneurysm did not reduce mortality among Australian men aged 65-83. Norman and colleagues (p 1259) randomised 41 000 men to invitation to ultrasound screening or no intervention. About 7% of respondents had an aortic diameter 
30 mm and 0.5% a diameter 55 mm. Almost twice as many men in the intervention group than in the control group had elective surgery. In the five years after the start of screening, 18 men in the intervention group and 25 in the control group died from abdominal aortic aneurysm. Any benefit of screening was almost entirely in men aged 65-75, but at a whole population level screening was not effective in reducing mortality.
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Doctors leave UK for better lifestyles
The most common reasons for wanting to leave both medicine and the United Kingdom are lifestyle and working conditions, and only a minority of doctors give positive reasons such as wanting to work in developing countries or an interest in a different career. Moss and colleagues (p 1263) posted questionnaires to 4221 doctors who qualified in 1999, asking them about their intentions regarding practising in Britain. Almost two thirds of respondents (1777/2727) said they did not definitely intend to practise medicine in the United Kingdom. The wish to work abroad, but to stay in medicine, was more common than the wish to leave medicine.
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Infections kill preterm infants
Systemic infections are an important cause of morbidity and mortality in preterm infants. Early onset infections are rare, but they present with signs of sepsis, such as respiratory distress or fever in the first 12 hours after birth, and need antibiotic treatment, say McGuire and colleagues (p 1277). Late onset infections are more common, mostly caused by Gram positive organisms, and can start insidiously. Fungal infections are challenging. Despite antimicrobial treatment, morbidity is high for all types of infections, and new prevention and treatment strategies are needed.
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Implementing WHO's "3 by 5" initiative
The World Health Organization has launched a programme that aims to deliver antiretroviral therapy to three million people with HIV in developing countries by 2005. Discussing the challenges facing implementation, Furber and colleagues (p 1281) say that if the initiative is to succeed, a constructive dialogue between stakeholders with different agendas—including healthcare workers, public health managers, community and faith based organisations, and people with AIDS—are crucial. They emphasise the importance of developing a chronic disease model of care through a strengthened public health infrastructure.
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Suppressing uterine natural killer cells is not justified
Treating women with infertility or recurrent miscarriage with immunosuppressive drugs to suppress uterine natural killer cells has no proved benefit, and such treatment poses risks to mother and fetus, say Moffett and colleagues (p 1283). The function of these cells is not yet known, and treatments are prescribed wrongly on the basis of counts of natural killer cells in peripheral blood—these differ from uterine natural killer cells and comprise a separate lymphoid subset.
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Quality of diabetes records varies with social mix
Women and people living in areas with high social deprivation or large ethnic minorities are less likely to have their diabetes care recorded thoroughly. Hippisley-Cox and colleagues (p 1267) surveyed 237 UK general practices and examined records of 54 180 diabetic patients among a population of 1.8 million patients. Of 17 recorded quality indicators for care (such as body mass index, smoking status, HbA1C concentration, blood pressure, and having flu vaccination or treatment with angiotensin converting enzyme inhibitors), 10 were inversely associated with deprivation, nine with ethnic origin, and eight with being female.
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