This week in the BMJ
Volume 330, Number 7483, Issue of 15 Jan 2005Month of birth is linked to risk of multiple sclerosis
2 agonists in deaths from asthma
Month of birth is linked to risk of multiple sclerosis
In the northern hemisphere, multiple sclerosis is more common in people born in May and less common in those born in November. Willer and colleagues (p 120) analysed the birth months of 42 045 people with multiple sclerosis from Canada, Great Britain, Denmark, and Sweden. Compared to predictions, 8.5% fewer people with multiple sclerosis were born in November and 9.1% more in May. The correlation was greater in countries with a higher prevalence of multiple sclerosis.
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Mental health care is being reinstitutionalised
Deinstitutionalisation of mental health care in the 1970s in western Europe now tends to be compensated or even overcompensated for by reinstitutionalisation. Priebe and colleagues (p 123) compared the data on changes in service provision in six western European countries. The number of psychiatric hospital beds has been reduced in five countries, but in only two countries this reduction outweighs the number of additional places in forensic institutions and supported housing. The authors discuss possible explanations, but reasons for the phenomenon remain unclear.
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Afghan children are more at danger from unexploded ordnance than landmines
Unexploded ordnance currently causes more injuries than landmines in Afghanistan, predominantly among children. After reviewing available surveillance data, Bilukha and Brennan (p 127) report that 6114 injuries were recorded between 1997 and 2002, of which 92% were in males and 54% in people under 18. The proportion of injuries caused by unexploded ordnance increased from 37% in 1997 to 57% in 2002, and the proportion of injuries from landmines decreased from 57% to 36%. This data gathering system captured less than half of events causing injuries.
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Home treatment of cellulitis with IV antibiotics is safe
Treating cellulitis with intravenous antibiotics can safely be done at home. Corwin and colleagues (p 129) randomly assigned 200 patients in need of intravenous treatment for cellulitis, and who did not have contraindications to home care, to receive treatment at home or in hospital. None of the outcome measures (days to no advancement of cellulitis, days taking antibiotics, days in medical care, complications, and degree of functioning and pain) differed significantly between the groups, but patients' satisfaction was greater among patients treated at home.
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Clustering in trials needs more recognition
Clustering in clinical trials randomising individuals needs to receive more attention in statistical analysis, discussion of the results, and drawing conclusions, argue Lee and Thompson (p 142). Reviewing all non-cluster randomised trials published in the BMJ during 2002, they found that 19 out of 42 trials showed clustering that was likely to affect their results, but only one attempted to take the issue into account. The authors show by example how clustering can affect a trial's results and conclusions.
Shedding light on role of 
2 agonists in deaths from asthma
Use of inhaled long acting 2 agonists in patients with asthma does not significantly affect mortality in these patients, but short acting 2 agonists are associated with increased mortality. In a case-control study, Anderson and colleagues (p 117) assessed 532 patients who died from asthma and 532 matched controls. The risk of death in patients who were treated with short acting 2 agonists was more than double that in controls. In addition to an adverse effect of the drug itself, the authors offer several alternative explanations.
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