This week in the BMJ
Volume 330, Number 7496, Issue of 16 Apr 2005Evidence doesn't support routine use of multivitamins
Evidence doesn't support routine use of multivitamins
It is still not clear how effective multivitamins and mineral supplements are in reducing infections in elderly people. A systematic review by El-Kadiki and Sutton (p 871) included eight randomised controlled trials with different outcome measures, and pooling of the compatible results gave conflicting answers. Although a meta-analysis of some trials showed a significant reduction in the mean annual number of days spent with infection, meta-analyses of other trials showed no difference for at least one infection in the study period or for the infection rate ratio. Adverse events were poorly reported in all trials.
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Quetiapine and rivastigmine may not work for dementia
An atypical antipsychotic, quetiapine, and a central cholinesterase inhibitor, rivastigmine, may not be effective for treating agitation in people with dementia in institutional care. In a randomised double blind placebo controlled trial including 93 patients with Alzheimer's disease, Ballard and colleagues (p 874) found that both of these drugs failed to reduce agitation or ameliorate the decline of cognition after six weeks and after 26 weeks of follow-up. In these patients, quetiapine was associated with accelerated cognitive decline.
Mode of delivery doesn't affect postnatal depression
Elective caesarean section does not protect women who are at risk of postnatal depression, nor are women who give birth by an emergency caesarean section or assisted vaginal delivery at more risk of postnatal depression than women who have a spontaneous vaginal delivery. On p 879, Patel and colleagues report their findings from a prospective population based cohort study including 14 663 women. These results should help women to make informed choices, the authors say.
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Young people's health needs action
Health behaviours that are laid down in adolescence are maintained into adulthood and influence lifelong health, say Viner and Barker on p 901. An efficient future health service should be built on adolescents' engagement with their own health, but there is much to be done to achieve this goal. Key public health indicators, teenage pregnancy for example, have shown adverse trends or no change in the past 20 years. The authors propose a number of action points, such as developing separate health policies for youth.
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The shift of funding should not hamper joint approaches
On page 898, Yach and colleagues propose that fighting the chronic disease epidemics that result from unhealthy diets and lack of physical activity is not all that different from fighting tobacco smoking. They argue that since the agencies that fund public health research and interventions shifted their focus from tobacco control to obesity, opportunities are being neglected for the interchange of experiences and joint approaches to these two major public health issues. The authors offer 12 lessons learnt from attempts to control tobacco smoking, and discuss how they could be used in fighting obesity.
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Learn how to critically appraise cohort studies
Cohort studies offer important advantages over randomised controlled trials, like determining if the efficacy observed in randomised controlled trials translates into effectiveness in broader populations and more realistic settings, and to provide information on adverse events and risks. In the first of three articles on critical appraisal of cohort studies, Gurwitz and colleagues (p 895) explain the role of cohort studies in the hierarchy of evidence, the characteristics of their design, and how selection bias can compromise their validity.
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