This week in the BMJ
Volume 330, Number 7499, Issue of 7 May 2005Overall incidence of first diagnosed coronary heart disease remains the same
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Overall incidence of first diagnosed coronary heart disease remains the same
A big drop in the rate of substantial coronary events between 1980 and 2000 in the United Kingdom seems to have been largely offset by the increase in diagnosing angina. In a cohort of 7735 men aged 40-59 at entry, Lampe and colleagues (p 1046) detected 1561 major coronary events over the 20 year period. The rate of major coronary events fell by an average of 3.6% a year, whereas the rate of first diagnosed angina increased by an average of 2.6% a year. These trends did not differ by social class.
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For newly diagnosed ischaemic heart disease give a statin, aspirin, and 
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Combinations of statins, aspirins, and blockers are associated with the greatest reduction in all cause mortality in patients with a first diagnosis of ischaemic heart disease. In a case-control analysis including 13 029 patients nested within an open prospective cohort study with 1.18 million patients, Hippisley-Cox and Coupland (p 1059) compared odds ratios for risk of death in patients with heart disease who were on different treatment regimens. The addition of an angiotensin converting enzyme inhibitor conferred no additional benefit despite adjusting the analyses for the presence of congestive heart failure.
Underwater birth poses risks for the baby
Although underwater birth promotes natural labour and is a safe and effective form of pain management, it also poses potential risks for the baby. On page 1071, Kassim and colleagues present a case report of a full term infant weighing 3150 g born underwater from a 34 year old, healthy primigravida who had had an uneventful pregnancy. Shortly after birth the baby was admitted to the neonatal intensive care unit with neonatal respiratory stress. The authors believe that the problem was aspiration of the birthing pool water.
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Computer program can identify cheating
A computer program can successfully identify cheating and could be used as part of the quality assurance process of multiple choice medical examinations. McManus and colleagues (p 1064) used Acinonyx to detect anomalous pairs among 11 518 candidates taking a postgraduate medical examination in the United Kingdom. The program examined over 6 million pairs of candidates and identified 13 pairs of candidates who may have cheated. Subsequent analysis of the seating plans showed that it was physically possible that all 13 pairs cheated.
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Mendelian randomisation empowers epidemiology
Mendelian randomisation—use of genetic variations as proxies for modifiable environmental risk factors in observational studies—is a powerful new strategy in epidemiological research. On page 1076, Davey Smith and Ebrahim explain what mendelian randomisation is and how it can be used better to understand, for example, health related behaviours. Although the authors acknowledge the limitations of the new method, they think that it could hold the key to better targeting of future public health prevention programmes.
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Allocation concealment is neglected in papers and protocols
Allocation concealment is inadequately reported in most published randomised controlled trials, as well as in the corresponding trial protocols. In a cohort study of 102 sets of publications and trial protocols approved by the scientific and ethical committees for Copenhagen and Frederiksberg, Pildal and colleagues (p 1049) found that allocation concealment was not clearly reported in 96 out of 102 published articles. Protocols of only 15 of these 96 trials had adequate allocation concealment (16%, 95% confidence interval 9% to 24%).
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