This week in the BMJ
Volume 331, Number 7507, Issue of 2 Jul 2005Open letter to Tony Blair about Africa
Open letter to Tony Blair about Africa
On p 46, Lavy—a British surgeon working in Africa—writes an open letter to Prime Minister Tony Blair as the world leaders prepare to discuss Africa at the G8 summit. Lavy points to omissions in the recent reports of the Commission for Africa and gives his perspective of the continent's health needs, focusing particularly on the escalating number of road traffic injuries and deaths, and adding that most people injured on the roads have little chance of adequate care. Lavy proposes that the United Kingdom starts giving 1% of its national income to development aid, instead of the current 0.7%.
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CRP should not guide antibiotic prescription in pneumonia
Testing for C reactive protein (CRP) is neither sensitive nor specific enough to be used to guide antibiotic prescription in patients with pneumonia. In a systematic review, van der Meer and colleagues (p 26) included all studies that compared C reactive protein testing with a chest radiograph or a microbiology work-up as a reference test. The authors conclude that with sensitivities ranging from 8% to 99% and specificities from 27% to 99%, testing for C reactive protein is neither sensitive enough to rule out nor sufficiently specific to rule in bacterial aetiology of lower respiratory tract infection.
Globalisation is imposing Western views of mental health
Globalisation is resulting in inappropriate domination by the Western view of mental health, yet child psychiatrists in the West could gain valuable new knowledge from examining childcare practices across the world, argues Timimi on p 37. She warns that a Western value system that promotes individualism, weakens social ties, and creates ambivalence towards children could adversely affect children's mental health. On the other hand, values found in many non-Western cultures, such as duty, responsibility, and a community orientation, may promote psychiatric wellbeing.
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Epilepsy and schizophrenia may share common causes
Patients with epilepsy are about two and a half times more likely to have schizophrenia and almost three times more likely to have schizophrenia-like psychosis than people without epilepsy. In a population based cohort study that included 2.27 million people from Danish longitudinal registers, Qin and colleagues (p 23) also found that family histories of epilepsy or psychosis were significant risk factors for schizophrenia or schizophrenia-like psychosis and the effect did not differ by type of epilepsy. Also, the effect did not show significant differences between men and women.
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Prevention of postpartum depression should start after delivery
Current evidence shows that preventive psychosocial and psychological interventions—analysed together—do not significantly reduce rates of postpartum depression, but some interventions show more promise than others. A systematic review and meta-analysis by Dennis (p 15) included 15 trials with 7697 women and showed that the interventions reduced the rates of depression but the results did not reach significance (relative risk 0.81, 95% confidence interval 0.65-1.02). The only intervention that had a clear effect was intensive postpartum support by a health professional, and exclusively postpartum interventions were more successful than the interventions that also incorporated a prenatal component. Also, individual therapy proved more effective than group therapy.
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French ethics committees should tackle publication bias
Many research studies approved by French research ethics committees do not get completed or published. Decullier and colleagues (p 19) followed up 649 research protocols approved by 25 committees. Nine out of 10 approved studies were started, of which 86% were completed. Only 38% of the completed studies, however, were published. Moreover, studies with confirmatory results were almost five times more likely to be published than studies with inconclusive results. Authors suggest that ethics committees should prospectively and systematically follow up on the approved protocols, thus reducing the publication bias.
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