This week in the BMJ
Volume 331, Number 7529, Issue of 10 Dec 2005What works for obesity
What works for obesity
To halt the obesity epidemic, interventions that are focused on individuals, such as lifestyle changes and prescribed drugs, are not sufficiently effective; the focus needs to shift to public health interventions. It is ironic, says Jain on p 1387, that although most experts agree that the obesity epidemic is primarily environmental, research has so far been ignoring this factor. This clinical review summarises the evidence for prevention and treatment of obesity, discusses the strengths and weaknesses of current research, and proposes a five part strategy for achieving an evidence based public health approach to the obesity epidemic.
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Nurses should lead UK hospital reform
Doctors, managers, and politicians must recognise and respect the contribution that nurses can and must make to the UK's much needed hospital reform, argues Black on p 1394. He revisits the crucial impact that nurses had in transformation of hospitals in the 19th century and says that nursing is the key to improving the hospital environment and to reducing the need for hospital care. The British public, which is losing faith in hospitals, is primarily concerned by the high rates of MRSA (methicillin resistant Staphylococcus aureus), poor food and cleaning, and the risk of medical error.
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We don't know the effects of paying doctors for trial recruitment
Evidence on the effects of paying doctors for recruiting participants to trials is scarce and inconclusive. In a systematic review (p 1377), Bryant and Powell found only a few studies of inadequate quality. Given the important associated issues such as potential conflict of interest, implications for informed consent and the doctor-patient relationship, and resource implications, the authors argue that robust evidence from well conducted trials is needed before publicly funded research programmes can consider adopting many pharmaceutical companies' practice of paying doctors for recruitment.
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Resistance to HIV drugs is high in the UK
The prevalence of primary resistance to HIV drugs in the United Kingdom is one of the highest reported in the world. In a multicentre observational study that included more than 2300 HIV positive people, the UK Group on Transmitted HIV Drug Resistance (p 1368) found that the prevalence of resistance was almost 15% and has increased markedly over time. The risk of being resistant was only weakly related to demographic and clinical factors such as ethnicity and viral subtype.
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Cannabis increases the risk of car crashes
Driving under the influence of cannabis increases the risk of having a fatal car crash. In a population based case-control study in France (p 1371), Laumon and colleagues estimated that nearly 3% of drivers use cannabis and they are more than three times as likely to be held responsible for a fatal car crash as drivers who don't use cannabis. Cannabis use and alcohol use were similar among the French drivers (2.9% and 2.7%, respectively), but alcohol seems to be causing significantly more fatal crashes than cannabis (28.6% v 2.5%).
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