This week in the BMJ

Volume 332, Number 7533, Issue of 14 Jan 2006

[Down]Women with diabetes are more at risk of fatal CHD than men
[Down]HPV triage could be cost effective
[Down]Neurotropic viruses are associated with cerebral palsy
[Down]Poverty, unemployment and raw milk are associated with TB in Russia
[Down]"Treat first, endoscope later" in GORD

Women with diabetes are more at risk of fatal CHD than men

Type 2 diabetes increases the risk of dying from coronary heart disease (CHD) by up to 50% more in women than in men. Huxley and colleagues (p 73) carried out a meta-analysis of 37 prospective cohort studies that included more than 445 000 cases—four times as many as in previous reviews. In the 29 studies with multiple adjusted estimates, they found a relative risk (female:male) of 1.46 (95% CI 1.14 to 1.88). This may be a consequence of diabetes inducing a more adverse cardiovascular risk profile in women, combined with possible disparities in treatment of cardiovascular disease that favour men, say the authors.


Figure 1
 Credit: IMAGE SOURCE/REX

 



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HPV triage could be cost effective

Using adjunctive testing for human papillomavirus (HPV) to triage women who have borderline and mildly dyskaryotic cervical smears costs more than repeat cytology, but it saves slightly more lives and could be cost effective in the long term. Legood and colleagues (p 79) modelled screening data of more than 10 000 women aged 25-64 from three centres participating in NHS pilot studies (p 83) which found that HPV triage leads to reduced rates of repeat smears but increased referrals to colposcopy.


Figure 1
 Credit: SPL

 



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Neurotropic viruses are associated with cerebral palsy

Perinatal exposure to neurotropic viruses is associated with a higher risk of cerebral palsy. In a laboratory based case-control study using dried blood from the newborn screening cards of 443 children with cerebral palsy and 883 controls, Gibson and colleagues (p 76) tested for viral nucleic acids from enteroviruses and herpesviruses and found a prevalence of herpes B group viruses of 12.1% for cerebral palsy cases and 7.6% for controls. The high prevalence of viral nucleic acids in the control group (39.8%) suggests that triggers are needed before brain damage can occur, say the authors.


Figure 1
 Credit: LIBBY WELCH/WELLCOME PHOTO LIBRARY

 



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Poverty, unemployment and raw milk are associated with TB in Russia

Exposure to raw milk and unemployment may be the most important contributors to tuberculosis in Russia. Coker and colleagues (p 85) carried out a case-control study on exposure to various risk factors before and during the development of pulmonary tuberculosis (TB) in 334 cases and 334 matched controls. A history of either imprisonment or detention in pretrial centres was highly associated with risk of tuberculosis, but because of the small numbers involved, incarceration does not contribute greatly to the overall burden of tuberculosis in Russia: the population attributable risk is only 0.8% for incarceration compared with 28% for being unemployed.


Figure 1
 Credit: WHO

 



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"Treat first, endoscope later" in GORD

A clinical review of gastro-oesophageal reflux disease (GORD) on p 88 finds enough evidence on the use of acid suppression in patients with "typical reflux symptoms" but only a few large and well done studies investigating patients with atypical symptoms and non-erosive oesophagitis, in whom acid suppression is less effective. Fox and Forgacs explain why the approach has shifted to looking at GORD as a family of diseases. The new model shifts attention to oesophageal symptoms, rather than injury to the oesophageal mucosa, and the corresponding shift in the NICE guidelines to "treat first, endoscope later" should benefit endoscopy negative patients with severe symptoms, they say.



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