This week in the BMJ

Volume 332, Number 7540, Issue of 4 Mar 2006

[Down]Oral misoprostol is safe for induction of labour at term
[Down]AUDIT to identify alcohol use disorders in primary care
[Down]Why do people die where they do?
[Down]Wine buyers buy healthier food than beer buyers
[Down]Work stress is associated with metabolic syndrome

Oral misoprostol is safe for induction of labour at term

For inducing labouroral misoprostol solution does not lead to poorer health outcomes than vaginal prostaglandin gel. In a double blind, placebo controlled trial, Dodd and colleagues (p 509) randomised 741 women whose attending obstetrician had decided to induce labour (at 36+6 weeks' gestation or greater) either to oral misoprostol—a prostaglandin E1 analogue—or to vaginal prostaglandin. They found that the two groups had similar rates of caesarean section, vaginal birth not achieved in 24 hours, and uterine hyperstimulation with fetal heart rate changes—but the women preferred oral treatment.


Figure 1
 Credit: BSIP, VILLAREAL/SPL

 



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AUDIT to identify alcohol use disorders in primary care

A short questionnaire might be more effective than biochemical markers in identifying patients with alcohol use disorders in an opportunistic screening programme. In a comparative study by Coulton and colleagues (p 511), about 200 men attending primary care completed the alcohol use disorders identification test (AUDIT) questionnaire, and their blood samples were assessed for {gamma}-glutamyltransferase, aspartate aminotransferase, and other markers. The questionnaire had higher sensitivity, specificity, and positive predictive value and was more cost efficient than biochemical markers.


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 Credit: JOHN POWELL/REX

 



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Why do people die where they do?

A complicated network of factors influences where patients with cancer die, a systematic review of 58 studies with more than 1.5 million terminally ill cancer patients has discovered. Gomes and Higginson (p 515) found consistent evidence for the effect of 17 factors on place of death, six of which were strongly associated with dying at home. Policies to enable people to die at home should focus on the empowerment of families, public education, home based models of care, assessment of risk, and training of practitioners in palliative care, say the authors.


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 Credit: JUSSI NUKARI/REX

 



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Wine buyers buy healthier food than beer buyers

People who buy—and presumably drink—wine make more purchases of healthy food items than people who buy beer. In a cross sectional study, Johansen and colleagues (p 519) analysed data from 3.5 million transactions in 98 supermarkets in Denmark and found that customers who bought wine were more likely to buy "Mediterranean" food items (fruit or vegetables, poultry, cooking oil, and low fat products) than people who bought beer, and beer buyers tended to buy more "traditional" food items (ready cooked dishes, sausages, and soft drinks) than those who bought wine.


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 Credit: JOHN SLATER/TAXI/GETTY

 



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Work stress is associated with metabolic syndrome

Stress at work is an important risk factor for metabolic syndrome. In a prospective cohort study by Chandola and colleagues (p 521), more than 10 000 men and women employed in 20 London civil service departments and aged 35-55 at baseline were followed up for an average of 14 years. Employees with chronic work stress were more than twice as likely to develop metabolic syndrome than those without work stress (odds ratio 2.25, 95% CI 1.31 to 3.85). This provides evidence for the biological plausibility of the link between psychosocial stressors from everyday life and heart disease, say the authors.


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 Credit: PHOTOS.COM

 



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