This week in the BMJ

Volume 332, Number 7541, Issue of 11 Mar 2006

[Down]Managing atopic eczema
[Down]Low molecular weight heparin preferred in palliative care
[Down]Does IQ explain socioeconomic inequalities in health?
[Down]Hip protectors may not be effective
[Down]Public-private collaboration improves tuberculosis control in India

Managing atopic eczema

Atopic eczema is a complex trait with important (but not well understood) genetic and environmental influences, and its prevalence is rising, say Brown and Reynolds on page 584. Their clinical review on eczema explores its management with emollients and topical steroids for mild to moderate eczema and additionally with second line agents such as calcineurin inhibitors, ultraviolet phototherapy, and systemic azathioprine for more severe forms. It also describes current knowledge on pathophysiology and genetic factors.


Figure 1
 Credit: DOIA

 



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Low molecular weight heparin preferred in palliative care

Palliative care inpatients at risk of thromboembolism find low molecular weight heparin more acceptable than wearing antiembolic stockings. In a qualitative study (p 577), Noble and colleagues interviewed 28 patients with advanced malignancy who were receiving low molecular weight heparin. Many of them thought that thrombophylaxis had a positive effect on their quality of life and gave them a feeling of safety. Thromboprophylaxis guidelines are urgently needed for palliative care inpatient units and hospices, say the authors.


Figure 1
 Credit: TIM EVANS/SPL

 



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Does IQ explain socioeconomic inequalities in health?

IQ may contribute to, but doesn't completely explain, socioeconomic gradients in health. In a prospective cohort study, Batty and colleagues (p 580) assessed IQ, socioeconomic status, mortality, and morbidity of 1347 middle aged people from Scotland and found that indices of socioeconomic position were significantly associated with all the health outcomes they examined. After adjustment for IQ, all associations were weaker and one fifth were reduced to statistical non-significance. In half of the associations, however, the risk of ill health in the socioeconomically disadvantaged group was still twice that of the advantaged group.


Figure 1
 Credit: PETER MARLOW/MAGNUM PHOTOS

 



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Hip protectors may not be effective

Providing padded hip protectors may not reduce the risk of a hip fracture in elderly people who fall. A systematic review of randomised controlled trials by Parker and colleagues (p 571) found no reduction in hip fractures for elderly people living in institutional care who were provided with a hip protector. None of the studies of those living in their own home showed any benefit. Compliance with wearing hip protectors is poor; the authors conclude that unless this can be improved, benefits will be limited.


Figure 1
 Credit: JOHN BIRDSALL

 



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Public-private collaboration improves tuberculosis control in India

In a series of pilot projects for better tuberculosis control in India, collaboration between public tuberculosis programmes and private healthcare providers improved case notification while maintaining good treatment outcomes. Dewan and colleagues (p 574) reviewed surveillance records from public tuberculosis programme projects, evaluation records, and medical literature for Indian public-private mix projects from 1999 to 2004. The authors conclude that such collaborations hold considerable potential to improve tuberculosis control in India.


Figure 1
 Credit: P VIROT/WHO

 



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