This week in the BMJ
Volume 332, Number 7544, Issue of 1 Apr 2006What predisposes women to chronic pelvic pain?
What predisposes women to chronic pelvic pain?
Several gynaecological and psychosocial factors are strongly associated with chronic and recurrent pelvic pain. Latthe and colleagues carried out a comprehensive systematic review (p 749) of 122 studies evaluating over 60 risk factors for dysmenorrhoea, dyspareunia, and non-cyclical pelvic pain. They found strong associations between all types of chronic pelvic pain and pelvic pathology, history of abuse, and psychological morbidity. Randomised controlled trials of interventions targeting the potentially modifiable key factors are needed to assess their clinical relevance, say the authors.
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Psychosocial care in nursing homes reduces drug use
Training and support for nursing home staff in psychosocial care reduces the need for neuroleptics among nursing home residents with severe dementia. In a study of 12 UK nursing homes, Fossey and colleagues (p 756) randomised half to a 10 month training and support intervention for staff that focused on alternatives to drugs for managing agitated behaviour by demented residents. At 12 months the proportion of residents taking neuroleptics in the intervention homes was 19% lower than in the control homes without worsening behavioural symptoms.
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Benefits of omega 3 fats may be in doubt
Omega 3 fats may have no effect on total mortality, combined cardiovascular events, or cancer. Hooper and colleagues (p 752) carried out a meta-analysis of randomised control trials and cohort studies of long chain and shorter chain omega 3 intake for at least six months in adults with or without risk factors. Trial results were inconsistent, and the study's pooled estimates showed no strong evidence of reduced mortality or cardiovascular events in participants taking additional omega 3 fats. However, they also showed no increased risk of cancer or stroke (suspected hazards) with higher omega 3 intake.
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What are the risks for couples with a balanced structural chromosome abnormality?
Couples found to be carrying a balanced structural chromosomal abnormality after two or more miscarriages are at low risk of having a viable offspring with unbalanced chromosomal abnormalities (that is, with major congenital defects). In a case-control study of 278 carrier couples and 427 non-carrier couples who had had two or more miscarriages, Franssen and colleagues (p 759) looked at reproductive outcomes over at least 24 months. The carrier couples' chances of having a healthy child were as high as those of the non-carrier couples, but they had a higher risk of miscarriages.
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Action research helps develop a pre-medicine summer school
An action research format might be effective in engaging schools and pupils in the design and delivery of a "widening access" summer school for pupils from socioeconomically deprived background with an interest in studying medicine. Greenhalgh and colleagues (p 762) carried out an action research study in five phases—school liaison, recruitment of pupils and assessment of needs, programme design, programme delivery, and evaluation. The summer school was popular with pupils, parents, teachers, and staff. It substantially raised pupils' confidence and motivation to apply to medical school.
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