This week in the BMJ
Volume 332, Number 7545, Issue of 8 Apr 2006Assertive mental health service improved engagement
Assertive mental health service improved engagement
Compared with usual care from community mental health teams, assertive community treatment teams in the London boroughs of Camden and Islington improved people's satisfaction and the quality of engagement with the services but didn't seem to offer other advantages. In a non-blinded randomised trial that included 251 people with serious mental illnesses who initially had high use of inpatient care and difficulties in engaging with community services, Killaspy and colleagues (p 815) found no difference between the groups in inpatient service use or in clinical or social outcomes over 18 months.
|
![[To top]](/icons/back.gif){kind=icon}
Could screening for amblyopia be better targeted?
Amblyopia doesn't seem to affect educational, professional, social, or health outcomes. Rahi and colleagues (p 820) used data from the 1958 British birth cohort, which included about 400 people with amblyopia, to assess the effect that the condition had had on their lives over four decades. Compared with over 8000 people without amblyopia from the same cohort, people with amblyopia do as well in education and occupation, behaviour and social functioning, and had similar health outcomes. The authors say that screening may be better targeted at patients with moderate or severe amblyopia than at whole populations.
|
Anxiety and depression in childhood may raise risk of ecstasy use
Adolescents who had symptoms of anxiety and depression in childhood seem more than twice as likely to use the recreational drug ecstasy (3,4-methylenedioxymethamphetamine, MDMA) than adolescents without such a history. Huizink and colleagues (p 825) conducted a prospective, longitudinal, population based study of over 1500 people in a Dutch province, with a follow-up of 14 years (response rate almost 80%). They found an increased risk of ecstasy use (hazard ratio 2.22 (95% confidence interval 1.20 to 4.11). Since ecstasy was not available in the Netherlands at the time of the baseline testing for anxiety and depression, the results support the view that symptoms of anxiety and depression can cause ecstasy use, says Poikolainen (p 803) in the accompanying editorial.
|
Ethnic groups and differences in hypertension
On p 833, Brown discusses the evidence for differences between ethnic groups in terms of pathogenesis, prevalence, complications, and treatment of hypertension. Hypertension in young white people seems to be high renin (type 1) hypertension and best responds to treatment with angiotensin converting enzyme inhibitors and 
blockers (AB drugs). Hypertension in young black people, however, seems to be low renin (type 2) hypertension and responds better to calcium channel blockers and diuretics (CD drugs). Differences in responses to treatment are yet to be studied in most ethnic groups and are important for our understanding of hypertension, says the author.
|
Biomedical research in developing countries needs local regulation
The autonomy of people who participate in biomedical trials in developing countries is not adequately protected by reliance on international laws and guidelines, argues Chima (p 848). He discusses how these are undermined by exceptions favouring researchers and sponsors from developed countries. He proposes that new local laws in developing countries be focused on the procedures for informed consent, local research ethics committees, standards of care, and distributive justice.
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
