This week in the BMJ
Volume 332, Number 7546, Issue of 15 Apr 2006Presence of metabolic syndrome improves mortality risk prediction
Presence of metabolic syndrome improves mortality risk prediction
The presence of the metabolic syndrome helps to predict risk for total and cardiovascular mortality above and beyond the usual cardiovascular disease risk factors, report Sundström and colleagues (p 878), who studied 2300 middle aged men for up to 32 years. When the metabolic syndrome was added to models of established cardiovasular risk factors (smoking, diabetes, hypertension, and serum cholesterol), the risk for total and cardiovascular mortality increased by 40-60%. In a commentary, however, Farmer (p 882) points out that research on the metabolic syndrome has so far yielded mixed results.
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Caution needed over role of MRI in diagnosing multiple sclerosis
Magnetic resonance imaging (MRI) on its own has limited ability to rule out or confirm a diagnosis of multiple sclerosis in patients with a single attack of neurological dysfunction. Whiting and colleagues (p 875) conducted a systematic review of 29 studies that evaluated the diagnostic accuracy of MRI for multiple sclerosis. Most studies were of poor quality and had short term follow-up. Even when MRI showed many lesions, it could not accurately confirm multiple sclerosis. Similarly, the absence of lesions could not accurately rule out the diagnosis.
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Improvements in services haven't matched increased spending in NHS
Service improvements in the NHS in the past seven years have not kept pace with the dramatic increase in spending. Although annual revenue increases of 7% since 2000 have improved services, overall NHS productivity seems to have declined, say Maynard and Street (p 906), and now the service faces large deficits. The authors blame lax spending controls as politicians and managers concentrated on targets for activity together with cost increases driven by NICE's limited powers, generous pay awards, and payment by results. They argue that the NHS needs to give NICE a wider remit, provide incentives for productivity, and measure outcomes.
Mobile phones do not increase risk of glioma...
Mobile phones are not associated with a raised risk of glioma in the short or medium term. In the UK part of an international study of mobile phone use and intracranial tumours, Hepworth and colleagues (p 883) conducted a case-control study that included interviews with almost 1000 patients with a glioma. They found an odds ratio of 0.94 (95% confidence interval 0.78 to 1.13) for glioma for regular phone users compared with those who never or only occasionally used one. Nor was there an association of glioma risk with lifetime years of use, cumulative hours of use, or cumulative numbers of calls.
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...and nor do they cause worse headaches in "sensitive" people
People who report being sensitive to mobile phone signals cannot detect such signals and are no more likely to have worse headaches than people who are not sensitive. Rubin and colleagues (p 886) conducted a double blind, randomised study in which 120 participants were each exposed to three "conditions": a 900 MHz GSM mobile phone signal, a non-pulsing signal, and a sham condition (no signal). Headache severity increased during exposure and decreased immediately afterwards for both sensitive and non-sensitive people. But no significant differences in severity of headaches were found for the three exposure conditions, or between the sensitive and non-sensitive groups. The authors suggest that self reported sensitivity to mobile phone signals may be primarily psychological.
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