This week in the BMJ

Volume 332, Number 7547, Issue of 22 Apr 2006

[Down]Education improves long term control of eczema
[Down]Delaying operation after hip fracture increases death rate
[Down]Preterm births have risen in Denmark in low risk women
[Down]Atorvastatin may cause nightmares
[Down]Online cancer support groups can police themselves

Education improves long term control of eczema

Educational programmes targeted at specific age groups of children and adolescents improve the control of atopic dermatitis. In a randomised controlled trial Staab and colleagues (p 933) delivered a weekly educational session to parents of children aged 3 months to 7 years and 8-12 years and to adolescents aged 13-18. The control group received no education. Dermatitis was significantly less severe in intervention groups at 12 months. The parents' quality of life also improved—as measured by all five quality of life subscales in parents of children aged less than 7 years and by three subscales in parents of children aged 8-12 years.


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Credit: IAN BODDY/SPL



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Delaying operation after hip fracture increases death rate

Delay in operating after hip fracture increases the risk of death in hospital. Bottle and Aylin (p 947) used inpatient hospital episode statistics to assess 129 522 admissions for fractured neck of femur across 151 trusts in England. After adjusting for comorbidity, they found that the odds of dying in hospital after a delay of more than one day relative to one day or less was 1.27 (95% CI 1.23 to 1.32). Emergency readmission within 28 days of discharge was not associated with delayed operations. The extent of delays varied widely between trusts.


Figure 1
 Credit: WELLCOME PHOTO LIBRARY

 



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Preterm births have risen in Denmark in low risk women

The rate of spontaneous preterm births in low risk primiparous women increased by 51% from 1995 to 2004 in Denmark, while the increase in all pregnant women was only 22%. Langhoff-Roos and colleagues (p 937) assessed 99.8% of deliveries over the nine years and found that primiparity and multiple birth were the most important risk factors for preterm birth. The reason for the disproportionate increase in low risk women is unclear, but using these authors' criteria to identify standard populations of primiparous women at low risk in other countries will make international comparisons of preterm delivery rates possible.


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 Credit: TINA STALLARD/SPL

 



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Atorvastatin may cause nightmares

A 72 year old women developed nightmares five days after taking atorvastatin for hypercholesterolaemia, reports Smak Gregoor (p 950). The nightmares occurred every night for two and a half weeks and stopped when atorvastatin was discontinued. A rechallenge prompted further nightmares, which again stopped when treatment was discontinued. A link between simvastatin and nightmares has previously been reported but this seems to be the first case of nightmares associated with atorvastatin. The mechanism, the author says, may be a direct effect on the central nervous system, or a pharmacokinetic or pharmacodynamic interaction.


Figure 1
 Credit: CHARLES WALKER/TOPFOTO

 



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Online cancer support groups can police themselves

Amid concerns about the quality of health information on the internet, most postings to an online breast cancer support group are accurate, and misleading postings are usually corrected by subsequent participants. Esquivel and colleagues (p 939) analysed the postings on an unmoderated email list for breast cancer patients and their families over four months in 2005. A mere 0.25% were misleading or false, and most were corrected by participants within four hours. The authors conclude that, given a sufficiently active forum, participants can identify and correct most false or misleading statements quickly and reliably without requiring professional review.


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