This week in the BMJ
Volume 332, Number 7550, Issue of 13 May 2006Statins show greater benefit for diabetic patients
Statins show greater benefit for diabetic patients
Lipid lowering drugs significantly reduce cardiovascular risk, but they may be especially effective in patients with diabetes. Costa and colleagues (p 1115) carried out a meta-analysis of 12 randomised controlled trials with follow-ups of at least three years that evaluated lipid lowering drug treatment in patients with or without type 2 diabetes.
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Risk reductions in primary and secondary prevention were similar in both groups, but, after adjustment for baseline risk, the diabetic patients showed greater benefit.
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Sample size considerations are under-reported in studies of diagnostic accuracy
Studies on the accuracy of diagnostic tests rarely report considerations of sample size, and their sample sizes tend to be small. Bachmann and colleagues (p 1127) conducted a literature survey of studies on diagnostic accuracy in all issues of eight major medical journals published in 2002: of the 43 studies analysed, only two reported that they considered sample size. The number of participants in most studies was probably too small to analyse variability of measures of accuracy across patient subgroups, conclude the authors.
Adolescent obesity is established in childhood
Persistent obesity in adolescents may be established well before the age of 11. Wardle and colleagues (p 1130) recruited more than 5800 pupils aged 11-12 years from 36 London schools and found 25% to be overweight or obese. Over the five years of follow-up, the prevalence of obesity increased at the expense of overweight, but the proportion of pupils with a body mass index within the healthy range stayed the same. Efforts to prevent obesity should therefore be targeted in the early years, say the authors.
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Cerebral emboli are linked with Alzheimer's disease and vascular dementia
Spontaneous cerebral emboli are significantly associated with both Alzheimer's disease and vascular dementia and may be involved in the pathophysiology of both conditions. Purandare and colleagues (p 1119) compared the occurrence of spontaneous cerebral emboli and venous to arterial circulation shunts in 170 patients with dementia (Alzheimer's disease or vascular dementia) and 150 controls. They found significant odds ratios for spontaneous cerebral emboli of 2.70 and 5.36 for Alzheimer's disease and vascular dementia, and non-significant odds ratios for venous to arterial circulation shunts. Cerebral emboli may represent a preventable and treatable cause of both types of dementia, say the authors.
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Delayed hospital access in the West Bank may worsen medical conditions
Patients whose transportation to emergency departments was delayed because of checkpoints or detours during the armed conflict in the Palestinian West Bank had a higher hospital admission rate than those who were not delayed. Heilskov Rytter and colleagues collected data for all 2228 patients who presented to the emergency departments of three West Bank hospitals during one week (p 1122). Of the 18% of patients who were delayed because of the occupation, 32% were admitted to hospital—compared with only 13% of those who were not delayed, suggesting that restriction in hospital access may influence the severity of the medical conditions presented.
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