This week in the BMJ
Volume 332, Number 7551, Issue of 20 May 2006Ethnicity can affect risk of adverse drug reactions
Ethnicity can affect risk of adverse drug reactions
Patients from different ethnic groups have different risks for adverse reactions to cardiovascular drugs. McDowell and colleagues (p 1177) carried out a meta-analysis of 24 studies containing information on adverse reactions to cardiovascular drugs in at least two different ethnic groups. Among other differences, they found that black patients had a relative risk of angio-oedema due to angiotensin converting enzyme inhibitors of 3.0 compared with non-black patients, and a relative risk of intracranial haemorrhage due to thrombolytic drugs of 1.5. Given these results, studies investigating drug treatment should report racial and ethnic classification more fully.
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Family-style mealtimes are good for nursing home residents
Family-style mealtimes can help maintain quality of life, physical performance, and body weight of nursing home residents with chronic somatic diseases. Nijs and colleagues (p 1180) examined these outcomes for 178 residents (mean age 77 years) in five Dutch nursing homes in a cluster randomised trial. Residents randomised to the intervention took their meals in a family style for six months, whereas the control residents had their meals served individually. The differences between the two groups were significant for overall quality of life, fine motor function, and body weight.
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A second prion protein genotype may be susceptible to vCJD
People with methionine homozygosity at codon 129 in the prion protein gene (PRNP) may not be the only subgroup to be susceptible to variant Creutzfelt-Jakob disease (vCJD). Ironside and colleagues (p 1186) analysed DNA from two appendix tissues which had tested positive for disease associated prion protein in a recent retrospective prevalence study. They found that both were homozygous for valine at codon 129 of PRNP. Individuals belonging to this subgroup may be susceptible to vCJD and have prolonged incubation periods, meaning they could act as asymptomatic carriers, the authors warn.
School based HIV education courses should be more successful
A rigorously designed and implemented HIV education course in 40 Mexican high schools did not reduce risky sexual behaviour. Walker and colleagues (p 1189) randomised 10 954 pupils to one of three educational courses—a 30 hour HIV education course which promoted condom use, the same course with emergency contraception as back-up, or to the existing sexual education course. Although knowledge of HIV improved in both intervention arms, reported condom use was the same in all arms. However, these results might be partly due to country-specific cultural and economic limitations of access to contraception.
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HIV positive children were underdosed with antiretrovirals
On current best evidence, UK and Irish children infected with HIV have been underdosed with antiretroviral drugs in the past nine years. Menson and colleagues looked at doses of antiretroviral drugs for 615 HIV infected children aged 2-12 years (p 1183). The proportion of time when children were prescribed less than 90% of the current recommended dose varied between 6% and 62%. The authors say that the reasons for suboptimal doses, which may also be relevant to other paediatric prescribing, included poor pharmacokinetic data at licensing, guidelines stating alternative dosage strategies, and failure to adjust for children's growth.
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