This week in the BMJ
Volume 333, Number 7564, Issue of 19 Aug 2006Chinese women want small families and male children
Chinese women want small families and male children
Since the Chinese policy of one child per family began in 1979, total birth rate and preferred family size have decreased, and a gross imbalance in the sex ratio has emerged. Ding and Hesketh (p 371) analysed data for almost 40 000 women collected by the Chinese National Family Planning Commission in 2001. Women's average fertility had decreased from 2.9 before the policy began by about one, the male to female ratio had increased from 1.11 in the 1980s to 1.23, and most women said they would prefer to have one or two children. However, the authors warn that the women might not have been willing to reveal violations of the rules.
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Hyperbaric oxygen may help neonatal hypoxic-ischaemic encephalopathy
Hyperbaric oxygen, a treatment frequently used in China, may reduce mortality and neurological sequelae in neonates with hypoxic-ischaemic encephalopathy. For this systematic review, Liu and colleagues (p 374) searched Western and Chinese databases and identified 20 Chinese trials comparing hyperbaric oxygen treatment with "usual care" for the severe neonatal condition. Hyperbaric oxygen produced better outcomes in most trials, but reporting of methods was poor by Western (CONSORT) standards. A good randomised controlled trial is needed to investigate the findings, conclude the authors.
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Serum vitamin B-12 assay results can mislead
When interpreting results of serum vitamin B-12 assays it is important to take into account the overall clinical picture. Devalia (p 385) describes two cases of paradoxical vitamin B-12 results, where meticulous clinical assessment—including assessment of autoimmune conditions and taking a family history—helped to decide on the best treatment. The first patient had symptoms and a family history of pernicious anaemia, macrocytic anaemia, and thyroid disease. Despite this three vitamin B-12 assays were normal. However, the patient responded fully to vitamin B-12 replacement therapy, and immunological analysis confirmed pernicious anaemia, preventing a potential misdiagnosis of myelodysplasia, which requires much more aggressive therapy. For more detail and the second case, please go to page 385.
Women exposed to environmental tobacco smoke have increased mortality
In non-smoking Chinese women exposure to environmental tobacco smoke is related to moderately increased mortality from all causes, from lung cancer, and from cardiovascular disease. Wen and colleagues (p 376) analysed data of over 72 000 women who had never smoked and found that exposure to tobacco smoke from husbands was associated with increased mortality from all causes and from cardiovascular disease. Exposure to environmental tobacco smoke at work was associated with increased mortality from cancer, especially lung cancer.
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How to manage psoriasis
Because of its chronic, incurable nature, psoriasis is associated with substantial morbidity. Anxiety and depression affect up to 25% of patients, and are often missed. Patients with severe disease also have an increased risk for cardiovascular disease. The clinical review by Smith and Barker (p 380) revisits the causes and diagnosis of this inflammatory skin disease, describes its significant clinical effects and comorbidities, outlines the treatment options (from topical therapy to recently licensed biological treatments), and discusses how treatment should be provided.
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