This week in the BMJ
Volume 333, Number 7569, Issue of 23 Sep 2006Acupuncture may help in non-specific low back pain...
Acupuncture may help in non-specific low back pain...
Referral to a qualified acupuncturist seems safe and acceptable to patients with persistent non-specific low back pain, say Thomas and colleagues (p 623). They randomised 241 adults with non-specific back pain of 4-52 weeks' duration to 10 individualised treatments with traditional acupuncture over three months or to usual care. They found weak evidence that a short course of acupuncture has an effect on low back pain at 12 months and stronger evidence of a small benefit at 24 months. The acupuncture group had a 10-15% better outcome in the final pain score compared with control.
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... and seems to be cost effective in the long term
In a related cost-effectiveness analysis, Ratcliffe and colleagues (p 626) compared the costs of acupuncture and usual care, and examined the incremental cost of acupuncture per quality adjusted life year (QALY) gained over two years. They found that total costs were higher on average for the acupuncture group because of the costs associated with initial treatment, but also that acupuncture seemed to be cost effective if decision makers are willing to pay up to £20 000 per QALY gained.
Obesity may bankrupt health services
The obesity epidemic in the UK is out of control, and none of the measures being taken shows signs of halting the problem, let alone reversing the trend, say Haslam and colleagues on page 640. This first article in the ABC series of obesity examines the health consequences and economic costs of obesity and discusses why there is only a limited time to save the health service from going bankrupt because of the complications of obesity. It also explains how early treatment and prevention offer many long term health benefits, and why they are the only way towards a sustainable health service.
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Fast breathing is not enough to diagnose childhood pneumonia
Many children who have non-severe pneumonia diagnosed on the basis of the current WHO definition (fast breathing alone) have no radiological evidence of pneumonia. In a descriptive analysis Hazir and colleagues (p 629) evaluated the chest radiographs of 1848 children aged 2-59 months from outpatient departments in four Pakistan cities with clinical diagnoses of non-severe pneumonia. Only 14% of the chest radiographs showed radiological evidence of pneumonia, and 82% were reported as normal. WHO definitions of pneumonia need to be more specific, mainly to improve the rational use of antibiotics, conclude the authors.
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How to manage oral malodour?
Oral malodour (halitosis) is common in people of all ages, and poor oral hygiene is the most common cause, say Porter and Scully (p 632). This clinical review discusses the common causes of halitosis—such as local bacterial production, oral disease, respiratory disease, and volatile foodstuffs—and the rarer causes such as systemic disorders, drugs, and psychological reasons for those with subjective halitosis. The authors describe how halitosis is diagnosed and assessed, and explore different treatment options, saying that improving oral hygiene and perhaps tongue cleaning are usually effective.
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