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Press releases Saturday 30 September 2006

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).

(1) TWINS HAVE SIMILAR SCHOOL PERFORMANCE TO SINGLE-BORN CHILDREN

(2) STEROID INJECTIONS DO NOT PROVIDE LONG-TERM RELIEF FROM TENNIS ELBOW

(3) CRIMINALISING HIV TRANSMISSION IS A THREAT TO PUBLIC HEALTH, SAY EXPERTS

(4) WAITING FOR TRIAL RESULTS SOMETIMES UNETHICAL

(1) TWINS HAVE SIMILAR SCHOOL PERFORMANCE TO SINGLE-BORN CHILDREN

Online First
(Comparison of academic performance of twins and singletons in adolescence: follow-up study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38959.650903.7C

Twins have similar academic performance to single-born children, finds a large Danish study published online by the BMJ today.

These findings challenge earlier research that show twins have considerably lower IQ in childhood than singletons.

Using the Danish national birth register, researchers identified 3,411 twins and a random sample of 7,796 singletons born in Denmark during 1986-8. They also gathered information on birth weight, gestational age at birth, and parents’ age and education.

At ninth grade (age 15 or 16), they analysed school test results and found almost identical scores for twins and singletons, despite the twins weighing on average 908 g less than the singletons at birth. In fact, twins did slightly better in mathematics than singletons.

Taking into account factors such as the child’s sex, age at test, birth weight, and parents’ education made little difference.

Birth weight had a minimal effect on test scores although twins of extremely low birth weight more often did not have a ninth grade test registered.

The authors suggest that better obstetric and paediatric practices over the past 50 years have improved the cognitive disadvantage identified in twins by earlier research.

Contact:

Professor Kaare Christensen, Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark
Email: kchristensen@health.sdu.dk

(2) STEROID INJECTIONS DO NOT PROVIDE LONG-TERM RELIEF FROM TENNIS ELBOW

Online First
(Randomised comparison of three interventions for Tennis Elbow: mobilisation with movement and exercise, corticosteroid or wait and see)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38961.584653.AE

Physiotherapy or a ‘wait and see’ approach are both more effective in tackling tennis elbow than corticosteroid (steroid) injections, a BMJ study reveals today.

Researchers in Australia tested different treatments on three separate groups of patients with tennis elbow. One group of participants were allocated the ‘wait and see’ approach – they were reassured that the condition would eventually settle down and encouraged to wait. They were also given specific instructions on modifying their daily activities so to avoid aggravating their pain.

A second group were given a local corticosteroid injection and advised to gradually return to normal activities. The final group received eight treatments of physiotherapy of 30 minutes over six weeks and were taught home exercises and self-manipulation. The physiotherapy group also received a resistant exercise band and exercise instruction booklet. Each group’s progress was measured at six weeks, and again after a year.

Initially, corticosteroid injections were the most successful treatment, with 78% of those in the group reporting improvements, followed closely by physiotherapy with a 65% success rate when compared to just 27% in the ‘wait and see’ group.

However, after 52 weeks the injection group rates of improvement were significantly worse than those of the physiotherapy group. The injection group also had the most reported recurrences, with 72% of participants’ condition deteriorating after three or six weeks – which could be due, in part, to a quicker initial recovery leading to greater use and over-taxing of the elbow.

The research also found that the superior long-term effects of physiotherapy were replicated by the wait and see approach – at the end of the study participants in both the physiotherapy and wait and see group had either much improved or completely recovered.

The authors say that “the…poor overall performance of corticosteroid injections should be taken under consideration by both the patient and their doctor in management of tennis elbow.”

The study findings also support the idea that tennis elbow is, in most cases, a self-limiting condition. They conclude that “patients with tennis elbow can be reassured that, in the majority of cases, they will improve in the long-term when given information and ergonomic advice about their condition.”

Contact:

Bill Vicenzino, Associate Professor, School of Health and Rehabilitation Sciences, The University of Queensland, Australia
Email: b.vicenzino@uq.edu.au

(3) CRIMINALISING HIV TRANSMISSION IS A THREAT TO PUBLIC HEALTH, SAY EXPERTS

(Editorial: Criminal prosecution for HIV transmission: a threat to public health)
http://bmj.com/cgi/content/full/333/7570/666

Experts in this week’s BMJ express serious concerns about the public health impact of criminalising HIV transmission.

The Crown Prosecution Service for England and Wales has issued, for public consultation, new guidance on criminal prosecution for the “sexual transmission of infections which cause grievous bodily harm.” It is likely to be used mostly in relation to HIV.

“Although this attempt to introduce standardised criteria for prosecutions is welcome, we have serious concerns about the public health impact of using the law to criminalise disease transmission,” say Ruth Lowbury of the Medical Foundation for AIDS and Sexual Health and George Kinghorn of the Royal Hallamshire Hospital.

The government has made it a policy priority to increase uptake of HIV testing and is funding prevention programmes in England for the population groups most at risk. Services around the country offer voluntary testing, confidential partner notification, and education and support for affected individuals and their partners.

Crucially, these measures rely on a relationship of trust and confidence between patients and healthcare professionals, but the sustainability and success of this approach are hugely threatened by the policy of criminal prosecution, they argue.

Already there are indications that this use of the criminal law is having unintended negative consequences. Awareness is spreading among those infected with HIV that they face the threat of criminal prosecution, while media coverage has vilified those convicted as “AIDS assassins,” exacerbating the stigma already associated with infection.

No wonder those unlucky enough to become infected often choose to keep their status a secret, they write.

Individuals in this situation need help and support to plan how and to whom they will disclose their status, and to find strategies for protecting others from infection.

An estimated 20,000 people in the UK have HIV which is still undiagnosed, they add. There is a clear disincentive to testing when prosecution relies on defendants knowing they are infected. Meanwhile, those who do take the test may not agree to their partners being notified for fear of legal repercussions, thereby jeopardising essential public health control efforts.

Doctors need guidance on whether the potential for criminal prosecutions changes their legal and ethical duty of confidentiality, and how to advise their HIV positive patients, who may become “victims” or “defendants” if a prosecution occurs. There is also an urgent need for further research, to see whether criminalisation may be leading to reductions in uptake of HIV tests.

Putting aside the difficulties in attributing who infected whom, they conclude that, in the case of criminal prosecution for reckless transmission of HIV, the public interest is not best served by pursuing justice against the few at the expense of the health of the many.

Contact:

Ruth Lowbury, Executive Director, Medical Foundation for AIDS & Sexual Health, BMA House, Tavistock Square, London, UK Tel (until 4pm, Thurs 28 Sept): +44 (0)20 7383 6315; After 4pm, contact press office: +44 (0)20 7383 6529 Email: rlowbury@medfash.bma.org.uk

(4) WAITING FOR TRIAL RESULTS SOMETIMES UNETHICAL

(Parachute approach to evidence based medicine)
http://bmj.com/cgi/content/full/333/7570/701

Waiting for the results of randomised trials of public health interventions can cost hundreds of lives, especially in poor countries. Researchers in this week’s BMJ argue that, if the science is good, we should act before the trials are done.

Randomised controlled trials are usually required before new interventions are implemented. But in 2003, the BMJ published an article about the lack of trials on parachutes to show that situations still exist where such trials are unnecessary.

This week, US researchers use examples from poor countries to show how an overemphasis on randomised controlled trials poses important ethical and logistical problems and may incur avoidable deaths.

In all three examples, the parachute approach has the potential to save tens of thousands of lives, say the authors. For instance, many lives could have been saved if male circumcision had been provided on a large scale from the early 1990s, when data showed that it protected against HIV, instead of waiting 10 to 15 years for more evidence.

Similarly, thousands of women could have been saved if a drug to control blood loss after childbirth was made available in remote areas. But the World Health Organisation has not added it to the essential drugs list because of a lack of evidence from randomised trials in home settings.

The authors stress that randomised controlled trials are needed and, when appropriate, should be part of the empirical evidence necessary for decision making. The question is how much evidence is needed to move from research to practice, when the matter is life saving interventions in poor settings.

The yardstick for decision making should take into account the risks and benefits in the local conditions, not those of an ideal situation, they conclude.

Contact:

Ndola Prata, School of Public Health, University of California, Berkeley, CA, USA
Email: ndola@berkeley.edu

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs DivisionBMA HouseTavistock SquareLondon WC1H 9JR
(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for theAdvancement of Science(http://www.eurekalert.org)