Online First articles may not be available until 09:00 (UK time) Friday.
Press releases Saturday 21 April 2007
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) Eating less salt could prevent cardiovascular disease
(2) Health effects of casinos have been ignored, say experts
(3) The growth of betting websites carries added risks for gamblers with Parkinson±s disease
(4) Delirium could be prevented in a third of cases
(4) Counselling after suicide has no effect on grief, but helps prevent feelings of blame
(1) Eating less salt could prevent cardiovascular disease
(Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of
hypertension prevention (TOHP)
BMJ Online First
People who significantly cut back on the amount of salt in their diet could reduce their chances of developing cardiovascular disease by a quarter, according to a report on bmj.com today.
Researchers in Boston also found a reduction in salt intake could lower the risk of death from cardiovascular disease by up to a fifth.
Cardiovascular disease refers to the group of diseases linked to the heart or arteries, for example a stroke or heart disease. While there is already a substantial body of evidence showing that cutting back on salt lowers blood pressure, studies showing subsequent levels of cardiovascular disease in the population have been limited and inconclusive.
This research provides some of the strongest objective evidence to date that lowering the amount of salt in the diet reduces the long term risk of future cardiovascular disease, say the authors of the report.
Researchers followed up participants from two trials completed in the nineties which had been conducted to analyse the effect that reducing salt in the diet had on blood pressure.
All the participants had high-normal blood pressure (pre-hypertension). They were therefore at greater risk of developing cardiovascular disease. 744 people took part in the first Trial of Hypertension Prevention which was completed in 1990, 2382 in the second, which ended in 1995. In both trials participants reduced their sodium intake by approximately 25% - 35% alongside a control group who didn±t cut back on their salt intake.
Detailed information about cardiovascular and other health problems was sought from participants in the earlier trials. As part of this researchers found that participants who had cut back on salt during the trials tended to stick to a lower salt diet compared to those who had been in the control group. In total the researchers obtained information from 2415 (77.3%) participants, 200 of whom had reported some sort of cardiovascular problem.
The reduction in the risk of developing cardiovascular problems as a result of the sodium reduction intervention was substantial. The results showed these pre-hypertensive individuals were 25% less likely to develop cardiovascular problems over the course of the 10-15 years post-trial. There was also a 20% lower mortality rate. This risk reduction was evident in each trial.
To the authors knowledge this study is the first and only study of sufficient size and duration to assess the effects of a low salt diet on cardiovascular problems based on randomised trial data. It provides unique evidence that lowering salt in the diet might prevent cardiovascular disease.
Contacts:
Nancy Cook, Associate Professor, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Email:
ncook@rics.bwh.harvard.edu
Lori Shanks, Media Relations Coordinator, Brigham and Women's Hospital
Email:
ljshanks@partners.org
(2) Health effects of casinos have been ignored, say experts
(Gambling with the nation±s health)
http://www.bmj.com/cgi/content/full/334/7598/828
Decisions about building casinos in the UK have not given enough weight to the potential health effects, argue two doctors in this week±s BMJ.
In March the House of Lords threw out government proposals to build the UK±s first Las Vegas-style super casino in Manchester and build 16 other casinos around the country. This decision reflects polarised views about the costs and benefits of liberalised gambling in the UK, but the health dimension of the debate has been lacking, write John Middleton and Farid Latif.
They call on the government to assess the health effects of any new proposals and urge doctors to be aware of problem gambling in just the same way they are with other potentially addictive activities like drinking alcohol and smoking.
The UK currently has a low prevalence of problem gamblers, but this seems likely to increase when the Gambling Act 2005 is implemented, they say.
Gambling affects physical, mental and social wellbeing as well as creating debt. Problem gamblers and pathological gamblers are more likely than others in the general population to have been divorced, had physical and psychological problems, lost a job, been receiving welfare benefits, been declared bankrupt, and been imprisoned.
Problem gambling is also associated with juvenile delinquency and family problems, while pathological gambling is a predictor of violence against intimate partners.
While the authors acknowledge that most casino customers will not be compulsive gamblers, they believe that the minor effects on large numbers of the population previously unexposed to casino gambling will be pervasive.
Research on lotteries shows that they tend to gather money from poor people to be spent on amusements for wealthy people. This has led Sandwell Council in the West Midlands to block any new build casinos in the area, based on risk of poverty and related health consequences.
Problem gambling is an addiction that medical professionals should be aware of, say the authors. Anything that makes the poor people in Britain even poorer, especially if they do not derive benefits in kind, will damage their health, further increasing inequality in health.
The UK government intends to bring forward new proposals for developing casinos next year. A prospective programme of properly funded assessment of health effects must be part of any new proposals, they conclude.
Contact:
John Middleton, Director of Public Health, Sandwell Primary Care Trust, West Bromwich, UK
Email: john.middleton@sandwell-pct.nhs.uk
(3) The growth of betting websites carries added risks for gamblers with Parkinson±s disease
(Editorial: Pathological gambling in Parkinson±s disease)
http://www.bmj.com/cgi/content/full/334/7598/810
Parkinson±s disease sufferers could be adversely affected by the growth of betting on the web because they are more likely to become gambling addicts, says a doctor writing in today±s BMJ .
Parkinson±s disease is common. It is estimated to affect one in 200 people in the developed world. Dr Sui Wong says while the motor symptoms and signs of Parkinson±s disease are well recognised, the behavioural disorders, such as problem gambling, are less well known.
It is estimated that 3.5% of people with Parkinson±s disease are pathological gamblers. That figure rises to 7.2% if they are taking drugs known as dopamine agonists. By comparison, in the general population only 1% of people become pathological gamblers.
Characterised by excessive betting, pathological gambling is a chronic and progressive mental disorder which can have devastating effects. Dr Wong says her patients are often secretive about their gambling and may end up thousands of pounds in debt before the problem is discovered.
The reason for the greater incidence of pathological gambling among users of dopamine agonists is unclear, says Dr Wong, as the drugs should lessen the symptoms of Parkinson±s. Many sufferers take dopamine agonists in the early stages of the disease. They work by directly stimulating the receptors in nerves in the brain which normally would be stimulated by dopamine.
Dr Wong goes on to warn about the effect easy accessibility to instant gambling on the internet could have on Parkinson±s sufferers. Nearly 5.8 million people, or one in ten online users, log onto internet gambling sites each month. This figure is expected to rise as more households connect to the internet.
Dr Wong says many internet gambling companies actively lure gamblers with pop-ups to place free-bets. This proactive marketing technique is pervasive and she warns it can make it hard for vulnerable individuals to wean off gambling.
She says "the current debate on regulating gambling is relevant to this group of patients. This provides an ideal opportunity to deal with the problem through appropriate legislation to protect a small, though highly vulnerable, group in our society."
Contact:
Sui H Wong, Neurology Specialist Registrar, The Walton Centre, Fazakerley, Liverpool, UK
Email: suiwong@doctors.org.uk
(4) Delirium could be prevented in a third of cases
(Clinical Review: Delirium in Older People)
http://www.bmj.com/cgi/content/full/334/7598/842
At least one third of cases of delirium could be prevented if better systems of care were in place according to a doctor in today±s BMJ.
Delirium - a temporary state of acute confusion - is becoming a major burden on health care services in countries with ageing populations says Professor John Young.
Characterised by fluctuating awareness, confusion and impaired memory, delirium contributes substantially to rates of sickness and death in the population. The condition causes considerable distress to patients and families and it is expensive - Professor Young estimates the cost of treatment can run to an additional ±1275 per patient.
It is the most frequent complication of hospital admission for older people and develops in up to half of older patients post-operatively, especially after a hip fracture or vascular surgery. People with delirium are also more likely to develop dementia and vice versa.
According to Professor Young, at the moment, over half of patients with the condition go unrecognised. This could be because diagnosis rests solely on clinical skills. There is no diagnostic test. To improve detection rates he says all clinical encounters with sick older people should routinely include an assessment of cognition.
Professor Young says a number of studies suggest the best way to prevent delirium is to lessen the risk factors for individual patients. He gives, as an example, one study involving medical and hip fracture patients where incidences of delirium typically reduced by one third. The delirium was also often shorter in duration and less severe.
Delirium could be prevented in many cases says Professor Young by improving routine care for frail older people in hospital, as aspects of hospital life are known to significantly aggravate the development of delirium.
He warns that health service practitioners "have yet to systematically tackle the potential for delirium prevention. Few national guidelines have been produced, and delirium remains disproportionately ignored relative to its impact."
Contact:
John Young, Academic Unit of Elderly Care and Rehabilitation, St Luke±s Hospital, Bradford, UK
Email: John.young@bradfordhospitals.nhs.uk
A grief counselling programme for families bereaved by suicide does not reduce grief or depression, but may help to prevent perceptions of blame among close relatives and spouses, finds a study published on bmj.com today.
Up to 15 per cent of bereaved people develop complicated grief, characterised by symptoms such as purposelessness, subjective sense of detachment, yearning, disbelief, and bitterness related to the death. It is also associated with long term psychiatric illness and suicidal ideation.
Relatives of people who have killed themselves may have particularly difficult grief reactions and studies have suggested that cognitive behavioural therapy is useful for the treatment of complicated grief.
So researchers in the Netherlands examined the effectiveness of a cognitive behaviour grief counselling programme to prevent complicated grief among families bereaved by suicide.
The study involved 122 first degree relatives and spouses of 70 people who had committed suicide between 1 September 1999 and 1 January 2002. Thirty-nine families (68 participants) were allocated to four sessions with a trained psychiatric nurse counsellor, while 31 families (54 participants) received usual care. The counselling sessions took place three to six months after the suicide.
Thirteen months after the event, self-reported grief was measured and the presence of depression, suicidal ideation, and perceptions of being to blame for the suicide were recorded.
Counselling had no beneficial effect on complicated grief, suicidal ideation or depression. However, after adjusting for several factors, the researchers did see a trend towards reduced perceptions of being to blame and fewer maladaptive grief reactions in the counselling group compared to the usual care group.
The authors suggest that having a chance in counselling to inform relatives of the psychiatric context in which suicide usually occurs, and reflect on and acknowledge their loved one±s difficulties before the suicide, may have helped relatives to realise that they did nothing wrong.
Contact:
Marieke de Groot, Psychiatric Nurse, Department of Social Psychiatry, University of Groningen, Netherlands
Email: m.h.de.groot@med.umcg.nl
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division, BMA House, Tavistock Square London WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)