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Press releases Saturday 2 February 2008
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(1) Training on the correct way to lift heavy objects does not prevent back pain
(2) Sugary soft drinks linked to increased risk of gout in men
(3) Is the obesity epidemic exaggerated?
(4) Parenting programme does not prevent toddler behaviour problems
(5) European regulatory agencies should employ full time statisticians
(1) Training on the correct way to lift heavy objects does not prevent back pain (Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review) http://www.bmj.com/cgi/content/short/bmj.39463.418380.BEv1 (Editorial: Preventing back pain) http://www.bmj.com/cgi/content/short/bmj.39464.656007.80v1
Training showing the correct way to lift heavy objects does not prevent back injuries, according to a systematic review published on bmj.com today.
Back pain is a highly prevalent complaint and a cause of much suffering. In the UK employers have to ensure workers get proper training on how to handle loads correctly and this generally includes advising workers on specific lifting techniques. However this study, which reviewed all the evidence currently available, found no evidence that the advice has any effect.
The researchers looked at eleven studies: eight studies dealt with health workers who manually handled patients, the other three looked at baggage handlers and postal workers. All the participants in the studies worked in jobs where there was strain on the back and where there was the potential for alleviating any strain through an intervention such as training. None of the workers in the studies were actively seeking treatment for back pain.
The researchers found no difference in back pain in studies where one group received training and the other didn't. Training compared to minor advice (a video) showed no effect on back pain after a year.
Another trial showed no significant difference in back pain between one group who received training and another who were given back belts to wear. Training and physical exercise were compared in one trial and again no difference in back pain was found during a follow up less than a year later.
Finally a group receiving both training and an assistive device was compared to a group receiving training only and another control group which received nothing – there was no difference in back pain at follow up.
The researchers say either the advocated techniques do not actually reduce the risk of back injury, or workers do not significantly change their habits enough for it to make any difference.
They conclude that we need a better understanding of the relationship between exposure to stresses on the back at work and the subsequent development of back pain in order to develop new and innovative ways of preventing back pain because of lifting.
In an accompanying editorial Associate Professor Niels Wedderkopp says the current advice for people with back pain to stay active may not be appropriate for people whose work involves heavy lifting. He says: "A change of job and (prudently) staying active in daily life may be the best way for these patients to regain command of their back and their occupation."
Contacts: Research paper: Kari-Pekka Martimo, Finnish Institute of Occupational Health, Helsinki, Finland Email: kari-pekka.martimo@ttl.fi Editorial: Niels Wedderkopp, Back Research Centre, Funen Hospital, Denmark Email: nwedderkopp@health.sdu.dk
(2) Sugary soft drinks linked to increased risk of gout in men (Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study) http://www.bmj.com/cgi/content/short/bmj.39449.819271.BEv1
Consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men, finds a study published on bmj.com today.
Gout is a joint disease which causes extreme pain and swelling. It is most common in men aged 40 and older. It is caused by excess uric acid in the blood (hyperuricaemia) which leads to uric acid crystals collecting around the joints.
In the United States, levels of gout have doubled over the last few decades, which coincided with a substantial increase in the consumption of soft drinks and fructose (a simple sugar and the only carbohydrate known to increase uric acid levels).
Conventional dietary recommendations for gout have focused on the restriction of purines (found in high levels in meat and meat products, especially liver and kidney) and alcohol but with no restriction of sugar sweetened soft drinks.
So researchers in the US and Canada examined the relation between intake of sugar sweetened soft drinks and fructose and the risk of gout.
They followed over 46,000 men aged 40 years and over with no history of gout. The men completed regular questionnaires on their intake of more than 130 foods and beverages, including sugar sweetened soft drinks and diet soft drinks, over a period of 12 years. Different types of fruits and fruit juices (high in natural fructose) were also assessed.
At the start of the study, and every two years thereafter, information on weight, regular use of medications and medical conditions were also recorded. Gout was diagnosed according to American College of Rheumatology criteria.
During 12 years of follow-up, the researchers documented 755 newly diagnosed cases of gout.
The risk of gout increased with increasing intake of sugar sweetened soft drinks. The risk was significantly increased with an intake level of 5-6 servings per week and the risk was 85% higher among men who consumed two or more servings of sugar-sweetened soft drinks per day compared to those who consumed less than one serving per month.
These associations were independent of other risk factors for gout such as body mass index, age, diuretic use, high blood pressure, alcohol intake, and dietary factors.
Diet soft drinks were not associated with the risk of gout.
Fruit juice and fructose rich fruits (apples and oranges) were associated with a higher risk of gout. However, the authors stress that this finding needs to be balanced against the benefit of fruit and vegetable intake to prevent other chronic disorders like high blood pressure, coronary heart disease, stroke and certain types of cancer.
In conclusion, our findings provide prospective evidence that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout, say the authors. Furthermore, fructose rich fruits and fruit juices may also increase the risk. In contrast, diet soft drinks were not associated with the risk of gout.
Contact: Hyon Choi, Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada Email: hchoi@arthritisresearch.ca
(3) Is the obesity epidemic exaggerated? (Head to Head: Is the obesity epidemic exaggerated?) Yes: http://www.bmj.com/cgi/content/short/336/7637/244 No: http://www.bmj.com/cgi/content/short/336/7637/245
Last week, the UK health secretary declared that we are in a grip of an obesity epidemic, but does the evidence stack up? Researchers in this week's BMJ debate the issue.
Claims about an obesity epidemic often exceed the scientific evidence and mistakenly suggest an unjustified degree of certainty, argue Patrick Basham and John Luik.
For example, the average population weight gain in the United States in the past 42 years is 10.9kg or 0.26kg a year. Yet, between 1999-2000 and 2001-2002, there were no significant changes in the prevalence of overweight or obesity among US adults or in the prevalence of overweight among children.
Furthermore, they say, the categories of normal, overweight, and obese is entirely arbitrary and at odds with the underlying evidence about the association between body mass index and mortality.
For example, the study on which the bands for overweight and obesity in the US are based found that the death risks for men with a body mass index of 19-21 were the same as those for men who were overweight and obese (29-31). Other studies have shown negligible differences between body mass index and death rates.
The association of overweight and obesity with higher risks of disease is equally unclear, they write. And, despite supposedly abnormal levels of overweight and obesity, life expectancy continues to increase.
They suggest that some public health professionals may have deliberately exaggerated the risks of overweight and obesity, and our capacity to prevent or treat them on a population wide basis, in the interests of health. They warn that this has unwelcome implications for science policy and for evidence based medicine.
But Robert Jeffery and Nancy Sherwood argue that a large body of scientific evidence shows that obesity is a major global health problem.
In the US, the prevalence of obesity in 1976-80 was 6.5% among 6-11 year olds and 5% among 12-17 year olds. In 2003-4 it was 19% and 17% respectively. Europe can also expect to see the numbers of overweight and obese children rising by around 1.3 million a year by 2010.
The risks of obesity on many serious health conditions including high blood pressure, diabetes, heart disease and some forms of cancer, are also serious and well established, they write.
Most health economists and epidemiologists agree that the contribution of obesity to current healthcare costs is high and that it is likely to get much higher. Some have argued that we may even see real falls in life expectancy within a few decades, they add.
In summary, a large body of evidence documents that over-nutrition and obesity are a major global health problem, say the authors. With the continuing rise in obesity and limited treatment efficacy, options for averting a poor public health outcome seem to rest either on the hope that scientists are wrong in their projections or speedy investment in the development of more effective public health measures to deal with it.
They think the second option a more prudent scientific and policy choice.
Contacts: Patrick Basham, Johns Hopkins University, Washington DC, USA Email: patrickbasham@gmail.com Robert Jeffery, University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, Minneapolis, USA Email: jefferyrw@gmail.com
(4) Parenting programme does not prevent toddler behaviour problems (Universal parenting programme to prevent early childhood behaviour problems: cluster randomised trial) http://www.bmj.com/cgi/content/short/bmj.39451.609676.AEv1
A study of the first universal parenting programme, designed to prevent early child behaviour problems, shows that it has little impact on toddler behaviour.
The study, conducted at the Centre for Community Child Health (CCCH) in Melbourne, Australia, is published on bmj.com today.
Behaviour problems affect up to 20 per cent of children and have major personal, societal and economic ramifications. Left untreated, up to half of behaviour problems in preschool children develop into later mental health problems.
Prevention targeted to high-risk families can be effective, but has limited reach and may stigmatise. Universal programmes offered to all families could address these concerns, but their effectiveness is uncertain.
Researchers from the CCCH and the Parenting Research Centre, with input from maternal and child health nurses, designed a programme suitable for all parents to be delivered by trained health professionals in primary care. The programme aimed to prevent child behaviour problems, such as defiance and aggression, and improve parenting and maternal mental health.
Over 700 mothers of 8 month-old infants participated in the study and were randomised to either the programme (three sessions at age 8-15 months) or usual care from their local Maternal and Child Health centre. Mothers were surveyed throughout the study and their mental health was assessed when their children reached 18 and 24 months.
At 18 months, child behaviour and parenting scores were similar between the two groups. By age 24 months, parents on the programme were less likely to report harsh or abusive parenting and unreasonable expectations of child development, but there was no improvement in maternal distress or toddler behaviour.
This was the first trial to evaluate a universal parenting programme involving families from all social backgrounds, say the authors.
They conclude that the outcomes are insufficient to support widespread introduction of this programme to prevent toddler behaviour problems.
Contact: Harriet Hiscock, c/o Kelly Furey, Media Officer, Murdoch Children's Research Institute, Victoria, Australia Email: kellie.furey@mcri.edu.au
(5) European regulatory agencies should employ full time statisticians (Open letter: European regulatory agencies should employ full time statisticians) http://www.bmj.com/cgi/content/short/336/7638/250 View PDF of full letter (page two)
European regulatory agencies should employ full time statisticians to enable competent licensing and labelling decisions to be made, argue leading statisticians in an open letter to this week's BMJ.
Sara Hughes, Chair of PSI, the professional UK body of statisticians in the pharmaceutical industry, and director of statistics at GlaxoSmithKline, together with 34 colleagues set out what they believe is a "major deficiency" in European regulatory agencies that are responsible for reviewing applications to market new medicines across the whole of the European Union.
Only agencies in the UK, Germany, Sweden, and Austria employ several full time statisticians, and a few others employ a single statistician, they write. Some do not employ any full time statisticians – instead they rely on external consultants.
Yet, statistics is central to the design of clinical trials and to the interpretation of their results.
Unless the design and statistical analysis of a trial are appropriate, results cannot be considered reliable and no confidence can be placed in the subsequent clinical interpretation, they warn.
Another important role of regulatory agencies is to provide scientific advice and general guidance on statistical issues, they add. But, without permanent statisticians, agencies are at risk of giving incomplete advice.
In particular, they point out that innovation may be stifled if novel methods that are presented are methodologically sound but are disregarded because they are poorly understood by regulatory advisers.
They argue that statistical review should be conducted by those who are professionally expert in the area, not by medical assessors with some knowledge of statistics.
"We believe the current situation is unacceptable," they say. "We call on the heads of the regulatory agencies in the EU that do not have full time statisticians in their organisations to rectify this as a matter of urgency."
Contact: Sara Hughes, Chair of PSI and Director of Statistics, GlaxoSmithKline, UK Email: sara.h.hughes@gsk.com
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