Press releases Monday 28 September to Friday 2 October 2009
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 website (http://www.bmj.com).
(1) Obesity in middle aged women cuts chance of a long and healthy life by almost 80%
(1) Electronic medical records could be used as a predictor of domestic abuse
(3) Tackling smoking during pregnancy could help plug social inequality gap in stillbirths and infant deaths
(4) Over 65s should take high dose vitamin D to prevent falls, say researchers
(5) Smoking cessation drug not linked to an increased risk of self harm or depression
(1) Obesity in middle aged women cuts chance of a long and healthy life by almost 80%
(Research: Adiposity and weight change in mid-life in relation to healthy survival after age 70 in women: prospective cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3796
The more weight women gain from the age of 18 until middle age, the less likely they are to enjoy a long and healthy life, according to new research published on bmj.com today.
Compared with lean women, the results show that being obese in middle age reduces those odds by 79%, underscoring the importance of maintaining a healthy weight from early adulthood, say the authors.
Despite the evidence that overweight and obesity can significantly increase the risk of early death, little is known about how adiposity affects overall health and wellbeing among those who survive to older ages.
To address this issue, researchers in the United States investigated the theory that being overweight in mid life is associated with a reduced probability of maintaining optimal health among those who survive to older ages.
Their findings are based on comprehensive two yearly monitoring of more than 17,000 middle-aged women in the United States as part of the Nurses Health Study.
Healthy survival referred to participants who survived to age 70 years or older, were free of major chronic diseases, and had good cognitive, physical and mental health. Usual survival referred to participants who survived to age 70 years or older but did not meet these criteria.
After adjusting for several factors, increased body mass index at the start of the study was significantly associated with reduced odds of healthy survival. Every one unit increase of body mass index was associated with a 12% reduction in the odds of healthy survival.
Similarly, in comparison to women of stable weight, weight gain since the age of 18 was significantly associated with reduced odds of healthy survival. For every one kilogram increase of weight gain since age 18 years, the odds of healthy survival decreased by 5%.
The worst odds of healthy survival were found among women who were overweight at 18 and gained 10kg or more by middle age.
But even among women who were lean at 18, relative to those who kept a stable weight, women who gained more than 10kg by middle age were 59% less likely to achieve healthy survival.
These data provide evidence that adiposity in mid life is strongly related to a reduced probability of healthy survival among women who live to older ages, and stress the importance of maintaining a healthy weight from early adulthood, say the authors.
"Given that more and more Americans are surviving to older ages and, at the same time, gaining weight, our results may be particularly important with respect to clinical or public health policies and deserve further investigation and confirmation in additional studies," they conclude.
Contact:
Qi Sun, Research Associate, Department of Nutrition, Harvard School of Public Health, Boston, USA
Email: qisun@hsph.harvard.edu
(2) Electronic medical records could be used as a predictor of domestic abuse
(Research: Longitudinal histories as predictors of future diagnoses of domestic abuse: modelling study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3677
Doctors could predict a patient's risk of receiving a domestic abuse diagnosis years in advance by using electronic medical records as an early warning system, according to research published on bmj.com today.
Lead author Dr Ben Reis from the Children's Hospital Boston Informatics Program and Harvard Medical School investigated whether the wealth of historical electronic data could be used to flag up high risk patients.
Reis says: "Doctors typically do not have the time to thoroughly review a patient's historical records during the brief clinical encounter. As a result, certain conditions that could otherwise be detected are often missed. One such condition is domestic abuse, which may go unrecognised for years as it is masked by acute complaints that form the basis of clinical encounters."
Domestic abuse is the most common cause of nonfatal injury to women in the United States, accounting for more than half the murders of women every year. It affects both men and women and can result in serious injury and death. Given this, say the researchers, "it is critical that at-risk patients be identified as early as possible."
While evidence demonstrates that screening is a useful tool in detecting domestic abuse, the authors believe that doctors "may not be taking full advantage of the growing amounts of longitudinal data stored in electronic health information systems."
The authors analysed medical records from over 500,000 non-identifiable patients over 18 years of age for whom they had at least four years' data on admissions to hospital and visits to emergency departments. The patients had over 16 million diagnoses among them and cases of abuse were identified according to established record-keeping codes.
The researchers developed a scoring system to predict which patients were likely to receive a domestic abuse diagnosis. The system was successfully able to predict future diagnoses of abuse an average of 10-30 months in advance.
Certain risk factors were strongly associated with a future diagnosis of abuse. For women the risk was highest after being seen in hospital or the emergency department for injuries, poisoning, and alcoholism. For men being seen for mental health conditions such as depression and psychosis conferred the greatest risk of a subsequent diagnosis of domestic abuse.
They also developed a prototype risk-visualisation environment which provides clinicians with instant overviews of longitudinal medical histories and related risk profiles at the point of care. According to the authors: "In conjunction with alerts for high-risk patients, this could enable clinicians to rapidly review and act on all available historical information by identifying important risk factors and long-term trends."
Reis maintains that these risk profiles could help doctors diagnose domestic abuse much earlier, perhaps many years in advance. He points out that: "With increasing amounts of data becoming available, this work has the potential to bring closer the vision of predictive medicine, where vast quantities of information are used to predict individuals' future medical risks in order to improve medical care and diagnosis."
Contact:
Keri Stedman, Department of Public Affairs, Children's Hospital Boston, Boston, USA
Email: keri.stedman@childrens.harvard.edu
(3) Tackling smoking during pregnancy could help plug social inequality gap in stillbirths and infant deaths
(Research: Contribution of smoking during pregnancy to inequalities in stillbirth and infant death in Scotland 1994-2003: retrospective population based study using hospital maternity records)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3754
Tackling smoking during pregnancy may help to reduce the socioeconomic inequalities in stillbirths and infant deaths by as much as 30-40%, according to new research published on bmj.com today.
Smoking during pregnancy has been clearly linked to stillbirth and infant deaths and smoking rates during pregnancy vary markedly with socioeconomic position. So a team of researchers set out to measure the contribution that smoking during pregnancy has on the social inequalities gap in stillbirths and infant deaths.
They studied the records of 529,317 live singleton births and 2,699 stillbirths delivered at 24-44 weeks' gestation in Scotland from 1994 to 2003.
Information on smoking during the pregnancy was identified and a deprivation score was assigned using postcode data from the 2001 population census.
The most deprived mothers tended to be younger and to be more likely to smoke and to give birth to preterm or low birth weight babies. Equally, the least deprived mothers were more likely to be older, non-smokers, and less likely to give birth to preterm or low birth weight babies.
The stillbirth rate increased from 3.8 per 1000 in the least deprived group to 5.9 per 1000 in the most deprived group. For infant deaths, the rate increased from 3.2 per 1000 in the least deprived group to 5.4 per 1000 in the most deprived group.
Stillbirths were 56% more likely and infant deaths were 72% more likely in the most deprived compared with the least deprived category.
Women in the most deprived category were three times more likely to smoke during pregnancy than were those in the least deprived category. Smoking during pregnancy accounted for 38% of the inequality in stillbirths and 31% of the inequality in infant deaths.
The authors conclude that both tackling smoking during pregnancy and reducing infants' exposure to tobacco smoke in the postnatal environment may help to reduce stillbirths and infant deaths overall and to reduce the socioeconomic inequalities in stillbirths and infant deaths perhaps by as much as 30-40%.
However, they stress that action on smoking on its own is unlikely to be sufficient and other measures to improve the social circumstances, social support, and health of mothers and infants are also needed.
Contact:
Ron Gray, Consultant Clinical Epidemiologist, National Perinatal Epidemiology Unit, University of Oxford, UK
Email: ron.gray@npeu.ox.ac.uk
(4) Over 65s should take high dose vitamin D to prevent falls, say researchers
A daily supplement of vitamin D at a dose of 700-1000 IU reduces the risk of falling among older people by 19% according to a study published on bmj.com today. But a dose of less than 700 IU per day has no effect.
IU is an international unit of measurement for vitamins and other biologically active substances.
Each year, one in three people aged 65 and older experience at least one fall, with around 6% resulting in a fracture. Fall prevention has therefore become a public health goal especially as the older segment of the population grows.
Several trials have shown that vitamin D improves strength and balance among older people, while others have found no significant effect on the risk of falling.
So an international team of researchers analysed the results of eight fall prevention trials to assess the effectiveness of vitamin D in preventing falls among older individuals (aged 65 or more). Differences in study design and quality were taken into account to minimise bias.
The pooled results showed that benefit from supplemental vitamin D on fall prevention depended on treatment dose.
Supplemental vitamin D2 and Vitamin D3 were investigated. 700-1000 IU supplemental vitamin D per day (vitamin D2 or vitamin D3) reduced falls by 19% and up to 26% with vitamin D3.
This effect was independent of age, type of dwelling or additional calcium supplementation. The effect was significant within two to five months of starting treatment and extended beyond 12 months.
Supplemental vitamin D did not reduce falls at a dose of less than 700 IU per day.
The use of active forms of vitamin D did not appear to be more effective than 700-1000 IU supplemental vitamin D. Active forms of vitamin D also cost more and are associated with a higher risk for hypercalcaemia (elevated calcium levels in the blood) than standard supplemental vitamin D.
To reduce the risk of falling, a daily intake of at least 700-1000 IU supplemental vitamin D is warranted in all individuals aged 65 and older, say the authors.
Higher doses may be even more effective and should be explored in future research to optimise the fall prevention benefit with vitamin D, they conclude.
Contact:
Professor Heike A Bischoff-Ferrari, Director, Centre on Aging and Mobility, University Hospital Zurich, Switzerland
Email: HeikeABischoff@aol.com
(5) Smoking cessation drug not linked to an increased risk of self harm or depression
(Research: Varenicline and suicidal behaviour: a cohort study based on data from the General Practice Research Database)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3805
There is no strong evidence that the popular smoking cessation drug varenicline increases the risk of self harm or depression compared to other cessation products, according to new research published on bmj.com today.
Varenicline is a recently introduced smoking cessation product of proven effectiveness, but there have been concerns that it may increase the risk of suicidal behaviour and suicide. Despite warnings about the possible increased risks issued by regulatory authorities worldwide, varenicline continues to be used widely.
To provide more evidence, a team of researchers from the University of Bristol and the UK's Medicines and Healthcare products Regulatory Agency (MHRA) compared the risk of self harm among people taking varenicline with the risk of self harm associated with other smoking cessation products bupropion and nicotine replacement therapy (patch, inhaler, gum, tablet or lozenge).
Using data from the General Practice Research Database, 80,660 men and women aged between 18 and 95 years were identified who were prescribed a new course of smoking cessation product between September 2006 and May 2008.
Participants were prescribed either nicotine replacement products for (n=63, 265), varenicline (n=10,973), or bupropion (n=6,422).
All electronic patient records over the period of the prescription and for three months after the date of the last prescription were examined for incidences of fatal and non-fatal self-harm, suicidal thoughts and depression.
After controlling for confounding factors, there was no clear evidence of an increased risk of self harm, suicidal thoughts or depression associated with either varenicline or bupropion.
The authors caution that although they found no strong evidence of an increased risk of self harm linked to varenicline, “the limited power of the study means we cannot rule out either a halving or a twofold increased risk.”
They go on to call for more investigation of varenicline's effect on suicide risk in other databases and secondary analysis of all adverse event reporting in clinical trials.
They conclude by cautioning that any risks must be balanced against the long term health benefits of stopping smoking and the effectiveness of varenicline as a smoking cessation product.
Contact:
Hannah Johnson, Press Officer, University of Bristol Public Relations Office, Bristol, UK
Email: hannah.johnson@bristol.ac.uk
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and from:
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