Press releases Monday 24 May to Friday 28 May 2010
Please remember to credit the BMJas 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) What's more important in the obesity battle – physical activity or medical treatment? (2) Single lens distance glasses reduce falls in active older people (3) If you don't brush your teeth twice a day, you're more likely to develop heart disease (4) Speed limit in built-up areas should be 20mph, says doctor who knocked down a child (5) Split swine flu vaccine more effective than whole vaccine in young children
(1) What's more important in the obesity battle – physical activity or medical treatment?
(Head to Head: Should health policy focus on physical activity rather than obesity?)
Yes: http://www.bmj.com/cgi/content/extract/340/may25_1/c2603
No: http://www.bmj.com/cgi/content/extract/340/may25_1/c2602
Experts disagree on bmj.com today about the best way to tackle the obesity crisis. While Professor Louise Baur and colleagues from the Children's Hospital at Westmead and the University of Sydney in Australia acknowledge that "physical inactivity is a major contributor to the global burden of disease," they says that it would be wrong to only focus on this and ignore the problem of obesity.
Baur and colleagues argue that physical inactivity is just one marker and that there is substantial evidence that unhealthy diets low in fibre and high in sugar and large portion size are also responsible for obesity and the diseases associated with it.
However, Dr Richard Weiler, a specialist registrar in sport and exercise medicine at Imperial College Healthcare NHS Trust and general practitioner, and colleagues believe that inadequate cardio-respiratory fitness causes disease more than excess body fat, waist size and body mass index.
Weiler and colleagues maintain that "physical inactivity is one of the greatest health threats facing developed nations today" and they are concerned that 95% of the populations in England and the United States do not meet the recommended guidelines of doing 30 minutes moderate to vigorous physical activity on at least five days a week or equivalent.
They say this is alarming given that physical inactivity rather than obesity per se is an actual cause for many illnesses including obesity, heart disease, type 2 diabetes, mental health problems, high blood pressure and dementia.
Spending huge amounts on treating obesity is not the right way forward, they argue. Weight loss drugs and surgery are risky and the long-term benefits are limited and they certainly do not have the associated health benefits linked to physical activity. They conclude that it is time for health policy and healthcare professionals to focus on fighting physical inactivity, a "chronic disease that has an adult population prevalence of 95%."
Professor Baur, on the other hand, believes that "on its own, improving physical activity will have little impact on reducing overall levels of already established obesity."
She believes that obese people need access to high quality treatment provided by well-trained professionals to deal with their weight and any linked health problems.
In conclusion, Professor Baur and colleagues advocate tackling obesity with a range of strategies, for example, increasing physical activity, improving diet and lifestyles. They say urban planning should be developed to encourage people to use their car less and cycle more and public transport should be made more accessible and affordable.
Contacts:
Louise Baur, The Children's Hospital at Westmead, Sydney, NSW, Australia
Email: louiseb3@chw.edu.au
Richard Weiler, Specialist Registrar in Sport and Exercise Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK and General Practitioner, Hertfordshire
Email: c/- cassie.zachariou@imperial.nhs.uk
(2) Single lens distance glasses reduce falls in active older people
(Research: Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial)
http://www.bmj.com/cgi/content/abstract/340/may25_1/c2265
(Editorial: Poor vision and falls)
http://www.bmj.com/cgi/content/extract/340/may25_1/c2456
Providing single lens distance glasses to older people who wear multifocal glasses and who regularly take part in outdoor activities is a simple and effective way of preventing falls, concludes a study published on bmj.com today.
However, the researchers warn that this strategy may not be appropriate for frailer people who spend more time indoors.
Presbyopia (a progressively diminished ability to focus on near objects) is the most common form of impaired vision in older people. To correct for this condition, people are either prescribed separate single lens glasses for distant and near vision or, for convenience, a single pair of multifocal (bifocal, trifocal, or progressive lens) glasses.
Multifocal glasses have benefits for tasks that require changes in focal length, such as driving, shopping and cooking. But they also have optical defects which can impair balance and increase the risk of falls in older people.
So researchers in Sydney, Australia set out to test whether giving older people an additional pair of single lens distance glasses for wearing when outdoors or in unfamiliar settings would help to reduce falls.
The study involved 606 people who were at high risk of falling (either aged 80+ years or aged 65+ years with a history of falls). All participants used multifocal glasses at least three times a week when walking outdoors and did not use single lens distance glasses.
Participants were randomly split into an intervention and a control group. After an initial examination by an optometrist, 305 intervention participants were prescribed a pair of single lens distance glasses for wearing outdoors and in unfamiliar settings, and were instructed in their use. They were also shown how multifocal glasses can increase the risk of falls.
The remaining control participants had the same optometrist examination as the intervention group but were not provided with single lens glasses and received no falls prevention advice.
Participants were monitored for 13 months. During that time, total falls in the intervention group were reduced by 8% compared with the control group. For those who regularly went outdoors, all falls, outside falls and injurious falls decreased significantly – by about 40%. However, for those who spent more time inside, outside falls increased significantly.
The intervention did not influence physical activity or improve quality of life.
Based on these findings, the authors recommend that older people who take part in regular outdoor activities should be provided with single lens distance glasses for outside use when they are prescribed their first pair of multifocal glasses. However, those who undertake little outdoor activity should use multifocal glasses for most activities, rather than using multiple pairs of glasses.
In an accompanying editorial, Professor John Campbell and colleagues at the Dunedin School of Medicine in New Zealand say that correcting vision can help lower the likelihood of a fall, but that any changes should be introduced step by step in a planned manner so that a person is not overwhelmed. They also recommend good communication between doctors and optometrists when considering vision, glasses and the risk of falls.
Contacts:
Research: Stephen Lord, Senior Principal Research Fellow, Prince of Wales Medical Research Institute, New South Wales, Australia
Email: s.lord@powmri.edu.au
Editorial: John Campbell, Professor of Geriatric Medicine, Department of Medical and Surgical Sciences, Dunedin School of Medicine, Dunedin, New Zealand
Email: john.campbell@otago.ac.nz
(3) If you don't brush your teeth twice a day, you're more likely to develop heart disease
(Research paper: Toothbrushing, inflammation, and risk of cardio vascular disease – results from the Scottish Health Survey)
http://www.bmj.com/cgi/doi/10.1136/bmj.c2451
Individuals who have poor oral hygiene have an increased risk of heart disease compared to those who brush their teeth twice a day, finds research published today on BMJ.com.
In the last twenty years there has been increased interest in links between heart problems and gum disease. While it has been established that inflammation in the body (including mouth and gums) plays an important role in the build up of clogged arteries, this is the first study to investigate whether the number of times individuals brush their teeth has any bearing on the risk of developing heart disease, says the research.
The authors, led by Professor Richard Watt from University College London, analysed data from over 11,000 adults who took part in the Scottish Healthy Survey.
The research team analysed data about lifestyle behaviours such as smoking, physical activity and oral health routines. Individuals were asked how often they visited the dentist (at least once every six months, every one to two years, or rarely/never) and how often they brushed their teeth (twice a day, once a day or less than once a day).
On a separate visit nurses collected information on medical history and family history of heart disease, blood pressure and blood samples from consenting adults. The samples enabled the researchers to determine levels of inflammation that were present in the body. The data gathered from the interviews were linked to hospital admissions and deaths in Scotland until December 2007.
The results demonstrate that oral health behaviours were generally good with six out of ten (62%) of participants saying they visit the dentist every six months and seven out ten (71%) reporting that they brush their teeth twice a day.
Once the data were adjusted for established cardio risk factors such as social class, obesity, smoking and family history of heart disease, the researchers found that participants who reported less frequent toothbrushing had a 70% extra risk of heart disease compared to individuals who brushed their teeth twice a day, although the overall risk remained quite low. Particpants who had poor oral hygiene also tested positive for inflammatory markers such as the C-reactive protein and fibrinogen.
Professor Watt concludes: "our results confirmed and further strengthened the suggested association between oral hygiene and the risk of cardiovascular disease - furthermore inflammatory markers were significantly associated with a very simple measure of poor oral health behaviour". He adds that "future experimental studies will be needed to confirm whether the observed association between oral health behaviour and cardio vascular disease is in fact causal or merely a risk marker".
Contact:
Richard Watt, University College London, Department of Epidemiology & Public Health, London
Email: r.watt@ucl.ac.uk
(4) Speed limit in built-up areas should be 20mph, says doctor who knocked down a child
(Personal view: It could happen to anybody: why 20 mph speed limits matter)
http://www.bmj.com/cgi/content/abstract/340/may19_4/c2369
In a personal and moving account of his involvement in a car accident with a child, Dr Nicholas Foreman, a GP from Rickmansworth is adding to callls for the speed limit in all built-up areas to be reduced to 20 miles per hour (mph).
Dr Foreman recalls the February evening when a young child, followed by a woman, suddenly ran out in front of his car. Foreman slammed on his brakes but unfortunately hit both.
Luckily the child and his aunt escaped with only bruising and the police pressed no charges but the episode affected Dr Foreman deeply. He says: "It is easy to exceed the speed limit and thank God on this occasion I wasn't. Nor was I fiddling with my mobile phone, sat nav or cd player all of which I do or have done - I think I was probably going 20 mph at the point of impact and maybe now you will agree with me that that should be the speed limit in built-up areas".
Contact:
Nicholas Foreman
Email: nicholas.foreman@gp-e82083.nhs.uk
(5) Young children respond well to recommended swine flu vaccine
(Research: Safety and immunogenicity of AS03B adjuvanted split virion versus non-adjuvanted whole virion H1N1 influenza vaccine in UK children aged 6 months-12 years: open label, randomised, parallel group, multicentre study)
http://www.bmj.com/cgi/doi/10.1136/bmj.c2649
The first head to head study of the two H1N1 vaccines used in the UK during the recent pandemic finds that the adjuvanted split virus vaccine induced higher immune response rates in young children, but was associated with more reactions than the whole virus vaccine.
These data provide important information to guide immunisation policy in an influenza pandemic, say the researchers.
During the 2009-10 influenza A (H1N1) pandemic, children experienced pandemic A (H1N1) infections at four times the rate of adults and were more commonly admitted to hospital, making them a priority group for vaccination.
The Department of Health purchased two H1N1 vaccines for the national immunisation programme, an adjuvanted split virion vaccine derived from egg culture and a non-adjuvanted whole virion vaccine derived from cell culture.
A team of UK researchers therefore set out to evaluate the safety, reactogenicity (tendency to cause reactions), and immunogenicity (ability to induce an antibody response) of the two vaccines in children aged 6 months to 12 years, to inform the scientific community, policy makers and parents.
Over 900 children participated in the study, which took place at five UK centres between 26 September and 11 December 2009, during the second wave of the pandemic in the UK. Children were grouped by age and were randomised to receive either the split vaccine or the whole virus vaccine in two doses, 21 days apart.
Details of reactions, such as fever, tenderness, swelling and redness of the skin, were collected for one week after vaccination. Blood samples were taken before vaccination and after the second dose to measure rises in antibody levels (a process known as seroconversion).
Both vaccines were well tolerated. The split virus vaccine was more immunogenic and achieved higher seroconversion rates than the whole virus vaccine, especially in children aged less than 3 years. The split virus vaccine was also associated with more reactions compared with the whole virus vaccine, although these reactions were generally in keeping with the product data produced by the manufacturer. Significantly fewer reactions, including fever, were observed after a first dose of adjuvanted vaccine than a second, especially in younger children.
The authors conclude: "In this first direct comparison of an AS03B adjuvanted split virion versus whole virion non-adjuvanted H1N1 vaccine, the adjuvanted vaccine, while more reactogenic, was more immunogenic and, importantly, achieved high seroconversion rates in children aged less than 3 years. This indicates the potential for improved immunogenicity of influenza vaccines in this age group."
Contact:
Matthew Snape, Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
Email: matthew.snape@paediatrics.ox.ac.uk
FOR ACCREDITED JOURNALISTS
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Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk
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