Risk of death is higher in asthmatic patients who use major tranquillisers
The problems associated with the management of patients with coexisting bronchial asthma and psychosis have been documented in the medical literature. These clinical concerns, however, are based almost solely on case reports. Joseph et al (p 79) conducted a population based investigation of the hypothesis that asthmatic users of major tranquillisers are at an increased risk of death or near death from asthma in comparison with asthmatic patients who do not use these drugs. The study showed that asthmatic users of major tranquillisers are at a threefold increased risk of death or near death from asthma. Past users of major tranquillisers are at particularly high risk. The authors suggest that physicians consider a history of use of major tranquillisers as a marker to identify asthmatic patients at increased risk for the serious complications of asthma.
Risk of thromboembolism and myocardial infarction measured in third generation oral contraceptives
Concern has recently been raised about third generation oral contraceptives (desogestrel and gestodene) and the risks of thromboembolism and myocardial infarction. Results from two European case-control studies (pp 83, 88) of the risks of different types of oral contraceptives show a fourfold higher relative risk of thromboembolism associated with current use of any oral contraceptive versus no current use. The odds ratio was 1:5 for third versus second generation products. The risk of myocardial infarction was appreciably lower (twofold to threefold) for current users of third generation products compared to second generation users, with no difference detected between third generation users compared to non-users. With a small number of cases in the study of myocardial infarction the confidence intervals were wide. The authors conclude that both risks and benefits must be invoked in a careful tailoring of contraceptive advice.
Cheeses made from raw milk account for a large proportion of the cheeses consumed in France. Though health hazards linked to unpasteurised products are well known, very few outbreaks of infection due to raw milk have been reported in France. On p 91 Desenclos et al describe a large outbreak of Salmonella paratyphi B infection that occurred in France during August to November 1993. Investigation showed that it was caused by a contaminated raw milk cheese produced at a single plant. Of the 273 patients identified, one third were admitted to hospital and one died. A case-control study showed that people who had eaten a particular raw goats' milk cheese were at much greater risk. Desenclos et al emphasise the need for strict control measures before raw milk cheeses are distributed.
Throughout Britain there is concern about the falling numbers of registrars in general practice. Harris et al (p 97) present figures for inner London which show some evidence for a dearth of vocational training within inner London compared with the rest of the Thames regions and England overall. A survey of registrars indicated that increased remuneration and improvements to personal safety are required to attract registrars back into inner London, and a survey of trainers and non-trainers suggested that to encourage more principals to become trainers required both increased remuneration and more protected time.