This Week in BMJ | Editor's Choice | Press releases | Advertisement details

Press releases Saturday 15 March 1997
Embargo: Friday 14 March 00.01 Hrs

HRT thrombosis risk confined to first year of use

Hormone replacement therapy and risk of venous thromboembolism: population based case-control study

Post-menopausal women using hormone replacement therapy (HRT) are at increased risk of deep vein thrombosis and pulmonary embolism during their first year of treatment compared with non-users, says a paper in this weeks' BMJ. The study of the medical records of nearly 350,000 women on the UK General Practice Research Database is the largest to date on the subject, says the authors.

The risk is highest during the first six months, when a woman using HRT has between four and five times the risk of thromboembolism (blood clots in the leg veins which can travel to the lungs and occasionally prove fatal) compared with a non-user. This drops to a threefold risk after six months of treatment, and after a year the risk is no greater than among non-HRT users. The type of treatment - high or low dose, pills or patches, plus or minus progestogens - does not seem to be a factor.

Between one and two cases of spontaneously occurring thromboembolism per 10,000 women per year could be attributable to HRT use, say the authors. The UK Committee on the Safety of Medicines has reviewed the evidence contained in the paper and has recently produced new guidelines for doctors.

Contact:
Dr Susanne Perez Gutthan
Spain

Tel: 0034 3 3064 200
Fax: 0034 3 3064 412
e-mail: sperez@ciba.es or jcastells@acmcb.es

Giving blood may lessen risk of heart attacks

[Cohort study of relation between donating blood and risk of myocardial infarction in 2682 men in eastern Finland]

Giving blood may offer some protection against heart attacks reports a study in this week's BMJ.

Researchers looked at 2682 middle aged men in eastern Finland to see if there was any association between blood donation and risk of heart attack. "The blood donors' risk of acute myocardial infarction was 86% less than that of the non-donors" say the authors.

The mechanism through which donating blood reduces the risk of heart attacks could be the depletion of body iron stores, say the researchers. It has been suggested that mild iron deficiency reduces the risk of heart disease. However, the study points out that "blood donors seem to be generally more health conscious and more healthy than those who do not donate blood" and this may have affected the results. The link between giving blood and lowered risk for heart attack was, however, still significant even after the main coronary risk factors had been taken into account.

Contact:
Professor Jukka T Salonen
Finland

Tel: 00 358 17162 910
Fax: 00 358 17162 936
e-mail: salonen@reivi.uku.fi

Infertility treatments linked to rise in multiple births

[Population based study of rates of multiple pregnancies in Denmark, 1980-94]

New treatments for infertility probably account for marked increases in the rate of twin and triplet pregnancies in Denmark. A study in this week's BMJ reports a 1.7 increase in the national incidence of multiple pregnancies in recent years, mainly in older women having their first baby.

For women over 30 having their first child, the twinning rate increased three-fold during 1989- 1994, and the triplet rate increased nine-fold. The proportion of women who had their first baby when they were aged 30 or over rose from 4.9% in 1980 to 10.3% in 1994. The researchers state :"The increases in the national multiple pregnancy rates seem closely related to the increasing use of ovulation induction and advanced reproduction techniques that may result in multiple pregnancy in about a quarter of births. Our findings of a dramatic increase in multiple pregnancy rates mainly among older primiparous women strongly supports the link to fertility enhancing treatment."

The proportion of multiple births among infant deaths in women aged 30 or over, starting their family, increased from 11.5% to 26.9% during the study. The total infant mortality, however, did not increase for these women because of a simultaneous decrease in deaths among babies born singly.

Contact:
Professor Mads Melbye
Danish Epidemiology Science Centre

Tel: 00 45 3268 3164/3163
Fax: 00 45 3268 3165
e-mail: mme@sissi.dk

Deprivation link with meningitis

[Social deprivation and bacterial meningitis in North East Thames region: three year study using small area statistics]

Some types of meningitis occurred twice as often in the more overcrowded and deprived areas of the North East Thames region of England compared to relatively more affluent parts reports a paper in this week's BMJ.

Researchers studied 369 cases of bacterial meningitis reported in the NE Thames region between 1991 and 1993. There were three types: meningococcal, haemophilus influenzae and pneumococcal . The districts (wards) where they occurred were classed as "most deprived", "intermediate" or "least deprived". "Overall, rates for meningococcal meningitis were 74% higher in overcrowded areas" says the report.. Rates for pneumococcal meningitis were approximately twice as high in the most deprived wards and the most overcrowded wards, state the authors. However, the rate for haemophilus influenzae meningitis was not linked to deprivation or overcrowding. The authors say that effective action to tackle social deprivation will have an effect on rates of bacterial meningitis.

Contact:
Dr Ian Rees Jones
Queen Mary and Westfield College
London

Tel: 0171 975 5400
Fax: 0181 981 6276, 0171 975 5500
e-mail: i.jones@qmw.ac.uk

Dr Gillian Urwin
Microbiology
Essex Rivers Trust

Tel: 01206 832 727/839

Untreated adult wheezing limiting lifestyles

[The prevalence of adult onset wheeze: longitudinal study]

Adult onset wheeze - breathing problems that start after 15 years of age - represents an important source of illness that may be under recognised and under treated, says a paper in this week's BMJ. A long term follow up study of men and women in Aberdeen showed that more than four in every ten people who said wheezing limited their activities were not receiving treatment.

In 1995, researchers from the University of Aberdeen followed up a 1964 study of local children by contacting the individuals (now aged 39-45 years) who had not wheezed as children. They heard from 1542 men and women of whom 177 (11.5%) reported adult onset wheezing. Almost one in five of them said they had to limit their activities because of wheezing in the previous week, but only 20 of the 34 people were receiving treatment. Current smoking and manual social class were identified as risk factors for wheeze. In the full cohort followed up in mid-life, adult onset disease accounted for a greater proportion of current wheezing than child onset disease.

Contact:
Dr David Godden
Aberdeen Royal Infirmary

Tel: 01224 681 818 x 53552
Fax: 01224 662 990
e-mail: d.j.godden

Who should be responsible for children's mental health?

Child mental health; Who is responsible?

The medicalisation' of behavioural problems in children has generated unrealistic expectations of what child mental health services can deliver, says a paper in this week's BMJ.

Dr. Robert Goodman, from the Institute of Psychiatry, London, argues that the categorisation of all maladjustment and distress among children as mental health disorders is diverting health professionals from their areas of expertise.

Conduct disorder among children, he argues, may stem from recognisable medical syndromes or have medical consequences, but is not a medical disorder. He cites a parallel with dangerous driving, where doctors may sometimes identify predisposing causes such as dementia, but no-one would argue that dangerous driving was a medical disorder per se. Large areas of child welfare work have been inappropriately annexed into the medical empire, says Dr. Goodman The result is that children with serious disorders such as autism, obsessive-compulsive disorder, and schizophrenia are going undiagnosed and untreated because the limited resources available have been diverted into general child welfare work.

Contact:
Dr Robert Goodman

Tel: 0171 919 3471
Fax: 0171 708 5800

EMBARGO: 00.01 HRS Friday 14 March 1997

Journalists: For further information, please contact:

Linda Millington on 0171 383 6473
Public Affairs Division,
BMA House,
Tavistock Square,
London,
WC1H 9JP

Telephone (8.30am - 6.00pm): 0171 383 6254
After 6pm & at weekends: 0181 651 5130, 01895 239687, 0181 674 6294, 0171 727 2897, 0181 769 4949.
Fax: 0171 383 6403.

If you currently receive your British Medical Journal press release by mail and you would like it faxed to you please telephone (00 44) 171 383 6123 (08.30hrs to 18.00 UK hours) or fax (00 44) 171 383 6403 (24 hours).

When dialling the UK from abroad, remember to delete the first zero from the local area code, eg, (00 44) 171...

BMA on Internet page: http://www.bma.org.uk

If you intend to use any article publicised in this press release, ensure you quote the British Medical Journal as source.