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This week in BMJ Saturday 5 April 1997

Hepatitis A seropositivity is linked to low risk of atopy

Infections acquired early in childhood are thought to prevent atopy, and the declining prevalence of common infections may be the cause of the increasing prevalence of allergy in Western countries. On p 999 Matricardi et al report the relation between atopy and the presence of antibodies to hepatitis A virus in over 1500 Italian military students. They found significantly lower prevalences of atopy and respiratory allergies among seropositive subjects even after adjusting for other relevant risk factors such as father's education, urban or rural residence, and the number of older and younger siblings. Among seronegative subjects only those having three or more older siblings had a prevalence of atopy as low as that of seropositive subjects. The authors conclude that indirect but important evidence is added to the hypothesis that common infections acquired early in life because of the presence of many older siblings or because of unhygienic living conditions may reduce the risk of developing atopy.

Post-term and heavy babies have increased risk of atopic dermatitis

Allergy to house dust mites and to cows' milk has been suggested as a possible environmental factor causing the increase in the prevalence of atopic dermatitis, but little evidence is available. Olesen et al investigated the effect of simple birth factors such as weight and age of mother on the prevalence of atopic dermatitis in Aarhus, Denmark (p 1003). They found a cumulative incidence of 18.7% at the age of 7 years in 1993. Children born post term and those who were heavier than expected had a significantly increased risk of developing the disease. The authors suggest that a genetically determined predisposition for atopic dermatitis is expressed before birth.

Researchers disagree with editors on criteria for authorship

Earning authorship in science is under vigorous debate, and, despite guidelines, problems remain with allocation and justification of authorship. In a survey of 66 researchers in a British medical faculty Bhopal et al (p 1009) found that, while most supported the concept of criteria for authorship, the criteria of the International Committee of Medical Journal Editors were seen as too restrictive and hard to apply. Gift authorship was perceived as common and encouraged by the research system. The range of reported authorship problems indicated that broader criteria for authorship are needed. Future debate should aim to produce guidelines for authorship that are agreed by editors and researchers, a prerequisite for effective dissemination and implementation.

Many ICUs use the wrong drug for prophylaxis of stress ulcers

Stress ulcers are common in critically ill patients, and intensive care units have traditionally given H2 receptor antagonists or sucralfate to patients at risk of serious bleeding, though a recent meta-analysis has shown sucralfate to be safer. In their telephone survey of 67 units in the Thames regions Wyncoll et al (p 1013) found that only 28 had a protocol for stress ulcer prophylaxis and that of 312 patients, 118 were receiving an H2 antagonist, 82 sucralfate, 3 omeprazole, and 110 no prophylaxis. Units with a protocol and teaching hospitals were more likely to prefer sucralfate.

GPs' recognition of psychosocial problems depends on characteristics of the patient

Previous studies have found that fewer than half of psychosocial problems are recognised in general practice. In a survey of 1401 patients visiting 89 general practitioners, Gulbrandsen et al (p 1014) explored doctors' recognition of nine indicator problems assessed by patients as affecting their health on the day of the consultation. Previous general knowledge of the patient increased recognition of more intimate problems but not of problems readily communicated by the patient, such as stressful working conditions. The study confirmed that fewer than half of psychosocial problems are recognised by general practitioners, but it found that awareness depended on the type of problem present. The recognition of most of the indicator problems was not affected by characteristics of the doctor or the practice. The authors conclude that patients' differing wishes and abilities to communicate, the need for confidence in the doctor-patient relationship before revealing intimate problems, and a tendency for the doctors to be entrapped by their expectations of where to find problems may explain their findings.