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

This week in BMJ Saturday 26 April 1997

Previous back trouble predicts new back pain in nurses

Back pain is common in nurses. Possible preventive approaches include screening applicants to exclude those at higher risk of back trouble and improving working methods with wider use of mechanical aids for lifting and moving patients. Smedley et al (p 1225) questioned 838 nurses who were initially free from back pain at three month intervals over two years. Previous back trouble was highly predictive of new back pain during follow up. Symptoms were more likely to develop in nurses who carried out frequent lifting tasks without the use of mechanical aids. The authors call for controlled trials on lifting aids.

Mutation in mannose binding protein gene leads to more infections in children

Mannose binding protein plays an important part in innate immunity. Point mutations in the mannose binding protein gene have been associated with repeated and severe infections in small groups of patients. Both mannose binding protein mutations and childhood infections are common, but there are no data on the extent to which mannose binding protein mutations predispose to childhood infections. Among 617 consecutive children attending an inner London paediatric department Summerfield et al (p 1229) found the prevalence of gene mutations in children with infection to be about twice that in children without. Susceptibility to infection was increased whether the children were heterozygotic or homozygotic for the mutations. Moreover, most of those homozygotic for mannose binding protein gene mutations presented with very severe infections.

Evidence of secular changes in HIV infection

It has been suggested that there have been recent changes in the clinical course of HIV infection. Sinicco et al (p 1232) recruited 285 Italian patients who seroconverted between September 1985 and January 1995 to assess this hypothesis of recent changes. Those who seroconverted after December 1989 showed earlier loss of CD4 cells, a faster progression to AIDS, and faster rate of decline in CD4 count. Seroconversion after December 1989, acute HIV infection, and baseline ß2 microglobulin >296 nmol/l were the most important predictors of poor disease course. The recent emergence of more virulent strains may be responsible for an increasingly aggressive course of the disease.

Only proved fungal infections should be treated in cancer

Disseminated fungal infection is an important cause of morbidity and mortality in patients with cancer complicated by neutropenia. Invasive fungal infections are difficult to diagnose before death. Hence antifungal agents are often given prophylactically in conjunction with chemotherapy or bone marrow transplantation or empirically to patients with persistent fever despite antibiotics. Gøtzsche and Johansen (p 1238) report a meta-analysis which failed to show a convincing effect of antifungal agents on mortality. The authors conclude that treatment should be restricted to patients with proved infections and those in randomised trials.

GPs change services through locality commissioning

General practitioners are increasingly encouraged to participate in the commissioning of health services, yet there is little research on the outcomes of their efforts. On p 1246 Hine and Bachmann evaluate a locality commissioning scheme for a district of 982,000 people. Locality groups of general practitioners achieved a variety of changes in local services, but general practitioners had doubts about sustaining the scheme. They thought that further progress depended on more resources, a clearer remit, and political commitment.