Editor's Choice | This Week in BMJ | Press releases
BMJ No 7098 Volume 314 Press Releases Saturday 28 June 1997 Embargoed: 00.01 Hrs 27 June 1997 UK time
Switching to pipes or cigars halves risk of death from smoking Smokers who switch from cigarettes to pipes or cigars halve their combined risk of dying of lung cancer, heart disease, or chronic lung disease compared with those who continue to smoke cigarettes, says a paper in this week's BMJ. But the men who switched still had about a 70% higher risk than that of people who had never smoked. The authors studied 21,520 men aged between 35-64 in 1975-82, and followed them up until the end of 1993, recording the cause of death in those who died. The men who had switched to pipes or cigars over 20 years before entry to the study smoked less tobacco than continuous cigarette smokers, which largely explained their reduced risk. But their risk was still higher than that for pipe and cigar smokers who had never smoked cigarettes. This was explained by their greater tendency to inhale tobacco smoke, as shown by the higher levels of carbon monoxide in their blood. Their inhaling habits were probably carried over from the days when they smoked cigarettes, say the authors. Cigarette smokers who have difficulty in giving up smoking altogether are better off changing to cigars or pipes, conclude the authors, although their risk of smoking related disease is still higher than for life-long non-smokers or those who give up completely.
Contact:
St. Bartholomew's and the Royal London School of Medicine and Dentistry,
Tel: (Wed & Thurs) in US:
001 212 535 79 58
Healthcare information on the World Wide Web is inaccurate and incomplete, says a paper in this week's BMJ. The authors studied parent-oriented web sites relating to home management of feverish children, and checked the reliability of the information provided against published guidelines. Out of 41 web pages studied, only 4 adhered closely to the main recommendations in the guidelines on such matters as minimum temperature that should be considered as fever, treatments, and conditions that might warrant calling the doctor. Fever is one of the most common medical conditions experienced by children, say the authors, and is often manageable by parents on their own. The availability of accurate information on the Internet about home management could be useful in counteracting parents' worries about fever, they say. However, many of the treatments suggested on the web pages would be ineffectual, and some should be actively discouraged, say the authors, who warn that information currently available on the Internet should not be used as a substitute for routine care by family doctors. Contact:
Istituto di Richerche Farmacologiche
Tel: 00 39 2 390 14511 [Commentary: Measuring the quality and impact of the world wide web] In an accompanying commentary, Dr. Jeremy Wyatt, senior research fellow at the ICRF Centre for Statistics in Medicine, Oxford, says that web pages do not help readers to discriminate between genuine insight and deliberate invention, and that they also allow authors to conceal commercial conflicts of interest. The content of the web site may not be correct even if the original information sources were correct, he says. "Unless we evaluate the quality of clinical sites and their effects on users, we risk drowning in a sea of poor quality information."
Contact: Imperial Cancer Research Fund
Tel: 0171 269 3637
Elderly people with diabetes in institutional care receive inadequate treatment despite their greater use of health service resources, says a paper in this week's BMJ. Diabetes is one the commonest chronic diseases of elderly people, say the authors, and sufferers are possibly the most vulnerable section of the aged population. In the 44 homes studied, 9.9% of the residents had diabetes. When 109 diabetic residents were compared with non-diabetics in the same homes, there was a significantly greater prevalence of lower limb amputation, foot ulceration, circulatory problems and use of catheters in the diabetic group. Despite the high level of health problems among the diabetics studied, many had no medical team responsible for their diabetic care and had not been assessed for the presence or risk of diabetic complications. Improved staff training, closer cooperation between primary and secondary care in the management of institutionalised diabetic residents, and individual care plans for these residents are needed, say the authors. Contact:
Walton Hospital
Tel: (Wed afternoon):
0151 529 2930
The theory that undernutrition of the mother in pregnancy leads to a combination of a large placenta and low birth weight, and hence predisposes towards cardiovascular disease in adulthood needs further examination, says a paper in this week's BMJ. The authors, who studied 2,507 women who gave birth to a single live infant, looked at the factors that influence the relative weights of the placenta and the newborn infant. They say that there are many variable factors involved including female sex, Asian parentage, socioeconomic status and gestational age. They found no consistent relations between the placental weight to birthweight ratio and measures of newborn size. But some of the factors which predict an increased placental weight, such as lower socio-economic status, are themselves predictors for hypertension in later life, they say, and the environmental factors relating to this continue to be influential long after birth. The usefulness of the placental to birthweight ratio as a marker of fetal growth is diminished because it is influenced by many factors apart from maternal nutrition, they conclude.
Contact:
King Edward Memorial Hospital
Tel: 00 61 89 340 1393
The prospect of devolution for Scotland holds out promise for the future of the country's healthcare, says an editorial in this week's BMJ. Recent NHS reforms incorporating market-led solutions were never convincing in a political culture more left leaning and less deferential than that south of the border, say the authors. The establishment of a Scottish Parliament with responsibility for health service provision could lead to the development of effective multi-agency solutions to some of Scotland's preventable health problems, and doctors should be leading the debate on the future, say the authors. Scotland, with good internal communications and the great majority of its population within two hours travelling time of the two main centres, could also lead the way in developing a strategy for national, local and regional services - "better than an agglomeration of boards and trusts." "The ultimate test of any post-devolution settlement is a long term one: the improvement of the health of the people of Scotland."
Contact: Edinburgh University Medical School
Tel: 0131 537 9252
Embargoed: 00.01 HRS 27 June 1997 UK time
For further information, please contact:
Mary Rice on 0171 383 6529
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