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BMJ No 7098 Volume 314 This week in BMJ Saturday 21 June 1997 Benefits of corticosteroid treatment in head injury are still uncertain Switching from cigarettes to cigars or pipes benefits health Placental weight to birthweight ratio: just a surrogate marker? Reliability of public oriented healthcare information on the internet is poor Benefits of corticosteroid treatment in head injury are still uncertainCorticosteroids have been used for over 30 years in the treatment
of head injury, though several randomised controlled trials have
produced apparently conflicting findings. This uncertainty is reflected
in substantial variation in the use of corticosteroids. On p 1855
Alderson and Roberts present a systematic review of such trials which
confirms continuing uncertainty over the effects of corticosteroids;
neither moderate benefit nor moderate harm can be excluded. This
situation can be resolved only by further large scale randomised
t The risk of smoking related diseases is lower in men who smoke pipes
and cigars than in men who smoke cigarettes. The best advice for a
cigarette smoker is to stop smoking, but not everyone is able to stop.
Should such people be advised to switch to pipes or cigars? The results
of the study by Wald and Watt on p 1860 show that the answer is yes:
such a switch will roughly halve the risk of dying of these diseases.
This prospective study of 21,520 men also showed that most of this
benefit is achieved through simply smoking less tobacco; though some
comes from reduced inhaling.
The relative weights of the infant and the placenta at delivery
are important predictors of adult disease, particularly hypertension.
Williams et al (p 1864) determined the demographic, environmental, and
medical factors which influence the relative weights of the newborn
infant and the placenta and compared this ratio with other factors
known to predispose to ill health. They conducted a prospective cohort
study of 2,507 pregnant women who delivered a single live infant at
term. Significant correlations were observed between the placental
weight to birthweight ratio and various known risk factors for adult
hypertension, suggesting that the ratio may be a surrogate for
biological and environmental factors which may act before or after
birth. No consistent correlations were observed between the placental
weight to birthweight ratio and measures of newborn size, so the ratio
may not be a good marker of fetal growth when used in retrospective
studies.
To assess the reliability of healthcare information on the world wide
web and how it may help lay people cope with common health problems,
Impicciatore et al (p 1875) made a systematic search of web pages
dealing with the home management of childhood fever. There was a wide
variety in both the type of information contained and the quality with
which it was organised and presented. Only four of the 41 web pages
retrieved gave the same main advice as the published guidelines chosen
as the standard.
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