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BMJ No 7099 Volume 315 This week in BMJ Saturday 5 July 1997 Dietary patterns are associated with all cause mortality Drugs misuse by prisoners goes undetected and untreated No evidence for effectiveness of shoulder physiotherapy Miscarriage statistics miss about a third of cases Dietary patterns are associated with all cause mortalityThe intake of nutrients is usually highly intercorrelated owing to the
choice of foods in which these nutrients occur. Thus investigating the
association of single dietary components with mortality is difficult.
To avoid this problem, Huijbregts et al (p 13) have de Three studies this week address different aspects of illicit drug use
in prisons. Mason et al (p 18) found that over half of all men
remanded to a large prison in north east England were misusing drugs
before reception. Not only did the prison reception screen
underestimate the misuse, so that many prisoners with serious problems
remained undetected, but many substance misusers who were identified
received inadequate treatment. Bellis et al (p 30) obtained
information on drug taking and sexual behaviour and a matched saliva
sample from 905 prisoners arriving at Liverpool prison. Only one tested
positive for HIV. Of 260 with a history of injecting drugs, 219 also
had a history of previous imprisonment: only 36 had ever injected in
prison, but 20 of them had shared injection equipment. The authors
conclude that imprisonment increases the risks of infection. Bird et al
(p 21) studied prisoners in Scotland on two surveillance days in
October 1996. They found that only four prisoners in 100 had been
offered vaccination against hepatitis B despite 40 in 100 having a
history of injecting drug use. Half of the injector inmates of Lowmoss
and Aberdeen prisons had injected inside prison in the previous four
weeks. The authors calculate that if, on average, prisoners who inject
heroin do so six times in four weeks they will test positive on random
tests on at most 18 days out of 28. This, they say, means that random
drugs testing underestimates the harm reduction needs of injectors
inside prison. A wide array of methods of physiotherapy are claimed to be effective
for shoulder disorders, but, to date, systematic information on their
effectiveness is lacking. On page 25 Van der Heijden et al present a
systematic review of 20 randomised clinical trials. The standardised
assessment of methods revealed that trials were often flawed by lack of
blinding, high proportions of withdrawals and missing values, and small
sample sizes. Randomised clinical trials provide insufficient evidence
to support the effectiveness of ultrasound therapy, low level laser
therapy, heat treatment, cold therapy, electrotherapy, exercise, and
mobilisation for shoulder disorders. Future trials should focus on the
effectiveness of exercise and mobilisation compared with analgesics,
non-steroidal drugs, steroid injections, and advice and a wait and see
policy.
No one knows how many miscarriages are already treated in primary care
as the only statistics published in Britain come from hospital
inpatient fi
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