Editor's Choice | This Week in BMJ | Press releases
BMJ No 7102 Volume 315 This week in brief Saturday 26 July 1997 Class differences in mortality in Finland are related to alcohol Cleansing birth canal with chlorhexidine reduces postpartum infections Decrease in bone density with age contributes only a little to increased risk of hip fracture with age Fundholding improves cost containment Medicine should not rely on the memories of experts Class differences in mortality in Finland are related to alcoholFew studies have examined the impact of specific factors on socioeconomic differentials in mortality. Mäkelä et al (p 212) used comprehensive register data to examine the contribution of alcohol related mortality to such differentials in Finland. They found that about a quarter of the six year difference in life expectancy between upper non-manual employees and manual workers could be attributed to alcohol related deaths among men, and 9% of the three year difference among women. Most of this effect operated through accidental and violent deaths. Cleansing birth canal with chlorhexidine reduces postpartum infectionsDeveloping countries have high neonatal and maternal postpartum morbidity and mortality due to bacterial infections. In Malawi, Taha and colleagues (p 216) replaced the solution routinely used for cleansing the birth canal (Savlon) with chlorhexidine. Not only did they find no adverse reactions, but among 3,743 infants born during the intervention there were reductions in overall neonatal admissions, admissions due to sepsis, overall neonatal mortality, and mortality due to infectious causes. Among the 3,635 mothers they found reductions in postpartum admissions related to delivery, admissions due to postpartum infections, and duration of hospitalisation. The authors recommend cleansing with chlorhexidine as part of standard care. Decrease in bone density with age contributes only a little to increased risk of hip fracture with ageThe association of low bone mass with an increased risk of hip fracture is well known, as is the association with age, but the effect of both together is poorly understood. De Laet et al (p 221) combined cross sectional data on bone mineral density from 5,814 men and women with national incidence data on hip fracture in the Netherlands. Bone density decreased linearly with age. After 60 men had a risk of hip fracture equivalent to that of women five years younger. Though the age related decline in bone density is larger in women, the risk of hip fracture when age and bone density are considered together is similar in men and women: the five year difference can be explained by different bone density distributions at those ages. Though the risk of hip fracture increased 13-fold from age 60 to 80 in both sexes, the age related decline in bone density explained merely a doubling of the risk. Screening for chlamydia may be viable in general practiceChlamydia trachomatis is the commonest bacterial
sexually transmitted infection in Britain. It is frequently
asymptomatic but can cause important complications in women, including
pelvic inflammatory disease, tubal infertility, and ectopic pregnancy.
Screening might be the way forward, but acceptable screening tests must
be established. On p 226 Grun et al describe the prevalence of
infection in women attending general practice and compare the
performance of a new test (ligase chain reaction) with an immunoassay.
They found that over 1 in 20 women aged 18-25 years had undiagnosed
chlamydial infection. The new test performed at least as well as the
immunoassay and uses urine specimens, unlike the older test, which
requires a cervical sample. These findings should improve the prospects
for community based screening for chl An extensive literature from cognitive psychology and other
disciplines has shown the limitations of the unaided human mind and
memory in performing complex tasks. Yet, argues Weed on p 231, doctors
persist in practising in a way that depends on loading their memories
with scientific knowledge and bringing it inefficiently to bear on
individual problems. Instead, he argues, that knowledge should be built
into information tools that practitioners - and more
importantly - patients use. He argues that the emphasis on artificial
intelligence fails to recognise that experts' decision making is only
as good as the information they take into account. The real need is for
a tool that retrieves and organises information and makes it easily
available to aid decision making. Such tools include knowledge
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