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BMJ No 7106 Volume 315 This week in brief Saturday 23 August 1997 Poor intrauterine nutrition is not related to high blood pressure in late adolescence Shorter questionnaires may produce better response rates than more complex ones Current management of chronic hepatitis C is often unacceptable to patients Numbers of cognitively impaired elderly people will rise radically in middle of next century Withdrawal of long term diuretics in elderly patients often produces heart failure symptoms Poor intrauterine nutrition is not related to high blood pressure in late adolescence Some, but not all, recent studies of blood pressure and birth weight have shown an inverse relation, which may result from fetal adaptation to an adverse environment, particularly undernutrition. Using a large computerised dataset (Israelis called up for military service), Laor et al evaluated the effects of size at birth and mother's nutritional status on blood pressure at 17 years (p 449). They used multiple regression analysis to adjust for the effects of height and weight of the subjects and their mothers, as well as birth order, ethnic origin, and socioeconomic factors, and they found that poor intrauterine nutrition - as reflected by the mother's low body weight before pregnancy and poor weight gain in pregnancy and by being born small for gestational age - was not associated with higher blood pressure in late adolescence. Shorter questionnaires may produce better response rates than more complex ones The impact of a condition such as stroke on quality of life is crucial but hard to measure. Dorman et al (p 461) postulated that the brevity of the EuroQol questionnaire (six questions and a visual analogue scale) would achieve a better response in stroke survivors than the SF-36 (34 questions). They tested this in a randomised controlled trial of 2253 stroke survivors: both the response rate and the proportion of completed forms were significantly higher in patients allocated the EuroQol questionnaire, even though patients responding to the EuroQol were more likely to be dependent. Current management of chronic hepatitis C is often unacceptable to patients The management of chronic hepatitis C is controversial, since the disease is new and treatment with interferon alfa is both unpleasant and of low efficacy. On p 453 Foster et al report a clinical audit of their management guidelines for chronic hepatitis C and show unexpected problems. Many of their patients were not prepared to undergo treatment with interferon alfa. In patients with cirrhosis related to hepatitis C treatment with interferon alfa was almost always ineffective, these patients having high incidence of complications, chiefly hepatocellular carcinoma. The authors conclude that drugs will be required to deal with the problems of chronic hepatitis C, but in the meantime doctors must ensure that patients are fully informed about the dangers of this disease. Doctors should also encourage patients with biopsy evidence of progressive disease to undergo treatment as some will be spared the problems associated with cirrhosis. Numbers of cognitively impaired elderly people will rise radically in middle of next century Financing long term care for elderly people, most of which is used by people with cognitive impairment, is a contentious issue. To inform planning Melzer et al used census and survey data to estimate future numbers of elderly people with cognitive impairment and hence likely to need long term institutional care (p 462). Their model estimated that in 1996, 563 000 people in Britain had cognitive impairment (rising from 2.3% in those aged 65-74, to 7.2% in those aged 75-84, and to 21.9% in those aged over 84). Their model predicts an increase of about 60% in the population aged 65 and over by 2036 but an increase of 100% in the percentage showing cognitive impairment, peaking in 2051. At present as many cognitively impaired people needing constant care live at home as in nursing or residential homes. Policymakers need to be aware of these trends. Withdrawal of long term diuretics in elderly patients often produces heart failure symptoms About a fifth of people aged over 65 and half of those aged over 80 use long term diuretics, but uncertainty exists over whether such extensive long term treatment does more good than harm. Walma et al (p 464) performed a double blind randomised controlled trial in general practice to assess what proportion of elderly patients could safely be withdrawn from their diuretic therapy; 202 patients with no heart failure and regulated blood pressure were allocated to withdrawal or continuation of diuretic therapy. Clinical conditions requiring prescription of diuretic therapy occurred in 49% of the withdrawn patients but only 13% of the controls; heart failure in 25% of withdrawn patients and 4% of controls. After cessation of diuretic therapy blood pressure rose by an average of 13.5/4.6 mm Hg. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline