This Week in BMJ | Editor's Choice | Press releases

497 Improving the health of the world's poor Davidson R Gwatkin, Patrick Heuveline

498 The trouble with bone allograft
Fabian H Norman-Taylor, Nicola Santori, Richard N Villar

499 Consumer participation in research and health care
Alessandro Liberati

500 Adverse drug reactions: finding the needle in the haystack
I Ralph Edwards

501 Hospital waiting lists grow by 13%
Psychologist wins damages for research theft
China's smoking epidemic grows
AMA apologises for commercial deal
Israel's mounting healthcare deficit
Necropsies decline in France
Tuberculosis infection process uncovered
Crackdown on locum doctors
Colombia struggles with healthcare reform
Medicinal marijuana provided at cost price

505 Randomised, double blind, placebo controlled clinical trial of efficacy of vitamin A treatment in non-measles childhood pneumonia
Luis C Nacul, Betty R Kirkwood, Paul Arthur, Saul S Morris, Marcelo Magalhães, Maria C D S Fink

510 Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study
Oliver Blatchford, Lindsay A Davidson, William R Murray, Mary Blatchford, Jill Pell

514 Water fluoridation, tooth decay in 5 year olds, and social deprivation measured by the Jarman score: analysis of data from British dental surveys
C M Jones, G O Taylor, J G Whittle, D Evans, D P Trotter

518 Electronic monitoring of vaccine cold chain in a metropolitan area
Andrew Wawryk, Chris Mavromatis, Michael Gold

519 Reporting of adverse drug reactions by hospital pharmacists: pilot scheme
Anne Lee, D Nicholas Bateman, Clive Edwards, James M Smith, Michael D Rawlins

520 Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations - a questionnaire study
Jill Cockburn, Sabrina Pit

524 The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register
Andrew D Morris, Douglas I R Boyle, Ritchie MacAlpine, Alistair Emslie-Smith, Roland T Jung, Ray W Newton, Thomas M MacDonald for the DARTS/MEMO Collaboration

529 Netlines
Mark Pallen

529 Netpoints: Piloting patient attitudinal surveys on the web
Marc A Suchard, Stephanie Adamson, Stephen Kennedy

530 Fortnighly review: Stress, the brain, and mental illness
J Herbert

536 ABC of mental health: Mental health on the margins
Philip Timms, John Balàzs

539 Corrections: ABC of mental health: Mental health emergencies
Zerrin Atakan, Teifion Davies

ABC of mental health: Addiction and dependence - I: Illicit drugs
Claire Gerada, Mark Ashworth

540 How to read a paper: Papers that report diagnostic or screening tests
Trisha Greenhalgh

544 Intensive insulin treatment after acute myocardial infarction in diabetes mellitus
R Williams; B M Fisher; K McLaughlin

545 Breast cancer risk with cyst type in cystic disease of the breast
S Ebbs and T Bates; J M Dixon and others

546 General practitioners' workload in primary care led NHS
C D Helliwell and T A Carney; J T Hart; I Sidford

547 Data on health economics of pulmonary rehabilitation programmes are needed
R J White and S T Rudkin

547 GPs' perceptions of tolerability of selective serotonin reuptake inhibitors and tricyclic antidepressants
J Grace; N Bhatti and J Graffy; I M Ali; R M Martin and others

548 Anonymity for unrelated bone marrow donors should remain
R Warwick

549 Diagnosing and managing polymyalgia rheumatica and temporal arteritis
C Sudlow; R Finlay; A G Freeman; P Roome; P Hodgkins and R Hull

550 Doctors should be trained in lifting patients
C Ng and others

551 Cognitive dysfunction may complicate assessment of pain in elderly patients
A M Severn and C Dodds

551 EU directive on bovine spongiform encephalopathy will not affect drugs
D R B Bowser

551 Obstructive sleep apnoea
J Wright and T Sheldon

552 M G Roberts, A T Roddie, B M A Rogers, R H Rushton, D G Scott

Soundings

553 A longer view
Colin Douglas

553 A doctor's dilemma
Margot Nelson-Owen

554 Publish and be damned?
Hilary Bower

555 Injured Brains of Medical Minds. Views from Within

Ed Narinder Kapur
Sean A Spence

Questioning the Solution: The Politics of Primary Health Care and Child Survival

David Werner, David Saunders
Martin Schweiger

556

Editor's choice

The world's health transition still leaves some behind

"The world's health transition" is the term given to this shift of emphasis, and it is, as Davidson Gwatkin and Patrick Heuveline remind us in their editorial, associated with reductions in fertility and improvements in overall health (p 497). Nevertheless, their main message is that if we care about the world's poor then communicable diseases among the young remain as important as ever. "Any shift in emphasis ... would move away from problems that are most important for the poor towards those that are more important for the better off."

A reminder of the scale of the problem comes on p 505 from Luis Nacul and colleagues' randomised controlled trial of vitamin A in childhood pneumonia in north east Brazil. In the developing world acute respiratory infections are the leading cause of mortality in young children, accounting for 30% of all deaths, with pneumonia the main cause of death. They reasoned that since high doses of vitamin A are effective in reducing case fatality and severity in cases of childhood measles complicated by pneumonia they might also be effective in pneumonia not associated with measles. Unfortunately, vitamin A added to standard treatment for pneumonia had no effect over placebo on the immediate outcome of pneumonia in this population of children (who had only marginal vitamin A deficiency).

An intervention that does work and that seems to matter more to the poor than the rich is fluoridation. C M Jones and colleagues studied tooth decay in three areas in Britain in the 1990s: one with natural fluoridation, one with artificial fluoridation, and one with no fluoridation (p 514). As expected, tooth decay was higher in deprived wards in all these areas, but fluoridation had an extra effect: in wards with the national mean deprivation score fluoridation produced a 44% reduction in decay, but in those with very high deprivation scores it produced a 54% reduction.

And finally, a good bit of teaching: anyone to whom a two by two table does not come naturally should read Trisha Greenhalgh's "How to read a paper" article this week (p 540). Her story of 10 men in the dock (three guilty, seven innocent, but two of the truly guilty and four of the truly innocent convicted) tells you all you need to know to work out sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. You'll have to read on for the likelihood ratio however - an even better measure of the usefulness of a test.