Editor's Choice | This Week in BMJ | Press releases
BMJ No 7107 Volume 315 This week in brief Saturday 30 August 1997 High dose vitamin A gives no benefit in childhood pneumonia Upper gastrointestinal haemorrhage is linked to deprivation Deprived areas benefit most from water fluoridation GPs' beliefs about their patients' expectations determine whether patients get drugs District diabetes registers can be created by electronic linkage of many data sources High dose vitamin A gives no benefit in childhood pneumoniaAcute respiratory infections are the leading cause of morbidity and mortality among young children in the developing world. Global efforts at mortality control currently focus on case management, mainly through use of antibiotics, and on improving the coverage of measles and pertussis immunisation. Nacul et al (p 505) report the results of a randomised double blind, placebo controlled clinical trial to evaluate the efficacy of adding high doses of vitamin A to protocols to manage pneumonia in childhood. The study was conducted in 472 children in north east Brazil, where around a third of children have some degree of biochemical vitamin A deficiency. Although therapeutic doses of vitamin A have been shown to be of benefit in the treatment of measles, the authors found no effect on the immediate outcome of pneumonia. Upper gastrointestinal haemorrhage is linked to deprivationAcute upper gastrointestinal haemorrhage is a common reason for admission to hospital. Despite many advances in its management, case fatalities have remained constant. On p 510 Blatchford et al show that this presentation is much more common in the west of Scotland than previously reported in other parts of Britain. They show a relation between incidence of acute upper gastrointestinal haemorrhage and socioeconomic deprivation and suggest that this may be mediated by Helicobacter pylori infection. Incidence and case fatality both increase steeply among older patients and the authors argue that overall population mortality from acute gastrointestinal haemorrhage may rise as a consequence of the aging population, despite improved clinical management. Deprived areas benefit most from water fluoridationSince 1985, no new water fluoridation schemes have been implemented in Britain. This has allowed a "natural experiment" to arise in Britain, where five million people have water fluoridation while the remaining population does not. Jones et al (p 514) used results from the NHS dental surveys of 5 year olds and Jarman underprivileged area score in three areas - one with no fluoridation, one with artificial fluoridation, and one with natural fluoridation. Their results confirmed dental decay as a disease of deprivation and showed that the more deprived an area, the greater benefit derived from fluoridation. Water fluoridation, especially in areas of social deprivation, has halved tooth decay in 5 year olds. The authors believe that water fluoridation would also benefit the rest of Britain. GPs' beliefs about their patients' expectations determine whether patients get drugsTo determine the role of both patients' and general
practitioners' expectations in prescribing, Cockburn and Pit gave
questionnaires to 22 Australian general pr District diabetes registers are a prerequisite to providing effective
diabetes care, but creating them has proved a major task. Morris et al
(p 524) report an initiative in Tayside to link multiple data
sources, including all patients attending hospital diabetes clinics,
all encashed prescriptions for diabetic drugs and monitoring equipment,
all patients discharged from hospital, patients attending eye
screening, and results for glycated haemoglobin and plasma glucose
concentrations from the regional biochemistry database. This register
identified 7,596 patients, giving a prevalence of diabetes of 1.94%.
Validation against general practice records showed the electronic
linkage to be more sensitive in ascertaining cases of known diabetes. A
unique patient identifier was fundamental for successful linkage.
|