Mystery of increase in hay fever and eczema remains
Should doctors pay patients to take their pills?
[Should we pay the patient. Review of financial incentives to enhance
patient compliance]
Patients who are given a financial incentive to take their pills are more
likely to follow their doctor's orders, says a report in this week's BMJ.
Giuffrida and Torgerson write that financial incentives (in the form of
cash or gift vouchers) can improve the widespread problem of patients not
complying with their prescribed medical treatment. People who do not
comply with certain treatments, may increase costs to society by wasting
medication and making an illness more difficult and expensive to treat in
the future. In their study, Giuffrida and Torgerson found that in ten out
of eleven trials, financial payments improved compliance and they conclude
that such practice could be cost effective in areas where compliance is
important not just to the patient, such as the treatment of TB.
Contact:
Mr Antonio Giuffrida,
research fellow
National Primary Care Research and
Development Centre for Health
Economics,
University of York
tel: 01904 433718
fax: 01904 433644
email: agia@York.ac.uk
Growth hormone treatment is falling short
[Growth hormone: panacea or punishment for short stature?]
Knowledge about the long term results of growth hormone treatment in
children of short stature is limited, as most studies report short term
results, usually after one year. In this week's BMJ, Coste et al report on
their study of children whose treatment with growth hormone started in
France, between 1973 and 1989. They found that growth hormone treatment
had not restored normal growth to children with growth hormone deficiency
and conclude that further research should be conducted to determine the
optimal use of such treatments, in the light of their highly demanding
nature on the patient and the high costs incurred.
Contact:
Dr Jo Coste,
associate professor of biostatistics
Departement
de Biostatistique et de
Informatique Medicale
(Faculte Cochin,
Universite Paris V)
tel: 00 33 1 4234 5170
fax: 00 33 1 4329 3860
email: coste@cochin.univ-paris5.fr
In an editorial in this week's BMJ, Brook expands on the paper by Coste et
al, with particular emphasis on short normal children. Brook suggests that
growth hormone for these children proves expensive and does little to
increase adult stature. The editorial advocates that it is much more
important for a short child to acquire coping skills and learn to live with
being short rather than trying to buy inches through pharmacological
means.
Contact:
Professor C G D Brook
London Centre for Paediatric Endocrinology,
Great Ormond Street and the Middlesex Hospitals.
Professor Brook is on
holiday until 1 October, but his academic secretary can arrange for him
to handle any queries on his return.
tel: 0171 380 9450
fax: 0171 636 9941
email: c.brook@med.ucl.ac.uk
Worrying rise in childhood diabetes
[Rising incidence of insulin dependent diabetes in children aged under 5
years in the Oxford region: time trend analysis]
The incidence of insulin dependent diabetes in children under five years,
has risen markedly over the last decade, write Gale et al in this week's
BMJ. Their study in the Oxford region, found that between 1985 and 1995,
the incidence of insulin dependent diabetes in children under five years
has doubled, whilst cases of diabetes in children under 15 years, has seen
an overall increase of four per cent each year. The study highlights that
the onset of diabetes at an early age, has a greater impact on the patients
and their families and a worse prognosis for complications in later life.
Gale et al suggest that identification of environmental influences
encountered before birth or in new born babies, seems to offer the best
hope for preventing the disease.
Contact:
Professor Edwin A M Gale,
professor of diabetic medicine
Diabetes
and Metabolism,
Department of Medicine,
University of Bristol
tel: 0117 959 5337
fax: 0117 959 5336
Mystery of increase in hay fever and eczema remains
[Investigation into the increase in hay fever and eczema at age 16 observed
between the 1958 and 1970 British birth cohorts]
The prevalence of childhood eczema and hay fever is reported to be
increasing. In this week's BMJ, Butland et al report on the results of two
national studies, of British children born in 1958 and 1970, who were
followed up in 1974 and 1986 respectively. Levels of hay fever and eczema
at age 16 years nearly doubled during this 12 year period. When taken
together, differences in sex, birth weight, birth order, maternal age,
breast feeding, maternal smoking during pregnancy and father's social class
at birth, between children born in 1958 and those born in 1970, did not
seem to explain any of the observed increases in prevalence of hay fever
and eczema at age 16 years. The authors suggest that factors which have
changed over time and which were once strongly associated with
socioeconomic class, may underlie the observed increase in reported cases
of these diseases and deserve further investigation.
Contact:
Ms Barbara K Butland,
lecturer in medical statistics
Department
of Public Health Sciences,
St George's Hospital Medical School.
Ms
Butland is on holiday until 22 September.
Co-author David Strachan,
will be available for interview on Wednesday 17 September.
tel: 0181 725 5429
fax: 0181 725 3584
email: b.nicholas@sghms.ac.uk
Please contact Public Affairs Division for the text
of the paper & the authors for further comment
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