The value of angiotensin converting inhibitors in non-diabetic
renal disease is shown in a meta-analysis of 10 randomised controlled
trials encompassing 1594 patients followed up for a minimum of one year
(Annals of Internal Medicine 1997;127:337-45). The
pooled relative risk of patients taking the drugs developing end stage
renal disease compared with controls was 0.70 (95% confidence interval
0.51 to 0.97), and there was no adverse effect on mortality in the
treated patients.
Another report in the Annals of Internal
Medicine (1997;127:372-5), compares endothelial
dependent arterial dilatation in healthy smokers living in southern
China with that in matched smokers from England and Australia. Unlike
their white counterparts, Chinese smokers showed no smoking associated
endothelial dysfunction. This may account for the low incidence of
coronary heart disease in southern China despite high rates of smoking.
Working in an area of extreme deprivation might be
expected to be associated with low morale, but a survey of 500 London
general practitioners working in practices with widely different
deprivation scores showed no such association (British Journal
of General Practice 1997;47:547-52). Factors that did correlate
with low wellbeing were subjective "stress" due to time pressures,
and working in small practices with small healthcare teams.
A prospective study of 479 hospital patients colonised
with methicillin resistant Staphylococcus aureus
found that being in intensive care, or having pressure sores, surgical
wounds, or intravenous cannulae were independent risk factors for
developing clinical infection (Journal of Hospital
Infection 1997;37:39-46) Adopting early and stringent infection
control measures in patients with these identified risk factors may be
an effective way of controlling the spread of infection in
outbreaks of methicillin resistant S aureus.
Inappropriate demand for prostate screening may be due to a
widespread misconception about both the value of screening and the true
risk of developing or dying of prostate cancer (Medical Journal
of Australia 1997;167:250-3). Among 340 randomly selected men
aged 40-80, 52 had been screened at least once in the past year and
over a third overestimated the risk of developing cancer by threefold.
"Drowsy driving" is an important and underappreciated cause
of car accidents involving human error, argues an editorial in
the New England Journal of Medicine (1997;337:783-4),
which cites data showing that sustained wakefulness for 17 hours
decreases performance as much as a blood alcohol concentration of
50 mg/100 ml, the legal limit in several countries in Europe. This and
other evidence suggests that managing with little sleep may be
antisocial rather than praiseworthy.
Having children late has its drawbacks, but Minerva was
interested in the silver lining offered in a study comparing 78 women
aged 100 with a comparable birth cohort of 54 women who died at 73. The
centenarians were four times more likely to have had children in their
40s (Nature 1997;389:133), suggesting that having
children late may be a marker of longevity.
Lung cancer remains the most common cancer in men in the
European Union; the Belgians have the highest rate (around
75/100,000). A report in the Journal of the National
Cancer Institute (1997;89:1183) puts the
Netherlands second in the grim league table, with Luxembourg, Italy,
and Britain in the next three places. The lowest
rate - 22/100,000 - is in Sweden.
Choice of implant is an important factor in determining revision
rates after total knee replacement, but choice is hampered by a lack of
objective evidence on relative efficacy, warns a review in the
Annals of the Royal College of Surgeons of England
(1997;79:321-2). Published results are not available for half of the 40
or so implants in current use in Britain, and there is no requirement
for new prostheses to undergo trials before they are introduced.
A study in Finland of 4,534 municipal workers aged 55-69 followed
up for 11 years (Scandinavian Journal of Work and Environmental
Health 1997;23(suppl 1):27-35) found that self assessed health
improved in all age groups. The explanation seems to be that the
criteria for perceived good health become lower as people age.
Reanalysis is needed to confirm or refute the report of a small,
statistically non-significant increase in infant mortality in some
provinces in Canada in 1993-4 (Canadian Medical
Association Journal 1997:157:535-41). But an
accompanying editorial warns against complacency. A possible link with
rising rates of poverty in Ontario, the key state concerned, needs to
be taken seriously.
An analysis of hospital episodes statistics between
1989 and 1995 found that private patients accounted for 1% of finished
consultant episodes (Health Trends 1997;29:21-5).
Although the authors conclude that treating private patients in NHS
hospitals is unlikely to have had an appreciable impact on the
treatment of NHS patients, the median waiting times of 9 days for
private patients and 42 days for NHS patients speak for
themselves.
Fundal examination of young children from families with
familial adenomatous polyposis may be an effective way of screening for
carriers of the adenomatous polyposis coli, APC, gene (British
Journal of Ophthalmology 1997;81:755-8). Two thirds of the
families affected have characteristic retinal pigment epithelial
lesions, which are homogeneous within families. The advantage of this
approach is that it is non-invasive and can be carried out earlier than
colonoscopy.
The prospect of an EU ban on tobacco advertising has
never been closer, says an article in European Voice
(1997;3(31):5). Germany, Greece, and Holland remain opposed but the
volte face of the UK government and recent amendments to the draft
directive to allow a three year run in period may just sway the vote at
the health council on 4 December.
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