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BMJ No 7121 Volume 315 This week in brief Saturday 6 December 1997
Alcohol may protect against active H pylori
infection Alcohol may protect against active H pylori infectionHelicobacter pylori infection is often acquired during childhood, but active infection may be acquired and eliminated throughout adulthood. On p 1489 Brenner et al report the influence of tobacco, alcohol, and coffee on active H pylori infection in patients from a general practice in Germany. They found that smoking was not significantly related to active infection, drinking coffee was associated with an increased risk of infection, and drinking alcohol had a protective effect that was strongly dose dependent. This beneficial effect may be related to the antimicrobial effects of alcoholic drinks. Surgery is not as effective in stress incontinence as textbooks suggestStress incontinence is one of the commonest problems affecting middle aged and elderly women. Little is known about women's views of the benefits of surgical treatment as studies have mostly been based on surgeons' impressions. On p 1493 Black et al report a large prospective cohort study carried out in 18 hospitals which showed that while most women report improved symptoms, only 28% were continent a year later. Women who had no urodynamic investigations were as likely to benefit as those who were investigated. Another surprising finding was the reduction in urgency and urge incontinence, symptoms that have traditionally been contraindications to surgery. Falling social status increases risk of having low birth weight infantBabies born with a low birth weight (<2500 g) constitute a high risk group for a number of diseases, and much antenatal care is devoted to preventing impaired fetal growth. Nevertheless, about 5% of all infants in Denmark are born with a low birth weight. On p 1498 Basso et al use several population based registers to study the effect of genetic and social factors on the risk of having a child with a low birth weight. They found that the tendency to have two low birthweight infants was strong. The risk was highest for women whose social status had declined between the two births. They conclude that a decline in social status at a time when the opposite is expected calls for medical and social support. Risk of thromboembolic stroke increases marginally with modern oral contraceptivesRecent publications dealt with the question of whether third
generation oral contraceptives are associated with a higher or lower
risks than second generation oral contraceptives. Thromboembolic stroke
has not been discussed in the same extent. On p 1502 Heinemann et al
report on a matched case-control study performed in 16 centres in the
United Kingdom, Germany, France, Switzerland, and Austria to study the
risk for thromboembolic stroke. Cases were 220 women who had had an
ischaemic stroke, who were compared with 775 controls. The authors
conclude that the risk of occlusive stroke for women who use modern
oral contraceptives is very small because the incidence of stroke in
this age range is low and is no different between women using second
and third g The evidence that patients' expectations of receiving a
prescription influences prescribing is equivocal. Britten and Ukoumunne
(p 1506) found that, in contrast to previous studies, the level of
patients' hopes for a prescription exceeded both doctors' perceptions
and actual prescribing. Although close agreement existed between
patients' hopes and doctors' perceptions, over a quarter of patients
who hoped for a prescription did not receive one. In one fifth of
consultations where a prescription was given, it was not medically
indicated. Doctors' perceptions of patients' hopes were the strongest
determinant of the decision to prescribe.
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