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BMJ No 7124 Volume 316 This week in brief Saturday 3 January 1998 Treatment decisions can be based on results of ultrasonography in suspected venous thrombosis Adherence to infant feeding guidelines improves childhood health Preventing illness does not save money Women often regret having sex at a young age Patients at high risk of melanoma can be identified in primary care Having both financial and clinical equity is impossible while variations in practice remain Treatment decisions can be based on results of ultrasonography in suspected venous thrombosis Clinical diagnosis of patients with suspected venous thrombosis of the leg is unreliable, and several repeat tests have to be performed over a week to identify most patients with the condition. On p 17 Cogo et al report a prospective study of compression ultrasonography in patients with suspected venous thrombosis designed to limit the number of repeat examinations to a single test one week after presentation. They show that such a strategy can identify nearly all patients with clinically relevant venous thrombosis. Anticoagulant treatment can be safely withheld from the many patients with normal results on both ultrasound examinations. Adherence to infant feeding guidelines improves childhood health Infant feeding practices within the United Kingdom vary widely, with many infants not receiving the recommended diet of exclusive breast feeding for four months followed by the introduction of solid foods. On p 21 Wilson et al show that children in Dundee whose diet during infancy most closely met the national recommendations had less respiratory illness, were leaner, and had lower blood pressures. Preventing illness does not save money If a certain disease is prevented, that disease will need no treatment. This simple fact has led to the widespread opinion that prevention of disease might contain the rapidly rising costs of health care. But prevention avoids not only morbidity but also mortality from fatal diseases, and in countries with low mortality it will add life years predominantly to old age. In old age, prevalence of disabling degenerative conditions increases steeply and the need for expensive long term nursing care increases. On p 26 Bonneux et al present an analysis of cause elimination life tables that show that whereas prevention of fatal diseases, such as coronary disease or cancer, will increase life years, it will not reduce lifetime costs because of the costs of disease in later life. Prevention of non-fatal diseases, such as musculoskeletal conditions and mental disorders, will result in greater cost savings. Women often regret having sex at a young age In many developed countries the age at first sexual intercourse has dropped over the past 30 years. Dickson et al (p 29) investigated the circumstances of first intercourse in young New Zealand adults. The median age at first intercourse was 17 years in men and 16 in women. Women commonly reported being forced at first intercourse, especially when it occurred before age 14. More women than men reported sexually transmitted disease, especially those who had intercourse before age 16. The authors conclude that the risks of early sexual intercourse are shared unequally between young men and women. Patients at high risk of melanoma can be identified in primary care Though public campaigns about melanoma increase the numbers of early lesions excised, they also prompt patients without malignant melanomas to seek treatment. On p 34 Jackson et al therefore performed a study in general practice to test a risk factor questionnaire to identify people at high risk. The questionnaire was completed by 3105 patients in 16 practices and identified 270 (8.7%) at increased risk. 388 of the sample also had a clinical examination: the self reported and clinical findings showed moderate to good agreement. The authors conclude that the self report risk score is a feasible way of identifying patients at high risk. Having both financial and clinical equity is impossible while variations in practice remain Separate waiting lists for patients of fundholders and other general practitioners have caused resentment: because fundholders have been funded more generously they have bought faster treatment for their patients. Thus making resource allocation more equitable and adopting common waiting lists should improve equity. But on p 39 Bevan argues that inequity will remain as long as general practitioners vary so much in their referral rates. Common waiting lists, reflecting clinical equity, will simply lead to inequitable variation and overuse. He argues that the government should adopt financial equity for the new primary care groups: this would challenge variations in medical practice by making practitioners responsible for the resources they use and lead ultimately to clinical equity. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline