Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change servers in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7125 Volume 316 Press Releases Saturday 10 January 1998 Embargoed: 00.01 hrs 9 January 1998 UK time Dead sober or dead drunk? Similar levels of asthma across the country Diabetics with low socioeconomic status twice as likely to die Should advance directives have a statutory basis? Dead sober or dead drunk? May be hard to determine In an editorial in this week's BMJ, Pounder discusses the difficulties of assessing alcohol levels in the blood of people who have died in accidents, such as Henri Paul (who was driving Diana, Princess of Wales at the time of her fatal accident) and the victims of the Hillsborough football disaster. Pounder recognises that measurements of ethanol levels in body fluids can be confounded by several factors. For example, distinguishing between alcohol ingestion and the result of the natural process of ethanol synthesis in a dead body is extremely difficult. Pounder concludes that blood analysis for alcohol is the commonest request in forensic toxicology and is positive in around one third of all unnatural deaths. Good practice requires that blood samples are taken from a peripheral vessel and that corroboration analyses are performed on vitreous (found in the eyes), as well as bladder urine, in order to distinguish the cause of high alcohol concentrations. See Editorial, p 87 Contact: Professor Derrick Pounder, Department of Forensic Medicine, University of Dundee, Royal Infirmary, Dundee tel: 01382 200794 fax: 01382 322094 Similar levels of asthma across the country (Prevalence of asthma symptoms, diagnosis, and treatment in 12-14 year old children across Great Britain (international study of asthma and allergies in childhood, ISAAC UK)) One in three (33.3 per cent) 12 -14 year old children complains of wheezing symptoms, says a report by Kaur et al in this week's BMJ, yet only one in five (19.8 per cent) is treated with anti-asthma drugs. The authors found that there has been an overall increase in the levels of asthmatic symptoms, as compared to previous studies and there was little geographical variation in the prevalence. Levels did seem, however, to be slightly higher in Scotland and, surprisingly, in non-metropolitan (ie. rural) areas. Kaur et al conclude that potential under diagnosis and under treatment of asthma symptoms remain important. See Paper (abstract only) p 118 Contact: Dr Balvinder Kaur, Clinical Lecturer in Public Health Medicine Department of Public Health Sciences, St George's Hospital Medical School, London tel: 0181 725 2799 fax: 0181 725 3584 Diabetics with low socioeconomic status twice as likely to die (Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall study and the WHO multinational study of vascular disease in diabetes) In a paper in this week's BMJ, Chaturvedi et al report that diabetic people from the lowest socioeconomic groups are twice as likely to die as those in the highest groups. The authors note that this difference is largely due to the fact that there are higher rates of smoking and high blood pressure in the lowest social groups, which confound their condition. They conclude that their results underline the need to improve conventional cardiovascular risk factors and reduce social inequality in order to reduce mortality in diabetic people. See Paper (abstract only) p 100 Contact: Dr Nish Chaturvedi, Senior Lecturer in Clinical Epidemiology EURODIAB, Department of Epidemiology and Public Health, University College London tel: 0171 391 1724 fax: 0171 813 0288 email: nish@public-health.ucl.ac.uk Should advance directives have a statutory basis? (Changing the law on decision making for mentally incapacitated adults) "Who takes decisions concerning the medical treatment of adults when they can no longer decide for themselves, because of mental incapacity", asks Gadd in an editorial in this week's BMJ. She notes that such patients may receive care in a wide range of settings and that their numbers are growing, largely due to our ageing population. Gadd states that there is a need for legal clarity for patients, their carers and health professionals. In the absence of a valid advance refusal of treatment, health care decisions for incapable adults are presently mainly taken by doctors, in the best interests of the patient. Advance refusals of treatment allow patients to take decisions, while they have the capacity to do so about their treatment when they become incapacitated. Last month the Government issued a consultation paper seeking public and professional views based on the 1995 Law Commission's proposals for legal provisions governing decisions on health, welfare and financial affairs in cases of mental incapacity. The author stresses that neither the Law Commission nor the Government are proposing to legalise euthanasia. Gadd also touches on the grey area of the performing of procedures that are neither of benefit nor are detrimental to the patient (for example, taking a blood sample to investigate the disorder affecting the patient). She points out that the Government is seeking views on the ethics of such procedures and on the proposals generally, from health care professionals, patients and carers. See Editorial, p 90 Contact: Elaine Gadd, Senior Medical Officer Department of Health, London tel: 0171 972 4769/4332 fax: 0171 972 4773 Embargo: 00.01 hrs Friday 9 January 1998 Please contact Public Affairs Division for the text of the paper & the authors for further comment For further information, please contact: Jill Shepherd on 0171 383 6254 Public Affairs Division, BMA House, Tavistock Square, London, WC1H 9JP After 6pm & at weekends: 0181 651 5130, 0181 241 6386, 0181 674 6294, 0171 727 2897, 0181 997 3653 Or fax requests to Public Affairs Division, BMA on 0171 383 6403. 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