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 This week in brief Saturday 10 January 1998 Risks of extended oral anticoagulation for factor V Leiden mutation exceed benefits British diabetics show socio-economic gradients in mortality Whole cell vaccines for typhoid are more effective but more toxic than newer vaccines Reduction in psychiatric beds diminishes the advantages of community care Zopiclone may cause withdrawal symptoms Prevalence of asthma in 12-14 year olds varies little across Britain Risks of extended oral anticoagulation for factor V Leiden mutation exceed benefits Patients who carry the factor V Leiden mutation have a high risk of recurrence after a first episode of deep vein thrombosis. Genetic screening for the abnormality followed by extended oral anticoagulation treatment is therefore sometimes recommended. On p 95 Sarasin and Bounameaux report on a decision analysis to measure the risks and benefits of extending oral anticoagulation up to 1-5 years. Compared with reinitiation of oral anticoagulants after a recurrent thrombosis, the number of major haemorrhages induced by extended oral anticoagulants would exceed that of pulmonary emboli prevented. The authors conclude that screening to detect the mutation should be questioned. British diabetics show socio-economic gradients in mortality A recent Finnish study found no socioeconomic gradient in mortality among people with diabetes. Chaturvedi et al (p 100) therefore examined mortality in two large studies with 20 year follow up - of 17 264 Whitehall civil servants (218 with diabetes) and 300 patients attending diabetes clinics in London. Mortality was twice as high in diabetic people in the lowest socioeconomic groups as in those in the highest, largely due to higher rates of smoking and high blood pressure in the lowest social groups. The authors emphasise the importance of improving conventional cardiovascular risk factors and reducing social inequality for reducing mortality in people with diabetes. Whole cell vaccines for typhoid are more effective but more toxic than newer vaccines Typhoid fever remains endemic in much of the developing world. Large field trials have provided different estimates of the efficacy of vaccines. Engels et al (p 110) performed a meta-analysis to assess the efficacy and toxicity of these vaccines. They found that the whole cell vaccines were more effective than either of the newer vaccines, Ty21a or Vi. The whole cell vaccines, however, were associated with the highest incidence of adverse events. Reduction in psychiatric beds diminishes the advantages of community care The view that there are now insufficient psychiatric beds for acute care receives support from the research by Tyrer et al (p 106), in which patients with recurrent psychotic disorders were randomised to community and hospital based care after discharge. One area (Brent) was severely depleted in hospital beds compared with the other (Westminster and North Kensington). The community care teams were more effective in reducing admissions and thereby costs of care, but the most striking finding was the doubling of costs in Brent. This was largely due to longer inpatient care, with many patients in hospitals away from the catchment area. Care disintegrates and costs mount when beds are short. Zopiclone may cause withdrawal symptoms Zopiclone is used for the short term treatment of insomnia and is believed not to cause dependence or withdrawal symptoms. On p 117, however, Jones and Sullivan report four patients who increased their initial dose of zopiclone and suffered withdrawal symptoms, including craving, anxiety, and insomnia, when they reduced the dose or tried to stop taking the drug. The authors say that zopiclone should be prescribed with the same caution as benzodiazepines. Prevalence of asthma in 12-14 year olds varies little across Britain As part of the international study of asthma and allergies in childhood (ISAAC), Kaur et al (p 118) administered questionnaires asking about symptoms, diagnosis, and treatment of asthma to over 27 000 children aged 12-14 across Great Britain. A third reported wheezing in the past year, and a fifth reported ever having had a diagnosis of asthma. The study highlights the potential unmet need for treatment: 4% of children reported having had a diagnosis of asthma but still had their lives disrupted by symptoms, while 1-3.4% reported moderate to severe symptoms but were undiagnosed. Prevalences of symptoms generally varied by a factor of 1.3 or less across Britain, and the authors conclude from this that geographical factors - climate, diet, and outdoor environment - are not the main determinants of prevalence. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline