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BMJ No 7126 Volume 316
This week in brief Saturday 17 January 1998
Vitamin K and leukaemia: one study finds no link, but others
don't completely exclude a risk
White consultants are three times more likely to get a distinction
award than non-white ones
Quilts are associated with sudden infant death only in infants who
do not sleep prone
Exposure to measles in utero does not lead to Crohn's disease
Severe childhood sexual abuse is associated with adult
depression
Effective purchasing needs big powerful purchasers
Vitamin K and leukaemia: one study finds no link, but others don't completely exclude a risk
In the early 1990s two reports by Golding et al suggested that the risk of childhood cancer, particularly leukaemia, was doubled in children who had recieved prophylactic intramuscular vitamin K at birth. None of the subsequent research found any significant association, but these studies used different methods and were hampered by lack of power. This week's issue includes four more studies: all provide further evidence against an effect of the vitamin K of the size suggested by Golding et al. The first, by McKinney et al, failed to show any significant association between cancer and vitamin K (p 173). In a population based case-control study in Scotland designed to identify risk factors for childhood cancer they investigated vitamin K by using information in hospital records and found no significantly raised risks for leukaemia or any other type of cancer. Accounting for other factors that might explain an association, such as type of delivery or deprivation, did not alter their findings. Two studies (case-control and ecological) by Passmore et al (p 178, p 184) and another case-control study by Parker et al (p 189) do not, however, exclude a possible association with leukaemia. Passmore et al consider that this might be explained by the association they found between type of delivery and risk of leukaemia. Parker et al found no association with non-leukaemia malignant disease but were unable to rule out an association with acute lymphoblastic leukaemia, especially for that diagnosed in children aged 1-6 years. Passmore et al and Parker et al suggest that their results support a policy of giving intramuscular vitamin K only to babies at high risk of vitamin K deficiency bleeding, with oral vitamin K being given to the others.
White consultants are three times more likely to get a distinction award than non-white ones
The distinction award scheme has been plagued by controversy ever since it was started when the NHS was created. Although the system of allocation is now more open, large differences still exist in the allocation of awards by region, specialty, and gender. On p 193 Esmail and Everington identify a further problem: large racial differences in the allocation of awards. Using surnames as proxies of ethnic group, the authors showed that white consultants were three times as likely to get an award as non-white consultants.
Quilts are associated with sudden infant death only in infants who do not sleep prone
A study of 100 of the 107 sudden infant deaths that occurred in infants aged under 1 year in Tasmania in 1988-95 examined the association with use of quilts and sleeping position. On p 195 Ponsonby et al show that the use of a quilt increases the risk of death among older infants who sleep supine or on their sides.
Exposure to measles in utero does not lead to Crohn's disease
Following Swedish studies that suggested a higher incidence of Crohn's
disease among people born after a measles epidemic, Nielsen et al
(p 196) performed a record linkage study of 33 pregnant women with
m
Severe childhood sexual abuse is associated with adult depression
Although an association is believed to exist between sexual abuse in childhood and increased psychopathology in adult life, the relation between childhood sexual abuse and adult depression is unclear. Cheasty et al (p 198) examined this relation in a population of Irish women in general practice. A positive association was found only between severe abuse - penetration or attempted penetration - and depression; all those who had experienced penetration were depressed.
Effective purchasing needs big powerful purchasers
As part of a series of commentaries on the recent white paper on the NHS (p 212), Light argues, from an American perspective, that the British NHS has never taken purchasing seriously (p 217). American purchasers have learnt that to purchase effectively for health gain and get the best value for money they need to be powerful enough and smart enough to outwit the attempts of providers to shift costs. In particular, purchasers need good data on what they are buying and to contract for all services, including primary care.
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