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Editor's Choice | This Week in BMJ | Press releases
BMJ No 7129 Volume 316
Press Releases Saturday 7 February 1998
Embargoed: 00.01 hrs 6 February 1998 UK time
Little likelihood of association between breast implants and connective
tissue disease
Assault and alcohol major causes of facial injury
Injecting drug users eight times more likely to overdose within two weeks
of release from prison
Are we misusing 999?
How can GPs and specialists best learn from each other?
Should doctors recontruct the hymens of young women to mimic the virginal
state?
Addicted doctors need special service
Reagent strips not sufficient in detecting bacteriuria in early pregnancy
Little likelihood of association between breast implants and connective tissue disease
(Risk of connective tissue disease and related disorders among women with breast implants: a nationwide retrospective cohort in Sweden)See Paper (abstract only), p 417
Since the introduction of breast implants, some reports have suggested that there is an association between implants and immunological disorders. In a study published in this week's BMJ, Nyrén et al found that in a nationwide study of over 7,000 Swedish women with breast implants (and a control group of over 3,000 women who had undergone breast reduction surgery) there was no excess risk of connective tissue disease.
The authors found that of the women with implants, 29 were hospitalised for connective tissue disease as compared to a national average of 25.5 and of the women who had undergone reduction, 14 were hospitalised as opposed to the expected 10.5. In fact, when conducting a direct comparison of the two groups of women the authors found that those with implants had a slightly lower risk of connective tissue disease than those who had undergone breast reduction surgery.
Nyrén et al conclude that there is little likelihood of an association between breast implants and connective tissue disease.
Contact:
Dr Olof Nyrén, Associate Professor,
Department of Medical Epidemiology,
Karolinska Institute,
Stockholm
(Do silicone breast implants cause connective tissue disease?)
See Editorial, p 403
An editorial by Cooper and Dennison in this week's BMJ provides a history
of the controversial issue of breast implants, pointing to a body of
evidence suggesting that there is no association with connective tissue
disorders. The authors advise that until the results of a report by an
independent Department of Health review group are published in the spring,
the medical community should place greater reliance on the quality of
evidence when appraising health issues such as this.
Contact:
Professor Cyrus Cooper, Professor of Rheumatology,
MRC Environmental
Epidemiology Unit,
University of Southampton,
Southampton General Hospital
(Media are too eager to link silicone to disease)
See Letter, p 477
In a letter in this week's BMJ, Collis et al underline research findings that there is no evidence of a connection between breast implants and neurological or connective tissue diseases. They note that the use of silicone is common - in teats of infant bottles, in dimethicone (for colic and griping) and in baby milk formulas. Yet, say the authors, despite so much evidence disputing an association between silicone implants and connective tissue disorders, legal aid has been granted to a woman who alleges that her child's stomach cramps, skin problems and food allergies are due to a silicone breast implant. Collis et al cite a recent letter to the lord chancellor from four professors, expressing their dismay that the British legal process may fall prey to unreliable scientific evidence and warn of the "price paid in North America as a direct result of such...litigation".
Contact:
Nicholas Collis, Specialist Registrar in Plastic and Reconstructive
Surgery,
Breast Special Interest Group,
British Association of Plastic
Surgeons,
Royal College of Surgeons,
London
Injecting drug users eight times more likely to overdose within two weeks of release from prison
(Mortality from overdose among injecting drug users recently released from prison: database linkage study)
See Paper (abstract only), p 426
In this week's BMJ, Seaman et al investigate the risk of death from overdose in injecting drug users with HIV, who resume drug use after release from prison. The authors find that overall, imprisonment does not increase injecting drug users? risks of dying from an overdose. However, this risk seems to be eight times higher within the first two weeks after release from prison than it is during the subsequent ten weeks. Seaman et al note that overdose deaths in injectors per annum may outnumber the deaths from suicide in Scottish prisons by three to one.
The authors suggest that lives could be saved by implementing prison based trials of interventions, which would take varying periods of time to undertake, to reduce the number of deaths from overdose. The trials could include providing an information sheet to prisoners who are about to be released; obtaining permission from the inmate for communications between the prison doctor and the inmate's GP or providing an appointment with prison health care staff before the inmate is released.
Seaman et al conclude that further studies will be needed to determine if their estimate of one death from overdose per 1,000 days spent recently released, can be generalised to those injectors who are not infected with HIV and to dependent drug users who do not inject.
Contact:
Dr Sheila Gore, Senior Statistician,
Medical Research Council
Biostatistics Unit,
Institute of Public Health,
Cambridge
Are we misusing 999?
(Is the emergency (999) service being misused? Retrospective analysis)The number of emergency admissions to hospitals in the UK has increased for reasons that are not fully understood. The ageing populations is not the principal cause, as demographic changes account for only five per cent of the increase and the increase is too steep to be explained by a worsening health of the nation. Other causes that have been suggested include, higher patient expectations and a rise in referrals by GPs ( GPs and hospital doctors both have an increasing fear of litigation). Also, falling death rates among patients who are admitted suggest that patients are being admitted with less serious problems than before.
In this week's BMJ Mann and Guly investigate whether an increase in "inappropriate" calls accounts for the increase, in their four year study (1993-7) with the Westcountry Ambulance Service and Derriford Hospital in Plymouth. During this period 999 calls increased by 28 per cent, but the authors found that this was not due to inappropriate calls, as the numbers of patients admitted also increased (inappropriate calls would have led to a fall in admissions).
Mann and Guly conclude that none of the reasons suggested for the increase can explain the size of the rise, but as the increase in numbers is far in excess of the rise in bed capacity, there is an increase in the pressures on A&E departments and hospital wards.
Contact:
Dr Clifford Mann, Senior Registrar,
Department of Accident and Emergency
Medicine,
Derriford Hospital,
Plymouth
How can GPs and specialists best learn from each other?
(Qualitative study of educational interaction between general practitioners and specialists)
See Paper (abstract only), p 442
In a General Practice paper in this week's BMJ, Marshall finds that there is a mismatch between the education GPs wanted from specialists and what specialists are actually providing. He found that GPs wanted to learn information that is directly applicable to their clinical work and to use referrals as a two-way learning process (they would like feedback about the quality and appropriateness of their referrals). However, the author found that GPs are not sufficiently explicit about their learning requirements and so specialists tended to concentrate their teaching activities on new developments in their subject. Also, specialists could benefit from learning different ways of teaching.
Marshall concludes that both participants are willing to learn from each other and that education should be a two way process, since this would help to promote mutual understanding of different roles and functions within the medical profession.
Contact:
Martin Marshall, Lecturer,
Institute of General Practice,
Postgraduate
Medical School,
University of Exeter,
Exeter
Should doctors reconstruct the hymens of young women to mimic the virginal state?
(Should doctors recontruct the vaginal introitus for adolescent girls to mimic the virginal state?)
See Education and debate, p 459
In the Netherlands doctors occasionally face requests by young women from immigrant families to reconstruct their hymens, as in some ethnic ocmmunities , women must be virgins when they marry. In an education and debate paper in this week's BMJ, the above ethical question is considered in six seperate commentaries.
Who wants the procedure and why?
Contact:
Dr A Logmans, Consultant Gynaecoogist,
Department of Gynaecology,
Dr Daniel den Hoed Kliniek,
Rotterdam
The ethical issue is deceit
Contact:
Professor D D Raphael, Emiritus Professor of Philosophy,
Imperial
College of Science,
Techonology and Medicine,
London
Promiscuity is acceptable only for men
Contact:
Dinesh Bhugra, Senior Lecturer in Psychiatry,
Institute of
Psychiatry,
London
Education about the hymen is needed
Contact:
Sara Paterson-Brown, Consultant Obstetrician and Gynaecologist,
Queen Charlotte and Chelsea Hospital,
London
Cultural complexities should not be ignored
Contact:
Elspeth Webb, Senior Lecturer,
Department of Child Health,
University of Wales College of Medicine,
Cardiff
Surgery is not what it seems
Contact: Lainie Friedman Ross, Assistant Director,
MacLean Center for
Clinical Medical Ethics,
University of Chicago,
USA
Addicted doctors need special service
(Missed problems and missed opportunities with addicted doctors)
See Editorial, p 405
In an editorial in this week's BMJ, Strang et al argue that a dedicated service for addict doctors is now long overdue and is an important element that was insufficiently addressed by the otherwise excellent BMA report on the subject last month. Doctors are at special risk of developing addiction problems, say the authors, owing to the strain of medical practice, erosion of the taboo against injecting and opiates and access to supplies. Once addicted, doctors face a major problem in accessing effective treatment, finding themselves isolated and carrying a stigma, such that they feel that they cannot seek treatment from "colleagues".
Strang et al suggest that three components of care are essential:- access to treatment should be simple particularly in times of crisis; treatment should be at a dedicated unit with other addicted healthcare professionals and there should be special arrangements for supervision and post-treatment monitoring. The authors conclude that the phenomenon of the addicted doctor may shock and offend, but nevertheless must be addressed by both the profession and employers as an important cause of impaired performance through ill health.
Contact:
Professor John Strang, Professor of the addictions,
National Addiction
Centre,
The Maudsley/Institute of Psychiatry,
London
Reagent strips not sufficient in detecting bacteriuria in early pregnancy
(Evaluation of reagent strips in detecting asymptomatic bacteriuria in early pregnancy: prospective case series)
See Paper (abstract only), p 435
Asymptomatic bacteriuria (bacteria in the urine suggesting illness, which is unnoticed by the patient) is a potentially serious clinical condition in pregnant women. In a paper in this week's BMJ, Tincello and Richmond note that early antenatal urine screening should identify all cases to ensure adequate treatment is administered. In their study, the authors found that reagent strips for testing urine do not perform to a sufficient standard and therefore they advocate that all patients should have at least one urine specimen formally cultured in early pregnancy to exclude bacteriuria.
Contact:
Dr Douglas Tincello, Research Registrar,
Department of Urogynaecology,
Liverpool Women's Hospital,
Liverpool
Embargo: 00.01 hrs Friday 6 February 1998
Please contact Public Affairs Division for the text of the paper & the authors for further comment
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