Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April

BMJ No 7130 Volume 316 14 February 1998 This Week in BMJ | Editor's Choice | Press releases Receive this page by email each week Editorials 487 Our healthier nation John Gabbay 488 Recovered memories of childhood sexual abuse: what is the evidence? Harrison G Pope, Jr 489 Achieving self sufficiency in blood across Europe Juhani Leikola 490 Imaging pulmonary embolism David M Hansell, Christopher D R Flower 492 Many NSAID users who bleed don't know when to stop Andrew Herxheimer News 493 Researchers must disclose financial interest China acknowledges AIDS problem Drug company merger should benefit research UK green papers on public health published St Bartholomew's saved in London plan Germany rejects ban on smoking in public Philippines passes antismoking laws Patients may be being detained illegally in UK Cuba shows health gains despite US embargo Racism is increasing in Ireland Vitamin B may reduce risk of heart disease In brief Papers 499 Childhood energy intake and adult mortality from cancer: the Boyd Orr cohort study Stephen Frankel, David J Gunnell, Tim J Peters, Maria Maynard, George Davey Smith 504 Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes Piero Ruggenenti, Flavio Gaspari, Annalisa Perna, Giuseppe Remuzzi 509 Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment Richard Thomson, Helen McElroy, Mark Sudlow 514 Winter mortality and cold stress in Yekaterinburg, Russia: interview survey G C Donaldson, V E Tchernjavskii, S P Ermakov, K Bucher, W R Keatinge 518 Relation of vagotomy to subsequent risk of lung cancer: population based cohort study Anders Ekbom, Göran Lundegårdh, Joseph K McLaughlin, Olof Nyrén General practice 520 Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey Robin Carlisle, Lindsay M Groom, Anthony J Avery, Daphne Boot, Stephen Earwicker 524 The use of out of hours health services: a cross sectional survey Catherine Brogan, Diane Pickard, Alastair Gray, Steve Fairman, Alison Hill Clinical review 528 Fortnightly review: Faecal incontinence Michael A Kamm 532 Lesson of the week: Unusual case of choriocarcinoma occurring 12 months after delivery Anthony Todd, Edward Newlands, Mark Palazzo 535 ABC of allergies: Good allergy practice A B Kay Education and debate 538 Stress and peptic ulcer: life beyond helicobacter Susan Levenstein 542 What are quality of life measurements measuring? Matthew F Muldoon, Steven D Barger, Janine D Flory, Stephen B Manuck 545 Continuing medical education: Recertification and the maintenance of competence Philip G Bashook, John Parboosingh 549 Statistics notes: Sample size in cluster randomisation Sally M Kerry, J Martin Bland Letters 550 Outcome of pregnancy in women with insulin dependent diabetes D Hadden and A Traub; C Lowy; G L Nielsen and others; L Rogerson and K Bancroft; I F Casson and others 552 Measures are needed to allow elderly inpatients to vote in general elections V Aylett and others 552 Integration of hepatitis B vaccination into national immunisation programmes W J Edmunds; M Kane and others 553 Covers of BMJneed to be strengthened J Norstein 553 Polymerase chain reaction as marker of infectivity in people with hepatitis C S Thomas and others; G J Dore and others 554 Committee said that midwives and GPs should work in partnership G Young 554 Inhaled corticosteroids in wheezing associated with viral infection in schoolchildren P Ehrhardt; I Doull 555 Physiotherapy for soft tissue shoulder disorders T Brockow and others; L Saunders; G J M G van der Heijden and others 556 Survival is better indicator than mortality in geographic comparisons of health P A West 556 Sexually transmitted infections in women who have sex with women C Ford and K Clarke; G Hughes and others 557 Southern Africa is good place to research role of fetal malnutrition in chronic diseases A R P Walker and K E Charlton 557 Occurrence of orf in humans was reported by Grant Peterkin in 1937 C W G Peterkin Obituaries 558 A R Allardice, E Browell, J M Fletcher, R M Livingston, G E Moloney, W G Roper, A Roy, J J Schofield, W G Skene, J G Stevenson, Z Thomas, W B Vallance, A F Wallace, F Welsh Views & reviews Soundings 560 Those were the days Liam Farrell Personal view 560 Around every tumour there's a person Surinder Singh Medicine and the media 561 Media dents confidence in MMR vaccine Norman Begg, Mary Ramsay, Joanne White, Zoltan Bozoky Minerva 562 S2 Career Focus Classified supplement Working as a ship's doctor Shafiq Shafi Editor's choice Lessons from a cold climate When it comes to snow, the British are flumoxed: an inch will shut motorways, bring the railways to a halt, and produce dire warnings on the radio: we aren't used to snow and don't prepare for it well. The same message seems to emerge about cold weather in general from a fascinating paper from Yekaterinburg, east of Moscow. In western Europe as a whole mortality rises as the temperature falls below 18°C. This is thought to be associated with cold stress, since the rise in mortality is less steep in parts of Europe where houses are warmer and more outdoor clothes are worn. Over one winter in Yekaterinburg (average winter temperature -6.8°C) G C Donaldson and colleagues measured indoor temperatures and asked people about the time they spent outdoors, physical activity, and the amount of clothes worn and correlated this information with daily reports of deaths (p 514). They found no increases in mortality as temperatures fell to 0°C and that high indoor temperatures, wearing many layers of clothes, and keeping active outdoors generally prevented cold stress: indoor temperatures in Yekaterinurg at 0°C were higher than those in European houses at 7°C. The lesson the authors draw is that the increase in mortality associated with cold weather in western Europe (at temperatures above 0°C) could be prevented by ensuring warm houses and that people wrap up against the cold. This week's journal also takes a sceptical look at two recently fashionable activities. On p 509 Richard Thompson and colleagues produce a depressing view of guidelines in their analysis of 20 guidelines for anticoagulant treatment in atrial fibrillation. Through applying each guideline to 100 elderly patients with atrial fibrillation and interviewing the developers of 15 of the guidelines they found great variation what the guidelines recommended, and only one guideline was truly evidence based. The other bit of scepticism comes from Matthew Muldoon and colleagues (p 542). In offering a framework for describing the elements of quality of life related to health they point out that many quality of life instruments muddle measures of objective functioning and of subjective well being - which each present different problems of validation. Subjective well being often measures personality characteristics and ignores how people adapt psychologically to chronic conditions. The authors argue that the quality of life "industry" has paid scant attention to these methodological difficulties - which explain why many doctors question the legitimacy of quality of life research. Yet those who devise quality of life measures are probably trying to respond to the needs of patients to be thought as more than simply "a grapefruit sized tumour." On p 560 Surinder Singh tells the story of his patient, Mr A, who resisted radical surgery for his tumour and fought hard and long to remind his doctors that "there is always a person who surrounds the tumour." Finally, this week sees the start of a new ABC - on allergies. Many people think that the NHS has inadequate facilities for managing allergies, but Barry Kay points out that there are many allergy clinics. He includes a guide for purchasers on what a good allergy clinic should provide and a list of "tests" used by alternative practitioners that are not evidence based (p 535). Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline