Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7130 Volume 316 This week in brief Saturday 14 February 1998 Cancer risk is greater in adults who had high energy intake as children Protein:creatinine ratio in spot morning urine samples predicts progression of renal disease Vagotomy may increase smokers' risk of lung cancer Winter increase in mortality in western Europe may be preventable Deprivation is main factor affecting demand out of hours Only half of out of hours contacts are with GPs Cancer risk is greater in adults who had high energy intake as children Restriction of energy intake results in reduced mortality from cancer in animals. In humans height is used as a proxy for childhood nutrition, and a positive association between height and cancer exists. On p 499 Frankel et al report the later mortality of nearly 4,000 young people whose diet was studied in the late 1930s. They found significant positive associations between childhood energy intake and mortality from cancers other than those related to smoking. Protein:creatinine ratio in spot morning urine samples predicts progression of renal disease Protein in 24 hour urine collections indicates progression of renal disease, but its measurement is time consuming. Measurement of protein excretion in spot, non-timed urine samples would allow identification of patients at increased risk of progression in outpatient clinics. On p 504 Ruggenenti et al found that the protein:creatinine ratio in spot morning samples correlated closely with 24 hour urinary protein excretion and accurately predicted rate of decline in glomerular filtration rate and risk of end stage renal failure in non-diabetic patients with proteinuria and chronic renal disease. At one year the risk of end stage renal failure was about 3% in patients with a ratio of <1.7 and 21% in those with a ratio >2.7. The routine measurement of this ratio is simple and inexpensive. Vagotomy may increase smokers' risk of lung cancer Smokers are at higher risk of peptic ulcer disease than non-smokers. Both surgery and drugs give symptomatic relief to patients with the disease. To study whether this relief affects smoking habits, Ekbom et al (p 518) compared the incidence of lung cancer in 7,000 patients who had had vagotomy with the incidence in 67,000 patients with peptic ulcer disease who had not had a vagotomy. The patients who had had a vagotomy had an increased risk of lung cancer. The authors conclude that vagotomy in smokers with peptic ulcer disease puts these patients at an even higher risk of lung cancer, as they increase their tobacco consumption once the symptoms have disappeared. Winter increase in mortality in western Europe may be preventable Mortality in western Europe rises as the temperature falls below 18°C. In Britain about 40,000 excess deaths each year are associated with falling temperatures. Increasing evidence suggests that this excess mortality is associated with personal exposure to cold rather than indirect factors such as a winter diet poor in vitamins. On p 514 Donaldson et al report that mortality in Yekaterinburg, an industrialised area north east of Moscow, does not rise when temperatures fall to 0°C. Indoor temperatures were higher than those in western Europe and residents were physically active when outdoors and wore sufficient clothing to prevent chilling of the body. Their findings suggest that most of the increase in mortality in western Europe in the winter could be prevented. Deprivation is main factor affecting demand out of hours Variations in out of hours activity of general practices have not been fully explained. In a six month study of general practice and accident and emergency services in Nottingham, Carlisle et al (p 520) found that out of hours activity varied more than twofold between electoral wards. Most of the variation could be explained by differences in deprivation. Demands on accident and emergency and general practice services were high in the same areas. The authors conclude that a disproportionate amount of out of hours activity falls on practices in deprived inner cities. Only half of out of hours contacts are with GPs Public demand for health services outside normal surgery hours is growing, as is the dissatisfaction of service providers. Brogan et al (p 524) studied the use and costs of out of hours health services in Buckinghamshire. Fees for night visits reimbursed only 39% of the home visits performed by general practitioners out of hours and less than one in seven of all patient contacts with general practitioners. However, about half of all out of hours contacts were with other providers such as nurses, ambulances, and accident and emergency departments. Policy changes to cope with growing demand for out of hours care will require more than changing general practitioners' contracts. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline