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 7132 Volume 316 Press Releases Saturday 28 February 1998 Embargoed: 00.01 hrs 27 February 1998 UK time One third of schoolchildren with asthma are undiagnosed Do asthma treatments affect childhood growth? Do deaths of babies from birth asphyxia vary depending on when they are born? Better communication between healthcare workers is needed One third of schoolchildren with asthma are undiagnosed (Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study) See Paper (abstract only), p 651 According to Siersted et al in this week's BMJ, one third of young people with asthma are not diagnosed, a phenomenon which is particularly prevalent in girls. In a Danish study of nearly 500 schoolchildren aged 12 -15 years, the authors found that asthma that had gone undiagnosed was usually linked to one or more of five factors. A low level of physical activity is relatively unlikely to provoke the types of symptoms of asthma induced by exercise and so may form as part of a "self-treatment" in childhood asthma. Low activity promotes weight gain, which in turn may lead to misinterpretation of asthma symptoms as due to lack of physical fitness. Family problems may obscure a child's symptoms and parents who smoke may be disinclined to get a doctor's advice about symptoms related to smoke in the family. If a child has no history of allergic rhinitis then this can also lead to a diagnosis of asthma being overlooked. Siersted et al conclude that as two thirds of those with undiagnosed asthma do not report their symptoms to a doctor, then there could be a good case for an asthma campaign targeting those families with children in the risk categories. Contact: Dr Hans Siersted, Senior Registrar, Section of Respiratory Diseases, Department of Medicine C, Odense Hospital, DK-5000 Odense C, Denmark The Siersted paper is accompanied by three commentaries: (Commentary: Risk factors for underdiagnosis of asthma in adolescence) Contact: John Rees, Consultant Physician, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London (Commentary: Identifying the correct risks in diagnosis) Contact: Stephen Evans, Visiting Professor of Medical Statistics, London School of Hygiene and Tropical Medicine, London (Commentary: Improving the diagnostic rate in asthma: a community issue) Contact: Hans Siersted, as above. Do asthma treatments affect childhood growth? (Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland) See Paper (abstract only), p 668 Some studies have shown that children with asthma have impaired growth, but many of these have not allowed for socioeconomic influences on growth. In a General Practice paper in this week's BMJ, McCowan et al found that in a study of 2,355 children in Tayside, Scotland, most children with asthma were of normal height and weight and had normal growth rates. However, the authors identified children using high dose steroid inhalers as an exception to this finding, as this group showed a significant reduction in their stature. Children in this group were shorter and lighter than their contemporaries, but social deprivation seemed to be the dominant influence. Contact: Mr C McCowan, Project Officer, National Asthma Campaign, Tayside Centre for General Practice, University of Dundee, Scotland Do deaths of babies from birth asphyxia vary depending on when they are born? (Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993-5) See Paper (abstract only), p 657 Deaths of babies around the time of their birth, although rare, seem to be more common at night and during months when annual leave is popular, suggest Stewart et al in this week's BMJ. The authors raise concerns about the variability of care around the time of delivery and from their study of 79 babies' deaths from birth asphyxia in Wales between 1993-5, the authors propose that errors of judgment are probably related to mental fatigue and that staff should be aware of how their performance may vary at different times. They indicate that mistakes may be mitigated with the greater use of shiftwork, but they stress that shifts need to be carefully designed to avoid the excessive disruption of circadian rhythms (upsetting the body clock) and consequent fatigue. Stewart et al conclude that greater supervision by senior staff may be required at night and during summer months. Contact: Dr Patrick Cartlidge, Senior Lecturer in Child Health, Department of Child Health, University of Wales College of Medicine, Cardiff, Wales (Deaths related to intrapartum asphyxia - Is there a problem with prevention?) See Editorial, p 640 In a related editorial in this week's BMJ, Spencer notes that more research needs to be conducted into recognition by fetal heart monitoring of problems with fetal oxygen supply, in an effort to ascertain whether the causes of fetal death around the time of delivery present themselves differently during the night. Contact: John Spencer, Consultant Obstetrician and Gynaecologist, Northwick Park Hospital, Harrow, Middlesex. Better communication between healthcare workers is needed (Communication behaviour in a hospital setting: an observational study) See Information in Practice, p 673 Despite the fact that healthcare seems to suffer from enormous inefficiencies because of poor communication infrastructures, little work has been done to assess communication systems. In this week's BMJ, Coiera and Tombs report a small communication study of 10 healthcare workers in Frenchay Hospital, Bristol. The authors found that the patterns of communication in this setting were extremely interruptive, which seemed to contribute to inefficiency in work practice. Coiera and Tombs note that medical staff generated twice as many interruptions (by telephone and paging systems) than they actually received themselves. This seemed to be because staff had a tendency to seek information from colleagues rather than refer to printed materials and they were often unsure of who was responsible for which specific role. Frequently staff interpreted the meaning of calls from the paging system based on insufficient information and this along with complex communication patterns, could lead to inefficiencies. The authors conclude that staff need to change their communication behaviour patterns, and that some form of training would be beneficial. Staff are highly mobile during their working day, communication technology (such as voicemail, email and mobile telephones) could help with contacting these "moving targets". They also suggest that a role based database (along the lines of the Yellow Pages) might be useful when ascertaining the "right person for the job". Some form of call screening may also be beneficial. Contact: Dr Enrico Coiera, Senior Project Manager, Hewlett-Packard Laboratories, Bristol (Communication between health professionals - Human factors engineering can help make sense of the chaos) See Editorial, p 642 In a linked editorial in this week's BMJ, Gosbee argues that a human factors engineering (cognitive ergonomics) approach is necessary for solving the chaos he believes current healthcare communication systems to be in. He suggests that healthcare professionals have a lot to learn from other disciplines about how to design, evaluate, select and set up efficient communication infrastructures. Gosbee states that poor communication is not only a waste of time, it can threaten patient care and is the chief culprit behind errors in clinical practice, which can lead to injury and even death. He argues that healthcare professionals should push for more research and development that pays attention to human factors engineering. Contact: John Gosbee, Director, Center for Applied Medical Informatics, Michigan State University, Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, Michigan, USA Embargo: 00.01 hrs Friday 27 February 1998 Please contact Public Affairs Division for the text of the paper & the authors for further comment For further information, please contact: Jill Shepherd on 0171 383 6254 Public Affairs Division, BMA House, Tavistock Square, London, WC1H 9JP After 6pm & at weekends: 0181 651 5130, 0181 241 6386, 0181 674 6294, 0171 727 2897, 0181 997 3653 Or fax requests to Public Affairs Division, BMA on 0171 383 6403. If you currently receive your British Medical Journal press release by mail and you would like it faxed to you please telephone (0)171 383 6123, Fax: (0)171 554 6123 or E-mail: ejacobs@mail.bma.org.uk When dialling the UK from abroad, remember to delete the first zero from the local area code, eg, (00 44) 171... 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