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BMJ No 7132 Volume 316
This week in brief Saturday 28 February 1998
Asthma may be underdiagnosed in overweight inactive girls
Babies born at night and in summer have a greater risk of
intrapartum death
The risk of haematological toxicity from chloramphenicol eye drops
is small
Vision screening in older people is of unproved benefit
Neither asthma nor its treatment adversely affects growth
Communication behaviour of hospital workers is inefficient
Asthma may be underdiagnosed in overweight inactive girls
Epidemiological studies suggest that asthma is still underdiagnosed in children and young adults. On p 651 Siersted et al report on a population based study among Danish adolescents in which they examined potential risk factors for underdiagnosed asthma. Asthma was defined independently of the physician's diagnosis as coexisting asthma-like symptoms and one or more positive test results of obstructive airway lability. Undiagnosed asthma comprised about one third of all cases of asthma identified, and two thirds were in girls. Underdiagnosis was associated with conditions that may complicate the diagnostic process, including being overweight and low physical activity, family problems, passive smoking, and the absence of allergic rhinitis.
Babies born at night and in summer have a greater risk of intrapartum death
Death due to intrapartum asphyxia is a measure of quality of care around the time of labour and delivery. Stewart et al (p 657) found twice as many deaths due to intrapartum asphyxia among babies born at night and in July and August. They conclude that there may be an overreliance on inexperienced staff at these times and that greater supervision by senior staff is required.
The risk of haematological toxicity from chloramphenicol eye drops is small
Chloramphenicol is thought to be associated with serious haematological toxicity, but few estimates of the size of the risk exist. On p 666 Wiholm et al describe two case-control studies, in Israel and Europe and in Thailand: 426 cases of aplastic anaemia were carefully ascertained and matched with 3,118 controls. None of the cases but 7 controls had used chloramphenicol eyedrops. Similarly, Lancaster et al found only three cases of serious haematological toxicity among 442,543 British patients who had received 674,148 prescriptions for chloramphenicol eye drops. They suggest this small risk should not prevent use of this cheap effective drug.
Vision screening in older people is of unproved benefit
Visual impairment is common among older people, is often unreported, and has several adverse associations including falls, reduced quality of life, and reduced functional ability. Since 1990 British primary healthcare teams have to offer an annual assessment to all patients aged 75 and over, including an assessment of vision. Smeeth and Iliffe (p 660) report a systematic review of the effectiveness of this screening. No improvement in vision was seen as a result of screening, although a small beneficial effect cannot be excluded.
Neither asthma nor its treatment adversely affects growth
Does asthma or its treatment affect growth? On p 668 McCowan et al combine results from a community growth study and a primary care asthma study in the Tayside population to try to answer this question. They found that most children with asthma had normal height, weight, and growth rate. A small subset were shorter and lighter - they received care from both hospital and general practice and were prescribed high doses of inhaled corticosteroids. There was also evidence of some reduction in growth rates in children taking high doses of inhaled corticosteroids, though these children seemed to experience a complex interplay of factors, social deprivation having a stronger influence than any factor related to asthma.
Communication behaviour of hospital workers is inefficient
Healthcare systems seem to suffer inefficiencies because of poor
communication. Coiera and Tombs (p 673) observed communication
behaviour among 10 hospital healthcare workers and found that this
resulted in an interruptive work place, which seemed to contribute to
inefficient work practice. Medical staff generated twice as many
interruptions via telephone and paging systems as they received;
possible causes included a tendency to seek information from colleagues
rather than printed materials, and poor provision of information for
contacting specific individuals. Staff inferred the intention of
messages from insufficient information. The authors conclude that
hospital staff may need instruction in appropriate use of communication
facilities and that some communication technology - voicemail and email
with acknowledgment, cellular t
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