Reviews

The evidence supporting the use of sodium cromoglicate in children with mild to moderate asthma is old, mediocre, and not very convincing, write systematic reviewers from the Netherlands (Thorax 2000;55: 913-20). The studies they found were a mixed bag that clearly suffered from publication bias, making sodium cromoglicate look better in theory than it is in practice. Though the drug has been used for decades, its value remains unproved.

Boys are at a distinct disadvantage around the time of birth: they are more likely than girls to be born prematurely, and then more likely than girls to die (Archives of Diseases in Childhood Fetal and Neonatal Edition 2000;83:F182-5). A retrospective look at the notes of over 6000 very premature babies born in the United States between 1991 and 1993 showed that the mortality for boys was 22%, compared with 15% for girls. Researchers still have no idea what it is about girls that makes them stronger.

George W Bush and Al Gore will be aware that the winner of the presidential race will inherit a legacy of over 44 million Americans without health insurance. The growth of managed care during the 1990s has not improved the health disadvantage of this substantial minority and may have made it worse, according to recent data in JAMA (2000;284:2061-9). People at high risk of cancer and heart disease and those with chronic illnesses such as diabetes suffer the most: they can't afford screening or regular check ups.

A Canadian clinic offering the controversial Di Bella regimen to patients with cancer has been disappointed by the demand. Doctors at the clinic in Toronto's Italian district have treated only "5 to 10" patients since its doors opened in August last year (Canadian Medical Association Journal 2000;163:1030). Advertising was initially low key, initially in an Italian language newspaper, but the unenthusiastic response is more likely to be due to the anti-cancer protocol on offer, which has been thoroughly discredited.

What will it take to get doctors to prescribe  blockers to patients after a heart attack, asks one exasperated family doctor from Washington, DC (American Family Physician 2000;62:1771). It's been nearly 20 years since researchers published the first evidence that  blockers reduce death rates after heart attack, and it has been confirmed many times since, but still only a minority of patients are prescribed these drugs. Fear of side effects has a lot to with it, says an accompanying article (1853-60); this can be overcome by careful dosing and close monitoring.

Athletes who don't fancy the testicular atrophy, aggression, and lengthy bans from competition that go with anabolic steroids look for "natural alternatives" to boost their performance. There are plenty on offer including creatine, chromium, and dihydroepiandrosterone. Evidence of effectiveness is predictably patchy, says a review in Postgraduate Medicine (2000;108:103-20), although creatine may work for weightlifters if they take it for long enough. The rest are probably no better than placebo.

A randomised trial of shared care for psychiatric patients explored the value of a common sense measurea healthcare record kept by patients and used jointly by their general practitioner and their psychiatrist (British Journal of Psychiatry 2000;177:319-24). The record made no difference to patients' mental state or their satisfaction with medical services. For some reason, doctors were reluctant to use itonly nine of the 51 doctors in the study recalled writing in the joint record.

About once every eight years, hepatitis A sweeps through the residents of Salt Lake City in Utah. The latest outbreak occurred between 1992 and 1996, when reported cases per year increased to more than six times the national average (www.pediatrics.org/cgi/content/full/106/4/e54). Fewer than half the cases had a recognised source, although an analysis of the outbreak suggests that small children with subclinical, asymptomatic infections were the main vectors.

Rumoursincluding media reportsthat isotretinoin, a treatment for severe acne, might cause depression and suicide prompted researchers from Boston to investigate. They analysed data from over 20 000 cases held on two community databases and found no connection between use of isotretinoin and a diagnosis of depression, psychosis, or suicidal behaviour (Archives of Dermatology 2000;136:1231-6).

Another negative study may reassure readers who are planning a long haul flight. It failed to find a link between travel and deep vein thrombosis (Lancet 2000;356:1492). The researchers, from the Netherlands and Italy, asked nearly 800 people with suspected deep vein thrombosis about recent travel. Those with proved deep vein thrombosis had similar travel histories to controls whose investigations all had negative results. Even long journeys (over five hours) seem not to increase risk.

The chances of surviving a cardiac arrest in the casinos of Nevada and Mississippi have improved substantially now that security guards in many casinos have automatic defibrillators and know how to use them (New England Journal of Medicine 2000;343:1206-9). In a study lasting more than two years, 105 guests collapsed with ventricular fibrillation in a sample of 32 casinos. Over half of them survived to hospital discharge after successful resuscitation. Defibrillation within three minutes of a witnessed collapse gave the best chance of survival.

View larger version (97K): [in this window] [in a new window]   A 57 year old woman with motor neurone disease had always been afraid of spiders. As her disability progressed, she dreaded being unable to escape should one approach her in her wheelchair. She was referred for behavioural therapy and after 13 hours of graded exposure was able to handle large spiders without anxiety. She is shown with Gina, a Mexican red-kneed spider. For people with motor neurone disease all potentially useful treatments, however seemingly unrelated, should be implemented. Matthew Parton, research fellow in neurology, P Nigel Leigh, professor of clinical neurology, King's College Hospital, London SE5 8AF; Margaret Whittaker, trainee behaviour therapist, Isaac Marks, professor of experimental psychopathology, Maudsley Hospital, London.

The latest in a long line of studies on the prevalence of tiredness in patients with cancer finds that more than three quarters of people on chemotherapy suffer from debilitating tiredness for at least a few days each month (Oncologist 2000;5:353-60). The profound effect this can have on their lives is well known, but management remains decidedly poor. An accompanying leader urges doctors to talk about and take seriously all reports of tiredness by cancer patients.

Footnotes

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