BMJ  2004;329:74 (10 July), doi:10.1136/bmj.329.7457.74

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What's new this month in BMJ Journals

Mortality in Atomic Energy Authority employees is not increased

Fifty years of data, including a cohort of 51 367 employees of the UK Atomic Energy Authority, show no evidence of a higher mortality than in the general population. Indeed, rates were generally lower, probably reflecting the healthy nature of recruits. In particular, there was no excess of cancer deaths. Previously reported increased risks of prostate cancer were not found, suggesting they had been due to a statistical artefact or a risk factor that was no longer operating. Those exposed to radiation had lower mortality than employees not so exposed, perhaps because of decreased opportunity to smoke. There was no excess of leukaemia deaths in radiation workers, nor any trend of increasing mortality with higher exposure. Endometrial cancer mortality was higher than in the general population but, again, there was no association with higher radiation dose.

Occup Environ Med 1004;61: 577-85

Children in prison have unmet health needs

England and Wales have a greater proportion of children (aged under 18) in prison than any other EU country: 2633 at the end of 2002, including 106 girls held in women's prisons. No study has investigated their health, but extrapolation from information about young offenders (aged under 21) and adolescents in secure units suggests that 25-33% are likely to have a chronic physical complaint. Up to 80% are likely to be smokers; two thirds of male young offenders and half of females report hazardous levels of alcohol intake; and almost as many report taking illegal drugs. Ten per cent of young offenders have self harmed and 11% say they have contemplated suicide. Since a judgment at the end of 2002, the Children Act applies to children in prison. The investigators conclude that there is an opportunity to detect and treat health problems in this "captive" population as primary care trusts (and local health boards in Wales) take over responsibility for commissioning their care.

Arch Dis Child 2004;89: 549-50[Abstract/Free Full Text]

Carotid aneurysms as a cause of migraine A 28 year old woman had frequent migraine headaches for 15 years with nausea and photophobia. Magnetic resonance imaging suggested a cerebral vascular lesion. Three dimensional digital subtraction angiography confirmed three aneurysms in the petrous and cavernous segments of the internal carotid artery. Permanent carotid occlusion resulted in resolution of her attacks. J Neurol Neurosurg Psychiatr 2004;75: 993[Free Full Text]

Media campaigns may not reduce door to needle time

Media campaigns and other public health initiatives have not been shown, in published trials, to reduce treatment delay in patients with suspected heart attack, although they may increase calls to emergency switchboards and visits to emergency departments. A systematic review of trials of public education intervention disclosed the usual disheartening methodological deficiencies.

Emerg Med J 2004;21: 506-8[Abstract/Free Full Text]

Open access clinic helps with heart failure

Cardiologists in Birmingham (UK) describe 963 patients referred by general practitioners to an open access heart failure service. It proved effective in diagnosing and managing chronic heart failure. The data show that the major risk factors are being male, over 60, and having ischaemic heart disease, atrial fibrillation, or diabetes. Simple tests such as a 12 lead electrocardiograph and a chest radiograph identified most patients with left ventricular systolic dysfunction; these can be used as the basis for diagnostic protocols.

Heart 2004;90: 755-9[Abstract/Free Full Text]

Speculum examination adds little in early pregnancy bleeding

Speculum examination changed the diagnosis or management, or both, in 13 of 236 pregnant women presenting to an emergency department with vaginal bleeding at less than 20 weeks. The investigators say that if clinicians are confident of findings obtained bimanually, little is likely to be gained by speculum examination.

Emerg Med J 2004;21: 461-3[Abstract/Free Full Text]

View larger version (26K): [in this window] [in a new window]   Less is more? Even though the United States spent more than twice as much per capita on health care than European Union countries, self ratings of health were lower at all ages in the USA. Expensive and technologically advanced procedures have yielded disappointing outcomes in population health. Provision of care in the USA is unequal and uncoordinated, the authors say. J Epidemiol Community Health 2004;58: 529-30

(h.marcovitch{at}btinternet.com)

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