BMJ  2005;331:540 (10 September), doi:10.1136/bmj.331.7516.540

BMJ family highlights

What's new this month in BMJ Journals

South Asians with chronic pain may be vitamin D deficient

In a population survey, one in seven South Asians living in the UK reported chronic widespread pain—nearly twice as many as age and sex matched European patients in the same practice. In a second study, South Asians living in the UK had much lower blood concentrations of calcidiol (25-hydroxyvitamin-D₃) than European controls: < 10 mg/ml in 70%. Almost all the Asian women with widespread pain were deficient in vitamin D. Confidence intervals were wide, however, meaning that the finding should be regarded as provisional, pending a larger study.

Ann Rheum Dis 2005;64: 1217-9[Abstract/Free Full Text]

Nurses can diagnose migraine and tension headache accurately

A specially trained neurology nurse and a consultant neurologist were equally effective in diagnosing migraine or tension headache in 239 patients who had been screened as having non-acute symptoms. Both nurse and doctor, in random order, saw each patient; blinded to each other's findings, they came to the same conclusion in over 90% of cases. In 13 role players who were added to the trial, chronic paroxysmal hemicrania was missed by both doctors and nurses in three cases. The authors conclude that a nationwide, nurse led diagnostic headache service could reduce outpatient waiting times considerably.

J Neurol Neurosurg Psychiatry 2005;76: 1170-2[Abstract/Free Full Text]

Prisoners consult their GPs excessively

Credit: CRISPIN HUGHES/PHOTOFUSION

A random analysis of 513 records from a cohort study of 3500 Belgian inmates showed that they consulted the prison's general practitioner an average of 17 times per year—nearly four times more than a demographically matched community population. Consultations are most commonly for psychological, respiratory, gastrointestinal, musculoskeletal, and skin problems. Provoking factors are likely to be the prevention of access to informal health services such as pharmacies, pre-existing drug misuse, and the specific experience of incarceration.

J Epidemiol Community Health 2005;59: 651-5[Abstract/Free Full Text]

Circumcision may help boys at high risk of urinary infection

A meta-analysis identified data on over 400 000 boys to determine the effect of circumcision on the incidence of urinary tract infection (UTI). Circumcision seems to reduce the odds of UTI by nearly 90%. When the prevalence of UTI and its recurrence rate was compared with the complications of circumcision, the benefit of the operation outweighed its risks only in boys who had had repeated urinary tract infections. The authors conclude that current evidence does not support circumcising boys to prevent UTI, but (pending a large randomised controlled trial) it should be considered in those with recurrent infection.

Arch Dis Child 2005;90: 853-8[Abstract/Free Full Text]

Does boxing harm women?

Credit: HANZ PUNZ/AP/EMPICS

Before and after each bout, Italy's 146 amateur and four professional female boxers submit to medical examination. A survey of 664 such examinations found no injury leading to hospital admission and no evidence of boxing related lesions to the breast or reproductive system.

Br J Sports Med 2005;39: 536-6

Long term whiplash is affected by compensation claims

Over half of people followed up for one year after sustaining a whiplash injury in a rear end collision still had neck pain at least one day a week. The most important predictors of long term problems were the severity of the symptoms soon after the accident and the existence of a continuing compensation claim. Factors related to the collision, such as car size and the struck car being stationary, were minor contributors to the pain model, and the estimated impact speed had no apparent effect. Intriguingly, at two years' follow-up, symptoms had not improved in people whose claim had been settled. Repeatedly recounting the event, and encouragement to report symptoms, as part of the legal process may exacerbate the problem, say the authors.

J Neurol Neurosurg Psychiatry 2005;76: 1146-51[Abstract/Free Full Text]

Ondansetron relieves fatigue in chronic hepatitis C

Taking 4 mg of the 5-HT receptor antagonist ondansetron twice daily reduced the severity of fatigue by more than 30% in patients with chronic hepatitis C. Thirty six such patients took part in a double blind randomised controlled trial against placebo, scoring their perception of the severity of fatigue on a visual analogue scale. The authors, from Nice, France, speculate that this supports the concept that fatigue involves serotoninergic pathways.

Gut 2005;54: 1169-73[Abstract/Free Full Text]

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