BMJ  2006;332:1145 (13 May), doi:10.1136/bmj.332.7550.1145

Practice

BMJ family highlights

What's new this month in BMJ Journals

Smokers risk impotence

A cross sectional survey of more than 8000 Australian men aged 16-59 has found that almost 10% had experienced erectile dysfunction for at least one month over the previous year. After adjustment for confounders such as age, marital status, and use of drugs for cardiovascular disease or diabetes, smoking remained a significant association. Intake of > 20 cigarettes per day led to an odds ratio of 1.36 (95% CI 1.05 to 1.83); intake < 20 per day had an odds ratio of 1.24 (1.01 to 1.52). The good news is that modest alcohol intake had an inverse relation. The authors say that this finding could be used to increase motivation for young men to quit smoking.

Tobacco Control 2006;15: 136-9[Abstract/Free Full Text]

Childhood epilepsy is easily overdiagnosed

Paediatricians in Bolton reviewed 380 children referred to a clinic dedicated to "fits, faints and funny turns." Epilepsy was confirmed in just 89; the other diagnoses included syncope (42% of all diagnoses), daydreams, pseudoseizures, panic attacks, temper tantrums, night terrors, migraine, and benign paroxysmal vertigo. Six had factitious seizures, and two families were so wedded to the diagnosis, despite lack of verification, that social services intervention was required. Non-epileptic events were characterised by such criteria as being triggered by certain situations and being interruptible, and by treating paediatricians having continuing clinical doubt or parents seeming to actively seek a diagnosis of epilepsy.

Arch Dis Child 2006;91: 214-8[Abstract/Free Full Text]

Self help works for irritable bowel...

A randomised study involving 54 primary care centres has shown that patients with irritable bowel syndrome benefit from a self help regimen. One group received a specially written booklet and attended a single group meeting, the second received the booklet only, and a control group received standard care. The booklet advised on lifestyle, diet, and available orthodox and alternative therapies. Patients in the intervention groups had 60% fewer reattendances with their GP over the following year, and they perceived greater improvement in symptoms than did controls. The single group meeting offered no discernible advantage. The intervention groups did not differ from the control group in pain, diarrhoea or constipation, nor in quality of life scores or general health status—but it seemed that these patients' attitudes changed such that they were better able to manage their condition. Health service utilisation and costs were reduced.

Gut 2006;55: 643-8[Abstract/Free Full Text]

... but acupuncture is only a placebo

Forty three patients with irritable bowel syndrome were randomised to receive 10 sessions of acupuncture according to the rules of traditional Chinese medicine or to sham acupuncture with a blunted telescopic placebo needle 2 cm away from the real acupuncture point (to avoid any effect of acupressure). Overall quality of life scores at three months improved in all patients, as did a score related to functional digestive disorders. The effect size (about 11%) was similar to that previously reported with psychotherapeutic interventions. No difference was detectable between the groups, suggesting that acupuncture in irritable bowel syndrome is primarily a placebo response. The authors claim this is the largest such trial published and calculate that 566 patients would need randomisation to prove effectiveness of acupuncture over its sham counterpart.

Gut 2006;55: 649-54[Abstract/Free Full Text]

Bump starting the heart

Ambulance paramedics noted the onset of ventricular tachycardia in a 75 year old man with acute severe chest pain whom they were transporting to hospital. The ambulance drove over a speed bump ("sleeping policeman") at 5 miles (8 km) per hour and the rhythm was instantly converted to normal by the jolt.

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Doping control is too tight for asthmatic athletes

Athletes with asthma may be prevented from using essential agonists by doping regulations that are too strict. Current international criteria permit use of agonists only if bronchial hyper-responsiveness is proved at rest or after a standard provocation test. Spanish investigators tested 31 high level athletes known to have asthma. One met sports bodies' criteria for a bronchodilation test at rest, a further nine after an effort test, and 14 after various doses of methacholine. This left seven for whom the rules would disallow agonists. However, none would have been deprived on the basis of standard therapeutic guidelines. A major problem is that many elite athletes have an FEV₁ as much as 120% of the norm—so they do not reach the therapeutic indication of 70% normal, even when they have significant bronchoconstriction. The authors call for a review of anti-doping rules.

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Br J Sports Med 2006;40: 363-6[Abstract/Free Full Text]

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