BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7092.1494 (Published 17 May 1997) Cite this as: BMJ 1997;314:1494

How late in pregnancy is termination justifiable on the grounds of a likelihood of physical or mental abnormalities causing serious handicap? In 1994 in Britain there were 94 terminations after 24 weeks. Late termination may be the best solution in some cases, says David Paintin in the British Journal of Obstetrics and Gynaecology (1997;104:398-400) “to enable the woman to avoid the considerable long term burden of providing care for a severely handicapped child.”

Men and women who are 40% overweight have mortality ratios from cancer of 1.33 and 1.55 respectively (ECP News 1997;30:9-11). In men the increased risk is due to higher rates of cancers of the large bowel and prostate, while in women the excess is found in cancers of the breast, endometrium, cervix, ovary, and gall bladder. The excess risk for cancer is smaller than risks for coronary heart disease or diabetes, but it is nevertheless important in practical terms.

And if obesity is a risk factor for breast cancer, it should not be too surprising that physical activity gives some protection against it. Research in Norway (New England Journal of Medicine 1997;336:1269-75) has shown that women who took regular physical exercise had a risk of breast cancer that was only two thirds of that in women whose work and leisure was spent in sedentary occupations. The benefits from exercise were greatest in women under the age of 45 at entry to the study.

Using a household washing up mop to clean the face is only one of many practical and simple suggestions from the Disability Information Trust in Arthritis: An Equipment Guide (details from the trust, Mary Marlborough Centre, Oxford OX3 7LD). The guide covers kitchen equipment, grab rails, toilet equipment, and recreations—from playing cards to angling.

Home testing for sexually transmitted infections is technically feasible and could help to control the current epidemic of infection with Chlamydia trachomatis, according to a review in Genitourinary Medicine (1997;73:96-8). Test kits can be bought over the counter—even in cigarette shops—in some countries, but many practical problems need to be solved. What is already clear is that screening programmes for Chlamydia are acceptable to the general population and that they can lead to effective treatment. Will politicians agree to finance a combination of screening for sexually transmitted diseases with advice on contraception and health risks such as smoking?

A Eurobarometer survey of people's views of their healthcare systems in each of the European Union's member states found that 48% of the 15 285 people surveyed were in favour of increasing healthcare spending, with Britain topping the list at 82% (Health Economics 1997;6:109-16). When they were asked how this should be achieved the prevailing view was “by spending less on other things.” Only 11% thought that the money should come from raising taxes or health insurance contributions. The country with the least resistance to tax increases was Britain.

AIDS cholangiopathy is the name given to hepatobiliary disease associated with HIV infection. A report from New York (Journal of the American College of Surgeons 1997;184:233-9) gives the results of surgery in 40 men positive for HIV who had cholecystectomies between 1986 and 1995. Thirty seven survived for 30 days, 23 survived one year, and 10 lived for three years. The likelihood of survival was directly linked with the numbers of CD4 cells in the blood.

One of the arguments in favour of hormone replacement treatment is that oestrogens protect against coronary heart disease, but that association is not supported by a study from the Netherlands. Urinary sex hormone concentrations were measured at baseline in 11 284 premenopausal women recruited for a research project on breast cancer. Follow up (Journal of Clinical Epidemiology 1997;50:275-81) from 1982 to 1991 identified 45 women who developed coronary heart disease: their baseline concentrations of urinary oestrogens and androgens did not differ from those in the whole study population.

Even when they satisfy strict eligibility criteria few patients over the age of 75 with acute myocardial infarction are treated with thrombolytic agents (Archives of Internal Medicine 1997;157:741-6). The proportion given this treatment has risen over the past 10 years, but doctors still seem reluctant to prescribe thrombolytic agents for elderly people despite the convincing evidence of benefit from randomised controlled trials.

A description of 90 women treated for ectopic pregnancy in Tanzania (Tropical Doctor 1997;27:78-9) says that 48 of them needed autotransfusion of blood recovered from the abdominal cavity. In 37 women this was judged to have been life saving. The report makes the point that in the context of the AIDS epidemic in Africa autotransfusion with all its drawbacks is probably a safer option than transfusion of blood from donors.

Suicide is now the third most important contributor to potential years of life lost in Britain. Deaths from this cause are much more common in young men than in young women, but two papers in the British Journal of Psychiatry (1997;170:447-55) have shown how complex the causes are and how difficult it will be to reverse the trends. One study, from Northern Ireland, found evidence of mental disorder in most of those who had killed themselves; the other study, from Avon, found that few of the young men studied had had recent contact with a doctor but that many had experienced interpersonal stress in the 72 hours before death.

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A man aged 32 came to the accident and emergency department having been assaulted some hours previously. He had pain and discomfort in his shoulders. On examination the appearances of the two shoulders were the same, as were the ranges of movement. Radiographs showed bilateral dislocations. This unusual injury has been described in healthy men after electrocution. Clinical examination of the locomotor system includes comparing the two sides: beware the possibility of a similar traumatic lesion on the two sides. Stuart Clark, senior house officer, Charles M Court-Brown, consultant, Edinburgh Orthopaedic Trauma Unit

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How much does cognitive function decline with normal aging? Tests on 2537 French men and women aged 65 or more using the mini mental state examination showed little change over five years (American Journal of Epidemiology 1997;145:498-506). By contrast, those who became clinically demented showed rapid falls in their scores. The study confirmed other studies in finding that people with high educational achievements seemed to be protected against cognitive decline. Minerva continues to hope that sustained mental activity in old age may also give some protection against mental deterioration.

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