BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1744 (Published 23 September 2008) Cite this as: BMJ 2008;337:a1744

Sleep deprivation leads to low mood and depression, and mothers of young children are likely to be affected. An Australian study tested a behavioural intervention designed to improve infants’ sleep, evaluating maternal depression and parenting style, as well as childhood mental health and sleep at age 2 years. The intervention was delivered by “well child” nurses when the children were 8-10 months old. At age 2 years, mothers in the intervention group reported less depression than controls, but neither parenting style nor child mental health differed between the groups (Pediatrics 2008;122:e621-7, doi:10.1542/peds.2007-3783).

Another study of depression looked at the possibility of preventing depression by using psychological interventions. Cognitive behavioural therapy seems to be the flavour of the month in the UK, but a meta-analysis in the American Journal of Psychiatry (published online 2 September 2008; doi:10.1176/appi.ajp.2008.07091422) reports that prevention of depression may be more successful with interpersonal psychotherapy than with cognitive behavioural therapy.

Elbow replacements are rarely written about, but total elbow replacement for the management of the ankylosed or fused elbow is recognised. A case series of 13 elbows replaced by linked semiconstrained, non-custom made implants over almost 20 years concludes that total replacement for the ankylosed elbow should be performed with caution. The long term outcome can be reliable and positive for patients, but there’s a high risk of complications—and further operations were required in seven of these patients (Journal of Bone and Joint Surgery 2008;90B:1198-204, doi:10.1302/0301-620X.90B9.19967)

Not everyone who has an unprovoked venous thromboembolic clot needs to continue to take anticoagulants. A four year follow-up of a multicentre cohort of almost 650 participants with a first venous thromboembolism identified 91 cases of confirmed recurrence after anticoagulation was stopped. The authors say that women with no or one risk factor can safely stop anticoagulation treatment after six months, but the same is not true in men (CMAJ 2008;179:417-26, doi:10.1503/cmaj.080493).

It’s never too late to start exercising. A study in QJM (2008;101:713-21, doi:10.1093/qjmed/hcn084) reports that physical activity is inversely associated with insulin resistance and the metabolic syndrome, even in older people. This Italian study of more than 1100 adults aged 65-91 linked their scores on the physical activity scale for the elderly with clinical and biochemical data. Regression analysis showed that the metabolic syndrome was more prevalent among the more sedentary participants.

Little is known about the effect of reducing smoking in Asian populations. In South Korea 52% of men smoke, and a large study has found that men who quit smoking had significantly lower risks of ischaemic stroke, subarachnoid haemorrhage, and myocardial infarction than heavy smokers who did not reduce their smoking. (Stroke 2008;39:2432-8, doi:10.1161/STROKEAHA.107.512632).

Women who experience menopausal hot flushes may have underlying, subclinical cardiovascular disease. Ancillary data from the US study of women’s health across the nation show that hot flushes are associated with significantly lower flow mediated dilation and greater coronary artery and aortic calcification. These associations remained when adjustments were made for cardiovascular disease risk factors and oestradiol levels (Circulation 2008;118:1234-40, doi:10.1161/CIRCULATIONAHA.108.776823).

A Swedish study that followed people from age 70 until death identified substantial acceleration in cognitive decline many years before death among people without dementia. The onset and the rate of terminal decline varied across the cognitive abilities that were measured. The onset of terminal decline for verbal ability was 6.6 years before death, spatial ability 7.8 years before death, and perceptual speed 14.8 years before death (Neurology 2008;71:882-7, doi:10.1212/01.wnl.0000312379.02302.ba).

When Catholic owned hospitals merge with, or take over, other health services, questions are raised over contraception and abortion services. The management of miscarriages can be affected, according to the American Journal of Public Health (2008;98:1774-8, doi:10.2105/AJPH.2007.126730). Interviews with US obstetricians show that ethics committees of Catholic-owned hospitals tend to deny approval for uterine evacuation while the fetus’s heart is still beating. This causes delay in offering medical care, or the obstetrician has to transport patients who are miscarrying to other hospitals. Some doctors violate protocol if they feel a patient’s safety is compromised.

Chilean children have been drinking a lot of high energy, nutrient poor drinks, especially ones sweetened with sugar, and obesity is now rife in Chile. A randomised controlled trial examined the effects on body composition of delivering milk drinks to the homes of overweight and obese children, in an attempt to displace the unhealthy drinks. Lean body mass and growth in these prepubertal children benefited, but percentage of body fat did not change significantly (American Journal of Clinical Nutrition 2008;88:605-11, www.ajcn.org).


Cite this as: BMJ 2008;337:a1744

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