MinervaBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5300 (Published 22 August 2012) Cite this as: BMJ 2012;345:e5300
Environmental factors associated with migration may contribute to the development of low functioning autism (British Journal of Psychiatry 2012;201:109-15, doi:10.1192/bjp.bp.111.095125). A Swedish study looked at children with autistic spectrum disorder (2855 with high functioning autism and 2097 with low functioning autism). Children of migrant parents were at increased risk of low functioning autism, and the risk peaked when migration took place around the time of pregnancy. Children of migrants have a reduced risk of high functioning autism regardless of when migration occurs.
Poor consent practices are killing off hospital autopsies (Journal of the Royal Society of Medicine 2012;105:288-95, doi:10.1258/jrsm.2012.110288). An analysis of the policies on consent for the procedure in 21 NHS trusts found that only half of them followed the Human Tissue Authority’s model of best practice, which deals with the needs of clinicians as well as the bereaved. A quarter had no documented procedures at all.
Video sharing websites are increasingly used to demonstrate clinical interventions. A YouTube search in August 2011 for videos of the entire Epley manoeuvre (a simple and effective treatment for benign paroxysmal positional vertigo) identified 3319 videos, of which 33 demonstrated the manoeuvre. Of these 33 videos, 21 (64%) were rated as accurate by two authors and an adjudicator if necessary. The effect of video websites on outcomes and costs of care is unknown (Neurology 2012;79:376-80, doi:10.1212/wnl.0b013e3182604533).
A non-randomised longitudinal intervention study from the Czech Republic used pedometers and accelerometers to assess the effect of regular exercise on 176 children in four schools. School based lessons in physical education, physically active short and long breaks, and physical activity during after-school nursery and in child friendly gyms, school playgrounds, and suitable school corridors brought about significant reductions in weight in obese and overweight young children. After two years, the intervention group had no obese children, while a quarter of controls were obese (BMC Public Health 2012;12:570, doi:10.1186/1471-2458-12-570).
A cohort study of patients participating in programmes at Denver Health and Kaiser Permanente Colorado concludes that simultaneous control of diabetes, hypertension, and hyperlipidaemia is uncommon and often only transient (Circulation Cardiovascular Quality Outcomes 2012, doi:10.1161/circoutcomes.111.963553). The study analysed data taken from 2000 to 2008, and showed that increasing age and white ethnicity, together with the presence of cardiovascular disease, were significantly (but not strongly) predictive of achieving simultaneous control. Control dropped with increasing severity of the underlying conditions.
Depression is associated with an increased risk of peripheral artery disease (PAD). Researchers using data from the Heart and Soul Study, a prospective cohort of 1024 adults with coronary artery disease, found that depression was significantly linked to prevalent PAD and subsequent PAD events. Since many factors contributing to the association between depression and incident PAD are modifiable (such as lipid concentrations, smoking, and levels of physical activity), treating them more aggressively could reduce the excess risk of PAD associated with depression, say the authors (Journal of the American Heart Association 2012, doi:10.1161/JAHA.112.002667).
In a simulation model, adding low dose aspirin to screening with colonoscopy and sigmoidoscopy resulted in an additional reduction in colorectal cancer (CRC) mortality of 13% and 30%, respectively, over and above the mortality reduction with endoscopy screening alone (Gut 2012;61:1172-9, doi:10.1136/gutjnl-2011-300206). A cost effectiveness analysis has found that the significant economic savings in CRC care can compensate for the costs of aspirin and of complications related to aspirin plus endoscopy, mainly because of the drug’s high efficacy in preventing proximal cancer.
In a population based study of over 75 000 adults with psoriasis, 976 developed psoriatic arthritis (incidence 26.5 per 10 000 person years). Incidence of psoriatic arthritis rose with increasing body mass index, and metabolic syndrome was common among patients with psoriasis. The researchers say that their findings support the importance of weight reduction for those with psoriasis (Annals of the Rheumatic Diseases 2012;71:1273-7, doi:10.1136/annrheumdis-2012-201299).
Participants in an educational programme for cardiac teams, based on high realism scenarios simulating acute crises, highlighted two key aspects: encouraging people to speak up about critical information and sharing information between professionals. The importance of briefings, early communication of surgical plans, and knowing members of the team were also seen as key for team performance. (Journal of Thoracic and Cardiovascular Surgery 2012;144:17-24, doi:10.1016/j.jtcvs.2012.03.006).
Children who receive transplanted livers donated by obese adults are more likely to lose the graft or die (Liver Transplantation 2012;18:930-9, doi:10.1002/lt.23438). Researchers assessed the effect of donors’ body mass index on paediatric recipients by using data from 3788 transplants between 2004 and 2010. The risk of graft loss and mortality was significantly higher if the donor’s body mass index was greater than 35.
Cite this as: BMJ 2012;345:e5300