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Quality of life measures soar
Over the past 10 years the number of reports relating to the
development of quality of life measures has grown exponentially. Garratt and colleagues (p 1417) found 3921 reports by systematically searching electronic databases to identify developmental and evaluative work relating to health outcome measures assessed by patients. The
largest numbers of evaluations were specific to diseases or populations
and 31% of reports were in rheumatology and
musculoskeletal medicine, cancer, and older people. The authors
conclude that, faced with a vast array of measures, potential users
require guidance on which measure to use.
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A systematic review of 26 trials by DiCenso and colleagues (p
1426) showed that pregnancy prevention strategies for adolescents do
not delay sexual intercourse, improve use of birth control, or reduce
the number of pregnancies in young women. Five
trials showed an increase in pregnancies among partners of young men who took part in the studies. Interventions should have input from
adolescents, say the authors, and they should focus on negotiation skills, communication, and sexual relationships rather than anatomy and
scare tactics.
(Credit: CHARLES OMMANNEY/REX)
Specially designed, teacher delivered sex education improved knowledge
about sexual health and reduced regret among teenagers but had no
effect on use of condoms or other contraceptives. Wight and colleagues
(p 1430) carried out a randomised trial of a 20 session sex
education programme in 25 schools across Scotland. They say that the
lack of effect on behaviour suggests that the programme was unable to
over-ride broader social influences and the effect of conventional sex
education.
Women with breast cancer need not fear that stressful experiences in
life will bring about the return of their disease. Graham and
colleagues (p 1420) found no evidence that women who have a severely
stressful life experience in the year before being diagnosed with
breast cancer, or in the five years afterwards, were at any increased
risk of developing a recurrence of their disease. These data do not
confirm an earlier finding from a case-control study, but different
methods may explain the contradictory results.
Good published evidence showing that telemedicine is a cost
effective alternative means of delivering care is lacking, concludes a
systematic review by Whitten and colleagues (p 1434). Their literature
search identified more that 600 cost related articles on telemedicine,
but just 4% of articles satisfied the inclusion criteria set for the
review. The authors say that the poor quality of the published studies
shows that peer reviewed publication should not be taken as an adequate
guarantee of quality for economic evaluations of
telemedicine.
(Credit: DALE SPARKS/AP)
Child health has improved markedly in developing countries in the past
decade. Child mortality has shown a relative decrease of 15% since
1990, but in more than 40 countries it remains above 100 per 1000 live births. On page 1444 the Working Group of Women and Child Health
reviews the major advances in child health in the developing world
since 1990. The group contends that national research capabilities need
to be strengthened to implement change and keep child health at the top
of the international development agenda.
Since 1990 the number of cases of occupational skin disease in
hairdressers in northern Bavaria has fallen. Dickel and colleagues (p 1422) report that the annual incidence fell from 194 to 18 per
100 000 between 1990 and 1999. This decline, they say, seems to
reflect an improvement in working conditions due to new legislation and
intensified preventive measures rather than a change in the clinical
course of occupational skin disease.
Diet has a substantial impact on chronic disease and health. Elliot and
Ong (p 1438) describe the field of nutritional genomics, which
could lead to an explanation of the bioactivities of food constituents.
The greatest potential, they say, is likely to be in health maintenance
and blocking the early stages of disease development through targeting
the genes responsible for disease with
nutritional agents. Such work will be complicated by the fact that the
natural components of food can have both beneficial and adverse
effects.
(Credit: KEITH WELLER/A.R.S.)
The limited quality and quantity of randomised trials of
surgical techniques give a disadvantage to research in surgery, and compensatory strategies are needed. McCulloch and colleagues (p 1448) examine the obstacles to performing such trials and possible solutions to each of them. They propose a strategy that involves integrating modified randomised trials with prospective audit and
quality control studies.
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