This week in the BMJ
Volume 326, Number 7398, Issue of 17 May 2003Environmental tobacco smoke does not affect mortality
Environmental tobacco smoke does not affect mortality
Environmental tobacco smoke was not associated with mortality from coronary heart disease or lung cancer at any level of exposure in a large study of Californians followed for 40 years. Based on an analysis tracking 35 561 adults who had never smoked and their smoker spouses between the periods 1960 and 1998, Enstrom and Kabat (p 1057) suggest that the effects of environmental tobacco smoke, particularly for coronary heart disease, are considerably smaller than generally believed. In contrast, active cigarette smoking was a strong, dose related risk factor for coronary heart disease, lung cancer, and chronic obstructive pulmonary disease. Despite these findings, Davey Smith (p 1048) says debate about the role of environmental smoke, as well as the risk of being married to a smoker, will continue. Additional research on the link between second hand smoke and disease is needed.
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Mortality is high in young offenders
Young people in Australia who have received custodial sentences have high mortality from drug overdose, suicide, and unintentional injury. In a retrospective cohort study, Coffey and colleagues (p 1064) compared death rates in young offenders with those in young people in the general population of the same state. They found that rates in young offenders were nine times higher in males and 40 times higher in females. A quarter of all drug related deaths in 15-19 year old men were of young offenders. The authors say that social policies to address drug and mental health problems and social disadvantage in young offenders are urgently needed.
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Standardised measures needed for data quality
Quality measurement of electronic patient records in primary care needs to be standardised. Thiru and colleagues (p 1070) conducted a systematic review of 52 publications on how data quality in primary care is measured and reported. Most (92%) were concerned with patient identification data, and their measurements varied. Reliability was typically measured through rate comparisons, whereas validity was assessed through either sensitivity or predictive probabilities. The recording of diagnostic and prescription data tended to be better than that of other variables. Until every practice is paperless and enters coded data for every consultation, the authors recommend that set reference standards be used to determine completeness and accuracy.
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Targeted programmes needed for hardcore smokers
Hardcore smokers say they will keep on smoking. In a cross sectional study of 7766 English smokers, Jarvis and colleagues (p 1061) found that 16% were hardcore, four times as many as previous research has suggested. Hardcore smokers were defined as those who had never attempted to stop smoking and did not wish or intend to give it up in the future, and those who had not gone a day without smoking cigarettes in the past five years. Hardcore smoking was commoner in older and more dependent smokers, and in those from more socioeconomically deprived backgrounds. They tended to believe that their present health was unaffected by smoking and was unlikely to be affected in the future. Despite hardcore smokers' recalcitrance, the authors say that targeted interventions could help older and socially disadvantaged smokers to quit.
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Promising new technologies for heart failure are available
The annual mortality from chronic heart failure remains as high as 40%. In this week's clinical review, Chow and colleagues (p 1073) discuss the effects of new pacing technologies on patients with chronic heart failure. They report that the use of biventricular pacing improves symptoms and reduces the number of hospital admissions and lengths of stay. Implantable defibrillators reduce mortality, and forthcoming data from randomised controlled trials suggest that a wider range of patients should receive them. The authors outline the characteristics of patients who could benefit from these technologies and the complications that might arise.
Student BMJ
Intimate examinations
Israeli students are refusing to perform intimate examinations on anaesthetised women without their informed consent.
