Intended for healthcare professionals



BMJ 1998; 316 doi: (Published 17 January 1998) Cite this as: BMJ 1998;316:240

Data from the Framingham heart study, which began in 1948, have shown that in men aged 45-65 the risk of ischaemic stroke was lowest in those who ate the most fat (JAMA 1997;278:2145-50). An editorial in the same issue uses these data to support the advisability of the Mediterranean diet, which has high levels of monounsaturated fat, notably olive oil. Olive oil does not increase the serum cholesterol concentration and so does not increase the risk of coronary heart disease.

Genetic counselling should be offered to couples when one of their children is found to have cystic fibrosis, but this does not always achieve its aim of preventing them having further affected children. An analysis of 42 families with two children with the disease (Archives of Disease in Childhood 1997;97:501-3) found that in 10 cases no offer of prenatal diagnosis had been made; in 24 cases the offer had been declined; and in eight cases the couples had accepted prenatal diagnosis but had decided against termination. Part of the problem seems to have been poor communication between the doctors who should be providing the advice.

Danish merchant ships commonly employ both sexes as sailors, navigation officers, and radio operators. Follow up of 6788 women seafarers (Occupational and Environmental Medicine 1998;55:49-51) found that those in traditionally male jobs had a far higher mortality than women working in the ships’ galleys. Working in tough jobs at sea seems to increase hazardous behaviour and make a high risk lifestyle more likely-or possibly attracts women with these characteristics.

One of the advisers to the BMJ is somewhat miffed to have had a grant application to a research funding body turned down by a standard letter explaining that the application had not been firmly stapled together. Stapling probably deserves further study: Minerva believes she can recognise papers that have been rejected by one competitor journal because staple holes (but no staples) have been left in the top left hand corner. When authors had secretaries manuscripts were retyped before being sent to another journal.

General practitioners are encouraged to document obesity, but an article in the British Journal of General Practice (1998;48:890-4) argues that this is a waste of resources. Obese patients know they are overweight, and most are aware that being obese carries health risks. Measuring and recording the patient's exact body mass index does little or nothing to help him or her lose weight.

It may be some consolation to Britons struggling with their New Year resolutions to lose weight that one quarter of all Americans are making the same effort. The New England Journal of Medicine (1998; 338:52-4) warns doctors to be cautious about exhorting patients to lose weight when they are only mildly obese. It suggests that more attention should be given to prevention: “If the time children now spend in front of the television eating junk food and watching advertisements for more junk food was spent instead in physical activity….”

Chronic pelvic pain is neither well understood nor well treated, says a review in the British Journal of Obstetrics and Gynaecology (1998;105:8-10). Gynaecological investigations typically find nothing abnormal. The part played by psychopathological factors is still uncertain. The conclusion is that the disorder is “a major problem seeking solutions”-and that, of course, more research is needed.

Traditional methods of child care may be attractive but may sometimes be dangerous. The sarong cradle is widely used in South East Asia to help get a child to sleep. It consists of a length of cloth suspended from a spring to a ceiling anchor. The Singapore Medical Journal (1997;38:517-9) describes 19 children aged between 13 days and 29 months, all of whom had fallen out of their cradles and sustained head injuries. None of the injuries was severe, but the cradle has the potential to cause a tragedy.

Findings from the health and lifestyle surveys of 1984-5 and 1991-2 show that Britain is continuing to show polarisation by social groupings (British Journal of Nutrition 1997:873-88). The healthy middle classes who don’t smoke and who drink alcohol in moderation are the same people who eat a lot of fruit, salads, and vegetables. However, despite the widening of the health divide some trends are positive: most people are using more low fat spreads and milk and are eating less fried foods including chips.

The search continues for an alternative to opioids: morphine has so many drawbacks that doctors use it cautiously. Researchers in the United States (Science 1998;279:32-3) believe that they may be close to a real breakthrough with an acetylcholine receptor blocker, ABT 594. This compound is chemically similar to nicotine and to a chemical found in the skin of some tropical frogs. The new analgesic is said to be as powerful as morphine, but because it acts on other receptors it may prove not to be addictive.

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A man aged 77 died of bronchopneumonia after many years of severe idiopathic Parkinson's disease. At necropsy a striking finding was black pigmentation of the cartilages. This included the ribs and the intervertebral discs. There was greyish discolouration of the pinnae and sclera. Ochronosis was excluded by the lack of degenerative changes in the knees and lumbar spine. He had been taking massive doses of levodopa. Pigmentation of the cartilages is a recognised harmless but irreversible side effect of high doses of this drug, but it usually affects only the cartilages of the ribs. C E Keen, consultant pathologist, Lewisham Hospital, London SE13 6LH

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Screening using serological tests for antibodies to reticulin or endomysium will detect many people with unrecognised adult coeliac disease and mild or atypical symptoms. A study in Finland (Scandinavian Journal of Gastroenterology 1997;32:1129-33) found that combining serological tests with open access endoscopy and small bowel biopsy led to a 10-fold increase in the incidence of the disease and an overall prevalence of 270/100 000 people. This is in line with findings of other recent studies in Europe suggesting substantial lack of recognition of a disease that may cause prolonged poor health and is easily treatable.

In the 1930s Nazi Germany condemned tobacco as a genetic poison and a cause of cancer and launched an aggressive antismoking campaign (Bulletin of Medical History 1997;71:435-88). German scientists had suggested a link between lung cancer and smoking as long ago as 1912, and throughout the Nazi regime they published research strengthening the association, but after the war ended, this work was either forgotten or ignored.

A massive review of antenatal screening for Down's syndrome (Journal of Medical Screening 1997;4:181-246) calls for the establishment of around 35 screening centres in Britain, each providing services for three or four maternity units. The procedure should be offered to all pregnant women in the second trimester and should use either triple or quadruple serum tests to identify women who should have amniocentesis.