BMJ family highlightsBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7393.785 (Published 12 April 2003) Cite this as: BMJ 2003;326:785
Smell is not helpful in diagnosing urine infection
Struthers and colleagues tested the common belief that if a child's urine smells unusual then it is probably infected. They checked 110 urine samples from acutely ill children, simultaneously asking parents whether the urine smelled differently from usual. Nearly half thought it did—but fewer than 6% of their children had infected urine. Roughly the same proportion was infected when parents considered the urine had a normal odour.
Short acting β agonists do not provoke myocardial infarction
A large epidemiological study has shown that short acting inhaled β agonists do not increase the risk of myocardial infarction in patients with chronic obstructive pulmonary disease (COPD). More than 12 000 patients aged over 55 with COPD were followed for up to nine years. Nearly 10% had a first myocardial infarction; the same proportion had used β agonists as in the cohort who did not have an infarction. The result contradicts the finding of a previous case-control study of β agonists in patients with known cardiovascular disease, but the authors say that angina associated with imminent infarction might have been misdiagnosed previously as COPD and asthma. A trend towards a small increase in myocardial infarction in patients reporting heavy use of β agonists was probably confounded by their having more severe COPD, itself responsible for the greater risk.
Reducing risk and blame by learning from aviation
An Israeli ambulatory healthcare provider has shown that principles of risk reduction developed in the aviation industry can be applied successfully to medicine. The main assumption was that people do not err maliciously. Reporters were granted “immunity” and offered a hotline for support and guidance. All those who were involved in adverse events with learning potential were debriefed, and when system failures were identified corrective guidelines were devised and distributed. Over five years, event reporting increased and reviews were prompt. Risks were reduced and physician-patient communication improved.
Inhaling volcano ash affects breathing
Children who were living on Montserrat when the Soufrière Hills volcano erupted in July 1995 have had an excess of respiratory illness since that time. A questionnaire survey of those who have remained on the island shows that those heavily exposed to volcanic ash have much higher rates of wheeze, cough, and exercise induced bronchoconstriction than those who lived in areas with lower exposure. Few were receiving recommended appropriate treatment.
Work stress leads to coronary heart disease
The Whitehall II study has followed more than 10 000 London based civil servants aged 35–55 for a mean of 11 years, in particular identifying those who developed coronary heart disease. A combination of high job demands and low decision latitude (“job strain”) put them at increased risk. More than 22% of participants were in the job strain group, implying a potential major public health impact. Strategies are needed to redefine jobs to reduce psychological demands and increase individual control.
Maternal drugs found in infants' meconium and hair
Pregnant women's illicit use of drugs can be identified by testing their babies' meconium or hair for cocaine, opiates, benzodiazepines, and cannabinoids. Pharmacologists from the Motherisk programme at the Hospital for Sick Children Toronto found meconium marginally more sensitive but available only for two days. Hair can be tested until babies are 3 months old, but some mothers objected to this method.
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