What's new this month in BMJ Journals

Fear of racism has adverse health effects

Expressing fear of racial harassment is associated with self reported health problems. One in four people responding to the UK fourth national survey of ethnic minorities reported being worried about the likelihood of being insulted or physically attacked or having their property damaged for reasons to do with race or colour. They were 60% more likely than unworried respondents to report that their health was “fair” or “poor.” This difference was independent of age, sex, or social class. The investigators, from University College London, call for policies to take into account the psychological environment of those who perceive themselves as potential victims as well as tackling overt racism.

J Epidemiol Comm Health 2004;58: 1017-8

Valproate in pregnancy may lower verbal IQ in offspring

A retrospective survey of 219 mothers with epilepsy and 249 of their children suggests that use of valproate during pregnancy is linked with impaired verbal IQ and an increased risk of dysmorphic features in infants. Fetal exposure to the drug may double the risk of a low IQ, but no such impairment was seen if mothers took carbamazepine, phenytoin, or polytherapy. Frequent seizures have a similar adverse effect, so there is a dilemma in how best to treat pregnant women with idiopathic generalised epilepsy, for which valproate is probably the most effective medication. The authors recommend pre-conception counselling of adolescents who have a seizure disorder.

J Neurol Neurosurg Psychiatry 2004;75: 1575-83

Australian Gulf war veterans report more symptoms than non-deployed servicemen

Follow up of the entire cohort of Australians deployed in the 1991 Gulf war shows that they report more symptoms of a more severe nature than servicemen who were eligible but not deployed. The most common problems are skin, eye, and sinus conditions and post-traumatic stress disorder. Comprehensive health assessments and telephone contact with non-respondents to the original questionnaire showed the symptoms were due neither to over-reporting nor to participation bias. Factor analysis failed to find any particular pattern of symptoms justifying classification as a specific syndrome. Increased symptoms are associated with greater exposure to a variety of agents including multiple immunisation, anti-biological warfare medication, and pesticides and with being in a reported chemical weapons area and facing stressful military experiences.

Occup Environ Med 2004;61: 1006-13, 1014-20

Systematic review favours moderate inhaled steroid dosage

A systematic review of randomised controlled trials comparing two doses of inhaled corticosteroids in adults with asthma shows that starting with a moderate dose is as effective as starting with a high dose, then stepping down. Thirteen trials were identified, involving over 2500 patients. Because of potential side effects with high doses, the authors advise starting treatment in people with mild to moderate asthma with low to moderate doses of inhaled corticosteroids at a constant level.

Thorax 2004;59: 1041-5

A golfing handicap

A handicap 6 golfer presented with an aching right wrist, made worse when he practised putting. A month previously he had changed his putting grip by supinating the forearm so that his palm faced more towards the ball (the figure shows original grip A and modification B). Examination showed tenderness over the insertion of the flexor carpi radialis. It was likely that the grip change had provoked strain of the radiocarpal joint and surrounding connective tissue inflammation. Stretching exercises, provision of an elastic therapy band, and advice to return to his previous method solved the problem.

Br J Sports Med 2004;38: e34

H pylori eradication is as good as endoscopy in managing dyspepsia

Five hundred patients consulting their general practitioner because of simple dyspepsia were randomised to testing for Helicobacter pylori, followed by eradication, if positive, or to prompt endoscopy. Symptoms, quality of life, patient satisfaction, medication, and hospital visits were recorded for six to seven years after presentation. Patients in both groups recorded the same number of days with and without dyspepsia during the follow up period. Quality of life and satisfaction were the same. The “test and eradicate” strategy resulted in less use of medication and fewer repeat endoscopies.

Gut 2004;53: 1758-63

Eyedrop labels need visible instructions

Patients attending a Glasgow eye clinic had their visual acuity recorded. They were then asked to read the instructions on a bottle of eye drops. They were allowed to wear their reading spectacles and bring the bottle as close to their eyes as they wished. People with an acuity worse than 6/18 encountered extreme difficulty. To ensure readability the investigators recommend printing instructions in Arial font at 22 point—numbers 15 mm high.

Br J Ophthalmol 2004;88: 1541-2

Full articles can be accessed via bmj.com