BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39422.530000.47 (Published 13 December 2007) Cite this as: BMJ 2007;335:1270

Aside from all the studies that show that p53 gene is the “guardian of the genome” in tumour prevention, little else is known about its normal function. Nature (2007;450:721-4; doi: 10.1038/nature05993) reveals that p53 regulates reproduction in female mice through the gene that encodes leukaemia inhibitory factor, which is critical for implantation. Evidence is building up that p53 may have a similar function in humans.

Researchers used existing national guidelines for the provision of care for adults with epilepsy, together with systematic reviews on the topic and ideas from patient focus groups, to develop a comprehensive list of indicators of quality of care. Each indicator was appraised for its appropriateness, reliability, and necessity by an expert panel. Of the total of 37 evidence based and 10 patient based indicators, just 24 evidence based and five patient based indicators made the grade, and nine were tossed out as being unnecessary for high quality care (Neurology 2007;69:2020-7; doi: 10.1212/01.WNL.0000291947.29643.9f).

Children in front facing car seats are likely to have more serious injuries than children restrained in rear facing car seats. Data from children up to the age of 2 years in the United States involved in car crashes is reported in Injury Prevention (2007;13:398-402; doi: 10.1136/ip.2006.015115). Rear facing seats are more effective than front facing seats in protecting unrestrained children, even for children aged 12-23 months.

The impact of divorce spreads much further than the family—into the environment. In both developed and developing countries it results in smaller average household size, which leads to more households and a higher demand for energy, water, and land. In the US alone, the researchers estimate, 38 million extra rooms are used, and electricity and water costs are increased, respectively, by 46% and 56% per person in divorced households (PNAS published online 5 December 2007; www.pnas.org/cgi/doi/10.1073/pnas.0707267104).

A study from New Zealand questions the wisdom of surgical repair for ruptured Achilles tendons (American Journal of Sports Medicine 2007;35:2033-8; doi: 10.1177/0363546507307503). Patients with acute rupture of the Achilles tendon were randomised to surgery or no surgery, with both groups receiving “early motion” in a removable orthotics appliance and full weight bearing by eight weeks. In 12 months of follow-up, the groups were similar in plantar flexion and ankle dorsiflexion and in their calf circumference. Complications and reruptures were uncommon in both groups.

The National Institute of Diabetes and Digestive and Kidney Disease (part of the National Institutes of Health; www.diabetes.niddk.nih.gov) is campaigning to ensure that doctors and patients know the importance of using accurate methods to test for haemoglobin A1c (HbA1c) in people with diabetes who also have sickle cell trait or other genetic variants of haemoglobin. “If an HbA1c result is unexpectedly high or it doesn’t correlate with the results of routine blood glucose monitoring, consider the possibility that the patient has a haemoglobin variant and make sure your local lab is using an accurate method to measure HbA1c” (www.nih.gov/news/pr/nov2007/niddk-28.htm).

Boys who suffer adversity in childhood are more likely to suffer poor health as adults. Vulnerability before enlisting in the UK armed forces turns out to be an individual risk factor for ill health in military men. It’s important to remember this when keeping an eye open for post-combat psychiatric disorders and for understanding post-traumatic stress disorder, say the authors of a cohort study (British Journal of Psychiatry 2007;191:506-11; doi: 10.1192/bjp.bp.107.039818).

Australian men are at the sharp end of a huge campaign to “save their lives” by getting their prostatic specific antigen (PSA) tested, even though there is little evidence that screening is useful. Analysis of four years of media coverage found wide promotion of the rhetoric that PSA testing helps detect early cancers, and downplaying of problems caused by surgery after a “screening” PSA. Those who raised concerns about the media image were “vilified,” and an epidemiological background was considered inferior to clinical experience (Journal of the Royal Society of Medicine 2007;100:513-21; www.jrsm.org/cgi/content/abstract/100/11/513).

A complex Bayesian analysis concludes that even when high specificity for a pre-hospital 12 lead electrocardiogram is assumed, populations at overall low risk for STEMI (ST elevation myocardial infarction) have a high rate of false positive results (Academic Emergency Medicine 2007;14:1165-7 doi: 10.1197/J.AEM.2007.07.009). The results speak for themselves—take care before spending precious resources getting 12 lead electrocardiograms done in the community. There are probably better uses of time and money.

Since 1990, maternal mortality has decreased by an estimated 7% worldwide, but why hasn’t it decreased more? Maternal mortality is an indicator of population health that shows inequalities between groups and countries, and maternity care in developing countries is still the most underfunded global priority. Just 2% of financial aid to developing countries in 2004 was spent on maternal, newborn, and child health—and most of this went to infant and child health, rather than mothers (Reproductive Health Matters 2007;15(30); www.sciencedirect.com/science/journal/09688080).

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