Marriage and health . . . and other stories
BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2929 (Published 12 July 2018) Cite this as: BMJ 2018;362:k2929
Better health in married people
A few months ago, Minerva mentioned a systematic review that found married people had a slightly lower risk of dementia than people who were single or widowed (BMJ doi:10.1136/bmj.k28). Another systematic review now reports that very much the same thing is true of cardiovascular disease (Heart doi:10.1136/heartjnl-2018-313005). It’s not clear how far this gets us. Perhaps the practical and emotional support provided by a long term partner is good for health. Or is it that people with poorer health are less likely to find partners?
Women’s views on mammography screening
Two community juries of Australian women decided by a majority verdict that screening mammography ought to be offered to women aged 70-74. Among their reasons was that it would show that society valued older women and understood that preventative health services were important for them (BMJ Open doi:10.1136/bmjopen-2017-021174). Counter arguments about declining benefits because of limited life expectancy, the potential for harm through overdiagnosis, and the existence of more effective ways to allocate health resources didn’t cut much ice. The symbolic value of screening programmes shouldn’t be underestimated.
Treating patients who are agitated
A study in an emergency department in the US compared four drugs: haloperidol, olanzapine, midazolam, and ziprasidone, for the treatment of agitated patients who required intramuscular sedation (Ann Emerg Med doi:10.1016/j.annemergmed.2018.04.027). The study was originally intended to be a randomised trial, and approval was withheld because of the impossibility of obtaining informed consent. Instead, treatments were given according to a protocol in which each of the individual drugs was given for a period of three weeks before switching to the next. Midazolam was the most effective treatment, providing 71% of patients with adequate sedation at 15 minutes, although olanzapine was very nearly as good.
TNF inhibitors and cancer
Tumour necrosis factor (TNF) inhibitors are highly effective in the treatment of several autoimmune conditions that affect children, including juvenile idiopathic arthritis, inflammatory bowel disease, and psoriasis. But questions have been asked about an increased incidence of malignancy. They’re not easy to answer because the rate of malignancy in this age group is low, and because other immunosuppressive treatments and the conditions themselves could also raise the risk. Even so, a large study from the US that used administrative claims data is reassuring. The incidence of malignancy among more than 15 000 children being treated with TNF inhibitors wasn’t substantially higher than in children with the same conditions taking other types of treatment (Ann Rheum Dis doi:10.1136/annrheumdis-2017-212613).
Infection in early childhood
A longitudinal study of children living in Copenhagen reports a wide variation in children’s experience of infection in the first three years of life. The median number of infectious illnesses per child was 14, mostly respiratory infections, but the range extended from 2 to 43 (Pediatrics doi:10.1542/peds.2017-0933). Maternal smoking, the presence of older siblings, and early attendance at day care centres increased the risk of infection slightly. However, the most notable finding was that environmental variables explained less than 10% of the variation in infection frequency. That only leaves host factors specific to the child, unless it’s just a matter of chance.