British Medical Journal articles from April 1996

British Medical Journal archives from April 1996

Inflammation in ischaemic heart disease: C reactive protein concentrations may provide useful information on risk.(Editorial)
April 27, 1996... Recent reports have suggested a link between blood concentrations of C reactive protein and the risk of cardiovascular disease. The ECAT study (European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study) followed 3000 people...

Managing peanut allergy: demands aggressive intervention in prevention and treatment.(Editorial)
April 27, 1996... The average American now ingests about 11 pounds (5 kg) of peanut products each year (United States Peanut Council, personal communication), about 55% as peanut butter and the rest in sweets, baked goods, and table nuts. As the American...

Smoking in public places: self regulation of business is not working.(Editorial)
April 27, 1996... Britain's environment minister, James Clappison, has released results of a National Opinion Poll study of provision of smoke free indoor environments by businesses that deal with the public.(1) Attempting to put a flattering spin on the...

Chernobyl 10 years on: thyroid cancer may be the only measurable health effect.(Editorial)
April 27, 1996... The beautiful countryside around Chernobyl belies the fact that this is the site of the world's worst nuclear accident. The explosion at the Chernobyl nuclear power station 10 years ago released radiation 200 times the level of the combined...

Drugs and the fetus: caution is needed in all women of childbearing age.(Editorial)
April 27, 1996... Doctors, patients, and the pharmaceutical industry are all cautious about the use of drugs during pregnancy.(1) Few applications for product licences for new drugs include use in pregnancy, and the British National formulary warns that all...

Describing race, ethnicity, and culture in medical research: describing the groups studied is better than trying to find a catch all name.(Editorial)
April 27, 1996... The terminology of race, ethnicity, and culture is a source of continuing debate and will change because of fashion and politics.(1) Given our diversity, the fact that ethnicity is now most often self classified, and that both ethnicity and...

European parliament gets ambitious about health. (Focus: Brussels)
April 27, 1996... It's a frustrating business trying to compare like with like when studying the prevalence of disease in different European Union countries--but help may now be at hand. The European Parliament is showing a growing enthusiasm for health issues,...

C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study.
April 27, 1996... Abstract Objective--To test the hypothesis that minor chronic insults such as smoking, chronic bronchitis, and two persistent bacterial infections may be associated with increases in C reactive protein concentration within the normal range...

Psychiatric problems in children with hemiplegia: cross sectional epidemiological survey.
April 27, 1996... Abstract Objective--To examine the prevalence and predictors of psychiatric problems in children with hemiplegia. Design--Cross sectional questionnaire survey of an epidemiological sample with individual assessments of a representative...

Randomised study of n of 1 trials versus standard practice.
April 27, 1996... Abstract Objective--To compare outcomes between groups of patients with irreversible chronic airflow limitation given theophylline by n of 1 trials or standard practice. Design--Randomised controlled study of n of 1 trials versus standard...

Clinical study of peanut and nut allergy in 62 consecutive patients: new features and associations.
April 27, 1996... Abstract Objective--To investigate clinical features of acute allergic reactions to peanuts and other nuts. Design--Analysis of data from consecutive patients seen by one doctor over one year in an allergy clinic at a regional referral...

Glycophorin A biodosimetry in Chernobyl cleanup workers from the Baltic countries.
April 27, 1996... The 1986 Chernobyl nuclear accident resulted in massive contamination of the area, necessitating evacuation of the population, extensive environmental cleanup of radioactive materials, and construction of a sarcophagus to isolate the...

Transformations, means, and confidence intervals. (part 18)
April 27, 1996... When we use transformed data in analyses,(1) this affects the final estimates that we obtain. Figure 1 shows some serum triglyceride measurements, which have a skewed distribution. A logarithmic transformation is often useful for data which...

Practicality of recording patient ethnicity in general practice: descriptive intervention study and attitude survey.
April 27, 1996... Abstract Objective--To assess the feasibility of recording patient ethnicity in primary care using the Office of Population Censuses and Surveys classification. Design--A descriptive intervention study and attitude survey in random...

An epidemic like any other? Rights and responsibilities in HIV prevention.
April 27, 1996... Throughout the 1980s and into the 1990s, HIV prevention has been closely associated with the protection of individual human rights. Traditional public health measures such as compulsory testing and isolation have largely been rejected as...

Addison's disease.
April 27, 1996... Primary adrenocortical insufficiency (Addison's disease) is a rare disorder in which there is destruction of the adrenal cortex, thus reducing the production of glucocorticoid, mineralocorticoid, and sex steroids.(1),(2) Most cases are now due...

Reactive (AA) systemic amyloidosis: a cause of refractory nephrotic syndrome. (amyloid A) (Grand Rounds: Hammersmith Hospital)
April 27, 1996... Reactive systemic (AA) amyloidosis occurs as a consequence of a prolonged acute phase response with the deposition of amyloid fibrils in various tissues. Renal involvement with the nephrotic syndrome is common, and reactive systemic amyloidosis...

Urothelial tumours. (Urological Malignancy, part 2) (ABC of Urology)
April 27, 1996... Tumours of the urinary tract vary in type. Less than 1% of cases of bladder cancer in Britain are due to squamous cell carcinoma (although 75% of cases in Egypt are), and less than 2% of primary bladder cancers are adenocarcinomas....

Clive Joseph Bruton.(Obituary)
April 27, 1996... Clive Bruton's interest in people's problems attracted him into general practice, but only after he had developed a fascination with neuropathology. The latter led to an international reputation in the study of temporal lobe epilepsy,...

999.
April 27, 1996... The BBC series 999 is basically a disaster fest in praise of the emergency services. Four or five stories feature in each episode, and the events leading up to, and following, the disaster in question are recreated by a mix of actors and actual...

Nadja.
April 27, 1996... A myth, in order to survive, must continuously reconstitute itself within the concerns and preoccupations of the present day. Recent cinematic accounts of the vampire myth have placed the familiar story within the context of latter day...

Charity for Chernobyl? (Personal View)(Column)
April 27, 1996... The media exposure about the children of Chernobyl generated a public outcry in Britain. Consciences were jarred, collecting tins were mobilised, and charities had a new cause to champion. At short notice in November 1995 we were approached by...

New Rules: Regulation, Markets, and the Quality of American Health Care.
April 27, 1996... Non-American readers will learn more from New Rules than they may want to know about the detailed history of regulation in the United States. But at times that history is fascinating, and the lessons that are drawn by Brennan and Berwick are...

Environmental and Health Atlas of Russia.
April 27, 1996... Social reform in 19th century Britain owed much to the painstaking collection and analysis of statistical data about the adverse consequences which a free market economy had for working people and their families. In Soviet Russia, by contrast,...

Family Violence and the Caring Professions.
April 27, 1996... The work of most doctors brings them into contact with families whose members' lives are blighted by violence; that some doctors fail to realise this has much to do with society's continued idealisation of the family as the repository of all...

Managing Health Promotion: Developing Healthy Organizations and Communities.
April 27, 1996... Reviewing health in the Mersey region in 1984, I described health promotion as "any combination of health education and political, economic and organisational activity designed to improve or protect health through its effect on the human...

Income inequality and mortality: why are they related? Income inequality goes hand in hand with underinvestment in human resources.(Editorial)
April 20, 1996... The long held belief that household income is an important indicator of risk of death has recently received strong support from a series of large prospective studies.[1 2] Income inequality within a population has also been suggested to be an...

Potential transmission of BSE via medicinal products: patients can be reassured that measures are in place to reduce risk. (bovine spongiform encephalopathy)(Editorial)
April 20, 1996... The identification of 10 cases of Creutzfeldt-Jakob disease, which seem to represent a new variant,[1] and the announcement by the Spongiform Encephalopathy Advisory Committee (SEAC) on 20 March that these cases could be linked to exposure to...

Shortage of organs for transplantation: crisis measures must include better detection and maintainence of donors.(Editorial)
April 20, 1996... Of all the problems foreseen in the pioneering days of organ transplantation, a shortage of donor organs was not even remotely considered as a barrier to progress. Such has been the success of transplantation over the past two decades that...

Landmines: time for an international ban, the United Nations must end this indiscriminate killing and maiming of civilians.(Editorial)
April 20, 1996... Anti-personnel landmines remain one of the unmet challenges of preventive medicine. In the aftermath of modern civil and international conflict, civilians--especially children--continue to be killed long after the end of hostilities.[1 2] Many...

The continuing rise in emergency admissions: explanations and responses must be properly evaluated.(Editorial)
April 20, 1996... Emergency admissions in Britain are continuing to rise.[1] The highly publicised bed crisis this winter and a number of national meetings have underlined concern over the lack of explanations and frustration at the lack of control. In Scotland,...

Inequality in income and mortality in the United States: analysis of mortality and potential pathways.
April 20, 1996... Introduction The inverse association between socioeconomic level and risk of disease is one of the most pervasive and enduring observations in public health.[1-4] This association is found for most diseases for most measures of socioeconomic...

Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States.
April 20, 1996... Introduction A small number of cross national studies have suggested a relation between income distribution and life expectancy: the greater the gap in income between the rich and poor in any given society the lower the average life...

Correction. (to "Alcohol consumption, serum low density lipoprotein cholesterol concentration, and risk of coronary heart disease" in March 23, 1996 issue)(Correction Notice)
April 20, 1996... Two editorial errors and a typesetting error occurred in this paper by Hans Ole Hein and colleagues (23 March, pp 736-41). The last sentence in the penultimate paragraph under results (p 739) should have read: "This agrees with Rimm et al, who...

Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices. (includes commentary)
April 20, 1996... Introduction For both primary and secondary care there is a well established association between deprivation measured in terms of census variables at the area level and various indices of rates of use of general medical services[1 2] and...

Does the variation in the socioeconomic characteristics of an area affect mortality?
April 20, 1996... Our research in England has shown that the more deprived an area the greater its incidence of premature mortality.[1] Wilkinson has argued that in the developed world income distribution is a more important predictor of life expectancy between...

Effect of inadvertent intradermal administration of high dose percutaneous BCG vaccine. (tuberculosis vaccine)
April 20, 1996... In the United Kingdom it is recommended that all children receive BCG vaccination to prevent development of tuberculosis.[1 2] The standard route of administration is intradermal. In neonates a 10 times more potent percutaneous preparation is...

Functional disability and antibody response to influenza vaccine in elderly patients in a Dutch nursing home.
April 20, 1996... Serological studies have yielded conflicting results about the antibody response to influenza vaccines in elderly people[1]--hence the association of advanced age with declined protection is in question. Differences in subjects' state of health...

Measuring outcomes in primary care: a patient generated measure, MYMOP, compared with the SF-36 health survey. (measure yourself medical outcome profile)
April 20, 1996... Introduction Medical outcomes belong first and foremost to patients. Their personal experience of illness, as well as the influence of the wide variety of help and treatments they seek, needs to be incorporated into the measurement process....

Medical genetics. (includes lists of available genetic tests and disease genes found in 1995)
April 20, 1996... If reports in the media are anything to go by, genome research in 1995 was mostly about genes for criminality, obesity, or "wolfmen" (the term coined by one newspaper to describe the members of a unique Mexican family affected by X linked...

All together now: why social deprivation matters to everyone.
April 20, 1996... Inequalities in health in the United Kingdom are widening as a result of economic policy. By focusing on specific diseases, health policy fails to address why less prosperous groups die earlier from most major categories of death. By...

A physiology classic revisited after 60 years: Goldblatt's "one kidney, one clipped" model of renovascular hypertension in a human. (Grand Rounds: Hammersmith Hospital)
April 20, 1996... Hypertension affects 10-15% of the population. Most cases (over 90%) are essential hypertension. Renovascular causes are the most common cause of secondary hypertension. In the first third of this century, Harry Goldblatt worked on the theory...

Prostate cancer. (Urological Malignancy, part 1) (ABC of Urology)
April 20, 1996... Haemospermia * Patients with haemospermia often present to their general practitioner thinking that they may have cancer * Haemospermia is usually related to nonspecific inflammation of the prostate and settles spontaneously The...

William McNeil Styles.(Obituary)
April 20, 1996... Being a general practitioner was the centre of Bill Styles's professional life, and fittingly his belief in the significance and centrality of general practice was endorsed by the quality of care he himself received in his last few years. In...

Visions of anaesthesia hell. (Personal View)(Column)
April 20, 1996... As a result of my long held desire to spend time working abroad, I find myself supplementing experience and income at a trauma centre in the United States. In Britain the chief medical officer, Sir Kenneth Calman, has offered his vision of...

Who Should We Treat? Law, Patients and Resources in the NHS. (National Health Service)
April 20, 1996... Christopher Newdick Oxford University Press, 15.99[pounds], pp 323 ISBN 0 19 825925 55 In Britain, the task of assessing populations' health needs and deciding what should be the priorities for spending money to meet them became formalised...

Prescribing in General Practice.
April 20, 1996... Ed Conrad Harris Radcliffe, 15[pounds], pp 191 ISBN 1 85775 042 X Prescribing in general practice is no longer just about which drugs to use for which indications. It is also about people, money, information, legal and administrative systems,...

Extending Primary Care: Polyclinics, Resource Centres, Hospitals-at-Home.
April 20, 1996... Ed Pat Gordon, Janet Hadley Radcliffe, 16.50[pounds], pp 160 ISBN 1 85775 029 2 The development of primary care-led health care continues, building on the experience of the past decades. The initial development of primary care focused on the...

Overwork can kill: especially if combined with high demand, low control, and poor social support.(Editorial)
April 13, 1996... The death of a junior doctor in Britain last year, after working excessive hours and sleeping little, brought new relevance to the question, can overwork kill? It seems reasonable to suggest that excessive workload could be harmful. In Japan,...

Privatising the NHS: dentistry paves the way. (National Health Service)(Editorial)
April 13, 1996... The suggestion last year that mixed public and private finance might be introduced to health care in Britain(1) provoked an outcry among supporters of the NHS.(2) Many feared that the government would extend free market principles and...

Hospital at home: an uncertain future.(Editorial)
April 13, 1996... Providing services traditionally associated with secondary care in the community is a feature of health policy both in Britain and abroad. "Hospital at home" is currently a popular response to the increasing demand for hospital beds. Cutting...

Health and human rights: protecting human rights is essential for promoting health.(Editorial)
April 13, 1996... When the World Health Organisation redefined health as "a state of complete physical, mental and social well-being"(1) it not only expanded health far beyond medicine, it openly acknowledged the vast accumulated knowledge about the central role...

Travel associated illness: we need to stop blaming the victim.(Editorial)
April 13, 1996... If you develop diarrhoea and vomiting on a foreign holiday this year, who is responsible? Some might argue that, because these symptoms are so common, affecting typically between 30% and 40% of people holidaying abroad, no one can be blamed.(1)...

Patenting gene sequences: not in the best interests of science or society.(Editorial)
April 13, 1996... The American biotechnology industry was shocked when social activist Jeremy Rifkin organised a petition drive last year to stir religious opposition to any patents on "the rich genetic resources of the Earth's biological commons," including...

Effect on lipoprotein profile of replacing butter with margarine in a low fat diet: randomised crossover study with hypercholesterolaemic subjects.
April 13, 1996... Abstract Objective--To examine the effect on lipid and lipoprotein concentrations when butter or an unsaturated margarine is used for cooking or spreading in a reduced fat diet. Design--Randomised crossover study with two intervention...

Clearance of chylomicron remnants in normolipidaemic patients with coronary artery disease: case control study over three years.
April 13, 1996... Abstract Objective--To test the hypothesis that subjects who clear chylomicron remnants slowly from plasma may be at higher risk of coronary artery disease than indicated by their fasting plasma lipid concentrations. Design--Case control...

Genetic influences on osteoarthritis in women: a twin study. (includes commentary)
April 13, 1996... Abstract Objectives--To assess the relative contribution of genetic and environmental factors to common forms of osteoarthritis of the hands and knees. Design--Classic twin study with unselected twins who were screened radiologically for...

Survey of intensive care of severely head injured patients in the United Kingdom.
April 13, 1996... Abstract Objectives--To study practice in intensive care of patients with severe head injury in neurosurgical referral centres in United Kingdom. Design--Structured telephone interview of senior nursing staff in intensive care unit of...

A follow up study of depression in the carers of dementia sufferers.
April 13, 1996... Caring for people with dementia is stressful,(1) and depression occurs in 30-50% of carers.(2) Few data are available, however, about the course of depression or variables associated with the length of episodes, such as age, closeness of...

Contrasting epidemiology of aortic aneurysm and peripheral vascular disease in England and Wales.
April 13, 1996... Age standardised death rates from aortic aneurysm in England and Wales rose 20-fold in men and 11-fold in women between 1950 and 1984.(1) Similar trends have been reported in other Western countries, most of the increase being in deaths from...

A study of general practitioners' reasons for changing their prescribing behaviour.
April 13, 1996... Abstract Objectives - To explore general practitioners' reasons for recent changes in their prescribing behaviour. Design - Qualitative analysis of semistructured interviews. Setting - General practice in south east London. Subjects -...

A method of creating a death register for general practice.
April 13, 1996... Registers of deaths, kept by general practices, are important for audit and research, to improve the care of dying patients, for planning services for terminally ill patients, and to improve the care of recently bereaved patients.(1),(2) A...

Evaluating fever in travellers returning from tropical countries.
April 13, 1996... With increasing numbers of travellers worldwide, doctors are often faced with the dilemma of a febrile patient who has recently visited a tropical country. Fever is an important and common presentation of tropical diseases and may sometimes be...

Seabather's eruption - a case of Caribbean itch.
April 13, 1996... Seabather's eruption is an intensely pruritic dermatitis that occurs after exposure to seawater and affects the areas of the body covered by swimwear. It has probably existed for centuries, but formal reports of it are relatively recent.(1)...

Patients' prerogatives and perceptions of benefit.
April 13, 1996... Patients today demand more information about their treatment. Doctors, however, seem reluctant to cast aside ingrained habits of paternalism, believing they can best interpret therapeutic choices for their patients. Whether doctors can be more...

Urinary incontinence and urinary infection. (ABC of Urology)
April 13, 1996... Urinary incontinence Urinary incontinence is a common reason for referral to a urologist, but the exact prevalence in the community is unknown as many patients conceal their symptoms because of embarrassment. Stress incontinence Stress...

Dangerous patients with mental illness: increased risks warrant new policies, adequate resources, and appropriate legislation. (includes commentary)
April 13, 1996... British people have become increasingly concerned about the risk of violence from patients with severe mental illness who have been discharged into the community. A few incidents have received considerable media attention and left a strong...

Alison McCartney.(Obituary)
April 13, 1996... Having decided as an undergraduate that she wanted to be a pathologist, Alison McCartney trained initially in general histopathology with emphasis on neuropathology. Then, however, she moved into the subspecialty of ophthalmic pathology at the...

Both sides of the coin. (accounts of schizophrenia) (Personal View)(Column)
April 13, 1996... The telephone rang and the person on the other end asked if I remembered her--she was in town and thought that she would get in touch. Things were going well; she'd recently completed her training and graduated, and was taking a few months off...

Are hospital patients fellow human beings? (Personal View)(Column)
April 13, 1996... Of course they are," you cry. Yes, we all agree they are human beings, but the question is, are they fellow human beings? In the early 1950s polio was endemic in England. One summer, at the age of 17, I suffered the classical minor illness...

Three rules to cut the hype. (media accounts of medical research)
April 13, 1996... Critical appraisal of articles on health published in newspapers is much more difficult than appraisal of papers published in medical journals, mainly because you don't have adequate information. But you also have to consider the spin put on...

Amputation: Surgical Practice and Patient Management.
April 13, 1996... In modern surgical practice amputation should not be regarded as a failure. Once a considered decision has been made to proceed with the ablation of a limb (for whatever reason), it is vital that the principles of preparation, surgical...

Current Controversies in the Anxiety Disorders.
April 13, 1996... It seems a good idea. Identify a series of topics in an area of research and treatment characterised by different views. Ask two or three experts to review a topic, each from a different viewpoint. Then ask them to comment on the contributions...

Future Options for General Practice.
April 13, 1996... There is a distinction between invention and innovation, which June Huntington illustrates in her chapter by quoting from Peter Senge's The Fifth Discipline: that cold clear morning...when the fragile aircraft of Wilbur and Orville Wright...

The Mystery of General Practice.
April 13, 1996... The role of the general practitioner is changing rapidly on both sides of the Atlantic. In the United Kingdom general practitioners enter into fund holding arrangements with the National Health Service. In the United States family physicians...

Hormone replacement for men: not enough evidence to recommend routine treatment with dehydroepiandosterone.(DHEA)(Editorial)
April 6, 1996... Some journalists, some patients, and some doctors believe that dehydroepiandosterone (DHEA) is the fountain of youth in a bottle. Most members of the biomedical community remain sceptical. The recent publication of a report of a conference at...

The prone position in acute respiratory distress syndrome: small studies have shown that it improves oxygenation.(Editorial)
April 6, 1996... Acute respiratory distress syndrome (ARDS) is characterised by radiographic diffuse bilateral infiltrates, decreased respiratory compliance, small lung volumes, and severe hypoxia.(1) Correcting life threatening hypoxia is one of the main goals...

Second primary cancers after childhood cancer: low absolute risk, but prevention and monitoring are high priorities.(Editorial)
April 6, 1996... Over the past two decades, impressive advances have been made in the treatment and survival of children with cancer. Population based data from the United States document a 68% five year survival for children aged 0-15 years who were diagnosed...

Long term care of older people: strategic management would stop people going too early to the wrong place.(Editorial)
April 6, 1996... Car manufacturers have responded radically to the challenge of global competition; they have revolutionised assembly through technology, just-in-time inventories, team working, and a focus on quality; they have optimised component supply by...

Promoting environmental health: needs closer collaboration between the NHS and local government.(National Health Service)(Editorial)
April 6, 1996... The British government's white paper, Health of the Nation, received a cautious welcome on its publication in 1992.(1) Its critics believed that its approach to health was limited, that it omitted many important issues such as the effects of...

Enteral nutrition after surgery: not routinely indicated in well nourished patients.(Editorial)
April 6, 1996... Perioperative nutritional support, whether by the central or parenteral route, remains controversial. Its efficacy in many circumstances is unproved and the indications for using it are unclear. Nutritional support can be expensive and is not...

Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection.
April 6, 1996... Abstract Objectives--To assess whether immediate postoperative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective. Design--Randomised trial of immediate postoperative enteral feeding through a...

Cohort study of predictive value of urinary albumin excretion for atherosclerotic vascular disease in patients with insulin dependent diabetes.
April 6, 1996... Abstract Objective--To examine whether slightly elevated urinary albumin excretion precedes development of atherosclerotic vascular disease in patients with insulin dependent diabetes independently of conventional atherogenic risk factors...

Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease.(includes commentary)
April 6, 1996... Abstract Objective--To determine whether QTc dispersion, which is easily obtained from a standard electrocardiogram, can predict those patients with peripheral vascular disease who will subsequently suffer a cardiac death, despite having no...