British Medical Journal articles from August 1998

British Medical Journal archives from August 1998

The public Health Act of 1848: the act's qualities of imagination and determination are still needed today.(Editorial)
August 29, 1998... The act's qualities of imagination and determination are still needed today The 1848 Public Health Act is 150 years old. Its context, origins, content, and compromises are extensively reviewed in this issue by Hamlin and Sheard (p...

From public health to the health of the public: modern public health problems will not be solved by anything as simple as sewers.(Editorial)
August 29, 1998... Modern public health problems will not be solved by anything as simple as sewers "I have... been taken to see the worst parts of the worst towns in England... but never did I see anything which could compare with Merthyr... one of the...

Providing spectacles in developing countries: millions endure poor vision for want of affordable glasses.(Editorial)
August 29, 1998... Millions endure poor vision for want of affordable glasses Imagine the scenario. You are an indigenous teacher or civil servant stationed in a small rural community in a tropical country. Almost by definition you are over the age of 40 as...

Community care for elderly people: will improve only when there are national standards and explicit funding.(Editorial)
August 29, 1998... Will improve only when there are national standards and explicit funding For an elderly person discharged from hospital in Britain, gaining access to continuing health care is like queuing for a car parking place in a multistorey car park...

The end of triglycerides in cardiovascular risk assessment?(Editorial)
August 29, 1998... Rumours of death are greatly exaggerated Although serum triglyceride concentrations are often measured in clinical practice, Garber and Avins[1] plausibly argued in the BMJ in 1994 that their use in screening for cardiovascular risk was...

A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, Hemoccult.
August 29, 1998... Introduction Colorectal cancer is a leading cause of illness and death in the Western world. In Australia, the United Kingdom, and the United States it is the commonest cancer in women after breast cancer (age standardised incidence...

Changes in left ventricular structure and function in patients with white coat hypertension: cross sectional survey.
August 29, 1998... Introduction A physical examination by a physician may cause a rise in the patient's blood pressure. Individuals showing such responses are considered to have white coat hypertension if their blood pressure reaches a hypertensive level...

Effect of community based management in failure to thrive: randomised controlled trial.
August 29, 1998... Introduction Failure to thrive is a common problem in primary care and paediatric practice. It usually results from a range and combination of dietary, organic, and social factors, leading to undernutrition.[1] Failure to thrive is...

Reasons for and outcome of upper gastrointestinal endoscopy in patients aged 85 years or more: retrospective study.
August 29, 1998... Upper gastrointestinal endoscopy has proved to be safe and gives a high diagnostic yield in elderly people.[1-5] The prevalence of gastrointestinal diseases increases with age, and elderly people are also more vulnerable to the complications of...

Call to needle times after acute myocardial infarction in urban and rural areas in northeast Scotland: prospective observational study.
August 29, 1998... Introduction Acute myocardial infarction is most often due to coronary thrombosis. Thrombolytic treatment, if given before myocardial necrosis becomes irreversible, is a radical treatment for this common and commonly fatal condition;...

Integrated record keeping as an essential aspect of a primary care led health service.
August 29, 1998... Three separate policy themes have been identified as important for the future development of effective health care in the United Kingdom. These are a focus on the extended primary care team as the prime means of healthcare delivery,[1-3]...

Public health.(Recent Advances)
August 29, 1998... Identifying particular advances in public health is difficult because, in the final analysis, success can be judged only by improvement in the health of a population. Progress is rarely, if ever, a matter of developing a technical intervention...

Revolutions in public health: 1848, and 1998?
August 29, 1998... This autumn marks the 150th anniversary of the Public Health Act for England and Wales, the beginning of a commitment to proactive, rather than a reactive, public health. The act began a series of legislative measures extending through the...

Millenium report to Sir Edwin Chadwick.
August 29, 1998... To mark the 150th anniversary of the 1848 Public Health Act, Iqbal Sram and John Ashton write a memo to Edwin Chadwick, the architect of the 1848 act, on the state of the public health at the end of the millennium I will not cease from...

The 1848 Public Health Act and its relevance to improving health in England now.
August 29, 1998... I keep copies of all major acts of parliament relevant to health and health care. I have consulted them from time to time over the past seven years. However, it is the 1848 public health act (An Act for Promoting Public Health) that I have...

When is medical evacuation justified?(Personal View)
August 29, 1998... Illness is a pain in the neck. Its arrival is always unwelcome, unsolicited, and an intrusion on the more pressing urgency of living. Only the most perverse individual could relish the experience. All the more inconvenient then when you are far...

Banking on interest.(Medicine and the Media)
August 29, 1998... "Test Tube Dads" (Inside Story, BBC1, 25 August) attempted to tell the human stories behind some of the million babies who have been born worldwide as a result of donor insemination By her own admission, Alton Blake fell madly in love with...

Cerebral sinus thrombosis and oral contraceptives.(Editorial)
August 22, 1998... There are limits to predictability In short succession two recently published papers have shown not only a very high relative risk of cerebral sinus thrombosis in users of oral contraceptives but an even stronger effect of contraceptives...

Diagnosing and responding to serious child abuse: confronting deceit and denial is vital if children are to be protected.(Editorial)
August 22, 1998... Confronting deceit and denial is vital if children are to be protected Publishing recently in Pediatrics, Southall et al described their experience of using covert video recordings to diagnose life threatening abuse[1] Of 39 children...

Crisis in cremation: positive action by the Home Office is urgently needed.(Editorial)
August 22, 1998... Positive action by the Home Office is urgently needed Disposal of bodies by cremation in the United Kingdom gathered pace in the last 25 years of the last century, following the establishment of the Cremation Society in 1874. It is now the...

Role of the ataxia-telangiectasia gene (ATM) in breast cancer: A-T heterozygotes seem to have an increased risk but its size is unknown.(Editorial)
August 22, 1998... A-T heterozygotes seem to have an increased risk but its size is unknown Genetic predisposition accounts for 5-10% of breast cancer, and two genes--BRCA1 and BRCA2--have attracted most attention as high risk factors.[1] However, these two...

Prescription charges: change overdue?
August 22, 1998... Britain can learn from systems of copayments based on drugs' effectiveness The NHS prescription charge, currently 5.80 [pounds sterling], is not related to the cost of the medicine but is a tax for the use of NHS services, intended partly...

The new WHO cabinet looks refreshingly different. (World Health Organization)
August 22, 1998... The top ranks of the World Health Organisation look dramatically different since Dr Gro Harlem Brundtland swept into office on 21 July, writes Adrea Mach The average age of WHO's new cabinet has dropped by almost a decade, from 59.2 to 49.9...

Routine protein energy supplementation in adults: systematic review.
August 22, 1998... Introduction Malnutrition is a common and underrecognised problem in hospital patients.[1-4] Furthermore, illness and hospitalisation are frequently associated with negative energy balance and further deterioration in nutritional...

Correction. (to 'The 1998 European Resuscitation Council guidelines for adult singe rescuer basic life support." in June 20, 1998 issue)(Correction Notice)
August 22, 1998... The 1998 European Resuscitation Council guidelines for adult single rescuer basic life support An error occurred in these guidelines by the Basic Life Support Working Group of the European Resuscitation Council (20 June, pp 1870-6). On p...

Effectiveness of the postcoital test: randomised controlled trial.
August 22, 1998... Introduction First introduced in 1866,[1] postcoital testing of cervical mucus for the presence of progressively motile sperm has become an important part of infertility investigations. It is used routinely in nearly haft of the...

Does moderate alcohol consumption affect fertility? Follow up study among couples planning first pregnancy.
August 22, 1998... Introduction The incidence of infertility is high and expected to increase. Intake of alcohol is a possible causal factor of public health importance as consumption is widespread and increasing in many countries. In experimental animals...

Psychological morbidity and job satisfaction in hospital consultants and junior house officers: multicentre, cross sectional survey.
August 22, 1998... Junior house officers have traditionally been the most distressed doctors in the health service.[1] Recently, however, there have been reports of significant psychological morbidity in senior doctors such as hospital consultants.[2] Previous...

The quality and stability of essential drugs in rural Zimbabwe: controlled longitudinal study.
August 22, 1998... In 1988 an alarming WHO report of substandard ergometrine injection in three developing countries[1] led to field studies on the stability of essential drugs during international transport to the tropics and to specific stability studies on...

Blood pressure and ageing: longitudinal cohort study.
August 22, 1998... Arterial blood pressure rises throughout most of life in industrialised societies.[l] In old age, however, blood pressure--especially diastolic--falls.[1] This may be because people who are included in epidemiological studies have diseases or...

Short stature and Helicobacter pylori infection in Italian children: prospective multicentre hospital based case-control study.
August 22, 1998... Helicobacter pylori is mainly acquired in childhood,[1] but the diseases associated with such infection remain unknown. Scottish and Italian schoolchildren infected with H pylori showed reduced growth in height,[2 3] and H pylori gastritis was...

Correction. (to 'Seasonal variation in coronary artery disease mortality in Hawaii: observational study,' in June 27, 1998 issue)
August 22, 1998... Seasonal variation in coronary artery disease mortality in Hawaii: observational study An authors' error occurred in this paper by Todd B Seto and colleagues (27 June, p 1946-7). The graph of variation in average temperature was incorrect....

Cohort study of plasma natriuretic peptides for identifying left ventricular systolic dysfunction in primary care.
August 22, 1998... Introduction Many studies have shown that the prognosis of patients with heart failure due to left ventricular systolic dysfunction can be improved by treatment with an angiotensin converting enzyme inhibitor? Clinical outcome in...

Assessing thrombotic risk.(Science, Medicine, and the Future.)
August 22, 1998... Venous thrombosis and venous thromboembolism are major medical problems. Because the time and scope for intervention are limited, the key to reducing the high morbidity and mortality of these conditions is prevention. Increased understanding of...

Deaths after delayed recognition of percutaneous endoscopic gastrostomy tube migration.
August 22, 1998... If early leakage around a percutaneous endoscopic gastrostomy tube occurs, stop enteric feeding immediately and perform an endoscopy as soon as possible Feeding by percutaneous endoscopic gastrostomy is an established method of maintaining...

North of England evidence based guideline development project: summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis.
August 22, 1998... This guideline addresses the appropriate use of non-steroidal anti-inflammatory drugs in the primary care treatment of patients with joint pain believed to be caused by degenerative arthritis. It does not consider therapies other than drug...

Implementing research findings in developing countries.(Getting Research Findings into Practice, part 8.)
August 22, 1998... Developing countries have limited resources, so it is particularly important to invest in health care that works. The growing number of relevant systematic reviews can assist policymakers, clinicians, and consumers in making informed decisions....

The stress: he could not face it all again.(Personal View)
August 22, 1998... Two years ago you published an article by a general practitioner who was beginning to find general practice particularly difficult and had become depressed (BMJ 1996; 313:210). That doctor was my husband. In between his writing the article and...

Science on a bad trip.(Medicine and the Media)
August 22, 1998... Colin Drummond and Hamid Ghodse argue that Sacred Weeds, a TVF production for Channel 4 on 3 August, made for tedious and arguably irresponsible viewing Take two young men to a Gothic country house. Give them a dose of the poisonous...

Candidate vaccines for Epstein-Barr virus.(Editorial)
August 15, 1998... Owing to our increased understanding of the immune variables that control Epstein-Barr virus infection, detailed planning can now be given to developing a vaccine.[1 2] Commercial and scientific considerations are likely to focus on a...

HIV and hepatitis C among injecting drug users: success in preventing HIV has not been mirrored for hepatitis C.(Editorial)
August 15, 1998... Injecting drug users have been capable of reducing their risky behaviour in the face of the HIV-AIDS epidemic.[1] To many this risk reduction, shown in numerous studies from different parts of the world, was unexpected as drug users are...

Cholesterol: how low is low enough? (Editorial)
August 15, 1998... Not so very long ago many of us did not realise the importance of cholesterol lowering in patients with coronary disease. After the World Health Organisation's clofibrate trial[1] many patients with hyperlipidaemia, with or without manifest...

Disease management in Europe: likely to grow as pressure to deliver cost effective care mounts.(Editorial)
August 15, 1998... Can healthcare providers improve the cost effectiveness of patient care by contracting out chunks to pharmaceutical companies? The evidence is equivocal, but the experiment is under way as drug companies move into chronic disease management....

Guidelines for clinical guidelines: a simple, pragmatic strategy for guideline development.(Editorial)
August 15, 1998... Clinical guidelines are systematically developed statements designed to help practitioners and patients make decisions about appropriate health care for specific circumstances.[1] Clinicians are being inundated by a tidal wave of guidelines....

Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study.
August 15, 1998... Introduction Several studies have documented high prevalence of infection with hepatitis C virus among injecting drug users, both in industrialised[1-9] and developing countries.[10-12] Although longer duration of drug use has been...

Mother to child transmission of hepatitis C virus: prospective study of risk factors and timing of infection in children born to women seronegative for HIV-1. (includes commentary)
August 15, 1998... Introduction Mother to child transmission of hepatitis C virus has been extensively studied in mothers with HIV-1 infection.[1-5] Previous reports have shown transmission rates ranging from 5.6% to 36%,[1 2 5] and the importance of...

Deliberate self-harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition.
August 15, 1998... Introduction Prevention of suicide is now included in health policy initiatives in several countries, and reduction in suicidal behaviour, both fatal and non-fatal, is part of the Health for All targets of the World Health...

An epidemiological needs assessment of carotid endarterectomy in an English health region. Is the need being met?
August 15, 1998... Introduction Stroke is the third commonest cause of death in the United Kingdom and the commonest cause of physical disability.[1] Each year 64 000 deaths (12% of all deaths) are attributed to stroke.[1] Treating and managing patients...

Why are patients being prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and precribing in the General Practice Research Database.
August 15, 1998... Introduction Dyspeptic symptoms are a common presenting complaint to general practitioners, and there is continuing debate about management.[1] Acid suppressant drugs, the most potent of which are proton pump inhibitors, are often...

Hormone replacement therapy.
August 15, 1998... The number of women who will live half their adult lives after the menopause increases every year.[1] A challenging question for doctors is how women should be counselled about postmenopausal oestrogen therapy. Methods This review is...

Yes, as long as the woman is fully informed.(Should doctors perform an elective caesarean section on request?)
August 15, 1998... Surgery is performed by doctors when they believe it is clinically justified and in accordance with accepted medical practice. In obstetrics an elective caesarean section in an uncomplicated pregnancy has traditionally been considered...

Maternal choice alone should not determine method of delivery.(Should doctors perform an elective caesarean section on request?)
August 15, 1998... The Cumberledge report, in response to the select committee report of 1992 (the Winterton report), advocated a shift of maternity services to a more woman centred approach to provide a service that is appropriate and acceptable to the...

Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings.(Getting Research Findings into Practice, part 7)
August 15, 1998... Despite the considerable amount of money spent on clinical research relatively little attention has been paid to ensuring that the findings of research are implemented in routine clinical practice.[1] There are many different types of...

Time to event (survival) data.
August 15, 1998... In many medical studies an outcome of interest is the time to an event. Such events may be adverse, such as death or recurrence of a tumour; positive, such as conception or discharge from hospital; or neutral, such as cessation of breast...

Stars disappear.(Personal View)
August 15, 1998... Why do I write? Because my mother killed herself. Twenty five years ago, one sunny autumn afternoon my father was mowing the lawn. My mother went down to the dank cellar of their Georgian house. She looped a belt around her neck, tied the other...

The changing classification and diagnosis of diabetes: new classification is based on pathogenesis, not insulin dependence.(Editorial)
August 8, 1998... At its annual meeting in June 1997 the American Diabetes Association announced the conclusions of an expert committee, which recommended changes to the way that diabetes is classified and to the choice of diagnostic method and cut off value...

Extending the benefits of breast cancer screening.(Editorial)
August 8, 1998... Ever since the implementation of the NHS breast screening programme in 1988 two important questions have been consistently raised. Should the age range of women invited be extended from the current range of 50-64 years, and should the...

The genetics of Alzheimer's disease: the number of genetic risk factors associated with the disorder is increasing steadily.(Editorial)
August 8, 1998... The genetics of Alzheimer's disease is proving to be complex and controversial. Nature Genetics this month contains a paper from Tanzi's group in Boston suggesting that a common polymorphism of [[Alpha].sub.2] macroglobulin is associated...

Minimisation: the platinum standard for trials? (Randomisation doesn't guarantee similarity of groups; minimisation does.)(Editorial)
August 8, 1998... When we have to decide which of two drugs, interventions, or management strategies is the better, the most secure evidence is generally obtained from a randomised controlled trial. The primary objective of randomisation is to ensure that all...

Staring into the abyss: walking the nuclear tightrope in south Asia: sanctions can only make things worse for the people of India and Pakistan.(Editorial)
August 8, 1998... Pokaran and Chagai, two remote wastelands in India and Pakistan, convulsed painfully under the impact of 11 nuclear explosions in May this year, as both countries overtly crossed the nuclear threshold. In the weeks that followed the...

Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study. (United Kingdom, National Health Service)
August 8, 1998... Introduction In 1988 the NHS breast screening programme, on the recommendation of an expert committee, began screening women aged 50-64 years every three years. However, the committee also concluded that the optimum frequency of...

Safety and toxicity of amphotericin B in glucose 5% or intralipid 20% in neutropenic patients with pneumonia or fever of unknown origin: randomised study.
August 8, 1998... Introduction Amphotericin B is regarded as the agent of choice for treatment of life threatening mycoses in neutropenic patients because of its broad antimycotic activity.[1] It is conventionally given intravenously in glucose 5%, as a...

Perinatal death associated with planned home birth in Australia: population based study.
August 8, 1998... Introduction Despite decades of political and academic debate the relative merits of home versus hospital birth remain unproved. This is likely to remain so. Comparisons that are sufficiently unbiased and large enough to address crucial...

Routine invitation of women aged 65-69 for breast cancer screening: results of first year of pilot study.
August 8, 1998... Evidence from Sweden shows that screening for breast cancer is as effective in reducing mortality from the disease in women aged 65-69 as it is in women aged 50-64.[1] However, although the British government's Forrest report recognised that...

Diabetes care in general practice: meta-analysis of randomised control trials.
August 8, 1998... Introduction The important and necessary involvement of general practice in diabetes care is well recognised.[1-5] Since 1970, increasing numbers of family doctors in the United Kingdom have assumed responsibility for the routine review...

Commentary: meta-analysis is a blunt and potentially misleading instrument for analysing models of service delivery.(Response to article by Simon Griffin in this issue, p. 390)
August 8, 1998... The organisation of diabetes services in the United Kingdom is currently high on both clinical and political agendas. The disease is common (and getting commoner); the variability in current standards is dramatic and unaccountable; the evidence...

Plastic surgery: recent advances.(Clinical Review)
August 8, 1998... The primary aims of plastic surgery are the restoration of appearance and function. This includes reconstruction after traumatic defects, congenital anomalies, and ablative surgery for malignancy, as well as surgery of the hand, breast surgery,...

Kabul diary.
August 8, 1998... When the charity Child Advocacy International invited the BMJ to experience aid work in war torn Kabul, I took the plunge. Tuesday 3 March: Manchester, England Aid work needs complex logistic support, and I'm greeted by workers from...

Decision analysis and the implementation of research findings.(Getting Research Findings into Preactice, part 6.)
August 8, 1998... Evidence based medicine is more than just reading the results of research and applying those results to patients because patients have particular features that may make them different from the "average" patient studied in a clinical trial.[1]...

Generalisation and extrapolation.(Statistics Notes)
August 8, 1998... All medical research is carried out on selected individuals, although the selection criteria are not always clear. The usefulness of research lies primarily in the generalisation of the findings rather than in the information gained about those...

When should a specialist retire?(Personal View)
August 8, 1998... In 1844 an editorial in the Lancet (1844;i:486-90), presumably by Thomas Wakley, excoriated the eminent William Prout as a man who had outlived his reputation and exerted a stultifying influence on progress in his field: "[H]is main...

Failed publications: the medical model.(Medicine and the Media)
August 8, 1998... Why are so many medical reports and newsletters written in pseudoscientific gobbledygook? Tim Albert considers these sad creations Next time you see a newsletter or an annual report from a distinguished medical body, look for the anodyne...

A Life Course Approach to Chronic Disease Epidemiology.
August 8, 1998... Ed Diana Kuh, Yoav Ben-Shlomo Oxford University Press, 45 [pounds sterling], pp 317 ISBN 0 19 2627821 The 20th century has seen a remarkable shift in the health of populations in industrialised countries. For example, life expectancy in...

Body Horror: Photojournalism, Catastrophe and War.
August 8, 1998... John Taylor Manchester University Press, 15.99 [pounds sterling], pp 210 ISBN 0 7190 3722 0 The thing about looking at photographs is that we have a choice of whether to engage with the event depicted or not. We may have little concept of...

Beyond conflict of interest: transparency is the key.(Editorial)
August 1, 1998... Conflict of interest is being taken more seriously by doctors and by society at large. The New England Journal of Medicine has twice recently been heavily criticised for failing to declare authors' conflicts of interest--despite its declared...

Older people with schizophrenia: providing services for a neglected group: it's the quality of their environment that matters, not where it is.(Editorial)
August 1, 1998... Schizophrenia is a severe psychiatric disorder affecting about 1% of the elderly population.[1] Symptoms include delusions and hallucinations as well as apathy, blunting or incongruity of emotional responses, and social withdrawal. Most...

How can treatment of systemic sclerosis be improved? By setting up a national database of all cases and entering patients into trials.(Editorial)
August 1, 1998... Systemic sclerosis is a rare disease (about 10 cases/1 000 000/year) with a substantially higher mortality than other autoimmune rheumatic diseases.[1] This, and an even greater morbidity, make it an unwelcome diagnosis for clinicians and a...

Sentinel node biopsy in breast cancer: a promising technoque, but it should not be introduced without proper trials.(Editorial)
August 1, 1998... The status of the axillary lymph nodes in a woman with breast cancer is the single most important prognostic factor, and important clinical decisions are based on it. In the absence of non-invasive methods, it has become routine either to...

Change at last at WHO: but will the regions play ball? (World Health Organization)(Editorial)
August 1, 1998... Dr Gro Harlem Brundtland has done what most people hoped she would. On her inauguration as director general of the World Health Organisation, she has swept away the existing secretariat (though keeping some members on as advisers), and...

New gene associated with Alzheimer's disease.
August 1, 1998... Researchers have uncovered intriguing new insights into the aetiology of the most common form of Alzheimer's disease. Most of those who succumb to Alzheimer's disease have the late onset form, and develop symptoms after the age of 60. Yet...

Operating the smokescreen.
August 1, 1998... "Haven't you sold your soul to the devil?" I ask Dr Chris Proctor, the head of science and regulation at British American Tobacco (BAT), one of the major tobacco companies. He smiles back at me. "I don't think I have, and my kids don't think I...

The "new WHO" commits to making a difference. (World Health Organization)
August 1, 1998... Dr Gro Harlem Brundtland, incoming director general of the World Health Organisation (WHO), tells Adrea Mach how her new team is applying a crisp, private sector type approach to public sector priorities Dr Gro Harlem Brundtland, Norway's own...

Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia.
August 1, 1998... Introduction Schizophrenia remains a debilitating disorder despite the development of drug treatments. Many patients continue to experience persistent positive psychotic symptoms, hallucinations, and delusions, which are disabling and...

Number needed to screen: development of a statistic for disease screening.
August 1, 1998... Introduction Too often politics, rather than evidence, dictates the national strategy for disease screening. There are too few clinical trials showing the efficacy of screening strategies.[1-4] More randomised trials are needed. In the...