(Apologies for X postings if you are a member of both EBH and Public Health
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Dear All,
Greetings from Al-Ain, the oasis city of the Middle East. The April issue of
JSCAN (monthly news letter for health professionals in our District) is now
on line and can be accessed @
http://www.uaeu.ac.ae/jscan
You can also download the news letter as a PDF file from the site above.The
list below describes the contents of this issue. If you access the site
please feel free to send your feed back as we greatly value your views and
comments. It is your comments and feed back that justifies the continued
existence of JSCAN.
Cheers and warm regards,
Badri
>From the Editor's desk:
We all need friends and strong social networks. According to a
community-based study published in the Lancet featuring in this issue of
JSCAN, social networks can also protect us from dementia. JSCAN also brings
you the latest on the unfolding mystery of unexplained illness among drug
abusers in Scotland. Please note! JSCAN will be conducting its second annual
survey next month. Survey forms will be sent out with the May issue and the
same will also be available from our website. Please spare a minute or two
and fill in the form as the continuation of JSCAN will depend on your feed
back.
Evidence Based Practice
The Question: Does low dose aspirin protect against pulmonary embolism and
deep vein thrombosis in high risk patients?
Answer in a nutshell: Aspirin reduces the risk of pulmonary embolism and
deep-vein thrombosis by at least a third in high risk groups.
Prevention of pulmonary embolism and deep vein thrombosis with low dose
aspirin: Pulmonary Embolism Prevention (PEP) trial. Pulmonary Embolism
Prevention (PEP) Trial Collaborative Group. Lancet 2000; 355: 1295 - 1302.
The question: Does poor or limited availability of social networks increase
one's risk of getting dementia?
Answer in a nutshell: A poor or limited social network increases the risk of
dementia by up to 60%.
Influence of social network on occurrence of dementia: a community-based
longitudinal study. Fratiglioni L, Wang HX et al. Lancet 2000; 355:1315-19.
The Question: Is there a relation between cumulative inhaled corticosteroid
use and bone-mineral density at the lumbar spine?
Answer in a nutshell: There exists a negative association between cumulative
dose of inhaled corticosteroid and bone-mineral density at the lumbar spine
(L2-L4), femoral neck, Ward's triangle, and trochanter.
Inhaled corticosteroid use and bone-mineral density in patients with asthma.
Wong CA, Walsh LJ et al. Lancet 2000; 355: 1399-403
The Question: What are the symptoms attributed to teething in healthy
infants and can tooth emergence be predicted from an infant's symptoms?
Answer in a nutshell: In this prospective study increased biting, drooling,
gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, and facial
rash, decreased appetite for solid foods, and mild temperature elevation
were all statistically associated with teething; by contrast congestion,
sleep disturbance, stool looseness, increased stool number, decreased
appetite for liquids, cough, rashes other than facial rashes, fever over
102°F, and vomiting were not significantly associated with tooth emergence.
It may not be possible to predict tooth emergence from the child's symptoms.
Symptoms associated with infant teething: a prospective study. Macknin ML,
Piedmonte M et al. Pediatrics 2000;105:747-752.
The Question: Does newborn circumcision reduce the incidence, morbidity, and
medical costs of UTI during the first year of life?
Answer in a nutshell: Newborn circumcision results in a 9.1-fold decrease in
incidence of UTI during the first year of life as well as markedly lower
UTI-related medical costs and rate of hospital admissions.
Newborn circumcision decreases incidence and costs of urinary tract
infections during the first year of life. Schoen EJ, Colby CJ et al.
Pediatrics 2000;105:789-793
The Question: What is the level of agreement between temperatures measured
at the axilla and at the rectum in children and young people?
Answer in a nutshell: The difference between temperature readings at the
axilla and rectum using either mercury or electronic thermometers showed
wide variation across studies in this systematic review of 20 studies. This
may be important in clinical situations where temperature needs to be
measured with precision.
Temperature measured at the axilla compared with rectum in children and
young people: systematic review. Craig JV, Lancaster GA et al. BMJ
2000;320:1174-1178.
The Question: What are the effects of walnuts on serum lipid levels and
low-density lipoprotein (LDL) oxidizability in free-living
hypercholesterolemic persons?
Answer in a nutshell: Substituting walnuts for part of the monounsaturated
fat in a cholesterol-lowering Mediterranean diet further reduces total and
LDL cholesterol levels in men and women with hypercholesterolemia.
Substituting walnuts for monounsaturated fat improves the serum lipid
profile of hypercholesterolemic men and women: a randomized crossover trial.
Zambón D, Sabaté J et al. Ann Intern Med. 2000;132:538-546.
The Question:
When should one see a callus on a follow-up radiograph of a fracture?
>From the pages of Archives of Family Medicine - SOAP
Follow-up radiographs to detect callus formation after fractures. McKinley,
DW, Chambliss L.
The Question: Is there an association between ascorbic acid status and gall
bladder disease in humans?
Answer in a nutshell: Serum ascorbic acid levels are inversely related to
prevalence of clinical and asymptomatic gallbladder disease among women, but
not among men. In women, each SD (27µmol/L) increase in serum ascorbic acid
level is independently associated with a 13% lower prevalence of clinical
gallbladder disease and asymptomatic gallstones.
Serum ascorbic acid and gallbladder disease prevalence among US adults. The
Third National Health and Nutrition Examination Survey (NHANES III). Simon
JA, Hudes ES et al. Arch Intern Med. 2000;160:931-936.
The Question: Does treatment of diastolic hypertension with beta-blocker
propranolol lead to impaired cognitive function, increased depressive
symptoms, or worsened sexual function as compared to placebo?
Answer in a nutshell: Treatment of hypertension with propranolol has limited
adverse effects on tests of cognitive function (which may not be clinically
significant), and there are no documented adverse effects on depressive
symptoms or sexual function in those on the drug as compared to the placebo
group.
The effects of propranolol on cognitive function and quality of life: a
randomized trial among patients with diastolic hypertension. Pérez-Stable
EJ, Halliday R et al. Am J Med 2000;108:359-65.
The Question: What is the frequency of sedation of second generation
antihistamines: loratadine, cetirizine, fexofenadine, and acrivastine
reported in post-marketing surveillance studies?
Answer in a nutshell: The risk of sedation was low with all four drugs but
fexofenadine and loratadine have the lowest sedation effects among the four
drugs.
Sedation with "non-sedating" antihistamines: four prescription-event
monitoring studies in general practice. Mann RD, Pearce GL et al. BMJ
2000;320:1184-1187
The Question: How accurate are patient history, wheezing, laryngeal height,
and laryngeal descent in the diagnosis of obstructive air way disease(OAD) ?
Answer in a nutshell: Smoking for more than 40 pack-years, self-reported
history of chronic OAD, maximum laryngeal height of at least 4 cm, and age
at least 45 years were significantly associated with OAD and patients having
all 4 findings had a likelihood ratio (LR) of 220 ruling in OAD; those with
none had an LR of 0.13, ruling out OAD.
The accuracy of patient history, wheezing, and laryngeal measurements in
diagnosing Obstructive Airway Disease. Straus SE, McAlister FA, Sackett DL
for the CARE-COAD1 Group. JAMA. 2000;283:1853-1857.
The Question: What is the effect of smoking cessation on mortality after
myocardial infarction?
Answer in a nutshell: In this meta-analysis, the combined odds ratio based
on a random effects model for death after myocardial infarction in those who
quit smoking was 0.54. Relative risk reductions across studies ranged from
15% to 61%. with a significant decrease in mortality.
Effect of smoking cessation on mortality after myocardial infarction:
meta-analysis of cohort studies. Wilson K, Gibson N et al. Arch Intern Med.
2000;160:939-944.
Health Services Research
The Question: What is the incidence of failure to hospitalize patients
presenting to the emergency department with acute cardiac ischemia and what
are the factors related to inadvertent discharge of these patients from the
emergency department?
Answer in a nutshell: Just over 2% of patients with cardiac ischemia
attending the emergency department are inadvertently sent home and the
factors associated with non admission are being a woman less than 55 years
old, nonwhite, reporting shortness of breath as the chief symptom and having
a normal or nondiagnostic electrocardiogram.
Missed diagnoses of acute cardiac ischemia in the emergency department. Pope
JH, Aufderheide TP et al. N Engl J Med 2000;342:1163-70.
The Question: Can judicious use of antibiotic policy for children with
respiratory tract infections (RTI) be adopted in private pediatric practice
without observing an increase in return office visits or in the rate of
bacterial infections that might follow?
Answer in a nutshell: In this busy American pediatric private practice, more
than 75% of the children presenting with an RTI did not have a presumed or
proven bacterial infection and were not prescribed antibiotics. These
children did not have a higher rate of return clinic visits or an increase
in bacterial infections.
Outcomes after judicious antibiotic use for respiratory tract infections
seen in a private pediatric practice. Pichichero ME, Green JL et al.
Pediatrics 2000;105: 753-759
The Question: What is the incidence of hospital admissions due to adverse
reactions and what drugs are commonly associated with these reaction?
Answer in a nut shell: In French public hospitals, the incidence is just
over 3% and the drugs commonly associated with adverse reaction admissions
are non-steroidal anti-inflammatory drugs, anticoagulant drugs, cardiac
stimulants, antiarrhythmic drugs, antineoplastic drugs, and antihypertensive
drugs.
Admissions to hospital caused by adverse drug reactions: cross sectional
incidence study. Pouyanne P, Haramburu F et al. BMJ 2000;320:1036
The Question: How effective is the organized system of trauma care in
reducing crash mortality?
Answer in a nutshell: Ten years after implementation of an organized system
of trauma care, crash mortality fell by 8% after adjusting for other
factors such as introduction safety laws.
The effect of organized systems of trauma care on motor vehicle crash
mortality. Nathens AB, Jurkovich GJ et al. JAMA. 2000;283:1990-1994.
Infectious diseases
An outbreak of hepatitis B associated with reusable subdermal
electroencephalogram electrodes. Hepatitis B Outbreak Investigation Team.
CMAJ 2000;162:1127-31.
Chronic diseases
The Question: What is the mortality risk associated with raised blood
pressure in young adulthood?
Answer in a nutshell: Systolic and diastolic blood pressure in young
adulthood is associated with risk of subsequent coronary heart disease and
cardiovascular disease mortality in later years though the association is
not statistically significant for diastolic blood pressure. Stroke mortality
is strongly associated with raised diastolic blood pressure.
Blood pressure in young adulthood and mortality from cardiovascular disease.
McCarron P, Smith GD et al. Lancet 2000; 355: 1430 - 1431.
The Question: Is there an association between daily airborne pollen
concentrations and daily death rates?
Answer in a nutshell: In this time series analysis from Netherlands daily
concentrations of Poaceae pollen was associated with deaths due to chronic
obstructive pulmonary disease (COPD) and pneumonia
Relation between airborne pollen concentrations and daily cardiovascular and
respiratory-disease mortality. Brunekreef B, Hoek G et al. Lancet 2000;
355: 1517 - 1518.
The Question: Where can I find a summary of evidence linking overweight and
obesity with morbidity and mortality?
Answer in a nutshell: This report by the National Task Force on the
Prevention and Treatment of Obesity reviews briefly the evidence linking
overweight and obesity with morbidity and mortality for a wide variety of
health conditions. This report also further presents the evidence on the
effect of intentional weight loss on mortality and morbidity.
Overweight, Obesity, and Health Risk. National Task Force on the Prevention
and Treatment of Obesity. Arch Intern Med. 2000;160:898-904
News from the Region
SANA'A Women's rights, a tourist boom, and the power of khat in Yemen.
Kandela P. Lancet 2000; 355: 1437-1440.
>From the Pages of Bandolier
The Question: Are breast implants safe?
Smokers' corner
Tobacco industry efforts subverting International Agency for Research on
cancer's second-hand smoke study. Ong EK, Glantz SA. Lancet 2000; 355:
1253-59
Diseases & Diagnostics making news
Meningitis cases in pilgrims returning from Haj
Serious unexplained illness among drug injectors in Scotland:
National health alert issued over legionnaires outbreak in Australia
For your patients:
Shingles: What is shingles, and who can get it?
Nightmares are scary dreams
Health diet sheet
Drug watch:
Association of venous thromboembolism and clozapine. Hägg S, Spigset O,
Söderström TG. Lancet 2000; 355: 1155 - 1156
Immune complex haemolytic anaemia associated with sulfasalazine. Teplitsky
V, Virag I et al. BMJ 2000;320:1113.
WEBWATCH
http://www.cma.ca/cpgs/index.asp
http://www.cdc.gov/ncidod/diseases/hepatitis/spotlight.htm
http://www.public.iastate.edu/~CYBERSTACKS/JAS.htm#Medicine
www.fitfortravel.scot.nhs.uk
http://medlineplus.adam.com/
Book Watch
Publishing your medical research paper: What they don't teach you in medical
school. by Daniel W. Byrne, 298 pp, with illustrations, $23.95, ISBN
0-683-30074-1, Baltimore, Md, Williams & Wilkins, 1998.
What U Say
Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)
Assistant Professor and Epidemiologist,
Department of Community Medicine,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates.
Tel: 00 971 3 7039 652
Fax: 00 971 3 7672022.
[log in to unmask]
If you are looking for a self taught tutorial on EBM you may find this site
useful.
http://www.geocities.com/badrishanthi/ebmfujairah
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