Dear All, (Apologies for X posting as I am posting this message both to
Evidence based and public health lists)

Greetings from Al-Ain, the Oasis city of the Middle East. October issue of
JSCAN (a professional news letter for health professionals in our health
district) is now on line and you can access it on the WWW @

http://www.uaeu.ac.ae/jscan

If you do access the site and have a minute to spare drop us a line on your
thoughts on JSCAN which will help us to improve the news letter. Please find
below the topics covered in the October issue. Apologies for this lenghty
message.

Evidence Based Practice

Effect of needle length on incidence of local reactions to routine
immunisation in infants aged 4 months: randomised controlled trial. Diggle
L, Deeks J BMJ 2000;321:931-933.
The question: Does needle length has an effect on local reactions due to
routine immunisation in infants?
Answer in a nutshell: Use of 25 mm needles significantly reduces rates of
local reaction to routine infant immunisation. On average, for every five
infants vaccinated, use of the longer needle instead of the shorter needle
would prevent one infant from experiencing any local reaction.

Low-dose hydrochlorothiazide and preservation of bone mineral density in
older adults - A randomized, double-blind, placebo-controlled trial. LaCroix
AZ, Ott SM et al. Ann Intern Med 2000;133:516-526.
The question: What is the effect of low-dose hydrochlorothiazide treatment
on bone mineral density in healthy older adults?
Answer in a nutshell: In healthy older adults, low-dose hydrochlorothiazide
preserves bone mineral density at the hip and spine

Vertebral fracture risk with long-term corticosteroid therapy - prevalence
and relation to age, bone density, and corticosteroid use. Naganathan V,
Jones G et al.
Arch Intern Med. 2000; 160:2917-2922.
The Question: Are people on long term corticosteroids at increased risk of
vertebral fractures?
Answer in a nutshell: Long term use of steroids in combination with
increasing age is associated with a marked increase in the risk of vertebral
deformity.

Exercise and changes in health status in patients with ankylosing
spondylitis. Uhrin Z, Kuzis S et al. Arch Intern Med. 2000;160:2969-2975
The Question: How effective are unsupervised recreational and back exercises
in the treatment of ankylosing spondylitis(AS)?
Answer in a nutshell: Unsupervised recreational exercise improves pain and
stiffness, and back exercise improves pain and function in patients with AS,
but these effects differ with the duration of AS.

Travel and risk of venous thrombosis. Kraaijenhagen RA, Haverkamp D et al.
The Lancet 2000;356:28 October 2000
The Question: Is there an increased risk of deep vein thrombosis in
travelers?
Answer in a nutshell: Travel does not appears to increase the risk of deep
vein thrombosis.

Hyperhomocysteinemia is associated with the presence of retinopathy in type
2 diabetes mellitus. The Hoorn Study. Hoogeveen EK Kostense PJ. Arch Intern
Med. 2000;160:2984-2990.
The question: Is there an association between homocysteine levels and
retinopathy among subjects with and without DM?
Answer in a nutshell: Increased levels of homocysteine appears to be a risk
factor for retinopathy in patients with type 2 DM, but probably not in
patients without DM.

Pediatric restraint use in motor vehicle collisions. Reduction of deaths
without contribution to injury. Tyroch AH, Kaups KL et al. Arch Surg.
2000;135:1173-1176
The question: Does the use of pediatric restraints in automobiles reduce
mortality and do they produce any specific injury pattern as seen in adults?
Answer in a nutshell: Age-appropriate restraint devices decrease mortality
and reduce the incidence of significant injury in motor vehicle collisions
for all anatomic sites in young children. In contrast to injuries attributed
to restraint use in adults, specific restraint-related injury patterns were
not seen in children.

The validity of a sore throat score in family practice. McIsaac WJ, Goel V
et al. CMAJ 2000;163:811-5
The question: Is an explicit scoring system useful in the management of
upper respiratory tract infections and sore throat and does it lead to a
reduction in antibiotic prescriptions for these conditions?
Answer in a nutshell: An explicit clinical score approach to the management
of patients presenting with an upper respiratory tract infection and sore
throat is valid in community-based family practice and could substantially
reduce the unnecessary prescribing of antibiotics for these conditions

Systematic review of water fluoridation. McDonagh MS, Whiting PF BMJ
2000;321:855-859.
The Question: What are the benefits and side effects of fluoridation of
drinking water?
Answer in a nutshell: Though water fluoridation causes reduction in caries
levels, this beneficial effect should be considered together with the
increased prevalence of dental fluorosis. There is no clear evidence of
other potential adverse effects.

Infectious disease

Use of systemic agents in the treatment of acne vulgaris. Johnson BA, and
Nunley JR. Am Fam Physician 2000;62:1823-30,1835-6.
The question: What systemic agents are available for the treatment of acne
vulgaris?
Answer in a nutshell: Inflammatory acne requires systemic antibiotics. The
options include newer formulations of combined oral contraceptives,
antibiotics and isotretinoin.

Risk of introduction of drug-resistant malaria in a non-endemic country,
Kuwait: a real threat? Iqbal J, Sher A et al. Medical Principles and
Practice 9:2:2000, 125-130.

Upper respiratory morbidity in preschool children. A cross-sectional study.
Kværner KJ, Nafstad P et al. Arch Otolaryngol Head Neck Surg.
2000;126:1201-1206
The question: How common are upper respiratory infections in pre school
children and what are its constitutional and environmental determinants?
Answer in a nutshell: In preschool children, acute otitis media,
tonsillopharyngitis, and common cold are quite common, while chronic
rhinitis is less prevalent and strongly associated with atopic disease.
Attendance at day care centers increased the risk of upper respiratory tract
infections in this age group, although the effect appears to be weaker than
that in younger children.


Chronic disease

Periodontal disease and risk of cerebrovascular disease. The first national
health and nutrition examination survey and Its follow-up study. Wu T,
Trevisan M et al. Arch Intern Med. 2000;160:2749-2755
The Question: Is periodontal disease a risk factor for stroke?
Answer in a nutshell: Periodontal disease is an important risk factor for
total cerebrovascular accidents (CVA) and, in particular, nonhemorrhagic
stroke.

Pulse pressure and mortality in older people. Glynn RJ, Chae CU et al. Arch
Intern Med. 2000;160:2765-2772.
The question: Does pulse pressure predict mortality in the elderly?
Answer in a nutshell: Pulse pressure appears to be the best single measure
of blood pressure in predicting mortality in older people.
arterial pressure (P = .11) had no significant association with mortality.

Antipsychotic drug use and risk of first-time idiopathic venous
thromboembolism: a case-control study. Zornberg GL, Jick H. Lancet 2000;
356: 1219­23
The Question: Do conventional antipsychotic drugs increase the risk of
idiopathic venous thromboembolism?
Answer in a nutshell: Current exposure to conventional antipsychotic drugs
significantly increases the risk of idiopathic venous thromboembolism in men
and women younger than 60 years of age.

Coronary heart disease mortality among Arab and Jewish residents of
Jerusalem  Kark JD, Gordon ES et al. The Lancet 2000;356:21 October 2000

Generalized Anxiety Disorder. Michael F et al. Am Fam Physician
2000;62:1591-600,1602.
The question: Where can I find up to date information on generalized anxiety
disorder?(GAD)
Answer in a nutshell: This review from the American Family physician
provides general information on GAD and the various treatment options
available for this condition.

Decreased prevalence of Alzheimer Disease associated With
3-Hydroxy-3-Methyglutaryl Coenzyme A reductase inhibitors. Wolozin B,
Kellman W et al. Arch Neurol. 2000;57:1439-1443
The question: Is there an association between prevalence of Alzheimer's
disease(AD) and the consumption of 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitors (statins)?
Answer in a nutshell: The prevalence of AD is lower in patients taking 2
different 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors -
lovastatin and pravastatin.

Money Matters

Cost-Effectiveness of colonoscopy in screening for colorectal cancer.
Sonnenberg A, Delc F, Inadomi JM et al. Ann Intern Med 2000;133:573-584
The Question: Is screening by colonoscopy a cost-effective measure in
reducing mortality due to colorectal cancer?
Answer in a nutshell: Colonoscopy screening represents a cost-effective
means of screening for colorectal cancer because it reduces mortality at
relatively low incremental costs. Low compliance rates render colonoscopy
every 10 years the most cost-effective primary screening strategy for
colorectal cancer.

Effectiveness and cost-benefit of influenza vaccination of healthy working
adults. A randomized controlled trial. Bridges CB, Thompson WW et al. JAMA
2000; 284: 1655-1663.
The Question: What is the effectiveness and cost benefit of influenza
vaccine in preventing influenza like illness (ILI) and reducing societal
costs of ILI among healthy working adults?
Answer in a nutshell: Influenza vaccination of healthy working adults
younger than 65 years can reduce the rates of ILI, lost workdays, and
physician visits during years when the vaccine and circulating viruses are
similar, but vaccination may not provide overall economic benefits in most
years.

Cost-effectiveness of screening for colorectal cancer in the general
population. Frazier LA, Colditz GA et al. JAMA. 2000;284:1954-1961.
The Question: What are the consequences, costs, and cost-effectiveness of
colorectal cancer (CRC) screening in average-risk individuals?
Answer in a nutshell: Screening for CRC, even in the setting of imperfect
compliance, significantly reduces CRC mortality at costs comparable to other
cancer screening procedures.

Health Services Research

Effectiveness of a hospital-wide programme to improve compliance with hand
hygiene. Pittet D, Hugonnet S et al and members of the Infection Control
Programme. Lancet 2000; 356: 1307-12.
The question: Does a hospital wide hand hygiene promotion programme have an
impact on nosocomial infection rates in the hospital?
Answer in a nutshell: The hygiene promotion campaign produced a sustained
improvement in compliance with hand hygiene, coinciding with a reduction of
nosocomial infections and MRSA transmission.

Improving quality or shifting diagnoses? What happens when antibiotic
prescribing is reduced for acute bronchitis? Hueston WJ, Slott K. Arch Fam
Med. 2000;9:933-935.
The question: Does diagnostic shifting occurs when antibiotic prescription
for acute bronchitis decreases?
Answer in a nutshell: When antibiotic prescriptions for acute bronchitis
decreases physicians do not shift their diagnoses.

Women's Health

Planned caesarean section versus planned vaginal birth for breech
presentation at term: a randomised multicentre trial Hannah ME, Hannah WJ et
al for the Term Breech Trial Collaborative Group. Lancet 2000; 356: 1375-83.
The Question: Is planned caesarean section better as compared to planned
vaginal birth for selected breech-presentation pregnancies?
Answer in a nutshell: Planned caesarean section is better than planned
vaginal birth for the term fetus in the breech presentation as shown by the
significantly lower perinatal mortality, neonatal mortality, or serious
neonatal morbidity in the planned caesarean section group.

A comparison of Glyburide and insulin in women with gestational diabetes
mellitus. Langer O, Conway DL et al. N Engl J Med 2000;343:1134-8
The question: How effective is the sulfonylurea drug Glyburide in women with
gestational diabetes?
Answer in a nutshell: In women with gestational diabetes, Glyburide is a
clinically effective alternative to insulin therapy.

Adolescent Health

Health-Compromising behaviors: Why do adolescents smoke or drink?
Identifying underlying risk and protective factors. Simantov E, Schoen C et
al. Arch Pediatr Adolesc Med. 2000;154:1025-1033
The question: What ate the motivational, protective and risk factors
associated with smoking and drinking behaviors of adolescent Americans?
Answer in a nutshell: History of abuse, family violence, depressive
symptoms, and stressful life events seems to be related to smoking and
drinking behavior in adolescence Americans though this relation ship differs
by sex of the subjects.

Medical Education

Teaching resuscitation to pediatric residents. The effects of an
intervention. Nadel FM, Lavelle JM et al. Arch Pediatr Adolesc Med.
2000;154:1049-1054
The question: Does an educational intervention leads to improvement in
knowledge, skills, confidence and performance among pediatric residents?
Answer in a nutshell: A structured, formal curriculum improves the necessary
fund of knowledge, skills, confidence, and leadership among these residents.

Miscellaneous

Religion, spirituality, and medicine: Application to clinical practice.
Koenig HG, MSJAMA Vol 284, p 1708, October 4, 2000

Update in Gastroenterology. Greenberger NJ. Ann Intern Med 2000;133:542-548.

Smokers' Corner

Smoking is related to albuminuria and abnormal renal function in nondiabetic
persons. Pinto-Sietsma SJ, Mulder J et al. Ann Intern Med 2000;133:585-591.
The Question: Is smoking associated with albuminuria and abnormal renal
function in nondiabetics?
Answer in a nutshell: In nondiabetics smoking is associated with albuminuria
and abnormal renal function though these associations are less pronounced or
absent in former smokers.

Irish take world's toughest stance on tobacco. Birchard K Lancet 2000;356,
07 October 2000.

From the pages of Bandolier
http://www.jr2.ox.ac.uk/Bandolier/band80/b80-4.html
Skull X-ray for mild head injury? (PA Hofman PA, Nelemans P et al.  Value of
radiological diagnosis of skull fracture in the management of mild head
injury: meta-analysis. J Neurol Neurosurg Psychiatry 2000 68: 416-422)

News from the region

Economic sanctions and public health: the case of Iraq. We have a duty to
speak out. Wareham SJ MJA 2000; 173: 438-439.

From Oman
According to WHO Oman notified at the end of October 2000 one imported
non-fatal case of cholera with onset on 1 Aug 2000 (which should have been
notified to WHO within 24 hours).

For your patients

Here is an excellent patient information sheet on influenza. Full free text
access is available @
http://jama.ama-assn.org/issues/v284n13/fpdf/jpg1004.pdf

This leaflet explains about the general anxiety disorder (GAD) using a
question and answer format. Free access to the leaflet is available @
http://www.aafp.org/afp/20001001/1602ph.html

Web Watch

http://www.visitingours.com/
http://www.britishairways.com/health/
www.firstgov.gov
http://home.clara.net/sisa/
www.caprostate.com
www.healthypalmpilot.com
http://www.drinet.com

Software watch

This time we present a software in this section. JSCAN is always on the look
out for simple, user-friendly, well-supported and economical software to
recommend to its readers. StatsDirect a statistical software developed by a
clinician satisfies all the criteria that we were looking for.It is
available free for 10days for you to try out and explore what it offers from
http://www.statsdirect.com.
You can also read the full JAMA review on StatsDirect @
http://jama.ama-assn.org/issues/v284n15/ffull/jbk1018-4.html.

Cheers and warm regards,

Dr.P.Badrinath M.D.,M.Phil(Epid).,PhD(Cantab),
Clinical Assistant Professor & Epidemiologist,
Department of Community Medicine,
Faculty of Medicine & Health Sciences,
UAE University, Po Box 17666, Al-Ain,
United Arab Emirates.
Tel: ++ 971 3 7039652
Fax: ++ 971 3 7672022
[log in to unmask]

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