Dear All,

Seasons greetings from Al-Ain, the oasis city of the Middle East. The
November issue of JSCAN (a news letter for health professionals with an
emphasis on evidence based practice) is now on line. You can read it either
on line or down load it as a PDF document. As always we welcome your
comments and suggestions which will appear in the coming issue. Please find
below the topics covered in this issue.

You can access JSCAN @ http://www.uaeu.ac.ae/jscan

Cheers and warm regards,

Badri

Evidence based practice

Antibody concentration and clinical protection after Hib conjugate
vaccination in the United Kingdom. Heath PT, Booy R et al. JAMA.
2000;284:2334-2340
The Question: What is the long-term clinical protection against Hib disease
and Hib antibody concentrations following primary Hib vaccination without a
booster dose?
Answer in a nutshell: Results from the UK suggest that anti-PRP antibody
levels and clinical protection against Hib disease wane over time after Hib
vaccination at 2, 3, and 4 months of age without a booster dose at 2 years
of age. However the decline in clinical protection is minimal, suggesting
that a booster dose of Hib vaccine following infant vaccination is not
essential.

Effectiveness of pseudoephedrine plus acetaminophen for treatment of
symptoms attributed to the paranasal sinuses associated with the common
cold.  Sperber SJ, Turner RB et al. Arch Fam Med. 2000;9:979-985
The Question: How efficacious is the combination of pseudoephedrine
hydrochloride with acetaminophen for the treatment of early symptoms during
colds, which are attributed by the patient to the sinuses?
Answer in a nutshell: The results of a controlled study suggest that
pseudoephedrine plus acetaminophen is effective for relief of symptoms
attributable to the paranasal sinuses that may develop early in the course
of a cold.


Rofecoxib, a new Cyclooxygenase 2 inhibitor, shows sustained efficacy,
comparable with other nonsteroidal anti-inflammatory drugs - A 6-Week and a
1-year trial in patients with osteoarthritis. Saag K, Ven der Heijde D et al
for the Osteoarthritis Studies Group. Arch Fam Med. 2000;9:1124-1134
The Question: What is the efficacy and safety of rofecoxib in treating
osteoarthritis (OA)?
Answer in a nutshell: Rofecoxib is effective in treating OA with once-daily
dosing for 6 weeks and 1 year. Rofecoxib was generally safe and well
tolerated in OA patients for 6 weeks and 1 year.

A randomized crossover study of silver-coated urinary catheters in
hospitalized patients. Karchmer TB, Giannetta ET et al. Arch Intern Med.
2000;160:3294-3298
The Question: How effective is the silver-alloy, hydrogel-coated latex
urinary catheter in preventing nosocomial catheter-associated Urinary tract
infections (UTIs)?
Answer in a nutshell: The risk of infection is reduced by 20 to 30% when the
more expensive silver-coated catheters are used and they also appear to
offer cost savings by preventing excess hospital costs from nosocomial UTI
associated with catheter use.

Can urine clarity exclude the diagnosis of urinary tract infection? Bulloch
B, Bausher JC et al. Pediatrics Vol. 106 No. 5 November 2000, p. e60
The Question: How does clear urine by visual inspection compares with
standard urinalysis in establishing the absence of significant bacteruria?
Answer in a nutshell: Though clear urine on visual inspection cannot
completely eliminate the possibility that a child has a urinary tract
infection, since it is a reproducible test offering the advantages of being
simple, fast, and inexpensive, this test should be considered as a
reasonable and relatively effective bedside screen for the presence of a
urinary tract infection.

A randomized, double-blind, placebo-controlled study of Sumatriptan nasal
spray in the treatment of acute migraine in adolescents.  Winner P, Rothner
AD et al. Pediatrics Vol. 106 No. 5 November 2000, pp. 989-997.
The Question: What is the efficacy and tolerability of sumatriptan nasal
spray (NS; 5 mg, 10 mg, and 20 mg) as compared to placebo for the treatment
of acute migraine in adolescents?
Answer in a nutshell: Sumatriptan NS is effective and well-tolerated for the
treatment of acute migraine in adolescents, with the 20-mg dose providing
the best overall efficacy and tolerability profiles.

Use of coping strategies and breast cancer survival: results from the
black/white Cancer Survival Study.  Reynolds P, Hurley S et al. Am J
Epidemiol 2000;152:940-9.
The Question: Does coping strategies influence survival in women with breast
cancer?
Answer in a nutshell: Emotion-focused coping strategies are significantly
associated with survival. Expression of emotion is associated with better
survival. Also perceived emotional support appears to increase  survival in
patients with breast cancer.

Risk of gastrointestinal haemorrhage with long term use of aspirin:
meta-analysis. Derry S, Loke YK BMJ 2000;321:1183-1187
The Question: What is the incidence incidence of gastrointestinal
haemorrhage associated with long term aspirin therapy and what is the effect
of dose reduction and formulation on the incidence of such haemorrhage?
Answer in a nutshell: Long term therapy with aspirin is associated with a
significant increase in the incidence of gastrointestinal haemorrhage and
there is no evidence to show that reducing the dose or using modified
release formulations would lower the incidence of gastrointestinal
haemorrhage.

Maternal morbidity and mortality associated with interpregnancy interval:
cross sectional study. Conde-Agudelo A, Belizán JM BMJ 2000;321:1255-1259.
The Question: What is the impact of interpregnancy interval on maternal
morbidity and mortality.
Answer in a nutshell: Interpregnancy intervals less than 6 months and longer
than 59 months are associated with an increased risk of adverse maternal
outcomes.

Risk of secondary meningococcal disease in health-care workers Gilmore A,
Stuart J et al. Lancet 2000; 356:11 November 2000.
The Question: What is the risk of meningococcal disease secondary infection
in health care workers?
Answer in a nutshell: The excess risk of meningococcal disease in health
care workers is small and inappropriate use of prophylactic antibiotics
should be avoided.

Lack of correlation between psychological factors and subclinical coronary
artery disease. O'Malley PG, Jones DL et al. N Engl J Med 2000;343:1298-304
The Question: Is there a relation between psychological variables and
subclinical coronary artery disease?
Answer in a nutshell: Data from studies on US army personnel suggest that
depression, anxiety, hostility, and stress are not related to
coronary-artery calcification and somatization is associated with the
absence of calcification.


The effect of fecal occult-blood screening on the Incidence of colorectal
cancer Mandel JS, Church TR et al. N Engl J Med 2000;343:1603-7
The Question: What is the effect of screening on the incidence of colorectal
cancer?
Answer in a nutshell: Data from a prospective study from the Minnesota Colon
Cancer Control shows that the use of either annual or biennial fecal
occult-blood testing significantly reduces the incidence of colorectal
cancer.

Health services research

A survey of primary care physician practice patterns and adherence to acute
low back problem guidelines. Di lorio D, Henley E et al. Arch Fam Med.
2000;9:1015-1021
The Question: How do primary care physicians in the US manage low back pain
in adults and how far do they adhere to published guidelines?
Answer in a nutshell: The management of patients with acute low back
problems by primary care physicians differs significantly from published
guideline recommendations in several key areas that include awareness of red
flags, use of medication, use of radiographic studies, the need for patient
education, and the use of physical modalities.

Quality improvement initiative and its impact on the management of patients
with acute myocardial infarction. Mehta RH, Das S et al. Arch Intern Med.
2000;160:3057-3062.
The Question: Does a quality improvement initiative in a health care
institution leads to appropriate management of acute myocardial infarction?
Answer in a nutshell: Implementation of a quality improvement program was
associated with a high adherence to quality-of-care indicators for AMI

Chronic diseases

Decade-Long trends and factors associated with time to hospital presentation
in patients with acute myocardial infarction - The Worcester Heart Attack
Study  Goldberg RJ, Yarzebski J et al. Arch Intern Med. 2000;160:3217-3223.
The Question: What are the factors associated with delayed presentation to
hospitals of patients with myocardial infarction?
Answer in a nutshell: Increasing age, history of angina or diabetes, onset
of symptoms in the afternoon or evening, and hospitalization in the most
recent study year were significantly associated with delays of more than 2
hours in seeking hospital care in patients with myocardial infarction.

Serum folate and cardiovascular disease mortality among US men and women
Loria CM, Ingram DD et al. Arch Intern Med. 2000;160:3258-3262
The Question: What is the relation between serum folate and cardiovascular
mortality?
Answer in a nutshell: Low serum folate concentrations are associated with an
increased risk of CVD mortality among adults who do not have diabetes.

Vitamin supplement use and incident cataracts in a population-based study.
Mares-Perlman JA, Lyle BJ et al. Arch Ophthalmol. 2000;118:1556-1563
The Question: Is there an association between vitamin supplement use and the
incidence of nuclear, cortical, and posterior subcapsular cataract?
Answer in a nutshell: Data from the Beaver Dam Eye Study cohort suggest a
lower risk of cataract among users of vitamin supplements and a stronger
associations with long-term use.

Epidemiological evidence on health risks of cellular telephones Kenneth J
Rothman Lancet 2000; 356:1837-40.
The Question: Where can I find the current epidemiological evidence on
health risks of cellular phones?
Answer in a nutshell: According to this review in the Lancet by renowned
epidemiologist Rothman there is no clear evidence of an association with
cellular phone use and brain tumours or other malignancies.

Medical EDucation

Research training in six selected internal medicine fellowship programs.
Whitcomb ME, Walter DL. Ann Intern Med 2000;133:800-807
The Question: What is the current status of research training in sub
specialty programs in the US and what are the opportunities for research
fellows?
Answer in a nutshell: In the United States only few internal medicine
subspecialty programs are currently designed to provide adequate research
training as defined by the Institute of Medicine and the American Board of
Internal Medicine (ABIM) and opportunities for research fellows are limited
in programs offered by teaching hospitals.

Validity of final examinations in undergraduate medical training  der
Vleuten CV, BMJ 2000;321:1217-1219.
The Question: How valid are final examinations in undergraduate medical
training?
Answer in a nutshell: According to this review in the BMJ final examinations
are of questionable reliability and validity and are of limited educational
value to students because there is little opportunity for feedback and
correction

Policies on faculty conflicts of interest at US Universities. Cho MK,
Shohara R et al. JAMA. 2000;284:2203-2208.
The Question: How comprehensive and comparable are the conflict of interest
policies of major biomedical research institutions in the United States?
Answer in a nutshell: There were wide variations in the content of the
conflict of interest policies across institutions in the United States. Most
policies on conflict of interest of major research institutions lacked
specificity about the kinds of relationships with industry that are
permitted or prohibited.

From the pages of Bandolier

N-acetylcysteine in chronic bronchitis
http://www.jr2.ox.ac.uk/Bandolier/band81/b81-2.html

Money Matters

Cost for inpatient care of venous thrombosis - A trial of Enoxaparin vs
standard heparin. De Lissovoy G, Yusen RD et al. Arch Intern Med.
2000;160:3160-3165
The Question: Is treating venous thrombosis patients with Enoxaparin cheaper
as compared to treating with heparin?
Answer in a nutshell: A cost minimization analysis showed that there is no
significant difference in the overall cost for the 3-month episode of care
for venous thrombosis patients treated with either enoxaparin or
unfractionated heparin.

Adoloscent/Paediatric health

Beverage choices affect adequacy of children's nutrient intakes. Ballew C,
Kuester S et al. Arch Pediatr Adolesc Med. 2000;154:1148-1152
The Question: What is the relationship between beverage choices and the
adequacy of nutrient intakes among children and adolescents?
Answer in a nutshell: Beverage choice have a significant effect on the
nutrient adequacy of the diets of children and adolescents with milk and
juice positively influencing and carbonated drinks negatively influencing
the choices of food and nutrient in take.

The undescended testicle: Diagnosis and management. Docimo SG, Silver RI et
al. Am Fam Physician 2000;62:2037-44,2047-8.
The Question: Where can I find an update on the diagnosis and management of
undescended testicles?
Answer in a nutshell: This review in the American Family Physician provides
the current concepts on the early diagnosis and management of undescended
testicles.

Women's health

Maternal hemoglobin concentration during pregnancy and risk of stillbirth.
Stephansson O, Dickman PW et al.  JAMA. 2000;284:2611-2617.
The Question: Is there an association between hemoglobin concentration at
first measurement during antenatal care, change in hemoglobin concentration
during pregnancy and risk of stillbirth?
Answer in a nutshell: High hemoglobin concentration at first measurement
during antenatal care appears to be associated with increased risk of
stillbirth, especially preterm and SGA antepartum stillbirths.

How many women lose bone mineral density while taking hormone replacement
therapy? Results from the postmenopausal estrogen/progestin interventions
trial Greendale A, Wells B et al for the Postmenopausal Estrogen/Progestin
Interventions Trial Investigators. Arch Intern Med. 2000;160:3065-3071
The Question: How frequent is the bone loss among women using postmenopausal
hormone therapy?
Answer in a nutshell: The Postmenopausal Estrogen/Progestin Interventions
Trial found that bone loss in women while taking postmenopausal hormones is
rare.

Association of diet with the onset of menopause in Japanese women. Nagata C,
Naoyoshi T et al. Am J Epidemiol 2000;152:863-7.
The Question: Is there an association between diet and the on set of
menopause in Japanese women?
Answer in a nutshell: In Japanese women there appears to be an inverse
association, with green and yellow vegetable intake and the onset of
menopause.

Infectious diseases

Clinical signs and symptoms predicting influenza infection. Monto AS,
Gravenstein S et al. Arch Intern Med. 2000;160:3243-3247
The Question: Which clinical signs and symptoms are most predictive of
influenza infection in patients with influenza like illness?
Answer in a nutshell: When influenza is circulating within the community,
cough and fever within 48 hours of symptom onset is most likely to predict
influenza.

Coping with Legionella CMAJ 2000;163:1336
The Question: Where can I find information on Legioner's disease?
Answer in a nutshell: The following review in the CMAJ provides information
on the background, aetiology and prevention strategies for Legioner's
disease.

Bovine Spongiform Encephalopathy and Variant Creutzfeldt-Jakob disease:
Background, evolution, and current concerns. Brown P, Will RG et al.
Emerging infectious diseases Vol. 6, No. 6 Nov-Dec 2000.
The Question: Where can I find an update on the ongoing BSE crisis?
Answer in a nutshell: This online review in the Emerging infectious diseases
provides comprehensive information on the history, major mile stones on the
evolving epidemic and fifty references with useful links.

Miscellaneous

"Is there a doctor on the aircraft?" Top 10 in-flight medical emergencies.
Dowdall N BMJ 2000;321:1336-1337.
The Question: What are the common medical emergencies in an aircraft?
Answer in a nutshell: The common medical emergencies encountered on board of
an aircraft include gastrointestinal, cardiac, neurological, vasovagal,
respiratory, ENT and infectious disease problems and this review elaborates
further on the standard and range of equipment and drugs available on board.

Prevalence and nature of orofacial and dental problems in family medicine.
Lockhart PB, Mason DK et al. Arch Fam Med. 2000;9:1009-1012
The Question: What is the prevalence and nature of orofacial and dental
problems in patients presenting to general practitioners in the US?
Answer in a nutshell: Dental problems appears to common in patients visiting
general practitioners as 1 in 5 visit their doctors for dental or orofacial
reasons. The commoners once include perioral pain and mucosal ulcerations.

Smokers corner

Association between cigarette smoking and anxiety disorders during
adolescence and early adulthood. Johnson JG, Cohen P et al. JAMA.
2000;284:2348-2351.
The Question: Is there an association between cigarette smoking and anxiety
disorders among adolescents and young adults?
Answer in a nutshell: Longitudinal data from the US suggest that cigarette
smoking may increase risk of certain anxiety disorders during late
adolescence and early adulthood.

News from the region

RVF Strikes the Middle East. Rebecca Voelker
http://jama.ama-assn.org/issues/v284n18/ffull/jwm00009-1.html

Update on the Outbreak of Rift Valley Fever in Yemen, August-October 2000
http://www.cdc.gov/mmwr//preview/mmwrhtml/mm4947a3.htm

For your patients

Migraine headache
This leaflet on migraine covers various areas concerning migraine. These
include triggers of a migraine headache, what is migraine aura, keeping a
head ache diary and treating migraine headache. There are also useful links
to headache sites.
http://jama.ama-assn.org/issues/v284n20/fpdf/jpg1122.pdf

Burns
These are two useful patient leaflets on how to prevent burns at home and on
taking care of burns from the American family physician which may be of
interest to our readers.
Leaflet on taking care of burns http://www.aafp.org/afp/20001101/2029ph.html
Preventing burns at home http://www.aafp.org/afp/20001101/2032ph.html

How do I know I have diabetes?
This leaflet using a series of questions helps patients to know whether they
have diabetes. The questions include: what is diabetes?, what are the
symptoms of diabetes?, who is at risk of diabetes?, How will I be tested for
diabetes and why is important that diabetes should be diagnosed early?
http://www.aafp.org/afp/20001101/2137ph.html

Information on normocytic anaemia
A series of questions help to uncover the details of anaemia in this
leaflet.
http://www.aafp.org/afp/20001115/2264ph.html

Drug watch

Hematologic dyscrasia associated with ticlopidine therapy: evidence for
causality  Paradiso-Hardy FL, Angelo MC et al. CMAJ 2000;163:1441-8
http://www.cma.ca/cmaj/vol-163/issue-11/1441.htm &
http://www.cma.ca/cmaj/vol-163/issue-11/1463.htm.

Web watch

http://www.conted.ox.ac.uk/health/

http://arjournals.annualreviews.org/biomedicalhome.dtl

http://www.100hot.com/directory/sports/health.html

http://www.cyberdiet.com

http://www.medem.com

http://www.asccp.org

http://www.helpdoctor.co.uk

http://www.drsref.com.au/index.html

http://www.nhs.uk/nelh

http://www.ftc.gov/bcp/conline/edcams/dotcon

http://www.totallab.com/html/download.htm


Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)Part I (MFPHMI)
Clinical 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]

"For an excellent review of the current medical literature, go to Journals
Scan www.uaeu.ac.ae/jscan/index.htm" - BMJ 3rd June 2000,Reviews(Netlines)

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