Releases Saturday 10 August 2002
No 7359 Volume 325
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(1) BIRTH WEIGHT AND SOCIAL CLASS LINKED
TO EDUCATIONAL ACHIEVEMENT
(2) WORRYING
RISE IN DEATHS FROM
ALCOHOLIC LIVER
DISEASE
(3) SCREENING
WOMEN FOR DOMESTIC
VIOLENCE "CANNOT
BE JUSTIFIED" ON
CURRENT EVIDENCE
(4) DOES THAT CUT REALLY NEED STITCHES?
(1) BIRTH WEIGHT
AND SOCIAL CLASS LINKED
TO EDUCATIONAL ACHIEVEMENT
(Birth weight, childhood socioeconomic
environment, and
cognitive development in the 1958
British birth cohort
study)
http://bmj.com/cgi/content/full/325/7359/305
Birth weight and social class at birth
have a strong
influence on cognitive (mental) function
in children, say
researchers in this week's BMJ.
The study involved 10,845 males and females
born
during 3-9 March 1958 in England, Scotland,
and
Wales. The team investigated the combined
effect of birth
weight and socioeconomic environment on
cognitive tests
and educational achievements at 7, 11,
16, and 33 years.
All cognitive tests and educational achievements
improved significantly with increasing
birth weight. For
example, the proportion of men with higher
qualifications
increased from 26% in the lowest (2500
g or less) birth
weight group to 34% in the highest (more
than 4000 g).
For women, equivalent percentages were
17% and 28%.
Standardised maths scores increased with
increasing birth
weight at all ages.
Social background had a strong effect on
maths scores,
with children from class I and II gaining
higher scores
than those from class IV and V. Looking
jointly at the
effects of birth weight and social class,
participants of low
birth weight from class I and II had higher
average scores
for maths than participants of normal
birth weight from
class IV and V. The association between
maths score
and social class seemed to strengthen
with age, whilst the
association with birth weight remained
similar with age.
"Our results suggest a cumulative effect
of prenatal (birth
weight) and postnatal (social class) influences
on
cognitive development," say the authors.
"Although the
overall effect size of differences in
cognitive scores
associated with birth weight is small
for individuals, the
impact in populations may be important."
The greater explanatory value of social
background
suggests that gains in cognitive development
may depend
more on efforts to redress disadvantages
in childhood
social environment, they conclude.
Contact:
Barbara Jefferis, Research Fellow, Centre
for Paediatric
Epidemiology and Biostatistics, Institute
of Child Health,
London, UK
Email B.Jefferis{at}ich.ucl.ac.uk
(2) WORRYING RISE
IN DEATHS FROM
ALCOHOLIC LIVER DISEASE
(Mortality from liver disease in
the West Midlands,
1993-2000: observational study)
http://bmj.com/cgi/content/full/325/7359/312
Deaths from alcoholic liver disease have
increased in the
West Midlands in the past decade, reflecting
a
nationwide trend, according to researchers
in this week's
BMJ.
The study was set in three boroughs in
the West
Midlands with a total population of 837,000.
Death rates
were obtained from the Office for National
Statistics.
Deaths from primary liver disease increased
from 6 per
100,000 population in 1993 to 13 per 100,000
in 2000.
The increase was almost exclusively the
result of
alcoholic liver disease, and death rates
were similar for
white men, white women, and Asian men.
After alcoholic liver disease, the largest
cause of death
was "unspecified" liver disease with an
annual incidence
of 2.5 per 100,000 population. Alcohol
misuse was the
presumed cause in 67% of cases identified
by the
research team.
This apparent increase might be the result
of increasing
alcohol consumption, but available evidence
does not
show any notable increase in the total
national alcohol
consumption in the past decade nor in
the number of
people drinking heavily, say the authors.
These data have important implications
for public health
and hospital physicians. The halting or
reversal of the
trend in deaths from alcoholic liver disease
requires
further public emphasis on the risk of
fatal liver disease
from excessive alcohol consumption, they
conclude.
Contacts:
Neil Fisher, Consultant Physician and Gastroenterologist,
Dudley Group of Hospitals NHS Trust, Russells
Hall
Hospital, Dudley, West Midlands, UK
Email: Neil.Fisher{at}dudleygoh-tr.wmids.nhs.uk
or
E T Swarbrick, Consultant Physician and
Gastroenterologist, University of Wolverhampton,
Division of Clinical Sciences, New Cross
Hospital,
Wolverhampton, UK
(3) SCREENING
WOMEN FOR DOMESTIC
VIOLENCE "CANNOT BE JUSTIFIED" ON
CURRENT EVIDENCE
(Should health professionals screen
women for domestic
violence? Systematic review)
http://bmj.com/cgi/content/full/325/7359/314
The Department of Health now recommends
that health
professionals should consider "routine
enquiry" of women
patients about whether they have experienced
domestic
violence. However, a study in this week's
BMJ
concludes that implementation of screening
programmes
in healthcare settings is not justified
by current evidence.
Researchers at Queen Mary's School of Medicine
reviewed 20 studies to assess the evidence
for the
acceptability and effectiveness of screening
women for
domestic violence in healthcare settings.
They found that screening by health professionals
increases the identification of domestic
violence, and
many women do not object to being asked.
However,
most health professionals were not in
favour of screening.
Other studies have shown that lack of
education in or
experience of screening, fear of offending
or endangering
patients, and lack of effective interventions
are given as
reasons for not routinely asking women
about domestic
violence. Little evidence also exists
to show whether
screening and intervention can lead to
improved
outcomes for women identified as abused.
It would
therefore be premature to introduce a
screening
programme for domestic violence in healthcare
settings,
say the authors.
However, these conclusions should not be
interpreted as
a denial of domestic violence as an important
issue for
healthcare providers, stress the authors.
Doctors and
nurses should not abandon the goal of
identifying and
supporting women experiencing domestic
violence.
Health professionals need education and
training to
remain aware of the problem if they are
to recognise
women who experience domestic violence,
while health
services, local authorities, and the police
need to
coordinate their responses to domestic
violence. Further
research is also essential to develop
and evaluate
interagency policies.
Research within the NHS on the effectiveness
of
screening and on care for women experiencing
abuse is a
priority, they conclude.
Contact:
Gene Feder, Professor of Primary Care Research
and
Development, Department of General Practice
and
Primary Care, Barts and the London, Queen
Mary's
School of Medicine and Dentistry, London,
UK
Email: g.s.feder{at}qmul.ac.uk
(4) DOES THAT CUT REALLY NEED STITCHES?
(Suturing versus conservative management
of lacerations
of the hand: randomised controlled
trial)
http://bmj.com/cgi/content/full/325/7359/299
Treating simple lacerations of the hand
conservatively
instead of with sutures is faster, less
painful, and
produces similar cosmetic and functional
outcomes, finds
a study in this week's BMJ.
Researchers identified 91 patients presenting
at an
emergency department in California with
simple
lacerations of the hand that would normally
be treated
with sutures. Patients received either
sutures or
conservative treatment and were asked
to return in 8-10
days for their sutures to be removed or
their wound to be
assessed. Patients also rated the pain
of their treatment
using a standard pain rating scale.
The mean time to resume normal activities
was the same
in both groups. Patients treated conservatively
reported
less pain and treatment time was 14 minutes
shorter.
There was also no difference in cosmetic
appearance
after three months.
The goal of wound care and closure is to
have a resultant
functional and cosmetically acceptable
scar, with low
morbidity and high patient satisfaction
and comfort, say
the authors. These goals can be achieved
by treating
simple lacerations of the hand conservatively
instead of
with sutures. The time saving has implications
for health
policy, they add.
Although these results cannot be generalised
to
cosmetically sensitive areas such as the
face, the authors
conclude: "We were impressed with how
inconspicuous
most scars were after three months and
at the high level
of patients' satisfaction with the appearance
of their
wound."
Contact:
James Quinn, Associate Clinical Professor,
Division of
Emergency Medicine, University of California
San
Francisco, San Francisco, USA
FOR ACCREDITED JOURNALISTS
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