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Richard Lehman’s journal review—18 August 2014

18 Aug, 14 | by BMJ

richard_lehmanNEJM 14 August 2014 Vol 371
601  The usual wisdom about sodium chloride is that the more you take, the higher your blood pressure and hence your cardiovascular risk. We’ll begin, like the NEJM, with the PURE study. This was a massive undertaking. They recruited 102 216 adults from 18 countries and measured their 24 hour sodium and potassium excretion, using a single fasting morning urine specimen, and their blood pressure by using an automated device. In an ideal world, they would have carried on doing this every week for a month or two, but hey, this is still better than anyone has managed before now. Using these single point in time measurements, they found that people with elevated blood pressure seemed to be more sensitive to the effects of the cations sodium and potassium. Higher sodium raised their blood pressure more, and higher potassium lowered it more, than in individuals with normal blood pressure. In fact, if sodium is a cation, potassium should be called a dogion. And what I have described as effects are in fact associations: we cannot really know if they are causal. more…

The BMJ Today: Computed tomography—to scan or not to scan?

18 Aug, 14 | by BMJ

wim_weberAs reported in the News section today, a group of experts has called attention to the dramatic rise in the use of computed tomography (CT) scanning.

The Committee on Medical Aspects of Radiation in the Environment said that English hospitals carried out almost five million CT scans in 2012-13, a fivefold rise of the numbers in 1996-97. This year saw an additional rise of 13%.

Quite spectacular numbers, as they suggest that almost 1 in ten of all people will have undergone a CT scan in 2014. These figures are by no means unique to England. I looked up the numbers for the Netherlands, and they are similar. more…

Julie Browne: Word counts, words count—how do we want things to be in medical education?

15 Aug, 14 | by BMJ

Julie BrowneI have just come across a neat little web tool from the New York Times. You can type in any word, and see a line graph showing how frequently it’s been used in the New York Times by year right back to 1860. You can also compare several words simultaneously. It’s a fascinating insight into the degree of public debate surrounding news stories in the United States over the last 150 years.

Take, for example, “influenza.” The graph shows a huge rise in mentions during the Spanish influenza pandemic of 1918, and more peaks mark the outbreaks of 1957, 1968, and the H5N1 bird flu scare of 2005. Some medical words make a dramatic appearance—like “antibiotic” in the 1940s or “anorexia” in the 1970s—while others disappear entirely, such as “scrofula,” which last showed up in 1899, and “phthisis,” which faded away in 1917. more…

Stuart Buck: Are scholars or journalists more to blame when correlation and causation are confused?

15 Aug, 14 | by BMJ

Stuart_BuckNews stories about everything from nutrition to epidemiology to family behavior often confuse correlation with causation. Drink coffee, we are told, and you will lower your risk of dying (or perhaps raise it, depending on the week). Get married, and you will have stronger bones.

Sophisticated news consumers in the know understand that it’s best to discount such stories, which do not report on randomized experiments or any other statistical model that could show causation. The articles are invariably about correlations—akin to demonstrating that sunburn goes up along with accidental drowning, which is true not because either one causes the other, but because both occur in the summer. more…

The BMJ Today: Urinating more frequently or having to go in the middle of the night? Yes—use this tool

15 Aug, 14 | by BMJ

I’m a sucker for interactive quizzes. Which Harry Potter character most reflects your personality? Which fictional literary character is most like you? How well do you know London—can you identify the London borough where this picture was taken? I’ve done them all!

As a health journalist, I know where to find risk assessment questionnaires online and do those too, so I can tell you that I have a low risk of a cardiovascular event in the next 10 years and that I am not clinically depressed at the moment. I also know where to find symptom algorithms, which I often look at if I have a health problem to make sure I access the right services and get the most appropriate care. But I have to say most of these are not, shall we say, user friendly.

Now there’s a new thing that I’d definitely be trying if I was a man. The BMJ has developed an interactive tool for urinary symptoms in men. more…

David Kerr: Self obsessing health technology

14 Aug, 14 | by BMJ

david_kerrHas the health tech industry and those who fund it lost the plot? Apparently, the next must have technology is the connected toothbrush. A “data driven oral health startup” company in the United States has just received a multi-million dollar investment to further develop a smartphone connected toothbrush.

With this toothbrush, an accelerometer measures how long a user brushes his or her teeth, and this information is then transferred to a smartphone that records teeth cleaning trends over time. The device can also play music during the suggested two minutes brushing time “to create a highly engaging user experience.” Whether this will be beneficial for the oral health of the nation remains to be seen, but this type of product is very likely to end up in one or two Christmas stockings this year. more…

The BMJ Today: When the worst choice is no choice at all

14 Aug, 14 | by BMJ

You would think that any woman raped as an act of war would be given access to a safe abortion by an international organisation providing aid. Sally Howard’s Feature on thebmj.com reveals that, astonishingly, this is often not the case.

I would highly recommend reading this article. It explains that the 1973 Helms Amendment to the United States (US) Foreign Assistance Act has resulted in “an outright ban on US aid funds being used for all abortion related activities, other than post-abortion care.” Although the amendment applies to aid from the US, aid workers have warned that, more broadly, the absence of abortion provision in humanitarian responses to conflict could be “squarely attributed” to US foreign aid policy. If you want to learn a bit more about the number of women who have undergone unsafe abortions there is an informative infographic here. more…

Jamila Sherif et al: The current state of healthcare in Gaza

13 Aug, 14 | by BMJ

State of healthcare in June 2014

Three weeks before the start of the current Israel–Gaza conflict, the Palestinian Ministry of Health in Gaza declared an emergency, saying that they were unable to maintain health services owing to a lack of sufficient electricity and necessary supplies. Elective operations had to be cancelled. Thirty per cent of essential medications were out of stock.[1]

Healthcare in Gaza has been under extreme pressure since 2007 because of the ongoing blockade imposed by Israel. This has resulted in significant difficulties in the sourcing of medical supplies, and in providing citizens with access to specialist care.[2] Three previous Israeli military operations in Gaza (2006, 2008-9, and 2012) had already caused considerable damage to the healthcare infrastructure.

In a report to the United Nations Relief and Works Agency (UNRWA) on the state of the Gaza health sector in June 2014, Gilbert [2] stated that: “The gravest threats to public health is the lack of basic determinants for healthy lives: safe water, food security, human security, housing, paid work, education, and, of course, also access to sufficient healthcare services.” more…

The BMJ Today: Doctors in Scotland plan to vote against independence

13 Aug, 14 | by BMJ

The results of a survey published today by The BMJ on how doctors in Scotland plan to vote in the referendum next month found that 60% plan to vote “no” to independence, while just a third (33%) said they intend to vote “yes.” Doctors are more staunchly opposed to independence than the overall population of Scotland, which puts the “yes” vote at 37%, the “no” vote at 52%.

Drilling down as to why doctors plan to vote the way they do showed that most of those (91%) planning to vote “no” said the most influential factor was a belief that the economy will suffer under independence, followed by 72% who feared medical research will flounder. more…

Mary McCarthy: UK GPs versus EU GPs

12 Aug, 14 | by BMJ

mary_mccarthyI sometimes wonder if the UK government realises how much general practices in this country accomplish in comparison to their counterparts in Europe and the United States.

There was a time, 20 or 30 years ago, when there was not much to choose between GPs in the UK and family doctors in other countries, apart from the fact that GP surgeries were usually open for considerably longer than the two to four hours a day that was normal in Europe, and that GPs here did house calls, which were becoming a rarity in Europe and the US.

However, general practice in the UK is now very different from the practices of many of our European colleagues. In a recent report, the American think tank the Commonwealth Fund placed the NHS at the top of the countries they studied, for the excellence and cost effectiveness of its health system. more…

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