{"id":10396,"date":"2011-08-05T09:32:05","date_gmt":"2011-08-05T08:32:05","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=10396"},"modified":"2011-08-05T09:32:05","modified_gmt":"2011-08-05T08:32:05","slug":"research-highlights-5-august-2011","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/08\/05\/research-highlights-5-august-2011\/","title":{"rendered":"Research highlights &#8211; 5 August 2011"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/research-methods-and-reporting.jpg\" alt=\"Research questions\" width=\"160\" height=\"110\" align=\"left\" \/>&#8220;Research highlights&#8221; is a weekly round-up of research papers appearing in the print <em>BMJ<\/em>. We start off with this week\u2019s research questions, before providing more detail on some individual research papers and accompanying articles.<\/p>\n<p><!--more--><\/p>\n<ul>\n<li><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4366.full\">In renal disease, which reduces proteinuria more: dietary sodium restriction or angiotensin receptor blockade?<\/a><\/li>\n<li><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4464.full\">Does calorie labelling on fast food menus affect the energy content of customers\u2019 purchases?<\/a><\/li>\n<li><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4306.full\">Are there socioeconomic inequalities in the outcome of pregnancies affected by congenital anomalies with a poor prognosis?<\/a><\/li>\n<li><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4411.full\">Did reductions in deaths from breast cancer appear first in countries with earlier implementation of mammography screening?<\/a><\/li>\n<\/ul>\n<p><strong><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4366.full\">Cutting proteinuria in patients on high dose ACE inhibitors<br \/>\n<\/a><\/strong>The <em>BMJ<\/em> doesn\u2019t receive many crossover trials, but here\u2019s one. It addresses what the editors thought to be an interesting and practical question about the comparative effectiveness of a dietary intervention versus polypharmacy. (And the authors adopted a particularly provocative acronym, the HONEST (HOlland NEphrology STudy) group, but that\u2019s not why we published the study.)<\/p>\n<p>Patients with chronic kidney disease need to keep hypertension and proteinuria at bay, but simply taking a high dose angiotensin converting enzyme (ACE) inhibitor doesn\u2019t usually tackle the proteinuria adequately. So Maartje Slagman and colleagues enrolled Dutch outpatients with non-diabetic renal disease who were already taking an ACE inhibitor at the maximum dose. All 52 patients had four treatment periods of six weeks in which they received, in random order, angiotensin receptor blockade or placebo, each combined with, consecutively, a low sodium diet and a regular sodium diet. Dietary sodium restriction to a level recommended in guidelines and reinforced through individual counselling by dieticians was more effective than dual drug blockade for reducing proteinuria and blood pressure.<\/p>\n<p>Just 52 patients may seem an awfully small sample size but\u2014as another paper, co-authored by the <em>BMJ<\/em>\u2019s senior statistics editor, Doug Altman, explains\u2014\u201ceach participant [in a crossover trial] is able to act as his or her own control and permits between and within group comparisons . . . when the new treatment [is] a slight modification to the standard\u2026there is likely to be a positive correlation in the responses to the new and old treatments making the crossover design ideal. Crossover studies are most appropriate in studies where the effects of the treatment(s) are short-lived and reversible and are best suited to trials related to symptomatic but chronic conditions or diseases\u201d (<a href=\"http:\/\/www.trialsjournal.com\/content\/10\/1\/27\">Trials 2009,10:27, doi:10.1186\/1745-6215-10-27<\/a>).<\/p>\n<p><strong><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4464.full\">Calorie labelling of fast food<br \/>\n<\/a><\/strong>In response to the obesity epidemic in its citizens, New York City approved a regulation requiring chain restaurants to provide calorie information prominently on all menus and item tags, and this regulation became effective in March 2008.\u00a0 To investigate whether this measure had any effect, surveys of customers\u2019 lunchtime purchases from fast food outlets were conducted in spring 2007 and spring 2009 (one year before and nine months after implementation of the regulation).\u00a0 Tamara Dumanovsky and colleagues now report their findings.<\/p>\n<p>No overall decline in energy content of purchases was observed, but the 15% of customers who actually bothered to read the calorie information reduced the energy content of their lunch by an average of 106 kcal, enough to make a real difference to body weight if sustained. The study has generated quite a bit of media publicity but with decidedly mixed reaction, with some stories claiming it shows the regulation to have been an abject failure while others have proclaimed it a triumphant success.<\/p>\n<p><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4502.full\">In her linked editorial<\/a>, Susan Jebbs seems to think the results are about as good as could be expected and concludes: \u201cCalorie labelling will help consumers make an informed choice about what they eat, but sustained improvements in the nation\u2019s diet will require a transformation of the food supply too.\u201d<\/p>\n<p><strong><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4588\">Impact of CYP2C19 variant genotypes on clinical efficacy of antiplatelet treatment with clopidogrel<br \/>\n<\/a><\/strong>The efficacy of antiplatelet treatment with clopidogrel is thought to be affected by the patient\u2019s genotype, and current guidelines advise taking this into account when deciding on antiplatelet treatment. But a systematic review and meta-analysis by Tim Bauer and colleagues found that the available evidence does not support this practice.<\/p>\n<p><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4521\"><strong>The health risks and benefits of cycling in urban environments compared with car use<\/strong><br \/>\n<\/a>David Rojas-Rueda and colleagues studied a public bike sharing scheme in Barcelona, Spain, and report that it was a good thing for both individual and public health.<\/p>\n<p><strong><a href=\"http:\/\/www.bmj.com\/content\/343\/bmj.d4661\">Oxytocin bolus versus oxytocin bolus and infusion for control of blood loss at elective caesarean section<br \/>\n<\/a><\/strong>The addition of an oxytocin infusion after caesarean delivery reduces the need for additional uterotonic agents, but does not affect the overall occurrence of major obstetric haemorrhage, say Sharon Sheehan and colleagues.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&#8220;Research highlights&#8221; is a weekly round-up of research papers appearing in the print BMJ. We start off with this week\u2019s research questions, before providing more detail on some individual research [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2011\/08\/05\/research-highlights-5-august-2011\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[1083,2461,134,997,2460],"class_list":["post-10396","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-breast-cancer","tag-calories","tag-nutrition","tag-pregnancy","tag-renal-disease"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Research highlights - 5 August 2011 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2011\/08\/05\/research-highlights-5-august-2011\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Research highlights - 5 August 2011 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"&#8220;Research highlights&#8221; is a weekly round-up of research papers appearing in the print BMJ. 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