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18 November 2002
| Breathing easy | |
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New research into air pollution confirms that it is associated with cardiorespiratory death and shows that, at least in one urban environment, reducing air pollution will save lives. In a 5000-person subset of the Netherlands Cohort Study on Diet and Cancer, exposure to traffic-related air pollution (regional and urban background concentrations of black smoke and nitrogen dioxide, and proximity of residence to a major road) was correlated with mortality between 1986 and 1994.1 Cardiorespiratory death was associated with living near a major road (RR, 1.95), but not with background pollution levels. A second study, in Dublin, Ireland, compared pollution levels and daily death rates in the two six-year periods before and after the sale and burning of coal was banned in the city.2 The ban was instituted in 1990 and led to an immediate and permanent reduction in average monthly particulate concentrations. Average black smoke concentrations declined by 70% in the second period. After adjustment for population changes, weather, respiratory epidemics and secular changes in death rates in the rest of Ireland, overall non-trauma death rates decreased by 5.7%, respiratory deaths by 15.5% and cardiovascular deaths by 10.3%. This amounted to about 116 fewer respiratory deaths and 243 fewer cardiovascular deaths per year after the ban.
1. Lancet 2002; 360: 1203-1209 |
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| Statin myopathy | |
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Muscular pain is common in older people, and so is statin therapy. Inevitably, many patients will have both, but might they be linked more often than we have suspected? A preliminary report from researchers working on the IMPOSTER (Is Mypoathy Part of Statin Therapy?) trial has found evidence of statin-associated myopathy in four patients with normal serum creatine kinase levels.1 The four were among the first 20 patients recruited for an ongoing double-blind crossover trial designed to investigate this issue. All had developed muscle pain while taking statins, which resolved during a two-week washout period and recurred within 48 hours of blind rechallenge. Muscle biopsies while on statins revealed evidence of mitochondrial dysfunction, including increased lipid stores, fibres that did not stain for cytochrome oxidase activity, and ragged red fibres, abnormalities which reversed in the three patients who had repeat biopsies after ceasing statin therapy. An accompanying editorial2 stressed that the findings were clearly preliminary, but that, given the millions of people who are prescribed lifelong statin therapy (with clear cardiovascular benefit), further study of low-grade myopathy in patients taking the drugs is justified.
1. Ann Intern Med 2002; 137: 581-585 |
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| All due care | |
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According to research conducted in the United Kingdom, it is not a good idea to discharge patients who present with deliberate self-poisoning home from hospital without a formal psychosocial assessment. A prospective study conducted in six hospitals in northwest England identified 604 people who deliberately poisoned themselves over an eight-week period, of whom 246 received a psychosocial assessment before discharge. Only 10% of these, compared with 18% of the 358 patients who did not receive an assessment, presented to hospital with self-poisoning again over the next 12 weeks. After adjustment for known risk factors for repeated self-poisoning, such as previous self-poisoning, psychiatric history and substance dependence, patients who had not been assessed were still more than twice as likely to present with another episode as those who had been assessed. BMJ 2002; 325: 866-867 Baubles and bacteria
J Hosp Infect 2002; 52: 68-70
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© 2002 Medical Journal of Australia.
In these days of imaginative body piercing, it is interesting to note
the results of a British study, which suggests that the practice of removing all jewellery before involvement in surgical procedures may, like many time-held rituals, do more harm than good! Volunteers with finger rings, pierced ears or nose piercings (or a combination
of these) were swabbed on the jewellery surface, immediately behind the jewellery after its removal, and on an adjacent area
of skin (20 examples of each type
of jewellery). After culture the lowest bacterial counts were found on the adjacent (control) areas of skin, with intermediate counts on the jewellery itself, and the highest counts on the skin underneath
the jewellery. The researchers suggested that nose-rings and earrings should be worn in theatre by staff who usually do so, and covered with masks and hats.