eMJA: In other journals

In Other Journals

3 March 2003

Nothing but trouble

Men are more likely than women to have health problems at most times in life, so the recent finding that male babies are born through more complicated labours than females should come as no surprise. Researchers analysed data from over 8000 births at the National Maternity Hospital in Dublin, Ireland, between 1997 and 2001. Among babies born to primigravid mothers after spontaneous labours, male infants were more likely than females to require oxytocin augmentation, fetal blood sampling, and forceps or caesarean section delivery. After adjustment for confounding factors such as birthweight, duration of labour and the use of epidural anaesthesia (all greater for boys), a strong association between sex, birthweight, duration of labour and mode of delivery remained. The big “hole” in the study was the lack of data on head circumference (also greater in boys than girls). However, the researchers did not believe this factor would fully account for the differences.

BMJ 2003; 326: 137

Upping the ante

Parents who fear that their marijuana-smoking teenagers may end up as drug addicts may have cause for their anxieties, if Australian twins are any example. Over 4000 twin pairs are enrolled in the Australian Twin Registry. Born between 1964 and 1971, their median age was 30 years when interviewed between 1996 and 2000. Three hundred and eleven of the 2765 twin pairs who were available for interview were termed discordant for early cannabis use (ie, one twin had used cannabis before the age of 17, the other had not). Early cannabis users were two to five times more likely than their co-twins to use a range of other drugs, and had higher rates of dependence on illicit drugs (including cannabis [OR, 1.96], stimulants [OR, 3.98] and opioids [3.67]) and alcohol (OR, 1.85). These results held when re-analysed to exclude the 77 pairs in which one twin had never used cannabis, and after controlling for multiple environmental risk factors.

JAMA 2003; 289: 427-433

The back-happy tap stand

Low back pain is a big problem in rural Tibet, say Australian researchers, who are also working on potential solutions. In 1999 they used two-stage random cluster sampling to survey 499 adults from 19 Tibetan villages. The point prevalence of low back pain, at 34.1%, was much higher than expected, and the 12-month prevalence was 41.9%. The researchers went on to determine precipitants of the pain (collecting water, harvesting, carrying heavy objects etc) and to observe that activities carried out at ground level, such as sweeping, washing and lifting, were often done with a flexed lumbar spine and little bending of the knees. Locally applicable back care programs are now being introduced, and waist-high tap stands are replacing the original, ground-level stands in many villages.

Lancet 2003; 361: 225-226

Lost property

Researchers in the United States have examined malpractice claims to determine some of the factors at play when surgeons inadvertently leave surgical paraphernalia inside patients. Reviewing the records of the Controlled Risk Insurance Company (insurer of a third of Massachusetts physicians) between 1985 and 2001, the researchers identified 54 patients with retained surgical sponges or instruments. One patient died from complications of the retained foreign body, and 37 required reoperation. Comparing each patient with four controls who had undergone the same operation during the same six-month period, three significant risk factors emerged: emergency operation (risk ratio [RR] 8.8), an unexpected change in the operation (RR 4.1), and increasing body mass index in the patient (RR 1.1/unit increment).

N Engl J Med 2003; 348: 229-235

Ageists or realists

The United States National Institutes of Health consensus guidelines for women with breast cancer recommend chemotherapy based on tumour size and the presence of positive nodes, but in the “real world” it seems that patient age is also a factor. According to the New Mexico Tumour Registry, among 5101 women diagnosed with breast cancer between 1991 and 1997, the overall rates of chemotherapy use were 11% for women with stage 1 cancer, 47% for stage 2 and 68% for stage 3A. Regardless of tumour stage, chemotherapy use declined significantly with age; for example, in women with node-positive and hormone-receptor positive tumours (n=1030) the percentage receiving chemotherapy was 87% for women aged <45 years, 67% for those aged 55–59 years and 22% for those aged 65–69 years. Clinical trials have shown that the efficacy of chemotherapy in early breast cancer decreases with age, which may explain US oncologists’ reluctance to use it, despite the guidelines.

Ann Intern Med 2003; 138: 90-97

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