eMJA: In Other Journals, 1 September 2003

Fatigue is the most prevalent symptom reported by patients with cancer and can be experienced before, during and even years after treatment ends. However, we still have much to learn about its causation, assessment and management, say Swedish and US authors.

In a literature review, they identified effective interventions which include treating anaemia, exercise, and psychological methods (eg, support groups, individual psychotherapy and stress management). Energy conservation and sleep are under further investigation, as are pharmacological therapies, such
as erythropoietin.

You must remember this . . .

Eating fish at least once a week may reduce the risk of developing Alzheimer's disease (AD), according to US researchers. They studied dietary intake in 815 elderly residents in a Chicago community, 131 of whom developed AD during a mean follow-up period of 3.9 years. Taking age and other risk factors into account, study participants who consumed fish once (or more) a week had a 60% lower risk of developing AD than those who rarely, or never, ate fish.

Fish is a direct dietary source of preformed docosahexaenoic acid -- this omega-3 polyunsaturated fatty acid is a major component of brain membrane phospholipids.

Arch Neurol 2003; 60: 940-946

Let's lighten the load

Tackling major known risk factors simultaneously, instead of one by one, has the potential to substantially reduce the global burden of disease, says an international research team. They estimated that 39% of the global burden of disease and injury in 2000 could be attributed to the joint effects of 20 selected risk factors, which included poor diet, physical inactivity and use of addictive substances.

In developed regions, non-communicable diseases -- such

as ischaemic heart disease, stroke, chronic obstructive pulmonary disease and alcohol use disorders -- and their risk factors dominated the burden of disease.

Lancet 2003; 362: 271-280

Difficult beginnings

While about one in 20 children will have a longstanding health problem at 8 months of age, this will increase to about one in 10 children when they are 3 years of age, according to UK research. A cohort study of more than 1 000 infants also found that,
as the children aged, congenital problems accounted for a decreasing percentage of problems, and developmental delay and asthma became more prevalent.

Children with longstanding health problems were at greater risk of impaired general and functional health and of poorer health-related life quality. By 3 years of age, the
risk of a longstanding health problem was linked to living in a smoking household and in rented accommodation.

Arch Dis Child 2003; 88: 570-573

Out of control?

UK researchers have expressed concern at the generally poor glycaemic control -- a mean HbA1c
of 9.5% -- found in their study of nearly 400 young people aged 16 to 25 years with type 1 diabetes.1 The researchers suggested that young adults in the UK may have difficulty complying with traditional clinic systems.

Another team of UK researchers has proposed a possible solution to the problem by suggesting that motivational interviewing may help adolescents improve their glycaemic control.2 Their pilot study involved 22 patients aged 14 to 18 years. After a 6-month intervention involving non-confrontational sessions, the mean HbA1c level of participants had decreased from 10.8% to 9.7%, and their fear of hypoglycaemia was reduced. Patients also perceived that diabetes was now easier to live with.

1. BMJ 2003; 327: 260-261
2. Arch Dis Child 2003; 88: 680-683

Autism aware

More evidence that a link between the measles, mumps and rubella (MMR) vaccine and autism is unlikely: a UK cohort study of 567 children with autistic spectrum disorder (ASD) living in north-east London has found that the prevalence of the disorder plateaued after reaching a peak in 1992.1 The study suggests that the rise in prevalence of ASD seen throughout the 1980s and early 1990s was not due to the MMR vaccine (which was introduced in 1988), but rather the increased recognition of and better recording of symptoms for ASD.

Across the Atlantic, a US Center for Autism Research studied changes in head circumference in 48 young children with ASD, reporting that an excessive increase in head size early in life may be an early warning sign of risk of autism.2

1. Arch Dis Child 2003; 88: 666-670
2. JAMA 2003; 290: 337-344

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