Worse than landmines

In Afghanistan, many more children are now injured while tampering or playing with unexploded ordnance than by contact with landmines, say US authors. They reported that of 6114 recorded munitions-related injuries occurring in Afghanistan in 1997-2002, only 13% were associated with military activity. Further, over this period, the proportion of injuries caused by unexploded ordnance rose from 37% to 57%, with 42% occurring in children. The authors say policy debates must go beyond landmines to address the effects of widespread deployment of other explosives, including cluster bombs, which may fail to explode on impact and persist for years. They wonder whether such munitions, which are more visible than landmines, can be designed to be less attractive to children.

BMJ 2005; 330: 127-128

Global pressure rising

More than a quarter of the world’s adult population — that is, 972 million, or nearly a billion, people — had hypertension in the year 2000, say US and UK authors. Their estimate of 26.4% was based on data from the largest and most recent studies conducted around the world, including Australia. They also calculated that by 2025 the number of people in the world with hypertension will have risen to more than 1.5 billion.

Lancet 2005; 365: 217-223

Long shift? Drivers beware

Driving home after working for more than 24 hours poses a safety hazard for interns, according to the Harvard Work Hours, Health, and Safety Group. The group conducted a US nationwide, prospective, web-based survey of 2737 interns who filled out a total of 17 003 monthly reports about their work hours and events that occurred while driving home. After an extended work shift of 24 or more hours, interns were more than twice as likely to experience a motor vehicle crash and more than five times more likely to have a near-miss incident. In months when interns worked five or more extended shifts, they were more likely to fall asleep while driving or stopped in traffic.

N Engl J Med 2005; 352: 125-134

Managing anticoagulation

Patient self-management of oral anticoagulation therapy at home can be as effective and even safer than clinical management, according to Spanish researchers. They randomised 737 patients seen at their hospital for oral anticoagulant treatment to receive either continuing clinic care or self-management. Self-management involved a short training course, followed by weekly use of a portable coagulometer and self-adjustment of the treatment dose of anticoagulant. After an average follow-up period of nearly one year, the researchers found that clinic-based treatment and self-management were comparable in terms of time spent in the therapeutic range of INR and percentages of in-range INR values. However, the self-management group experienced fewer complications, including severe haemorrhage and thromboembolism.

Ann Intern Med 2005; 142: 1-10

Multiple sclerosis and May

In the northern hemisphere, multiple sclerosis is more common in people born in the month of May. It is also less common in people born in November. So says an international collaborative study group that examined pooled data from more than 42 000 people with multiple sclerosis from Canada, Great Britain, Denmark and Sweden. They found that 9.1% more people with multiple sclerosis were born in May and 8.5% fewer people in the month of November. The researchers said this abrupt change in risk by month suggested a threshold effect for both increased and decreased risk. They wondered whether sun exposure and maternal serum levels of vitamin D during pregnancy might be relevant factors.

BMJ 2005; 330: 120-123

Dr Ann Gregory, MJA