eMJA: In Other Journals, 19 March 2007

Pancreatic panacea?

Surgical drainage of the pancreatic duct is generally more effective than endoscopic treatment in patients who have chronic pancreatitis and a dilated pancreatic duct, according to a Dutch study. Pain is the pre-dominant symptom in chronic pancreatitis, with pancreatic duct obstruction being the most important aetiological factor. Decompression of the duct can be achieved surgically by pancreaticojejunostomy or endoscopically with sphincterotomy and dilatation. Researchers conducted a randomised controlled trial to compare the efficacy of surgical and endoscopic drainage. Of the 39 patients in the trial, 19 underwent endoscopic treatment and 20 had operative pancreaticojejunostomy. Outcomes included pain relief, physical and mental health, morbidity, mortality, and pancreatic function. Patients in the surgical arm experienced more rapid and effective pain relief and a better state of physical health. The surgical patients also underwent fewer subsequent procedures. Despite these findings, the researchers comment that endoscopic treatment is still a viable alternative, particularly in people with less extensive disease.

N Engl J Med 2007; 356: 676-684

Highway to wheeze

Children who live within 500 m of a major road are more likely to have significant deficits in lung function compared with those living further than 1500 m away, according to US researchers. In a prospective study based in California, 3677 children (mean age, 10 years) were followed for 8 years, with yearly lung function tests. Lesser distance from the child’s residence to a freeway was associated with reduced growth in lung function, as measured by percentage predicted FEV1 values. The authors conclude that exposure to airborne pollutants, such as elemental carbon, could explain the reported health effects of proximity to large volumes of traffic.

Lancet 2007; 369: 571-577

Seafood as brain food

Contrary to advice commonly given to US women, the positive effects on childhood neurodevelopment of maternal seafood intake may outweigh any negative outcomes due to accumulation of toxins. In a study of British women and their children, maternal intake of seafood during pregnancy was correlated with neurodevelopmental outcomes in childhood. Over 11 000 women who gave birth in the Bristol area between 1991 and 1992 were included, and followed for 8 years. The children of mothers who ate less than 340 g of seafood per week while pregnant were 48 per cent more likely to have a relatively low verbal IQ (intelligence quotient) score at age 8 compared with children whose mothers ate greater amounts of seafood. Children of mothers who ate more than 340 g of seafood per week had a higher verbal IQ and better communication skills. According to the authors, the results of the study were unexpected, as a US advisory report concerned with the effects of accumulated toxins in fish suggests the opposite. The authors conclude that the risks from loss of nutrients were probably greater than the adverse effects due to exposure to possible contaminants in seafood.

Lancet 2007; 369: 578-585

Exercise affects cancer patients

Supervised group exercise programs have a beneficial effect on the physical and mental health of breast cancer patients, UK researchers claim. Women being treated for early stage breast cancer were randomised into two groups: one group received usual care alone and the other group participated in a supervised 12-week group exercise program in addition to usual care. At 12 weeks, the exercise group showed improvements in fitness, mobility and mood. They also had better outcomes on the breast cancer specific quality of life scale in comparison to the non-exercise group. After follow-up at 6 months, these differences were maintained, and researchers noted a trend towards an improvement in the primary outcome — FACT-G, a measure of general quality of life. Although the authors note that a weakness of the study is the inability to determine which aspect of the group exercise experience provided the most benefit, they conclude that it is probably due to a combination of the exercise and the group experience.

BMJ Online, 16 Feb 2007

Life’s a BEACH

Assessing the quality of data used to measure quality of care is an essential component of any study of general practice, according to a group of Australian general practitioner academics. In an evaluation of the BEACH (Bettering the Evaluation and Care of Health) program, the authors discuss the benefits of using data generated from the survey. They point out that despite limitations resulting from the response rate and cluster sample design, data collected by the BEACH program go beyond those available from the Pharmaceutical Benefits Scheme and Medicare Benefits Schedule. The BEACH program provides information on problems managed with medication, details of content of consultations, and specific information about tests ordered by GPs, and indications for such tests.

Aust Fam Physician 2007; 36: 36-40

Dr Tanya Grassi, MJA

The Medical Journal of Australia eMJA