eMJA: In Other Journals, 2 April 2007

Daily consumption of watercress, a cruciferous vegetable, may have significant antioxidant effects and reduce damage to lymphocyte DNA, according to a study from Northern Ireland. In the single-blind, randomised study, subjects consumed 85 g of raw watercress daily in addition to their normal diet during the intervention phase. The control group maintained their normal diet. Blood was taken from each group before and after the intervention period. Researchers performed screening of peripheral blood lymphocytes and measured levels of antioxidants for each specimen, and found a significant increase in the plasma concentration of the anti-oxidant β-carotene. They also demonstrated a reduction in basal DNA damage in lymphocytes after challenge with hydrogen peroxide. The effects of watercress consumption appeared to be greater in smokers than in non-smokers.

Stages of Sadness

The five stages of grief after bereavement — disbelief, yearning, anger, depression, and acceptance — are well described and accepted in medical teaching on death and grief. The Yale Bereavement Study set out to test the five-stage theory empirically, and to determine if the stages were relevant and useful in a clinical sense. Researchers interviewed over 200 recently bereaved people, using scales to assess the frequency and timing of each of the grief indicators. In the circumstances of a natural (non-traumatic) death, the authors found that the normal grief response initially involves acceptance and yearning for the deceased. The stages indicated by the theory then peak in order as previously described. It appears that all the negative grief indicators are declining by 6 months after the loss. The authors comment that the persistence of such negative emotions after 6 months may suggest the need for further assessment and possible intervention for the bereaved survivor.

JAMA 2007; 297: 716-723

Faecal occult blood tests

Detecting occult blood in faeces is a widely used method of screening for colorectal cancer. Commonly used guaiac-based faecal occult blood tests (FOBTs) are not specific for human haemoglobin and have low sensitivity, despite their use being shown to reduce mortality from colorectal neoplasia. An alternative quantitative immunochemical FOBT has been put to the test by Israeli researchers in a prospective study of 1000 colonoscopy patients.1 The haemoglobin content of faecal samples from each patient was measured and correlated with findings at colonoscopy. Patients who had neoplasia (advanced adenoma or carcinoma) showed significantly higher levels of faecal haemoglobin than those who were free of disease or had only small polyps. Thus, the authors were able to determine a threshold for the detection of clinically significant amounts of faecal haemoglobin. Despite some limitations of the study, including the use of patients selected for colonoscopy, and an effect of variable faecal consistency on sampling, an accompanying editorial comments on the clinical usefulness of a quantitative immunochemical FOBT in allowing the clinician to choose the positivity threshold for the test.2

1. Ann Intern Med 2007; 146: 244-255

2. Ann Intern Med 2007; 146: 309-311

Babycino

Reducing caffeine intake in the second half of pregnancy does not have an effect on birthweight or length of gestation, according to Danish researchers. In a randomised, double-blind controlled trial involving more than 1100 pregnant women, one group was supplied with decaffeinated coffee from 20 weeks’ gestation, and a second group with caffeinated coffee. All the participants were coffee drinkers in the first 20 weeks of pregnancy. After adjusting for other factors, including smoking status and alcohol consumption, a difference in caffeine intake of three cups of instant coffee a day during the second half of pregnancy did not have an effect on birthweight or the length of gestation. Women who smoked more than 10 cigarettes a day and were in the caffeinated coffee group had babies with a lower mean birthweight than smokers in the decaffeinated coffee group. The authors comment that the results seem to contradict some earlier studies, which indicated a relationship between higher caffeine intake in pregnancy and preterm birth.

BMJ 2007; 334: 409

Circumcision short circuits AIDS in Africa

Male circumcision can significantly reduce the risk of HIV acquisition in young African men, according to the results of two randomised controlled trials.1,2 HIV-negative men in the Ugandan and Kenyan studies were randomised to an intervention group (circumcision) or a control group (delayed circumcision after 2 years). Both trials showed a positive effect of circumcision, with the intervention groups having a significantly lower incidence of HIV in all sociodemographic and behavioural categories. An accompanying editorial3 comments that wide-scale implementation of circumcision has the potential to significantly decrease the transmission of HIV in sub-Saharan Africa, but points out that a fresh approach to HIV prevention in women is urgently required.

1. Lancet 2007; 369: 643-656

2. Lancet 2007; 369: 657-666

3. Lancet 2007; 369: 615

Dr Tanya Grassi, MJA

The Medical Journal of Australia eMJA