eMJA: In Other Journals, 5 October 2009

Imaging procedures are common and their use is increasing, leading to concerns about the safety for patients of exposure to low-dose ionising radiation. In a US study, over 900 000 adults were identified and utilisation data used to estimate the cumulative effective doses of radiation from imaging procedures. Doses were defined as low, medium or high, and data were used to calculate population-based rates of exposure. Procedures such as nuclear and computed tomography imaging contributed significantly to the total effective dose, despite being less common than plain radiographic procedures. Cumulative effective doses of radiation were higher in women and increased with age. The authors conclude that adults in the US are being exposed to substantial doses of ionising radiation and suggest health strategies are needed to address the safe use of these procedures.

Compensation and causation

Assessing compensation claims in cases of occupational injury is usually the task of occupational medicine specialists, but other health care providers may become involved in the process. According to the NZ authors of a recent review of the subject, a lack of common understanding between legal and medical practitioners is at the heart of the issue. They suggest that considering causation as a sequential event involving first general and then specific causation is a useful approach and one that is familiar to medical professionals. A discussion of the judicial meaning of balance of probabilities and the understanding of the scientific meaning of relative risk concludes a useful review for doctors who find themselves involved in medical compensation proceedings.

Intern Med J 2009; 39: 506-511

Fibre and IBS — a soluble problem

Soluble fibre in the form of psyllium appears to benefit patients with irritable bowel syndrome, but insoluble fibre does not seem to be helpful, according to the results of a randomised controlled trial. In a general practice setting, 275 patients aged 18-65 years with irritable bowel syndrome were placed in three groups treated daily for 12 weeks with 10 g of psyllium, 10 g of bran, or a placebo. All participants completed a validated symptom severity score for irritable bowel syndrome. Patients taking psyllium had the best response, with a significant reduction in symptom severity. Early dropouts were most common in the bran group, mainly because of worsening symptoms of irritable bowel syndrome. The authors conclude that soluble fibre is a useful adjuvant in the management of irritable bowel syndrome, but that bran should be used with caution, and may in fact worsen symptoms.

BMJ 2009; 339: b3154

Sex differences in heart mortality

The question of sex differences in mortality following acute coronary syndromes (ACS) has been addressed in a study pooling data from 11 independent international trials. Over 130 000 patients were included, all of whom had suffered either myocardial infarction or unstable angina. The main outcome measure in the study was 30-day mortality following ACS. After multivariable adjustment, mortality was not significantly different between women and men overall, but certain interactions were noted depending on the type of ACS experienced. Among patients with ST-segment elevation myocardial infarction (STEMI), mortality was higher among women, but for non-STEMI and unstable angina, mortality was lower among women. When the researchers corrected for the severity of coronary vascular disease (which tends to be worse in men), they found that the differences in mortality became insignificant.

JAMA 2009; 302: 874-882

Afghanistan — a legacy of violence

A study assessing the mental health of young people in Afghanistan has revealed that mental health problems and exposure to traumatic events continue to be problematic. Using a sample of over 1000 children aged 11-16 years and their caregivers and teachers, researchers conducted interviews and assessed participants for possible psychiatric disorders and social functioning. They also evaluated the mental health of caregivers and examined exposure to traumatic events, with a focus on finding significant risk factors for mental health problems and psychological distress. Results show that Afghan children experience a range of disturbing traumatic events that affect their psychological health, not all associated directly with war. In particular, those related to physical and social stresses within the family can have significant impact. The authors conclude that exposure to multiple traumatic events and poor caregiver mental health are strong predictors of poor mental health in young people living in Afghanistan.

Lancet 2009; 21 Aug [Epub ahead of print]

Dr Tanya Grassi, MJA

mja.com.au | The Medical Journal of Australia

Username:
Password:

Password forgotten? Click here What is my username?